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Welcome to brasel’s page.
Contributor score: 20


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 +3  visit this page (nbme19#0)
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Overflow incontinence is present (bladder fills then leaks slightly), so either:

1.) something blocking outflow (e.g.; BPH)

2.) impaired contraction of bladder (e.g.; damaged nerves)

Only the pelvic nerve causes detrusor contraction, so it is the only possible answer. External sphincter, pudendal nerve, and skeletal muscle all does the same thing. Hypogastric nerve helps retain urine (relaxes detrusor) so it is clearly not damaged.

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solidshake  I agree answer is the parasympathetic Pelvic Splanchnic nerve, but don't forget there are 2 mechanisms that are affected when it's damaged: 1. Impaired involuntary contraction of bladder and also 2. Impaired involuntary relaxation of the internal urethral sphincter. Pelvic Splanchnic nerve facilitates both of those + voluntary somatic relaxation of external urethral sphincter via pudendal nerve allows you to pee +1
chaosawaits  @solidshake I may be just unable to search properly, but I found the internal urethral sphincter to be innervated by the sympathetic fibers from T10-L2 through the inferior hypogastric plexus (source: Wikipedia) Urination occurs by preganglionic inhibition of the sympathetic fibers via descending reticulospinal tract. Fact check appreciated. +2

 +1  visit this page (nbme21#11)
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Power = ability to detect a difference between groups (if one exists) P value (<0.05) = probability that results were due to random chance

80% power = 80% chance of the study being able to detect symptom changes, which in this case was 0.4 (AKA 80% chance of detecting a significant p value)

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Subcomments ...

submitted by hungrybox(1277), visit this page
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The 2 commandments of ethics questions:

  1. Don't ever pick an answer where you sound like a dick
  2. Don't ever consult the ethics committee

Served me well on this question.

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linwanrun1357  If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +4
champagnesupernova3  If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1
brasel  also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1


submitted by wasabilateral(47), visit this page
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I think it has something to do with glycine (due to its small size it can fit in many places where other amino acids can not and hence it provides “structural compactness” to the collagen, i.e. put a kink in the alpha helix). If glycine is misplaced by something else, I don’t think pro-collagen can form its correct secondary structure.

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jotajota94  True! also, glycine is 1/3 of collagen alfa chains, so it makes sense that substitution with alanine (which is much bigger) would lead to disruption in the alpha helix formation. +2
jotajota94  True! also, glycine is 1/3 of collagen alfa chains, so it makes sense that substitution with alanine (which is much bigger) would lead to disruption in the alpha helix formation. +
thepacksurvives  Glycine is small and bendy, which allows it to form the fibrils for the triple helix +
brasel  Also in general (FA 2018 pg 50) OI is from problems forming the triple helix which is secondary structure. Fortunately, they gave us something to reason with in the question (Gly->Ala) +3
amy  Can someone help me understand why A is incorrect? FA2020 page 50: Triple helix of 3 collagen a chains is formed from procollagen via hydrogen and disulfide bond. Is this very similar to what A is decribing? A. Decreased hydrogen-bond formation between collagen molecules. +
umpalumpa  The explanation given by wasabilateral could work if the question would say Gly-->Ala mutation. However, the question states that there is an Ala-->Gly mutation. +


submitted by amarousis(27), visit this page
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so for this one you have to look at the diastolic blood pressure and that's the values you're supposed to read. not the numbers in the columns. Like group X's mode is 70 because it has that value 32 times. group y's mode is 80 because it appears 20 times. for median, you would have to write the diastolic number 50-120 how ever many times it appears and then find the middle. tricky question.

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sahusema  Wow. I hate this. I only looked at the number of participants and completely ignored the Diastolic BP readings +5
ma_rad  Everyone commented how to get the mode right. But there is an easier way to realize that the median in Y is higher without all the calculations. If you see, the last Diastolic BP in group X is 110 (as there are ZERO people with 120). While group Y has 8 people with 120 DBP. This automatically shifts the median to the higher side. I got this wrong though at first I didn't pay attention to the "0" number at group X for 120 DBP +11
brasel  I think there's another easy way to find the median without writing out every value. There are 100 total people in each group, so that means the median (if the DBPs are written in ascending order, which they are) is the 50th person. Group X: 8 + 12 + 30 = 50, so median is 70 Group Y: 2 + 8 + 10 + 20 +10 = 50, so median is 90 +12
mangotango  I did it the way @brasel explained. The way @ma_rad did it could give the incorrect answer in some cases (e.g. Group X had 0 ppl with 120 BP but a ton of ppl for 110 BP etc. + Group Y had 10 ppl with 120 BP but basically none with 110 BP etc.). In this question that way worked but it's not always guaranteed since median doesn't sway with outliers, but mean does. // FA 2019 pg. 261 +2
unknown001  for median write down every value ? i reeeally hope you were joking, the data is already arranged from least to greatest, which is a criteria for determining mean. now add up till you reach 50, and correlate it with value of diastolic blood pressure and BOOM, its that easy +


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