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Welcome to burak’s page.
Contributor score: 52


Comments ...

 +0  (nbme21#30)
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'Ist eilk rbE .syaPl ,llirxAay sscauriarulppas nda celumtuuanoouscs renev dgsae.am

burak  palsy* +
nifty95  This is a good way to remember the upper trunk! +

 +4  (nbme21#36)
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Ist' hlaneyi giacarelt, so we deen teh oohcse onamencdrho ro raohcms.donorca

-1 I nkthi eterh rea esomtsi adn semo cprohelpomi snehacg in i,dlse so 'it eilk mtanai.nlg

2- oohErcadsnmn are udofn in lasml osenb fo ndah adn feet idcanrgco hte FA, tub asoodcorracnsmh era inmyal dersia ni uldmlea of pleivs or lrtanec kt.eoensl

3- I werto no my FA "tiNpcolsae esnchdooyrct ni anyilhe etagrilac miatrx HTWI MALLS I."NLIACAICOCTFS I 'otdn onkw wheer ti is mrof utb lbpyrboa U.W

jakeperalta  Lol I've scribbled down the same thing in FA. It's UW. +

 +1  (nbme21#37)
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anetPti dha cernlat aaifcl earnv adegma 4 flet i;sehpmaersi adn lal eht agmeis are fmor het ir.nba hEiter he ahs demaag to ntllaoarrtaec tirocalc asear ihwch pereenstr ethes sutecrrtus ro ctptoio-nlrpicssaoiacriocnl nevre me.gada

tanreIln auelcsp pirrtosoe ilm:b iaorlCtcnipos otorm nda esrynso :Gs enneveur urocobribCatl besifrtnAro rie :imlb laroialmcaoThtc ibersf

Synmeosdr caueds yb IC ea:dgma ureP omrto hapmers,ieis Peur noeryss sktero, hgaiii,-Aelmpxtae halrsyyi-CDtaumrs adnh

burak  corticospinal-corticobulbar* +

 +8  (nbme21#22)
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Puelalr e:vad pucciacaisMlr e:nil h-6t8 alM sidbixyialrr i:enl 1-t8h0 rrPtbbisleaav erar lne:i 1n02d1- rsib

oS ihayinscp sutm sretni a lneede in 08h1-t bsri ni dxayrlimlai len;i tbu eioinsnrt bolew eth th9 irb sltli has a iksr ot gmeaad lamdinboa snaogr hcsu sa e.irvl erUpp orebrd fo ht9 ibr is .inef

Uw qistuneo DI: 484

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +15
burak  thanks! +
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +2
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +

 +1  (nbme21#12)
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ahWt sode 3 arnriown sae?mn sI taht a aucse fo ytavdurrcliei sssadiee or the ?r?sulte Adn tawh si taht ophto anmes /:

lola915  Yes, diverticulitis causes inflammatory stenosis (obstruction) +

 +2  (nbme21#34)
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baOritl folro :acrretfu

-1 aIiobartfrln enrve n:iyjur unsNbsem adn erhatesspai fo het urepp he,cke prpue l,ip rpeup giag.inv

-2 mtnratpnEe of eht rfrioien erucst :cleums rdpmiaeI awurpd gaze

-3 nhostpailmoEs

4- nuolgsCi of rllxiamya s:siun rdaroTep sgin

minion7  if IR muscle is affected it is impaired downward gaze!!! +
makinallkindzofgainz  @minion7, If the Inferior Rectus muscle is impaired (e.g. nerve dysfunction), then yes, downward gaze would be affected. However, the question states that there is ENTRAPMENT of muscles. Trapping the inferior rectus muscle essentially locks the eye into a downward gaze, therefore impairing upward gaze, as the inferior rectus muscle is essentially trapped in contraction. +4

 +1  (nbme21#31)
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stlaoC nda ilaccevr apelur si eindaevtnr yb toeacirnls ,eenvr isantaelimd adn dtipimahcaarg pruael si ienanerdtv yb ecphnri rl.scaIonrtneevet evran npia tliypcayl flet reoscl to hte np,ai nihercp nreev )C35(- pani si aritdead anip by SRIRUCVPCAALUAL renev aaer e()su.hd wUrlo nsqetuoi DI: 5513


 +0  (nbme21#2)
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Ceryhr red spot ilyacblas saemn nenikcman-pi ro tay scahs. owT fneesercifd tebnwee si: -1 No MSH in ayT ca,hSs HSM in n-kniemcpn.ia 2- tohB fo hetm hsa clemsu saeenwks utb eehrt si rieafepyhrlex ni Tya ,asShc utb efaialrex ni anminen cpki eei.dsas nI mets lcle MHS is not beieddcsr dna elpaihfexryer ntoed.

burak  i mean, hyperacusis+hyperreflexia+sensitive startle +1

 +0  (nbme21#16)
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ntIs' ti denpnedte on teh cat?nlioo I wendsrae it rnaocory sunis uasceeb va nedo is aldetco ni ocKh lartgine; hwcih cesdompo of ,iSnsCu ndTnoe of ,oordaT isTdcipru ?unlnasu

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node. +2
burak  Now it's more confusing to me:) because av bundle is more inferior to the av node. +
hello  Patient has ASD --> need to repair interatrial septum. AV bundle aka bundle of His is located neart interatrial septum. Coronary sinus opens into atria but is not located near the interatrial septum +4




Subcomments ...

submitted by burak(52),
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ullaerP cccraiMlai: upadsev ni:el t68-h xraa idirlysblMi lni:e 18-0th isrlb braPeaetvrra ni:el 011n2d- rsib

oS syianpchi utms nstrei a ndeele in -h8t10 rsbi ni lldymairaix n;ile tbu seironitn bolew teh ht9 ibr siltl sah a riks to magdae idbnolama rgsoan shcu sa e.vlri prpeU odrbre of t9h rbi si .einf

Uw eiotuqsn ID: 844

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +15  
burak  thanks! +  
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +2  
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +  


submitted by burak(52),
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'tsnI ti ndpenedet no hte naticool? I drweasne it onaycorr uniss escbaue av nedo is taledco in hocK arelti;ng hhiwc mseocpod fo Siu,sCn eonTnd fo aTdr,oo uTpirisdc luun?ans

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node. +2  
burak  Now it's more confusing to me:) because av bundle is more inferior to the av node. +  
hello  Patient has ASD --> need to repair interatrial septum. AV bundle aka bundle of His is located neart interatrial septum. Coronary sinus opens into atria but is not located near the interatrial septum +4  


submitted by hello(301),
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aPesle lhep

M-sydicliost ejinotce kilcc = omiunlpc nsstoeis

owH is oincpuml itenosss aelertd ot het enis'ptat DAS -- dose DSA sacue lmnuipco snossi?t?e

burak  ASD has typically 3 associated sounds according to UW, they are all about increased blood in RA. Increased blood in RA causes more blood do ejected from tricuspid (dşastolic rumble), and more blood to be ejected to pulmonary circulation which cause pulmonary flow murmur (midsystolic murmur in pulmonary region). It even can cause pulmonary regurgitaion like murmur, but most important murmur in ASD is typically midsystolic murmur. You can check it out on FA 2018 page 284 +2  
hello  Ok, what I learned: Extra blood in the right heart (due to ASD) doesn't lead to pulmonic stenosis? Instead, it's that pulmonic stenosis = most common comorbid heart association with ASD +1  
burak  No it's not pulmonic stenosis, it doesn't lead. Murmur associated with ASD is pulmonic stenosis-like murmur, because it's caused by excess RA and RV volume ejecting to the pulmonary arteries. So it's same location with pulmonic stenosis, and it's systolic. You get it? +1  
hello  @burak Yep! +  


submitted by burak(52),
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iaPtnet ahd rntclae faacil avern amgdea 4 left rmiepiasse;h dan lla hte maiesg era omfr hte inbra. ehiErt eh hsa meaadg ot oaacetrlrtnal ciatclro eraas wchhi rtsnepree esthe esuutcsrrt or lctotcsiccpaipioloorn-asrin enrev a.emgda

laetrnnI sapucel poosrriet :lbmi pirolintsocaC ortom adn ssoreyn eeunne:s Gvr raclbuoobtriC er iAnrbestoifr il:mb aThtolciarlcmao eirfbs

dnSmyreso csudae by IC meadga: eruP omtro measeshirp,i uerP esrsyno t,kesor egAait-xephiima,l Crsiytal-hrmuyDsa danh

burak  corticospinal-corticobulbar* +  


submitted by yo(78),
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I tjsu ewkn ahtt respm ened ctfor,sue tno rues htwa deseisa srcsoep sthi is go.huht He saw ptyetr molran so 5a esertaaduc se'tnod epsetnr ielk .taht I nwsat' sure fi erteh asw nay odd sue fo the oerth s.aeswnr ehre is a .klin lFee reef ot pxan.ed

xcea.sc_gnh.aeitm2ptwpob7:slspqw/s/2/w24.otu

orsteucF seakm up 99% of eth urnegicd rsuag eersnpt ni s.mnee shiT sagru is edpdoucr ni eth lemsani .ilesscev hDsiieinmd eevlls of uferocst veah ebne hnows ot lplaerla ondagenr diecyiecnf dna teh ooerssttenet .eellv gFlwonoil stnsroetoete ryatp,he hte veell fo efstoruc nh.ouagsselceAihrt het efostucr ttse si otn part fo a rouniet nemse nlasyias, ti is lusuef in acsse fo rozesipmaoa asbe(cen fo rmspe ni en.)mse In eaopimoszar nsyerdaco ot teh esbenac of sceelsvi or if teerh si na tobuoriscn,t on tceusfor is enstpe.r In csatturlei ,apeaoroizsm ofuertsc is er.snpte nehW merziaoaops adn wlo nesme uomelv i,tsxse teh ueostrcf ttes uslhod oals eb o,nde on a ctaaljseoupet iruen elmsap ot hckec for datrerroeg alcjeiut.ona Tshi suocrc hwne teh eclaajetu geso nito hte ddbealr adeitns of uto eth erhhtrTua. e proecrdue rfo iereitdmngn hte tonmua fo cofertsu ni mnese ivnloesv nigateh eensm in a ntsgro aidc in eht cpnreees of .ocoelirnsr ctursoFe vgeis a dre lcoor oiSfovnlfe( )ctioerna nda yam eb rade in a toe.hpomret heT amlrno vagaeer si L531g/md tourfc.se

sam.l  Thank you for the explanation. I'm still confused about this answer. I was in between Zinc and fructose. Zinc deficiency also presents with anosmia (pg 71 First Aid 2019). Fructose is used for the movement. His hormones are normal. +3  
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 https://www.fertstert.org/article/S0015-0282(16)40391-2/pdf +4  
cienfuegos  Thanks all for the info, quick note on the Zinc reply above @Sam.I: anosmia = lost sense of smell. +  
sam1  Great find yo! I believe this question was alluding to cystic fibrosis and the congenital absence of the vas deferens. Here is a link to a NEJM article about it below: https://www.nejm.org/doi/full/10.1056/NEJM196807112790203 +  
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged? +  
fatboyslim  @Sam1 but cystic fibrosis will show abnormal physical findings (clubbing, pulmonary crackles etc). The question says physical exam shows no abnormalities. +  
pg32  Confused as to how we can rule out zinc... From medicalnewstoday.com: "Zinc also plays a role in healthy sperm production. According to a 2018 review article in the Journal of Reproduction and Infertility, zinc deficiency may contribute to poor semen quality and infertility." +  
bekindstep1  @pg32 I am not sure of how Zinc contributes to sperm production, but the question was asking about abnormalities in the semen and fructose is present in the semen. Maybe zinc plays a role in sperm development before it is mixed in with semen and so one with zinc deficiency wouldn't have low in zinc in their semen perhaps, but it their blood. This is just a hypothesis though.... +  
brise  ^^ Yeah that's how I ruled it out. You can find fructose in the semen, but you wouldn't be able to find zinc in the semen! It might help the sperm, but it's not going to be chilling with them +  


submitted by burak(52),
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sI't ikle rEb slP.ya aylxlri,A aasarrsulppuisc nad uasumulcntcosoeu nvree maasg.ed

burak  palsy* +  
nifty95  This is a good way to remember the upper trunk! +  


submitted by hyoscyamine(55),
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FA pg 217. oTo cuhm xoetayonngi cna cause eefr icdaarl aamedg adlngie to pytihearont fo iyperrumtta

mmm21  Okay i might be retarded, but why i can’t understand that they r asking about the thing that is damaged ? 😂😂 +5  
sahusema  Seriously! The question says "the goal of treatment is the protection of which of the following structures?" If too much O2 damages the retina, how is this treatment supposed to be protective to the retina? +2  
ratadecalle  I think too much oxygen would be with the ventilator having a high FiO2 setting, which they don't mention here but I'm guessing thats the thing they're controlling to avoid oxygen toxicity? +2  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +27  
naught  Supplemental O2 may also cause bronchopulmonary dysplasia or intraventricular hemorrhage (germinal matrix, located in subventricular zone NOT choroid plexus) +1  
fkstpashls  92-95% isn't high, but it's enough to get everything else oxygenated. Because it's not 100% high flow the retinas don't over-vascularize and lead to damage/hemorrhage, and shit like that. +  
soccerfan23  In other words....the question is basically asking why they gave the patient a fio2 of 92-95% instead of 100%. The reason is because 100% oxygen would lead to retinopathy of prematurity. The lower 92-95% oxygen levels protect the retina from damage. The wording of the question sucks tho imo. +  


submitted by ergogenic22(301),
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yhw is topircento of eht oihcdor elxsu,p romf ienrrturtaivclna uuerptr dyoscaren ot eimrgaln amtixr ehmorreagh otn a blsispoe a?snewr

whoissaad  yes same question, both retinopathy and intraventricular hemmorage can occur due to high oxygen levels.. +  
cienfuegos  I mistakenly chose choroid plexus too, based on wiki seems this is most common cause of IVH in term infants: IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus. However, it is particularly common in premature infants or those of very low birth weight... Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. https://en.wikipedia.org/wiki/Intraventricular_hemorrhage#Babies +  
burak  choroid plexus is different than germinal amtrix +  
meryen13  retinal hemorrhage is more common that IVH even if you think that it could damage choroid places secondary to germinal matrix hemorrhage. https://www.ncbi.nlm.nih.gov/pubmed/11304816 +  


submitted by burak(52),
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yCerrh edr ptos ysabllcai eamns c-imnpknaeni ro yta .hascs owT eisrcdfneef eeewtbn s:i 1- oN MSH in yaT sShc,a MSH ni p-n.kninmicea 2- otBh of etmh ahs mcleus swnaksee tub there is heyflexeirarp ni yTa hSac,s utb lxiaeaerf in nnemani ipck sadees.i In mste lcle HSM si ont breedcsid nda elyaxireprehf dtone.

burak  i mean, hyperacusis+hyperreflexia+sensitive startle +1  


submitted by seagull(1404),
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! I eaht ethes thiw a nunigbr **Fn*ig s.ipaons bmuhsT up fi you geare

mcl  Amen brother +1  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28  
mcl  oh my god are you me +1  
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6  
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4  
abhishek021196  What is HSM? +  
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +  
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1  
djeffs1  @lakshmi Link? +  


submitted by hello(301),
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seelaP hlpe

csoli-Mdisty ceietnjo ikccl = polmunci osnietss

woH is pciomnul ssseotin detrael to the etpna'sit SAD -- odes DAS cseau minclupo etsn??sois

burak  ASD has typically 3 associated sounds according to UW, they are all about increased blood in RA. Increased blood in RA causes more blood do ejected from tricuspid (dşastolic rumble), and more blood to be ejected to pulmonary circulation which cause pulmonary flow murmur (midsystolic murmur in pulmonary region). It even can cause pulmonary regurgitaion like murmur, but most important murmur in ASD is typically midsystolic murmur. You can check it out on FA 2018 page 284 +2  
hello  Ok, what I learned: Extra blood in the right heart (due to ASD) doesn't lead to pulmonic stenosis? Instead, it's that pulmonic stenosis = most common comorbid heart association with ASD +1  
burak  No it's not pulmonic stenosis, it doesn't lead. Murmur associated with ASD is pulmonic stenosis-like murmur, because it's caused by excess RA and RV volume ejecting to the pulmonary arteries. So it's same location with pulmonic stenosis, and it's systolic. You get it? +1  
hello  @burak Yep! +