By Carlos Ayala MD FACS, Brad Spellberg MD FIDSA

This moment variation of forums and Wards: A overview for the USMLE Steps 2 & three deals the data essential to triumph over the USMLE. This crucial assessment booklet, written in a succinct, high-yield define layout, beneficial properties 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 resources for Boards and Wards: A Review for the USMLE, Steps 2 and 3

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Tx a. Chemotherapy → induction, consolidation (no maintenance) b. All-trans retinoic acid used for a subtype of AML, causes differentiation of blasts, beware of onset of DIC in these patients 5. Px = overall 30% cure, bone marrow transplant improves outcomes CHRONIC MYELOGENOUS LEUKEMIAS Presents most commonly in the 50s, can be any age Si/Sx = anorexia, early satiety, diaphoresis, arthritis, bone tenderness, leukostasis (WBC = 1x105 ) → dyspnea, dizzy, slurred speech, diplopia Labs → Philadelphia chromosome (+), peripheral blood → cells of all maturational stages, ↓ leukocyte alkaline phosphatase Philadelphia (Ph) chromosome is pathognomonic, seen in >90% of CML pts, due to translocation of abl gene from chromosome 9 to bcr on 22 Tx in chronic phase = reduction of WBC count with hydroxurea or interferon (IFN)-α, or brand new Tx with the drug-designed tyrosine kinase inhibitor, signal transduction inhibitor (STI)-571, which specifically blocks the oncogenic tyrosine kinase protein formed by the bcr:abl translocation Blast crisis = acute phase, invariably develops causing death in 3-6mo, mean time to onset = 34yr, only BMT can prevent CHRONIC LYMPHOCYTIC LEUKEMIA 1.

Give all patients with prosthetic heart valves antibiotic prophylaxis to prevent bacterial endocarditis 6. Hematologic a. Deep venous thrombosis (DVT) prevented by early ambulation & mechanical compression stockings b. Subcutaneous heparin may be substituted for compression stockings c. Pulmonary embolus should always be considered as a cause of postop acute onset dyspnea 7. Endocrinology a. Adrenal insufficiency i. Surgery creates stress for the body, normally the body reacts to stress by secreting more corticosteroids ii.

5. b. Hypercalciuria can be idiopathic or due to ↑ intestinal calcium absorption, ↑1o renal calcium excretion, or Hypercalcemia c. 50% a/w idiopathic hypercalciuria d. Tx = vigorous hydration, loop diuretics if necessary Ammonium magnesium phosphate stones (“struvite stones”) a. 2nd most common form of stones, are radiopaque b. Most often due to urease (+) Proteus or Staph. saprophyticus c. Can form large staghorn or struvite calculi d. Tx = directed at underlying infection Uric acid stones a. 50% of pts with stones have hyperuricemia b.

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