Welcome to maddy1994’s page.
Contributor score: 24
lucid. nice catch.
WHY not blockage of h2 receptors
@maddy1994. PPI are more effective than H2 blockers in suppression of gastric acid
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
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.
why would injury to supraspinatus cause weakness with internal rotation though?
yeah coz of that i picked subscapularis
ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis
I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me.
FA2019 pg. 438
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.
"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
another mechanism is by blocking proteosome u even decrease degration of proapoptotic proteins...so it enchances apoptosis(from uworld)
But CD8+ and NK cells kill via perforin! Why is this answer wrong? Is it because it's not the primary effect?
"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."
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.
Yeah I literally picked SCC bc I knew she'd smoked in the past smh
20 years of non smoking history ,she wouldnt be at elevated risk for smoking related carcinoma.
According to FA19 p. 693, large cell carcinoma of the lung is also peripheral.
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.
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
100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value.
I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM.
I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation.
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
Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis