Remember the tip that you can use clindamycin for anaerobes above the diaphragm, and metronidazole for below.
My silly mnemonic...
Schizotypal: are your archeTYPAL weirdos (no offense to anyone, just a mnemonic!)
Schizoid: like to avOID people/attention
AvoidANT: generally wANT to like people/attention
"During strength testing the patient has pain and weakness with abduction, particularly with simultaneous shoulder internal rotation"
This is a descriptive way of describing Neer's impingement sign, which is a (fairly) specific indicator of shoulder cuff tendon impingement; the most commonly impinged tendon of the rotator cuff being supraspinatus of course.
Lol I was stupid and put increased serum cholesterol concentration because I thought that the fluid loss would lead to a concentration of substances in the ECF (e.g. like how dehydration can trigger gout). RIP.
Of all these viruses, Hep B is the only one that a child, if infected, would be a chronic carrier. Thus we should screen to make sure that we can prevent future risk of cirrhosis, etc.
You do not need to memorize a formula to know this, as long as you know the units (which are SO much easier to remember as they are intuitive). The answers are mostly clearance and steady state, which means you can cancel units to see if the answer choice makes sense.
For example, since CL has units of L/min and Css has units of mg/L, then (A) works out because L/min x mg/L = mg/min which is the correct units for infusion rate.
Whereas (B) CL/Css would not work because those units would be L/min / mg/L = L^2/min*mg, which does not make sense.
So if you just cancel some units, you can answer many of the questions.
Huge disclaimer: this won't work with things like half-life, because there is a factor of Ln(2) that has no units, so you have to memorize formulas that have factors before them.
I tried to use logic to answer this question (I did not know about the hexosamine pathway). Here is my attempt--this is probably wrong somewhere.
I figured that if you want to make glucosamine, you need to combine glucose + an amine group
(A) Arginine I knew was involved in donating nitrogen, but it is in the urea cycle, so I figured this was probably not the answer but it had potential. I figured that the major way this compound removes its nitrogen is through urea, though.
(B) ATP. Since F6P already has the phosphate group, I figured ATP is probably not necessary as the compound in question already has a PO4 group.
(C) Carbamoyl phosphate. I knew this was involved in both the urea cycle and nucleoside synthesis, so this was less likely. It also is the product of a NH3 and CO2 so that means that I wouldn't expect it to donate an amine group
(D) Glutamine I figured has an amine group attached to it ready for donation. I also know that transamination reactions are common with amino acids and alpha-ketoacids (e.g. alpha ketoglutarate with alanine can get you glutamate and a pyruvate via ALT) thus it made sense that an amino acid could donate an amine group.
(E) The only thing I knew about NAG was that it was used in the urea cycle as an allosteric activator of CPS, so I didn't think that it was useful as a donator of nitrogen since its function is to help aid nitrogen excretion.
So then I was stuck between A and D, but based on transamination reactions, I picked D.
Unfortunately, I chose (C) thinking that the down-regulation of receptors would lead to needing higher doses for efficacy (patient is using a patient controlled pump), however tolerance to miosis does not develop, and thus eventually this side effect would occur.
Could anyone point out where my train of thought is incorrect? I suspect that my assumption of the patient increasing their dose is not warranted?
I'm a simple man, I see encephalitis and temporal lobe involvment, I click herpes.
(A) aggregates of large atypical lymphocytes = infectious mononucleosis (CD8+ T cells responding to EBV infection in CD21+ B cells)
(B) Granulation tissue containing pseudohyphae and budding yeasts = candidiasis
(C) Intracellular yeasts in macrophages = histoplasmosis
(D) Macrophages containing acid-fast bacilli = mycobacterium
(E) Multinuclear cells containing intranuclear inclusions = cytomegalovirus (or most members of the herpesvirus family)
If more people have the disease in your population, then the chance of a positive test result actually being positive will increase -- more people have the disease, so you're more likely to be "right"
Let's say you didn't know methionine was essential.
(A) Alanine -- you can create alanine from the enzyme ALT (alanine aminotransferase), thus this enzyme cannot be essential
(B) Aspartate -- you can create aspartate from the enzyme AST (aspartate aminotransferase), thus this enzyme cannot be essential
(C) Glycine -- this one is low yield, but it is made from serine (serine + THF -> CO2 + Me-THF + glycine). If you didn't know about this, you had a 50/50 shot
(E) Tyrosine -- you can create tyrosine from phenylalanine (unless of course you have phenylketonuria), and thus this cannot be essential.
Perhaps this is an incorrect way of thinking about this, but I always associate the virulence of Strep pneumo to its capsule, but I only associate the K capsular antigen of E. coli to meningitis (recall that E. coli has other specific virulence factors like fimbriae for UTI).
So basically, I figured that the capsule of Strep pneumo is involved in more disease processes (MOPS) than the capsule of E. coli (mostly meningitis), and thus I chose Strep.
mnemonic: schizOID (avOID companionship) vs avoidANT (wANT companionship)
Perhaps I under-thought this questions, but it is highly unlikely to have HYPER- of anything when consuming large amounts of water, because whatever ion is present is going to get diluted. So in the case of normal gap acidosis from diarrhea, yes there may be an initial hyperchloremia, but the water is going to dilute it out.
Between hypoglycemia and hyponatremia, it is more likely to be hyponatremia because the child had seizures
SIGECAPS criteria: (1) feeling weepy/overwhelmed, (2) fatigue/irritability, (3) anhedonia, (4) difficulty sleeping, (5) "I feel guilty...", for a period of 6 weeks = meets the criteria for a depressive episode, and since this was in the post partum period, may be post partum depression.
Next best step is to screen for suicidal ideation/thoughts of harming the child.
First sentence of the stem: he has a 6-week history (e.g. >2 weeks) of depression (1), difficulty sleeping (2), fatigue (3), decreased appetite (4), and poor memory/concentration (5)
For a diagnosis of MDD, you need a 2 week history of 5 of the SIGECAPS symptoms which he meets (he is only missing suicidal ideation and interest in activities). Thus he meets the diagnostic criteria for a major depressive episode, which means that treatment is indicated with an SSRI.
For the other cardiovascular factors, the only ones proven to improve mortality are statins, ACEi, BB (esp. carvedilol in heart failure), and spironolactone. None of those were answer choices, so MDD treatment was the best choice.
Patient has low serum sodium = hyponatremia.Given that the patient has a LOW URINE OSMOLARITY, it suggests that ADH is NOT active. The only way for someone to have hyponatremia AND a low ADH (in this case) is through psychogenic polydipsia (e.g. if it was SIADH, the urine would be MAXIMALLY concentrated and it is NOT in this case)
(A) would cause central DI -- no ADH means one develops hypernatremia as free water is lost in the urine, thus concentrating the serum.
(B) osmotic diuresis could cause hypernatremia due to loss of free water in the urine
(C) degradation of ADH leads to DI which means one develops hypernatremia
(E) resistance to ADH (nephrogenic DI), again, hypernatremia.
To expand on this, what we think happens with Parkinson's disease (and parkinsonianism) is an imbalance between dopamine and acetylcholine. It makes more sense if you look at this diagram, paying particular attention to the indirect pathway. Loss of dopaminergic (DA) neurons from the substantia nigra (SNc) results in constant activation of those ACh secreting neurons, which ultimately results in inhibition of thalamus from initiating movements. Therefore, using anticholinergics help with parkinsonianism secondary to haldol.
The patient has a prior history of hysterectomy with bilateral salpingo-oophorectomy, and received external beam radiation to the pelvis. The patient now displays hydronephrosis and hydroureter, with distal ureteral narrowing bilaterally. The likeliest option is that we are seeing adhesions from previous surgery constrict the ureters, causing this.
E) Urothelial carcinoma (also called transitional cell carcinoma) is also a possibility. What makes this unlikely is the location: bilateral. The prior hysterectomy and bilateral salpingo-oophorectomy would leave scar tissue on both sides of the body, but the odds of urothelial carcinoma arising bilaterally are very slim.
A) The patient had a hysterectomy, so the odds of recurrent cervical carcinoma are also incredibly low. C) and D) Urethral condyloma and urethral transitional cell papilloma are in the wrong location to account for bilateral urethral narrowing with hydroureter.
https://en.wikipedia.org/wiki/Proofreading_(biology)
Here is a little bit on proofreading.Hope it helps
Ritonavir inhibits CYP450! So you can use it to boost the concentration of the other Protease inhibitors by preventing their metabolism by CYP450!
always remember them in order with formula, SITS=AEEI
and the two on the END are AD-DUCTION
Per FA (pg. 636): Concerning breast cancer...
"Amplification/overexpression of estrogen/ progesterone receptors or c-erbB2 (HER2, an EGF receptor) is common; ER โ, PR โ, and HER2/neu โ form more aggressive."
why does treatment of hypothyroid (with levothyroxine I'm assuming) increase risk for myopathy? I chose it simply bc its a common adverse effect of statins but I don't really understand how treating hypothyroidism at the same time would have anything to do with it ??? help please!
In an elderly patient with isolated elevated alkaline phosphatase (normal serum calcium and phosphate) Paget's disease of bone should be at the top of the differential. This disease is due to dysregulation of osteoclastic and osteoblastic activity; first an initial osteoclast hyperactivity phase, then increased osteoblast activity for a mixture, then osteoclasts "burnout" leading to over-mineralization and sclerotic bone plaques. In addition, this can create arteriovenous shunts in the bones which decreases resistance, leading to high output cardiac failure (a similar problem can arise in arteriovenous fistulas from blood dialysis). On histology it will have a "mosaic" pattern.
A)- Aneurysmal bone cyst- largely a product of hyperactivity of osteoclasts, this occurs more often in the limbs, and shows a cystic space with balloon-like dilation. B) Angiosarcoma- angiosarcoma of the bone is n almost purely lytic lesion. They occur more frequently in younger people. C) Niacin deficiency- I can find nothing about vitaminb B3 deficiency involving bones. B3 deficienct results in pellagra, with the classic Three D's- dermatitis (rash necklace on C3/C4 dermatome), dementia, and diarrhea. E) Osteosarcoma- Found almost exclusively in younger people, this bone growth occurs at the growth plate, particularly at the proximal end of the tibia, distal end of the femur, or proximal end of the humerus (in the long bones around your knees or at your shoulders). It shows a large, solid growing mass that may raise the periosteum in a sunburst pattern/Codman's triangle. F) Prostatic carcinoma- rare for being one of, if not the only metastatic bone cancer that is purely osteoblastic.
the patient has asbestos which is restrictive (clue was pleural plaques) DLCO is decreased in intra-thoracic conditions (interstitial lung dz etc) and normal on extra-thoracic conditions (muscular issues)
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
Patient has polycythemia vera, as evidenced by erythrocytosis, granulocytosis, and headaches & diziness. EPO is decreased due to erythrocytosis. Decreased LAP would indicate CML, not PV.
There have been a couple of questions about this topic on the newer exams. Iโve been answering by equating libido to testosterone levels and nocturnal erections to health of vasculature (atherosclerosis or not). Is this correct?
So I think that issue of wrist extension and/or finger drop would be more radial nerve. However, there was more proximal weakness, so it would be C7.
"7-8 lay them straight", the pt couldn't "lay them straight" so it would be C7 root
How do you rule out Protein C deficiency in this case? doesn't that also increase risk of thrombosis and miscarriage?
THis question is just critical thinking. The adrenals are bilaterally and symmetrically small. All other answer choices are not likely to be even bilaterally. Cancer won't equally spread in perfect symmetry nor infectious causes while maintaining the adrenal architecture.
THis question is just critical thinking. The adrenals are bilaterally and symmetrically small. All other answer choices are not likely to be even bilaterally. Cancer won't equally spread in perfect symmetry nor infectious causes while maintaining the adrenal architecture.
So this patient is essentially in hypovolemic shock because he's hemorrhaging blood from the aorta.
A) You'd have increased ADH to conserve volume B) You'd have increased BUN:Cr ratio b/c due to a decrease in blood flow C) Increased TPR naturally due to less pressure on barorecptors D) Decreased Capillary hydrostatic pressure b/c they have decreased volume E) Decreased Carotid sinus firing rate b/c less pressure F) The Answer: RAAS is activated -
What do you use to treat Hepatic Encephalopathy? Lactulose. What does that do, it acidifies NH3 in the GI tract into NH4+ and promotes loss of the nitrogenous products that cause encephalopathy. This is how you remember this process.
Orlistat works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine.
Don't break things down in the intestines----> osmotic diarrhea
Apparently people use it to lose weight. Who knew. Not me
Wouldn't telling the patient about the referral do more harm than good?
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
(From UW 11852) Some medications including opioids, radiocontrast dyes, and some antibiotics (e.g. vancomycin) can induce and IgE-INDEPENDENT mast cell degranulation by activation of protein kinase A and PI3 kinase, which results in release of histamine, bradykinin, and other chemotactic factors -> diffuse itching, pain, bronchospasm, and localized swee=lling (urticaria).
bronchus obstruction traps oxygen in alveoli no nitrogen able to enter (atmospheric air entering body (78% nitrogen and 21% oxygen, nitrogen is so important nitrogen bc it is a poorly absorbed gas and thus is in charged of keeping alveoli inflated) oxygen in the alveoli is absorbed into the blood reducing the volume of the alveoli alveolar collapse absorption atelectasis
The whole "picks at the lesion...causes some bleeding", made me think Psoriasis. Should have gone with Actinic Keratosis based on the patient history (lots of sun exposure).
Actinic Keratosis
Premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules or plaques. Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia.
R Lower quadrantanopia = C/L Parietal Lesion/MCA via Dorsal optic radiation.
If top quarter was gone, then it would be C/L temporal lesion via meyer loop.
Secondary hyperparathyroidism (usually d/t chronic renal failure).
Lab findings include โ PTH (response to low calcium), โ serum calcium (renal failure), โ serum phosphate (renal failure), and โ alkaline phosphatase (PTH activating osteoBlasts).
I think that if they had something like "statin therapy" as an answer choice, we would have an argument for that as it would decrease mortality by helping prevent ANOTHER heart attack. However, I think that anti-depressant therapy will do a LOT to prevent suicide, while omega-3 fatty acids (healthy as they are) wouldn't do AS MUCH to prevent a heart attack.
The question is basically asking, "You can only prescribe one of these to keep this dude alive as long as possible. Which one will have the best chance at accomplishing that?"
Therefore, the answer should be anti-depressant therapy.
Encapsulated organisms run rampant in patients who have no spleen, whether physically or functionally. (Recall the wide-array of sequalae sickle cell patients experience thanks to their functional autosplenectomy.)
This question is bullshit. The woman would most likely be vaccinated to Strep pneumo, especially if she had a splenectomy.
E coli is also an encapsulated bacterium that causes pneumonia, so that is more likely IMO.
These always tripped me up:
+ Polydipsia= responds to water deprivation, low serum Na
+ Central= responds to vasopressin, high serum Na
+Nephrogenic = responds to nothing, normal serum Na
This is a hypoplasia of the pleuroperitoneal membrane. The guts herniate into the thorax, usually on the left side, and result in hypoplasia of the lungs (because they're horribly compressed).
The maneuver described is known as Finkelstein's test, which is meant to be specific for DeQuervain tenosynovitis.