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Contributor score: 93
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Comments ...

 +1  (nbme22#12)

Think ex vauco for = fake IE: The ventricles appear to be big but in reality it just looks a lot bigger because its being compared against a atrophic brain from something like (Alzheimers, advanced HIV, Pick disease, Huntingtons).

Communicating hydrocephalus is due to decreased CSF absorption by arachnoid granulations which causes ICP --> papilledema and herniation.

Normal pressure hydrocephalus affects the elderly and causes "Wet, wobby, wacky"


 +0  (nbme21#30)

Going over the other answer choices:

  • ApoC2 defect as already explained in the other comments is Type 1 hyperchylonmicronemia with increased TG and chylomicrons, creamy layer in the supernatant, and is associated with pancreatitis and eruptive xanthomas.

  • LDL receptors are defective in Type 2 which is associated with a MI before age  29 20, accelerated atherosclerosis and increased LDL levels.

  • Someone with a pancreatic lipase defect will probably have pancreatitis and have increased triglycerides in their stool because pancreatic lipase can break down the TG into FFA.

UW has a question on the familial dyslipidemia III which is a defective ApoE. ApoE is what mediates chylomicron remnant uptake into the liver and so if its defective the liver cant efficiently remove chylomicrons and VLDL from the circulation. You get an increase in those things causing premature atherosclerosis, palmar xanthomas.

this stuff is hard

madojo  typo per FA age 20* swy

 +7  (nbme21#28)
  • CholecystokinIn is secreted from the I cells of the duodenum and jejunum.
  • Gastrin is released from the G cells of the antrum of the stomach.
  • IF is secreted by the stomach and absorbed in the terminal ileum with B12.
  • Pepsin is secreted from the chief cells of the stomach and plays a role in protein digestion.
  • Secretion of VIP increases intestinal water and electrolyte secretion by acting on the parasympathetic ganglia
nobody  PAGE 365 FA 2019

 +4  (nbme21#35)

Going over other answers:

  • Abacavir is a NRTI so all of this inhibit nucleotide binding to RT and terminate the DNA chain. It doesnt end in the typical -vudine that we are used to for NRTI's but I guess we should keep it in mind because its contraindicated in patients with HLA B5701 mutation due to an increased risk in hypersensitivity. *Sketchy remember the Wizard aba cadabra guy with his spell book opened to HLAB5701 and associated skin rash on the wizards arm

  • Acyclovir is a guanosine analog that is monophosphorylated by thymidine kinase that inhibits viral DNA polymerase onces its incorporated into the replicating chain and terminates dNA. Its for HSV or VSV which doesn't fit in this question. Remember crystalline nephropathy and need for IV fluids with this one.

  • Didanosine is a NRTI as already mentioned that now we know causes pancreatitis.

  • Lamivudine is also a NRTI, Zidovudine also NRTI that causes anemia and can be used during pregnancy to decrease the risk of fetal transmission.

  • Ribavirin is an IMP inhibitor used in Hep C and inhibits purine synthesis. Side effects: causes hemolytic anemia and is a severe teratogen.


 +3  (nbme21#21)

Going over the other answer choices:

  • Blocking ATP sensitive potassium channels in the pancreatic beta cells to increase insulin secretion would be drugs like Sulfonylureas or Meglitinides for example like Glyburide.

  • Increasing endogenous GLP1 or GIP levels are drugs like Sitagliptan and Saxagliptan. They have GLP in them

  • Increasing peripheral glucose uptake would be the biguanides like metformin.

  • Stimulating transcription regulator PPAR-gamma decreases insulin resistance and is the MOA of thiazolidenediones like Pioglitazone.


 +17  (nbme21#39)

Know your STD's baby ;-) (going through every other choice on this question):

  • Bacterial vaginosis caused by gardnerella vaginallis. Se a thin, off white discharge and fishy smell (fish in the garden). There's no inflammation Lab findings: pH greater than 4.5 (just like trichomoniasis), and a positive whiff test with KOH. Stem will say something about malodorous discharge and show the infamous CLUE CELLS if we are lucky. Not the answer for this question obviously because we would not expect vesicles with this bacterial disease.

  • Candidiasis is going to be your thick cottage cheese discharge, with inflammation. normal pH see pseudohyphae. Treat with topical nystatin, or oral fluconazole unless you're pregnant than use Clotrimazole. Again not going to see any vesicles.

  • Chancroid per uworld is associated with Haemophilus ducreyi you will have a Deep purulent painful ulcer with suppurative lymphadenitis. Will be told that patient has painful inguinal nodes, there may be multiple deep ulcers with gray-yellow exudate. You do cry with H. duCRYi This wouldn't be true for what our patient has in this question because we aren't told of any inguinal adenopathy. a link to a chancroid VDA

  • Chlamydia trachomatis causes lymphogranuloma venereum which is small shallow ulcers, painless, but then the large painful coalesced inguinal lymph nodes aka BUBOES. Compared with gonnorhea the discharge is more thinner and watery. Again not the case here as its painful and no mention of any BUBOOESS. The discharge in gonorrhea is more thicker. Both lead to PID, treat for both because confection is common. With both patient may have some sort of pain or burning sensation upon urination. Sterile pyuria though for both.

  • Condyloma accuminatum is a manifestation of HPV 6 + 11 (genital warts). They look like big cauliflowers. This is in contrast to Condyloma lata that you see in syphillis which is just a flatter latte brown looking macule.

  • Genital Herpes (the answer to the question) will present with multiple painful superficial vesicles or ulcerations with constitutional symptoms (fever, malaise) Just fits better than all the other choices I ran through.

  • Syphillis is the painless chancre. UW describes it as a single, indurated well circumscribed ulcer, with a clean base. See corkscrew organisms on DF microscopy. Keep in mind other painless ulcers are lymphogranuloma venereum of clamydia (but the buboes are whats painful not the ulcer), and granuloma inguinale (donovanosis - klebsiella granulomatis) but whats hallmark about this one is that its painless without lymphadenopathy

In short, be safe.

drdoom  this write-up is AWESOME ... but it also made me vomit.
b1ackcoffee  This is awesome, writeup, not the stds.

 +5  (nbme24#44)

Going over other answers:

Alteration in 30S ribsomal RNA refers to aminoglycosides, tetracyclines, glycylcylines Alternation in RNA polymerase refers to drug like Rifampin Alterations in penicillin binding proteins would be for penicillinases


 +1  (nbme24#41)

Going through other answer choices:

Bismuth and Sucralfate is used for ulcer healing or travelers diarrhea, it provides physical protection by binding to the ucler base and allows bicarb secretion to establish pH gradient in mucous layer.

FamotiDINE is a H2 receptor blocker

Omeprazole is a PPI and increases risk of C diff infxn, and decreases Mg and Ca absorption (can cause fx in elderly)


 +1  (nbme24#34)

-Adenosine decreases AV node conduction used in SVT, and its side effects include flushing, hypotension, chest pain, impending doom. -Flecainide is a Sodium channel blocker Class 1C with strong Na channel blockage and its contraindicated in structural and ischemic heart disease. -Phenytoin is an anti epileptic, associated with teratogenicity, p450 induction, osteopenia


 +4  (nbme24#7)

This is transitional cell carcinoma aka urothelial carcinoma which is the most common urinary tract system tumor. On histo you expect to see fibrovascular core in a papillary tumor and dysplastic urothelium. It occurs with painless hematuria with no casts.

Predisposing risk factors: Pee Sac Phenacetin (NSAID), smoking, aniline dyes, and cyclophosphamide (alkylating agent that cross links DNA).

Vinyl chloride is incorrect because thats associated with angiosarcoma of the liver, because vinyl chloride is whats in PVC pipes (plumber). Schistosoma is a trematode fluke that is associated with squamous cell carcinoma of the bladder in which you would also see painless bleeding but see squamos cell and not really the papillary growth we see here.


 +3  (nbme24#7)

FA 19 256

Does the drug SWIM? Phase 1 - small number of volunteers assess for Safety Phase 2 - moderate number of patients, does it Work Phase 3 - large number random assignment, with placebo, any Improvement? Phase 4 - hit the market, any unexpected side effects, can be withdrawn from Market

kpjk  just would like to make a small correction phase 3- not placebo, but a drug already present in market so to test if there is improvement over standard care phase 2- would have the placebo, to see if the drug is actually working thats why i got confused in this question couldnt phase 2 also have randomized,prospective double blinded study
kpjk  Sorry! Just saw FA- it says even placebo can be used in phase 3
llamastep1  Ugh I over thought it, I figured if you wanna give your patient a new treatment you wouldn't send her to possibly receive PLACEBO, am I the only who thought this?
turtlepenlight  for the vast majority of drugs, the FDA / NIH don't allow placebo testing anymore (regardless of FA!)

 +1  (nbme24#9)

Pathoma

Lung metastasis is the more common than a primary lung cancer and its most common source is breast or colon carcinoma. You will see canon ball nodules on imaging. Seperated by space nodules. Search canon ball nodules gross looks similar to this image.

Carcinoid tumor is the most common primary lung tumor in CHILDREN. Could be a central or peripheral tumor but i think they would show a polyp like mass in the bronchus for carcinoid. https://www.webpathology.com/slides-13/slides/Lung_Neoplastic_Carcinoid_Gross1.jpg

Malignant mesothelioma some sort of asbestos exposure with the tumor encasing the lung like the other photo posted on the comments.

Pulmonary hamartoma umm well there's two of them in this photo, a hamartoma is usually just a single nodule.

Small cell carcinoma would be more centrally located not peripheral.


 -1  (nbme24#25)

https://www.sketchymedical.com/products/catalog

CORONAVIRUS SKETCHY

positive sense RNA virus, sun crown corona king wearing robe - encapsulated helical virus - spiraling road, helical trees sneezing and blowing king - common cold with bronchiol tree on king pointing to SARS and middle east respiratory syndrome (acute bronchitis)

This virus replicates in the cytoplasm thats why King is outside his castle (nucleus)


 +4  (nbme24#29)

A key property of partial agonists is that they display both agonistic and antagonistic effects. In the presence of a full agonist , a partial agonist will act as an antagonist, competing with the full agonist for the same receptor and thereby reducing the ability of the full agonist to produce its maximum effect. Ex. Morphine (full agonist) vs buprenorphine (partial agonist) at opioid mu receptors 234 FA 19


 +2  (nbme24#41)

The main ingested seafood toxins we should know (246 Fa2019)

Histamine, Tetrodotoxin, and Ciguatoxin. Histamine - spoiled dark meat (tuna, mahi mahi) causes like an anaphylactic reaction because the bacterial toxin converts histidine --> histamine. Tetrodoxin - seen in this Q, pufferfish - blocks Na channels NO depolarization Ciguatoxin - reef fish barracuda - opens Na channels so CONTINUAL depolarization

For last 2 no cure, supportive only


 +0  (nbme24#18)

The Km is inversely related to the affinity of the enzyme for its substrate so in this case we want to increase Km so that the affinity of hepatic alcohol dehydrogenase decreases for methanol and the ethanol can then act as a competitive inhibitor by overcoming the concentration of methanol thus preventing toxicity.


 +3  (nbme24#30)

Ugh when you do it in uworld, write it down but still miss it.

Anyway going over other answers (pathoma): Fibrocystic changes of the breast --> benign, usually no discharge with this and you will usually have a lumpy breast or something palpable and it is hormone mediated. Pagets disease of the breast --> extension of ductal carcinoma in situ to lactiferous ducts and skin of nipple producing rash, so you see skin changes. No skin changes mentionedh ere. Prolactinoma --> gallactorhea not blood tinged

So per UW intraductal papilloma is a proliferation of papillary cels in a cyst wall or duct that may cause focal atypia - IT IS THE MOST COMMON CAUSE OF BLOODY NIPPLE DISCHARGE AND BREASTS WITHOUT BREAST MASS OR SKIN CHANGES

compare this to papillary carcinoma where you also have nipple discharge but you would see it in a post menopausal women.

drpatinoire  Upvote it wishing I could memorize it lol

 +4  (nbme24#2)

I don't know if this was the right way i thought about it but i remembered C.H.A.L.K the things that cause vasodilation in skeletal muscle

C - Co2, H - H+, A- adenosine, L - lactate K- K+

drdoom  This is great; these are all proxies of catabolism, i.e., "net" ATP consumption! (ATP->ADP)
drdoom  Potassium might be the one that doesn't seem to fit but recall that cells have an H+/K+ antiporter: cells can act as a "sink" for high blood H+; they "take up" H+ (from blood, into cell) but "in exchange" they have to put out a K+ (to maintain a normal electro-gradient). So, as blood acid starts to creep up, cells actually "attempt" to bring it back to equilibrium by sucking up H+ (and putting out K+, which, as you surely recall ;), is the predominant cation within cells).
misterdoctor69  @drdoom, would you also venture to say that there is increased Na+/K+ ATPase activity in an increased metabolic state which might also contribute to greater K+ efflux into the blood?

 +0  (nbme24#45)

Going over other choices (FA 19 514): Oligodendrocytes are part of the CNS so a tumor there would be an oligodendroglioma which is relatively rare, and in frontal lobes. On histology you would see fried egg appearance with chicken wire capillaries. Glioblast tumor would be a glioblastoma multiforme which is common and has a 1 year survival, its the one with the butterfly glioma crossing the corpus callosum.


 +2  (nbme24#9)

SKETCHY https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjQy9nft4fmAhUiCTQIHXh6BZEQjRx6BAgBEAQ&url=https%3A%2F%2Fquizlet.com%2F348275903%2F52-tissue-nematodes-dracunculus-medinensis-wuchereria-bancrofti-onchocerca-volvulus-toxocara-canis-loa-loa-flash-cards%2F&psig=AOvVaw2G9ehu-3FpT74t1v5_W2Ut&ust=1574842527097175

FLY GUY IN THE BACK Stains on the lab coat and pants --> black fly bites human host and the larvae burrow down into the host and make microfiliarial that come back out making hyper and hypopigmented spots. Human hand covering eyes --> causes river blindness Stray pink granules --> eosinophilia Microscope --> microfilaria on skin biopsy under microscope No dumping drains to river - Ivermectin for treatment


 +0  (nbme24#5)

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi_15-2tYfmAhXEGDQIHUx4D1MQjRx6BAgBEAQ&url=https%3A%2F%2Fquizlet.com%2F355174098%2Fsketchy-micro-super-worms-enterobius-vermicularis-ancylostoma-duodenale-necator-americanus-ascaris-lumbricoides-strongyloides-stercoralis-trichinella-spiralis-intestinal-nematodes-diagram%2F&psig=AOvVaw0NZl1rWBeFkgoYNiM5nwJb&ust=1574841902769110

SKETCHY trichenlla spiralis pig (can be polar bear too) * round glasses --> perio orbital edema sweating and green vomit round things on walls ==> forms cysts in striated muscle (so for this question makes sense that you do muscle biopsy) fire --> inflammation of muscle eosinophil granules --> non specific as you can see its all over this image so its for many different types of nematodes


 +4  (nbme24#31)

IL-3 (not an answer choice) also functions like GCSF supporting growth and differentiation of bone marrow stem cells.


 +3  (nbme24#38)

Alprazolam is a benzodiazepine whose MOA is to facilitate GABAa action by increasing Cl- channel opening, this would be more for anxiety than the depression presented. Amitriptyline is a TCA that inhibits serotonin and NE reuptake and is not indicated for those over 65 (Beers). Buspirone is for generalized anxiety disorder and stimulates serotonin receptors, again this patient has depression. Carbamazepine is an anti epileptic drug that blocks Na channels and is first line for trigeminal neuralgia. Haloperidol is typical antipsychotic that blocks D2 receptors and should not be given to 65+ (De beers plus why would we want to give him extrapyramidal symptoms). Methylphenidate is a stimulant used in ADHD. Finally paroxetine is a SSRI that inhibits serotonin reuptake. It is first line for major depressive disorder and has fewer side effects than TCA.


 +1  (nbme24#19)

The answer is not B because with interstitial fibrosis you have a decrease in the diffusing capacity because of the thickened alveolar membrane. The answer is not FRC because that will decrease in a restrictive lung disease such as fibrosis. FVC, RV, and TV are all expected to decrease.


 +9  (nbme24#9)

Another way to think about this is whats the closes stage to mitosis because right before M (mitosis) you need to have mitotic cyclins synthesized, and that would be G2

G1 --> S --> G2 --> M


 +8  (nbme24#15)

The two main types of radiation type are ionizing and nonionizing.

The ionizing would be the radiotherapy and non-iodizing is from the sun.

Ionizing = free radical formation non ionizing (UVB) = DNA damage by formation of pyrimidine dimers


 +1  (nbme24#28)

Sketchy Micro coming through with the Paramyxovirus family and the night scene.


 +1  (nbme24#4)

A is oculomotor Theres 4 cranial nerves that are medial (3, 4, 6, 12) So C is abducens B is big fat one so trigeminal I think D is 8, and E is 9 so Vestibulocochlear and Glossopharyngeal I guess F is vagus....


 +2  (nbme24#46)

Cyclosporin is an immunosuppressant that blocks T cell activation by inhibiting IL-2, so we know thats not right. Cyclophosphamide is an alkylating agent. Doxorubicin is an antitumor antibiotic that generates free radicals and causes breaks in DNA. 5'fluorouracil is associate with pyrimidine synthesis. Leaving Vincristine which is a neoplastic drug that works on microtubules (other drugs that do this colchicine, paclitaxel.

As mentioned already, the cell is stuck in metaphase and cannot undergo the seperation anaphase. M cycle arrest is associated with vincristine and which the mitotic spindle which is what separates the chromosomes is not forming.

suckitnbme  The funny thing is that the image seems to show that the spindle did in fact form.

 +1  (nbme24#39)

The answer is not osteoclast activity because that would be referring to osteopetrosis in which there is a defect in osteoclast activity and you have thick dense bones that fracture easily. Improper osteoclast activity could also refer to Pagets disease of the bone aka Osteitis deformans but I don't think that would present this young and would be more associated with bone remodeling problems and an increase in hat size, etc.

The head size isn't increased it just looks like a large head in comparison to the dwarfism because achondroplasia doesn't affect membranous bones of the head. Increased growth hormone synthesis would be acromegaly I think but that is seen in adults. Low nasal bridge = saddle nose.

TMI but in FA there's something called Laron syndrome which is AR, and a defective GH receptor so you have increased GH and would also see dwarfism and a saddle nose and prominent forehead but a small head circumference.





Subcomments ...

submitted by burak(32),

Pleural space: Midcavicular line: 6-8th ribs Midaxillary line: 8-10th ribs Paravertebral line: 10-12nd ribs

So physician must insert a needle in 8-10th ribs in midaxillary line; but insertion below the 9th rib still has a risk to damage abdominal organs such as liver. Upper border of 9th rib is fine.

Uw question ID: 844

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +12  
burak  thanks! +  
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +2  
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +  


submitted by madojo(93),

Going over the other answer choices:

  • ApoC2 defect as already explained in the other comments is Type 1 hyperchylonmicronemia with increased TG and chylomicrons, creamy layer in the supernatant, and is associated with pancreatitis and eruptive xanthomas.

  • LDL receptors are defective in Type 2 which is associated with a MI before age  29 20, accelerated atherosclerosis and increased LDL levels.

  • Someone with a pancreatic lipase defect will probably have pancreatitis and have increased triglycerides in their stool because pancreatic lipase can break down the TG into FFA.

UW has a question on the familial dyslipidemia III which is a defective ApoE. ApoE is what mediates chylomicron remnant uptake into the liver and so if its defective the liver cant efficiently remove chylomicrons and VLDL from the circulation. You get an increase in those things causing premature atherosclerosis, palmar xanthomas.

this stuff is hard

madojo  typo per FA age 20* swy +  


submitted by pparalpha(66),

The inguinal part of the question points you to a a femoral hernia

Femoral hernia: uncommon type of inguinal hernia, in which intra-abdominal contents (in this case the small bowel) herniate into the femoral canal through the femoral ring

The image: strangulation: ischemic necrosis of contents within the hernia sac as blood flow is compromised due to incarceration (irreducible femoral hernia due to trapped hernia contents in hernia sac)

So, in short: femoral hernia can lead to a complication called incarceration which can lead to strangulation

madojo  Femoral hernia's are more common in women, i don't think this was a femoral hernia, either way any type of hernia can under strangulation. +  


submitted by mcl(453),

While antihistamines with action at H1 receptors are used for allergies, H2 antihistamines are typically used for ulcers. Therefore the best answer is stabilization of mast cell membranes. These drugs (cromolyn) prevent vesicles of histamine from fusing with the membrane.

madojo  Take H2 before you dine, remember H2 blockers for GERD +  


what I got from this question: NEVER (99% of the time) refer a patient to see anyone

usmlecrashersssss  hopefully we are not going to get remaining 1% question on real exam +  
madojo  I was convinced this one was the exception, but guess not, NEVER REFER! +  


submitted by aesalmon(65),

Can anyone explain why this is not a pituitary adenoma? Is it just a lack of other symptoms?

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +10  
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1  
teepot123  fa '19 pg 516 +  


submitted by aesalmon(65),

Can anyone explain why this is not a pituitary adenoma? Is it just a lack of other symptoms?

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +10  
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1  
teepot123  fa '19 pg 516 +  


submitted by hello(184),

can someone please explain this?

thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC). +2  
madojo  Meniere's disease is sensorineural hearing loss with peripheral vertigo due to increased endolymph within the ear. +  


Allodynia is central pain sensitization. Triggering of pain by a non painful stimuli. Also seen in Fibromyalgia. [vs Hyperalgesia : Inc response to painful stimuli]

Its a positive (i.e Actively feeling, not lack of feeling) symptpms. so B & C is not the answer. D isnt answer either. as vanilloid receptor (TRPV1) is also afferent nociceptive transmission (modulated by capsaicin). Activation is soon followed by desensitization.

A - IDK. if problem was in DRG there would be lot more symptoms.

madojo  if you are an idiot like me than that long word in option b is GABA +  


submitted by famylife(61),

Phase III Clinical Trial (per FA 2019, p. 256): Large number of patients randomly assigned either to the treatment under investigation or to the standard of care (or placebo).

usmile1  also just to verify, there is no such thing as phase 0 right? +  
madojo  Not that i know of or is in FA +  
llamastep1  I've heard animal testing is called phase 0. +  


submitted by neonem(451),

Cerebellopontine angle mass = Vestibular schwannoma (AKA acoustic neuroma). Derived from Schwann cells, which are of neural crest origin.

yotsubato  Ugh. Of course they dont put schwann cells as a choice. So I pick oligodendrocytes like a dumbass +22  
subclaviansteele  Same^ +1  
madojo  Schwann cells = PNS Oligodendrocytes = CNS +1  
suckitnbme  NBME loves their neural crest cells +3  


submitted by krewfoo99(58),

NRTI - Bone marrow supression, Lactic Acidosis, Anaemia NNRTI - Hepatotoxicity, rash Integrase inhibitor (tegras) - Myopathy (causing Increased Creatinine Kinase) Protease Inhibitors (navir) - Lipodystrophy, Hyperlycemia, GI intolerance (think of hormonal effecs)

madojo  building off on this... answer choice A would be something like Maraviroc, and B is basically the same thing as A because a fusion inhibitor would be something like Maraviroc where you don't have any interaction with CCR5 and gp120. +  


submitted by majic(5),

THE MOST COMMON route of Toxo transmission in adults in the USA is ingestion of undercooked pork. Even if cat litter is an option, undercooked pork is still more common.

yotsubato  Also another fun fact. Most people in France are infected by Toxo (like 80%) because of how they eat meat. (Very rare) +1  
madojo  To add on might be TMI but most people have Toxo but are asymptomatic because its in its latent form as a pseudocyst and its not untill you are immunocompromised that it strikes +  
suckitnbme  This patient also probably got toxo in Brazil +  
luciana  JFYI people in Brazil love to eat rare meat at barbecues +  


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