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Welcome to tissue creep’s page.
Contributor score: 85

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 +3  (nbme18#15)
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Mdil jadcnieu iwht eneiasrdc jnugnotaduec ni an olred follew si rsacedeed aPlgo-urryUecsentfarlDnus ctiv.iyta Plaalyiurrtc in ttnxeco fo estssr t)pa(denypcmoe

pg32  Went with hepatitis because of his recent surgery. Seen problems like this before where recent surgery means they were given inhaled anesthetic that can cause hepatotoxicity/hepatitis. That, along with the elevated AST/ALT and unconjugated bilirubinemia (signifying liver losing its ability to conjugate bilirubin due to inflammation) made me pick hepatitis. Why is that wrong? +
suckitnbme  @pg32 AST/ALT are only slightly elevated. The patient also is not particularly symptomatic. He's really not that sick. Hepatoxicity is also most associated with halothane which is no longer used in the US. It would be a different story if the patient had surgery done in a different country (as is common in Uworld questions on this) +3
mumenrider4ever  I don't know why NBME uses ALT/AST reference ranges from 8-20 u/L when the reference ranges for uworld are 8-40 u/L. So maybe his liver enzymes aren't really elevated since they're below 40 +2
cheesetouch  Can someone refute 'surgical trauma'? +
cancelstep  Appendix is pretty far anatomically from the bile ducts. Also damage to bile ducts should cause direct hyperbilirubinemia since there's no problem with conjugation versus Gilbert syndrome which causes impairment of UGT +

 +61  (nbme24#49)
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heT poelod si lryianhlcpoeg,e nad a 001/1 ogdo .ybo

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +

 +0  (nbme24#35)
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I eretdta shti klei dreWinng a/SMoHffnmA et"(uong ofasntsacuci"il,) and ujts kidn fo dtpecace it eibng rweid ot be in a o5arye-5l.-d

dr.xx  SMA4 (Adult-onset)? +

 +8  (nbme22#25)
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tfiignL ahde hliwe eon:pr 1 honoamiltcS e:lsmi 2 gn Coihoot:mns 2 hosntm

pg32  Where do you guys learn that cooing starts at 2 months? It isn't in first aid or boards and beyond so this was an annoying question for me +1
drschmoctor  @pg32 From being a parent! Otherwise little chance I'd remember all these milestones. +3
drzed  I'll get right on that @drshmoctor :). If only I could have a kid to memorize all these damn developmental milestones. That would make life easier haha. +5
snripper  Yeah, I don't see cooing anywhere. +
teepot123  thankfully a lot of my friends on insta keep posting pics/vids of their babies reaching milestones so im well updated lol +1
pjpeleven  Mnemonic: "Coo at Two" +

 +2  (nbme21#39)
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fI ndyboay sah a dogo awy of udngeisgnm/grtinibimerhesi lla hte edirtneff aprstosienent fro eitganl o,rses 'Id ceieaapptr het e.phl

hungrybox  Pls post as a separate post and not a comment to this tho. The formatting for these comments sux +1
whossayin  Assuming u have UWorld, just type sexually transmitted infections.. that table is the best IMO +

 +0  (nbme21#14)
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My hhtgotu rosepsc swa fi het eomthr ash neiscrdea ,TSH s'ehd be isgnu mroe doieni to oeudrpc T3.4/ einMgan esls ouwdl eb leab ot get to eth ybab orf riban tldeov.enpem

 +11  (nbme21#50)
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tpAoorhdr ofr sur,e but rfo eth codrer m'I ttrepy reus itsh was ngknyuahCui riuV.s ylnO tgo isth rmfo a dWolrU enustiqo sa I thnad' esen it tuinl then, ubt napaepyrlt eth lihrrataga is llryae d,ab ihchw is wtah wdre me ot the .nsrawe


meningitis  More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico). Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities. +10
nala_ula  I'm shocked that I found a fellow puerto rican on this site! Good luck on your test! +1
namira  dont be shocked! me too! exito! +2
niboonsh  Dengue is also known as "bone break fever" which makes me think its more likely to be dengue due to the "excruciating pains in joints and muscles". +20
dr_jan_itor  I was thinking that its Murine typhus transmitted by fleas +
monique  I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection. +1
jakeperalta  Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience. +
almondbreeze  UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika +
lovebug  FA2019, page 167 RNA virusesy. +
lovebug  Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on the face, trunk and limbs. It is typically asymptomatic but may be pruritic (Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. ) +

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