welcome redditors!to snoo-finity ... and beyond!
Welcome to bullshitusmle's page.
Contributor score: 2
School:


Comments ...

 +0  (nbme24#15)

therapeutic ionizing radiation(gamma rays,x-rays); -DNA double-strand breakage -Free radical formation





Subcomments ...

submitted by m-ice(135),

The patient states that she does not want a hormonal form of birth control. So, the question is really asking which of the non-hormonal options is most effective. The tricky part here, I think, is that the question makes you want to not pick IUD, because many IUDs are hormonally based. However, a non-hormonal IUD, like a copper IUD, is still more effective than the other options listed.

bullshitusmle  copper intrauterine devices are hormon free FA2017 page 622 +1  


submitted by neonem(278),

I think metastasis was the best option here because there are multiple malignant neoplasms... primary cancers tend to start as a single mass in the tissue of origin. In the lung, metastases are more common than primary neoplasms.

dbg  I seriously could not figure out whether those white opacities were actual lesions or reflections from the actual picture (flash light) ... mind went all the way maybe this is the shiny pleura so they're going after mesothelioma. smh +1  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +1  
bullshitusmle  guys something I learned from NBMEs is that if there is a clinical vignette dont even look at the images they give you ,they are all useless and time-consuming +  
goaiable  The way i narrowed it down was that the patient had signs of weight loss since three months whereas her cough developed recently (3 weeks). If the cancer arose in the lung then I think the cough or other pulmonary symptoms should emerge earlier. +  


submitted by keycompany(127),

This patient has a pneumothorax. Hyperventillation is not enough to compensate for the overall decrease in lung surface area.

_yeetmasterflex  Could the pneumothorax also cause less ventilation due to decreased lung surface, retaining more CO2 causing respiratory acidosis? That's how I got to the answer at least. +1  
duat98  I think pneumothorax would increase RR because you're probably hypoxic. Also I'm sure when you have a lung collapse on you you'd be scared and that would trigger your sympathetic so your RR will go up either way. +1  
kateinwonderland  Arterial blood gas studies may show respiratory alkalosis caused by a decrease in CO2 as a result of tachypnea but later hypoxemia, hypercapnia, and acidosis. The patient's SaO2 levels may decrease at first, but typically return to normal within 24 hours. (https://journals.lww.com/nursing/Fulltext/2002/11000/Understanding_pneumothorax.52.aspx) +1  
linwanrun1357  How about choice C, --ARDS? +  
bullshitusmle  there is no bilateral lung opacities as you would see in ARDS +1  


Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

shriya goyal  yes I answered it like that +1  
redvelvet  me too :( +  
abigail  me three :( +  
yex  Me four :-/ +  
link981  Slowly raising my hand as well +  
tinydoc  Sammmme +  
bullshitusmle  same here!!!:@ +  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +