Welcome to beeipโs page.
Contributor score: 141
Comments ...
lindasmith462
I mean I get that Calcium is the right answer (it acts the fastest in 1-3 min) but its supper annoying because you'd be giving insulin and glucose AT THE SAME TIME too - they just take longer to work once you put them in....
+1
boeboeboe
Patient likely has primary TB presenting with fever, chest pain. Lower lung fields are affected, but usually nothing seen on CXR. Secondary TB affects upper lobes, and is when cavitary lesions will be seen on CXR
+1
kingfriday
There's a uworld question that mirrors this presentation, it got me then- the adenopathy is huge
+2
sniperx3
I think it's because Bethanechol acts on M3 receptors which can treat her urinary problems but it might exacerbate her asthma symptoms since there are M3 receptors on the lungs.
+42
suckitnbme
I definitely had to read this question multiple times to understand it.
+2
motherhen
I definitely had to read this question multiple times to still not understand it
+2
lsmarshall
Rectal prolapse through posterior vagina ("rectocele").
https://www.drugs.com/cg/images/en2362586.jpg
+8
famylife
"When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (โsplintingโ). Rectoceles are more common in women who have delivered children vaginally."
https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version
+19
nnp
why not spasm of external anal sphincter?
+
vulcania
After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam...
+1
ajss
I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam.
+
mnunez187
I didn't choose spasm because the stem says there the rectal tone is normal
+1
atstillisafraud
I guess F is the vagus nerve. Thanks to NBME I am also training to become a mind reader.
+38
seagull
Thanks to the NBME I have crippling depression
+43
mousie
My exact thinking also!
+7
meningitis
My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things?
+
criovoly
You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS
+6
eve1000
Could this be due to the PTEN gene being linked to endometrial hyperplasia?
+
feochromocytoma
The question stem says it's glandular hyperplasia "without" atypia
It's just due to increased levels of estrogen causing the hyperplasia
+4
faus305
This is a bunch of scientific mumbo jumbo
+1
chaosawaits
^^ I read your name as "ugly chromocytoma" and if that was intentional, buena onda
+1
yo
You're not. I also goofed.
+23
seagull
https://www.youtube.com/watch?v=Kps3VzbykFQ
This video is a pretty decent explination worth your time on the subject.
+2
hungrybox
I got it right but I was only like 50% sure. So I appreciate it.
+
teepot123
^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form
+
sahusema
Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft
+11
jotajota94
Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient.
+7
tinydoc
Decreased Na and increase K+ --- Hypoaldosteronisim
Hypoglycemia, and hypotension --- Hypocortisolism
so the adrenals arent working ---- adrenal Insufficiency
the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation.
+12
bilzcop
Ugh! I misread the question and chose ACTH :(
+3
cienfuegos
@bilzcop: let's never do it again, k?
+2
lovebug
@ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me.
+1
strugglebus
You know itโs Noro because people are vaccinated against Rota at 2,4,6 months.
+8
beeip
@strugglebus: I didn't know about the vaccine schedule. Thanks!
+1
strugglebus
As an addendum, you know itโs not staph aureus b/c that is rapid onset within 4 hours.
+5
asapdoc
@Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong
+5
savdaddy
its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus.
+
savdaddy
***after the initial outbreak
+1
eacv
for me this was a discart qx:
1.Giardia lamblia not showed steatorrhea and it needs medication to go away.
2. Rotavirus normally in unvaccinated kids.
3. Shiguella VERY inflammatory stool test do not show anything
4.S areus is very FAST 2-6 hr after eat the contaminated food.
+4
link981
Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination.
+ Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause.
+2
merpaperple
As best I can understand, what they are trying to get at is that "EMB stain showing neutrophils" -> "EMB stain NOT showing organisms" -> more likely Shigella than E Coli. If a special culture for an organism (e.g. EMB for E. Coli) shows no organisms but only inflammatory cells, i.e. neutrophils, that means that organism is not present. If that's the point here it's kind of a trick question, as we all would have gotten it right if they had just said "EMB showed no organisms." I guess the takeaway is that the point of a special culture is binary - you are looking for a specific organism, and it is either there or it isn't.
+1
hello
Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods.
+
breis
I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption..
+6
teetime
This isn't right because the bariatric surgery will cure the prediabetes. It's dumping.
+2
dr_jan_itor
Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled.
+2
dhkahat
yeah but he's prediabetic. you want someone like that to shove a bunch of starch down all the time?
+
Subcomments ...
strugglebus
You know itโs Noro because people are vaccinated against Rota at 2,4,6 months.
+8
beeip
@strugglebus: I didn't know about the vaccine schedule. Thanks!
+1
strugglebus
As an addendum, you know itโs not staph aureus b/c that is rapid onset within 4 hours.
+5
asapdoc
@Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong
+5
savdaddy
its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus.
+
savdaddy
***after the initial outbreak
+1
eacv
for me this was a discart qx:
1.Giardia lamblia not showed steatorrhea and it needs medication to go away.
2. Rotavirus normally in unvaccinated kids.
3. Shiguella VERY inflammatory stool test do not show anything
4.S areus is very FAST 2-6 hr after eat the contaminated food.
+4
link981
Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination.
+ Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause.
+2
beeip
Loss of negative feedback from resected ovaries leads to gonadotroph hyperplasia.
+2
halux
so, the explanation is that in the absence of Estrogen negative feedback inhibition to LH and FSH, this leads to Gonadotrophs Hyperplasia at the Pituitary resulting in elevated LH and FSH secretion levels?
I get busted by this one :/
Thanks in advance!
+14
nala_ula
@halux exactly, there's no negative feedback telling them there is an increase in the hormones (since there are no ovaries) so gonadotrophs work in overdrive to keep stimulating the gonads via FSH and LH.
+1
A precipitous drop in Hgb effectively rules out malrotation. Overaggressive anticoagulation is associated with intramural hematoma.