to snoo-finity ... and beyond!
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Just to add to this; a-thal is due to a deletion. While b-thal is due to a mutation. If they had a b-thal there would be target cells. a-thal just presents as microcytic & hypochromic.
hydrocholorothiazide is DOC for Nephrogenic Diabetes insipidus because it paradoxically causes an increase in BP by increasing sodium absorption and thus water absorption, Pathoma explains this nicely.
Also you shouldn't have chosen Desmopressin because upon fasting (fluid restriction) ADH is increased meaning ADH is being released Centrally but is not working in the kidneys at the V2 receptors of the epithelial renal cells at Collecting duct.
On that note, Amiloride is used for Lithium induced nephrogenic DI.
Had the same reasoning
I get that it's not significant, but why is it 0.05<p<1 and not p>1.0
nvm, it's can't be greater than 1 because then it would have a negative% confidence interval which cannot happen (Think if p>0.05 means at least 95% within confidence interval)
p=0.05 means theres 5% chance null hypothesis is true. p=1 means theres 100% chance null hypothesis is true. >1 means >100% chance which isnt possible.
p is a probability, so can't be greater than 1
Can anyone explain why the serum lactate dehydrogenase (LDH) level was elevated?
Vitamin E is an antioxidant. Thus a deficiency can cause hemolytic anemia.
@karljeon Intravascular hemolysis = LDH release from RBCs
Im pretty sure so is strept pneumoniae
COPD is also exacerbated by Viral infection: Rhinovirus, influenza, parainfluenza; and Bacterial infection: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus.
however, the questions gives a hint that it may be legionella = "weekend retreat" which may be associated with this infection
From FA 2017 pg 139: Legionnaires’ disease—severe pneumonia (often unilateral and lobar A ), fever, GI and CNS symptoms. Common in smokers and in **chronic lung disease.**
I also believe that the other attendees showed signs of pontiac fever, which is another hint they tried to get at.
i did it wrong and chose influenza virus since it is most common infection in COPD but the clue in the Question is that the other attendee didnt get sick since in legionella there is no person to person transmission
but in Uworld s. pneumo is one of the most common bacterial exacerbation of COPD legionella wasn't even mentioned. How do we rule out s. pneumo ?
maybe because in children s.pneumo causes otitis media?
Another hint made in the Q stem is the location being rural Pennsylvania.... Legionnaires disease was first discovered by the outbreak in 1976 at a convention held in Philadelphia, Pennsylvania. Not sure why I know this fact...
Biggest hint towards legionella to me was that they all were at a residence hall... i.e. where there'd be air conditioners and such.
You know it’s Noro because people are vaccinated against Rota at 2,4,6 months.
@strugglebus: I didn't know about the vaccine schedule. Thanks!
As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours.
@Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong
its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus.
***after the initial outbreak
for me this was a discart qx:
1.Giardia lamblia not showed steatorrhea and it needs medication to go away.
2. Rotavirus normally in unvaccinated kids.
3. Shiguella VERY inflammatory stool test do not show anything
4.S areus is very FAST 2-6 hr after eat the contaminated food.
Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination.
+ Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause.
Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture.
I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/
I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_-
The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women);
hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies)
Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names.
Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls.
*sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries.
These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN!
Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years)
If it was the consequence, the presentation is still not classical! -_-
Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches
If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld.