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To add to this it causes Meningoencephalitis. Look out for confusion and brain signs mixed with signs of meningitis. Only a handful of organisms that cause both.
Am I the only one who thought portal of entry cant be through a nerve and just ignored all the nerves?
@osler_weber_rendu I thought the same... I knew it was through cribriform plate, but not that was actually through the nerve
@osler_weber_rendu yeah same here, otherwise would have been a much simpler question
In line with the thinking above, SketchyMicro teaches it as if it just passes through the cribriform plate, ignoring the nerves. Wikipedia says that it actually enters the nerves, then passes through the plate.
Why does his cell differential show no eosinophilia? Schistosoma is a worm..?
It also says in FA that SCC of bladder is associated with painless hematuria. My dude in the question stem is having "pain with urination that has increased in severity during the past month."
@Takayasuarteritis, technically he does have eosinophilia. Reference range is 1 - 3%. His is 5%. Also, although SCC of bladder presents with painless hematuria, schistosomiasis itself can have hematuria, and that hematuria can be painful.
Page 332 FA 2019; cAMP signaling pathway, thus increase adenylyl cyclase was best option imo
Page 337 FA 2020; This is working via V2 receptor, which uses the Gs pathway to generate cAMP. Reminder: V1 works via Gq. V1 is present on the blood vessel smooth muscle
Nitrates, such as nitroglycerin, increase nitric oxide, which then increases cGMP (not cAMP)
UW ID 666 has a great explanation.
From the UW ID 666 explanation, although type II pneumocytes normally differentiate into type I pneumocytes after proliferation, they do not differentiate in idiopathic pulmonary fibrosis due to altered cell signals and altered basement membrane, which is why type II pneumocytes are increased.
Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing?
*Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5)
What is special about the Pouch of Douglas is that it is the lowest point of the peritoneal cavity, so even if blood gets in between the layers of the broad ligament (which I agree with you, it looks like it should), I bet it somehow makes its way down to the Pouch of Douglas due to gravity.
To tweak the above a little, eccrine glands are more commonly known as "sweat glands," although sweat glands that are apocrine do exist in the armpits and perineal area, though they do not contribute to cooling.
it inhibits Carnitine acyltransferase-1 in beta-oxidation.
FA 2020 pg 89
Reminder: CTLA-4 on T-cells also binds to B-7, and the effect is opposite that of CD28 (inhibits T cell activation)
FA 2020 pg 222
prefer “patients with hx of substance abuse” over more conveniently typed but less redemptive “drug addict”
I don't see why switching her to oral pain meds when she is ready would be incorrect. Clearly she is worried about being on the pain meds, I feel making a proclamation that she has a low risk of addiction would be profiling just because she doesn't have a history.
The opioid epidemic also affects people who didn't have a previous history of drug abuse. Just a thought, not trying to push any buttons. Maybe I am thinking to hard about this, but I don't see the clear A vs B line for this question.
@sugaplum I thought the exact same thing as you and chose the acetaminophen answer accordingly. I maintain that I am correct, my score be damned!
I had a similar question on UW and the explanation stated that the correct answer choice was the only one that addressed the patient's concern and answered her question. The rest were just alternative treatments, so they were incorrect.
But I too answered with oral pain meds.
couldn't agree more with you all. I chose acetaminophen because opioid abuse is NO joke. The crisis is still going strong because of answers like this...
I ruled out oral acetaminophen because they described in great detail the severity of her injuries, and indicated that she wasn't even fully conscious/aware when she asked this question about opioids. Rather than expose her to more pain, and possibly worsen her long-term pain prognosis, by switching to acetaminophen too early, in this case it makes sense to keep her comfortable because she's very seriously injured and not even fully lucid. It's kind to reassure her in this case.
I appreciate all of the passion for the opioid crisis, and the wording of the answer is definitely not ideal. However, PAIN is also very real, and there is no way acetaminophen alone would cut it in a case like this, not "as soon as she can take medications orally." Maybe I'm lucky to have 6 months in clinicals before STEP or had a mom who just went through urgent spine surgery for breast cancer mets, but there is a time and place for opioids and this is clearly one of them. Thank you for coming to my ted talk.
I agree with anastomoses, cmon guys have you ever had serious pain? oral acetaminophen is NOT enough for that type of pain.
I r/o oral acetaminophen b/c she's post-op for major GI surgeries so you might want to avoid PO meds for a while
As argument against the oral acetaminophen answer choice, it says "switch the patient to oral acetaminophen boldas soon as she can take the medication orallybold" This means you're just waiting for her swallowing inability from the facial fracture surgery to come back, which might not have much to do with her pain, and so it seems somewhat arbitrary.
Maybe logically/clinically A is true, but this seems like a "patient communication" question to me and I could NEVER imagine A being a good way to phrase this point IRL.
Hypotension and jugular venous distension are two components of Beck's triad, which is associated with acute cardiac tamponade. The third component is muffled heart sounds, which is not addressed in this question.