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Welcome to mcl’s page.
Contributor score: 586


Comments ...

 +7  (nbme24#18)
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olllo os instdea of iungs fioepozeml yhet just agonn etg hmi earl kudrn

johnson  yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole. +5
usmlecrasherss  Drink vodka man , either way you're dying +
drschmoctor  Or if you really wanna get drunk and have a warm place to sleep, drink a bunch of methanol in the waiting room of the ED, then let them pump you full of ethanol and keep you safe. +2

 +1  (nbme24#4)
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nosBu creavda mdagair, dik yhw hsit saw no ..?.r.tepsn..t...e.i.

yotsubato  nurses +4
faus305  Cause it's cute unlike the monstrosities they always put on the NBMEs +

 +5  (nbme23#10)
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So if you nd'itd 8h sudgbbe hueo,ng yhet acn erapalptyn oals vrese sa tovecsr for sriegautrt-snd baareitc nnugcdiil ARSM OWH UNF SI ATTH

spacepogie  SO FUN +3

 +8  (nbme23#23)
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To xnedap on thsi, htwa we thikn nhepasp thwi n'osnPkrsai esaedsi (dna snsamaonirinki)p si an iemnalbac btweeen pemdoain nda lnloeice.ahtyc It mesak orme nsese if oyu okol ta shit agiram,d yipnga iatrcalrpu ntietoant ot hte rtenicdi aa.phtwy oLss of nridmigapcoe (DA) senruno mofr eth itasntsbau aingr N)(Sc esrulst in onatstnc ntaovtiiac fo ehsto ChA inteercsg uoens,rn hhciw ytaimtelul tlrseus ni btiiniiohn fo tushmaal romf intnigiiat tesme.onvm reTfr,eeoh igusn sroaccheitinnigl hlep thwi anmoiinpasrikns secynorad ot ldoha.l

mcl  Also, you don't wanna use sinemet since that would be counterproductive +2
drzed  Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing? +

 +7  (nbme23#16)
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nI csae you nanaw og rspeu ernd and dare bouat ,iymeln t,enapicaacc nad eacisrns,et tshi ugy soed a godo bjo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +21
sweetmed  this helped a lot! +
roaaaj  Well explained! +
euchromatin69  or see u world 917 same concept +
brise  Uworld 1318*** +

 +5  (nbme23#40)
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FA 1029 P 357 - Teh ylon part fo the nrheopn hatt ftirs aid yssa ash na etfefc no 4OP 3- si PT.C

motherfucker  PTH inhibits na/PO4 cotransport -> PO4 excretion +4

 +8  (nbme23#10)
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siTh is a ncie iukcq efrehesrr of hwat UCA .is


 +19  (nbme23#28)
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oBuns ucqik rievwe


 +6  (nbme23#18)
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ncgrioAdc to thsi prp,ea ulniisn nshtiibi phlaa celsl omrf lsaengeri g.cnlgaou hiTs is eth vnealert eigfru from hte .prpea

medpsychosis  There are three ways that Glucagon secretion is stimulated: +(1) a stimulatory effect of low glucose directly on the alpha cell, +(2) withdrawal of an inhibitory effect of adjacent beta cells, and +(3) a stimulatory effect of autonomic activation. The response of Glucagon to hypoglycemia is diminished in T1Diabetes. Hence in this pt, the impaired release of Glucagon allows for prolonged Hypoglycemia. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005043/ +9

 +16  (nbme23#26)
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iatnteP twhi lrateibal laren yrater ubstri nad psyetionhenr wlli fro esur ahve tcatoanivi of ASR estysm adn feeehrotr snraceie ni sn.ioitagnne

lhoghAtu moyoepoocrhahcmt nda tqeeunncos vealetde nlestcaichmoae acn acnserie bolod usepr,sre ymsmtops are ytlyclapi escpiido adn lnera brsuti aer ton ykiell to eb eadrh. lveaEdte elsvel fo tnrnsioeo nac olsa eascu pesrtiyo,hnne ubt ew dlowu osal pxcete ot see shuginf;l ola,s hetre si nngotih ni eth mste ot cdinetia itenpta is kiatgn SSIRs ro htmigsnoe eels thta duocl pdioerseps hre to tladeeve sevlel fo onorsnt.ei ealEedtv lveesl of toidryh nhmeoor ulcod lsoa vgei nattipe yo,rtneniepsh tub ew wldou osla ptexce hoter snsig of hdrmioheiryspyt str,emro( gtiewh lsso, etc..)

I swa a tlteli oefcdusn fi POE udolw be valdeete -- fi eethr si otnsiess of nrael srrteeia a(s edcniadti by the sir)ubt hte nkiedsy dlocu olas etetdc tsih sa ioaxyhp dan aprm up uciodortnp fo PEO. veHewro, I ddene up ggnoi wtih ninsoitgnae icnse ti eesdme eorm or"c"netce ot me hatt RAS dwuol eb pu. oeDs eaonny nwko hwy s'ti ont EOP?

brise  Wouldn't that be more long term? +3
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2

 +8  (nbme23#34)
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To danexp on s,thi oreaopnhpstsgaoh ear nylocomm sude as cei,distiensc and ofunictn yb ibgdnin ayetosccseltlihnerae dan geii"tatc"ndav i,t os to kae.ps This ersustl in an secsex of AhC htiwni the nepyas,s ihcwh uecsas dgsule rmdnyeos it,i(vongm giwns,tea arreiahd -- blacilsay lost fo ).ulsdfi hTe trmteenat rfo this si plcyilaty eoinrpta mtcn(iracu)ins,iain dna imrxedpolia (fi gnevi yaelr ,eohgun can ecv"trtaie"a hte .h-saACe)s heT darmgai enivg sdoe otn sohw sC-Aa,eh nylo eth ,-CRhA retfeoreh D is hte best ew.rsan

lowyield  Also according to uworld you give atropine before pralidoxime because pralidoxime can cause an initial exacerbation (even though you might think you should give pralidoxime first because it is time sensitive) +2

 +6  (nbme23#10)
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hisT ifuger is a plfuhel srreehefr for hte ./9/675899 eulr


 +32  (nbme22#37)
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iTsh giaem si .ueusfl tNoe atht hte nstia euds mksea myleni raeapp akrd.

teVinegt si patiylc for nisonka'srP se.iasde aeAr D is eht tusbisanta i.ragn

oznefu  Oh nice! Thanks! +
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +
apurva  Saved My life +1
john198  is this link only for MSU students??? , I can't access it . +

 +2  (nbme22#19)
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Egniw csaamor is hte necdos most nmcoom enbo igayncanml in lerndch.i golytsHoi si lyuslua irdscdebe sa a alslm lcel tmrou twhi hhig CN: tioa.r

praderwilli  Also the concentric layers of reactive bone sounded like "onion skin" to me! +7

 +5  (nbme22#8)
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iHromgel tog oesm caieclrv letotu msdyorne dan lohuds rlpabybo teka moes fftus tou of hre ckpbakca or gte oen of setho ill llorre osen.

mcl  Whoops, my bad, THORACIC outlet syndrome +4
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1

 +2  (nbme22#29)
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Teseh eaigms are seuufl ni oonbnmita.ci


 +7  (nbme22#39)
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Psioon iyv seriggtr a tpye IV reytspvnhiiyteis tm(deiade yb T ;lcs)le ynlo noe fo hte rnsawe hceocis eimsnotn T se.lcl


 +1  (nbme22#44)
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Seicabs kiels to rurbwo in eht easra ebwteen het finsger nad oets (FA 0921 )116 adn auecss cingth.i uloCd saol lolnpattyei eb leci nrio(g eetmivnvon),l but tnetaretm orf ehteri lasovper -- aotgt seu riemne.rpht

kchakhabar  If only one person is there to see the doctor, why would the doctor prescribe medicine even for his family members who are not there? +
mcl  Unfortunately, both of these are pretty contagious conditions. FA mentions that scabies spreads via skin to skin contact, and goes on to mention that you're supposed to treat close contacts. I think in this scenario it's ok to give permethrin to the family members who are not present but affected (it's also non-prescription in some cases, I believe.) Slightly related note, similar to why you would treat the sexual partner of someone with chlamydia/gonorrhea, or close contacts of someone with n. meningitides infection. +10
teaandmusic  Agree with kchakhabar. Just because pt says others in family have the same thing, doesn't mean they do, they may have a different condition (small chance, but still possible). Not to mention allergic reactions and other considerations that the Dr. isn't aware of regarding family members ... with chlamydia/gonorrhea, etc you'd have the close contact go and see a doctor and get a prescription also, you wouldn't just write out a prescription for someone you haven't seen +

 +2  (nbme22#45)
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oT napexd on tsi,h iphonayooutlestlg dcsrebies eth iotyloshg of oiapkws rcmoasa sa eds"pnil eclls nifgrom tsisl tihw vadsxaaterte dre obodl le"lcs

mcl  lul i don't know why i spell kaposi like that, my b +10
bubbles  This site is super helpful. Thanks for sharing :) +
mcl  yesssssss ofc <3 I love path outlines +
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. 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 +5

 +3  (nbme22#37)
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at2Be- ecrtpreso rea ldcepuo to Gs p,noeirts hcihw atveatic lleadyyn asylcce adn eiranesc PMAc. Cccily PMA nteh ceensairs itityvca of rentipo kneisa ,A which hepsopshrtlyoa snmyoi ilght ichan ,siaenk lueilatymt islgrnute ni mtshoo uecmsl xlnoatiare. Aebrotl,lu a 2B naosgit, si roeerefht uulfes ni gnttaier nr.somasbochp

impostersyndromel1000  are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation? saw this on another Q with the nitrates causing headache so now im confused +
dubywow  @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +2
iwannabeadoctor2  cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +
castlblack  cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +3

 +5  (nbme22#28)
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CCD dmdcnoereme marttenet of tismaoshcso asmonin si ntarqi.zualep

makinallkindzofgainz  It's also the pretzel in the Sketchy video, which I think most would agree is more reputable than whoever these "CDC" people are +15
rockodude  ya until step 1 fucks us with some esoteric cdc guideline +

 +3  (nbme22#8)
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Since 'ueroy slingo lal ruyo racibb nito uroy eep, you uwldo ectexp hte Hp ot be orem ilknea.al sAo,l csine etehr si ddercesae /++aNH prt,aniot erthe is sels idoums srbeaordeb dan fererothe nciaderse sslo fo fere uidlf ot hte nui.er

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1
meningitis  Lol yw!! +

 +6  (nbme22#32)
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inatteP llyeki ash COPS. POSC si eoaaistdsc hitw ldeateve veslel fo HL ofmr eht api,iuttry hchwi stiteuaslm siveaor ot pudorec ienaerdcs asuotmn fo exs iodrests (nuicdilng doneragns ;t-&-g .msuitihrsi) nndniesrteedAoo si oetcnervd to senteor ni yiscdaep,to ichwh tulrsse ni ltsil erftuhr sardecine seerale fo .HL bsetyiO nad niinusl rneceisats si adcotssiae wtih .PSOC


 +16  (nbme22#30)
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hTe tosuqien si nrfegirer ot eht nixmaheeos yhpat.aw

mCrbaaoly hstoeahpp dan airgnnie aer oleivvnd in the eura ecylc. oS is ttungaeayme-ctlal ()NAG suerl(etag udotcoipnr of abomrylca phsaoep.th)


 +18  (nbme22#22)
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eDpeits a nurmice eluav (odbol s)eeurrsp gbine e,adesmur ttpnsaei owldu be neadegidts erteih eehevstyinrp or esnrento.vomi oT my dseinu,tnrngda eht tebs ttse fro gorianpmc ocalgcriaet ivesbaral scsrao grpsuo is a ihc qauesr .etst

In catn,stro a ttte-s is edus to ocaremp nbewtee hte measn fo tow rpousg uemd(sera ivbaarel sumt eb .auitaetnqvt)i


 +0  (nbme22#47)
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geap 191 itFan AtPe si ersinenpgt tnmosh etafr eht lrtat,spnan hwhic msean it na'tc eb etcyurepah slsenu he dpspteo gkntia sih pn.ntuspuoiasmresms enh/cocur/tHcGAVi aedeiss era mitdedea by T cllse ofr the mots prta (I )hkni,t os htis wdulo mane lhtccoiyypm lfetasn.iitr

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2

 +4  (nbme22#1)
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traoPonr teesr nad duqatsura era otbh espdulpi by ediamn renve /TC7(C,1/5C68//C os sttah' not pures plheful.) Exnsetoni of teh maeforr si arilad reevn l(soa 1C5-T, oasl tno l)fpleuh. hsTi soed ltel su si it an'ct eb iosatdel aeidnm or .laadri pcesrTi donnte erflxe is 87,/CC wcihh snwraor ti dwon ot these .wto

aCn oeynna exipanl yhw is't C7 rveo C?8

joha961  Same question. How could you determine between the specific nerve roots (C7 vs. C8)? +2
mcl  Someone I was talking to (and post below) was saying that first aid mentions triceps is C7, so that's what should've been the big thing for us. +2
joanmadd  you might see some ulnar nerve involvement if C8 was involved her +
passplease  but he has generalized tingling which is in both ulnar and median regions? +

 +8  (nbme22#15)
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oT andxep on ,tish nrtncacooit fo foerxl gdutimiro fdsouuprn csmelu esslrut in elxnoif at eht IsPD dna IPPs. The nntdeo tsahacet ta eth pti fo het nfi,erg ni rtonscat to flxore imigutdor fliiacespsrui acs(ahtet at het s.IP)P elRalc nnritvianeo of eth farermo ecsulms si otylsm mofr teh damein nre,ev ptxece rfo 51. clsmesu (rnlua lfha fo lefoxr doiitrmug nrfpuosud nad het lerfox ripca rilnuas, boht eupsipdl yb ualrn whcih easmk ti ze ot rbeeermm yy.)a

utB slao fi uyo tgo htsi grown kiel em go edra that nikl beeaucs 'tsi a ylerla ecin ewrvie.

samsam3711  Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +2
brbwhat  FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +
brbwhat  Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +

 +10  (nbme22#14)
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ecIoraltnts siven irnda into eth ayhasgooyuus/gmizez esnvi, whhci urn rhgti nxte ot hte vlrteraeb oclmnu. eonthrA uluesf aadrgmi wsogihn etlf nad igrht crilsotenat isv.en


 +1  (nbme21#30)
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reP 0p86 in FA 092,1 YSR no Y smhcooeomr ltssure ni vneldpeemto of tstes.e DTH eusrtls ni temednvlpeo of mlae rletxnea egiitlaan d(na the pae.)totrs

mrsmac  No sertoli cells or lack of mullerian inhibitory factor makes more sense. bc there is both male and female internal genitalia but only male external genatalia. and karyotype would show 46XY. First Aid 2018 pg. 604 - the "Sexual Differentiation" charge delineates exactly this. If it were 5areductase deficiency the child would have testicles and scrotum, which in this case is absence. Hope this makes sense. Please let me know if you disagree and why. Thanks. +
mixmasta  I believe the tricky part is that they don't mention the status of the Male external genitalia. Pg. 605 from FA ( bottom portion) shows the external development of the Male/Female genitalia; you see DHT is need for male. Furthermore, pg. 604 (SEXUAL DIFFERENTIATION) DHT is also needed for Male external development. +
niboonsh  My understanding of this is that the diagnosis is 5alpha reductase deficiency because the newborn has female external (aka ambiguous) with male internal (aka "male genital ducts"). According to FA, leydig cells produce testosterone, which can either stimulate the mesonephric duct to form the INTERNAL male genitals (as see in the pt). Testosterone can also be acted on by 5alpha reductase to become Dihydrotestosterone, which forms the male EXTERNAL genitalia. Since this kid has "female" genitals, but has male insides and is 46XY, id say this is a simple case of 5alpha reductase deficiency. No sertoli cells or no MIF would present as both female and male internal (because MIF typically inhibits differentiation of female internal) and male external genitalia (bcuz leydig cells are unaffected) +15

 +36  (nbme21#16)
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aLelbed CXR owgshni noitipso of nrfietfed .evalvs

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2

 +7  (nbme21#36)
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hiTs eamig is vrey hpulefl.

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 +

 -3  (nbme21#17)
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Mnteenhoii is an talssenei amoni i.cad All hortse dstile era tno.

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +15
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1

 +9  (nbme21#19)
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atteinP mya heav eeiyadthrr eiegdmno,aa hhciw si aodaseistc ithw nceeurrr"t asckatt of tesn,nie svase,im dioeczlal stuueosbcnua emade vgviinlon eth mitrxiseet,e talien,gia caf,e ro ,ntruk or amlsbuuosc adeem fo urpep ayiwra or bwles".o ehT cletiar osge on ot ysa s"eae-C1rtse boihtiirn rkswo tlrydcie on het elnocempmt adn nctotca spalam ssdaacce to eurcde nbiadnryik elserea" icwhh si olas yolapbbr ogdo to wn.ko

hg/icCic.icb.t.mpaw/n61lp3/t6mhs//e/nlwP3ts6w8.o:Mnrv

notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +22
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +2
teepot123  fa 19 pg 107 +
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1

 +3  (nbme21#12)
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CSOP is soditcsaae htwi abalrmno pindcoourt fo xes rtesdsi,o cilgunidn uftyionsndc fo eongestr cdorinupot nda teprgoo.rsene cylralhConi dveeatle elesvl fo rntoeseg acn easuc netmdolaeri yal.apprhise

//1o9t.lwP/9cst7/M.nvp:/bCimcsle9ntnrim5wc3hah./.piwg

meningitis  Why isnt it endometriosis? Could someone help me out on this? +1
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +25
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +1
lovebug  FA 2019, page 631 +
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +

 +15  (nbme21#45)
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otN uers fi hsit is hte gthir way to nthki tuoba t,i but fi PT dan PTT rea thbo ndgo,lepro shti osmt yeklli mneas tehre is a rlmbeop ihtw the mncomo hpawyat ak(a caftor X).

temmy  exactly...i just thought the problem has to be where they meet or somewhere similar to both..hence the common pathway 12(PTT Heparin) 7 (PT, Warfarin) 11 9 10 5 2 1 In my head, both sides are looking for the perfect 10 +

 +4  (nbme21#9)
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ehnW oknrgiw on seb/iadca dosierrd,s it slehp ot oklo almstclseitayy ta het nlwloo:gif )1( pH hciwh( yslad asw tno vnieg ni sith ,belmp)ro )2( grufie tou hwcih mbropel si rairypm by nlikoog at COP2a and ibacrb, dan ()3 lkoo rof nay nmsnpoteoaic ciwh(h het sotniueq dsnoe't ksa tbu )sillt.

eeH,r ew see atht eht 2OC si ihgh no eth A.GB iTsh aenms htta teiaptn si tgyenaopnliviht sncei esvlel fo 2CO rae viitntanoel npdt,eened nda aslo taht pinaett sha rpesrartiyo icisdaso. s,olA riacbb is lwo, hwich mpiseli thta sti' ebign s"kdoea p"u by micetaolb sadiscio.

privatejoker  I just look at these as "what makes the most sense" and this is is sufficient in nearly every scenario. Out of the given options, the only explanation that even lines up with the given numbers is the answer choice. +

 +19  (nbme21#30)
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Tshi is a tyrtpe good reiguf ownihsg eth rvcnoosnei fo memrenba dhiohsplsiopp to rchadoainic aetsoeinkdrleiuc/ ce.t

dBekcalo fo OCX meznye yb uebrpfion stsrlue in dcdsearee dtniprocuo fo gnnrasdslaoitp 2H dna ,E2 ilewh scgnuai het crsroupser ot ak"bc pu" rasede(cin nraaodiccih iac).d iTs,h in rn,tu sruselt ni rsaicened norodctupi fo kese.ioulretn

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +1

 +5  (nbme21#30)
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dotielD is arievtnden by laralxyi rene,v cwhih omecs omfr rotso /CC5.6 otncsiA of hte toleidd iceldun cdunbatio fo eth prpeu ett.eymrix

seagull  I hope everyone memorized every single part of the brachial plexus and all the roots of each, No detail let untouched!!! +26
mcl  In case anyone else has purged the whole brachial plexus from your memory (like me), this is a great resource linked by another user. https://geekymedics.com/nerve-supply-to-the-upper-limb/ +11
zevvyt  I thought it was radial since he lost sensation in his thumb. If Radial is C5-T1, wouldn't that be included in C5-C6? +1
alimd  they force us to know brachial plexus like the holy bible +

 +7  (nbme21#13)
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Naiinc minavt(i B3) oengzastina VDLL orlhceolest sicrnetoe

sbryant6  Fibrates stimulate PPAR-alpha --> LPL upregulation --> decreased triglycerides. However, this question asked about a vitamin. Vitamin B3=niacin. +4
lovebug  FA 19, PG 315. Lipid lowering drug bro. +

 +1  (nbme21#1)
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Page 250 FA - tEoathbulm si atdessicoa thwi vlasui bsunratidsec (acgnseh ni olorc v)ioins.

dashou19  On FA page 250, it is said that Isoniazid can also cause optic neuritis and color vision change. Sometimes it hurts if you know too much lol +1

 +12  (nbme21#44)
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lWeih misnasathetiin twhi atnioc ta H1 rtsorpece aer ueds ofr iaegll,ser 2H niishatimtsean are clalyytip sued ofr crsl.eu reefoTher the tsbe swaern si aiibtiatsolzn of astm ellc aserbe.mnm Thsee sgdur m(olo)cnry nveerpt lcsseive of seianmthi mfor figusn wthi eth embn.aerm

madojo  Take H2 before you dine, remember H2 blockers for GERD +

 +9  (nbme21#14)
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Vrioib aecelorh is a r-evmn,gieaagt acmmo ehsapd eabtrcai atht nac uecsa ryweat aiera.rhd alChero xoint nnoctiufs yb niatvtgaci het Gs speriotn t-&;-g rseiagcinn cvytiait of elndayly aclcyes tg--;& adseecirn AMcP t-g;&- sranicede +aN and lC- felxfu &;-t-g eir.hraad

teepot123  fa 19 pg 146 +
lovebug  Cholerae's exotoxin does not invade mucosa. but just permanently activates Gs according to FA. +
lovebug  Same mechanism[Increase cAMP] : 1) Labile toxin of ETEC, 2) Edema factor of B. anthracis, 3) Pertussis toxin of B. pertusssis +1

 +9  (nbme21#34)
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bsrMaeonum resmrhltupoipligoe (aka onsammbeur o,ayehrthpnp p 485 AF 1)209 aym roccu onrcdsaye ot dgsru such as eelcpilnminai. moonelmuenrseccfIu wsohs raluagnr etsopids ude ot emmuni olxempc idoienps.ot liWl aols see udefsfi raallpyci dna MBG iengchtkni, nda SME iwll owsh epiks dan odem ecnerpaapa ued to sulieleibptah odipste.s


 +1  (nbme21#44)
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ruseomdiFe nad rthoe opol edcuitsri rae inctdaied orf seu ni evluom avroodel deansoryc to ernla afrilue. acRell lopo eusdiitrc tiibihn teh +lNa-//+CK ppmu ta het itkhc dsnigecan oopl fo e,Hnel iwhch mssees tihw hte ttpioyicnreyh fo teh ellmadu and rheoeerft trpsnvee nuier ofrm nbeig onarenetctcd. hsTi ureltss ni nsriaeced ulfid lsso ot euinr, dan si heplufl ni aitrngte ystsmmpo of ee.adm


 +7  (nbme21#7)
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tGia rosplbem serias cnsupiios rfo loalcoh beuas or nlhiead e.lgu Hwer,ove oenst of tagi orlbmpse si altrlviyee ipdar c(loepu of )shmtno dna tgai stnraucbeid twhi greadrs ot ahclolo is ieehrt eud ot aniixotictno ro chrcion usaeb. tnailetAvre atoxplennai ieaalvbla no SDN. sAlo ees toneleu xtoiiytc no esdame.cp

sbryant6  I got this correct solely based on the patients demographic. Glue is cheap and easily accessible to underage populations. +4
whossayin  Kinda racist of us but that’s how I reasoned my answer too lol @sbryant6 +
hpsbwz  how is it racist if the only thing thats given is his age lol @whossayin +21

 +3  (nbme21#2)
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netPait msto llykei sha Ths-Sayac es.esiad iThs ieugrf lcneyi whoss teh bhieomcacli p.watahy aclRel tath htbo achSy-sTa dna ninmaNe ckiP esasdei esnerpt hitw a rehrcy der otsp no oscnpo,yduf utb Tya hcaSs kalsc teh onplehsealetypgoam enes in PN.

hungrybox  Man this is such a nice figure except it doesn't have Krabbe disease :( +
mcl  Here's another one with Krabbe! :) https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg +7
hungrybox  thank u +1

 +1  (nbme21#46)
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Ohetr yaw ot tge isth tsnouieq is by imeninalitg hoter niootsp -- htis irgufe si eluufs ni ngitlis eoms msauotnit adn aciassdeto nrsa.cec


 +2  (nbme21#33)
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i"rhcnoc hhgi nxegyo atosuaistrn nca eryesvald ftecaf glun and yee tosocemu of remerpt tnn"f sa.inikl





Subcomments ...

submitted by usmleuser007(377),
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ym lsit fo liedpns ptey lcels dan onstin:iocd

  • a. 1-NF
  • .b N2F- ~ ohScaanwmn nnotiA( )A = oneCutsua oibarnmufroe ~ hihg teclilyaurl (w/ sdlinaigpa apsnrtte ihtw rrsgninpetsie eruleecfnar- onesz ylbepc&;nleoaVrdsac dsbeoi
  • .c momaieyLo ru(estu ±a phsuegosa)
  • .d eMohmoiletas rna(eittcoyk ipvots)ie
  • e. canilAspta idTyhor cnrcea bhiac(isp a;mp& anlog whti agnti lcle)s
  • f. raMyeluld orTdihy areccn na(c slao ahev glnlaoyop sellc)
  • g. iPamryr acdiacr gnarcoaiaoms g(nmlainta ralscuva plendsi e)lcsl
  • .h tmaosOcsoaer (onbe crnea)c loi(pcrhemop lcles)
  • .i maeniiogMn
  • .j pso'Kias Somraca (HV-)H8 = litkel-Si vcuslraa escaps whti lumpp sdeladp-hispne mtsalro lcsle
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +7  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  


submitted by medstruggle(12),
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yWh si ti ont roniaav illoflec scl?le I thouthg teh lfeame ganola of loSerti and gLiyde si n/shcugteolraaa .eslcl

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 medstruggle(12),
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Wyh si it ont naarvoi coflilel sl?elc I ghtutho eth eamefl naolga of orSilte dna gdyieL si sacghlnotaruae/ el.cls

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 +  


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hWy are hte IMA nad AMS smto eiklyl to be fcaefedt in hre tnoo?niidc

sattanki  Again, not too sure, but I think they were describing a patient with chronic intestinal angina, which is classically from atherosclerosis of the IMA/SMA. +3  
mcl  I was also thinking about which areas have crappy blood supply (watershed areas), which I assume would be worse off in the case of chronic mesenteric ischemia. If you look on page 357 of FA 2019, SMA & IMA at the splenic flexure is a watershed area; the other is rectosigmoid junction (sigmoid branch from IMA and superior rectal). +  


submitted by medstruggle(12),
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yWh si ltrtnveaeai pgsiclin ro rttoa-nlsrppctaoiins donocfmtiiai rotcric?ne

tea-cats-biscuits  You just have to know that POMC is a pro-protein that must be cleaved; not sure if there’s anything in the stem that would really have given it away. +2  
mcl  Dunno if this helps, but it says "this protein" (singular) is the precursor of two different protein products. This must mean that the modification occurs after the protein is made, which means after transcription and splicing has already happened. +31  
ngman  Also I believe mRNA refers to after the splicing already occurs. If the protein products are from the same mRNA then it can't be alternate splicing. +1  
medschul  They're cleaved by tissue-specific proteases +1  
duat98  I think: Alternative splicing occurs with hnRNA not mRNA. You get mRNA from alternatively splicing the hnRNA. an mRNA can only make 1 type of protein. Since the question says the 2 proteins comes from the same mRNA it cannot be alternative splice or post transcriptional mod. FA 2018 page 43 has a good illustration. +6  
tadki38097  Just general testing taking strategy i guess, but for this question i was torn between post-transcriptional and post-translational, but then i saw that alternative splicing was also a choice...because alternative splicing IS a post-transcriptional modification you know it has to be post-translational because you can't select two answer choices. +1  


submitted by seagull(1436),
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The sntsmaiec fo tsih tuesnoiq daem em vtiom o.bdol

eOn yda a ittpane wlil ookl me ni eht eyes nda ask, "reWhe ear itesipretd nrokeb dn?"wo I llwi emisl ta etmh nad yas, et"h eitanlinst amcosu and not teh mudu.n"deo 'lTlehy eislm cakb nad I'll klaw waay nda hinkt fo sith eonmmt as I jmpu ofmr hte nwdow.i

sympathetikey  Too real. +3  
mcl  how do i upvote multiple times +16  
trichotillomaniac  I made an account solely so I could upvote this. +30  
dragon3  ty for the chuckle +6  
cinnapie  @trichotillomaniac Same +3  
thedeadly96  XD made my day! +  
hardly43  RIP legend @seagull +  
seagull  A legend never die +1  


submitted by mcl(586),
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nSiec 'oyreu sinlgo all oyur cbirab into oyru ee,p yuo luwdo xtecpe hte pH ot be oerm ilkael.an osl,A seinc treeh is edsedrcea /HN++a tioa,trpn ethre is lses dsoium brsoebread nda eeorehrtf eerinsdac slso of refe iudlf to het reni.u

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by chris07(55),
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deB sbug slvemetehs rea tno onwnk ot eb iasrercr of n,lsslei utb etyh acn ealev tchyi .tsebi eTh lirg is leylki ot actshcr eesht tei,sb abrade eth s,kin dna hsut enrecsai eth srki of a hpast niks toecinnfi n(csei sahtp reusua is teh tsmo ocmnmo knis nitifecon eoan)tpgh

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +6  
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1  
frijoles  So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich +13  
anechakfspb  @frijoles - Hey if it makes you feel any better I put HIV too, with my reasoning being that they feed on blood...and HIV is transmitted via bodily fluids. Whoops! +  


submitted by mcl(586),
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To axpden no ,thsi elougsoiytapltonh eebidcsrs hte gothisoyl of ispakow aaocsrm sa "psidlen llsce mnigfor stisl wiht tsaavrdeaxte edr loodb s"lelc

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. 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 +5  


submitted by mcl(586),
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To axpend no tsh,i awht we htink epanshp whit aoknPs'nsir diseesa a(nd pina)rnoikanmsis is an nbieacmal wntebee eomandip adn yealnohcetcil. tI kmesa mreo ssnee if ouy kool at iths ,agdaimr gnyipa uclripaart antotient to hte iedcntri wy.thaap sLos fo mdpniceogair )A(D srunnoe rmof het tasbtuinsa nargi Nc()S rsetlsu ni totncans viotncatai of ehsto ChA rtciegnse enou,rns ihcwh tlitelauym suletrs ni itibnniioh of amultsah rfmo iatginiint otemnev.sm Terh,eoefr iungs ahinorceigtcinls hple tihw issmaiannriknpo csaerydon ot hl.laod

mcl  Also, you don't wanna use sinemet since that would be counterproductive +2  
drzed  Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing? +  


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We'er nvegiiw hits ciesl of eht nialsp drco fmro eth obttom hrtg?i ehT tfle grith blsael laawys xim me .up

mcl  Yeah, I just stared at this again for a solid 5 minutes straight up dying. I think if we're going with the L/R labels as they are shown on the image, imagine the patient lying on their stomach with their feet pointed towards you and it should make sense. +10  


submitted by lfsuarez(141),
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Wehn pteintsa era eigvn cciniotiN a(cnadiNi)ci htye ear dotl ot cxepte ommnco desi fstceef to ucocr ushc sa rthwam dna es.densr One anc davoi ehest seid tfcsefe yb igatnk niaprsi

mcl  To expand on this, the flushing/warmth/redness is due to release of PGD2 and PGE2 which is why taking an NSAID helps. +17  
snripper  Doesn't acetaminophen inhibits COX 1-2, too? Why can't you use that instead of aspirin? Just wondering. +4  
raspberryslushy  I had this same question too, and had it narrowed down to those two choices. Ended up going w/aspirin but it was sort of a coin toss. Still not sure why it's not acetaminophen. +  
eagleeeee  I think the reason is that acetaminophen is inhibited peripherally and is mainly used to inhibit COX in the CNS +5  
whatup  The worst side effect of Niacin is hepatotoxicity. Acetaminophen is famously known for hepatoxicity so aspirin is a better answer +1  


submitted by mcl(586),
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etPinat tmos ykleil ahs hTa-Scays .edaiess iTsh iefgur cleyin sshow eht mlceihboaci ya.hwtap lcaRel ahtt both chaaSysT- dna Nanimne kPic aedisse renepst wiht a erhycr dre ospt no dsofoy,unpc utb ayT scaSh sclak hte legtsphyoalnmeapoe ense in N.P

hungrybox  Man this is such a nice figure except it doesn't have Krabbe disease :( +  
mcl  Here's another one with Krabbe! :) https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg +7  
hungrybox  thank u +1  


submitted by seagull(1436),
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! I eath tshee hwti a urnigbn *n*Fi*g nop.sias hsTbmu up fi yuo eegar

mcl  Amen brother +1  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28  
mcl  oh my god are you me +1  
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6  
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4  
abhishek021196  What is HSM? +  
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +  
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1  
djeffs1  @lakshmi Link? +  


submitted by mcl(586),
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necSi y'ruoe isogln lal uryo aibbcr iont rouy epe, uoy louwd tpxece the Hp to eb eomr aineka.ll sol,A cenis ehter is seaereddc ++aN/H tntpir,oa rethe is ssle suodmi ersaebrdbo dan rhefoetre iaenrsdec sosl fo free liduf ot eht i.enru

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by mcl(586),
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rroaotPn retes and ratquausd aer obht iuledspp yb meadin reenv 1/T5(7C,/CC68//C so that's tno presu pleu)l.fh onnExites fo teh efmarro si adalri enrve sloa( T1,-5C also otn fluh.p)le This odes tlel us is ti at'nc eb liedasot mdnaie ro ai.lard rciespT ednton lferex is 7C/C,8 chwih aosrnwr it owdn to etseh owt.

nCa onenya eainplx hwy 'sit 7C voer ?C8

joha961  Same question. How could you determine between the specific nerve roots (C7 vs. C8)? +2  
mcl  Someone I was talking to (and post below) was saying that first aid mentions triceps is C7, so that's what should've been the big thing for us. +2  
joanmadd  you might see some ulnar nerve involvement if C8 was involved her +  
passplease  but he has generalized tingling which is in both ulnar and median regions? +  


submitted by mcl(586),
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nieSc yu'oer nislog lla yrou cbabri tion yuro ee,p uyo wuold xeetcp teh Hp ot eb eorm inakla.le ol,As snice rthee si cedresaed +HaN/+ tr,ontipa eterh is lsse imsoud broesbdear nda reethfore deainrces slso of rfee fildu ot teh .unrei

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by magrufnis(0),
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I’m ufdceson boatu hsit noe. keeWanss fo xoseneint nda ptianoonr fo eth trihg rmfeaor, iwht a reeescadd sertipc seculm tsrhtec exer.lf eTh srwean aws C7 veren o,tro tbu woh era ouy labe to zillcaeo to C7 nda tno 6C ro 8?C I dguierf atth tieonnxes is alr,ida T-,51C adn oianptorn si iamedn, osla -T1C5. sTrepic xrelef si C78C- 9102FA( yssa -.)7C6C How ldwou ouy rnroaw ownd to tjus C7 ga?mdae

txallymcbeal  My FA2018 has “C7” bolded, meaning it is the main nerve root. But I also got this one wrong so I can’t be much help besides that. +1  
mnemonia  Honestly just a guess but I have this vague understanding that intrinsic hand muscles are C8-T1 so we might’ve expected more hand motor findings as well with a C8 lesion. +4  
theecohummer  I narrowed it down to C7 using the fact that the C7 myotome is elbow extension. I also learned that the C7 nerve root was the main contributor to the triceps DTR so I just went with that. +  
mchu21  They also mentioned that the person had weakness pronating the right forearm which is performed by the biceps. Biceps is innervated by the musculocutaneous nerve which is C5-C7 and that's what helped me pick C7 > C8. +1  
mcl  Sorry, I thought the biceps was a supinator of the forearm? +15  
henoch280  yes.. its the supinator not pronator +  


submitted by mcl(586),
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ceaSsib lkesi to brrowu in eth eaars ebetwen the ienrsgf and esot FA( 2109 161) dan cseaus .ictnigh Cuold lsoa enltpyiaotl eb ilce ngr(io emn,vo)vlntie tub rnttemate for hreite sverpoal -- gtota sue .eneprmtrhi

kchakhabar  If only one person is there to see the doctor, why would the doctor prescribe medicine even for his family members who are not there? +  
mcl  Unfortunately, both of these are pretty contagious conditions. FA mentions that scabies spreads via skin to skin contact, and goes on to mention that you're supposed to treat close contacts. I think in this scenario it's ok to give permethrin to the family members who are not present but affected (it's also non-prescription in some cases, I believe.) Slightly related note, similar to why you would treat the sexual partner of someone with chlamydia/gonorrhea, or close contacts of someone with n. meningitides infection. +10  
teaandmusic  Agree with kchakhabar. Just because pt says others in family have the same thing, doesn't mean they do, they may have a different condition (small chance, but still possible). Not to mention allergic reactions and other considerations that the Dr. isn't aware of regarding family members ... with chlamydia/gonorrhea, etc you'd have the close contact go and see a doctor and get a prescription also, you wouldn't just write out a prescription for someone you haven't seen +  


submitted by hayayah(1057),
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hrtwGo hnmrooe ialsnerge ehonrmo atsc iva lupoecd-G e.scoterpr G pedoucl esorprtec eedn TGP ot mboeec dtataeivc dna TsGaPe ot cbmeeo devctat.niia

No PsTGe-a --g&;t cnrolyhalic atevci hgrotw ernmoho rgasilnee ornomhe cpetoerr ;t-g&- stcanont iniaotcvta fo denaylyl aclceys / AMPc tpaywha and eelaesr of wrtogh .enorohm

mcl  This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png +  
mcl  [link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png) +  
meningitis  How did you knkow it was GHRH and not GH perse? +4  
meningitis  nevermind; I just read down below. Thank you +13  


submitted by hayayah(1057),
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ohrwtG eoomhnr ireenalsg omreohn csta vai pGcedo-lu ertpco.ers G pocudel csotrpeer dene GPT ot oeembc vaacidtet dan seTaPG ot obeecm .tdcatevnaii

No ae-sPTG ;--> ylaclchnrio vcaeit ogtwrh ehmrono ngaielesr onoermh perectro ;-g-&t taonsnct niacaoivtt fo ydlyeanl lccaesy / AcMP apyhawt nad reealse of orthwg n.omhero

mcl  This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png +  
mcl  [link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png) +  
meningitis  How did you knkow it was GHRH and not GH perse? +4  
meningitis  nevermind; I just read down below. Thank you +13  


submitted by mcl(586),
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Hrielmog ogt semo vrleccai oleutt esnomryd dan oushdl bybralop take mseo tffus tou of ehr acbcpkka or egt one of ohest lil lroelr eos.n

mcl  Whoops, my bad, THORACIC outlet syndrome +4  
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1  


submitted by mcl(586),
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oT dnaexp on sih,t lstguioeloynapoth rdcbsiees hte sltohygoi of osipakw omascra as spedlin" clsle mirnfgo sltsi iwht etterdxvaasa rde oldob llces"

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. 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 +5  


submitted by mcl(586),
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eScni euy'ro soilgn lal uryo bcirab niot uyor epe, oyu douwl cpxeet teh pH ot eb orme laa.linke ,slAo inces eethr si asreeedcd +a+H/N ,tnaoiptr ehert si sles dmuosi rbaroseedb nad eethrofre eiecsrnad sosl fo free udfli to teh .irnue

joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link: http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png +4  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  


submitted by mcl(586),
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odetDil si artenviend yb arilyxal ,ernve iwchh scemo form tsroo /.56CC onsitcA fo teh ledtiod neuclid uboitdanc of teh peupr xreeimt.ty

seagull  I hope everyone memorized every single part of the brachial plexus and all the roots of each, No detail let untouched!!! +26  
mcl  In case anyone else has purged the whole brachial plexus from your memory (like me), this is a great resource linked by another user. https://geekymedics.com/nerve-supply-to-the-upper-limb/ +11  
zevvyt  I thought it was radial since he lost sensation in his thumb. If Radial is C5-T1, wouldn't that be included in C5-C6? +1  
alimd  they force us to know brachial plexus like the holy bible +  


submitted by seagull(1436),
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! I haet sheet htiw a rbnigun *gnF*i* ni.sosap bmTshu up fi uoy earge

mcl  Amen brother +1  
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +28  
mcl  oh my god are you me +1  
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6  
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4  
abhishek021196  What is HSM? +  
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +  
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1  
djeffs1  @lakshmi Link? +  


submitted by hayayah(1057),
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olwre :oiadaaqurannpt rlpteiaa seolni

vs euprp poiaaqrauatdnn = metlpoar nioels

mcl  also, to differentiate whether it is the left or right parietal lobe, recall that stimuli from the left visual field hits the nasal side of the left retina and the temporal side of the right retina, then goes to the right side of the brain. [This figure](https://operativeneurosurgery.com/lib/exe/fetch.php?w=600&tok=856a37&media=optictract.jpg) is helpful. +6  
d_holles  So you're saying that there's two crosses, making it ipsilateral? @mci +  


submitted by hayayah(1057),
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rctuHeaype nrlsattanp nretoiecj sruocc nitwhi iunesmt /dt sntrgxp-ieei eiicpnrte nebastiiod hatt retac ot rnood taenngi (ytep II inphetvssiteyiry ntroeci,)a ittveaac ecpemmotnl.

mcl  [Useful figures illustrating transplant rejection](https://www.stomponstep1.com/transplant-rejection-hyperacute-acute-chronic-graft-versus-host/) +  
drdoom  ^ via @mcl [Useful figures illustrating transplant rejection](https://www.stomponstep1.com/transplant-rejection-hyperacute-acute-chronic-graft-versus-host/ +1  


submitted by haliburton(209),
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laSlm lecl ungl caecnr esascu IS.ADH aLtonoic + reyxlsnoiuac ce.usl

mcl  To expand, SIADH may also result in euvolemic hyponatremia. This is because, as we know, ADH increases absorption of water and therefore initially results in an increased circulating volume. However, this results in increased stretch of the atria and subsequent secretion of ANP. ANP (atrial natriuretic peptide) then results in loss of sodium and water. +10