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 +1  (nbme22#2)

Shouldn't the treatment for hyperTG be a fibrates? Which would indicate the answer to be increasing HDL (FA.2017 p306)

I see decreasing VLDL as a function of niacin, which serves to decrease hepatic VLDL..

keycompany  Fibrates inhibit VLDL secretion (by inhibiting 7-a Hydroxylase) and they increase HDL. However, this patient has chronic pancreatitis, which decreases enzymes that allow for fat absorption. Because a large portion of HDL is synthesized in enterocytes from newly absorbed fat, HDL content is unlikely to increase in patients with chronic pancreatitis from any of the lipid-lowering agents. Hope this helps!
mr_haib  fibrates cause decreased VLDL as well as niacin. They increase the activity of LpL by activating PPARa causing increase catabolism of VLDL and chylomicrons. since VLDL are rich in triglycerides, this is how they decrease triglycerides.
lordxrequiem  but fibrates also decrease bile acid production by inhibiting 7alpha hydroxylase, which is how they cause increased cholesterol gallstones.

 +2  (nbme22#27)

emphysema leads to CO2 trapping leading to increase paCO2 in the blood, which gives you a respiratory acidosis Proper renal compensation will increase bicard reabs and decrease excretion- giving you increased bicarb in the blood

meningitis  Increased blood HCO3 could have easily been interpreted as increased blood pH aswell. FOllowing your explanation, since the pt had acidosis, the increased HCO3 will just make it a normal pH. Another way to think of the question is: if there is decreased exhalation due to COPD --> increased CO2 --> increased CO2 transported in blood by entering the RBC's with Carbonic Anhydrase and HCO3 is released into blood stream. So increased CO2 -> increased HCO3 seeing as this type of CO2 transport is 70% of total CO2 content in blood.

 +6  (nbme22#32)

Of these options available, Schwann cells would be the only cells present in the PNS. Astrocytes, microglia and oligos are all CNS cells Satellite cells are in the muscle and serve to aid in muscle repair and regeneration

yb_26  Thats myosatellite cells. Satellite cells are also glial cells that form around damaged nerve cells and lie close to neuron bodies in the CNS

 +1  (nbme22#14)

Glucose is co-transported into enterocytes of SI via sodium


 +1  (nbme22#25)

Wound healing inflammatory for up til 3 days (clots, PMNs, macros) Proliferative 3days til weeks- granulation tissue, new vessels, new epithelium, contraction (repair and regeneration) Remodel 1wk til 6m- replace collagen III with I, increase strength (up to 60-70% original strength possible)


 +0  (nbme22#21)

A little math here.. pH is low --> acidosis pCO2 is high --> respiratory Normal compensation should be roughly a 1 (acute) to 4(chronic) increase in bicarb per every 10 increase in pCO2.. Its lower here, so clearly not compensated and indicated additional drop in bicard --> add on metab acidosis

hello  Hm, what do you mean by "normal compensation?" Are you talking about the bicarb should be increased? Are you saying that a normal compensation would be metabolic alkalosis? Would metabolic alkalosis be an increase in bicarb?
kateinwonderland  How do you know which one has bigger contribution in this situation where there's increased CO2 and decreased HCO-, both indicating acidosis??
yb_26  normal kidney compensation would be an increase in bicarb reabsorption => increased serum bicarb. This pt has low serum bicarb => concurrent metabolic acidosis

 +1  (nbme22#17)

Phase 1- small # of healthy people. Is the drug safe? Phase 2- smell # with disease. Does it work? Phase 3- large #, some with new drug, some with old. Is is good or better? Phase 4- Postmarket watch. Can it stay?


 +1  (nbme22#47)

Down syndrome 2nd trimester screen (usually around 16-18wks) shows decreased AFP, estriol and increased hCG and inhibin A.

Of trisomy 13/18/21, Down Syndrome is the only to have an eleveted hCG


 +1  (nbme22#50)

Hypopigmented lesions refer to Ash-leaf spots, CNS lesions likely hamartomas . TS also associated with seizures.

fcambridge  How is Tuberous Sclerosis the most likely given that it is an AD disorder and there is no family history of "seizure disorder or major medical illnesses"?
d_holles  @fcambridge variable expressivity of TSC allows for many different phenotypes.




Subcomments ...

submitted by mattnatomy(21),

I believe they're referring to compression of branches of the Ilioinguinal Nerve (possibly the Anterior Scrotal Nerves.

Source: https://en.wikipedia.org/wiki/Anterior_scrotal_nerves

armymed88  Ilioingual covers part of the medial thigh, base of penis and anterior scrotum Posterior scrotal nerves are a branch of pudendal and cover said area Doral nerves cover the dorsum of the penis which are also from the pudendal +1  
meningitis  I thought it was the Genitofemoral nerve because the genital branch supplies the cremaster and scrotal skin, but I looked it up and: The genital branch passes through the *deep inguinal ring* and enters the inguinal canal; also, Ilioinguinal wraps around the spermatic cord just like the question stem says. +1  
jean_young2019  "The structures which pass through the canals differ between males and females: in males: the spermatic cord[6] and its coverings + the ilioinguinal nerve." from wiki "Inguinal canal", which means the ilioinguinal nerve lies on the external surface of spermatic cord. https://en.wikipedia.org/wiki/Inguinal_canal The contents of spermatic cord includes, "nerve to cremaster (genital branch of the genitofemoral nerve) and testicular nerves (sympathetic nerves). It is worth noting that the ilio-inguinal nerve is not actually located inside the spermatic cord, but runs along the outside of it, in the inguinal canal." from wiki spermatic cord. https://en.wikipedia.org/wiki/Spermatic_cord +  


submitted by moloko270(30),

this is Wallenberg syndrome - stroke caused by obstruction of PICA - so thats why we get symptoms of dysphagia, hoarseness, absent gag reflex (p. 502 FA)

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already +  
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this. +1  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +