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Welcome to usmle11a’s page.
Contributor score: 102


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 +1  visit this page (nbme22#4)
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spironolactone acts as an aldosterone antagonist which means decreasing Na+ permeability

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j000  i think they're referring to triamterene and amiloride, not spironolactone spironolactone doesn't actually decrease Na+ permeability +1
jackie_chan  @j000 It doesnt matter, spiro and triamterene/amiloride have a common effect of messing with ENaC. Aldosterone upregulates ENaC, spiro would inhibit that so in effect would decrease luminal permeability to Na in duct due to fewer ENaC channels; triamterene would block the channel directly, same effect. http://tmedweb.tulane.edu/pharmwiki/doku.php/potassium_sparing_diuretics +1

 +0  visit this page (nbme24#50)
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/

says that hyperosmolarity and acidosis alter mental status.

which correlates with the right answer

p.s i got it wrong too :)

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 +5  visit this page (nbme24#6)
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the only thing made me choose IMA and SMA is the fact they supply the intestine which is the common site for ischemic mesenteric disease.

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 +2  visit this page (nbme24#38)
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my way was

SV =EDV-ESV

EDV increases in pregnancy due to an increase in plasma volume

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 +5  visit this page (nbme24#24)
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guys VG would worsen with galactose infusion, remebmber they dont have G6Pase which means they cant convert anything to glucose

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tyrionwill  Yes, VG makes the liver into muscle, where all sugars (except glucose) can only be burned to lactate+glycerol(from glycolysis), ATP (from TCA metabolism, to give uric acid), and fat deposit (from glycerol+pyruvate going to FA+TG) to worsen the situation. Sugar cannot be made into glucose in liver for other tissues. +

 +1  visit this page (nbme23#35)
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ok the way i looked at this was:

youre not 100% sure she was attacked nor do you want to be the person telling the husband hes an attacker so you remove: B C

allowing him in with the patient, god knows what that guy has hidden with him also you will make a huge scene : A

the only thing to do is be diplomatic as people know they arent allowed in the treatment area and by that you assure her saftey.

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drdoom  The prevailing rule of American medicine (and law) is individual autonomy. No other person, professional or otherwise, is granted “default access” or privilege to another person’s body—that includes the physician! The physician must receive consent from a (conscious) “person” before they become “a patient”. In the same way, the person (now, the patient) must give consent before anyone else is permitted to be involved in her care—spouses included! +1
llamastep1  Alright we got it! lol +2
123ojm  B and C are actually wrong because they put the patient in danger for when she is discharged and has to return home. she probably has things she needs in their home (eg passport, money, etc) and if the husband knows she has told you about the abuse she is at risk of being killed. +

 +3  visit this page (nbme23#6)
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the child is asymptomatic because hepatitis B is mostly silent in infants due to poor lymphocyte system. other diseases would probably show more symptoms

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 +10  visit this page (nbme23#12)
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guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos

anyway (p.s i got it wrong)

A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities)

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usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +4
usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +
stemcellpsc  wouldn't D be also true based on this video? +1

 +7  visit this page (nbme23#13)
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The medical requirements to obtain a permit vary by state, but are usually confined to specific types of disabilities or conditions. These as a general rule include the use of any assistive device such as a wheelchair, crutches, or cane, as well as a missing leg or foot. Some states also include certain cardiovascular, pain, or respiratory conditions. About half of US states (26) include blindness as a qualifying disability enabling the person to obtain a disability parking permit for use as a passenger, and 14 states include a disabled hand as a qualifying disability. Four states include deafness, and two states (Virginia and New York) include mental illness or developmental disabilities as qualifying disabilities

our guy uses a cane so...

btw i got it wrong :) cause i thought it is up to the DMV

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usmle11a  also it is the dr who decides the eligibility then sends it to the DMV disability --> Dr --> DMV +6
peridot  I'm not sure if I'm being here or if the test question changed, but I don't see anywhere in the stem that says that the patient uses a cane? I even ctrl+F the word "cane" lol. I picked referring to PM&R specialist for full assessment cause I figured that another pattern is to always gather more info, but I guess that's not the case here T_T +5
azibird  It does NOT say he uses a cane. +3
sonofarathorn  I can also confirm that there was no cane involved. I repeat, NO CANE. +7
yesa  But I will confirm the doc is the one who sends eligibility to DMV, they (we will) have to do this too if the patient isn't qualified to drive anymore... +1
lukin4answer  NOCAIN, COCAINE, TETRACAINE.. I mean, No CANE here! +1
chaosawaits  Not even sugar cane +
madamestep  See my extremely healthy cousin has a parking permit for her well-controlled RA. So I just assumed we were throwing these things out willy nilly. Chose DMV... +

 +6  visit this page (nbme20#8)
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legionella : very common in advanced age, COPD, immunosuppressed patients and " going back from a residence hall" which probably had a contaminated AX system (basically fits every one in the Q)

adeno X : would present with conjunctivitis, throat pain ... flu virus: not everyone got the disease RSV: no children strep pneumo: would target a larger population of healthy people as well.

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bharatpillai  why would they say that the only people who didnt get affected by the disease were people on steroids (lupus nephritis and severe asthma) couldnt have been rsv since it causes croup in children. strep pneumo would cause fever and other systemic signs. i went for adenovirus because uworld says most common causes of copd excacerbation are viral infections... +4
brbwhat  I went for adeno forr the same reason. I guess the MAIN HINT is that this is not a copd exacerbation. Since people without prexesting copd also had pneumonia, also people with copd exacerbation will have different presenting symptoms, here it was told, that we are told that dx was penumonia. People with copd exacerbation wouldn’t be diagnosed with pneumonia if it was an adenovirus infections. +4
j44n  adenovirus doesnt cause pneumonia its just makes the current COPD sx worse +1
j44n  the SLE and asthmatic patient were both considered slightly immunosupressed or theyre just more likely to get something (SLE pt= your B cells are too busy making Ig's to kill your kidney, and the asthmatic is on corticosteroids that aopotose your t cells) but they're not COPD patients so the pneumonmia wont be as severe, all in all legionella causes really really bad pneumonia in COPD patients and less severe (pontiac fever) in those with mild immunosupression +5

 +17  visit this page (nbme20#19)
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https://www.youtube.com/watch?v=k0YqEpA-62A

guys this video explains alot

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 +6  visit this page (nbme20#31)
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ok here is how i broke it down: a) wrong because most cases would have some risk factor "old female ..." b) "deltoid" c) under pressure it can burst and frankly it is mentioned in FA as a very common cause. D) i think it would need something like a posterior dislocation of hip. e) would probsbly not cause neruo S $S

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 +4  visit this page (nbme21#9)
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i did the

(Hco3-)x1.5 +8 +-2

it should CO2 that is wat higher than compensation indicating mixed

another way is the ↑ ↓ way

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 +18  visit this page (nbme21#15)
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ok i think i have a theory in regards for this:

the whole procedure is done to decrease the portal HTN. which means the shunt should be portal to systemic avoiding the liver.

a) hepatic (systemic) to inf phrenic ( systemic ) ; no B) ileocolic (portal ) to inf mesentric (portal) ; no c) splenic (portal) left renal (systemic); yes d) superior epigastric (systemic) to inferior epigastric (systemic) ; No e) superior rectal (portal) to superior mesentric ( portal) ; NO

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whossayin  You’re a legend. Good theory man, makes memorization a whole lotta easier! +
lovebug  2019FA, 359pg. +1

 +0  visit this page (nbme21#21)
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guys!!

the question doesnt say that the 500 got cured, so it will be 2000 who are at risk.

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 +1  visit this page (nbme21#23)
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IFN y will inhibit differentiation of Th2 cells and therefore (a,e wrong) b) regulatory T cells d) if the case was talking about virus

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teepot123  fa 19 pg 108 +

 +0  visit this page (nbme21#45)
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i did this through elimination:

a,c and D intrinsic; ↑PTT only

B) which is actually the PIP2; involved in Gq signaling

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 +4  visit this page (nbme21#28)
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ok guys and i quote from https://www.orthobullets.com/pediatrics/4102/osteogenesis-imperfecta

"90% have an identifiable genetic mutation COL 1A1 and COL 1A2
causes abnormal collagen cross-linking via a glycine substitution in the procollagen molecule "

which means that OI has a glycine substitution and therfore its unable to form a secondary sturucture.

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Subcomments ...

submitted by usmle11a(102), visit this page
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guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos

anyway (p.s i got it wrong)

A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities)

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usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +4
usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +
stemcellpsc  wouldn't D be also true based on this video? +1


submitted by usmle11a(102), visit this page
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guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos

anyway (p.s i got it wrong)

A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities)

get full access to all contentbecome a member
usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +4
usmle11a  guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos anyway (p.s i got it wrong) A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities) +
stemcellpsc  wouldn't D be also true based on this video? +1


submitted by usmle11a(102), visit this page
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The medical requirements to obtain a permit vary by state, but are usually confined to specific types of disabilities or conditions. These as a general rule include the use of any assistive device such as a wheelchair, crutches, or cane, as well as a missing leg or foot. Some states also include certain cardiovascular, pain, or respiratory conditions. About half of US states (26) include blindness as a qualifying disability enabling the person to obtain a disability parking permit for use as a passenger, and 14 states include a disabled hand as a qualifying disability. Four states include deafness, and two states (Virginia and New York) include mental illness or developmental disabilities as qualifying disabilities

our guy uses a cane so...

btw i got it wrong :) cause i thought it is up to the DMV

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usmle11a  also it is the dr who decides the eligibility then sends it to the DMV disability --> Dr --> DMV +6
peridot  I'm not sure if I'm being here or if the test question changed, but I don't see anywhere in the stem that says that the patient uses a cane? I even ctrl+F the word "cane" lol. I picked referring to PM&R specialist for full assessment cause I figured that another pattern is to always gather more info, but I guess that's not the case here T_T +5
azibird  It does NOT say he uses a cane. +3
sonofarathorn  I can also confirm that there was no cane involved. I repeat, NO CANE. +7
yesa  But I will confirm the doc is the one who sends eligibility to DMV, they (we will) have to do this too if the patient isn't qualified to drive anymore... +1
lukin4answer  NOCAIN, COCAINE, TETRACAINE.. I mean, No CANE here! +1
chaosawaits  Not even sugar cane +
madamestep  See my extremely healthy cousin has a parking permit for her well-controlled RA. So I just assumed we were throwing these things out willy nilly. Chose DMV... +


submitted by imgdoc(183), visit this page
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This question is asking about the insulin receptor tyrosine kinase pathway. So take it from there,

  1. The phosphorylation of the IRS activates a signal transduction cascade that leads to the activation of other kinases as well as transcription factors that mediate the intracellular effects of insulin. Nuclear/Cytoplasmic shuttling - yes (reversible)

  2. Serine/Threonine kinases are also known to reduce the activity of insulin. - yes (reversible)

  3. Ubiquitin - mediated proteolysis - no (not reversible), and also insulin metabolically increases protein synthesis so it doesn't match what insulin does anyways.

correct me if I'm wrong.

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usmle11a  i think youre correct cause ubiquitin mediated proteolyis is an irreversible step. +1


submitted by cr(5), visit this page
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why not increased 25-hydroxycholecalciferol?, with the same logic haliburton explain +

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usmle11a  i believe increase 25OHcholecalciferol indicates the storage capacity of vit D, which wont be affected in case of CKD. it goes like this, kidneys wont respond to regular PTH, loses Ca and cant execrete PO4, PTH gets made and tries to burn bone to produce Ca, resulting in elevated levels of Ca and PO4, Ca will bind the calcium and go to kidneys, yet same story all over. add to that the fact that 1 oh hydroxylase wont be able to function in a dead kidney. +1


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