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Welcome to liverdietrying’s page.
Contributor score: 80


Comments ...

 +28  (nbme22#15)
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sThi eno saw a illtet rc.ikyt oFr ihts oen het eky is eth wol riienoidaod kptae.u sTih tepaint ahs hgih T4 dan wol STH hhciw keams ssene in a ehprtoiryhdy ei,tnpta spepahr yoru tisrf oghtuht is htat itsh tneapti sah vrGse’a desa.eis Hroevwe, ni vae’Gsr yuor odirhyt si ngeib ittlemasdu ot emka eomr iyrdtho eoonmrh omfr hctascr and as hcus udwlo eavh an sanicrede ddiaeniroio tpeaku euescba hte hioytrd is gbriinng ni hte iereurqd (now elodaleaidr)b nd.ioie isTh si hyw ti is ton aersvG “lr(seaee of dotrihy rnmhooe orfm a ydrohti uiatdlstme by ts”i)aob.eidn

oS if ist tno rGes’av htaw ulocd it e?b For iths duo’y eavh ot wkno htta ’mitassohHo thsirodTyii lsa(o konwn as Chicorn cphtoiLcymy itioTrsdhyi dan is notef fereredr ot sa hcsu on abodr xsmae ot hrtwo uyo fof) sah htere shseap - trifs yteh era yrhdeho,rptyi enht tdyhu,iore tnhe het iccsasl hotiorhpydy htta yuo udwol eptxec twhi olw T4 and hghi T.HS isTh asw teh key to ihts toe.uinqs The aosrne rfo tsih is hatt ittryhdnaio sdxeipoare tasiondeib ni oHss’amioth ecasu het oditryh ot seerela lla of its tdoesr yhtroid rnmohoe ikgamn teh petaint dhyprtyeiroh rfo a toshr oidpre fo .mite erftA htis aissevm sraeeel of dihtoyr nmh,eoro eth iostaeinbd maek hemt eluban to meak wne HT nda frhoreete hyet eocemb eoidrhytu fro a sroth erpodi nad htne hyohitrpdyo iwchh uoy owuld ecx!tep eincS teyh nc’at akme wen T,H hte rtodihy wlli otn take pu eth irinoddoaei dan ftheorere ehtre will be low idraoednioi .kteaup cn,eHe sraeel“e of eotdrs otriyhd omonerh frmo a yhdtior ngdla telfdniiart yb mpys.oytlce”h aka yhpL“cycotmi h()omosahist id.ro”thisiyt

I hnitk aserele“ of yorhtid rohnmeo fmro a yuooamhtlpsm rotyihd dln”ag si rrefrnegi to eosm dnki of rtodhiy anecrc in cihwh asec yuo ldowu ecxtpe mthe to be reidnibcsg a dunoel no oididoearin kpaeu.t

​myrmuaS eiovd eher dna sloa a agrte tsei ni nlegre:a d/nrao/ici/edru:enehclysdtnpgihmd/oet.pereins//rtaoqo

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +6
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +7
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +1

 +15  (nbme22#32)
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Godo atfc to moitmc ot eymom:r uoy lsoe crbaib ni hte oltso c(ehne why aehdriar scaseu nniaoonn pga cebitalmo )sodiisa,c dan yspeeiacll eols tuosipasm with ltiavxae buesa as( nmtoeeidn in eht suetniqo e)m.st el-tsbe:coomeetwuldctstire-i.c/he//ilcattaraaea.wrmynhsdwiao-ptpana-/ooebditht-wndnts-r

sbryant6  I'm going to go take a big bicarbonate poop now. +20
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse — Metabolic Alkalosis :   ↓K+     ↑Cl-                   ↑pH    ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +1
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1
texasdude4  easy way to remember : "Bicarb out the Butt" +




Subcomments ...

submitted by medstudied(1),
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hWy si eth roercct asrnew hescuar-iq ts?te I get ttha ’its desu ofr carlaitgoce ivasbrlae ubt ew’re mngpociar nreceepavl agn.etescper Is tath dnoecesidr aactroi?lecg

liverdietrying  You’re looking at two categorical variables, Caucasian vs. AA and HTN versus normotensive. So you’re still using Chi2 to analyze. +4  


submitted by iviax94(7),
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hereT hvae enbe a oclpue fo ouqtnssie tboau isth ptoic no the wreen mxs.ae I’ev eben wnrnigesa by inegqatu olbdii to steotnseoetr veslle nda nutorlcna toineecsr to ehhalt fo lrtaesacuuv ihrs(cerolesstao or ot).n Is htis oercc?tr

liverdietrying  When you’re thinking of libido, don’t just equate it to testosterone -- make sure you’re always considering depression! Depression following stroke is common, especially with residual physical disability, so this would decrease his libido. Nocturnal erections equate to “does it actually work?” not just the vasculature but the neural input as well. For example, during prostatectomy damage to the pelvic plexus (nerves) can lead to impotence. There’s nothing to suggest that he has vascular or neurologic erectile dysfunction here, which is why his nocturnal erections are intact. +18  
_pusheen_  @liverdietrying Was it premature to assume he has trouble with erections because of neural damage from the stroke? I put low libido, low nocturnal erections. Is it because the stroke resulted in hemiparesis and not autonomic dysfunction or something like that? +5  
liverdietrying  @pusheen Correct, you won’t classically get impotence after a hemiplegic stroke. His inability to achieve an erection is much more likely to be 2/2 psychosocial effects than organic disease. If this vignette instead said that this had gotten a prostatectomy with resulting damage to the pelvic nerves that allow for erection, then it’d be a more safe choice to put no nocturnal erections. +4  
fast44  Is there a video or somewhere that explains these sexual dysfunctions? This seems to be a topic that keeps repeating on the new exams. +2  
forerofore  well, i though that because he had a stroke he would be likely to have atherosclerosis, which would keep libido high and reduce nocturnal erections, i kinda ignored the whole "he´s depressed" part of the vignette despite understanding the mechanism well. but from a clinical depression point of view, if his arteries are intact, and he is depressed, then libido would be low, and erections present at night. +4  
pg32  I can't remember exactly but I swear the question on NBME 21 the guy's wife had died as well...? Or they had gotten divorced? Either way, he had some psychological baggage as well, but his libido was still normal, and the explanation was that his testosterone would be fine regardless of his depressed mood. So I went with that logic here and missed this question. I don't understand how I am supposed to gauge someone's libido based on vague hints at their mood, especially when in one exam mood does not decrease libido and in the other it does. +  
drzed  @pg32 bro spoilers +2  


submitted by iviax94(7),
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I saw beteewn iapaohmykle d(ue ot ahidaer)r dan phaprceciyiemly/huaeamrcier i(nces wstae si iopyhntco adn lowdu eucas rthciyempsoo vemlou nra)ittoncoc. I ’dnitd eavh a geart yaw to ddciee eewtben ic/pCuyirhmeyeeahrpar os I rgefiud yhet dtwean p.Kyoh sI eehtr a rteetb oelaainrt rof yhw eth pheyr nsawres rea ocnterri?c

liverdietrying  I think you over-thought this one a little bit with the hypercalcemia/hyperuricemia. Good fact to commit to memory: you lose bicarb in the stool (hence why diarrhea causes nonanion gap metabolic acidosis), and especially lose potassium with laxative abuse (as mentioned in the question stem). https://www.uptodate.com/contents/acid-base-and-electrolyte-abnormalities-with-diarrhea +1  
w7er  Basically they are asking about electrolyte distrubance that cause collapse mainly due to hypokalemia from laxative abuse because diarreha cause hypokamlemia and also cause incrase in renin angiotensin sytem which will further cause hypokalemia resuling cardiocascular colapse :) +  
hyperfukus  i thought the hyperuricemia thing too but i wasn't smart enough to think they wanted hypokalemia like u :( +1  


submitted by iviax94(7),
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eeThr aevh eebn a eloucp of tuqnssieo obtua iths octpi on eht nerew ax.ems Ie’v enbe sreaiwngn by teuinqag iiblod to eseottnertso vllsee nad tnacronlu ieecrston to hhtale of cueuvsralat (sarhslisceeootr or .otn) sI tsih crco?rte

liverdietrying  When you’re thinking of libido, don’t just equate it to testosterone -- make sure you’re always considering depression! Depression following stroke is common, especially with residual physical disability, so this would decrease his libido. Nocturnal erections equate to “does it actually work?” not just the vasculature but the neural input as well. For example, during prostatectomy damage to the pelvic plexus (nerves) can lead to impotence. There’s nothing to suggest that he has vascular or neurologic erectile dysfunction here, which is why his nocturnal erections are intact. +18  
_pusheen_  @liverdietrying Was it premature to assume he has trouble with erections because of neural damage from the stroke? I put low libido, low nocturnal erections. Is it because the stroke resulted in hemiparesis and not autonomic dysfunction or something like that? +5  
liverdietrying  @pusheen Correct, you won’t classically get impotence after a hemiplegic stroke. His inability to achieve an erection is much more likely to be 2/2 psychosocial effects than organic disease. If this vignette instead said that this had gotten a prostatectomy with resulting damage to the pelvic nerves that allow for erection, then it’d be a more safe choice to put no nocturnal erections. +4  
fast44  Is there a video or somewhere that explains these sexual dysfunctions? This seems to be a topic that keeps repeating on the new exams. +2  
forerofore  well, i though that because he had a stroke he would be likely to have atherosclerosis, which would keep libido high and reduce nocturnal erections, i kinda ignored the whole "he´s depressed" part of the vignette despite understanding the mechanism well. but from a clinical depression point of view, if his arteries are intact, and he is depressed, then libido would be low, and erections present at night. +4  
pg32  I can't remember exactly but I swear the question on NBME 21 the guy's wife had died as well...? Or they had gotten divorced? Either way, he had some psychological baggage as well, but his libido was still normal, and the explanation was that his testosterone would be fine regardless of his depressed mood. So I went with that logic here and missed this question. I don't understand how I am supposed to gauge someone's libido based on vague hints at their mood, especially when in one exam mood does not decrease libido and in the other it does. +  
drzed  @pg32 bro spoilers +2  


submitted by iviax94(7),
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CT wohss asms on hte ltfe sedi fo ish daboemn adn ru’eyo oltd it’s ottussn.sueipicn ksAs wichh prat fo teh GI arctt is msot elyilk to useac eht .niap I itimadeemly ooekld rof caocielel inujtnco ... ont na warens chi.eoc yWh si het nwaser jnmuuje s.v( m)uouddn?e

liverdietrying  The picture is key here. You’re right that ileocecal is most common, but ileo-ileal and jejuno-jejunal are the next most common (I think I might just know this from having done clerkships already, not sure). Ileo-ileal isn’t an answer, so that rules that out. Look at where the arrows are pointing in the picture as well. Its on the L, ruling out appendix and cecum. And the slice is not at the level of the duodenum, ruling out that answer. So by process of elimination based on the picture you could get this one too. +4  
dr.xx  Duodeno-duodenal intussusception is a rare because of the retroperitoneal fixation of the duodenum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529645/ +1  


submitted by airhead5(2),
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ehT easnrw is mcnoiarac of het tsreba. I get ,ahtt btu ’mI ingvah btleuor rgfiugni out hcwih ocCnirama of eBrtsa ti .is m’I sktcu wenebte I,DSC dan Ieiavsvn tulcDa mncoaa.Cir I’m nleniag dsoatrw esvnIaiv luatcD ncaa,mriCo just csaubee s’ti 1() mots mmcoon nda 2)( hte mssa tihw giularrre nsragim in uercstls ssoudn ikel ti dclou eb altt‘lese aiirfoitnt,l’n eens ni Insvveia lacuDt acam.nroiC tuB Im’ not re.su anC aennoy ?ephl

liverdietrying  There is not enough information in the question stem to determine what kind of cancer it is. You would need a biopsy and histology information to determine that. However, this is definitely not DCIS since there *is* a mass. DCIS usually just shows up as small microcalcifications on XR (I’d google an image so you can see it). All the words they use here describe an invasive cancerous scary mass -- what kind of cancer can’t be known until they biopsy it! +2  


submitted by airhead5(2),
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eoDs nnyaeo know het sdesiea eyth era galkitn tbua?o I aws itnkihng pusul cwihh saekm seesn wiht het na,rwes btu i tanc’ idfn yntahgni on ariroten rhcmeba of eey dan dchioro esuxl.p

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +4  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1