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Welcome to dubywow’s page.
Contributor score: 17


Comments ...

 +0  (nbme22#1)
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tnoDdaspmeeec FH. cLka fo odlbo fwlo ude to lgfaini arteh t;&-g eolwr BP &g-t; rncedesai DHA ot ecsaeirn blood usresrep ackb to sbltea .evlel In ,FDH HAD pstoucea ohssetiamos of iegcutnacornt PNA &p;am B.PN sT,hu hte emtr d"ncetap".msdoee esdciaAtso hwit ehrsnsots of eatb,hr eemda on(eft of )gnslu.

Tshi iusicov clecy isucnntoe sa ydob izitrrsopei equtadea PB rof uivvrl,as tbu it smeco at eht eenesxp fo wovoerekdr athre taht tusm okrw hrdera nad ,drrhea umilltytea baaergnxtice hte arthe iafuelr notdiinoc.





Subcomments ...

submitted by lilyo(72),
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I ahd teh ames ietsnuqo grrneigad t.shi I kwno ttha atlneerx hrdoeohmsri learry elbed nda lnniarte rmoeohsihdr tpreesn sa lssneipa eibengld os ni ym mdni I wnek I saw engbi adkes atubo tlnrinea mrhoeidhor.s e,ewHorv ueprsior ga&tretc;--l feiinror eicntresem n&;-e-gtvi talrpo in,ev nac onnaye ltle me hwy het rnaswe saw irorseup leatrc nad nto nifrieor rmteesneci?

dubywow  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. +3  
drdoom  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). +5  


submitted by drdoom(896),
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ouY ehav to ithkn oubat htsi gnsui the necoctp fo CIDILOAONNT A.PIROTYBLBI nAohetr wya ot ksa shti epyt of qisnteuo is klei s:iht I“ oswh uyo a ietnpta htiw euanonpsost oomutexnhpar. icWhh thero gnthi is omts lyleik ot eb uter buoat atht e”pnso?r rO you can earhps it esteh :sawy

  • ivenG a OIOCNTDNI (etsosopunna onepum), atwh rothe gniidfn is msot lekliy to be the s?aec
  • nvGei a opol of epople twih paosenstnou ,axhtnpooemru whta hoert ihngt si tosm kyeill to eb uret uobat tem?h

nI htroe drswo, fo all eelppo owh edn up thiw uentsponosa opm,nue teh sotm oconmm retho nghti abtou mthe si ttah hety rae ELMA pm;a& .INTH

fI I evga oyu a etbcuk of usnsopanote emnpou eatsitnp -- and yuo heecdra oyru hnad in trehe adn pldeul neo tuo -- thaw oisrncea ulwdo eb mero mo:cmno nI ouyr adnh oyu avhe a oersmk or ni ruoy dnah uoy ahve a tihn l?ema tsI’ eth rlt.aet

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  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." +4  
drdoom  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].) +5  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  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. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  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. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  


submitted by seagull(1583),
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ehT suotrah went tuo of irthe yaw ot fidn ehtw wostr ophot of a oargmlanu hyte dlo.cu ehT htrwe on a mtes taht sgutsges ttah it ouwld be tgoalnuanri ti.seu Btu ttlile idd ew .w.k.no

amorah  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. +17  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4  
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1  


submitted by sunny(4),
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YWH NTO aYdnES, thne sahre het omeyn tiwh hte eantypi so eh odt'nes udobt uory otimevs.

ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment +  
ergogenic22  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 +  
dubywow  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. +2  


submitted by mcl(601),
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eB-2at eopstcrer era udoepcl ot sG po,senrit hhciw iatcvtea neldylay accylse nda rnaceies c.APM yiclcC MPA hnet saiensrce ivyictta fo repinot neiaks ,A whihc lpyrhsaspoohte oimsny htgli acnhi ,skiean ilutetalym urtgleins in mhtsoo mucesl etn.aixrlao Albtol,eur a B2 sti,oagn si rheeefort eflsuu in tntargei s.copbmahrnos

impostersyndromel1000  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 +  
dubywow  @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +2  
iwannabeadoctor2  cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +  
castlblack  cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +3  


submitted by hopsalong(25),
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sihT niuqstoe sha a lot fo rnwaes ipson,to nad uyo aveirr ta iliihsraetohNps by otwhring uot all the theor tnospoi yb whta is is.singm

,A B - crtioalC Nseicros and ylaPalrip ossNierc lmoast wlyaas ucorc in the stegitn of imiaceh.s rioesvPyul helhyta 28 yrea dlo nam ahs on eednevic fo facgntlniyiis aeddeecsr alren einfpru.so

C - ueAtc urTblua oierNssc si thwa oyu oudlsh inthk of with Stayaiellc SD)(NAI o.ttxiciy ehrTe era yman ertoh erotchpoxni gsudr tath cuaes ,TNA btu knith of TAN as dgru eidncdu ydniek agd.mae

D - tyistisC - Fnlak pnai si ealdret to ednyki n,rjiuy nto deardlb mgead.a ssttiiCy doluc eb spilobes ni einsdngac UI,T ubt eth teaptni sah on vefre nda si aeml (cumh sles mocmon in )elsm.a

E - oemsirrlpiGluetnoh - ishT sgte tino /oncinchtheperirtpi rs.oednsmy eTh mets senniotm hatt he hsa lobdo in the erniu iwchh aym laed uyo donw the hpierncti hptyaw,a utb eh eods otn veha nya of teh eohtr eiaadctoss msoymspt.

F - eypHrhnpoaemr - oertAnh rwdo fro eRlan ellC aacior.nmC No igwhte ossl or rhtoe rccnae ldertae ympsomst (iuaftge .cet)

G - retalttsniiI eiNrispth - iTsh si oenft a rdug ndiuecd EMMNIU teameddi ni.irextpotohcy hiTs is a pety IV pttyihyseeiirnvs noatcrie ttha socucr eeskw to smntoh trafe hte srtta fo dietnimoac i(lke Ns)IA.DS ATN si rmoe seisaotcda wiht gurd doverseo lwihe etstlrItinia is meor odcesisata htiw unemim e.otairnc atIlserntii heritpisN ilwl vahe WCB atcss in ireu.n

I - topsPrileyhnie - Cudesa by senicadgn UTI tub on fvree is s.pernet

Tsih seeval tpihriiNsehosal )H( sa hte crocetr rae.nws %58 fo shpahoiitserlNi is eaatsocisd thwi eithpocayv weobl s.nosud ehT pain for phhieioisranstl can reespal adn ,tremi adn acnlyoscilao eth pani cna laterv ormf the nkediy k(alnf apin) ot het ocumstr sa the osent mvseo tghhoru teh reeur.t

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +4  
hyperfukus  yasss +  
dubywow  "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. +5  
bharatpillai  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 :( +  
targetmle  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 +  


submitted by keycompany(311),
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Notngrie lnecaba is a etmnmeauesr of oreitpn mtsbaleomi in eth .dybo A eevaitgn ntrgioen nbealac tsniiecda umlsec lss,o sa iaeesrncd mntuoas fo iaonm iscad aer eibng bmzloeeiatd ot rocepud ger.ney isTh rscnesiea teh tonmua of goirnnte retseedc rfom the ob.yd eBuaecs eht umoatn of intgreno oyu aer itkgan ni is lses naht teh uanotm of netoirgn you rae engscitre, uoy evha a aveeigtn tnieognr abanelc.

ishT amn si nuldishar,eom oeadseut,m tcai,hcec dan ash aenipmlhoab.iumy eehsT aiclclin fsinnigd tpnoi ot ionrtep ulriottimann oih(askrKaw sei)Dsae, ichwh usaecs emead eud to srdedeeac sremu otcinoc psuresr.e Lwo cnootic resepsru in iths acse is eud ot rpneito sl,os and eenhc a eigveatn gnrntoie .eabancl

drdoom  Nice! +21  
dubywow  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! +3  
macrohphage95  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 .. +4  
zevvyt  also, it says that his albumin is low. +  


submitted by sbryant6(167),
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mCnaoaingriphaoyr twhi filicnoCistcaa nda leteCosorlh tssrlyCa mo-(lrtoio if.d)lu tanmeRn of hsRat'ke ho.cup oNt to be eocudnsf iwth truaiyitp mnedo.aa

dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +