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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.
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
meningitis  I guess that's another reason for steroids and doping up.

 +2  (nbme22#17)

FA2019 p256 "SWIM"

  • 1 - small, healthy group or volunteers w/ disease- Is it S afe
  • 2 - moderate-sized group w/ disease - Does it W ork
  • 3 - large group w/ disease/RCT - Is it an I mprovement compared to currently available treatment
  • 4 - Surveillance after approval - Can it stay on the M arket?

 +8  (nbme20#12)

FA2019 p 357 on Gastrointestinal blood supply and parasympathetic innervation:

  • Foregut --> celiac artery, vagus innervation
  • Midgut --> SMA, vagus
  • Hindgut --> IMA, pelvic innervation

 +4  (nbme20#36)

Low C-peptide, low proinsulin, high plasma free insulin and low glucose, in a nurse, who presents with episodes of symptoms of hypoglycemia without apparent precipitants, is straight out of FA's textbook definition of a factitious disorder. See FA 2019 p554


 +1  (nbme20#35)

In the first stage of overcoming addiction, or precontemplation, the patient denies the presence of a problem.

In the second stage, or contemplation, the patient acknowledges the problem but is unwilling to make a change at the current time.


 +3  (nbme20#42)

I'm not a fan of gross path images and questions that say "look, what is this thing?" - that said meningiomas are the most common brain tumor and this picture is is a good example of one. I had no idea what these things looked like and got it wrong, too. Take a look at this one

johnthurtjr  [Here's more info](http://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html)
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.
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball.
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.

 +5  (nbme20#39)

FA 2019 pg 400:

Mast cells... can be activated by tissue trauma, C3a and C5a, surface IgE cross-linking by antigen (IgE receptor aggregation) --> degranulation --> release of histamine, heparin, tryptase, and eosinophil chemotactic factors.


 +2  (nbme20#38)

Drugs like inflixamab and adalimumab are monoclonal anti-TNF-alpha antibody drugs that can be used to treat inflammatory bowel disease.

Important note - before administering, need to test for latent TB as reactivation can occur (TNF-alpha important in granuloma formation and stabilization)


 +1  (nbme20#15)

While I can get on board with Adjustment Disorder, I don't see how this answer is any better than Somatic Symptom Disorder. From FA:

Variety of bodily complaints lasting months to years associated with excessive, persistent thoughts and anxiety about symptoms. May co-appear with illness.

SSD belongs in a group of disorders characterized by physical symptoms causing significant distress and impairment.

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.
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
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".
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/




Subcomments ...

submitted by mattnatomy(22),

Answer = C. (Decreased hepatic VLDL synthesis)

Nicotinic acid = Niacin. Niacin works by:

  1. Inhibiting lipolysis (hormone sensitive lipase) in adipose tissue)

  2. Reducing hepatic VLDL synthesis

johnthurtjr  Well color me surprised. I was completely thrown off here. +12  


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. +2  
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 +  
meningitis  I guess that's another reason for steroids and doping up. +2  


submitted by hayayah(416),

Pregnancy + Hx of thrombosis --> think antiphospholipid syndrome

The PT and PTT are prolonged d/t interference from the antibodies to phospholipids. Thrombin time normal.

Had to find research articles about it so take it from here and don't waste your time...

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +3  
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) +1  
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. +1  
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 +3  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +1  
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 +  


submitted by seagull(437),

out of curiosity, how may people knew this? (dont be shy to say you did or didnt?)

My poverty education didn't ingrain this in me.

johnthurtjr  I did not +  
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 +  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +5  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +3  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +  
jaxx  Not a clue. This was so random. +  
wolvarien  I did not +  
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?" +  


submitted by step420(18),

Other kidney Hypertrophies due to increased stress --> not hyperplasia bc not cancerous

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. +6  
johnthurtjr  FTR Pathoma Ch 1 Dr. Sattar mentions hyperplasia is generally the pathway to cancer, with some exceptions like the prostate and BPH. +2  
sympathetikey  Tubular hypertrophy is the natural compensation post renal transplant. Just one of those things you have to know, unfortunately. +1  
charcot_bouchard  Isnt Kidney a labile a tissue & thus should undergo both. This ques is dipshit +  


submitted by haliburton(85),

Mycoplasma pneumoniae cold agglutinins, no response to amoxicillin.

FA 2017: Classic cause of atypical “walking” pneumonia (insidious onset, headache, nonproductive cough, patchy or diffuse interstitial infiltrate). X-ray looks worse than patient. High titer of cold agglutinins (IgM), which can agglutinate or lyse RBCs. Grown on Eaton agar. Treatment: macrolides, doxycycline, or fluoroquinolone (penicillin ineffective since Mycoplasma have no cell wall). ABC = Africa, Blindness, Chronic infection. D–K = everything else. Neonatal disease can be acquired during passage through infected birth canal. No cell wall. Not seen on Gram stain. Pleomorphic A. Bacterial membrane contains sterols for stability. Mycoplasmal pneumonia is more common in patients < 30 years old. Frequent outbreaks in military recruits and prisons. Mycoplasma gets cold without a coat (cell wall).

johnthurtjr  Have you mixed Chlamydia in with Mycoplasma? +1  
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(56),

This is a hypoplasia of the pleuroperitoneal membrane. The guts herniate into the thorax, usually on the left side, and result in hypoplasia of the lungs (because they're horribly compressed).

johnthurtjr  Usually on the left because the liver prevents herniation through the right hemidiaphragm +1  
asdfghjkl  aka congenital diaphragmatic hernia +1  


submitted by hayayah(416),

Defective homologous recombination is seen in breast/ovarian cancers with the BRCA1 gene mutation.

johnthurtjr  Ashkenazi Jews have a higher risk of inheriting the BRCA1 and BRCA 2 gene mutations, just another tip! +  
lebron james  BRCA1/BRACA2 are involved in the repair of DNA double stranded breaks +1  


submitted by johnthurtjr(53),

I'm not a fan of gross path images and questions that say "look, what is this thing?" - that said meningiomas are the most common brain tumor and this picture is is a good example of one. I had no idea what these things looked like and got it wrong, too. Take a look at this one

johnthurtjr  [Here's more info](http://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html) +  
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. +  
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball. +3  
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. +4  


submitted by celeste(33),

Sounds like a hypertrophic scar. "Hypertrophic scars contain primarily type III collagen oriented parallel to the epidermal surface with abundant nodules containing myofibroblasts, large extracellular collagen filaments and plentiful acidic mucopolysaccharides." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022978/

johnthurtjr  I think it may actually be a keloid, not a hypertrophic scar, as it expands beyond the borders of the original incision. +2  
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 +2