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Gynecology_Novak	Patients treated with radical hysterectomy who have intermediate or high risk factors have a 30% and 40% risk, respectively, of recurrence within 3 years (100–102). Lesion Size Lesion size is an independent predictor of survival. Patients with lesions smaller than 2 cm have a survival rate of approximately 90%, and pat...	Gynecology_Novak. Patients treated with radical hysterectomy who have intermediate or high risk factors have a 30% and 40% risk, respectively, of recurrence within 3 years (100–102). Lesion Size Lesion size is an independent predictor of survival. Patients with lesions smaller than 2 cm have a survival rate of approxim...
Surgery_Schwartz	sloping upward from the C-loop of the duodenum to the splenic hilum (Fig. 33-1). In an adult, the pancreas weighs 75 to 100 g and is about 15 to 20 cm long. The fact that the pan-creas is situated so deeply in the abdomen and is sealed in the retroperitoneum explains the poorly localized and sometimes ill-defined natur...	Surgery_Schwartz. sloping upward from the C-loop of the duodenum to the splenic hilum (Fig. 33-1). In an adult, the pancreas weighs 75 to 100 g and is about 15 to 20 cm long. The fact that the pan-creas is situated so deeply in the abdomen and is sealed in the retroperitoneum explains the poorly localized and sometimes...
Pharmacology_Katzung	2. Indications: Although said to be equivalent to aspirin as an analgesic and antipyretic agent, acetaminophen lacks anti-inflammatory properties. It does not affect uric acid levels and lacks platelet-inhibiting effects. The drug is useful in mild to moderate pain such as headache, myalgia, postpartum pain, and other ...	Pharmacology_Katzung. 2. Indications: Although said to be equivalent to aspirin as an analgesic and antipyretic agent, acetaminophen lacks anti-inflammatory properties. It does not affect uric acid levels and lacks platelet-inhibiting effects. The drug is useful in mild to moderate pain such as headache, myalgia, postp...
Surgery_Schwartz	surgical diseases: a modelling study. Lancet Glob Health. 2015;3(suppl 2):S21-S27. 145. United Nations Population Fund (UNFPA); Providing emer-gency obstetric and newborn care to all in need. Available at: http://www.unfpa.org/public/mothers/pid/4385. Accessed August 22, 2018. 146. Marseille E, Larson B, Kazi DS, et al...	Surgery_Schwartz. surgical diseases: a modelling study. Lancet Glob Health. 2015;3(suppl 2):S21-S27. 145. United Nations Population Fund (UNFPA); Providing emer-gency obstetric and newborn care to all in need. Available at: http://www.unfpa.org/public/mothers/pid/4385. Accessed August 22, 2018. 146. Marseille E, Larson...
Neurology_Adams	Monocular diplopia occurs most commonly in relation to diseases of the cornea and lens rather than the retina; usually the images are overlapping or superimposed rather than discrete. In most cases, monocular diplopia can be traced to a lenticular distortion or displacement but in some, no abnormality can be found and ...	Neurology_Adams. Monocular diplopia occurs most commonly in relation to diseases of the cornea and lens rather than the retina; usually the images are overlapping or superimposed rather than discrete. In most cases, monocular diplopia can be traced to a lenticular distortion or displacement but in some, no abnormality ...
Immunology_Janeway	Experiments with mice transgenic for rearranged T-cell receptor genes show clearly that the specificity of the T-cell receptor for self peptide:self MHC complexes determines which co-receptor a mature T cell will express. If the transgenes encode a T-cell receptor specific for antigen presented by self MHC class I mole...	Immunology_Janeway. Experiments with mice transgenic for rearranged T-cell receptor genes show clearly that the specificity of the T-cell receptor for self peptide:self MHC complexes determines which co-receptor a mature T cell will express. If the transgenes encode a T-cell receptor specific for antigen presented by s...
Psichiatry_DSM-5	Physical violence may take the form of rape, assault, or, in rare cases, homicide. Deliberate destruction of others’ property may include deliberate fire setting with the intention of caus- ing serious damage (Criterion A8) or deliberate destroying of other people’s property in other ways (e.g., smashing car windows, v...	Psichiatry_DSM-5. Physical violence may take the form of rape, assault, or, in rare cases, homicide. Deliberate destruction of others’ property may include deliberate fire setting with the intention of caus- ing serious damage (Criterion A8) or deliberate destroying of other people’s property in other ways (e.g., smash...
Surgery_Schwartz	between the neck of the pancreas and the portal and superior mesenteric veins.Celiaclymph nodeHepaticlymph nodePyloriclymph nodeAnteriorpancreatico-duodenallymph nodePosteriorpancreaticoduodenallymph nodeSuperior mesentericlymph nodeInferiorbodySuperior body Splenic lymphnodeDuodenumSpleenFigure 33-6. Lymphatic supply ...	Surgery_Schwartz. between the neck of the pancreas and the portal and superior mesenteric veins.Celiaclymph nodeHepaticlymph nodePyloriclymph nodeAnteriorpancreatico-duodenallymph nodePosteriorpancreaticoduodenallymph nodeSuperior mesentericlymph nodeInferiorbodySuperior body Splenic lymphnodeDuodenumSpleenFigure 33-6....
Psichiatry_DSM-5	It can also occur upon awakening from a daytime nap. During that period, the individual appears awake, but there is a decline in motor dexterity, behavior may be very inappro- priate, and memory deficits, disorientation in time and space, and feelings of grogginess may occur. This period may last some minutes to hours....	Psichiatry_DSM-5. It can also occur upon awakening from a daytime nap. During that period, the individual appears awake, but there is a decline in motor dexterity, behavior may be very inappro- priate, and memory deficits, disorientation in time and space, and feelings of grogginess may occur. This period may last some...
Neurology_Adams	In the spheres of speech and language, a number of abnormalities other than Broca aphasia appear in conjunction with disease of the frontal lobes: laconic speech, lack of spontaneity of speech, telegrammatic speech (agrammatism), loss of fluency, perseveration of speech, a tendency to whisper instead of speaking aloud,...	Neurology_Adams. In the spheres of speech and language, a number of abnormalities other than Broca aphasia appear in conjunction with disease of the frontal lobes: laconic speech, lack of spontaneity of speech, telegrammatic speech (agrammatism), loss of fluency, perseveration of speech, a tendency to whisper instead o...
Obstentrics_Williams	Calcium and magnesium promote the biosynthesis and secretion of calcitonin. Various gastric hormones-gastrin, pentagastrin, glucagon, and pancreozymin-and food ingestion also increase calcitonin plasma levels. In normal pregnancy, unlike their fetal counterparts, the maternal adrenal glands undergo little, if any, morp...	Obstentrics_Williams. Calcium and magnesium promote the biosynthesis and secretion of calcitonin. Various gastric hormones-gastrin, pentagastrin, glucagon, and pancreozymin-and food ingestion also increase calcitonin plasma levels. In normal pregnancy, unlike their fetal counterparts, the maternal adrenal glands underg...
Cell_Biology_Alberts	(Adapted from A. Radzicka and R. Wolfenden, Science 267:90–93, 1995.) catalysis. (A) The start of the uncatalyzed reaction that hydrolyzes a peptide bond, with blue shading used to indicate electron distribution in the water and carbonyl bonds. (B) An acid likes to donate a proton (H+) to other atoms. By pairing with t...	Cell_Biology_Alberts. (Adapted from A. Radzicka and R. Wolfenden, Science 267:90–93, 1995.) catalysis. (A) The start of the uncatalyzed reaction that hydrolyzes a peptide bond, with blue shading used to indicate electron distribution in the water and carbonyl bonds. (B) An acid likes to donate a proton (H+) to other at...
Neurology_Adams	Incipient respiratory failure is usually marked by a reduction of vital capacity, often accompanied by restlessness, anxiety, diaphoresis, or tremor. Once the diaphragm fails, movements of the chest wall and abdomen become paradoxical (the abdomen moves inward during inspiration) or there may be shallow excursions of t...	Neurology_Adams. Incipient respiratory failure is usually marked by a reduction of vital capacity, often accompanied by restlessness, anxiety, diaphoresis, or tremor. Once the diaphragm fails, movements of the chest wall and abdomen become paradoxical (the abdomen moves inward during inspiration) or there may be shallo...
InternalMed_Harrison	Isocyanates (TDI, Production of polyurethane foams, plastics, Mucous membrane irritation, dyspnea, Upper respiratory tract irritation, cough, HDI, MDI) adhesives, surface coatings cough, wheeze, pulmonary edema asthma, hypersensitivity pneumonitis, reduced lung function Nitrogen dioxide Silage, metal etching, explosive...	InternalMed_Harrison. Isocyanates (TDI, Production of polyurethane foams, plastics, Mucous membrane irritation, dyspnea, Upper respiratory tract irritation, cough, HDI, MDI) adhesives, surface coatings cough, wheeze, pulmonary edema asthma, hypersensitivity pneumonitis, reduced lung function Nitrogen dioxide Silage, me...
Surgery_Schwartz	abdominal injuries. AASW = anterior abdominal stab wound; CT = computed tomography; DPL = diagnostic peritoneal lavage; GSW = gunshot wound; LWE = local wound exploration; RUQ = right upper quadrant; SW = stab wound.Table 7-6Criteria for “positive” finding on diagnostic peritoneal lavageABDOMINAL TRAUMATHORACOABDOMINAL...	Surgery_Schwartz. abdominal injuries. AASW = anterior abdominal stab wound; CT = computed tomography; DPL = diagnostic peritoneal lavage; GSW = gunshot wound; LWE = local wound exploration; RUQ = right upper quadrant; SW = stab wound.Table 7-6Criteria for “positive” finding on diagnostic peritoneal lavageABDOMINAL TRAU...
Immunology_Janeway	‘Cytokine’ is a term for any protein secreted by immune cells that affects the behavior of nearby cells bearing appropriate receptors. There are more than 60 different cytokines; some are produced by many different cell types; others, by only a few specific cell types. Some cytokines influence many types of cells, whil...	Immunology_Janeway. ‘Cytokine’ is a term for any protein secreted by immune cells that affects the behavior of nearby cells bearing appropriate receptors. There are more than 60 different cytokines; some are produced by many different cell types; others, by only a few specific cell types. Some cytokines influence many ...
Pediatrics_Nelson	Place self-adhesive defibrillation pads or paddles with electrode gel at the apex of the heart and the upper right side of the chest Notify all participating personnel before discharging paddles so that no one is in contact with patient or bed Begin with 2 J/kg; resume chest compressions immediately If unsuccessful, in...	Pediatrics_Nelson. Place self-adhesive defibrillation pads or paddles with electrode gel at the apex of the heart and the upper right side of the chest Notify all participating personnel before discharging paddles so that no one is in contact with patient or bed Begin with 2 J/kg; resume chest compressions immediately ...
Gynecology_Novak	The diagnostic workup is summarized as follows: 1. The initial laboratory test should be assessment of serum FSH and LH levels unless the history and physical examination suggest otherwise in order to differentiate hypergonadotropic and hypogonadotropic forms of hypogonadism. If the FSH level is elevated, a karyotype s...	Gynecology_Novak. The diagnostic workup is summarized as follows: 1. The initial laboratory test should be assessment of serum FSH and LH levels unless the history and physical examination suggest otherwise in order to differentiate hypergonadotropic and hypogonadotropic forms of hypogonadism. If the FSH level is eleva...
Gynecology_Novak	Endometrial, cervical, and ovarian malignancies must be ruled out in the presence of post-menopausal bleeding. One series found a malignancy (endometrial or cervical) in approximately 10% of women with postmenopausal bleeding (253). A Pap test is essential when postmenopausal bleeding is noted, although the Pap test is...	Gynecology_Novak. Endometrial, cervical, and ovarian malignancies must be ruled out in the presence of post-menopausal bleeding. One series found a malignancy (endometrial or cervical) in approximately 10% of women with postmenopausal bleeding (253). A Pap test is essential when postmenopausal bleeding is noted, althou...
Pharmacology_Katzung	act at the actin-troponin-tropomyosin complex where activator calcium brings about the contractile interaction of actin and myosin. Black arrows represent processes that initiate contraction or support basal tone. Green arrows represent processes that promote relaxation.	Pharmacology_Katzung. act at the actin-troponin-tropomyosin complex where activator calcium brings about the contractile interaction of actin and myosin. Black arrows represent processes that initiate contraction or support basal tone. Green arrows represent processes that promote relaxation.
InternalMed_Harrison	access to medical care. Failure of veterinary control programs due to conflict or for economic reasons contributes further to the emergence and re-emergence of disease, as seen currently in some eastern Mediterranean countries.	InternalMed_Harrison. access to medical care. Failure of veterinary control programs due to conflict or for economic reasons contributes further to the emergence and re-emergence of disease, as seen currently in some eastern Mediterranean countries.
Gynecology_Novak	The 2003 Rotterdam Consensus Group recommends that obese women with PCOS and nonobese PCOS patients with risk factors for insulin resistance, such as a family history of diabetes, should be screened for metabolic syndrome, including glucose intolerance with an oral glucose tolerance test (19). The standard 2-hour oral ...	Gynecology_Novak. The 2003 Rotterdam Consensus Group recommends that obese women with PCOS and nonobese PCOS patients with risk factors for insulin resistance, such as a family history of diabetes, should be screened for metabolic syndrome, including glucose intolerance with an oral glucose tolerance test (19). The sta...
Obstentrics_Williams	EI-Mohandes A, Herman AA, Kl-Khorazaty MN, et al: Prenatal care reduces the impact of illicit drug use on perinatal outcomes. J Perinatol 23:354, 2003 Eriksen JLK, Pilliod A, Caughey AB: Impact oflate initiation of prenatal care on pregnancy outcomes among women who use drugs. Abstract No. 732. Am J Obstet Gynecol 214:...	Obstentrics_Williams. EI-Mohandes A, Herman AA, Kl-Khorazaty MN, et al: Prenatal care reduces the impact of illicit drug use on perinatal outcomes. J Perinatol 23:354, 2003 Eriksen JLK, Pilliod A, Caughey AB: Impact oflate initiation of prenatal care on pregnancy outcomes among women who use drugs. Abstract No. 732. Am...
InternalMed_Harrison	a As determined by retrospective serologic survey of individuals alive during those years (“seroarchaeology”). b Hemagglutinins formerly designated as Hsw and H0 are now classified as variants of H1. c From this time until 2008–2009, viruses of the H1N1 and H3N2 subtypes circulated either in alternating years or concur...	InternalMed_Harrison. a As determined by retrospective serologic survey of individuals alive during those years (“seroarchaeology”). b Hemagglutinins formerly designated as Hsw and H0 are now classified as variants of H1. c From this time until 2008–2009, viruses of the H1N1 and H3N2 subtypes circulated either in alter...
InternalMed_Harrison	FIGURE 326-2 The emergency management of patients with cardiogenic shock, acute pulmonary edema, or both is outlined.	InternalMed_Harrison. FIGURE 326-2 The emergency management of patients with cardiogenic shock, acute pulmonary edema, or both is outlined.
Neurology_Adams	Of course, any person facing a challenging or threatening task for which he may feel unprepared and inadequate experiences some degree of nervousness and anxiety. Anxiety is then not abnormal, and the alertness and attentiveness that accompany it may actually improve performance up to a point. Barratt and White found t...	Neurology_Adams. Of course, any person facing a challenging or threatening task for which he may feel unprepared and inadequate experiences some degree of nervousness and anxiety. Anxiety is then not abnormal, and the alertness and attentiveness that accompany it may actually improve performance up to a point. Barratt ...
Biochemistry_Lippinco	A. Carbohydrate metabolism The liver is normally a glucose-producing rather than a glucose-using organ. However, after a meal containing carbohydrate, the liver becomes a net consumer, retaining roughly 60 g of every 100 g of glucose presented by the portal system. This increased use reflects increased glucose uptake b...	Biochemistry_Lippinco. A. Carbohydrate metabolism The liver is normally a glucose-producing rather than a glucose-using organ. However, after a meal containing carbohydrate, the liver becomes a net consumer, retaining roughly 60 g of every 100 g of glucose presented by the portal system. This increased use reflects inc...
First_Aid_Step1	Urinary incontinence Mixed incontinence has features of both stress and urgency incontinence. Acute cystitis Inflammation of urinary bladder. Presents as suprapubic pain, dysuria, urinary frequency, urgency. Systemic signs (eg, high fever, chills) are usually absent. Risk factors include female sex (short urethra), sex...	First_Aid_Step1. Urinary incontinence Mixed incontinence has features of both stress and urgency incontinence. Acute cystitis Inflammation of urinary bladder. Presents as suprapubic pain, dysuria, urinary frequency, urgency. Systemic signs (eg, high fever, chills) are usually absent. Risk factors include female sex (sh...
InternalMed_Harrison	Clinical Features and Relevance to the WHO Classification The WHO ETIOLOGY classification also considers clinical features in subdividing AML. For Heredity, radiation, chemical and other occupational exposures, and example, it identifies therapy-related AML as a separate entity that drugs have been implicated in the de...	InternalMed_Harrison. Clinical Features and Relevance to the WHO Classification The WHO ETIOLOGY classification also considers clinical features in subdividing AML. For Heredity, radiation, chemical and other occupational exposures, and example, it identifies therapy-related AML as a separate entity that drugs have bee...
Pediatrics_Nelson	The goal in managing a child with SHCN is to maximizethe child’s potential for productive adult functioning bytreating the primary diagnosis and by helping the patientand family deal with the stresses and secondary impairmentsincurred because of the disease or disability. Whenever a chronic disease is diagnosed, family...	Pediatrics_Nelson. The goal in managing a child with SHCN is to maximizethe child’s potential for productive adult functioning bytreating the primary diagnosis and by helping the patientand family deal with the stresses and secondary impairmentsincurred because of the disease or disability. Whenever a chronic disease i...
Cell_Biology_Alberts	Signaling through BCRs or TCRs and their associated proteins alone is not sufficient to activate a lymphocyte to proliferate and differentiate. Extracellular co-stimulatory signals produced by another cell are also required, and they are provided by membrane-bound proteins (see Figure 24–34) and secreted cytokines. Ind...	Cell_Biology_Alberts. Signaling through BCRs or TCRs and their associated proteins alone is not sufficient to activate a lymphocyte to proliferate and differentiate. Extracellular co-stimulatory signals produced by another cell are also required, and they are provided by membrane-bound proteins (see Figure 24–34) and s...
InternalMed_Harrison	for many forms of epilepsy. However, the barbiturates frequently cause sedation in adults, hyperactivity in children, and other more subtle cognitive changes; thus, their use should be limited to situations in which no other suitable treatment alternatives exist.	InternalMed_Harrison. for many forms of epilepsy. However, the barbiturates frequently cause sedation in adults, hyperactivity in children, and other more subtle cognitive changes; thus, their use should be limited to situations in which no other suitable treatment alternatives exist.
InternalMed_Harrison	Hyperphosphatemia, which can be caused by the release of intracellular phosphate pools by tumor lysis, produces a reciprocal depression in serum calcium, which causes severe neuromuscular irritability and tetany. Deposition of calcium phosphate in the kidney and hyperphosphatemia may cause renal failure. Potassium is t...	InternalMed_Harrison. Hyperphosphatemia, which can be caused by the release of intracellular phosphate pools by tumor lysis, produces a reciprocal depression in serum calcium, which causes severe neuromuscular irritability and tetany. Deposition of calcium phosphate in the kidney and hyperphosphatemia may cause renal f...
InternalMed_Harrison	slow taper over 8–12 weeks. A steroid-sparing agent, such as mycophenolate mofetil, may be indicated in cases of rapid recurrence upon steroid taper. In all cases, rapid withdrawal of the suspected drug is required. Given the severe long-term complications of myocarditis, patients should undergo cardiac evaluation if h...	InternalMed_Harrison. slow taper over 8–12 weeks. A steroid-sparing agent, such as mycophenolate mofetil, may be indicated in cases of rapid recurrence upon steroid taper. In all cases, rapid withdrawal of the suspected drug is required. Given the severe long-term complications of myocarditis, patients should undergo c...
Psichiatry_DSM-5	long periods of time; only a small minority present to clinical attention with observable alternation of identities. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense ofagency (Crit...	Psichiatry_DSM-5. long periods of time; only a small minority present to clinical attention with observable alternation of identities. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and se...
Histology_Ross	FIGURE 4.4 Nerve tissue. a. A Mallory-stained section of a peripheral nerve. Nerve tissue consists of a vast number of threadlike myelinated axons held together by connective tissue. The axons have been cross-sectioned and appear as small, red, dotlike structures. The clear space surrounding the axons previously cont...	Histology_Ross. FIGURE 4.4 Nerve tissue. a. A Mallory-stained section of a peripheral nerve. Nerve tissue consists of a vast number of threadlike myelinated axons held together by connective tissue. The axons have been cross-sectioned and appear as small, red, dotlike structures. The clear space surrounding the axons...
InternalMed_Harrison	After sleep deprivation, NREM sleep is generally recovered first, followed by REM sleep. However, because REM sleep tends to be most prominent in the second half of the night, sleep truncation (e.g., by an alarm clock) results in selective REM sleep deprivation. This may 06.00 08.00 increase REM sleep pressure to the p...	InternalMed_Harrison. After sleep deprivation, NREM sleep is generally recovered first, followed by REM sleep. However, because REM sleep tends to be most prominent in the second half of the night, sleep truncation (e.g., by an alarm clock) results in selective REM sleep deprivation. This may 06.00 08.00 increase REM s...
InternalMed_Harrison	At least two newer anti-CD20 monoclonal antibodies have 703 become available, ofatumumab and obinutuzumab. Both have activity in previously treated patients. Agents targeting signaling pathways, such as ibrutinib, an irreversible inhibitor of Bruton’s tyrosine kinase, and idelalisib, an inhibitor of phosphoinositide3-k...	InternalMed_Harrison. At least two newer anti-CD20 monoclonal antibodies have 703 become available, ofatumumab and obinutuzumab. Both have activity in previously treated patients. Agents targeting signaling pathways, such as ibrutinib, an irreversible inhibitor of Bruton’s tyrosine kinase, and idelalisib, an inhibitor ...
Surgery_Schwartz	artery as opposed to hepa-tocytes, which receive oxygen primarily from the portal vein. Performed via angiography, embolization may be performed alone (bland embolization) or in combination with chemothera-peutic agents (chemoembolization). Radioembolization, the selective distribution of radioactive yttrium-90 microsp...	Surgery_Schwartz. artery as opposed to hepa-tocytes, which receive oxygen primarily from the portal vein. Performed via angiography, embolization may be performed alone (bland embolization) or in combination with chemothera-peutic agents (chemoembolization). Radioembolization, the selective distribution of radioactive ...
Gynecology_Novak	Perforation Perforation may occur during dilation of the cervix, positioning of the hysteroscope, or as a consequence of the intrauterine procedure. With complete perforation, the endometrial cavity typically does not distend, and the visual field is generally lost. When perforation occurs during dilation of the cervix...	Gynecology_Novak. Perforation Perforation may occur during dilation of the cervix, positioning of the hysteroscope, or as a consequence of the intrauterine procedure. With complete perforation, the endometrial cavity typically does not distend, and the visual field is generally lost. When perforation occurs during dila...