Master the Boards USMLE Step 2 CK, 6th Edition (2021)

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Master the BoardsUSMLE®Step 2 CKSixth EditionConrad Fischer, MD

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OTHER TITLES BY CONRAD FISCHERMaster the Boards USMLE®Step 3OTHER TITLES FROM KAPLAN MEDICALUSMLE Step 2 CK Lecture NotesDr. Pestana’s Surgery Notes

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USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the NationalBoard of Medical Examiners (NBME), which neither sponsor nor endorse this product.This publication is designed to provide accurate information in regard to the subject mattercovered as of its publication date, with the understanding that knowledge and best practiceconstantly evolve. The publisher is not engaged in rendering medical, legal, accounting, or otherprofessional service. If medical or legal advice or other expert assistance is required, the servicesof a competent professional should be sought. This publication is not intended for use in clinicalpractice or the delivery of medical care. To the fullest extent of the law, neither the publisher northe editors assume any liability for any injury and/or damage to persons or property arising out ofor related to any use of the material contained in this book.© 2021, 2019, 2017, 2015, 2013, 2011 by Conrad Fischer, MDThe authors of the following sections have granted Conrad Fischer, MD, and Kaplan Publishingexclusive use of their work:All rights reserved. The text and illustrations of this publication, or any part thereof, may not bereproduced in any manner whatsoever without written permission from the publisher.10 9 8 7 6 5 4 3 2 1ISBN: 978-1-5062-5459-3Kaplan Publishing print books are available at special quantity discounts to use for salespromotions, employee premiums, or educational purposes. For more information or to purchasebooks, please call the Simon & Schuster special sales department at 866-506-1949.Victoria Hastings, DO, MPH, MS: Part 8, Obstetrics, and Part 9, GynecologyNiket Sonpal, MD: Part 4, Surgery; Part 7, Pediatrics; and Part 16, Patient SafetyAlina Gonzales-Mayo, MD, Mena Mirhom, MD, and Niket Sonpal, MD: Part 12, PsychiatryPhilip J. Koehler III, DO, MS: Part 5, Sports MedicinePublished by Kaplan Publishing, a division of Kaplan, Inc.750 Third AvenueNew York, NY 10017

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Table of Contents

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Title PageOther TitlesCopyright PageTable of ContentsAbout the AuthorsAcknowledgmentsIntroductionPART 1:Internal MedicineChapter 1:GastroenterologyChapter 2:EndocrinologyChapter 3:CardiologyChapter 4:PulmonologyChapter 5:Infectious DiseasesChapter 6:Fungal, Tropical, and Animal-BorneDiseasesChapter 7:Allergy and ImmunologyChapter 8:RheumatologyChapter 9:HematologyChapter 10:NeurologyChapter 11:NephrologyChapter 12:OncologyPART 2:Preventive MedicinePART 3:DermatologyPART 4:SurgeryPART 5:Sports MedicinePART 6:Ear, Nose, and Throat (ENT)PART 7:PediatricsPART 8:ObstetricsPART 9:GynecologyPART 10:RadiologyPART 11:OphthalmologyPART 12:PsychiatryPART 13:Emergency MedicinePART 14:EthicsPART 15:Biostatistics and EpidemiologyPART 16:Patient Safety

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For Test Changes or Late-BreakingDevelopmentskaptest.com/retail-book-corrections-and-updatesThe material in this book is up-to-date at the time of publication.However, the Federation of State Medical Boards (FSMB) and the NationalBoard of Medical Examiners (NBME) may have instituted changes in thetest aer this book was published. Be sure to carefully read the materialsyou receive when you register for the test. If there are any important late-breaking developments—or any changes or corrections to the Kaplan testpreparation materials in this book—we will post that information onlineat kaptest.com/retail-book-corrections-and-updates.

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Additional resources available athttps://www.kaptest.com/usmle-step-2ck/free/mtb-step-2ck-qbank-free-trial

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About the AuthorsConrad Fischer, MD,is program director of the Internal Medicineresidency program at Brookdale University Hospital and Medical Center,as well as professor of medicine at Touro College of Osteopathic Medicinein New York City. He teaches USMLE Steps 1, 2, and 3; Internal MedicineBoard Review and Attending Recertification; and USMLE Step 1 -Physiology.

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SECTION AUTHORSNiket Sonpal, MD,is assistant professor at Touro College of OsteopathicMedicine in New York City and a fellow of the American College ofPhysicians. He is a practicing gastroenterologist and hepatologistfocusing on men’s health and women’s health and co-author of the best-selling booksMaster the Boards: USMLE Step 2 CKandMaster the Boards:USMLE Step 3. Dr. Sonpal teaches USMLE, COMLEX, and American Boardof Internal Medicine review.Victoria Hastings, DO, MPH, MS,is a resident physician in obstetrics andgynecology at New York Presbyterian Brooklyn Methodist Hospital. Shereceived her master of public health degree in biostatistics andepidemiology from Saint Louis University and her doctorate inosteopathic medicine with a master of science from NYIT College ofMedicine. She is section editor of the obstetrics and gynecology chaptersinMaster the Boards: USMLE Step 3. She teaches obstetrics, gynecology,and biostatistics for USMLE Steps 1, 2, and 3.Philip J. Koehler III, DO, MS,is a resident in physical medicine andrehabilitation. He completed an Osteopathic Manipulative Medicine(OMM) teaching fellowship at the Philadelphia College of OsteopathicMedicine.Previous contributions by Elizabeth August, MD, Alina Gonzalez-Mayo,MD, and Mena Mirhom, MD.

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Peer Reviewers/Section EditorsPharmacology(throughout the book): Ed El SayedCardiology: YuryMalyshev, Hal ChadowDermatology: Niket SonpalEmergencyMedicine: Sandra ScottEndocrinology: Chris ParasFungal, Tropical, and Animal-Borne Diseases: Richard CofskyGastroenterology: Niket SonpalHematology: Hamza MinhasInfectious Diseases: Richard CofskyNephrology: Muhammad BakhtyarKhanNeurology: Alexander AndreevObstetrics/Gynecolog: Victoria HastingsOncology: Hamza MinhasPediatrics: Conrad FischerPreventive Medicine: Herman LebovitchPsychiatry: Mena Mirhom,Peter YouPulmonology: Seth Wenig, Sonu ShaniRadiology: NiketSonpalRheumatology: Chris ParasSports Medicine: Philip KoehlerSurgery: Conrad Fischer

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AcknowledgmentsThe authors wish to acknowledge the expert attention to detail of Dr. AnaFranceschi and Dr. Gabriel Vílchez Molina.Niket Sonpal wishes to acknowledge Mr. Navin Sonpal, Mahendra Patel,Raj Patel, and Dr. Mukul Arya for their unwavering support, hope, andstance by me through thick and thin. Without them my path to becominga physician would not have been possible.Victoria Hastings wishes to acknowledge her husband, who lis me upand pushes me to achieve great things.

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IntroductionAbout the USMLE Step 2 CK ExaminationThe USMLE Step 2 CK (Clinical Knowledge) is typically taken as thesecond test in a series of 3 certifying examinations that are necessary toobtain a license to practice medicine in the United States.Step 2 CK isusually taken in medical school between the end of years 3 and 4.The most common mistake in preparation is doing the samesingle question bank over and over! Doas manydifferentquestions as you can.Step 2 CK is more clinically based than Step 1. Although there is norequirement to take Step 1 before Step 2 CK, that is the typicalsequence for U.S. graduates. According to the test maker, thequestions on Step 2 CK measure the ability to apply medicalknowledge, skills, and understanding of clinical science as they pertainto patient care (under supervision), with emphasis on healthpromotion and disease prevention.Step 2 CS (Clinical Skills) is the second part of the USMLE Step 2 exam;it uses model patients to test the ability to perform in a real clinicalsetting.

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Step 2 CK Examination StructureUSMLE Step 2 CK is a computer-based test that will not exceed 318questions taken over a 9-hour period.USMLE Step 2 CK uses 2 types of questions: single best answer (mostcommon type) and sequential.USMLE Step 2 CK questions have to be unequivocally clear. If anarea is controversial, USMLE will avoid it, and ask only what isclear. The exam will not trick you.SINGLE BEST ANSWERThe majority of Step 2 CK questions are multiple-choice questions thatfollow a clinical vignette. The basic structure is:Eight blocks, each one 60 minutesOnce you have completed a block or 60 minutes has run out, you willnot be able to go back to any questions in that block.The total break time throughout the day will be 45 minutes. Thecomputer will keep track of your break time. Be sure not to exceed the45 minutes or you will be penalized by having time deducted fromyour last block of the test.

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There are 5 basic question types (and consequently, the very structurearound which this book is created):When the question reads: “What is the most appropriate next step inmanagement?” this can refer to a test or a treatment. The phrase “mostappropriate next step” can also be referred to as action, management, orsimply what should you do next?The phrase “most appropriate” can be very difficult to interpret. Itis not always clear whether it means “first,” “best,” or “mostaccurate.”The most frequently asked question on Step 2 CK is “What is the mostlikely diagnosis?” As a result, many of the chapters in this book have aspecific section labeled “What is the most likely diagnosis?” One of themany unique attributes of theMaster the Boardsformat is that theHistory of present illnessPhysical examinationPossibly laboratory and radiologic testsWhat is themost likely diagnosis?What is thebest initial diagnostic test?What is themost accurate diagnostic test?Whatphysical findingis most likely to be associated with this patient?What is thebest initial therapy?

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