NBME Answers : blueberriesyum's page

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+5 visit this page (nbme19#23)

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Presence of multinucleated giant cells surrounding foreign body (staple) shows granuloma.

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+21 visit this page (nbme19#0)

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A 70 year old develops a progressive disinhibition syndrome with episodes of emotional outbursts, inappropriate use of language, and socially inappropriate behavior. Where is the most likely damage?

Answer: Frontal lobe disinhibition.

Bilateral amygdala (medial temporal lobe) would've been affected if it was Kluver Bucy Syndrome.

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flapjacks If you know the story of Phineas Gage, it can help +6

helppls How do you tell the difference from a frontal lobe issue and Kluver Bucy Syndrome? +1

nikitasr27 I would say the emotional and language part. The frontal lobe is very involved in emotions and the limbic system as well as in complex language concepts. Kluver Bucy would lack these aspects as the individual is “indifferent” to everything (no fear, no emotions) just like my ex +3

randi Kluver-bucy is also marked by specific behaviors like hyperphagia, hyperorality, hypersexuality. Apparently can also be associated with HSV-1 encephalitis FA2019 p499. +1

chaosawaits What am I looking at? From what viewpoint am I looking? Can anyone identify the labels? I have A is olfactory tract, C/D are optic nerves, E/F are optic tracts, G/H are substantia nigra of midbrain & still I am totally lost. +1

chaosawaits I imagine that we are viewing the front of the brain from underneath and slightly angled to expose the midbrain more easily. Obviously B is the frontal lobe. But what are I and J? +

an1 @chaosawaits I think J might be the partial lobe. the only thing confusing me is that B is the frontal lobe with the amygdala is actually in the temporal lobe... +

an1 I take that back, I thought it was Kluver body for a second but its just frontal lobe stuff lol +

pakimd can anyone explain why this is kluver bucy and not frontotemporal dementia? +

doida it is not kluver, it is frontal lobe dementia +

thatmd I and J are the temporal lobes +

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submitted by notsogreat(-7), visit this page

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blueberriesyum People are going to move to a different platform now that this isn't free anymore. +1

azibird Oh shit, is that what's happening? Someone explain. I was wondering why there are so many questions missing, is that related? +

thisshouldbefree @azibird i dont think the missing questions is related to that as i dont think ppl would delete them +1

drdoom @thisshouldbefree after you pass a certain score threshold, you can add missing questions via a form on the main exam pages +

pelparente Yah it sucks that they are charging now, but I'm assuming they have to pay hosting fees for the website. It is basically going to cost you at most 10 bucks for your dedicated period, which isn't terrible, and good on them if they make a bit of money for having this idea. That's capitalism. I would love for it to be free, but please don't delete your comments if you posted something... I still need to study and these answers don't seem to be aggregated anywhere else. @not_greedy_like_you make another website that is free then get this content on there and create competition so they have to go back to free in order to have anyone on here if you feel so strongly. +

submitted by cassdawg(1781), visit this page

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This is my best interpretation with a source and paragraph from the source listed:

In anemia, hemoglobin available is decreased. This causes decreased oxygen binding, and ultimately less oxygen is available for release onto tissues.

PaO2 will be normal-ish because the arterial blood will still equilibrate in the lungs even though the hemoglobin binding is decreased (think of CO poisoning where PaO2 looks normal).
Arterial O2 content is actually decreased because there is less oxygen total available (less hemoglobin bound to oxygen)
Mixed venous O2 content (%) is decreased for a similar reason and also for the reason listed below
Venous PO2 is slightly decreased because there is higher oxygen extraction at tissues due to the compensatory mechanisms from less total O2 being delivered and less O2 being unloaded (since there is less hemaglobin bound O2 in the first place in anemia)
PCO2 is normal-ish for similar reasons to the first bullet

"The circulatory adjustments in response to anemia will be similar to those of the preceding case. In order to maintain tissue oxygen consumption at baseline levels associated with a normal oxygen carrying capacity of blood, the reduction in oxygen delivery will lead to an increase in capillary perfusion, and oxygen extraction will increase. Arteriolar dilation and viscosity reduction (for the case of a reduction in Hct) will cause blood flow and oxygen delivery to increase. Both oxygen extraction and oxygen delivery will continue to increase until the oxygen requirements of the tissues are met or until the capacity to increase oxygen extraction and delivery has been reached. The resulting situation is one in which venous oxygen content and PvO2 are less than normal. Since PaO2 is normal for all the anemic situations considered, this defect is not sensed by the respiratory chemoreceptors. Thus, increasing the inspired oxygen fraction is not helpful except for the case of CO poisoning, where high inspired oxygen (e.g., 100% oxygen at ambient barometric pressure or placement of the subject into a hyperbaric chamber) competes with CO binding at the heme site (recall Haldane's first law)." - https://www.ncbi.nlm.nih.gov/books/NBK54113/

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blueberriesyum Also, in first aid respiratory chapter for anemia it says, Hb conc is low, %O2 sat is normal, dissolved oxygen (PaO2) is normal, but total O2 content is low. Total oxygen content is the sum of oxygen bound to Hb and dissolved oxygen. (FA 2018 pg 649) +1