Tuesday, May 31, 2005

Clinical Microbiology Made Ridiculously Simple

In addition to being a good USMLE review book, Clinical Microbiology could replace the syllabus, especially for bacteria. Its easy to read and has enough supporting details to give a clear understanding of the pathogens. The virus, fungi, and parasite sections are very basic, and they hit the main topics of each pathogen. The medicine chapters are also very basic. Each chapter has a good summary table of pathogens or medicines. A pathology textbook would be good for associated color pictures and diagrams.

MedicalMnemonics.com | Browse | Browse by Category

MedicalMnemonics.com | Browse | Browse by Category

Contains contributions from around the world. Also available for download onto a PDA.

Saturday, May 28, 2005

BRS Physiology

Organized by organ systems, this 322 page book can be finished in four days with relative ease. It does not require any other supplementary books. Although the questions at the end of each chapter are good review questions of concepts, they seem to be a lot easier than board type questions. Related pathology and pharmacology are integrated well into the text. It's a good book to have during first year while taking physiology, and it would be a good idea to review of the physiology of an organ system before learning about its pathology. Important concepts can be found on pages 92-93, 142, 196, 200, 252, 256, 265, 270, and 283.

BRS Pathology

At 450 pages, this book can be finished in 5 days, spending about 8 hours a day, and finishing 90 pages per day. It is organized by organ systems. This book lacks color pictures, so its a good idea to use this book with a pathology textbook like Rubin's Pathology Fourth Edition. In addition to good microscopic, gross, and radiologic pictures, Rubin's has diagrams explaining diseases. Unlike a textbook, the main distinguishing factors of a disease are emphasized. The details are usually left out since they could cause confusion when covering several diseases in one organ system. This BRS book is purely a review book, and it would be difficult to understand unless you learned about the diseases while in class. This book is good to have while you take the course. In the second edition, important tables can be found on pages 6, 24, 62, 66, 75, 284, 320, and 384. The comprehensive examination at the end of book is a good, challenging review of the entire book.

Tuesday, May 24, 2005

USF USMLE 1

Contains several documents for Step 1 studying with hundreds of flashcards in Word documents for anatomy and biochemistry. Smaller documents on specific topics like metabolic diseases are available.
http://www.med.usf.edu/2003/usmlesmack.html

Monday, May 23, 2005

The New York Times > Technology > Circuits > State of the Art: A New Spin on a Palmtop (or Inside It)

The New York Times > Technology > Circuits > State of the Art: A New Spin on a Palmtop (or Inside It)

Great PDA, have to wait till the problems are worked out before it could be really useful in the field.

http://www.palmone.com/us/products/mobilemanagers/lifedrive/

High Yield Neuroanatomy

133 pages may seem like a lot to get through in one day for board review. The preface does a good job of highlighting important topics in each chapter for the USMLE Step 1. The clinical correlations at the end of each chapter are excellent. Pick and choose which chapters to review since a chapter like autonomics can be found in other review books. It's a good book to have while taking the course.

BRS Histology

Although this large book is too much for board review, it would probably help while taking the class, even in undergraduate. The first five chapters are sufficient for USMLE Step 1 Review, and it contains detailed review of the basic concepts of histology. The chapter on blood may overlap with immunology review.

Sunday, May 22, 2005

Gosling - Atlas of Human Anatomy

It has good gross pictures of anatomy with simple drawings accompanying them. The captions are concise.

Saturday, May 21, 2005

Step 1 Released Questions

http://www.usmle.org/Orientation/Step1MCQ.zip

This is the software link for the 150 questions released by USMLE.org. It can be taken in a test format or untimed. Kaplan provides detailed explanations for this series of questions.

Friday, May 20, 2005

High Yield Anatomy

This USMLE step 1 book is a lot more dense than the title implies. With over 180 pages, it does provide a good basis for anatomy based pathology. The MRI pictures are great. Key chapters would be heart, lung, upper extremity, spine, and lower extremity. Anatomy of the upper limb is extremely high yield review. A good understanding of the nerves and muscle enervation of the hands and arms will help answering several questions. An other priority is to understand fractures and their related deficiencies.

Wednesday, May 18, 2005

Student Loan Consolidation

Recently, loan companies have decided to allow students to consolidate their student loans while they are still attending college. Currently, interest rates are at a historic low around 2.77% for Stafford loans. The interest rate could be lower for people who pay their loans on time. By June 30, 2005, the rates will rise to 4%, and they will probably not decrease after this time. Students are eligible to consolidate loans accrued up to this time; loans for next year are not eligible. Although a student could save up to fifty percent on their loan repayments, the payment period could be extended from 10 years to 30 years. Currently, THE, Wells Fargo, and several other lending companies are offering consolidation.

Monday, May 09, 2005

Metabolic Bone Diseases

Condition
Thin Trabeculae
Numerous Osteoclasts
Excessive Osteoid
Fibroblast/ Collagen
Osteoporosis
X



Osteomalacia


X

Primary Hyperparathyroidism

X

X
Renal Osteodystrophy

X
X
X
Source: Rubin's Pathology 4th Edition

Sunday, May 08, 2005

Dermatopathology II

DiseasePathogenesisPathologyClinical Features/ Treatment
Erythema nodosumtrigger: drugs, microorganisms, systemic diseases
drugs: sulfonamides

fibrous septa of subcutaneous tissue - neutrophil inflammation, extravasation of erythrocytes
chronic - septa widened, giant cell macrophages, altered collagen

dome-shaped, tender, nodules on extensor surface of legs
3rd decade, 3xF:M
Erythema induratumMycobacterium tuberculosis

initially lobular panniculitis, vasculitis - ischemic necrosis of fat lobules
dense, chronic inflammatory infiltrate in fat lobules
extensive ischemic necrosis - ulceration of overlying epidermis

chronic, recurrent, subcutaneous plaques or nodules on legs, women

T - systemic steroids

Sclerodermapathcy lymphocytic infiltrate, loss of peri-eccrine fat, plugging of sweat glands, obliteration of hair follicles, subcutaneous fat turns into collagen

fibrosis and tightening of skin
mask face
4xF:M, 30-50y
non-pitting edema of hands or fingers

Granulomatous dermatitislocalized collection of epitheliod macrophages around insoluble antigen
Allergic Contact dermatitis

sensitization - haptens: oleoresins, Langerhans Cells - CD4+ T cells
Elicitation - activated T cells, IFN-gamma - Fas ligand on keritanocytes - apoptosis

spongiotic dermatitis - edema in epidermis
spongiotic vasculitis - vacuoles filled with lymphocytes and macrophages
immune rxn to poison ivy, poison oak, poison sumac


Source: Rubin's Pathology 4th Edition

Dermatopathology I

DiseasePathogenesisPathologyClinical Features/ Treatment
Pemphigus Vulgarisantibodies to keratinocytes, autoimmune IgG to desmoglein 3

seperation of stratum spinosum and outer epidermal layers from basal layer
blister - moderate lymphocytes, macrophages, eosinophils, neutrophils

blistering skin
large, scalp, mucous membranes, periumbilical and intertriginous areas
Diseases of the Basement Membrane Zone
Epidermolysis Bullosahereditarysplitting of epidermis at or near basement membraneblisters
Epidermolytic EBdisruption of basal keratinocytesvacuoles filled with abnormal keratin 5 and 14blisters from minor trauma - no scarring
Junctional EB

AR
benign - mutation in gene encoding for type XVII collagen
severe- laminin and integrin genes

lamina lucida blister
roof - intact epidermis
base - lamina densa

blisters
Dermolytic EBdefect in anchoring fibrils, defective collagen type VII

roof - normal epidermis, lamina lucida, lamina densa
floor - outer part of papillary dermis

atrophic scarring
Bullous Pemphigoidcomplement fixing IgG antibodies to BPAG1 and BPAG2subepidermal blisters
roof - intact epidermis
base - lamina densa
cytology - numerous eosinophils, arranged along BMZ
seperation at lamina lucida

large, tense blisters
erythematous base +/-

T - corticosteroids


Source: Rubin's Pathology 4th Edition

Saturday, May 07, 2005

Psoriasis

DiseasePsoriasis
PathogenesisGenetic factors - HLA-B13,HLA-B17, HLA-Bw57, HLA-Cw6 increased
Environmental factors - physical injury, infection, drugs
Abnormal cellular proliferation of keratinocytes
microcirculatory changes - "bridged" fenestrations, neutrophils at tipsof dermal papillae, dec cAMP
Immunologic factors - T cell infiltration
Pathologythickened epidermis -hyperkeratosis + parakeratosis
uniformally elongated rete ridges and dermal papillae
dilated and tortuous capillaries of papillae
epidermal hyperplasia
Munro microabscesses - dense collection of neutrophils
ClinicalFeatures/Treatmentlarge, erythematous, scalyplaques
dorsal extensor cutaneous surfaces
7% - seronegative arthritis, mild
neutrophilic pustules
T - coal tar or wood tar, anthralin, corticosteroids, methotrexate,vitamin A, vitamin D
Source: Rubin's Pathology 4th Edition

Ichthyosis

Disease
Pathogenesis
Pathology
ClinicalFeatures/Treatment
Ichthyoses
increasesed cohesiveness,abnormal keratinization, increased basal cell proliferation
abnormally thickened stratumcornerum, hyperkeratosis, thin nucleated epidermis
coarse, fish-like scales
Ichthyosis Vulgaris
Autosomal Dominant
- reduced or absent keratohyaline granules in epidermis
attenuated stratum granulosum - reduced profilaggrin
loose stratum corneum,basket-weave appearance
most common, begins earlychildhood, small white scales on extensor surfaces of extremities andon trunk and face, lifelong disease
abnormalities in lipid metabolism from drugs or other diseases
X- linked ichthyosis
deficiency of sterioid sulfatase
steroid sulfatase degrades cholesterol sulfate
persistent cohesion of stratumcorneum

Lamellar ichthyosis
autosomal recessive - disorderof cornification, defect in lamellar body secretion
increased cohesivenss of stratumcorneum, numerous keratinosomes, abnormally large amount ofintercellular substance
severe and generalized ichthyosis
Epidermolytic hyperkeratosis
autosomal dominant, mutation inkeratin genes in suprabasal epidermis
faulty assembly of keratintonofilaments, impaired insertion into desmosomes, prevents normaldevelopment of cytoskeleton -> epidermal lysis and vesicles
generalized erythroderma,blistering, ichthyosiform skin
Source: Rubin's Pathology 4th Edition

Skin Layers and Diseases

Layer of Skin
Associated Disease
Basement Membrane
Bullous pemphigoid - antibodies to BPAG1 and BPAG2 - Type XVII colagen
Papillary dermis
psoriasis, lichen planus
Recticular dermis
scleroderma, erythema nodosum

Source: Rubin's Pathology 4th Edition

Skin Cell Types

Cell TypeFunctionStructures
Melanocytes
color of the skin
melanosome - melaninsynthesis
Langerhan cells
antigen presenting cells
Birbeck granules, MHC I, MHC II,receptors for Fc IgG and Fc IgE
Merkel Cell
neurosecretory, tactilemechanoreceptor
form desmosomes with keratinocytes, basal aspect apposed to a small nerve plate
Keratinocytes
produce keratin filaments
Keratohyaline granules, Odlandbodies - keratinosomes

Source: Rubin's Pathology 4th Edition

Gynecological Pathology Endometrium


Condition

Cause

Pathology/Histology

Clinical Features

Other Features

Proliferative Enodmetrium

· Straight glands

· Narrow lumens

· Pallisading nuclei

· Ovoid nuclei

· Mitoses

Early Secretory Endometrium

First manifestation of effect of ovulation on endometrium

· Glands remain straight

· Lumens remain narrow

· Subnuclear vacuoles appear

24-36 hours after ovulation

Mid Secretory Endometrium

· Glands become coiled

· Vacuoles no longer present in glands

· Secretory product appears in lumen

Postovulatory days 5-9

Late Secretory Endometrium

· Intralumenal secretions are spent

· Stromal predecidua appears

· First predecidua around spiral arteries

· Later predecidua beneath surface

Postovulatory days 10-14

Menstrual Endometrium

· Stromal collapse

· Fribrin thrombi and blood

· Glands are broken apart

· Glands have no secretions

Hyper-secretory Endometrium of Pregnancy

· Arias-Stella reaction

· large, hyperchromatic nuclei

· prominent cytoplasmic vacuolization

Atrophic endometrium

· short glands

· glandular cells – flat, without significant mitotic activity

Dysfunctional Uterine Bleeding

· anovulatory bleeding

· luteal phase defect

Unopposed Estrogen

· proliferative glands

· stromal breakdown

· fibrin thrombi

· wreathing of stroma by glandular cells

Contraceptives

Combined oral agents

· mix of proliferative and secretory changes

· long use

· atrophic glands

· stromal predecidual pattern dominates

Depoprovera

· unopposed progesterone

Tamoxifen

· inc risk of carcinoma

· inc incidence of polyps

· large, mucinous metaplasia, fibrotic

Endometrial Hyperplasia

· unopposed estrogen stimulation – exogenous, endogenous

· no progestational stimulation

· simple or complex architecture

· typical or atypical nuclei

Vaginal bleeding, 60s

Risk factors – obesity, diabetes, nulliparity, early menarche, late menopause

Complex atypical hyperplasia progresses to carcinoma – 1/3

T – hysterectomy, hormonal manipulation

Endometrial Carcinoma Type 1 Endometrioid

· PTEN gene mutation à cell growth and apoptosis

· squamous or mucinous

Grade determines prognosis

T – hysterectomy, good survival

Low grade – hormonal

Endometrial Carcinoma Type 2 Unfavorable Histology

· serous-p53 mutations

· clear cell

Early spread outside uterus long term survival uncertain

Gynecological Pathology I

Condition

Cause

Pathology/Histology

Surface Features

Other Features

Vulvar Malgnancies

Vulvar Intraepithelial Neoplasia

HPV

Varying degrees of loss of maturation of squamous cells

Single or multiple plaques or papules

Co-exists with cervical dysplasia

Invasive squamous cell carcinoma

Keratinizing squamous cell histology

Ulcerated exophytic lesions

Most common vulvar malignancy

Verrucous carcinoma

Well differentiated, locally invasive

Giant condyloma

Unlikely to metastasize, subset of invasive squamous cell carcinoma

Extramammary Paget’s Disease

Intraepithelial adenocarcinoma in the vulva

Red, moist plaque

Malignant Melanoma

Same as skin melanoma

Second most common malignant tumor in vulva

Benign Disorders of Vulva

Lichen Sclerosis

Atrophic epidermis, hyalinized epidermis

White plaques

Squamous hyperplasia

Thickened epidermis

White plaques

Hidradenoma

Benign tumor

Sweat gland origin – apocrine

Syringoma

Benign tumor

Sweat gland origin – eccrine

Hemangioma

Benign tumor

Mesenchymal

Vagina

Failure of squamous cell maturation

Absence of estrogen

Adenosis

DES exposure, sporadic

Abnormal retention of embryologic glandular epithelium

Benign disorder

Squamous cell carcinoma

Vaginala intraepithelial neoplasia

Most common vaginal neoplasm, assoc w cervical and vulvar SSC, 80% spread from cervix

Clear Cell Adenocarcinoma

Prior DES exposure

Peak age 17-22, very uncommon

Embryonal Rhabdomyosarcoma

Sarcoma of primitive skeletal muscle

Sarcoma botryoides – grape like

Seen in young children

Cervix

Cervical Intraepithelial Neoplasia

HPV esp types 16,18, 31, 33, 35 à Inactivation of suppressor gene products p53 and Rb

Occurs in transition zone

Degree of loss of maturation in squamous cells

Invasive Carcinoma of Cervix

Microinvasion, non-keratinizing squamous cel,l Advancing disease can obstruct ureters, invade locally

Adenocarcinoma – less common, more aggressive

2nd most common cause of death WW

Gynecological Pathology





















































































































































































































































































































































































Condition

Cause

Pathology/Histology

Clinical Features

Other Features

Proliferative Enodmetrium

·
Straight glands


·
Narrow lumens


·
Pallisading nuclei


·
Ovoid nuclei


·
Mitoses

Early Secretory Endometrium

First manifestation of effect
of ovulation on endometrium

·
Glands remain straight


·
Lumens remain narrow


·
Subnuclear vacuoles appear

24-36 hours after ovulation

Mid Secretory Endometrium

·
Glands become coiled


·
Vacuoles no longer present in glands


·
Secretory product appears in lumen

Postovulatory days 5-9

Late Secretory Endometrium

·
Intralumenal secretions are spent


·
Stromal predecidua appears


·
First predecidua around spiral arteries


·
Later predecidua beneath surface

Postovulatory days 10-14

Menstrual Endometrium

·
Stromal collapse


·
Fribrin thrombi and blood


·
Glands are broken apart


·
Glands have no secretions

Hyper-secretory Endometrium
of Pregnancy

·
Arias-Stella
reaction


·
large, hyperchromatic nuclei


·
prominent cytoplasmic vacuolization

Atrophic endometrium

·
short glands


·
glandular cells – flat, without significant mitotic activity

Dysfunctional Uterine Bleeding

·
anovulatory bleeding


·
luteal phase defect

Unopposed Estrogen

·
proliferative glands


·
stromal breakdown


·
fibrin thrombi


·
wreathing of stroma by glandular cells

Contraceptives

Combined oral agents

·
mix of proliferative and secretory changes


·
long use à


·
atrophic glands


·
stromal predecidual pattern dominates

Depoprovera

·
unopposed progesterone

Tamoxifen

·
inc risk of carcinoma


·
inc incidence of polyps


·
large, mucinous metaplasia, fibrotic

Endometrial Hyperplasia

·
unopposed estrogen stimulation – exogenous, endogenous


·
no progestational stimulation

·
simple or complex architecture


·
typical or atypical nuclei

Vaginal bleeding, 60s


Risk factors – obesity, diabetes, nulliparity, early menarche, late
menopause

Complex atypical hyperplasia
progresses to carcinoma – 1/3


T – hysterectomy, hormonal manipulation

Endometrial Carcinoma Type 1
Endometrioid

·
PTEN gene mutation à
cell growth and apoptosis

·
squamous or mucinous

Grade determines prognosis


T – hysterectomy, good survival


Low grade – hormonal

Endometrial Carcinoma Type 2
Unfavorable Histology

·
serous-p53 mutations

·
clear cell

Early spread outside uterus
à long term survival uncertain

Uterine Mesenchymal Tumors

Leiomyoma

·

·
smooth muscle


·
multiple nodules


·
no coagulative necrosis


·
mitotic rate is low

Extremely uncommon

Leiomyosarcoma

·

·
increased mitotic rate (>10/10 hpf)


·
necrosis


·
cytologic atypia

Stromal Sarcoma

·

·
vascular invasion


·
receptors for progesterone

Appearance of endometrial stroma

T- hormonal therapy

Uterine Mixed Tumors

Adenomyoma

·

·
benign glands and stroma

Adenosarcoma

·

·
benign glands and malignant
stroma

Carcinosarcoma

·

·
malignant epithelial and
stromal elements

Fallopian Tube

Infection

·
STD


·
Polymicrobial infection

Important cause of infertility

Ecotpic Pregnancy

·
Possible result of salpingitis

Ruptured fallopian tube is life
threatening

Most common site of ectopic
pregnancy

Ovary and Placenta

Polycystic Ovary Syndrome


(Stein-Levanthal)

-
Increased ovarian androgen production


-
Arrested follicle development due to androgens

-
Androgen excess, ovarian cysts


-
Common cause of infertility

Endometriosis

-
Mestrual implantation


-
Surgical


-
Vascular spread


-
Coelomic metaplasia

-
Benign endometrial glands and stroma present outside the uterus

-
cyclic pain with menses


-
may cause infertility

Ovarian Tumors

-

-

-

Ovarian Epithelial Carcinomas

-
c-erbB-2 42%


-
K-ras mucinous lesions


-
P53 mutation 50-60%


-
BRCA1 and BRCA2 -15X risk, 10%


-
Lynch Syndrome II, subtype of HNPCC

-

-

Highest mortality rate of female
genital cancers


Difficult to detect early, spread beyond ovaries


Adults, first-degree relatives, industrialized


Inc with age, dec with parity and oral contraceptive

Benign Ovarian Germ Cell Tumors

-

-
mature adult type tissue


-
all three germ layers


-
“dermoid cysts”


-
adult type carcinoma arises from tissue elements

-

Wide age range

Malignant Ovarian Germ Cell
Tumors

-

-
Dysgerminoma – undifferentiated germ cells – best prognosis


-
Immature (malignant) teratoma
– fetal type tissue


-
Choriocarcinoma – mimics placental trophoblast


-
Endodermal sinus tumor – embryonic yolk sack type tissue

-

Highly malignant course but
responsive to chemotherapy or radiation


Exclusively children, young adults

Sex Cord Stromal Tumors

-
ovarian stroma or primitive sex cords

-

-

-
Variable from benign ot low grade malignancy


-
most hormonally active ovarian tumors

fibroma

-

-

-
hormonally inert

-
most common,

Thecoma

-

-
lipid laden theca cells

-
produces estrogen

-

Granulosa cell tumor

-

-

-
produces estrogen

-
low grade malignancy

Sertoli-Leydig cell tumor

-

-

-
produces androgens

-
rare

Metastatic Tumors to the Ovary
(Krukenberg)

-

-

-
can stimulate stroma to cause hormone production

-
3% of ovarian carcinoma


-
colon and upper GI

Placenta

-

-

-

-

Chorioamnionitis

-
ascending infection through the birth canal


-
coliforms, vaginal bacteria

-

-

-
preterm labor


-
neonatal infections

Villitis

-
blood borne source of infection


-
viral, parasitic, spirochetes

-

-

-

Sponataneous Abortion

-
infections


-
mechanical


-
endocrine


-
fetal abnormality


-
immunologic

-

-

-
15% of recognized pregnancy


-
30% of unrecognized pregnancy

Septic Abortion

-
uterine infection following induced abortion

-
acute inflammatory cells and necrosis

-

-
uncommon in hospital performed procedures

Toxemia of Pregnancy

-
failure of spiral arterioles to fully dilate


-
placenta shows acute atherosis in maternal vessels


-
kidney: vacuolization of endothelial and mesangial cells, fibrin
deposition

-

-
hypertension


-
proteinuria


-
edema


-
convulsions - eclampsia

-
more common in first pregnancy

Placental Abnormalities

-

-

-

-

Retroplacental Hematoma/ Abruption

-
Hematoma separates placenta from uterine blood supply


-
Abruption: premature separation of placenta

-

-

-

Placenta Accreta

-

-
abnormal adherence of placenta to myometrium


-
+/- invasion of myometrium

-

-

Gestational Trophoblastic
Disease

-

-

-

-

Complete Hydatidiform Mole

-
Fertilization of empty ovum


-
23x paternal chromosome


-
divides to 46xx (diploid)

-

-

-
Hydropic, avascular villi

Partial Hydatidiform Mole

-
Fertilization of normal ovum by 2 sperm


-
Triploid karyotype

-

-

-
some villi normal and others avascular

Choriocarcinoma

-
malignant tumor derived from trophoblast

-

-
vaginal bleeding


-
excessively high HCG levels

-
good response to chemotherapy

Pregnancy and Preeclampsia

Normal Pregnancy

Preeclampsia

Blood Pressure

Fall in first 24 weeks, rises to baseline by term

140/90 after 20 weeks gestation

severe - >160/100

Kidneys

GFR increases 50%, renal plasma flow increases

serum urea and creatinine decrease;

enhanced waste metabolite removal;

glycosuria

Vasospasm and capillary endothelial swelling -> reduction in GFR

Serum uric acid and creatinine increased

Proteinuria > 300 mg in a 24 hour collection

Severe – proteinuria > 5 g/24h, oliguria (<500cc/24h)

Edema

Normal

Presenting sign but 1/3 don’t have it

Hemostatic

Venous stasis from hypercoagulable state

Systemic vasospasm, coagulation system activation, abnormal hemostasis

Cycle – endothelial injury, platelet activation, platelet consumption

Prostanoid Changes

Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA

TXA > PGI

PGI – vasodilator and inhibitor of platelet aggregation

TXA – vasoconstriction and platelet aggregation

Autonomic

Increased sympathetic state – vasoconstriction

Nitric Oxide

Reduced

Free radical oxidation products

Increased

Hematologic

Plasma vol inc, RBC mass inc à “physiologic anemia” of pregnancy Hgb 11.5 mg/dl

WBC count increases

Hypercoagulable state – inc fibrinogen, factor VII to X increase – venous stasis

- Thrombocytopenia

- Severe - <100,000

- fibrinogen decreased

- coagulation time increased (PT, PTT)

Hepatic

Signs of liver disease

Spider angiomata and palmar erythema – elev estrogen

Serum – dec albumin, elev alk phos, elev cholesterol

Estrogen increased proteins – fibrinogen, thyroid hormone binding globulin, ceruloplasmin

Hepatic enzymes – AST/ALT, PTT unchanged

10% - transaminase elevation

severe – impaired liver function (AST/ALT >70)

Pulmonary

Severe – pulmonary edema

Cerebral or visual disturbances

Severe cases

Epigastric pain

Severe cases

Seizures

Severe cases -> Eclampsia