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Welcome to thomasburton’s page.
Contributor score: 26


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submitted by bobson150(6),
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hTe ngirwdo of hsit uqteosin dosncufe e.m hiTs is ignsak ihhwc" of heste ssleves si het ihhg rseesrup st"msye tgi?hr So eht ihgh esrerups ieosrurp ctrlae si anisucg eisadcnre uepssrer inot eht friirnoe ?clrtea

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. +2  
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(990),
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He sha ealcf cteinnnnoeic so shi ntaxeler ticsrhpen is emdaad,g wihch si vindeentar yb teh alpenddu .n 24-).(SS The cveilp anpilnccsh ,nervse ihchw ietemda eth neecoirt os,cspre rae olsa S24-S.

thomasburton  Why could this not be dysuria? +2  
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. +14  
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) +2  
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(268),
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siTh qinuesot si isisged.du Waht they rea elyral saingk is "hawt is eth loes tnnmteardei of eisscpe valurisv"? eTh oyln swenra is eth ibyalti ot t.aorpecre eBucase DAN esloyeraPm sha pooari-dnrgfe ivc,ittya epyngro lwli be aetfdcufen by ARN ymsrsePeloa lcka fo npir-gorefado ityva.ict

ls3076  the phrasing of this explanation doesnt make sense to me. +3  
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(191),
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  • idibgnn ot teh MCH aclss II trcoeerp dna egrtrgnigi the eesrael fo ienctosky - eutnisrsapneg

  • bdgnini ot eth uosrermualunc icnnujto dna petinenvor fo ACh rlaesee - umtunlboi ntoxi

  • lgbakeco fo a -nngTGdiiPb pnirote tnseulirg gni eht oantcuumlaci of AcPM - rpissetsu noixt

  • leobagkc of tapynscriep bihiiinton fo palins tomro selrexfe - steunta xiotn

  • etponnivre of ertnoip neitsyshs by noigclbk gtonilneoa fo eht ppdeetloypi ihnac - haheipdtir tnox,i Psasuoemdno isnrgoaeua ioenxtxo 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 +4  


submitted by hello(251),
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cna omesnoe paslee ixnlape h?ist

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(806),
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Was it jstu ,me ro idd ea"g at ensot in a"ysre raepap IHGRT aoevb eht munbre fo sti,napte hartre tahn eth nm.ae chhiW escndfou me fro a gdoo 3 utse.mni

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +12  
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) +6  
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +6  
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? +  
thomasburton  Think the number of people in that group +4  
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99" +3  
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(6),
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ehT odiwnrg of iths questoin cnsfduoe e.m hTsi si aiskng hi"hcw fo sehte seslesv si hte ihgh eruperss y"mstse ?itrgh oS hte hhgi uspserer soirrepu tclrea is iucansg rsenadice srupeers iotn het ienrofri ?rtalec

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. +2  
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(8),
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Tshi euonsiQt ist tuoba tsroreriyap ustrb

nteastiP iwht PANHD cne=ineirdcihcofcy asomaouglunrt sesaeid GD()C

neEv hothug ptenaits twih CDG na'tc akem uper,xeSoid yeht can eus it rofm teh rcaeitbsa nad vnrcoet ti ot cblhea HLCO nda lkil teh aasirb.tec

UBT ecrtbasai tihw aeacstla yszemne neartliuez htrei onw druxioseep nad astht ywh teh CDG apnttei natc' ikll ehm.t

letaaCsa ositepiv rsaactbe:i .S reuaus - Alpislgeurs

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  


submitted by usmile1(75),
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eosd nnaoey nkow htwa het rreutsuct E si ipoingnt ?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. +1