NBME Answers : cuteaf's page

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+0 visit this page (nbme23#34)

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The tissue that invades the liver looks entirely different than the liver itself. This is what made me think that its origin is foreign. It doesn't look like fibrosis either, which would usually lead to some degree of constriction.

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+1 visit this page (nbme23#23)

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Why is it not answer " Postatic venous plexus to the the internal iliac veins" I thought the route of metastases to the spine is prostate plexus -> internal iliac veins -> vertebral plexus??

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mariame The major metastatic pathway to the vertebral column is via the vertebral venous system, and it appears that prostate cancer cells first metastasize to the vertebral body and then spread secondarily to the processes or other vertebrae. https://pubmed.ncbi.nlm.nih.gov/8065995/ +

+2 visit this page (nbme20#40)

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You should always, always follow the patient's wishes (in this case you are aware that the patient did not want a transfusion). Family's input is only useful when it helps you understand what the patient would have wanted. The husband is clearly going against the wife's wishes.

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submitted by krewfoo99(115), visit this page

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Image shows Stahorn Calculus

1) Staghorn Calculus in adults - Manesium Ammonium Phosphate 2) Staghorn Calculus in Children - Cystine

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cuteaf The history of recurrent pyelonephritis + fever is also a giveaway that this was due to a bacterial infection. +1

an1 I thought the image looked like stag horn, but the pH is acidic, and MAP is alkaline! whyyy do they do this, literally mixing up incorrect info (unless im wrong, in that case lmk) +

bcher normal urine pH is 4.5-8. Seems to me that 7.3 is on the higher side. +2

submitted by thotcandy(131), visit this page

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Everyone asking why not PPIs?

if you give NSAIDs which decrease PGs so you get GERD, the simplest way to fix it is to bring those PGs back, so misoprostol.

Just simply -PGs --> +PGs

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hungrybox This is the best explanation IMO Also makes me feel like an absolute idiot +9

guber also per FA, misoprostol is used specifically for prevention of NSAID_induced peptic ulcers +4

cuteaf I think the key to answering this question is to remember the specific side effects associated with misoprostol -> severe diarrhea. No other GERD medications in the answer choices have this side effect. Antiacids could also cause diarrhea (MgOH) but not in the answer choices +4

deathcap4qt Actually one of the side effects of PPI use is diarrhea (and other GI issues). Not in FA but emphasized in AMBOSS and Sketchy. I got this Q wrong for that reason but I see now why Misoprostol is the better answer. +3

veryhungrycaterpillar That's wild. I take PPIs like candy and I've never had diarrhea, but I chose histamine blocked because Pepcid/Famotidine gives me the WORST diarrhea ever. +

an1 I changed my answer from PG to PPI because I recall sketchy saying PPI was the best for an ulcer, adn they both had diarrhea in the sketch. but I realized why im wrong Why isn’t this PPI (E)? because PPI’s INHIBIT the pump (should have been a dotted line) Also, PPI’s increase the risk for C.Diff which can lead to diarrhea, they don’t directly cause diarrhea unline PG misoprostol PPI RF’s include osteoporosis, lung decline, increased risk for AI Nephritis, and reduced absorption of Fe, Mg, and Ca (not the best choice for an old guy) +1

kcyanide101 NBME [redacted] HAS A VERY SIMILAR Q THAT THEY CHOSE PPI over PG analog for NSAID induced stomach issue! Really annoying how they flip! +1