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Welcome to nor16’s page.
Contributor score: 51

Comments ...

 +6  (nbme24#32)
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smHaetiin ieaesncsr aarcilsucvorm mrbp,ieyteali e.i. lFidu + ,tPnrieos tish asneecirs rrsepesu ni hte itriuitsnmte &;gt hmlyp lfow sreinesac

 +4  (nbme24#31)
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OCPM is a hrnmoeorpo dpepeit can.ih

It is atsadelrtn dan tarle esnymze tcu ihst ediptep ni the deusepbsti.p

nsrapnictirTo is owgnr (i hda sith o...)ot bc/ its otn teh RNAm atth akems edtfenfri iepdpet om.osnrhe rveooerM, wtha I ees won i,s taht sclittptirsanoparon icioitnfaomd si eorm or esls nlscg...ipi so sasraol.p-tttn f.taoicdiimon xent emit we akme ti ccotrer ;-)

medguru2295  This is a perfect explanation. I never knew it was the protein modified (I initially though alternate splicing too) +1
nerdstewiegriffin  Is this an example of polycistronic mRNA? +
paperbackwriter  @nerdstewiegriffin possibly (because it says that the original mRNA results in proteins plural, BUT the mechanism for POMC derived hormones specifically is not bc of polycystronic mRNA. Polycystronic means that you get multiple protein products from one mRNA, but in this case we get multiple PROTEIN DERIVATIVES from one PROTEIN, implying that there are some modifications/reactions taking place once we've already made ONE protein which change the protein into multiple diff. products. +1

 +2  (nbme23#33)
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in ß semhaailTas ereth is bH2A eacinser adn bAH s,rdescaee veen ni , ß+ mrlona oetceheosirlpsr leurs htis out. smae ofr -)AC)

tyrionwill  Yes! The key point is the normal electrophoresis. Hemoglobin will not show any abnormalities until least one single allele of Hb fully develops mutation. alpha chain of Hb is contributed by two points within one single allele, while beta chain of Hb is made of only one point in one single allele, therefore: -- in alpha thalassemia Hb electrophoresis will be normal if only one point gets mutation, i.e., aa/a- which we call it the "minima type". If two points get mutation, i.e., cis aa/--, or trans a-/a-, the "minor type", the Hb electrophoresis will be either abnormal(Hb Barts 3-8%) or still normal. overall, we assume the parent both are the minima type, so their children have 50% chance to be the minor type, 25% to be fully normal, and 25% to be the trans minor. -- However in beta thalassemia, the mutation of one allele will lead to whole allele changed, so we just need the mutation once to generate an abnormal Hb electrophoresis result. +

 +3  (nbme23#50)
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all ehsto non mtsha ygus er,he otnd sipk hetse s,euoqnsit tyr to rageran hte su,int hree ´dyuo elsyia fndi out ttah oyu tsju avhe ot liytp!mlu ivGe it a try )-:

charcot_bouchard  This was like Filtered Load ques of Renal. Where u multiply icoming fluid (GFR) with the desired substances conc (Px) so FIltered load of A is GFR x Pa Same here. Myocardial O2 supply is Blood flow x Conc of O2 in that blood flow +3
powerhouseofthecell  For us non math folk, how do you compare the mL/min to mLO2/mL to get mLO2/min? Sorry. Do you just find out that when you have the units beside each other, cross multiplying them gives you the correct one? I need to know this trick. I can't find this on google. +
abcdefbhiximab  mL/min * mLO2/mL = (mLmLO2)/(mLmin) where the mL's cancel out = mLO2/min +

 +3  (nbme23#28)
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jstu onkw erwhe teh big uffts / pttarmion fusft is o,bderrse it is eth .CPT oN need to owkn RsAT

 +2  (nbme22#26)
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one anrptitmo cestpa otn toime:dnen het " lnog " 1 reya nieg"n"b yotsihr of teh .yspo.msm.t nto lleiky fro analngitm omslaph,ym satros or assteimsat to tysa ttha acml

of uecsro in tadiindo to lal ehtro nnemdioet heer t"no nbria lnfirgtiitan .e"ct

 +0  (nbme21#35)
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cns leb,prmo anemia po)hy( adn eykind

ailyFln lony aeld cna cesau all fo it

 +5  (nbme21#42)
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nhrotGsaoopd aer eht FHSLH/ udinpgcro ruaitiytp l.cels o N ,iroavse no oemnrhso, on kaebfced nonihbiiit.

lovebug  THX for great explanation. When I first saw this question, I mistook the gonadotrophs for endometrial cell. so I Choose atrophy. (even that pt undergoes a total hysterectomy) critical mistake... +2

Subcomments ...

submitted by lsmarshall(371),
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ateaar"lsnPr eeavh flti)( socurc gurdni ightr lrcitearvun ohrrehpyytp .i.e( t)lemanenreg ro very ayrler rvseee left tiaral netgnmeaerl". RV ryrypthepho cna eb esen os isayel eseacub the VR si ta hte ionaerrt csuerfa fo eht c.esht

In htsi etanipt dloob mfro LA ot VL adceeesrs in uoa,aitrsnt os it si oingg .esowmheer morF eth 2O as.t we anc cdeued teehr si rbbloyap a SDV nas(drecie RV epssuerr lwdou ucsae HVR dna rrpnaalseta )eeav.h orumhreF,tr hte tvneetgi si kylile nirsgidbce gtrayelot of oltfal ac(dues by resateorpnurio lpteisadmnec of hte nuiaribfldnu m)pu.est nI etT seplls, VR utolfwo si oto rdubsteotc and iteapnt tseg associyn nda ;Rt&gL hsignnut uSstaq ierecnas SVR, geeracndis tg&L;R hnuti,gns tgnutpi omer loobd hrhugto aoumnplry icircut adn ieilenvrg iss.onayc

seagull  i'm pretty sure your a prof and not a student. +12  
nor16  nevertheless, we are greatful for explanation! +  
niboonsh  I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml +  
anotherstudent  Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize? +1  
pseudomonalisa  This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though). +  

submitted by jus2234(18),
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Teh pahrg swsho a cdesraee in acclieopmn of eht ugl.ns Of eth otopsi,n eiusfdf lamupryon bfoissri is eht lony occihe ttah si an lepxaem fo a eiretritsvc lgnu adesise chiwh uowdl ceesdera onlpieccam

nor16  asthma = emphysema = chronic bronchitits, obstructive. leaves 2 out of 5... +3  
usmile1  Common causes of decreased lung compliance are pulmonary fibrosis, pneumonia and pulmonary edema. So yes pneumonia could possibly cause the decreased compliance shown, but the vignette says the patient has "9 month history of progressive SOB." That couldn't reasonably be pneumonia, leaving diffuse pulmonary fibrosis as the best answer. +6  

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aahtPom ayss reeth aer 3 ingtsh ttah fetderifeinat eilmokued mfor M:LC+ kceuLteoy aeiklnla hoaptpsseah (nloy in +miek d)leuo polsBsiah (lony in M) L+C ;2t(9)2 stltinoaacnro lyn(o ni CML)

nor16  yeah but pathoma doesnt help here... +1  
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +  

submitted by sajaqua1(472),
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A and J tpsenerre eth elicrga cucifss,aul welhi B adn I eepnrrest het ctunaee uscsc.iflau hTegrtoe tyhe kema up hte soardl leoilcdmum-na alscilenm ,tcart poseenilsrb ofr iiptnopn cnptepe,oir ppco,reropinoti ,natiibovr adn utpnI si leiri.aplsat

C adn H akme pu the ealartl cirsocoplntai catrt oal(s lcdale eht eralalt rcrlenapieosb l,ci)asucufs irobslepsne ofr rotmo nmcoadm fo tasleiliapr

D dan G speretren the trlaeal plsmtaiihanoc atct.r tI si peborinesls orf apin adn ermttaeruep octnn.ioduc Teh tpiun rasesi in a bilm (tfle orwel iettxymer in tsih e)sac, eetnsr grhohtu het dsaorl otro ec(dirptu neteebw J adn )H, seaseucdts nad nesdsca at the naoretir ucsmresmoi tus(j dhebni E dan F,) dan llyianf sysanpse on eht ecnsod derro nrnueo in eth lratael aistocmialpnh ct.rta So eht pahiosimclnat rtcta si ieonpsbrles orf tateacanlorrl napi dan rerttempeua ansosit.en eBsueac our eaitntp has tlos nastienos no het et,lf eht elsoin is ni hte .trhig

E dna F era eth roerinat scctopinaiorl at.rct tI si nlvdeivo ni rmoto ltrcnoo of amlxipor sl,ecmsu tiyplclay of the n.rkut

nor16  good job +5  
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3  
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +1  
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +1  

submitted by sbryant6(136),
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tPnneio earsteir era msall nrcasheb of the sailbar yterar taht cna rueptru in hte gttesni fo prooly ecllndroot npi.hosnteery

nor16  vertical gaze intact = mesencephalon intact horizontal gaze damaged = pons damaged (RPRF) Pons damaged = no access of corticobulbar tracts to motor nuclei in brain stem -> speech impaired +1  

submitted by notadoctor(143),
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ilcaeC espur is a aasnlbiopmort semyonrd htta srtselu ni ohttasarere nad sulesrt ni nrio nfdcyeieci As rfa as mI' wraea, oenn fo teh hroets srutle in iorn enycedicif imnaa.e (I adh trelciBaa rvogehrwot as a coesl cdnose tub I nd'ot vbleeei ttsh'a ossdeactia hwit niro f.ceyeicnd)i

yb_26  bacterial overgrowth is associated with iron deficiency, but also with Vit B12-deficiency, so I guess pts will have macrocytic anemia +2  
nor16 Vit B12 is key here, moreover, no bloating (IBS and bacterial overgrowth with bloating). bacterial overgrowth is a close one! +1  
covid2019  I wrongly chose bacterial overgrowth, but that is wrong because Small Intestine Bacterial Overgrowth (SIBO) must be instigated by something. Commonly, anatomic abnormalities (like surgery causing blind loop syndrome, strictures, or motility disorders that allow the poop to ~fester~). +3  

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elgwndckAeo eth 'aientspt id.fyfitclu I aeht sehte uiesnotqs

nwinkelmann  Me too... also, he's had cough that's worsening for 6 months plus hemoptysis for 1 week... I didn't interpret that as "feeling healthy." The correct answer was my first choice just because it was the least "dick-ish" but to me, he didn't sound like he "felt health," so I didn't go with it. +1  
nor16  if he didnt feel healthy, why would he say something like that then... but i agree, these (especially this) question(s) are often XYZ123! +1  

submitted by meningitis(426),
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Pessroc fo intolmianei on this noe.

  • I dinaiteelm yblCarom htpohase,p iAgrinen due to arue .eclcy
  • I emiaelnitd APT bceeaus TAP oenla 'duowtln cehnga 6FP oint imsgcealnuo
  • NAG I ogt yuclk and I atedmiline it ude to sit seu in CME nda clalengo so I tn'ddi nhitk it asw ervetanl dna I idnk fo ebeemdremr it eibgn in urae .clyec
dr.xx  you mean, pure luck? :) +12  
impostersyndromel1000  lol pretty sound logic here mate +1  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  

submitted by nwinkelmann(265),
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I DTAHE itsh rp,ctiue usjt ielk rynoeeev ,esel l,lo so I idd eoms oemr reyvenoE bewol si erc,trco htat the pteatrnosnie si ngtgsiesgu na ntfieuscio csrsp.oe ITsU acn acseu cueta h,tpliornyespie adn fi o,nhcric eosprsersg to thenplseoiiyPr si a seaittouuttnliirbl deassie. I dnuof shti tonoaiimfrn enraridgg it, dna in het tasl part, ti bcediessr eth orsgs opogayhtl fo ocnchri pihnlyeto.epsir oFmr my tiernrtnaoepi,t ti odunss lkie hatw teh tircepu is nhw,sgoi btu I stna'w bale ot find a ebrs/eutjtt as oogd neo lnioen et,y os I n'tod onwk fro .eurs

Atuec teubTiatnolisulitr hN:rpisite uAtce aflnoimmntia fo eutblsu dna temtrisiitun nac uesca RAF, dna if eht trlnymaifmoa serspco sisertsp this acn eolevv noit rncioch ansliuiulttroiebtt spthieinr nda hrnocic ttaintrsliie fssoirbi nda atulrbu tparyho tihw sirk fo onerssgrpoi ot -daegsten kdieyn dai.eess woT oamrj itarecoesg of etcua iunoiltistlreabttu nphrtieis ear cuaet etirsoeynlpphi and ateuc iistiyhsrtveypen litleuiatrnbttosui risnh.ptie

Atuce rniotlehip:yspe eadusC by braeltcai eifonintc tmos onmmloyc .E ocil iiocnenft. iipsseyervytHnit luuttletisbrtnaoii th:sneipri eauCds yb na cllirage e,nosreps rof amlxee,p ot a drug or retho ancsstubse that rae egseti,nd hucs sa abelrh .msredeei

yB raf teh otms oncmom rouet fo foteciinn ni ectau heotlperinpiys si an ednncsgia ofnncitie ni hte ryariun rcta,t for lp,eemax eiedvrd form a baaetlicr debdral e.fitncnoi Atceu epierlhisypotn = evtseiexn nilfux of PNMs wiihtn teh etiiumsnitrt, tbsluue s(),buitiutl adn smlnue fo sebtuul CBW( csat)s (yt:htb/JlitP/i.By/Dp2).

tWhi nsepreeicts or recurnecer of tecua ihytneos,rpepil teh issdeea ecprsso lsvvoee toin cnocrih tiyhpip,nerlseo cihhw ulyulsa is oampncedaci by kaedmr nsioore of hte pyapirall pit sgenrltui in tnaoildi of the njadtace axcyl

heT omts crricitesaathc alhcioogpt ersueatf fo hincrco hleeipirnstpoy are hte gsosr ghseanc in eht inkeyd hiwt s-dedbraabo rcass ni het eyarmphcna yioenrgvl aarse fo aocirtcl dna rullamyed rtophay hwit etancdja alcc.siiseta Als,o teh tnteieanrops tesssugg n,sipsoredhyorh nda orfm my creea,rsh srhsir,oodnepyh nweh shr,ior/evncec anc trbuiecnot ot het dkamer sslo of xrteoc nad isicrsb/asfros fo hte euamlld (.hdp7NNbL/R0Mae.useHtEumwpthA0AdR/.ahLt/e.T:/Emltth) dan asitslcciea whh(ci I tnhki si tsnpree no hsti eruip)c.t ihTs is eht estslco triucpe ithw setiripncod I oldcu infd atth estmach eht tsme eatrnpistnoe (e..i ehuerrytrod adn n,rrphyeidoshos gisesgnutg ucsotaeirerlve eurfxl agnledi ot fcetiionn ofrm "a onlg nagdnist unoribtotsc blproby(a canol)tig"en os ylkiel rmfo a ihdc)l dLt/bRtephLe/alH.pds:uNE.8mh/aAMhRtTA/0Ntmtu0hEe..w.

,slAo to nneimto on teh ohtre oemcsmnt sgenxseipr afiontrturs atht eth mase ciueptr saw ueds orf usromt and tlburau yopa,trh mfor awth I rea,d htta gossr gaptl,ooyh is eth glearen arapecpnea of rdryuhtoeer deu to trvbutsceio uhporyat (i.e. btaluur thrpy,oa finrgs/ia,rbrsiocs siecalsatyx/accli litiand,o adn thin cltcrioa mri eud to ytr.poah yaotihoeoglc.Pnolnm assy taht the cicslesitaa si gexadeeagrt in sels eevesr sesipalatca/r bouottscnri scine RGF si otn dspseupesr poeothtlpsov.kdstt/cluwwoyet/igw/

poeH ihts slhep rnoeev!ye tI ruse leephd m,e btu okto YAW oto goln ot audnen,rstd l.lo

nor16  nice job, but i dont think you need all this for these questions +4  
alimd  next step is to do randomized trial) +1  

submitted by luckeroo(5),
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hwy swa isth gremflzioib adn nto i?ainnc I was yulkc nad u,dseseg tbu I hthgotu iancin ocniembd ldcuo alos tggrier a?poymyth

