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Welcome to baja_blast’s page.
Contributor score: 34

Comments ...

 +0  (nbme16#31)

Vinca alkaloids (e.g. vincristine, vinblastine) inhibit microtubule production and mitotic spindle assembly. They bind Beta-Tubulin and inhibit its polymerization into microtubules, arresting dividing cells in the M-phase of mitosis. FA 2019 p. 433.

 +1  (nbme16#34)

Lymphocytic infiltrate and collagen deposition are hallmarks of chronic inflammation. One might also observe plasma cells, macrophages, and angiogenesis. FA 2019 p. 217.

Worth noting is that of the Hepatitis viruses, Hepatitis C is the most likely to cause a chronic infection (C for Chronic).

 +1  (nbme15#48)

In this study, a placebo is not used on the control group. The experimental group gets dextromethorphan while the control group gets "no treatment". This results in procedure bias, as subjects in different groups are not treated the same. Blinding and use of a placebo reduce the influence of participants and researchers on procedures and interpretation of outcomes as neither are aware of group assignments.

See table on bias and study errors in FA 2019 p 260.

 +0  (nbme15#7)

Anyone know why this was Hydronephrosis and not Staghorn Calculus??

hchairston  There are no calculi in the image. The image shows a dilated ureter, you know it's a ureter because there is an opening into the hilum of the kidney. +

 +1  (nbme15#32)

Cocaine use in pregnancy is associated with low birth weight, premature membrane rupture and abruptio placentae. Click here for more.

FA 2019 p. 600 gives a list of drug effects during pregnancy.

cheesetouch  teratogens FA2018 p596 +

 +0  (nbme15#8)

Vitamin B12 (Cobalamin) is absorbed in the terminal ileum along with bile salts. Remember that this inquires Intrinsic Factor from the stomach! Other answer choices are primarily absorbed in other components of the GI tract.

Folic acid = Duodenum, Jejunum ("small bowel" in FA)

Iron = Duodenum

Thiamine = Jejunum

Riboflavin = "upper small intestine" when dietary or large intestine for the riboflavin produced by gut microbiome. See this paper

See FA 2019 p. 368 for the high-yield absorption sites.

 +0  (nbme15#49)

Glucokinase expression is induced by insulin and helps to store glucose in the liver. FA 2019 p. 75

 +2  (nbme17#39)

Fibrosis pulls the airway open, increasing radial traction and decreasing resistance to airflow.

Here is a picture comparing fibrosis (increased traction) to emphysema (decreased traction) to a healthy lung.

 +2  (nbme17#0)

Gluconeogenesis primarily occurs in the liver, but enzymes for gluconeogenesis are also found in kidneys and intestinal epithelium. FA2019 p. 78

 +1  (nbme20#46)

The key bit in this question that makes the answer Cholecalciferol rather than 7-dehydrocholesterol is the nugget that the patient "rigorously avoids exposure to the sun." Conversion of 7-dehydrocholesterol to Cholecalciferol can only occur when the skin is exposed to sunlight. Therefore, decreased production of Cholecalciferol (D3) is the better answer.

This picture always helps me remember Vitamin D metabolism.

 +0  (nbme21#9)

Whole point of administering a SERM after breast cancer is to reduce risk of recurrence. Increased estrogen exposure is associated with increased risk of breast cancer (per FA 2019 p. 636). So you're looking for something that is an estrogen antagonist at the breast, which narrows it down to B and C right off the bat.

Subcomments ...

submitted by bingcentipede(120),

This is a peri-menopausal woman experiencing the typical symptoms of hot flashes and irregular periods. Decreased estrogen/progesterone production leads to vaginal atrophy and negative feedback onto the anterior pituitary, leading to increased FSH and LH hormones.

baja_blast  Menopause on FA2019 p. 622 +  

submitted by aoa05(11),

here are partial clinical manifestations of the right oculomotor nerve palsy:  the right pupil is 6 mm and nonreactive to light, and adduction of the right eye is impaired. The oculomotor nerve exits midbrain through the interpeduncular fossa and goes between the beginning of the posterior cerebral and superior cerebellar arteries. Rapture of an aneurysm in the posterior communicating artery near the beginning of the posterior cerebral artery may compress the oculomotor nerve and affect its function

medstudent  FA 2020 P. 516 +  
baja_blast  FA 2019 p. 529. +  

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oYu oshudl eb itnigkhn fo geohmitsn ekli coseEtc.ncrou Tyeh ahd a UG rruoceepd dna uequnsbets arcicda iuses.s

Wenh I aehr tfso ,1S i kihtn tath eht tntaipe tsum eavh ahd a usise iwht eth lgnicos of rtieeh het iamlrt or ictpuidrs sv.vlea ayPnlgi d,dso isht houlds be teh lraimt vveal. uYo asol ereh na larye idcosilta mrrum,u so you hgmti be tknighin lveomu ldevorao .(3S)

baja_blast  You're almost certainly right that it's mitral valve endocarditis. The murmur is accentuated by Expiration, consistent with lEft-sided murmurs. On the other hand, rIght-sided murmurs are accentuated by Inspiration. Note the capital letters for a handy trick. God Bless Dr. Jason Ryan. +  

submitted by cassdawg(580),

Hairy cell leukemia is notable for staining tartrate-resistant acid phosphatase positive (TRAP positive) and for having hairy cytoplasmic projections [FA2020 p432].

If you did not know this, you could eliminate other answers based on the stem:

  • Lymphomas would have swollen lymph nodes
  • It mentions the lymphocytes as the issue and he has lymphocytosis, so you can eliminate the myelogenous leukemias and focus on the ones from the lymphocytic cell lines
  • Acute lymphoblastic leukemia most commonly occurs in children and is associated with immature B/T-cells that are TdT+, so you can eliminate this
  • Chronic myelogenous leukemia is slowly progressing and associated with smudge cells, so it also does not match the descriptors.
baja_blast  For the last bullet, I believe OP meant CLL instead of CML. +  

submitted by bingcentipede(120),

FA 2019, P. 304:

2-7 days following an MI, there can be a papillary muscle rupture, leading to mitral regurgitation. Thus the murmur in the answer, specifically the description of holosystolic and cardiac apex

baja_blast  A) describes Aortic Regurgitation. B) describes Mitral stenosis. C) describes Aortic stenosis. D) describes a PDA. +1  

submitted by cassdawg(580),

This is mesenteric artery stenosis causing postpranidal intestinal ischemia/angina. I definitely did not know this answering the question and I personally got to the answer by attempting to logically think through the symptoms:

  • Weight loss and abdominal pain in general pointed to intestinal ischemia of some sort and since most absorption of nutrients happens in the jejunum, ischemia there would cause weight loss. Jejunum is supplied by SMA
  • Bruit to me meant a larger vessel was blocked since to be able to hear it it has to be a pretty large vessel, SMA is one of the larger arteries listed
  • No liver symptoms (i.e. jaundice) so eliminated hepatic artery

If anyone has a better explanation please offer it.

deathcap4qt  great explanation for not knowing the answer! You're right in that it has to do with a vessel of a larger size. Generally Celia, SMA or IMA. pt hx of atherosclerosis should be a big hint. FA 2019 pg 380. +2  
nbmeanswersownersucks  SMA is the MOST COMMON vessel involved in ischemic bowel disease. +1  
baja_blast  I reasoned this out by remembering that the Abdominal Aorta was the most common place for atherosclerosis and picking the only option that branches off immediately from there. Not sure if that's what they were going for but it got me to the right answer. +  

submitted by andro(116),

Fatty Acid degradation
-Occurs in mitochondria or peroxisomes

First step - uptake of the fatty acids by the cell and addition of CoA to them

Second step - Uptake of the Fatty Acyl CoA molecule into the mitochondria by the Carnitine Shuttle *( which involves removal and then addition of the CoA molecule again to the fatty acid once inside the mitochondria)

Once in the mitochondria the fatty acid may undergo , Beta-oxidation ( a process in which a fatty acid is oxidized/cleaved at the Beta carbon to generate Acetyl CoA in several cycles )

An Acyl CoA dehydrogenase catalyzes the initial step .
Look out for Hypoketotic Hypoglycemia in defects of fatty acid degradation

The 2 main subtypes to be aware of are -a problem with the carnitine shuttle ( systemic carnitine deficiency) - or with an Acyl CoA dehydrogenase ( eg MCAD deficiency )

notyasupreme  It's actually funny because the question stem makes it seem like it's an MCAD deficiency (presence of dicarboxylic acid) and all the symptoms, but then treat it with MCAD. Whatever, I got it right but it just felt like a weird question to me. +  
nbmeanswersownersucks  yeah I was confused too but I also think the negative serum carnitine is supposed to help r/o MCAD deficiency since that usually has elevated serum carnitine. +  
baja_blast  If Carnitine was an option here, how could we differentiate this from primary carnitine deficiency? Would it have been possible? +  

submitted by ergogenic22(243),
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looC dna aelp mtexitreeis lesru tuo erbitivdiust saeucs e,geoicrn(nu aixnph,lyaas )ecptsi.

coloipvymeH oduwl isdceber a scpoesr of vloume loss lgdbnie(e or han)yioedtdr and doulw ont plnexai hte klsaecrc ro lujuagr envi

tno'd be rnhwto ffo by eht normal haret dsuson.

baja_blast  Raise your hand if you were also thrown off by the normal heart sounds. +4  

submitted by cheesetouch(23),

A decrease in cell number means APOPTOSIS has occurred, thus the surviving tumor cells have a mutation which inhibits apoptosis

baja_blast  TGF-Beta helps regulate cellular differentiation, proliferation, and apoptosis +  

submitted by moms(1),

In this case, the question is asking about Km and we know that Km is equal to the half of Vmax. So,

Vmax=2 (because is the higher number)

1/2 Vmax= 1

So the concentration is between 0.2 to 0.5.

baja_blast  FA 2019 p. 232 for a review +  

submitted by cassdawg(580),

Total gastrectomy = absence of parietal cells

Parietal cells are necessary to secrete intrinsic factor which binds vitamin B12 to allow absorption.

Also his symptoms (which fit the description of subacute combined degeneration) are characteristic of B12 deficiency.

FA2020 p69 (insert sunglasses emoji here)

bingcentipede  The gastrectomy was also 10 years ago; it takes 3-4 years to deplete your hepatic B12 stores. +1  
baja_blast  Nice +  

What you can see is

1.Hyperkeratosis (thickened stratum corneum) 2.Parakeratosis (you can see the nuclei very clearly in the stratum corneum) 3.Dysplasia (notice keratinocytes hyperchromatic and large nuclei go up almost all the way to the top. This isnt so in normal skin)

all this fits actinic keratosis

cassdawg  Actinic keratosis is FA2020 p482 if anyone needs it! +4  
baja_blast  FA2019 p. 472 +1  

submitted by cassdawg(580),

T10 is the dermatome level for the umbilicus, hence the periumbilical discomfort (Landmark dermatomes FA2020 p510)

In appendicitis, the first pain is generalized referred pain and comes from stimulation of visceral afferents (which is why it is poorly localized). Pain eventually localizes as irritation to the parietal peritoneum occurs (FA2020 p383)

waitingonprometric  T10 for bellybutTEN dermatome. +3  
baja_blast  FA 2019 p. 498 for dermatomes and p. 377 for appendicitis +  

Metabolic acidosis because the arterial pH goes in the same direction as the bicarb and pCO2 (i.e. both pH and bicarb/pCO2 are decreased from normal); in primary respiratory acidosis/alkalosis the arterial pH goes in the opposite direction as the bicarb and pCO2.

Once you know that it is a primary metabolic acidosis, you have to check for concomitant respiratory disorders. Do this with Winter's formula:

expected pCO2 = 1.5(HCO3) + 8 +/- 2

so... expected pCO2 = 1.5(11) + 8 +/- 2 --> pCO2 = 24.5 +/- 2 = expected pCO2 is between 22.5-26.5, therefore, 23 is in the expected range, no concomitant respiratory process

baja_blast  Was looking for "Metabolic acidosis and respiratory acidosis" and was wondering why it wasn't a choice. Totally forgot about Winter's formula. Thanks!! +2  

submitted by tinyhorse(3),

Frankly pretty floored that anybody thought that this question contained enough information for someone to confidently answer it.

The question has you assume that both parents are heterozygotes at the locus. Why? I assume I'm missing some esoteric fact about P450 allele frequencies.

flapjacks  I got lucky guessing the same % chance that siblings share HLA markers +2  
baja_blast  I agree with OP seriously no idea how anyone could have gotten this right without totally guessing it. Am I missing something here?? +  

submitted by cassdawg(580),

His low urine specific gravity combined with excessive thirst and urination indicates diabetes insipidus, which can be central (defect in the posterior pituitary production of ADH) or nephrogenic (kidney nonresponsive to ADH). (FA2020 p338)

Seeing as it asks us to ID the endocrine organ (and he does not have history indicative of nephrogenic, the less common variety), this indicates central diabetes insipidus and defect in posterior pituitary ADH production.

baja_blast  Posterior Pituitary produces ADH and Oxytocin. Anterior pituitary produces ACTH, TSH, FSH, LH, GH, and Prolactin +1  

submitted by haliburton(192),
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itranidine slckob 2H rteepco,r icwhh is G.s Gs saitcaetv nlelyyda ycslace &t-;g McPA+.

q: VHeA 1 Mam;&pM g&t=; H1, hal,1pa ,1V ,1M :M i3 ADM 2 t;=&g ,M2 lhpa2a, :2 Ds eirte(hngvy eel)s t=;&g 1b,ate b2ea,t V2, 1D H2

I kthin isth si ormf .FA

baja_blast  Yes; FA2019 p. 238 +  
medstudent  FA 2020 238 too. +  

submitted by drmohandes(73),

Countertransference (FA2019 pg. 542) = doctor projects feelings about formative or other important persons onto patient (e.g. Epstein didn't kill himself).

baja_blast  They really had mercy here by not also including Transference as an option.... phew. +  

submitted by welpdedelp(198),
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tI swa jtsu kngias the nfapiesl of RCBs 02(1 yda)s

haliburton  If I'm reading this right, this is just a tricky dicky question. I think CO binds 200x stronger than O2. But if an O2 cycles through binding / unbinding 200 times before a CO gets kicked off, this should still clear the CO from that cell sooner or later. strange to think it is 1. essentially permanently trapped in a cell, and 2. doesn't kill you and can be treated with O2 to resolution within a few hours or a day. They must just be thinking, until that last RBC dies, you've got original CO in a circulating cell. but just a fraction (because you didn't die). not sure how that CO isn't just passed on during recycling, based on this line of thinking. +7  
link981  The question while stupidly written, asks how long the RBC's that carry the CO take to be removed from the circulation, not how long the CO takes to be removed from the RBC. Just asking the lifespan of RBCs in an stupidly complicated way. As we know, RBC's life span is about 120 days and then they are removed from our circulation. 120 days is about 4 months. Next time they will probably ask weeks or in hours, who knows? smh +5  
baja_blast  If that's what they're looking for why cant the NBME people just ask "How long does it take for RBCs to turn over?" Ridiculous. +  

FA 2019 p156 Does anyone know how to differentiate the picture labeled Trypanosoma brucei and cruzi?

footballa  This question is likely not important for two reason: They're both Trypansomastigotes, so of course they look almost the same. You can differentiate these two species clinically as they have very little clinical similarity in patient presentation. For these reasons there's little to no reason you would be expected to differentiate these two species by histology alone +2  
snripper  Does Chagas have recurrent fever? Because that's what pointed me to African Sleeping Sickness. +  
baja_blast  The history of travel to the Amazon is what pointed me to Cruzi over Brucei but agree it's a tough distinction to make here. In the absence of that detail I would have probably picked Tsetse fly. +1  

submitted by armymed88(48),
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lucGseo is -nsrotpoeatrdc nito oyetnsetrce fo SI iav odimus

toxoplasmabartonella  That makes that glucose needs to be given with sodium. But, what about bicarb? Isn't the patient losing lots of bicarb from diarrhea? +3  
pg32  Had the same debate. I knew glucose/sodium was the textbook answer for rehydration but also was wondering if we just ignore the bicarb loss in diarrhea...? +2  
makinallkindzofgainz  @pg32 - Sure, they are losing bicarb in the diarrhea, and yes this can effect pH, but it doesn't matter that much. You're not going to replace the bicarb for simple diarrhea in a stable, but hydrated previously healthy 12 year old. You're gonna give him some oral rehydration with a glucose/sodium-containing beverage. Don't overthink the question :) +1  
makinallkindzofgainz  *dehydrated +  
teepot123  salt and sugar, that's all the kid needs when ill simple +1  
mtkilimanjaro  Hm I put bicarb/K+ since thats lost in diarrhea, but I think the key thing in this Q is that its only 6 hours of acute diarrhea and nothing else. You would prob give bicarb and K+ in more "chronic" diarrhea over a few days or longer not just a few hours +1  

submitted by seagull(1112),
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otu fo uito,scyir hwo yam oleepp nkew ?ihts dton( eb syh ot ysa you did or ntdi)d?

yM rypveto onecdiuat tid'dn griinan hits in m.e

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +11  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +15  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
wolvarien  I did not +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +6  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +15  
drschmoctor  Is it biochemistry? Then I do not know it. +3  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +  

submitted by oznefu(16),
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I teg atht teh ewsnar is ertcroc rfo a vleresebri ujirny rweeh erhet is lcel ngiellsw aecbseu of teh arnsecdei acltrrlnualei Na+ dan +aC2 due to mideiarp a/KN dna ilrccapsomas cmutlruei vaiticty ...

utB fi rehet aer esdaircne adcarci yzeensm in eth olobd gicdniatin llce dahte nda mrnmeabe am,gdea ’wdntluo hte ialrluaetlrnc srclolyeetet eb olw sinec teyh aer ledarese ntio eht ob?ldo

lord_voss  troponin = irreversible injury and membrane damage -> high extracellular concentration of Na+ and Ca++ causes both to move into cell through damaged membrane and high intracellular K+ leaves the cell +11  
rogeliogs  Question is asking about the changes in the myocardiocytes and my second interpretation was that they are asking the changes before they "rupture" and liberate their content in the blood producing increase enzymes in the patient. Therefore because is a ischemic process = reduction of O2 = low ATP = impairment of Na/K ATPase = increase Na-decrease K intracellular = block Ca/Na exchanger = increase Ca intracellular. the same effect as digoxin +3  
allodynia  What will happen to Na and ca conccentration when there is an irreversible injury? +  
baja_blast  @allodynia Pathoma pg. 4 has a really good summary of this. In short, Na+ and Ca2+ both increase intracellularly in an irreversible injury. +  

submitted by usmleuser007(326),
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)1 EVB = tutBkri ol,mpmahy oHgnkid lo,mpahmy nryslhpeagoaan roniaamc,c 1° SCN ymlpoahm (ni snmeupodoirmmmcio t)naptesi

2) BHV pm&a; CVH = cleptalualreoH occniaarm

H3)-VH8 = oiaKsp comrsaa

)4 V=HP rlCveiac dan aenaenli/lp ccarnioam py(ste 61, 81,) deah and nkce reaccn

5) .H ylrpoi = trsGiac ocoinaemadnrca adn LMAT omphalym

6) L1H-TV = ldAtu llcT-e uelmhlpkmmeoia/ay

7) ierLv ufelk rohoicn(Cls sisne)nsi = aomhagnCioanlccroi

8) cssamoihSto mauomiethba = eladrdB acncer oauuqmss( cle)l

some0217710  Aren’t both H.pylori and EBV associated with gastric lymphoma? +3  
baja_blast  You're right that EBV is associated with gastric lymphomas, but this is specifically asking about marginal zone lymphoma (or MALToma) which is associated with H. Pylori, not EBV. +1  

submitted by joha961(41),
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eiMennactna esdo = s(Cs * LC * t) / F

... eherw t si lespeda item eewebnt oesds t(no eavelrnt eher secni ’sit uionnsctuo in)uifnso and F si tilaaiiavbyoilb whhc(i si 010% or 01. here csueeab ’tis vnieg .IV)

C​soarntt thiw ilgdano :oeds

Cs(s * V)d / F

... erhew Vd is olumev fo ts.odrtubniii

yotsubato  So do we just have to memorize this... +8  
gh889  yep +10  
drschmoctor  @yotsubato Not necessarily. I can't remember a formula to save my life. The Css is the amount you want in the blood. The clearance is the fraction removed per unit time. Since we want to maintain a steady state, we only need to replace what is removed. Thus, maintenance dose = amount present * fraction removed. +7  
mambaforstep good & short explanation +1  
castlblack  I remember CLoCk Time as in check the clock time to give the next dose Cl = clearance, C = concentration and T = half life. I have never had to use F. +13  
baja_blast  This is on p. 233 in FA 2019. +  

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hhgotAul heert are no ecfsipci ersehp dntri,ascio a FSC lneap iwht tsomly euyktocsel tciasnide a vrlai ftnicieon a(s lwel as hte ralonm go)lc.esu So you can uler tou ,TB iasscosnodeourri and ralebt.cai rki/ugniBiekrdzsn snig era aereltd to mgisnt,iein ubt eenv if oyu tond' nkow awht etohs r,ea teh ieuqostn yssa htat etreh is na oayintralbm ni eht RLMEPTOA bleo isntgimnei( = nnis)gme.e hltEniiapcse wolud eb eth esbt ea,snrw plicsaeyle bsuceae sHeerp scipEealinth cfefsat hte amltepor leb.o

taediggity  Also look for Kluver-Bucy like symptoms in the stem +1  
mambaforstep  why? +  
b1ackcoffee  I agree with everything but normal glucose. Glucose here is NOT normal. to quote wiki "The glucose level in CSF is proportional to the blood glucose level and corresponds to 60-70% of the concentration in blood. Therefore, normal CSF glucose levels lie between 2.5 and 4.4 mmol/L (45–80 mg/dL)." +  
baja_blast  NBME reference table gives normal CSF glucose to be 40-70 mg/dL. As far as I'm concerned, for the purposes of the exam the reference table is probably a better source than wiki. +3  

submitted by bhangradoc(19),
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Teh elvu-Pa is ablycaisl etyp 1 ,rorer dna ehty ekep het u-aeplv the mase t(a )&;.50lt ni othb isnorvse of teh stenxmr.eepi By rsaiignnce mruben of atepnits in het urpg,o ethy esieranc powre of eht du,tys hhcwi sdrueec etyp II .rreor

jfny21  Thank you +1  
baja_blast  For more, FA 2019 p. 262 goes over Type I and II errors. +  

submitted by neonem(503),
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cAoolhl alwiatwdrh slead to a veylythkh-tstayieiati-ipercpcm rdneymso tiwh orsr,mte N,HT iianmos,n IG eut,sp esosihrpaid, nad midl tintaigoa 336- sohur rtaef hte tlas .rdikn hTeer si a imil,asr tub sllyuua tslghlyi e,atrl poaelrv of arhwidaltw ssieeuzr -468 surho freta het tals .rnkdi

baja_blast  p. 558 in FA 2019. +  
cp87  p 547 FA 2019. Hallucinations are usually tactile. +  

submitted by sympathetikey(980),
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tDiecr gtlonnAibliu = rDicet obomCs setT

eecDtts teaodnbisi nubod ilcedrty to BsRC. iylmHssoe omst leliky ude to etsnghmoi ni het fdetrsasun lobod no(t reus hwy it okto 4 sekew ehwn eTyp 2 SH si ospedpus ot be rkqiecu btu )/we.

ergogenic22  there is a delayed onset hemolytic transfusion reaction which should be evaluated with direct cooms test. +5  
hungrybox  such a dumb question wtf +21  
sonichedgehog  takess longer due to slow destruction by RES +  
baja_blast  Dang, I didn't know that was the same thing as a direct Coombs test. I guess it makes sense in hindsight. Thanks! +  
sars  Theres a UWORLD question with a table displaying the different types of hemolytic reactions. Don't know the question ID. Agree with delayed hemolytic transfusion reaction due to formation of antibodies against donor non ABO antigens. Typically presents as an asymptomatic patient or mild symptoms (jaundice, anemia). Different from an acute hemolytic transfusion reaction, which is against ABO antigens. +1  
tomatoesandmoraxella  The Uworld table is in question 17780 +  

submitted by lilyo(53),

Take a look at FA pg.623 for tanner stages of sexual development.

baja_blast  (This is the right page for FA 2019) +1  

submitted by hayayah(990),
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'anisocnF si a glereeazind npeborriatos eetfdc in CPT suncaig aedicnres oexrentic of inaom s,diac ouesgc,l OH,–3C dna –O3P4, nad all esunacstsb draebsbroe yb the P.CT

baja_blast  FA2019 p. 581. Fanconi syndrome causes a type 2 (proximal) renal tubular acidosis +1  

submitted by ankirin(3),

What is esophageal spasm and how would it present differently?

baja_blast  I had narrowed it down to that and the correct answer. I think the difference is that esophageal spasm tends to present with pain and dysphagia. FA 2019 p. 371, right at the top of the page. +  
orthonerd  Relating the phrase "diffuse painful contraction" to esophageal spasm has helped me remember the associated descriptions they go to. +  

submitted by hayayah(990),
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In erosa,nylpc erhte si a dcietr nntriioats frmo aukseswlnef ot ERM .sleep sBaiallcy tsdaine of nggio rthoguh hte ryael stsgea nad gayurllad gailnfl noit a peed sl,epe ouy sjtu yeldunds og rfom eibng kaewa ot igneb ni a pdee elsep.

kamilia20  FA2020 P497(Sleep physiology): Changes in narcolepsy: decrease REM latency. +1  
baja_blast  p. 485 for us plebs still using FA 2019 +  

submitted by divya(49),

Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same?

the_enigma28  Mechanism of opioid-induced rhinorrhoea, lacrimation, stomach cramps and diarrhoea is actually muscarinic receptor effects, rather than alpha adrenergic blockade caused by cocaine, causing nasal vasoconstriction. +1  
baja_blast  Symptoms of Opioid Withdrawal can be remembered with the phrase "anxious, hot, and moist" per SketchyPharm Opiods. Rhinorrhea is one way people can be "moist" during opioid withdrawal, but they can also sweat excessively and lacrimate too. +1  

submitted by tinydoc(190),
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rapitNceuoh ianP tefra keotrs si lcaetnr otPs tsroke pian emnyoSdr

ecasud yb rnrtcoalatlae tamiaclh ioslnes

g.P 450 91AF

chandlerbas  agreed! more specifically damage to the VPL +5  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +2  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +  

submitted by est88(16),
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vuatyPer eanKsi tfedec aleds ot aereeddcs PAT dinglae to drgii RsCB dan atxre sarcuavl o.lsydsyrih aIsnercde esvlle fo -23G,PB ceesedrsa bglomnieoh yfitnaif fro .O2

baja_blast  FA 2019 pg 414 +1  

submitted by temmy(115),
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espael lpeh nigcdaroc to itwsern iuetqano eht ntpeiat ahs a normal inaon apg

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +  

submitted by benzjonez(34),
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FA 2081 .p 6.90 Stupesc lhurrate uiynrj fi odblo is ense at het luertahr sa.muet ahniemcMs of poeotrris arruleth iunryj = eilcpv tf,rercau hwich ew ees ni hsit .enttapi reaUlrth ittaaoecnethzri is lelatieyrv iat.tdocraincned

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? +  

submitted by hyoscyamine(55),
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FA .3.g27p qumasSou lelc mracncoai occurs ni eth upepr 2/3 of hpgsuaeos ewhesar oaidmnoanreacc uccsor ni eth sdiatl /1.3 iecnS sith asw in eth dim osha,pguse ist aumusosq clel ocaca.mnri Key furatee of uaoqmsus lelc iomcancar is tnierak .rplesa

turtlepenlight  can remember it as wearing a pearl necklace (upper 2/3 of throat-ish) +4  
baja_blast  Patient is also a heavy smoker and drinker. In the absence of GERD this should raise suspicion for SCC of esophagus over Adenocarcinoma. +1  
lovebug  Is there anyone who can explain about C)Intra-cytoplasmic pigment? what is this?;; +  

submitted by thotcandy(48),

What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +  
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +5  
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1  

submitted by krewfoo99(75),

Epinephrine acts mostly on Beta receptors. Beta receptors are G coupled.

baja_blast  Alpha receptors are also G-coupled and are another potential site of action for Epinephrine (at high doses according to SketchyPharm Sympathomimetics) +