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Introduction
Why should I use this book?
We are excited to introduce First Aid Clinical Algorithms for the USMLE Step 2 CK, a new and improved study tool to help you excel on the Step 2 CK. Unlike other textbooks that present diseases by shared pathology, this book organizes material by presenting symp- toms in algorithms meant to demonstrate the clinical reasoning that should be used to answer the questions on test day.
Many chief complaints have broad differentials that are often not helpful to consider in their entirety for any given patient. Instead, a clinician or test-taker should notice a few initial clues to narrow the differential from, say, dizziness to vertigo or a car- diac arrhythmia. Before developing a differential diagnosis. In this book, this step is organized by “meta-algorithms” that show the steps to reach a more specific chief complaint, for which there is an algorithm/HYF page from the broader chief complaint (dizziness to vertigo). These pages serve to describe frameworks for a chief complaint and the initial salient features to note.
Algorithms present in a visually clear way the most vital infor- mation needed to discriminate between similarly presenting diag- noses and the correct timing of different management steps. The benefit of this format is that it helps the reader to distill the “infor- mation overload” often present in Step 2 question stems to the salient information that is needed to answer the questions quickly and correctly without being bogged down in unnecessary details.
The book is comprised of paired algorithms and “High-Yield Facts” (HYF) pages so that, for a given chief complaint, the diseases that should be on your differential will be included in an algorithm that provides a step-by-step method to guide you from the chief complaint to the correct diagnosis and initial treatment. Accompa- nying each algorithm will be the HYF page, which lists the diseases from the algorithm and includes pertinent high-yield information that is not present in the algorithm, in particular, a brief clinical vignette, management steps, and potential complications.
How should I use this book?
• It will be most helpful to begin using this book early in your clinical education as you prepare for and start clerkships. The specialty-specific chapters are designed to be study tools for the shelf exams and will also provide frameworks for the patients and diseases you encounter on the wards and in clinic. As you work through the chapters on each clerkship, you will be well prepared to review the book as a whole when studying for the
Step 2 CK exam.
• This book will help you to answer the 6 primary types of ques-
tions on the Step 2 CK (and shelf) exams:
1. “Diagnosis” questions simply ask you to diagnose the
condition based on a question stem and set of data. The algorithm, as well as the clinical vignette on the HYF page. should be studied to answer these questions.
2. “Treatment” questions ask you to identify the appropriate treatment for the described condition. Often you must first identify the condition based on the question stem. Studying the algorithms (and potentially further treatment steps on HYF pages) should prepare you well for these questions.
3. “Best next step” questions ask you to (implicitly) form a differential and then decide the next step in either diagnosis or treatment. Oftentimes the specific diagnosis is not clear, but a management step must be chosen anyway. The algorithm format is ideal for thinking through these questions.
4. “Complications” questions ask you to predict the treatment complication the patient is at risk for developing based on the drug or procedure indicated once you know a diagnosis or treatment. Use the algorithm to determine the diagnosis and then the complications are listed in the HYF page.
5. “Differentiate” questions ask what essential diagnostic test will differentiate one diagnosis from another, closely related diagnosis. The algorithm format is designed to focus on these essential diagnostic steps.
6. “Facts” questions ask for specifics on a disease once
you have identified it, such as epidemiology (often what
populations are at risk) and pathophysiology. The highest- yield facts are covered in the HYF page. The algorithms are best used alongside practice questions. •
After you finish a practice exam or question set, use this book as you review incorrect (and correct) answers. Identify the chief complaint and turn to the corresponding meta-algorithm Work your way down the algorithm using the data provided in the question stem. If you made a mistake in the workup or sequence of management, it should be clear where that mistake
or primary algorithm. Alternately, as you glance through the answer choices, identify the algorithm that best includes these.
was made based on the algorithm. If you answered correctly,
tracing your steps down the algorithm will help to reinforce
your reasoning.
• The algorithms can also be used to help to understand clini- cal decision-making on the wards or to provide guides for brief on-rounds teaching on the management of specific complaints. However, it should be noted that in instances of conflict, this book favors the “test correct” approach, and occasionally this approach may differ from usual clinical practice.
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