lolol so instead of using fomepizole they just gonna get him real drunk

Bonus cadaver diagram, idk why this was on pinterest...........?

So if you didn't h8 bedbugs enough, they can apparently also serve as vectors for drug-resistant bacteria including MRSA HOW FUN IS THAT

To expand on this, what we think happens with Parkinson's disease (and parkinsonianism) is an imbalance between dopamine and acetylcholine. It makes more sense if you look at this diagram, paying particular attention to the indirect pathway. Loss of dopaminergic (DA) neurons from the substantia nigra (SNc) results in constant activation of those ACh secreting neurons, which ultimately results in inhibition of thalamus from initiating movements. Therefore, using anticholinergics help with parkinsonianism secondary to haldol.

In case you wanna go super nerd and read about myelin, capacitance, and resistance, this guy does a good job.

FA 2019 P 573 - The only part of the nephron that first aid says has an effect on PO4 3- is PCT.

This is a nice quick refresher of what AUC is.

Bonus quick review

According to this paper, insulin inhibits alpha cells from releasing glucagon. This is the relevant figure from the paper.

Patient with bilateral renal artery bruits and hypertension will for sure have activation of RAS system and therefore increase in angiotensin.

Although pheochromocytoma and consequent elevated catecholamines can increase blood pressure, symptoms are typically episodic and renal bruits are not likely to be heard. Elevated levels of serotonin can also cause hypertension, but we would also expect to see flushing; also, there is nothing in the stem to indicate patient is taking SSRIs or something else that could predispose her to elevated levels of serotonin. Elevated levels of thyroid hormone could also give patient hypertension, but we would also expect other signs of hyperthyroidism (tremors, weight loss, etc.).

I was a little confused if EPO would be elevated -- if there is stenosis of renal arteries (as indicated by the bruits) the kidneys could also detect this as hypoxia and ramp up production of EPO. However, I ended up going with angiotensin since it seemed more "concrete" to me that RAS would be up. Does anyone know why it's not EPO?

To expand on this, organophosphates are commonly used as insecticides, and function by binding acetylcholinesterase and "deactivating" it, so to speak. This results in an excess of ACh within the synapse, which causes sludge syndrome (vomiting, sweating, diarrhea -- basically lots of fluids). The treatment for this is typically atropine (antimuscarininic), and pralidoxime (if given early enough, can "reactivate" the ACh-ases). The diagram given does not show ACh-ase, only the ACh-R, therefore D is the best answer.

This figure is a helpful refresher for the 68/95/99.7 rule

This image is useful. Note that the stain used makes myelin appear dark.

Vignette is typical for Parkinson's disease. Area D is the substantia nigra.

Ewing sarcoma is the second most common bone malignancy in children. Histology is usually described as a small cell tumor with high N:C ratio.

Homegirl got some cervical outlet syndrome and should probably take some stuff out of her backpack or get one of those lil roller ones.

These images are useful in combination.

Poison ivy triggers a type IV hypersensitivity (mediated by T cells); only one of the answer choices mentions T cells.

Scabies likes to burrow in the areas between the fingers and toes (FA 2019 161) and causes itching. Could also potentially be lice (groin involvement), but treatment for either overlaps -- gotta use permethrin.

To expand on this, pathologyoutlines describes the histology of kapowsi sarcoma as "spindle cells forming slits with extravasated red blood cells"

Beta-2 receptors are coupled to Gs proteins, which activate adenylyl cyclase and increase cAMP. Cyclic AMP then increases activity of protein kinase A, which phosphorylates myosin light chain kinase, ultimately resulting in smooth muscle relaxation. Albuterol, a B2 agonist, is therefore useful in treating bronchospasm.

CDC recommended treatment of schistosoma mansoni is praziquantel.

Since you're losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

Patient likely has PCOS. PCOS is associated with elevated levels of LH from the pituitary, which stimulates ovaries to produce increased amounts of sex steroids (including androgens --> hirsutisim). Androstenedione is converted to estrone in adipocytes, which results in still further increased release of LH. Obesity and insulin resistance is associated with PCOS.

The question is referring to the hexosamine pathway.

Carbamoyl phosphate and arginine are involved in the urea cycle. So is n-acetylglutamate (NAG) (regulates production of carbamoyl phosphate).

Despite a numeric value (blood pressure) being measured, patients would be designated either hypertensive or normotensive. To my understanding, the best test for comparing categorical variables across groups is a chi square test.

In contrast, a t-test is used to compare between the means of two groups (measured variable must be quantitative).

page 119 FA Patient is presenting months after the transplant, which means it can't be hyperacute unless he stopped taking his immunosuppressants. Acute/chronic/GVH disease are mediated by T cells for the most part (I think), so this would mean lymphocytic infiltrates.

Pronator teres and quadratus are both supplied by median nerve (C5/C6/C7/C8/T1, so that's not super helpful.) Extension of the forearm is radial nerve (also C5-T1, also not helpful). This does tell us is it can't be isolated median or radial. Triceps tendon reflex is C7/C8, which narrows it down to these two.

Can anyone explain why it's C7 over C8?

To expand on this, contraction of flexor digitorum profundus muscle results in flexion at the DIPs and PIPs. The tendon attaches at the tip of the finger, in contrast to flexor digitorum superficialis (attaches at the PIPs). Recall innervation of the forearm muscles is mostly from the median nerve, except for 1.5 muscles (ulnar half of flexor digitorum profundus and the flexor carpi ulnaris, both supplied by ulnar which makes it ez to remember yay).

But also if you got this wrong like me go read that link because it's a really nice review.

Intercostal veins drain into the azygous/hemiazygous veins, which run right next to the vertebral column. Another useful diagram showing left and right intercostal veins.

Per p608 in FA 2019, SRY on Y chromosome results in development of testes. DHT results in development of male external genitalia (and the prostate).

Labeled CXR showing position of different valves.

This image is very helpful.

Methionine is an essential amino acid. All others listed are not.

Patient may have hereditary angioedema, which is associated with "recurrent attacks of intense, massive, localized subcutaneous edema involving the extremities, genitalia, face, or trunk, or submucosal edema of upper airway or bowels". The article goes on to say "C1-esterase inhibitor works directly on the complement and contact plasma cascades to reduce bradykinin release" which is also probably good to know.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666183/

PCOS is associated with abnormal production of sex steroids, including dysfunction of estrogen production and progesterone. Chronically elevated levels of estrogen can cause endometrial hyperplasia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917599/

Not sure if this is the right way to think about it, but if PT and PTT are both prolonged, this most likely means there is a problem with the common pathway (aka factor X).

When working on acid/base disorders, it helps to look systematically at the following: (1) pH (which sadly was not given in this problem), (2) figure out which problem is primary by looking at PaCO2 and bicarb, and (3) look for any compensation (which the question doesn't ask but still).

Here, we see that the CO2 is high on the ABG. This means that patient is hypoventilating since levels of CO2 are ventilation dependent, and also that patient has respiratory acidosis. Also, bicarb is low, which implies that it's being "soaked up" by metabolic acidosis.

This is a pretty good figure showing the conversion of membrane phospholipids to arachidonic acid/leukotrienes etc.

Blockade of COX enzyme by ibuprofen results in decreased production of prostaglandins H2 and E2, while causing the precursors to "back up" (increased arachidonic acid). This, in turn, results in increased production of leukotrienes.

Deltoid is innervated by axillary nerve, which comes from roots C5/C6. Actions of the deltoid include abduction of the upper extremity.

Niacin (vitamin B3) antagonizes VLDL cholesterol secretion

Page 250 FA - Ethambutol is associated with visual disturbances (changes in color vision).

While antihistamines with action at H1 receptors are used for allergies, H2 antihistamines are typically used for ulcers. Therefore the best answer is stabilization of mast cell membranes. These drugs (cromolyn) prevent vesicles of histamine from fusing with the membrane.

Vibrio cholerae is a gram-negative, comma shaped bacteria that can cause watery diarrhea. Cholera toxin functions by activating the Gs proteins --> increasing activity of adenylyl cyclase --> increased cAMP --> increased Na+ and Cl- efflux --> diarrhea.

Membranous glomerulopephritis (aka membranous nephropathy, p 584 FA 2019) may occur secondary to drugs such as penicillamine. Immunofluorescence shows granular deposits due to immune complex deposition. Will also see diffuse capillary and GBM thickening, and SEM will show spike and dome appearance due to subepithelial deposits.

Furosemide and other loop diuretics are indicated for use in volume overload secondary to renal failure. Recall loop diuretics inhibit the Na+/K+/Cl- pump at the thick ascending loop of Henle, which messes with the hypertonicity of the medulla and therefore prevents urine from being concentrated. This results in increased fluid loss to urine, and is helpful in treating symptoms of edema.

Gait problems raises suspicion for alcohol abuse or inhaled glue. However, onset of gait problems is relatively rapid (couple of months) and gait disturbance with regards to alcohol is either due to intoxication or chronic abuse. Alternative explanation available on SDN. Also see toluene toxicity on medscape.

Patient most likely has Tay-Sachs disease. This figure nicely shows the biochemical pathway. Recall that both Tay-Sachs and Neimann Pick disease present with a cherry red spot on fundoscopy, but Tay Sachs lacks the hepatosplenomegaly seen in NP.

Other way to get this question is by eliminating other options -- this figure is useful in listing some mutations and associated cancers.

"chronic high oxygen saturations can adversely affect lung and eye outcomes of preterm infants." link

my list of spindle type cells and conditions:

• a. NF-1
• b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies
• c. Leiomyoma (uterus & esophagus)
• d. Mesothelioma (cytokeratin positive)
• e. Anaplastic Thyroid cancer (biphasic & along with giant cells)
• f. Medullary Thyroid cancer (can also have polygonal cells)
• g. Primary cardiac angiosarcoma (malignant vascular spindle cells)
• h. Osteosarcoma (bone cancer) (pleomorphic cells)
• i. Meningioma
• j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells

Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

Why are the IMA and SMA most likely to be affected in her condition?

Why is alternative splicing or post-transcriptional modification incorrect?

The semantics of this question made me vomit blood.

One day a patient will look me in the eyes and ask, "Where are tripetides broken down?" I will smile at them and say, "the intestinal mucosa and not the duodenum." They'll smile back and I'll walk away and think of this moment as I jump from the window.

Since you're losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

Bed bugs themselves are not known to be carriers of illness, but they can leave itchy bites. The girl is likely to scratch these bites, abrade the skin, and thus increase the risk of a staph skin infection (since staph aureus is the most common skin infection pathogen)

To expand on this, pathologyoutlines describes the histology of kapowsi sarcoma as "spindle cells forming slits with extravasated red blood cells"

To expand on this, what we think happens with Parkinson's disease (and parkinsonianism) is an imbalance between dopamine and acetylcholine. It makes more sense if you look at this diagram, paying particular attention to the indirect pathway. Loss of dopaminergic (DA) neurons from the substantia nigra (SNc) results in constant activation of those ACh secreting neurons, which ultimately results in inhibition of thalamus from initiating movements. Therefore, using anticholinergics help with parkinsonianism secondary to haldol.

We're viewing this slice of the spinal cord from the bottom right? The left right labels always mix me up.

When patients are given Nicotinic acid(Niacin) they are told to expect common side effects to occur such as warmth and redness. One can avoid these side effects by taking aspirin

Patient most likely has Tay-Sachs disease. This figure nicely shows the biochemical pathway. Recall that both Tay-Sachs and Neimann Pick disease present with a cherry red spot on fundoscopy, but Tay Sachs lacks the hepatosplenomegaly seen in NP.

! I hate these with a burning F***ing passion. Thumbs up if you agree

Since you're losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

Pronator teres and quadratus are both supplied by median nerve (C5/C6/C7/C8/T1, so that's not super helpful.) Extension of the forearm is radial nerve (also C5-T1, also not helpful). This does tell us is it can't be isolated median or radial. Triceps tendon reflex is C7/C8, which narrows it down to these two.

Can anyone explain why it's C7 over C8?

Since you're losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

I’m confused about this one. Weakness of extension and pronation of the right forearm, with a decreased triceps muscle stretch reflex. The answer was C7 nerve root, but how are you able to localize to C7 and not C6 or C8? I figured that extension is radial, C5-T1, and pronation is median, also C5-T1. Triceps reflex is C7-C8 (FA2019 says C6-C7). How would you narrow down to just C7 damage?

Scabies likes to burrow in the areas between the fingers and toes (FA 2019 161) and causes itching. Could also potentially be lice (groin involvement), but treatment for either overlaps -- gotta use permethrin.

Growth hormone releasing hormone acts via G-coupled receptors. G coupled receptors need GTP to become activated and GTPase to become inactivated.

No GTP-ase --> chronically active growth hormone releasing hormone receptor --> constant activation of adenylyl cyclase / cAMP pathway and release of growth hormone.

Growth hormone releasing hormone acts via G-coupled receptors. G coupled receptors need GTP to become activated and GTPase to become inactivated.

No GTP-ase --> chronically active growth hormone releasing hormone receptor --> constant activation of adenylyl cyclase / cAMP pathway and release of growth hormone.

Homegirl got some cervical outlet syndrome and should probably take some stuff out of her backpack or get one of those lil roller ones.

To expand on this, pathologyoutlines describes the histology of kapowsi sarcoma as "spindle cells forming slits with extravasated red blood cells"

Since you're losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

Deltoid is innervated by axillary nerve, which comes from roots C5/C6. Actions of the deltoid include abduction of the upper extremity.

! I hate these with a burning F***ing passion. Thumbs up if you agree

lower quadrantanopia: parietal lesion

vs upper quadrantanopia = temporal lesion

Hyperacute transplant rejection occurs within minutes d/t pre-existing recipient antibodies that react to donor antigen (type II hypersensitivity reaction), activate complement.

Small cell lung cancer causes SIADH. Location + exclusionary clues.