USMLE Step 2 Secrets by O'Connell, Theodore X. -- Read -- Imperial Library of Trantor

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Cover Image Table of Contents Front matter Copyright Dedication 100 Top Secrets CHAPTER 1. Acid-Base and Electrolytes

1. How do you analyze arterial blood gas values? 2. True or false: The body does not compensate beyond a normal pH 3. List the common causes of acidosis 4. List the common causes of alkalosis 5. What type of acid-base disturbance does aspirin overdose cause? 6. What happens to the blood gas of patients with chronic lung conditions? 7. Should you give bicarbonate to a patient with acidosis? 8. The blood gas of a patient with asthma has changed from alkalotic to normal, and the patient seems to be sleeping. Is the patient ready to go home? 9. List the signs and symptoms of hyponatremia 10. How do you determine the cause of hyponatremia? 11. How is hyponatremia treated? 12. What medication is used to treat SIADH if water restriction fails? 13. What happens if hyponatremia is corrected too quickly? 14. What causes spurious (false) hyponatremia? 15. What causes hyponatremia in postoperative patients? 16. What is the classic cause of hyponatremia in pregnant patients about to deliver? 17. What are the signs and symptoms of hypernatremia? 18. What causes hypernatremia? 19. How is hypernatremia treated? 20. What are the signs and symptoms of hypokalemia? 21. What is the effect of pH on serum potassium? 22. Describe the interaction between digitalis and potassium 23. How should potassium be replaced? 24. When hypokalemia persists even after administration of significant amounts of potassium, what should you do? 25. What are the signs and symptoms of hyperkalemia? 26. What causes hyperkalemia? 27. What should you suspect if an asymptomatic patient has hyperkalemia? 28. The specimen was not hemolyzed. What is the first treatment? 29. What are the signs and symptoms of hypocalcemia? 30. What should you do if the calcium level is low? 31. What causes hypocalcemia? 32. Describe the relationship between low calcium and low magnesium 33. How does pH affect calcium levels? 34. Describe the relationship between calcium and phosphorus 35. What are the signs and symptoms of hypercalcemia? 36. What causes hypercalcemia? 37. Why is asymptomatic hypercalcemia usually treated? 38. How is hypercalcemia treated? 39. In what clinical scenario is hypomagnesemia usually seen? 40. What are the signs and symptoms of hypomagnesemia? 41. In what clinical scenario is hypermagnesemia seen? 42. How is hypermagnesemia treated? 43. In what clinical scenarios is hypophosphatemia seen? What are the signs and symptoms? 44. What is the intravenous fluid of choice in hypovolemic patients? 45. What is the maintenance fluid of choice for patients who are not eating? 46. Should anything be added to the intravenous fluid for patients who are not eating?

CHAPTER 2. Alcohol

1. With which cancers is alcohol intake associated? 2. What is the most common cause of cirrhosis and esophageal varices? 3. Describe the relationship between alcohol and accidental or intentional (i.e., suicide and murder) death? 4. What may happen if you give glucose to an alcoholic without giving thiamine first? 5. What is the difference between Wernicke and Korsakoff syndromes? What causes each? 6. True or false: Alcohol withdrawal can be fatal 7. How is alcohol withdrawal treated? 8. What are the stages of alcohol withdrawal? 9. What are the classic physical stigmata of liver disease in alcoholics? 10. What are the classic laboratory findings of liver disease in alcoholics? 11. What diseases and conditions may be caused by chronic alcohol intake? 12. Describe the classic derangement of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in alcoholic hepatitis 13. What is the best treatment for alcoholism? 14. Describe the effects of alcohol on pregnancy 15. Discuss the epidemiology of alcohol abuse 16. What kind of pneumonia should you suspect in a “skid-row” alcoholic? 17. True or false: Alcohol can precipitate hypoglycemia 18. What are the classic electrolyte and vitamin/mineral abnormalities in alcoholics? 19. How are bleeding esophageal varices treated? 20. How are varices with no history of bleeding treated?

CHAPTER 3. Biostatistics

1. How is the sensitivity of a test defined? What are highly sensitive tests used for clinically? 2. How is the specificity of a test defined? What are highly specific tests used for clinically? 3. Explain the concept of a trade-off between sensitivity and specificity 4. Define positive predictive value (PPV). On what does it depend? 5. Define negative predictive value (NPV). On what does it depend? 6. Define attributable risk. How is it measured? 7. You need to develop the habit of drawing a 2 × 2 table for Step 2 statistics questions. Given the 2 × 2 table below, define the formulas for calculating the following test values: 8. Define relative risk. From what type of studies can it be calculated? 9. What is a clinically significant value for relative risk? 10. Define odds ratio. From what type of studies is it calculated? 11. What do you need to know about standard deviation (SD) for the USMLE? 12. Define mean, median, and mode 13. What is a skewed distribution? How does it affect mean median and mode? 14. Define test reliability. How is it related to precision? What reduces reliability? 15. Define test validity. How is it related to accuracy? What reduces validity? 16. Define correlation coefficient. What is the range of its values? 17. True or false: A correlation coefficient of −0.6 is a stronger correlation coefficient than +0.4 18. Define confidence interval. Why is it used? 19. What five types of studies should you know for the Step 2 exam? 20. What is an experimental study? 21. What are prospective studies? Why are they important? 22. What are retrospective studies? Discuss their advantages and disadvantages 23. What is a case series study? How is it used? 24. What is a prevalence survey? How is it used? 25. What is the difference between incidence and prevalence? 26. If a disease can be treated only to the point that people can be kept alive longer without being cured, what happens to the incidence and prevalence of the disease? 27. Define epidemic 28. When do you use a chi-squared test, T-test, and analysis of variance test? 29. What is the difference between nominal, ordinal, and continuous types of data? 30. Define p-value 31. What three points about p-value should be remembered for the Step 2 exam? 32. Explain the relationship of the p-value to the null hypothesis 33. What is a type II error? 34. What is the power of a study? How do you increase the power of a study? 35. What are confounding variables? 36. Discuss nonrandom or nonstratified sampling 37. What is nonresponse bias? 38. Explain lead-time bias 39. Explain admission rate bias 40. Explain recall bias 41. Explain interviewer bias 42. What is unacceptability bias?

CHAPTER 4. Cardiology

1. What is your job when the Step 2 exam describes a patient with chest pain? 2. What elements of the history and physical exam steer you away from a diagnosis of myocardial infarction (MI)? 3. What findings on EKG should make you suspect an MI? 4. Describe the classic pattern of chest pain in an MI 5. What tests are used to diagnose an MI? 6. Describe the classic physical exam findings in patients with MI 7. What historical points should steer you toward a diagnosis of MI? 8. Describe the treatment for an MI 9. True or false: With good management, patients with an MI will not die in the hospital 10. When is heparin indicated in the setting of chest pain and MI? 11. What clues suggest the common noncardiac causes of chest pain? 12. How can you recognize stable angina? 13. Define unstable angina. How is it diagnosed and treated? 14. Describe variant (Prinzmetal) angina 15. Define silent MI. How common is it? 16. What physical exam findings are associated with various heart valve abnormalities? 17. True or false: An understanding of the pathophysiology behind the various changes associated with long-standing valvular heart disease is high-yield for the Step 2 exam 18. Who should receive endocarditis prophylaxis? 19. Describe the protocols for endocarditis prophylaxis 20. What is Virchow's triad? 21. List the common clinical scenarios for development of DVT 22. Describe the physical signs and symptoms of DVT. How is it diagnosed? 23. True or false: Superficial thrombophlebitis is a risk factor for pulmonary embolus 24. How is DVT treated? For how long? 25. What is the best way to prevent DVT in patients undergoing surgery? 26. In what clinical settings does pulmonary embolus (PE) occur? Describe the symptoms and signs 27. True or false: DVT can lead to a stroke 28. How is PE diagnosed? 29. How is PE treated? 30. What is the most important side effect of heparin? 31. How are the effects of aspirin, heparin, and warfarin monitored? 32. How are the effects of low-molecular-weight heparin monitored? 33. In an emergency, how can you reverse the effects of heparin, warfarin, and aspirin? 34. How do the conditions below affect coagulation tests? 35. What are the general symptoms and signs of congestive heart failure (CHF)? 36. What symptoms and signs help to determine whether CHF is due to left or right ventricular failure? 37. How is chronic CHF treated? 38. How is acute congestive heart failure treated? 39. What factors precipitate exacerbations in previously stable patients with CHF? 40. Define cor pulmonale. With what clinical scenarios is it associated? 41. What causes restrictive cardiomyopathy? How is it different from constrictive pericarditis? 42. What is the most common kind of cardiomyopathy? What causes it? 43. Which cardiomyopathy is likely in a young person who passes out or dies while exercising or playing sports and has a family history of sudden death? 44. What EKG abnormalities do I need to know about for the Step 2 exam? How are they treated? 45. What endocrine disease is suggested when a patient presents with sinus tachycardia or atrial fibrillation? 46. How does Wolff-Parkinson-White syndrome classically present? 47. What do you need to know about the common congenital heart defects? 48. What is important to remember about tachycardia in children? 49. In the fetal circulation, where is the highest and lowest oxygen content? 50. What changes occur in the circulation as an infant goes from intrauterine to extrauterine life?

