welcome redditors!to snoo-finity ... and beyond!
Welcome to dr.xx's page.
Contributor score: 39
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Comments ...

 +2  (nbme23#35)

right. he absolutely must remain in the waiting area so that he is at hand to attack his wife whenever her exam ends. go NBME!

meningitis  I guess it was all about not offering battering information in order to not make matters worse since he will figure out that the wife told on him.. Also, its a HUGE STRETCH but the only reason I thought he should stay in the waiting room was just in case the wife died they could detain him and call the police for questioning.
temmy  Also, he should stay there because his wife did not grant him the permission to see him. Patients requests trumps.
nephcard  Doctor should not believe what wife told her. There may be some other reason for injury so batttering information should not be provided. But her wish of not letting her husband in should be fulfilled
charcot_bouchard  No. In real life patient lies. In Board ques they always tell the truth. Unless they make it very obvious. in fact its a board ques rule. So u believe her untill proven otherwise.
drdoom  The prevailing rule of American medicine and law is individual autonomy. No other person is granted “default access” or privilege to another person’s body—that includes the physician! The physician must receive consent from a (conscious) “person” before they become “a patient”. In the same way, the person (the patient) must give consent before anyone else is permitted to be involved in her care, spouses included!

 -3  (nbme23#48)

... that and a psych consult for the schizo mother...


 -1  (nbme23#33)

Abuse of laxatives => usually decreased serum potassium. As to chloride and bicarb, that depends. They could be increased or decreased.

https://www.aafp.org/afp/2004/0315/p1530.html


 +1  (nbme23#49)

Treatment of acute gouty arthritis Several drugs are effective for terminating the acute gouty attack. Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are standard approaches. Adrenocorticotropic hormone (ACTH) is also very effective, but has become increasingly scarce or too expensive to be a practical alternative in the US. Regardless of the particular agent chosen, the sooner these drugs are started, the more rapid the response. If a patient cannot take NSAIDs or colchicine, the choice is among oral, intra-articular or parenteral glucocorticoids. Local application of ice packs may help control pain. In some cases, analgesics, including opioids, may be added.

Drugs that affect serum urate concentrations (E.G., ALLOPURINOL), including antihyperuricemic agents, should not be changed, started, or stopped during an attack, as this may worsen the inflammatory response already in progress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/

nwinkelmann  Love the last quote/sentence from the article! So helpful for clinical decision making!

 +1  (nbme23#45)

SSRIs produce a sustained increase in extracellular 5-HT in the dorsal raphe (DR), and this leads to autoinhibition of serotonergic neurons.

http://jgp.rupress.org/content/145/4/257

davidw  Pg 483 in firstaid has a good table of where the neurotransmitters work

 +0  (nbme22#31)

The most important waste product is ammonia (NH3). This small molecule crosses the blood–brain barrier and is absorbed and metabolised by the astrocytes, a population of cells in the brain that constitutes 30% of the cerebral cortex. Astrocytes use ammonia when synthesising glutamine from glutamate. The increased levels of glutamine lead to an increase in osmotic pressure in the astrocytes, which become swollen. There is increased activity of the inhibitory γ-aminobutyric acid (GABA) system, and the energy supply to other brain cells is decreased. This can be thought of as an example of brain edema of the "cytotoxic" type.

https://en.wikipedia.org/wiki/Hepatic_encephalopathy#Causes


 +0  (nbme22#49)

Medication dosages should be titrated promptly to achieve effective pain control.

https://www.aafp.org/afp/2000/0201/p755.html


 -3  (nbme22#25)

The β-cells have evolved a mechanism to detect the amount of insulin stored and secreted and adjust insulin synthesis accordingly. A granule transmembrane protein called islet cell autoantigen 512 (ICA512), is a crucial part of this feedback control. Insulin granules travel a long distance on tubulin tracks before arriving at the peripheral actin network [125]. Before becoming linked to the cytoskeleton, insulin granules are anchored to actin cortex via ICA512 and β2-synthrophin. Upon activation, the granule membrane fuses transiently to the cell membrane to release insulin. Elevated Ca2+ levels in the meantime activate the protease μ-calpain to cleave away a cytosolic fragment from ICA512. The free ICA512 cytosolic fragment then moves to the nucleus and binds to the tyrosine-phosphorylated transcriptional factor STAT5 to prevent STAT 5 from dephosphorylation, which in turn upregulates insulin transcription [127]. Nuclear free ICA512 cytosolic fragments also bind to sumoylating enzyme PIASγ. The sumoylation of ICA512 by PIAS γ reverses the binding of ICA512 to STAT5 [127]. Hence, the release of insulin from secretory granules is communicated to the nucleus, which serves as a positive feedback mechanism to initiate insulin translation for maintaining an adequate amount of stored insulin.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934755/


 +1  (nbme22#6)

The t test is one type of inferential statistics. It is used to determine whether there is a significant difference between the means of two groups.

https://researchbasics.education.uconn.edu/t-test/


 +2  (nbme22#45)

As part of embryonic development, the pancreas forms as two buds from the foregut, an embryonic tube that is a precursor to the gastrointestinal tract. It is therefore of endodermal origin.

https://en.wikipedia.org/wiki/Pancreas#Development

gh889  nice! I reasoned it as that most of the GI system is of endodermal origin

 +1  (nbme22#34)

Epstein-Barr virus (EBV) is carried by most humans. It can cause several types of cancer. In healthy infected people, EBV persists for life in a "latent" state in B cells.

https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004906


 +1  (nbme22#12)

The four types of hydrocephalus are communicating, noncommunicating, ex vacuo, and normal pressure. Diagnosis is typically made by physical examination and medical imaging.

Hydrocephalus ex vacuo also refers to an enlargement of cerebral ventricles and subarachnoid spaces, and is usually due to brain atrophy (as it occurs in dementias), post-traumatic brain injuries and even in some psychiatric disorders, such as schizophrenia. As opposed to hydrocephalus, this is a compensatory enlargement of the CSF-spaces in response to brain parenchyma loss; it is not the result of increased CSF pressure.

https://en.wikipedia.org/wiki/Hydrocephalus#Type


 +0  (nbme22#46)

Inability to walk cannot be explained by medical evaluation. ==> Conversion disorder


 +1  (nbme22#43)

Hereditary angioedema. Type I and II are caused by a mutation in the SERPING1 gene that makes the C1 inhibitor protein.

https://en.wikipedia.org/wiki/Hereditary_angioedema


 +1  (nbme22#1)

CHF patients often display signs and symptoms of increased vasopressin secretion.

hyperfukus  if all else fails i hope i just drill this one statement in my brain and it comes out in the right way on test day thank u!!!

 +1  (nbme22#18)

Pubertal gynecomastia is thought to be a physiological phenomenon, and is most commonly seen in midpuberty with Tanner stage 3–4 pubic hair and testicular volumes of 5 to 10 mL bilaterally.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706045/


 +2  (nbme22#23)

Hypovolemia is a direct loss of effective circulating blood volume leading to:

  • A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia
  • Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction
  • Rapid and shallow breathing due to sympathetic nervous system stimulation and acidosis
  • Hypothermia due to decreased perfusion and evaporation of sweat
  • Thirst and dry mouth, due to fluid depletion
  • Cold and mottled skin (Livedo reticularis), especially extremities, due to insufficient perfusion of the skin

https://en.wikipedia.org/wiki/Shock_(circulatory)


 +0  (nbme22#21)

The most common and severe form of autosomal dominant polycystic kidney disease (ADPKD) results from mutations in PKD1, encoding polycystin-1 (PC1)..

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348948/

yotsubato  Here we thank FA for failing us yet again. Giving us PKD1, but not polycystin. I got the question right but I just guessed it because nothing else made sense.
usmleuser007  Autosomal dominant polycystic kidney disease 1) occurs in patients with mutations in the gene (PKD1) encoding polycystin-1 (PC1). 2) PC1 is a complex polytopic membrane protein expressed in cilia that undergoes autoproteolytic cleavage at a G protein–coupled receptor proteolytic site (GPS). 3) A quarter of PKD1 mutations are missense variants, though it is not clear how these mutations promote disease. 4) GPS cleavage is required for PC1 trafficking to cilia. 5) A common feature among a subset of pathogenic missense mutations is a resulting failure of PC1 to traffic to cilia regardless of GPS cleavage. 6) Missense mutation in the gene encoding polycystin-2 (PC2) that prevented this protein from properly trafficking to cilia. 

 +0  (nbme22#12)

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency

wutuwantbruv  Can't be 17α-hydroxylase because this would present with hypertension and some sort of ambiguous sexual presentation (males) or lack of secondary sexual development (females). Can't be 11β-hydroxylase because this would present with the opposite of the kid's presentation due to the production of 11-deoxycorticosterone (similar effects to aldosterone but not nearly as potent). The other two would not really make sense since there are increased levels of 17-hydroxyprogesterone.

 +2  (nbme22#42)

Severe, rapidly evolving disseminated intravascular coagulation (DIC) causes thrombocytopenia, depletion of plasma coagulation factors and fibrinogen, and bleeding.

https://www.msdmanuals.com/professional/hematology-and-oncology/coagulation-disorders/disseminated-intravascular-coagulation-dic


 +0  (nbme22#2)

Fibrates decrease triglycerides by reducing the production of VLDL.


 +0  (nbme21#17)

More fully: Afferents to gastric varices. The afferents to GV come from left gastric vein, short gastric veins and posterior gastric vein the left gastric vein mainly contributes to formation of cardiac varices whereas the short gastric vein and posterior gastric vein contribute to formation of fundal varices. Isolated gastric varices are more likely to be related to gastroepiploeic veins.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940321/


 -1  (nbme22#5)

Normal respiratory rate for a 10 month old > 50 breaths per minute.

Naloxone should be given in the presence of respiratory depression and may require repeated dosing.

https://www.ncbi.nlm.nih.gov/pubmed/28506439


 +1  (nbme22#20)

MRI is highly sensitive, specific, and accurate in the detection of AVN.

T1-weighted images: AVN most often presents with a crescentic, ring-like or well defined band of low signal within the superior portion of the subchondral femoral head bone marrow. This band is thought to represent the reactive interface between the necrotic and reparative zones, and typically extends to the subchondral plate.

http://radsource.us/avn-of-the-hip/


 +2  (nbme22#47)

The hallmark of ITP is isolated thrombocytopenia.

https://emedicine.medscape.com/article/202158-workup

jboud86  Refer to page 419 in FA2019.
hello  @dr.xx Compared to what?

 +1  (nbme22#13)

During this initial encounter, we establish what the parents' concerns are, obtain a family history, and ask about previous medical problems. This begins the transition from parent to teen as the medical historian. We next ask parents to wait in the waiting room so that we can speak privately with the adolescent. We interview the adolescent alone, perform a physical examination with a chaperone, and then invite the parents back into the room at the conclusion of the visit to discuss our findings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070800/


 -2  (nbme21#9)

Henderson-Hasselbach Equation: pH = 6.1 + log(HCO3 / (0.03 * PaCO2)); so here, pH = 6.92 => Acute (uncompensated) primary respiratory acidosis, with metabolic acidosis

sbryant6  calculator can't do logs yo.

 +2  (nbme21#49)

Molluscum contagiosum is caused by a poxvirus called the molluscum contagiosum virus (MCV). In about 10% of the cases, eczema develops around the lesions..

https://en.wikipedia.org/wiki/Molluscum_contagiosum


 +3  (nbme21#7)

Among the most prevalent hematologic abnormalities in patients with rheumatologic disorders are the anemia of chronic disease (ACD), a mild anemia that is generally asymptomatic, and iron deficiency anemia.

In iron-deficiency anemia, the TIBC would higher than 400–450 mcg/dL because stores would be low.

Patients with RA occasionally have concurrent iron deficiency anemia and ACD. When this occurs, the hemoglobin level usually drops to below 9.5 g/dL, and the MCV is less than 80.

https://www.uptodate.com/contents/hematologic-manifestations-of-rheumatoid-arthritis

sympathetikey  Got the right answer too, but man, that whole "1 month after starting therapy" almost threw me off.

 +0  (nbme21#38)

Paclitaxel stabilizes the microtubule polymer and protects it from disassembly. https://en.wikipedia.org/wiki/Paclitaxel#Mechanism_of_action


 +0  (nbme21#43)

In most individuals infected with M. tuberculosis, mononuclear cells in the blood release interferon-gamma when stimulated with antigens derived from M. tuberculosis.

https://www.uptodate.com/contents/use-of-interferon-gamma-release-assays-for-diagnosis-of-latent-tuberculosis-infection-tuberculosis-screening-in-adults


 +1  (nbme21#47)

hereditary hemochromatosis.

HFE is mutated => the intestines perpetually interpret a strong transferrin signal as if the body were deficient in iron. This leads to maximal iron absorption from ingested foods and iron overload in the tissues.

https://en.wikipedia.org/wiki/HFE_hereditary_haemochromatosis#Pathophysiology


 +0  (nbme21#32)

Bleomycin is known to cause lung and skin toxicity due to relative absence of hydrolase in skin tissue resulting in decreased metabolism and delayed clearance. Pulmonary complications are common but skin changes are rare and include hyper-pigmentation, plaques, hyperkeratotic lesions, erythema multiforme, alopecia, stomatitis and nail changes. The exact mechanism of skin changes caused by bleomycin is not known. The treatment involves management of underlying disorders or withdrawal of the offending drug.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003049/


 +0  (nbme21#40)

Structures within the outer (lateral) wall of the compartment from superior to inferior: Oculomotor nerve Trochlear nerve Ophthalmic and maxillary branches of the trigeminal nerve Structures passing through the midline (medial) wall: Abducens nerve Internal carotid artery accompanied by the Internal carotid plexus

https://en.wikipedia.org/wiki/Cavernous_sinus


 +1  (nbme21#17)

Gastric varices are fed by the short gastric veins.

https://www.sciencedirect.com/science/article/pii/B9781437707748100764

cienfuegos  Add'l UW fun fact is differentiating from gastric varices 2/2 PHTN: Gastric varices: can also be seen w/ splenic vein throbmobis 2/2 chronic panceatitis, pancreatic cancer and abdominal tumors - gause gastric varices only in the fundus (remainder of stomach and esophagus usually not affected vs. PHTN: increased pressure in left gastric vens thus both gastric and esophageal varices)

 +2  (nbme21#6)

In sarcoidosis, hypercalcemia normally suppresses the release of PTH and therefore the production of calcitriol (1,25-dihydroxycholecalciferol), but in sarcoidosis and other granulomatous diseases, activated mononuclear cells (particularly macrophages) in the lung and lymph nodes produce calcitriol (1,25-dihydroxycholecalciferol) from calcidiol (25-hydroxycholecalciferol) independent of PTH.

https://www.uptodate.com/contents/hypercalcemia-in-granulomatous-diseases

dr.xx  ~~In sarcoidosis,~~
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that.




Subcomments ...

submitted by sattanki(31),

Muscle pain + periorbital edema is a classic presentation for trichonella spiralis. Best diagnosis for this is a muscle biopsy, as the wormy likes to hangout within the muscles.

sympathetikey  That's what you get for killing polar bears. +11  
dr.xx  That's what you get for not cooking them well. +  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +  


Fibronectin is an extracellular matrix glycoprotein, while lamin is an intermediate filament that specifically provides support to the cell nucleus. Don’t confuse lamin with laminin (science hates us clearly); laminin is like fibronectin, an ECM glycoprotein and a major component of the basal lamina of basement membranes.

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +2  
dr.xx  blasphemy @masonkingcobra +  


submitted by neonem(251),

Falling on outstretched hand: scaphoid is most common one to be fractured, lunate is most common to be dislocated. Lunate dislocation can cause acute carpal tunnel syndrome.

Think of the mnemonic "Straight Line To Pinky, Here Comes The Thumb" for the bones of the palm, drawing a football shape starting below the thumb MCP joint adjacent to the radius, then moving to your medial wrist, and then back to the thumb.

Scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium. The lunate looks like it's posteriorly dislocated here.

sympathetikey  Yep. I didn't even look at the X-ray. +1  
dr.xx  loonies love lunate +1  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +  
wes79  i legit have no idea whats going on in that xray lol +1  
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +  
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +1  
doctorevil  She Looks Too Pretty, Try To Catch Her is a mnemonic that works for me. +  
niboonsh  Some Lovers Try Positions That They Cant Handle +1  


submitted by m-ice(122),

The patient needs medical attention immediately, which eliminates obtaining a court order, or transferring her. A nurse does not have the same training and qualifications as a physician, so it would be inappropriate to ask them to examine the patient. Asking the hospital chaplain again could be inappropriate, and would take more time. Therefore, the best option among those given is to ask the patient if she will allow with her husband present.

sympathetikey  Garbage question. +17  
masonkingcobra  So two men is better than one apparently +5  
zoggybiscuits  GarBAGE! ? +  
bigjimbo  gárbágé +  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +1  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +1  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +5  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +5  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +  


I treated this like Werdning Hoffman/SMA ("tongue fasciculations"), and just kind of accepted it being weird to be in a 55-year-old.

dr.xx  SMA4 (Adult-onset)? +  


submitted by yotsubato(255),

This is a question about patient privacy. The patient here is the child. The proxy for the patient is the mother and father. They must know whats wrong. Sister and mother are just lookyloos, and parents may not want to tell them (stupid I know, but whatever) so you send them out and then tell the parents the situation.

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +1  
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +  


submitted by lfsuarez(65),

First heart sound (S1) is generated by two heart valves: the mitral valve and tricuspid valve. Nearly simultaneous closing of these valves normally generates a single S1 sound. Splitting of the S1 sound is heard when mitral and tricuspid valves close at slightly different times, with usually the mitral closing before tricuspid

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +4  
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts. +2  


submitted by nlkrueger(6),

.... would we really take the word of a friend who definitely can't be confirmed? I feel like this is misleading

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +2  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +3  
dr.xx  The patient has no wife, children, or close relatives... +  
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +  


submitted by mousie(82),

Can someone please explain this to me? I don't understand why starting the other drug would not count as exclusion criteria?

seagull  This has to do with Intention-to-treat analysis. Essentially, when participants are non-adherent but the data shouldn't be lost. They just undergo another statistical model to account for their changes. Here is a nice video https://www.youtube.com/watch?v=Kps3VzbykFQ&t=7s +6  
dr.xx  Where does the question mention "intention-to-treat"? +  
notadoctor  They seem to be pretty obsessed with "intention-to-treat" it's been asked in one way or another in all the new NBMEs that I've done. (Haven't done 24 as yet) +2  
wutuwantbruv  They don't, intention-to-treat is just the best way to go about it @dr.xx +  
smc213  Great for ITT: https://www.youtube.com/watch?v=Kps3VzbykFQ +  
yex  I agree with @notadoctor !! +  


submitted by chris07(12),

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 +  


submitted by meningitis(150),

Process of elimination on this one.

  • I eliminated Carbomyl phosphate, Arginine due to urea cycle.
  • I eliminated ATP because ATP alone wouldn't change F6P into glucosamine
  • NAG I got lucky and I eliminated it due to its use in ECM and collagen so I didn't think it was relevant and I kind of remembered it being in urea cycle.
dr.xx  you mean, pure luck? :) +7  
impostersyndromel1000  lol pretty sound logic here mate +  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  


submitted by marbledoc(0),

What is this medication being described here? Can someone chime in.

thatyummyslice  Nitrates i believe! NO --> increased cGMP in vessel smooth muscle --> myosin light chain dephosphorylate --> vascular smooth muscle RELAX --> Dilate (primarily in venous) AKA more venous capacitance --> LOWER preload and workload for heart. +2  
marbledoc  Thanks! Thought it was nitrates too from the Q stem. But had no clue it was notorious for headaches (only thought of hypotension, dizziness, etc) so doubted it all together. But you’re absolutely right apparently it’s the most common side effect! +  
dr.xx  Previously, Ferid Murad et al. described that organic nitrates, such as nitroglycerine, induce vasodilation by release of nitric oxide, activating soluble guanylyl cyclase and subsequent cyclic guanosine monophosphate formation.7 These discoveries rendered Robert Furchgott, Louis Ignarro, and Ferid Murad the Nobel Prize in Physiology or Medicine in 1998. https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2085806 +  


submitted by nosancuck(34),

Dam son this lil b got some UMBILICATED Molluscum all up in her bizness

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  


submitted by moloko270(30),

this is Wallenberg syndrome - stroke caused by obstruction of PICA - so thats why we get symptoms of dysphagia, hoarseness, absent gag reflex (p. 502 FA)

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already +  
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this. +1  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +  


submitted by mcl(202),

Homegirl got some cervical outlet syndrome and should probably take some stuff out of her backpack or get one of those lil roller ones.

mcl  Whoops, my bad, THORACIC outlet syndrome +1  
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +  


submitted by iviax94(5),

CT shows mass on the left side of his abdomen and you’re told it’s intussusception. Asks which part of the GI tract is most likely to cause the pain. I immediately looked for ileocecal junction ... not an answer choice. Why is the answer jejunum (vs. duodenum)?

liverdietrying  The picture is key here. You’re right that ileocecal is most common, but ileo-ileal and jejuno-jejunal are the next most common (I think I might just know this from having done clerkships already, not sure). Ileo-ileal isn’t an answer, so that rules that out. Look at where the arrows are pointing in the picture as well. Its on the L, ruling out appendix and cecum. And the slice is not at the level of the duodenum, ruling out that answer. So by process of elimination based on the picture you could get this one too. +2  
dr.xx  Duodeno-duodenal intussusception is a rare because of the retroperitoneal fixation of the duodenum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529645/ +1  


Hereditary (or acquired) angioedema = C1 inhibitor deficiency. Patient has a 9-year Hx of soft tissue swelling, especially of the face. It's Autosomal Dominant if inherited, or can be acquired through multiple mechanisms.

https://www.ncbi.nlm.nih.gov/pubmed/11532278

dr.xx  wrong question? +  


submitted by nosancuck(34),

Dam son this lil b got some UMBILICATED Molluscum all up in her bizness

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  


submitted by lnsetick(33),
  • APocrine = your armpits smell like an APE
  • ceRUMen = there’s no ROOM in your ears since they’re full of wax
  • EC-CRYne = when you ECercise, your pores are CRYing
  • SEBaceous = SEBum is SEEPing out of your pores
hungrybox  as an ape i'm offended +9  
dr.xx  stop being an ape. evolutionize! +5  
dbg  as a creationist i'm offended +  
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +  


submitted by nosancuck(34),

you know how it is deez bois got dat facial FLUSH due to external stimulatin

dr.xx  please use standard English. I cannot understand a word of what you are saying. +3  
aishu007  FA pg 468, facial flushing due to external stimuli like spicy food. InAammatory fac ial skin disorder characterized by erythematous papules and pustu les 0 , but n<> comedones. May be associated with fac ial Rushing in response to external stimu li (eg, alcohol, heat). Phymatous rosacea can cause rhinophyma (bu lbous deformation of nose). +1  
madisonivy  https://madisonivy.online/ +  
madisonivy  madison ivy +  


submitted by dr.xx(39),

In sarcoidosis, hypercalcemia normally suppresses the release of PTH and therefore the production of calcitriol (1,25-dihydroxycholecalciferol), but in sarcoidosis and other granulomatous diseases, activated mononuclear cells (particularly macrophages) in the lung and lymph nodes produce calcitriol (1,25-dihydroxycholecalciferol) from calcidiol (25-hydroxycholecalciferol) independent of PTH.

https://www.uptodate.com/contents/hypercalcemia-in-granulomatous-diseases

dr.xx  ~~In sarcoidosis,~~ +  
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +  
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +