Download Appleton & Lange's Review for the USMLE Step 2 - 3rd Edition by Caryle Chan PDF

By Caryle Chan

Supplying a evaluate of severe thoughts in a query and resolution structure, this up to date version offers a learn reduction for college students getting ready for the USMLE Step 2. it truly is geared for college students taking the 1999 computerised examination, and encompasses a CD-ROM.

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Furthermore, the serum testosterone level is often misleadingly low because increased production rates of testosterone stimulate an increase in the rate of removal (the metabolic clearance rate) of testosterone from the circulation. The degree of hirsutism is the best gauge of the amount of excessive androgen production. Most virilizing ovarian tumors 22 1: Obstetrics and Gynecology are palpable in young women, and a pelvic ultrasound is useful only when the bimanual exam is inadequate. Elevated prolactin levels may cause amenorrhea but do not cause hirsutism.

In addition to MSAFP, the American College of Obstetricians and Gynecologists recommends hCG and unconjugated estriol to screen for Down syndrome and trisomy 18 as well. MSAFP is a screening test only; an abnormal result must be evaluated further by ultrasonography to identify the presence or absence of open neural tube defects or abdominal wall defects. In skilled hands, an ultrasound reduces the risk of such an anomaly by 95%. If the diagnosis is still uncertain, the woman should be offered amniocentesis for measurement of alphafetoprotein and acetylcholinesterase activity (increased in neural tube defects).

Inactivated viruses are generally safe but should be given only if there is a specific indication, usually exposure to the virus. Measles, mumps, rubella, poliomyelitis, and yellow fever vaccines are all live viruses. Polio vaccine may be given if there is an increased risk of exposure. Although fetal risk from rubella vaccine has not been confirmed, the vaccine should not be used because the congenital rubella syndrome is a theoretic possibility. Tetanus toxoid in conjunction with diphtheria vaccine should be given if there has been no primary immunization or there has been no booster within 10 years.

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