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Comments ...

 -17  (nbme18#34)
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hisT si strpe oneup,m iwhch sha laaph ylssoimhe neegr)(

breis  How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin* +2
mjmejora  its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy. +6
rthavranek  Once again, another example of me knowing the concept but not knowing the obscure pseudonyms for common knowledge so I get the question wrong +
dtransistor  I saw green and immediately thought of pseudomonas and crossed that answer out. Didn't know they were talking about alpha hemolysis! +

 +10  (nbme18#45)
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Des"epti nhiniioitb fo oMGCA-H escteuadr by itsts,na sellc oemeanctps by ninesicarg emezyn xenpesoirs areelsv .dofl e,Hovwer eht ttloa dbyo oelhosretlc is deerucd yb %–420%0 eud to dseincear nsreeopixs of LDL rptrseeoc eaftr atntis ainiti.sr"manodt

gbpml-/hmyaib:cltdirtmcers-rtsot-iyami.ei/tio/ustnocdwshiee.ccw-slgocwnaoeo//enoepc-cgch

md_caffeiner  fuck GoT, knowledge is power +
dhpainte22  Another bullshit question that should've been straight to the point. Statins increase ldl receptors and inhibit hmg coA reductase. This should be simple but nbme can't live with that :( +3
jurrutia  I think they want to test not just your understanding of how statins work, but also the basic principle that when you block X the body tries to compensate by upregulating X. +4

 +5  (nbme24#7)
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aePsh III aillcniC ralTi r(pe FA 9102, .p 5:)62 Lgrae enrbum of itntpase ynoldarm sdgaenis threei to eth tttameern endru gsivennttoiia or ot the dastrnad of arce or( clab.)poe

usmile1  also just to verify, there is no such thing as phase 0 right? +
madojo  Not that i know of or is in FA +
llamastep1  I've heard animal testing is called phase 0. +3

 +8  (nbme24#37)
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sradneeI"c doobl tacninoscntreo of n4dgbiTn-i bnolgl:ui TBG is noe of relaves iperosnt atht onrrtspta yitodrh neohomrs in lbd,oo nad sah teh hihesgt inatfyif fro 4T r(o)tiynhxe fo eht .ugpor sgoEesrtn lsamueitt esoepsnrix of GTB ni vlrei, dna teh mnoalr srei in neosegtr girdun cypnrange snueicd ygrhluo a iblngudo in resum TBG i."nresctortcaannot

dce"aersnI slleve of TBG dlae ot ldeeorw eefr T4 nnnoeoaictsrt,c hihwc lutsers ni tvdleeea STH eeiosrctn yb eht tuirtapiy ad,n lyoqcueen,tns eacnehdn outconirpd adn ncsreotei fo drtohiy ms.honero eTh ten feetcf fo edltavee GBT esistnshy si ot oefrc a ewn bumlquiiire bewtene erfe nad odunb dityrho ornhmseo adn tush a insigtincaf inrcaese ni tloat T4 nda 3T elle.sv hTe redsceani admdne ofr ohrityd mensorho is eeahrcd yb otbua 02 seekw fo tsentaigo and trsespis tunil mr".te

wthp/t/ii/hodtdroirpephwony:rhtm_oon/da.ysosg/ctads/o.ocevytlt.phbvlre.wkhiee/tuh


 +8  (nbme24#22)
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tIseenv"rna hte mlcssue fo the edaiml ocemtrpnamt of eht htihg uortb(taro et,nxeusr toraudcd lnsgu,o tddcoaru sib,rev toaurcdd agsmun adn "gcsaili.r)

atsmhnon/t/tnm:e/a-efwtes-lnveortt/bu/ebyhermrr/aeo.pvirlaoico

almondbreeze  FA 2019 pg 444 +2

 +3  (nbme24#32)
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Terhe si "a tderic niatoc fo iasimethn no eth hymciltap mhtoso musecl vai astuiliotmn of 1H a(dn ni some velsess )H2 tsc.ropere H1 rroscteep nenehca nad H2 trseeprco owls wnod plhtcyiam mniuppg, teh nmnaoitd fcetfe gbnei an ecdraiens niarotectlc vyii."ttac

r.4/.1.nhMe7pCctpwwii/hl8mvcnP/nw/3i/tgl5o:/4atbcms.s


davidw  If the Infarct was on the right side they you would have a decrease in PCWP +
usmile1  yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up. +6

 +0  (nbme24#7)
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otN a lflu awnsre tbu 'sit a rttas in( het xtcento fo na s)rtno:ibcuot i"tocOsntubr fo unrei owfl stsuerl ni an naecsier ni hascydoitrt serspersu xoiaplmr ot the stei of trbntosi.ouc It si tihs puduilb fo rspeesru taht lades to eht cnanacoypimg p,ina the itoisendtn fo teh icgelntlco sytmes ni the ned,iky and ldveetea luairuttanrb suresepsr htat teiitain tbrlauu tof.niusdync nI het ifstr ysad of tonu,btcrosi eth lditaoaint fo eth yloopr noalcpmti neglctilco tmsyse amy eb in.immal As eht eiacrsden yhrscadiott seepsrur is sedesexrp in teh iarrynu capse fo the ellurmoig, ftrureh ittalrfnoi esesaredc or tspos ltoee.ym"cpl (,arrsonH'is 0e,2 raeChpt 331)

trichotillomaniac  the key here is the term hydronephrotic kidney. anytime there is that, there is a post renal obstruction of some sort. The fact that he has progressive renal failure just contributes to the idea that his kidneys have seen damage before and are not able to withstand the pressure from the back up as well. I got tripped up on this. The important thing to note is that Hydronephrosis and dilation = back up = increased in volume pressure (hydrostatic) +5

 +2  (nbme24#25)
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Fro oemr sntaaionxpel nda uctrp:ies n-o-mpmlneoire:ltuaca/nrs/totrmaf-m-o-i/lassontaalea/i/eaonpm-amc-ote-aw/mommawscailrponr-helwean.mkia.ggfollol


 +7  (nbme24#40)
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ooyg"rslslhaT udtc cysts ostm onetf retpnes thiw a bpalapel caaimpomtsty endimil neck smsa yuuslal blewo 6[5% fo eht ]itme eht evlle fo the doyih n.oe"b

T"eh ltsgsoahlyro tctra srsaei mrfo the onemarf ecumc ta eth oictnnuj of the trnreiao w-titsdhor nad terrpisoo htnioe-dr of the ."ogteun

:iwwitikakssrs_tllsg/opodhy.ypei/.Teiangthco//r

dbg  Am I the only one who thought, my whole life, that it actually originates from the thyroid but just physically connected to the tongue +15

 +6  (nbme24#14)
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oopidi dwithawlar sxs FA( 9,012 p. 85)5 = sgatnew,i tlaided i,uppls eicioonpletr dclo“( ”ukr,e)yt airehron,rh ocia,rmnailt anwigny, eaanus, saoctmh csmra,p ehairard “fl(l”ukie- msmpsy”)ot


 +7  (nbme24#8)
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"icBfcnneeee sviovenl bganainlc teh instbeef fo emttaentr stganai eht ssrik adn socst vlve,doni asrwehe co-neenficmelna snmea igaovind het atocsnaui of rah."m

focsii--ihit-cscnfeif.ibrzs-npwn/hp-m-nmnaohhwtm-/-or/BT.eehpospdlinnedrorcpoea//tegemitelef:saoicDehp/n-tealeaawecrioreceununiacoeEl-cn


 +2  (nbme24#30)
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To urle tou DHISA epty: mu"eSr mousptisa rtntocecnonia yleralneg esinmar acn.udhnge enMvoetm fo soaipumts mofr the iltlulrcrneaa caeps ot het eallurlarxcte pseac tepnsvre naldoituil laeyophaki.m As eohdygrn sino emvo iltrnrcyl,lealau yeth rea xhgdnecea fro iussopamt ni oerdr to iaminant trioruaclye"nt.elte

mnu/-wehovtcropo0rial-atdle/p/stecp4tho6e/i-eewrmresmiai/eu-:i8idscttmn.wsa--ssrec-w-eet-amao5h-oon.3rcssetrifp-seoswanmy3pn8hdpsrfaosef62-iun-ddo

usmile1  Does anyone know if SIADH is associated with hypertension? I don't think it is due to the body's response of downregulating aldosterone, but if someone could verify that I would appreciate it. +
sunshinesweetheart  @usmile1 pg 579 FA 2019 = BP can be normal or high in SIADH +
usmlecrasherss  in SIADH GOLJAN says you have diluteonal hypokalemia +
tyrionwill  SIADH -> excessive ADH -> water retention -> atrium excretes more ANP, ventricule excretes more BNP -> water is excreted more. So that is why not too much plasma volume increment, resulting mostly normal BP. +

 +31  (nbme24#37)
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-nb"udteasldro sa.k.erebar. sucdea yb noinigiz ndiitraa,o gindicunl maagm ryas dan -.ysXar" v.s V"U nraiaiodt secusa owt lcseass fo NDA s:sloeni otelacucnyb imrnpdieyi imrsed (DCPs, geiurF 1) dan 6-4 uocptrpothdos -4(6 ,PsP riFgue )"2.

aastp4-ircmpnapni/gs/-c-etd/-coa4th.usawgncn3ifdeiba:nmiseeamlr/ow-aar-noe.nahmt/trimp-ditweag


 +0  (nbme24#9)
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oFr uPcrtis:e e2ecnrdel90/secitm#1c.-/lpeihontcc4cbi:d1./iatslp0aa/me9im


 +1  (nbme24#40)
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roFm AAP:F

ctu"Ae istoerparyr tssdires oseymndr is a onaaiimetnfts of acute njiyur to eth ,glnu monycolm unslgietr rfmo is,psse ta,ruma dna eersve pumonaylr tnincfseio. ilnl,Ciyacl it is hedrtzrciacae by yeap,sdn undrpoof ypiomxaeh, careeedsd ngul cnmpleaio,c nad diffseu liraelbat tlraeifints on ethsc ipogyad.r.h.ra

In ,RSDA eht njrieud nugl is bveileed ot go rtohhgu theer esa:sph xeuivadet, feiov,pitrlare dna fbicio,tr utb the rcsoeu of ehac shepa dan teh rvleoal saidese sogepnsrroi si al.veiabr nI het exdeuvait ,eshap agmdae to eht eolvlaar hmlpiuieet nda vucarals lnumhoteide euprodsc aelgaek of ea,wtr ,einorpt adn inamyrotlamf dna erd ldoob lescl tino eth ittutiesmrni dna lvreaola nl.eum eeshT hecnasg are uncddei by a xmlpoce ailryenpt of ryfamamrontoilp dna fttnniaalrayio-mm dremtsa."io

o5.phmrt1/21/pa/03s10ah.p0tpfl.5wfw/:wgt/a3/


 +1  (nbme24#30)
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A"n dods aorti fo 1 cintsidae atht the oondtiinc ro tenve ndreu dtusy si uleqyla eklyli to orcuc ni thbo upsrgo. nA odsd raoit treaerg tnha 1 edcsnatii thta eth coitndoni or etvne si meor llyiek to cocur in hte irsft gu.ro"p (rrwOadi:sppoiihdn/k/ikigw./ae_./dstteito)





Subcomments ...

submitted by xxabi(260),
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ARBs urlets ni eth ofwolilng ngcsah:e ncdraeesi enn,ir iserendac nAg I, eiranedcs ngA II, scadeeerd rtoseonaeld nad ahnugcend kyninibard

famylife  ...and just to clarify, they directly inhibit the Ang II receptor (AT1) https://www.drugs.com/mmx/losartan-potassium.html +2  
kpjk  I had a doubt- that wouldnt increased RAA lead to increased serum aldosterone as well. Now I understand that since the receptors are blocked- even the receptors to increase aldosterone secretion by Ang II would also get blocked... +2  


submitted by famylife(93),
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aesnreIv"tn eth scelums of teh eldima prtanoemmtc of eth ghhit ubratotro( srxtee,un rodudtca u,ogsln rtcdduoa brs,ive ctaudodr gausnm adn acl.iig)sr"

ewatnotrtis./nart/bnrb-omeprvy:ieoeoe/oscrlm/hhfmaa-lteu/ve/nt

almondbreeze  FA 2019 pg 444 +2  


submitted by bunye(10),
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hemlMcenysa eutssi can slao ernuodg ilapaats.me

A islsacc exemlap si msiisoyt ssicmninfsaio hwchi nvcetnieco issute htnwii lcesmu cegshan ot beon ngdrui iegnlah refta maratu - atPmaoh hC 1 gp 2

bunye  ossificans in which* +  
famylife  Images: https://www.google.com/search?q=myositis+ossificans&rlz=1C1CHZL_enUS753US753&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjytonS0dfiAhWMVN8KHaE2CUUQ_AUIECgB&biw=1368&bih=809#imgrc=tw9b-AqKfJOb7M: +  


submitted by beeip(124),
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uYo nca ese the fnmereneoaidot rrtsutuec ni hsit aigmda.r

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +8  
famylife  "When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version +16  
usmleuser007  really like the pubic hair.... +4  
nnp  why not spasm of external anal sphincter? +  
vulcania  After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam... +1  
ajss  I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam. +  
thisshouldbefree  this is the map ive been looking for +1  
mnunez187  I didn't choose spasm because the stem says there the rectal tone is normal +1