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92 Cards in this Set
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- Back
40 yo female, w muscle pain and stiffness all over, it gets worse w exercise..normal strength and joint ROM...tenderness around scapule/lateral epicondl/and bilateral medial knee fat pads...not ablt to sleep/is tired what she got?
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fibromyalgia!
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common symptoms of fibromyalgia from FA!
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women 20-50yo, chronic, widespread musculoskeletal pain w stiffness, parastehsia, poor sleep, & fatigue
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symmetric pain/morning stiffness MCP/PIP involved- warm, swollen, tender you're thinking?
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Rheumatoid arthritis!
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bilateral proximal wekaness, can't climb the stairs, can't comb your hair, heliotrope rash (racoon eyes) grolton nodules, and an incr CK characteristics of?
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dermatomyotitis
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Low back stiff and resolves with exercise- usually develops in young males, and PE shows a decrease in flexion of the spine?
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anklyosing spondylitis
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pt is >50, w/ morning stiffnedd neck, shoulder, pelvic, wt los fever and incr ESR, occurs in 1/2 pt w temporal arteritis
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polymyalgia rheumatica
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woman comes w infertility, acne, hirsutism, HTN, BMI high, irregular menstruation, what would her ovaries appear as?
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enlarged, PCOS causes subcortical cysts that enlarge ovaries
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what are the levels of LH, FSH, estrogen, and androgen in a woman w PCOS?
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LH is increase, FSH is decr, androgens incr, and estrogen is incr
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what causes the acne, hirsutism, excess sweat w PCOS?
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theca cells hyperplasia from excess androgens
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what is the cause of insulin resistance in women w PCOS?
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some transcription factor after insulin binds does not respond anymore, therefore causing insulin R
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what kind of endometrium do women with PCOS have?
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thick due to the excess estrogen causing proliferation
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if a woman w PCOS wants to get pregnant what do you prescribe?
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clomiphine- an ERM, will inhibit the production of estrogen from outside sources (ovaries etc.) and stimulate GnRH again to release estrogen-->ovulate etc.
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woman w PCOS not trying to get pregnant?
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OCP, this extra estrogen will turn off the GnRH stimulation and cause menses
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Baby with bilateral retinal hemorrhage and subdural hematoma, what should you be thinking
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Shaken baby Syndrome
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Babies have a unique antomy, their head is a lot larger- larger subarachnoid space, and subdural...therefore if you shake the immature brain in the large cavity- it rips the skull and bridging veins
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subdural hematoma
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other veins close to the head rupture too such as
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retinal veins
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what is associated with fracture of the skull?
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middle meningeal artery & and subsequent epidural hematoma
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hemophilia A is associated with
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soft tissue and joint hemorrhage
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idiopathic thrombocytopenia purpura is associated with
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petechia/ecchymoses/bleed quick w injury usually seen after a viral infection
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bacterial vagionisis most common cause is
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gardenerella vaginalis
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alters the normal flora- get a loss of lactobailli and overgrowth of mixed anaerobes, grey "fish" odor with adding KOH and a clue cell on wet mount is
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bacterial vagionsis
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gonorrhea and trachomatitis
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infect together, cervicitis w white discharge--> infect--> PID, on culture you can see N. gonorrhea not trachomatitis
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MCC fungal vaginitis, white-curd appearance, labial erythema, KOH shows yeast & psuedohyphae, no oder w KOH
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Candida albicans
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flagella protozoan, vagina shows yellow-green foam/ full trophozites w flagella on wet mount
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trichomonas
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what gene is effected in CF?
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CFTR
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What is the mutation mechanisms of CF
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the release of Cl and water is supressed and instead you release a viscious mucous which is stasis and accumulates
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what two organs are affected the most with CF?
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respiratory & pancreas
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What other systems can get plugged by CF?
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male repro, salivary glands, & liver
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How does CF cause problems in respiratory?
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the increase in viscosity decreases the clearance of bacteria- you're likely to get repeatitive pulmonary infection from pseudomonas
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what does aspergillus funigatus cause in CF pts?
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allergic bronchopulmonary aspergillosis w asthma or CF
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alkaline phosphatase is made by
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placenta,intestine, bone, & liver
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How do you differentiate alkaline phosphatase from bone vs liver?
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electrophoresis & specific monoclonal antibody- bone AP is easily denatured by heat
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Acid phosphatase is present in
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osteoclasts- not useful bc of cross-reactivity from other tissues, and is resistant to degradation by tartrate
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calcitonin or C-cells are a marker for
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medullary thyroid cancer
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urinary deoxypyridonline is released by
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osteoclasts
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pyridoniline cross-links collagen fibers which is useful for assessing
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osteoclasts * best way to measure osteoclasts
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what is hydroxyproline
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breaks collagen, released by osteoclasts- not useful bc also seen in meats
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47 XXY, normal neonate--> puberty, primary testicular failure, hyalinization/fibrosis of seminiferous tubules, lack of testosteron syntheiss, small testis, gynecomastia, MR, azoospermia, infertility, tall stature, FSH/LH high, eunuchoid body habitus =
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Klinefelter syndrome
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How are all anueplodies formed?
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meiotic nondisjunction
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macroochidism, largew jaw, MR =
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fragile X syndrome
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arachonodactyly, scoliosis, aortic root dilation=
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Marfan syndrome
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short, hypotonia, obese?
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Prader-willi, microdeletion of chrom 15 from paternal
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homeless alcoholic, w swollen gums, ecchymoses, & hyperkeratosis what are you thinking?
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vitamin C deficiency
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what do you need vitamin C for
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hydroxylation of proline & lysine -- pro-collagen makes hydroxyproline & hydroxylysine
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people with scurvy lack
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collagen cross-linking
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symptoms of scurvy?>
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caused by low connectve tissue include" swollen gums, mucosal bleeding, poor wound healing, spots on skin
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in children's scurve is worse why?
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can cause hemorrhage of subperisoteal & joint hematomas
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what is thiamini (b1) used for
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co-enzyme for dexcarboxylation of pyruvate --> acetyl coA and alpha-ketogluterate --> succinyl coA (citric acid)
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deficiency in B1 causes
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neuropathy and high-output heart failure
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what is B6 used for
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co-factor with amino acids
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what is deficiency in B6 cause
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sebhemorrhic dermatitis, glossitis, & peripheral neuropathy
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what is B12 used for
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methionin & making succinyl coA from methyl malonyl coA
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deficieny in B12
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megaloblastic anemia- subacute combined degeneration of spinal cord
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purine deficiency causes
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decr purines with folate defiencey= decr erthrypoitic to make DNA= megaloblastic DNA
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Prolactin increases throughout the pregnancy, however no production of lactate- how come?
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progesterone/estrogen increase by placent and fetal adrenal glands, inhibit lactation- once this seperates and ruptures= lactate
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What is the role of HCG in pregnancy?
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keeps corpus luteum to produce progesteronuntil placenta can make it- once the CL is gone, HcG levels drop low- nothing to do w lactation
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amonrrhea anorexic pts lose what control?
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pulsatile GnRH release from hypothalamus
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FSH is responsibile for what in males?
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spermatogensis & inhibin B
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which cells does FSh stimulate?
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sertoli to produce ABP (androgen binding protein) & inhibin B
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what does ABP do for spermatogenesis?
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increases local tesosterone which is needed for spermatogenesis
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What negatively inhibits Lh and FSH in males?
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testosterone & inhibin
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no fetal heart tones, pt w vaginal bleeding and 46XX
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hyatid mole! all paternal chromosome, no fetus embryo
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honeycomb uterus, enalrges w cluster of grapes appearance
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hydatidform mole
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abduction greater than 30 degrees?
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deltoid muscle
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rotatoe cuff muscles are
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supraspinatus, infraspinatus, teres minor, and subscapularis
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what degree does supraspinatus abduct
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10-15 degrees
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what's the test to measure supraspinatus function?
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empty can test
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34 yo comes to the ER with R shoulder pain from falling froma tree- X-ray shows fracture in middle 1/3 of his right clavicle, medial clavicle has upward traction by the
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SCM
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where does the SCM insert?
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sterno: manubrium of the sternum
cleido: superior medial (upward traction of medial fracture) mastoid: mastoid of skull |
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where do the pec majors insert on the clavicle?
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inferior medial clavicle
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where does the deltoid inserrt on clavicle?
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inferior lateral clavicle
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where does the subclavius insert on clavicle?
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inferior lateral clavicle
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where does the trapezius insert on clavicle?
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superior lateral clavicle
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Which nerve innervates the SCM and for what function?
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XI turns the head the opposite way
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serratus anterior inserts where
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1-8 ribs and inserts on medial scpula- innervated by long thoracic nerve
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major and minor rhomboid muscles insety
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vertebral body/spine and insert medial border scapula
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pec minor insert
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3/4/5 ribs on coracoid of scapula
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subclavius insert
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on 1st rib and inderior lateral aspect clavicle
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Low-fever, anorexia, nausea, dark urin, RUQ tenderness, & returning from a foreign region you should think about?
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HAV
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Acute viral you see
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diffuse balloon degeneration, mononuclear cells, & councilman bodies
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What causes gallstones in pregnant females?
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estrogen increases cholesterol due to incr in HMG-coA-reductase activity & progresterone slows down gall bladder motility= gallstones
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37yo 12 weeks in gestation female comes in with glucose of 210 & TG= 232 what is the explanation for these results?
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HPL causes insulin resistance, proteolysis, lipolysis (mostly in the 3rd trimester) shunts glucose to the fetus & inhibits gluconeogenesis
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if the mother pancrease can not overcome what is caused by HPL what develops?
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gestational DM
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someone w CINIII what's the most important risk factor for them to develop a poor prognosis?
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multiple sexual partners- usually stems from HPV 16 & 18
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An immigrant pt comes in at 20 weeks gestation with a rash thats moved from her face--> trunk--> extremities, what is she and her fetus at risk for?
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She probably doesn't have vaccine for measles, mumps, & rubella- rash spread from head and moves doen--> truncal rash, postauricular lymphadenopathy, fetus is at rish for PDA/hypoplasia/cataracts/deafness/blueberry rash and mom: rash/arthiritis/polyalthralgia
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Most common reason for an elevated AFP in a pregnant lady?
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dating error
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baby comes in "floppy" enlarged tongue, disturbed, and anxious most likely?
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hypothyroidism
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How can you get hepatitis B?
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any body fluid, blood semen tears etc. except stool
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Tired eyes & anterior medistinal mass most likely
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MG autoantibodies to post-synaptic membrane
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Theca cells produce
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progesterone
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Granulosa cells produce
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progesterone & estrogen (b/c have aromatase)
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what is theca externa?
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support and connective tissue surrounding theca interna
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