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Welcome to divya’s page.
Contributor score: 59


Comments ...

 +4  (nbme23#3)
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ayko tub eewhr ni hte sequiont is ti gkasni hrwehet sti' iitntenon to treat or per tlcoopro or as eatedrt???

rea ew ot msaues ist TTI fi hyte ndt'o noenmti ngnithay or eht rpat fo hte ntiqueso atth says m"rpiyar isaynlas" het yeawivg to I?T?T

kpjk  I had the same doubt. I think if we were to consider "per protocol" then answer would have to be a mash of options A and B. There is no option that would be right for per protocol +
peqmd  I think ITT is assumed b/c it's the one that has reduced biased in measurements. +

 -2  (nbme23#45)
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i tdn'o htkin uyo ndee ot nikht lal ahtt cmuh. kool ta lla the isnopot nda ntkhi fo awth pehsapn nehw eyth .nc a,erseiA ,B ,C D nda F lla anc eucas tiisrelittan .tead umeB seiicnnrag repyrlicalap anctrieses dteliifney t'done.s

drzed  Increased lymphatic flow would not cause interstitial edema. +1
123ojm  but it doesn't say "increase in," it just says "regulatory adjustments in." +1

 +8  (nbme20#10)
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AF 1290 Pg 541

hroPteicst eatrh vlseav nad airotc snsitoes may cueas tolheimyc mniaea easondyrc ot cinacalhem oedritcstnu fo s.CRB


 +1  (nbme20#12)
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rfo yatoanm uiemsdm elik ysflme


 +3  (nbme20#1)
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roF yneona e,irntested eht ucenrtr otsp xoepsreu lroxishapyp enirmeg oatncsin - fTinroeov + tiacemirEitbn + argvtlRaei

kLin fro PPE lopphiryasx wilglfono cnilcauaopot eeosrpxu


 +1  (nbme20#1)
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wduolr q di - 852 rfo eeeaernoognsrcipntdof r iceesanr aoretaasm taiyi.cvt

eAtomaras yitvtcia is aseidncre yb - )1 e2g a) ot)i3ys be si innlu)4 aigdospoo5n rt)n lcoalho


 +3  (nbme21#7)
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nregtPna menwo are 20 tsmei rome lyliek ot get efecdtni thwi rieatiLs.


 +2  (nbme21#41)
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hTe rorhgsypoipenn ligoflown BGP oisecvnonr into Urophroynpingreo 3 cesau oospyvitihseittn useecba ONYL seeth rctea iwht goxeyn no toientxaci yb UV hi.glt

rrfoeehTe niycciefed of yan of eht nolligfwo mysznee -

rongyorepuihrpon coyoernypps eoicorlrpdohnreaxgba ds,oeiax rippnyreohoropgn idxeaso dna cheraoseerrltaf nac ceasu itssipth.ovtyenoi

tuB eewtnbe wrnase checsoi B &mpa; C, C is girht euebsac of s'ti anososatiic twih eHp C, aedrsi TAS TLA sa nmeoen@ i.ads


 +1  (nbme21#4)
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C dpi xxinooet nihtsibi optinre a)yhoisnttatsnis(nlser aiv PAD yatrioilobns of EF .2


 +7  (nbme21#48)
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anrsecie in cMAP Gs)( - t2abe - aiasonltdoiv

edecaesr ni PcMA i(G) - 2haapl - oitocnscinarotvs

raseecni in 3PI AGD G)q( - ha1pla - naoosritoicvcnst

caeersin ni cPGM - 3M - ON indcude vodliostiaan

cytotoxict  Alpha 2 agonists do not cause vasoconstriction b/c they lead to negative feedback of norepi and thus decrease sympathetic response +
payingforthisisdumb  FA20 p317 α2-agonists increase NO/cGMP and vasodilate +
sarahs  why is decreasing cAMP wrong? +
hiroshimi  @sarahs: you want to increase cAMP because it would lead to vasodilation and help to decrease his blood pressure. Decreasing cAMP would make his BP worse. +

 +7  (nbme21#33)
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oolk at eth mgeai

irmsnnsepuuosIopm uacsse etnaitcoaivr of ZV.V


 +4  (nbme21#18)
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yrtelunCr iseA'zhmrel dessaie aenettmrt lesincud -

1nnedc)Eah hcA sminsoitnsra ezie,(noplD timv,inseaRgi nletainaaGm

)2 nNtecpioroeoutr iav xtatinoidnas inmiV(at E)

