Underground Clinical Vignettes: Biochemistry: Classic Clinical Cases for USMLE Step 1 Review

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9781890061340: Underground Clinical Vignettes: Biochemistry: Classic Clinical Cases for USMLE Step 1 Review

S2S introduces the 2nd Edition of the only Step 1 review series dedicated to Clinical Vignettes. Each Underground Clinical Vignettes book presents 100+ frequently tested diseases with thousands of classic buzzwords in Hx, PE, lab, imaging and pathology.

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From the Publisher:

Buy the UCV Step 1 Bundle (0-632-04559-0) and receive a new FULL COLOR picture atlas -- completely free! - Hundreds of classic full-color photos of Histo, Path, Hem, Micro, and clinical images - Page references to the UCV volumes for quick navigation - Format designed for easy quizzing

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ID/CC-A 16-year-old girl is referred to an endocrinologist owing to lack of menses (AMENORRHEA) and absence of pubic hair, axillary hair, and breast development (LACK OF SECONDARY SEXUAL CHARACTERISTICS).

HPI-She also complains of frequent headaches and ringing in her ears (due to hypertension).

PE-VS: hypertension (BP 160/105). PE: funduscopic exam normal; no lymphadenopathy; no hepatosplenomegaly; absence of breast tissue; no abdominal or pelvic masses palpable; no axillary or pubic hair; vulvar labia normal.

Labs-Lytes: hypokalemia; hypernatremia. ABGs: metabolic alkalosis (due to mineralocorticoid action of 11-deoxycorticosterone and corticosterone). Suppressed renin; increase in urinary gonadotropins (due to attempt to compensate for lack of sex hormones); diminished 17-ketosteroids (product of sex hormones); increased progesterone, pregnenolone, 11-deoxycorticosterone, and corticosterone.

Imaging-N/A

Gross Pathology-N/A

Micro Pathology-N/A

Treatment-Glucocorticoids. Sex hormones.

Discussion-A decrease in 17-á-hydroxylase produces an increase in 11-deoxycorticosterone and corticosterone (due to shifting metabolism of sex hormones to aldosterone pathway); renin is suppressed (due to aldosterone negative feedback). Females fail to develop secondary sexual characteristics; males develop ambiguous external genitalia (MALE PSEUDOHERMAPHRODITISM).

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