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 +1  (nbme23#41)

Regular rhythm (count the boxes, they're same), 1 unconducted p wave with regular rhythm --> atria and ventricles beating independently (likely ventricles ctrl by His-Purkinje) --> complete (3rd) heart block --> AVN ablation (this is actually done for pts with Afib sometimes)





Subcomments ...

What are we supposed to be looking at? I see multinucleated giant cells. I also see infiltrate (can’t tell if this is mononuclear or not).

methylased  Young child following URI with TCP is pretty classic ITP. Sometimes they throw in extra stuff on purpose, but I didn’t see much on the bone marrow aspirate either. +1  
mousie  I was also thinking ITP but the bone marrow image kind of threw me off too, not sure what I'm supposed to see but still think ITP is best choice ... +  
meningitis  It also almost threw me off, but then I remembered he had low platelet count and I guessed those multinucleated cells were Megakaryocytes (I looked for Megakaryocyte Bone Marrow Biopsy in google and they are the same). +1  
what  Bone marrow shows increased megakaryocytes -> ITP +  


Why does methylation cause loss of resistance to GATC restriction endonuclease? Does this have to do with methylation of U to T?

methylased  GATC related to methylase --> https://en.wikipedia.org/wiki/Dam_methylase +2  
sympathetikey  Dam methylase, alright +2  


I thought that the primary sympathetic innervation to the heart was through T1-T4. Why would stimulation of this ganglion not affect skin vessels in the upper limb?

methylased  Stellate ganglion --> sympathetics for sweat to skin in UE + head. Apparently also to increase HR (some cardiologists ablate stellate ganglion for tachy that cant be controlled by beta blockers). +  
tea-cats-biscuits  The stellate ganglion is a sympathetic ganglion, so it wouldn’t increase vasodilation in the skin of the upper extremity. Also in most people, the inferior cervical ganglion is fused with the first thoracic ganglion (T1), forming the stellate ganglion. +1  
sympathetikey  Got this wrong too. I think upper extremity skin vasodilation (which I picked) is probably more due to local metabolites. +