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Comments ...

 +0  (nbme21#28)

Gly is polar, Alanine is nonpolar and hydrophobic. Missense nonconservative mutation. These AAs have different chemical properties which lead to disrupted protein folding (secondary structure). Similar to Glu - Val substitution in Sickle Cell Disease.


 +1  (nbme21#32)

Chemo-tox man picture from the FA (last page of the hem and onco section) works well for me in these types of questions.



 +0  (nbme21#47)

There is nothing indicating that this is a femoral hernia. It could be any type of hernia in the inguinal region (femoral, direct of indirect inguinal). No need to overthink: symptoms of incarceration, piece of dead bowel - strangulation, done, keep going.


 +0  (nbme21#47)

Remember PTH as Phosphate Trashing Hormone.

↑Phosphorus -> ↑PTH secretion -> ↑bone resorption -> ↑ALP and bone pain.





Subcomments ...

Candida is a part of the normal flora of skin, could cause contamination of a central venous catheter. The question states that the organism is purple, budding, did not respond to broad spectrum antibiotics (aka they didn't use fluconazole or amphotericin B). Lastly, they showed it plated on blood agar and there was no hemolysis which eliminates staph (the only other possible contender here.)

Cryptococcus usually involves meningitis in immunocompromised pts. E. coli is gram negative sporothrix is usually transmitted by a thorn on a rose or someone with a history of gardening

hungrybox  Also, the yeast form of Candida is gram (+) +4  
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +  
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +  


submitted by kentuckyfan(20),

A labeled image

A/B look like grey matter to me

C looks like caudate nucleus

D looks like anterior internal capsule

E looks like thalamus

lilmonkey  yep, I also chose C. Relatively easy question, but a bit misleading picture. +  


submitted by hayayah(416),

Wernicke-Korsakoff syndrome. Don't have to be an alcoholic to get this, just usually is related to alcoholism / thiamine deficiency.

d_holles  Yeah the negative EtOH screen threw me off +1  
dr_jan_itor  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. +1  
kimcharito  it said broad based gait and nystagmus +1  
lilmonkey  She is/was an alcoholic and appears pretty much homeless, just not drunk at this moment. +  


Syphilis pathogenesis is the inflammation and obliteration of the vasa vasorum (small blood vessels) that feeds bigger blood vessels like aorta, arteries, arterioles. It does not matter what the stage is, T. pallidum infects the vasa vasorum and, in the process, obliterates the nerves and blood vessels. This kills blood supply to those areas = ischemia but no pain (painless chancre). More localized in earlier stages, and in later stage, the spirochetes disseminate, so you have the aorta and spinal cord involvement but same pathogenesis. (Edit: Goljan explained this somewhere.)

privatejoker  So is the heavily implied step-wise formation of Syphilis symptoms as presented in FA complete BS then? Why break it down into stages and have us learn it as such if this is not the case in real practice? +1  
lilmonkey  Exactly, Goljan mentioned this in one of his audio lectures. All kinds of lesions in syphilis caused by vasculitis. +  


submitted by tamey(2),

im a little confused isnt blocking ampulla of vater(hepatopancreatic ampula) would cause obstruction of both pancreatic duct and common bile duct and in this case the patient would have cholangits too, not only pancreatitis!!!

divya  true but none of the other options cause pancreatic duct dilation. options a, b and c would cause obstruction above the level of pancreas. +  
lilmonkey  It doesn't say ONLY pancreatitis, but just enough information to choose the correct answer. Maybe, in the test writers mind if they mention cholangitis and jaundice that would be too much hints :). +  


don't be a dick? not really sure what more there is to it. The patient doesn't have any other family so this woman should be considered family

aesalmon  Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine? +  
hungrybox  Yeah, I got this one wrong with the same logic as you, aesalmon. +  
emmy2k21  I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines! +1  
dr_jan_itor  @emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase +1  
et-tu-bromocriptine  Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice. Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy. +1  
lilmonkey  I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time. +