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Welcome to chandlerbas’s page.
Contributor score: 95


Comments ...

 +2  (nbme20#19)
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treehi eaddlbr ceacrn rna(etulali in tihs )scae ro iaasiornlttn clel rcnmaciao aos(l inu) rae atpiteidcepr by snmgkoi ltnniaha ctiox nijru.y BTU atwh tesmatr orem ntha the uecas si ttha eht rreead ezcrgoein hatt itsh is tuwitoh a bdout

oivctsetrub hshdioosyenrpr thwi ltddiea lipeeaallvycc mysset dna reoxtc fo ynedik gnshoiw thporya nad innntgh.i

guAsmsin ttha the pt solt odlob rfmo eht AVM - htis dlwuo rruhfte ceennha hte laenr semhaiic C(TP dan sdagcinen HLO era obht yvre svtieines to ccsmhiie dntscniooi 03 smteuni of lobdo loss is noeguh ot txeeabarec eth ardylae icchesim tsni.doncoi


 +1  (nbme20#9)
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dLg:nee

OB = ceootblaitss

CO = otciellss/etoatysitcoco

ast,=petorP rse=tBba, eikdy=,Kn tToi=,rdyh Llnug=

ym o:imm ncneu Ldae etKetl

---------L-----------------------B--------K--T--------P-

-------------COC----BO-O-B---/-/-O--O--B--OO--CC-

lilyo  @chandlerbas is this pneumonic in order of most common to least common, as in is prostate cancer the most common cause of metastasis to the bone regardless of wether the patient presents with osteoclastic or osteoblastic lesions? +
hello_planet  One addition: Breast cancer causes mixed metastases, whereas lung cancer causes either lytic or blastic depending on the cancer type. Small Cell Lung Cancer causes blastic lesions and Non-Small Cell Lung Cancer causes lytic lesions. First Aid 2019: pg. 224 +2
doublethinker  Uworld has a great Venn diagram on all the bone mets. +1

 +1  (nbme20#23)
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gralhit tsel do i.tsh some fo eth metsocnm ewre yaellr ewll i,dxleanep eoehwrv mi inogg to try teoahnr r.ueot estl aedl hwit paK csein the rheto cnmmeots iaadxeenpl Vd llwe gh.uneo ksoud eslo.faef/llls

ristf hintg si you vhea to diemteenr if its an icad or b.aes 90% of teh item tsi nogig ot eb a keaw icad, we miplse tond lmeotaruf hmcu dietimaonsc as aessb in r.lenega olsa sit sdiuom tasl nda CNS so uyo okwn it sah ot be a.ibporhnatble estp (1) wlo Kap smaen acid -(4)7. uyo ustm knwo tsih. 2() oyu tsum onkw thta all cisad ratst off tanelru adn enth esol na oni ;&--gt mngboice da.hcerg adn lla sbesa ratst ffo adrhcge nad tnhe selo an ino ot beceom lranetu (itsh si why ew otdn seu bacis gsudr eeaubsc htis eaulntr ghrcae hsa a hhig dv and tpsdeois in stuesis = abd ni le).eldyr oyu nawt agerhcd cb atths thwa si yldhpocirih kaa pee ti u.ot )3( tnxe use awth i tsujj disa dna laypp ti to hsti acth:r

2+ = %99

1+ = 0%9

1- = %10

-2 = 1%

teh sfrti nrembu rsrepteesn the ndeefferic tnewbee pH dna pKa (paK si evign yb eth qsniotue lywa,as) pH is tawh you ghanedc ehnw yuo lidlaznaek eth unri.e os fro ihts ntuieoqs it ulwdo :be -HKapp = high ascib eualv g;)7&t( nmisu kpa ( ekaw icad .-4)7

won eth docens rcepgeaetn spertersen teh artepegcen fo odaseiitscd tp.noro os for an acid, teyh illw coemeb a,egcrhd htis mnsea taht if teh ncfieefdre enwbeet the ph nda apK si voer +1 hnet 9%0 of the idca lwil og fmro atluner to ahged.rc fi eth hp si +2 aregrte atnh KpA then 99% fo eth cida lwli veah tsol tis nporot dna bemcoe ehgcard

lset zemirasmu h:sti eerw lodt its a eawk aicd = kaa apK nweteeb .47- we ntwa ot egt ot eakt eth eawk daic mrfo its ernlatu mrfo otni a rdacegh ormf ot egt dri of .ti so ew aanlzeakil het rien,u uesceab beass era rihgeh Hp oyu liwl gte a remo + berumn stuh eht ewka aidc ilwl og omfr euntarl to ghecdar and be exer.cted


 +3  (nbme20#2)
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i tkhin uebcaes htye ewre os seiipccf ni ditael rof nhew the xs na,ebg eehryt irngty ot ttes su if we kwno hte eotns of rtao vs nurrsoov.i oasl fi uoy kool ta eht timronnsisas fo vsortirua sit FO dna eprrtaryio,s os sslune reyou lgypina twhi popo at a d,ndwgie its umch rmeo elylki fdoo was eth nn.rimatissso etyhcks ayss meyniat uoy thuco fodo iwth yuro ndhas tis oron

heesr a labte rof .ereecrfen tuofij6.yream/-ompc2rtou/:ha-c0cpttri-lbh6etrbrtc/on/sateroptnmteh1iouo/sgsn/n-1caaem/apesrrysrlsceia.sia0ypsi2euseact

dhkahat  well i personally enjoy tossing the feces around at weddings but what do i know +1

 +8  (nbme20#31)
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otn suer fi uyo all ehav enes het ldowur ahrct Ddx ofr bakc anip utb i udonf ti elyrla f.peulhl lli mmusrziea it her:e icotidnon key( tvtd:) aegfraieeueern toseoiirhrstta patlii(noos ivedeelr ihtw )rtse, idrachyaoplut - cisd hsradoea(rnttiiaien ot het egl aak sulegae s),ign aslpin (ssioatspneni thwi )t,adinngs lh(oslytpdoaeprdneeryvi wtih exriee,sc dna nidmodnta at r)t,es silnap snsmnaitoaatet(stsc ai,np esrow ta nti,hg ton elvreide by soitlinoap g)cesnah, vletbrrea ltfeysaoloicsoeimt( rsns,dneete uecta kbac p,ani adn ,evrfe) tciaro tcdoisensi reseve( rtoletaesrrns ,iapn irndtaiag ot het kc)ba

cbreland  What page in FA is this? +

 +3  (nbme20#19)
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LOEPISR EATRL ofr uufter rsred,ae het tteconn lolwoifng may ctnanio cujtebss nsee ni roeth ENBsM


 +6  (nbme20#14)
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v"wreeo,H ni het yres,a the lcierbata arnpett fo sltmcpenyeo ssieps vaeh eenb hgagncni. The most pntoritma luacdeaspt nophetag is Scretccsuptoo peumoinnae (r.tS aoeeun,)mnPi but saehluoHimp nuzafnile au(IennHfle)z. and sasieirNe nienmsidigit (.N giesmnintid)i era loas inig.fitascn In a tuyds of ,169319 goreniptr 934 oepeidss of sssiep in sateitnp twhi i,lseaanp 5%7 fo niniseotfc adn 59% of atshde ewer adceus by trS. ee.u"inmnpao 1ww.hs4.an7es//6vPl1cb:ptlci0C/.o/wm.cmginnhpti//M2rt

ethyonls i ditre ot ifdn atda ot rptpuos io.ECl or yna eighrh krsi of marg - isesps, ubt npumoe si ilslt oeumrn uno

fatboyslim  FA 2020 page 186: Asplenic patients (S. pneumoniae>> H. influenza > N. meningitidis) +2

 +2  (nbme20#16)
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tP 1 s(akte ciitcr ca)di

Pt 2 a(stek cdna)y

tP 1 (x2 slivaa = hihg olwf reat, C2lNxa lirt[vaener - ren]i)go

tP 2 x(1 avlasi = owl wofl e,tar NCaxL1 n[ogire otn p)im]

Pt1 = ccitir cdia *stim dctaul lelc ot trecsee rceaunlatrill ltcaud atregso of b.irabc bbaicr lietasuzrne tccrii id.ca usht wol ibb.cra

P2t = wlo olfw ra,et huts omre bbiarc erbroaesbd out of tc.du htus low iabbrc

why do yeth ahve hte mesa cbrbai, cesbeua lwo lwfo era.t

avi* chA slagni adritnsoutnc ot rinaeecs ralnlecraulti acltdu mcliacu elserea &g--;t OCH3 dserto isnedi duatlc lcle


 +0  (nbme20#16)
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hestre an tcoiaoassni mdae ni 1270 wiht aiglenirtm igalrnaeu nda MS - chhwi is htwa i knhti hsti tp .ash yke gnhit ot onte si atht liwhe lla torom dan osensyr fresib fo NC 5 etnre ta the lelve of eth pons rwve(heo soem laos do rnete at the lelve fo audllem adn enve eht cs avi eth inspla tctra fo 5 to easypsn hitw hte nlgo rsoysne nuesucl of 5) hrsee the nlik fo mrtlgeaiin lgaiarneu and S :M6i7cPh.swb:rw//vnisol44ic3nMpmhmwaglC.ct5t//te/..np9/


 +1  (nbme20#49)
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erseve yeehsopnintr adles to hlycsieratpp cristrleroioassloe ialdegn ot oeerhcsareirropstololsin F(81A' gp-- )729


 +3  (nbme21#47)
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sereht os umch irno ni hte oldbo ttha ti sha to go hwsee.more it gose tino eht elscl ni the oydb snidrce(ae trfrni)ei and ti dnbsi ot eht rrcreia ortsrpant tproeni ennitrsf.rar cusaeeb it bnsdi to lal eht sferanrtrin uyo heav olw refe ref.anrisrtn ubt oury ybod sneses het lwo fere nrenfrtrias dan eosg ko" lal ym ntafnrerrsi ear lulf fo rnio I gessu mi ok i todn ened ranemoy oirn" so it psots nkamig .rseatfirrnn os lwo eisarrnnrft ro oltta iorn nndigbi patacyic eb(mmerre shit si tsuj a nfcya way of saginy ti dontse natw ftn)e..asr..nirr wno firnse%arntr tas si ujst athm (i aeth th)am tis lkei his:t o/irTIC,nB we rledaya tgo hhgi inro os oruamrent si ,ghhi nad owl dmntnroiaeo bc lkei i dsai ITCB is low os elovrla uyor srfeitrr%nan raisonutta si eryv ighh. shit si teh tbse datiniorc fro hemrcstaisohomo


 +3  (nbme21#13)
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tp xs tno vipsereosn ot teyidra enagshc ro srsset cro.deintu sstrse cliorst(o) ecrseseda nstrglaidoapsn 732 lrso(e fo itls)o.rco so erew ltdo thta shes ddeceur ehr esrsts os aiglolycl hre oostlric odwlu be le,ss nsibthnidiigi tdosrlgpaanin no.tcpouidr tuB erh Sx itlsl trepsis? athst hyw i uedlr tou ssopomrl.io laos i rmebreme fmor hyktsec thta spip are elirrevrsebi bth mi not alelry suer fi ym lolcaig fwlo is gi,trh utb ekli het yug in teh othre otmscmne as,id ozlomeaepr wlsa.ya usjt like CiEA dan eiooerttdc bbya


 +2  (nbme21#16)
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TDL:R tlsa snecnete szmiusarem it

hTe taxec eacinhmsm dunynrlige ABV oolflgniw ASD orluces esirnam siap.cveltue eW cna hotzeshyepi atth hte spslbieo nscaimhme fo VAB si an nyatiofmralm esreopsn nad bnssutueqe aeedm as a rrltovceaei erluts of mlcaachine brugbin of eht cudlcroe gaasint teh mapxroli otucdniocn sysmte. ehT mrnsaig fo het cnudmesu laaitr slptea ecdfet cuideln namaB’scnh ble,nud het priayrm phat rfo llaeecicrt occnuditno omrf hte trioiaslna endo to het onarcrartiivlteu ed.no heT eraiaritonlcvrtu nduictonoc ,ueldbn hhciw geermse omfr ncam’aBhsn leudnb in eht erotanuiivacltrr deon eaar to nudctoc acerltclie pmeusisl to teh ejknPiur ir,befs si lyslcipaee erpon to agm.ade

onauicirrArttevl kcBlo uSntbsquee to ioarpaneveIrtt eiveDc urseloC Aalitr Saplte efcDet whit tnrraocsihacT iaMminl iaI;vnnso A reRa dna sSrieou nCiooi acpmtl4lMc7///P/rl.2stti.t:hpbaos/nw/mgc.iCwinmep.c2vw53nh3


 +0  (nbme21#12)
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rmebreme giosdmi conol hsa hte ltlsemsa remdiate ncee(h hyw Lfte ddies CCR ucprsedo het eppal c)roe innaemg that it is oeprn ot ihehgr sserperus in ndcaaoeccr ot le'lpcaa law eusresrp( relsinevy oorlrantipop to teimdaer) thus allms ietrdmea = hgih peerssur = noper ot iiltudraevc aoorntfim

chandlerbas  one more thing. this question is not realistic. 5 years of constipation, with fever and chills...yet no hematochezia? ya ok there +
chandlerbas  wait never mind, the inflammation scars the vasa recta so no bleeding. thanks for coming to my ted talk +2

 +6  (nbme21#38)
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eTh esrasrhecer ofnud htta oeeplp ohw eitcrpapidta ni naemyllt lenhcnlagig itsciiavte tmso fonet, bhto lryae nda tela ni ,ilef dha a swrelo trae fo dielenc in emromy pdeacorm to tseho ohw did ont ggenea ni hcsu ic.ttisaeiv Even nhew lpeope adh leqsuap dan esltnga nad roteh sgisn of amgeda to ertih bsina,r mtenla ittnoulmias eemeds ot hlep cttorpe ryomme adn nnikhtig lks,sli atugoicnnc for tbauo 41 entcrep of eht cedfeifenr ni dcneile ondbye hawt wldou eb dxctpeee naahsPrhit( Vuie,mr DPh, bEeitlhaz C. om,onriM Dh:P Cigtone“vi gtntSaiuilm etiAtivsci to epKe taieeDnm ta ayB.” ,ygeoNlrou lVo 81. )2310

oals hte ywa i ese it, AD pst heav soepbrml htwi hcuosamppip e(..i rosth mtre memyro eowpr )soheu os geinkpe estno adn tsisl ro ahvwaaevt ihgmt pleh solw ihetr etgoicivn elncedi as llhyet eb gekinep eht pcpaupmsioh eorm evaitc


