welcome redditors! to snoo-finity ... and beyond!

Some recent contributions

... breis made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
 +0  upvote downvote
submitted by breis(1)

I am not 100% on this being correct, but I briefly remember a Psychiatrist saying that the patient has to be seizure free for 6 months minimum and preferred to have no seizure within the last 3 years to be asymptomatic. Do with that information what you will. but for Boards: 3 years.


... breis made a comment on nbme18/block3/q#14 (2 yo boy, 2 days of fever, sore throat, rash)
 +0  upvote downvote
submitted by breis(1)

Streptococcus Pyogens (group A strep) has a superantigen causing shock. This antigen Erythrogenic Exotoxin A causes a Toxic shock-like syndrome: Fever, Rash, Shock, Scarlet Fever.

FA pg 133 (2019)


... breis made a comment on nbme18/block3/q#48 (52 yo man, chronic pancreatitis)
 +0  upvote downvote
submitted by breis(1)

Colipase is a protein that functions as a cofactor for pancreatic lipase, with which it forms a stoichiometric complex. It also binds to the bile-salt covered triacylglycerol interface thus allowing the enzyme to anchor itself to the water-lipid interface.


... fallenistand made a comment on nbme24/block2/q#20 (A 52-year-old man is admitted to the hospital for...)
 +0  upvote downvote
submitted by fallenistand(0)

Since you see vascularity that is why it is granulation tissue. Fibrous scar would be 1 month after and you wouldn't see that much blood.


... notadoctor made a comment on nbme23/block3/q#30 (A 20-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by notadoctor(17)

SLE is associated with deficiency of early complement proteins(eg. C1q, C4, C2). (FA 19, pg. 462)


... gh889 made a comment on nbme23/block4/q#14 (A 61-year-old woman comes to the physician for a...)
 +0  upvote downvote
submitted by gh889(8)

(Great video on S1 and it's split!!)[https://www.youtube.com/watch?v=kvQ2IU3ILRo]


... sweetmed made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
 +0  upvote downvote
submitted by sweetmed(0)

Eumelanin also helps the choroid limit uncontrolled reflection within the eye that would potentially result in the perception of confusing image


... kernicterusthefrog made a comment on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
 +0  upvote downvote
submitted by kernicterusthefrog(5)

Just in case that lovely little equation provided by @keycompany wasn't quite enough for you, here's a link to a more complete explanation by Kahn Academy. Helped me, when I looked at the equation and said, whaaaa?


... sweetmed made a comment on nbme21/block4/q#9 (A 60-year-old woman with psoriasis comes to the...)
 +0  upvote downvote
submitted by sweetmed(0)

https://www.ncbi.nlm.nih.gov/pubmed/25382505

PUVA is used to treat Psoriasis and Vitiligo


... leny123 made a comment on nbme24/block4/q#41 (A 30-year-old man who is a migrant farm worker comes...)
 +0  upvote downvote
submitted by leny123(0)

General rule - Chloroquine sensitive if from Caribbean or Central America west of Panama Canal, this patient immigrated from Honduras so you can eliminate chloroquine resistance as an answer choice (in addition to the vivax/ovale info above).


... gh889 made a comment on nbme23/block3/q#47 (A 14-year-old boy with a tibial fracture is fitted...)
 +0  upvote downvote
submitted by gh889(8)

compression of the common peroneal nerve as it wraps around the neck of the fibula causes decreased sensation from the superficial peroneal nerve, responsible for the anterolateral aspect and dorsum of the leg and foot

Deep peroneal nerve is sensory to the webspace between the hallux and 2nd digit

pic


... kchakhabar made a comment on nbme24/block2/q#15 (An investigator is studying a new drug for the...)
 +0  upvote downvote
submitted by kchakhabar(1)

Radiation causes damage by generating hydroxyl free radicals (Pathoma chapter 3 table). Therefore, if something minimizes the damage of radiation, it has to inhibit free radical formation.


... bigjimbo made a comment on nbme24/block2/q#32 (A 35-year-old woman undergoes a left oophorectomy...)
 +0  upvote downvote
submitted by bigjimbo(0)

The suspensory ligament contains the ovarian vessels. Since that is not an answer choice, it has to be the ureters, as the ureters and the ovarian vessels run posterior to the ovaries (where the ovarian vessels branch off to be contained in the suspensory ligament).


... sweetmed made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
 +0  upvote downvote
submitted by sweetmed(0)

At resting membrane potential the NMDA receptors are blocked by Mg2+. The voltage dependent Mg2+ block is relieved upon depolarization of the post-synpatic membrane . The ligand dependent activation of the NMDA receptor requires co-activation by two ligands, namely glutamate and glycine.


... sweetmed made a comment on nbme21/block4/q#7 (A 14-year-old boy is brought to the physician by his...)
 +0  upvote downvote
submitted by sweetmed(0)

Toluene, the main component of volatile glues, lacquer thinners and aerosol paints is the chemical responsible for most clinical toxicity. Inhalants cause an initial excitatory response through the release of epinephrine and activation of the dopamine system, followed by central nervous system depression mediated by the use of GABA pathway1 It manifests as a sense of euphoria, excitation, dizziness, disinhibited behaviour and exhilaration similar to alcohol intoxication, thus resulting in psychological dependence. Repeated inhalations by the user to prolong the intoxication will develop in headache, slurred speech, diplopia, gait abnormality, delusions, visual hallucinations and disorientation. Behavioural changes and characteristic odour on breath or clothing are helpful clues to detect cases. Suspected users may also complain of cough, stuffy nose, sneezing, flushing, salivation, nausea, vomiting and photophobia. Other signs and symptoms of inhalant abuse include spots or sores in or around the mouth, injected sclera, nystagmus, irritability or excitability, anxiety and sleep disturbances. Paint or other stains on the face, hands, or clothes are other indicators of abuse. Severe dryness of facial skin and mucus membranes can also be a feature of repeated, prolonged use of volatile substances8 . Bacterial infection of the dry and cracked skin may result in perioral and perinasal pyodermas, sometimes referred to as “huffer’s rash”9


... cocoxaurus made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +0  upvote downvote
submitted by cocoxaurus(6)

Found this link pretty helpful: https://www.nursingtimes.net/clinical-archive/cardiovascular/effects-of-bedrest-1-cardiovascular-respiratory-and-haematological-systems/5002005.article


... sweetmed made a comment on nbme21/block2/q#31 (A 37-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by sweetmed(0)

Pain fibers for Parietal pleura: Cervical and Costal parts is by Intercostal Nerve, Diaphragmatic and Mediastinal via Phrenic Nerve. Rib cage injury causes costal pleural pain.


... kentuckyfan made a comment on nbme23/block1/q#49 (Electrical stimulation of the stellate ganglion is...)
 +0  upvote downvote
submitted by kentuckyfan(0)

Notice that A) Bronchoconstriction, B) Glandular secretion, D) Peristalsis, E) Vasodilation of skin are all under parasympathetic control.

The only sympathetic control is heart rate, which would increase.


... gh889 made a comment on nbme23/block2/q#34 (A 35-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by gh889(8)

Referring to NRTIs and NNRTIs as mainstay of treatment

Mainstay: efavirenz (NNRTI), tenofovir (NRTI), and emtricitabine (NRTI)


... sweetmed made a comment on nbme21/block1/q#15 (A 35-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by sweetmed(0)

The chemotactic factors produced by monocytes and mast cells and the local vasodilatation stimulates neutrophilic chemotaxis. Also, endothelial cells activation further aggravates the inflammatory response and migration of neutrophils. This leads to an influx of neutrophils locally.

refrence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512152/


... sweetmed made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
 +0  upvote downvote
submitted by sweetmed(0)

Fatty Change in Liver [2/2 High NADH made by ADH and AldDH -> inhibits FA oxidation, impaired lipoprotein assembly and secretion-> FA accumulates.]


... sweetmed made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
 +0  upvote downvote
submitted by sweetmed(0)

Usual interstitial pneumonia (UIP) is a form of lung disease characterized by progressive scarring of both lungs.[1] The scarring (fibrosis) involves the supporting framework (interstitium) of the lung. UIP is thus classified as a form of interstitial lung disease. The term "usual" refers to the fact that UIP is the most common form of interstitial fibrosis. "Pneumonia" indicates "lung abnormality", which includes fibrosis and inflammation. A term previously used for UIP in the British literature is cryptogenic fibrosing alveolitis (CFA), a term that has fallen out of favor since the basic underlying pathology is now thought to be fibrosis, not inflammation. The term usual interstitial pneumonitis (UIP) has also often been used, but again, the -itis part of that name may overemphasize inflammation. Both UIP and CFA have been described as synonymous with idiopathic pulmonary fibrosis.


... kchakhabar made a comment on nbme24/block3/q#11 (The pedigrees of patients with schizophrenia most...)
 +0  upvote downvote
submitted by kchakhabar(1)

The way I approached this problem was, schizophrenia doesn't have a clear pattern of inheritance. Among the option choices, only Type 1 DM doesn't have a clear inheritance pattern (eg: CF is auto recessive, Fragile X is XD, and so on).


... link981 made a comment on nbme21/block4/q#39 (A 46-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by link981(0)

p^2 + 2pq + q^2 = 1 p+q= 1

q^2= 1/900 q= 1/30 p= 29/30 which rounds to 1

They are asking for carrier frequency which is 2pq.


... hpsauce made a comment on nbme20/block4/q#13 (A 62-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by hpsauce(0)

I believe this is Caplan Syndrome (bronchogenic carcinoma + rheumatoid arthritis). Only flaw to that is that the pulmonary findings don't perfectly represent pneumoconioses.


... yogi made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by yogi(1)

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.


... sup made a comment on nbme22/block3/q#12 (An 82-year-old woman has been bedridden since...)
 +0  upvote downvote
submitted by sup(0)

Why not PGI2 by way of ASA? Especially given other answer choices of proteins C + S: doesn't warfarin also suppress these?


... acanthosisnegrocans made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
 +0  upvote downvote
submitted by acanthosisnegrocans(0)

In the great words of Dr Sattar:

"Prostaglandin E2 mediates feeeeeeeeeever"

NSAIDs --> block prostaglandin syn


... meningitis made a comment on nbme23/block4/q#16 (In a study of the use of ultrasonography for the...)
 +0  upvote downvote
submitted by meningitis(50)

The question is confusing because a TRUE POSITIVE test result is finding detecting cancer by US (goes to show you we gotta look at what the test is looking for).

An ABNORMAL test detecting PrCa means its NOT A POSITIVE: ie: 35 out of 50 were False Positives

An ABNORMAL test WITHOUT PrCa means its NOT A NEGATIVE: 20 out of 100 WITHOUT PrCa were FALSE NEGATIVE.

TN = 80, FP = 15. Specificity: TN/(TN+FP); 80/(80+15) = 84%. And since it says "best represents" then 84% is closest to 80%.


... yogi made a comment on nbme23/block4/q#14 (A 61-year-old woman comes to the physician for a...)
 +1  upvote downvote
submitted by yogi(1)

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.


... omerta made a comment on nbme22/block3/q#9 (Microelectrode injection of antibodies to α-actinin...)
 +1  upvote downvote
submitted by omerta(1)

I thought this image was helpful.

https://doctorlib.info/physiology/medical/49.html


... saifshaikh made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
 +0  upvote downvote
submitted by saifshaikh(0)

I think this picture explains it well:

http://www.groinpainclinic.co.uk/data/images/nervesaffected.jpg


... moo made a comment on nbme21/block3/q#16 (A 16-year-old boy is brought to the physician...)
 +0  upvote downvote
submitted by moo(0)

if the lungs were clear to auscultation and the kid even said he doesn't want to be on the team anymore why couldn't it be malingering?


... usmleuser007 made a comment on nbme22/block2/q#41 (A 12-year-old boy is swimming in a mountain stream....)
 +0  upvote downvote
submitted by usmleuser007(17)

This question has nothing to do with temperature (the vignette doesn't address the temperature of the water - so don't assume)

This is how you get the answer:

1) Being in outer-space or in a swimming pool up to the neck will:

a. Increases Central blood volume (more blood returns to the right side of heart = increased preload)

b. Increases ANP = increased dilation of ventricles ~ compensatory mechanism to reduce volume overload

c. Decreased ADH & Renin-aldo-system = body is in state of volume overload & needs to reduce systemic volume


... usmleuser007 made a comment on nbme22/block1/q#45 (A 16-year-old girl is brought to the physician...)
 +0  upvote downvote
submitted by usmleuser007(17)

This more likely to be diuretics rather than laxatives b/c

the lab study shows a renal dysfunction (BUN & Creatinine are elevated)

Most likely the patient abused loop diuretics; also knows to cause contraction alkaloids, along with renal problems such as interstitial nephritis


... nala_ula made a comment on nbme21/block1/q#46 (A 66-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by nala_ula(5)

Toll like receptors are pattern recognition receptors (on innate immunity cells like macrophages) that recognize pathogen associated molecular patterns (PAMPs) and lead to activation of NF-kB. One example of a PAMP is LPS (gram negative bacteria). This leads to secretion of IL-1, IL-6 (cause fever), TNF-a (causes fever and hypotension), Nitric Oxide (causes hypotension).

Complement activation itself leads to hypotension via C3a, as well.

All this can be found on page 133 on FA, as @meningitis pointed out, and page 99 of FA 2019.


... usmleuser007 made a comment on nbme22/block1/q#34 (A 15-year-old girl is brought to the physician by...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) Superficial (first-degree) = Epidermis ~ presents as red skin without blisters

2) Superficial partial thickness (second-degree) = Extends into superficial (papillary) dermis ~ Presents with redness with clear blister & blanches with pressure

3) Deep partial thickness (second-degree) = Extends into deep (reticular) dermis ~ presents as yellow or white skin with less blanching. May be blistering.

4) Full thickness (third-degree) = Extends through entire dermis ~ presents as stiff and white/brown skin. No blanching.

5) Fourth-degree = Extends through entire skin, and into underlying fat, muscle and bone ~ presents as black skin; charred with eschar


... nala_ula made a comment on nbme21/block1/q#37 (A 35-year-old man with diabetic ketoacidosis has a...)
 +0  upvote downvote
submitted by nala_ula(5)

In diabetic ketoacidosis, there is increased acid in the extracellular space. According to FA there is a transcellular shift due to decreased insulin that leads to more H+ entering the cell in exchange for K+. This leads to hyperkalemia with depleted intracellular stores of K+. There is also osmotic diuresis that leads to increased K+ loss in the urine and total body K+ depletion. The question asks that is most likely to decrease with insulin therapy: serum potassium concentration will decrease as K+ is now exchanged for H+ inside the cell.


... usmleuser007 made a comment on nbme22/block1/q#29 (A 28-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by usmleuser007(17)

Intussusception is generally caused by a blockage in the GI tract caused by a tumor, polyp, diverticulum, or just immobility at part of the tract.

1) My thought was that the patient had a Meckel diverticulum yes it happens in 2 feet from the ileocecal valve; but that is in about %2 of the population


... pseudorosette made a comment on nbme24/block1/q#42 (A 68-year-old woman with acute myelogenous leukemia...)
 +0  upvote downvote
submitted by pseudorosette(0)

I could be wrong.. but the normal ANC (absolute neutrophil count) ranges from (1,500 to 8,000/mm3) this patient is way below the normal ANC range, thus a GMCSF could help boost neutrophils which are granulocytes!


... usmleuser007 made a comment on nbme22/block1/q#21 (A 30-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) ADPKD = polycystins (PC2)

2) ARPKD = fibrocystin /polyductin (FPC) -- similar to polycystins

FPC protein is found on the primary cilia of epithelia cells of cortical and medullary collecting ducts and cholangiocytes of bile ducts

FPC interacts with ADPKD protein PC2 and may also participate in this regulation pathway of the mechanosensory function of the primary cilia, calcium signaling, and PCP.


... usmleuser007 made a comment on nbme22/block1/q#20 (A 49-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by usmleuser007(17)

Causes

1) Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

2) Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.

3) Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.

4) Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher's disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.


... usmleuser007 made a comment on nbme22/block1/q#20 (A 49-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by usmleuser007(17)

(A) Risk factors for developing avascular necrosis include:

1) Trauma = Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.

2) Steroid use= Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow.

3) Excessive alcohol use = Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.

4) Bisphosphonate use = Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer.

5) Certain medical treatments = Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

(B) Medical conditions associated with avascular necrosis include:

Pancreatitis Diabetes Gaucher's disease HIV/AIDS Systemic lupus erythematosus Sickle cell anemia


... amirmullick3 made a comment on nbme23/block4/q#41 (Electrophysiology of the heart is studied in an...)
 +1  upvote downvote
submitted by amirmullick3(3)

ECG Tracings. The distance between QRS complexes is continuously about 6 boxes, so rate is unaffected. This is a 3rd degree block where teh atria and ventricles are beating independently of eachother and the RR is equivalent all along. The 2nd QRS complex is SUPER narrow, and others are also narrow, which means theyre depolarizing thanks to bundle of His.


... yotsubato made a comment on nbme24/block2/q#45 (A 2-year-old boy is brought to the physician because...)
 +0  upvote downvote
submitted by yotsubato(54)

Cool another question taken from the list of things not in FA


... yotsubato made a comment on nbme24/block3/q#6 (A 43-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by yotsubato(54)

ALT and AST are enzymes within hepatocytes. Without hepatocyte damage, you wont have elevations.

Alkaline phosphatase is present in all tissues throughout the entire body, but is particularly concentrated in the liver, bile duct, kidney, bone, intestinal mucosa and placenta.


... yotsubato made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +0  upvote downvote
submitted by yotsubato(54)

Cold air induces asthma attacks.

Decreasing course load wont help

Taking steroids is too much for now

Moving back to the dorms is not viable

Air cleaners dont work enough

Dont get rid of the Good Boye

Smoking indoors is disgusting


... yotsubato made a comment on nbme24/block4/q#13 (A 90-year-old man has a 1-week history of...)
 +0  upvote downvote
submitted by yotsubato(54)

Why is the patient not in pain. I wouldnt expect Incarcerated hernia to present with zero pain, but 1 week of constipation and swelling.


... yotsubato made a comment on nbme24/block4/q#41 (A 30-year-old man who is a migrant farm worker comes...)
 +0  upvote downvote
submitted by yotsubato(54)

Kind of tricky question. The hypnozoites are chloroquine resistant. But the species may not be.

P. Falciparum is resistant and looks like a banana, but you dont know if the malaria in the RBC is falciparum or not.


... yotsubato made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +0  upvote downvote
submitted by yotsubato(54)

Amyloid A : seen in chronic inflammatory conditions, deposition of amyloid in tissues

B2 microglobulin: associated with ESRD and long term dialysis

Neurofilament protein: Form the cytoskeleton of neurons (in healthy individuals)

Presenilin: associated with familial alzheimers disease


... sup made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by sup(0)

Somehow I was able to convince myself that increased testosterone --> decreased estrogen --> decreased negative feedback on LH/FSH secretion --> increased FSH. Does anyone care to explain why this logic is wrong? Thanks :)


... usmleuser007 made a comment on nbme22/block3/q#11 (A 38-year-old man with Down syndrome is brought to...)
 +0  upvote downvote
submitted by usmleuser007(17)

In cases of child or adult abuse

1) if there is clear evidence such as if a child states that parents punish by hitting, child is showing fear of parent ---- call child protection right away ( don't need to wait and ask)

2) same thing goes for the adult but call the adult protection services


... usmleuser007 made a comment on nbme22/block3/q#36 (A 62-year-old man comes to the physician's office...)
 +0  upvote downvote
submitted by usmleuser007(17)

The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

The diagnosis (when known) The nature and purpose of recommended interventions The burdens, risks, and expected benefits of all options, including forgoing treatment (c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.

In emergencies, when a decision must be made urgently, the patient is not able to participate in decision making, and the patient’s surrogate is not available, physicians may initiate treatment without prior informed consent. In such situations, the physician should inform the patient/surrogate at the earliest opportunity and obtain consent for ongoing treatment in keeping with these guidelines.

AMA Principles of Medical Ethics: I, II, V, VIII


... usmleuser007 made a comment on nbme22/block2/q#32 (A 54-year-old man who works in a delicatessen comes...)
 +0  upvote downvote
submitted by usmleuser007(17)

Central nervous system regeneration

Unlike peripheral nervous system injury, injury to the central nervous system is not followed by extensive regeneration. It is limited by the inhibitory influences of the glial and extracellular environment. The hostile, non-permissive growth environment is, in part, created by the migration of myelin-associated inhibitors, astrocytes, oligodendrocytes, oligodendrocyte precursors, and microglia. The environment within the CNS, especially following trauma, counteracts the repair of myelin and neurons. Growth factors are not expressed or re-expressed; for instance, the extracellular matrix is lacking laminins. Glial scars rapidly form, and the glia actually produce factors that inhibit remyelination and axon repair; for instance, NOGO and NI-35.The axons themselves also lose the potential for growth with age, due to a decrease in GAP43 expression, among others.


... usmleuser007 made a comment on nbme22/block2/q#32 (A 54-year-old man who works in a delicatessen comes...)
 +0  upvote downvote
submitted by usmleuser007(17)

Neuroregeneration in the peripheral nervous system (PNS) occurs to a significant degree.[5][6] After an injury to the axon, peripheral neurons activate a variety of signaling pathways which turn on pro-growth genes, leading to reformation of a functional growth cone and regeneration. The growth of these axons is also governed by chemotactic factors secreted from Schwann cells. Injury to the peripheral nervous system immediately elicits the migration of phagocytes, Schwann cells, and macrophages to the lesion site in order to clear away debris such as damaged tissue which is inhibitory to regeneration. When a nerve axon is severed, the end still attached to the cell body is labeled the proximal segment, while the other end is called the distal segment. After injury, the proximal end swells and experiences some retrograde degeneration, but once the debris is cleared, it begins to sprout axons and the presence of growth cones can be detected. The proximal axons are able to regrow as long as the cell body is intact, and they have made contact with the Schwann cells in the endoneurial channel or tube. Human axon growth rates can reach 2 mm/day in small nerves and 5 mm/day in large nerves.[4] The distal segment, however, experiences Wallerian degeneration within hours of the injury; the axons and myelin degenerate, but the endoneurium remains. In the later stages of regeneration the remaining endoneurial tube directs axon growth back to the correct targets. During Wallerian degeneration, Schwann cells grow in ordered columns along the endoneurial tube, creating a band of Büngner (boB) that protects and preserves the endoneurial channel. Also, macrophages and Schwann cells release neurotrophic factors that enhance re-growth.

(wiki)


... notadoctor made a comment on nbme23/block1/q#47 (A 61-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by notadoctor(17)

According to Goljan, polycythemia vera is one of the most common causes of Budd-Chiari syndrome. According to FA, Budd-Chiari is associated more generally with hypercoagulable states, polycythemia vera, postpartum states, and HCC.

Hepatic cirrhosis can be ruled out based on the time course of the patient's presentation - he was fine 2 weeks ago and the abdominal pain started an hour ago.


... nala_ula made a comment on nbme21/block3/q#43 (An undernourished 70-year-old man has fever, night...)
 +0  upvote downvote
submitted by nala_ula(5)

M. tuberculosis replicates in an unchecked fashion within the alveoli and alveolar macrophages due to virulence factors (cord factor) that prevent macrophage-mediated phagolysosome destruction. After a few weeks, macrophages infected display antigen on MHC II to stimulate T CD4+ cells which leads to an increase in interferon-y (Th1 cytokine) that active macrophages. Activated macrophages can also differentiate into epithelioid histiocytes and coalesce into multinucleated Langhans giant cells that wall off extracellular mycobacteria within granulomas.


... hmorela made a comment on nbme20/block1/q#22 (A 38-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by hmorela(1)

Why is it that the answer isn't also glossopharyngeal since you test CN IX by saying "Ah" also? Please help! Thanks!!


... usmleuser007 made a comment on nbme22/block2/q#2 (A 65-year-old man starts using topical fluorouracil...)
 +0  upvote downvote
submitted by usmleuser007(17)

Two major mechanisms of action have been elucidated:

1) Flucytosine is intrafungally converted into the cytostatic fluorouracil which undergoes further steps of activation and finally interacts as 5-fluorouridinetriphosphate with RNA biosynthesis thus disturbing the building of certain essential proteins.

2) Flucytosine also undergoes conversion into 5-fluorodeoxyuridinemonophosphate which inhibits fungal DNA synthesis.

3) Thymidylate synthetase is an enzyme that catalyzes the conversion of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP).

Thymidine is one of the nucleotides in DNA.

With inhibition of TS, an imbalance of deoxynucleotides and increased levels of dUMP arise. Both cause DNA damage.

(WIKI)


... pseudorosette made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by pseudorosette(0)

Why is it that the pulmonary capillary wedge preesssuree is increased? on pg. 307 of FA 2019 it says it can be increased or decreased :/


... usmleuser007 made a comment on nbme22/block2/q#23 (A 32-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by usmleuser007(17)

Arthropod infections

a. Trypansoma cruzi = reduviid bug

b. Trypanosoma brucei = Tsetse fly

c. Malaria = Anopheles mosquito

d. Flavivirus Group (West Nile Virus, Dengue) = Aedes mosquito

e. Microfilariae = black fly

f. Leishmania braziliensis = sand fly

g. Borrelia & Babesia =Ixodes tick

h. Rickebsia rickebsii & Francisella tularensis = Dermacentor tick

i. Rikebsia prowazekii = lice

j. Loa loa (African eye worm) = deer fly

k. Wuchereria bancrofti = mosquitoes


... usmleuser007 made a comment on nbme22/block2/q#23 (A 32-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by usmleuser007(17)
16. Arthropod infections a. Trypansoma cruzi = reduviid bug b. Trypanosoma brucei = Tsetse fly c. Malaria = Anopheles mosquito d. Flavivirus Group (West Nile Virus, Dengue) = Aedes mosquito e. Microfilariae = black fly f. Leishmania braziliensis = sand fly g. Borrelia & Babesia =Ixodes tick h. Rickebsia rickebsii & Francisella tularensis = Dermacentor tick i. Rikebsia prowazekii = lice j. Loa loa (African eye worm) = deer fly k. Wuchereria bancrofti = mosquitoes

... usmleuser007 made a comment on nbme22/block2/q#25 (A 37-year-old woman undergoes excision of a 1-cm,...)
 +0  upvote downvote
submitted by usmleuser007(17)

https://www.google.com/search?q=wound+healing+steps&tbm=isch#imgrc=WGrdA71sE1oqXM:


... usmleuser007 made a comment on nbme22/block2/q#15 (A 62-year-old woman comes to the physician 3 days...)
 +0  upvote downvote
submitted by usmleuser007(17)

Per Pathoma:

Most common in postmenopausal women:

1) fibrocystic changes, intraductal papilloma, Fibroadenoma

More likely in postmenopausal women: 1) phyllodes tumor (fibroadenoma-like tumor) 2) Breast cancers increased risk d/t 1) increased age, duration of estrogen throughout life (early menarche, late menopause, obesity) 2) Atypical hyperplasia 3) First degree relatives

Question states presents it as: a) 2cm firm, nontender mass b) no axillary lymphadenopathy or nipple discharge c) extremly radiodense mass with irregular margins clustered irregular microcalcifications

so what can it be: 1) DICS = does not usually produce mass

2) Comedo type = high- grade cells with necrosis & dystrophic calcifications at center of duct

3) Paget Disease = involves the skin of the nipple (underlying carcinoma)

4) IDC = a) forms duct-like structures (>80% of cases) b) mass detected by physical examination (check) c) usually 1cm or greater (check) d) Desmoplastic stroma = connective tissue growing with tumor (supports tumor) ~~~ (check -- irregular margins) e) Medullary Carcinome (IDC) = mimics fibroadenoma

5) LCIS & ILC = DO NOT produce calcifications or mass a) ILC - cells have "single-file pattern" think of a beaded necklace and you cut it in middle (lack E-cadherin)


... cbrodo made a comment on nbme23/block1/q#37 (A 47-year-old woman with multiple sclerosis is...)
 +0  upvote downvote
submitted by cbrodo(2)

The posterior columns (Fasciculus cuneatus/Fasciculus gracilis) carry information to the brain regarding proprioception, vibration, discriminative touch and pressure. Physical exam findings suggest a lesion here (the spinothalamic tract carries pinprick/pain and temperature, and these were normal). Since the patient has abnormal findings in the lower extremities, and normal findings in the upper extremities, the answer is Fasciculus gracilis. This is because information from body areas below the level of T6 is carried by gracilis and information from body areas above the level of T6 is carried by cuneatus.


... tissue creep made a comment on nbme18/block4/q#15 (45 yo man follows up 1 week after appendectomy)
 +0  upvote downvote
submitted by tissue creep(7)

Mild jaundice with increased unconjugated in an older fellow is decreased UDP-glucuronyltransferase activity. Particularly in context of stress (appendectomy)


... dr.xx made a comment on nbme23/block3/q#35 (A 31-year-old woman comes to the emergency...)
 +1  upvote downvote
submitted by dr.xx(9)

right. he absolutely must remain in the waiting area so that he is at hand to attack his wife whenever her exam ends. go NBME!


... usmleuser007 made a comment on nbme22/block1/q#16 (An Rh-negative woman, gravida 3, para 2, has had an...)
 +1  upvote downvote
submitted by usmleuser007(17)

Mother is Rh-neg --> she will generate RH-antibodies 1) fetus affected by Anti-Rh if it is Rh-positive 2) even if O-Rh-Positive is given, then still mother's Rh-antibodies will attack transfused blood due to its cells containing Rh+ 3) therefore, O-Rh-negative is best


... usmleuser007 made a comment on nbme22/block1/q#48 (A 1-year-old boy is found to have an impairment of...)
 +0  upvote downvote
submitted by usmleuser007(17)

Note: the questions stated "respiratory burst" suggesting an URT infection.

1) this rules out anything but respiratory infection (non rep infection: E. coli, E. faceium)

2) G6PD deficiency more susceptible to catalase positive organisms -- this rules out (all strep organisms)

3) Left with H. influenzae & Straph. aureus (BOTH are catalase positive)

4) Encapsulated organism are most concerning when there is asplenia.


... usmleuser007 made a comment on nbme22/block1/q#7 (Two patients, a 54-year-old man (Patient X) and a...)
 +0  upvote downvote
submitted by usmleuser007(17)

Someone care to explain why [time to steady-state concentration] is not the correct answer?


... fahmed14 made a comment on nbme24/block1/q#32 (A 24-year-old man receives an injection of histamine...)
 +0  upvote downvote
submitted by fahmed14(0)

Histamine plays a major role in the cardinal signs of inflammation. It helps mediate vasodilation and vascular permeability (via endothelial cell contraction). These two functions are already contrary to A, B, C, and D. By increasing fluid in the interstitial space, you can reason that there will be increased lymph flow.


... usmleuser007 made a comment on nbme22/block3/q#9 (Microelectrode injection of antibodies to α-actinin...)
 +0  upvote downvote
submitted by usmleuser007(17)

Actinin is a microfilament protein. α-Actinin is necessary for the attachment of actin filaments to the Z-lines in skeletal muscle cells,[1] and to the dense bodies in smooth muscle cells.[2] The functional protein is an anti-parallel dimer, which cross-links the thin filaments in adjacent sarcomeres, and therefore coordinates contractions between sarcomeres in the horizontal axis.

The non-sarcomeric α-actinins, encoded by ACTN1 and ACTN4, are widely expressed. ACTN2 expression is found in both cardiac and skeletal muscle, whereas ACTN3 is limited to the latter. Both ends of the rod-shaped α-actinin dimer contain actin-binding domains.

Mutations in ACTN4 can cause the kidney disease focal segmental glomerulosclerosis (FSGS).

(WIKI)


... niboonsh made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by niboonsh(0)

" Other classes of medications that cause hyperprolactinemia include antidepressants, antihypertensive agents, and drugs that increase bowel motility. Hyperprolactinemia caused by medications is commonly symptomatic, causing galactorrhea, menstrual disturbance, and impotence. It is Important to ensure that hyperprolactinemia in an Individual patient is due to medication and not to a structural lesion in the hypothalamic/pituitary area; this can be accomplished by (1) stopping the medication temporarily to determine whether prolactin levels return to normal, (2) switching to a medication that does not cause hyperprolactinemia "

https://www.ncbi.nlm.nih.gov/pubmed/16092584

"Non-dose-dependent side effects — Although low-dose therapy seems to minimize the metabolic complications induced by a thiazide or thiazide-like diuretic, it may not necessarily eliminate other side effects. As an example, as many as 25 percent of men treated with 25 mg/day of chlorthalidone develop a decline in sexual function [34]. Sleep disturbances can also occur, particularly if the patient is on a low-sodium diet [34]. How these problems occur is not known."

https://www.uptodate.com/contents/use-of-thiazide-diuretics-in-patients-with-primary-essential-hypertension#H2250530998


... usmleuser007 made a comment on nbme22/block3/q#45 (A 28-year-old man who is seropositive for HIV has...)
 +1  upvote downvote
submitted by usmleuser007(17)

my list of spindle type cells and conditions:


... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) Analysis of variance is a procedure used for comparing sample means to see if there is sufficient evidence to infer that the means of the corresponding population distributions also differ.

2) Where t-test compare only two distributions, analysis of variance is able to compare many. • What does the one-way part mean? It is one dependent variable (always continuous) and exactly one independent variable (always categorical). A single independent variable can have many levels.


... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +0  upvote downvote
submitted by usmleuser007(17)

https://www.slideshare.net/adsarwar/anova-and-ttest


... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +0  upvote downvote
submitted by usmleuser007(17)

Just remember:

1) T-test (tea for two) = looks at the mean values of 2 groups

2) ANOVA (analysis of variance) ~ like t-test but = looks at mean values of 3 or more groups

3) Chi-square = looks at the (%) or proportions between 2 or more groups.

so, just look for how many groups being addressed and what values they are using (% or means)


... gabeb71 made a comment on nbme23/block3/q#20 (An 82-year-old woman is brought to the physician by...)
 +0  upvote downvote
submitted by gabeb71(2)

The puborectalis muscle, which is one of the muscles that comprise the pelvic floor and plays an important role in both fecal continence and defecation, is tonically contracted and maintains the anorectal angle at rest.

here is a picture: https://www.123rf.com/photo_46940875_stock-vector-the-rectum-and-anus-showing-the-puborectalis-muscle-part-of-the-levator-ani-used-for-the-control-of-.html


... usmleuser007 made a comment on nbme22/block3/q#17 (A 50-year-old man with chronic gastritis is...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) EBV = Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, 1° CNS lymphoma (in immunocompromised patients)

2) HBV & HCV = Hepatocellular carcinoma

3)HHV-8 = Kaposi sarcoma

4) HPV= Cervical and penile/anal carcinoma (types 16, 18), head and neck cancer

5) H. pylori = Gastric adenocarcinoma and MALT lymphoma

6) HTLV-1 = Adult T-cell leukemia/lymphoma

7) Liver fluke (Clonorchis sinensis) = Cholangiocarcinoma

8) Schistosoma haematobium = Bladder cancer (squamous cell)


... dr.xx made a comment on nbme23/block4/q#48 (A 2-week-old female newborn of Mexican descent is...)
 +0  upvote downvote
submitted by dr.xx(9)

... that and a psych consult for the schizo mother...


... ihavenolife made a comment on nbme21/block2/q#4 (An 18-year-old woman comes to the office because of...)
 +0  upvote downvote
submitted by ihavenolife(2)

Tennis elbow results in strain of the common extensor tendon and inflammation of the periosteum of lateral epicondyle.

Lateral elbow pain, often felt when opening a door or lifting a glass.

origins of the muscles that may be affected (all have extensor in the name so if you remember that you could get this question by elimination)

  1. extensor carpi radialis longus
  2. extensor carpi radialis brevis
  3. extensor digitorum
  4. extensor digiti minimi
  5. extensor carpi ulnaris

From the 100 most important Anatomy Conceptions PPT (St Matthews University)


... dr.xx made a comment on nbme23/block4/q#33 (A 16-year-old girl with bulimia nervosa is brought...)
 +0  upvote downvote
submitted by dr.xx(9)

Abuse of laxatives => usually decreased serum potassium. As to chloride and bicarb, that depends. They could be increased or decreased.

https://www.aafp.org/afp/2004/0315/p1530.html


... usmleuser007 made a comment on nbme22/block4/q#35 (Nicotinic acid acts at which of the following...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD.

2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs

Note VLDL are very rich in TAGs


... ihavenolife made a comment on nbme21/block4/q#26 (The immunosuppressive agent cyclosporin A (CsA) is a...)
 +0  upvote downvote
submitted by ihavenolife(2)

Idk if it helps but I got it using the Hot T-Bone stEAK mnemonic

Hot -> IL 1 (Fever)

T cell stimulation -> IL 2

Bone marrow stimulation -> IL 3

IgE -> IL 4

IgA -> IL 5

aKute phase protein -> IL 6


... famylife made a comment on nbme18/block2/q#34 (25 yo woman, fatigue for 3 weeks)
 +0  upvote downvote
submitted by famylife(9)

This is strep pneumo, which has alpha hemolysis (green)


... famylife made a comment on nbme18/block1/q#45 (55 yo man; father and brother died of myocardial infarct at early age)
 +0  upvote downvote
submitted by famylife(9)

"Despite inhibition of HMG-CoA reductase by statins, cells compensate by increasing enzyme expression several fold. However, the total body cholesterol is reduced by 20%–40% due to increased expression of LDL receptors after statin administration."

https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/hmg-coa


... usmleuser007 made a comment on nbme22/block4/q#31 (A 65-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by usmleuser007(17)

Just note why other answers are not correct:

  1. Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis.

