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search for anything ⋅ score predictor (โ€œpredict me!โ€)

Some recent contributions

... โˆ—tamarafainblout made a comment (nbme16)
 +0  submitted by tamarafainblout(1)

why cant it be A? Aren't melanocytes derived from neural crest cells?


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Proteoglycans are extracellular matrix molecules that have a central protein core or backbone structure with covalently attached glycosaminoglycans. Proteoglycans, cartilage, and water are the main constituents of human cartilage.

In osteoarthritis, the breakdown of articular cartilage caused by chronic repetitive use and inflammation results in the decreased synthesis of proteoglycans by the chondrocytes. The loss of this component of cartilage is reflected at the macroscopic level by cartilage degradation and bone-bone contact osteoarthritic degenerative joint disease. Decreased proteoglycan secretion is expected on arthrocentesis, synovial fluid may show few leukocytes, but otherwise will be without evidence of acute inflammation or infection.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

The patient's enzyme needs more substrate to achieve the same effect as the normal enzyme.

The Km is the substrate concentration at which the enzyme achieves 50% maximal concentration.

More substrate is needed in the patient to reach the 50% maximal velocity than is needed in the normal patient so it must be that there is a mutation in the enzyme that increases Km.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

The Bartholin glands, or the greater vestibular glands, are a pair of glands on either side of the posterior vaginal orifice that secretes a lubricating fluid through two small ducts into the vestibule. When one of these glands becomes blocked, a cyst may occur.

The infection is generally polymicrobial, but anaerobes such as Bacteriodes fragilis, Clostridium perfringens, Peptostreptococcus, and Fusobacterium are key pathogens.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Cryptosporidiosis presents with severe watery diarrhea in immunocompromised patients; it is diagnosed by microscopy of the stool showing red-pink oocysts on the acid-fast stain.

The patient with HIV infection and 10 days of watery diarrhea and abdominal cramps has been infected with Cryptosporidium, an intracellular parasite that causes a severe GI illness in an immunocompromised patient.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See this question in NBME 27


... โˆ—shak360 made a comment (nbme18)
 +0  submitted by shak360(14)

See this question from NBME 25.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

The peripheral blood smear shows a schizont form of the parasite, although any malarial stage (gametocyte, schizont, trophozoite, or ring) can be seen on a smear and is diagnostic of infection. CHLOROQUINE effectively eradicates circulating forms if there is no resistance but has NO EFFECT ON THE HYPNOZOITE EXOERYTHROCYTIC forms of P Vivax and P ovale. Addition of PRIMAQUINE effectively treats these liver forms and prevents relapsing infection.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Pulsus paradoxus refers to the abnormal variation of systolic blood pressure between inspiration and expiration (greater than 100 mm Hg). This presents as jugular venous distension sometimes and is often seen in conditions that restrict expansion of the heart, such as cardiac tamponade.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Maternal glucose crosses the placenta while insulin does not (remember that HPL services the baby by shunting the mother's glucose to the baby by conferring insulin resistance to the mom). In response to hyperglycemia in the mom, the fetal pancreatic islet cells increase the production of insulin. If the source of glucose is quickly removed, such as after delivery, the infant has a high risk of developing hypoglycemia, which can lead to convulsions and death.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See this question in NBME 27 asking about what a 5-alpha-reductase deficiency would look like.

The SRY gene is located on the Y chromosome and is responsible for producing the testis-determining factors, which results in male gonadal differentiation. In testis development, hormones secreted by Sertoli cells (MIF Macrophage Inhibiting Factor) and Leydig cells (testosterone and DHT) promote the development of male internal and external genitalia and suppress the development of female structures. SRY gene translocation can occur during recombination in which the SRY gene on the Y chromosome becomes part of the X chromosome, leading to an XX embryo developing male characteristics.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

An intensely eosinophilic globule in the liver is a Councilman body that is indicative of an underlying hepatic disease, viral Hepatitis (usually Hepatitis A), or Yellow fever. This represents a hepatocyte undergoing APOPTOSIS.

Recall that Yello Fever is caused by flavivirus/arbovirus transmitted by the Aedes mosquito causing black vomitus, jaundiced eyes, and the Councilman bodies (intensely eosinophilic apoptotic globules in the liver).

To also answer this question, one had to know that apoptosis caused by activation of the mitochondrial intrinsic pathway is triggered by cellular damage such as radiation, oxidative damage, ischemia, or toxin exposure and leads to release of cytochrome C from mitochondria. Cytochrome C in turn leads to the activation of caspase enzymes. Viral hepatitis primarily leads to apoptosis through the extrinsic rather than the intrinsic pathway.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Morbilliform skin rash is HIGH-YIELD for a drug reaction, the most severe being Drug reaction with eosinophilia and system symptoms (DRESS). It is associated with the use of allopurinol, anticonvulsants, antibiotics like TMP-SMX, and sulfa drugs. This is a potentially fatal delayed hypersensitivity reaction.

It is also related to a severe rash Stevens-Johnson syndrome or Toxic epidermal necrolysis which is also caused by anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, and penicillin.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See here in FA 2020 for a list of extrahepatic manifestations in HepC and HepB. Importantly HepC can induce essential mixed cryoglobulinemia. It presents with palpable purpura in association with arthralgia and peripheral neuropathies caused by immune-complex type III hypersensitivity mediated vasculitis.

The triad is weakness, arthralgia, and palpable purpura. Keep in mind peripheral neuropathy, hematuria, and hepatosplenomegaly and most importantly, Hepatitis C.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

This image is clinically extremely similar to the image for Fibromuscular dysplasia in FA 2020 on pp300.

90% of hypertension is 1ยฐ (essential) and related toยCO orยTPR. The remaining 10% is mostly 2ยฐ to renal/renovascular diseases such as fibromuscular dysplasia (characteristic โ€œstring of beadsโ€ appearance of the renal artery, usually seen in women of child-bearing age) and atherosclerotic renal artery stenosis or to 1ยฐ hyperaldosteronism.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

This question should be easy but if you didn't go through all the options, or if you're like me and tunnel-vision on seemingly right options, then you can miss "gimme" points on a question like this. We know that DNA plasmids in bacterial are circular and don't really have a terminal end or beginning but rather have DNA synthesis sites where DNA polymerases can attach to begin replication.


... โˆ—shak360 made a comment (nbme25)
 +1  submitted by shak360(14)

See this question in block 1 about GVHD.

See also these tables on transplant rejection pathologies from FA 2020.

Chronic allograft rejection of a transplanted organ occurs over months to years (the question was in the timeline of weeks). It is secondary to a CD4+ T lymphocyte response against donor peptides such as MHC. T cell activation leads to cytokine production and humoral and cellular hypersensitivity reactions (type II and IV). When you think Chronic rejection, you should be thinking VESSELS because this often leads to vascular arteriosclerosis and smooth muscle proliferation with parenchymal fibrosis and atrophy.

With acute rejection, you should be thinking of INFILTRATION, that is T-lymphocytes in the vasculature of the tubules and arterial walls leading to endothelitis. The primary histologic changes include interstitial infiltration with lymphocytic cells, in addition to the obliteration of the tubular basement membranes (as in this question with a kidney transplant).


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See pages from FA 2020 and other resources.

The moment we see HepB seropositivity, cutaneous eruptions, and different stages of TRANSMURAL INFLAMMATION WITH FIBRINOID NECROSIS, we should be thinking Polyarteritis nodosa (PAN). It is treated with corticosteroids and cyclophosphamide.

This patient had segmental transmural necrotizing arteritis making PAN the best answer.

Recall that for Giant cell arteritis or temporal arteritis, one would see a headache, temporal tenderness, jaw claudication, and fever.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See this question in NBME 27.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Antiphospholipid syndrome is diagnosed based on recurrent venous thromboses (hypercoagulability), frequent miscarriages, thrombocytopenia, and a false-positive rapid plasma reagin test. It is associated with clinical criteria including a history of thrombosis (arterial or venous) or spontaneous abortion along with laboratory findings of lupus anticoagulant, anticardiolipin, anti-ฮฒ2 glycoprotein I antibodies.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

See this question from the same block asking about Kawasaki syndrome (but related to hepatic encephalopathy).

Systemic ammonia absorption is prevented by the administration of lactulose, which is degraded by gut bacteria to create an acidic environment (via conversion to lactic and acetic acid) that facilitates the conversion of ammonia to ammonium, trapping it in the lumen of the bowl for subsequent excretion in the stool.

Recall that you can also give rifaximin or neomycin to decrease the levels of ammoniagenic bacteria.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Target cells have 4 possible associated pathologies HALT:

"HALT," the hunter said to his target.

Thalassemias can also present with basophilic stippling, where an erythrocyte is just muddled with darkly staining granules (that do NOT contain iron). This is also seen in sideroblastic anemia. Note that in sideroblastic anemia you would see Pappenheimer bodies (iron-containing basophilic granules).

Thalassemias are diseases of defective globin chains, either in the alpha or beta globin chain. The moment you see HbA2 mentioned, you should be thinking of beta-thalassemias. To differentiate between major and minor beta-thalassemias, you need to look at the amount of HbA2 and HbF replacing HbA.

beta-thalassemia minor is primarily an asymptomatic disease with mild microcytic anemia. Hb electrophoresis shows a small amount of HbA2 and HbF and near normal (90%) concentrations of HbA.

This person has NO HbA (an absence of HbA) and increased concentrations of HbA2 and HbF so it must be major beta thalassemia.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

This page from FA2020 and other resources show that certain lab values in pregnancy screening are diagnostic for Trisomy 21.

The easy thing to remember is that in all autosomal trisomies PAPP-A is decreased. (In trisomy 21 Down, 18 Edwards, and 13 Patau, PAPP or pregnancy-associated plasma protein is decreased).

For Down syndrome specifically, first-trimester ultrasound commonly shows increased nuchal translucency and hypoplastic nasal bone.

Finally, in trisomy 21 Down syndrome, the markers are HI up, as in

In other trisomies, these values are decreased.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

These are usually what they teach in school I think:

In general, you want to do it above a rib because the intercostal arteries, veins, and nerves run along the bottom of a rib. You're aiming for the costodiaphragmatic recess which is usually found between the 8th and 10th ribs. The correct position for a thoracocentesis is above the 9th rib on the affected side, along the midaxillary line if the patient is supine, or the posterior midscapular line if the patient is upright.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

I answered this question using the fact that HMG-CoA reductase inhibitors or statins greatly decrease LDL concentrations by upcycling LDL receptors on hepatocytes. It must be that the primary mechanism of serum LDL cholesterol accumulation is then decreased clearance by the liver.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

I thought this question was difficult because I tunnel-visioned on the diagnosis being hepatic encephalopathy (which it somewhat is), but it is hepatic encephalopathy secondary to Reye syndrome.

Mitochondrial dysfunction is associated with the pathogenesis of Reye syndrome, which is associated with salicylate use (such as aspirin) in children preceding viral infection. Usually, a VZV or influenza infection is treated with aspirin, and aspirin metabolites decrease beta-oxidation by reversibly inhibiting MITOCHONDRIAL enzymes. These mitochondrial abnormalities are associated with SHINE:

You want to avoid aspirin in children, except in those with Kawasaki (mucocutaneous lymph node syndrome) disease.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Cat scratch disease is caused by infection with the gram-negative coccobacillus Bartonella henselae*. Infection is acquired via scratches or bites from domestic or feral cats, which can most commonly cause local lymphadenitis in the lymphatic drainage pattern of the scratch location. Because people get scratched on their arms, the most common locations are the axillary nodes. Histological examination shows NECROTIZING GRANULOMAS WITH STELLATE MICROABCESSES.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Recall that red infarcts happen not only when there is venous occlusion and ischemia in organs with multiple blood supplies (such as the liver, lung, intestine, and testes) BUT ALSO WHEN there is reperfusion injury, mainly after angioplasty. Reperfusion injury is due to the production of free radicals and peroxides. Reperfusion injury can also happen after thrombolytic therapy. This is also seen in the first 0-24 hrs of myocardial infarction where reperfusion injury can cause free radicals and increased Calcium influx.

So why then is E) Protease inactivation by cytoplasmic free calcium ions incorrect? Although altered membrane permeability as a result of oxidative damage leads to changes in calcium flux and a rise in intracellular calcium, this intracellular calcium leads to ACTIVATION, rather than inactivation.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

I saw the government building/employees being affected and I instantly picked Anthrax because of that incident where people sent Anthrax-laced letters to people in the US through the mail as a form of bioterrorism. If I had read the question more clearly, the symptoms of organophosphate (or anticholinesterase) poisoning were evident (DUMBBELSS).

The easiest way to remember these is just know that acetylcholine or cholinergic tone in general is usually parasympathetic or "rest-and-digest". So you can urinate and defecate, you can keep your pupils closed, slow your heart rate down, and salivate to eat. Though organophosphate poisoning through something like parathion or malathion is commonly seen in insecticides (where the poisoned victim is usually a farmworker or someone in an agricultural setting), I guess it can also happen as a form of bio-terrorism.

You can reverse this poisoning through Atropine, a muscarinic antagonist, a competitive inhibitor that can cross the BBB. Pralidoxime is also given to regenerate AChE.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Sometimes in pathology, a term will be used exclusively for one situation, and thatโ€™s it. Two phrases that come to mind are โ€œstarry sky patternโ€ (Burkitt lymphoma) and โ€œcerebriform nucleusโ€ (mycosis fungoides/Sezary syndrome). ... โ€œOwlโ€™s eyeโ€ belongs to the latter category of patterns in pathology images that are seen in multiple diseases. It can be used to describe the nuclei of cells infected by CMV (as in this question), and it can also be used to describe the nuclei of Reed-Sternberg cells in Hodgkin lymphoma (CD15+ and CD30+ B-cells) (taken from this blog).


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

This clip from Family Guy always sticks with me for some reason. Some people can become addicted to Phenylephrine or Oxymetazoline (alpha-1-receptor agonists) nasal sprays (like Afrin).


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

The difficult aspect of this question was making the jump from noting he has asthma (which was not obvious to me) and then that he might be hyperventilating and then the final jump to respiratory alkalosis (due to low CO2 from the hyperventilation). If you can make those jumps, you just pick the answer with the high pH, and low CO2 (of which there is only one option).

I guess the acute onset and the high minute ventilation do indicate asthma but it is hard to catch. Dyspnea and hypoxia stimulate an increase in respiratory drive, which in turn leads to tachypnea or increased tidal volume; hyperventilation occurs leading to respiratory alkalosis as acidic CO2 is eliminated.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Dipeptides and tripeptides are produced by the activity of trypsin and chymotrypsin within the lumen of the duodenum. Free amino acids are produced upon further digestion of these small peptides within the brush border of the intestinal mucosa.

The lumen of the duodenum is wrong because that is where larger complex polypeptides are broken down to di- and tripeptides but the action of taking di- and tripeptides down to individual amino acids happens in the intestinal mucosa.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Polyhydramnios is almost always associated with an issue with the baby's ability to swallow amniotic fluid, preventing its recycling and resulting in the overproduction of amniotic fluid. Inability to swallow may be due to esophageal or duodenal atresia or anencephaly. It can also be associated with maternal diabetes, fetal anemia, and multiple gestations.


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Increased concentrations of fetal hemoglobin results in a left shift of the oxygen dissociation curve with the maintenance of the sigmoidal cooperative binding characteristics.

I like to remember the "CADET!, stand RIGHT" mnemonic:

Factors that move the oxygen dissociation curve to the right are those physiological states where tissues need more oxygen. For example, during exercise, muscles have a higher metabolic rate, and consequently need more oxygen, produce more carbon dioxide and lactic acid, and their temperature rises (from Wikipedia on the O2-Hb dissociation curve).


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

Total blood volume can be calculated by the following equation:

Total blood volume = Erythrocyte stuff + Plasma stuff

TBV = hematocrit% * TBV + plasma% * TBV

(where hematocrit% + plasma% = 100%)

TBV = hematocrit% * TBV + plasma volume


and in this question

TBV = 0.4*TBV + 3L

0.6*TBV = 3L

TBV = 5 L


... โˆ—shak360 made a comment (nbme25)
 +0  submitted by shak360(14)

I-cell disease is an AR lysosomal storage disease that results from a defect in N-acetylglucosaminyl-1-phosphotransferase enzymes. This results in the failure of phosphorylation of lysosomal hydrolases, which subsequently leads to their exocytosis from the cell instead of routing to their normal site of action within the lysosome.


... โˆ—shak360 made a comment (nbme25)
 +1  submitted by shak360(14)

One way to have answered this question, if you didn't have the ion values memorized for metabolic alkalosis caused by vomiting is to remember what happens in BULIMIA NERVOSA.

Bulimia nervosa consists of recurring episodes of binge eating with compensatory purging behaviors at least weekly over 3 months. The electrolyte disturbances seen in that disease (which are high-yield and tested often) are

Vomiting and Bulimia both lead to hypochloremic hypokalemia and metabolic alkalosis.


... โˆ—shak360 made a comment (nbme18)
 +0  submitted by shak360(14)

See this question in NBME 25.


... โˆ—shak360 made a comment (nbme18)
 +0  submitted by shak360(14)

See this question in NBME 25.


... โˆ—namesthegame22 made a comment (nbme13)
 +0  submitted by namesthegame22(16)

While EBV infects B cells through CD21,

the atypical lymphocytes in on peripheral blood smear are cytotoxic CD8+ T lymphocytes reacting to the viral infection.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Region of consolidated parenchyma in pneumonia

demonstrates impaired gas exchange and may cause hypoxia.


... โˆ—namesthegame22 made a comment (nbme15)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme22)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme19)
 +0  submitted by namesthegame22(16)

Infertile patient with autoantibodies to sperm on Labs = dysfunctional Sertoli cells.


... โˆ—namesthegame22 made a comment (nbme20)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme21)
 +0  submitted by namesthegame22(16)

Oxygenation of mechanically ventilated patients in the setting of acute lung injury is challenging because of reduced lung compliance and absorptive atelectasis from fluid in the alveolar space.

Positive end-expiratory pressure (PEEP) can reduce the amount of alveolar collapse and atelectasis.


... โˆ—namesthegame22 made a comment (nbme16)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Nevocellular nevus = Nevus.

DDX:


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Epithelial cell connections include tight junctions, adherens junctions, desmosomes, and gap junctions.

Tight junctions are responsible for creating a tight seal to prevent the paracellular movement of solutes or water through an epithelial or endothelial lining.

Inflammation often impairs the efficacy of tight junctions.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

The physician should respond that cancer is a possibility!!


... โˆ—namesthegame22 made a comment (nbme19)
 +0  submitted by namesthegame22(16)

Allosteric activators influence enzymes by inducing conformational change at the active site, which increases binding affinity for the substrate. This is reflected by a decreased Km.

AMP a breakdown product of adenosine triphosphate, is generated in states of fasting and thus upregulates glycogen phosphorylase to liberate stored glucose and supply the cells with a substrate for glycolysis when none is nutritionally available.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

vs.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

The volume of distribution is a theoretical volume in which a drug exists based on its plasma concentration.

It is altered by changes in volume of the intravascular, interstitial, and intracellular compartments.

Increases in volume of distribution are exhibited by a slower rate of increase in plasma drug concentration and a prolonged period before reaching steady-state concentration. (slower to reach the plateau)


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Waardenburg Syndrome


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Most children between the ages of three and five years old will he death is temporary and reversible. Further, preschool-age children are frequently unaware of the inevitability of death.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

The cut point of a test should be set to optimize sensitivity, specificity, or both depending on the clinical utility of the test.

A more sensitive test should be employed when ruling out a significantly mortal or morbid diagnosis.

There is overlap between the two, suggesting that some patients will test equivalently on the test but may or may not have the disease. Setting the cut point to point B would permit all patients within the area under the infected curve to be identified as positive, which maximizes sensitivity, while minimizing the number of false positives, and therefore optimizing specificity while prioritizing sensitivity.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Alcohol leads to the induction of P450 enzymes that convert acetaminophen to N-acetyl-p-benzoquinoneimine (NAPQI), a toxic metabolite that causes hepatotoxicity in the setting of acetaminophen overdose.

M. Acidosis or decreased NAD+ and increased NADH do not play a direct role in acetaminophen-mediated hepatotoxicity!


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

Examination during an open fung biopsy shows a thick: firm, white pleural tumor that ensheathes the right lung. = Mesothelioma.

Asbestosis is a chronic progressive pulmonary disorder associated with interstitial fibrosis and an increased risk for both primary bronchogenic carcinoma and malignant mesothelioma. Occupational risk factors for asbestos exposure include shipbuilding, roofing, and plumbing.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

The round ligament of the uterus is a fibromuscular band of tissue that extends from the superolateral part of the uterus where the fallopian tubes insert, passes through the inguinal canal, and ends in the labia majora. Stretching of the round ligament commonly leads to pain during pregnancy.


... โˆ—namesthegame22 made a comment (nbme23)
 +0  submitted by namesthegame22(16)

The postsynaptic membrane potential (Choice D) may be decreased in LEMS secondary to the decreased presynaptic release of acetylcholine. = WRONG ANS.


... โˆ—namesthegame22 made a comment (nbme30)
 +0  submitted by namesthegame22(16)

During pregnancy, progesterone is produced by the:


... โˆ—namesthegame22 made a comment (nbme16)
 +0  submitted by namesthegame22(16)

Brief psychotic disorder Is characterized by at least one acute psychotic symptom (eg. delusions, hallucinations, disorganized speech, disorganized behavior) lasting less than one month.


... โˆ—namesthegame22 made a comment (nbme15)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme20)
 +0  submitted by namesthegame22(16)

*results in a defect of addition of mannose phosphate to lysosomal enzymes.


... โˆ—namesthegame22 made a comment (free120)
 +0  submitted by namesthegame22(16)

Anticipation is a genetic phenomenon in which disease traits are more severe and/or appear at earlier ages in later generations. Anticipation typically results from trinucleotide repeat expansions. Myotonic dystrophy, which features intergenerational anticipation, results from a trinucleotide repeat expansion of the DMPK gene in skeletal muscle cells that leads to progressive muscle dysfunction.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Struvite precipitates as renai calculi in alkaline urine, which can be caused by urinary tract infections with urease-producing organisms such as Proteus. Urease catalyzes the conversion of urinary urea to ammonia and carbon dioxide, which results in alkalinization. Struvite calculi may be large and branching, often requiring surgical removal

(image with large staghorn stone)


... โˆ—namesthegame22 made a comment (nbme17)
 +0  submitted by namesthegame22(16)

Next step: colonoscopy to rule out CRC.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Protein-calorie malnutrition, or failure to thrive, characterizes the terminal stage of dementia, Alzheimer type.

Signs of protein-calorie malnutrition include weight loss, muscle wasting, hypoalbuminemia, and signs of vitamin deficiencies.


... โˆ—namesthegame22 made a comment (step2ck_form8)
 +0  submitted by namesthegame22(16)

Central diabetes insipidus may result from head trauma and is characterized by inadequate secretion of ADH.

Lack of ADH leads to decreased free water reabsorption from collecting tubules, resulting in an abnormally increased serum osmolality.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Brain Stem Gliomas are the most common pediatric brain tumor and are typically low-grade pilocytic astrocytomas that may occur in the cerebellum or brain stem.

DDX: Arnold-Chiari malformations:


... โˆ—namesthegame22 made a comment (nbme29)
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Clinical manifestations include neurotransmitter deficiency in addition to symptoms normally associated with PKU: microcephaly, skin disease, seizures, and intellectual disability.


... โˆ—namesthegame22 made a comment (nbme18)
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... โˆ—namesthegame22 made a comment (nbme29)
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Colonic malignancy has a long latency period, which suggests that any study intended to detect the difference in risk factors and exposures should also have a similarly long evaluation period.

An absence of sufficient duration may limit internal validity and limit the ability to conclude the presence or absence of an association between the exposure and outcome in question.


... โˆ—namesthegame22 made a comment (nbme24)
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DDX:


... โˆ—namesthegame22 made a comment (nbme29)
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DDX:


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

DDX:


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme29)
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Cortisol and glucocorticoids have a significant anti-inflammatory effect that is primarily mediated by decreasing production of prostaglandins and leukotrienes, which are derived from arachidonic acid.

Activation of the glucocorticoid receptor increases the production of annexin A1: which inhibits phospholipase A2; the enzyme responsible for producing arachidonic acid from phospholipids in membrane.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

DDX:


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Constitutional growth delay presents in patients:

It is associated with normal development and stature once the patient reaches puberty.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

In the dehydrated state:


... โˆ—namesthegame22 made a comment (nbme20)
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... โˆ—namesthegame22 made a comment (nbme29)
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Aortic stenosis is common with aging because of the calcification and fibrosis of the valve that occurs with repeated opening and closing.

Aortic stenosis classically presents with a crescendo-decrescendo systolic murmur best heard at the upper sternal border.

H/o TB not a RF.


... โˆ—namesthegame22 made a comment (familymed1)
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... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme17)
 +0  submitted by namesthegame22(16)

Also Noteworthy:

In acetaminophen overdose, a saturation of phase II metabolic pathways leads to excess acetaminophen metabolized by CYP-mediated reactions to N-acetyl- benzoquinoneimine (NAPQI), which has strong oxidizing properties and is directly hepatotoxic. It's the reactive oxygen species that cause hepatotoxicity from acetaminophen overdose.

Oxidizing free radicals damage hepatocytes through peroxidation of lipids in cell membranes, oxidative damage to intracellular proteins, and strand breaks in DNA.


... โˆ—namesthegame22 made a comment (nbme23)
 +0  submitted by namesthegame22(16)

Type III hypersensitivity is defined by the presence of circulating antigen-antibody-complement complexes that deposit in tissues and cause inflammation and destruction. (she had decreased C3)

type III hypersensitivity reactions: SLE, serum sickness reaction, polyarteritis nodosa(PAN), and post-streptococcal-glomerulonephritis(PSGN). RA is also a mixed Type 3 and Type 4 HSR.

Serum sickness occurs when a drug, such as anti-thymocyte globulin, acts as a hapten to the immune system, triggering antibody formation. Serum sickness reaction usually occurs 1 to 2 weeks after the initial exposure to the drug, reflecting the time required to mount an immune response. The antibodies then bind the drug, deposit in tissue, and attract and activate complement. The result is fever, rash, and arthralgias.


... โˆ—namesthegame22 made a comment (nbme24)
 +0  submitted by namesthegame22(16)

Acral lentiginous melanoma is a subtype of melanoma, that occurs on the distal extremities (ie, acral sites). Its development is not associated with UV radiation, and it is the most common subtype of melanoma in individuals with darker skin (AA).


... โˆ—namesthegame22 made a comment (nbme15)
 +0  submitted by namesthegame22(16)

Also noteworthy:

Macrophages are attracted to the area of PPD exposure via the action of Th1 lymphocytes in patients previously exposed to MTB. They are the predominant cell type found at the site of PPD exposure (the area of skin injection at 48 hours, when it's read) and also in the lungs of patients with pulmonary tuberculosis.


... โˆ—namesthegame22 made a comment (nbme17)
 +0  submitted by namesthegame22(16)

Also noteworthy:

Macrophages are attracted to the area of PPD exposure via the action of Th1 lymphocytes in patients previously exposed to MTB. They are the predominant cell type found at the site of PPD exposure (the area of skin injection at 48 hours, when it's read) and also in the lungs of patients with pulmonary tuberculosis.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Somatostatin analogs, such as octreotide, inhibit the release of VIP and counteract its effects.

Used to treat VIPoma: VIP is released by parasympathetic ganglia and leads to the increased secretion of water and electrolytes by the intestines as we as the increased relaxation of smooth muscle fibers in the gastrointestinal tract. Excess production results in profound fluid and electrolyte secretion into the gastrointestinal tract, severe watery diarrhea, electrolyte disturbances, achlorhydria, alkalosis, flushing, and vasodilation.

Also used to treat diarrhea


... โˆ—namesthegame22 made a comment (nbme24)
 +0  submitted by namesthegame22(16)

Also noteworthy: Somatostatin analogs, such as octreotide, inhibit the release of VIP and counteract its effects.

Used to treat VIPoma: VIP is released by parasympathetic ganglia and leads to the increased secretion of water and electrolytes by the intestines as we as the increased relaxation of smooth muscle fibers in the gastrointestinal tract. Excess production results in profound fluid and electrolyte secretion into the gastrointestinal tract, severe watery diarrhea, electrolyte disturbances, achlorhydria, alkalosis, flushing, and vasodilation.


... โˆ—namesthegame22 made a comment (nbme15)
 +0  submitted by namesthegame22(16)

The cardiovascular system must adjust to postural changes to maintain adequate perfusion pressure to the head and upper body.

Baroreceptors in the carotid sinus and aortic arch detect changes in pressure and stimulate the body's response.(INCREASE FIRING)

Inadequate intravascular volume results in symptomatic orthostatic hypotension.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

SGLT-1 is the cotransporter that absorbs galactose and glucose through the intestinal enterocytes. Deficiency of this enzyme manifests early in infancy as watery, acidic diarrhea and severe dehydration.

Fructose absorption is unaffected as this utilizes the GLUT-5 transporter instead.


... โˆ—namesthegame22 made a comment (nbme29)
 +0  submitted by namesthegame22(16)

Gastric volvulus occurs when the stomach rotates along either its short or long axis to cause gastric outlet obstruction.

It may be caused by anatomic abnormalities (secondary gastric volvulus), the most common of which is a paraesophageal hernia.

Gastric volvulus classically presents with:

severe abdominal pain + dry heaving + and inability to pass a nasogastric tube (referred to as the Borchardt triad).




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