If its intrinsic defect HTF urinalysis is normal with no casts?
Its not Fire ant. because if it was he would notice instantly. Intense pain followed by intense pruritus.
Hypereosinophilic syndrome is a disease characterized by a persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood for at least six months without any recognizable cause, with involvement of either the heart, nervous system, or bone marrow.[2]
HES is a diagnosis of exclusion
Adrenal Insuff - No. Normal K & HCO3. Also normal BP.
Adverser effect of FQ - It doesn't cause anything like this. SIADH causing drugs are SSRI, Cabamazepam, Cyclophosphamide
DI - Would cause mild hypernatremia
SIADH - (the one I chose,,,dk what kind of drug I was on) is also ruled out for one there's no indication of that duh. second the Uosm < Sosm here. 200 vs (2x122 i.e 244+ )
Ascites & adnexal mass >> Follow adnexal mass workup Even if you follow ascites protocol - ans is diagnostic paracentesis, not therapeutic.
So here you do USG + CA 125 There can be 4 combination -
High Risk USG + Elevated CA125. Worst scene >>Imaging with CT/MRI Exploratory LAP
High Risk USG + Normal CA125. intermediate scene. Also do same as prev. We trust USG more.
Low Risk USG + Elevated CA125. Intermediate scene. But here do only imaging. CA 125 is less trustable.
Low Risk USG feature + Normal CA 125. Best scene. U do further imaging and CA 125 serially to monitor.
Cricothyrotomy -
Indications: 'cannot-intubate-cannot-ventilate' (CICV) scenario (if orotracheal intubation has failed or is contraindicated)
Angioedema
Foreign body in upper airway
Severe oropharyngeal/nasal bleeding
Severe maxillofacial trauma
First, I guess everyone was correct to diagnose it was a TOF case with VSD.
All murmur follows V shape relation to flow and intensity. TOo much flow (for eg, Such a big VSD that equalize pressure) - Weak murmur.
Too little flow (like severe stenosis, right after birth hish pulmonary resistance) - Weak murmur.
If you decide ur murmur is VSD ans option comes down to A & C. C is not realistic.
They mentioned costophrenic angle to tip you over to empyema rather than abscess. Also abscess would cause productive cough. this kid has nonproductive one
Related note - If this was a post mens woman she would need a USG & CA-125 measurement next.
Indication for bariatric surgery:
BMI ≥40 kg/m2. BMI ≥35 kg/m2 with serious comorbidity (eg, T2DM, hypertension, OSA). BMI ≥30 kg/m2 with resistant T2DM or metabolic syndrome.
This lady needs to cut her stomach as well as all the friends and family around her
It never occured to me this guy can have HTN. All i thought we have a Marshal Eriksen in stem
This one was also confusing...i choose Influ because i guess no matter what in the history (untold) this one must be taken in future. And as said in prev comment Yes maintainance is the key...bcz only this one is need to be repeated year after year
She is obese. No 1 risk factor for OA which affects hip joint. So lose some weight
Deficiency - Stimulation test Excess - Supresssion Test
Basis of these are to inc sensitivity as they are screening test.
BDX, Naloxene all are self explanatory.
Aspirin cant be given due to bleeding risk.
Pain is moderate to severe. there goes ibuprofen...they are for mild to mod.
Fentanyl to dangerous. transcutaneous patch means long duration of action which is needed for cancer pain that wont go away ever.
so u give morphine....patient controlled.
I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue?
If you want to know about the unknown - Methaqualone is a sedative that increases the activity of the GABA receptors in the brain and nervous system, similarly to benzodiazepines and barbiturates. When GABA activity is increased, blood pressure drops and breathing and pulse rates slow, leading to a state of deep relaxation. These properties explain why methaqualone was originally mainly prescribed for insomnia An overdose can lead to nervous system shutdown, coma and death.[4] Additional effects are delirium, convulsions, hypertonia, hyperreflexia, vomiting, kidney failure, coma, and death through cardiac or respiratory arrest. It resembles barbiturate poisoning, but with increased motor difficulties and a lower incidence of cardiac or respiratory depression. The standard single tablet adult dose of Quaalude brand of methaqualone was 300 mg when made by Lemmon. A dose of 8000 mg is lethal and a dose as little as 2000 mg could induce a coma if taken with an alcoholic beverage.
i also spent a lot thinking due to foul smelling stool. But at the end went with IBS because take that out and it's a perfect IBS scenario. Anyone can have a occasional foul smelling stool. Don't lie...You had it in last 6 months
Think of it as spectrum PMR >> GCA >> GCA with Vision loss
In PMR you treat with low dose steroid only. If improve great. No need for a biopsy.
Temporal artery biopsy is indicated only in GCA with or without PMR.
But when things get dark you don;t wait for a biopsy and start pulse dose steroids.
All sexually active women age <25 are screened for chlamydia annually.
If you look at the penetrating abdominal trauma algorithm it has no place for DPL. Indication of lap in PAT - evisceration, HD instability, peritonitis, impalement
Medical mx is preferred bcz surgical ones carry risk for incondinence
This pt has dysthymia... MDD and all it;s subtype needs an suicidal risk assessment
It's not asthma. Asthma would have longer history..subacute to chronic i.e >3 weeks. Its AB. mild wheezing no added lung sounds. AB lasting >5days to 3 weeks
Old dudette have Aortic stenosis. Atrial contraction become essential for this patient. so AS + AFIb is dangerous because this reduces the LV preload significantly and this patient develops HF. So AFib in AS patient need to correct immediately
A case of Fanconi syndrome. If it was isolated Type 2 RTA option B would be the answer.
After everything its jjust an epidem ques. Below 55 vs Above 55 years
Apparently theres role of sympathetic system in psychogenic erection and its comes from T11-L2. So if patient have transaction at L5 they lose reflex erection but still retain psychogenic one.
ABove T9 transaction cause loss of psychogenic erection
Narcolepsy has one of the following 3 chraracter - 1. Cataplexy 2. dec orexin in csf 3. REM latency <15 min
its ass with (not dx criteria( Hypnagogin/pompic hallcination. Sleep paralysis
I get why its lateral but dont all cranial nerve except 4 arise Ventrally? WTF they add this Dorso before lateral?
Pleurisy (or potentially costochondritis) secondary associated with a URI, either way, treat with NSAIDs.
This is a great RCT. The issue is that EPCS is a specialized treatment not as widely and emergently available as the usual GI-doc on call.
Am I the only one always see conversion disorder of UWORLD as reassure and follow-up. This test is giving me conversion disorder.
Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history
Everything you need to know about Ca, Mg, K And Alcoholics
Dec serum Ca2+ >> Inc PTH secretion
Inc serum PO4− >> Inc PTH secretion
Dec serum Mg2+ >> Inc PTH secretion
Vert low serum Mg2+ >> Dec PTH secretion
3rd point from step 1 knowledge made me choose inc PTH but it shouldn't. This guy has mg of 0.4 which is very low and remember dr ryan “some Mg is needed to release PTH hormone”.
In alcoholics,
Low Mg (Decreased intake) >> PTH resistance + Inhibit PTH release >> Low Ca, Normal to Low Phosphate (can be normal due to low PTH, tends to be low due to nutrition and urinary loss in alcoholics).
Hypomagnesemia is Common in alcoholics due to ↑ urinary loss, malnutrition, acute pancreatitis and diarrhea. Does not respond to calcium. Magnesium Repletion quick PTH recovery, calcium takes time to reach normal level.
Alcoholics also have low K+ refractory to supplementation. This is also due to low Mg. Basically Mg prevents urinary loss via ROMK channel. Mg supplementation is needed to reach normal K level.
Bottom line, Alcoholics are very likely to have low K, Ca, Mg. This can accompany low to normal PO4. This is independent to whether or not CLD is present.
After everything its jjust an epidem ques. Below 55 vs Above 55 years
I didn't think it could get any more low yield after that Pompe dz question... I was wrong
Criteria for weaning from ventilator:
BMI is 75 Kg/m2!!! GAHHH how does it get to that x_x
What about acute intermittent porphyria 2/2 alcohol? It also has painful abdomen, polyneuropathy
This is obviously a clinical trial. If you know you are getting a drug, then you are not blinded: it’s an open-label trial. There is no randomization as there is only a single treatment group.
Memorize aspirin’s unique acid-base effects: metabolic acidosis and respiratory alkalosis. Note, this is likely actual respiratory alkalosis, not simply normal respiratory compensation for metabolic acidosis.
The important thing for most of the ethics questions are to look for the answer where you are being the nicest/most professional while respecting the patient’s autonomy, beneficence, non-maleficence, etc. Most of the choices here were either accusatory or basically being mean to the patient. The correct choice is to help the patient but also motivate them to continue physical therapy and to only use the permit as little as necessary. A similar question (which I think was on NBME 23 -- they are kind of blending together) was the one where the patient had test results that indicated he had cancer but the resident said not to (voluntarily) tell him until the oncologist came in later that day, and the patient asked you about the results. You don’t want to the lie to the patient and say you don’t know or that he doesn’t have cancer, but you also don’t want to be insubordinate to the resident’s (reasonable) request.
The posterior columns (Fasciculus cuneatus/Fasciculus gracilis) carry information to the brain regarding proprioception, vibration, discriminative touch and pressure. Physical exam findings suggest a lesion here (the spinothalamic tract carries pinprick/pain and temperature, and these were normal). Since the patient has abnormal findings in the lower extremities, and normal findings in the upper extremities, the answer is Fasciculus gracilis. This is because information from body areas below the level of T6 is carried by gracilis and information from body areas above the level of T6 is carried by cuneatus.
The single most important thing about this gross pathology is that the disease is multinodular. This indicates metastases from distant sites.
Liver abscesses are usualy singular, filled with creamy yellow pus, and may show a fibrous capsule. Cirrhosis often shows a yellow color due to fatty change as well as regenerative nodules, which are not present here. A focal nodular hyperplasia is a singular tumor of the liver, and this is multinodular. Hepatitis B is a little harder to distinguish because from what I can tell it can be multinodular in some cases, but this liver also shows none of the sclerosis from chronic inflammation that would likely accompany Hep B. Finally, we see no dark discoloration to indicate infarction.
Attributable risk = incidence in exposed – incidence in unexposed
= 30/1,000
(smokers) - 30/3,000
(nonsmokers)
= 0.03 - 0.01
= 0.02
(so the attributable risk is about 2%)
Applying it to a population of 10,000:
= 0.02 * 10,000
= 200
Attributable risk = incidence in exposed – incidence in unexposed
= 30/1,000
(smokers) - 30/3,000
(nonsmokers)
= 0.03 - 0.01
= 0.02
(so the attributable risk is about 2%)
Applying it to a population of 10,000:
= 0.02 * 10,000
= 200
Mad at myself for changing my answer.
Faulty logic made me wonder if hitting your head would caused increased ICP so, like a cushing ulcer, you would get increased Vagus nerve activity and maybe bradycardia + hypotension. But I guess the RAAS system would have counteracted that and caused vasoconstriction over 24 hours, so Hypovolemic shock is definitely the best choice.
Always should go with the obvious answer :)
However weird, you have to respect the patient's beliefs as long as they aren't putting the newborn at harm. In these types of questions you have to build patient-physician relationships because the patient might become offended if you disregard their beliefs. So while the newborn most likely has gas and not "the evil eye", choice E is the least "offending" answer that suggests treatment.
Case of arteriolosclerosis.
Hyperplastic arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle ('onion-skin appearance')
Narcolepsy has one of the following 3 chraracter - 1. Cataplexy 2. dec orexin in csf 3. REM latency <15 min
its ass with (not dx criteria( Hypnagogin/pompic hallcination. Sleep paralysis
Since the pain is radicular, a disc herniation is most likely.
This is mullerian agenesis. Normal ovaries but absent uterus.
Add on to the other comment: SICKFACES.COM (when I Am drinking Grapefruit juice) is the mnemonic for remembering the CYP450 Inhibitors:
M etronidazole
A miodarone
Is 45 minutes too long to be anaphylactic and would the absence of rash (urticaria, pruritus) RO anaphylactic?
The answer is hyporeflexia because the afferent arc of the muscle stretch reflex has to go through the dorsal rami and dorsal root ganglia. Dumb question, I know, but it’s the only answer that made sense. If you hurt the DRG, you not only lose afferent somatic sensory fibers, you also lose the sensory bodies involved in the various reflexes.
You can also get hyporeflexia from damaging the efferent neurons that innervate the muscle (like a LMN), but as you know these are in the anterior horn and ventral rami.
General rule - Chloroquine sensitive if from Caribbean or Central America west of Panama Canal, this patient immigrated from Honduras so you can eliminate chloroquine resistance as an answer choice (in addition to the vivax/ovale info above).
The analysis only showed a mutation in one allele. CF is an autosomal recessive disease: the disease only manifests if there are mutations in both alleles of the CFTR gene.
If you still have 1 functional copy of the CFTR gene, you can still make the CFTR protein (the chloride channel/transporter), hence your body won’t have any issues.
This is analogous to tumor suppressor genes like Rb: so long as one of the alleles you have is functional, you can make enough of the protein to “make up” for the defective allele. If both get knocked out (Rb-/-), you lose the protection provided by the gene because now you make no protein at all.
The only thing that made sense for this question was the fact that the other allele was not included in the analysis.
Cool another question taken from the list of things not in FA
Any idea why hyperchloremia isn't an answer? The diarrhea would cause an normal anion gap (hyperchloremic) metabolic acidosis.
jesus said "Protec thy heart"