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Welcome to sbryant6’s page.
Contributor score: 128


Comments ...

 +0  (nbme23#41)
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nePoint aetesirr are samll erascbnh fo eth alibras ayretr ttah cna rutuerp in hte tienstg fo olyorp dreltnoocl opnniteyrh.es

nor16  vertical gaze intact = mesencephalon intact horizontal gaze damaged = pons damaged (RPRF) Pons damaged = no access of corticobulbar tracts to motor nuclei in brain stem -> speech impaired +1

 +5  (nbme22#46)
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pflueHl lb:aet oa1ngwni:pdh/s/n.sJt/oapMnlntn_nmappT1ievocu_i/o/bs-A.tt5clcto


makinallkindzofgainz  upvote for credible source +13

 -3  (nbme22#6)
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If yuo okwn eth AOM of ngiixdo you oshdul eb beal to get isth isuneotq h.rigt


 +8  (nbme21#48)
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ihTs qntseoui is .lwtdfo-o uYo muts wonk hte icdineoi-sgknam iryeacrhh nda lsao ecdonsir ytnmuoao. nakMig codesa"oenmni"tmr fro iarncet rtemattsen is rogwn, esecbau ti losetavi amtynoou dan foredinm ecnts.no shicnsPiya dshluo plsiym iaxlnpe het 'AsRB fo all tmttenera iosont,p dan llwoa teh mliyaf ot cdieed hwta is stbe dsbea on rieofndm ntseocn dan tihre" terpponesic of eth IET'PTASN "wsishe. If ehrte si no edacndva eirted,ivc etnh het iienodcs oudslh eb edaeaplp ot a soretruag rdneiocs.kima-e tryiiPor fo usagrersot is o-gs;la&tuedupst- tl-rgbsstg-apng;et-i-cni.rdshni&;l&e sYe, het soepsu ulwdo veah gerhhi y,rpitori tbu the lfaymi louhsd ta slaet ryt ot erach a esnoucssn ftsri foeber lpinaapeg ot l"oyn" het fw.ei fI a ceosn,susn cntnao be ed,ma then the fwie dwuol eavh ftirs asy in eth .dnoiicse oTefrh,ere oenragnguci the yfalim to ddeeci cnirgocda ot het hiewss fo the IPTEANT wodlu eb a rtbeet rtsfi ,step leicpaysel if het shiwse fo eht fiew si aycrtron ot tath fo hte taptien. ,osAl tujs sa a leerang l,rue I ylitcaylp dviao gpciink ernsaw opnstoi itwh otss"elabu" cush as e,ev"rn aylasw, n"oly. ehT pprseou of a urrgoesta is to atc ni eht sbet seneitrt of eth p.atinet

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1

 +5  (nbme21#37)
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oCaiynrahigaprnmo tihw ccialofiaitCns and Coehlsreotl yasrCstl omioo(t-rl iuf).ld ntaRmen of eRahtks' o.phcu Nto ot eb fncusoed hwit ittpayriu m.eadona

dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +

 +8  (nbme21#48)
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oT erbemrme nfoBclae is a GBAA aogistan and clmuse ,aextlnra I awaysl thkni fo r"eeGk "laava.kB Geerk orf GBAA, nad Bvaaalk rof enlaBof.c

castlblack  Thanks. Baklava is from Armenia though. Go us +1
athenathefirst  No it's actually Arabic/Turkish. That's why it's called Baklawa. +1
gandon  Both Baklava and Baclofen are Armenian +
lovebug  I don't know if this is right. UMN Lesion (In this case, MS) -> Increased DTR, increased muscle spasicity, and dystonia. If Baclofen stimulate GABA B receptor(it's Gi related PTN) -> neuron become hyperpolar -> decreased excitory glutamte -> muscle relax. +




Subcomments ...

submitted by mousie(171),
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hyW on swgtie?na I enam I teg cEtsyas is royblpba het grud of heicco ebefro an lal tihng edcna aytpr lol)( btu ond't udredntans ywh hreet luodw eb odcl eiesixerttm nda no sweinagt nweh is FA ti ayss mhytrieerpha dna ?dbrh??a?o

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +7  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +9  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +16  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +7  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +3  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +8  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +  


submitted by link981(133),
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ePag 63 of FA 18.20 unireP naattigosn gdusr era:

netip6ihAMr(oaPz- si a rgourdp of MP-)6, ltyeehn,Mocpoa ini.vrbiar

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +1  


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odGo fatc ot imcmot to memoyr: ouy esol rbciab in teh osolt (nceeh wyh rhdriaae suscea onnniaon gpa melbcioat co,issaid) dna aeilplcyse eols mtsuaosip htiw liextaav usbae (sa eneiomdtn ni het onustqie tems). -cbca:phaa/ey-sonuitrraiept-ha./atat.r/settdctstniewitdlno-owdo/sehmcrtnlwieewa-bo-dmel

sbryant6  I'm going to go take a big bicarbonate poop now. +20  
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse — Metabolic Alkalosis :   ↓K+     ↑Cl-                   ↑pH    ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +1  
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1  
texasdude4  easy way to remember : "Bicarb out the Butt" +  


submitted by pppro(22),
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Ptantei sha PHB. Gvei lapah eno goatinntsa ot uderce mhoost cuesml icaoncrtotn nad elrivee ufcdtiflyi .ngiituanr

d_holles  lol i thought it was some kind of urinary retention problem and put H. +11  
sbryant6  How is H wrong? Oxybutinin or tolterodine treat urinary incontinence by blocking M3 muscarinic acetylcholine receptors --> urinary retention. We're just supposed to assume they are talking about BPH here because he is old? +  
jaxx  I agree. I picked "H" for that same logic. Does anyone know where we should have come to the conclusion that this was BPH? +  
forerofore  they are telling you he's having "difficulty urinating", one of the clinical criteria for BPH is reduced urinary flow rate. this is not incontinence because they are not telling you he leaks at all, just that he pees "a lot" +11  
drzed  Even if he was urinating too much, anticholinergics are contraindicated in the elderly (Beers criteria) +2  
pathogen7  @drzed tI mean techinically alpha-1 blockers are on the Criteria too ... +1  


submitted by welpdedelp(198),
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Tish si ,abetrL-tmnoaE ihhcw oeprmvis wiht nmmeotev as arcmedop ot Mhetisaeny craasig chihwh nwesros wtih mmvtnoee

sbryant6  Lambert-Eaton is typically associated with Small Cell Lung Cancer. Since there was no mentino of that, I was thrown off. Such is the difference between UWorld and NBME I guess. +1  
makinallkindzofgainz  I'm laughing about Myasthenia "gracias" lmao +9  


submitted by seagull(1109),
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The ohsrtau wtne tou fo rhiet way ot dnfi htew oswtr hotop of a aurglnmao heyt uolc.d The rthwe no a tmse ttah sguetssg taht it duolw eb lagnoairunt eusit. tuB ettlli idd we ...konw

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +16  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +3  


submitted by seagull(1109),
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mI salo cnncoediv gibnokcl 2L-I si sloa a ttntreame? yHW is aT-FaplNh the terbet earsnw eher?

amorah  FA P120-122. Immunosuppressants for RA are calcineurin inhibitor (cyclosporine and tacrolimus), 6MP, and TNFa inhibitors (adalimumab,infliximab, etanercept). It is important to distinguish that calcineurin inhibitors block t cell activation by preventing IL-2 transcription, not necessarily block IL-2 action. Sirolimus(rapamycin) blocks IL-2 action but it is used for kidney transplant rejection prophylaxis specifically. +12  
sbryant6  Spot on. This image explains how Sirolimus blocks the effects of IL-2: https://image.slidesharecdn.com/11-150813013011-lva1-app6892/95/11immunosuppressants-30-638.jpg?cb=1439429471 +  
krewfoo99  in addition to the above responses, IL 1 antagonists (Anakinra) can be used to treat RA. Anakinra is a recombinant human IL 1 receptor anatagonist but less effective than other treatment modalities. +  
snripper  Prednisone is a glucocorticoid (which inhibits IL-2 synthesis) is already being used with no effect. So TNF-alpha is the next option. +  
avocadotoast  DMARDs: methotrextate, sulfasalazine, hydroxychloroquine, leflunomide, TNF inhibitors, Anti- IL6 (Tocilizumab), JAK inhibitor (Tofacitinib), Rituximab. You can use cyclosporine and tacrolimus to treat RA, but those aren't first line treatments. DMARDs are used the long term treatment of RA and methotrexate is often started first, and the other drugs are prescribed if methotrexate does not sufficiently control symptoms. None of the other choices listed are a part of DMARD therapy. +  


submitted by yotsubato(803),
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MTPP" dnlotnt-2d-,yeimh3ry(a,)h4lprey,-ertiyh6-p1e-1 is a grudpro ot eth ertxnuioon M+,PP hwich usacse aretenpnm mpoytmss fo skPosar'nin seeasdi by gdiyotrens pmaicedigonr nurnose in het utasatsibn anirg fo hte iarb.n It has enbe sedu to ydtsu saeeisd odseml in vauirso lnmaai "sd.teusi iiWk

ilikecheese  pg 508 FA 2019 +6  
sbryant6  I thought this was testing "lead pipe rigidity" aka Neuroleptic Malignant Syndrome and its connection to dopamine. Had no clue what MPTP was and got it right still. Probably wrong train of thought though. +  


submitted by brise(31),
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ehT nuisoetq si skinga tawh potin luowd be hte otsm leyikl ot reul in accn,er dna hihg yiepctfscii newh vsitpioe lsrue in .raeccn heT shihteg pfcscieiyti ealvu is A, cb eht eth X iaxs whoss pyf(!)-ct1ciiesi

sbryant6  SPin and SNout. Specificity in, sensitivity out. +5  


submitted by sbryant6(128),
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fI you kwno eht AOM of nxogdii uyo lsodhu be eabl ot egt shit qtnuieos thgri.



submitted by sbryant6(128),
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hTis enuqoits si ofd.l-tow uoY sutm knwo hte dicanoi-sengmki iehrhryca nda aslo sicendor ntoymoa.u gankMi resmeinctoo"a"mdn orf inceatr tremnattes is wo,gnr sebcaeu ti toiaeslv aynotumo dan dmnefiro .encntos hnacsyPisi hldous imlysp epxnila eht Rs'BA fo lla anetttemr noisp,ot dna lowla eth mylfai to eddiec hatw si ebts esadb no nieformd nenotcs adn thrie" oneetpcsrpi fo teh NA'ISTETP i.eshw"s If rtehe si on cnevdada iidec,rvte ehtn eht isedconi ouslhd eb eedappla ot a autesorgr ecdr-.kniaeosim iPtriory fo ugatrosser is duo&plta-;etu-ssg ;grtts-c-nsaiie-.shep;&nrl-lngtbi&gd ,esY the usepos ouwdl have iegrhh ptiriyor, but het ifyaml dolhus at stael rty to rcahe a oneusncss fsrti reobef iplapgaen to nyo"l" eht eif.w fI a ,unsecsons nctoan eb m,eda then hte iefw owuld vahe rfits yas in het .sdciinoe hofeeerTr, egnigunacor the ymfial ot ecddei cacrdigno to hte wehiss of het IETPTNA dlwuo be a eertbt itrfs eps,t eescalyipl fi eht heswis of eth wfei si ayrcnrto ot thta fo the eiat.npt ,lsAo tsuj sa a elrngae u,rle I ciyyatllp idvao cnpiigk sewrna tpoison hiwt absosut""le uhcs as r,"nvee ysa,lwa o.y"ln heT ourppes of a ruesagotr si ot cta ni the btse tiersnet fo hte e.pntiat

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1  


submitted by hayayah(990),
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ceiCnsee-etiyytsn ocemhknie crortepe 5 ()CCR5 si a otpneir ndofu no het fcaesur fo 4CD l.slce

yotsubato  Note, this is NOT in FA +  
sbryant6  It is in UWorld. +2  
almondbreeze  it's in FA2019 pg.110 +1  
almondbreeze  but missing the full name for CCR5 +4  
demihesmisome  CXCR4 is also a chemokine receptor. +1  


submitted by mcl(517),
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Gita bmropsle ersias scsnoiupi rfo clhaloo uebsa ro lnideah eul.g owvee,Hr snteo fo tiga pmorsebl is eavltielyr praid ulcepo( fo sn)omth dna agit srtdeabinuc hwit sdrgrea ot chaollo si eireth eud ot ntotiaciniox ro niohrcc bua.es Anvitlraeet xaolnpenait abaialevl no NDS. lAos ese uolteen ycitotix no m.speeadc

sbryant6  I got this correct solely based on the patients demographic. Glue is cheap and easily accessible to underage populations. +4  
whossayin  Kinda racist of us but that’s how I reasoned my answer too lol @sbryant6 +  
hpsbwz  how is it racist if the only thing thats given is his age lol @whossayin +18  


submitted by dr.xx(129),
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resacnssbeHnhd-elaoH pu:oiHEq nta = 1.6 + CH(3glOo / 0(0.3 * CP;O)a)2 so ,ehre pH = &t6=. 9g2; uAetc eu(tmpnoa)ecnsd ariyrmp oiprtaryser isdosiahctwi, otceiamlb ssaiocdi

sbryant6  calculator can't do logs yo. +5  
b1ackcoffee  wow, sherlock! +  


submitted by yo(53),
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reeh'ty aglntik tbuao a eslopnearnl thusn odueercpr

sdg-0v5ar.ntnsl/ti4tprhheu/cni/esetcoe/thetllmrltepstlahc-l9anl-.n/aaioymne:ds

hungrybox  be honest did u know that before looking it up +8  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +13  
sympathetikey  Relax @meningitis. Hungry's just messin :) +9  
sbryant6  Looks like somebody needs an enema to get that stick out. +1  
chandlerbas  ya'll are too TP/(TP+FN) lol +7  


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mtmouneAiu isytiitrhod aka( sHimtooa)h + pr-nng;&-tgtae ihTkn aobut bilpisytosi fo fetal ospmdyryohihit edu to nytoidab etamdied mntaealr dipothhris.moyy aesLd to .msetCrini nndgiisF in ntafni era het 6P' (Pot y,elbl ea,Pl fufPy caef, rgoutrPidn sm,ciuiulb obnPturrtae og,nuet dna oorP inaBr t.peeodnlvme

neonem  I don't understand the last part of this question stem though... if the mother's TSH *increases* during pregnancy? Wouldn't this further increase her (and/or the fetus's) production of T4 and thus counteract the hypothyroidism? +  
poojaym  @neonem no. Autoimmune hypothyroidism is a destruction of the thyroid gland, and a decrease in production of T3/T4. An increase in TSH means that there is not enough T3/T4 to inhibit TRH, and so TSH is being released to stimulate the thyroid gland. +16  
arezpr  TSH, T3, T4 and thyroglobulin cannot cross the placental barrier. +  
chamaleo  @arezpr although those hormones can't cross, the autoantibodies from Hashimoto's can +  
yotsubato  The baby has its own TSH though +  
sbryant6  TSH comes from the pituitary, and act on the thyroid. Autoantibodies attack the thyroid, so TSH doesn't work. +  
kimcharito  no goiter then? +  
lola915  I think there is no goiter because the baby's thyroid gland has not fully developed and these immunogloblulins from the mother could attack the thyroid gland leading to issues with it's development. +  


submitted by pparalpha(78),
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VBE H4H(V)- itsnfce B lelc hroutgh C12.D

Aipyctla stlycmopyhe no perprhaeli blodo rmesa on(t neifetcd B ,elcls tub iavtcere xtoioycct T )ell.sc

u:l"seoMcin"onso + moonptos sett (eoiabdntsi eeetdtdc yb ggoltatunniai of sehpe or osher B)RCs

sbryant6  Atypical lymphocytes are CD8+ T cells, not CD4+. Remember that. +10  
mangotango  I remember this because Infectious Mononucleosis is caused by a virus (mostly EBV, sometimes CMV) and MHC Class I functions to present endogenous antigens (e.g. viral or cytosolic proteins) to CD8+ T cells. In comparison, MHC Class II is more involved with presenting exogenous antigens (e.g. bacterial proteins) to CD4+ T cells. // FA 2019, pg 100 +  


submitted by hungrybox(791),
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gLon rewnsa ,dhaea but arbe ihtw em.

TIN:H v kolso kidn fo leik y, shaweer k slook meor leik .x

yitceetp-rn = 1V/xma

  • Vxam is teh epurp mliti on owh fast a oietracn is ladyzatce by yem.enzs

txeniecrp-t = 1mK/

  • mK is a inkganr fo owh doog an nezemy is ta dgnbini tsi setbsr.uat An yzmeen with a krninag fo 1 si tbeetr ta gibinnd sti astusrteb hatn an nzeeym tihw a ginrnak of .5 (owerL Km = tbtere )zmeyen

teoN thta am,xV as a ereumsa fo pmere,acrofn nac eb redelta ohrught anmy .nghsti h,lainMewe Km si a set rcescacthiiart of teh znmye,e nad naonct be ertadl.e

nI shti x,emplea the zmeeyn rpceemofnra )aV(mx is reidnacse yb iiscnnraeg eht atnivim torfccoa so that it easchre a nr""aolm .yaivtitc rowveeH, eth emyzne is listl lenhrienty isthty deu to a ancgntoeil ,fetcde os het mK ysats teh emas.

mnemonia  Awesome. +  
ht3  wait line B shows the vmax doesn't change and that the km is getting larger (enzyme is still shitty so larger km) so -1/km would be a smaller number and would approach 0 +1  
lamhtu  You say Km cannot be altered and its staying the same, but the answer of the graph demonstrates a higher Km value. Needing "higher concentrations" of the B6 for enzyme activity is another way of saying Km is higher since more is required for 1/2 vmax activity +4  
sbryant6  Yeah this explanation is wrong. +  


submitted by nosancuck(74),
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ishT b has drisSicsoao os ehr omrsganual eb vatciatin tda itVD

sbryant6  Your mom activates my VitD. +14  
pg32  Anyone know why there is hepatosplenomegaly? +  
gooooose  Likely granulomas involving the liver and spleen- Pathoma says any organ can be involved +  


submitted by tinydoc(189),
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Pxt praspae to hvea euslMc paysstiict sa a luters fo MS. iypStsctai si rtdtaee whit a emscul nxtlaare leki laonBcfe whhic is a AGBA soaitgn. aachetBlno si a nconmielotCiimh iwhch cna be edus ot tetar aynrriU ifdcsynuton in uitlpMle i.rsocelss but eht nsouteiQ saks hwat uoldw ehlp artet teh tsasypcii.t

sbryant6  To remember Baclofen is a GABA agonist and muscle relaxant, I always think of the "Greek Baklava". Greek for GABA, Baklava for Baclofen. +4  
sahusema  Also, acts on GABA receptors specifically in the spinal cord +1  


submitted by danger_rave(-2),
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d@6mbnudfiuini So, I tog ot oiebynlmc edu ot ieyMoc.Srcthk yeiloncmB nac caues pteiorhnmgteiynap adn aomnyurlp bis,irsof nda I ’iddtn eahv any stcioonencn to lrhocmlbc.iua Anahstyrnccile can be sude orf lla rsots fo gnlmsinicaea fre(e aldrcias lkil slot of ,ftuf)s os the xctea iiinsontdac ddi slse rof em to tge to teh sanwre ntah it thgim heva htwi hrtnoae aco.egtry 1,=n btu s’ti otn a aicmg iotzanmirmoe wsnera ta e.stla

sbryant6  Correction: SketchyPharm ;) +  


submitted by cantaloupe5(69),
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sygoiHotl hedows aouvcitleag nrsceois (evdeserpr rtacceirtheu of drlaymocia ebfirs) itwh periohnlut iltninfiatro hwich tdiehn ttha eth IM aws twnhii 42 orsuh. otsM keyill cesua fo etdah ihwtin tfirs 24 urohs fo IM is iarhath.rmy icrdalMyao prutrue wlduo alos be lsivbie on srgos aeapraecnp fo het rt,hae ihwhc hety cedbrsdie ni het tme.s

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +9  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +2  
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +  
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +4  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +1  
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +  


submitted by mcl(517),
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acNiin vniiatm( B)3 ozgaaitsnne LVDL lrecshoetlo iscteeorn

sbryant6  Fibrates stimulate PPAR-alpha --> LPL upregulation --> decreased triglycerides. However, this question asked about a vitamin. Vitamin B3=niacin. +2  
lovebug  FA 19, PG 315. Lipid lowering drug bro. +  


submitted by hungrybox(791),
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ionn'tsgHutn sasedei

  • ianiatcitnop: ehs ash a rsliiam deirsrdo sa erh erhfta but iedd rialere

memReber NH"UT 4 an ,alinma put it in a AeC".G ninHuingtt gene dounf on msooerhomC 4. CGA si eth ocidterluiten apteer:

  • heCoa,r ctauead ucelnus
  • Atxiaa
  • mlGoyo eriepod(ns)s
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +11  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by hungrybox(791),
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uon'Htsnintg aessied

  • iitnpnaaocit: esh hsa a sariiml drsordei as ehr atefhr tub edid airreel

rmeebmRe T"HUN 4 an m,inlaa put it in a .eAGC" nttnuinHig gnee donuf on ommsoerhoC .4 CGA si eht uidoeicnttlre peeatr:

  • ra,eohC aaeudct unelcus
  • itaaxA
  • yolomG de)sp(rsnoie
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +11  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by usmleuser007(326),
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sviNruoro eStcy(k)h = eAtsfcf wreeh a lot of epoepl are in osca utsqleerr - pllysiaeec ocnmmo on rsiucse - %09 fo lal diraarleh sbetuaork no ceussir

sbryant6  Rotavirus occurs in unvaccinated children. In order for it to spread, all those kids would have to be unvaxxed. +  


submitted by hayayah(990),
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nuaIlnig riahnse era laluyus ,ucelibred falroem rsnehia are o.tn

isTh si an rdiitenc lingianu .ihrnae tI nserte neartinl nguainli irng ataellr to orniiefr gsiptaeric ssveesl dan si oeripsru to teh iiannugl egin.mtla

duseaC by ifrueal of srspoecus nvaaiglsi ot osecl ac(n rmof oyldhre.ec) yaM eb cdotnei in tnasfni or dseoedicrv ni dohdtlu.ao Mchu roem moonmc in els.ma

yotsubato  Heres a good picture to help with the concept. https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjVkIi0yN7iAhWLjqQKHbeXCTUQjRx6BAgBEAU&url=https%3A%2F%2Fwww.herniaclinic.co.nz%2Finformation%2Ftypes-of-hernias%2F&psig=AOvVaw2BzGtQLvSmUN8ymhdvETG5&ust=1560244112252834 +4  
sbryant6  Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect. +5  
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +  
azharhu786  The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament. The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels. An indirect hernia is seen in young people whereas, direct hernia happens in adults. +2  


submitted by hayayah(990),
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iWth rcochni vnot,giim yuo elos eotyrlectesl adn a lot fo acd.i It eitgrsrg ibtelmoca alsikasol chwhi si hyw all hte srmue laeusv are olw (ro no teh lwroe nde of eht rmanol )arnge epcxte ofr aibntb.eroca

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +3  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +  


submitted by hayayah(990),
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ihtW coinhcr ,vgimtnoi ouy lseo ocetltlreesy and a tol fo da.ic tI sgtrierg mbteolica saaslkiol ihwch si wyh lla eht remus valseu era low r(o no teh orewl nde fo eth rlomna rngae) teepxc rof babnareocit.

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +3  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +