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submitted by bobson150(3),

The wording of this question confused me. This is asking "which of these vessels is the high pressure system" right? So the high pressure superior rectal is causing increased pressure into the inferior rectal?

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +5  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +2  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +1  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  


submitted by hayayah(414),

He has fecal incontinence so his external sphincter is damaged, which is innervated by the pudendal n. (S2-S4). The pelvic splanchnic nerves, which mediate the erection process, are also S2-S4.

thomasburton  Why could this not be dysuria? +  
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +1  


submitted by keycompany(123),

This question is disguised. What they are really asking is "what is the sole determinant of species survival"? The only answer is the ability to procreate. Because DNA Polymerase has proof-reading activity, progeny will be unaffected by RNA Polymerases lack of proof-reading activity.

ls3076  the phrasing of this explanation doesnt make sense to me. +2  
ls3076  oh wait sorry i just read it again. So instead of proofreading how are errors handled with RNA? +  
thomasburton  Think the point is basically although errors with RNA polymerase make make the bacterium not very good at infecting or killing or whatever it does not affect replication as it is not used during replication! +1  


submitted by yb_26(49),
  • binding to the MHC class II receptor and triggering the release of cytokines - superantigens

  • binding to the neuromuscular junction and prevention of ACh release - botulinum toxin

  • blockage of a GTP-binding protein resulting gin the accumulation of cAMP - pertussis toxin

  • blockage of presynaptic inhibition of spinal motor reflexes - tetanus toxin

  • prevention of protein synthesis by blocking elongation of the polypeptide chain - diphtheria toxin, Pseudomonas aeruginosa exotoxin A

thomasburton  Not sure I agree with the second one, M.O.A for botulinum is cleave of SNARE protein preventing pre-synaptic ACH release. Think the second one almost describes something like sux or some other deporalising nicotinic drug. +  
humble_station  You are right but to get the muscle spasms, trismus & seizures it has to inhibit GABA & Glycine release from Renshaw cells Cleaving the snare proteins will cause paralysis +1  


submitted by hello(66),

can someone please explain this?

thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC). +  


submitted by yotsubato(282),

Was it just me, or did "age at onset in years" appear RIGHT above the number of patients, rather than the mean. Which confused me for a good 3 minutes.

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +4  
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +3  
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +  
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +  
monkey  what is 36 supposed to be? +  
thomasburton  Think the number of people in that group +  


submitted by bobson150(3),

The wording of this question confused me. This is asking "which of these vessels is the high pressure system" right? So the high pressure superior rectal is causing increased pressure into the inferior rectal?

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +5  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +2  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +1  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  


submitted by rogeliogs(1),

This Question its about respiratory burst

Patients with NADPH deficiency=chronic granulomatous disease (CGD)

Even though patients with CGD can't make Superoxide, they can use it from the bacterias and convert it to bleach HCLO and kill the bacterias.

BUT bacterias with catalase enzymes neutralize their own superoxide and thats why the CGD patient can't kill them.

Catalase positive bacterias: S. aureus - Aspergillus

thomasburton  I thought E.coli was catalase positive too? Why can that not be correct? +2  
mb10  (FA 186) Catalase (+) microbes, especially S aureus +1  


submitted by usmile1(14),

does anyone know what the structure E is pointing to?

thomasburton  Not sure looks like it might be free ribosomes or other such small cytosolic structure (I picked E too, thought B looked way too big!) +  
targetusmle  same here!! marked e thinking of it as a mitochondria +1  
msyrett  Glycogen Granules! They are not membrane bound and float freely in the cytoplasm. +