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 +0  (nbme22#7)

Answer = Decreased libido; normal nocturnal erections

I believe what they were trying to indicate in this question was Psychological Sexual Dysfunction (aka - Performance Anxiety).

In this case, it wasn't so much the performance that worried the man, but he may be so focused on his health issues (post stroke), that he is unable to perform adequately. Therefore, his natural libido would be decreased. However, because it's psychogenic & not physiologic, he should still have normal nighttime erections.

 +2  (nbme22#11)

I believe they're referring to compression of branches of the Ilioinguinal Nerve (possibly the Anterior Scrotal Nerves.

Source: https://en.wikipedia.org/wiki/Anterior_scrotal_nerves

armymed88  Ilioingual covers part of the medial thigh, base of penis and anterior scrotum Posterior scrotal nerves are a branch of pudendal and cover said area Doral nerves cover the dorsum of the penis which are also from the pudendal
meningitis  I thought it was the Genitofemoral nerve because the genital branch supplies the cremaster and scrotal skin, but I looked it up and: The genital branch passes through the *deep inguinal ring* and enters the inguinal canal; also, Ilioinguinal wraps around the spermatic cord just like the question stem says.
jean_young2019  "The structures which pass through the canals differ between males and females: in males: the spermatic cord[6] and its coverings + the ilioinguinal nerve." from wiki "Inguinal canal", which means the ilioinguinal nerve lies on the external surface of spermatic cord. https://en.wikipedia.org/wiki/Inguinal_canal The contents of spermatic cord includes, "nerve to cremaster (genital branch of the genitofemoral nerve) and testicular nerves (sympathetic nerves). It is worth noting that the ilio-inguinal nerve is not actually located inside the spermatic cord, but runs along the outside of it, in the inguinal canal." from wiki spermatic cord. https://en.wikipedia.org/wiki/Spermatic_cord

 +1  (nbme22#29)

A Pacemaker is the correct treatment for 3rd degree AV block. Makes it so the atria and ventricles beat in sync.

 +4  (nbme22#9)

Diagnosis: Acute Hemolytic Transfusion Reaction


Type II hypersensitivity reaction. Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs).


Fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular hemolysis), jaundice (extravascular). Within 1 hour.

 +4  (nbme22#1)

I believe this is referring to midgut malrotation. Due to improper positioning of bowel (on the right side). Ladds bands connect the large intestine to the liver.

Can lead to:

  1. Volvulus

  2. Duodenal obstruction

3. SMA Occlusion -- I'm guessing based on the answer to the question

meningitis  Yes, the question clicked for me when I realized the ligament was on the RT side instead of LT so I thought of Volvulus. Image of ligament of treitz: https://media.springernature.com/original/springer-static/image/chp:10.1007/978-3-642-13327-5_17/MediaObjects/978-3-642-13327-5_17_Fig3_HTML.gif
hyperfukus  So Volvulus regardless in baby or adult is gonna cause SMA prob + Duodenal Obstruction: d/t Ladd bands im gonna go back and remember those associations :)

 +8  (nbme22#35)

Answer = C. (Decreased hepatic VLDL synthesis)

Nicotinic acid = Niacin. Niacin works by:

  1. Inhibiting lipolysis (hormone sensitive lipase) in adipose tissue)

  2. Reducing hepatic VLDL synthesis

johnthurtjr  Well color me surprised. I was completely thrown off here.

 +1  (nbme22#11)

I thought initially we were dealing with post-partum psychosis, but on re-reading, this looks more like either Generalized Anxiety Disorder or OCD or both. Either way, treatment should be an SSRI (Sertraline).

seagull  OCD for sure

 +0  (nbme22#22)

Severe hypertension often leads to hyperplastic arteriolosclerosis (onion-skin appearance). Also see proliferation of smooth muscle cells.

meningitis  and explains the flame hemorrhages (Goljan) caused by malignant HTN

 +1  (nbme22#28)

Most common cause of splenic vein thrombosis is chronic pancreatitis, caused by perivenous inflammation.

Source: https://www.ncbi.nlm.nih.gov/pubmed/14502405

hyperfukus  great link! helps answer other qs too thank you :)

 -8  (nbme22#31)

Crackles either indicates chronic bronchitis or consolidation (from pneumonia or pulmonary edema).

Given that there's only a 1 day history of SOB, I'm leaning more towards lobar pneumonia. Maybe that's also what's causing the S3 at the LLSB? If it's Staph Aureus, I guess we could be looking at acute endocarditis + pneumonia? Or Q Fever? But that's just speculation. Could also just be that the lung consolidation is altering blood flow, leading to the back up into the Right Atrium & Ventricle.

brise  Patient has CHF from the S3 heart sound and has MR. You hear fine crackles in early congestive heart failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/
usmleuser007  No Infection - normal temps ; Q-fever presents with A patient with exposure to waste from farm animals who develops: a. nonspecific illness (myalgias, fatigue, fever [>10 days], b. retroorbital headache) c. normal leukocyte count d. Thrombocytopenia e. increased liver enzymes

 +4  (nbme22#44)

You can basically think of Dicumarol as warfarin. MOA: Depletes vitamin K stores Since Vitamin K is involved in gamma carboxylation of factors 2, 7, 9, & 10, you can use the Prothrombin Time to measure the response. Prothrombin time measures the extrinsic pathway of coagulation, which is mainly mediated via Factor 7.

 +3  (nbme22#38)

I-cell disease (inclusion cell disease/mucolipidosis type II)—inherited lysosomal storage disorder; defect in N-acetylglucosaminyl-1-phosphotransferase ; failure of the Golgi to phosphorylate ; mannose residues (mannose-6-phosphate) on glycoproteins --> proteins are secreted extracellularly rather than delivered to lysosomes. Results in coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes. Often fatal in childhood.

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