welcome redditors!to snoo-finity ... and beyond!
Welcome to btl_nyc's page.
Contributor score: 16
School:


Comments ...

 +2  (nbme22#35)

A: cholestryramine and other bile acid resins prevent the reuptake of bile acids from the gut.

B: Statins inhibit HMG-CoA reductase, preventing the liver from making mevalonic acid, a precursor to cholesterol.

C: Niacin (nicotinic acid) reduces hepatic VLDL synthesis and also inhibits lipolysis in adipose tissue by inhibiting hormone sensitive lipase.

D&E: Fibrates upregulate lipoprotein lipase (LPL), increasing triglyceride clearance (VLDL and chylomicrons are full of triglycerides) and also activate peroxisome proliferator-activated receptor- alpha (PPAR-alpha) to induce HDL synthesis.


 +2  (nbme22#35)

A: cholestryramine and other bile acid resins prevent the reuptake of bile acids from the gut. B: Statins inhibit HMG-CoA reductase, preventing the liver from making mevalonic acid, a precursor to cholesterol. C: Niacin (nicotinic acid) reduces hepatic VLDL synthesis and also inhibits lipolysis in adipose tissue by inhibiting hormone sensitive lipase. D&E: Fibrates upregulate lipoprotein lipase (LPL), increasing triglyceride clearance (VLDL and chylomicrons are full of triglycerides) and also activate peroxisome proliferator-activated receptor- alpha (PPAR-alpha) to induce HDL synthesis.


 +1  (nbme22#25)

Proliferative phase of wound healing. FA 2019 pg 217





Subcomments ...

submitted by usmleuser007(126),

Treat this like a VIPoma (Watery diarrhea, achlorhydria = reduced HCl in the lumen, & hypokalemia)

this will lead to metabolic acidosis d/t loss of bicarb in stool

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(13),

I thought of it like when she gets up from a prone position, she is decreasing the blood going to her heart, so so the the myxoma causes more obstruction. Also myxomas cause tiny emboli, which can go to the systemic circulation causing mini thrombi in the brain and limbs.

bigjimbo  Left atrial myxoma can mimic mitral stenosis (thus diastolic murmur) +  
btl_nyc  RVOT obstruction would cause a systolic murmur that gets louder when standing, not diastolic. +1  


submitted by yotsubato(282),

Why is his Libido normal? It's totally expected that he may have reduced libido after his wife died 2 years ago from some horrible prolonged illness.

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(126),

1) Superficial (first-degree) = Epidermis ~ presents as red skin without blisters

2) Superficial partial thickness (second-degree) = Extends into superficial (papillary) dermis ~ Presents with redness with clear blister & blanches with pressure

3) Deep partial thickness (second-degree) = Extends into deep (reticular) dermis ~ presents as yellow or white skin with less blanching. May be blistering.

4) Full thickness (third-degree) = Extends through entire dermis ~ presents as stiff and white/brown skin. No blanching.

5) Fourth-degree = Extends through entire skin, and into underlying fat, muscle and bone ~ presents as black skin; charred with eschar

endochondral1  what is rhus dermis? +1  
endochondral1  nvm its urshiol +  
btl_nyc  Allergic contact dermatitis because of contact with poison ivy. +  


submitted by sup(3),

Somehow I was able to convince myself that increased testosterone --> decreased estrogen --> decreased negative feedback on LH/FSH secretion --> increased FSH. Does anyone care to explain why this logic is wrong? Thanks :)

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. +  
impostersyndromel1000  @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +  


submitted by yotsubato(282),

Murmur that is louder with reduced venous return => Hypertrophic cardiomyopathy

HOCM is due to mutations encoding sarcomeres such as myosin binding protein C and beta myosin heavy chain.

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. +  


Patient has polycythemia vera, as evidenced by erythrocytosis, granulocytosis, and headaches & diziness. EPO is decreased due to erythrocytosis. Decreased LAP would indicate CML, not PV.

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +2  
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +4  


Patient has polycythemia vera, as evidenced by erythrocytosis, granulocytosis, and headaches & diziness. EPO is decreased due to erythrocytosis. Decreased LAP would indicate CML, not PV.

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +2  
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +4  


submitted by bigjimbo(7),

Episiotomy is cut from vagina to the perineal body for child birth

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


submitted by aladar50(17),

I’m not the best at the calculations of ICF/ECF, but basically you are infusing a hypertonic solution into the animal. Initially, this is all going to go into the extracellular space, as any IV infusion will do. Since it is higher than isotonic solution, water is going to go from the intracellular space to the extracellular space to try to balance it out, so the intracellular space will have decreased volume and increased osmolality (since only water is leaving, making it more concentrated).

So you know for sure ICF volume is decreased and osmolality increased, and the extracellular volume will be increased. I think the osmolality of the extracellular space is the tricky part and the part where maybe someone else can help with the calculations but basically it’s hypertonic enough that the osmolality will still be increased.

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. +4  
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) +