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This baby has abetalipoproteinemia. ("without Beta apolipoproteins"). Thus they will lack B-48 and B-100 and have absent levels of chylomicrons, VLDL, and LDL. Infants present with severe fat malabsorption and deficiencies of all fat soluble vitamins (ADEK). Lack of vitamin A renders them vulnerable to Retinitis pigmentosa and lack of VitE leads to spinocerebellar degeneration.
Muscle: Adductor magnus
Origin: Pubis, tuberosity of ischium
Action: Adducts the thigh at the hip
Positive staining for synaptophysin and chromogranin are immediate buzzwords for neuroendocrine tumors. Paragangliomas are the only type listed here.
Others would be small cell carcinoma of lung, carcinoid tumor, gastrinomas/insulinomas/etc, pheos, medullary carcinoma of thyroid.
If anyone else is on the dumdum boat and didn’t know what a paranganglioma was: a neuroendocrine tumor that begins in nerve cells, closely related to a pheochromocytoma
Halides are the elements in the 2nd the last column of the periodic table (F, Cl, Br, I, etc). Defective MPO prevents conversion of H2O2 into HOCl (a hydroxy-halide) which is aka bleach and the most powerful antimicrobial our phagocytes can synthesize
Remember, HOT T Bone Steak. IL-1 causes severe inflammation and is directly involved in the creation of the lytic lesion.
This one was a doozy. I think by saying "nerve studies show slow conduction velocity," they are referencing saltatory conduction impairment. Therefore they are asking us which channels are necessary for saltatory conduction - which would be voltage-gated Na+ channels.
rssheercare wtan ot oknw CV kisr touba ranfciA imaAcrne aopsilutnpo tbu do ton vaeh daat rof rvyee fpsreI.on a ehrsaecrre awnetd ot nrlae tewrheh bnieg ircntea niyctieth erecansi a iksr fo icrrtaalpu ees,sida ti wluod not be caipcrlta to tusdy eevry daiulidivn from hatt eiinchtyt . I,asentd teh eecaerrsrh hmgti eclets a alsmpe of hte lpoip.ntuoa A malpes si a lelsamr ropgu of ebmmsre of a alpiuotpno sceledte ot ntpsrreee het iooalup.npt nI dorer ot esu stttiascis to nreal inghts utabo teh oonu,ipltap het aepmls stum eb arndom. A onmrad mpales si oen in hiwhc rveye rebmme fo a ouipoplant ash na qleua eccanh of nbieg te.cseeld Teh stmo clymonmo ueds almsep is a eimpsl mndaor .paelms tI urqrisee ttha veyre spieolbs semalp fo the etedslce ezis sah na eqaul hcacne fo gbein u.sde
I answered this via process of elimination.
A) Gliobastoma multiforme - no b/c that would need to show a tumor B) HSV encephalitis - would need to be in the temporal region and also doesn’t quite fit with the 25 year seizure disorder history C) Mesial temporal sclerosis - i have no idea what this is really, but judging from “sclerosis” i assume there needs to be some signs of sclerosis which is not present in the photo D) Neonatal ischemic stroke - no she old E) Vascular malformation - could not think of a vascular disorder that was associated with seizures, but it makes sense b/c the picture shows a bunch of dilated spaces which I assumed are the vessels being malformed
So I think where I got tripped up is that she does, indeed, have multiple myeloma (so there will be increased serum IgG), but the thing that is actually causing her bones to show the osteoclastic lesions shown in the image is IL-1 (osteoclast activating factor). Weird wording. Thanks NBME.
I thought lytic bone lesion-->multiple myeloma-->hypercalcemia
but I suppose that calcium isn't involved in the process of creating the lytic lesion, that would be IL-1 and TNF
Branchial cleft cysts typically occur due to failure of the 2nd branchial cleft to obliterate resulting in a persistent cervical sinus. Branchial cleft cysts will not move with swallowing and classically occur anterior to the sternocleidomastoid muscle
This is straight up testing if you knew Ab nomenclature 🙄. -umab designates human origin while -omab designates murine origin. So bevacizumab is a humanized Ab. The other answer choice saying it was a murine Ab directed against VEGF was designed to trick you. Luckily I did not fall for such witchery.
Diagnosis: strawberry hemangioma
Heme = blood -ang- = vessel -oma = benign mass
A benign tumor of capillaries, therefore the origin is endothelium
FYI since I didn't know the difference
Normal hormonal, male sperm study and normal semen: still can’t conceive then give TYR (???) with clomiphene, that is antagonist at GnRH receptor at hypothalamus, block estrogen mediated inhibition of GnRH hence increase release of LH surge Bromocriptine - would be helpful if the pt has infertility due to INCREASE LPEDS CTIRAON (??? I am assuming its PROLACTIN) - is stopped in US due to clear cell carcinoma in young female born to term. Ethinyl estradiol - bind estrogen & GnRH; LH surge: no use. (Inc risk of endometrial carcinoma) Medroxyprogesterone - is progesterin bind progesterone eonis(oeeccn.rprpmot..t. (???) of morning after pill)
I got this wrong I thought Decreased Myosin Light Chain Phosphatase activity would play a factor from the long leg cast immobilization for 6 months. Not being able to use the leg would cause atrophy. But I was wrong.
Klebsiella has a capsule and is spread through person-to-person contact (e.g. from patient to patient via the contaminated hands of healthcare personnel). "The bacteria are not spread through the air"
Seminal vesicles contribute fructose to the ejaculate. Decreased fructose concentration may indicate an ejaculatory duct obstruction.
isth lecsl lhduos be mste ellc nsaatptlr,n so onghim is the invneeornmt htat acetpc ehtm and osrhuni meht whit tghorw acstorf to rteaum
Colonic bacteria convert lactulose into lactic acid and acetic acid, which acidifies colonic contents. This leads to the conversion of ammonia (NH3), which is a weak base, into its nonabsorbable protonated form, ammonium (NH4+). Once protonated, the positive charge prevents ammonium from crossing cell membranes, keeping the molecule in the colon. As the levels of ammonia in circulation gradually declines, the symptoms of hepatic encephalopathy improve
Diffuse alveolar damage = ARDS -> alveolar hyaline membranes
2 places with osteoprogenitor cells are periosteum and endosteum. Stem cells from periosteum are involved in fracture healing, whereas those in the endosteum are involved in bone remodeling. Source: https://www.kenhub.com/en/library/anatomy/histology-of-bone
SMH I was thinking alcoholic B12 loss of vibratory, so obvious now he has ALS. Hyperreflexia UMN sign, fasciculations LMN sign. And common cause of death is due to aspiration pneumonia because of dysphagia (LMN deficit). FA 2018 p 514
Hurler syndrome (Auto Rec) symptoms - Developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly. Deficient - α-l-iduronidase accumulation of- Heparan sulfate,dermatan sulfate
Hunter syndrome (X-linked Rec) - Mild Hurler + aggressive behavior, no corneal clouding. deficient - Iduronate sulfatase Build up - Heparan sulfate,dermatan sulfate
Why is this VSD? Is it just because she is 3 years old? I was stuck between MVP, VSD.
Middle aged woman thinking autoimmune condition... Restrictive lung symptoms (decreased lung volumes) that get worse as the day progresses matches well with myasthenia gravis.
Chronic bronchitis and alpa1-antitrypsin deficiency both cause obstructive lung disease.
carbon monoxide inhibits the final step of ETC, cytochrome oxidase
Patient is obese with a BMI of 30 and a major risk factor for T2DM is obesity and high-calorie diet.
I get HOT T Bone STEAK IL 1 for fever
but 90% neutrophils, why cant it be LTB4 neutrophil chemotaxis?
https://www.slideshare.net/csbrprasad/imn-csbrp-54556104 i found this link helpful. the atypical cd8+ lymphocytes are diagnostic for EBV
Nitric oxide (NO) is a vasodilator, thus helping to decrease the high pressure of the pulmonary vessels. Pulmonary hypertension has excess vasoconstrictors (endothelin), and deceased vasodilators (NO, prostacyclins). FA18 p 661
Midline mass that moves with swallowing = thyroglossal duct cyst
P. jiroveci: Causes Pneumocystis pneumonia (PCP), a diffuse interstitial pneumonia. Yeast-like fungus (originally classified as protozoan). Inhaled. Most infections are asymptomatic. Immunosuppression (eg, AIDS) predisposes to disease. Diffuse, bilateral ground-glass opacities on CXR/CT. Diagnosed by lung biopsy or lavage. Disc-shaped yeast seen on methenamine silver stain of lung tissue
Treatment/prophylaxis: TMP-SMX, pentamidine, dapsone (prophylaxis only), atovaquone. Start prophylaxis when CD4+ count drops to < 200 cells/mm3 in HIV patients.
A) Codeine - common in cough syrup but it’s a weak agonist at mu and delta receptors, so there’s potential for substance abuse.
B) Dextromethorphan - a cough suppressant with low potential for abuse and does not cause constipation; antagonizes NMDA receptors (not mu kappa or delta receptors).
C & D) Hydromorphone & oxycodone -- potent opioids used to treat moderate to severe pain (I am assuming they work at mu receptors but it’s not in FA so 🤷🏻♀️)
E) Tramadol - a weak opioid agonist used for neuropathic pain, acts by reuptake of NE and 5HT
Loss of heterozygosity: If a patient inherits or develops a mutation in a tumor suppressor gene, the complementary allele must be deleted/mutated before cancer develops. This is not true of oncogenes. (FA)
Chronic EtOH induces CytP450. Acetaminophen metabolism yields NAPQI, which is highly hepatotoxic.
CytP450 inducers: CRAP GPS
Carbamazepine Rifampin Alcohol (chronic) Phenytoin
Griseofulvin Phenobarbitol St. John's wart
FA 2020 pg 206 - Cellular Adaptations - Atrophy
This homing phenomenon may be related to tumour cell recognition of specific “exit sites” from the circulation or to awareness of a particularly favourable—or forbidding—“soil” of another tissue. This may occur because of an affinity that exists between receptor proteins on the surface of cancer cells and molecules that are abundant in specific tissues.
FA 2020, pg 221, "Hallmarks of Cancer"
Metastasis is defined by distant spread via blood/lymphatics --> binding to endothelium --> extravasation & homing.
Since metastasis to only one organ has been affected, it's safe to say this liver cell surface antibody has affected "homing" towards the liver.
This cells should be stem cell transplant so homing is the environment that accept them and nourish them with growth factors to mature
Symptoms of brain AVMS (arteriovascular malformations) include seizures. Brain avms can be found in HHT (hereditary hemorrhagic telangiectasia / Osler Weber Rendu syndrome). More info here: https://www.mayoclinic.org/diseases-conditions/brain-avm/symptoms-causes/syc-20350260 & at curehht.org
ACTH-secreting pituitary adenoma (Cushing disease); paraneoplastic ACTH secretion (eg, small cell lung cancer, bronchial carcinoids)—result in ACTH, bilateral adrenal hyperPLASIA. Cushing disease is responsible for the majority of endogenous cases of Cushing syndrome. Cortisol produced in zona fasciculata in cortex.
Scleroderma (systemic sclerosis) - Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition with fibrosis. Commonly sclerosis of skin, manifesting as puffy, taut skin A without wrinkles, fingertip pitting B . Also sclerosis of renal, pulmonary (most common cause of death), cardiovascular, GI systems. 75% female. 2 major types:
Diffuse scleroderma—widespread skin involvement, rapid progression, early visceral involvement. Associated with anti-Scl-70 antibody (anti-DNA topoisomerase I antibody).
Limited scleroderma—limited skin involvement confined to fingers and face. Also with CREST syndrome: Calcinosis C , anti-Centromere antibody, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. More benign clinical course
i was so confused by this question. is this because the rest are human antigens, so why would we have antibodies against them? but HPV is antibody toward E6 is foreign...?
I think Cheidak-Higashi syndrome -albinism, pyogenic infections, giant granules in granulocytes, cytopenia => defect in lysosomal trafficking regulator gene (LYST) => microtubule dysfunction in phagolysosome fusion.
Top 1/3: Esophageal branches of inferior thyroid artery, which is a branch of the thyrocervical trunk (option E)
Middle 1/3: Esophageal branches of thoracic part of aorta (option B)
Bottom 1/3: Esophageal branches of left gastric artery (which is branch of celiac trunk, which is branch of aorta) (option A)
FA 2020 pg 364: abdominal aorta --> celiac trunk --> left gastric --> esophageal arteries