.ooo.   Gemfibrozil is a CYP450 inhibitor causing an increase drug concentration of statin which would lead to the adverse side effect of myopathy. Not sure about niacin in combination with statin but believe this would be more likely to occur. Hope this helps! +1  
yb_26  yes, it can be seen with niacin and esetemibe as well, according to UWorld. But first choice in such questions is always fibrates. +  
nor16  number one no-go combi is statin+fibrate here +3  

submitted by mguan1993(8),
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nac eooesmn ailepxn why eth aensrw si otn adlnear nd?lag I lefe eki if ranlade dnlag wsa hte esisu rtehe dulwo asol eb edcerdase oactrcsinneotn of ,SFH ,LH dan rtosgene hir?gt

mguan1993  ^nvm had a brain fart and go adrenal gland mixed up with anterior pituitary lmao +4  
nor16  ovaries are #1 estrogen producer no estrogen no lubricant = dyspareunia no estrogen and no fsh/lh --> there must be a "higher" problem, up there in the brain +3  
pg32  I agree that hypothalamus is the most logical answer, but if she had overactivation of the adrenal gland (cortisol secreting tumor), that could also inhibit GnRH and cause these same symptoms. +  
drzed  @pg32 the physical examination would not be normal with either a ACTH or cortisol secreting tumor. +  

submitted by niboonsh(299),
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i got tsih qnuisote grthi utb why oucdlnt it be igokn ba?ilob

nor16  and why no therapy, i.e. cognitive training` +  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +1  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +  
tryntofigritout  Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha +5  
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." +2  

submitted by enbeemee(13),
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i teg why sti' el,gialnfl utb si hte fiespcic onrase hatt LPS is wgnro si euabces 'ist sjtu nto woh hte cvnceia is edm?a PSL ulwod aosl elitic an inemum ncoeatr,i hi?rgt

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +2  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +1  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  

submitted by ragacha(14),
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EGPA 492 FA 1820 AMEGDA NI OSLARD MLOCNU nuitnof( ear: pssuerer, vii,anorbt iefn oct,uh oepropintcipro) YPASSNE 1 : .N raiLgec ( wLore ,yobd )eLsg DNA N. naeUstcu rppe(U dyob, s)arm

nor16  Cuneatus = Cervical, write into columns CG ( fron left to right) Cuneatus, Gracilis (CG) +1  

submitted by neonem(527),
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hTis si a acse fo tcuea uogt. soouomMind tuaer ctlasrys ear netak up by usrihnp,teol gnadlie to na uctea oymifaatmlnr erot.naic cslleT- nar'te lryael ideolnvv in uogt eom(r ohmtuaerdi ht)rita.rsi

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy. +3  
temmy  the way i thought about it was how did the neutrophils get there? the answer is via increased vascular permeability +12  
nor16  they, unfortunately, did not ask " how did neutrophils get there" but " whats the cause of the swelling " not to confuse with " what causes the swelling " +1  
divya  absolutely right temmy. that's how i thought about it too. +  

submitted by usmleuser007(337),
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roF CR:C sA( epr DLROWU)

icmreStym tirlleaba werol mtrxietye tngiitp aeemd dna utsortou dlmnibaoa evsin ear ocncinngre orf iifnn eoarr evan caav IV()C u,rcoisotbtn ihhwc, ni hte testgin of a d-flsidtee nkfal mass, srgasuesgn lte lecl nai coc()RaCrmC thiw tnxoeiesn ntio eth C. VI RCC asuncotc rfo 9&t%;0g fo lla amceinignals ngsriai ni hte ekydni adn si glihyh tssacaoide wthi omsig.nk  taietns P twih CRC slalslcycai aveh a atrdi fo afkln ,ainp alpbaple mas,s nad miaahreut, haoglhtu anym enmari itcpomaaytsm lnuit teh isdsaee is R.ndaCv Caedc is a lhyghi avurlcsa tmuro  dnasvitheat the aelrn ii ennv pu to 5%2 fo  ssea.c VIC sobtcitruno cna ccuro ude ot uirnllmianta noenetxsi nad hsobtumr miof,narto rerhat hant ssam tfceef romf the rtuom  .iflest

heT ctsorboiutn nca ocruc ceulyta ro llygaduar veor t.em i nI chrcnoi s,ecas laorcleatl sneuvo caotucilirn yam olvpede sbade on eht site fo teh urscobtt.on i etoPnimrn iaodnamlb loara eltlllwca en,siv sa ni hist aettni,p usgstge bsnoituotcr fo eth ppuer eemtsgn of the VI.C

nor16  high blood pressure, i.e. Hypertension, risk factors for atheroscl., bruit !!! over left abdomen, secondary art. Hypertension. they always want the renal artery stenosis (like vWF in coag. disorders...) +