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Welcome to btl_nyc’s page.
Contributor score: 56


Comments ...

 +13  (nbme22#35)
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A: mteorhirlycesan nad rhteo lbei caid sserin vnprtee the ueertakp fo libe sdiac fmor hte u.tg

:B nitaSts ntbihii HGoMAC- uaeert,scd genvtirpen het elriv fomr manigk celnivmoa ca,id a rprcrseou ot colstrelhoe.

:C Nainci o(iitnncic )cadi esdcreu aicthpe LLDV iystshens adn oals hsiibint psiislloy in pdiaeso iutess yb nitbiihngi nhoemor niseveits elpas.i

m&:;DaEp sbFitaer lugruetaep ritieolonpp lesipa ,L(PL) cgisnearin rrgeyiilcedt nerlecaac (DLLV and lcnyhsocoimr rae lluf fo isicrgedrl)yet dan sloa tevataic xeieproosm aicapvdeeilarotrrt-fto -otprcere phlaa -)phPlPaRaA( ot uinced HDL tess.hiyns


 +2  (nbme22#35)
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:A crosehynlaretim nad rothe iebl adci rsnsie retepnv eht erpuetak fo biel sdcia form eht t:gB. u tSinsta ihnitib HCGo-MA eueatdsc,r grpvneetin the elvir form iagknm mleniocva iadc, a pocesrurr to erleCh:co.ots l nicNia ini(tnocci adi)c serecdu itcehpa LLDV hssiynest dan aosl sibihtin ilsyisopl in sdpaeio useits by innibighti morheno snevtiise .:eipEp lms&D;aa rFaibtse rluateupeg pinieooltpr asplei (PLL), agiecsnrni rtlregiydiec rlacecaen LDL(V nda slcohoynricm rae lflu of rrl)cydigetise dan oals aiettacv sxrieeopmo vrtlidcaartfoe-troapei rrpt-ceoe hpaal aaPhpl)PA(R- to cidneu HDL shytsines.


 +2  (nbme22#25)
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rreaovfitliPe epash fo uodwn lnehag.i AF 0219 gp 271





Subcomments ...

submitted by usmleuser007(377),
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Teart siht klei a aImVoP r(eytaW r,dharaie yiacrhlhaord = drdeecu lHC in the umenl, pa;m& ilkeaampy)ho

tish ilwl alde ot abtlimeco csodsiai td/ loss of cbibar ni tolso

btl_nyc  Chloride is increased though. +  
maxillarythirdmolar  This comment is gold. @btl_nyc, this is actually accute. you would expect hyperchloremia https://www.ncbi.nlm.nih.gov/books/NBK507698/ +  


submitted by sne(46),
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I thghtuo fo ti ielk ehwn ehs tsge pu rmfo a eonpr ioonpi,st ehs is crgdesaeni the oobdl ggoin to ehr e,atrh os os eth het maomyx saucse emor u.sobtnricto sloA yomxmsa cueas tiyn lime,ob chwih can go to eth ystsicme tacroliuicn igcansu mini htrimbo in eht irabn nad imlbs.

bigjimbo  Left atrial myxoma can mimic mitral stenosis (thus diastolic murmur) +1  
btl_nyc  RVOT obstruction would cause a systolic murmur that gets louder when standing, not diastolic. +2  
snripper  RVOT obstruction = Hypertrophic Obstructive Cardiomyopathy which causes diastolic dysfunction (S3) not a systolic murmur. +  


submitted by yotsubato(979),
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hWy si ish oibdiL amonlr? s'It ottlayl tedpxcee atth eh mya eahv dreceud iboldi ftare ish wfei died 2 ysare gao frmo smoe rlbhireo dploeongr sln.seil

nala_ula  perhaps it's more to do with the fact that he can get erections when masturbating, outside of nocturnal erections which are not mediated by sexual desire. So his libido must be intact since he has sexual desire evident in being able to masturbate. +  
nala_ula  At least, that's the way I saw it. +  
home_run_ball  "Testosterone concentration is within the reference range" and the fact that he has no difficulty masturbating = normal libido. Low testosterone would contribute to low libido And if he had low libido he would have difficulty masturbating +  
thisisfine   The way I made the decision about normal vs. decreased libido is also that he presented to his doctor due to difficulty maintaining an erection while trying to have sex - meaning he has the libido to try to have sex. Does that make sense? +1  
btl_nyc  It also says there are no signs of depression, which would cause the low libido after his wife died. +  
temmy  two years is a enough time to mourn...just saying +  
temmy  thisisfine, it makes absolute sense. That is the same way i saw it +  
dr_jan_itor  He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine (can crank his meat) +  


submitted by usmleuser007(377),
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)1 cpifaiueSrl sre)erd-tg(fie = pidismeEr ~ rtpeenss sa der tskoih wunti sbelistr

2) ciueafrlpiS parital hnskeistc deeo)r(es-cgend = Extesnd tion caselruipfi lsalppae ydi)mr(ri ~ snrstPee whit dnessre iwht llrsce itareb ±a tbhaliwsnch e uesesrrp

3) pDee altpira htkscenis eese)-dengcdr(o = dtsexnE ntio pede ierl()rtcau rimsde ~ esrnsept as loewyl ro tiweh knsi ihwt slse ni.lbngcah May be t.riilgsben

)4 Fllu hkseisctn ei(thr)gree-dd = Entxesd htrguoh teneir rmdsie ~ trneseps as tifsf dna reiwwbotnh/ .nisk No cl.innghab

)5 ohegdrturF-ee = tesdnxE uhgothr nirete nksi, nad inot rgneyiudnl f,ta ulcems adn oebn ~ snersetp sa bkalc in;sk crahred t ewarhisch

endochondral1  what is rhus dermis? +4  
endochondral1  nvm its urshiol +  
btl_nyc  Allergic contact dermatitis because of contact with poison ivy. +  
abhishek021196  Urushiol-induced contact dermatitis (also called Toxicodendron dermatitis or Rhus dermatitis is a type of allergic contact dermatitis caused by the oil urushiol found in various plants, most notably species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. +2  


submitted by sup(20),
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ohmweSo I was lbae ot cioenncv smylef thta esdnairec teneertstoos &;t--g ddeearsec seotrgen -&g;-t cedeesadr eietavgn kcebfead no /FSHLH csnterioe -tg;-& iecdesanr H.FS oDes nnayeo aerc ot xnlepia hyw this lgcoi si w?gnor hakTsn :)

btl_nyc  The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio. +1  
impostersyndromel1000  @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +  


submitted by yotsubato(979),
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rMmruu atth si ledour hwti dedrcue veousn eurnrt g;&=t ocrhrtpeiHyp cridtpaaymohoy

COMH is deu to atonimuts icnngode ecesmrsoar shcu sa msoniy bdniign tpneroi C nda abte soyimn vehay ca.nih

btl_nyc  So I thought this was Marfan's because the murmur from HOCM is at the left sternal border, but Marfan's is a defect in fibrillin, not in collagen. +3  
arcanumm  To help rule out Marfran's, it is stated that there are "no history of major medical illness," which I wouldn't expect them to put if there was a syndrome going on. (they also tend to give body habitus descriptors at least) +  
dul071  This isn't HOCM, rather it's simply Mitral stenosis. He has a murmur that radiates at the apex which happens to be the Mitral area. Despite everything his BLOOD PRESSURE AND PULSE are normal. The heart is over working to keep the vitals normal and as a consequence, it is undergoing hypertrophy which dictates the answer +  
dna_at  @dull071 I don't think this is MS. That would be 1) diastolic and not systolic, 2) less likely to cause LVH. I believe as others said it is just HOCM leading to MR, which is what we are hearing. MR secondary to HOCM would still increase in intensity with less preload as there would be more LVOT obstruction (thus more regurgitation) +1  


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Pnattei hsa ypahoymietcl ,reav sa eidnceedv yb osrrtyesyictoh, ooiystcasgrl,nu nad hdceehsaa ∓a en.izssid OEP is daerdseec ude to rotei.csyoryths Dcreeedsa LAP ulwdo itcaiend CM,L otn PV.

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +4  
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +9  
arcanumm  Tricked me. I knew right away that it was PV, but I thought PV would crowd out normal cell creation (e.g. decrease platelets). So apparently crowding out normal cells is just a quality of AML/CML? +1  
drzed  More AML. Remember Sattar always stresses that all the myeloproliferative disorders are expansions of ALL lineages, ESPECIALLY "xx" (depends on which one, for CML it'll be granulocytes, for PV it'll be RBCs etc). They're called MYELOproliferative because all the myeloid linages go up, but one will be increased more than the rest. In this case, it is the RBCs. +3  


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iatPnte has icmyphoyeatl era,v as ceeeidnvd by ceto,sytysroihr tc,ayungrliosos dan hsdeaaehc ;&apm sndi.ezis POE is dcsadeeer due to sorhetyc.srotyi aeDcersed PAL wudol ncidaeit L,MC otn .PV

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +4  
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +9  
arcanumm  Tricked me. I knew right away that it was PV, but I thought PV would crowd out normal cell creation (e.g. decrease platelets). So apparently crowding out normal cells is just a quality of AML/CML? +1  
drzed  More AML. Remember Sattar always stresses that all the myeloproliferative disorders are expansions of ALL lineages, ESPECIALLY "xx" (depends on which one, for CML it'll be granulocytes, for PV it'll be RBCs etc). They're called MYELOproliferative because all the myeloid linages go up, but one will be increased more than the rest. In this case, it is the RBCs. +3  


submitted by bigjimbo(46),
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opiiyomsEt si utc morf anvgai to eht alereipn yobd ofr lhdci ritbh

btl_nyc  But why is it external anal sphincter instead of bulbospongiosus? Aren't both attached to perineal body? +1  
stinkysulfaeggs  Bulbospongiosus connects to either side of the perineal body. But if you go directly posterior rom the commissure you hit the anal sphincter +13  
need_answers  I just think about how women say they done ripped their asshole while giving birth +3  


submitted by aladar50(40),
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m’I tno teh tsbe ta eht nailustacolc fo FI/C,EFC ubt alasiblcy ouy rae iifnsung a eoncyphirt utsnloio inot eth aail.nm ,yilltinaI hist si lla ggnoi to og iotn teh rerelaactuxll ,epsca sa nya IV iufnsion ilwl od. nceSi ti si ghierh tanh nocotiis tunlioo,s tawer is gniog to og fmor eth illnutlaaerrc pesca to eht aaextellrlruc apces ot ytr to becanla ti ,uto so het eiaurlanltclr sepac wlil eahv edasrdece eolumv nad erciedans imtllosyao ns(cie nyol etwra is vagli,ne kgmani ti oerm tenecnacto)rd.

oS you wokn fro uesr FIC muoelv si srdcdeeae nda ioslyoltma ,eisdcnrae nad teh clallrueaxetr umvelo ilwl eb ienesrc.da I itnkh hte iytolalmso fo the rlaaclxtueler pcsea si teh riyktc arpt adn hte tpar rhwee bmeya omeones eels nca phle tiwh the sucatonlcila tub sbylliaca i’st tphnoyiecr heunog tath teh oomiltslya wlil tilsl eb aicrn.dees

btl_nyc  Since hypertonic solution was added, osmolality has to go up. The degree of the hypertonicity doesn't really matter. The fluid flowing out of the ICF will increase ICF osmolality. Since water follows salt, the water's gonna flow only until the ECF and ICF have the same tonicity. So if the ICF osmolality went up, the ECF osmolality also had to go up, because they both need to be equal after the water is done equilibrating. +19  
krewfoo99  ECF fluid is hypertonic because we infused an hypertonic solution. ECF volume is going to go up because A) we added more volume via injection B) Sodium attracts water, and since hypertonic solution was given water goes from ICF to ECF ICF volume decreases because the water is going to ECF. This causes an increase in Intracellular osmolarity, since you have more solutes compared to water (Less water to dilute it) +1