http://ebook2book.ir/ USMLE® STEP 2 CK: INTERNAL MEDICINE Lecture Notes http://ebook2book.ir/ 2019 http://ebook2book.ir/ USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), neither of which sponsors or endorses 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 © 2018 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-13: 978-1-5062-3625-4 http://ebook2book.ir/ Table of Contents USMLE Step 2 CK Lecture Notes 2019: Internal Medicine Cover Title Page Copyright Editors Chapter 1: Preventive Medicine Cancer Screening Travel Medicine Immunizations Smoking Osteoporosis Abdominal Aortic Aneurysm Hypertension, Diabetes Mellitus, and Hypercholesterolemia Alcohol Abuse Violence and Injury Chapter 2: Endocrinology Diseases of the Pituitary Gland Diseases of the Anterior Pituitary Diseases of the Posterior Pituitary Diseases of the Thyroid Gland Diseases of the Parathyroid Glands Disorders of Carbohydrate Metabolism Diseases of the Adrenal Gland Diseases of the Testes, Hypogonadism Chapter 3: Rheumatology Evaluating a Patient with Arthritis Tests in Rheumatologic Disease Rheumatoid Arthritis Systemic Lupus Erythematosus Drug-Induced Lupus Scleroderma Sjögren Syndrome Seronegative Arthropathies, Spondyloarthropathies Osteoarthritis http://ebook2book.ir/ Crystal-Induced Arthropathies Septic Arthritis Vasculitis Syndromes Inflammatory Myopathies Chapter 4: Gastroenterology Diseases of the Esophagus Epigastric Pain Inflammatory Bowel Disease Diarrhea Malabsorption Syndromes Diverticular Disease Constipation Colon Cancer Gastrointestinal Bleeding Acute Pancreatitis Autoimmune Pancreatitis Liver Disease and Cirrhosis Chapter 5: Cardiology Acute Chest Pain/Chest Discomfort Ischemic Heart Disease Acute Coronary Syndrome Congestive Heart Failure (CHF) Valvular Heart Disease Cardiomyopathies Pericardial Disease Rate and Rhythm Disturbances Drugs for Cardiovascular Disease Shock Syndromes Chapter 6: Hematology Anemia Microcytic Anemia Macrocytic Anemia Hemolytic Anemia Aplastic Anemia Acute Leukemia Chronic Leukemia Plasma Cell Disorders Lymphoma Platelet Disorders http://ebook2book.ir/ Coagulopathy Chapter 7: Infectious Diseases Antibiotics Central Nervous System Infections Head and Neck Infections Lung Infections Gastrointestinal Infections Acute Viral Hepatic Infections Genital and Sexually Transmitted Infections Urinary Tract Infections Bone and Joint Infections Carditis Lyme Disease Rocky Mountain Spotted Fever Acquired Immune Deficiency Syndrome (AIDS) Toxic Shock Syndrome Leptospirosis Tropical Diseases Tetanus Aspergillosis Chapter 8: Nephrology Diagnostic Testing in Renal Disease Acute Kidney Injury Glomerular Diseases End-Stage Renal Disease Nephrolithiasis Cystic Kidney Disease Hypertension Fluid and Electrolyte Disorders Acid/Base Disturbances Chapter 9: Pulmonology Diagnostic Tests Disturbances in Gas Exchange Chest Radiography Ventilation Obstructive Diseases Interstitial Lung Disease Pulmonary Thromboembolism Acute Respiratory Distress Syndrome (ARDS) http://ebook2book.ir/ Sleep Apnea Lung Cancer Atelectasis Chapter 10: Emergency Medicine Basic Life Support (Cardiopulmonary Resuscitation) Cardiac Dysrhythmias Toxicology Acetaminophen Alcohols (Methanol and Ethylene Glycol) Carbon Monoxide (CO) Caustics/Corrosives (Acids and Alkali) Drugs of Abuse Heavy Metals Lithium Salicylates Digoxin Tricyclic Antidepressants Anticholinergic Poisoning Organophosphates Alcohol Head Trauma Subarachnoid Hemorrhage Burns Radiation Injuries Drowning Anaphylaxis Venomous Bites and Stings Chapter 11: Neurology Spinal Cord Compression Syringomyelia Subacute Combined Degeneration Anterior Spinal Artery Occlusion Brown-Séquard Syndrome Cerebrovascular Accident (CVA) Seizures and Epilepsy Vertigo and Dizziness Disorders Associated with Headache Guillain-Barré Syndrome (GBS) Myasthenia Gravis http://ebook2book.ir/ Amyotrophic Lateral Sclerosis Multiple Sclerosis Dementia Huntington Disease Parkinson Disease Benign Essential Tremor Restless Leg Syndrome Chapter 12: Dermatology Bullous/Blistering Diseases Drug Eruptions/Hypersensitivity Infections Parasitic Infections Toxin-Mediated Diseases Benign and Precancerous Lesions Malignant Diseases Scaling Disorders (Eczema)/Papulosquamous Dermatitis Decubitus (Pressure) Ulcers Hair Acne Chapter 13: Radiology/Imaging Chest X-Ray Common Disorders Seen on Chest X-Ray Abdominal X-Ray PET Scanning Central Nervous System Visualization Bone Imaging Chapter 14: Ophthalmology Retinal Diseases Glaucoma Cataracts Conjunctival Diseases Keratitis Periorbital Cellulitis Uveitis http://ebook2book.ir/ Wet-type ARMD is treated with VEGF inhibitors ranibizumab and bevacizumab http://ebook2book.ir/ CENTRAL RETINAL ARTERY OCCLUSION There are various etiologies of central retinal artery occlusion: carotid artery embolic disease, temporal arteritis, cardiac thrombi or myxoma, or any of the usual causes of thrombophilia such as factor V Leiden mutation Patients present with a sudden, painless, unilateral loss of vision There is no redness of the eye Ophthalmoscopy reveals a pale retina, with overall diminished perfusion and a “cherry-red” spot at the fovea There is also “boxcar” segmentation of the blood in the veins To diagnose, patients should undergo evaluation with carotid artery imaging, echocardiography, and evaluation for thrombophilia Central retinal artery occlusion is managed in much the same way as for a stroke (cardiovascular accident or transient ischemia attack Lay the patient flat Supply oxygen and ocular massage in an attempt to unobstruct the vessel Also consider acetazolamide and thrombolytics Anterior chamber paracentesis has been used to try to decompress the pressure in the eye and dislodge the embolus http://ebook2book.ir/ CENTRAL RETINAL VEIN OCCLUSION Patients with retinal vein occlusion are at particularly high risk for developing glaucoma They should be monitored for the possible use of laser photocoagulation Younger patients should be investigated for inherited causes of thrombophilia, such as factor V mutation, protein C deficiency, and antiphospholipid syndromes Presentation is similar to retinal artery occlusion: sudden loss of vision without pain, redness, or abnormality in pupillary dilation Ocular examination by funduscopy reveals disk swelling, venous dilation, tortuosity, and retinal hemorrhages Retinal hemorrhage is the main way to distinguish venous obstruction from arterial obstruction You can’t have a hemorrhage in the retina if you don’t have blood getting into the eye There is no specific treatment for retinal vein obstruction http://ebook2book.ir/ Clinical Recall Which of the following fundoscopic findings is representative of proliferative diabetic retinopathy? ) Dilation of veins, microaneurysms, retinal edema, and retinal hemorrhages ) ) Vitreal hemorrhages with optic nerve concealment by neovascular growth Floaters, red cells in the vitreous with a wrinkled, detached retina ) Yellowish, small, and granular extracellular subretinal deposits ) A pale retina with diminished perfusion and a cherry-red spot at the fovea Answer: B http://ebook2book.ir/ GLAUCOMA The precise etiology of glaucoma is not clearly known In open-angle glaucoma, the precise etiology of the decrease in the outward flow of aqueous fluid has never been elucidated Thus, the precise cause of the increase in intraocular pressure is not known Acute angle-closure glaucoma can be precipitated by anticholinergic medications such as ipratropium bromide or tricyclic antidepressants; however, most people with narrow angles in their anterior chambers never develop glaucoma http://ebook2book.ir/ OPEN-ANGLE GLAUCOMA This disorder accounts for >90% of cases of glaucoma Patients are asymptomatic for a long time, and this is the reason why it is important to screen older patients The first clue to the diagnosis is a cup-to-disk ratio >0.5, which should be confirmed by repeated elevation in intraocular pressure as determined by tonometry Treatment is based on decreasing the production of aqueous humor while increasing its drainage Medications that decrease the production of aqueous humor are betablockers (timolol, betaxolol, levobunolol), alpha-adrenergic agonists (apraclonidine, brimonidine), and carbonic anhydrase inhibitors (dorzolamide and brinzolamide) Medications that increase the outflow of the humor are prostaglandin analogs such as topical latanoprost, travoprost, and bimatoprost (The prostaglandin analogs can lead to a change in the color of the eyes and a darkening of the eyelid Pilocarpine is a miotic agent that constricts the pupil to allow greater outflow of the aqueous humor.) If maximal medical therapy is ineffective in controlling intraocular pressure, consider surgery Laser trabeculoplasty and surgical trabeculectomy are the most commonly performed procedures http://ebook2book.ir/ CLOSED-ANGLE GLAUCOMA Closed-angle glaucoma is often an ophthalmologic emergency precipitated by the use of medications with anticholinergic properties It presents with an eye that is red, painful, hard to palpation, and associated with a fixed midpoint pupil The cornea has a hazy cloudiness, and there is marked diminishment of visual acuity Treatment of acute angle-closure glaucoma is an ophthalmologic emergency Use IV acetazolamide, urea, and osmotic diuretics such as mannitol and glycerol Pilocarpine can be used to open the canal of Schlemm, and beta-blockers are used to decrease humor production If these medical therapies are ineffective, laser trabeculoplasty can be performed http://ebook2book.ir/ CATARACTS Cataracts are opacifications of the lens They are slowly progressive, with a blurring of vision occurring over months to years Glare from the headlights of cars is particularly a problem when driving at night Color perception is reduced in general The etiology of cataracts is unknown, although there is an association with cigarette smoking Mature cataracts can be easily seen on physical examination Earlier-stage disease is seen with a slit lamp There is no medical therapy for cataracts Surgical removal with the placement of an intraocular lens is the standard of care http://ebook2book.ir/ CONJUNCTIVAL DISEASES CONJUNCTIVITIS Conjunctivitis can occur from any infectious agent, including bacteria, viruses, and fungi Bacterial conjunctivitis is often unilateral and presents with a marked purulent discharge from the eye This is most symptomatic in the morning, when the patient’s eye has developed a significant crust overnight, sometimes making it hard to open the eye There is less itching compared with viral conjunctivitis Although the eye can be red, there is a normally reactive pupil, normal ocular pressure, and no impairment of visual acuity Viral conjunctivitis is often bilateral, with severe ocular itching and enlarged preauricular adenopathy The eyes are also red, but there is a normally reactive pupil and no photophobia Treat bacterial conjunctivitis with a topical antibiotic such as erythromycin ointment, sulfacetamide drops, or topical fluoroquinolones Treat viral conjunctivitis symptomatically with topical antihistamine/decongestants There is no specific microbiologic treatment http://ebook2book.ir/ SUBCONJUNCTIVAL HEMORRHAGE Subconjunctival hemorrhage is more dangerous in its appearance than in its actual damage to vision or even the eye itself The most common cause is trauma, particularly in the presence of thrombocytopenia The collection of the hematoma stops at the limbus, which is the anatomic connection between the conjunctiva and the cornea Because this prevents the blood from covering the cornea, there is no impairment of vision There is no intraocular or intravitreal damage and hence no impairment of vision No specific therapy is necessary http://ebook2book.ir/ KERATITIS Keratitis refers to any infection or inflammation of the cornea Usually, keratitis happens as a result of trauma to the cornea with the inoculation of bacterial or fungal elements into the cornea http://ebook2book.ir/ HERPES SIMPLEX KERATITIS Herpes simplex keratitis is characterized by severe pain in the eye and a sensation that something is caught under the eyelid Diagnosis is based on finding a characteristic dendritic pattern over the cornea on fluorescein staining of the eye with examination under a blue light Treatment is oral acyclovir, famciclovir, or valacyclovir, plus topical trifluridine 1% solution or idoxuridine Note that oral and topical steroids should never be used in an attempt to relieve the inflammation of herpes simplex keratitis That can markedly worsen the growth of the virus (acting as "fertilizer") http://ebook2book.ir/ PERIORBITAL CELLULITIS Cellulitis is caused by Staphylococcus aureus or Streptococcus invading the dermis and subcutaneous tissues surrounding the eye Treatment is an antistaphylococcal penicillin such as oxacillin or nafcillin In cases of penicillin allergy, use a first-generation cephalosporin such as cefazolin http://ebook2book.ir/ UVEITIS Uveitis occurs when the structures of the uveal tract (the iris, ciliary body, and choroid) become inflamed It is caused by various systemic inflammatory conditions, such as psoriasis, sarcoidosis, syphilis, Reiter syndrome, and IBD Uveitis leads to a painful, red eye with marked photophobia One clue to diagnosis is pain that occurs even when shining a light in the unaffected eye This is because of the consensual light reflex in which the affected pupil will constrict even when light is shined in the normal eye Diagnosis is made by slit lamp examination Inflammation of the iris, ciliary body, and choroid is visible Inflammatory cells may accumulate on the inside of the cornea after they precipitate out of the aqueous humor, rather like an accumulating snowfall These focal collections are called keratic precipitates Basic management, despite the varied underlying conditions, is to treat with topical or systemic steroids http://ebook2book.ir/ Clinical Recall A 32-year-old man presents with redness of his eyes, marked photophobia, and normal conjunctiva Which of the following is the best initial treatment? ) Topical corticosteroids ) ) Topical oxacillin Topical acyclovir ) Oral idoxuridine ) Topical trifluridine Answer: A http://ebook2book.ir/ ... ISBN-13: 978-1-50 62- 3 625 -4 http://ebook2book.ir/ Table of Contents USMLE Step 2 CK Lecture Notes 20 19: Internal Medicine Cover Title Page Copyright Editors Chapter 1: Preventive Medicine Cancer Screening... USMLE? ? STEP 2 CK: INTERNAL MEDICINE Lecture Notes http://ebook2book.ir/ 20 19 http://ebook2book.ir/ USMLE? ? is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of... Assistant Professor of Internal Medicine, Department of Hospital Medicine Associate Program Director of Education for Elmhurst Site Icahn School of Medicine at Mt Sinai Internal Medicine Clerkship and Sub-Internship Site Director