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The kid has albinism, which is due to decreased tyrosinase activity. If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability, musty body odor, etc., in addition to his fair complexion.
I see, so if it was PKU he wouldn’t just be presenting for a routine examination. It would be one of those “oh crap what’s wrong with my baby” ones.
Just a note that UWorld says phenylketonuria patients ALSO have albinism, it's just that the neuro sx and musty order are giveaways.
Technically, albinism is a problem processing DOPA, and not tyrosine, no? I always associated "tyrosine processing defect" with ochronosis, which is why I didn't choose tyrosine. Guess I'm wrong.
@pathogen7 you're not wrong it is specifically DOPA but would any of the other answer choices make any sense over tyrosine?
no pneumonia it is UTI
this is essentially urosepsis, one of the leading causes of sepsis
UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability)
While L gastroepiploic would make more sense than the other answers, considering it has an anastomosis (and therefore an outlet for the increased blood) I think it would have much less risk of varices/bleeding than the short gastric would
jesus this answer was probably too long i'm sorry
I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks.
This is what NBME should be providing with each question's correct answer! Thanks hungrybox!
@hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."?
Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides?
@madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx
Yeah, I probably should have went with that. Just got thrown off, since I know that usually the serum calcium levels for someone with Calcium kidney stones is normal.
i understand the link to MEN 1, but why are we checking the calcium level?
I feel like it's important to get a baseline of where the calcium is at for two reasons:
1. if the patient does indeed have MEN 1 it would be good to know if she has high calcium levels and possible Parathyroid etiology
2. You're putting the patient on a PPI which are known to decrease calcium levels and increase risk of osteoporosis
for both these possible factors/concerns it would be good to see where calcium is currently at
His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS
even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense.
Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization.
@hungrybox my mans just slipped in 3 high yield facts within a joke
@hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery.
Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes
there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this.
please why is there where a diastolic mumur?
@temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border)
Does anyone know why is this patient's tepmerature elevated?
@garibay92, not important for this question I think but cocaine can cause malignant hyperthermia
judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm
he's only 28 - another clue for marfan?
did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection
@almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN.
@turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection.