FIRST AID ™ Q&A FOR THE USMLE STEP CK Second Edition SENIOR EDITORS EDITORS TAO LE, MD, MHS HERMAN SINGH BAGGA, MD Assistant Clinical Professor Chief, Section of Allergy and Clinical Immunology Department of Medicine University of Louisville Resident Department of Urology University of California, San Francisco Medical Center KRISTEN VIERREGGER, MD Resident Department of Dermatology Mayo Clinic Resident Department of Pathology University of California, Irvine Medical Center THOMAS L.H HOCKER, MD CHRISTOPHER R KINSELLA, JR., MD Research Fellow University of Pittsburgh Medical Center MATTHEW O'ROURKE, MD Resident Morgan Stanley Children's Hospital of New York– Presbyterian Columbia University Medical Center JOHN RHYNER, MD Resident Department of Internal Medicine University of Michigan Medical Center SADE CLARKE UDOETUK, MD Resident Department of Psychiatry Baylor College of Medicine New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City Milan / New Delhi / San Juan 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no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise D E D I C AT I O N To the contributors to this and future editions, who took time to share their knowledge, insight, and humor for the benefit of residents and clinicians and To our families, friends, and loved ones, who supported us in the task of assembling this guide This page intentionally left blank CONTENTS Authors vii Faculty Reviewers ix Preface xi Acknowledgments xiii How to Contribute xv S EC T IO N I O R G A N SYST E M S Chapter Cardiovascular Chapter Dermatology 47 Chapter Endocrinology 57 Chapter Epidemiology and Preventive Medicine 91 Chapter Ethics and Legal Issues 117 Chapter Gastrointestinal 127 Chapter Hematology/Oncology 167 Chapter Infectious Disease 211 Chapter Musculoskeletal 261 Chapter 10 Neurology 285 Chapter 11 Obstetrics 321 Chapter 12 Gynecology 351 Chapter 13 Psychiatry 375 Chapter 14 Pulmonary 409 Chapter 15 Renal/Genitourinary 441 S EC T IO N I I F U LL-LE N G T H E X A M I NAT I O N S 471 Test Block 473 Test Block 507 Test Block 539 v Test Block 573 Test Block 607 Test Block 641 Test Block 675 Test Block 709 About the Authors 743 vi AUTHORS CYNTHIA ADAMS, MD LAURA MEINTS Resident Boston Combined Residency Program in Pediatrics Children's Hospital Boston Vanderbilt University School of Medicine Class of 2009 CLARISSA BARNES, MD Resident Department of Internal Medicine Johns Hopkins University School of Medicine RACHEL BORTNICK, MPHIL Medical Scientist Training Program Harvard Medical School CHRISTOPHER CHAPMAN, MD Resident Department of Internal Medicine University of Chicago Medical Center LIA CLATTENBURG, MD, MPH Resident Department of Internal Medicine Union Memorial Hospital Baltimore, Md GILLIAN DIERCKS Columbia University College of Physicians and Surgeons Class of 2009 VAHID ENTEZARI, MD Postdoctoral Research Fellow Orthopedic Biomechanics Laboratory Beth Israel Deaconess Medical Center JOHNATHAN ETHRIDGE Johns Hopkins University School of Medicine Class of 2009 ROBERT MICHELETTI, MD Resident Departments of Internal Medicine and Dermatology Hospital of the University of Pennsylvania DANIEL L MILLER Johns Hopkins University School of Medicine Class of 2009 Johns Hopkins Bloomberg School of Public Health Class of 2009 DEEPIKA NEMANI University of Pennsylvania School of Medicine Class of 2009 TIMOTHY NIESSEN Johns Hopkins University School of Medicine Class of 2009 Johns Hopkins Bloomberg School of Public Health Class of 2009 HOWARD O'ROURKE, MD Resident Department of Diagnostic Radiology University of Pittsburgh Medical Center NISHANT PATEL Johns Hopkins University School of Medicine Class of 2009 ROHITH PIYARATNA, MD ERICA Y FAN Resident Department of Anesthesiology Stanford University Medical Center St Louis University School of Medicine Class of 2009 ANTHONY PRINCE, MD CARL ERIK FISHER Resident Department of Otolaryngology Mount Sinai Medical Center Columbia University College of Physicians and Surgeons Class of 2009 SATTAR GOJRATY, MD FIORELLA SAPONARA, MD Resident Department of Internal Medicine Hospital of the University of Pennsylvania Resident Transitional Program Maimonides Medical Center New York City NILAY KAVATHIA, MD ASHA JAYENDRAKUMAR SHAH, MD Resident Department of Internal Medicine Thomas Jefferson University Hospital Intern Department of Internal Medicine Emory University School of Medicine vii MONICA E SHUKLA BRANT W ULLERY, MD Vanderbilt University School of Medicine Class of 2009 Resident Department of Surgery Hospital of the University of Pennsylvania MEGHAN SISE Columbia University College of Physicians and Surgeons Class of 2009 D'MITRI SOFIANOS, MD Resident Department of Orthopedic Surgery University of Utah Medical Center ANNA E TEETER Duke University School of Medicine Class of 2009 JOSHUA D UDOETUK, MD KELLY VRANAS, MD Resident Department of Internal Medicine Hospital of the University of Pennsylvania DAVID WEI Columbia University College of Physicians and Surgeons Class of 2009 ZACHARY ZAVODNI Duke University School of Medicine Class of 2009 Transitional Intern University of Texas-Houston Medical School ASSOCIATE AUTHORS MARINA FRIMER, MD SUNIL SHETH Resident Department of Obstetrics and Gynecology and Women's Health Albert Einstein College of Medicine Harvard Medical School Class of 2009 MARK J MANN, MD Resident Department of Urology State University of New York Upstate Medical University Syracuse, N.Y PARIN J PATEL, MD Resident Department of Internal Medicine Hospital of the University of Pennsylvania viiiviii LEANNE STANLEY Duke University School of Medicine Class of 2009 TIAN ZHANG Harvard Medical School Class of 2009 FACULTY REVIEWERS JONATHAN W BRESS, MD KERILYN MORGAN, MD Nephrologist Philadelphia Hypertension & Nephrology Consultants RACHEL CHONG, MD Associate Program Director Department of Internal Medicine Banner Good Samaritan Medical Center Phoenix, Ariz Endocrinologist Lakeridge Health Corporation RINI BANERJEE RATAN, MD PETER DANYI, MD, MPH, MBA Assistant Clinical Professor Department of Obstetrics and Gynecology Columbia University College of Physicians & Surgeons Instructor, Hospitalist Program Division of General Internal Medicine Johns Hopkins University School of Medicine ROBIN GIRDHAR, MD Vice Chairperson and Director of Quality Assurance Division of Cardiology Shadyside Hospital University of Pittsburgh School of Medicine ANDREW J LENNEMAN, MD Clinical Fellow Cardiovascular Medicine Division Vanderbilt University School of Medicine ESTER C LITTLE, MD Associate Director Banner Liver Disease Center Clinical Assistant Professor of Medicine University of Arizona College of Medicine MARCUS A MCFERREN, MD, PHD Department of Dermatology Yale-New Haven Hospital ELIZABETH SASTRE, MD Assistant Professor Vanderbilt University Medical Center Attending Physician Medical Service, Primary Care Tennessee Valley Healthcare Veteran’s Administration Hospital JERRY D SMILACK, MD Emeritus Associate Professor of Medicine Mayo College of Medicine Retired Consultant Department of Internal Medicine Mayo Clinic MYRA J WICK, MD, PHD Department of Medical Genetics Mayo Clinic APRIL ZHU, MD The Permanente Medical Group Santa Clara, Calif ix