to snoo-finity ... and beyond!
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How does telling an "embarrassed kid" that he will have big tits for 12-18 months help?!
Also wouldn't mammography be secondary prevention since you'd look for asymptomatic disease already present?
be kind to yourself, doc! (it's a long road we're on!)
Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency?
I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency
maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well.
Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me...
It's a B12 deficiency
Ileum is where B12 is reabsorbed, folate is jejunum
The blood smear is showing enlarged RBCs
Methionine synthase does this conversion, using cofactor B12
Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia.
Thanks NBME, that really helped me....
the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption.
I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF
Is there a situation where you would pick fibromuscular dysplasia over atherosclerosis if given both options? Thanks for your help!
Atherosclerosis affects PROXIMAL 1/3 of renal artery
Fibromuscular dysplasia affects DISTAL 2/3 of renal artery
Why is there ↓ size in both kidneys? This threw me off
@gonyyong : Maybe because narrowed renal a. d/t atherosclerosis led to renal hypoperfusion and decrease in size?
Fibromuscular dysplasia occurs in young females according to Sattar Pg 67, 2018.
Normally you will see Fibromuscular dysplasia in a young female 18-35 with high or resistant hypertension. She is older has a history type II DM predispose you to vascular disease and normal to moderate elevation in BP
Also the MCV was normal, not megaloblastic like you would see in B12 deficiency
I think the distribution half-life and elimination half-life was saying that by the time you checked, it had fully distributed (10 half-lifes) and had not been cleared yet (super long half-life)
1000ug= 1mg and 1g=1000000ug
so then 4ug/ml * 1g/ 1000000ug= 0.000004 g/ml
0.000004g/ml * 1000ml/L= 0.004 g/L
80mg*1g/1000mg= 0.08 g
vd= 0.08g/ 0.04g/l =20L
It looks like it was a type II RTA. The difference is incredibly subtle from the info given in this question.
He has Fanconi syndrome which is generalized reabsorption defect in PCT which leads to metabolic acidosis and hypophosphatemia → can lead to rickets
Also, does lead to type II RTA
Also the proximal tubule is the place with the highest phosphate absorption rate. That's why PTH works here mostly and a little bit in the distal tubule.
Lol I guessed it exactly because of that
Never heard of that one before. Thanks!
This is not prosopagnosia, but instead a case of apperceptive agnosia.
Wiki: "...patients are more effective at naming two attributes from a single object than they are able to name one attribute on each of the two superimposed objects. In addition they are still able to describe objects in detail and recognize objects by touch."
Although, lesions tend to be in the occipito-parietal area so PCA again is the answer!
Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage
I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage?
Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/
But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia
I thought it was that if you are taking a PPI, you will see elevated gastrin regardless of it you have a gastrinoma.
Thus to confirm diagnosis, you make them stop taking it, then re-measure gastrin → if it's still high, you have confirmed. If it's normal, it's something else