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 +0  (nbme21#30)

It's like Erb Plays. Axillary, suprascapularis and musculocutaneous nerve damages.

burak  palsy*

 +0  (nbme21#36)

It's hyaline cartilage, so we need the choose enchondroma or chondrosarcoma.

1- I think there are mitoses and some pleomorphic changes in slide, so it' like malignant.

2- Enchondromas are found in small bones of hand and feet according the FA, but chondrosarcomas are mainly arised in medulla of pelvis or central skeleton.

3- I wrote on my FA "Neoplastic chondrocytes in hyaline cartilage matrix WITH SMALL CALCIFICATIONS". I don't know where it is from but probably UW.

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

 +1  (nbme21#37)

Patient had central facial nerva damage 4 left hemiparesis; and all the images are from the brain. Either he has damage to contralateral cortical areas which represent these structures or corticospinal-corticospinal nerve damage.

Internal capsule posterior limb: Corticospinal motor and sensory nerves Genu: Corticobulbar fibers Anterior limb: Thalamocortical fibers

Syndromes caused by IC damage: Pure motor hemiparesis, Pure sensory stroke, Ataxia-hemiplegi, Dysarthria-Clumsy hand

burak  corticospinal-corticobulbar*

 +2  (nbme21#22)

Pleural space: Midcavicular line: 6-8th ribs Midaxillary line: 8-10th ribs Paravertebral line: 10-12nd ribs

So physician must insert a needle in 8-10th ribs in midaxillary line; but insertion below the 9th rib still has a risk to damage abdominal organs such as liver. Upper border of 9th rib is fine.

Uw question ID: 844

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH
burak  thanks!

 +0  (nbme21#12)

What does 3 narrowin means? Is that a cause of diverticulary diseases or the result?? And what is that photo means :/


 +2  (nbme21#34)

Orbital floor fracture:

1- Infraorbital nerve injury: Numbness and paresthesia of the upper cheek, upper lip, upper gingiva.

2- Entrapment of the inferior rectus muscle: Impaired upward gaze

3- Enophtalmosis

4- Clousing of maxillary sinus: Teardrop sign

minion7  if IR muscle is affected it is impaired downward gaze!!!

 +0  (nbme21#31)

Costal and cervical pleura is innervated by inercostal nerve, mediastinal and diaphragmatic pleura is innervated by phrenic nerve.Intercostal nerva pain typically felt closer to the pain, phrenic nerve (C3-5) pain is radiated pain by SUPRACLAVICULAR nerve area (shoulder). Uw question ID: 1535


 +0  (nbme21#2)

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.

burak  i mean, hyperacusis+hyperreflexia+sensitive startle

 +0  (nbme21#16)

Isn't it dependent on the location? I answered it coronary sinus because av node is located in Koch triangle; which composed of CSinus, Tendon of Todaro, Tricuspid annulus?

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node.
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




Subcomments ...

submitted by burak(9),

Pleural space: Midcavicular line: 6-8th ribs Midaxillary line: 8-10th ribs Paravertebral line: 10-12nd ribs

So physician must insert a needle in 8-10th ribs in midaxillary line; but insertion below the 9th rib still has a risk to damage abdominal organs such as liver. Upper border of 9th rib is fine.

Uw question ID: 844

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +2  
burak  thanks! +  


submitted by burak(9),

Isn't it dependent on the location? I answered it coronary sinus because av node is located in Koch triangle; which composed of CSinus, Tendon of Todaro, Tricuspid annulus?

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node. +1  
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 +3  


submitted by hello(83),

Please help

Mid-systolic ejection click = pulmonic stenosis

How is pulmonic stenosis related to the patient's ASD -- does ASD cause pulmonic stenosis??

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 +1  
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(9),

Patient had central facial nerva damage 4 left hemiparesis; and all the images are from the brain. Either he has damage to contralateral cortical areas which represent these structures or corticospinal-corticospinal nerve damage.

Internal capsule posterior limb: Corticospinal motor and sensory nerves Genu: Corticobulbar fibers Anterior limb: Thalamocortical fibers

Syndromes caused by IC damage: Pure motor hemiparesis, Pure sensory stroke, Ataxia-hemiplegi, Dysarthria-Clumsy hand

burak  corticospinal-corticobulbar* +  


submitted by yo(26),

I just knew that sperm need fructose, not sure what disease process this is though. He was pretty normal so 5a reducatase doesn't present like that. I wasn't sure if there was any odd use of the other answers. here is a link. Feel free to expand.

https://www.labce.com/spg27422_question.aspx

Fructose makes up 99% of the reducing sugar present in semen. This sugar is produced in the seminal vesicles. Diminished levels of fructose have been shown to parallel androgen deficiency and the testosterone level. Following testosterone therapy, the level of fructose increases. Although the fructose test is not part of a routine semen analysis, it is useful in cases of azoospermia (absence of sperm in semen). In azoospermia secondary to the absence of vesicles or if there is an obstruction, no fructose is present. In testicular azoospermia, fructose is present. When azoospermia and low semen volume exists, the fructose test should also be done, on a postejaculate urine sample to check for retrograde ejaculation. This occurs when the ejaculate goes into the bladder instead of out the urethra. The procedure for determining the amount of fructose in semen involves heating semen in a strong acid in the presence of resorcinol. Fructose gives a red color (Selivonoff reaction) and may be read in a photometer. The normal average is 315mg/dL fructose.

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. +1  
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 +1  
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? +  


submitted by burak(9),

It's like Erb Plays. Axillary, suprascapularis and musculocutaneous nerve damages.

burak  palsy* +  


submitted by hyoscyamine(23),

FA pg 217. Too much oxygenation can cause free radical damage leading to retinopathy of prematurity

mmm21  Okay i might be retarded, but why i can’t understand that they r asking about the thing that is damaged ? 😂😂 +2  
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? +  
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? +  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +2  
naught  Supplemental O2 may also cause bronchopulmonary dysplasia or intraventricular hemorrhage (germinal matrix, located in subventricular zone NOT choroid plexus) +  


submitted by ergogenic22(55),

why is protection of the choroid plexus, from intraventricular rupture secondary to germinal matrix hemorrhage not a possible answer?

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 +  


submitted by burak(9),

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.

burak  i mean, hyperacusis+hyperreflexia+sensitive startle +  


submitted by seagull(467),

! I hate these with a burning F***ing passion. Thumbs up if you agree

mcl  Amen brother +  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +8  
mcl  oh my god are you me +  
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! +3  
tentorium  [special] +  
tentorium  [special] +1  
tentorium  [special] +  
drhello  hello +  
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. +  
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 +  


submitted by hello(83),

Please help

Mid-systolic ejection click = pulmonic stenosis

How is pulmonic stenosis related to the patient's ASD -- does ASD cause pulmonic stenosis??

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 +1  
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! +