isTh isavre gnmao steats but ni tsom of the testsa a -21 yare rfee ruszeei peirod si qreidure ofr ctlepiiep tnptiesa to teg trehi encsile
COPD is usually associated with Pulmonary Hypertension. The examiner tells you that there is a loud pulmonary component of S2 ie: P2 (Loud S2/P2= Pulmonary Hypertension). Fev1:FVC is just related to COPD. The question is asking what is DECREASED in the pulmonary VASCULAR SMOOTH MUSCLE. do not get confused with the line stating there is decreased diffusing capacity for CO. the question isn't asking about that.
In pulmonary hypertension there is an imbalance between vasodilation substances and vasoconstrictors. therefore our vasodilators would be decreased eg: Nitric Oxide
if it asked increased, you could go with Endothelin (remember the endothelin antagonists used for t/t of Pulm HTN ie: bosentan sorry gave some extra info but all of it is important because they can ask this concept in many ways
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shTi atntpei sha a dyr apt, hwchi si nese ni sfombrsieilyo nda stacipla inmaae. eTh alobrman BCR ear omts iyellk rdyesocact dreaotpr( lsc.)le
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Costanzo Physiology 6th E p456
Regulation of Vitamin D Synthesis Whether the renal cells produce 1,25- dihydroxycholecalciferol (the active metabolite) or 24,25-dihydroxycholecalciferol (the inactive metabolite) depends on the “status” of Ca2+ in the body. When Ca2+ is sufficient, with an adequate dietary intake of Ca2+ and normal or increased plasma Ca2+ concentration, the inactive metabolite is preferentially synthesized because there is no need for more Ca2+. When Ca2+ is insufficient, with a low dietary intake of Ca2+ and decreased plasma Ca2+ concentration, the active metabolite is preferentially synthesized to ensure that additional Ca2+ will be absorbed from the gastrointestinal tract.
The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!
THIS IS KAPOSI's SARCOMA ==> give antineoplastic
"THIS IS JUST TO LENGTHEN THIS ANSWER, NEVER EVER PAY THIS SITE, EDUCATION SHOULD BE FREE FOR ALL!"
th4 yaahrpelgn phcuo siegv ires ot ureiorsp ysa.odrriathp
FA 0129 gp 067
In meiosis I, the gametocyte splits from a single cell (XXYY) -> 2 cells (XX + YY). In meiosis II these two cells split again (-> X + X, Y + Y). Hence in order for a father to pass on both an X and a Y chromosome to his son (eg in Klinefelter syndrome, w/ XXY chromosome), a spermatid must contain both an X and a Y chromosome, which means that there was an error in meisosi I. The stage at which meiosis I occurs is the primary spermatocyte.
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nitotmarp mnnoite to hcawt out r:fo
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If you got all tangled up on this question like me:
anatomic dead space= conducting airways
Alveolar dead space= alveoli that are ventilated but not perfused (wiki)
physiologic dead space=anatomic dead space+ alveolar dead space
Po2: just no
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Here's how I understand this; please correct me if I'm wrong: Fibrin exudation is part of the acute inflammatory response if the inflammatory stimulus is a lacerating wound, (such as, in this patient, perforated diverticulitis), along with platelets and other clotting factors, in order to clot the wounded area. Hence in this patient who died 2 days following acute perforated diverticulitis, the inflammatory exudate surrounding the liver would most likely contain fibrin (not collagen, since the inflammation is acute and not chronic). Fibronectin and proteoglycans, the other two options, are extracellular matrix proteins.
acute interstitial nephritis
keys are: urine eosinophils + NSAID use + Rash
in the setting of fever and urinary issues
Here's how I thought through this. problem with DCML (absent proprioception and vibration sense), problem with deep tendon reflexes (DRGs), ataxic gait (spinocerebellar pathway), mild weakness (motor neurons). The only thing that all of these pathways have in common is that they all use myelinated afferents.
I don't know if Guillan Barre would actually present like this, but you don't have to know what the illness is to figure the question out.
Just a rant - i hate this f*cking picture it's been on 3 NBMEs now and every time I've gotten it wrong.
If it ain't broke don't fix it. The patient is showing improvement and there are no signs of developing drug resistance or unwanted side effects, so maintain the patient on her current therapy.
Typical antiretroviral HIV therapy regime is:
3 NRTIs OR 2 NRTIs AND 1 NNRTI OR 1 Protease inhibitor OR 1 Integrase inhibitor
In this case the patient is on 2 NRTIs (emtricitabine, tenofovir) and an NNRTI (efavirenz)
If you knew that basement membrane disruption prevents restoration of normal tissue (repeat from another NBME), then you missed this because you didn't know what "preclude" means.
Missing questions I miss due to lack of vocab and grammar, you love to see it
Increased pressure is in the Bowman space (NOT the glomerular capillaries) so the only pathology listed that would cause backward build up of pressure is BPH
did anybody else second guess the heck out this answer just because he's got a pH of 7.2 and he's hanging out in an outpatient clinic? I haven't done my clinicals yet but it seems like this guy would be struggling..
AF 9210 egap 38.0 stMo nmmoco caesu fo ret/myrciaapu iitdsrricaep is ademuss to be la.vri
FA 2109 gp 6-195
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os 2/1 * 21=/ 1/4
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basically polycystic kidneys won't work properly, they've hinted at this with the s.creat of 4mg/dl. thus the kidney won't do what its supposed to do. REMEMBER to check whether they are asking SERUM changes or URINE changes
Kidneys normal function - reabsorb HCO3- , its not doing that now > decreased HCO3
PTH - would cause increased Calcium reabsorption in kidneys, but kidneys aren't able to reabsorb calcium > PTH responds to low calcium levels and levels increase
PO4 ties into PTH as well, PTH acts be DECREASING PO4 reabsorption. Since kidneys aren't working ie: not responding to PTH > there would be increase in PO4
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So we already know the answer is either 11- or 21- Betahydroxylase. How to determine which one?
Question stem cells "dry mucous membranes". He is dehydrated.
We already know that he can't make aldosterone since the lack of either of these enzymes would block that pathway. However, if he is able to make a molecule that ACTS like aldosterone, he would not have dry mucus membranes. He could save water.
Do we have such a molecule? YES! 11-deoxycorticosterone.
Now, if he has 11-beta hydroxylase deficiency, there would be a buildup of 11-deoxycorticosterone. Hence, it has to be the other option.
xaaenoseDtmhe uissspoenpr stet si iicnddeat rfo ittnaeps woh seternp tihw sgnis fo locisrto SE.SECX
She's vomiting - Metabolic Alkalosis > loss of HCL > ie; acid, there would be increased HCO3 Anion gaps are usually with metabolic acidosis because in alkalosis there is high HCO3 which keeps gap normal. For the K+ > vomiting > loose water along with the vomit > decreased blood volume > RAAS activation > aldosterone secretes H+ and K+ > hypokalemia
glSaelpi of astrntoc otni hte neiutproem igudrn a apolytsrrgosimhegan is lnaomr dna dneaicist tapecny fo eht pfoilnlaa bstue.
-aeiMcdl ihtPeprsra oRigaoldy
hte iiradonta eahptry euacsd fbisirso dna eth sfybitoarmbslo nocct"a"rt inrudg sib,soifr guacnis the ecluosr of irywaas nda htsu lcstseeiaat
The subcutaneous tissue is highly vascularized and has larger blood vessels than the dermis, leading to a higher risk of metastasis and worse prognosis (TNM staging system)
The IMA comes off the aorta between the renal arteries and bifurcation. The IMA supplies the hindgut, which spans the distal 1/3 of transverse colon to upper portion of anal canal. Compromise of the IMA would lead to decreased blood supply to these structures, of which "Descending colon" is the only answer choice.
This is the most poorly drawn cell diagram. I see zero ribosomes, so I figured F was the smooth endoplasmic reticulum. However, now I can see that the curved organelle is the golgi apparatus and F must represent the whole endoplasmic reticulum.
I believe plasma membrane proteins are synthesized in the rough endoplasmic reticulum.
FA2020 p46 Rough endoplasmic reticulum Site of synthesis of secretory (exported) proteins and of N-linked oligosaccharide addition to lysosomal and other proteins.
Free ribosomes—unattached to any membrane; site of synthesis of cytosolic, peroxisomal, and mitochondrial proteins.
Smooth endoplasmic reticulum Site of steroid synthesis and detoxification of drugs and poisons. Lacks surface ribosomes. Location of glucose-6-phosphatase (last step of glycogenolysis).
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roocatmOsase oagtihlclosi ap.narepcea tPaeg sseieda is neo fo ikrs crafto
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I went with metastatic breast because they made a point of saying metastatic as if the thyroid carcinoma has not spread to the bone.
hte edeerp eht mloamnea sego eth eoswr het sospnirog
olleisrisy,B tvyeprynieisitHs oeunnisptim nad Ssocosaiird all ahev mraanolgu armfootn.i oAsl aeeniildmt cnogiecpyrt gzrinnagio meinunpoa bc/ hte pt i'dntd aveh nay hcnroic /ds.eeessamsid o,S I asw ltef itwh iipcadtohI nrmypualo sofbiisr as het iohc.ce
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Intracellular aggregates in neurodegenerative conditions :
Alpha synuclein- a protein mainly found in terminal axons which can aggregate and deposit intracellularly to form Lewy Bodies . These are associated with the neurodegenerative conditions 1. Parkinsons Disease 2. Lewy Body Dementia
Neurofibrillary tangles - hyperphosphorylated tau protein , number of tangles correlates with degree of dementia
Pick bodies - hyperphosphorylated tau . these are round aggregates though in contrast to neurofibrillary tangles. Seen in Frontotemporal dementia and other neurodegenerative conditions
Hirano bodies - intracellular aggregates of damaged actin filaments seen in various neurodegenerative conditions e.g AZ , ALS , Creutzfeldt-jakob Disease ( These are not really tested on )
tMso brsempol thwi lelc ivdnisio rcuoc in hepanasa fo osiiesM I.
Follow-up vs support group?
The only thing that saved me was the ancient Step 1 adage: "Never refer!"
Especially when the answer to another question in the same exam was "Encourage the patient to participate in a support group for persons with her condition"
I mean REALLY! The only difference is that they used the word "encourage" instead of refer. Exact same answer.