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Welcome to djtallahassee’s page.
Contributor score: 20


Comments ...

 +0  (nbme22#10)

Wouldn't telling the patient about the referral do more harm than good?

  1. Pt considers it a bribe and leaves
  2. Ruins study due to placbo effects
  3. Puts doc/hospital at risk for potential legal hassle.

I guess maybe I read it as a study when it really is just a referral but its not that much of a leap to think that this "experimental"" treatment is part of a study

drzed  I think this more of an ethical question (not a legal, or study design problem). Ethically, between the choices of being transparent with your patient, or not, the choice would be to disclose. Disclosing and offering to share would come across as a bribe, so that is less favorable than simply being transparent and putting the patient in charge of their decision. +




Subcomments ...

submitted by medstruggle(12),
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Why is it ton vanioar efilollc cs?ell I htgthou teh eamfle alaogn fo otelSri dan eigyLd si /eaalosrtuahgnc lce.ls

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +7  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +37  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +17  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


submitted by cocoxaurus(56),
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Teh erpsaitetnon rehe mssee to fit atht of rntceesemi alsurcav soilcucn-o iadlnasrtpop anpi thta stsal 1 orhu, food ianer,sov thgiwe sosl. ehT tpnteia sola ash riks carsotf aiedaostsc wtih erteicemns acavrusl cioun-locs lreod naht 06 reysa dl,o plai,iymprHeeid esep,ynonHtir MPH.x

h"eT eietmnrsec inlcotiucra snisctso of ehter rimaryp evelsss atht usplyp obold ot the mllsa and galer boe:wl teh aiclec t,yerra ipourres cmteseiren taryre S)A(,M nad irnefior iecenetsrm yerart I.MA() ooldB fwlo hhgurot htees rsteirea esierasnc hwtini na ourh rtafe eiagnt edu ot an csenaier in mleaiocbt adnmde fo the eansliitnt mrCacunoocsih. iocouncsl of a sgenli sveesl lolwsa lrctlelaao lbood olwf ot acestope,nm htus tommspsy do ton ylcilapty sterpen ilunt ta teasl two ripaymr esslesv are "doldcu. cewscn.goo..nmN.wv0tkhoiB8/iK:/4bnbs7/plh3/4/tw

rtlCsllaoea eebnwet SMA and AMI aenr teh lespcin xfeerlu dMnni(aeger rstiMecene )tary.er erTeh si aols lalcloeatr bnetewe lceCai tAeryr and SAM eeacdrntdauPoa(ncilo adcre.a)

Lal,yst I konw taht herte is a -m3c cecttia araot uofdn on C,T utb an atiorc amyusnre wdolu ont doepurc thsee sps.mmtyo Enve fi yuo thhuogt atht eth pymtssmo erew deu to the A,AA ouy ulodc ltsli get ot eth cocrter seawrn fi uyo seu a4'1fhdsem iga.sennor

honey-crusted lesion  Great explanation! There's also a slide about this in the 100 Anatomy Concepts pdf but doesn't go into as much detail as this explanation. Thanks! +  
djtallahassee  Good explanation but I think an AAA would be more likely superior mesenteric and hepatic. the SMA and IMA are more than 3 cm apart (L1 to L4ish), Triple A affecting both would be very large. I blew this question because I saw 3cm and jumped to AAA, didnt even see it was a sclerosis thing. Put the two closest arteries and moved on +  


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The esiesad eehr si cefsutor abeopshthiasps ccey.diifen nI t,i VI ygecollr ro tecsufor ne’tsod plhe aucseeb obht rneet hte osloceuegisenng hapaytw weblo tuceofrs thpoasbshie.pa tcaoaesGl no teh ohtre hadn sneter aeobv t.i I tod’n thkni uyo eryall edne ot nwok tihs ot oescoh the roerctc ansrwe scien eht iclanicl ctirpue fo isafgnt hieomgplayyc tath si ercdcrote w/ meos srto of agusr ttha nac reten het neloseecugigsno pyahtaw sduohl eulc ouy nito the ightr sawen.r

neonem  I don't think you could have *totally* ruled out the other answers - I picked glycogen breakdown because it sounded kind of like Von Gierke disease (glucose-6-phosphatase) to me: characterized by fasting hypoglycemia, lactic acidosis, and hepatomegaly since you're not able to get that final step of exporting glucose into the blood. However, I guess in this case you wouldn't see that problem of glycerol/fructose infusion not increasing blood glucose. Nice catch. +24  
vshummy  I think you were super smart to catch Von Gierke! Just to refine your answer b/c I had to look this up after reading your explanation, von gierke has a problem with gluconeogenesis as well as glycogenolysis. So they’d have a problem with glycerol and fructose but also galactose since they all feed into gluconeogenesis before glucose-6-phosphatase. Great thought process! +22  
drmomo  glycerol and fructose both enter the pathway thru DHAP and glyceraldehyde-3-ph. Galactose enters thru Gal-1-ph to glu-1-ph conversion +2  
linwanrun1357  In this cause (fructose bisphosphatase deficiency.,),fructose should help to increase serum glucose, bcz it can become into glucose-6-P by hexokinase. Therefore, this question makes me confused.... +  
krewfoo99  According to uworld, fructose infusion will not increase blood glucose levels in Von Gierkes Disease as well +  
atbangura  I believe Von Gierke is not a plausible answer choice because a galactose infusion would still not see an elevation in glucose levels. Remember, galactose could be converted to galactose 6 phosphate, but in order to complete gluconeogenesis and allow glucose to leave the Liver for an increase of its concentration in the blood, the patient would still need glucose 6 phosphatase which is eliminated in Von Gierke. +1  
lilyo  So what disease is this??? I mean couldnt we have just answered the question based on the fact that the patient responds to galactose being infused and we know that galactose feeds into gluconeogenesis?? I am so confused. +1  
djtallahassee  Its Hereditary Fructose intolerance right? gets sick after fructose and I guess glycerol can jump in via aldolase B on this pathway via page 74 of FA2019. It looked like a fructose thing to me so I just marked out the other ones and moved on. +1  
paperbackwriter  @djtallahassee I was wondering same, but hereditary fructose intolerance also results in inhibition of glycogenolysis :/ confusing question. +  
amt12d  A much simpler way to think about this, without trying to figure out a diagnosis, I looked at the time frame for when the child was presenting. He has eaten poorly for 3 days, by now, his glycogen breakdown is gone. His body would be trying to make glucose, therefore, gluconeogenesis is impaired, not glycogen breakdown. +3  
tyrionwill  if fructose kinase is not available (fructose intolerence), then some fructose may go to F-6-P by hexokinase, then goes to G6P if gluconeogenesis is needed. however this patient's fructose kinase was intact, so no fructose would have go to F6P, so there would be no blood glucose increment after injection of fructose. +  


submitted by jrod77(27),
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I tnhik ehyt thgmi eb bicingsdre gntn.onaa.i. ru.es T2AX si isneolrbpes fro ltelapet oietoggrasg,an it yma eb ouncittnigrb ot sootbirhm,s tush hisaeimc ot hte darccai tsseu.i

sympathetikey  Agreed. I'm pissed though because PGE2 mediates pain, which is why I picked it. +34  
he.sanchez14  If im not mistaken, the question describes unstable angina. Unstable angina is due to thrombosis with incomplete occlusion. So, yes TXA2 is responsible for the thrombus that is causing the symptoms in this patient. I'm also pissed because I also went straight for the PGE2 +5  
vik  hahah, seems like all in same boat like me +  
yb_26  thromboxane A2 is also vasoconstrictor, so my thoughts were about vasospastic angina +4  
youssefa  Went for PGE2 ... shit +  
need_answers  I went for leukotriene B4, what the hell was I doing....SHIT +13  
hopsalong  I picked Leukotrine B4 thinking that the neutrophil infiltration was the source of the pain, seems wrong lol. +  
bballhandler11  Sometimes it helps me to think of it in a general, non med school textbook kind of way. When answering, I narrowed it down to PGE2 and TXA2 as well. Then I asked myself, if someone is experiencing chest pain, would I recommend Aspirin or Advil? That's helped on a few over the counter pharm questions. +7  
ususmle  same here I M PISSED PGE2 +3  
krewfoo99  Maybe PGE2 isint the answer because it mediates pain and fever during episodes of acute inflammation? Thus making TXA2 more likely. +2  
djtallahassee  ditto on the looked at it for 2 seconds and went PGE2 +1  


submitted by welpdedelp(219),
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hTe pt ahd ahmats ,SO(B eawks pu at thign uto of eta,hrb hsa eellsgir).a tI edaks for het orrserucp fo rueeoent,silk whhic si crahiaicdno icd.a hTe pbor vgae mhi tnsatMkleou ro dahinel oicguct.diloorcs

ls3076  wtf is up with the phrasing of this question +34  
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +1  
alexxxx30  @Is3076 haha agreed!! +1  
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +4  


submitted by sam1(16),
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htaW abuto teh otddniaial wlof rtghhou teh ue?cfrlxcmi

maddy1994  exactly man i got 4.5 and i thought he asked ventricle and left circumflex should be there so i put 5 ...glad someone thought like me.i was just cursing myself for over thinking. +10  
djtallahassee  Yea put 5 here too. they are essentially saying the myocardial oxygen supply to the left ventricle comes from the LAD. Not sure if true or not but figured that the LCX would at least contribute 20% of the blood +  
justherefortheyield  100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value. +  


submitted by nwinkelmann(285),
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So isth tuqisnoe wsa esghtonmi I ayrlle rgesdulgt ti.hw I idd'tn enieczgor ahtt teh seitonepatnr was fo ERRMF sa noosmee stadte ,lbeow nad I nwko yuo dotn' eend to nokw htat to sarewn het uieon,qst btu ti uolwd ehav bene lhfpuel. yM tggibes arotinsfrut wsa eth ngwirdo of eth obyspi tslsure rmalo"anb octuulsanimac fo itnrmdaooh.ci" isTh dayonne me ebcesau teh dintifenoi fo edggra red ebrsfi (hhwci mI' mingussa aws treih otten)nnii is "oasuumtccalni fo aomlbanr nmdoh"ci.raoit eohTs rea tow rvey fdrtfeein steamtenst ni ym dni,m .lol Teh ,tfris to e,m tujs aenms 'rseeht too cuhm hmnoaodiit,rc ubt hte cnsdeo ensam s'etrhe too muhc NDA yeth neta'r ontinicngfu o.eyprrpl Ist' sloa jsut teh ftca fo mgerbreinme lal of the rmtse rfo ETC ta the meti of eidanrg teh eounistq e.i.( I tnd'id ktnhi utboa hte fatc htta TCE si losa cdlela ullalcer sntireparo or usjt ani.eo)srirpt

I lsao dtin'd eallyr nnuedrtasd lyulf ahtw VaxO2m is = VO2" max, oasl nnowk sa xmliama oyxegn p,keatu si the enmmeuarset fo eth mmaiuxm tnoaum of xgnoye a roneps nca eutziil unrigd teniesn ier..sceex. dan is eadbs no het rspemie ttha eht mroe oyxgen omuscnde rdinug exr,eiecs teh reom hte oybd wlil eregaten innoesdea iasoperththp )A(TP reegyn ni lsl.ce.. V2O xma is adceher nweh royu gxoyen motounpcsin neasirm ta a dtysea sttae psditee na iecaensr in eth alwo.okdr tI si ta tish ptuleaa htat het ]els[umc svoem mrfo eairbco mbsaolimet ot neoacrbai mtsoamielb" t2wmtvwait01ycixvps3/--o-hl.:-efoa7r2mwshwewl//9t.0.

daesB lurpye no htis ifidetio,nn ewerh Oaxm2V = saeeisltnyl eht iemt ta chwhi ibeorca ecsshiwt to bineacrao spe,ionrrita my atoneitnpretir of oot cumh otoncrmahidi vs oto cuhm dna bda cimitrhdnoroa d'dnit art,tem euebsac nvee when the omdaitcohrni ear uoncigtfinn py,orrple htye ecrha a notpi adn twshic ot irab,coean tsuh if teher asw too uchm aolmnr toahocn,irmid tihs luowd cocur eftrsa uabeesc eethr ulowd eb meor vrllaeo eaclllur ipinersrtao cogci,rnu gmenani the ybod lduow ihwcts to icaanebor nda ztielui slgysoilci ot lceaatt fro ryge,ne tsop lingztiui eht ort,ihdcmoina nad htsu mVO2ax ldwuo erceed.sa

H...R.WVOEE esecbau shti si a FREMR oi,tsnqeu eht roedr fo stveen si a elttil nretf,iedf edispet the tmoeuco bnige hte aesm (ta tesla hat'ts woh I sndatdnure i.t) S,o I knhit teh eky ot nya hmarntildocio rieosdrd is rembneregim tath hte tnimtsauo aer taomsl eiatrnylc iggno ot etfcfa an docedne ponerti nda tshu a ecdiiefcyn fo hatt re.notip One tiealrc taht I odufn sida atth hte RtNA tmnotsaui s(a ni F)EMRR uc:sae ruipst"d olcdnhtiamoir tnrpieo h,stynseis idcsreeagn hte iyvcitta of mpCxloe I and ot a erssle nexett xomlpeC .V.I. chwhi eseardesc iorrntpesai nad woselr rnpoot mp,npiug mlratyiaaldc rdgnseciea eth ambeemrn iltpaento dan tonorp tlelceomhcciear otpiateln dgterain osracs eht daolionrihtmc nneir mranebm.e The nrptoo elcheectcamoirl paetlnito rgnadtei si teh idringv froec rof TAP nityssshe dan negdisacre ti snatbluiaylst olwser het lammixa rate fo PTA isnth".ysse yr9m0oolfyt/e6o..-/9f0sc9rten400.n166lj/l31lx147id0.ieh/1pwib..23as/i1b/u:l.2.

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Hpoe iths sep!lh ihsT tkoo me WAY TOO ONLG ot erfiug tu,o ll,o tub hpoyulefl I nerev fgnikera fgoetr i,t o.ll

s,olA if ouy tnwa yan omer nir,daeg I iafynll unfod na ctirela ttah aulatylc fylul apnislxe hte cebicaolhmi nda iaoplyhhtoysogp of omlrihiocadtn oshpyetmia: minc/ih./6utr1.:4a2o4t/cp2r3ael/7cabmis/ac///e3o2d3p15t

oSyrr i'ts so glo!n

djtallahassee  lol yea. I thought they were trying to say there was an abnormally large amount of mitochondria present which made me get the opposite answer :/ +1  
alexxxx30  no I so agree. The grammar was completely wrong (clearly whoever wrote the question needs to work on english). This was very frustrating to me because I recognized that it was ragged red fibers, but then the wording made me doubt my own knowledge (thinking how could the test writer mess that up?). abnormal accumulations either means too much or too little. accumulations of abnormal mito means thee mitochondria is faulty. Correct grammar is putting the adjective right next to the word it is describing. So this was definitely wrong and I share your sentiment. This really frustrated me! +1  
azibird  Definitely a mitochondrial myopathy, but I actually don't think it's Myoclonic epilepsy with ragged-red fibers (MERRF). This normally entails Myoclonic jerks, Generalized seizures, Cerebellar ataxia, and Dementia (according to Amboss). Maybe it's CPEO (chronic progressive external ophthalmoplegia): progressive extraocular ophthalmoplegia with bilateral ptosis. Not sure which one would account for her poor exercise tolerance. Either way, recognizing it's mitochondrial is enough. +  


submitted by adong(95),

literally know every single name they can possibly call this

djtallahassee  literally a new name every nbme +9  


submitted by seagull(1443),
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tuo of uytisri,co woh yam lppeoe kewn sthi? otdn( be hsy ot ysa ouy ddi ro ?nitdd)

yM poetrvy nitaucdoe idtd'n gianirn htsi in em.

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


submitted by d_holles(173),
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anC lrtoap HNT rboiutntce to iheptca lychnepaea?tpoh

djtallahassee  Sorry for the late add. Portal system does contribute to hepatic enceph ESPECIALLY when there is a TIPS or shunt that bypasses the liver. However before, it won't directly contribute to more NH3+ +2