CHAPTER 5. Cholesterol

1. When is cholesterol screening done? 2. What physical findings will the Step 2 test use as clues to hypercholesterolemia? 3. What are the current recommendations for management of cholesterol levels? 4. List the major risk factors for coronary heart disease 5. Discuss other possible risk factors for heart disease 6. How is LDL calculated? 7. Describe the treatment for hypercholesterolemia 8. How is HDL affected by alcohol? Estrogens? Exercise? Smoking? Progesterone? 9. What causes hypercholesterolemia? 10. Why is cholesterol so important?

CHAPTER 6. Dermatology

1. Cover the two right-hand columns and define the following common terms used in dermatology to describe skin findings: 2. Define vitiligo. With what diseases is it associated? 3. Name several conditions to think about on the Step 2 exam in patients with pruritus. 4. Define contact dermatitis. How do you recognize it? What are the classic culprits? 5. Define atopic dermatitis. What history points to this diagnosis? 6. Define seborrheic dermatitis. What part of the body does it involve? How is it treated? 7. Name the various dermatologic fungal infections. 8. What organisms cause fungal infections? 9. How are fungal infections diagnosed and treated? 10. True or false: Candidiasis is often a normal finding in some women and children. 11. How is candidiasis treated? 12. What causes scabies? How do you recognize it? 13. How do you diagnose and treat scabies? 14. How do you recognize and treat tinea versicolor? 15. What causes lice? How are they treated? 16. What causes warts? How are they treated? 17. Define molluscum contagiosum. How do you recognize it? How is it treated? 18. True or false: A child with genital molluscum is probably a victim of sexual abuse. 19. How is acne described in medical terms? What bacteria may be partially involved in its pathogenesis? 20. True or false: Acne is not related to food, exercise, or sex. 21. What are the treatment options for acne? 22. Define rosacea. In what age group is it seen? How do you treat it? 23. What should you think about if hirsutism is described on the Step 2 exam? 24. What are the common pathologic causes of baldness? 25. What causes ordinary male pattern baldness? 26. Describe the classic psoriatic lesion. 27. What other historical points and physical findings may be seen with psoriasis? How is it diagnosed and treated? 28. Give the classic description and natural course of pityriasis rosea. 29. What are the “four Ps” that clinch a diagnosis of lichen planus? 30. List the classic drugs that cause photosensitivity of the skin. 31. Describe the classic lesion of erythema multiforme. What drugs classically cause it? 32. Describe the classic lesion of erythema nodosum. With what diseases is it commonly associated? 33. Define and describe pemphigus vulgaris. How is it different from bullous pemphigoid? 34. What skin disease is associated with celiac disease (gluten intolerance or sensitivity)? How is it treated? 35. What are decubitus ulcers? What is the best method of prevention? 36. What conditions should excessive perspiration suggest on the USMLE? 37. True or false: Most melanomas start out as simple moles. 38. Define dysplastic nevi syndrome. How is it managed? 39. Why is keratoacanthoma of note? 40. When and where are keloids seen? 41. Describe the classic lesion of basal cell cancer. What should you do if you suspect it? 42. True or false: Basal cell skin cancer almost never develops metastases. 43. From what lesion does squamous cell cancer classically develop? What is Bowen disease? 44. To what parameter is the prognosis of a malignant melanoma most closely related? 45. What type of melanoma do black patients tend to develop? How do you recognize it? 46. Describe Paget disease of the nipple. What is its significance? 47. Define stomatitis. What does it suggest?

CHAPTER 7. Diabetes Mellitus

1. Outline the current recommendations for diabetes mellitus screening. 2. Define diabetes. 3. What are the classic differences between type 1 and type 2 diabetes? 4. What are the goals of treatment in terms of glucose levels? 5. What is a good measure of long-term diabetes control? 6. When a nondiabetic patient presents with hypoglycemia, how can you distinguish between factitious disorder (exogenous insulin) and an insulinoma (endogenous insulin)? 7. What should you remember before giving intravenous iodinated contrast material to a diabetic patient or a patient with renal insufficiency? 8. What is diabetic ketoacidosis (DKA)? How is it treated? 9. What is nonketotic hyperglycemic hyperosmolar state? How is it treated? 10. What are the classic presenting symptoms of new-onset diabetes? 11. What are the common long-term complications of diabetes mellitus? 12. What problems may result from diabetic peripheral neuropathy? 13. Describe the treatment for diabetic retinopathy. 14. How do you adjust the dosage of neutral protamine Hagedorn (NPH) or regular insulin for high glucose levels? 15. Define the Somogyi effect and the dawn phenomenon. 16. How do you manage diabetic patients who are not allowed to eat because they are scheduled for surgery? 17. What is the deal with beta blockers, hypoglycemia, and diabetics? 18. What are the best oral agents to use in type 1 diabetes? 19. What is the first treatment for type 2 diabetes?

CHAPTER 8. Ear, Nose, and Throat Surgery

1. What is the most common cause of lower motor neuron facial nerve paralysis? How does it present? 2. What are the other causes of lower motor neuron facial nerve paralysis? 3. What are the common causes of hearing loss? 4. What is the usual cause of sudden deafness? 5. What is the most common cause of acquired hearing loss in children? 6. What are the common causes of vertigo? 7. How is a deviated nasal septum treated in patients with recurrent sinusitis? 8. What are the three common causes of rhinitis? 9. How do you recognize and treat viral rhinitis? 10. How do you recognize and treat allergic rhinitis? 11. What causes bacterial rhinitis? How is it treated? 12. What causes nosebleeds? 13. True or false: A neck mass is more likely to be benign in a child than in an adult. 14. What are the common causes of a neck mass? 15. Describe the work-up for an unknown cancer in the neck. 16. What is the scientific name for “swimmer's ear”? What causes it? 17. What causes otitis media? How do you recognize it? 18. What are the complications of otitis media? How are they avoided? 19. What is the problem with recurrent otitis media? How is it treated? 20. What causes infectious myringitis? How do you recognize and treat it? 21. What are the common bacterial causes of sinusitis? How is this condition recognized clinically? 22. By what age are the frontal sinuses well-developed in children? 23. Define otosclerosis. How is it treated? 24. What causes parotid gland swelling? 25. How do you recognize a nasal fracture? What complication may result? 26. What is the Weber test used to evaluate? How is it performed and interpreted? 27. What is the Rinne test used to evaluate? How is it performed and interpreted?

CHAPTER 9. Emergency Medicine

1. What are the three causes of burns? How should all burns be managed initially? 2. What are the important sequelae of electrical burns? 3. How are chemical burns managed? Which is worse—acid or alkali burns? 4. What is burned skin prone to develop? 5. How is burn severity classified? Describe the management of each class 6. Define hypothermia. How is it managed? What are the complications? 7. Distinguish between frostnip and frostbite. How are they managed? 8. True or false: You should not give up resuscitation efforts until the patient is fully warmed in the setting of hypothermic cardiac arrest 9. Define hyperthermia. What causes it? How is it managed? 10. What are the two classic examples of hyperthermia due to medication? 11. How are patients managed after a near-drowning episode?

CHAPTER 10. Endocrinology

CHAPTER 11. Ethics

1. True or false: Adult patients of sound mind are allowed to refuse life-saving treatments 2. What should you do if a child has a life-threatening condition and the parents refuse a simple, curative treatment (e.g., antibiotics for meningitis)? 3. True or false: People with terminal illnesses can choose to die 4. What is the difference between active and passive euthanasia? 5. With whom can you discuss your patient's condition? 6. In what situations are you allowed to breach patient confidentiality? 7. What are the components of informed consent? 8. What should you do if a patient is incompetent to make decisions? 9. True or false: A living will should not be respected if the next of kin asks you not to follow it 10. What should you do if a patient is in critical condition or in a coma and has made no advance directive or living will? 11. What about depression in the context of end-of-life decisions? 12. True or false: In some circumstances, patients can be hospitalized against their will 13. True or false: Restraints can be used on patients against their will 14. When do patients under the age of 18 years not require parental consent for a medical decision? 15. What should you do if a child has a medical emergency and the parents are unavailable for decision-making? 16. True or false: It is acceptable to hide a diagnosis from a patient if the family asks you to do so 17. What should you do if a patient requires emergency care but the patient cannot communicate and no family members are available? 18. True or false: Withdrawing care and withholding care are the same in the eyes of the law 19. True or false: In terminally ill, noncurable patients, one of the primary goals is to relieve pain

CHAPTER 12. Gastroenterology

1. Define gastroesophageal reflux disease (GERD). What causes it? 2. Describe the classic symptoms of GERD. How is it treated? 3. What are the sequelae of GERD? 4. What is a hiatal hernia? How is it different from a paraesophageal hernia? 5. How does peptic ulcer disease (PUD) present? 6. Explain the classic differences between duodenal and gastric ulcers 7. What is the diagnostic study of choice for PUD? 8. What is the most feared complication of PUD? What should you suspect if an ulcer does not respond to treatment? 9. How is PUD treated initially? 10. List the surgical options for ulcer treatment. What complications may occur? 11. Define achlorhydria. What causes it? 12. What are the classic differences between upper and lower gastrointestinal (GI) bleeds? 13. How is a GI bleed treated? 14. What radiologic imaging studies can be done to localize a GI bleed? Does surgery have a role? 15. Define diverticulosis. What are its complications? 16. How do you diagnose and treat diverticulitis? What test should a patient have after a treated episode of diverticulitis? 17. How is diarrhea categorized according to etiology? 18. Define osmotic diarrhea. How can an easy diagnosis be made? 19. What causes secretory diarrhea? 20. What are the common causes of malabsorptive diarrhea? 21. What are the common clues to infectious diarrhea? What are the common causes? 22. What causes exudative diarrhea? 23. What are the common causes of diarrhea due to altered intestinal transit? 24. Define irritable bowel syndrome. How do you recognize it? 25. What should you do if a patient has diarrhea? 26. What should you watch for in children after a bout of diarrhea? 27. Specify the classic differences between Crohn disease and ulcerative colitis 28. Describe the extraintestinal manifestations of inflammatory bowel disease 29. How is inflammatory bowel disease treated? 30. What causes toxic megacolon? How is it treated? 31. List the common findings of acute liver disease 32. List the common causes of acute liver disease 33. What is the classic abnormality on liver function tests in patients with alcoholic hepatitis? 34. What clues suggest hepatitis A? Describe the diagnostic serology 35. How is hepatitis B acquired? What is the best treatment? 36. Describe the serology of hepatitis B infection, including the surface, core, and “e” markers 37. What are the possible sequelae of chronic hepatitis B or C? 38. What should be given to persons acutely exposed to hepatitis B? 39. Which type of viral hepatitis is the new king of chronic hepatitis? 40. Describe the serology and treatment for hepatitis C 41. When is hepatitis D seen? Describe the serology 42. How is hepatitis E transmitted? What is special about the infection in pregnant women? 43. What are the classic causes of drug-induced hepatitis? 44. When should you suspect idiopathic autoimmune hepatitis? What is the serologic marker? 45. What are the usual causes of chronic liver disease? 46. Which species of viral hepatitis can lead to chronic liver disease? 47. Define hemochromatosis. How do you recognize it? 48. Define Wilson disease. How do you recognize it? How is it treated? 49. What are the clues to a diagnosis of alpha1 antitrypsin deficiency? 50. What metabolic derangements accompany liver failure? 51. What signs and symptoms suggest biliary tract obstruction as a cause of jaundice? 52. What are the commonly tested types of biliary tract obstruction? 53. What are the two major causes of common bile duct obstruction? How are they distinguished? 54. What are the two common causes of cholestasis? 55. What clues suggest a diagnosis of primary biliary cirrhosis? 56. Who gets primary sclerosing cholangitis? 57. What usually precipitates cholangitis? What is the tip-off to its presence? How is it treated? 58. What are the classic symptoms of esophageal disease? 59. Define achalasia. How is it diagnosed and treated? 60. What are the symptoms and signs of esophageal spasm? How is it treated? 61. What clues suggest scleroderma as the cause of esophageal complaints? 62. What do you need to know about the epidemiology of esophageal cancer? 63. What is the relationship between Barrett esophagus and esophageal cancer? 64. What causes acute pancreatitis? 65. What are the signs and symptoms of acute pancreatitis? 66. How is acute pancreatitis treated? 67. What are the complications of acute pancreatitis? 68. What causes chronic pancreatitis? How is it treated? 69. Distinguish between Mallory-Weiss and Boerhaave tears in the esophagus. How are they diagnosed? 70. What is the rule about bowel contrast when a GI perforation is suspected? 71. Which GI malformations are common in children? How can they be distinguished? 72. What other pediatric GI conditions are commonly found on the Step 2 boards? How are they distinguished? 73. Which GI malformation causes primarily respiratory problems? 74. How are omphalocele and gastroschisis differentiated? 75. What is Henoch-Schönlein purpura? Why is it mentioned in the GI section? 76. What is the most common cause of diarrhea in children? 77. True or false: Children may develop inflammatory bowel disease and irritable bowel syndrome 78. What is the first step in evaluating neonatal jaundice? Why is jaundice of concern in a neonate? 79. What causes physiologic jaundice of the newborn? Who gets it? 80. How is pathologic jaundice recognized? What are the causes? 81. How is pathologic jaundice treated? 82. What should you do if an infant is born to a mother with active hepatitis B?

CHAPTER 13. General Surgery

1. Define the acute abdomen. What physical exam signs suggest its presence? 2. What should you do if you are not sure whether a stable patient has an acute abdomen? 3. Name a few causes of peritonitis that do not require laparotomy or laparoscopy 4. Specify which conditions are associated with pain and peritonitis in the listed abdominal areas 5. What are the classic symptoms and signs of gallstone disease? 6. What are the six Fs of cholecystitis? How are the demographics of patients with pigment stones different from those with cholesterol stones? 7. How is a clinical suspicion of cholecystitis confirmed and treated? 8. Define cholangitis. How does it differ from cholecystitis? How is it treated? 9. Describe the classic presentation of appendicitis. How is it treated? 10. What is the cause of left lower quadrant pain and fever in a patient over 50 years old until proved otherwise? How is it treated? 11. What tests should and should not be done to confirm possible cases of diverticulitis? What test does every patient need after a treated episode of diverticulitis? 12. Describe the typical history, physical exam and lab findings of pancreatitis. How is it treated? 13. Describe the usual history of a perforated ulcer. How is it treated? 14. What are the hallmarks of small bowel obstruction? How is it treated? 15. What are the common causes of a small bowel obstruction? 16. Describe the signs and symptoms of large bowel obstruction. What causes it? How is it treated? 17. List and differentiate the three common types of groin hernias 18. Define incarcerated and strangulated hernias 19. True or false: Generally, patients should not eat or drink for 8 or more hours before surgery 20. What is the best test (other than a good history) for preoperative evaluation of pulmonary function? 21. What measures help to prevent intraoperative and postoperative deep venous thrombosis and pulmonary embolus? 22. What is the most common cause of fever in the first 24 hours after surgery? 23. What are the other common causes of postoperative fever? 24. Define fascial or wound dehiscence. How do you recognize it? 25. Explain the ABCDEs of trauma. How are they used? 26. What is the difference between airway and breathing in trauma protocol? 27. Explain circulation, disability, and exposure 28. What imaging films are routinely ordered for most patients with at least moderately severe trauma? 29. What is the imaging study of choice for head trauma? 30. How do you manage a patient with blunt abdominal trauma? 31. How is penetrating abdominal trauma managed? 32. Which six thoracic injuries can be rapidly fatal? 33. How do you recognize and treat airway obstruction? 34. How do you recognize and treat an open pneumothorax? 35. How do you recognize and treat a tension pneumothorax? 36. Describe the usual presentation of cardiac tamponade. How is it diagnosed and treated? 37. Define massive hemothorax. How is it diagnosed and treated? 38. How do you recognize and treat flail chest? 39. What is the most common cause of immediate death after an automobile accident or a fall from a great height? 40. What do you need to know about splenic rupture? 41. What clues suggest a diagnosis of diaphragmatic rupture? How is it treated? 42. What are the three zones of the neck? How is trauma in each of the different zones managed? 43. How should a choking victim be managed? 44. What should you do if a tooth is knocked out?

CHAPTER 14. Genetics

1. Specify how the following disorders are usually transmitted genetically. The choices are autosomal dominant or recessive, X-linked recessive, chromosomal disorder or polygenic disorder 2. What is the likelihood that a mother with an autosomal dominant condition will pass the condition to the child if the father does not have the disease? 3. Genetic testing reveals that both mother and father are carriers of a diseased gene for an autosomal recessive condition but do not have the condition themselves. What are the odds that their first child will develop the condition or be an asymptomatic carrier? 4. The father has an X-linked recessive disorder. What are the chances that he will pass the disease to his son or daughter if the mother does not have the diseased gene? 5. The mother is a carrier for an X-linked recessive disorder and the father is healthy. What are the odds that a son or daughter will develop the disease? 6. How do you recognize Down syndrome? 7. What is the second most common known cause of inherited mental retardation? 8. How do you recognize Edward syndrome? 9. What is Patau syndrome? 10. How do you recognize Turner syndrome? 11. Describe Klinefelter syndrome 12. What is the hallmark of cri du chat syndrome? 13. What presentation suggests galactosemia? 14. Describe the clinical findings in tuberous sclerosis 15. What causes Lesch-Nyhan syndrome? What classic behavior do patients exhibit? 16. What causes Marfan syndrome? How do you recognize it?

CHAPTER 15. Geriatrics

1. What age group constitutes the most rapidly growing segment of the population? 2. True or false: An 80-year-old person needs more calories than a 30-year-old person 3. True or false: Hearing and vision changes are a normal part of aging 4. True or false: Brain atrophy is a normal part of aging 5. Describe the normal changes in male sexual function that occur with aging 6. Describe the normal changes in female sexual function that occur with aging 7. True or false: Impotence and lack of sexual desire are normal in elderly people 8. What is the best prophylaxis for pressure ulcers in an immobilized patient? 9. Describe the normal changes in sleep habits in elderly people 10. Define pseudodementia. How do you recognize it on the Step 2 exam? 11. True or false: Roughly 2% of the population is over the age of 65 12. True or false: Almost 50% of patients over the age of 65 suffer from some type of dementia 13. True or false: Only 5% of people over the age of 65 live in nursing homes

CHAPTER 16. Gynecology

1. What is the most common cause of preventable infertility in the United States? 2. What is the most likely cause of infertility in a normally menstruating woman under the age of 30? 3. What is PID? How do you recognize it on the Step 2 exam? 4. How is PID treated? What are the common sequelae? 5. Define endometriosis. What are the symptoms and signs? 6. How is endometriosis diagnosed and treated? 7. What is the most likely cause of infertility in a menstruating woman over the age of 30 without a history of PID? 8. Cover the right-hand columns and specify the findings and treatment for the following vaginal infections: 9. True or false: With all of the infections listed in the previous table, you should seek out and treat the patient's sexual partners 10. True or false: Patients with gonorrhea usually are treated for presumed chlamydial infection 11. Define adenomyosis. How does it classically present? What is the treatment? 12. What are fibroids? How common are they? How often do they become malignant? 13. Explain the relationship between uterine leiomyomas and hormones. How do leiomyomas present? What is the treatment? 14. What is the first test to order in any woman of reproductive age with abnormal uterine bleeding? 15. Define dysfunctional uterine bleeding (DUB). When is it physiologic? 16. Why is dilation and curettage done in women over 35 with DUB? What other test should be ordered in all women with DUB (regardless of age)? 17. What causes DUB other than PCOS? How is DUB treated? 18. Define PCOS. How do you recognize it? 19. What is the most likely cause for infertility in a woman under 30 with abnormal menstruation? 20. How is PCOS treated? With what risk is it associated? 21. Is infertility usually a male or a female problem? 22. Assuming that the history and physical exam offer no clues, what is the first step in evaluating a couple for infertility? 23. List the relevant characteristics of normal semen 24. What is the next step after semen evaluation? 25. What radiologic test is commonly used to examine the fallopian tubes and uterus? What points in the history may lead you to suspect a uterine or tube problem? 26. What test is the last resort in the work-up for infertility? 27. Which two medications can be used to try to restore female fertility? In what situations are they effective? 28. What is the main risk associated with medical induction of ovulation? 29. Distinguish between primary and secondary amenorrhea 30. Until proved otherwise, what is the cause of secondary amenorrhea in a previously menstruating woman of reproductive age? 31. True or false: Excessive exercise may cause amenorrhea 32. What are other common causes of secondary amenorrhea? 33. After ruling out pregnancy, if the cause of secondary amenorrhea is not obvious from the history and physical exam, what is the next step in your evaluation? 34. What if the patient fails to have vaginal bleeding after receiving progesterone? 35. True or false: Pregnancy can present as primary amenorrhea 36. At what age can primary amenorrhea be diagnosed? What is the first step in evaluation? 37. In a patient older than 14 with no secondary sexual characteristics or development, what is the most likely cause of amenorrhea? 38. When in doubt, what is the best way to evaluate any type of amenorrhea? 39. When does menopause occur? What are the symptoms and signs? 40. What is the current state of hormone replacement therapy? 41. When a woman presents with a nipple discharge, what historical points are important? 42. What are the most likely causes of a breast mass in a woman under the age of 35? 43. True or false: Mammography should be done for any suspicious breast lesion in a woman under age 30 44. What are the likely causes of a breast mass in a woman over the age of 35? 45. True or false: If a patient is postmenopausal or over age 50 and develops a new breast mass, you should assume cancer “until proven otherwise.” 46. True or false: Mammography is best used as a tool to evaluate a palpable breast mass 47. What causes pelvic relaxation or vaginal prolapse? What are the symptoms and signs? 48. What types of pelvic relaxation are seen clinically? How are they treated? 49. Other than abstinence, what are the most effective forms of birth control (when used properly)? 50. Which forms of birth control prevent sexually transmitted diseases? 51. What are the major problems with intrauterine devices? 52. What is the classic cause of ambiguous genitalia on the Step 2 exam? 53. What should you tell the parents of a child with ambiguous genitalia? 54. What is indicated by a “bunch of grapes” protruding from a pediatric vagina? 55. Define precocious puberty. What causes it? How should it be treated? 56. What causes vaginitis or discharge in prepubescent girls? 57. How do you recognize and treat an imperforate hymen? 58. What is the usual cause of vaginal bleeding in neonates? How is it treated? 59. Which women are candidates for hormone replacement therapy? 60. What are the known benefits of estrogen therapy? 61. What are the known risks of estrogen therapy? 62. What are the most common side effects of estrogen therapy? 63. What are the absolute contraindications to estrogen therapy? 64. What are the relative contraindications to estrogen therapy? 65. What test is often done before starting estrogen therapy? 66. True or false: Women without a uterus do not need to take progesterone with estrogen 67. What are the absolute contraindications to oral contraceptive pills? 68. What are the relative contraindications to oral contraceptive pills? 69. What is the relationship between oral contraceptive pills and hypertension? 70. What do you need to know about oral contraceptive pills and surgery? 71. What are the side effects of oral contraceptive pills? 72. What is the relationship between oral contraceptive pills and breast and cervical cancer? 73. What is the relationship between oral contraceptive pills and ovarian and endometrial cancer? 74. What are the other beneficial effects of oral contraceptive pills?

CHAPTER 17. Hematology

1. Define anemia 2. What are the symptoms and signs of anemia? 3. What are the important elements of the history when anemia is present? 4. What medications can cause anemia? How? 5. What test should be ordered first to help determine the cause of anemia? 6. What test should be ordered next? 7. What are reticulocytes? Why is a reticulocyte count routinely ordered in an anemia work-up? 8. Which test comes next? 9. What are the classic causes of microcytic, normocytic, and macrocytic anemia? Which of these tends to have an inappropriately low reticulocyte count? 10. What clues point to hemolysis as the cause for anemia? 11. What is the most common cause of anemia in the United States? 12. Why do people get iron deficiency? 13. What are the classic laboratory abnormalities in iron deficiency anemia? What weird cravings may occur with iron deficiency? 14. What is Plummer-Vinson syndrome? 15. How is iron deficiency treated? 16. What causes folate deficiency? In what patient populations is it commonly seen? 17. What is the most common cause of vitamin B12 deficiency? 18. What else may cause vitamin B12 deficiency? How is B12 deficiency diagnosed? 19. How is vitamin B12 deficiency treated? 20. How is thalassemia differentiated from iron deficiency? 21. What diagnostic test confirms a diagnosis of thalassemia? How is it treated? 22. What two clues on the Step 2 exam often point to a diagnosis of sickle cell disease? 23. What are the clinical manifestations and complications of sickle cell disease? 24. How is sickle cell disease diagnosed and treated? 25. What findings help you in the setting of acute blood loss as a cause of anemia? 26. What are the commonly tested causes of autoimmune hemolytic anemia? 27. What lab test is often positive in patients with autoimmune anemia? 28. What clues point to lead poisoning as a cause of anemia? 29. True or false: Children with risk factors should be screened for lead poisoning 30. How is lead poisoning treated? 31. How can sideroblastic anemia be recognized on the Step 2 exam? Should the presence of sideroblastic anemia raise concern about other conditions? 32. How do you recognize anemia of chronic disease? 33. Describe the hallmarks of spherocytosis 34. Why do chronic renal disease patients develop anemia? How do you treat it? 35. What clues point to a diagnosis of aplastic anemia? 36. Define myelophthisic anemia. What clues on the peripheral smear suggest its presence? 37. How do you recognize glucose-6-phosphatase deficiency on the USMLE? 38. Name some other causes of anemia 39. When is transfusion indicated for anemia (at what hemoglobin level)? 40. What are the indications for the use of various blood products? 41. What is the most common cause of a blood transfusion reaction? What blood type can be given in an emergency to avoid a reaction? 42. Describe the signs and symptoms of a blood transfusion reaction 43. What should you do if you suspect a transfusion reaction? 44. What are the other risks of transfusion? 45. What are the most common causes of disseminated intravascular coagulation (DIC)? 46. How do I recognize and treat DIC in a classic at-risk patient? 47. With what conditions is eosinophilia associated? 48. With what conditions is basophilia associated? 49. True or false: The lupus anticoagulant causes a clotting tendency 50. What genetic and acquired causes of an increased tendency toward clot-forming may appear on the Step 2 exam? 51. Which clotting tests measure which portions of the coagulation cascade? Which medications affect these tests? 52. How do specific diseases affect clotting tests? What are the main differential points? 53. What are the common causes of thrombocytopenia? What kind of bleeding problems are caused by low platelet counts? 54. What causes petechiae or “platelet-type” bleeding in the setting of normal platelets?

CHAPTER 18. Hypertension

1. How often should you screen for hypertension? 2. Define hypertension 3. What is the “two-measurement” rule in the diagnosis of hypertension? 4. What are the conservative (i.e., nonpharmacologic) treatments for hypertension? 5. List the first-line medications for treatment of hypertension 6. What about women of reproductive age and pregnant women with hypertension? 7. Define hypertensive urgency. How is it different from hypertensive emergency? 8. What causes hypertension? 9. What are the common causes of secondary hypertension in younger men and women? 10. List less common causes of secondary hypertension 11. What does lowering blood pressure accomplish? 12. What is the most common cause of death among untreated patients with hypertension? 13. Which tests should be ordered for every patient with a diagnosis of hypertension? Why?

CHAPTER 19. Immunology

1. List the four classic types of hypersensitivity reactions 2. What causes type I hypersensitivity? Give the classic clinical examples 3. Describe the clinical findings with chronic type I hypersensitivity 4. What medication should be avoided in patients with nasal polyps? 5. How do you recognize and treat true anaphylaxis? 6. What usually causes hereditary angioedema? 7. What type of testing can identify an allergen if it is not obvious? 8. What causes type II hypersensitivity? List some classic clinical examples 9. What lab test is usually positive with a type II hypersensitivity that causes anemia? 10. What causes type III hypersensitivity? List some classic clinical examples 11. What causes type IV hypersensitivity? How is it related to tuberculosis testing? 12. What sexually transmitted infectious disease should be in the back of your mind when a patient presents with a sore throat and mononucleosis-like syndrome? 13. How is HIV diagnosed? How long after exposure does the HIV test become positive? 14. Are “control” tests needed when a PPD tuberculosis test is done in HIV-positive patients? 15. How do you recognize Pneumocystis carinii pneumonia (PCP)? 16. What is the most common primary immunodeficiency? How do you recognize it? 17. How do you recognize Bruton agammaglobulinemia? 18. What causes DiGeorge syndrome? How do you recognize it? 19. What is the classic cause of severe combined immunodeficiency? How does it present? 20. What triad indicates the diagnosis of Wiskott-Aldrich syndrome? 21. How do you recognize Chediak-Higashi syndrome? 22. Describe the pathophysiology of chronic granulomatous disease 23. Cover the right-hand column, and answer the questions about HIV management on the left 24. Complement deficiencies of C5 through C9 cause recurrent infections with which genus of bacteria? 25. Define chronic mucocutaneous candidiasis 26. Give the classic description of hyper-IgE syndrome (Job-Buckley syndrome)

CHAPTER 20. Infectious Diseases

CHAPTER 21. Laboratory Medicine

1. What may cause a false lab report of hyperkalemia? 2. What can cause a “false” hyponatremia? 3. What may result from rapid correction of hyponatremia? 4. What effect do serum acidosis and serum alkalosis have on potassium and calcium levels? 5. Other than pancreatic disease, what else can cause elevated levels of amylase and lipase? 6. Which diseases can cause elevated levels of alkaline phosphatase? What lab test is used to distinguish among these diseases? 7. True or false: Hypothyroidism can cause elevated cholesterol 8. Injury to what organ (other than the heart) causes elevated levels of creatine kinase (CK)? 9. What is the relationship of low calcium and potassium levels to low levels of magnesium? 10. Which two electrolytes are classically depleted in the setting of diabetic ketoacidosis or diabetic hyperosmolar, hyperglycemic state? 11. What does a blood urea nitrogen (BUN)-to-creatinine ratio greater than 15 or 20 generally imply? 12. What disease classically causes a false-positive result on the rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) syphilis test? 13. Define isosthenuria. What condition does it suggest? 14. What does an elevated erythrocyte sedimentation rate mean in pregnancy? 15. True or false: A high-normal level of BUN or creatinine during pregnancy often indicates renal disease

CHAPTER 22. Nephrology

1. What are the symptoms and signs of acute renal failure? 2. What are the three broad categories of renal failure? 3. Define prerenal failure? What are the causes? How do you recognize it? 4. Define postrenal failure. What causes it? 5. What is the most common cause of intrarenal failure? 6. What do you need to know about intravenous contrast and renal failure? 7. True or false: Muscle breakdown can cause renal failure 8. What medications commonly cause renal insufficiency or failure? 9. Define Goodpasture syndrome. How does it present? 10. Define Wegener granulomatosis. How does it present? 11. What is the prototypical cause of glomerulonephritis? How does it present? 12. What are the indications for dialysis in patients with renal failure? 13. Define nephrotic syndrome. What causes it? How is it diagnosed? 14. Define nephritic syndrome. What is the classic cause? How is it treated? 15. What causes chronic renal failure (CRF)? 16. What metabolic derangements are seen in CRF? 17. How is CRF treated? 18. What are the signs and symptoms of urinary tract infection (UTI)? What are the most likely organisms? 19. What factors increase the likelihood of UTIs? 20. How do you diagnose and treat UTIs? 21. Why are UTIs in children of special concern? 22. True or false: You should treat asymptomatic bacteriuria in most patients 23. How does pyelonephritis usually occur? What are the signs and symptoms? How is it treated? 24. How do you differentiate among the common pediatric hematologic disorders that affect the kidney? 25. Which is more likely to be seen on a plain abdominal radiograph: kidney stones or gallbladder stones? 26. What are the signs and symptoms of renal stones? How are they diagnosed and treated? 27. What causes kidney stones?

CHAPTER 23. Neurology

1. In what common situation is a lumbar puncture contraindicated? 2. Cover all but the left-hand column and describe the classic findings of cerebrospinal fluid (CSF) analysis in the following conditions: 3. Give a classic case description of multiple sclerosis 4. What is the most sensitive test for diagnosis of multiple sclerosis? How is it treated? 5. Define Guillain-Barré syndrome 6. What causes nerve conduction velocity to be slowed? 7. What causes an electromyography (EMG) study to show fasciculations or fibrillations at rest? 8. What causes an EMG study with no muscle activity at rest and decreased amplitude of muscle contraction upon stimulation? 9. What is the most common cause of syncope? What other conditions should you consider? 10. Cover the right-hand column and localize the neurologic lesion for each of the following symptoms and signs: 11. For delirious or unconscious patients in the emergency department with no history of trauma, for what three common causes should you think about giving empiric treatment? 12. What are the classic differential points between delirium and dementia? 13. What symptoms and signs do delirium and dementia have in common? 14. Define pseudodementia 15. What treatable causes of dementia must always be ruled out? 16. Define Wernicke encephalopathy and Korsakoff syndrome. What causes them? 17. Differentiate among tension, cluster, and migraine headaches. How is each treated? 18. How do you recognize a headache secondary to brain tumor or intracranial mass? 19. Define pseudotumor cerebri. How is it diagnosed and treated? 20. How do you recognize a headache due to meningitis? 21. What causes the “worst headache” of a patient's life? 22. What are the common extracranial causes of headache? 23. What does a lesion of the first cranial nerve (CN I) cause? What exotic syndrome should you watch for clinically? 24. True or false: Brain lesions can be localized based on the visual field defect 25. How do you distinguish between a benign and serious cause of CN III deficit? 26. What does CN V (trigeminal nerve) innervate? What classic peripheral nerve disorder affects its function? 27. What structures does CN VII innervate? What is the difference between an upper and lower motor neuron lesion of the facial nerve? 28. What problems other than facial droop affect patients with a CN VII lesion? 29. What rare tumor is a classic cause of lower motor neuron lesions of CN VII and CN VIII? 30. Describe the function of CN VIII. What symptoms do lesions cause? 31. What does CN IX innervate? What physical findings are associated with a lesion? 32. Describe the function of CN X. Specify the physical findings and causes of lesions 33. What muscles does CN XI innervate? How do you know on which side the lesion is located? 34. What does a lesion of CN XII cause? 35. Which vitamin deficiencies may present with neurologic signs or symptoms? 36. What are the six general types of seizures that you should be able to recognize? 37. Describe a simple partial seizure. How is it treated? 38. Describe complex partial seizures. How are they treated? 39. Give the classic description of an absence seizure 40. How do you recognize a tonic-clonic seizure? 41. Define febrile seizure 42. What are the common causes of secondary seizures? How are they treated? 43. Define status epilepticus. How is it treated? 44. True or false: Hypertension can cause seizures 45. What do you need to remember when giving anticonvulsants to women? 46. What causes strokes? How common are they? 47. How is an acute stroke treated? 48. Define transient ischemic attack (TIA). How is it managed? 49. Describe the signs and symptoms of Huntington disease. How is it acquired? What is the classic CT finding? 50. Define Parkinson disease. How do you recognize it on the Step 2 exam? 51. Describe the pathophysiology of Parkinson disease. How is it treated pharmacologically? 52. What is the classic iatrogenic cause of parkinsonian signs and symptoms? 53. What brain lesions cause a resting tremor and an intention tremor? What about hemiballismus? 54. What conditions other than Parkinson disease cause a resting tremor? 55. What diseases should come to mind in children with cerebellar findings? 56. What diseases should come to mind in adults with cerebellar findings? 57. How do you recognize amyotrophic lateral sclerosis (ALS) on the Step 2 exam? 58. What are the two classic causes of a “floppy” (flaccid) baby? How do you differentiate the two? 59. List the causative categories of peripheral neuropathy and give examples of each 60. What test can be used to prove the presence of a peripheral neuropathy, regardless of etiology? 61. Describe the pathophysiology of myasthenia gravis (MG). Who is affected? What are the classic physical findings? 62. How is MG diagnosed? What tumor is associated with it? 63. What three conditions may cause an MG-like clinical picture? 64. What is the most common type of muscular dystrophy? How is it inherited? What are the classic findings? 65. List the five less common types of muscular dystrophies 66. What class of inherited metabolic disorders affect muscle and may resemble muscular dystrophy?

CHAPTER 24. Neurosurgery

1. List the four major types of intracranial hemorrhage 2. What causes a subdural hematoma? How do you recognize and treat it? 3. What causes an epidural hematoma? How do you recognize and treat it? 4. Define subarachnoid hemorrhage. What causes it? How is it treated? 5. What causes an intracerebral hemorrhage? How do you recognize and treat it? 6. After a history of head trauma, what does a dilated, unreactive pupil on one side mean until proved otherwise? 7. List the four classic signs of a basilar skull fracture 8. What is the imaging test of choice for skull fractures of the calvarium? How are they managed? 9. True or false: Severe, permanent neurologic deficits may occur after head trauma, even with a negative CT or MR scan of the head 10. What finding suggests increased intracranial pressure? 11. How should increased intracranial pressure be managed? 12. True or false: Lumbar puncture is the first test that should be performed in a patient with increased intracranial pressure 13. How do patients with spinal cord trauma present? How are they managed? 14. What causes spinal cord compression? How do patients present? 15. How should patients with subacute spinal cord compression be diagnosed and treated? 16. Define syringomyelia. What causes it? How does it usually present? 17. Define spina bifida. How can it be prevented? 18. Define hydrocephalus. How is it recognized in children? 19. In what setting does dural venous sinus thrombosis occur? How is it diagnosed and treated?

CHAPTER 25. Obstetrics

CHAPTER 26. Oncology

CHAPTER 27. Ophthalmology

1. What is the hallmark of conjunctivitis? 2. Distinguish among allergic, viral, and bacterial conjunctivitis in terms of signs and symptoms and treatment 3. What are the three common causes of neonatal conjunctivitis? 4. What causes chemical conjunctivitis? How do you recognize it? 5. How can you distinguish gonorrheal from chlamydial conjunctivitis? 6. If you forget everything else about neonatal conjunctivitis, what point should you remember to help you distinguish among the three discussed causes? 7. True or false: Conjunctivitis frequently causes loss of vision 8. Define glaucoma. What are the risk factors for developing it? What are the two general types? 9. Describe the physical findings of open-angle glaucoma. How common is it? How is it treated? 10. How does closed-angle glaucoma present? What should you do if you recognize it? 11. How do steroids affect the eye? 12. Define ultraviolet keratitis. How is it treated? 13. What pediatric rheumatologic condition is commonly associated with uveitis? 14. What is the most common cause of painless, slowly progressive loss of vision? 15. What should cataracts in a neonate suggest? 16. What changes in the retina and fundus are seen in diabetes and hypertension? 17. What is the most common cause of blindness in patients under and over the age of 55? In black patients? 18. Define proliferative diabetic retinopathy. How is it treated? How is nonproliferative diabetic retinopathy treated? 19. Distinguish between preorbital (preseptal) and orbital cellulitis 20. What are the common bacterial causes of preorbital and orbital cellulitis? How are they treated? 21. What is the key to managing chemical burns to the eye? Which is worse—acid or alkaline burns? 22. Distinguish between a hordeolum (stye) and a chalazion. How are they treated? 23. How do you recognize and treat herpes simplex keratitis? 24. What findings suggest an ophthalmic herpes zoster infection? 25. How do you recognize a central retinal artery occlusion? What causes it? 26. Describe the symptoms of temporal arteritis. What should you do if you suspect it? 27. How do you recognize central retinal vein occlusion? Describe the cause and treatment 28. Describe the classic history of a patient with retinal detachment 29. True or false: Cataracts and macular degeneration are common causes of bilateral, painless loss of vision in the elderly 30. How do optic neuritis and papillitis present? What are the common causes? 31. What causes bitemporal hemianopsia until proved otherwise? 32. Use the visual field defect to localize the sight of the brain lesion (Figure 27-2). 33. What two diseases commonly cause isolated palsies of cranial nerves III, IV, and VI? How do you recognize them? 34. What are the physical exam findings of a third cranial nerve palsy? What should you remember when trying to determine the cause? 35. What are the physical findings in palsies of cranial nerves IV and VI? How do lesions of cranial nerves V and VII affect the eye? 36. What is strabismus? Beyond what age is it abnormal in children? 37. Why does blindness develop in patients with strabismus? 38. What is presbyopia? When does it occur?

CHAPTER 28. Orthopedic Surgery

1. What orthopedic fractures are associated with the highest mortality rate? 2. Why should areas distal to the fracture site be assessed by physical exam? 3. Distinguish between an open and a closed fracture 4. Explain the difference in management of open and closed fractures 5. What are the indications for open reduction other than an open fracture? 6. What type of radiographs should you order if you suspect a fracture? 7. How should you treat a patient with severe pain after trauma and negative x-rays? 8. Define compartment syndrome. What is the cause? 9. What are the symptoms and signs of compartment syndrome? How is it treated? 10. Cover the right-hand columns and specify the motor and sensory functions of the following peripheral nerves. In what common clinical scenarios are they often damaged? 11. What is the difference between insufficiency stress fracture and fatigue stress fracture? How are stress fractures diagnosed and treated? 12. What fracture usually is diagnosed in trauma patients with pain in the anatomic snuff-box? 13. What are the most common locations of intervertebral disc herniations? What symptoms do they cause? 14. How is intervertebral disc herniation diagnosed and treated? 15. Define Charcot joint. What causes it? How is it managed? 16. What is the most common bacterial cause of osteomyelitis? In what clinical scenarios should you think of other causes? 17. Which bacteria are the most common cause of septic arthritis? In what scenario should you think of another cause? 18. What is reflex sympathetic dystrophy (RSD)? How do patients present? 19. True or false: There is a high incidence of vascular injury with posterior knee dislocations 20. What is the most common type of bone tumor? 21. What is a pathologic fracture? What is the most common cause of a pathologic fracture? 22. To what site is pain from hip inflammation or dislocation/fracture classically referred? 23. Specify age at presentation, epidemiology, symptoms and signs, and treatment for the three classically tested pediatric hip disorders 24. If you forget everything else about differentiating the three pediatric hip disorders, what historical point will help you the most on the USMLE? 25. Define Osgood-Schlatter disease. How is it recognized and treated? 26. How do you check for scoliosis? Who is usually affected? What is the treatment? 27. What are the common findings with ligament injuries of the knee? How do you distinguish injuries of the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments on physical exam? 28. What are the risk factors for avascular necrosis (AVN)? What is the best test to make the diagnosis?

CHAPTER 29. Pediatrics

1. Give the average ages at which the following commonly tested milestones are achieved 2. True or false: The overall pattern of development is more important than the age at which individual milestones are reached 3. What screening and preventive care measures should be done at every pediatric visit? 4. True or false: Screening and preventive care are important mainly during a well check-up 5. What are the commonly performed screening tests for metabolic and congenital disorders? 6. What are the frequently tested items under the umbrella of primary prevention using “anticipatory guidance”? 7. How often should height, weight, and head circumference be measured? What do they signify? 8. What if a child has low height, weight, or head circumference compared with peers? 9. Define failure to thrive. What causes it? 10. What conditions are suggested by obesity in children? 11. What conditions should you consider in a child with an abnormal head circumference? 12. How are hearing and vision screened? 13. In what situations should you worry about hearing loss? 14. What is the red reflex? What should an abnormal reflex suggest? 15. True or false: Before a certain age intermittent strabismus is normal 16. How is screening for anemia done? 17. True or false: All children should be given prophylactic iron supplements 18. How and when do you screen for lead exposure? 19. True or false: Most children need fluoride supplementation 20. True or false: Breast-fed infants are more likely to require vitamin D supplements than formula-fed infants 21. When should children be screened for tuberculosis? 22. True or false: Screening children for renal disease with a urinalysis is not recommended 23. True or false: Current vaccine recommendations and schedules are always provided on the USMLE 24. True or false: Sexually active teenaged girls need screening for chlamydial infection and gonorrhea 25. When should you recommend that a child see a dentist for the first time? 26. What are the Tanner stages? When do they occur? 27. Define delayed puberty. What is the most common cause? 28. What are other causes for delayed puberty? 29. What causes precocious puberty? 30. True or false: If the underlying cause for precocious puberty is uncorrectable or idiopathic after diagnostic work-up, patients should receive treatment 31. How are cavernous hemangiomas treated? 32. Distinguish between caput succedaneum and cephalohematoma. How are these conditions treated? 33. When does the anterior fontanelle usually close? What disorder should you suspect if it fails to close? 34. How many vessels does a normal umbilical cord have? What disorder should you suspect if one of the vessels is absent? 35. True or false: Milky-white and possibly blood-tinged vaginal discharge is usually abnormal in the first week of life for a female newborn 36. What findings should make you suspect child abuse? 37. True or false: You do not need proof to report child abuse 38. True or false: Children have the same range of normal vital signs as adults 39. What is an APGAR score? When is it measured? 40. True or false: The APGAR score is important because it is the first assessment of how a child is doing 41. What should you always remember when a question mentions that a child was given aspirin? 42. When should the Moro and palmar grasp reflex disappear?

CHAPTER 30. Pharmacology

1. On the USMLE, bizarre, unique, and fatal side effects are tested as well as common side effects of common drugs. Cover the right-hand column and name the side effects of the listed drugs 2. What are the side effects of diuretics? 3. What are the side effects of beta blockers? 4. What class of antihypertensive agents is best known for severe, first-dose orthostatic hypotension? 5. What antihypertensive is best known for causing depression? 6. Cover the right-hand column and give the antidote(s) for overdose or toxic exposure to the drugs in the left-hand column 7. If the following medications are given at the same time, what may happen? 8. What prophylactic medication should be given to contacts of a patient with neisserial meningitis? 9. Name three medications that cause hepatic enzyme induction and two that cause hepatic enzyme inhibition 10. True or false: If a patient responds to placebo, a psychosomatic condition can be diagnosed 11. Describe the mechanism of action for aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). How do they differ? 12. How is acetaminophen different from aspirin and other NSAIDs? 13. What are the side effects and toxic effects of aspirin? 14. What are the side effects of non-aspirin NSAIDs? 15. What two developments in NSAID therapy may reduce gastrointestinal and bleeding complications? 16. What happens with an overdose of acetaminophen? 17. What age group should not be given aspirin? What finding on physical exam is a contraindication to aspirin use? 18. What is the relationship between aspirin and myocardial infarction? 19. Discuss the relationship between aspirin and strokes 20. True or false: Patients should be given an aspirin as soon as possible in the emergency department for a suspected myocardial infarction or unstable angina 21. True or false: In the setting of an acute neurologic deficit, you should give aspirin before ordering brain imaging

CHAPTER 31. Preventive Medicine

1. Cover all but the left-hand column, and give the appropriate screening recommendations. Although other guidelines for cancer screening are in clinical use, the recommendations from the American Cancer Society (below) are a good guideline to use for the USMLE 2. True or false: Tumor markers are generally not used for cancer screening 3. True or false: Urinalysis should not be used to screen the general population for bladder cancer 4. Cover the right-hand column and give the indications for each of the following vaccines in adults 5. Define the following rates that are commonly seen on the USMLE 6. Define stillbirth 7. Name the major cause of neonatal mortality. What is the neonatal mortality rate in the United States? 8. List the top three causes of infant mortality in the United States 9. List the top three causes of maternal mortality in the United States 10. What is the basic difference between Medicare and Medicaid?

CHAPTER 32. Psychiatry

1. What are the five main diagnostic criteria for schizophrenia? 2. Why is the duration of symptoms important with psychosis? 3. List the positive symptoms of schizophrenia 4. List the negative symptoms of schizophrenia 5. What features of schizophrenia suggest a poor prognosis? 6. What features suggest a good prognosis? 7. What is the difference in age of onset for schizophrenia in males and females? 8. True or false: Roughly 1% of the population has schizophrenia in almost every country in the world 9. True or false: In the United States, most schizophrenic people are born in the summer months 10. Roughly what percentage of patients with schizophrenia commit suicide? 11. True or false: Psychosocial treatment has been shown to improve outcome in schizophrenia 12. Differentiate among the classes of antipsychotics drugs 13. What are the four commonly tested extrapyramidal side effects of antipsychotics? 14. Define acute dystonia. How is it treated? 15. Define akathisia 16. Describe the relationship between antipsychotics and parkinsonism 17. Define tardive dyskinesia. When does it occur? 18. What is neuroleptic malignant syndrome? How do you recognize and treat it? 19. Describe the relationship between antipsychotics and prolactin 20. What are the classic side effects of thioridazine, chlorpromazine, and clozapine? 21. What are the side effects of the atypical antipsychotics? 22. Define bipolar disorder. What are the classic symptoms? 23. How is bipolar disorder treated? 24. What are the side effects of lithium, valproic acid, and carbamazepine? 25. Define bipolar II disorder and cyclothymia 26. List the major risk factors for suicide 27. What is the best predictor of future suicide? 28. True or false: Be careful in asking about suicide because you may plant the idea in the patient's head 29. True or false: When patients are just emerging from a deep depression, they are at an increased risk of suicide 30. True or false: The highest suicide rates are in people aged 15 to 24 years 31. True or false: Patients with depression often do not complain about it directly 32. How do you treat depression? 33. Is depression more common in males or females? 34. What is an adjustment disorder with depressed mood? 35. Define dysthymia 36. True or false: Antidepressants can trigger mania or hypomania 37. How do tricyclic antidepressants work? What are their side effects? 38. How do selective serotonin reuptake inhibitors (SSRIs) work? Why are they preferred over tricyclics? 39. How do serotonin-norepinephrine reuptake inhibitors (SNRIs) work? 40. What are monoamine oxidase (MAO) inhibitors? Describe their side effects 41. What is the most notorious side effect of trazodone? 42. Distinguish between normal grief and pathologic grief (i.e., depression) 43. How do you recognize and treat panic disorder? 44. What is generalized anxiety disorder? How is it treated? 45. Give the classic examples of simple phobias. How are they treated? 46. What is social phobia? 47. How do you recognize and treat posttraumatic stress disorder? 48. True or false: Homosexuality is not considered a psychiatric disorder 49. Explain the concept of somatoform disorders 50. Describe the four major somatoform disorders 51. How are somatoform disorders treated? 52. Distinguish among somatoform disorders, factitious disorders, and malingering 53. How do you recognize dissociative fugue (also called psychogenic fugue or fugue state)? 54. What psychiatric disorder is most likely to be associated with childhood sexual abuse? 55. Define personality disorders 56. Give a one- or two-sentence description of each of the following ten personality disorders below 57. Define obsessive-compulsive disorder. How is it treated? 58. True or false: Some psychiatric patients can be hospitalized against their will 59. Describe the hallmark findings of narcolepsy. How is it treated? 60. What is the difference between objective and subjective psychological tests? 61. Characterize each of the following psychological tests as objective or subjective and briefly describe its use: 62. True or false: Roughly 85% of cases of mental retardation are mild 63. What are the common causes of mental retardation? 64. How do you recognize autism? 65. What is a learning disorder? 66. Define conduct disorder. With what adult disorder is it associated? 67. Define attention-deficit/hyperactivity disorder (ADHD) 68. Describe the behavior of a child who has oppositional-defiant disorder 69. Give the classic description of children with separation anxiety disorder 70. How do you recognize anorexia? 71. Define bulimia. What are the classic findings of the mouth and fingers? 72. Describe Tourette syndrome. How is it treated? 73. True or false: A diagnosis of encopresis or enuresis cannot be made before a certain age 74. True or false: Depression in children frequently presents as an irritable rather than a depressed mood 75. What are the three leading causes of death in adolescents? 76. What is the most commonly abused illicit drug? Describe its effects on users 77. What symptoms are associated with cocaine intoxication? Cocaine withdrawal? 78. Describe the symptoms of amphetamine intoxication 79. Describe the effects of opioids. What symptoms are seen in withdrawal? 80. How do you recognize intoxication with lysergic acid diethylamide (LSD) or hallucinogenic mushrooms? 81. What about phencyclidine (PCP) intoxication? 82. Describe the symptoms and signs of inhalant intoxication. Who is likely to abuse inhalants? 83. True or false: Benzodiazepines and barbiturates can be fatal in overdose but not in withdrawal 84. Describe the symptoms and signs of benzodiazepine or barbiturate intoxication 85. What are the symptoms of caffeine withdrawal? 86. What is the basic rule of thumb about the difference in symptoms between intoxication and withdrawal for the same drug?

CHAPTER 33. Pulmonology

1. Describe the difference between obstructive and restrictive pulmonary disease on pulmonary function testing 2. What causes emphysema? 3. How do you recognize and treat asthma? 4. What is a common cause of wheezing in children under age 2 years? 5. What should you think if a patient with acute asthma stops hyperventilating or has a normal carbon dioxide (CO2) level? 6. When should you intubate? 7. What should you do if a patient has a solitary pulmonary nodule on chest radiograph? 8. What classic clues on the Step 2 exam point to the cause of a solitary pulmonary nodule? 9. What should you know about pulmonary function in the setting of surgery? 10. How do you recognize and treat adult respiratory distress syndrome (ARDS)? 11. How is pneumonia diagnosed? 12. What is the difference between typical and atypical pneumonia? 13. What are the classic clinical clues on Step 2 for the different causative bugs in pneumonia? 14. What should you suspect if a child has recurrent pneumonias? 15. What is “round” pneumonia? 16. Why should you get a follow-up chest x-ray in all people over age 40 who develop pneumonia? 17. What should you know about infant respiratory distress syndrome? 18. What prenatal tests help to determine whether respiratory distress syndrome will occur? 19. Define diaphragmatic hernia. How is it recognized clinically? 20. How do you recognize and diagnose a tracheoesophageal fistula? How is it treated? 21. What is the most common lethal genetic disease in Caucasians? How do you recognize it? 22. How is cystic fibrosis diagnosed and treated? 23. What should you do if a patient has a pleural effusion?

CHAPTER 34. Radiology

1. Cover the right-hand columns and specify what imaging study you should order for the following conditions

CHAPTER 35. Rheumatology

1. What is the most common form of arthritis? 2. If the cause of arthritis is in doubt, what should you do? 3. How do you distinguish among the common causes of arthritis? 4. What other clues point to a diagnosis of osteoarthritis? 5. What clues point to a diagnosis of rheumatoid arthritis? 6. What clues point to a diagnosis of gout? 7. What causes pseudogout? How is it diagnosed? 8. What clues point to a diagnosis of septic arthritis? What are the common causes? 9. Name some other causes of arthritis 10. True or false: Psoriasis can cause an arthritis that resembles osteoarthritis 11. Describe the hallmarks of ankylosing spondylitis 12. How do you recognize Reiter syndrome as the cause of arthritis? 13. Why do patients with hemophilia get arthritis? 14. What clues point to Lyme disease as the cause of arthritis? 15. True or false: One of the major Jones criteria for the diagnosis of rheumatic fever is arthritis 16. Why do patients with sickle cell disease often have arthritis? 17. Define Charcot joint. What clues point to its presence? 18. What about lupus erythematosus and other autoimmune disorders as a cause of arthritis? 19. How do hemochromatosis and Wilson disease cause arthritis? 20. What generalized systemic signs of inflammation may suggest an autoimmune disorder? 21. Describe the hallmarks of systemic lupus erythematosus (SLE) 22. Describe the hallmarks of scleroderma 23. What are the hallmarks of Sjögren syndrome? 24. What are the signs and symptoms of dermatomyositis? 25. With what is polyarteritis nodosa associated? How is it diagnosed? 26. Describe the usual presentation of Kawasaki disease. How is it treated? 27. How does Takayasu arteritis present? 28. How do you recognize Behçet syndrome on the Step 2 exam? 29. How do you distinguish among fibromyalgia, polymyositis, and polymyalgia rheumatica? 30. Give the basic facts of Paget disease. How is it linked with cancer? 31. If a pediatric patient has uveitis and an inflammatory arthritis, but the rheumatoid factor is negative, what disease should you suspect?

CHAPTER 36. Shock

1. Define shock 2. List the five primary clinical types of shock 3. What should you do if a patient is in shock? 4. How should fluids be given if a patient is in shock? 5. What should you do if fluid challenges fail to raise the blood pressure? 6. What are the classic parameters of each type of shock? 7. Specify the usual findings in patients with neurogenic shock 8. How do you recognize septic shock? 9. What clues suggest cardiogenic shock? 10. How do you recognize hypovolemic shock? 11. What clues suggest anaphylactic shock? 12. What clues suggest pulmonary embolus as a cause of shock? 13. How do you recognize pericardial tamponade as a cause of shock? 14. Explain toxic shock syndrome 15. What clues suggest Addison disease as a cause of shock? 16. What is the most important point to remember if a patient is in shock? 17. Discuss the use of dobutamine, dopamine, norepinephrine, and isoproterenol to support blood pressure in the setting of shock 18. What about the use of phenylephrine, epinephrine, and milrinone in the setting of shock?

CHAPTER 37. Smoking

1. Does smoking really deserve its own chapter in this book? 2. How is smoking related to heart disease? 3. What cancers are more likely in smokers? 4. Describe the effect of smoking on the lung 5. What about second-hand smoke? 6. What other bad things does smoking do? 7. True or false: Women who smoke cannot take birth control pills 8. So what is the bottom line for the boards?

CHAPTER 38. Urology

1. Cover the right-hand columns and specify the classic differences between testicular torsion and epididymitis. What imaging test can diagnose and distinguish these two conditions? 2. How does testicular cancer usually present? Describe the major risk factors, histology, and treatment 3. How is renal cell carcinoma diagnosed and treated? 4. What is the classic cause of orchitis? How is it treated? Does it usually cause infertility? 5. What are the symptoms and sequelae of benign prostatic hypertrophy (BPH)? 6. How is BPH treated? 7. How do you recognize and manage acute urinary retention? 8. What are the common causes of impotence? 9. What are the signs of urethral injury? 10. True or false: Urethral injury is a contraindication to passing a Foley catheter 11. Distinguish between hydrocele and varicocele 12. Describe the classic findings of nephrolithiasis 13. What are the different types of stones? What causes them? 14. How is nephrolithiasis treated? 15. Define cryptorchidism. When does it occur? 16. True or false: It is important to place abdominal testes in the scrotum surgically to decrease the risk of cancer 17. Where do the left and right ovarian/testicular veins drain? 18. When is kidney transplant considered for patients with renal disease? 19. Who makes the best donor for patients who need a kidney transplant? 20. Describe unacceptable kidney donors 21. Where is the transplanted kidney placed? What happens to the native kidneys? 22. What are the three basic types of rejection with kidney transplantation? 23. What causes hyperacute rejection? What is the classic clinical description? 24. What causes acute rejection? How does it present? How is it treated? 25. What causes chronic rejection? How does it present? How is it treated? 26. Discuss the mechanism of action of the commonly used immunosuppressant drugs in transplant medicine 27. How do you distinguish the nephrotoxicity of cyclosporine from rejection? 28. What risks are associated with immunosuppression? 29. Define epispadias and hypospadias. How are they treated? 30. Define Potter syndrome. With what is it associated?

CHAPTER 39. Vascular Surgery

1. What clues suggest carotid stenosis? How is it diagnosed? 2. How is carotid stenosis managed? 3. What is the most common cause of death during vascular surgery? 4. What are the classic findings in a patient with an abdominal aortic aneurysm? How is it evaluated? 5. How is an abdominal aortic aneurysm managed? What clues indicate that the aneurysm has ruptured? 6. Define Leriche syndrome. For what is it a marker? 7. Define claudication. What are the associated physical findings? 8. How are patients with claudication managed? 9. What is the probable cause of severe, sudden onset of foot pain in patients with no previous history of foot pain, trauma, or associated chronic physical findings? 10. Describe the classic presentation of chronic mesenteric ischemia 11. How does an acute bowel infarction present? 12. What causes arteriovenous fistulas and pseudoaneurysms in the extremities? How do you recognize them? 13. What are the signs and symptoms of venous insufficiency? How is it treated? 14. True or false: A superficial palpable cord is a fairly specific sign of deep venous thrombosis 15. Describe the usual history of a patient with superficial thrombophlebitis. How is it treated? 16. Define subclavian steal syndrome. What symptoms does it cause? How is it treated? 17. What are the symptoms of thoracic outlet syndrome? How is it treated?

CHAPTER 40. Vitamins and Minerals

1. Specify the signs and symptoms of the various vitamin deficiencies and toxicities 2. Specify the signs and symptoms of the various mineral deficiencies and toxicities 3. What are the fat-soluble vitamins? In what general category of patients are they deficient? 4. What vitamin, mineral, and electrolyte deficiencies are classically seen in alcoholics? 5. What is the most common cause of vitamin B12 deficiency? 6. What is the classic iatrogenic cause of vitamin B6 deficiency? 7. Which medications may cause folate deficiency? 8. Which vitamin is a known teratogen? 9. Which vitamin should be taken by all sexually active women of reproductive age? 10. What are the physical findings of rickets (vitamin D deficiency in children)? 11. Which vitamin is given to all newborns? 12. Which clotting factors are affected by vitamin K? What is the interaction of vitamin K and the liver? 13. Describe the relationship between vitamin K and broad-spectrum antibiotics 14. What is the classic Step 2 description of a vitamin C-deficient patient?

Index

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