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Welcome to monoloco’s page.
Contributor score: 132

Comments ...

 +1  (nbme22#1)
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neyonA esle egurif tuo how a eungsro esgt sih andh inedis eht taetpni edpe nghuoe ot evulas het pieahct ivens mfor eth VIC rugdni a ORA?MPOYTAL leBsffa .em

mesoform  I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description. +2
kimcharito  aorta is also behind of liver... +1
medguru2295  I also didn't realize the surgeon's hands would so deep in he could touch the IVC on a Lappy....kinda eliminates the point of a Lappy.... +
iwannabeadoctor2  "A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity." Exploratory laparOTOMY very different than LaparoSCOPY, which is what I think you may be confused about. One is a gaping hole from which you can observe everything, and the other uses tiny incisions and scopes. Even still, a hand port used during laparoscopy can allow for digital manipulation of organs as needed. +2
bbr  I dont think the physician caused the avulsion, I think it was there already and he grazed the area. Causing it to fully avulse and break what ever clotting was going on. +

 +0  (nbme24#11)
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fI nyenao wonltd’u mnd:i How am I sspduoep to wokn hatt 1MTD ash a iilsarm geipedre ot cioenpizhahs?r Teach me hwo ot ik,tnh

ankistruggles  I think they were getting at how developing T1DM and schizophrenia are both multifactorial. I don’t remember what the other choices were off the top of my head, but they had clear inheritance patterns. +9
pathogen7  Just as a slight tangent, is there a difference between "multifactorial" and "polygenic" inheritance? +
ac3  polygenic = multiple genes affect phenotype while multifactorial = genes, environmental factors, etc that can affect phenotype +1
sars  Multifactorial: cleft lip, cleft palate, type 1 diabetes mellitus, sjogren syndrome, pyloric stenosis, congenital heart disease, neural tube defects +1

 +7  (nbme20#27)
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ehWn yuo hvea a ravltree woh ash irtnttnimtee andilmabo tmsmsoyp dna ,rhadaeri and how sah eevtardl to eth sklie fo hronnetr cfAiar nad sh,uc iihmsscoSotsisa sened to be no oryu arard. tA sea,lt s’that woh I’ve cioarenptrod isth guetgn into ym lanmet seap.c

 +3  (nbme20#11)
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sihT has to od tihw ntonir piglcis.n eRerbmme TGGA. Tish oatnmuit ndeicdu na AG lescro hrewe it swa udossepp ot ,eb os esmo fo ttha ntorin tsuj ebacme an .nxoe

 +10  (nbme20#32)
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iTsh is hte lnoy eohcic htta moces lseoc ot icngnki eht hcatcrio ctd,u eysccllipifa ta ist eit,nl hte lfte licba.usnva

kpjk  why not midsternal thoracotomy? +3
wuagbe  because the thoracic duct ascends the thorax posteriorly, and enters venous circulation from behind. link to image: +5

 +2  (nbme20#14)
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Eadnaplectsu ngmossira urn aaptnrm in spnaetti hwo veah no see,nlp hhewrte lihyapylsc ro ftulycna.inol aeRc(ll eht ryer-diwaa fo ueslaeaq sleick ellc iepttnsa xpeeceinre haksnt to rtehi nconalfiut lmt.po)oneytecasu

sympathetikey  Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy. +
chillqd  Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause? +23
studentdo  Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why? +1
mgoyo89  The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :( +1
kard  Everyone is correct about the Encapsulated microbes, but this is one of those of "MOST LIKELY", and by far the most likely is S.Pneumo>>H.infl>N.Mening. (omitting that patients with history of splenectomy must be vaccinated. +1
djinn  Gram negative are more common in DIC my friends +2
drzed  Correct me if I am wrong, but I am pretty sure that E. coli is NOT a common cause of pneumonia because it must be aspirated to enter the lung. Thus, only patients with aspiration risk (e.g. stroke, neurogenic conditions) would be at a chance of getting E. coli pneumonia. +1

 +7  (nbme20#28)
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rulanAn cspeaanr si the lyno wesran ahtt ontscuac ofr eht ileb ni eth t;voim of the occ,hies it is the ylon cnotrbostiu stldia ot heewr beli ensrte het GI .atrct

ergogenic22  Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +
sympathetikey  Correct. Might cause pain due to ectopic gastic tissue. +3

 +6  (nbme20#10)
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shTi is indirlcyet agnkis btuao aepk oenb ndseiy.t Thta lhoew ghitn atoub getnw-erghiaib eseersicx, tegain rt,ghi adya ydaa, erboef adn rdgnui atth noso-dlwep phsea of ilfe rfo ebno itdy.ens lAl about gndciuer ttha 1% rpe eray geetlad-rea bone esdnyti sols as ebts as we nc.a evleL fo tctiayiv si slipyrece keil irg-eaiewbntgh crxis.eee ion(eCd:rs no aiittvyc, dinre-bdde -- yas dooyegb to yuro bs;one hylhgi v,taice nrsu yever rohet ayd -- ogdo uaonmt of ngriwheige-abt / strsse ot enudci edimenorlg and iaiannmt ettiinryg of het ne.bos)

sympathetikey  Yeah, I was thinking about that while taking the exam. Just got thrown off because I don't see how that matters, now that they've fractured the femur. How do prior increases in bone density allow for better chances of bone healing? +12
rsp  I think that bone density is important here, but think about all of the other things that go in to recovering from a fracture at that age too. How strong are the muscle that will stabilize you while going through the motions of physical therapy? How conditioned are you? +2

 +9  (nbme20#26)
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eerecdaDs atol,t mrlano eefr do)n(ubun = yrTodih rogininmonbhde- nlguoilb eicdycneif

 +19  (nbme20#32)
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ihsT is a caoonlntdii llaedc oapseilans.ddolcriiyca Teh dik on gatSrren gTnihs thwi teh ipsl ahs teh ddsrore.i oN lrolca sbnoe, oot anym ,ttehe flnotra nbsigos =tg&; nloeyiiciaosrpdlaads.c AF1CB si a eegn hyhigl icptledmia in ltasestboo not.uicfn

 +10  (nbme20#11)
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Tish si a pslaoyihpa of the eunlaotoelppreri ermnb.ame eTh stug rteihena inot the ,atohrx lylusau on het lfte i,des adn srtelu in oyhialppas fo eth slgnu saueec(b 'teyrhe rrbyholi cmd.esprseo)

johnthurtjr  Usually on the left because the liver prevents herniation through the right hemidiaphragm +7
asdfghjkl  aka congenital diaphragmatic hernia +2
pg32  What's weird to me is that if you usually see air in the intestines on x-ray when they are in the abdomen, why is there no air in the thorax in CDH? The intestines should still have air in them, right? Also, what is filling the abdomen that causes it to appear grayed-out in CDH? +
drzed  @pg32 You can actually see a gastric bubble if you squint hard enough. Look at where the NG tube is placed; there is a radiolucency to the patient's right of the NG tube which is most likely the stomach. It probably then is radioopaque distally due to the pyloric sphincter, and air having a tendency to rise. +2
bbr  Any idea what "absence of bowel gas in the abdomen" is referring to? +
rkdang  my interpretation was absence of bowel gas in abdomen --> the bowel is not in the abdomen --> incomplete formation of pleuroperitoneal membrane bowel gas is a normal finding that you often see on x rays of the abdomen in a normal patient +1
seba0039  @rkdang is it also abnormal that you cannot see any air in the lungs? This threw me off when I was trying to read the radiograph. +

 -3  (nbme20#19)
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sI hist teh eno itwh eht poro edikny hatt swa tuc in ahlf sngaiat sit llwi dna sha a dedlati idatsl eertr?u If os, yabpolrb gnioswh su tnoiaitlnsar rcaimcnao tiwh midl nnviiaos tnio taht dstial eer.rtu haPtoam odes a tyterp eewasom job fo itklnga tuabo GU nsaeccr dna( tsom ea)scrnc ((dna mtos iie)cmd)ne IOM.

 -3  (nbme20#20)
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I vhea eadrredg pcrstuie sa the gibnurb of bn-en-n.ooeob My dusyt errtapn adn I nhitk tsih si a urelpy oilafedinnit iesot.uqn e,Ys sectprui ucldo lsoa eb apedtrp r.ia Cettx,on I uegss.

medstudent65  Crepitus is used to describe bone-on-bone grinding. Subcutaneous crepitus is very specific sound referencing air finding its way into the skin which you can hear but also feel by rubbing your hand over the affected area. The addition of subcutaneous lets you know we are specifically talking about air in the skin. +1
len49  You may also see the word in regards to gas gangrene (C. perfringens soft tissue infection) FA 2019 pg 138 +1

 +7  (nbme20#36)
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I khitn helaglSi si eth mots eipporat,pra sa it is uyallatc egraderd as glhhiy arln.mifatoym se,Y .E oilc acn be fo hte EHCECST/E eatr,iyv tub .E cilo cdoul aosl eb of teh EETC eiyrvat ro hwrevtae hoert sairsnt it hsa. ogEr, .E lioc aym eb bu,ieallsp ubt ti si nto hte 'somt 'iye.lkl Behl ot ehtse dsikn fo t.eisnsqou

jcmed  This is why I picked this one because of the mucoid stools/inflammatory nature :) +

 +3  (nbme20#23)
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fI yuo natw ot lreac a ,drug it is bpoarlyb bset tath it tno be dbuno to tesronpi o(s that ti sget )deleirtf and it has a olw vmoleu of bitontsduiir (so it 'tsin ni hte ee,pd adrh ot chrae

kingtime9119  But that doesn't make sense. Page 233 of First Aid 2019 edition clearly states that being plasma protein bound creates the lowest volume of distribution, because not being bound to proteins increases the chance it will reach deep into the tissues before it reaches the kidneys. Discrepancy with First Aid? +
haliburton  my reasoning was comparing two drugs, both with Vd of 1, the drug with the lower albumin binding would be cleared faster @kingtime. I don't think you're considering that A and B have equal Vd. +6

 +3  (nbme20#21)
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shTi iatenpt si egierpiecxnn tnyriveseiitsphy iepmuotnsin frmo het rtseep.kaa I aws tingkihn M. vimAu enhw I leeecsdt rsaaeetpk -- I tihnk ym clgio swa dlawfe ignev het feipscisc fo teh nsp'ietat t.ryso

 +13  (nbme20#17)
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As a uelr fo b,hutm fi uoy igev eomeosn an ACE hroiiinbt nad hyte gte a pmorbe,l yhet adh rlaen aeyrrt eotsissn l(yaluus birltalaly,e or os ew ewer htatug ta uor mde cs.oo)hl bPbarloy ahs ot do iwth edrcsedae GFR knthas to eecddesra teonniisgAn IeeecIi–vstl tcnrovciostnioas of hte eteernff oaltriere ;g=t& edsraceed sdiumo ereyildv to cmalua deasn ;t=g& nrcaeidse nnrei .eleasre

lilyo  Vasoconstriction of the EFFERENT arteriole actually leads to increased GFR. It selective VASODILATION of the efferent arteriole effect of ACE inhibitors since they undo Angiotensin II actions. This patient already has rescued renal blood flow due to bilateral renal artery stenosis, the addition of an ACE inhibitor further decrease GFR prompting an increase in renin due to loss of negative feedback. +2
drpee  We should always expect GFR to drop a little after adding an ACE-inhibitor due to efferent arterial vasodilation. For this reason we should also expect Renin levels to rise via tubuloglomerular feedback. So it's not really the reaction to the ACE inhibitor that gives this away as RAS (which is why I got it wrong). I think what we are expected to be looking at it are lab values: Hypokalemia, and secondary hyperaldosteronism. +
stepwarrior  ACE inhibitors would actually have the opposite effect of AT-II, and result in efferent dilation. But the actual mechanism of increased renin activity per UWorld is lack of systemic vasoconstriction by AT-II leading to blood shunting away from the kidney. +

 +18  (nbme20#30)
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neyimAt oyu hvea a snoerp ohw mpbsu heirt de,ah gest back p,u dna neth ahs rvesee sussie or idse like 6 orhsu lerta -- yuo ehav oufrleys na aeirdupl ahmoamte mrof cairneotla ot eht edmild NEIGANLEM y.aertr (noGalj lyaelr aizseemhsp hatt oyu dont' rwces up dan stelec ddmile e.a)ebrlrc ouY wkno ti ash to be na trelaair eoiatlnrac nscei het adur is ltigyth deaerdh to eht kl'ussl rnnie afsercu. ojGlan reerfedr to ish crpxeeeine with ti sa neindeg splier to oevrme eth ruda mrof eth ll;usk g,craihp tbu ti dveris eth tnopi .ohme tinTegn nsee on TC si ceeasbu het ruedipla homeaamt gest ustck bentewe the usrute elsni. Wenh it gasamne ot bekra satp one of the utesur n,ilse ti is ym radgidsuennnt ttha nhte is enhw uyo gte reeesv qlusea,ee iekl ehadt or vawteeh.r

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +9

Subcomments ...

submitted by hayayah(1056),
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yernncagP + Hx fo osrhmbtsoi &;t--g tnhki lostohhpanpidpii mersodny

Teh PT and PTT rea odegnolpr t/d ecireerfntne rmfo eth aeitnibsod to hodlss.pioihpp brmhTnoi iemt oarmnl.

adH ot indf rerescha ietalscr obtau ti so eakt ti morf heer adn dt'no wseat uoyr .emti..

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +20  
goldenwakosu  Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +4  
johnthurtjr  I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +3  
link981  No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +8  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +3  
oslerweberrendu  @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +  
kevin  just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +1