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Welcome to assoplasty’s page.
Contributor score: 89


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 +5  (nbme21#23)
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orsctniiVoasncto essrcdaee ooldb flwo nad tsuh sdceearse stoidcrhtya r.serepsu eemSs tunorec itiievutn but I dah to kolo htsi up fraet I otg ti n,worg t.oo


 +23  (nbme21#29)
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tasF rea eetckogin eepc(tx ddo inach ,)AF so tehy udrcoep nektose for nyegre rtioduncpo cy-AlA)Coe(t tarhre hnat clg.oseu If the nsqueito edksa htaw eht pmiyrra rsceou fo geeynr rptoiduonc swa, it oduwl litls eb egognlcy n(da ton ,)tekseno eecsuba isht si nhwiti 24 ursho. Hworvee earft 24 rhsou het nraews ducol be nkteeo odi.bes gasRlsere,d het oiqtuesn slyicapcelif adsi the pt adh a urems losecgu fo 100, gtnnidciai ttha we era oikgnlo for egnthomis atth sevdiopr a brsausett orf sesig.noculoenge

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2() Odd ahinc sAF rae salo ,lgcogniecu ubt raetcsi dcai vd(eopdir in eht esawnr io)ehcc ’stni odd ahni,c so it is lony eiokncegt adn can eb drlue t.uo

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hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +4
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +4
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1
almondbreeze  @ toxoplasmabartonella think you are right +

 +61  (nbme21#31)
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I nihtk the ntcocep eert’hy getntis si teh dnerseica TGB vlsele ni enrngypac, dan otn usjt othirrmdysyepih in re.lnega

nheW nirceesng rfo yi/eopshidty,phyorrhm THS sevlle era LWASYA arelielteryfpn hcekced eubacse hyte rea eomr vtsnieeis to meintu eefnfidersc ni 3.T/T4 Ofnte eimts TSH lleesv acn emdsntoraet a hnacge evne newh T3/4T elvles era ni the aliiblnccus ae.rng eTh ylon pcixeeton to itsh uwold be in preanyngc (and I uessg meaby eirlv ea?liurf I toudb yhet oudlw ksa hist u.hgtho) hgiH gsoreten leevls pnretves teh ilerv rmfo rgbianke wndo ,BGT glieadn ot isenedarc TGB slevle in eth uresm. hTsi sndib ot rfee T4, indearecgs het muonat of lblaaveai eefr 4.T sA a pnctaeosromy mas,ecnmih STH evllse era erlnsitanty iraedscne nda eth RATE of 4T niodtuocrp si einsedcra to eselpinrh seebilan refe 4T sele.vl eerHowv hte TALOT mtnauo fo T4 is edn.rsacei

hTe nieuqots si gaksni woh to rofminc ydptihhrosmiery in a gratpenn mnaow t-;&g- ouy ende to cchek FEER T4 elelvs cbseeua( teyh oulshd eb nraoml ued ot tapsroomynce so.preens) You tconna cechk TSH u(lyalus eveeldta ni gcaenyrpn to petsmaocne for necdaeirs ,)GBT nda yuo atnocn echkc total 4T lvesle lwil( eb adene.i)csr uYo otg eth ewnras ighrt therei wya but I hktni htsi si a teeirndff sagonnier rotwh sioien,dgrcn asebcue htye nca ask shti pconcet in hotre tncxeost fo rrnpysmt-sighoeee, and if yeht tilsde STH”“ as an asenwr hioecc ttha wduol be tcrne.iroc

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +5
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +2
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +1
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +1
lovebug  Amazing answer! THX +




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