USMLE Step 2 CK Lecture Notes 2021: Internal Medicine, 1st Edition (2020)

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Practice with USMLE Step 2 CK Lecture Notes 2021: Internal Medicine, 1st Edition (2020) to familiarize yourself with common certification exam questions and formats.

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K A P L A N
MEDICAL
USMLE
Step 2 CK
Lecture Notes
2021Internal Medicine
Obstetrics and Gynecology
Pediatrics
Psychiatry, Epidemiology,
Ethics, Patient Safety
Surgery
USMLE ® is a joint program of the Federation of State Medical Boards ( FSMB) and the National
Board of Medical Examiners ( NBME ) , which neither sponsor nor endorse this product .

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USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National
Board of Medical Examiners (NBME), which neither sponsor nor endorse 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 profes-
sional 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.
© 2020 by Kaplan, Inc.
Published by Kaplan Medical, a division of Kaplan, Inc.
750 Third Avenue
New York, NY 10017
All rights reserved. The text of this publication, or any part thereof, may not be reproduced in any
manner whatsoever without written permission from the publisher.
10 9 8 7 6 5 4 3 2 1
Course ISBN: 978-1-5062-6141-6
Course Kit ISBN: 978-1-5062-6135-5
Retail ISBN: 978-1-5062-6139-3
Retail Kit ISBN: 978-1-5062-6137-9
Thekits come as a set and should not be broken out and sold separately.
Kaplan Publishing print books are available at special quantity discounts to use for sales
promotions, employee premiums, or educational purposes. For more information or to purchase
books, please call the Simon & Schuster special sales department at 866-506-1949.

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Editors
Joseph J. Lieber, MD
Director of Medicine
Elmhurst Hospital Center
Associate Professor of Medicine
Associate Program Director of Medicine for Elmhurst Site
Icahn School of Medicine at Mt. Sinai
New York, NY
Frank P. Noto, MD
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
Icahn School of Medicine at Mt. Sinai
New York, NY
Contributors
Raj Dasgupta, MD, FACP, FCCP, FAASM
Assistant Professor of Clinical Medicine
Assistant Program Director of Internal Medicine Residency
Associate Program Director of Sleep Medicine Fellowship
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
Keck School of Medicine of USC
University of Southern California
Los Angeles, CA
The editors would also like to acknowledge
Manuel A. Castro, MD, AAHIVS; Amirtharaj Dhanaraja, MD; Aditya Patel, MD;
Irfan Sheikh, MD; and Frazier Stevenson, MD for their contributions.

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Chapter Title 00v
Table of Contents
Chapter 1: Preventive Medicine 1
Chapter 2: Endocrinology 13
Chapter 3: Rheumatology 69
Chapter 4: Gastroenterology 95
Chapter 5: Cardiology 137
Chapter 6: Hematology 203
Chapter 7: Infectious Diseases 241
Chapter 8: Nephrology 305
Chapter 9: Pulmonology 353
Chapter 10: Emergency Medicine 399
Chapter 11: Neurology 443
Chapter 12: Dermatology 473
Chapter 13: Radiology/Imaging 497
Chapter 14: Ophthalmology

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Chapter Title #1
Learning Objectives
❏ Describe appropriate screening methods as they apply to neoplasms of the colon,
breast, cervix, and lung
❏ Describe epidemiological data related to incidence and prevention of common
infectious disease, chronic illness, trauma, smoking, and travel risks
SCREENINGS
For all diseases that have recommended screening:
• Effective intervention must exist
• After a positive test result, course of events must be acceptable to patient
• Screening test must be valid, i.e., it must have proven in trials to decrease overall
mortality
For a screening test to be recommended for regular use, it has to be extensively studied to
ensure that all of the above requirements are met.
Cancer Screening
A 39-year-old woman comes to the clinic very concerned about her risk of developing
cancer. Her father was diagnosed with colon cancer at age 43, and her mother was
diagnosed with breast cancer at age 52. She is sexually active with multiple partners
and has not seen a physician since a car accident 15 years ago. She denies any
symptoms at this time, and her physical examination is normal. She asks what is
recommended for a woman her age.
Screening tests are done on seemingly healthy people to identify those at increased risk of
disease.
Preventive Medicine 1

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Chapter 1 ● Preventive Medicine
3
Lung Cancer
Current recommendations for lung cancer screening are as follows:
• For adults age 55–80 with a 30-pack-year smoking history and currently smoke or
have quit within 15 years, screen annually with low-dose CT.
• For those who have not smoked for 15 years; age >80; or who have another medical
problem which significantly limits life expectancy or the ability to undergo surgery,
screening is not necessary.
Clinical Recall
Which of the following patients is undergoing an inappropriate method of
screening as recommended by the USPSTF?
A. A 50-year-old man gets his first screening for colon cancer via
colonoscopy
B. A 50-year-old woman gets her first screening for breast cancer via
mammography
C. A 17-year-old woman is screened for HPV via a Pap smear after her
first sexual encounter
D. A 65-year-old man with a 30-pack-year smoking history gets a low-
dose CT
E. A 21-year-old woman with a high risk of developing breast cancer is
given tamoxifen
Answer: C
Osteoporosis Screening
A bone density test uses x-rays to measure how many grams of calcium and other bone
minerals are packed into a segment of bone. The bones typically tested are the spine, hip,
and forearm.
• Screening with a DEXA bone density scan should be given to all women age >65.
• Screening should begin at age 60 if there is low body weight or increased risk of
fractures.
Bone density test results are reported in 2 numbers.
• The T-score compares the patient’s bone density with what is normally expected in a
healthy young adult of the same sex. This score is the number of units—standard
deviations—that bone density is above or below the average.
–

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