Welcome to champagnesupernova3โs page.
Contributor score: 93
Comments ...
drzed
I think the initial hyperchloremia would be quickly diluted out by the large consumption of water, so those two competing processes would likely neutralize the chlorine level, or even make the child hypochloremic.
+1
dulxy071
Wouldn't Granulation tissue be the (more correct) answer since the initial collagen laid down for wound healing is Type III collagen which is consistent of granulation tissue? Collagen is a vast for so many types of itself as we know
+4
kpjk
@dulxy071 she had a surgery 3 months ago
healing was fine even uptill 6 weeks ago
so the abnormality occurred during remodeling- when type 3 is replaced by type 1 collagen, so the answer wouldnt be granulation tissue
+6
pontiacfever
Keloid has both 1 and 3 types of Collagen increased production. Whereas, granulation tissue consists of type 3 collagen only.
which is why collagen synthesis as answer would be more specific
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Subcomments ...
cienfuegos
Thanks for passing off the knowledge. Regarding the last part, aren't morphine and codeine full agonists?
+5
hungrybox
Woops, E is also on the right side (also remember that imaging is looking up at someone, feet first). But a cerebellar stroke would have caused ataxia.
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usmleuser007
What gets me is that they mention that Left 2/3 of face is affected. This should indicate a non cortical innervation as most of the cranial nuclei are bilaterally innervated from the left and right hemisphere.
If left 2/3 of the face is affected then it should also mean that the lesion is after CN5 nuclei.
+1
yotsubato
@hungrybox
Thats not the cerebellum thats the occipital lobe. You would see leftsided homonymous hemianopsia in that lesion
+8
mrsmac
To my mind, it is simpler to consider the question first in terms of blood supply distribution. Left sided hemiparesis and weakness of lower 2/3 of face are both indicative of a MCA rupture/stroke (First Aid 2018 pg. 498). Furthermore, since the injury has affected motor function we would be considering the descending tract i.e. lateral corticospinal which courses through the ipsilateral posterior limb of the internal capsule then decussates in the caudal medulla.
+1
mrsmac
You're considering the wrong CN here. CN5 motor function involves muscles of mastication and lower 2/3 of tongue. The nerve in question in this case is CN7/VII Facial n. CNVII UMN injury affects the contralateral side, whereas LMN injury affects ipsilateral (First Aid 2018 pg. 516). i.e. before and after the nucleus in pons respectively. I hope this helps.
+3
nala_ula
Spastic means UMN lesion, since they also don't specify if there is arm or leg weakness, I didn't assume it was MCA stroke. I went with the reasoning that for there to be spastic hemiparesis, there must be damaged to the UMNs and therefore the internal capsule is where these tracts are.
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champagnesupernova3
Omg this whole discussion is confusing. Internal capsule contains ALL corticospinal and corticobulbar fibers = contralateral hemiparesis and UMN facial lesion
+24
linwanrun1357
If there is a choice about asking what the patient is worried about. Is this right?
It does not sound like a dick :)
+4
champagnesupernova3
If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him
+1
brasel
also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time.
+1
champagnesupernova3
FEV1 is increased due to greater recoil of the lung tissue. FEV1/FVC is increased bc of that and bc of decrease in FVC
+1
mangotango
But I thought with restrictive diseases, the FEV1 dec a little and FVC decreases a lot, yielding an FEV1/FVC ratio that's normal or increased??
+2
an_improved_me
Yea the OP is wrong here. FEV1 does NOT equal expiratory flow rate.
FEV1 is not a really a rate; its a volume of air pushed out in 1 second specifically. This will be decreased in a pt with ILD. This is because the volume of the lung decreases (due to increased elastic recoil).
Expiratory flow rate (in this question) will be elevated, b/c of the answer stated.
From uworld: "[fibrosis] causes increased lung elastic recoil, as well as airway widening due to increased outward pulling (radial traction) by surrounding fibrotic tissue. The resulting decrease in airway resistance leads to supernormal expiratory flow rates (higher than nromal when corrected for lung volume)".
+3
drdoom
You canโt rule out suicidal thoughts via inference.
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drdoom
LAWYER: Did you ask the patient if she was suicidal? DOCTOR: Well, um, no, not exactly โ but, I mean, she seemed okay ..
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drdoom
LAWYER: So, a patient walks into your office, you suspect post partum depression โ a diagnosis with known suicide risk โ and you didn't ask if she was suicidal?
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beetbox
@drdoom wow ok now this will stick to me forever. Always ask your patient so I can avoid lawsuits!
+1
champagnesupernova3
Reducing acid production helps mucosa heal alot more than increasing prostaglandins. We learn about misoprostol because it can be used if you dont have anything else but you're never gonna choose it over a PPI
+3
sympathetikey
Exactly. That's the only way I got to the answer.
+4
pakimd
isnt increased alk phos consistent with increased osteoblastic activity?
+1
champagnesupernova3
A defect with chondrocytes would cause an short limbs like in achondroplasia so those are ruled out
+1
pg32
Exactly. Can also be helpful if you remember that the clavicles are formed by intramembranous ossification rather than endochondral; that allows you to rule out the chondroblast/cyte answer choices.
+7
usmleuser007
These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score.
+2
xxabi
I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental.
+24
xxabi
Also its the only one that's an opioid antagonist from the list!
+2
redvelvet
they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it.
+4
champagnesupernova3
Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis.
+2
usmleuser007
These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score.
+2
xxabi
I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental.
+24
xxabi
Also its the only one that's an opioid antagonist from the list!
+2
redvelvet
they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it.
+4
champagnesupernova3
Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis.
+2
zevvyt
methadone isn't a pain med(even though it's an opiate), it's used for opiate addiction. And hydrocodone is used for "moderate" pain and this person is in "severe" pain.
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shakakaka
Drugs for neuropathic pain:
TCA, SNRI, Anticonvulsant, Opioids, Lidocaine, Capsaicin
+1
champagnesupernova3
They tried to confuse us saying both low dose and high dose dexamethasone didnt suppress it. But when ACTH is low you dont even need to do high dose dexamethasone test. The high dose is only to differentiate between Pituitary adenoma and ectopic ACTH production
+8
hungrybox
@champagnesupernova3 fuck they got me
+16
azharhu786
They got me on that question as well. I thought it was ectopic ACTH production due to some paraneoplastic syndrome and this is why Low/ high dose dexa is unable to suppress it.
+1
skonys
High dose dexamethasone would rule out Cushing Disease because the adenoma responds to cortisol, just at a higher set point. But even before that, the ACTH is low, so it can't be A or B because they would be high. The problem is downstream; low ACTH -> body saying "NOO! Stop! You can't just keep making cortisol!" but the zona fasciculata is like "haha, negative feedback go brrrrr"
+2
utap2001
Low dose dexamethsone is just for screening of Cushing syndrome(adenoma, ectopic, adrenal). For rule out normal person. High dose dexa is used to D/D adenoma and ectopic.
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brownielove79
can it be a facial nerve??? with lateral head trauma (injury during passage through middle ear, or external auditory canal??) doubt!!!
+2
doodimoodi
Olfaction is actually more important that tongue sensation in terms of food taste (think of how food tastes bland when you have a cold)
+2
champagnesupernova3
If taste is completely lost then it's an olfactory issue. If its lost only on a part of the tongue then the nerve that provides taste to that area is suspected.
+14
veryhungrycaterpillar
UWorld QID 12227
The sense of taste isn't lost due to CSF in the nose, but due to avulsion of olfactory rootlets.
+13
topgunber
yeah i wanted something to do with chorda tympani but i guess its something to remember
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redvelvet
Patients with hepatic ascites have hyperaldosteronism; because the intravascular volume is escaped to third space(ascites). So adding spironolactone is a good choice.
+3
bryno20
My rational was a bit different. The patient likely has hepatorenal syndrome leading to a the ascites and decreased GFR. All diuretics, except for the steroids (eg, spironolactone), require secretion into the PCT in a GFR-dependent manner; for this reason, patient's with renal impairment show best success the steroid diuretics since their action is independent of renal function and GFR.
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utap2001
RAAS system is increased in hepatic disease and HF, ACEI or ARB are good choices in diuresis therapy.
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kcyanide101
I got this question wrong... My mind set was that in cirrhotic cases they have hyper estrenism which accounts for the spider angioma etc.... As such adding spironolactone which is a potent blocker of testosterone will make their condition worse :(
+2
epiglotitties
@kcyanide101 glad i'm not the only one who went about it that way
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champagnesupernova3
FA says you cant assist suicide but you can prescribe pain medication which they can conveniently overdose on
+1
dickass
"Physicians may, however, prescribe medically appropriate analgesics even if they shorten the patient's life." (wink, wink)
It's vague, but I guess the main point is to let the patient have relief, side effects no longer important. I still don't think you can just give the patient a bottle of benzos though.
+1
champagnesupernova3
FEV1 and FVC both decrease but FEV1/FVC actually increases because FVC decreases more than FEV1 so the ratio increases
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imnotarobotbut
How is one supposed to know this before having read this article?
+37
imgdoc
This question falls under the either you know it or you dont category. It isnt in FA or Uworld
+2
jaxx
So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-|
+9
usmlecrasher
and there's so much unnecessarily BS instead of real questions
+3
j44n
I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center
+9
feanor
This Question is a perfect example of where you just jump off your seat to demand a refund or you decide to go Antisocial Disorder on your computer screen.
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olddoc
I don't think it has to do with any extra info. The dx is FAP (mutation in APC gene) which is inherited in an AUTOSOMAL DOMINANT fashion ("A" is the mutant allele and "a" is the normal one. The girl in the question stem MUST be heterozygote "Aa", getting the mutant "A" from her sick father and "a" from her healthy mother. Assuming she marries a healthy husband (aa) (this is a normal assumption in genetics questions), their kid will be Aa (the phenotype that will 100% result in CRC) by a probability of 50%. Recall that FAP will 100% progress to CRC is not prophylactically removed.
+5
conniea168
It sucks because in psychiatry rotation as MS3 you may come across this fact that rate is ~50% in identical twins, but other than that it's unfair for Step 1 :/
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Diarrhea causes loss of water, Na and Bicarb. Remember that diarrhea is a cause of non anion gap metabolic acidosis because the loss of bicarbonate is compensated by increasing Chloride reabsorption. So she can have hyperchloremia or hyponatremia due to intake of only free water for 24 hours. But she has SEIZURES so hyponatremia is most likely