Yale-G Refined Clinical Review for the USMLE Step 2 CK: 4th Edition by Yale GongUpdated and published as of 8/15/2016:
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Chapter 2 CARDIOVASCULAR DISEASES
IMPORTANT DIFFERENTIATIONS OF CHEST PAIN
Chest pain is the most common symptom for most CVDs, respiratory diseases, and some upper abdominal diseases. Thus, it’s important to grasp the differential points.
Angina and myocardial infarction (MI): See details on the same topic below.
Myocarditis: It is usually preceded by a viral disease, with a vague chest pain. CK-MB is often increased. ECG (EKG) will show abnormal conduction or Q waves.
Pericarditis: It may be preceded by a viral illness. Chest pain is sharp, pleuritic, and positional -- worse with lying down and relieved by sitting up; pericardial rub is often positive. ECG usually shows diffuse ST elevation without Q waves. CK is mostly normal. It responds well to anti-inflammatory drugs.
Pleuritis: Mostly after lung infection; sharp chest pain worse on inspiration and certain position; tenderness, friction rub or dullness may be present. CXR or CT scan is the best means of diagnosis.
Pneumonia: Moderate chest pain with fever, cough, sputum, and hemoptysis. CXR is the best test.
Pneumothorax: Sudden, sharp, pleuritic chest pain and dyspnea; absent breath sounds; mediastinum shifted to the opposite site. Suspect of tension pneumothorax requires emergent intercostal needle puncture. Non-tension pneumothorax can wait for CXR confirmation and natural relief.
Aortic (aneurysm) dissection: Very severe, sharp, tearing chest pain; typically radiating to the back; loss of pulses, unequal BP between arms, or aortic insufficiency; neurologic signs; widened mediastinum on CXR. MI may occur if dissection extends into coronary artery. Diagnosis is confirmed by TEE, CT scan, or aortography.
Pulmonary embolism (PE): Sudden chest pain, dyspnea, tachycardia, cough, and hypoxemia, usually 3-5 days after a surgery or long immobility; pain is usually pleuritic but may resemble angina. LDH may be elevated. ECG is non-specific. CT pulmonary angiography has supplanted V/Q scanning as the preferred means of diagnosis.
Mitral valve prolapse: Transient chest pain and typical midsystolic click murmur.
Pulmonary hypertension: Dull chest pain with symptoms and signs of right ventricle (RV) failure.
Internal Medicine Review Questions (Set Two) - CRASH! Medical Review Series
Step-Up to Medicine (Step-Up Series) 4th Edition (Download PDF)
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Step-Up to Medicine (Step-Up Series): Medicine & Health Science Step-Up to Medicine, Fourth Edition delivers exactly what you need to .
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It is presented in an appealing format that is effective for learning. It is intended to consolidate important information which otherwise may need to be extracted from multiple sources. It will be particularly helpful during third and fourth year internal medicine clerkships. Important clinical points are highlighted in the margins. Tables, illustrations, and clinical vignettes are effectively used.
I first purchased this text as a third year medical student on my internal medicine clerkship and was instantly impressed with both the level of detail present and the organized flow that takes you from how a disease presents through how it is diagnosed and managed. This resource later came in handy for studying for my family medicine the ambulatory and infectious diseases chapters are very high yield and neurology shelf exams. Naturally, given the positive results that I had throughout third year, it felt like a no-brainer utilizing Step Up to Medicine again to prepare for Step 2 CK. For the most part, my students really enjoy this resource and feel that it does a great job preparing them for their medicine shelf. However, I almost always encounter the question:. I think having previous exposure to Step Up to Medicine is very beneficial if you are planning to use it to prepare for CK.