Corrections & Updates

Pulmonary Medicine: Card Number 458

Text currently reads:

Diagnosis is idiopathic pulmonary hemosiderosis. More often we see pulmonary-renal vasculitides present in adults. IPA is one of the rare causes of pulmonary hemorrhage that can present in young adults.

Text should read:

Diagnosis is idiopathic pulmonary hemosiderosis. More often we see pulmonary-renal vasculitides present in adults. IPH is one of the rare causes of pulmonary hemorrhage that can present in young adults.

Nephrology, Core Script card #371, On the Answer side

Currently reads: DX: Clinical + persistently low UOsm after water restriction; administration of ADH increases UOsm in nephrogenic DI, but does not increase UOsm in central DI.

Should read: Clinical + persistently low UOsm after water restriction; administration of ADH increases UOsm in central DI, but does not increase UOsm in nephrogenic DI.

Endocrinology Script Number 70:

The explanation currently reads: “Rarely, this disease can be confused with familiar hypercalcemic hypocalciuria…”
It should instead read: “Rarely, this disease can be confused with familial hypercalcemic hypocalciuria…”

Answer #195
The correct answer should be: A. Dissection of the ascending aorta should be treated with aggressive medical therapy and close observation.

Add the following sentence to the beginning of the explanation: The patient has Marfan syndrome and is suffering a dissection of the aorta.

The Board Testing Point should read: Recognize the clinical characteristics of a dissection of the aorta in a patient with Marfan syndrome.

Question/Answer #255
Question and Answer/Explanation #255 in Infectious Disease topic should be moved to the Nephrology topic.
The scenario, answer choices, correct answer indication, and explanation are still valid.

Answer #271
The first paragraph in the explanation currently reads:
Alkalosis is generated when H+ is lost or bicarbonate is gained by the body or contraction of the plasma volume around a fixed amout of total body bicarbonate; i.e., loss of bicarbonate-free fluid. Less common causes of alkalosis generation are H+ shifts from the extracellular to the intracellular space. The alkalosis is then maintained by the inability of the kidneys to excrete excess bicarbonate in the urine (usually driven by aldosterone and decreased distal chloride delivery). The urinary chloride concentration is the most important lab test in the workup of metabolic acidosis. Chloride-responsive alkalosis (urine chloride < 10 mEq/L) is characterized by volume depletion; examples include vomiting, nasogastric suction, and contraction alkalsois (due to remote diuretic use).

The first paragraph in the explanation should read:
Alkalosis is generated when H+ is lost or bicarbonate is gained by the body or contraction of the plasma volume around a fixed amount of total body bicarbonate; i.e., loss of bicarbonate-free fluid. Less common causes of alkalosis generation are H+ shifts from the extracellular to the intracellular space. The alkalosis is then maintained by the inability of the kidneys to excrete excess bicarbonate in the urine (usually driven by aldosterone and decreased distal chloride delivery). The urinary chloride concentration is the most important lab test in the workup of metabolic alkalosis. Chloride-responsive alkalosis (urine chloride < 10 mEq/L) is characterized by volume depletion; examples include vomiting, nasogastric suction, and contraction alkalosis (due to remote diuretic use).

Answer #291
The explanation currently reads:
Answer: Na 136, K 5.0, Cl 102, HCO₃ 20, Serum Creatinine 3.5, Arterial pH 7.36, Urine pH 5.0. With a moderate glomerulonephritis, metabolic acidosis is usually mild, and the anion gap is only slightly elevated, if at all.

The explanation should read:
Answer option “Na 136, K 5.0, Cl 102, HCO₃ 20, Serum Creatinine 3.5, Arterial pH 7.36, Urine pH 5.0” best fits the laboratory pattern of someone recovering from acute kidney injury due to glomerulonephritis. With a moderate glomerulonephritis, metabolic acidosis is usually mild, and the anion gap is only slightly elevated, if at all. The other answer options are incorrect for the following reasons: these choices portray a more severe metabolic acidosis; hypokalemia is not typically seen in acute glomerulonephritis; the presence of significant hyperkalemia would not be expected in a patient who is in renal recovery. In addition, a high urine pH with a mild metabolic acidosis signifies a tubulointerstitial process (i.e., distal RTA), whereas acute post-infectious glomerulonephritis is primarily a glomerular disease.

General Internal Medicine: Card Number 166

Question Side

Text currently reads:

Middle-aged, Caucasian, female smoker with h/o of primary ovarian insufficiency complains of pain in her back and presents with:

Text should read:

Middle-aged, Caucasian, female smoker with h/o primary ovarian insufficiency complains of pain in her back and presents with:

Endocrinology: Card Number 103

Question Side

Text currently reads:

↓FSH, ↑LH, FSH:LH > 2, slightly ↑ testosterone and DHEA

Text should read:

↓FSH, ↑LH, LH:FSH > 2, slightly ↑ testosterone and DHEA

Answer Side:

Text currently reads:

On exam, a Cushing’s case will probably not include the FSH:LH ratio.

Text should read:

On exam, a Cushing’s case will probably not include the LH:FSH ratio.

Gastroenterology: Card Number 127

Answer Side

Text currently reads:

Dx: Clinical ± endoscopy with biopsies if symptoms fail to respond to bid PPIs and in the presence of worrisome symptoms such as odynophagia, GI bleeding, weight loss, and/or anemia ± RUQ U/S to exclude biliary tract disease if nausea and epigastric pain are present.

Text should read:

Dx: Clinical ± endoscopy with biopsies if symptoms fail to respond to bid PPIs, or in the presence of worrisome symptoms, such as odynophagia, GI bleeding, weight loss, and/or anemia, ± RUQ U/S to exclude biliary tract disease if nausea and epigastric pain are present.

Neurology: Card Number 405

Answer Side

Text currently reads:

Remember the 20-30-40 rule for vent assistance: VC < 20 mL/kg, MIP < –30 cm H₂0, and MEP < 40 cm H₂0.

Text should read:

Remember the 20-30-40 rule for vent assistance: VC < 20 mL/kg, MIP > –30 cm H₂0, and MEP < 40 cm H₂0.

Please note: The eSyllabus does not contain page numbers.

 Gastroenterology: Page 10, Esophagus — Anatomy > Patient with Ulcerative Esophagitis

Text currently reads:

Patient with Ulcerative Esophagitis

• Start with PPI daily
• Rescope to assess healing and exclude Barrett esophagitis
• If persistent esophagitis: Change PPI to bid
• Indefinite maintenance treatment — Up to 80% recur off meds

Text should read:

Patient with Ulcerative Esophagitis

• Start treatment with PPI twice daily
• Repeat EGD to assess for healing and to exclude Barrett esophagitis
• Indefinite maintenance treatment — Up to 80% recur off meds

Gastroenterology: Page 13, The Stomach > AR 14B

Text currently reads:

What is the appropriate management?

1. Keep NPO to allow ulcer to heal
2. Continue PPI bid for 8 weeks
3. Continue PPI bid and check for H. pylori
4. Refer to surgery for management of ulcer

Text should read:

What is the appropriate management?

1. Keep NPO to allow ulcer to heal.
2. Continue PPI bid for 8 weeks.
3. Continue PPI bid, avoid NSAIDs, and check for H. pylori.
4. Refer to surgery for management of ulcer.

Gastroenterology: Page 56, Liver > AR 78

Text currently reads:

A 25-year-old male with history of IV drug use presents with 2-week history of fatigue, RUQ pain, and yellowing of his eyes. He denies alcohol use.

Lab Studies:

WBC 5.0, Hgb 14, AST 1500, ALT 1634, TB 3.2

RUQ sonogram shows no masses, no gallstones,

Normal-sized CBD

Which of the following serologic pattern would confirm the diagnosis?

1. HAV IgM+, HAV IgG+
2. HBcAg IgM+, HBsAg+, HBeAg+
3. HBcAg IgM+, HBsAg–

Text should read:

Which of the following serologic patterns would confirm the diagnosis?

1. HAV IgM+, HAV IgG+
2. HBcAb IgM+, HBsAg+, HBeAg+
3. HBcAb IgM+, HBsAg–

 Gastroenterology: page 63, Liver > AR 91

Text currently reads:

A 66-year-old female with HCV and alcohol-induced cirrhosis is admitted for confusion. She has a known history of encephalopathy, history of variceal bleeding s/p EGD with banding × 3, and ascites (on diuretic therapy).

Medications at home: nadolol 20 mg daily, spirnolactone 100 mg daily, furosemide 40 mg daily

Vitals signs on admission: HR 88, BP 100/55, T 99.2° F (37.3° C) + asterixis, distended abdomen with fluid wave

Labs: WBC 15, Hgb 10.3, Cr 1.2, plts 55, TB 1.3

Diagnostic paracentesis: Cell count 900, 65% PMNs

Text should read:

A 66-year-old female with HCV and alcohol-induced cirrhosis is admitted for confusion. She has a known history

of encephalopathy, history of variceal bleeding s/p EGD with banding × 3, and ascites (on diuretic therapy).

Medications at home: nadolol 20 mg daily, spironolactone 100 mg daily, furosemide 40 mg daily

Vitals signs on admission: HR 88, BP 100/55, T 99.2° F (37.3° C)

+ asterixis, distended abdomen with fluid wave

Labs: WBC 15, Hgb 10.3, Cr 1.2, plts 55, TB 1.3, albumin 3.4

Diagnostic paracentesis: Cell count 900, 65% PMNs, albumin in ascitic fluid 2.1, total protein in ascitic fluid 2.4

Infectious Disease, page 5-56, under Diagnosis

Text currently reads: Possible infective endocarditis is diagnosed with 1 major + 3 minor criteria.
Text should read: Possible infective endocarditis is diagnosed with either 1 major criterion + 1 minor criterion OR 3 minor criteria.

Endocrinology Section, Book 4, Page 7-41, Diabetes Mellitus section, middle of second column:
Currently reads: “Like GLP-1 antagonists, DPP4Is are reserved as 1st line drugs…”
This should instead read: “Like GLP-1 agonists, DPP4Is are served as 1st line drugs…”

Nephrology Section, Book 2, Page 4-19, Renal Tubular Acidosis section:
Currently reads: “Dietary restriction of sodium or bicarbonate administration may be sufficient treatment.” This should instead read: “Dietary restriction of potassium or bicarbonate administration may be sufficient treatment.”

Cardiology Section, Book 3, Pages 5-34 and 5-35:

Information in Tables 5-10 and 5-11 should be read across the 2 tables when side-by-side. Text in Table 5-11 is incorrect in several rows when reading across both tables.

Table 5-11 has been corrected.

Click here for pdf of tables

Common Pediatric Disorders: Question 76

Correct answer currently is:

A. Treatment is not required if function is maintained.

Correct answer should be:

E. Clonidine or guanfacine may be considered if the tics are disruptive to his functioning.

The Fetus & Newborn: Page 1-1, Mortality / Morbidity in Newborns > Common Terms

Text currently reads:

Preterm: an infant born before the last day of the 37^th week (259^th day) of gestation (i.e., born before the 38^th week of gestation).

Text should read:

Preterm: an infant born before the 37^th week (259^th day) of gestation.

Gastroenterology & Nutrition: Page 14-1, Nutritional Disorders > Fat-Soluble Vitamin

Text currently reads:

Typically, vitamin A deficiency results in night blindness, Bitot spots (keratinization of the cornea),

xerophthalmia (dry eyes), corneal opacities, growth failure, increased susceptibility to infection, and even death.

Text should read:

Typically, vitamin A deficiency results in night blindness, Bitot spots (keratinization of the conjunctiva),

xerophthalmia (dry eyes), corneal opacities, growth failure, increased susceptibility to infection, and even death.

Hematology: Page 16-20, Differentiating the Pure Red Cell Aplasias

Text currently reads:

A child comes in with anemia without low reticulocytes, especially consider the aforementioned disorders: parvovirus B19, TEC, and congenital hypoplastic anemia (Diamond-Blackfan anemia).

Text should read:

A child comes in with anemia with low reticulocytes, especially consider the aforementioned disorders: parvovirus B19, TEC, and congenital hypoplastic anemia (Diamond-Blackfan anemia).

Cardiology: Page 12-26, Complete (d-) Transposition of the Great Arteries

Text currently reads:

Because the great arteries are completely transposed, the aorta is connected to the right ventricle instead of the left ventricle, and the pulmonary artery is connected to the left atrium instead of the right atrium.

Text should read:

Because the great arteries are completely transposed, the aorta is connected to the right ventricle instead of the left ventricle, and the pulmonary artery is connected to the left ventricle instead of the right ventricle.

Allergy & Immunology: Page 6-12, Phagocyte Disorders > Overview

Text currently reads:

1. Neutropenia (< 1,000 PMN, severe = < 100):
   • Kostmann syndrome (AD)
   • Severe chronic neutropenia (AR)

Text should read:

1. Neutropenia (< 1,000 PMN, severe = < 100):
   • Kostmann syndrome (AR)
   • Severe chronic neutropenia (AD)

Growth & Development: Page 1-1, Overview of Growth

Text currently reads:

Remember that 5% of the population have heights, weights, or head circumferences that normally lie outside of 2 standard deviations from the mean. (By definition, 2.5% are > 95^th percentile, and 2.5% are < 5^th percentile.)

Text should read:

Remember that 5% of the population have heights, weights, or head circumferences that normally lie outside of 2 standard deviations (SDs) from the mean. (By definition, 2.5% are > +2 SD and 2.5% are < –2 SD).

Cardiology: Page 12-26, Complete (d-) Transposition of the Great Arteries

Text currently reads:

Because the great arteries….and the pulmonary artery is connected to the left atrium instead of the right atrium.

Text should read:

Because the great arteries….and the pulmonary artery is connected to the left ventricle instead of the right ventricle.

Infectious Disease: Page 5-2, Gram-Positive Bacteria/Staphylococcus aureus

Text currently reads:

Mild: Patients with a fever, who are immunocompetent can sometimes be managed similarly to those with mild cases. Or, patients with moderate infections may require hospitalization if the area of involvement is extensive, if they have significant systemic symptoms, or if medication adherence is an issue.

Note: The D-test determines if there is macrolide-inducible clindamycin resistance. The test must be done when the S. aureus isolate is erythromycin-resistant but shows clindamycin susceptibility. If the D-test is positive, do not use clindamycin as treatment. Most microbiology laboratories perform this test routinely and report only clindamycin susceptibility based on its result.

Moderate: Previously healthy patients who have fever can be managed similarly to the mild cases. Or, they may require hospitalization and managed similar to severe cases if the area of involvement is extensive; if they have significant systemic symptoms; or if medication adherence is an issue.

Text should read:

Mild: Afebrile patients who are immunocompetent can sometimes be managed with incision and drainage alone. Often they require oral antibiotic therapy which includes trimethoprim/sulfamethoxazole, clindamycin, or doxycycline (if > 7 years old).

Note: The D-test determines if there is macrolide-inducible clindamycin resistance. The test must be done when the S. aureus isolate is erythromycin-resistant but shows clindamycin susceptibility. If the D-test is positive, do not use clindamycin as treatment. Most microbiology laboratories perform this test routinely and report only clindamycin susceptibility based on its result.

Moderate: Previously healthy patients who have fever can be managed similarly to the mild cases. Or, they may require hospitalization and managed similar to severe cases if the area of involvement is extensive; if they have significant systemic symptoms; or if medication adherence is an issue.

