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Welcome to aakb’s page.
Contributor score: 10


Comments ...

 +0  (free120#35)

I believe this is aspirin intolerant asthma. Aspirin inhibits cycloxygenase. This leads to more shunting of the arachidonic acid to the leukotriene pathway (excessively), which leads to a bronchospasm.

Aspirin-induced bronchospasms can occur in aspirin intolerant asthma occurs more in adults. Additionally, she experienced this previously with ibuprofen (another NSAID that inhibits cox).


 +0  (nbme18#7)

Sheehan syndrome - ischemic infarct of pituitary following postpartum bleeding: pregnancy-induced pituitary growth; inc susceptibility to hypoperfusion; usu presents w/ failure to lactate, absent menstruation, cold intolerance

FA 2020 p 339

Keys here are recent delivery w/ severe bleeding requiring transfusions + inability to breastfeed (decreased prolactin)


 +0  (nbme23#24)

can someone explain to me why 0% basophils is incorrect?


 +3  (nbme18#33)

warfarin inhibits epoxide reductase which prevents gamma carboxylation of NEW vitamin K dependent clotting factors. the therapeutic efficacy of warfarin is delayed until prexisting/OLD factors get consumed, which usu takes at least 3 days.

Therefore, it will not affect the PT for at least three days because the old factors are still around. Since factor II has the longest half life, it takes the longest for the old factor II to go away/get used up and that is why the PT has not increased yet in this patient.


 +0  (nbme16#20)

what is the lesion/picture? not really sure what to even google for this.

skilledboyb  I got the feeling that this was some type of a hemorrhoid. The reason why is because they speak about constipation (risk factor for hemorrhoids) and the bigger give away is that this patient is pregnant. The uterus can compress the IVC when it gets large enough and lead to blood stasis behind the obstruction. +3




Subcomments ...

submitted by castlblack(55),

I picked A, but what is wrong with B? Which type of immunization works faster?

aakb  I thought the same thing. Active immunization is slower while passive immunization is faster. but both forms of vaccines (live and killed) are active forms of immunization. In both cases, it takes time for your body to develop a response to the immunization. Passive forms of immunization would include receiving the preformed antibodies (ie. from breast milk) +  


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TTP sah a caiclss paentd: ciiarmincoatopgh lceyoitmh man,iea rmtcbihoto paru,urp vfre,e rnale uafl,ire roloiegunc oirtasbenliam M.)S(A enverehW uyo ese a tsuqonei weher the ietntap ndylused sah a lto onigg ,on odncseri .TTP

mgemge  Why is TSS wrong? +1  
aejinkim  @mgemge: the patient's BP is still up there, and for me, she doesn't have a crazy fever that i associated with when i think of TSS +  
cheesetouch  also TSS they would have to give you tampon use or nasal packing left in for a day. And it wouldn't cause schistocytes. +  
beltorres23  TTP pentad FAT RN: Fever, Anemia, Thrombocytopenia, Renal, Neuro symptoms +  
aakb  The big hint for me was schistocyte formation +  


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eH ash ys(pearlmbu SVR) nsbciohtilr.oi SRV si an NAR viurs taht ensret hte cell iva a fnoius oritnpe hwh(ic si hte atgret of teh ptpcylhoicra ocoolnnaml aytibond gudr mPbiu)i.azval

aakb  I thought the fusion protein produces multinucleated giant cells. I thought RSV enters using the epithelial G protein? First aid literally says "All contain surface F (fusion) protein, which causes respiratory epithelial cells to fuse and form multinucleated cells." +  


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ID si na pomtanirt apotilmcnico fo eoms lsklu aesb arreucfst dna anc eb artetde twhi D.VADP ouY orbpyabl embreemr taht thsi rswko via eth vtniaactoi of ruoapqnia lenc,hans btu teseh era vemdo rmof ilalnacleurrt esvclsie ot the paaicl bnraemem rceasfu as a rluset of a AePDiDaetm-dVd esrcanie yneetalad cycelas aiv a lusoytamrit G oteinrp that aseecnrsi tllauareicnrl Ac.PM

aneurysmclip  Page 332 FA 2019; cAMP signaling pathway, thus increase adenylyl cyclase was best option imo +1  
melchior  Page 337 FA 2020; This is working via V2 receptor, which uses the Gs pathway to generate cAMP. Reminder: V1 works via Gq. V1 is present on the blood vessel smooth muscle +10  
aakb  also according to sketchy V1 is the vasoconstriction Gq (q shaped raised hole/stand in mini golf) and V2 is in the collecting duct Gs (s shaped mini golf pattern on the grass) +  


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hisT is a adb .inqotsue etPlaetl ioaggntaegr teim negib olmanr, ok ifne I acn see at.ht tuB WFV sbeizatsli ofrcat 8 nad duy'o see na iecenras ni PTT fris(t enli xnet ot VWF in Fitrs ).iAd hWy si htrie PTT nmr?lao

a1_antitrypsin  Totally agree, and they give you a slight increase in PT instead +  
mambaforstep  yeah but if they gave you an increase in PTT then Hemophilia A could have been a valid answer choice. so they prob showed a nl PTT to differentiate vWF dz from hemophlia A +  
drpee  VWD only sometimes presents with a slightly increased PTT. Don't let those anki facts steer you wrong... Plus all the other answers make no sense. Afibrinogenemia? That means literally no fibrinogin (PT and PTT would be infinitely increased). Hemophelia? Or vitamin K deficiency? Those are coagulation factor disorders so they would present with deep bleeding and large bruising. (Unlike platelet disorders, including VWD, which present with mucosal bleeding, petechiae, and heavy menses). VWD is actually the ONLY one that makes sense. +5  
cbreland  I get why it's not afibrinogenemia (which is what I picked), but still don't understand how VWD is right. You have normal PTT and normal platelet aggregation (both of which should be abnormal). Is the only thing leading us to VWD is it being a primary bleeding issue? Again, my answer made no sense, but VWD in this context, seems way out there +  
osteopathnproud  I agree with you @cbreland once I noticed I had to bend lab values for any answer choice then in my head most of them were possible. I took a step back and answer with the most common bleeding disorder, vW disease. Funny thing is when I retook it to check my answers, I had time to overthink and got it wrong. +  
aakb  the anki facts never steer you wrong! my zanki cards say "Low vWF in von Willebrand disease impairs platelet {{c1::adhesion}}" (Gp1B binds to vWF) not platelet aggregation (GpIIbIIIa binds to fibrinogen). additionally it says you can have either a normal or increase PTT. in this case the PT is not increased. It is decreased a little, which I assume is fine esp w an INR of 1.0 +  
lebabs  Shut up +  


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aoEeihtdlln githt nu’tonijsc libpeeryatmi si eaisnedcr in npeeross ot jyuirn dna toalannfi,mmi llgnaowi ongatimri fo tiewh odbol cllse and sdnirfe to the seti fo ni.yujr

jesusisking  Thank you! +  
focus  Ugh I was thrown off by "disruption of vascular basement membranes" since it seemed similar to the correct answer but I can see how "separation" would be a normal, expected response of the body that is needed vs. "disruption" would be traumatic and abnormal... please correct me if I am wrong! +1  
blah  @focus reasoning sounds right. I nearly picked that but the other choice sounded better. Just semantics. +3  
aakb  um just to clarify I don't think the differentiating factor is the wording of separation vs disruption. but rather that the correct answer is separation of ENDOTHELIAL junctions meaning that the spaces between the endothelial cells get wider. vs the answer youre thinking of says the disruption of the vascular BASEMENT MEMBRANE (which is under the endothelial cells) gets disrupted. so meaning something literally broken through the blood vessel and made a cut in the layer beneath the endothelial cells that line the blood vessel Dr. Sattar from pathoma usually draws a basement membrane and a layer of endothelial cells sitting on top +  


submitted by acerj(8),

Catalytic efficiency is defined as K_cat/K_M.

If you know what that is (I did not), then this problem is a simple division.

See here for more info (stop at the first line of the article for your own sanity): https://en.wikipedia.org/wiki/Specificity_constant

aakb  This problem may not solved just by knowing the above equation, if you're like me and get confused when you see lots of numbers and letters together. You need to use Kcat/Km to find the catalytic efficiency for both E487 and K487. Doing this, you'll see both A and B are true. Catalytic efficiency for K487 is 9.5/5600 = 0.002, which is decreased (A) and for e487 you get 180/37 = 4, making B true. Now how do you pick between A and B? The patient has disulfram-like reactions whenever he consumes alcohol since his acetylaldehyde dehydrogenase is slower (decreased catalytic efficiency), seen w/ K487, which the patient actually has if the question is read closely. So if you knew he had k487 from reading the confusing question stem it would have been easy to pick between A and B but if you're like me and can't seem to make those connections quickly, knowing something about ethanol metabolism helps. +1  
tekkenman101  The fastest way to answer this question is realizing the patient has the oriental variant, so all options regarding E can be excluded. Then you can see that the Km of the K-variant is much larger than the E-one. Larger Km = decreased binding = decreased turnover/catalytic efficiency. 30 seconds tops. +  


This lady had preterm premature rupture of membranes. She had a genital tract infection, which is a risk factor for PPROM.

From Uptodate: Many of the microorganisms that colonize the lower genital tract have the capacity to produce phospholipases, which can stimulate the production of prostaglandins and thereby lead to the onset of uterine contractions. In addition, the host's immune response to bacterial invasion of the endocervix and/or fetal membranes leads to the production of multiple inflammatory mediators that can cause localized weakening of the fetal membranes and result in PPROM.

alimd  did you pay fucking $30? +1  
cheesetouch  some institutions give students UpToDate access +3  
cbreland  I knew that misoprostol (PGE1) can be used for abortions by forcing uterine contractions, so I figured the answer had something to do with prostaglandins +5  
rthavranek  I knew prostaglandins increased uterine contraction, but I also thought PGE2 caused cervical ripening and since there was a closed cervix, I eliminated that choice. I had no idea what was going on so I just picked oxytocin since that would increase uterine tone without dilation, though my reasoning seems to be incorrect +2  
utap2001  Great, the above message deserve $30. +  
notyasupreme  I think also it said that the fetus releases oxytocin and steroids, which I guess is stupid wording that makes it not right. Anyways, fuck the curve on NBME 18 :) +3  
okokok1  if anyone didn't know what "PPROM" stood for it is: Preterm Premature Rupture Of Membranes" +2  
aakb  I was between the prostaglandin answer and stressed fetal production and release of oxytocin and the reason I didn't pick oxytocin was if the cervical os is closed (membranes ruptured 32 hrs ago and contractions been going on for 12) and there's no effacement, it didn't seem like that baby actually wanted to come out so I thought that's not what's happening here. Plus mom has a fever so inflamed maternal decidua seemed to fit. +  
helppls  If there was an increase in Pgs why did she not have a ripened cervix? +  


submitted by dentist(56),
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nfudo hist surpe lfsuue kboo no zamona oubat Baidu-dhirC ckche( otu eht kcsi ov)cre

llamastep1  Thank you for that +  
focus  hahahahaha. DEAD. +  
anjum  I endorse clicking that link +1  
azibird  Hahahahahahaha, that's a must click. Someone please buy it and let me know. +  
chediakhigashi  hahahaha +  
aakb  I don't know what I was expecting... +  


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Why is ti 9%9 dan not 5?%9 tI saedk rof onest of deiaess at slse tahn 9 aesyr fo ea.g 'mI elcrlay igssmni ogtehinsm reeh

cbrodo  @fulminant_life because the mean age is 3.8 with a standard deviation of 1.8. An age of onset of 9 years is nearly 3 standard deviations above the mean. Therefore, since we know +/- 2 SD covers 95% of the bell curve, it must be higher than that. The only option higher than 95% is 99%. +10  
charcot_bouchard  Yes 9.2 was the upper limit for 99% CI. I picked 95 first because i thought 2.5% would be out of this range. But changed ans because it should be less than 2.5% because 9.2 is so close to 9. Also they are asking CLOSEST to which of the following? +4  
aakb  I see what you are saying but you have to remember to add the things on the right side to include all the values under 9. So even if you go with the 2 standard deviations for 95%, youd have to add 2.5% that's on the left. which would be 97.5 and you know you would still add more on the left to get to 9 years of age so it would have to be closer to 99% than to 95%. hope that helps +  


submitted by airhead5(2),
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sDoe noeany onkw the assedei ethy era lnakgit oaut?b I was ntigikhn upslu hhwic esmak sense wthi teh rea,snw but i acn’t nfid nnhaigty no nrirteao remhbac of eey and croohid .lpsexu

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +5  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1  
aakb  woman of child bearing age + serositis + arthralgias/arthritis >=2 +  
aakb  kidney issues (main cause of death in sle) +  


submitted by airhead5(2),
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Deos eaoynn nwok hte aiedses eyth ear nkgital u?tabo I wsa intgkhni puusl hcwhi kmesa snese htwi het a,snerw ubt i actn’ ifdn yingntha on rorntiae mearchb of eye nad cordhio sulex.p

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +5  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1  
aakb  woman of child bearing age + serositis + arthralgias/arthritis >=2 +  
aakb  kidney issues (main cause of death in sle) +  


(FA 2020 Pg 214)

Acute inflammation + Vasodilation of vasculature and increased endothelial permeability. IL1, IL6, and TNFa are all involved in acute inflammation.

aakb  it literally says "Macrophages predominate in the late stages of acute inflammation (peak 2–3 days after onset)" this question is asking for 6 hrs after onset +6  


submitted by sh_nu(3),
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cbreland  I marked off Entamoeba because I thought it always caused bloody diarrhea... damn +2  
aakb  between Giardia and Entamoeba -- giardia doesn't invade intestinal wall but entamoeba does (per sketchy) +  
pfebo  Entamoeba: flask-shaped ulcers, Liver abscess +