Author: Jonathan P. Van Kleunen

Publisher:  Wolters Kluwer-Lippincott, Williams & Williams – 372 pages

Book Review by:  Nano Khilnani

This book on preparing to take the third and final examination to qualify for gaining a medical license in the United States is focused more on decision-making in medical cases than on testing your knowledge of medicine and surgery, and its specialties. “It is the final hurdle in the transition from medical school to graduate medical education,” the author Dr. Jonathan P. Van Kleunen describes it.

The other two exams prior to this third and final one – the Step 1 and Step 2 – are focused relatively more on testing your knowledge of subject matter, and less so on your ability to choose a course of action, given the details of a medical case.

The contents in this book are organized in a much different way than the test-prep books for the Step 1 and Step 2 of the U.S. medical licensing exam.

Dr. Van Kleunen has written this book on the basis that you already have a sufficient body of knowledge on the various medical specialties, some experience treating patients with different types of conditions, and the ability to choose the correct course of action should you encounter a case that is new and unfamiliar to you.

The basic purpose of this exam is to test the ability of new doctors to apply the vast amount of knowledge and the information they have acquired to treat patients.

“Because of the emphasis on patient management in the examination, this book has been designed to provide a realistic clinical scenario for the many tested diagnoses. The organization of this book is unlike other reviews for the USMLE Step 3 in that nearly all of the information is presented in a case-based format. Each case consists of an extensive history and physical for the presenting patient, multiple diagnostic studies performed during work-up, the diagnosis made due to this work-up, the treatment administered, and the follow-up of the patient following therapy.”

Accordingly, the entire book has got nothing but cases presented to you – 75 of them –  on which you have to make decisions. What is the right thing to do, given this particular patient’s diagnosis, you ask yourself. You tap into all the knowledge you have gained in medical school, your memory, your experience, your common sense, and your decision-making ability, when you take this third and final board exam.

The contents of this 372-page book are organized into 13 chapters – one on each specialty – plus a 24-page Appendix section with six subsections, and an 18-page Index.

The 13 chapters with a total of 75 cases presented to you to test your ability to make the right decisions are on (alphabetically): cardiology, dermatology, endocrinology, gastroenterology, gynecology, hematology (and oncology), nephrology (and urology), neurology, obstetrics, ophthalmology, orthopedics (and rheumatology), psychiatry and pulmonary medicine.

The cases in each chapter are presented in the form of  patients’ remarks or complaints. For example, in Chapter 1 on Cardiology, in Case 1-1, the patient has remarked “My father died when he was young.”

Upon questioning, it was found that the patient’s father died at the age of 50. An observation of the patient showed multiple hard nodules behind his knees and heels. Initial differential diagnosis was chronic tendonitis. Lab test results revealed in the lipid panel that patient had total cholesterol of 350 mg/dL, LDL of 290 mg/dL, HDL of 45 mg/dL and triglyceride of 120 mg/dL.

The diagnosis was: familial hypercholesterolemia (heterozygote).  The treatment: Patient was placed on a regular exercise regimen and a low-fat, low-cholesterol diet. The drugs prescribed were simvastatin and ezetimibe.

The follow-up a month later showed in the lipid analysis that the patient’s LDL cholesterol to have been cut to almost half to 155 mg/dL and the tendon xanthomas to have gradually regressed. The patient was followed regularly to confirm an adequate reduction of his lipid levels and for cardiac screening.

This is an essential book for you when you are preparing to take Step 3 of the USMLE, to successfully go past the final hurdle to becoming a full-fledged physician. Dr. Van Leunen has done excellent work in compiling information and writing it.