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Welcome to mtkilimanjaro’s page.
Contributor score: 7


Comments ...

 +0  (nbme22#6)

Another way to think about this is just that decreased O2 leads to dysfunction of the Na+/K+ ATPase as others have mentioned.

This is pretty much identical to the mechanism of digoxin, which blocks the Na/K ATPase and calcium accumulates in the cell because it cant be exchanged for extracellular Na+ (which is not intracellular due to defective Na/K ATPase)


 +0  (nbme24#27)

Also to note: Uric acid KIDNEY STONES are rhomboid not needle shaped. I was dumb and thought gout crystals in synovial fluid were rhomboid and forgot about needle shape :(





Subcomments ...

submitted by gh889(115),
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ehT senawr is ude ot an necoxietp oldnetui hree rwehe cnnaii si ueds in pst o/w etbesida woh veah otyrfrarec cyrirelmaeteiiryhdgp at ihhg ikrs ro sah a xh fo re.ptasictani

I egare htta tfiebars aer fitrs ilne d(na so sedo ttah ltiace)r but ENMB asw nnoigh ni no a eifpsicc xpieotnec hatt iicnna acn laos eb udes sinec LVDL adn GsT are hhig in yiegycphmi.dirarelrte

hTe c""elu yteh adh swa nrc"rreetu rtca"sentiaip hicwh si udesplpsoy a adel sdtwoar nani.ci

I olsa put iaersecn D.LH...

wutuwantbruv  Correct, you would not want to give fibrates to someone with recurrent pancreatitis since fibrates increase the risk of cholesterol gallstones due to inhibition of cholesterol 7α-hydroxylase. +  
kernicterusthefrog  FYI @gh889 can't follow your link w/o an NYIT username and password, unless there's a more tech-savvy way around that.. I appreciate the info, though. Niacin rx for familial hypertriglyceridemia w/ recurrent pancreatitis. Now I know.. +2  
impostersyndromel1000  Great points, very in depth knowledge taking place here. Also, familial hypertriglyceridemia (per FA 2019 pg 94) has hepatic overproduction of VLDL so picking this would have been the easiest answer (in retrospect) +2  
hyperfukus  @impostersyndrome1000 literally that's the ONE thing i remembered and i went YOLO lol cuz i was staring for a while +  
osler_weber_rendu  @gh889 I agree niacin is the answer, but even niacin causes increase in HDL. As if getting to the drug wasnt tough enough, NBME puts two of its actions in the options! What a shit question +1  
mtkilimanjaro  I forget where I saw (maybe UWorld), but I always thought increasing HDL is never really a primary form of lipid control. You want to lower the bad cholesterol etc. since increasing good cholesterol wont change LDL VLDL etc. +  


submitted by usmleuser007(370),
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Mtoerh si g-nhRe -;g&-t esh liwl entreage dti1s nHoi)a-eRb tuesf aefedtcf by AtR-nhi if ti is pi 2)oeRv-isht nvee if -stRh-iPoiOve si evin,g nthe tllis hstr'eom ebadihnsRo-ti wlil attack rnfdtseaus lobdo eud ot ist slelc inicaontng ) hR+3 orfrthe,ee ieht--vgenaOR si bste

makinallkindzofgainz  you're not wrong, but I think it's better to have put O-negative because that's the preferred type of RBC for transfusion unless you've type and crossed your patient +  
mtkilimanjaro  I think fetus is O+ but if you give them that the RBCs will still be destroyed. You want to give O- as it wont get destroyed and wont affect the fetus in any way. Similar mechanism to giving platelets to someone with TTP, HUS, etc. they just get destroyed so its useless +  
tylerwill33  In utero, should give O- to avoid mom attacking again. After birth, O+ probably better. +  


submitted by seagull(1404),
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This is na tpleicnemo roihmaydtidf m.oel Tyeh intanco miotenelpc eaflt arpst giicnundl mste llsce hiwhc rae rmtysio and eigv rsei ot neusdcuurttr siets.u

kard  Can someone explain why the other choices are incorrect?, Thanks +  
mtkilimanjaro  I got it wrong and put the lacunae one, I wasnt sure if hematopoietic stem cells could occur from the mother as well. If it had any other cell line i wouldve picked it. For the others: this lady has a partial mole, which has fetal parts. A complete mole has NO fetal parts. Both mole types have cyto, syncytio, and villi. Thats how I ruled those ones out +2  


submitted by armymed88(47),
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pashymmee alsde ot C2O rptpigan engidal ot arnecsei 2aOCp in eht obld,o cwhhi veisg yuo a poitareysrr iaidssco proPer aelrn teincpmnoaos lwli resicaen arbdic serab nda eraecdse ecioxetn-r igivgn yuo raceeisdn ibbarc in eht doobl

meningitis  Increased blood HCO3 could have easily been interpreted as increased blood pH aswell. FOllowing your explanation, since the pt had acidosis, the increased HCO3 will just make it a normal pH. Another way to think of the question is: if there is decreased exhalation due to COPD --> increased CO2 --> increased CO2 transported in blood by entering the RBC's with Carbonic Anhydrase and HCO3 is released into blood stream. So increased CO2 -> increased HCO3 seeing as this type of CO2 transport is 70% of total CO2 content in blood. +21  
drmohandes  I thought you could never fully compensate, so your pH will never normalize. Primary problem = respiratory acidosis → pH low. Compensatory metabolic alkalosis will increase blood HCO3-, but not enough to normalize pH, it will just be 'less' low, but still an acidosis. +3  
mtkilimanjaro  I also think decreased blood PCO2 and increased blood pH are very similar (less CO2 in the blood means less acidic, pH could go up) therefore I ruled both of them out just from that +  
brise  Aka this is the Bohr effect! +  


submitted by armymed88(47),
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uocGesl si prdns-ectaotro noti eytoesncetr fo SI iva iosmdu

toxoplasmabartonella  That makes that glucose needs to be given with sodium. But, what about bicarb? Isn't the patient losing lots of bicarb from diarrhea? +3  
pg32  Had the same debate. I knew glucose/sodium was the textbook answer for rehydration but also was wondering if we just ignore the bicarb loss in diarrhea...? +4  
makinallkindzofgainz  @pg32 - Sure, they are losing bicarb in the diarrhea, and yes this can effect pH, but it doesn't matter that much. You're not going to replace the bicarb for simple diarrhea in a stable, but hydrated previously healthy 12 year old. You're gonna give him some oral rehydration with a glucose/sodium-containing beverage. Don't overthink the question :) +2  
makinallkindzofgainz  *dehydrated +  
teepot123  salt and sugar, that's all the kid needs when ill simple +1  
mtkilimanjaro  Hm I put bicarb/K+ since thats lost in diarrhea, but I think the key thing in this Q is that its only 6 hours of acute diarrhea and nothing else. You would prob give bicarb and K+ in more "chronic" diarrhea over a few days or longer not just a few hours +1  


submitted by usmleboy(9),

Could someone explain why "Cardiac catheterization with stent placement" is incorrect?

My thought process was that this guy has an occlusion of his RCA --> knocking out his AV node --> 3rd degree AV block. Also his pulse is 40 which suggest a RCA infarction as well.

The reason I went with this is because he got to the hospital within 30 minutes and they put this information first and made it seem important. If his RCA could be opened up, then the damage could be reversible.

I get the pacemaker, but first I feel like you would attempt to unocclude the vessel and give it some integrity.

hajdusa  That choice is incorrect because you can't assume that he has an occlusion from the information that you have. There can be many etiologies of a heart block, and they do not have to be ischemic in nature - for example there are different microbes that can cause heart block too. Additionally, if this guy were to have an RCA occlusion you'd likely see evidence of ischemia or infarction on the ECG but the only findings we're given are bradycardia and 3rd degree block. Hope this helps! +  
mtkilimanjaro  Also, the two cardiac catherization options would ultimately result in a similar outcome. It's like how the poster above mentioned the two imaging are very similar that you can rule them out. +  


submitted by hungrybox(968),
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kaa apmulla fo rtVea ro hte tcairenopatphaec tdcu

hungrybox  tripped me up cause I didn't know the names :( +13  
sympathetikey  @hungrybox same +9  
angelaq11  omg, same here! I thought, well, I don't know of any duct that connects the pancreas to the liver, so...2nd part of the duodenum it is :'( :'( +7  
alimd  actually Ampulla of Vater is located in the 2nd part of the duodenum. +  
mtkilimanjaro  I think 2nd part of duodenum could be viable if the ampulla was not an option. The ampulla is way more localized/specific to this scenario +  


submitted by jambo2222(28),
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st’I an acamososrt.oe cmSaaor = tshnugeeomoa sm.et Its’ in eth slge os ntkhi owh a VTD egos to lngu. eSam eadi.

tinydoc  Perfect way to remember it. Thank you! +7  
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1  
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +13  
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +  
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1  


submitted by neonem(550),
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oiclmendsgysoiA aer r;itoecxohnp hoixnercopt acshmsiulgcdre/ saceu ucate ltuubar oscrnise (,)NTA techzdarcerai yb gemdaa ot the TPC. ANT scause eht tafrioonm fo nwr,ob dmyu,d urglanar ssatc ni eht urnei. hTe fcat ttha hsti pnetait si a igcuialqrepd htimg eb tinggugess that htye veha a oelrw volmeu of dubnoistitri orf eht rudg n(da refoheert ieghrh obodl o.oan)scntntirec

mtkilimanjaro  I would also like to add ATN is nephrotoxic ischemia and the two places in the tubule that are susceptible are the PCT (proximal straight part) and the thick ascending limb. The TAL is not labeled as a choice so that is why it has to be B (and why B is a little further down from the convoluted part) +2  
mtkilimanjaro  Actually aminoglycosides might only affect the PCT idk :( +1  
peridot  on p. 591 of FA 2019, it talks about ATN. The two types are 1. ischemic - affects PCT and thick ascending limb because those two areas use ATP the most (think of all the ion pumps) and 2. nephrotoxic - PCT only (I think of it as that's the first part, so it's most exposed to toxins). Aminoglycosides fall under scenario 2. +1  
cassdawg  If you wanna see nephrotoxic drugs in one place, here's an image with the locations of different nephrotoxic drugs: https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41581-018-0003-9/MediaObjects/41581_2018_3_Fig1_HTML.jpg +2  
corndog  Before anyone looks at @cassdawg link, consider taking some Loperamide. +  


submitted by neonem(550),
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dAinocsmgliyose rea rhxeoci;pnto xroethnipoc d/scemigarlshuc eausc eutca utlraub oicsrnes TN,A() aeeitrdzhcrac by dgmaae to hte P.TC ANT aescus het ioafmtnro of nwob,r my,dud rarualng atscs in het rien.u ehT fatc ttha sith peitatn is a idgpucreialq hgtmi eb gtiusgseng that yeth eahv a lweor omvule fo dibonursitit for het rdug d(na heroretfe eighhr loobd ctrn.etinaocsn)o

mtkilimanjaro  I would also like to add ATN is nephrotoxic ischemia and the two places in the tubule that are susceptible are the PCT (proximal straight part) and the thick ascending limb. The TAL is not labeled as a choice so that is why it has to be B (and why B is a little further down from the convoluted part) +2  
mtkilimanjaro  Actually aminoglycosides might only affect the PCT idk :( +1  
peridot  on p. 591 of FA 2019, it talks about ATN. The two types are 1. ischemic - affects PCT and thick ascending limb because those two areas use ATP the most (think of all the ion pumps) and 2. nephrotoxic - PCT only (I think of it as that's the first part, so it's most exposed to toxins). Aminoglycosides fall under scenario 2. +1  
cassdawg  If you wanna see nephrotoxic drugs in one place, here's an image with the locations of different nephrotoxic drugs: https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41581-018-0003-9/MediaObjects/41581_2018_3_Fig1_HTML.jpg +2  
corndog  Before anyone looks at @cassdawg link, consider taking some Loperamide. +