First Aid for the USMLE Step 1 2019-670-820

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646 ~

SECTION Ill

RESPIRATORY

~ RESP I RATORY-EMBRYO LOGY

RES PIRATORY-EMBRYOLOGY

Lung development

Occurs in five stages. Initia l development includes development of lung bud from distal end of respiratory diverticulum during week 4. Every Pulmono logist Can See Alveoli.

STAGE

STRUCTURAL DEVELOPMENT

NOTES

Embryonic (weeks 4-7)

Lung bud - trachea - bronchial buds - ma instem bronchi - secondary (lobar) bronchi - tertiary (segmental) bronchi.

Errors at this stage can lead to tracheoesophagea l fistula.

Pseudoglandular (weeks 5-17)

Endoderma l tubules - termina l bronchioles. Surrounded by modest capillary network.

Respiration impossible, incompatible wi th life.

Canalicular (weeks 16- 25)

Termina l bronchioles - respiratory bronch ioles - alveolar ducts. Surrounded by prominent capillary network.

Airways increase in diameter. Respiration capable at 25 weeks. Pneumocytes develop starting at 20 weeks.

Saccular (week 26-bi rth)

Alveolar ducts - terminal sacs. Terminal sacs separated by 1° septae.

Alveolar (week 36-8 years)

Termina l sacs - adu lt alveoli (due to 2° septation). In utero, "breathing" occurs via aspiration and expulsion of am niotic flu id - t vascu lar resistance th rough gestation. At birth, fluid gets replaced with air - I in pulmonary vascu lar resistance. Embryonic period

At bi rth: 20-70 million alveoli. By 8 years: 300- 400 mi llion alveoli.

Fetal

Postnatal

period

period Alveolar

I

Saccular

t

BIRTH Pseudoglandular Eml:tyol'IC.

Surfactant

30

32

34

36

38

40

4

6

8

>--Weeks Years ©

I

•

®

Congenital lung malformations Pulmonary hypoplasia

Poorly developed bronchia l tree with abnormal histology. Assoc iated with congenital diaphragmatic hernia (usually left-sided), bilateral renal agenesis (Potter sequence).

Bronchogenic cysts

Caused by abnormal budding of the foregut and di lation of termina l or large bronchi. Discrete, rou nd, sharply defined, fluid-filled densities on CXR (air-filled if infected). Genera lly asymptomatic but can drain poorly, causing ai rway compression and/or recurrent respiratory infections.

RESPIRATORY

~ RESP I RATORY - EMBRYO L OGY

SECTION Ill

647

Noncil iated; low columnar/cuboida l with secretory granu les. Located in bronchioles. Degrade toxins; secrete component of surfactant; act as reserve cells.

Club cells

Alveolar cell types

973 of a lveolar surfaces. Line the a lveoli.

Type I pneumocytes

Squamous; th in for optima l gas diffusion . Type II pneumocytes

Secrete surfactant from lamellar bodies (white alveola r surface tension, arrowheads in prevents a lveolar collapse, l lung reco il, and t compl iance. Cuboidal and clustered Ill Also serve as precursors to type I cells and other type II cells. Proliferate during lung damage.

rm - •

(P'l 2 (surface tension) . C IIapsmg pressure / = d. ra IUS Law of Laplace - Alveol i have t tendency to collapse on expiration as radius l. Pu lmonary surfactant is a complex mix of lec ithins, the most important of which is d ipalmitoylphosphatidylcholine (DPPC). Surfactant synthesis begins around week 20 of gestation, but mature leve ls are not achieved unti l around week 35. Corticosteroids important for fetus surfactant prod uction and lung development. Type II pneumocytes produce 2 cell types and have 2 functions (surfactant and stem cell functions).

Et

Alveolar macrophages

Neonatal respiratory distress syndrome

Phagocytose foreign mater ia ls; release cytok ines and a lveolar proteases. Ilemosiderin-laden macrophages may be found in the setting of pu lmonary edema or a lveolar hemorrhage.

Surfactant deficiency - t surface tension - alveola r collapse ("ground-glass" appearance of lung fie lds) f'J. Risk factors: prematurity, materna l diabetes (due to t fetal insu lin), C -section delivery (I release of feta l g lucocorticoids; less stressfu l than vaginal delivery). Treatment: materna l steroids before bi rth; exogenous surfactant for infant. Therapeutic supplemental Oz can resu lt in Re tinopathy of prematurity, l ntraventricu la r hemorrhage, Bronchopu lmonary dysplas ia (RIB).

Screening tests for fetal lung maturity: lecithinsphingomyelin (LIS) ratio in amn iotic fluid (~ 2 is hea lthy;< 1.5 pred ictive ofNRDS), foam stabi lity index, surfactant-a lbum in ratio. Persistently low Oz tension - risk of PDA. 3 Mature

2

0

Trans~iooal -~

::;

Immature 30 35 Gestational age (wl risk of mesothelioma. t risk of Caplan syndrome (rheumatoid arth ritis and pneumoconioses with intrapulmonary nodu les).

Affects lower lobes. A5bestos (ferrugi nous) bodies are golden-brown fusiform rods resembling dumbbell s ~' fou nd in alveolar sputum sample, visua lized using Prussian blue stai n, often obtainecl by bronchoalveolar lavage. t risk of pleural effusions.

Berylliosis

A5sociatecl with exposure to beryllium in aerospace and ma nufacturi ng industries. Cranulomatous (noncaseating) [!] on histology and therefore occasionally responsive to steroids. t risk of cancer and cor pulmonale.

Affects upper lobes.

Coal worke rs' pneumoconiosis

Prolonged coal dust exposure - macrophages laden with carbon - inAammation and fibrosis. Also known as black lung disease. t risk of Caplan syndrome.

Affects upper lobes. Small, rounded nodu lar opacities seen on imagi ng. Anth racosis- asymptomatic condition fou nd in many urba n clwellers exposecl to sooty air.

Silicosis

A5sociatecl with sandblasti ng, foundries, mines. Macrophages respond to silica and release fibrogen ic factors, leading to fi brosis. It is thought that silica may disrupt phagolysosomes and impai r macrophages, increasing susceptibility to TB. t risk of cancer, cor pulmonale, and Caplan syndrome.

Affects upper lobes. "Eggshell" calcification of hilar lymph nodes on

Asbestosis

rn

CXR.

The silly egg sandwich I found is mine!

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Mesothelioma

RESPIRATORY

~

RESPIRATORY-PATHOLOGY

Malignancy of the pleura associated with asbestosis. May resu lt in hemorrhagic pleural effusion (exudative), pleura l thickeni ng rJ.

Psammoma bodies seen on histology. Calre tin in EE> in a lmost a ll mesotheliomas, 8 in most carcinomas. Smoking not a r isk factor.

Acute respiratory distress syndrome PATHOPHYSIOLOGY

Alveolar insu lt - release of pro-inAammatory cytokines - neutroph il recruitment, activation, and release of toxic mediators (eg, reactive oxygen species, proteases, etc) - capi llary endothel ia l damage a nd t vessel permeabi lity - lea kage of protei n-ri ch Auid into a lveol i - formation of intra-alveolar hyal ine membranes (arrows in fi.1) and noncardiogenic pu lmonary edema (norma l PCWP). Loss of surfactant also contri butes to alveolar collapse.

CAUSES

Sepsis (most common), aspiration, pneumon ia, trauma, pancreatitis.

DIAGNOSIS

Diagnosis of exclusion with t he following criteria (ARDS): • Abnorma l chest X-ray (bilatera l lu ng opacities) 1JJ • Respiratory fai lure with in I week of alveo lar insult • D ecreased Pao/Fio2 (ratio< 300, hypoxemia due to t intrapulmonary shunting and d iffusion abnormal ities) • Symptoms of respiratory fa ilure are not due to I IF/Au id overload

CONSEQUENCES

Impai red gas exchange, I lu ng compl ia nce; pulmonary hypertension.

MANAGEMENT

Treat the underlying cause. Mechanica l ventilation: I tida l volumes, t PEEP.

RESPIRATORY

Sleepapnea

~ RESPIRATORY-PATHOLOGY

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665

Repeated cessation of breathing> lO seconds during sleep - d isrupted sleep - dayti me somnolence. Diagnosis con fi rmed by sleep study. Normal Pao2 during the day. Nocturnal hypoxia - systemic/pu lmonary hypertension, arrhythm ias (atria l fibri llation/flutter), sudden death. Hypox ia - t EPO release - t erythropoiesis.

Obstructive sleep apnea

Respiratory effort aga inst a irway obstruction. A~sociated with obes ity, loud snoring, daytime sleepiness . Caused by excess parapharyngeal tissue in adu lts, adenotonsillar hypertrophy in ch ildren. T reatment: weight loss, CPAP, surgery.

Central sleep apnea

Impai red respiratory effort due to CNS injury/toxicity, I IF, opioids. May be associated with Cheyne-Stokes respirations (osci llations between apnea and hyperpnea). T hink 3 C 's: C ongestive HF, C NS toxicity, C heyne-Stokes respirations. Treat with positive airway pressure.

Obesity hypoventilation syndrome

Obesity (BM I 2: 30 kg/m 2) - hypoventilation - t Paco 2 during wak ing hours (retention); I Pao2 and t Paco 2 during sleep. Also known as Pickwickian syndrome.

Pulmonary hypertension

Norma l mean pu lmonary artery pressure = I0- 14 mm Hg; pulmonary hypertension 2: 25 mm Ilg at rest. Results in arteriosd ersis, med ial hypertrophy, intima l fibrosis of pu lmonary arteries, plexiform les ions. Course: severe respiratory d istress - cyanosis and RVI I - death from decompensated cor pu lmonale.

ETIOLOGIES

Pulmonary arterial hypertension

Often id iopathic. lleritable PAii can be due to an inactivating mutation in BMPR2 gene (normally in hibits vascu la r smooth muscle pr liferation); poor prognosis. Pu lmonary vascu lature e ndothe lial dysfu nc tion resu lts in t vasoconstrictors (eg, e ndothelin) and I vasodi lators (eg, NO and prostacyd ins). Other causes inc lude drugs (eg, amphetami nes, cocai ne), con nective tissue d isease, JJJV infection, porta l hypertension, congen ita l heart disease, schistosomiasis.

Left heart disease

Causes inc lude systolic/diastolic dysfu nction and va lvular d isease.

Lung diseases or hypoxia

Destruction of lung parenchyma (eg, COPD), lung inflammation/fibros is (eg, interstitial lung d iseases), hypoxem ic vasoconstriction (eg, obstructive sleep apnea, livi ng in h igh altitude).

Chronic

Recurrent m icrothrombi - I cross-sectional area of pu lmonary vascu la r bed.

th romboembolic Multifactorial

Causes inc lude hematologic, system ic, and metabolic disorders, a long with compress ion of the pu lmonary vascu lature by a tumor.

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RESPIRATORY

~

RESPIRATORY-PATHOLOGY

Lung- physical findings in select lung diseases ABNORMALITY

BREATH SOUNDS

PERCUSSION

FREMITUS

TRACHEAL DEVIATION

Pleural effusion

Du ll

None if sma ll Away from side of lesion if large

Atelectasis

Dull

Toward side of lesion

Simple pneumothorax

I lyperresonant

None

Tension pneumothorax

I lyperresonant

Away from side of lesion

Dull

None

Consolidation (lobar pneumonia, pulmonary edema)

Bronchia l breath sounds; late insp iratory crackles, egophony, whispered pectori loguy

Atelectasis

Alveolar collapse, which can be due to mu ltiple etiologies: • Obstructive- ai rway obstruction prevents new air from reaching distal ai rways, old a ir is resorbed (eg, foreign body, mucous plug, tumor) • Compress ive- external compression on lung decreases lung volumes (eg, space-occupying lesion, pleural effusion) • Contraction (c icatrization) - scarring of lung parenchyma that distorts a lveoli (eg, sarcoidosis) • Ad hesive-due to lack of surfactant (eg, NRDS in premature babies)

Pleural effusions

Excess accumu lation of Auid fl between pleura l layers - restricted lung expansion during inspiration. Can be treated with thoracentesis to remove/red uce Au id Ill

Transudate

I protein content. Due to t hydros tatic pressure (eg, IIF) or I oncotic pressure (eg, neph rotic synd rome, cirrhosis).

Exudate

t protein content, cloudy. Due to mal ignancy, pneumon ia, collagen vascu la r disease, trauma (occurs in states oft vascu lar permeabi lity). M ust be drained due to risk of infection.

Lymphatic

Also known as chylothorax. Due to thoracic duct injury from trauma or ma lignancy. M ilkyappea ring Auid; t triglycerides.

Post-treatment

RESPIRATORY

Pneumothorax

~ RESPIRATORY-PATHOLOGY

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667

Accumu lation of ai r in pleura l space f'J. Dyspnea, u neven chest expa nsion. Chest pa in, I tacti le fremitus, hyperresonance, and dimin ished breath sounds, a ll on the affected side.

Primary spontaneous pneumothorax

Due to rupture of apical subpleura l bleb or cysts. Occurs most frequently in tall, thin, you ng ma les and smokers.

Secondary spontaneous pneumothorax

Due to diseased lung (eg, bullae in emphysema, in fections), mechanica l venti lation with use of high pressures - barotrauma.

Traumatic

Caused by blu nt (eg, rib fracture), penetrating (eg, gunshot), or iatrogen ic (eg, centra l line placement, lung biopsy, barotrauma due to mechanical ventilation) trauma.

pneumothorax Tension pneumothorax

Can be from any of the above. Ai r enters pleura l space but cannot exit. Increasi ng trapped a ir - tension pneumothorax. Trachea deviates away from affected lung [lJ. May lead to increased intrathoracic pressure - med iastinal d isplacement - kinking of IVC - I venous return - I card iac output. Needs immediate need le decompression and c hest tube placement.

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RESPIRATORY-PATHOLOGY

Pneumonia TYPE

TYPICALORGANISMS

CHARACTERISTICS

Lobar pneumonia

S pneumoniae most frequently, also Legionella, Klebsiella

Intra-alveolar exudate - consolidation rJ; may involve en tire lobe or the whole lung.

Bronchopneumonia

S pneumoniae, S aureus, 11 inf/uen;zae, Klebsiella

Acu te inAammatory infi ltrates E!I from bronchioles into adjacent alveol i; patchy distribution involvi ng ~ I lobe (!].

Interstitial (atypical) pn eumonia

Mycoplasma, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella, viruses

Diffuse patchy inAammation localized to interstitial areas at alveolar walls; CXR shows bilateral mu ltifoca l opacities I]. Generally follows a more indolent course ("wa lking" pneumon ia).

(RSV, CMV, inAuenza, adenovirus)

Cryptogenic organizing pn eumonia

Etiology unknown. Secondary organizing pneumon ia caused by ch ronic inAammatory diseases (eg, rheumato id arthritis) or medication side effects (eg, am iodarone). e sputum and blood cultures, no response to antibiotics.

a

Formerly known as bronchiolitis obliterans organizing pneumonia (BOOP). Non infectious pneumon ia characterized by inAammation of bronchioles and surrounding structure.

Natural history of lobar pneumonia

Congestion

Red hepatizat ion

Gray hepatization

Resolution

DAYS

1-2

3- 4

5- 7

8+

FINDINGS

Red-purple, partial consolidation of parenchyma Exudate with mostly bacteria

Red-brown, consolidated Exudate with fibrin, bacteria, RBCs, and WBCs

Un iformly gray Exudate fu ll of WBCs, lysed RBCs, and fibrin

Enzymes diges t components of exudate

RESPIRATORY

Lung cancer

TYPE

~ RESPIRATO RY-PATHOLOGY

Lead ing cause of cancer death. Presentation: cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on CXR or noncalcified nodule on CT. Sites of metastases from lung cancer: Liver (jaundice, hepatomegaly), Ad rena ls, Bone (pathologic fracture), Brain; "Lung 'mets' Love Affective Boneheads and Brainiacs." In the lung, metastases (usually mu ltiple lesions) are more common than 1° neop lasms. Most often from breast, colon, prostate, and bladder cancer.

SECTION Ill

669

SP HERE of complications: Superior vena cava/thoracic outlet synd romes Pancoast tumor Horner syndrome E ndocri ne (paraneoplastic) Recurrent laryngea l nerve compression (hoarseness) E ffusions (pleural or pericardia!) Risk factors include smoking, secondhand smoke, radon, asbestos, fam ily h istory. Squamous and Small cell carcinomas are Sentra l (centra l) and often caused by Smok ing.

LOCATION

CHARACTERISTICS

HISTOLOGY

Centra l

Und ifferentiated - very aggressive. May produce ACTI I (C ushing syndrome), SIADI I, or Antibodies against presynaptic Ca 2+ channels (LambertEaton myasthen ic synd rome) or neurons (para neoplastic myeli tis, encepha litis, subacute cerebellar degeneration). Amplification of myc oncogenes common. Managed with chemotherapy+/- rad iation.

Neoplasm of neuroendocri ne Ku lchitsky cells - sma ll dark blue cells rJ. C hromogran in A ®, neuron-speci fie eno lase®, synaptophysin ®·

Adenocarcinoma

Periphera l

Most common 1° lung cancer. More common in women than men, most likely to arise in nonsmokers. Activati ng mutations inc lude KRAS, ECFR, and /\LK. Associated with hypertrophic osteoarthropathy (c lubbing). Bronchioloalveolar subtype (adenoca rcinoma in situ): CXR often shows hazy infi ltrates simi lar to pneumon ia; better prognosis.

C landu la r pattern on histology, often stains mucin ® [1J. Bronchioloalveolar subtype: grows a long alveolar septa - apparent "thickening" of alveolar wa lls. Tall, columnar cells conta ining mucus.

Squamous cell carcinoma

C entra l

ll ilar mass m a rising from bronchus; Cavitation; C igarettes; hyperC alcemia (produces PTHrP).

Keratin pearls [!J and intercellular bridges.

Large ce ll carcinoma

Periphera l

ll igh ly anaplastic undi fferentiated tumor; poor prognosis. Less responsive to chemotherapy; removed surgically. Strong association with smoking.

Pleomorph ic giant cells O .

Bronchial carcinoid tumor

Centra l or periphera l

Excellent prognosis; metastasis rare. Symptoms due to mass effect or carcinoid syndrome (flushing, diarrhea, wheezi ng).

Nests of neuroendocrine cells; chromogranin A®·

Small cell Small cell (oat cell) carcinoma

Non-small cell

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RESPIRATORY

~

RESPIRATORY-PATHOLOGY

Lung abscess

Localized collection of pus with in parenchyma ri.]. Caused by aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness [eg, a lcoholics, epileptics)) or bronchia l obstruction (eg, cancer). Air-Auid levels I] often seen on CXR; presence suggests cavitation. Due to anaerobes (eg, Bacteroides, Fusobacterium, Peptostreptococcus) or S aureus. Treatment: antibiotics, dra inage, or surgery.

Pancoast tumor

Also known as superior su lcus tumor. Ca rcinoma that occurs in the apex of lung f'J may cause Pancoast synd rome by invad ing/compressing local structures. Compress ion of locoregional structures may cause array of find ings: • Recurrent laryngeal nerve - hoarseness • Stell ate ganglion - Ilorner syndrome (ipsilateral ptosis, miosis, anh idrosis) • Superior vena cava - SVC syndrome • Brachiocepha lic vein - brachiocepha lic syndrome (un ilateral symptoms) • Brachia! plexus - sensorimotor deficits

Superior vena cava

An obstruction of the SVC that impa irs blood dra inage from the head ("facia l plethora"; note blanching after fingertip pressure in f'J}, neck (jugu la r venous distention), and upper extremities (edema). Common ly caused by ma ligna ncy (eg, med iastinal mass, Pancoast tumor) and thrombos is from indwell ing cathe ters I]. Medica l emergency. Can raise intracran ia l pressure (if obstruction is severe) - headaches, dizziness, t risk of aneurysm/ rupture of intracranial arteries.

syndrome

Lung abscess 2° to aspiration is most often found in right lung. Location depends on patien t's position dur ing aspiration: RLL if upright, RUL or RML if recum bent.

RESP IRATORY

~

~ RESPIRATORY - PHARMACOLOGY

SECTION Ill

671

RES PIRATORY-PHA RMACOLOGY

Histamine-1 blockers

Reversible inh ibitors of I 11 histamine receptors .

First generation

Diphenhydramine, dimenhydrinate, ch lorpheniramine, doxylamine.

CLINICALUSE

Allergy, motion sickness, sleep aid.

ADVERSEEFFECTS

Sedation, antimuscarinic, anti-a -adrenerg ic.

Second generation

Loratadine, fexofenadine, desloratadine, ceti ri zine.

CLINICALUSE

Allergy.

ADVERSEEFFECTS

Far less sedating than !st generation because of I en try into CNS.

Names usually contai n "-en/-ine" or "-en/-ate."

Names usually end in "-ad ine."

Guaifenesin

Expectora nt-th ins respiratory secretions; does not suppress cough reflex.

N-acetylcysteine

Mucolytic - liquifies mucus in chron ic bronchopu lmonary diseases (eg, COPD, CF) by disrupting d isulfide bonds. Also used as an antidote for acetaminophen overdose.

Dextromethorphan

Antitussive (antagonizes NMDA glutamate receptors). Synthetic codei ne analog. Ilas mi ld opioid effect when used in excess. Na loxone can be g iven for overdose. M ild abuse potentia l. May cause seroton in syndrome if combined with other serotonergic agents.

Pseudoephedrine, phenylephrine MECHANISM

a -ad renergic agonists.

CLINICALUSE

Reduce hyperemia, edema (used as nasa l decongestants); open obstructed eustachian tubes.

ADVERSEEFFECTS

Hypertension. Rebound congestion if used more than 4- 6 days. Can a lso cause CNS sti mu lation/ anxiety (pseudoephed rine).

Pulmonary hypertension drugs DRUG

MECHANISM

CLINICALNOTES

Endothelin receptor

Competitively antagonizes endothel in-1 receptors - I pulmona ry vascu lar resistance.

I lepatotoxic (mon itor LFTs). Example: bosentan.

PDE-5 inhibitors

In hibits PDE-5 - t cGMP - prolonged vasod ilatory effect of NO.

Also used to treat erectile dysfunction. Contraind icated when ta king nitroglycerin or other n itrates (due to risk of severe hypotension). Example: si ldenafil.

Prostacyclin analogs

PGI 2 (prostacyclin) with d irect vasod ilatory effects on pulmonary and systemic arterial vascular beds. Inh ibits platelet aggregation.

Side effects: flush ing, jaw pain. Examples: epoprostenol, iloprost.

antagonists

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SECTION Ill

Asthma drugs

RESPIRATORY

~ RESP I RATORY-PHARMACOLOGY

Bronchoconstric tion is med iated by ( I) in Aammatory processes and (2) parasympathetic tone; therapy is directed at these 2 pathways.

~-agonists

Albuterol-relaxes bronchia l smooth muscle (short acti ng ~z-agon ist). For acute exacerbations. Can cause tremor, arrhythmia. Salmeterol, formoterol -long-acting agents for prophylaxis. Can cause tremor, arrhythmia.

Inhaled corticosteroids

Fluticasone, budesonide-in hibit the synthesis of virtually all cytokines. Inactivate NF-KB, the transcription factor that induces production ofTNF-et and other inAammatory agents. 1st-line therapy for chron ic asth ma. Use a spacer or rinse mouth after use to prevent ora l thrush.

Muscarinic antagonists

Tiotropium, ip ratropi um - competitively block muscarinic receptors, preventing bronchoconstriction. Also used for COPD. Tiotropium is long ac ting.

Antileu kotrienes

Montelu kast, zafi rlu kast-block leu kotriene receptors (CysLTI). Especially good for aspirin-induced and exercise-induced asth ma. Zileuton - 5-1ipoxygenase pathway inhibitor. Blocks conversion of arachidon ic acid to leukotrienes. I lepatotoxic.

Anti-lgE monoclonal therapy

Exposure to antigen (dust pollen. etc)

1~~··· Antigen and lg£ on mast cells

Omalizumab-binds mostly unbou nd serum IgE and blocks bindi ng to FceRL Used in allerg ic asthma wi th t IgE levels resistant to in ha led steroids and long-acting ~z-agonists.

Methylxanthines

l

r-0- Steroids

Theophyll ine - likely causes bronchodi lation by in hibiti ng phosphodies terase - t cAMP levels due to I cAMP hydrolysis. Limited use due to na rrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome P-450. Blocks actions of adenosine.

Chromones

Cromolyn - prevents mast cell degra nu lation. Prevents acute asthma symptoms. Rare ly used.

r-0- Omalizumab

Chromones

Mediators (leukotrienes. histamine. etc)

antagonists

ATP

Bronchodilatioo

~

jl-agonists

-0-cAMP Bronchial tone

~ i--0- Theophylline AMP

ACh Muscarinic antagonists

Early response: bronchoconstriction

l Symptoms

l ate response: inflammation

l Bronchial hyperreactivity

--0--+ - 0 - Adenosine

~ "R Theophylline Bronchoconstrictioo

Methacholine

Nonselective muscari nic receptor (M,) agonist. Used in bronchia l challenge test to help d iagnose asthma.

H I GH - Y I ELD SYSTEMS

Rapid Review

"Study without thought is vain: thought without study is dangerous." -Confucius

"It is better, of course, to know useless things than to know nothing." -Lucius Annaeus Seneca

"For every complex problem there is an answer that is clear, simple, and ivrong." -II. L. Mencken

The following tables represent a collection of high-yield associations between diseases and their clinical findings, treatments, and pathophysiology. They can be qu ickly reviewed in the days before the exam.

6 74

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~ CLASS I C

RAPID REVIEW

~ CLASSIC

PRESENTATIONS

PRESENTATIONS

CLINICALPRESENTATION

OIAGNOSIS/DISEASE

Gout, intellectual disability, self-mutilating behavior in a boy

Lesch-Nyhan syndrome (IICPRT deficiency, X-linked recessive)

37

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Kartagener syndrome (dynein arm defect affecting cilia)

Blue sclera

Osteogenesis imperfecta (type I collagen defect)

Elastic skin, hypermobi lity of joints, t bleeding tendency

Ehlers-Danlos syndrome (type V collagen defect, type Ill collagen defect seen in vascular subtype of ED)

49 51 51

Arachnodactyly, lens dislocation (upward), aortic dissection, hyperAex ible joints Cafe-au-lait spots (u ni lateral), polyostotic fibrous dysplasia, precocious puberty, mu ltiple endocrine abnormalities Calf pseudohypertrophy

Marfan syndrome (fibrillin defect)

52

McCune-Albright syndrome (C,-protei n activating mutation)

57

Muscular dys trophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene) Duchenne muscular dystrophy (Cowers sign)

61

Slow, progressive muscle weakness in boys

Becker muscular dystrophy (X-linked n·otrophic lateral sclerosis alanine transaminase American ~'teclical Association, antin1itochoncl rial antibody acute myelogenous (myeloid) leukemia aclenosine monophosphate antinuclear antibody antineutrophil C)1oplasmic antibody anal}'Sis of variance atrial natriuretic peptide

• Jmage abbrev iation on ly

anti-CCP Ao• AOA AP APC Apo APP APRT aPTT APU D AR ARB ARDS Arg ARPKD ART AS ASA ASD ASO AST AT ATN ATP ATPase ATTR AUB AV AZT BAL BCC BH4 BM BOOP BP BPC BPH BT BUN Ca'

Ca2+ CAD

MEANING autonon1ic nervous systen1 anterior

anti-cyclic citrullinated peptide aorta American Osteopathic A.:;sociation action potential, A & P [ribosomal binding sites)

antigen-presenting cell, acti,"1ted protein C apolipoprotein amyloid precursor protein adenine phosphoribosyltransferase aclivalecl partial thromboplastin lime amine precursor uptake clecarboxylase attributable risk, autosomal recessive, aortic regurgitation angiotensin receptor blocker acute respiratory distress S)'·retin-n1ecliated arnyloidosis abnonnal uterine bleeding atrioventricular azidothymicline British anti-Lewisile [dimercaprol) bacille Calmette-Cuenn lelrahyclrobioplerin basement membrane bronchiolitis obliterans organizing pneumonia bisphosphate, blood pr"mre bisphosphoglycerate benign prostatic h)1>erplasia bleeding lime blood urea nitrogen capillary• calciun1 ion coronary artery•disease

702 ABBREVIATION

CAF cAl'vtP CBC Cbm• CBSE CB SSA CBT

cc• CCA• CCK

ccs CD CDK cDNA CEA CETP CF CFTR

CCD cCMP C11 l-C 11 3 ChAT C HO'

x2 CI C IN C IS CK

CKD C K-MB CL CL

CJCL L CMC CML CMV

CN CNCNS

CNV

co C02 CoA COLIA I COLIA2 COMT COP COPD CoQ

cox

c,, CPAP

SECTION IV

ABBREVIATIONS AND SYMBOLS

MEANING common application fonn cyclic aclenosine rnonophosphate

~~rticosteroid-binding globulin cerebellum Con1prehensive Basic Science Examination Con1prehensive Basic Science Self-Assessn1ent

computer-based test, cognitive behavioral therapy corpus callosum common carotid artery

cholecystokinin computer-based case simulation cluster of differentiation c\'din..(fepenclent kinase

c~rnplen1entary deoxyribonucleic acid carcinoembryonic antigen cholesteryl-ester transfer protein cvstic librosis c; stic fibrosis transn1en1brane conductance regulator chronic granulomatous disease 1

cyc1ic guanosine n1onophosp~te

constant regions, heavy chain (antibody) choline acetyltransferase common hepatic duct chi-squared confidence interval candidate iclentilication number, carcinoma in situ, cervical inlTaepithelial neoplasia

Communication and Interpersonal Skills clinical knowledge, creatine kinase chronic kidney disease creatine kinase, ~1B fraction

constant region, light chain (antibodX] clearance chloride ion

chronic l)'mphoc)'tic leukemia carpometacarpal( joint) chronic myelogenous (myeloicl) leukemia cytomegalovirus cranial nerve cyanide ion central nervous s~'Stem cop)' number variation carbon monoxide, cardiac output carbon dioxide coenzyrne A

collagen, type I, alpha I collagen, type I, alpha 2 catechol-0-methyltransferase coat protein chronic obstructive pulmonary disease coenzyrne Q cyc1oo'.\ygenase plasma concenlTation continuous positive ain"ar pressure

• Jmage abbrev iation on ly

ABBREVIATION

CPR Cr C RC CREST C RH C RP

MEANING cardiopulmonary resuscitation creatinine colorectal cancer

calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerosis, and telangiectasias [syndrome) corticotropin-releasing horn1one Creactive protein

cs

clinical skills

Csection

cesarean section cerebrospinal Auid

CSF CT CTP

CXR DA DAF DAC clATP DCIS

computed tomograph2' cyticline triphosphate chest x-r'!}_' dopamine decay-accelerating factor

diacylglycerol cleo~y;denosine triphosphate ductal carcinon1a in situ

DCT

distal convoluted tubule

dell DES DH DHAP DHEA DHF DHT DI

didanosine

DIC DIP DKA DLCO

DM DNA

DNR clNTP DO

DPCN DPM DPP-4 DPPC DS clsDNA dsRNA

cHT clTMP DTR DTs dUDP clUMP DVT

E' EBV ECA' ECF ECFMC

diethylstilbestrol clehydrogenase clihyclroxyacetone phosphate dehydroepiandrosterone

clihydrofolic acid dihyclrotestosterone diabetes insipidus disseminated intra.vascular coagulation

distal interphalangeal (joint] diabetic ketoacidosis diffusing capacity for carbon monoxide

diabetes mellitus deoxyribonucleic acid do not resuscitate

cleoxynucleotide triphosphate doctor of osteopathy diffuse proliferative glomerulonephritis doctor of podialTic niedicine

clipeptidyl peptidase-4 clipalmitoylphosphaticlylcholine double stranded double-stranded deoxyribonucleic acid double-stranded ribonucleic acid cliclehydrodeo')1h)'midine [~tavucline) cleoxi1hymidine monophosphate deep tendon reflex delirium tren1ens

cleoxyuridine diphosphate deoxyuridine nionophosphate deep venous thrombosis euthron1atin, esophagus Epstein-Barr virus external carotid artery

extracellular Auicl Educational Commission for Foreign Medical Cracluates

ABBREVIATIONS AND SYMBOLS

SECTION IV

ABBREVIATION

MEANING

ABBREVIATION

MEANING

ECC ECL ECM

electrocardiogram

fluorescence in situ hybridization

enterochromaffin-like (cell]

ECT

e lectroconvulsive therap~·

ED;o EDRF EDTA EDV EEC EF' ECF EHEC ElEC ELISA EM EMB EPEC Epi EPO EPS ER ERAS ERCP ERP eRPF ERT ERV ESR ESRD ESV ETEC EtOH EV

median effective dose

FISH FKBP !Met FMC FMN

F

extracel1ular n1atrix

FK506 binding protein forn1ylmethionine

foreign medical graduate flavin mononucleotide

FN

false negati\'e false positive, foot process

epidermal gro\\1h factor enterohemorrhagic £coli enteroinvasive E c.oli

FP, FP' FRC FSH FSMB FTA-ABS FTD ' 5-FU

enzyme-Jinked irnmunosorbent assay

FVC

forced vital capacity

e lectron n1icrograph/microscopy

glycosaminoglycan galaclose

epinephrine

CABA CAC Cal C BM

eri1hropoietin

cc

glomerular capillaf)'

extrap~·rarniclal systen1

C-CSF CERD C FAP C FR CCT CH C HB C HRH

granuloc)1e colony-stimulating factor

ejection fraction

eosin-rnethy1ene blue

eneteropathogenic £coli

endoplasmic reticulum, estrogen receptor

Electronic Residency Application Service endoscopic retrograde cholangiopancreatography effective refractory period effective renal plasn1a Aow

estrogen replacement therapy expiratory reserve volume

eri1hrOC)1e sedimentation rate

5-fluorodeoxyuricline monophosphate

C1 Cl C IP C IST C LOT CM C M-CSF C MP CnRH CP C6P C6PD C Pe C Pi C PI C RP Cs CSH

ferrous ion

cssc

ferric ion femur

CTP CT Pase

excreted fraction of filtered sodium

cu

forced expiratory volun1e in l second

H' H•

end-stage renal disease end-systolic volume enterotoxigenic Eco/;

ethyl alcohol esophageal vein

bioa\'ailability fatty acid fragment, antigen-binding

FA Fab FAD FADH2 FAP Fl,6BP F2,6BP FBPase Fe FcR 5f-clUMP Fe1• F'e 3•

familial adenomatous polyposis fructose-1,6-bisphosphate fructose-2,6-bisphosphate fructose bisphosphatase fragment, Cf}•lallizable

Fem• FENa FEV 1 FF FFA FC F FCFR

flavin adenine dinucleotide reduced Aavin adenine dinucleotide

-

-

Fe receptor

filtration fraction free fatty acid fibroblast growth factor fibroblast growth factor receptor

• Jmage abbrev iation on ly

HI' H2 H2S HAV

functional residual capacity

follicle-stimulating hormone Federation of Stale Medical Boards fluorescent treponemal antibody-absorbed frontotemporal dementia 5-fluorouracil y..arninobutyric acid

glon1erular basen1ent men1brane

gastroesophageal ref! ux disease glial fibrillaf)' acid protein glomerular filtration rate )'-glutamyl transpeptidase growth hormone )'-hydro,ybut)Tale growth hormone-releasing hormone

C protein, I polypeptide gastrointestinal

gastric inhibitOf)' peptide gastrointestinal stromal tun1or glucose transporter

-

granulocite macrophage granulocite-macrophage colony stimulating factor -~

electroencephalogram

~

endothelium-clerivecl relaxing factor ethylenedian1ine tetra.acetic acid end-diastolic volume

-

guanosine nionophosphate gonaclotropin-releasing honnone -

-

gl}·coprotein

glucose-6-phosphate glucose-6-phosphate dehydrogenase globus pallidus externa globus pallidus intema glycosyl phosphatidylinositol gastrin-releasing peptide C protein, S polypeptide reduced glutathione oxidized glutathione guanosine triphosphate guanosine triphosphatase genitourinary heterochromatin

hydrogen ion histan1ine receptors

hydrogen sulfide hepatitis A \'irus

703

704

SECTION IV

ABBREVIATIONS AND SYMBOLS

ABBREVIATION

MEANING

ABBREVIATION

HAVAh Hb H BcAh/HBcAg HBeAblHBeAg H BsAh/HBsAg HbC02 HBV HCC hCC

hepatitis A antibody hemoglobin hepatitis B core antibody/antigen hepatitis B early antibody/antigen hepatitis B surface antibody/antigen carbaminohemoglobin

ICA !CAM ICD ICE ICF ICP ID

Hco,Hct HCTZ HCV HDL HON HOV H&E HEV HF Hfr HFpEF HFrEF HCPRT HHb HHV 5-HIAA HIT HIV HL HLA Hl'vlC-CoA Hl'vlP Hl'vfWK HNPCC hnRNA HzOz HOCM HPA HPL HPO HPV HR HSP HSV 5-HT HTLV

HTN HUS HVA IBD

ms IC

le;, 1,

hepatitis B virus hepatocel1u1ar carcinon1a human chorionic gonaclotropin bicarbonate hen1atocrit

ID;o IDL

hepatitis C virus

IF IFN lg ICF'

high-density lipoprotein

[K

hen1ol~tic disease of the newborn

IL IM ll'vlA ll'vlC ll'vlP ll'vlV

hydrochlorothiazide

hepatitis D virus hen1ato'.\:ylin and eosin

hepatitis E virus heart failure high-frequency recombination [cell]

MEANING internal carotid artery' intercell ular adhesion molecule

implantable cardioverter defibrillator Integrated Clinical Encounter intracellular fluid intracranial pressure identification median infective close intenne1'osis colorectal cancer heterogeneous nuc1ear ribonucleic acid

hydrogen peroxide hipertrophic obstructive cardiomyopathy hipothalamic-pitu ita1y-adrenal [a.'is] human placental lactogen hipothalamic-pitu ita1y--0varian [axis] -

-

isoniazicl International Normalized Ratio intraocular pressure

inositol triphosphate inactivated po1io vaccine

current x resistance [Ohm's law], inferior rectus (muscle] inspiratory' reserve volun1e

ITP

idiopathic thrombOC)1openic purpura

IUD IUCR IV IVC IVDU IVIC )AK/STAT

intrauterine device intrauterine growth restriction intravenous inferior vena cava intravenous drug use intravenous immunoglobu1in Janus kinase/signal transducer and activator of transcription

)CA

juxtaglomerular apparatus jugular venous distention jugular venous pulse potassiun1 ion

[pathway]

human papillomavirus

)VD

heart rate Henoch-Schonlein purpura

)VP

K·

herpes simplex virus

KatC

catalase-peroxidase produced by M tuberculosis

5-hyclroxyh)1>tamine (serotonin)

K,

human T-cel1 leuken1ia virus h)')>ertension hen1ol~tic-uremic syndrome homovanil1ic acid inAamn1atory bowel disease irritable bowel syndron1e inspiratory' capacity, immune complex

Kr

elin1ination constant filtration constant

calcium current (heart] frmn)' current (heart]

• Jmage abbrev iation on ly

KC Kul

KOH L LA LAD LAP Latcond•

ketoglutarate Michaelis-l'vlenten constant potassium hydroxide left, liver left atrial, left atrium left anterior descending coronary' artery

leukoci1e alkaline phosphatase lateral condyle

ABBREVIATIONS AND SYMBOLS

SECTION IV

ABBREVIATION

MEANING

ABBREVIATION

MEANING

Lb• LCA LCAT

lamellar body

Ml MIF' MIRL MLCK MLF MMC MM R 6-MP MPCN

m>·ocardial infarction

MPO

myeloperoxidase

MJ'O.ANCN p-ANCA MR MRI miRNA mRNA MRSA MS MSH mtDNA mTOR

perinudear antineutrophil c~toplasmic antibody

left coronary• artery

lecithin-cholesterol acyltr.msferase

Lee·

left comn1on carotid artery

LCFA LCL LCl'vl£ LCMV LCX LD LD;o LOH LDL LES LFA

long-chain fatty acid lateral collateral ligament

LFT LH LLL•

LLQ LM LMN LOS LPA• LPL LPS LR LT LUL* LV M 1-M;

Liaison Committee on ~'teclical Education

l)rmphocytic choriomening itis virus left circumAex coronary artery'

loading close median lethal close lactate clebydrogenase low..-Oensity Jipoprotein

lower esophageal sphincter 1eukoc)1e function-associated antigen liver function test luteinizing hormone

left lower lobe (of lung) left lower quadrant lateral meniscus, left main coronaryartel'}', light microscopy lower motor neuron

lipooligosaccharicle left puln1onary artery lipoprolein lipase lipopolysaccharide lateral rectus [muscle]

MAC

membrane attack complex, minimum alveolar concentration

MALT MAO MAOI MAP Ma.x• MC MCA MCAT MCHC MCL MCP MCV MD MOD Med cond• MEL.AS

mucosa-associated lymphoid tissue

syndron1e

MEN Mgl• MgS04 MCUS MHC

monoan1ine oxiclase rnonoan1ine oxiclase inhibitor

mean arterial pressure, mitogen-activated protein maxillary sinus

midsy•lolic cl ick middle cerebral arter)' Medical College Admissions Tes! mean corpuscular hen1oglobin concentration

m>·osin light.chain kinase medial longitudinal fasciculus migrating motor complex

measles, mumps, rubella ['"'ccine] 6-mercaptopurine membranoproliferative glon1erulonephritis

medial reclus (muscle], milTal regurgitation magnetic resonance in1aging microribonucleic acid messenger ribonucleic acid methicill in-resistant S aure-us mitral stenosis, multiple sclerosis melanoc~te-stimulating horn1one

mitochondrial DNA mammalian target of rapamycin

MTP MTX

methotrexate

MV0 2

myocardial oxygen consumption

MVP

milTal ,,,.]ve prolapse

metatarsophalangeal (joint]

nucleus sodiun1 ion

labile toxin, leukotriene

left upper lobe (of lung) left ventricle, left venlTicular muscarinic (parasympathetic) ACh receptors

mUllerian inhibiting factor membrane inhibitor of reactive lysis

NAT NAO NAO• NADH NADP• NADPH NBME NBOl'vlE NBPl'vt£ NE NF NFAT NH 3 NH4 +

nucleic acid testing nicotinamide adenine dinucleotide oxidized nicotinarnide adenine dinucleotide reduced nicotinamide adenine dinucleotide oxidized nicotinarnide adenine dinucleotide phosphate reduced nicotinamide adenine dinucleotide phosphate

National Board of Medical Examiners National Board of Osteopathic Medical faaminers National Board of PodialTic Medical Examiners norepinephrine neurofibron1atosis

nuclear factor of activated T-cell ammonia ammonium

medial collateral ligament metacarpophalangeal (joint]

NK

natural killer (cells]

N~,

muscarinic ACh receptor in neuron1uscular junction

mean corpuscular volume

Nl'vlDA Nl\·lj NMS

neuromuscular junction neuroleptic nialignant syndron1e

NN

nicotinic ACh receptor in autonon1ic ganglia

maintenance dose major depressive disorder

medial cond)'le mitochondrial encephalopathy, lactic acidosis, and slrokelike episodes multiple endocrine neoplasia magnesium ion magnesium sulfate

NRMP NNRTI NO N20 NPH

• Jmage abbrev iation on ly

National Residency l\·ocarclial infarction nucleolus oxaloacetic acid obsessive-compulsive disorder

oral conlTaceptive pill

ABBREVIATION

phosphofmctokinase

PFT

pulmonary function test

PC P; PICA PID

P102 PIP PIP2 PIP,

PKD PKR

interferon.a - induced protein kinase

PKU

phenylketonuria pyridoxal phosphate p;ogressil'e multifocal leukoencephalopath)'

hydro·clicline h>·drochloride, Pne-umocystis jimveci; pneumonia polymerase chain reaction proximal convoluted rubule pneumococcal conjugate vaccine pulmonary capillary wedge pressure patent cluctus arteriosus, posterior descending artery

PCV l3

PPD PPI PPSV23

-

periodic acid-Schiff patella penicill in-binding protein

PCP

PCT

pnel

po~morphonuclear (leukoc~te]

pregnanC)'-associated plasn1a protein A

PCOS

PCR

phosphoglycerate plasma interstitial osmotic pressure, inorganic phosphate posterior inferior cerebellar artery pelvic inAammatory disease Po 2 in inspired air

proximal interphalangeal (joint] phosphatidylinositol 4,;.bisphosphate phosphatid)'linositol 3,4,5-bisphosphate polycy•tic kidne)' disease

ODC OH 1,25-0H 0 3 25-0H 0 3

oxygen-hemoglobin dissociation curve

MEANING

PFK

~

SECTION IV

~

706

• Jmage abbrev iation on ly

prion protein phosphoribos)'lp~-rophosphate

phosphatase and tensin homolog parathyroid hormone parathyroid hormone-related protein post.traun1atic stress disorder

PTT

partial thromboplastin time

PY Pv•

plasma volun1e, venous pressure pulmonary vein

PVC

polyvin)'I chloride

PVR

pulmonary vascular resistance

R

correlation coefficient, right, R variable [group] Registration, Ranking, & Results (s~•tem]

R, RA RAAS RANK-L RAS RBF' RCA

REM

right atrium renin-a~giotensin-aldosterone ~·stem

receptor activator of nuclear factor·K' B I~and reticular activating s~'Stem

renal blood Aow r~ght coronary_· arte')_' rapid eye niovement

ABBREVIATIONS AND SYMBOLS

SECTION IV

ABBREVIATION

MEANING

ABBREVIATION

MEANING

RER Rh RLL' RLQ RML' RNA RNP ROS RPF RPCN RPR RR rRNA RS RSC' RSV RTA RUL' RUQ RV RVH [SJ SA

rough encloplasn1ic reticulum

so

superior oblique [muscle] Supplemental Offer and Acceptance Program spleen

SAA

serum amyloid-a,'iOciated [protein]

SAM SARS

S-adenosyln1ethionine

sec

squamous cell carcinoma

SC D SC IO

sudden cardiac death

sq SC M SCN SD SE SEP SER SERM SCLT SHBC SIADH

SIDS SJS SLE SLL SLT Sl'vlA Sl'vfX SNARE SNc SNP SNr SNRI snRNP

rhe:;us antigen right lower lobe (of lungs) right lower quadrant right middle lobe (of lung) ribonucleic acid ribonucleoprotein reactive O'.\')'gen species

renal plasma Aow rapidly progressive glomernlonephritis rapid plasma reagin relative risk, respiratory rate ribosomal ribonuc1eic acid

Reed-Sternberg [cells] right subclavian artery respiratory S)'llC)tfial vinlS renal tubular acidosis

right upper lobe (of lung) right upper quadrant residual volun1e, right ventricle, right ventricular

right ventricular hypertrophy suOOtrate concentration

sinoatrial

severe acute respiratory syndron1e

severe combined in1n1unodeficienc)' disease squamocolumnar junction sternoc1eidomastoicl muscle suprachiasn1atic nucleus standard deviation

standard error [of the mean] Spoken English Proficiency smooth endoplasn1ic reticulum selective estrogen receptor niodulator sodiun1.glucose transporter

sex hormone-binding globulin syndron1e of inappropriate [secretion of] antidiuretic horn1one

sudden infant death syndrome Stevens-Johnson syndrome systemic lupus ery1hematosus

small lymphoc~tic lymphoma Shiga-like toxin superior niesenteric artery

sulfamethoxazole soluble NSF attachment protein receptor substantia nigra pars compacta

single nucleotide pol~morphism substantia nigra pars reticulata serotonin and norepinephrine receptor inhibitor small nuclear ribonucleoprotein

• Jm age abbrev iation on ly

SOAP Sp' spp SR SS " DNA SSPE SSRI " RNA St' ST SIAR STEM!

species

superior rectus [muscle] single stranded single-stranded deo~'fibonucleic acid subacute sc1erosing panencephalitis selective serotonin reuptake inhibitor single-stranded ribonucleic acid ston1ach

Shiga toxin steroidogenic acute regulatory• protein ST-segn1ent elevation ni yocardial infarction

STI STN

sexuall>1 transmitted infection subthalamic nucleus

sv

splenic vein, stroke volume superior vena cava systemic vascular resistance supraventricular tachycardia trachea

SVC SVR

svr T' t 112

half-life

T, T,

triiodothxronine

TAPVR TB TBC 3TC TCA Tc cell TCR TDF TdT TE TFT TC TCF Th cell THF Tl TIA Tib' TIBC TIPS TLC

total anon1alous pulmonary venous return tuberculosis

Tul TMP TN TNF TNl'vl TOP ToRC HeS TP tPA TPO TPP

707

th~·roxine

th~rnxine-binding globulin dideo,)1hiacytidine [lamivudine] tricarbo')'lic acid [cycle], tricyclic antidepressant cxtotoxic T cell T-cell receptor

tenofovir disoproxi] fumarate terminal cleo~'tlucleotidyl transferase

tracheoesophageal thyroid function test

triglyceride transforn1ing growth factor

helperTcell tetrahydrofolic acid therapeutic index transient ischemic attack tibia total iron.binding capacity transjugular intrahepatic portosystemic shunt

total lung capacity maximum rate of transport trimethoprim true negative tumor necrosis factor

tumor, node, metastases [staging] topoisomerase

Toxoplasma gondii, rubella, CMV, HIV, HSV-2, s~philis true positive tissue p1asminogen activator

thyroid peroxidase, thrombopoietin thiamine p~rnphosphate

708 ABBREVIATION

TPR TR TRAP TRH tR,',\

TSH TSI TSS TSST TTP TTR 1\' TX\ 1

SECTION IV

ABBREVIATIONS AND SYMBOLS

MEANING total peripheral rc.,.tance lricuspid regurgitJtion lartralc-rcsislonl actd 1>ho•phal;o;e lh)TOlropin-rcleasing hormone lransfcr ribonucleic acid lh\Totd-stimubtin~ hormone

'"!!'"

11on triple toxic shock s\ndro1nc toxic shock s\ndrotnc to"n lhrombotic lhromboc:,topcnic purpura

ABBREVIATION \/(D i) VDRL

VE.CF

""

\'HL

\"IP \'!Poma

\1 \'L

tran'lth\TCtin

\"LDL

tidal ,-olunlc

\~ L\

thrombo>.;1nC A 2

\~IAT

MEANING \-ariable, (dilenil\ ), joining gene segment> rearranged lo form lg gene< Venereal Disease Research Labo121on \-ascubr endolhclial grou1h faclor ,-.riable region, heon chain f•nltbod\ ) \'On Mippel-Lindou fdisea~I '-asoacti,·e inte.tinal peptide \'Cl500Cti\'e intestinal pohl>CJ>hdc-.sccreh~ tumor lighl-chain h1l"'n-ariablc region fanltbod\·) ,-.riable region. light ch:tin [on1tbod1·) ,·ery loo densit\ lipoprotcin ,-,mill) lmandelic :tcid \'esicular mon«intinc l1"31uportcr maximum velocit\

UDP

uridine diphosphatc

UMN

upper n1otor neuron

"·= \'PL

U~I P

uridinc nlonophosphatc unipnrcntal dison'I}

VP.\ I VPN

upper rc~pi mlory infection United Stntcs i'.tcdical Liccn~i ng £xa1n inatio11 urinn l)' trnct infection

V/Q

\'entral posterior nudcu~. l;atcral \'entral posterior nuclcu;;, n1cdi.tl \'ancomrcin. polpl l)'Xin, 11\'1\lahn [rneclia] venlilalion/ pcrfmion [rntio)

\IRE

\'anco1nrcin-rci:htant cntcrococcu!i

VSD

uridinc t·ripho)phatc u h mliolel ,·a~oprcssi n rcccpto11 vital cap.1cit) ,·ol111ne of di11trib11tion physiologic dead space

\IT VZ\I

\'entricular scptnl defect tidal \'Ohunc \'On Willc hrnncl faclo r \'aricella-1.ostcr 'cin1;;

\~ IAT

,·esic11lar 1nono.an1inc transporter

XR 'JC. chro1no~1nes for fe1nale/n1ale

ZDV

zidomdine lformerh-AZf]

UPD URI

USMLE LIT! LITP

UV \11 "1· \IC

\Id VD

•image abbreviation only

,WF

SECTION IV

Image Acknowledgments In this edition, in colbbor•llon •nth ~ 1cd1Q Learning, LLC, and a \":lriety of other partners. \\e are pleased to include the follO\\ ing clinical images and diagrams for the benefit of mlegrJti•e student learning. 11!1 Portions of this book tdentaficd "ilh the >)mbol li!I are cop)Tight :1' US'.\rLE-Rx.com ('.\1ed1Q Learning, LLC>. fil!l Portions of this book odcnhficd "ilh the : I n-- 1H-. DOI: 10. IHMiio.!OIHH;.

49

Olia structure: Image C. De•trocardia. This image is a deri.-ati•·e work, adapted from the foll°" ing source, 3\ailable under Et:Cl Olu"":ldare 0, A)ola AO. ,\l.omolafc RO. ct al. 111e role of electrocardiogram in the diagnosis of dcA1rocardi:i "ilh 1nirror in'lage atrial arrangement and ventricular position in a )011ng adult Nigerian in lle-lfe: a ca~ report

55

Fluorescence in situ hybridization: Image A. T hi< image is a derirnlive work, adapled from the follO\\ing source. arailable under i::i:::::::I: Paar C, 1lerber C. Voslo1":1, cl al. i\ case of acute m)eloid leukemia (,\.\IL) "ilh an unreported combination of chromosomal abnormalities: gain of isochromosomc Sp. !cir.Isom\ Sand unbalanced translocation der(l91t( i-:19J(qH:pl>). \lo/ Crtogentt. 2013;6:40. DOI: IO.l lli6/n;..s166-6-40.

57

Genetic terms. Image A. Cafwu-laol . This image is a deri•-ali•·e worlailable under: ~ Stefano Nase. The image may have been modified by cropping, labeling, and/or captions. .\1ed1Q Learning, LLC makes this available underS!!l.

Immunology

98

98

98

Sinusoids of spleen. Red and white pulp. This image is a derivative work, adapted from the following source, available under Ella Heinrichs S, Conover LF, Bueso-Ramos CE, et al. 1'v!YBL2 is a subhaploinsufficient tumor suppressor gene in n1yeloid n1alignancy. eLife. 2013;2:e00825. DOI: 10.7554/elife.00825. The image may have been modified by cropping, labeling, and/or captions. All rights to this adaptation b)' MedlQ Leaming, LLC are reserved. Thymus: Image A. Hassall corpuscles. This image is a derivative work, adapted from the following source, a1>ailable under E;m: Minato H, Kinoshita E, Nakada S, et al. Thymic lymphoid hyperplasia \\ith multilocular th)'mic cy•ts diagnosed before the Sjogren syndrome diagnosis. Diagn Patliol. 2015;10:103. DO I: 10.1186/s13000-0150H2-y.

Bacterial spores. This image is a deri1>ative work, adapted from the following source, m>ailable under ~:. Jones SW, Paredes CJ, Traer B. The transcriptional program underl)'ing the phy•iology of clostTidial sporulation. Ce110111e Biol. 2008;9:Rl 14. DOI: 10.1186/gb-2008-97-rl 14.

135

a-hemolytic bacteria. a -hemol)'sis. This image is a derivative work, adapted from the following source, available under: ~ Y. Tambe. The image may have been modified b)' cropping, labeling, and/or captions. MedlQ Learning, LLC makes this available under ~.

135

~-hemolytic bacteria. Jl-hemol)~is. This image is a deri1>ative work, adapted from the following source, available under: l?lllW Y. Tambe. The image may have been modified b)' cropping, labeling, and/or captions. .\1ed1Q Learning, LLC makes this available under Wl:ll.

135

Staphylococcusaureus. llliil Courtesy of the Department of Health and Human Services and Dr. Richard Facklam.

136

Streptococcus pneumoniae. !§al Courtesy of the Department of

Thymus: Image B. ·'Sail sign· on x-ray of normal th)'rnus in neonate. This in1age is a derivative work. adapted from the follo\ving source,

available under Rm Di Serafino M, Esposito F, Severino R, et al. Think thymus, think well: the chest x-ray thymic signs. / Pediatr Moth Care. 2016;1(2): IOS.109. DO I: 10.19104/japm.2016.108. 107

128

Paroxysmal nocturnal hemoglobinuria. This image is a derivative work, adapted from the following source, available under ~ Nakamura N, Sugawara T, Shirato K, et al. / Med Case Reports. 2011;5:550. doi: 10.1186/1752-1947-5-550.

Health and Human Services and Dr. 1'vlike !\•tiller. 136

Streptococcus pyogenes:(groupAstreptococci). Cram stain. This image is a derivative work, adapted from the follo\\'ing source,

available under: ~ Y. Tambe. The image may have been modified

IMAGE ACKNOWLEDGMENTS

by cropping, labeling, and/or captions. MedlQ Leaming, LLC makes this available under el'l:ll. 137

Bacillus anthracis. Ulcer with black eschar. !Piiii Courtesy of the Department of Health and Human Services and James H. Steele.

138

Clostridia (with exotoxins): Image A. Cas gangrene clue to Clo.str;dium per{r;ngens in fection. This image is a derivative work, adapted from the following source, available under E;m: Schropfer E, Rauthe S, !\urcc, avnilahle under: E!E' Y. Tan1be. 1 he i111ngc 111n) lrnvc hecn modified b\' cropping, labeling, and/or captions. Med IQ Leaming, LLC makes lhis a\'ailable under Opportu nistic fungal infections: Image 8. Germ lubes of Candida alb1ca11s. 1 his image is a deri\'3live worl:, adapleI. jiiiil Courtoy of the Department of Health and Human Sen ices.

155

Protozoa- GI infections: Image C. E11tamocba histolytica lrophozoilt's. Cou rtesy of lhe Department of Health

""d 1111111011

Ser\'ices.

155

Protozoa- GI infections: Image 0. E11tamoeba l1istolytica C)SI.

~ CourlcS\ oflhc DcpartmenlofHealth and Human Services.

155

Protozoa- GI infections: Image E. Cryptosporidium oocnts. ~ CourlcS\ of lhc Dep:irtmenl of Health and Human Sen1ces.

156

156

Toxoplasma gondii: Image A. Ring-enhancing lesions in 1 gond11 infection. ·nm image is a deri,'3ti\'e worl:, adapted from the folloo ing source, ..-.ilable under .\grawal A, Bhake ,\_ S.ngole \XI, el al. :.lultiplc-rini; enh•ncing lesions in an immunorompelenl adult. / Clob Infect Dis. 2010 Sep-0«;2(3): 313-4. DOI: I0.4103..007477iX.6854S. Protozoa- CNS infections: Image B. Toxoplasma go11dii tach)LOitc.

~ Cou rte>)' of the Dcpartmenl of Heallh and Human Scn•ices and

I h11n:in Sc1vicc~.

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Pneumocystis jlrovecl: Image C. D isc-shaped yeasl. ' l11is im"gc is a

Dr. L.L. Moore, Jr.

156

Protozoa- CNS infections: Image C. Naegleria fowleri amoebas.

~ CourlcS\ of lhc Dcpartmenl of Health and Human Sen·ices.

156

Protozoa- CNS infections: Image 0. Trypanosomu brucei gambie11se. ~ CourleS\ of lhe Dcp:irtmenl of Health and Human Sen ices and

Dr. :I lae :I feJ, 111.

153

Opportu nistic fungal infections: Image G. Cnf'loroccu• MO(onnam. Courten of the Department of Health and I luman Senices and Dr. Leanor I lal2-19·+--1·115.

154

Sporothrix schenckii. Subcutaneous mvcosis. llm image is a dem-:ih\C \\Ori:. adapted from the following source. a\"Oilable under

. Co, ender J\P, ~laphanga TC, Zulu IC, cl ol. An oulbreal: of lpnphoculaneons sporotrichosis among n1inc-workcrs in South Africa.

' I

IMAGE ACKNOWLEDGMENTS

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the Syrian ci\'il ""'· PLoS Pathog. 2014 NO\ol0(1 l):el00H38. DO I: 10.13i l/journal.ppal. IOO+BS.

165

Herpesviruses: Image 8. 1lcrpcs labialis. Courtcsr of the Department of I lealth and 1luman Services and Dr. Herrmann.

158

Protozoa- others: Image 0. 1richomo11t1t .-agirw/is. the Department of I lcalth and I luman Seni=.

165

159

Nematodes (roundworms): Image A. £11ttrobiru "'rmiro/aris eggs. Courtes\ of the Oq>.,rtment of I lea Ith and Human Senices, BC Partin. •nd Dr. l\loore.

Herpesviruses: Image E. Shmgles (•aricclla-1oster •im< infection). This image is a deri\'ali•o worl. adapted from the follO\\ing source, a)' of the Dcparh11ent of I lcalth and Human Cestodes (tapeworms): Image 8. l\euroC)«ticercosc: a ease report. / \led Case &p. 2011;5:328. DOI: IO.l lb6W52-19'1i-S-l28.

Courtes\' of the Courtesy of

Services and Cynthia Coldsin1th.

171

Rabies virus: Image 8. Negri bodies. Councsy of the Deparhnent of I lealth and 1lum:rn Services nncl Dr. Daniel P. Perl.

180 Osteomyelitis: Image 4. X-rny (lcfl) and MRI (right) vie"~- Thi)' of DeNanneke. under "

tmmcatheter therapies. Curr Cardiol Rev. 2013 Aug: 9(3): 211-219. 001: I0.2174/l 57H03Xll3099990032. Hypertension: Image A. ··String of heads" appearance in fibron1u~cular dysplasia. This image is n dcrh01thc ''ork, adapted Plou in PF, Perdu J, from the follO\\ingsource, a\'3ilable under LaBatide-Alanore .\,et al. Fibromuscular d\~plasia. Orplwnet /Rare Dis. 200i;i:2S. DOI: J0.1186/1 750.1172-2-2S.111e image n12J have been modified by cropping, labeling, and/or capbon>. ,\II righls to this adaptation b\ .\ledlQ Leaming, LLC are rescned.

299

Arteriosderosis: Image A. Hi-.line l\pe. lliis image ;, • dern-.ti,·e work, t\ephron. The acbptcd from lhe follO\\ing source, available under: ima.ge 1na1 have been modified b)· cropping, labeling. and/or captions. MedlQ Learning. LLC makes thi< availahle under

299

Arteriosderosis: Image B. Hnierpla.stic type. ' Ihos image is a deri,,.ti,·e Paco work, adapted from the follm,ing source, nvailablc under: · Larosa. 111e image ma)' have been modified by cropping, labeling, ancV or captions. Med IQ Leaming, LLC makes lhb a\'aibblc under ~.

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Li1n OS. Coarc tation of the aorta - the current state of surgical a nd

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Hyperlipidemia signs: Image C. Tendinous xm1thoma . "l11is image is a dcri' ative work, adapted from the following ; I>. 9. DOI: IO. llS6/sl2969.015.000;.0.

336

Pheochromocytoma. !nis image is a dcri,'3h1e 11or\:, adapted from Courtes1 of Or. :\lichael the follO\\·ing source. al'aibblc under Feldman.

337

Hypothyroidism vs hyperthyroidism. On1chol1>is. Ibis image is a deri1'3tive work, adapted from the follO\\ mg source. a1;iilable under e::=, Rajebi Mil Shahrokni J\. Choo>00n \1. Uncommon °""°us invoh·ement in multi\\'\femic 5arcoid05i.s. J\1111 Saudi i\ led. 2009 NO\·· Ded916H8>-4S6.

338

Hypothyroidism: Image 8. Before and after treatment or congenital Courtetol"!:). This image is a deri1'3ti1e worl, adapted from the foll011 ing source. al'ailable l\bn in. The image rna1 ha1e been modified b1· cropping, under: labeling. and/or captions. \ led IQ Leaming. LLC makes this 3\'0ilable under

311

311

cropping, labeling, and/or captionCnteric duct cpl in an omphalocele: a rnrc association. Pt1k J Med Sci. 2013 May-Jun; 29(3): 866-868. 353

Intestinal atresia. This image is a dcril'alhc 1101·k, adJplcd from the : Soaha ~ I. Ali1nenlarr tract follo"ing .source, ::wailablc under atresias associated \\'ilh anoreclal 1n;alfonnaho1u: 10 yean' experience.

/ .T\'eonatal Surg. 2016 Oct.Dec: 5(4): 43. DOI: 10.21699/jns.\'M.++9.

353

Hypertrophic pyloric steno sis. TI1is ima~ 1> a deri1ati'e11ork. . llassan RA\. adapted from the follm1ing source. 01ailable under Choo )lJ, Noraida ll et al. Infantile hipcrtrophic 11) Jorie stcnosis in postoperatil'e esophagC'31 atresia 11ith tracheocsophagcal fistula. J .\'eo11atal Su'!:. 20I) Jul-Sep;4{3): >2.

IMAGE ACKNOWLEDGMENTS

354

Pancreas and spleen embryology. Annular pancreas. This image is

371

endoscop)'· This image is a derivative work, adapted from the

E;m: .\1ahdi B, Selim S, Hassen T, et al. A rare cause of proximal

following source, m':lilable under ~: Costaguta A, Alvarez F. Etiology and management of hemorrhagic complications of portal hi1>ertension in children. Int I Hepatol. 2012;2012:879163. DOI: 10.1 155120121879163.

Pa11 Afr Med/. 201 1; 10:56. The image may have been modified by cropping, labeling, and/or captions. All right' to this adaptation by Med IQ Learning, LLC are reserved.

371

available under: ~ Dr. Paul Hellerhoff. The image may have been modified by cropping, labeling, and/or captions. Med!Q Leaming, LLC makes this .,,,.;[able underEll!!l.

of an accessory renal artery during repair of an abclon1inal aortic

356

Digestive tract histology: Image A. i!iBl Courtesy of Courtesy of Dr. l'vlichale Boner!.

356

Digestive tract histology: Image B. !$iii Courtesy of Courtesy of W. Ben Smith.

356

Digestive tract histology: Image C, D, E. This image is a derivative work, adapted from the following source, available under: Elm Courtesy of Wikimedia Commons.

361

Liver tissue architecture. This image is a derivative work, adapted from the following source, .,,,.;]able under lilla Liver de\'elopment. In: Zorn Al'vt. Stem book. Cambridge: Haf\'ard Stem Cell Institute, 2008.

Esophageal pathologies: Image C. Esophageal varices on CT. This in1age is a derivative work, adapted from the follo''~ng source,

Retroperitoneal structures. This image is a deri,"1tive work, adapted from the following source, a\"1ilable under EtlU: Sammut J, Ahiaku E, Williams DT. Complete regression of renal tumour following ligation aneurysm. Arm R Coll Surg E11gl. 2012 Sep; 94(6): e l 9~200. DOI: IO. I 308/003588412X I3373405384972.

717

Esophageal pathologies: Image B. Esophageal \'arices on

a derivative worl:, adapted from the following source, available under intestinal obstruction in adult'i-annular pancreas: a case report.

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Esophageal pathologies: Image D. Esophagitis. This image is a derivative work, adapted from the follo\\'ing source, available under E'lll:I: Takahashi Y, Nagata N, Shimbo T. Long-term trends in esophageal canclidiasis prevalence and associated risk factors with or

without HIV infection: lessons from an endoscopic study of 80,2 I9 patients. PLoSOne. 2015; 10(7): e0133589. DOI : 10.1 371/joumal. pone.OJ 33589. 372

Barrett esophagus: Image A. Endoscopy. This image is a derivative work, adapted from the following source, a\'ailable under E1m Coda S, Thillaina)':lg:tm AV. State of the art in advanced endoscopic imaging for the detection and evaluation of clysplasia and earl>1 cancer

361

Liver tissue architecture: Image B. Kupffer cells. This image is

of the gastrointestinal tract. Clin Exp Castroenterol. 2014; 7: 133-150. DOI: 10.2147/CEC.$58157. The image may have been modified by cropping, labeling, and/or captions. All right< to this adaptation by MedJQ Learning, LLC are reserved. 372

Barrett esophagus: Image B. Coble! cells. This image is a derivati\'e work, adapted from the following source, a\'ailable under: Wi!lll Dr. Michael Boner!. The image may ha\'e been modified by cropping, labeling, ancl/or captions. Med!Q Leaming, LLC makes this .,,,.;[able under WW. Menetriere disease. This image is a deri,"1tive work, adapted from the following source, available under: wm:l Dr. Paul Hellerhoff. The image may have been modified by cropping, labeling, and/or captions. Med IQ Learning, LLC makes this available underflJill:).

a derivative worl:, adapted from the following source, available under: a.li:ili Dr. Michael Boner!. The image may have been modified

by cropping, labeling, and/or captions. MedlQ Leaming, LLC makes this .,,,.;]able under~ 362

Biliary structures. Gallstones. This image is a derivati\'e work, adapted from the following source, .,,,.;]able under: WW J. C untau. The image may have been modified by cropping, labeling, and/or captions. l'vledlQ Learning, LLC makes this a\'ailable under~.

373

364

Hernias: Image A. Congenital diaphragmatic hernia. This image is a deri\'ative work, adapted from the following source, m"1ilable under E'lll:I: To'"'' J. Congenital diaphragmatic hernia. Orphanet I Rare Dis. 2012;7:1. DOI: 10.1 1861175().1 172-7-1.

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370

Peyer patches. This image is a deri\'ali\'e work, adapted from the following source, m"1ilable under: ~ Plainpaper. The image may have been modified by cropping, labeling, and/or captions. Med!Q Learning, LLC makes this a\'ailable under~. Sialolithiasis. This image is a derivative work, adapted from the following source, m"1ilable under ~: Pastor-Ramos V, C uervo-Diaz A, Aracil-Kessler L. Sialolithiasis. Proposal for a new minimally invasive procedure: piezoelectric surgery. / Cli11 Exp De11t. 2014 Jul;6(3):e29;-e298. DO!: 10.431 7/jced.51253.

patients: a 26-year retrospective study in C hina. PLoS One. 2015; 10(3): eO 121944. DOI: I0.1371/journal.pone.0121944. 374

375

Achalasia. This image is a deri\':ltive work, adapted from the following source, available under li1m Courtesy of Famoosh Farrokhi and l'vlichael F. Vaezi. The image may have been modified by cropping, labeling, ancl/or captions. All right' to this adaptation by .\1ed1Q Learning, LLC are reserved.

371

Esophageal pathologies: Image A. Pneumomediastinum in Boerhaave syndrome. This image is a derivative work, adapted fron1 the following source, available under: Em \Vikimeclia Comn1ons.

The image may have been modified by cropping, labeling, and/or captions. .\1ed1Q Learning, LLC makes this available under Wll:ll.

Whipple disease: Image A. Celiac disease. Sedda S, Camso R, Ivfarafini I, et al. Pyodern1a gangrenosum in refractory celiac disease:

a case report. BMC Ca..iroenterol. 2013; 13: I62. DOI: IO. I 1861147 1230X-13-162. 375

Whipple disease: Image B. Tropheryma whippeli on PAS stain. This in1age is a derivative work, adapted from the follo''~ng source,

available under a;;Ji!2 Tran HA. Reversible hypothyroidism and Whipple's disease. BMC Endocr Disord. 2006;6:3. DO!: 10.1186/14726823-6-3.

is a derivative work, adapted fron1 the fol1owing source, available under: ~ \Vikin1edia Commons. The image niay have been

370

Ulcer complications. Free air under diaphragm in perforated ulcer. Reproduced, \\oth permission, from Dr. Frank Caillard and www. radiopaeclia.org.

Salivary gland tumors. Pleomorphic adenoma histology. This image modified by cropping, labeling, and/or captions. l'vlecl!Q Leaming, LLC makes this .,,,.;[able under z=.

Gastric cancer Tan Y, Fu J, Li X. A minor (TOCr SD. Colorectal pohi» and pokposis syndromes. Caslroerilerol Rep (Oxn. 20H Fcb;20 ):1-IS. DOI: 10.1093/gastrolgoti< cocktail? Psori3'is, methotrexate and genetic hcmochronut0>is. B\IC CNrmatol. 2005:5:12. DOI: IO.l l86fl·n.;9-1;.;.12. 390

390

390

Gallstones (cholelithiasis): Image. A CroS> •pccimen. Ibis image is a derivatil-e work, adapted from the foll0\1 ing erl) Sinclair.

391

Pancreatic adenocarcinoma: Image A. 1li>tolc>g).111i< image is • derh-.ti\e work, adapted from the folio" ing source. a1-ailable under: KCH. The image ma\ h:l\e been modifie image is a deri•ah•c 11ork, adapted from the folloo;ng source. a•-aibble under •-an Dijk IL\, Fre a deri•"ti' e "°'I:, adapted from lhe follO\\ ing 50urcc. a•-:iilable under Como-Rivera F, £1Saggar AK Cuha-Thalurta 1\. et al. Rhcumalood arthrilis mimicking metastatic squamoU> cell carcinoma. I-lead .\rck011col. 2011;3:26. DOI: I0.1186/J-;s.ns-1-3-26.

459

Calcium pyrophosphate deposition disease. Calcium phosphale Cf)>lals. 'll1i< image is a deri,.. ti,·e work, adapled from lhc follO\•ing source. a•a1lable under Em: Dieppe P, s\\.. n A ldenhficalion of crplah in >yno.-ial Auid. A11n Rheuni Dis. 1999 Mar;58(5):261-263.

Common fractures: Image B. Buckle fraclurc. '!'hihoto. Thi< image is a derivative wor\:, adapled from the followin.g ened. Osteomalacia/rickets: Image B. lbchilic rmnry on chesl X-ray. TiliS irnage is a deri\'ative work, adapted fro1n lhc follO\\cing.source, available under E:m Essabar L, Meskini T. Ettair S. cl al. Malignant infantile osteopetrosi.s: case report " 'ith reviC'\\ of literature. Pdn J\fr J\led }. 2014:17:63. DOI: IO.l 1604/pamj.2014.17.63.37;9.

cleri\'afivc \\Ork, adapted from the following source, :::wailable under • J cgmlo CA, 1arzia 0. Buccal alterations in diabetes mcll ih". Diabrtol 1\letab Smdr. 2010;2:3. DOI: 10.118611758-5996.2-3.

461

461

5eronegative spondyloarthropathies: Image(, left. Bamboo •pine. This image is a deri•-:itive work, adapted from lhe foll°" 11~ source. .,-.ilable under: S1evenfruitsmaak. The image ma\ ll3\c been modified t,, cropping. labeling, and/or captions. I\ led IQ Leaming. LLC males Ibis a•-ailable under Seronegative spondyloarthropathies: Image(, right Bamboo )' of I lealher

464

Raynaud phenomenon. This image is a derivati•·e work, adaplcd

fro1n the follo\\~ng source, available under: EJCJ Jmnclna!lscn. 'The

imogc may have been modified by cropping, labeling, and/or captions. Mecl lQ Learning. L.L.C makes this available under 465

Epithelial cell junctions: Image A. Intracellular membrane. Thi< image is a deri,athe work. adapted from the follo\\·ing source. a\·ailable under

457

457

Primary bone tumors: Image A. O.tcochondroma. ThL< image is a deri•-ative "ork, adapted from lhe foll°'' mg 50urce. available under: Lucien Monfils. The i""'!:e rna\ lme been modified br cropping, labeling, and/or captions. ~lcdlQ Leaming. LLC makes tbis "'..1lable under Primary bone tumors: Image B. Oslcoid mtcoma. Thi• image is a dcri•-:ili•·e "or\:, adapled from the foll°" ing source. available under . Janl:haria B, Burule l'roteomic and bioinfonnatic anahsis of cpilhelial tight juncbon rC\cals an unexpected cluster of ml3ptic molecules. Biol Oim:L ?006: I: r . DOI: 10.1186/17-lxi!;O.l-3-. 465

Epithelial cell junctions: Image B. Large, eleclTon-9.

515 Adult primary brain tumors: Image A. This image is a dcrivati\'e worl. adaplcd from lhe following .ource, availoble under r::i::i::: Rossmeic been modified hi cropping. labeling, ancVor captions. Med IQ Leaming. LLC make> lh1> a1-.ilable under

515 Adult primary brain tumors: Image D. Oligodendroglioma. "fried egg" cell>. 111is image is a deri\'ati,.., \\Ork, adaplcd from the follO\\ing source, t1\-aib hle under:

515

516 Childhood primary brain tumors: Image F. Epcndrmoma hi>lology.

Nephron. 1l1e i111ngc 1nar hrwe been

modified hr cropping, labeling, and/or caption>. LLC makes lh is available under m:.ll.

~lcd lQ

This in1age b n dcri\'nti\'e work. adapted from the following~ourcc.

Learning,

Adult primary brain tumors: Image E. Meningioma wilh durnl l•il. ll•is in1agc i'i a clerivati\•e work, adapted fro1n the fol 10\\'ing ~ource, available under Em Smits A, Zetterling \\ I. Lundin \\ I. ct al.

available under: l\ephron. The image may ha"e been modified by cropping, b beling, nncl/or captions. MedlQ Leaming, LLC makes lhis available under •

516 Childhood primary brain tumors: Image G. er or craniopharvngion1a. Thi\ image is a derivative work, adapted fro1n the

Neurological impairment linked "ith cortico-subcorlical infiltration of d1ffuic IO\\-grade gliomas al initial diagnosis supports carh brain plasllcil\. Front Nturol. 201>;6: 137. DOI: IO.HS911"ncur.2015.0013;.

515 Adult primary brain tumors: Image F. ~ leningioma. P>"mrnoma

KCH. The image ma\' have burce. "'"ilablc under ~ Celzo F'C. \ enslcmuns C. De Seider F', cl al. Brain slones re.isited-belween a rock and a 1,.rd place. Insights Imaging. 2013 Oct;-li5 ):625-35. DOI: 10.1007/•I "!244-013-0279-z.

Courtcs\ of \I R:l-Bild.

515 Adult primary brain tumors: Image L Schwann cell origin of

Neurocutaneous disorders: Image I. Cerebellor hcmongiohb "e work, adapled from the foll"''ing source. a\'ailablc under.

~ephron. The image may ha'e been

modified 11) cropping. labeling, and/or captions. Med IQ Leaming. LLC makes lhis Dl':lilablc under llll:O.

515 Adult primary brain tumors: Image G. Cerebellar hemangiohlastoma.

519 Friedreich ataxia: Image A. Clinical l·yphoscoliosis. This image

'llus i1nagc i'i :J clerivati\'e work, adapted fro1n lhc fo11ov.,ingsource, available under El:ll2 Park DM, Zhengping Z. Chen 1.., cl al. von I lippcl·Lindnu disease.as.wciated hen1angioblJ~to1na:. nrc derived fron1 cmbriologic multipolenl cells. PLoS Med. 2007 Fcl>;4(2):e60. 001: I0.1371/joumal.pmecl.0040060.

is a cleri\'ali\'C work. :idnpted fron1 the fo lJowing source, available

under Ai.clrod FB, Colcl-\'on Simson. Hereditary sen>O')' and aulonomic ncuropalh ics: 1)11es 11 . Ill , and IV. Orplw11et I Rare Dis. 2007;2:39. DOI: 10.1 18611750-1172.2-39.

519 Friedreich ataxia: Image B. Radiograph showing kyphoscoliosis.

515 Adult primary brain tumors: Image H. Minimal parencl11ma in hcmangiobla.loma. This image is a derh-.ti' e \\Or~. adapled from the follooing .ource, .,-.;table under: t\lo"·in IOI. The image mar ha'e been modified~- cropping. labeling. ancVor caplions. !\ledIQ Lcamin~. LLC males this a\'ailable under

515 Adult primary brain tumors: Image I. Proloctinoma. Thi5 image is a dcm-alhe \\Ori:. adapted from the follc,.ving source.•,-.ilable under . \\'ang CS, Yeh TC, Wu TC. el al. Piluilary macro.1denoma cc>encd.

524

Glaucoma: Image 0. Acute angle closure glaucoma. ·1his image is a

529

c\·aluation of diabetic retinopathy in single-field retinal ilnages- a

529

525

Hypertensive retinopalhy. This image is a deri•-.h•e \\ork, adapted Diallo JW. :'lleda X, from the foll""ingsource, ••-ailable under 1ougouma SJB, et al. lnterets de !"examen du fond d'•lil en pratique de •ille: bilan de-138 cas. PanJ\{TJ\led /. 201 >:20:363. 001: JO.I 160-ll pamj.2015.20.363.6629.

ophtlulmoplcgio of the left ere in a I9-year-0ld female, "ith an emphasis in lolosa-Hunt S\ndrome: a case report. Casn J. 2009; 2: sr1. DOI. 10.-w-6fn--1626-2.sz-1. 529

569

Ureters: course. This image is a deri,-.ti,·e work, adapted from the \\'ilimedio Commons. Ilic follcrning source. ••0urce, a\'ailable under e::::D Pern1ello ~1,\. Diagnosing drug-induced AIN in the hospitalized patient: a challenge for the clinician. C/111.\'cpluol. 2014 Jun; 81 (6): 381-8. DOI: 10.Hl41 CJ\ IOS301.

582

Waxy casts: Image 0. This image is a deri•-ati•·e "orl:. adapted from the follo11 ing source. .,,.;Jable under E:::.D Court.

526

Papilledema. Courtesy of Dr. :\ichola< l\lahol1C) .

526

leukocoria. This image is a deri•-ative "ork, aibblc under

This in1agc i) a derivative work, adapted from the follO\\;ng source.

derivative work, adapted &om the foll°'' ing rourcc, available under

525

725

\\Ori:. adapted from

1,..,, 522

SECTION IV

584

Nephrotic syndrome: Image 8. Histology of focal segmentn1 glorncruloM:lcro~b. 'rhis in1age

is a derivative work. adnptcd frorn the

foll0\1 ing somce, al'ailable under: e;:c:I Dr. ~lichael Bonert. The image mai lmc been modified by cropping, labeling, ondlor captions. ,\led IQ Learning, LLC makes this a\'ailable under E!J:.. 584

Nephrotic syndrome: Image D. Diabetic glomemlosclerosis "ith Kimmclsticl-\\"ilsou lesions. This image is a deri•-..ti•c \\Orl. adopted Doc \lari llie from the follo"mgsource. a•-ailable under: image ma1 ha•c been modified Ii,· cropping, labeling. andfor captions. MedlQ Lcormng. LLC makes this a\':lilable under

585

Nephritic syndrome: Image A. Histolo~· of acute poststreplococc•I glomen1 loncphrilis. 'rhis image is a deri\'ative work. adapted fro1n

726

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IMAGE ACKNOWLEDGMENTS

the following source, available under: wtC Dr. Michael Boner!. The image may have been modified by cropping, labeling, and/or captions. 1'vlecllQ Learning, LLC makes this available under~. 585

Nephritic syndrome: Image B. This image is a derivative work, adapted from the following source, available under E;m:

589

Pyelonephritis: Image A. This image is a derivative work, adapted from the follo\\ing source, a\oailable under: WlO Dr. Michael Boner!. The image may have been modified by cropping, labeling, and/or captions. MedlQ Learning, LLC makes this available under a.IW.

589

Pyelonephritis: Image B. CT scan. Courtesy of the Department of Health and Human Services and the Armed Forces Institute of Pathology.

591

Acute tubular necrosis: Image A. Muddy brown casts. This image

ln1n1un0Auorescence of acute post.;treptococca) glon1en1lonephritis.

Oda T, Yoshizawa N, Yamakami K, el al. The role of nephritis-associated plasmin receptor (naplr) in glomerulonephrilis associated "~th streptococcal infection. Biomed Biotechnol. 2012;2012:41 767; . DOI 10.1155/2012/417675.

is a derivative work, adapted fron1 the fol1owing source, a\'ailable

under: EJ1iilll Dr. Serban Nicolescu. 585

Nephritic syndrome: Image C. Histology of rapidly progressive glomemlonephritis. i!BI Courtesy of the Department of Health and

591

Renal papillary necrosis. i!lBl Courtesy of the Department of Health and Human Services and William D. Craig, Dr. Brent J. Wagner, and Mark D. Travis.

592

Renal cyst disorders: Image C. Ultrasound of simple 9•1. This image

Human Services and Uniforn1ecl Services University of the Health Scie nces.

585

Nephritic syndrome: Image D. This image is a derivative work, adapted from the following source, available underEClll: Kiremitci S, Ensari A. C la«ifying lupus nephritis: an ongoing stmy. Scientific World Journal. 2014; 2014: 580620. DOI: 10.115512014/580620.

586

Kidney stones: Image A. Nair S, George J, Kumar S, et al. Acute oxalate nephropath)' following ingestion of Averr/ioa bilimbi juice. Case Rep Nep/irol. 201 4; 2014: DOI: 10.115512014/240936.

586

Kidney stones: Image B. This image is a derivative work, adapted from the following source, available under: l;ll1i:ll Joel Mills. The image may have been modified by cropping, labeling, and/or captions. MedlQ Learning, LLC makes this available under~.

587

Hydronephrosis. Ultrasound. This image is a derivative work, adapted from the following source, available under: Wli:l Wikimedia Commons. The image may have been modified by cropping, labeling, and/or captions. 1'vlecllQ Leaming, LLC makes this available under E!W.

is a derivative work, adapted fron1 the fol1owing source, a\'ailable

under: E!l1lilll Nevit Oilmen. The image may have been modified by cropping, labeling, ancllor captions. MedlQ Leaming, LLC makes this available under ~.

Reproductive 601

Fetal alcohol syndrome. This image is a derivative work, adapted from the follo\\ing source, a\oailable under: Wll:ll Courtesy of Teresa Kellerman. The image may have been modified by cropping, labeling, and/or captions. 1'vlecllQ Learning, LLC makes this available under 'E.:!i!).

587

Renal cell carcinoma: Image A. Histoilogy. This image is a derivative work, adapted from the following source, available under: ~Dr. Yale Rosen. The image may have been modified by cropping, labeling, and/or captions. 1'vlecllQ Leaming, LLC makes this available under

604

Umbilical cord. Cross-section of normal umbilical cord. This image is a derivative work, adapted fron1 the fol1owing source, available under: ~ Dr. Ed Uthman. The image may have been modified by cropping, labeling, ancllor captions. MedlQ Leaming, LLC makes this available under WW.

604

Meckel diverticulum. This image is a deri,oative work, adapted from the follo\\ing source, a\oailable under a;m: Mathur P, Gupta R, Simlot A, et al. Congenital pouch colon with double Meckel's cliverticulae. / 1 eonatal Suig. 2013 Oct-Dec; 2(4): 48.

~.

587

Renal oncocytoma: Image A. Cross specimen. This image is a derivative work, adapted from the following source, moailable under EtlU: Courtesr oftvl. Emmanuel.

607

Cleft lip. This image is a deri,oalive work, adapted from the following source, available under ~: Shkoukani 1'vtA, Chen !vi, VongA. Cleft lip- a comprehensive review. Front Pediatr. 20 13; l: 53.

587

Renal cell carcinoma: Image B. Cross specimen. i!BI Courtesy of Dr. Eel Uthman.

609

587

Renal oncocytoma: Image B. Histology. This image is a derivative work, adapted from the following source, available under: ~Dr. 1'vlichael Boner!. The image may have been modified by cropping, labeling, ancl/or captions. MedlQ Leaming, LLC makes this moailable under EI!!:!.

Uterine (Miillerian) duct anomalies: Images A-0. This image is a derivative work, adapted from the following source, a'oailable under E;m: Ahmadi F, Zafarani F, Haghighi H, et al. Application of 30 ultrasonography in detection of uterine abnormalities. hit/ Pertil Sten/. 2011; 4: 144-147. PtvlCID PMC4023499.

587

612

available under E:m Courtesy of Dr. Eel Uthman. The image may have been modified by cropping, labeling, ancllor captions. All right' lo this adaptation b)' MedJQ Learning, LLC are reserved.

Renal cell carcinoma: Image C. CT scan. This image is a deri,oative work, adapted from the following source, available under nm Behnes CL, Schlegel C, Shoukier !vi, et al. Hereditary papillary renal cell carcinoma primarily diagnosed in a cervical l)rmph node: a case

614

Seminiferous tubules. This image is a derivative work, adapted from the following source, available under: ~ Dr. Anlt Rao. The image may have been mcxlified b)' cropping, labeling, ancl/or captions. .\1ecllQ Leaming, LLC makes this moailable under liiIE.

627

Pregnancy complications. This image is a derivative work, adapted from the follo\\ing source, a\oailable under EtlU: Li W, Wang C, Lin T, el al. Misdiagnosis of bilateral tubal pregnancy: a case report. / Med Ca,1 in N~1 IBC nianagement-an overview of daily

practice. / Med Life. 2013;6: 140-145. PtvlCID PMC3725437.

Female reproductive epithelial histology. Transformation zone. This in1age is a derivative work, adapted from the fol1o"~ng source,

628

Choriocarcinoma: Image B. "Cannonball " metastases. This image is a derivative work, adapted from the following source, available under ~ Lekanidi K, Vlachou PA, .\forgan B, el al. Spontaneous regression

of metastatic renal cell carcinoma: case report. /Med Case Rep. 2007;1:89. DOI: 10.1186/1752-1947-1-89.

IMAGE ACKNOWLEDGMENTS

630

Court"" of the Vulvarpathology:lmageA. Bartholin~,1. Oep;utrnent of Health and Human Sen ices ond Susan Lindsle\·.

630

Vulvar pathology: Image B. Lichen aldilable under ~

633

633

Ovarian neoplasms: Image D. Yolk sac hunor. This i1ruge is a clcm;iti\e \\Ork, adapted &om the follO\'ing source, .,.,;fable Jensllorian. The image m;n h3\ c been modified by under: cropping. labeling, and/or c-aptions. ~ led IQ Lc:immg. U..C makes this O\;i1lable under

image is a cleri\'ative work, adapted &om Ihe following source. avnilnble under ECICI: Mak CW, Tzeng WS. Sonogmphy of the scrotum. DOI: 10.5772/27586.

637

Squamous cell carcinoma. This image is a deri\'ati1·e work. adapted from the following source, .,.. ilable under c:::::I: Antonio JR, Antonio CR, ' IHdico LA El)1hroplasia of queyrat !Teated "ith topical 5-Auorouraal. i\r1 Bra• Dennatol. 2016 Sep-Oct; 91 (5 Suppl I): 42-44. 001: I0.1590/abdl80&4841.2016-1595.

638

Scrotal masses: Image A. Congenital hrdrorele. This image "a deri,.. li\e "orl. adapted &om the foll°";ng source. °'"ilable under Leonardi S. Barone P, Cmina C, et al. Se\'ere Ka\\asali disease in a 3-month-olcl f"'ticnt: a case report. BJ\IC RA-s /'>:()(es. 2013;6:500. DOI: 10.1186/1756-0500-6.500.

is a deri\'ati\·e work:, adapted fron1 the folfo,,ing source,

available under ECi2 Londero AP, Perego P. i\ langioni C, et al. Loca11) relapsed and metastatic uterine lcion1yo1nri: a case report.

I AledCase Rep. 2008;2:308. DOI: 10.1 18611752-1947-2-308. The image may have been modi fied hy cropping. labding, and/or captions. All rights lo this adaptation hy /d ecllQ Learning, LLC arc reserved. 634

634

Uterine conditions: Image D. f.ndometrili< with inAammation of the cndo1netrium. This image is a deri\'alh e \\Ol'k. adaplcd from . \lontcsinos L, ,\cien P, the follO\•ing source, a\'ailable under .\lartinez.Beltran ~I, et al. mo {fibroid l. gross specimen. 11m image is a dem.. tive work. adapted &om the foll°" ing source. .,.,fable under GZl Courtesy of Hie et nunc.

Breast cancer: Image 0 . lm-asi\·e lobular carcinoma. ll1i; im;age is a dcri•'3thc \\Orl. ..d.pted &om the foll°"ing source. a\-.iloble under c:::;;:J Franceschini C, l\lanno A. ~ lule ,\ et al. C3"r-intcstmal symploms as clinical manifestation of peritoneal and retropcntoneal

spre:id of an 1n\01.)i\e lobular breast cancer: report of a c~c and rc\iC\\

gestation: a case report/ Med RRp. 2012;6:3'l9. DOI : IO. l 186/1752194i -0-3Q9. 634

Breast cancer: Image C. Paget disease of breast. ' l11i< image is a E:lltl: Mullarak 1\1, Siri)" B, Kongmebhol P, et al. 1>ngcl'< dic of the hrc::i~t: clinical, in1aging and pathologic findi ngs: n re' icw of 16 patients. 81omcd Imaging lnterv /. 2011;7:el6. DOI: I0.2H9/ biij .7.2.cl6.

I0. 1 186/17~6-1596-7- 1 64.

, ~1ontesinos L, Aden fro1n the follow-ingsource, available under P. ~1artinez.Beltran :X I, et al. O\'arian dy~crn1ino1na and synchronic contralateral tubal pregnancy followed b, normal in Ira-uterine

Breast cancer: Image B. Comedocarcinoma. This image is a dcri,.. ti,e "orl:. adapted from the foll011ing source, ....;table under Costarelli I.., C.mpagna D. i\lauri i\I, et al. lntr.iductol prol1fcrati1e lesions of the breast- terminology and biology matter: premol1gn.nt lesions or premldshe cancer? Int/ Surg Onc:ol. 2012:501'»1. 001 : I0.1155/20IZ/50190-I. The image may ha1-e been modified b) cropping. labeling, and/or captions. All rights lo this adaplahon b) J\ledlQ Learning, LLC are reserved. clcri\'11ti\'c \\Ork, adapted fro1n the follow-ing source. U\'ailnblc under

Ovarian neoplasms: Image E. Call.f.mer bodies. This image is a dcm·Jtive \\Ork, adapted &om the follooing ;ourcc. onilable under Katoh T. Yasuda ~I, Ha.onance imaging. CaSl:c< this "'"ilJble under

modified b\· cropping, labeling. and/or captions. McdlQ Leaming. U.C mal:es this .,..ilable under

664

SECTION IV

73Q ~

NOTES

SECTION IV

IMAGE ACKNOWLEDGMENTS

Index

A A-a gradient in elderll', 654 with hypoxemia, 654, 655 restrictive lung disease, 66 l Abacavir, 201, 203 Abciximab, 122 C lycoprotein llb/llla inhibitors, 429 thrombogenesis and, 403 Abdominal aorta, 357 atherosclerosis in, 305, 687 bifurcation of, 649 Abdominal aortic aneury'sm, 306 Abdominal colic lead poisoning, 4 11 Abdominal pain bacterial peritonitis, 384 Budd-Chiari S)'fldrome, 386, 676 cilostazol/dipyriclamole, 429 Clostridium difficile, 675 diabetic ketoaciclosis and, 346 ectopic pregnancy, 627 Henoch-Schonlein purpura, 318, 676 hypercakemia, 579 hyperparath)'roidism, 342 intussussception, 379 irritable bowel svndrome, 376, 377 Mc Burneysign:676 Meckel dil'erticulum, 604 pancreas divisum, 354 pancreatic cancer, 391

panic disorder, 55) periumbilical, 377 polyarteritis nodosa, 317 porphyria, 41 7 postprandial, 357 RLQ pain, 378 Rovsing sign, 676 RUQ, 390 Abdominal striae, 333 Abdominal wall inguinal hernias, 362, 363 ventral defect,, 352, 354 Abducens nerve (CN VI), 494 function of, 494 location, 492 ocular motility, 528 palsy, 529 pathwa)' for, 493 Abduction arm, 438 hand,438 hip, 445 Abductor digiti minimi muscle, 439 Abductor pollicis brevis muscle, 439

Abetalipoproteinemia, 94, 406 Abnonna] pas.'iive adduction, 44 3

Abnorrnal uterine bleeding (AUB), 6 18,619 aclenomyosis, 634 anen1ia "'ith, 4) 0 A-;hern1an syndrome, 634 leiomyoma (libroid), 634 polyps (endometrial), 634 thecoma, 632 ABO blood classilication, 397 newborn hemolysis, 397 Abniptio placentae, 626 cocaine use, 600 preeclampsia, 629 Abscess, 470 acute inAammation and, 215

lung,670 Absence seizures

characteristics of, 505

drug therapy for, 532 treatment, 685 Absolute risk reduction (ARR), 258, 691 Absorption disorders and anemia, 410 AB toxin, 132 Abuse. See also Child abuse dependent p~~,?nal ity disorder and,,,, intin1ate partner violence, 267

Acalculia, 499 Acalculous cholecystitis, 390

heart failure, 311 hi1>ertension, 319 nan1ing convention for, 253

preload/afterloacl effect,, 282 teratogenicity, 600 Acetalclehyde, 72 Acetalclehyde dehydrogenase, 70, 72 Acetan1inophen, 474

I'S. aspirin for pecGatric patienls, 474 free radical injury and, 210 hepatic necrosis from, 249 N-acetylc)'steine for overdose, 671 for osteoarthritis, 458 toxicity effect,, 474 toxicity treatment for, 247 Acetazolamide, 252, 539, 594 idiopathic intracranial

hi1>erlension, 509 metabolic acidosis, 580 in nephron ph~•iology, 573 pseudotumor cerebri, 509 site of action, 593 Acetoacetate metabolism, 90 Acetone breath, 346 Acet\'lation chromatin, 34

posltranslation, 45 Acetylcholine (ACh) anticholinesterase effect on, 240

Achondroplasia, 454 chromosome disorder, 64 endochondral ossilication in, 450 inheritance, 60

ACh R (acetylcholine receptor), 229 Acid-base physiology, 580 Acidemia, 580 diuretic effect on, 595 Acid-fast ooc~•ls, 177 Acid-fast organisms, 125, 140, 155 Acidic amino acids, 81 Acid maltase, 86 Acidosis, 578, 580 contractility in, 282 h~perkalemia with, 578 Acid phosphatase in neutrophils, 398

Acid reflux

H, blockers for, 392 proton pump inhibitors for, 392 Acid suppression therapy, 392 Aduetobacter bau1uannii highly resistant bacteria, 198 Aduetobacter spp. nosocon1ial infections, 185 Acne, 466, 468 danazol, 64 3 PCOS,631 tetracyclines for, 192 Acquired hydrocele (scrotal), 638

change with disease, 483

Acrodermatitis enteropathica, 7 J

Acamprosate

opioid analgesics, 538

alcoholism, 559, 685 Acanthoci1es, 406

pacen1aker action potential and,

Acromegal)', 34 3 carpal tunnel S)'ndrome, 451 CH, 327 octreotide for, 393

Acanthoc)1osis in vitamin E deficiencv, 70 in abetalipoproteinen1ia, 94 Acanthol~•is, 466 Acanthosis, 466 psoriasis, 468 Acanthosis nigricans, 229, 466, 472, 631

stomach cancer, 373 Acarbose, 349

Accessory ner\'e (CN XI), 494 arrn abduction, 4 38 functions of, 494 lesion of, 520 location, 492 pathway for, 493 Accessory• pancreatic duct, 354, 362

Accountable care organization, 269 Accuracy vs. precision, 259 Acebutolol, 245 ACE inhibitors, 596 acute coronary s~ndromes, 310 CJ esterase inhibitor deficiency,

107 dilated cardiomyopath)', 311 dry cough, 251

295 Acetylcholine (ACh) receptor agonisb, 229, 237, 538 autonomic drugs and, 239

Acetylcholinesterase in. amniotic Auid, 479 Acetylcholinesterase (AChE) malathion, 200 neural tube defect' and, 479 Acetylcholinesterase (AChE) inhibitors

cholinergic drugs and, 239 nan1ing convention for, 253 for neuron1uscular junction disease, 463

toxicity treatment for, 247 Acetyl-CoA carboxylase fatty acid S)'nthesis, 73 vitamin B~ and, 68

Achalasia, 3fo esophageal cancer and, 372

LES lone in, 365 Achilles reAex, 498 Achilles tendon xanthomas, 304, 674 Achlorhydria stomach cancer, 373 VI Pomas, 365

son1atostatin analogs for, 325 son1atostatin for, 350 Acron1ion, 438 Ac tin

C)1oskeleton, 48 muscular d~•lrophies, 61 Actin lilament' epithelial cells, 465 Acting out, 542 Actinic keratosis, 472 associations of, 689 squan1ous cell carcinoma, 473 Actinomyces israelii

labs/findings, 6i9 oral infections, 186 pigment production, 128 Actinomyces spp. anaerobic organisn1, J 27

Cram-positil'e algorithm, 134 Nocardia spp. vs., 139 penicillin CN for, 187 Action potentials

axonal, 482 niotor neurons, 295 niuscle contraction, 448

INDEX

Action potentials (continued) myocardial, 294 pacemaker, 295

ventricular. 295

Adaptive immune system de ndritic cells in, 400

Adaptive immunity. 99 lj~phOC)1es in, 401

Action/willpower, 556

Addiction, 5 56

Activated carriers, 75 Active errors, 272

Addison disease, 3 34 metabolic acidosis in, 580

Active immunity, I JO Acute chest syndrome, 414 Acute cholestatic hepatitis drug reactions and, 248 macrolides, I 93

Acute coronary syndron1e ADP receptor inhibitors fo r, 429 heparin for, 427

treatn1ents for, 310

presentation, 676

Additive drug interactions, 233 Adduction arrn (rotator cuff}, 438 hand, 439 hip, 445, 446 thigh, 444 Adductor brevis, 444 Adductor longus, 444, 446

Acute cystitis, 582 Acute d isseminated (postinfectious) encephalomyelitis, 512 Acute dvstonia, 557 trean;1ent of, 241

Adductor longus niuscle, 362 Adductor magnus, 444 Adenine rnethylation of, 34

Acute gastritis, 373 Acute hemolytic transfusion reactions, l 14

Adenocarcinoma

Acute hemorrhagic cystit is, 164 Acute inflammation

Adenocarcinomas carcinogens causing. 226 esophagus, 372

characteristics of, 2) 5 Acute inAamrnator>1 clernye1inating Acute Acute Acute Acute

polyradiculopathy, 5 12 inte rmittent porp h)~i a, 417 interstitial nephritis, 591 kidney injury, 590 lymphoblastic leukemia (ALL), 424

associations with, 689 methotrexale fo r, 432

oncogenes and, 225 Acute mesenteric ischemia, 380 Acute m yelogenous le ukemia (Al'vlL), 424

chron1osomal translocations, 426 9tarabine for, 432 myelod~•plastic syndromes, 423 Acute m yeloid le ukemia (Al'vl L)

associations with, 689 Acute pancreatitis, 39 1 associations, 689 DICand,689

Shiga/Shiga-like toxins and, 132 lungs, 669 vaginal, 630

gastric, 217, 226 lung, 225 nomenclature for, 22 1

nonbacterial thron1botic e ndocarditis and, 229 pancreas, 362, 391 pancreatic, 227 paraneoplastic s~ndromes, 229 pectinate line, 360 prostatic, 640 stomach, 373, 688 Adenohn1oph~•is, 323 emb1yologic derivation, 599 h)1mthalamus and, 486

Adenornas bone,456 colorectal, 383 nomenclatme for, 22 1 primary hyperparalh)~oidism, 34 I

salivar>1 g1and, 370 thvroid, 340

hyperparath)~oidism, 342

Ade~omalous colonic 1mlyps, 38 1

necrosis and, 209

Adenomyosis (endometrial), 634 u te rine bleeding from, 6 19 Adenopathy

Acute pericarditis, 3 14 Acute-phase proteins, I08, 213 Acute p hase reactants, 213, 108 Acute poststreptococcal glomerulonephrilis, 585

Acute pron1yeloc~tic leukemia treatment, 684

vitamin A for, 66 Acute puln1onary edema opiod analgesics, 538 Acute pyelonephritis, 589 labs/findings, 682 renal papillary necrosis and, 591 WBC casts in, 582 Acute renal failure, 590

Acute respiratory•distress S)ndrome (ARDS), 664

acute pancreatitis, 39 l eclampsia a nd, 629 inhalational injury, 662

Acute stress disorder, 5 52 Acute transp lant rejection, I 19

Acute tubuJar necrosis, 59 1 Acyclovir, 20 I Adalimumab, 122, 476 fo r Crohn disease, 376

Kawasaki disease, 316 Whipple disease, 676

Adenosine blood Aow regulation, 300

deaminase deficiency, 37, I 17 pacemaker action potentia l and, 295 Adenosine lriphosphate (ATP) e lectron transport chain, 78 in glycogen regulation, 85 nephron physiology, 573 production of, 74, 78 in TCA cvcle, 77

in urea cYcle, 82 synthase inhibitors, 78

Adenoviruses characteristics of, 164 conjunctivitis, 522 pneumonia, 668 viral envelope. 163 Adherens junctions, 465

Adjustment disorder, 552 Ad nexal (ovarian) torsion, 6 1 I Adoption studies, 256 ADPKD (Autosomal dominant pol)'cystic kidney disease)

saccular aneurysms and, 504 ADP receptor inh ib itors, 429 ADP ribosyltransferases, I 32 ad renal, 6 16

Adrenal adenomas C ushing syndrome, 333 h)1'era1dosteronisn1, 334 Adrenal carcinomas C ushingsyndrome, 333 Li.Fraumeni s~ndrome, 225 P-glycoprolein in, 228

Adrenal cortex, 322 embryologic de rivatives, 599 progesterone production, 616

Adrenal enzyme deficiencies (congenital), 328 Ad renal gland cortical development of, 599 Ad renal hemorrhage, 675

\Vaterhol1se.Friderichsen syndrome, 334 Ad renal hyperplasia

C ushing syndrome, 333 hn,eraldosteronism a nd, 3 34

Adrenal insufficiencv. 334

adrenoleukod~•lr~phy, 4 7

a novulation with, 63 1 Aud rocortisone fo r, 3 50 vitamin Bl deficiency, 67 Ad renal medulla, 322

neuroblaston1as of, 335 pheochromoc~tomas in, 336 tumors, 688 Ad renal steroids, 328 Ad renal zona fasciculata, 329 Ad renocortical adenomas, 688 Ad renocortical atrophy Addison disease, 3 34

exogeneous corticosteroids, 333 Adrenocortical insufficienc~· drug reaction and, 248 presentation, 676

Adrenocorticotropic horn1one (ACTH ) adrenal cortex regulation of, 322 in Cushing syndrome, 229, 333

secretion of, 323 signaling pathwa~' of, 332 Adrenoleukod)~lrophy, 47, SI 2 Ad renoreceptors, 239 Adu lt T cell leukemia, 226 Adu lt T-cell lymphoma, 422

Advance directives, 265 Adverse e ffect'i/events. See also Teratogens ACE inhibitors, 596

acetazolamicle, 592 a ntacids, 392, 393

antidepressant drugs, 563-564 a ntipsychotic d rugercalcemia and, 229 Schistosoma haematobium, 160, 161 Blast crisis, 424, 689 Blastocy•t implantation, 598 Blastomyces spp. amphotericin B, 199 itraconazole, l 99 Blastomycosis, 151 Bleeding adenomatous polips. 38 I control of, 355 direct factor Xa inhibitors, 429 direct thromhin inhibitors, 427 diverticulosis, 377

essential thromboc1themia, 425 glycoprotein llhlllia inhibitors, 429 heparin, 427 inAammatory• bowel disease, 376 peptic ulcer disease, 374

thrombolytics, 429 varicea1, 365

warfarin, 428 Bleeding time, 4 18 Bleomycin, 4 31 in cell cycle, 4 30 pulmonary fibrosis, 251 target< of, 430 Bleomycin toxicity, 436, 66 I Blepharospasm, 507 Blindness. See also Vision lo« Chlamydia trachomatis, 149 conversion disorder, 554 giant cell arteritis, 315

neonatal, 142 Onchocerca mlvulus, I 59 temporal arteritis, 687 Toxocara canis, ) 59

Blood chocolate-colored, 653 coagulation and kinin pathwa~'S,

404 en1bryologic derivatives, 599

hCC detection in, 6 I9 metrorrhagia, 618 oxygen content, 653 in placenta, 603

umbilical cord, 604 viscosity of, 654

Blood-brain harrier anesthetics, 536 astrocytes, 481 function and niechanisn1, 484

at hypothalamus, 486 L-DOPA, 536 Blood Aow autoregulation, 300 Blood Aow exercise response, 656 Blood groups, 397 Blood-nerve permeabilil)• barrier, 483 Blood pH diuretic effects on, 595

Blood pressure angiotensin ll effects, 576, 578 antidiuretic hormone regulation

of, 327 cortisol effect on, 329 renal disorders and, 579 renin-angiotensin-aldosterone s~'Stem, 576 S)rrnpathomirnetic effect on, 24 3

Blood-testis harrier, 484, 614 Blood transfusions, 421 reactions, 114 Blood urea nitrogen. See BUN (blood urea nitrogen)

Blood vessels collagen in, 50 Ehlers-Danlos syndrome, 50 hereditary• hemorrhagic telangiectasia, 3J9 Blood volume atrial natriuretic peptide (ANP), 298 regulation, 576 Bloody diarrhea, 179 Campylobacter jejuni, 145, 149 Shigella, 144 u1cerative colitis, 376

Bloody stool, 360 Blotting procedures, 53 Blowing murn1ur, 293 Blown pupil, 529 CN 111 damage, 529 saccular aneurvsn1s, 504

··BJue babies", 296 Blueberry muffin rash C)1omegalovirus, 182 rubella, 169, 182 Toxoplasma gondii, I 82 Blue sclerae, 51 osteogenesis imperfecta, 674 Blumer shelf, 373 BMPR2 gene, 665 Body dysmorphic disorder, 551 Boerhaa\'e syndrome, 371, 659 Bohr effect, 656 Bombesin, 335 Bone cancer, 456 prin1ary bone tun1ors. 456 tun1or nomenclature, 22 1

Bone cell biology, 450 Bone crises, 88

Bone disorder lab ,,.Jues, 456

INDEX

Bone disorders "brown" tumor, 681 osteogenesis irnperfecta, 5 J

pain, 677 raised periosteum, 68 I "soap bubble" (x-ra)'), 681 Bone formation, 450 Bone fractures

fat emboli from, 658 Bone-in-bone (x-ra)'), 455 Bone lesions

adult T-cell l)mphoma, 422 Langerhans cell histioq1osis, 426 ))'tiC, 426 multiple rnyeloma, 423 Bone n1arrow

phago9tosis of, 427 procarbazine suppression of, 4 33 suppression, 433

transplant in osteopetrosis, 455 Bone n1arrow stimulation, I21 Bone n1arrow suppression, 199 Bone n1arrow transplant

osteopetrosis, 455 severe combined in1n1unodeficiency. J 17 Bone n1inera) clensitv scan, 454 Bones

·

collagen in, 50 cortisol effect on, 329 l)'tic/blastic metastases, 224 P'fH effect on, HO renal osteodystroph)', 590 Bone tumors, 456-457 "Boot-shaped" heart (X-ray), 679 Borderline personality disorder, 553 dissociative identity disorder, 546

Bordete//a pertussis, I4 3 culture requirements, ) 26

exotoxin production, I 32 Cram-negative algorithm, I 4 I macrolides, 193 vaccines, 143

Bordet-Cengou agar, I 26 Borrelia spp., 146 Borrelia burgdorferi anin1al transn1is.~ion, J49 coinfection with, I 57

facial nerve palsy, 186 Lyme disease, I46 tetrac)-clines, 192 Borre/;a recurrentis anin1al transn1is.~ion, J49 vectors, I 61

Bortezon1ib, 435 Bosentan, 671 Botulinum, 239 Botulinum toxin

lysogenic transduction, I 30 passil'e antibodies for, I I 0 toxin effect~. l 32 Botulism Clostridium botu/inum, I 38 exotoxin, ) 28 Bovine spongifonn encephalopath)' (BSE), 178 Bowel smooth n1uscle activation, 240

Bowel stenosis, 377 Bowen disease, 637 Bowenoicl papulosis, 637

Bow legs (genu varum), 455 Bowman capsule, 57 I Boxer's fracture, 451 BPH (benign prostatic hyperplasia) az.otemia with, 590 hydronephrosis in, 587

BrachiaI artery, 447 Brachia! plex~s Pancoast tumor, 670

Brachia! plexus lesions, 441 Brachiocephalic artery, 491 Brachiocephalic syndrome, 670 Brachiocephalic vein, 670 Brachioradialis reflex, 498 Bradycardia atropine for, 24 I jl-blockers and, 246 dopamine for, 242 on ECC, 296 h)1'ermagnesemia, 579 reflex, 576 s)'mpatholytic drug< and, 244 Bradykinesia with an tipsychotic drugs, 56 I Bradykinin, 596 ACE inhibitors and, 596 breakdown of, 576 C) esterase inhibitor deficiency,

107 BRAP gene, 225, 381 melanomas and, 473 papillary• th)Toid carcinoma and,

HO vemurafenib and, 4 35 Brain

blood Aow autoregulation, 300 choriocarcinoma and, 638 embryologic derivatives, 599

embryology of, 478 glucose usage b)', 324 infarcts, 209 ischemia in, 210 macrophages in, 399 metastasis to, 224

ring-enhancing lesions, 679 Brain abscesses

HIV-positive adults, 180 Toxoplasma gondii, I 77 Brain cyst,, 16 I Brain death, 267, 489, 490 Brain injury

gastritis with, 373 h)1mpituitarism from, H 3 Brain lesions (common), 499 Brain natriuretic peptide (BNP), 299, 576 in SIADH, 344 signaling path,va~'S for, 332 Brain stem dorsal view, 492 ventral view, 492 Brain tumors

Branching gram-positive rods/sulfur granules, 679 BRCA1/BRCA2 genes, 225 breast cancer and, 636, 636-644 DNA repair protein, 225

Bronchio1itis obliterans organizing

Breast cancer

Bronchoconstriction, 672

breastfeeding, gro\\1h signals in, 222 gro\\1h signals in, 222 h)1'ercalcemia and, 229 inciclence/n1orta1ity of, 223 key associations. 690

oncogenes and, 225 paclitaxel for, 4H paraneoplastic cerebellar degeneration and, 229 postrnenopausal women, 686 tamoxifen for, 435 trashtzumab for, 435 hlmor suppressor genes and,

225 Breast disorders

benign,635 Breastfeeding, 622 ovarian neoplasm risk, 632 Breast milk lgA antibodies in, 105 prolactin and, 326 Breast/ovarian cancer BRC1\ I mutation, 64

BRC1\2 mutation, 64 incomple te penetrance, 56 Breast pathology, 635 benign disorders, 635 cancer, 636 libroc)•tic change, 635 gynecon1astia, 63 5 inAan1matory process, 635 invasive carcinon1as, 636 Breast tumors (malignant)

aromatase inhibitors for, 642

breastfeeding and, 622 hormonal contraception contraindication, 64 3

Breathing mechanics of, 66 I with pneumothorax, 667 Breath sounds, 666 bronchial, 666, 667 diminished, 667 Brenner tumor, 632

Brittle bone disease, 51. See Osteogenesis imperfecta

biopsy findingertension,

665 syrnpathomirnetic action, 24 3

teratogenicity, 600 Coccidioides spp. silver stain, J 25

treatment, 199 Coccidioiclon1ycosis, 15 1

en1hema nodosum and, 472 Hiv-positive adults, 177 Coccobacilli, 141 Coccus bacteria

antibiotic tests, 134 C ram stain identification, I 34 Cochlea CN Vlll, 494 inner ear, 52 1 presbycusis, 52 J

Codeine, 538 Codman triangle, 457, 681 Codon1inance, 56

Codons genetic code features, 37

start and stop, 40 Coefficient of determination, 263 Cofactors apo1ipoproteins, 93

biotin, 68, 73 cobalamin, 68, 69 copper, 51 Menkes disease, 51 pantothenic acid, 67 phenylketonuria, 84 pyridoxine, 67 pyruvate dehydrogenase con1plex,

76 riboflavin, 67

INDEX

TCA cycle, 76, 77 thiamine, 74 vitamin K, 7 l ''Coffee bean" nuclei, 632 Coffee bean sign (x-ray), 380 Cognitive beha\'ioral therapy (C BT), 545 ADHD, 545, 685 for anxiety disorders, 550 for al)1>ical depression, 549 body dysmorphic disorder, 551

Colorado tick fe\'er, 167 Color blindne", 197

conduct disorder, 545 major depressive disorder, 549 obsessive-con1pulsive clisorcler, 55 J

Colovesical fistulas, 377 Coltivims, 167 Coma

oppositional defiant disorder, 545 panic disorder, 55)

phobias, 551 postpartum depre"ion, 550 PTSD, 552 Cohort studies, 256 Coin lesion (x-ray), 669 Cola-colored urine, 585 Colchicine acute gout attack, 685 agranuloci1osis, 249 calcium pyrophosphate deposition disease, 459 diarrhea with, 249 gout, 459, 476 microtubules and, 48 m)·opathy with, 250 Cold agglutinin disease, 677 Cold agglutinins, 150 Cold autoimmune hemol)1ic anen1ia,

4 15 Colecton1y adenomatous polyposis, 381 inAammatory bowel disease, 376 Colistin, 143 Colitis Clostridium difficile, 138 HIV-positi\'e adults, 177 oral vancon1ycin, J90 pseudomembranous, 128, 179, 188, 192 Collagen, 50 clecreased/faull)•production, 51 osteoblasts and, 450 scar forrnation, 219 svnthesis and struchlre, SO ~1>es of, 50 vitamin C, 69 wound healing, 21 7 Collagenase in neutrophils, 398 Collapsing pressure (al\'eoli), 647 Collecting tubules, 574 diuretics and, 593 nephron ph)•iology, 573 potassiun1.sparing diuretics and, 595 Colles fracture, 454 Colliculi, 492 Colon histology of, 356 ischen1ia in, 210 Colon cancer

5-fluorouracil for, 4 32 irinotecan/topotecan for, 434 labs/fincling.erplasias, 328 Congenital heart disease, 301-303 autosomal trisomies, 63 defect associations, 303

hepatic encephalopath)', 385

maternal phenylketonuria, 84 pulmonary arterial h)1'ertension,

nonketotic syndron1e, 346

hn1onatremia, 579 rabies, 17 1 reticular activating s~'Stem, 499 thvroid storm, 339 T~xoc.ara canis, 159 Trrpa>Josoma brucei, I 56

Combined pathway for coagulation, 404 Comedones, 46S Con1n1aless genetic code, 37

Comma-shaped rods, 141 Common bile duct, 355, 362 Con1n1on chemotoxicities, 4 36

Common cold, 168 Con1n1on i1iac artef)'', 3 57 Con1n1on peroneal nerve, 444 Con1n1on variable in1n1unodeficiency

665 rubella, 182 teratogens, 600 Turner syndrome, 678 Congenital hydrocele (scortal), 638 Congenital h)pothyroiclism, 338 Congenital long QT S)'ftcl rome, 297 Congenital lung malforrnations, 646 Congenital malforrnation mortality, 270 Congenital nevus, 466 Congenital rubella cardiac defect associations, 303

heart murmur, 294 Congenital solitar)' functioning kidne)', 567 Congenital syphilis, 147 Congestion (respiratory) inhalation injury, 662

(CVID), 116 Communicating hydrocephalus, 510

with lobar pneumonia, 668 Congo reel stain, 212, 584

Con1n1unication \\'ith patient, 266 Con1partn1ent syndrome, 453

Conivaptan

Competence (bacterial genetics), 130 Competitive agonists, 234 Con1petitive inhibitors, 232

Complement, 106 activation inhibition, 135

binding of, I04 disorders of, I07 eculizumab, 122 endotoxin activation, 13 3 in1munocleficiency infections, I l 8

immunoglobulin isol)1>es, 105 innate imn1unity, 99

splenic dysfunction, 98 transplant rejection, 119 Con1plement activation pathwa~'S.

106 Complementation (viral), 162 Complete mole (hydatidiforrn), 628 Complete (thircl-n1e Cori disease, 87 glycogen metabolism, 86 Decay-accelerating factor (OAF), I06 Deceleration injury, 306 Decidua basalis, 603 Decision.n1aking capacity, 265 Decompression sickness, 658 Decorticate posturing, 499 Decussation in spinal tracterglycemic state, 346 loop diuretics and, 594 mannitol and, 594 osmotic 1a" >6 somatostatin production, 365 Delta rh)1hm (EEC), 485 Delta virus, 167 Deltoid muscle axillary• nerve injury', 440 Erb palsy, 441 Delusional disorder, 546, 548 Delusions, 547 mesolimbic pathwai•. 487 Den1eclocycline, 350 diabetes insipidus and, 248, 344 for SIADH, 344 Den1entia common brain lesions, 499 frontotemporal, 499 HIV-positive adults, 177 metachromatic leukodystrophy, 88 neurodegenerative disorders, 508-509 Pick disease, 681 prion disease, I78 splice site mutations, 39 vitamin B3 deficiency, 67 Demyelinatingldy• myelinating disorders, 512 Den1yelination lead poisoning (adult), 41 7 metachromatic leukodystrophy, 88 Den1yelination/dysn1yelination progressive rnultifocal leukoencephalopath, 512 vitamin B12 deficiency, 518 Den1yelination/dysn1yelination disorders, 5 12 progressive rnultifocal leukoencephalopathy, 512 vitamin B12 deficiency, 518 Dendritic cells, 400 IL-10, 108 innate in1n1unity, 99 Langerhans cell histiocytosis and, 426 T- and B-cell activation, 101, 103 Dengue, 167 Denial, 542 Denosumab, 122 for osteoporosis, 454

De novo mutations

Rett srndrome, 62 De novo P>·rirnicline and purine S):nthesis, 36 rate.cletern1ining enzyme, 7 3

Dense deposit disease, 585 Dental plaque nonnal Rora, 178 viridans streptococci, J 28 Dentate nucleus, 487 Dentin collagen in, 50 osteogenesis in1perfecta, 5 l Dentinogenesis imperfecta, 51 Denys-Drash srndrome, 588 Dependent personality disorder, 553 Depersona1ization/clerea1ization disorder, 546 panic disorder, 551 Depression atypical antipsychotics for, 561 atypical features in, 549 benzodiazepine \Vithdra\\'al, 555, 558 dissociative identity disorder, 546 drug therapy, 560 electroconvulsive therap)', 550 glucagonomas, 336 hyperparathrroidism, 34 2 niarijuana "'ithclrawal, 559 MOMA withdrawal, 559 metoclopramide, 394 niirta1...apine for, 244 neurotransn1itters for, 483 pos~>artum, 550 seasonal pattern \\;th, 549 serotonin.norepinephrine reuptake inhibitors (SNR!s) for, 563 sexual d}'Sfunction caused by, 555 SSRls for, 563 stimulant withdrawal, 558 suicide and, 550 Deprivation effect< (infants), 544 de Quervain (granulomatous) thrroiditis, 218 De Quervain tenosynol'itis, 452, 453 De Quervain thyroiditis, 338 Demwcentor tick (disease vector), 149 Dermatitis B-complex deficiency, 65 drug reactions and, 249 glucagonomas, 336 f PEX syndrome, 102 type IV h)1>ersensitivity reaction, 113 vitamin B5 deficiency, 67 vitamin B7 cleficienC) 68 Dennatitis herpetifonnis, 471 autoin1n1une disorder, 471 celiac disease and, 375 Dennatologic lesion tenns, 466 Dennatornes landmark.·ositis, 229 autoantibody, 115 Dennatorn>·ositis/polymrositis, 463 Dennatoph)1es, 152 Dennatoph)1oses, 199 Dennis, 465 Dennoid C}'Sf, 632 Descending colon, 354 Desert bumps, 151 DesAurane, 537 Desipramine, 563 Desloratadine, 671 Desmin, 48, 228 1 ,

INDEX Desmoplakin, 465 Desn1opressin fo r hemophilia, 418 Desn1opressin acetate central DI, 327, 350 DI treatment, 344 Desn1oson1e, 465 Desquamation, 135 Desvenlafaxine, 563 De tached retina, 525 De temir insulin. See also Insulin De trusor instability, 588 Developmental delay fetal alcohol s~ndrome, 601 renal failure a nd, 590 Developmental milestones, 62 1 Dexarne thasone arachidonic acid pathwa)', 474

Cushing syndrom diagnosis, 333 Dexlansoprazole, 392

Dexrazoxane, 431 Dextroamphetamine, 560 Dextrocardia, 49, 278 Dextromethorp han, 538, 67 1 DHT (dih)'drotestosterone), 608,

622, 625 Diabetes insipidus, 344 antidiuretic hormone in, 327 demeclocycline and, 350 clesmopressin acetate for, 350 drug reaction and, 248 lithium, 562 lithium toxic!)>, 557 potassiun1.sparing d iure tics for, 59) thiazides fo r, 595 Diabetes mellitus, 345-346. See also H)1>ergl)'cemia acanthosis nigricans, 472

atherosclerosis and, 305 al)•p ical antipsychotics, 561 ~blockers and, 246 carpal tunne l synd rome, 451 cataracts and, 523 chronic renal failure and, 590 CN Ill damage, 529 diabetic ketoacidosis, 346 diabetic retinopathy, 525 F'riedreich ataxia, 519 fungal infections, 186 glaucoma a nd, 524 glucagonomas, 336 g1ucosuria in, 572 hemochromatosis, 389 hepa titis C, 173 hyperosmolar hyperglycemia nonketotic syndron1e, 346 hypertension a nd, 303, 319 iron poisoning, 4) 8 Klebsiella, 145 neonatal respiratory•distress smdrome, 647 nephrorathy with, 582, 584 neural tube defect a'sociation, 4 79 opportunistic infections, 153

urinary tract infections. ) 81 UT!s ~nd, 589 D iabetes nieJlitus managen1ent,

344-345, 348-349 D iabetes mellitus 1)1>< I, 346 autoantibody, 115 H LA subl)1>es with, JOO D iabetes mellitus 1)1>< 2, 346 amyloidosis, 212 h)1>erosmolar hypergl)'cemia nonketotic syndron1e, 346 D iabetic glomerulonephropathy, 584 D iabetic ketoacidosis black eschar, 675 OM type I a nd, 345 ketone bodies, 90 metabolic acidosis, 580 D iabetic nephropathy ACE inhibitors fo r, 596 angiotensin II receptor blockers fo r, 596 D iabetic neuropathy, 563 D iabetic retinopathy, 525 D iagnosis errors, 272 D iagnostic criteria grief, 550 major depres.~ive disorder, 549 panic disorder, 551 S)'l11pton1 duration and, 5 52 D iagnostic nianeuvers/signs Cower sign , 61 fo r hearing loss, 521 D iagnostic test evaluation, 257 D iagnostic tests/n1aneuver hip instability, 453 D iagnostic tests/n1aneuvers bedside cardiac exan1, 293 laboratory tests in bone disorders,

456 lower extremitl', 479 Prehn sign, 639 Weber/Rinne tests, 521 wrist and hand injury. 451 D ialectical behavior therapy, 553 D ial)'Sis-relate d am)'loidosis, 212 Diamonc~Blackfan a nemia, 412 D iapedesis, 216 D iaper rash

Candida albicn11s, 153 n y•tatin, 199 D iaphoresis, 307 acromegaly. 34 3 D iaphragmatic hernias, 364 D iaphragm structures, 649 D iaphysis, 457 D iarrhea

Bacillus cereus, 138 B-complex deficienc)', 65 bismuth/sucralfate for. 393 bronchial carcinoid tun1or. 669

readmissions "~th, 270

Campylobacter jejuni, 145 Celiac disease, 680 c hole ra toxin, 132 clindam)·cin, 192 Cleer-lgE syndrome, 116, 675 phenylketonuria, 84 1)1>e l hy1>0rsensitivity, 112 Wiskott-Aldrich syndrome, 117, 679 Eczema (atopic dermatitis) atopic dennatitis, 468

skin scales in, 4-66 Eczematous dennatitis, 4-66

Edema, 596. See also Cerebral edema in acute inAan1n1ation, 215 acute poststreptococcal

antips>·chotics/anticonvulsanl'i, 557

glomemlonephritis, 585 Arthus reaction, 113 capillar)' fluid exchange and, 300

benztropine for, 241 Lesch-Nyhan syndrome, 37

danazo1, 64 3 diabetic ketoaciclosis, 346

movement disorders, 507

endotoxins, 133

nigrostriatal pathway and, 487 treatment of, 241 D}• trophic calcification, 211, 228 D}•trophin gene, 61 D}• uria, 639 C)•titis, J8J

binge eating disorder, 555

Eaton agar culture requirements, J 26

Mycoplasma p11eumo11iae, 150 Ebola virus, 167, 171 Ebstein anomal)', 279, 301, 303 fetal lithium exposure, 600 lithium, 562 E-cadherin, 465 e'l'ression, 636 loss of inhibition, 222 in neoplastic progression, 220

Echinocandins, 198, 200 Echinococcus granulosus cestodes, 160 disease association, 161

Echinocytes, 406 Echothiophate glaucoma, 539 Echovirus

picornavirus, 167, 168 Eclampsia, 303, 629 Ecth)'ma gangrenosum, 14 3 Ectocervix, 612 Ectoclern1

branchial clefts, 605 derivatives of, 599

Ectoparasites, 161 Ectopic pregnanc)', 627 appendicitis differential diagnosis, 377 Clilamrdia trachomatis, 149 hCC in,6 19

heart murn1ur with, 294

Ehrlicliia chaffeensis, 149 Ehrlichiosis animal transmission, 149

rickettsial/vector-borne, 150 Eisenn1enger s~nclrome, 302 Ejaculation

derivatives, 599

Audrocortisone, 350

Ejection niurmur, 675

pancreas and spleen, 353, 354

Elastase, 367

renal, 566-567 reproductive, 59~09 respiratO')', 646-647 thyroid development, 322 USMLE Step I preparation, 274

with h>1'eraldosteronisn1, 334

hi1>erammonia, 82 in1rnunosuppressants, ) 20

bulin1ia nervosa, 555 characteristics of, 555 pica, 555

collagen deficiency in, 50

atrial fibrillation, 297 atrial septa! defect, 302 patent foramen ovale, 278 pulmonary, 312 Embolic stroke, 500 Emboliforrn nucleus, 487 Embolism pulmonary, 580 Embryogenesis genes involved in, 598 intrinsic pathway and, 208 Embryologic derivatives, 598, 599 Embryology cardiovascular, 278-280

glomerular filtration barrier and, 569 heart failure and, 31 1

inhalational injur", 662 Kawasaki disease ~nd, 316 kwashiorkor, 71 loop diuretics for, 594 nephrotic sp1drome, 584, 678 pepripheral, 312 periorbital, 159, 161 pitting, 311 pseudoepherine/phenylephrine, 671 pulmonary, 114

anovulation in, 63 l

aneurysn1 association with, 504

atherosclerosis, 305

eri1hropoiesis, 396 gastrointestinal, 352-353 genital, 608 gland derivations in, 607 neurological, 478-480

UTls causing, 589 Ear branchial pouch derivation, 607 development of, 599 Eardrum, 52 1 Early-onset Alzheimer disease, 63 Eating disorders amenorrhea with, 63 1

Ego-syntonic behavior, 551, 552, 553

Ehlers-Danlos S)'Ttdrome, 51

Emboli

inner"ation of, 6 13 spenn pathway in, 612 Ejaculatmy ducts, 6 12 embryology of, 608 Ejection fraction, 283, 692

urinary catheterization, 185

E

Efficacy vs. potency of drugs, 236 ECFR gene, 669 -Eggshell" calcification, 663 Ego defenses, 542, 543 Ego-dy•tonic behavior, 551 Egophony,666

superior vena cava syndron1e, 668

Trichinella spiralis, 159, 161 trichinosis, 159 upper extremil)', 670 wet beriberi, 66 Edema (generalized) cirrhosis, 383

Edema (peripheral), 596 acute poststreptococcal

glomemlonephritis, 585 glomemlar filtration barrier and, 569 loop diuretics for, 594 nephrotic syndrome, 584 superior vena cava syndron1e, 670 Eden1a toxin, 132

Edema (vasogenic), 484 Edinger-Westphal nuclei, 527 Edrophonium, 240 myasthenia gravis diagnosis, 463 Edwards syndrome (trisomy 18), 63 cataracts and, 523 chron1oson1e association, 64

horseshoe kidney and, 567 Efavirenz

HIV-positive adults, 203 mechanism, 201 Effective refractory period myocardial action potential, 295 Effective renal plasma Aow, 570, 692 Efferent/afferent ner"es, 299 Efferent arteriole, 568 angiotensin II, ;18 ANP/BNP, 576 constriction of, 571

dopamine and, 577 filtration, 57 1

activity in en1ph~'Sema, 660

Elastic recoil, 651 Elastin, 52 Elbow injuries, 450 Electrocardiogram (ECC), 296 acute pericarditis on, 314 cardiac tan1ponade on, 3) 5

low-voltage, 311, 315 !vll diagnosis with, 309 tracings of, 297 with pulmonary embolism, 658 Electroconvulsive therapy (ECT) adverse effecl'i, 550 major depressive disorder, 549

postpartum psychosis, 550 Electroencephalogram (EEC) C reutzfeldt-Jakob disease, 509 in dilirum, 546 sleep spindles/K complexes, 485 sleep stages, 485 wake and sleep rhythms, 485 Electroh1es disturbances in, 579 diuretic effecl'i on, 595

Electron acceptors (universal), 75 Electron transport chain, 78 Electron transport inhibitors, 78 Electrophoresis hemoglobin, 402 Elek test, 139 Elementary bodies (chlamydiae), 148 Elephantiasis, 159 11~hydroxylase, 328 11- fever HLA-DR2 and, JOO 1)1>e l hypersensitivity, I I 2 HbA1c test, HS H BcAg (hepatitis B core antigen), 174 HbC disease, 414 anen1ia taxonorn}:, 409 target cells in, 407 HBsAg (hepatitis B surface antigen), 174 hCC (human chorionic gonaclotropin}, 619 choriocarcinomas, 628, 638 ectopic pregnanc)', 627 embf)•onal carcinomas, 638 h)'datidiform moles, 628 pregnanc)', 6 I9 secretion of, 598, 6 I9 signaling pathwa~,, 332 source and function of, 6 19 HDL (high-density lipoprotein), 94 Headache, 506 C hiari I malformation, 480 drug adverse effect~. 532, 533 gianl cell (temporal) arteritis, 506 glaucoma, 524 increased intracranial pressure, 491, 509 1

poliomyelitis, 519 subarachnoid hemorrhage, 501, 504 tTiptans for, 534 venous sinus thrombosis and, 49 l Headaches o.-blockers, 244 bupropion toxicil)', 564 caffeine "'ithclrawal, 558 cilostazol/dipyridamole, 429 cimetidine, 392 drug ad\'erse effects, J9;, 199, 200 electroconvulsive therapy. 550 genital herpes, 184 h)1'ersensitivity pneun1onitis, 661 Jarisch-Heixheimer reaction, 148 lead poisoning, 417 malaria, I 57 Mucorspp. and Rhizopus spp, I53 nitrates, 313 ondansetron, 394 PDE-5 inhibitors, 644 pituitary•apoplexy. 34 3 Rocky Mountain spotted fever, I 50 subarachnoid hemorrhage, 678 vasculitides, 3 I 5 Head and neck cancer, 657 cetuximab for, 434

Head size

Padget disease of bone, 455 Head trauma, 545 Healing, wound, 2 17 Healthcare delivery, 269-272 Healthcare payment models, 269 Healthcare proxy, 267 Health niaintenance organization plan, 269 Hearing lo«, 52 I conductive, 49 C)1omegalovirus, 182 osteogenesis in1perfecta, 51 Paget disease of bone, 455 sensorineura) deafness, 585 Heart autoregulation of, 300 electrocardiograms, 296 embryology, 278 en1bryonic structt1res, 278 fetal development, 598 ischemia in, 2 J0 morphogenesis of, 278-2i9 normal pressures in, 300 sclerosis of, 464 Heart auscultation, 292 bedside maneuvers for, 292 Hamman sign, 659 heart sounds, 293 murn1urs, 292, 293 Heartburn, 37 I Heart disease common cause of death, 270 congenital, 63, 301-302 Fabf)' disease, 88 ischemic, 306 Heart failure, 3 I I ACE inhibitors for, 596 acron1egaly, 34 3 acute tubular necrosis with, 59) amioclarone, 3J8 ang iotensin 11receptor blockers, 596 associations, 690 atrial septa! defect, 302 jiblockers for, 246 B-type natri uretic peptide in, 299 chronic ischemic heart disease, 307

contractility in, 282 diabetic ketoacidosis, 346

dobutamine for, 242 dopamine for, 24 2 Ebstein anon1aly, 30 I ES R in, 214 Audrocortisone and, 350 h~pertension, 304 h>pertension treahnent in, 3J9 h>pertensive emergency and, 303 jugular venous pulse in, 290 loop diuretics for, 594 Ml, 307 Paget disease of bone, 4 55 pleural effusion, 666 potassium-sparing diuretics, 595 pulmonary h)1>ertension, 665 readmissions with, 270 shock caused by, 3 I 3 in sleep apnea, 665 thiazicles for, 59; ventricular septa) defect, 302 with renal failure, 590 Heart murn1urs, 293 aortic regurgitation, 675 aortic stenosis, 675 auscultation of, 292 cardiornyopathies, 31 1 patent duchls arteriosus, 302 Heart rate, 24 3 Heart sounds, 290, 291, 543 associations, 687 auscultation of, 292 cardiac c>·de, 290 cardiac tamponade, 315, 676 splitting in, 29 I Heart lransplant dilated cardiomropathy, 3 I I Heart valve development, 2i9 Heat-labile toxin, 132 Heat shock proteins, 45 Heat-stable toxin, I 32 Heat stroke, 505 Hea'1' menstrual bleeding (AUB/ HM B), 6 19 Heel pain, 453 Heinz bodies, 79, 408, 414 Helicase, 38 Helicobacter pylori, I 46 associations, 686 catalase-positive organism, 128 disease association, 373 Cram-negative algorithm, 14 I metronidazole, 19; as oncogenic microbe, 226 penicillins for, 188 silver stain, ) 2) u1cers and, 374 urease-positive organism, 127 Heliotrope rash, 229, 463 HELLP sp1drome, 629 schistoc11es in, 407 Helmet ceils, 407 Helminthic infections eosinophils and, 400 Helminths. See a/,ro Antihelminthic drugs Helper T cells cell surface proteins, I JO C)1okine secretion, I08 secretions of, I02 Hemagglutinin influenza viruses, ) 69 parainAuenza viruses, 170 Hemangioblastomas, 514 von Hippel-Linclau disease, 678

INDEX

Hemangiomas, 22 1 cavernous (liver), 386 cherr)', 469 pyogenic granuloma, 469 stTawberry, 469 Hemarthrosis, 69, 4 18 Hernatemesis, 371 Mallory-Weiss synd rome, 676 Hematin, 126, 142 Hernatochezia diverticulosis, 377, 378 intestinal disorders, 380 Meckel diverticulum, 604 Hematocolpos, 630 Hernatocrit h igh altitude a nd, 656 polyc~themia vera, 4 2 5 Hematologic disorders paraneoplastic syndromes, 229 Hematologic drug reac tions, 249 Hematology/oncology, 398- 435 anatom)', 398-40 I pathology, 396-416, 406-426 pharmacologr. 427-435 Hematopoiesis, 398, 4 23 extramedu llary, 455 Hematopoietic stem cells, 110 Hematuria, 582, 583 bladder cancer, 588 heredita ry hemorrhagic telang iectasia, 3 19, 676 lgA nephropathy, 585 lgA vasculitis (He noc h-Schonle in purpura), 676 interstit ial nephritis, 59) kidnev stones, 586 neph; itic syndrome, 585 nephroblastoma, 588 protease inhibitors, 203 renal 9•t disorders, 592

renal oncoc>.fomas, 587 Schistosoma haenwtobium, 161 transitional cell carcinoma, 587, 588 lJfls, 181

\.Vegener granulon1atosis, 3 l 7 Wilms tumor, 588 Herne bil imbin and, 369 chloroquine, 200 porphyria a nd, 417 sideroblastic anemia a nd, 41 1 synthesis of, 72, 417 vitamin B6 a nd, 67 Hemianopia, 503, 530 Hernianopia '''ith macular sparing,

530 Hemiballismus, 507 brain lesions a nd, 499 Hemidesmosome, 465 Hemineglect, 502 Hemiparesis, 51 1 saccular a neurysms, 504 Hemispatial neglect syn drome, 499 Hemochromatosis, 389 calcium pyTOphosphate deposition disease, 459 cardiomyopath)' with, 3 11 chron1osome association, 64 free radical injury, 2 10 hepa tocellular carcinoma and, 386 HL-\-A3 and, I 00 transfusion a nd, 42 1

Hemoglobin, 65 1 carbon dioxide transport, 656 development of, 396

kinetics of, 232 Hemoglobin e lectrophoresis, 402 Hemoglobinuria acute tubular necrosis a nd, 59 1 C6PD deficie ncy, 414

intravascular hernolvsis, 413 paro')~mal nocturn~l. 122 transfusion reaction, I 14 Hemol)~is

alpha toxin as cause, l 33 Clostridium perfringens as cause, 138 complement.n1ecliated inlTavascular, 414 HELLI' syndrome, 629 intravascu]ar vs extravascular, 4 13 intrinsic vs extrinsic, 4 l 3 mechanical, 4 13, 415 sulfonamides as cause, 194 transfusion reactions, 114 Hemol)~is in C6PD deficienc)', 249 Hemol)'tic a nemia, 4 13 autoimmune, 112, 189 babesiosis, 157 cephalosporins, 189 cold agglu tinin disease, 677 direct Coombs-posit ive, 249 extrinsic, 414, 4 15 fo late deficiency and, 4 12 C6PD deficie ncy, i9 in taxonomv, 409 intrinsic, 4 i 3, 414 penicill in C, V, 187 pymvate kinase deficiency a nd, 414 spherocj1es in, 407 sulfa drug allergies, 252 Wilson disease, 389 Hemol)'tic disease of newborn, 112, 397 Hemol)'tic reactions blood groups and, 397 in newborns, 397 Hemol)'tic-uremic s~ndrome (HUS) Escherichia coli, 145, 179 exotoxins, 132 platelet d isorders, 4 19 schistOC)1es in, 407 Hemophagoc)1ic l)'rnphohistiocj1osis, 427 Hemophilia, 4 18 de ficie ncies causing, 404 X-linked recessive disorder, 6 1 Hemopl)~is

Aspergil/us fumigatu, (HAART), 203 High-riding prostate, 6 13 Hilar l)'mphadenopathy, 661, 679 Milar l)'mph nodes calcilication of, 663 Milar ma", 669 Hilarnodes, 140 Hilum (lung), 649 l)'mphadenopath)', 661 Hindbrain, 478 Hindgut blood supplyfinnervation of, 357 development of, 352 1

Histone acetylation, 34 amino acids in, 8 1 cleacetylation, 34

methylation, 34 Histoplasnra capsulatu1n HIV-positive adults, 177 necrosis and, 209 Histoplasmosis, 151 e1)1hema nodosum, 472 treatment, 199 Histrionic personality disorder, ;s3

HIV (human immunodeliciency virus), 175 aplastic anemia in, 4 l 3 cervical cancer and, 631

diagnosis, 175

non-Hodgkin lrmphoma and, 421 Pueunux:ystis jimved;, 154 primarr central nervous systen1

lymphoma (PCL) and, 422 prophrlaxis for HN patient,, 198 pulmonary arterial h)1'ertension,

665 retrovirus, 167 rifamvcins in, J96

STI, i84 T cells and, 401 therapy for, 20 I, 203 ToRCHeS infection, 182 untreated time course, 176

viral receptor, 166 Western blot diagnosis, 53 HLA-DR4, 458 HLAgenes associations, 677, 681 celiac disease and, 375 disease as.wciations, JOO, 338

DM 1)1'e I association, 346 seronegative spond)'loarthritis, 461 uveitis, 524 Hl'vlC-CoA reductase cholesterol synthesis, 73 metabolic pathway•, 74 Hl'vlC-CoA synthase, 73 Hl'vlP shunt, 79 diagram, 74 metabolic site, 72 NADPH production, 75, 78, 79 rate-determining enz~n1e, 73

vitamin B1 delicienc)', 66

Hoarseness

gastroesophageal reflux disease, 371 lung cancer, 669 Pancoast tumor, 670 "'Hobnail" Ji\'er in alcoho1ic cirrhosis, 385

Hodgkin lymphoma bleomycin for, 4 31 non-Hodgkin .,., 421 oncogenic microbes and, 226

paraneoplastic cerebellar degeneration and, 229 procarbazine for, 433 types of, 689 vinca alkaloids for, 433 Holistic medical therapy, 267 Holoprosencephal)', 479 Patau syndron1e, 63

Sonic hedgehog gene and, 598 Homatropine, 241 Homeobox (Hox) genes, 598 Homer-Wright rosettes, 516 Homicide, 270 Homoc~'Stei ne

Hormone effect' on kid ne)', 578 Horn1one replacement therapy, 64 2

endometrial hyperplasia, 633, 634 estrogens for, 64 2 for h~popituitarisn1, 34 3

thrombotic complications, 249 Horn1ones acting on kidney, 577

Hormones (reproductive}, 640 Horn cysts, 468 Horner S)'ndrome, ;02, 506, 528 labs/linclings, 683 lung cancer, 669 Pancoast tumor, 670 presentation, 678 Horner-Wright rosettes, 335 Horse flies (disease vector}, 159 Horseshoe kidne)', 567 Turner syndrome, 678 Hospice care, 270 Hospital readmission causes, 270

Hot Aashes drug raction and, 248 menopause, 622 "Hourglass stomach", 364 Howell-Jollv bodies, 408, 680 postsple~ectom)', 98 Hu antigens, 229 Human chorionic gonaclotropin

(hCC) signaling pathways, 332 Human factors design, 271 Human herpes\'irus 6 (HHV-6), 165, 183 Human herpes\'irus 7 (HHV-7), 165 Human herpes\'irus 8 (HHV-8), 165, 177 Kaposi sarcoma, 469 as oncogenic niicrobe, 226 Human imn1unodeficiency

virus. See HIV (human immunodeficiency \'irus) Humanized monoclonal antibodies,

110 Human papillomavirus 6 (H PV-6), 184 Human papillomavirus 11 (H PV-1 1), 184 Human papillomavirus 16 (HPV-16), 657 Human papillomavirus (H PV) cer\'ical pathology, 631 HIV-positive adult'. 177 as oncogenic niicrobe, 226 penile cancer, 637

tumor epidemiolog)', 629 vern1cae, 468

warts, 164 Human placental lactogen, 6 19, 620

B12 deliciency, 412 folate deliciency, 412 vitamin B9 delicienc)', 68 vitamin B12 deficienc)', 68, 69

Humerus fracture

deliciency in, 84 vitamin B12 and, 69

Hungerlsatief)• regulation, 486 Hunter S)'ndrome, 61, 88

Homoc~'Steine methyltransferase

disease associations, 177 ex vacuo ventriculon1egal)'. 508,

Homoc~'Stinuria, 84 Homologous recon1hination repair,

510 flow C)1ometry diagnosis, 54 hail)' leukoplakia, 470 heroin addiction and, 564 Kaposi sarcoma, 165, 469 lrmphopenia, 4 16 meningitis, 180 microglia in, 481

40 Homo,':tnillic acid (HVA) in neuroblastomas, 3 35 tyrosine catabolisn1, 83 Homunculus, 490

Honeycombed uterus, 628 Honeycomb lung, 661 Hookworms, I59

axillal)' nerve and, 440 radial nerve \\ith, 440 Humor, 543 Humoral immune response, 40 I

Huntington disease

basal ganglia lesions, 499 ni edications for, 536 neurodegenerative disorder, 508 neurotransn1itters for, 483 trinucleoticle repeat e'.\."(>ansion

diseases, 62 ventromegal)', 5 I0 Hurler S)'ndrome, 88 HHrthle cells, 338

INDEX Hutchinson teeth, I47 Hyaline arteriolosclerosis, 304 Hyaline casteraldosteronism, 334 hypertension \\'ith, 303 metabolic alkalosis, 580 potassiun1-sparing diuretics for. 595 H }'peramrnonen1ia, 82 H)perbilirubinemia cirrhosis and, 383 hereditary, 388 jaundice with, 387 H}'percalcemia acute pancreatilis and, 39 I adult T-cell l)mphoma, 422 bisphosphonates for, 475 ca1ciun1 carbonate in, 393 diabetes insipidus, 344 granulornatous inflammation and, 218 hyperparath)'roidism, 342 loop diuretics for, 594 lung cancer, 669 paraneoplastic syndrome, 229 PTH-independent, 34 I sarcoidosis and, 662 succinylcholine, 538

teriparatide, 476 thiazicles as cause, 595

Will iams S)ndrome, 64 Hn>ercalciuria h)1>erparathyroidism, 342 thiazides for, 595 Hn>ercapnia contractility in, 282 H)l>ercholeslerolemia, 94 familial, 60 nephrolic syndrome, 678 presentation, 674 H}'perchylornicronemia, 94 H)percoagulability, 657 hereditary syndromes, 420 in pregnancy, 6 I 9 warfarin adverse effect, 428 Hypercoagulable stale venous sinus thron1bosis \\'ith, 49 l H)peremesis gravidarum, 628 H}'peren1ia pseudoepherine/phen)'lephrine, 671 H)l>ereosinophilic syndrome, 3 I I Hyperestrogenism, 632 Hyperglycemia C ushing S)'l1dron1e, 333 diabetic ketoacidosis, 346 diabetic retinopathy, 525 drug reaction, 248 glucagon and, 325 h)1>erkalemia, 578 in1munosuppressants, J 20 pancreatic cel1 tumors, 336 protease inhibitors, 203 thiazides, 595 vitan1in B3 toxicity, 67 H)l>ergonadotropic hypogonadism, 625 H)l>ergranulosis, 466 H)l>er-lgE syndrome presentation, 675 Hyper-lgl'vl syndrome, I I 7 H)perinsulinemia, 63 I Hyperkalemia, 578 aldosterone in, 576 aliskiren, 5% angiolensin II receptor blockers,

596 causes of, 578

diabetic ketoacidosis, 346 potassiun1-sparing diuretics, 595 primary adrenal insufficiencr. 334 renal failure, 590 transfusions and, 42) tumor lysis S)'l1dron1e, 426 H)l>erkalemic tubular acidosis (type 4, 581 Hyperkeralosis, 466, 468 H)l>erlipidemia, 304 atherosclerosis and, 305 atwical antipsychotics, 56 I glomerular filtration barrier and, 569 in1munosuppressants, ) 20 nephrotic sp1drome, 584 thiazides, 595 H)l>eropia, 523 H)perorality Klliver-Buc)' syndrome, 499 H}'perosmolar coma OM type2, 345 Hn>erosmolar h}'pergl}·cemic state, 346 H)l>erosmolarity, 578 Hyperparath)'roidism, 342 associations, 688

calcium pyrophosphate deposition

disease, 459 cinacalcet for, 350 lab findings, 681 lab values in, 456 osteoporosis, 454 renal osteod)•lroph)' and, 590 Hyperphagia depre"ion with, 549 hn>olhalamus and, 486 Kluver-Bucy S)'ndrome, 499 Prader-Willi syndrome, 58 Hyperphosphatemia h)1>oparath)Toidism, 34 I renal osteod)•lrophy and, 590 tumor lysis S)'ndrome, 426 Hyperpigmenlation. See also Skin lesions adrenocortical insufficiency, 676 bleomycin, 4 3 I busulfan, 4 33 Audrocortisone, 350 hemochromatosis, 389 Peutz-Jeghers S}'ndrome as cause, 381 primar> adrenal insufficiency, 334 Hyperplasia, 206, 220 adrenal, 333, 334 parath)'roid, 34 I, 34 2, 347 Hiperplasia/malignancy uterine bleeding with, 6 I 9 Hjperplastic arteriolosclerosis, 304 Hiperplastic poll1"· 38 I Hiperprolactinemia, 248, 325, 5 I 4 anovulation, 63 I risperidone and, 561 Hiperp)'rexia with TCAs, 563 fTicyclic antidepressants, 563 H)')>erresonance (chest percussion), 667 pneumothorax, 666, 667 H)')>ersensitivity pneumonitis, 218, 661 Hipersensitivity reactions, I I 2-113 acute interstitial nephritis, 591 blood transfusions, 114 C3 deficiencv, I 07 cephalospori~s. 189 Craves disease, 339 lgE antibodies, I 05 mast cells and, 400 organ transplants, I I 9 penicill ins, 187, 188 rheun1atic fever, 3) 4 sulfonamides, 194 Hipersensitivity reaction 1)1>< II rapidly progressive glomerulonephritis, 585 Hipersensitivity reaction 1)1>< Ill acute poslstreptococcal glomerulonephritis, 585 Hipersensitivil)' reaction 1)1>< N contact dermatitis, 468 Hipersexualil)' Kluver-Bucy S)'ndrome, 499 Hipersomnia, 549 Hipertension, 303 ACE inhibitors for, 596 alcohol withdrawal, 559 aliskiren for, 596 o.-blockers for, 244 ang iotensin I[ receptor blockers for, 596 1

aortic dissection and, 306, 687 atherosclerosis and, 305 atrial fibrillation and, 297 autosomal recessive polycystic kidney disease, 592 fl-blockers for, 245 Charcot-Bouchard niicroaneurysn1s, 504 Cushing syndrome, 33 3 ecstasr intoxication, 559 episodic, 336 from renovascular disease, 592 C uillain-Barre smdrome, 512 heart failure, 319 h)peraldosleronism, 334 immunosuppressants, I 20 intraparenchymal hemorrhage, 50 I leAunomide, 475 local anesthetics, 537 loop diuretics for, 594 MOMA, 559 niicroang iopathic anemia, 415 minoxidil, 644 nephritic S}'ndrome and, 585 PCP, 559 pheochromoci1omas, 336 placental abruption, 626 polyarteritis nodosa, 317 preeclampsia, 629 in pregnanc)', 244, 629 renal cyst disorders, 592 renal failure, 590 sleep apnea, 665 thiazides for, 595 thoracic aortic aneurysms and, 306 treatn1ent for, 3J9 l)•ramine, 244, 563 H)1'ertensive crisis, 557 ~'1.AO inhibitors as cause, 563 phenoxybenzamine for, 244 pheochromoci1oma, 336 H)1'ertensi\'e en1ergency, 303, 585 RBC casts in, 582 H)1>ertensive nephropathy, 304 H)1>ertensive retinopathy, 525 H)1'ertensive urgency, 303, 319 H)1>erthermia atropine causing. 242 ecstasy intoxication, 559 MOMA, 559 H)1>erth)widism, 337, 338, 339, 632 amiodarone, 248 fl-blockers in, 245 choriocarcinon1as, 638 drug reactions, 248 hCC elevation and, 619 hydatidiform moles, 628 niature C}''Stic teratoma, 632 osteoporosis, 454 thionamides for. 347 H)1>ertrigl)'ceridemia, 94 acute pancreatitis and, 391 H)1>ertrophic cardiom)'opathy, 3 I I, 519 Pompe disease, 87 s~'Stolic murmur in, 292 H)1>ertrophic osteoarthropathy, 669 cancer association, 229 H)1'ertrophic pyloric stenosis, 353 H)1>ertrophic scar formation, 219 H)1>erventilation (therapeutic), 489 H}'perviscosity syndrome, 423 Hn>0reAexia Ll'vlN lesions, ; I9 magnesium hydroxide and, 393 Hypospadias, 6 10 H)'(>OSplenia, 408 H}'potension acute tubular necrosis '''ifh, 59 1

adrenal insufliciencl', 334 aclrenocortical insufficiency, 676

aliskiren, 5% amphotericin B, 199 angiotensin II receptor blockers, 596 baroreceptors in, 299

cardiac tamponade, 3 I5 cilostazol/dip)'ridamole, 429 endotoxins, 131 ephedrine for, 243 Cuillain-Barre syr1drome, 5 I2 h)1>e II hwersensiti,;t)' reactions, I I 2 IDL (intermediate-density lipoprotein), 94 IFN-0. (lnterferon-0.) clinical uses, 12 I hepatitis, 684 natural killer cells, I0 I IFN-J3 (lnterferon-J3) clinical uses, 12 I natural killer cells, I0 I

IFN-y (lnterferon-y), 102, 108, I 16 cachexia and, 228 chronic inflammation, 21 7 clinical uses, I 2 I C raves disease and, 339

lfosfamide, 4 33 hemorrhagic cystitis, 250 lgA and lgC deamidated gliadin peptide autoantibody, I 15 lgA antibodies, I05 ataxia-telangiectasia, I 16, I I7 breast milk, 622 in celiac disease, 375 deliciencr in, I 16, 674 h~]>er-lgl'vl syndrome, I I7 multiple myeloma production of, 423 passive immunity. l I0

Peyer patches and, 368 lgA anti-endom~sial autoantibody, I I 5 lgA anti-tissue transglutaminase autoantibody, I 15 lgA nephropathy, 585 Henoch-Schtinlein purpura and, 318 lgA protease, I 29 lgD antibodies, I05 lgE antibodies, I05 ataxia-telangiectasia, I 16, I I7 eczema, 468 h~]>er-lgl'vl syndrome, I I7 mast cells and, 400 type I h)1>, 122

son1atostatin and, 365 son1atostatinomas and, 336

InAammatory· breast disease, 635 lnAammatory diseases

Staph)'lococcu,es of, 210

Inferior colliculi, 492 ' Inferior gluteal nerve, 445

Innate immune response in acute inAammation, 2 l 5

erythema nodosun1, 472

pituitary, 343

ESR in, 214

106 Inhibitory pathway, 488 lnjur)' (unintentional), 270

azathioprine for, 432

wound healing, 2 I7 lnAammatory bowel disease (IBD), 376

calcification in, 21 I

Infections caseating granulomas with, 218

Inhibitors of complement activation,

forH HNS, 346 fructose bisphosphatase-2 and, 76 CIP effect on, 36S glucagon and, 32S glycogen regulation, 73, 8S hypokalemia from, S78

systen1ic nianifestations, 213

for ulcerative colitis, 376, 684 ln Auenza, I69 orthomvxovirus, 167 pneum~nia, 668 treatment/prevention, 201 Informed consent, 264

atherosclerosis, 305

lnhibin cryptorchidism, 637 Klinefelter syndrome, 624 Sertoli cell secretion of, 6 I4 lnhibin B cryptorchidism, 637 Klinefelter S)ndrome, 624 Sertoli cell secretion of, 6 I4

Insulin-dependent glucose transporters, 324 Insulin.independent transporters, 324

Insulin-like gro\\1h factor I (!CF- I) acron1ega1~·. 34 3 Laron syndrome, 34 3

signaling pathways for, 332 lnsulinomas

insulin and C-peptide in, 324 MEN I syndrome, 347 pancreatic cell tlln1or, 336 Insulin preparations, 348 Insulin resistance acanthosis nigricans and, 472 acron1egaly, 34 3 cortisol, 329 Cushings)rndrorne, 333

DM 1)1>< 2, 346 during pregnanc)', 6 I9 CH, 324, 327 non-alcoholic fatty liver disease,

Inguinal canal, 363

Inguinal hernia, 364 Inguinal (Hesselbach) triangle, 364 Inguinal ligament, 362, 363 lnhalational injury, 649, 662 Inhaled anesthetics, 537 Inheritance niodes, 59

385

PCOS,631 Insurance

disregarding in treatment, 266 Medicare/Medicaid as, 270 types of plans, 269 lntegrase inhibitors, 203

INDEX

lntegrins epithelial cells, 465 viral receptor, 166 Intellectual disahilitl', 545 autism and, 545 · Jnte l1ectua1ization, 54 3 Intention tren1or, 507

cerebellar lesions, 499 multiple sclerosis, 5 I I, 678 Interactions, drug, 233

lntercostobrachial nerve, 440 Interferon-"( release assay (IC RA). 140 lnterlobar arterl', 568 Interlobular ariery, 568 lntern1ecliate lilaments

9toskeletal element, 48 Intermediate lobe of pituitary, 323 lntermenstrual bleeding (AUB/IMB)., 6 19 Internal auditmy meatus, 493 Jnterna1 capsule

intraparenchymal hemorrhage, 50 I stroke effects, 502 Jnte rna1 caroti~ arte~~' cavernous sinus, ',o

circle of Willis, 491 Internal hemorrhoids, 360 Internal iliac arterl', 280, 357 Internal iliac lymph nodes, 6 10 Internal inguinal ring, 364 Internal jugular l'ein, 49 I Internal oblique muscle, 363 Internal rotation

arm (rotator cuff), 438 hip, 446 Jnterna1 spennatic fascia, 363

Internuclear ophthalmoplegia, 499, 531 multiple sclerosis, 678 lnterossei muscles, 4 39

Klumpke palsy, 44 I ulnar nefl'e, 440 Interpreting stud)' results, 260 lntersex, 62 5 Interstitial fluid, 300 Interstitial lung disease, 458, 66 I Interstitial nephritis

acute, 590, 591 as drug reaction, 250, 25 I NSAID toxicity, 475 penicillins, I88 Jnterstitia) pneumonia, 668 lnterstitium Jeul:ocvte extravasation and, 2) 6 lnterventricular foran1en, 279 lnterventricular septa! ruphlre, 309,

310 Intestinal ang ina, 380 Intestinal atresia, 353 Intestinal obstruction hernias, 364 superior mesenteric artery

smdrome, 357 Intestinal ,;illi, 356 Intimate partner violence, 267 Intoxication (psychoactil'e drugs), 558 Intracellular flu id (ICF). 569 lnlTacellular organisms, I27 lnlTacellular pathogens NK cells and, 40 I lnlTacellular receptors endocrine horn1one messengers,

332 lntracranial hemorrhage, 501 eclampsia, 629

lnlTacranial hypertension (idiopathic). 509 lnlTacranial pressure, 489 hydrocephalus, 5 I0 papilledema, 526 superior vena cava syndron1e, 670

lnlTaductal papilloma, 635 lntraocu1ar pressure, 524

lnlTaparench)'fnal hemorrhage, 50 I lnlTauterine device (IUD) copper, 643 endometritis, 634 Intrauterine growth restriction

Iron cleficiencr anen1ia, 4) 0 in anemia taxonon1y, 409 colorectal cancer, 382

libroid tumors, 634 Plummer-Vinson syndrome, 371 Iron poisoning, 418 lrre\'ersible cell injury, 207 Irritable bowel si11drome (IBS), 377 antispasmodic drugs, 24 I lschemia, 210, 655 acute tubular necrosis from, 59 1 atherosclerosis, 305

digital, 464

(IUCR) low birth weight, 62 I

Fanconi svnclrome, 574 in gastroi~testinal tract, 380

substance abuse, 600

necrosis and, 209 in renal medulla, 568

lnlT3'"1scular hemoly•is, 4 I 3 paro'.'l:ysrna1 nocturnal

hemoglobinuria, I07 Intravenous anesthetics, 537

lnlTaventricular hemorrhage, 500 low birth weight, 62 I neonatal respiratory distress S)'l1dron1e as cause, 647 in neonatal respiratory clistres.~

S)'ndrome, 647 lnlTinsic factor, 366, 367

[schen1ic brain disease, 500 lschen1ic heart disease heart murn1urs in, 293

manifestations of, 306 lschemic priapism, 637 Islet amyloid po1)1'eptide (JAPP), 2 I 2 Islet cell 9toplasmic antibodies, I I 5 Islets of Langerhans, 323 lsocarboxazid, 563

Intrinsic hemo1)'tic anen1ia, 414

lsocitrate dehydrogenase metabolic pathwa~'· 74

lnlTinsic pathway, 208 for coagulation, 404 coagulation defects of, 4 I8 heparin and, 428 lnlTinsic renal failure, 590

rate determining enz~n1e, 73 lsodison1y, ~~lsoAurane, '> I Isolation of affect, 54 3 lsoleucine

lntrons vs exons, 42, 43

lntussusception, 3i9 Meckel diverticulum as cause,

378 Jnulin extracellular volume and, 569 glomerular liltration rate and, 570 in proximal convoluted tubules,

classilication of, 8 I maple syrup urine disease and, 84 lsoniazid, I97 C)1ochrome P-450, 252 drug-induced SLE, 68 I hemolysis in C6PD deliciency, 249 hepatitis, 249 Mycobacterium tuberculosis, I 96

575 lm"1riant chain, JOO

sideroblastic anemia, 4 I I

Invasive carcinon1a, 220

visual distrubance with, 250

Jnvasi\'e carcinon1a

(cervical), 631

Invasive lobular carcinon1a (breast),

636

seizures, 250

lsoproterenol norepinephrine "'" 24 3 sympathomin1etic action, 24 2

Inversion, 445

lsosorbide dinitrate, 3 I 3

Jn vil'o biolilm-producing bacteria, 128 Involuntary treahnent, 268

lsosorbide rnononitrate, 313 [sotretinoin cystic acne, 66

Iodine deliciency in, 338, 339 infection conlTol, 204 teratogenicity, 600

lsovolurnetric contraction, 290 [sovolumetric relaxation, 290 ltraconazole

thionamide effect on, 347

lodophors, 204 IPEX s~ndrome, 102 lpralTopium, 241, 672 Jrinotecan, 434

in cell cycle, 430 targets of, 430

teratogenicity, 600

azoles, 199 mechanism (diagram), 198 Sporothrix schenckii, I 54 systen1ic ni>·coses, l 5 J

IV drug use common organisms, 179

ll'ermectin, 200

lrinotecan/topotecan, 38

Ivory white plaques, 663

Iris, 522 lritis, 524

IV phlebitis, 199 lxodes ticks, 146, 149, I 57

Iron

absorption of, 69, 368 anen1ia, 4 I6 anen1ia of chronic disease, 413

excess, 67 in hemochromatosis, 389 lab values in anemia, 4 I6 metabolic acidosis, 580 sideroblastic anemia, 4 I I toxicity of, 69 toxicity treahnent, 247

J /AK2 gene, 225 mutation in niyeloproliferative

disorders, 425 Janeway lesions, 3 I3, 675 jarisch-Herxheimer reaction, 148 Jaundice, 387 alcoholic cirrhosis and, 385 biliary !Tact disease, 389 cholangitis, 362, 390

cirrhosis, 383

Crigler-Najjar syndrome, 676 drug reaction, 248 fructose intolerance, 80 galactosemia, 80 graft-versus-host disease, I I9 hepatitis B, 184 hepatocellular carcinoma, 386

hereditary h~perbilirubinemias, 388 leptospirosis, 147 newborn hemolrtic disease, 397 painless, 676 pancreatic cancer, 39 1 persistent neonatal, 387 ToRCHeS infections, I82 transfusion reaction, 114 yellow fel'er, I68 Jaw jerk reflex, 495 JC virus (John Cunningham virus) HIV-positive adult,, I77 immunocompromised patients, J 18

pol)·omaviruses, I64 Jejuna) and ilea] atresia, 353 Jejunum, 3;6 Jerl'ell and Lange-Nielsen syndrome, 297 Jimson weed, 24 2 Job syndrome, I I6 Jod-Basedow phenomenon, 339 Joint abnorn1alities h~permobility, 5 I J point in ECC, 296 Jugular foramen, 491, 493 Jugular \'enous distention ()VD), 312,670 Justice (ethics). 264 Ju"enile idiopathic arthritis, 524 Ju"enile poll1'osis, 38 I Juxtaglomerular apparatus ()CA), 577 liltration, 571 juxtaglomerular cells, 568

renin secretion, 576

Juxtaglomerular cells tun1ors in, 3 34

K Kala-azar, I58 Kallikrein C I esterase inhibitor deliciency, 107 neulTophils and, 398 Kallmann S)'ftdrome, 486, 62 5 Kaposi sarcon1a, 469

AIDS and, 184 bacillary angion1atosis vs., 469

HHV-8, 165 HIV-positive adult,, I77 oncogenic microbes and, 226

Kartagener syndrome, 49, 278 infertility with, 6 15 obslTucti\'e lung disease, 661 presentation, 674 Karyol)~is, 207 Karyorrhexis, 207 Ka1yol)1,ing, 55 Kawasaki disease, 316 presentation, 67;, 676 Ka~'Ser-Fleischer rings \~li lson disease as cause, 389 K cells, 365 K complexes/sleep spindles, 485 Kegel exercises, 588 Keloid scars, 219

Keratinoc}1es

in wound healing. 217

INDEX

Keratin pearls, 669 Keratoconjunctivitis, 164 Keratoconjunctivitis sicca, 460 Keratomalacia, 66

presentation, 675 UTis caused b)', 181 Klebsie//a spp., 145 alcoholism, 179

Keratosis

bronchopneun1onia, 668

actinic, 472 hyperkeratosis, 466 parakeratosis, 466 seborrheic, 468 Kemicterus, 194, 204 Kemohan notch, 517 Ketamine, 537 Ketoaciclosis, 72, 90 Ketoconazole, 198, 199, 644 9tochrome P-450, 252 gynecomastia from, 635 PCOS,63 1 reproductive honnones and, 640

currant jellr sputum, 145, 186 Cram-negative algorithm, 141 kicl ner stones, 586 lactose fermentation, 144

Ketogenesis

diabetic ketoacidosis, 346 diagram of, 74

nosocomial infections, J85 pneumonia, 668 urease-positive, 127 urinary tract infections, 589

Klinefelter syndrome, 624 chron1oson1e association, 64 gynecomastia, 635

anatom)', 568 chronic graft nephropathy, 119 donor transplantation of, 568 embr)'ology of, 566 endocrine functions, 577

glomerular structure, 568 hormones acting on, 578

solitary functioning. 567 transplant prophylaxis, 120 Kiclne)' disease anemia of chronic disease and, 413

hypertension, 304 prenatal diagnosis of, 566, 567 Kiclne)' endocrine functions, 577 Kiclne)' injury' tumor lvsis svndrome, 426 Kidneys • •

blood flow regulation, 300 calcilication in, 21 1 embr)'ologic derivation, 599 ischen1ia in, 210 location of, 354 retroperitoneal location of, 354

sclerosis, 464 Kiclne)' stones, 586 Crohn disease association, 376 electrol)1e disturbances, 579 hematuria with, 582 horseshoe kidney and, 567 hydronephrosis, 587 hyperparath)'roidism, 342 postrenal a1..oternia, 590

risk factors for, 581 UTls, 181 Kiesselbach plexus, 657 Ki11ian triangle, 378

Kimmelstiel-Wilson nodules diabetes niellitus, 345 Kinases, 73 Kinesin, 48 Kinin cascade/pathwa}'S, 404 Kinl·y hair, 5 I

Kissing bug (disease vector), I 58 Klebsiella pne-umoniae cephalosporins, 189 encapsulation, 127

Lactiferous sinus, 635 Lactoferrin

in neutrophils, 398 in respiratory burst, J09 Lactose-fennenting enteric bacteria,

126, 144 Lactose intolerance, 375

Lactose metabolism, 39 Lactulose for hepatic encephalopathy, 385,

394 Lacunar infarcts, 502

463 autoantibodr. II 5 as paraneoplastic syndrome, 229 small cell lung cancer, 669 Lamina propria, 356 Peyer patches in, 368 in Whipple disease, 375 Lamins, 48

Baker crst, 452

Ki cine)'

Lateral ventricles herniation S)'t1dron1es, 517 optic radiation, 530 ventricular S}'Stem, 492 Laxati\'es, 394

deliciency, 77

Kluver-Bue)' S}ndrome, 499 Knee exan1ination, 44 3 Knee injuries/conditions Jigan1ent and meniscus, 452

arachidonic acid pathwa)', 474

pynwate deh>·drogenase complex

Laclcl bands, 379

insulin deficiency, 345

Ketonen1ia, 345 Ketonuria, 345 Ketorolac, 475

Lateral spinothalamic tract, 496 Lateral thoracic artel)', 447

testicular tumors, 638 Klumpke palsy, 441

metabolic site, 72

rate-detennining enzyme for, 73 Ketone bodies, 90

1vl£LAS syndrome, 59 metabolic acidosis, 580

prepatellar bursitis, 452 Knees common conditions of, 45 1 Knock-0ut/Knock-in genes, 56 KOH preparation, I 52 Koiloc,1es condvJomata acuminata, 184

Koilocyiosis, 468 Koplik spot,, 183, 675 Korsakoff psychosis, 5 59 Korsakoff syndrome, 546 Krabbe disease, 88 KRAS gene, 22 S, 669 adenomatous colonic pol>1's and,

381 colorectal cancer and, 383

lung cancer and, 669 Krebs cycle. See TCA C)'cle Krukenberg tumor, 373, 633

Ki.ibler-Ross grief model, 550 Kulchitskl' cells, 335, 669 Kupffer c~lls, 361, 399 Kuru, 178 Kussmaul respirations in diabetic ketoacidosis, 346 Kussmaul sign, 3) 9

Kwashiorkor, 7 1 Kyphoscoliosis, 519 Kyphosis, 84 K'", 232

L Labetalol, 245 gestational hypertension, 629 h)1'ertension in pregnanC)', 319 Labia, 6 11 male homolog of, 609 Labile cells, 46 Lach man test., 44 3 Lac operons, 39 Lacrimation reflex, 495

Lactase deliciency, 81 Lactation, 622 dopamine an~~ 326 OX)10Clfl

for. ) ,o

progesterone and, 6 I6 prolactin and, 326 Sheehan syndrome and, 34 3 Lactational niastitis, 63 5

Lactic acid dehydrogenase, 77 Lactic acidosis

ethanol metabolism and, 71, 72 exercise and, 656

Lambert-Eaton niyasthenic syndron1e,

Lamivudine

HN therapy, 203 mechanism, 20 I Lamotrig ine

for epileps)', 532 rash caused by, 250 Lancet-shaped diplococci, 136 Landmark., (anatomical) for dennatomes, 498 midclavicular line, 649 pudenda) nerve block, 445 Langerhans cell histiOC)1osis, 426 pulmonary, 661 Langerhans cells Birbeck granules in, 681 proliferatil'e disorder of, 426 pulmonary histiOC)1osis, 661 in skin, 399 Language development, 621 Lanosterol synthesis, 198 Lansoprazole, 392 Laplace law, 283, 647 Large cell carcinoma, 669 Large-vessel vascu]itis, 315 Laron syndrome, 34 3

Larva migrans, 159 La1yngopharyngeal reflux, 37 1 La1yngospasm, 353 drug-induced, 557

Lar)'nX, 648 museJes of, 606 respiratory tree, 648 Lar)'nXmuscles, 606 Lassa fever encephalitis, 167

LOH exuclates, 214 tun1or burden indicator, 227 LDL (low-< I deficiency, 216 Leukocite adhesion deficiency, 117, 216 Leukocite alkaline phosphatase (LAP), 398 Leukocite esterase, 181, 589 Leukocite extravasation, 21 S, 216 Leukocites basophilia in CML, 400 leukemias, 424 in urine, 181, 582, 589 Leukoc)1oclastic vascu1itis, 173 Leukocitosis, 213 Clo.erplasia, 377 Lymphoid neoplasms, 424 Lymphoid structures, 96-97 Peyer patches, 356, 368 Lymphoma carcinogens causing. 226

cyclophosphamide for, 433 C)tarabine for, 4 32 doxombicin for, 43 1 etoposide/teniposide for, 4 34 Hodgkin, 42 1 h)1>ersensitivil)', 112 MYCLJ gene, 225 Ml'CN gene, 225 l'vl)'cobacterial cells, 196 Mymbacterium spp., 140 inlTacellular organism, 127 1\4yc.obacteriun1 avium.intracellulare, 140 HIV-positive adults, 177 prophylaxis with HIV, 198 vertebral osteomyelitis, 180 Myc.obacterium leprae animal transmission, 149 diagnosis, 141 rifamycins/dapsone, 196 1\4yc.obacterium marinum, 140 Myc.obacteriun1 pueunwuiae, ) 26 Mycobacterium scrofulaceum, 140 Mymbacterium spp. granulon1atous inflammation, 218 Mymbacterium tuberculosis, 140 aerobic organism, 126 culture requiren1ent~ for, ) 26 osteomvelitis, 180 therap~utic agents, 196, 197 l'vl)'colic acid isoniazid, 197 S)'flthesis of, 196 l'vl)'cology, 151-154 l'vl)'cophenolate mofetil, 36, I 20, 121 1\4yc.oplas11w pne-umoniae, 150 anemia and, 4 J5 en1hema multiforme, 47 1 teh-acyclines, 192 Myc-0plasma spp al)pical organisms, 179 interstitial nephritis with, 591 niacro1icles, J93 pneumonia, 179, 668 l'vlycoses cutaneous, I52 s~'Stemic, J 5 I l'vlycosis fongoides, 422 l'vlydriasis C-protein-linkecl second receptor, 238 niuscarinic antagonists for, 24 J pupilla1y conlTol, 527 saccular aneurvsn1, 504 l'vl)'elencephalon: 478 l'vlyelin, 482 l'vlyeloblasts (peripheral smear), 424 l'vlyelod}'Plastic syndromes, 423 sideroblastic anemia, 41 1 l'vlyelofibrosis, 425 dacroc)tes in, 406 l'vlyeloid neoplasms, 424

INDEX

Myeloperoxidase, I09 in neulTophils, 398 Myeloproliferative disorders, 425 ANIL,424 basophilia, 400 chronic, 425 hydroerglycemia, 248 myopathy caused by, 250 tachyphylactic drug interaction, 23 3 Nicardipine, 313 Nicotinamicle adenine di nucleotide.

See NADH (nicotinamide adenine dinucleotide) Nicotinamicle adenine di nucleotide

proximal upper and lower

phosphate. See NADPH

exlTemitl', 490 Neurologic d rug r~actions, 250 Neurology, 478-532 anatomy/physiology, 481-503 embryology, 478-480

(nicotinamide adenine

clinucleotide phosphate) Nicotinamicles, 7) Nicotine

teratogenicity, 600

558 Nicotinic acetylcholine receptors.

166, 237 inhibitor), 240 Niemann-Pick disease, 88, 674 Nifeclipine, 319, 629, 643 Nifurtimox, I 58, 200 Night blindne•·cosis

terbinafine, 199 tinea unguium, 152

Oocysts acid-fast stain, 155 Toxoplasmosis, 156 Ziehl-Neelsen stain, 125 Oogenesis, 61 7 Oophorectom)', 61 1 Open-angle glaucoma, 524 carbachol for, 240 pilocarpine for, 240 Operant conditioning, 54 2 Operating point of heart, 284 Ophthalmia neonatorum, 183 Ophthalmology, 522-529 Ophthalmoplegia, 66 cavernous sinus syndron1e, 530 common lesions with, 499

internuclear, 531 \Vernicke-Korsakoff s~nclrome,

66, 559 Opioids, 538 agonists, 538 Beers criteria, 246, 247 lgE-indepenclent mast cell degranulation, 400 intoxication and withdrawal, 558 niixecl agonist/antagonist

analgesics, 539 pentazocine and, 539

sleep apnea, 665 toxicity treatn1ent, 247

withdrawal/detoxification, 564 Opponens digiti rninimi muscle, 4 39

Opponens poll icis muscle, 439 Opportunistic fungal infections, 153-154 Oppositional defiant disorder, 545 Opposition (thumb), 439, 442 Opsoc1onus-n1yoclonus syndrome,

229, 335 Opsonin, I 06, 213 Opsonization, 98, 104, 106, 112 Optic canal, 493 Optic chiasm, 492 circle of Willis, 491 pupilla1y reaction, 527 Optic disc, 522 papilledema in, 526 Optic gliomas neurofibromatosis, 678 Optic nerve (CN II), 494 embryologic deri,"1tion, 599 anatomv, 522

functio~ of, 494 optic tract, 492 pathway, 493 Optic neuritis, 51 1 Optic neuropathy, 197 Optochin C ran1-positive antibiotic test, 134

Oral advance directives, 265 Oral contraceptives (OCPs) endon1etriosis, 634 hepatic adenomas and, 386 ovarian neoplasms, 632

PCOS,631 prolactin effects on, 326 reproductive horn1ones, 640

SHBC effects on, 332 venous sinus thrombosis with,

491 Oral glucose tolerance test, 345

Oral hairy leukoplakia, 177 Oralfantestina) ganglioneuron1atosis,

347 Oral rehydration therapy, 146 Oral thrush, 177 Orange body Auids, 196 Orbital fibroblasts (Craves orbitopathy), 339 Orchiectomv, 637 Orchiopexy,· 637

Orchitis, 170, 639 Orexigenic effect, 327 Orexin, 556 Orexin receptor antagonist, 534 Organ failure, in acute pancreatitis,

391 Organogenesis embryologic deri\"1tives, 598, 599 errors in, 599

fetal development, 598 teratogens, 600

I

INDEX

Org:moph0>phatcs tO\ic1t\

trcoatment. 2-+i'

Org;m tr;msplanl> 01.atluoprine for. 432 C\tomegalmims, 186 hair\ lculoplakia and, 4i0 kidne\'s, 568 wnc' ca;ts, 582 Orgnnu1n vasculosun1 of the Jan1ina

terminalis (OVLT), 486 Orientntion, 545 Origin or repl ication, 38 Orlilinuria. 85 L:idnc\ 'tone!. and. 586 urea C\de. 82 Orn1th11;e tr.mscarbamrlase deficicllC). 6i. -4, 83 Orofat ics or, 167, 168 influcn1.a vin1ses, 169 , 450 bone fonmtion. 4 50 cortilOI effect on, 329 Pa!;"I , 450 bisphosphonale effects. ii) bone rormalion, 450 111onoc\ tc differentiation into, 399

osteopctr0>is. 4 55 Pogct disease or bone. 455 Osteod)>troph1 .\!bright hcrcditar\. HI rennl, HZ. 590 Ostcogenesis imperfocta, 51 bisphosphonnles, 4i5 collagen and, 50 presentation, 674 Ostcogenic ""'comas, 455, 457 Ostcoid osteorna, 456 Ostcoma. 221, 456 Osteo1n:11::icia h)llOphe>, 455 lab '"lues m. 4 56 Osteom\elilh, ISO diognostic findings, 681 Prrodomona1 "'"'!linosa. IH sickle cell anemia. 4 H Staphvlococcus ""''"'· 135 Osteonccros1s, 455 bisphosphonales causing, 4i5 Oslcopenia. 455 Ostcopclrosis, 454, 455, 456 Ostcoph) tes, 458 Ostcopormis, 454 bisphosphonaks, 475 cortico, 120 Cmhing S) ndrome, 333 denosu1nab. 122 dmg rcachon. 250 estrogen, 450 CauchCT disease. 88 hcp:irin. 42" homoC\>linuria. M hom>0~e replacement therapy, &H lab '"'lues m. 456 menopamc. 622 pih1ilar\ prolactinoma>, 325 raloxifonc for, 435, 642 tcripnratidc for. 4i6 thiozides for. 595 vcrtchrnl

coinprc~.si on

fractures,

689 Ostcosarcomn, 221, 457 Otiti!i1ncdi:1 brain ab" ith, 180 Haemophilus influen;:ae, 128, 142 histiOC\1e>an' cell hisliOC)1osis, 426 Streptococcw p11eu111011iae, 136 \\Cgencr granulon1atosis and, 310tolog_i. 521 01otoxicill aminogi)cosidc>, 191, 204. 600 cihil is in, I 4 7 tern1ination of, 642

ToRCHeS infec tions, 182 Turner synd rome and, 624 tw inning in, 602 urinary tract infections, 181 venous sinus thrombosis in, 49 1 vitamin B9 deficiency, 68 Pregnancy complications, 626-627 Pregnenolone, 328 Prehn sign, 639 Preload in cardiac output, 282 Premature ejaculation, 563 Premature labor a nd delivery cryptorchidism and, 637 low birth weight \\;th, 621 murn1ur in pren1aturity, 294 neonatal respiratory distress S)'lldrome a nd, 647 Premahlre ovarian failure, 622, 631 Premenstrual clysphoric disorder (PMDD), 563 Premotor cortex, 489 Preoptic nucleus, 486 Prepatellar bursitis, 452 Preprocollagen, 50 Preproinsulin, 324 Prepuce, 612

Prerenal azoten1ia, 590 Presbycusis, 268, 521 Presbyopia, 523 Preschool age development, 621 Presenilin, 508 Presentation sympton1s and signs. See a/,c,o Diagnostic maneuvers/ signs cerebral circulation and, 502-504, 503-505 childhood conditions, 453 clin ically significant reffexes, 498 cranial nerve lesions, 520 inAan1mation cardinal signs, 2) 3 Kussn1aul sign, 319 lower extremity, 44 3-444 lumbosacral radiculopathy, 446 spinal cord lesions, 5 I 8 upper extremity, 440, 44 1, 453 upper extren1ity nerves, 442 Pressure-volume loops, 290 PreS)'llaptic cxriutoreceptor, 239 Pretectal nuclei, 527 Preterm birth common cause of death, 270 Pretest probability, 257 Prevalence diagnostic test evaluation, 257 incidence vs., 259 observational studies, 256 Prevalence vs. incidence medical error correction, 259 Prerotel/a spp., 179 Priapism, 637 sickle cell anemia, 4 I 4 trazodone a nd, 564 Primaquine, 157 hemolysis in C6PD deficiency, 249 Prin1ary adrenal insufficiency, 3 34

Primary• amyloidosis, 2 I 2, 68 1 Primary• bacte rial peritonitis, 384 Primary• biliarr cirrhosis labs/fi ndings, 680 Primary• central nervous system lymphoma (PCL}, 422 Primary• ci1iary dyskinesia. See Kartagener syndron1e Primary• disease prevention, 269 Primary• glomerular disease, 582 Primary• hemostasis, 403 Primary• h)'peraldosteronism, 3 H h~pertension with, 303 markers in, 579 Primary' h)1>erparath~Toidism, HI, 342 Primal}'' h}pertension, 319 Primary• h~pogonadism, 62 5 Primary• hypoparath yroidism, HI Primary• ovarian insufficiency, 631 Primary• polyq1hemia, 4 2 5 Primary• sclerosing c holangitis, 389 u1cerative colitis, 376 Primary•spontaneous pneumothorax,

667 Primase, 38 Primidone, 507 Primitive atrium, 278 Primitive pulmonary vein, 278 Primitive reffexes, 498 Primitive ventricle, 278 Pringle nianeuver, 355 PR interval, 296, 298 prolonged, 298 shorte ned, 297 Prinzmetal angina calcium channel blockers for, 3I 9 ischemic manifestations, 306 Prions, 178 Privacy and confidentiality, 268 Probenecid, 252 cidofovir \\;th, 202 for gout, 685 gout, 476 Procaine, 537 Procarbazine, 251, 4H Procedure bias, 260 Process improvement model, 271 Process (quality measurement), 271 Processus vaginal is, 610 Procoagulation, 405 Progesterone, 6 16 ganulosa cell tumors, 6H lactation a nd, 622 menstrual c1•c le, 618 O\'Ulation, 6'17 pregn ancy, 6 19 signaling pathways for, HZ source and func tions of, 6 I 6 Progesti ns, 64 2 endon1etriosis, 634 Programmed cell death, 208 Progressive multifocal leukoencephalopathy (PML), 482, 5 12 HIV-positive adults, 177 polyomaviruses, I 64 rituximab, 4 35 Proguanil, 200 Projection, 54 3 Prokary•otes DNA replication in, 38 mRNA start codons, 40 RNA polymerases in, 42 Prolactin, 326 circadian rh11hm, 485 lacta tion a nd, 622

INDEX

Prolactin (continued) pregnancy, 619 secretion of, 323, 325 secretion regulation, 6 16 signaling pathw·ays for, 332 tuberoinfundibular pathway, 487 Prolactinon1as

dopamine agonists for, 326 Proliferative glomerular disorders, 582 Prometaphase, 46 Promoters (gene e'l'ression), 4 1 Promyelocytic leukemia, 66 Pronephros, 566 Proopiomelanocortin, 323, 325 Propanolol, 339 Propantheline, 240 Proper hepatic artery, 3;5 Prophase, 46 Prophylaxis (antimicrobial), 197, 198 Propionyl-CoA carboxylase metabolic pathways, 74 vitamin B- and, 68 Propofol, 537 Propranolol, 245 essential tremor, 507

Proprioception. See Peripheral neuropathy

Friedreich ataxia, 519 Propylthiouracil, 33 l agranuloci1osis, 249 aplastic anemia, 249

thionamides, H9 for th~·roid storn1, 339 Prosencephalon, 478 Prostacyclin, 474 Prostacyc1in analogues, 671 Prostaglandin analogs, 253 Prostaglandins arachidonic acid pathway, 474 aspirin effects, 475 cortisol effect on, 329 glaucoma ITeatment, 539 kidnev functions, 577 PDA ;ncl, 280 primary' dysmenorrhea, 633 Prostate cancer adenocarcinornas, 640

eslTogens for, 642 incidence/mortality of, 223 leuprolide for, 641 metastases from, 224 tumor suppres.wr genes and, 225

Prostate gland, 6 12 female homolog of, 609 lymphatic drainage of, 610 with urethral injury, 613 Prostate-specific antigen (PSA)., 639 Prostatic acid phosphatase (PAP), 640 Prostatic adenocarcinoma, 640

Prostatitis, 639 gonorrhea, 184 Prosthetic devices

Stapliyloccus epidermidis, 135 Prosthetic heart valves, 415 Protamine sulfate, 247, 427 Protease inhibitors acute pancreatitis, 39 1

fat redislTibution, 249 HIV therapy, 203 hj'(>erglycemia, 248 mechanism (diagram), 201 naming convention for, 252 Proteases, 367

Proteasome, 48

Protein A, 129, 135 Proteinases, 398

Protein CIS deficiency, 420 Protein kinase A

fructose bisphosphatase-2 and, 76 glycogen regulation, 85 Protein metabolism, 74 Protein phosphatase, 85 Protein S}nthesis, 187, 201 elongation, 45

Proximal renal tubular acidosis (type 2), 581 PRPP (glutamine-phosphoribosyl pyrophosphate) amidotTansferase, 73 Pruritus

anal, 159 atopic dermatitis, 468 biliary• !Tact disease, 389 chloroquine, 200

initiation of, 45

cutaneous mycoses, I52

insulin and, 324 metaboilic site, 72 posttranslational modification, 45 sequence of, 4 5

dermatitis herpetiformis, 47 1 ectoparasites, 161

termination, 45

trimming. 45 Protein S}nthesis inhibitors, 191, 252 Proteinuria, 583

ACE inhibitors for, 596 angiotensin II receptor blockers, 596 diabetes mel1itus, 345 nephritic syndron1e, 585

nephrotic sp1drome, 584, 678 preeclampsia, 629 renal papillary• necrosis and, 591 serun1 sickness, I ) 3 Proteolysis cortisol and, 329 in insulin deficiencv, 345 Proteus mirabi/;s ·

bacterial cystitis, 589 cephalosporins, 189 kidney stones, 586 penicill ins for, 188 urinarv tract infections, 589

UT!s,'181 Proteus spp Cram-negative algorithm, 141 urease-positive, 127 xanthogranulomatous

pyelonephritis, 589 Prothrombin complex concentrate transfusion,

421 warfarin effect on, 428 Prothrombin gene mutation, 420 Prothrombin time (!YT'), 418 Protofilament, 48 Proton pump inhibitors (PPls), 392 acute interstitial nephritis, 591

Beers criteria, 247 gaslTin and, 365 for Helicobacter pylori, 146 naming convention for, 25 3 Proto-oncogenes, 222 Protozoa

CNS infections, I56 C l infections, 155 hematologic infections, 157 rniscel1aneous, ) 58

waten•diarrhea, 179 Proxim~I convoluted tubules (PCT) inATN, 591 defectopituitarism, 343 myelodysplastic syndromes, 423 of thyroid gland, 339 Radiation therapy acute pericarditis ancl, 3 I4

effect on purine synthesis, 36

Toxoplasma gondii, 684 Pyrimidine dimers, 40

osteosarcon1as, 457 pancreatic cancer, 39) papillary thyroid carcinoma risk,

P)Timidines de novo synthesis, 36 mutations in DNA, 39

readn1issions with, 270

Pyrimidine sin thesis, 475 Pyrogens, 213 P)Tuvate carbo')'lase, 77, 78 metabolic pathways, 74 vitamin B7 and, 68 Pyruvate dehyclrogenase complex, 76 deficiency, 77 metabolic pathways, 74 vitamin B1 and, 66 P)Tuvate kinase, 74 Pyruvate kinase deficiency, 4 I4 in anemia taxonomv, 409

echinOC)1es in, 406. Pyruvate nietabolisn1, 77

Pyuria, 591

Q Q fever rickettsial disease, I 50 transmission, 149 QRS complex, 296 QT interval af)1>ical antipsychotic effect on, 561

ang iosarcomas, 469

lymphopenia, 416 neulTopenia, 4 I6

340 Radiculopathy lumbosacral, 446 Radiocontrast dye

lgl?.-indepenclent mast cell degranulation, 400 Radon as carcinogen, 226

lung cancer, 669 Ragged reel muscle fibers, 59 Rales, 31 I Raloxifene, 4 35, 642 Raltegravir, 201, 203 Ran1elteon, 534

Ramipril, 596 Ranibizumab macular degeneration, 524 Ranitidine, 392 RANK-L, 330, 450 Raphe nucleus, 483 Rapid-eye movement (REI'vl) sleep, 485 Rapid filling (cardiac cycle), 290 Rapidly progressive glomerulonephritis (RPCN), 585 Rapid squatting on auscultation, 293

Rasagiline, 536 Rasburicase, 435, 586 in tumor lvsis svndron1e, 426

RAS gene, 3t0 ' Rashes ''blueberry muffin'", 169 butterfly, 677 carbapenems, I90 childhood, 183 C)1omegalovirus, 182 desquamating, 3I 6, 676 fluoroquinolones, 195 heliolTope, 229 niacrolicles, J93 nipple/areola, 678 palms and soles, I 50, 67 5 penicillinase-sensitive penicillins,

188 rickettsial diseases, 150 rubella, 169, 182 syphilis, 147, 184 un\'accinated children, 186 Rathke pouch, 323, 516, 599 Rationalization, 543 Raynaucl phenomenon, 464 Buerger disease, 316 calcium channel blockers for, 3I 9 presentation, 677 SL£, 677 Razor bumps, 468 RBC cast' (urine), 582, 585 Rb gene, 225 Reabsorption/secretion rate calculation, 572 Reaction forn1ation, 54 3

Reactive arthritis, 461 Campylobacter jejuni, 145 chlamy·dia, 148, 184 HLA-B27 and, JOO presentation, 677 Reactive attachment disorder, 544 Readmission recurrences, 270

Rea"ortment (viral), 162, 169 Recall bias in studies, 260 Receptor-n1ecliatecl endoc)1osis, 47 Receptors adrenergic, 231

binding of, 234 histamine, 231

muscarinic acel)•lcholine (ACh), 231 nicotinic acetylcholine, 23 I parasympathetic, 23 I vasopressin, 231 Receptors (l'iral), 166 Receptor tyrosine kinase honnone niessenger, 332 as oncogene product, 225 Recessive inheritance, 59

Recombinant C)1okines, I 2 I Recombination (viral), 162 Recruiting study participants, 260 Rectal \'eins, 359 Rectosigmoid junction

blood supply to, 357 Rectum anaston1osis at, 359 blood supply and innervation, 357 familial adenomatous pol}l>OSis,

381 Hirschsprung disease, 378 ischemia susceptibility, 210 portosystemic anastomosis, 359 Rectus abclon1inis niuscle, 363

INDEX

Recurrent branch (median nerve), 440 Recurrent lar)'ngeal nerve, 605, 670 compression of, 669 Pancoast tumor, 670 Red cell cast,, 317 Reel-green color blindness, 197 Red (hemorrhagic) infarct, 210 Red hepatization, 668 Red man syndrome, 190 Red muscle libers, 449 Red nucleus (midbrain), 499-539 Reclox reactions

radical injury and, 210 vitamin B, and, 67 Red pulp (spleen), 98 Red rashes of childhood, 183 Reduced lilling (cardiac cycle), 290 Recluviid bug (disease vector), 158 Reed-Sternberg cells, 421 Refeecling s~ndrome, 555 Referred pain cholecvstitis. 390 from diaphragm, 649 free

free air under diaphragn1, 374

pericarditis, 281 ReAex bracl)°cardia, 576 ReAexes clinical, 495, 498 cranial nerve, 495

517 primitive, 498 ReAex tach)'cardia, 244 motor neuron sign,

Refractive errors (vision), 523

Refractory• h)'pertension, 644 Ref.mm disease, 47 Refusing care minors, 267 Regaclenoson, 307 Regan-Lowe medium, 126 Regional specilication (brain), 478 Regression, 54 3 Regular insulin. See insulin

Regulation of gene expression, 4 1 Regulatory•T cells, 102 cell surface proteins, 110 Regurgitation inCERD, 371 Reichert cartilage, 606 Reid index, 660 Reinforcement, 542 Reinke cry'Stals, 639, 682 Relapse stage, 556 Relapsing fever anin1al transn1i s.~io n, ) 49

lice, 161 Relationship with patients, 266 Relative risk reduction (RRR), 258, 691 Relative risk (RR), 256, 258, 262, 691 Reliabilitl', 259 Remodeling (tissue), 217 REM sleep, 485 Renal agenesis

bilateral, 566 unilateral, 567 Renal arterl', 357, 568 horsesh0e kidney, 567 stenosis, 596 Renal blood Aow (RBF), 568, 692 acute injury and, 591 endocrine function and, 577

NSAID effects on, 577 renal plasma Aow and, 570 Renal cell carcinomas, 587 associations, 690

be\'acizumab for, 4 34 carcinogens for, 226 chron1oson1e association, 64

horseshoe kidne)' and, 567 h)1' ercalcemia and, 229 in1munohistochen1ical stain for,

228 metastases of, 224 recon1binnat C\1okines, 121

therapeutic antibodies, 122 von Hippel-Lindau disease, 678 Renal clearance, 570, 692 Renal cortex, 568 atrophy of, 587 Renal 9•tic disorders, 592 Renal disorders/failure, 590 acute injury'. 590 consequences of, 590 diabetes mel1itus, 345 diffuse cortical necrosis, 590, 591,

592 Enterotoxigenic Escherichia coli

(EHEC), 145 ESR in, 214 Fabry• disease, 88 features of, 579 guanosine analogs, 20 I labs/linding,t pattern, 381 Saxagliptin, 349 SBL-\ cancer S)'lldrome, 22 5 Scabies, 161, 200 Scalded skin smdrome Stapliylo~us aureus, 135 toxic shock syndron1e toxin, 13 3 Scales (skin), 466 basal cell carcinoma, 473 pityriasis rosea, 472 psoriasis, 468 seborrheic clern1atitis, 467

Scaphoid bone, 439 Scar fonnation, 219 Scarlet fever presentation, 136, 675 rash with, 183 Streptococcus pyogenes, 136 S cells, 365 Schatzki rings, 371 Schaumann bodies, 662 Schiller-Duval bodies, 633 Schilling test, 412 Schistoc)tes, 407 HELLP S)'lldrome, 629 in intravascular hen1olysis, 413 in microangiopathic anemia, 415 Schi,erosmolar h)1>erglrcemia nonketotic syndrome, 346

INDEX

Sialaclenitis, 370 Sialolith iasis, 370 Sialvl-Lewis', 20;, 216 Sibiing studies, 2;6 Sickle cell a nemia, 414 in anen1ia taxonomy, 4-09 ESR in, 214 sic kle cells in, 407 Sickle cell disease autosplenectomr, 689 missense n1utation, 39 osteonecrosis and, 455 postsplenectomy state in, 98 priapism, 637 renal papillary necrosis, 591 Sickle cells, 407 Sideroblastic anemia, 407, 4 1I in anen1ia taxonomy, 4-09 iron granules in, 408 labs/finding1>hilis, 147 heart disease with, 315

presentation, 67 5 ST!, 184 tabes dorsalis, 518 testing for, 148 thoracic aortic aneu1ysms and, 306

ToRCHeS infection, 182 Sn>hilitic heart disease, 3 I 5 s)~ingomyelia, 480 Homer s~ndrome, 528

spinal cord lesions, 518 s)~inx, 480 Systen1ic an1yloidosis, 212 Systen1ic juvenile idiopathic arthritis,

460 Systemic lupus el)1hematosus, 462 Ra)'T1aud phenomenon, 464 S)stemic mycoses, 151 Systen1ic prin1ary carnitine

deficiency, 89 S)stemic senile amyloidosis, 212 $)stole cardiac cycle, 290 heart murmurs of, 292, 293 heart sounds of, 293

S)stolic ejection, 290 Systolic murn1ur, 31 I

INDEX

T Tabes dorsalis, 147, 184 spinal cord lesions, 518 Tachyarrh)1hmia isoproterenol for e\':tluating, 24 2 th~·roicl storn1,

339

Tachycardia alcohol withdrawal, 559 amphetamines, 557, 558 ~blockers, 245 MOMA ascause, 559 metronidazole, 195 with rnyocarclitis, 3J5 PCP, 559 phenoxybenzamine, 244 reflex, 244 stimulants a nd, 5 58 supraventricular, 245 th~-roid hormones, 349 tricrclic anticlepres.~ant~. 563 Wolff-Parkinson-White s~ndrome, 297 Tach)1>hylactic drug in te ractions, 23 3 Tach)1mea asthma, 660 Tacrolin1us hyperglycemia, 248 in1n1unosuppression, ) 20 targets of, I 21 Tactile hallucinations, 547 cocaine, 558 Tadalafil, 644 Tae11ia solium, 160, 161 Taka\'asu arte ritis, 218, 316 Talcosis, 218 Tamm-Horsfall mucoprotein, 582 Tamoxifen, 435, 642 fo r breast cancer, 686 hot Aashes with, 248 Tamsulosin, 244, 639, 644 Tanner stages (sexual development),

623 Tarasoff decision, 268 Tardive clyskinesia antipsychotic drugs and, 556, 561 metoclopramide adverse effect, 394 n igrostriatal pathway, 487 Target cells, 407 postsplenectomy, 98 Tarsal tunnel syndrome, 445 Taste cranial nerve lesions and, 520 cranial nerves in, 494 loss with stroke, 502 thalamic relay for, 486 TATA box,41 Tau proteins, 681

Taxanes, 433 Tay-Sachs disease

frameshift n1utation, 39 lysosomal storage disease, 88 presentation, 674 Tazobactam, 189 TCA cycle, 77 diagram, 74, 77 h)')>eramn1onernia,

82

metabolic site, 72 p)~U\'ate metabolism, 77 rate-deterrnining enz)~e fo r, 73 T cells, 401 acti\'ation, I 03 adaptive immunity, 99 anergy, 110 cell surface proteins, I I 0 corticosteroid effect1, 334 Tertiary disease prevention, 269 Tertiary hyperparath)~oidism, 342 Tertiary syphilis aortic aneurysn1s, 687 presentation, 675 Tesarnorelin, 325 Testes, 6 12 atrophy with alcoholism, 559 descent of, 610 en1bryologic derivation, 599 lymphatic drainage of, 6 10 progesterone production, 616 Testicular a trophy alcoholism, 559 cirrhosis, 383 muscular d ystrophy, 61 Testicular cancer/hln1ors, 638 bleomycin fo r, 4 31 cisplatin/carboplatin for, 4 33 gerrn cell, 638 non-gerrn cell, 639 Testicular l~mphoma, 639 Testicular/ovarian arteries, 35 7 Testicular torsion, 637 Testis-dete rmining factor, 608 Testosterone, 622, 64 3 androgen insensitivity syndrome, 625 cryptorchidism, 637 Klinefelter synd rome, 624 Leydig cell secretion, 614 pharrnacologic control, 640 Sertoli cells, 614 sex hormone disorder diagnosis, 624 SH BC effect on, 332 signaling pathwa~' for, 332 sperrnatogenesis, 614 Testosterone-secreting tun1ors, 625 Testosterone smthesis, 199 Tetanospasn1i~, l 32, 138 Tetanus, 110, 138 exotoxins, l 3J spore-forming bacteria, 128 vaccine, 138 Tetanv h)1;ocalcemia, 579 h)1>oparath)Toidism, 341 Tetrabenazine Tourette syndrome, 545, 560 Tetracaine, 537 Tetracyclines, 192 esophagitis, 249 Fanconi syndrome, 250

Idiopathic intracranial h~pertension and, 509 mechanism (d iagram), 187 photosensitivity. 250 protein synthesis in hibition, 191 pseudotumor cerebri and, 509 teratogenicity, 204, 600 tooth discoloration, 2 50 Tetrah\'d rofolic acid, 68, 194 Tetralogy of F'allot, 30 I 22q I J s~ndrornes, 303 C)':tnosis caused by, 687 fe tal alcohol syndrome, 303 lab findings in, 679 outAow tract forn1ation, 279 Tetrodotoxin, 246 TCF'-J3 in acute inflammation, 215 regulatory T cells, I 02 scar forn1ation, 219 in wound healing, 217 Thalamus, 478 limbic S)'litem and, 486 neuropathic pain, 503 Thalassemia, 410 in anen1ia taxonon1>'• 409 target cells in, 407 Thalidomide teratogenicity, 600 Thayer-l'vlartin agar, 126 Theca in terna cells, 6 16 Theca-lu tein C)'lits, 628, 632 Thecoma, 632 Thenar muscles, 439, 441 Theophylline, 672 therapeutic index of, 236 Therapeutic antibodies, 12 1, 122 Therapeutic index (Tl}, 236 Therrnogenin, 78 Theta rh)thm (EEC), 485 Thiazide diuretics, 595 gout, 250 heart failure, 31 1 h~pertension. 319 site of action, 593 Thick ascending loop of Henle Bartter S)'llclrome ancl, 574 ethac1ynic acid effect on, 594 loop diuretics effect on, 594 nephron ph)'liiology, 573 Thin descending loop of Henle, 573 Thionamides, 349 Thiopental, 533 Thioridazine, 561 3rd branchial arch, 606 3rd branchial pouch, 607 Third-degree (complete) AV block, 298 Thirst h~pothalamus and, 486 renin.angiotensin.aldosterone s~•tem a nd, 576 30S in hibitors, 191 Thoracentesis, 666 Thoracic aortic aneurvsm, 303, 306 Thoracic outle t S)'fld1~me, 441, 669 Threadworrns, 159 Threonine, 8 1 Threonine kinase, 225 Thrombi atherosclerosis, 305 niural. 310 post-.\11, 308 Thrombin, 427 Thromboang iitis obliterans, 316

INDEX

·niromboc\tes. 399 aw~ation inhibition. -129 chronic m\eloproliferative disorderign. -151 1

1""i nnilu~

streplomicin. 197

e.x1rinsic pJth\\CrlelbJOn. 509 migraine hcacbches. 506 pseudotumor ccrcbri, 509 \isual disturNncc ,,;th. 250

Topoisomerase inhibitors. -f 30 Topoisomerases. 195 Topotecan, 4 30. 4 34 To RC HeS infectionichotics for, 561 drug therap)' for. 560

)51

2+1

Toxic dose, 236 Toxicities and side effect>. H7 Toxicitv o f i~munosuppr~!klnts, 120

treatments for, 247 Toxic megacolon, 138 Toxic multinodular goiter, H9 Toxic shock-like >ynclromc, 136 Toxic shock syncl ro1nc, I 33 exotoxin A, I H presentation, 135 Staplrrloroccus aureus, 135 Toxic shock s\ndron1c to\in, 1ll

Toxins seafoood (ingested), 2-16 To.,;ns (bacterial ) anthrax. 13endoto:.;ns, 132. I B enterotoxins, 135 erithrogenic, 136 exfoliatil'e, IB. I 35 exotoxins, 132-133 features of, 131 lysogenic phage cncoding, 130 toxin-mediated disease. 135 Toxocara spp., 158 Toxoeara c:erkalemia, 578 labs/findings, 681 Tumor markers acute l)'mphoblastic leukemia, 424 colorectal cancer, 382 pancreatic aclenocarcinomas, 39 l in serum, 227 Tumors benign " · malignant, 221 grade vs. stage, 221 immune evasion in, 223

immunohistochemical stains for,

228 nomenclature of, 221 Tumor suppressors, 46, 225 Tunica albuginea, 612, 637 Tunica n1uscularis e:derna, 356 Tunica serosa, 356 Tunica subn1ucosa, 356 Tunica '"'ginalis, 6 10 Turcot s\'lldrome, 381 Turner ~'lldrome, 624 cardiac defect association, 303 coarctation of aorta and, 302 CH for, 350 horseshoe kidney, 567 presentation, 678 Twave, in ECC, 296 21-hydro,)•lase, 328 21-hydro,)•lase deficiencr, 687 22q 11/ microdeletion, 116 22q I I deletion sp1dromes, 303 Twin concordance shldies, 2 )6 Twinning, 602 2-naphthylamine, 226

TXA, asi}irin effecl'i, 475 thrombogenesis, 403 Tipe I muscle fibers, 449 Tipe 2 muscle fibers, 449 Tipe I errors (h)-pothesis testing), 262 Tipe I h)1>ersensitivity, I 12 lgE antibodies and, I05 mast cells and, 400 Tipe Il errors in hn1othesis testing, 262 Tipe II hypersensitivity, 112 blood transfusions, 114 organ transplant for. 391 Zolpidem, SH Zona fasciculata, 322, 329 Zona glomerulosa, 322 Zona reticularis, 322 Zonular fi bers, 522 Zoonotic bac teria, 149 Z~mogens, 367

About the Editors

Tao Le, MD, MHS Tao developed a passion for medical educat ion as a medical student. He currently edits more than 1S titles in the Firsr Aid series. In addit ion, he is Founder and Chief Education Officer of USM LE-Rx for exam preparation and ScholarRx for undergraduate medical education. As a medical student, he was editor-in-chief of the University of California, San Francisco (UCSF) Synapse, a university newspaper wit h a weekly circulation of 9000. Tao earned his medical degree from UCSF in 1996 and completed his residency training in internal medicine at Yale University and fellowship training at Johns Hopkins University. Tao subsequently went on to cofound Medsn, a medical education technology venture, and served as its chief medical officer. He is currently chief of adult allergy and immunology at the University of Louisville.

Matthew Sochat, MD Matthew is a second-year hematology/oncology fellow at St. Louis University in St. Louis, Missouri. He completed his internal medicine residency training at Temple University Hospital in Philadelphia. He completed medical school in 20 13 at Brown University and is a 2008 graduate of the University of Massachusett s, Amherst, where he studied biochemistry and t he classics. Pastimes include skiing, cooking/baking, traveling, t he company of friends/loved ones (especially his wonderful wife}, t he Spanish language, and computer/video gaming. Be warned: Matt also loves to come up with corny jokes at {in)opportune moments.

Yash Chavda, DO Yash is an emergency medicine chief resident at St. Barnabas Hospital in the Bronx and a resident education fellow for ALL NYC EM. He earned his medical degree from NYIT College of Osteopathic Medicine and completed his undergraduate degrees in biology and psychology at CUNY Baruch College. Yash has many interests out side of medicine and enjoys spending t ime with his loved ones. He is a developing photographer, former web/graphic designer (who still dabbles), video gamer, foodie, and avid explorer who wants to travel the world (whenever he actually gets a chance). He hopes to always keep improving at everything he does.

Vikas Bhushan, MD Vikas is a writer, editor, entrepreneur, and teleradiologist on extended sabbatical. In 1990 he conceived and authored the original FirsrAid for rhe USMLE Step I . His entrepreneurial endeavors include a student-focused medical publisher (S2S}, an e-learning company, and an ER teleradiology practice (24/7 Radiology). Trained on t he Left Coast, Vikas completed a bachelor's degree at the University of California Berkeley; an MO with thesis at UCSF; and a d iagnostic radiology residency at UCLA His eclectic interests include technology, cryptoeconomics, information design, photography, South Asian diasporic culture, and avoiding a day job. Always finding t he long shortcut, Vikas is an adventurer, knowledge seeker, and occasional innovator. He enjoys intermediate status as a kiteboarder and father, and strives to raise his children as global citizens.

Jordan Abrams Jordan is a third-yea r medical student at SGU School of Medicine. He graduated magna cu m laude from the University of Delaware and earned a bachelor's degree in neuroscience w ith m inors in medical humanities and biological sciences. Combining his creative mindset and passion for drawing, Jordan founded theHYMedicine.com, an educational website that offers free medical study guides, tutoring, and study schedules for students worldwide. Aside from medicine, Jordan enjoys reading, playing soccer, and traveling to new places.

Mehboob Kalani, MD Mehboob is a fourth-year internal medicine chief resident at Allegheny Health Network Medical Education Consortium in Pittsburgh. He was born in Karachi, Pakistan, g rew up in Toronto, Canada, and pursued medicine upon completing high school. He earned his bachelor's and medical degrees at American University of Integrative Sciences in 20 15. After residency, his interests lie in pulmonary cri tical care medicine, and he is researching COPD exacerbation treatment and readmission rates. In his limited leisure time, Mehboob enjoys playing or watching soccer, long drives, and family gatherings.

Kimberly Kallianos, MD

Vaishnavi Vaidyanathan, MD

Originally from Atlanta, Kimberly graduated from the Universi ty of North Carolina at Chapel Hill in 2006 and from Harvard Medical School in 20 11. She completed her radiology residency and fellowship at the University of California, San Francisco (UCSF) and is currently an Assistant Professor of Clinical Radiology at UCSF in the Card iac and Pulmonary Imaging sect ion.

Vaishnavi is a first-year child neurology resident at Phoenix Children's Hospital in Phoenix, Arizona. She is a recent graduate of the University of Missouri-Kansas City School of Medicine, where she earned her bachelor's and medical degrees. Her interests include medical education and health advocacy. Outside of medicine, she loves to dance, learn new languages, and watch Bollywood movies.

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