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Welcome to maddy1994’s page.
Contributor score: 24


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 +0  (free120#20)
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srsset ansicrsee oihhls.ctw.roic caresedes -IL2 ycctiethv,aien aedneisrgc hT1 crnodiotpu nda tseffce a.mespacrohg





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hTe equsotin asys heyt n'tdo ensrospd ot tinacdsa ENHT sska hihwc yuo ot ifnyidte ichwh rdgu si teh mtos veceiftfe ta nruspsegpis aicd ,ptdcinooru ONT awht teh sotm etfvicfee adcatni .is Teh ewsnar si PsI'P.

I will y,sa re,wvhoe I asw inklgoo ofr oesmtginh ikel troteo.deic

drdoom  lucid. nice catch. +1  
maddy1994  WHY not blockage of h2 receptors +3  
krewfoo99  @maddy1994. PPI are more effective than H2 blockers in suppression of gastric acid +1  


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heT tmso ipnatmrot ihnst to het esontuiq era sa solof,wl htwi #2 bgien eth mtos spic:icfe

)1 apnteit rrtepos inap with rdeavhoe tminoo adn rpsoret unretecrr eedarvoh tomnio undrig rkw.o Oeravhde ntioom can mdgeaa teh unsaatsipusrp uelcsm edu ot mmepenginit yb eht .nmoaroic

)2 Pani is otrws ithw ntnielar otartino fo het suedolhr - hsit si tncnteioss wthi eht nnsigifd of het yctaepm-n t,tes cihhw aisictned a rsapuusiapstn .ruyinj

mousie  I was thinking along the lines of overhead motion - damage to the subacromial bursa which is between the acromion and the supraspinatus ... also its the most commonly injured rotator cuff m. so could have guessed this one right +1  
sympathetikey  Thanks for the explanation. I was scratching my head as to why this is correct, since supraspinatus only does 15 degrees of abduction, but you make a lot of sense. +1  
charcot_bouchard  IDK WTF i picked Trapezius +34  
ls3076  why would injury to supraspinatus cause weakness with internal rotation though? +6  
targetusmle  yeah coz of that i picked subscapularis +2  
maddy1994  ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis +3  
darthskywalker306  I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me. +1  
lowyield  saw someone post this on one of the other questions about shoulder... and it works pretty good for this https://www.amboss.com/us/knowledge/Soft_tissue_lesions_of_the_shoulder there's some videos in it, this specific one for the question is the neer test +  
psay1  FA2019 pg. 438 +1  


submitted by sajaqua1(516),
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HMC I inutcfon is tnieralg to ercacn ssuperins.op CMH I psiadlys onoseyulgend dissenzhtey reotnspi nda tenpsrse ehtm ot D8+C T lcels. The aiefurl ot isdlayp CHM I, ro CHM I lsaydip fo noesfnl- n(da yb neexotnsi ceucoar)sn sronpiet itgrsger a lelcaurl unmiem ,esonreps dealign to stcrdoeinut of eth .lelc

hTe eramposote is ueds ofr teh rationgeadd fo ronw tuo, c,sneneest ro lomarmfde esptoin.r As ccnrae vedsopel, oerm ttsinumoa aedl ot naereicsd ogrnw pioe.ntrs nOyl yb onierpexss fo teh es,armetopo ro sit -oxesivpresroen, anc eetsh atutnm psieotrn eb daderegd ftsa eughon to not eb ieldpsday by CHM I adn eadl ot eth lecl benig liel.dk ieozmbrBot bcolks eth ,teameoposr so eth tumatn rsnptioe ear dyplsdiea no hte cu,fesra glwnlioa het uimnme sytmse to ezigcrone nad likl aptglhioolac eclls.

catch-22  Another way to approach it is to think about MHC class I processing. Basically, if you inhibit the proteasome, peptides will not be generated and nothing is available to be loaded onto MHC I (remember MHC I has to be loaded before it's transported to the cell surface). Cells that don't express MHC I get killed by the natural killers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214736/ +25  
kai  "In conclusion, we have demonstrated that the proteasome inhibitor bortezomib down-regulates class I and enhances the sensitivity of myeloma to NK cell–mediated lysis" from the conclusion of the NIH paper +5  
maddy1994  another mechanism is by blocking proteosome u even decrease degration of proapoptotic proteins...so it enchances apoptosis(from uworld) +3  
azibird  But CD8+ and NK cells kill via perforin! Why is this answer wrong? Is it because it's not the primary effect? +2  
testready  "The proteasome is the major source of proteolytic activity involved in the generation of peptides for presentation by major histocompatibility complex class I molecules. We report the new observation that bortezomib down-regulates HLA class I on MM cells, resulting in increased NK cell–mediated lysis." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214736/ +  


submitted by welpdedelp(215),
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It wsa eth onyl ihprpeealr gunl arc,nce ist salo erom mmncoo ni .wnmoe tistsMaeas oldwu avhe nshwo eultlimp eslnois

sympathetikey  Also, lung adenocarcinoma is the most common lung cancer overall, most common in women, and most common in non-smokers. I know she smoked in the past, but that's what tipped me off to it. +5  
alexb  Yeah I literally picked SCC bc I knew she'd smoked in the past smh +  
maddy1994  20 years of non smoking history ,she wouldnt be at elevated risk for smoking related carcinoma. +2  
larryd  According to FA19 p. 693, large cell carcinoma of the lung is also peripheral. +  


submitted by sam1(16),
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hatW btaou hte liantiodda lofw rohtuhg hte ?mucrxclfie

maddy1994  exactly man i got 4.5 and i thought he asked ventricle and left circumflex should be there so i put 5 ...glad someone thought like me.i was just cursing myself for over thinking. +10  
djtallahassee  Yea put 5 here too. they are essentially saying the myocardial oxygen supply to the left ventricle comes from the LAD. Not sure if true or not but figured that the LCX would at least contribute 20% of the blood +  
justherefortheyield  100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value. +  


submitted by welpdedelp(215),
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rmeshoiHo,sctmao kaa n"obrez sebaid.e"t onntCa be osndAid ued to hte emcirayyhlepg nad mnlaro PB

alexb  I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM. +2  
tinydoc  I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation. +11  
maddy1994  testicular atrophy &hepatomegaly helped me out to eliminate the options..when i was left with ferritin and saw pigmentation it clicked that it is hemochromatosis +3  
krewfoo99  Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis +3