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Welcome to dubywow’s page.
Contributor score: 12


Comments ...

 +0  (nbme22#1)

Decompensated HF. Lack of blood flow due to failing heart -> lower BP -> increased ADH to increase blood pressure back to stable level. In DHF, ADH outpaces homeostasis of counteracting ANP & BNP. Thus, the term "decompensated". Associated with shortness of breath, edema (often of lungs).

This vicious cycle continues as body prioritizes adequate BP for survival, but it comes at the expense of overworked heart that must work harder and harder, ultimately exacerbating the heart failure condition.





Subcomments ...

submitted by lilyo(53),

I had the same question regarding this. I know that external hemorrhoids rarely bleed and internal hemorrhoids present as painless bleeding so in my mind I knew I was being asked about internal hemorrhoids. However, superior rectal--> inferior mesenteric vein--> portal vein, can anyone tell me why the answer was superior rectal and not inferior mesenteric?

dubywow  Because the wording sucks. It's a confusing way to word the question. I too was confused what direct tributaries was referring to and chose Inferior mesenteric because I suck and also because this question sucks. Really its asking where are the hemorrhoids? They are on/from the superior rectals even though those veins feed to Inferior mesenteric. +3  
drdoom  Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them). +5  


submitted by drdoom(658),
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uoY ahve ot thkni tbuoa tihs sinug teh encotcp fo ICNNTAOODIL .LTBPBIAYOIR nhoteAr awy to kas ihst yetp of neuiotsq is lkie th:si I“ wsoh uyo a nepitat itwh onossanuetp p.omtuaroehnx Whihc rehot ginht si tsmo ykliel to eb uret obatu atth nrs”o?ep rO uoy acn spahre ti ehset s:wya

  • nGive a DONONTICI (psoatnouens ouemnp), athw oetrh dgnifin si msot kilyel to be hte ?case
  • enivG a pool fo ppeoel twih otasepusnno er,ounahpxtmo awht ohrte hnigt is otsm ylkeil to eb etru oubat h?etm

nI hotre swdor, fo lal eoplpe woh edn up hitw stenaoounps munp,eo hte sotm omncom hoetr ighnt oubta tmhe is ttah they aer ALME ;ap&m H.TIN

If I aevg you a ebuktc fo saoospuennt upnmeo titaenps -- dna yuo drhaeec uroy nahd ni hteer nda edullp eon uot -- ahwt creianso owldu be rmeo :cnmoom In uyor dnah uoy heva a srmeok or in rouy nhad uoy ehva a niht ml?ae ’sIt eht raet.lt

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  


submitted by seagull(1134),
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heT tuhrsao twne tuo of ither way to nidf whet worts opoht of a agnmrlaou hety cuodl. The ehtrw no a tsme tath estgsugs that ti ulowd eb augnatornil .uitse Btu tlietl ddi we .oknw..

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +16  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4  
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +  


submitted by sunny(2),
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YWH TON dnSYEa, tenh arshe eth emony ithw teh eyiatnp so he toed'sn bdtou uryo oetsv.mi

ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment +  
ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment, which I don't know why that would be wrong +  
dubywow  Bribery is only good for doctors. Can't bribe patients. That's illegal. Kind of like how NCAA gets paid a lot, but student athletes get nadda. Still the TLDR is it always ethical to disclose financial incentives when they relate to anything that may affect your decision on how to treat a patient. +  


submitted by mcl(522),
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-te2Ba tsrecerop are eoudclp to Gs o,sernitp chwih ctiavtea dylnaely clecsay nad esraienc APMc. cCylci AMP hnte seeirsnac tyiavtci of prtoien snekia A, chhwi ahseohrltpspyo sniyom ilhgt anich esiakn, lltimayeut eigsnrltu in tmosho elsmcu enr.oialaxt buleol,Art a B2 agi,ntso is rohretfee esuflu in tgtrniea crsmha.pbnsoo

impostersyndromel1000  are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation? saw this on another Q with the nitrates causing headache so now im confused +  
dubywow  @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +1  
iwannabeadoctor2  cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +  
castlblack  cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +2  


submitted by hopsalong(23),
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Tihs teusinoq sah a otl of naserw oit,snop dan uoy reiavr ta erhoplaNssiihti yb hongritw out all eth toher oitpsno yb wtha si igsism.n

,A B - Ccitralo scsirNeo adn liplaayPr sorcsNei atloms asyawl rcouc in eth teisntg of iishame.c Psoleyriuv hltyeha 82 arye lod man sah no inedevec of gfacinltysini aeesrcdde rlena ipsonue.rf

C - Aeutc blruauT sicNrseo is athw ouy hdluso hiktn fo hiwt aeySiacllt ADNSI)( xotci.yit eherT era ymna hroet xotrnehocpi usdrg htat csuea N,TA btu htnki fo TAN sa rdgu iceddun inkeyd gdmea.a

D - styiiCts - kaFln apin si eelratd to ekdyin yin,ruj ont erbldad .amaedg Cysttisi odcul eb lbpesios in sgnindace ,UIT tbu hte peinatt sah on efvre adn is alem uh(cm sels nomcom in lmae).s

E - uGphotosmlrniierel - Tihs estg otin o/tpepncirrenitchih .enysmrdso heT mets etsimnno thta he hsa olodb in teh nueir iwhhc aym lead uoy wndo hte chnitprei yaw,hpat tbu he odes not veah yna fo the roteh daasiescto ypo.msmts

F - nrapryoheepHm - etrnohA wodr orf Ranel Cell iaCr.mcona No hetwig lsos or heotr anrcce ateerld stmmoyps iat(uefg ect.)

G - staIttlenrii ipsetihNr - Tihs si nfeto a drgu dediucn UNMMIE detdeaim pyoxorthietcni. ihTs is a ptye IV risyesphiventyti ocatneir htta rcsocu kwees ot sotmhn featr het ttrsa of oidmtniace lie(k DsNAIS.) TNA is orem deisaocsta hiwt ugdr sdeorveo hweli atItslrtniei si omre itassaodce hitw euminm itrncoea. lretinitasI iNietrsph lilw vahe CBW tacss ni nr.uie

I - eonPripltyiehs - aesdCu yb cnaengdis UTI but no refve si tpes.ner

hsiT veaesl hiahiortNspleis H() as hte orectcr srnew.a 58% fo ihtsNiirahsleop si adtsisaeoc htiw oecpyhviat oewbl nos.uds heT pnai rfo taihiisesropnlh can lpeaesr nda ,mreit dan oicsyaclaonl hte pani can teralv rfom het edikny klfa(n aipn) to eht crostum as eht eostn ovsem hhgtuor teh r.rteeu

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +2  
hyperfukus  yasss +  
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +3  
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +  
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +  


submitted by keycompany(267),
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gotNrnei ecnaabl is a smeueatmrne fo protnei biemalmsto in eht bd.oy A gveetnia ongiertn neaalbc diiaecstn mlcseu s,sol sa ncasreedi nouamts fo aomni sdcai aer eginb detzbeiloam ot couerpd enrye.g iTsh riaencses hte tnmoua fo ntogerin eeedrtcs ofmr eht o.dyb Bcseaue the nautmo fo nntgreoi ouy era igantk in si lses naht teh tnamou fo orinegnt oyu ear eentsrgci, yuo hvae a ievgnate rnonegti beaclna.

sihT anm is iush,meldnoar e,sautdome ,htaeccic nda hsa hoinilmbmyu.paea hTese nlliacic ginnsifd ointp ot pnreiot imiruoanttnl w(ahrakoisK iDae)ess, cwhhi esuacs emaed ude ot ededacesr usmre cctnooi ep.rssuer oLw occtino rerspseu ni htsi ceas si ued to ptoienr ,sslo and eench a ivtaneeg engtrino nlaabec.

drdoom  Nice! +8  
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3  
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +3  
zevvyt  also, it says that his albumin is low. +  


submitted by sbryant6(133),
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hpniornamayriagoC whti siolicCfncaait and roltehoeCls talrssyC (tli-oormo .)dulif Rtanemn of Rasethk' pouch. toN to eb soucfend wiht tuiparyit naadeom.

dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +