Errors in Step-Up to the USMLE Step 2

 Page Number

Error

Errors Posted On 6-7-2011

Figure 1-19 - The Jones criteria are for the diagnosis of acute rheumatic fever, not rheumatic heart disease. The major Jones criteria include erythema marginatum, not erythema nodosum.

Hemothorax - #4 Should read “CXR resembles that for pleural effusion (blunting of costophrenic angles)”. The x-ray findings listed correspond to pneumothorax, not pleural effusion/hemothorax.

Portal Hypertension - #7 should read “paracentesis shows serum with albumin > ascites albumin by at least 1.1g/dL.” (Look up serum-ascites albumin gradient [SAAG] for further information.)

Quick Hit - Nephrotic syndromes are characterized by the presence of proteinuria >3.5g/day, not 3g/day.

Nephritic Syndromes - #3 24-hr urine collection measures protein <3.5g/day, not 3g/day.

Nephrotic Syndromes - #1 the cut-off for diagnosing nephrotic syndrome is >3.5 g/day, not 3g/day.

Table 6-4 – In the row for Hydrops Fetalis, write in “Bart’s hemoglobin” under characteristics. In the row for Hemoglobin H disease, cross out “Bart’s hemoglobin in serum”.

Table 6-5 – Type II Hypersensitivity includes “hemolytic disease of the newborn”, not “hemolytic disease of the syndrome”.

Errors Posted On 6-22-2010

Endocarditis - #4a - replace Staphylococcus pyogenes with Streptococcus pyogenes.

Psoriatic arthritis - #1 - replace 1% with 10-30%.

Figure 9-7 - replace femur with tibia.

Precocious puberty #4b - Clarification of the term "adrenarche." Adrenarche indicates the onset of production of androgens by the adrenal cortex which precedes axillary hair growth.

Replace Staphylococcus with Streptococcus.

Premenstrual syndrome - in the title replace dystrophic with dysphoric.

Cervicitis - #5 - Fluoroquinolones are no longer used for cervicitis due to antibiotic resistance.

Preeclampsia - #4a - replace "> 4g protein" with "> 300mg protein."

Table 12-10 - Stage 1, Activity column - Active phase should correctly state "1.2 cm/hr for nulliparous women, and 1.5 cm/hr for multiparous women."

Errors Posted On 7-16-2009

Table 1-7 - In the right column, to make the diagnosis of infective endocarditis using the Duke criteria, you either need 2 major criteria, 1 major and 3 minor criteria, or 5 minor criteria.

Table 1-11 - Neurogenic shock Mechanism - should read "Widespread peripheral vasodilation and bradycardia."

Polyarteritis Nodosa - #1e - delete the p-ANCA association with polyarteritis nodosa.  In fact, if analysis reveals a (+) p-ANCA, this indicates that it is more likely to not be polyarteritis nodosa. 

Table 2-2 - FVC in obstructive lung disease should be down arrow not up arrow

Viral influenza - #4d - Amantadine is no longer used in the treatment of influenza due to widespread resistance. Oseltamivir (Tamiflu) or Zanamivir (Relenza) are currently used, but resistance is developing to these drugs as well.

Table 2-4 - Viral Pneumonia Treatment- Replace amantidine with oseltamivir or zanamivir (see above correction on p35).

Atypical Bacterial Pneumonia - Atypical pneumonias are called atypical because patients may not present with the classic symptoms of pneumonia despite obvious infection on CXR.  The only organisms responsible for atypical pneumonia are M. pneumoniae, L. pneumophilia, and C. pneumoniae.  The other organisms listed in this category do not cause atypical pneumonia.

Pneumothorax - #5e - immediate needle decompression should take place at either (1) 4th or 5th IC space at the mid-axillary line or (2) 2nd or 3rd IC space at the mid-clavicular line.

Table 3-1 - C. diff Signs and Symptoms - C. diff. can cause either a watery or bloody diarrhea.

Figure 3-9 - Change "perform string test (Giardia)" to "Ova & Parasites x3 sets (O&Px3)" - (explanation in the course videos).

GI bleeding - #6 - Change "prophylactic antibiotics in patients with a known history of cirrhosis" to "prophylactic beta-blockers in patients with esophageal varices to decrease the incidence of rebleeding"

Figure 4-5 - This figure is so messed-up that you'll have to watch the course video for this correction!

Errors Posted On 6-30-2009

Figure 1-3 - The PR interval as drawn should begin at the start of the P wave and continue to the beginning of the QRS complex.

Next Step in margin should read "In a patient with Afib of unknown duration or duration greater than 2 days, TEE (transesophageal echocardiogram) should be performed before cardioversion..."

Table 1-4 - Add MAT to the potential uses of beta-blockers.

CHF - #2b - cross-out Eisenmenger's syndrome.  Eisenmenger's syndrome occurs when an uncorrected congenital left-to-right shunt later becomes a right-to-left shunt with cyanosis.

Figure 7-1 - In adults, each arm represents 9% of the body surface area and each leg represents 18% of the body surface area.

Figure 7-4 - The new treatment protocol for V.fib starts with shocking at 360J initially rather than the previous protocol of 200J --> 300J --> 360J.

Figure 8-2 - The labels of anterior and posterior should be reversed.

TIA - #1 should read "Acute focal neurologic deficits that last < 24 hours ...

last Quick Hit - should read "... can help differentiate it from blood in the CSF resulting from subarachnoid hemorrhage."  Xanthochromia is the yellowing of the CSF that occurs as hemoglobin is broken down into bilirubin after subarachnoid hemorrhage.

ALS - #1 add "...involving degeneration of the anerior horn cells and corticospinal tract."

Syringomyelia - #3b - delete the entire sentence due to the fact that with syringomyelia there are no symptoms below the cavity especially not involving the dorsal columns (proprioception and vibration) or the corticospinal tract (spasticity and increased DTRs)

first Quick Hit - delete the entire Quick Hit due to the fact that one of the hallmarks of Guillain-Barre is the notable absence of sensory impairment.

last Quick Hit - Astrocytoma is the most common brain tumor in children followed by Medulloblastoma then Ependymoma.

Figure 8-6 - Multiple errors: (1) ocular mobility --> ice water (caloric testing) --> conjugate deviation toward the ice water side --> intact brain stem (2) motor function --> spastic paralysis --> high spinal cord injury (3) motor function --> decerbrate posturing (elbows extended, legs extended)

Meniere's disease - In #4 Treatment, replace acetazolamide with thiazide diuretics.

Somatization disorder - #3 H/P should read " diagnosis requires symptoms in four unrelated regions:"