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Comments ...

 +1  (nbme22#31)

FA 2019 page 306, under "Heart failure"

"Clinical syndrome of cardiac pump dysfunction --> congestion and low perfusion. Symptoms include dyspnea, orthopnea, fatigue; signs include S3 heart sound, rales (aka crackles), jugular venous distention (JVD), pitting edema."

Yeah, I forgot that rales = crackles... why can't they just stick with ONE terminology... anyway. Hope this helps.

 +0  (nbme22#4)

This website explains it too:

"A decrease in cardiac output either due to decreased heart rate or stroke volume (e.g., in ventricular failure) results in blood backing up into the venous circulation (increased venous volume) as less blood is pumped into the arterial circulation. The resultant increase in thoracic blood volume increases CVP."

 +1  (nbme22#16)

Why are his labs normal?

Protein electrophoresis is to r/o MM. What are the others trying to rule out? Also, if it was prostate adenocarcinoma, wouldn't there be elevated PSA in the urine (which might result abnormal UA)?

lsp1992  Urinalysis provides a microscopic examination of urine, which would tell you about the presence of RBC, WBC, casts, crystals, epithelial cells, and a chemical test for nitrites, bili, urobilinogen, ph, specific gravity, proteins, glucose, blood, and ketones. PSA is a specific protein that would be found in the blood, and a lab test that would have to be ordered specifically. +1

 +2  (nbme22#10)

I actually picked "No; the arrangement is contractual between the physician and the company, not the patient." However, after some FA review (2019, page 264), informed consent include disclosure, which includes the the incentive that the company is offering the physician.

I hope this helps!

Subcomments ...

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^^^a iftuebual lbate htta hswso fstacef on tlorlcetyee lsleev in xeasvtail vs idtrsiuec sv ingmo.vit

cAgcndoir to eth bae,lt sti ahdr ot eltl iiercdut sv tavelaix asebu yb mures letlstrceoey noeal. The riune llstrteoyeec udwol elryamdk ffredi in tath ticeuidr ilwl heva ncidserae Ca/KlN/ nda laxeivtas luodw foollw het iptesoop nerdt adresecd)(e. r,wHvoee hitw het fcat taht NUB is acisgenirn adn htat ew nac llte ertshe' a eaoblicmt isaklasol hwit rsraptreioy ciiosdas cp,sanoetnoim ew nac bet no suetdiric orev l.avsextia

EXRTA INOF rfom hte eblat ni teh nilk ev:abo

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:aLasx etiv K[ ]ecd l[C icn ro ]ecd H3[CO cde ro ic]n Hp[ dce or c]ni
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(nrwAde ganY rfo ri)tdPesne

drdoom  table -> +2  
nootnootpenguinn  The last sentence is nice touch!!! +2  

submitted by yotsubato(1019),
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3p5 is datetmu nda ctan bidn het TTAA ,obx so awht naepphs to iactsrionpnrt of onyirihitb p?sortien

Is lyasclbia htaw hits nqetusio is ngirty ot .ka.s.

So no ATTA xob etmororp ;=gt& eceDasdre nnbidgi fo ANR oysreapmel

link981  You said it, they are "trying" to ask. Should use better grammar. +3  
titanesxvi  This is on first aid, and says that the promoter region is where RNApolymerase binds +  
nootnootpenguinn  Hakuna NO-TATA box... thank you for this explanation! +  

submitted by seagull(1539),
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idD onnyea ened to edar ttha tlsa ecneenst ekli 50 ietms beuasce eht hrouat eeufsrs ot sue ertbet gamamr.r Jtsu tsatugri.rnf

link981  Author rationale: "What is grammar?" +6  
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +17  
drbravojose  Actually never understand what the author saying at any time. LOL +3  
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +  
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +  

submitted by jackie_chan(19),

I found an easier way to just logic through this is the complaints are basically muscle spasms, tetany, hyperreflexia.

  • Abnormalities in bicarbonate give metabolic acidosis/alkalosis, nothing in stem gives us reason to think theres acid/base balance.
  • calcium, hypocalcemia textbook fits with tetany, hyperreflexia
  • abnormal chloride not much clinically significant
  • potassium abnormalities can have tetany but also arrhythmia, no signs of cardiac involvement
  • sodium, hyponatremia can have seizures, hypernatremia have irritability and signs unlikely to be ongoing for entire month.
nootnootpenguinn  Thank you so much for the potassium explanation! It was totally a "D'oh!" moment, haha! +1  

submitted by nwinkelmann(292),
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I uofdn siht hnew tnyrig ot nntddsurae ywh canesider ON dauces dhsaea:ech ia/nrttesittseNri aer a evry cmoonm hdeheaca nda egiriamn oofd grtigsre bMD)(eW nad iesra irticn oeixd evlls.e High elselv of itnicr exiod rea aactssioed thwi rgnaieim tS.)u(yd hadcsHaee dna sanmigeri rea aosl veyr onmomc in dnoiimtecas ahtt oobst citirn dio,xe hscu a viaagr sdy(ut,) tub ti is cureanl ywh isth hpapnes. hTe aoiglnir ohheystisp aws atth iintrc iedxo esiscrane dlboo sevlse szei dan sreggrti a ameirn,gi btu hte vrgaia duyts dna tesorh spoerdidv .hits werNe diessut no tcinir ixdeo owhss tath it saiersnce teh dtppiee CGR)(P ahtt si nrceodeids snrseilbeop rof enrgtirigg aiseirnmg (y)utdS frate nscesriae ni ain.lnotifmma Becesua critin deiox si escsaitaod norgceinue aiinamlftnmo aieds,ess i'st yleikl ahtt adheeshca nad iaseinmgr from icitnr xideo aer a wirangn gnsi of ihst lninfmmoatia )t(dySu.

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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 +