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submitted by hpsbwz(98), visit this page
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The way I got this was first based off the MRI, it's definitely not the stomach, as it's no where near the stomach. Going off that, the duodenum comes right off the stomach, leading me to also cross that out. Then from the stem it said LEFT MIDabdominal pain, allowing me to cross out appendix (also no fever) and therefore cecum as well. Only remaining choice you're left with is jejunum!

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kevinsinghkang  CT, not MRI* +


submitted by blue4415(4), visit this page
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can Gonadotrophs “hyperplasia” rather than hypertrophy?

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kevinsinghkang  wondering the same +
escherichia95  Hormonal stimulation will lead to production of new cells from stem cells i.e. hyperplasia. Hypertrophy is gene activation, protein synthesis and production of organelles. +


submitted by cassdawg(1781), visit this page
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Yellow nodules (cholesterol deposits) on the achilles tendons have a very high association with Type II familial dyslipidemia, or familial hypercholesterolemia. This is caused most often by a defect in the LDL receptor function. (FA2020 p94)

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cassdawg  NOTE: This patient shows a SELECTIVE increase in LDL so it is a defect in the LDL receptor NOT a defect in ApoB100. A defect in ApoB100 would present with increased VLDL as well! +28
ginachipotle  Note that the answer is ABSENT LDL receptors vs. partial reduction b/c LDL >700 (LDL = 980), indicating individual is likely homozygous for the trait. (FA2020 pg. 94) +12
jdc_md  you trick me nbme. veryy veryy tricky +5
i_hate_it_here  <- +4
kevinsinghkang  Why not E? partial reduction? +
kevinsinghkang  never mind i see it above now. thanks ginachipotle +


submitted by cassdawg(1781), visit this page
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Yellow nodules (cholesterol deposits) on the achilles tendons have a very high association with Type II familial dyslipidemia, or familial hypercholesterolemia. This is caused most often by a defect in the LDL receptor function. (FA2020 p94)

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cassdawg  NOTE: This patient shows a SELECTIVE increase in LDL so it is a defect in the LDL receptor NOT a defect in ApoB100. A defect in ApoB100 would present with increased VLDL as well! +28
ginachipotle  Note that the answer is ABSENT LDL receptors vs. partial reduction b/c LDL >700 (LDL = 980), indicating individual is likely homozygous for the trait. (FA2020 pg. 94) +12
jdc_md  you trick me nbme. veryy veryy tricky +5
i_hate_it_here  <- +4
kevinsinghkang  Why not E? partial reduction? +
kevinsinghkang  never mind i see it above now. thanks ginachipotle +


submitted by cassdawg(1781), visit this page
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This woman is showing signs of HELLP syndrome (Hemolysis, elevated liver enzymes, low platelets) [FA2020 p643] HELLP can lead to DIC.

A blood smear will show schistocytes.

HELLP syndrome is a manifestation of severe preeclamspia (hypertension after 20 weeks with either proteinuria or end-organ dysfunction).

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imgdoc  EVERY TIME THERE IS A PREGNANT LADY WITH HYPERTENSION AFTER 20 WEEKS GESTATION YOU SHOULD IMMEDIATELY BE THINKING PREECLAMPSIA and ALL ITS COMPLICATIONS. Sorry for all caps, but I've gotten so many preeclampsia questions wrong, and because of it, I'll never miss another one! Hopefully this helps you guys clue into Preeclampsia -> HELLP. +
kevinsinghkang  Why is it not spherocytes? I thought hemolytic anemia---> spherocytes? +1
thatmd  @kevinsinghkhan AIHA=Spherocytes VS MAHA=Schistocytes FA 2020pg 423 +


submitted by andro(269), visit this page
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Question describes the genetic concept of uniparental disomy ( inheriting both genes/ alleles from one parent )

Most cases of uniparental disomy will give a normal phenotype but in cases when imprinting is involved ( natural silencing of genes ) , abnormalities may occur . * Take for example the two most commonly cited examples of this situation

  • Prader -Willi and Angelman syndrome

  • In Prader Willi - normally the gene derived from mother(at that specific locus ) is silenced and it is the paternal allele which is functional. If the paternal gene becomes deleted , all you end up with a is the mothers silenced/nonfunctional allele . Alternatively if both genes are maternally derived ( Uniparental Disomy ) , you end up with 2 nonfunctional/silenced genes

  • The same thing occurs for angelman just vice-versa

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kevinsinghkang  why not loss of heterozygosity ? why is it wrong +


submitted by lpp06(41), visit this page
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CYP's are highly polymorphic genes, so it's likely that there are 4 different alleles in the 2 parents, making for 4 possible different combinations in the offspring and a 25% chance of each one occurring.

Agreed that the question is a bit nit-picky because it requires you to know that CYP is a polymorphic gene. However you can back into the reasoning by combining 2 ideas: CYP's function is drug metabolism + there is a wide spectrum of how quickly patients metabolize drugs (ie fast, medium, slow acetylators). From there you can make the wide arrange of phenotypes must mean that there is a wide number of alleles.

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kevinsinghkang  That's true but the sister had confirmed breast cancer too so wouldn't it be more than 25% in this case? Or should we just ignore the fact that she had breast cancer too +
thatmd  the sister has breast cancer but was treated with tamoxifen, which means she doesn't have this cyt p450 that causes the reduced active form of the drug. So the question is not about breast Ca +1


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