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Welcome to amphotericin’s page.
Contributor score: 8

Comments ...

 +1  (nbme21#6)

Why would you not check cortisol, if you're worried for MEN1? I assumed high calcium was implied based on the renal stones

 +2  (nbme22#39)

I put constipation because I thought the medication being described might be CCB: can someone explain why nitrates over CCB?

seracen  Wouldn't nitrates be a faster acting drug here? That was my take-away anyway. One is more acute, the other for long term maintenance. +4
suckitnbme  I also believe it's because CCBs have minimal effect on venous beds and would not cause a significant decrease on preload. +2
beto  decrease of cardiac preload is another word of Venodilation, so Nitrates primarly venodilators. CCB dilate arteria more than veins +
zevvyt  also, verapamil is the one that causes constipation. But Verampamil is non-dyhydropiridine, so it works more on the heart than the vessels +2

 +0  (nbme22#16)

how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing

suckitnbme  You should be able to rule it out by the normal Thrombin time. Abnormal fibrinogen would have increased PT/PTT but also increased Thrombin time because the entire pathway is compromised by the inability of fibrinogen to be cleaved to functioning fibrin. +4

 +3  (nbme22#46)

la belle indifference suggests conversion disorder. also not explained by physical exam

 +1  (nbme22#27)

I ruled out Paget's because Paget's is usually localized, per FA, Pathoma, B&B. Although this patient definitely fits the demographic picture, prostate cancer is definitely not the only cancer that can metastasize to the bones. Because these are lytic lesions, it's probably some other cancer that's spread to the bones

medguru2295  Possibly Multiple Myeloma. That is classic for an older person with back pain and lytic lesions in the back. +
asharm10  osteolytic- multiple myeloma, Osteoblastic- Prostate; dont think beyond this for this exam, i have never seen a question in NBME or uworld they tried to fool us off on this concept so far. +1
euchromatin69  u world 341 same concept +
skuutnasty  I'd like to reiterate what's stated above... dx NOT MM in this question because MM is PRIMARY not METASTATIC @ bone (answer reads: metastatic carcinoma) <3 +

 +1  (nbme24#2)

How does OSA lead to peripheral edema and loud S2?

futuredoc  Hypoxia leads to pulmonary vasoconstriction and therefore pulmonary HTN. This can lead to the peripheral edema. Furthermore pulmonary HTN can present with a loud S2. +6

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