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Comments ...

 +1  (nbme22#35)

Hypothalamus controlling temperature set point is briefly mentioned in Pathoma 2018 edition page 13, Chapter 2 III Cardinal signs of inflammation D. Fever

Pyogenes -> macrophage release IL-1 and TNF -> increased cyclooxygenase activity in hypothalamus perivascular cells -> increased hypothalamus PGE2 -> raised temperature set point

 +0  (nbme20#28)

Pathoma 2018 edition page 4 chapter 1 - Cellular Injury - III. Reversible & irreversible cellular injury - B.1.

I had difficulty trying to figure out what hydropic change means though...

bharatpillai  i swear i've done the same question before on uworld/ one of the previous NBMEs and the answer to that was intracellular Ca accumulation.

 +1  (nbme20#19)

Does anyone know what are A, C, D? For C not sure if it's pointing to the ribosomes on RER.

(I'm assuming E is glycogen granules based on a comment below!)

Subcomments ...

I get why its lateral but dont all cranial nerve except 4 arise Ventrally? WTF they add this Dorso before lateral?

qfever  I think it's the nucleus affected in lateral medullary syndrome (instead of the nerve axons) +  
nerdstewiegriffin  Because in the medulla section the nucleus is dorsal motor nucleus of X +  

submitted by lsmarshall(262),

Synaptobrevin is the target of tetanospasmin (tetanus toxin); muscle spasms are characteristic. Only other answer you might consider is Acetylcholinesterase since he is a farmer and buzzwords often carry us to the promised land... but symptoms of a cholinergic storm are absent.

vshummy  Synaptobrevin is a SNARE protein. Why they couldn’t just give us SNARE I’ll never know. +20  
yotsubato  Cause they're dicks, and they watched sketchy to make sure our buzzwords were removed from the exam +15  
yotsubato  Oh and they read FA and did UW to make sure its not in there either +14  
soph  This toxin binds to the presynaptic membrane of the neuromuscular junction and is internalized and transported retroaxonally to the spinal cord. Enzymatically, tetanus toxin is a zinc metalloprotease that cleaves the protein synaptobrevin, an integral neurovesicle protein involved in membrane fusion. Without membrane fusion, the release of inhibitory neurotransmitters glycine and GABA is blocked. -rx questions! +2  
qfever  So out of curiosity I checked out B) N-Acetylneuraminic acid It's sialic acid typical NBME +  

submitted by hayayah(597),

Coloboma is an eye abnormality that occurs before birth. They're missing pieces of tissue in structures that form the eye.

  • Colobomas affecting the iris, which result in a "keyhole" appearance of the pupil, generally do not lead to vision loss.

  • Colobomas involving the retina result in vision loss in specific parts of the visual field.

  • Large retinal colobomas or those affecting the optic nerve can cause low vision, which means vision loss that cannot be completely corrected with glasses or contact lenses.

mousie  thanks for this explanation! +  
macrohphage95  can any one explain to me why not lens ? +  
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss +1  
qfever  Do anyone know why not choroid? +  
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina +1  

submitted by sajaqua1(338),

Pravastatin is the only statin drug not metabolized by the P450 system in the liver. Because of this, pravastatin is also unique in that more of it is excreted by the kidneys than any other statin, In addition to hypothyroidism this patient has mild renal failure. This will impair excretion of pravastatin, leading to increased pravastatin and its metabolites, increasing its potential for causing myopathy.

B) Nephrolithiasis- while the patient is hypercalcemic, pravastatin does not increase the incidence of kidney stones. C) Pancreatitis- I do not know of any significant interactions between the pancreas and pravastatin. D) Toxic hepatitis- while statins can cause mildly elevated liver function test scores, they are generally not associated with hepatotoxicity. E) Type 2 Diabetes mellitus- I do not know of any effect that pravastatin has on diabetes or diabetes medications.

motherfucker2  Lucid. Nice +  
qfever  But isn't statin associated with hepatotoxicity too? FA 2019 page 320 +3  

submitted by seagull(706),

Did anyone need to read that last sentence like 50 times because the author refuses to use better grammar. Just frustrating.

link981  Author rationale: "What is grammar?" +3  
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +3  
drbravojose  Actually never understand what the author saying at any time. LOL +  

Premie has no surfactant

Angiotensin II - generated in hypovolemia

Dipalmitoyl lecithin aka dipalmitoylphosphatidylcholine lung surfactant

Phosphatidylinositol 4,5-bisphosphate aka PIP2 Gq receptor pathway

Phosphatidylserine -involved in intrinsic apoptosis when exposed on extracellular surfaces

Sphinogmyelin - composes myelin and also has roles in signal transduction, apoptosis. Lecithin: Sphingomyelin ratio >2 indicates mature fetal lungs.

endochondral1  how are we supposed to know that dipalmitoyl lecithin is the same thing as dipalmitorylphosphatidylcholine +3  
qfever  FA 2019 page 647 Pulmonary surfactant is a complex mix of lecithins, the most important of which is dipalmitoylphosphatidylcholine (DPPC). Also: Screening tests for fetal lung maturity: lecithin- sphingomyelin (L/S) ratio in amniotic fluid (≥ 2 is healthy; < 1.5 predictive of NRDS) +4