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 +0  (nbme22#2)

Why is acetaminophen the correct answer other than process of elimination. NSAIDs can be used for tension HA and she’s too old for Reye Syndrome (i mean technically shes a child since shes <17, but not a classic picture at all). I’m confused.

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction.
gainsgutsglory  @zelderon But what’s the pathophys here?
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease.

 +1  (nbme22#35)

Why is this Intersitial Inflammation? I understand this is a VUR causing hydronephrosis.

skinnynomore  this kid has chronic pyelonephritis due to recurrent UTIs (VUR/hydronephrosis is a risk factor). And -itis = inflammation. That was my take on it.

 +1  (nbme24#35)

She has Osteogenesis Imperfecta. Aka “Brittle Bone Dz” aka Collagen Type I deficiency. U need collagen type I to make scars (granulation tissue is type III and then metalloproteases and zinc cofactors help digest into the firm type I collagen).

wowo  FA 2019 p51




Subcomments ...

Why is acetaminophen the correct answer other than process of elimination. NSAIDs can be used for tension HA and she’s too old for Reye Syndrome (i mean technically shes a child since shes <17, but not a classic picture at all). I’m confused.

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction. +  
gainsgutsglory  @zelderon But what’s the pathophys here? +  
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +2  


submitted by pitaziki(0),

Why is it that the intercostal vein provides the most direct pathway for metastatic breast cancer cells to spread to vertebral column? I thought it was internal thoracic (mammary) and I couldn’t find much searching online, besides wikipedia saying that internal thoracic vein drains the breast.

gainsgutsglory  Intercostal vein → Azygos → Batson vertebral plexus → infection of inner vertebral body +2  
realmedicmd  The internal thoracic drains into the subclavian, intercostal drains into the azygos system which is a more direct path to the vertebral drainage. +  


submitted by pitaziki(0),

Why is the answer fibularis brevis and not fibularis tertius? How do you distinguish between the two from this vignette?

gainsgutsglory  tertius is an anterior muscle and overlays the dorsum of foot as it fans out to the toes. Does not relate to the lateral malleolus. +  


Our little friend has a Parvovirus infection, which infects erythroid precursors, causing interruption of erythrocyte production. This is the same way it causes hydrops fetalis in unborn babies and aplastic anemia in sickle cell, etc.

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +2  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +1  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +2  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +