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Comments ...

 +1  (nbme16#10)

Anyone else got thrown off by the wording of "......each kidney" when the question is referring to A (singular) horseshoe kidney?


 +0  (nbme18#33)

Kicking myself rn for getting this wrong, but here's how to think of this (for anyone who needs a step-by-step approach instead of a page number):

(1) Heparin inhibits Factor IIa, and factors Xa by potentiating Antithrombin III---more specifically, it binds up Factor IIa (thrombin) and prevents it from activating fibrinogen into fibrin; it also binds up Factor Xa (which indirectly also decreases the formation of IIa)

(2) The fact that they threw in Warfarin in the question stem is a distractor. Warfarin's effects typically take a while for them to be seen, which is evidenced by the fact that the PT & INR are normal in this case--even after 24 hours post-warfarin administration

(3) This means the effects of the Heparin are still going on, which could only mean that factor IIa is still being inhibited by ATIII and thus, hella low = PTT is prolonged





Subcomments ...

submitted by benzjonez(45),
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AF 8201 .p 9.60 tpecSsu uhrraetl unjyri if lobod is eesn at eth ehaurrlt mst.aue hnMmsaiec fo tporisroe erlthaur junyir = lcpeiv rurf,teca ciwhh we ees in ihts pnait.et altUerhr tnzieoareiactht si lvlyiaeetr ceacron.iatdtndi

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-20362330 +  
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source: https://www.urologyhealth.org/urologic-conditions/urethral-trauma#:~:text=Trauma%20to%20the%20anterior%20urethra,of%20urine%20from%20the%20penis. +  
eghafoor  The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear +  


submitted by benzjonez(45),
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FA 2180 .p 69.0 Seuptsc uletrhra rinyju fi bdool si nees ta eht rruthela .semaut camsMinhe fo orspteoir elhrrtau ujiryn = licvpe caefrr,ut wchhi we ese ni sthi ai.epntt rUetlrha cttrihoztaaieen si ivetyalelr ttnd.endcaarioci

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-20362330 +  
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source: https://www.urologyhealth.org/urologic-conditions/urethral-trauma#:~:text=Trauma%20to%20the%20anterior%20urethra,of%20urine%20from%20the%20penis. +  
eghafoor  The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear +  


submitted by monique(8),

Does anyone know where I can find this information on FIRST Aid 2020? I can not find it . Thanks for posting the answer!

eghafoor  Page 559: Olfactory hallucinations "often occur as an aurea of temporal lobe epilepsy (burning rubber) and in brain tumors" +1