and we’re back! with BRAND SPANKIN' NEW tangents!
welcome redditors!to snoo-finity ... and beyond!
Welcome to chris07's page.
Contributor score: 9
School:


Comments ...

 +2  (nbme23#10)

Bed bugs themselves are not known to be carriers of illness, but they can leave itchy bites. The girl is likely to scratch these bites, abrade the skin, and thus increase the risk of a staph skin infection (since staph aureus is the most common skin infection pathogen)

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ?
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :)

 +0  (nbme23#20)

I'm guessing that since this is hashimoto's that a biopsy of the thyroid would show the thyroid gland completely engulfed by attacking lymphocytes. Over time though, wouldn't the thyroid be completely destroyed and fibrotic?

dr.xx  Progressive thyroid cell damage can change the apparent clinical picture from goitrous hypothyroidism to that of primary hypothyroidism, or "atrophic" thyroiditis. https://www.ncbi.nlm.nih.gov/books/NBK285557/ The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. https://www.researchgate.net/publication/302196286_Atrophic_Thyroiditis

 +1  (nbme23#6)

The only infection on that list that you would even screen an otherwise healthy appearing individual is HepB. The others I would think you only check if the patient has a presentation that makes you suspect them, like EBV if they had signs of mono, or RSV if they had respiratory symptoms. At that point, they're no longer screening tests, but more diagnostic ones.

gilbert  I got it right because I thought of the prevalance of HBV in China.




Subcomments ...

submitted by chris07(9),

Bed bugs themselves are not known to be carriers of illness, but they can leave itchy bites. The girl is likely to scratch these bites, abrade the skin, and thus increase the risk of a staph skin infection (since staph aureus is the most common skin infection pathogen)

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +  
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1  


submitted by mousie(74),

Not sure I am understanding this question - the patient got an NSAID for RA and this decreased her prostaglandins so she developed GERD... Doc added Misoprostol to counteract the decreased Prostaglandins I the gut and an adverse reaction of Misoprostol is diarrhea .. Correct?

chris07  Yes. Diarrhea is a side effect of misoprostol. +1  


The thing is, the spinothalamic tract crosses 2 vertebral levels up and then decussates at the anterior white commissure to get from the right to the left, so how do I know which vertebral level I'd be working on this guy?

chris07  I think the assumption here is that we are dealing with the cord section at the level of the problem. The picture is incredibly misleading. You have to orient yourself. The dorsal columns F, E, A, B are facing the patient's posterior. Once you properly orient it in 3D space, you know that what's labeled "right" is actually the patient's left, and what's labeled "left" is his right side. Super confusing. +  
sne  The input arises in a limb/part of body at the level of lesion, enters through the dorsal root (pictured between A and B), decussates and ascends at the anterior commissure, and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. So AT THE LEVEL technically would be in the dorsal column +1  
nwinkelmann  also, @chris07, I think you're wrong about the labels being wrong on the image. Becuase the spinothalamic tract = contralateral pain and temperature, and the patient's pain is on the right side, you would want to target the left spinothalamic tract for pain relief, i.e. the area labeled H. The area labeled D would be the right spinothalamic, purely because that is how the image is labeled. If you assume the label is different, you will get it wrong. +1  


The question stem is describing a mitochondrial disease, which commonly present with lactic acidosis. There is an increase in anaerobic forms of energy production (glycolysis). The mitochondria are faulty, so they can’t use the end product of glycolysis (pyruvate) in TCA. Instead pyruvate is shunted over and is used by LDH (lactate dehydrogenase) to generate pyruvate.

Aside: Recall that LDH uses NADH and generates NAD+. Deficiency of LDH can lead to loss of regeneration of NAD+ and inhibits glycolysis.

drdoom  ... pyruvate is shunted over and is used by LDH (lactate dehydrogenase) to generate lactate*. +  
chris07  It's hinted in the answer, but I would like to clarify: max O2 consumption is decreased because O2 is consumed in the Electron Transport Chain, which occurs in the mitochondria. With the mitochondria not working, the ETC cannot work, and thus there is less demand for Oxygen. +4  
masonkingcobra  Mitochondria are the powerhouse of the cell +11  
uslme123  Apparently ragged red fibers are the result of coarse subsarcolemmal or intermyofibrillar mitochondrial accumulations.. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mitochondrial-myopathy +