Which are the early (prodromal) clinical manifestations of hepatitis. (Select all that apply).

A. The Somogyi effect results from an excessive insulin dose causing hypoglycemia overnight, triggering a rebound hyperglycemia via release of glucagon, cortisol, and growth hormone. In contrast, the dawn phenomenon is a natural early morning rise in blood glucose due to circadian increases in cortisol and growth hormone without preceding hypoglycemia.

B. The Somogyi effect happens only in type 2 diabetes, while the dawn phenomenon happens only in type 1 diabetes: Both effects can occur in either type 1 or type 2 diabetes depending on insulin therapy and individual physiology.

C. Both the Somogyi effect and the dawn phenomenon occur due to nighttime hyperglycemia: The Somogyi effect starts with nighttime hypoglycemia, not hyperglycemia, while the dawn phenomenon involves a gradual early morning rise in glucose levels.

D. The Somogyi effect is caused by insufficient insulin at night, while the dawn phenomenon is caused by excessive nighttime insulin: The Somogyi effect is caused by excessive insulin leading to hypoglycemia, not insufficient insulin. The dawn phenomenon is unrelated to nighttime insulin dosing and is caused by hormonal changes.

A. Glomerulonephritis: This is an immune-mediated condition involving inflammation of the glomeruli and typically presents with proteinuria, hematuria, hypertension, and edema rather than urinary frequency, burning, or foul-smelling urine. The presence of E. coli and leukocytes does not support this diagnosis.

B. Kidney calculi: Kidney stones may present with flank pain, hematuria, and sometimes nausea or vomiting, but are not usually associated with urinary frequency, burning, or bacterial growth on urine culture. Randi’s symptoms point more toward an infectious etiology rather than a structural obstruction.

C. Lower UTI: cystitis (bladder infection) and possibly lower ureters: The burning, itching, frequent urination, and foul smell are classic signs of cystitis. The absence of flank pain and only a slightly elevated temperature further supports a lower tract infection rather than an upper one.

D. Upper UTI (pyelonephritis): Pyelonephritis typically presents with fever over 101°F, chills, nausea, vomiting, and significant costovertebral angle (CVA) tenderness or back/flank pain. Since Randi denies back pain and has only a mild temperature elevation, an upper UTI is unlikely.