By Carlos Ayala MD FACS, Brad Spellberg MD FIDSA
This moment variation of forums and Wards: A evaluation for the USMLE Steps 2 & three deals the knowledge essential to overcome the USMLE. This crucial evaluate publication, written in a succinct, high-yield define layout, good points seventy five fresh, board-formatted Q&As and covers every one self-discipline of drugs showing at the USMLE Steps 2 & three, together with dermatology, radiology, and ophthalmology.
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Extra info for Boards and Wards: A Review for the USMLE, Steps 2 and 3
Diseases of muscle are divided into 2 groups: neurogenic & myopathic 2. Neurogenic diseases → distal weakness, no pain, fasciculations present 3. Myopathic diseases → proximal weakness, +/- pain, no fasciculations DUCHENNE’S MUSCULAR DYSTROPHY 1. X-linked lack of dystrophin 2. Si/Sx commence at 1yr of age with progressive proximal weakness & wasting, ↑ CPK, calf hypertrophy, waddling gait, Gower’s maneuver (pts pick themselves off the floor by using arms to help legs) 3. Tx = supportive 4. Px = death occurs in 10s-20s, most often due to pneumonia 5.
Tx = lifelong Synthroid 4. Subacute thyroiditis a. Seen following flu- like illness with sore throat & fevers b. Si/Sx = jaw/tooth pain, can be confused with dental dz, ↑ ESR c. Early on looks like hyperthyroidism as damaged gland spills T4 d. Tx with aspirin, only with cortisol in very severe disease e. Usually self- limiting, resolves after weeks to months 5. Myxedema coma a. The only emergent hypothyroid condition—spontaneous onset or precipitated by cold exposure, infection, analgesia, sedative drug use, respiratory failure, or other severe illness b.
Neurologic disability assessed by history, careful neurologic examination (Glasgow Coma Scale), laboratory tests (blood alcohol level, blood cultures, blood glucose, ammonia, electrolytes & urinalysis) & skull x-rays b. Loss of consciousness i. DDx = AEIOUS TIPS = Alcohol, Epilepsy, Environment (temp), Insulin (+/-), Overdose, uremia (electrolytes), Trauma, Infection, psychogenic, Stroke ii. Tx = Coma cocktail, dextrose, thiamine, naloxone & O2 c. ↑ ICP → HTN, bradycardia & bradypnea = Cushing’s triad d.