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Welcome to surfacegomd’s page.
Contributor score: 2


Comments ...

 +1  (free120#10)

Exercise physiology (UWorld)

Increase muscle activity causes:

  • Venous constriction --> increase preload
  • Increase cardiac contractility and HR

Both --> increase cardiac output

  • Resting muscle and splanchnic vasoconstriction
  • Arteriolar dilation within muscles (lowers total systemic vascular resistance)

Both --> increase blood supply to active muscles


 +0  (nbme22#44)

The qx asks for the direct tributaries following the vein that is producing the hemorrhoids, in this case internal hemorrhoids because they are painless.

(Amboss) Internal hemorrhoidal plexus -> superior rectal vein -> inferior mesenteric vein -> splenic vein -> portal vein -> ICV


 +1  (nbme22#32)

FA 2020 654

"Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response higher LH:FSH, higher androgens (eg, testosterone) from theca interna cells, and decrease rate of follicular maturation producing unruptured follicles (cysts) + anovulation"

surfacegomd  correction FA 645* +

 +0  (nbme17#40)

FA 2020 page 563 OCD Obsessive-compulsive disorder treatment: CBT and SSRI's. Second line: clomipramine and venlafaxine.


 +0  (nbme17#0)

FA 2020 page 561. Recurrent episodes lasting more than 2 weeks.





Subcomments ...

submitted by welpdedelp(225),
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It swa ae,scsib chiwh is instrttemda rs-eroonpeon.p

welpdedelp  **person-person lol +6  
suckitnbme  NBME loves their scabies +15  
dentist  did you get scabies from "burrows" and "night itching" +  
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +  
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +  
zevvyt  to summarize leafhouse: Fomites +1  
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +  


submitted by mattnatomy(43),
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reSeve eoyiensprtnh eofnt ldaes ot ltihappsreyc csooerieilalsortrs o(-innsinko ee)craa.pnap osAl ees tarfnoiiplero fo tsmhoo mlusce .slelc

meningitis  and explains the flame hemorrhages (Goljan) caused by malignant HTN +5  
taediggity  FA 2020 pg. 537 +  
dentist  FA 2020 pg 301* +  
ally123  The flame hemmorhages are also a good buzz word for recognizing he has hypertensive retinopathy 2e chronic, uncontrolled HTN. Pt's with hypertensive retinopathy can also present with "cotton wool spots" and "macular star". Pics on FA 2019, p. 299 +2  
surfacegomd  Pathoma (2018) p. 69 +  


submitted by seagull(1539),
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uto of ouiyctris, woh may peepol wenk sti?h odtn( be syh ot ays uyo ddi or t)dd?in

My eorpyvt cdnauteoi tn'did ringain htis ni .em

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +5  
snoochi95  hell no brother +1  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


FA 2020 654

"Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response higher LH:FSH, higher androgens (eg, testosterone) from theca interna cells, and decrease rate of follicular maturation producing unruptured follicles (cysts) + anovulation"

surfacegomd  correction FA 645* +  


submitted by haliburton(213),
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no rsniatol utssei si a uegh eulc ehre. latot aklc of gI hwchi esuasc rteruencr esointcifn efrta om6 telaar(mn gIG si o)ng.e LN adn ltsinos ear n.ntrx/ooe-nmtiiesn FA( .)2107

angelaq11  I totally hated this Q! I almost completely overlooked the "no tonsillar tissue", and thank God I didn't because that's the clue that made me change my answer. I had CGD (yeah, I know, S. pneumoniae not catalase +), but it said that he had muuultiple infections since birth. And I took to heart that "since birth" thing, because, isn't Bruton supposed to present with infections from around 6moa? I hope I don't screw this up next week +2  
surfacegomd  @angelaq11 I thought the same thing!! because it said "since birth" I thought Ok this is not Bruton :( +