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)
in which ages of woman have propensity to have fibroadenoma
risk factors of themmyxoid stromal proliferation compressing the ducts the slits(black arrow)
common in woman <35yo
the epithelial content is estrogen-sensitive, resulting in size increase ★with OCP use ,☆pregnancy , or the luteal phase of the menstrual cycle reproductiveUWorld step2CKUWorld HirotoShishido
presentation of fibrocystic changesdiffuse small cysts(black arrow) with or without papillary apocrine metaplasia
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
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
How long do water soluble vitamins stay in the body?all are washed out easily from body except for B12 and B9
B12 stored in liver for 3-4 years(depletion will take longer)
☆B9 stored in liver for 3-4 months
→★folate deficiency arises far more quickly biochemistryUWorldUWorld step2CK HirotoShishido
benzodiazepines which has higher addictive potential☆short acting→ATOM CL(くる)
Alprazolam(intermediate 6-50hrs)
Triazolam(short<6hrs)
Oxazepam(intermediate)
Midazolam(short)
+clonazepam(intermediate), ☆lorazepam(intermediate)
alprazolam, a short-acting benzodiazepine, is the most likely to result in ★seizures following abrupt discontinuation. Symptoms of withdrawal from benzodiazepines with short half-lives can appear as early as 24 hours after cessation and include seizures, tremors, anxiety, perceptual disturbances, and psychosis pharmacologyUWorldUWorld step2CK HirotoShishido
Conn disease
treatmentaldosterone secreting adenoma of the adrenal cortex→hyperaldosteronism
potassium sparing diuretics
(eg ★eplerenone, spironolactone, amiloride)
eplerenone is a new aldosterone antagonist that has fewer side effects
