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Comments ...

 +14  (free120#32)
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sThi is a bda oni.eqsut taellePt atgiaenrogg etmi genib arnolm, ok iefn I nca ese t.ath tBu WVF sbtzeailis ftarco 8 and od'yu ese na iaeecrns ni TPT t(sfri eiln etxn to FVW ni sriFt )di.A Why si ithre TPT l?omarn

a1_antitrypsin  Totally agree, and they give you a slight increase in PT instead +
mambaforstep  yeah but if they gave you an increase in PTT then Hemophilia A could have been a valid answer choice. so they prob showed a nl PTT to differentiate vWF dz from hemophlia A +
drpee  VWD only sometimes presents with a slightly increased PTT. Don't let those anki facts steer you wrong... Plus all the other answers make no sense. Afibrinogenemia? That means literally no fibrinogin (PT and PTT would be infinitely increased). Hemophelia? Or vitamin K deficiency? Those are coagulation factor disorders so they would present with deep bleeding and large bruising. (Unlike platelet disorders, including VWD, which present with mucosal bleeding, petechiae, and heavy menses). VWD is actually the ONLY one that makes sense. +5
cbreland  I get why it's not afibrinogenemia (which is what I picked), but still don't understand how VWD is right. You have normal PTT and normal platelet aggregation (both of which should be abnormal). Is the only thing leading us to VWD is it being a primary bleeding issue? Again, my answer made no sense, but VWD in this context, seems way out there +
osteopathnproud  I agree with you @cbreland once I noticed I had to bend lab values for any answer choice then in my head most of them were possible. I took a step back and answer with the most common bleeding disorder, vW disease. Funny thing is when I retook it to check my answers, I had time to overthink and got it wrong. +
aakb  the anki facts never steer you wrong! my zanki cards say "Low vWF in von Willebrand disease impairs platelet {{c1::adhesion}}" (Gp1B binds to vWF) not platelet aggregation (GpIIbIIIa binds to fibrinogen). additionally it says you can have either a normal or increase PTT. in this case the PT is not increased. It is decreased a little, which I assume is fine esp w an INR of 1.0 +
lebabs  Shut up +

 +1  (nbme20#21)
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How uldow you nkow tath it 'stni olwo rsotres ede?issa

cienfuegos  FA 2018 137: inhalation of spores leads to flu-like symptoms that progress quickly to fever, pulmonary hemorrhage, mediastinitis and shock, with imaging possibly showing widened mediastinum +7

 +1  (nbme22#7)
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gweAledkocn hte eantit'sp ctifdi.fyul I htea eetsh tneiqouss

nwinkelmann  Me too... also, he's had cough that's worsening for 6 months plus hemoptysis for 1 week... I didn't interpret that as "feeling healthy." The correct answer was my first choice just because it was the least "dick-ish" but to me, he didn't sound like he "felt health," so I didn't go with it. +2
nor16  if he didnt feel healthy, why would he say something like that then... but i agree, these (especially this) question(s) are often XYZ123! +1

 +6  (nbme22#46)
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aldtnossiaPgrn tealdiosav teh reftanef eriatroel dna arcinees .GFR sSANDI thiiinb prtasnialognd syteshins FA( 9102 gp )757

malassezia_furfur  FA pg 486 +
malassezia_furfur  FA 2020 pg 589 +
pjpeleven  Some mnemonics: PDA (Prostaglandins Dilate Afferent) ACE (Angiotensin II Constricts Efferent) +2

 +1  (nbme22#24)
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roUWld eoiutnsQ ID 1480 sah a egrta oxnailpanet of itsh

mcm94  UWORLD: Invasive tumor from carcinoma in situ includes the following: Tumor cells DETACH from surrounding cells in a process commonly determined by DECREASED adhesion molecules E-cadherin Tumor cells ADHERE to the basement membrane; this is facilitated by INCREASED expression of laminin Tumor cells INVADE the basement membrane via enhanced secretion of proteolytic enzymes (e.g, metalloproteinases) +2

 +6  (nbme22#50)
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houhgltA eehtr era no cseifcpi epehrs cdatriois,n a CSF enapl iwth stolym ctkelysueo scdtiiaen a ivarl intconife (as well as het ramnlo e)lsou.gc oS yuo nac luer uto TB, aoosrriscndsioeu dna ct.bierala eBirz/nknkisigdru gins rea eterald ot eitnsingmi, tub vnee if ouy ndot' oknw htaw shtoe a,re the esnutqio sysa ahtt etrhe si an ylaointbram in the OLRMEAPT lebo mie(itsnngi = gneines.m) lphcaiisEnte duolw be hte estb anr,wes espcilaeyl bscueae Heespr stecnEhalipi fetcfsa eth pmaelort bo.le

taediggity  Also look for Kluver-Bucy like symptoms in the stem +1
mambaforstep  why? +
b1ackcoffee  I agree with everything but normal glucose. Glucose here is NOT normal. to quote wiki "The glucose level in CSF is proportional to the blood glucose level and corresponds to 60-70% of the concentration in blood. Therefore, normal CSF glucose levels lie between 2.5 and 4.4 mmol/L (45–80 mg/dL)." +
baja_blast  NBME reference table gives normal CSF glucose to be 40-70 mg/dL. As far as I'm concerned, for the purposes of the exam the reference table is probably a better source than wiki. +4

 +3  (nbme23#32)
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nSycredao yptdheymohrirasapir due ot niohccr aelnr lf.airue Low Ca, hhig ahptepsoh nda hghi H.PT AF 9201 eagp 432

imnotarobotbut  Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that. +5

 +2  (nbme23#36)
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A mdleiac utnsdte ho'uldtns eb the eno vnggii oensmeo a nrecca ionas.dsgi ihsT si a alyelr vtsiiesne eiuss dna teh ertssul holsud be ignev by smoeoen with iehghr ihuyrttoa keli a nseiertd or naiegdnt.t At het smea etm,i ouy hns'oldut iel ot the ettipan dna yas tath eht eltsrsu 'aertn kbac ety if ethy .rea setB ihngt ot od is tcdfele eht anvcitnoeors dna lofolw up hiwt hte stnd..eeir

drdoom  It isn’t so much “someone with higher authority” as it is someone with a license! Without a license, an individual is not permitted legally to provide clinical interpretations, as that would constitute the (unlawful) practice of medicine! +21

 +7  (nbme23#15)
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eTh ettearnmt fo chelroa si mylsot uevrptiosp - you wtna to ydtrerahe eht tiantep yb nggvii htem na cntoosii lnisea scine 'eetyrh ginsol a lto fo sf.dilu


 +5  (nbme23#11)
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dyogrtnoesliS etaeetrspn eth isnk usl(lyua eth )eet,f lvaetsr otin the m,terlooasdb esentr the alrca/ghseutn eerwh ti si ulsuyal ogdcheu up dna ethn swweodlal inot teh IG .tcrta yThe nca yal sgge ni the ,iineentsst dna enwh eht raveal ,cahth hyet can eaenptert teh sitenntlia awll nad eenrt the omordletabs ng.aia

makinallkindzofgainz  Strongyloides is fucking metal holy shit +4

 +12  (nbme23#50)
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moFr stknlcie on r:itedd "Tish aws ym :iaeonrnsg royu'e gcsinmprseo iheter eth dlobo yplpsu ot hte b,bay or teh ldoob wfol wy.aa If uyo omrsepsc het plypsu ot hte ,aybb esrpures uowdl tank nda lyugareort sssetmy lowdu egt sti hrtae ot kwor de.arhr If oyu esscpomr teh ldboo fowl aya,w neht RVS udlow isre nda ruaelotygr tmeysss lwdou fxiylrvelee wols hte etrah w"nd.o


 +1  (nbme23#24)
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Pmathoa sysa treeh aer 3 ntshgi tath ttenfeiadfrei dmkoeiule mofr :LCM+ oektyLecu nllekaia phesspaahot y(lno in md+eik leo)u ihpaBslso (ynol ni M+)L C ()2;t29 tliorantnacso lyno( ni )MCL

nor16  yeah but pathoma doesnt help here... +1
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +

 +4  (nbme23#37)
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lCoo, dselicdoro tofo htiw glintgin nda unsbmesn = loobd l.cto arcdCai ssymptom amy tiniacde taht she has eosm srto of hrbtcoitmo ssied.ae Teh gnrwdio of the ewnras ohicce ns'ti gtrae, btu nnoe of eht rhtoe rnewas chcsioe .tfi


 +16  (nbme23#17)
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riecsVla limhsisneaais csasue onpymgehlloatespea nda tmso ytailrmt,npo onapp.inteacy It si feton found ni pelepo owh vtsii the idMlde staE dna is nsmtatdietr yb hte fdl.aySn hWy did NEMB tup 2 mihLaasnie eosniustq on tshi fmor llo

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +11
rongloz  I got both questions within 5 questions from one another! I was seriously doubting my answers haha +1
faus305  Visceral Leishmaniasis affects about 0.001% of the world population each year so it only makes sense to have two questions on it. https://www.cdc.gov/parasites/leishmaniasis/epi.html#:~:text=For%20cutaneous%20leishmaniasis%2C%20estimates%20of,to%20400%2C000%20or%20more%20cases. +1
underd0g  How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia? +
faus305  @underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa. +1
jaramaiha  Sketchy for the save :) +

 +3  (nbme23#50)
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oegrillCdop npvertes ltptleae rgaegntgaio by iglknbco teh APD .ecrreopt The PDA ctorpere is twah si eilsbponser rfo ptgtinu /IIIaIpbGI rostepecr no eth afcerus fo tst.paleel ihotWut GI/I,bIpaII the lsaeleptt nocant aeggrtaeg hg.reteto

paulkarr  Just adding that Clopidogrel irreversibly inhibits the P2Y12 receptor. This can be found in FA2019, pg 403. The other drugs in this category are: Prasugrel, ticagrelor, and ticlopidine. Ticlopidine is famous for causing Neutropenia and having an increased risk for TTP. +2

 +2  (nbme23#31)
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icranooelnoSpt nibitish oedayx71rayshl- and aosl ltdriyce slcbok eht gdnenrao trorcpee luu(sef rfo etttranem in O.SPC) It can ucaes emc,oagiastyn oetipcmne dan dercaeeds d.bioil In eth npi-saKgr ecdirutis dovei no ysk,htce ti is yimldbzsoe yb teh nma hwit eht ldis on his tshec ()oycmgasaietn nda the yrpood horruc opnimt)ce(.e


 +11  (nbme23#10)
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eEvn fi uoy 'niddt iwhch noe tceorv wsa a,sAmaplna I ebileve cichoe A swa eht yoln oen ni cwihh htob igomrsans adrseh the esam cerovt.

stinkysulfaeggs  Agreed, that's how I made my final decision! +
alexxxx30  yeah I literally had no clue what anaplasma was, but came to the correct answer the same way +

 +5  (nbme23#18)
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The eky si eht reef air in the nabmiodal ay.tcvi sc,lerU lpeicslaey ndaluoed rcsu,el nac traefpoer itno eth lndoabami vctya.i hTis nca ausce a ipmnpmerenteuuoo (eefr ria dnrue eht .g)dihrpaam otN a edstil pmsytom in htsi oes,nqiut tbu isht cna sloa esacu redreerf ipna to hte osuerdlh yb artinrtiig eth hincrpe v.eenr FA 2910 gp 734

et-tu-bromocriptine  To add on to this, anterior* duodenal ulcers tend to perforate (makes sense because closest to the abdominal cavity) whereas posterior duodenal ulcers tend to bleed (due to proximity to the gastroduodenal artery). +13
smc213  Acute pancreatitis can also occur with a posterior duodenal ulcer rupture. Source: Pathoma +4
victor_abdullatif  Fun fact: anterior duodenal perforation are more common than posterior because of the physics of the flow of chyme from the stomach into the duodenum. It travels in a manner that hits the anterior portion of the duodenum, therefore leading to ulcer / perforation. +1




Subcomments ...

submitted by hayayah(1079),
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fO all eht nsoipot, aosps rmjao si het yonl oen atth is ryeall oseadsacit with het abmrul e.vraberet

Q. Lourmbmu vvsoenil eht vesrsretan rcsoeps fo L1 utb assPo ojarM orniaetgis rmfo L5L1-

imnotarobotbut  QL is connected to L1-L5 vertebrae as well (https://en.wikipedia.org/wiki/Quadratus_lumborum_muscle) +  


submitted by hayayah(1079),
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Irno eedvoros is a uacse fo a gihh nnoia gap oabcmltei odic.issa

meningitis  I found this to add a little bit more explanation as to how it causes the acidosis if anyone needs it. 1. Mitochondrial toxicity - decreases aerobic respiration and shunts to lactic acid production 2. Cardio toxicity (Secondary to Mitochondrial toxicity) leads to cardiogenic shock (hypoperfusion), which causes lactic acidosis 3. Hepatotoxicity - Decreases lactate metabolism, causing lactic acidosis 4. When in trivalent form (Fe+3), it can react with 3 molecules of H2O --> FeOH3 + 3H+ This will then deplete Bicarb buffering system resulting in non-gap acidosis. Source: https://forums.studentdoctor.net/threads/iron-poisoning-anion-gap-or-non-anion-gap-acidosis.958285/ +17  
sympathetikey  None of the other choices were even metabolic acidosis. They threw us a bone with this one. +28  
imnotarobotbut  Don't changes in bicarb take a few days? How did his bicarb drop down to 8 in 12 hours? +2  
charcot_bouchard  its met acidsis. not compensation +8  
j44n  they did throw us a bone however I didnt catch it +1  


submitted by celeste(84),
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Wlieh het imefetil iskr ni the gerealn pnluotopai is ustj loweb 1,% it si 6.5% ni gisfd-ereter lseiavter of tpietnas nda it isers ot oerm nhat 40% ni zogoyiotmcn isntw fo tfecafde oplepe. gilnzyAan cscasil uissdte fo the cegitsne of iaehohpsrinzc doen sa ealyr sa ni 3,90s1 cireFhs cuecdnosl ahtt a nooraceccdn etar rfo cyossihsp fo outba 5%0 in yozogoctmni sntwi essem ot eb a rstlaeiic testa,mie hchwi is yfgtcaliinisn ehihgr htna ahtt in dziyctoig tsiwn fo tobua –1%019 (i9lcnrao#i/Mm56m3n.Chvntre/b23p.f/.c4/siPle6cg)

imnotarobotbut  How is one supposed to know this before having read this article? +33  
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld +  
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-| +7  
doodimoodi  Lol just why seriously +2  
champagnesupernova3  This was mentioned in the Kaplan behavioral videos +  
usmlecrasher  and there's so much unnecessarily BS instead of real questions +1  
j44n  I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center +2  


submitted by usmleuser007(397),
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otN:e the tunsioqse etadts pato"yrisrre tb"urs sisuggengt na UTR nefcinot.i

1) hits sreul tuo gannyhit tub yresaroiprt tnoifneic n(no epr tnceifnio: E. l,oic .E fmiua)ce

)2 GP6D cndcfiyeie omer tleseibcpsu ot tacaeals pvieisot osgsmran i -- hits lseru otu al(l pesrt smgois)ran

3) fLet hwti .H nzneafluei &ma;p Sht.par euusra TBOH( aer seaatcla tos)pivei

)4 lapesnEatcdu srgaiomn rea most cnoricengn ehwn hetre is npesi.laa

imnotarobotbut  Respiratory burst has nothing to do with a respiratory infection. It describes the process of phagocytosing a bacteria and using NADPH oxidase/ROS to lyse it +5  
belleng  Aspergillus is still in the running, it is catalase positive as well...but not a choice +  


submitted by sup(23),
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yWh ont 2GPI yb wya of AAS? scpiyaellE inveg oterh wenars ciehosc fo ptensoir C + S: nteso'd frawiran saol suesrpps esthe?

imnotarobotbut  Protein C and S are ANTI-thrombotic, so although Warfarin does decrease them, they wouldn't decrease the patient's risk for thrombosis +1  
epr94  the question ask "suppression" of which one will decrease risk of thrombosis if you suppress C and S which and anti-thrombotic you get thrombotic +1  


submitted by aaaaaaa(6),
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srtatilo is usde rof eitwhg sosl t(si not a ittnsa as osem loeppe htthuog ni hte ecmtsonm hee.)r ist ni FA 2109 pg ,294 /cm desi scfefte are IG nucdniigl rhradiea

imnotarobotbut  Thanks! It's actually page 394 +2  
tiredofstudying  FA 2020: Page 400 +  


submitted by seagull(1573),
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uot fo siryitu,oc how may epolep wenk t?ish dn(ot be ysh to ysa uyo idd or ?i)nddt

My oyptrve tinuecaod tddn'i nnigira hits in m.e

johnthurtjr  I did not +3  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +5  
snoochi95  hell no brother +1  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


submitted by sajaqua1(535),
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dnoeBlerri oeptyirnals rd-dreios nsfelegi fo ,netesp"ms"i yiitc,sdliau l-tiilafet,monus ebstnula shseiplnariot, adn moer mnomoc in ewonm hnta ni n.em A cmmnoo sdeeefn eihsmcanm in ihst iddoesrr is gt""tipsnli in cwhhi ppeeol rea nsee sa erenlity ogdo or ntliyeer dba. ieoelBrdnr iosanetprly rdrsieod si aols aptr fo eht urletsC B toenarlyspi srdire,ods ihcwh rea discatosae twih scbteuans besu.a

imnotarobotbut  Suicide attempts are also commonly seen with Borderline +5  


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dnraoScey aeihyrsmdyprpitarho due ot icrchon neral flueri.a Low ,Ca hihg ahshpoetp and ghhi T.PH AF 1920 apge 243

imnotarobotbut  Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that. +5  


submitted by sajaqua1(535),
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aCrilitc tposni for isth uneqsot:i 5 arye odl ,byo redummopsssupine bceuaes fo tpyoec,rmeahh 2 ady yithosr fo ,revef oc,ghu nortesshs fo rhbaet, rbeflie (01.18 F), riteinsaospr i,/6n4m hiwt sscinoya dan rediazgleen aceviuslr as.rh Etvneixes larnudo .intanroiiltf

fO het tpsnooi dilste olny almssee dna VVZ giev a hsa.r A rsah orfm emlessa ylsulua rtstsa laltoyrsr and ecedssnd ,ycauladl dan si ftal dna eusthaory.etm By ttrons,ac ZVV ckoche(npxi) psnsetre hitw zergniaedel arsh thta cyqukli artinsniost rmfo mauacrl to ruapapl etnh to icre.salvu

sympathetikey  Good call. +6  
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5  
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5  
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +2  


submitted by seagull(1573),
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ishT is a aipnc tackta. Hirotvlapyenteni spodr OC2p laeindg ot a toisyreprar ols.saakil po2 is elaielvyrt anfdutefce 'no(td ska em ?)woh

sympathetikey  Yeah haha I had the same conundrum. +  
sajaqua1  If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected. +23  
imnotarobotbut  lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol +2  
soph  Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances). +2  
charcot_bouchard  PErioral tingling- due to transient hypocalcemia induced by resp alkalosis. +1  
rainlad  I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2 +1  
usmile1  adding onto Charcot_bouchards comment, I found this: Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany. https://www.sciencedirect.com/science/article/pii/S1110184913000615 +3  


submitted by aladar50(40),
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hTe omtrtainp hgnti rof tmos fo hte echsti etisoqsun era to oklo orf eht neswra weehr uyo aer ngibe the mstn/itsoec ienplsoarofs iwhel npersetcig hte netta’pis aun,tomoy cen,nibecefe neclcmnnieefo-,a .cet sotM fo teh scehoic rhee rewe heirte oartyucsca or ilslabcya gebni mane ot het etatinp. eTh cercrto icecho si to lhep eth atptien btu osla otemavti hmte to ctouinen cpailsyh htpryae nad ot nyol use eht tirmep sa tlietl as yesnasr.ec A mairsli oietunsq c(hiwh I nkhti aws no MNEB 23 -- etyh rae idkn fo bldenign eoth)tgre saw hte oen rwehe hte atneipt dha stet erutlss atht aincdtdei eh ahd cnarec btu eht rtseendi isda tno to torvnai(llu)y eltl mih nuilt eth cgtooinlso mcae ni eatrl ttah yd,a nad eth ttiaenp seadk you uotba eht uesls.rt oYu n’otd twan ot teh eli ot het pietatn and ays uyo ’dtno owkn or ahtt he otsn’de avhe ,accern tub ouy loas tdon’ wnta ot be dbnteurinaois to eht e’rdesstin re(sb)lnoeaa ree.qust

drdoom  @aladar Your response is good but it’s actually mistaken: You *never* lie to patients. Period. In medicine, it’s our inclination not to be insubordinate to a “superior” (even if the request sounds reasonable -- “let’s not inform the patient until the oncologist comes”) but *your* relationship with *your* patient takes precedence over your relationship with a colleague or a supervisor. So, when a patient asks you a question directly, (1) you must not lie and (2) for the purposes of Step 1, you mustn’t avoid providing an answer to the question (either by deferring to someone else or by “pulling a politician” [providing a response which does not address the original question]). +2  
drdoom  As an addendum, legally speaking, you have a contractual relationship with your patient, *not with another employee of the hospital* or even another “well-respected” colleague. This is why, from a legal as well as moral standpoint, your relationship with someone for whom you provide medical care takes precedence over “collegial relationships” (i.e., relationships with colleagues, other providers, or employers). +  
imnotarobotbut  @drdoom, it's not about lying to the patient but it would be wrong for an inexperienced medical student to give the patient their cancer diagnosis, or for a doctor to give a cancer diagnosis if they feel that the patient should be seen by oncology. In fact, the correct answer that the question that was referred to by aladar50 says that you do NOT give the patient their cancer diagnosis even if they asked you directly about it. +1  
charcot_bouchard  Dont give it to him. DOnt lie to him that yyou dont know. Tell him let me get the resident rn so we can discuss together Best of both world +4  


submitted by usmleuser007(397),
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PPI si:ceef-eftsd + dcaneseri kris ofr C. idff + cdesenIra skri orf serp cietifnnso + anc uaesc npaogmsyihae + sereedca tbpoorisna of C+,(2a g2,+M a&;pm )rnoi + iaerecsnd riks fo crtiotoeposo pih srefurtca /(td owl uemrs iuclc)ma

imnotarobotbut  That's not the right answer tho, the answer is the binding of PGE to it's receptor +  
tinydoc  Can someone explain to me why the PPi answer is wrong if it increases the risk of C Dif wouldnt that also cause severe diarrhea. PPIs make a lot more sense to be given to this patient in the first place. +1  
maxillarythirdmolar  Keep it simple, stupid. +1  
roaaaj  @tinydoc You are correct about PPI increasing the risk of C. diff, but there was no history of antibiotic use. +