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Welcome to ergogenic22’s page.
Contributor score: 303


Comments ...

 +8  (nbme18#17)

acute interstitial nephritis

keys are: urine eosinophils + NSAID use + Rash

in the setting of fever and urinary issues


 +5  (nbme18#21)

I went with metastatic breast because they made a point of saying metastatic as if the thyroid carcinoma has not spread to the bone.


 +0  (nbme23#33)
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1) kown ttha Ct&ABCg; = iuccodtenv gihanre )ss lo2 necdovtuci geraihn lsso enmas ueiss thiw etuscrtur efroeb the enrni a)e r3 yhvritgnee sele orsucc in eht ienrn rae ro in eth brnia


 +7  (nbme22#36)
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st1 luec si htat sit a istrevcitre gunl dieases via teh FVEF/1CV oiart egbni serc.aeind

N,ext the DOLC is sadeerced omarl(n is 80 ot )%1,20 niamegn an sisue iwht the nollpolamuavy-earr paiyllcar irrbear (a ifuesdf unlg ospcr.e)s

Teh TC ash clscasi dinsnigf orf haocidpiti ynrumloap ifoirbss.

The nclaicil cirutpe vdeo-oti(ucnpnr g,ucoh OBS tihw xinore,te arli)efbe rae onienstsct iwth docphiiati lnpmyuaor si.froisb

evrlOla a ryev onn smiuuboga qeo.iustn


 +2  (nbme22#14)
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shiT ioseuqnt ielews rlaelytt hte iienfdiotn of mrieliagnt ngearlaiu

eky idnfsgin rfo hsoret

a) rlotparbiie pn,ai hnerhr,irao lnicaatrmio

b) uaatlleirn HA, aaru, hoipoopatbh

c) etilpmul sslnoei in tmie nda ecpas

)d jwa ,npia nblnsis,ed eachahde


 +5  (nbme22#28)
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sihniiilopaE = lasr eteriagpa nipse + oaeplleahepgomstny = ioctmsshose omnnsia


 +3  (nbme15#6)
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laMlreduy odhryti cmanorica si feeiddn s:a

a mgntalina taoplnrieirof of lflaopriuaarcl ""C clesl ttah eetscer lntccoaiin

osoigtlyh oshsw amnnitlga urmot celsl inwthi pink lny,()ahi aydolmi rotmsa


 +2  (nbme15#15)
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Due to n"cottciraon ll"iaosspolkoa tcsridieu secua eulmov ,acortnintoc ahtst hwy yuo vgei hemt.

sA a ,rsulet hreet is aneicrse nstngieoina II ese,rela seircnea in /Na++H xcnegahe ni teh CTP (a tifnconu of aseirnce inoansitgne I),I and nthe csiernead C-H3O barsei,pornot ildnage ot lisaolaks

cassdawg  Important to remember: Loop and Thiazide diuretics cause alkalosis; Carbonic anhydrase inhibitors and potassium sparing diuretics cause acidosis (FA2020 p609) +4
cheesetouch  RE: cassdawg - FA18 p 591 +

 +3  (nbme15#36)
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This uentsqoi is nigkas htaw flet tinandom ccuitinolra msne.a I supsepo it nwtsa su ot eirfn hatt eht DPA is splgpinuy het pahdgiarm eufscra nad VA oend.

It si unsgncifo to me eucbsea ymrlnaol hte tighR gilrnaam arryte suepplsi hte gpicmtraihdaa brrdeo auc(te )rmniag of teh hret.a mI' nto erus htta it gnsecah in tlef modntina iarccnu.iotl tehuroeFrmr it dwlou not hbranc ffo het DAP, touhgalh mbyea ptsar of ti aer iselupdp by the DAP

oAsl eth VA deno is piulpeds yb teh rvoinituArtarlce dloan rryeta, ihwch anc eb a acbnhr fof of hte CLA ro hte butX LC tno aelyrl the ADP

/M/:nvwptwt/oslCnPng9/1..elt.cw5m.cb3hai3pmh/csii79r/

os ucngfsion etunoqsi rof me utb eht nipto is to kwon het ocsreu of etfl intmonda itcrluoinca to het DAP

epiglotitties  What the heck is it with this scrambling?😡 +
5thgencephalosporin  you need to be a member to have total access to the content +

 +6  (nbme15#26)
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eAtuc MI nda mtarli ruregg rfo(m hte )umrmru lesad to VL ilfauer dan lcokfwab fo odolb tino teh us.nlg

siTh dlsae to dsaerncie pomlunayr sctyairdoth cyilalrap ses.erpru isTh lilw dlea to eesxcs lmoevu naielgk morf the apnlruymo aicplisealr itno teh rlnistiateit nad hsti illw tesfmian as nmpuryaol emade ls)c(reka.c

oayrnlmPu meeda wlli eetnirerf twhi asg xhceeang gaiednl to epim.axyoh

medstudent  Doesn’t this also result in decreased alveolar ventilation since the fluid blocks air from getting to the alveoli? +3
cassdawg  ^I would agree, but I think the primary cause of hypoxemia in pulmonary edema is actually the diffusion defect rather than strictly the decrease in alveolar ventilation so the better (more NBME) answer would simply be the increased pulmonary capillary pressure as this is the root cause of all of the issues in this guy's oxygenation. +
cassdawg  Another way of saying this is that if the defect was purely due to a decrease in alveolar ventilation, the A-a gradient would be unchanged and CO2 would be increased. However, since it is edema, the A-a gradient is increased because there is a diffusion defect, and CO2 is not significantly increased. +1

 +3  (nbme15#40)
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saclCis epucitr rfo hueDnnec laumsrcu dytps.royh hiwch si ued to detdlee dsiyphtron oe.nitrp

oFrm AF: ysrtDhionp" pslhe coranh cmsule ,frsbei lrpayrmii ni skaletle dna caricda .uscelm tI cocsetnn het iluraertnclal oknlcotsytee t)i(nca ot het maabmensrretn nrpsieot α- dan ,noclyg-yrsadtβ ihhwc rea ntncedceo to eht rellrlctxaaeu tiamxr ME"C()

cheesetouch  fa2018 p61 +1

 +3  (nbme15#43)
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loCo nda apel xmeesiirtet erslu tuo ititburisvde aucses ceinur,ogn(e apxinas,lahy )escpt.i

iyeHvlcmopo uowdl bseridce a cseprso of lomeuv ssol (bedinleg ro )hnoidtdyera nad wudlo ton exilnap the cslcarke or gjuarul eniv isdsient.no

od'nt eb nwroth off yb teh omlanr hrtea nudso.s

baja_blast  Raise your hand if you were also thrown off by the normal heart sounds. +6
jmd2020  I think this question is poorly constructed. Cardiogenic shock would result in an INCREASE in SVR - this woman's BP is 70/40... +1
drdoom  @jmd2020 low BP does not mean the SVR isn't increased — it /is/ increased! it's just that the heart is so effed up that even massively increased SVR is not enough to maintain good pressure +2
drdoom  another way to explain: imagine you are losing blood volume at a constant rate (someone punched a tube into your aorta and draining you like a pig); at first, your heart would beat stronger (ionotropy) and faster (chronotropy) to maintain BP; at the same time, all your arterioles would constrict to maintain blood flow rates (and perfusion) to vital tissues ... but at some point you will have lost so much blood that all the ionotropy, chronotropy & SVR in the world could not save you or your BP .. your BP will plummet no matter what compensatory mechanisms your body has up its sleeve. +3
drjo  Jugular venous distension clued me into cardiogenic shock (heart isn't pumping well resulting in back up) vs the others listed, esp since obstructive shock isn't an answer choice +

 +2  (nbme15#45)
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isTh tieuosqn ecriessdb Ill-ce iadssee cslinuni(o lecl miecild/oopuisesasids ypet ).II You can letl bueseac teerh is imxde omuliatucnac of njuk gmrfino eht oinlunsci oebdsi. rOhte oamylosls aresotg sieesasd avhe tulcniamocua of eon ypet of .ucatebsns

nlssilaEeyt, reeth is a fdtece ni eetcfd ni eth nyzeme i1opNeltccn-a-ogphlosta-mfsea.anssyruryleh

shiT masen eht a-m6hphons-eaotensp tag cannto eb ddade ot optsnri.e tuWhoti siht t,ag ienrptso rae tccryirnoel nste to hte ltrluxelcaaer cspea raetrh hnat eredliedv to ml.yossoes

ergogenic22  ^^correction. You can tell because there are elevated lysosomal enzymes in the plasma. This is because the proteins are not tagged with M6P and thus are excreted to the extracellular space. +20

 +1  (nbme15#49)
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A cthroo ustdy osmearpc a orupg htiw a eginv osrepxue raeceigt(t osmgnik) to a rgoup thitwou cush exr.esupo It tnhe lsoko ot see fi euxoresp or irsk foract si cedssioaat ihtw earlt denevetmolp of ieea."dsdso se noksgim eadl to ODP"C

no hte etrho ah ,dna tlcooec-rnas utsdy olkos at ethso hwit eht seeisad vs uwiotht to ese fi eehrt si a nrecifdfee wneebet rorip seeruopx ro iskr "ardfDtcio epople wiht OCPD eoskm"


 +3  (nbme15#15)
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LTC eacedsrde tusgssge crietrsvite aesd.sei cReuatirl tpaertn sussetgg rlpyumaon rsbfiois

cheesetouch  fa2018 p657 +
whk123  So after seeing clubbing of fingers we have two D/D's in our mind 1)Bronchiectasis (a type of COPD in which TLC increases your lungs expand due to obstruction air can't go out from lungs so air keeps on expanding lungs) 2)Idiopathic pulmonary fibrosis why IPF is a ans here because in q stem TLC is decreased and the coarse reticular pattern (honeycomb appearance) is also a giveaway. +

 +3  (nbme15#21)
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Seh ahs ortmo dan yorsens mytoss.mp Tsih ro/ ohbt nsdik of il.emsp eHr sruezesi ear ton sbdcreied as cnc/notiiclo ,toevsmnem nad unildec psdeiro of eiampird snucin.soesosc ishT lurse uot iereezldnag noliccoi/c.nt erTeh si a tols-atcpi teats, htta ersul otu .ceebnsa

Aosl eht pil iagnskcm is ahrcceiicattrs of m,atousmtia cwihh is undof in oplxmec atlirap susezire

bbr  Isn't is just motor symptoms, thats why its Partial? Maybe Im conflating things here. But complex partial decoded would be: Complex (lose consciousness) and partial (just 1 area of the brain, just motor). +6
euchromatin69  simple seizure wont have altered cociousness....alt. concious = complex or generaliised +
i_hate_it_here  What's the difference between a complex partial and an absence seizure? +
kaf  Absence - they just gaze off as if they're daydreaming. +1

 +4  (nbme15#28)
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ascslic ainasmtehy irsgav rpeti.uc ssWnore itwh eu.s Sx duilnce lpid.paoi Ipmmroteven ihtw hCEA.

loAs dsie eot,n 'otdn sfcuo no het nprceynag su,tsta tbu women woh ear ni the rptpatumso iedor aer at aiypllrutrac hghi irsk fo ievnedgopl imyehnstaa rgvias

pakimd  why are answers unscrambled on here? +

 +2  (nbme15#47)
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obldo nucot owhss edvatlee si,trenulpho luopitrehN cmhtntasceota cdulein rableicat pcro,sudt ,8L-I ,Ca5 eiilrkamnlk ttenla-eapgcitlivta afrtoc nda BLT4

dulxy071  if they asked exogenous (a product not formed by the body) the answer would have been N-fMET +
whk123  Neutrophil chemotactic agents: C5a, IL-8, LTB-4, kallikrein, and platelet-activating factor +

 +1  (nbme15#14)
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Septr Vrisnadi si oarl of,arl uaecss uutsaecb ardtdscionie fgtineacf olpevsruiy gdaemad lesa,vv nda is tofne oadasceits ihtw aseeuqle of lednta .poucdrere

)A iocercnceot can oasl eacsu etubusac edoaitcrisnd tub yteh rae mamga homislyse adn olfwlo IGG/U eeBdpc)rou r btae ssohmeily adn cessau etc)uac btea ylessmioh adn scsaeu atu)cee hplaa oliyhmses btu yieuknll to caues ac,ddriontsie esusac iig,mtnnies ttii,os onemaiu,np sniiutsis - S)(OPM


 +2  (nbme15#3)
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saitlv dna need ot eb readtte ,sfrit so naoirtpe dan ethn oii.mealdpxr

.pCn2vr/9p/t:n.cb/30mshc/i93sMoaiwP./lhwl./t4imwentgc

inttaporm ot nteo tath gashharsteooopnp eobmec ierbrvelseri ta a tcaeirn iotnp os moriadpexli dsoe tlsli eden ot be igven larye


 +1  (nbme15#39)
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ANPIQ is a tocxi eeenrititdma is fdemro yb ni mllas onusamt by mailmbesto of pnmhtciaeaeon. npDteileo of etpihca oguatthilne reosts yb INPQA lased to tucae PAPA yixciott nad tuaec lrvei rnijy.u

cassdawg  Also relevant to the question: the CYP450 pathway is what turns acetaminophen into NAPQI, and chronic alcohol abuse is one of the inducers for the CYP pathway so it increases NAPQI production. Chronic alcohol abuse itself also depletes glutathione, increasing propensity for toxicity when acetaminophen is introduced. +
specialist_jello  my probably stupid thought process was : treatment of acetaminophen toxicity is N acetyl cystine which regenerates gluathione. so toxicity will be coz of dec glutathione. +7
i_hate_it_here  Real talk, can this site even charge for the contributions made by other people?? +1
cheesetouch  FA18 470 & 243 +1

 +1  (nbme15#6)
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mass ni het egshapous hiwt disllui/oqid aygsIhp a'imd. ton erus atwh hte ithso hssow tub no hte motbot hrtee era roem tfla llecs dna the opt etreh ear rdeiw ceasps hwniti the lslce twih osem ,atf so I itnkh it maeby a alhiegn rucel gniadle to a tserrtu.ic

waasyn rhteo eatsgnhpo ear mero sadaotisce thwi ehtor tfieocnins

A) lsaontgsle nda ihcalcomgiaoocarB) nn ostiecghpia) s ivelr bsaescsE ) i ntihk ilayirm BT acn npseret in het lvire


 +0  (nbme15#6)
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mssa ni teh phsesuoga iwth iqsdil/ldiou gdm.ph'ysIaai ton eurs thwa the thsio shsow tbu on eht ttmoob heert rea omer ltfa lselc dna hte otp tehre ear diwer cpsase iiwhtn eht lcesl itwh esmo ,aft os I tkinh ti myabe a neahgli lrecu elgiand to a rrsi.ttuec

ysnaaw herto ogtpnashe era erom tiaosasdce whit othre nfoinectsi

A) loatgnlses nda lcioBo gar)nmccaoaihn ic)tiosseph ag eilvr e)caE bsss i nithk iymlari BT nca nteprse in eth vlrei


 +5  (nbme15#9)
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eH has a onwd and tuo i,uplp cadeus by NC III .splay His aezg si eud ot updeopsno otnaci fo the teaallr curste dna rouiesrp oeulib;q spsiot ued to drnoiaevent fo loaetvr rebpepala useri.isspo

ehT ylon uyjrni ditles thta cludo escau a NC III aslpy is emrnuysa fo eth PAC nescpmsroig hte ltraucoromo cnsueul.

cheesetouch  Compression of superior cervical ganglion -> Horner's syndrome -> ptosis, miosis, anhidrosis, would NOT have dilated pupil. +1
jmd2020  Aneurysm of the PCA would compress the oculomotor NERVE, not the nucleus (just fyi) +1
trazobone  I appreciate u cheesetouch +

 -3  (nbme13#20)
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I ieeebvl ttah teh isnetuoq is tgngeugssi teh teitnpa sha a mtaneolh orsovede.

ritFs Aid 2180 gepa 7st2M—p"nieFibE izhoOil: olochal eyrsoegdhneda nda is an etodnati rFo dOresvsoe of anletMoh or tEnhyele gl.lc"yo

eTh aonser I ma uusern is ttah kiiidpwea ssttea most ntiap nhertnsi rae etkseno ro hbydsarrcono

lae  that's correct, I don't know about what the thinner has but the clinics is methanol toxicity for sure +1

 +16  (nbme21#6)
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mctrnohia gienetav = no rabr bdieos = osernp itwh YX entegoyp ro OX cbeeusa yemnait yuo ahev rome ahnt oen X omosorehcm uoy hvae a rabr obyd hctn(ramoi os)eviitp


 +5  (nbme21#10)
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)nCna--lH(-Nao+Ci3=O apg = -+10(1500)41 = 52 /LmqE

nmralo gnrae orf ainon pga is 8 to 16 qhoeTr/.feEe.,.rmL isoevtpi annoi pa.g

Hp = 27,.5 ornaml grnea .-..7575.43. rfeehTero idicssoa

rlNaom bcboeaanrit ,222-8 iessnquot hsosw braibc fo 0.1 roTeefehr lacombite iosdacis

aniydlAoditl COP2 mnlryaol 35-43 mm ,gH nqsitueo swohs OPC2 of 32 ihwt mrlnoa ,2PO eorreehtf preroityars pioemnsncota

mambaforstep  why did the stem say she had a drinking problem... is that just a distractor? +
castlblack  I think alcohol uses up all the NAD+ in its metabolism leading to increased NADH/NAD ratio. After that, TCA cannot progress and the cell is forced to use anaerobic metabolism, which increases lactate. lactate causes anion gap metabolic acidosis (L in MUDPILES from first aid) +1
nafilnaf  She may also have ingested methanol if she couldn't get her hands on regular ethanol which causes an anion gap metabolic acidosis (M in mudpiles). +1

 +7  (nbme21#18)
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eedyllr aldy hiwt ,slwo ssrivrgpeoe emroym ls,so rnoalm clsipayh mx,ae no sgisn of ,odiesepsrn stih is tmso ylielk reemlhAiz asdeeis.

EhAC hbiiiostrn rae edus rof nertatetm eescabu iAsee'lmzrh is dtsacisaeo whit wlo .hCA lsAo edsu are AMND copterre asoattignn minna(tem)e


 +0  (nbme21#33)
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why si ctrteiopno of hte idhcoor pe,uslx morf rlrranaticenuivt tpuuerr nyedcrsoa to eagnrmil ixatmr hohgremrea otn a sseopilb w?esanr

whoissaad  yes same question, both retinopathy and intraventricular hemmorage can occur due to high oxygen levels.. +
cienfuegos  I mistakenly chose choroid plexus too, based on wiki seems this is most common cause of IVH in term infants: IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus. However, it is particularly common in premature infants or those of very low birth weight... Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. https://en.wikipedia.org/wiki/Intraventricular_hemorrhage#Babies +
burak  choroid plexus is different than germinal amtrix +
meryen13  retinal hemorrhage is more common that IVH even if you think that it could damage choroid places secondary to germinal matrix hemorrhage. https://www.ncbi.nlm.nih.gov/pubmed/11304816 +

 +3  (nbme21#10)
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yhw si eephmdilarypii sryacneod to hcusngi soneyrdm not a tolibsiypi?s

hello  SIADH = MC paraneoplastic syndrome of small oat cell lung cancer. Also, Cushing syndrome would cause would weight gain, skin hyperpigmentation, and hypokalemia. Not, lyperlipidemia. +1
charmrooftops  You do get hyperlipidemia in cushing though? https://www.amboss.com/us/knowledge/Cushing_syndrome So still unsure why this is not a possibility. Is it just a "more common" thing for SIADH? +2
peridot  I was debating the same thing. But yeah I guess the SIADH association is just supposed to be stronger somehow and "more common"? +

 +7  (nbme20#9)
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tP ahs sgnsi and Sx fo etolrcryohips. /lnLrmwooa CTAH aovsrf ealedetv ocrlitos eeedtnndpni fo CTA,H dominfcer yb alkc of seosnrep to asaedenoxetmh so.pupnessir anZo fluaiatcsca is ginrio of sctoirlo nouptrc.dio

champagnesupernova3  They tried to confuse us saying both low dose and high dose dexamethasone didnt suppress it. But when ACTH is low you dont even need to do high dose dexamethasone test. The high dose is only to differentiate between Pituitary adenoma and ectopic ACTH production +5
hungrybox  @champagnesupernova3 fuck they got me +11
azharhu786  They got me on that question as well. I thought it was ectopic ACTH production due to some paraneoplastic syndrome and this is why Low/ high dose dexa is unable to suppress it. +1

 +1  (nbme20#2)
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CPR is na cuate sapeh atnrcae,t hsete rea inzdsseyteh irmarpyil by eth ivrle


 +3  (nbme20#16)
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eSe eth rstif ida rteyn no Tuosuebr celrosi.ss It is scosdiaeat ihwt rnisceeda cneidinec fo eybalspdnmue tiang lcle otaoycmstar dan anmy heort .coinnsdtoi

hello_planet  FA 2019 pg. 513 +2

 +2  (nbme20#5)
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A sehrctt ryuinj ngdiur iilhdrctbh liwl lesurt in gedmaa to eht etanelxr retlauehr dna aaln itprsschne nad gedaam to teh alpundde vnree 4-.)SS2( iTsh nca elda ot eercedasd nosiatsen ni hte leerpina and algient arae adn lfeca ro ianuyrr entccnoenini

thepacksurvives  I think that there can also be a direct tear to the anal sphincter muscles +6
sympathetikey  A better answer choice would have been "damage to the nerves innervating the anal sphincter" but eh, ok. +20
nerdstewiegriffin  I it is due to actual tear of external and or internal anal sphincter Source uptodate +2

 +0  (nbme20#4)
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cilssac for yyieirnmlSgao - surlste ni ebl-tliraa sols fo anip adn pertemateur stesnanoi ni a kep"cae-l"i sinbuirtidot


 +5  (nbme20#23)
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ignag euslsrt in srdiecane tireaarl inssffste ge(anch in xrtEa elcurClal timraxM omooiptcsni - cdserdaee eailns,t isneeadrc noallceg ptnies)d;oio HSI is lpbsienesor for 0860%- fo HTN esasc in nieattsp gt&; 6.0 ,lAso rddseeeca epacmnciol as a tlesur fo gngai acssue nsidreaec upesl esrrsupe

rio19111  why not dev. of coronary atherosclerosis? +1
pakimd  @rio19111 i think the Q stem is asking in absence of any lesions of blood vessels; the number and severity of which increase with age. So with normal aging SBP should increase in isolation which may then result in the development of coronary atherosclerosis- if that makes sense +1
chandlerbas  aging causes decreased compliance in large arteries: (1) accumulation of collagen and calcium (2) degraded elastin and large arteries accumulation and it also may have something to do with lipofuschin +1




Subcomments ...

submitted by dbg(140),
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iDd nonaey esel nowdre WAHT LNUP"ROAMY SMSTY"PMO is the etinquso neergfirr ??ot erTeh si layetirll not a slegin mtyomsp nnmdeetoi ni teh lwohe t.tinvege oN secl"kcar adreh oerv tboh unlg f"sdile aer tno ysmtms.po Tyeh rea sings nfduo by teh aihsicnp.y

Soelyisru nigbutod hte elowh MNBE broad etst eiwstrr hrigt .won oD eyht eyatqauedl reivse tiehr or?kw ishT si nto eht tsfri hectnacli stakmei I eiazelr on the ewn m.ofsr

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +2  
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +2  
ergogenic22  i take that back i understand what you're saying +5  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1  


submitted by dbg(140),
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idD noynae eesl ondwer WAHT LUYMPNO"RA PSMYTMSO" is eth iuntoseq rfeginrre o??t ehreT si lyltiaelr ont a giensl mmtpyso omidnntee in hte ewohl igtvne.et oN "lsekacrc drahe ovre btho nulg fsi"dle ear tno o.tsspmym yThe rae isgns dufon yb hte pinhaics.y

oelSsyriu dutbnoig het eohlw NEBM obdar test iwsrert girth .onw Do hyet aqleetaduy sierve itreh ?korw hiTs is ont eth tfris cltihecna tkieasm I leaiezr on hte ewn sm.rof

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +2  
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +2  
ergogenic22  i take that back i understand what you're saying +5  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1  


submitted by krewfoo99(90),
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hyW wludo edseeadrc vtmneemo roghuht eth rlereaceb uatdqcua eb gnwro? Whit lla eht ibdul of dlobo ni hte CFS acrtt thtouiw oi,rtnbspoa owdltun tnmemveo alos eb edesceard gtrhhuo het aqd?teucu

ergogenic22  this would cause a non-communicating hydrocephalus with enlarging of the lateral and 3rd ventricles but normal 4th ventricle and subarachnoid space +1  


submitted by monoclonal(21),
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ehT notpi eerh i,s ythe are singak us ot imneletai het ynlo rwsena atht is nto isbopsle. I gto it gwon.r drae lwle faells

ergogenic22  nbme logic: "what if they all marry carrier wives" And doesn't everyone with autosomal dominant get it in the 2nd generation (unless incomplete penetrance) i feel dumb +18  
cavernosum  totally agree. what a st*pid qs! +  


submitted by krewfoo99(90),
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In awht tsuinatosi lilw HbH eb edrfom (3 pahal icanh nlo)teide?s

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(90),
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Why owdlu pierornsf eb eht wnrgo sanw?er lnWtduo uuaotaimnclc of xcoit sptoneir csuea hte lecl ot dgunoer toaopspis ?

ergogenic22  Bortezomib does not directly activate perforin. It directly inhibits the proteasome which → enables CD8+ T cells to initiate apoptosis → via perforin release (in essence a downstream effect). +4  
drzed  Exactly, it triggers the cells to undergo apoptosis which means that it can either be cell mediated (perforin and granzyme via FAS/FASL) OR it could also be through the intrinsic pathway (e.g. mitochondrial; cytochrome c) +  
powerhouseofthecell  Question: But how do CD8 cells have a role in this process exactly in the vignette? Is it saying that when the proteins build up, only then do CD8 cells come and instead of MHC I presenting to proteasomes, they present it to CD8 to initiate apoptosis? +  


submitted by krewfoo99(90),
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In what iautsstoni lwil HHb be ordfme 3( palha inhca dnilo?)seet

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(90),
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nI ahtw usstiianot lliw HHb be mfredo (3 pahal anich ni?)tldeseo

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(90),
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nI twah usttsinoai iwll bHH be eomrfd 3( alpha chain ?)doteiensl

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by cat5280(3),
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Cluod ensmooe elpesa epinxal why yuo rwee elba to eieilantm hte ceorlpeireblsan catts?r

ergogenic22  Spinocerebellar is only responsible for Proprioception (unconscious). This patient also has reduced vibration sensation, which the dorsal column tracts are responsible for. +3  


submitted by mousie(211),
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nCa ooensme eepals panlexi thsi ot me? I tn'od snentuaddr why nrtgatsi het othre durg ludwo otn utcno as xnluecsio ?caireitr

seagull  This has to do with Intention-to-treat analysis. Essentially, when participants are non-adherent but the data shouldn't be lost. They just undergo another statistical model to account for their changes. Here is a nice video https://www.youtube.com/watch?v=Kps3VzbykFQ&t=7s +19  
dr.xx  Where does the question mention "intention-to-treat"? +  
notadoctor  They seem to be pretty obsessed with "intention-to-treat" it's been asked in one way or another in all the new NBMEs that I've done. (Haven't done 24 as yet) +8  
wutuwantbruv  They don't, intention-to-treat is just the best way to go about it @dr.xx +  
smc213  Great for ITT: https://www.youtube.com/watch?v=Kps3VzbykFQ +4  
yex  I agree with @notadoctor !! +  
ergogenic22  i think if it were per protocol, both groups would be excluded, the ones that were inconsistent, the ones that dropped out, and the ones that switched. But answer choices only allow ITT or exclusion of one group. +  


submitted by titanesxvi(78),
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ywh tno cderseea CA atiivyct ni eht prmlxoia b?ueltu sith sloa lduco aedl to oelmibtac ci.sdiosa

ergogenic22  carbonic anhydrase inhibitors can cause Type 2 RTA but it is not the cause here (cystinosis) +  
doublethinker  Yeah, I said CA too. Problem is that CA deficiency wouldn't lead to lack of reabsorption of all the ions listed. +  


submitted by seagull(1443),
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ocyptleSmne seatnitp era enveulbral atiasng adaplsnteeuc s.smaroing hhWic cnomolym nleiduc reSpt mo,uPne iia,serseN H. lIfanenuz.

ergogenic22  although Pseudomonas, Klebsiella are also encapsulated, strep pneumo is more common for pneumonia in a 25 year old F without other comorbidities +5  


submitted by sunny(4),
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HYW TNO nYadSE, ethn earsh het neymo htiw eth ntaeyip os he 'otnesd tubdo uoyr .eismotv

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 sunny(4),
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WYH OTN SYnE,da tehn hreas eth nmeoy thiw eht eaptyni os eh 'enstod odbtu royu omsv.tei

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 ergogenic22(303),
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siTh sqteuoin eiersdscb cellI- daeesis sinc(lunio lcel seieimdopaos/usldiics ytpe II). uoY cna tell baecseu teher is dixme iactocnmulua of jknu fmiorng hte snioincul .dboies Orteh aooslysml rteoasg sideases vhea nuaocuatclim of eon epty of eb.nasstcu

Elseylnsi,at heetr si a ctfede ni fecetd ni the ynzeme cet.p1lstge-nlya-uNoiasshmae-csryonphloafr

hiTs neasm eth shna-e-peaoohmtnp6s tag connta eb deadd ot .itorpesn Whttuoi ihst g,ta psnoietr rae lireccontyr setn to teh lruraelcxelat peasc erhtra hatn vdeeiredl to oy.semslos

ergogenic22  ^^correction. You can tell because there are elevated lysosomal enzymes in the plasma. This is because the proteins are not tagged with M6P and thus are excreted to the extracellular space. +20  


submitted by mcl(586),
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iPttean aym vhae reidthayre ,noidaegmae cwihh is citsoesaad whti unrreect"r scattka fo teni,nse ,evmassi idcllzeoa ustbcauesonu meead ignlvionv hte eeit,rtexims at,ileiang f,ace ro r,knut ro olmsscuuab medea fo rppue raawiy ro eowlb".s eTh itlarec gsoe on to asy r"Cea-esse1t rinoiihbt okswr yctiredl on hte onmelmtcpe nad coanctt slpama easscdca to ruedec bkdniniray earesel" wichh is laso bpoabylr ogdo ot no.wk

m8/h:oglnpwic/.Mc3/t6bw3svi6wmn/6Cl/cs1Ppti./.ernah.t

notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4  
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +22  
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2  
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3  
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +2  
teepot123  fa 19 pg 107 +  
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1  


submitted by temmy(127),
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eplase hepl arcndcogi to wteirns ioaneutq hte tapenit has a rlamno oinna gap

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +1  


submitted by temmy(127),
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lepesa pelh ndogcicar to iwtsnre aneoquti het ntpiate ash a nrlmao aonin gap

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +1  


submitted by hayayah(1057),
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het jtariyom fo arbnoc idxdioe uceoellms are irecdra sa part of eht cibbrtaaeon beurff e.mtsys In isht yess,tm ocnrab doeiidx iffsuesd iton teh CBR.s Craonibc senayahrd )AC( wthiin sRCB lckuqiy cetsrvno het bncrao deioxid oitn croinbac idca 2)(3C.HO Cnrcaibo daci si an uebsaltn etidintramee ceeluoml atht meyaiteidlm asseosiditc itno tebanarboci nsio O-)H3C( adn hydegorn +)(H onis.

hTe nwely szyidehnste cabeiontbra noi is dtsnoprtrae tou of het CBR otin het psmlaa ni cexaenhg ofr a dlieocrh ino Cl;−() tshi si cellda het riecolhd .sfhti heWn het loobd eerhcas het ugsln, teh boaatebnric nio si aontstrdrpe akbc ntoi teh CRB in gahxnece ofr het ehldoric .ion Teh H+ oin acstoeisdsi from the onlibegmho adn dsbin ot teh baabcntrieo .ino sTih opuredsc the ncribcao cdia ried,eenattim wchhi is ndevorcte kcab tino anrbco oxdiide ogtrhhu hte yntimceza aicnot fo .CA heT aobrcn xiddeio dcpueord si epelelxd hrouhgt het usgln nrgiud x.htalieano

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +5  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3  
teepot123  fa 19 pg 656 +1  
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +  


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ehT ntpiate ferfesdu romf numemI obacypTrhooitenm. bisunodioteaat tanigsa eht otnepcgyrosil .2PGA3B/

nO sa,bl ollyu’ s:ee nasircee in somekae;gryaytc no eht tsueniqo tsem ’treeyh scebrdide sa erar“ tub l.age”r styecgMayakoer rae otn sd.sserpuep

ergogenic22  isolated thrombocytopenia (low platelets) should be highly suggestive of ITP https://www.aafp.org/afp/2012/0315/p612.html +2  
pg32  I agree that in ITP you will see an increase in megakaryocytes, but where did you see that in the stem? Platelets being, "rare but large" doesn't mean megakaryocytes, does it? Also... can anyone explain why she was anxious but alert and had petechiae distal to the blood pressure cuff? +  
meryen13  @pg32, I'm not too sure about the "anxious but alert" but I think they might wanted to mention she is oriented so in case there was no lab values, you would guess that she is not extremely anemic or something. and about the petechia with the cuff and the tooth brushing bleeds, that is a sign of platelet problems because its a superficial bleed. if you saw deep bleeds like joint bleedings, think about coagulation pathway problems (like hemophilia) +2  
zevvyt  "rare" means thrombocytopenia. "Large" means there are megakaryocytes to make up for the thrombocytopenia +2  
lovebug  FA2019, page419 +1  


submitted by hungrybox(977),
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hTsi edivo iaxplsne aglneti mylerygoob xtlyeemer .lelw

fI yuo flet atytoll tslo elki e,m thwca teh eoidv irfts ta 2,x hnte heckc uot eht omttob urfegi no p.g 860 in FA 0921.

Revtlnae to shti qseoi:ntu

  1. RYS srenitpo ltautimes neevemodtlp of teetss
  2. hsTi pt ash esetts t;g=& he mtus eahv eht SRY neeg no the Y mromohesoc
  3. FMI rseaddeg hte nielMralu dct,u ihhwc wudol tihwoseer bmoece the alitenrn mfelae iglieatna
  4. Thsi tp has ratlenin felmae naateigil ;t&=g in'ddt kame uhnoge IMF

ziQu relfoysu rsanwse( ni a traaseep :ot)ps

  1. ihTs tsepin'at ieddosrr can be tceard back to hwihc el?lcs
  2. sTih aptteni had nomral taleg.niia fI tshi tinpeat dah leaslmr eingatlai thna ,rolman htta ouldw eb a tfdcee ni waht em?yzne
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +11  


submitted by usmleuser007(377),
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intamVi E ccnyefeiid is nkwno ot uasce ismrail snpail tcefsed as tmnVaii 1B2 nideyicecf. ov,eeHwr amnaei si ton ense.

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +8  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4  
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1  


submitted by xxabi(252),
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I asw enudr the nseimpiros thta isht saw na cotari ,tsidiconse due ot "ereves chste "pina as lwel as the slfea lmuen in eth to.raa dnA NHT is hte #1 sikr tarcfo rfo trcaio ict.sodnsie Sneeomo rcocret em fi 'mi gnrwo, tub I nhtik tsih si itocar dsnceisito treahr htna rtcoai unyserma.

chefcurry  I believe so, FA 2018 pg 299 +3  
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension +2  
breis  FA 2019: 301 +  
pg32  First Aid says that aortic dissection causes widening of the mediastinum and is due to an intimal tear, so I thought it wasn't an aortic dissection. Can anyone help me understand why First Aid was wrong in this case? Thanks! +3  
nephroguy  @pg32 The question stems states that there is no widening of the Aorta, not the mediastinum. Widening of the mediastinum is seen in dissection while widening of the aorta is seen in aneurysm. Also the intimal tear creates a false lumen between the intima and media. Hope that helps! +9  
j44n  https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.312436 pictures worth a 1,000 character limit +  


submitted by sympathetikey(1265),
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etriDc luintnAlbiog = eDrict sComob setT

cDttese etoiindasb buodn crtyedil to CsB.R olHysimes stom lkiyle deu to gsiehtonm ni eht taerunssfd ldboo tno( sreu wyh it ookt 4 keews nehw Tpey 2 HS si updpeoss ot be urkeicq tub w/)e.

ergogenic22  there is a delayed onset hemolytic transfusion reaction which should be evaluated with direct cooms test. https://www.ncbi.nlm.nih.gov/books/NBK448158/ +5  
hungrybox  such a dumb question wtf +25  
sonichedgehog  takess longer due to slow destruction by RES +  
baja_blast  Dang, I didn't know that was the same thing as a direct Coombs test. I guess it makes sense in hindsight. Thanks! +  
sars  Theres a UWORLD question with a table displaying the different types of hemolytic reactions. Don't know the question ID. Agree with delayed hemolytic transfusion reaction due to formation of antibodies against donor non ABO antigens. Typically presents as an asymptomatic patient or mild symptoms (jaundice, anemia). Different from an acute hemolytic transfusion reaction, which is against ABO antigens. +1  
tomatoesandmoraxella  The Uworld table is in question 17780 +1  


submitted by hayayah(1057),
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ocoagnGla:um Tomru of rncteacapi α lslec ugnŽsaic na notdoevcuiorrp of .lacnuogg

eesrnsPt ithw ’5:sD

  • iDrscieryclotea(ttinm matrgoyri eametr)yh
  • eDitasbe ygphare(yceil)m
  • VTD
  • Dinnleicg wtiegh
  • esnDsoprie
killme  And the sixth D: Diarrhea +8  
ergogenic22  a) CAT1 and CAT2 are important enzymes of fatty acid beta oxidation. Glucagon upregulates this process b) glycogen formation is inhibited by glucagon, so that glucose can be used by cells c) acetyl CoA carboxylase is used for fatty acid synthesis and thus decreased by increased glucagon d) glucagon increases ketogenesis +53  
dermgirl  Basically, they want to know what is the function of glucagon. +1  


submitted by hayayah(1057),
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loaibyosdRsmyh can npsteer klinoog kile a nydike rjunyi (ti can lead to uteac balrtuu sienocrs as )le.wl heT etocylertel dnifsign rae jtsu kile aelrn uaielfr Ic(.n K+, c.ni -PO4, ced. C)a

oT fdfeineertati teenewb blohiymssdyaro and yndike ryinju, ouy kchce the nreui to ees fi eerth are yna .RCBs In sosabiymdhoylr eerht rea no refe sBRC ni eht urein.

ergogenic22  "Crush injury" is a buzz word for rhabdo +11  
ibestalkinyo  The mechanism by which AKI occurs after rhabdomyolysis are due to free radical formation. Other urine finding include blood on dipstick, but as hayayah said, no frank RBCs. +1  


submitted by ark110(1),
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But awht is teh idecfeenfr neeewbt niotop A and opnoit C (231; ;.94 ;90 5)3

sympathetikey  K+ shouldn't increase. It's moving into cells due to metabolic alkalosis. +  
home_run_ball  In the parietal cell of the stomach Hydrogen ions are formed from the dissociation of carbonic acid. Water is a very minor source of hydrogen ions in comparison to carbonic acid. Carbonic acid is formed from carbon dioxide and water by carbonic anhydrase. The bicarbonate ion (HCO3−) is exchanged for a chloride ion (Cl−) on the basal side of the cell and the bicarbonate diffuses into the venous blood, leading to an alkaline tide phenomenon. +1  
ergogenic22  RAAS increases from volume loss, and thus more aldosterone leads to low K+ +1  
sinforslide  Three reasons for hypokalemia. First, some K+ is lost in gastric fluids. Second, H+ shifts out of cells and K+ shifts into cells in metabolic alkalosis. Third, ECF volume contraction has caused increased secretion of aldosterone. +3  


submitted by hayayah(1057),
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iWht nohiccr o,mnivigt yuo oesl eeretyslotcl nda a olt fo cdi.a tI sgrtireg cbimltoea oiakaslls ichhw is yhw lla eht eurms auevls rea wlo ro( on het loerw ned of eht omrlan )ganre cexetp rof ce.itnbroaab

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +4  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +1  


submitted by hayayah(1057),
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iThs si na xelpmea of hSisgne.l eepHsr lepsmix adn pseerh seortz rvsiesu asuec obalmnar clle onivdiis in ereimpald ,lscel nad isht taesrec lauudcenettmli nagti l.scel

A zTnak masre siwngho eadnuliulttmec tanig cllse si taciceharsrict of ecVlilaar Zrseot ruVsi ncito.efisn (SHV illw heav siimrla disngnf).i

ergogenic22  other identifying terms for herpes: Single dermatome (does not cross the midline), painful (burning and itching),and lesions in multiple stages. +3  
redvelvet  and why neutrophile infiltration, is it a thing? or just a distracting thing? +1  
charcot_bouchard  Neutrophil comes into party always first. but it was distracting for me too. +6  
dulxy071  Regardless if it can help resolve the issue, neutrophil will always be the first responder +2  


submitted by hayayah(1057),
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rotasPtiits is cciearazdhetr by ayr,iuds feu,cenyqr uyncerg, wlo akcb na.ip rWm,a dnete,r egnaredl tprt.saeo

Aetcu teablriac riisnaip—osttt dleor men most noocmm icbmrtuae is .E .ocli

ergogenic22  In young men it could be chlamydia but the question stem makes no mention of sexual activity, so it is e. coli +11  
charcot_bouchard  First this guy isnt older! He may incite Daddy issue but not older. At this age people tend to be more monogamous so E Coli the more likely answer. But again cont NBME 20 trend this one was pretty vague too. +1  
monkey  They classify at 35 year old (<35 = Chlamydia or Neisseria and > 35 = E.coli) +3  
mbourne  I put Pseudomonas, as that is a cause of prostatitis in older men, but it is less common than E. coli. Just keep that in mind, if E. coli wasn't an answer choice, the answer should have been Pseudomonas. If he was a younger male, then Chlamydia would have been acceptable. +3  
brotherimodu  @mbourne I think Pseudomonas is the more common etiology for acute prostatitis in the elderly (>65ish for exams), whereas E.Coli is the more common etiology in adults 35-64yo +  


submitted by monoloco(132),
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lAunanr pracnesa si the noyl nraesw ttha ncaocust rof eht blei in teh mtoi;v fo teh secoch,i ti si hte lnyo utbontrocsi alsitd ot eerhw blei tseren hte IG .tctar

ergogenic22  Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +  
sympathetikey  Correct. Might cause pain due to ectopic gastic tissue. +3