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Comments ...

 -1  (nbme22#15)

lex ring and little fingers at DIPJs-ulnar nerve flex index and middle fingers at DIPJs-median nerve


 +0  (nbme22#14)

Glucose is co-transported into enterocytes of SI via sodium





Subcomments ...

submitted by tissue creep(112),
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drhoAtrpo for ,seur utb orf eht odcrer Im' ertpyt sreu hist asw akyCingunuh srVi.u Oyln otg shit orfm a rlWdoU soniqute as I d'hatn snee it iltnu hn,te tub plypnetara hte rtairaalgh si lelyra d,ab iwhhc is ahtw ewrd me to teh n.wsear

a/owkumh/gdt:hniecv/p/swi.cl.ynwhutxgdcn.t

meningitis  More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico). Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities. +12  
nala_ula  I'm shocked that I found a fellow puerto rican on this site! Good luck on your test! +2  
namira  dont be shocked! me too! exito! +2  
niboonsh  Dengue is also known as "bone break fever" which makes me think its more likely to be dengue due to the "excruciating pains in joints and muscles". https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242787/ +21  
dr_jan_itor  I was thinking that its Murine typhus transmitted by fleas +  
monique  I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection. +2  
jakeperalta  Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience. +  
almondbreeze  UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika +  
lovebug  FA2019, page 167 RNA virusesy. +  
lovebug  Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on the face, trunk and limbs. It is typically asymptomatic but may be pruritic (Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. ) +1  
beto  it is chikungunya->fever, polyarthralgia, diffuse macular rash, dengue has retro-orbital pain mostly +1  


submitted by bingcentipede(243),

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  
beto  Can be VSD rupture too +1  
sexymexican888  ALSO remember that this is probably due to posteromedial papillary muscle because it only has 1 blood supply (PDA from RCA if right dominant, from LCX if left dominant) while the anterolateral papillary muscle has dual blood supply. This of course is in the left ventricle -> papillary muscle rupture -> mitral regurgitation +1  
sexymexican888  ALSO remember that this is probably due to posteromedial papillary muscle because it only has 1 blood supply (PDA from RCA if right dominant, from LCX if left dominant) while the anterolateral papillary muscle has dual blood supply. This of course is in the left ventricle -> papillary muscle rupture -> mitral regurgitation +  
sexymexican888  ALSO remember that this is probably due to posteromedial papillary muscle because it only has 1 blood supply (PDA from RCA if right dominant, from LCX if left dominant) while the anterolateral papillary muscle has dual blood supply. This of course is in the left ventricle -> papillary muscle rupture -> mitral regurgitation +  
sexymexican888  ALSO remember that this is probably due to posteromedial papillary muscle because it only has 1 blood supply (PDA from RCA if right dominant, from LCX if left dominant) while the anterolateral papillary muscle has dual blood supply. This of course is in the left ventricle -> papillary muscle rupture -> mitral regurgitation +  


submitted by cheesetouch(131),

Ampicillin (and amoxicillin and aminopenicillins) are penicillinase-sensitive penicilins. Resistance occurs when bacteria produce penicillinase (a type of beta lactamase) which cleaves the B-lactam ring. Resistance to cephalosporins occurs when bacteria produce cephalosporins (a type of beta lactamase) OR through structural changes in penicillin-binding proteins (transpeptidases). FA2018 188-189

beto  produce cephalosporinases* +1  


submitted by hungrybox(1026),

A: Gonadal mosaicism | Present in child, not parent β†’ would not have family history of disease

B: Incomplete penetrance | Correct! Half of children affectd, skips a generation β†’ AD inheritance likely.

C: Nonpaternity β†’ Prader-Willi

D: Somatic mosaicism | Present in parent, not child β†’ would not have family history of disease

E: Variable expressivity | Affected patients have varying disease severity β†’ Rule out b/c mother is unaffected

cassdawg  Also, nonpaternity can be a way of saying that the assumed biological father is not actually the father (can be a case of artificial insemination or cheating, etc.). +2  
beto  In genetics, a non-paternity event is when someone who is presumed to be an individual's father is not in fact the biological father. +  


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I tpu cottanoinspi sebecua I hughtot the ioitdmenca beign edcirbdes ithgm eb B:CC can onseoem paxieln ywh enarstit vreo BCC?

seracen  Wouldn't nitrates be a faster acting drug here? That was my take-away anyway. One is more acute, the other for long term maintenance. +4  
suckitnbme  I also believe it's because CCBs have minimal effect on venous beds and would not cause a significant decrease on preload. +2  
beto  decrease of cardiac preload is another word of Venodilation, so Nitrates primarly venodilators. CCB dilate arteria more than veins +  
zevvyt  also, verapamil is the one that causes constipation. But Verampamil is non-dyhydropiridine, so it works more on the heart than the vessels +2  


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nCa yenona ipnaxle why borFsui srsca twih msaapl lcsel si ton hte ecorctr awe?nsr

osler_weber_rendu  Exactly. Three months can fall under chronic rejection as well. FA pg 119 states "interstitial fibrosis". Chronic rejection is predominantly Bcell mediated (plasma cells). +  
beto  chornic rejection > 6 month acute < 6 month +2  
beto  also there are no B cells in the site of fibrosis. humoral response due to antibody themself,not by direct B cells response +2  


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aCn aoenyn nxaiepl wyh Firsbou csasr ihtw apmlsa lelcs si nto eht rtorcec ?ernwas

osler_weber_rendu  Exactly. Three months can fall under chronic rejection as well. FA pg 119 states "interstitial fibrosis". Chronic rejection is predominantly Bcell mediated (plasma cells). +  
beto  chornic rejection > 6 month acute < 6 month +2  
beto  also there are no B cells in the site of fibrosis. humoral response due to antibody themself,not by direct B cells response +2  


submitted by drmohandes(93),
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  • CI,D eyknu:lil TTP/PT man;rol ud'tlwon just see umg iglebdne
  • hlpeypemrni:ss wuldo aseuc anaeim
  • orin nefciyc:ide enmiaa
  • iatnimv C iecf:neyicd dtuolnw' uscea peticnabrtmhooyo
  • von bllrWednia sadse:ie xdmie aepatanitueoglc/ltol drsdoeir β†’ ldwou asecu pdee nojit gbidnlee nsadtei of lusmaoc anmebmer lge.dienb derhtIeni aosm(Atoul )it,namnDo woudl ees omtmspsy robe.ef TPT acn eb lonmaghhri/.
beto  Bleeding symptoms in von Willebrand disease tend to occur in mucous membranes. deep joint bleeding is rare +4  
castlblack  New onset bleeding? Immediately rule out vWD! +  
waterloo  Vit C def I thought was super tricky. My knee jerk reaction was oh easy bruising, bleeding from gums that's what it has to be. But yeah, I think low platelet is key here. +  
nafilnaf  Platelet count would be normal in vWD because there's nothing wrong with the platelets themselves. +1  


submitted by rogeliogs(9),
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at:Fc 7%5 rae ued to a oeleintd in eth goln mar of teh oorehmmcos 1.5

tpnuI: ihTs stnoiuqe dickert me up eacubse enwh I saw a neieltod in het rh1c5 sa an otnipo I tgohuh "I ogt "it utb tcllauya I idd ont auseceb ti si otn ni eth tosrh mar si in eth nolg ram.

beto  there written "studies do not show deletion in the usual site on chromosome 15." +1  


submitted by seagull(1539),
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Teh hasotur ntwe out fo hiret yaw ot ifnd ehtw swtor otpoh fo a ganmuaolr ythe c.oudl heT etrhw no a tsme tath gsutgess tath ti owldu eb glanitrauno e.situ Btu tiellt idd ew ow..kn.

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +17  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4  
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1