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other than the patient not haveing any sxs of crohn's i dont see any reason why its not crohn's. we differ crohn's and rta by urine anion gap. in chronic diarrhoea it is negative while in rta its +ve but in question the anion gap was normal
I solve it like this: So age is 70 (already, nothing we can do to change it), is asking about a predictor of success in the Rehab process (So basically, what this patient did in matter of activity, life style, etc. to have a Good rehab process). So From all the answers the, Activity level is the most likely choice because of the, increase in Bone density(Specially Weigh bearing) and OsteoBlastic activity.
Hey thanks for finding the image! Do you know why the answer can’t be Chloroquine resistance? I was b/w that and formation of hypnozoites.
I think it's just that Schuffner stippling and hypnozoites are both specific to vivax and ovale species. These species could be chloroquine resistant or sensitive, but if you have Schuffner stippling or hypnozoites, you can definitively say that it's either vivax or ovale.
Species with hypnozoites is not called chloroquine resistant. Chloroquine-resistant species means trophozoite/schizont cant be killed by chloroquine. We dont have enough info to decide whether the spp in the q is resistant/sensitive. But we do know he moved from Honduras to USA 1 year ago.
UW: in africa most malaria species are resistant to chloroquine. he is from hondruas
Can anyone explain the 1-week history of fever? Ruled out vivax and ovale due to 48 hr cycles. Or did they just throw that in as an unspecific symptom.
unspecific symptom probably
how I know that is an infection by vivax/ovale ? if there's nothing that says about tertian fever?
While it COULD be Chloroquine resistant, its not likely.
This patient is likely infected with Vivax or ovale (not Falciparium) why?
1. Honduras (Falcip would be Africa)
2. Sx 1 year later (Liver form Vivax or OVale)
3. As many mentioned, Schuffer bodies
Falciparium tends to be the species resistant to Chloroquine.
Typically, Chloroquine is given for Vivax & Ovale (typically with something else- Atovaquone, Dapsone etc) to cover Liver
Falciparium (no Liver form) is generally Chloroquine resistant (B) and therefore covered with Atovaquone/Proguanil. You do need 8-14 days of tx after coming for Falcip bc it can remain in the Liver for a few days (just not a dormant hypno form).
To cover the "week of fever" question- its re-emergence of her sx. They probably just did not want to say cyclic to make it trickier.
Why would the second part of that be correct when there is not mention of a DNR?
DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too?
DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question.
"The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing !
I believe this question was not well constructed... it's one of those!
@shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state.
I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills
It’s just canker sores, they come and go. I think in herpes the gingivostomatitis really only happens when you first get infected. After that you just get recurrent cold sores.
Herpes zoster is not the same as herpes simplex virus.
you would see dermatome rash in zoster
cf) Just in case someone wanted to know the causative organism of aphthous ulcers
:The precise cause of canker sores remains unclear, though researchers suspect that a combination of factors contributes to outbreaks, even in the same person.
Unlike cold sores, canker sores are not associated with herpes virus infections.
Herpes Zoster doesnt cause gingivostomatitis. Herpengina can cause vesicular lesion in mouth but happens to children in summer season by entero virus
I'm wondering if this could be a mild case of Behcet syndrome without genital involvement
It sure can be Behcet or Pemphigus if the q provides us with more info. Canker sores just come and go for years with unclear mechanism. Also herpes zoster is shingles by VZV, not HSV1.
What's tough about these answer choices though is that you have 2 different viable combos.
The ectatic aorta might also mean AAA below the renals, affecting the IMA,
Also since there is this ectatic aorta, the arteries involved need to be adjacent to one another. If there is a choice as in celiac and SMA, it could also be correct.
-V:sup. rectal v -> inf. mesenteric v. -> splenic v. -> portal v
-internal iliac LN
-V:inf. rectal v -> internal pudendal v->internal iliac v->common iliac v->IVC
-superficial inguinal LN
(FA 2018 p360)
Venous drainage above pectinate, most to the portal vein, some to internal iliac v via middle rectal vein. I think the real solid key here is that the clinical vignette suggests hepatic cirrhosis.
internal hemorroids are not related to portal hypertension
https://www.ncbi.nlm.nih.gov › pmc › articles › PMC4691702
also FA 383
anorectal varices are. now if you check FA it say
Pg 359 First Aid 2019
Superior rectal ↔ middle and inferior rectal
all of them include in the answers options
Also NRTIs are hepatotoxic, cause the increased liver enzymes seen in the patient.
Actually, NNRTIs are more well-known for hepatotoxicity. But I guess NRTIs is the next best option for this one.
this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect?
The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no.
I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh
I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask.
This question is a3othobillah
this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol
I think this NBME24 is a waste of $60.
On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying.
On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions.
@sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam.
I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications.
Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc."
Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house
Stress can actually be a trigger for asthma. I think the problem here is that she has alwasys carried a heavy course, while the disease just started recently.
Stress makes asthma worse. Therefore, keep doggo for stress relief!
I agree. I was hesitating between the two choices. I still think cohort study is better regarding the "risk". I hope this kind of questions wont pop out on the real thing.
I think key here was they were measuring risk though
I also chose cohort, since it is comparing a given exposure.
I was also thinking retrospective cohort study - just as time efficient, can look at risk, and the Q stem said the cancer was common, and I think of case-control for rare conditions. It's like they forgot a cohort study could be retrospective.
That's exactly what I was thinking when I was taking the test. But I was sidetracked by same HCO3 level. Can somebody explain this part to me??
Because salivary duct removes Na & Cl while secrete K & Hco3 in lumen. In low flow rate HCO3 & K inc because duct is doing its thing for more time. At high flow rate K slightly dec (as cant be secrted as much) but HCO3 stays almost same. the reason is high flow indicates higher metabolism & higher bicarb production.
Regarding the bicarb (via BRS Physiology, which explains flow rate as coming down to "contact time" where slow flow allows more reabsorption of NaCl): The only ion that does not “fit” this contact time explanation is HCO3−; HCO3− secretion is selectively stimulated when saliva secretion is stimulated.