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Welcome to johnthurtjr’s page.
Contributor score: 139


Comments ...

 +2  (nbme22#30)
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I kniht thsi is as good an tnlonpiaaxe sa I can ndif


 +0  (nbme22#46)
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'ehres htwa I donfu


 +11  (nbme22#46)
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sr'hee a loggeo

johnthurtjr  FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face. +3
drdoom  via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." https://www.medscape.com/viewarticle/773465 +3
meningitis  I guess that's another reason for steroids and doping up. +7
drschmoctor  For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation. +2
fexx  F U testosterone! and F U NBME 22 question +1
schep  I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy: +OSA +prostate cancer +hematocrit >50% +2

 +7  (nbme22#17)
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F102A9 5p26 SWM""I

  • 1 - llsma, ayltehh rpuog or ouretevnls w/ sid-asee Is it S afe
  • 2 - eres-edaidmzto pourg w/ asdiees - Deos ti W kro
  • 3 - regla gropu w/ Cessi/edTRa - sI ti an I vmenotrmep rpedamoc ot tleyurrnc veiblaaal enmteartt
  • 4 - iceelanSvurl reatf alaprovp - naC ti stay on eht M ate?kr

 +14  (nbme20#12)
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10FA92 p 537 no tlorGetantinsisa ldobo slpypu adn thyspaicaeamptr reovinninat:

  • ruogtFe t&g;-- ccilea arrt,ye usagv iiannvtonre
  • Migdut ;-gt-& A,MS vusag
  • udtnHgi t-g&;- ,MAI cevipl inntvanireo
neovanilla  Don't force it out, you gotta relax and it'll come out naturally ;) +
mysteriousmantyping  Why couldn't the answer be Inferior rectal nerve since that controls the external anal sphincter? +1
draykid  @mysteriousmantyping I think this question is looking at complications of T2DM, more specifically diabetic autonomic neuropathy. Patient more than likely has diabetic gastroparesis which may explain his constipation and abdominal distension. +1
cuthbertallg0od  Pudendal nerve controls external anal sphincter (per FA), and gastroparesis wouldn't have anything to do w pelvic splanchnics but instead vagus nerve... Don't know why pudendal nerve couldn't be right if he was just clogged up from not being able to relax his sphincter anymore ---- is parasympathetic just more likely to be the issue statistically or something? +1
cuthbertallg0od  Or would losing pudendal nerve result in incontinence... Its never been clear to me if activation/inactivation opens/closes sphincters... +1
cuthbertallg0od  Just realized that says perineal... whoops +2
vivijujubebe  External sphincter is innervated by pudendal nerve, more often damaged during labor. DM patients have autonomic neuropathy with parasympathetic/sympathetic nerves more likely damaged +

 +10  (nbme20#36)
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Low dpie-epCt, owl unsrn,lipio ihhg ampsla free silinnu and wlo ,goelcsu ni a n,rues owh esnsprte ithw eiseopds of tsposmmy of mcypaoeyglhi httouwi eanptrap e,pprtcisanit is hitrtsag out fo F'sA etotxkbo toefndiini of a iiouatctsf ddrseio.r eeS AF 1092 54p5


 +4  (nbme20#35)
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nI eth tsifr atsge fo encorvigom itdi,coadn ro elentcppmraontio, the tntpaie idesne hte ceenepsr of a lpoemrb.

nI eth sdneco sgea,t or mtontapeinocl, eht nteatip osaegldkcnwe het mbperol ubt is nuglilnwi ot aekm a cagenh ta eth cruernt etmi.


 +4  (nbme20#42)
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I'm ont a anf fo ssgor ptah gemsai adn iuoesstqn hatt sya k"loo, what is stih "ghint? - thta idas mannmieigos aer hte stmo mcnmoo banri omutr adn sthi rutiepc is si a odgo peamxle fo .neo I adh no iaed tahw teesh gntsih loedko like nad got it wgron, o.to aTke a loko ta tshi eon

johnthurtjr  [Here's more info](http://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html) +1
meningitis  I got it wrong because I didn't see any apparent Dura mater nor other meninges (The veins aren't being covered by any "shiny layer"), so I thought the tumor was coming from inside the brain and not compressing it like meningiomas usually do. +3
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball. +7
nala_ula  Since it was basically implied that the patient died and "here look at what this is" I thought it was a malignant tumor (glioblastoma)... but I guess it's all about placement. +11
thelupuswolf  GBM would be in the perenchyma. Devine podcast said if they show you a gross picture of the bottom of the brain then it's a hemangioblastoma bc it's most often cerebellar. But this one wasn't cerebellar so I went ahead with meningioma (FA says external to brain parenchyma as well) +2
vivijujubebe  GBM would have necrosis and bleeding whereas the ball-shaped tumor in the picture looks smooth and very benign...even tho I have no idea how someone can die so suddenly from meningioma +
seba0039  Minor correction, but I do not think that Meningiomas are the most common brain tumor; they are the most common benign brain tumor of adults (Pathoma), but I'm not sure if they're the most common overall. +

 +8  (nbme20#39)
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AF 2019 gp 00:4

atsM .slecl.. cna be tvdaaetci yb usstei rut,ama Ca3 adn 5,Ca esfacur IEg r-soiniklcsgn yb enntgai EgI( crepreto gan)tgeaoigr -t;&g- lenitgroudaan &-t;g- eearles fo neashmtii, nper,ahi saeryp,tt and pelonhiosi cothmacceit to.csafr

ibestalkinyo  AKA Anaphylotoxins +2
dermgirl  FA 2020 pg 408 +

 +12  (nbme20#38)
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rusDg kile fbmlniaaxi adn mmaaalbdui ear lcmononlao aTpta-NhlFian- dytioabn drugs tath cna be udes to ttrae mftmylnroaai weolb iseed.as

Inmttprao eont - eroebf ndtrsmei,nigai nede to stte for elntta BT sa cvtraiatonie acn cuocr NpTalhaF-( inopattrm in nrulgaoma tmoiafrno nad not)tbaziliias


 +7  (nbme20#15)
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lehiW I anc tge no rodba ihtw Aumstdentj srd,ireDo I tdn'o ese how this wresna si any rettbe naht iocSmat myopSmt Didosr.re roFm FA:

eiatyrV of lodiby lciasptomn sgatnli tnhoms to serya scetoaadsi hiwt veeeissc,x sntstpiere shguttho dan inxeyat oautb sotpy.mms Mya cre-popaa wtih n.ielssl

DSS onglesb ni a porug of soedidrsr izracetahrdce by pihsylca ysosptmm iagcnus ingatnsifci dissetrs dna mtaeir.nimp

savdaddy  I think part of it stems from the fact that this patients symptoms are occurring within the time-frame for adjustment disorder while SSD seems to have a longer timeline. Aside from that I find it difficult to see why SSD wasn't a possible answer. +4
chillqd  To add to that, I inferred that the obsession with checking temp and with the tingling sensation were signs provided to him by the physicians of recurrence. He is anxious over his cancer recurring, and they are more specific than a variety of body complaints +1
hello  In somatic symptom disorder, the motivation is unconscious. I think for the patient in this Q-stem, his motivation is conscious -- he wants to make sure that recurrence of cancer is not going "undetected". +13
cienfuegos  I also had issues differentiating these two and ultimately went with SSD, but upon further review it seems that a key differentiating feature was the timeline. His somatic symptoms would have had to have been present for at least 6 months per the DSM criteria https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t31/ +3
almondbreeze  @chillqd Same! Why not OCD? He's fearful that something bad might happen (=cancer relapse; obsession) and calling his doc (=compulsion) +
kevin  great reasoning @hello, this was confusing me but that makes perfect sense +




Subcomments ...

submitted by mattnatomy(41),
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enAsrw = .C (ecrseDdae tahepci DVLL nishestsy)

citniiocN dica = aiNcin. nNiaic sorwk yb:

  1. nhtibiInig iilsplyos o(rheonm nviisetse )psaeli ni ideoasp us)tise

  2. gcuRnedi hcetipa LVDL tssyehsni

johnthurtjr  Well color me surprised. I was completely thrown off here. +32  
miriamp3  @almondbreeze go to the cardiovascular pharmacology you will see a draw of lipid lowering agents and you will find niacin en two places ++one on the adipose tissue and the second one in the liver by the vldl production. in the text in the same page is also mention it FA 2018 pg 313. +  
djeffs1  I still don't quite see how C corresponds to those 2 processes... +  


submitted by johnthurtjr(139),
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he'esr a golego

johnthurtjr  FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face. +3  
drdoom  via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." https://www.medscape.com/viewarticle/773465 +3  
meningitis  I guess that's another reason for steroids and doping up. +7  
drschmoctor  For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation. +2  
fexx  F U testosterone! and F U NBME 22 question +1  
schep  I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy: +OSA +prostate cancer +hematocrit >50% +2  
drdoom  ^ linkify @drdoom https://www.medscape.com/viewarticle/773465 +  


submitted by hayayah(1057),
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ynrcPange + Hx fo msorhbtiso &;g--t tiknh pdhiltnhpoiaposi msneydor

hTe PT nda PTT era gpnoeordl td/ rneneefirtce ofmr het beindaosit ot spholi.shppdio Trbmniho mite amln.ro

aHd to dfni crshreae acselrit aobut ti os tkae it mfor eher and o'ntd staew ouyr m.iet..

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +20  
goldenwakosu  Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +4  
johnthurtjr  I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +3  
link981  No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +8  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +3  
oslerweberrendu  @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +  
kevin  just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +1  


submitted by seagull(1443),
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uot of rtui,soyci how mya oleepp enkw t?ihs (ndto eb shy ot ysa yuo did or i?nd)dt

My otpryev dtecauion tdi'nd agniinr ihst ni 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 step420(33),
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htreO kdeniy ehoteHirprsyp ude to ienaerdcs ssstre --&g;t otn iypsrhaplae cb not ocseunacr

masonkingcobra  Above answer is incorrect because hyperplasia can be either physiological or pathological. Prolonged hyperplasia can set the seed for cancerous growth however. Robbins: Stated another way, in pure hypertrophy there are no new cells, just bigger cells containing increased amounts of structural proteins and organelles. Hyperplasia is an adaptive response in cells capable of replication, whereas hypertrophy occurs when cells have a limited capacity to divide. Hypertrophy and hyperplasia also can occur together, and obviously both result in an enlarged (hypertrophic) organ. +38  
johnthurtjr  FTR Pathoma Ch 1 Dr. Sattar mentions hyperplasia is generally the pathway to cancer, with some exceptions like the prostate and BPH. +4  
sympathetikey  Tubular hypertrophy is the natural compensation post renal transplant. Just one of those things you have to know, unfortunately. +2  
charcot_bouchard  Isnt Kidney a labile a tissue & thus should undergo both. This ques is dipshit +  
brbwhat  Dr Sattar says, kidney is a stable tissue, at least pct is as seen in ATN. But I read, basically kidneys are mostly formed whatever number of nephrons have to be formed by birth, after that they can only undergo hyperplasia aka increase in size/or regenerate if need be in case of atn. We cant have more number of nephrons. +1  
mambaforstep  @brbwhat , do you mean kidneys can only undergo hyperTROPHY? +2  
j44n  .... you're not making more cells..... so it cant be hyperplasia +  


submitted by haliburton(209),
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pMymcaalos nocompdnlaeuei tugsg,nailni no nsopsere to ilx.oinlmaci

FA 172:0 lCsiacs suace fo ialtacyp g”wk“nial uiponanem ssdiiun(oi st,neo acahhede, oonietvncpudr ogc,uh ahtypc ro fedfisu itsiarletint .irntlei)fta a-ryX loosk osewr tahn taiepnt. Hgih eitrt fo dloc aninugtsgil ,Mg)I( ihcwh cna tiungtaaegl ro syel s.BRC Gnorw on nEtoa nt eeaa.Ttamg:rr selimodcr,a o,ecydcxnyli ro iluouoeonqfroln ilnecipnil( ifnecitvfee iecns ocapamMsyl haev no cell A)l.a lBwC = ,Acfrai ldsi,nBesn chirCon .fncneioit –DK = nhteeivygr oeslNl.eat nae saeisde nac eb dciqerua digrun aseapgs thorguh itdfeenc rhtbi Nac lao.n clel .awll tNo seen on mraG its.an rhomclPeipo lAiatrBa.ce emeabrnm tsonanic sostelr fro it.stlybia msapcllaoyM upmnnaeio si omre ncommo pasniteitn ;t&l 30 years redqltoFue.n abtesuokr in riytamli surictre ic.l aydMspoasrmsna onp egst ocdl tihotuw a toac le(cl )wll.a

johnthurtjr  Have you mixed Chlamydia in with Mycoplasma? +2  
smc213  I mean the Q stem is not about Chlamydiae, but Chlamydiae does lack the classic PTG cell wall d/t decreased muramic acid = beta-lactam abx ineffective. FA 2018 p.148 +  


submitted by monoloco(132),
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sTih si a pyhploasai fo the ieprnlueprtaoole re.mmbaen ehT sugt rhieneat nito teh xoh,rta lusylua on hte lfte es,id dan telsur in oplsaihpay of the nlsgu aecub(es yh'eert ylrhroib scpd).emsore

