fI a merg lcle or oitmcas clel dha eth logranii nttmou,ia hetn e'rhtes an rsecdiane rski orf cecarn in ohetr atsrp of teh doby Io.tof lyno iealtrn sclel in eon yee is tdmute,a lnoy atht noe eey is ta skri fro erna.cc
So ahtlough otlMsoorisp DEOS recinesa suucm cdnuopoitr and is vrto-estprigctoea d(na ni FA sdeo taets ttha ti sedarcese idca pndt)ocuio,r hyetreb raiscneedg topssymm nda ngaiid ni age,hlni zmopelorea is het "meor crtorce" coec.ih isTh si ebcaues peomerolza si a rtpopp-oumn intobii,hr iwhhc wlil tca eylitrcd on hte noptor upmsp fo eht mosthca nad eseraedc the iodnfnfeg tenag omer naht eht tlmiooosspr ilw.l eor,ehTefr it si teh rstfi nlei drug ofr .GRDE
roiCcihno ivlil mangilps si eht tikagn of etegcin lateraim iwntih in het rcoionich vilil of teh tpac.elan oociCirnh nagmlsip si ndeo nhwe a npeiatt is ta gihh rski ofr achmomolosr nrmaseilaoibt orvisp(eu pso. stes,t o35y ro drl,oe fmylai .)hx ngridu the 103-1 ekwes fo naenr.ycgp
dnoeCfin lpcanleat mosmcsaii trsuels enhw eth ...CSV gnittse ocmse back kbac shginow a oirmys,t tbu lla nsutubqsee isetngt nd(a eht ustef elfits) heva anlrmo comsolhmrao .cnsuot iThs aym eb deu ot eierht a oiabtctplhrso itm,oantu or yb t"omrcsii erc,"seu ni whchi srotmici slcel atth ewre dsoeppus ot eb in hte utsef aer cneonfdi to eth cntaepla ot nevtrpe na amlrbona e.fstu
terfA eth +4DC eclsl ceembo tdefc,nie eth C+8D sllce llki hmet.
So I hate this question because you can know what the diagnosis is and still miss it.
TL;DR: This is lead poisioning, so there is basophilic stippling in a peripheral blood smear [BUT ringed sideroblasts would also be found in the bone marrow]
Why this is lead poisoning: (FA2020 p425)
Why it is NOT the other answers:
This patient is presenting with with STEMI (FA2019 p301), thus the entire vessel must be occluded. Coronary vasospasm via a1 stimulation (increased smooth muscle contraction) would lead to these findings.
As far as the nitro aspect, I think this could be referring to pt history of ischemic heart disease, and the scenario of coronary steal, however I don't think you would need that to answer this question (and I could be going down an unnecessary rabbit hole of misery).
Other helpful pages are FA2019 p238, a1 sympathetic stimulation results in increased vascular smooth muscle contraction.
Last, big ups to the brother for setting arguments aside and still taking his hermano to the emergency department. Perhaps they were arguing at who responded to COVID-19 and medical education worse: USMLE or Prometric.
lIanbiiyt to ntnaimai na eerioctn = tieerlec uytniosfcnd. oS now eht oueqnsti is ?"hWy"
iFegatu, ducitflfiy ielgsnep, yitdfcluif ginotcantercn si iatrgsnt ot ndsuo lkie sdirpeneos. ylucf"iDift crn"toanncietg thgmi eb rpitteeendr as eraimpdi ivxteueec ntufnoic ro the niningesgb of arse-ulaactrvdle mneidaet da(eeitmn dterlae ot lamsl btu onuurmse arleberc i,tcnfsra) but on epSt 1 imeadent illw eb nbtltaa ,(..ie "tlos ish ywa eo,"hm w""igean,nrd c.).et
soeprDisen si tyaucall nmoomc trfea a dngiitbielat tneev ielk o,rekts as oyu hgmit xpcet.e hWti inoeserpds cosme a slso fo aeusxl irntetes dan eit—dheatrs si eesdcaedr ldiibo.
nOe nca ekam teh meartgun hatt a "luarcasv "aptenit hmigt ehav seom isuses wiht ihs sp"eip" aritseos(roielr,sc amiiascraeyym/htspphttaptec tuinfsyod)cn d,na ofr hits nsreo,a nocnrulta cierteon dolhsu eb eerdecdas; but neot ttah hnignto is endoiemnt tuoba sdggniann-tlo rsvauacl dsasiee (no hx fo en)pieohnsr.ty
sA a lu,erst hte sbte wresan oceich hree si C. bdoi(iL eedacrsde btu trnuaonlc eseotnirc n.rml)oa hTe igb onieustq I have i,s woh eht eckh dseo tish guy wonk e'sh rdha nehw 'hse lsaep?!!e p:
eScni teh arf'thes ibligsn si fce,adetf ew wnok thta teh aer'thsf taerpsn ear htob racresir. htaT neams het ibpslseo onepsgtye fo het ahrtfe rea A,A aA, ,Aa or aa.
We owkn teh ehfatr is dneate,ffcu so htat easnm eh ntnoca eb ,aa and utsm eb hirete A,A Aa, or .Aa
ecSin eethr ear nloy 3 inefedfrt npeyetosg he doclu vhe,a ithw 2 of etmh enibg creairr otyes,pnge rhtee si a 23/ briylaipotb he is a ecir.rar
So we nbotia hte pblibtyriao of teh tfearh gpaniss no a csriveees leella sa 23/ (iibtpyorlba of ngibe a rrari)ec x 1/2 atlipro(biby fo sngsipa on a vseeisrce lelael fi he si a ).arcerir heT /32 is not atrvnlee ot hte poliiyatbbr that eth moethr is a cirea.rr
We oknw eth uefcrqeny of afcetdfe asdiidnviul ni het noupoltiap at grale si /,001400 ,^q(=2) os 0q/=12.0
=,q1+P os /00192=9p adn p202q0/)9=1(02/2)0(91.
oT amke ulpltnmictaiio eiears ew asuesm ,21=/90091 s:o
002(q12/=0p211/)=*0 -g;-t& hits si het arcrier ueqrfyecn ..ak.a,( rhost)eoetegyz ni hte pua,itlpoon ichhw we anc muases fro het eomrht.
,So to neswra eth ireten enuositq ew iullptym het bpyrltiiabo hatt fteahr si a raerrci )/23( dan essspa on the lelael 2(/1) meist teh rlitobyipab ttha mhreot is a reirrac 1)010(/ nda ssspae on hte lleael 2()/1; igtptnu it lla oghtetre we h:aev
/3(11)*1))1)22(/(**/0/20( = 102/20 = 0/610
I love this question because we are all obviously trained radiologists...
In reality, rather than identifying every X-ray given and trying to match it to the question stem, the best way to approach this question is to identify what his most likely issue(s) and match to the general characteristic of an X-ray, going to the X-rays looking for these characteristics.
He is an alcoholic with foul smelling (ding anaerobic) sputum. Because he is an alcoholic he is at risk for aspiration pneumonia and anaerobic pulmonary abscesses from aspiration (which is why they mentioned the bouts of blacking out). So what are the characteristics of these diseases? Aspiration pneumonia is a lobar pneumonia which would present with lobar infiltration (see here for example). Pulmonary abscess would present with cavitation and an air-fluid line (see here for example with air fluid level pointed out and here for cavitation/abscess pointed again).
Thinking of this now approach the X-rays looking for specific findings. One has the air fluid level and cavitation, so that is the answer (it is an abscess). None of the others have lobar infiltrate and are either more diffuse or hilar so they should be ruled out.
Oral rehydration therapy commonly consists of sugar/electrolyte water because of the ability to utilize the sodium glucose symporter. Where sodium goes, water follows, so by hydrating with this mixture it allows for an osmotic "pull" of water into the intestines.
Here is an article with more detail and a pretty diagram: https://basicmedicalkey.com/therapy-of-viral-gastroenteritis/
hisT tnpaeti srespetn wthi csiacls purep ootrm ournne ileons pmsys:omt wsesek,an y,rieraeexhlfp nad rcesddeea neissaton. orHvew,e het ontseqiu tsaste ehs n"ncato llte erwhteh her eftl atger teo si drsiea ro sdedspe"re wehn her yees rea oldes,c wihch amy emak oyu irecndorse adn think htree yam eb eoms erpvoicpirtoep ssusie ythe ear yrngit ot ithn .at hsTi si tno eht csea. Elspcyaile noec ethy onteinm eehrt rae on otrhe ieabiomaltnsr i.,.(e on urpep lmib iaratmnioelsb ro irhtg eddsi btmio)aesairl.n If thsi si teh ,asec hetre is no adaemg to het castrt at lal hwc(ih ear ilslt dnodsrieec )MU.N
hofee,Trre eht aadgme si yrlupe omotr adn rssyoen ni het etfl gel, hwich si on the aliedm sapect fo the afrlton and ltarapie eoslb vlersice.eytp isTh aera is dplispeu yb the nrarotei bacreler rt.yaer
Answering this question requires you understand the mechanism of osteoclast stimulation by parathyroid hormone (FA 2020 p332).
Parathyroid hormone stimulates osteoclases indirectly by stimulating the release of RANKL bu osteoblasts which will bind to RANK receptor on osteoclasts and stimulate the resorption of bone. This is a paracrine process because paracrine signaling refers to stimulation by neighboring cells (short distances).
This is my best interpretation with a source and paragraph from the source listed:
In anemia, hemoglobin available is decreased. This causes decreased oxygen binding, and ultimately less oxygen is available for release onto tissues.
"The circulatory adjustments in response to anemia will be similar to those of the preceding case. In order to maintain tissue oxygen consumption at baseline levels associated with a normal oxygen carrying capacity of blood, the reduction in oxygen delivery will lead to an increase in capillary perfusion, and oxygen extraction will increase. Arteriolar dilation and viscosity reduction (for the case of a reduction in Hct) will cause blood flow and oxygen delivery to increase. Both oxygen extraction and oxygen delivery will continue to increase until the oxygen requirements of the tissues are met or until the capacity to increase oxygen extraction and delivery has been reached. The resulting situation is one in which venous oxygen content and PvO2 are less than normal. Since PaO2 is normal for all the anemic situations considered, this defect is not sensed by the respiratory chemoreceptors. Thus, increasing the inspired oxygen fraction is not helpful except for the case of CO poisoning, where high inspired oxygen (e.g., 100% oxygen at ambient barometric pressure or placement of the subject into a hyperbaric chamber) competes with CO binding at the heme site (recall Haldane's first law)." - https://www.ncbi.nlm.nih.gov/books/NBK54113/
This individual has active Hepatitis B, as evidenced by their Hepatitis B surface antigen positivity. Hepatitis B virus productively infects hepatocytes. The CD8 cells will thus attack the hepatocytes.
Another way of approaching this question is to notice AST and ALT elevation are typically indicative of hepatocyte damage.
Ito cells are the same thing as stellate cells, and their primary function is to store vitamin D and fat and produce ECM when activated. Kupffer cells are the liver's macrophages. Bile duct epithelium is not infected in hepatitis.
TL;DR: This is Ewing sarcoma because it is a young boy with small blue cell bone tumor in the diaphysis of the femur
Ewing sarcoma is a malignant bone tumor common in young boys <15y.o. typically found in the diaphesis (middle) of long bones (particularly femur) or pelvic flat bones. It is a small blue cell tumor, meaning the descriptor of small, uniform, hyperchromatic cells with high nucleus:cytoplasm ratio. It also has an "onion skin" periosteal reaction in the bone (described as tissue surrounded by concentric layers of reactive bone in the question). Not mentioned is the association with t(11;22). [FA 2020 p 464]
Why the others are wrong:
eWhn a esculm ursn uto fo ulef e(g, seocgu)l dra/no cinpugrod essl TPA nad as“rce”inde lcnaaomciutu of tsoiabtmlee lla( htreo stoiopn esdsbei hte crcteor ,hoceci) it si a sngi of soetn fo lmsuec .utaigfe The tmse is ngkais hwihc of eth filwgoonl lliw a,e”rs?“dece nad ti si teh Hp hatt lwil sadceeer ssia(c)iod eud to eht umaotlccuina of clcait aidc membere(r ycslsogiyl wayhpta werhe avurypet gset edoetrvcn to ciatlc a).icd
A 70 year old develops a progressive disinhibition syndrome with episodes of emotional outbursts, inappropriate use of language, and socially inappropriate behavior. Where is the most likely damage?
Answer: Frontal lobe disinhibition.
Bilateral amygdala (medial temporal lobe) would've been affected if it was Kluver Bucy Syndrome.
Niemann-Pick is a lysosomal storage disease that is a deficiency in sphingomyelinase that leads to a buildup of sphingomyelin (Niemann picks his nose with his sphinger)
Sphingomyelinase is considered a lysosomal hydrolase
sihT is htaw is known sa a iocsmta otntuima: a oinmtatu ttha uosccr ni gnnniloe-mre lselc dn,a foe,reetrh yonl ffsecte guerhadt clesl edierdv ofrm het rntape lecl iwht eth ottuiam.n So, a nmoutiat curroecd ni a tfetderdianefi aetrnp clle ahtt avge reis ot a ste fo ahredgtu llecs ,ich(wh ni tish eca,s erwe idntesde to oeebcm italenr )sstuie.
giHh craadci ttuupo ot the alnrmoypu aciuitrncol gudirn ceeisxre iwll esuca teh iietonnssd dan cretrunemti of vsoimleecss nad ahtt lwdou cuaes the snarecei ni ttalo ssoaiocrsctnle- area.
reHe rae otw esmiga ttah srtautlile hist pincprile incyl:e
This ratio is used to determine appropriate production of lung surfactant, so this baby would not have appropriate production of surfactant if birthed at the time of the ratio calculation. It would go into neonatal respiratory distress syndrome.
TL;DR: surfactant decreases lung recoil, so the lack of surfactant in this baby will cause an increased recoil which will decrease the functional residual capacity (FA 2020 p661-662)
Surfactant is necessary to decrease surface tension of alveoli and increase compliance of the lungs (remember when the lungs have greater compliance, this makes the lungs easier to fill). Surfactant also helps to prevent alveolar collapse as the lack of surfactant allows there to be varying surface tensions between large and small alveoli (Law of Laplace), so lack of surfactant would lead to widespread atelectasis (alveolar collapse). Because surfactant serves to decrease these forces which normally favor collapse of the lung, it also serves to decrease the lung recoil.
Lack of surfactant in a baby = increased alveolar surface tension, lower compliance, more alveolar collapse, more recoil (less residual volumes)
Total lung capacity is unchanged because with enough force you can still expand the lungs to full capacity.
The above is correct in terms of MoA, however I believe the stem states it is PT (prothrombin) prolongation, not PTT (Partial Thromboplastin). I did not have any idea what dicumarol was.. but here was my logic:
iThs Q dculo be nsewaedr wot a,wsy noe htrough iaeiimotnnl or kinwngo woh to yifntdie the el!uc Now iav elntmniaioi ..A.) ymlnai nsee in IDSA tisptaen ( Q etms edso not etcidr Q ttah w) a)yC uFlo mngilsel rdhaiaer ty a"f")Dt reehT sndee ot be a tdiar " eys yagelPEHmTOA + eSngeo"ayepllm pgkiisn" e"vref "ayniptponcae" yam osla ehva isnk nmlveevoitn E) ulfo lleimgns eenrg gaalvin hciegdrsa
)B CE*LU QUR APIN + celru
gnenosOec iwht agin of nionufct uantmtoi dael to nsceidear cnpisatt,rroni ct,.e haserew muort speopusrrs ensge bkloc ;-S&tG1-g h.easp N1F enge ptodurc has SAR eaTsGP tiyiacvt whchi ksowr by nophoahitglrpys nad vinactatgi enriotp u)nmifib.(eronor oS erteh is ta lstea 1 omrut srrospuesp egen that okwrs houthrg n.hpiolytrhaopos
isTh is yseilnsteal a ormlaf ilgoc snuq.ioet oilaLycgl ,paiekgns the euqostni ksas su ot idyeitfn a aisenhcmm taht turom sspusropsre aevh chihw opntrgosooeenc- od on.t nI oerht ,odwsr what si a nsmhemiac hardes yb lal nknow orumt epsrsusprso tbu not ehsdra by nya knnow octone?n-sprgeoo Fro hatt esoan,r it tan’c be ntiypah;lsohoopr ,resu yapitlhhorosnop is a smmichane fo utrmo pssorrespus tbu ist’ aosl a mascmenih fo aymn nnowk eegcnpoo.onsr-ot
ndignouCnfo" "lbieasrva rhee enmsa fn"nuoonigcd b,"isa sieea.nstlyl And sith si tuer sabeeuc a cpspevreoit rohoct oslko ta a ciipesfc eexospur to a besuctnsa vnniealmrtno(e ,onixt u,rdg ce,.)t nad kssa h"Wo llwi lopevde this eisseda if x"oe?dpse sPS'C kloo ttaeptm ot infd a artelevi kris csesaaotid ithw na xsruoe.ep ehyT do nto akte noit unaotcc the ftcsefa rothe .exsuoersp ihTs is oury nuofidnocng i.abs AF gseiv the elaepmx of fdoonnicngu bsai as rmaPlu"yno eeissad si mero nmcmoo in skowerr ni a loca min;e ewerho,v ensmri are mero elkiyl ot k"meos, nad ecisn smkgino anc alos aled to nuamloypr edessa,i uyo n'cta yrlela say heethrw eht snigkom tifs(r or nsodce ah)dn ro eht lcao udts cueass eht per.olbm A callniic r,tail on hte htroe nhad, ascnntoi a stet rougp dna a nctorol ,ruogp so eblasiarv hcsu as eht onifnudgnoc ilabaevr emennidto veboa aer iie.mtdl
TL;DR: You want the most sensitive test first to rule out the disease in negatives (least likelihood of false negative) and the most specific test next to "rule in" only true positives (least likelihood of false positives) [FA2020 p257]
The way I always think of sensitivity and specificity is in relation to false negatives and false positives.
In this question, you want to ensure you are only treating those who actually have the disease, or in other words that you want to minimize your false positives. The best way to do this is maximize sPecificity. Test 1 has 100% specificity meaning it will have essentially NO false positives which is great so we definitely want to use it (eliminating all but two options)! The better way to ensure you are catching as many cases as possible while still only getting true positives is to test with test 3 first, which has a much higher sensitivity. That way we are ruling out disease in the negatives of test 3. This also adds to our ability to only truly treat those with disease as we have ruled out disease in our first negative population, then we test the positives to "rule in" disease with a highly specific test.
The issue with using Test 1 first and only testing the positives is we know the positives from test 1 are likely true positives, as the highly specific test would have a basically zero false positive rate. At that point there would be no point in testing with test 3, as we have basically a true positive population. The issue is we have missed a lot of diseased due to the low sensitivity and high false negative rate of test 1.
Another way to think of this is to remember the formulas (as seNsitivity contains false Negatives, and sPecificity contains false Positives in the formulas; see FirstAid):
SPIN/SNOUT also helps to remember that specific tests rule in disease, and sensitive tests rule out disease
This requires knowledge of MOA for phosphodiesterase inhibitors (which are also used for erectile dysfunction). All phosphodiesterase inhibitors will inhibit phosphodiesterase, which normally catalyzes hydrolysis of cAMP or cGMP, so they will work by increasing cAMP/cGMP levels! [FA2020 p246]
NOTE: do not get confused by the addition of NO as an answer, though arteriole dilation by phosphodiesterase inhibitors works in part by enhancing NO activity on smooth muscle, it does not increase the concentration of NO. NO triggers increased cGMP to dilate smooth muscles, and phosphodiesterase inhibitors prevent breakdown of this cGMP, so they work in synergy!
hTe tirgh 'eesy ffteeenr rsenev rae kgi,worn as elft yee tmisoanilut eascsu a ngaech ni eth ithgr hye.eeT itghr eey tcpio n. maaged acsuse 'tsi fteneafr .n ot eb agdema.d It 'tnac rcyra ionf to ,abnri so rhigt dna flte eey a'tcn nttiorcsc to hlit.g
7-dehydrocholesterol is a form of pre-vitamin D3 synthesized in the skin from UBV. It is converted to Cholecalciferol, which is the inactive form of Vitamin D3 that is actually in first aid.
ehT mest etsats thta the rtmhoe is 21 wseek ntisto.aeg CSV si fperrmedo s1t treteis,mr uasluly t/b 0-141 ekwes sgentioat ognrdcaci to e-Dp-att.oU Amino si mpeorfedr ertfa 15 ewsk.e Frmo tteDa:-p-Uo ets“Aeiscinmno oldhsu eb ferdpmoer refta 51 wskee of nittgosae euseacb eerlair sprecedour rea sels yellki ot eb uf,usecscls ear osseaaditc ihwt eghrhi retsa fo lelc lcuutre r,liuafe and ryarc eargter tfeal ”rsk.is
Another tRNA has to attach to the A site before the peptide chain can be hydrolyzed from the P site and moved to the A site tRNA (FA 2020 pg 45)
hiTs tptiena ihtw a ohrsyti ihcrcno rnptinsyoeeh is stom ilyekl ifufgrnse frmo felt aetrh ilfauer ereadde(sc adcaric tu,ou)top ngicusa eht obldo to back up ni eth gsnul (realkcCs rae eadhr ,ellatrbyila ehnssrsot of abh)ert nda taht nrsgltuei tino dnrceisea rtafleoda orf the tihrg esid fo het ,aerth nagirsi eht purseser ni eht ihgrt hrate hcr,mbase whihc gte tsdaenirtmt abck ot cltenra en.vi
Penicillin can cause a direct Coombs + autoimmune hemolytic anemia
The Direct Coomb's test involves anti-Ig antibody (Coombs reagent) added to patient’s RBCs. RBCs agglutinate if the RBCs are already coated with antibodies (indicating that the body is making antibodies that bind the RBCs). RBCs tagged with antibodies are destroyed in the spleen. Penicillin is thought to act as a hapten binding with proteins on the RBCs and triggering an antibody response against the penicillin-RBC complex [FA2020 p423]
tight junctions between adjacent sertoli cells form blood-testis barrier--> isolate gametes from autoimmune attacks
Overflow incontinence is present (bladder fills then leaks slightly), so either:
1.) something blocking outflow (e.g.; BPH)
2.) impaired contraction of bladder (e.g.; damaged nerves)
Only the pelvic nerve causes detrusor contraction, so it is the only possible answer. External sphincter, pudendal nerve, and skeletal muscle all does the same thing. Hypogastric nerve helps retain urine (relaxes detrusor) so it is clearly not damaged.
This is G6PD deficiency. (FA2020 p422)
G6PD deficiency causes a hemolytic anemia when individuals are exposed to antimalarials due to the increased oxidative stress. This is due to the deficiency in replenishing NADPH which is necessary to replinish reduced glutathione which aids in quenching free radicals.
The key to answering this is that she seems unconcerned with her symptoms, which is a hallmark of conversion disorder (la belle indifference) [FA2020 pg 566]
Illness anxiety disorder would be preoccupation with having a certain illness, and inability to be reassured when there are negative findings.
Depersonalization/derealization is a dissociative disorder and "out of body experience" with a feeling of detachment from the body or environment.
Brief psychotic disorder would present more likely with delusions, hallucinations, or some other characteristic of psychosis.
PTSD would present after an extremely traumatic event when symptoms such as anxiety, flashbacks, hyperarousal, and nightmares persist for greater than 1 month after the event.
The first thing to look at is potassium, which would decrease because insulin facilitates intracellular shift of potassium (which is why it is used as a treatment for hyperkalemia!). This leaves only two potential answers!
The next thing I immediately noticed was that our patient's labs indicated anion gap metabolic acidosis (likely due to diabetic ketoacidosis). Administration of insulin would improve this condition, and one of the main things that would occur is correction of acidosis, so pH would increase. The other parts of the answer also make sense, as bicarbonate begins to return to normal with the increase in pH and less necessity for use in buffering, BUN decreases as the kidney damage occurring can be mostly reversed, and blood CO2 increases because there is no longer the need for respiratory compensation of the metabolic acidosis.
Presence of multinucleated giant cells surrounding foreign body (staple) shows granuloma.
TL;DR: T-cells are primarily responsible for both acute (weeks to months) and chronic (months to years) rejection; this would be acute rejection [FA2020 p119]
Hyperacute rejection (minutes): from pre-formed antibodies in the recipient which trigger an immune response in the recipient via complement activation (Type II hypersensitivity)
Acute Rejection (weeks to months): recipient T-cells recognize donor MHC on donor dendritic cells (Type IV hypersensitivity); humoral component (Type II hypersensitivity) to a lesser extent AFTER the T-cells have recognized the MHC as foreign
Chronic (months to years): recipitent T-cells recognize alloantigens [which are antigens which would be self in a normal tissue in the donor, but are recognized as foreign in the recipient] presented by recipient dendritic cells (Type IV hypersensitivity); humoral component (Type II hypersensitivity) AFTER the T-cells have recognize the MHC as foreign
tWha saw ungiconsf rof me in isth qeusnoit asw taht eh ash an cetua ioerantspetn. atTh dditn eamk sesen to ..e.m He vdeil 47 sryae whti arlen reytra ionssste nad now sha nnpiheoesrty esacbeu fo it!?
While not traditionally discussed, the kidneys' contributions to maintaining glucose homeostasis are significant and include such functions as release of glucose into the circulation via gluconeogenesis, uptake of glucose from the circulation to satisfy their energy needs, and reabsorption of glucose at the level of the proximal tubule.
FA2019 p78 - [Gluconeogensis] occurs primarily in the liver; serves to maintain euglycemia during fasting. Enzymes also found in kidney, intestinal epithelium.
... seems like a silly thing to test... shrugs shoulders laughs in NBME
Amniotic fluid phospholipid analysis is used for testing fetal lung maturity via measuring surfactant production.
Fetal echocardiography would reveal any congenital heart defects if present, but would not be diagnostic of Downs syndrome
Fetal ultrasound First-trimester ultrasound commonly shows increased nuchal translucency and hypoplastic nasal bone. But I feel this is used more commonly in older women who might have chromosomal dysgenesis as the cause of downs syndrome
Fetal biopsy Pretty invasive technique, when we have a lesser invasive and more specific test available.
Many opioids (like morphine) are potent histamine releasers, which can cause puritis and anaphylactoid reactions (such as seen in this patient with the facial flushing, drop in blood pressure and corresponding increase in heart rate). Puritis is actually a common side effect of morphine.
Source: First Aid and
I am assuming this is just something we are expected to know; tubular reabsorption requires the most oxygen because it would consume the most ATP out of the processes in the kidney?
Complete Androgen Insensitivity Syndrome (CAIS):
In heparin induced thrombocytopenia IgG Ab are developed against platelet factor 4 leading to thrombosis and thrombocytopenia
FA2020 pg 436
FA2020 pg 48
retrograde transport= dynein
anterograde transport= kinesin