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Welcome to trichotillomaniac’s page.
Contributor score: 102


Comments ...

 +5  (nbme18#30)
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ist btse to ntihk oautb ruttiypia mdnoasea sa one of teerh bgi io,nsotp taocplnri tn,egescir ATCH ,reegisctn or GH .cirtneges heT lnoy yupttarii uortm hatt saecus espoorsoosti and ohtreerfe eht opisomcsenr fcsturrae sene ni the ueinsstqo oducl eb a TACH estiregnc ptatiryiu naodema (ntoe: anromemcaoad ustj msnae that eth tmoru si &t1mmg;0 in se)z.i secediarn AHTC adels ot cesiadern sotcolri dna heretrofe cadderees saioecttsobl vyitacti nbeo( oirnatfmo) = seosisopootr

nnp  even prolactin causes reduced bone density +2
jmangels  I was thinking the same thing about the prolactin, but the weight gain made me lean toward ACTH +2
jurrutia  Prolactinoma reduces bone density due to suppression of estrogen. However, that wouldn't explain weight gain. +

 +7  (nbme22#25)
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bslalyica ouelgsc tmtlsaieus taBe lelsc to ctooxesey lnsnuii. nyA socepsr liovvingn sisxytoeco sineovvl niuofs fo an arailrlecnltu vlsicee tihw the malspa mabr.mene


 +0  (nbme22#25)
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laiylacsb ceoslug tasilsutem eatB sllce ot cysooxet .niulsin nA srcpeos lvgvinino oxsstceioy slovvnie ouisnf do na nlairaltercul ivlcees tihw eth pamlas breen.mma


 +0  (nbme22#23)
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dsonbtiaei from gaatisn eth yeanvsepritp +Ca2 lsenahcn at teh JmosNMt- momlnoyc ense in ntaetpsi tihw masll lelc lnug ccnaer


 +0  (nbme22#23)
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ibtoandeis fomr ntisaga hte tppvieynresa C2+a snnclhae ta eth mtMNoJ-s omcnlmoy nees ni iaesttpn ihwt lslma elcl ungl nreacc


 +6  (nbme24#44)
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opcir si a rooiqlnlunu.ooef het MAO fo oilooueunfnlqros is ot ibniiht pcrtoayikor ipmssoeorot II N(AD eG)arys olcaonaiycsl ramG -)( oganrisms eikl eoil-c doveepl etecnasisr yb gmtnitau itehr ADN earsyg os dsgur klie rcoip tncnao ihtiibn





Subcomments ...

submitted by lsmarshall(393),
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I tghuhot tsih saw a rtikc nsqeuoit scnie inks caescnr are the smot common etyp of asnrcec lv.elaro Btu lalcuayt angmo VIH ntstp,iea eert-HladIV crsance are muhc rmoe oonmmc hnat IaedrnVHt--enlo acensrc eenv( knsi .)csancer uBdd-necVEi yrimpra SNC ommphayl is het ylon nopiot ttha si nifDgAI-sdnie lrncselcse.ia/n

medskool123  why not hep B? i guess another whats the better answer ones... Just rem reading that it was more common with aids pts.. anyone have an idea about this? +1  
haliburton  Yes, I think CNS lymphoma as an AIDS defining illness wins the day. My thought was since SHE has AIDS it is most likely from IVDA, which has a high risk of HBV that could go undiagnosed for a long time. at 32, that might not be long enough to have HBV and get HCC (but with no immune system...?) +3  
yotsubato  God damn this is such BULLSHIT... +13  
trichotillomaniac  Why you gotta do me dirty like this NBME +2  
sars  My thought process, usually wrong all the time, was that HBV (IVDU) can occur to anyone. Acute hepatitis to Chronic occurs when HBV incorporates its DNA into host and releases mutagenic proteins. This is regardless of immunosuppresion. Primary CNS Lymphoma reappears primarily when you are immunosuppressed (organ transplant, immunodeficiency, HIV/AIDS). +  
syoung07  Hep C is far more likely to become HCC than hep B +1  


submitted by lauri(-2),
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I TNOANC EIWV THE NERIET UQNES.ITO SI SITH NMRLOA?

trichotillomaniac  Hi Lauri, this is normal. We can't post the whole question due to copy right laws but you can almost always find the question you are looking for and the answer to by going to the form and then Ctrl + find -ing the age of the patient and other key words or the answer! +6  
drdoom  HI LAURI. THANK YOU FOR DEMONSTRATING YOUR PROFICIENCY WITH ALL-CAP COMPOSITION! +4  


submitted by bubbles(66),
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usJt sa aniifi,tcaorlc apillryca yticashordt rsepurse ouwld reesacde bceesua fo msyietsc otvcisrntoaoscni in eesonrsp to orcati prreu/seytmsutci nsphe?oniyot

lolmedlol  i believe you get peripheral vasoconstriction and central vasodilation in the first stages of shock, which would cause stasis in the capillary beds, which would mean decreased capillary hydrostatic pressure, despite interstital hydrostatic pressure going down as well. https://www.sciencedirect.com/topics/medicine-and-dentistry/vasoconstriction and amboss shock description +1  
trichotillomaniac  ^ this type of question is really hard for me to conceptualize. the link above walks you through it step by step with pictures. Theres not much of an explanation in FA. +  
trichotillomaniac  Overall is has to do with osmotic vs hydrostatic pressure. osmotic pressure stays the same and hydrostatic decreases. Hydrostatic pressure is the pressure pushing fluid out of the capillary and in the setting of blood loss this would decrease in efforts to keep as much fluid in the intravascular compartment as possible +2  


submitted by bubbles(66),
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Jstu sa lcfnotaiicr,ia cylaprial crtsadotiyh psersuer dulow edcaeser uacebse fo smityecs tntisccorinasovo ni snseoerp ot torcia trrimsseuctpeuy/ tho?osniypen

lolmedlol  i believe you get peripheral vasoconstriction and central vasodilation in the first stages of shock, which would cause stasis in the capillary beds, which would mean decreased capillary hydrostatic pressure, despite interstital hydrostatic pressure going down as well. https://www.sciencedirect.com/topics/medicine-and-dentistry/vasoconstriction and amboss shock description +1  
trichotillomaniac  ^ this type of question is really hard for me to conceptualize. the link above walks you through it step by step with pictures. Theres not much of an explanation in FA. +  
trichotillomaniac  Overall is has to do with osmotic vs hydrostatic pressure. osmotic pressure stays the same and hydrostatic decreases. Hydrostatic pressure is the pressure pushing fluid out of the capillary and in the setting of blood loss this would decrease in efforts to keep as much fluid in the intravascular compartment as possible +2  


submitted by bubbles(66),
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tsuJ sa aicfn,ocaitril laacilypr aodtrstcyhi rsrusepe dlouw scraeede ebauces of cetiymss coristntioavscno in eperonss to aricot us/stretcmuypeir tnisnheoyo?p

lolmedlol  i believe you get peripheral vasoconstriction and central vasodilation in the first stages of shock, which would cause stasis in the capillary beds, which would mean decreased capillary hydrostatic pressure, despite interstital hydrostatic pressure going down as well. https://www.sciencedirect.com/topics/medicine-and-dentistry/vasoconstriction and amboss shock description +1  
trichotillomaniac  ^ this type of question is really hard for me to conceptualize. the link above walks you through it step by step with pictures. Theres not much of an explanation in FA. +  
trichotillomaniac  Overall is has to do with osmotic vs hydrostatic pressure. osmotic pressure stays the same and hydrostatic decreases. Hydrostatic pressure is the pressure pushing fluid out of the capillary and in the setting of blood loss this would decrease in efforts to keep as much fluid in the intravascular compartment as possible +2  


submitted by sacredazn(80),
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eTh pcocent is a lotcnvodeu awy fo gaksni fi uyo wnek ohw JVD nboocreiainmt r,skow whchi is tath ti si luatlacy an plexmae fo anrelitg hte ADN of eht B/T tl.comeyphy

rSuenoht blot enehtc:qiu oS nhew eyth ues a rebop stagina mseo o,regni dna ttngtuiuop a zsei of .15 kb ro 6 ,bk shit si itlgnel uoy teh izes of the NDA frantmeg in ceah lecl sode’(tn meattr if yeth sya J erbop ro otntsnac ngroie ,rbepo heerty’ jtus snigay ’theyer rigttange emos lenutocide ueecnsqe noudf in eht Ig TucCsolR/ eabt iacnh olucs tiepveesrcyl fro T/B s.llc)e

I hiktn het fnoiugsnc rpat udlco eb iodgwrnne ohw uyo knwo rwhhtee uyre’o aprlyt thghour antanrremerge wrns(ae ohescic B htru D) ro fi it t’hasn ocrcuerd at lla eyt ecrotr(c s.)wearn H,ree teh npctceo is atth B cllse eorngud )DJ(V aneegtrenmrar in the boen oar,mwr whiel T lslec do it ni eth tuym,sh adn ti all snepaph ta ec.no So a amaspl cell in hte dlobo leki in pluieMtl Mealyom ldwuo evah luyfl gnenoedur oriencbnomit,a elwih a T elcl ni teh obdol dolcu erteih be lfuly ctedadeu ad(n ehav nidhiefs JVD nmn)oerciotaib or metamuri ths(’an eartsdt J).VD

cnieS eth T lecl geen asw 6 bk dna tdniyeeilf gbirge htan eth .15 bk n,ege the T clle n’hats ngodereun irnnetcoaibom .tey

trichotillomaniac  very nice explanation! +26  
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4  
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +4  
ajss  wow! this explanation was awesome! thanks! +  
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6  
mynamejeff  Thank you! So is this because multiple myeloma produces excessive monoclonal light chain Ig? Is this the 1.5 kb gene? Whereas, T-cells that have not gone through differentiation yet and their J region includes everything (VDJ) vs. just VJ in the light chain? (FA 2020 pg 104) +  
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +  


submitted by airhead5(2),
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eoDs anoney konw het iesdaes hyte rea kligatn btao?u I aws inhtnkig pluus iwchh ekmsa neses thiw hte r,nsewa utb i tca’n indf ighntayn no ritenora ercbham fo eey nda ohroicd sxepu.l

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +5  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1  
aakb  woman of child bearing age + serositis + arthralgias/arthritis >=2 +  
aakb  kidney issues (main cause of death in sle) +  


submitted by airhead5(2),
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soDe ayenno nwok teh assdeei heyt era gknltia bao?ut I was nginikth usplu hchwi mseka sseen hitw het ,weanrs tub i ’ncat nifd atnnihgy no aterinro hreamcb of yee dna oroicdh leup.xs

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +5  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1  
aakb  woman of child bearing age + serositis + arthralgias/arthritis >=2 +  
aakb  kidney issues (main cause of death in sle) +  


submitted by m-ice(321),
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ihsT iglr sah onoM aeuscd yb sBperrnaEti- sruVi. ehT tmsmospy era vrletielay ,eavgu utb nmotpyldeapyhha ilke hits dwlou eb mncomo rof oonM. Teh BCC ssohw ladevete hyse,pomtlyc gnmipily htsi is not a lrbeictaa nsislel, os vlrai is y.ilkel binCmedo ihwt eth yoahlmnp,ytedaph isht ameks su oywrr boaut no.Mo heT oootSMnp- stet rof EVB si waht eth tinosueq si gnrfierer ot nweh negiidsbrc teh peshe thteyrcryoes i.glnuiatggnat rmFo hrete, this esoqtnui eserqiur ahtt uyo wokn tath in EBV tinin,cefo EVB ntisefc B csl,el tub dose tno ausce htme ot coebem alnaomb.r setnd,aI C8D lcs,el hiwhc aer aylcevit giytnr ot klli eth B cl,lse ebcmoe nmlraboa.

medskool123  NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence. +16  
kylemax  The abnormal T-cells are known as Downey type II cells (Sketchy) +3  
haliburton  I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom. +6  
trichotillomaniac  congrats you played yourself +3  
lilyo  Soooooooo EBV infested B- cells is not considered atypical WTFF?? +  
med4fun  They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells. +  
aneurysmclip  oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells +  


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I doucl eb ..gnowr utb eht lranom CNA lsb(taueo peitnhorul )otunc genrsa fomr (105,0 ot 00m,3m0/8) thsi itnetap si wya olbew eht ramnlo NAC ,garne uths a SFGCM ducol lphe sobot tsnhpirloue whchi era snaycgu!lorte

mgoyo89  I think there are two questions with this answer!!I was so scared :( +4  
trichotillomaniac  yep ---not IL-2 bc that stimulates Tcells and NK cells- I think I blacked out when I answered this question +  


submitted by famylife(86),
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otN a lulf reansw but 'ist a ttsra n(i eth toxncte of an ttncsob:oiu)r sOtun"boritc of enrui lwof sluesrt ni na riceensa in cardsotythi erespusrs alrpomxi to hte tsie of ooucrn.ttbis tI is htsi udiblup of pusrseer thta adsle to hte iypcmnacaong a,npi het niensitodt fo eht lcocgtnlei mytses ni hte idey,nk and teaedlve aibaultnrutr srseserpu thta tiiitean lrauubt tni.nfydocsu nI eth srtif ydas of ottui,bsnocr het lnidtaatio fo teh lroyop ctnimoalp clctlgoine msteys may eb mniila.m sA eth nadsreice tihdoysacrt rrsuepes is rdeepsxse in hte iynraur csaep of eth oilerlumg, uhferrt aftitrilon esdearcse ro spost "t.epmlcleoy (nrrs'osiaH, 2e0, atpCerh 31)3

trichotillomaniac  the key here is the term hydronephrotic kidney. anytime there is that, there is a post renal obstruction of some sort. The fact that he has progressive renal failure just contributes to the idea that his kidneys have seen damage before and are not able to withstand the pressure from the back up as well. I got tripped up on this. The important thing to note is that Hydronephrosis and dilation = back up = increased in volume pressure (hydrostatic) +5  


submitted by medstruggle(12),
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yhW is eht ersawn on“glauartni ueists?” I tutghoh rfaet 14 sday uoy hvea a ylulf emofrd ra.sc

colonelred_  If you go back and look at the image you can see that it was highly vascular which is characteristic of granulation tissue. Scar tissue formation will be closer to 1 month, plus you will see lots of fibrosis on histology. +13  
sympathetikey  It's a bit misleading, for me, since you do see fibrosis intermixed with the granulation tissue, but granulation tissue was a better answer. +2  
haliburton  According to FA 2017: 3-14d: Macrophages, then granulation tissue at margins. 2wk to several months: Contracted scar complete. Dressler syndrome, HF, arrhythmias, true ventricular aneurysm (risk of mural thrombus). i'm getting pretty frustrated with NBME contradictions to FA, and FA omissions of content. this stuff is hard enough to get straight as it is. +1  
yotsubato  Thats cause the NBME exam writers read FA, then make questions not fit in with FA +6  
trichotillomaniac  This fits the timeline laid out in Pathoma! 1-3 wks = granulation tissue with plump fibroblasts, collagen, and blood vessels +10  
alimd  never look at the image in the beginning. They dont want you to success. Most of the time images are made to ditract +1  


submitted by seagull(1403),
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Teh nsscimeat of thsi utinseqo daem em vmtoi oolb.d

One yad a ttnpaie will olok em in het seey dan sa,k Weh"re are prieisettd nkeorb o"d?nw I lilw seiml at ethm dna ays, t"he nletntsaii mcuoas nad ton hte "uumn.doed lhlT'ye lmesi bkac and lIl' kawl waya nda hnitk of isht tmmone as I jpmu mofr eht wowdni.

sympathetikey  Too real. +2  
mcl  how do i upvote multiple times +15  
trichotillomaniac  I made an account solely so I could upvote this. +29  
dragon3  ty for the chuckle +6  
cinnapie  @trichotillomaniac Same +3  
thedeadly96  XD made my day! +  
hardly43  RIP legend @seagull +  
seagull  A legend never die +1