to snoo-finity ... and beyond!
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@kimcharito Aortic stenosis radiates to the carotids
FA pg. 285 (2018)
Reducing acid production helps mucosa heal alot more than increasing prostaglandins. We learn about misoprostol because it can be used if you dont have anything else but you're never gonna choose it over a PPI
I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description.
aorta is also behind of liver...
I agree! Also, At the end of the stem, the question is which of the following best explain the patients symptoms? Not physical exam findings. Since this patient is coming in with a chief complaint of SOB while playing sports exercise induced asthma is the best choice. Hopefully that helps.
I mean... couldn't increased BP during exercise worsen his MVP and give him SOB?
(by causing slight regurg)
"Lungs are clear to auscultation"
But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for?
I incorrectly chose malingering and am wondering if the fact that he presented (although it doesn't state who brought him in/confirmed his symptoms while exercising) makes this less likely despite the fact that he clearly states "I don't want to play anymore" which could be interpreted as a secondary gain? Also, regarding the MVP, I'm wondering if the fact that these are usually benign should have factored into our decision to rule it out? Thoughts?
Just noticed that he has FHx, game changer.
clear lungs, they try to say no cardiogenic Pulm. edema, means is not due to MVP
shortness of breath while doing sports and no shortness at rest makes me to think more asthma induced by exercise)
Isn't exercise induced asthma usually found in people running outside, especially in cold weather? I feel like that is how it is always presented in NBME questions, so this threw me off. Not to mention the MVP.
Yeah the negative EtOH screen threw me off
Why cant it be early alzheimers and hippocampus? She could easily have been a former prominent physician and member of city council. Am i supposed to assume that simply because shes disheveled and poor hygeine that she must be an alcoholic homeless person? It also mentions no symptoms of nystagmus, ataxia, etc.
it said broad based gait and nystagmus
She is/was an alcoholic and appears pretty much homeless, just not drunk at this moment.
@ dr janitor. The question says "physical exam shows a broad-based gait and nystagmus."
NBME questions also stereotype the shit out of their patients
I don't understand the last part of this question stem though... if the mother's TSH *increases* during pregnancy? Wouldn't this further increase her (and/or the fetus's) production of T4 and thus counteract the hypothyroidism?
@neonem no. Autoimmune hypothyroidism is a destruction of the thyroid gland, and a decrease in production of T3/T4.
An increase in TSH means that there is not enough T3/T4 to inhibit TRH, and so TSH is being released to stimulate the thyroid gland.
TSH, T3, T4 and thyroglobulin cannot cross the placental barrier.
@arezpr although those hormones can't cross, the autoantibodies from Hashimoto's can
The baby has its own TSH though
TSH comes from the pituitary, and act on the thyroid. Autoantibodies attack the thyroid, so TSH doesn't work.