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Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

shriya goyal  yes I answered it like that +2  
redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +2  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  

submitted by sympathetikey(756),

Any time you see fixed wide splitting of S2, smash ASD.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +  
need_answers  https://www.youtube.com/watch?v=7hzabZ7YBr0 -smash, smash, smuh-ash +2  
usmlecharserssss  with airpods in 2012 +  
paulkarr  Low key was hoping for someone to try and argue this one... +  

submitted by nwinkelmann(219),

Here's a GREAT video explaining ultrasound findings of pregnancy. @9:57 is a great picture so far with labels of the yolk sac, gestational sack, fetal pole, and amnion. One thing the person explaining said that I thought would be good to keep in mind is that the yolk sac looks like a cheerio inside the gestational sac. Also, this site has a bunch of pictures as well: https://radiopaedia.org/articles/first-trimester?lang=us.

zpatel  what video? +7  
usmlecharserssss  porn video how they make this embryo and yolk sac +  
samsam3711  Shorter video that explains this pretty well: https://www.youtube.com/watch?v=01mMBDEthV8 +1  
focus  @samsam3711 that video is BOMB. Thank you!!! +  

submitted by paulkarr(22),

Visceral Leishmaniasis aka. "Kala-Azar"

Caused by Leishmania Donovani. (an intracellular protozoan)

Transmitted via the Phlebotomine Sand Fly.

Treated with Amphoterrible B. Can also use Sodium Stibogluconate, miltefosine, or paromomycin.

Will commonly be seen with pancytopenia, fever, and splenomegaly are the three big clues. Other symptoms you can see are night sweats, blackening of the skin, scaly skin, weakness, and substantial weight loss. This will kill ya if you don't get treatment.

usmlecharserssss  i got 2 leishmania questions 38 and 39 in 3rd block , both got incorrect because i thought no way they can do that ((((((( +6  

submitted by yex(43),

Hmmm. Well my mind has blown off because what hit my mind was dehydration since he was in the desert. As soon as my mind started to wander about all of the other options that could make sense... I just clicked and moved!

charcot_bouchard  Smart boi +2  
usmlecharserssss  hiking in sahara desert SMH +  

submitted by sympathetikey(756),

Acute gout treatment:

  1. NSAIDs
  2. Steroids
  3. Colchicine

I, like a dumby, misread -zone for -sone, thinking it was steroid picked that. For anyone who cares, Sulfinpyrazone competitively inhibiting uric acid reabsorption in the proximal tubule of the kidney.

Source: https://en.wikipedia.org/wiki/Sulfinpyrazone

yb_26  even if it would be steroid in the list, if NSAIDs are contraindicated => we give Colchicine, and if pt can't tolerate Colchicine as well => then we use steroids +4  
usmlecharserssss  uptodate - try to avoid steroid therapy in gout , in this case patient has aspirin (NSAID) allergy , so second line is Colchicine , not Allopurinol, which is for chronic management. This case is not RARE and a lot of people sits on Colchicine therapy even if they do not have NSAID problems. Colchicine also First line treatment for Familial Mediterranean Fever, prevent exacerbations. +3  

submitted by momof21234(3),

the patient has asbestos which is restrictive (clue was pleural plaques) DLCO is decreased in intra-thoracic conditions (interstitial lung dz etc) and normal on extra-thoracic conditions (muscular issues)

usmlecharserssss  how FEV1/FVC is normal i cannot get that +1  
sammyj98  I think this is standard for restrictive lung diseases. In obstructive the airways collapse during expiration so it's hard to expire, but there's a long drawn out end to epiration as little by little it escapes, leading to a decreased FEV1/FVC. In restrictive pt's just aren't able to move and expand their lungs enough, so when they expire it's of a small volume, but there isn't any collapse involved. It's like a normal expiration just with a restricted volume, making the FEV1/FVC normal. +  
spow  @usmlecharserssss In restrictive lung diseases, the ratio is either normal or increased. +  
drzed  And the reason why FEV1/FVC is either normal or increased in restrictive lung disease is very simple: the FEV1 and FVC both decrease because you are restricting airflow, but the FVC will decrease MORE than the FEV1, and thus because the denominator is larger, the fraction either stays normal, or increases slightly Contrast this to obstructive lung disease where you have an obstruction to air FLOW, e.g. the FEV1 will decrease more than the FVC, leading to a low ratio by defition +1  
llamastep1  To add to what @drzed said, fibrosis causes radial traction on the airways therefore increasing FEV1/FVC. Theres a Uworld q on it +  

submitted by hello(184),

which letter is CN IX in this diagram?

titanesxvi  A think is D, but it is not very clear +  
usmlecharserssss  A WHAT anatomical structure is this ???????? +  

submitted by mousie(136),

Cholera = Fecal oral /Legionnaires = Legonalla pneumo = NO person to person only by inhalation of bacteria contaminated water /Lyme = tick bite /Meningiococcal = sharing respiratory and throat secretions (saliva or spit). Generally, it takes close (for example, coughing or kissing) or lengthy contact to spread these bacteria (CDC) /RMSF = tick bite

smc213  Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments. +5  
dentist  So, Cholera is also p2p but Mening is more likely? +1  
usmlecharserssss  in cholera people to water => water to people +  
qball  Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person. +  
drschmoctor  but the poop water comes from people so.... +1  
llamastep1  Respiratory dropplets is easier than fecal-oral tho +  
lowyield  Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals +  

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