Crush Step 1, 1st Edition Errata

Last Updated: 3/21/2015 2:03:00 PM by Ryan Pedigo, M.D.

Chapter 2: Biochemistry
Page 23
Figure 2-9: Figure shows arrows in urea cycle pointing wrong direction; see
updated figure:

Page 30
Incorrect figure was placed for Figure 2-16A. Please see the correct figure:

Chapter 5: Microbiology
Page 120
Comma in incorrect place; tularemia is transmitted through deer flies (not deer,
flies as written).
Francisella: Francisella tularensis (tularemia) causes a bubonic plague
like illness. Transmission occurs through rabbits, deer, flies, deer flies, or
ticks.

Page 124
Ehrlichia chaffeensis is transmitted by the Lone Star tick (Ambloymma
americanum), not the dog tick.
Ehrlichia chaffeensis is transmitted by dog ticks the Lone Star tick
(Amblyomma americanum) and causes ehrlichiosis

Page 126
First paragraph states there are three important subspecies of T. pallidum but only
endemicum (causes endemic syphilis) and carateum (causes Pinta) are discussed.
Add pertenue which causes Yaws, a tropical infection of the skin, bone, and
joints.

Page 161
Aspergillus has septated hyphae (previously written as non-septated).
Diagnosis is made by visualization of the characteristic mold forms in tissue
biopsy or sputum (Fig. 5-70). Aspergillus hyphae are nonseptated septated
and branch at acute angles of 45 degrees (Fig. 5-71).

Page 165
Treatment of babesiosis has changed to atovaquone and azithromycin; quinine and
clindamycin (currently listed as treatment) is now considered to be second-line
because it has higher side-effects.
Babesia microti (babesiosis) Treat with atovaquone and
azithromycin; quinine and clindamycin is considered second-line
therapy.

Page 177
Under amphenicols the last bullet regarding Neosporin ointment should instead be
placed under aminoglycosides on the previous page (176), as neomycin is an
aminoglycoside and not an amphenicol.
Neosporin ointments original formula included polymyxin B, bacitracin,
and neomycin.

Chapter 6: Immunology
Page 202
Interleukin 5 promotes class switching to IgA and not IgE.
IL-5: Interleukin secreted by Th2 cells that enhances immunoglobulin class
type switching to IgE IgA and increases production of eosinophils.

Chapter 7: Pharmacology and Toxicology

Page 216
Under 2nd paragraph of Adrenergic Pharmacology, reference to Figure 7-8A says that
acetylcholine is released into the cleft, but it should be norepinephrine (Figure 7-8A
is correct).
Figure 7-8A depicts an adrenergic synapse. The presynaptic neuron is
stimulated to release acetylcholine norepinephrine into the synaptic cleft

Chapter 9: Endocrinology
Page 305
Microangiopathy is misspelled (written currently as microangioGRAPHY).

Page 314
PTHrP is classically associated with squamous cell carcinoma, not small cell.
Hypercalcemia of malignancy The classic cause of this is small cell
carcinoma squamous cell carcinoma of the lung.

Chapter 10: Gastroenterology

Page 325
Clarify that amylase does not "form" disaccharides but cleaves polysaccharides into
disaccharides.

Carbohydrates Once in the duodenum, however, pancreatic amylase

continues the process and catalyzes the glycosidic bonds in carbohydrates to
form break down polysaccharides into disaccharides.

Page 341
Comma insert between leukocytosis and elevated liver enzymes under
cholecystitis section.
Cholecystitis Labs may reveal leukocytosis, elevated liver enzymes, and
elevated AP.

Page 342/343
The explanations and figure for direct and indirect hernias are correct, but the text
reference has Figure A and B switched.
Direct Inguinal Hernia: A protrusion of bowel or omentum medial to the
inferior epigastric artery (Fig. 10-27AB).
Indirect Inguinal Hernia: A protrusion of bowel or omentum through the
internal inguinal ring, the inguinal canal, and the external inguinal ring (Fig.
10-27BA).

Page 344
Typo: High-yield fact box on the right should say ingestion of aspirin, not ingestion
on aspirin.
Reyes syndrome presents as liver failure and encephalopathy after
ingestion on of ASA.

Chapter 11: Hematology and Oncology

Page 351
Mast cells are not derived from basophils (although similar).
Basophils become mast cells when they exit the circulation and enter
tissues are very similar to mast cells, but basophils exist in the blood
whereas mast cells exist in the tissue.

Page 385
Peak incidence of AML is incorrect; should be median 65 years of age.
Acute Myelogenous Leukemia (AML) The peak incidence of this
disorder is between the
ages of 15 and 39 years median age is 65 years old.

Page 402-403
Treatment for Hodgkin lymphoma has acronym both ABVD and AVBD; standardize to
ABVD for consistency (although neither is wrong). The entire acronym is listed on p.
389.

Doxorubicin (Adriamycin), an antibiotic, is the A part of the AVBD ABVD

chemotherapeutic regimen. (p. 402)
Bleomycin is a G2 phasespecific drug and is the B part of the AVBD ABVD
chemotherapeutic regimen. (p. 403)
Vinblastine is a similar medication that is the V part of the AVBD ABVD
chemotherapeutic regimen. (p. 404, under Vincristine and Vinblastine)

Chapter 12: Musculoskeletal and Rheumatology

Page 418
The unhappy triad has controversy on whether or not it includes the medial or
lateral meniscus.
Unhappy triad: Refers to simultaneous injury of the ACL, medial collateral
ligament, and either the medial or the lateral meniscus, which may occur
with lateral impact to the knee when the foot is planted on the ground.

Page 430
Osteoblastomas are not relieved by aspirin classically, unlike osteoid osteomas.
Osteomas usually present in the vertebral column or long bones.
Osteoblastoma, osteoid osteoma: originally thought to be variants
of the same disease (e.g., that an osteoblastoma was a large osteoid
osteoma), but may actually be separate entities. Osteoblastomas
have pain that is not relieved by aspirin, whereas osteoid osteomas
typically are smaller and the pain can be relieved by aspirin. Benign
tumor of bone that presents between 10 and 20 years of age as localized and
severe bony pain caused by prostaglandin production. The pain is relieved
with aspirin.

Chapter 13: Neurology

Pages 450 and 451
Figure 13-14 and 13-15 captions say communicating when instead should read
cerebral.

Figure 13-14: Caption correction: ACA, anterior communicating cerebral

artery
Figure 13-15: Caption correction: Cerebral circulation with anterior
communicating cerebral artery (ACA)
Figure 13-15: Caption correction: Posterior communicating cerebral artery
(PCA)

Page 452
Table 13-1 alignment errors

Glossopharyngeal, IX, Both should be moved up one set of rows to be

aligned with: Motor elevates pharynx and larynx

Vagus, X, Both should be moved up one set of rows to be aligned with:

Motor laryngeal and pharyngeal muscles except

Page 474
Presenilin 1 is chromosome 14, presenilin 2 is chromosome 1 (it is switched
currently).
Early-onset AD is also seen in mutations in presenilin-1 and -2
(chromosomes 1 14 and 14 1, respectively)

Page 475
Typo: Abbreviation is MPTP and not MTPT
Methyl-phenyl-tetrahydropyridine (MTPT MPTP), a contaminant in illicit
street drugs

Chapter 15: Nephrology

Page 527
Typo under loss of more solute than water bullet point (4 th from the bottom);
hyposmotic ECF would have an osmolarity less than 290 and not greater than. The
explanation is correct, but the greater than sign (>) should be replaced with a less
than sign (<).
Loss of more solute than water (e.g., adrenal insufficiency, leading to
decreased ability to reabsorb sodium in the kidney because of lack of
aldosterone) will cause the ECF to become hyposmotic, favoring water
movement from ECF (osmolarity > < 290 mEq/L) to ICF (osmolarity = 290
mEq/L) until equilibrium is reached.

Page 529
Clarify that posterior pituitary does not technically antidiuretic hormone (ADH), but
rather releases it (cell bodies in hypothalamus make the hormone).
Antidiuretic hormone (the no pee hormone; just as the diuretic
medication class causes urination, anti-diuretic hormone stops it) is produced
released by the posterior pituitary gland.

Page 534
Pseudohyponatremia is due to certain conditions that interfere with lab tests (e.g.,
hyperlipidemia, hyperproteinemia), but hyperglycemia is not a
pseudohyponatremia, but a true dilutional hyponatremia from the osmotic shift of
pulling water into the intravascular space with hyperglycemia.
The third cause of hyponatremia is traditionally referred to as
pseudohyponatremia; it is typically observed in a hyperosmotic
hyperglycemic state in which intracellular free water shifts extracellularly to
maintain osmotic balance. The extracellular free water shift induces a
dilutional state for sodiumhence, hyponatremia. The total body sodium,
however, is not reducedhence, the term pseudohyponatremia.

Hyponatremia associated with hyperglycemia can be corrected by the control

of hyperglycemia alone. Pseudohyponatremia is due to conditions that
interfere with laboratory tests such as hyperlipidemia or
hyperparaproteinemia; the actual level of sodium in the body is
normal, but the lab test will indicate hyponatremia due to this
interference.

Page 544
Retinopathy, neuropathy, and NEPHROPATHY (currently retinopathy is erroneously
repeated).
Diabetes is a very common cause of renal damage (diabetes causes the
triad of retinopathy, neuropathy, and retinopathy nephropathy as part of its
microvascular disease)

Page 546
Type 1 RTA should lead to hypokalemia and not hyperkalemia (the explanation on
the mechanism is correct, but the wrong word was written).
Type 1 RTA (distal RTA): The collecting tubules (specifically the
intercalated cells) in the distal nephron are unable to secrete H+ and reclaim
K+. This leads to a normal anion gap hyperkalemic hypokalemic metabolic
acidosis

Page 552
Altered mental status, not altered metal status.
Uremia: A consequence of nitrogenous waste products building up, leading
to altered metal mental status

Chapter 16: Reproductive System

Page 572
Formatting error -- summary of breast cancer is under male pathology and BPH
MALE PATHOLOGY: Summary of Breast Cancers: Benign Prostate Hyperplasia
(BPH)

Chapter 17: Pulmonology

Page 588
NITRITES not nitrates convert hemoglobin into methemoglobin.
Interestingly, methemoglobin has an affinity for cyanide (CN) that is
cleverly used in the treatment of CN poisoning. CN antidote kits contain
nitrates nitrites such as amyl nitrite and also have sodium thiosulfate.
Nitrates Nitrites are administered

Page 635
Answer to question 16 is the table under the answer to question 17 (table needs to
be moved up to the answer to question 16).

The above table should be under the answer to question 16.