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Yes agree! Lymphocyte count is so low, which suggest HIV.
yes because i thought they wont give ques on current coronavirus situation so early!!
I thought to myself "damn it sure would be fuckin hilarious if Coronavirus was the answer".. turns out it was and it wasn't hilarious since I got it wrong.
no quotes needed for pandemic anymore :( big sad
whats a coronavirus? never heard of it
Sometimes these questions are made more difficult by trying to decipher the order in which these changes happen (first cause). In my mind, whenever I see a question on renal insufficiency, I know that phosphate in the serum will increase. In response, Ca will decrease and in response to that, PTH will increase. Lastly and unrelated, HCO3 will decrease because the kidneys aren't absorbing HCO3 as they usually do.
why do I feel like this was supposed to be an easy question
Page 332 FA 2019; cAMP signaling pathway, thus increase adenylyl cyclase was best option imo
Page 337 FA 2020; This is working via V2 receptor, which uses the Gs pathway to generate cAMP. Reminder: V1 works via Gq. V1 is present on the blood vessel smooth muscle
why cant this be hand foot and mouth disease cause of coxsache
Also thought it was Hand-foot-mouth an RNA virus but I did consider Herpes. Changed because I thought Hand foot and mouth would be more common.
Hand foot mouth usualy involves all 3 places (hands, feet and mouth/perioral area) and the lesions on the hand arent localized to just one finger.
Hand foot mouth disease affects palms and soles. ref: FA 2019 - 150
wouldnt the history also be different for coxsakie
I think this image is trying to show the "dew drops on a rose petal" sign on Hermes, the god of Herpes on Sketchy Micro
Google some images of HF&M disease. The small blisters look very different from herpetic whitlow.
can we have a moment of appreciation for Dr Sattar
NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence.
The abnormal T-cells are known as Downey type II cells (Sketchy)
I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom.
Soooooooo EBV infested B- cells is not considered atypical WTFF??
They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells.
oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells
Great video! Very, very solid review of brainstem anatomy.
This image was surprisingly interpretable for NBME standards
and the fact that all you needed to know was the side of the lesion to answer tbh lmao, but other than that localizing to medulla wasn't hard.
Actually, they were quite nice. You didn't even have to know what side. There was no option for left medulla.
This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin
@lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific.
shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals)
'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro
i get why its borderline now (I guess I kind of always thought suicide was the biggest part of that) but can someone tell me why its not paranoid? Is it just a matter of the "better" choice? The "youre the only one i can trust" thing lead me to that.
Paranoid is where they don't trust anyone or are weary of people. because she said she trusts only the physician can be a bit confusing, but she describes her coworkers as jerks, not that "oh they're out to kill me, they're government agents watching me"
Splitting association with borderline in FA 2020 pg 555 and 565
therefore biliary atresia would also be non bilious vomit. :)
Curious as to why this presented at 3 years of age
To answer my own curiosity; according to UWorld - most cases are asymptomatic at birth, so likely it presented when this child's organs began to increase in size (particularly the descending duodenum)
the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions.
I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" .
$60 a pop and no competitors...That's what happen when there's a monopoly.
Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary.
It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"...
could be due to increased blood volume leading to secretion of ANP and thus natriuresis which would normalize serum sodium levels?
that's the only reason I could think of
My guess is that the sodium and water loss from 21a-hydroxylase deficiency would result in increased RAAS activation and production of Angiotensin II (AGII). Recall that AGII affects the PCT by upregulating Na/H+ exchangers, allowing for there Na/H2O to be resorbed, thus partially counteracting the impact of aldosterone deficiency at the collecting duct. However, I'm not sure if the effect of AGII on the PCT is great enough to entirely counterbalance the loss of aldosterone to present with normal sodium levels.
Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia?
Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening?
UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process.
You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely.
I picked “diffuse alveolar damage” with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/
thank you swagcabana! Very good explanation and strategy!
This question is asking about the ‘S’ of FA Mnemonic for S. Pneumonia “MOPS”. Strep pneumo is the most common cause of sepsis in adults.
MOPS stands for meningitis, otitis, pneumonia, and SINUSITIS. It doesn't stand for sepsis. My guess as well is which is "more correct". It's about being able to identify encapsulated organisms and the spleen's role in immunity. Ha I chose E coli as well.
emmy2k21 is correct, the S is for sinusitis. I was between E.coli & Strep Pneumo, but then recalled Sketchy putting the sickle on the 'encapsulated' knight in the Strep Pneumo video; Strep Pneumo is more associated with infecting sickle cell "functionally asplenic" patients.
You could also recall that before splenectomy(ik this is a emergency splenectomy) we would want to give an encapsulated vaccine like the pneumococcal vaccine. this pushed me towards strep over ecoli