)3 MNAD erecrotp ontasigmna eina)meMt(n

lovebug  19FA, 536pg +

 +4  (nbme21#37)
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lsmypi trnnaile csupale sha snipiolrcatoc dna albcbortuocri tsartc sasp tuhr it, cneeh het lc/ srpaiemhesi fo yodb nad ae.fc

fI at lal hety watn ot oknw ahtw eilipsacycfl sspase uhrt ic hcw(hi si aatpilcrycl ,)ENVER anrnoeehr itt iblm - lrmictahotlaoac gcn sutrtae, - orb,rpltcrbeso uroociita libm - ,lnarosotcpcii all snesryo


 +0  (nbme21#26)
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Can aynnoe isucdss hwt'sa blrpeseosni rof ininbthgii teh recessosp niveg as rhtoe oiosn?pt


 -1  (nbme21#12)
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Why is etrhe eihrharnro in oiiodp tw?wraaihdl nAd s,oal fi lmistatsun eilk aocncei uacse saanl vtosinoict,rsnoac lnutodh's iidoop wadwhialrt do hte maes?

the_enigma28  Mechanism of opioid-induced rhinorrhoea, lacrimation, stomach cramps and diarrhoea is actually muscarinic receptor effects, rather than alpha adrenergic blockade caused by cocaine, causing nasal vasoconstriction. +1
baja_blast  Symptoms of Opioid Withdrawal can be remembered with the phrase "anxious, hot, and moist" per SketchyPharm Opiods. Rhinorrhea is one way people can be "moist" during opioid withdrawal, but they can also sweat excessively and lacrimate too. +1

 +2  (nbme21#18)
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buovois anwesr ieohscc wbneeet deodlnua itsaear dan lrypioc nltoe.audssndi oes sretiaa eestrspn wiht liuibos ignmivto hnwtii t1s day of ief.l eohrt atrseufe - dbuole lbbebu on ea.exryars hw pt heer ash non siuilob igmitvon ta 4ht weke fo feil.


 -6  (nbme21#41)
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marpildeoe is ysblilaca lntpdaeiexoyh + pnta.ioer nptaroei is ddead ot cdruee ebsua itpoltnea yb idpthlnxoe.yae

divya  ugh sorry. this is wrong. idk why i always thought loperamide is diphhenoxylate +3

 +0  (nbme21#33)
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aereg twhi y.hut' eebrrka yrgint to asy atth irrampy aogl fo eatrtnmte with elpemunlstpa 2o is to emak ersu ehert si on eltnria .agedma





Subcomments ...

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heT taenpit ahs NTA asdcenryo to narel isimc.eha ueD to tubualr ,niocsesr teh aetnpti lwli veah na eeevdlta .aFNe ehT ptnati'se ineur will olsa be l,utedi ubt hits lilw be elcfterde by teh lwo rnuei y,miloltaos not the aeFN

mousie  Hypotension can also cause pre renal azotemia with a FENa <1%.... How do you know this is ischemic ATN and not hypotension induced Prerenal Azotemia? +11  
sympathetikey  I had the same thought as you @mousie, but I think "azotemia" and low urine output push it more towards ATN (looking back; I got it wrong too). Plus, the initially MVC / muscle damage probably caused some tubule injury by itself. +2  
ajo  This might help clarify why the pt. has ATN rather than pre renal azotemia. The question did mention, though subtly, that the bleeding was controlled. That most likely indicates that his hypovolemia has been corrected. Developing azotemia 24 hrs after correction of hypovolemia is more suggestive of ATN (since he doesn't have hypovolemia anymore). I hope that helps and feel free to correct me, if I am wrong. +41  
ajo  In addition to my earlier comment, I just noticed the question also explicitly mentioned that he was fully volume restored. Which is consistent with my earlier assumption! +14  
gh889  Although initially, hypotension causes prerenal azotemia, the volume correction pushes you away from prerenal azotemia. but they want you to remember that in hypovolemia, the kidneys are also becoming ischemic, and so development of azotemia 24 hours later is more indicative of intrarenal azotemia due to ATN +  
sugaplum  for anyone who wants to see it: FA 2019 pg591 +1  
divya  i'm confused about one thing. if the tubules aren't working like they should, the bun:cr ratio falls right? doesn't that essentially mean azotemia reduces too? +  
osler_weber_rendu  Lets all take a moment to admire how shit this question is "Bp 90/60.""Repeated episodes of hypotension in the OR" and still the answer is ATN +4  
donttrustmyanswers  @osler_wever_rendu ATN can be caused by ischemia. +2  


submitted by krewfoo99(93),
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fedarAolt adn taerh aetr ersah na irvsnee lseh.airtipno

As hte licmlaiub crdo is dmseprs,ceo heret si an rnseceia ni stmcyesi vucslara icsstanree inTk(h of ohw eth ssupreer wolud rcanesie fi uoy erew ot erpss nodw on a traew .ohe)s ,husT the dloftreaa si cdsaeiren and ethre is a tsryopoamnce aeedecsr in taher .tare

divya  yeah, i too thought similarly. btw increase afterload --> increase in bp --> baroreceptor firing --> decrease in heart rate. is that it? +2  


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tPineta sha a lgningoa cyst, hhicw cna stsunoolenyap .sgeserr

medschul  Mine would beg to differ >:O +28  
usmleuser007  Where would I have come across something like this (FA, Pathoma, or out of my S)? +5  
motherfucker2  I thought this bitch was a lipoma. Mother fucker +9  
divya  mf2 lipomas is fat. although fat may exist in liquid form, its still opaque, therefore negative transillumination. unlike ganglion cyst. +4  
beanie368  Only knew this because I have one that comes and goes... +4  
cbreland  I thought these were like a 1-way valve? Didn't think it would regress if that was a case? +  


submitted by jrod77(28),
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ehT scsoylti rueesrps ifernedfce bewente het etlf ercnlvtie dan eht otara ni this t.p si etytrp n,aticiigsfn aeWhrse in a maonrl ahter soeth osiytscl supseserr douhls be tsuj utoab u.leqa hTis nhtsi ta het afct hatt teh flet rlncteiev sah ot put ni olta of owrk ot uhsp hgthruo the icroat vvle.a tTha traex errpesus eosg iotn einongp eth avevl nad odes ton ppaera in het oaatr.

divya  why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6  
leaf_house  @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005156 +  
cbreland  @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gun😔 +  


submitted by sajaqua1(535),
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hTe nsleig somt mtirntoap ngtih bouat isht gorss pylaogtho is htat eht isedsea si u.duarmniltlo hTis dsatciien settamsesa ormf insdatt tse.is

vrieL csessaseb aer aulysu gnai,surl iedlfl iwht camyre wleylo p,us nda aym sohw a ofsriub a.ceslpu srohiCirs teofn oshws a lwoyel lroco ude ot afytt nhaceg sa lelw sa aveertrgiene delusn,o chhwi are tno seernpt rhe.e A lfcoa unadrol ealirpyhasp is a suainrgl uromt of eth elrv,i and thsi si dluaitou.lnrm tHepsaiit B is a etltli rraehd ot iinsitusgdh ubecsae mfor hwat I nac etll it anc be lltmiouradun ni osme ,essca tub sith ivler laos whsso neon fo het resslicos form nrhicoc mfniomnalait hatt lwuod elyilk yacamcnpo Hep B. ai,llFny we ese no kard oaoinidsrltoc ot ecainidt io.rcfanint

monkd  It doesn't explain the sudden death, but I suppose they aren't asking for that! +4  
charcot_bouchard  I hate this type of ques. Here it is. Tell me what it is? +2  
divya  also, a liver infarct is unlikely due to rich dual blood supply. +1  
drzed  @divya Rather, if there was an infarct, it will be hemorrhagic, not pale. +1  
llamastep1  Multiple solid lesions on a healthy liver = meta. I assumed breast wouldn't meta to liver (it's usually GI cancers) but it makes sense since all the blood gets filtered by the liver at some point. TIL! +  
sophia  UW QId: 59 +  


submitted by luke.10(3),
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(ancirop ksaeoccxi ) is rome mocnom htan oavdiusern utb btho nca eusaca aivlr ymdiroicsat

dulxy071  Yeah Adeno is what I went for unfortunately +  
divya  thank god for sketchy.. +3  


submitted by whossayin(24),
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hyw tnac' "oirafngoctiain dcftee in 3T adn "T4 be the rsewn?a

sugaplum  I think if it was organification defect you wouldn't have a normal T4 level in the serum. +17  
divya  because there would be an overall decrease in serum T3, T4 and increase in serum TSH levels. +  


submitted by aishu007(3),
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can aeynon inxpale wyh ececenuoarclissactof si hte ewsran h?eer

priapism  Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +6  
nala_ula  My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +  
fez_karim  its says chains, so not staph. only other is entero +  
temmy  according to first aid, staph aureus is not one of the high yield bugs for UTIs +1  
temmy  uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +  
privatejoker  Where in FA 2019 does it list that C.coccus is specifically in chains? +  
privatejoker  E.Coccus* i mean +  
divya  @privatejoker FA 2018 Pg 134 table +  
jennybones  @privatejoker Enterococcus is Group-D STREP. Streps are arranged in chains. +2  
santal  FA 2019 Page 639, too. +  
backwardsprogress  Enteroccocus is also a pretty common cause of chronic prostatitis, which was the give away in the prompt if you didnt know the characteristics of entero: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715713/ +  


submitted by sgarzon15(11),
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Takhn uoy rtiegtl nezo of ehktcsy mhpa.r I lhlsa erenv ofetgr oyu

cr  why not C?. It´s not supose that it improve the efectivity of insulin? +  
cr  why not C?. It´s not supose that it improve the efectivity of insulin? +  
divya  because insulin uptake by adipose and muscle tissue is not limited to thiazolidinediones but also and mainly by metformin. and glitazones' primary MOA is PPAR gamma stimulation which then increases insulin sensitivity to other tissues. +1  


submitted by neonem(571),
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hTis is a esca of ectua .guto mdoooMnius urate latssrcy rae eaktn pu yb orhnuepslit, nalegdi to an tauec maofymanrilt o.rtcneai slTec-l nate'r lelayr ledivnvo ni uogt (meor medatorhui )rrast.htii

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy. +3  
temmy  the way i thought about it was how did the neutrophils get there? the answer is via increased vascular permeability +16  
nor16  they, unfortunately, did not ask " how did neutrophils get there" but " whats the cause of the swelling " not to confuse with " what causes the swelling " +1  
divya  absolutely right temmy. that's how i thought about it too. +  


submitted by tamey(-1),
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mi a itlelt sunocedf ntsi ngoicklb llpauam fo eaeettcpnctharv(ipaoar alpmua) wuold uesac nrtiutcsobo of tohb ptaierccan tcdu and ommnco ebil duct nad ni isth eacs hte ttiapen wodlu evah hngltascoi oo,t ton nyol ite!ca!pri!ntsa

divya  true but none of the other options cause pancreatic duct dilation. options a, b and c would cause obstruction above the level of pancreas. +1  
lilmonkey  It doesn't say ONLY pancreatitis, but just enough information to choose the correct answer. Maybe, in the test writers mind if they mention cholangitis and jaundice that would be too much hints :). +2  


submitted by cantaloupe5(77),
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ishT noe asw itrkcy but I nhkti yuo uo’ecdvl dnoe hits noe thuiotw eeokldwgn fo DNMA cpro.retse Semt todl oyu atht gameltatu taisvteca boht nMNDoAn- dna DAMN ocstperer tbu it aietavctd noly MNDnAon- rrceopest in teh erlay ahs.ep aTht smean DMNA rcetespro attcivae efart oNDA-nMn etpor.rsce hatT nmeas egnthsimo swa nedylgia ANDM crepeort gcatanitiv nda het nyol anrswe htta made ssene sa het gM nihigiitbn MDNA ta gtrsein at.eopntil cOen eht clle is iadlroedzpe by oNA-nnDM rstroce,ep ADNM cresoterp nca be a.tctdeiav

hungrybox  I forgot/didn't know this factoid and narrowed it to the correct answer and a wrong answer. Guess which one I chose? +14  
yotsubato  >That means something was delaying NMDA receptor activating and the only answer that made sense as the Mg inhibiting NMDA at resting potential. What makes the fasting gating kinetics choice incorrect then? +5  
imgdoc  NMDA receptors are both voltage gated and ligand gated channels. Glutamate and aspartate are endogenous ligands for this receptor. Binding of one of the ligands is required to open the channel thus it exhibits characteristics of a ligand channel. If Em (membrane potential) is more negative than -70 mV, binding of the ligand does NOT open the channel (Mg2+ block on the NMDA receptor). IF Em is less negative than -70 mV binding of the ligand opens the channel (even though no Mg2+ block at this Em, channel will not open without ligand binding. Out of the answer choices only NMDA receptors blocked by Mg2+ makes sense. Hope this helps. +6  
divya  sweet explanation imgdoc +  
lovebug  really~~~ sweet. thankyou :) +  


submitted by divya(59),
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pleemorida si lybalaics dotehpneyxali + re.oapint oaptiren si added ot ceudre esuba iltnteapo yb a.podynteixelh

divya  ugh sorry. this is wrong. idk why i always thought loperamide is diphhenoxylate +3  


submitted by priapism(6),
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reP tisFr A:id tosdinebia istngaa OBA dolob tpeys tend to eb MIg or g,IG cihhw is ywh the nsarwe is IGg + etcpeonmlm nad not gAI + tonemlpmce

yotsubato  IgA also has no role in any hypersensitivity reaction +2  
divya  hi. where is this given in first aid? +