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Welcome to bbr’s page.
Contributor score: 25

Comments ...

 +0  (nbme21#3)

Study: TV exposure ----> Disability

Sorting by disability/disease = Case-Control

BnB approach: contrOl (2nd to last letter is "O"--> "O"dds ratio)

(if we were sorting by exposure, that could be cohort, use RR)

 +0  (nbme21#34)

I'm still confused, where is this guys problem occuring? Is that he is unable to urinate, or that he has overflow incontinence? Getting lost in these nerves.

 +1  (nbme21#24)

Abscess: You'd see a hole (remember the air/fluid level on x ray?)

Hamartomas: Benign neoplasm of normal tissue (you'd see more Lung tissue, whatever this white stuff ain't normal red lung tissue). Infarct: No wedge?

Malignant lymphoma: (idk how to rule out)

Mesothelioma: Pleural plaques (this is intra-parenchymal)

Squamous cell Carcinoma: bingo. Centrally located.

 +0  (nbme21#18)

"Has it come as a surprise to you how hard parenting is? Many people feel that way." I don't think this validates their feelings, and it would make someone feel badly if you said "hey everyone deals with this shit". Also this answer focused on parenting, rather than the psychiatric concern (postpartum depression).

"im concerned about how bad you've been feeling lately". I think this does acknowledge their feelings, and does show that the physician is engaged. Yes, its blunt. But at its worst, its still more complete than the other ones.

Tough question based on you're reading style.

drdoom  if a disease or syndrome has known risk of suicide, and you fail to assess for it, that's negligence brotha (“if you suspect, you must protect!”) +

 +1  (nbme20#35)

damn, the spleen was so big I thought we were looking at the 2 kidneys. Found a new way to get things wrong.

lovebug  @bbr me too. lol +2

 +3  (nbme20#20)

Another way to think of this: She has a strong family history, so we are thinking she probably does indeed have this mutation (probably a True Positive). Our fear, would be we do the wrong test and aberrantly tell her that she is in the clear (False Negative). Having a high False Negative would be deleterious to this patient, and plugging this into a 2x2 table gives a low sensitivity (TP/ TP +FN).

trazobone  What a beautiful explanation THANK YOU +

Subcomments ...

submitted by monoloco(136),
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ynoAen eesl uiegrf tuo woh a rgnusoe sgte ish hadn seniid het eiantpt dpee hgonue to luvase eth tcpihae vnise fmro the VCI urigdn a MTROOPA?YLA fafBlse em.

mesoform  I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description. +4  
kimcharito  aorta is also behind of liver... +1  
medguru2295  I also didn't realize the surgeon's hands would so deep in he could touch the IVC on a Lappy....kinda eliminates the point of a Lappy.... +  
iwannabeadoctor2  "A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity." Exploratory laparOTOMY very different than LaparoSCOPY, which is what I think you may be confused about. One is a gaping hole from which you can observe everything, and the other uses tiny incisions and scopes. Even still, a hand port used during laparoscopy can allow for digital manipulation of organs as needed. +2  
bbr  I dont think the physician caused the avulsion, I think it was there already and he grazed the area. Causing it to fully avulse and break what ever clotting was going on. +  

submitted by ergogenic22(321),
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heS sah troom dna soseryn o.ymmstsp hsiT r/o btho dinks fo ip.elms Hre zrsesuei aer ton bdesicdre sa ci/cnciolotn ,emvnseotm dna ulindec posride of pameidir .uscnonsceoiss hTis lseur tuo nregdaielze /icocnlctnoi. ehreT is a oatpict-ls s,etat that ueslr out naese.cb

sAlo eth ilp aisncmgk is taiatccehsirrc fo it,musaomta hihcw is onfud in ompelcx tiaalpr uesreszi

bbr  Isn't is just motor symptoms, thats why its Partial? Maybe Im conflating things here. But complex partial decoded would be: Complex (lose consciousness) and partial (just 1 area of the brain, just motor). +6  
euchromatin69  simple seizure wont have altered cociousness....alt. concious = complex or generaliised +  
i_hate_it_here  What's the difference between a complex partial and an absence seizure? +  
kaf  Absence - they just gaze off as if they're daydreaming. +1  

submitted by cassdawg(1148),

She has left homomynous hemianopia, which can be due to lesion of the contralateral optic tract or as in this case lesion to the contralateral occipital lobe. It is not mentioned explicitly but this causes macular sparing. (FA2020 p542 gives the visual field defects)

bbr  tricky tricky +1  
pontiacfever  Left homonymous hemianopia w/o macular sparing can also occur due to damage to parietal and temporal lobes. But occipital lobe damage is more common. +  
i_hate_it_here  <-- +  
pakimd  macular sparing will only occur if there is an infarct of the posterior coronary artery supplying the occipital lobe. this is because the macular region of the visual cortex has a double blood supply from the middle cerebral artery and the posterior cerebral artery. this woman has breast cancer hence the mets are probably directly to the occipital lobe causing left homonymous hemianopia WITHOUT macular sparing. FA pg 542 look at the illustration: it says number 3 (left homonymous hemianopia WITHOUT macular sparing) and 6 (if PCA infarct when there is left homonymous hemianopia WITH macular sparing) +1  

submitted by angelaq11(67),
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I ahte sQ liek st.hi heyT amke me lfee lla knids fo en.sadss

bbr  It is sad, but we are on the front lines and can intervene. And so we should keep an eye out for these types of situations. As mad eye moody said....."constant vigilance!" +  

submitted by mousie(218),
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oareClh = clFae olsrnoeii ne/arLag = ngoLaelal moepun = NO epsnor ot sopner lyno by ahatiilonn fo cabireta otmnatceidan ra/mL eeytw = kict cct/lob iiaoniecMgne = ngshira rtpeaiorrys and rhotta stersneioc sviaal( or pi)s.t ernle,lyaG ti atske csleo (for e,amxple oughcing or gssnik)i ro lhtgney cttcona ot ersadp eetsh atcreiba /CMS(DFC R) = cikt btei

smc213  Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments. +6  
dentist  So, Cholera is also p2p but Mening is more likely? +1  
usmlecharserssss  in cholera people to water => water to people +  
qball  Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person. +  
drschmoctor  but the poop water comes from people so.... +1  
llamastep1  Respiratory dropplets is easier than fecal-oral tho +1  
lowyield  Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals +1  
peridot  I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis. +  
bbr  To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly). +  

submitted by tinydoc(233),
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uicpNeratho Pani eafrt krseot is alntrce stoP ksroet apin eSyormnd

ascude yb cotarenarllat itmchala oniessl

g.P 045 1FA9

chandlerbas  agreed! more specifically damage to the VPL +6  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +4  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +  

submitted by hungrybox(1035),
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eoms wongr eass:wnr

ek*sam neess cb/ lysatsloemb are orcuepsrrs ot loegcyatnur,s whhci eus PMO to thifg off innoeticsf

temmy  Hungrybox aka life saver +1  
hello  Thank you!!! +  
bbr  ....uh yeah im pretty sure we just call em "Auer Rods" now. Appreciate the answer tho! +7  

submitted by niboonsh(357),
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i htkni of isth sa elo ermfar joe on hsi ictinca mfra piincgk rtaska orscrt)(a tc(nacii sktesio)ar

bbr  haha good point +  

submitted by step1soon(48),
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ookL ta ewhre eht scups rae nitpiong → swuadrp feteohrre arioct. if csusp ewer adodrwwn → hent airltm lvvea ulowd eb het hgtir nswrea

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +  
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +3  

submitted by hayayah(1078),
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hTsi tp hsa na SAD ihwhc si a elh"o" eebtewn the AL and AR. iFnxig ti cludo agamde eht AV ld.nsueb

sahusema  the atrioventricular bundle is also called the bundle of his +3  
bbr  What if it had said "AV node", that's in the interaatrial septum as well, right? I'm wondering, that could be answer as well. (FA 2019 pg291) +  

submitted by hayayah(1078),
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rchettS or itnalido of eht rcexvi dna aaingv aer tnsrog utisiml orf ncixooyt rnece,oist edtamedi yb aeurln awshptya ledcla hte erFogsun fx.reel

:rteAcil wcmcroseec/o:oeingew/tefocnctces/.i-/inefwrperrcniedt/lthuxsups.s

readit  This is also why ob-gyn's will massage the uterus (which is part of the birth canal) after delivery. It's to get the body to release oxytocin and cause the uterus to contract (to prevent postpartum hemorrhage) +5  
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +1  
drzed  During pregnancy, oxytocin RECEPTORS are upregulated (by estrogen) as parturition approaches, but the ferugson reflex creates a positive feedback loop where the dilation of the cervix further releases more oxytocin. The inciting event that starts this feedback loop is the dilation of the cervix leading to a direct release of oxytocin, not the presence of more oxytocin receptors. +3  
bbr  To add, the positive feedback loop here is pretty elegant. Basically, it seems like the cervix doesnt want anything in it. When its stretched --> oxytocin --> contract uterus --> push baby --> more stretch at cervix---> more oxytocin (and forward). The positive feedback loop aspect is that oxytocin-based contractions cause more dilation of the cervix (as the baby moves into it!). +1  

submitted by meryen13(18),

interferon gamma will do a few things in body--> 1 activate macrophages to kill! or to become epitheliod histiocyte to wall off infections. 2- it will increase the mac molecules on the surface of the cells. 3. it inhibits differentiation of t cell to th2 cell because th2 has anti inflammatory (il-10 secretion) and eosinophilic activation function. 4. also activated the nk cells to start killing!

bbr  and (just for completeness), promotes Th1 +  
ege  what does "Mac" stand for? "it will increase the mac molecules of the surface of the cells." Thanks! +  
saqeer  mac= membrane attack complex +1  

submitted by pharmtomed(2),

Could anyone help me on why this couldn't be C (facial portion of the homonculus in the primary motor cortex)? It explicitly mentions motor issues with the face - not just speech. I understand why it would be Broca's - that's what I put originally. But the last sentence mentioning motor disruption caused me to change my answer. Thanks.

jaeyphf  I didn't even think about the motor part during the question, but it might be related to the homonculus (FA 2020 pg 502). Motor and sensory areas of the lower face generally fall towards the lower half of the brain. Answers B/C/D would probably show some hand or arm involvement. +1  
bbr  I know this isnt a great answer, but I was assuming that they wanted us to "play the game" and decide broca/wernicke. It seems set up for us answering that type of question. Going off buzzwords like "fluency", "phrase length", "comphrension". +1  

submitted by smpate(15),
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oT teg htis neo irt,gh oyu oulwd avhe ot nwko taht oen taandsrd nedviiato wyaa orfm hte emna on a blel ervcu is 4%3 on riteeh ied.s trAef hatt it owdul be nrtaheo 5%.13 (tbu igozirnmme ahtt si owl ldyie). ngokLoi at hte cpfdeiise age ,gpuor ew watn to kwon woh mcuh is rgetear ahtn teh mane pusl 1 adtardsn idt.nvieao eerheor,Tf 50% (hte nm)ea upls %34 1( adrdastn evtaodini) is 4.%8 ehT ster si 4-0081 = .16

I nfduo tihs maeig neolni for rlctiay


bbr  Is the plus/minus sumbol always used for standard deviation? Or can it be used for confidence interval. +  

submitted by hayayah(1078),
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tsMo orecinitsrt enmyezs bdin adn.isemprol

So ohtb 5G'CCG ro 3'GCCG lduow veha eneb cetpbclaae in htsi .saocerin

meningitis  Yes, correct. The 5'GGCC option could cause some confusion. +  
guillo12  I really don't understand the question nor the answer. Can someone explain it for dummies like me? +10  
whossayin  yes please.. I'm with guillo12 on this +  
sugaplum  @guillo12 @whossayin questions says you've created a new cut site, 1. look at the region on the sick vs healthy. The C to G is the change 2. Write out the sick "CCGG" from 5'3'- you could write out the whole thing, but the answer only has 4 letters, so being lazy here 3. write under it, its complement, the dna base pair. So "GGCC" 4. remember both strands are going in opposite directions when you write them out on top of each other. 5. So the bottom strand actually reads 5' CCGG 3' so that is the answer I hope that clears it up +51  
shirafune  To add to the palindrome part, many restriction endonucleases actually function as dimers. Each individual subunit usually has a nickase, so to create a double-stranded break in DNA, they must bind a palindrome so that each enzymatic domain creates a single-stranded break (thus a double-stranded break). +1  
alimd  Why do we start from CCGG? Why not CGGG or TACC? +2  
alimd  Why do we start from CCGG? Why not CGGG or TACC? +1  
ssbhatti  I think its due to the palindrome requirement? +  
bbr  Maybe I'm missing a part here, but the substrate that the enzyme will bind to will be the DNA. I went with the line that was from the questions stem, as it is the mtuated DNA will be recognized by the restriction enzyme. I didnt see the need to convert it into base pairing. Let me know what you guys think. +1  
uloveboobs  @bbr I agree. I'm definitely not an expert in these lab tests, but the question asks "substrate specificity." I was thinking that it would recognize the abnormal DNA; nothing to do with RNA. I didn't know about the palindromic preference of restriction enzymes, but I don't think there's any need to figure out base-pairing and whatnot here. (At least for this question it didn't work out that way!) +  
spaceboy98  sugaplum, I'd give you an award if this was Reddit +5  

submitted by monoloco(136),
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shiT si a hayoppasli fo eht ppneeauirellroto .anmbeerm hTe tsug inateehr niot hte x,taohr aluuyls on eth letf eids, dna lrseut in shpalyiapo fo teh nugsl ee(bsuac etr'hey riybolhr pessdo)

johnthurtjr  Usually on the left because the liver prevents herniation through the right hemidiaphragm +9  
asdfghjkl  aka congenital diaphragmatic hernia +3  
pg32  What's weird to me is that if you usually see air in the intestines on x-ray when they are in the abdomen, why is there no air in the thorax in CDH? The intestines should still have air in them, right? Also, what is filling the abdomen that causes it to appear grayed-out in CDH? +  
drzed  @pg32 You can actually see a gastric bubble if you squint hard enough. Look at where the NG tube is placed; there is a radiolucency to the patient's right of the NG tube which is most likely the stomach. It probably then is radioopaque distally due to the pyloric sphincter, and air having a tendency to rise. +2  
bbr  Any idea what "absence of bowel gas in the abdomen" is referring to? +  
rkdang  my interpretation was absence of bowel gas in abdomen --> the bowel is not in the abdomen --> incomplete formation of pleuroperitoneal membrane bowel gas is a normal finding that you often see on x rays of the abdomen in a normal patient +1  
seba0039  @rkdang is it also abnormal that you cannot see any air in the lungs? This threw me off when I was trying to read the radiograph. +  

Anyone find a problem with the stem? Seems to me that it doesn't help to state "however, his father's sister and children are unaffected". We already know the mutation runs in the mother's side, right? It seems like that statement doesn't discard nor confirm any inheritance pattern. Why would we care about the patient's father's side?

bbr  It just further helps to tell us this is mitochondrial. I guess they are doing us a favor. +