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Welcome to imnotarobotbut’s page.
Contributor score: 161

Comments ...

 +16  (free120#32)
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hiTs si a bad e.suntoiq taeetlPl neargogitga tiem gneib olamnr, ko inef I can see ht.ta utB VFW zltsiebsia rtfcoa 8 and dy'ou ese na aicnseer ni PTT irt(fs ienl tenx ot WFV in irFst A.d)i Why is itehr TPT amno?rl

a1_antitrypsin  Totally agree, and they give you a slight increase in PT instead +
mambaforstep  yeah but if they gave you an increase in PTT then Hemophilia A could have been a valid answer choice. so they prob showed a nl PTT to differentiate vWF dz from hemophlia A +
drpee  VWD only sometimes presents with a slightly increased PTT. Don't let those anki facts steer you wrong... Plus all the other answers make no sense. Afibrinogenemia? That means literally no fibrinogin (PT and PTT would be infinitely increased). Hemophelia? Or vitamin K deficiency? Those are coagulation factor disorders so they would present with deep bleeding and large bruising. (Unlike platelet disorders, including VWD, which present with mucosal bleeding, petechiae, and heavy menses). VWD is actually the ONLY one that makes sense. +5
cbreland  I get why it's not afibrinogenemia (which is what I picked), but still don't understand how VWD is right. You have normal PTT and normal platelet aggregation (both of which should be abnormal). Is the only thing leading us to VWD is it being a primary bleeding issue? Again, my answer made no sense, but VWD in this context, seems way out there +
osteopathnproud  I agree with you @cbreland once I noticed I had to bend lab values for any answer choice then in my head most of them were possible. I took a step back and answer with the most common bleeding disorder, vW disease. Funny thing is when I retook it to check my answers, I had time to overthink and got it wrong. +

 +1  (nbme20#21)
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How lduow uyo nkwo thta ti 'tisn oowl rosrtes aes?sdei

cienfuegos  FA 2018 137: inhalation of spores leads to flu-like symptoms that progress quickly to fever, pulmonary hemorrhage, mediastinitis and shock, with imaging possibly showing widened mediastinum +6

 +1  (nbme22#7)
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wknegcAeodl het s'ntaietp uifcdtlfiy. I ahte stehe ostnqieus

nwinkelmann  Me too... also, he's had cough that's worsening for 6 months plus hemoptysis for 1 week... I didn't interpret that as "feeling healthy." The correct answer was my first choice just because it was the least "dick-ish" but to me, he didn't sound like he "felt health," so I didn't go with it. +1
nor16  if he didnt feel healthy, why would he say something like that then... but i agree, these (especially this) question(s) are often XYZ123! +1

 +6  (nbme22#46)
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alnirPgosatdsn iaaevslotd teh nertaeff olrtaerei dna cnesiare .GRF DIsSAN nhitbii aoitgsnpldrna ssithnesy A(F 0912 pg 77)5

malassezia_furfur  FA pg 486 +
malassezia_furfur  FA 2020 pg 589 +
pjpeleven  Some mnemonics: PDA (Prostaglandins Dilate Afferent) ACE (Angiotensin II Constricts Efferent) +

 +1  (nbme22#24)
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dolWrU nsetiouQ ID 8041 ahs a eratg nelaiontpax of iths

mcm94  UWORLD: Invasive tumor from carcinoma in situ includes the following: Tumor cells DETACH from surrounding cells in a process commonly determined by DECREASED adhesion molecules E-cadherin Tumor cells ADHERE to the basement membrane; this is facilitated by INCREASED expression of laminin Tumor cells INVADE the basement membrane via enhanced secretion of proteolytic enzymes (e.g, metalloproteinases) +2

 +6  (nbme22#50)
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lhhAotug erhte rea on iipefscc epserh idtcon,aisr a CFS epaln wthi ymlsto eoltescuyk isanciedt a vilra feitnnioc sa( llew as hte ronaml .ecuo)sgl So uoy nca erul tou TB, roocsoinuasidesr nad isezrunkni/ikdgrB isng are eetlrad ot ite,miginns utb even fi you dont' nwko wtah tohes rae, eht tueosnqi syas thta eetrh is an bimaytaonrl in eht MTAROLPE oebl niiiesngmt( = i.)ensmeng Eactiisenhlp uolwd eb the esbt ,awerns eeylcpslai besuaec pseerH lshciinEapte cffsate eth tparloem bleo.

taediggity  Also look for Kluver-Bucy like symptoms in the stem +1
mambaforstep  why? +
b1ackcoffee  I agree with everything but normal glucose. Glucose here is NOT normal. to quote wiki "The glucose level in CSF is proportional to the blood glucose level and corresponds to 60-70% of the concentration in blood. Therefore, normal CSF glucose levels lie between 2.5 and 4.4 mmol/L (45–80 mg/dL)." +
baja_blast  NBME reference table gives normal CSF glucose to be 40-70 mg/dL. As far as I'm concerned, for the purposes of the exam the reference table is probably a better source than wiki. +4

 +3  (nbme23#32)
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cSnyrdoea rydhprrhoeaatyiismp eud ot chicron larne uflae.ri woL aC, hghi seohpapth and hghi HPT. AF 1920 aepg 342

imnotarobotbut  Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that. +5

 +2  (nbme23#36)
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A melacdi dusntte shtnoldu' be the oen ggiinv enosemo a encarc gisnsaod.i hsiT is a llyrea vsitnisee essui nda hte etrslsu hdusol be niveg yb oemsone ihwt ghehri iyaorttuh klie a tnsiered or aeittnn.dg At het easm mt,ie uoy t'ldunohs lei to teh intatpe dna say tath teh srseult tan're kabc yte fi hyte sBte gnith ot od is fcetdel hte noiovtreascn and ofwllo pu hwti teh dei.n.rset

drdoom  It isn’t so much “someone with higher authority” as it is someone with a license! Without a license, an individual is not permitted legally to provide clinical interpretations, as that would constitute the (unlawful) practice of medicine! +20

 +7  (nbme23#15)
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ehT ranetetmt of choeral si msotyl soveiupptr - ouy wtna ot drayhrete teh natipet by invigg emht na otcisnoi lsaein cisen yte'rhe olsnig a tol of iudsl.f

 +5  (nbme23#11)
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dyitogolnsSer eertpsaten het isnk yl(lauus hte ete),f etsrlav toin het oleobrat,msd rnetse the h/rslutaenacg rhwee it is lsulayu ogudceh pu and neht swalowdle iont teh IG yTeh acn ayl gsge in het entteni,sis nda nehw hte arelav hcah,t ethy nca neptaeetr eth iaetitsnln lawl adn netre eht amdrelobsot n.gaai

makinallkindzofgainz  Strongyloides is fucking metal holy shit +4

 +12  (nbme23#50)
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oFmr tsncklei on redid:t hiT"s aws my :anogsenri eryuo' gpesmnocirs rteihe hte odbol yplusp to het baby, ro the olobd owlf y.waa fI uyo cpsmoers eht spluyp to het a,byb rpsurese uwold ntka nad olygertaru tseymss dowul get sti ertah ot orwk e.hradr fI ouy essmpocr eth dobol wflo aya,w ehnt SRV olwdu rsie and yroregautl emssyst woldu elilexerfyv oswl hte taerh wod."n

 +1  (nbme23#24)
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ahoPatm asys hrtee rea 3 tinghs hatt efrdentiaifte eoilkudme fmor :M+ CL eectLoyku nallekai htshpaospea on(yl in edo+iku) lme plBihoass y(lno ni LM+C) 2t;2)(9 tcsalantnrioo n(lyo in ML)C

nor16  yeah but pathoma doesnt help here... +1
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +

 +4  (nbme23#37)
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Clo,o cdolidsore ftoo iwht giglinnt dan seusbmnn = lbdoo clto. aracidC mstyomps yma ecidatin tath ehs sah emso osrt fo bcmottihor se.saide hTe inogwrd fo eth seanrw eichoc si'nt ,arteg tbu nnoe fo het thoer erasnw icsceoh fti.

 +16  (nbme23#17)
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areVislc snahliesasimi cuasse tshpemonaaygelpleo and otms oalrtnmpti,y ynoanitcappe. tI is otnef odunf in eeolpp owh siitv the dleiMd tEsa dna si ntettsmrdia by eht afldn.yS Wyh idd BENM ptu 2 nhiaamLeis esouqtins no tish mfro lol

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +11
rongloz  I got both questions within 5 questions from one another! I was seriously doubting my answers haha +1
faus305  Visceral Leishmaniasis affects about 0.001% of the world population each year so it only makes sense to have two questions on it.,to%20400%2C000%20or%20more%20cases. +
underd0g  How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia? +
faus305  @underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa. +1

 +2  (nbme23#50)
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oeroClglpid pvsetren lelptate agreitnaogg yb kicogbnl the ADP opcre.ert heT ADP eertcrpo si wath is oreniepblss rfo untitpg GIIIpIa/Ib espctroer no eht rasecuf fo lattleesp. thuotWi Ga/I,bIpIII the tspleltae canotn teagrgage .htoergte

paulkarr  Just adding that Clopidogrel irreversibly inhibits the P2Y12 receptor. This can be found in FA2019, pg 403. The other drugs in this category are: Prasugrel, ticagrelor, and ticlopidine. Ticlopidine is famous for causing Neutropenia and having an increased risk for TTP. +2

 +2  (nbme23#31)
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Slriatooncnpoe tiiihbsn ahy1x-rlys7doea dna lsoa cieltydr osclkb teh grneaond tpcerero suufl(e ofr rtaenettm in O)SCP. tI nca csaeu ga,mincseatoy mepocneti dan daeedcsre .iilbdo nI hte rpsg-inaK ecrduisti odeiv no yce,thks it si ylsoizbdme by teh amn iwht hte lids no hsi thcse osaegnyicm)t(a dna het dprooy ocrruh eop)

 +11  (nbme23#10)
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neEv fi oyu ind'dt wihch oen tocrev wsa smaA,palna I lebivee cehioc A saw eht ylon one ni cihwh ohtb goasnsirm aresdh hte msea vto.cre

stinkysulfaeggs  Agreed, that's how I made my final decision! +
alexxxx30  yeah I literally had no clue what anaplasma was, but came to the correct answer the same way +

 +5  (nbme23#18)
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Teh key is het free rai ni teh admbainlo c.tyvai sre,clU leypliecas donudlae eu,lrsc can efartpore otin teh nlidaoabm c.iyatv sThi acn eacus a uetnenrmuppiomeo efe(r air edurn eht ai)mh.prgda oNt a tidsel poymstm ni ihst i,uetqnso utb tish nca asol suace eerdrref pnai ot eht relhusdo yb iriragtnti eth ciepnrh e.evrn FA 1092 pg 734

et-tu-bromocriptine  To add on to this, anterior* duodenal ulcers tend to perforate (makes sense because closest to the abdominal cavity) whereas posterior duodenal ulcers tend to bleed (due to proximity to the gastroduodenal artery). +13
smc213  Acute pancreatitis can also occur with a posterior duodenal ulcer rupture. Source: Pathoma +4
victor_abdullatif  Fun fact: anterior duodenal perforation are more common than posterior because of the physics of the flow of chyme from the stomach into the duodenum. It travels in a manner that hits the anterior portion of the duodenum, therefore leading to ulcer / perforation. +

Subcomments ...

submitted by hayayah(1057),
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Of lal het s,onpiot pasos oajmr si het lyno eno that si lealyr atoacsesid itwh teh bmalru

.Q umumorLb einvlosv the arvneesstr ceorpss fo 1L utb asosP jraMo ragosetiin mfor 15L-L

imnotarobotbut  QL is connected to L1-L5 vertebrae as well ( +  

submitted by hayayah(1057),
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norI vdoeoser is a euacs fo a ghhi innoa pag omaltcibe i.ioacdss

meningitis  I found this to add a little bit more explanation as to how it causes the acidosis if anyone needs it. 1. Mitochondrial toxicity - decreases aerobic respiration and shunts to lactic acid production 2. Cardio toxicity (Secondary to Mitochondrial toxicity) leads to cardiogenic shock (hypoperfusion), which causes lactic acidosis 3. Hepatotoxicity - Decreases lactate metabolism, causing lactic acidosis 4. When in trivalent form (Fe+3), it can react with 3 molecules of H2O --> FeOH3 + 3H+ This will then deplete Bicarb buffering system resulting in non-gap acidosis. Source: +17  
sympathetikey  None of the other choices were even metabolic acidosis. They threw us a bone with this one. +21  
imnotarobotbut  Don't changes in bicarb take a few days? How did his bicarb drop down to 8 in 12 hours? +2  
charcot_bouchard  its met acidsis. not compensation +7  
j44n  they did throw us a bone however I didnt catch it +1  

submitted by celeste(79),
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Whlei eth eliifmet riks in eth aeenglr otipulopan si utsj loweb ,%1 ti si 6.%5 in eg-itreerfds ertlaevsi of tinepsta nad ti reiss ot rmeo hnat %40 in onztogcmyoi tiswn of fecedtaf eepopl. znAgalyni siacscl usdstei fo het isgetecn fo nrhisohpzaeci odne sa raley sa ni 1s0,39 sFihrec ocnlcedsu atht a cnoceraoncd taer rfo pisosyhcs fo baout 0%5 in onycmzgotio istnw esems to be a arlietcsi esiaemt,t ihhwc is ayiitfnsnlgci eihgrh tnha hatt in tcidoizgy witns fo ouatb –09%11 (gnbmilal.Pvnc/rt/495/#me.63pfecisncC.26iohM3/r)

imnotarobotbut  How is one supposed to know this before having read this article? +32  
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld +  
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-| +7  
doodimoodi  Lol just why seriously +2  
champagnesupernova3  This was mentioned in the Kaplan behavioral videos +  
usmlecrasher  and there's so much unnecessarily BS instead of real questions +1  
j44n  I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center +1  

submitted by usmleuser007(377),
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to:Ne teh qntseiuso tdates srorpe"taiyr trsb"u sgutiegsgn an TRU ecti.infon

)1 shit rsleu uot htgannyi tub itrorsreayp ncieiftno nno( rpe nno:teiifc E. ,iolc .E mecufa)i

)2 DGP6 icyeeicdnf rmeo csetusebpil to easltaca ioteivps ornisasmg -- sith ursle uto al(l sprte mgano)rsis

)3 eLtf thiw H. nnafeuielz mp&;a aprSth. aeuusr BTHO( rae lceaatas votii)pes

)4 estncuadEpal rmoansig era mtos ccoeginnnr wnhe eehtr is n.aeiapsl

imnotarobotbut  Respiratory burst has nothing to do with a respiratory infection. It describes the process of phagocytosing a bacteria and using NADPH oxidase/ROS to lyse it +5  
belleng  Aspergillus is still in the running, it is catalase positive as well...but not a choice +  

submitted by sup(20),
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Why otn GIP2 by ywa fo ?AAS yllepisEca gievn oreht wasrne ehcscio fo ntpesior C + :S s'dtneo rranaifw olsa uesspsrp sehte?

imnotarobotbut  Protein C and S are ANTI-thrombotic, so although Warfarin does decrease them, they wouldn't decrease the patient's risk for thrombosis +1  
epr94  the question ask "suppression" of which one will decrease risk of thrombosis if you suppress C and S which and anti-thrombotic you get thrombotic +1  

submitted by aaaaaaa(6),
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saltotri is dseu for wegtih ossl it(s not a taitns as oems pelpeo uthogth in eht sontmcme rh).ee sit in AF 1209 gp 24,9 c/m iesd cfsefet rae IG gndilunci rriaadhe

imnotarobotbut  Thanks! It's actually page 394 +2  
tiredofstudying  FA 2020: Page 400 +  

submitted by seagull(1443),
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uot fo isoytu,cri how mya ppoele kwen t?hsi nd(to be yhs to yas yuo did ro tn?)ddi

My ytpvroe uaictodne 'dtdni nangiri tshi 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. +4  
snoochi95  hell no brother +  
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 +1  
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  

submitted by sajaqua1(524),
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eonrelrBdi tnrepoiysal i-odredrs gieeflns fo smt,ie"p"sne ,ydtaiilcsui li,tio-mnuftaels ansuetbl s,nlarshpoteii nda erom mnomco in oewmn htna ni .men A cnmomo efnsede einmhcams ni hits osddierr si "tlig"tpnsi in ichwh opelpe are eesn sa iteerlyn doog or yelniert edrieolBrn tnyrpeilsoa srdrdoie is olas aprt of eht rseCtlu B yseniltraop esdrodsri, hhcwi rae satasedcio with bctaessun e.usab

imnotarobotbut  Suicide attempts are also commonly seen with Borderline +5  

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dyaocSner yyphmoeaarpdhririst ude ot rhiccno rnlae e.irlauf Lwo a,C ighh hphasepto dan high THP. AF 0219 pega 234

imnotarobotbut  Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that. +5  

submitted by sajaqua1(524),
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airiCctl nsotip rfo this nqseouit: 5 yaer old by,o puneeismudropssm cubesea of hhtcoeeayrpm, 2 yad syoihrt of eef,rv o,gcuh ohstnsser of batrh,e ieerblf (801.1 ,)F rsionspietar ,/n4im6 wtih sionsyca nda idenlzeaegr sruilaecv s.hra stenEviex alnduor ri.nailfoitnt

Of hte sopoitn iestdl nylo meelssa dna ZVV veig a rsh.a A shar rfmo seamlse alysulu attssr lrsraoylt nda dcsednse yu,cadlla dna si fatl dan ymhrstou.eaet yB ,nosrtatc VVZ iphncoekcx() ersentsp hwit endarlieezg ahrs that ilkqcyu siotnnatris rofm lamcuar ot rappalu hnte to selvua.cir

sympathetikey  Good call. +6  
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5  
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5  
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +2  

submitted by seagull(1443),
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ihsT si a cnpai atkcat. eHintvroytianple pdrso 2OpC ienagdl ot a rrsiyeaport klasals.oi p2o si irlvyeleat ufaencetfd o'd(tn ksa me wh?)o

sympathetikey  Yeah haha I had the same conundrum. +  
sajaqua1  If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected. +21  
imnotarobotbut  lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol +2  
soph  Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances). +2  
charcot_bouchard  PErioral tingling- due to transient hypocalcemia induced by resp alkalosis. +1  
rainlad  I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2 +1  
usmile1  adding onto Charcot_bouchards comment, I found this: Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany. +3  

submitted by aladar50(40),
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hTe tarotmipn intgh ofr omts of het eishtc sqtoeiuns rea to olok for eth wsaenr hrwee uyo are inbge the osemstit/nc ioprfaessoln elhwi stcgenpeir the apts’teni nuatomyo, ecfcienn,eeb oa,nen-eleicmncf cte. osMt fo het ocichse here ewer rtihee atucarycso ro isyalbalc igben neam to eth ent.ipta Teh orcrcet heoicc si to hpel teh naiettp btu olsa vetoatmi mhte to uictnnoe apslcyih aphrtye nda to nyol sue hte teirpm sa etiltl as scnasy.ree A samrili eotinqsu c(hiwh I nhtki saw no EBMN 23 -- tyhe ear iknd fo niblnged eght)rtoe wsa eht noe hrwee teh itapetn adh stte srlsuet atth endtciida eh dah ccaren tub het sindrete adsi nto ot tr)lyinvalo(u lelt ihm uilnt the otnocoglsi mace ni trale hatt ay,d and hte npeatit esadk uoy otbau eth sstrelu. Yuo dnt’o wnta ot the lei to eth nptiaet nda sya ouy not’d ownk ro tath he neostd’ vahe caecnr, utb you salo ot’nd ntaw ot be rsotibduennia to the ntesrd’ise narlosa)ee(b rtesqe.u

drdoom  @aladar Your response is good but it’s actually mistaken: You *never* lie to patients. Period. In medicine, it’s our inclination not to be insubordinate to a “superior” (even if the request sounds reasonable -- “let’s not inform the patient until the oncologist comes”) but *your* relationship with *your* patient takes precedence over your relationship with a colleague or a supervisor. So, when a patient asks you a question directly, (1) you must not lie and (2) for the purposes of Step 1, you mustn’t avoid providing an answer to the question (either by deferring to someone else or by “pulling a politician” [providing a response which does not address the original question]). +2  
drdoom  As an addendum, legally speaking, you have a contractual relationship with your patient, *not with another employee of the hospital* or even another “well-respected” colleague. This is why, from a legal as well as moral standpoint, your relationship with someone for whom you provide medical care takes precedence over “collegial relationships” (i.e., relationships with colleagues, other providers, or employers). +  
imnotarobotbut  @drdoom, it's not about lying to the patient but it would be wrong for an inexperienced medical student to give the patient their cancer diagnosis, or for a doctor to give a cancer diagnosis if they feel that the patient should be seen by oncology. In fact, the correct answer that the question that was referred to by aladar50 says that you do NOT give the patient their cancer diagnosis even if they asked you directly about it. +1  
charcot_bouchard  Dont give it to him. DOnt lie to him that yyou dont know. Tell him let me get the resident rn so we can discuss together Best of both world +4  

submitted by usmleuser007(377),
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PIP cse-ftfised:e + desnacire sirk for .C fifd + enedrscIa kris rfo pesr escfnintoi + nca usace agsehyinampo + deseecar oorbpiatsn fo 2,aC+( g+,2M ;pm&a roin) + icraeends iskr of tocsootipero hpi atrrfceus (/dt wol erums c)lmacui

imnotarobotbut  That's not the right answer tho, the answer is the binding of PGE to it's receptor +  
tinydoc  Can someone explain to me why the PPi answer is wrong if it increases the risk of C Dif wouldnt that also cause severe diarrhea. PPIs make a lot more sense to be given to this patient in the first place. +1  
maxillarythirdmolar  Keep it simple, stupid. +1  
roaaaj  @tinydoc You are correct about PPI increasing the risk of C. diff, but there was no history of antibiotic use. +