U S M LE S t e p 3 Fourth Edition TAO LE, MD, MHS Associate Clinical Pro essor o Medicine and Pediatrics Chie , Section o Allergy and Immunology Department o Medicine University o Louisville VIKAS BHUSHAN, MD Diagnostic Radiologist JAMES S. YEH, MD, MPH Attending Physician Research Fellow Department o Medicine Brigham and Women’s Hospital Harvard Medical School KACHIU CECILIA LEE, MD, MPH Clinical and Research Fellow Wellman Center or Photomedicine Department o Dermatology Massachusetts General Hospital Harvard Medical School New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto 1095_FA_Step3_4e_ch00_FM.indd 1 7/6/15 2:56 PM Copyright © 2016 by Tao Le and Vikas Bhushan. All rights reserved. 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Under no circumstances shall McGraw-Hill Education 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. DEDICATION To Andrea “Andi” Fellows, who loyally shepherded countless First Aid manuscripts and proo s to publication or the bene t o students and physicians everywhere. 1095_FA_Step3_4e_ch00_FM.indd 3 7/6/15 2:56 PM This page intentionally left blank v Co nte nts Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii CHAPTER 10. Infectious Disease . . . . . . . . . . . . . . . . .179 Image Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Faculty Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii CHAPTER 11. Musculoskeletal . . . . . . . . . . . . . . . . . . .213 Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi CHAPTER 12. Nephrology . . . . . . . . . . . . . . . . . . . . . . . .231 How to Contribute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii CHAPTER 13. Neurology. . . . . . . . . . . . . . . . . . . . . . . . . .253 CHAPTER 1. Guide to the USMLE Step 3 and Supplement: Guide to the CCS . . . . . . . . . . . . . . . . . . . . . .1 CHAPTER 14. Obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . .273 CHAPTER 2. Ambulatory Medicine . . . . . . . . . . . . . . . 15 CHAPTER 15. Gynecology . . . . . . . . . . . . . . . . . . . . . . . .293 CHAPTER 3. Cardiovascular. . . . . . . . . . . . . . . . . . . . . . . 35 CHAPTER 16. Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . .309 CHAPTER 4. Emergency Medicine . . . . . . . . . . . . . . . . 57 CHAPTER 17. Psychiatry. . . . . . . . . . . . . . . . . . . . . . . . . .355 CHAPTER 5. Endocrinology . . . . . . . . . . . . . . . . . . . . . . . 85 CHAPTER 18. Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . .381 CHAPTER 6. Ethics and Statistics. . . . . . . . . . . . . . . . .105 CHAPTER 19. High-Yield CCS Cases. . . . . . . . . . . . . .397 CHAPTER 7. Gastroenterology . . . . . . . . . . . . . . . . . . .115 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495 CHAPTER 8. Hematology . . . . . . . . . . . . . . . . . . . . . . . . .137 About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529 CHAPTER 9. Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 1095_FA_Step3_4e_ch00_FM.indd 5 7/6/15 2:56 PM This page intentionally left blank vii AUTHORS Eike Blohm, MD Joshua M. Liao, MD Toxicology Fellow, Department o Emergency Medicine General Internal Medicine Fellow University o Massachusetts University o Pennsylvania School o Medicine Rupal D. Mathur, MD Mirjana Domakonda, MD Resident, Department o Medicine Fellow, Division o Child and Adolescent Psychiatry Massachusetts General Hospital Department o Psychiatry Harvard Medical School New York-Presbyterian Hospital o Columbia and Cornell Universities Valentina Rodriguez-Triana, MD, MS Health Sciences Assistant Clinical Pro essor Julie C. Fu, MD Department o Obstetrics and Gynecology Fellow, Department o Hematology/Oncology David Ge en School o Medicine Tu ts Medical Center University o Cali ornia at Los Angeles Pourya Ghazi , MD Sonali Saluja, MD, MPH Hospitalist General Internal Medicine Fellow Optum Medical Partners Cambridge Health Alliance Monarch HealthCare Harvard Medical School Kate Humphrey, MD Yifan Zheng, MD Faculty, Division o Patient Sa ety and Quality Clinical Research Fellow, Division o Thoracic Surgery Pediatric Hospitalist, Division o General Pediatrics Department o Surgery Department o Medicine Brigham and Women’s Hospital Boston Children’s Hospital Harvard Medical School IMAGE EDITOR Mariam Aboian, MD, PhD Resident, Department o Radiology University o Cali ornia, San Francisco 1095_FA_Step3_4e_ch00_FM.indd 7 7/6/15 2:56 PM viii FACULTY REVIEWERS Aaron Berkowitz, MD, PhD Katherine Lupton, MD Associate Neurologist Instructor, Department o Medicine Department o Neurology Cambridge Health Alliance Brigham and Women’s Hospital Harvard Medical School Instructor in Neurology Richard J. Pels, MD Harvard Medical School Director, Internal Medicine Residency Program Cambridge Health Alliance Fabienne Bourgeois, MD, MPH Harvard Medical School Pediatric Hospitalist, Division o General Pediatrics Corinne Rhodes, MD Department o Medicine Fellow, Division o General Internal Medicine Boston Children’s Hospital Department o Medicine Massachusetts General Hospital Eddy J. Chen, MD Harvard Medical School Instructor o Medicine Department o Medical Oncology Brianne Romeroso, MD Dana-Farber Cancer Institute Assistant Clinical Pro essor, Obstetrics and Gynecology University o Cali ornia, Los Angeles Emily Grover, MD Heather F. Sateia, MD Fellow in Medical Simulation and Education Instructor, Division o General Internal Medicine STRATUS Center or Medical Simulation Department o Medicine Department o Emergency Medicine Johns Hopkins School o Medicine Brigham and Women’s Hospital Joji Suzuki, MD Harvard Medical School Director, Division o Addiction Psychiatry Kathleen J. Haley, MD Department o Psychiatry Associate Physician, Pulmonary and Critical Care Medicine Brigham and Women’s Hospital Brigham and Women’s Hospital Harvard Medical School Associate Pro essor o Medicine Athe Tsibris, MD, MS Harvard Medical School Associate Physician, In ectious Diseases Brigham and Women’s Hospital Ole-Petter R. Hamnvik, MB, BCh, BAO, MMSc Assistant Pro essor o Medicine Associate Director, Fellowship Program Harvard Medical School Division o Endocrinology, Diabetes, and Hypertension Amanda R. Vest, MBBS Department o Medicine Assistant Pro essor, Division o Cardiology Brigham and Women’s Hospital Department o Medicine Harvard Medical School Tu ts University School o Medicine Hamed Khalili, MD, MPH Daniella A. Zipkin, MD Instructor o Medicine, Division o Gastroenterology Associate Pro essor o Medicine Massachusetts General Hospital Department o Medicine Harvard Medical School Duke University Medical Center 1095_FA_Step3_4e_ch00_FM.indd 8 7/6/15 2:56 PM ix Pre face With First Aid for the USMLE Step 3, we continue our commitment to providing residents and international medi- cal graduates with the most use ul and up-to-date preparation guides or the USMLE exams. This ourth edition represents a thorough review in many ways and includes the ollowing: An updated review o hundreds o high-yield Step 3 topics, presented in a ormat designed to highlight board- ■ relevant in ormation. A renewed emphasis on integrated pathophysiology and on the “next step” in diagnosis and management. ■ More high-yield, vignette-style “f ash cards” and our-color images designed to enhance study. ■ A thoroughly revised exam preparation guide or the USMLE Step 3 with test-taking strategies pertinent to the ■ newly revised exam. A high-yield guide to the Computer-based Case Simulations (CCS) that includes invaluable tips and shortcuts. ■ One hundred updated minicases with presentations and management strategies similar to those o 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, p. xiii. Tao Le Louisville Vikas Bhushan Los Angeles James S. Yeh Boston Kachiu Cecilia Lee Boston 1095_FA_Step3_4e_ch00_FM.indd 9 7/6/15 2:56 PM