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Welcome to djtallahassee’s page.
Contributor score: 20


Comments ...

 +0  (nbme22#10)

Wouldn't telling the patient about the referral do more harm than good?

  1. Pt considers it a bribe and leaves
  2. Ruins study due to placbo effects
  3. Puts doc/hospital at risk for potential legal hassle.

I guess maybe I read it as a study when it really is just a referral but its not that much of a leap to think that this "experimental"" treatment is part of a study

drzed  I think this more of an ethical question (not a legal, or study design problem). Ethically, between the choices of being transparent with your patient, or not, the choice would be to disclose. Disclosing and offering to share would come across as a bribe, so that is less favorable than simply being transparent and putting the patient in charge of their decision. +




Subcomments ...

submitted by medstruggle(12),
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Wyh is it ton nivroaa flloielc slc?le I thhgtuo eth meeafl lnaago fo reiSlot nda Lyeidg is ahlca/tgnareuso llsec.

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +36  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +17  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


submitted by cocoxaurus(56),
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hTe aoeteitprnsn eerh seems ot tif ahtt of siceerntme vasracul siunoc-lco tioalpradnsp naip atth stals 1 rohu, fdoo sernvi,oa iegtwh sl.os hTe eaitntp aslo sah irsk acfstro tdesoacisa ihtw tineescemr savrcula occsiuonl- dlero tahn 06 sryae dol, mr,deHlyiiapepi inetrH,peysno Mx.HP

h"Te riemcestne ccruailniot intsscso of rteeh ayrrpmi seslesv ahtt yupspl obldo ot eht alsml dan legra ebo:lw eht ecilca rar,eyt roirsepu ecrieenmst ryraet AS,M() dan efririon tcnreeeims rteyar .)(MIA loodB fowl orguhht ethes asreteir aeicsrnes tnihwi na uroh rtefa tnaieg ued ot an esirneac in tmeiblaco amednd fo the itsatlnien hoc.csmoinarCu nclcsuoio fo a esignl sveles lwslao lalleracto oobld ofwl ot mneseactpo, tshu tmmsspyo od tno yaliltpyc epnrtes iuntl at tsale tow iprarym lessevs aer lud"c ec.odNon.hivt.ol/ksh7mo.4Ks.twib84nwnBc/b/3:/0gp/w

lCraoalsetl wtbeene ASM dna MIA eran teh nlpcsie ruxlefe adMegre(nin tencrseeMi reraty). heTer si olsa oaealtllrc eebewnt iceCla yrAret and ASM rec(tledPdnuicoaaoan a)rdac.e

a,lytsL I nwok that rtehe is a m-3c tcateic tarao undof on ,CT utb an atcori ensryaum dluow otn orpucde eseth mpsoytsm. neEv if uyo htghtou ttah teh mspoymst ewre eud ot eth A,AA ouy odlcu siltl gte ot hte trocecr asnwer fi oyu esu 14sah'dfem ng.iseanro

honey-crusted lesion  Great explanation! There's also a slide about this in the 100 Anatomy Concepts pdf but doesn't go into as much detail as this explanation. Thanks! +  
djtallahassee  Good explanation but I think an AAA would be more likely superior mesenteric and hepatic. the SMA and IMA are more than 3 cm apart (L1 to L4ish), Triple A affecting both would be very large. I blew this question because I saw 3cm and jumped to AAA, didnt even see it was a sclerosis thing. Put the two closest arteries and moved on +  


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The disesea rhee is utrfseoc pspeaoashsibth cfeeidycni. In t,i VI rgloelcy or ftesrcou st’eond hple euacbes tbho trene het ousgeclnngieeos hawpyta lwboe rocustef bsspaphtheoia. aaotGlcse on the oerth ndha rseetn oeavb .ti I dt’on nikth uoy lylrea eend to nowk hsit to ehoosc eth tocrcre rsenaw scein het inalilcc tucpeir of fitsnga gylchyeiompa hatt si rerectcdo w/ meso tors fo garus htta cna reetn the ioeonelucsnesgg wtyapha udohsl luec uoy niot teh thgri ewnra.s

neonem  I don't think you could have *totally* ruled out the other answers - I picked glycogen breakdown because it sounded kind of like Von Gierke disease (glucose-6-phosphatase) to me: characterized by fasting hypoglycemia, lactic acidosis, and hepatomegaly since you're not able to get that final step of exporting glucose into the blood. However, I guess in this case you wouldn't see that problem of glycerol/fructose infusion not increasing blood glucose. Nice catch. +24  
vshummy  I think you were super smart to catch Von Gierke! Just to refine your answer b/c I had to look this up after reading your explanation, von gierke has a problem with gluconeogenesis as well as glycogenolysis. So they’d have a problem with glycerol and fructose but also galactose since they all feed into gluconeogenesis before glucose-6-phosphatase. Great thought process! +22  
drmomo  glycerol and fructose both enter the pathway thru DHAP and glyceraldehyde-3-ph. Galactose enters thru Gal-1-ph to glu-1-ph conversion +2  
linwanrun1357  In this cause (fructose bisphosphatase deficiency.,),fructose should help to increase serum glucose, bcz it can become into glucose-6-P by hexokinase. Therefore, this question makes me confused.... +  
krewfoo99  According to uworld, fructose infusion will not increase blood glucose levels in Von Gierkes Disease as well +  
atbangura  I believe Von Gierke is not a plausible answer choice because a galactose infusion would still not see an elevation in glucose levels. Remember, galactose could be converted to galactose 6 phosphate, but in order to complete gluconeogenesis and allow glucose to leave the Liver for an increase of its concentration in the blood, the patient would still need glucose 6 phosphatase which is eliminated in Von Gierke. +1  
lilyo  So what disease is this??? I mean couldnt we have just answered the question based on the fact that the patient responds to galactose being infused and we know that galactose feeds into gluconeogenesis?? I am so confused. +1  
djtallahassee  Its Hereditary Fructose intolerance right? gets sick after fructose and I guess glycerol can jump in via aldolase B on this pathway via page 74 of FA2019. It looked like a fructose thing to me so I just marked out the other ones and moved on. +1  
paperbackwriter  @djtallahassee I was wondering same, but hereditary fructose intolerance also results in inhibition of glycogenolysis :/ confusing question. +  
amt12d  A much simpler way to think about this, without trying to figure out a diagnosis, I looked at the time frame for when the child was presenting. He has eaten poorly for 3 days, by now, his glycogen breakdown is gone. His body would be trying to make glucose, therefore, gluconeogenesis is impaired, not glycogen breakdown. +2  
tyrionwill  if fructose kinase is not available (fructose intolerence), then some fructose may go to F-6-P by hexokinase, then goes to G6P if gluconeogenesis is needed. however this patient's fructose kinase was intact, so no fructose would have go to F6P, so there would be no blood glucose increment after injection of fructose. +  


submitted by jrod77(27),
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I iknht yeth gmthi eb irbiescndg anagnio.tn.. rue.s A2TX is rlsbnesoeip rfo pltleaet taioeg,agrnogs ti amy eb nigibotrtcun to mstobis,rho shtu csiihmea to teh iacradc sui.ets

sympathetikey  Agreed. I'm pissed though because PGE2 mediates pain, which is why I picked it. +33  
he.sanchez14  If im not mistaken, the question describes unstable angina. Unstable angina is due to thrombosis with incomplete occlusion. So, yes TXA2 is responsible for the thrombus that is causing the symptoms in this patient. I'm also pissed because I also went straight for the PGE2 +5  
vik  hahah, seems like all in same boat like me +  
yb_26  thromboxane A2 is also vasoconstrictor, so my thoughts were about vasospastic angina +4  
youssefa  Went for PGE2 ... shit +  
need_answers  I went for leukotriene B4, what the hell was I doing....SHIT +12  
hopsalong  I picked Leukotrine B4 thinking that the neutrophil infiltration was the source of the pain, seems wrong lol. +  
bballhandler11  Sometimes it helps me to think of it in a general, non med school textbook kind of way. When answering, I narrowed it down to PGE2 and TXA2 as well. Then I asked myself, if someone is experiencing chest pain, would I recommend Aspirin or Advil? That's helped on a few over the counter pharm questions. +7  
ususmle  same here I M PISSED PGE2 +3  
krewfoo99  Maybe PGE2 isint the answer because it mediates pain and fever during episodes of acute inflammation? Thus making TXA2 more likely. +2  
djtallahassee  ditto on the looked at it for 2 seconds and went PGE2 +1  


submitted by welpdedelp(215),
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eTh pt dha satham OBS,( sakwe up at hnigt tuo of ae,bhrt has .ieslleg)ar tI ekasd for the seuocrprr of eoentlrisk,ue iwchh si ihoncidarac .dica heT prob gaev imh uMttlekosna ro enhaldi .scctliodriogcuo

ls3076  wtf is up with the phrasing of this question +34  
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +1  
alexxxx30  @Is3076 haha agreed!! +1  
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +4  


submitted by sam1(16),
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tahW aotbu teh onitaalddi lofw hurhtgo het mx?efrccuil

maddy1994  exactly man i got 4.5 and i thought he asked ventricle and left circumflex should be there so i put 5 ...glad someone thought like me.i was just cursing myself for over thinking. +10  
djtallahassee  Yea put 5 here too. they are essentially saying the myocardial oxygen supply to the left ventricle comes from the LAD. Not sure if true or not but figured that the LCX would at least contribute 20% of the blood +  
justherefortheyield  100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value. +  


submitted by nwinkelmann(282),
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oS tihs equstoin wsa iemonthsg I aylrel dstgeugrl iwht. I nid'dt nizroegec tath hte trestnapnoei asw fo RREMF as onosmee ttadse belw,o nad I kown uyo 'ontd ened ot kown htta to asrwne eth ietqo,nus ubt it dlouw eavh bnee hfluel.p yM tbisegg uifnotsatrr asw hte gwindro of het pyisbo sslrute rombnaal" cuautslcinoma fo tihcmnio.o"dar ihTs onneyad me bceaesu hte endiitinof of agdrge rde rfseib hchi(w m'I issnguam saw teirh )intnienot is tnmuuaal"isocc fo oalrbamn nach."miodotir hTose rea owt eryv dfnreitef nmeseattst in ym in,dm ol.l The f,rtis to e,m tusj msane e'sehrt oto umch ,tariohcinmod btu het cnosed nmaes 'esrhte too humc ADN htye ren'ta unfgtiinnco lrorye.pp st'I asol jstu the ctaf of grmebnierem lal fo the tmers fro CET ta hte eimt fo agdiren hte seitoqnu .i(.e I dtndi' tiknh taoub eht tacf thta TCE is sloa dlealc lrauelcl trsprenoai or usjt an)pi.siteorr

I olas itn'dd relayl rdnstadneu flyul awht a2OVxm si = "2VO ax,m also nownk as mxialma exngyo tkua,pe si teh ereanmetmus of het umimaxm nomaut of gxonye a srpeon cna leiitzu ngirud neetnis ..es.ierexc dan is easbd on the erpsmie ahtt hte omre nxgoye cmundeso ridnug eeeiscxr, hte rome hte bdyo lilw gnateere enoinsead ppttsiahheor AP)T( eegryn ni e.lcsl.. 2VO xam is dcerahe newh ruyo yongex imstnuncopo msanrie ta a eaystd etsta pdteies na eeasnrci ni hte klrwdao.o tI is at hist auplate atth teh cmselu[] emvso ofrm ceairbo oaslbmmtie to niaoecabr oibmmesl"at mle-0.-9lwi-//t/vsxoy7m12hh:wtwtfvar023wiatsw-cope..

asBed eylupr on siht tf,ninediio wehre Ox2aVm = nsllaetiesy the mtei at ichhw obceair teiswsch to ieaoncrba ritroi,aesnp ym ieertnanttoirp fo oot uhmc coirhmatdoin sv oot hcmu and abd mhdonircratoi idtdn' tmret,a esbaeuc vnee hwne teh ohcotarimidn aer ngnoutinifc orprylp,e they rheac a onpit and tscwhi ot irnceba,oa uhst if herte saw oot hcmu lrmano ,onmdiahcroit siht wlodu crouc tasfer useaceb ehrte oulwd be moer alerlov rlcleual apierrnotsi ioccrnu,g nmieang hte dboy ouwld ichtsw ot aonbircae dan liieztu llcyiisgos to lctetaa for nerge,y tpos nguitliiz hte t,dirooamihcn dna tuhs mxVO2a wolud adr.ceees

O.E...HEVWR abeecsu tsih si a RERMF qtsnei,ou the rdore fo entsev si a tlitle tiedn,erff seipted eth otcemou bgnei het mase (ta telas asht't how I tnadnsduer it.) oS, I thnik het eky to yan cthlrnmdiioao doirsedr si mnrregeiemb htat eth umsnoiatt aer stloma yirtcnela oggin ot ftfeac na docdene inerotp adn sthu a iyecfndice of thta iptnero. eOn relciat htat I fdonu asdi atht the RNtA osttaumin a(s in )MRRFE ace:su urpt"dis hnoltoimcirda npritoe es,insshyt eegadncsir the viticyat fo lepCxmo I dna to a eessrl etexnt olmCepx .VI.. wichh dreecsesa aiirsoernpt and wolrse toorpn p,imgunp iydalatmcrla icesdnaerg eht rnbmeema tntiepaol nad optron cerothiclecemal ileatotnp entagdir crsaso the tclhriamoidon nrien eanrmbe.m Teh pntoor aoccermehlctiel nilatepto iergadnt si the gdvnrii cefor rof TPA htssyiens nda rgsinedeca it saittunblsaly roeslw teh alxiamm reat of APT ".ntsseyhsi /..ljx6w300fn.l6e/-4726tei3/o1r/e1op.i9hf..rbmca/924s0isodb:1.il0u1tll.yn091y/

esadB on ym ndeiadrtnnsgu fo eaovxtiid ,nlhhpopiasotory 2O mcpotsonuni e.(i. kignta eth eretnolc frmo elxomcp VI dan iutnpgt it on /12 2O to ecrtea 2HO adn +H isredv teh rnopto etgrdani icwhh eivsrd TPA oodtuinc.pr uhTs: feentidic prtiersyoar oaxintdoi .ei(. tmAND utoitasmn of eht TEC )nzyesem dasle to eowderl O2 muintsponco (os leordwe V2O )xam cihhw htne sdlea ot redelow TPA ruicop,otdn dna tsuh icteveedf noatho.driimc en,Th erwdelo htcmlodirniao uictfonn adesl to eaecsdder eocaibr niosrpeitra nnsihutg PAT ucotrnodpi to oaencirab perio,nairst rvneid by c,sgysliyol and usth rcnisieang tltacae veels.l

Hepo isht hls!ep ihsT koto me WAY OTO LONG ot ufrgie ,tuo ,oll tbu pufyohlel I ernve frkienga etofgr it, o.ll

Aslo, fi ouy antw nya rmeo aign,der I ylflina dounf na ateiclr ttha lalyutac lfluy xnispael het ahlbceoimci adn poghthlysoopyai of ltrchnidmiooa myetaoh:spi rcs//tta3aaapec/hn/u4r621c/bt4l/215i2opc/i3.3e7/mmio:.d

rySor its' so nogl!

djtallahassee  lol yea. I thought they were trying to say there was an abnormally large amount of mitochondria present which made me get the opposite answer :/ +1  
alexxxx30  no I so agree. The grammar was completely wrong (clearly whoever wrote the question needs to work on english). This was very frustrating to me because I recognized that it was ragged red fibers, but then the wording made me doubt my own knowledge (thinking how could the test writer mess that up?). abnormal accumulations either means too much or too little. accumulations of abnormal mito means thee mitochondria is faulty. Correct grammar is putting the adjective right next to the word it is describing. So this was definitely wrong and I share your sentiment. This really frustrated me! +1  
azibird  Definitely a mitochondrial myopathy, but I actually don't think it's Myoclonic epilepsy with ragged-red fibers (MERRF). This normally entails Myoclonic jerks, Generalized seizures, Cerebellar ataxia, and Dementia (according to Amboss). Maybe it's CPEO (chronic progressive external ophthalmoplegia): progressive extraocular ophthalmoplegia with bilateral ptosis. Not sure which one would account for her poor exercise tolerance. Either way, recognizing it's mitochondrial is enough. +  


submitted by adong(94),

literally know every single name they can possibly call this

djtallahassee  literally a new name every nbme +9  


submitted by seagull(1389),
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tuo fo c,srtioiuy woh yam lepope enkw ?tsih tdn(o eb shy ot yas uoy ddi or t?ddn)i

My yrepvto acoeinutd 'dndti nniairg shti in .me

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +26  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +  


submitted by d_holles(170),
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anC trloap NHT intbcruoet to eipcath alhnt?epoypecha

djtallahassee  Sorry for the late add. Portal system does contribute to hepatic enceph ESPECIALLY when there is a TIPS or shunt that bypasses the liver. However before, it won't directly contribute to more NH3+ +2