NBME Answers : rina's page

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submitted by prosopagnosia(5), visit this page

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The only ones that are systolic murmurs are Aortic Stenosis, Mitral Regurg, Tricuspid Regurg
Aortic Stenosis often radiates to the carotid, not the axilla
Tricuspid Regurgitation is usually heard at the tricuspid area and doesn't radiate
Mitral Regurgitation is loudest at apex and radiates towards axilla. Therefore, this is the right answer.

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rina also to harp on buzzwords: aortic stenosis: "harsh, crescendo decrescendo murmur" while in chronic mitral regurg it's almost always described as holosystolic, high-pitched or blowing. +1

submitted by zincy7(29), visit this page

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Burning Abdominal Pain hours after eating = Gastric ulcer
Black stools for 2 days = ???
Refractory to OTC Antacids and H2 Blockers
Sweating and Low BP
Pancreatic Mass = most likely GASTRINOMA

LOGIC

Immunohistochemical labeling uses antibodies as markers for what they want to find. In this case, we're suspecting gastrin given the symptoms

Note: You should revise the function, stimulation, and site of release for each of the hormones mentioned as well

REFERENCE: Zollinger-Ellison Syndrome

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bingcentipede Black stool because blood in the GI tract? +2

passplease I was tempted to pick insulin, because of the orthostatics and sweating that could resemble hypoglycemic episodes. Why are those present in a gastrinoma? +3

deberawr @passplease it's possible that increased gastrin -> peptic ulcers -> perforation -> shock -> sympathetic nervous system overload -> sweating and hypotension +

jsanmiguel415 Black stool = melena = bleeding above the ligament of trietz from ulcers +1

rina @passplease according to amboss gastrinomas can cause steatorrhea and malabsorption, in addition to anemia from GI bleeding. that might explain the light headedness and low-ish bp. +

jj375 Zollinger Ellison Syndrome --> causes duodenal ulcers that are bleeding causing melena and the low blood volume (symptoms of light headed and low BP). I would guess that sweating is from what @deberawr said of the increased sympathetics from the low blood volume +4

cheesetouch FA18 347 zollinger ellison +

ley black stools is caused by blood/bleeding in the upper GI like ulcers(stomach,duodenum) and stools with light red blood y caused by lower bleeding like external hemorroids. +

submitted by rina(13), visit this page

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why isn't it serum cortisol concentration though. Couldn't that help you identify a pituitary adenoma (i.e. because increased ACTH --> increased cortisol concentration)?

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rina is it because she's showing no symptoms or something? +

jj375 I'm not sure but I would assume you would want to first confirm that her symptoms are from a gastrinoma (pancreatic endocrine tumor) and a parathyroid adenoma to confirm MEN1 before you would go and then try to preventatively check for a pituitary tumor even without symptoms. So I would guess it is just about what takes priority, focus on the things with the symptoms to confirmt he diagnosis +1

unknown001 if the option included serum prolactin, then i would consider pituitary in the evaluation, because usmle is all about most common. having said that, the next best is calcium assesment +

submitted by peteandplop(42), visit this page

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The above is correct in terms of MoA, however I believe the stem states it is PT (prothrombin) prolongation, not PTT (Partial Thromboplastin). I did not have any idea what dicumarol was.. but here was my logic:

Patient had aortic valve replacement, she's 80, probably put on an anti-coagulant
I know Warfarin is sold under the brand name Coumadin
Remind yourself that Warfin was discovered in 1927 (10,9,2,7) and inhibits Vit K dependent clotting factors (vit K deficiency-like state)
Pronounce the drug not in FA as diCOUMarol, and you shall hopefully now know it also inhibits epoxide reductase, and pseudo guess your way to victory.

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rina Yes it was PT! Personally I forgot that PT detects changes in I, II (thrombin), V, VII, & X. Vit. K affects II (thrombin), VII, IX & X so there is significant overlap. +

submitted by tea-cats-biscuits(273), visit this page

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You know it’s an enveloped virus since it doesn’t hold up to acid or being dried. You know it causes a fever and a cough, while affecting the larynx. Only virus category that fits all that info is the coronavirus (causes SARS) from that list.

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zelderonmorningstar EBV doesn’t cause fever and cough? +1

zelderonmorningstar Wow, just checked First Aid and it doesn’t list “cough” as a symptom of EBV. +4

drdoom EBV is not a “respiratory virus”; it’s a *B cell virus*. Even though you might associate it with the “upper respiratory tract” (=kissing disease), it doesn’t cause respiratory inflammation since that’s not its trope. B cells are its trope! That’s why EBV is implicated in Burkitt Lymphoma, hairy leukoplakia and other blood cancers. (EBV is also known as “lymphocryptovirus” -- it was originally discovered “hiding” in *lymphocytes* of monkeys.) So, EBV = think B cells. +30

fulminant_life EBV does cause pharyngeal and laryngeal inflammation along with fever, malaise, and cough and LAD. The only thing that pointed me away from mono and towards coronavirus was the patients age. +8

nbmehelp Can someone explain what not holding up to acid or being dried has to do with being enveloped? +

yb_26 @nbmehelp, the envelope consists of phospholipids and glycoproteins => heat, acid, detergents, drying - all of that can dissolve the lipid bilayer membranes => viruses will loss their infectivity (because they need an envelope for two reasons - to protect them against host immune system, and to attach to host cells surface in order to infect them) +12

lowyield @yb_26 does that mean that non-enveloped viruses hold up better to acid/dryness? +2

rina yes enveloped viruses are easier to kill (see post from drsquarepants: https://www.nbmeanswers.com/exam/nbme23/1161). also i think the "when dried" might refer to the fact that coronavirus is spread by respiratory droplets (don't even need to read first aid can just read the news at this point!) +4

submitted by thotcandy(131), visit this page

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What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

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baja_blast Deltoid only does abduction from 15 to 90 degrees. So not overhead. +1

donttrustmyanswers With that logic, supraspinatus only does abduction form 0-15 +10

rina the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +2

submitted by sne(59), visit this page

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Alcoholic = pancreatic insufficiency. Linoleic, oleic, and palmitic acid can be absorbed without pancreatic lipases since they're just free fatty acids. Triglycerides need to be broken down by lipases before absorption.

Bile acids are the main method for eliminating cholesterol, not pancreatic enzymes

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rina also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out +6