medEssentials Update List

(Created March 2007)

Below is a list of updates; please write these directly in your book. If you have any questions, please contact us at
medfeedback@Kaplan.com.

Pg. 9

Pg. 95

Note the corrections to the second column of the Changes During the First 3 Hours of Sleep table:

Human growth hormone (HGH)

Prolactin

Dopamine

Serotonin

Thyroid-stimulating hormone (TSH)

In the Other Chemical Mediators of Inflammation table (top half of the page), please note the changes in the
Effects column for both Cyclooxygenase and Lipoxygenase (changes in bold):
Arachidonic Acid
Product

Effects

Thromboxane A2

Vasoconstriction,
platelet aggregation

Prostacyclin (PGI2)

Vasodilation and
inhibits platelet
aggregation

PGE2

Pain

PGE2, PGD2, PGF2

Vasodilation

LTB4

Neutrophil chemotaxis,
increased vascular
permeability,
vasoconstriction or
vasodilation*

LTC4, LTD4, LTE4

Bronchoconstriction,
increased vascular
permeability,
vasoconstriction or
vasodilation*

*Can be tissue specific (e.g., vasoconstriction in kidneys and heart; vasodilation in skin and nasal mucosa)

Pg. 174 In the last row of the table (Radial dilator muscle), second column, Contracts pupil should read: Contracts
(dilates pupil). Under Pupillary sphincter muscle, in the same row but in the fourth column, Contracts pupil
should read: Contracts (constricts pupil).
Pg. 231

Under the Normal PV Curve, the legend for FA should read: FA: isovolumic relaxation.

Pg. 284 The last bulleted text on the page says: The female urethra is derived from two sources. The upper two-thirds
develop from the mesonephric ducts, and the lower portion is derived from the urogenital sinus. It should read:
The female urethra is derived entirely from urogenital sinus (endoderm).
Pg. 316

Modify the last row, titled transitional cell carcinoma, to read as follows (changes in bold):

Carcinoma of the
bladder

Transitional cell carcinoma: 90% of primary bladder neoplasms

Risk factors: Smoking, occupational exposure (e.g., naphthylamine), infection with
Schistosoma haematobium (more commonly associated with squamous cell carcinoma)
3% of all cancer deaths in the United States - peak incidence between 40 and 60 years of age.
Usually presents with painless hematuria, may also cause dysuria, urgency, frequency,
hydronephrosis, and pyelonephritis.
Prognosis. High incidence of recurrence at multiple locations.

Pg. 390 In the second bullet point within the Overview section on this page, the second sentence should read (changes in
bold): The period from ovulation to the onset of menses is always 14 days, so any varaiation from 28 days occurs
during the follicular phase.
Pg. 406 Transpose the last two columns of the action potential and excitation-contraction coupling rows in the table on
this page. Correction should appear as follows (these two rows only):
Action potential
Upstroke

Inward Na+
current

Inward Ca2+ current (SA node)

Inward Na+ current (atria,
ventricles, Purkinje fibers)

Inward Na+ current

Plateau

No plateau

No plateau (SA node)

Plateau present (atria,
ventricles, Purkinje fibers)

No plateau

AP T tubules
Ca2+ released
from SR

Inward Ca2+ current during plateau

Ca2+ release from SR

AP opens voltage-gated Ca2+

channels in sarcolemma; hormones
and neurotransmitters open IP3gated Ca2+ channels in SR

Excitationcontraction
coupling

Pg. 339

The following table should be included within Gastrointestinal Pathology, after the Large Intestine table on pg. 342.

Inflammatory Bowel Disease: Crohn Disease Versus Ulcerative Colitis

Crohn Disease

Ulcerative Colitis

Most common site

Terminal ileum

Rectum

Distribution

Mouth to anus

Rectum colon
Backwash ileitis

Spread

Discontinuous/skip

Continuous

Gross features

Focal ulceration with intervening normal mucosa

Linear fissures
Cobblestone
Thickened bowel wall
Creeping fat

Extensive ulceration
Pseudopolyps

Micro

Noncaseating granulomas

Crypt abscesses

Inflammation

Transmural

Limited to mucosa and

submucosa

Complications

Strictures
String sign on barium studies
Obstruction
Abscesses
Fistulas
Sinus tracts

Toxic megacolon

Genetic association

Family history of any type of inflammatory bowel disease is associated with

increased risk.

Extraintestinal
manifestations

Less common

Common [e.g., arthritis,

spondylitis (HLA B27
positive), primary
sclerosing cholangitis,
erythema nodosum,
pyoderma gangrenosum]

Cancer risk

Slight 13%

525%