Preface

This USMLE step II Course is designed to provide information regarding clinical subjects that are tested as part of the USMLE II examination. This includes the study and practice of internal medicine, preventative care, obstetrics, gynecology, ophthalmology, psychiatry, dermatology, sports medicine, pediatrics, emergency medicine, and radiology. Each topic is designed to cover the common clinical diseases associated with these medical specialties, including their treatment. Medical students are expected to understand the causes of disease, risk factors, and treatment. The more theoretical topics of ethics, biostatistics, and epidemiology will also be discussed as part of this course.

The focus of chapter one is internal medicine, which is a broad subject involving the care of adult patients with problems related to the heart, lungs, kidneys, brain, endocrine system, and gastrointestinal tract. While there are hundreds of possible illnesses an adult can have, the internist will deal primarily with common diseases affecting adult patient in an internal medicine clinic.

Chapter two discusses preventive medicine. Preventive medicine involves evaluations, screening tests, and recommendations that are intended to decrease the incidence of a disease before it occurs, identify disease in high risk patients, and decrease the complication rates of disease the patient may already have. The use of preventive medicine applies to patients of all ages.

Chapter three in the course involves the various dermatological conditions that an internist deals with on a regular basis. The skin is the largest organ of the body with hundreds of possible disorders and manifestations of disease elsewhere in the body. The main focus of this chapter includes benign skin lesions, skin cancers, acne, and less common skin-related conditions.

Chapter four in the course discusses various types of surgeries and surgical techniques seen in a variety of surgical fields. While many surgeons are general surgeons, some surgical specialties focus on certain areas of surgery, such as orthopedic surgery, neurosurgery, and gynecological surgery. This chapter will cover some of the most common surgical techniques utilized in the surgical realm.

The focus of chapter five in the course is sports medicine. The provider involved in sports medicine will deal with healthy or “normal” patients that seek assistance to lose weight or become more fit. They will also deal with common sports-related injuries, in particular, musculoskeletal injuries, mild traumatic brain injuries, and major injuries. The use of anabolic steroids is covered in this chapter as this is a common problem in among competitive athletes.

Chapter six covers common ENT (Ear, Nose, and Throat) conditions. These types of disorders are common in any emergency department and general practice clinic. Providers need to understand the most common diseases of the head and neck including acute diseases and infections, as well as chronic ENT problems. Head and neck cancers are usually managed by the ENT specialist but can be diagnosed by any provider of older adults, so these are included as part of the discussion.

The topic of chapter seven is pediatrics and the different pediatric conditions that might be seen by the primary care physician. Many children do not have access to pediatricians and are seen by the general practitioner for most of their medical needs. Caring for children involves caring for their acute and chronic conditions so this will be the focus of this chapter.

Chapter eight involves the topic of obstetrics. While pregnancy care can be given by an obstetrician, it is often a part of healthcare that is provided by the general or family practitioner. Care of the pregnant woman begins before she becomes pregnant and continues with the prenatal visit. The women will have several prenatal visits during the pregnancy. Labor and delivery ends with either a vaginal delivery or a cesarean section in some cases. Prenatal care and birth are o discussed in this chapter.

Gynecology is the topic of chapter nine in the course. It involves the care and management of diseases that affect women of all ages with regard to their pelvic structures. Women can be affected with sexually transmitted infections, abnormal uterine bleeding (AUB), polycystic ovarian syndrome, and endometriosis. Gynecological cancers and menopause are also covered in this chapter.

The topics of chapter ten is radiology. Radiology includes the basic x-ray, which is the basis of everyday radiology. There are many other types of radiological tests and procedures besides the basic x-ray. Patients can undergo ultrasounds, CT scans, MRI scans, PET scans, and SPECT scans, which are specialized radiologic tests. Radiologists may also perform interventional procedures and radiotherapy. Each of these topics are discussed in this chapter.

Chapter eleven involves the subject of ophthalmology. While the eye is a small organ, it is crucial to every patient’s life, with a variety of illnesses and disorders that can affect it. The chapter will talk about the many common diseases affecting the eye, including glaucoma and cataracts, retinal diseases, uveitis, refractive errors, and eye trauma. An ophthalmologist treats many of these diseases, but they should also be identified and managed, to a limited degree, by the general practitioner or emergency room specialist.

The topics covered in chapter twelve is psychiatric disorders. Psychiatric disorders are extremely common and can affect people of all ages. There are several broad categories of psychiatric disorders that are covered in this chapter. They include things like mood disorders, psychoses, anxiety disorders, amnestic disorders, dissociative disorders, somatoform disorders, and personality disorders. Substance use disorders are considered psychiatric and included as part of the discussion of psychiatry in this chapter.

Chapter thirteen discusses common problems seen in emergency medicine. Emergency medicine physicians will see patients with fever, sometimes caused by Bacteremia or even septic shock. Other problems seen in the emergency department include chest pain, acute coronary syndrome, respiratory arrest, and cardiac arrest. Abdominal pain and the acute abdomen are seen in emergency medicine as well as trauma. Major traumatic diseases seen include head trauma, chest trauma, and abdominal trauma. These are discussed in this chapter as part of common issues seen in emergency medicine.

Medical ethics is the topic of chapter fourteen. There are many issues involved in medical ethics, including the doctor-patient relationship, conflicts of interest in medical practice, and patient confidentiality. Areas of medicine surrounded in ethical issues are those involved in reproductive medication and the care of the dying patient. The ethics of euthanasia in the dying patient are discussed as part of this chapter. Issues around human testing are also covered as these are important ethical issues in medical research.

Biostatistics and epidemiology are related topics that are the focus of discussion in the fifteenth chapter of the course. Much of epidemiology relates to research, although it is important to know the

epidemiology of various diseases in clinical practice. Many topics of biostatistics are purely related to research; however, in clinical practice, statistical issues like the mean, median, mode, and prevalence versus incidence of diseases are important to understand in clinical practice. For these reasons, they are covered in this chapter.

The sixteenth chapter of this course will be a comprehensive discussion of cardiology. Congenital heart diseases will be discussed as part of this chapter as well as the major types of heart-related diseases, including heart failure, acute myocardial infarction, valvular diseases, and cardiomyopathies that can affect the heart.

The seventeenth chapter of the course primarily covers the topic of gastroenterology. This starts with disorders of the pharynx and esophagus, including cancers of these tissues. Diseases of the stomach, liver, gallbladder, small intestine, and colon will be discussed as part of this chapter. Nutritional diseases like gluten insensitivity and malabsorption disorders will also be covered in this chapter.

The eighteenth chapter of this course will involve a comprehensive discussion of hematology. This includes disorders of the red blood cells, including anemia and polycythemia. There are diseases that affect the white blood cells, which will be covered in this chapter as well as diseases affecting platelets, such as thrombocytopenia and thrombocytosis. Disorders of the bone marrow and hematological cancers will also be discussed as part of this chapter.

The nineteenth chapter discusses oncology. This will include coverage of the major etiologies behind cancer and overviews of all of the major cancer types seen in adults and children, some of which have hereditary components, while others are considered purely acquired cancers.

The twentieth chapter of the course will be a discussion of the diseases of the kidneys. The basic structure and function of the kidneys will be covered along with the diseases of the glomeruli, the tubules, and the collecting system of the kidneys. Genetic and acquired kidney disorders will be discussed in this chapter.

The twenty-first chapter of this course is a comprehensive discussion of pulmonology and diseases of the lungs. The major acquired disorders of the lung will be covered, including chronic obstructive pulmonary disease, chronic bronchitis, and acute pneumonia. The different cancers of the lung are also discussed as part of this chapter.