MKSAP 14 Errata and Revisions - (Updated March 2008)

The U.S. Food and Drug Administration (FDA) has requested that the manufacturer of the prokinetic agent tegaserod voluntarily discontinue marketing the drug because of recently identified adverse cardiovascular side effects associated with its use. The drug is mentioned in the following locations in MKSAP 14:

• Gastroenterology and Hepatology: Pages 20-21 in the discussion of Gastric Motility Disorders; Pages 43-46 in the discussion of Dysmotility Syndromes, including Table 33; Page 127, Item 135, Option D; Page 173, left column, Critique of Item 135.
• General Internal Medicine: Page 13, left column, paragraph 3 under Irritable Bowel Syndrome; Page 14, left column, paragraph 2 under Nonulcer Dyspepsia; Page 164, left column, Item 84, option E; Page 212, right column, Critique of Item 84.

The FDA also requested that manufacturers of pergolide drug products voluntarily remove these drugs from the market because of the risk of serious valvulopathies associated with their use. The drug is mentioned in the following locations in MKSAP 14:

• Neurology: Page 81, Item 24, Option B.
• Endocrinology and Metabolism: Page 24, right column under Treatment of Prolactinoma; Page 147, left column, Critique of Item 106.

Page 31, right column under the heading "Pharmacodynamics," the Key Point should be revised as follows:

Patients who are at risk for thrombosis and who respond poorly to the platelet-inhibiting effects of aspirin should receive alternative antiplatelet therapy. (Added Aug. 2007)

Page 40, right column under the heading "Atrial Flutter," paragraph 1, sentence 3, lines 5 and 6: "...counterclockwise direction around the mitral annulus." should be "...counterclockwise direction around the tricuspid annulus." (Added Aug. 2007)

Page 63, left column, paragraph 3, lines 10 and 11: "These drugs have been withdrawn from the market in the United States." should be "Fenfluramine has been been withdrawn from the market in the United States." (Added Aug. 2007)

Pages 107 and 108, Self-Assessment Test, Item 49: Options B and D are both correct answers. If you are doing your own scoring of the test, delete Item 49 and calculate your score by using 131 as the denominator. (Added Aug. 2007; updated March 2008)

Page 158, Critique of Item 44: The first sentence should read as follows: "This young man has a systolic ejection murmur that does not radiate to his carotid arteries." (Added Aug. 2007)

Page 159, Critique of Item 44, first full paragraph (beginning "In contrast to the murmur of hypertrophic cardiomyopathy..."), line 10 should read as follows: "...complex toward S₂ and increases the intensity of the murmur." (Added March 2008)

Page 160, Critique of Item 46, first full paragraph (beginning "A bicuspid aortic valve..."), line 6 should read "...at the second right intercostal space..." (Added March 2008)

For Figure 3, in the MKSAP 14 CD-ROM only, the red line should designate "no surveillance" and the blue line should designate "in surveillance." Print and online versions of Figure 3 are accurate. (Added Aug. 2007)

Page 96, left column, Item 11, paragraph 2, sentence 3 should read "A colonoscopic examination 1 year ago..." not "1 month ago." (Added Aug. 2007)

Page 149, left column, Item 57, Key Points. The first Key Point should read as follows: "In elderly patients, ischemic colitis is a common cause of self-limited hematochezia." (Added March 2008)

For Item 126, in the MKSAP 14 CD-ROM only, the correct answer should be "(D) Evaluation for liver transplantation." Print and online versions of Item 126 are accurate. (Added March 2008)

Page 106, Critique of Item 26, paragraph 2, sentence 1 should read "The movement disorders associated with frontotemporal dementia usually consist of extrapyramidal or spinal motor symptoms." (Added March 2008)

Page 117, Critique of Item 57, the final sentence of the first paragraph should read "Lorazepam is preferred over diazepam because of its longer duration of action." (Added March 2008)

Page 24, right column, line 1: dosage in parenthesis should be "40 mg/d for 4 days," not "40 mg/kg/d for 4 days." (Added Aug. 2007)

Page 31, left column, paragraph 2, lines 6 and 7: the term in parenthesis after "hemoglobin A2" should be "α₂δ₂" not "α₂β₂." (Added Aug. 2007)

Page 8, Table 5: Under the first column heading, "CSF Parameter," the unit for opening pressure should be "mm H₂O," not "cm H₂O." (Added March 2008)

Page 30, left column under "Key Points," the seventh entry should read "Initial therapy for cryptococcal infections most often includes amphotericin B and flucytosine." (Added Aug. 2007)

Page 32, right column under the heading "Vaginitis," the final two sentences should read as follows: "A wet prep (saline) showing characteristic trichomonads and clue cells is diagnostic for trichomoniasis and bacterial vaginosis, respectively. A potassium hydroxide (KOH) prep will document the yeast forms and vaginal pH >5 is associated with trichomoniasis and bacterial vaginosis." (Added Aug. 2007)

Page 54, paragraph 3 under the heading "Human Herpesvirus 6" should read as follows: "In contrast, HHV-8, which is known to cause Kaposi's sarcoma and to be associated with Castleman's syndrome and primary effusion lymphoma, does not appear to cause hepatitis, encephalitis, or other illnesses in transplant recipients." (Added Aug. 2007)

Page 118, right column, Item 131: Option (C) should be "Transmission of a rimantidine-resistant virus from the index case to family members." (Added Aug. 2007)

Page 132, left column, Item 31, paragraph 2: sentence 1 should be "Cidofovir is used primarily to treat cytomegalovirus retinitis in patients with AIDS; trimethoprim-sulfamethoxazole is used to treat bacterial infections, which this patient does not have." (Added Aug. 2007)

Page 135, Item 40, left column, paragraph 1, lines 4 and 5 should be "...with an intravaginal clotrimazole cream for the Candida and metronidazole for the bacterial vaginosis." (Added Aug. 2007)

The units for opening pressure of cerebrospinal fluid are incorrect in various multiple-choice questions. The units should be "mm H₂O," not "cm H₂O," in the following items: page 80, Item 5; page 89, Item 34; page 104, Item 87; page 110, Item 104; page 111, Item 109. (Added March 2008)

Page 3, right column, Table 4: for the entry "Fasting glucose," the defining level should be =110 mg/dL. (Added Aug. 2007)

Page 11, right column under the heading "Management," paragraph 2, sentence 2 should read as follows: "Initially, a bolus of 0.15 units/kg is recommended followed immediately by an infusion at a rate of 0.1 units/kg/h." (Added Aug. 2007)

Page 42-43; page 42, right final paragraph beginning "Cases in which screening tests..." and continuing on page 43, left column to the end of the paragraph with "...the clonidine suppression test." This entire paragraph should be deleted. (Added Aug. 2007; updated March 2008)

Page 42, left column, Table 30 under the heading "Mineralocorticoid (Primary failure)," the dosage of fludrocortisone should be 0.05-0.1 mg QD. (Added March 2008)

Page 43, right column under the heading "Primary Aldosteronism," paragraph 3, sentence 3 should read as follows: "A plasma aldosterone/plasma renin activity ratio greater than 20 with a plasma aldosterone level greater than 15 ng/dL strongly suggests primary aldosteronism." (Added Aug. 2007)

Page 44, right column, first Key Point, lines 4 to 6 should read as follows: "...renin activity ratio greater than 20 with a plasma aldosterone level greater than 15 ng/dL strongly suggests primary aldosteronism." (Added Aug. 2007)

Page 82, Item 51, the value for free thyroxine (T₄) should read "free T₄ of 0.69 ng/dL (8.89 pmol/L)." (Added March 2008)

Page 93, Item 101, the value for free thyroxine (T₄) should read "1.2 ng/dL (15.4 pmol/L)." (Added March 2008)

Page 96, Item 112, the value for thyroid-stimulating hormone should read "0.1 µU/mL (0.1 mU/L)." (Added March 2008)

Page 142, right column, Critique of Item 93, the second Key Point, line 5 should read "...2-h ≥155 mg/dL..." (not ≥55 mg/dL). (Added March 2008)

Page 146, Critique of Item 103, right column, the first Key Point should read as follows: "Hypopituitarism is a frequent outcome in patients treated with irradiation of the pituitary gland." (Added Aug. 2007)

The values and/or units for total triiodothyronine (T₃) and free T₃ in various multiple-choice questions are incorrect. The page numbers, item numbers, and correct values for the ratio are as follows:
Page 77, Item 29, Free T₃ = 6 ng/L (9.2 pmol/L)
Page 83, Item 55, Free T₃ = 1.17 ng/L (1.8 pmol/L)
Page 87, Item 71, Total T₃ = 315 ng/dL (4.83 nmol/L)
Page 89, Item 78, Total T₃ = 165 ng/dL (2.53 nmol/L)
Page 89, Item 82, Total T₃ = 270 ng/dL (4.2 nmol/L)
Page 90, Item 86, Total T₃ = 52.1 ng/dL (0.8 nmol/L)
(Added March 2008)

Page 17, left column, paragraph 2, sentence 3: delete "(see Chronic Cough section)." (Added Aug. 2007)

Page 96, right column, paragraph 3, sentence 1 should read "Nonpharmacologic treatment of otitis externa involves evacuation of cerumen..." (Added March 2008)

Page 3, right column, Table 1: Replace the current Table 1 with the following corrected table (Added Aug. 2007):

Table 1. Different Measurements of Proteinuria

Page 66, right column, paragraph 1 under the heading "Metabolism": the final sentence should be "However, some experts suggest that calcium levels >200 mg/d for both men and women are abnormal." (Added Aug. 2007)

Page 78, left column under the heading "Pathophysiology": lines 3 and 4 should be "defined as a urinary albumin excretion >30 mg and <300 mg/24 h." (Added Aug. 2007)

Page 90, right column, Item 5, laboratory studies, the value for lactic acid should be 83.7 mg/dL (9.3 mmol/L). (Added March 2008)

Page 137, right column, Critique of Item 28: sentence 3 should be "Winter's formula can be used to estimate the expected PCO₂: 1.5 × [HCO₃⁻] + 8 ± 2." (Added Aug. 2007)

Page 150, right column, Critique of Item 62, paragraph 2: final sentence should be "Similarly, neither respiratory acidosis nor a non-anion gap acidosis is present." (Added Aug. 2007)

Page 151, right column, Critique of Item 65, paragraph 1: sentence 1 should be "This patient has a triple acid-base disorder of mixed anion gap metabolic acidosis/metabolic alkalosis/respiratory alkalosis." (Added Aug. 2007)

Page 151, right column, Item 65, Key Points: delete the first Key Point. (Added Aug. 2007)

Page 155, left column, Critique of Item 73, paragraph 1: final sentence and paragraph 2 should be "To confirm this suspicion, Winter's formula can be used to estimate the expected PCO₂: 1.5 × [HCO₃⁻] + 8 ± 2. According to this formula, the expected PCO₂ is 30.5 ± 2 mm Hg, which confirms the presence of a respiratory alkalosis." (Added Aug. 2007)

Page 158, Critique of Item 83, sentence 1 should be "This patient has a congenital glomerular disease known as Alport's syndrome, which is associated with a glomerulonephritis with dysmorphic erythrocytes, mild proteinuria, and a high-frequency hearing loss. (Added March 2008)

The value for the urinary protein-creatinine and albumin-creatinine ratios in various multiple-choice questions is incorrect. The page numbers, item numbers, and correct values for the ratio are as follows:
Page 97, Item 24, Urinary protein-creatinine ratio = 3000 mg/g
Page 106, Item 50, Urinary protein-creatinine ratio = 3500 mg/g
Page 109, Item 58, Urinary protein-creatinine ratio = 3000 mg/g
Page 113, Item 68, Urinary protein-creatinine ratio = 2500 mg/g
Page 115, Item 75, Urinary protein-creatinine ratio = 2000 mg/g
Page 116, Item 78, Urinary protein-creatinine ratio = 5000 mg/g
Page 117, Item 80, Spot urine albumin-creatinine ratio = 300 mg/g
Page 118, Item 83, Urinary protein-creatinine ratio = 1200 mg/g
Page 120, Item 88, Urinary protein-creatinine ratio = 1500 mg/g
Page 122, Item 94, Urinary protein-creatinine ratio = 800 mg/g
(Added March 2008)

Page 3, right column, Key Points: in the final line of the third Key Point, the word "typical" should be "atypical." (Added Aug. 2007)

Page 15, right column under the heading "Controlled Oxygen Therapy," line 6 should read "...patients with PaO2 <55 mm Hg..." (not >55 mm Hg). (Added March 2008)

Page 23, Table 14, add the following to the list of abbreviations at the bottom of the table: "DAD = diffuse alveolar damage." (Added March 2008)

Page 36, left column under the heading "Exposure to Chemical Asphyxiants," line 3 should read "carbon monoxide," not "dioxide." (Added March 2008)

Page 97, right column, Item 30: Option (B) should be "Hypercalcemia." (Added Aug. 2007)

Page 98, left column, Item 32, line 6: change PCO₂ value to 79 mm Hg. (Added Aug. 2007)

Page 133, Critique of Item 30, first full paragraph (beginning "The cornerstone of therapy...") line 7 should read "...Scadding radiographic stage." (Added March 2008)

Page 142, left column, Critique of Item 54, second paragraph, final sentence, delete the word "blocking" in the phrase "unopposed α-blocking effects." (Added Aug. 2007)

Under "Blood, Plasma, and Serum Chemistry Studies," the normal range in conventional units should be added to the "Homocysteine, plasma" entry so that it reads as follows: "Homocysteine, plasma - Male: 0.54-2.16 mg/L (4-16 µmol/L); female: 0.41-1.89 mg/L (3-14 µmol/L)." (Added March 2008)

Under "Endocrine Tests, Thyroid Function Tests": The normal range for thyroid-stimulating hormone in SI units should be 0.5-5.0 mU/L, not mU/mL. (Added Aug. 2007)

Under "Endocrine, Thyroid function tests," add "Triiodothyronine, free (T₃) - 3.6-5.6 ng/L (5.6-8.6 pmol/L)." (Added March 2008)

Under "Urine," the value for protein-creatinine ratio should be less than or equal to 200 mg/g, not 0.2 mg/mg. (Added March 2008)

Under "Cerebrospinal Fluid," the units for Pressure (opening) should be mm H₂O, not cm H₂O. (Added March 2008)