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Comments ...

 +0  (nbme23#42)

I figured this was a variable intrathoracic obstruction and got it wrong.

According to UpToDate, INTRAluminal tracheal obstruction is varaible, while EXTRAluminal tracheal obstruction (like in this case) is fixed.


 +0  (nbme21#17)

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine

mrglass  I meant to say Cysteine and Methionine*

 +1  (nbme21#8)

Despite the patient not being intoxicated, this patient is presenting with classic findings of Wernicke-Korsakoff syndrome. Even if you figured that Thiamine deficiency wasn't likely given the history, if you know that WKS causes mammilary body atrophy, and this "mystery disease" is causing similar symptoms to WKS, you can guess that this "mystery disease" is causing mammilary body atrophy


 +0  (nbme20#35)

Why would this not be acute transplant rejection leading to ARDS? The creatinine is elevated, and I see any reason why it would be elevated beyond rejection

sammyj98  I selected the same. I think part of the question wanted us to recognize that the pt was not receiving CMV prophylaxis (hinted that they are getting TMP-SMX but no Gancyclovir) so they're at really high risk for CMV specifically. UpToDate: •Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations. (See 'Cytomegalovirus' above.)




Subcomments ...

submitted by sacredazn(48),

The concept is a convoluted way of asking if you knew how VDJ recombination works, which is that it is actually an example of altering the DNA of the B/T lymphocyte.

Southern blot technique: So when they use a probe against some region, and outputting a size of 1.5 kb or 6 kb, this is telling you the size of the DNA fragment in each cell (doesn’t matter if they say J probe or constant region probe, they’re just saying they’re targeting some nucleotide sequence found in the Ig locus/TCR beta chain locus respectively for B/T cells).

I think the confusing part could be wondering how you know whether you’re partly through rearrangement (answer choices B thru D) or if it hasn’t occurred at all yet (correct answer). Here, the concept is that B cells undergo V(D)J rearrangement in the bone marrow, while T cells do it in the thymus, and it all happens at once. So a plasma cell in the blood like in Multiple Myeloma would have fully undergone recombination, while a T cell in the blood could either be fully educated (and have finished VDJ recombination) or immature (hasn’t started VDJ).

Since the T cell gene was 6 kb and definitely bigger than the 1.5 kb gene, the T cell hasn’t undergone recombination yet.

trichotillomaniac  very nice explanation! +7  
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4  
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +2  
ribosome01  I would like to meet you personally and say thank you I wish I had a teacher like you +  
ajss  wow! this explanation was awesome! thanks! +  
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +1  


submitted by seagull(714),

out of curiosity, how may people knew this? (dont be shy to say you did or didnt?)

My poverty education didn't ingrain this in me.

johnthurtjr  I did not +  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +8  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +11  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +  
jaxx  Not a clue. This was so random. +  
wolvarien  I did not +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +4  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +2  
djtallahassee  yea, I mature 30k anki cards to see this bs +3  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +1  
drschmoctor  Is it biochemistry? Then I do not know it. +1  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +  


submitted by mrglass(6),

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine

mrglass  I meant to say Cysteine and Methionine* +  


submitted by paloma(5),

What about pulmonary vascular resistance? It follows the systemic vascular resistance?

cooldudeboy1  crackles are heard bilaterally so there is pulm patho which leads to increased pulm vascular resistance, since systemic blood flows into the lungs. any block in the flow ahead (lungs) will increase resistance in flow behind ( systemic ) +2  
mrglass  This patient is hypoxic increased diffusion distance. This causes pulmonary vasoconstriction. Ordinarily this response is designed to shunt blood to parts of the lungs that are well ventilated, but the response is maladaptive in global hypoxia +2  


submitted by yotsubato(519),

It cant be Bacterial abscess (Nocardia) because shes taking TMP SMX.

It cant be toxo, because she has one lesion and is also taking TMP SMX which should improve her symptoms.

Glioblastoma is a disease of older individuals

Metastatic disease that mets to the brain is unlikely at this age.

CNS lymphoma is common in HIV AIDS patients, so that is the most likely choice.

mrglass  She's not taking TMP/SMX though. I would pick lymphoma over abscess mainly because .5cm growth in 2 weeks is incredibly rapid, which is classic for diffuse B-cell lymphoma, which is what tends to be in the CNS. Also there was no evidence of a classic source of brain abscess like mastoiditis. +