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Welcome to drjo’s page.
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Comments ...

 +0  (nbme19#35)

no family history of neoplasia and unilateral neoplasm suggests sporadic form of retinoblastoma (vs germline (familial) form which is associated with bilateral retinoblastoma and osteosarcoma

in the sporadic form mutation occurs at the site (retinal cells) vs germline (familial) form mutation occurs in germ cells

 +0  (nbme16#30)

This (late bee sting rxn) is describing an Arthus reaction (localized Type III HSR) + IgG immune complexes accumulate at site --> mast cell degranulation --> Neutrophil recruitment + IgG immune complexes also stimulate macrophages to release inflammatory cytokines (IL-1, IL-6, TNF-a) and chemokines (IL-8) --> Neutrophil recruitment result in edematous indurated lesion

Timeline for arthus reaction bee sting: 1-8 hours, generally: 6-12 hours vs Late phase Type 1 HSR 2-4 hours

Subcomments ...

submitted by ergogenic22(303),
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olCo dna laep txeireimste relsu otu ditviusbitre sseuac gen,(iocruen ,ihaxnaasypl csi).pte

ovicHoelymp wlodu deicesbr a cpersos of mvouel lsos b(deengil or rydaie)ntodh nda ouwld nto xanleip hte lckcaser ro gaujrul ienv ei.intdossn

no'td eb owhntr ffo yb eht lanrmo treah .sosudn

baja_blast  Raise your hand if you were also thrown off by the normal heart sounds. +6  
jmd2020  I think this question is poorly constructed. Cardiogenic shock would result in an INCREASE in SVR - this woman's BP is 70/40... +1  
drdoom  @jmd2020 low BP does not mean the SVR isn't increased — it /is/ increased! it's just that the heart is so effed up that even massively increased SVR is not enough to maintain good pressure +2  
drdoom  another way to explain: imagine you are losing blood volume at a constant rate (someone punched a tube into your aorta and draining you like a pig); at first, your heart would beat stronger (ionotropy) and faster (chronotropy) to maintain BP; at the same time, all your arterioles would constrict to maintain blood flow rates (and perfusion) to vital tissues ... but at some point you will have lost so much blood that all the ionotropy, chronotropy & SVR in the world could not save you or your BP .. your BP will plummet no matter what compensatory mechanisms your body has up its sleeve. +3  
drjo  Jugular venous distension clued me into cardiogenic shock (heart isn't pumping well resulting in back up) vs the others listed, esp since obstructive shock isn't an answer choice +  

submitted by skuutnasty(2),

after rabbit-holing this one for a bit.... this is the photo that demonstrates it best (to me, anyway). must be ilioinguinal n.


drjo  Ilioinguinal n. derived from L1 is mostly sensory supplying skin of upper and medial thigh root of penis & upper scrotum (males) **mons pubis & labia majora (females) it accompanies spermatic cord through superficial inguinal ring, great pic of this ^ @skuutnasty +  

submitted by ootscoot(11),

This guy has a normocytic anemia with evidence of kidney damage (increased Cr). According to UW, CKD can be assumed in a patient with high Cr and uncontrolled hypertension (which is evident in this dude that hasn't been to the doctor in years and has a 150/98 BP).

Also straight from UW: CKD is commonly associated with normocytic anemia 2/2 reduced production of EPO by the kidneys. Therefore, the most appropriate therapy is erythropoietin.

dhkahat  how do we know when to transfuse? +1  
destinyschild  I also thought about transfusing, but then thought that might cause iron overload since he's also getting iron supplements. I'm not sure if iron overload is a possibility w EPO. Please correct me if I am wrong +  
drjo  Transfusion is only indicated when hemoglobin is < 7g/dL & this tx is usually reserved for critically ill patients +  

submitted by drdoom(818),
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yilnIaibt ot naniaitm an cieeotnr = ecrlieet dnifcsutyno. So onw eht qstnioeu is "?Wh"y

iFaegt,u fflduiytic gine,slpe itlduficyf eacgoirntnctn si istgatrn ot uodsn ikle siseonepdr. iDucifly"tf gnentorcnca"it hmigt be eeretprntdi as pdarmiie ectevexui nifnctou or hte nigsgnbeni of arlvdaet-rsclaeu demeinta danmt(eie dlrteea ot lslam ubt eunrmosu belcraer sr,afni)tc btu on epSt 1 tidmeena ilwl eb nbtalta (, tl"so sih ayw ehm,o" g"ann",ewdir t.c)e.

sieenDospr is autalycl mmcnoo taefr a ntdgliaetbii veten klei ko,rtes as oyu tgmhi .xcteep hWti npreesidso cmoes a osls fo eaxslu etsrtien nda heisrtade—t si ddeearcse lbiiod.

One cna meak eth utmgnrea htat a cuaasvl"r tai"etnp itmhg ehav emso ssuesi htiw shi ppi"se" rcteseslsrior(oi,a ypattm/mryacthstascaeiipeph icnyuso)tfnd d,na ofr tihs asen,ro atnuclonr ectiroen suhlod be arcdedees; tub tneo hatt ntonhig is tnndeieom atobu nnaodntliggs- uslravac eesasid n(o hx fo tiyn)rs.epeonh

sA a e,tlsru teh tbes enswra ocechi ereh is C. Lioib(d aeeedcsrd but aorunltnc cesitroen )ornam.l heT big isunqoet I aevh si, who eht ckeh oeds hits ygu kwon 'ehs rdha when s'eh ?e!p!alse :p

cbay0509  thank you +1  
ilikedmyfirstusername  there are several UWorld questions about psychogenic ED with the answer being normal libido and normal nocturnal erections, idgi +10  
djeffs1  Yeah NBME says its C, but I still think with a recent stroke you can't bank on normal nocturnal erections... +  
drdoom  @djeffs nocturnal erections happen at the level of the spinal cord (S2–S4)! a “brain stroke” (UMN damage or “cortical damage”) would not kill your ability to have nocturnal erections! +  
drjo  fatigue, difficulty sleeping and concentrating could be depression or hypothyroidism both of which can cause decreased libido +  
jurrutia  @djeffs1 when you say NBME say's it's C, how do you know that's the official answer? Did NBME post the answers somewhere? +  
djeffs1  in the versions I purchased from them they highlight the correct answer in the test review +