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Comments ...

 +0  (nbme24#29)

Pathoma Ch 1, of 3.

Slowly developing ischemia (ie atherosclerosis) leads to atrophy whereas, acute ischemia (ie renal artery embolus) results in injury.


 +0  (nbme23#29)

FAB GUT

Fructose is to Aldolase B as Galactose is to Uridyl Transferase. Leads to phosphate depletion.

Fructokinase def and Galactokinase def are kinder.

FA 2018 pg 80


 +0  (nbme23#48)

I came here just to read the comments

MJ at the movie theaters eating popcorn meme


 +0  (nbme23#8)

Labetalol = "alpha"-"beta"-lol

From Sketchy

Andrew Yang for president. is it 50 characters yet?


 +0  (nbme22#7)

Organic ED: normal libido, decreased nocturnal erections

Psychogenic ED: decreased libido, normal nocturnal erections

Got it.


 +0  (nbme22#7)

Nocturnal penile tumescence measurement (phallography) is a test that measures spontaneous nightly erections in erectile dysfunction (primarily performed in a sleep laboratory). It's useful for differentiating between organic from psychogenic erectile dysfunction.

Vignette describes a possibly depressed patient => psychogenic erectile dysfunction. Since it is not an organic cause of ED, nocturnal erections would be normal. Organic etiologies of ED include neurogenic or vascular.

Libido part confuses me here. Libido means sexual desire or appetite. I was thinking since he's coming in to get ED checked, it indicates he's appetite for sex is enough that it made him get it check. So libido should be normal. Any help?


 +2  (nbme22#45)

https://www.aafp.org/afp/2004/0315/p1530.html

^^^a beautiful table that shows affects on electrolyte levels in laxatives vs diuretics vs vomiting.

According to the table, its hard to tell diuretic vs laxative abuse by serum electrolytes alone. The urine electrolytes would markedly differ in that diuretic will have increased Na/K/Cl and laxatives would follow the opposite trend (decreased). However, with the fact that BUN is increasing and that we can tell there's a metabolic alkalosis with respiratory acidosis compensation, we can bet on diuretics over laxatives.

EXTRA INFO from the table in the link above:

Vomiting: [K dec] [Cl dec] [HCO3 inc] [pH inc]
Laxatives: [K dec] [Cl inc or dec] [HCO3 dec or inc] [pH dec or inc]
Diuretics: [K dec] [Cl dec] [HCO3 inc] [pH inc]

In urine for vomiting, Na/K/Cl will all be decreased In urine for laxative abuse, Na/K will be decreased. Cl is normal or decreased. In urine for diuretic abuse: Na/K/Cl will all be increased

(Andrew Yang for President)


 +0  (nbme22#38)

Can someone correct my reasoning here:

I was thinking positive airway pressure will increase alveolar ventilation and decrease hypoxia induced pulmonary vasoconstriction. Thus, RV after load would decrease => more preload to LV and more cardiac output. Then wouldn't BP decrease?

Any help is appreciated. Thanks.


 +0  (nbme22#35)

Picture shows dilated ureter and renal pelvis

Chronic PYELOnephritis (pyelo = pelvis) <= recurrent episodes of Acute Pyelonephritis <= UTI

This patient likely has vesicoureteral reflex leading to recurrent UTIs.


 +0  (nbme22#35)

Picture shows dilated ureter and renal pelvis.

Chronic PYELOnephritis (pyelo = pelvis) <= recurrent episodes of Acute Pyelonephritis <= UTI

This patient likely has vesicoureteral reflex leading to recurrent UTIs.


 +0  (nbme22#44)

Superior hemorrhoids blood, Inferior hemorrhoids thrombos. Always remember that.

-Goljan





Subcomments ...

submitted by nwinkelmann(72),

Per pathologyonlines.com

Leukoplakia = risk factors include male gender, 40-70 years old, smoking, White patch or plaque, 5 mm or more, on oral mucous membranes that cannot be removed by scraping, not due to another disease entity such as lichen planus or candidiasis and not reversed by removal of irritants and lesion must be considered precancerous until proven otherwise. Premalignant lesion transformation would lead to invasion of the submucosa.

Micro = Varies histologically from acanthosis, hyperkeratosis, dysplasia or carcinoma in situ (associated with lymphocytes and macrophages). This article explains it much better and has pictures: https://emedicine.medscape.com/article/1840467-overview#a6. Based on this article and the pictures, I'd say the histo slide in the question is at least moderate squamous dysplasia.

Hairy Leukoplakia = White, confluent patches of fluffy (hairy) mucosa, bilateral, along lateral tongue, and associated with HIV+ patients (AIDS may appear within 2 - 3 years) but actually due to EBV infection

Histo = Hyperkeratotic oral mucosa due to piling of keratotic squamous epithelium, Cowdry type A intranuclear inclusions, Balloon cells with margination of chromatin (nuclear beading); EBV present in clear cells of spinous layer, variable koilocytosis, superimposed Candida infection, without inflammatory response.

From pictures (and this video: https://youtu.be/Shx61qKuIv8 timestamp 1:22), hairy leukoplakia has a lightly stained band of cells "ballon cells" in the stratum spinosum which is where the EBV lives. It looks much different than the histo slide shown in the question.

yb_26  great explanation, thanks for sharing! +  
shriya goyal  great explanation thanks +  
cathartic_medstu  on point +  


submitted by oznefu(7),

I’m having trouble understanding why this is a better choice than Paget disease, especially with the increased ALP?

zelderonmorningstar  Paget’s would also show some sclerosis. +1  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +1  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +5  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +2  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +1