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
restless leg syndrome
cause, treatmentworse at rest/nighttime
relieved by movement
idiopathic, 国試iron deficiency, uremia, diabetes(especially with neuropathy), ★multiple sclerosis
Avoidance of aggravating factors (eg, alcohol, sleep deprivation, antipsychotics)
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
presentation of fibrocystic changesdiffuse small cysts(black arrow) with or without papillary apocrine metaplasia
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
treatment for cluster, migrane, tension, trigeminal neuralgiacluster→ acute(abortive): SC sumatriptan, ★100% O2
prophylaxis(preventive): verapamil (Ca blocker)
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)
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.
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
erythema multiforme
association, pathophysiologymost commonly associated with ☆★HSV, ☆mycoplasma pneumoniae
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
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 HirotoShishido
causes of acute pancreatitisI GET SMASHED
idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune disease
scorpion bites
hypercalcemia/☆hypertriglyceridemia(>1000mg/dL)
ERCP
drugs(sulfa→★thiazide/furosemide are the most common, NRTIs(didanosine)) gastrointestinalUWorldUWorld step2CK HirotoShishido
