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Welcome to frijoles’s page.
Contributor score: 10

Comments ...

 -1  (nbme21#30)

I chose E) because I was thinking androgen insensitivity syndrome. However, I realize the wording of the question is which HORMONE would be reduced and in AIS, testosterone levels would not actually be reduce.

To be clear though, AIS could have the EXACT same described presentation, yes? (46.XY with male genital ducts & female external genitalia) Just want to make sure there is nothing else that could have tipped me off. Thanks.

daddyusmle  Yup you got it. AIS is a defect with the androgen receptor in target tissues, not with the hormones. AIS has the same presentation: Genotypically XY but has female external genitalia and male internal genitalia. This is most likely 5-alpha reductase deficiency. +

Subcomments ...

submitted by cassdawg(575),

IgG can be aquired from the mother by crossing the placenta, but IgM cannot. Thus, the presence of IgM indicates that the baby has encountered the infection in utero and generated its own antibodies to the infection. So the baby has congenital CMV. (See FA2020 p105 for information on immunoglobulin isotypes)

NOTE: IgM is the first antibody formed in response to infection and for most serologies IgM presence will be indicative of ongoing infection.

frijoles  Why is the IgG up then? Wouldn't that suggest a resolved infection? I get that kid is infected but I figured the IgG was a false result and that it would explain the labs. +1  
nsinghey  Mother's IgG was transferred through placenta +  
305charlie94  Shouldn't the mother also be positive for IgM? I get that the baby has congenital CMV but I figured the mother should be infected as well to transmit the disease +  

submitted by cassdawg(575),

This woman has gout which is associated with hypertension and diabetes and attacks can be precipitated by diuresis (such as with furosemide). Negatively biorefringent crystals (uric acid crystals) are also characteristic of gout. Gout is associated with kidney stones (nephrolithiasis). [FA2020 p467]

frijoles  I don't see where it says that gout is associated with kidney stones. Gout is more commonly caused by underexcretion than overproduction, yes? And this patient has renal insufficiency, yes? So if anything, they have LESS uric acid in the urine and are LESS likely to have stones. It's the reason they have gout to begin with (because it's out of the urine and into the blood). This answer would make sense if the gout was due to overproduction but there is no evidence of that here. This isn't a very good question imo. Please lmk if I'm missing something here. +1  
jt263619  uric acid stones... +1  

submitted by m-ice(272),
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nI SADIH, teh sevexices HAD asuecs het cgnillceot cdut fo eth nieykd ot babosrer hgue osmuatn fo erawt htat it dlohsu molranly et.exrec Thta nemas htat the alsmap lwil nwo eahv umch reom eawtr lvteerai to losteu wl(o tll)omoaysi and teh rnuei illw eavh cuhm reom atsl eevlatri ot teraw (ehgirh al.lo)imyost

frijoles  So potassium does not become diluted in SIADH? +1  
ruready4this  I feel like I was overthinking this question so much for some reason!! C definitely makes the most sense but I was also wondering what would happen to potassium. Then I was thinking maybe the excess ADH would suppress aldosterone secretion and serum potassium concentration would actually be higher +1  
peridot  @frijoles Aldosterone can adjust the K+ levels: too much water --> less aldosterone --> no excretion of K+, so this helps retain the K+ to a normal level. However, less aldosterone also means --> more excretion of Na+, so the hyponatremia is not corrected. +  

submitted by chris07(43),
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edB gubs lsehtvmees rea tno nnwok ot be srricear fo sl,niles tub teyh acn levae ihytc bste.i hTe gril si eklyli to cscraht ehset ibest, abader eht nski, nad stuh ceeianrs het iskr fo a pthas ikns foniecitn n(csei ashpt usareu si eth msot mcoonm isnk enfonctii et)ngohap

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +6  
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1  
frijoles  So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich +7  
anechakfspb  @frijoles - Hey if it makes you feel any better I put HIV too, with my reasoning being that they feed on blood...and HIV is transmitted via bodily fluids. Whoops! +  

submitted by xxabi(224),
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srBc’oa hapais:a exvpirsees mroot( aspihaa) ihtw misgammatra t(ps aaerw ahtt ehty n’dto emka e)ssne - area skA inc’eeWr sha:aaip etrvpecei er(sos)ny siaaahp hiwt deirapmi horensnpecomi s(pt aclk htign)si

breis  Why would B be incorrect? I realize Broca is "technically lower" but A seems too low to be causing weakness of the lower 2/3 of the face? Am I missing something? +  
shaeking  @breis B is incorrect because of the lower 2/3 of the face weakness. B isn't located on the motor cortex but in the premotor cortex, plus it isn't low enough for the lower two thirds of the face. +1  
cienfuegos  @breis, per UW: "a/w r. hemiparesis (face & UE) bc close to primary motor cortex" +  
almondbreeze  B is close to premotor cortex which is involved in learned or patterned skills & in planning movements. (i.e. two-hand coordination) slide 25/37 : +  
almondbreeze  B is also close to frontal eye field; eyes look toward the lesion FA pg. 499 +  
frijoles  I incorrectly picked C. When answering this, Broca's "broken speech" was my first thought, but I figured a lesion causing a facial droop would have to involve the motor strip so I prioritized that and chalked up the speech issue to dysarthria (I understand this is more of a "slurred speech" than broken, abrupt speech, but again, I simply misprioritized concepts.). So for the record, Broca area is part of the motor cortex? +1