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Would pheo have a normal resting BP though?
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
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.
Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing.
No problem! Thank you for all your contributions throughout this page!
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.
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.
UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure.
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
How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin*
its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy.
Once again, another example of me knowing the concept but not knowing the obscure pseudonyms for common knowledge so I get the question wrong
I saw green and immediately thought of pseudomonas and crossed that answer out. Didn't know they were talking about alpha hemolysis!
However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad
oh what a catch! I also thought this was Blasto until you explained otherwise
Blasto = broad-based budding, the two 'circles' look equal in size.
Crypto = narrow-based -unequal- budding.
^ I would disagree a little bit. "Broad based" and "narrow based" refer to how smushed the circles are. So narrow based is when the membrane bit they're sharing is small, and broad based is when they share a lot of membrane. So if just pinching off --> crypto, if they look stuck/have a flat membrane between them --> blasto
Azithromycin is a macrolide, not an aminoglycoside FYI, and its use in HIV is primarily as prophylaxis at very low CD4 counts for, among other things, the mycobacterium avium complex.
How would we have known to choose Zidovudine over Lamivudine tho
@nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off
you have ero bone marrow if you take idovudine
the z's were supposed to be bold idk what happened.
you have Zero bone marrow if you take Zidovudine
Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects
thats actually really funny
Because I said so, applies here... :-/
Cant believe we pay $60 for this crap
best comment doodimoodi)
that fucking threw me off on exam. I was like is there an effect modification by "Not drinking milk". the fuck!
Standard lab values are incorrect, way to go NBME.
I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg.
I lost a bit of time wondering about that ugh lol
I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high.
Pseudo tumor cerebri can have normal ICP. Who knew
Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles?
They are just asking about side effect of statins, not about treatment of hypothyroidism
Hypothyroidism is just a red herring.
statins cause both hepatotoxic and mypopathy so I want for hepatotoxic:( I thought usmle expects different stuff
Statins don't cause 'toxic hepatitis' they just cause a mild asymptomatic rise in LFTs that is reversible with discontinuation of the drug. The more worrisome side effect is of course, myopathy
statins cause both liver injury and myopathy in a dose related, so kidney failure increases their dose, which leads both liver and muscle risk elevated;
Pravastatin is said less liver concerns but the myopathy, so choose myopathy when renal failure.