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 +0  (step2ck_form7#38)

Unless there is a contraindication because of the ascites, it would be an exploratory laparoscopy not a laparotomy. I took flak on GYN-Onc for saying the wrong one


 -2  (step2ck_form7#5)

This is not correct. While atropine is the correct answer to manage organophosphate poisoning, it is more appropriate to stop the seizure immediately. Benzos should be given initially in the presence of seizure with atropine and 2-pam for management of poisoning

etherbunny  The atropine would work as fast as the benzo. We also don't know the duration of the seizure- benzos are only indicated after initial measures to control the seizure have failed. https://www.aafp.org/afp/2003/0801/p469.html +
lindasmith462  Yea this is a crappy question - you could DEF make an argument for diazepam as it indicated specifically for seizures in organophosphate poisoning and does act faster than the atropine. Early benzo use (regardless of seizures) has been associated with improved long term neuro probs and really should be given WITH/"right after" atropine. I guess I went with this question is getting at me knowing this is organophosphate poisoning and what to do vs seizure. https://www.uptodate.com/contents/image?topicKey=EM%2F339&search=organophosphate%20poisoning%20treatment&imageKey=EM%2F63540&rank=1~28&source=see_link +




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seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +42  
nc1992  I think it's just a bad question. It should be "on weekends" +16  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +21  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +1  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +14  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


submitted by bobson150(14),
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ehT oindgwr fo hsti uonsteqi sdnefcou em. hTsi is sagnik ih"whc fo seeth slesvse si eth high reeusspr s"esymt ?rithg oS teh gihh upsrrese roeurpsi eratcl is cigsuna ceerinasd rreeusps nito eth nioirerf ?aerlct

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +2  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by iviax94(7),
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I egfidur etyh weer ityrgn ot tge at het lefi nyapxtecce of an B,CR btu ’wnltodu amentulesppl 2O tcleihaclyn ealeprc het CO oudbn ot CsB?R AF enve mnsineto atht CO nsidb timeytlcivepo ot ,sCBR nad s’int htta het loewh tpion fo nivggi h0%r10pyaierc/b ?O2

nc1992  First aid has a lot of errors +  
yotsubato  Thats not an error though. Thats the actual reason behind giving hyperbartic O2 for CO poisoning... +11  
mumenrider4ever  The question ask how long it takes to remove all the CO-carrying RBC so I think they're implying that theoretically not every single CO-carrying RBC would be replaced with oxygen from the supplemental O2 and some would die off naturally +  


submitted by haliburton(214),
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goacirdnc to uleelsmtdb ilkn sn ss ANR stmu carry NRA nteddeepn NAR plaroseyme (so hatt is t)u.o

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nc1992  negative stranded can't be read by a translator so it needs to be transcribed into + first. Only then can it be used for protein. + is basically mRNA already. There's only one double stranded RNA family as far as I know- Reovirus so no encephalitis +9  


submitted by seagull(1566),
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hWy nsnu?opatseo es'H negagngi in an tveica pstro with an dacrsneei sikr of armTauitc j.irnuy So we lyarel stju esuams seh ont nedurij sebauec eth emts ednsot idyletcr sya es'h j?neurdi hTees nosteiusq alde to too aymn smo.aunpssti n(i ym ooiinnp)

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +