UW Step 3: Testing New Recommendations

[futuredoctor10]

Having started USMLE World for Step 3, I have noticed there are several questions that are testing management guidelines or recommendations which are new / different from those I learned previously (during my MS3 year which was just last year):

For example:

• influenza treatment: should not use amantadine/rimantadine due to increasing resistance. I picked oseltamivir (since that is generally first line) but was surprised to also see amantadine in the answer choices and saw that as their explanation why
• cryptorchidism: learned you can "wait 1 year" for the testicles to self-migrate down before performing orchiopexy. UW question states you should only wait 6 months prior to surgical referral [as changes which may increase infertility begin starting after 6 mo and it is unlikely to self-migrate after 6 mo]
• fever of unknown origin (FUO) in adults: Connective tissue diseases are more common than infection as a cause of FUO in adults (!?!?!). This really surprised me since I have learned previously the most likely causes of FUO are typically infection then CTD then malignancy (in books and on ID).

Looks like UW and presumably USMLE are really testing to see if we are studying the newest info!
And many review books are not updated to reflect above changes (esp cryptorchidism and FUO).

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[thehundredthone]

The influenza treatment rationale changed a while ago to what you have mentioned as far as I can remember. The cryptorchidism waiting time has been argued, with recent studies stating your point of the testes being unlikely to descend after 6 months of age. Your third point is definitely news to me.