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Welcome to medschul’s page.
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 +1  (nbme20#35)
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I nca egt beihnd peeysl,mongla tub wath is the dreirs?do

sup  Felty syndrome, an extraarticular manifestation of RA. Symptoms include a triad of RA, splenomegaly and neutropenia. It's in FA, you just have to squint (look at the fine print under the RA vs OA table in the MSK section). +21

Subcomments ...

submitted by yotsubato(1041),
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hyW is the tptaine ton in .pain I olnwdtu ecxpte caenrIcdrtae anhier to ptnsree ihwt roez api,n utb 1 ewek fo nnoisoacttpi dan wslel.gni

yotsubato  Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas. Like really? Why is he not in pain? +2  
medschul  I thought that inguinal hernias were reducible? +  
fahmed14  could be a femoral hernia as they are more likely to cause incarceration. They do, however, present more often in females. (FA 2019- 364) +1  
wowo  incarcerated, not strangulated, thus no pain as there's no serious tissue damage/ischemia. Incarcerated hernias may progress to strangulated in which case he would have pain Under section, "complications" +6  

submitted by medstruggle(12),
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hWy si eveattilran iiscpnlg ro taoclrrsp-ptsainntoi ifcidnomatio orieccr?nt

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 shaydawn88(8),
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Is ti vta-olnrlearia asuntadrets esauceb thsi tniepat mtghi ahev FH t/d .a bfi nda ltfe liaart &n;nlgregteme-ta cin ritasthydco gusee-;&rprts aurnstatde peaullr soufnf?ie

sajaqua1  Basically. +4  
medschul  Why can it not be arterial hypertension? +2  
meningitis  I think Arterial HTN is referring to Pulmonary Artery HTN which would be present in LT HF in the long run with RT HF and edema. Pulm HTN would cause a backflow, and doesn't really answer the question "explain the patients Dyspnea". At least, that's how I saw it. Hope this helped. +5  
sugaplum  the question has 2 murmurs, so does she have aortic stenosis too? i guess it is not relevant since it asked for what is causing her SOB +2  
nukie404  I guess pulmonary HTN would happen in response to increased pressure after the edema happens, and would cause backflow (to the RV) over pulmonary edema. +  
vulcania  There's a really great diagram in UWorld (QID 234) that explains what happens as a result of mitral stenosis. Very similar sounding to the patient in this question. +  
srdgreen123  @sugaplum, yes rheumatic heart disease can cause mitral and aortic stenosis. Rheumatic aortic stenosis can be distinguished from degenerative aortic stenosis by 1)coexisting mitral stenosis and 2)fusion of the commisures. +1  

submitted by welpdedelp(229),
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No etdi cfdey,eniic eth ntpeait had exescs oneatcre deu ot ish deit

sympathetikey  Would never have thought of that. Thanks +9  
medschul  that's messed up dog +19  
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +  
davidw  this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7  
davidw  β-Carotenes are present in dark-green and yellow vegetables. +  
hyperfukus  ohhhh hellllll no +7  
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6  
cbreland  I'm okay with missing this one +4  

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ttPneai ahs a olgangni cy,st whihc anc osunyeasnplot e.ssgerr

medschul  Mine would beg to differ >:O +28  
usmleuser007  Where would I have come across something like this (FA, Pathoma, or out of my S)? +5  
motherfucker2  I thought this bitch was a lipoma. Mother fucker +9  
divya  mf2 lipomas is fat. although fat may exist in liquid form, its still opaque, therefore negative transillumination. unlike ganglion cyst. +4  
beanie368  Only knew this because I have one that comes and goes... +4  
cbreland  I thought these were like a 1-way valve? Didn't think it would regress if that was a case? +  
yesa  I had that exact ganglion cyst because of too much multichanneling in lab, it would go away if I didn't use my hand for a while but then come back if I did. Had to get it surgically removed during first year of med school... +  

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xnfoaiTem ahs to be aibeldzotem aiv tfsri asps msbamiloet to an vtieac otalbtmeei xn(oeedi)nf. hTe anpttie ash ecdreedsa asnectcnrnitoo of the bedeizlaomt ourpdct iinadgticn htat hte anep’stti airp of trmhococye 5P40 laeells rneta’ nztblmiioega ntaimfoex lcycreo.rt The qtosuien is akgisn thaw het echcans are eht ietssr hsa eht msea teep,oygn iwhch wludo be 25% ;-&g-t 21/ * /21 = 41/

medschul  How do we know the parents are not homozygous +6  
yotsubato  Chances are they are not unless they had or are incestuous +  

submitted by seagull(1583),
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lupeoC sway to etg eht w.nsrea .1 ssaoniten of eht teariron hhgti adn adimle egl rae yb naecrhsb of hte meolarf erenv (,3L ,L4 5).L 2. Scine eth atniorer gihth si aeedctff eth laetprlal lexerf is ykelli fadeetfc chihw is a rabnhc of 4L.

medschul  Isn't the femoral nerve innervated by L2-4? +4  

submitted by meningitis(546),
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enhW nngisatd ,pu eth ybod olrmalny eivsctata shmptyaitec eystsm to aodvi rtocoathsit tnhsyioonpe.

uBt nseic hteer si onw an viiadted efcfet fo teh ehocommcapyhtoor ei,rgnsdreac it lwil adle ot a sirhpnnoyete

.:(ei ubeolD sioasvtrccitonon = oePh idgneercras + iyeSamhpttc smts)ey

sympathetikey  Brilliant. +5  
medschul  Would pheo have a normal resting BP though? +13  
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +  
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +8  
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +1  
nala_ula  No problem! Thank you for all your contributions throughout this page! +1  
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +  
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +  
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +  
hello_planet  FA 2019 pg. 336 +1  
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +  

submitted by strugglebus(165),
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The eytasbrrwr ghsamnmeioa etnd to rwog dna hetn rnamdoyl o.vitluen

medschul  My problem with this question is that a strawberry hemangioma should continue to grow until 5-8 yrs old so I did not see the answer choice "Continued enlargement as the child grows" would not be an acceptable answer as well. +10  
merpaperple  I still don't get that. Over the course of the next 5 years, it will 1. continue to enlarge as the child grows, and also 2. spontaneously involute. Both answers are literally correct. +  
fatboyslim  "Continued enlargement as the child grows" implies that the strawberry hemangioma will continue to grow and will not regress with time. That's why it's wrong I think +1  

submitted by strugglebus(165),
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As na d8t0i,:0 011e loeppe oeedprrt ot ehav ieds ceesfft wenh gikatn ac lrnzhHgioAyeioomddr.oth hte,m 25 poeelp (0%2)0. veah Baetrs hgicdreas

neonem  I think the best way to answer this question was by process of elimination. +1  
sympathetikey  That's some bullshit lol +9  
karljeon  Haha I eliminated the answer by process of elimination. +20  
medschul  I eliminated thiazides by process of elimination :( +1  
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary +2  

submitted by celeste(83),
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ihsT ndusso keil nFaocin sodr.myne The oxairplm btruula heatliilep selcl haev a darh mite beinrosarbg eitrtl,fa so ylou'l see a sslo fo tshhaoppe, aoimn dai,cs otecaair,bbn and gsleco.u

medschul  Wouldn't Fanconi syndrome also cause hypokalemia though? +4  
yotsubato  Especially considering the fact that the DCT will be working in overdrive to compensate for lost solutes??? +1  
nala_ula  This question did not make sense to me at all. I knew it was Fanconi syndrome yet didn't select the obvious answer because it said "follow up examination 1 week after diagnosis". I thought it would already be in treatment... I searched (now) and it says that treatment is basically replenishing was is lost in the urine. So definitely the wording is like wtf to me +1  
sugaplum  I was thinking since it affected the PCT that Na resorption would be affected as well? But I guess the other segments will pick up the slack? +