NBME Answers : rthavranek's page

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Malignant pleural effusion. Cancer is full of protein.

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nbmehelp ??????????? +

drdoom hi @nbmehelp. if you are confused about a comment or unhappy with an explanation, please pose a specific question so we can help answer or clarify. thanks! +

rthavranek But malignancy effusion also has glucose < 60 mg/dL so I was between that and increased protein. My reasoning was that cancer cells have high metabolic rate so they require increased energy/glucose +1

cbreland I thought the same thing @rthavranek , all exudative effusions should have increased protein. That being said, still picked decreased glucose +

submitted by derpymd(20), visit this page

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Note to self: coccobacilli are apparently bacilli in exam situations. I guess I need to be less pedantic.

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rthavranek I had the same reasoning where I thought they were trying to trip us up on if we knew H. flu was coccobacillus. But looking into it, it seems that coccobacilli are a type of bacilli that are just shorter, so calling H. flu bacillus is not technically wrong +

submitted by famylife(110), visit this page

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This is strep pneumo, which has alpha hemolysis (green)

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breis How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin* +2

mjmejora its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy. +8

rthavranek Once again, another example of me knowing the concept but not knowing the obscure pseudonyms for common knowledge so I get the question wrong +1

dtransistor I saw green and immediately thought of pseudomonas and crossed that answer out. Didn't know they were talking about alpha hemolysis! +

submitted by scrambledeggs(17), visit this page

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This lady had preterm premature rupture of membranes. She had a genital tract infection, which is a risk factor for PPROM.

From Uptodate: Many of the microorganisms that colonize the lower genital tract have the capacity to produce phospholipases, which can stimulate the production of prostaglandins and thereby lead to the onset of uterine contractions. In addition, the host's immune response to bacterial invasion of the endocervix and/or fetal membranes leads to the production of multiple inflammatory mediators that can cause localized weakening of the fetal membranes and result in PPROM.

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alimd did you pay fucking $30? +2

cheesetouch some institutions give students UpToDate access +6

cbreland I knew that misoprostol (PGE1) can be used for abortions by forcing uterine contractions, so I figured the answer had something to do with prostaglandins +11

rthavranek I knew prostaglandins increased uterine contraction, but I also thought PGE2 caused cervical ripening and since there was a closed cervix, I eliminated that choice. I had no idea what was going on so I just picked oxytocin since that would increase uterine tone without dilation, though my reasoning seems to be incorrect +2

utap2001 Great, the above message deserve $30. +

notyasupreme I think also it said that the fetus releases oxytocin and steroids, which I guess is stupid wording that makes it not right. Anyways, fuck the curve on NBME 18 :) +4

okokok1 if anyone didn't know what "PPROM" stood for it is: Preterm Premature Rupture Of Membranes" +4

aakb I was between the prostaglandin answer and stressed fetal production and release of oxytocin and the reason I didn't pick oxytocin was if the cervical os is closed (membranes ruptured 32 hrs ago and contractions been going on for 12) and there's no effacement, it didn't seem like that baby actually wanted to come out so I thought that's not what's happening here. Plus mom has a fever so inflamed maternal decidua seemed to fit. +2

helppls If there was an increase in Pgs why did she not have a ripened cervix? +

leemax read it again guys-option E-stressed fetal production and release of OXYTOCIN. good nbme,got me there! +1

gabriellerenai I think a key thing is that oxytocin is never the primary initiator of labor even in full term labor (it mainly controls Phase 3 and 4): via up to date - "It is unlikely that oxytocin provides the trigger for the initiation of labor, but the release of oxytocin during labor results in more forceful uterine contractions and undoubtedly facilitates delivery of the fetus and placenta." +3

gabriellerenai and their question was what is the primary stimulus +

epiglotitties @leemax doesn't the fetus produce oxytocin? and its clearly stressed, a fetal heart rate of 210 is high isnt it? Still don't get why that couldnt be the answer.. +

fatboyslim I got this wrong and chose oxytocin. But now I recall a UW question saying oxytocin receptors on the uterus don't play much of a role in uterine contractions until about the late 3rd trimester. This fetus is 27 weeks gestation. +