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 +0  (nbme24#43)

Can anyone explain what they're getting at here? How can bethanechol be indicated and contraindicated?

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.

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg
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 (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version

 +1  (nbme24#4)

Inability to elevate the palate suggests damage of the vagus nerve.

F. (CN X)

atstillisafraud  I guess F is the vagus nerve. Thanks to NBME I am also training to become a mind reader.
seagull  Thanks to the NBME I have crippling depression

 +4  (nbme23#35)

The best I can understand, they're describing endometrial hyperplasia, a result of excess estrogen, a steroid hormone that translocates to the nucleus and binds its transcription factor.

mousie  My exact thinking also!
sympathetikey  Ditto.
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?

 +1  (nbme21#42)

[moved to subcomment]


 +5  (nbme21#4)

I might be the only person on earth who got this one wrong, but regardless:

"ITT analysis includes every subject who is randomized according to randomized treatment assignment. It ignores noncompliance, protocol deviations, withdrawal, and anything that happens after randomization."[1]

yo  You're not. I also goofed.
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject.
hungrybox  I got it right but I was only like 50% sure. So I appreciate it.

 +2  (nbme21#36)

This review suggests that enchondroma and chondrosarcoma are unable to be differentiated on histology alone. According to Orthobullets:

"unlike enchondroma, most chondrosarcomas have non-mechanical pain (rest pain and nocturnal pain)"

Guess this diagnosis is made on history.


 +2  (nbme21#34)

"Excitatory amino acids" refers to glutamate, while "Biogenic" apparently refers to tyrosine, the precursor AA to dopamine and norepi.


 +5  (nbme21#6)

This has been a tough concept for me to get, but I think I'm finally there:

The stem is describing primary adrenal insufficiency, or Addison's.

  • ACTH is being over-produced to stimulate the adrenals to produce cortisol, but they can't respond, either due to atrophy or destruction (TB, autoimmune: DR4, etc.)
  • The first 13 amino acids of ACTH can be cleaved to form α-MSH, which stimulates melanocytes, causing hyperpigmentation
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient.
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.
hungrybox  thank u for this answer

 +0  (nbme20#2)

[moved to subcomment]


 +2  (nbme20#2)

How to differentiate between Norovirus and Rotavirus here? Must be related to the the contagious nature of the illness?

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months.
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks!
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours.
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
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

 +3  (nbme20#35)

Liver looks pretty normal-sized to me. Pic here for comparison


 +4  (nbme20#36)

Apart from the line in FA referencing PMN infiltrate in Shigella, there is no way to differentiate here between it and E. Coli. Cheap shot.


 +0  (nbme20#21)

I also was thinking M. avium here, but hypersensitivity pneumonitis seems to fit with the reticulogranular changes.


 +3  (nbme20#44)

Thought this would be something regarding "bariatric surgery," but nope, just "no starchy foods, because you're pre-diabetic."

hello  Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods.
yotsubato  such a BS question IMO
yotsubato  such a BS question IMO
breis  I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption..




Subcomments ...

submitted by beeip(34),

How to differentiate between Norovirus and Rotavirus here? Must be related to the the contagious nature of the illness?

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +  
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 +  
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 +  


submitted by halux(2),

can some one please explain why is the hyperplasia?

beeip  Loss of negative feedback from resected ovaries leads to gonadotroph hyperplasia. +1  
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! +1  
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. +