The key point was ''sphincteric incompetence''. Stimulation of B3 adrenoreceptors will work if it was overreactive bladder, where detrusor muscle is over activated. This patient's main problem was sphincteric incompetence, so relaxing the bladder wouldn't solve the problem. I think of it as if you should try to close the door, so there are two doors, internal (sympathetic) and external (somatic, pudendal). In stress incontinence, the external door is not working, probably due to pudendal nerve injury after vaginal delivery or obesity. So you should try to close the remaining door, the internal sphincter which contracts with Alpha 1 adrenergic stimulation.
regarding my understanding, we are looking for option with high anion gap metabolic acidosis so you will exclude choice A and D because HCO3 high in them, then you will consider Na 140 as they mention in the question it is normal so if you add the cl to HCO3 in option C you will get 134 so it will be normal anion gap so only choice you left with is B.
Quoting step-prep - https://step-prep.org/tutoring/
NBME loves to ask about complaints in elderly patients to assess whether you know which changes are physiological vs. pathological (same with newborns and developmental milestones)
In this patient, all of the findings are normal except for the memory loss because it has only been present for 1 month, which does not correspond with the typical picture of Alzheimer’s
Patients with suspected cognitive impairment are often worked up with cognitive tests (MOCA, MMSE, Mini-Cog), Lab testing (CBC, B12, TSH, BMP +/- syphilis) and Imaging (CT or MRI of brain)
-Key idea: Mild cognitive impairment = short-term memory/cognitive problems that are concerning to patient/family but that DON’T affect daily life or ADLs (using phone, driving, cooking, etc.)
doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything...
Echinocandins is a class of antifungals that include caspofungin MOA is to inhibit synthesis of beta-glucan component of fungal cell wall. This will lead to decreasing the glucan expression on the fungal cell wall.
Delivering bad news requires the physician to be direct, to not give false hope about treatments not readily available, and to use limited medical jargon.
In DKA, epinephrine (adrenaline) stimulates hormone-sensitive lipase to breakdown fat stores in the body, releasing ketones and free fatty acids.
In DKA the body can't use the glucose (due to lack of insulin), and enters starvation mode by breaking down fat stores for energy, releasing free fatty acids (causes an acidosis) and ketones. Adipose cells release energy via hormone-sensitive lipase. Adrenaline including epinephrine stimulates lipase in adipose cells.
This patient still has histoplasmosis. Omeprazole (a PPI) changes the pH of the stomach and can prevent the absorption of certain drugs that require acidic breakdown to be absorbed. Omeprazole is also a P450 inhibitor, increasing the effect and concentration of other drugs.
fa 2020 pg 527 You'll see IDIOPATHIC INTRACRANIAL HYPERTENSION
Also called pseudotumor cerebri. INCREASE ICP with no obvious findings on imaging. Risk factors include female sex, Tetracyclines, Obesity, vitamin A excess, Danazol (female TOAD).
Treatment: weight loss, acetazolamide, invasive procedures for refractory cases (eg, CSF shunt placement, optic nerve sheath fenestration surgery for visual loss
said simply, in biomedical research, the default is to use an intention-to-treat analysis instead of an as-treated analysis.
I find this counterintuitive but such is life.
First lymph nodes to drain different regions of the tongue:
Why did they ask this same questions twice doe
It spells "WitHHold" :).....................
Fancy buzzwords for the same shit: "Amaurosis Fugax" and "Duplex U/S of the neck".
Small Cell - Central. SIADH. Squamous Cell - Central. PTHrP. Adeno - Peripheral. Clubbing (EGF). Carcinoid - Bronchi? Flushing (Serotonin).
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I remember my man Dr. Goljan talking about taking Aspirin and Acetaminophen together and saying buy-buy to your kidneys. good ol' days...
2 in 1 - Tx + Dx for little bastards. But don't do it to an old crank with a perforated diverticulum.