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yesss! me too -.-
Exactly. Three months can fall under chronic rejection as well.
FA pg 119 states "interstitial fibrosis".
Chronic rejection is predominantly Bcell mediated (plasma cells).
chornic rejection > 6 month
acute < 6 month
also there are no B cells in the site of fibrosis. humoral response due to antibody themself,not by direct B cells response
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.
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.
How would we have known to choose Zidovudine over Lamivudine tho
@nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off
you have ero bone marrow if you take idovudine
the z's were supposed to be bold idk what happened.
you have Zero bone marrow if you take Zidovudine
Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects
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.
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.
The cardiac stuff is not a distractor - MDD is common after an MI, and a very poor prognostic factor (reinfarction)
Beers criteria also says avoid antidepressants though.
What is the clue that this is not pulmonary fibrosis? How do I decide between Doxorubicin and Bleomycin?
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
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.
Also pulmonary fibrosis would more likely cause right-sided HF. This patient has left-sided HF (orthopnea, crackles, pulm edema.)
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.
omg when the hell am I going to remember this equation? Jesuusssssss, this kind of details makes me want to give up on STEP
*low HDL level
(refer to table 3 of the article)
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
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.
This question inspired my screen name
"Statins are always the answer", "Fat Female 40 Fertile", "Fibrates can cause gallstones". I feel lied to
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.