Motor + Sensory + rapid progress :: may be R/O Acute inflammatory demyelinating polyradiculopathy

i think this was tested in a similar way in another question in this form. the patients have a right to know or not know their resuts.

MM will be induced a AL(primary amyloidosis).

Draw out your 4/4 box.

Note that prevalence does not change specificity or sensitivity and that's why you can eliminate C and D right off the bat.

so with low prevalence, you decrease the amount of people with the disease and if you write out for formulas for PPV and NPV you can see that PPV has its variable in the numerator and denominator decrease (decrease overall) while the NPV only has its numerator in the denominator decrease. i wish I could draw it out i hate typing out math

Pathoma 2018 pg. 53. Chemotherapy hurts neutrophils the most. Radiation hurts lymphocytes the most.

honestly someone explain this one to me other than the memory loss is her newest thing and needs to be evaluated. pls

• Catecholamine producing tumor -> not likely since the presentation would be more of an intemittent episode of HTN and other sympathetic symptoms
• Decreased distensibility caused by atherosclerosis: could be describing RAS which is discounted by the lack of abdominal bruits
• Execess production of ANP -> can be seen in volume overload states and would also result in a reduction of Na+ in the serum due to the actions of ANP- maximal point of impulse not displaced, no edema, low-normal resp.
• Juxtaglomeular cell hypertrophy and sclerosis -> this would suggest findings of diabetic nephropathy. Patient doesnt have hx or HTN.
• along with patients labs suggesting high aldosterone state - answer is most likely pointing toward autonomous production of aldosterone.

Patient does NOT currently have back pain- asking for how to prevent her back pain from occuring.

Being obese is the most important risk factor in back pain and osteoarthritis (step-prep)

USMLE

• Acute pain (< 4 weeks)
• treat with NSAID/acetaminophen, maintain activity, consider muscle relaxants or spinal manipulation
• Subacute (4-12) or Chronic (>12 weeks)
• Intermittent use of NSAIDs or acetaminophen (decreased freq. in comparison to acute pain), Exercise therapy (stretching/strengthening - which is what i put because i thought the patient was currently in pain), and tricyclics or duloxetine

Secondary prevention also includes exercise therapy and education, and according to this NBME weight loss as well.

HBsAb = HBs Antibody = negative... so give the vaccine

.___. wow

Why it's not the other choices:

Cystic hygroma: if you see this, associate it with Turners.

Thyroglossal duct cyst: moves up and down with swallowing and doesnt cause the sx presented in this stem.

Tracheomalacia: In tracheomalacia, the cartilage of the windpipe does not develop properly in utero, leaving them weak and flaccid. The weakened walls are likely to collapse and cause an obstruction of the airway. Yes it can cause stridor but has no relation or association with maternal Graves as the cause and also doesnt present as a neck mass.

Vascular ring: occurs when the aorta or its branches form a complete ring around the trachea and the esophagus. This happens when certain parts of the aorta that normally disappear during fetal development persist abnormally. Sx are dysphagia and cough. Most sx are so mild that children who have it often go years without diagnosis. Also doesnt present as a neck mass.

A way to differentiate between a leukemoid reaction vs CML is that CML has a very low leukocyte alkaline phosphatase (LAP) as a result of low activity in malignant neutrophils, vs benign neutrophilia (leukemoid reaction) in which LAP is  due to  leukocyte count with neutrophilia in response to stressors (eg, infections, medications, severe hemorrhage).

Also some helpful hints is that his temperature is raised as well as his leukocyte count. So an infection from his cut.

I think "leukoclastic response" was just there to trip you up. The closest thing I could find to that term online was: Leukocytoclastic vasculitis (LCV), which refers to small blood vessel inflammation.

Leukopenia is LOW leukocyte count.

Leukoplakia is that "white plaque" you see with Bowens disease (squamous cell CA of penis) and can also be seen in vulvar CA.

Leukotrienes deal with your immune system and are synthesized and released on demand from basophils.

γ-aminobutyric acid =GABA, so not a neurotransmitter dealing with pain. deals with excitability and movement.

dopamine: think of parkinson's (too little of it) and schizophrenia (too much of it), either way doesn't deal with pain reception.

Enkephalin: related to a type of opioid receptor. It closes presynaptic Ca2+ channels, open postsynaptic K+channels and thus decreases synaptic transmission. It actually inhibits the release of ACh, norepinephrine, 5-HT, glutamate, substance P.

Serotonin: think of depression. again, doesnt deal with pain reception.

Substance P: even if you didn't know exactly what it did, you could rule out the others. you could also remember the pathophysiology of migraines: "Due to irritation of CN V, meninges, or blood vessels (release of vasoactive neuropeptides [eg, substance P, calcitonin gene-related peptide]) causing the immense pain of migraines."

For completeness sake: "Muscle nociceptors contain neuropeptides, including substance P (SP) and calcitonin-gene-related peptide (CGRP). These peptides are released when nerve endings are activated and induce local edema by dilating the local blood vessels and increasing their permeability." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696782/

also, good to know aprepitant is an anti-emetic that is Substance P antagonist. Blocks NK1(neurokinin-1) receptors in brain. yes, theres no mention of "pain" in that FA definition but Substance P got its hands in a lot of cookie jars ok

Albinism: Normal melanocyte number with DECREASED melanin production due to decreased tyrosinase activity or defective tyrosine transport. risk of skin cancer.

pressure (decubitus) ulcers

• over bony prominence
• impaired mobility / abnormal mental status

arterial ulcers

• most distal parts where blood flow is low (tips of toes)

diabetic foot ulcers

• Charcot deformity
• soles of feet under metatarsal heads
• tops of toes

venous stasis ulcers

• edema
• stasis dermatitis
• pretibial or above medial malleolus

Histamine causes endothelial contraction, this increases vascular permeability and leakage of protein-rich fluid from the postcapillary venules into the interstitial space -> increases interstitial oncotic pressure. (choice C).

Due to this it also increases capillary filtration rate, because the endothelial contracts. (choice A)

Because there is more fluid in the interstitial space, there is more lymph flow. (choice E).

FA19, pg 213

The only variable that changes with diet is the triglycerides (goljan)

The formula for total cholesterol:

• Total = HDL + LDL + VLDL
• VLDL = TG/5
• Total = HDL + LDL + TG/5

We need this patient to be fasting to get an appropriate Total cholesterol level.

• need to do step 1 diet (decrease fats, calories, cholesterol etc.) before moving to step 2 diet (more aggressive diet than step 1)