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submitted by hyoscyamine(55),
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FA pg 7.21 ooT mchu ngtonioayex nca scaue feer iadrlca egamda geindla ot hnattiyreop fo utreratmpyi

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? +2  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +29  
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. +  
soccerfan23  In other words....the question is basically asking why they gave the patient a fio2 of 92-95% instead of 100%. The reason is because 100% oxygen would lead to retinopathy of prematurity. The lower 92-95% oxygen levels protect the retina from damage. The wording of the question sucks tho imo. +2  
randi  FA 2019 p210 under Free radical injury examples +  


submitted by neonem(571),
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orjMa srki coratf for cortai ocdistiens is nihne,rpeytos and ni thsi seca ightm be deu ot coecnai ,eus wihhc ucsase dakrem n.setyheripno cstoDssniie aescu a reta in hte acniut iitnma -- lobod anc owfl dbskcaraw iotn eht imrcpaieurd dna csaue ta.emonadp ishT fnietassm sa ceaklsrc in het guln ued ot proo ftle vtainlurecr nctfuoin gltodcifn(iisla/li breopml eud to )oems.rcspino

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. +1  


submitted by assoplasty(93),
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I kntih teh tpccone hyr’ete ingstet si het indacrees GBT elsevl ni nny,acprge dna nto usjt ydtripesohhimyr ni nea.regl

hneW sgcnieenr fro o/yy,rmtpeyrishdophih THS vlsele aer ALWYSA filrpeenaeytlr ckchdee acbeeus yeth rea moer eniessitv to nmutei snfridcefee in T43/.T fetnO itmse SHT llevse nca smodrntaeet a nghcae evne wnhe 3TT/4 elvsel are in eth iauislbclcn ge.nar eTh yonl xocnepiet to hsti owuld be ni cpnygerna n(da I eussg yabme rvlie eir?lufa I obtud hyte oduwl sak isht h.ogh)tu ihgH egeosrtn ellvse rsenevpt eth vlrei mofr gkanebir owdn G,TB gdelnia to deicearns TBG vlslee in the rm.esu ihsT idbns ot refe ,T4 agneedrcsi hte utnoam of ailavlbea feer T.4 sA a poncysteomar h,imemscna STH leselv are lyritnetnsa nrdsicaee adn the AETR of T4 cdutonpiro is eineadrsc ot ihelsnerp bieaelns feer 4T evl.els woevHer het TOTAL utnamo fo 4T is dnesc.reia

The tusnqeio si sgikna woh ot cnofrim ymyohiitrprdseh ni a gernpnat wanmo >--; you need to ceckh EREF 4T elslev ucee(bas yhte soulhd eb rmlaon edu to pcoymnoserta essneor.p) uYo taoncn chkce HST uasl(uyl lvdeeeat ni yrpancgne to tspceanoem fro rnadseeci TGB), dna ouy oactnn ehkcc aotlt 4T vlsele w(ill be ei)drnsc.ea uYo got teh nsewra tgrhi rhieet ywa tbu I htkin ihts is a ridfeefnt ngoaserin orwht irgndiscoe,n saubece yeth cna kas iths pceocnt ni trhoe notscxte fo teenhrsmgry-opise, dan if etyh edtsil SHT”“ sa an snarwe echcoi ahtt dlowu be tr.nceirco

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +8  
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 +  
an_improved_me  Just to add: Pregnancy is not an exception to using TSH in suspected hyperthyroid pregnant patients (not sure in hypothyroid); you would still get a TSH first, and if its unusually low, you would then proceed to measure T4 (free, total), and so on. https://www.uptodate.com/contents/hyperthyroidism-during-pregnancy-clinical-manifestations-diagnosis-and-causes?search=hyperthyroidism%20in%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H994499 +  


submitted by rocmed(-1),
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Cn'at ernla cell anoccarim caesu aivnoisn of het rlean ry,tear trostuncgib bolod lwof (rlesgtniu ni a rit,bu) ehtyebr utglgrpinaue SARA nda inrsicenag dobol eus?persr

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(12),
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atW'sh het dnecfreeif ebteewn tcaeeirv oicsaultonrygs vs tcpls?msiyhooy

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 +8  
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. +