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Comments ...

 +0  (nbme23#33)

The first drug given was an NSAID (prostaglandins inhibitor) this caused GERDS/ulcer because of decrease mucosal protection.

The second drug was misoprostol which gives mucosa protection and a common side effect is diarrhea.

 +0  (nbme23#18)

Insulin decreases the level of blood glucose and Glucagon increases levels of blood glucose. They both counter block each other. If insulin is high glucagon will be inhibited, and when glucagon is high insulin will be inhibited. FA 2018 page 76.

 +1  (nbme23#6)

In the picture there is no fibrosis, leyding cells tumors have crystals, there is no muscle and Sertoli tumors are rare.. You have only Germ Cells answer.

 +2  (nbme23#15)

This patient is giving symptoms of hypovolemic shock, mainly due of dehydration. The HYPOTENSION is an example of severe dehydration and hypovolemic shock. You need to expand the vessels rehydrating the patient in order to avoid further shock and dehydration.

 +0  (nbme23#49)

the stellate ganglion is part of the sympathetic nervous system flight or fight. Increase heart rate is the most obvious.

Subcomments ...

submitted by beeip(90),

The best I can understand, they're describing endometrial hyperplasia, a result of excess estrogen, a steroid hormone that translocates to the nucleus and binds its transcription factor.

mousie  My exact thinking also! +4  
sympathetikey  Ditto. +  
meningitis  My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things? +  
criovoly  You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS +3  
eve1000  Could this be due to the PTEN gene being linked to endometrial hyperplasia? +  

submitted by step420(26),

Ritonavir inhibits CYP450! So you can use it to boost the concentration of the other Protease inhibitors by preventing their metabolism by CYP450!

mousie  who knew +1  
sympathetikey  Right on (thanks sketchy) +4  
mguan1993  MAGIC RACKS is a good mnemonic ive heard for 450 inhibitors (macrolides, amiodarone, grapefruit, cimetidine, RITONAVIR, alcohol (chronic), cipro, ketoconazole, sulfa +2  
criovoly  "CRACK AMIGOS" Cimetidine Ritonavir Amiodarone Ciprofloxacion Ketoconazole Acute alcoholism Macrolides Isoniasid Grapefruit juice Omeprazole Sulfonamides +4  
drzed  Macrolides EXCEPT azithromycin -- they like to trick you with that one. +1  
steatorrhea  chronic alcohol induces 450, acute alcohol inhibits 450 +  

submitted by m-ice(184),

The patient shows no sign of cortical activity, but has some brainstem function intact, which implies she is in a form of persistent vegetative state. She has a living will that designates mechanical ventilation should be discontinued if that situation arises, so we must follow it and make not attempt to resuscitate.

lfsuarez  Why would the second part of that be correct when there is not mention of a DNR? +7  
ug123  DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +1  
sherry  DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question. +  
shayan  "The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing ! +3  
criovoly  I believe this question was not well constructed... it's one of those! +  
suckitnbme  @shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state. +  
luciana  I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills +