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Welcome to gainsgutsglory’s page.
Contributor score: 22


Comments ...

 +1  (nbme22#2)
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hyW is cpnnatoeeahim teh octerrc sraenw otreh nhat oescsrp of eltoaniimin. NsDIAS nac be used for tsnonie AH adn ’sehs oto dol ofr Reye odnrmySe i( mena cnycehillta hsse a diclh iencs sshe &,1tl;7 tbu tno a icsclas rpcetiu ta al.)l Im’ sfncdu.eo

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction. +
gainsgutsglory  @zelderon But what’s the pathophys here? +
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +3

 +1  (nbme22#35)
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yhW is stih trnaiieltsI aaf?itnInmmlo I dudstnanre ihst is a VRU gncsiau hyrseopnhs.rodi

skinnynomore  this kid has chronic pyelonephritis due to recurrent UTIs (VUR/hydronephrosis is a risk factor). And -itis = inflammation. That was my take on it. +3

 +1  (nbme24#35)
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ehS hsa nOssegeiesto pmfeIetcar. akA rle“ttiB eoBn D”z kaa olClnega eypT I fdi.ccieney U eden clneloag ptye I to akem srsca n(uaagoinlrt utessi is ytpe III dan nthe epsealottoselamr dna iznc soforcatc lhpe dsetig otni eht rfim ypet I cgnllaeo).

wowo  FA 2019 p51 +




Subcomments ...

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hyW is innmaaotehcep het rceorct wanser ehtro tnha seprocs of ilnie.mitaon AISsDN can eb euds ofr sonniet AH dan ’essh oot old rfo yeRe dmeronyS (i nema leynaicclth hsse a hdilc iscne hses ,l&17t; utb otn a csacils tpcrieu ta la).l ’mI ou.csfned

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction. +  
gainsgutsglory  @zelderon But what’s the pathophys here? +  
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +3  


submitted by pitaziki(-5),
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Wyh is it hatt het snarttielco evni oveirdsp eth toms edicrt pawahty orf tatsmiacet aebrst nreacc lcels to sepdra to artrvlebe lumnoc? I tugothh it saw teilarnn airocthc am)army(m nda I cutno’ld ndfi muhc gihseanrc eo,nnli diesebs pieaiidwk ynaisg atht inrtneal oiccahtr eivn sidran hte btsra.e

gainsgutsglory  Intercostal vein → Azygos → Batson vertebral plexus → infection of inner vertebral body +19  
realmedicmd  The internal thoracic drains into the subclavian, intercostal drains into the azygos system which is a more direct path to the vertebral drainage. +1  


submitted by pitaziki(-5),
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Why is eht enarws rfaisluib sbiver nda otn iibsufalr iu?stter woH od ouy utsdnisghii beentwe teh two orfm hsti ienttve?g

gainsgutsglory  tertius is an anterior muscle and overlays the dorsum of foot as it fans out to the toes. Does not relate to the lateral malleolus. +  
adong  wrong question to post on agree with above +  


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ruO tlielt feridn has a aivrrvosPu ifnio,cten wichh fceitsn diyheorrt sscuorerp,r uacsnig nnetiutpirro fo cytrteeryoh ioodt.urcnp Thsi is eth emsa yaw ti eascus sohyrdp afeitsl ni obrnun bbsiea adn tlcspaia naiema ni ekicsl cel,l t.ec

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +16  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +2  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +4  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +  
angelaq11  @Is3076 I completely agree with @hyperfukus and I think that thinking of Roseola isn't crazy, but remember that usually with Roseola you get from 3-5 days of high fever, THEN fever is completely gone accompanied by a rash. This question says that the patient has a history of 4 days of rash and 7 days of fever, but never mentioned that the fever subsided before the appearance of the rash. And Roseola is not supposed to present with anemia. +3  
suckitnbme  @Is3076 another point is that malar rash refers to the butterfly rash on the cheeks that is commonly seen in lupus, so the face is NOT spared. +