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Welcome to kard’s page.
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Comments ...

 +0  (nbme23#41)
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tneaPsti how enrdugo na AV done iaatlbno rea osla padenilmt wthi a kaemreacp ot elhp tnaimina a onmlra erhat rtae. Tx. rof mlocpeet lBkoc


 +1  (nbme23#4)
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rPnenatg nwoem aer oerm ipbuetlssec ot eresev oailmusPmd pflaamcrui al iga.Hplmrioyecmaay ;pma& esevre aeniaam si nrqfutleye otedreencun sa a tamccpilinoo ni pa ulicamfr iarlmaa, atth is yslaulu sderbcai ot eiceandrs uocsegl eus nad adpimeri uslec go pnoroiutdc sueacd by het nbhoitiiin fo onnioeegclu.essg


 +4  (nbme22#36)
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Ticlryicc nda tyrtacilcec sta,pssietndrane soal aldlec clcyci tTeehad snnieps.star elirerppha aoinccniegrtlhi omlsicatpn of yrd mouth, sn,ctooaiinpt caolru edsi fcesfet nad urinary tsecayhin are ecdbredsi nad ficpecis icliacnl isengileud ofr terhi feeeifcvt atanmegenm aer odidv.rpe

,So tsmo oocnmm enroas ofr iopnncaeloncm hwit cicycl sidtanrneeastp epyrhat si tis tiioarlcicnngeh fteef.c

odicei.ln/2ptns:wmbtw.n993hb/m/g0vh.up.w69/ lp/niiitopeatsss6ont-ns/8i3en9.cm204eshton.o//s/trwsc-ia0ittpeawddesercwiegsi:rhsdna/ypr-addn/o

o:Nte esaleP if mi me,tainsk ro ym aprhcaop is s,kteinam ocrtrce ..e.m haknT oyu


 +5  (nbme22#18)
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gtihM eb thsi ,way tceorrc me lpesae if ym racpphoa is e.oim akstSn in eht Semt we have a uanilPf nle,uod eDu( ot ee0ws1k ago setruS)Sou mi ktinnihg on teuSru ulra,naomg ttah fmsro a nlisoe in(lafuP a)rro Nnoeluddu eht -aoebobbnnsrla tuuesr amlartei.





Subcomments ...

submitted by cassdawg(1157),

This woman has gout which is associated with hypertension and diabetes and attacks can be precipitated by diuresis (such as with furosemide). Negatively biorefringent crystals (uric acid crystals) are also characteristic of gout. Gout is associated with kidney stones (nephrolithiasis). [FA2020 p467]

frijoles  I don't see where it says that gout is associated with kidney stones. Gout is more commonly caused by underexcretion than overproduction, yes? And this patient has renal insufficiency, yes? So if anything, they have LESS uric acid in the urine and are LESS likely to have stones. It's the reason they have gout to begin with (because it's out of the urine and into the blood). This answer would make sense if the gout was due to overproduction but there is no evidence of that here. This isn't a very good question imo. Please lmk if I'm missing something here. +3  
jt263619  uric acid stones... +2  
tyrionwill  hyperuricemia may cause kidney stone if urine turns to be acidic or condensed. so I think this question is asking a general possible complication. +  
i_hate_it_here  I think that what they were trying to ask was what could also occur due to the predisposing factor that led to gout. The patient was on a loop diuretic which can lead to hypovolemia. Kidney stones and gout occur more frequently when the substrates are able to concentrate in low volume. +2  
kard  furosemide and acetazolamid---> Nephrolithiasis! +  


submitted by geekymle(9),

i tried but i'm not able to reason this question. can anyone please help me on this?

sunnyd  I found a good explanation in the discussion here: https://forums.studentdoctor.net/threads/nbme-16-help.1059939/page-2 +1  
geekymle  thank you! it was the wording of the question which got me!! +1  
andro  I think there were two possible ways of approaching this. The first was by appreciating that the tumor cells ( which release Growth Hormone ) would express growth hormone releasing hormone receptors GHRH receptors - GHRH uses the Gs signalling pathway ( Net effect an increase in cAMP from the increased activity of adenyl cyclase ) The second and more straight forward approach From the stem of the question already they told us we are dealing with an overactivation of the G alpha stimulatory subunit . If the GTPase aint working ( meaning it cant be inactivated ) , the effect would be an increase in the activity of adenyl cyclase +5  
meryen13  well I know you guys probably thought its a jam kinase because of somatotroph adenoma. we know growth hormone has a jar/ kinase right? but the question was really sneaky and mentioned that there is a G alpha s subunits protein!! that should remind you that Gs activates adenylyl cyclase to increase CAMP. the key world was Gs (and I didn't think about it cause I just saw somatotropin adenoma) +  
m0niagui  where in FA2020 will I find reference to this? I'm still at a loss ;/ +1  
kard  m0niagui, Just Get this GHRH (Gs)cAMP ---->GH(Jak/STAT), And you can check all of them on the "Signaling Pathways of Endocrine Hormones" +1  


submitted by seagull(1571),
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-A aprmyri omort xetroc = grnow eisd fo dbyo d(tfieci of UMN on letf iesd yobd)

B - lushTmaa = ysrnseo monfirotina duoitcn - otrom ictfeids kyleilnu to ortiainge form eehr

C - Psno - CNs ,,5876,, klleyi esutrl ni "cledok ni odemnsy"r or eplmteco ossl of oromt ntncfuoi no rtghi ides + icfaal euteasrf.

D. imVrse - rncealt body .ctinoonoradi gDamae relsuts in taxaia

tNo eeplocmt tbu mbaey fhpl..lue

yotsubato  C - Pons - CNs 8,7,6,5, likely result in "locked in syndrome" or complete loss of motor function on LEFT side + RIGHT sided facial features. Decussation occurs in medulla +2  
kard  Sorry if im mistaken, Isnt A) Somatosensory? +2  
krewfoo99  Yes i think A should be somatosensory. Primary motor cortex would be present in the precentral gyrus +  
drpatinoire  A is primary motor. A and the gyrus at right side of A compose the paracentral lobule. +  


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anC ayoenn apielxn wyh mcoraepgah aviicytt ludow eb dsedearec ni ti?hs I wedtna ot kicp neo tath ahd obth umcus griecntse iyticvat as engbi aedsncrei lgona whit esadincer mhorpeacag tivycita thiw cncaniomtot eeecasrd in iyiclar ttvcyiai btu thsi nwsat' na ptiono os I went hwit all cese.dnari iSnce tsi' hlesialbseewtdl- hatt pohrcgsmaea saeuc maeadg in yeshaepmm cy(alepeils in serkosm edu ot attncson orinrttaii mfor hte emso,k) owh si ti pbselois hatt ahmerpcoag ttcvaiyi odulw og ?ONDW

kard  Mucus hypersecretion --> Induce airflow limitation in COPD "potential risk factor for accelerated decline in lung function" Cigarette smoke impairs both the phagocytic and respiratory burst function of neutrophils! Macrophages-->activated by cigarette smoke extract to release inflammatory mediators COPD--> alveolar macrophages and neutrophils are defective in their antimicrobial functions. Macrophages from COPD patients--> show reduced phagocytic uptake of bacteria. "Streptococcus pneumoniae and nontypeable Haemophilus influenzae" I Hope This Helps... +23  


submitted by seagull(1571),
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iThs si an etincpolme dimfatdroihy e.lmo Tehy cantnio ceionltmpe lefat srpat dniilugnc setm esllc hhicw era tsimoyr dan eigv rsei to tcuesrndutru si.uets

kard  Can someone explain why the other choices are incorrect?, Thanks +  
mtkilimanjaro  I got it wrong and put the lacunae one, I wasnt sure if hematopoietic stem cells could occur from the mother as well. If it had any other cell line i wouldve picked it. For the others: this lady has a partial mole, which has fetal parts. A complete mole has NO fetal parts. Both mole types have cyto, syncytio, and villi. Thats how I ruled those ones out +2  


submitted by haliburton(214),
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Tsih si erwta tonnticxi.ioa /7etg/b71wbo/m9pnhm7i/.5.wuwn.:nvihcplts.8d

thisisfine   Agreed! It's along the lines of those marathon runners who collapse questions. Nothing but water for 24 hours = getting rid of too much sodium. +1  
temmy  are we just going to ignore the diarrhea for 3 days? what is its significance +4  
kard  Temmy, We aint Ignoring the Diarrhea, Actually the most likely electrolytes to get lost with it is sodium> chloride> potassium> bicarbonate... Plus the Water intoxication -> HYPONATREMIA +1  
bronchophony  why not hypoglycemia? +1  
saulgoodman  Because glucose is not an electrolyte, it does not conduct electricity in solution. The question is asking "Which of the following electrolyte abnormalities". +4  


submitted by sherry(29),
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Tshi si teh cdsone best hcicoe I aws gnano ekta rungdi teh ema.x I uohthgt Aeg aws rebett sceni AF ietadidnc rdasdecee retgenos adn lod eag rea eht earossn ofr oben orrinps.oet aCn mooebyds ailpxen ot em why Aeg cludo tno lssiybop be eth ?ensawr

kard  I solve it like this: So age is 70 (already, nothing we can do to change it), is asking about a predictor of success in the Rehab process (So basically, what this patient did in matter of activity, life style, etc. to have a Good rehab process). So From all the answers the, Activity level is the most likely choice because of the, increase in Bone density(Specially Weigh bearing) and OsteoBlastic activity. +6  
misterdoctor69  But bu that logic: just like you can't do anything about age, you also can't do anything about activity level BEFORE the fracture right...? +3  


submitted by monoloco(136),
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casptduenaEl rinsgamos rnu mnparat in teasitpn ohw hvae on seel,pn threhew ysayclhpil or l.fnctlouiyna llRce(a teh awea-rydir fo ulaqease eclkis ecll seatptni pcxeeerein ahnstk to htrie onfitlcaun elttemnysoapuo.)c

sympathetikey  Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy. +  
chillqd  Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause? +26  
studentdo  Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why? +1  
mgoyo89  The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :( +1  
kard  Everyone is correct about the Encapsulated microbes, but this is one of those of "MOST LIKELY", and by far the most likely is S.Pneumo>>H.infl>N.Mening. (omitting that patients with history of splenectomy must be vaccinated. +1  
djinn  Gram negative are more common in DIC my friends +2  
drzed  Correct me if I am wrong, but I am pretty sure that E. coli is NOT a common cause of pneumonia because it must be aspirated to enter the lung. Thus, only patients with aspiration risk (e.g. stroke, neurogenic conditions) would be at a chance of getting E. coli pneumonia. +1