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Comments ...

 +1  (nbme21#48)
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HNT geernc,yme Suomdi .Npsiosrtreuid nlUike ynleriaadhz a cneblaad vrlsadtiaoo (vnei = )arlertoi

sympathetikey  Well then, I guess we should just forget about our old pals the Alpha-2 agonists. Good call. I didn't even see that this was hypertensive emergency. Dumb on my part. +
zup  so yea clonidine would be used for hypertensive urgency, but this guy is over 180 (210) so they have to use something like hydralazine or nitroprusside both will increase cGMP +
whoissaad  Drugs used to treat HTN emergency: Nitroprusside Labetolol Nicardipine Clevidpine Fenoldapam Clonidine +16
lola915  Hydralazine actually vasodilates arteries>veins and Nitroprusside vasodilates arteries = veins. Both increase cGMP. +9




Subcomments ...

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I hknti tyhe tnwa uoy ot kthin uabot woh jgeoautnc ccaenvi si :emad iplasyaccdheor + pnirtoe nftegamr t(o iunecd T pndeentde mmuine sep.es)rno yOnl ilelgnafl si a iopretn o(r at asetl nduoss klei )one in het tpiono is.lt

vi_capsule  Flagellum is protein. Pilli/Fimbriae - GLycoprotein +2  


submitted by taway(31),
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eosD dabyony rtnsdaednu hwy ew ear oeldlaw to rnefiteer hwit the icllanci nikiegcnomasid fo otw orhte ceaislisstp rtyecld?i tdnul'oW that dmdyu het tsewar vene meor yb gdanid oru poin?oni I todn' see eht nrgeuyindl nppcreiil ttah xlsapine the nataeliro in sith nrw.aes

jcrll  I think it's about adding our opinion and more about seeing what the situation is because a patient contacted you in distress. The others are about contacting management off hearsay; that could also "muddy the waters," I Is this question also addressing quaternary prevention? +1  
meningitis  I agree with jcrll. My same thought process but then I changed it to psychiatric consultation in order to first attend the patient's distress and anxiety since it was hindering her decision making. Besides, the whole ordeal about her treatments and ineffectiveness was emotionally and physically exhausting her. +2  
vi_capsule  Referral is NEVER a answer +10  
tsl19  Going straight to the chair of the ethics committee without having spoken to the other physicians would be inappropriate because it would be jumping a bunch of steps in communication first - like jcrll said, you want to get the picture of what's going on from the other physicians first. Maybe the gynecologic oncologist isn't actually as opposed to palliative measures as the patient perceives him to be and thinks he's doing what the patient wants, etc. It could just be miscommunication, which you could help clear up without getting ethics involved ... better to start there. +10  
an_improved_me  Also, to add a little bit: internists on a healthcare team are the care coordinators. For any given problem a patient has, the internist is responsible for managing all the different aspects of a patients treatment. In this case, the intern has to manage the dissenting opinions of her different gynecologists. In other instances, an internist may have to manage the disagreement between a Surgeon vs. IR vs. Onc. +  


submitted by mcl(599),
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CSPO is doteassica ihwt lbnmoara ocitrunpod fo sxe sir,tdsoe ldinucing ndyusnctiof of oegrnset rniopodtuc and go.reetspenro yhilalnrcoC edleeatv leslve fo noegtesr acn eusca ladntoeiemr paiypshar.el

:po9msci//Pc7nM/nmt.bCihiavhctlwpes/99nwwr.3//.t.15lg

meningitis  Why isnt it endometriosis? Could someone help me out on this? +1  
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +  
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +  
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +29  
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +1  
lovebug  FA 2019, page 631 +  
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +  
xw1984  Isn't option G, Leiomyomata uteri, associated with high estrogen level? Per FA 2020, fibroid is estrogen sensitive. +  
ownersucks  @xw1984 gross image would show multiple whorled masses +