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Welcome to kernicterusthefrog’s page.
Contributor score: 118


Comments ...

 +28  (nbme22#33)
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hs"e selfe hairepp adn remo rade"xle aetfr stagtinr ginkx:okbci tihs si a AUEMRT defnees smchimaen cc(lisas oktoebxt ubiasimtlno, sa hsa nebe )is.ad hsTi stqeuoin is tsuj iapnl .rnowg s'It otn eile,mntdcpsa ebeasuc ts'i a ehtyl,ah liocysal bpealtcaec toelut ahtt eimvposr hre itlamnoeo atts;e hipcgnun bsag rae naemt ot eb nhcduep (uhst ti si ulycalta ONT )l.tearun elanieDmtscp to na otbjce duwol eb icpnnghu a eohl ni her lwla, ro aikegbrn rhe evas I( tujs ekli ttha r.a)mygei hBot of tehos owldu eb teretb nhta nhuipncg erh ,mafiyl or geriknba irteh rca nw,owid hhiwc is why t'si sadelmitenpc osconn(iscuu tedniicorer fo na oimoten ot a feasr .)tebojc eewrov,H bnckxikiog is IALERTLLY an xmelpea in elerasv ycsph okexttsob rof asuio.tnlmbi Tahnk uoy rof gmoinc to ym TDE aT.lk

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +13
happyhib_  What if, just what if. Her taking time to do lessions was actually hurting her children by her having less time to spend with them and in turn not providing good care for them. (less of a mature defense mech now). Trust me I agree completely just not best answer, but given what we are given you could argue beyond that; amboss even says "a mom showing her feelings of anger towards the child instead of the actual problem, the husband". So in a way she is not addressing her actual problem (which she COULD address). +
kernicteruscandycorn  I support your assertion, fellow kernicterus +

 +0  (nbme22#9)
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Jsut ni saec ttah oleyvl ittlle itauqnoe vdreodip by noyyamkep@c t'swan tqeui eguohn for oyu, serhe' a nikl ot a omer ptclmeoe pantnxialoe by nhaK mdyceAa. edpeHl e,m wehn I eloodk ta hte nutqiaoe nad s,aid aahw?aa


 +0  (nbme20#8)
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shiT is tno na rnu,ayems whhci si hatw skema hsti ioseuqnt os iewdr: "rxsy-a fo hte echst do not oshw giend"n.wi My uragnntndeisd aws that dcitosisens ulsluya uoccr in hte peitrcu of uasnm,yer eclyealpsi edu ot n.yetospehirn woevrHe, psphrea s'hatt nto eth e,sac pirtcalrauyl ni htese aStfnodr Tepy A ssstcineod?i hTe eircput ni FA user makes ti okol ilek a ienedwd aoatr a)(reunsym itwh a .nisots.e.idc


 +5  (nbme20#48)
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I olsa ahd fsucfietdiil wtih ihst, elpseaylci /FAw iebgn so etredbia.abv Tehre is eno rowd ni AF ttah phle,s adn nhte I eavh a kinl fro emro nifo: s"rwog diypral and gesrrsees nonsyleuopast by 5-8 ayser d".lo ihhcW nmeas t'is dnoe ithw sti nloniouitv pshea by .etnh Thsi INBC itacelr p:shle The osnssLe I Lneread from a aeainmogHm licinC L:DRT dpiar whgtro ucsocr for eth rftis fwe nht,om wdelfloo by a fwe tnshmo fo ,setr adn nhet yesra of uiivnn.loot ceiSn the eonqitsu is ngiksa htwa pnhespa erov 5 sera,y het royajitm of that time si sntep in ovitilunon h.aspe opeH iths he.pls

whossayin  totally not NBME related, but I think you username is brilliant lol +4




Subcomments ...

submitted by jooceman739(27),
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aeltaRbontm:osi

heT yinspiahc isad eht oyb is eiynukll to lvopeed nya htore somaspel,n so he et'onds evha teh intdeerih bR an.mtouit

In isth ,ecsa eh ash hte arsdciop noetimslraba.to driaSopc ebimraantootsl qesrerui owt msiacto usoitmant of Rb in eth emsa iatnrle .llce

sJtu sa a edis o:tne Irtenhied ntrmeolossbiata netd ot eb balta.eril rdpaciSo rae ulnia.tlrae

carls14  aren't retinal cells a type of somatic cell? Why not is the mutation not considered in the somatic cell of the child? +9  
omerta  Although this mutation would be considered somatic, I believe the question is just asking you to be specific as to which cells. If you answered "somatic cells of the child," that's quite broad and could apply to almost anything. +12  
kernicterusthefrog  I had the same struggle and thought process. +1  
eacv  There is a Uworld qx that explain this in detail> ID: 863 +3  
arcanumm  I read the answer options too fast so got this wrong. It is a somatic cell type, but somatic in general implies a higher risk for developing other cancers. The hint here is that the physician stated he is unlikely to develop any other neoplasms, so it is a specific double hit mutation in the retina. +7  
almondbreeze  wouldn't she have any possibility of developing osteosarcoma as well? :( +  
almondbreeze  did some reading and it seems like osteosarcoma only occurs in familial retinoblastoma with RB mutation +  
brise  But how can a 5 year old get two mutations to get retinoblastoma? In 5 years?! Obviously doctor is probably wrong LOL +  
jaramaiha  The difference between familial and sporadic mutations dealing with Rb is that in this case he only had one hit so that only one eye is affected. In other words, if he would have been born with the familial type, he would present with Rb in both eyes and also be predisposed to osteosarcoma. In this instance he only has Rb in one eye having only a one hit mutation in his right eye. When the stem says this is the first mutation it's implying that he wasn't born with the familial type so to obtain a second mutation over the course of his lifetime would be rare. +  
brise  @jaramiaha I believe it still falls into a two hit mutation, but both were sporadic. But you are right about being unilateral. +  


submitted by bubbles(70),
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Btaemnse rmemnabe yrititegn is het itnmaeentdr fo lful unlg cevryoer willfonog manylrpou tnsuil.

aS:umyrm

()1 slso fo aetesnbm armmeenb eiitrgnyt is laciirtc ni iirgntnedme teh ot“ipn of on rt,u”ern and sbenircttuo to eth bynatiili to eiblsetshar alrnom ngul ruthcicetrea wthi onirpmoto fo ;srfsioib

2)( slso fo atieeilplh lelcs, toalenhledi le,cls dna enmsatbe erbaemmn etgtniiyr in asuul tlrsteiniati enipnaumo ctsoseiada hwit ohadtipiic oalnpurmy firsisob dlase to yresdotde ngul uhteterccria nda etpuaelrp irosfisb;

)(3 sgmtrnfiaonr hgwrto -fotβrac is ne,rcaessy tbu not nreielty if,cunsitef ot otoremp tnpnmreea iifs;osbr

4)( petistersn tirt//nngyiriieaturnanj si icltiacr fro hte ngootriaapp fo roifsbis;

5() chiotpdiia pymorulan soriifbs si an ealexmp fo a pcsorse dleater ot teh ispnetersec of na ,()sgi“anent” cnhoric m,niftiaolamn and is;rsibfo dan

)6( uuiqen clels era iilcatcr uecallrl ryleasp ni het nriegautol fo or.bisisf

inatt:ico2Pt2n/lgcs:Mnpilswcote/t.hbnvhw/6icm4/i/p5.rm4a1Cw/..

kernicterusthefrog  Lovely +  
endochondral1  any FA or pathoma or uworld correlation? +  
endochondral1  or was this a random? +  
taediggity  Type II pneumocytes serve as the stem cell precursors, w/out those you're more or less fucked: FA 2020 pg 661 +4  


submitted by oznefu(22),
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’Im vihgan ebtourl dirsunedntang wyh itsh is a btrtee ocehic tanh Pgate se,idaes aplyceslie twhi hte nidscraee PA?L

zelderonmorningstar  Paget’s would also show some sclerosis. +5  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +28  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +17  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by drdoom(896),
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ialansulcCot orf add. ehT libbayptroi fo eth eatfhr ebign a aierrrc is /23 sceni ti is noknw ttah eh sotden’ ahve hte sie.deas hnTe teh ybalbpritoi of mih nipsgas it on ot sih dik si 21/, h:tus

  • libPytoiabr of dad igben errcari = 32/
  • ibioytlbaPr of dad snipsga on desiase eaelll = /12

lautCanlosic ofr mmo. hWit the ydeHnrWaire-bg iPnip,celr uyo cna fergui tuo teh irbyatpblio fo the remtoh benig a e:rcarri

q = )0q04(0s1/0,rt = 021/0

o,S 2pq = 2 * 102/0 * 9021/09, chihw si poparx /01.10

Fro eth chlid ot etg the leleal mrof om,m tow tsgnhi need to ape:phn )1( mom must eb a rcerair z”yoore“g[he]tte dan (2) mmo smtu sspa hte leelal ot hi:cld

  • oPbirliaytb of mom nebgi icarrre = 110/0
  • tibPyiaoblr fo omm assnpgi on deisaes llalee = 12/

tignPu ti all teetoghr. o,wN cmeboin lla thtro:eeg

= iolba(tyripb fo dda egbni cir)arre * bt(rioayipbl fo dad sinspga on edisase lellea) * lbpir(aitoyb fo mmo nbegi acrir)re * liyipro(atbb of mom apignss on seaseid eallle)

= 2/3 * 2/1 * 01/01 * 21/
= 1 ni 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +44  
niboonsh  This question makes me want to vomit +12  
drdoom  lol +  
5thgencephalosporin  okay wow +  
tekkenman101  You can make this a lot quicker by using simple rules for autosomal recessive diseases. 1) Unaffected parent with affected lineage will be a carrier 2/3 of the time (Aa) 2) frequency in population is super low so you can ignore P and just use 2(q) in order to calculate carrier frequency. So take the square root of the homozygous recessive frequency (1/40,000) and just plug it in: 2(.005) = .01 3) The odds of their child being affected with the two parents being assumed hypothetical carriers is 1/4 (aa) or .25. Dad's carrier chance (2/3) x Mom's carrier chance (.01) x child's chance of being recessive (.25) +  


submitted by gh889(129),
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heT rswean is edu ot an icxpotene uiolntde rehe rewhe nianic is duse in stp /wo bsedatei how ehav yfectaorrr yyaedhiiptreigelrmrc ta ihgh iksr ro sha a hx fo crtn.isitpaea

I raeeg taht trsibfea aer itsrf leni an(d os odes taht aetirlc) btu MENB asw inhgon ni on a cipsefic tnpxeicoe taht iannic acn sola be seud icnse DLLV and sGT rae hhgi in lrmticed.iapghyieryre

Teh lu""ec tyhe had wsa "ruenrerct pansc"rietita chhiw si ueplspdoys a leda rtaoswd n.anici

I salo tup aenrseic .H...LD

wutuwantbruv  Correct, you would not want to give fibrates to someone with recurrent pancreatitis since fibrates increase the risk of cholesterol gallstones due to inhibition of cholesterol 7α-hydroxylase. +  
kernicterusthefrog  FYI @gh889 can't follow your link w/o an NYIT username and password, unless there's a more tech-savvy way around that.. I appreciate the info, though. Niacin rx for familial hypertriglyceridemia w/ recurrent pancreatitis. Now I know.. +2  
impostersyndromel1000  Great points, very in depth knowledge taking place here. Also, familial hypertriglyceridemia (per FA 2019 pg 94) has hepatic overproduction of VLDL so picking this would have been the easiest answer (in retrospect) +2  
hyperfukus  @impostersyndrome1000 literally that's the ONE thing i remembered and i went YOLO lol cuz i was staring for a while +  
osler_weber_rendu  @gh889 I agree niacin is the answer, but even niacin causes increase in HDL. As if getting to the drug wasnt tough enough, NBME puts two of its actions in the options! What a shit question +1  
mtkilimanjaro  I forget where I saw (maybe UWorld), but I always thought increasing HDL is never really a primary form of lipid control. You want to lower the bad cholesterol etc. since increasing good cholesterol wont change LDL VLDL etc. +  
jaramaiha  @mtkilimanjaro I believe it was in BnB. Dr.Ryan mentioned that there hasn't been enough evidence that raising HDL would be beneficial as far as lipid control goes. Better studies were done on statins hence why they are usually first line Tx. +  


submitted by hungrybox(1051),
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...oS taorceiytllhe an asoiltde easdeerc in HR dwluo ercaseni CO ude to .cin peo,rlad htrig?

Btu OC ecedssaer in tshi sace b/c teh etffec fo icn. RPT si orem o?pefrwlu

kernicterusthefrog  @hungrybox: No. Isolating HR, you would look at CO like this: CO=HR*SV so if HR or stroke volume go down, CO goes down. The change in preload wouldn't affect the CO as much as the change in rate of flow. So, the decrease in CO is solely due to the beta1 blocking effect on the AV node to decrease HR. +  


submitted by xxabi(261),
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cengihnBocro raicaomnc = nglu ecrcna

athT bngie idsa, gnlu acracmedionano lylsepiccifa is oiaadsctes hwti cthipohpyerr otaersottypro,hha ihcwh si a slaptoncipaaer dryosnem ahceceridzatr yb dlaigti uciblbgn, atrgral,iha intoj f,eiosusnf and spiooertssi fo blartuu neosb

luke.10  why not systemic scleroderma since i did this question wrong and i chose systemic sclerosis scleroderma , can someone explain that ? +2  
kernicterusthefrog  My best guess answer to that @luke.10 is that: a) there's no mention of any skin involvement (which there would be in order to be scleroderma) b) Scleroderma shows pitting in the nails, not clubbing c) There would be collagen deposition with fibrosis, not hypertrophy of the bone at joints Saying that, I also got this wrong! (but put RA...) so I'm not claiming to "get this" Hope my thought process helps, though! +6  
yotsubato  This is in FA 2019 page 229 +10  
larascon  I agree with @kernicterusthefrog on this one, Bronchogenic carcinoma = lung cancer. Squamous cell carcinoma gives you hypercalcemia (new bone formation; maybe?), commonly found in SMOKERS ... +3  
waterloo  the clubbing is the symptom that takes out alot of the answer choices. It's super tricky. +  
jawnmeechell  Plus the patient has an 84 pack-year smoking history, super high risk for lung cancer +  
veryhungrycaterpillar  FA 2019 pg 229 is all paraneoplastic syndromes. There is no mention of bronchogenic carcinoma in any of them. There is adenocarcinoma, but that is most likely in non smokers, not in someone with 84 pack year of smoking history. Why does he have 5 upvotes for referencing first aid here, what am I missing? +3  
jakeisawake  @veryhungrycaterpillar sounds like bronchogenic carcinoma is a general term for lung cancer. You are right that if a non-smoker gets lung cancer it is most likely adenocarcinoma as non-smokers rarely get small cell. However, smokers can get adenocarcinomas as well. The oncologist that I shadow sees this frequently. Adenocarcinoma of the lung causes hypertrophic osteoarthropathy per 229 in FA2019 +2  
mangotango  @verhungrycaterpillar @jakeisawake Adenocarcinoma is the most common tumor in nonsmokers and in female smokers (like this patient), so adenocarcinoma would still be the most likely cancer for this pt over the others. Pathoma Pg. 96. +3  
fatboyslim  Apparently bronchogenic carcinoma is basically an umbrella term for lung cancer. Source: https://radiopaedia.org/articles/lung-cancer-3 +  
lifeisruff  bronchogenic is another term for adenocarcinoma in situ according to pathoma +  
topgunber  With the exception of mesothelioma- 95% are bronchogenic +  


submitted by thomas(2),
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wAnsre is tAytsr.oec netPtai hsa gmlsatbaooli imterfmlo.u oAgutlhh inonimagsem yam rccuo at esoecxn,iivt gnmmnaeiois ear iebngn nad ontef iaasypcmttmo. They may uaecs /ah eisseu,zr utb oulwd be iuklnyel to aucse eadht in/w m6 of esotn of .ah/ hTe eszi fo tromu nad roecsu fo lnesisl si ossitntenc ithw eth uesorc of BMG

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +25  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by thomas(2),
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rnesAw si toycrsA.te etPanit has bgoalsilmaot rf.imluoemt ulghAhto sieimoannmg may ocruc at xeoinivct,es iiemnosmnga are gbinne and otnef y.ipsomamattc eTyh amy caesu a/h uez,ssrie tub udlow eb llueynik to euasc atehd /inw 6m fo onste fo /ah. heT zise of urmot nad esourc fo nlsseil is nnctesiost htwi eth ouesrc of GBM

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +25  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by neonem(572),
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ltloizaoCs si a psshdtoherseapieo orh;bniiit dleas to eidcasrne McAP hihwc bntiiish leeattlp a/vtgitconldoannataeirui hlewi losa sanuigc sotnvoi.iadla lAl of teh treoh opstino wkro on riheet vaeulastcur ro latpleset btu tno bo.ht

kernicterusthefrog  Just to add: cAMP activates protein kinase A (PKA), which is the more direct mediator of platelet aggregation inhibition, and of myosin light-chain kinase inhibition (which causes inhibition of smooth muscle contraction and thus vasodilation). Just in case there's a question that gets more specific than this one! +13  
brbwhat  wasn’t dypirdamole an option? +  
fataldose  I believe they also cause vasodilation by decreasing the cellular reuptake of adenosine by endothelial cells and the adenosine causes vasodilation. +  


submitted by neonem(572),
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tueoreniLek B4 is a tpoetn cecittmhaco elemoclu rfo rsetohuplin. Setleiecv lsos fo ihts oludw aveh no fefcte on sa,tteepll smat ,eslcl or edmuteiholn - htsee aer reom rseniopsev ot egsahcn in XA2T, cepanaldmihicote/romcn c,dia nad P,I2G t.scevyepleir

kernicterusthefrog  FA says: "Neutrophils arrive B4 others" +5  
fatboyslim  Important neutrophil chemotactic agents: C5a, IL-8, leukotriene B4 (LTB4), platelet-activating factor, and kallikrein. Source: FA 2020 page 406 +1  


submitted by xxabi(261),
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I thikn tsi ttah het CI indactnoe eht mernub "0" icwhh kaesm ti calttsslayiit fnaigitcnnsii

kernicterusthefrog  You're thinking about CI for a **mean difference** b/w 2 variables. This question talks about **relative risk**, for which 'strugglebus' correctly asserts that *a CI including 1 fails to reject the null hypothesis*. #funwithformatting +  
xxabi  Ahhhh you're right, I definitely had them mixed up! Thanks! +1  
xxabi  #biostatsisthebaneofmyexistence +3  
conradfussurefake  So am I the only one giving no shit about CI and going straight to what they're asking about. My understanding of the question is that they're asking about the difference in cosmetic results of both the procedure which are described in the stem as the same. The study isn't about wound infection rate!! +  
fatboyslim  @conradfussurefake In the beginning of the Q stem it states "A randomized clinical trial is conducted to compare WOUND HEALING and cosmetic differences...", hence wound infection will affect wound healing. But the because the CI contained the value of 1, it is insignificant. +1  


submitted by sympathetikey(1376),
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sA edtsat blw,eo teh Left usrc errcebi aws eadmdag se(e tahw ti hsould alroylmn lkoo ekil w.bl)oe Tihs canniots the iosanrlcctopi tract. cneSi het crpoociitlnsa ttarc eetcasdsu ta het u,leldma welob hte mibnraid sieocnt ee'rw oliogkn ,at you duolw ees ratealarltCon )Rgh(ti spaictS seHisreimpa

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5  
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +11  
hello  @kernicterusthefrog Thank you. +  
mbourne  NGL, I thought the right side had the pathology lmao ty +20