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Welcome to joonam’s page.
Contributor score: 26

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 +5  (nbme23#48)
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meningitis  To make sure, palpable Gallbladder is more in cholangiocarcinoma and Pancreatic Cancer? And if it were non-tender, could palpable gallbladder mean gallstones? +7
yb_26  @meningitis, it is a Courvoisier sign of pancreatic adenocarcinoma: jaundice + palpable, nontender gallbladder +2

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As aawl,ys sit’ sotaml tbrete to ionreg the csreiput hnwe boilsps.e sihT geennalmt sah a pptcei le,ruc hhcwi we knwo si asudec oldymientraep yb H. yolrip tceionn.if .H olryip osedcrpu sepestoar nad yrcailtraplu se,eura whcih aolwl ti ot ansierce the pH fo sti lacol oveirnnment yb egcnaliv reau tion aoman,im ciwhh si ctiox ot itacsgr oscau.m ehT rcpieut adsrenmettos H rpilyo, hihwc aer eindvte iwth veslri aginnti.s

joonam  Hey bro, thank you so much for your contributions on these free 120 questions. Your advice on test taking strategies for step 1 have been very helpful. +21  
luciana  "Elaborated enzymes by H. pylori may also contribute directly to epithelial cell injury. Ammonia produced through urease activity may be toxic to gastric epithelial cells. H. pylori protease and lipase degrade gastric mucus and disrupt the phospholipid-rich layer at the apical epithelial cell surface, allowing for cell injury from back diffusion of gastric acid." +2  
luciana  I got tricked :( Thought the damage was due to destruction of local somatostatin cells with increased gastrin and acid production... but this is actually the mechanism of duodenal ulcers development related to H. pylori But makes sense, so thats how the somatostatin producing cells are destroyed lol +4  
drpee  "Hyperacidity and gastric ulcer development" is also sort of true, but this is hinting at the mechanism for DUODENAL ulcer development from H Pylori. Irritation in the stomach leads to G Cell hyperplasia, increasing acid secrection which causes downstream ulceration. +5  
itsalwayslupus  Did anyone else pick the hyperacidity answer just because the correct answer had "local tissue destruction" in it? I figured that H. Pylori was non-invasive, so would not directly damage the tissue it is localized too +4  
cbreland  @itsalwayslupus exact same thoughts over here +  

submitted by seagull(1443),
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yWh si htsi otn U?HS woH idd ouy ugys hacroapp eht ioenusq?t

joonam  I think if this was HUS (d/t a bacterial infection) the leukocyte count would be abnormal (11k<) +  
yotsubato  normochromic normocytic RBC thats why. You would see schistocytes +9  
vulcania  Also for HUS I would expect mention of h/o bloody diarrhea, or at least diarrhea (not URI), and mention of something to do with kidney damage. +