NBME Answers : icrieeverytiem's page

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submitted by madden875(25), visit this page

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From Goljan:

Platelet problem = epistaxis, echymoses, petechia, bleeding from superficial scratches

Coagulation problem = late re-bleed, Menorrhagia, GI bleeds, hemarthroses

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step7777 Also that: Platelet problem = primary hemostasis = superficial bleeding Coagulation problem = secondary hemostasis = "deep" / internal bleeding +2

zevvyt i thought I read that INR was 12 and got real confused on that question +

topgunber is there a reason for the decreased PTT? or is that just a distraction +

justanotherimg @topgunber It throwed me off as well, but I found this on google- Sometimes a traumatic or difficult blood collection may result in activation of the coagulation pathway in the sample, resulting in a shortened aPTT time. So I guess it was just a distraction. +

icrieeverytiem It's still confusing. The decreased PT and PTT seemed like hypercoagulability and the only rationale to eliminate that is that he is asymptomatic. Unfortunately I picked DVT and lost an easy point. +1

athenathefirst also is subungal hemorrhage seen in infective endocarditis? +

submitted by drachenx(72), visit this page

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These kinds of questions are really hard because I've never seen female reproductive structures irl. :c

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nbmehelp Lmao +3

regularstudent Lmao +1

mutteringly Lmao +

rockodude lmao +

abkapoor Lmao +

dang90 LMao +

noopnoop Lmfao +

stunna216 LMAO +

icrieeverytiem lmao +

peteralamir Lmaoo +

empem28 lmao +

submitted by castlblack(78), visit this page

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I have read all the comments, but none explain why hyponatremia is wrong. There is definitely Na+ in stool....thats why sugar+salt is rehydration for peds diarrheal sickness. Low Na+ causes low EVV explaining the low BP, high HR, pallor, and dehydration. Is it correct but just not as correct as C?

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waterloo I Dont know what you mean by low EVV. But here's my thought process. This pt lost lots of water, and when someone takes a laxative causing them to have diarrhea that will lead to metabolic acidosis. A buffering mechanism for the decreased bicarb in the blood is for H+ to leave cells and K+ to go into the cells. So he has to have hypokalemia (low K+ in serum). They gave him IV fluids, so his BP should be headed back to normal. I would think his RAAS will chill out. But it takes time to correct the acidosis, you're kidney won't just immediately stop reabs bicarb so you're body will still be buffering against the acidosis (H+ out of cell, K+ in). +2

waterloo sorry, I wrote increased bicarb, I meant DECREASED bicarb in the blood. And also should have written "you're kidney won't just immediately START reabs new bicarb" My Bad, wasn't trying to add to confusion. +1

drdoom i think by `EVV` author meant `ECV` (extracellular volume). @waterloo, appreciate the explanation but think something is off: loss of HCO3- via diarrhea should result in acidemia, which would oppose the presumption of ‌``H+ leaving cell, K+ going in´´. +2

waterloo hey so sorry, I must have been super tired posting this. Can't believe I made so many mistakes. Read over it again, and it sounds like gibberish. Wish there was a way to delete. My bad. +1

waterloo I think I tried to explain too hard. Looking at this question again, I think really the only this is when you lose that much volume, you lose bicarb and K+. Nothing really to do with acid-base. My b. +1

drdoom no worries! +1

castlblack EVV = effective vascular volume. Thank you for trying to help but I still don't understand. I still agree with my above mechanism as correct. Whether or not it's most correct idk. +1

amy what about the long steamy bath? He also sweat a lot, and profuse sweating is going to cause hyponatremia? +1

helppls thats what I was thinking as well^^^ I figured he was sweating out a lot of NaCl +1

icrieeverytiem The Q mentions that he feels better after an infusion of fluids so I assumed any hyponatremia that he had must've been resolved. +1

submitted by mcl(671), visit this page

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Homegirl got some cervical outlet syndrome and should probably take some stuff out of her backpack or get one of those lil roller ones.

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mcl Whoops, my bad, THORACIC outlet syndrome +6

dr.xx Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +3

homersimpson Anybody else read @mcl's comment in Tom Haverfords voice? +3

icrieeverytiem Now that you mention it @homersimpson +1

submitted by btl_nyc(72), visit this page

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A: cholestryramine and other bile acid resins prevent the reuptake of bile acids from the gut.

B: Statins inhibit HMG-CoA reductase, preventing the liver from making mevalonic acid, a precursor to cholesterol.

C: Niacin (nicotinic acid) reduces hepatic VLDL synthesis and also inhibits lipolysis in adipose tissue by inhibiting hormone sensitive lipase.

D&E: Fibrates upregulate lipoprotein lipase (LPL), increasing triglyceride clearance (VLDL and chylomicrons are full of triglycerides) and also activate peroxisome proliferator-activated receptor- alpha (PPAR-alpha) to induce HDL synthesis.

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icrieeverytiem My dumbass thought nicotinic acid=something to do with smoking smh +2

chaosawaits @icrieeverytiem me toooo +

kani me 3 +