Errors in First Aid for the USMLE (2007): Heme/Onc

As always, comments are welcome.
Heme/Onc

  1. P.302, High-Yield Clinical Vignettes
    1. The patient presenting with macrocytic megaloblastic anemia that receives folate (when a B12 deficiency is to blame) is not at risk of masking signs of neural damage. The neural damage is either present or not. This should be changed to:
      1. “Masks signs of anemia while allowing neural damage to progress with vitamin B12 deficiency.”
  2. P.303, Basophil
    1. Bosiphilic stippling is scene in RBCs, not Basophils. “Basophilic stippling is seen in TAIL” should be moved to p.307 with the other “RBC forms.”
  3. P.307, Blood groups
    1. I think it’s worth mentioning that the Rh+ and Rh- is referring to the D-antigen.
  4. P.308, Anemia
    1. “Macrocytic” should include “hypochromic”.
    2. The category for “Microcytic hyperchromic” is missing and should list Hereditary Spherocytosis and Hemolytic Anemia.
  5. P.311, Lymphomas, Hodgkin’s
    1. I do not understand why this is listed as “more common in men except for nodular sclerosing type” since nodular sclerosing type is the most common form of Hodgkin’s lymphoma.
  6. P.313, Leukemias
    1. I think it is worth mentioning here that ALL is the most common childhood malignancy and pointing out the association between basophilia and CML.
  7. P.320, Etoposide
    1. This is listed here as G2-phase specific. It’s activity is both in S and G2-phase and this is correctly illustrated in the figure “Cancer drugs – cell cycle” on page 318.
  8. P.320, Tamoxifen, Raloxifene
    1. These drugs have different activities but are described together, and this leads to confusion. Tamoxifen is a receptor antagonist in breast and a partial agonist in the endometrium, but it is not an agonist in bone nor is it clinically useful in preventing osteoporosis. Raloxifene is an agonist in bone and an antagonist in breast and endometrial tissue and is useful in preventing osteoporosis. To recap:
      1. tamoxifene has no activity in bone and is not used for osteoporosis.
    2. I think this section should be rewritten to:
      1. Tamoxifene: receptor antagonist in breast, partial agonist in bone, no bone activity. Useful in treating breast cancer. Increased risk of endometrial CA.
      2. Raloxifene: receptor antagonist in breast and endometrium, receptor agonist in bone. Useful in treating breast cancer and preventing osteoporosis. No increased risk of endometrial CA.

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10 Responses to Errors in First Aid for the USMLE (2007): Heme/Onc

  1. Brian says:

    With regards to Tamoxifen and osteoporosis. Ch 51 of G&G, 11th Ed. states, “In addition to its ability to prevent recurrence or the development of primary breast cancer, tamoxifen has other end-organ benefits related to its partial estrogenic action. For example, it may slow the development of osteoporosis in postmenopausal women.” Futhermore, http://www.mayoclinic.org states, “Although tamoxifen blocks estrogen’s effect on breast tissue, it has an estrogenlike effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50.” with in reference to Osteoporosis Drug Therapy.

  2. Elian says:

    Page 319 adverse effects of Nitrosureas include delayed hematopoietic depression, renal toxicity and pulmonary fibrosis. According to Lippincots’s illustrated pharmacology page 470. CNS toxicity is not mentioned.

  3. Elian says:

    Furthermore Page 303 Basophilic Stippling:
    in TAIL the I is not “Iron deficiency” but is “Iron Overload”

  4. Adrian says:

    Good God. There are way too many errors and omissions in this First Aid thing.

  5. Fernando says:

    I agree with Brian that, according to the literature, it is well accepted that Tamoxifen does have a positive effect on bone. Of note, until April 2006, Raloxifene was primarily used to treat osteoporosis in postmenopausal women. In April 2006 it was announced that this anti-osteoporosis drug is just as effective as Tamoxifen at reducing the risk of breast cancer in certain high risk groups. http://www.medicalnewstoday.com/medicalnews.php?newsid=41917

  6. Ian says:

    Pg 310 states that PT is increased in Hemophilia A/B and von Willebrand’s dz. PT should be normal, only PTT is increased in these coagulation disorders. They have deficiencies effecting the intrinsic pathway but not the extrinsic pathway.

  7. Rachel says:

    p 317 (hematology and oncology): bleomycin is listed as both cell cycle specific and cell cycle non-specific. it should be cell-cycle specific (it is the only antibiotic that is cell cycel specific).

  8. Lydia says:

    Great post! Also check out http://www.SaveOurBones.com/ for the truth about osteoporosis.

  9. Retail says:

    What a wonderful read thanks for the insight loved it !

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