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Contributor score: 70
Comments ...
andro
The question specifically asks for a process in myocytes
Fatty Acids ( Triglycerides ) are primarily stored in adipocytes . It is from adipocytes, that the fat can be mobilized for use by other cells .
Loss of adipocytes can decrease the width of the calf , but then again we are talking about mechanisms of muscle atrophy and the most important mechanisms for this is ubiquitination - breakdown of the cytoskeleton proteins
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Subcomments ...
weenathon
Why isn't this rheumatoid arthritis? Doesn't osteoarthritis improve with movement and RA doesn't? Also isn't RA usually symmetrical like this guy and OA isn't? Also I know th heberden nodes are OA, but his pain was in the base of the thumbs, not the DIPs. Is it because there was no redness in the knees? I'm calling shenanigans on this Q.
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weenathon
New recommendation is to give ceftriaxone and doxy for nonpregnant patients being treated for gonorrhea. the CDC specifically recommends doxycycline if chlamydial infection has not been excluded, based on increasing azithromycin resistance in gonorrhea (uptodate).
Not sure how long it will take NBME to catch up though
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weenathon
What's with the Grade 2/6 systolic crescendo-decrescendo murmur along the left sternal border? Is that what a friction rub would sound like or is it something else?
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weenathon
I originally chose vein because I was thinking maybe the hormone release couldn't be carried to the body anymore, but looking back the working of "moderate hemorrhaging" and vessels requiring ligation is what implies it's an artery. Just throwing that out there in case you thought like I did.
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cheesetouch
if you were clueless like me (well I knew artery but..), picking one with 'thyro' in the name when discussing a thyroid surgery is a good guess :)
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cbreland
I'm really out here picking one of the answers with vein
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weenathon
This question confused me because wouldn't she have already formed antibodies in her previous pregnancy?
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nbmeanssux
Pregnant mothers don't form anti-RhD antibodies until around 28 weeks (that's why we administer it then) so she shouldn't have formed any from the 12wk aborted first pregnancy
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weenathon
For anyone else who was wondering why a cancer was undergoing apoptosis (classically we think of cancer EVADING apoptosis), apparently it's due to the myc mutation classic in Burkitt Lymphoma. While myc causes the cell to proliferate, it also induces apoptosis - hence the tingible bodies containing apoptotic cells. (https://www.ncbi.nlm.nih.gov/pubmed/8247541)
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itsalwayslupus
Also just for people who watch boards and beyond or pathoma (I don't remember which exactly it is from), the "stars" in the "starry night" appearance of Burkitt's (what is being shown here) are lighter because the the cells are dying/gone via apoptosis (supposed to be the "holes" in the "night sky" lol).
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jbrito718
composed of intermediate-sized lymphoid cells with a โstarry skyโ appearance due to numerous reactive tingible-body macrophages (phagocytosis of apoptotic tumor cells). There is a characteristic t(8;14) translocation juxtaposing MYC to the immunoglobulin heavy chain locus in most cases.
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realfakedreams
@hayayah you were being lazy.. smh..
Homie started anti-retroviral therapy. HIV infects CD4 T-Cells through either CCR5 or more commonly CXCR4. Because of anti-retrovirals start working, HIV isnt able to infect anymore CD4 T cells. Thus CD4 t lymphocytes levels start to rise and are able to active B cells.
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myf1991
Why can't it be monocyte? macrophage eat MAC and interact with CD4
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weenathon
@myf1991 I also incorrectly chose monocytes, but if you look at the question carefully, it is specifically asking what cell is required for the lymph nodes to enlarge, not which cell is handling the mycobacterium avium infection. Since CD4 cells stimulate B cells to proliferate in lymph node follicles, which would make them bigger, CD4+ T cells is the answer.
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j44n
macrophages dont enlarge nodes in fact they make them smaller, tingle body macs eat all the bad B cells in a node so improved mac fxn would decrease the node size
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mpel14
To add to @namira, an infectious disease doc described this concept in an HIV lecture where he said that prior to the Tx with antiretroviral therapy, the pt has such low CD4 count that their immune system cannot form a response to the infection, and after their immune system is given a slight boost with the drugs, their immune system can finally "see" the infection -> mount response -> causes S/S
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drdoom
why did this get downvoted?
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weenathon
The missing structure is the cerebral peduncle (also called the crus cerebri). You can tell it is a good slice and not a weird cut because of the symmetry of the rest of the midbrain structures. Everything is symmetrical except the cerebral peduncles, with the left one missing. I also think it's a safe bet to say it's not a random piece of tissue missing because tissue artifact is not one of the choices.
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weenathon
I don't think A is the nucleus, It seems more like a lysosome with digested material inside. If you watch the video below it shows the relative size of the nucleus to the mitochondria - a nucleus would be MUCH bigger than the mitochondria
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weenathon
I don't think A is the nucleus, It seems more like a lysosome with digested material inside. If you watch the video below it shows the relative size of the nucleus to the mitochondria - a nucleus would be MUCH bigger than the mitochondria
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hpsbwz
Why is it regurg instead of stenosis?
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minhphuongpnt07
Vague question requires a lot clinical reasoning.
mitral regurgitation: holosystolic murmur( this cv: midsystolic), enlarged LA, LV
Mitral stenosis: diastolic murmur, enlarged LA, normal LV.
only best explanation I can think of: early stage Mitral regur, that's why the murmur is not holosystolic but midsystolic and LV still adequately handle the situation
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dickass
@hpsbwz it's regurgitation because the murmur is SYSTOLIC, when the mitral valve is not supposed to make any sound. mitral valve leaks in systole, which causes blood to back up, which causes the left atrium to work harder and eventually hypertrophy.
Mitral stenosis would be a DIASTOLIC sound, which is when the left atrium normally contracts.
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themangobandit
I'm still confused as to why mitral regurg has an enlarged left atrium. Are we supposed to think that it was mitral stenosis for a time, the high LA pressure led to hypertrophy, and then became mitral regurg? That's how it works in rheumatic fever, right?
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shapeshifter51
I agree that mitral regurgitation is a holosystolic murmur heard best heard over the apex. However, with the murmur being found in the mitral valve area of auscultation it was the only answer choice that could result in LA enlargement and normal LV. Ruled out mitral valve stenosis since it is a diastolic murmur.
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weenathon
@themangobandit I believe mitral regurg could cause an enlarged left atrium from the increased amount of blood flooding back into the left atrium with each systole causing increased pressure on the wall.
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rockodude
why is LV size normal? doesnt cause MR cause increased preload and overload over time leading to enlarged LV?
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Decubitus ulcer is a pressure sore that could be anywhere on the body, and in this case is on the head because the baby can't move.
Ecthyma gangrenosum is an infection usually seen in patients who are critically ill and immunocompromised. The characteristic lesions of ecthyma gangrenosum are haemorrhagic (bloody) pustules that evolve into necrotic (black) ulcers, which doesn't really fit the description here.
Kerion is an abscess caused by a fungal infection, and likely wouldn't be ulcerative
Recluse spider bite would have more severe systemic symptoms in a child (weakness, fever, joint pain, hemolytic anemia, thrombocytopenia, organ failure, disseminated intravascular coagulation, seizures, or death) and you would see puncture wounds.
I didn't think atypical TB or scabies made sense so I didn't go into those.