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I think you made one slight mistake.
TIBC = total iron binding capacity. It is synonymous with "transferrin saturation". This patient has increased transferrin saturation aka increased TIBC.
The transferrin molecules are saturated -- it is incorrect to say "as transferrin saturation increases, there is less circulating carrier molecules."
It is more correct to say that the amount of free (unbound) transferrin is decreased.
@hello Transferrin saturation and TIBC are not synonymous. Transferrin is calculated using total body iron / TIBC.
While the serum iron level continues to increase, the transferrin level decreases. Thus, the amount of transferrin available to bind iron (TIBC) decreases and the amount of transferrin saturated with iron (i.e., percent transferrin saturation) increases.
Just to clear up definitions: Total Iron Binding Capacity (TIBC) = measure of trasnferrin molecules in the blood (bound by Fe or not). % Saturation = percentage of transferrin molecules that are bound by Fe (normally 33%) // Pathoma pg. 42
FA mnemonic = Microtubules Get Constructed Very Poorly:
Mebendazole (antihelminthic), Griseofulvin (antifungal), Colchicine (antigout), Vincristine/Vinblastine (anticancer), Paclitaxel (anticancer).
A = dont confuse colchicine with celecoxib. celecoxib is a 'celective' COX inhibitor
B = ziLEUton = leukotriene inhibitor for asthma
Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy.
Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause?
Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why?
The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :(
Everyone is correct about the Encapsulated microbes, but this is one of those of "MOST LIKELY",
and by far the most likely is S.Pneumo>>H.infl>N.Mening. (omitting that patients with history of splenectomy must be vaccinated.
Gram negative are more common in DIC my friends
Correct me if I am wrong, but I am pretty sure that E. coli is NOT a common cause of pneumonia because it must be aspirated to enter the lung. Thus, only patients with aspiration risk (e.g. stroke, neurogenic conditions) would be at a chance of getting E. coli pneumonia.
I think part of it stems from the fact that this patients symptoms are occurring within the time-frame for adjustment disorder while SSD seems to have a longer timeline. Aside from that I find it difficult to see why SSD wasn't a possible answer.
To add to that, I inferred that the obsession with checking temp and with the tingling sensation were signs provided to him by the physicians of recurrence. He is anxious over his cancer recurring, and they are more specific than a variety of body complaints
In somatic symptom disorder, the motivation is unconscious. I think for the patient in this Q-stem, his motivation is conscious -- he wants to make sure that recurrence of cancer is not going "undetected".
@chillqd Same! Why not OCD? He's fearful that something bad might happen (=cancer relapse; obsession) and calling his doc (=compulsion)
great reasoning @hello, this was confusing me but that makes perfect sense