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I agree, felt like all the other choices would have something odd in the stool studies
Orthostatic hypertension implies sympathetic dysfunction. Loss of sympathetic input causes dishinibition of intestinal motility.
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
They're using the broad category for PSGN, Pathoma pg 130 IIC. PSGN = Hypercellular, inflammed glomeruli on H&E stain and cross referencing the FA table mentioned hypercellular => Proliferative.
Great, same thought process, murmur made me think of aortic stenosis, supported by the LV hypertrophy in stem. Then you have syncope during exercise because the heart is not able to keep up with the demands of the body
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!
For anybody still stuck on "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not," although this statement may be true, there is not enough information in the question to prove this. We know for fact that because the Amount of labeled X bound reaches 0, at the very least, protein X and Y express the same epitopes since at a certain concentration, Y is able to completely displace all X from the system. This doesn't exclude the possibility that there may be extra epitopes on Y, but it doesn't prove it either.
Not “technically” but actually! To say “I don’t know” when you *do* know is as lyin’ as it gets! Just remember, before a state issues you a license to practice medicine in their backyard, they look to the National Board of Medical Examiners and ask, “Should we trust this person to practice medicine here?” The NBME is in the business of telling states, “Yes, we believe this person knows enough to practice morally and competently.” Answer ethics questions with this in mind.
Besides technically lying, it also probably isn't a good idea to drop the word "oncologist" to a patient before they hear they have cancer, especially as a student who can't answer any further questions about the biopsy results.
@pseudo_ shit I just realized that telling them that the oncologist will be seeing them, is essentially telling them they have cancer. Additionally, you can't lie and say you don't know. no Idea what I was thinking when I took this.
Caudal = Bottom of the SC = failure to close = spina bifida and Rostral = top of SC = failure to close = Anencephaly
I'm confused. In first Aid doesn't have meningomyelocele as failure of caudal or rostral pore to close. Is the answer Cadual because in this patient specifically, his condition takes place on L2-5 which is more caudally?
its a neural tube defect aka failure of neural tube closure
Vasodilation of the skin is under sympathetic control as well -- beta-2 receptors when stimulated cause vasodilation (via increase of cAMP in vascular smooth muscle). The key is recognizing that stimulation of a GANGLION of the pns will lead to release of NOREPINEPHRINE, which preferentially stimulates alpha-1 receptors. Those receptors will cause vasoconstriction.
If the question asked what happens when you stimulate the adrenal medulla, the answer would be (potentially) vasodilation. This is because the adrenal medulla releases EPINEPHRINE which preferentially stimulates beta-1/2 receptors.
@drzed Awesome explanation except I think sympathetic response induces vasoconstriction in the skin though vasodilation in the muscles!
@jesusisking yes you are correct!
α1: vasoconstriction in skin and intestine ;
β2: vasodilation in skeletal muscle (transmitter: only epinephrine!)
Yeah haha I had the same conundrum.
If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected.
lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol
Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances).
PErioral tingling- due to transient hypocalcemia induced by resp alkalosis.
I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2
adding onto Charcot_bouchards comment, I found this:
Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany.
they have IgG and IgM
if it had been anaphylaxis- there would have been urticaria and pruritis
wow I've never seen an answer on here be just so wrong
wrong q bro @ maxillarythirdmolar
nope right question. he just went even deeper into the answer.
When the answer is so obvious that you pick a stupid answer instead of it. DOH
Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage
@sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that.
probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia.
Lol. I got the right answer but took long time
The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant
Thats how I reasoned it anyways
Bilateraly messed up pupils = Drugs (most of the time)
why is there basal ganglia hemorrhage?
Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong
basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501)
I didn't pick this one because I thought Serum sickness was too systemic and RA was a more localized Type 3. Again, im overthinking things.
Goljan: RA is a mixed type III and type IV immune reaction
I though NK cell killing was similar to T cell so and RA is also Type IV
NK cell killing would be a type of innate immunity, not similar to memory T cells. because they did not give an example of a type 4 HSY, the answer must be serum sickness.
Because you'll see some blast cells in a leukemoid reaction. It won't be 0%.
Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils"
the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them
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've heard animal testing is called phase 0.
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!
From what I understand, inhibin is only released by granulosa cells when FSH levels are high. This is a boy. Next off, this question is about puberty, which is due to pulsatile GnRH leading to large amounts of LH and FSH, leading to large amounts of dihydrotestosterone (males) and estradiol (females), and eventually secondary characteristics of puberty. The increased pulse of estrogen and testosterone leads to GH release, which is metabolized into IGF-1 in the liver. This leads to long bone growth from what I understand, which is not much.
@sars inhibin B is also released by sertoli cells in males and will feedback to inhibit FSH release, its not just a female thing. Also, there is actually an inhibin B pubertal surge in both females and males that corresponds to maturation of the granulosa and sertoli cells, respectively. Hormones are wack. https://pubmed.ncbi.nlm.nih.gov/15319819/
I think youre just supposed to see that he's starting puberty and know that the nocturnal pulses are involved
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
FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms)
Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum
Mefloquine : treats malaria
Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite)
Dexamethasone: Steroid for inflammation
FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well.
When in doubt, pick a bendazole
When in doubt, pick a bendazole
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.
is his small head common is Toxoplasma?
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
SIADH -> excessive ADH -> water retention -> atrium excretes more ANP, ventricule excretes more BNP -> water is excreted more. So that is why not too much plasma volume increment, resulting mostly normal BP.
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
Gracilus Fasciculus = Graceful legs
Check out FA2020 pg 508
myelin= black --> color of the normal white matter
no myelin= pink --> color of the normal gray matter and the damaged area
Dorsal columns= vibration, proprioception, pressure fine touch
F. graciLis= Lower body
F. cUtaneous= Upper body
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.
@usmile1 I was thinking the exact same thing...
I agree this is a trash question; I was like well if this is done yearly for new freshman the following year would be of the new class (but the word additional made me go against this). Also you could assume that they were treated and no longer have the disease... I dont like it honestly but know for incidence they want you to not include those with disease so i just went with dogma questions on incidence to get to 10%
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!