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

March 21, 2007

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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