This fourth edition of Crush Step 2 attempts to incorporate the many changes that have occurred in medicine and the exam since 2007, as well as suggestions from readers based on material they encountered on their exams.
For this edition, we have created a student review board composed of recent students who each scored in the 99th percentile on Step 2. Their input and suggestions have been invaluable in helping this book reflect the content and structure of the recent USMLE Step 2 exams. Though the format of the exam is constantly changing, many of the basic concepts you need to know to be a successful house officer have not changed in decades. If you understand the concepts in this book, you should do much better than pass: you should Crush Step 2!
Though Step 2 is the same level of difficulty as Step 1, the focus is more clinical and the questions are more relevant to the everyday practice of medicine. Knowing how to recognize, diagnose, manage, and treat common conditions is stressed. The exam tests not just theory but practice—in other words, what you should do next. Treatable emergency conditions are also tested, because you will soon be asked to take care of patients in the middle of the night, some of whom may require heroic measures if they are to survive until morning rounds.
Some information from Step 1 is still relevant and high yield for Step 2. Epidemiology and biostatistics, pharmacology, and microbiology are all tested with a slightly more clinical slant. Cardiac physiology and pathophysiology and behavioral science are also retested and are high yield. Overall, though, Step 2 has a different focus, and that focus is clinical. If a patient presented with chest pain, what would you do? What kinds of questions would you ask him or her? Which tests would you order? How would you select medications or treatments?
Here are some general tips to keep you focused while studying for and taking the test:
1. Always get more history when it is an option, unless the patient is unstable and you think immediate action is needed.
2. Know the cutoff values for the treatment of common conditions (e.g., at what numbers do you treat hypertension, diabetes, and hypercholesterolemia; below what CD4 count should you institute chemoprophylaxis in HIV patients).
3. A presentation might be normal, especially in psychiatry and pediatrics, and require no treatment!
4. Don’t forget to study your subspecialties. Just because you never took an ophthalmology or dermatology rotation doesn’t mean there won’t be any basic questions on these topics. You don’t have to be an expert, but knowing common and life-threatening diseases in the subspecialties can significantly increase your score.
5. Time management during the exam is critical. Make sure you are prepared to answer all of the questions in the allotted time.
Residency programs generally only see those magic two- and three-digit scores, not the breakdown. Don’t skip studying a subject because you know you aren’t going into it—you might miss out on easy points.
Studying for Step 2 can seem like an overwhelming task. Given the time constraints of medical students in their clinical years, most need a concise, high-yield review of the tested topics. It is our hope that Crush Step 2, fourth edition, will meet your needs in this regard.
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