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Contributor score: 12
Not sure I understand why T is wrong, but DHT is correct.
I thought about this some more -- DHT forms external genitalia while T forms 'male genital ducts'. That's why the correct answer is DHT, not T, since the PT had +ext genitalia, but -internal genitalia. I was thinking that the PT had CAIS, but that would lead to testes only w/o male genital ducts. See FA2019 p608.
*I meant -ext genitalia, +int genitalia
Also see UWORLD ID: 15255
I believe that the arrow pointed to the uvula; uvular deviation would be testing for CN X palsy. CN IX's only motor innervation is the stylopharyngeus. (Not testing for gag reflex!)
K+ shouldn't increase. It's moving into cells due to metabolic alkalosis.
In the parietal cell of the stomach
Hydrogen ions are formed from the dissociation of carbonic acid. Water is a very minor source of hydrogen ions in comparison to carbonic acid. Carbonic acid is formed from carbon dioxide and water by carbonic anhydrase.
The bicarbonate ion (HCO3−) is exchanged for a chloride ion (Cl−) on the basal side of the cell and the bicarbonate diffuses into the venous blood, leading to an alkaline tide phenomenon.
RAAS increases from volume loss, and thus more aldosterone leads to low K+
Three reasons for hypokalemia.
First, some K+ is lost in gastric fluids.
Second, H+ shifts out of cells and K+ shifts into cells in metabolic alkalosis.
Third, ECF volume contraction has caused increased secretion of aldosterone.
Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen
In this case, patient's CF also predisposes fat-soluble vitamin deficiency.
FA pg 70
Correction: Read more on this
Vitamin-E deficiency can in fact cause anemia - hemolytic anemia.
This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries.
The "**iod**" part of am**iod**arone reminds me of it's high **iod**ine content.
I think of it as the trifecta - gotta monitor LFTs, PFTs, and Ts (thyroid) when on amiodarone!
Also, the patient presented with Afib; this might've been caused by transient hyperthyroidism as a prelude to Hashimoto's. In this case, if you give Amio, you'd cause serious hypothyroidism!