Crush the Boards

The Ultimate USMLE Step 2 Review

Adam Brochert, M.D.


Department of Internal Medicine Eastern Virginia Medical School Norfolk, Virginia


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Chapter Subject Page

Introduction vii

2 Cardiovascular Medicine '- 17

3 Pulmonology 25

4 Gastroenterology 29

5 Endocrinology 39

6 Nephrology 43

7 Rheumatology 47

8 Hematology 51

10 Infectious Disease 69

11 Dermatology 79

12 Neurology 87

13 Immunology 95

14 Genetics 99

15 Geriatrics 103

16 Preventive Medicine, Epidemiology, and Biostatistics 105

17 Psychiatry 113

18 Gynecology 123

19 Obstetrics 131

20 General Surgery 147

21 Ophthalmology 155

Chapter Subject Page

22 Orthopedic Surgery 161

23 Neurosurgery 165

24 Ear, Nose, and Throat Surgery 169

25 Vascular Surgery . 173

26 Urology 175

27 Emergency Medicine 179

28 Pediatrics 181

29 Pharmacology 185

30 Radiology 191

31 Laboratory Medicine 193

32 Ethics 195

34 Signs, Symptoms, and Syndromes 203

35 Abbreviations 207

Index 219

This book was written because I felt there was not a good, comprehensive, high-yield review book for the USMLE Step 2. The goal of the book is to provide information that has appeared on recent administrations of Step 2. The exam covers a lot of information, but if you know all the concepts in this book, you should do much better than just pass: you should CRUSH THE BOARDS!

Step 2 is the same level of difficulty as Step 1, but the questions are more relevant to the practice of medicine. Step 2 stresses the things that are necessary to be a good first-year resident in the emergency room or a general clinic. Knowing how to diagnose, manage, and treat common conditions is stressed. Not just theory, but practice—in other words, knowing the next step. The other topics that frequently appear on Step 2 are treatable emergency conditions. Remember, these are the situations that you, as a future house officer, may have to diagnose and treat at three o'clock in the morning while on call.

Knowing how to manage exotic or rare conditions is low-yield. It is much more high-yield to know rare complications and presentations of common diseases. Usually, when you are asked about a rare disease, you simply need to recognize it: from a classic presentation.

Some information from Step 1 is high-yield for Step 2. Epidemiology and biostatistics are retested, as well as pharmacology and microbiology (which bugs cause which conditions in specific patient populations). Cardiac pathophysiology is high-yield, as is common EKG pathology. The behavioral science/psychiatry questions are also similar to those in Step 1.

Overall, though, Step 2 has a different focus, and that focus is clinical. If a patient presents with chest pain, what would you do? What kinds of questions would you ask the patient? What tests would you order? What medications might you give?

There are also five general tips I would like to pass on to those preparing for Step 2:

1. Always get more history when it is an option, unless the patient is unstable and immediate action is needed.

2. You must know cut-off values for the treatment of common conditions (at what numbers do you treat hypertension and hypercholesterolemia, and at what CD4 counts do you need chemoprophylaxis in HIV?).

3. A presentation may be normal (especially in pediatrics and psychiatry) and need no treatment!

Don't forget, to study your subspecialties. Just because you never took an ophthalmology rotation doesn't mean there won't be any questions about it on the exam. You don't have to be an expert, but knowing common and life-threatening diseases in the subspecialties can increase you score substantially.

5. Remember that residency programs don't usually see the breakdown of your score, only those magic 2- and 3-digit overall scores (in other words, don't skip studying a subject because you hate it and aren't going into it).

Studying for Step 2 can seem like an overwhelming task. Given the time constraints of medical students in their clinical years, most need a concise review of the tested topics. It is my hope that CRUSH THE BOARDS will meet your needs in this regard.

Adam Brocbert, M.D.

Internal Medicine

Screening for hypertension should be done roughly every 2 years, starting at the age of 3. Whenever a patient comes in for any kind of medical visit or hospitalization, it is standard practice to measure the blood pressure. The current accepted cut-off value is 14-0/90 mmHg (lower in children). A blood pressure of 145/75 mmHg is still considered hypertension (isolated systolic hypertension) and should be treated if it persists. Both systolic and diastolic hypertension decrease life expectancy. Hypertension is not diagnosed until three separate measurements on three separate occasions are greater than 140/90 mmHg (except in pregnancy, when waiting for a return visit could be devastating). Also, if hypertension is severe (>210 systolic, > 120 diastolic, or end-organ effects), immediate treatment with medication is warranted:



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