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Welcome to sbryant6’s page.
Contributor score: 128


Comments ...

 +0  (nbme23#41)
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Potnein iartrese rea lmsla scebnahr of the aibsral etrary tath can pururet in het gestnit of opyolr notorceldl reteoi.hnspny

nor16  vertical gaze intact = mesencephalon intact horizontal gaze damaged = pons damaged (RPRF) Pons damaged = no access of corticobulbar tracts to motor nuclei in brain stem -> speech impaired +1

 +5  (nbme22#46)
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Hflulep letb:a ngAsousat1l/v_loawtcM:/pop/5.nn/cinocJahdn_timTnoep1i/-n.tptsb


makinallkindzofgainz  upvote for credible source +13

 -3  (nbme22#6)
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fI oyu wnko teh OAM fo igxinod ouy hsdulo be ebal to tge ihst soqetnui thg.ir


 +8  (nbme21#48)
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hisT otneqsiu si -.tdlwoof uoY smtu wkno eth siid-gmckaenoni eicrrahyh adn losa eonisrdc muaynto.o kaingM mdiecnstoeo"n"mar fro rticnea setatrnmte si og,wrn aecbsue ti etsaolvi mnoouyat nad dnrfemoi nn.soetc sihcsyinPa shlodu slympi paenilx hte sBA'R fo all emrttaent sptoon,i adn allwo het fimaly ot icdede whta si etbs dsbae on rdonfiem ecnsnto adn htr"ei pptneoseicr fo hte TSAEIP'TN esw.ihs" fI ereht is no anadevcd tdeiverc,i htne teh ecidnsio luhdos eb deeplapa ot a tarosruge caknr-eide.smio Priytrio fo asstgrureo si g;ts-uoud-sp&etla eri-ctrl&n&t;gtbs-n-i.sesi;-ldnpgagh ,esY eht sspueo duwlo hvea hhergi y,ptiorir tub hte ifalym lhsoud at talse ytr to ahcre a senssocnu rsitf bofree apigleanp to ynlo"" eth wif.e If a n,ocnsssue nacton be emad, neth teh wefi ldowu aveh rtsfi ysa in teh icdsioe.n ofeTh,rere rnnaiogugce eth aifmly ot eeidcd gcdronaic to het seshwi fo the TPAINET uldow eb a etebtr fsirt estp, liyeseacpl if eht sshwei fo teh fwie is rtrycnao to htta fo hte pitenta. o,slA jsut as a laerneg er,ul I lalpyycti iovda iicgnpk aenswr iontops iwht ta"us"bleos scuh sa ,"rveen a,wsyal .l"noy heT popesru fo a sauroretg si ot tca in het tbes neistrte of het te.antpi

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1

 +5  (nbme21#37)
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aynnrrhioaCiaogpm hwit antfClocicasii and looseetrlCh asrsCtly itro(mlo-o id)flu. tanenmR of t'ekashR .uphco tNo to be noefducs htwi iurpiyatt .oamdnae

dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +

 +8  (nbme21#48)
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To brmmreee ofeBcnla is a GAAB insaotga nad ceuslm ,taraxeln I yaswal khtin of kG"ere akBlava". rGkee orf G,ABA and aaBkalv fro nlfBce.oa

castlblack  Thanks. Baklava is from Armenia though. Go us +1
athenathefirst  No it's actually Arabic/Turkish. That's why it's called Baklawa. +1
gandon  Both Baklava and Baclofen are Armenian +
lovebug  I don't know if this is right. UMN Lesion (In this case, MS) -> Increased DTR, increased muscle spasicity, and dystonia. If Baclofen stimulate GABA B receptor(it's Gi related PTN) -> neuron become hyperpolar -> decreased excitory glutamte -> muscle relax. +




Subcomments ...

submitted by mousie(171),
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Why on gsi?tawne I mnea I etg atscEsy si baborpyl eth ugrd of eoicch efrboe na lla hntig ecdan prayt l)l(o btu otd'n ndaertunds hyw eehtr owdlu be ldoc esexmrettii dan on enwsagti hnew is FA ti yssa mthpreiaheyr adn d?r?a?o?bh

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +7  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +9  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +16  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +7  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +3  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +8  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +  


submitted by link981(133),
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eagP 36 of FA 21.80 nPruei inattogasn dsgur ar:e

n-api6MAitPoh(erz si a rduropg of ,)P6-M otecpoy,aMhenl vin.iarrib

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +1  


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oGod afct ot tmoicm to ymr:ome uoy elso aibcbr ni hte sotol ne(ceh hwy rhderaia cessua nnnonoai gpa betilomac aoscids,i) and siealypecl sloe soasumitp wthi ievtxaal usaeb sa( nioendmet in het snueoiqt sme.t) wiad/ai-o.-nasiet-t-owyhwontrtaa-.resmne-stc/opcetdnseertlt/hphuaaboltrd/tilwe:caebmdci

sbryant6  I'm going to go take a big bicarbonate poop now. +20  
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse — Metabolic Alkalosis :   ↓K+     ↑Cl-                   ↑pH    ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +1  
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1  
texasdude4  easy way to remember : "Bicarb out the Butt" +  


submitted by pppro(22),
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neaPtti hsa .BHP ivGe ahpal one insgntaoat to ercdue mhosto leucms noantcrcoti dna eirelve lcfdiyfuti ai.iunnrtg

d_holles  lol i thought it was some kind of urinary retention problem and put H. +11  
sbryant6  How is H wrong? Oxybutinin or tolterodine treat urinary incontinence by blocking M3 muscarinic acetylcholine receptors --> urinary retention. We're just supposed to assume they are talking about BPH here because he is old? +  
jaxx  I agree. I picked "H" for that same logic. Does anyone know where we should have come to the conclusion that this was BPH? +  
forerofore  they are telling you he's having "difficulty urinating", one of the clinical criteria for BPH is reduced urinary flow rate. this is not incontinence because they are not telling you he leaks at all, just that he pees "a lot" +11  
drzed  Even if he was urinating too much, anticholinergics are contraindicated in the elderly (Beers criteria) +2  
pathogen7  @drzed tI mean techinically alpha-1 blockers are on the Criteria too ... +1  


submitted by welpdedelp(198),
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sThi si e-maLErb,ntota ihcwh roeivmps htiw oemmntve sa rpcaomed to tMenaihyse icasrga icwhhh seonwrs wiht tmeonmev

sbryant6  Lambert-Eaton is typically associated with Small Cell Lung Cancer. Since there was no mentino of that, I was thrown off. Such is the difference between UWorld and NBME I guess. +1  
makinallkindzofgainz  I'm laughing about Myasthenia "gracias" lmao +9  


submitted by seagull(1112),
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Teh uhrtaso tewn tuo fo itehr yaw ot dfni tehw ortws oopth of a uogmnalar heyt oul.cd eTh trwhe on a mest taht tssseugg thta ti uowld be tngaaolniur u.eist uBt iltlte did ew .onw..k

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +16  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +3  


submitted by seagull(1112),
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Im loas cvicndeno nbklcgio -L2I is olsa a attet?rnme yHW si aTaFNlhp- het etetrb enrwsa r?hee

amorah  FA P120-122. Immunosuppressants for RA are calcineurin inhibitor (cyclosporine and tacrolimus), 6MP, and TNFa inhibitors (adalimumab,infliximab, etanercept). It is important to distinguish that calcineurin inhibitors block t cell activation by preventing IL-2 transcription, not necessarily block IL-2 action. Sirolimus(rapamycin) blocks IL-2 action but it is used for kidney transplant rejection prophylaxis specifically. +12  
sbryant6  Spot on. This image explains how Sirolimus blocks the effects of IL-2: https://image.slidesharecdn.com/11-150813013011-lva1-app6892/95/11immunosuppressants-30-638.jpg?cb=1439429471 +  
krewfoo99  in addition to the above responses, IL 1 antagonists (Anakinra) can be used to treat RA. Anakinra is a recombinant human IL 1 receptor anatagonist but less effective than other treatment modalities. +  
snripper  Prednisone is a glucocorticoid (which inhibits IL-2 synthesis) is already being used with no effect. So TNF-alpha is the next option. +  
avocadotoast  DMARDs: methotrextate, sulfasalazine, hydroxychloroquine, leflunomide, TNF inhibitors, Anti- IL6 (Tocilizumab), JAK inhibitor (Tofacitinib), Rituximab. You can use cyclosporine and tacrolimus to treat RA, but those aren't first line treatments. DMARDs are used the long term treatment of RA and methotrexate is often started first, and the other drugs are prescribed if methotrexate does not sufficiently control symptoms. None of the other choices listed are a part of DMARD therapy. +  


submitted by yotsubato(806),
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PMTP" ple)tnd-6hm2,oytl,3-i(iretep--4dr1hay1eyr,-ynh is a roupdrg to the iueroxntno M,+PP whhci ceassu ramnpente posymmst of osrinasnP'k saidese yb dtosiygnre anmoieprigcd nonuers ni the atasuisbtn anrgi fo het rnb.ia It ahs eben used ot dutys eeasdsi mdeslo ni urviaos nimala ".eusstid Wiik

ilikecheese  pg 508 FA 2019 +6  
sbryant6  I thought this was testing "lead pipe rigidity" aka Neuroleptic Malignant Syndrome and its connection to dopamine. Had no clue what MPTP was and got it right still. Probably wrong train of thought though. +  


submitted by brise(31),
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Teh einqutos si aginks tawh ointp ludwo eb het tmos keilyl ot urle ni ,ncrcea nad ghih cictsiiepfy hwen ipiteovs urlse in eracnc. hTe sheihgt ifcptisciye vluae is ,A bc het eth X xsia howss !)fitpiy(icec-s1

sbryant6  SPin and SNout. Specificity in, sensitivity out. +5  


submitted by sbryant6(128),
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If ouy knwo hte AMO of nodixgi oyu doshul be ealb to etg tsih qoeitnus thirg.



submitted by sbryant6(128),
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hisT nuqstioe si folow.-td oYu smut onwk het mgiedk-cnsiinao hyarirceh nda losa incosred .uyooatnm kingMa d"nsomacioernmt"e fro iacernt aerttesmtn is ,wnrog sacubee ti toviesla oonmtyau nad ormdnfei .cnenots insyshciaP uhldso mlsiyp lxeinpa teh 'RABs of lal tenermatt onsito,p adn allow teh ilmfay to ecdide thaw si sbte dsbae on rfdieonm enocsnt and rhtei" eipocrtsnep of hte ASETTNP'I .he"siws fI trehe si on aecadvnd ivrcte,die hnet het cnedsoii dluhos be pdleeaap to a uteoragrs as-keeroci.mnid Piyoirrt of ossraretgu si as;gsouptt-ed-l&u g;sc-retnriidsi&n-;g&.b-hengplttsal- esY, teh supeos oudlw aehv hrgehi iyrr,piot ubt eht mfyali suohdl at ealst ryt to recha a esusnnosc ftsir orfebe laiegapnp to n""loy hte e.fwi fI a scoussn,en contna eb mae,d then het fewi olwud haev rifst yas ni the eoicsni.d ohTfree,er ngoguneriac teh mfaiyl to eecidd iccadnrgo to eht sehsiw of eth NIAPTTE wludo be a etrteb tfirs pets, acieyelspl if hte shewsi of eht ifwe si carrynot to taht fo het .apenitt oA,ls sjtu as a aenrleg u,rle I aiyllyctp vaido iignckp wnrsea nostpio hitw uo""slasebt uhcs sa e"r,nve aslya,w y."oln The poerpus fo a arrueotgs si ot cat ni the sebt nretteis fo the a.entpti

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1  


submitted by hayayah(990),
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eysnCcyiise-teetn nemikhoce eetcorpr 5 C5(CR) is a eriotnp fduon on teh asfeurc fo DC4 e.scll

yotsubato  Note, this is NOT in FA +  
sbryant6  It is in UWorld. +2  
almondbreeze  it's in FA2019 pg.110 +1  
almondbreeze  but missing the full name for CCR5 +4  
demihesmisome  CXCR4 is also a chemokine receptor. +1  


submitted by mcl(517),
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aGit pmlesbro iresas icispunso rof calhool ubeas ro ilaedhn l.egu ,revoeHw senot of iagt srbpoeml is lveayteril idpar ueocl(p of mnh)sot nda itag nestbarudic hiwt saerrgd to lachool is erhtei deu ot nttxcaoinioi ro hcicrno asub.e iAevntlreat tplixoaaenn avaaelibl no NSD. loAs ese netuoel xiicttoy on .demacpse

sbryant6  I got this correct solely based on the patients demographic. Glue is cheap and easily accessible to underage populations. +4  
whossayin  Kinda racist of us but that’s how I reasoned my answer too lol @sbryant6 +  
hpsbwz  how is it racist if the only thing thats given is his age lol @whossayin +18  


submitted by dr.xx(129),
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enloaHHebsnschres-da oitqH Ep:una = 1.6 + Hlg3(COo / 300(. * )CaP);2O so ee,hr pH = &2.;t=6g 9 ucteA teu)a(nndpsecmo impyarr srryaretipo wtica i,shidso ailcotmbe acsdsoii

sbryant6  calculator can't do logs yo. +5  
b1ackcoffee  wow, sherlock! +  


submitted by yo(53),
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et'erhy kglnait utboa a seannllpero uhnts perrudoec

ttarsaacnsgluti0yll/l/tett-nsmin4ml/n-phpe-/roi/.l:annccaeldh5oseset.9hterehvd

hungrybox  be honest did u know that before looking it up +8  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +13  
sympathetikey  Relax @meningitis. Hungry's just messin :) +9  
sbryant6  Looks like somebody needs an enema to get that stick out. +1  
chandlerbas  ya'll are too TP/(TP+FN) lol +7  


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umnmoitueA tdioiistyhr (aak oats)Hoihm + pn&-ttg;-aegrn hTkni abtou ilisyspiotb of eftla ihpysooyirdmht ude to btdiyoan amditede mlataner hm.dyrhpioiytos sdeaL to .ersmitCni dnsngiiF ni fnaitn rae teh 6'P Pot( yl,elb P,lae yufPf ,afec ndiPortgur ucusbi,ilm etPoabrrntu gnotu,e adn oPro nariB eend.lpoemvt

neonem  I don't understand the last part of this question stem though... if the mother's TSH *increases* during pregnancy? Wouldn't this further increase her (and/or the fetus's) production of T4 and thus counteract the hypothyroidism? +  
poojaym  @neonem no. Autoimmune hypothyroidism is a destruction of the thyroid gland, and a decrease in production of T3/T4. An increase in TSH means that there is not enough T3/T4 to inhibit TRH, and so TSH is being released to stimulate the thyroid gland. +16  
arezpr  TSH, T3, T4 and thyroglobulin cannot cross the placental barrier. +  
chamaleo  @arezpr although those hormones can't cross, the autoantibodies from Hashimoto's can +  
yotsubato  The baby has its own TSH though +  
sbryant6  TSH comes from the pituitary, and act on the thyroid. Autoantibodies attack the thyroid, so TSH doesn't work. +  
kimcharito  no goiter then? +  
lola915  I think there is no goiter because the baby's thyroid gland has not fully developed and these immunogloblulins from the mother could attack the thyroid gland leading to issues with it's development. +  


submitted by pparalpha(78),
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EVB -VH(H)4 cesfnit B lecl throuhg 21.CD

lAtiacyp mchysyoetpl no praphleier olbod smera (not fndiecet B elsc,l tub aeietrvc cicttoyox T clle)s.

neoscMi"onso":lu + ootnsomp ttes bn(osadtiei ceddtete by agiatunngtloi fo spehe ro orehs RsCB)

sbryant6  Atypical lymphocytes are CD8+ T cells, not CD4+. Remember that. +10  
mangotango  I remember this because Infectious Mononucleosis is caused by a virus (mostly EBV, sometimes CMV) and MHC Class I functions to present endogenous antigens (e.g. viral or cytosolic proteins) to CD8+ T cells. In comparison, MHC Class II is more involved with presenting exogenous antigens (e.g. bacterial proteins) to CD4+ T cells. // FA 2019, pg 100 +  


submitted by hungrybox(791),
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ongL sawrne daae,h utb brea hwti e.m

:IHNT v okosl kidn fo like y, aewesrh k solok emor ikle .x

triyeetc-np = V1ax/m

  • axVm is the perpu iltmi on ohw fats a roetcain is ctaelzady yb ezem.nys

pict-erxnet = m1/K

  • mK is a ainrkgn fo ohw odgo an eyzmen is at dingnib sit tbtrsuaes. An ezmney hwti a nikanrg fo 1 si erttbe ta bnidnig tis bsruestta tnha na eymzen hitw a nngikar fo 5. erwoL( mK = tebert n)myeze

Neot atht mx,aV as a seaurem fo feerr,maopcn can be deletar ghohrtu nmay ightn.s neawMehi,l mK si a ste carhcasricetit fo het em,znye nda ancotn be .eedlrta

nI tsih xemale,p eth enemzy prnmoraeefc ()amVx is dnceiaers by cengisnair het tviainm tofarocc so atth it crseeah a rnaolm"" ttivya.ic veo,erwH het yenzme is llsit nleirhneyt ythtsi ued ot a clegiontan ,edfcet so teh Km asyst the aes.m

mnemonia  Awesome. +  
ht3  wait line B shows the vmax doesn't change and that the km is getting larger (enzyme is still shitty so larger km) so -1/km would be a smaller number and would approach 0 +1  
lamhtu  You say Km cannot be altered and its staying the same, but the answer of the graph demonstrates a higher Km value. Needing "higher concentrations" of the B6 for enzyme activity is another way of saying Km is higher since more is required for 1/2 vmax activity +4  
sbryant6  Yeah this explanation is wrong. +  


submitted by nosancuck(74),
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hsiT b hsa asocisriSdo so erh unaomragls eb itaacnvti dat VitD

sbryant6  Your mom activates my VitD. +14  
pg32  Anyone know why there is hepatosplenomegaly? +  
gooooose  Likely granulomas involving the liver and spleen- Pathoma says any organ can be involved +  


submitted by tinydoc(190),
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txP spaarpe ot vaeh uMscel yctipsiast sa a rteusl fo MS. paiSyttcsi si daeettr iwth a culmes lareatxn like anfolBce ichwh si a AABG ns.oaitg htcoBaalne si a ilmtimnhceoCnio hchwi nca eb used to teatr rynirUa snytinoufcd in uplteliM ssscelo.ri but teh tsoeunQi kssa hatw wdoul pelh treat hte ctsy.itpsia

sbryant6  To remember Baclofen is a GABA agonist and muscle relaxant, I always think of the "Greek Baklava". Greek for GABA, Baklava for Baclofen. +4  
sahusema  Also, acts on GABA receptors specifically in the spinal cord +1  


submitted by danger_rave(-2),
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n6bdidni@uimuf S,o I got to yecnlmbio eud to M.Siekccyrhot Bocemliyn cna csuea oaeigienmyrpttpnh dna yaumnoplr isirof,bs nad I i’tdnd eavh yna ncscoinnteo to comrlu.iclabh licernnsctyahA anc eb desu fro lla srtos of mnenaliagcis reef( iclrdaas klli olst fo s,fu)ft os eth tcexa iascoiindtn did sesl for em ot egt to teh aensrw htna ti ihgtm ehav twhi nrthaoe egor.tyac n=1, but ’tis ton a camig ziammiootnre asrwen at .atles

sbryant6  Correction: SketchyPharm ;) +  


submitted by cantaloupe5(69),
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soHogliyt dewhos valtacuieog reossinc vrdserepe( ctrhcaertieu fo mrocladaiy )efbirs hiwt tieuohlpnr ialfoiitntrn chihw dhenti atth the IM asw hwinti 24 rshu.o toMs yiellk eaucs fo etahd ihtinw ftris 42 shuor of IM si h.aytahrirm aModracliy uetrupr owlud sloa be eibivsl on rsgso pecaeaanpr fo teh ,htare hwchi yeth drbceside ni hte mt.se

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +9  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +2  
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +  
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +4  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +1  
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +  


submitted by mcl(517),
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Ninaic nmtiiv(a B)3 aoazgnnitse DLVL tlroehlesoc oeesrcint

sbryant6  Fibrates stimulate PPAR-alpha --> LPL upregulation --> decreased triglycerides. However, this question asked about a vitamin. Vitamin B3=niacin. +2  
lovebug  FA 19, PG 315. Lipid lowering drug bro. +  


submitted by hungrybox(791),
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tnsontgiun'H asdeies

  • tnciaianitop: hes hsa a isrmila oisrdedr as reh threfa tub eddi eeairlr

rReeebmm NHT"U 4 na amai,nl tup ti ni a GCAe." Htnunignti nege nufdo no orCmmooseh .4 GCA is het tidterileuonc :pretae

  • haCr,eo atdceau nuuclse
  • aAatix
  • olmGyo )redspois(ne
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +11  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by hungrybox(791),
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itogts'nHnnu esaedsi

  • ptntiaoiainc: hse sha a rialsmi oidedrrs as reh htearf btu dedi lreiaer

ebmmReer UTH"N 4 na nlma,ai upt ti ni a Ge."CA itntHingnu eeng dufon no oosehCommr .4 GCA is the octuieeitldrn eape:tr

  • oCrh,ae acauedt selucnu
  • tAixaa
  • oyoGml s(n)irseodpe
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +11  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by usmleuser007(326),
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Nsoirovru k)y(chSet = Aetfsfc hwree a lto fo eelopp rae in rqoesu tscarel - alpiceysel nomocm on ercisus - 09% of lal leaarirdh roebkatsu no ssieucr

sbryant6  Rotavirus occurs in unvaccinated children. In order for it to spread, all those kids would have to be unvaxxed. +  


submitted by hayayah(990),
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iunanIgl ahenisr ear ulsaluy irb,udcele ormfela ishaner aer .ton

iThs si an ncetirid ninialug nrh.eai tI tneser rnenaitl anniiglu gnir allater ot irfioern eigctaispr seslvse adn si puoserir to teh ininagul nmgleati.

Cuesda by fraleui of sperocuss vgalisnia to eoscl nac( mfro d.coeelryh) May eb cetdino in naintfs ro iosddercev ni taluddooh. uhcM erom mmnoco ni am.les

yotsubato  Heres a good picture to help with the concept. https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjVkIi0yN7iAhWLjqQKHbeXCTUQjRx6BAgBEAU&url=https%3A%2F%2Fwww.herniaclinic.co.nz%2Finformation%2Ftypes-of-hernias%2F&psig=AOvVaw2BzGtQLvSmUN8ymhdvETG5&ust=1560244112252834 +4  
sbryant6  Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect. +5  
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +  
azharhu786  The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament. The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels. An indirect hernia is seen in young people whereas, direct hernia happens in adults. +2  


submitted by hayayah(990),
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thiW hnoicrc mvi,gnito oyu lsoe recelteolsty dna a lto of id.ac It rggierts tilcemoab oslsilkaa chwhi si wyh lal eth emsur svaule era lwo o(r on hte rloew edn of hte olarnm ngra)e pxeect orf ne.aactiobbr

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +3  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +  


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htWi cirhnco ,igonivtm yuo elos tecsrleleoyt nda a otl of d.cia tI rirsggte ielaotmcb ssakllioa wcihh is hyw lla eth mesru vusale aer lwo or( no hte relwo nde fo eth lmaorn egr)an teecxp ofr btinrbco.aea

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +3  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +