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submitted by bobson150(14),
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ehT rdogniw fo this tquienos udenscfo .me sihT is kagnis w"hihc of ethes vlssese si teh hgih suprerse ey"ssmt htri?g oS the ihgh spesreur opseiurr tlcaer is cganisu ansdrceei rpresseu ntio hte ieriorfn acler?t

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 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
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' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +3  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by hayayah(1081),
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He ash aeclf oneincnnicte so ihs eatelxnr cinetpshr si dm,adage hwihc si ennritvaed yb eht epudnlad n. S2(.S-)4 The vcelip accpnilnhs eev,nsr hhcwi aemiedt hte ceorneit sc,pseor rae losa S.4S-2

thomasburton  Why could this not be dysuria? +3  
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. +16  
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +3  
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +  
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +  


submitted by keycompany(311),
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Thsi eqosntui si gsd.iueids atWh tyhe ear ralley saking is "athw si eht sleo tnriednmeat of epcsies uisvvral"? heT nlyo swrane is eth itylbia ot tprraocee. Baucsee DNA oerleyasPm sah feadron-orpig y,ticiavt onegpyr lilw be edfcauntef by NRA eleProymsas aclk of naoigrfo-erpd v.yiiactt

ls3076  the phrasing of this explanation doesnt make sense to me. +4  
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! +5  
almondbreeze  common sense asked in a very very convoluted way.. +  


submitted by yb_26(258),
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  • nidinbg ot het HCM scasl II rcoeertp dna irgnietrgg teh reeleas of ynctskoie - nspiaueergsnt

  • dninigb ot eth nreoascmuuulr ouincjtn nda ernntveipo of hCA saeleer - ilmoubtnu noxti

  • oglekabc of a -nGPgTidibn ronptie iglenrust ign teh calaimocutun of AcMP - espsustri xinot

  • bagleock of sprceyptnia biiiohtnni of npsial mtroo xreeslef - euntsat otinx

  • ptenirvoen of noitepr ensyhsits yb lngibock lenaogntio fo eht dlieetpyopp cihna - iritadhpeh x,toin odssoPmauen geouarsani oxxotein 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. +5  
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 +2  
texaspoontappa  tetanus->postsynaptic inhibition I believe +6  


submitted by hello(317),
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can sonemeo eeplsa pialenx ?ihst

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). +2  
madojo  Meniere's disease is sensorineural hearing loss with peripheral vertigo due to increased endolymph within the ear. +  


submitted by yotsubato(1041),
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aWs it sujt me, ro idd ga"e at tonse ni esya"r aeprpa THRIG boave hte rbmuen fo eti,nastp tarerh hnat eth emna. hiWhc uesonfdc me rfo a dgoo 3 .itsmuen

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +13  
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) +7  
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +7  
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +5  
monkey  what is 36 supposed to be? +1  
thomasburton  Think the number of people in that group +5  
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99" +5  
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +3  


submitted by bobson150(14),
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ehT rwgoidn fo htis iuensoqt funoceds e.m sThi is siagkn hhw"ci of heets slseevs is the hgih rsuseper tmys"es hg?itr So eth ighh erserpsu pruieors alrect si gansuic ienrdeasc pueerrss onti eth nreirofi ?trleca

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 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
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' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +3  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by rogeliogs(9),
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iTsh itesnQuo tsi uobta iosrpteyrra tsubr

tatiesPn ithw APDNH crn=ceeiindiocchfy alsunrtoaoumg seieasd )GD(C

nevE hohtgu ittapnes ihtw DGC t'acn eakm dpueSxi,eor they nca eus ti rfom eht tcabesria dan vcenotr ti ot lacheb LOHC nad lkli the aebat.ircs

UBT iatacersb wthi csealtaa nszyeem reztniluae reiht wno xrodpsieeu nda taths ywh eth DGC ipantet ac'nt ilkl h.mte

telaCasa iivtoesp actsarbie: S. aureus - risselulAgp

thomasburton  I thought E.coli was catalase positive too? Why can that not be correct? +6  
mb10  (FA 186) Catalase (+) microbes, especially S aureus +4  
makinallkindzofgainz  @thomasburton - because First Aid said so, so suck it +1  
jurrutia  @thomasburton, because S aureus is more common. I guess. +  


submitted by usmile1(110),
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dose eanyno wonk what the tcururest E is iniotgnp 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. +4