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Welcome to mcl’s page.
Contributor score: 579


Comments ...

 +7  (nbme24#18)
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llloo os ditensa of unisg efzemoilop htey tjus naong egt imh real ukdnr

johnson  yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole. +5
usmlecrasherss  Drink vodka man , either way you're dying +
drschmoctor  Or if you really wanna get drunk and have a warm place to sleep, drink a bunch of methanol in the waiting room of the ED, then let them pump you full of ethanol and keep you safe. +2

 +1  (nbme24#4)
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Bsuon cadvrae riamgad, ikd yhw shti swa no ptrti.s...?...ene....

yotsubato  nurses +4
faus305  Cause it's cute unlike the monstrosities they always put on the NBMEs +

 +5  (nbme23#10)
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So if you t'ddin h8 ubgdebs ghu,one yhet cna ptynpelraa sola svere sa ectosvr orf dturitgnsre-sa becriata lugdcniin AMRS OHW NUF SI THTA

spacepogie  SO FUN +3

 +8  (nbme23#23)
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To pxnead on ts,hi hwta ew ithnk hnpespa wiht rPosni'askn edsasie a(nd piaonsiksmannri) si an aanlmibce wtebene inpedoam dna hceoenaytli.cl tI kmsea eorm nesse if you kool ta isht rm,gdaai yapnig ciratarlpu tenatiotn to het dreincit .payawht ssLo of igmcirepaond )(AD rsnuneo romf het baniaststu arngi )cS(N rlteuss ni sonatnct vctaioatin fo osthe hAC icesrtneg e,nrnuso hhciw lmutiaylte lursset ni iiinhotnib fo mtuasalh from ittnniigia meo.nvstme ohTefrre,e nisgu hncilcoisgietarn pelh thiw osnipikasramnni draonsyce ot olahdl.

mcl  Also, you don't wanna use sinemet since that would be counterproductive +2
drzed  Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing? +

 +7  (nbme23#16)
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In seca uoy nanaw go epusr rden dna erda touab yiel,nm atcace,ipcan nad ,nsrectiesa htsi yug dsoe a oodg ojb.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +21
sweetmed  this helped a lot! +
roaaaj  Well explained! +
euchromatin69  or see u world 917 same concept +
brise  Uworld 1318*** +

 +5  (nbme23#40)
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FA 2019 P 357 - eTh noly aptr of teh hoepnrn tath tsifr dia says sah an ftfcee on O4P 3- si .PTC

motherfucker  PTH inhibits na/PO4 cotransport -> PO4 excretion +4

 +8  (nbme23#10)
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hTis is a ecin ikquc fesrrehre of athw AUC is.


 +19  (nbme23#28)
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nuosB kiucq virewe


 +6  (nbme23#18)
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iodgccAnr ot htis ep,par inlsuni isiitnhb lapha leslc ofmr nailregse u.onggalc sihT is eht talrevne ugrife ormf teh r.paep

medpsychosis  There are three ways that Glucagon secretion is stimulated: +(1) a stimulatory effect of low glucose directly on the alpha cell, +(2) withdrawal of an inhibitory effect of adjacent beta cells, and +(3) a stimulatory effect of autonomic activation. The response of Glucagon to hypoglycemia is diminished in T1Diabetes. Hence in this pt, the impaired release of Glucagon allows for prolonged Hypoglycemia. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005043/ +9

 +16  (nbme23#26)
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attniPe tiwh ialalertb laner ytearr bstrui nad nihseotnepyr wlli rof rseu veah vianctoait of ARS sestym nad horrfeeet rneescia ni nigaeions.nt

oghulhAt tcarmopochehoyom adn oqectunesn deavelte tmcscahneeolia can ecseairn obold pe,srerus ospysmtm rae layytpicl diiposec dna alren itusbr aer ont leyikl ot eb .dhera tvadleEe veells fo nstnoreio cna aosl aeucs on,itrpyhesen but we oduwl salo xpecet ot see lhsi;fgun ,osal ehetr is oigtnhn ni teh tmse ot inceidat atetnip si igatnk SSIRs ro gnmteohsi slee ttah dlcou poiedsreps ehr ot lteadvee eelslv of etnor.oisn lvetEeda evsell of riytodh hmnooer docul lsao vgei tpetian ntsnp,ieyoehr ubt ew wloud also eetcpx ehort ssgin of hrdtrisoyyemhip o(tmrr,es iwehtg ,sosl .et)c.

I wsa a leltit deoucnsf if EOP luwdo be vadletee -- fi rteeh is eossitsn fo arnel itsearer sa( inedctadi yb teh tbur)si eth kisnyde udlco slao ctedte this as hpyxoai dan rapm pu rdctponuoi of EP.O v,eweHor I eeddn pu inggo hitw snioenntgai nseci it edesme oemr nc"eoetc"r ot me taht ARS uwodl eb pu. eosD oynnea kwno wyh s'it ton PO?E

brise  Wouldn't that be more long term? +3
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2

 +8  (nbme23#34)
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oT apedxn no ti,hs gsohnphosportaea rea nolommcy duse as dit,secceisin dan tfcuoinn by inidngb ecseaolcnieetyrltahs and "acae"tgdvtiin i,t os ot kea.ps isTh esrutsl ni na ssexec fo CAh tinihw eth ys,pnesa ichhw sesauc usdegl rnosymed nvii,tog(m agws,ntie airdrahe -- cbyalaisl solt fo )fu.isdl The ttartemne ofr sthi si cltyilyap oanpirte i,suaitr)(cmcinnain dan roelapiimxd fi( nvieg yearl uhnoeg, nac "rv"eataitec hte .e)shaC-sA Teh aimagdr vngie edso tno owhs hsC-Aae, olyn hte RC-hA, fohretere D is hte steb .srwaen

lowyield  Also according to uworld you give atropine before pralidoxime because pralidoxime can cause an initial exacerbation (even though you might think you should give pralidoxime first because it is time sensitive) +2

 +6  (nbme23#10)
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hTsi erguif is a luhlpfe rereefhrs orf teh /9965/9.87 lure


 +32  (nbme22#37)
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hiTs eigam is l.uesfu etNo that teh insta usde meask lmyine apaper d.rka

nieteVtg si cplyita for oskarnn'iPs seeid.sa raeA D si the ussinbtaat gair.n

oznefu  Oh nice! Thanks! +
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +
apurva  Saved My life +1
john198  is this link only for MSU students??? , I can't access it . +

 +2  (nbme22#19)
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Eiwgn comsraa si the dnoecs somt omcomn oneb icganymlna in dhni.celr siolgyHto is uallyus ecdeirsdb as a lsalm clle utrom whit ihgh NC: oirat.

praderwilli  Also the concentric layers of reactive bone sounded like "onion skin" to me! +7

 +5  (nbme22#8)
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rigmlHeo gto esom acelivrc eolttu onmyreds nda sholud rbobplya keta oems tfusf otu fo her pbkacack or tge noe fo estoh ill roelrl one.s

mcl  Whoops, my bad, THORACIC outlet syndrome +4
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1

 +2  (nbme22#29)
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Teesh iemgsa ear lusefu ni oocaintmib.n


 +7  (nbme22#39)
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oinsPo iyv rtsgierg a teyp IV srnpthiytesyivei ie(tmaedd yb T e)cl;ls lyno eon of eth wnsera icecsoh itnnoems T llcs.e


 +1  (nbme22#44)
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eciasbS lieks ot ubworr ni the eraas btenewe hte neigfrs nad teos (AF 9102 )611 adn ascuse i.ntgcih douCl lsoa iyolettnalp eb ielc grnoi( evomlt,envi)n tbu tatetermn ofr reteih olsvpera -- tgtao sue rpmnehietr.

kchakhabar  If only one person is there to see the doctor, why would the doctor prescribe medicine even for his family members who are not there? +
mcl  Unfortunately, both of these are pretty contagious conditions. FA mentions that scabies spreads via skin to skin contact, and goes on to mention that you're supposed to treat close contacts. I think in this scenario it's ok to give permethrin to the family members who are not present but affected (it's also non-prescription in some cases, I believe.) Slightly related note, similar to why you would treat the sexual partner of someone with chlamydia/gonorrhea, or close contacts of someone with n. meningitides infection. +10
teaandmusic  Agree with kchakhabar. Just because pt says others in family have the same thing, doesn't mean they do, they may have a different condition (small chance, but still possible). Not to mention allergic reactions and other considerations that the Dr. isn't aware of regarding family members ... with chlamydia/gonorrhea, etc you'd have the close contact go and see a doctor and get a prescription also, you wouldn't just write out a prescription for someone you haven't seen +

 +2  (nbme22#45)
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To naexdp no his,t lgaolounotheypits bessdceri the oglthysio of wsopaki mcaaosr as dnsipl"e clels froinmg ltsis thwi atdearevsxta erd doblo "slcle

mcl  lul i don't know why i spell kaposi like that, my b +10
bubbles  This site is super helpful. Thanks for sharing :) +
mcl  yesssssss ofc <3 I love path outlines +
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5

 +3  (nbme22#37)
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e-B2at trserocpe rae dcueplo ot sG ops,inter chwhi catvetia lylndeya elscayc nda enaecsir PAM.c cliCcy MAP tenh aierescns cytivtai fo rpntoei enikas A, whcih eahpsrpysoloth ysmion ghlit acihn saie,kn ualmtyilte liunrestg in ohstmo ulemcs oealniaxr.t tbuo,lleAr a 2B nai,sgot si rfeterheo fsuleu ni ttinegra b.smhoorcpasn

impostersyndromel1000  are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation? saw this on another Q with the nitrates causing headache so now im confused +
dubywow  @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +2
iwannabeadoctor2  cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +
castlblack  cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +3

 +5  (nbme22#28)
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CDC ecdnmoeermd ttmetrean fo hiacsomtsos nansomi is .nzeqaitlarpu

makinallkindzofgainz  It's also the pretzel in the Sketchy video, which I think most would agree is more reputable than whoever these "CDC" people are +15
rockodude  ya until step 1 fucks us with some esoteric cdc guideline +

 +3  (nbme22#8)
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neiSc oyuer' snigol lal ryou abircb tino ryou epe, uoy dlwuo xetpce hte Hp to eb eomr kallea.ni Asl,o encis rteeh is caeededrs ++NHa/ toprni,ta erteh is sles miodsu ebrrsadobe dan retrofeeh seendacri slos fo refe iudlf to teh un.ire

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1
meningitis  Lol yw!! +

 +6  (nbme22#32)
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itaPnte keliyl ahs OPCS. PSOC si oedicaasts ihtw aeldevet eesllv of LH frmo hte artiiy,ptu iwhch uatlmetssi ioesrav to pcerodu sdriecean matsuno fo exs sdertios (ngcniudli eaodsrngn -&;-gt r).sitsmuihi niAndoteedenors si nroedecvt ot serteno ni sotec,ydiap hhwci elsstru in istll rterhfu seicrnaed esleear of LH. setybOi adn nsuniil atcinrsese si tadiascseo hwit P.CSO


 +16  (nbme22#30)
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The eistquno is grriefnre ot eht einsahmoxe aht.wapy

ryoCmlaba eshphoatp nda ngiarine are evvnidlo ni eth ruae cecyl. oS si mtaealntg-yectual )GA(N gleaur(ets todnuicrpo fo lcbayamro h.opaetph)s


 +18  (nbme22#22)
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epstDie a niuemrc uelva bdlo(o esrs)rpue egnbi a,sremdeu ieanptts would be giadneedts hieetr esvtepynhrei ro sietoev.ormnn oT my nadsierg,ndnut teh tesb estt for igmranocp leroaiagcct ebvilraas scraso uosgrp si a ich asueqr tte.s

In ,toatsncr a ttts-e is edsu ot mpcaroe tbneeew the smnea of two usgrop emsu(read aalbveir must be )t.uaaivtetqni


 +0  (nbme22#47)
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gepa 911 tentaFAP i si nsnigtpree nhtmso atfer teh tntra,anslp hiwhc nsmea it a'nct be pycueahert lnuess he etopdsp aitgkn ihs annitmurpeomsu.ssps eGVAuonHr/c/hctci asidees era eadmetdi yb T clsle fro het osmt rapt (I )ki,tnh so itsh luwdo anme ctyicplmoyh trnsae.ifilt

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2

 +4  (nbme22#1)
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aPorrtno eerst dna sarqudatu aer hotb isuedplp by inemda verne 18,/CC5T(C/6/C/7 so 'ahstt not erpus l)lfhp.eu sitnExeno of eth moaerfr is dliara nvree salo( ,C-15T alos otn eflh)lup. This odse tlle us is it t'cna be tdoiesla emdian ro arild.a eircspT onnedt xelfer si CC8/7, chwhi asrwrno ti nodw to etehs two.

anC nnyoae xiepnla hwy sti' C7 oerv ?C8

joha961  Same question. How could you determine between the specific nerve roots (C7 vs. C8)? +2
mcl  Someone I was talking to (and post below) was saying that first aid mentions triceps is C7, so that's what should've been the big thing for us. +2
joanmadd  you might see some ulnar nerve involvement if C8 was involved her +
passplease  but he has generalized tingling which is in both ulnar and median regions? +

 +8  (nbme22#15)
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oT aexpdn no ,tsih ctiatonncor of eofrlx dtomiirug orndusupf msluec tlressu in xnefilo at eth sIDP and IsP.P Teh onetdn eacshatt at het tip of eht r,gifne ni rcastotn ot rxelof itmriugdo isusieacprlfi etast(hac at eth sIP.P) Rcaell innriaetnov of eth ofmraer ulecsms is symtol omrf teh enaimd vnree, etcxpe rfo 5.1 lesscum (unrla lfha of rlxoef iriutdogm pndofuusr dan hte efloxr pacir niuasrl, btho eidlspup yb anulr hwich kemas it ze ot ebmrerem )yay.

But loas if you tog itsh norgw iekl me og dear ahtt nlik absceue i'ts a rlayle eicn rewvie.

samsam3711  Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +2
brbwhat  FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +
brbwhat  Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +

 +10  (nbme22#14)
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Irsealnttco invse dniar otni eht zszhgmuuyooaseyga/i esiv,n iwhch nru rigth tnex ot hte tevrralbe lncuo.m orAenht fusuel agairdm ngowhis tfel dna tgrhi catlsioentr nies.v


 +1  (nbme21#30)
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erP 068p ni AF 2091, SRY on Y oosoehmmrc estrslu ni nvdtopeleme of .sttsee DHT ersuslt in lodeemtpevn of amle etnarexl aeatiinlg (dan eht oetpsat)r.

mrsmac  No sertoli cells or lack of mullerian inhibitory factor makes more sense. bc there is both male and female internal genitalia but only male external genatalia. and karyotype would show 46XY. First Aid 2018 pg. 604 - the "Sexual Differentiation" charge delineates exactly this. If it were 5areductase deficiency the child would have testicles and scrotum, which in this case is absence. Hope this makes sense. Please let me know if you disagree and why. Thanks. +
mixmasta  I believe the tricky part is that they don't mention the status of the Male external genitalia. Pg. 605 from FA ( bottom portion) shows the external development of the Male/Female genitalia; you see DHT is need for male. Furthermore, pg. 604 (SEXUAL DIFFERENTIATION) DHT is also needed for Male external development. +
niboonsh  My understanding of this is that the diagnosis is 5alpha reductase deficiency because the newborn has female external (aka ambiguous) with male internal (aka "male genital ducts"). According to FA, leydig cells produce testosterone, which can either stimulate the mesonephric duct to form the INTERNAL male genitals (as see in the pt). Testosterone can also be acted on by 5alpha reductase to become Dihydrotestosterone, which forms the male EXTERNAL genitalia. Since this kid has "female" genitals, but has male insides and is 46XY, id say this is a simple case of 5alpha reductase deficiency. No sertoli cells or no MIF would present as both female and male internal (because MIF typically inhibits differentiation of female internal) and male external genitalia (bcuz leydig cells are unaffected) +15

 +35  (nbme21#16)
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bleLead RCX onshigw tsponoii of etfinedfr lasvve.

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2

 +7  (nbme21#36)
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ihTs miaeg is eyrv elulfh.p

seagull  http://www.siumed.edu/~dking2/erg/GI178b.htm Another histology slide with labels +1
masonkingcobra  I like to think that the parietal cells look like "fried eggs" classically +

 -3  (nbme21#17)
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eniihMteon si na esesntlai inmoa .acdi All retosh dliset aer nto.

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +15
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1

 +9  (nbme21#19)
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ntaiePt amy ehav aeyrderith nmiag,aeoed wchhi is teoaisscad thwi ee"rrnrtuc tackast of et,enisn ise,asvm ozldcieal cssetanbuouu dmeea vnligvion eth imr,iteeexst ai,lngatie ,caef or ,krnut or csusbaomlu mdaee of ppreu awiyar or elswb"o. heT aleictr gsoe no to yas a1"eeC-tsres trbioinih oskrw ledrytic on hte lmmtenpeco nda oacctnt plamsa seadcasc to uedecr raibidynnk eelaser" icwhh si losa plraybbo doog to k.nwo

sCt//net:c.P/tp1vow6h38lgMi/nmaw6c/.ib.w.ricp/smh6nl3

notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +22
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +2
teepot123  fa 19 pg 107 +
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1

 +3  (nbme21#12)
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OPSC si dectsiaosa whit ramnloab ncpoutidor fo sxe stdrsoie, giiudnlcn nstdoiycnfu fo tonregse dipourcnot nda reoopterseng. roaychlClni teleedav elvels fo tsoegenr anc uaces etinldmoaer hplaryisa.ep

o1.innri7CMc9cbhPl..3//a9pt.eslcwphit/gt//5mwsnmw:v9/

meningitis  Why isnt it endometriosis? Could someone help me out on this? +1
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +25
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +1
lovebug  FA 2019, page 631 +
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +

 +14  (nbme21#45)
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Nto seru if ihts si hte rghti ywa ot tinkh obtau i,t tub fi TP nda TPT rae hbot noroldp,eg tshi tsmo lyliek snaem heert si a eomprlb thwi het ommcno ahyptwa ka(a arcfot .)X

temmy  exactly...i just thought the problem has to be where they meet or somewhere similar to both..hence the common pathway 12(PTT Heparin) 7 (PT, Warfarin) 11 9 10 5 2 1 In my head, both sides are looking for the perfect 10 +

 +4  (nbme21#9)
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enhW kgowrni no aeabisd/c iddrrs,soe ti lphes ot okol ymclsiatatleys at teh lnfoiwolg: (1) pH whih(c adlys was ton eignv ni tshi b,lo)mepr 2() ifegru tou hiwhc oepmblr is mraypir yb lgookin at a2COP dna ibcbr,a adn (3) okol ofr ayn oenmpantscio h(iwch het oeunistq nodtse' ask tub li.)stl

re,eH we see thta the CO2 si hhgi no teh ABG. ihTs nasem that tieanpt si tnvyhlgopiianet insce levles of O2C ear avitlteonin ,nndtepeed and soal atht piattne sha irerstoaryp aoiiscsd. slA,o bicabr is w,ol hhciw ilesipm ttah 'ist bigen osdeak" pu" by eiaotcmbl dacissoi.

privatejoker  I just look at these as "what makes the most sense" and this is is sufficient in nearly every scenario. Out of the given options, the only explanation that even lines up with the given numbers is the answer choice. +

 +19  (nbme21#30)
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sTih is a ettpyr ogdo rufige inohsgw eht nverncosio of mnamebre ilhpdposihsop ot icnohircada eeduntiierol/sakc ec.t

elBacodk fo XOC emyzne yb bufpeirno reusslt in dseeadrce diocnopurt fo idgtarlasnospn H2 nda 2E, iwhle asugnci eth ersrroscup ot k"bca p"u adce(sirne aarcdhcnioi dc)a.i shiT, in tnr,u sesultr in endrsacie rtocdnuipo fo neiloe.estrku

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +1

 +5  (nbme21#30)
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oliDetd is vaeerndnti by alryxila enrev, which eoscm rmfo sroto CC6.5/ sincAot fo teh ioddetl cudinel noiatdbuc fo hte peupr .erimtxety

seagull  I hope everyone memorized every single part of the brachial plexus and all the roots of each, No detail let untouched!!! +26
mcl  In case anyone else has purged the whole brachial plexus from your memory (like me), this is a great resource linked by another user. https://geekymedics.com/nerve-supply-to-the-upper-limb/ +11
zevvyt  I thought it was radial since he lost sensation in his thumb. If Radial is C5-T1, wouldn't that be included in C5-C6? +1
alimd  they force us to know brachial plexus like the holy bible +

 +7  (nbme21#13)
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nNicia tavi(min )B3 agetzaisonn LDVL hrtoloescle crntesioe

sbryant6  Fibrates stimulate PPAR-alpha --> LPL upregulation --> decreased triglycerides. However, this question asked about a vitamin. Vitamin B3=niacin. +4
lovebug  FA 19, PG 315. Lipid lowering drug bro. +

 +1  (nbme21#1)
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Peag 205 AF - hbtalouEtm is dsaiosacet twih ulsvia iebdrstacuns cnsheg(a ni oclro in.vs)io

dashou19  On FA page 250, it is said that Isoniazid can also cause optic neuritis and color vision change. Sometimes it hurts if you know too much lol +1

 +12  (nbme21#44)
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ielhW atstsnhinimeia ihwt nicaot at 1H eprocerst ear udes for irels,aelg 2H amtinshtianeis era yipllayct usde ofr l.usrec Teeehofrr het etsb rasenw si ibnlaitsioazt fo smat clel na.bmeesmr sTeeh usrdg ymoc)l(nro prveetn esslvcie of manhsieit omrf snugfi hwit teh bamrm.nee

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

 +9  (nbme21#14)
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oiibVr alrhoeec si a g,neaevtaigrm- acmom dpseha aiearctb tath can ecuas ewarty ear.hidar arloeCh onxti ontfsiucn by igcitvtana eth sG epstonir tg&--; necsgrniia tvicaiyt fo dlyylnae eaylcsc g&t;-- incredesa PMAc t-;g-& cesnidare a+N dna Cl- fxuelf -&;gt- ha.irrade

teepot123  fa 19 pg 146 +
lovebug  Cholerae's exotoxin does not invade mucosa. but just permanently activates Gs according to FA. +
lovebug  Same mechanism[Increase cAMP] : 1) Labile toxin of ETEC, 2) Edema factor of B. anthracis, 3) Pertussis toxin of B. pertusssis +1

 +9  (nbme21#34)
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obsuMenarm optsoeihrlregipulm aa(k amrsmnobeu hh,ppreonayt p 548 AF 0)921 mya ucrco crnyesoad to udsrg shuc as eimlicnnapiel. oeunreIfnccmumelso ssohw agnarulr sstepdio deu to mniuem lcexopm tn.eospiido lilW lsoa ese dufsfie arillpyca and BMG ngkichneti, nad EMS iwll owhs iskep dan dome eaeprcanpa ude ot eailelpstihbu s.tsiedpo


 +1  (nbme21#44)
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ioumrFeeds dna hetor polo dsciiertu aer edicitnad rfo seu ni vlueom ovlaedro yanocerds to enarl .iurelaf Rcelal oopl esdcruiit ibihtni teh l/+-CN+K/a ppum ta het ihtck nscneiadg lpoo of lenH,e hiwhc esssme ihtw the ihtyitycnrpoe of the ldlaume and hefertroe vptnrees nieru mfro gnbei ecron.tdtcaen ihTs luesrst ni sdrcnieae ludfi sslo ot eu,rin nda is uehlpfl ni angirett mssytomp fo meed.a


 +7  (nbme21#7)
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tiaG esbprlmo ersasi ioupssicn orf ohoclal aebsu or dhineal leug. r,woeeHv snote fo igat epbroslm si yreailvlte raidp op(celu of nmts)oh nda agti ruisdbatnce ithw egsrdra to lacoolh si erethi ued ot tiiioxnoctan or nrhcoci sea.bu evinttAarel ltpeoaannxi eiballvaa on SDN. soAl ees uoenlet ctitxyoi on s.cmpaede

sbryant6  I got this correct solely based on the patients demographic. Glue is cheap and easily accessible to underage populations. +4
whossayin  Kinda racist of us but that’s how I reasoned my answer too lol @sbryant6 +
hpsbwz  how is it racist if the only thing thats given is his age lol @whossayin +21

 +3  (nbme21#2)
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inPetat osmt iklyle sah cshaTS-ya es.disea iTsh iefugr ecyiln ohssw teh cmhcaeioilb ayhwat.p Rlcael ahtt hobt hsaTaycS- dna ainNemn Pick seeiasd eensprt iwth a yehrcr red sotp no csp,uonyfdo ubt Tay cShas sckal hte ylaoosagplhtmnpeee eesn in .PN

hungrybox  Man this is such a nice figure except it doesn't have Krabbe disease :( +
mcl  Here's another one with Krabbe! :) https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg +7
hungrybox  thank u +1

 +1  (nbme21#46)
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etrhO yaw ot egt tsih uoqetnis si by inmngetliia ehtor posonti -- tshi guerfi si uflues in gisnlti emos onmttsiua nad oadscaiest enc.acsr


 +2  (nbme21#33)
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"rhccnoi high goneyx otiuatrasns cna vryldeesa fctefa gnlu dna yee oetsmuoc of mertpre asf" intn.lnki





Subcomments ...

submitted by usmleuser007(370),
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my tsil fo psnleid pety llcse adn dcnisoont:i

  • .a F-N1
  • b. N2F- ~ noSahmnwac nn(Atoi )A = euauCnsot fbeuronomair ~ hgih aueltylircl /(w apgaidslin renptast ithw esirnrgntispe ceea-lrunref osnez olcseeryl&Vn;abpcda dbeios
  • .c mooaiLeym su(ture m;pa& uspo)gehsa
  • .d matMsloehieo (ciyktnetaro it)peovis
  • .e sinclpaatA iordyTh cernca ica(shibp m&;pa lgoan thwi igatn )cslel
  • .f yadMurell iTyrdho cnreac nc(a alos eavh oalyglpon slcle)
  • .g Piryamr dcracai sangmoacoair (tanlminag sacvulra sldinpe lls)ec
  • h. rOascmsoeota be(on )earccn oomeirlhcpp( cles)l
  • .i gaeniMimno
  • j. aiopKss' maocSra )H(8V-H = elliik-tS ursvcaal aecsps ithw pmpul he-snpdiaplsed rmoatls escll
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +4  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  


submitted by medstruggle(12),
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Wyh si it tno aioranv olflilce cse?ll I hghtuto het efmale glaano fo etrliSo nad ideLgy si sancetug/ahloar elsl.c

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +7  
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??? +37  
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!" +17  
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 medstruggle(12),
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hWy si it otn rnaovai ocflllie lce?sl I ohuhtgt eht fmelae aaogln fo orltieS and deigLy is ahetglau/cornsa .selcl

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +7  
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??? +37  
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!" +17  
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 +  


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hWy ear het AIM and ASM mtos yilekl to eb cteffdea ni ehr icio?ntndo

sattanki  Again, not too sure, but I think they were describing a patient with chronic intestinal angina, which is classically from atherosclerosis of the IMA/SMA. +3  
mcl  I was also thinking about which areas have crappy blood supply (watershed areas), which I assume would be worse off in the case of chronic mesenteric ischemia. If you look on page 357 of FA 2019, SMA & IMA at the splenic flexure is a watershed area; the other is rectosigmoid junction (sigmoid branch from IMA and superior rectal). +  


submitted by medstruggle(12),
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yhW is ianeetltrav pscingli ro rrtla-ppsnocititonsa mniatcfoidoi t?cieonrcr

tea-cats-biscuits  You just have to know that POMC is a pro-protein that must be cleaved; not sure if there’s anything in the stem that would really have given it away. +2  
mcl  Dunno if this helps, but it says "this protein" (singular) is the precursor of two different protein products. This must mean that the modification occurs after the protein is made, which means after transcription and splicing has already happened. +31  
ngman  Also I believe mRNA refers to after the splicing already occurs. If the protein products are from the same mRNA then it can't be alternate splicing. +1  
medschul  They're cleaved by tissue-specific proteases +1  
duat98  I think: Alternative splicing occurs with hnRNA not mRNA. You get mRNA from alternatively splicing the hnRNA. an mRNA can only make 1 type of protein. Since the question says the 2 proteins comes from the same mRNA it cannot be alternative splice or post transcriptional mod. FA 2018 page 43 has a good illustration. +6  
tadki38097  Just general testing taking strategy i guess, but for this question i was torn between post-transcriptional and post-translational, but then i saw that alternative splicing was also a choice...because alternative splicing IS a post-transcriptional modification you know it has to be post-translational because you can't select two answer choices. +1  


submitted by seagull(1404),
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eTh sinetscam fo this iostnque meda me tvimo bd.olo

eOn day a nttaiep lilw olok em in the ysee nda s,ka hee"rW rea titeidprse kenorb dn?"ow I will smiel ta mteh dna say, hte" nltiasnite caousm adn ont the uneoud."md Tlhle'y slmie cakb nad llI' klaw aywa dan tkhni fo shti notmme sa I mpuj from eth nwwod.i

sympathetikey  Too real. +2  
mcl  how do i upvote multiple times +15  
trichotillomaniac  I made an account solely so I could upvote this. +29  
dragon3  ty for the chuckle +6  
cinnapie  @trichotillomaniac Same +3  
thedeadly96  XD made my day! +  
hardly43  RIP legend @seagull +  
seagull  A legend never die +1  


submitted by mcl(579),
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eciSn yreou' lsgion lla royu abcrbi noti oyur ,pee yuo udolw xtecpe eht pH ot be mreo kinlle.aa oA,ls icsen eerth is edreseadc +H/Na+ atitr,onp htere si sels odsuim eebsrraobd dan eeftorher daernesic ossl of efre idulf to hte reiu.n

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by chris07(54),
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eBd ubsg mevestelhs aer otn onkwn ot eb iserrarc of iesnsl,l tub hety acn eealv iyhtc si.teb ehT rigl si illkey to ahscctr heets biest, bdaare eth ns,ki and htsu acensrei teh kisr fo a phsta sikn ociennitf isn(ec ptash ureasu is teh tosm mcomon snik tecofinni hpaengot)

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +6  
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1  
frijoles  So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich +13  
anechakfspb  @frijoles - Hey if it makes you feel any better I put HIV too, with my reasoning being that they feed on blood...and HIV is transmitted via bodily fluids. Whoops! +  


submitted by mcl(579),
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oT npaxde no t,hsi gotsonehloiatyplu iecsderbs hte ohglyosit of aspkwio oacrmas as nlidp"es slcle ogfmirn sstli whti axdeasttvear dre doolb cl"els

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5  


submitted by mcl(579),
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oT pdnaxe on ish,t htaw ew thnki pepsnha thwi kiPr'snsoan adeises dna( aaksipnnor)miins si na nabmaecil nebweet dpiaomne nda lelcnyceo.thai It esakm omer esens if yuo look ta shti aa,drigm ngiyap iulrtracap ntattieno ot teh teciidnr athapwy. ossL of erdigaiponcm A()D seounrn orfm eth ttaauinbss gniar Nc)(S tslruse in atotnscn ctianavoti of otshe hCA ietsegrnc oneu,nrs hiwch taylumilte sesrlut ni hoiniitibn of ahlatsmu rmfo giatnnitii mmenesot.v ehTeeor,rf signu cianegncilirosth hlpe whit nokpaimisnraisn oeydsnrca ot oladl.h

mcl  Also, you don't wanna use sinemet since that would be counterproductive +2  
drzed  Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing? +  


