Understanding Medical Exams: USMLE 1, 2 and 3

UNDERSTANDING THE USMLE EXAMS

The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®). Physicians with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States.

Q&A: Incubation Period for Rubeola

Rubeola is a highly contagious viral illness that occurs worldwide. The infection is characterized by fever, malaise, cough, coryza, and conjunctivitis, followed by exanthem. Following exposure, approximately 90 percent of susceptible individuals will develop the disease. The period of contagiousness is estimated to be from five days before the appearance of the rash to four days afterward. The illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Q&A: Haematological Complication of Down's Syndrome

Down syndrome (DS) is the most common chromosome abnormality among liveborn infants. It is the most frequent form of intellectual disability caused by a microscopically demonstrable chromosomal aberration. DS is characterized by a variety of dysmorphic features, congenital malformations, and other health problems and medical conditions. Not all of them are present in each affected individual.

Q&A: Causes Of Unintentional Weight Gain

Unintentional weight gain occurs when you put on weight without increasing your consumption of food or liquid and without decreasing your activity. This occurs when you’re not trying to gain weight. It’s often due to fluid retention, abnormal growths, constipation, or pregnancy. Unintentional weight gain can be periodic, continuous, or rapid.

Q&A: Interpreting Iron Studies

A tight regulation of iron balance is essential to avoid both iron deficiency and overload. The regulation of iron metabolism involves the interaction of a number of specific proteins as well as the interplay between iron absorption, recycling, and iron loss. Disorders of iron balance, both iron deficiency and iron overload, could result from a disruption of this delicate balance.

Q&A: Investigating Speech Problems

Language is a distinctive human facility for communication through symbols. Aphasia is the loss of ability to produce and/or understand language. This usually manifests as a difficulty speaking or understanding spoken language, but reading and writing are also usually impacted. Aphasia can also impact the use of manual sign language and Braille.

Q&A: Interpretation of Iron Studies

A tight regulation of iron balance is essential to avoid both iron deficiency and overload. The regulation of iron metabolism involves the interaction of a number of specific proteins as well as the interplay between iron absorption, recycling, and iron loss. Disorders of iron balance, both iron deficiency and iron overload, could result from a disruption of this delicate balance.

Q&A: Treatment Of Hypertension in Pregnancy

Hypertension, either chronic or pregnancy-related, is a common complication of pregnancy. When severe, it can lead to stroke and death, but prompt recognition and treatment can reduce the risk of these complications. When hypertension is diagnosed in a pregnant woman, the major issues are establishing a diagnosis, deciding the blood pressure at which treatment should be initiated and the target blood pressure, and avoiding drugs that may adversely affect the fetus.

Q&A: Anterior Horn Cell Degeneration As Mechanism Of Disease

Neuromuscular disorders often present with hypotonia and weakness. These disorders are caused by a variety of conditions that affect the central nervous system (brain or spinal cord), peripheral nervous system, or skeletal muscle. One of the mechanisms of diseases affecting the peripheral nervous system or skeletal muscle is the degeneration of the anterior horn cells of the spinal cord.

Q&A: Likely Pathogen Of Chest Infection

Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia. CAP is a common and potentially serious illness. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with significant comorbidities.

Q&A: Microbiological Diagnosis Of Chest Infection

Lower respiratory tract infections are among the most common infectious diseases of humans worldwide. In the United States alone, pneumonia and influenza rank as the sixth leading cause of death. Changes in the characteristics of the population as it ages and the swelling numbers of patients with immunocompromising conditions have increased the number of individuals at risk. An expanded variety of emerging pathogens likewise provides challenges for the microbiology laboratory.

Q&A: Concerning Inherited Ion Channel Diseases

Genetic testing can allow tailored interventions to prevent or treat disease or disease complications. Appropriate use of genetic testing, including understanding the limitations and challenges of available testing approaches, is crucial to the successful use of genetic testing in improving health and quality of life.

Q&A: Diagnostic Assessment Of Seafood Poisoning

As world travel and trade grow, physicians are increasingly likely to encounter patients poisoned by marine toxins. The world's oceans harbor hundreds of different types of marine toxins, and the epidemiology and clinical manifestations of these toxins vary widely. Several of these toxins are produced by dinoflagellates or phytoplankton during algae or marine diatom blooms. Shellfish and pufferfish poisoning arise from consumption of seafood that is contaminated by various toxins

Q&A: Evaluation Of Chronic Cough

The symptom of cough is one of the most common symptoms for which outpatient care is sought. In an outpatient pulmonary practice, evaluation and management of persistent cough can account for up to 40 percent of the practice volume. Acute cough exists for less than three weeks and is most commonly due to an acute respiratory tract infection. Cough that has been present longer than three weeks is either subacute (three to eight weeks) or chronic (more than eight weeks).

ABCs of CPR Rearranged to "CAB" - 2010 AHA guidelines

Chest compressions should be the first step in addressing cardiac arrest. This is why the American Heart Association now recommends that the A-B-C (Airway-Breathing-Compressions) of cardiorespiratory resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

Q&A: Evaluation of the Painful Eye

Red eye" is a common presenting complaint in ambulatory practice. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated by the primary care clinician. There are little epidemiologic data on the red eye, and there are no evidence-based data to guide us in the management of these patients. Conjunctivitis (allergic or viral) is probably the most common cause of red eye in the community setting, but a number of more serious conditions can also occur.

Q&A: Concerning Neutrophilia and Left Shift

Neutrophilia refers to an increase of peripheral blood neutrophils at least two standard deviations above the mean. For adults, this generally corresponds to >7700 neutrophils/microL (typically seen in patients with >11,000 white blood cells/microL).

Q&A: Diagnosing Tropical Diseases

Tropical diseases encompass all diseases that occur solely, or principally, in the tropics. In practice, the term is often taken to refer to infectious diseases that thrive in hot, humid conditions, such as malaria, leishmaniasis, schistosomiasis, onchocerciasis, lymphatic filariasis, Chagas disease, African trypanosomiasis, and dengue.

Q&A: Concerning Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common cause of mitral regurgitation (MR). Although most patients with MVP have mild, trivial, or no MR, MVP is the most common cause of surgical MR in developed countries. Other potential complications include infective endocarditis and arrhythmias. The diagnosis of MVP is suspected on physical examination and confirmed by echocardiography.

Q&A: Concerning Amyloidosis

Amyloidosis is the general term used to refer to the extracellular tissue deposition of fibrils composed of low molecular weight subunits of a variety of proteins, many of which circulate as constituents of plasma. These deposits may result in a wide range of clinical manifestations depending upon their type, location, and the amount of deposition.

Q&A: Treatment of Rhinitis

Rhinitis is common, affecting nearly everyone at one time or another. There are various types of acute and chronic rhinitis which commonly affect adults and children. Rhinitis caused by viral respiratory infection is usually self-evident. There are multiple causes of rhinitis. Different syndromes are recognized mainly by clinical history, patterns of symptoms, and to a lesser extent, physical signs.

Q&A: Concerning Anatomy Of The Eye

Structures in the eye bend the light rays entering the eye so that when they reach the retina they are focused. The cornea and lens both help to do this. The cornea gives the initial bend to the light but the lens is the fine tuner.

Q&A: Diagnosis Of The Adult With Jaundice

Jaundice and asymptomatic hyperbilirubinemia are common clinical problems that can be caused by a variety of disorders, including bilirubin overproduction, impaired bilirubin conjugation, biliary obstruction, and hepatic inflammation. Liver test reference ranges will vary from laboratory to laboratory.

Q&A: Concerning Aqueous Humour

The aqueous humour is a transparent watery fluid similar to plasma, but containing low protein concentrations. It is secreted from the ciliary body, a structure supporting the lens. It fills both the anterior and the posterior chambers of the eye, and is not to be confused with the vitreous humour, which is located in the space between the lens and the retina, also known as the posterior cavity or vitreous chamber.

Q&A: How The Ear Hears (Mechanism Of Hearing)

Hearing, or auditory perception, is the ability to perceive sounds by detecting vibrations, changes in the pressure of the surrounding medium through time, through an organ such as the ear. Sound may be heard through solid, liquid, or gaseous matter. And there are three main components of the human auditory system: the outer ear, the middle ear, and the inner ear.

Q&A: Physiology of the Eye

When you look at an object you see it because light reflects off the object and enters your eye. The eyes receive light from many different directions and distances. To be seen, all this light must focus on the comparatively tiny area of the retina. This means the eyes have to bend light from different angles and directions.

Q&A: Treatment of Heart Failure

Heart failure (HF) is a common clinical syndrome in which symptoms result from a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders.

Q&A: Complications of Hepatitis B Virus Infection

The identification of hepatitis B virus (HBV) infection was revolutionized by the discovery of Australia antigen, now called hepatitis B surface antigen (HBsAg). During the ensuing two decades, serologic assays were established for HBsAg and other HBV antigens and antibodies. Advances in molecular biology techniques led to the development of hybridization and polymerase chain reaction (PCR) assays for direct determination of hepatitis B virus DNA (HBV DNA). The diagnosis of HBV infection can also be made by the detection of HBsAg or hepatitis B core antigen (HBcAg) in liver tissues by immunohistochemical staining and of HBV DNA by Southern hybridization, in-situ hybridization, or PCR.

Q&A: Diagnosis of Hearing Loss

Hearing loss is a common problem that everyone experiences from time to time. Most commonly it occurs when flying or traveling up a mountain, and a full sensation develops in the ears, leading to the feeling of wanting to pop the ears open in order to hear better. Diminished hearing also may occur during an ear infection. These causes of hearing loss are usually short-lived.

Q&A: Features of Eye Tumours in Children

Orbital and ocular tumors are benign (non-cancerous) or malignant (cancerous) tumors that develop in or around the eyes. Many of these types of tumors are congenital (present at birth) and are benign. Whether they are benign or malignant, orbital and ocular tumors can cause vision problems or disfigurement if left untreated. They can also spread to the optic nerve, the brain and the rest of the body and become life-threatening.

Risk of thigh fractures with bone drugs - FDA

WASHINGTON (Reuters) - Osteoporosis drugs used by millions of women to prevent bones from breaking may increase the chances for an unusual type of thigh fracture, U.S. health officials warned on Wednesday.

3 Healthy Habits That Reduces Risk of Breast Cancer

Exercise, healthy weight, moderate alcohol benefit even women with a family history, experts say
Women who maintain certain "breast-healthy" habits can lower their risk of breast cancer, even if a close relative has had the disease, a new study finds.

Q&A: Concerning Hepatitis B Prevention

There are more than two billion individuals with serologic evidence of hepatitis B virus (HBV) infection worldwide. Of these, 292 million are chronic carriers, and approximately 686,000 hepatitis B-related deaths occur annually. Despite advances in antiviral therapy, only a minority of patients with chronic hepatitis B will have a sustained response. Thus, primary prevention by vaccination to increase herd immunity remains the main focus in controlling HBV infection.

Q&A: Concerning Aniridia

Aniridia is an eye disorder characterized by a complete or partial absence of the colored part of the eye (the iris). These iris abnormalities may cause the pupils to be abnormal or misshapen. Aniridia can cause reduction in the sharpness of vision (visual acuity) and increased sensitivity to light (photophobia).

Q&A: Diagnosing Cause of Vaginal Bleeding in Pregnancy

Bleeding from the vagina is a common event at all stages of pregnancy. The source is virtually always maternal, rather than fetal. Bleeding usually results from disruption of blood vessels in the decidua (ie, pregnancy endometrium) or from discrete cervical or vaginal lesions. The clinician typically makes a provisional clinical diagnosis based upon the patient's gestational age and the character of her bleeding (light or heavy, associated with pain or painless, intermittent or constant). Laboratory and imaging tests are then used to confirm or revise the initial diagnosis.

Q&A: Concerning Antimicrobial and Antibiotic Resistance

Antimicrobial stewardship consists of systematic measurement and coordinated interventions designed to promote the optimal use of antimicrobial agents, including their choice, dosing, route, and duration of administration. The primary goal of antimicrobial stewardship is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use. Additional benefits include improving susceptibility rates to targeted antimicrobials and optimizing resource utilization.

Q&A: Diagnosis of Chest Pain

Patients who present with chest pain are a diagnostic challenge given the wide array of possible etiologies, including a potentially life-threatening condition. Studies have estimated that approximately one-third to one-half of these patients have musculoskeletal chest pain, 10 to 20 percent have gastrointestinal causes, 10 percent have stable angina, 5 percent have respiratory conditions, and approximately 2 to 4 percent have acute myocardial ischemia (including myocardial infarction).

Q&A: Diagnosis involving Photophobia and Sectoral Hyperemia

Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation. Clinically, hyperaemia in tissues manifest as erythema (redness of the skin) because of the engorgement of vessels with oxygenated blood. Hyperaemia can also occur due to a fall in atmospheric pressure outside the body.

Q&A: Concerning Complications of Diabetes

The term diabetes mellitus describes diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice.

Q&A: Diagnosing Cause of Jaundice

The normal serum bilirubin concentration in children and adults is less than 1 mg/dL (17 micromol/liter), less than 5 percent of which is present in conjugated form. The measurement is usually made using diazo reagents and spectrophotometry. Conjugated bilirubin reacts rapidly ("directly") with the reagents. The measurement of unconjugated bilirubin requires the addition of an accelerator compound and is often referred to as the indirect bilirubin.

Q&A: Optochin in Diagnosing Diseases

Optochin (ethylhydrocupreine hydrochloride), a quinine derivative, is a chemical and completely soluble in water. Optochin is an antibiotic that interferes with the ATPase and production of adenosine triphosphate (ATP) in microorganisms.

Q&A: Complications of Gonorrhea

Gonorrhea, or infection with the gram-negative coccus Neisseria gonorrhoeae, is a major cause of morbidity among sexually-active individuals worldwide. In the United States, it is the second most commonly reported communicable disease, with more than 500,000 cases reported annually, with probably an equal number of cases that remain unreported. In the UK, the prevalence of gonorrhoea has increased gradually over a period of ten years, principally in men with a disproportionate increase in men who have sex with men (MSM).

Q&A: Diagnosis of Skin Lesions

Patients with skin and soft tissue infection may present with cellulitis, abscess, or both. Cellulitis (which includes erysipelas) manifests as an area of skin erythema, oedema, and warmth; it develops as a result of bacterial entry via breaches in the skin barrier. A skin abscess is a collection of pus within the dermis or subcutaneous space. Misdiagnosis of these entities is common, and possible alternative diagnoses should be considered carefully.

Q&A: Diagnosis of Wolff-Parkinson-White Syndrome

Louis Wolff, Sir John Parkinson, and Paul Dudley White published a seminal article in 1930 describing 11 patients who suffered from attacks of tachycardia associated with a sinus rhythm electrocardiographic (ECG) pattern of bundle branch block with a short PR interval. This was subsequently termed Wolff-Parkinson-White (WPW) syndrome, although earlier isolated case reports describing similar patients had been published.

Q&A: Causes of Confusion in HIV-infected Patients

Changes in memory, concentration, attention, and motor skills are common in HIV-infected patients and present a diagnostic challenge to the clinician. Since these symptoms can be caused by a variety of disorders, accurate diagnosis is critical for patient treatment. When not clearly attributable to an alternate cause other than HIV infection, such impairments have been collectively classified as HIV-associated neurocognitive disorders (HAND).

Q&A: Benign Vs Malignant Lumps

A lump or swelling is a common presenting problem. A lump may also be found by the examining clinician in the course of routine examination. A methodical approach to history and examination, with particular emphasis on inspection and palpation, is usually important in the correct description and initial diagnosis of a lump. This initial diagnosis will enable a management plan to be formulated and discussed with the patient. Management may range from explanation and reassurance to urgent referral for surgery.

Q&A: Diagnosis of Groin Lumps

Lumps in the groin and scrotum can occur at any age. Clinical assessment is needed to detect those which need urgent investigation or treatment. Usually a working diagnosis can be made clinically, and ultrasound is often helpful.

Q&A: Diagnosis Of Acute Confusion in a Child

Delirium and confusional states are among the most common mental disorders encountered in patients with medical illness, particularly among those who are older. They are associated with many complex underlying medical conditions and can be hard to recognize. Systematic studies and clinical trials are difficult to perform in patients with cognitive impairment. Recommendations for evaluating and treating delirium are based primarily upon clinical observation and expert opinion.

Q&A: Nonarticular Manifestations of Rheumatoid Arthritis

Although rheumatoid arthritis (RA) develops its central pathology within the synovium of diarthrodial joints, many nonarticular organs become involved, particularly in patients with severe joint disease. Despite the differences between the normal form and function of joints and, for example, the bone marrow, it is becoming clearer that the same cytokines that drive synovial pathology are also responsible for generating pathology in extraarticular tissues.

Q&A: Diagnosis of Nerve Damage in Mid-Shaft Humeral Fracture

Fractures of the humerus can occur proximally, in the shaft (diaphysis), or distally. The majority of both proximal and midshaft humeral fractures are nondisplaced and can be treated conservatively (ie, nonsurgically). Complex fracture patterns pose greater challenges for treatment.

Q&A: Evaluation of Nipple Discharge (Galactorrhea)

Nipple discharge is the third most common breast-related complaint, after breast pain and breast mass. During their reproductive years, up to 80 percent of women will have an episode of nipple discharge. Most nipple discharge is of benign origin. The primary goals of evaluation and management are to differentiate patients with benign nipple discharge from those who have an underlying papilloma, high-risk lesion, or cancer and to manage patients with underlying pathologic nipple discharge.

Q&A: Diagnosis of Sexually Transmitted Infections (STIs)

Sexually transmitted infections (STIs) are a major public health problem in both resource-rich and limited settings. STIs are frequently asymptomatic and can lead to various complications. The immediate goal of screening for STIs is to identify and treat infected persons before they develop complications and to identify, test, and treat their sex partners to prevent transmission and reinfections.

Q&A: The Causes of Hearing Loss

Hearing loss is a common problem that everyone experiences from time to time. Most commonly it occurs when flying or traveling up a mountain, and a full sensation develops in the ears, leading to the feeling of wanting to pop the ears open in order to hear better. Diminished hearing also may occur during an ear infection. These causes of hearing loss are usually short-lived. The other extreme is the permanent sensorineural hearing loss that occurs with aging, which most people experience to some degree.

Q&A: Diseases and Peripheral Blood Smear

Examination of the peripheral blood smear is an inexpensive but powerful diagnostic tool in both children and adults. In some ways it is becoming a "lost art" but it often provides rapid, reliable access to information about a variety of hematologic disorders. The smear offers a window into the functional status of the bone marrow, the factory producing all blood elements. It is particularly important when assessing cytopenic states (eg, anemia, leukopenia, thrombocytopenia). Review of the smear is an important adjunct to other clinical data; in some cases, the peripheral smear alone is sufficient to establish a diagnosis.

Q&A: Side Effects of Oral Contrceptives

Since the development and approval of the first combined oral contraceptive (COC) pill, combined estrogen-progestin hormonal contraception (CHC) has evolved from high-dose estrogen formulations (150 mcg) to very low doses (10 and 20 mcg). Simultaneously, dosing mechanisms have expanded to include vaginal rings and the transdermal patch. While most women are candidates for CHC use and do well on them, the safety and side effect profiles must be considered as women balance their long-term need for birth control with the management and treatment of any concurrent medical conditions.

Q&A: Management of Chronic Anal Fissure

Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding. Anal fissures typically start with a tear to the anoderm within the distal half of the anal canal. The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients. The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

Q&A: Treatment of Bradycardia

The normal adult heart rate, arising from the SA node, has been considered historically to range from 60 to 100 beats per minute, with sinus bradycardia being defined as a sinus rhythm with a rate below 60 beats per minute. However, the "normal" heart rate is, in part, the result of the complex interplay between the sympathetic and parasympathetic nervous systems. It is affected by numerous factors and varies in part with age and physical conditioning. Sinus arrhythmia, changes in the sinus rate as a result of respiratory cycles, often accompanies sinus bradycardia.

Career in Obstetrics and Gynaecology As Clinician And Researcher

Obstetricians are physicians who provide medical care related to pregnancy or childbirth, while gynaecologists are physicians who diagnose, treat, and help prevent diseases of women, particularly those affecting the reproductive system. They may also provide general medical care to women.

Requirements for ECFMG certification - what happens to IMGs in 2023

ECFMG® has announced that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited.