focal nodular hyperplasia(NFH)
common in female, age 20-50
regenerative reaction to hyperperfusion from anomalous arteries at center of nodule
☆lighter than normal liver tissue and lobulated with stellate scar from which ☆fibrous septate radiates to the periphery
helical CT scan (which evaluates the mass during different phases of vascular contrast) generally reveals a hyperdense lesion (ie, filled with contrast during hepatic arterial phase) and a ★central scar.
the first symptoms/ associated conditions of primary biliary cholangitis(PBC)fatigue and ★pruritus (very severe especially at night)
★cutaneous xanthomas and xanthelasmas
(ascending cholangitis (★narrowing and dilatations of bile ducts that may result in “beading”, both intrahepatic and extrahepatic bile ducts) is associated with PSC and not with PBC)
epidermolysis bullosaEB simplex, is caused by mutations in keratin genes that ☆impair the assembly of keratin into filaments.
It presents in early in life with friction-induced blisters at the ☆palms and soles and other exposed areas.
Lesions typically heal with no residual scarring, although patients may have chronic thickening of the skin of the feet. Infants with EB simplex may develop ☆★oral blisters with bottle-feeding. dermatologyUWorldUWorld step2CK HirotoShishido
parasomniasREM(beta waves)→ nightmare disorder, REM sleep behavior(patients remember the dream)(more common in adults)
☆↑Ach
NREM(N3, ☆delta waves)→ ☆sleepwalking, ★night terrors(no memory of the dream)(more common in children)
★Reassurance
Administer low-dose benzodiazepine at bedtime if episodes are frequent, persistent & distressing
placental aromatase deficiencyInability to synthesize estrogens from androgens.
Masculinization of female (46,XX DSD) infants (ambiguous genitalia),serum testosterone and androstenedione.
☆★Can present with maternal virilization during pregnancy (fetal androgens cross the placenta). reproductiveUWorldUWorld step2CK HirotoShishido
alternative treatment for patients with gastroparesis who cannot tolerate metoclopramideerythromycin (macrolide)
what should be carefully done about the use of exogenous insulin to the patient with CKDChronic kidney disease
Patients taking exogenous insulin are at increased risk of hypoglycemia if there is no decrease in dosage to compensate for renal failure. In light of this patient's worsening CKD, his symptomatic hypoglycemia is likely due to ☆reduced renal insulin clearance and a prolonged insulin effect. renalUWorldUWorld step2CK HirotoShishido
prenatal screening for group B streptococcus
characteristics of the bacteriaGBS colonization by vaginal-rectal culture at 35-37 weeks gestation is recommended to identify colonized woman who require ★intrapartum penicillin/ampicillin to prevent neonatal GBS sepsis, pneumonia and meningitis
women with heavy colnization (eg. asymptomatic bacteriuria) needs ampicillin (★)regardless of screening status or rectovaginal culture results
autoimmune vs H. pylori-induced chronic gastritis (distribution, inflammatory cells, gastrin, sequelae, malignancy, risk factors)・autoimmune
diffuse (body and fundus of stomach , spares antrum)
Lymphocytes, macrophages
↑ gastrin (produced by G cells on the antrum)
Vitamin B12 deficiency/pernicious anemia
★Adenocarcinoma, carcinoid
Other autoimmune diseases
・H. pylori-induced chronic gastritis
affects antrum first and spread to body of stomach (Multifocal; patchy)
Neutrophils, plasma cells, lymphocytes
normal or ↓ gastrin from G cells
Gastric ulcer
Adenocarcinoma, MALT lymphoma
Poverty, living in developing country gastrointestinalUWorldUWorld step2CK HirotoShishido
methotrexate
mechanism, clinical use, adverse effect, rescueinhibit the production of THF via ↓dihydrofolate reductase
steroids
mumps
autoimmune disease
scorpion bites
hypercalcemia/☆hypertriglyceridemia(>1000mg/dL)
ERCP
drugs(sulfa→★thiazide/furosemide are the most common, NRTIs(didanosine)) gastrointestinalUWorldUWorld step2CK HirotoShishido
Picture
how common?, symptoms, pathophysiologythe second most common genetic cause of intellectual disability=fragile X syndrome(FXS)
(CGG)n (protruding)Chin, Giant Gonads(after puberty)
+★autism, ☆large head,★ large ears
FXS is caused by a mutation of the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. FMR1 normally has 5 to 55 CGG trinucleotide repeats and can potentially expand during meiosis in oocytes. "Full mutation" is characterized by >200 CGG trinucleotide repeats, which causes FMR1 ☆h... geneticsUWorldUWorld step2CK HirotoShishido
