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The questions asks for response to ATRA. Should that not be decreased transcription to treat the cancer? Which makes methyl transferase (aka methylation) the more likely answer
@osler, no @sympathetikey is correct. ATRA's mechanism in treating APML is to encourage the cells to mature. Maturation would require gene transcription, meaning histone acetylases would be used.
but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation)
i believe the mechanism of APML is that the compound protein is ineffective at allowing for maturation of the blasts. giving ATRA allows the blasts to circumnavigate this step, relieving the backup
even prolactin causes reduced bone density
I was thinking the same thing about the prolactin, but the weight gain made me lean toward ACTH
Prolactinoma reduces bone density due to suppression of estrogen. However, that wouldn't explain weight gain.
Yep. They tried to throw you off with the picture, but the wording in the stem says its a "photomicrograph" -- not exposed to plane polarized light, where you would see the negative birefringence.
Why is NBME so mean to us. Do those mean a lot in clinic？
@linwanrun1357 I highly doubt you would be looking at your own joint fluid aspirates instead of sending it to the lab.
what those yellow white nodules signify?
In clinic gout is typically a clinical diagnosis. If you can treat w/ NSAIDs instead of aspirate you would do that. You would aspirate if you are considering septic arthritis so you can get culture. I don't think anyone aspirate for heck of it.
@nnp, the yellow white nodules are tophus which is a sign of chronic gout, characterized histologically by aggregates of uric acid crystals, can show up as skin nodules most commonly on external ear, olecranon bursa or achilles tendon (pg 467 FA 2020)
Rectal prolapse through posterior vagina ("rectocele").
"When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally."
why not spasm of external anal sphincter?
After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam...
I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam.
I didn't choose spasm because the stem says there the rectal tone is normal