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It's not necessarily late dumping syndrome, this is the dietary guideline for early dumping syndrome too. Based on UpToDate and ScienceDirect this is how it works:
Absent or dysfunctional pyloric sphincter
-> food is rapidly emptied from the stomach into the small bowel
-> hypertonic solution forms in the jejunum
-> rapid fluid shifts from the plasma into the bowel
-> hypotension and SNS response (eg. colicky abdominal pain, diarrhea, nausea, tachycardia)
Simple carbohydrates are more hypertonic, I think.
starches are complex carbs= more than 2-3 sugar molecules, if they have dumping syndrome they have decreased gastric transit time= more undigested carbs are delivered to the intestines and that gives you more carbs for bacteria to break down (flatulence and osmotic diarrhea)
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.
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.
"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
I agree with you, only possible logic for their answer:
the qualifier asplenic makes the "ShIN" pathogens more likely, even though Ecoli can cause gram negative sepsis and DIC. FA 2019 pg 127
Also it says s pneumo causes sepsis specifically in asplenic patients Pg 136
To be honest, the only reason I got this right (because I really was thinking E.Coli as well), is that I ended up remembering the MOPS part of the Sketchy, and I couldn't remember if he said that it was the number 1 cause of all of them or not, and ended up clicking it. It's pretty shitty they don't offer explanations for these.
I thought this too but it seems like Strep pneumo is just more specifically associated with infection in asplenic/sickle cell patients than E. Coli is. Just one of those classic associations. There's a sickle in the Sketchy Strep pneumo sketch, vs. no sickle in the E.Coli sketch.
E. coli causes pneumonia by aspiration, for which this patient had no risk factors. For USMLE, if they don't say the patient is vaccinated, you can assume they are NOT. Just because she has a history of splenectomy following trauma does NOT mean she had to been vaccinated--don't fill in the history for the patient, only use the information they give you.
also DIC more often seen with G- bacteria right???? That's why I chose E.coli instead of S.pneumonia
As best I can understand, what they are trying to get at is that "EMB stain showing neutrophils" -> "EMB stain NOT showing organisms" -> more likely Shigella than E Coli. If a special culture for an organism (e.g. EMB for E. Coli) shows no organisms but only inflammatory cells, i.e. neutrophils, that means that organism is not present. If that's the point here it's kind of a trick question, as we all would have gotten it right if they had just said "EMB showed no organisms." I guess the takeaway is that the point of a special culture is binary - you are looking for a specific organism, and it is either there or it isn't.