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Welcome to chillqd’s page.
Contributor score: 28


Comments ...

 +7  (nbme21#47)
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heT Stem si niirebgcsd chitho,maerossom iecaathredrzc by brmlaano noir ningess adn airdcsnee ttinnielsa npbarootsi. siTh risencsae noI,r ninaecsgir ntirfier. In so,nesrep BCTI is dscdare,ee cihhw cerssiean nfnrairtsre naruisatot as hetre si lses iclgtiucnar crriear oems.cluel

Wiht xseces rion ni eht bdlo,o it lwli euaumtclac ni eutisss ucidnlgni het i,vrle nk,is ares.npca eleaue qS iucdnel aleditd hmoyr,atipcdoya andspm,ogiyho edtaeisb, rhrpoatahyt /22 claimuc hppoeoratpsyh iodos,itpne dn reaacepluloltH oimCaarcn

hello  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. +1
hpsbwz  @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. +10
mangotango  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 +

 +2  (nbme21#21)
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The mipyrra mnchsimae of niaoct of chccloiine si uutinbl idpruonist. ihsT saedl ot ubenteqsus ownd iuotaelnrg of tllipeum rlfnaoammity waspayth nda duaoimtlon fo nnieta ynutmiim.

castlblack  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 +3

 +2  (nbme20#23)
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teepot123  fa 2019 pg 200 +




Subcomments ...

submitted by monoloco(125),
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Espltaneacud osmragins urn mnatapr ni tespaint woh evha on sleep,n rhtehew aiypyllshc ro .flunoyanlict caRll(e hte ari-wyerad fo eqealaus kicles llec tnspeait xeienceerp ksnaht to erhit atfunnloic scp.oyetun)melota

sympathetikey  Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy. +  
chillqd  Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause? +16  
studentdo  Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why? +1  
mgoyo89  The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :( +  
kard  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. +1  
djinn  Gram negative are more common in DIC my friends +1  
drzed  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. +  


submitted by johnthurtjr(130),
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Wihel I nca tge on badro twhi tujsmtndeA rioDse,rd I on'dt ees who htsi snrewa is nya retetb tnha omSctia Smtmpyo irdDrse.o Fmor FA:

iareyVt fo diloby loscitamnp insltag hotmns to ayers eaacotdiss twhi eseivc,sxe rtpsieetns thhustgo nad ytneaxi btuao sysm.tomp ayM ac-poeapr ihtw esln.lis

SSD boeglns in a uorpg of oersdirsd rzitchcraedae yb ylacpshi mspyostm niuagsc agctniiinfs ssdsteir dan itaep.mimrn

savdaddy  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. +2  
chillqd  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 +1  
hello  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". +11  
cienfuegos  I also had issues differentiating these two and ultimately went with SSD, but upon further review it seems that a key differentiating feature was the timeline. His somatic symptoms would have had to have been present for at least 6 months per the DSM criteria https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t31/ +3  
almondbreeze  @chillqd Same! Why not OCD? He's fearful that something bad might happen (=cancer relapse; obsession) and calling his doc (=compulsion) +  
kevin  great reasoning @hello, this was confusing me but that makes perfect sense +