I am so frustrated - First Aid errors

[1dayatatime]

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So FA 2014 says that ventricular free wall rupture is most likely 6-14 days post MI -- and Goljan says 3-7 days post MI (range is 1-10) is when "rupture" (I'm assuming they're talking about the same thing) is when it's most soft and therefore most likely.

Then FA says "ventricular pseudoanerysm" forms at 1 week post-MI; also inconsistent with Goljan "clinically recognized within 4-8 wks after STEMI" but begins to develop in first 2 days.

I know this stuff is kinda variable, is a range, yada yada BUT these numbers are kind of grossly diff imo and i'm scared that i'll get a q that's hinging on this. it's so frustrating! like how am i supposed to learn when there's all these errors and inconsistencies?!

also i've noticed that even though i've corrected my FA with the recent errors pdf, i've still found really big ones..what gives? i'm taling about p. 272 MVP intensity inc/dec with earlier/later onset of click -- totally screwed up and not consistent with Uworld.

p. 445 meningocele has normal AFP?

p. 588 Bowenoid papulosis is a precursor to CA? not accordin to Goljan RR4th.

 

[periaqueductal]

So FA 2014 says that ventricular free wall rupture is most likely 6-14 days post MI -- and Goljan says 3-7 days post MI (range is 1-10) is when "rupture" (I'm assuming they're talking about the same thing) is when it's most soft and therefore most likely.

Then FA says "ventricular pseudoanerysm" forms at 1 week post-MI; also inconsistent with Goljan "clinically recognized within 4-8 wks after STEMI" but begins to develop in first 2 days.

I know this stuff is kinda variable, is a range, yada yada BUT these numbers are kind of grossly diff imo and i'm scared that i'll get a q that's hinging on this. it's so frustrating! like how am i supposed to learn when there's all these errors and inconsistencies?!

also i've noticed that even though i've corrected my FA with the recent errors pdf, i've still found really big ones..what gives? i'm taling about p. 272 MVP intensity inc/dec with earlier/later onset of click -- totally screwed up and not consistent with Uworld.

p. 445 meningocele has normal AFP?

p. 588 Bowenoid papulosis is a precursor to CA? not accordin to Goljan RR4th.

1. Take a deep breath.
2. Nothing is going to be perfect. That's why you use multiple sources. If you find conflicting info, google it.

 

[Apoplexy__]

So FA 2014 says that ventricular free wall rupture is most likely 6-14 days post MI -- and Goljan says 3-7 days post MI (range is 1-10) is when "rupture" (I'm assuming they're talking about the same thing) is when it's most soft and therefore most likely.

Then FA says "ventricular pseudoanerysm" forms at 1 week post-MI; also inconsistent with Goljan "clinically recognized within 4-8 wks after STEMI" but begins to develop in first 2 days.

I've gotten UWorld Q's right following FA on this stuff. To be fair regarding the rupture, FA actually says 3-14 days. This matches with Pathoma too.

p. 272 MVP intensity inc/dec with earlier/later onset of click -- totally screwed up and not consistent with Uworld.

This did definitely annoy me when I stumbled across it, but to be fair, it matches with Goljan audio. I feel like with something so controversial, they either 1) wouldn't ask that sort of detail alone without providing other clues to get the right answer or 2) enough people would be on either side of it that it would get tossed.

The errors you mentioned are definitely wrong, but my general mentality with these mistakes is that:
-The only mistakes that will hurt you are the ones that are wrong and you didn't know better
-Most mistakes are either blatantly wrong or stated correctly in another page of FA and every single other super-commonly-used resource
-The sum of all the mistakes in FA that fit the description in bullet 1 will make a difference of 0 +/- 1 points on your board score.

 

[1dayatatime]

thanks guys!

it's just weird b/c i looked at the looooong list of submitted errors for FA and they had some things on it that somehow didn't get approved (like the MVP murmurs) and AFP -- why wouldn't they correct it in the published pdf? did they somehow find something to justify the error? i do google these thigns but find more inconsistency + i have no time to google all of them.

 

[1dayatatime]

p. 289 FA 2014 clearly says "6-14 days" for V. free wall rupture. wtf?

 

[MilkIsGood]

thanks guys!

it's just weird b/c i looked at the looooong list of submitted errors for FA and they had some things on it that somehow didn't get approved (like the MVP murmurs) and AFP -- why wouldn't they correct it in the published pdf? did they somehow find something to justify the error? i do google these thigns but find more inconsistency + i have no time to google all of them.

this is a controversial one because last year they had what uworld says and had an errata that changed it to what it is now

 

[Missorleans]

Lol, uworld says free wall rupture 3-7 days post MI. It makes sense, considering that's when the most macrophage/breakdown activity is going on, unless they changed all the time lines for scar formation after MI as well.

 

[whomikejones]

this is a controversial one because last year they had what uworld says and had an errata that changed it to what it is now

Yeah I noticed this, too. I think uworld may be wrong on this one, though. According to UpToDate, "Standing, sitting, Valsalva's maneuver (phase 2), and amyl nitrite inhalation all decrease left ventricular volume and cause an earlier onset of the click and murmur, which also appear long. The intensity, however, becomes softer." Consistent with what FA says.

either way, something this minute isn't going to make or break you on a question. there should be enough context in the stem to tease out the answer without these details.

 

[Apoplexy__]

p. 289 FA 2014 clearly says "6-14 days" for V. free wall rupture. wtf?

I'm looking at pg. 288. I didn't notice that 289 says 6-14 instead...weird. FYI: UWorld says 3-7 days.

i do google these thigns but find more inconsistency + i have no time to google all of them.

When I was an MS1, I read a thread just like this one, where everyone reassured the guy that the time necessary to find every error and confirm+write down every suggested change in the errata is extremely low-yield. When you think of it in terms of yield (i.e. treat finding errata like another "resource" that you'll only get to if you have time), I think it's more understandable.

 

[Instatewaiter]

So FA 2014 says that ventricular free wall rupture is most likely 6-14 days post MI -- and Goljan says 3-7 days post MI (range is 1-10) is when "rupture" (I'm assuming they're talking about the same thing) is when it's most soft and therefore most likely.

Then FA says "ventricular pseudoanerysm" forms at 1 week post-MI; also inconsistent with Goljan "clinically recognized within 4-8 wks after STEMI" but begins to develop in first 2 days.

I know this stuff is kinda variable, is a range, yada yada BUT these numbers are kind of grossly diff imo and i'm scared that i'll get a q that's hinging on this. it's so frustrating! like how am i supposed to learn when there's all these errors and inconsistencies?!

also i've noticed that even though i've corrected my FA with the recent errors pdf, i've still found really big ones..what gives? i'm taling about p. 272 MVP intensity inc/dec with earlier/later onset of click -- totally screwed up and not consistent with Uworld.

p. 445 meningocele has normal AFP?

p. 588 Bowenoid papulosis is a precursor to CA? not accordin to Goljan RR4th.

Most of the studies on free wall rupture come from the pre-fibrinolysis era. After fibrinolysis free wall rupture and ventricular septal rupture all started happening earlier. So it's not really that one is right and the other is wrong, it is more that it is a moving target. You're unlikley to get a question of timing of free wall rupture. You may get a clinical scenario of someone who has a free wall rupture. In that case the answer is that they're ****ed. It is rare for people to survive a ventricular free wall rupture.

As to the pseudoaneurysm- forming and being clinically recognized are 2 different things.

 

[notbobtrustme]

Use Pathoma's guide and it makes sense in terms of wound healing.

Ventricular free wall rupture is going to occur after macrophages get in there and start phagocytosing all the dead/dying material and if they are too zealous, they can rip the ventricular wall. Nitpicking on a day here or there will just drive you crazy and not really explain anything anyways.

 

[Flamen04]

UWorld never outright just gives you timelines for answers....I'm sure you could answer the question based on the other part of the answer

 

[ButterButter]

If anyone's looking for a little UWorld closure on this topic, they are now going with the 5-14 day post-MI timeline for free-wall rupture, which is more in line with FA

 

[ct303]

Seeing as this thread is 2 years old, I think that the closure occurred already.

 

[TheAberrantGene]

I agree 100% with this conversation.. being a 25 year old book and without proofreading..kinda makes me wonder whether they deserve the status of the No. 1 USMLE book

Even the 25th edition out right now has an errata of a 100 or more errors i think..