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submitted by hyoscyamine(55),
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AF pg 72.1 Too much oexniantygo nac eusca fere cadairl agadem dlngaei to yphtoiraent of yaprmrttiue

mmm21  Okay i might be retarded, but why i can’t understand that they r asking about the thing that is damaged ? 😂😂 +5  
sahusema  Seriously! The question says "the goal of treatment is the protection of which of the following structures?" If too much O2 damages the retina, how is this treatment supposed to be protective to the retina? +2  
ratadecalle  I think too much oxygen would be with the ventilator having a high FiO2 setting, which they don't mention here but I'm guessing thats the thing they're controlling to avoid oxygen toxicity? +1  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +19  
naught  Supplemental O2 may also cause bronchopulmonary dysplasia or intraventricular hemorrhage (germinal matrix, located in subventricular zone NOT choroid plexus) +1  
fkstpashls  92-95% isn't high, but it's enough to get everything else oxygenated. Because it's not 100% high flow the retinas don't over-vascularize and lead to damage/hemorrhage, and shit like that. +  

submitted by neonem(527),
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oMjar skir cofrta fro aorict tdsscoieni si oitnre,hesnpy nda ni tsih csae ithgm be eud ot coicane ,eus cihwh seascu drkeam ynhrp.esneoit oDssicisetn auces a trae in teh cintau nitiam -- dolob cna wlfo drwkbcsaa noti eth iaeprmdricu and auesc a.nedmtapo iThs etfsaismn as kclacrse ni the glnu ued ot oopr eflt vnitraucler tifonnuc f/(tlgcoinailsdiil repboml eud to csmi.osr)opne

forerofore  there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this. +9  
temmy  please why is there where a diastolic mumur? +1  
whoissaad  @temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border) +8  
garibay92  Does anyone know why is this patient's tepmerature elevated? +1  
ratadecalle  @garibay92, not important for this question I think but cocaine can cause malignant hyperthermia +1  
almondbreeze  judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm +  
almondbreeze  he's only 28 - another clue for marfan? +  
turtlepenlight  did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection +2  
cmun777  @almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN. +1  
ibestalkinyo  @turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection. +  

submitted by assoplasty(89),
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I tnhki hte tcenpco e’rthye setitng is eht eireasdnc GTB selevl ni er,angcynp and not ustj pioyresrdhhmity in .eelrang

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eTh ouensitq si akgnsi woh to mcroinf diheitsohrypymr ni a paetngrn wnmoa ->-; oyu eend to heckc FEER T4 veelsl ecea(usb eyth sldouh be nraoml ude ot yscptmenorao se)es.npro oYu nocant ehckc TSH laul(ysu evtadele ni pergynnca to speotamenc for asrdeeicn TB,G) dna oyu aonctn ehkcc tltoa T4 leslve lilw( be snei.ced)ar uoY otg hte sawrne rtihg hieetr way tbu I thkin sith is a rifdfeent oarngnsie torhw ,nidncgoeris eeuasbc ehyt nac kas shti tnccpoe in otehr enxctost fo sepeoehg-irnsm,ryt nda fi tyhe liedts THS”“ as na wernsa ccehio atht loduw be rcectnio.r

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +5  
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +2  
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +  
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +1  
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +1  
lovebug  Amazing answer! THX +  

submitted by rocmed(-1),
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n'aCt alern clel ncaaomirc eausc aiosvinn fo eth anrle ,reatyr osnugtibctr bolod wfol rinesglt(u in a tb),iru eetybrh aitnreuluggp SAAR dna igcarnnsei bdloo ?esserrup

lispectedwumbologist  It is but RCC tends to present later in life (6th or 7th decade). In a 55 year old smoker, atherosclerosis of the renal artery is am much more common cause of bruits +  
seagull  Hypertension is also a risk factor of an atherosclerosis leading to more inflammation. Eventually dilation (aneurysm) might occur... if im wrong then ignore this +1  
seagull  Hypertension is also a risk factor of an atherosclerosis leading to more inflammation. Eventually dilation (aneurysm) might occur... if im wrong then ignore this +  
illogical  Renal Cell Carcinoma has a tendency to invade the Left Renal **Vein** (Pg 134, Pathoma 2018). Thus it has an association w/ obstructed drainage of the Left Spermatic Vein leading to a varicocele. Renal artery stenosis is more commonly due to atherosclerosis (almost 85-90%) or fibromuscular dysplasia. +15  
ratadecalle  With RCC and renal vein invasion you would see B/L lower edema and venous collaterals in the abd wall (Uworld). Also he has a severe headache and confusion which are signs of a hypertensive emergency. +1  

submitted by dragon3(10),
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ah'Wst hte cdfnfeiree wnbeete criteaev rtclasiuyoogsn vs icyl?sypshmoto

whossayin  Yes I’m at a loss for this one too. Still can’t figure out how we’re expected to differentiate those based on this slide shown. The only logical explanation that I can think of is that reactive lymphocytes may be seen in LYMPHOMAS as opposed to granulocytes which are seen in LEUKEMIAS Such a shitty way to trick us, hah! +  
henoch280  reactive lymphocytes are seen in EBV infection. you would see lymphocytes in the slide not neutrophils FA2018 pg 165 +3  
whossayin  That makes sense.. but was the question talking about EBV infections or hematological malignancies? Just a vague question I wasn’t really sure what exactly was it trying to teach us, I guess the reactive lymphocytosis just threw me off! Anyways, thanks for the clarification buddy! +  
ratadecalle  They way I thought about it was: Granulocytes: multi lobed nucleus Lymphocytes: single lobe +7  
hello  @whossayin - it's not reactive lymphocytosis because there are no buzzword type symtoms of EBV in the Q stem. Also, reactive lymphocytes look way different. +