Welcome to mcl’s page.
Contributor score: 586
Comments ...
johnson
yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole.
+5
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
faus305
Cause it's cute unlike the monstrosities they always put on the NBMEs
+
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?
+
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
motherfucker
PTH inhibits na/PO4 cotransport -> PO4 excretion
+4
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
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
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
bend_nbme_over
Great image thanks! Even though it was an MSU link :P Go Blue!
+
john198
is this link only for MSU students??? , I can't access it .
+
praderwilli
Also the concentric layers of reactive bone sounded like "onion skin" to me!
+7
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
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
+
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
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
castlblack
cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317
+3
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
+
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.
+
mcl
ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3
+1
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
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?
+
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,
+
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
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
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
+
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
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
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
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
Other answer H)Meigs syndrome :
triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632
+
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
+
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.
+
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
+
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.
+
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
madojo
Take H2 before you dine, remember H2 blockers for GERD
+
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
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
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
Subcomments ...
drdoom
@usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work
+1 2019-06-17T19:55:56Z
mcl
I love this and I love you
+7 2019-06-18T21:24:58Z
usmleuser007
LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested
+3 2019-06-19T01:00:18Z
leaf_house
@uslmeuser007 "MAMML PONNK" is the best I can do with that
+ 2020-04-04T19:05:01Z
colonelred_
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+7 2019-05-21T09:21:27Z
brethren_md
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+4 2019-06-02T01:13:03Z
sympathetikey
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+5 2019-06-09T03:52:30Z
s1q3t3
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+11 2019-06-10T22:04:18Z
masonkingcobra
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+3 2019-06-12T03:37:40Z
mcl
Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen???
+37 2019-06-13T02:06:35Z
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 2019-06-13T02:24:04Z
fallenistand
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+5 2019-06-20T19:51:54Z
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 2019-06-25T17:45:31Z
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 2019-06-26T12:07:44Z
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 2019-06-27T19:08:25Z
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
+ 2019-07-01T17:42:39Z
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 2019-07-20T16:17:29Z
youssefa
Hahahahaha ya'll just bored
+9 2019-07-24T14:28:56Z
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 2019-07-29T22:48:52Z
nbmehelp
I dont get it
+ 2019-07-31T07:06:04Z
redvelvet
how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen?
+1 2019-08-04T04:22:56Z
drmomo
what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen
+ 2019-08-27T13:42:09Z
sunshinesweetheart
hahahaha this made my day #futurephysicians #lowkeyidiots
+ 2019-10-16T11:31:49Z
sunshinesweetheart
@medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation
+ 2019-10-16T11:34:57Z
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 2019-10-25T00:38:00Z
noplanb
Wait... I might actually never forget this now lol
+3 2019-11-05T05:06:24Z
drmohandes
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+1 2019-11-22T01:43:50Z
lilmonkey
Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome!
+ 2019-11-27T17:07:20Z
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?
+ 2019-12-15T09:18:52Z
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 2019-12-29T02:10:05Z
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 2020-01-25T10:28:15Z
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 2020-01-26T05:32:39Z
medguru2295
Wait..... so can females get Sertoli Leydig cells that produce androgens then??????
+ 2020-02-09T00:41:29Z
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 2020-02-27T21:04:03Z
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 2020-02-29T23:08:27Z
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 2020-03-01T02:24:01Z
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"
+ 2020-05-06T07:10:09Z
mbate4
According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens
+ 2020-05-18T21:33:24Z
drdoom
the tradition lives on
+1 2020-05-21T04:18:55Z
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
+ 2020-06-06T19:10:38Z
abkapoor
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
sorry for bad Englesh
+ 2020-06-18T00:32:24Z
faus305
Sertoli-leydig cells are notorious for producing lots of androgens, females can get these.
+ 2020-06-20T22:04:40Z
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
+ 2020-07-01T22:26:04Z
colonelred_
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+7 2019-05-21T09:21:27Z
brethren_md
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+4 2019-06-02T01:13:03Z
sympathetikey
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+5 2019-06-09T03:52:30Z
s1q3t3
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+11 2019-06-10T22:04:18Z
masonkingcobra
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
+3 2019-06-12T03:37:40Z
mcl
Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen???
+37 2019-06-13T02:06:35Z
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 2019-06-13T02:24:04Z
fallenistand
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+5 2019-06-20T19:51:54Z
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 2019-06-25T17:45:31Z
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 2019-06-26T12:07:44Z
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 2019-06-27T19:08:25Z
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
+ 2019-07-01T17:42:39Z
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 2019-07-20T16:17:29Z
youssefa
Hahahahaha ya'll just bored
+9 2019-07-24T14:28:56Z
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 2019-07-29T22:48:52Z
nbmehelp
I dont get it
+ 2019-07-31T07:06:04Z
redvelvet
how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen?
+1 2019-08-04T04:22:56Z
drmomo
what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen
+ 2019-08-27T13:42:09Z
sunshinesweetheart
hahahaha this made my day #futurephysicians #lowkeyidiots
+ 2019-10-16T11:31:49Z
sunshinesweetheart
@medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation
+ 2019-10-16T11:34:57Z
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 2019-10-25T00:38:00Z
noplanb
Wait... I might actually never forget this now lol
+3 2019-11-05T05:06:24Z
drmohandes
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen.
+1 2019-11-22T01:43:50Z
lilmonkey
Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome!
+ 2019-11-27T17:07:20Z
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?
+ 2019-12-15T09:18:52Z
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 2019-12-29T02:10:05Z
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 2020-01-25T10:28:15Z
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 2020-01-26T05:32:39Z
medguru2295
Wait..... so can females get Sertoli Leydig cells that produce androgens then??????
+ 2020-02-09T00:41:29Z
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 2020-02-27T21:04:03Z
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 2020-02-29T23:08:27Z
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 2020-03-01T02:24:01Z
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"
+ 2020-05-06T07:10:09Z
mbate4
According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens
+ 2020-05-18T21:33:24Z
drdoom
the tradition lives on
+1 2020-05-21T04:18:55Z
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
+ 2020-06-06T19:10:38Z
abkapoor
Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen
sorry for bad Englesh
+ 2020-06-18T00:32:24Z
faus305
Sertoli-leydig cells are notorious for producing lots of androgens, females can get these.
+ 2020-06-20T22:04:40Z
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
+ 2020-07-01T22:26:04Z
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 2019-05-20T10:14:48Z
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).
+ 2019-06-13T02:00:58Z
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 2019-05-20T02:17:53Z
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 2019-06-12T21:49:46Z
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 2019-06-18T15:07:34Z
medschul
They're cleaved by tissue-specific proteases
+1 2019-06-20T18:12:52Z
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 2019-06-20T21:26:31Z
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 2020-05-17T20:59:06Z
mcl
how do i upvote multiple times
+16 2019-06-12T16:54:32Z
dragon3
ty for the chuckle
+6 2019-07-05T22:58:12Z
cinnapie
@trichotillomaniac Same
+3 2019-07-20T15:32:29Z
hardly43
RIP legend @seagull
+ 2020-06-11T14:43:20Z
seagull
A legend never die
+1 2020-06-17T01:24:20Z
joker4eva76
Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5?
+1 2019-06-02T20:12:57Z
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.
+ 2019-06-02T23:05:50Z
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.
+ 2019-06-03T01:43:26Z
mcl
ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3
+1 2019-06-11T18:08:30Z
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 2019-06-09T15:26:08Z
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 2019-06-10T04:38:59Z
frijoles
So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich
+13 2020-02-26T00:10:45Z
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!
+ 2020-05-24T23:30:38Z
mcl
lul i don't know why i spell kaposi like that, my b
+10 2019-05-31T02:34:36Z
bubbles
This site is super helpful. Thanks for sharing :)
+ 2019-06-08T22:39:19Z
mcl
yesssssss ofc <3 I love path outlines
+ 2019-06-09T02:47:29Z
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 2019-06-17T17:54:20Z
mcl
Also, you don't wanna use sinemet since that would be counterproductive
+2 2019-06-09T02:40:50Z
drzed
Whaaat? How could increasing levels of dopamine in a psychotic patient possibly be a bad thing?
+ 2020-02-06T18:13:43Z
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 2019-06-09T01:59:54Z
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 2019-06-07T19:34:32Z
snripper
Doesn't acetaminophen inhibits COX 1-2, too? Why can't you use that instead of aspirin? Just wondering.
+4 2020-02-23T20:25:13Z
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.
+ 2020-03-01T17:45:41Z
eagleeeee
I think the reason is that acetaminophen is inhibited peripherally and is mainly used to inhibit COX in the CNS
+5 2020-03-07T23:38:27Z
whatup
The worst side effect of Niacin is hepatotoxicity. Acetaminophen is famously known for hepatoxicity so aspirin is a better answer
+1 2020-03-12T21:29:37Z
hungrybox
Man this is such a nice figure except it doesn't have Krabbe disease :(
+ 2019-06-01T14:36:47Z
mcl
Here's another one with Krabbe! :)
https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg
+7 2019-06-03T17:31:52Z
mcl
Amen brother
+1 2019-05-30T23:58:05Z
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 2019-06-02T22:30:11Z
mcl
oh my god are you me
+1 2019-06-03T17:31:28Z
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 2019-06-04T02:37:17Z
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 2019-08-07T20:08:28Z
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
+ 2019-12-07T08:21:22Z
lakshmi
Dirty USMLE has an incredible video that makes these super easy to get.
+1 2020-05-08T23:26:19Z
djeffs1
@lakshmi Link?
+ 2020-06-28T16:43:54Z
joker4eva76
Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5?
+1 2019-06-02T20:12:57Z
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.
+ 2019-06-02T23:05:50Z
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.
+ 2019-06-03T01:43:26Z
mcl
ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3
+1 2019-06-11T18:08:30Z
joha961
Same question. How could you determine between the specific nerve roots (C7 vs. C8)?
+2 2019-06-02T02:33:07Z
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 2019-06-02T23:07:48Z
joanmadd
you might see some ulnar nerve involvement if C8 was involved her
+ 2020-03-16T20:30:54Z
passplease
but he has generalized tingling which is in both ulnar and median regions?
+ 2020-05-09T20:36:31Z
joker4eva76
Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5?
+1 2019-06-02T20:12:57Z
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.
+ 2019-06-02T23:05:50Z
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.
+ 2019-06-03T01:43:26Z
mcl
ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3
+1 2019-06-11T18:08:30Z
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 2019-06-02T02:42:47Z
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 2019-06-02T02:43:43Z
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.
+ 2019-06-02T02:45:15Z
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 2019-06-02T02:46:50Z
mcl
Sorry, I thought the biceps was a supinator of the forearm?
+15 2019-06-02T17:53:08Z
henoch280
yes.. its the supinator not pronator
+ 2019-07-16T20:43:28Z
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?
+ 2019-06-01T05:50:13Z
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 2019-06-02T17:30:31Z
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
+ 2020-06-30T03:09:22Z
mcl
This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png
+ 2019-05-31T03:36:45Z
mcl
[link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png)
+ 2019-05-31T03:37:10Z
meningitis
How did you knkow it was GHRH and not GH perse?
+4 2019-06-11T07:29:20Z
meningitis
nevermind; I just read down below. Thank you
+13 2019-06-11T07:32:14Z
mcl
This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png
+ 2019-05-31T03:36:45Z
mcl
[link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png)
+ 2019-05-31T03:37:10Z
meningitis
How did you knkow it was GHRH and not GH perse?
+4 2019-06-11T07:29:20Z
meningitis
nevermind; I just read down below. Thank you
+13 2019-06-11T07:32:14Z
mcl
Whoops, my bad, THORACIC outlet syndrome
+4 2019-05-31T03:18:19Z
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 2019-06-13T14:48:37Z
mcl
lul i don't know why i spell kaposi like that, my b
+10 2019-05-31T02:34:36Z
bubbles
This site is super helpful. Thanks for sharing :)
+ 2019-06-08T22:39:19Z
mcl
yesssssss ofc <3 I love path outlines
+ 2019-06-09T02:47:29Z
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 2019-06-17T17:54:20Z
joker4eva76
Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5?
+1 2019-06-02T20:12:57Z
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.
+ 2019-06-02T23:05:50Z
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.
+ 2019-06-03T01:43:26Z
mcl
ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3
+1 2019-06-11T18:08:30Z
seagull
I hope everyone memorized every single part of the brachial plexus and all the roots of each, No detail let untouched!!!
+26 2019-05-29T17:25:13Z
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 2019-05-31T01:13:23Z
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 2020-03-29T17:46:12Z
alimd
they force us to know brachial plexus like the holy bible
+ 2020-05-02T02:52:53Z
mcl
Amen brother
+1 2019-05-30T23:58:05Z
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 2019-06-02T22:30:11Z
mcl
oh my god are you me
+1 2019-06-03T17:31:28Z
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 2019-06-04T02:37:17Z
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 2019-08-07T20:08:28Z
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
+ 2019-12-07T08:21:22Z
lakshmi
Dirty USMLE has an incredible video that makes these super easy to get.
+1 2020-05-08T23:26:19Z
djeffs1
@lakshmi Link?
+ 2020-06-28T16:43:54Z
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 2019-05-25T01:44:55Z
d_holles
So you're saying that there's two crosses, making it ipsilateral? @mci
+ 2019-07-01T22:28:18Z
mcl
[Useful figures illustrating transplant rejection](https://www.stomponstep1.com/transplant-rejection-hyperacute-acute-chronic-graft-versus-host/)
+ 2019-05-24T22:15:26Z
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 2019-05-24T22:12:34Z
olllo os instdea of iungs fioepozeml yhet just agonn etg hmi earl kudrn