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If you're asking how to rule out diabetes insipidus, I think it's because:
Diabetes insipidus is caused by a lack of ADH effect, so they will be peeing out too much water, thus making them dehydrated and hyperosmolar (thirsty). This CHF patient is presenting with signs of fluid overload
The mneumonic for B1 selective antagonists: "A BEAM"
Its the action of PDE inhibitors. They inhibit PDE = increase cyclic compounds. Doesn't effect NO.
*alpha chain is on chromosome 16, beta chain is on chromosome 11
And it dramatically increases lifespan in experimental animals! Human trials in progress!
Neutrophils sequestered in recipient lung are triggered by donor antigen (e.g., anti leukocyte IgG), which causes release of cytokines, inflammation party in the lungs.
be kind to yourself, doc! (it's a long road we're on!)
Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency?
I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency
maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well.
Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me...
It's a B12 deficiency
Ileum is where B12 is reabsorbed, folate is jejunum
The blood smear is showing enlarged RBCs
Methionine synthase does this conversion, using cofactor B12
Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia.
Thanks NBME, that really helped me....
the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption.
I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF
Leave it to NBME to find the palest macrocytes on the planet.
@at0xibolic, I think you won this competition on finding better picture lol thanks
yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole.
Drink vodka man , either way you're dying
Or if you really wanna get drunk and have a warm place to sleep, drink a bunch of methanol in the waiting room of the ED, then let them pump you full of ethanol and keep you safe.
How are you supposed to remember which S is which?
@drzed "Supra" = on top, so the 1st S is for supraspinatus.
according to Physeo :
wow, sugapulm, that mnemonic is gold. you are gold.
If it was a woman would be a dysgerminoma. Seminomas have excellent prognosis and highly radiosensitive. MCC testicular tumor
Spunky fun fact:
In a normal adult male >1,000 sperm are made per heartbeat.
Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments.
So, Cholera is also p2p but Mening is more likely?
in cholera people to water => water to people
Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person.
but the poop water comes from people so....
Respiratory dropplets is easier than fecal-oral tho
Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals
I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis.
To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly).
this is all irrelevant. the dude is having an MI so the answer is Thromboxane A2
Bruh, you gotta read all the 2008 papers. It was a fire year for obscure shit you need to know in 2020.
you're definitely not alone lol
And its not in FA, so fuck it IMO
I guessed it because the names sounded similar :D
I also guessed because both words start with "glu")))
same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle.
Not a clue. This was so random.
this made me feel a lot better.
also, no fucking clue
My immediate thought after reading this was "why would i know this and how does this make me a better doctor?"
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.
yea, I mature 30k anki cards to see this bs
I literally shouted wtf in quiet library at this question.
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
Is it biochemistry? Then I do not know it.
I Ctrl+F'd glucosamine in FA and it's not even there lol
i definitely guessed, for some reason got it down to arginine and glutamine
I did not
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 no idea!
Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing
no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle
just adding in to say, nope.
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
Will TB be the answer if they'd mentioned the patient from developing world?
Autoimmune adrenalitis aka addisons disease → adrenals atrophy
1. developing world: TB
2. Western world:autoimmunne
FA 2019 page 334
I think the cancer reference (C) was with respect to an ACTH secreting tumor, which would symmetrically and bilaterally HYPERTROPHY the adrenals
^Just kidding, it says metastatic. My bad!
So do we just have to memorize this...
@yotsubato Not necessarily. I can't remember a formula to save my life. The Css is the amount you want in the blood. The clearance is the fraction removed per unit time. Since we want to maintain a steady state, we only need to replace what is removed.
Thus, maintenance dose = amount present * fraction removed.
I remember CLoCk Time as in check the clock time to give the next dose
Cl = clearance, C = concentration and T = half life. I have never had to use F.
This is on p. 233 in FA 2019.
Where do you guys learn that cooing starts at 2 months? It isn't in first aid or boards and beyond so this was an annoying question for me
@pg32 From being a parent! Otherwise little chance I'd remember all these milestones.
I'll get right on that @drshmoctor :). If only I could have a kid to memorize all these damn developmental milestones. That would make life easier haha.
Yeah, I don't see cooing anywhere.
thankfully a lot of my friends on insta keep posting pics/vids of their babies reaching milestones so im well updated lol
Mnemonic: "Coo at Two"
FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face.
via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." https://www.medscape.com/viewarticle/773465
I guess that's another reason for steroids and doping up.
For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation.
F U testosterone! and F U NBME 22 question
I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy:
Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine?
Yeah, I got this one wrong with the same logic as you, aesalmon.
I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines!
@emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase
Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice.
Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy.
I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time.
@lilmonkey can you please give the QID for the UWorld question?
Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall.
Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. P.s:it struck me as a romantic relationship as well, but it doesn't clear my doubt😓😭
@jakeperalta Following the hospital policy is wrong because it would be cruel and unnecessarily rigid to deny a dying woman the comfort of her closest companion. Also, It would be inappropriate to ask the Pt to lie.
What's the point of becoming a doctor if you have to follow some BS corporate policy instead of calling the shots and doing right by your patients?
Ya kinda dumb that usually NBME usually tells us to never break the rules, yet here it's suddenly ok. But here the reason for this exception is that while only "family" is allowed, a lesbian relationship qualifies the "friend" as family (they just were never officially acknowledged as family/married due to stigma or state laws, which society recognizes today is dumb and outdated). It's a stupid technicality that her significant other isn't allowed to visit as a family member, so while we usually never want to break rules, this scenario follows the "spirit" of the rule. Plus it's a really extreme scenario where the woman is dying and just wants to spend her last moments with her loved one and it would be too cruel to deny someone that. There is no lie involved, which kinda leaves open the chance for the situation to be cleared up if worse comes to worst. This is different from E which is a straight up lie. Hope that helped.
Yes, he does explain very well how both cellular swelling & fat accumulation occur.
... which is exactly why this question is some chicken vs egg BS.