Boards and Wards: A Review for the USMLE, Steps 2 and 3 by Carlos Ayala MD FACS, Brad Spellberg MD FIDSA

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By Carlos Ayala MD FACS, Brad Spellberg MD FIDSA

This moment variation of forums and Wards: A evaluation for the USMLE Steps 2 & three bargains the data essential to overcome the USMLE. This crucial overview e-book, written in a succinct, high-yield define structure, good points seventy five fresh, board-formatted Q&As and covers every one self-discipline of medication showing at the USMLE Steps 2 & three, together with dermatology, radiology, and ophthalmology.

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Si/Sx = painful oral & genital ulcers, also arthritis, vasculitis, neurologic dz 3. Tx = prednisone during flare- ups SERONEGATIVE SPONDYLOARTHROPATHY Osteoarthritis A noninflammatory arthritis caused by joint wear & tear The most common arthritis, results in wearing away of joint cartilage Si/Sx = pain & crepitation upon joint motion, ↓ range of joint motion, can have radiculopathy due to cord impingement X-ray → osteophytes (bone spurs) & asymmetric joint space loss Physical exam → Heberden’s nodes (DIP swelling 2o to osteophytes) & Bouchard’s nodes (PIP swelling 2o to osteophytes) Note: RA affects MCP & PIP joints, osteoarthritis affects PIP & DIP Tx = NSAIDs, muscle relaxants, joint replacement (third line) Isometric exercise to strengthen muscles around joint has been shown to improve Sx Ankylosing spondylitis Rheuma tologic dz usually in HLA-B27(+) males (male- female = 3:1) Si/Sx = sacrolitis, spinal dz → complete fusion of adjacent vertebral bodies causing “bamboo spine”, uveitis, heart block If sacroiliac joint is not affected, it is not ankylosing spondylitis!

Are they functionally active or not) 2. Hot nodules are rarely cancerous, usually seen in elderly, soft to palpation, ultrasound (Utz) shows cystic mass, thyroid scan shows autonomously functioning nodule 3. Cold nodule a. Has a greater potential of being malignant b. More common in women c. Nodule is firm to palpation, often accompanied by vocal cord paralysis, Utz shows solid mass 4. Papillary CA a. The most common cancer of thyroid b. Good Px, 85% 5-yr survival, spread is indolent, via lymph nodes c.

Tx = excision of adenoma—bilateral hyperplasia → spironolacotne; bilateral adrenalectomy should NOT be performed o 2. 2 hyperaldosteronism a. , CHF, shock, renal artery stenosis), cirrhosis, or tumor b. Dx = ↑ renin (renin levels differentiate 1o vs. 2o hyperaldosteronism) c. Tx = underlying cause, β-blocker or diuretic for hypertension ADRENAL MEDULLA 1. Pheochromocytoma a. Si/Sx = hypertension (episodic or chornic), diaphoresis, palpitations, tachycardia, headache, nausea/vomit, flushing, dyspnea, diarrhea b.

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