USMLE Step 2 CS Lecture Notes 2019 USMLE® Step 2 CS Lecture Notes 2019 Patient Cases + Proven Strategies USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Boa.
USMLE® Step 2 CS Lecture Notes 2019 Patient Cases + Proven Strategies USMLE ® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), which neither sponsor nor endorse this product This publication is designed to provide accurate information in regard to the subject matter covered as of its publication date, with the understanding that knowledge and best practice constantly evolve The publisher is not engaged in rendering medical, legal, accounting, or other professional service If medical or legal advice or other expert assistance is required, the services of a competent professional should be sought This publication is not intended for use in clinical practice or the delivery of medical care To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book © 2019 by Kaplan, Inc Published by Kaplan Medical, a division of Kaplan, Inc 750 Third Avenue New York, NY 10017 All rights reserved under International and Pan-American Copyright Conventions By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this eBook on screen No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of the publisher ISBN: 978-1-5062-4310-8 Editors Mariana Cuceu, MD Sherine Elsayegh, MD Phyllis Levine, MD Contributor Edward Kalpas, MD Curriculum Editor Ilonka S Rincon Portas, MD HEA Associate Director of Facilitation and Clinical Skills Kaplan Medical We want to hear what you think What do you like or not like about the Notes? Please email us at medfeedback@kaplan.com Table of Contents Part I: USMLE ® Step 2 Clinical Skills Exam Chapter 1: About the USMLE Step 2 Clinical Skills (CS) Exam Part II: Communication and Interpersonal Skills (CIS) Chapter 2: Communication and Interpersonal Skills (CIS) Part III: Spoken English Proficiency (SEP) Chapter 3: Spoken English Proficiency (SEP) Part IV: Integrated Clinical Encounter (ICE) Chapter 4: Focused History-Taking Chapter 5: Focused Physical Exam Chapter 6: Patient Note Chapter 7: Differential Diagnosis Part V: Putting It All Together Chapter 8: Putting It All Together: CIS, SEP, and ICE Case 1: Fatigue, Cough, and Chest Pain Case 2: Back Pain and Fever Case 3: Bloody Stools Case 4: Chest Pain Case 5: Irregular Periods Case 6: Sore Throat Case 7: Hearing Loss Case 8: “Something Is Wrong with My Dad” Case 9: Severe Headache Case 10: Severe Abdominal Pain Case 11: Chronic Diarrhea Case 12: Abdominal Pain and Yellow Skin Case 13: Cough Case 14: Blood in Urine Case 15: Pediatric Diarrhea Case 16: Dizziness Case 17: Difficulty Swallowing Case 18: Shortness of Breath Case 19: Adult Nosebleed Case 20: Adolescent Weight Loss Case 21: Pediatric Vomiting and Diarrhea Case 22: Lack of Energy Case 23: Chest Pain Case 24: Knee and Great Toe Pain Case 25: Severe Chest Pain Case 26: Confusion and Blurry Vision Case 27: Life Insurance Request Case 28: Pre-Employment Physical Case 29: Medication Refill Case 30: Breaking Bad News Case 31: Weakness Part VI: Appendix Common Medical Abbreviations PART I USMLE ® Step 2 Clinical Skills Exam About the USMLE Step 2 Clinical Skills (CS) Exam The 3-step USMLE examination required for medical licensure in the United States assesses a physician’s ability to (a) apply knowledge, concepts, and principles, and (b) demonstrate fundamental patient-centered skills which constitute the basis of safe and effective patient care Each of the steps complements the others Step 1 assesses whether one can understand and apply important concepts of the sciences basic to the practice of medicine It is based on an integrated content outline which organizes basic science material along 2 dimensions: system and process It is a 1-day multiple-choice exam Step assesses whether one can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision It includes emphasis on health promotion and disease prevention There are 2 components of Step 2 Step 2 CK (Clinical Knowledge) is based on an integrated content outline that organizes clinical science material along 2 dimensions: physician task and disease category Step 2 CK uses a 1-day multiplechoice format to test clinical knowledge Step 2 CS (Clinical Skills) is a “hands on” exam to test one’s ability to gather information from patients, perform physical examinations, and communicate findings to patients and colleagues Step 3 assesses whether one can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings It is the final examination in the USMLE sequence DIAGNOSIS 3 BOTULISM History Findings Physical Exam Findings Progressive fatigue Ptosis Blurry vision/diplopia Normal plantar reflex Jaw weakness and weakness with chewing Slurred speech Diagnostic Studies Acetylcholine receptor antibodies Muscle specific tyrosine kinase antibodies, anti-striated muscle antibodies (anti-SM) Botulinum toxin blood test FVC, negative inspiratory force (NIF) Tensilon test EMG, NCS Chest x-ray PART VI Appendix Common Medical Abbreviations Use abbreviations sparingly For clarity, it is always better to spell out the acronym or abbreviation 4Q 4 quadrants yo or y/o year old m male f female b black w white L left R right hx history h/o history of c/o complaining/complaints of c with NL normal limits s without WNL within normal limits Ø without or no + positive – negative A&0x3 alert & oriented to person, place, and time AA Alcoholics Anonymous AAA abdominal aortic aneurysm abd abdomen ABG arterial blood gas ACTH adrenocorticotropic hormone ADH antidiuretic hormone AFB acid-fast bacilli afib atrial fibrillation AIDS acquired immune deficiency syndrome Alb albumin Alk phos alkaline phosphatase ALS amyotrophic lateral sclerosis ant anterior A&P auscultation and percussion ARDS acute respiratory distress syndrome AV arteriovenous AP anteroposterior approx approximately ASA aspirin b/l bilateral BID twice a day BM bowel movement BP blood pressure BPH benign prostatic hypertrophy BUN blood urea nitrogen Bx biopsy Ca calcium CA cancer CABG coronary artery bypass grafting CAD coronary artery disease cath catheterization CBC complete blood count cc chief complaint CCU cardiac care unit CF cystic fibrosis Chemo chemotherapy CHF congestive heart failure chol cholesterol cig cigarettes Cl chloride CMV cytomegalovirus CN cranial nerve CNS central nervous system c/o complains of COPD chronic obstructive pulmonary disease CPK creatine phosphokinase CPR cardiopulmonary resuscitation Cr creatinine C&S, C/S culture and sensitivity CSF cerebrospinal fluid CT computed tomography CTA clear to auscultation CVA cerebrovascular accident CVP central venous pressure Cx cervix CXR chest x-ray D&C dilatation and curettage d/c discontinue DI diabetes insipidus DM diabetes mellitus DTR deep tendon reflexes DVT deep vein thrombosis dx diagnosis ECG/EKG electrocardiogram EEG electroencephalogram ED emergency department EGD esophagogastroduodenoscopy EMG electromyogram EMT emergency medical technician ENT ears, nose, and throat EOMI extraocular muscles intact ER emergency room ERCP endoscopic cholangiopancreatography ESR erythrocyte sedimentation rate EtOH alcohol ext extremities FBS fasting blood sugar Fe iron FSH follicle stimulating hormone FH family history FUO fever of unknown origin Fx fracture GA general appearance retrograde GERD gastroesophageal reflux disorder GI gastrointestinal Glu glucose GSW gunshot wound GTT glucose tolerance test GU genitourinary HA headache Hct hematocrit HEENT head, eyes, ears, nose, and throat Hgb hemoglobin HIV human immunodeficiency virus HRT hormone replacement therapy HPI history of present illness H pylori Heliobacter pylori HR heart rate HSM hepatosplenomegaly HTN hypertension IBS irritable bowel syndrome ICU intensive care unit IDDM insulin-dependent diabetes mellitus IM intramuscularly INR international ratio IUD intrauterine device IV intravenously JVD jugular venous distension JVP jugular venous pressure K potassium KUB kidney, ureter, and bladder LAD lymphadenopathy or left anterior descending LDH lactate dehydrogenase LE lower extremity LH luteinizing hormone LLL left lower lobe LLQ left lower quadrant LMP last menstrual period loc loss of consciousness LP lumbar puncture LUL left upper lobe LUQ left upper quadrant M, R, G murmurs, rubs, or gallops meds medications mets metastases MI myocardial infarction MRI magnetic resonance imaging MS multiple scleroris MVA motor vehicle accident MVP mitral valve prolapse Na sodium NAD no apparent distress NC/AT normocephalic atraumatic neg negative neuro neurologic NIDDM non–insulin-dependent diabetes mellitus NKA no known allergies NKDA no known drug allergy NPH normal pressure hydrocephalus NSR normal sinus rhythm N/V nausea and vomiting occ occasional OCP oral contraceptives OD right eye OS left eye OTC over-the-counter PA posteroanterior PCP primary care provider PCP pneumocystis carinii pneumonia PE physical examination PE pulmonary embolus PERRLA pupils are equal, round, and reactive to light and accommodation PET scan positron emission tomography PFTs pulmonary function tests PID pelvic inflammatory disease PMI point of maximum impulse po orally pos positive PPD packs per day PPD purified protein derivative PRN as needed PSA prostatic specific antigen PT prothrombin time PTT partial prothrombin time PUD peptic ulcer disease PVD peripheral vascular disease r/o rule out RA rheumatoid arthritis RBC red blood cells RLL right lower lobe RLQ right lower quadrant RMG rubs, murmurs, or gallops ROM range of motion RR respiratory rate RRR regular rate and rhythm RUL right upper lobe RUQ right upper quadrant Rx prescription SH social history SLE systemic lupus erythematosus SLR straight leg raising sob shortness of breath SQ subcutaneous Staph staphylococcus STD sexually transmitted disease Strep streptococcus T temperature TB tuberculosis TIA transient ischemic attack TSH thyroid stimulating hormone TURP transurethral prostatectomy TVF tactile vocal fremitus U/A urinalysis UE upper extremity UGI upper gastrointestinal URI upper respiratory tract infection U/S ultrasound UTI urinary tract infection vag vaginal VCUG voiding cystourethrogram VDRL Venereal Disease Research Laboratory vs vital signs w/ with WBC white blood cells wks weeks WNL within normal limits wt weight Behind each champion, you will find a great coach 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Step 2 CS Lecture Notes 20 19 Patient Cases + Proven Strategies USMLE ® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), which neither sponsor nor endorse this product... Common Medical Abbreviations PART I USMLE ® Step 2 Clinical Skills Exam About the USMLE Step 2 Clinical Skills (CS) Exam The 3 -step USMLE examination required for medical licensure in the United States... Case 19: Adult Nosebleed Case 20 : Adolescent Weight Loss Case 21 : Pediatric Vomiting and Diarrhea Case 22 : Lack of Energy Case 23 : Chest Pain Case 24 : Knee and Great Toe Pain Case 25 : Severe Chest Pain Case 26 : Confusion and Blurry Vision