USMLE Step Third Edition TAO LE, MD, MHS Assistant Clinical Professor of Medicine and Pediatrics Chief, Section of Allergy and Immunology Department of Medicine University of Louisville VIKAS BHUSHAN, MD Diagnostic Radiologist HERMAN SINGH BAGGA, MD Resident, Department of Urology University of California, San Francisco New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010, 2008, 2005 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-173603-9 MHID: 0-07-173603-4 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-171297-2, MHID: 0-07-171297-6 All trademarks are trademarks of their respective 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MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise From the Authors of FIRST AID ® 3Qmax STEP 1000+ high yield Step questions with detailed explanations Create highly custom tests Simulate a half-day or full-day exam Pass guarantee - pass or we will double your subscription www.usmlerx.com Your Prescription for USMLE Success DEDICATION To the contributors to this and future editions, who took time to share their experience, advice, and humor for the benefit of students and To our families, friends, and loved ones, who endured and assisted in the task of assembling this guide This page intentionally left blank v Contents Authors vii Faculty Reviewers vii Preface ix Acknowledgments xi How to Contribute xiii CHAPTER Guide to the USMLE Step and Supplement: Guide to the CCS CHAPTER Ambulatory Medicine 15 CHAPTER Cardiovascular 31 CHAPTER Emergency Medicine 49 CHAPTER Endocrinology 73 CHAPTER Ethics and Statistics 91 CHAPTER Gastroenterology 103 CHAPTER Hematology 127 CHAPTER Oncology 143 CHAPTER 10 Infectious Disease 165 CHAPTER 11 Musculoskeletal 195 CHAPTER 12 Nephrology 213 CHAPTER 13 Neurology 235 CHAPTER 14 Obstetrics 257 CHAPTER 15 Gynecology 275 CHAPTER 16 Pediatrics 289 CHAPTER 17 Psychiatry 331 CHAPTER 18 Pulmonary 357 CHAPTER 19 High-Yield CCS Cases 375 Appendix 467 Index 473 About the Authors 497 This page intentionally left blank vii AUTHORS K Pallav Kolli, MD Imaging Editor Resident, Department of Radiology and Biomedical Imaging University of California, San Francisco Clarissa Barnes, MD Resident, Department of Internal Medicine Johns Hopkins Hospital Jonathan Day, MD Resident, Department of Internal Medicine Saint Vincent Hospital Heidi Reetz, MD Resident, Family Medicine Santa Rosa Family Medicine Residency Amar Dhand, MD, DPhil Resident, Department of Neurology University of California, San Francisco Sapna Shah, MD Resident, Department of Internal Medicine University Hospitals Case Medical Center Catherine R Harris, MD Resident, Department of Urology University of California, San Francisco Shannon Shea, MD, MPH Resident, Department of Pediatrics University of California, San Francisco Sandarsh Kancherla, MD Fellow, Department of Gastroenterology St Luke’s-Roosevelt Hospital Benjamin Silverberg, MD, MS Resident, Department of Family Medicine University of Virginia Nilay Kavathia, MD Resident, Department of Internal Medicine Thomas Jefferson University Alex Wu, MD Resident, Department of Urology University of California, San Francisco FACULTY REVIEWERS Charles Angell, MD Assistant Professor of Medicine Johns Hopkins University Gregory C Kane, MD Professor of Medicine, Vice-Chairman, Education Jefferson Medical College Rizwan Aslam, MD Associate Clinical Professor, Department of Radiology and Biomedical Imaging University of California, San Francisco Armand Krikorian, MD Assistant Professor, Division of Clinical and Molecular Endocrinology Case Western Reserve University Mitchell Conn, MD Associate Professor of Medicine, Department of Gastroenterology Thomas Jefferson University Hospital Lowell Lo, MD Assistant Professor, Department of Medicine University of California, San Francisco Vanja Douglas, MD Assistant Clinical Professor, Department of Neurology University of California, San Francisco Aleksandr Gorenbeyn, MD, FACEP Assistant Professor, Department of Traumatology and Emergency Medicine University of Connecticut Sharad Jain, MD Professor, Department of Clinical Medicine University of California, San Francisco Gregory S Janis, MD Associate Director, CCU St Luke’s-Roosevelt Hospital Center Andrea Marmor, MD, MSEd Assistant Clinical Professor, Department of Pediatrics University of California, San Francisco Charles J Nock, MD Assistant Professor, Department of Medical Oncology University Hospitals Case Medical Center Maria Isabel Rodriguez, MD Clinical Instructor, Department of Obstetrics and Gynecology University of California, San Francisco David Schneider, MD Faculty, Santa Rosa Family Medicine Residency Associate Clinical Professor, Department of Family and Community Medicine University of California, San Francisco This page intentionally left blank INDEX Pralidoxime, 60 Precocious puberty, 304–305 Predictive values, 96 Preeclampsia/eclampsia, 262, 263 Pregnancy ectopic, 281–282, 420–421 medical complications of, 261–264 diabetes mellitus (DM), 261 gestational trophoblastic disease, 263–264 hyperemesis gravidarum, 262 preeclampsia/eclampsia, 262 obstetric complications of, 268–270 intrauterine growth restriction (IUGR), 268 oligohydramnios and polyhydramnios, 268, 269 third-trimester bleeding, 269–270 teratogens in, 266–267 Premature atrial contraction (PAC), 54, 55 Premature ventricular contraction (PVC), 54, 56 Prenatal care and nutrition, 258 Prenatal diagnostic testing, 259 amniocentesis, 259 chorionic villus sampling, 259 triple-marker screen/quadruple test (quad screen), 259 Presbycusis, 18 Presbyopia, 69 Preterm labor, 271 Preterm premature rupture of membranes (PPROM), 270–271 Prevalence, 97 Prolactinoma, 88 Propionibacterium acnes, 24 Proportionality, 92 Propranolol, 81, 336 Propylthiouracil, 81 Prospective and retrospective studies, 99 Prostaglandin E, 315 Prostate cancer, 158, 434–435 screening guidelines for, 28 Prostate-specific antigen (PSA), 164 Prostatic nodules and abnormal PSA, workup of, 27, 28 Prostatitis, 181, 436–437 Protamine sulfate, 60 Protease inhibitors (PIs), 185 Proteinuria, 214, 226–227 location of renal disease in, 227 Proteus, 63, 192, 193 Pseudodementia, 339 Pseudoephedrine, 19 Pseudomembranous colitis, 428–429 Pseudomonas, 168, 172, 173, 175, 176, 189, 192, 193 Pseudomonas aeruginosa, 63, 373 Psoriasis, 21 Psoriatic arthritis, 21 Psychiatric disorders, childhood, 348–349 attention-deficit hyperactivity disorder (ADHD), 349 autism spectrum disorders, 348 disruptive behavioral disorders, 348 enuresis, 349 learning impairment, other causes of, 349 Psychiatric emergencies, 349–350 neuroleptic malignant syndrome, 350 serotonin syndrome, 350 suicide risk assessment, 349–350 Psychotic disorders, 340–342 dissociative fugue, 342 dissociative identity disorder, 342 schizophrenia, 340–341 Pulmonary embolism (PE), 53, 366– 368, 394–395 diagnostic approach to, 367 Pulmonary function tests (PFTs), 358 Pulmonary nodule, solitary (SPN), 369–370 Pulmonology, pediatric, 321–325 bronchiolitis, 324–325 croup (laryngotracheobronchitis), 321–323 characteristics of, 322 epiglottitis, 323–324 characteristics of, 322 pertussis, 324 Pulseless arrest, 57 Pustules, definition of, 20 Pyelonephritis, 181, 412–413 Pyloric stenosis, 316–317 Pyoderma gangrenosum, 107 Pyrazinamide, 180 Pyridoxine (vitamin B6), 60 Q Quetiapine, 336, 338, 353 Quinupristin, 193 R R-CHOP therapy, 148 “Raccoon eyes,” 51, 244 Radiation exposure from common radiologic procedures, 266 Radiology, 71 483 Radionuclide tracer (thallium or technetium), 39 Ramsay Hunt syndrome, 249 Randomized controlled trial (RCT), 101 Recurrent abortion, 274 Reed-Sternberg cells, 147 Relative risk (RR), 97–98 Relative risk reduction (RRR), 98 Renal amyloidosis, 228 Renal artery stenosis, 43, 44 Renal basics, 214–215 fractional excretion of sodium (FeNa), 215 glomerular filtration rate (GFR) and surrogates, 214 urinalysis (UA), intrepretation of, 214–215 Renal cell carcinoma, 159–160, 412–413 Renal failure, 149 acute (ARF), 222–223 causes of, 223 Renal tubular acidosis (RTA), 230– 231 types of, 231 Repaglinide, 77 Respiratory acidosis, 229–230 Respiratory alkalosis, 229–230 Respiratory depression, 58 Respiratory disorders, neonatal, 295 Respiratory distress syndrome, 295 Restraints, use of, 93 Retinal detachment, 69 Retinoblastoma, 328 Retinopathy, 79 Retrograde amnesia, 339 Rett’s disorder, 348 Reynolds’ pentad, 118 Rhinitis, allergic, 18–19 Rhinophyma, 22 Rheumatoid arthritis (RA), 198–199, 452–453 radiographic findings in, 199 Rheumatology, pediatric, 310–312 Henoch-Schönlein purpura (HSP), 311–312 juvenile idiopathic arthritis (JIA), 310–311 pauciarticular, 310 polyarticular, 310–311 systemic, 310 reactive arthritis, 311 Ribavirin, 372 Richter’s transformation, 146 Rickettsia, 193 Rifampin, 180 484 INDEX Rights of minors, 92–93 Rinne test, 18 Risperidone, 336, 338, 353 Ritonavir, 185 Rodent bites, 63 Rome III criteria, 110 Rosacea, 22 Roseola infantum (exanthem subitum), 456–457 Rosiglitazone, 77 Rotavirus, 112, 187 Roth’s spots, 46 Rubella, 298 Ruptured globe, 68 S Salicylate toxicity, 60 Salmonella, 112, 168, 187, 311 Salter-Harris fractures, 207–208 Saquinavir, 185 Sarcoidosis, 370 Schizoaffective disorder, 341 Schizoid personality disorder, 333 Schizophrenia, 340–341 Schizophreniform disorder, 341 Schizotypal personality disorder, 333 Schwannoma, 249 Scleroderma, 104, 211–212 limited vs diffuse, 212 Scorpion stings, 62 Seasonal affective disorder (SAD), 339 Seborrheic dermatitis, neonatal, 302, 303 Sedative-hypnotic toxidrome, 59 Seizures, 241–242 grand mal (complex tonic-clonic), 386–387 prevention of, first-line drugs for, 242 Selective serotonin reuptake inhibitors (SSRIs), 26, 333, 335, 336, 347, 350, 352 Selegiline, 353 Selenium sulfide, 25 Seminoma, 159 Sensitivity and specificity, 96 Sepsis, 189–191 severity of, 190 Septic arthritis, 168–169, 450–451 Septic shock, 53, 460–461 Serotonin syndrome, 350, 353 Sertraline, 352 Serum protein electrophoresis (SPEP), 148 Severe combined immunodeficiency (SCID), 308 Sexual assault, 62 Sexually transmitted diseases (STDs), 182–184 cervicitis/urethritis, 183 genital herpes, 183 pelvic inflammatory disease (PID), 184 syphilis, 182–183 Sheehan’s syndrome (postpartum hypopituitarism), 264 Shigella, 112, 187, 311 Shock, 53 hemodynamic characteristics of, 53 symptoms of, 53 types of, 53 Shoulder dislocation, 206 Shoulder dystocia, 272 Shprintzen syndrome, 329 Sickle cell anemia, 134–136 complications of, 135 Sildenafil (Viagra), 26 Simvastatin, myopathy due to, 448– 449 Sinus bradycardia, 54, 65 Sinus tachycardia, 55 Sinusitis, 172 acute, 172 chronic, 172 Sipple’s syndrome, 89 Sitagliptin, 77 Sjögren’s syndrome, 198 Skin tumors, 161–163 basal cell carcinoma, 161, 162 melanoma, 161–162 squamous cell carcinoma, 162–163 Skull fracture, basilar, 51 Sleep apnea, 344 obstructive (OSA), 371 Sleep disorders, 343–344 circadian rhythm sleep disorder, 344 insomnia, primary, 343 narcolepsy, 343–344 sleep apnea, 344 Smallpox immunization, 30 Smudge cells, 146 Snake bites, 63 Social phobia, 335 Sodium, fractional excretion of, 215 Sodium bicarbonate, 60 Sodium nitrite, 60 Sodium thiosulfate, 60 Soft tissue infections, 166–167 cellulitis, 166 necrotizing fasciitis, 166–167 Somatoform disorders, 342–343 body dysmorphic disorder, 343 conversion disorder, 342 hypochondriasis, 342–343 pain disorder, 343 somatization disorder, 342 Spherocytosis, hereditary, 132, 133 Spider bites, 63 Spinal cord compression, 244–246 Spinal nerve damage, 205 Spinal stenosis, 44, 205 Spironolactone, 35, 124 Spontaneous abortion (SAB), 273– 274, 444–445 types of, 273 Spontaneous bacterial peritonitis (SBP), 123 Squamous cell carcinoma, 162–163 Staphylococcus, 68, 112, 193, 307, 373 Staphylococcus aureus, 46, 47, 63, 69, 168, 173, 174, 265, 308 methicillin-resistant (MRSA), 175, 176, 192, 193 methicillin-sensitive, 176, 192 Staphylococcus epidermidis, 46 Statins, 45 Statistical significance/p-value, 98 Status epilepticus, 241 “Steakhouse syndrome,” 104 Steeple sign, 321 Stevens-Johnson syndrome, 355 Strabismus (“lazy eye”), 69 Streptococci, α-hemolytic, 63 group A, 173 group B, 171, 296 viridans, 46, 63 Streptobacillus moniliformis, 63 Streptococcus, 68, 192, 193, 363 Streptococcus agalactiae, 172 Streptococcus bovis, 47 Streptococcus pneumoniae, 171, 172, 174, 175, 308 Streptokinase toxicity, 60 Stroke, 237–240 hemorrhagic, 237–238 ischemic, 237–238 Study design, 99–101 case-control study, 100 cohort study, 99 prospective and retrospective studies, 99 randomized controlled trial (RCT), 101 surveys, 99 Subarachnoid hemorrhage (SAH), 237, 239 Subdural hematoma, 244 INDEX Substance-related disorders, 344–346 alcoholism, 346 substance abuse/dependence, 344–346 intoxication and withdrawal, signs and symptoms of, 345 Succimer, 60 Suicide risk assessment, 349–350 Sulfonylureas, 77 Superior vena cava syndrome, 152 Surrogate/proxy, 93 Surveys, 99 Syndrome of inappropriate secretion of antidiuretic hormone (SIADH), 153, 221 causes of, 221 Syphilis, 182–183, 298 Systemic inflammatory response syndrome (SIRS) criteria, 190 Systemic lupus erythematosus (SLE), 196–197, 446–447 T 22q11 syndrome, 329 Tachyarrhythmias, common, 55–56 supraventricular, 55 ventricular, 56 Tachycardia, 58 Tachypnea, 58 Tadalafil, 26 Takayasu’s arteritis, 41 Tardive dyskinesia, 354 Tazobactam, 192 Technetium, 39 Teeth, numbering system and types of, 70 Temporal arteritis (giant cell arteritis), 208–209, 380–381 Tenofovir (TNV), 185 Tensilon (edrophonium chloride), 248 Tension headache, 246, 380–381 Tension pneumothorax, 53, 366, 404–405 Teratogens in pregnancy, 266–267 Terazosin, 27 Terbinafine, 25 Terminal complement deficiency, 309 Testicular cancer, 158–159 Tetanus, 63–64 immunization, 30 prophylaxis schedule, 64 Tetracyclines, 193 Tetralogy of Fallot, 315 Thallium, 39 Thiazide diuretics, 41 Thiazolinediones (“glitazones”), 77 Third-trimester bleeding, 269–270 Thrombocytopenia, 136, 137–138 acquired, 138 autoimmune, 138 drug-induced, 137 heparin-induced, 138 inherited, 138 Thrombophilia, 140–141 Thrombotic thrombocytopenic purpura (TTP), 133–134 Thumbprint sign, 323 Thymic aplasia (DiGeorge syndrome), 307 Thyroid disorders, 80–82 functional, 80–82 clinical presentation of, 80 differential and treatment of, 81 workup of, 81 thyroid nodules, 82 Thyroid storm, 82 Thyroidectomy, 81 Ticarcillin, 192 Tick-borne diseases, 187–189 babesiosis, 188–189 ehrlichiosis, 188 Lyme disease, 187–188 Tinea capitis, 25 Tinea corporis, 25 Tinea pedis, 25 Tinea versicolor, 25 Tirofiban, 32 Tissue plasminogen activator (tPA) toxicity, 60 Tobramycin, 193 Todd’s paralysis, 241 Topiramate, 336, 355 ToRCHeS infections, congenital, 297, 298 Torsades de pointes, 56, 57 Tourette’s syndrome, 349 Toxic shock syndrome, 460–461 Toxicology, 58–61 drug withdrawal syndromes and treatment, 61 specific antidotes and treatments, 60 toxidromes, classic, 59 Toxoplasma gondii, 186 Toxoplasmosis, 298 Tracheitis, characteristics of, 322 Tracheoesophageal fistula, 298 Transcutaneous pacing, 56 Transfusion complications, 142 Transient ischemic attack (TIA), 237, 390–391 Transient neonatal pustular melanosis, 302 485 Transient tachypnea of the newborn, 295 Transposition of the great arteries (TGA), 315 Transurethral resection of the prostate (TURP), 27 Tranylcypromine, 353 Trauma, 50–52, 450–451 ABCs and the primary survey, 50 nonaccidental, 450–451 secondary survey, 51–52 Travel medicine, 186–187 malaria prophylaxis, 186 traveler’s diarrhea (TD), 186–187, 428–429 common pathogens causing, 187 Trazodone, 352 Treadmill (stress test), 39 Treatment, withdrawal of, 96 Treponema pallidum, 182, 192 Trichomonas vaginalis, 280 Tricophyton mentagrophytes, 25 Tricophyton rubrum, 25 Tricophyton tonsurans, 25 Tricyclic antidepressants (TCAs), 26, 333, 335, 336, 352–353 intoxication, 390–391 toxicity, 60, 352 Trigeminy, 54 Triglycerides, 45 Trimethoprim-sulfamethoxazole (TMP-SMX), 193, 363 Trisomy 13, 329 Trisomy 18, 329 Trisomy 21, 329 Trousseau’s sign, 220 Trousseau’s syndrome, 153 Truth telling, 92 Tuberculosis, 177–180, 398–399 drugs, common side effects of, 180 extrapulmonary, 177 latent, 177 pulmonary, 178, 179 evolution of, 178 purified protein derivative (PPD) interpretation, 179 reactivation, 177 Tubo-ovarian abscess, 184 Tumor lysis syndrome, 148, 328 Tumor markers, 164 Tumors, definition of, 20 Turner’s syndrome, 316, 330, 442–443 U Ulcerative colitis, 109, 432–433 Ultrasound, 71 486 INDEX Upper GI bleed, 113–114 Upper motor neuron (UMN) lesions, 236 Upper respiratory tract infections, 172–174 otitis externa, 173 otitis media, 173 pharyngitis, 173–174 sinusitis, 172 acute, 172 chronic, 172 Urethritis, 183, 438–439 Urinalysis (UA), intrepretation of, 214–215 Urinary incontinence, 285–286 types of, 286 Urine protein electrophoresis (UPEP), 148 Urinary tract infection, pediatric, 305–306 USMLE Step 3, guide to, 1–7 computer-based testing basics, 2–6 examination results, recent, incomplete test, questions, types of, 3–4 registering, 4–6 rescheduling, scoring, 4, structure, test format, 2–3 time, testing agencies, USMLE/NBME resources, Uterine bleeding, abnormal, 276–277, 442–443 types of, 276 Uveitis, 69 Vancomycin, 193 Vardenafil, 26 Vaso-occlusive crisis, 135 Vasopressin, 114 Velocardiofacial syndrome, 329 Venlafaxine, 334, 350, 352 Venom snake, 63 spider, 63 Ventricular fibrillation (VF), 56 Ventricular septal defect (VSD), 313 Ventricular tachycardia (V-tach), 56 Vertigo, 249–250 central, 249–250 peripheral, 249 Vesicles, definition of, 20 Vesicoureteral reflux, 305, 306 Viagra (sildenafil), 26 Vibrio, 187 Vibrio parahaemolyticus, 112 Vildagliptin, 77 VIPoma, 157 Virchow’s triad, 140, 366 Viridans streptococci, 46, 63 Vitamin B6 (pyridoxine), 60 Vitamin B12 deficiency, 131 Vitamin K, 60 deficiency, 138 Volitional/intentional disorders, 343 factitious disorder, 343 malingering, 343 Volvulus, 318–319, 416–417 von Willebrand’s disease (vWD), 140 V/Q scan, 71 Vulvovaginitis, 280–281 common causes of, 281 W V Vaginal bleeding, 442–445 Vaginitis, atrophic, 462–463 Valproic acid, 355 Waldenström’s macroglobulinemia, 148 Warfarin, 141 toxicity, 60 Weber test, 18 Well-child care/routine health screening, 290 anticipatory guidance, 294 growth and development, 290–292 developmental milestones, 292 failure to thrive (FTT), 290–291 prevention of illness, 293 immunizations, 293 safety, 293–294 child abuse, 293–294 general principles, 293 Wermer’s syndrome, 89 Wernicke-Korsakoff syndrome, 255 Wernicke’s aphasia, 239 Wernicke’s encephalopathy, 255, 346 West Nile encephalitis, 170 West syndrome (infantile spasms), 326 Western blot, 184, 188 Whipple procedure (pancreaticoduodenectomy), 154 Wilms’ tumor, 326–327 Wilson’s disease, 125 Wiskott-Aldrich syndrome, 308 Wolff-Parkinson-White syndrome, 55, 57 X Xanthomas, 44 Xerophthalmia, 69 Y Yersinia, 112, 187, 311 Z Zavanelli maneuver, 272 Zenker’s diverticulum, 104 Zidovudine (AZT), 185 Ziprasidone, 353 Zolpidem, 351 Zoster immunization, 30 NOT E S NO T E S NOT E S NO T E S NOT E S NO T E S NOT E S NO T E S NOT E S NO T E S ABOUT THE AUTHORS 497 About the Authors Tao Le, MD, MHS Tao has pursued his passion for medical education for the past 18 years As senior editor, he has led the expansion of First Aid into a global educational series In addition, he is the founder of the USMLERx online learning system as well as a cofounder of the Underground Clinical Vignettes series As a medical student, he was editor-in-chief of the University of California, San Francisco Synapse, a university newspaper with a weekly circulation of 9000 Tao earned his medical degree from the University of California, San Francisco in 1996 and completed his residency training in internal medicine at Yale University and allergy and immunology fellowship training at Johns Hopkins University At Yale, he was a regular guest lecturer on the USMLE review courses and an adviser to the Yale University School of Medicine curriculum committee Tao subsequently went on to cofound Medsn, a medical e-learning company, and served as its chief medical officer He is currently section chief of adult allergy and immunology at the University of Louisville He enjoys travel, movies, good food, and spending time with his family Vikas Bhushan, MD Vikas is an author, editor, entrepreneur, and teleradiologist In 1990 he conceived and authored the original First Aid for the USMLE Step His entrepreneurial adventures include a successful software company, a medical publishing enterprise (S2S), an e-learning company (Medsn), and an ER teleradiology service (24/7 Radiology) His eclectic interests include medical informatics, independent film, humanism, Urdu poetry, world music, South Asian diasporic culture, and avoiding a day job A dilettante at heart, he coproduced a music documentary on qawwali music and coproduced and edited Shabash 2.0: The Hip Guide to All Things South Asian in North America Vikas completed a bachelor’s degree in biochemistry from the University of California, Berkeley; an MD with thesis from the University of California, San Francisco; and a radiology residency from the University of California, Los Angeles Herman Singh Bagga, MD Herman is a urology resident at the University of California, San Francisco He has been involved in multiple First Aid projects since his time in medical school at the Johns Hopkins University School of Medicine He was raised in New York City (which explains his rough and tough exterior) until moving to Erie, Pennsylvania (a small, quiet city responsible for cultivating his soft side), for the rest of his youth As an undergraduate at Case Western Reserve University, he studied economics and biology before committing to medicine as his career path His academic interests include outcomes research and medical education [...]... of the Step 3 exam and will offer you proven approaches toward conquering the exam For a high-yield guide to the Computer-Based Clinical Simulations (CCS), go to Section I Supplement: Guide to the CCS For a detailed description of Step 3, visit www usmle. org or refer to the USMLE Step 3 Content Description and Sample Test Materials booklet that you will receive upon registering for the exam USMLE Step. .. information concerning the time required for score reporting is posted on the USMLE Web site GUIDE TO THE USMLE STEP 3 USMLE/ NBME Resources We strongly encourage you to use the free materials provided by the testing agencies and to study the following NBME publications: ■ ■ ■ ■ USMLE Bulletin of Information This publication provides you with nuts-and-bolts details about the exam (included on the USMLE. .. preparation guide for the computerized USMLE Step 3 with test-taking strategies for the FRED v2 format • A high-yield guide to the CCS that includes invaluable tips and shortcuts • One hundred minicases with presentations and management strategies similar to those of the actual CCS cases We invite you to share your thoughts and ideas to help us improve First Aid for the USMLE Step 3 See How to Contribute,... THE EXAM? 4 1 2 CHAPTER 1 GUIDE TO THE USMLE STEP 3 Introduction KEY FACT Step 3 is not a retread of Step 2 For house officers, the USMLE Step 3 constitutes the last step one must take toward becoming a licensed physician For international medical graduates (IMGs) applying for residency training in the United States, it represents an opportunity to strengthen the residency application and to obtain an... as the patient’s primary physician and will bear complete responsibility for his or her care What Is the CCS Like? KEY FACT Do all the sample CCS cases prior to the actual exam For the CCS, there is no substitute for trying out the cases on the USMLE CD-ROM or downloading the software from the USMLE Web site If you spend at least a few hours doing the sample cases and familiarizing yourself with the. .. from the start We gratefully acknowledge the thoughtful comments, corrections, and advice of the residents, international medical graduates, and faculty who have supported the authors in the development of First Aid for the USMLE Step 3 For support and encouragement throughout the process, we are grateful to Thao Pham, Selina Franklin, and Louise Petersen Thanks to our publisher, McGraw-Hill, for the. .. of 82 is equivalent to a score of 200 on the first scale Approximately 95% of graduates from U.S and Canadian medical schools pass Step 3 on their first try (see Table 1-1) Approximately two-thirds of IMGs pass on their first attempt HO W DO I R E G I S TE R TO TAK E THE E X AM ? To register for the Step 3 exam in the United States and Canada, apply online at the Federation of State Medical Boards (FSMB)... Preface With First Aid for the USMLE Step 3, we continue our commitment to providing residents and international medical graduates with the most useful and up-to-date preparation guides for the USMLE exams This third edition represents a thorough review in many ways and includes the following: • An updated review of hundreds of high-yield Step 3 topics with full-color images, presented in a format designed... CCS format There is a 15-minute CCS tutorial as well as 45 minutes of allotted break time WH AT I S S TE P 3 LI K E ? Even if you’re familiar with the CBT and the Prometric test centers, FRED v2 is a relatively new testing format that you should access from the USMLE CD-ROM or Web site and try out prior to the exam In addition, the CCS format definitely requires practice GUIDE TO THE USMLE STEP 3 CHAPTER... Web site (www.fsmb.org) A printable version of the application is also available on this site Note that some states require you to apply for licensure when you register for Step 3 A GUIDE TO THE USMLE STEP 3 TA B L E 1- 1 CHAPTER 1 5 Recent Step 3 Examination Results 2008a 2007 # TESTED % PASSING # TESTED % PASSING 17,570 95 18,241 94 16, 633 96 17,245 95 937 72 996 67 21 86 21 90 20 85 19 95 1 Not reported