This is septic shock leading to pulmonary edema aka “symptoms”. The leakage is caused by LPS leading to IL-1, IL-6, TNF-alpha which increases vascular permeability! The question and answers tries to trick you into thinking it’s something else but you know she had gram neg infections and the presentation is just sequelae of septic shock!
Snitching to the mom would ruin your relationship with the patient. his social skills are pretty good to me if hes getting laid at his age. based on vignette, testosterone levels dont seem to be an issue. and suggesting decrease in masturbation is not medically relevant. The most lucrative next step would be to schedule next appointment like you would with any patient. Dont overthink this question. its straight forward! keep it simple!
FA2019, p259: Remember that prevalence / (1-prevalence) = incidence * (average duration of disease). It has nothing to do with this but I wanted to write that because I saw it written wrong on another website explaining this. This is a very simple question that I completely overthought. To answer this question, I think all you need to know is that TB is a chronic disease. Therefore incidence > prevalence. Lowering the threshold for negative results will increase the incidence of positive results. And since prevalence must always be greater than incidence, it will increase the prevalence as well. Sounds logical to me now.
Everything else is an NSAID and contraindicated due to chronic abdominal pain. Acetaminophen is antipyretic and analgesic. It is not anti-inflammatory, but more importantly, it does not affect gastrin release or stomach mucosa.
First-line therapy for chemotherapy-induced nausea are ondansetron and aprepitant. If she was actively vomiting due to chemotherapy, you could give metoclopramide as it is a strong antiemetic, according to UWorld, but this is written in a prophylactic sense. So go with the above mentioned.
CO = HR*SV, HR is increasing because SV is decreasing fast. If CO output decreases, pulses will weaken. RBF decreases during SNS activation. That's why you don't have to pee while working out or until few minutes after sex.
Area labeled: A= mitochondria B= Golgi C= Cell membrane D=Lysosomes/vacuoles E= Cytoplasm or free Ribosomes (subjective) F= [Rough] Endoplasmic Reticulum
Precursor protein would be coming from translation of mRNA which would happen in the rough ER
The question hints at ADHD due to "constant motion", disruptive behaviors, incomplete assignments in school + impulsive/reckless behaviors outside of school leading to MULTIPLE ER visits from injuries.Methylphenidate (Ritalin) is tx for ADHD.
I got this question more by ruling out everything else. Not B because no symptoms of CHS (albinism, primary hemostasis deficiency, peripheral neuropathy), not C because Streptococcus is catalase negative, not D because no symptoms of DiGeorge (cardiac defects, facial defects, no missing thymus), not F because IgA deficiency would have airway and GI infections. Recurrent ear infections doesn't seem related to IgA. That leaves me either Bruton agammaglobinemia and IgG2 deficiency. And Bruton's is more commonly seen in males. So I went with A.
Gynecomastia can be caused by elevated estrogen levels, decreased testosterone levels, or both. In pubertal males, adult estrogen levels are reached before adult testosterone levels. The effects of estrogen further causes increases sex-hormone binding globulins which further lowers testosterone, leading to gynecomastia (FA 2019-332; FA2020-337). Another cause of gynecomastia is hypogonadism (FA 2019-635; FA2020-649), which is what this patient seems to be experiencing .
Differentials: Kallman?, Prader Willi?,idiopathic I personally put low pitched voice, thinking his low testosterone would cause delay in deepening of his voice but I guess this varies and gynecomastia is a "better" choice in the eyes of NBME.
I would love to know the true odds that three separate samples of the chorionic villus are made and each 3 are completely isolated genotypes and none are a mixture of both. Also, I'd like to know how often a laboratory error is. If anyone has that data, I would love to see it.
Endometriosis explains the bleeding out of the butthole during menstruation. Furthermore, leiomyomas are estrogen sensitive, so it would be more likely to cause pain at ovulation. (FA2019, p634)
FA2019, p51: osteogenesis imperfecta. Patients with OI can't BITE (bones, eyes, teeth, ears).
Enterocytes have the highest turnover rate of any fixed cell population in the body. Stem cells for enterocytes are located in the crypts. Mature enterocytes do not stimulate cell turnover.
This is a simple metformin MOA question (FA2019, p348). Everything before the last sentence is distraction.
(FA2019, p643): Sildenafil causes increased flow in corpus cavernosum, D. Rest of the answers: A is deep dorsal vein. B is areolar tissue. C is corpus spongiosum. The deep dorsal vein keeps you hard but it's increase blood flow to the corpus cavernosum that gets the fireman ready and able to put on his coat. Practice safe sex. :)
I don't know about you, but I got hung up on the fact that she's in her 20s and female and "recently developed" her symptoms of hyperthyroidism. Hypothyroid disorders are more common than hyperthyroid disorders and Hashimoto's disease, which is the most common hypothyroid disorder, has an initial hyperthyroidism. So I went with C "thyroid peroxidase autoantibodies." To be honest, the only thing that makes me confident it's not early Hashimoto's still is that B is also an autoantibody of Hashimoto's. And there can't be two right answers. So that leaves D "Thyrotropin receptor autoantibodies" (Grave's disease) as the correct answer. Better responses requested:
I think this question is only hard because it is written so vaguely that it took me a while to even understand what the question was: was it asking what was important for the virus to infect or for the body to recognize that an infection has occurred? Basically, to answer this question, all you have to understand is that for a virus to infect a cell, there has to be on the cell some receptor for which the virus can bind to. That's it. "If the virus cannot bind, you will be fine." -Johnnie Cochraine
See page 367 in FA2019. Trypsinogen is converted to trypsin by enterokinase/enteropeptidase, a brush border enzyme on duodenal and jejunal mucosa