First Aid Cases for the USMLE Step 1, Third Edition (First Aid USMLE)

By Tao Le, James Yeh

The crucial case spouse to First relief for the® USMLE Step 1

400 high-yield cases

First reduction™ instances for the USMLE Step 1 gains four hundred well-illustrated circumstances that will help you relate uncomplicated technological know-how suggestions to medical occasions. every one case contains drawings or scientific pictures with Q&As that strengthen key innovations. Chapters are keyed to Tao Le's First reduction for the USMLE Step 1 permitting you to concurrently examine situations and high-yield facts.

Content that spans the total exam:
normal rules, Behavioral technological know-how, Biochemistry, Microbiology and Immunology, bankruptcy four. Pharmacology, Organ structures, Cardiovascular procedure, Endocrine process, Gastrointestinal approach, Hematology and Oncology, Musculoskeletal procedure and Connective Tissue, Neurology and Psychiatry, Renal approach, Reproductive process, respiration System.

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Reproduced, with permission, from Imboden J, et al. present Rheumatology analysis & remedy. manhattan: McGraw-Hill, 2004: 249. ) 6 Endocrine 147 A SE zero zero Endocrine bankruptcy 6 Case 1 A 4-year-old lady with a historical past of ambiguous genitalia is delivered to her pediatrician for a check-up. The child’s blood strain is located to be 130/89 mm Hg. actual exam is amazing for clitoral growth, partial labial fusion, and scant pubic hair progress. Laboratory checks exhibit the subsequent: Sodium: 142 mEq/L Potassium: three. 1 mEq/L Chloride: 102 mEq/L Bicarbonate: 25 mEq/L What enzyme-deficiency is that this? 11β-Hydroxylase deficiency is advised through the constellation of high blood pressure, masculinization, and hypokalemia. How is that this situation differentiated from a extra universal, yet comparable, enzyme deficiency? 21β-Hydroxylase deficiency provides with hypotension and hyperkalemia. either deficiencies current with masculinization of the exterior genitalia. A overview of adrenal steroid synthesis is proven in determine 6-1. Ketoconazole ACTH + − ldl cholesterol Desmolase A Pregnenolone Progesterone 17-hydroxypregnenolone A 17α-hydroxyprogesterone B Dehydroepiandrosterone (DHEA) 11-deoxycorticosterone 11-deoxycortisol C Estrone Androstenedione B Testosterone 5a-reductase Aromatase Estradiol C Cortisol Corticosterone DHT Aldosterone synthase Aldosterone + 148 Angiotensin II Mineralocorticoids C21 Congenital adrenal hyperplasias ͕ Glucocorticoids 21C Androgens C19 Estrogens C18 A = 17␣-hydroxylase deficiency. ↓ intercourse hormones, ↓ cortisol, ↑ mineralocorticoids. Cx = high blood pressure, hypokalemia; phenotypically girl yet no maturation. B = 21ß-hydroxylase deficiency. most typical shape. ↓ cortisol (increased ACTH), ↓ mineralocorticoids, ↑ intercourse hormones. Cx = masculinization, lady pseudohermaphroditism, HYPOtension, hyponatremia, hyperkalemia, ↑ plasma renin task, and quantity depletion. Salt losing may end up in hypovolemic surprise within the baby. C = 11ß-hydroxylase deficiency. ↓ cortisol, ↓ aldosterone and corticosterone, ↑ intercourse hormones. Cx = masculinization, high blood pressure (11-deoxycorticosterone acts as a susceptible mineralocorticoid). determine 6-1. Adrenal steroid synthesis. (Reproduced, with permission, from Le T, et al. First relief for the USMLE Step 1: 2011. ny: McGraw-Hill, 2011: 291. ) How does this enzyme deficiency lead to high blood pressure? 11β-Hydroxylase converts 11-deoxycorticosterone into corticosterone, and 11-deoxycortisol into cortisol. 11β-Hydroxylase deficiency factors a scarcity of cortisol and aldosterone. even though, the precursor 11-deoxycortisone is a susceptible mineralocorticoid and factors high blood pressure. what's the applicable therapy for this ? Dexamethasone or hydrocortisone can be utilized to switch the lacking corticosteroid. the bottom powerful dose will be used to prevent the Cushingoid antagonistic results of glucocorticoids, together with bone demineralization and progress retardation. what's the mode of inheritance of this ? Inheritance is autosomal recessive, with mutations within the CYP11B1 gene.

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