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Welcome to euchromatin69’s page.
Contributor score: 10

Comments ...

 +0  (nbme15#23) similar image in colored form ....

 +3  (nbme22#7)

see 18636 .world

brise  I can't find this!? +

 +0  (nbme23#32)

check out uw 18661

 +0  (nbme23#15)

both statins and hypothyroidism can cause myopathy, one of the musculoskeletal effect of hypothyroidism is myopathy with inc ck.

 -1  (nbme20#46)

pregnancy is a risk factor for acute pyelonephritis FA 2019 pg 589

Subcomments ...

submitted by ergogenic22(320),
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Seh ash tomor nad ssreony tossp.ymm hiTs /ro tboh dkisn of iplesm. Her ieszuers ear nto icrbdseed sa cncoctlniio/ et,envsomm nad nuldice reipsod fo dreiiamp ncscoinosseu.s Tihs erlus out ezgereaidln ioit/olc.nncc ehreT is a ilatto-spc ,steat tath leusr otu ans.eecb

Aosl het pli misgnkac is trrceataihccsi of aimatts,omu hchiw is udofn in coexpml ialptra ziruesse

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  

submitted by cassdawg(1101),

Key aspects of the question:

  • Hypokinesis of the posterior left ventricle with increasing activity levels - in my opinion this is the primary clue to stenosis of the right coronary artery. This is because the posterior heart is supplied by the posterior descending artery, which in most people who have right dominant coronary circulation is a branch of the right coronary artery.
  • "When climbing stairs" and the hypokinesis being present on stress testing - this helps you to know the condition is only exacerbated in exercise, and stenosis of the RCA generates symptoms in exercise because in excersise the increase in oxygen demand typically causes dilation of the coronary vessels to accomadate. When there is stenosis, the vessel cannot dilate and thus there is transient ischemia of the area the vessel supplies (this is potentially exacerbated by the coronary steal phenomenon in a stress test which can occur with administration of vasodilators) FA2020 p304

Increase in oxygen consumption is the normal response to exercise and alone is not pathologic. Extravascular compression of the coronary arteries is also considered normal and nonpathologic; this is why most coronary blood flow occurs during diastole and why the endocardium is most susceptible to ischemia.

euchromatin69  but isnt stenosis gonna cause m.infarction? we have not been told any percentage of stenosis +  

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The enooabnmplehcrh duolw be no the aaultc fsteu os tusj egt ird fo .)(D Teh "kalbc "ohle hatt eth steuf si lgiatfno ni si hte aogitelasnt csa so tge ird fo )C(. woN I am on orsudtlaun ertxpe utb I nwko htta eht atconimi vctyia vllenteuay psnaxde to usef twih the hnocori yreebth iilmeniangt eth cnocihior aciyvt B(.) In strem of heewr hte inicatmo cyaivt si nowsh in isht ai,mge I am ont r,esu os myeab sonmoee acn hepl btu hsit alseev het lkoy sac hchiw citllypay rpapaes ihiwnt hte aaginottsel sac uanrod 5.5 .wkees

kateinwonderland  At the end of the fourth week, the yolk sac presents the appearance of a small pear-shaped opening (traditionally called the umbilical vesicle), into the digestive tube by a long narrow tube, the vitelline duct. (Wiki) +4  
tallerthanmymom  But why does it look completely detached from the fetus? I eliminated yolk sac first because of this +  
makinallkindzofgainz  If you look reeeeeeeally closely, you'll see some signal between the yolk sac and the baby. Although you can't see the entire connection, they are connected. +4  
thotcandy  Pt is roughly 8 weeks pregnant so and typically by 9th week, Amniotic cavity has expended to fill entire volume of Gestational sac. So the entire black part around the fetus is GS/AC. +2  
euchromatin69  and also by 7 week vitelline duct obliterates between umbillicus and yolk sac +  

submitted by mcl(597),
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nI ecas oyu nwana go rupes ndre dan edra btaou mly,eni pac,caiatnec adn eecsn,tsiar sthi ugy sdeo a doog bjo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +21  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  
brise  Uworld 1318*** +1  

Free radicals damage cells via membrane lipid peroxidation, protein modification, DNA breakage. Initiated via radiation exposure (eg, cancer therapy), metabolism of drugs (phase I), redox reactions, nitric oxide (eg, inflammation), transition metals, WBC (eg, neutrophils, macrophages) oxidative burst.

euchromatin69  fa19 pg 210 +1  

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I duler uto aPgets' busceae aetg'sP si uuylals al,dzloiec epr AF, ,mPoaaht a;.BmpB& hhuAogtl ihst tntiape fieiyenltd tsfi eth pomrdhgaice cr,teuip opsrteta crnace si lnfiyediet ton teh only crnaec ahtt can taeasetsizm ot het ns.oeb cueseaB tseeh ear clity n,issole it's pablybor mseo etrho ncacre tat'hs dserap to the onseb

medguru2295  Possibly Multiple Myeloma. That is classic for an older person with back pain and lytic lesions in the back. +  
asharm10  osteolytic- multiple myeloma, Osteoblastic- Prostate; dont think beyond this for this exam, i have never seen a question in NBME or uworld they tried to fool us off on this concept so far. +1  
euchromatin69  u world 341 same concept +  
skuutnasty  I'd like to reiterate what's stated above... dx NOT MM in this question because MM is PRIMARY not METASTATIC @ bone (answer reads: metastatic carcinoma) <3 +  

submitted by notadoctor(158),
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asAysinl fo teh tsniale in eth soeiutnq hesowd a aesdcerde bumner of msseneido kosisnrs-l.c sDnmioees si adme up of uorf nyisel .ersesidu hreofTree roblmana alnesti si ylklei mgsiisn ylseni csyrseena ofr teh ntriooafm fo ehste edensmios ornss-.licks akWipdeii lraceti no nDmieseso.

dbg  how can i trust you, you aint even a doctor +22  
euchromatin69  trust this then U.W 1249 +3  
tryntofigritout  UW 1249 was perfect. #loveyourname euchromatin ha +  

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nI gehipycnsco iopa,ydipls ursem mousid is w,ol dna erfta aertw dnrtvaopeii est,t eurin slooityalm si icdeUaeeni rrn.s taoymsloli dose otn ceisenra whti oapirnsevss itjioncen

In nncorgiephe saidtebe up,idiniss rmuse omisdu is hgih nda hetre si on ehligcma/dn ncaeeris in irnue soyitaomll ftear wetra oevtrdipnia

yotsubato  This patient does not undergo a water deprivation test +12  
niboonsh  Compulsive water drinking or psychogenic polydipsia is now increasingly seen in psychiatric populations. Effects of increased water intake can lead to hyponatremia causing symptoms of nausea, vomiting, seizures, delirium and can even be life threatening if not recognized and managed early. +7  
missi19998  Just wondering why it in not resistance to ADH action of vasopressin +  
amarousis  because he would be hypernatremic with no ADH. can't resorb any water +1  
minhphuongpnt07  low osm/urine, low os/plasma => psychogenic polydipsia +  
benitezmena  In this question the pt had a normal urine osm (80) a low urine osm would be <50mosmol/kg. +  
euchromatin69  u world 212 +  

submitted by mbourne(78),

This is a mish-mash of information I can find on this subject. Can't find good info on this anywhere. I think this question sucks

"Isotretinoin has a low affinity for retinoic acid receptors (RAR) and retinoid X receptors (RXR), but may be converted intracellularly to metabolites that act as agonists of RAR and RXR nuclear receptors.

In the nucleus of a cell, retinoic acid acts as a ligand, which is a molecule that binds to a site on a specific protein, to activate two families of transcriptional factors. These two families are the retinoic acid receptors (RAR) and retinoid X receptors (RXR), which bind to genes that respond to retinoic acid. There are three forms of RARs and three forms of RXR.

Studies with in vitro rat embryos have shown that retinoids act directly on the embryo, causing those embryo to develop abnormally."

euchromatin69  u world 1568 flow chart +4