First Aid for the USMLE Step 2 CS,

433 Pages·2009·1.98 MB·English

by  Tao Le

FIRST AID
FOR
THE®
USM LE
STEP 2 CS
Third Edition
TAO LE, MD, MHS
Assistant Clinical Professor of Medicine and Pediatrics
Chief, Section of Allergy and Immunology
Department of Medicine
University of Louisville
VIKAS BHUSHAN, MD
Diagnostic Radiologist
MAE SHEIKH-ALI, MD
Assistant Professor, Department of Medicine
Division of Endocrinology
University of Florida College of Medicine–Jacksonville
FADI ABU SHAHIN, MD
Fellow, Gynecologic Oncology
Cleveland Clinic
New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City
Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto
Copyright © 2010, 2007 by Tao Le. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be repro-
duced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.
ISBN: 978-0-07-162913-3
MHID: 0-07-162913-0
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DEDICATION
To the contributors of this and past editions, who took time to share their
experience, advice, and humor for the benefi t of future physicians.
and
To our families, friends, and loved ones, who supported us in the task of
assembling this guide.
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CONTENTS
Contributors ix
Faculty Reviewers ix
Preface xi
Acknowledgments xiii
How to Contribute xv
SECTION I GUIDE TO THE USMLE STEP 2 CS 1
Introduction 2
USMLE Step 2 CS—The Basics 2
Preparing for the Step 2 CS 8
Test-Day Tips 10
First Aid for the IMG 12
Supplement—The USMLE Step 2 CS Travel Guide 21
SECTION II THE PATIENT ENCOUNTER 39
Introduction 40
Doorway Information 42
Taking the History 42
The Physical Exam 53
Closure 61
How to Interact with Special Patients 63
Challenging Questions and Situations 65
Counseling 72
The Patient Note 75
SECTION III MINICASES 81
Headache 83
Confusion/Memory Loss 85
v
Depressed Mood 87
Psychosis 88
Dizziness 89
Loss of Consciousness 90
Numbness/Weakness 91
Fatigue and Sleepiness 93
Night Sweats 94
Insomnia 95
Sore Throat 96
Cough/Shortness of Breath 97
Chest Pain 99
Palpitations 101
Weight Loss 101
Weight Gain 102
Dysphagia 102
Nausea/Vomiting 103
Abdominal Pain 104
Constipation/Diarrhea 108
Upper GI Bleeding 110
Blood in Stool 110
Hematuria 111
Other Urinary Symptoms 112
Erectile Dysfunction 113
Amenorrhea 114
Vaginal Bleeding 115
Vaginal Discharge 116
Dyspareunia 117
Abuse 118
Joint/Limb Pain 119
Low Back Pain 122
Child with Fever 123
Behavioral Problems in Childhood 124
vi
SECTION IV PRACTICE CASES 127
Case 1 48-Year-Old Woman with Abdominal Pain 130
Case 2 21-Year-Old Woman with Abdominal Pain 136
Case 3 74-Year-Old Man with Right Arm Pain 143
Case 4 21-Year-Old Man with Sore Throat 149
Case 5 55-Year-Old Man with Bloody Stool 156
Case 6 46-Year-Old Man with Chest Pain 162
Case 7 7-Month-Old Boy with Fever 168
Case 8 18-Month-Old Girl with Fever 174
Case 9 26-Year-Old Man with Cough 180
Case 10 54-Year-Old Woman with Cough 186
Case 11 52-Year-Old Woman with Jaundice 193
Case 12 65-Year-Old Woman with Forgetfulness and Confusion 200
Case 13 56-Year-Old Man Presents for Diabetes Follow-up 207
Case 14 53-Year-Old Man with Dizziness 214
Case 15 46-Year-Old Man with Fatigue 220
Case 16 32-Year-Old Woman with Fatigue 227
Case 17 61-Year-Old Man with Fatigue 234
Case 18 35-Year-Old Woman with Headaches 241
Case 19 57-Year-Old Man with Bloody Urine 247
Case 20 54-Year-Old Man Presents for Hypertension Follow-up 253
Case 21 33-Year-Old Woman with Knee Pain 260
Case 22 66-Year-Old Man with Tremor 267
Case 23 49-Year-Old Man with Loss of Consciousness 273
Case 24 30-Year-Old Woman with Weight Gain 279
Case 25 36-Year-Old Woman with Menstrual Problems 285
Case 26 28-Year-Old Woman with Pain During Sex 291
Case 27 51-Year-Old Man with Back Pain 297
Case 28 6-Month-Old Girl with Diarrhea 303
Case 29 75-Year-Old Man with Hearing Loss 309
Case 30 8-Year-Old Boy with Bed-Wetting 315
vii
Case 31 25-Year-Old Man Presents Following Motor Vehicle Accident 321
Case 32 25-Year-Old Woman Presents Following Sexual Assault 328
Case 33 28-Year-Old Woman Presents with Positive Pregnancy Test 335
Case 34 20-Year-Old Woman with Sleeping Problems 342
Case 35 27-Year-Old Man with Visual Hallucinations 349
Case 36 10-Year-Old Girl with New-Onset Diabetes 355
Case 37 35-Year-Old Woman with Calf Pain 361
Case 38 31-Year-Old Man with Heel Pain 367
Case 39 5-Day-Old Boy with Jaundice 375
Case 40 2-Year-Old Girl with Noisy Breathing 381
Case 41 32-Year-Old Man Presents for Pre-employment Physical 387
SECTION V TOP-RATED REVIEW RESOURCES 395
How to Use the Database 397
Appendix 403
Index 407
About the Authors 415
viii
CONTRIBUTORS
David Beversluis Mary Iruthayanathan, MBBS, PhD
Case Western Reserve University School of Medicine Postdoctoral Scholar, Department of Internal Medicine
Class of 2010 Division of Endocrinology and Metabolism
University of Iowa Carver College of Medicine
Patrick Elliott
Neeraj Lalwani, MBBS, DMRD, MD
Case Western Reserve University School of Medicine
Fellow, Body Imaging
Class of 2010
University of Texas, San Antonio
Chad M. Fortun, MD Shadi Mayasy, MD
Resident, Orthopaedic Surgery Resident, Internal Medicine
University Hospitals Case Medical Center Case Western Reserve University/St. Vincent Charity Hospital
FACULTY REVIEWERS
Kayla D. Chapman, MD Senan Sultan, MD
University of Kansas School of Medicine Fellow
Class of 2009 Department of Medicine, Divion of Endocrinology
University of Florida College of Medicine—Jacksonville
Roger Maalouf, MD
Assistant Professor of Medicine
Department of Medicine, Division of Hospital Medicine
University of Florida College of Medicine–Jacksonville
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