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Contributor score: 92
I thought about that but then I ruled it out as with the NBME ethics questions the answer is almost never to defer to someone else. The question doesn't ever tell you what type of doctor you are for you to be referring to a different more specialized physician. Also I assume that they think if there was something wrong you could handle it.
Out of all the questions (UWorld,NBMEs etc.) I can only think of 1 question where you had to refer.
even i thought pediatrician should be called as after all, every newborn is screened by pediatrician and in this case, he had abnormality! i still wonder why would gynaec comment on that!
Slowly raising my hand as well
patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia
I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency.
me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong.
Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect).
Why would the onset be 15 years later though?
I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor.
Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman
Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization.
Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded.
Agreed, that's how I made my final decision!
yeah I literally had no clue what anaplasma was, but came to the correct answer the same way
tell me about it... I got both in one block and started seriously reconsidering my answer choices!
I got both questions within 5 questions from one another! I was seriously doubting my answers haha
How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia?
@underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa.
Hate this question though... the first thing you would have to do in this situation is refuse to do what the resident asks you to do. Then you could accompany them....
If not for the additional "refuse to sign consent". I think the answer would have been extremely straightforward.
I was taught that that the person who is operating should get the consent that's why I got this wrong..
But why is it external anal sphincter instead of bulbospongiosus? Aren't both attached to perineal body?
Bulbospongiosus connects to either side of the perineal body. But if you go directly posterior rom the commissure you hit the anal sphincter
I just think about how women say they done ripped their asshole while giving birth