Preface

If you are taking this course, it means you are preparing to take the final USLME test—the USMLE III examination. This is designed to provide you with the information necessary to make clinical decisions in real-world settings. The topics include the various internal medicine subjects (like infectious disease, pulmonology, cardiology, and gastroenterology). It also includes obstetrics and gynecology, radiology, emergency medicine, and ethics, among others.

Regardless of your final specialty, you need to be able to respond effectively in a variety of clinical settings—each of which is covered as part of this course. Study the course material and take the quiz at the end of each chapter. There will be a follow-up test and the end of the course that will mimic the actual test you will take for the USLME III examination.

Chapter one in the course covers infectious disease. While infectious disease is a broad category, there are certain infections that bear studying. The first is sepsis, which is an extreme reaction to a systemic infection. Osteomyelitis is an extreme infection that requires intensive diagnosis and long-term management. The various head and neck, skin, and urinary tract infections are covered as well as STDs and HIV/AIDs.

The topic of chapter two in the course is allergy and immunology. The important things to remember for the test include anaphylaxis, a serious and sometimes catastrophic, allergic reaction that often presents to the ED. Office visits related to allergy and immunology include allergic rhinitis and atopic dermatitis—two aspects of the allergic triad. Rarer diseases include primary immunodeficiency states, which will be covered in this chapter.

Chapter three has a focus on tropical, fungal, and animal-borne diseases. These are diseases that sometimes have a vector, which can be an animal or insect. Fungal diseases often affect the lungs but can involve other body areas. Tropical diseases are rare in the US but include Dengue fever, Leishmaniasis, Ebola, and Zika virus. Many of these tropical infections have an animal or insect vector.

The focus of chapter four in the course is cardiology. This includes a range of things, including the management of acute and chronic ischemic heart disease. Congestive heart failure, including pulmonary edema, are discussed. Aspects of valvular heart disease are covered as well as cardiomyopathy and pericardial diseases. Finally, different arrhythmias and treatment strategies are discussed.

Chapter five is about endocrinology. The largest focus is on diabetes mellitus and its complications, including diabetic ketoacidosis, neuropathy, gastroparesis, kidney damage, and retinopathy. Thyroid disease, particularly hypothyroidism and hyperthyroidism, are covered in this chapter, as well as parathyroid diseases. Prolactinomas are discussed (in both men and women) and diseases of the sexual hormones are discussed.

Pulmonology is the subject of chapter six in the course. It includes a discussion of the most common pulmonary conditions, such as asthma and COPD/emphysema, with an emphasis on diagnostics and treatment. Less common lung diseases, such as ARDS, sarcoidosis, pulmonary embolism, and interstitial lung disease are covered. Sleep apnea falls under the main category of pulmonology as is the topic of pneumonia. Finally, rarer diseases like pulmonary aspergillosis and tuberculosis are discussed in this chapter.

Chapter seven in the course covers joint diseases and related rheumatological diseases. This primarily involves things like rheumatoid arthritis and osteoarthritis but includes the autoimmune diseases related to the joints, like scleroderma and Sjogren’s syndrome. Gout and pseudogout are covered as part of this chapter as well as septic arthritis. There are a great many rarer rheumatologic diseases that are important to know about and are covered in the chapter.

The topic of chapter eight in the course is the study of blood or hematology. This involves an extensive discussion of the different types of anemia and their causes. Sickle cell anemia and sickle cell disease is covered in this chapter. Several rare blood disorders are covered as well as leukemia, which is more common. The test will also cover platelet cell disorders so this is a part of the chapter as well, including disorders involving too few or too many platelets (thrombocytopenia and thrombocytosis).

Chapter nine in the course covers the topic of gastroenterology. It includes a discussion of esophageal disorders, including dysmotility and esophageal cancer, stomach and small intestinal diseases, peptic acid disease, malabsorption, constipation, diarrhea, and colon cancer. Hepatitis and other hepatic diseases are also covered as part of this chapter on GI-related disorders.

Neurology is the topic of chapter ten. It starts with a discussion of strokes and TIAs, the most common neurologic problems. Seizures, Parkinson’s disease, multiple sclerosis, and dementia are also covered. Headache, CNS infections, and hemorrhages in the CNS are discussed as part of a thorough discussion of neurologic problems seen by neurologists and non-neurologists alike. The goal is to have a broad understanding of common neurological conditions, the diagnostics involved, and their treatment.

Chapter eleven in the course covers the topic of nephrology. The chapter covers acute and chronic renal failure and their causes as well as the different inflammatory renal diseases, such as interstitial nephritis and glomerulonephritis. The different electrolyte disorders associated with renal insufficiency and renal diseases are discussed in the chapter. Primary and secondary hypertension, which is often related to the kidneys is part of the chapter’s discussion. Chapter twelve in the course is, by necessity, a brief one, as the USMLE III test does not ask many questions about oncology. The main focus of the test is on screening for the various cancers. Only a few cancers are currently screened for in clinical practice, including breast cancer, cervical cancer, prostate cancer, skin cancer, and colon cancer. The USMLE III test focuses on currently accepted guidelines and avoids the gray areas that exist in detecting some forms of cancer.

Chapter thirteen is a short assessment of preventive medicine. This involves cancer screening and other types of screening tests performed on asymptomatic patients. Other preventive strategies include immunizations given to adults and children. There are other screening tools in the chapter that will be discussed. This is a brief chapter that covers what you’ll need to learn for the examination. The focus of chapter fourteen in the course is dermatology. This will include a discussion of the various types and classifications of dermatologic conditions, including bullous diseases of the skin, skin infections, sexually transmitted diseases that affect the skin, scabies and related diseases, malignancies, toxin-mediated diseases, eczematous diseases, acne, and rosacea.

Chapter fifteen is about surgery, which is a broad topic. It starts with a discussion of general surgical topics, which mostly encompass the abdomen and abdominal surgery. Preoperative and postoperative care are a part of this discussion. Orthopedic surgery topics are also covered and issues regarding

urology and its surgical management are discussed. Finally, vascular surgery is covered to complete this chapter.

Chapter sixteen in the course encompasses the topic of pediatrics. The first part of the chapter covers newborn care and diseases of the neonate, including common genetic diseases. Then comes a discussion of childhood growth and development, including nutrition. Common behavioral disorders in pediatrics are discussed. Respiratory/cardiac conditions are covered in detail. Childhood GI and renal/gastrointestinal disorders are a part of this chapter. Endocrine, hematologic, and neurologic diseases as they apply to children are discussed as are childhood infectious diseases.

Chapter seventeen talks about obstetric care of the normal and complicated pregnancy. The first, second, and third trimester normal pregnancy care is discussed as are complications of these aspects of pregnancy. Prenatal and perinatal infectious diseases are covered in detail. The management of hypertensive disorders in pregnancy are part of this chapter. Medical issues complicating a pregnancy are discussed as well. Finally, there is a discussion of normal and abnormal labor as well as postpartum care.

The topic of chapter eighteen in the course is gynecology. It starts with a discussion of breast diseases, both benign and malignant. Uterine diseases are next, focused on signs of uterine disease and their workup. The same is true of ovarian diseases, cervical diseases, and pelvic pain. Disorders of vaginal bleeding and menstruation are covered. There are endocrine diseases that primarily affect the woman’s reproductive tract, which are discussed, as are menopausal diseases. Contraception and infertility are briefly discussed.

As radiology is not tested much on the USMLE III course, chapter nineteen in the course is brief. It will discuss the test specifically, including when a certain test is indicated or not in radiologic evaluations. There will be a list of things you will need to memorize regarding radiology for the test and some radiologic terms to memorize.

Chapter twenty focuses on different psychiatric disorders. There is a section on psychotic disorders and their treatment, a section on anxiety disorders and trauma-related disorders. Mood disorders like bipolar disorder and major depression are discussed as is the treatment of these disorders. Somatic symptoms and somatoform disorders are covered. Eating disorders are a part of this chapter as are impulse-control disorders. Substance use disorders and substance withdrawal are covered in detail in this chapter as well. Finally, sexual disorders are covered.

Chapter twenty-one in the course involves those things that an emergency medicine physician might encounter in the ED. It starts with a discussion of trauma and shock management as well as head trauma. Management of the overdose patient is part of the chapter as are several toxicological emergencies that usually present to the ED for initial management.

Chapter twenty-two is a very brief chapter on medical ethics. It includes issues like autonomy, capacity, and the care of minor patients. Informed consent Is covered as is confidentiality. Finally, end-of-life issues are discussed along with the doctor-patient relationship and what to do with an impaired physician.

Chapter twenty-three in the course is a discussion on epidemiology and biostatistics. It will cover the basic types of research data, incidence and prevalence, precision, accuracy, and standard deviation.

Research concepts of the Z-score and confidence intervals are covered. Different types of study designs are explained in this chapter as well as the terminology associated with them. The meaning of the Pvalue is explained. The common terms of specificity, sensitivity, and the positive and negative predictive values are discussed as part of this chapter.