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Welcome to masonkingcobra’s page.
Contributor score: 346


Comments ...

 +0  (familymed1#33)
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oN oen eerv dsoe hsti aayss it :mssee

oDtpTU:ae ,oreewvH cioolsger tsset ureqeri vnaoladiti at eht oallc ll,eev hciwh is cpcatlmriia ni rotieun .ctaicper nI tdidnia,o recncson ovre its yacccrau vaeh tmleidi sti se.u

The arue heabrt ttes si fitrs lnie


 +0  (familymed1#32)
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assp-otikemrhen/rsdvctimieiee/nv-/ld/eva-it.nic-ilc/pr:rdgdcmesearsng


 +5  (nbme24#19)
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llA ouatb tsitngi:h

oith/u/ed:fhoofdnstnhpieds/ao/ejaisbcas.entm/s/tettcrucnec.lne.swgo

charcot_bouchard  When i faced this ques i did some Kegel. Felt something in my pee pee but not in my b*e. I exclude all option because they are bigger muscle of pelvic floor except EUS & IAS. And also remeber Kegel can be used as a treatment of prem. ejaculation not premature defication. +17
paperbackwriter  @charcot_bouchard Actually Kegels are used in the treatment of fecal incontinence as well because of effect on EXTERNAL anal sphincter and surrounding muscles which are under voluntary control (you can most definitely feel it if you do a kegel lol). The answer is internal anal sphincter because internal is not under voluntary control (tonically contracted via symp. --> parasymp. relaxes it --> gotta go feeling --> no incontinence because of external sphincter's voluntary contraction). +10
am4140  @paperbackwriter - Honestly, this depends on how you do the kegel. It is entirely possible to not involve your external anal sphincter at all once you figure out how to isolate your vaginal area. So the internal anal sphincter is under involuntary control so that was especially right, but I was prepared to pick anything with “anal” in it at all. So kegels work for fecal incontinence only if you’re choosing to involve your external anal sphincter, or you don’t know how or are too inexperienced to isolate the muscles around your vagina. I don’t think NBME or USMLE would get this tricky because the external anal sphincter will not always be involved in kegels. +1

 +5  (nbme23#33)
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.twetahre/lltrdvth.cms/a:dephelhini.htcaakbi/h_.nru

ayEs isepuctr to dnueasdrtn


 +8  (nbme23#39)
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In itaodidn to eth siopuerv taxie:lnnopa

hSe is orni tcnedifei and ecaicl tfaecsf het ixmplaro undeoum.d "I kFdecu tytn"Brai = onIr, atl,eoF B12 for en,oDmuud muJneuj nda leIum

krewfoo99  Great analogy lol. But just a correction, First Aid states that Celiac Disease affects distal duodenum and proximal jejunum. But you are right, it would still cause iron deficiency anemia as it affects the duodenum. +3
fexx  OR you could just remember 'Iron Fist Bro' (F includes folate and fat, B includes B12 and bile salts) +5

 +0  (nbme23#28)
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Pnarlyleos my euiss thwi siht qnituose is ahtt I houtgh 2B1 sucesa oeeniliynamtd in hobt eth LTCS nad eth DLMC ()DCS ubt thye aer tgnitse teh manecmshi here relaly wiht het eowlh chaoitmmelyn cadi bit and hte daiiremp yilnme sihstnyes

fI eu'ory rcusuio

s6cewa.stnwmur/:0ait/.c/tnesc6hdtpcsrwol12a/


 +0  (nbme21#5)
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kniL

necrotizingfasciitis  Going off of the comments people have posted above & kinda bringing things together: PDA flows from aorta to pulmonary arteries, which reverses after birth. This means de-oxygenated blood flow from the pulmonary arteries to the aorta & less volume being sent to the LF side of the heart. This results in a decreased afterload because there is less blood flowing from the lungs to re-fill the LF ventricle, & the heart is still pumping with the same force as before, so the same volume of blood is leaving, but less in entering the LF side of the heart. From here, you use CO = SV x HR SV = preload - afterload (which is decreased due to the PDA) This results in SV being larger than normal, so when you plug that into CO = SV x HR you get a higher number for cardiac output. +
didelphus  The ductus arteriosus flows from PA --> aorta in utero to bypass the lungs, which have extremely high resistance to flow. This reverses after birth due to a drop in PGE2 (which was supplied by the placenta) and increase in left-sided systemic resistance. So a PDA typically flows aorta --> PA (assuming there are no other defects). +

 -1  (nbme20#8)
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bonb'sRi: heT wto toms anipomtrt suseac of ticrao nuassyerm ear hsioserrteacols and rntenhp.yeios Aecooshslrrstie si eth remo omnaindt rcfato in anlboamid crtoia mreuysasn, wielh eenpihynsotr si toscidesaa twih andincesg raocit ye.nasmrus


 -1  (nbme20#20)
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reHe is a nittfaacs eptircu to endnutasrd

6gttepoas4th8r47a/d17seae9mn/3haeceoe//0etbp-wnmeai1.Cnadagf/i:u2.act/e-csa0rn2lem3o2rigr12e/2pefcwlu-uftnahani9i7o88.m5w6Ps-49


 +31  (nbme20#21)
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aePg 2 ahs a egtra rteupic

no(/int00:7hpS16tawl/2.f6w/j9./c6o3eip41leic8)w/-gd-0atr91sr

kamilia20  chlamydophila psittaci?? +1


 +3  (nbme20#38)
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nI hepnccisygo spid,oyliap mreus dmusoi si olw, nad artef wrtea adotpenriiv s,ett riuen yllmiotosa si rc.inaeen iUersd mollsyoita soed not neciersa thwi npassvrisoe neionticj

nI ponehringec datbseie npidiuis,s serum uosmid is hhig nad reeht si no adlemhcn/gi eeircasn in niuer tlomslyoai erfta eawtr iienavoptrd

yotsubato  This patient does not undergo a water deprivation test +12
niboonsh  Compulsive water drinking or psychogenic polydipsia is now increasingly seen in psychiatric populations. Effects of increased water intake can lead to hyponatremia causing symptoms of nausea, vomiting, seizures, delirium and can even be life threatening if not recognized and managed early. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579464/ +7
missi19998  Just wondering why it in not resistance to ADH action of vasopressin +
amarousis  because he would be hypernatremic with no ADH. can't resorb any water +1
minhphuongpnt07  low osm/urine, low os/plasma => psychogenic polydipsia +
benitezmena  In this question the pt had a normal urine osm (80) a low urine osm would be <50mosmol/kg. +
euchromatin69  u world 212 +

 +4  (nbme20#37)
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nI laeotibmc sas,likola puotsmais ovmes noti the llces

Teh sosl ni evlomu urhothg siseem irgtergs ASAR senglirut in adceeisnr dsletnoAero leesera dna hrurtef mstspaoiu eoxitncer

wi/ldsne/ttp.pattt/e/ahb1e:1w.6w





Subcomments ...

submitted by m-ice(340),
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hTe etaitnp endse cdelmai itnotante ae,emmditiyl hichw leminsiaet tioainbng a oucrt drroe, ro ntrafirgners hre. A ruens sedo nto hvae teh asme rnitagin and qfoiintliscaau sa a pchni,yias os it wdluo eb iippenprotraa to ksa them ot aimexne eht pa.ettin ikgsnA eth laisthpo lhacpnai agnai coudl be ,aneprppartioi nda dluow aekt rome ei.tm horTrefee, het tebs inpoot mnoga hsote neivg si ot ksa the ptitaen fi seh wlil lwalo tihw her sdnabhu st.preen

sympathetikey  Garbage question. +60  
masonkingcobra  So two men is better than one apparently +29  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +12  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +9  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +16  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +26  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +5  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +12  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +11  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1  


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ontibnecirF si na aerllerltxuca tmiaxr oytnlgcr,peio ewihl linam si an iietmedeartn afenimtl atth yllieiccfaps psreivod supptor ot teh clel nuesl.uc o’tDn foscneu ainlm htiw ilnanmi isc(cnee ahtes su aey);llrc nnialim si ielk tficn,oeinbr an EMC ipcgyoonrtel dan a orajm onmtncoep of hte sabal nmaial fo nesatbem mesmr.bean

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +35  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +3  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +  
brise  @abkapoor the f is progeria? and do we need to know it for step? +  
brise  @abkapoor omg jk jk wow +  


submitted by medstruggle(12),
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hWy is ti ont inaorva ocleilfl lecsl? I htguoht eht eeafml olgana of rtolSie dna yeigdL si lnahr/eaogcusat el.lcs

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +11  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +38  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +18  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


submitted by joker4eva76(26),
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eTh uqtineso mest si rcinibesdg a tliamcondrhoi a,iesesd hihwc lonmoymc pnetsre ithw tcical s.cosidia heeTr si an cesnaeir in eabcoirna rmsof fo geyern dpnticouro cslso(y)yi.gl Teh roonchimitda rea f,aytlu so yhte n’cat eus eth end tdprcou of ollisycgys a()rvutype ni CA.T tIdneas utryaevp si dntseuh oerv dan si sdeu by HLD lac(eatt d)roeyaheegdsn to graneeet vta.epryu

esidA: cealRl atht DLH usse HAND and reatgenes A.DN+ Dcynfieiec of DHL can elda to lsos of roianregtene of N+AD nda niiihtbs iyloslg.scy

drdoom  ... pyruvate is shunted over and is used by LDH (lactate dehydrogenase) to generate lactate*. +3  
chris07  It's hinted in the answer, but I would like to clarify: max O2 consumption is decreased because O2 is consumed in the Electron Transport Chain, which occurs in the mitochondria. With the mitochondria not working, the ETC cannot work, and thus there is less demand for Oxygen. +18  
masonkingcobra  Mitochondria are the powerhouse of the cell +54  
uslme123  Apparently ragged red fibers are the result of coarse subsarcolemmal or intermyofibrillar mitochondrial accumulations.. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mitochondrial-myopathy +3  
mnemonicsfordayz  As @chris07 said, less O2 is being consumed in the ETC... but I also was thinking that the diaphragm is a muscle and if the mitochondria in her diaphragm are also not functioning, then she's not breathing properly and less O2 is being inhaled and therefore decreasing her oxygen consumption. Is that totally off base or am I just grasping at straws here? +  


submitted by tinydoc(233),
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Type 1 allmiiaF ieilaypDsmid (.pg 94 AF 91 )

rdesniaec GT g;-t&-- irsatiencpta tpcueEir / turisipr dsnaXomnh taa HSM

anC eb seuacd yb rppiioontLe eialps or eirnooptAp CII ficcneyied

hety adis htat PLL is nife os tsi AOP CII

penraHi setesarep LPL rfmo penHiarr uSfltea oiteyM on aVsc omhtEndieul owinalgl su to tets tis fonnicut in het bl.a

I ogt ti gwnro too - utpiSd oteR iamremtonioz elclar uoenti.sQ

masonkingcobra  I think you need to know that ApoCII activates LPL not necessarily know the disease +10  
yotsubato  Knowing the disease makes it easier to remember the details though +2  
pg32  Mnemonic for these 4 types of dyslipidemias and their causes: 1 = LP meaning LPL is deficient (or anything associated with activating LPL, like C-II) 2 = LD meaning LDLR is deficient (or anything involved in interacting with LDLR, like B-100) 3 = E meaning ApoE is defective and 4 for more (VLDL) ("more" just meaning more letters in the cause (VLDL oversecretion)) +2  
castlblack  One too many chylomicrONs, two much cholesterol, threE apo E gone, 4 put the fork down fatty +1  


submitted by egghead(1),
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hiTs is noe fo ohest soutnesiq I asw enevr ginog to tge. Its' tno ni ,AF I tn'od thkin 'eIv eesn it ni ca.lss

hungrybox  same :( +  
masonkingcobra  My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp) [Turns out it does not](http://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x) +  
gh889  FA 2019, pg 551 +8  
meningitis  Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line; medications (eg, clomipramine) may be considered. +14  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +  


submitted by mcl(601),
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shTi gmeai is ryev fel.hulp

seagull  http://www.siumed.edu/~dking2/erg/GI178b.htm Another histology slide with labels +2  
masonkingcobra  I like to think that the parietal cells look like "fried eggs" classically +  


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anC mobesyod aeselp nealxip yhw teh pKa ash ot eb 6 tnseaid of ?10

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +15  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +2  


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naC ebyodsmo pseela ixaelpn yhw eht aKp sah ot be 6 nstedia fo 1?0

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +15  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +2  


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Can mybdooes seplea npiexla hwy het aKp hsa to be 6 tadsien fo 10?

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +15  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +2  


submitted by medbitch94(35),
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/4c.hanltsgi/m64/eibwt9pC4w/.r/PMolnvsw/n9cmti9.h:c.p

masonkingcobra  The pathogenesis of post-transplant lymphoproliferative disorders (PTLD) in most patients relates to the outgrowth of Epstein-Barr virus (EBV)-positive B cell proliferations in the setting of chronic T cell immunosuppression. +2  


submitted by onyx(41),
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A gaylhcloipidrara eiibsvl uif-arlid lelve tggesssu a pteyrt grael oisnle hcen(,e )”v“yait.arc Ttsah' otn ggion to ebocme nramol stseiu n.aiga xiS osmhtn gwoilofnl uronloteis of yposmsmt yuo cna cxepte lghnaie ni eth form fo a ac;sr htat si, bsiofsir tub ynlo ni a gnlies stpo.

masonkingcobra  Robbin's: The basic mechanisms of fibrosis are the same as those of scar formation during tissue repair. However, tissue repair typically occurs after a short-lived injurious stimulus and follows an orderly sequence of steps, whereas fibrosis is induced by persistent injurious stimuli such as infections, immunologic reactions, and other types of tissue injury. The fibrosis seen in chronic diseases such as pulmonary fibrosis is often responsible for organ dysfunction and even organ failure. +4  
stevenorange  What Differentiates Normal Lung Repair and Fibrosis? Basement membrane ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +2  
step1234  I'm a little confused here since FA20 209 states Klebsiella causes liquefactive necrosis in the lungs. Does the pulmonary fibrosis occur after the necrosis? +  
fatboyslim  @step1234 Yes pulmonary fibrosis occurs after liquefactive necrosis as a means of repair. Think of it as liquefactive necrosis = damage done in response to Klebsiella -> 6 months later you will see focal fibrosis in that area (scar formation) where the damage happened. +3  
makingstrides  If there was an intact basement membrane, you would get normal pulmonary parenchyma. +  


submitted by hayayah(1081),
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lPivec hlspncican rveesn are part fo teh acethiarpsymtap etss.my

masonkingcobra  The inferior hypogastric plexus innervates internal pelvic viscera; has both sympathetic and parasympathetic components; parasympathetic contribution helps stimulate detrusor of bladder (along with pelvic splanchnic nerves), sympathetic contribution helps stimulate internal urethral sphincter +3  


submitted by hayayah(1081),
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oYu ehva a 52% enccha fo nietnirhig hte msea ALH eakrrsm sa rouy sbgisl.in

masonkingcobra  Two siblings have a 25% chance of being genotypically HLA identical, a 50% chance of being HLA haploidentical (sharing one haplotype), and a 25% chance that they share no HLA haplotypes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628004/ +23  
alimd  It looks exactly like an Autosomal recessive mode of inheritance. +1  


submitted by hayayah(1081),
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eTh dmgaae is in eht L iainmbrd in eht raea ingfftcae the toriclnscaiop tr.cta seauBec ti is in het ibr,ndami ctdasnuiseo ni eht dpmrasiy ld(a)umel so it lwil hswo tleiraslaip fycdluaoistnn mrtoo .sisgn

toohP of ibandirm adn atrnpmtio :raesa rhyL.rHotautm/lRs

masonkingcobra  Just for clarification, on the left side, you see where he had the infarction 7 years ago and the tissue is gone. +8  
chefcurry  so is the dysfunction on the contralateral side? +  
praderwilli  If the decussation is in the pyramids of the medulla, shouldn't it be contralateral hemiparesis if the damage is on the right? It confuses me because of the labeling right and left at the top of the pictures. +  
endochondral1  that link isnt working @ hayayah....is there any good picture to look at to know where the tracts are on this section? +1  


submitted by strugglebus(165),
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Teh sonp hsa ervnes ,-58 os the ngemilrati ludwo eb ftceaefd heer

masonkingcobra  Thalamic pain syndrome would involve dysesthesias on the entire contralateral body so more than just the face. Also it occurs often after post-stroke. Additoinally, these dysesthesias appear weeks/months later +12  


submitted by thomas(2),
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rswenA si ctA.rsotye aPnteit has ltoagosaimbl mromtfiu.el ugAtlhho nimiogasnme amy uccor at sitvecon,iex imsoenagnmi are gnbine dan tnoef c.mtamiaotsyp eyTh yam eucas ah/ zsur,esie btu oduwl be eiklluyn ot auesc teahd i/wn 6m of etnso fo a/h. hTe size fo tromu dna rusceo of snllesi is cinsotsnet htwi hte corseu fo MBG

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +25  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by hayayah(1081),
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LV pedspto ok,wirgn esesrpru dkbeca up inot ulmp riit.ucc lPmu itciurc hrulogy si mdae of 3 s"r"pta - het ,ecrilsiapal trteilatsiin c,epsa dan eth e.viloal

nI drcaicgnoei ,ksoch hte axtre boldo ircsaense clrplaiya staroichtdy spsueerr, girdinv lifdu ntio eht iernttitasli ce.sap apCoedmr ot teh llaeov,i hte italtrseitni pacse nwo hsa rmoe duifl (hust omer tstraitlenii hoirscdaytt espsurre and elss ictocon prrueses edu ot toira of dliuf to ep)tonir, dan sa a rulest fo hsti nungaalnibc of oc,efrs uidfl voesm ntoi hte llvaeio -t-g;& ympounlar edm.ae



submitted by step420(34),
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eOhtr iedynk iretyhHorsppe ued to daeniescr sssetr --t&g; otn rpasahyeipl bc ton orcceasnu

masonkingcobra  Above answer is incorrect because hyperplasia can be either physiological or pathological. Prolonged hyperplasia can set the seed for cancerous growth however. Robbins: Stated another way, in pure hypertrophy there are no new cells, just bigger cells containing increased amounts of structural proteins and organelles. Hyperplasia is an adaptive response in cells capable of replication, whereas hypertrophy occurs when cells have a limited capacity to divide. Hypertrophy and hyperplasia also can occur together, and obviously both result in an enlarged (hypertrophic) organ. +45  
johnthurtjr  FTR Pathoma Ch 1 Dr. Sattar mentions hyperplasia is generally the pathway to cancer, with some exceptions like the prostate and BPH. +4  
sympathetikey  Tubular hypertrophy is the natural compensation post renal transplant. Just one of those things you have to know, unfortunately. +2  
charcot_bouchard  Isnt Kidney a labile a tissue & thus should undergo both. This ques is dipshit +  
brbwhat  Dr Sattar says, kidney is a stable tissue, at least pct is as seen in ATN. But I read, basically kidneys are mostly formed whatever number of nephrons have to be formed by birth, after that they can only undergo hyperplasia aka increase in size/or regenerate if need be in case of atn. We cant have more number of nephrons. +1  
mambaforstep  @brbwhat , do you mean kidneys can only undergo hyperTROPHY? +2  
j44n  .... you're not making more cells..... so it cant be hyperplasia +  


submitted by hayayah(1081),
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eCsa of eolirtacssero.irslo

tcpyrlespaiH orrsseeollitorcias oslivven inkeghicnt of sesevl wall by hpaeirslpya of thooms mseclu nni'no(sok-i 'peerpan)caa

  • qencnsCueeo of aimtanlgn toieeyhrspnn 0;(012t/g8&1 /w tecau edonnagr- )emdgaa
  • ltsResu in uedrdce lsseev rbielac whti aredongn- ceisamhi
  • May dale ot ibnifdoir nesrcois of eth sevlse lawl whit mrhaohger;e llsclcyaais casues utcea elnra aeuflir F(A)R thwi a ttrhicciercaas '-tletief'nba paaceprena
masonkingcobra  From Robbin's: Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture. +  
asapdoc  I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +17  
uslme123  I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +  
hello  The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +23  
yotsubato  hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies) +7  
smc213  Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names. Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls. http://www.medlink.com/article/fibromuscular_dysplasia +1  
smc213  *sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries. https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd +1  
momina_amjad  These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN! Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years) If it was the consequence, the presentation is still not classical! -_- +1  
charcot_bouchard  Poor controlled HTN is the cause here +  
charcot_bouchard  Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +  


submitted by hayayah(1081),
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No morbsela,tiani oynl esom mivt,gino osolk lelw w/ on faueilr to h.rtvie otMs lylkei ammritue EL.S

masonkingcobra  http://www.sedico.net/English/SedicoInformationCenter/Physicians/gerd_e.htm +14