Growth & Development / Preventive Pediatrics: Page 1-19, Cholesterol and Lipid Screening

Text currently reads:

Consider pharmacologic therapy at 10 years of age in children with an LDL-C ≥ 190 mg/dL…

Text should read:

Consider pharmacologic therapy at 8 years of age in children with an LDL-C ≥ 190 mg/dL…

Adolescent Health and Gynecology: Page 4-27, Pelvic Inflammatory Disease

Text currently reads:

Recommended treatment:

• Cefoxitin 2 gm IV every 6 hours, plus

Doxycycline 100 mg orally or IV every 12 hours for 14 days

Outpatient treatments for PID:

• Other 3^rd generation cephalosporins, plus
  Doxycycline 100 mg 2x/day for 14 days +/–

Text should read:

Recommended treatment:

• Cefoxitin 2 gm IV every 6 hours, plus

Doxycycline 100 mg 2x/day PO x 14 days

Outpatient treatments for PID:

• Other 3^rd generation cephalosporins, plus
  Doxycycline 100 mg 2x/day PO x 14 days +/–

Metabolic Disorders: Page 10-6, Phenylalanine-Tyrosine Disorders, Tyrosinemia,
Hereditary Tyrosinemia Type I

Text currently reads:

You can treat liver failure and Fanconi syndrome of hepatorenal tyrosinemia with 2-(nitro-4-trifuoro-methylbenzoyl)-1,3-cyclohexanedione…

Text should read:

You can treat liver failure and Fanconi syndrome of hepatorenal tyrosinemia with 2-(2-nitro-4-trifluoro-methylbenzoyl)-1,3-cyclohexanedione… 

Metabolic Disorders: Page 10-7, Sulfur-Containing Amino Acid Defects, Homocystinuria

Text currently reads:

Classically, the term was used specifically to indicate disease due to a defect in the cystathionineβ-synthetase enzyme.

Text should read:

Classically, the term was used specifically to indicate disease due to a defect in the cystathionine β-synthase enzyme.

Hematology: Card Number 519, Question Side

Text currently reads:

The PTT of the patient + normal prolonged is normal.

Text should read:

The PTT of the mixed plasma remains prolonged.

Infectious Disease: Card Number 568

Text currently reads:

It can be treated with macrolides, including doxycycline, erythromycin, or azithromycin.

Text should read:

It can be treated with macrolides, including erythromycin or azithromycin. Tetracyclines and fluoroquinolones are also effective.

Infectious Disease Card Number: 565, On the Answer side

Last bullet currently reads: Persons undergoing immunosuppressive therapy (equivalent to < 15 mg/day prednisone)
Last bullet should read: Persons undergoing immunosuppressive therapy (equivalent to > 15 mg/day prednisone)

Biostats/Ethics/Safety/QI: Card Number 130, Question Side

Text currently reads:

What statistical parameter identifies how well a test rules out those in a population who do not have a given disease?

Text should read:

What statistical parameter identifies how well a test rules in those in a population who have a given disease?

Neurology: Card Number 823, Question Side

Text currently reads:

After a difficult labor, a newborn presents with:

• A sagging left shoulder
• A left arm that hangs limp in internal rotation with a pronated wrist
• Absent biceps tendon reflex
• Absent triceps tendon reflex
• Normal sensory examination?

Text should read:

After a difficult labor, a newborn presents with:

• A sagging left shoulder
• A left arm that hangs limp in internal rotation with a pronated wrist
• Absent biceps tendon reflex
• Triceps tendon reflex is present.
• Normal sensory examination?

Oncology: Card Number 883, Question Side

Text currently reads:

What is the most common congenital renal disorder?

Text should read:

What is the most common congenital renal tumor?

 Ophthalmology & ENT: Page 21-16, Neck > Neck Mass

Text currently reads:

Lymphatic malformation (previously cystic hygroma; multilobular cyst filled with lymph; transilluminates well)

Text should read:

Lymphatic malformation (includes cystic hygroma, lymphangioma circumscriptum, and mixed type; multilocular cyst filled with lymph; transilluminates well)

Gastroenterology: Page 10-22, Intestinal Disorders > Gluten-sensitive Enteropathy (Celiac Disease)

Text currently reads:

In susceptible individuals, gluten from wheat products (and similar proteins found in rye and barley) can induce the immune reaction to human transglutaminase and the resulting mucosal damage.

Text should read:

In susceptible individuals, gluten from wheat products (and similar proteins found in rye, barley, and malt) can induce the immune reaction to human transglutaminase and the resulting mucosal damage.

Gastroenterology: Page 10-14, Stomach Disorders > Nonerosive Gastropathy > Helicobacter pylori Gastritis

Text currently reads:

The incidence of H. pylori is decreasing in the U.S., but it remains endemic in many parts of the world, including Africa, the Middle East, India, and Southeast Asia.

Text should read:

The incidence of H. pylori is decreasing in the U.S., but it remains endemic in many parts of the world, including Africa, the Middle East, India, and Southeast Asia, and South America.

Behavioral Medicine and Substance Abuse: Page 6-22, Summary of Clinical Findings, Table 6-8

Text currently reads:

MDMA (3,4-methylenedioxymethaphetamine)

Text should read:

MDMA (3,4-methylenedioxymethamphetamine)

Behavioral Medicine and Substance Abuse: Page 6-11, Rett Syndrome

Text currently reads:

It has a typically regressive course, beginning after several months of apparent normal development. Deceleration of head growth at 2–4 months of age is often the earliest finding. A period of developmental stagnation is then followed by a period of regression characterized by loss of purposeful hand skills, use of the hands, and loss of language milestones associated with development of hand stereotypies (hand wringing) and gait dyspraxia. Growth failure ensues with periods of apnea and peculiar sighing respirations during wakefulness. Oral-motor dysfunction, abnormal gut motility, progressive development of scoliosis, and autonomic dysfunction are common. Screaming episodes, sleep disturbances, and poor social interactions are also typical. No additional cognitive decline occurs following the period of regression; autistic-like behaviors persist. Most children with Rett syndrome develop a seizure disorder and continue to have difficulty with feeding and weight gain due to poor oral skills. Death occurs during adolescence or early adulthood.

Text should read:

Rett Syndrome is considered a regressive neurological disorder. Infants appear normal at birth, but their growth stagnates and then regresses. Microcephaly or deceleration of head growth is a common feature in early infancy. Hypotonia is also often identified. Hallmark is loss of purposeful hand skills, development of hand stereotypies, loss of language milestones, and gait dyspraxia. Growth failure ensues with periods of apnea and peculiar sighing respirations during wakefulness. Oral-motor dysfunction, abnormal gut motility, progressive development of scoliosis, and autonomic dysfunction are common. Screaming episodes, sleep disturbances, and poor social interactions are also typical. No additional cognitive decline occurs following the period of regression; autistic-like behaviors persist. Most children with Rett syndrome develop a seizure disorder and continue to have difficulty with feeding and weight gain due to poor oral skills. Death occurs during adolescence or early adulthood.

Neonatology: Page 1-1, Mortality / Morbidity in Newborns > Common Terms

Text currently reads:

Preterm: an infant born before the last day of the 37^th week (259^th day) of gestation (i.e., born before the 38^th week of gestation).

Text should read:

Preterm: an infant born before the 37^th week (259^th day) of gestation.

Nutrition: Page 3-7, Nutritional Disorders > Fat-Soluble Vitamin Deficiencies > Vitamin A

Text currently reads:

Vitamin A deficiency can result in night blindness, Bitot spots (keratinization of the cornea), xerophthalmia (dry eyes), corneal opacities, growth failure, and increased susceptibility to infection; in severe or prolonged cases, it can result in death as well.

Text should read:

Vitamin A deficiency can result in night blindness, Bitot spots (keratinization of the conjunctiva), xerophthalmia (dry eyes), corneal opacities, growth failure, and increased susceptibility to infection; in severe or prolonged cases, it can result in death as well.

Oncology: Page 25-9, Other Kidney Problems

Text currently reads:

Mesoblastic nephroma is the most common congenital renal disorder, presenting as a firm, solitary mass of the kidney.

Text should read:

Mesoblastic nephroma is the most common congenital renal tumor, presenting as a firm, solitary mass of the kidney.