USMLE Step 2 Clinical Skills Triage: A Guide to Honing Clinical Skills

279 Pages·2010·2.75 MB·English

by  Kevin Schwechten

USMLE Step 2
Clinical Skills Triage
This page intentionally left blank
USMLE Step 2
Clinical Skills Triage
A Guide to Honing Clinical Skills
Kevin Schwechten, MD
Teaching Faculty and Staf Physician
Magnolia Regional Health Center
Magnolia Regional Health Center Residency Program
Corinth, Mississippi
1
2010
3
Oxford University Press, Inc., publishes works that further
Oxford University’s objective of excellence
in research, scholarship, and education.
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With of ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland T ailand Turkey Ukraine Vietnam
Copyright © 2010 by Kevin Schwechten, M.D.
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
www.oup.com
Oxford is a registered trademark of Oxford University Press.
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Schwechten, Kevin.
USMLE step 2 clinical skills triage : a guide to honing clinical skills / Kevin Schwechten.
p. ; cm.
Includes index.
ISBN 978-0-19-539823-6
1. Clinical medicine—Examinations, questions, etc. 2. Clinical medicine—Case studies.
3. Physicians—Licenses—United States—Examinations—Study guides.
4. Medical history taking— Examinations, questions, etc. 5. Medical history taking—Case studies.
6. Diagnosis, Dif erential—Case studies. 7. Diagnosis, Dif erential—Examinations, questions, etc. I. Title.
[DNLM: 1. Physical Examination—methods—Case Reports. 2. Physical Examination—methods—
Examination Questions. 3. Diagnosis, Dif erential—Case Reports. 4. Diagnosis, Dif erential—Examination
Questions. 5. Physician-Patient Relations—Case Reports. 6. Physician-Patient Relations—Examination
Questions. WB 18.2 S412u 2010]
RC58.S39 2010
616.0076—dc22
2009045015
ISBN: 978-0-19-539823-6
T is material is not intended to be, and should not be considered, a substitute for medical or other professional advice.
Treatment for the conditions described in this material is highly dependent on the individual circumstances. And,
while this material is designed to of er accurate information with respect to the subject matter covered and to be
current as of the time it was written, research and knowledge about medical and health issues is constantly evolving
and dose schedules for medications are being revised continually, with new side ef ects recognized and accounted
for regularly. Readers must therefore always check the product information and clinical procedures with the most
up-to-date published product information and data sheets provided by the manufacturers and the most recent codes
of conduct and safety regulation. T e publisher and the authors make no representations or warranties to readers,
express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher
and the authors make no representations or warranties as to the accuracy or ef cacy of the drug dosages mentioned in
the material. T e authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability,
loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of
this material.
9 8 7 6 5 4 3 2 1
Printed in USA
on acid-free paper
To my amazing family: Dawn, my wife, whose support has meant everything, and to my children,
Ariel and Tristan who gave me the great gif s of motivation, inspiration, and hope.
Also, to the soldiers, medics, and of cers of the U.S. Army’s 2–4 Infantry battalion,
th
10 Mountain Division (2008), who did a truly professional job in Iraq
and made it possible for all of us to come home.
This page intentionally left blank
About the Author
Kevin Schwechten, born in Montana, earned his medical doctorate from Oregon Health & Science
University in Portland, Oregon. He joined the U.S. Army during medical school and completed his Family
Medicine residency at Martin Army Community Hospital in Fort Benning, Georgia. Af er training, he
spent over a year as battalion surgeon in Baghdad, Iraq, where he cared for both soldiers and the Iraqi
populace. Dr. Schwechten now lives, works, and teaches in Mississippi.
vii
This page intentionally left blank
C onte nts Contents
Section 1: Logistics of Step 2 Clinical Skills 1
Section 2: USMLE Clinical Skills Strategy 8
1. Vision Loss 17
2. Red Eye 23
3. Mental Status Change 29
4. Dizziness 36
5. Headache 42
6. Sleep Dif culties 48
7. Headache and Stif Neck 54
8. Syncope 60
9. Heat-Related Injury 66
10. Breast Lump 73
11. Chest Pain 79
12. Chronic Cough 86
13. Shortness of Breath 92
14. Weight Loss and Fatigue 99
15. Respiratory Symptoms 105
16. Male Abdominal Pain 112
17. Nausea and Vomiting in a Diabetic 121
18. Nausea and Vomiting 127
19. Female Abdominal Pain 133
20. Anterior Knee Pain 139
21. Wrist Pain 147
ix