USMLE Step 2 Ck Internal Medicine Lecture Notes

449 Pages·2013·7.713 MB·English

by  Kaplan Inc.

GI
GI
USMLE Step 2 CK
TM*
Internal Medicine
Lecture Notes
BL4017J *USMLE is a joint program of the Federation of State Medical Boards of the United States, Inc. and the National Board of Medical Examiners.
GI
©2013 Kaplan, Inc.
All rights reserved.
Published by Kaplan, Inc.
395 Hudson Street
New York, NY 10014
No part of these materials may be reproduced, transmitted, downloaded, decompiled,
reversed engineered, or stored in or introduced into any information storage and
retrieval system, in any form or by any means, whether electronic or mechanical, now
known or hereinafter invented, without prior written authorization from Kaplan, Inc.
Kaplan, Inc. grants you a non-transferable, non-exclusive license to access the materials
and read the text on screen, solely for your personal, non-commercial use.
10 9 8 7 6 5 4 3 2 1
ISBN: 978-1-61865-492-2
GI
AUTHORS
Conrad Fischer, M.D.
Director of Educational Development
Associate Professor of Medicine, Physiology, and Pharmacology
Touro College of Medicine
New York, NY
Jamaica Hospital Medical Center
Queens, NY
Charles Faselis, M.D.
Chairman of Medicine
VA Medical Center
Washington, DC
Associate Professor of Medicine
George Washington University School of Medicine
Washington, DC
CONTRIBUTORS
Joseph J. Lieber, M.D. Chris Paras, D.O.
Associate Professor of Medicine Endocrine Faculty
Associate Program Director in Medicine Winthrop University Hospital
Site Director, Internal Medicine Residency Program Mineola, NY
Mount Sinai School of Medicine
New York, NY Assistant Clinical Professor of Medicine
Touro College of Osteopathic Medicine
Frank P. Noto, M.D. New York, NY
Assistant Professor of Internal Medicine
Assistant Professor of Medicine
Mount Sinai Hospital
Frank H. Netter School of Medicine/Quinnipiac University
New York, NY
Hamden, CT
Site Director, Internal Medicine Clerkship and Sub-Internship
Mount Sinai School of Medicine
New York, NY
Hospitalist
Elmhurst Hospital Center
Queens, NY
GI
Acknowledgment
The authors wish to recognize the gracious support of:

Edmund Bourke, M.D.
Former Chairman, Department of Medicine
SUNY Downstate School of Medicine
GI
Contents
Author’s Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Chapter 1. Preventive Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2. Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 3. Rheumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chapter 4. Gastroenterology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 5. Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chapter 6. Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Chapter 7. Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Chapter 8. Nephrology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Chapter 9. Pulmonology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Chapter 10. Emergency Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Chapter 11. Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .353
Chapter 12. Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379
Chapter 13. Radiology/Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Chapter 14. Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
v
GI
GI
Author’s Note
Here you will find all of the content and material that you need for your journey to master the
material necessary to pass and excel on the USMLE Step 2 CK.
This journey will involve much work, struggle, and at times, pain. Aristotle said “The greatest
part of courage is endurance.” What can we offer you as an analgesic for this pain?
If your highest goal is simply to pass the exam, you may well succeed, but the journey will be
fraught with more anguish. If you can remember that someday you can relieve the suffering of
one individual or save the life of even a single person from what you will learn as you study for
Step 2, then your efforts will take on a new meaning and purpose. Make your goal the eternal
quest to perfect the Art of Medicine in the service of Humanity.
Hold fast to this goal and several extraordinary things will happen:
1. You will help people.
2. You will exchange bliss, relaxation, and a sense of joy for much of the hardship.
3. You will get an even higher grade.
Many years from now, when you have achieved all you desire professionally, much of the infor-
mation you learn today will have faded. But if you see yourself as serving the ideals of goodness
and beauty through medicine, then this simple but crucial purpose will not be forgotten with
the rest.
Medicine is more than just applying scientific facts to treat people. Learn to love what you do,
and this will enrich not only your patients’ lives, but yours as well. As the thirteenth century
poet Rumi said, “Let the Beauty that we love be what we do, there are hundreds of ways to kneel
and kiss the ground.”
Conrad Fischer, M.D.
Co-Chairman, Internal Medicine
Kaplan Medical
vii
GI
GI
1
Preventive Medicine
CANCER SCREENING
A 39-year-old woman comes to the clinic very concerned about her risk of developing
cancer. Her father was diagnosed with colon cancer at age 43, and her mother was
diagnosed with breast cancer at age 52. She is sexually active with multiple partners
and has not seen a physician since a motor vehicle accident 15 years ago. She denies
any symptoms at this time, and her physical examination is normal. She asks what
is recommended for a woman her age.
Screening tests are done on seemingly healthy people to identify those at increased risk of
disease. Even if a test is available, however, that does not necessarily mean it should be used to
screen for a particular disease.
• Several harmful effects may potentially result from screening tests.
• Any adverse outcome that occurs (large bowel perforation secondary to a colonoscopy)
is iatrogenic.
• Screening may be expensive, unpleasant, and/or inconvenient.
• Screening may also lead to harmful treatment.
Finally, there may be a stigma associated with incorrectly labeling a patient as “sick.”
For all diseases for which screening is recommended, effective intervention must exist, and the
course of events after a positive test result must be acceptable to the patient. Most important, the
screening test must be valid, i.e., it must have been shown in a randomized, double-blinded trial
to decrease overall mortality in the screened population. For a screening test to be recommended
for regular use, it has to be extensively studied to ensure that all of the above requirements are met.
The 3 malignancies for which regular screening is recommended are cancers of the colon,
breast, and cervix.
Colon Cancer
In the patient with no significant family history of colon cancer, screening should begin at age 50.
The choices are annual fecal occult blood testing or sigmoidoscopy with barium enema every
5 years. The preferred screening modality for colon cancer is colonoscopy every 10 years.
In the patient with a single first-degree relative diagnosed with colorectal cancer before age 60
or multiple first-degree relatives with colon cancer at any age, colonoscopy should begin at age
40 or 10 years before the age at which the youngest affected relative was diagnosed, whichever
age occurs earlier. In these high-risk patients, colonoscopy should be repeated every 5 years.
The U.S. Preventive Services Task Force (USPSTF) does not recommend routine screening in
patients age >75.
1