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 +1  (nbme23#12)
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vshummy  I got this wrong but best I could come up with was this was about Bradford Hill Criteria for establishing causality. And of the 9 included, F has the most that are actually included in the information given to us. I chose D but I think since we don't know about other study results, we can't include it as directly answering the question about *this* study. https://en.m.wikipedia.org/wiki/Bradford_Hill_criteria Someone double check me here: A: biologic plausibility is a weak point in the criteria, according to the wiki. Also probably not true in regards to this study. B: Sensitivity is not part of the criteria C: " " D: We don't know about consistency E: " B " +26
mousie  Found this ... still confused about why A and D are wrong though... https://stats.stackexchange.com/questions/534/under-what-conditions-does-correlation-imply-causation +1
2zanzibar  The three criteria for causality are: 1) empirical association (i.e. strength of association; a change in independent variable correlates or is associated with a change in dependent variable), 2) time order (i.e. temporal relationship; the independent variable must come before change in the dependent variable, or plainly stated, cause must come before effect). and 3) nonspuriousness (i.e. dose-response gradient; the relationship between 2 variables is due to a direct relationship between the two, not because of the actions of changes in a third variable... this can be evinced by a dose-dependent response). +9

 +1  (nbme23#2)
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hayayah  Adhesive capsulitis causes severe restriction of both active and passive range of movement of the glenohumeral joint in all planes (especially external rotation). +22
catch-22  Adhesive capsulitis is aka "frozen shouder" so you can expect exactly that. The entire shoulder will be hard to move in all directions. +3
meningitis  Since it says there is NO impingement sign, it cant be rotator cuff tendinitis correct? What other signs eliminate this option? +

 +3  (nbme23#29)
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wired-in  Patient has 5 yr h/o hep C, so it is chronic. Chronic inflammation is characterized by presence of lymphocytes & plasma cells while neutrophils is more characteristic of acute inflammation (Pathoma Ch. 2). AFP is within reference range so probably not HCC. Choice D, palisading lymphocytes & giant cells suggests granuloma which isn't typical of hep C. +42
almondbreeze  Fa2019 pg 215, 217 on acute/chronic inflammation +1
popofo  But doesn't AFP has not-so-high sensitivity for hepatocellular carcinoma (HCC)? If so, a negative result shouldn't be able to rule out HCC? +
popofo  But doesn't AFP has not-so-high sensitivity for hepatocellular carcinoma (HCC)? If so, a negative result shouldn't be able to rule out HCC? +

 +0  (nbme23#42)
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nlkrueger  I agree that it's confusing but I looked at it as a physical *obstruction* since it's impinging on the airway.... but yeah idk this is weird +
ferrero  Doesn't the trachea have cartilage rings so it wouldn't collapse which makes it seem less like a typical obstructive disorder? I'm really not sure why FVC would change because I don't see how total lung capacity or residual volume would change because those are static conditions where there is no airflow at all. I understand FEV1, peak expiratory flow, peak inspiratory flow etc. +2
mousie  Agree this is a really tough Q but I also think I really over thought it... I eliminated all with a normal Ratio bc something obstructing would obviously produce an obstructive pattern although I don't know why FVC would be decreased. I wasn't sure about both peak expiratory and inspiration flow being decreased can someone help me with this or tell me I'm totally overthinking again.. are they both decreased simply bc theres an obstruction ..? +4
mimi21  Yea I got confused on this question. But I guess they wanted us to look at it as a obstructive disease . If this were the case all of those function tests would dec. ( See FA ) +
gh889  Because the obstruction is above the alveolar regions there is a decrease in air flow, not lung volumes, which would make this an obstructive pathology. +3
charcot_bouchard  FVC here dec same way it dec in Obstructive lung disease. Read the concept of Equal pressure point of BnB. There he says in bronchitis we have onstructive pattern because inflammed airways gen more resistance. so EPP comes early. I guess here due to tracheal narrowing pressure inc downstream. which collapses smaller airway. result in air trapping. +1

 +0  (nbme23#21)
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nlkrueger  only if it's an interstitial lung disease i believe. like polio can cause a "restrictive lung disease" but it's due to muscle effort and would expect to see a decrease in diffusing capacity (FA 2018 pg 657.2) +6
meningitis  Construction worker, Diffuse reticular opacities screamed restrictive and low DLCO for me. Anything that either adds fibrosis to alveoli, or thickens the diameter between alveoli and alveolar capillaries will cause low DLCO. +8
305charlie94  Actually polio is one of the restrictive lung diseases that have a normal diffusing capacity for carbon monoxide (FA 2019 p.661) +

 +0  (nbme23#15)
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mousie  Equation is Maintenance dose = (concentration at steady state) * (Clearance) if you convert all the units to what it wanted them in (mg/kg/day) you'll get 25.92 like weird-in said above I didn't think to round 0.09 to 0.1 of course so I guessed 2.5 assuming I must have done a conversion wrong and was off by a tenth .... BOO bad Q +4
hyperfukus  OMG ME TOO!!!!! +




Subcomments ...

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docred123  So do these patients have h.Flu? What was the giveaway? Thanks +1  
mousie  I chose Enveloped simply bc it said dies when heated, not sure if there where any other clues to narrow this down or make me feel more confident in my choice but I went with it anyway +16  
eclipse  I don't think they expected us to narrow down the answer to a specific virus. Enveloped viruses tend to be less stable (?) than the non-enveloped ones and don't survive as well under harsher environments (outside human's body, heat, etc.) +2  
peridot  To add on, I also have no idea what virus this could be but the question stem does say "A previously unidentified virus is recovered from urine specimens" making me think that it's not something we're supposed to have know about, unless I'm totally understanding it wrong. +1