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InternalMed_Harrison	Beta Blockers β-Adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other proposed mechanisms by which beta blockers lower blood pressure include a central nervous system effect and inhibition of renin release. Beta blockers are particularl...	InternalMed_Harrison. Beta Blockers β-Adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other proposed mechanisms by which beta blockers lower blood pressure include a central nervous system effect and inhibition of renin release. Beta bl...
Neurology_Adams	Further evidence of a genetic factor in the causation of MS is the finding that certain histocompatibility locus antigens (HLAs) are more frequent in patients with MS than in control subjects. The strongest association is with the DR locus on chromosome 6. Other HLA haplotypes that are overrepresented in MS (HLA-DR2 an...	Neurology_Adams. Further evidence of a genetic factor in the causation of MS is the finding that certain histocompatibility locus antigens (HLAs) are more frequent in patients with MS than in control subjects. The strongest association is with the DR locus on chromosome 6. Other HLA haplotypes that are overrepresented ...
Immunology_Janeway	A lymphocyte expresses many exact copies of a single antigen receptor that has a unique antigen-binding site (see Section 1-12). The clonal expression of antigen receptors means that each lymphocyte is unique among the billions of lymphocytes that each person possesses. Chapter 4 described the structural features of im...	Immunology_Janeway. A lymphocyte expresses many exact copies of a single antigen receptor that has a unique antigen-binding site (see Section 1-12). The clonal expression of antigen receptors means that each lymphocyte is unique among the billions of lymphocytes that each person possesses. Chapter 4 described the struc...
Neurology_Adams	Lesions of the macula, retina, or optic nerve cause a scotoma (an island of impaired vision surrounded by normal vision) rather than a defect that extends to the periphery of one visual field (“field deficit”). Scotomas are named according to their position (central, cecocentral) or their shape (ring, arcuate). A small...	Neurology_Adams. Lesions of the macula, retina, or optic nerve cause a scotoma (an island of impaired vision surrounded by normal vision) rather than a defect that extends to the periphery of one visual field (“field deficit”). Scotomas are named according to their position (central, cecocentral) or their shape (ring, ...
InternalMed_Harrison	the per-specimen cost of point-of-care testing, in terms both of reagents and supplies and of personnel, is often greater than that of centralized testing. Other concerns relate to the adequacy of personnel training for point-of-care testing, the quality of the results, and the incorporation of results into the medical...	InternalMed_Harrison. the per-specimen cost of point-of-care testing, in terms both of reagents and supplies and of personnel, is often greater than that of centralized testing. Other concerns relate to the adequacy of personnel training for point-of-care testing, the quality of the results, and the incorporation of re...
InternalMed_Harrison	30-35 Based on estimates from the United Nations 25-30 Population Division, 809 million people were 20-25 15-20 age 60 years or older in 2012, of whom 279 mil 5-10 million in less developed countries (as classified < 5 by the United Nations). The countries with the largest populations of those age 60 and older	InternalMed_Harrison. 30-35 Based on estimates from the United Nations 25-30 Population Division, 809 million people were 20-25 15-20 age 60 years or older in 2012, of whom 279 mil 5-10 million in less developed countries (as classified < 5 by the United Nations). The countries with the largest populations of those age...
Surgery_Schwartz	Serial magnetic resonance imaging may be necessary to confirm the diagnosis.31Potassium Hyperkalemia Treatment options for symptomatic hyperka-lemia are listed in Table 3-14. The goals of therapy include reducing the total body potassium, shifting potassium from the extracellular to the intracellular space, and protect...	Surgery_Schwartz. Serial magnetic resonance imaging may be necessary to confirm the diagnosis.31Potassium Hyperkalemia Treatment options for symptomatic hyperka-lemia are listed in Table 3-14. The goals of therapy include reducing the total body potassium, shifting potassium from the extracellular to the intracellular ...
InternalMed_Harrison	Glucose tolerance is classified into three broad categories: normal glucose homeostasis, DM, or impaired glucose homeostasis. Glucose tolerance can be assessed using the fasting plasma glucose (FPG), the response to oral glucose challenge, or the hemoglobin A1c (HbA1c). An FPG <5.6 mmol/L (100 mg/dL), a plasma glucose ...	InternalMed_Harrison. Glucose tolerance is classified into three broad categories: normal glucose homeostasis, DM, or impaired glucose homeostasis. Glucose tolerance can be assessed using the fasting plasma glucose (FPG), the response to oral glucose challenge, or the hemoglobin A1c (HbA1c). An FPG <5.6 mmol/L (100 mg/...
Physiology_Levy	Controls: rest Sens 1 Sens 2 •Fig. 17.41 Effects of Different Stimuli on Regional Blood Flow in the Contralateral Human Cerebral Cortex. Sens1,low-intensityelectricalstimulationofthehand;Sens2,high-intensity(painful)electricalstimulationofthehand.Otherstimuliareasnoted.(RedrawnfromIngvarDH.Brain Res. 1976;107:181.) on ...	Physiology_Levy. Controls: rest Sens 1 Sens 2 •Fig. 17.41 Effects of Different Stimuli on Regional Blood Flow in the Contralateral Human Cerebral Cortex. Sens1,low-intensityelectricalstimulationofthehand;Sens2,high-intensity(painful)electricalstimulationofthehand.Otherstimuliareasnoted.(RedrawnfromIngvarDH.Brain Res. 1...
Neurology_Adams	The most important neurotransmitter substances from the point of view of basal ganglionic function are glutamate, GABA, dopamine, acetylcholine, and serotonin. A more complete account of this subject may be found in the reviews of Penney and Young, of Alexander and Crutcher, and of Rao. The following is what is known w...	Neurology_Adams. The most important neurotransmitter substances from the point of view of basal ganglionic function are glutamate, GABA, dopamine, acetylcholine, and serotonin. A more complete account of this subject may be found in the reviews of Penney and Young, of Alexander and Crutcher, and of Rao. The following i...
Neurology_Adams	A considerable group of patients come to the physician with physical complaints, the most common being dizziness, a vague mental “fogginess,” and nondescript headaches. The patient’s inability to give a coherent account of his symptoms bears witness to the presence of dementia. Sleep disturbances, especially insomnia, ...	Neurology_Adams. A considerable group of patients come to the physician with physical complaints, the most common being dizziness, a vague mental “fogginess,” and nondescript headaches. The patient’s inability to give a coherent account of his symptoms bears witness to the presence of dementia. Sleep disturbances, espe...
Physiology_Levy	18. What are the roles of saccades and smooth pursuit movements in visual tracking? 19. What is nystagmus, and what types of sensory stimulation can drive nystagmus in a normal individual? 20. What is the somatotopic organization of the different CNS regions involved in motor control. ovements are the major way in whic...	Physiology_Levy. 18. What are the roles of saccades and smooth pursuit movements in visual tracking? 19. What is nystagmus, and what types of sensory stimulation can drive nystagmus in a normal individual? 20. What is the somatotopic organization of the different CNS regions involved in motor control. ovements are the ...
Immunology_Janeway	It has become apparent that there are many different phenotypic subtypes of asthma. These subtypes are being recognized because patients differ widely in responsiveness to different therapies, in the nature of the inflammatory cell infiltrates that are present in their airways, and in the molecular signature of inflamm...	Immunology_Janeway. It has become apparent that there are many different phenotypic subtypes of asthma. These subtypes are being recognized because patients differ widely in responsiveness to different therapies, in the nature of the inflammatory cell infiltrates that are present in their airways, and in the molecular ...
InternalMed_Harrison	Terminally ill patients have a wide variety of advanced diseases, often with multiple symptoms that demand relief, and require noninvasive therapeutic regimens to be delivered in flexible care settings. Fundamental to ensuring quality palliative and end-of-life care is a focus on four broad domains: (1) physical sympto...	InternalMed_Harrison. Terminally ill patients have a wide variety of advanced diseases, often with multiple symptoms that demand relief, and require noninvasive therapeutic regimens to be delivered in flexible care settings. Fundamental to ensuring quality palliative and end-of-life care is a focus on four broad domain...
Surgery_Schwartz	clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL, LaMonte MJ, Walk...	Surgery_Schwartz. clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL...
Neurology_Adams	of neurosyphilis with these syndromes. The meningitis may persist in an asymptomatic state and, ultimately, after a period of years, may lead to parenchymal damage. In some cases, however, there is a natural subsidence of the meningitis.	Neurology_Adams. of neurosyphilis with these syndromes. The meningitis may persist in an asymptomatic state and, ultimately, after a period of years, may lead to parenchymal damage. In some cases, however, there is a natural subsidence of the meningitis.
Immunology_Janeway	the instability sequence, resulting in increased translation and more IL-2 protein. Finally, PI 3-kinase helps activate the protein kinase Akt (see Section 7-17), which generally promotes cell growth and survival, increasing the total production of IL-2 by activated T cells.	Immunology_Janeway. the instability sequence, resulting in increased translation and more IL-2 protein. Finally, PI 3-kinase helps activate the protein kinase Akt (see Section 7-17), which generally promotes cell growth and survival, increasing the total production of IL-2 by activated T cells.
Cell_Biology_Alberts	Riboswitches are particularly common in bacteria, in which they sense key small metabolites in the cell and adjust gene expression accordingly. Perhaps their most remarkable feature is the high specificity and affinity with which each recognizes only the appropriate small molecule; in many cases, every chemical feature...	Cell_Biology_Alberts. Riboswitches are particularly common in bacteria, in which they sense key small metabolites in the cell and adjust gene expression accordingly. Perhaps their most remarkable feature is the high specificity and affinity with which each recognizes only the appropriate small molecule; in many cases, ...
Neurology_Adams	Diagnosis Because the symptoms of plumbism are nonspecific, the diagnosis depends on an appreciation of the potential causative factors and the results of certain laboratory tests. Lead lines at the metaphyses of long bones and basophilic stippling of red cells are seen but are too inconstant to be relied on, but basop...	Neurology_Adams. Diagnosis Because the symptoms of plumbism are nonspecific, the diagnosis depends on an appreciation of the potential causative factors and the results of certain laboratory tests. Lead lines at the metaphyses of long bones and basophilic stippling of red cells are seen but are too inconstant to be rel...
Pathoma_Husain	Normal PT/PTT-Coagulation factors are not affected. 3. F. Initial treatment is corticosteroids. Children respond well; adults may show early response, but often relapse. 1. IVIG is used to raise the platelet count in symptomatic bleeding, but its effect is short-lived. 2. Splenectomy eliminates the primary source of an...	Pathoma_Husain. Normal PT/PTT-Coagulation factors are not affected. 3. F. Initial treatment is corticosteroids. Children respond well; adults may show early response, but often relapse. 1. IVIG is used to raise the platelet count in symptomatic bleeding, but its effect is short-lived. 2. Splenectomy eliminates the prim...
Psichiatry_DSM-5	Cannabis use disorder among adults typically involves well-established patterns of daily cannabis use that continue despite clear psychosocial or medical problems. Many adults have experienced repeated desire to stop or have failed at repeated cessation attempts. Milder adult cases may resemble the more common adolesce...	Psichiatry_DSM-5. Cannabis use disorder among adults typically involves well-established patterns of daily cannabis use that continue despite clear psychosocial or medical problems. Many adults have experienced repeated desire to stop or have failed at repeated cessation attempts. Milder adult cases may resemble the mo...
Obstentrics_Williams	By week 14, the loop of Henle is functional and reabsorption occurs (Smith, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Although the fetal kidneys produce urine, their ability to concentrate and modiy the pH is limited even in the mature fetus. F...	Obstentrics_Williams. By week 14, the loop of Henle is functional and reabsorption occurs (Smith, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Although the fetal kidneys produce urine, their ability to concentrate and modiy the pH is limited even ...
Pediatrics_Nelson	One third of children with HSP develop renal involvement, which can be acute or chronic. Although renal involvement is mild in most cases, acute glomerulonephritis manifested by hematuria, hypertension, or acute renal failure can occur. Most cases of glomerulonephritis occur within the first few months of presentation,...	Pediatrics_Nelson. One third of children with HSP develop renal involvement, which can be acute or chronic. Although renal involvement is mild in most cases, acute glomerulonephritis manifested by hematuria, hypertension, or acute renal failure can occur. Most cases of glomerulonephritis occur within the first few mont...
Surgery_Schwartz	barriers to expansion. To date, the most headline-grabbing procedures have been the transvaginal and transgastric removal of the gallbladder84-86 (Fig. 14-25). To ensure safety, all human cases thus far have involved laparoscopic assistance to aid in retrac-tion and ensure adequate closure of the stomach or vagina. To ...	Surgery_Schwartz. barriers to expansion. To date, the most headline-grabbing procedures have been the transvaginal and transgastric removal of the gallbladder84-86 (Fig. 14-25). To ensure safety, all human cases thus far have involved laparoscopic assistance to aid in retrac-tion and ensure adequate closure of the stom...
Pharmacology_Katzung	One therapeutic application of this otherwise toxic effect of nitrite has been discovered. Cyanide poisoning results from complexing of cytochrome iron by the CN− ion. Methemoglobin iron has a very high affinity for CN−; thus, administration of sodium nitrite (NaNO2) soon after cyanide exposure regenerates active cytoc...	Pharmacology_Katzung. One therapeutic application of this otherwise toxic effect of nitrite has been discovered. Cyanide poisoning results from complexing of cytochrome iron by the CN− ion. Methemoglobin iron has a very high affinity for CN−; thus, administration of sodium nitrite (NaNO2) soon after cyanide exposure re...
Immunology_Janeway	autoantigenic peptides might be expressed at too low a level or bind too poorly to MHC molecules to drive thymic negative selection, but might be present at a sufficient level or bind strongly enough to drive positive selection. This hypothesis is supported by observations that I-Ag7, the MHC class II molecule in NOD m...	Immunology_Janeway. autoantigenic peptides might be expressed at too low a level or bind too poorly to MHC molecules to drive thymic negative selection, but might be present at a sufficient level or bind strongly enough to drive positive selection. This hypothesis is supported by observations that I-Ag7, the MHC class ...
InternalMed_Harrison	Neurally mediated syncope comprises a heterogeneous group of functional disorders that are characterized by a transient change in the reflexes responsible for maintaining cardiovascular homeostasis. Episodic vasodilation (or loss of vasoconstrictor tone) and bradycardia occur in varying combinations, resulting in tempo...	InternalMed_Harrison. Neurally mediated syncope comprises a heterogeneous group of functional disorders that are characterized by a transient change in the reflexes responsible for maintaining cardiovascular homeostasis. Episodic vasodilation (or loss of vasoconstrictor tone) and bradycardia occur in varying combinatio...
Pharmacology_Katzung	E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient ...	Pharmacology_Katzung. E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not esta...
Pharmacology_Katzung	the low extracellular pH favors the charged form, with less of the neutral base available for diffusion across the membrane. Conversely, adding bicarbonate to a local anesthetic—a strategy sometimes used in clinical practice—will raise the effective concentration of the nonionized form and thus shorten the onset time o...	Pharmacology_Katzung. the low extracellular pH favors the charged form, with less of the neutral base available for diffusion across the membrane. Conversely, adding bicarbonate to a local anesthetic—a strategy sometimes used in clinical practice—will raise the effective concentration of the nonionized form and thus sh...
Psichiatry_DSM-5	Alterations in neuromuscular control of breathing can occur in association with med- ications or substances used in individuals with mental health conditions, which can cause or exacerbate impairments of respiratory rhythm and ventilation. Individuals taking these medications have a sleep-related breathing disorder tha...	Psichiatry_DSM-5. Alterations in neuromuscular control of breathing can occur in association with med- ications or substances used in individuals with mental health conditions, which can cause or exacerbate impairments of respiratory rhythm and ventilation. Individuals taking these medications have a sleep-related brea...
Pathology_Robbins	Fig. 16.17 Hepatocyteinjuryinfattyliverdiseaseassociatedwithchronicalcoholuse.(A)Clusteredinflammatorycellsmarkingthesiteofanecrotichepatocyte.AMallory-Denkbodyispresentinanotherhepatocyte(arrow). (B)“Ballooned”hepatocytes(arrowheads) associatedwithclustersofinflammatorycells.Theinsetstainedforkeratins8and18(brown) sho...	Pathology_Robbins. Fig. 16.17 Hepatocyteinjuryinfattyliverdiseaseassociatedwithchronicalcoholuse.(A)Clusteredinflammatorycellsmarkingthesiteofanecrotichepatocyte.AMallory-Denkbodyispresentinanotherhepatocyte(arrow). (B)“Ballooned”hepatocytes(arrowheads) associatedwithclustersofinflammatorycells.Theinsetstainedforkerati...
Obstentrics_Williams	The risk of neonatal hypoxia or meconium aspiration is also greater. hus, care for the newborn should be provided immediately by an attendant who can skillfully clear the airway and ventilate a neonate as needed (Chap. 32, p. 608). he severely growth-restricted newborn is particularly susceptible to hypothermia and may...	Obstentrics_Williams. The risk of neonatal hypoxia or meconium aspiration is also greater. hus, care for the newborn should be provided immediately by an attendant who can skillfully clear the airway and ventilate a neonate as needed (Chap. 32, p. 608). he severely growth-restricted newborn is particularly susceptible ...
Cell_Biology_Alberts	In plants, plasmodesmata perform Many of the Same Functions as Gap Junctions The tissues of a plant are organized on different principles from those of an animal. This is because plant cells are imprisoned within tough cell walls composed of an extracellular matrix rich in cellulose and other polysaccharides, as we dis...	Cell_Biology_Alberts. In plants, plasmodesmata perform Many of the Same Functions as Gap Junctions The tissues of a plant are organized on different principles from those of an animal. This is because plant cells are imprisoned within tough cell walls composed of an extracellular matrix rich in cellulose and other poly...
InternalMed_Harrison	For many LSDs, the accumulated substrates are endogenously synthesized within particular tissue sites of pathology. Other diseases have greater exogenous substrate supplies. For example, they are delivered by low-density lipoprotein receptor–mediated uptake in Fabry and cholesteryl ester storage diseases (CESDs) or by ...	InternalMed_Harrison. For many LSDs, the accumulated substrates are endogenously synthesized within particular tissue sites of pathology. Other diseases have greater exogenous substrate supplies. For example, they are delivered by low-density lipoprotein receptor–mediated uptake in Fabry and cholesteryl ester storage d...
Gynecology_Novak	A nonclassic form of this disorder may be associated with heterosexual precocious pubertal development (as is the classic form if untreated), but postpubertal hyperandrogenism occurs more often. The androgen excess in individuals with nonclassic 3β-HSD deficiency appears to result from androgens derived from the periph...	Gynecology_Novak. A nonclassic form of this disorder may be associated with heterosexual precocious pubertal development (as is the classic form if untreated), but postpubertal hyperandrogenism occurs more often. The androgen excess in individuals with nonclassic 3β-HSD deficiency appears to result from androgens deriv...
InternalMed_Harrison	undergoing resection and a complete mediastinal lymph node dissection compared with lymph node sampling. Moreover, complete mediastinal lymphadenectomy added little morbidity to a pulmonary resection for lung cancer when carried out by an experienced thoracic surgeon.	InternalMed_Harrison. undergoing resection and a complete mediastinal lymph node dissection compared with lymph node sampling. Moreover, complete mediastinal lymphadenectomy added little morbidity to a pulmonary resection for lung cancer when carried out by an experienced thoracic surgeon.
Surgery_Schwartz	cells, which may explain large inter-individual variability in innate cytokine profiles observed following injury. Epinephrine infusion at higher doses has been found to inhibit production of tumor necrosis factor (TNF)-alpha in vivo and to enhance the production of the anti-inflammatory cytokine interleukin IL-10.97 A...	Surgery_Schwartz. cells, which may explain large inter-individual variability in innate cytokine profiles observed following injury. Epinephrine infusion at higher doses has been found to inhibit production of tumor necrosis factor (TNF)-alpha in vivo and to enhance the production of the anti-inflammatory cytokine inte...
Cell_Biology_Alberts	Figure 3–62 an evolutionary tree of selected protein kinases. A higher eukaryotic cell contains hundreds of such enzymes, and the human genome codes for more than 500. Note that only some of these, those discussed in this book, are shown. Figure 3–64 The activation of a Src-type protein kinase by two sequential events....	Cell_Biology_Alberts. Figure 3–62 an evolutionary tree of selected protein kinases. A higher eukaryotic cell contains hundreds of such enzymes, and the human genome codes for more than 500. Note that only some of these, those discussed in this book, are shown. Figure 3–64 The activation of a Src-type protein kinase by ...
Surgery_Schwartz	multicenter, randomized trial of patients with ARDS from a variety of etiologies, limiting plateau airway pressure to less than 30 cm H2O and tidal volume to less than 6 mL/kg of ideal body weight reduced 28-day mortality by 22% relative to a ventilator strategy that used a tidal volume of 12 mL/kg.56 For this reason, ...	Surgery_Schwartz. multicenter, randomized trial of patients with ARDS from a variety of etiologies, limiting plateau airway pressure to less than 30 cm H2O and tidal volume to less than 6 mL/kg of ideal body weight reduced 28-day mortality by 22% relative to a ventilator strategy that used a tidal volume of 12 mL/kg.56...
Pediatrics_Nelson	Retroperitoneal tumor (lymphoma), retroperitoneal fibrosis, chronic granulomatous disease Bladder Neurogenic dysfunction,* tumor (rhabdomyosarcoma), diverticula, ectopic ureter Urethra Posterior valves,* diverticula, strictures, atresia, ectopic ureter, foreign body, phimosis,* priapism *Relatively common. outlet obstr...	Pediatrics_Nelson. Retroperitoneal tumor (lymphoma), retroperitoneal fibrosis, chronic granulomatous disease Bladder Neurogenic dysfunction,* tumor (rhabdomyosarcoma), diverticula, ectopic ureter Urethra Posterior valves,* diverticula, strictures, atresia, ectopic ureter, foreign body, phimosis,* priapism *Relatively c...