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Hematology Diagnostic Testing Initial testing is as follows: ·· Skeletal survey to detect punched out osteolytic lesions. (Osteoblastic lesions suggest metastatic prostate cancer.) ·· Serum protein electrophoresis (SPEP): You are looking for elevated levels of monoclonal antibody (usually IgG). 20% are IgA. ·· Urine protein electrophoresis (UPEP): Detects Bence-Jones protein. ·· Peripheral smear: Shows “rouleaux” formation of blood cells. Mean platelet volume (MPV) is elevated because the cells stick together. ·· Elevated calcium level: Makes sense with the osteolytic lesions. ·· Beta 2 microglobulin level: This is a prognostic indicator. ·· BUN and creatinine: This is to detect the frequent occurrence of renal insufficiency. Bortezomib reverses renal dysfunction. Basic Science Correlate Mechanism of Renal Failure in Myeloma •• Hypercalcemia leads to nephrocalcinosis. •• Hyperuricemia is directly toxic to kidney tubules. •• Bence-Jones protein clogs up glomeruli and is toxic to kidney tubules. •• Amyloid occurs in myeloma. The single most specific test is the bone marrow biopsy, which detects high numbers of plasma cells (10 percent). The B12 and LAP levels are elevated in Pvera. “Rouleaux” formation of blood cells 179
Master the Boards: USMLE Step 3 Treatment Treat with melphalan and steroids. Thalidomide, lenalidomide, or bortezomib may be added: Thalidomide is an inhibitor of tumor necrosis factor that has the same efficacy as chemotherapy. The most effective therapy is an autologous stem cell bone marrow transplantation. This is reserved for patients who are relatively young (
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THIRD EDITION Master the Boards USM
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THIRD EDITION Master the Boards USM
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Dedication To the Reader, This book
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Table of Contents Acknowledgments .
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About the Authors Conrad Fischer, M
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Infectious Diseases 1 Introduction
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Infectious Diseases Anaerobes ··
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Infectious Diseases -- Adverse effe
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Infectious Diseases Basic Science C
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Infectious Diseases Otitis Media Ke
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Infectious Diseases Diagnostic Test
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Infectious Diseases Cellulitis Look
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Infectious Diseases KOH Prep Basic
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Infectious Diseases Treatment Treat
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Infectious Diseases Lymphogranuloma
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Infectious Diseases Answer: D. Perf
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Infectious Diseases Pyelonephritis
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Infectious Diseases Duke’s Criter
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Infectious Diseases Endocarditis Pr
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Infectious Diseases Basic Science C
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Infectious Diseases Maintenance the
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Infectious Diseases A 43-year-old m
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Infectious Diseases Treatment ··
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Allergy and Immunology 2 Anaphylaxi
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Allergy and Immunology Answer: This
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Allergy and Immunology Treatment Li
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Pulmonology 5 Asthma Asthma present
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Pulmonology Nonacute Asthma 1. Best
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Pulmonology -- Chemistry: Increased
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Pulmonology Diagnostic Testing A ch
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Pulmonology Diagnostic Testing ··
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Pulmonology Pulmonary Embolism (PE)
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Pulmonology Basic Science Correlate
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Pulmonology ·· If pleurodesis fai
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Page 182 and 183: Hematology 7 Anemia All forms of an
Page 184 and 185: Hematology Microcytic Anemia Diagno
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Page 188 and 189: Hematology answer antiparietal cell
Page 190 and 191: Hematology Treatment ·· Next best
Page 192 and 193: Hematology Treatment ·· Best init
Page 194 and 195: Hematology Pyruvate Kinase Deficien
Page 196 and 197: Hematology A pregnant woman comes w
Page 198 and 199: Hematology Myelodysplasia This cond
Page 200 and 201: Hematology Smudge cell (found in CL
Page 204 and 205: Hematology Aplastic Anemia This con
Page 206 and 207: Hematology Distinguishing Types of
Page 208 and 209: Hematology Clotting Factor Deficien
Page 210 and 211: Gastroenterology 8 Esophageal Disor
Page 212 and 213: Gastroenterology Diagnostic Testing
Page 214 and 215: Gastroenterology CCS Tip: How do I
Page 216 and 217: Gastroenterology Barrett Esophagus
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Page 220 and 221: Gastroenterology Inflammatory Bowel
Page 222 and 223: Gastroenterology Diarrhea Infectiou
Page 224 and 225: Gastroenterology Chronic Diarrhea L
Page 226 and 227: Gastroenterology Treatment Treat wi
Page 228 and 229: Gastroenterology When is a “virtu
Page 230 and 231: Gastroenterology Treatment Antibiot
Page 232 and 233: Gastroenterology Why not use the NG
Page 234 and 235: Gastroenterology Diagnostic Testing
Page 236 and 237: Gastroenterology Other symptoms inc
Page 238 and 239: Gastroenterology Most accurate test
Page 240 and 241: Gastroenterology Vaccination Vaccin
Page 242 and 243: Gastroenterology Primary Biliary Ci
Page 244: Gastroenterology Diagnostic Testing
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Section 2 Preventive Medicine Cance
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Preventive Medicine Influenza vacci
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Section 3 Dermatology Bullous and B
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Dermatology Foliaceus is diagnosed
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Dermatology Erythema Multiforme (EM
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Dermatology Infections Fungal Infec
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Dermatology Impetigo This is a supe
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Dermatology Paronychia This is an i
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Dermatology Syphilis Both primary a
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Dermatology Toxin-Mediated Diseases
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Dermatology They are removed with l
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Dermatology Treatment ·· Preventi
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Section 4 Surgery contributing auth
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Surgery Abdominal Trauma A 24-year-
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Surgery A man is hit over the head
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Surgery ·· Diagnosis: CT scan sho
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Surgery Pneumoperitoneum in a child
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Surgery Obstruction Suspect obstruc
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Surgery Acute Pancreatitis Suspect
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Surgery Ischemia Always consider th
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Surgery Obstructive Jaundice Caused
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Surgery Preoperative and Postoperat
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Surgery The following table shows t
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Surgery Nutritional support should
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Surgery Basic Science Correlate Ven
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Surgery Basic Science Correlate Edw
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Surgery Hypertrophic Pyloric Stenos
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Surgery ·· Closed reduction is th
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Surgery ·· Rupture of the Achille
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Surgery Ankylosing Spondylitis This
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Surgery Testicular Torsion Testicul
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Surgery Vascular Surgery A 48-year-
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Surgery A 65-year-old man presents
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Surgery Patient Safety Catheter-Ass
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Section 6 Obstetrics contributing a
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Obstetrics Screening Test Diagnosti
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Obstetrics Third Trimester A 38-yea
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Obstetrics • Perform further step
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Obstetrics Abruptio Placenta Placen
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Obstetrics Management ·· Test for
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Obstetrics Treatment ·· Antiviral
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Obstetrics Syphilis If the case des
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Obstetrics Prevention ·· Hepatiti
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Obstetrics Treatment ·· Blood pre
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Obstetrics Management of Specific C
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Obstetrics Routine Monitoring in Di
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Obstetrics ·· Medical abortion th
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Obstetrics Ectopic Pregnancy The mo
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Obstetrics Symmetric IUGR Asymmetri
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Obstetrics Ferning pattern of amnio
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Obstetrics Umbilical Cord Prolapse
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Obstetrics A 31-year-old primigravi
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Obstetrics -- Carboprost is a prost
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Section 7 Gynecology contributing a
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Gynecology ·· Mammography (> 50 y
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Gynecology A 68-year-old woman visi
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Gynecology Leiomyoma Three layers f
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Gynecology Postmenopausal Bleeding
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Gynecology Prepubertal or Postmenop
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Gynecology When is screening starte
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Gynecology Invasive Cervical Cancer
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Gynecology Cervicitis This is the d
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Gynecology Endometriosis This invol
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Gynecology A 17-year-old girl is br
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Gynecology Premenstrual Syndrome Pr
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Gynecology Idiopathic Hirsutism Thi
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Gynecology ·· Calcitonin, denosum
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Gynecology Infertility A 35-year-ol
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Gynecology Benign: H. Mole Complete
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