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 +0  (nbme20#10)

FA19, pg 69 - perifollicular and subperiosteal hemorrhages, pg 674 specifically lists mucosal bleeding





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submitted by lamhtu(55),

Stem should maybe say some lesions are lytic and some are sclerotic. Breast mets to bone is mixed type according to FA? If you go off the mets being purely lytic, one could think thyroid carcinoma is the correct primary tumor.

lae  thats also what I thought +1  
pg32  Yeah I didn't pick breast for the same reason. Then I didn't pick thyroid because I doubt serologic studies would be normal in thyroid cancer (if you check T3/T4 and TSH). So I went with avascular necrosis -_- +  
lynn  in the FA index, the only things listed under lytic bone lesions are adult T cell lymphoma, langerhan histiocytosis, and multiple myeloma. Obviously there's more than that but those might be the main ones we need to know. You could also say that a giant cell tumor is also technically lytic, considering they describe it as "osteoclastoma." Idk. I thyroid but looking at FA, none of the thyroid carcinomas describe metastatic lytic lesions. Medullary carcinoma might be the one to confuse you, but it secretes calcitonin which inhibits osteoclasts, so it shouldn't cause resorp or lytic lesions. Right?? +  


submitted by radion(9),

Hypercarbia causes cerebral vasodilation. If you have ever seen an intra- or acute post-op neurosurgical patient, or really any patient about to herniate, you can remember this because they will be hyperventilated to pCO2 around 25-30 to decrease ICP via cerebral vasoconstriction; in this case, we have the opposite. The curve of pCO2 vs cerebral blood flow is quite steep in the physiologic range meaning small changes in ventilation make a significant difference in CBF.

smc213  FA 2018 p.486 +3  
lynn  2019 - pg 489 +  


submitted by hayayah(599),

Earliest detectable secondary sexual characteristic is breast bud development in girls, testicular enlargement in boys.

pg32  How did you know this? The Tanner stages in FA simply list pubarche and breast buds developing in the same stage without stating which comes first. Thanks! +  
lynn  @pg32 look at the paragraph above the diagram, it says that exactly. Took me a minute too lol +1  


submitted by alexb(31),

I confused myelodysplastic syndrome with primary myelofibrosis because I thought 2-3 of those RBCs looked like teardrop cells. Just like when they show an image for bullous pemphigoid and there's some weird second rip through the dermal/subdermal layer making me think it's not BP even though I don't know what else it would be. fml

whoissaad  Made the same mistake +3  
targetusmle  i thought exactly the same!! 2 cells looked like tear drop cells :/ +2  
ilovemypuppies2295  I thought there were tear drop cells too. Seemed like it should be a metaplasia then. Oh well +  
lynn  I did the same, but looking at FA19 pg 423 it says "ineffective hematopoiesis --> defects in cell maturation of nonlymphoid lineage." You can get bilobed neutrophils, or if it progressed to AML you'd see auer rods. Nothing about tear drop cells. Then on pg 406 tear drop cells would be seen in myelofibrosis, and possibly thalassemias +  


submitted by sugaplum(122),

These always tripped me up:
+ Polydipsia= responds to water deprivation, low serum Na
+ Central= responds to vasopressin, high serum Na
+Nephrogenic = responds to nothing, normal serum Na

lynn  I think serum Na+ only depends on the patient's access to water. FA19 pg 344 says serum osm is high in both and doesn't mention Na specifically. Spent a while double checking for DI, but low serum Na for polydipsia is definitely correct. +  
drzed  In general, SIADH or polydipsia will cause HYPOnatremia, and DI (central or nephrogenic) will cause HYPERnatremia, but in the latter--as you stated--water access change the serum Na. +