Errata
MKSAP for Students and Internal Medicine Essentials for Students
MKSAP for Students 5/Internal Medicine Essential for Students, A Companion to MKSAP for Students 5
Cardiovascular Medicine
Supraventricular Arrhythmias > Follow-Up, "diffusing capacity for carbon dioxide" should read "diffusing capacity for carbon monoxide".
In Table 3, the Drug Treatment of Chronic Stable Angina, under Agent it should read: "Dihydropyridine calcium channel blockers (amlodipine, nifedipine)" and under Notes it should read: "Second-line agents. Reduce blood pressure; do not affect heart rate and can be used with β-blockers. Avoid short-acting nifedipine."
In Table 3, the Notes for ACE inhibitors should read, "Reduce blood pressure by reducing preload and afterload. Reduce ventricular remodeling and fibrosis after infarction. Improve long-term survival in patients with LVEF ≤40% and, possibly, in patients with high cardiovascular risk (e.g., diabetes mellitus, PVD). Improve short-term survival in subsets of patients with acute MI. Side effects include cough, hyperkalemia, kidney failure, and angioedema."
Endocrinology and Metabolism
Item 8, "blood glucose level less than 250 mg/dL (13.9 mmol/L)" should read "blood glucose level greater than 250 mg/dL (13.9 mmol/L)."
Gastroenterology and Hepatology
Item 16, in the stem, the second sentence in the first paragraph should read: "He had symptoms of right upper quadrant abdominal pain several times over the past few months..."
Item 42, in the critique section, second paragraph, second sentence, it should read "Sjögren or sicca syndrome..."
General Internal Medicine
Item 6, "Patients who receive their initial vaccine at older than 65 years of age..." This is incorrect and" should read, "Patients who receive their initial vaccine at less than 65 years of age..."
Item 26, in the stem, "His pupils are dilated." should read: "His pupils are constricted."
Health Promotion and Screening > Screening Guidelines > Pneumococcal Infection, added the following information: "All persons should be given a single dose of 23-valent pneumococcal polysaccharide vaccine at age 65 years. Those who received a pneumococcal vaccination before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. Routine revaccination is not recommended because of uncertainty regarding clinical benefit and safety. Patients aged 19--64 years who smoke, have asthma or other chronic or immunocompromising conditions should also be vaccinated. A second dose is recommended 5 years after the first dose for persons aged 19--64 years with functional or anatomic asplenia and in persons with immunocompromising conditions."
Hematology
Immunologic Thrombocytopenic Purpura, the 1st sentence of the 4th paragraph should read: "the 2nd sentence of the 5th paragraph should have a < symbol, not >."
Table 1, the Finding for Spherocytes should read: "small, round erythrocytes that are uniformly dense without central pallor".
Infectious Disease Medicine
Page 162, Item 4, answer (A): This answer is no longer valid because activated protein C (drotrecogin alfa activated) has been withdrawn from the market. Recombinant human activated protein C (drotrecogin alpha) is a serine protease that had been approved by the Food and Drug Administration (FDA) in 2001 for the treatment of patients with sepsis and evidence of associated organ failure and high risk of death. However, subsequent clinical trials showed no efficacy for the treatment of severe sepsis and the drug was removed from the market in October 2011. For further information, please see http://www.fda.gov/Drugs/DrugSafety/ucm277114.htm.
Page 162, Item 6: This question is no longer valid because activated protein C (drotrecogin alfa activated) has been withdrawn from the market. Recombinant human activated protein C (drotrecogin alpha) is a serine protease that had been approved by the Food and Drug Administration (FDA) in 2001 for the treatment of patients with sepsis and evidence of associated organ failure and high risk of death. However, subsequent clinical trials showed no efficacy for the treatment of severe sepsis and the drug was removed from the market in October 2011. For further information, please see http://www.fda.gov/Drugs/DrugSafety/ucm277114.htm.
Page 162, Item 7, answer (D): This answer is no longer valid because activated protein C (drotrecogin alfa activated) has been withdrawn from the market. Recombinant human activated protein C (drotrecogin alpha) is a serine protease that had been approved by the Food and Drug Administration (FDA) in 2001 for the treatment of patients with sepsis and evidence of associated organ failure and high risk of death. However, subsequent clinical trials showed no efficacy for the treatment of severe sepsis and the drug was removed from the market in October 2011. For further information, please see http://www.fda.gov/Drugs/DrugSafety/ucm277114.htm.
Page 192, Table 4, Row 6: This content is no longer valid because activated protein C (drotrecogin alfa activated) has been withdrawn from the market. Recombinant human activated protein C (drotrecogin alpha) is a serine protease that had been approved by the Food and Drug Administration (FDA) in 2001 for the treatment of patients with sepsis and evidence of associated organ failure and high risk of death. However, subsequent clinical trials showed no efficacy for the treatment of severe sepsis and the drug was removed from the market in October 2011. For further information, please see http://www.fda.gov/Drugs/DrugSafety/ucm277114.htm.
Page 192, first full paragraph, left column: This content is no longer valid because activated protein C (drotrecogin alfa activated) has been withdrawn from the market. Recombinant human activated protein C (drotrecogin alpha) is a serine protease that had been approved by the Food and Drug Administration (FDA) in 2001 for the treatment of patients with sepsis and evidence of associated organ failure and high risk of death. However, subsequent clinical trials showed no efficacy for the treatment of severe sepsis and the drug was removed from the market in October 2011. For further information, please see http://www.fda.gov/Drugs/DrugSafety/ucm277114.htm.
Nephrology
The following information in chapter 60 Nephrology, Approach to Kidney Disease, The Determination of Glomerular Filtration Rate,
The formula should read as follows:
(140 – age [y]) × (weight [kg]) ÷ (SCr × 72)
If female, multiply result by 0.85.
Pulmonary Medicine
Item 2, Chronic Dyspnea, and COPD > Diagnosis, "diffusing capacity for carbon dioxide" should read "diffusing capacity for carbon monoxide".
Oxygen treatment, the 'less than' 55% for hematocrit should be 'greater than' 55%: "Patients with arterial Po2 of ≤59 mm Hg (7.8 kPa) or oxygen saturation ≤89% also qualify for oxygen therapy if they have pulmonary hypertension, evidence of cor pulmonale or edema as a result of right-sided heart failure, or a hematocrit >55%."
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Internal Medicine Essentials 2
The following information should be included in Internal Medicine Essentials for Clerkship Students 2, Sexually Transmitted Diseases (Chapter 49).
In uncomplicated pelvic inflammatory disease, ambulatory patients are treated with IM ceftriaxone or cefoxitin/probenicid and doxycycline with or without metronidazole. In April 2007, the CDC updated its recommendations for gonococcal treatment to eliminate the first-line use of flouroquinolones given widespread resistance across the United States. If cephalosporin therapy is not feasible, use of flouroquinolones may be considered if the individual risk of gonorrhea and community prevalence is low. When possible, treatment should always follow results of antimicrobial susceptibility.
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MKSAP for Students 4
MKSAP for Students 4, Hematology, Item 4
A couple of readers have questioned whether the blood smear is actually a case of hereditary spherocytosis. It is, but unfortunately it is not a classic example. The number of spherocytes seen on a peripheral blood smear is a function of erythrocyte age. Reticulocytes and the newest erythrocytes are morphologically normal. Also, the number of spherocytes is a function of the severity of the defect and may be as few as 1 to 3 per high power field in mild cases. More severe moderate cases can have 30 spherocytes per high power field.
MKSAP for Students 4, Cardiovascular Medicine, Item 28.
This item describes a patient with atrial fibrillation and normal jugular venous pulse x and y descents. This is in error. A patient with atrial fibrillation will not have a normal venous pulse. In atrial fibrillation the a wave and x descent are absent.
In MKSAP for Students 4, Hematology, Item 20.
Laboratory values were obtained at weeks 12 and 23 (not 33 as printed).
In MKSAP for Students 4, Hematology item 24.
The case vignette erroneously suggests that heparin followed by warfarin is the proper treatment for deep venous thrombosis during pregnancy. This is incorrect; warfarin is teratogenic (FDA pregnancy risk class D) and the correct treatment is either low molecular weight heparin or unfractionated heparin without warfarin until delivery. Following delivery, warfarin is an option if continued anticoagulation is required.
In MKSAP for Students 4 Hematology Section, question 28 is keyed incorrectly in the electronic version (CD ROM). It is keyed correctly in the print version. The correct answer is "E."
In MKSAP for Students 4, Nephrology, item 21. On physical examination, temperature is 38.8 ºC (101.8 ºF) not 38.8 ºC (98.8 ºF) as printed.
MKSAP for Students 4 Pulmonary Medicine item 3 The use of atenolol, a β1-selective blocker, may also contribute to his dyspnea; β1 selectivity is not absolute protection against bronchospasm, particularly if β1 selective drugs are used at higher doses. (Original incorrect wording substituted β2 for β1.)
In MKSAP for Students 4, Pulmonary, item 12.
β1 selectivity is not absolute protection against bronchospasm, particularly if β1 selective drugs (e.g., atenolol, metoprolol) are used at higher doses. (Original incorrect wording substituted β2 for β1. )
MKSAP for Students 4 Question 4 Endocrine and Metabolism
In 2010 the American Diabetes Association published new guidelines relating to the diagnosis of diabetes. The current guidelines state that hemoglobin A1C =6.5% is now a diagnostic criteria for diabetes. The test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP) certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay.