Welcome to mumenrider4everโs page.
Contributor score: 63
Subcomments ...
nc1992
First aid has a lot of errors
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yotsubato
Thats not an error though. Thats the actual reason behind giving hyperbartic O2 for CO poisoning...
+12
mumenrider4ever
The question ask how long it takes to remove all the CO-carrying RBC so I think they're implying that theoretically not every single CO-carrying RBC would be replaced with oxygen from the supplemental O2 and some would die off naturally
+2
mumenrider4ever
While you will have a high serum potassium, your total body potassium will be low due to very low intracellular potassium (which is where the majority of the body's potassium is usually).
This is why you give potassium to patients with DKA
+1
passplease
Why do you not get an increased bicarbonate concentration?
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briangibbs3
Bicarb acts as a buffer and binds up excess H+ in DKA
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jurrutia
In other words, DKA a is a cause of metabolic acidosis. Hallmark of MA is low bicarb.
+1
skonys
Also INsulIN shifts K+ INto cells. Insulin is used as a treatment for hyperkalemia. This person has DKA thus low Insulin so shes expected to have hyperkalemia because insulin isn't shiting K+ into cells. Theres also the DKA acidosis too.
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usmleboy
Gaaaaaatttoooraaddeeee!
Water sucks! It really really sucks!
+3
skonys
Any hydrohomies? My patient's will be getting straight RO water to the neck. None of that heretical devil-drink.
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chaosawaits
@rockodude, if only FSU had made it; we'd all be drinking Seminole Fluid ;)
+1
ht3
you're definitely not alone lol
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yotsubato
And its not in FA, so fuck it IMO
+1
link981
I guessed it because the names sounded similar :D
+18
yb_26
I also guessed because both words start with "glu")))
+30
impostersyndromel1000
same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle.
+1
jaxx
Not a clue. This was so random.
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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?"
+10
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.
+6
taediggity
I literally shouted wtf in quiet library at this question.
+2
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
+25
drschmoctor
Is it biochemistry? Then I do not know it.
+5
jesusisking
I Ctrl+F'd glucosamine in FA and it's not even there lol
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batmane
i definitely guessed, for some reason got it down to arginine and glutamine
+3
baja_blast
Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic.
+2
feeeeeever
Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing
+1
schep
no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle
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flvent2120
Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least
+1
taediggity
Goljan and FA mentioned this as Monday Disease for people who worked in industries that heavily used nitrates, where they would build tolerance during the week and then get a headache when they went back to work on Monday
+4
nootnootpenguinn
Just to add to this- one of the side effect of NG when given to patients with MI is "massive headache"! That's how I the question right!
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mumenrider4ever
This is similar in how triptans induce vasoconstriction which is used to treat migraines
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wishmewell
NVM! i read the question again. The patient has visited already 4 times with cheif complains regarding sexual organs in a short period of time. According to FA page 262 (2018) at this point a chaperone should be added, if this doesnt help then the patient needs to be forwarded to another physician.
+5
groovygrinch
Can someone explain why " Tell the patient that it is common for patients to fantasize about their physicians" is wrong?
+7
mumenrider4ever
@groovygrinch I don't think it's normal for patients to have sexual fantasies about their physicians lol
+20
jurrutia
Switching to a neutral subject doesn't "address the problem". Never refer, always address the problem.
+3
jbrito718
a 35 year old with a chaperrone doesnt sound right to me. but nothing in NBME sounds right. I really hope step isnt this retarded
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neurotic999
I was between chaperone and switching to neutral topic. With the chaperone I somehow felt it was against the patient's privacy and shi*. lol.
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leonelgonzalezdiaz
look at the chief complaint, it is pretty obvious why she is there when you add the rest of the information, you need a chaperone.
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m-ice
M1 receptors are for sure the major muscarinic receptor type found in the CNS, but M3 receptors are the muscarinic subtype involved in vomiting controlled by the CNS. This is definitely a random fact, but I think they also wanted you to eliminate all other options. Targeting the sympathetic system (options A and B) won't make a difference. NMDA receptors are a major receptor throughout the CNS, but they're not a target of antihistamines, and neither are serotonin receptors. We know that antihistamines target histamine and muscarinic receptors, but the H2 histamine receptor is responsible for gastrin secretion in the stomach, so the answer must be antagonism of M3 receptors.
+8
dorsal_vein
^ First generation antihistamines definitely antagonize serotonin receptors within the CNS, which can cause weight gain and increase appetite. However, this plays little role in motion sickness.
+15
mumenrider4ever
That is confusing because scopolamine (anti-muscarinic used to treat motion sickness) is an M1 receptor antagonist
+4
osteopathnproud
I had @m-ice logic down to H2 and M3, then from base knowledge, I was like H2 gastrin secretion or M3 contraction of smooth muscle like bladder... stomach stuff is for me so H2... I do not know how you can get this question without knowing that M3 has to do with motion sickness
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mariame
First generation antihistamine are used for extrapyramidal sx in parkinson, and in elderly they have anticholinergic side effects. So I think you could also use this information to answer the question. It antagonizes H1 receptors and also M receptors.
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mumenrider4ever
I think that's a chondrosarcoma (tumor of malignant chondrocytes, found in the pelvis, proximal femur and humerus, FA 2020 pg. 465)
+1
mumenrider4ever
Also talked about under liquefactive necrosis on pg. 209 FA 2020
+3
lokotriene
UW: 302 & 9989 are both great for representing/explaining this.
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tekkenman101
pancreatitis is fat saponification not liquefactive according to FA.
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chj7
@tekkenman101 Inflammation of the pancreas itself is liquefactive due to pancreatic enzymes digesting everything; inflammation of the fat surrounding the pancreas leads to fat necrosis. (Dr. Sattar distinguishes this when he talks about the different types of necrosis)
+1
pg32
Went with hepatitis because of his recent surgery. Seen problems like this before where recent surgery means they were given inhaled anesthetic that can cause hepatotoxicity/hepatitis. That, along with the elevated AST/ALT and unconjugated bilirubinemia (signifying liver losing its ability to conjugate bilirubin due to inflammation) made me pick hepatitis. Why is that wrong?
+2
suckitnbme
@pg32 AST/ALT are only slightly elevated. The patient also is not particularly symptomatic. He's really not that sick. Hepatoxicity is also most associated with halothane which is no longer used in the US. It would be a different story if the patient had surgery done in a different country (as is common in Uworld questions on this)
+7
mumenrider4ever
I don't know why NBME uses ALT/AST reference ranges from 8-20 u/L when the reference ranges for uworld are 8-40 u/L. So maybe his liver enzymes aren't really elevated since they're below 40
+5
cancelstep
Appendix is pretty far anatomically from the bile ducts. Also damage to bile ducts should cause direct hyperbilirubinemia since there's no problem with conjugation versus Gilbert syndrome which causes impairment of UGT
+4
jaramaiha
To add to that, it showed a well-healing scar so no fluid's draining. Less likely to have any trauma.
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chandlerbas
agreed! more specifically damage to the VPL
+6
baja_blast
Both commenters above got the page wrong; it's FA 2019 p. 503.
+5
teepot123
looooool ^
what were the odd of both being wrong
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bbr
503 in 2019
Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain.
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skonys
Underlying Mech From Wiki:
The thalamus is generally believed to relay sensory information between a variety of subcortical areas and the cerebral cortex. It is known that sensory information from environmental stimuli travels to the thalamus for processing and then to the somatosensory cortex for interpretation. The final product of this communication is the ability to see, hear or feel something as interpreted by the brain. DejerineโRoussy syndrome (Thalamic Pain Syndrome) most often compromises tactile sensation. Therefore, the damage in the thalamus causes miscommunication between the afferent pathway and the cortex of the brain, changing what or how one feels
+1
sahusema
Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft
+11
nor16
and why no therapy, i.e. cognitive training`
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jessica_kaushal
first step is to make the patient's environment accomodating for the patient.
+3
jessica_kaushal
first step is to make the patient's environment accomodating for the patient.
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tryntofigritout
Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha
+7
skonys
The only TCM that is actually used in western med is clove oil for pain from dry-socket in 3rd molar extractions. We even use a fancy product called "socket paste" which is literally collagen and clove oil.
Fun fact: Ginko Biloba is the only species in it's genus.
I'm fun at parties
+1
mumenrider4ever
Great explanation! FA 2020 pg. 216 describes the phases of wound healing
+1
baja_blast
Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong.
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daddyusmle
I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH.
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nio5021
could someone explain why urethral stricture is incorrect?
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eghafoor
The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear
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sympathetikey
Never had heard of that one. Just a good guess. Thanks!
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yb_26
IgE-independent mast cell degranulation can also be caused by radiocontrast agents, some antibiotics (vancomycin)
+8
temmy
it was a u world question
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mannywillsee
i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535
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mannywillsee
i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535
+1
mambaforstep
under mast cells "IgE-independent mast cell degran"! FA 2019 pg 400
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mumenrider4ever
Uworld QID 11852 talks about this
Also FA 2020 pg. 408 (under mast cells)
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covid2019
I'm confused that they said she appeared "normal". I thought AIS would mean the patient has very scant pubic hair / underarm hair. Wouldn't this be abnormal in a 17 year old? Should have Tanner stage 5 hair....
+2
mumenrider4ever
FA2020 (pg. 639) describes AIS as "Defect in androgen receptor resulting in normal-appearing female (46,XY DSD)" so I assume they're talking about general outwards appearance
+2
lola915
You do get breasts because patient has build up of testosterone that is aromatized into estrogen. No axillary or pubic hair because that requires testosterone.
+2
lovebug
THX. SEE AIS (FA19 pg,625)
+1
hyperfukus
thanks u saved me time in looking that up :)
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violethall11
Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic .
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mumenrider4ever
Small edit, achondroplasia is due to constitutive activation (not inactivation) of FGFR3, which inhibits chondrocyte proliferation
+11
"The ileocolic vein is located within the digestive tract. It receives blood from the appendicular vein, and it drains oxygen-depleted blood from the ileum in the small intestine and the cecum and colon, parts of the large intestine.
From there, this deoxygenated blood flows to the superior mesenteric vein, which joins with the hepatic portal vein."
Link: https://teachmeanatomy.info/abdomen/vasculature/arteries/superior-mesenteric/