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Welcome to usmlehulk’s page.
Contributor score: 4


Comments ...

 +0  (nbme23#14)

Please read the last sentence of the question. I think the split might be because of Rbb,. this causes the mitral and tricuspid valve to close at different times.

-so which of the following best explains the first component of the heart sound (split S1). Should be the mitral valve closure before the tricuspid valve.


 +1  (nbme22#16)

can someone please explain this question. i thought the patient is actually having cleft lip and palate, but why is the correct answer addressing only the cleft lip.

dentist  The question asks "the most likely cause of the facial finding involving the lip in this patient..." +5
snripper  lmao. gottem +3
ace9yak  cleft lip = 'processes' clef palate = 'shelves' +1
mutteringly  Don't let a dentist tell you whats up :( +

 +0  (nbme22#27)

can anyone please explain why option E which is increased in Urinary pH is not the correct answer. becasue hydrogen wasting is also a form of correcting respiratory acidosis.

wfma888  right- you will increase excretion of protons which will LOWER the pH! +2




Subcomments ...

In addition to the more obvious hint of budding organism, candida has fuzzy edges on blood agar which the others don't.

usmlehulk  @paperbackwriter cryptococcus have a narrow budding. +  
lovebug  wow I Didn't know that. THX~! +  


submitted by krewfoo99(88),
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toWlnud the OMHC rurmum eb ebst hrade ni eht aoirtc ear?a

krewfoo99  Correction: Shouldnt it be heard best in the left upper sternal border? +  
usmlehulk  In FA 2018 page 303. patients with HOCM presents with MItral regurgitation due to impared mitral valve closure. Hence this explains the murmur. +1  


submitted by marbledoc(0),
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Why ldwuo ouy sak eht attiepn ot tnediify het psro nad snoc? I ’tnod teg het acorphap r!hee

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3