Welcome to tissue creepโs page.
Contributor score: 133
Comments ...
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?
+2
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)
+7
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
+5
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
+4
jaramaiha
To add to that, it showed a well-healing scar so no fluid's draining. Less likely to have any trauma.
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medguru2295
For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life!
+1
mynamejeff
The poodle is hypoallergenic, and a 10/10 good boy.
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dr.xx
SMA4 (Adult-onset)?
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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.
+4
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.
+9
snripper
Yeah, I don't see cooing anywhere.
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teepot123
thankfully a lot of my friends on insta keep posting pics/vids of their babies reaching milestones so im well updated lol
+1
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
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lumd
Thank you so much for the tip! Didn't know that you can search for specific topics in UW.
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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.
+12
nala_ula
I'm shocked that I found a fellow puerto rican on this site! Good luck on your test!
+2
namira
dont be shocked! me too! exito!
+2
dr_jan_itor
I was thinking that its Murine typhus transmitted by fleas
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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.
+2
jakeperalta
Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience.
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almondbreeze
UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika
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lovebug
FA2019, page 167 RNA virusesy.
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lovebug
Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2โ3 days of the illness and subsides within 7โ10 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. )
+1
beto
it is chikungunya->fever, polyarthralgia, diffuse macular rash, dengue has retro-orbital pain mostly
+1
Subcomments ...
Mild jaundice with increased unconjugated in an older fellow is decreased UDP-glucuronyltransferase activity. Particularly in context of stress (appendectomy)