to snoo-finity ... and beyond!
Welcome to usmile1's page.
Contributor score: 33
This was my precise login. I wound up getting it by elimination. But, didn't like that answer as its uncommon in small children and the child seemingly had no risk factors.
@medguru2295 FA says it's most commonly seen in children and it's selflimited vs adults is rare and can lead to renal insuff
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!)
same here!! marked e thinking of it as a mitochondria
Glycogen Granules! They are not membrane bound and float freely in the cytoplasm.
omg YES!! thanks Uworld I got it correct! exactly this qx asked the exact opposite thing! Hahaha I loved it !!
Even after reading the UWorld explanation, I am still not sure how the answer that reads, "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not..." is incorrect. Based on the graph, I don't see a way we can rule out that answer choice and it sounds more likely than both X and Y having the EXACT SAME epitopes. Can anyone explain? What would the graph look like if the quoted answer choice was correct?
If you make up an example with numbers, it really helps! “Protein Y expresses all of the epitopes expressed by X, but protein X does not express all of epitopes expressed by Protein Y.”
If we say protein Y has epitopes 1, 2, and 3. Then Protein X has epitopes 1 and 3. Then we can clearly see the relationship the AMOUNT of Y added relative to X bound would NOT be linear. Stated another way – we need an exponentially more amount of Y to COMPLETELY unbind X and therefore there would not be a one to one depiction in the graph
Similar logic applies for the answer choice that states "protein X expresses all of the epitopes expressed by protein Y, but protein Y does not express all of the epitopes expressed by protein X.
E.g. If protein Y has epitopes 1 and 2. And protein X has epitopes 1, 2, and 3. Here again, we have satisfied the answer choices condition, and no matter how much we increase protein Y, protein X will still have epitope 3 bound in this case.
Just to clarify for the first scenario: We have 3 epitopes on Y, and 2 epitopes on X. That means, assuming the epitopes are all present in equal amounts, if I add 300 grams of protein Y to the solution - only 200 grams will bind protein X. AND ONLY 200 grams of protein X can be unbound. Hope the numbers help!
only 3 patients
uggghhh not in FA ...
i think neutrophils (in addition to lacking granzymes and perforins which are used to kill viruses and fungi) dont recognize intracellular things; viral antigens needs to be processed and presented on an MHC for the lymphocytes to recognize
also neutrophils are only seen in acute inflammation. This pt has longstanding inflammation which is associated with monocytes, lymphocytes, macrophages, plasma cells.
Neutrophil come and goes quick like day or two , after that rest of immune cells take care
also the meningococcal vaccine!
also just to verify, there is no such thing as phase 0 right?
Not that i know of or is in FA
I also picked decreased inhibin.
may be it was one of the "experimental questions", which are not even counted on the real exam
Inceased FSH will lead to spermatogenesis and spermiogenesis NOT Increase in Testosterone which is causing increased Height of this pt
Inhibin B only has negative feeback on FSH not GnRH. see the diagram on the topic of semineferous tubules in FA. Testosterone has a negative feedback on BOTH LH and GnRH
Kind of like how nocturnal pulsatile GNRH release occurs during sleep to stimulate growth (FA page327), the same thing happens for puberty. Pg 325 in FA, "pulsatile GnRH leads to puberty and fertility." It doesn't explicitly state during sleep, but pulsatile release of GnRH leading to pulsatile release of LH and FSH will lead to puberty. Puberty starts in the brain, its onset really has nothing to do with decreased inhibin levels which happens in the testes. hope that makes sense!
just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol
they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020)))
also a side note:
cutaneous larva CURRENS is pathognomonic for strongyloides whereas
Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus
If the Infarct was on the right side they you would have a decrease in PCWP
yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up.
perfect except it is a PGE1 analog, not 2
PGE2 will increase uterine tone (Pg. 270 FA 2018)
Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby.
asthma = emphysema = chronic bronchitits, obstructive.
leaves 2 out of 5...
Common causes of decreased lung compliance are pulmonary fibrosis, pneumonia and pulmonary edema. So yes pneumonia could possibly cause the decreased compliance shown, but the vignette says the patient has "9 month history of progressive SOB." That couldn't reasonably be pneumonia, leaving diffuse pulmonary fibrosis as the best answer.
Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours.
(pg 114 of the 2019 FA has a list of them ordered by time)
(also allergy / anaphylactic presents with more skin findings (urticaria, pruritus)
The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer.
Guys anaphylactic reaction to whole blood doesnt occur much except for selective IgA defi. so look out for prev history of mucosal infection. And it can have all feature of type 1 HS inclding bronchospasm.
I saw hypotension and though anaphylaxis........ -.-
Chest Xray showed "bilateral diffuse airspace disease". This is much more indicative of TRALI than anaphylaxis which would have wheezing and possibly respiratory arrest but no actual damage to the lungs. Additionally there was no urticaria or pruritus one would expect to see with anaphylaxis.
I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful.
99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will
also note that toxoplasma can cause the "blueberry muffin" rash (also rubella can as well)
So looking at the CDC website, it looks like "accidental ingestion of oocysts after touching cat feces" is the route you were talking about in the first paragraph, so inhalation of air droplets is wrong inherently.
Does anyone know if SIADH is associated with hypertension? I don't think it is due to the body's response of downregulating aldosterone, but if someone could verify that I would appreciate it.
@usmile1 pg 579 FA 2019 = BP can be normal or high in SIADH
in SIADH GOLJAN says you have diluteonal hypokalemia
omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school!
How do you know the gracile fasciculus is damage?!?!
which parte of the image its damage?, the pink? or black?
the pink park yes
i still don't see where the damage is lol! FML
i finally figured it out lol that was a slow moment i hope im not this slow on step yikes!
@hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped
Yeah, this was my issue. I got it wrong because of this-- still don't understand the logic bc you can get chlamydia multiple times
FUCK you're right. Damn I didn't even think about that. That's fucking dumb. I guess this is why nobody gets perfect scores on this exam lol. Once you get smart enough, the errors in the questions start tripping you up. Lucky for me I'm lightyears behind that stage lmao
to make it even more poorly written, it says they are doing a screening program for FIRST YEAR women college students. So one year later, are they following this same group of students, or would they be screening the incoming first years?
I think the same at first, but after a second read, the question stem said "additional" 200 students, which means the first 500 students don't count.
@hungrybox You are me.
Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao
can someone please explain the median in this
The median can be known by first assembling the numbers in order from least to greater.
If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12].
Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people!
Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks!
I mean how is the mode for Y greater than mode for x?
Mode is the one that repeats the most once you list them in order
Median would be the BP value that the person in the 50th percentile of each group would have.
So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X.
Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y.
hope that isn't wrong, and helps someone!
I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer!