USMLE Step 2 Secrets E-Book

Theodore X. O'Connell

BOOK

USMLE Step 2 Secrets E-Book

Theodore X. O'Connell

(2017)

Additional Information

Book Details

ISBN: 978-0-323-52804-7
Edition: 5
Language: English
Pages: 420
Subjects: Medicine: general issues
Medical study & revision guides & reference material

Abstract

Concise and easy to use, USMLE Step 2 Secrets, by prolific author Theodore X. O’Connell, MD, is an effective, high-yield review for achieving success on this high-stakes exam. Presented in the popular, time-tested Secrets® Q&A format, this bestselling USMLE review book prepares you for the broad-based diagnosis, treatment, and management questions you’ll face on the vignette-style USMLE exam.

The proven Secrets® format gives you the most return for your time – concise, easy to read, engaging, and highly effective.

Essential questions and answers cover the key conditions you will be expected to recognize, all specialty and subspecialty topics, and necessary clinical concepts.

Top 100 Secrets, tips, and memory aids provide a fast overview of the secrets you must know for success in practice and on exams.

Portable size makes it easy to carry with you for quick reference or review anywhere, anytime.

Thoroughly updated to ensure that content reflects the current USMLE exam.

New color images added throughout, plus numerous figures, tables, and summary boxes for visual overview of essential, board-relevant content.

Section Title	Page	Action	Price
Front Cover	Cover
IFC	ES1
USMLE STEP 2	i
USMLE STEP 2	iii
Copyright	iv
Dedication	v
CONTENTS	vi
Dedication	viii
100 TOP SECRETS	1
1 - ACID-BASE AND ELECTROLYTES	15
1.How do you analyze arterial blood gas values?	15
2.True or false: The body does not compensate beyond a normal pH	15
3.List the common causes of acidosis	15
4.List the common causes of alkalosis	15
5.What type of acid-base disturbance does aspirin overdose cause?	15
6.What happens to the blood gas of patients with chronic lung conditions?	15
7.Should you give bicarbonate to a patient with acidosis?	16
8.The blood gas of a patient with asthma has changed from alkalotic to normal, and the patient seems to be sleeping. Is the pati...	16
9.List the signs and symptoms of hyponatremia	16
10.How do you determine the cause of hyponatremia?	16
11.How is hyponatremia treated?	16
12.What medication is used to treat SIADH if water restriction fails?	16
13.What happens if hyponatremia is corrected too quickly?	16
14.What causes spurious (false) hyponatremia?	16
15.What causes hyponatremia in postoperative patients?	17
16.What is the classic cause of hyponatremia in pregnant patients about to deliver?	17
17.What are the signs and symptoms of hypernatremia?	17
18.What causes hypernatremia?	17
19.How is hypernatremia treated?	17
20.What are the signs and symptoms of hypokalemia?	17
21.What is the effect of pH on serum potassium?	17
22.Describe the interaction between digoxin and potassium	17
23.How should potassium be replaced?	17
24.When hypokalemia persists even after administration of significant amounts of potassium, what should you do?	17
25.What are the signs and symptoms of hyperkalemia?	18
26.What causes hyperkalemia?	18
27.What should you suspect if an asymptomatic patient has hyperkalemia?	18
28.The specimen was not hemolyzed. What is the first treatment?	18
29.What are the signs and symptoms of hypocalcemia?	18
30.What should you do if the calcium level is low?	18
31.What causes hypocalcemia?	19
32.Describe the relationship between low calcium and low magnesium	19
33.How does pH affect calcium levels?	19
34.Describe the relationship between calcium and phosphorus	19
35.What are the signs and symptoms of hypercalcemia?	19
36.What causes hypercalcemia?	19
37.Why is asymptomatic hypercalcemia usually treated?	19
38.How is hypercalcemia treated?	19
39.In what clinical scenario is hypomagnesemia usually seen?	20
40.What are the signs and symptoms of hypomagnesemia?	20
41.In what clinical scenario is hypermagnesemia seen?	20
42.How is hypermagnesemia treated?	20
43.In what clinical scenarios is hypophosphatemia seen? What are the signs and symptoms?	20
44.What is the IV fluid of choice in hypovolemic patients?	20
45.What is the maintenance fluid of choice for patients who are not eating?	20
46.Should anything be added to the IV fluid for patients who are not eating?	20
2 - ALCOHOL	21
1.With which cancers is alcohol intake associated?	21
2.Describe the relationship between alcohol and accidental or intentional death (i.e., suicide and murder)	21
3.True or false: Alcohol can precipitate hypoglycemia	21
4.What may happen if you give glucose to an alcoholic without giving thiamine first?	21
5.What is the difference between Wernicke and Korsakoff syndromes? What causes each?	21
6.True or false: Alcohol withdrawal can be fatal	21
7.How is alcohol withdrawal treated?	21
8.What are the stages of alcohol withdrawal?	21
9.What are the classic physical stigmata of liver disease in alcoholics?	21
10.What are the classic laboratory findings of liver disease in alcoholics?	22
11.What diseases and conditions may be caused by chronic alcohol intake?	22
12.Describe the classic derangement of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in alcoholic hepatiti...	22
13.What is the best treatment for alcoholism?	22
14.Describe the effects of alcohol on pregnancy	22
15.Discuss the epidemiology of alcohol abuse	22
16.What kind of pneumonia should you suspect in a homeless alcoholic patient?	22
17.What are the classic electrolyte and vitamin/mineral abnormalities in alcoholics?	23
18.How are bleeding esophageal varices treated?	23
19.How are varices with no history of bleeding treated?	23
3 - Biostatistics	24
1. How is the sensitivity of a test defined? What are highly sensitive tests used for clinically?	24
2.How is the specificity of a test defined? What are highly specific tests used for clinically?	24
3.Explain the concept of a trade-off between sensitivity and specificity	24
4.Define positive predictive value (PPV). On what does it depend?	25
5.Define negative predictive value (NPV). On what does it depend?	25
6.Define attributable risk. How is it measured?	25
7.Develop the habit of drawing a 2 × 2 table for Step 2 statistics questions. Given the 2 × 2 table below, define the formulas f...	25
8.Define relative risk. From what types of studies can it be calculated?	25
9.What is a clinically significant value for relative risk?	25
10.Define odds ratio. From what types of studies is it calculated?	25
11.What do you need to know about standard deviation (SD) for the USMLE?	25
12.Define mean, median, and mode	26
13.What is a skewed distribution? How does it affect mean, median, and mode?	26
14.Define test reliability. How is it related to precision? What reduces reliability?	26
15.Define test validity. How is it related to accuracy? What reduces validity?	26
16.Define correlation coefficient. What is the range of its values?	26
17.True or false: A correlation coefficient of –0.6 is a stronger correlation coefficient than +0.4	26
18.Define confidence interval. Why is it used?	27
19.What five types of studies should you know for the Step 2 exam?	27
20.What are experimental studies?	27
21.What are prospective studies? Why are they important?	27
22.What are retrospective studies? Discuss their advantages and disadvantages	27
23.What is a case series study? How is it used?	27
24.What is a prevalence survey? How is it used?	27
25.What is the difference between incidence and prevalence?	27
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 i...	28
27.Define epidemic	28
28.When are a chi-square test, t-test, and analysis of variance test used?	28
29.What is the difference between nominal, ordinal, and continuous types of data?	28
30.Define P-value	28
31.What three points about P-value should be remembered for the Step 2 exam?	28
32.Explain the relationship of the P-value to the null hypothesis	28
33.What is a type II error?	28
34.What is the power of a study? How do you increase the power of a study?	29
35.What are confounding variables?	29
36.Discuss nonrandom or nonstratified sampling	29
37.What is nonresponse bias?	29
38.Explain lead-time bias	29
39.Explain admission rate bias	29
40.Explain recall bias	29
41.Explain interviewer bias	29
42.What is unacceptability bias?	29
4 - Cardiology	30
1. When Step 2 describes a patient with chest pain, what do you do?	30
2.What elements of the history and physical exam steer you away from a diagnosis of myocardial infarction (MI)?	30
3.What findings on EKG should make you suspect an MI?	30
4.Describe the classic pattern of MI chest pain	30
5.What tests are used to diagnose an MI?	31
6.Describe the classic physical exam findings in patients with MI	31
7.What historical points should steer you toward a diagnosis of MI?	31
8.Describe the treatment for an MI	31
9.True or false: With good management, patients with an MI will not die in the hospital	31
10.When is heparin indicated in the setting of chest pain and MI?	31
11.What clues suggest the common noncardiac causes of chest pain?	31
12.How can you recognize stable angina?	33
13.Define unstable angina. How is it diagnosed and treated?	33
14.Describe variant (Prinzmetal) angina	33
15.Define silent MI. How common is it?	33
16.Describe the etiology and classic history of the various heart valve abnormalities	33
17.What physical exam findings are associated with various heart valve abnormalities?	34
18.Describe the treatment of each of the aforementioned valvular disorders	34
19.True or false: An understanding of the pathophysiology behind the various changes associated with long-standing valvular hear...	34
20.Who should receive endocarditis prophylaxis?	34
21.Describe the protocols for endocarditis prophylaxis	35
22.What is Virchow’s triad?	35
23.List the common clinical scenarios leading to the development of DVT	35
24.Describe the physical signs and symptoms of DVT. How is it diagnosed?	35
25.True or false: Superficial thrombophlebitis is a risk factor for pulmonary embolus	35
26.How is DVT treated? For how long?	35
27.What is the best way to prevent DVT in patients undergoing surgery?	35
28.In what clinical settings does pulmonary embolus (PE) occur?	35
29.True or false: DVT can lead to a stroke	36
30.How is PE diagnosed?	36
31.How is PE treated?	36
32.What is the most important side effect of heparin?	36
33.How are the effects of aspirin, heparin, and warfarin monitored?	37
34.How are the effects of LMWH monitored?	37
35.In an emergency, how can you reverse the effects of heparin, warfarin, and aspirin?	37
36.How do the conditions below affect coagulation tests?	37
37.What are the general signs and symptoms of congestive heart failure (CHF)?	37
38.What signs and symptoms help to determine whether CHF is due to left or right ventricular failure?	37
39.How is chronic CHF treated?	38
40.How is acute CHF treated?	38
41.What factors precipitate exacerbations in previously stable patients with CHF?	38
42.Define cor pulmonale. With what clinical scenarios is it associated?	38
43.What causes restrictive cardiomyopathy? How is it different from constrictive pericarditis?	38
44.What is the most common kind of cardiomyopathy? What causes it?	38
45.Which cardiomyopathy is likely in a young person who passes out or dies while exercising or playing sports and has a family h...	38
46.What EKG abnormalities do I need to know about for Step 2? How are they treated?	39
47.What endocrine disease is suggested when a patient presents with sinus tachycardia or atrial fibrillation?	43
48.Which patients with atrial fibrillation should receive anticoagulation?	43
49.How does Wolff-Parkinson-White syndrome classically present?	43
50.What do you need to know about the common congenital heart defects?	43
51.Name the noncyanotic congenital heart defects	43
52.Name the cyanotic congenital heart defects	44
53.What is important to remember about tachycardia in children?	44
54.In the fetal circulation, where is the highest and lowest oxygen content?	44
55.What changes occur in the circulation as an infant goes from intrauterine to extrauterine life?	44
5 - CHOLESTEROL	45
1.When is cholesterol screening done?	45
2.Why is cholesterol so important?	45
3.What physical findings will Step 2 test use as clues to hypercholesterolemia?	45
4.What are the current recommendations for management of cholesterol levels?	45
5.What is meant by high-intensity and moderate-intensity statins?	45
6.List the major risk factors for coronary heart disease (CHD)	46
7.Discuss other possible risk factors for heart disease	46
8.How is LDL calculated?	46
9.How is HDL affected by alcohol? Estrogens? Exercise? Smoking? Progesterone?	47
10.What causes hypercholesterolemia?	47
6 - Dermatology	48
1. Cover the two right-hand columns and define the following common terms used in dermatology to describe skin findings:	48
2.Define vitiligo. With what diseases is it associated?	48
3.Name several conditions to think about on the Step 2 exam in patients with pruritis	48
4.Define contact dermatitis. How do you recognize it? What are the classic culprits?	48
5.Define atopic dermatitis. What history points to this diagnosis?	48
6.Define seborrheic dermatitis. What part of the body does it involve? How is it treated?	49
7.Name the various dermatologic fungal infections	49
8.What organisms cause fungal infections?	49
9.How are fungal infections diagnosed and treated?	50
10.True or false: Candidiasis is often a normal finding in some women and children	50
11.How is candidiasis treated?	50
12.What causes scabies? How do you recognize it?	50
13.How do you diagnose and treat scabies?	50
14.How do you recognize and treat tinea versicolor?	50
15.What causes lice? How is lice treated?	51
16.What causes warts? How are they treated?	51
17.Define molluscum contagiosum. How do you recognize it? How is it treated?	51
18.True or false: A child with genital molluscum is probably a victim of sexual abuse	51
19.How is acne described in medical terms? What bacteria may be partially involved in its pathogenesis?	51
20.True or false: Acne is not related to food, exercise, or sex	51
21.What are the treatment options for acne?	51
22.Define rosacea. In what age group is it seen? How do you treat it?	51
23.What should you think about if hirsutism is described on the Step 2 exam?	51
24.What are the common pathologic causes of baldness?	52
25.What causes ordinary male pattern baldness?	52
26.Describe the classic psoriatic lesion	52
27.What other historical points and physical findings may be seen with psoriasis? How is it diagnosed and treated?	52
28.Give the classic description and natural course of pityriasis rosea	52
29.What are the “four Ps” that clinch a diagnosis of lichen planus?	52
30.List the classic drugs that cause photosensitivity of the skin	52
31.Describe the classic lesion of erythema multiforme. What drugs classically cause it?	53
32.Describe the classic lesion of erythema nodosum. With what diseases is it commonly associated?	53
33.Define and describe pemphigus vulgaris. How is it different from bullous pemphigoid?	53
34.What skin disease is associated with celiac disease (gluten intolerance or sensitivity)? How is it treated?	54
35.What are decubitus ulcers? What is the best method of prevention?	55
36.How are decubitus ulcers staged?	55
37.What conditions should excessive perspiration suggest on the USMLE?	55
38.True or false: Most melanomas start out as simple moles	55
39.Define dysplastic nevi syndrome. How is it managed?	55
40.Why is keratoacanthoma of note?	55
41.When and where are keloids seen?	56
42.Describe the classic lesion of basal cell cancer. What should you do if you suspect it?	56
43.True or false: Basal cell skin cancer almost never develops metastases	56
44.From what lesion does squamous cell cancer classically develop? What is Bowen disease?	57
45.To what parameter is the prognosis of a malignant melanoma most closely related?	57
46.What type of melanoma do black patients tend to develop? How do you recognize it?	57
47.Describe Paget disease of the breast. What is its significance?	57
48.Define stomatitis. What does it suggest?	58
7 - DIABETES MELLITUS	59
1.Outline the current recommendations for diabetes mellitus screening	59
2.Define diabetes	59
3.What are the classic differences between type 1 and type 2 diabetes?	59
4.What are the goals of treatment in terms of glucose levels?	59
5.What is a good measure of long-term diabetes control?	59
6.When a nondiabetic patient presents with hypoglycemia, how can you distinguish between factitious disorder (exogenous insulin)...	60
7.What should you remember before giving intravenous iodinated contrast material to a diabetic patient or a patient with renal i...	60
8.What is diabetic ketoacidosis (DKA)? How is it treated?	60
9.What is nonketotic hyperglycemic hyperosmolar state? How is it treated?	60
10.What are the classic presenting symptoms of new-onset diabetes?	60
11.What are the common long-term complications of diabetes mellitus?	60
12.What problems may result from diabetic peripheral neuropathy?	61
13.Describe the treatment for diabetic retinopathy	61
14.Describe the onset, peak, and duration of action of each of the insulin preparations	61
15.How do you adjust the dosage of neutral protamine Hagedorn (Nph) or regular insulin for high glucose levels?	62
16.Define the Somogyi effect and the dawn phenomenon	62
17.How do you manage diabetic patients who are not allowed to eat because they are scheduled for surgery?	62
18.What is the deal with beta-blockers, hypoglycemia, and diabetics?	62
19.What are the best oral agents to use in type 1 diabetes?	62
20.What is the first treatment for type 2 diabetes?	62
8 - EAR, NOSE, AND THROAT SURGERY	63
1.What is the most common cause of lower motor neuron facial nerve paralysis? How does it present?	63
2.What are the other causes of lower motor neuron facial nerve paralysis?	63
3.What are the common causes of hearing loss?	63
4.What is the usual cause of sudden deafness?	63
5.What is the most common cause of acquired hearing loss in children?	64
6.What are the common causes of vertigo?	64
7.How is a deviated nasal septum treated in patients with recurrent sinusitis?	64
8.What are the three common causes of rhinitis?	64
9.How do you recognize and treat viral rhinitis?	64
10.How do you recognize and treat allergic rhinitis?	64
11.What causes bacterial rhinitis? How is it treated?	64
12.What causes nosebleeds?	65
13.True or false: A neck mass is more likely to be benign in a child than in an adult	65
14.What are the common causes of a neck mass?	65
15.Describe the work-up for an unknown cancer in the neck	65
16.What is the scientific name for “swimmer’s ear”? What causes it?	65
17.What causes otitis media? How do you recognize it?	65
18.What are the complications of otitis media? How are they avoided?	65
19.What is the problem with recurrent otitis media? How is it treated?	65
20.What causes infectious myringitis? How do you recognize and treat it?	66
21.What are the common bacterial causes of sinusitis? How is this condition recognized clinically?	66
22.By what age are the frontal sinuses well developed in children?	66
23.Define otosclerosis. How is it treated?	66
24.What causes parotid gland swelling?	66
25.How do you recognize a nasal fracture? What complication may result?	66
26.What is the Weber test used to evaluate? How is it performed and interpreted?	66
27.What is the Rinne test used to evaluate? How is it performed and interpreted?	66
9 - EMERGENCY MEDICINE	67
1.What are the three causes of burns? How should all burns be managed initially?	67
2.What are the important sequelae of electrical burns?	67
3.How are chemical burns managed? Which is worse, acid or alkali burns?	67
4.What is burned skin prone to develop?	67
5.How is burn severity classified? Describe the management of each class	67
6.Define hypothermia. How is it managed? What are the complications?	67
7.Distinguish between frostnip and frostbite. How are they managed?	68
8.True or false: You should not give up resuscitation efforts until the patient is fully warmed in the setting of hypothermic ca...	68
9.Define hyperthermia. What causes it? How is it managed?	68
10.What are the two classic examples of hyperthermia due to medication?	68
11.How are patients managed after a near-drowning episode?	68
12.What are toxidromes? Describe the toxidromes associated with cholinergic crisis, anticholinergic crisis, sympathomimetics, an...	69
13.Name the antidote for each of the poisonings or overdoses listed on the left side of the table	69
10 - Endocrinology	70
1. What are the common signs and symptoms of hyperthyroidism?	70
2.What are the most common causes of hyperthyroidism?	70
3.Describe the classic laboratory pattern of hyperthyroidism	70
4.How is hyperthyroidism treated?	70
5.What are the signs and symptoms of hypothyroidism?	70
6.What are the common causes of hypothyroidism?	70
7.Describe the laboratory findings in hypothyroidism	71
8.Why is free T4 (or free T4 index) better than total T4 for measuring thyroid hormone activity?	71
9.How is hypothyroidism treated?	71
10.What is sick euthyroid syndrome?	71
11.What are the signs and symptoms of Cushing syndrome (increased corticosteroids)?	71
12.What causes Cushing syndrome?	71
13.How is Cushing syndrome diagnosed?	71
14.What are the signs and symptoms of hypoadrenalism (Addison disease)?	71
15.What is the most common type of hypoadrenalism?	72
16.What are the other causes of hypoadrenalism?	72
17.How is hypoadrenalism diagnosed?	72
18.Define hirsutism. What causes it?	72
19.What causes virilization in children?	72
20.What are the signs and symptoms of hyperparathyroidism?	72
21.What causes hyperparathyroidism?	72
22.What are the signs and symptoms of hypoparathyroidism?	72
23.What causes hypoparathyroidism?	73
24.What are the signs and symptoms of hypercalcemia?	73
25.What causes hypercalcemia?	73
26.What are the signs and symptoms of hypocalcemia?	73
27.What causes hypocalcemia?	73
28.What specific problems are caused by obesity?	74
29.Define precocious puberty and pseudoprecocious puberty	74
30.How is precocious puberty different from pseudoprecocious puberty?	74
31.What causes pseudoprecocious puberty?	74
32.How is precocious puberty treated?	74
33.What is the difference between a primary and secondary endocrine disorder?	75
34.What are the signs and symptoms of primary hyperaldosteronism (Conn syndrome)? What are the causes?	75
35.What causes secondary hyperaldosteronism?	75
36.Give the classic clinical description of a pheochromocytoma. How is it diagnosed?	75
37.Define diabetes insipidus (DI). What are the two types?	75
38.What causes central DI?	75
39.What causes nephrogenic DI?	75
40.What diagnostic test can reveal whether DI is central or nephrogenic? How are these conditions treated?	76
41.Define the syndrome of inappropriate antidiuretic hormone secretion (SIADH). How is it diagnosed?	76
42.What causes SIADH?	76
43.How is SIADH treated?	76
11 - ETHICS	77
1.What are the general principles of ethics?	77
2.True or false: Adult patients of sound mind are allowed to refuse life-saving treatments	77
3.What should you do if a child has a life-threatening condition and the parents refuse a simple, curative treatment (e.g., anti...	77
4.What is the difference between active and passive euthanasia?	77
5.With whom can you discuss your patient’s condition?	77
6.In what situations are you allowed to breach patient confidentiality?	77
7.What are the components of informed consent?	77
8.What should you do if a patient lacks capacity to make decisions?	78
9.True or false: A living will should not be respected if the next of kin asks you not to follow it	78
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?	78
11.What about depression in the context of end-of-life decisions?	78
12.True or false: In some circumstances, patients can be hospitalized against their will	78
13.True or false: Restraints can be used on patients against their will	78
14.When do patients under the age of 18 years not require parental consent for a medical decision?	78
15.What should you do if a child has a medical emergency and the parents are unavailable for decision making?	78
16.True or false: It is acceptable to hide a diagnosis from a patient if the family asks you to do so	78
17.What should you do if a patient requires emergency care but the patient cannot communicate and no family members are availabl...	79
18.True or false: Withdrawing care and withholding care are the same in the eyes of the law	79
19.True or false: In terminally ill, noncurable patients, one of the primary goals is to relieve pain	79
12 - Gastroenterology	80
1. Define gastroesophageal reflux disease (GERD). What causes it?	80
2.Describe the classic symptoms of GERD. How is it treated?	80
3.What are the sequelae of GERD?	80
4.What is a hiatal hernia? How is it different from a paraesophageal hernia?	80
5.How does peptic ulcer disease (PUD) present?	80
6.Explain the classic differences between duodenal and gastric ulcers	80
7.What is the diagnostic study of choice for PUD?	80
8.What is the most feared complication of PUD? What should you suspect if an ulcer does not respond to treatment?	81
9.How is PUD treated initially?	81
10.Name the surgical options for ulcer treatment. What complications may occur?	81
11.Define achlorhydria. What causes it?	81
12.What are classic differences between upper and lower gastrointestinal (GI) bleeds?	82
13.How is a GI bleed treated?	83
14.What radiologic imaging studies can be done to localize a GI bleed? Does surgery have a role?	83
15.Define diverticulosis. What are its complications?	83
16.How do you diagnose and treat diverticulitis? What test should a patient have after a treated episode of diverticulitis?	83
17.How is diarrhea categorized?	83
18.Define osmotic diarrhea. How can an easy diagnosis be made?	83
19.What causes secretory diarrhea?	83
20.What are the common causes of malabsorptive diarrhea?	84
21.What are the common clues to infectious diarrhea? What are the common causes?	84
22.What causes exudative diarrhea?	84
23.What are the common causes of diarrhea due to altered intestinal transit?	84
24.Define irritable bowel syndrome. How do you recognize it?	84
25.What should you do if a patient has diarrhea?	85
26.What should you watch for in children after a bout of diarrhea?	85
27.Specify the classic differences between Crohn disease and ulcerative colitis	85
28.Describe the extraintestinal manifestations of inflammatory bowel disease	86
29.How is inflammatory bowel disease treated?	87
30.What causes toxic megacolon? How is it treated?	87
31.List the common findings of acute liver disease	87
32.List the common causes of acute liver disease	87
33.What is the classic abnormality on liver function tests in patients with alcoholic hepatitis?	87
34.What clues suggest hepatitis A? Describe the diagnostic serology	87
35.How is hepatitis A acquired? What is the best treatment?	87
36.Describe the serology of hepatitis B infection, including the surface, core, and “e” markers	87
37.What are the possible sequelae of chronic hepatitis B or C?	89
38.What should be given to persons acutely exposed to hepatitis B?	89
39.Which type of viral hepatitis is the new king of chronic hepatitis?	89
40.Describe the serology and treatment for hepatitis C	89
41.When is hepatitis D seen? Describe the serology	89
42.How is hepatitis E transmitted? What is special about the infection in pregnant women?	89
43.What are the classic causes of drug-induced hepatitis?	89
44.When should you suspect idiopathic autoimmune hepatitis? What is the serologic marker?	89
45.What are the usual causes of chronic liver disease?	89
46.Which species of viral hepatitis can lead to chronic liver disease?	90
47.Define hemochromatosis. How do you recognize it?	90
48.Define Wilson disease. How do you recognize it? How is it treated?	90
49.What are the clues to a diagnosis of alpha1 antitrypsin deficiency?	90
50.What metabolic derangements accompany liver failure?	90
51.What signs and symptoms suggest biliary tract obstruction as a cause of jaundice?	91
52.What are the commonly tested types of biliary tract obstructions?	91
53.What are the two major causes of common bile duct obstruction? How are they distinguished?	91
54.What are the two common causes of cholestasis?	91
55.What clues suggest a diagnosis of primary biliary cirrhosis?	91
56.Who gets primary sclerosing cholangitis?	91
57.What usually precipitates cholangitis? What is the tip-off to its presence? How is it treated?	91
58.What are the classic symptoms of esophageal disease?	92
59.Define achalasia. How is it diagnosed and treated?	92
60.What are the signs and symptoms of esophageal spasm? How is it treated?	92
61.What clues suggest scleroderma as the cause of esophageal complaints?	92
62.What do you need to know about the epidemiology of esophageal cancer?	93
63.What is the relationship between Barrett esophagus and esophageal cancer?	93
64.What causes acute pancreatitis?	93
65.What are the signs and symptoms of acute pancreatitis?	94
66.How is acute pancreatitis treated?	94
67.What are the complications of acute pancreatitis?	94
68.What causes chronic pancreatitis? How is it treated?	94
69.Distinguish between Mallory-Weiss and Boerhaave tears in the esophagus. How are they diagnosed?	94
70.What is the rule about bowel contrast when a GI perforation is suspected?	94
71.What are the common GI malformations in children? How are they distinguished?	94
72.What other pediatric GI conditions are commonly found on Step 2? How are they distinguished?	96
73.Which GI malformation primarily causes respiratory problems?	96
74.How are omphalocele and gastroschisis differentiated?	96
75.What is Henoch-Schönlein purpura? Why is it mentioned in the GI section?	96
76.What is the most common cause of diarrhea in children?	96
77.True or false: Children may develop inflammatory bowel disease and irritable bowel syndrome	97
78.What is the first step in evaluating neonatal jaundice? Why is jaundice of concern in a neonate?	97
79.What causes physiologic jaundice of the newborn? Who gets it?	98
80.How is severe hyperbilirubinemia recognized?	98
81.What are the causes of neonatal jaundice?	98
82.How is severe hyperbilirubinemia treated?	99
83.What should you do if an infant is born to a mother with active hepatitis B?	99
13 - General Surgery	100
1. Define the acute abdomen. What physical exam signs suggest its presence?	100
2.What should you do if you are not sure whether a stable patient has an acute abdomen?	100
3.Name a few cause of peritonitis that do not require laparotomy or laparoscopy	100
4.Specify which conditions are associated with pain and peritonitis in the listed abdominal areas	100
5.What are the classic signs and symptoms of gallstone disease?	100
6.What are the six Fs of cholecystitis? How are the demographics of patients with pigment stones different from those with chole...	100
7.How is a clinical suspicion of cholecystitis confirmed and treated?	101
8.Define cholangitis. How does it differ from cholecystitis? How is it treated?	102
9.Describe the classic presentation of appendicitis. How is it treated?	102
10.What is the cause of left lower quadrant pain and fever in a patient over 50 years old until proven otherwise? How is it trea...	102
11.What tests should and should not be done to confirm possible cases of diverticulitis? What test does every patient need after...	102
12.Describe the typical history, physical exam, and lab findings of pancreatitis. How is it treated?	103
13.Describe the usual history of a perforated ulcer. How is it treated?	103
14.What are the hallmarks of small bowel obstruction? How is it treated?	103
15.What are the common causes of a small bowel obstruction?	103
16.Describe the signs and symptoms of large bowel obstruction. What causes it? How is it treated?	104
17.List and differentiate the three common types of groin hernias	104
18.Define incarcerated and strangulated hernias	105
19.True or false: Generally, patients should not eat or drink for 8 or more hours before surgery	106
20.What is the best test (other than a good history) for preoperative evaluation of pulmonary function?	106
21.What measures help to prevent intraoperative and postoperative deep venous thrombosis and pulmonary embolus?	106
22.What is the most common cause of fever in the first 24 hours after surgery?	106
23.What are the other common causes of postoperative fever?	106
24.Define fascial or wound dehiscence. How do you recognize it?	106
25.Explain the ABCDEs of trauma. How are they used?	106
26.What is the difference between airway and breathing in trauma protocol?	106
27.Explain circulation, disability, and exposure	106
28.What imaging films are routinely ordered for most patients with at least moderately severe trauma?	107
29.What is the imaging study of choice for head trauma?	107
30.How do you manage a patient with blunt abdominal trauma?	107
31.How is penetrating abdominal trauma managed?	108
32.Which six thoracic injuries can be rapidly fatal?	108
33.How do you recognize and treat airway obstruction?	108
34.How do you recognize and treat an open pneumothorax?	108
35.How do you recognize and treat a tension pneumothorax?	108
36.Describe the presentation of cardiac tamponade. How is it diagnosed and treated?	108
37.Define massive hemothorax. How is it diagnosed and treated?	108
38.How do you recognize and treat flail chest?	109
39.What is the most common cause of immediate death after an automobile accident or a fall from a great height?	109
40.What do you need to know about splenic rupture?	109
41.What clues suggest a diagnosis of diaphragmatic rupture? How is it treated?	110
42.What are the three zones of the neck? How is trauma in each of the different zones managed?	110
43.How should a choking victim be managed?	110
44.What should you do if a tooth is knocked out?	110
14 - GENETICS	111
1.Specify how the following disorders are usually transmitted genetically. The choices are autosomal dominant or recessive, X-li...	111
2.What is the likelihood that a mother with an autosomal dominant condition will pass the condition to the child if the father d...	112
3.Genetic testing reveals that both mother and father are carriers of a diseased gene for an autosomal recessive condition but d...	112
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 th...	112
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 daughte...	112
6.How do you recognize Down syndrome?	112
7.What is the second most common known cause of inherited mental retardation?	112
8.How do you recognize Edward syndrome?	113
9.What is Patau syndrome?	113
10.How do you recognize Turner syndrome?	113
11.Describe Klinefelter syndrome	113
12.What is the hallmark of cri du chat syndrome?	113
13.What presentation suggests galactosemia?	115
14.Describe the clinical findings in tuberous sclerosis	115
15.What causes Lesch-Nyhan syndrome? What classic behavior do patients exhibit?	115
16.What causes Marfan syndrome? How do you recognize it?	115
15 - Geriatrics	116
1. True or false: Roughly 2% of the population is over the age of 65.	116
2.What age group constitutes the most rapidly growing segment of the population?	116
3.True or false: An 80-year-old person needs more calories than a 30-year-old person	116
4.True or false: Hearing and vision changes are a normal part of aging	116
5.True or false: Older patients require higher doses of most medications	116
6.What is frailty?	116
7.Why are falls so dangerous for older patients, and how can they be prevented?	116
8.What is osteoporosis? Who should be screened?	116
9.What are the risk factors for osteoporosis? What are the typical therapies for osteoporosis?	117
10.Describe the normal changes in male sexual function that occur with aging	117
11.Describe the normal changes in female sexual function that occur with aging	117
12.True or false: Impotence and lack of sexual desire are normal in elderly people	117
13.Describe the normal changes in sleep habits in elderly people	117
14.What is the best prophylaxis for pressure ulcers in an immobilized patient?	117
15.True or false: Brain atrophy is a normal part of aging	117
16.Define pseudodementia. How do you recognize it on the Step 2 exam?	117
17.What is the difference between dementia and delirium?	117
18.True or false: Almost 50% of patients over the age of 65 suffer from some type of dementia	118
19.Describe the characteristics of Alzheimer dementia	118
20.Describe the characteristics of dementia with Lewy bodies	118
21.Describe a scenario that would make you suspect vascular dementia	118
22.True or false: Dementia is common in patients with Parkinson disease	118
23.Describe the characteristics of frontotemporal dementia	118
24.True or false: Only 5% of people over the age of 65 live in nursing homes	118
25.How can advance directives be useful?	118
16 - GYNECOLOGY	119
1.What is the most common cause of preventable infertility in the United States?	119
2.What is the most likely cause of infertility in a normally menstruating woman under the age of 30?	119
3.What is PID? How do you recognize it on the Step 2 exam?	119
4.How is PID treated? What are the common sequelae?	119
5.Define endometriosis. What are the signs and symptoms?	119
6.How is endometriosis diagnosed and treated?	119
7.What is the most likely cause of infertility in a menstruating woman over the age of 30 without a history of PID?	119
8.Cover the right-hand columns. Specify the findings and treatment for the following vaginal infections	120
9.True or false: with all of the infections listed in the previous table, you should seek out and treat the patient’s sexual par...	120
10.True or false: Patients with gonorrhea are usually treated for presumed chlamydial infection	120
11.Define adenomyosis. How does it classically present? What is the treatment?	120
12.What are fibroids? How common are they? How often do they become malignant?	120
13.Explain the relationship between uterine leiomyomas and hormones. How do leiomyomas present? What is the treatment?	121
14.What is the first test to order in any woman of reproductive age with abnormal uterine bleeding?	121
15.Define dysfunctional uterine bleeding (DUB). When is it physiologic?	121
16.Why is endometrial biopsy recommended in women over 35 with DUB? What other test should be ordered in all women with DUB (reg...	121
17.What causes DUB other than PCOS? How is DUB treated?	121
18.Define PCOS. How do you recognize it?	122
19.What is the most likely cause for infertility in a woman under 30 with abnormal menstruation?	122
20.How is PCOS treated? With what risk is it associated?	122
21.Is infertility usually a male or a female problem?	122
22.Assuming that the history and physical exam offer no clues, what is the first step in evaluating a couple for infertility?	123
23.List the relevant characteristics of normal semen	123
24.What is the next step after semen evaluation?	123
25.What radiologic test is commonly used to examine the fallopian tubes and uterus? What points in the history may lead you to s...	123
26.What test is the last resort in the work-up for infertility?	123
27.Which two medications can be used to try to restore female fertility? In what situations are they effective?	123
28.What is the main risk associated with medical induction of ovulation?	123
29.Distinguish between primary and secondary amenorrhea	123
30.Until proved otherwise, what is the cause of secondary amenorrhea in a previously menstruating woman of reproductive age?	123
31.True or false: Excessive exercise may cause amenorrhea	123
32.What are other common causes of secondary amenorrhea?	123
33.After ruling out pregnancy, if the cause of secondary amenorrhea is not obvious from the history and physical exam, what is t...	123
34.What if the patient fails to have vaginal bleeding after receiving progesterone?	124
35.True or false: Pregnancy can present as primary amenorrhea	124
36.At what age can primary amenorrhea be diagnosed? What is the first step in evaluation?	124
37.In a patient older than 14 with no secondary sexual characteristics or development, what is the most likely cause of amenorrh...	124
38.When in doubt, what is the best way to evaluate any type of amenorrhea?	124
39.When does menopause occur? What are the signs and symptoms?	124
40.What is the current state of hormone replacement therapy?	124
41.When a woman presents with a nipple discharge, what historical points are important?	124
42.What are the most likely causes of a breast mass in a woman under the age of 35?	125
43.True or false: Mammography should be done for any suspicious breast lesion in a woman under age 30	125
44.What are the likely causes of a breast mass in a woman over the age of 35?	125
45.True or false: If a patient is postmenopausal or over age 50 and develops a new breast mass, you should assume cancer “until ...	125
46.True or false: Mammography is best used as a tool to evaluate a palpable breast mass	125
47.What causes pelvic relaxation or vaginal prolapse? what are the signs and symptoms?	125
48.What types of pelvic relaxation are seen clinically? How are they treated?	126
49.Other than abstinence, what are the most effective forms of birth control (when used properly)?	126
50.Do intrauterine devices (IUDs) increase the risk of ectopic pregnancy or PID?	126
51.What is the classic cause of ambiguous genitalia on the Step 2 exam?	126
52.What should you tell the parents of a child with ambiguous genitalia?	126
53.What is indicated by a “bunch of grapes” protruding from a pediatric vagina?	126
54.Define precocious puberty. What causes it? How should it be treated?	126
55.What causes vaginitis or discharge in prepubescent girls?	126
56.How do you recognize and treat an imperforate hymen?	126
57.What is the usual cause of vaginal bleeding in neonates? How is it treated?	126
58.Which women are candidates for hormone replacement therapy?	126
59.What are the known benefits of estrogen therapy?	127
60.What are the known risks of estrogen therapy?	127
61.What are the most common side effects of estrogen therapy?	127
62.What are the absolute contraindications to estrogen therapy?	127
63.What are the relative contraindications to estrogen therapy?	127
64.What test is often done before starting estrogen therapy?	127
65.True or false: Women without a uterus do not need to take progesterone with estrogen	127
66.What are the absolute contraindications to combined oral contraceptive pills?	127
67.What are the relative contraindications to combined oral contraceptive pills?	128
68.What is the relationship between oral contraceptive pills and hypertension?	128
69.What do you need to know about oral contraceptive pills and surgery?	128
70.What are the side effects of oral contraceptive pills?	128
71.What is the relationship between oral contraceptive pills and breast and cervical cancer?	128
72.What is the relationship between oral contraceptive pills and ovarian and endometrial cancer?	128
73.What are the other beneficial effects of oral contraceptive pills?	128
17 - Hematology	129
1.Define anemia	129
2.What are the signs and symptoms of anemia?	129
3.What are the important elements of the history when anemia is present?	129
4.What medications can cause anemia? How?	129
5.What test should be ordered first to help determine the cause of anemia?	129
6.What test should be ordered next?	130
7.What are reticulocytes? Why is a reticulocyte count routinely ordered in an anemia work-up?	130
8.Which test comes next?	130
9.What are the classic causes of microcytic, normocytic, and anemia? Which of these tends to have an inappropriately low reticul...	135
10.What clues point to hemolysis as the cause for anemia?	136
11.What is the most common cause of anemia in the United States?	136
12.Why do people get iron deficiency?	136
13.What are the classic laboratory abnormalities in iron-deficiency anemia? What weird cravings may occur with iron deficiency?	136
14.What is Plummer-Vinson syndrome?	136
15.How is iron deficiency treated?	136
16.What causes folate deficiency? In what patient populations is it commonly seen?	136
17.What is the most common cause of vitamin B12 deficiency?	136
18.What else may cause vitamin B12 deficiency? How is B12 deficiency diagnosed?	136
19.How is vitamin B12 deficiency treated?	137
20.How is thalassemia differentiated from iron deficiency?	137
21.What diagnostic test confirms a diagnosis of thalassemia? How is it treated?	137
22.What two clues on the Step 2 exam often point to a diagnosis of sickle cell disease?	137
23.What are the clinical manifestations and complications of sickle cell disease?	138
24.How is sickle cell disease diagnosed and treated?	138
25.What findings help you in the setting of acute blood loss as a cause of anemia?	138
26.What are the commonly tested causes of autoimmune hemolytic anemia?	138
27.What lab test is often positive in patients with autoimmune anemia?	138
28.What clues point to lead poisoning as a cause of anemia?	138
29.True or false: Children with risk factors should be screened for lead poisoning	138
30.How is lead poisoning treated?	139
31.How can sideroblastic anemia be recognized on the Step 2 exam? Should the presence of sideroblastic anemia raise concern abou...	139
32.How do you recognize anemia of chronic disease?	139
33.Describe the hallmarks of spherocytosis	139
34.Why do chronic renal disease patients develop anemia? How do you treat it?	139
35.What clues point to a diagnosis of aplastic anemia?	139
36.Define myelophthisic anemia. What clues on the peripheral smear suggest its presence?	139
37.How do you recognize glucose-6-phosphatase deficiency on the USMLE?	139
38.Name some other causes of anemia	140
39.When is transfusion indicated for anemia (at what hemoglobin level)?	140
40.What are the indications for the use of various blood products?	140
41.What is the most common cause of a blood transfusion reaction? What blood type can be given in an emergency to avoid a reacti...	140
42.Describe the signs and symptoms of a blood transfusion reaction	140
43.What should you do if you suspect a transfusion reaction?	140
44.What are the other risks of transfusion?	140
45.What are the most common causes of disseminated intravascular coagulation (DIC)?	141
46.How do I recognize and treat DIC in a classic at-risk patient?	141
47.With what conditions is eosinophilia associated?	141
48.With what conditions is basophilia associated?	141
49.True or false: The lupus anticoagulant causes a clotting tendency	141
50.What genetic and acquired causes of an increased tendency toward clot forming may appear on the Step 2 exam?	141
51.Which clotting tests measure which portions of the coagulation cascade? Which medications affect these tests?	141
52.How do specific diseases affect clotting tests? What are the main differential points?	142
53.What are the common causes of thrombocytopenia? What kinds of bleeding problems are caused by low platelet counts?	142
54.What causes petechiae or “platelet-type” bleeding in the setting of normal platelets?	142
18 - HYPERTENSION	143
1.How often should you screen for hypertension?	143
2.Define hypertension	143
3.What is the “two-measurement” rule in the diagnosis of hypertension?	143
4.When should you initial therapy for hypertension for various groups according to JNC-8? What are the blood pressure targets in...	143
5.What are the conservative (i.e., nonpharmacologic) treatments for hypertension?	144
6.List the first-line medications for treatment of hypertension	144
7.What about women of reproductive age and pregnant women with hypertension?	144
8.Define hypertensive urgency. How is it different from hypertensive emergency?	144
9.What causes hypertension?	145
10.What are the common causes of secondary hypertension in younger men and women?	145
11.List less common causes of secondary hypertension	145
12.What does lowering blood pressure accomplish?	146
13.What is the most common cause of death among untreated patients with hypertension?	146
14.Which tests should be ordered for every patient with a diagnosis of hypertension? Why?	146
19 - IMMUNOLOGY	147
1.List the four classic types of hypersensitivity reactions	147
2.What causes type I hypersensitivity? Give the classic cinical examples	147
3.Describe the clinical findings with chronic type I hypersensitivity	147
4.How do you recognize and treat true anaphylaxis?	147
5.What usually causes hereditary angioedema?	147
6.What type of testing can identify an allergen if it is not obvious?	147
7.What causes type II hypersensitivity? List some classic clinical examples	147
8.What lab test is usually positive with a type II hypersensitivity that causes anemia?	148
9.What causes type III hypersensitivity? List some classic clinical examples	148
10.What causes type IV hypersensitivity? How is it related to tuberculosis testing?	148
11.What sexually transmitted infectious disease should be in the back of your mind when a patient presents with a sore throat an...	148
12.How is HIV diagnosed? How long after exposure does the HIV test become positive?	148
13.Are “control” tests deeded when a PPD tuberculosis test is done in HIV-positive patients?	149
14.How do you recognize Pneumocystis jirovecii pneumonia (PCP)?	149
15.What is the most common primary immunodeficiency? How do you recognize it?	149
16.How do you recognize Bruton agammaglobulinemia?	149
17.What causes DiGeorge syndrome? How do you recognize it?	149
18.What is the classic cause of severe combined immunodeficiency? How does it present?	150
19.What triad indicates the diagnosis of Wiskott-Aldrich syndrome?	150
20.How do you recognize Chediak-Higashi syndrome?	150
21.Describe the pathophysiology of chronic granulomatous disease	150
22.Cover the right-hand column, and answer the questions about HIV management on the left	150
23.Complement deficiencies of C5 through C9 cause recurrent infections with which genus of bacteria?	152
24.Define chronic mucocutaneous candidiasis	152
25.Give the classic description of hyper-IgE syndrome (Job-Buckley syndrome)	152
20 - INFECTIOUS DISEASES	153
1.Cover the middle and right-hand columns, and specify which bugs are associated with each type of infection and what type of em...	153
2.Cover the right-hand columns, and specify the empiric antibiotic of choice for each organism	154
3.Cover the right-hand column, and specify what each Gram stain most likely represents	154
4.What is the gold standard for diagnosis of pneumonia?	155
5.What is the most common cause of pneumonia? How does it classically present?	155
6.What is the best prevention against S. pneumoniae?	155
7.How do you recognize and treat Haemophilus Influenzae pneumonia?	155
8.Describe the hallmarks of Staphylococcus aureus pneumonia	155
9.In what clinical situations do you tend to see gram-negative pneumonias?	155
10.How do you recognize Mycoplasma pneumonia?	155
11.What about chlamydial pneumonia?	156
12.In what setting do you see Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) pneumonia?	156
13.What is the best time to treat PCP?	157
14.Cover the two right-hand columns. Specify the organism after looking at the scenario associated with it	157
15.How is syphilis diagnosed?	159
16.Which group of patients should always be screened for syphilis?	159
17.How is syphilis treated?	159
18.Describe the three stages of syphilis	159
19.How do you recognize measles (rubeola) infection in a child?	159
20.Describe the complications of measles	160
21.Why is rubella infection (German measles) an important disease?	160
22.How do you recognize a rubella infection in children? What are the complications?	160
23.How do you recognize roseola infantum (exanthem subitum)? What causes it?	160
24.How do you recognize erythema infectiosum (fifth disease) in children? What causes it?	160
25.How do you recognize chickenpox? What causes it?	160
26.How can you make a definitive diagnosis of chickenpox? At what point is a patient with chickenpox no longer infectious?	161
27.What are the complications of chickenpox?	161
28.Describe the treatment and prophylaxis for chickenpox	162
29.What is scarlet fever? What causes it? How is it recognized and treated?	162
30.What are the diagnostic criteria for Kawasaki disease (mucocutaneous lymph node syndrome)?	162
31.What is the most feared complication of Kawasaki disease? How do you prevent it?	162
32.Describe the classic findings of Epstein-Barr virus (EBV) infection (infectious mononucleosis)	162
33.What is an important differential diagnosis of EBV infection or influenza infection?	162
34.What is the association between EBV and cancer?	162
35.Describe the classic clinical vignette for Rocky Mountain spotted fever. What causes it? What is the treatment?	162
36.How do you recognize and treat the rash of impetigo? What causes it?	163
37.Describe the two clinical types of endocarditis. What are the causative organisms?	163
38.How is endocarditis diagnosed and treated?	163
39.What are the classic signs and symptoms of endocarditis?	163
40.What elements of the history point to endocarditis?	163
41.What are the recommendations for endocarditis prophylaxis?	164
42.What is the classic age group for meningitis? Describe the physical findings	164
43.What should you do if you suspect meningitis?	164
44.What is the most common neurologic sequela of meningitis?	164
45.What are the common viral (aseptic) causes of meningitis in children?	164
46.Which types of bacterial meningitis require antibiotic prophylaxis in contacts?	164
47.What are the “big three” respiratory infections in patients younger than 5 years?	164
48.How do you recognize croup (acute laryngotracheitis)? Describe the cause and treatment	164
49.How do you recognize epiglottitis? Describe the cause and treatment	164
50.Describe the classic clinical vignette for bronchiolitis. What is the cause? How is it treated?	165
51.What “old-school” pediatric infection causes pseudomembranes and myocarditis? What about whooping cough?	165
52.In what clinical scenario does rabies occur in the United States? Describe the classic physical findings	166
53.What should you do after a patient is bitten by an animal?	166
54.What are the two main infections caused by S. pyogenes (group A streptococci)? What are the common sequelae?	166
55.How does streptococcal pharyngitis present? How do you diagnosis and treat it?	166
56.What are the major and minor Jones criteria for rheumatic fever? Why is rheumatic fever less common today?	167
57.How do you recognize poststreptococcal glomerulonephritis? How is it treated?	167
58.Distinguish between impetigo and erysipelas	167
59.What organisms typically cause cellulitis? What special circumstances should make you think of atypical causes?	168
60.Describe the physical findings of cellulitis	168
61.Define necrotizing fasciitis. How is it treated?	168
62.What is the most common cause of endometritis (puerperal fever)? How do you recognize and treat it?	168
63.What infection in neonates is caused by Streptococcus agalactiae (group B streptococci)?	168
64.Other than pneumonia, what infections does S. pneumoniae commonly cause?	168
65.What are the main infections caused by S. aureus?	168
66.What is the treatment of choice for staphylococcal infections on the USMLE?	169
67.Cover up the right-hand column in the table below, and describe the preferred treatment for tuberculosis based on the clinica...	169
68.Name some other important tuberculosis treatment issues	169
21 - Laboratory Medicine	170
1. What may cause a false lab report of hyperkalemia?	170
2.What can cause a “false” hyponatremia (pseudohyponatremia)?	170
3.What may result from rapid correction of hyponatremia?	170
4.What effect do serum acidosis and serum alkalosis have on potassium and calcium levels?	170
5.Other than pancreatic disease, what else can cause elevated levels of amylase and lipase?	170
6.Which diseases can cause elevated levels of alkaline phosphatase? What lab test is used to distinguish among these diseases?	170
7.True or false: Hypothyroidism can cause elevated cholesterol	170
8.Injury to what organ (other than the heart) causes elevated levels of creatine kinase (CK)?	170
9.What is the relationship of low calcium and potassium levels to low levels of magnesium?	170
10.Which two electrolytes are classically depleted in the setting of diabetic ketoacidosis or diabetic hyperosmolar, hyperglycem...	171
11.What does a blood urea nitrogen (BUN)-to-creatinine ratio greater than 15 or 20 generally imply?	171
12.What disease classically causes a false-positive result on the rapid plasma reagin (RPR) or Venereal Disease Research Laborat...	171
13.Define isosthenuria. What condition does it suggest?	171
14.What does an elevated erythrocyte sedimentation rate mean in pregnancy?	171
15.True or false: A high-normal level of BUN or creatinine during pregnancy often indicates renal disease	171
22 - Nephrology	172
1. What are the signs and symptoms of acute kidney injury?	172
2.What are the three broad categories of renal failure?	172
3.Define prerenal failure? What are the causes? How do you recognize it?	172
4.Define postrenal failure. What causes it?	172
5.What is the most common cause of intrarenal failure?	172
6.What do you need to know about intravenous contrast and renal failure?	172
7.True or false: Muscle breakdown can cause renal failure	172
8.What medications commonly cause renal insufficiency or failure?	173
9.Define nephritic syndrome. What is the classic cause? How is it treated?	173
10.Define Goodpasture syndrome. How does it present?	173
11.Define Wegener granulomatosis. How does it present?	173
12.How do you recognize PSGN? How is it treated?	173
13.What are the indications for dialysis in patients with renal failure?	173
14.Define nephrotic syndrome. What causes it? How is it diagnosed?	173
15.What causes chronic renal failure (CRF)?	173
16.What metabolic derangements are seen in CRF?	174
17.How is CRF treated?	174
18.What are the signs and symptoms of urinary tract infection (UTI)? What are the most likely organisms?	174
19.What factors increase the likelihood of UTIs?	174
20.How do you diagnose and treat UTIs?	174
21.Why are UTIs in children and males of special concern?	175
22.True or false: You should treat asymptomatic bacteriuria in most patients	175
23.How does pyelonephritis usually occur? What are the signs and symptoms? How is it treated?	175
24.How do you differentiate among the common pediatric hematologic disorders that affect the kidney?	175
25.Which is more likely to be seen on a plain abdominal radiograph: kidney stones or gallbladder stones?	176
26.What are the signs and symptoms of renal stones? How are they diagnosed and treated?	176
27.What causes kidney stones?	176
23 - Neurology	178
1. In what common situation is a lumbar puncture contraindicated?	178
2.Cover all but the left-hand column, and describe the classic findings of cerebrospinal fluid (CSF) analysis in the following c...	178
3.Give a classic case description of multiple sclerosis	178
4.What is the most sensitive test for diagnosis of multiple sclerosis? How is it treated?	179
5.Define Guillain-Barré syndrome	179
6.What causes nerve conduction velocity to be slowed?	179
7.What causes an electromyography (EMG) study to show fasciculations or fibrillations at rest?	179
8.What causes an EMG study with no muscle activity at rest and decreased amplitude of muscle contraction upon stimulation?	179
9.What is the most common cause of syncope? What other conditions should you consider?	179
10.Cover the right-hand column, and localize the neurologic lesion for each of the following signs and symptoms	179
11.When evaluating a delirious or unconscious patient with no history of trauma, for what three common conditions should you thi...	180
12.What are the classic differences between delirium and dementia?	180
13.What signs and symptoms do delirium and dementia have in common?	180
14.Define pseudodementia	180
15.What treatable causes of dementia must always be ruled out?	180
16.Define Wernicke encephalopathy and Korsakoff syndrome. What causes them?	181
17.Differentiate among tension, cluster, and migraine headaches. How is each treated?	181
18.How do you recognize a headache secondary to brain tumor or intracranial mass?	181
19.Define pseudotumor cerebri. How is it diagnosed and treated?	181
20.How do you recognize a headache due to meningitis?	181
21.What causes the “worst headache” of a patient’s life?	181
22.What are the common extracranial causes of headache?	181
23.What does a lesion of the first cranial nerve (CN I) cause? What exotic syndrome should you watch for clinically?	182
24.True or false: Brain lesions can be localized based on the visual field defect	182
25.How do you distinguish between a benign and serious cause of CN III deficit?	182
26.What does CN V (trigeminal nerve) innervate? What classic peripheral nerve disorder affects its function?	183
27.What structures does CN VII innervate? What is the difference between an upper and lower motor neuron lesion of the facial ne...	183
28.What problems (other than facial droop) affect patients with a CN VII lesion?	183
29.What rare tumor is a classic cause of lower motor neuron lesions of CN VII and CN VIII?	183
30.Describe the function of CN VIII. What symptoms do lesions cause?	183
31.What does CN IX innervate? What physical findings are associated with a lesion?	183
32.Describe the function of CN X. Specify the physical findings and causes of lesions	183
33.What muscles does CN XI innervate? How do you know on which side the lesion is located?	183
34.What does a lesion of CN XII cause?	183
35.Which vitamin deficiencies may present with neurologic signs or symptoms?	183
36.What are the six general types of seizures that you should be able to recognize?	184
37.Describe simple partial seizures. How are they treated?	184
38.Describe complex partial seizures. How are they treated?	184
39.Give the classic description of an absence seizure	184
40.How do you recognize a tonic-clonic seizure?	184
41.Define febrile seizure	184
42.What are the common causes of secondary seizures? How are they treated?	184
43.Define status epilepticus. How is it treated?	185
44.True or false: Hypertension can cause seizures	185
45.What do you need to remember when giving anticonvulsants to women?	185
46.What causes strokes? How common are they?	186
47.How is an acute stroke treated?	186
48.Define transient ischemic attack (TIA). How is it managed?	186
49.Describe the signs and symptoms of Huntington disease. How is it acquired? What is the classic CT finding?	186
50.Define Parkinson disease. How do you recognize it on the Step 2 exam?	187
51.Describe the pathophysiology of Parkinson disease. How is it treated pharmacologically?	187
52.What is the classic iatrogenic cause of parkinsonian signs and symptoms?	187
53.What brain lesions cause a resting tremor and an intention tremor? What about hemiballismus?	187
54.What other common conditions other than Parkinson disease cause a resting tremor?	187
55.What diseases should come to mind in children with cerebellar findings?	187
56.What diseases should come to mind in adults with cerebellar findings?	187
57.How do you recognize amyotrophic lateral sclerosis (ALS) on the Step 2 exam?	187
58.What are the two classic causes of a “floppy” (flaccid) baby? How do you differentiate the two?	187
59.List the causative categories of peripheral neuropathy, and give examples of each	188
60.What test can be used to prove the presence of a peripheral neuropathy, regardless of etiology?	188
61.Describe the pathophysiology of myasthenia gravis (MG). Who is affected? What are the classic physical findings?	188
62.How is MG diagnosed? What tumor is associated with it?	188
63.What three conditions may cause an MG-like clinical picture?	188
64.What is the most common type of muscular dystrophy? How is it inherited? What are the classic findings?	188
65.List the five less common types of muscular dystrophies	189
66.What class of inherited metabolic disorders affects muscle and may resemble muscular dystrophy?	189
24 - Neurosurgery	190
1. List the four major types of intracranial hemorrhages.	190
2.What causes a subdural hematoma? How do you recognize and treat it?	190
3.What causes an epidural hematoma? How do you recognize and treat it?	190
4.Define subarachnoid hemorrhage. What causes it? How is it treated?	191
5.What causes an intracerebral hemorrhage? How do you recognize and treat it?	191
6.What does a unilateral, dilated, unreactive pupil after head trauma suggest?	191
7.List four classic signs of a basilar skull fracture	191
8.What is the imaging test of choice for skull fractures of the calvarium? How are they managed?	192
9.True or false: Severe, permanent neurologic deficits may occur after head trauma, even with a negative CT or MRI scan of the h...	192
10.What finding suggests increased intracranial pressure?	192
11.How should increased intracranial pressure be managed?	192
12.True or false: Lumbar puncture is the first test that should be performed in a patient with increased intracranial pressure	193
13.How do patients with spinal cord trauma present? How are they managed?	193
14.What causes spinal cord compression? How do patients present?	193
15.How should patients with subacute spinal cord compression be diagnosed and treated?	193
16.Define syringomyelia. What causes it? How does it usually present?	194
17.Define spina bifida. How can it be prevented?	194
18.Define hydrocephalus. How is it recognized in children?	194
19.In what setting does dural venous sinus thrombosis occur? How is it diagnosed and treated?	194
25 - OBSTETRICS	195
1.A patient who is taking birth control pills presents with amenorrhea. What is the likely cause?	195
2.List the signs and symptoms of pregnancy	195
3.Which vitamin should all pregnant women take? Why?	195
4.Define macrosomia. What is the likely cause?	195
5.What routine tests should be obtained for all pregnant patients?	195
6.On every prenatal visit, listen to fetal heart tones, and evaluate uterine size. When can these factors first be noticed? What...	196
7.When is ultrasound most accurate at estimating the fetal age?	196
8.What is a hydatidiform mole? What are the clues to its presence?	196
9.Distinguish between complete and partial moles. How are hydatidiform moles treated?	196
10.How is intrauterine growth retardation (IUGR) defined? What causes it?	196
11.When should ultrasound be used to evaluate the fetus?	197
12.How is fetal well-being evaluated?	197
13.True or false: A biophysical profile is often used in high-risk pregnancies in the absence of obvious problems	197
14.True or false: Aspirin should be avoided during pregnancy	197
15.Define postterm pregnancy. Why is it a major concern? How is it treated?	197
16.What two rare disorders are associated with prolonged gestation?	197
17.What are the normal changes and complaints in pregnancy?	197
18.What test is used to screen for neural tube defects? At what time during pregnancy is it measured? Explain the significance o...	197
19.What should be done if the AFP is elevated?	198
20.What further testing should a patient undergo if the AFP remains elevated?	198
21.What prenatal tests are available to screen for Down syndrome?	198
22.What is the first trimester combined test? When is it performed?	198
23.Describe the integrated tests	198
24.What is the quadruple test? For whom is it typically used? When is it performed?	198
25.What is a maternal plasma–based test?	198
26.What is the next step if a woman has a positive screening test for Down syndrome?	199
27.Why is CVS done instead of amniocentesis in some cases?	199
28.True or false: CVS can detect neural tube defects but not genetic disorders	199
29.Cover the right-hand column, and specify the effects of the following classic teratogens on an exposed fetus	199
30.List the teratogenic effects of maternal diabetes mellitus. What is the best way to reduce these complications?	199
31.What other problems does maternal diabetes cause in pregnancy?	200
32.True or false: Oral hypoglycemic agents should not be used during pregnancy	200
33.What commonly used drugs are generally considered safe in pregnancy?	200
34.What are the TORCH syndromes? What do they cause?	200
35.True or false: With most in utero infections that can cause birth defects, obvious clues are present in the mother and/or fet...	200
36.What do you need to know about HIV testing and transmission in mother and child?	200
37.What should you do if a pregnant woman has genital herpes?	201
38.What should you do for the child if the mother has chronic hepatitis B or chickenpox?	201
39.How do you treat gonorrheal and chlamydial genital infections during pregnancy?	201
40.How is tuberculosis treated in pregnancy?	201
41.What are the signs of placental separation during the third stage of labor?	201
42.True or false: After cesarean section, a patient may have a vaginal delivery in the future	201
43.Define lochia. When is it a problem?	201
44.What treatment may be given to a woman who does not want to breastfeed?	201
45.List the common contraindications for breastfeeding	201
46.What are the options for anesthesia in obstetric patients? Why?	201
47.True or false: Asymptomatic bacteriuria, detected on routine urinalysis, should be treated during pregnancy	202
48.What do you need to know about vaginal GBS colonization and pregnancy?	202
49.When does mastitis occur? How do you recognize and treat it?	202
50.What are the diagnostic signs and symptoms of preeclampsia? When does it occur?	202
51.What are the main risk factors for preeclampsia? How is it treated?	202
52.Define the different types of hypertension in pregnancy (high yield)	202
53.What are the recommended gestational ages for delivery for cHTN? gHTN? Preeclampsia?	203
54.What are the problems with chronic maternal hypertension in pregnancy?	203
55.When is edema normal during pregnancy? When is it not?	203
56.What should you consider if preeclampsia develops before the third trimester?	203
57.Distinguish between preeclampsia and eclampsia. How can eclampsia be prevented?	203
58.What should you use to treat seizures in eclampsia? What are the toxic effects?	203
59.True or false: When eclampsia occurs, you must deliver the infant immediately, regardless of maternal status	203
60.Why are preeclampsia and eclampsia so important?	203
61.True or false: Preeclampsia and eclampsia are risk factors for development of hypertension in the future	203
62.What are the major causes of maternal mortality associated with childbirth?	203
63.How do you recognize an amniotic fluid pulmonary embolism?	204
64.Define oligohydramnios. What causes it? Why is it worrisome?	204
65.Define polyhydramnios. What causes it? Why is it worrisome?	204
66.When does a standard home pregnancy test become positive?	204
67.Define the characteristics and duration of the normal stages of labor	204
68.Distinguish between a protraction disorder and an arrest disorder. What should you do when either occurs?	204
69.What is the most common cause of protraction or arrest disorder?	204
70.Distinguish between true labor and false labor	204
71.What problems may be encountered when oxytocin is used to augment labor?	205
72.What problems are associated with the use of intravaginal prostaglandin and amniotomy?	205
73.What are the contraindications to labor induction or augmentation?	205
74.Define abortion	205
75.What are the different terms for spontaneous abortion?	205
76.Define induced and recurrent abortions. What do recurrent abortions suggest?	205
77.True or false: hCG roughly doubles every 2 days in the first trimester	206
78.When can ultrasound detect an intrauterine gestational sac? Why do you need to know this information?	206
79.What are the risk factors for developing an ectopic pregnancy?	206
80.What are the classic signs and symptoms of a ruptured ectopic pregnancy?	206
81.What should you do if you suspect an ectopic pregnancy?	206
82.How is symptomatic ectopic pregnancy managed?	206
83.What does a basic fetal heart monitoring strip contain?	206
84.In fetal heart monitoring, what is the difference between early decelerations, late decelerations, and variable decelerations...	206
85.What other patterns of fetal distress may be seen on a fetal heart tracing? What is a normal fetal heart rate?	208
86.What if the question gives you a value for fetal oxygen saturation or scalp pH?	208
87.What should you do if shoulder dystocia or impaction occurs during vaginal delivery?	208
88.What causes third trimester bleeding?	208
89.True or false: The initial work-up of third trimester bleeding, like most conditions, requires a history and thorough physica...	208
90.Why should you do ultrasound before you do a pelvic exam for third trimester bleeding?	208
91.Define placenta previa. How does it present? How is it diagnosed and treated?	208
92.Define placental abruption. How does it present? How is it treated?	208
101.What tests can be used to assess fetal lung maturity?	210
102.What is the role of steroids in preterm labor?	210
103.Define quickening. When does it occur?	210
104.Give the order of fetal positions during normal labor and delivery	210
105.What subtype of maternal antibody can cross the placenta?	210
106.Explain Rh incompatibility. In what situations does it occur?	210
107.How do you detect and manage potential hemolytic disease of the newborn?	210
108.True or false: The first child is usually the most severely affected by Rh incompatibility	210
109.How much RhoGAM should you give if the maternal Rh antibody titer is extremely high?	210
110.How do you recognize, monitor, and treat hemolytic disease of the newborn?	211
111.True or false: ABO blood group incompatibility can cause hemolytic disease of the newborn	211
112.When should RhoGAM be given?	211
113.Define premature rupture of membranes (PROM). How is it diagnosed?	211
114.What usually follows membrane rupture? What should you do if it does not occur?	211
115.Define preterm premature rupture of membranes (PPROM). How is it managed?	211
116.How does chorioamnionitis present, and how is it treated?	211
117.Define postpartum hemorrhage. What are the common causes?	211
118.What causes uterine atony? How is it treated?	212
119.What is the treatment for retained products of conception?	212
120.What causes uterine inversion? How is it treated?	212
121.Define postpartum fever. What are the common causes?	212
122.What should you do if a patient has postpartum fever?	212
123.What should you do if postpartum fever does not improve with antibiotics?	212
124.What should you consider if a postpartum patient goes into shock without evident bleeding?	212
125.What normal lab changes of pregnancy may be encountered on Step 2?	212
126.What cardiovascular and pulmonary changes occur in a normal pregnancy?	213
127.What is the average weight gain during pregnancy? What commonly causes weight gain to be more or less?	213
128.Define hyperemesis gravidarum. How do you recognize and treat it?	213
129.Define cholestasis of pregnancy. How is it treated?	213
130.What is acute fatty liver of pregnancy? How is it treated?	213
131.True or false: In terms of surgery, the usual rule of thumb is to treat the disease in a pregnant woman the same as you woul...	213
132.How do you manage fetal malpresentation?	213
133.What is the “poor man’s way” to distinguish between monozygotic and dizygotic twins?	214
134.What are the maternal and fetal complications of multiple gestations?	214
135.How are multiple gestations delivered?	214
26 - ONCOLOGY	215
1.What are the key differential points for the commonly tested blood dyscrasias?	215
2.Which cancers have the overall highest incidence and mortality rate in men and women in the United States?	216
3.What are the most common types of cancer in children and young adults (younger than age 30 years)?	216
4.What is the major risk factor for cancer? What is the major modifiable risk factor for cancer?	216
5.What is the most common cancer in most organs?	217
6.Metastatic cancer to the spine can cause spinal cord compression. How do you recognize and treat this medical emergency?	217
7.Name the mode of inheritance and types of cancer found in the following conditions	217
8.What other conditions are associated with an increased risk of malignancy?	218
9.Cover the right-hand column and specify the major environmental risk factors for the following cancers	218
10.What clinical vignette should make you suspect lung cancer?	219
11.How do you diagnose and treat lung cancer?	220
12.What consequences can result from an apical (Pancoast) lung cancer?	220
13.What is a paraneoplastic syndrome? What are the commonly tested paraneoplastic syndromes of lung cancer?	220
14.How should you manage a patient with a solitary pulmonary nodule on chest radiograph?	221
15.Over the course of their lifetime, how many women in the United States will develop breast cancer?	221
16.What are the risk factors for breast cancer?	221
17.What classic signs and symptoms indicate that a breast mass is cancer until proved otherwise?	222
18.What is the conservative approach to ensure that you do not miss a breast cancer?	222
19.What should you do with a breast mass in a woman under age 30?	222
20.What is the most common histologic type of breast cancer?	222
21.What is the role of mammography in deciding whether to biopsy a breast mass?	222
22.True or false: A mammogram should not be done in women under age 30	222
23.What are the adjuvant therapies for breast cancer? How does each type of therapy work?	222
24.How are the adjuvant therapies used in nonmetastatic, hormone receptor-positive breast cancer?	223
25.How is human epidermal growth factor receptor 2 (Her-2/neu) breast cancer treated?	223
26.What is the recommended treatment for women at high risk of developing breast cancer who have not yet developed breast cancer...	223
27.True or false: Mastectomy and breast-conserving surgery with radiation are considered equal in efficacy	224
28.What are the three main risk factors for prostate cancer?	224
29.How do you recognize prostate cancer on the Step 2 exam?	224
30.How is prostate cancer treated?	224
31.List the primary risk factors for colon cancer	224
32.How do patients with colon cancer tend to present?	224
33.What is the rule about occult blood in the stool of a patient over age 40?	224
34.How is colon cancer treated?	224
35.What is the classic tumor marker for colon cancer? How is it used clinically?	225
36.Describe the classic presentation of pancreatic cancer. How is it treated? What is the cell of origin?	225
37.What is the most common islet cell tumor of the pancreas? How is it diagnosed?	225
38.Define Zollinger-Ellison syndrome. What clues point to the diagnosis?	225
39.Name the other two islet cell tumors. What should islet cell tumors make you think about?	226
40.How does ovarian cancer classically present? How are ovarian masses evaluated?	226
41.How is ovarian cancer treated? What is the cell of origin? What is the most common type of ovarian cancer?	226
42.List the three commonly tested germ cell tumors. What clues suggest their presence?	226
43.What is Meigs syndrome?	226
44.What is a Krukenberg tumor?	226
45.What commonly used medication has been shown to reduce the risk of ovarian cancer?	227
46.What is the best available screening method to reduce the incidence and mortality of cervical cancer?	227
47.What should you do if a Pap smear is abnormal?	227
48.List the main risk factors for cervical cancer	227
49.Where does cervical cancer begin? How does it present? How is it treated?	227
50.What do you need to know about diethylstilbestrol (DES) and cancer?	227
51.What is the rule of thumb for postmenopausal vaginal bleeding?	227
52.List the main risk factors for endometrial cancer	227
53.What is the most common type of endometrial cancer? How is it treated?	227
54.What commonly prescribed medication reduces the risk of endometrial cancer?	227
55.Describe the common presentations of brain tumors	228
56.What are the most common histologic types of primary CNS tumors in children and adults? How are primary brain tumors treated?...	228
57.Which cancers tend to metastasize to the brain?	228
58.What tumor is most likely in a young, obese woman with headaches, papilledema, vomiting, and a negative CT/MR scan?	228
59.What tumor should you suspect in an adult with signs of eighth cranial nerve damage and increased intracranial pressure?	228
60.What tumor should you suspect in children with intracranial calcifications on skull radiographs?	229
61.What should you know about testicular cancer?	229
62.What tumor resembles “a bunch of grapes” coming out of the vagina?	229
63.What is the classic physical finding of a pituitary tumor? What is the most common type?	229
64.What two points do you need to know about nasopharyngeal cancer?	229
65.Describe the classic presentation of esophageal cancer. What is the most common cell type?	229
66.What physical and laboratory findings suggest thyroid cancer? What is the most common type of thyroid cancer? What historical...	230
67.How should you evaluate a thyroid mass for possible malignancy?	230
68.What clinical vignette is suspicious for bladder cancer?	230
69.What increases the risk for hepatocellular cancer of the liver? What is the classic tumor marker for liver cancer?	230
70.How do patients with liver cancer present? How is liver cancer treated?	230
71.What other tumors of the liver may appear on the USMLE? What clues suggest their presence?	230
72.What is the significance of adrenal tumors?	230
73.What are the risk factors for stomach cancer? What are the symptoms?	231
74.What is a Virchow node?	231
75.What do you need to know about osteosarcomas for the Step 2 exam?	231
76.What are the symptoms of carcinoid tumors? Where are they most commonly found?	231
77.What lab test detects carcinoid tumors?	231
78.What is the classic clinical manifestation of Kaposi sarcoma?	232
79.What is the main risk factor for skin cancer?	232
80.Explain the ABCDEs of melanoma. What should you do if they are present?	232
81.What do you need to know about basal cell and squamous cell skin cancers?	232
82.How can you differentiate a Wilms tumor from a neuroblastoma?	232
83.What factors increase the risk for oral cancers? Describe the typical appearance	233
84.What are the two major cytologic clues for histiocytosis?	233
85.What is a unicameral bone cyst? Who gets it? Describe the classic presentation	233
86.Describe the classic presentation of a retinoblastoma	233
87.True or false: All patients with metastatic cancer should be encouraged to receive chemotherapy	233
88.Cover the right-hand column and name the cancer(s) associated with the following tumor markers	233
27 - OPHTHALMOLOGY	235
1. What is the hallmark of conjunctivitis?	235
2. Distinguish allergic, viral, and bacterial conjunctivitis.	235
3. What are three common causes of neonatal conjunctivitis?	235
4. What causes chemical conjunctivitis? How do you recognize it?Silver nitrate (or erythromycin) drops, which are given to all newborns to prevent gonorrhea	235
5. How can you distinguish gonorrheal from chlamydial conjunctivitis?	235
6. If you forget everything else about neonatal conjunctivitis, what point should you remember to help you distinguish among the three discussed causes?	235
7. True or false: Conjunctivitis frequently causes loss of vision.	235
8. Define glaucoma. What are the risk factors for developing it? What are the two general types?	235
9. Describe physical findings of open-angle glaucoma. How common is it? How is it treated?	236
10. How does closed-angle glaucoma present? What should you do if you recognize it?	236
11. How do steroids affect the eye?	236
12. Define ultraviolet keratitis. How is it treated?	236
13. What pediatric rheumatologic condition is commonly associated with uveitis?	236
14. What is the most common cause of painless, slowly progressive loss of vision?	236
15. What should cataracts in a neonate suggest?	236
16. What changes in the retina and fundus are seen in diabetes and hypertension?	236
17. What is the most common cause of blindness in patients under and over the age of 55? In black patients?	236
18. Define proliferative diabetic retinopathy. How is it treated? How is nonproliferative diabetic retinopathy treated?	236
19. Distinguish between preorbital (preseptal) and orbital cellulitis.	237
20. What are the common bacterial causes of preorbital and orbital cellulitis? How are they treated?	237
21. What is the key to managing chemical burns to the eye? Which is worse—acid or alkaline burns?	237
22. Distinguish between a hordeolum (stye) and a chalazion. How are they treated?	237
23. How do you recognize and treat herpes simplex keratitis?	238
24. What findings suggest an ophthalmic herpes zoster infection?	238
25. How do you recognize a central retinal artery occlusion? What causes it?	238
26. Describe the symptoms of temporal arteritis (giant cell arteritis). What should you do if you suspect it?	238
27. How do you recognize central retinal vein occlusion? Describe the cause and treatment.	238
28. Describe the classic history of a patient with retinal detachment.	239
29. True or false: Cataracts and macular degeneration are common causes of bilateral, painless loss of vision in the elderly	239
30. How do optic neuritis and papillitis present? What are the common causes?	239
31. What causes bitemporal hemianopsia until proven otherwise?	239
32. Use the visual field defect to localize the sight of the brain lesion (Fig. 27.3).	240
33. What two diseases commonly cause isolated palsies of cranial nerves III, IV, and VI? How do you recognize them?	240
34. What are the physical exam findings of a third cranial nerve palsy? What should you remember when trying to determine the cause?	240
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?	240
36. What is strabismus? Beyond what age is it abnormal in children?	240
37. Why does blindness develop in patients with strabismus?	240
38. What is presbyopia? When does it occur?	240
39. What is pterygium? How is it treated?	241
40. What is trachoma? Which organism causes it?	241
28 - Orthopedic Surgery	242
1. What orthopedic fractures are associated with the highest mortality rate?	242
2.Why should areas distal to the fracture site be assessed by physical exam?	242
3.Distinguish between an open and a closed fracture	242
4.Explain the difference in management of open and closed fractures	242
5.What are the indications for open reduction other than an open fracture?	242
6.What type of radiographs should you order if you suspect a fracture?	242
7.How should you treat a patient with severe pain after trauma and negative x-rays?	242
8.Define compartment syndrome. What is the cause?	242
9.What are the signs and symptoms of compartment syndrome? How is it treated?	243
10.Cover the right-hand columns and specify the motor and sensory functions of the following peripheral nerves. In what common c...	244
11.What is the difference between insufficiency stress fracture and fatigue stress fracture? How are stress fractures diagnosed ...	244
12.What fracture is usually diagnosed in trauma patients with pain in the anatomic snuff-box?	244
13.What are the most common locations of intervertebral disc herniations? What symptoms do they cause?	244
14.How is intervertebral disc herniation diagnosed and treated?	244
15.Define Charcot joint. What causes it? How is it managed?	246
16.What is the most common bacterial cause of osteomyelitis? In what clinical scenarios should you think of other causes?	246
17.Which bacteria are the most common cause of septic arthritis? In what scenario should you think of another cause?	246
18.What is complex regional pain syndrome? How do patients present?	246
19.True or false: There is a high incidence of vascular injury with posterior knee dislocations	246
20.What is the most common type of bone tumor?	246
21.What is a pathologic fracture? What is the most common cause of a pathologic fracture?	246
22.To what site is pain from hip inflammation or dislocation/fracture classically referred?	246
23.Specify age at presentation, epidemiology, signs and symptoms, and treatment for the three classically tested pediatric hip d...	247
24.If you forget everything else about differentiating the three pediatric hip disorders, what historical point will help you th...	247
25.Define Osgood-Schlatter disease. How is it recognized and treated?	247
26.How do you check for scoliosis? Who is usually affected? What is the treatment?	247
27.What are the common findings with ligament injuries of the knee? How do you distinguish injuries of the anterior cruciate, po...	247
28.What are the risk factors for avascular necrosis (AVN)? What is the best test to make the diagnosis?	248
29 - PEDIATRICS	249
1.Give the average ages at which the following commonly tested milestones are achieved	249
2.True or false: The overall pattern of development is more important than the age at which individual milestones are reached	249
3.What screening and preventive care measures should be done at every pediatric visit?	249
4.True or false: Screening and preventive care are important mainly during a well check-up	250
5.What are the commonly performed screening tests for metabolic and congenital disorders?	250
6.What are the frequently tested items under the umbrella of primary prevention using “anticipatory guidance”?	250
7.How often should height, weight, and head circumference be measured? What do they signify?	250
8.What if a child has low height, weight, or head circumference compared with peers?	250
9.Define failure to thrive. What causes it?	250
10.What conditions are suggested by obesity in children?	250
11.What conditions should you consider in a child with an abnormal head circumference?	251
12.How are hearing and vision screened?	251
13.In what situations should you worry about hearing loss?	251
14.What is the red reflex? What should an abnormal reflex suggest?	251
15.True or false: Before a certain age intermittent strabismus is normal	251
16.How is screening for anemia done?	251
17.Do infants require iron supplementation?	251
18.How and when do you screen for lead exposure?	252
19.True or false: Most children need fluoride supplementation	252
20.True or false: Breastfed infants are more likely to require vitamin D supplements than formula-fed infants	252
21.When should children be screened for tuberculosis?	252
22.True or false: Screening children for renal disease with a urinalysis is not recommended	252
23.True or false: Current vaccine recommendations and schedules are always provided on the USMLE	252
24.True or false: Sexually active teenaged girls need screening for chlamydial infection and gonorrhea	252
25.When should you recommend that a child see a dentist for the first time?	252
26.What are the Tanner stages? When do they occur?	252
27.Define delayed puberty. What is the most common cause?	253
28.What are other causes for delayed puberty?	253
29.What causes precocious puberty?	253
30.True or false: If the underlying cause for precocious puberty is uncorrectable or idiopathic after diagnostic work-up, patien...	253
31.How are cavernous hemangiomas treated?	253
32.Distinguish between caput succedaneum and cephalohematoma. How are these conditions treated?	254
33.When does the anterior fontanelle usually close? What disorder should you suspect if it fails to close?	254
34.How many vessels does a normal umbilical cord have? What disorder should you suspect if one of the vessels is absent?	254
35.True or false: Milky-white and possibly blood-tinged vaginal discharge is usually abnormal in the first week of life for a fe...	254
36.What findings should make you suspect child abuse?	254
37.True or false: You do not need proof to report child abuse	255
38.True or false: Children have the same range of normal vital signs as adults	255
39.What is an APGAR score? When is it measured?	255
40.True or false: The APGAR score is important because it is the first assessment of how a child is doing	255
41.What should you always remember when a question mentions that a child was given aspirin?	255
42.When should the Moro and palmar grasp reflex disappear?	255
43.True or false: A diagnosis of encopresis or enuresis cannot be made before a certain age	255
30 - Pharmacology	256
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.	256
2.What are the side effects of diuretics?	257
3.What are the side effects of beta-blockers?	257
4.What class of antihypertensive agents is best known for severe, first-dose orthostatic hypotension?	258
5.What antihypertensive is best known for causing depression?	258
6.Cover the right-hand column and give the antidote(s) for overdose or toxic exposure to the drugs in the left-hand column	258
7.If the following medications are given at the same time, what may happen?	258
8.What prophylactic medication should be given to contacts of a patient with Neisseria meningitis?	258
9.Name three medications that cause hepatic enzyme induction and two that cause hepatic enzyme inhibition	258
10.True or false: If a patient responds to placebo, a psychosomatic condition can be diagnosed	259
11.Describe the mechanism of action for aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs). How do they differ?	259
12.How is acetaminophen different from aspirin and other NSAIDs?	259
13.What are the side effects and toxic effects of aspirin?	259
14.What are the side effects of nonaspirin NSAIDs?	259
15.What two developments in NSAID therapy may reduce GI and bleeding complications?	259
16.What happens with an overdose of acetaminophen?	259
17.What age group should not be given aspirin? What finding on physical exam is a contraindication to aspirin use?	259
18.What is the relationship between aspirin and myocardial infarction (MI)?	259
19.Discuss the relationship between aspirin and strokes	260
20.True or false: Patients should be given an aspirin as soon as possible in the emergency department for a suspected MI or unst...	260
21.True or false: In the setting of an acute neurologic deficit, you should give aspirin before ordering brain imaging	260
31 - PREVENTIVE MEDICINE	261
1.Cover all but the left-hand column, and give the appropriate screening recommendations. Although other guidelines for cancer s...	261
2.True or false: Tumor markers are generally not used for cancer screening	262
3.True or false: Urinalysis should not be used to screen the general population for bladder cancer	262
4.Cover the right-hand column and give the indications for each of the following vaccines in adults	262
5.Define the following rates that are commonly seen on the USMLE	263
6.Define stillbirth	263
7.Name the major cause of neonatal mortality. What is the neonatal mortality rate in the United States?	263
8.List the top three causes of infant mortality in the United States	263
9.List the top three causes of maternal mortality in the United States	263
10.What is the basic difference between Medicare and Medicaid?	263
32 - Psychiatry	264
1. What are the five main diagnostic criteria for schizophrenia?	264
2.Why is the duration of symptoms important with psychosis?	264
3.List the positive symptoms of schizophrenia	264
4.List the negative symptoms of schizophrenia	264
5.What features of schizophrenia suggest a poor prognosis?	264
6.What features suggest a good prognosis?	264
7.What is the difference in age of onset for schizophrenia in males and females?	265
8.True or false: Roughly 1% of the population has schizophrenia in almost every country in the world	265
9.True or false: In the United States, most schizophrenic people are born in the summer months	265
10.Roughly what percentage of patients with schizophrenia commit suicide?	265
11.True or false: Psychosocial treatment has been shown to improve outcomes in schizophrenia	265
12.Differentiate among the classes of antipsychotics drugs	265
13.What are the four commonly tested extrapyramidal side effects of antipsychotics?	265
14.Define acute dystonia. How is it treated?	265
15.Define akathisia	265
16.Describe the relationship between antipsychotics and parkinsonism	265
17.Define tardive dyskinesia. When does it occur?	266
18.What is neuroleptic malignant syndrome? How do you recognize and treat it?	266
19.Describe the relationship between antipsychotics and prolactin levels	266
20.What are the classic side effects of thioridazine and chlorpromazine?	266
21.What are the side effects of the atypical antipsychotics?	266
22.Define bipolar disorder. What are the classic symptoms?	266
23.How is bipolar disorder treated?	266
24.What are the side effects of lithium, valproic acid, and carbamazepine?	266
25.Define bipolar II disorder and cyclothymia	267
26.List the major risk factors for suicide	267
27.What is the best predictor of future suicide?	267
28.True or false: Be careful in asking about suicide because you may plant the idea in the patient’s head	267
29.True or false: When patients are just emerging from a deep depression, they are at an increased risk of suicide	267
30.True or false: The highest suicide rates are in people aged 15–24 years	267
31.Define depression	267
32.True or false: Patients with depression often do not complain about it directly	267
33.How do you treat depression?	268
34.Is depression more common in males or females?	268
35.What is an adjustment disorder with depressed mood?	268
36.Define dysthymia	268
37.True or false: Antidepressants can trigger mania or hypomania	268
38.How do SSRIs work? Why are they preferred over tricyclics?	268
39.How do SNRIs work?	268
40.How do tricyclic antidepressants work? What are their side effects?	268
41.What are monoamine oxidase (MAO) inhibitors? Describe their side effects	268
42.What is the most notorious side effect of trazodone?	268
43.Distinguish between normal grief and pathologic grief (i.e., depression)	269
44.How do you recognize and treat panic disorder?	269
45.What is generalized anxiety disorder? How is it treated?	269
46.Give the classic examples of simple phobias. How are they treated?	269
47.What is social anxiety disorder?	269
48.How do you recognize and treat posttraumatic stress disorder?	269
49.Explain the concept of somatic symptom disorders (previously called somatoform disorders)	269
50.Describe the four major somatic symptom disorders	269
51.How are somatic symptom disorders treated?	270
52.Distinguish among somatic symptom disorders, factitious disorders, and malingering	270
53.How do you recognize dissociative fugue (also called psychogenic fugue or fugue state)?	270
54.What psychiatric disorder is most likely to be associated with childhood sexual abuse?	270
55.Define personality disorders	270
56.Give a one- or two-sentence description of each of the following ten personality disorders below	270
57.Define obsessive-compulsive disorder. How is it treated?	271
58.True or false: Some psychiatric patients can be hospitalized against their will	271
59.Describe the hallmark findings of narcolepsy. How is it treated?	271
60.What is the difference between objective and subjective psychologic tests?	271
61.Characterize each of the following psychologic tests as objective or subjective, and briefly describe its use	271
62.True or false: Roughly 85% of cases of intellectual disabilities are mild	272
63.What are the common causes of mental retardation?	272
64.How do you recognize autism spectrum disorder?	272
65.What is a learning disorder?	272
66.Define conduct disorder. With what adult disorder is it associated?	272
67.Define attention-deficit/hyperactivity disorder (ADHD)	272
68.Describe the behavior of a child who has oppositional-defiant disorder	272
69.Give the classic description of children with separation anxiety disorder	272
70.How do you recognize anorexia?	272
71.Define bulimia. What are the classic findings of the mouth and fingers?	273
72.Describe Tourette syndrome. How is it treated?	273
73.True or false: Depression in children frequently presents as an irritable rather than a depressed mood	273
74.What are the three leading causes of death in adolescents?	273
75.What is the most commonly abused illicit drug? Describe its effects on users	273
76.What symptoms are associated with cocaine intoxication? Cocaine withdrawal?	273
77.Describe the symptoms of amphetamine intoxication	273
78.Describe the effects of opioids. What symptoms are seen in withdrawal?	273
79.How do you recognize intoxication with lysergic acid diethylamide (LSD) or hallucinogenic mushrooms?	273
80.What about phencyclidine (PCP) intoxication?	274
81.Describe the signs and symptoms of inhalant intoxication. Who is likely to abuse inhalants?	274
82.True or false: Benzodiazepines and barbiturates can be fatal in overdose but not in withdrawal	274
83.Describe the signs and symptoms of benzodiazepine or barbiturate intoxication	274
84.What are the symptoms of caffeine withdrawal?	274
85.What is the basic rule of thumb about the difference in symptoms between intoxication and withdrawal for the same drug?	274
33 - PULMONOLOGY	275
1. Describe the difference between obstructive and restrictive pulmonary disease on pulmonary function testing.	275
2. What is COPD?	275
3. How is COPD diagnosed and treated?	275
4. How are COPD exacerbations treated?	275
5. How do you recognize and treat asthma?	275
6. What is the concern with the use of long-acting beta-agonists (LABAs) in the treatment of asthma?	275
7. What is a common cause of wheezing in children under age 2 years?	276
8. What should you think if a patient with acute asthma stops hyperventilating or has a normal carbon dioxide (CO2) level?	276
9. When should you intubate?	276
10. What should you do if a patient has a solitary pulmonary nodule on chest radiograph?	276
11. What classic clues on the Step 2 exam point to the cause of a solitary pulmonary nodule?	276
12. What should you know about pulmonary function in the setting of surgery?	276
13. How do you recognize and treat adult respiratory distress syndrome (ARDS)?	276
14. How is pneumonia diagnosed?	277
15. What is the difference between typical and atypical pneumonia?	277
16. What is the difference between aspiration pneumonia and aspiration pneumonitis?	277
17. What are the classic clinical clues on Step 2 for the different causative bugs in pneumonia?	277
18. What should you suspect if a child has recurrent pneumonias?	278
19. What is “round” pneumonia?	278
20. Why should you get a follow-up chest x-ray in all people over age 40 who develop pneumonia?	278
21. What should you know about infant respiratory distress syndrome?	279
22. What prenatal tests help to determine whether respiratory distress syndrome will occur?	279
23. Define diaphragmatic hernia. How is it recognized clinically?	279
24. How do you recognize and diagnose a tracheoesophageal fistula? How is it treated?	279
25. What is the most common lethal genetic disease in Caucasians? How do you recognize it?	279
26. How is cystic fibrosis diagnosed and treated?	279
27. What should you do if a patient has a pleural effusion?	279
34 - RADIOLOGY	281
1. Cover the right-hand columns and specify what imaging study you should order for the following conditions.	281
35 - RHEUMATOLOGY	284
1. What is the most common form of arthritis?	284
2. If the cause of arthritis is in doubt, what should you do?	284
3. How do you distinguish among the common causes of arthritis?	284
4. What other clues point to a diagnosis of OA?	284
5. What clues point to a diagnosis of rheumatoid arthritis (RA)?	284
6. What clues point to a diagnosis of gout?	286
7. What causes pseudogout? How is it diagnosed?	286
8. What clues point to a diagnosis of septic arthritis? What are the common causes?	286
9. Name some other causes of arthritis.	286
10. True or false: Psoriasis can cause an arthritis that resembles OA.	286
11. Describe the hallmarks of ankylosing spondylitis.	286
12. How do you recognize reactive arthritis as the cause of arthritis?	286
13. Why do patients with hemophilia get arthritis?	287
14. What clues point to Lyme disease as the cause of arthritis?	287
15. True or false: One of the major Jones criteria for the diagnosis of rheumatic fever is arthritis.	288
16. Why do patients with sickle cell disease often have arthritis?	288
17. Define Charcot joint. What clues point to its presence?	288
18. What about systemic lupus erythematosus and other autoimmune disorders as a cause of arthritis?	288
19. How do hemochromatosis and Wilson disease cause arthritis?	288
20. What generalized systemic signs of inflammation may suggest an autoimmune disorder?	288
21. Describe the hallmarks of SLE.	288
22. Describe the hallmarks of scleroderma.	289
23. What are the hallmarks of Sjögren syndrome?	289
24. What are the signs and symptoms of dermatomyositis?	289
25. With what is polyarteritis nodosa associated? How is it diagnosed?	289
26. Describe the usual presentation of Kawasaki disease. How is it treated?	289
27. How does Takayasu arteritis present?	289
28. How do you recognize Behçet syndrome on the Step 2 exam?	290
29. How do you distinguish among fibromyalgia, polymyositis, and polymyalgia rheumatica?	290
30. Give the basic facts of Paget disease. How is it linked with cancer?	290
31. If a pediatric patient has uveitis and an inflammatory arthritis, but the rheumatoid factor is negative, what disease should you suspect?	290
36 - SHOCK	291
1. Define shock.	291
2. List the four primary clinical types of shock	291
3. What should you do if a patient is in shock?	291
4. How should fluids be given if a patient is in shock?	291
5. What should you do if fluid challenges fail to raise the blood pressure?	291
6. What are the classic parameters of each type of shock?	291
7. Specify the usual findings in patients with neurogenic shock.	291
8. How do you recognize septic shock?	291
9. What clues suggest cardiogenic shock?	292
10. How do you recognize hypovolemic shock?	292
11. What clues suggest anaphylactic shock?	292
12. What clues suggest pulmonary embolus as a cause of shock?	292
13. How do you recognize pericardial tamponade as a cause of shock?	292
14. Explain toxic shock syndrome.	292
15. What clues suggest Addison disease as a cause of shock?	292
16. What is the most important point to remember if a patient is in shock?	292
17. Discuss the use of dobutamine, dopamine, norepinephrine, and isoproterenol to support blood pressure in the setting of shock.	292
18. What about the use of phenylephrine, epinephrine, and phosphodiesterase inhibitors in the setting of shock?	293
37 - SMOKING	294
1. Does smoking really deserve its own chapter in this book?	294
2. How is smoking related to heart disease?	294
3. What cancers are more likely in smokers?	294
4. Describe the effect of smoking on the lung.	294
5. What about second-hand smoke?	294
6. What other bad things does smoking do?	294
7. True or false: Women who smoke should not take birth control pills.	294
8. So what is the bottom line for the boards?	294
38 - UROLOGY	295
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?	295
2. How does testicular cancer usually present? Describe the major risk factors, histology, and treatment.	295
3. How is renal cell carcinoma diagnosed and treated?	295
4. How is bladder cancer diagnosed and treated?	295
5. What is the classic cause of orchitis? How is it treated? Does it usually cause infertility?	295
6. What are the symptoms and sequelae of benign prostatic hyperplasia (BPH)?	296
7. How is BPH treated?	296
8. How do you recognize and manage acute urinary retention?	296
9. What are the common causes of impotence?	296
10. What are the signs of urethral injury?	296
11. True or false: Urethral injury is a contraindication to passing a Foley catheter	297
12. Distinguish between hydrocele and varicocele.	297
13. Describe the classic findings of nephrolithiasis	297
14. What are the different types of stones? What causes them?	297
15. How is nephrolithiasis treated?	297
16. Define cryptorchidism. When does it occur?	297
17. True or false: It is important to place abdominal testes in the scrotum surgically to decrease the risk of cancer	298
18. Where do the left and right ovarian/testicular veins drain?	298
19. When is kidney transplantation considered for patients with renal disease?	298
20. Who makes the best donor for patients who need a kidney transplant?	298
21. Describe unacceptable kidney donors	298
22. Where is the transplanted kidney placed? What happens to the native kidneys?	298
23. What are the three basic types of rejection with kidney transplantation?	298
24. What causes hyperacute rejection? What is the classic clinical description?	298
25. What causes acute rejection? How does it present? How is it treated?	298
26. What causes chronic rejection? How does it present? How is it treated?	298
27. Discuss the mechanism of action of the commonly used immunosuppressant drugs in transplant medicine	298
28. How do you distinguish the nephrotoxicity of cyclosporine from rejection?	299
29. What risks are associated with immunosuppression?	299
30. Define epispadias and hypospadias. How are they treated?	299
31. Define Potter syndrome. With what is it associated?	299
39 - VASCULAR SURGERY	300
1. What clues suggest carotid stenosis? How is it diagnosed?The classic presentation of carotid stenosis is a transient ischemic attack	300
2. How is carotid stenosis managed?	300
3. What is the most common cause of death during vascular surgery?	300
4. What are the classic findings in a patient with an abdominal aortic aneurysm? How is it evaluated?	300
5. How is an abdominal aortic aneurysm managed? What clues indicate that the aneurysm has ruptured?	300
6. Define Leriche syndrome. For what is it a marker?	301
7. Define claudication. What are the associated physical findings?	301
8. How are patients with claudication managed?	301
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?	302
10. Describe the classic presentation of aortic dissection.	302
11. Describe the classic presentation of chronic mesenteric ischemia	302
12. How does an acute bowel infarction present?	302
13. What causes arteriovenous fistulas and pseudoaneurysms in the extremities? How do you recognize them?	302
14. What are the signs and symptoms of venous insufficiency? How is it treated?	302
15. True or false: A superficial palpable cord is a fairly specific sign of deep venous thrombosis.	302
16. Describe the usual history of a patient with superficial thrombophlebitis. How is it treated?	303
17. Define subclavian steal syndrome. What symptoms does it cause? How is it treated?	303
18. What are the symptoms of thoracic outlet obstruction? How is it treated?	303
40 - VITAMINS AND MINERALS	304
1. Specify the signs and symptoms of the various vitamin deficiencies and toxicities.	304
2. Specify the signs and symptoms of the various mineral deficiencies and toxicities.	305
3. What are the fat-soluble vitamins? In what general category of patients are they deficient?	305
4. What vitamin, mineral, and electrolyte deficiencies are classically seen in alcoholics?	305
5. What is the most common cause of vitamin B12 deficiency?	305
6. What is the classic iatrogenic cause of vitamin B6 deficiency?	305
7. Which medications may cause folate deficiency?	305
8. Which vitamin is a known teratogen?	305
9. Which vitamin should be taken by all sexually active women of reproductive age?	305
10. What are the physical findings of rickets (vitamin D deficiency) in children?	306
11. Which vitamin is given to all newborns?	306
12. Which clotting factors are affected by vitamin K? What is the interaction of vitamin K and the liver?	306
13. Describe the relationship between vitamin K and broad-spectrum antibiotics.	306
14. What is the classic Step 2 description of a vitamin C–deficient patient?	306
INDEX	307
A	307
B	309
C	310
D	313
E	314
F	315
G	316
H	316
I	319
J	319
K	319
L	320
M	320
N	322
O	322
P	323
Q	326
R	326
S	326
T	328
U	329
V	330
W	331
X	331
Z	331

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