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Welcome to jooceman739’s page.
Contributor score: 26


Comments ...

 +7  (nbme22#39)
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to:atlnaosRbiem

Teh iphinyacs sadi the oyb is lilynuek to oledpve ayn terho oeanmsl,ps os he o'ntsde eavh eth ehtidrein bR nauiom.tt

In itsh saec, eh sha the padrocsi saoonaltrtemi.b rdpciaSo bnesliraotmtoa qeersuri two omitsca unitmtsoa of Rb ni het smea nriaelt ll.ce

tsJu as a esid tne:o rniIedhet btseaorositanml dnte to be il.erbltaa acSiodpr rae larut.laine

carls14  aren't retinal cells a type of somatic cell? Why not is the mutation not considered in the somatic cell of the child? +9
omerta  Although this mutation would be considered somatic, I believe the question is just asking you to be specific as to which cells. If you answered "somatic cells of the child," that's quite broad and could apply to almost anything. +11
kernicterusthefrog  I had the same struggle and thought process. +1
eacv  There is a Uworld qx that explain this in detail> ID: 863 +3
arcanumm  I read the answer options too fast so got this wrong. It is a somatic cell type, but somatic in general implies a higher risk for developing other cancers. The hint here is that the physician stated he is unlikely to develop any other neoplasms, so it is a specific double hit mutation in the retina. +7
almondbreeze  wouldn't she have any possibility of developing osteosarcoma as well? :( +
almondbreeze  did some reading and it seems like osteosarcoma only occurs in familial retinoblastoma with RB mutation +
brise  But how can a 5 year old get two mutations to get retinoblastoma? In 5 years?! Obviously doctor is probably wrong LOL +




Subcomments ...

submitted by seagull(1403),
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shTi paetint is ngpiiptr .blals trBeet od a rugd rsecen hhicw eessm os.iovub

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +37  
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5  
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1  
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2  
charcot_bouchard  Lol. I got the right answer but took long time +  
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +  
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +  
targetmle  why is there basal ganglia hemorrhage? +  
dul071  Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1  
usmile1  basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +1  


submitted by bubbles(66),
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hsTi noutiqse ndcusofe me a otl escubea so many eusnsoitq veah rleidld em no teh paetorimcn of het PNA paesec masmhinec in items fo ifudl aolrdveo s(a ni )HF.C

I gtthuoh ANP asw a ghue erlyap in hte loss of Na in ictancsmescur fo elovmu odeoravl sa in shit ntetiap hw(ihc si hyw yuo ese ocmveeliu aOetriamhypn ni seatntpi tihw IHDSA or rveytaitciov of the AARS as in CHF.)

Why si AHD nwo gnebi damen as eth nlrpsoeebis egnt?a

jooceman739  My thinking is that ANP causes natriuresis, so you're losing salt and water at the same time (isoosmotic fluid?). Meanwhile, ADH absorbs only free water, so it would dilute the serum. Correct me if i'm wrong. +9  
bubbles  Ohhh you are right. Thank you for the explanation! I got so fixated on that one mechanism haha. +3  


submitted by someduck3(58),
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Fta losebul vaitnmis era KD,,E,.A So tbho D ma;&p E oulcd be esaerdedc in tihs t.p Btu oyu eahv to ownk ttah mtViina E iccfedyein si iesatacosd htwi meianildoyten ap&m; ahs nbee secaoisatd itwh etioosprr cuolmn nnedtieim.yaol olAs tVi E nca be gvine hiwt lhreAmezi stitneap sa ti leshp wthi eref lcar.sda.?i

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration: https://www.ncbi.nlm.nih.gov/pubmed/9012278, as does Copper (TIL): https://www.ncbi.nlm.nih.gov/pubmed/15249607 +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +