2011 First Aid for the USMLE Step 1 Official Updates, Corrections, and Clarifications Updated August 17,

2011 Despite our best efforts, errors do occur during the revision. If you see a verifiable error not on this list, please report it to our blog at www.firstaidteam.com. If you are the first to report the error, you will receive a $10 gift certificate. In order to identify and correct every possible error, we review every single submission, as well as search other websites and blogs that claim to have a comprehensive listing of errors in First Aid 2011. If you find that our material conflicts with a source that youre reviewing, please point us toward it with a corroborating reference. As always, we will check every submission against primary references to ensure the most accurate, high-yield study guide available. If you submitted an erratum and it does not appear in an update, then either it does not agree with the primary literature in the field or we consider it a detail beyond the scope of the book. Please note that we will not list simple typos or, unless egregious, omitted material; our goal is to provide a high-yield framework for studying and not a comprehensive textbook. The list below reflects content errors and typos that may create confusion that were submitted before July 15, 2011. As always, updates are available at www.firstaidteam.com. Good luck with your studies! The First Aid/USMLERx Team Page # Entry Title Correction/Clarification In the second full paragraph, change "To avoid a rescheduling fee, you will need to request a change before noon EST at least five business days before your appointment" to "No fee is charged for changing your testing appointment 31 or more calendar days prior to the first day of the scheduled test." Shift the reference to sleep spindle in the figure slightly to the left. The figure should illustrate the phosphodiester linkage between the top two deoxyribonucleotides, which is an important component of the DNA backbone, and also crucial for binding of phosphodiesterases. In the diagram, change the 5' cap to "Gppp. It is a TRIphosphate cap (rather than 4 phosphates). In a previous erratum we indicated changes to the figure. More research indicates that the image as typeset is correct. Note that using a DNA fragment from a eukaryotic cell and inserting that into a plasmid would not generate a cDNA library as stated, but would generate a genomic DNA library (which includes introns) because the bacterium used to clone the plasmid cannot splice out the introns; they would remain intact. In the entry for X-lined recessive, the text incorrectly states that "Heterozygous females" may be affected. In fact, females must be homozygous for the recessive allele in order to be affected by an X-linked recessive disease. Therefore, change heterozygous to homozygous in the third column. Familial adenomatous polyposis is due to a mutation (rather than a deletion) on chromosome 5. Fragile X syndrome is not associated with chromosomal breakage. The 2 Cs entry in column 3 should align with the entry for Deficiency. Add ethanol to fomepizole, as ethanol is also an antidote to methanol and ethylene glycol poisoning. The statement "High blood levels of fructose and galactose also result in conversion via aldose reductase..." is incorrect. Fructose is not an aldose sugar and therefore cannot be acted upon by aldose reductase. Include lactulose in the list of treatments for hyperammonemia.

6 62

Rescheduling an exam Sleep stages

71 72 73

DNA/RNA/protein synthesis direction RNA processing (eukaryotes) Splicing of mRNA

82

Cloning methods

85 86 87 91 94 *

Modes of inheritance Autosomal-dominant diseases Fragile X syndrome Vitamin B2 (riboflavin) Ethanol metabolism

104 105

Sorbitol Hyperammonemia

107 108 * 109

Catecholamine synthesis Cystinuria Glycogen Glycogenolysis/glycogen synthesis Heart embryology

110 123

127

Posterior fossa malformations

128

Branchial arch derivatives Pancreas and spleen embryology Kidney embryology Special culture requirements

131 132 138

(1) The arrows for dihydropterin reductase reaction are both pointing the wrong direction. The enzyme recovers THB from DHB and makes NADP+ from NADPH. Reverse the arrows. (2) Carbidopa inhibits dopa decarboxylase, not dopamine hydroxylase; thus the carbidopa over the arrow should move up one arrow. Cystine kidney stones are better described as hexagonal in shape, rather than cystine staghorn calculi. Glycogen phosphorylase leads to the creation of limit dextrins (not dextrans). (1) The enzyme responsible for glycogen synthesis is glycogen synthase, not glycogen synthetase. (2) Change limit dextran to limit dextrin. Change the entry for "Primitive ventricle" to "Trabeculated parts of right and left ventricles. On further examination by multiple authors, we conclude that the original text is correct in listing a Chiari type II (not type I) malformation. Sorry for the confusion, the literature is rather confusing on this as well. The list of muscles of pharyngeal arch 1 includes the anterior 2/3 of the tongue. While it is true that CN V supplies somatic sensation to the mucosa of the tongue via the lingual nerve, it does not innervate any of the muscles of the tongue. All of the muscles of the tongue are innervated by CN XII, with the exception of CN X's contribution by innervating the palatoglossus. The dorsal and ventral pancreatic buds contribute to the pancreatic head and the main pancreatic duct. The uncinate process is formed by the ventral bud alone. In the last line of text, change uteropelvic to ureteropelvic. Change the media used for isolation for Legionella to include iron in addition to cysteine. Add Yersinia sp. (both Y. pestis and Y. pseudotubercolosis) to the list of facultative intracellular bugs. Modify the mnemonic to read Some Nasty Bugs May Live FacultativeLY. The mode of action of endotoxin is to induce (not include) TNF and IL-1. In the entry for ADP ribosylating A-B toxins, note that the terms "adenylyl cyclase (in the description for Vibrio) and "adenylate cyclase (in the description for E. coli) refer to the same cyclase molecule and are used interchangeably. The reference to "(TSST-1 toxin)" is redundant because TSST stands for toxic shock syndrome toxin. The entry should read (TSST-1). Note that tuberculoid disease is the result of high cell-mediated immunity with a largely Th1-type immune response, and lepromatous leprosy is characterized by low cell-mediated immunity with a humoral Th2 response. EIEC does not produce Shiga-like toxin as stated. EIEC invades the mucosa like Shigella, but produces no toxins. Include a third, and newest, triple therapy for H. pylori, (3) proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. The fever associated with Plasmodium malariae infection is quartan, with a 72-hour cycle. The fever of P. vivax/ovale infection is tertian, occurring every 48 hours. Heterophile is incorrectly spelled as heterophil. In the entry for Reoviruses, note that coltivirus (not reovirus) is the cause of Colorado tick fever.

139 140

Intracellular bugs Main features of endotoxins and exotoxins

141

Bugs with exotoxins

145

Staphyloccus aureus

149 151

Leprosy (Hansens disease) E. coli

152

161 167 168

Helicobacter pylori Medically important protozoasingle-celled organisms (continued) EBV RNA viruses

170 173 * 177 178 * 180 181

Rubella virus HIV diagnosis Common causes of meningitis UTI bugs Red rashes of childhood Sexually transmitted diseases

Although rubella is associated with a "truncal rash," typically the rash begins at the head and moves down. Change Western blot assay to indicate that it has a low falsepositive rate instead of a high false-negative rate. In adults, S. pneumoniae is a more common cause of bacterial meningitis than N. meningitidis. Regarding the nitrite test: S. saprophyticus is a gram-positive coccus and will be nitrite negative. Revise the clinical presentation of Mumps virus to include rash. In the entry for bacterial vaginosis, note that it can be sexually transmitted, but it is not exclusively an STD. Change the statement "C. trachomatis --the most common STD in the United States" to "C. trachomatis -- the most common bacterial STD in the United States." Shift the entry for HBV down one line, so that HBV and its risk factor do not overlap with the Pseudomonas notes. (1) Listeria monocytogenes is incorrectly listed as a gram-negative rod, while it is in fact a gram-positive rod. (2) Enterococci are incorrectly listed as gram-negative rods, while they are in fact gram-positive cocci.\ Note that Cilastatin is an inhibitor of renal dehydropeptidase. Aminoglycosides do not inhibit A-site tRNA binding as shown in the diagram (this is the mechanism of action of tetracyclines). Aminoglycosides inhibit formation of the initiation complex, which is mRNA binding to the 30S small ribosomal subunit. Clindamycin works by binding the 50S ribosomal subunit and blocking translocation (not by blocking peptide bond formation). (1) The NNRTI delavirdine is misspelled; the correct spelling is delavirdine. (2) Zalcitabine and amprenavir have both been withdrawn from the market. Erythromycin should be removed from this list as it is a class B in pregnancy. More specifically, erythromycin estolate should be avoided only in patients with current liver disease (not pregnancy) because of its potential for worsening liver damage. This also changes the mnemonic in column 3; the E in SAFE should not be boldface. Some misalignment of text was introduced during proofing: (1) In line 5 the area of the body is Rectum (above pectinate line) and primary lymph node drainage is internal iliac. (2) In item 6 the area of the body is Anal canal below pectinate line" and primary lymph node drainage is Superficial inguinal nodes. (1) Change figure to specify Th1 cell in the middle diagram and Th2 in the right diagram. (2) Add IL-10 to the list of Th2 cytokines. IL-6 should be included in the list of Th2 cytokines. Note that isotype switching proceeds through DNA recombination, not by alternative splicing of mRNA. It is a permanent differentiation step. Change the classical pathway convertase for C3 from C4b,2b to C4b2a. To clarify an earlier erratum: in the entry for Bruton's agammaglobulinemia, in the Defect column, note that the defect in BTK blocks pre-B cells from maturing into immature B cells. Note that sirolimus inhibits (not binds to) mTOR.

181 181

Pelvic inflammatory disease Nocosomial infections

185 186

Ampicillin, amoxicillin (aminopenicillins) Imipenem/cilastatin, meropenem

187 188

Protein synthesis inhibitors Clindamycin

197

HIV therapy

198 *

Antibiotics to avoid in pregnancy

200

Lymph drainage

204 204

B cell and T cell activation Helper T cells

206 207

Immunoglobulin isotypes Complement

213 216

Immune deficiencies Sirolimus (rapamycin)

220

Necrosis

220 222 223

Apoptosis vs. necrosis Free radical injury Granulomatous diseases

In item 5, change Fibroid to Fibrinoid. (1) Change menstruation to menopause, since an example of atrophy is the endometrial lining during menopause. (2) Change the title of the diagram to read Intrinsic apoptosis vs. extrinsic apoptosis. In item 3, change CCi4 to CCl4 (carbon tetrachloride). In the third column, delete the last paragraph; it duplicates what is said in the paragraph above it. For the senile cardiac and diabetes mellitus type II entries, the entries for proteins and derived from are transposed. Senile cardiac amyloidosis is associated with AF protein and derived from transthyretin. Diabetes mellitus type 2 is associated with AE protein and derived from amylin. The associated tumor of ret should be MEN types IIA and IIB instead of types II and III. (1) Under EBV, add Hodgkins lymphoma. (2) Schistosoma haematobium, not merely Schistosoma, is associated with SCC of the bladder. Under Neoplasm, change Renal cell carcinoma, hemangioblastoma to read Renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma. In the entry for Direct sympathomimetics, low doses of epinephrine are selective for receptors in general, whereas higher doses are selective for receptors. Change text in first paragraph to conversion of lactate to pyruvate In the third column, during the early stages of exercise, CO is maintained by stroke volume; during the late stages of exercise, CO is maintained by HR. In the entry for Paradoxical splitting, change Therefore on inspiration, the later P2 and earlier A2 sounds move closer to one another." to "Therefore on inspiration, the earlier P2 and later A2 sounds move closer to one another." (1) In the entry for mitral prolapse, change the last sentence to read, Enhanced by maneuvers that venous return (e.g., standing or Valsalva). (2) In the entry for mitral stenosis, the opening snap is due to an abrupt halt in leaflet motion in early systole. In the entry for phase 0, the text states that pacemaker cells lack fast voltage-gated Na+ channels. In fact, such channels are present, but they are permanently inactivated because of the resting voltage of pacemaker cells. Change vascular hypertrophy to ventricular hypertrophy. Change the entry under Subendocardial infarcts to "Subendocardium especailly vulnerable to ischemia due to fewer collaterals, higher pressure." (all on one line.) In the diagram, change the arrow from " sympathetic activity" that currently points to " renal Na+ and H2O reabsorption so that it points to " renin-angiotensin-aldosterone." Change the title of the Fact from Rheumatic heart disease to Rheumatic fever. (1) Delete the reference to (Kussmaul's pulse) after "pulsus paradoxus" as Kussmauls pulse is a sign of constrictive pericarditis, not cardiac tamponade. (2) As a result of (1), the updated correct definition for pulsus paradoxus is a in amplitude of SBP by 10 mm Hg during inspiration.

224 227

Amyloidosis Oncogenes

229

Oncogenic microbes

229

Paraneoplastic effects of tumors

240 246

Sympathomimetics Alcohol toxicity

254 *

Cardiac output

258

Splitting

259

Heart murmurs

261 267

Pacemaker action potential Eisenmengers syndrome

272

Types of infarcts

274 276

CHF Rheumatic heart disease

276

Cardiac tamponade

288 305 310 313 318 319 320 323

Pituitary gland Propylthiouracil, methimazole Digestive tract anatomy Portosystemic anastomoses GI secretory products Gastric parietal cell Carbohydrate digestion Esophageal cancer Inflammatory bowel disease (IBD) Meckels diverticulum Appendicitis Molecular pathogenesis of CRC Budd-Chiari syndrome Wilsons disease (hepatolenticular degeneration)

Neurophysins carry ADH and oxytocin only from their site of synthesis (hypothalamus) to their site of release (posterior pituitary). The notation that they carry hormones in circulation is incorrect. Propylthiouracil can also cause hepatotoxicity. In the diagram, change Muscularis mucosae to "Muscularis mucosa." Delete the number 4 from the diagram. Change the text under Pepsin regulation, third column, to stimulation and local Move the reference to Gastric lumen to the other side of the diagram under Gastric parietal cell. Under Salivary amylase, change dextrans to dextrins. The plural of diverticulum is "diverticula," not "diverticuli. Ankylosing spondylitis and uveitis are more commonly associated with ulcerative colitis than with Crohn's disease and should be moved to the correct column. Change Dx: Pertechnetate. Study for ectopic uptake. to Dx: Pertechnetate study for ectopic uptake. McBurneys point is 1/3 of the distance from the iliac spine (not crest) to the umbilicus. Underneath the graphic, Intercellular is incorrectly spelled Intercelullar. Hypercoagulable is misspelled as hypercoaguable. (1) Remove "Choreiform movements" from the list of characteristic features. (2) Next to "Dementia," add dyskinesia and dysarthria. In reference to biliary colic, remove the phrase that states, "... cause bile duct obstruction which results in bile duct contraction." It is a repeat of the previous sentence. Under causes, change Hyperlipidemia to Hypertriglyceridemia. Note that cromolyn sodium is used as asthma prophylaxis, not to treat asthma as indicated. In addition to factors IXa, Xa, XIa, and XIIa, antithrombin also inhibits factor VIIa. In the first sentence of the last column, change Warfarin inhibits reductase to Warfarin inhibits epoxide reductase. Change the Adhesion box entry to Platelets bind vWF via GpIb receptor at the site [not side] of injury only (specific). (1) Remove G6PD deficiency from extravascular hemolysis and include under intravascular hemolysis. (2) To clarify previous errata, note that G6PD deficiency is associated only with intravascular hemolysis. Orotic aciduria is not a nonmegaloblastic macrocytic anemia. Orotic aciduria is a megaloblastic macrocytic anemia that cannot be fixed with treatment of either folate or vitamin B12. (1) In the entry for hereditary spherocytosis, change band 4.1 to band 3.1. (2) To clarify previous errata, note that G6PD deficiency is associated only with intravascular hemolysis. (3) In the entry for paroxysmal nocturnal hemoglobinuria, the text synthesis of GPI anchor appears twice. Delete one occurrence of this text.

326 327 327 * 330 332

333

335 335 343 345 346 346

Gallstones (cholelithiasis) Acute pancreatitis Mast cell Coagulation, complement, and kinin pathways Coagulation cascade Platelet plug formation

350 *

Normocytic, normochromic anemia Macrocytic (MCV >100) anemia

350

352 *

Intrinsic hemolytic normocytic anemia

357

Hodgkins lymphoma

358

Multiple myeloma

359 361

Leukemias Chronic myeloproliferative disorders

361 362 363 * 365 372 *

Polycythemia Heparin Clopidogrel, ticlopidine Antimetabolites Upper extremity innervation

Note that the nodular sclerosis type occurs with equal frequency in males and females. The M protein in multiple myeloma is most commonly IgA or IgG. Multiple myeloma cells produce excessive monoclonal proteins, called M proteins, and are recognized as IgA, IgD, IgG, IgE, IgM. The M protein level is referred to as the M-spike. (1) Hairy cell leukemia is most likely to occur in middle-aged people and the elderly (not only elderly, as stated in the text). (2) In the entry for CML, change the Comments to "Responds to imatinib (a small molecule inhibitor of the bcr-abl tyrosine kinase). Imatinib is not an antibody. Shift the second CML label down one line so that it aligns with "bcr-abl transformation leads to..." (1) Note that RCC, Wilms' tumor, cyst, HCC, and hydronephrosis are associated diseases of inappropriate absolute polycythemia due to ectopic erythropoietin. (2) Note that EPO is indeed decreased in polycythemia vera. (3) In the second row under Associated Diseases, the word congenital is misspelled as "congential." The "decrease" sign in the first sentence refers to both thrombin and Xa levels. Clopidogrel and ticlopidine act by preventing glycoprotein IIb/IIIa from binding fibrinogen. Cytarabine is a pyrimidine analog, not a pyrimidine antagonist. Figure D should be labeled Cutaneous innervation patterns of the hand. The median nerve entry has multiple errors: (1) Change Median (C6-C8, T1) to Median (C5-C8, T1). (2) The median motor deficits are transposed. Switch the positions of Lateral finger flexion/wrist flexion and Opposition of thumb. (3) Signs of a proximal nerve lesion include impaired wrist flexion (due to loss of the flexor carpi radialis and other wrist flexors), loss of lateral finger flexion at the DIP and PIP joints, and all of the deficits associated with a distal nerve lesion. It would also cause ape hand. (4) A distal nerve lesion (as in carpal tunnel syndrome) would not impair wrist flexion because the wrist flexors have already been innervated at that point. It would cause loss of lateral finger flexion at the MCP joint. It would also cause claw hand. In addition to flexing the MCP joint, the lumbrical muscles extend the PIP and DIP joints In the entry for the superior gluteal nerve, a positive Trendelenburg sign can be better defined as: contralateral hip drops when standing on leg ipsilateral to lesion/deficit. In diagram B, change the label myofiber to myofibril. Pseudogout is incorrectly stated to have no treatment, when it can be treated with: 1. NSAIDs to treat sudden/severe pseudogout attacks 2. Steroids (injected into the joint or given orally to those who cannot tolerate NSAIDs) 3. Colchicine to reduce recurrence over the longer term. There is no perifascicular inflammation in polymyositis. In dermatomyositis, perifascicular atrophy is sufficient for diagnosis. (1) Include a reference to image 66 in the description of acanthosis nigricans. (2) Include a reference to image 55 in the description of erythema multiforme.

374 376

Upper extremity nerves Hand muscles

376 377

Lower extremity nerves Muscle conduction to contraction

384 386

Pseudogout Polymyositis/dermatomyositis

389

Skin disorders (continued)

397

Neurotransmitters

399

Thalamus

405 406 407

Circle of Willis Intracranial hemorrhage Ischemic brain disease

418

Cranial nerve lesions

421 * 423

Glaucoma Cranial nerve III in crosssection

423 426 427 * 429

Visual field defects Seizures Headache Herniation syndromes

ACh in REM sleep is increased, not decreased. (1) Change the VPL reference from "position and proprioception to pressure, touch, vibration, and proprioception." (2) The input of the MGN is the superior olive and inferior collculus of tectum [not pons]. (1) Medullary syndrome is most often caused by infarcts in the vertebral artery, so the first entry should read, Vertebral artery/anterior spinal artery (medial medullary syndrome). (2) In the last line in the entry, change dominant hemisphere (ataxia) to dominant hemisphere (aphasia). In the entry for subarachnoid hemorrhage, change APCKD to ADPKD. Note that the guidelines for the administration of tPA have extended the window to a 4.5-hour time frame. (1) In the entry for CN XII, all corticobulbar tracts are bilaterally innervated except that of CN VII. The reason we "lick toward the lesion" is due to a lower motor lesion of the 12th nucleus or CN XII leading to a weakened tongue on the lesioned side. (2) In the entry for CN V, the reason the jaw deviates toward the side of the lesion is due to unopposed force from the opposite pterygoid muscle. "Narrow-angle" refers to the angle between the cornea and the iris, not the cornea and the lens. The closure of this angle prevents aqueous humor access to the canal of Schlemm. Should read cornea and iris, not cornea and lens. The output to ocular muscles is due to decreased [not increased] diffusion to interior. In item 7, central scotoma, change the image of the left eye to show a dark circle in the middle as opposed to being completely shaded in. Partial seizures most commonly originate in the medial, not mesial, temporal lobe. For cluster headache, many experts consider hyperbaric oxygen to be first-line treatment rather than sumatriptan. Redirect arrow 3 from the uncus through the tentorium cerebelli. In the first entry in column 2, change the text to read, Bromocriptine (ergo derivative) and pramipexole and ropinirole (non-ergot derivatives). The latter are preferred and have largely replaced bromocriptine as the preferred treatment for Parkinsons. Change the first sentence to read, "Unconscious mental processes of the ego used [not uses] to resolve conflict and prevent feelings of anxiety and depression." Under Huntingtons disease, add dopamine. The entry for Tourette's disorder should read "stereotyped motor movements AND vocalizations" instead of "stereotyped motor movements OR vocalizations. (1) Under alcohol, add a period after "Serum -glutamyltransferase (GGT) - sensitive indication of alcohol use" (2) Delete naltrexone as a treatment for alcohol intoxication; it is used to treat alcohol and opioid dependence, not acute intoxication. The top of page 451 is a continuation of Signs and symptoms of substance abuse from page 450. The top of page 451 should be changed to include the title, Signs and symptoms of substance abuse (continued).

435

Parkinsons disease drugs

440 442

Ego defenses Neurotransmitter changes with disease Childhood and early-onset disorders

442

450

Signs and symptoms of substance abuse

451

Signs and symptoms of substance abuse

453 455

Antipsychotics (neuroleptics) SSRIs

458

Kidney anatomy and glomerular structure

461 463

Nephron physiology Kidney endocrine functions

464 *

Hormones acting on kidney

467

Nephritic syndrome

468

Nephrotic syndrome

469 470 475 *

Kidney stones Transitional cell carcinoma K -sparing diuretics

+

Under the treatment options for neuroleptic malignant syndrome, agonists should be changed to D2 agonists. Serotonin syndrome is associated with myoclonus, not muscle rigidity. In the upper right image, the labels for efferent and afferent arterioles are reversed; afferent arterioles deliver blood to the glomerulus, while efferent arterioles take blood from the glomerulus to the peritubular capillaries or the vasa recta. (1) In the upper left drawing, within the proximal convoluted tubule, show that H2CO3 splits into H+ and HCO3- and the H+ then goes into the lumen and the HCO3 goes into the interstitium. (2) In the lower right drawing, change the label from Distal convoluted tubule to Collecting tube transport. In the entry for vitamin D, note that 1,25-(OH)2 vitamin D increases intestinal absorption, not reabsorption. The diagram is somewhat misleading. The diagram currently appears to indicate that aldosterone works on the medullary segment while ADH works on the cortical segment of the collecting duct. Switch the descriptions for Aldosterone and ADH so that aldosterone is shown acting on the collecting duct and ADH working on the medullary segment. (1) In the entry for RPGN, in the second column, delete the word function. The entry should read, Crescents consist of fibrin and plasma proteins (e.g., C3b) with glomerular parietal cells, monocytes, and macrophages. (2) In the entry for diffuse proliferative glomerulonephritis, in the last column, the text should read (see next page) instead of (see below). (3) For Alports syndrome, change deafness X-linked dominant to deafness X-linked. Transmission of Alport's syndrome can be Xlinked, autosomal recessive, or autosomal dominant. (1) Note that focal segmental glomerulosclerosis, not membranous glomerulonephritis, is the most common cause of adult nephrotic syndrome. (2) In the entry for membrano-proliferative glomerulonephritis, tram tracking can be seen on LM, not EM. In the entry for Ammonium magnesium phosphate, in the Notes column, delete magnesium or radiolucent and phosphate. Ammonium magnesium phosphate stones are caused by infection with urease-positive bugs. In the right column, insert a comma between Smoking and Aniline dyes. Triamterene and amilioride act in the DCT, not the CCT. Some text is repeated: "and flagellum (tail) from one of the centrioles" and "Tail forms from centrioles." Please delete the duplicate text. Trophoblasts secrete hCG, not -hCG. Two errors to correct: Decreased synthesis of GnRH (not gonadotropin) occurs in the hypothalamus (not the anterior pituitary). Delete ascending infection as a cause of endometriosis. Cross Ashermans syndrome off the list of causes of anovluation. Ashermans syndrome can cause amenorrhea, but it does not cause anovulation. Note that the mature teratoma is the "most frequent benign ovarian germ cell tumor." A serous cystadenoma is the most common benign ovarian tumor.

479 484

Derivation of sperm parts Pregnancy

486 489

Kallmann syndrome Endometriosis Most common causes of anovulation

489 *

491 *

Ovarian germ cell tumors

492 492 496

Ovarian non-germ cell tumors Benign breast tumors Tunica vaginalis lesions

508 509

Alveolar gas equation Response to high altitude

510

Obstructive lung disease (COPD)

510

Embolus types

518 *

Classic presentations

519 *

Classic presentations

524

Classic labs/findings

525 *

Classic labs/findings

526 527 *

Classic labs/findings Brain tumor (kids)

528

Key associations

529 *

Key associations

595

Abbreviations and symbols

Note that serous cystadenocarcinomas make up 45% of malignant ovarian tumors. Note that fibroadenomas are the most common tumor in those <35 [not 25] years old. While hydroceles and spermatoceles can be transilluminated, varioceles do not transilluminate. In three instances, in the abbreviation for arterial carbon dioxide pressure, change the capital A to a lower case a, to indicate were measuring arterial carbon dioxide pressure instead of Alveolar. In item 4, change "2,3-DPG" to "2,3-BPG" (to represent 2,3bisphosphoglyceric acid). (1) Formatting error: shift Bronchiectasis and Chronic necrotizing infection of down one line so that they line up with Associated with bronchial obstruction (third column). (2) The criteria for chronic bronchitis is productive cough for >3 months/year for 2 consecutive years. The imaging of choice for emboli is incorrectly stated as CT angiography. In fact, helical CT is the imaging test of choice for emboli. In the second column for Chronic exercise intolerance with myalgia, fatigue, painful cramps, insert the word glycogen, so that the text reads muscle glycogen phosphorylase deficiency. (1) The 4 F risk factors of Fat, Female, Forty, and Fertile suggest acute cholelithiasis, not acute cholecystitis. (2) In the third entry from the bottom, Hypertension, hypokalemia, and metabolic alkalosis (not acidosis) are characteristic of Conns syndrome. (3) In the entry for Conns syndrome, delete (1 hyperaldosteronism). (1) In the diagnosis/disease associated with Hair-on-end (crewcut) appearance on x-ray, change extramedullary hematopoiesis to marrow expansion. (2) Hilar lymphadenopathy, peripheral granulomatous lesions in middle or lower lung lobes is associated with a Ghon complex (not a Ghon focus). In the fourth entry from the top, for Cowdry type A bodies, replace yellow fever, with CMV. Yellow fever may result in Councilman bodies. In the entry for spikes on basement membrane, change "domelike" endothelial deposits to read dome-like subepithelial deposits. The most common infratentorial brain tumor in kids is astrocytoma, followed by medulloblastoma, then ependymoma. (1) In the entries for hematoma, the shape descriptions of the ruptures of epidural and subdural hematomas are reversed. In actuality, epidural hematomas are lentiform shaped, and subdural hematomas are crescent shaped. (2) Additionally, epidural hematomas are more strongly associated with trauma from fractures than subdural hematomas. (1) In the entry for HLA-B27, the most common associations are Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reiters syndrome (remember PAIR). (2) Segmental glomerulosclerosis, not membranous glomerulonephritis, is the most common cause of adult nephrotic syndrome. (1) SNRI is an abbreviation for serotonin and norepinepherine reuptake inhibitor. (2) The correct abbreviation for small nuclear ribonucleoprotein is snRNP, not snRMP.

604 620

Endocarditis Subarachnoid hemorrhage

Add these pages to the index entry: 275, bacterial endocarditis 275, Libman-Sacks endocarditis Subarachnoid hemorrhage is also discussed on page 406. The #6 label on the image is difficult to see (in black) and is currently labeling the frontal lobe or the posterior orbit, not the frontal sinus as indicated. The image shows boutonniere deformity, not swan-neck. Change hyercellularity to hypercellularity. A staghorn calculus is composed of ammonium magnesium phosphate, not calcium oxalate. Joint is incorrectly spelled as join.

I-11 I-14 I-21 I-22 I-30

Image 43 Image 56 Image 86A Image 88b Image 119B

*corrections and clarifications added since June 30, 2011.