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Because the wording sucks. It's a confusing way to word the question. I too was confused what direct tributaries was referring to and chose Inferior mesenteric because I suck and also because this question sucks.
Really its asking where are the hemorrhoids? They are on/from the superior rectals even though those veins feed to Inferior mesenteric.
Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them).
Is this the best approach to all of the "strongest predisposing risk factor" type questions?
There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer."
There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].)
beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies.
@impostersyndrome I love me some probability and statistics. Glad my rant was useful :P
i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom!
I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation.
It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo???
I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks.
Got this right because the exact same question is in Uworld.
Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L".
Anytime they go out of their way to mention sutures, my mind goes right to granulomas
there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue
because then it is as if you are paying the patient to enroll in the experimental treatment
because then it is as if you are paying the patient to enroll in the experimental treatment, which I don't know why that would be wrong
Bribery is only good for doctors. Can't bribe patients. That's illegal. Kind of like how NCAA gets paid a lot, but student athletes get nadda. Still the TLDR is it always ethical to disclose financial incentives when they relate to anything that may affect your decision on how to treat a patient.
are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation?
saw this on another Q with the nitrates causing headache so now im confused
@impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link
cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317
Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks!
"occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future.
i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :(
i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell
I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation!
I agree with you in first part but i dont think it has any relation to kwashirkor.
It is simply due to cachexia which causes muscle destruction through the proteasome pathway ..
Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me.