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Official Updates, Corrections, and Clarifications June 8, 2015
Official Updates, Corrections, and Clarifications June 8, 2015
Official Updates, Corrections, and Clarifications June 8, 2015
OfficialUpdates,Corrections,andClarifications
June8,2015
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CATEGORIESOFUPDATES
MajorCorrections
Factualerrorsthatcouldinterferewithcomprehension
MinorCorrections
Lesssignificanterrorsthatmaycauseconfusion
Clarifications
Thetextisaccurate,butcouldbewrittenmoreclearly
Minorformattingissues(misalignments,indents,etc)thatmayconfuse
MAJORCORRECTIONS
Page
FactName
Revision
57
Advance
directives
IntheentryforMedicalpowerofattorney,replace"Canberevoked
anytimepatientwishes(regardlessofcompetence)."with"Canberevoked
atanytimebyapatientwithdecisionmakingcapacity."Thishighlightsthe
notionthatadvancedirectivesservetoguidedecisionmakingwhena
patientisunabletodosothemselves.
83
Autosomal
dominant
disorders
(1)IntheentryforMarfansyndrome,replacedefectivefibrinwith
defectivefibrillin
(2)IntheentryforTuberousSclerosis,removeIncompletepenetrance
fromthelastsentence,asmostsourcesnowcharacterizeitashaving
completeornearcompletepenetrance.
112
Fattyacid
metabolism
Inthelowerrightsideofthefigure,replace"AcylCoA"with"AcetylCoA,"
asshownintheimagebelow,toreflectthatitisAcetylCoAthatcanbe
usedtoformketonebodiesorenterintotheTCAcycle.
294
EvolutionofMI
Intherowfor424hr,inthecolumnforLIGHTMICROSCOPE,change
"(duetofreeradicaldamage)"to"(duetoinfluxofcalciumions)."
337
Multiple
endocrine
neoplasias
IntheentryforMEN2A,replace"Associatedwithmarfanoidhabitus
mutationin
RET
gene(codesforreceptortyrosinekinase)"with
"Associatedwithmutationin
RET
gene(codesforreceptortyrosine
kinase)"
379
Octreotide
IntherowforMECHANISM,replace...inhibitsactionsofmanysplanchnic
vasoconstrictionhormones."with"...inhibitsactionsofmanysplanchnic
vasodilatoryhormones."
460
Aphasia
IntheentryforMixedtranscortical,replace"BrocaandWernickeareas
involved..."with"BrocaandWernickeareasnotdirectlyinvolved
(involvementofsurroundingareasresultsinsimilarpresentation)..."
499
Baclofen
IntherowforMECHANISM,replaceInhibitsGABA
"withActivates
B
GABA
500
Parkinson
diseasedrugs
IntherowforPreventdopaminebreakdown,replacethetwobulletpoints
withthefollowing:
SelegilineblocksconversionofdopaminetoDOPACby
selectivelyinhibitingMAOB.
Tolcaponeblocksconversionofdopamineto3MTbyinhibiting
centralCOMT.
524
Atypical
antidepressants
IntheentryforTrazodone,replace"Primarilyblocks5HT
and
2
adrenergicreceptors."with"Primarilyblocks5HT
and
adrenergic
1
2
1
receptors,alsoweaklyinhibits5HTreuptake."Theblockadeof5HT
reuptakeisbelievedtobeonthecomponentsmostresponsibleforthe
antidepressanteffectathigherdosages.
535
Juxtaglomerular
apparatus
Replacethesecondandthirdsentencesinthesecondcolumnwith"JG
cellssecreterenininresponsetoBP,sympathetictone(1),and
NaCldeliverytomaculadensainDCT."
MINORCORRECTIONS
Page
FactName
Revision
96
Ratedetermining IntheentryforGluconeogensis,inthecolumnforRegulators,remove
enzymesof
"ATP(+)andacetylCoA(+),"asthereispaucityofevidencesuggesting
metabolic
theseactdirectlyonFructose1,6bisphosphatase.
processes
99
Pyruvate
dehydrogenase
complex
Atthebottomofthesecondcolumn,replace"Activatedbyexercise,
which:"with"Activatedby:"forclarityastheeffectsofexercisearemore
complicatedthandescribedhere.Ingeneral,exerciseresultsinadecrease
+
intheNAD
/NADHratio.However,thepyruvatedehydrogenasecomplexis
+
activatedbyanincreaseintheNAD
/NADHratio.
102
HMPshunt
(pentose
phosphate
pathway)
IntheentryforNonoxidative(reversible),replace"Glucose3phosphate"
with"Glyceraldehyde3phosphate"asshownbelow:
110
Glycogen
storagediseases
IntheentryforMcArdledisease(typeV),underCOMMENTS,remove
"TreatwithvitaminB
(cofactor),"asthereisinsufficientevidenceto
6
suggestthisisaneffectiveformoftreatment.
114
Lipidtransport,
keyenzymes
Inthefirstimage,deletethegreenLPLandHL(totheright)thatact
uponchylomicronremnantspriortotheiruptakebytheliver
229
Woundhealing
IntherowforEGF,replace"Stimulatescellgrowth...asexpressedby
ERBB2
)with"Stimulatedcellgrowth...asexpressedby
ERBB1
."
ERBB2
isthegenethatisoverexpressedinsometypesofbreastcancer(also
knownas
HER2
/
Neu
)"
309
Antiarrhythmics
potassium
channelblockers
(classIII)
Inthefigureforthisfact,pleasenotethatthevoltageshownontheYaxis
shouldbe85mV(not85mV).
313
Pituitarygland
IntheentryforPosteriorpituitary(neurohypophysis),replace"...(supraoptic
andparaventricularnuclei,respectively)..."with"...(supraopticand
paraventricularnuclei)...."
328
Hypothyroidism
IntheentryforHashimotothyroiditis,replace"...anautoimmunedisorder
(antithyroidperoxidase,antimicrosomalandantithyroglobulinantibodies)."
with"...anautoimmunedisorderwithantithyroidperoxidase(aka,
antimicrosomal)andantithyroglobulinantibodies."
330
Thyroidcancer
Makethefollowingchangestoclarifythecommonpathwaysofmetastasis
indifferenttypesofthyroidcancer:
IntheentryforFollicularcarcinoma,changetextsothatitreads
Goodprognosis,invadesthyroidcapsule(unlikefollicular
adenoma),uniformfollicles,hematogenousspreadiscommon."
IntheentryforMedullarycarcinoma,remove"hematogenous
spreadcommon."
380
Metoclopramide
IntherowforTOXICITY,replace"...(duetoD
receptorblockade)"with
1
"...(duetodopamineblockade)."AsdescribedintherowforMECHANISM,
themajoreffectisthatofD
receptorantagonism.
2
390
Microcytic,
hypochromic
(MCV<80fL)
anemia
IntheentryforIrondeficiency,underFINDINGS,replace
"...PlummerVinsonsyndrome(triadofirondeficiencyanemia,esophageal
webs,andatrophicglossitis)."with"...PlummerVinsonsyndrome(triadof
irondeficiencyanemia,esophagealwebs,anddysphagia)."
393
Nonhemolytic,
normocytic
anemia
IntheentryforAplasticanemia,inthesecondbullet,replace"Viralagents
(parvovirusB19,EBV,HIV,HCV)"with"Viralagents(parvovirusB19,EBV,
HIV,viralhepatitis)".
405
Warfarin
IntherowforTOXICITY,secondcolumn,replace"ProteinsCandS...
clottingfactorsII,VI,IX,andX"with"ProteinsCandS...clottingfactorsII,
VII,IX,andX"tomaintainconsistencywiththelistvitaminKdependent
clottingfactorsdescribedpreviously.Specifically,notethatitshouldbe
FactorVII,notFactorVI,inthislist.
412
Rituximab
IntherowforCLINICALUSE,replace"IBD"with"ITP"tomore
appropriatelyreflecttheuseofthisdrug.
438
Pigmentedskin
disorders
IntherowforAlbinism,changethesecondsentencetoreadasfollows:
"Piebaldismreferstoaseparateconditioncharacterizedbyafailureof
neuralcrestcellmigrationduringdevelopment."
489
Seizures
Intherighthandcolumn,regardingStatusepilepticus,replace"variably
definedas>1030min"with"operationallydefinedas>5min."Althougha
consensusdefinitionbasedontimeislacking,mostclinicalguidelines
agreethatseizureslastinggreaterthan5minutesshouldbetreatedas
statusepilepticus.
521
Antipsychotics
(neuroleptics)
(1)Inthethirdcolumn,intherowforMECHANISMandCLINICALUSE,
replace"(e.g.,Huntingtondisease,delirium,EPSsymptoms)."with"(e.g.,
extrapyramidalsymptoms)."
(2)Inthesecondcolumn,intherowforCLINICALUSE,replace"...acute
mania,Tourettesyndrome."with"...acutemania,Tourettesyndrome,
Huntingtondisease."
559
Embryologic
derivatives
IntheentryforMesoderm,replace"...vagina,kidneys,adrenalcortex..."
with"...uppervagina,kidneys,adrenalcortex..."
IntheentryforEndoderm,replace"...mostofurethra(derivedfrom
urogenitalsinus)..."with"...mostofurethraandlowervagina(derivedfrom
urogenitalsinus)...."
Thishighlightstheimportancethatthevaginaandotherurogenital
structureshaveamixedembryologicaloriginbetweenmesodermand
endoderm.
563
Vitellineduct
Intheimage,thepartlabelled"Vitellinefistula"wouldbemore
appropriatelyclassifiedasa"Vitellinecyst,"giventhatitscavityisin
discontinuitywithboththelumenofadjacentbowelandthesurfaceofthe
umbilicus.
Avitellinefistulawouldbemoreappropriatelyshownasfollows:
568
Uterine
(M
llerianduct)
anomalies
Inthesetoffiguresforthisfact,pleasenotethatthefigureforDidelphys
shoulddepictadoublevaginainadditiontoadoubleuterusanddouble
cervix,asdescribedinthetext.Pleaseseethisimageforanexampleof
suchadiagram.
571
Urethralinjury
Thebulbarurethraismoreappropriatelyconsideredaspartoftheanterior
urethraandiscommonlyinjuredinperinealsaddleinjuries.Pleasechange
thetextasfollows:
Posteriorurethramembranousurethrapronetoinjuryfrompelvic
fracture.Injurycancauseurinetoleakintoretropubicspace.
Anteriorurethrabulbarandpenileurethraatriskofdamagedueto
perinealstraddleinjury.Cancauseurinetoleakbeneathdeepfasciaof
Buck.Iffasciaistorn,urineescapesintosuperficialperinealspace.
583
Gynecological
tumor
epidemiology
Replace"Worstprognosisovarian>cervical>endometrial."with
"Mortalityovarian>endometrial>cervical."toalignmoreappropriately
withthestatisticsandterminologyusedincurrentliterature.
587
Ovarian
neoplasms
IntheentryforChoriocarcinoma,remove"Veryresponsiveto
chemotherapy."
CLARIFICATIONS
Page
FactName
Revision
291
Arteriosclerosis
IntheentryforMnckeberg(medialcalcificsclerosis),replace
CalcificationofelasticlaminaofarterieswithCalcificationofinternal
elasticlaminaandmediaofarteries
322
Thyroid
hormones(T
/T
)
3
4
IntherowforREGULATION,secondcolumn,replaceThyroidstimulating
immunoglobulins(e.g.,TSH)stimulatefollicularcells(e.g.,Graves
disease).with"InGravesdisease,thyroidstimulatingimmunoglobulins
stimulateTSHreceptorsonfollicularcells,causinghyperthyroidism."
369
Alcoholicliver
disease
IntheentryforAlcoholichepatitis,intherighthandcolumn,replace"(ratio
usually>1:5)"with"(ratiousually>2:1)"toremainconsistentwithcriteria
usedelsewhereinthebook.
423
Muscle
conductionto
contraction
Intherighthandcolumn,notethatterminalcisternaearepartofthe
sarcoplasmicreticulum.Forclarity,replacethefirstsentenceinthethird
columnwiththefollowing:
Ttubulesareextensionsofplasmamembranejuxtaposedwithterminal
cisternaofthesarcoplasmicreticulum.
494
Glaucomadrugs
IntheentryforCholinomimetics,Direct(pilocarpine,carbachol),under
SIDEEFFECTS,replace"Miosisandcyclospasm(contractionofthe
ciliarymuscle)"with"Miosis(contractionofthepupillarysphincter
muscles)andcyclospasm(contractionoftheciliarymuscle)"
524
Atypical
antidepressants
IntheentryforTrazodone,thefirstsentenceshouldread:Primarily
blocks5HT
and
adrenergicreceptorsalsoweaklyinhibits5HT
2
1
reuptake.