FIRST AID ™ CASES FOR THE USM LE STEP 2 CK Second Edition TAO LE, MD, MHS Assistant Clinical Professor of Pediatrics and Medicine Division of Allergy and Clinical Immunology Department of Pediatrics University of Louisville ELIZABETH EBY HALVORSON, MD Vanderbilt School of Medicine Class of 2009 Resident Department of Pediatrics Wake Forest University Baptist Medical Center New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto Copyright © 2010, 2007 by Tao Le. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be repro- duced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-162926-3 MHID: 0-07-162926-2 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-162570-8, MHID: 0-07-162570-4. 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This page intentionally left blank CONTENTS Contributing Authors xv Senior Reviewers xvii Preface xix Acknowledgments xxi How to Contribute xxiii Cardiology 1 Case 1: Abdominal Aortic Aneurysm 2 Case 2: Acute Cardiogenic Pulmonary Edema 3 Case 3: Acute Coronary Syndrome 4 Case 4: Aortic Dissection 6 Case 5: Acute Myocardial Infarction—Long-Term Management 8 Case 6: Aortic Regurgitation 9 Case 7: Atrial Fibrillation 10 Case 8: Cardiac Tamponade 12 Case 9: Congestive Heart Failure 14 Case 10: Deep Venous Thrombosis 16 Case 11: Dilated Cardiomyopathy (Alcoholic) 18 Case 12: Diastolic Heart Failure 20 Case 13: Aortic Stenosis 21 Case 14: Hypercholesterolemia 22 Case 15: Hypertension—Essential 23 Case 16: Hypertension—Renal Artery Stenosis 24 Case 17: Hypertrophic Obstructive Cardiomyopathy 26 Case 18: Infective Endocarditis 28 Case 19: Myocardial Infarction 30 Case 20: Papillary Muscle Rupture 32 Case 21: Pericarditis 34 Case 22: Peripheral Vascular Disease 36 Case 23: Mitral Regurgitation 37 Case 24: Second-Degree Heart Block 38 Case 25: Wolff-Parkinson-White Syndrome 40 Dermatology 43 Case 1: Acanthosis Nigricans 44 Case 2: Acne Vulgaris 46 Case 3: Atopic Dermatitis 47 v Case 4: Basal Cell Carcinoma 48 Case 5: Bullous Pemphigoid 50 Case 6: Herpes Simplex 51 Case 7: Hidradenitis Suppurativa 52 Case 8: Kaposi Sarcoma 53 Case 9: Lichen Planus 54 Case 10: Molluscum Contagiosum 56 Case 11: Pemphigus 58 Case 12: Pityriasis Rosea 60 Case 13: Psoriasis 62 Case 14: Stevens-Johnson Syndrome 64 Case 15: Varicella-Zoster Virus 66 Case 16: Tuberous Sclerosis 68 Case 17: Onychomycosis 69 Case 18: Melanoma 70 Endocrinology 71 Case 1: Acromegaly 72 Case 2: Cushing’s Syndrome 74 Case 3: Adrenal Insuffi ciency (Addison’s Disease) 76 Case 4: Diabetes Insipidus 77 Case 5: Diabetes Mellitus, Type 1 78 Case 6: Diabetic Ketoacidosis 79 Case 7: Hyperthyroidism (Graves’ Disease) 80 Case 8: Hypokalemia (Hyperaldosteronism) 82 Case 9: Hyperparathyroidism 84 Case 10: Hypothyroidism (Hashimoto’s Thyroiditis) 85 Case 11: Multiple Endocrine Neoplasia, Type I 86 Case 12: Metabolic Syndrome 88 Case 13: Multiple Endocrine Neoplasia, Type II 89 Case 14: Osteoporosis 90 Case 15: Paget’s Disease of Bone 92 Case 16: Pheochromocytoma 94 Case 17: Syndrome of Inappropriate Antidiuretic Hormone Secretion 96 Case 18: Thyroid Nodule 98 Case 19: Subacute Granulomatous Thyroiditis (de Quervain’s Thyroiditis) 100 Epidemiology and Preventive Medicine 101 Case 1: Bias and Confounding 102 Case 2: Bioterrorism 104 Case 3: Breast Cancer Screening 106 Case 4: Cohort Studies 108 Case 5: Health Care Screening 109 Case 6: Incidence and Prevalence 110 Case 7: Infl uenza Vaccine 112 vi Case 8: Obesity Effects on Health 114 Case 9: Randomized Clinical Trial 116 Case 10: Sensitivity and Specifi city 118 Case 11: Reliability and Validity 120 Case 12: Positive Predictive Value, and Negative Predictive Value 121 Ethics and Legal Issues 123 Case 1: Confi dentially and Disclosure 124 Case 2: End-of-Life Issues (Advance Directives and Withdrawal of Care) 125 Case 3: Informed Consent 126 Case 4: Minors 127 Gastrointestinal 129 Case 1: Acute Cholecystitis 130 Case 2: Acute Pancreatitis 132 Case 3: Achalasia 134 Case 4: Carcinoid 135 Case 5: Colorectal Cancer 136 Case 6: Celiac Disease 138 Case 7: Diverticulitis 139 Case 8: Esophageal Carcinoma 140 Case 9: Gastroesophageal Refl ux Disease 141 Case 10: Hemochromatosis 142 Case 11: Hiatal Hernia 144 Case 12: Infl ammatory Bowel Disease 146 Case 13: Liver Cirrhosis 148 Case 14: Irritable Bowel Syndrome 150 Case 15: Peptic Ulcer Disease 151 Case 16: Primary Sclerosing Cholangitis 152 Case 17: Pseudomembranous Colitis 153 Case 18: Small Bowel Obstruction 154 Case 19: Spontaneous Bacterial Peritonitis 156 Case 20: Viral Hepatitis 157 Case 21: Wilson’s Disease 160 Case 22: Zollinger-Ellison Syndrome 162 Hematology/Oncology 163 Case 1: Acute Myelogenous Leukemia 164 Case 2: Acute Lymphoblastic Leukemia 166 Case 3: Amyloidosis 167 Case 4: Chronic Lymphocytic Leukemia 168 Case 5: Factor V Leiden 170 Case 6: Fanconi’s Anemia 171 Case 7: Glucose-6-Phosphate Dehydrogenase Defi ciency 172 Case 8: Hairy Cell Leukemia 174 vii Case 9: Hemophilia 175 Case 10: Hodgkin’s Lymphoma 176 Case 11: Microcytic Anemia 178 Case 12: Multiple Myeloma 180 Case 13: Idiopathic Thrombocytopenic Purpura 182 Case 14: Neutropenia 183 Case 15: Polycythemia 184 Case 16: Sickle Cell Anemia 186 Case 17: α-Thalassemia 188 Case 18: Hemorrhage, Drug-Induced 190 Case 19: Thrombotic Thrombocytopenic Purpura with Hemolytic Uremic Syndrome 191 Case 20: Porphyria 192 Case 21: Transplant Rejection 193 Case 22: von Willebrand’s Disease 194 Infectious Disease 195 Case 1: AZT-Induced Anemia 196 Case 2: Chlamydia 197 Case 3: Gonococcal Infection 198 Case 4: Histoplasmosis 200 Case 5: Infectious Mononucleosis 201 Case 6: Lyme Disease 202 Case 7: Malaria 204 Case 8: Methicillin-Resistant Staphylococcus aureus 206 Case 9: Necrotizing Fasciitis 208 Case 10: Neutropenic Fever 209 Case 11: Osteomyelitis 210 Case 12: Pneumocystosis 212 Case 13: Endocarditis 214 Case 14: Rocky Mountain Spotted Fever 215 Case 15: Septic Arthritis 216 Case 16: Thrombophlebitis 217 Case 17: Urinary Tract Infection 218 Musculoskeletal and Connective Tissue 219 Case 1: Ankylosing Spondylitis 220 Case 2: Carpal Tunnel Syndrome 222 Case 3: Compartment Syndrome 223 Case 4: Dermatomyositis 224 Case 5: Duchenne Muscular Dystrophy 225 Case 6: Herniated Lumbar Disk 226 Case 7: Gout 228 Case 8: Fibromyalgia 229 Case 9: Juvenile Rheumatic Arthritis 230 Case 10: Legg-Calvé-Perthes Disease 231 viii Case 11: Osteosarcoma 232 Case 12: Rheumatoid Arthritis 234 Case 13: Scleroderma 236 Case 14: Spinal Stenosis 238 Case 15: Systemic Lupus Erythematosus 240 Case 16: Slipped Capital Femoral Epiphysis 242 Case 17: Osteoarthritis 244 Case 18: Takayasu Arteritis 245 Case 19: Temporal Arteritis 246 Case 20: Polymyalgia Rheumatica 247 Neurology 249 Case 1: Amyotrophic Lateral Sclerosis 250 Case 2: Dementia 252 Case 3: Epidural Abscess 254 Case 4: Epidural Hematoma 256 Case 5: Glaucoma 258 Case 6: Glioblastoma Multiforme 260 Case 7: Guillain-Barré Syndrome 262 Case 8: Headache 264 Case 9: Huntington’s Disease 266 Case 10: Infantile Spasms 267 Case 11: Internuclear Ophthalmoplegia 268 Case 12: Benign Positional Paroxysmal Vertigo 269 Case 13: Meningitis 270 Case 14: Multiple Sclerosis 272 Case 15: Myasthenia Gravis 275 Case 16: Partial Complex Seizures 276 Case 17: Stroke 278 Case 18: Parkinson’s Disease 281 Case 19: Subacute Combined Degeneration 282 Case 20: Subarachnoid Hemorrhage 284 Case 21: Subdural Hematoma 286 Case 22: Tonic-Clonic Seizures 288 Case 23: Tabes Dorsalis 290 Obstetrics 291 Case 1: Abortion 292 Case 2: Contraception 293 Case 3: Deep Venous Thrombosis 294 Case 4: Disseminated Intravascular Coagulation 295 Case 5: Ectopic Pregnancy 296 Case 6: Fetal Monitoring 298 Case 7: Gestational Diabetes 300 Case 8: Hydatidiform Mole 302 ix