    • a. It is due to enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out.
  2. Whispered pectoriloquy refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient’s torso.

    • a. Usually spoken sounds of a whispered volume by the patient would not be heard by the clinician auscultating a lung field with a stethoscope.

    • b. However, in areas of the lung where there is lung consolidation, these whispered spoken sounds by the patient (such as saying ‘ninety-nine’) will be clearly heard through the stethoscope.

    • c. This increase in sound exists because sound travels faster and thus with lower loss of intensity through liquid or solid (“fluid mass” or “solid mass,” respectively, in the lung) versus gaseous (air in the lung) media.

    • d. Whispered pectoriloquy is a clinical test typically performed during a medical physical examination to evaluate for the presence of lung consolidation, which could be caused by cancer (solid mass) or pneumonia (fluid mass).


... .ooo. made a comment on nbme23/block2/q#42 (A 63-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by .ooo. (3)

I personally thought of this questions thinking of it in these terms.. Since the patient has a mass in the trachea peak expiratory and inspiratory flow will be interrupted, and would therefore be decreased. FVC1 would also have to decrease by this. This eliminated all the other choices.


... notadoctor made a comment on nbme23/block2/q#20 (A 47-year-old woman has had a goiter for 10 months....)
 +1  upvote downvote
submitted by notadoctor(17)

Remember on histology Hashimoto's thyroiditis has two distinct features Hürthle cells(which are eosinophilic metaplastic cells that line follicles) and lymphoid aggregates with germinal centers.(pg. 338, FA 2019) The correct answer describes the latter feature of Hashimoto's.


... niboonsh made a comment on nbme20/block3/q#47 (A 60-year-old woman has prolonged apnea following...)
 +0  upvote downvote
submitted by niboonsh(0)

https://www.youtube.com/watch?v=WGWFFN01qkA succinylcholine usually has v fast duration of action bcuz metabolized by plasma pseudocholinesterase. With atypical pseudocholinesterase, decreased metabolism of succinylcholine and thus causes a prolonged duration of action of succinylcholine ----> APNEA


... notadoctor made a comment on nbme23/block4/q#39 (A 44-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by notadoctor(17)

Celiac sprue is a malabsorption syndrome that results in steatorrhea and results in iron deficiency anemia. As far as I'm aware, none of the others result in iron deficiency anemia. (I had Bacterial overgrowth as a close second but I don't believe that's associated with iron deficiency).


... notadoctor made a comment on nbme23/block4/q#4 (A 76-year-old woman is brought to the physician by...)
 +1  upvote downvote
submitted by notadoctor(17)

The definition of Decision-Making Capacity according to B+B is ability to comprehend information about illness and treatment options and make choices in keeping with personal values.


... lianallado made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by lianallado(0)

This patient presents with a mitochondrial myopathy since the disorder is inherited from the mother. Mitochondrial myopathies show “ragged red fibers” on muscle biopsy due to the accumulation of diseased mitochondria in the subsarcolemma of the muscle fiber.


... lianallado made a comment on nbme20/block3/q#17 (A 45-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by lianallado(0)

Schizoid personality disorder is characterized by voluntary social withdrawal, limited emotional expression and social isolation.


... 2zanzibar made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by 2zanzibar(2)

Patient is in cardiogenic shock. Characteristic features of cardiogenic shock: increased cardiac pressures and decreased cardiac output due to impeded forward flow, as well as increased systemic vascular resistance


... dr.xx made a comment on nbme23/block2/q#49 (A 56-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by dr.xx(9)

Treatment of acute gouty arthritis Several drugs are effective for terminating the acute gouty attack. Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are standard approaches. Adrenocorticotropic hormone (ACTH) is also very effective, but has become increasingly scarce or too expensive to be a practical alternative in the US. Regardless of the particular agent chosen, the sooner these drugs are started, the more rapid the response. If a patient cannot take NSAIDs or colchicine, the choice is among oral, intra-articular or parenteral glucocorticoids. Local application of ice packs may help control pain. In some cases, analgesics, including opioids, may be added.

Drugs that affect serum urate concentrations (E.G., ALLOPURINOL), including antihyperuricemic agents, should not be changed, started, or stopped during an attack, as this may worsen the inflammatory response already in progress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/


... fulminant_life made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +1  upvote downvote
submitted by fulminant_life(2)

Why is it 99% and not 95%? It asked for onset of disease at less than 9 years of age. I'm clearly missing something here


... dr.xx made a comment on nbme23/block2/q#45 (A 61-year-old man is prescribed fluoxetine for major...)
 +0  upvote downvote
submitted by dr.xx(9)

SSRIs produce a sustained increase in extracellular 5-HT in the dorsal raphe (DR), and this leads to autoinhibition of serotonergic neurons.

http://jgp.rupress.org/content/145/4/257


... notadoctor made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +0  upvote downvote
submitted by notadoctor(17)

I've been searching for my source for this but can't seem to find it. However, the way I thought about it was that edema happens via the capillaries. If there is increased resistance via the precapillary sphincters as much blood wouldn't be able to get into the capillaries. The blood would instead get shunted via anastomoses to the veins. This article from cvphysiology.com explains it a little better: CV Physiology: Tissue Edema and General Principles of Transcapillary Fluid Exchange


... yotsubato made a comment on nbme23/block2/q#49 (A 56-year-old man comes to the physician because of...)
 +1  upvote downvote
submitted by yotsubato(54)

Although acetaminophen (Tylenol) is not considered an NSAID, it too may provoke an aspirin-like sensitivity.