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Welcome to mumenrider4everโ€™s page.
Contributor score: 63


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 +1  visit this page (nbme18#29)
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"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/

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ih8payingfordis  FA 2019 Pg 259 also has a good visual +1




Subcomments ...

submitted by iviax94(7), visit this page
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I figured they were trying to get at the life expectancy of an RBC, but wouldnโ€™t supplemental O2 technically replace the CO bound to RBCs? FA even mentions that CO binds competitively to RBCs, and isnโ€™t that the whole point of giving hyperbaric/100% O2?

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nc1992  First aid has a lot of errors +
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


submitted by kobeandming23(8), visit this page
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DKA (acidosis) > Potassium shifts out of the cell > hyperkakemia

FA 2019, pg 578

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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? +
briangibbs3  Bicarb acts as a buffer and binds up excess H+ in DKA +
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. +


submitted by gunnersinchrome(6), visit this page
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Easiest way to think of this is that this is Gatorade. Sure everyone thinks that sports drinks have glucose for the energy (which is also true) but they also contain sugar because the Na/Glucose co-transporter in the small intestine helps drive electrolyte intake. Without glucose, you donโ€™t pull in sodium nearly as efficiently in the gut and the first makers of the Gatorade formula at UF found that once they gave glucose and electrolytes instead of just water to the football team during practice, they didnโ€™t get as dehydrated and their electrolyte balance was a lot more stable.

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usmleboy  Gaaaaaatttoooraaddeeee! Water sucks! It really really sucks! +3
mumenrider4ever  You're drinking the wrong water https://www.youtube.com/watch?v=7I2-14y6-jM +1
rockodude  go gators, we made that shit +
username  go dawgs +
skonys  Any hydrohomies? My patient's will be getting straight RO water to the neck. None of that heretical devil-drink. +
chaosawaits  @rockodude, if only FSU had made it; we'd all be drinking Seminole Fluid ;) +1
impostersyndromel1000  @chaosawaits underrated comment +


submitted by seagull(1933), visit this page
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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.

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johnthurtjr  I did not +3
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 +18
d_holles  i did not +
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. +
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?" +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
djtallahassee  yea, I mature 30k anki cards to see this bs +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
snoochi95  hell no brother +1
roro17  I didnโ€™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 +3
waterloo  Nope. +
monique  I did not +
issamd1221  didnt +
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
amy  +1 no idea! +
mumenrider4ever  Had no idea what glucosamine was +
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1
surfacegomd  no clue +
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +
chediakhigashi  nurp +
kidokick  just adding in to say, nope. +
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
l0ud_minority  No fucking clue I guessed wrong:( +


submitted by nwinkelmann(366), visit this page
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I found this when trying to understand why increased NO caused headaches: Nitrates/nitrites are a very common headache and migraine food triggers (WebMD) and raise nitric oxide levels. High levels of nitric oxide are associated with migraine (Study). Headaches and migraines are also very common in medications that boost nitric oxide, such a viagra (study), but it is unclear why this happens. The original hypothesis was that nitric oxide increases blood vessel size and triggers a migraine, but the viagra study and others disproved this. Newer studies on nitric oxide shows that it increases the peptide (CGRP) that is considered responsible for triggering migraines (Study) after increases in inflammation. Because nitric oxide is associated neurogenic inflammation diseases, it's likely that headaches and migraines from nitric oxide are a warning sign of this inflammation (Study).

The research is basically stating that nitrates raise nitric oxide levels and high nitric oxide levels increase inflammation and headaches and migraines. However, the exact reason why this happens is unknown.

https://www.quora.com/Why-do-nitrates-cause-headaches

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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! +
mumenrider4ever  This is similar in how triptans induce vasoconstriction which is used to treat migraines +


submitted by wishmewell(59), visit this page
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In my opinion this is kinda rude as an intial action. if the person continues to go back to the topic, I would say having a chaperone would help.... idk why Interrupting the patient with a more neurtal topic isnt the answer

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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
abcdefbhiximab  @groovygrinch lmao +1
kindcomet  im dying of laughter +1
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 +
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. +
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. +
payingforthisisbs  as a young woman I would just yeet them from my practice +


submitted by iguzman2(4), visit this page
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Aren't M1 receptors found in the brain and are responsible for motion sickness?

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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
pelparente  So according to amboss scopolamine is a nonspecific antiemetic. I think Sketchy probably just confused everyone. https://www.amboss.com/us/knowledge/Antiemetics +5
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 +
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. +


submitted by mamed(25), visit this page
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What is the neoplastic chondrocytes filling lacunes?

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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


submitted by plummervinson(4), visit this page
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Contraction atelectasis occurs when local or generalized fibrotic changes in the lung leads to collapsed alveoli. It can an occur after radiation therapy, necrotizing pneumonia, or granulomatous disease

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submitted by mousie(272), visit this page
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Read pathoma...... chapter 1 p 5 on "cell death" Liquefactive necrosis occurs in brain infarct ( proteolytic enzymes from microglial cells liquify the brain) & Abscess (proteolytic enzymes from neutrophils liquify tissue [in this case pulmonary parenchyma]) & pancreatitis (same thing)

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mumenrider4ever  Also talked about under liquefactive necrosis on pg. 209 FA 2020 +3
lokotriene  UW: 302 & 9989 are both great for representing/explaining this. +
tekkenman101  pancreatitis is fat saponification not liquefactive according to FA. +
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


submitted by tissue creep(133), visit this page
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Mild jaundice with increased unconjugated in an older fellow is decreased UDP-glucuronyltransferase activity. Particularly in context of stress (appendectomy)

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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
cheesetouch  Can someone refute 'surgical trauma'? +
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. +


submitted by tinydoc(276), visit this page
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Neuropathic Pain after stroke is central Post stroke pain Syndrome

caused by contralateral thalamic lesions

Pg. 504 FA19

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chandlerbas  agreed! more specifically damage to the VPL +6
docshrek  Pg. 403 FA 19. +
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 +
mumenrider4ever  Pg. 515 FA 2020 +
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +
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. Dejerineโ€“Roussy 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


submitted by beeip(141), visit this page
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"Excitatory amino acids" refers to glutamate, while "Biogenic" apparently refers to tyrosine, the precursor AA to dopamine and norepi.

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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
mumenrider4ever  FA 2020 pg. 239 +3


submitted by madojo(212), visit this page
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  • CholecystokinIn is secreted from the I cells of the duodenum and jejunum.
  • Gastrin is released from the G cells of the antrum of the stomach.
  • IF is secreted by the stomach and absorbed in the terminal ileum with B12.
  • Pepsin is secreted from the chief cells of the stomach and plays a role in protein digestion.
  • Secretion of VIP increases intestinal water and electrolyte secretion by acting on the parasympathetic ganglia
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nobody  PAGE 365 FA 2019 +2
mumenrider4ever  FA 2020 pg. 371 +
ali_hassan  pg. 365 2018 +


submitted by niboonsh(409), visit this page
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i got this question right but why couldnt it be ginko biloba?

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nor16  and why no therapy, i.e. cognitive training` +
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. +
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
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." https://en.wikipedia.org/wiki/Ginkgo_biloba#Traditional_medicine +4
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


submitted by usmleuser007(464), visit this page
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  1. Hemostasis (blood clotting): Within the first few minutes of injury,
    1. platelets in the blood begin to stick to the injured site.
    2. This activates the platelets, causing a few things to happen.
    3. They change into an amorphous shape, more suitable for clotting, and they release chemical signals to promote clotting.
    4. This results in the activation of fibrin, which forms a mesh and acts as "glue" to bind platelets to each other.
    5. This makes a clot that serves to plug the break in the blood vessel, slowing/preventing further bleeding.[5][6]

  2. Inflammation: During this phase, damaged and dead cells are cleared out, along with bacteria and other pathogens or debris.
    1. This happens through the process of phagocytosis, where white blood cells "eat" debris by engulfing it. 
    2. Platelet-derived growth factors are released into the wound that cause the migration and division of cells during the proliferative phase.

  3. Proliferation (growth of new tissue): In this phase, angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction occur.
    1. In angiogenesis, vascular endothelial cells form new blood vessels.
    2. In fibroplasia and granulation tissue formation, fibroblasts grow and form a new, provisional extracellular matrix (ECM) by excreting collagen and fibronectin.
    3. Concurrently, re-epithelialization of the epidermis occurs, in which epithelial cells proliferate and 'crawl' atop the wound bed, providing cover for the new tissue.
    4. In wound contraction, myofibroblasts decrease the size of the wound by gripping the wound edges and contracting using a mechanism that resembles that in smooth muscle cells.
    5. When the cells' roles are close to complete, unneeded cells undergo apoptosis.
  4. Maturation (remodeling): During maturation and remodeling,

    1. collagen is realigned along tension lines, and cells that are no longer needed are removed by programmed cell death, or apoptosis.

  5. Approximate times of the different phases of wound healing,[10] with faded intervals marking substantial variation, depending mainly on wound size and healing conditions, but image does not include major impairments that cause chronic wounds.
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mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +1


submitted by benzjonez(48), visit this page
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FA 2018 p. 609. Suspect urethral injury if blood is seen at the urethral meatus. Mechanism of posterior urethral injury = pelvic fracture, which we see in this patient. Urethral catheterization is relatively contraindicated.

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hyperfukus  thank you! +
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. +
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. +
mumenrider4ever  FA 2020 pg. 627 +3
nio5021  could someone explain why urethral stricture is incorrect? +
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-20362330 +
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source: https://www.urologyhealth.org/urologic-conditions/urethral-trauma#:~:text=Trauma%20to%20the%20anterior%20urethra,of%20urine%20from%20the%20penis. +
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 +
skonys  FA19 613 +1


submitted by neonem(629), visit this page
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Morphine is a mu opioid agonist - one adverse effect of opioids is mast cell degranulation that is IgE-independent. Release of histamine is akin to an anaphylactic reaction --> pruritis, etc.

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sympathetikey  Never had heard of that one. Just a good guess. Thanks! +
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 +
mambaforstep  FA 2019 pg 400 +1
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 +
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 +
mumenrider4ever  Uworld QID 11852 talks about this Also FA 2020 pg. 408 (under mast cells) +


submitted by hyperfukus(111), visit this page
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Also another key is it says normal appearing girl one of the things about the AIS is that they do get secondary sexual characteristics...turner girls don't look normal they'd be short and stubby no boobs fat neck etc

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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


submitted by usmleuser007(464), visit this page
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As per FA 1) fatty infiltration 2) cellular ballooning 3) eventual necrosis

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hyperfukus  thanks u saved me time in looking that up :) +
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 . +
mumenrider4ever  FA2020 pg. 391 +


submitted by m-ice(370), visit this page
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This boy has achondroplasia, which is caused by an autosomal dominant mutation in Fibroblast Growth Factor Receptor 3. FGF signaling is needed for proper cartilage function, and without it, the long bones of the body will not grow because the growth plate (made of chondrocytes) does not function. However, bones that undergo membranous ossification, like the bones of the head, will grow normally. This results in the patient having short extremities with a normal size trunk and large head relative to the limbs.

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mumenrider4ever  Small edit, achondroplasia is due to constitutive activation (not inactivation) of FGFR3, which inhibits chondrocyte proliferation +11


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