FYI for surg residents on passing step3

8/5/2012 1:39:29 PM
sounds practical and intuitive but take your exams early in your residency!

i made the mistake of holding out until 5th year and had to relearn everything...i mean pedi, ob, neuro, ID, rheum, derm...everything

i found crush too light on above topics and firstaid too detailed.
i did buy both of these review texts and read thru them once each.
you'll notice that what crush does not cover firstaid covers and vice versa.

you really must do all 1300+ questions on UWorld and read all the explanations...i didn't know IRIS existed for HIV patients who started HAART therapy until Qbank.

though it takes time, when i read about skin lesions and rheum lesions i made mneumonics and also kept a slide of that lesion.
i.e. gottron's lesions associated with polymyositis seen in those patients with solid abdominal tumors, i googled an image of gottron's so i can reference them later.
it really helps..do you think as a surgery resident you can tell what a lichen planus lesion looks like versus a psoriatic lesion?

mneumonics...mneumonics...key!
ie. multiple myelomas...

B: Bence Jones proteins
I: IgG elevated
G: IgG elevated

C: calcium elevated
R: renal failure
A: anemia
B: bone scan negative (nuclear bone scans picks up osteoblastic lesions such as prostate CAs and Paget's of bone)

B: bone lytic lesion
A: amyloid neuropathy
H!: hyperviscosity syndrome

know cause, sx/signs, dx, 1st and 2nd line Tx and if possible Px.
you don't have to read Harrison's for that. it's impossible to learn all the topics...

ie. 5th disease
causes: parvovirus B19
Sx: fever, rash (slapped cheek) but testers won't give it away that easily
Dx: Ag test
Tx: supportive

***i hate this and it's annoying but remember that preg women are HUGE in step3. so ask yourself how ID can affect pregnancy and Px.

THEY ALSO CAN ASK ABOUT MEDS AND LACTATION, MEDS AND PREGNANCY
DID YOU KNOW ANTI SZ MEDS ARE ALL OK EXCEPT VALPROATE (CAUSES NTDS)

As to the 2nd day clinical scenario thing, i agree everybody should do go through the motions to know how the computer system works but the questions are straight forward (no zebras there)

remember We are much better at work up then most non surgery ppl.
don't jump to CTs either because you get deductions if you delay an obvious urgent dx that require ICU admissions (DKAs) or OR.

if an old guy who smokes tons, had a TIA in past, has syncope and abdominal fullness you MUST rule out enlarged AAA.
BUT get abdominal series before you put the whack on em to make sure this isn't diverticular abscess. the xray should guide your Dx to vascular dz instead of GI dz by showing calcified vassels or something...

hope that helps guys


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