Cases & Concepts Step 1: Basic Science Review PDF
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Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page i Cases and Concepts Step 1: Basic Science Review Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page ii Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page iii Cases and Concepts Step 1: Basic Science Review Aaron B.Caughey,MD,MPP,MPH,PhD Jillian S.Main Associate Professor Class of 2009 Fellowship Program Director Chicago Medical School Division of Maternal-Fetal Medicine Chicago,Illinois Department of Obstetrics,Gynecology,and Reproductive Services University of California at San Francisco Judith Neugroschl,MD San Francisco,California Assistant Professor of Psychiatry Director of Medical Student Education in Psychiatry Paul Baum,MD Mount Sinai School of Medicine Assistant Adjunct Professor of Medicine New York,New York Division of Experimental Medicine UCSF School of Medicine Laetitia Poisson de Souzy,MD San Francisco,California Resident Department of Obstetrics and Gynecology Christie del Castillo-Hegyi,MD University of California at San Francisco Attending Emergency Physician San Francisco,California Presbyterian Hospital University of New Mexico Teresa Sparks Albuquerque,New Mexico Class of 2009 UCSF School of Medicine Monica Ghandi,MD San Francisco,California Assistant Professor Division of Infectious Diseases Annie Tan,MD Department of Medicine Clinical Fellow University of California at San Francisco Department of Obstetrics and Gynecology San Francisco,California University of Minnesota Minneapolis,Minnesota Larissa R.Graff,PharmD Assistant Clinical Professor Susan H.Tran,MD Department of Clinical Pharmacy Fellow in Maternal-Fetal Medicine and Clinical Genetics School of Pharmacy Department of Obstetrics,Gynecology, University of California at San Francisco and Reproductive Sciences Clinical Pharmacist—Hematology/Oncology University of California at San Francisco University of California at San Francisco Medical Center San Francisco,California San Francisco,California Juan E.Vargas,MD C.Bradley Hare,MD Assistant Clinical Professor Assistant Professor University of California at San Francisco School of Medicine Division of Infectious Diseases San Francisco,California Department of Medicine University of California at San Francisco Jed T.Wolpaw,M.Ed San Francisco,California Class of 2010 UCSF School of Medicine Jennifer Hoblyn,MB,MMSci,MRCPsych,MPH San Francisco,California VA Palo Alto Health Care System Palo Alto,California Katherine Y.Yang,PharmD,MPH Department of Psychiatry and Behavioral Sciences Assistant Clinical Professor Stanford University School of Medicine Department of Clinical Pharmacy Stanford,California School of Pharmacy University of California at San Francisco Jonathan Z.Li,MD Infectious Diseases Clinical Pharmacist Clinical and Research Fellow University of California at San Francisco Medical Center Division of Infectious Disease San Francisco,California Brigham and Women’s Hospital Massachusetts General Hospital Boston,Massachusetts Series Editor:Aaron B.Caughey,MD,MPP,MPH,PhD Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page iv Acquisitions Editor:Charles W.Mitchell Senior Managing Editor:Stacey L.Sebring Marketing Manager:Emilie J.Moyer Production Editor:Beth Martz Creative Director:Doug Smock Compositor:International Typesetting and Composition First Edition Copyright © 2010 Lippincott Williams & Wilkins,a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore,MD 21201 Philadelphia,PA 19106 Printed in the People’s Republic of China All rights reserved.This book is protected by copyright.No part of this book may be reproduced or transmitted in any form or by any means,including as photocopies or scanned in or other electronic copies,or utilized by any information storage and retrieval system,without written permission from the copyright owner,except for brief quotations embodied in critical articles and reviews.Materials appearing in this book prepared by individuals as part of their official duties as U.S.government employees are not covered by the above-mentioned copyright.To request permission,please contact Lippincott Williams & Wilkins at 530 Walnut Street,Philadelphia,PA 19106, via email at [email protected],or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Cases and Concepts Step 1:Basic Science Review / Aaron B.Caughey ...[et al.]. p.;cm. Includes index. ISBN-13:978-0-7817-9391-9 ISBN-10:0-7817-9391-2 1. Medicine—Case studies. 2. Medical sciences—Case studies. I. Caughey,Aaron B. II. Title:Basic science review. [DNLM: 1. Clinical Medicine—methods—Case Reports. 2. Clinical Medicine—methods—Examination Questions. WB 293 C338 2010] RC66.C365 2010 610—dc22 2008044380 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However,the authors,editors,and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty,expressed or implied,with respect to the currency, completeness,or accuracy of the contents of the publication.Application of this information in a particular situation remains the professional responsibility of the practitioner;the clinical treatments described and recommended may not be considered absolute and universal recommendations. 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Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page v PREFACE The first 2 years of medical school are a demanding time for This series covers all the essential material needed in the basic medical students.Whether the school follows a traditional science courses.Where possible,the books are organized in an curriculum or one that is case based,every student is expected organ-based system.Clinical cases lead off and are the basis for to learn and be able to apply basic science information in a discussion of the basic science content.A list of thought ques- clinical situation. tions follows the case presentation.These questions are designed Medical schools are increasingly using clinical presentations as to challenge the reader to begin to think about how basic sci- the background to teach the basic sciences.Case-based learning ence topics apply to real-life clinical situations.The answers to has become more common at many medical schools,as it offers these questions are integrated within the basic science review a way to catalogue the multitude of symptoms,syndromes,and and discussion that follows.This offers a clinical framework diseases in medicine. from which to understand the basic content. Cases and Concepts is a new series by Lippincott Williams & The discussion section is followed by a high-yield Thumbnail Wilkins designed to provide students with a textbook to study the table and a Key Points box that highlight and summarize the basic science topics combined with clinical data.This method of essentialinformation presented in the discussion.The cases also learning is also the way to prepare for the clinical case format of include two to four multiple-choice questionsthat allow readers to USMLE questions.The books in this series will make the basic check their knowledge of that topic.Many of the answer explana- science topics not only more interesting but also more meaning- tions provide an opportunity for further discussion by delving into ful and memorable.Students will be learning not only the why of more depth in related areas.Fullanswer explanations can be found a principle but also how it might commonly be seen in practice. at the endof the book. The books in the Cases and Concepts series feature a com- This series was designed to provide comprehensive contentin prehensive collection of cases that are designed to introduce one a concise and templated format for ease in learning.Adedicated or more basic science topics.Through these cases,students gain attempt was made to include sufficient art,tables,and clinical an understanding of the coursework as they learn to: treatment information,all while keeping the books from becoming too lengthy.We know you have much to read and that what you • Think through the cases want is high-yield,vital facts. • Look for classic presentations of most common diseases Lippincott Williams & Wilkins and the authors wish you suc- and syndromes cess in your studies and in your future medical career.Please • Integrate the basic science content with clinical application feel free to offer us any comments or suggestions on these books • Prepare for course exams and Step 1 USMLE at www.lww.com. • Be prepared for clinical rotations v Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page vi Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page vii CONTENTS Preface v Case 1-25.Coccidioidomycosis and the Endemic Abbreviations xi Mycoses 68 Normal Ranges of Laboratory Values xvii Case 1-26.Plasmodium 71 PART I: MICROBIOLOGY PART II: IMMUNOLOGY Case 1-1. StaphylococcusAureus 2 Case 2-1. Cell-Mediated Immunity 76 Case 1-2. Streptococcus Pyogenesand the Other Case 2-2. Humoral Immunity and Autoimmune β-hemolytic Streptococci 5 Disease 83 Case 1-3. α-Hemolytic Streptococci 8 Case 2-3. Innate Immunity and the Complement System 87 Case 1-4. Enterococci 12 Case 2-4. Immunodeficiency 92 Case 1-5. Nocardiaand an Overview of the Gram-Positive Rods 14 PART III: PHARMACOLOGY Case 1-6. Clostridium Difficile 17 Case 3-1. Clinical Pharmacokinetics 98 Case 1-7. Neisseria Meningitidis 19 Case 3-2. Nitrates 103 Case 1-8. Gram-Negative Rods that Cause Case 3-3. Beta-Blockers 105 Gastrointestinal Infections 22 Case 3-4. Calcium Channel Blockers 108 Case 1-9. Pseudomonas Aeruginosa 25 Case 3-5. Diuretics 110 Case 1-10.Salmonella Typhi 28 Case 3-6. Angiotensin-Converting Case 1-11.Mycobacterium Tuberculosis 30 Enzyme Inhibitors 112 Case 1-12.Nontuberculous Mycobacteria 33 Case 3-7. Angiotensin Receptor Blockers 114 Case 1-13.Mycoplasma 37 Case 3-8. Anticoagulant Agents 116 Case 1-14.Treponema Pallidum 40 Case 3-9. Opioids 119 Case 1-15.Herpes Simplex Virus 42 Case 3-10.Anticonvulsants 122 Case 1-16.Cytomegalovirus 45 Case 3-11.Agents Used for Anxiety Disorders 125 Case 1-17.Human Immunodeficiency Virus 47 Case 3-12.Agents Used for Depression 127 Case 1-18.West Nile Virus 50 Case 3-13.Agents for Schizophrenia 129 Case 1-19.Hepatitis A Virus 53 Case 3-14.Agents for Hyperthyroidism 131 Case 1-20.Hepatitis B Virus 55 Case 3-15.Agents for Diabetes: Insulin 133 Case 1-21.Influenza Virus 58 Case 3-16.Agents for Diabetes: Oral Agents 135 Case 1-22.Aspergillus Fumigatus 61 Case 3-17.Agents for Hyperlipidemia 138 Case 1-23.Cryptococcus Neoformans 64 Case 3-18.Agents for Asthma 140 Case 1-24.Candida Albicans 66 Case 3-19.Oral Contraception 143 vii Caughey FM_i-xviii.qxd 12/10/08 9:24 AM Page viii Contents Case 3-20.Agents for Peptic Ulcer Disease 145 Case 5-3. X-Linked Dominant Inheritance 222 Case 3-21.Agents for Gastroesophageal Case 5-4. Mitochondrial Inheritance 224 Reflux Disease 147 Case 5-5. Variable Penetrance 227 Case 3-22.Penicillins 149 Case 5-6. Chromosome Structure 230 Case 3-23.Cephalosporins 151 Case 5-7. Sex Chromosomes 232 Case 3-24.Macrolides 154 Case 5-8. Genomic Imprinting 234 Case 3-25.Tetracyclines 156 Case 5-9. Cell Cycle 237 Case 3-26.Fluoroquinolones and Trimethoprim- Sulfamethoxazole 158 PART VI: EMBRYOLOGY Case 6-1. Embryonic Development 240 Case 3-27.Aminoglycosides 161 Case 6-2. Teratogens 243 Case 3-28.Vancomycin 163 Case 6-3. Neural Tube Development 246 Case 3-29.Antianaerobic Agents 165 Case 6-4. Branchial Arch Anomalies 249 Case 3-30.Antiviral Agents for Herpes Viruses 167 Case 3-31.Antifungal Agents 169 PART VII: BEHAVIORAL SCIENCE Case 3-32.Anthracyclines 171 Case 7-1. Developmental Milestones 254 Case 3-33.Alkylating Agents 173 Case 7-2. Depression in Pregnancy 257 Case 3-34.Antimetabolites 175 Case 7-3. Psychopharmacology 259 Case 3-35.Vinca Alkaloids 177 Case 7-4. Learning Theory 262 Case 3-36.Taxanes 179 Case 7-5. Defense Mechanisms 265 Case 7-6. Suicide Attempt 268 PART IV: BIOCHEMISTRY Case 4-1. Glycolysis 182 Case 7-7. Abuse 271 Case 4-2. Glycogen Synthesis and Degradation 184 Case 7-8. Capacity 273 Case 4-3. Oxidative Phosphorylation 187 Case 7-9. Eating Disorders 276 Case 4-4. Fatty Acid Metabolism 189 Case 7-10.Obesity 279 Case 4-5. Steroid Biosynthesis 192 PART VIII: NEUROSCIENCE,PSYCHIATRY, PSYCHOPHARMACOLOGY, Case 4-6. Cholesterol Synthesis 195 AND PSYCHOPATHOLOGY Case 4-7. Cholesterol and Lipid Metabolism 198 Case 8-1. Depression 284 Case 4-8. Homocystinuria 201 Case 8-2. Bipolar Disorder: Etiology Case 4-9. Phenylketonuria 203 and Epidemiology 287 Case 4-10.The Urea Cycle 205 Case 8-3. Anxiety Disorders 290 Case 4-11.Vitamin Function 209 Case 8-4. Obsessive-Compulsive Disorder 293 PART V: GENETICS Case 8-5. Delirium 296 Case 5-1. Autosomal Dominant Inheritance 216 Case 8-6. Dementia 299 Case 5-2. Autosomal Recessive Inheritance 219 Case 8-7. Personality Disorders 303 viii
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