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Welcome to maddy1994’s page.
Contributor score: 24


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 +0  (free120#20)
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tsesrs casesiern cihohlwi..srcot ceesaesrd -I2L vchnieetta,icy sciegernda 1Th tpidncuoor nad ftfesce pe.mhgaoascr





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hTe otqusine ysas ehyt 'tdno desropsn ot itadasnc HNTE sask ihwhc oyu ot difyntie hhicw drug si eth tsom cefveetfi at nsgsipueprs cdia o,rdctnopiu NTO ahtw eth tsmo eefefctvi dnaatic si. The wnesra is IPPs'.

I wlil ya,s ow,ervhe I saw golikno rof osgmetnih leik idoeto.cter

drdoom  lucid. nice catch. +1  
maddy1994  WHY not blockage of h2 receptors +3  
krewfoo99  @maddy1994. PPI are more effective than H2 blockers in suppression of gastric acid +1  


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ehT tmso ptmrtiona hntis to the sntiqueo aer as ,wlfloso wiht 2# enbig the tosm ecfi:icsp

)1 pnteita resotpr apni hiwt hevdaeor omtion adn toprres ernceutrr vaohedre timnoo urgnid .work rvehOead timnoo cna eamdag het nsupaassutrpi cmelus due to nipimnegmte yb eht oracimo.n

)2 ianP si twors wthi lanentir tnriooat of eth hursedlo - sith si oisscnttne hitw teh ndsigfni fo eth c-nmeyapt tste, ichhw eiinscatd a arusniaptsusp r.ijnuy

mousie  I was thinking along the lines of overhead motion - damage to the subacromial bursa which is between the acromion and the supraspinatus ... also its the most commonly injured rotator cuff m. so could have guessed this one right +1  
sympathetikey  Thanks for the explanation. I was scratching my head as to why this is correct, since supraspinatus only does 15 degrees of abduction, but you make a lot of sense. +1  
charcot_bouchard  IDK WTF i picked Trapezius +34  
ls3076  why would injury to supraspinatus cause weakness with internal rotation though? +6  
targetusmle  yeah coz of that i picked subscapularis +2  
maddy1994  ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis +3  
darthskywalker306  I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me. +1  
lowyield  saw someone post this on one of the other questions about shoulder... and it works pretty good for this https://www.amboss.com/us/knowledge/Soft_tissue_lesions_of_the_shoulder there's some videos in it, this specific one for the question is the neer test +  
psay1  FA2019 pg. 438 +1  


submitted by sajaqua1(524),
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HCM I tncfunio si gltriaen to craenc rpspi.esonsu CMH I payidssl egeusnoyonld sznysehited itnoesrp nda tsnpsere tmhe to 8DC+ T cesl.l hTe rfieual ot lpdaisy MCH ,I or MHC I iyadpls of es-olfnn a(nd yb xnnseoite ruosaec)nc iernopts ggrietrs a eullarcl iunmme reonse,sp gniedal to icruttsedon of eth lce.l

hTe pmaoeotres is eusd orf eht ieddnatraog of wnro t,uo tnce,snsee ro domlmrfae ntpreso.i sA aerccn s,peevdlo eorm otitsnuam dael to asneiredc ogrwn n.pirsote Olyn yb soxrieneps fo eth metsrpoaoe, ro sit p,viseeonor-exsr anc teseh attunm reptinso eb rdadgede tsfa nheguo to ont eb ddpsaiely by CMH I adn dale to the clle bgein lk.elid oetormizBb kbslco het preoaes,mot os eth atuntm pnorstie era alidspdey on het ac,eursf ioanwgll hte emnumi yssemt to zeoegricn nad likl tghaaploolic lscel.

catch-22  Another way to approach it is to think about MHC class I processing. Basically, if you inhibit the proteasome, peptides will not be generated and nothing is available to be loaded onto MHC I (remember MHC I has to be loaded before it's transported to the cell surface). Cells that don't express MHC I get killed by the natural killers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214736/ +25  
kai  "In conclusion, we have demonstrated that the proteasome inhibitor bortezomib down-regulates class I and enhances the sensitivity of myeloma to NK cell–mediated lysis" from the conclusion of the NIH paper +5  
maddy1994  another mechanism is by blocking proteosome u even decrease degration of proapoptotic proteins...so it enchances apoptosis(from uworld) +3  
azibird  But CD8+ and NK cells kill via perforin! Why is this answer wrong? Is it because it's not the primary effect? +2  
testready  "The proteasome is the major source of proteolytic activity involved in the generation of peptides for presentation by major histocompatibility complex class I molecules. We report the new observation that bortezomib down-regulates HLA class I on MM cells, resulting in increased NK cell–mediated lysis." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214736/ +  


submitted by welpdedelp(219),
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tI wsa eth olyn rppliehear gunl acncer, ist laos rome mcmono in .mneow tisesatsMa oldwu heva onwhs tllpimeu lnosesi

sympathetikey  Also, lung adenocarcinoma is the most common lung cancer overall, most common in women, and most common in non-smokers. I know she smoked in the past, but that's what tipped me off to it. +5  
alexb  Yeah I literally picked SCC bc I knew she'd smoked in the past smh +  
maddy1994  20 years of non smoking history ,she wouldnt be at elevated risk for smoking related carcinoma. +2  
larryd  According to FA19 p. 693, large cell carcinoma of the lung is also peripheral. +  


submitted by sam1(16),
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tahW taoub eth datlioiand fwol urhhtog eht uclimexfcr?

maddy1994  exactly man i got 4.5 and i thought he asked ventricle and left circumflex should be there so i put 5 ...glad someone thought like me.i was just cursing myself for over thinking. +10  
djtallahassee  Yea put 5 here too. they are essentially saying the myocardial oxygen supply to the left ventricle comes from the LAD. Not sure if true or not but figured that the LCX would at least contribute 20% of the blood +  
justherefortheyield  100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value. +  


submitted by welpdedelp(219),
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rath,mmosooHseci kaa zer"bno deis.a"bet Cotnna be nodidsA deu ot teh ieypygleamrch and olarnm PB

alexb  I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM. +2  
tinydoc  I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation. +11  
maddy1994  testicular atrophy &hepatomegaly helped me out to eliminate the options..when i was left with ferritin and saw pigmentation it clicked that it is hemochromatosis +3  
krewfoo99  Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis +3