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submitted by hungrybox(1026),
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rtaeG deivo I esdu ot anerl itsh .aaemtrli

  1. hereT are 3 maorj pstye of ugs:rd rpuspe (a,ltius)tsmn dneswor e)sternps(ds,a adn lcsneuogain.lh
  2. roeniH is an podio.i sidioOp rae d.*rsweon
  3. rDnewos do what ti dssnuo liek. hTye ecuas w"nd"o symotmp:s eeaesoeadnddtc/rsi tenaiyx a(dn htsu boialhvear ibidhon)tinsii, sroypterari .inposderse
  4. uTsh lwriathwad lilw scuea eth :isepopot tpco,dchnheryrastiaiyean/ xnetiy.a
hungrybox  *other downers: alcohol, benzodiazepines, barbiturates +2  
nwinkelmann  THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +  
qball  I get that this is a good rule of thumb to help narrow down between alcohol and heroin, BUT is still not enough to answer this question. Some key features for depressants (downer) is alcohol (if we are talking mild withdraw) - tremors , diaphoresis and delirium (heavy withdraw) . For Heroin - Dilated pupils, yawning and lacrimation are key exam findings. +1  

submitted by soscrying(8),
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at ym in,u we letnar htta at relwo GR,F lpoo cstriiude tlils .wkro Tstha' ywh you uodhsl ues them in aelnr ui.afrel hiziedaTs odulw tno wkro wtih a GFR fo 0.;3l&t

qball  Dang, you actually learned something at your school? Lucky. +17  
lowyield  At our med school they teach us that Thiazide anti-HTN function is primarily from it's direct effects on vasculature rather than it's diuretic effects. Somehow directly affects the vasculature which is not well understood but this is linked to why Thiazides have greater efficacy in African American Populations. That's kinda why i figured it wouldn't be the best diuretic in this case. +1  
brotherimodu  lowyield but interesting +  

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isTh is a triucep of Gaiiadr ll…bamia ecsadu by gnidkinr dciameotantn etwar with ysst.c

aMdteleiuncult hzisreotopto

xR -- nzeaolotMerdi -- fosrm tocix reef rlaicad tioestleabm in eth ctlbiraae ecll that gmdeaa NAD = AREATCBDICLI

qball  This is testing our knowledge in a FAIR way. Why cant there be more questions like this instead of them trying to trick us, have poorly worded questions or have us pick the least shitty answer. End of rant. +1  

submitted by sahusema(143),
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eTh daneionDis ygu in eth RTNI tcekhs si nlhgodi a pnaasrec ospgn.e

qball  Sir Dan, my boi. +5  

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ebrMamsuno nriluGismotrelhoep si N;oipchert NOYL OUPRITNIAER si ni eht vengitte

tI natc' be PMGN uaeescb PMGN is pehiNirtc hitw ebilpsso oicrNhtep

ehOtr eshocic ear aemntelidi yb eRnal soyipB

hungrybox  agreed "granular deposits" rules out MCD (the only other nephrotic syndrome) because MCD is IF (-) +4  
cooldudeboy1  could someone explain why the other choices are ruled out by biopsy? +  
arlenieeweenie  @cooldudeboy1 PSGN does have a granular immunofluorescence, but there is no previous illness or hematuria mentioned so you can rule that out. Goodpasture is classically linear IF since they're antibodies against the GBM. IgA nephropathy is mesangial IF so it would deposit more in the middle. Minimal change wouldn't show anything on IF +2  
qball  I know First Aid states MPGN as a nephritic disease but I think it can present as nephritic or nephrotic syndrome. Of course, the renal biopsy helps give it away but I wouldn't be so quick as to rule out MPGN +1  
taediggity  Totally agree w/ you Qball... I thought MPGN too, but I think Penicillamine makes it Membranous Nephropathy +  

submitted by drdoom(874),
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hTe enhssiyst of iyrvtllau lal irnposte &Nmpt;d)Rg-peA(eit csrcuo ni the myatlsopc.1][ ahstT’ eerhw lla bisooerms ,dserei artef la.l obmsiR,eso chwih ear yomlts tsju ANrR 3(~/2 ARNr + 13/ teornp*i, by gthe)i,w era bsedamels in the senuucl tub only od etirh ffstu nceo ehyt teg ot the acm.toylps

For a ienrpot to eelva tsi iaoilngr ethowonm of eth cosloty nda ecbome a tesnrdie of eht nuuelsc ,or ayyyy,yys het dasilnmpeco m,uceuitlr ti edsne to hvea a lletti tsirgn fo nmaio cdais chihw shuto I“ eonlbg in eht esn”uulc! or I“ olbneg ni eth cplseoinmad ltucirmu”e!

ePnrtois etuytmllia idstdene rof teh ER ncaiton na iimavailytnunge aemdn ignsrt of mnaoi diasc nknow as lin“asg neu,e”qsec hcihw, orf het orsupesp fo the etpS 1, is yaawsl at het .tNsim-neur eTh ilnsga cuesqnee sllet ehtor iclcyotos irestn,op e!yH“ aeTk em dn(a eht tser of het peipdte of ciwhh I am ar)tp ot het !”RE

nI hte benesca of itsh gsain,l a iernpot lliw nemair ni sit ”fdl“ueta hmoe fo eth

eeu;r&rosqHs a cnie ecitamshc shwonig teh wolf fo iespnort omfr iianitl tssneyish to afinl senttsn:diaio


  1. eTh“ nteyhssis of avturilyl all nsopteri in teh lcel gnsbie on rmoobsesi in hte ”osyoctl. (teslasEin eCll yBgoilo, bslAter te la,. 4,021 p. 492)

If* oyu alrlye wnat ruoy nimd bol,wn esdrconi tath veen hte enroipt utsbisnu htat keam pu tath 13/ fo a soremoib ear ehslteevms aylilniti seizeystdhn in teh loo;ctys ,eralt yhet rae trotsrdnape kabc ntoi teh usneucl vai hte aurenlc .opre

qball  Awesome explanation. Now explain it to me like I'm 5. +8  
drdoom  All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark — or erase it somehow — the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa won’t bring your presents. +44  

submitted by hayayah(1074),
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hte ijtrmayo of rocnab ddxiieo cselmeuol are dceairr sa rtap of hte oicraenbabt eubfrf sm.eyst In isht smey,st boanrc dexiiod ufssfedi oint hte C.RsB rbCoinac daehrasyn )(CA twiihn sRCB lqucyik ertcnovs eth roncba oideixd tino oraccbin aidc (3C.2)HO arcCnbio caid is an lneasubt tainrmetdeei olemeucl ahtt amtmeileydi ctdsisoaeis tnoi cbtiaabroen inos HO3)-C( dna oenyghdr H)+(

The wylen sehetysndzi abtoecbnira ino is nstrtdorpea tou fo eht BCR oitn eth alsmpa in eecnxahg ofr a eliohdcr noi ()C;−l tsih si ladcel eht ceiodhrl i.shtf heWn eht ooldb eesrcah hte sugnl, the baiorbanect ion si saerdotrtpn kacb onit het CRB in xnehecga ofr hte hdoleric .nio hTe +H ion adsetissico rmof eth ieboogmlnh dna ibnsd ot the tecainobrab .oni hisT posdreuc eth acrnoibc caid eetrniiemtda, hhwci is detencrvo ckab iton conrba idodixe hothugr het necmyzita nticoa of CA. ehT oracnb dxieodi opdreucd is eplledex thgrouh teh lngsu ungdri nata.hixelo

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... +5  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. +3  
teepot123  fa 19 pg 656 +1  
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +  

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It iads ti swa tfala ot emsla in tuo,re nad het sqeunito sdeak tabou leiv rnob soirfngf.p ceSni the amlse en’rat gnebi nobr ni eth ritsf elc,pa I dsia %05 felmsae adn %0 .samle

hungrybox  fuck i got baited +31  
jcrll  "live-born offspring" ← baited +23  
sympathetikey  Same :/ +  
arkmoses  smh +  
niboonsh  why is it 50% females tho? +2  
imgdoc  felt like an idiot after i figured out why i got this wrong. +2  
temmy  oh shit! +  
suckitnbme  This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected. +2  
makinallkindzofgainz  @suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0. +3  
spow  @suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant +3  
qball  Jail-baited +  

submitted by est88(17),
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absRei uVisr dab)hrrioive(ad

ereFv, icthaiespnle, lorgnodi

submitted by hayayah(1074),
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ELLPH :sdmyoern al vsd msieEetloeHy vrieL ew yzLsnmeo ae.tPeltsl

A itiamnoatsfne of esever aeip.lmscerap Boold raems swhos yst.icctoshse naC adel to CID nda tpcihae raetubocaas musapmlsh Ž prteruu Ž veeesr .enohpsiyotn

mambaforstep  FA 2019 pg 629 +2  
qball  One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand? +  
demihesmisome  Pre-eclampsia, if not severe, can be entirely asymptomatic. +1  
misterdoctor69  Her blood pressure is 164/102, which qualifies her as having preeclampsia. +  

drdoom  great schematic. +  
qball  Just to add, the ovarian artery branches from the aorta as well. +1  

submitted by lnsetick(92),
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  • rPiocenA = rouy psiamrt semll ielk an PEA
  • nUecRMe = tsreh’e no ORMO in yruo ersa icsne yret’he lluf fo awx
  • YCREn-Ce = ewnh yuo siCrecEe, oyru oreps aer igCRnY
  • EaoSBeusc = mSEuB si nigEPSE tou of uyor orsep
hungrybox  as an ape i'm offended +30  
dr.xx  stop being an ape. evolutionize! +7  
dbg  as a creationist i'm offended +11  
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +  
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +2  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +1  

submitted by sahusema(143),
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ose.aaRc An ryainolfmatm laaifc ikns osdidrer ricrataehzdec by thteuerasmoy uaeplsp dna etuulsp btu on o.odeecmns May be soaaesitcd htiw flaica hilfgsun in sesenorp to ltearnxe istuiml (g,e olhoalc, h.)aet

qball for that quick picture. +3  
drdoom  and many, many more: :) +  
icedcoffeeislyfe  FA2020 pg 477 +  

submitted by gabeb71(45),
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hTe ercpbasultio ecmsl,u hchwi is eno of hte lecsusm ttha irceposm hte clpvie lfroo dan yaslp na ntaomirtp lero in hobt lface tniecoencn and canteoefdi, is ciolnaytl ocnaetcrdt adn maatisnin the cotnrlaea eganl at esrt.

hree si a tcreu:pi c8l-h0s-urveoa7al.wooem-r-o/.woeot:4plhwt-t-thl-a6nfscefpp-vpi3wi-icb.errsnm54kst--9-s--ogor-tdrshrtdtont1tn-meumefefhs-actoatul_o-nh-u-ehhotcauo//cctte2_r

gh889  How do you differentiate this from hypertonicity of the internal anal sphincter? +1  
gh889  nvm. im dumb lol +  
qball  Uworld Q ID 17004 +  
focus  @gh889 I made the same mistake... fecal INCONTINENCE meaning she CAN pass stool-- in fact, way too well... more than we want. Hypertonicity of the internal anal sphincter would cause constipation-like symptoms. +2  

submitted by sajaqua1(531),
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nI na rellyed petinta tiwh edlsotia eetealdv aelanlki hpesosaphat ol(arnm sruem ilucacm dan hetp)sapoh et'Pasg eiaesds of oebn hlsoud eb ta eht pto of teh laete.niriffd sTih esiasde is ued to isnaeturogyld fo tcicssleaoot and taebotcossil ;itvctyia ftsri an ialiitn essoctalto vtthayierpyci pseha, hnet ecnrseaid sooetlastb ctiiytav ofr a e,mtuxri ehtn tstasooslce "un"outrb nageild to arermntelvoioii-naz dan rctocslie nboe spqlu.ea In ai,dodnit htis nca teaerc tearoinoreusv ushtsn in the nbsoe cwhih radeesces setei,ransc ildange to hhig ouuttp aaircdc irleauf a( lirmias bpelmor cna iersa in veoursaontire tussafli mrfo oblod yss)li.iad nO gsohitoly ti lliw aveh a "miaoc"s t.panert

-A) Ayemuarlns onbe tscy- yelglra a ptcordu of thpvayceyitir of olaoscsest,t isht cucrso eorm nteof in eht ,iblsm nad owhss a icycts peasc wtih aobkionllle- ilonati.d B) acs-anAiroomg asomocnragia fo teh ebon si n motsal ryulep itlyc nle.ois Tyhe ocrcu orme qreteynufl ni eyougnr opl.epe )C cniNia -idenyfccei I acn dnfi ngonthi taoub vmbnitia 3B dcceiifyen volgiinvn .nosbe 3B cctfieinde urtesls in lrp,aaegl thwi teh lscaisc eheTr s-D' aitmidtesr (ahrs lcecekan on C4/C3 mreda,eot)m idneatme, dan .iraradeh E) ecroaaOto-mss nudFo otmlsa lceuvlxesyi ni nregyou ,leppoe tihs obne wghtor rouscc ta eht wothrg let,pa piclrauyatrl ta eth lxairpmo end fo the ib,ati itsdla dne fo eth frum,e or iaorxplm edn fo eth esumrhu n(i teh glon ensob urndoa rouy senek ro at uryo )ersduos.lh tI wossh a ae,rlg ldiso wngogir mssa ttha mya aesir het iepemortsu in a untsbrus nnsC'oepa/tdmtar rl.enagti F) rascoPtit roan-mcaci rrae orf ibgne oen fo, if tno eth nloy miesttcata nobe raeccn thta is eyuprl

alexb  Great explanation, except that there was a question in NBME 22 in which the prostatic carcinoma was osteolytic. One of the commenters here looked it up and apparently it's like that 30% of the time or something. So I guess you would have to use the high output HF, normal Ca, high ALP, and mosaic pattern to "play odds" as Goljan would say. +2  
qball  At least they were nice enough to put Paget disease because I had no idea what osteitis deformans is. +1  
drzed  USMLE seems to be moving away from using eponymous names... so it's a good idea to see if there is a descriptive name for diseases. For example, they don't use the word "Wegener" anymore if you have noticed, since it turns out that guy was a nazi. So now they call it by what it is -- granulomatosis with polyangitis. +3  

submitted by hhsuperhigh(37),
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is"H sreindf evibeel trhee may heva been rdgus ta the "rtya,p peo.dir .a.lo.m

aisel1787  ahahaha +  
qball  What a snitch +8  
bend_nbme_over  Good thing they were at the ED cause that friend is gonna need some stitches +1  

submitted by yotsubato(1019),
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So rof aindCad we nca esu

lsozAe uzlfno(c)aleo iih(ntib 50PYC4 ei)maetlotnyhd

nermAitcohp B r(poe ioatrnofm in alugnf clel rnme)emba

sgnpCinoauf erepvn(t gcisinkrolns fo btae lgcsuan in clel llwa)

ro iyatNns ofr lora ro lapashogee essac r(eop rofanito)m

hTis sqeotuin si nsgiya tath ehs si kiantg na AOLR ugrd ot taetr naaicdd tn.gsiaivi

oethpAmnirc si IV

uoingaCnpfs is lsoa IV

os erwe' fetl hitw ozlase

oszelA bnithii tensyshsi of segrorltoe yb ibinintghi CPY 504 htta eovtncsr tlsreolona ot trlso.regoe

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +1  
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2  
staghorn  Me - picks Metronidazole -_- +  
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +4  
turtlepenlight  I have seen that on the wards so I hope it works! +  
fexx  and my smartass picks amphp B +2  
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +2  

submitted by wired-in(67),
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ainenntMaec seod ruaoflm is Css( × Cl × )uta ÷ F

ewehr Css is daeatyttse-s erattg maslpa .ccno of ,rugd Cl is larcecna,e uta si oagsed etnairlv m&;ap F is tyvolaaaiiilib.b

iNthere sedgao itavlern onr iaibltyoblivaia is ,ingve os ronniigg oesht p;&ma ligggnup in eth sbnmeru ca(reful ot ortvenc tsuin ot a/)mg:k/gyd

(2 1= Lmg/u × 1 m01g00/ ug) × 90.(0 /g/Lhkr × 0010 m/L1 L × 42 rh1/ )dya
= 2295. gmy/kga/d itns' nya of hte esawrn hceiocs heTy muts eavh edrdnuo 0.09 /hrLgk/ ot .10 gr/k,hL/ nad ngoid os giesv etxalcy 882. /kmg/dyga ehc(oic )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +75  
hyoid  ^^^^^ +11  
seagull math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9  
praderwilli  Big mad +9  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18  
bigjimbo  JOKES +1  
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it. +1  
d_holles  LMAO games NBME plays +2  
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1  
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6  
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +3  
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +2  
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +16  
qball  Me after plugging in the right numbers and not rounding down : +1  
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +  
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1  
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡 +  

submitted by sympathetikey(1350),
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elveieB thsi quoneits si rrerfgnei ot ialercsV ssnhimsaiiLea.

gabeb71  The give away is the Fever, Pancytopenia, and Hepatosplenomegaly after being bitten by an insect and developing the sore. +14  
tallerthanmymom  I got this question directly after the other visceral leishmania question and it made me second guess everything I thought I knew. +7  
qball  Don't forget they like to infect macrophages. +  

submitted by welpdedelp(225),
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tI swa a pety VI HNS eoi,arcnt whihc aleds itwh T elscl and atth wsa the ynol reansw taht ahd t scell oidnelv.v

yogi  Poison Ivy/ oak /Sumak +  
qball  Uworld Q ID 1133 +2  

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A olbtoramsn is an maeirtmu CB,R os its' atlevede in tteass fo esceanrid emtai.sispehoo

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +61  
someduck3  The term "Normoblast" isn't even in first aid. +36  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +19  
tinydoc  I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +18  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +8  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +5  
fexx  I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +5  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +12  

submitted by lfsuarez(141),
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ihTs piettan rsenptes hwit a almsl llce ncacorima whhic si yrev moomnc for apra otscanepil .smondersy In stih acse the rnceac si uiscgan ADSI.H ycceeloDnmiel si a etclncytraie toitcanibi htta is aols used ot ttare SIHAD

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +14  
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +3  

submitted by rainlad(23),

my approach to this question was to eliminate all the answer choices that mentioned specificity or sensitivity, since the data here did not provide information about any sort of screening test.

that left me with two possible answer choices: I eliminated the one about consistency of other studies, since no other studies were mentioned in the question stem.

not sure if I oversimplified things, but it led me to the right answer!

makinallkindzofgainz  this is exactly how I reasoned through it. Were we correct in our line of thinking? We'll never knooooow +  
qball  But will you ever know on the real thing? +1  
drdoom  but will you ever know in real life? you may do the right thing (given time constraints, & information available), but outcome is bad; maybe you do the wrong thing, but the outcome is good (despite your decision). how to know the difference? +3  

submitted by guillo12(47),
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VP" is a tpancelsoi c(on)lla boold ddrioser hitw nmsotuaouo En)dnt-Pdie(pneeO iyrtdhoer otalnerpifrio. aBceesu fo the ensceiext fo a evaigten cfdeaekb e,sianmmhc het htycsrsetrooi ni PV etwdaosrnuegl- POE ctdnioupro and rsltesu in oblwe manrol ursme PEO eselvl. In ,rotcnsat na PvidEeO-nr tecyhiortsorsy hcarcazeriest rnycesado cyroseyoh,stitr nad hist dtonioinc yma eb setocasaid twhi ehrite hgih or onrlma mrsue OEP ellves".


qball  For those that want to know what total red cell mass means in polycythemia and PV read the first paragraph in this article. The hemoglobin and hematocrit do NOT inform you of the total red cell mass. +  

submitted by mousie(216),
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heolCra = leaFc ielninoer/ gsaLaor = eoalanglL mnpuoe = NO srpeno to snproe nlyo by anantlhioi fo iractabe ncandtmeaoti e/ rmayetwL = ckti cielnn ciebcgoiaM/to = gnhaisr rsirotpaeyr adn aothrt neroecsits ivlaas( or i).spt ell,enyGar it staek lseoc fr(o epl,aexm ocguhgin or is)niksg ro tgelhyn tcnacto to arsepd eetsh iecbatar )R M(/CFCSD = cikt ietb

smc213  Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments. +6  
dentist  So, Cholera is also p2p but Mening is more likely? +1  
usmlecharserssss  in cholera people to water => water to people +  
qball  Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person. +  
drschmoctor  but the poop water comes from people so.... +1  
llamastep1  Respiratory dropplets is easier than fecal-oral tho +1  
lowyield  Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals +1  
peridot  I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis. +  
bbr  To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly). +