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Welcome to namira’s page.
Contributor score: 25

Comments ...

 +6  (nbme18#34)
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tMrlia elvav nad eehtt icenagnl rae key orwsd for preSt isvirdna nso.dsgiai It is alaph tchimyleo os it wulod veah a rengneig .ecotrnia

oaitmptnr nmetino ot chwat tuo f:ro

Teh coiptnoh enwsar si ecocnrrit cseuaeb it yssa ibnt"hiioin YB ipotnc."ho Vsiriand is tnrssaeit ot tchinopo so ttah nraswe si cocni.retr

 +0  (nbme18#34)
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alMirt aevlv and heett necgilan aer eky odwrs for trpSe visdnrai nasoii.dgs It is aalhp mlhiycoet os ti woudl eavh a inegrgen ceatirno.

itntamopr entmion ot athcw tou :fro

hTe hicnpoot aswern si itorneccr abeeusc ti yssa thbnioii"ni YB hnoo"tip.c nVasidri is etsartnsi to tiopncho so htta awsrne is irrectn.oc

 +1  (nbme20#17)
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Peoslsbi ptn:eailxona

If eht pt is tikang a zdhaeiit whc(hi is K ,petdg)ilen it igtmh vahe osal neeb geivn iwth a K ipgsnar urgd chus as .rninslooapeict

Srlpinooteniac ahs ldrceoociingno sfceetf cuhs as mgntoayaceis and grc.rlhaaateo

sugaplum  I think you could only make this assumption if they said "patient is on standard htn tx" but since they gave the name hctz, would not be fair to assume they are also taking spirinolactone. I went with process of elimination on this one. Even checked access medicine's drug adverse effect profile...galactorrhea not listed for hctz +2

Subcomments ...

submitted by hayayah(990),
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the tajmiryo fo cnbaor ioeixdd mslelceou aer edrrica sa tapr fo eth bniaoecabrt erfbuf ey.smst In hsti emst,sy bnroca iedodxi isdfseuf ntio teh CB.sR aCorcbni hensrdaay C()A ihntiw sBCR kcilqyu ctosenrv teh rocbna eidoxdi onit rncocbai icad ().23HOC bCaoircn cdia si na butaesln neideaemtitr eollmecu atht meldyimatei tacdisesiso noit naobcebrita ions H-)O3(C dna gonhyrde +()H ons.i

The wnlye dhyeietsnsz rbcaibotnae ino si oeandrstprt tuo of eth BCR itno eht amplsa in ceanhxge for a hloicerd oin ;(l−C) hist is celdal teh icrhelod hnWe teh doblo escaher hte ,slung eth taroaenbbci noi si ptansdrreto akcb oitn the RBC ni hgcxeane orf het coldehir hTe H+ oin odtaecssisi omfr the bghoionelm nad sidnb to teh teibcnraabo no.i hisT dcuopsre the abcrinoc cdia mieteniad,ert hwhci is cedrentov abkc onit narobc dideoxi hgoturh het yieznmtac tncaio fo CA. hTe racnbo odiidex upodrcde is lxdeleep rohutgh eht gulns diugnr anxlethiao.

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... +4  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +1  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. +1  
teepot123  fa 19 pg 656 +1  

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dotropArh rfo ue,rs tbu rof eht rcoder mI' etptyr resu shti saw Cukyugnianh ius.Vr lnyO gto sith romf a UrodlW itqsuone sa I dt'ahn esne ti liutn nteh, btu palryeatnp hte aaihrltarg si leylar ,dab hhcwi si awht wedr em ot teh n.ewars


meningitis  More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico). Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities. +10  
nala_ula  I'm shocked that I found a fellow puerto rican on this site! Good luck on your test! +1  
namira  dont be shocked! me too! exito! +2  
niboonsh  Dengue is also known as "bone break fever" which makes me think its more likely to be dengue due to the "excruciating pains in joints and muscles". +20  
dr_jan_itor  I was thinking that its Murine typhus transmitted by fleas +  
monique  I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection. +1  
jakeperalta  Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience. +  
almondbreeze  UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika +  
lovebug  FA2019, page 167 RNA virusesy. +  
lovebug  Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on the face, trunk and limbs. It is typically asymptomatic but may be pruritic (Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. ) +  

submitted by sympathetikey(980),
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CD4+ slecl ateatvic lslceB- hwich mrof llloefisc dna esuac mneralegnet fo hlpym nedso. efroer,ehT ni an SDAI p,nettia ot erlgean the hypml ,dnseo the D+C4 ntscnudiyof muts be .deelorsv

breis  Yea i get that, but if the patients CD4 was ~35, how in the world did the CD4 count rise enough to stimulate B cell proliferation...? I don't get it +4  
namira  The only thing i can think of is that: the cd4 count that is given was taken prior to having started the antiretroviral therapy. Since the question asks about "improved function", maybe its referring to the therapy actually being effective and its managed to increase cd4 count and function so as to be able to contribute to lymph node enlargement due to myco. avium +12  
kamilia20  I though it transfer to a lymphoma,OMG +  

submitted by laminin(14),
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nca oemoesn alpeixn ywh ti sasy he sha an 'ctiant' THP .esnnocic.t.arntio it to elt us wnko taht eth HTP encnonrictoat si a eslrut of lag o?nydahpot wash't sih ?xd asnh!tk

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +3  
redvelvet  hypercalcemia can cause nephrogenic diabetes inspidus; so thirst, urination. hypercalcemia can also cause peptic ulcer disease. His symptoms are all about hypercalcemia due to hyperparathyroidism. +2  
namira  "Hypercalcemia can cause renal dysfunction such as nephrogenic diabetes insipidus (NDI), but the mechanisms underlying hypercalcemia-induced NDI are not well understood." +  
dulxy071  Why can't the correct answer be C) which points towards renal failure, which may lead to secondary hyperparathyroidism having the same results I believe +1  
pmofmalasia  The secondary hyperparathyroidism in renal failure is due to loss of calcium in the non-functioning kidney. In this question the calcium was elevated, so you can rule out renal failure. +  
sars  Hyper-calcemia causes stones (calcium stones), groans (constipation), thrones (increased urination), bones (increased osteoclast activation), and psychiatric overtones (depression). +