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Welcome to msw’s page.
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Comments ...

 +1  (nbme21#45)

theres a uworld question like this ... ,, rivoraxaban and other factor Xa inhibitors prolong pt and aPTT but they dont affect thrombin time ... while direct thrombin inhibitors prolong PT aPTT and Thrombin time , also unfractionated heparin prolongs aPTT and Thrombin Time (Theoreticallly it should prolong PT too but in the test the PT reagent contains heparin neutralizers that minimize this effect ) . sorry if this veered off course a little





Subcomments ...

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stI’ cutea cahlolo innopctmuso so yttfa hgeanc ermo kiyell. lClarleu niegwsll aectindsi clhaliooc tiaithspe wchih esqurrei ohrcinc lhaocol cntsnopuoim (See AF 9102 gp .385) tA leats ahtst’ eht glico I edus ot pkci yfatt eac.ngh

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +40  
nc1992  I think it's just a bad question. It should be "on weekends" +16  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +20  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +12  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


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stI’ ctaue ochallo tonncmopuis os atfty hncgae erom ek.lyil Cuallrle ngseiwll istinaedc olchoical ttpsehiia hhiwc iusrerqe hccinor holaolc nuonisctmop Se(e FA 2901 pg .385) tA sealt ah’stt the ilogc I duse ot ckip ftyta ngchae.

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +40  
nc1992  I think it's just a bad question. It should be "on weekends" +16  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +20  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +12  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


submitted by tinydoc(223),
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isTh ietquons is rvey nkeays, btu in scseene thsi is swaht ppnaheig.n

Teh calinatced aolmver of het HTP adsgnl niudrg tyoidrmehotcy ⇒ ↓ THP

PTH on-a :-nllimyr :eonb ↑ orlemav fo ⁺a²C nda oeahptPh ormf oi n-enb- k:nediys ↑ ⁺Ca² iprnosbroaet adn ↓ O₄³P⁻ brr-↑np-e soiato rovisnnoce fo ,52 imioxyntHvaydr D ot ,521 aiHtrdinymvxyo D raiocilCt(l - tievca omr)f via ↑ ticvyait of a1- oyHxaylrdes cnyfiecedi

eToefehrr a ↓ TPH ulwdo edal ot:

⇒ ↑ P₄O³⁻ ⇒ ↓ C²⁺a ⇒ ↓ 5,12 dynmvoxtiiryHa D

The oeisuqtn is saekny hm(cu ielk teh tres of sith m)exa seeacbu meeonso woh itsn fsguncio eayrll dhra or in a shru gihtm ckip eth tonipo C ewher tpeahohp si ↑ nad THP is ↓ TUB ↓ 52 imdnvoxiytryha D

Tish si ownrg as ylno 12,5 nyyhitxdimvaor D wlodu be da,rdsceee hte osnvrecison eboerf hits rae onde yb het iksn stn()uglhi nad vre.il

I yaller sihw they dwluo psot gkmnia eht suitosnqe unncisogf YLUPRE fro the aeks of mkanig hetm oucsnfgin. tIns it ghueon htat ew ehva ot okwn hsit luiiosdurc mntuao fo atonnrm,fioi titowuh vihnag tehm eynntoiilntal angkmi it hrared yb gipninot yuo ot 1 reanws ichoce utb ngncihag a nmeitu aitdel ot ekam uoy enawrs ogwn.r rO nisug a adornm ssa teuanrcmlone ofr a eaesdsi ot odvia magikn ti oto eplsim PSG(N = eliev"prfatroi G)N"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1  
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2  
graciewacie9  Amen to the PSGN question. They got me on that one. lol +  
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +  
msw  *pointing +  
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1  
avocadotoast  this bs is prob why the question isnt on step 1 anymore +  
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +  


submitted by tinydoc(223),
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ishT qiuneots si reyv sk,naye tbu in eeesncs tshi is hastw .nephniapg

hTe cicdenlaat rmvaelo fo hte PTH saglnd gniudr hoyryitmcetod ⇒ ↓ THP

PHT mnilolr: na-y- be:on ↑ omvealr of aC²⁺ dan phehPtoa romf inen--o b eyskn:di ↑ ⁺aC² santboirepor dan ↓ ₄P³O⁻ rtep ibrns↑o-oa- vnroosecni of 25, ytdiarovixymnH D ot 52,1 tairvHiomnyyxd D rcClo(liita - eavcit o)rmf via ↑ iiyvattc of -a1 dlroHeyayxs ceydefinci

rTehofere a ↓ PTH dwoul dael :to

⇒ ↑ ₄⁻³OP ⇒ ↓ C²a⁺ ⇒ ↓ 125, vxiyoidrmtHany D

hTe neqitous is anyske m(hcu eilk eth sret fo hist xe)am baesecu snomeeo hwo nits fncgsoiu alyler drah or ni a hrus tgimh pikc the intoop C wrehe etaphpoh is ↑ and PTH si ↓ BTU ↓ 52 niyhtmdrxiyova D

sThi si nwgro sa oyln 2,51 nxmrvyityahodi D dlwou be seeddar,ce teh ioesnnocvsr erbefo itsh rae oden by het nksi (ntgi)ushl and re.vli

I alryel whis tyeh wulod post gkamin eth ousnitesq ofsucignn UPLEYR fro teh eksa fo kagnim temh fignnc.suo Itsn it ehongu atht we evha ot konw htis icusoulrdi antmuo fo f,tronioamni hoitutw ihvnga them lnntiyelniaot kganmi it aherdr yb tipngoni yuo to 1 anwers hoccei tbu chiangng a mitneu teadil to meak you seawrn wgrno. Or ignsu a odnarm ssa nlremtuoneca fro a eedasis to viado kagnmi ti too slpmei GNSP( = aeifiptre"vlor NG)"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1  
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2  
graciewacie9  Amen to the PSGN question. They got me on that one. lol +  
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +  
msw  *pointing +  
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1  
avocadotoast  this bs is prob why the question isnt on step 1 anymore +  
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +