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Welcome to lulumomovicky’s page.
Contributor score: 4


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 +0  visit this page (nbme22#19)
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Hypocalcemia can present with muscular twitching and spams, might cause tetany, and in severe cases lead to seizures like happened in this patient.

This question can be confusing mainly because whenever u think of seizure or neurologic manifestation, you think of Sodium, but the key here is the 1 MONTH history of episodes of pins-and-needles with involuntary contraction of muscles. Also you can rule out Potassium, because although it can cause muscle cramps, spasms and weakness, it leads to cardiac abnormalities (arrhythmias).

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 +0  visit this page (nbme20#46)
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Thymic output of T cell repertoire during the growing phases is vital, but it becomes unnecessary for repertoire maintenance during adulthood. This happens because the T cell regeneration in adulthood is almost entirely derived from homeostatic proliferation of the EXISTING T cell pool, which is sufficient to maintain a large compartment of naive CD4 T cells. Thymic T cell generation can add new naive T cells and enrich diversity, while homeostatic T cell proliferation can sustain the richness of the TCR repertoire already created. This means that the Thymic lymphocytes produced before thymectomy are long-lived naive T cells, which are maintained stable in quantity thanks to Homeostatic proliferation in adulthood.

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 +1  visit this page (nbme23#12)
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The key point was ''sphincteric incompetence''. Stimulation of B3 adrenoreceptors will work if it was overreactive bladder, where detrusor muscle is over activated. This patient's main problem was sphincteric incompetence, so relaxing the bladder wouldn't solve the problem. I think of it as if you should try to close the door, so there are two doors, internal (sympathetic) and external (somatic, pudendal). In stress incontinence, the external door is not working, probably due to pudendal nerve injury after vaginal delivery or obesity. So you should try to close the remaining door, the internal sphincter which contracts with Alpha 1 adrenergic stimulation.

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blue4415  wow ! exactly what I think ~ nice metaphor +




Subcomments ...

submitted by hayayah(1212), visit this page
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Pt. has Familial dyslipidemias. Type I—Hyperchylomicronemia.

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estefanyargueta  Lipoprotein lipase: degradation of TGs circulating in chylomicrons and VLDLs. +2
breis  FA 2019 pg 94 +4
lulumomovicky  Hyperchylomicronemia can be due to LPL or Apolipoprotein C-II deficiencies --> leading to high levels of QM, TG, and Cholesterol +


submitted by andremosq(9), visit this page
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Question asks about the cause of the enlargement of Lymph nodes .. Lymph node Paracortex enlarges in an extreme cellular immune response (paracortical hyperplasia) against virus infected cells (FA20.Pag 96.) T cells regulate cell- mediate immunity ... CD4 T cells specifically is the DIRECT Cell Immunne response. CD8 T cell is cytotoxic.

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lulumomovicky  THIS IS THE REAL EXPLANATION. Thanks +
realnorthomfs  Hear hear! FA2020 p96 +


submitted by sympathetikey(1600), visit this page
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As stated below, the Left crus cerebri was damaged (see what it should normally look like below). This contains the corticospinal tract. Since the corticospinal tract decusates at the medulla, below the midbrain section we're looking at, you would see Contralateral (Right) Spastic Hemiparesis

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hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +13
hello  @kernicterusthefrog Thank you. +
mbourne  NGL, I thought the right side had the pathology lmao ty +34
lulumomovicky  Damaged area is the cerebral peduncle, which contains the Corticospinal tract --> contralateral hemiparesis. You know this because the upper diamond shape is the cerebral Aqueduct, which indicates you that the slice give corresponds to the Mesencephalon --> where you know you can find Substantia nigra, just by the side of the CEREBRAL penduncles. Don't confuse with CEREBELLAR penducles, which you might see within the pons and the upper part of the medulla oblongata. If these are damaged --> dysmetria, ataxia, dysarthria, etc. +


submitted by lulumomovicky(4), visit this page
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Thymic output of T cell repertoire during the growing phases is vital, but it becomes unnecessary for repertoire maintenance during adulthood. This happens because the T cell regeneration in adulthood is almost entirely derived from homeostatic proliferation of the EXISTING T cell pool, which is sufficient to maintain a large compartment of naive CD4 T cells. Thymic T cell generation can add new naive T cells and enrich diversity, while homeostatic T cell proliferation can sustain the richness of the TCR repertoire already created. This means that the Thymic lymphocytes produced before thymectomy are long-lived naive T cells, which are maintained stable in quantity thanks to Homeostatic proliferation in adulthood.

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submitted by sympathetikey(1600), visit this page
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That's a new one....

https://en.wikipedia.org/wiki/Accessory_spleen

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sympathetikey  Makes total sense looking back. Just didn't know that was a thing :) +38
sugaplum  Fun fact: Meredith from Grey's anatomy got her idea for Mini livers from a patient who presented with an accessory spleen.... and who said watching TV doesn't count as studying +28
123ojm  have gotten at least 10+ NBME or Uworld questions correct because of grey's anatomy +3
rongloz  LOL got this right because of Grey's anatomy too +
chediakhigashi  ...today years old +1
lulumomovicky  I literally picked accessory spleens because in remembered Meredith did her mini liver lol +


submitted by brainchild(3), visit this page
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For all the ~math~ people out here:

CI = mean + Z(SE)

For a 95% CI, Z = 1.96. For a 99% CI, Z = 2.58.

The CI is +3/-3 from the mean, so 3 = 1.96(SE) with the 95% CI. Solve for SE (which doesn't change if you change the CI), which comes out to about 1.53.

Now switch up the Z value for the 99% CI, with the SE you just calculated. CI = 2.58 * 1.53 = 3.95. Add this to both sides of the mean (113), and you get the answer!

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lulumomovicky  I did exactly the sameeee +


submitted by weirdmed51(30), visit this page
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Phenotype- male; genotype- female

I could think 2 causes 1. Placental aromatase defc 2. CAH (21 OH defc)

1 isn’t an option.

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lulumomovicky  I thought the same ! And also, if 1 was an option, they could've mentioned that the mom got hirsutism or other changes due to elevated androgens during the pregnancy. +


submitted by jgraham3(30), visit this page
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https://slideplayer.com/slide/5957557/

The first slide

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lulumomovicky  This one was the most useful site ! I finally understood the point of choosing ITT ! Thank youuuu +


submitted by nwinkelmann(366), visit this page
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I literally just realized why this question confused me so much (and I've tried to figure it out a couple of times, lol). I let the colloquial definition of bulimia (i.e. vomiting) stick in my mind, that I forgot the actual medical definition = normal BMI (>18) + binge eating and purging (where purging could be induced vomiting or diuretic use or laxative use or/and excessive exercise). So really, what this question was asking is simply what is the electrolyte balance of excessive diarrhea? GEEZ! I made it so much harder in my head when trying to answer it originally.

Diarrhea causes non-anion gap (i.e. hyperchloremic) metabolic acidosis. Stool predominantly contains HCO3- and K+, so excessive diarrhea = excessive loss of HCO3- and K+. Chloride levels in the serum will be increased due to the normal HCO3-/Cl- equilibrium, so as negative charge dissipates due to loss of HCO3-, Cl- will increase correcting the anion-gap.

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drdoom  Bulimia comes from Greek "ravenous hunger"; the term is a literal concatenation of the words for ox (bous) + hunger (limos). So, in Greek, bou-limia is literally "ox hunger", which is a nod to how the word is used in medicine = perpetual and insatiable appetite for food (the very "opposite" of vomiting). +5
abhishek021196  I agree with your reasoning but the classic case description of Bulima lists electrolyte disturbance of HypOkalemia, HypOchloremia, and Metabolic Alkalosis, along with other things like parotid hypertrophy and dorsal hand calluses due to the induced vomiting. I tripped up there. :/ FA 20 Pg 567 +
llamastep1  Take home lesson: reasoning > memorizing +3
lulumomovicky  I thought more of it by the following: the patient loses HCO3 in the stools and this diarrhea causes the Metabolic acidosis. Because normal HCO3/Cl equilibrium should be maintained, chloride levels in serum go up to compensate the loss of Bicarb. As the patient is also HYPOVOLEMIC due to BP of 89/61, then RAAS activates. Aldosterone will increase Na and water reabsorption to keep volemia and K will be excreted (hypokalemia). Also H-ATPase in the intercalated cells of the collecting duct will be activated by aldosterone, further propagating the metabolic acidosis. +1


submitted by sympathetikey(1600), visit this page
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Biggest clue was that there was no time frame given. Therefore, this seems to be a "slice in time" study, which lines up with cross sectional study.

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paulkarr  Damn, epi at it again... +5
lulumomovicky  Also when they mention ''the main outcome measure is hypertension control defined as most recent blood pressure reading less than 149/90'' = which means they will measure BP from a RECENT reading : a one time measurement +1


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