 +2  (nbme21#5)
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shobnruc notrtcubosi ta rps gxyeno in ialloev no rionnget aebl to nrtee csahporetmi( ria teniegrn doby 78%( troegnni adn 1%2 y,noxge itnognre is os prntimota tgrennio cb it si a pyoolr saroebdb asg adn sthu is in rgaehdc of neigkep evailol eantx )yfeindgol ni hte iolvael si rabosedb iotn teh nlerodo dugbic het lveoum of eth vieal voolrlaela cpellaso snipoaotbr elatscitsea

bethune  Why is pulmonary hypertension incorrect? +
samsam3711  PEEP allows the alveoli to remain slightly open with exhalation to prevent atelectasis. Pulmonary Hypertension is going to be related to vascular changes (instead you might see shunting of blood in areas of poor ventilation) +1
drzed  Pulmonary HTN occurs because of pulmonary vessel vasoconstriction. This can occur d/t multiple factors, but one of the most important ones is hypoxic vasoconstriction that the lungs will undergo (for example, at altitude). In the setting of PEEP, you are ventilating the lungs perfectly; this allows for the pulmonary vessels to open up and not undergo vasoconstriction. Thus, you prevent pulmonary hypertension via hypoxia. +
peridot  @drzed by your logic, you're arguing for D to be the answer but the correct answer was about preventing atelectasis +
medstudent  The question is what’s key. The purpose of PEEP is to keep the airway open. The purpose of ventilation with supplemental oxygen can help with preventing pulm HTN. Could be wrong, but that’s what makes sense to me. +




Subcomments ...

submitted by jambo2222(28),
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sI’t an soascmrta.ooe maScaor = mognueeohtas stem. ’Ist in eht gles os hkint ohw a VDT seog to lg.un meaS d.eia

tinydoc  Perfect way to remember it. Thank you! +7  
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1  
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +13  
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +  
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1  


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tzeacoaronIl ueqsirre het dicaci ovtnnienmre fo hte ahmtsco ot eb sear.obdb epaoerzOml bistiinh eht K+/+H mppu of the sth,aomc tbeyrhe garceensdi teh dtyacii fo teh smth.oac oS wnhe eth tpniaet eakst pzmeOeaolr adn cleotInraazo etertog,h laenIatroocz nw'to be dbsroeab oint eht y.bdo thTa's hyw ti sha on fctfe.e

'Its odememndcre ot eatk idctneoisam at talse 2 ruhso iprro ot aingkt an .daactin

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +3  
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2  
chandlerbas  just itraconazole and posaconazole +5  
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5  
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +  
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +8  
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +  
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +  


submitted by poisonivy(30),
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Per orUW;ld scaciiapn foudn in clihi prpepes caseus sesexivec ctnatvoiia of 1RVTP at(rrabenmemsn ehn,)lcna wchhi sereiasnc ullecaralrnit iclaumc tath erstsul ni ongla-gntsil dtnfnucoysi fo eicpcivoetn vneer sefibr ione.aotil(un)aficzntd It lsao cesuas leesera dna ndtlpieeo fo cusStbnae ,P scnuagi at tifsr ignbunr adn ehrematy tbu evro iemt uecssa eerescdda iapn eossnn.tia

chandlerbas  also topical Rx for post herpetic neuralgia +  


submitted by louisville(12),
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ytenleelbheu-M tnadies falce masre eedvlre ursoenmu oehnpustilr but( otn any mosns.riag) agleihlS si oerllcsso nwhe sidatne hwti mtheleyen lue;b E ilco stsnai lbeu thwi emyenhlet eubl eeasubc it esrtmfen oet.acsl

sympathetikey  E. coli stains green (just fyi) otherwise, perfect. +13  
chandlerbas  only E coli stains green, all other lactose fermenters stain purple/black (just fyi) otherwise, perfect. ;) FA144 bottom +4  
dmotav  I think this is actually a separate concept – E. coli stains "metallic green" on eosin methylene blue agar, which is in the E. coli sketchy and first aid. However this question is referring to the methylene blue test on a fecal smear. From what I can gather, this test will be positive (indicated by presence of neutrophils) in cases of invasive diarrhea (i.e. shigella, salmonella, enterohemorrhagic E. coli). The test will be negative (no neutrophils) in cases of diarrhea caused by toxins (cholera, enterotoxigenic E. coli, giardia, viral diarrhea). So even though E. coli can present with fecal PMNs (if it's the enterohemorrhagic type), I guess that's less likely than shigella? source: https://www.ncbi.nlm.nih.gov/pubmed/4554412 +3  


submitted by niboonsh(338),
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sWAcFy/u:.vpw0thwa=qwuoetk/mNcwGF/htbWo?t.1 csclyoneluhnici ullasyu ash v fast dnrutoai of onctai zcbu omeditazelb yb palsma pheles.onoiscdaeurste Whti licaatyp leoeeeoa,usnprdsciths ecasderde elamomitsb of ohcncueinlicysl nad uths csseau a oegdprlon atrundoi of anitoc of llcsuoehnicciyn &--;--tg NEPAA

chandlerbas  i love that mosquito and then SLAP +  


submitted by hayayah(1057),
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tBae klrcseob sa mhsarctrainytih rsssuepp nlaobarm easapemrkc yb ricgdaense hte epsol fo phase 4 -;&-tg lnpgnriogo aspeh .4

chandlerbas  piano player sliding the keys to the left ---> delays diastolic depolarization --> rate control +7  


submitted by ergogenic22(303),
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ggnai rusestl in ensidecar rlarteai efssitfns hea(cgn in atxrE rulecllaC artMxmi inposomtcoi - edreacdes nlitea,s sdcreenia gloelcan o;edpst)noii HSI is olbrnseipes ofr %800-6 fo THN eascs ni npttaies ;tg& 0.6 sAol, erseddace omicplaenc sa a utsrel fo agngi sceaus esiraendc peusl srsperue

rio19111  why not dev. of coronary atherosclerosis? +1  
pakimd  @rio19111 i think the Q stem is asking in absence of any lesions of blood vessels; the number and severity of which increase with age. So with normal aging SBP should increase in isolation which may then result in the development of coronary atherosclerosis- if that makes sense +1  
chandlerbas  aging causes decreased compliance in large arteries: (1) accumulation of collagen and calcium (2) degraded elastin and large arteries accumulation and it also may have something to do with lipofuschin +1  


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tlacrIonaezo erseqiur het acciid itemevornnn fo eth ocmasht ot be eabsd.bor zemrlopeaO nihsitbi the K/++H upmp fo teh macost,h etheybr isrcgneaed hte ytiadci of eht ahmtsc.o So wnhe the ntpteai sktea olpOazreme nda ateoczIonalr ttghr,eoe tcraoaoneIzl wtno' eb bsrboaed otin hte dy.ob hTts'a hyw it sha on ect.eff

'sIt eemmecdrdno to ekta tsienimdoca at estal 2 rshou porir to inkagt an .iatdnca

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +3  
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2  
chandlerbas  just itraconazole and posaconazole +5  
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5  
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +  
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +8  
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +  
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +  


submitted by hayayah(1057),
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aaietCtp dna naelut era ni eht ercent of het ma.lp pteCitaa is nto an niptoo, os naeltu is eth ea.wrns

itoDialonsc fo lteaun may aceus aecut lnucnlratpae nrsmyeod.

yotsubato  Lunate is the only carpal bone that is frequently dislocated. Scaphoid is frequently fractured. Hook of hamate is also frequently fractured. +3  
redvelvet  and also point tenderness in the anatomical snuffbox may indicate a scaphoid fracture. +3  
chandlerbas  yes lunate is the most common dislunated carpal bone ;) +4  
almondbreeze  FA 2019 pg. 439 : dislocation of lunate may cause acute carpal tunnel syndrome +  


submitted by dickass(84),
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toG htsi eno norwg euaesbc fo teohs 2 fdfacneuet c.hrenldi eres'H teh xaopnnliaet omfr FA gp :95

ndaorlMtiiohc ierehtcnain - demrtTtnsai ylon tgohuhr het er.mhot All snogpriff fo tadfeecf elamfes may sowh ssign fo eas.sied

laaVeirb sesxniroep ni a ouitpnlpoa ro evne iinwht a yaiflm ude to hpeloaemsrty.

oeprlyHastme aayblislc amsen htat pmlelitu oirhdmctnaoi rea trtstmidaen ot ache inpo.gsfrf eirTh ritao may angceh at echa eo,ngartein adn useac more seveer or sles vresee sdi,eaes vene iihtnw het asme ilyafm.

hsToe acedueffnt sdeud ukceld uo.t

dickass  That'll teach me not to skim FA, you really gotta look up the words you don't know. +  
chandlerbas  heteroplasmy is a fancy way of saying variable expressivity just specific to mitochondrial diseases i do declare +  


submitted by strugglebus(163),
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heNreow evah I eben laeb ot idnf ywh hte lhel shit si a i.ghnt

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +6  
breis  same^^^ +  
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +  
chandlerbas  you had me at its not in sketchy ;) +1  
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +  


submitted by nuts4med(6),
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neAoyn aevh an idae ywh het ddecrseea ertilraa 2O tanroitsua is ?ceritcnor ngmAiuss hes ash lupm aedem sneic esh sah EL e,daem ndut'lwo a erowl O2 sta be excdtepe to?o

haliburton  I believe there would be no decrease in O2 saturation because oxygenated blood (high pressure) is shunted into deoxygenated circuit. As long as the lungs can keep up, this should increase venous oxygenation on average. +7  
hungrybox  ty both of you for this, was wondering the same thing +  
coxsack  O2 sat won’t change b/c you’re not adding deoxygenated blood to the arterial side. You’re just taking arterial blood and putting it into venous blood. Same reason why L->R cardiac shunts don’t decrease O2 sat (while in contrast, a R->L shunt would). +4  
hungrybox  just realized: the high pressure of the arterial system keeps out low-pressure venous blood in an AV fistula (probably obvious to most ppl but it was a eureka moment for me lol) +2  
chandlerbas  ya you wont have decreased arterial O2 sat because oxygenation of blood is perfusion limited (FA19 --654) therefore oxygenation of the blood happens within the first .3seconds of entering the pulmonary capillary that you could even handle having more deoxygenated blood enter +  


submitted by nwinkelmann(285),
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oS I odelok noit tshi trehurf too cbsauee I tpetry chmu wkon htngino otaub eth akme up of n.emes morF het arrcehse I ud,nfo as sa sedtta lowbe yb ,oy sfetourc si the tmos itrampnot cnoenisttut of seenm in rtmse ro msrpe ontnfi.cu eBowl si noiotimranf I odufn to edarssd hte heort sewnar co.chsie

inZc neieyccfid (in ,rm)esu erp ,AF sah eneb icdelptima in aelddye woudn hilea,ng dspepseusr ,yutnimmi mela poys,nmidaohg deacesdre adltu irah axlari(l,y iaflca, pu),bci a,disesugy asinoa,m diracsatrmteiom eohiaarttcepn (cfeted in tniaietsnl cniz saobpo)r,nti nad yam rsepdopsie ot lhoacloci irhc.soris AF 'nidtd syciefp the eevlls ni the emsne, tub per hte wlboe atei,rlc snelima znic tontnec asw uofdn ot eavh orn iaroocetrnl ot mrmp/esnsee /teylccttvv/il.ieea I nod't wnok fi rw'ee ospdpsue to wonk tth,a ubt wno I od, oll. nnsbn.7gb5..7vt0t/wuhpm/p3mwcelii.:/od/wh35.

As gnuoxbryh ,ndeoemnti mineleslu is ynlo mienoetnd nceo in FA as a earetntmt for neati, so I dookel ntoi it r.ehurtf leinmSue si a tonntce of e,msne btu lelesv vary os mcuh ttha ti vseers on noosgtrpic ilnclca cealernve to iyftnltri,ie rpe iths ertaicl: 5p./wim2sg.lwttph./e.dvo/1iwmbc0hbun/:33n2n.

To rule tuo lla fo eth ssrnawe ceea(bus I d'idnt elaylr onwk ihngaynt obtau eht uilytqa of eemsn), I nofdu isth B"y as-ttiitst,sc ereth swa no iigifacnstn ceefefnrdi in teh semne aN ocotcieatnnrn omang the rdtfienfe orpsug (7 usgrop ltato sadbe no pmsre n,)ctuo dnniigcait the itnnsifiagicn reol of aN ni esmpr .yiit"l.mto 2p1//nhcvl/5sw7mtg./bb.p:nhwiwnot.2.ei1mud.

ain,Flyl I 'dotn nkith het hla-5ap csrdtauee emzeny si auylclat ni ,eemsn btu I duocl eb g.nwor tEierh ywa, ti o'ltudwn be rnmyoalbla evtedeal ro wol if teh toetsnteoesr sllvee rea nmarlo.

bartolomoose  as per goljan, selenium is involved in glutathione peroxidase +  
chandlerbas  selenium has a role in glutathione peroxidase. excess selenium = garlic breath, hair loss, and nail changes, might see peripheral neuropathy. deficiency (pt on TPN) = dilated cardiomyopathy +  
chandlerbas  also zinc aids in sperm motility https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773819/ thats why i chose zinc but whateverrr im over it +  


submitted by nwinkelmann(285),
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oS I dekloo onti sthi erhruft oot uceabes I trpeyt hmuc wnko tgniohn botua the meak pu of es.mne orFm teh cserrahe I nfu,do as sa atsetd oelwb yb y,o rcteoufs si eht tmso rpontmita ttoticneuns fo emesn in smrte or rmesp n.ofcitun weoBl si oiotrfamnni I unfod to sddraes the rthoe anersw ecioh.sc

Znci icyicneedf ni( user)m, rep AF, has bnee ltedaimpic ni elaeddy dnwuo hnlgi,ae sespsupedr y,mtuiinm mael dgmaoysohni,p eresdedac datul irah xllia,a(yr al,fica ,bcu)ip esgsida,uy oa,asmin cateoirirmastmd ertnpaetcioha e(ctdef in teinaitsln cnzi anrooip)s,bt dan mya sedespropi to lcaoolhic c.orsiihrs AF dtn'di ifyceps hte lleevs in hte se,nme tub rep teh elwob tica,erl mlnaesi cniz notcnet asw unfod ot evah nro eotlraoircn to smmr/senpee elecl.vctaityi/e/vt I on'dt wnok fi w'ree udsopspe ot konw ,thta utb onw I od, ll.o hcdm/57oww.ntuiv.3/m:w3h0el.nbgpin5/t7bsp/..

sA bgnyorxuh ed,etmnion iesnlmule is oynl netomeind ocen ni FA as a tmeranett orf nat,ie os I koeodl tion it hfture.r eiSuenml si a tntecon of m,ense tbu levlse ravy so uchm atht it rseesv on trgcsnooip ilnlcca cnlevreae ot nty,teriflii per ihst :reclita gv2w./nh3e:i/tldwuimnn...bo32p0/bws5thm1cp/.

oT lrue uot all fo eth sesrawn esu(aebc I dtidn' yealrl nkwo nnahtigy utaob het lqaytui fo e,n)ems I odunf hsit yB" tttcist-ai,ss rhete swa on tagsnnicfii fencdfriee ni eht esenm aN ctocioetrnnan ogamn het dtfeenirf souprg (7 osrupg lttoa daesb on persm t,noc)u idigncitna hte insftnaiingic oelr fo Na in seprm tii".om.lty 1psm.5nwnwnhce:gbu/d2m/v/w.b1.i27/iltht.po.

naiF,lly I o'ndt hnkit eht ah5-alp teuecrdsa meenyz is ataullyc ni ee,mns but I loudc eb w.onrg hireEt ya,w it wdntl'ou be oanlyablmr tevdeale or olw if eht sretesenoott lseevl rea ro.lnma

bartolomoose  as per goljan, selenium is involved in glutathione peroxidase +  
chandlerbas  selenium has a role in glutathione peroxidase. excess selenium = garlic breath, hair loss, and nail changes, might see peripheral neuropathy. deficiency (pt on TPN) = dilated cardiomyopathy +  
chandlerbas  also zinc aids in sperm motility https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773819/ thats why i chose zinc but whateverrr im over it +  


submitted by yo(79),
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ehytre' ntkgial utabo a enrpeallosn hntus epoudcrer

p9h-geavss0aeh/hlen5tio4yn/etnrcilaen-mr.c.llintehlltt/last-stnro:/ptsedacm/ud

hungrybox  be honest did u know that before looking it up +9  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +24  
sympathetikey  Relax @meningitis. Hungry's just messin :) +9  
sbryant6  Looks like somebody needs an enema to get that stick out. +1  
chandlerbas  ya'll are too TP/(TP+FN) lol +11  


submitted by sympathetikey(1265),
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Inreroif leqioub = peslh uoy olko up p&;am .in

ol,sA htey dasi olfro fo eht r,ibot os it ekams nesse htat het enfiiorr elcsmsu uwodl mda.gade

sahusema  I know you're right. I was just so uncomfortable picking an answer with "inferior rectus" because damage to the inferior rectus does nothing to explain the clinical findings of impaired upward gaze. Unless the muscle is physically stuck and can't relax or something +5  
emmy2k21  Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :( +2  
dr_jan_itor  in the last sentence it asks you to assume an "entrapment", so it is actually the inferior rectus which is the cause of the upward gaze palsy. The entrapped muscle is functionally trapped in it's shortened position, thereby not allowing the orbit to gaze upward. +14  
chandlerbas  bam! dr_jan_itor just cleaned up that confusion +1  


submitted by chandlerbas(95),
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bereremm ioisdmg noolc sha eth smsellat reademti ch(ene yhw ftLe esddi CCR odscuerp eht ppela reco) naneimg tath ti si pnero to egirhh esrsrepus ni acoeaccrnd ot aap'lecl alw s(reperus yevreslni lroniopotrap to eatrdm)ei uhst lsmla dramtiee = gihh sepersru = eprno ot luadievticr aitnroomf

chandlerbas  one more thing. this question is not realistic. 5 years of constipation, with fever and chills...yet no hematochezia? ya ok there +  
chandlerbas  wait never mind, the inflammation scars the vasa recta so no bleeding. thanks for coming to my ted talk +2  


submitted by chandlerbas(95),
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brrmeeme gosmdii cnloo hsa teh telalmss eirmdate h(nece hyw teLf ddeis RCC osdcruep het epalp )ecro einganm htat it si eoprn ot hhrgei respsruse ni eadccranco ot ellaapc' alw srser(pue eelsivyrn oolirtrpapno ot irdmetae) uhts alslm mteediar = hghi peserusr = orepn ot alrvdieticu ioarntmof

chandlerbas  one more thing. this question is not realistic. 5 years of constipation, with fever and chills...yet no hematochezia? ya ok there +  
chandlerbas  wait never mind, the inflammation scars the vasa recta so no bleeding. thanks for coming to my ted talk +2  


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rulalgIurryer augelIrrr rthmyh = fAiiAb bf ;t-g-& tasssi fo odblo ni eth taHer ;-t&--g uhmTsobr aonfrtimo m buhTosr liwl bilozeme to eht l(leik)y het lotleapip taeyrr egaidln to taeuc mlbi mcaiehsi

194orbust  why would an embolectomy be favored over clopidogrel? +3  
194orbust  oh nvm......it's bc clopidogrel won't bust a clot, just prevents them from forming. +17  
chandlerbas  also the way i see it is the hommie has so much pain as indicated by "sudden onset of severe pain" so you want something fast and effective. surgery time! grab my scalpel! drugs could be indicated but arent an option even then heparin takes 20 to 60 minutes to work so +2  


submitted by neonem(556),
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sTih is a mutpopsrta omod c,nsbareidtu a reptyt mocmno sdierrdo taht sha to ehav an noset hniwti 4 ekwes of delriyve ot eb edmtre as .hcsu spotramPtu lbseu is eth mtos mdli, itwh a %8550- cdcneneii arte (epr FA ,2180) usllauy seoerlvs tniiwh 01 sday and ettnartme si ynol pirptousve tub ndee to oou-llfwp ot esssas orf iplssebo toraptpsmu rnisdsoe.ep rtpsPtaoum seiposrned = 11%-05 ,rtea rzeirdeacthca yb epreesdsd e,tffac txyaei,n rpoo cocietnnortna rfo tgeerra naht 2 kswee and esend ot eb radeett w/ CBT + ISR.S I ktnih hte oqitunes is gttiegn at ncsegrnie ofr isht dan a lpntaeiytol omre lbmporctiea ,ncoaoipctiml tamprposut sihypco.ss

thisisfine   Found this difficult because FA characterizes "thoughts of harming baby or self" as postpartum psychosis - which is super rare, and doesn't fit this case. Also, CBT is first line treatment for postpartum depression - so I still like the offer to refer to a therapist as the best choice. +11  
d_holles  Same @thisisfine. +2  
chandlerbas  i see what youre saying but we should make sure that the mother is alive for us to refer to a therapist. remember if shes willing to harm herself most likely also willing to harm the the little cutie baby....so asking for suicidal thoughts screens for progression to post partum psychosis with the aim to prevent the sentinel event: harm to the baby +  


submitted by assoplasty(91),
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taFs era eickegton tex(cpe ddo nahci F)A, os ehty urceodp ktnseeo rfo erenyg otcundirpo o(tyecCAlA)- erthra hant elo.scgu fI teh itseqnuo dkase twah eth pimryra uecsro of yegnre ocutdornpi as,w it duowl ilstl be ggnyeocl (dna otn toes,ne)k aceebus hsti is iwtnhi 24 ohru.s eHowevr traef 42 uorsh the wnraes lcodu eb oktnee s.eibdo reaRdes,lsg teh qiunstoe alecifclisyp said the pt ahd a mrues sgleuco of 100, iinctgadni that we are ooignkl orf gstneohim ttha vosdeipr a astseutrb for eegloigns.euocns

Dgnrui opdersi fo v,aintaosrt stbtsusaer orf geeosglisunncoe emoc omrf wto rssue:oc ()1 drwokbnae fo tsxeiing lsumc,e ro )(2 vai docani-hd AF utgrhho pon.yroilA-pCo (iealVn* sloa sedef tnoi ropnopyil ,ACo tbu si tno evovinld rugind svrnaitaot g;--&t ees )oebwl

1)( hTe ayurtpaael-nvine lccye ipvdesro htsi umliteg(na ni uemcsl + uvptyare g;t--& lnaiean &g;t-- esog to lrvei g-&t;- atrisonnatniam to lukotlprge-tehaaato t;-g-& ryetapvu is eraatpesd mrof litgunmae -t;&g- tlinuaegm egos to ruae ,cylec rupyatev gseo no to cisl.gegeuoeno)ns tatLcae nca asol eb used hts(i dlcou aveh eebn a rtghi rasenw fi it wree st)l.ied

()2 dOd nhaci sAF rae alos olcu,nicgge tub etsrica ciad (ivropedd ni het asrewn )ociehc n’tsi dod ,cnhai so ti si lnyo egoeticnk adn acn be druel o.ut

ultogAhh vanile na(d ehrto ndcarbeh .).aa feed toin o-yinPooCl,rAp yteh ear otn udes in nrtsoitava usceeab nvrsaottai riycsltt sreeli no ehacitp sgi.nogelcsoneue ehTse a.a. era not iebtlzmeoda ni het verli ecuesba the virle kascl hbea-dcnachnri .aa. fseasrntrea my.neez In Fsirt ,diA Bhimceo sic,eont nderu Faiav,g/itosarntSnt in bhto eth itfnsa“g ”taste cwhih( si nwiiht teh item afrem fo shit n,oesqut)i or het aviasnot“rt stt,a”e both itilezu acithpe scelo.gginseoneu My omuassnpti si hatt neliva is udse irgdun gleurra lsimt,meoba nda tno duingr orspdei fo rnstoavat.i

hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +7  
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +4  
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1  
almondbreeze  @ toxoplasmabartonella think you are right +  


submitted by jambo2222(28),
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’tIs na maosetoracos. aoaSrmc = egeoahstomnu .stme ts’I in hte glse os htnik woh a TDV oges ot nglu. eSma deai.

tinydoc  Perfect way to remember it. Thank you! +7  
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1  
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +13  
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +  
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1  


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to'dn tfrgeo tbuao the gM l!kcob . . . . . .



submitted by tinydoc(223),
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tieruacphNo ainP erfta okrset si lacrtne otsP oektrs pina yeomnrSd

ceadsu yb alntrerolaatc camtlhia oesnils

P.g 054 1FA9

chandlerbas  agreed! more specifically damage to the VPL +6  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +4  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +