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Welcome to kpjk’s page.
Contributor score: 24


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submitted by xxabi(250),
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sBRA retslu ni hte wfingolol n:hgaecs aincseerd irn,ne snaeciedr Ang I, cedsaerin nAg I,I rsdacedee etesoadlorn dan gauencdhn idnairkbny

famylife  ...and just to clarify, they directly inhibit the Ang II receptor (AT1) https://www.drugs.com/mmx/losartan-potassium.html +2  
kpjk  I had a doubt- that wouldnt increased RAA lead to increased serum aldosterone as well. Now I understand that since the receptors are blocked- even the receptors to increase aldosterone secretion by Ang II would also get blocked... +2  


submitted by madojo(160),
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AF 19 562

Dseo eht gdur eIMaP ?hsSW 1 - slaml rmbnue of elvonruets ssseas ofr etehfaasPyS 2 - rtoeaedm mnrbue fo in,eattps odse it so aPerkWh 3 - aeglr bmnure dnorma eis,agmstnn wtih bcpolea, any henmpave?ItPo semr 4 - ith the km,ater nay xedectepnu edis se,ftfec anc eb tnrwhwdia frmo Mtaerk

kpjk  just would like to make a small correction phase 3- not placebo, but a drug already present in market so to test if there is improvement over standard care phase 2- would have the placebo, to see if the drug is actually working thats why i got confused in this question couldnt phase 2 also have randomized,prospective double blinded study +4  
kpjk  Sorry! Just saw FA- it says even placebo can be used in phase 3 +2  
llamastep1  Ugh I over thought it, I figured if you wanna give your patient a new treatment you wouldn't send her to possibly receive PLACEBO, am I the only who thought this? +  
turtlepenlight  for the vast majority of drugs, the FDA / NIH don't allow placebo testing anymore (regardless of FA!) +  


submitted by madojo(160),
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AF 91 625

Does hte urgd PeaIhWSsM ? 1 - mlasl urbnme of eetvuoslrn ssssea rof estaSPhyafe 2 - oeraemdt mrbuen of pneattsi, odes ti rPsoWkaeh 3 - glera eumnbr damron imtnnsegsa, twih ebplaco, nay v?artsnmPmepIohe e 4 - hit teh e,raktm any tdunecepex sedi effet,cs nac be nhairwdtw orfm terakM

kpjk  just would like to make a small correction phase 3- not placebo, but a drug already present in market so to test if there is improvement over standard care phase 2- would have the placebo, to see if the drug is actually working thats why i got confused in this question couldnt phase 2 also have randomized,prospective double blinded study +4  
kpjk  Sorry! Just saw FA- it says even placebo can be used in phase 3 +2  
llamastep1  Ugh I over thought it, I figured if you wanna give your patient a new treatment you wouldn't send her to possibly receive PLACEBO, am I the only who thought this? +  
turtlepenlight  for the vast majority of drugs, the FDA / NIH don't allow placebo testing anymore (regardless of FA!) +  


submitted by colonelred_(100),
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oekoLd ti pu and ofund ahtt bcesuae oyure’ ni a snupie ptsioion fro a nlog tmie re’ouy nggio ot ahev sainredec ensuvo rtrune hwchi slade ot rsdiecnae OC. shTi neyetlvgia deeskcbaf on ARAS, dglaien to cesaededr ol.tnodserae As a utse,lr ’eoury gonig ot have cidensear eiiussdr wichh sadel to deaerscde dobol nda smapla u.eovlm

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4  
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +7  
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3  
yotsubato  You gotta be preggers to compress your IVC +5  
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1  
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5  
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4  
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +  
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +  


submitted by divya(58),

okay but where in the question is it asking whether it's intention to treat or per protocol or as treated???

are we to assume its ITT if they don't mention anything or the part of the question that says "primary analysis" the giveway to ITT??

kpjk  I had the same doubt. I think if we were to consider "per protocol" then answer would have to be a mash of options A and B. There is no option that would be right for per protocol +  
peqmd  I think ITT is assumed b/c it's the one that has reduced biased in measurements. +  


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ehT tghni s,i hte omanatplchsii tartc scroess 2 rrbalvete lslvee up and etnh teascsseud at het rniareot iewth sirseoumcm to get rofm het rithg to eht fle,t os how do I kown cihhw eevlatrbr lleve 'Id eb onkwgri on tsih gu?y

chris07  I think the assumption here is that we are dealing with the cord section at the level of the problem. The picture is incredibly misleading. You have to orient yourself. The dorsal columns F, E, A, B are facing the patient's posterior. Once you properly orient it in 3D space, you know that what's labeled "right" is actually the patient's left, and what's labeled "left" is his right side. Super confusing. +2  
sne  The input arises in a limb/part of body at the level of lesion, enters through the dorsal root (pictured between A and B), decussates and ascends at the anterior commissure, and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. So AT THE LEVEL technically would be in the dorsal column +10  
nwinkelmann  also, @chris07, I think you're wrong about the labels being wrong on the image. Becuase the spinothalamic tract = contralateral pain and temperature, and the patient's pain is on the right side, you would want to target the left spinothalamic tract for pain relief, i.e. the area labeled H. The area labeled D would be the right spinothalamic, purely because that is how the image is labeled. If you assume the label is different, you will get it wrong. +11  
kpjk  @sne I don't think entering from the dorsal root would be between A and B. It would be part of the gray matter so, lateral to B and F +2  


submitted by patricknguyen(-12),
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O pety enipatts veha orrfpme gGI anit A anit B. toN MgI i"olehsny tSbridota atefr s"snrnfiaotu eaisr up cuoiinssp rof saxnhaaiply. n o ngsi fo -ilty&sseghm;o ovafr hayxpslaina ude ot IAg endgi;ecty=&cfi ftcfoere clle is atsM clesl

eclipse  they have IgG and IgM +2  
kpjk  if it had been anaphylaxis- there would have been urticaria and pruritis +2  
usmile1  wow I've never seen an answer on here be just so wrong +  


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shiT is a elodk.i In rmolna wnoud ealnhig yetp 3 lnoelgca is fsitr tzsneheidsy dan tenh dgededar yb itaxMr romeeoitaltnlespa (a oecegalalns iwhhc ssue Zcin sa a otf)cocra dan lrcaedep by Teyp 1. nI a dliKeo an sescexvei tmuoan fo sdireiondgaz Teyp 3 lnglcoae s.pissrte rehfoereT eth cetfed si in loaCenlg sseytinhs (ypTe 1 stysi)enhs

dulxy071  Wouldn't Granulation tissue be the (more correct) answer since the initial collagen laid down for wound healing is Type III collagen which is consistent of granulation tissue? Collagen is a vast for so many types of itself as we know +3  
kpjk  @dulxy071 she had a surgery 3 months ago healing was fine even uptill 6 weeks ago so the abnormality occurred during remodeling- when type 3 is replaced by type 1 collagen, so the answer wouldnt be granulation tissue +5  
pontiacfever  Keloid has both 1 and 3 types of Collagen increased production. Whereas, granulation tissue consists of type 3 collagen only. which is why collagen synthesis as answer would be more specific +  


submitted by step1soon(45),
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Teh epetodrr diecnecni fo pnaaCl ronmsdye is 1 ni vyree 0,10000 .oeeplp Tsih sha nebe a igelcdnin remnbu ued to lerwo souexpre ot cola, so,esabst nad .ilicas lercevenaP fo Cpaanl ymsenrod is hhireg ni tpsetnai hwti clasii repusxeo pcoedarm to hte hreot eaussc. hTe itrsf oedicelpmgioi sdytu nndrkutaee by het smnooiouiePnsc rsecheaR intU dbsorvee na idcrseean lrecpnveea of AR tosamgn nem hwti evpirsrsgoe veasmsi ssifoibr M).(FP liMal te .la udofn no rceednsai pleceavren fo othreuamdi rrtsaithi in iremsn ewnh romaedpc ot a oimtmynuc wrhee PMF nda rhteuamido asriritht ewer arepvtenl adn oerftehre lceudnodc thta eth gyoeltoi of AR swa ton cstasdoaie wtih opuxeesr ot tdsu or nugl agcenhs fo docmiaeltpc ciem.spouosnoni eheTr asw a hihg eaevlnpecr atre fo MFP nda srcuielsoutb gantmso erimns dna in-mxeesr hwit iremuodaht ar.4i]hrts[it5[]

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lwtu'odn hte lninrdugey sisedae eb AR hwhci is hnet suacign hcoenngcirob rnma?iacoc 'mI neo!u!cfds

kpjk  i dont think its RA, because they said xray shows new bone formation, where as RA would have erosion +  


submitted by monoloco(132),
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iTsh is the oyln chcoei tath meosc eclos to nkiginc the ioathccr tdcu, lecypicsflai ta its ite,nl the lfte naluivcb.sa

kpjk  why not midsternal thoracotomy? +3  
wuagbe  because the thoracic duct ascends the thorax posteriorly, and enters venous circulation from behind. link to image: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/thoracic-duct +5