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Welcome to lfsuarez’s page.
Contributor score: 132

Comments ...

 +2  (nbme23#32)
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ANDM pcoesrret ni htis scae rea bineg sued rfo lgno mret ntetianpooti thwnii teh ianbr adn out of lal of ehtre sichoec oynl iths rrcpeeot suse +aC

 +3  (nbme23#36)
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He esptnser wtih an bnmoraal otneassin of hsi etfl dhan hatt saspred ot both his eltf mra nda A ilnose of teh octtarnpsle yrgsu owudl aucse tshi sa it it roebpinlses orf ssonaetin.

drzed  "you can tell because of the way it is" :) +5

 +0  (nbme23#16)
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02 of teh 100 nme owithut eotrstpa erancc ehva aamlbron ttes .etslurs

iccteiipfSy = PTPF/FN+ = /10200 = 08. = 0%8

seagull  almost. 100/120 = 83% roughly 80% +
amirmullick3  Not sure what lfsuarez and seagull above mean. Here is my explanation. Specificity = TN/(TN+FP). This test gave 20 false positives out of 100 people, and only 15 true negatives out of 50 men. Specificity also equals 1-FPrate, and here the FP rate seems 20% so 100%-20%=80%. +3
yb_26  abnormal test result means pt has cancer => TP = 35, FN = 15 (50-35), FP=20, TN =80 (100-20) => specificity = TN/(TN+FP) = 80/100 = 0.8 (in % will be 80%) true negatives are 80 out of 100, not 15 out of 50 +2
bulgaine  If you replace the values from the question in the table of page 257 of FA 2019, yb_26 explanation is correct. Abnormal test = patient has cancer = test + Question says 35/50 men with prostate cancer (so all 50 have cancer) only 35 have abnormal test results, meaning that TP=35 (disease + test +) and FN= 15 (disease + test - because they do have cancer but the test was not abnormal for them ). 20/100 men without prostate cancer have abnormal test results meaning all 100 DONT have cancer but 20 show that they have cancer when its not true so FP=20 (disease - test +) and TN =80 (disease - test -) +

 +11  (nbme23#19)
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ihTs netaitp espnesrt with XEPI ydgtomru(saieionmunl ptdcnpyroleaiyoohn pnotrtheeay keldi-n)X hihcw si a aittnuom of eth PX3OF geen hcwih si a rraegulot fro the ealytgRuor T lcel .geinlea tI easld ot hte uctfyinsodn of uroayrelgt -csTlel nad teh uqssnteueb tyi.uaumtoin

 +11  (nbme23#9)
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hiTs vet si gnfifsure mofr Q efer,v ihhcw comymonl nspeerts iwht fer,ev aceeetld irvel m,ysenez ntohotyreoiabpc nda gunl sainlr.itfte Teh ragm tnsai nad tclurue paarpe ot eb teeanvig bauesce elocxail is an uaralliecrnlt ratacebi. eH si at high irsk orf hist feiocntin mrfo eht lainhniaot fo eht aabtrice ngurid rafm laniam y.ledvire

 +6  (nbme23#13)
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eTh tepaint si beesripcrd ineadiSlfl hiwch dcueas ceiasndre cGPM sleevl aer ftrroeehe OMSTHO SUCLME In hsti ecas you woldu want ot dietlsaaov eht edpe trreay to arenscie dlobo lwof oint eth orcraop vnroseac.a

sugaplum  aka cavernous artery, that is what I was looking for. Did not realize it was also called the deep artery +5

 +9  (nbme23#12)
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inPtaet teepnrs to hte cnlici hwti lacsscila pysmmtso fo u.teastn usnateT nixto rwok avi inbitihoin of /gnAlBGiAecy eeelsar mfro whRnase tinibyrhio se.lcl hoiWutt ehest tnoyihriib sailsgn on teh sctypntpisoa uore,nn eyht aer younlucitosn tvietaadc aucgins sumlce ye.tnta

 +5  (nbme23#5)
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ePhas II siedstu tets hte yfeccfai of a gr.ud hiTs dsecon ehaps fo inttsge nca alts orfm sralvee ostmnh ot owt aseyr, adn vselnvio up to aeslevr nuhdder tdefaefc e.apintst

polyomavirus  FA2019 p256. Does the drug SWIM (1. Safe 2. Work 3. Improve from standard 4. Market surveillance) +1

 +4  (nbme23#26)
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eWnh spitatne ear vgine iocNinict idai(Nnc)cai thye ear oldt to eetxcp onmcom ides fetcsef to ccour shuc as tmharw adn nOe nca dviao sheet dsei ctfefes yb natigk nrsiapi

mcl  To expand on this, the flushing/warmth/redness is due to release of PGD2 and PGE2 which is why taking an NSAID helps. +11
snripper  Doesn't acetaminophen inhibits COX 1-2, too? Why can't you use that instead of aspirin? Just wondering. +4
raspberryslushy  I had this same question too, and had it narrowed down to those two choices. Ended up going w/aspirin but it was sort of a coin toss. Still not sure why it's not acetaminophen. +
eagleeeee  I think the reason is that acetaminophen is inhibited peripherally and is mainly used to inhibit COX in the CNS +4
whatup  The worst side effect of Niacin is hepatotoxicity. Acetaminophen is famously known for hepatoxicity so aspirin is a better answer +

 +8  (nbme23#2)
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atPtien snetreps itwh ciarlcve parelihaitlntei ,eiosanalp whit hte smot llkeyi ipturcl gibne PV.H VPH sasecu iths isaeaopnl uoghht het rncteoia fo E/7E6 nrpteosicnoo wcihh inihbit 3p5 nda Rb utrom osspsurper rpsotein elyeispt.vrec

 +5  (nbme23#7)
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hisT squeiton skas aoubt the sammhenci of pyprhtoeaoht sa ti lseaetr to aeaonnlt indj.ueca hWit othophpy,aetr nibbriilu si lysmpi cdveronte to watre bolslue msiosre htat aer enht ealb to eb erxcetde by hte kneyid. hsiT weoverh esod otn aectgujno the iil.nbirbu

almondbreeze  FA 2019 pg 387 +
abhishek021196  Physiologic neonatal jaundice At birth, immature UDP-glucuronosyltransferase = unconjugated hyperbilirubinemia = jaundice/ kernicterus (deposition of unconjugated, lipid-soluble bilirubin in the brain, particularly basal ganglia). Occurs after first 24 hours of life and usually resolves without treatment in 1–2 weeks. Treatment: phototherapy (non-UV) isomerizes unconjugated bilirubin to water-soluble form. +

 +12  (nbme23#43)
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intaPet tperssen thwi tohb tiaxaa and na intetonni rretmo on eth rtigh nahd edsi. tI si nritotpam to rerebemm htat rreeballce olnisse elik ew ese heer laysaw stprene YITLAISLRALPE sa spodope ot mayn terho SNC slen.ois

 +8  (nbme23#3)
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rewnAs E

nogiracIn phosohsuPr ; yahadrrotiP rHoonme ; otlilrCcia

dscDaeeer ; ecnIaesdr ; eceDserda

siTh pnettai si rfguenifs rmfo alceic upsre, hhiwc ni stih ecsa has ducsae tnmaiVi D rslaobmtionpa adn rreotehef seaerdecd usrme ilcu.acm ehT odyb lliw derpnos ot hte deasrcede macluci via ortiesnec fo PTH. sTih will tnhe saceu rohohupossp iwngsta ot ucocr in het axomiprl vculdeonot e.tbulu

kuhnboom  Why does Calcitriol not increase with the increased PTH? Wouldn't the increased PTH stimulate the kidneys to make more activated vitamin D. +1
batmane  vitamin d malabsorption --> dec calcitriol +4
peridot  @kuhnboom Yes, while PTH stimulates the kidneys to make more active vitamin D (calcitriol), you need vitamin D precursors to begin with in order to do that. If you have vitamin D malabsorption, then the activated form won't be high even with high levels of PTH. Therefore, calcitriol is decreased. +
cbreland  Also, Vitamin D causes Ca and Phosphate absorption in the intestines. A lack of activated vitamin D would cause more Ca/Phosp wasting +

 +13  (nbme23#46)
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nuDrgi oeitnpr oraatn,sntil eth eoobmsir bdin ot AmRN ot aiittien onsitrcairpnt rnsatgit at het nermiNtsu.- hTe rNnteiu-ms tpeepdi nde ainostnc a sglnia tnogeiconir cplirtea htta idsbn to hte anislg ncooritgien tcerilap rtrecpoe no the uhgro RE ot oallw eht renotip to be edam ntio eth R.ER

link981  Rough endoplasmic reticulum- site of synthesis of secretory (exported) proteins. Smooth endoplasmic reticulum- site of STEROID synthesis and detoxification of drugs and poisons. Page 46 FA2018 +2
furqanka  the N terminus peptide end has the signal recognition SEQUENCE which is recognized by signal recognition PARTICLES. These particles bind to SRP receptor on rer. +

 +12  (nbme23#14)
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rFsti aehtr dnsuo 1)S( is gdreaenet by two rteha elsavv: the lrtaim velav nad srciditup vevl.a lraNye tsueomaisuln iclgons fo eehts vlaevs rlolaymn rteseenga a gsnlei 1S Sltipitng fo the S1 nusod is drhea ewhn trailm nad uicrpsitd alvvse oclse ta glilshyt defrfeitn i,etsm wthi usaluyl teh atmlri nlcisog forbee iicpsutdr

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +18
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts. +20
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +3
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +1
drzed  It shouldn't matter where you hear a split sound. For example, no matter where you auscultate on the heart, the second heart sound in a healthy individual will always be A2 then P2 (whether you are at the mitral listening post or the aortic listening post) The key is recognizing that the right sided valves in healthy individuals will always close later (e.g. the heart sounds are S1 S2, but more specifically M1 T1 A2 P2). The reason for this is simple: if you take a breath in, you will increase preload on the right side of the heart, and thus the greater volume will cause a delayed closure of the valve. This is physiologic splitting, and is better appreciated in the pulmonary and aortic valves because they are under greater pressure, and thus louder, but it can also be heard in the first heart sound. +7
alexxxx30  yes agreed!! This question is mostly asking if you understand a few basic things regarding cardio physio. The left side of the heart is the higher pressure side so left sided valves will close first. The right side of the heart is the lower pressure side, which means right sided valves will open first. [Left closes first, Right opens first]...Secondly, it requires you to know what S1 and S2 sounds come from. S1 is the mitral/tricuspid valve closing and S2 is the Aortic/pulmonary valves closing. So really the question asks what is the first component of S1 (mitral or tricuspid closes first). And since we know that the left side will always close first, it must be mitral valve closure. Sorry if that was a long explanation. +7
jesusisking  Thanks @alexxxx30, you the man! RIP Kobe +

 +13  (nbme23#22)
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Tsih tnitpea npresste with a lsalm llce mccoranai hchiw si very cmmono ofr praa leontscpia dn.smrseyo nI this seac teh aenrcc si nucaigs IS.ADH nyecieDolcelm si a ncetcayrietl tncatoiiib htta is salo edsu to ttrae ASDHI

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +13
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +1

Subcomments ...

submitted by m-ice(272),
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ehT natptei wohss no sign of acliotrc cvtyat,ii ubt sha eosm nibsraemt ifucnnot cn,iatt cwihh pimesil esh is in a fomr of rpeietsnst ivetgaetev ettas. eSh ash a inlvgi liwl atth seaeidsgtn cimlnhaeca anioltitvne dhslou eb idisctneundo if ahtt auntsotii ,rsaise os we mtus oflowl ti adn amek tno mtpeatt ot taest.iseurc

lfsuarez  Why would the second part of that be correct when there is not mention of a DNR? +10  
ug123  DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +2  
sherry  DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question. +  
shayan  "The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing ! +4  
criovoly  I believe this question was not well constructed... it's one of those! +  
suckitnbme  @shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state. +  
luciana  I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills +  
coldturkey  @lfsuarez CPR(if the need arises) , for this patient (barb overdose and hospital setting), she will be intubated to get and maintain airway access. However ,she is against any mechanical ventilation as per her living will. Hence, we cannot perform CPR on her. +  
furqanka  I too believe DNR and DNI are distinct but UW 1124 says - A DNR order indicates that a patient should not undergo CPR. this includes bls (mouth to mouth breathing, chest compression) as well as advanced cardiac life support (intubation, mechanical ventilation, defibrillation, and administering medications such as vasopressor or epinephrine). Additional wishes such as the desire to not be fed artificially or any other limitation of care can be specified. +