Quick USMLE Review Notes for Step 2 CK

USMLE step 2 CK is more of a clinical exam. So they ask 'what is the diagnosis'(around 30% of questions) and 'Next best step in the management' of the patient by giving different scenarios in the exam. So you must need the most complete notes which covers the first line management of all diseases according to U.S. clinical standard, not like a general book which covers all possibilities for all diseases.

ALL SUBJECTS [INTERNAL MEDICINE, SURGERY, PEDIATRICS, PSYCHIATRY & OB-GYN] ARE TYPED. ALL ARE PDF FILES

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Only 152 pages which covers all high yield topics for USMLE step 2 CK exam.

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Few Example:

Chest Pain:

Myocardial Ischemia / Myocardial Infarction: Substernal squeezing chest pain [not reproduce by palpation, not change with change in position, not pleuritic]

Pericarditis: chest pain [relieve by leaning forward]

Costochondritis: chest pain [reproduce by palpation]

Dissecting aortic aneurysm: tearing chest pain radiate to back

Pneumonia: pleuritic chest pain

Pulmonary embolism: pleuritic chest pain, dyspnea, tachypnea

Esophageal spasm (“nut cracker disease”): h/o GERD, gastritis, pain occur after eating, normal EKG

Stable angina: chest pain after exertion

Unstable angina: chest pain at rest [ST Depression] [D - E]

Myocardial Infarction: chest pain at rest [ST Elevation]

Prinzmetal angina: chest pain at rest [ST elevation – Transmural Ischemia] [due to coronary
artery spasm. Pain may relieve by little exercise like patient gets up and walking and pain relieve
because exercise causes increase in Adenosine which is a potent coronary vasodilator] [Best
diagnostic test – Angiography shows No atherosclerosis] [Treatment: Ca++ channel blockers (CCB), Nitrates] [Not Aspirin and b-blockers]

Patient with Stable/Unstable angina and MI should receive Aspirin, Nitrates and b-blockers (if no contraindications like Asthma, etc.)

Patient should also receive oxygen (if oxygen saturation is low) and morphine (if patient is still having pain)

Unstable Angina (clot is forming): above 2 steps + Heparin (not thrombolytics) + Statins
MI (clot is already formed): above 2 steps + Thrombolytics (If certain criteria meets, see below) + Statins + Low molecular weight Heparin (If not contraindicated) + ACE inhibitors (only If CHF due to acute MI) + Lidocaine (only If ventricular arrhythmias)

Thrombolytics (If it is not contraindicated, if Angioplasty is not available):

Within 12 hrs of the onset of MI.
> 1 mm ST segment elevation in two contiguous EKG.
New LBBB (Left Bundle Branch Block).

Best Initial test: EKG
Most accurate diagnostic test: Angiography (Ischemia) / Cardiac Troponin & CK-MB (Infarction) [Both begin to elevate in 4-6 hrs] [Cardiac Troponin remains elevated for 1-2 wks]
[CK-MB remains elevated for 2-3 days] [best test to check re-infarction within a week – CK-MB because it disappears in 2-3 days]
Most accurate treatment for MI / Unstable angina: Angioplasty

Most important is to know when you will do diagnostic test and when you will start treatment. Answer what they asked like best initial / most accurate

If patient comes with chest pain for last 1-hr and still having pain, what will you do first or best initial test? – EKG

If patient comes with chest pain for last 1-hr and still having pain, EKG shows ST depression / ST elevation, what will you do now? – Start treatment (all patient should receive above treatment depends upon what they have like Unstable angina or MI or stable angina or Prinzmetal angina

If patient comes with chest pain off & on and no pain now in your office, what will you do first? – Stress test (EKG may not show anything cause no pain now)
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Classic presentation of Acute Appendicitis [pain start in mid epigastric region and then shifted to RLQ, positive rebound tenderness, Psoas sign, Rovsing’s sign, etc], next step? - Appendicectomy

Above presentation, On Abdominal exploration, Appendix is normal but ileum is inflamed (Crohn’s ileitis), next step? - Proceed with Appendicectomy and close the abdomen

Above presentation, On Abdominal exploration, Appendix is normal but ileum & cecum are inflamed, next step? - Do nothing and close the abdomen [when cecum is inflamed, Appendicular stump doesn’t heal and it can cause fecal fistula which leads a hemicolectomy]

Female patient without classical presentation of appendicitis, next step? - USG

Classic presentation of appendicitis but 6-7 days old pain, mass on abdominal palpation, diagnosis? - Appendicular mass, next step? - IV fluid, bowel rest, IV antibiotics, serial examinations

If above scenario, 24-hrs after starting treatment, patient is getting worse (spiking fever, tachycardia, increase in localize tenderness), next step? - CT scan (Appendicular abscess) - Tx : CT guided drainage
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Mallory Weiss Tear - continuous retching followed by large painless bloody vomiting (mucosal tear), best diagnostic test? - Endoscopy – Tx: resolve itself / laser photocoagulation

Boerhaave Syndrome - continuous retching followed by severe chest pain, Crepitation in the
neck, air in mediastinum on CXR (Esophageal rupture – distal third, posterolateral segment (no serosa) is the most common site), best diagnostic test? - Gastrografin swallow - Emergency Surgical repair.

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Comment I received about my hand writing:

Hello,
I have received all three e mail, all in good order. HY are also written in hand but for some odd reason I like hand written material better then typed. I think it's because of ability to draw graphs and connect the dots that's somewhat limited when you use MS Word. Do not really understand people who complain about it.

Anyhow if you do get a chance, give me your two cents regarding how to prepare for USMLE Step 2 CS. I am foreigner attending med school in USA so that makes me somewhat less confident in my ability to perform well especially for the exam that's unpredictable to begin with. What did you use, what works etc.

Thanks a lot and I will contact you if I feel that I could benefit from your USMLE 1 notes too.

Delivery of My notes:

You will receive a link in Email to download my high yield notes after you complete payment. It may take you time to receive a link sometimes but definitely before 24-hrs.