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Comments ...

 +2  (nbme24#7)

Why there's no increase in Hydrostatic pressure in glomerular capillaries?

rihan  Between the glomerulus and Bowman's space there is a hydrostatic pressure gradient. This gradient is normally the result of a LARGE glomerular hydrostatic pressure and a LOW pressure in Bowman's space which normally favors filtration. Diagram here: http://physiologyplus.com/wp-content/uploads/2017/08/Glomerular-Filtration.png In the case of post-renal obstruction, hydrostatic pressure behind the blockade will rise and urine will reflux into the capsular space and renal tubules (while glomerular hydrostatic pressure is unaffected) effectively decreasing the pressure gradient which reduces the filtration rate.

 +0  (nbme24#35)

"The loss of lower motor neurons leads to weakness, twitching of muscle (fasciculation), and loss of muscle mass (muscle atrophy)".

https://www.medicinenet.com/script/main/art.asp?articlekey=33870


 +2  (nbme23#24)

"PV is a neoplastic (clonal) blood disorder with autonomous (EPO-independent) erythroid proliferation. Because of the existence of a negative feedback mechanism, the erthrocytosis in PV down-regulates EPO production and results in below normal serum EPO levels. In contrast, an EPO-driven erythrocytosis characterizes secondary erythrocytosis, and this condition may be associated with either high or normal serum EPO levels."

https://www.mayoclinicproceedings.org/article/S0025-6196(11)63840-8/fulltext


 +1  (nbme23#50)

Fick principle: CO= Rate of O2 consumption/arterivenous O2 concentration

CO means cardiac output or Flow of blood

charcot_bouchard  This wasnt Fick

 +4  (nbme23#47)

The subscapularis muscle is very important for the Internal rotation of the humerus. The internal rotation supports the upper arm during abduction and adduction.

There are some band exercises that can help you strength the Subscapularis muscle... 1. Internal Rotation - uses medial internal rotation 2. External Rotation - uses lateral external rotation 3. Front Row - You have you hand up in front of you and with your arm extended pull back the band. 4. Side Row - You're side to the band with your hand facing the hip, pull down toward your body. (ADDUCTION)

THIS IS NOT A FAIR QUESTION NBME!!!


 +4  (nbme20#43)

Negative nitrogen balance is associated with burns, serious tissue injuries, fevers, hyperthyroidism, wasting diseases, and during periods of fasting. This means that the amount of nitrogen excreted from the body is greater than the amount of nitrogen ingested.

Positive nitrogen balance is associated with periods of growth, hypothyroidism, tissue repair, and pregnancy. This means that the intake of nitrogen into the body is greater than the loss of nitrogen from the body, so there is an increase in the total body pool of protein.

guillo12  by Wiki

 +1  (nbme24#15)

I don't know the equation for this, but I did this: The sum of incidence per year/ the sum of number reamainig in population. So... 1,500/28,800 = .05208 or 5.2%


 +2  (nbme24#37)

In situation of an inflammatory response such as in burns, anaphylaxis or sepsis, intercellular contacts disintegrate in post-capillary venules leading to intercellular gap formation.

https://www.ncbi.nlm.nih.gov/pubmed/28231640





Subcomments ...

submitted by m-ice(123),

This question only concerns women in the 50-54 age group. The group has a mean of 246 and standard deviation of 50. Therefore, all those with values greater than 296 are all those above one standard deviation. 2/3 of all values on a normal distribution are within one standard deviation in either direction. Therefore, 1/3 are outside of this in either direction, meaning 1/3 of women have a value less than 196 or greater than 296. If we split that in half to only choose those greater than 296, we get 1/6 women, which is about 16%.

guillo12  Sorry, but there is not other way that I can understand this? +1  
fulminant_life  @guillo12 basically 67% fall within 1 sd. That means that 33% are +/- >1sd. So taking only those with above 296, you only look at those >1sd above the mean which is 16.5% . The other 16.5% are those >1sd below the mean. +4  
guillo12  Thank you!!! @fulminant_life +  


submitted by neonem(254),

this patient has symptomatic aortic stenosis. This can be identified by the ventricular hypertrophy (to compensate for increased functional afterload from non-compliant aortic valve), midsystolic murmur and the location at the normal aortic area.

Per UpToDate on Clinical manifestations of Aortic Stenosis:

"Dizziness and syncope — Syncope occurs as a presenting symptom in approximately 10 percent of patients with symptomatic severe AS (or approximately 3 percent of all patients with severe AS) [3]. There are several proposed explanations for exertional dizziness (presyncope) or syncope in patients with AS, both of which reflect decreased cerebral perfusion. Exercise-induced vasodilation in the presence of an obstruction with fixed cardiac output can result in hypotension."

guillo12  What does "fixed cardiac output" signify? +  
usmleuser007  "fixed cardiac output" might mean that with the stenosis (ie. narrowed aortic valve) there is a limited or rather reduced cardiac output. Exercise would not increase cardiac output because the stenosis is caused by a mechanical (physical) rather than a biochemical process. Therefore, At any given moment the heart can not increase its output no matter how forcefully it contracts. +1  
fallot4logy  why not option A?arterial compression ? +  
sunshinesweetheart  @fallot4logy LVH does not lead to coronary artery compression. only reallyyyy rarely will pulmonary artery dilation cause coronary artery compression. plus that would cause angina but probably wouldnt decrease cerebral bloodflow to syncope. her murmur + LVH point us toward aortic stenosis which does cause those --> fixed CO +  


submitted by yotsubato(262),

Arent we NOT supposed to use ipratropium in old people?

amirmullick3  Who said not to use it in old people? Remember "I pray that tio can breathe soon" and tio is an old uncle in spanish but its also the other drug, tiotrropium. +  
drdoom  discussion of anticholinergics & elderly also discussed at some length (but different context) here: https://www.nbmeanswers.com/exam/nbme22/1288 +  
guillo12  Ipratropium does not penetrate the blood-brain barrier, so I think this is why it can be given to old people. https://www.rxlist.com/duoneb-drug.htm#clinpharm +  


submitted by haliburton(82),

this is a cervical spinal cord section. the cuneate fasciculus is intact (UE) vibration and proprioception, but the white section is the gracile fasciculus (LE) and is damaged. I think the lateral portion that is uneven is just natural/artifact.

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +1  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +1  
d_holles  If you look at https://en.wikipedia.org/wiki/Gracile_fasciculus#/media/File:Spinal_cord_tracts_-_English.svg you can see that the closer to the center = legs, while further away = arms. +1  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +  


submitted by hayayah(395),

Most restriction enzymes bind palindromes.

So both 5'CCGG or 3'GGCC would have been acceptable in this scenario.

meningitis  Yes, correct. The 5'GGCC option could cause some confusion. +  
guillo12  I really don't understand the question nor the answer. Can someone explain it for dummies like me? +  
whossayin  yes please.. I'm with guillo12 on this +  
sugaplum  @guillo12 @whossayin questions says you've created a new cut site, 1. look at the region on the sick vs healthy. The C to G is the change 2. Write out the sick "CCGG" from 5'3'- you could write out the whole thing, but the answer only has 4 letters, so being lazy here 3. write under it, its complement, the dna base pair. So "GGCC" 4. remember both strands are going in opposite directions when you write them out on top of each other. 5. So the bottom strand actually reads 5' CCGG 3' so that is the answer I hope that clears it up +7  


submitted by guillo12(18),

Negative nitrogen balance is associated with burns, serious tissue injuries, fevers, hyperthyroidism, wasting diseases, and during periods of fasting. This means that the amount of nitrogen excreted from the body is greater than the amount of nitrogen ingested.

Positive nitrogen balance is associated with periods of growth, hypothyroidism, tissue repair, and pregnancy. This means that the intake of nitrogen into the body is greater than the loss of nitrogen from the body, so there is an increase in the total body pool of protein.

guillo12  by Wiki +  


submitted by m-ice(123),

This question only concerns women in the 50-54 age group. The group has a mean of 246 and standard deviation of 50. Therefore, all those with values greater than 296 are all those above one standard deviation. 2/3 of all values on a normal distribution are within one standard deviation in either direction. Therefore, 1/3 are outside of this in either direction, meaning 1/3 of women have a value less than 196 or greater than 296. If we split that in half to only choose those greater than 296, we get 1/6 women, which is about 16%.

guillo12  Sorry, but there is not other way that I can understand this? +1  
fulminant_life  @guillo12 basically 67% fall within 1 sd. That means that 33% are +/- >1sd. So taking only those with above 296, you only look at those >1sd above the mean which is 16.5% . The other 16.5% are those >1sd below the mean. +4  
guillo12  Thank you!!! @fulminant_life +