USMLE Step 2 Secrets, 3rd Edition

366 Pages·2010·4.341 MB·English

by  Theodore X. O'Connell, Adam Brochert

USMLE STEP 2 SECRETS
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USMLE STEP 2
SECRETS
Third Edition
Theodore X. O’Connell, MD
Program Director
Family MedicineResidencyProgram
KaiserPermanente WoodlandHills,WoodlandHills,California;
Assistant ClinicalProfessor
DepartmentofFamilyMedicine
David GeffenSchoolofMedicineatUCLA,LosAngeles, California;
PartnerPhysician
SouthernCaliforniaPermanente MedicalGroup,WoodlandHills,California
Adam Brochert, MD
StaffRadiologist
Eisenhower MedicalCenter
RanchoMirage, California
1600JohnF.KennedyBlvd.
Ste1800
Philadelphia,PA19103-2899
USMLESTEP2SECRETS ISBN:978-0-323-05713-4
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O’Connell,TheodoreX.
USMLEstep2secrets/TheodoreX.O’Connell,AdamBrochert.–3rded.
p.;cm.–(Secretsseries)
Rev.ed.of:USMLEstep2secrets/AdamBrochert.2nded.c2004.
Includesbibliographicalreferencesandindex.
ISBN978-0-323-05713-4
1.Clinicalmedicine–Examinations,questions,etc.I.Brochert,Adam.II.Brochert,Adam,
-USMLEstep2secrets.III.Title.IV.Title:USMLEsteptwosecrets.V.Series:Secretsseries.
[DNLM:1.ClinicalMedicine–ExaminationQuestions.WB18.2O18u2010]
RC58.B762010
616.0076–dc22
2009039617
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DEDICATION
ForClaire.
Welcometotheworld,littleone.
v
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CONTENTS
100 Top Secrets...............................................................
1
1. Acid-BaseandElectrolytes................................................ 18
2. Alcohol.................................................................. 25
3. Biostatistics ............................................................. 29
4. Cardiology............................................................... 36
5. Cholesterol .............................................................. 50
6. Dermatology............................................................. 53
7. Diabetes Mellitus......................................................... 63
8. Ear,Nose,andThroatSurgery ............................................ 68
9. EmergencyMedicine ..................................................... 73
10. Endocrinology ........................................................... 76
11. Ethics................................................................... 85
12. Gastroenterology......................................................... 88
13. GeneralSurgery......................................................... 107
14. Genetics................................................................ 118
15. Geriatrics............................................................... 122
16. Gynecology............................................................. 124
17. Hematology............................................................. 137
18. Hypertension ........................................................... 150
19. Immunology............................................................ 154
20. InfectiousDiseases...................................................... 161
21. LaboratoryMedicine..................................................... 177
22. Nephrology............................................................. 179
23. Neurology.............................................................. 185
24. Neurosurgery........................................................... 199
25. Obstetrics .............................................................. 204
26. Oncology............................................................... 227
vii
viii CONTENTS
27. Ophthalmology.......................................................... 250
28. OrthopedicSurgery...................................................... 257
29. Pediatrics .............................................................. 266
30. Pharmacology .......................................................... 274
31. PreventiveMedicine..................................................... 279
32. Psychiatry.............................................................. 284
33. Pulmonology ........................................................... 297
34. Radiology .............................................................. 303
35. Rheumatology .......................................................... 306
36. Shock.................................................................. 313
37. Smoking ............................................................... 316
38. Urology ................................................................ 317
39. VascularSurgery........................................................ 323
40. VitaminsandMinerals................................................... 327
Index.......................................................................
331
100 TOP SECRETS
Thesesecretsare100ofthetopboardalerts.Theysummarizetheconcepts,
principles,andmostsalientdetailsthatyoushouldreviewbeforeyoutaketheStep
3exam.UnderstandingoftheseTopSecretswillserveyouwellinyourfinalreview.
1. Smokingisthenumber-onecauseofpreventablemorbidityandmortalityintheUnited
States(e.g.,atherosclerosis,cancer,chronicobstructivepulmonarydisease).
2. Alcoholisthenumber-twocauseofpreventablemorbidityandmortalityintheUnited
States.Morethanhalfofaccidentalandintentional(e.g.,murderandsuicide)deathsinvolve
alcohol.Alcoholisthenumber-onecauseofpreventablementalretardation(fetalalcohol
syndrome);italsocausescancerandcirrhosisandispotentiallyfatalinwithdrawal.
3. Inalcoholichepatitistheclassicratioofaspartateaminotransferase(AST)toalanine
aminotransferase(ALT)isgreaterthanorequalto2:1,althoughbothmaybeelevated.
4. Vitamins:Givefolatetoreproductive-agewomentopreventneuraltubedefects.Watchfor
perniciousanemia,andtreatwithvitaminB12topreventpermanentneurologicdeficits.
Isoniazidcausespyridoxine(vitaminB6)deficiency.WatchforWernickeencephalopathy
inalcoholics,andtreatwiththiaminetopreventKorsakoffdementia.
5. Minerals:Iron-deficiencyanemiaisthemostcommoncauseofanemia.Thinkof
menstruallossinreproductive-agewomenandofcancerinmenandolderwomenifno
othercauseisobvious.
6. VitaminAisaknownteratogen.Counselandtreatreproductive-agewomenappropriately
(e.g.,takecareintreatingacnewiththevitaminAanalogisotretinoin).
7. Complicationsofatherosclerosis(e.g.,myocardialinfarction,heartfailure,stroke,
gangrene)areinvolvedinroughlyonehalfofdeathsintheUnitedStates.Theprimaryrisk
factorsforatherosclerosisareage/sex,familyhistory,cigarettesmoking,hypertension,
diabetesmellitus,highLDLcholesterol,andlowHDLcholesterol.
8. Diabetesleadstoatherosclerosisanditscomplications,retinopathy(aleadingcauseof
blindness),nephropathy(aleadingcauseofend-stagerenalfailure),peripheralvascular
disease(aleadingcauseoflimbamputation),peripheralneuropathy(sensoryand
autonomic),andanincreasedincidenceofinfections.
9. Althoughhypertensionismostoftenmildormoderateandclinicallysilent,severe
hypertensioncanleadtoacuteproblems(knownasahypertensiveemergency):
headaches,dizziness,blurryvision,papilledema,cerebraledema,alteredmentalstatus,
seizures,intracerebralhemorrhage(classicallyinthebasalganglia),renalfailure/azotemia,
angina,myocardialinfarction,and/orheartfailure.
10. Inmildercases,lifestylemodifications(e.g.,diet,exercise,weightloss,cessationof
alcohol/tobaccouse,elevationofheadofbed)maybeabletotreatthefollowingdisorders
withouttheuseofmedications:hypertension,hyperlipidemia,diabetes,gastroesophageal
refluxdisease(GERD),insomnia,obesity,andsleepapnea.
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