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 +1  (nbme22#18)

can someone explain how morphine is degraded into active metabolites that accumulate? I couldn't find any sources that state this fact. Isn't it metabolized through the P450 system and excreted in urine?

staygoodpupper  Morphine mostly undergoes phase II metabolism and is then excreted renally. Some of the metabolites are metabolically active, and her creatinine was a little elevated, so renal clearance could have been impaired.

 +0  (nbme22#43)

Can someone please explain why the answer to this is injury to the posterior cord rather than the radial nerve?

pipter  because raising the arm above the shoulder suggests abduction which would mean the axillary nerve is also involved. the lesion would be more proximal.
kchakhabar  I thought "up to the shoulder" is done by deltoid muscle (aka axillary nerve) and above is done by trapezius.
forerofore  as far as i can find, abduction ranges of motion, per first aid are: 0-15° = supraspinatus 15-90° = Deltoid 90° = trapezius 100° (over the head) = serratus anterior in this question, they are directly telling you its not the serratus (long thoracic), because no option compromises it. Also, trapezius is innervated by cranial nerve XI, which is not a part of the brachial plexus, so, even though its worded weirdly, you can assume they are talking about deltoid disfunction. so deltoid disfunction (axillary) + radial disfunction = posterior cord

 +0  (nbme22#22)

Why is the correct answer chi-square test? I get that it’s used for categorical variables but we’re comparing prevalence percentages. Is that considered categorical?

liverdietrying  You’re looking at two categorical variables, Caucasian vs. AA and HTN versus normotensive. So you’re still using Chi2 to analyze.

 +0  (nbme22#49)

Why is it azithromycin not doxycycline? According to sketchy, you treat chlamydia with macrolides/doxy +ceftriaxone. You treat neisseria gonorrhea with ceftriaxone+azithromycin+doxycycline.

​Not sure what this question is testing -- is it wanting us to know that gonorrhea has to be treated as well? In that case, doxy would work for both according to sketchy ... Any other reasonings appreciated!

dr_salface  The patient in the stem is pregnant! The question wants to see if you know that doxy is a teratogen. Tetracyclines in general like to bind to fetal bone/teeth which can impair development.
dr_salface  As a side note, treating chlamydia alone only requires macrolides or doxy. Treating gonorrhea alone only requires ceftriaxone or macrolides. The reason sketchy includes all three is because you usually treat one infection and co-treat the other.
yotsubato  Theres a crow in the chlamydia sketchy. You can use Macrolides, OR Ceftriaxone, OR Doxycycline. Most doctors in real life just give the azithromycin z pack (which kicks ass cause its one drug 5 doses thats it)

 +1  (nbme22#41)

I missed this as well because I completely overthought it since they had to add (vasopressin) instead of just saying ADH which made me think of its role in constriction of smooth muscle, but the point is that there will be pooling of the blood volume in the viscera and vital organs which will increase ANP release from the atria and since ANP is released with higher blood volume/atrial stretch, you can draw the conclusion that ADH will be low because ANP is signaling to the kidneys that there is an abundance of volume. Also, since the viscera is going to get more blood flow compared to the extremities since he is going to be hypothermic, you should also get increased flow to the kidneys or at least preservation (to a certain extent) and this would not promote the release of ADH which is only released when the body senses an increase in blood osm.

 +0  (nbme24#31)

Can someone explain why the correct answer for the question here is conjugation but can’t be transposition?

catacholamine16  Transposition is when a segment of DNA (in this case, coding for resistance) jumps onto a plasmid within the same bacterial cell. That plasmid might then transfer to another nearby bacterial cell via conjugation. Transposition is happening WITHIN the bacterium. Conjugation is how that resistance gene gets transferred.
lsmarshall  Also, E. coli is the classic example of a bug tat uses conjugation. ^but explanation above is correct^
seagull  I think he might have did what I did. I got Transformation mixed up with transposition. FML

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