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Comments ...

 -1  (nbme24#5)

Inhibition of GpIIb/IIIa receptors would be the mechanism of either (FA 2020 411):

Clopidogrel, prasugrel or ticlopidine via inhibition of ADP-induction of GpIIb/IIIa by blocking P2Y12

or

Abciximab, eptifibatide, and tirofiban by direct GpIIb/IIIa inhibition.

A lot of questions will have very similar answer choices on the real exam, but there will always be one best answer, and decreased platelet adherence was the better answer here. As stated on many other question threads, there are plenty of tricky questions to be upset about, but this was not one of them.

woodmeister  That's not what's upsetting. What's upsetting is that there is NO correct answer available. You have to put yourself into the head of whatever twit wrote this question and try to guess how much they care about the fact that aggregation (GPIIB/IIIA + TXA2 mediated) and adherence (GPIB mediated) are not the same thing. +1

 +9  (nbme24#48)

Radshopeful had a good explanation but a few typos may confuse people, so to recap:

The patient is suffering from systolic HF secondary to chronic HTN. The LV has lost contractile function (decreased LV systolic function from Qstem) which leads to decreased SV (and subsequently decreased CO since CO = HR x SV, the HR in this patient is also within normal limits). Finally, LVEDV is the amount of volume left in the LV at the end of diastole (or filling) and since the blood from systole was not able to be pumped forward efficiently (decreased SV) this leftover blood will cause this value to be increased.


 +2  (nbme22#20)

FA 2020: 463

Causes of avascular necrosis: CASTS Bend LEGS. +Corticosteroids +Alcoholism +Sickle cell disease +Trauma +SLE

+“the Bends” (caisson/decompression disease) +LEgg-Calvé- Perthes disease (idiopathic) +Gaucher disease +Slipped capital femoral epiphysis

drdoom  for bulleted lists, be sure to follow the plus sign with a space! :) +2




Subcomments ...

submitted by lsmarshall(417),
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erelewgZl rsmnoyde - otusaalmo eeevrscsi dersorid fo prmxesooei nisiobsege ued ot udttmea EXP en.sge Hpyo,inoat eizrsuse, hmgpate,eyola yaelr edhat twh(iin 1 ae.yr) niooaiβxt-d of FAVCL nphspae ni pxesomsiroe os het chlid ynmegleis nvihag emso osrt fo teinnacgol ltmoiebac edrisodr iwth eteaedlv FLVCAs olsuhd aevh bene hugoen to gte the nswear wothiut nwgiokn obuat ger.lewZle

jucapami  furthermore, FA 2019 pg 47 +4  
tiredofstudying  Same page for FA 2020^ +4  


submitted by m-ice(340),
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The neitatp ahs sols fo anip nda rpereetutam on eth htrgi sdei of sih cefa. etaiSnson fo teh ecfa si salatriiep,l so het ueiss stmu eb on eht ipa'sntte rgtih id,es ichhw ew nca cmirnof by niowgkn ttah ntsaesnio of hte dbyo si tnr,ecatlaarol nda he hsa solt tlfe idsde anip adn tmpeeurtrae of eth .dybo

Pian adn mtaeepurter nsaonites of eth bdoy is rtap of eth aimiahploncst tcra,t wihch waaysl unrs aaletllyr utrohgh eth ema.bintsr hTis anc eb romnedcfi yb rmbgmiernee taht nstnoiesa to het eafc aslo runs raaleytll tuhorhg teh ntrb.imeas ,So we nac fmircon sith is a irthg idsde llaeatr snaermitb eus.si

ehT lsso fo gag efrlxe nda spraayils fo the vcoal orcsd miply eitpirnamm fo nirclaa evsnre XI dan X, btho of hhcwi oelazlic ot hte udale.lm h,orfeeTer the swarne si hrigt oterllodrasa ldule.ma

duat98  You're a good man. +4  
charcot_bouchard  You must be handsome too +10  


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Teh’rey gngvii a tol of osngnfciu reatx nmrtfooiani e,erh meayb ot ptir us .up yheT tusj wnat uvemol fo tdisiinutrb,o psleim sa thta.

dV = [ugdr sedie]diranmt ÷ [lpmasa drug inc]oanotctner

sitrF rveocnt it lal ot /Lg ueasbec hsit is owh hte nrswea lwil :eb

esd:itemrndai 08 gm = .080 g saplam eoirt:tnaconnc 4 ug/lm = 0004. Lg/

sTh,u

dV = 080. samrg ÷ .0004 gL/ = 20 L

naeCalcre of rugd is nto a hgue oaftrc baceues eht alfh lefi is so olng that eht urgd si tuigirsdnbti eorfeb tnicngaifis arceaceln r.osccu

gonyyong  I think the distribution half-life and elimination half-life was saying that by the time you checked, it had fully distributed (10 half-lifes) and had not been cleared yet (super long half-life) +14  
soph  1000ug= 1mg and 1g=1000000ug so then 4ug/ml * 1g/ 1000000ug= 0.000004 g/ml 0.000004g/ml * 1000ml/L= 0.004 g/L 80mg*1g/1000mg= 0.08 g vd= 0.08g/ 0.04g/l =20L +4  
tiredofstudying  Or, like a normal human, convert 4ug/mL into mg/L ... which is 4 mg/L. 80mg/4mg/L is 20L. +20  
corgilobacter  I hate NBME... I thought these stupid conversions were over after undergrad. Nope. +1  
yesa  You do 1000000000s of these a day if you do any type of labwork o.O You just get used to it eventually +  


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F*K* itsh tquoie!ns

nwoK cxaetly awht eth sdesaie si tuoiwht wioknng hawt the fing*k* nee"zrgladie oialtm"spoarbn !!emsan

tiredofstudying  Hope your day got a little better after this +6  


Anyone going to mention that C. perfringens has been demonstrated to have a high association with gastritis and shellfish and that parahaemolyticus is a cause of necrotizing fasciitis?

tiredofstudying  FA 2020 Pg 178. +  


submitted by nwinkelmann(294),
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I ujts tthoghu fo a yaw to lyhlu(eo)fp idoav tgegitn eesth peyts of aswsern gonrw. trisF, ehnw I rdea tmhe I slaayw oklo rfo hte satel "alehso"s w.naers ,Tehn if yroue' ltisl utcsk, ytr to put teh mtentesat itno a toequ tath you ldwou asy to a tipntae as a iyhai,sncp nreebmgeirm that e,pedo-nend eulnamngjn-dot ienqstuos ear da.lie

ehT ewnras for hist doluc eb edasrph as a tonqsiamtsuteeen/t by the otr,cdo to eth yaifl,m as lle"T me eomr uobat woh htsi ipgimctna yuor fmyali nad layid "li.ef Had it been adeshrp leki t,aht I FLIDENETIY 'wdlunto vhae tenotg ti .orgwn I dluwo eahv nevre neev dha the pyrtiutonpo to mkae an psitaounms bauto eht smfl'ayi igfhgitn nbige deu to iedt enonrscc nda stuh igneedn a ruittinnsiot leerfra ihh(cw is wath I e).scoh

usmile1  I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful. +4  
tiredofstudying  99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will +3  


submitted by gh889(128),
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coKreoatl is a belrreeisv SAIND nigve IV, all DAsISN aevh a kris fo trteiasnltii hiristnp,e enral mciehai,s gcisrat ,eslurc nda acsapitl mae.ian

eth etsb wraesn is laren ieurfla /cb ti is vineg IV nad hsa sles fo a caehnc of acugisn rtgcais ceulrs

tiredofstudying  I would also take into account that this patient has had HTN and T2DM for 20 years. His kidneys are probably shot. +5  
jackie_chan  @tiredofstudying 100%, thats probably why the mentioned it, if you didn't know wtf ketorolac was (I didnt) but i saw a long 20 year history of HTN, DM I assumed his kidney def could not be fully functional +  
faus305  I just ordered sushi from Japan. +  


submitted by aaaaaaa(6),
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trolsati is usde rfo htewig lsos si(t otn a snaitt as some peploe tuhtgoh ni eht omctemsn )eh.re its ni AF 1290 pg 924, m/c sdie csffete rae IG idgluinnc airarhde

imnotarobotbut  Thanks! It's actually page 394 +2  
tiredofstudying  FA 2020: Page 400 +  


submitted by guillo12(47),
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hTe lsbuiscspaaru mucesl is evyr irtmotanp ofr the nnIterla attoorni of the .hremuus ehT nnetrlia naottoir tosuppsr teh uerpp mra dgurni biudcntao nda nidout.cda

ereTh are semo bdna iesecxesr tath acn lhpe uoy nshgtter eht sblauSrscpiua m.sc u.l.e 1. Inrtlean onRtoait - sesu meiadl neaitlrn toitroan .2 arlxentE Rottnioa - sseu artlael etaxenrl otnaiort .3 otFrn Rwo - Yuo heav oyu andh pu in nrfot fo yuo and iwth yuor amr tdeenxed upll cbka het n .dab 4. dSie woR - Yo'ure eids to eht ndab ihwt yruo hand aficgn eth i,hp ullp dnwo rodwta your yob.d (DCITAONUD)

STIH IS TON A FRIA QTSIEONU MEN!!!B

arcanumm  I got this wrong too, but I think the exercise of internal rotation makes sense because it will isolate the muscle (without assistance by teres minor for adduction). +5  
tiredofstudying  The subscapularis assists in medial (internal) rotation and adduction, but the teres minor also assists in adduction, so the best choice to isolate the subscapularis would be internal (medial) rotation. Choice E +2  
thotcandy  @tiredofstudying teres major also internally rotates so it wouldn't really be isolated either. I guess Tmajor isn't relevant cuz it's not a SITS muscle? Still a stupid question. +1  
jaramaiha  I just remember subscapularis muscle function by thinking that Subs go into the sea (or internal/medially rotate). Also the only muscle set that happens to perform internal/medial rotation in the rotator cuff set. +