USMLE Step 2 Secrets 5th Edition PDF Free Download
1. Smoking is the number-one cause of preventable morbidity and mortality in the United States (e.g., atherosclerosis, cancer, chronic obstructive pulmonary disease).
2. Alcohol is the number-two cause of preventable morbidity and mortality in the United States. More than half of accidental and intentional (e.g., murder and suicide) deaths involve alcohol. Alcohol is the number-one cause of preventable mental retardation (fetal alcohol syndrome); it also causes cancer and cirrhosis and is potentially fatal in withdrawal.
3. In alcoholic hepatitis, the classic ratio of aspartate aminotransferase to alanine aminotransferase is greater than or equal to 2:1, although both may be elevated.
4. Vitamins: give folate to reproductive-age women prior to conception and throughout pregnancy to prevent neural tube defects. Watch for pernicious anemia, and treat with vitamin B12 to prevent permanent neurologic deficits. Isoniazid causes pyridoxine (vitamin B6) deficiency. Watch for Wernicke encephalopathy in alcoholics and treat with thiamine to prevent Korsakoff dementia. Consider offering vitamin D supplementation to geriatric adults who are at increased risk of falls or have a history of recurrent falls.
5. Minerals: iron-deficiency anemia is the most common cause of anemia. Think of menstrual loss in reproductive-age women and of cancer in men and menopausal women if no other cause is obvious.
6. Vitamin A is a known teratogen. Counsel and treat reproductive-age women appropriately (e.g., take care in treating acne with the vitamin A analog isotretinoin).
7. Complications of atherosclerosis (e.g., myocardial infarction, heart failure, stroke, gangrene) are involved in roughly one-half of deaths in the United States. The primary risk factors for atherosclerosis are age/sex, family history, cigarette smoking, hypertension, diabetes mellitus, high low-density lipoprotein (LDL) cholesterol, and low high-density lipoprotein (HDL) cholesterol.
8. Diabetes leads to macrovascular and microvascular disease. Macrovascular disease includes coronary artery disease, stroke, and peripheral vascular disease (a leading cause of limb amputation). Microvascular disease includes retinopathy (a leading cause of blindness), nephropathy (a leading cause of end-stage renal failure), and peripheral neuropathy (sensory and autonomic). Diabetes also leads to an increased incidence of infections.
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