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Comments ...

 +0  (nbme18#18)

I put CHF, still not sure why it is wrong over BPH, but my reasoning is that BPH causes obstructive urine flow --> Hydronephrosis and once the urine has been made it can't be redone and is like filling up a damn with water. Straight Stasis. vs CHF there is protective mechanisms in place for a while until frank CKD.

 +0  (nbme18#26)

I am not 100% on this being correct, but I briefly remember a Psychiatrist saying that the patient has to be seizure free for 6 months minimum and preferred to have no seizure within the last 3 years to be asymptomatic. Do with that information what you will. but for Boards: 3 years.

 +0  (nbme18#14)

Streptococcus Pyogens (group A strep) has a superantigen causing shock. This antigen Erythrogenic Exotoxin A causes a Toxic shock-like syndrome: Fever, Rash, Shock, Scarlet Fever.

FA pg 133 (2019)

 +1  (nbme18#48)

Colipase is a protein that functions as a cofactor for pancreatic lipase, with which it forms a stoichiometric complex. It also binds to the bile-salt covered triacylglycerol interface thus allowing the enzyme to anchor itself to the water-lipid interface.

 +0  (nbme20#41)

your guess is as good as mine.....................................................................

nala_ula  I spent so long on this question and same... hahaha

 +3  (nbme20#29)

Doxycycline is a Tetracycline (binds 30s subunit) and is used off label for treatment of Acne. Can cause discoloration of teeth, and is known to be PHOTOSENSITIVE.

This patient had diffuse erythema and mild edema over her face and extremities, most likely from sun exposure while being on the med for Acne.

FA 2019: pg 192

 +1  (nbme17#16)

HCG injections down regulate the pituitary release of GnRH.

however HCG alpha subunit can stimulate cells influenced by LH, FSH, TSH.

 +1  (nbme20#21)

Psittacosis (sometimes called ornithosis or parrot disease or parrot fever) is an infection of the lung (pneumonia) caused by the bacterium Chlamydophila (Chlamydia) psittaci.

Signs and symptoms: fever. cough, usually without much phlegm. headache. rash. muscle aches. chest pain. shortness of breath. sore throat.

charcot_bouchard  Update on my prev comment : Yes this is psittacosis. not hypersensitivity pneumonitis. How do u know? Lymphocyte and Presence of Granuloma - response to intracellular chlamydia. Now HS can also cause loose granuloma too and the clinical picture still more look like HS You know what ......... fuck this ques
shemle  Here Pt. doesn't have fever!

 +2  (nbme20#2)

Dx: Acute Monocytic Leukemia. Proliferation of monoblasts; lack MPO. CD14 + CD13+ MPO -. blasts characteristically infiltrate the gums.

A Xanthine Oxidase inhibitor is given to prevent adverse reactions of Tumor Lysis Syndrome which results from expulsion of cellular debris/material after the cell dies.

 +1  (nbme20#12)

Patient has Midsystolic murmur heard at the cardiac apex. there is also a LEFT ATRIAL abnormality. Echo shows LEFT ATRIUM is enlarged.

Mid systolic... enlarged left atrium...

Best choice: Mitral Regurg

hpsbwz  Why is it regurg instead of stenosis?
minhphuongpnt07  Vague question requires a lot clinical reasoning. mitral regurgitation: holosystolic murmur( this cv: midsystolic), enlarged LA, LV Mitral stenosis: diastolic murmur, enlarged LA, normal LV. only best explanation I can think of: early stage Mitral regur, that's why the murmur is not holosystolic but midsystolic and LV still adequately handle the situation
dickass  @hpsbwz it's regurgitation because the murmur is SYSTOLIC, when the mitral valve is not supposed to make any sound. mitral valve leaks in systole, which causes blood to back up, which causes the left atrium to work harder and eventually hypertrophy. Mitral stenosis would be a DIASTOLIC sound, which is when the left atrium normally contracts.

Subcomments ...

submitted by famylife(43),

This is strep pneumo, which has alpha hemolysis (green)

breis  How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin* +  
mjmejora  its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy. +1  

submitted by sympathetikey(460),

CD4+ cells activate B-cells which form follicles and cause enlargement of lymph nodes. Therefore, in an AIDS patient, to enlarge the lymph nodes, the CD4+ dysfunction must be resolved.

breis  Yea i get that, but if the patients CD4 was ~35, how in the world did the CD4 count rise enough to stimulate B cell proliferation...? I don't get it +1  
namira  The only thing i can think of is that: the cd4 count that is given was taken prior to having started the antiretroviral therapy. Since the question asks about "improved function", maybe its referring to the therapy actually being effective and its managed to increase cd4 count and function so as to be able to contribute to lymph node enlargement due to myco. avium +7  
kamilia20  I though it transfer to a lymphoma,OMG +  

submitted by hayayah(525),

Neoplasia is new tissue growth that is unregulated, irreversible, and monoclonal.

Clonality can be determined by glucose-6-phosphate dehydrogenase (G6PD) enzyme isoforms. G6PD is X-linked.

*For more information check out Ch. 3 Neoplasia in Pathoma

hello  This is great, thank you. +4  
breis  Pathoma ch. 3 pg 23 "Basic Principles" +3  
charcot_bouchard  Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec. +6  

submitted by strugglebus(87),

Nowhere have I been able to find why the hell this is a thing.

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +3  
breis  same^^^ +  
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +  
chandlerbas  you had me at its not in sketchy ;) +  

submitted by hayayah(525),

Pt. has Familial dyslipidemias. Type I—Hyperchylomicronemia.

estefanyargueta  Lipoprotein lipase: degradation of TGs circulating in chylomicrons and VLDLs. +1  
breis  FA 2019 pg 94 +  

submitted by xxabi(131),

Broca’s aphasia: expressive (motor aphasia) with agrammatism (pts aware that they don’t make sense) - area A Wernicke’s aphasia: receptive (sensory) aphasia with impaired comprehension (pts lack insight)

breis  Why would B be incorrect? I realize Broca is "technically lower" but A seems too low to be causing weakness of the lower 2/3 of the face? Am I missing something? +  
shaeking  @breis B is incorrect because of the lower 2/3 of the face weakness. B isn't located on the motor cortex but in the premotor cortex, plus it isn't low enough for the lower two thirds of the face. https://thebrain.mcgill.ca/flash/a/a_06/a_06_cr/a_06_cr_mou/a_06_cr_mou.html https://www.sciencenews.org/blog/science-ticker/homunculus-reimagined +1  
cienfuegos  @breis, per UW: "a/w r. hemiparesis (face & UE) bc close to primary motor cortex" +  
almondbreeze  B is close to premotor cortex which is involved in learned or patterned skills & in planning movements. (i.e. two-hand coordination) slide 25/37 :https://www.slideserve.com/hal/the-motor-system-and-its-disorders +  
almondbreeze  B is also close to frontal eye field; eyes look toward the lesion FA pg. 499 +  

submitted by beeip(79),

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 +4  
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.. +3  
teetime  This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +1  
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. +1  

submitted by usmleuser007(174),

Vitamin E deficiency is known to cause similar spinal defects as Vitamin B12 deficiency. However, anemia is not seen.

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +1  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +4  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +3  

submitted by xxabi(131),

I was under the impression that this was an aortic dissection, due to "severe chest pain" as well as the false lumen in the aorta. And HTN is the #1 risk factor for aortic dissection. Someone correct me if i'm wrong, but I think this is aortic dissection rather than aortic aneurysm.

chefcurry  I believe so, FA 2018 pg 299 +2  
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension +  
breis  FA 2019: 301 +  
pg32  First Aid says that aortic dissection causes widening of the mediastinum and is due to an intimal tear, so I thought it wasn't an aortic dissection. Can anyone help me understand why First Aid was wrong in this case? Thanks! +1  
nephroguy  @pg32 The question stems states that there is no widening of the Aorta, not the mediastinum. Widening of the mediastinum is seen in dissection while widening of the aorta is seen in aneurysm. Also the intimal tear creates a false lumen between the intima and media. Hope that helps! +  

submitted by celeste(43),

Sounds like a hypertrophic scar. "Hypertrophic scars contain primarily type III collagen oriented parallel to the epidermal surface with abundant nodules containing myofibroblasts, large extracellular collagen filaments and plentiful acidic mucopolysaccharides." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022978/

johnthurtjr  I think it may actually be a keloid, not a hypertrophic scar, as it expands beyond the borders of the original incision. +2  
thepacksurvives  I believe this is a keloid; a hypertrophic scar does not extend past the borders of it's original incision, while a keloid does. regardless, the answer to this question is the same :) +  
breis  First AID pg 219 Scar formation: Hypertrophic vs. Keloid +  
charcot_bouchard  They give granulation tissue is a option which is type 3 collagen. so if it was hypertrophic scar it would be ap problem since its only excessive growth of Type 3. while keloid is excessive growth of both 1 and 3 +3  
bharatpillai  I literally ruled put collagen synthesis defect since this is not a collagen synthesis defect at all ( EDS, Scurvy) :/ hate these kind of questions +