NBME Answers : johnson's page

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How do you distinguish this from testicular torsion? Is it just because it started in the left flank?

neels11 and there's no mass in the scrotum, whereas testicular torsion will have that "bag of worms" feel (along with a lack of cremaster reflex) testicular torsion usually happens in a younger age group +3

medpsychosis @neels11 I would like to clarify a piece of information. I believe you are confusing Varicocele with Testicular Torsion. Varicocele will present with "bag of worms" feeling. While the absence of cremasteric reflex is a sign of testicular torsion. +6

johnson This is the classic "loin to groin pain" of nephrolithiasis. +

suckitnbme Testicular torsion would also tend to have a unilateral high-riding testicle. +

submitted by subclaviansteele(6),

Ugh... got tripped up with "Refer both patient and her parents to a dietician"

Over thinking...I thought the source of their arguments were at meal times especially...so maybe they can find a good solution with a dietician.

OCCAMs RAZOR THIS SHIT. keep it simple stupid. The answer fits the best after re reading it.

nwinkelmann SAME.... ugh! +

johnson Also - you're almost NEVER referring/passing on a patient with the USMLE. +6

bmd12 They are at meal times, which is why she's having difficulty following the prescribed diet bc her parents are arguing during that time so its difficult for her to correctly execute it when theyre constantly bickering, and bc she's only 13 so she cant effectively manage her diet without the help of her parents. And since the diet has been working with the patient prior to all the bickering, you can assume the diet is not the root cause. +

submitted by medstruggle(10),

Can someone explain why does this patient have hypokalemia?

colonelred_ Catecholamines activate the Na/K pump, which will drive K inside. +6

trazabone Read online that catachelamines are released following tonic clonic seizures. Besides that, BP of 180/100 could indicate that catecholamines are circulating. +1

fulminant_life This mechanism is why giving albuterol for hyperkalemia works +4

nbmehelp Why does this guy have increased catecholamines tho +

johnson His SNS activity is seriously increased --> increased catecholamines. +

nbmehelp Why is his SNS activity increased? Is the BP literally the only hint? +

youssefa Alcohol withdrawal creates a hyper- catecholaminergic state + Seizures do that as well. +2

water My best guess is that withdrawal puts the body in a state of stress (same for seizures) and with stress you have release of catecholamine which we'll see in the BP and the hypokalemia. +1

submitted by m-ice(185),

The most important ethical principle that supersedes all others is autonomy. From an ethical standpoint, this patient has the right to refuse further treatment as he is mentally competent, in this case in the form of having the respiratory removed. From a legal standpoint, the physician is allowed to discontinue treatment for a patient if that is what the patient wants. This is different from situations of physician assisted suicide, which is more complicated and has variable ethics and legality.

rhsteps isnt this considered physician assisted suicide? +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +

submitted by m-ice(185),

rhsteps isnt this considered physician assisted suicide? +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +

submitted by m-ice(185),

rhsteps isnt this considered physician assisted suicide? +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1

johnson No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +

submitted by mcl(380),

lolol so instead of using fomepizole they just gonna get him real drunk

johnson yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole. +3

usmlecrasherss Drink vodka man , either way you're dying +

drschmoctor Or if you really wanna get drunk and have a warm place to sleep, drink a bunch of methanol in the waiting room of the ED, then let them pump you full of ethanol and keep you safe. +

submitted by vshummy(83),

So the best i could find was in First Aid 2019 pg 346 under Diabetic Ketoacidosis. The hyperglycemia and hyperkalemia cause an osmotic diuresis so the entire body gets depleted of fluids. Hence why part of the treatment for DKA is IV fluids. You might even rely on that piece of information alone to answer this question, that DKA is treated with IV fluids.

kbland https://step1.medbullets.com/endocrine/109032/diabetic-ketoacidosis-dka +

fulminant_life I just dont understand how that is the cause of his altered state of consciousness. Why wouldnt altered affinity of oxygen from HbA1c be correct? A1C has a higher affinity for oxygen so wouldnt that be a better reason for him being unconscious? +4

toupvote HbA1c is more of a chronic process. It is a snapshot of three months. Also, people can have elevated A1c without much impact on their mental status. Other organs are affected sooner and to a greater degree than the brain. DKA is an acute issue. +1

snafull Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +3

johnson Probably because they're sustained on ketones. +1

doodimoodi @snafull glucose is very high in the blood, why would neurons not be able to use it? +1

soph @snafull maybe u are confusing bc DK tissues are unable to use the high glucose as it is unable to enter cells but I dont think thats the case in the neurons? +1

drmomo https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/ states its primarily due to acidosis along wth hyperosmolarity. so most relevant answer here would be dehydration +

drmohandes I thought the high amount of glucose in the blood (osmotic pressure), sucks out the water from the cells. But you also pee out all that glucose and water goes with it. That's why you have to drink and pee a lot.. +3

titanesxvi Neurons are not dependent on insulin, so they are not affected by utilization of glucose (only GLUT4 receptors in the muscle and adipose tissue are insulin dependent) +5

drpatinoire @titanesxvi You really enlightened me! +