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Comments ...

 +0  (nbme19#21)

I got this one through the process of elimination. He has significant blood loss, which can be inferred he might be in hypovolemic shock. This would activate the sympathetic nervous system, which would contract the systemic arteriole and venous smooth muscle to shunt blood back to the heart. Secretion of renin will be increased to increase BP. ANP is the hormone that counteracts the effect of aldosterone so it would be decreased in this case.

Among these answers, only reabsorption of fluid into capillaries make sense as it would help increase the intravascular volume.


 +0  (nbme19#24)

One of the risk factors associates with any vascular repair is the detachment of the atherosclerosis plaque. It can clog and cause embolism with the histology of needle shape cholesterol cleft.


 +0  (nbme19#0)

Since the obturator nerve innervate most of the adductor muscles in the hip, section it would relieve the adduction contracture.


 +1  (nbme19#23)

I got this one wrong because I didn't know the difference between the area postrema and the OVLT, since both are not covered by the BBB and exposed to the contents in circulation, so I thought both can cause vomiting.

But apparently the OVLT are osmoreceptor responding to sodium content and the osmotic pressure through regulating the activity of ADH, while the area postrema is the vomiting center, responding to the visceral afferent input from CN IX and CN X.

a short reading on wiki here explaining the role of OVLT


 +0  (nbme16#12)

The description match with UC. Crohn would spare the rectum, tend to affect the terminal ileum, and have non-caseating granuloma in the crypt.

Amebic dysentery caused by E.histolytica would probably present similar with bloody diarrhea, and "flask-shaped" ulcers but the hx should include some risk factors such as traveler, MSM...

Ischemic bowel disease usually associates with atherosclerosis. Commonly see in elderly.


 +1  (nbme16#24)

Among these, only amphetamine is a stimulant drug. Stimulants intoxication usually characterize by mydriasis, high BP, high HR, and one way to detox is through activated charcoal. Pt may also experience paranoia which can be mistaken for schizophrenia. Another drug that has the same presentation is cocaine since they are both stimulants.

Barbiturate, benzo, and opioids characterized by respiration depression, miosis (for opioid). Marijuana intoxication with sx of hyperphagia and probably other sx but I forgot.

cheesetouch  FA18 p 556 - CNS stimulants/amphetamines +




Subcomments ...

submitted by lickmyass(0),

Why not Multiple renal artery aneurysms? I was thrown off by the description of hyperplastic arteriolosclerosis and so I went with this choice. I thought hyperplastic arteriolosclerosis may lead to fibrinoid necrosis of the vessel wall with hemorrhage.

hiroshimi  I think hyperplastic arteriosclerosis meaning that the wall of the artery is thicker, and that narrows the lumen, making it more "stiff" and reduce compliance. It's exactly what you see in patient with HTN. Think about pt with aortic stenosis, it's similar. In contrast, in aneurysm, the wall of the artery is actually thinner, the wall is weakened, that's why it's easier to rupture, think about the aortic aneurysm, it's more likely to rupture if's not treated. +  


submitted by foodi(0),

why can't this be OCD? fits the time frame, his obsessions are checking his temp and he relieves these with calling the physician (compulsions)...

hiroshimi  According to DSM-5, with OCD, the disturbance is not better explained by the symptoms of another mental disorder such as preoccupation with having an illness, as in illness anxiety disorder. In his case, he was previously dx with cancer, treated, then develop these anxieties that he may have missed some sign is more fitted with illness anxiety disorder. Moreover, OCD is characterized by ego-dystonic, which is "thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept", which clearly doesn't apply to the pt case, as checking the temperature is actually meaningful and goal-directed. +  


Figure from this paper shows the course of the inferior alveolar n.

https://www.ncbi.nlm.nih.gov/books/NBK546712/

Inferior alveolar n. is also sometimes called the inferior dental n. b/c it supplies sensation to the lower teeth.

j44n  why couldnt it be the maxillary artery? doesnt that run through the jaw as well +1  
hiroshimi  @j44n: Maxillary artery give a branch called inferior alveolar artery that travels with the inferior alveolar nerve. The maxillary artery itself will travel up and give branches other including the middle meningeal artery around the temporal. So saying maxillary is too broad I think. +  
sexymexican888  This shit is so fucking annoying LMAO its so fucking shitty how they ask questions on shit you can find or FA +  


can anyone elaborate why they chose this answer?

hiroshimi  Even though legally the wife has the right to make the decision first, then the adult children. However, it's still best the wife and children come to a consensus that reflects pt's wish. If there is a disagreement between them that can't be resolved, then the doctor will need to follow what the wife said. In these difficult situations, you are not only treating the patient, but also the whole family so you would try to integrated the family into the process. In short, i feel like the point of this question is don't be an asshole, and don't choose answer that have absolute words in it like "only" +1  


submitted by cassdawg(1165),

I am assuming this is just something we are expected to know; tubular reabsorption requires the most oxygen because it would consume the most ATP out of the processes in the kidney?

waitingonprometric  I believe this is correct--assuming that active transport of solutes at the thick ascending limb and active transport of solutes (secondary to Na/K pump) at the PCT consumes O2 at highest rate b/c of ATP use. Since tubular reabsorption always happening...very high use of O2 relative to the other answer choices that occur sporadically in response to body homeostatic changes? Note: glomerular filtration is always happening, but that's passive movement through fenestrated capillaries (i.e. no ATP used). +2  
hiroshimi  Also, PCT and thick ascending tubule are the two areas that are most susceptible to hypoxic injury in the kidneys. +2  


submitted by justoil(0),

In ectopic pregnancies, hCG is elevated from baseline, but less than in normal pregnancy and much less than hydatidiform mole.

This stem only says that hCG is elevated from baseline, so it could be ectopic, normal pregnancy or hydatidiform mole.

From those 3 options, it's not normal pregnancy bc of low hCG & presentation, and it's not hydatidiform mole because of low hCG, the presentation & the gross pathology (hydatidiform mole wouldn't have something that looks that much like a fetus). So it's most likely an ectopic pregnancy.

hiroshimi  How do you know that the "increased hCG" is actually lower than what you expect, since the stem did not say anything else??? I was between ectopic pregnancy and hydatidiform mold since the partial mole can have partial fetus as well. But I guess it's just partial, not the full fetus like we see in the picture. Also, hydatidiform associate with irregular bleeding and/or hyperemesis than acute pain. +1  
trazobone  Also to add to the partial vs ectopic, the presence of leukocytosis fits better with ectopic since she’s in pain which means the fallopian tube ruptured and now you need immune system to go work. But FA mentions nothing about leukocytosis associated with ectopic pregnancy so I am conjecturing. +1  


submitted by djeffs1(10),

I just want to know why the blood pressure is decreased..

hiroshimi  For a 7 month old baby, the normal SBP is between 67-104 (the number is varies depending on the sources but generally around <105. So this baby BP is actually high normal. Another sign for coarctation is the decrease in the femoral pulse, and that tell you the differential. +1  
whk123  Imp complications of COA: ↑ risk of Cerebral hemorrhage, HF, aortic rupture, and endocarditis. +  
sirknit  Coarctation of the aorta often occurs distal to where the left subclavian artery branches off the aorta. The coarctation causes a decreased blood flow only to the lower body (so you'll see decreased femoral pulses, as in this case). If coarctation is located before the left subclavian branches off, then you could see lowered brachial pulse. +  
sirknit  Edit to my subcomment: decreased left brachial pulse** +  


submitted by cassdawg(1165),

FA2020 p144

An USMLE testable fact about salmonella species is that antibiotic use actually prolongs the excretion of the organism. Fun fact(?) for memorization as there is no clear answer as to why that I could find.

hiroshimi  Have a card in Zanki saying this using abx with salmonella can cause HUS so may be it's linked? +  


submitted by divya(59),
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sreiecna ni MAcP ()sG - 2beat - ltooadvsnaii

cseeread in cMPA ()Gi - 2aphal - noitsvcrosacoint

cneaeisr in P3I GAD )Gq( - phaal1 - sotnscaoonitivrc

ecrianes ni MPcG - M3 - ON niudedc doalsnvaoiit

cytotoxict  Alpha 2 agonists do not cause vasoconstriction b/c they lead to negative feedback of norepi and thus decrease sympathetic response +  
payingforthisisdumb  FA20 p317 α2-agonists increase NO/cGMP and vasodilate +  
sarahs  why is decreasing cAMP wrong? +  
hiroshimi  @sarahs: you want to increase cAMP because it would lead to vasodilation and help to decrease his blood pressure. Decreasing cAMP would make his BP worse. +