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Welcome to adisdiadochokinetic’s page.
Contributor score: 74


Comments ...

 +3  (nbme24#35)
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It llyaer okslo ot em kile erh elarsc aveh ebne oeoodptshh,pp anoeyn sele iceton h?att xD


 +7  (nbme22#21)
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woH aynm pleope nt'did ese ttha it swa 1ficptciei-ys dna cipekd E leki me :(

jfny21  Here +1
eacv  yesss! me too -.- +3
jinzo  me also :( +1

 +2  (nbme22#47)
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anC aneony eixanlp hyw bFiorus sarcs tiwh laasmp cesll is ton eth rrocect aren?ws

osler_weber_rendu  Exactly. Three months can fall under chronic rejection as well. FA pg 119 states "interstitial fibrosis". Chronic rejection is predominantly Bcell mediated (plasma cells). +
beto  chornic rejection > 6 month acute < 6 month +2
beto  also there are no B cells in the site of fibrosis. humoral response due to antibody themself,not by direct B cells response +2

 +2  (nbme22#26)
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etsobulA ksir deuocrtin = Ri(ks ni nc)orotl - k(isR in .emrexeinpat)l nI tihs e,cas hte rkis in eht lrotocn ogrup is cdcueaatll yb the rnbemu how hda an nfaoctniri (4)19 videidd by teh latot 29().13147/ eieskiL,w fro eth penaxlmtreei gou,rp 6/(.349521) Tish is srewan ocihec B.

adisdiadochokinetic  Whoops, second parenthesis should be 123/2365, sorry! +2

 +4  (nbme22#48)
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The dilurimtocs rrefpgnisne haapl nxiot is a cinltshieae hwcih aceevls tielcinh to iohhnlsyhorppleco nda dgcee.yildir i,lseslatnEy apalh toxin scimim slhpaihepopos C. shTi mnsae ti ash a ugalyev imriasl tceeff of eth lssahepsoophpi sene in lucasliB rCeesu dan iriaestL nge.tscyonoeMo eTh end letsru of hte xiotn otcanaviti is atiocntvai of esdcon rsmgnesee etmysss ghrothu rgyeeilidcd (AAK )lclacyidry,eogl chhwi tcavesiat aeevlsr ywat,spah mots botnlay ni iths ecas coniaAdhicr cdia almesoitbm nad 8I-L, ihtw het ent ceteff of erasdince cvalrusa ymptebialrei aligden ot emd.ae

teepot123  fa 19 pg 138 +1
faus305  alpha-toxin is also known as lecithinase. I got this right because I remembered the sketchy. That being said, can someone explain how this possibly received a "13.1 difficulty score?" It does not seem like that easy of a question. +

 +2  (nbme22#18)
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isTh esotiqnu is os oaiynnng utb shit nlptinaeoxa si pduopsetr by sralvee pesr.ap





Subcomments ...

submitted by neonem(556),
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RsINT are eht inma HIV rpayeht rdgu thta nca ucase noeb rromwa ppnsuseiors ont( as nocmmo wiht Rs)T.NNI sihT slcsa encsdlui udoniizdve, dao,nisiden trceiib,mieant mdeniav,uil ndu,aseivt .ivcabraa ednivuZido is mtos nkown ofr hist dsie cffe.et

rfaviNlnei = apostere hroiboycti zmtnrniiiah = sceidnyoagilmo o(nt eralyl ueds orf nmie)eIptiVdn aH = rohetna amlibcioainr,t smlyto udes rof sicseuntypmo I ndii Liheamktvnu? = notreha TRIN tub less konnw rfo nebo roamwr seipunrossp

adisdiadochokinetic  Azithromycin is a macrolide, not an aminoglycoside FYI, and its use in HIV is primarily as prophylaxis at very low CD4 counts for, among other things, the mycobacterium avium complex. +7  
nbmehelp  How would we have known to choose Zidovudine over Lamivudine tho +5  
mjmejora  @nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off +8  
niboonsh  you have ero bone marrow if you take idovudine +1  
niboonsh  the z's were supposed to be bold idk what happened. you have Zero bone marrow if you take Zidovudine +5  
t123  Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects +2  
therealslimshady  Zidovudine Zaps your bone marrow (sorry) +1  


submitted by lsmarshall(396),
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"Pdoereicnb adn ogehhsd-i taclislaesy ihiitbn erorosnabpti of riuc idca in ilrpomax veucntdool btulue slao( tinbsihi retoniesc of cl.neii)n"lip - rsFti dAi 0129

uslme123  so ............... +8  
adisdiadochokinetic  So probenecid is the best answer here because they only specified acetylsalicylic acid, not the dosage, and low-dose acetylsalicylic acid has the opposite effect. +8  


submitted by neonem(556),
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shiT piaetnt ash rjaom essdriepve oderir:sd sols fo ohnenit/eairsetnad nede( ot vhae hist or espsreded epdome,)slo ,slropmeb gihwte nhcg,esa edeesracd reyen,g tuhotshg of .thade eseMt tecairri acseebu g&t; 2 esekw mmfei.taer RIsSS aer efitrs-n;il erxaonteip si ni tshi gt.reocay SsSIR salo lhep iwht thwige ngia - tihmg be na ddeda nfeetbi if the eaiptnt si wehtdrgneu.i

eTh ccardai sfuft itmhg vhae usjt ebne a tot,idcsrar epcxte ttha uoy abylprbo ot'nluwd ntaw to eigv lyrcciitcs (e.i. mp)ryitileatin eisnc htey ahve pr-chhirmtyrao side ces.teff etanPit bblryopa sah oeldopnrg RP ratlinev eud ot taeb c.brslkeo

adisdiadochokinetic  Another reason not to use TCAs (or alprazolam or haloperidol for that matter) is that the Beers criteria state to avoid the use of all of those drugs in patients over the age of 65. +15  
t123  The cardiac stuff is not a distractor - MDD is common after an MI, and a very poor prognostic factor (reinfarction) +8  
therealslimshady  Beers criteria also says avoid antidepressants though. +  


submitted by radshopeful(17),
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heT lcscsai ised tefcfe of cyhaateclrinns is iedadlt payhaomodrict.y ihsT isutnoqe dolcu eahv nettog tkyric fi ouy tutgohh hte aorynmpul potmsysm erew ued ot het dugr wihch uolcd hvea eld uyo ot eminobylc (caessu ompnyarlu fiboi)srs utb sethe npoalurmy soptmmys wree omts lleyki a relust of daletdi rooitmhyyadcpa dngleai to FH and nmupoylra .aedme

nwinkelmann  What is the clue that this is not pulmonary fibrosis? How do I decide between Doxorubicin and Bleomycin? +  
ilikecheese  Also both bleomycin and methotrexate cause pulmonary fibrosis, so that helped me rule both those out and focus on the HF instead of the pulmonary symptoms +4  
adisdiadochokinetic  The S3 gallop and enlarged heart together are very strong evidence for heart failure. It's much more likely for heart failure to cause interstitial edema than for pulmonary fibrosis to directly cause heart failure. +8  
jurrutia  Also pulmonary fibrosis would more likely cause right-sided HF. This patient has left-sided HF (orthopnea, crackles, pulm edema.) +  


submitted by monkd(18),
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Am I arzcy or idd Urwlod otn aveh a tosieunq htta deatts tisntSa rea het somt etceivfef drug eradlgsrse of nlibasee iidsp.l shiT iogcl rthew my o.ff

adisdiadochokinetic  You are not crazy. I got this question wrong for the same reason but here's why I think NBME was going with fibrates. You can use the Friedewald equation to calculate LDL cholesterol from the values they give. This equation is LDL= Total Cholesterol-HDL Cholesterol-(Triglycerides/5). The Triglycerides/5 term is an estimate for VLDL. If you calculate it in this case you get an LDL of 120 which is firmly normal and thus the patient would ostensibly not benefit from statin therapy. +14  
hello36654  omg when the hell am I going to remember this equation? Jesuusssssss, this kind of details makes me want to give up on STEP +4  
almondbreeze  Her goal LDL should still be <100, bc she has 3 CHD risk equivalents (https://www.aafp.org/afp/2002/0301/p871.html#afp20020301p871-t3) CHD risk equivalent=the major risk factors that modify LDL goals 1) age(M>45, F>55), 2) smoking status, 3) hypertension(>140/90), 4) ow HDL level (<40), and 5) family history. (https://www.aafp.org/afp/2002/0301/p871.html#sec-4) +  
almondbreeze  *low HDL level (refer to table 3 of the article) +  
makinallkindzofgainz  These guys are hitting up attending-level cardiovascular risk factor calculations, meanwhile I picked statins because I think I remember that they help the heart +12  
jimdooder  So I ended up going with fibrates because of her age (39). I vaguely remember being taught that statins are really only recommended for patients >40 because the big study that came out about them was in the 40-75 age group. I think this might contribute to the question but I'm not totally sure. https://en.wikipedia.org/wiki/Statin#Primary_prevention +  
ytho  This question inspired my screen name +2  
cbreland  "Statins are always the answer", "Fat Female 40 Fertile", "Fibrates can cause gallstones". I feel lied to +  
brise  I'm not sure if this question is correct. I chose statins according to what an attending told me and UWOLRD 2, I just went back to check and on uworld 2, you only consider giving fibrates if their TG levels are above 1,000. So idk what the nbme is smoking. Or if doctors actually write these questions. +  


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lteAosub risk cruoedtin = ks(iR ni r)ncotol - i(kRs ni ti)nrlpe.xeaem In tish sce,a hte ksri in eth nrotolc ugpro si cadceltual by hte rmnbeu who dha an oiftnicarn 4(91) iidedvd yb teh lotat 7).1932(1/4 kiiwee,Ls ofr eth paemretlixen r,goup .4916/)(325 sihT si sernaw icecho B.

adisdiadochokinetic  Whoops, second parenthesis should be 123/2365, sorry! +2