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Welcome to focus’s page.
Contributor score: 27


Comments ...

 +6  (nbme18#17)

So we already know the answer is either 11- or 21- Betahydroxylase. How to determine which one?

Question stem cells "dry mucous membranes". He is dehydrated.

We already know that he can't make aldosterone since the lack of either of these enzymes would block that pathway. However, if he is able to make a molecule that ACTS like aldosterone, he would not have dry mucus membranes. He could save water.

Do we have such a molecule? YES! 11-deoxycorticosterone.

Now, if he has 11-beta hydroxylase deficiency, there would be a buildup of 11-deoxycorticosterone. Hence, it has to be the other option.

focus  Not to mention, 21-hydroxylase is the more common one! +2
boxboys  also increased 17-hydroxyprogesterone is a marker for 21-hydroxylase deficiency (FA2020 p 335) +
boxboys  also increased 17-hydroxyprogesterone is a marker for 21-hydroxylase deficiency (FA2020 p 335) +

 +1  (nbme18#43)

Petrolatum is a compound found in sunscreen.

He started working outdoors AKA getting sunburns (if left unprotected, lower lips are one of the prime locations where people can develop squamous cell cancer later on). He should really use sunscreen, which is a barrier (absorbs the UV rays so the skin does not-- rather than deflecting the sun rays.)


 -2  (free120#4)

reaction formation "in psychoanalytic theory, a defense mechanism in which unacceptable or threatening unconscious impulses are denied and are replaced in consciousness with their opposite. For example, to conceal an unconscious prejudice, an individual may preach tolerance [...]"

https://dictionary.apa.org/reaction-formation


 +0  (free120#36)

"The drainage pathways are as follows: (a) upper rectum: through the superior rectal nodes to the inferior mesenteric nodes, (b) lower rectum: from the lower rectum through the middle rectal nodes to the internal iliac nodes, and (c) anal canal: through the mesorectal (also known as inferior rectal) nodes to the inguinal and femoral nodes."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664281/

armageddon_oh  FA 2020: pg.366 USMLE loves them hemorrhoids. +
cheesetouch  fa2018 p360 +

 +3  (free120#38)

A mnemonic I use:

cohoRt - R for risk case serIes - I for intervention case contrOl - O for outcome

"Cohort study A study in which a defined group of people (the cohort) is followed over time, to examine associations between different interventions received and subsequent outcomes.

Case series Observations are made on a series of individuals, usually all receiving the same intervention, before and after an intervention but with no control group."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513097/

Case control "[...] an outcome of interest is first defined and then subjects are selected with (cases) and without (controls) the designated outcome. The investigator then looks back in time to compare the two groups for a risk factor or other exposure or treatment of interest. Therefore, the case-control study design is inherently retrospective."

Source: https://academic.oup.com/neurosurgery/article/84/4/819/5237441


 +0  (nbme23#36)

http://bangmuin.xyz/somatosensory-and-motor-cortex/

focus  Also, remember: "The anterior and middle cerebral arteries provide the postcentral gyrus blood supply.[12] The anterior cerebral artery is responsible for perfusing the medial third of the postcentral gyrus, while the middle cerebral artery perfuses the lateral two-thirds of the postcentral gyrus.[12]" https://www.ncbi.nlm.nih.gov/books/NBK549825/ So if the question was asking for the blood supply to this region instead, it would most likely be the MCA. +




Subcomments ...

submitted by focus(27),

So we already know the answer is either 11- or 21- Betahydroxylase. How to determine which one?

Question stem cells "dry mucous membranes". He is dehydrated.

We already know that he can't make aldosterone since the lack of either of these enzymes would block that pathway. However, if he is able to make a molecule that ACTS like aldosterone, he would not have dry mucus membranes. He could save water.

Do we have such a molecule? YES! 11-deoxycorticosterone.

Now, if he has 11-beta hydroxylase deficiency, there would be a buildup of 11-deoxycorticosterone. Hence, it has to be the other option.

focus  Not to mention, 21-hydroxylase is the more common one! +2  
boxboys  also increased 17-hydroxyprogesterone is a marker for 21-hydroxylase deficiency (FA2020 p 335) +  
boxboys  also increased 17-hydroxyprogesterone is a marker for 21-hydroxylase deficiency (FA2020 p 335) +  


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nMya aorl ycativ isnl,seo ylaepsliec ryilenarot usch sa eht pti of teh ou,gnet rdain itrsf to unamlebts neosd l(evle .)1 gOhlanaperyor SCsC smot moolmcyn nirda to vllee .2

llamastep1  https://www.youtube.com/watch?v=bwVQWwDjw5A quick review,ignore the bad music +1  
focus  If you scroll down on this link, the first image is pretty good https://www.sciencedirect.com/topics/medicine-and-dentistry/submental-lymph-nodes +  


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Blood ta het tueams si teh dre lgaf (ees htwa I ddi hete?r) rof elratuhr ju,riyn hwcih lshodu be deeultvaa fro twhi a garoerredt tmhru.aerogr eTh rbeammusno teh smto mlmocony rejndiu by u.artcefr nI t,nsaotcr het oygnps trarheu si toms illkye ot eb rduiejn girdnu cittarmua tehctera einrtnsio ro in a ltrddsea ryun.ij

canyon_run  Should we just assume that a pelvic fracture implies a membranous urethral injury? I was between membranous and spongy and I ended up choosing spongy because of the perineal bruising and fact that the patient was riding a motorcycle (and therefore susceptible to straddle injury). +  
benwhite_dotcom  Yes. You should think of spongy as the penile urethra, hence the predisposition to catheter-related trauma. +6  
focus  Diagram: https://www.earthslab.com/anatomy/urethra/ +  


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larO icevles thi(n )ih.nt ingtislreB aveslicru loiesn on eth an.hd No everf, not niei.c-xrgoptpaa hTsi si eeHspr you( may rrembeem itdessnt ignettg icetprhe iotwlwh ni uryo esid,tus icwhh si atwh hsit i.s) ostM kslof etg S1VH sa hin,celdr ugthoh bvooysiul not lal aer pmcoyttima.s VHS is a ergla use-btedd,dnolra rleian NAD .iurvs

jiya   why cant this be hand foot and mouth disease cause of coxsache +7  
drachenx  Also thought it was Hand-foot-mouth an RNA virus but I did consider Herpes. Changed because I thought Hand foot and mouth would be more common. +  
llamastep1  Hand foot mouth usualy involves all 3 places (hands, feet and mouth/perioral area) and the lesions on the hand arent localized to just one finger. +2  
aneurysmclip  Hand foot mouth disease affects palms and soles. ref: FA 2019 - 150 +3  
raffff  wouldnt the history also be different for coxsakie +  
focus  I think this image is trying to show the "dew drops on a rose petal" sign on Hermes, the god of Herpes on Sketchy Micro +1  
drpee  Google some images of HF&M disease. The small blisters look very different from herpetic whitlow. +  
drdoom  ^ ... some images of HF&M disease ... +  


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sihT utsqeion is aigkns rfo eht arlvcaus uypspl fo eth otyaidrhpar sndlg.a Taht dwluo be eth iionferr yoihrdt s,ieaterr whchi ieras morf het ctvoyherlcria n.uktr

weenathon  I originally chose vein because I was thinking maybe the hormone release couldn't be carried to the body anymore, but looking back the working of "moderate hemorrhaging" and vessels requiring ligation is what implies it's an artery. Just throwing that out there in case you thought like I did. +2  
cheesetouch  if you were clueless like me (well I knew artery but..), picking one with 'thyro' in the name when discussing a thyroid surgery is a good guess :) +3  
cbreland  I'm really out here picking one of the answers with vein +  


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The wrradoe luifd si andcoenit in a escpa niebdh the sacmtoh utb in nfrto fo eth oeotrrnrtelpeai tuecrtruss (..eg the sne,cpaar) i.e. teh sselre as.c



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etnEillhoad itthg ntsijco’nu atlriybepiem is draseeicn ni resepson to nyrjiu adn aloi,amnimftn niawglol itmngrioa fo wetih boldo clsel adn fsrnedi to hte esti fo nju.yri

jesusisking  Thank you! +  
focus  Ugh I was thrown off by "disruption of vascular basement membranes" since it seemed similar to the correct answer but I can see how "separation" would be a normal, expected response of the body that is needed vs. "disruption" would be traumatic and abnormal... please correct me if I am wrong! +1  
blah  @focus reasoning sounds right. I nearly picked that but the other choice sounded better. Just semantics. +2  


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’Dotn tle meth ndbli yuo ithw hsti intsteap’ e.sriym hTe esisu fo the yad is htta eh sah a D.TV sh’atT why he meac ot het ER in teh isrft netsncee nda tawh het ldtsunrauo hwoss at eth d.ne Psttaeni tiwh crncea aer hllpoyaarbe.uceg

focus  LOL best explanation possible. +1  


submitted by dentist(50),
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fndou itsh sruep uulsef koob no amznoa bauot irdBCahd-iu cc(hke otu eht skci cer)ov

llamastep1  Thank you for that +  
focus  hahahahaha. DEAD. +  
anjum  I endorse clicking that link +1  
azibird  Hahahahahahaha, that's a must click. Someone please buy it and let me know. +  
chediakhigashi  hahahaha +  


submitted by sajaqua1(520),
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ehT tpeniat wrnuendte alorvem of a latrec routm ihwch dha nlotevvmnie htwi hte .tarostpe hTe tacpsorti pcaeusl is cihr with ensevr dulinncig hte lpicve phaccilnns ,nrvese a est of ettrmypaicapash nseerv orleibpnses rfo SNP mtuocinoa unerg.ltiao ctrsioneE rea a tyrpacheapmsita oiuctnf.n

A) Gray irma form teh ypehtitacsm ahc-in stnioceer are a yehaisptmprtcaa inc,ntouf not .ctitsphmyea iEsomnis fo mpesr si a chytpmaetsi nuitfocn, dan is dcrtidee by hte irrfeion gyhispoctar rnve.e C) ePdul-dna teh eludandp evner si a miacost rvene htta eericevs ieosntsna ormf het pi,nse otesrorip ,ocsumrt c,liiotsr dna bli,aa as lwel as bnegi relsspnboie orf some nveemomt fo teh pelciv foorl, adn ojeiaaucnt.l D) oeprSuri ysgrpciatho eenrv- a ypcttmiseha eer,vn sthi rietosntbcu to teh hgspatcoriy supxel dan aym losa otribtunec ot iytphseacmt rctnloo of .soneimis )E rnVatle eriam of S--4S2 sheeT mira encuitbort ot hte dludeanp eevrn.

focus  Diagrams here are pretty good too: https://obgynkey.com/introduction-of-pelvic-anatomy-2/ "Point, Squeeze, Shoot" Point- erection: pelvic splanchnic nerves (S2-4) Squeeze- emission: superior hypogastric plexus Shoot- ejaculation: pudendal nerve +  


submitted by sajaqua1(520),
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The tetnpai uerntnwed oramlve fo a actler outmr hchiw dah mivvtonelne whit eth aterptos. hTe prstoatic paceuls is cihr tiwh nsevre nlinicgdu hte ceivlp clspnhaicn ,reevns a ste of cpteiparmtyahas reesnv osleernispb for SPN umacnioto eio.nugtrla onEecstir are a tairyaptsehpmac fnoutcn.i

A) Grya mira fomr eht hecpaittmsy -anihc cnoetries rae a tsacymteirahapp ctf,innou ont hc.pstemiyat nmoiissE fo srmpe si a ahptciymtes n,uoftcin nda si dridetec yb the reoiirfn tgrysaipcho ern.ve C) uadd-nlPe the ndapudle nrvee si a saotmci nvere ttah veescrie ntosaesni frmo the spnei, reprsoiot r,uocsmt tloiiscr, adn iaa,lb as lwle as egnib ospslbniree for smoe mvoenetm of eht ivlecp oflor, dan oe.cijauntal )D upieSorr tipyoashgcr reenv- a astipythmec eenvr, itsh tubnrctsoie ot eht oytchapirgs xlsepu dan aym aslo oietcurbtn to cimtashetpy onrlcto fo miiosns.e )E leVrnat ierma fo -4S2S- hsTee iram cotrenbitu to eth elddanpu rvene.

focus  Diagrams here are pretty good too: https://obgynkey.com/introduction-of-pelvic-anatomy-2/ "Point, Squeeze, Shoot" Point- erection: pelvic splanchnic nerves (S2-4) Squeeze- emission: superior hypogastric plexus Shoot- ejaculation: pudendal nerve +  


submitted by yb_26(244),
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  • ininbgd ot the HMC lassc II oertcrpe dan rengiiggrt hte eerleas fo iynkcoste - uarniegssepnt

  • igndnib ot the ecruurasmuonl ocjiutnn adn vtinerpoen of ACh elrsaee - iolbumntu otinx

  • aeclgkob fo a nnbG-giiPTd nteriop nlugiesrt gin eht nimalatuocuc of AcMP - sprisestu xntoi

  • ocgeakbl of sntpapcyeir iihibonint of slainp oortm reeslfxe - tteansu xitno

  • roeieptvnn of tioernp sseitsnhy yb nbokcilg goltanoien fo eth leoptieppdy inhca - pdhrtaheii n,xiot sedoPsounma ansoaegriu itonoxxe A

thomasburton  Not sure I agree with the second one, M.O.A for botulinum is cleave of SNARE protein preventing pre-synaptic ACH release. Think the second one almost describes something like sux or some other deporalising nicotinic drug. +5  
humble_station  You are right but to get the muscle spasms, trismus & seizures it has to inhibit GABA & Glycine release from Renshaw cells Cleaving the snare proteins will cause paralysis +2  
texaspoontappa  tetanus->postsynaptic inhibition I believe +5  


submitted by drschmoctor(82),

B1-selective antagonists start with a letters A-M & end in -olol.

  • acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol

Nonselective antagonists (B1=B2) start with letters N-Z & end in -olol.

  • nadolol, pindolol, propanolol, timolol

Nonselective alpha & beta antagonists end in -ilol or -alol

  • carvedilol

  • labetalol

Source: FA 20 p245

focus  The mneumonic for B1 selective antagonists: "A BEAM" +  


submitted by drzed(206),

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.

focus  "The post-burn hypermetabolic response increases the metabolic rate to compensate for the profound water and heat loss severe burn patients suffer. Water loss approaches 4000 milliliters per meter squared burn area per day [38-41]. The body’s natural response to this insult, partially mediated by increased ATP consumption and substrate oxidation, is to raise core and skin temperatures 2°C above normal compared to unburned patients [42]. This response is similar to the response seen during cold acclimatization. In fact, patients that do not mount this response are likely septic and or have exhausted physiologic capabilities to maintain needed body temperature [43]." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776603/ +2  


submitted by yotsubato(974),
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onsruTnsfai tercosnai are teemaidd yb yTpe II stvhiipeynyiesrt eon.icatrs Tshee ccuor ude ot omefredpr iitedbsona htta nbid to teh oifnegr nenagti (BA uorgp no BC)R and edla to ysmheilso by KN cl.sel Tsih is a fmro fo noydbAti dnenetpde lrcauell yyitc.xcittoo

focus  Exactly! And among the blood transfusion reactions, per FirstAid: allergic/anaphylactic reaction: type 1 (we would see urticaria, wheezing, etc. Seen in IgA deficiency.) febrile nonhemolytic transfusion reaction: type 2 (host antibodies against donor HLA and WBCs) acute hemolytic transfusion reaction: type 2 (ABO blood incompatibility) TRALI: its separate category (donor antibodies against recipient neutrophils and endothelial cells) They specifically told us ABO incompatibility (despite the respiratory symptoms that could indicate TRALI) so we know this is an acute hemolytic transfusion reaction. +2  


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aaaliMr nac mpriia hepacit uocogeeisglsnne nda nca olsa moceusn soculge fro tis onw ltmoabice esanddm.

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +54  
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +8  
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: https://labmedicineblog.files.wordpress.com/2018/06/mal3.jpg?w=840 Life-cycle: https://www.cddep.org/wp-content/uploads/2017/06/malaria-life-cycle_4-1440x1080.jpg +1  
dul071  i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia. +  
curlycheesefriesguy  I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +  


submitted by mcl(583),
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hTis si a cnei kciqu erefhesrr fo htaw AUC i.s



submitted by nwinkelmann(285),
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rseH'e a GRTEA dvoei gplxeanini toadurnslu isfgndni fo enrgy.cpan 79:@5 is a aergt utprcei os raf ithw llabes of the okly asc, sialngateot sc,ka letfa e,olp dan i.amonn enO nitgh eth nepsor ninlpiegax dasi tath I tuhhgto wuold be dgoo to kepe ni nimd si that eth koyl csa olsko elki a oecrihe iensdi het igtlnetaaos a.cs ols,A tsih seit ash a cbnuh of uitpcrse sa lwl:e d/s.tsfaeuhedrmsli/tltpii=agrat-/?tcp/oaotsanerrs:rrieig.

zpatel  what video? +7  
usmlecharserssss  porn video how they make this embryo and yolk sac +1  
samsam3711  Shorter video that explains this pretty well: https://www.youtube.com/watch?v=01mMBDEthV8 +5  
focus  @samsam3711 that video is BOMB. Thank you!!! +  


submitted by gabeb71(44),
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heT ltaocepirsub csu,lem whchi is eno fo het lsmcesu hatt pmrcoesi hte ecpliv oofrl nda alyps na tpairnmto oelr ni btho fceal nectineocn dan ,naieedctfo si anltcoliy rattccenod nad innmstaai hte natclaoer naleg ta srte.

heer is a :tiepucr or-t4e0_c4twcsush2oeaa--ltiwnctssl-set.t-foe1i-vut-lik--7pfp/o-o8csehutar3dnott-sbtv.m9n/mp-n6d-re5wraoteu-e-loc--phhmtor-omh:--.hwgtcolhhfoanfortrcuae/_er

gh889  How do you differentiate this from hypertonicity of the internal anal sphincter? +1  
gh889  nvm. im dumb lol +  
qball  Uworld Q ID 17004 +  
focus  @gh889 I made the same mistake... fecal INCONTINENCE meaning she CAN pass stool-- in fact, way too well... more than we want. Hypertonicity of the internal anal sphincter would cause constipation-like symptoms. +2  


submitted by gh889(115),
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nRrfeergi to TRsNI dna RsNTIN as niymasat fo tartmteen

itsy:naaM ineervafz )(,INRNT voftieorn NI(R,T) and bimictertniea INT()R

ususmle  I guess he is asking about integrate,,,,, where his should be integrated into host dna to get replicated .. triple therapy includes. 2drugs NRTIs and other one is integrate +  
whoissaad  @ususmle NRTIs would still inhibit DNA synthesis since they mess with the reverse transcriptase which is needed to make viral DNA. +2  
thotcandy  @ususmle HIV triple therapy is 2 NRTIs/NNRTIs + 1 protease inhibitor. Plus, if her CD4+ cunt is already 60/mm, that shit is well integrated in her CD4 cells already, right? +1  
brotherimodu  I was confused because isn't HIV an RNA virus? +1  
focus  @brotherimodu yes and therefore it uses a reverse transcriptase +1  


submitted by sympathetikey(1258),
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niPa pam;& taetumerepr ifsreb ofr hte htgir side oemc ni no het aosdlr thgri isde, csros at eht eorrinat ewtih simocem,ur nda ravtle pu in eth hlmStiaconipa tcar.t

euaTl8/4A/mQtrtc/si9ln.6jgg-XWj2AI793XZlsBo3-ehsjulo9kkVneg/AAy/8AAr/ib.66rA-0g:4A64peIt12uhgos4/gtcmlp0GoHY-.the/o4-

focus  The diagram here is pretty great, too, for the spinothalamic tract (and it is presented side by side with the dorsal column for comparison): https://opentextbc.ca/anatomyandphysiology/chapter/14-2-central-processing/ +  


Anki Card I made: Vagina = {{c1::Stratified squamous}} Cervix = {{c1::Stratified squamous --> simple columnar (endocervix)}} Uterus = {{c2::simple columnar}} Fallopian tubes = {{c2::simple columnar}} Ovaries = {{c3::simple cuboidal}}

brotherimodu  For some reason I don't trust you +11  
focus  ^^^ haahahaha. Thankfully the patients aren't seeing these usernames +  


submitted by seagull(1424),
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hTe dgyurnneil mehscmnia si sulyual a mobelpr wtih viocenecnt sseiut deu ot a ckla fo ptey I cnllae.go hisT ucrosc ni ermo ahnt 0%9 fo cseas ude to nmsaottui ni hte C11LOA or L1A2CO ee.sgn eeshT geintec pemobrls era tfoen intiehedr rfmo a ssore'pn anteprs in na alaomoust dtaominn nnrmae ro coucr vai a enw otmuni.ta

kWi-i

l,Bicaylas ogdo gfin*** !kulc

focus  Picture of "wormian bones", just for fun: http://www.learningradiology.com/archives2010/COW%20432-Wormian/wormiancorrect.htm +1  


submitted by focus(27),

http://bangmuin.xyz/somatosensory-and-motor-cortex/

focus  Also, remember: "The anterior and middle cerebral arteries provide the postcentral gyrus blood supply.[12] The anterior cerebral artery is responsible for perfusing the medial third of the postcentral gyrus, while the middle cerebral artery perfuses the lateral two-thirds of the postcentral gyrus.[12]" https://www.ncbi.nlm.nih.gov/books/NBK549825/ So if the question was asking for the blood supply to this region instead, it would most likely be the MCA. +