CLINCAL SUBJECTSREVIEW SERIESUSMLE

usmle step 3 Secrets Ebook PDF download free

usmle step 3 Secrets Ebook PDF download free

usmle step 3 Secrets Ebook PDF download free What age group constitutes the most rapidly growing segment of the population?
Persons older than 85 years.
Trueorfalse:An80-year-oldpersonneedsmorecaloriesthana30-year-oldperson.
False. An 80-year-old person has half the lean body mass of a 30-year-old person and thus needs fewer calories. The basal metabolic rate is based on lean body mass. Older patients, however, need more sodium, vitamin B12, vitamin D (and/or calcium), folate, and nonheme iron than younger patients do.
True or false: Hearing and vision changes are a normal part of aging.
True. Presbyopia (hardening of the lens that decreases the ability to accommodate) becomes almost universal after the age of 50 years, so there is a common need for reading glasses after this age. Presbyacusis, the loss of ability to discriminate sounds, is also part of the normal process of aging.
True or false: Brain atrophy is a normal part of aging.
True. Decreased brain weight, enlarged ventricles and sulci, and a slightly decreased ability to learn new material are normal parts of aging.
Describe the normal changes in male sexual function that occur with aging.

usmle step 3 Secrets Ebook PDF download free Increasedrefractoryperiod(afterejaculation,ittakeslongerbeforeanothererectionispossible) • Increased amount of time to achieve an erection
• Delayed ejaculation (an older man may ejaculate only 1 of every 3 times that he has sex)
Describe the normal changes in female sexual function that occur with aging.
• Decreased vaginal lubrication (women not on hormone replacement therapy may use estrogen cream or water-soluble lubricants)
• Dyspareuniaduetoatrophyofclitoral,labial,andvaginaltissues(treatedwithestrogencream)
• Delayed orgasm
True or false: Impotence and lack of sexual desire are normal in older people.
False. Impotence in men and a lack of sexual desire in either sex are not normal and should be investigated. Causes include psychiatric disorders (e.g., depression) as well as physical causes, such as medications (selective serotonin reuptake inhibitors and antihypertensives are notorious culprits), vascular disease (watch for atherosclerosis risk factors), and neurologic disease (especially in diabetics).
Describe the normal changes in sleep habits in older people.
Older persons require less sleep, sleep less deeply, wake up more frequently during the night, and awaken earlier in the morning. It also takes longer for older persons to fall asleep (longer sleep latency) and they have less stage 3 and 4 and rapid eye movement sleep.
De ne pseudodementia. How do you recognize it in the Step 3 exam?
Depression in older individuals can resemble dementia. Look for a history that would trigger depression (e.g., loss of a spouse, terminal or debilitating disease) and other symptoms of depression (e.g., frequent crying, suicidal thoughts).
True or false: Almost 50% of patients over the age of 65 suffer from some type
of dementia.
False. Roughly 15% of people over the age of 65 suffer from dementia. The most common types of dementia are Alzheimer dementia, dementia with Lewy bodies, vascular dementia, Parkinson dementia, and frontotemporal dementia. Other disorders that can cause dementia include HIV and Pick disease (a subtype of frontotemporal dementia). Test for reversible causes of dementia such as hypothyroidism, depression, and vitamin B12 de ciency.
What else do you need to know about dementia?
The various types of dementia are discussed in detail in Chapter 2.
What is the best prophylaxis for pressure ulcers in an immobilized patient?
Frequent turning and the use of special air mattresses.

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