NBME Answers : dul071's page

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submitted by hayayah(1074),

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He sha alfce tnnceiconien so his xarlente cptesihrn is admaged, wichh si eatnrvenid by het dnuapdel n. .24)-S(S heT pviecl plhsnccnia ,nersve hichw iaemetd eth toerncei osepr,cs rea salo .S4-S2

thomasburton Why could this not be dysuria? +3

lilyo I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +16

alexxxx30 dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +3

peqmd Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +

dul071 ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +

submitted by humble_station(68),

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orriIdanati fo ofdo rptdsocu is eno wya ot ltiim het ksir of grme taiicnntoamno nda fdoo i.snpgiono nI teh nitdUe St,sate meos ofdso, hsuc sa escsi,p aer ytiuerlon .daaedriitr tdriIraead mtase dan oehrt fsodo rae salo lyeiwd ilav.aleba aecesuB iinartdao si onwnk to csaue cnre,ac trhee ash enbe oreccnn ttha food dtrrniaoiia mya enretsp a rcenac kr.is ovwee,rH adntaiior eods tno mnraie ni fdoos htta have nebe rtddiraeai

gdiocAncr to amAenrci Cnrcea .etyoS.i.c rnLadee gotmenhis nwe

nukie404 I wonder though, is it not possible for irradiated food to change in their protein structure, possibly somehow affect us? Some suggest Regardless I guess since it as irradiate with gamma radiation, there's no chance of the radiation staying in the food. In that sense I guess the answer makes sense but... +4

dul071 "the 100" on netflix taught me this lol +

submitted by mousie(216),

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Yrou ipuayritt rolatpoct llsec eyhrrpothyp drginu ycnarpgen to oderupc grsniiecan utaonsm of ptncoaril - prat fo eht ahloyooiytghpps fo shhnSeae' ody..mrs.en cdasierne obldo ossl gdniur ldevirye nca uacse micicehs ocenissr of ityrapitu

tinydoc I thought the elevated Estrogen and progesterone depress the function of Prolactin until delivery. I guess you needed to know that it decreases its function by downregulating receptors or something as opposed actually decreasing the prolactin production. I picked gonadotrophs. This was a fair question but I reasoned it out and arrived at the wrong conclusion. +7

maxillarythirdmolar Specifically, the estrogen is stimulating lactotrophs as progesterone is preventing the prolactin from actually working on the breasts. So it's the estrogen that is stimulating the lactotrophs to grow, and you would see the effects of this growth if it weren't for the progesterone preventing the action of prolactin (their secretory product) on the breasts. +9

dul071 why not somatotrophs. she's understress. wouldn't that increase the production of GH +

submitted by thomasalterman(150),

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iMrlaaa anc apiirm cheptia necoeogenigulss dan acn asol uocmnse golscue rof sit nwo blamoietc .adnsmde

yotsubato Truly a bull shit question... Its not in FA, Sketchy or Pathoma +55

meningitis I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +8

focus ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: https://labmedicineblog.files.wordpress.com/2018/06/mal3.jpg?w=840 Life-cycle: https://www.cddep.org/wp-content/uploads/2017/06/malaria-life-cycle_4-1440x1080.jpg +1

dul071 i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia. +

curlycheesefriesguy I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +

submitted by mousie(216),

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My desanninrugtd fi C;A&CgBt tihs is barnlmao = nedvucitco aigrenh sosl = ltircsessooo VS enlrsoernuSay irhngae slos lwil hvae mrnalo tAg&BCC; = slos fo ahir sllec

dentist VS: progressive unilateral hearing loss, doesn't affect Rinne Test, associated with NF2 and actor Mark Ruffalo Otoslcerosis is (usually....) progressive bilateral hearing loss, BC > AC. source +

tallerthanmymom If BC > AC in BOTH ears, why does he have hearing loss in only one ear? My logic was that he probably had otosclerosis in both ears and then something extra going on in his right ear that would make it worse than the left. I still don't understand why otosclerosis is the best answer here. +2

dul071 Finally!!!! Someone who ACTUALLY explains what the fuck bone conduction even is and teaches the whole topic. Here's the link for anyone else who struggled to find someone who takes time to explain this concept https://www.youtube.com/watch?v=cZYJL9Jg-3k +4

sonofarathorn ^ Halle-freakin-lujah +

submitted by seagull(1539),

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hiTs etanpti si tipgrnip ls.bal eteBtr do a rgud ncesre chhwi eemss bo.suivo

sympathetikey When the answer is so obvious that you pick a stupid answer instead of it. DOH +42

jooceman739 Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5

yotsubato @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1

yogi probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2

charcot_bouchard Lol. I got the right answer but took long time +

goodkarmaonly The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +

llamastep1 Bilateraly messed up pupils = Drugs (most of the time) +

targetmle why is there basal ganglia hemorrhage? +

dul071 Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1

usmile1 basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +1

submitted by yotsubato(1019),

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Mumrru that is duerol htwi eddrecu ueovsn nruert =&g;t coirppyertHh opayroihctdyam

HCOM si edu to oiumsantt ogcdneni rsmeoaescr hscu sa yoimns dnibgni printoe C adn eatb onimsy yevha hcnia.

btl_nyc So I thought this was Marfan's because the murmur from HOCM is at the left sternal border, but Marfan's is a defect in fibrillin, not in collagen. +3

arcanumm To help rule out Marfran's, it is stated that there are "no history of major medical illness," which I wouldn't expect them to put if there was a syndrome going on. (they also tend to give body habitus descriptors at least) +

dul071 This isn't HOCM, rather it's simply Mitral stenosis. He has a murmur that radiates at the apex which happens to be the Mitral area. Despite everything his BLOOD PRESSURE AND PULSE are normal. The heart is over working to keep the vitals normal and as a consequence, it is undergoing hypertrophy which dictates the answer +

dna_at @dull071 I don't think this is MS. That would be 1) diastolic and not systolic, 2) less likely to cause LVH. I believe as others said it is just HOCM leading to MR, which is what we are hearing. MR secondary to HOCM would still increase in intensity with less preload as there would be more LVOT obstruction (thus more regurgitation) +1