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Recent comments (see more)

... divinedomain made a comment (free120)
 +0  submitted by divinedomain(1)

honestly fuck them. increased direct should point you to another dx.

... kshaps44 made a comment (nbme20)
 +0  submitted by kshaps44(1)

^ Important read, if you have the time.

... calvin_and_hobbes made a comment (nbme21)
 +0  submitted by calvin_and_hobbes(1)

Tacrolimus has the same MOA as cyclosporine

... antigunner made a comment (nbme22)
 +0  submitted by antigunner(1)

This question is describing what is literally called "Head Out Water Immersion." The pressure that the water exerts on the body is greater than the pressure that air exerts on the body. This hydrostatic pressure pushes the water in the limbs up into the central cavity (the rib cage protects from this hydrostatic pressure). Because there's more blood in the central cavity, the heart experiences an increase in volume. This is why you often need to pee more often when standing in the pool.

In summation: water pushes blood into center cavity -> increased blood volume in central cavity -> blood stretches heart -> increase in ANP

... hivwizard made a comment (nbme23)
 +0  submitted by hivwizard(1)

The owners are a bunch of assholes they just took everyones descriptions and are now trying to make money off of it you guys are useless

... hivwizard made a comment (nbme24)
 +0  submitted by hivwizard(1)

The owners are a bunch of assholes they just took everyones descriptions and are now trying to make money off of it you guys are useless

... calvin_and_hobbes made a comment (nbme21)
 +0  submitted by calvin_and_hobbes(1)

"clear-fluid-filled, tense blisters" and "subepthelial blister" with "autoantibodies" scream bullous pemphigoid, but I thought BP blisters were itchy>>painful. Contrast with pemphigus vulgaris in which pain>>itch.

... calvin_and_hobbes made a comment (nbme21)
 +0  submitted by calvin_and_hobbes(1)

This Q stem was confusing to me because I thought pain>>itch for shingles. Any thoughts?

... calvin_and_hobbes made a comment (nbme21)
 +0  submitted by calvin_and_hobbes(1)

"In addition to slightly decreased platelet count..." — why are plts slightly low in EBV infection/mono?

... empem28 made a comment (nbme22)
 +0  submitted by empem28(1)

totally buy the answer of K+ being increased, but can somebody explain why her extreme dehydration (decreased skin turgor, excess urine output) wouldn't lead to an increase in serum [Na+]?

... jamespham93 made a comment (free120)
 +0  submitted by jamespham93(1)

Pt shows classical signs of lack of platelet ADHESION. ADHESION is mediated by vWF. Platelet AGGREGATION studies test for AGGREGATION, which is mediated by fibrinogen, thus they have normal results on lab testing as they are not testing a pathway that uses vWF (very miniscule detail I know, very annoying).

... peachespeaches made a comment (nbme20)
 +0  submitted by peachespeaches(2)

Because it is a straight downward slope, you can also tell that Y and X are bound in similar ways by antibodies. What differentiates the two, then, isn't epitope binding capability, but the concentration. All else equal with binding sites, more Y with an unchanging amount of X will lead to less X bound, in a 1:1 manner.

... peachespeaches made a comment (nbme20)
 +1  submitted by peachespeaches(2)

Don't need to know this is FAP to get it right.

Father and Grandfather had it, so can assume an AD mutation in this patient. Assuming her partner is homozygous without the mutation, the risk of her AD train going to her child is 50%

peachespeaches  *AD trait +
... sd22 made a comment (nbme21)
 +0  submitted by sd22(1)

Can anyone help explain what the other options would entail?

... sd22 made a comment (nbme21)
 +0  submitted by sd22(1)

RIPE: Rifampin, Isoniazid (INH), Pyrazinamide, Ethanbutol.

RIPE treats TB.

Side Effects:

  • Rifampin: Red-orange metabolites. Skin/fluids can become red-orange. 'R'ifampin makes you 'R'ed
  • INH: Drug-induced lupus (DLE), iron accumulation in mitochondria (can lead to sideroblastic anemia), neuritis, and hepatitis. Give B6 for neuritis and SB anemia. INH has 3 letters like DLE
  • Pyrazinamide: Hyperuricemia (gout). pURICinamide
  • Ethanbutol: Effects eyes. Decreased visual acuity, red-green colorblindness. EYEthanbutol
... magneto made a comment (nbme21)
 +0  submitted by magneto(1)

Dirty Medicine has a great mnemonic to memorize these diseases:

... magneto made a comment (nbme21)
 +0  submitted by magneto(1)

Compression of the C5/C6 spinal nerves would mean the axillary nerve is compressed.

(Use the mnemonic: 5 Muskateers Assassinated 5 Rats 5 Mice, and 2 Unicorns; assassinated would be C5/C6 and axillary sounds like assassinated)

The axillary nerve innervates the deltoid muscle which abducts the upper extremity.

... machetebetty made a comment (step2ck_form6)
 +0  submitted by machetebetty(1)

Bacterial vaginosis is also very common in women/people with vaginas who have sex with women/people with vaginas, and more common in that population vs gen pop.

One 2005 study of 12K vagina-owners found 45% prevalence in folx who'd had at least one partner with a vagina, vs 29% rest of study population.

(Sorry no link, just sharing from "Lesbian Health" by Dibble & Robertson.)

... uasid made a comment (nbme18)
 +0  submitted by uasid(67)

Hydronephrosis causes tubular atrophy from compression of the tubules by urine. Two common causes of hydronephrosis in infants and young children include pelvic-urethral obstruction and vesicourethral reflux.

Some notes
❧ Some comments are scramble-resistant (Scramble-resistant Staphylocomment aureus)
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Help your fellow humans! (see more)

calvin_and_hobbes asks (nbme21):
This Q stem was confusing to me because I thought pain>>itch for shingles. Any thoughts? help answer!
calvin_and_hobbes asks (nbme21):
"In addition to slightly decreased platelet count..." — why are plts slightly low in EBV infection/mono? help answer!
empem28 asks (nbme22):
totally buy the answer of K+ being increased, but can somebody explain why her extreme dehydration (decreased skin turgor, excess urine output) wouldn't lead to an increase in serum [Na+]? help answer!
sd22 asks (nbme21):
Can anyone help explain what the other options would entail? help answer!
marcspoop asks (nbme20):
Anyone else jump to phenylephrine as a drug that would clear the sinus congestion and also happens to cause constipation? Just me... cool help answer!
ekraymer asks (nbme22):
Was it wrong to see blood tinged sputum, and automatically assume its cancer? since none of the others would have caused blood tinged sputum? help answer!
calvin_and_hobbes asks (nbme20):
Due to its pink staining, I thought B was smooth muscle surrounding the corpus cavernosum. But I suppose that the cells composing the CC are contractile by themselves? And my assumption would make the penis a giant muscle — which it most certainly is not... help answer!
calvin_and_hobbes asks (nbme20):
Why is the T normal in this patient? I would have predicted underlying infection — ie, fever — before even "early" septic shock. I selected septic shock purely for the intractable low SVR despite fluids but want to understand more about the absence of fever... Thanks! help answer!
drdoom  Elderly (and immunocompromised, generally) do not mount robust fever responses to bacteria and other microorganisms; in elderly, this probably has to do with “declines” of the innate immune system (your macrophages, dendritic cells, monocytes, &c., just don't function as well as they used to). In other words, if you (1) wiped out someone's immune system and then (2) injected bacteria into their bloodstream, you wouldn't observe any fever either. The presence of a “typical” (normal) fever in an elderly or immunocompromised patient can be a super concerning sign: they might have a raging infection on the inside. +
drdoom  ^from the article: “Absent or blunted fever response in the elderly. There is ample evidence that a blunted fever response to a serious bacterial, viral, or fungal infection suggests a poorer prognosis than does a robust fever response [13]. In addition, there is a substantial body of data, mostly from animal models, that fever—through its effects on immune function—may be an important host defense mechanism [14]. Roughly 20%–30% of elderly persons with serious bacterial or viral infections will present with a blunted or entirely absent fever response [2,3,15].” +
iwannabedonewiththis asks (nbme21):
just as a general question, would there be low levels of 1 25-(OH)2 ? help answer!
sd22  Yes, kidney has 1-alpha hydroxylase which converts 25-HCC to 1,25-HCC. CKD -> low 1-a-OHase activity -> low 1,25-HCC +
peachespeaches asks (nbme21):
I agree that Serum K decrease is the better answer, but wouldn't Urine K also decrease once blood sugar goes down with insulin treatment (i.e. osmotic diuresis would lessen)? help answer!
freemanpeng asks (nbme24):
No one talks about AR? That's much more unlikely in this case than XR help answer!
epiglotitties asks (nbme18):
I understand that feedback inhibition isn't working and is why ACTH is undetectable/low (and why there is no change after dexamethasone), but wouldn't cortisol levels increase after dexamethasone? Or does dexamethasone not count as cortisol when quantifying serum levels? pls help help answer!
misseili  This patient has Cushing Syndrome and as you stated their feedback inhibition is hampered. Low-dose dexamethasone causes a decrease in cortisol in normal individuals but not in those with Cushing Syndrome, only high dose dexamethasone causes a decrease in cortisol with Cushing Syndrome. Add'l info: In ectopic ACTH (ie Small cell lung cancer) high dose dexamethasone leads to no change in cortisol. Pathoma 2020 Pg 171 +1
freemanpeng asks (free120):
The key is when her legs up, Bp normal and symptoms free. In contast, When standing up(running), low Bp and syncope. And Low volume is surly the MMC. It's just so weird. "retrospective posture change"?? help answer!
madamestep asks (nbme24):
Anyone else get this right because they get them so often from absolutely uncontrolled stress? help answer!
bfinard1 asks (nbme20):
Can someone explain why cardiac output is high in septic shock? help answer!
drdoom  Bacteria and bacterial components (like LPS) in circulation trigger massive release of cytokines (Interleukin-1, Interleukin-6 and TNFa), resulting vasodilation. Heart rate increases to maintain decent BP. +1
bfinard1  Is stroke volume not affected by that massive vasodilation? I would think if venous system is vasodilated then you'd have reduced EDV from reduced blood flow to heart +
zedora  Both of you are correct. In septic shock there is a massive vasodilation. In order to compensate for the reduced blood pressure, there is an increased heart rate. Now, keeping this in mind, what is the CO formula? CO = HR x SV Right? Lets say under normal conditions HR is 60 & Stroke volume is 50. Your cardiac output = 60 x 50 = 3000. Now in septic shock, your heart rate is massivly increased but your stroke volume is decreased minimally. So lets plug in the numbers. Lets say, under septic shock, HR = 150 & stroke volume is now 30. The cardiac output is now gonna be = 150 x 30 = 4500, hence your CO is increased. In Septic Shock, the heart rate is massively increased compared to the amount of SV decreased. +
drdoom  @bfinard1 By vasodilation, I almost exclusively mean arterial vasodilation. When it comes to CV, I always work backward from “first principles”, and in my view the first principle of the CV system is, “Maintain pressures to maintain good flow.” All other accommodations of the CV system (changes in inotropy[strength], chronotropy[time], vasoconstriction and vasodilation) are in *service* to maintaining flows. Without good flows, you get the thing human tissues like the least: not lack of oxygen but accumulation of CO2 (and the acidity that goes with it). +
drdoom  So, all that was a long-winded way of saying that Cardiac Output will remain high when the body is producing higher-than-desired levels of CO2 (when organs and the immune system have gone into overdrive to respond to a threat or to address decompensation in some other part of the system); the plummeting of Cardiac Output heralds the beginning of the end. It signifies that the stresses being imposed on the body exceed the capabilities of the system. +
duckhunter324 asks (nbme18):
What would a rupture of the fallopian tube look like then? Compared to normal spillage.. help answer!
epiglotitties  I was wondering the same thing +
sunnyside asks (nbme20):
Can anyone justify why they did not describe an increased MCHC? FA 2019 says spherocytosis has high MCHC, and they did not even have it on the upper end of normal. help answer!
peterngo1994 asks (nbme22):
The thing that threw me of was the 74% neutrophil count. Does anyone have an explanation for this? help answer!
drdoom  Neutrophil count is different than neutrophil percentage (%). Percentages can be influenced by changes in volume, e.g., if the patient is dehydrated, percentage by volume can be skewed. +
madamestep asks (nbme23):
Remember that medullary carcinoma of the thyroid is medullary. So it's between the follicles. What's between the follicles in the thyroid? C cells that secrete calcitonin. help answer!
daplatesofmetal asks (nbme23):
What is TARNATION is going on here!? help answer!
freemanpeng asks (nbme21):
Can anyone explain what "diplopia" implies? I got sutck by"these clinical findings" (thinking upward gaze+ diplopia....) Or is "Diplopia" just a unspecific word in exam?? help answer!
madamestep asks (nbme21):
Why don't we see a decrease in the size of the prostate gland? Is it a difference between atrophy vs. apoptosis? help answer!
unknown001 asks (nbme21):
ATTENTION DEFICIT- hyperactivity disorder. how do we improve the attention deficit in that kid ? by increasing dopamine and norepi levels in the brain. dopamine and norepi= biogenic amines funstory. newyork times once reported abuse of stimulants by students so they can have an academic advantage by improving attention help answer!

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