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Contributor score: 7
Literally had it on OI until I saw no family hx... Isn't it AUTOSOMAL DOMINANT?
FA 2019 pg. 51. Yes it is autosomal dominant. This question is poorly written but the clues are "wormian bones" and multiple fractures. Pretty sure everyone on this page would've nailed the diagnosis if seeing a real patient instead of using three lines of text with two hints. Questions like this demonstrate how this test became a way of ranking people based off of minutia they know and not their clinical abilities. This is why step is pass/fail in 2 years.
I wonder though, is it not possible for irradiated food to change in their protein structure, possibly somehow affect us? Some suggest Regardless I guess since it as irradiate with gamma radiation, there's no chance of the radiation staying in the food. In that sense I guess the answer makes sense but...
"the 100" on netflix taught me this lol
Why can it not be arterial hypertension?
I think Arterial HTN is referring to Pulmonary Artery HTN which would be present in LT HF in the long run with RT HF and edema. Pulm HTN would cause a backflow, and doesn't really answer the question "explain the patients Dyspnea". At least, that's how I saw it. Hope this helped.
the question has 2 murmurs, so does she have aortic stenosis too?
i guess it is not relevant since it asked for what is causing her SOB
I guess pulmonary HTN would happen in response to increased pressure after the edema happens, and would cause backflow (to the RV) over pulmonary edema.
There's a really great diagram in UWorld (QID 234) that explains what happens as a result of mitral stenosis. Very similar sounding to the patient in this question.
@sugaplum, yes rheumatic heart disease can cause mitral and aortic stenosis. Rheumatic aortic stenosis can be distinguished from degenerative aortic stenosis by 1)coexisting mitral stenosis and 2)fusion of the commisures.
The image shows a staghorn calculi which content is usually magnesium ammonium phosphate (can also be cystine but pH would be decreased not increased) and is caused by urease positive bugs that hydrolyze urea to ammonia leading to urine alkalinization (page 586 of FA 2019)
Patient also has a fever, suggestive of a UTI
Why not calcium phosphate, also at high pH? I was between the two but decided on calcium phosphate because the images of staghorn I've seen seem to be more smooth and rounded. I guess should've gone more based on the pyelonephritis symptoms as well caused by the stone harboring bacteria.