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DEJA REVIEWTMUSMLE Step 2 CKNOTICEMedicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes intreatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed tobe reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at thetime of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authorsnor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that theinformation contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors oromissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirmthe information contained herein with other sources. For example and in particular, readers are advised to check the productinformation sheet included in the package of each drug they plan to administer to be certain that the information containedin this work is accurate and that changes have not been made in the recommended dose or in the contraindications foradministration. This recommendation is of particular importance in connection with new or infrequently used drugs.

DEJA REVIEWTMUSMLE Step 2 CKSecond EditionJohn H. Naheedy, MDFellow, Pediatric Radiology Department of RadiologyChildren’s Hospital BostonHarvard Medical SchoolBoston, MassachusettsDaniel A. Orringer, MDChief ResidentDepartment of NeurosurgeryUniversity of Michigan Medical SchoolAnn Arbor, MichiganKhashayar Mohebali, MDChief Resident, Clinical InstructorDivision of Plastic and Reconstructive SurgeryDepartment of SurgeryUniversity of California, San Francisco San Francisco, CaliforniaPeter F. Aziz, MDFellow-Pediatric CardiologyDepartment of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphia, PennsylvaniaSusie Lim, MDClinical InstructorObstetrics and GynecologyKaiser Permanente NorthwestPortland, Oregon

Copyright 2010, 2006 by John H. Naheedy, Daniel A. Orringer, Khashayar Mohebali, Peter F. Aziz, and Susie Lim. Allrights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may bereproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior writtenpermission of the publisher.ISBN: 978-0-07-163941-5MHID: 0-07-163941-1The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-162716-0, MHID: 0-07-162716-2.All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of atrademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intentionof infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps.McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use incorporate training programs. To contact a representative please e-mail us at bulksales@mcgraw-hill.com.TERMS OF USEThis is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights inand to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and theright to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify,create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of itwithout McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other useof the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES ORWARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BEOBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSEDTHROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY,EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITYOR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that thefunctions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. NeitherMcGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless ofcause, in the work or for any damages resulting there from. McGraw-Hill has no responsibility for the content of anyinformation accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for anyindirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use thework, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to anyclaim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.To my family and friends, for their love and encouragement; and to my parents, for being an example of everything Iwant to be.—JohnTo Megan, the true author in the family.—DanTo my parents for dedicating and sacrificing their lives to make mine better and to my friends for their invaluableloyalty.—KhashiTo my family, for teaching me that the love of medicine can be genetically inherited; and to the bunker, the sand trap ofmy closest friends, thanks for the inspiration.—PeteTo Michael, Oliver and Soë

—Susie

sChapter 1 INTERNAL MEDICINECardiologyPulmonaryInfectious ermatologyPreventative Medicine, Ethics, and BiostatisticsChapter 2 SURGERYTraumaGeneral SurgeryVascular SurgeryOrthopedicsAbdominal PainMake the DiagnosisChapter 3 NEUROLOGYHeadacheSeizuresCerebral VasculatureIntracranial HemorrhageBrain TumorsCNS InfectionsCognitive DisordersMovement DisordersAmyotrophic Lateral Sclerosis, Multiple Sclerosis, and other Demyelinating DiseasesVertigoNeuromuscular DiseaseOphthalmologySyncopePeripheral NeuropathyLocalize the LesionMake the DiagnosisCHAPTER 4 PSYCHIATRYMood DisordersSuicide and ViolencePsychotic DisordersAnxiety DisordersSomatoform DisordersEating DisordersSubstance AbuseChildhood Disorders

Personality DisordersMiscellaneous Psychiatric DisordersPsychopharmacologyMake the DiagnosisChapter 5 OBSTETRICS AND mGynecologyGynecology OncologyReproductive EndocrinologyUrogynecologyMake the DiagnosisChapter 6 PEDIATRICSGenetic DefectsCongenital Heart DiseaseDevelopmentImmunodefiency SyndromesChild AbuseNeonatologyInfectious ellaneousMake the DiagnosisChapter 7 EMERGENCY MEDICINETraumaToxicologyEnvironmental EmergenciesMake the DiagnosisAppendix ABBREVIATIONSIndex

ContributorsKarla Fredricks, MDResidentDepartment of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphia, PennsylvaniaChapter: PediatricsEmily Y. Fukuchi, MDResidentDepartment of Obstetrics and GynecologyUniversity of California, San FranciscoSan Francisco, CaliforniaChapters: Internal Medicine, SurgeryKaren A. Kinnaman, MDUniversity of Michigan Medical SchoolAnn Arbor, MichiganClass of 2009Chapter: Emergency MedicineVijay Pottathil, MDResidentDepartment of Internal MedicineUniversity of IowaIowa City, IowaChapter: Internal MedicineJayson Sack, MDResidentDepartment of NeurosurgeryUniversity of South FloridaTampa, FloridaChapters: Neurology, PsychiatryMiguel Trujillo, MDResidentDepartment of Obstetrics and GynecologyOregon Health and Science UniversityPortland, OregonChapter: Obstetrics and Gynecology

ReviewersJessica Bury, MPHMedical StudentMayo Clinical College of MedicineClass of 2010Tina Nguyen, MDResident, Emergency MedicineHarbor UCLA Medical CenterUniversity of California Los AngelesSUNY Upstate Medical UniversityClass of 2008

PrefaceDéjà Review USMLE Step 2 CK has been scrutinized and edited to produce a second edition that is even higher yield andeasier to use than the first. Outstanding medical students, who have recently taken Step 2, revised the original text to ensurethe material covered herein is complete and current. The authors, now with a combined 30 years of experience in themedical field, have also edited the manuscript to emphasize the clinical relevance of the core concepts covered in Step 2.We are confident that our efforts have produced one of the most useful guides for Step 2 review available today.Step 2 of the United States Medical Licensing Examination (USMLE) tests the senior medical student’s ability to apply thebasic principles of clinical medicine. However, before you can apply those principles, you must be able to rapidly recall acore body of essential facts. This is why the Déjà Review series is the most efficient, well-organized, portable, and aboveall, high-yield resource to prepare students for the USMLE. As recent graduates who have taken Step 2, we are confidentthat we have compiled a novel review guide that promotes rapid recall of all of the essential facts necessary for success onthis examination. We also realize that a solid foundation in these principles will allow you to make a smooth transition intoyour residency.ORGANIZATIONAll concepts are presented in a question and answer format that covers the key facts on hundreds of common anduncommon diseases. The material is divided into chapters covering the six major divisions of clinical medicine: internalmedicine, surgery, neuroscience, psychiatry, OB/GYN, and pediatrics. We have also included a brief emergency medicinechapter that addresses topics not covered under emergent conditions in each of the other chapters.This question and answer format has several important advantages: It provides a rapid, straightforward way for you to assess your strengths and weaknesses. It allows you to efficiently review and commit to memory a large body of information. It will prepare you for getting “pimped” by residents and attendings on the wards. It offers you a break from tedious, convoluted multiple-choice questions. The clinical vignettes will expose you to the prototypic presentation of diseases classically tested on the USMLEStep 2. It serves as a quick, last-minute review of high-yield facts.The compact, condensed design of the book is conducive to studying on the go, especially during any downtime on thewards.HOW TO USE THIS BOOKRemember, this text is not intended to replace textbooks, course packs, or lectures. It is, however, intended to serve as asupplement to your studies during the third and fourth years of medical school. This text has been sampled and refined by anumber of medical students who found it to be an essential part of their preparation for the USMLE shelf examinations, inaddition to Step 2 itself. We recommend having the text spiral bound to make it more portable and easier to use. Beginusing this book early in your third year by carrying it with you during your clinical clerkships. You may cover up the

answers with the included bookmark and quiz yourself or even your classmates. For a greater challenge, try covering up thequestions!However you choose to study, we hope you find this resource helpful during your preparation for the USMLE Step 2 andthroughout your clinical rotations. Best of luck!John H. Naheedy, MDDaniel A. Orringer, MDKhashayar Mohebali, MDPeter F. Aziz, MDSusie Lim, MD