NBME Answers : snafull's page

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+1 visit this page (nbme24#36)

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Can somebody explain why this is not a foreign body granuloma?

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yb_26 because they mention scattered fragments of foreign material (pt presents 2 months after c-section, sutures are either removed in 1 week or dissolve in few weeks (depends on type of suture material) +

suckitnbme I think it IS a foreign body granuloma. The sutures are supposed to be removed or dissolve but sometimes one gets left in. The question says foreign material and sutures are often polarizable. +5

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submitted by kentuckyfan(47), visit this page

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I get why the mixed venous oxygen tension decreased. However,, isn't the systemic vascular resistance also decreased?

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yb_26 no, decreased CO => peripheral vasoconstriction => SVR will be increased +8

yssya1992 No SVR will increase due to RAAS and SAN thats why we decrease afterload in HF treatment ( ACEI, ARBs ) +6

snafull Wouldn't pulmonary vascular resistance also be decreased here due to pulmonary vasodilation in the setting of an MI? +

cienfuegos @snafull: my initial thought is that we would see pulmonary vasoconstriction because of the relatively low oxygen tension (that results from the low cardiac output). +3

submitted by vshummy(184), visit this page

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So the best i could find was in First Aid 2019 pg 346 under Diabetic Ketoacidosis. The hyperglycemia and hyperkalemia cause an osmotic diuresis so the entire body gets depleted of fluids. Hence why part of the treatment for DKA is IV fluids. You might even rely on that piece of information alone to answer this question, that DKA is treated with IV fluids.

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kbland https://step1.medbullets.com/endocrine/109032/diabetic-ketoacidosis-dka +3

fulminant_life I just dont understand how that is the cause of his altered state of consciousness. Why wouldnt altered affinity of oxygen from HbA1c be correct? A1C has a higher affinity for oxygen so wouldnt that be a better reason for him being unconscious? +8

toupvote HbA1c is more of a chronic process. It is a snapshot of three months. Also, people can have elevated A1c without much impact on their mental status. Other organs are affected sooner and to a greater degree than the brain. DKA is an acute issue. +10

snafull Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +5

johnson Probably because they're sustained on ketones. +6

doodimoodi @snafull glucose is very high in the blood, why would neurons not be able to use it? +3

soph @snafull maybe u are confusing bc DK tissues are unable to use the high glucose as it is unable to enter cells but I dont think thats the case in the neurons? +2

drmomo https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/ states its primarily due to acidosis along wth hyperosmolarity. so most relevant answer here would be dehydration +3

drmohandes I thought the high amount of glucose in the blood (osmotic pressure), sucks out the water from the cells. But you also pee out all that glucose and water goes with it. That's why you have to drink and pee a lot.. +10

titanesxvi Neurons are not dependent on insulin, so they are not affected by utilization of glucose (only GLUT4 receptors in the muscle and adipose tissue are insulin dependent) +33

drpatinoire @titanesxvi You really enlightened me! +2

mutteringly I don't make the connection of what titanesxvi said to the question - can someone explain? +1

motherhen @mutteringly it explains why the answer choice "inability of neurons to perform glycolysis" is wrong +2

jbrito718 The real question is does HbA1C even alter O2 affinity? +