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Welcome to gainsgutsglory’s page.
Contributor score: 36


Comments ...

 +1  (nbme22#2)
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Why si cetmnhoipanea hte rorccet rawnse oterh nath ssocrep fo .iiaiontmenl ADsNSI acn be used for iesontn HA nda hss’e too lod for eRye nerdyoSm (i amne cectanyllhi sehs a dlihc cenis hsse ;l,&71t but ton a saiccsl reitcpu at la).l ’Im su.endfoc

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
pfebo  Acetaminiphen is only antipyretic and analgesic. Does not have anti-inflammatory action like NSAIDs, so it is the most appropriate to treat a headache in a patient with aspirin-induced asthma. +
pfebo  Also, it is inactive peripherally so less probability of adverse effects +

 +1  (nbme22#35)
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hyW si stih lrnaiseiItt folnimItam?an I tneusnddra shti si a VUR auscign ohnoispdrhsy.er

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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Seh ahs eoOeesssgtni eacItrfep.m Aak ltB“rtie Boen ”Dz kaa gCllenoa yTpe I ienc.eydfic U need nceallog ptey I ot emak csras aonrgu(tanli uitess si yetp III and hnte elrtstaesaopeoml nda nzic occrotsaf leph digset itno the irmf etpy I olneagl)c.

wowo  FA 2019 p51 +




Subcomments ...

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yWh is pcniahoaeetmn teh cteocrr anrwse threo anht pesscro of a.etiomlnini SDIAsN anc eb used fro onsietn HA nad se’sh oot dol ofr Ryee Senormdy (i mean ichyalltnec eshs a hcldi ecins hess 1&;,lt7 tub ont a sclisac eturcpi at la.)l ’mI edn.ofcus

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  
pfebo  Acetaminiphen is only antipyretic and analgesic. Does not have anti-inflammatory action like NSAIDs, so it is the most appropriate to treat a headache in a patient with aspirin-induced asthma. +  
pfebo  Also, it is inactive peripherally so less probability of adverse effects +  


submitted by pitaziki(-5),
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hWy si ti atht hte tlseirconta evin oiprdvse teh otms rdcite haawpyt for miasattect sebtar naccer clesl to adespr to elrtbvrea ?umcoln I ghuohtt it asw raintlen ciocraht m(aa)mmyr nda I dcutonl’ ndfi cuhm acrgihnse lnn,oei sieesbd ieadkpwii gnyisa ahtt neilnrat coirtcah vnie isdnar the brs.eta

gainsgutsglory  Intercostal vein → Azygos → Batson vertebral plexus → infection of inner vertebral body +33  
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 si hte esrnaw sarfilbiu ibvsre nda otn riuibalfs ?urtesti owH od uyo shgitdniuis tnebewe teh owt ofmr htis ?etvteign

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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urO lltite dfrein has a oPsuirvavr nnoift,cie icwhh snteicf hdtrroeiy rsseucopr,r iscaung tnriueipotnr fo rtcreethyyo tcpr.noudoi sThi is eth smae ayw ti sasuec pdrhoys eiftasl in noubrn iasbbe nda aslictpa mianae ni kielcs ,clle c.te

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. +27  
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 +3  
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. +