Success on the United States Medical Licensing Examination (USMLE) Step 1 requires a thorough understanding of the basic sciences covered in the first and second years of medical education. To offer the most complete and accurate review book, we assembled a team of authors and editors from around the country who are engaged in various specialties and involved in both academic and clinical settings. The author team was asked to research and write test questions using the parameters set forth by the National Board of Medical Examiners (NBME). All the subjects, types of questions, and techniques that will be encountered on the USMLE Step 1 are presented in this book. Lange Q&A: USMLE Step 1 is designed to provide you with a comprehensive review of the basic sciences as well as a valuable self-assessment tool for exam preparation. A total of 1200 questions are included in this edition. Approximately 150 questions are covered in each of the basic sciences: Anatomy, Physiology, Biochemistry, Microbiology, Pathology, Pharmacology, and Behavioral Sciences. • Questions are followed by a section with answers and detailed explanations referenced to the most current and popular resources available. • Seven practice tests simulating the USMLE Step 1 are included at the end of this text. • We believe that you will find the questions, explanations, and format of Lange Q&A: USMLE Step 1 to be of great assistance to you during your review. We wish you luck on the USMLE Step 1
SIXTH EDITION LANGE Q&A ™ USMLE STEP Michael W King, PhD Professor Department of Biochemistry and Molecular Biology Center for Regenerative Biology and Medicine Indiana University School of Medicine Terre Haute, Indiana New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2008 by The McGraw-Hill Companies, Inc All rights reserved Manufactured in the United States of America Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher 0-07-164314-1 The material in this eBook also appears in the print version of this title: 0-07-149219-4 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs For more information, please contact George Hoare, Special Sales, at george_hoare@mcgraw-hill.com or (212) 904-4069 TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc (“McGraw-Hill”) and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise DOI: 10.1036/0071492194 Professional Want to learn more? 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If you’d like more information about this book, its author, or related books and websites, please click here For more information about this title, click here Contents Contributors v Preface vii Review Preparation Guide ix Standard Abbreviations xiii USMLE Step Common Laboratory Values xv Anatomy TAIHUNG DUONG, PHD Questions Answers and Explanations 30 Bibliography 55 Physiology 57 GABI NINDL WAITE, PHD, BRIAN G KENNEDY, PHD, AND STEPHEN ECHTENKAMP, PHD Questions 57 Answers and Explanations 82 Bibliography 108 Biochemistry 109 MICHAEL W KING, PHD Questions 109 Answers and Explanations 132 Bibliography 174 Microbiology 175 JAMES D KETTERING, PHD Questions 175 Answers and Explanations 198 Bibliography 228 Pathology 229 KAREN D TSOULAS, MD, EDD Questions 229 Answers and Explanations 256 Bibliography 288 iii iv Contents Pharmacology 289 BERTRAM G KATZUNG, MD, PHD Questions 289 Answers and Explanations 307 Bibliography 333 Behavioral Sciences 335 HOYLE LEIGH, MD Questions 335 Answers and Explanations 342 Bibliography 348 Practice Test 349 Questions 349 Answers and Explanations 359 Bibliography 371 Practice Test 373 Questions 373 Answers and Explanations 382 10 Practice Test 395 Questions 395 Answers and Explanations 404 11 Practice Test 417 Questions 417 Answers and Explanations 426 12 Practice Test 439 Questions 439 Answers and Explanations 449 13 Practice Test 461 Questions 461 Answers and Explanations 470 14 Practice Test 481 Questions 481 Answers and Explanations 491 Index 503 Color insert appears after the Index Contributors Taihung Duong, PhD James D Kettering, PhD Associate Professor Department of Anatomy and Cell Biology Indiana University School of Medicine-Terre Haute Terre Haute, Indiana Professor Emeritus Department of Biochemistry and Microbiology Loma Linda University School of Medicine Loma Linda, California Stephen Echtenkamp, PhD Hoyle Leigh, MD Associate Professor Department of Cellular and Integrative Physiology Indiana University School of Medicine-Northwest Gary, Indiana Professor Department of Psychiatry University of California, San Francisco Fresno, California Bertram G Katzung, MD, PhD Karen D Tsoulas, MD, EdD Professor Emeritus Department of Cellular and Molecular Pharmacology University of California, San Francisco San Francisco, California Assistant Professor Department of Pathology and Laboratory Medicine Keck School of Medicine University of Southern California Los Angeles, California Brian G Kennedy, PhD Associate Professor Department of Cellular and Integrative Physiology Indiana University School of Medicine-Northwest Gary, Indiana Gabi Nindl Waite, PhD Associate Professor Department of Cellular and Integrative Physiology Indiana University School of Medicine-Terre Haute Terre Haute, Indiana v Copyright © 2008 by The McGraw-Hill Companies, Inc Click here for terms of use This page intentionally left blank Preface Success on the United States Medical Licensing Examination (USMLE) Step requires a thorough understanding of the basic sciences covered in the first and second years of medical education To offer the most complete and accurate review book, we assembled a team of authors and editors from around the country who are engaged in various specialties and involved in both academic and clinical settings The author team was asked to research and write test questions using the parameters set forth by the National Board of Medical Examiners (NBME) All the subjects, types of questions, and techniques that will be encountered on the USMLE Step are presented in this book Lange Q&A: USMLE Step is designed to provide you with a comprehensive review of the basic sciences as well as a valuable self-assessment tool for exam preparation A total of 1200 questions are included in this edition Key Features and Use • Approximately 150 questions are covered in each of the basic sciences: Anatomy, Physiology, Biochemistry, Microbiology, Pathology, Pharmacology, and Behavioral Sciences • Questions are followed by a section with answers and detailed explanations referenced to the most current and popular resources available • Seven practice tests simulating the USMLE Step are included at the end of this text • We believe that you will find the questions, explanations, and format of Lange Q&A: USMLE Step to be of great assistance to you during your review We wish you luck on the USMLE Step The Editor and the Publisher vii Copyright © 2008 by The McGraw-Hill Companies, Inc Click here for terms of use This page intentionally left blank 514 Index MPS disease (See Mucopolysacharidotic diseases) MRI (magnetic resonance image), MSUD, 115, 144 Mucolipidosis type II, 120, 153 Mucopolysacharidotic (MPS) diseases Hunter syndrome, 440–441, 451 Hurler syndrome, 121, 153 Multiaxal system, 336, 342 Multi-infact dementia, 335, 342 Multiple myeloma, 247, 276–277, 442, 454 Multiple personality disorder (dissociated identity disorder), 335–337, 342, 343 Multiple sclerosis, 18, 43, 72, 97 Mumps virus, 196, 226 Muscarinic receptors, 303, 326–327 Muscle cell energy production, 118, 149 Muscle phosphofructokinase deficiency, 109, 132–133 Muscle spindles, 21, 46 Muscular dystrophy, Duchenne, 253, 284 Musculocutaneous nerve, 8, 34 Musculotaneous nerves, 421, 433 Mutism, 450, 482, 491 Mu-type opioid receptors, 301, 324 Myasthenia gravis (MG), 247, 277, 302, 326, 355, 366 anti-acetylcholine receptor antibodies, 182, 205–206 cholinergic crisis, 302, 326 and cholinergic receptors, 27, 53 myasthenic crisis, 302, 326 Mycobacterial infection, 191, 218 Mycoplasma, 193, 221 Mycoses, 184, 208 Myelin, 11, 37 Myelocyte stage, 15, 41 Myocardial contractility, 296, 315 Myocardial infarct (MI), 234, 240–241, 262, 268–269, 418, 427 coagulative necrosis, 234, 262 effect of aspirin, 295, 314–315 healing of, 378, 390–391 and mural thrombus, 402, 415 and renal infarct, 238, 265 and troponin I, 253, 283, 485, 496 Myocardial replacement, 237, 264 Myocarditis, 176–177, 200 Myopia, 59, 65, 84, 89 Myosin, 30 Myosin light chain kinase, 65, 89 Myotonic dystrophy, early onset, 127, 164 Myxedema (See Hypothyroidism) N N meningitides, 462–463, 471–472 N-acetylglutamate, 111, 136 NADH-coenzyme Q reductase, 125, 160–161 Naloxone, 340, 346 Naltrexone, 292, 310 Narcotic drug addiction, 338, 344 Nasal polyps, 236, 263 Nausea, postoperative, 291, 309 Nearsightedness, 65, 89 Neocerebellum lesion, 12, 38 Neoplasm, malignant, 232–233, 260 Neoplastic changes to skin, 5, 32 Nephroblastoma (See Wilms’ tumor) Nephrogenic diabetes insipidus, 292, 309, 486, 497 and excreted glucose, 64, 88 and lithium carbonate, 292, 309 Nephrotic syndrome, 244, 273–274, 489, 500 NEU oncogene, 248–249, 278 Neural (sensory) retina, 13, 38 Neuroblastoma, 230–231, 258 Neurogenic diabetes insipidus, 78, 104 Neuroleptic antipsychotic drugs, 379, 392 Neuromuscular irritability, 79, 105 Neuron identification, 6–7, 33 Neuronal action potential, 72, 97 Nicotine craving, reduction of, 292, 310 Niemann-Pick disease (NPD) type 1A, 377, 387–388 type 1B, 469, 480 Nitric oxide (NO) arginine, 122, 155 endothelium-derived relaxing factor, 78, 104–105 inhaled anesthetics, 299, 321 penile artery dilation, 78, 104–105 Nitrovasodilators, 301, 323–324 NO (See Nitric oxide) Nocardia asteroides, 419 Nocardiosis, 419 Nonsteroidal anti-inflammatory drugs and GI bleeding, 60, 85 and rheumatoid arthritis, 298, 319 Norwalk virus, 184, 208 Notochord, 377, 388 NPD (See Niemann-Pick disease) NSAIDs (See Nonsteroidal antiinflammatory drugs) Nuclear morphology, 6–7, 33 Nucleus raphe magnus, 21, 47 O Obesity, 113, 140 Obliquus capitus superior muscle, 23, 49 Obsessive personality, 461, 470, 487, 498 Obstruction of the intestine, 21, 46 Obturator artery, 9, 35 Obturator nerve, 16, 26, 42, 52 Occipital bone, 23, 49 Occlusive embolus, 230, 257 Oculomotor nerve, Odorant-binding protein, 376, 386–387 Ohm’s Law, 66, 91 Olfactory gland of Bowman, 376, 386–387 Oncogenes, 354, 366 Ondansetron, 397, 408 Oocytes, maturation of, 24, 49 Opioid mu receptors, 292, 309–310 Opioid peptides, 77, 103 Opioid use, 302–303, 326 Optic chiasma, 399, 411 Orad stomach, 78, 103–104 Oral anticoagulants, 304, 328 Orbicularis oculi, 17, 43 Organ transplant and creatinine clearance, 292–293, 311 and cytomegalovirus, 192, 219 immunologic suppression for, 191, 218 Ornithine transcarbamoylase (OTC) deficiency, 117, 146–147 Ornithosis, 193, 221 Orotic acid concentration, 109, 132 Osmotic diuresis, 78, 104 Osmotic laxative, 294, 312 Osteoarthritis, degenerative, 236, 263 Osteoblasts, 481, 491 Osteoclastic activity, 289, 307 Osteoclasts, 27, 52, 486, 497–498 Osteocytes, 17, 42–43 Osteogenesis imperfecta, 116, 144–145 Index Osteogenesis imperfecta type I, 248, 278 Osteogenic sarcoma, 464–465, 474 Osteoid location, 27, 53 Osteomalacia, 27, 53 Osteomyelitis, 232, 260 Osteoporosis and osteoclasts, 486, 497–498 senile or post-menopausal, 254, 284 Osteosarcoma, 244, 249, 274, 278–279 Ostium secundum atrial septal defect, 17, 42 OTC deficiency (See Ornithine transcarbamoylase) Otitis, diabetic malignant external, 301, 324 Otitis media, 241, 269, 350, 360 Outer hair cells, 374, 383 Ovary activity, 80, 106 Ovulation, and LH, 72, 97–98 Ovum, 24, 49 Oxygen, lack of, 62, 87 P P malariae, 422, 434 P mirabilis, 187, 213 P multocida, 187, 212 Pacinian corpuscle, 397, 407–408, 421, 432 Paclitaxel (See Taxol) PAF (platelet-activating factor), 127, 164 Paget disease, 464–465, 474 Pain receptors, 338, 344–345 Pain transmission, modulation of, 21, 47 Palatoglossus muscle, 10, 36 Pancreas A and B cells in, 12, 38 carcinoma of, 338, 344 glucagon in, 12, 38 and insulin, 421, 433 insulin in, 12, 38 secretions of, 12, 38 Pancreatic adenocarcinomas, 247, 276 Pancreatic duct, 489, 500–501 Pancreatic secretion, 59, 85 Pancreatitis, acute, 236, 263 Pancreatitis, acute hemorrhagic, 16, 41–42 Pancreatitis, and didanosine, 296, 316, 444, 457 Panic disorders, 338, 345 and hyperthyroidism, 341 patient history of, 341, 346 sertraline for, 338, 345 Papex circuit, 18, 44 Paracrine hormones, 400, 412 Parainfluenza viruses, 350, 360 Paralysis, transient, 335, 342 Paramesonephric ducts, 19, 44 Paramytonia congenita (PC), 444, 456 Paramyxovirus, 189, 215–216 Paraquat, 466, 475–476 Parasites, obligate intracellular, 193, 199, 221 Parasitic infection, 79, 105 Parasympathetic nerves, 62, 87 Parathion intoxication, 293, 312 Parathyroid gland development, 18, 43 Parathyroid hormone (PTH) and hypocalcemia, 443, 455–456 and squamous cell carcinoma of lung, 467, 477–478 Parenchyma of the kidney, 424, 437 Parinauds syndrome, 23, 48–49 Parkinson’s disease, 303, 326–327 bromocriptine for, 421, 432–433 dopamine receptor agonist, 291, 309 and ropinirole, 374, 384 and substantia nigra, 357, 368 Parotid gland, 16, 24, 41, 50 Paroxetine, 340, 346 Paroxysmal nocturnal hemoglobinuria, 395, 404 Parsimony, 339, 345 Patient-controlled analgesia, 487, 498 PC (paramytonia congenita), 444, 456 PCA, 487, 498 PCOS, 128, 166 PCR, 119, 150 PDH complex, 126, 162 Pectineus muscle, 16, 42 Peer relationships, 339, 345 Pelvic inflammatory disease, 238, 266 Pemphigus vulgaris, 234, 261 Penicillin, 187, 212–213, 424, 436 Penile artery dilation, 78, 104–105 PEP carboxykinase, 350, 360 Peptic (chief, zymogenic) cells, 4, 32 Peptic ulcer disease, 73, 98, 235, 262 515 Peptide elongation process, 118, 149–150 Perfusion-limited gas, 444, 457 Perilunate fracture dislocation, 11, 37 Peripheral nervous system, 11, 37 Pernicious anemia, 247, 277, 294, 312 Peroxisome proliferator-activated receptor-gamma nuclear receptor, 293, 311 Peroxisomes, defective assembly of, 124, 159 Personality, 425, 437 Perspiration, 24, 50 Pertussis (See Whooping cough) Peutz-Jeghers syndrome, 483, 492–493 P53 protein, 130, 168 cell-cycle arrest, 123, 157 Li-Fraumeni syndrome, 130, 168 tumor suppressor, 123, 157 Pharyngeal arch, 467, 477 Pharyngeal arches, 23, 48 Pharyngeal pouch, 18, 43 Phencyclidine, 292, 310 Phenotype differences, 127, 165 Phenotypic variation, 130–131, 170 Phenylcyclidine, 292, 310 Phenytoin toxicity, 300, 322 Philadelphia chromosome, 417 Phosphate concentration, 57, 82–83 Phosphorylase kinase, 125, 161 Phosphorylation, 126, 162 Phosphorylation, oxidative, 127, 164 Photoreceptors, 2, 119, 150 Phrenic nerve, 12–13, 38 Phytanic acid, serum, 129, 166 Piaget, 337, 338, 343, 345 PID, 238, 266 Pinworms, 427 Pituitary gonadotropes, 111, 136 Pituitary hormones, 68, 93 PK1, 117, 148 Plasma clearance of drugs, 300–301, 323 Plasma renin level, 76, 101 Platelet aggregation, 296, 316 Platelet crosslinking, 113, 141 Platelet membrane protein complex GPIIb-GPIIIa, 113, 141 Platelet-activating factor (PAF), 127, 164 Pleomorphic adenoma, 352, 362 Pleuroperitoneal membrane defect, 19, 44–45 516 Index Pneumocystis carinii, 178, 201 Pneumocytes, type II, 26, 51 Pneumonia and alcoholism, 186, 210–211 and antibody activity, 175, 198 cord factor, 179, 202 fungal, 184, 208 and polysaccharide capsule, 490, 501 “walking” primary atypical, 177, 200 Pneumotaxic center, 15, 40 Poliovirus, types of, 184, 207–208 Poliovirus, wild-type, 192, 219–220 Polyarteritis nodosa, 240, 268 Polycystic ovarian syndrome, 128, 166 Polymerase chain reaction, 119, 150 Polymorphic repeat sequences, 123, 157 Polypeptide hormone, 69, 94 Poly-ubiquitination of proteins, 121, 154 Polyuria, 78, 104 Pompe disease, 418, 428 Pons, 15, 40 Porphyria cutanea tarda (PCT), 110, 134 Portocaval shunt, end-to-side, 20, 45 Posterior cricoarytenoid muscle, 24, 49 Post-menopausal osteoporosis, 254 Postoperative nausea, 291, 309 Postrenal obstruction, 245, 275 Potassium, 462, 471 conductance, 76, 101–102 serum, 293, 312 wasting, 290, 304, 307, 328 Potassium channel blocking, 296, 315 Potassium clearance, 76, 102 Potassium wasting hydrochlorothiazide, 290, 304, 307, 328 Potassium-sparing diuretics, 300, 321–322 PPAR-gamma nuclear receptor, 293, 311 PPD (purified protein derivative), 191, 218 Precocious (early onset) puberty, 66, 91 Predictive value positive, 422, 434 Prednisone, 293, 311 Prenatal testing, 444, 456–457 Primary aldosteronism, 76, 101, 235, 262–263 adrenal adema, 76, 101 aldosterone, 122, 155 plasma renin level, 76, 101 Primary hyperparathyroidism (HPT), 419, 429–430 Primary sclerosing cholangitis, 369–370 Primary syphilis, 190, 217 Proconvertin (See Factor VII) Progesterone receptors, 289, 307 Prolactin acidophil secretion of, 15, 41 breast enlargement, 122, 156 lactation, 122, 156 Prolactin secretion, 68, 93 Prolactin-releasing factor, 116, 146 Propofol, 291, 309 Proprioception, conscious, 5, 32–33 Prostaglandin, 70, 95 Prostate carcinoma, metastatic, 243, 272, 296, 315 Protease, viral, 121, 154 Protein targeting glycogen, 397, 408–409 Protein zero (P0), 11, 37 Proteins intermediate filament, 17, 42 and muscle cell contraction, 17 poly-ubiquitination of, 121, 154 synthesis, 119, 151 Proximal tubule, 78, 104 Proximate cause of death, 236, 263 Pseudomonad aeruginosa, 197, 226–227 Psittacosis, 193, 221 Psychomotor retardation, 399, 411 Psychosis, 340, 346 Psychotropic drugs, 298, 318 PTG, 397, 408–409 PTH (See Parathyroid hormone) Puberty, onset of, 66, 91, 336, 343 Pubis, 29, 54 Pulmonary abscess, 250, 280 Pulmonary capillaries, 376, 386 Pulmonary edema, 294, 313 Pulmonary fibrosis and amiodarone, 435, 469, 480 and bleomycin, 461, 469, 470–471, 480 and forced expiratory volume, 65, 90 and forced vital capacity, 65, 90 Pulmonary hypoplasia, 19, 44–45 Pulmonary irritant receptors, 70, 95 Pulmonary surfactant, 26, 51 Pulmonary tuberculosis, 57, 82 Pulmonary valve, stenosis of, 402, 415 Pulmonary arteries, 398, 409–410 Pulmonary capillary membrane, 445, 457 Pulsatile release, 60, 85 Pupil size, 58, 83 Pupillary light reflex, 13, 19, 39, 45 Purified protein derivative (PPD), 191, 218 Purine nucleotide cycle, 118, 149 Purine nucleotide salvage enzyme (HGPRT) deficiency, 118, 149 P-waves, 73, 98 Pyelonephritis, 178, 201 Pyruvate carboxylase, 127, 164, 483 Pyschomotor retardation, 354, 365 P0 (protein zero), 11, 37 Q Quartan fever, 422, 434 R RA (See Rheumatoid arthritis) Rabies virus, 179, 202 Radial nerve lesion, 15, 40–41 Radiation, exposure to, 467, 477 Radioallergosorbent test (RAST), 185, 210 Rate limiting step glycolysis, 111, 136 Receptive relaxation reflex, 78, 103–104 Rectouterine pouch, 9, 35 Red blood cell membranes, 380, 393–394 Reflux esophagitis, 468, 478 Refsum disease, 129, 166 Relapsing fever, 182, 205 Renal arteries, bilateral stenosis of, 64, 88–89 Renal artery stenosis, 65, 89 Renal cell carcinoma, 254, 284 Renal clearance, 76, 102 Renal disease, chronic, 57, 82–83 Renal failure, 72, 97, 234, 261, 396 Renal infarct, 238, 265 Renal insufficiency, 122, 155 Renal malformation, fetal, 304, 328 Renal toxicity, 297, 317 Renal tubular acidosis (RTA), 73, 98 Renal urate stones, 298, 319 Index Renal vascular disease, 65, 90 Renin secretion, 64, 88–89 Repaglinide, 378, 389 Repression, 447, 459 Resolution, 250, 280 Respiration, noisy, Respiratory acidosis, 417, 426 Respiratory alkalosis, 74, 99 Respiratory distress syndrome (See Hyaline membrane disease) Respiratory syncytial virus, 483, 492 Response time, 289, 307 Restriction endonuclease BamHI, 119, 150 Reticuloendothelial system, 176, 199–200 Retina ganglion cell, 74, 99–100 Retinal detachment, 13, 38 Retinal pigment epithelium, 13, 38 Retinitis pigmentosa, Rh (—) blood type, 484, 494–495 Rheumatoid arthritis (RA), 62, 87, 486, 498 choriocarcinoma, 294, 312 methotrexate for, 375, 385–386 and NSAIDs, 298, 319 tumor necrosis factor-alpha, 292, 310–311 Rhinitis, allergic, 185, 210 Rhinovirus, 187, 213 Rickettsia rickettsii, 193, 221 Rifampin, 399, 411–412 Right coronary artery, 23, 48 Risperidone, 481, 491 RNA editing, 128, 165 RNA interference (RNAi), 375, 384 RNA translation, 130, 168 Rocky Mountain spotted fever, 193, 221 Rod cells, 119, 150 Romberg’s sign, 440, 450 Ropinirole, 484, 495 Rotavirus, 231, 259 RTA (renal tubular acidosis), 73, 98 Rubella virus, 184, 208–209 Rubeola (See Measles virus) Running, difficulty, S S pyogenes, 446, 459 SA (sinoatrial) node, 23, 48 Salivary glands, 16, 41, 303, 326–327 Salt wasting, 353, 363–364 Sarcoidosis, 418, 428 Sarcolemma, 30 Sarcomeres, 28, 53, 423, 435 Sarcoplasmic reticulum, 79, 106 Sargramostim, 299, 321 SARS, 178, 201 Scatchard plot, 60, 85 Schistosomiasis, 79, 105 Schizophrenia chlorpromazine for, 69, 95 risperidone for, 481, 491 treatment of, 298, 318 Schwann cells, 11, 37 SCID (See Severe combined immunodeficiency disease) Sclerosing cholangitis, primary, 369–370 Scotopsin, 119, 150 Scrotum, innervation of skin of the, 19, 44 Second branchial arch, anomalies of, Second pharyngeal arch, 467, 477 Secondary hyperparathyroidism, 396, 406 Secondary hypertension, 65, 89 Secondary syphilis, 190, 216 Secretin, 59, 85, 352, 362 Sedation and absence seizures, 291, 308–309 antidepressants, 298, 318 kava, 295, 314 Seminoma, 469, 479–480 Senile osteoporosis, 254 Sensitivity testing, 464, 473–474 Sensorimotor period, 337, 343 Sensory relay thalamic nuclei, 13, 39 Sensory (neural) retina, 13, 38 Separation anxiety disorder, 340, 346 Septum primum, 17, 42 Septum secundum, 350, 360 Serological testing, 186, 211 Serotonin (5-HT), 290, 308 Serous secretory cells, 16, 41 Sertraline, 338, 345 Serum hormone-binding globulin, 128, 166 Serum sodium concentration, 66, 91 Seventh cranial (facial) nerve, 17, 43 Severe acute respiratory syndrome, 178, 201 Severe combined immunodeficiency disease stem differentiation defect, 177, 200 Severe combined immunodeficiency disease (SCID), 123, 157 517 Severe non-hemolytic icterus, 124, 159 SGLT (See Sodium-dependent secondary active transporter) SGLT-1 protein, 80, 107 SHBG, 128, 166 Sheathed arteriole, 21, 47 Shingles, 442, 454 SIADH, 74, 99 Sickle trait, 252, 282 Sildenafil (Viagra), 301, 323–324 and hypotension, 290, 307 and nitrovasodilators, 301, 323–324 Sinoatrial nodal tissue, 352, 362 Sinoatrial (SA) node, 23, 48 Sinopulmonary disease, chronic, 126, 163–164 Sjögren syndrome, 231, 258–259 Skeletal muscle contraction, 57, 82 and creatinine, 129, 166–167 tension, 70, 95 Skin and Horner syndrome, 20, 45 perspiration of the, 24, 50 sensation loss, 12, 38 SLE (See Systemic lupus erythematosus) Sleeping pills, 291, 308 Sliding filament theory, 435 Slow calcium channels, 58, 83 Smoking and porphyria cutanea tarda, 110, 134 squamous cell carcinoma of the esophagus, 241, 269–270 Sodium electrochemical gradient, 80, 107 Sodium excretion, 65, 90 Sodium reabsorption, by kidney, 113, 139 Sodium-dependent secondary active transporter, 80, 107, 484, 494 Solute clearance, 401, 413 Somatosensory deficits, 5, 33 Somatostatin, 79, 106 Somatostatin-analogue treatment, 69, 94 Somatotropin release inhibiting factor, 69, 94 Sonic hedgehog gene, 41 Spastic neurogenic urinary bladder, 18, 43–44 518 Index Special visceral afferent fibers, 25, 50 Spinal accessory nerve, 11, 37 Spinal cord lesion, 18, 43–44 Spinal nerves, 24, 49–50 Spironolactone, 465, 474 and diuresis, 375, 385 and heart failure, 401, 413 and hepatic cirrhosis, 375, 385 Spleen, 9, 35 arterial circulation of, 21, 47 arterial circulation of the, 21, 47 and immunoglobulins, 176, 199 Splenic (left colic) flexure, 20, 45 Sporotrichosis, 190, 216 Squamous cell carcinoma (SCC), 248, 277 of esophagus, 241, 269–270 of lung, 467, 477–478 on middle nasal concha, 487, 499 ultraviolet radiation, 244, 273 SRIF, 69, 94 SSRIs, 305 Standing, difficulty with, Stapedius, 467, 477 Staphylococcal scalded skin syndrome, 189, 215 Starling forces, 80, 106–107 Status asthmaticus, 245, 274 Steady-state concentration, 446, 458 Steely hair disease, 141 Stem differentiation defect, 177, 200 Sterility, 66, 91 Steroid-receptor complexes, 126, 162–163 Stimulus generalization, 424, 437 Straight sinus, 28, 53 Stratified squamous epithelium, 24, 50 Streptococci, group D, 183, 206 Streptococcus pyogenes, 178, 201 Streptokinase, 300, 322 Streptomycin use, 301, 323 Stretch receptors, atrial, 62, 87 Stria terminalis, 7, 33–34 Stridor, Stroke volume (of heart), 60, 61, 85, 86 Stylohyoid muscle, 17, 42 S-type lectins (galectins), 467, 476 Suboccipital triangle, 375, 385 Substantia nigra, 357, 368 Subthalamic nucleus of Luys, 9, 35 Succinyl-CoA-acetoacetate-CoAtransferase, 115, 143 Suicide, 354, 365 Sun, long-term exposure to, 5, 32 Superego, and guilt, 339, 346 Superficial flexor muscles, 8, 34 Superior alternating hemiplegia, 19, 45 Superior alveolar nerves, 20, 45 Superior ganglion of ninth cranial nerve, 357, 369 Superior mesenteric artery, 21, 46 Superior sagittal sinus, 11, 37 Superior vena cava, 22, 47 Supraorbital nerve, 5, 32 Suprascapular artery, 12–13, 38 SVA fibers (See Special visceral afferent fibers) Sweating, thermoregulatory, 289 Sympathetic nerves, 63, 70, 88, 96 Syndrome of inappropriate hypersecretion of antidiuretic hormone, 74, 99 Syphilis, 190, 216, 217 Systemic lupus erythematosus (SLE), 181, 195, 204, 224, 356, 367, 395, 405 Systemic vasculitis, 240, 268 T T pallidum, 190, 216 T spiralis, 439, 449 T vaginalis, 377, 388 Tachycardia acute AV nodal reentrant, 302, 325–326 and isoproternol, 468, 479 Taeniae coli muscles, 19, 45 Tardive dyskinesia, 298, 318 and AIMS, 463, 472 extrapyramidal dystonia, 298, 318 Tarui disease, 132–133, 137–139, 428 Taxol (paclitaxel), 122, 156, 294, 313 Tay-Sachs disease, 114, 142 TCA cycle (See Tricarboxylic acid cycle) T-cells and contact dermatitis, 191, 218–219 deficiency of, 356, 367 and DiGeorge syndrome, 3, 31 Telomerase, 115, 143 Tenth cranial (vagus) nerve, 5, 33 Testicular cancer, 11, 37, 297, 317 Testicular vein, left, 22, 48 Testosterone, 66, 91 Tetanus, 188, 189, 214, 215 Tetracycline antimicrobials, 181, 204, 301, 323 Tetracycline resistance, 297, 316 Tetralogy of Fallot, 469, 480 TGA (See Transposition of the great arteries) Thalamic motor nucleus, 21, 46 Thalamic nuclei, 13, 39 Thalamus, 481, 491 Therapeutic index of drugs, 302, 325 Thermoregulatory sweating, 289, 307 Thiazide diuretic chlorothiazide, 78–79, 105 Thiazolidinediones (TZDs), 442, 453 Thoracentesis, 23, 48 Thought blocking, 399, 411 Thrombin, 422, 434–435 clot formation, 76, 102 inhibitor, 486, 498 Thromboplastin, 349, 359 Thrombotic thrombocytopenic purpura, 237, 264 Thymic hypoplasia, 242, 270–271 Thymidine kinase, viral, 296, 316 Thymidylate synthase inhibition, 297, 317 Thymus, 15, 40 Thyroid peroxidase, 293, 311 Thyroiditis, 69, 94 Thyrotoxicosis, 298, 320 Thyroxine deficiency, 241, 269 Tic douloureux (See Trigeminal neuralgia) Tick, hard-bodied, 197, 226 Tidal volume, 74, 99 Tight junction (zonula occludens), 14, 39 Tinea cruris, 192, 219 Titin, 30 TNF-alpha (See Tumor necrosis factor-alpha) Tobacco, 337, 344, 376, 387 Tongue development, 23, 48 Tongue innervation, 23, 48 Topoisomerase II DNA strand breakage, 297, 318 and doxorubicin, 130, 169–170 Toxoplasmosis, 466, 475 Transferrin, 124–125, 160 Transient paralysis, 335, 342 Index Transitional epithelium, 22, 47 Transitional objects, 339, 345 Translation factor eEF-2, 118, 149–150 Transmissible spongiform encephalopathies, 183, 207 Transposition of the great arteries (TGA) and cyanotic heart disease, and right ventricle, 3, 31 and truncoconal septum, 22, 47 Transverse cervical artery, 12–13, 38 Treadmill stress test, 68, 93–94 Tremors, Tricarboxylic acid cycle, 112, 118, 139, 149 Trichinosis infections, 439, 449 Trigeminal (gasserian) ganglion, 463, 472 Trigeminal nerve (cranial nerve V), 25, 50 Trigeminal neuralgia, 29, 54, 463 Trinucleotide repeat expansion, 114, 122–123, 142, 156 Troponin I, 30, 253, 283 Trousseau sign, 79, 105 Truncoconal septum, 22, 47–48 Tryptophan, 417, 427 Tuberculosis, 235, 262 diagnosis of, 175, 198 and hypocortisolism, 57 pulmonary, 57, 82 Tuberculosis, secondary, 255, 286 Tubular fluid osmolality, 68, 93 Tumor necrosis factor, 249, 279 Tumor necrosis factor-alpha, 292, 310–311 Tumor suppression Li-Fraumeni syndrome, 130, 168 p53 protein, 123, 157 Tumors, pathological staging of, 424, 436 Tunica intima, 6, 33 Turner syndrome, 125, 161 21-beta hydroxylase deficiency, 353, 363–364 Type III hyperlipoproteinemia, 120, 152 Type IV glycogen storage disease, 111, 138 Typhoid fever, 252, 282–283 TZDs (thiazolidinediones), 442, 453 U U urealyticum, 440, 450–451 UCD (See Urea cycle defect) UGT, 124, 159 Ulcerative colitis, 230, 242, 257–258, 271 Ulcers, 339, 345 Ulnar nerve, 448, 460 Ultraviolet radiation, 244, 273 Umbilical vein, 11, 37, 465, 474–475 Urea cycle, 110–111, 136 Urea cycle defect, 109, 132, 485, 495 neonatal, 396, 407 and OTC deficiency, 117, 146–147 Urease, 375, 385 Ureter development, 26, 52 Uric acid, 121, 155 Uridine, 129, 168 Urinary system, 22, 47 Urinary tract infection (UTI), 187, 213 Urination, and micturition reflex, 18, 44 Uterus, embryonic development of, 19, 44 Uterus development, 19, 44 Uterus didelphys, 19, 44 V V vulnificus, 379, 392 “V wave,” 62, 87 Vagus (tenth cranial) nerve, 5, 20, 33, 45 Valproic acid, 440, 450 Valsava maneuver, 22 Vancomycin, 399, 411 Varicella, 189, 215 Vasa recta of jejunum, 21, 46 Vascular permeability, 175, 198 Vasculitis, 229, 240, 256–257, 268 Vasoactive intestinal peptide, 79, 106 Vasoconstruction, 409–410 Vein of Galen, 16, 28, 41, 53 Ventral lateral nucleus, 21, 46 Ventral posterior lateral nuclei, 13, 39 Ventral posterior medial nuclei, 13, 39 Ventricular action potential, 58, 83 Ventricular arrhythmia, 251, 281 Ventricular blood pressure, 64, 88 Ventricular depolarization, 402, 414 Ventricular load, 294, 313 519 Ventricular systole, 62, 87 Ventriculopertoneal shunts, 337, 343 Verapamil, 381, 394 Vertebral artery, 3, 31 Vertigo, 77, 102 Vestibular sensitivity, 58, 83 Vestibular system, 398, 409 Viagra (See Sildenafil) Vibration sensation, 18, 43 Vinyl chloride exposure, 229, 256 VIP (vasoactive intestinal peptide), 79, 106 Viral DNA synthesis, 190, 216 Viral mRNA activity, 176, 199 Viral multiplication curve, 484 Viral myocarditis, 351, 361 Virulence factor encapsulated bacteria, 187, 213 for gonorrhea, 179, 202 M protein, 195, 223–224 Visual impairment, 59, 84 Vitamin A, 126, 162 Vitamin B12 deficiency, 67, 92 Vitamin C deficiency, 233, 261, 441, 451 Vitamin D, 293, 312 Vitamin K, 126, 162 Vocal cord polyp/nodules, 482, 492 Vocal fold, abduction of the, 24, 49 Vocal folds, covering, 24, 50 Volume of distribution, apparent, 295, 314 Vomiting, excessive, 58, 83 von Gierke disease, 112, 117, 139, 147–148 von Recklinghausen disease, 130–131, 170 von Willebrand disease, 420, 431–432 von Willebrand factor, 124, 158–59 VPL nuclei, 13, 39 VPM nuclei, 13, 39 W Walking, slow and clumsy, Wallenberg syndrome (See Lateral medullary syndrome) Wallerian degeneration, 299, 320 Warthin tumor (adenolymphoma), 445, 457 Wasp sting, 356–357, 368 520 Index Water deprivation, 67, 92 Water ingestion, 63, 88 Water intoxication, 58, 83 Water secretion, 63, 88 Weakness, progressive generalized, Wernicke syndrome, 337, 344 Western blot test, 185, 210 Wheezing respiration, 25, 51 Whooping cough, 191, 196, 217–218, 226 Wilms’ tumor, 255, 275, 286 Wilson disease, 232, 260 Wolman disease, 116, 145–146 Wrist injury, 11, 37 Z Z lines, 28, 53 Zellweger syndrome, 124, 159 Zollinger-Ellison syndrome, 235, 262 Zone of equivalence, 181, 204 Zonula occludens (tight junction), 14, 39 Zymogenic (chief, chief) cells, 4, 32 FIG 1-1 (Question 5) FIG 1-3 (Question 11) FIG 1-4 (Question 12) FIG 1-6 (Question 15) FIG 1-7 (Question 17) FIG 1-10 (Question 23) Copyright © 2008 by The McGraw-Hill Companies, Inc Click here for terms of use FIG 1-8 (Question 21) FIG 1-12 (Question 33) FIG 1-14 (Question 43) FIG 1-15 (Question 44) FIG 1-16 (Question 52) FIG 1-19 (Question 63) FIG 1-23 (Question 112) FIG 5-1 (Question 5) FIG 5-2 (Question 10) FIG 5-3 (Question 15) FIG 5-4 (Question 20) FIG 5-5 (Question 25) FIG 5-6 (Question 30) FIG 5-7 (Question 35) FIG 5-8 (Question 40) FIG 5-10 (Question 50) FIG 5-9 (Question 45) FIG 5-12 (Question 60) FIG 5-11 (Question 55) FIG 5-14 (Question 70) FIG 5-13 (Question 65) FIG 5-15 (Question 75) FIG 5-16 (Question 80) FIG 5-17 (Question 85) FIG 5-18 (Question 90) FIG 5-19 (Question 95) FIG 5-20 (Question 100) FIG 5-21 (Question 105) FIG 5-22 (Question 110) FIG 5-23 (Question 115) FIG 5-24 (Question 120) FIG 5-25 (Question 125) FIG 8-3 (Question 17) FIG 8-7 (Question 46) FIG 9-1 (Question 6) FIG 9-2 (Question 22) FIG 9-4 (Question 41) FIG 10-1 (Question 12) FIG 10-4 (Question 36) FIG 11-1 (Question 9) FIG 12-1 (Question 4) FIG 11-4 (Question 26) FIG 12-2 (Question 25) FIG 12-6 (Question 47) FIG 13-4 (Question 27) FIG 13-6 (Question 47) FIG 14-3 (Question 14) FIG 14-5 (Question 34) ... million/mm3 Male: 0 15 mm/h Female: 0–20 mm/h Male: 41 53% Female: 36–46% ≤6% Male: 13 .5 17 .5 g/dL Female: 12 .0 16 .0 g/dL 1 4 mg/dL 2–7 4.3–5.9 × 10 12/L 3.5–5.5 × 10 12/L 0 15 mm/h 0–20 mm/h 0. 41 0.53 0.36–0.46... 2.09–2. 71 mmol/L 1. 86–2.48 mmol/L 0 .16 –0.62 mmol/L 4500 11 ,000/mm3 54–62% 3–5% 1 3% 0–0.75% 25–33% 3–7% 25.4–34.6 pg./cell 31 36% Hb/cell 80 10 0 μm3 25–40 s 15 0,000–400,000/mm3 11 15 s 0.5 1. 5%... from control 4.5 11 .0 × 10 9/L 0.54–0.62 0.03–0.05 0. 01 0.03 0–0.0075 0.25–0.33 0.03–0.07 0.39–0.54 fmol/cell 4. 81 5.58 mmol Hb/L 80 10 0 fL 25–40 s 15 0–400 × 10 9/L 11 15 s 0.005–0. 015