HOW U.S. STUDENTS CAN GET THE MOST OUT OF THIS BOOK ❑ Read through “Section I: Guide to the USMLE Step 2 CS,” but skip the “First Aid for the IMG” subsection. ❑ Skim through “Section II: The Encounter.” Pay special attention to the following sub- sections: • “How to Interact with Special Patients” • “Challenging Questions and Situations” ❑ Skim through “Section III: Minicases” to get a feel for the typical clinical presenta- tions. ❑ Read through “Section IV: Practice Cases” with an emphasis on pediatric or tele- phone interview cases. ❑ Cram “Section III: Minicases” 3–4 days prior to the exam. HOW IMGs CAN GET THE MOST OUT OF THIS BOOK ❑ Read through “Section I: Guide to the USMLE Step 2 CS.” Pay special attention to the “First Aid for the IMG” subsection. ❑ Read through “Section II: The Encounter” in detail. Pay special attention to the fol- lowing subsections: • “Taking the History” • “The Physical Exam” • “Closure” • “How to Interact with Special Patients” • “Challenging Questions and Situations” ❑ Study “Section III: Minicases” to get a feel for the typical clinical presentations. ❑ Do “Section IV: Practice Cases” in detail with a study partner who can play the part of a standardized patient. ❑ Cram “Section III: Minicases” 3–4 days prior to the exam. Copyright © 2007 by Tao Le. Click here for terms of use. FIRSTAID ® FOR THE USMLE STEP2CS Second Edition TAO LE, MD, MHS Assistant Clinical Professor of Medicine and Pediatrics Division of Allergy and Clinical Immunology University of Louisville VIKAS BHUSHAN, MD Diagnostic Radiologist MAE SHEIKH-ALI, MD Fellow in Endocrinology Mayo Clinic FADI ABU SHAHIN, MD Resident in Obstetrics and Gynecology Northwestern University McGraw-Hill MEDICAL PUBLISHING DIVISION New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto Copyright © 2007 by Tao Le. All rights reserved. Manufactured in the United States of America. 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This page intentionally left blank For more information about this title, click here CONTENTS Contributors ix Preface xi Acknowledgments xiii How to Contribute xv SECTION I GUIDE TO THE USMLE STEP 2 CS 1 Introduction 2 USMLE Step 2 CS—The Basics 2 Preparing for the Step 2 CS 7 Test-Day Tips 9 First Aid for the IMG 11 SECTION II THE ENCOUNTER 19 Doorway Information 21 Taking the History 22 The Physical Exam 33 Closure 41 How to Interact with Special Patients 43 Challenging Questions and Situations 44 Counseling 51 The Patient Note 54 SECTION III MINICASES 61 Headache 63 Confusion/Memory Loss 65 Depressed Mood 67 Psychosis 68 Dizziness 69 v Loss of Consciousness 70 Numbness/Weakness 71 Fatigue and Sleepiness 73 Night Sweats 74 Insomnia 75 Sore Throat 76 Cough/Shortness of Breath 77 Chest Pain 79 Palpitations 81 Weight Loss 81 Weight Gain 82 Dysphagia 82 Nausea/Vomiting 83 Abdominal Pain 84 Constipation/Diarrhea 88 Upper GI Bleeding 90 Blood in Stool 90 Hematuria 91 Other Urinary Symptoms 92 Erectile Dysfunction 93 Amenorrhea 94 Vaginal Bleeding 95 Vaginal Discharge 96 Dyspareunia 97 Abuse 98 Joint/Limb Pain 99 Low Back Pain 102 Child with Fever 103 Behavioral Problems in Childhood 104 SECTION IV PRACTICE CASES 107 Case 1 48-Year-Old Woman with Abdominal Pain 109 Case 2 21-Year-Old Woman with Abdominal Pain 115 vi Case 3 74-Year-Old Man with Right Arm Pain 122 Case 4 21-Year-Old Man with Sore Throat 128 Case 5 55-Year-Old Man with Bloody Stool 134 Case 6 46-Year-Old Man with Chest Pain 140 Case 7 7-Month-Old Boy with Fever 146 Case 8 18-Month-Old Girl with Fever 152 Case 9 26-Year-Old Man with Cough 158 Case 10 54-Year-Old Woman with Cough 164 Case 11 52-Year-Old Woman with Jaundice 170 Case 12 65-Year-Old Woman with Forgetfulness and Confusion 177 Case 13 56-Year-Old Man Presents for Diabetes Follow-up 184 Case 14 53-Year-Old Man with Dizziness 191 Case 15 46-Year-Old Man with Fatigue 197 Case 16 32-Year-Old Woman with Fatigue 204 Case 17 61-Year-Old Man with Fatigue 211 Case 18 35-Year-Old Woman with Headaches 218 Case 19 57-Year-Old Man with Bloody Urine 224 Case 20 54-Year-Old Man Presents for Hypertension Follow-up 230 Case 21 33-Year-Old Woman with Knee Pain 237 Case 22 66-Year-Old Man with Tremor 244 Case 23 49-Year-Old Man with Loss of Consciousness 250 Case 24 30-Year-Old Woman with Weight Gain 256 Case 25 36-Year-Old Woman with Menstrual Problems 262 Case 26 28-Year-Old Woman with Pain During Sex 268 Case 27 51-Year-Old Man with Back Pain 274 Case 28 6-Month-Old Girl with Diarrhea 280 Case 29 75-Year-Old Man with Hearing Loss 286 Case 30 8-Year-Old Boy with Bed-Wetting 292 Case 31 25-Year-Old Man Presents Following Motor Vehicle Accident 298 Appendix 305 Index 307 About the Authors 319 vii