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Comments ...

 +5  (nbme21#10)

Key phrase is hexagonal crystals in urinary sediment which means means its Cystine (i remember it as SIX-tine for hexagon) crystals which is made up of 2 cysteine molecules.

 +4  (nbme21#33)

FA pg 217. Too much oxygenation can cause free radical damage leading to retinopathy of prematurity

mmm21  Okay i might be retarded, but why i can’t understand that they r asking about the thing that is damaged ? πŸ˜‚πŸ˜‚
sahusema  Seriously! The question says "the goal of treatment is the protection of which of the following structures?" If too much O2 damages the retina, how is this treatment supposed to be protective to the retina?
ratadecalle  I think too much oxygen would be with the ventilator having a high FiO2 setting, which they don't mention here but I'm guessing thats the thing they're controlling to avoid oxygen toxicity?
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way
naught  Supplemental O2 may also cause bronchopulmonary dysplasia or intraventricular hemorrhage (germinal matrix, located in subventricular zone NOT choroid plexus)

 +0  (nbme21#1)

I know this is just a straight up fact from FA, but couldn't ureters (transitional cell carcinoma) also be correct?

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis.
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma.
vinnbatmwen  p631 β†’ Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure.
privatejoker  Thanks!
emmy2k21  It's also in Pathoma page 140 in the 2018 edition!

 +4  (nbme21#23)

FA pg.372. Squamous cell carcinoma occurs in the upper 2/3 of esophagus whereas adenocarcinoma occurs in the distal 1/3. Since this was in the mid esophagus, its squamous cell carcinoma. Key feature of squamous cell carcinoma is keratin pearls.

 +2  (nbme21#41)

This is lateral medullary/PICA/Wallenberg syndrome. The woman has damage in the sympathetic chain (sensory syndromes are lateral according to the rule of 4s) resulting in Horner syndrome, spinothalamic tract (pain/temp which are also sensory), and CN IX and CN X dysfunction resulting in the dysphagia/dysarthria (helps us localize to the medulla).

nala_ula  Also, just to add, FA specifies that Nucleus ambiguus effects (dysphagia, hoarseness, decreased gag reflex) are specific to PICA lesions.
cienfuegos  Thanks for the input. I have always found this topic to be tricky and just came across this article that helped me out a ton regarding the rule of 4's hoscyamine mentions above. https://rdcu.be/bLjOB

Subcomments ...

submitted by yo(25),

surprisingly good explanation and picture found on this site. something along the lines of micturination reflex (aka bladder is full and you piss reflex) is gone so the afferent fibers carrying the signal that the bladder is full aren't working. those fibers are carried in the pelvic nerves


yo  if still confused, a better explanation can be found here https://courses.washington.edu/conj/bess/urination/urination.html +  
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. https://i.ytimg.com/vi/JwaeWXhklio/maxresdefault.jpg +2  

submitted by strugglebus(69),

OK, so if I remember correctly this is the one that shows the inheritance pattern. mitochondrial is also passed by the mother; however, it can have variable expressivity and incomplete penetrance, which is why some members were not affected.

hyoscyamine  Also, question said there was a deficiency in NADH dehydrogenase activity which is another fancy way of saying complex I in the mitochondria. +4  
yotsubato  That unaffected male really threw me off... : ( +4  
charcot_bouchard  It was pure MELAS description. the unaffected male threw me off +2