This new edition of Yale-G First Aid: Crush USMLE Step 2 CK & Step 3 has been continuously updated from the previous editions.
According to the large volume of feedbacks on Amazon and to our author team from medical students and doctors in the US and around the world, this book has collected the most up-to-date, comprehensive, and high-yield clinical knowledge (CK) for the USMLE Step 2 CK and Step 3 as the best-rated one in the USMLE market.
This book can be the equivalent of "First Aid for the USMLE Step 1" for the USMLE Step 2 CK. Important features of this book include:
1. Systematic, comprehensive, and concise reviews of most diseases and disorders that are frequently tested in the USMLE Step 2 CK and Step 3. They are composed of important concepts, etiologies, essentials of diagnoses, differential diagnoses, treatments, and preventive measures.
2. Well-organized contents in easy-to-remember formats, abbreviations, and more than 100 tables and figures with summaries and differential diagnoses, and with necessary details of high-yield “orderly steps” in the diagnosis and management of major diseases. Most important clinical points are in “PEARLS”, underlined, and bolded as priority contents.
3. 800 high-yield clinical questions in USMLE format to help you digest the fundamental knowledge.
4. 155 high-yield clinical color images with brief diagnostic features (in the back of book to cut cost) for deeper digestion and memory of the associated fundamental clinical knowledge.
After thorough digestion of this book followed by practice with the best Q-bank on UWorld.com and NBME.org Self-Assessments, with note-taking, you are ready to crush the USMLE Step 2 CK and Step 3 with high scores!
Yale-G First Aid: Crush USMLE Step 2 CK and Step 3 (臨床醫學精華) 第八版是集其十年心血之作,主要基於美國醫學界權威的美國醫師執照考試委員會的要求和Current Medical Diagnosis and Treatment等內容,第七版在同類書中獲得AMAZON 的最高評級與評語 (https://www.amazon.com/Yale-G-First-Aid-Crush-USMLE/dp/1637957580)。 本書堪稱全球醫學生畢業與執照考試的最佳工具書之一。
Yale Gong, MD, MS, USMLE-Certified, has been an Assistant Professor of Neurology in USUHS, Senior Research Investigator in the University of Pennsylvania School of Medicine, Neuroscientist, Clinical Scientist, and Army Scientific Advisor for the past 30 years in the US. The latest 8th edition of Yale-G First Aid: Crush USMLE Step 2 CK and Step 3 under publication is the intelligent fruits after the author’s ten years of persistent efforts, based on the requirements of USMLE.org and authoritative Current Medical Diagnosis and Treatment, etc. The 7th edition has gained the best rating and reader’s reviews among all similar books on amazon.com. This book can be one of the best tool books for all medical students’ graduating and licensing examinations around the world!
章節試閱
Chapter 1 INFECTIOUS DISEASES
Infectious diseases are among the most common diseases that we encounter in our daily lives with a tremendous loss. Nevertheless, most of them are preventable and curable. While the main pathogens causing particular diseases have not changed much over time, the sensitivity pattern of these microorganisms to antibiotics has changed significantly in recent years. Therefore, pathologic culture and drug sensitivity testing (C/S) is still the best clinical guide to the treatment of infectious diseases.
PEARLS—High-yield Applications of Antibiotics
I. Antibiotics for Gram+ Cocci —Staphylococcus (Staph) and Streptococcus (Strep) are the most common organisms. 1. Drugs of choice (1) Strep-pneumoniae; Strep-hemolytic group A, B, C, G; Strep-viridans: penicillin (PCN) G, V/K. (2) Staph, non-penicillinase-producing: PCN; penicillinase-producing Staph: semisynthetic PCN. (3) Enterococcus faecalis: Ampicillin +/- gentamicin. (4) Enterococcus faecium: Vancomycin +/- gentamicin. 2. Semisynthetic or penicillinase-resistant penicillins (PRPs): Mechanisms: Blocking peptidoglycan cross-linking and inhibiting transpeptidases. IV: Oxacillin, nafcillin, or methicillin (rare); oral (PO): cloxacillin, dicloxacillin, etc. They are highly effective against Staph and Strep, and thus usually used in bacterial skin infections (cellulitis, impetigo), meningitis, endocarditis, osteomyelitis, and septic arthritis. Main adverse effects include anaphylaxis (rare) and interstitial nephritis (methicillin is #1). Methicillin is rarely used now due to its renal toxicity. Thus, “Methicillin-resistant S. aureus” (MRSA) actually refers to “oxacillin- or nafcillin-resistant S. aureus”, and the drug of choice is vancomycin. However, for sensitive organisms, oxacillin/nafcillin is preferred to vancomycin. Beta-lactamase inhibitors — “CAST”: Clavulanic acid, Avibactam, Sulbactam, Tazobactam. 3. PCN-G, PCN-V/K, ampicillin, and amoxicillin: Effective against Strep. (S. pyogenes, S. viridans, and S. pneumonia) and Gram- bacteria, but not against S. aureus. Ampicillin and amoxicillin are penicillinase sensitive and only effective against S. aureus when combined with sulbactam or clavulanate; both are effective against Enterococci and Listeria. 4. Replacement for penicillin (PCN) allergy: (1) Replacement for mild PCN allergy: Cephalosporins (Cepha-): See below. (2) Replacement for severe PCN allergy (hypersensitivity): Fluoroquinolones, clindamycin, and macrolides. Fluoroquinolones (ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, ofloxacin): Mechanisms: Inhibit DNA topoisomerase II and IV → bactericidal. The new fluoroquinolones (moxifloxacin, levofloxacin, and gatifloxacin) are strongly effective against Pneumococcus, Mycoplasma, Chlamydia, and Legionella. Thus they are the first-line empiric antibiotics for pneumonia. Most quinolones are active against the Enterobacteriaceae. Only ciprofloxacin covers Pseudomonas. Adverse effects: Abnormal bone growth and cartilage in children and pregnant women (contraindicated), tendonitis, Achilles tendon rupture, and prolonged QT on ECG. Gatifloxacin is rarely used now due to potentially abnormal glucose metabolism. Macrolides (erythromycin, clarithromycin, azithromycin): Inhibit translocation during protein synthesis → bacteriostatic. They are mainly used for atypical pneumonia (Mycoplasma, Chlamydia, Legionella), STDs (Chlamydia), B. pertussis, and some patients infected with Gram+ cocci but severely allergic to PCNs. Novel macrolide fidaxomicin is reserved for treating the second or greater recurrence of C. difficile infection. Note: For life-threatening S. aureus (MRSA) and Strep-B infection with severe PCN allergy, strongest antibiotics are vancomycin, synercid, and linezolid. Macrolides are never used for severe S. aureus infections.
II. Antibiotics for Gram- Bacteria 1. Drugs of first choice for Gram- Cocci Moraxella catarrhalis: Cefuroxime; Gonococcus: Cefixime, ceftriaxone; Meningococcus: PCN or cefotaxime. 2. Drugs of first choice for Gram- Rods Pseudomonas-A: It’s an opportunistic pathogen that mostly affects immunosuppressed patients. Drugs of choice: piperacillin-tazobactam (with beta-lactamase inhibition), ceftazidime, or cefepime, or a carbapenem +/- gentamicin. Acinetobacter: imipenem, meropenem; Bacteroids (GI strains): Metronidazole; Campylobacter jejuni: Erythromycin or azithromycin; Enterobacter: Ertapenem, imipenem, cefepime; E. coli: Uncomplicated—fluoroquinolones, nitrofurantoin; sepsis—cefotaxime, ceftriaxone; Haemophilus: General infection—TMP-SMX (co-trimoxazole, bactrim); central nervous system (CNS) or serious infection—cefotaxime, ceftriaxone; Helicobacter pylori: Amoxicillin + clarithromycin + proton pump inhibitors (PPI); Klebsiella: A 3rd-generation cephalosporin; Legionella species (pneumonia): Azithromycin or fluoroquinolones +/- rifampin; Proteus mirabilis: Ampicillin. For most multidrug resistant infections (including P. aeruginosa), colistin (polymyxcin E) is the only option despite its nephrotoxicity and ototoxicity. Cefepime plus amikacin can be the second. 3. PCNs (piperacillin, ticarcillin, azlocillin, mezlocillin): They are strong against the large Enterobacteriaceae group (E. coli, Proteus, Enterobacter, Citrobacter, Morganella, Serratia, and Klebsiella) and Pseudomonas; usually applied for hospital-acquired pneumonia, intra-abdominal infections (cholecystitis, cholangitis, pyelonephritis), bacteremia, neutropenia with fever, etc. 4. Cephalosporins: See below. 5. Fluoroquinolones: See above. 6. Aminoglycosides (gentamycin, tobramycin, amikacin) and monobactams (aztreonam): Mechanisms: Block transpeptidation at 30S → bactericidal. (1) Effective against the same Gram- bacilli as listed above. (2) Synergistic with beta-lactam antibiotics for enterococci and staphylococci. (3) Ineffective against anaerobes. (4) Kidney and ear toxicity. 7. Carbapenems (imipenem, meropenem): These are broad-spectrum antibiotics on gram+ cocci, gram- rods, and anaerobes, strongly active against Enterobacteriaceae and Pseudomonas (EXCEPT ertapenem), also against S. aureus. Main adverse effects (S/E) include GI distress, CNS toxicity, and nephrotoxicity, which is preventable by using with cilastatin. Significant adverse effects limit use to life-threatening infections.
Chapter 1 INFECTIOUS DISEASES
Infectious diseases are among the most common diseases that we encounter in our daily lives with a tremendous loss. Nevertheless, most of them are preventable and curable. While the main pathogens causing particular diseases have not changed much over time, the sensitivity pattern of these microorganisms to antibiotics has changed significantly in recent years. Therefore, pathologic culture and drug sensitivity testing (C/S) is still the best clinical guide to the ...
顯示全部內容
作者序
Preface
This new edition of “Yale-G First Aid: Crush USMLE Step 2 CK & Step 3” has been continuously updated from the previous editions. According to the large volume of feedbacks on Amazon and to our author team from medical students and doctors in the US and around the world, this book has collected the most up-to-date, comprehensive, and high-yield clinical knowledge (CK) for the USMLE Step 2 CK and Step 3 as the best-rated one in the USMLE market. This book can be the equivalent of “First Aid for the USMLE Step 1” for the USMLE Step 2 CK. Important features of this book include: 1. Systematic, comprehensive, and concise reviews of most diseases and disorders that are frequently tested in the USMLE Step 2 CK and Step 3. They are composed of important concepts, etiologies, essentials of diagnoses, differential diagnoses, treatments, and preventive measures. 2. Well-organized contents in easy-to-remember formats, abbreviations, and more than 100 tables and figures with summaries and differential diagnoses, and with necessary details of high-yield “orderly steps” in the diagnosis and management of major diseases. Most important clinical points are in “PEARLS”, underlined, and bolded as priority contents. 3. 800 high-yield clinical questions in USMLE format to help you digest the fundamental knowledge. 4. 155 high-yield clinical color images with brief diagnostic features (in the back of book to cut cost) for deeper digestion and memory of the associated fundamental clinical knowledge. After thorough digestion of this book followed by practice with the best Q-bank on UWorld.com and NBME.org Self-Assessments, with note-taking, you are ready to crush the USMLE Step 2 CK and Step 3 with high scores! This book is your ticket to the USMLE and ECFMG Certification! It can also be a powerful study aid in medical school education in the US and around the world. The author’s team takes all feedbacks and corrections positively and thankfully with rewards and maintains frequent updates to make it better and better for the USMLE clinical knowledge. Best wishes to all who appreciate this book! Yale Gong, MD Washington, D.C.
*www.usmle.org: “USMLE Step 3: Examinees are seeing increased numbers of items that assess an expanded range of competency-based content, including foundational science essential for effective healthcare; biostatistics, epidemiology, and population health; literature interpretation; medical ethics; and patient safety.”
Preface
This new edition of “Yale-G First Aid: Crush USMLE Step 2 CK & Step 3” has been continuously updated from the previous editions. According to the large volume of feedbacks on Amazon and to our author team from medical students and doctors in the US and around the world, this book has collected the most up-to-date, comprehensive, and high-yield clinical knowledge (CK) for the USMLE Step 2 CK and Step 3 as the best-rated one in the USMLE market. This book can be the equivalent of “Firs...
顯示全部內容
目錄
Chapter 1: INFECTIOUS DISEASES (Suggested range according to usmle.org: 7-8%) 1 PEARLS—High-yield Applications of Antibiotics 1 EYE, EAR, NOSE AND THROAT INFECTIONS 5 RESPIRATORY TRACT INFECTIONS 10 INFECTIONS OF THE CENTRAL NERVOUS SYSTEM (CNS) 19 GASTROINTESTINAL TRACT INFECTIONS 23 VIRAL HEPATITIS 25 UROGENITAL INFECTIONS AND SEXUALLY TRANSMITTED DISEASES (STD) 30 UROGENITAL INFECTIONS 30 SEXUALLY TRANSMITTED DISEASES (STD) 34 OPPORTUNISTIC INFECTIONS (OIs) 40 BLOOD INFECTIONS AND RELATED DISEASES 42 BONE, JOINT AND MUSCLE INFECTIONS 47 ARTHROPOD-BORNE AND ZOONOTIC INFECTIONS 50 Chapter 1: High-yield Questions (HYQ) 54
Chapter 3: RESPIRATORY DISEASES (Suggested range: 7-8%) 134 GAS EXCHANGE DISORDERS AND RESPIRATORY FAILURE 135 OBSTRUCTIVE LUNG DISEASES 137 RESTRICTIVE AND INTERSTITIAL LUNG DISEASES 143 ALVEOLAR FILLING DISEASES 148 DISEASES OF THE PULMONARY VASCULATURE 150 PLEURAL DISEASES 153 NEOPLASMS OF THE RESPIRATORY TRACT 154 MISCELLANEOUS DISEASES 158 Chapter 3: High-yield Questions (HYQ) 159
Chapter 4: DIGESTIVE AND NUTRITIONAL DISORDERS (Suggested range: 9-10%) 166 DISEASES OF THE ESOPHAGUS 166 DISEASES OF THE STOMACH AND DUODENUM 173 DISEASES OF THE PANCREAS 178 DISEASES OF THE GALLBLADDER 181 DISORDERS OF THE LIVER 185 GENETIC BILIRUBINEMIA 192 DISORDERS OF THE INTESTINE 193 INFLAMMATORY BOWEL DISEASES (IBD) 197 NEOPLASMS OF THE INTESTINE 201 HEMORRHAGE OF THE DIGESTIVE TRACT 203 MISCELLANEOUS DISEASES 205 NUTRITIONAL MEDICINE AND DISORDERS 208 Chapter 4: High-yield Questions (YHQ) 215
Chapter 5: ENDOCRINOLOGY (Suggested range: 7-8%) 223 DISORDERS OF GLUCOSE AND FAT METABOLISM 223 PITUITARY AND HYPOTHALAMIC DISEASES 228 DISORDERS OF THE ANTERIOR PITUITARY LOBE 229 DISORDERS OF THE POSTERIOR PITUITARY LOBE 232 DISEASES OF THE THYROID 234 DISORDERS OF THE PARATHYROID GLANDS 242 DISORDERS OF THE ADRENAL GLAND 245 HYPOGONADISM 250 Chapter 5: High-yield Questions (HYQ) 252
Chapter 12: OBSTETRICS (Suggested range: 5-6%) 487 PHYSIOLOGY OF NORMAL PREGNANCY 487 NORMAL LABOR 495 ABNORMAL LABOR 496 MEDICAL COMPLICATIONS OF PREGNANCY 499 OBSTETRICAL COMPLICATIONS OF PREGNANCY 504 POSTNATAL (PUERPERIUM) 509 TERATOLOGY 511 Chapter 12: High-yield Questions (HYQ) 512
Chapter 13: PEDIATRICS (Suggested range: 9-10%) 518 NEWBORN DISEASES 518 DEVELOPMENT AND RELATED PROBLEMS . 531 PEDIATRIC NUTRITION AND RELATED DISORDERS. 531 PEDIATRIC INFECTIONS 531 CONGENITAL INFECTIONS 531 VIRAL INFECTIONS IN CHILDREN 533 RESPIRATORY TRACT INFECTIONS IN CHILDREN 534 CONGENITAL ABNORMALITIES 536 GENETIC SYNDROMES 540 GENETIC METABOLIC ABNORMALITIES 541 LYSOSOMAL AND GLYCOGEN STORAGE DISEASES 542 Chapter 13: High-yield Questions (HYQ) 544
Chapter 14: EMERGENCY MEDICINE (Suggested range: 5-6%) 551 SHOCK AND CARDIOPULMONARY RESUSCITATION 551 ALTERED MENTAL STATUS 552 ANAPHYLAXIS 554 TOXICOLOGY 555 INTOXICATIONS OF SPECIAL TOXIC SUBSTANCES 556 INTERACTION, INTOXICATION AND DETOXIFICATION OF DRUGS 561 THERMAL INJURIES 565 DROWNING 567 VENOMOUS BITES 568
Chapter 15: SURGERY (Suggested range: 10-11%) 569 TRAUMA AND INJURY 569 CHEST TRAUMA 570 ABDOMINAL TRAUMA 574 PELVIC AND UROGENITAL TRAUMA 576 EXTREMITY TRAUMA 579 ORTHOPEDIC TRAUMA AND INJURIES 579 PREOPERATIVE EVALUATION 585 COMPLICATIONS OF SURGERY 586 ANALGESIA AND ANESTHESIA IN SURGERY AND OBSTETRICS 587 VOLUME DISORDERS 588 ABDOMINAL SURGERY 590 Chapter 14-15: High-Yield Questions (HYQ) 596
Chapter 16: PSYCHIATRY (Suggested range: 9-10%) 610 BASICS 610 NEURODEVELOPMENTAL DISORDERS 612 DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDERS 618 DEPRESSIVE DISORDERS 621 BIPOLAR AND RELATED DISORDERS 625 NEUROTIC, STRESS-RELATED, AND SOMATOFORM DISORDERS 627 ANXIETY DISORDERS 627 TRAUMA- AND STRESSOR-RELATED DISORDERS 631 PERSONALITY DISORDERS 633 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS 637 SOMATIC SYMPTOM AND RELATED DISORDERS 642 SUBSTANCE-RELATED AND ADDICTIVE DISORDERS 646 FEEDING AND EATING DISORDERS 652 SLEEP-WAKE DISORDERS 655 SEXUAL DISORDERS 660 MIX—SOCIAL SCIENCES: SUICIDALITY AND DEATH 667 Chapter 16: High-yield Questions (HYQ) 667
Chapter 17: EPIDEMIOLOGY, BIOSTATISTICS, PREVENTIVE MEDICINE, AND MEDICAL ETHICS (Range: 5-6%) 675 EPIDEMIOLOGY AND LITERATURE INTERPRETATION 675 ASSESSMENT OF DISEASE FREQUENCIES 675 ASSESSMENT OF DIAGNOSTIC TESTS 677 ASSESSMENT OF RISK AND MEASURES OF EFFECT 679 TYPES AND EVALUATIONS OF STUDIES 681 BIOSTATISTICS AND LITERATURE INTERPRETATION 683 INFERENTIAL STATISTICS 683 PREVENTIVE MEDICINE 690 POPULATION HEALTH 690 IMMUNIZATION AND VACCINATION 696 MEDICAL AND RESEARCH ETHICS 698 ABUSE 703 Chapter 17: High-yield Questions (HYQ) 706
NORMAL LAB VALUES OF IMPORTANCE 715 INDEX 718 ABBREVIATIONS 725 HIGH-YIELD CLINICAL IMAGES 729
Chapter 1: INFECTIOUS DISEASES (Suggested range according to usmle.org: 7-8%) 1 PEARLS—High-yield Applications of Antibiotics 1 EYE, EAR, NOSE AND THROAT INFECTIONS 5 RESPIRATORY TRACT INFECTIONS 10 INFECTIONS OF THE CENTRAL NERVOUS SYSTEM (CNS) 19 GASTROINTESTINAL TRACT INFECTIONS 23 VIRAL HEPATITIS 25 UROGENITAL INFECTIONS AND SEXUALLY TRANSMITTED DISEASES (STD) 30 UROGENITAL INFECTIONS 30 SEXUALLY TRANSMITTED DISEASES (STD) 34 OPPORTUNISTIC INFECTIONS (OIs) 40 BLOOD INFECTIONS AND RELATED DI...