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Contributor score: 228


Comments ...

 +0  (step2ck_form6#34)

She met the Centor criteria for empiric antibiotics, why was is culture?

tinylilron  I think that if you do a rapid test for group A strep if it is negative you have to follow it up with a throat culture... I remember this from my pediatric rotation... the culture is supposed to be more sensitive(?) than the rapid test. https://www.uofmhealth.org/health-library/hw204006#:~:text=A%20t +
sassy_vulpix  As per UWorld : Adults : Centor Criteria : 0-1 : viral,No test reqd; 2-3 : RSAT, if positive antibiotics, if negative, we assume it to be viral so nothing; 4 : penicillin/amoxiciliin whereas for kids, we always need to follow up a negative RSAT with a throat culture. In adults, there is no need. +

 +0  (step2ck_form6#19)

Always best to discuss pregnancy prevention prior to pt participating in sex, if not it will be too late


 +0  (step2ck_form6#46)

Dementia is a risk factor for aspiration


 +0  (step2ck_form6#15)

Just as another POV, you might have seen well-demarcated and thought erysipelas..but remember that is not bullous. Plus, everything else fell more in line with Type 4 HSN.


 +2  (step2ck_form6#24)

Ca Gluconate must be given immediately if K > 6.5; think of it as "no point in hydrating or pushing K into cells with insulin if they will die rn of an arrhythmia"

Ca will stabilize immediately, which is why its initial tx.

ronabobonafofona  I also generally use "are there ECG changes?" as a good marker of it you need to give it or not. +

 +12  (nbme24#4)
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aotccpCrocly mitgnsinie ahtt si tnresfrrade hhotrug tpraoeyrirs doresptl

fg/ocllybta.rcimcivi/c/lw/tghpea.:t.na-ndh/gltstglcwomopnoucsw


mousie  http://www.sparknotes.com/biology/cellreproduction/cellcycle/section3/page/2/ +3
fahmed14  Cyclins help regulate cell cycle phases. They help with checkpoints before progression to the next phase of a cell cycle. Therefore the checkpoint before mitosis would be in G2 and probably where mitotic specific cyclins are synthesized +11
artist90  https://en.wikipedia.org/wiki/Cyclin . 4 types of Cyclins and when they rise and fall. +2

 -1  (nbme24#18)
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iThs asw ltaaelr mlrealdu odsrmyne aak loedrarslota nticrfa of hte C.IPA



 +3  (nbme24#44)
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I htoguth sthi saw sujt nerfceinerg oilnlzreg l,oseiln hhiwc dowlu veha aeleetvd ntgasri


 +12  (nbme23#20)
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It swa a type IV NSH ortaniec, chiwh eslad tihw T lslec dna ttha saw het lony aewnrs atht dha t lslec ie.olvvdn

yogi  Poison Ivy/ oak /Sumak +
qball  Uworld Q ID 1133 +2

 +4  (nbme23#15)
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ehT pt ahd sahtam B(S,O wkaes up ta nhtgi uot fo het,bar ahs gree.lsia)l tI dksea fro eth esrporurc fo es,rieeonktlu wchih is ccadhniroai ic.da Teh prob vgea mhi ktalsteuMno or eilhdan iguicc.tdsorlooc

ls3076  wtf is up with the phrasing of this question +35
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +1
alexxxx30  @Is3076 haha agreed!! +1
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +5
yesa  GERD-induced symptoms would be related to meals +

 +9  (nbme23#24)
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itreHosco,asomhm kaa "zrenbo "at.deesbi nnCota be iAdosnd eud to het acpheeylrgimy nad malorn PB

alexb  I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM. +2
tinydoc  I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation. +12
maddy1994  testicular atrophy &hepatomegaly helped me out to eliminate the options..when i was left with ferritin and saw pigmentation it clicked that it is hemochromatosis +3
krewfoo99  Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis +3

 +7  (nbme23#10)
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I soche itsh c/b sti het smot onomcm gaphenot rof sikn setcoinfni

seagull  same here +2
sympathetikey  Some bowlsheet +11

 +7  (nbme23#26)
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/32 /521 /41

He ahs a /23 hancec fo nbgei oregoyzstheu tno( 24/ bc/ we kwon he ofr ruse 'todnse veah FC)

152/ ehccna ni hte tnouialpop

/14 heaccn of a egutheyoorzs pocuel vhgina a idchl wthi FC

welpdedelp  ok, so it messed up the formatting 0.66667 x 1/25 x 0.25 +
nwinkelmann  ugh... I ALWAYS forget about changing the carrier status to 2/3. Chance of affected individual = chance of father passing allele * chance of mother passing allele = 2/31/21/25*1/2 = 2/300 = 1/150. +1
zpatel  2/3(chance of heterozygous) * 1/25(meet carrier) * 1/2(chance of male to transfer affected gen) * 1/2(female to transfer affected gen) = 1/150 +4

 +6  (nbme23#50)
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0*3 ..015 inThk otuba ti, eerht is x wofl twih na yenogx itoantceonnrc fo soy-- ot dnfi out eht eierdlvy uyo tujs yllimput htme heger.tot

yotsubato  One of those questions too simple to believe its actually the right answer +29
mimi21  Right, I was like this is too simple lol ! im not sure if this is also a good tip but I tend to look at the units they are asking for and double check my math to make sure I end up with them. +7
osgood-schlatter  what equation is it exactly? +
arcanumm  Literally did not even conceptualize this question, just looked at the units. +5

 +9  (nbme23#1)
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nweh a flceliol deosn't rupertu ka(a an)iovnutola htne it lliw ofmr a tscy.

uslme123  n premenopausal women, simple adnexal cysts (image 1) that are <3 cm in diameter typically represent normal follicles or may be a corpus luteal cyst (these may appear simple or complex) and may be considered a normal finding. Even when up to 5 cm in diameter, these simple cysts are so commonly due to normal menstrual physiology that the Society of Radiologists in Ultrasound (SRU) does not recommend follow-up when asymptomatic +8

 +11  (nbme23#43)
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It saw het oynl ierpeharlp lgnu cea,nrc tsi soal emor nmomoc ni ne.wmo seMassitat louwd have nowhs limtpelu senilos

sympathetikey  Also, lung adenocarcinoma is the most common lung cancer overall, most common in women, and most common in non-smokers. I know she smoked in the past, but that's what tipped me off to it. +5
alexb  Yeah I literally picked SCC bc I knew she'd smoked in the past smh +
maddy1994  20 years of non smoking history ,she wouldnt be at elevated risk for smoking related carcinoma. +2
larryd  According to FA19 p. 693, large cell carcinoma of the lung is also peripheral. +

 +24  (nbme23#44)
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No tdei ecedcyi,nif eth intetap dha eesxcs reetaocn due to ish deit

sympathetikey  Would never have thought of that. Thanks +9
medschul  that's messed up dog +19
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +
davidw  this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7
davidw  β-Carotenes are present in dark-green and yellow vegetables. +
hyperfukus  ohhhh hellllll no +7
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6
cbreland  I'm okay with missing this one +4

 +1  (nbme22#1)
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oS I nhitk atht esisu of sriwt netenxios na/rdo ginerf rpod loduw be remo arilad vnee.r ,wevreHo ehetr saw orme aloxirpm a,esksnwe so it wldou eb .7C

"7-8 aly tmeh i"hts,atgr hte pt 'tnoucdl lay" hmte tt"gsirha so ti duwlo be C7 toro

welpdedelp  *As an addition, median nerve involvement would have leaned more toward C8 than C7. +6
meningitis  Do you have anymore useful mnemonics for brachial plexus? +
henoch280  FA pg 494 for mnemonics +
winelover777  Doesn't look like there are many in FA 2019. S1/S2 - Buckle my shoe. L3/L4 - Shut the door. C5/C6 - Pick up sticks. +
drzed  S2-S4 keeps the penis off the floor :) (cremaster reflex) +
peridot  What's crazy @drzed is that in FA 2019 it says L1-L2 ("testicles move") on p.498 so I wonder if that changed +

 +3  (nbme22#4)
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iThs swa SLE. 2.pelisoeetbyhtt3m1t-:tp/c9sltssmumsusptmhkseoss/u1rcm01e/.-uela//yd

ih:knT 1,=,32 S-L-E

Uings DACI: Tyep III is for eImmun eColxmspe

jurrutia  What do you mean by ACID? +

 -4  (nbme22#38)
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eranecsId larniairntca rsuserpe taht lressut in 'suChsing taird of asirenedc odolb rups,eres rgieurrla tnibgaerh, dan raarbid.dcya ,hsTu hgih O2C scnuide hsuicng traid adn fi uoy igve PP enth it wlli euddecr 2O,C dna hnet ndwo etegarlu the smptycaihet rcct.otssnvoniaoi yglanriOil eht binra adh so hmcu 2CO ttah ti azpzsde otu dna ertid ot naceesir the PB ni oderr ot usph orme togxeednay blood ot het narib.

/oiagwSjZmtrhU.:pei/e:A5/.mpCqtAfcKdsbal3/gsgtpmJ.s-k

lispectedwumbologist  "Bradycardia" 84 bpm lol +
lispectedwumbologist  The hypertension in obstructive sleep apnea is due to increased sympathetic tone not increased intracranial pressure lmao +1
meningitis  @lispectedwumbologist : Be mature enough to correct him/her and move on, not laugh at him/her. +14


 +10  (nbme22#6)
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tI was sjtu iaksgn hte faspnlie of sBCR (201 adys)

haliburton  If I'm reading this right, this is just a tricky dicky question. I think CO binds 200x stronger than O2. But if an O2 cycles through binding / unbinding 200 times before a CO gets kicked off, this should still clear the CO from that cell sooner or later. strange to think it is 1. essentially permanently trapped in a cell, and 2. doesn't kill you and can be treated with O2 to resolution within a few hours or a day. They must just be thinking, until that last RBC dies, you've got original CO in a circulating cell. but just a fraction (because you didn't die). not sure how that CO isn't just passed on during recycling, based on this line of thinking. +7
link981  The question while stupidly written, asks how long the RBC's that carry the CO take to be removed from the circulation, not how long the CO takes to be removed from the RBC. Just asking the lifespan of RBCs in an stupidly complicated way. As we know, RBC's life span is about 120 days and then they are removed from our circulation. 120 days is about 4 months. Next time they will probably ask weeks or in hours, who knows? smh +8
baja_blast  If that's what they're looking for why cant the NBME people just ask "How long does it take for RBCs to turn over?" Ridiculous. +1

 +2  (nbme22#5)
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,kO so NAR neepnetdd ADN rempesaoly is rof evserre tsr.ns.pca.iaret gensli adsnetrd + ues ANR enndpteed NAR eoaery.plsm naC oeemosn xea?ilnp

hyoid  The only thing I can think of is that HIV is a (+)-sense single-stranded RNA virus that relies on an RNA dependent DNA polymerase (reverse transcriptase) to synthesize DNA. +1
haliburton  according to [medbullets link](https://step1.medbullets.com/step1-microbiology/104196/rna-viruses_) ns ss RNA must carry RNA dependent RNA polymerase (so that is out). also, according to medbullets there are very few ds RNA viruses, so "most likely" will be ss. Also, RNA-dependent DNA polymerase = Reverse Transcriptase. Since HIV is a ss ps RNA virus with RT, they've described an HIV cousin. not sure beyond this. +
some0217710  Can’t think of any retroviruses outside of HIV and HTLV and they’re both +ssRNA +1

 +11  (nbme22#3)
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tI aws a isurreonugF b;eig&tdso-- sseis.osbta sFueorirugn ebdosi era edevbile ot be rfdome yb mspehgoraca htat vaeh gohdsopacyet dan etdatmtpe ot sgdiet eht bsfr.ie

almondbreeze  info about ferruginous bodies being mf can't be found on FA/UW :'( they just say it's 'material' +
taediggity  FA 2020 677, FA 2019 659... mf?? mofos?? +3
69_nbme_420  Just to add: The question asks what cell type initiated the Fibrosis → Alveolar macrophages engulf the particles and induce fibrosis (same pathophys for all Pneumoconiosis). Pathoma 2019 Pg 92 +7

 +7  (nbme22#23)
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iTsh is e-rtaLotmbEna, chihw rmviseop ithw vetmnmeo sa rpamoedc ot tnyaMeihes siaagrc ihchwh swreosn wthi nmoeemvt

sbryant6  Lambert-Eaton is typically associated with Small Cell Lung Cancer. Since there was no mentino of that, I was thrown off. Such is the difference between UWorld and NBME I guess. +1
makinallkindzofgainz  I'm laughing about Myasthenia "gracias" lmao +16

 +12  (nbme22#22)
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It swa acebsi,s chhwi is asetnmirtdt -preooonsnep.r

welpdedelp  **person-person lol +6
suckitnbme  NBME loves their scabies +16
dentist  did you get scabies from "burrows" and "night itching" +
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +
zevvyt  to summarize leafhouse: Fomites +1
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +




Subcomments ...

submitted by step_prep3(11),
  • Newborn with cyanosis found to have a heart murmur and hypoxia unresponsive to supplemental oxygen, which is consistent with a severe intracardiac shunt)
  • Patient should be treated with alprostadil (or another prostaglandin analog) in order to keep the PDA open until the heart defect can be operatively managed

https://step-prep.org/tutoring/

seagull  Doesn't it take like 2-7 days for the duct to close? Why is this hour old newborn already cyanotic? +  
kingfriday  early cyanosis might be consistent with transposition of the great vessels and those can be associated with ejection murmurs and a loud S2 +1  
welpdedelp  Following ABCs, why wouldn't you intubate first? I understand shunt doesn't get corrected, but it would seem you would still take control of airway since kid seems to be crashing. +  
quaranqueen  I think that intubation wouldn't make a difference if it's transposition of the great arteries because the oxygenated blood would just end up going back to the right heart and back through its closed circuit +  


submitted by seagull(1580),

I was desperately looking for cellulitis. I never did see it. Some say I'm still looking for it to this day.

welpdedelp  Same lol. A question I had was I thought lymphangitis was supposed to precede some sort of injury, obv not lol but was the lymph node the main giveaway? +  
keyseph  I think the key distinguishing features are the red streaks leading to an area of local lymphadenopathy. Otherwise, cellulitis would be a viable option if given. +  


submitted by medicalmike(48),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  
tinylilron  does the decanoate make it a long-acting medication? +  


submitted by medicalmike(48),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  
tinylilron  does the decanoate make it a long-acting medication? +  


submitted by medicalmike(48),

Schizophrenic patients with medication non-compliance need long-acting injectable formulations

welpdedelp  Risperidone is also injectable though Injectables: Haloperidol decanoate Fluphenazine decanoate Flupenthixol decanoate Zuclopenthixol decanoate Aripiprazole monohydrate Olanzapine pamoate Paliperidone palmitate Risperidone +  
welpdedelp  I think there was another reason since there were 3 injectables among the answer choices +  
welpdedelp  As a correction I see what you mean, its the only LONG acting, sorry +  
tinylilron  does the decanoate make it a long-acting medication? +  


submitted by medicalmike(48),

Breast engorgement is normal while a woman is breastfeeding. Mild tenderness is normal for several weeks following low-transverse C-section, a notoriously painful incision. This patient has resumed sexual activity and would benefit from contraception, but this is not an answer choice.

welpdedelp  U/S indicated if there was fluctuance, fever or marked leukocytosis +2  


submitted by sugaplum(382),

This kid has signs and sx of dehydration Hyaline casts due to hypovolemia resulting in concentrated urine

welpdedelp  I was thinking RBC cast due to GI illness, thought they were pointing to some sort of IgA nephritis (╯°□°)╯︵ +  
bigjimbo  hypovolemia causing ARF (pre-renal azotemia) leads to normal bland casts aka hyaline casts +  


submitted by medstruggle(12),
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hWy od ouy evig IV ernviclouo iwth carltetianh mxt?eheateotr ndW’luot XMT loes sti cfieafyc scien ocloeuivrn rsrveese eht ftscfee fo TMX?

colonelred_  MTX will still work but yes some purine/pyrimidine synthesis can still occur. You often give leucovorin to decrease adverse effects of MTX. +  
welpdedelp  ok I have a question, leucovorin is the same as folic acid...so why give one over the other? +1  
lsmarshall  Leucovorin, folinic acid, is a modified version of THF and enter folate metabolism where THF is, after the point where methotrexate takes its effect. I have a pharm. card that says "toxic effects on normal cells may be reduced by administration of folinic acid (a.k.a. leucovorin or citrovorum factor), which is **preferentially taken up by normal cells versus tumor cells**." +13  
jj375  @welpdedelp I also struggled with that and chose the wrong one, but then I remembered something from biochem that I think is helpful:I think the good thing about leucovorin is that it doesn't need to be activated by dihydrofolate reductase. Methotrexate is directly blocking Dihydrofolate reductase, so folate can't be activated to help, but leucovorin doesnt need the activation, it is turned into Tetrahydrofolate and rescues the cell! +  


submitted by medstruggle(12),
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nCa eoneoms aeselp iexnlpa hsti? haWt is eht aosngsidi eh?er

welpdedelp  I thought it just as it was, polyneuropathy is supposed to be a burning pain affecting the extremities, he might have acute intermittent porphyria. He was too young and didn't fit ALS due to the rapid onset. No loss of pain in the arms so it couldn't be syringomelia. Wasn't asymmetric so couldn't be polio. Didn't have anything resembling Parkinson. +5  
j44n  I got tripped up on this too. I think what youre supposed to see is multiple areas of nerve damage on the motor tracts and proprioception is a senory component, so instead of saying they feel burning, they cant tell where their limbs are in 3D space. If they said burning you wouldn't have to know all the other 4 possible answer choices to get to this one. +  


submitted by medstruggle(12),
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hWsta the efrndceefi tbeween usetoehro“gzy nlul tamuinto ni B obngil neeg” dna go“oureyezhts oamtnitu okwnn to uasce 0%5 eaeescdr ni B onligb eegn nicotfnu fo noe ee?ll”la

welpdedelp  I interpreted "null" as meaning full deletion while the other heterozygous mutations was only a 50% decrease in the function. One child would inherit 1 null mutation and 1 50% mutation, which would leave them with a 25% functional gene. +15  
j44n  A thal is the deletion, B thal is mutations on promoters or splice sites. +  


submitted by medstruggle(12),
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Why is dundelao uelnm et?rirocnc I htugtoh ectcaiparn sznymee hosimn,ypc(yrt brpsapdcyxetoaei) uwodl eb tocldae ehe.r

colonelred_  Enterokinase actives trypsinogen and is located closer to the intestinal mucosal (“brush border”). +1  
drdoom  Yeah, @colonelred is right. @medstruggle: the duodenal lumen (and the pancreatic /proteases/ you mention) is the site where pancreatic enzymes (“endopeptidases”) cleave large polypeptides into smaller bits. It is at the BRUSH BORDER where the smallest kinds of peptides (dipeptides, tripeptides) are broken down into their amino acids, which finally can be co-transported with Na+ into the intestinal cell. I think about it this way: stomach acid denatures and “opens up” proteins (without any specific cleavage); pancreatic enzymes then cleave denatured polypeptides into smaller bits; brush border enzymes finally break down tiny peptides into absorbable amino acids. +3  
drdoom  Nice schematic, @welpdedelp +  


submitted by colonelred_(107),
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keoLod it up dna undfo taht ubeeacs y’eoru in a sinpue iptsnioo orf a nglo item yuer’o ngigo ot ehav sencrdaie esunov rruent hiwch selda to ceiredsan CO. sihT tvglyieena kaescefbd no A,ASR daienlg to eeredcads ondre.asetol As a rsue,lt oreuy’ onggi to hvea eencsiadr rdusesii cwhih sdlae to ededcraes bdolo adn lpsmaa mleov.u

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4  
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +8  
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3  
yotsubato  You gotta be preggers to compress your IVC +5  
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1  
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5  
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4  
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +  
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +  
theunscrambler  @peqmd thanks for sharing that. According to the presentation, the diuresis via ANP occurs (along with sodium), which is followed up by an increased in RAAS --> maintains sodium levels. This cycle can then continue. Slide 13. +  
jj375  @urachus - Either BB or Sattar taught me this but I feel like it is often forgotten. "RAAS/Aldosterone affects blood volume, and ADH affects Na level". So Increasing aldosterone will increase blood levels however water follows the sodium so you will not get a change in sodium levels. ADH however does affect Na since aquaporins are bringing in water without affecting sodium levels. +  


submitted by welpdedelp(228),
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32/ 2/15 /14

He has a /23 enchac of igbne oetgzeryohus tn(o 42/ /cb we nkwo eh orf rseu noet'ds aveh CF)

21/5 hneacc ni eht intoualopp

4/1 hccane of a geuetrosoyzh peuclo vnhagi a cldhi hitw CF

welpdedelp  ok, so it messed up the formatting 0.66667 x 1/25 x 0.25 +  
nwinkelmann  ugh... I ALWAYS forget about changing the carrier status to 2/3. Chance of affected individual = chance of father passing allele * chance of mother passing allele = 2/31/21/25*1/2 = 2/300 = 1/150. +1  
zpatel  2/3(chance of heterozygous) * 1/25(meet carrier) * 1/2(chance of male to transfer affected gen) * 1/2(female to transfer affected gen) = 1/150 +4  


submitted by welpdedelp(228),
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oS I htink taht iuess of writs entnisoex on/adr nerfig dopr wdluo eb moer ardali enevr. Hvo,ewre herte was ermo maplixor wseanesk, so it lduwo be 7C.

"-78 ayl htme ,g"atirsth eht tp ct'luodn a"yl htem r"gaitsth so ti ulwdo eb 7C orto

welpdedelp  *As an addition, median nerve involvement would have leaned more toward C8 than C7. +6  
meningitis  Do you have anymore useful mnemonics for brachial plexus? +  
henoch280  FA pg 494 for mnemonics +  
winelover777  Doesn't look like there are many in FA 2019. S1/S2 - Buckle my shoe. L3/L4 - Shut the door. C5/C6 - Pick up sticks. +  
drzed  S2-S4 keeps the penis off the floor :) (cremaster reflex) +  
peridot  What's crazy @drzed is that in FA 2019 it says L1-L2 ("testicles move") on p.498 so I wonder if that changed +  


submitted by bobson150(14),
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hTe nrdgwio fo hsti suteqoni fuoscend .em ihsT is ngikas whhi"c fo ehtse leessvs si hte hghi ssprruee setmy"s hi?rtg oS teh ghhi eprruess sourpier arletc si nasguic secdirnea sperrues nito het ioerirnf rleatc?

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +2  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by welpdedelp(228),
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It asw s,cebisa wichh si etandtimsrt e-onpnr.epsoro

welpdedelp  **person-person lol +6  
suckitnbme  NBME loves their scabies +16  
dentist  did you get scabies from "burrows" and "night itching" +  
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +  
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +  
zevvyt  to summarize leafhouse: Fomites +1  
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +