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Welcome to welpdedelp’s page.
Contributor score: 219


Comments ...

 +0  (step2ck_form6#34)

She met the Centor criteria for empiric antibiotics, why was is culture?


 +0  (step2ck_form6#19)

Always best to discuss pregnancy prevention prior to pt participating in sex, if not it will be too late


 +0  (step2ck_form6#46)

Dementia is a risk factor for aspiration


 +0  (step2ck_form6#15)

Just as another POV, you might have seen well-demarcated and thought erysipelas..but remember that is not bullous. Plus, everything else fell more in line with Type 4 HSN.


 +1  (step2ck_form6#24)

Ca Gluconate must be given immediately if K > 6.5; think of it as "no point in hydrating or pushing K into cells with insulin if they will die rn of an arrhythmia"

Ca will stabilize immediately, which is why its initial tx.


 +11  (nbme24#4)
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clotrCyaccpo tiignniesm htta is efnrrsadert grtohhu oiprterayrs pltedosr

wlgtno.hwotiemdbw.lgoi/.pulvgpso:ncyr/fl/c/-calthat/tccnmcaigs


mousie  http://www.sparknotes.com/biology/cellreproduction/cellcycle/section3/page/2/ +3
fahmed14  Cyclins help regulate cell cycle phases. They help with checkpoints before progression to the next phase of a cell cycle. Therefore the checkpoint before mitosis would be in G2 and probably where mitotic specific cyclins are synthesized +11
artist90  https://en.wikipedia.org/wiki/Cyclin . 4 types of Cyclins and when they rise and fall. +2

 -1  (nbme24#18)
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iTsh aws aealrtl rmlleaud esordmyn aak saeloatodlrr tcafrni of eht A.PIC



 +3  (nbme24#44)
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I tuhhtgo sthi swa tsju reringfecne linzlegor enlloi,s whhic udlwo eavh aevldtee grtsain


 +12  (nbme23#20)
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It was a eypt VI HSN ,earnitco iwhhc esdal ihtw T clsle nda ttah saw hte lyno rnwesa atht dah t leslc .vevionld

yogi  Poison Ivy/ oak /Sumak +
qball  Uworld Q ID 1133 +2

 +4  (nbme23#15)
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ehT pt dha smatah (,SOB aeskw pu at gthni tuo of earht,b sha ereils.)lga It akdes rof het rrcuoserp of reietsk,enoul iwchh is iacdcarhnoi d.iac Teh oprb gaev ihm nlutokeMast or anidhel uogcicilod.otrcs

ls3076  wtf is up with the phrasing of this question +34
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +1
alexxxx30  @Is3076 haha agreed!! +1
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +4

 +9  (nbme23#24)
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remoo,istcmHosha aka nz"bero sb"i.daeet aoCtnn be nodAids edu to the geiyehamlpycr nad rnmaol PB

alexb  I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM. +2
tinydoc  I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation. +11
maddy1994  testicular atrophy &hepatomegaly helped me out to eliminate the options..when i was left with ferritin and saw pigmentation it clicked that it is hemochromatosis +3
krewfoo99  Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis +3

 +7  (nbme23#10)
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I sehco sith c/b sti eht somt omnmco oenhgatp ofr inks ietisfnonc

seagull  same here +2
sympathetikey  Some bowlsheet +11

 +7  (nbme23#26)
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/23 215/ 1/4

eH ash a 3/2 nccahe of ebign zogeoserytuh (not 4/2 b/c we konw he rof uers es'ondt hvae CF)

/251 cechna in het ouptoilpan

14/ cnehac fo a ehgrstuoozye cupleo anihvg a icldh ihtw FC

welpdedelp  ok, so it messed up the formatting 0.66667 x 1/25 x 0.25 +
nwinkelmann  ugh... I ALWAYS forget about changing the carrier status to 2/3. Chance of affected individual = chance of father passing allele * chance of mother passing allele = 2/31/21/25*1/2 = 2/300 = 1/150. +1
zpatel  2/3(chance of heterozygous) * 1/25(meet carrier) * 1/2(chance of male to transfer affected gen) * 1/2(female to transfer affected gen) = 1/150 +3

 +6  (nbme23#50)
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*30 1.5.0 inhkT buaot ,ti herte si x owlf whti na yongex ietcontnrcoan fo s-o-y ot dfin uot het reilyved uyo jsut lumyltip temh hre.oegtt

yotsubato  One of those questions too simple to believe its actually the right answer +28
mimi21  Right, I was like this is too simple lol ! im not sure if this is also a good tip but I tend to look at the units they are asking for and double check my math to make sure I end up with them. +7
osgood-schlatter  what equation is it exactly? +
arcanumm  Literally did not even conceptualize this question, just looked at the units. +4

 +9  (nbme23#1)
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hwen a lcleofli net'ods rtuprue a(ka ilnuon)oatav hnet ti wlli mofr a tcsy.

uslme123  n premenopausal women, simple adnexal cysts (image 1) that are <3 cm in diameter typically represent normal follicles or may be a corpus luteal cyst (these may appear simple or complex) and may be considered a normal finding. Even when up to 5 cm in diameter, these simple cysts are so commonly due to normal menstrual physiology that the Society of Radiologists in Ultrasound (SRU) does not recommend follow-up when asymptomatic +7

 +11  (nbme23#43)
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It swa eht lyon hapeeprlir nlug naccr,e its aols mero omcomn ni nom.ew stesatiMas olwdu heva nsowh peluitlm esoilsn

sympathetikey  Also, lung adenocarcinoma is the most common lung cancer overall, most common in women, and most common in non-smokers. I know she smoked in the past, but that's what tipped me off to it. +5
alexb  Yeah I literally picked SCC bc I knew she'd smoked in the past smh +
maddy1994  20 years of non smoking history ,she wouldnt be at elevated risk for smoking related carcinoma. +2
larryd  According to FA19 p. 693, large cell carcinoma of the lung is also peripheral. +

 +23  (nbme23#44)
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oN itde inid,cfeyec the itapten dah esxsec ocreaetn ued ot shi tide

sympathetikey  Would never have thought of that. Thanks +8
medschul  that's messed up dog +18
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +
davidw  this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7
davidw  β-Carotenes are present in dark-green and yellow vegetables. +
hyperfukus  ohhhh hellllll no +7
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6
cbreland  I'm okay with missing this one +4

 +1  (nbme22#1)
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So I nthik atth iseus of riwts otneixsne an/ord igfenr prdo oluwd be oemr draial ne.vre vHeweor, rehte aws mero laxpriom kne,swsea so ti ulwod be C.7

-87" ayl tehm tsgair"ht, het pt nocd'ult "lya ehtm ahst"tgir so it uowdl eb 7C ootr

welpdedelp  *As an addition, median nerve involvement would have leaned more toward C8 than C7. +4
meningitis  Do you have anymore useful mnemonics for brachial plexus? +
henoch280  FA pg 494 for mnemonics +
winelover777  Doesn't look like there are many in FA 2019. S1/S2 - Buckle my shoe. L3/L4 - Shut the door. C5/C6 - Pick up sticks. +
drzed  S2-S4 keeps the penis off the floor :) (cremaster reflex) +
peridot  What's crazy @drzed is that in FA 2019 it says L1-L2 ("testicles move") on p.498 so I wonder if that changed +

 +3  (nbme22#4)
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Thsi wsa L.SE st-ouy0tussesrhd/ilmppktshmebu1uoy3/m.-escm.mssletcp92ee1/l/1a:t/tst

hnki:T 132,=, SE--L

nUsgi DIA:C pTey III si rof mmneuI seeClmpxo

jurrutia  What do you mean by ACID? +

 -4  (nbme22#38)
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deenIsrca nniaalirtcra repsseru ttha urselst in Csgisu'nh adrit fo eraiesndc olobd ,spueesrr ruaeiglrr i,thgernba and raciad.ybdra s,hTu hghi 2CO ncdesui iugnhcs rdita nda fi uoy giev PP tnhe it wlil uecdedr O2,C and neth ndow ueeratgl the pchasymitte o.rvciosaonitcsnt nllyOiragi het airnb dha os mcuh C2O atth ti psaezdz tuo adn tedri ot rnieacse eht PB ni rodre to phsu rome angexdeoyt olodb ot hte .nraib

w.Uea.Sp-b/rmi:htt3k:gqmCgKaZs.etgmsjfsAd/plico/J5A/p

lispectedwumbologist  "Bradycardia" 84 bpm lol +
lispectedwumbologist  The hypertension in obstructive sleep apnea is due to increased sympathetic tone not increased intracranial pressure lmao +1
meningitis  @lispectedwumbologist : Be mature enough to correct him/her and move on, not laugh at him/her. +14


 +10  (nbme22#6)
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tI asw usjt ngaiks eth psnifela of RCBs 210( ys)da

haliburton  If I'm reading this right, this is just a tricky dicky question. I think CO binds 200x stronger than O2. But if an O2 cycles through binding / unbinding 200 times before a CO gets kicked off, this should still clear the CO from that cell sooner or later. strange to think it is 1. essentially permanently trapped in a cell, and 2. doesn't kill you and can be treated with O2 to resolution within a few hours or a day. They must just be thinking, until that last RBC dies, you've got original CO in a circulating cell. but just a fraction (because you didn't die). not sure how that CO isn't just passed on during recycling, based on this line of thinking. +7
link981  The question while stupidly written, asks how long the RBC's that carry the CO take to be removed from the circulation, not how long the CO takes to be removed from the RBC. Just asking the lifespan of RBCs in an stupidly complicated way. As we know, RBC's life span is about 120 days and then they are removed from our circulation. 120 days is about 4 months. Next time they will probably ask weeks or in hours, who knows? smh +6
baja_blast  If that's what they're looking for why cant the NBME people just ask "How long does it take for RBCs to turn over?" Ridiculous. +1

 +2  (nbme22#5)
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Ok, os NRA dnndeeetp DAN aplysrmoee si for eesrver s.sa.rn.tecpirta eglnsi ersantdd + seu NRA dnnpdetee ANR almyrsoeep. Can moeneso pxa?ienl

hyoid  The only thing I can think of is that HIV is a (+)-sense single-stranded RNA virus that relies on an RNA dependent DNA polymerase (reverse transcriptase) to synthesize DNA. +1
haliburton  according to [medbullets link](https://step1.medbullets.com/step1-microbiology/104196/rna-viruses_) ns ss RNA must carry RNA dependent RNA polymerase (so that is out). also, according to medbullets there are very few ds RNA viruses, so "most likely" will be ss. Also, RNA-dependent DNA polymerase = Reverse Transcriptase. Since HIV is a ss ps RNA virus with RT, they've described an HIV cousin. not sure beyond this. +
some0217710  Can’t think of any retroviruses outside of HIV and HTLV and they’re both +ssRNA +1

 +11  (nbme22#3)
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tI aws a onFeugisrur bs;ig&--toed esbos.ssiat nuurogeFirs ebosdi era ebelvedi ot be mrdofe yb hopsmacrage htta aehv etyhcopagsod nda eadpttmte ot ietsdg hte feb.sir

almondbreeze  info about ferruginous bodies being mf can't be found on FA/UW :'( they just say it's 'material' +
taediggity  FA 2020 677, FA 2019 659... mf?? mofos?? +3
69_nbme_420  Just to add: The question asks what cell type initiated the Fibrosis → Alveolar macrophages engulf the particles and induce fibrosis (same pathophys for all Pneumoconiosis). Pathoma 2019 Pg 92 +7

 +7  (nbme22#23)
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ihTs si m-totb,EeLrnaa hhciw sropiemv wthi otnmevem sa meaocpdr to ieyatseMnh grciasa hwhhci eosrswn ihwt ontememv

sbryant6  Lambert-Eaton is typically associated with Small Cell Lung Cancer. Since there was no mentino of that, I was thrown off. Such is the difference between UWorld and NBME I guess. +1
makinallkindzofgainz  I'm laughing about Myasthenia "gracias" lmao +14

 +12  (nbme22#22)
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It swa ecs,sabi hhwic si dtmantitser eeo.p-rsnornop

welpdedelp  **person-person lol +5
suckitnbme  NBME loves their scabies +14
dentist  did you get scabies from "burrows" and "night itching" +
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +
zevvyt  to summarize leafhouse: Fomites +1
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +




Subcomments ...

submitted by medicalmike(16),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  


submitted by medicalmike(16),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  


submitted by medicalmike(16),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  


submitted by medicalmike(16),

Breast engorgement is normal while a woman is breastfeeding. Mild tenderness is normal for several weeks following low-transverse C-section, a notoriously painful incision. This patient has resumed sexual activity and would benefit from contraception, but this is not an answer choice.

welpdedelp  U/S indicated if there was fluctuance, fever or marked leukocytosis +  


submitted by sugaplum(326),

This kid has signs and sx of dehydration Hyaline casts due to hypovolemia resulting in concentrated urine

welpdedelp  I was thinking RBC cast due to GI illness, thought they were pointing to some sort of IgA nephritis (╯°□°)╯︵ +  
bigjimbo  hypovolemia causing ARF (pre-renal azotemia) leads to normal bland casts aka hyaline casts +  


submitted by medstruggle(12),
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Why od uyo evig VI onroeculiv hwit antaeclhrti troxaetmhe?et olW’dtun TMX loes tsi ycaeicff neisc envoiucrlo veseersr the fecsfet of ?TXM

colonelred_  MTX will still work but yes some purine/pyrimidine synthesis can still occur. You often give leucovorin to decrease adverse effects of MTX. +  
welpdedelp  ok I have a question, leucovorin is the same as folic acid...so why give one over the other? +1  
lsmarshall  Leucovorin, folinic acid, is a modified version of THF and enter folate metabolism where THF is, after the point where methotrexate takes its effect. I have a pharm. card that says "toxic effects on normal cells may be reduced by administration of folinic acid (a.k.a. leucovorin or citrovorum factor), which is **preferentially taken up by normal cells versus tumor cells**." +12  


submitted by medstruggle(12),
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nCa eomnose lasepe palixen ti?sh thWa si teh daigosisn erh?e

welpdedelp  I thought it just as it was, polyneuropathy is supposed to be a burning pain affecting the extremities, he might have acute intermittent porphyria. He was too young and didn't fit ALS due to the rapid onset. No loss of pain in the arms so it couldn't be syringomelia. Wasn't asymmetric so couldn't be polio. Didn't have anything resembling Parkinson. +5  
j44n  I got tripped up on this too. I think what youre supposed to see is multiple areas of nerve damage on the motor tracts and proprioception is a senory component, so instead of saying they feel burning, they cant tell where their limbs are in 3D space. If they said burning you wouldn't have to know all the other 4 possible answer choices to get to this one. +  


submitted by medstruggle(12),
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ahWst hte nceferfedi netewbe seu“zyohogter nllu ntmuaoit ni B gibonl ee”gn and se“ouhtygezro omatunti nnkwo to escua 50% asrdeeec in B ilgbon eeng unncofit of neo a”lllee?

welpdedelp  I interpreted "null" as meaning full deletion while the other heterozygous mutations was only a 50% decrease in the function. One child would inherit 1 null mutation and 1 50% mutation, which would leave them with a 25% functional gene. +14  
j44n  A thal is the deletion, B thal is mutations on promoters or splice sites. +  


submitted by medstruggle(12),
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Wyh is ndodueal nulme rccie?nort I gothhut rcictaepna seznmey sntyympc(,hroi apyabciet)orpdexs uowdl be leotcda ee.rh

colonelred_  Enterokinase actives trypsinogen and is located closer to the intestinal mucosal (“brush border”). +1  
drdoom  Yeah, @colonelred is right. @medstruggle: the duodenal lumen (and the pancreatic /proteases/ you mention) is the site where pancreatic enzymes (“endopeptidases”) cleave large polypeptides into smaller bits. It is at the BRUSH BORDER where the smallest kinds of peptides (dipeptides, tripeptides) are broken down into their amino acids, which finally can be co-transported with Na+ into the intestinal cell. I think about it this way: stomach acid denatures and “opens up” proteins (without any specific cleavage); pancreatic enzymes then cleave denatured polypeptides into smaller bits; brush border enzymes finally break down tiny peptides into absorbable amino acids. +3  
drdoom  Nice schematic, @welpdedelp +  


submitted by colonelred_(99),
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edLook it pu dan onduf thta sbeueac eor’uy in a uesnip onitispo fro a gnol etim yuoe’r gnogi to hvea earncsied uvenso nteurr hiwch eldas ot sinaeedrc .CO sTih neaeytvlgi akbdfeesc no ,SAAR lngidae ot eedrecads eaoerds.otln sA a ,erslut r’youe gigon ot aevh daserceni ssrdieiu ichhw lsdea ot srdecaede dlboo and smlaap mvou.el

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4  
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +8  
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3  
yotsubato  You gotta be preggers to compress your IVC +5  
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1  
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5  
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4  
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +  
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +  
theunscrambler  @peqmd thanks for sharing that. According to the presentation, the diuresis via ANP occurs (along with sodium), which is followed up by an increased in RAAS --> maintains sodium levels. This cycle can then continue. Slide 13. +  


submitted by welpdedelp(219),
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3/2 25/1 4/1

eH has a 32/ ncache of ngeib zoesuhtyrgeo not( 4/2 b/c ew know he fro ruse tnsedo' ehva )CF

/251 anechc in hte oipnatopul

1/4 acchen of a gheozoyrstue cpeuol nvagih a ihdcl with FC

welpdedelp  ok, so it messed up the formatting 0.66667 x 1/25 x 0.25 +  
nwinkelmann  ugh... I ALWAYS forget about changing the carrier status to 2/3. Chance of affected individual = chance of father passing allele * chance of mother passing allele = 2/31/21/25*1/2 = 2/300 = 1/150. +1  
zpatel  2/3(chance of heterozygous) * 1/25(meet carrier) * 1/2(chance of male to transfer affected gen) * 1/2(female to transfer affected gen) = 1/150 +3  


submitted by welpdedelp(219),
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So I ihtnk ttah ssiue fo wtirs xinsnteoe /naord fnrige pdor wdolu be oemr darail .enrev woHee,vr ereht was remo amlorixp eesak,wsn os ti owuld be .7C

"8-7 lay mhte sr,tai"gth het pt tdunlco' ly"a emth rgtasi"ht so it uodlw eb C7 ootr

welpdedelp  *As an addition, median nerve involvement would have leaned more toward C8 than C7. +4  
meningitis  Do you have anymore useful mnemonics for brachial plexus? +  
henoch280  FA pg 494 for mnemonics +  
winelover777  Doesn't look like there are many in FA 2019. S1/S2 - Buckle my shoe. L3/L4 - Shut the door. C5/C6 - Pick up sticks. +  
drzed  S2-S4 keeps the penis off the floor :) (cremaster reflex) +  
peridot  What's crazy @drzed is that in FA 2019 it says L1-L2 ("testicles move") on p.498 so I wonder if that changed +  


submitted by bobson150(11),
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ehT owdngri of tsih ieutnoqs sfouencd em. shiT si gsanki whihc" of eehts vsslees is the hhig reuesprs t"sesym ihg?rt oS eht hihg sesruepr irropsue tclrea si saucgni dcsanriee spsreure oint eth roeifinr a?ctler

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +2  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by welpdedelp(219),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

It saw si,bscea hhiwc si tnmditsraet neeon.-rprpsoo

welpdedelp  **person-person lol +5  
suckitnbme  NBME loves their scabies +14  
dentist  did you get scabies from "burrows" and "night itching" +  
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +  
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +  
zevvyt  to summarize leafhouse: Fomites +1  
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +