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 +6  (nbme23#17)

ITP - Platelet + Ab goes to spleen - Lysed - Low plt count.After splenectomy - usually plt count improve and Peripheral blood smear show - HJ bodies as a sign of asplenia ( nuclear remnants in RBC usually removed by spleen). If there was an accessory spleen (which was not functional when the main spleen was working) will take over the function gradually - HJ bodies will disappear and Plt starts to lyse - which has happened in this case scenario.

spow  But why are there no bite cells? Question stem states that there is normal morphology? That's why I didn't pick accessory spleen
makinallkindzofgainz  Bite cells are seen when splenic macrophages take "bites" out of hemoglobin precipitates in G6PD deficiency, which doesn't have to do with our question. This patient had a splenectomy 3 months ago, 6 weeks later showed Howell-Jolly bodies (asplenia), and then today now has normal erythrocytes (spleen is working again somehow = accessory spleen)
snripper  @spow Bite cells are associated with G6PD deficiency, not ITP.

 +1  (nbme23#14)

Q: Split S1 heard over Left sternal border - tricuspid area. First component of S1? A: anything (MC in RBBB) that causes delayed closure of tricuspid valve compared to mitral valve- will cause split S1 with delayed T1 and early M1 heard at Tricuspid area.





Subcomments ...

submitted by welpdedelp(154),

It was a type IV HSN reaction, which deals with T cells and that was the only answer that had t cells involved.

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


Why does methylation cause loss of resistance to GATC restriction endonuclease? Does this have to do with methylation of U to T?

methylased  GATC related to methylase --> https://en.wikipedia.org/wiki/Dam_methylase +4  
sympathetikey  Dam methylase, alright +2  


submitted by seagull(839),

This patient is tripping balls. Better do a drug screen which seems obvious.

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +16  
jooceman739  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 +3  
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1  
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2  
charcot_bouchard  Lol. I got the right answer but took long time +  
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +  
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +  
targetmle  why is there basal ganglia hemorrhage? +  
dul071  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 +  


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