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 Jun 13, 2020, 5:12 AM 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 Apr 8, 2020, 5:50 AM HirotoShishido
erythema multiforme
association, pathophysiologymost commonly associated with ☆★HSV, ☆mycoplasma pneumoniae
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 Mar 4, 2020, 2:17 AM 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 Nov 26, 2019, 7:20 AM HirotoShishido
methotrexate
mechanism, clinical use, adverse effect, rescueinhibit the production of THF via ↓dihydrofolate reductase
Whipple disease
symptoms/ treatmentPAS the foamy WHIPPed cream in a CAN
+PAS stain
+foamy macrophages in intestinal lamina propria
Cardiac symptoms (eg. valve insufficiencies)
(★)Arthralgia (60% of cases)
Neurologic symptoms (eg. myoclonia, ataxia, impairment of oculomotor function)
are common
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 Jul 18, 2019, 2:27 AM 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 Jul 18, 2019, 1:56 AM 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
carcinoid syndrome
symptoms, histopathologyCarcinoid syndrome does not occur if (carcinoid) tumor is limited to the GI tract(intestine, rectum, appendix→ can cause ☆acute appendicitis)
characterized by its uniformity in shape and size of the cells that comprise the islands, and the cells of eosinophilic cytoplasm and oval-to-round stippled nuclei endocrinologyUWorldUWorld step2CK Jun 26, 2019, 3:39 AM HirotoShishido
treatment for cluster, migrane, tension, trigeminal neuralgiacluster→ acute(abortive): SC sumatriptan, ★100% O2
prophylaxis(preventive): verapamil (Ca blocker)
