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 +0  (nbme23#44)

I actually think he might have iron-deficiency anemia that can be described as pallor or "yellowing of the skin." He does not have jaundice (anicteric sclera) Patients who are strict vegans can develop iron deficiency. The best way to correct this is to encourage a dietary change


 -2  (nbme21#24)

Esophageal squamous cell cancers are more common in smokers





Subcomments ...

submitted by nwinkelmann(218),

Here's a GREAT video explaining ultrasound findings of pregnancy. @9:57 is a great picture so far with labels of the yolk sac, gestational sack, fetal pole, and amnion. One thing the person explaining said that I thought would be good to keep in mind is that the yolk sac looks like a cheerio inside the gestational sac. Also, this site has a bunch of pictures as well: https://radiopaedia.org/articles/first-trimester?lang=us.

zpatel  what video? +7  
usmlecharserssss  porn video how they make this embryo and yolk sac +  
samsam3711  Shorter video that explains this pretty well: https://www.youtube.com/watch?v=01mMBDEthV8 +1  
focus  @samsam3711 that video is BOMB. Thank you!!! +  


submitted by emh(7),

Prostaglandins increase GI motility due to peristalsis. It's the same reason why the uterus contracts during menstruation.

samsam3711  Also Misoprostol is used for the prevention for NSAID induced peptic ulcers +1  


submitted by mcl(449),

To expand on this, contraction of flexor digitorum profundus muscle results in flexion at the DIPs and PIPs. The tendon attaches at the tip of the finger, in contrast to flexor digitorum superficialis (attaches at the PIPs). Recall innervation of the forearm muscles is mostly from the median nerve, except for 1.5 muscles (ulnar half of flexor digitorum profundus and the flexor carpi ulnaris, both supplied by ulnar which makes it ez to remember yay).

But also if you got this wrong like me go read that link because it's a really nice review.

samsam3711  Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +1  
brbwhat  FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +  
brbwhat  Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +  


submitted by hpsbwz(48),

Omeprazole heals gastric and duodenal ulcers more effectively than misoprostol, whereas misoprostol was more effective in patients with erosions alone.

https://www.nejm.org/doi/full/10.1056/NEJM199803123381105

samsam3711  Misoprostol is indicated for prevention of NSAID-induced peptic ulcers (FA 2019 pg 393). Omeprazole is better for treatment +  


submitted by chandlerbas(63),

bronchus obstruction traps oxygen in alveoli no nitrogen able to enter (atmospheric air entering body (78% nitrogen and 21% oxygen, nitrogen is so important nitrogen bc it is a poorly absorbed gas and thus is in charged of keeping alveoli inflated) oxygen in the alveoli is absorbed into the blood reducing the volume of the alveoli alveolar collapse absorption atelectasis

bethune  Why is pulmonary hypertension incorrect? +  
samsam3711  PEEP allows the alveoli to remain slightly open with exhalation to prevent atelectasis. Pulmonary Hypertension is going to be related to vascular changes (instead you might see shunting of blood in areas of poor ventilation) +  
drzed  Pulmonary HTN occurs because of pulmonary vessel vasoconstriction. This can occur d/t multiple factors, but one of the most important ones is hypoxic vasoconstriction that the lungs will undergo (for example, at altitude). In the setting of PEEP, you are ventilating the lungs perfectly; this allows for the pulmonary vessels to open up and not undergo vasoconstriction. Thus, you prevent pulmonary hypertension via hypoxia. +  


submitted by yotsubato(641),

Why is this NOT chancroid? Theres nothing here that rules it out.

drachenx  Chancroid is described as an ulcer.. whilst in this question they mentioned "vesicles". Pretty much only herpes is vesicular +5  
whoissaad  They mentioned ulcers too. I chose chancroid as well, couldn't find a clue to rule it out. Also thought "discharge" was pointing you towards a bacterial infection. But guess I'm wrong :) +  
emmy2k21  I think NBME/USMLE writers make the assumption the patient is in America unless specified otherwise. Chancroid is not common in the US. If the question stem mentions a developing country, then chancroid can make your differential list. +1  
selectuw  for chancroid, there may be a mention of inguinal lymphadenopathy +2  
samsam3711  Also with chancroid questions they want you to differentiate it between chancroid and syphilis, (eg. Painful vs. painless) and is usually described as a much larger ulcer that is painful (not vesicular as in this question) +  
suckitnbme  Also believe that chancroid does not presents with systemic symptoms like in this vignette. +  


submitted by readit(9),

Why is is not pseudo aneurysm?

"Aortic pseudoaneurysms typically occur as a result of trauma +/- intervention, a considered subset of traumatic aortic injury in the majority of cases. They can be acute or chronic."

https://radiopaedia.org/articles/aortic-pseudoaneurysm?lang=us

readit  *same goes for saccular aneurysm, which also is usually 2/2 trauma +  
samsam3711  In the question stem there is no indication of trauma so it would be hard to just assume that +  
almondbreeze  see my comment above for marfan syndrome. might help +  
drzed  This is because a pseudoaneurysm is between the media and adventitia, and is incited by trauma; a dissection is between the intima and the media and is a result of hypertension causing an intimal tear. The history points toward cocaine -> hypertension rather than penetrating trauma. +  


submitted by sklawpirt(23),

I think the idea here is simply that one should think about where vesicles are coming from on their way to the golgi complex.

"Two steps forward and one step back." Specfically the question may be referring to a rare craniofacial disorder. an awarenesss of that disease is not necessary. What is necessary is understanding the origin from where vesicles are traficked to the Golgi apparatus.

COPI protein is needed to coat vescles from the RER to send to golgi. Thus, with a mutation in that protein, the packaged proteins that should bleb off and be sent to the golgi, instead accumulate in the RER and dilate it. Thus the answer.

https://www.cell.com/ajhg/pdf/S0002-9297(16)30214-2.pdf

hayayah  pg. 47 on FA got the good visuals! +2  
notadoctor  COPII* proteins are needed to coat vesicles from the RER to Golgi. "Two(COPII) steps forward; one(COPI) step back." Anterograde goes RER -> Golgi -> Lysosomes/Secretory Vesicles -> Plasma membrane +15  
titanesxvi  why not small lysosomes? +2  
varunmehru  and I thought large lysosomes due to lack of enzymes to degrade +  
samsam3711  The size of the lysosome is not affected by the presence or absence of protein, but its function is compromised (eg. protein is getting stuck in the RER) +  
fattyacid  I hope this helps to whomever was lost like me Null mutation: A mutation (a change) in a gene that leads to its not being transcribed into RNA and/or translated into a functional protein product. For example, a null mutation in a gene that usually encodes a specific enzyme leads to the production of a nonfunctional enzyme or no enzyme at all. +2  


submitted by hayayah(884),

Defective homologous recombination is seen in breast/ovarian cancers with the BRCA1 gene mutation.

johnthurtjr  Ashkenazi Jews have a higher risk of inheriting the BRCA1 and BRCA 2 gene mutations, just another tip! +1  
lebron james  BRCA1/BRACA2 are involved in the repair of DNA double stranded breaks +4  
samsam3711  Other answers: DNA Mismatch Repair: Lynch Syndrome (MLH1, MSH2) DNA Nucleotide Excision Repair: Xeroderma Pigmentosa +4  


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