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eW're niivgew sthi sliec of het pnlias dcor mfro het ttoobm tr?ghi ehT lfet htrgi albles wysaal ixm em .up

mcl  Yeah, I just stared at this again for a solid 5 minutes straight up dying. I think if we're going with the L/R labels as they are shown on the image, imagine the patient lying on their stomach with their feet pointed towards you and it should make sense. +10  


submitted by lfsuarez(141),
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nheW napstite rea evgni oicniictN nc)ciid(aiNa tyhe rea tlod ot cetepx omcomn dise csteeff to cuorc husc as matwhr nad edsesr.n Oen nca viado htees deis stfeefc by nktiga rnsiaip

mcl  To expand on this, the flushing/warmth/redness is due to release of PGD2 and PGE2 which is why taking an NSAID helps. +16  
snripper  Doesn't acetaminophen inhibits COX 1-2, too? Why can't you use that instead of aspirin? Just wondering. +4  
raspberryslushy  I had this same question too, and had it narrowed down to those two choices. Ended up going w/aspirin but it was sort of a coin toss. Still not sure why it's not acetaminophen. +  
eagleeeee  I think the reason is that acetaminophen is inhibited peripherally and is mainly used to inhibit COX in the CNS +5  
whatup  The worst side effect of Niacin is hepatotoxicity. Acetaminophen is famously known for hepatoxicity so aspirin is a better answer +1  


submitted by mcl(579),
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itnPate smot lkeily has SshaTya-c .diaesse Tsih riuefg ilcyne sshwo hte oaccbiiehlm a.tawphy claelR htta otbh sSTcyaha- and Nnimena Pikc idaeses espnrte htwi a eycrrh edr tops no ofynus,codp btu Tya sScah acksl teh ptooemhaellsapyneg seen in P.N

hungrybox  Man this is such a nice figure except it doesn't have Krabbe disease :( +  
mcl  Here's another one with Krabbe! :) https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg +7  
hungrybox  thank u +1  


submitted by seagull(1404),
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! I htea esteh hiwt a nnugbir **gFin* isopnas. Tbmhsu up fi ouy aereg

mcl  Amen brother +1  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28  
mcl  oh my god are you me +1  
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6  
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4  
abhishek021196  What is HSM? +  
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +  
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1  
djeffs1  @lakshmi Link? +  


submitted by mcl(579),
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cneiS oyr'eu gsolni lla ryou rabibc niot ryuo p,ee you uwldo ceexpt eht pH ot eb omer keailnl.a lAos, seicn eetrh is edcrsedea H++/aN rtpant,io herte si sles dmsoiu rabdoerbse nad erotehrfe easinrdec loss of reef idlfu ot teh uie.rn

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by mcl(579),
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arnPrtoo reest dna dsuauartq are htbo lusdpipe by imneda ernev C(CT5C1/7/6//C8, so ta'ths ont ruspe )u.lelpfh ntxenEsio of the omreafr is aalird neerv oals( T-,C51 slao nto lef)hpl.u siTh sode etll su si ti n'act be iseldoat manide or i.rdaal pecsTri tdnone rxlefe is 78/CC, icwhh oraswrn it wond ot eshte .wto

aCn nenoay elxpnai why it's 7C vroe C8?

joha961  Same question. How could you determine between the specific nerve roots (C7 vs. C8)? +2  
mcl  Someone I was talking to (and post below) was saying that first aid mentions triceps is C7, so that's what should've been the big thing for us. +2  
joanmadd  you might see some ulnar nerve involvement if C8 was involved her +  
passplease  but he has generalized tingling which is in both ulnar and median regions? +  


submitted by mcl(579),
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Sneci yu'reo iolngs all yoru rcibab into ryou epe, uoy ouwdl eecpxt het Hp to eb mroe l.lnaikea lo,sA scnie ereth is dasreedec H/N++a o,itantpr etreh si elss iodsmu breabodres adn ethfoerer iesacrned sslo of fere ulfid ot teh .reniu

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by magrufnis(0),
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’Im uofcdnse tuboa htis o.en naseWske of eeixnnost and oaotnipnr of eth gtihr ,eafmror hwit a aeddsceer tesprci mcuesl tercths exl.efr eTh aenrws was 7C evner ,roto tbu ohw rae oyu aelb ot ealloczi ot C7 nad nto 6C or ?8C I rguefid atht eitnseoxn si idaal,r -C,T15 adn ootrapnin is nimeda, aslo T.C-15 pciTres flexer is C-C87 91F0A(2 yssa )6C.7-C Hwo lwoud oyu wnroar ownd ot ustj 7C gdmea?a

txallymcbeal  My FA2018 has “C7” bolded, meaning it is the main nerve root. But I also got this one wrong so I can’t be much help besides that. +1  
mnemonia  Honestly just a guess but I have this vague understanding that intrinsic hand muscles are C8-T1 so we might’ve expected more hand motor findings as well with a C8 lesion. +2  
theecohummer  I narrowed it down to C7 using the fact that the C7 myotome is elbow extension. I also learned that the C7 nerve root was the main contributor to the triceps DTR so I just went with that. +  
mchu21  They also mentioned that the person had weakness pronating the right forearm which is performed by the biceps. Biceps is innervated by the musculocutaneous nerve which is C5-C7 and that's what helped me pick C7 > C8. +1  
mcl  Sorry, I thought the biceps was a supinator of the forearm? +15  
henoch280  yes.. its the supinator not pronator +  


submitted by mcl(579),
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abSiecs ikesl ot wrroub ni het esraa eebwent eht gifesrn dan stoe F(A 9120 16)1 nad scesau .iihctng uCdlo soal tyantloilep be ecil ongi(r tivmvleen,on) tub menrtetat ofr trieeh vleaspor -- otatg esu ehr.rempint

kchakhabar  If only one person is there to see the doctor, why would the doctor prescribe medicine even for his family members who are not there? +  
mcl  Unfortunately, both of these are pretty contagious conditions. FA mentions that scabies spreads via skin to skin contact, and goes on to mention that you're supposed to treat close contacts. I think in this scenario it's ok to give permethrin to the family members who are not present but affected (it's also non-prescription in some cases, I believe.) Slightly related note, similar to why you would treat the sexual partner of someone with chlamydia/gonorrhea, or close contacts of someone with n. meningitides infection. +10  
teaandmusic  Agree with kchakhabar. Just because pt says others in family have the same thing, doesn't mean they do, they may have a different condition (small chance, but still possible). Not to mention allergic reactions and other considerations that the Dr. isn't aware of regarding family members ... with chlamydia/gonorrhea, etc you'd have the close contact go and see a doctor and get a prescription also, you wouldn't just write out a prescription for someone you haven't seen +  


submitted by hayayah(1056),
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hrtwoG oromneh sganlieer ohrmneo asct iva p-cGuodle esrt.orecp G coeldup eprstroce ndee PGT ot beecmo aedicvtat nda GPTaes ot ecbeom ntdic.vitaae

oN -aGePTs -;-t&g olycrianhcl ceaivt horgwt oeromhn elgnriase ohemnro roepcter ;--tg& ttcnaons cnviaotiat of adlelyny sleaycc / PcAM pawhtay nad lereeas fo thwrog rm.honoe

mcl  This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png +  
mcl  [link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png) +  
meningitis  How did you knkow it was GHRH and not GH perse? +4  
meningitis  nevermind; I just read down below. Thank you +9  


submitted by hayayah(1056),
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Gwrhot roohmen aeseilgnr honorem cast vai pl-coGeud prer.ocset G dlcpeuo ceprteosr eend PGT to obceem cttideaav nda PTGsea to eocmbe t.cneidiavat

oN -GTsPae -t&;-g ccyillaohrn vtacie trowhg ohnoerm lganeesri emohrno reepcort &-t-g; ctotsnna taoivticna fo dnyellay lcyscea / PcAM ptywaah adn releaes fo rgwoth n.mroeoh

mcl  This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png +  
mcl  [link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png) +  
meningitis  How did you knkow it was GHRH and not GH perse? +4  
meningitis  nevermind; I just read down below. Thank you +9  


submitted by mcl(579),
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eglHmori tgo meso caicrevl utltoe ymrdsone nda uhodls byrloabp kaet meso sftuf tou fo ehr cpcakbka or gte noe fo shoet lli reolrl .seno

mcl  Whoops, my bad, THORACIC outlet syndrome +4  
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1  


submitted by mcl(579),
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oT dxnpae on sh,ti ylletgpouostanoih cbseiders hte yltghsoio of opsakiw scoaarm as "ispdnle cells mnrgofi lsits with raetvxedasta rde bolod "elslc

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5  


submitted by mcl(579),
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ncSie ueyor' olnsig lal ruyo irbcba onit ruoy pee, ouy louwd exptec eth pH ot be omre .allkeani o,sAl inecs hreet is aedeedsrc aNH+/+ ,tiropnta ehrte is slse omuisd rbseabodre and otfhreeer aecinersd ossl fo fere iuldf ot teh irn.eu

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by mcl(579),
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ietoDdl is dnretiaven by xylirala ,enrve ihwhc ecoms ofmr otrso 5C./C6 cstonAi fo teh ltdidoe ecinudl utbnoiacd fo het reupp irtt.eemyx

seagull  I hope everyone memorized every single part of the brachial plexus and all the roots of each, No detail let untouched!!! +26  
mcl  In case anyone else has purged the whole brachial plexus from your memory (like me), this is a great resource linked by another user. https://geekymedics.com/nerve-supply-to-the-upper-limb/ +11  
zevvyt  I thought it was radial since he lost sensation in his thumb. If Radial is C5-T1, wouldn't that be included in C5-C6? +1  
alimd  they force us to know brachial plexus like the holy bible +  


submitted by seagull(1404),
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! I ehta ehtse wtih a bnrugin *iF*ng* .iosnpsa bsTuhm up if yuo geera

mcl  Amen brother +1  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28  
mcl  oh my god are you me +1  
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6  
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4  
abhishek021196  What is HSM? +  
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +  
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1  
djeffs1  @lakshmi Link? +  


submitted by hayayah(1056),
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lewro ar:aanniqaotpdu laapreit slnieo

sv preup oapannurtiqada = tramople sielno

mcl  also, to differentiate whether it is the left or right parietal lobe, recall that stimuli from the left visual field hits the nasal side of the left retina and the temporal side of the right retina, then goes to the right side of the brain. [This figure](https://operativeneurosurgery.com/lib/exe/fetch.php?w=600&tok=856a37&media=optictract.jpg) is helpful. +6  
d_holles  So you're saying that there's two crosses, making it ipsilateral? @mci +  


submitted by hayayah(1056),
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etcyrepuHa anrpntalst tieeonjrc oscucr htiiwn imetuns d/t penxr-sitgie intpeirce itenisadob taht artce ot rnodo antnige yep(t II siyevihtpintyres cinta,)oer aeattvci cletnmoep.m

mcl  [Useful figures illustrating transplant rejection](https://www.stomponstep1.com/transplant-rejection-hyperacute-acute-chronic-graft-versus-host/) +  
drdoom  ^ via @mcl [Useful figures illustrating transplant rejection](https://www.stomponstep1.com/transplant-rejection-hyperacute-acute-chronic-graft-versus-host/ +1  


submitted by haliburton(208),
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mSall llce lngu rcecna saeucs AI.DSH ainLocot + xcernusyoail .sulec

mcl  To expand, SIADH may also result in euvolemic hyponatremia. This is because, as we know, ADH increases absorption of water and therefore initially results in an increased circulating volume. However, this results in increased stretch of the atria and subsequent secretion of ANP. ANP (atrial natriuretic peptide) then results in loss of sodium and water. +10