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This is a case of postrenal azotemia. BPH is the only available option tbat causes it
Question stem also implies that the patient has been driving already. "has not had any collisions while driving his personal motor vehicle".
Also 10 years is a really long time. Just didn't seem like a good answer
correction: GAS erythrogenic toxin causes scarlet fever specifically in this question
there is no reason for this child to have TSS
SpeA and SpeC toxin is erythrogenic toxin referred to here.
Erythrogenic exotoxin A + Strep Pyogenes is responsible for BOTH Scarlet Fever and Toxic Shock Like Syndrome. It can also cause Necrotizing Fasciitis. It's definitely Scarlet Fever in this question but I just don't want people to get confused. FA2019 pages 133, 136
Sorry, not A. Just Erythrogenic Exotoxin +.
Lipase (active) and procolipase (inactive) are both secreted by the pancreas. Lipase is inactivated by bile salts in the intestines. Colipase (once activated by trypsin) is able prevent the interaction of bile salts and lipase. End result being that lipase is doesn't have to worry about bile salts if colipase is around
To add onto this, I had picked Phospholipase A2, but that's used for phospholipid hydrolysis and not triglyceride hydrolysis specifically.
I spent so long on this question and same... hahaha
also FSH upregs aromatase so you increase test (LH) and increase aromatase (FSH) that then converts that test to estradiol
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
Here Pt. doesn't have fever!
Why is it regurg instead of stenosis?
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
@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.
I'm still confused as to why mitral regurg has an enlarged left atrium. Are we supposed to think that it was mitral stenosis for a time, the high LA pressure led to hypertrophy, and then became mitral regurg? That's how it works in rheumatic fever, right?
I agree that mitral regurgitation is a holosystolic murmur heard best heard over the apex. However, with the murmur being found in the mitral valve area of auscultation it was the only answer choice that could result in LA enlargement and normal LV. Ruled out mitral valve stenosis since it is a diastolic murmur.
@themangobandit I believe mitral regurg could cause an enlarged left atrium from the increased amount of blood flooding back into the left atrium with each systole causing increased pressure on the wall.
why is LV size normal? doesnt cause MR cause increased preload and overload over time leading to enlarged LV?
How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin*
its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy.
Once again, another example of me knowing the concept but not knowing the obscure pseudonyms for common knowledge so I get the question wrong
I saw green and immediately thought of pseudomonas and crossed that answer out. Didn't know they were talking about alpha hemolysis!
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
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
I though it transfer to a lymphoma,OMG
This is great, thank you.
Pathoma ch. 3 pg 23 "Basic Principles"
Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec.
Clonality can also be determined by androgen receptor isoforms, which is also present on the X chromosome (Pathoma Ch. 3 Neoplasia)
@fatboyslim thanks for reminding!
Just to make sure I got this right, because this is neoplastic and its monoclonal, you want to look at the isozymes to determine its clonality?
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.
The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia).
you had me at its not in sketchy ;)
i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me.
Lipoprotein lipase: degradation of TGs circulating in chylomicrons and VLDLs.
FA 2019 pg 94
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?
@breis, per UW: "a/w r. hemiparesis (face & UE) bc close to primary motor cortex"
B is also close to frontal eye field; eyes look toward the lesion
FA pg. 499
I incorrectly picked C. When answering this, Broca's "broken speech" was my first thought, but I figured a lesion causing a facial droop would have to involve the motor strip so I prioritized that and chalked up the speech issue to dysarthria (I understand this is more of a "slurred speech" than broken, abrupt speech, but again, I simply misprioritized concepts.). So for the record, Broca area is part of the motor cortex?
Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods.
such a BS question IMO
such a BS question IMO
I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption..
This isn't right because the bariatric surgery will cure the prediabetes. It's dumping.
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.
yeah but he's prediabetic. you want someone like that to shove a bunch of starch down all the time?
Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen
In this case, patient's CF also predisposes fat-soluble vitamin deficiency.
FA pg 70
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.
AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E.
I believe so, FA 2018 pg 299
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
FA 2019: 301
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!
@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!
I think it may actually be a keloid, not a hypertrophic scar, as it expands beyond the borders of the original incision.
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 :)
First AID pg 219
Scar formation: Hypertrophic vs. Keloid
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
I literally ruled put collagen synthesis defect since this is not a collagen synthesis defect at all ( EDS, Scurvy) :/
hate these kind of questions