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 +1  (nbme24#23)
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utsj fro iddtnoai - ereh VCM is a,lromn ni 1B2 fnyccdeiie it si ghih

Subcomments ...

submitted by sajaqua1(531),
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Pooisrert orcd msdeoynr cscrou edu to nfiroacnit of eth ootrripes alhf of teh pisanl ,cdro rmof ciosoucnl fo hte iotorrpes lnaspi a.rrtey ruO tpatein enesptrs ihwt esdeerdca siaoesnnt ot ikcnippr elbwo the evell fo eth keesn sa lwle as gklnawi itwh a sbeaedwd-i igta, lkeyil ciidnantgi slso fo .eticprroionpop The ettianp si soal iaencm hwit ndgheespyeret-m l.utieonrsph

msdynpreHeegte thnsieourlp aer cpyatilyl adcsue yb an iyinlaibt ot eamk guheno DAN, csadue by a kcal of erncassye rcsreusrpo dan iimavsnt ingdlnuci 9B l(aet)fo adn 1B2 (obm) fI teh iaentpt is aftelo t,eiiendfc we ees vealdeet emnsoeoyhtci cencedyiif. If hte naiettp si 2B1 de,tinfcei we see eatdlvee ncemmayltihlo acdi nad ohicseenytom les.lve Hepyeostahyocmriinme can arcensie sihmsboTro ni hte rootseirp anipsl retyra nca sauce orptrsioe orcd r.eyndsmo nI ddoit,ain kcla of ivtamni 1B2 apismir liynem oioanmrtf nad lesad to utaScube bCeondmi ig,teneornaeD cwihh tfafsce het oaaimnciSpthl trtca o(nccnutgai fro rcdeedaes picnikrp sn)neios,at tonirpcioslCa c,raTt nad srDlao Cmna-leluoMid cuiLnesms Tcart g(nunticaoc fro teh eeucrdd cp.ionroopeirpt

)A trrAnoie docr dyseorm-n sols fo tmoro ao,cmdnm as lewl sa bltaaleir osls fo teha and i,pna teh ttienpa sha not olts toorm tunc,onif os ti ntanco eb B) trealCn rdco enmro-ysd ternsesp as a nnoiibactmo of ormot adn orssney l,oss uusyall whti beaddrl yciuns.ntfdo ishT itaptne soed ont lsdaiyp ortom lsos or blraded du.nscfytoni C) rmicdoHe sdn-oreym slAo dllace ,reoBurqadn-Sw hits si omceetpl rnijyu ot threei eth tlef or ithgr edis fo the anlpsi ro.dc tI nrespset ithw mtroo tyndufcosin and xrlefe cuiodfstnny irsaelitplayl at the lelev fo eth ;lenosi olss fo prpeu rtomo mncdoma wolbe hte leison ilalreiysplta c(sastpi rp)eas;si lsos fo rsodal rieanrlcmo-ucd tsisennao rlilltsayeapi ta and leowb the e;olins and loss fo inap dan retuereatpm eoasnnsit aalrtecotlarlyn 2 to 3 veeabrrt obwle teh esnil.o E) mtnSrgeaye y-edmsrno a gntoiclnae lieuraf ot elevopd ptra fo the ipasln ord.c eTh ewn nsteo of ostymmsp at 82 sreya ldo askem stih an lnklieyu igia.,dsosn

yb_26  amazing, thank you! +  
aisel1787  great explanation +  
rockodude  sensation to pinprick is DCML tract. SCD affects spinocerebellar (not spinothalamic), corticospinal, and DCML. otherwise good explanation. +1  
azibird  Sensation to pinprick is not dorsal column-medial lemniscal tract, it's spinothalamic tract. So this patient has a lesion of the dorsal columns, spinothalamic tract hypersegmented neutrophils, and anemia. What the hell is going on? How is this just posterior cord syndrome? Spinothalamic is not posterior cord. +4  

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Skni oidpvres stuoaniinl and nsepervt thea o.ssl iTsh teip'sant obdy liwl nmosetcepa for ndresceia ater of ateh sosl by negnsiraic catmleoib etr.a

davidw  This is directly from Goljan I) Hypovolemic shock may occur due to loss of plasma from the burn surface (refer to Chapter 5). • Loss of protein from the plasma loss may result in generalized pitting edema. II) Infection of the wound site and sepsis may occur. (a) Sepsis due to Pseudomonas aeruginosa is the most common cause of infection in burn patients. (b) Other pathogens include methicillin-resistant S. aureus and Candida species. (3) Curling ulcers may occur in the proximal duodenum (refer to Chapter 18). (4) Hypermetabolic syndrome may occur if >40% of the body surface is burned. +12  
yex  Can someone explain why is it not increased ECF? +24  
charcot_bouchard  i picked same. Increased ECF but cant remember why. Can you explain WHY it is increased ECF? what was ur reasoning +2  
isotopes  Burns would lead to a decrease in ECF because the protection from fluid loss is absent; it can lead to shock. :) +2  
tinydoc  My reasoning behind picking ↑ ECV was that your losing fluid but not electrolytes with the burn ⇒ the ecv would have increased osmolarity, so the fluid from the ICV would be pushed the the ECV. It made sense to me at the time. I guess technically its wrong because the loss of fluids and the gain of fluids would amount to pretty much the same thing. But the insulation and heat loss thing makes sense I guess. +  
yex  Increased ECF, bc I was thinking about the edema formation.... :-/ +3  
atbangura  I picked increased ECF because burns increase the capillary permeability coefficient, but now that I am going over it I realized that increasing the permeability would only transfer plasma volume to the interstitial volume, which are both a part of the ECF so therefore ECF would not change. SMH +5  
aisel1787  thanks +  
69_nbme_420  Burns (and Diarrhea) cause ISOsmotic volume contraction; Costanzo BRS Physio +  
tiagob  in severe burned patient, also has increased fluid in third spacing or interstitial (leading EDEMA). Different extracellular space is interstitial and vascular +  
peridot  I also wanted to add, another huge job of the skin is to prevent loss of fluid. Burn patients are easily dehydrated because they've lost that barrier. This helped me lean away from increased ECV - despite the edema (from one compartment to another) as others have mentioned above, there is a loss in overall ECV due to evaporation from body. +  

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dOl etuedtd hvea tciroA ts.noesis aAlitr oicrctnaotn oceebm eteisnlsa fro sthi epnti.ta os AS + bAFI is rsdnaouge eubecas this ersudec hte VL deaolrp snicgtifinyla nda shti antiept ovdpeels .FH oS bAiF ni AS tntpaie ened to erorcct litemedimya

aisel1787  she's not so old! stupid comment +  

submitted by hhsuperhigh(37),
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Hs"i drfseni eilvebe ehtre yma haev bene rdgus ta hte p"at,ry rpiode. o...mla

aisel1787  ahahaha +  
qball  What a snitch +8  
bend_nbme_over  Good thing they were at the ED cause that friend is gonna need some stitches +1  

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idD aoenny eesl go dwno ht:e h'ess tesvpnhioey os emaby 'lhesl gte arhoeetusw rchrnsdfeiie rsyemdon eusceba gontihn eles is naikmg enses to me ta itsh t?poni?? uoter -

nruTs ,otu eersve iaalamr anc seuac aoruvrdlsaicca loclsaep dna eipo.hstnnyo

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +11  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +1  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1  

submitted by drdoom(874),
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retfA the cuff si die,t the sllec and sutsie ladtis ot eht cffu ilwl oueinnct nmgsnoicu APT (DPAATg;-&tP,) ubt no efrhs ldboo lwil be rideeveld to “lra”ce ahtw lwli be na lmcitgauacun uantom fo DAP nda htroe ebaltosi.mte APD s=ed(eAnoni) is feislt a yrpox of ipunmcosont adn irdsev vioantisdola of sriea!tre oov(ltEniu si s!mtr)a nsainergIc /esodADinnPeA ni a o“clal ”riemntnneov is a glasni to eht oybd atht a tol of uomcnspnoti si uorcicnrg the;re ,thsu sareiert nda etesaorlir lrunltyaa ladtei ot naereics oobld wolf rsate nad p“swee wy”aa cltaobime borptuc.ysd

lispectedwumbologist  You're a good man. Thank you. +  
drdoom  So glad it helped! +1  
seagull  very well put, thank you +1  
eosinophil_council  Great! +  
aisel1787  gold. thank you! +  
pediculushumanus  beautiful explanation! +2  
rockodude  this explanation was on par with Dr. Sattar IMO +2  
flvent2120  Just to add on to this: FA2020 pg. 297. CHALK (Calcium, H+, Adenosine, Lactate, K+) is known to vasodilate muscles during exercise as well as regulate sympathetic tone of arteries at rest +  

submitted by seagull(1539),
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sTih si a niec paporach ot inindfeyigt nda entigrat iiaoftutcs ds.orreid


cinnapie  Not all heros wear capes +  
privwill  Mother of mine strongly believes in this method of treatment... +9  
aisel1787  lmao +1  

submitted by doodimoodi(62),
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Did on neo cieont tath the dOsd atrio no eht opt felt si wngro? Am I miginss ms?engihto fI yuo culeatcla ,ti t'si 6 sutj elik teh top hrtgi one....

mjmejora  thats actually really funny +  
yex  Because I said so, applies here... :-/ +1  
doodimoodi  Cant believe we pay $60 for this crap +41  
aisel1787  best comment doodimoodi) +1  
b1ackcoffee  that fucking threw me off on exam. I was like is there an effect modification by "Not drinking milk". the fuck! +1