NBME Answers : shayan's page

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submitted by m-ice(370), visit this page

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The patient shows no sign of cortical activity, but has some brainstem function intact, which implies she is in a form of persistent vegetative state. She has a living will that designates mechanical ventilation should be discontinued if that situation arises, so we must follow it and make not attempt to resuscitate.

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lfsuarez Why would the second part of that be correct when there is not mention of a DNR? +19

ug123 DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +4

sherry DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question. +2

shayan "The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing ! +7

criovoly I believe this question was not well constructed... it's one of those! +1

suckitnbme @shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state. +

luciana I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills +

coldturkey @lfsuarez CPR(if the need arises) , for this patient (barb overdose and hospital setting), she will be intubated to get and maintain airway access. However ,she is against any mechanical ventilation as per her living will. Hence, we cannot perform CPR on her. +2

furqanka I too believe DNR and DNI are distinct but UW 1124 says - A DNR order indicates that a patient should not undergo CPR. this includes bls (mouth to mouth breathing, chest compression) as well as advanced cardiac life support (intubation, mechanical ventilation, defibrillation, and administering medications such as vasopressor or epinephrine). Additional wishes such as the desire to not be fed artificially or any other limitation of care can be specified. +1

submitted by lsmarshall(465), visit this page

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Metaplasia - A reversible adaptive response in which there is "Reprogramming of stem cellsreplacement of one cell type by another that can adapt to a new stress." Both are normal cells. Respiratory tree should not have squamous cells until respiratory bronchioles (before that; cuboidal in term. bron. > columnar in bronch. > pseudostratified columnar in large. bronch.).

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shayan if its a metaplasia, then how it be normal ? I mean Metaplasia is not normal? +3

artist90 i got it confused bc the question stated that there was a mass in one lobe of lung and i didn't knew that squamous metaplasia also presents as a mass in lung. i missed that on biopsy they were clearly stating squamous metaplasia. +4

suckitnbme @shayan The term "normal" in the answer is used to indicate that the cells appear normal (meaning appropriate size/architecture/appearance). Remember that metaplasia is a normal response to stress. +11

jurrutia Metaplasia is not normal (in the sense that you only have metaplasia as a reaction to stress, but under not under normal circumstances), but the cells in metaplasia are normal. When they become abnormal, you get dysplasia. +