Errata for Yale-G First Aid 6th Edition Paperback
(Apology from the reviewers; Been corrected in the 6th-Ed Kindle version)
P297 & 306: Chapter 6 Table 6-4 and HYQ answer 30 for GCD: NNT>>NBT is (-) in GCD and catalase test is not necessary or sufficient for Dx.
P421: Chapter 9 HYQ 12 D: “Helical CT angiography”. It is most sensitive in detecting suspected arterial injury and the best test in this case.
2020 Yale-G’s Monthly Clinical Updates According to www.uptodate.com
(As of 2020-03-28; Been updated in the 6th-Ed Kindle version)
Chapter 1: Infectious Diseases
Special Viruses: Coronaviruses
Coronaviruses are important human and animal pathogens, accounting for 5-10% community-acquired URIs in adults and probably also playing a role in severe LRIs, particularly in immunocompromised patients and primarily in the winter. Virology: Medium-sized enveloped positive-stranded RNA viruses as a family within the Nidovirales order, further classified into four genera (alpha, beta, gamma, delta), encoding 4-5 structural proteins, S, M, N, HE, and E; severe types: severe
acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and novel coronavirus (2019-nCoV, which causes COVID-19). Routes of transmission: Similar to that of rhinoviruses, via direct contact with infected secretions or large aerosol droplets. Immunity develops soon after
infection but wanes gradually over time. Reinfection is common. Clinical manifestations: 1. Coronaviruses mostly cause respiratory symptoms (nasal congestion, rhinorrhea, and cough) and influenza-like symptoms (fever, headache). 2. Severe types (2019-nCoV, MERS-CoV, and SARS-CoV): Typically with pneumonia–fever, cough, dyspnea, and bilateral infiltrates on chest imaging, and sometimes enterocolitis (diarrhea), particularly in immunocompromised hosts (HIV+, elders, children). 3. Most community-acquired coronavirus infections are diagnosed clinically, although RT-PCR applied to respiratory secretions is the diagnostic test of choice.
Treatment: 1. Mainly consists of ensuring appropriate infection control and supportive care for sepsis and acute respiratory distress syndrome.
2. In study: Chloroquine showed activity against the SARS-CoV, HCoV-229E, and HCoV-OC43 and remdesivir against 2019-nCoV.
Prevention: 1. For most coronaviruses: The same as for rhinovirus infections, which consist of handwashing and the careful disposal of materials infected with nasal sec retions. 2. For novel coronavirus (2019-nCoV), MERS-CoV, and SARS-CoV: (1) Preventing exposure by diligent hand washing,
respiratory hygiene, and avoiding close contact with live or dead animals and ill individuals. (2) Infection control for suspected or confirmed cases: Wear a medical mask to contain their respiratory secretions and seek medical attention; standard contact and airborne precautions, with eye protection.
Hepatitis C: 8-week glecaprevir-pibrentasvir is recommended for chronic HCV infection in treatment-naive patients.
New: Lefamulin is active against many common community-acquired pneumonia pathogens, including S. pneumoniae, Hib, M. catarrhalis, S. aureus, and atypical pathogens.
Vitamin C is not beneficial in adults with sepsis and ARDS.
Chapter 2: CVD
AF: Catheter ablation is recommended to some drug-refractory, paroxysmal AF to decrease symptom burden. In study: Renal nerve denervation has been proposed as an adjunctive therapy to catheter ablation in hypertensive patients with AF. Alcohol abstinence lowers the risk of recurrent
atrial fibrillation among regular drinkers.
VF: For nonshockable rhythms, epinephrine is given as soon as feasible during CPR, while for shockable rhythms epinephrine is given after initial defibrillation attempts are unsuccessful. Avoid vasopressin use.
All patients with an acute coronary syndrome (ACS) should receive a P2Y12 inhibitor. For patients undergoing an invasive approach, either prasugrel or ticagrelor
has been preferred to clopidogrel. Long-term antithrombotic therapy in patients with stable CAD and AF has newly been modified as either anticoagulant (AC)
monotherapy or AC plus a single antiplatelet agent.
Ticagrelor plus aspirin may be a reasonable preventive antiplatelet strategy in some patients with CAD and diabetes.
VTE: LMW heparin or oral anticoagulant edoxaban is the first-line anticoagulants in patients with cancer-associated VTE (venous thromboembolism).
Dosing of warfarin for VTE prophylaxis in patients undergoing total hip or total knee arthroplasty should continue to target an INR of 2.5.
Chapter 3: Resp. Disorders
Asthma Tx: Benralizumab is an IL-5 receptor antibody that is used as add-on therapy for patients with severe asthma and high blood eosinophil counts.
Recombinant GM-CSF is still reserved for patients who cannot undergo, or who have failed, whole lung lavage.
Pulmonary embolism (PE): PE response teams (PERT, with specialists from vascular surgery, critical care, interventional radiology, emergency medicine, cardiac surgery, and cardiology) are being increasingly used in management of patients with intermediate and high-risk PE.
Although high-sensitivity D-dimer testing is preferred, protocols that use D-dimer levels adjusted for pretest probability may be an alternative to unadjusted D-dimer in patients with a low pretest probability for PE.
Cystic Fibrosis (CF): Tx: CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) is recommended for patients ≥12 years with the F508del variant.
Vitamin E acetate has been implicated in the development of electronic-cigarette, or vaping, product use associated lung injury.
Chapter 4: Digestive and Nutritional Disorders
CRC: Patients with colorectal adenomas at high risk for subsequent colorectal cancer (CRC) (≥3 adenomas, villous type with high-grade dysplasia, or ≥10 mm in diameter) are advised short follow-up intervals for CRC surveillance.
UC and CRC: Patients with extensive colitis (not proctitis or left-sided colitis) have increased CRC risk.
Eradication of H. pylori: adding bismuth to clarithromycin-based triple therapy for patients with risk factors for macrolide resistance.
Avoid coffee, tea, or soda to reduce GERD. Thromboelastography and rotational thromboelastometry are bedside tests recommended for patients with cirrhosis and bleeding.
Screening for patients at risk for hereditary pancreatic cancer (PC): Individuals with mutations in the ataxia-telangiectasia mutated gene and one first-degree relative with PC can be screened with endoscopic ultrasound and/or MRI/magnetic retrograde cholangiopancreatography.
UC: Ustekinumab (-umab) anti-interleukin 12/23 antibody, is available for treating UC.
Crohn disease: The combination of partial enteral nutrition with the specific Crohn disease exclusion diet is a valuable alternative to exclusive enteral nutrition for induction of remission.
Chapter 5: Endocrinology
Teprotumumab, an insulin-like growth factor 1 receptor inhibitor, can be used for Graves’ orbitopathy if corticosteroids are not effective.
Subclinical hypothyroidism should not be routinely treated (with T4) in older adults with TSH <10 mU/L.
A single high dose of vitamin D does not improve outcomes in critically ill patients.
Chapter 6: Hematology
Anticoagulants: Apixaban is preferred to warfarin for atrial fibrillation with osteoporosis because it lowers the risk of fracture.
Cancer-associated VTE: LMW heparin or oral edoxaban is the first-line anticoagulant prophylaxis.
NH-Lymphoma Tx: New suggestion is four cycles of R(rituximab)-CHOP for limited stage (stage I or II) diffuse large B cell non-Hodgkin lymphoma (DLBCL) without adverse features.
Chimeric antigen receptor (CAR)-NK immunotherapy is newly suggested for refractory lymphoid malignancies, with less toxicity than CAR-T therapy. Polatuzumab + bendamustine + rituximab (PBR) is an alternative to CAR-T, allogeneic HCT, etc. for multiply relapsed diffuse large B-C NHL.
Refractory classic Hodgkin lymphoma (r/r cHL) is responsive to immune checkpoint inhibition with pembrolizumab or nivolumab, including those previously treated with brentuximab vedotin or autologous transplantation.
Mantle cell lymphoma: Begin with induction therapy with bendamustine + rituximab or other conventional chemoimmunotherapy rather than more intensive approaches.
Multiple myeloma (MM): Levofloxacin prophylaxis is suggested for patients with newly diagnosed MM during the first three months of treatment.
For relapsed MM: Isatuximab is combined with previously used therapies, including lenalidomide and a proteasome inhibitor, adding to pomalidomide plus dexamethasone.
Afamelanotide is newly available for adults with (erythropoietic) protoporphyria.
Chapter 12: GYN
Table 12-6: Active labor can start after OS > 4cm, and 6cm is relatively more acceptable but not a strict number.
Table 12-7: Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria, or of hypertension and significant end-organ dysfunction with or without proteinuria, in the last half of pregnancy or postpartum. Once a diagnosis of preeclampsia is established, testing for proteinuria is no longer diagnostic or prognostic. “proteinuria>5g/24hours” may only indicate the severity.
Chapter 14: EM
Emergency treatment—critical care!
“A-B-C”: Breathing: …In mechanically ventilated adults with critical illness in ICU, intermittent sedative-analgesic medications (morphine, propofol, midazolam) are
Chapter 16: Psychiatry
Narcolepsy: Pitolisant, a novel oral histamine H3 receptor inverse agonist, is used in narcolepsy patients with poor response or tolerate to other medications.
Chapter 17: Last Chapter
Errata-updates for Yale-G’s 5th Edition:
- P49: Malaria (five strains): Add one more strain (P. knowlesi) to the four strains:
- P65: Chapter 1 HYQs #44 Answer = “B” (oseltamivir).
- P279&286: Chapter 6 Table 6-4 and HYQ answer 30 for GCD: “NNT (+)” should be “NBT (-)”.
- P388: Meniere Disease: Essentials of Dx: 1. “bilateral” (hearing loss) should be “unilateral.”
- P388: Essential Tremor (updated PEARLS): Heavy alcohol ingestion may be in the patient’s history, and small amount of alcohol can help alleviate symptoms shortly.
- P396: HYQ 12-D: Helical CT angiography.
- P437 update: “Dysfunctional Uterine Bleeding” is no longer accredited and should be part of “Abnormal Uterine Bleeding”.
- P529 and 532: Methemoglobinemia Tx-Antidote: “…dapsone, local anesthetic agents, aniline dyes, and high nitrate levels …” should be removed.
- P647: Cause specific mortality rate = Deaths due to a specific cause per 100,000 person-year at risk for a population, usually in a specific geographic area.
- P87: Systemic Hypertension Table 2-5: Update:
All Chapters: many updates and 100 more HYQs have been added in the 6th edition (Amazon Kindle version).