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Comments ...

 +1  (nbme24#3)

@lsmarshall Thanks for sharing BCa met via venous routes spreading through the batson plexus which is a network of veins receiving from azygos vein. The azygos receiving from intercostal veins that drains the breast. Which makes intercostal right


 +1  (nbme24#3)

This patient has Distal-Type I RTA which is explained by Normal Serum Anion gap (8) Metabolic acidosis with her positive urinary anion gap(+5).

krewfoo99  Why would the urine Potassium be so high if it is type 1 ? Shouldnt it be type 2?




Subcomments ...

can someone explain why this is not transduction? Last nbme I said conjugation and got it wrong for transduction.. this one I say transduction and its conjugation.

pseudorosette  I would say because this happened between two bacteria, but in transduction what causes the acquisition of bacterial resistance is coming from a bacteriophage, which is a virus that infects bacteria, but that is never hinted at the question! +  
medpsychosis  Quick Overview of the involved topics and answer choices that are relevant in this question: Transduction: Involves phage, cleaves DNA and takes a part with it as it is packaged. Generalized is when is happens by accident. Specialized is an excision event. Transformation: bacteria takes up naked DNA around it and incorporates it therefore becoming "transformed" e.g. (SHiN) S. Pneuma, H. Influenza type B, and Neisseria. Transposition: Jumping from one location to another within same bacterial organism (e.g. from chromosome to plasmid) Conjugation: Above mentioned plasmid gets transferred from conjugal bridge from one bacteria to another. +5  
wowo  FA2019 p130 +  
zbird  Easy here...first both are G-ves which likely have a sex pilus and if cultured together as in this case transfer their plasmid. Transduction need phage. Transposition is exchange of genetic material inside the bacteria b/n the dna and the plasmid or vv (FA2019) +  


submitted by trazabone(7),

Kidney makes 1-25, hydroxy vitamin D. (calcitriol) 25-hydroxy vit D (calcidiol) is made in the liver, and hypoparathyroidism would not decrease its levels as it acts to increase 1-alpha hydroxylase in the kidney to increase calcitriol concentrations --> Ca/phosphate reabsorption from the bone and small intestine.

queezyfish  I'm confused about the phosphate level in questions like these. Decreased calcitriol would decrease phosphate absorption while PTH decrease lowers phosphate excretion. I'm assuming that the PTH decrease has the greater effect with serum phosphate levels? +1  
mousie  PTH = "Phosphate trashing hormone" if PTH is high Phosphate must be low - they are always opposite (unless d/t renal failure then Phosphate will be high - kidneys will be unable to get rid of phosphate) So low Ca d/t low PTH does not effect 25 H. Vit D ... only 1,25 H Vit D (active Calcitriol)? +4  
haliburton  Clarification because I was confused: PTH stimulates kidney to produce 1,25-(OH)2 D3 (calcitriol) via 1α-hydroxylase in proximal convoluted tubule. Therefore, without parathyroid glands, low PTH, 25,D is not converted and therefore not down (normal or up). phosphate "trashed" by PTH as eloquently stated above. +  
zbird  Here the primary defect is high up from the parathyroid gland, there is decresed or no PTH which normally trashes phosphate but not in this case so serum PHOSPHATE INCREASES and the serum calcium is low because PTH should have prevented the urine calcium so there is calciuria and no resorption from bone-LOW CALCIUM, Vitamin-D is independent of PTH so stays NORMAL +  


submitted by roygbiv(8),

The patient has a leaking berry aneurysm --> this leads to a subarachnoid hemorrhage (or leakage into subarachnoid space) --> acute SAH can lead to decreased absorption and movement via arachnoid villi

zbird  So this patient has a leaking berry aneurysm which undergone to surgery and repaired but in two days she developed widening of the SA space which could be explained by increased CSF production but a decreased in absorption, which is due to blockage of the arachinoid granulations by the leaked red and white cells therefore there is a decreased movement of the CSF via the arachinoid villi +1