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In a pancreatic B cell glucose enters via GLUT 2 and enters glycolysis. This causes the increased concentration of ATP in the cell causes the closure of ATP sensitive K+ channels. When this happens the cells becomes depolarized allowing Voltage gated Ca2+ channels to be open. The Ca2+ allows for exocytosis of insulin into the blood vessel.

Hence the answer here... Fusion of an intracellular vesicle with the plasma membrane.

pg 324 FA 2019 has the image

brotherimodu  Woah. Who knew the body was so complicated? +  

submitted by soscrying(4),

at my uni, we learnt that at lower GFR, loop diuretics still work. That's why you should use them in renal failure. Thiazides would not work with a GFR of <30.

qball  Dang, you actually learned something at your school? Lucky. +1  
lowyield  At our med school they teach us that Thiazide anti-HTN function is primarily from it's direct effects on vasculature rather than it's diuretic effects. Somehow directly affects the vasculature which is not well understood but this is linked to why Thiazides have greater efficacy in African American Populations. That's kinda why i figured it wouldn't be the best diuretic in this case. +  
brotherimodu  lowyield but interesting +  

yb_26  @at0xibolic, I think you won this competition on finding better picture lol thanks +3  
drschmoctor  Those may be better, but this is the BEST. http://bitly.com/98K8eH +2  
brotherimodu  god damnit +  
jesusisking  Not again (´∀`) +  

submitted by beeip(90),

Can anyone explain what they're getting at here? How can bethanechol be indicated and contraindicated?

sniperx3  I think it's because Bethanechol acts on M3 receptors which can treat her urinary problems but it might exacerbate her asthma symptoms since there are M3 receptors on the lungs. +20  
suckitnbme  I definitely had to read this question multiple times to understand it. +  
brotherimodu  I read it like 6 times and gave up +  

submitted by youssefa(58),

I mean why would a testicle turn around itself when someone's sleeping. This typically occurs after sports/ bicycle riding etc..

brotherimodu  People can move in their sleep? +  

submitted by usmleuser007(220),

Neuroregeneration in the peripheral nervous system (PNS) occurs to a significant degree.[5][6] After an injury to the axon, peripheral neurons activate a variety of signaling pathways which turn on pro-growth genes, leading to reformation of a functional growth cone and regeneration. The growth of these axons is also governed by chemotactic factors secreted from Schwann cells. Injury to the peripheral nervous system immediately elicits the migration of phagocytes, Schwann cells, and macrophages to the lesion site in order to clear away debris such as damaged tissue which is inhibitory to regeneration. When a nerve axon is severed, the end still attached to the cell body is labeled the proximal segment, while the other end is called the distal segment. After injury, the proximal end swells and experiences some retrograde degeneration, but once the debris is cleared, it begins to sprout axons and the presence of growth cones can be detected. The proximal axons are able to regrow as long as the cell body is intact, and they have made contact with the Schwann cells in the endoneurial channel or tube. Human axon growth rates can reach 2 mm/day in small nerves and 5 mm/day in large nerves.[4] The distal segment, however, experiences Wallerian degeneration within hours of the injury; the axons and myelin degenerate, but the endoneurium remains. In the later stages of regeneration the remaining endoneurial tube directs axon growth back to the correct targets. During Wallerian degeneration, Schwann cells grow in ordered columns along the endoneurial tube, creating a band of Büngner (boB) that protects and preserves the endoneurial channel. Also, macrophages and Schwann cells release neurotrophic factors that enhance re-growth.


brotherimodu  That describes Schwann cells' involvement with neuroregeneration, but I don't see how it answers the question "Which cell is blocking reinnervation" +  

submitted by cr(1),

why not C?. It´s not supose that it improve the efectivity of insulin?

yb_26  thiazolidinediones (pioglitazone) increase insulin sensitivity (in muscles and liver) through activation of peroxisome proliferator-activated receptor-gamma (PPAR) I think they are asking about primarily mechanism of action, that's why it is E +  
cienfuegos  UW explanation regarding the genes upregulated 1. GLUT4: insulin responsive on adipocytes/skeletal increases G uptake 2. adiponectin: cytokine secreted by adipocytes increases # of insulin responsive adipocytes and stims FA oxidation 3. PPAR family also plays significant role in pathogenesis of metabolic syndrome +1  
poisonivy  Also, I think the word uptake shouldn't be right when speaking about insulin, it does increase insulin sensitivity and therefore glucose uptake +3  
brotherimodu  @poisonivy That's why I didn't choose C and went with E since it was more specific +  

submitted by hungrybox(433),

when diff single strand repair mechanisms are used:

  • repair newly synthesized strand: mismatch repair (Lynch syndrome)
  • repair pyrimidine dimers caused by dat UV exposure: nucleotide excision repair (Xeroderma pigmentosum)
  • repair spontaneous/toxic alteration: base excision repair
meningitis  Brca: recombinant repair +  
usmlecrashersssss  also BLM gene bloom syndrome +  
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +  

am i the only one who chose mesothelioma? didnt that look like a pleural plaque posteriorly to anyone?

brotherimodu  That's what I thought too. +  

submitted by hayayah(603),

Prostatitis is characterized by dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate.

Acute bacterial prostatitis—in older men most common bacterium is E. coli.

ergogenic22  In young men it could be chlamydia but the question stem makes no mention of sexual activity, so it is e. coli +6  
charcot_bouchard  First this guy isnt older! He may incite Daddy issue but not older. At this age people tend to be more monogamous so E Coli the more likely answer. But again cont NBME 20 trend this one was pretty vague too. +1  
monkey  They classify at 35 year old (<35 = Chlamydia or Neisseria and > 35 = E.coli) +1  
mbourne  I put Pseudomonas, as that is a cause of prostatitis in older men, but it is less common than E. coli. Just keep that in mind, if E. coli wasn't an answer choice, the answer should have been Pseudomonas. If he was a younger male, then Chlamydia would have been acceptable. +1  
brotherimodu  @mbourne I think Pseudomonas is the more common etiology for acute prostatitis in the elderly (>65ish for exams), whereas E.Coli is the more common etiology in adults 35-64yo +