why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion?
the child was in a daycare, sonnei and rotavirus are the ones to keep in mind. sonnei can also be due to unwashed veggies too. and the inflammatory stool (neutrophils) also indicates sonnei. the lack of exposure (undercooked meat for EHEC) helps to rule out E.Coli. dirty water (ETEC and EIEC) aren't possible because of this kids bloody stool. Also for this to be HUS (the only possible E.Coli with bloody diarrhea), we should have seen the triad or at least something about it (anemia + thrombocytpoenia + Acute Renal Insuff.). Also, "mucoid stools" is right from the FA chart for shigella.
I just used common sense to rune out the answers here. Firstly, knowing that cortisol is increased during times of stress (starvation; like this stem). Insulin causes hypoglycaemia so the body wouldn't produce more in a stressful state (expect glycogen to be higher). IGF-1 acts like GH and these states of growth require energy which this man clearly doesn't have. There wasn't enough to support testosterone and T3 changes so those were ruled out pretty quick.
Side note for those of you who hate familial dyslipidemias: don't usually watch dirty USMLE videos but I couldn't keep the familial dyslipidemias straight in my head and someone on reddit recommended his video on this. Personally found it really helped.
scary crying old ostrich man that's all I can see :O
This man likely has ALS-> weight loss, progressive weakness causing him to now be in wheelchair, dysphagia, no PMH, fasciculations. It is a mix of upper and lower motor neuron deficit and MOTOR ONLY. Because muscles will not be stimulated, they will atrophy. "USE IT OR LOSE IT"
SUBACUTE COMBINED DEGENERATION (B12 deficiency):
Spinocerebellar tract -- Unconcious proprioceptive sensation. 'tingling'
Lateral Corticospinal tract -- Controls ipsilateral limb fine motion. 'weakness of extensors and flexor muscles. exaggerated reflexes'
Dorsal Column -- White matter in posterior. Made of gracille and cuneatus fasciculi. Gracile is for lower body sensory and cuneate is upper body sensory. 'decreased sensation to vibration and position'
-initially i put B6 because of descriptions of peripheral neuropathy, but the decreased vibration/proprioception was the key differentiator
This homing phenomenon may be related to tumour cell recognition of specific “exit sites” from the circulation or to awareness of a particularly favourable—or forbidding—“soil” of another tissue. This may occur because of an affinity that exists between receptor proteins on the surface of cancer cells and molecules that are abundant in specific tissues.
FA 2020, pg 221, "Hallmarks of Cancer"
Metastasis is defined by distant spread via blood/lymphatics --> binding to endothelium --> extravasation & homing.
Since metastasis to only one organ has been affected, it's safe to say this liver cell surface antibody has affected "homing" towards the liver.
ACE inhibitors are associated with oligohydramnios, renal failure, hypocalvaria. - FA2019 pg600; FA2020 pg 614
"Ileal (Meckel) diverticulum occurs when a remnant of the vitelline duct persists, thereby forming a blind pouch on the antimesenteric border of the ileum. It is often asymptomatic but can become inflamed if it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration. It is typically found 2 feet from the ileocecal junction, are 2 inches long, and appears in 2% of the population."
Kaplan 2020 Book.
Antimesenteric seems to be a buzzword for Meckels, saw this in UWorld as well (might have been one of the UWSA).
Damage to orbital floor can lead to impaired vertical gaze (ocular movement is restricted)via entrapped inferior rectus, numbness and paresthesia of the upper cheek/lip/gingiva, enophthalmos. UWORLD qid:11742, same concept
According to UW qid:839 "The membranous segment is relatively unsupported by the adjacent tissues and is the weakest point of the posterior urethra. Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the bulbomembranous junction." The presence of a pelvic fracture and presence of blood at the urethral meatus are key signs of urethral injury.
the MAIN SUPPLY IS FROM THE INFERIOR THYROID ARTERIES. the little bit of blood received from the collateral (superior thyroid from external carotid) keeps them alive but now they sense low ca2+ --->>> so release tons of PTH... if the superior was knocked out = not a big deal --> not main supply to the glands.
** I copied @mistermbg explanation because he explains it really well!
why is the answer not choristoma?!!
Atropine reverses acetylcholinesterase poisoning due to organophosphates
Bethanechol is an M3 agonist used to treat urinary retention
Physostigmine is an antidote for anticholinergic toxicity
This is the stupid way I've ever seen anyone ask a question
Di- and Tri- peptides can enter into enterocytes via PepT1 transporters and be broken down to amino acids within the enterocytes. Hence why the lumen is not the best answer
Top 1/3: Esophageal branches of inferior thyroid artery, which is a branch of the thyrocervical trunk (option E)
Middle 1/3: Esophageal branches of thoracic part of aorta (option B)
Bottom 1/3: Esophageal branches of left gastric artery (which is branch of celiac trunk, which is branch of aorta) (option A)
FA 2020 pg 364: abdominal aorta --> celiac trunk --> left gastric --> esophageal arteries
This question has changed. Sept 23rd 2020. 2-day-old female with murmur. Next step in management: Observation only.