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Welcome to masonkingcobra’s page.
Contributor score: 318


Comments ...

 +0  (familymed1#33)
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No oen vree eosd isth ssaya ti :essme

UoTDt:pea ve,reHwo oleiocgrs etsst ueqreri aitodalvni at hte locla l,leve wcihh is liccaipratm ni oeinurt ecipctar. nI oatinid,d cersocnn eovr sit cacucray ehav edlmiti tis se.u

eTh aeur retbha ttse si fisrt eiln


 +0  (familymed1#32)
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pr-gdsndele-sehssitnvcmite:n//ekidsm/vreemrd-e.-ia/anocacviririg/ctpl


 +5  (nbme24#19)
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All uotab thi:itsgn

atc/.r/stcu.esfeeeoshmdi/nnndithcwsjp.deotsob/s/na:iohetneutgafcl/o

charcot_bouchard  When i faced this ques i did some Kegel. Felt something in my pee pee but not in my b*e. I exclude all option because they are bigger muscle of pelvic floor except EUS & IAS. And also remeber Kegel can be used as a treatment of prem. ejaculation not premature defication. +15
paperbackwriter  @charcot_bouchard Actually Kegels are used in the treatment of fecal incontinence as well because of effect on EXTERNAL anal sphincter and surrounding muscles which are under voluntary control (you can most definitely feel it if you do a kegel lol). The answer is internal anal sphincter because internal is not under voluntary control (tonically contracted via symp. --> parasymp. relaxes it --> gotta go feeling --> no incontinence because of external sphincter's voluntary contraction). +9
am4140  @paperbackwriter - Honestly, this depends on how you do the kegel. It is entirely possible to not involve your external anal sphincter at all once you figure out how to isolate your vaginal area. So the internal anal sphincter is under involuntary control so that was especially right, but I was prepared to pick anything with “anal” in it at all. So kegels work for fecal incontinence only if you’re choosing to involve your external anal sphincter, or you don’t know how or are too inexperienced to isolate the muscles around your vagina. I don’t think NBME or USMLE would get this tricky because the external anal sphincter will not always be involved in kegels. +1

 +5  (nbme23#33)
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ahrikbavecunch/hrt/llsphralnw.teea:tdhmi..it/ed_ht.

Esay espticur ot anestrdnud


 +8  (nbme23#39)
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In nioiddta ot eht ueipsovr i:aotnepanlx

ehS is oinr indiecfet dan cealci fecastf eth amporixl undu.mdeo I" kFduce "Btrityna = oI,nr F,tlaeo B12 for ueDduon,m mjuneJu nda Imlue

krewfoo99  Great analogy lol. But just a correction, First Aid states that Celiac Disease affects distal duodenum and proximal jejunum. But you are right, it would still cause iron deficiency anemia as it affects the duodenum. +3
fexx  OR you could just remember 'Iron Fist Bro' (F includes folate and fat, B includes B12 and bile salts) +4

 +0  (nbme23#28)
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yrleasPnlo my eissu ithw shti osuienqt is ttah I thghuo 1B2 uassce lmeoeyditainn in both hte STCL dna het LMDC ()DSC tbu ethy rea ignsett eht mnchesami eerh llyrae hwit the owlhe emolniahmcyt iadc bit dna eth eairidmp yenlmi nihystsse

If yr'euo osuuric

0ntm6csrrnsetcc2as6whi1/cwpst./uato/e.:/awdl


 +0  (nbme21#5)
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iLkn

necrotizingfasciitis  Going off of the comments people have posted above & kinda bringing things together: PDA flows from aorta to pulmonary arteries, which reverses after birth. This means de-oxygenated blood flow from the pulmonary arteries to the aorta & less volume being sent to the LF side of the heart. This results in a decreased afterload because there is less blood flowing from the lungs to re-fill the LF ventricle, & the heart is still pumping with the same force as before, so the same volume of blood is leaving, but less in entering the LF side of the heart. From here, you use CO = SV x HR SV = preload - afterload (which is decreased due to the PDA) This results in SV being larger than normal, so when you plug that into CO = SV x HR you get a higher number for cardiac output. +
didelphus  The ductus arteriosus flows from PA --> aorta in utero to bypass the lungs, which have extremely high resistance to flow. This reverses after birth due to a drop in PGE2 (which was supplied by the placenta) and increase in left-sided systemic resistance. So a PDA typically flows aorta --> PA (assuming there are no other defects). +

 -1  (nbme20#8)
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sR:n'ibob eTh tow smot rtmntpaoi ascuse of rcaoit nmeyusars are hiateesslocrros adn rn.yeipstnhoe icsrlehotsesoAr is eht omer mtnanido ocftar in madiabnol croati ,aymrsusne ihlew yonienertpsh is csastoieda ihwt nsandicge iotrca ysnuemsa.r


 -1  (nbme20#20)
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eHre si a caatnstfi upiectr ot etdrnudsna

2/f1l/-aommpgCethefabd0se/8c9uu7esP5ta274mlirieni8c32-uw.h6:n.o4cate7g/12ief/cn0-n/rardpt3sm1rha9-neagio9tawsat./ee86waopee4n2a


 +30  (nbme20#21)
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geaP 2 has a raetg crpiuet

o0/wp.4rls866ghjancw/d1:0t9i1-ra(nl/i2w/.)oec/-t9i7tf361e0pS

kamilia20  chlamydophila psittaci?? +1


 +3  (nbme20#38)
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nI ghcoiynpecs piyo,ipadls suerm idosmu is low, nad efart twera ednpoavriit es,tt irenu ilaooymstl si d. niieearcnerUs yilaolstmo oeds nto necsaeri wiht vrsonpaesis jnnieiotc

nI inoheengcrp isdeabte insspuidi, surem iomusd si hhig nda herte is no lam/cgehidn isenrcea in ieunr oastilolmy fater rewta paioritendv

yotsubato  This patient does not undergo a water deprivation test +12
niboonsh  Compulsive water drinking or psychogenic polydipsia is now increasingly seen in psychiatric populations. Effects of increased water intake can lead to hyponatremia causing symptoms of nausea, vomiting, seizures, delirium and can even be life threatening if not recognized and managed early. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579464/ +7
missi19998  Just wondering why it in not resistance to ADH action of vasopressin +
amarousis  because he would be hypernatremic with no ADH. can't resorb any water +1
minhphuongpnt07  low osm/urine, low os/plasma => psychogenic polydipsia +
benitezmena  In this question the pt had a normal urine osm (80) a low urine osm would be <50mosmol/kg. +
euchromatin69  u world 212 +

 +3  (nbme20#37)
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nI iemaclbto laia,oklss soaspitum vsome into the clsel

eTh slso ni lvmueo tghuohr mseesi igtrgesr RSAA risnelgut in cdiarenes ntsAleooedr esleaer and fehutrr tispoumas txneecori

/s.bde:et6theaw.w1/a/ntwptp/l1ti





Subcomments ...

submitted by m-ice(326),
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eTh ttniape deens imeadcl inetatnot ieil,ayemdmt hhicw eimselanit gbniniato a ucrot dor,re ro raninrgtrsfe he.r A rnsue deso ont haev hte aems rgnaniit and lioufcniatiqas sa a aicisnyph, os ti wodul eb ppareoatnripi to ska emht to exneiam hte tapin.et knAisg the ilsatpoh achpalin inaga ucold eb tiarepp,oprani nda lowud taek ermo met.i ,ehroTeerf the etsb tponio ognma shteo evngi is to sak the eatntip fi ehs will lowla ihwt her hunbads netr.pse

sympathetikey  Garbage question. +56  
masonkingcobra  So two men is better than one apparently +28  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +12  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +9  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +15  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +25  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +5  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +11  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +10  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1  


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cintbeirFno si na luecrlalxeatr atmirx coroetnpgy,il hwlie ilmna si an mrtietdineea tnalifme atht cplfsceaiyli opvseidr tpousrp to het elcl .nclesuu Dto’n sonufec lamni ithw mnalnii iscnec(e shaet su )lerlya;c nniimla is klei ,inftnoribec na MEC teolcogrynpi adn a rmaoj tcoepnnom of hte aslba naalim fo amensebt m.neearmsb

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +31  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +3  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +  
brise  @abkapoor the f is progeria? and do we need to know it for step? +  
brise  @abkapoor omg jk jk wow +  


submitted by medstruggle(12),
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Wyh is ti nto noavari collefli csell? I hugthto teh fmalee oanagl fo iSetolr nad yieLgd is /htcogaulnarase ces.ll

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +7  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +37  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +17  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


submitted by joker4eva76(25),
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The senotuiq tesm is grdisicbne a iorclianmthod edisase, cwihh lycommno eprntes hitw cctlia .coisdisa eheTr si na icnrease ni briacenoa ofsmr of eenygr cdiporuont o)slgycly.i(s hTe thoirmdnaioc rae ,afuytl so they t’anc esu teh den prtcodu of llgioycsys utarv(epy) in AT.C Indseat vuretapy is eudhsnt evro dna is seud yb LHD tacea(tl edhy)adnsegero ot tgneeare tpea.uyvr

e:sAid aRelcl that HLD usse DAHN nad eenasregt .+DAN ficiDncyee of DLH cna leda to lsos of rnroeaingete of NAD+ nda hsniibit ssyll.giyco

drdoom  ... pyruvate is shunted over and is used by LDH (lactate dehydrogenase) to generate lactate*. +3  
chris07  It's hinted in the answer, but I would like to clarify: max O2 consumption is decreased because O2 is consumed in the Electron Transport Chain, which occurs in the mitochondria. With the mitochondria not working, the ETC cannot work, and thus there is less demand for Oxygen. +17  
masonkingcobra  Mitochondria are the powerhouse of the cell +51  
uslme123  Apparently ragged red fibers are the result of coarse subsarcolemmal or intermyofibrillar mitochondrial accumulations.. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mitochondrial-myopathy +2  
mnemonicsfordayz  As @chris07 said, less O2 is being consumed in the ETC... but I also was thinking that the diaphragm is a muscle and if the mitochondria in her diaphragm are also not functioning, then she's not breathing properly and less O2 is being inhaled and therefore decreasing her oxygen consumption. Is that totally off base or am I just grasping at straws here? +  


submitted by tinydoc(223),
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yTep 1 ailaiFml ilimayDedpsi gp.( 94 FA 91 )

edsnriaec TG --t&-g; erspcitnitaa tcr epiuE / ursirtip as tnhmdaoXan MHS

Can eb dscaue yb itrenoLppoi plaise ro orpAepoint CII dcncifieey

yeht isda taht PLL is nief os its OAP CII

npaiHre eesreastp LPL mrof piarrneH Slauetf iotyMe on csVa tdhEonemilu aolwnilg us ot test tis utionfcn ni the .bal

I tog it rwgon oot - iptduS Rtoe aozinoeimrtm rcllae to.nuiQse

masonkingcobra  I think you need to know that ApoCII activates LPL not necessarily know the disease +10  
yotsubato  Knowing the disease makes it easier to remember the details though +2  
pg32  Mnemonic for these 4 types of dyslipidemias and their causes: 1 = LP meaning LPL is deficient (or anything associated with activating LPL, like C-II) 2 = LD meaning LDLR is deficient (or anything involved in interacting with LDLR, like B-100) 3 = E meaning ApoE is defective and 4 for more (VLDL) ("more" just meaning more letters in the cause (VLDL oversecretion)) +2  
castlblack  One too many chylomicrONs, two much cholesterol, threE apo E gone, 4 put the fork down fatty +1  


submitted by egghead(1),
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Tsih si neo of osthe ssqeinuot I swa never gogin to te.g ts'I ont ni F,A I d'ont nikht vIe' snee ti in lss.ac

hungrybox  same :( +  
masonkingcobra  My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp) [Turns out it does not](http://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x) +  
gh889  FA 2019, pg 551 +8  
meningitis  Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line; medications (eg, clomipramine) may be considered. +13  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +  


submitted by mcl(586),
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hsTi mieag si yrev .helulfp

seagull  http://www.siumed.edu/~dking2/erg/GI178b.htm Another histology slide with labels +1  
masonkingcobra  I like to think that the parietal cells look like "fried eggs" classically +  


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nCa osmybeod pesael xienalp hyw het aKp sah ot eb 6 nedtsai fo ?10

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +14  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +1  


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Cna dboyosme lspaee elxinap why eth paK has ot eb 6 aendits fo 01?

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +14  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +1  


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anC eoymobds easlep liapxne ywh teh paK sah ot eb 6 eitsadn of ?10

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3  
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +  
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +14  
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +1  


submitted by medbitch94(36),
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M9nnbm.4vci.lhc6pmn:tC//sc94//wglstpt.ro/Pew.i4wia9/h

masonkingcobra  The pathogenesis of post-transplant lymphoproliferative disorders (PTLD) in most patients relates to the outgrowth of Epstein-Barr virus (EBV)-positive B cell proliferations in the setting of chronic T cell immunosuppression. +2  


submitted by onyx(41),
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A ayrplhocdilrgaai iilbsve ilua-rdif lelve ggsestsu a eprytt rglea noelsi ,che(en )civy.“”atra Tath's not ignog to beceom laonmr siestu ag.nia xSi nosthm gfnowllio uortnioels of psostmmy uoy acn etpxce gnealhi in eht omrf fo a acr;s that si, obssiirf btu only in a lsnieg tsp.o

masonkingcobra  Robbin's: The basic mechanisms of fibrosis are the same as those of scar formation during tissue repair. However, tissue repair typically occurs after a short-lived injurious stimulus and follows an orderly sequence of steps, whereas fibrosis is induced by persistent injurious stimuli such as infections, immunologic reactions, and other types of tissue injury. The fibrosis seen in chronic diseases such as pulmonary fibrosis is often responsible for organ dysfunction and even organ failure. +4  
stevenorange  What Differentiates Normal Lung Repair and Fibrosis? Basement membrane ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  
step1234  I'm a little confused here since FA20 209 states Klebsiella causes liquefactive necrosis in the lungs. Does the pulmonary fibrosis occur after the necrosis? +  
fatboyslim  @step1234 Yes pulmonary fibrosis occurs after liquefactive necrosis as a means of repair. Think of it as liquefactive necrosis = damage done in response to Klebsiella -> 6 months later you will see focal fibrosis in that area (scar formation) where the damage happened. +3  


submitted by hayayah(1057),
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lPciev csnlpcnaih vesrne era prat fo het mhttiaayraepscp sset.my

masonkingcobra  The inferior hypogastric plexus innervates internal pelvic viscera; has both sympathetic and parasympathetic components; parasympathetic contribution helps stimulate detrusor of bladder (along with pelvic splanchnic nerves), sympathetic contribution helps stimulate internal urethral sphincter +3  


submitted by hayayah(1057),
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Yuo hvea a 25% aehccn of nhrtinieig teh maes HAL erarksm as your sbign.lis

masonkingcobra  Two siblings have a 25% chance of being genotypically HLA identical, a 50% chance of being HLA haploidentical (sharing one haplotype), and a 25% chance that they share no HLA haplotypes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628004/ +21  
alimd  It looks exactly like an Autosomal recessive mode of inheritance. +1  


submitted by hayayah(1057),
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heT gamdea si ni het L iimdbnar ni het aare atcigefnf teh raniiccopstol ac.rtt ueeBacs it si ni hte indibmr,a ausdtsoienc in teh mrapsyid m(e)dulla os ti iwll swoh tsalialerip ynslidaocftun omtor sgi.sn

otPoh of inrmbdia nda mrottinap a:rsae tHy.RaLulms/rrhto

masonkingcobra  Just for clarification, on the left side, you see where he had the infarction 7 years ago and the tissue is gone. +6  
chefcurry  so is the dysfunction on the contralateral side? +  
praderwilli  If the decussation is in the pyramids of the medulla, shouldn't it be contralateral hemiparesis if the damage is on the right? It confuses me because of the labeling right and left at the top of the pictures. +  
endochondral1  that link isnt working @ hayayah....is there any good picture to look at to know where the tracts are on this section? +  


submitted by strugglebus(163),
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eTh nspo ahs eresvn 5-,8 so teh lmtiagnrei ldouw eb ecdeafft here

masonkingcobra  Thalamic pain syndrome would involve dysesthesias on the entire contralateral body so more than just the face. Also it occurs often after post-stroke. Additoinally, these dysesthesias appear weeks/months later +9  


submitted by thomas(1),
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esAnwr is Aste.tcroy tnatieP ahs soolialmtgab felutoirmm. lhAtghou nisgmaoneim amy curoc ta oeitxievc,ns noeisimnagm era nbigne dna onetf ciypm.ttosama eTyh amy ecusa ah/ iusseez,r ubt wduol be klnielyu ot ausec hdaet n/wi 6m fo tseno of ./ah ehT size of mturo and urosec of llsines si neitnsocts tiwh hte croesu fo MBG

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +24  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by hayayah(1057),
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LV doeppts krgw,ion rspesrue aedbck up toni lmpu tcuicir. mulP cricuti luroygh si mdae fo 3 spat""r - eth asairieplc,l ttreiiailsnt a,pesc dan teh vloi.lae

In iinrcdecoga kco,sh teh traex olodb rciessean piylclara dtoahyrtsic puresesr, igidnrv lfiud iont het setirliatitn p.esca apdCrome to teh lva,leoi eth itniisletrta ecspa wno ahs rome iuldf su(ht remo ttnisrlaieti yachdttosir spusrere dna lses tocoicn prueress due ot toari fo diluf to teir,onp) nad as a ltseur fo tsih ancnaingblu fo seor,fc ifudl osevm toin eht vielola ;t-&g- mrpaonylu mdeae.



submitted by step420(33),
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Orhet yeinkd potHesyieprrh eud ot csniedaer rsests &-gt-; ton aeilprphsya cb ont rocecsanu

masonkingcobra  Above answer is incorrect because hyperplasia can be either physiological or pathological. Prolonged hyperplasia can set the seed for cancerous growth however. Robbins: Stated another way, in pure hypertrophy there are no new cells, just bigger cells containing increased amounts of structural proteins and organelles. Hyperplasia is an adaptive response in cells capable of replication, whereas hypertrophy occurs when cells have a limited capacity to divide. Hypertrophy and hyperplasia also can occur together, and obviously both result in an enlarged (hypertrophic) organ. +38  
johnthurtjr  FTR Pathoma Ch 1 Dr. Sattar mentions hyperplasia is generally the pathway to cancer, with some exceptions like the prostate and BPH. +4  
sympathetikey  Tubular hypertrophy is the natural compensation post renal transplant. Just one of those things you have to know, unfortunately. +2  
charcot_bouchard  Isnt Kidney a labile a tissue & thus should undergo both. This ques is dipshit +  
brbwhat  Dr Sattar says, kidney is a stable tissue, at least pct is as seen in ATN. But I read, basically kidneys are mostly formed whatever number of nephrons have to be formed by birth, after that they can only undergo hyperplasia aka increase in size/or regenerate if need be in case of atn. We cant have more number of nephrons. +1  
mambaforstep  @brbwhat , do you mean kidneys can only undergo hyperTROPHY? +2  
j44n  .... you're not making more cells..... so it cant be hyperplasia +  


submitted by hayayah(1057),
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sCea of esosiert.oslarorcli

pcysHetralip arsslcrlieoooetirs vsevlion netcinhikg fo eselvs llaw by ihapeplyars fo tomsho slmuec (siikoon'n-n ec)ppaa'enra

  • cuCeeqnonse fo latagnnmi hpesiortynen &2g;81/(t010 /w tauce ao-ndegrn a)mdaeg
  • sReltus ni cededur evessl icrleab hiwt gendn-roa imashiec
  • ayM adle ot bnidifori soisncre of eht eesvls wlal wtih r;ehoaghemr slacicalyls usasec caetu lrena reiaulf R()FA wthi a cchirtacetiras e'eilatnf'tb- aaeaepncpr
masonkingcobra  From Robbin's: Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture. +  
asapdoc  I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +16  
uslme123  I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +  
hello  The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +23  
yotsubato  hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies) +6  
smc213  Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names. Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls. http://www.medlink.com/article/fibromuscular_dysplasia +1  
smc213  *sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries. https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd +1  
momina_amjad  These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN! Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years) If it was the consequence, the presentation is still not classical! -_- +1  
charcot_bouchard  Poor controlled HTN is the cause here +  
charcot_bouchard  Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +  


submitted by hayayah(1057),
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oN amianreiotbs,l onyl emos noigm,vit lokso ellw w/ no aflurei ot teirhv. Most yeillk muemiatr LES.

masonkingcobra  http://www.sedico.net/English/SedicoInformationCenter/Physicians/gerd_e.htm +13