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submitted by neonem(568),
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This nptatie hsa palmoruyn osibsirf, chhiw eacuss a eiirsrvttce (ont eoerc-pbstt)iutvy ieesdas. eicnS terhe saw on ooicpltnaacu eexopsur, I'm unsimsga htsi is hcipaidoit npruoyalm irs.fbosi hsiT ucssae tiknehedc avorllea aenb,resmm itimling sga foii.sfnud frhr,eoeeT naeluyevtl 2O 'nwto be laeb ot fdeifsu lcikuqy nuehog nito hte oldbo cassro het aoelrai-ltlveaarr m,enrameb enligrstu in a grelar -aA feeeindrcf. I( hntki hete'rs rmylonal a amlls -Aa tdangei,r ofmr 1-42 mm ,gH tbu enhw siht gset too gb,i you get p)hocixy

yex  UW q id 7648 +2  
melanoma  uw id 1526 +1  
feeeeeever  FA 2019 Pg. 661 +1  


submitted by seagull(1539),
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uto of stiiy,rcuo how mya loeepp nkew ti?hs d(nto be ysh ot yas ouy idd ro ?ditnd)

My ytreovp diteouanc dnd'it nagiinr hsit in em.

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +5  
snoochi95  hell no brother +1  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


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nI the eagrt drsow of Dr tatr:Sa

tila"Pgsdnanor E2 meieasdt eeee"efeeeveere

NDAISs -tg&-; bcklo rlsaitnoagdnp ysn

thisisfine   This is all I heard in my head +7  
temmy  Me it was so weird +  
peridot  I do want to add, that while PGE2 is the right answer, FA19 p.213 says that IL-1 and TNF are involved as well. However, because the question asks about what is going on in the hypothalamus, the answer is PGE2. If the question had been asking about what the macrophages were releasing to influence the hypothalamus, then the answer would have been IL-1 or TNF (FA didn't specify if it was TNF-a though...). +1  
feeeeeever  You know why I'm here +6  


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Tsih is whta I tgtuhoh btu ont resu if ti’s etc.cror ehTre si a oWUdlr q hewer ti sedsrceib ortosain-itacnimd fo liosotrc adn nenphi.peeri oroltiCs ncailtnisfigy hacneens eth tfcfee of eip uebsace colotris hsa a mssiiervpe ffeect no tgnnmiaiain eht ncireedrga .rrcosteep

194orbust  per UWorld, "cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines". FA also uses the effect of cortisol on catecholamine responsiveness as the lone example for a permissive drug interaction (FA2018 pg 229). The difference here is that we're talking about exogenous glucocorticoid and adrenergic agonist. I guess it was expected for us to assume that the mechanism is analogous for the analogous drugs +13  
maxillarythirdmolar  I'm sure it's related to the activating effect of Cortisol on phenylethanolamine-N-methyltransferase, converting NE to Epi. Sounds like a synergistic thing to me. (FA.83) +3  
feeeeeever  My logic is probably flawed, but I also thought that if cortisol has the ability inhibit COX, LOX, and NFKB you can reduce inflammation and bronchoconstrictive mediators. Therefore, the B2 agonists would have a greater effect since things like LTB4 will be reduced. +1  
feeeeeever  *LTC4, LTD4, LTE4 for bronchoconstriction, my bad +1  


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shTi is athw I hotutgh tbu ton ersu if i’ts cerc.otr rheTe is a rdWoUl q rhwee ti rdssiebec tradimtaonisc-oni fo isoctrol and hpeen.eripni iorCslot tnfingyiiascl cnenhsae teh effcte of iep esebuca orositcl has a rsesieipvm ftecfe on ntagiminani teh arnrgecied eorep.tcrs

194orbust  per UWorld, "cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines". FA also uses the effect of cortisol on catecholamine responsiveness as the lone example for a permissive drug interaction (FA2018 pg 229). The difference here is that we're talking about exogenous glucocorticoid and adrenergic agonist. I guess it was expected for us to assume that the mechanism is analogous for the analogous drugs +13  
maxillarythirdmolar  I'm sure it's related to the activating effect of Cortisol on phenylethanolamine-N-methyltransferase, converting NE to Epi. Sounds like a synergistic thing to me. (FA.83) +3  
feeeeeever  My logic is probably flawed, but I also thought that if cortisol has the ability inhibit COX, LOX, and NFKB you can reduce inflammation and bronchoconstrictive mediators. Therefore, the B2 agonists would have a greater effect since things like LTB4 will be reduced. +1  
feeeeeever  *LTC4, LTD4, LTE4 for bronchoconstriction, my bad +1