to snoo-finity ... and beyond!
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I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description.
I think they were getting at how developing T1DM and schizophrenia are both multifactorial. I don’t remember what the other choices were off the top of my head, but they had clear inheritance patterns.
why not midsternal thoracotomy?
Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy.
Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause?
Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why?
The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :(
Everyone is correct about the Encapsulated microbes, but this is one of those of "MOST LIKELY",
and by far the most likely is S.Pneumo>>H.infl>N.Mening. (omitting that patients with history of splenectomy must be vaccinated.
Gram negative are more common in DIC my friends
Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting
Correct. Might cause pain due to ectopic gastic tissue.
Yeah, I was thinking about that while taking the exam. Just got thrown off because I don't see how that matters, now that they've fractured the femur. How do prior increases in bone density allow for better chances of bone healing?
Usually on the left because the liver prevents herniation through the right hemidiaphragm
aka congenital diaphragmatic hernia
What's weird to me is that if you usually see air in the intestines on x-ray when they are in the abdomen, why is there no air in the thorax in CDH? The intestines should still have air in them, right? Also, what is filling the abdomen that causes it to appear grayed-out in CDH?
Crepitus is used to describe bone-on-bone grinding. Subcutaneous crepitus is very specific sound referencing air finding its way into the skin which you can hear but also feel by rubbing your hand over the affected area. The addition of subcutaneous lets you know we are specifically talking about air in the skin.
But that doesn't make sense. Page 233 of First Aid 2019 edition clearly states that being plasma protein bound creates the lowest volume of distribution, because not being bound to proteins increases the chance it will reach deep into the tissues before it reaches the kidneys. Discrepancy with First Aid?
my reasoning was comparing two drugs, both with Vd of 1, the drug with the lower albumin binding would be cleared faster @kingtime. I don't think you're considering that A and B have equal Vd.
Vasoconstriction of the EFFERENT arteriole actually leads to increased GFR. It selective VASODILATION of the efferent arteriole effect of ACE inhibitors since they undo Angiotensin II actions.
This patient already has rescued renal blood flow due to bilateral renal artery stenosis, the addition of an ACE inhibitor further decrease GFR prompting an increase in renin due to loss of negative feedback.
omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school!
yeah, i’ve never heard of antiphospholipids increasing PT time ...
Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis)
I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies.
No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it
UWorld mentioned "prolong aPTT (and sometimes PT)" in APS
@yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal."