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Dawn Phenomenon and the Somogyi Effect-USMLE CK



For Dawn phenomenon HYPER -INCREASE INSULIN 
For Somogyi phenomenon HYPO -DECREASE INSULIN

In other way which we are giving insulin :---
Somogyi = so much insulin. 
Dawn = down insulin.

Lyme disease




Lyme disease.Erythema chronicum migrans. Expanding “bull’s eye” red rash.

Caused by Borrelia burgdorferi,which is transmitted by the tick Ixodes A (also vector for Babesia). Natural reservoir is the mouse.Mice are important to tick life cycle.

Common in northeastern United States.


Initial symptoms—erythema chronicum migrans, flu-like symptoms, +/- facial nerve palsy.
Later symptoms—monoarthritis (large joints) and migratory polyarthritis, cardiac (AV nodal block), neurologic (encephalopathy, facial nerve palsy, polyneuropathy).


Treatment: doxycycline, ceftriaxone.

Thyrotoxicosis with low radioactive iodine

The most important cause of thyrotoxicosis with low radioactive iodine uptake include:

1.Subacute painless thyroiditis
2.subacute granulomatous thyroiditis
3.iodine induced thyroid toxicosis
4.levothyroxine overdose
5.Struma ovarii