Theodore X. OConnell MD - USMLE Step 2 Secrets
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USMLE Step 2 Secrets is an easy-to-read review perfect for busy students like you. Adam Brochert, MD-who scored in the 99th percentile on the Step 2 USMLE-and Theodore X. OConnell, MD-author of several review and clinical reference books-present essential questions and answers covering the important concepts you need to know to score well on the USMLE Step 2 exam: key conditions you will be expected to recognize, all specialty and subspecialty topics, and necessary clinical concepts. Learn the most important questions and answers with the proven format of the highly acclaimed Secrets Series. Master all specialty and subspecialty topics covered on Step 2. Identify key facts and secrets using the Top 100 Secrets chapter. Review material quickly and easily thanks to bulleted lists, algorithms, and illustrations. Apply the pearls, tips, memory aids, and secrets from well-known and highly popular authors, Adam Brochert, MD and Theodore X. OConnell, MD. Find information quickly with a second color highlighting chapter and section titles, legends, bullets and icons, and key terms. Consult the book wherever you go thanks to the portable size that fits in your lab coat pocket.
Theodore X. OConnell MD: author's other books
Who wrote USMLE Step 2 Secrets? Find out the surname, the name of the author of the book and a list of all author's works by series.
Theodore X. OConnell MD
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OConnell Theodore X.
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USMLE Exam Secrets Test Prep Team
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Front matter
USMLE Step 2 Secrets
USMLE Step 2 Secrets
Third Edition
Theodore X. O'Connell, MD Program Director, Family Medicine Residency Program, Kaiser Permanente Woodland Hills, Woodland Hills, California; Assistant Clinical Professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Partner Physician, Southern California Permanente Medical Group, Woodland Hills, California
Adam Brochert, MD Staff Radiologist, Eisenhower Medical Center, Rancho Mirage, California
Copyright 2010 Elsevier Inc.. All rights reserved.
Copyright
USMLE STEP 2 SECRETS
ISBN: 978-0-323-05713-4
Copyright 2010, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier's Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: .
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
O'Connell, Theodore X.
USMLE step 2 secrets / Theodore X. O'Connell, Adam Brochert. 3rd ed.
p. ; cm. (Secrets series)
Rev. ed. of: USMLE step 2 secrets / Adam Brochert. 2nd ed. c2004.
Includes bibliographical references and index.
ISBN 978-0-323-05713-4
1. Clinical medicine--Examinations, questions, etc. I. Brochert, Adam. II. Brochert, Adam, - USMLE step 2 secrets. III. Title. IV. Title: USMLE step two secrets. V. Series: Secrets series.
[DNLM: 1. Clinical MedicineExamination Questions. WB 18.2 O18u 2010]
RC58.B76 2010
616.0076dc22
2009039617
Acquisitions Editor: James Merritt
Developmental Editor: Christine Abshire
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Sukanthi Sukumar
Marketing Manager: Jason Oberacker
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
For Claire.
Welcome to the world, little one.
100 Top Secrets
These secrets are 100 of the top board alerts. They summarize the concepts, principles, and most salient details that you should review before you take the Step 3 exam. Understanding of these Top Secrets will serve you well in your final review.
1. Smoking is the number-one cause of preventable morbidity and mortality in the United States (e.g., atherosclerosis, cancer, chronic obstructive pulmonary disease).
2. Alcohol is the number-two cause of preventable morbidity and mortality in the United States. More than half of accidental and intentional (e.g., murder and suicide) deaths involve alcohol. Alcohol is the number-one cause of preventable mental retardation (fetal alcohol syndrome); it also causes cancer and cirrhosis and is potentially fatal in withdrawal.
3. In alcoholic hepatitis the classic ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is greater than or equal to 2:1, although both may be elevated.
4. Vitamins: Give folate to reproductive-age women to prevent neural tube defects. Watch for pernicious anemia, and treat with vitamin B12 to prevent permanent neurologic deficits. Isoniazid causes pyridoxine (vitamin B6) deficiency. Watch for Wernicke encephalopathy in alcoholics, and treat with thiamine to prevent Korsakoff dementia.
5. Minerals: Iron-deficiency anemia is the most common cause of anemia. Think of menstrual loss in reproductive-age women and of cancer in men and older women if no other cause is obvious.
6. Vitamin A is a known teratogen. Counsel and treat reproductive-age women appropriately (e.g., take care in treating acne with the vitamin A analog isotretinoin).
7. Complications of atherosclerosis (e.g., myocardial infarction, heart failure, stroke, gangrene) are involved in roughly one half of deaths in the United States. The primary risk factors for atherosclerosis are age/sex, family history, cigarette smoking, hypertension, diabetes mellitus, high LDL cholesterol, and low HDL cholesterol.
8. Diabetes leads to atherosclerosis and its complications, retinopathy (a leading cause of blindness), nephropathy (a leading cause of end-stage renal failure), peripheral vascular disease (a leading cause of limb amputation), peripheral neuropathy (sensory and autonomic), and an increased incidence of infections.
9. Although hypertension is most often mild or moderate and clinically silent, severe hypertension can lead to acute problems (known as a hypertensive emergency): headaches, dizziness, blurry vision, papilledema, cerebral edema, altered mental status, seizures, intracerebral hemorrhage (classically in the basal ganglia), renal failure/azotemia, angina, myocardial infarction, and/or heart failure.
10. In milder cases, lifestyle modifications (e.g., diet, exercise, weight loss, cessation of alcohol/tobacco use, elevation of head of bed) may be able to treat the following disorders without the use of medications: hypertension, hyperlipidemia, diabetes, gastroesophageal reflux disease (GERD), insomnia, obesity, and sleep apnea.
11. Arterial blood gas analysis: In general, pH tells you the primary event (acidosis vs. alkalosis), whereas carbon dioxide and bicarbonate values give you the cause (same direction as pH) and suggest any compensation present (opposite of pH).
12. Exogenous causes of hyponatremia to keep in mind: oxytocin, surgery, narcotics, inappropriate IV fluid administration, diuretics, and antiepileptic medications.
13. EKG findings in electrolyte disturbances: tall, tented T waves in hyperkalemia; loss of T waves/T-wave flattening and U waves in hypokalemia; QT prolongation in hypocalcemia; QT shortening in hypercalcemia.
14. Shock: First give the patient oxygen, start an IV line, and set up monitoring (pulse oximetry, EKG, frequent vital signs). Then give a fluid bolus (1 L normal saline or lactated Ringer solution) if no signs of congestive heart failure (e.g., bibasilar rales) are present while you try to figure out the cause if it is not known.
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