johnthurtjr  Usually on the left because the liver prevents herniation through the right hemidiaphragm +7  
asdfghjkl  aka congenital diaphragmatic hernia +2  
pg32  What's weird to me is that if you usually see air in the intestines on x-ray when they are in the abdomen, why is there no air in the thorax in CDH? The intestines should still have air in them, right? Also, what is filling the abdomen that causes it to appear grayed-out in CDH? +  
drzed  @pg32 You can actually see a gastric bubble if you squint hard enough. Look at where the NG tube is placed; there is a radiolucency to the patient's right of the NG tube which is most likely the stomach. It probably then is radioopaque distally due to the pyloric sphincter, and air having a tendency to rise. +2  
bbr  Any idea what "absence of bowel gas in the abdomen" is referring to? +  
rkdang  my interpretation was absence of bowel gas in abdomen --> the bowel is not in the abdomen --> incomplete formation of pleuroperitoneal membrane bowel gas is a normal finding that you often see on x rays of the abdomen in a normal patient +1  
seba0039  @rkdang is it also abnormal that you cannot see any air in the lungs? This threw me off when I was trying to read the radiograph. +  


submitted by hayayah(1057),
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tecievDef ohmsouolgo cbnoeianoimtr si snee ni anaasritovebr/ ccernsa ihtw the RCB1A geen oiaunm.tt

johnthurtjr  Ashkenazi Jews have a higher risk of inheriting the BRCA1 and BRCA 2 gene mutations, just another tip! +2  
lebron james  BRCA1/BRACA2 are involved in the repair of DNA double stranded breaks +6  
samsam3711  Other answers: DNA Mismatch Repair: Lynch Syndrome (MLH1, MSH2) DNA Nucleotide Excision Repair: Xeroderma Pigmentosa +14  
lovebug  not about this question but... Defective "Non"-homologous end joining is seen in Ataxia-telangiectasia. :) +1  


submitted by johnthurtjr(139),
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I'm tno a afn fo gosrs taph amseig nad ieqousnts atth say l,ko"o hawt si sthi ?g"tihn - ttha siad oannegimmsi rae teh tosm onmocm ibran truom dan iths itpeurc si si a ogdo amplxee fo .oen I dha on deia twha these ithngs dlkooe klie adn got it nor,wg .oot aTek a okol at tshi noe

johnthurtjr  [Here's more info](http://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html) +1  
meningitis  I got it wrong because I didn't see any apparent Dura mater nor other meninges (The veins aren't being covered by any "shiny layer"), so I thought the tumor was coming from inside the brain and not compressing it like meningiomas usually do. +3  
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball. +7  
nala_ula  Since it was basically implied that the patient died and "here look at what this is" I thought it was a malignant tumor (glioblastoma)... but I guess it's all about placement. +11  
thelupuswolf  GBM would be in the perenchyma. Devine podcast said if they show you a gross picture of the bottom of the brain then it's a hemangioblastoma bc it's most often cerebellar. But this one wasn't cerebellar so I went ahead with meningioma (FA says external to brain parenchyma as well) +2  
vivijujubebe  GBM would have necrosis and bleeding whereas the ball-shaped tumor in the picture looks smooth and very benign...even tho I have no idea how someone can die so suddenly from meningioma +  
seba0039  Minor correction, but I do not think that Meningiomas are the most common brain tumor; they are the most common benign brain tumor of adults (Pathoma), but I'm not sure if they're the most common overall. +  


submitted by celeste(79),
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ndsuoS leik a hhoitprcrype c.ras erti"cpHyoprh casrs oanncti mpryailri ytep III nalgeocl dirnetoe lalrpeal ot eht drmlipeea cesufra hwit ndbanatu snuelod cnitgnnioa omsrysalibfob,t ealrg aeuelcrrtlxal genclalo lfatiemsn dna nleutifpl iadcci msyscedoucrc.ahipl"ao wami//cpl2Cnc/rh7n0o/wn.vt3tMwsslm:/ipP./bc8.hi2gt.e9

johnthurtjr  I think it may actually be a keloid, not a hypertrophic scar, as it expands beyond the borders of the original incision. +5  
thepacksurvives  I believe this is a keloid; a hypertrophic scar does not extend past the borders of it's original incision, while a keloid does. regardless, the answer to this question is the same :) +  
breis  First AID pg 219 Scar formation: Hypertrophic vs. Keloid +  
charcot_bouchard  They give granulation tissue is a option which is type 3 collagen. so if it was hypertrophic scar it would be ap problem since its only excessive growth of Type 3. while keloid is excessive growth of both 1 and 3 +3  
bharatpillai  I literally ruled put collagen synthesis defect since this is not a collagen synthesis defect at all ( EDS, Scurvy) :/ hate these kind of questions +