Need Explanations to NBME 19! Help Please.... - blessedalways

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21- Dx: Androgen Insensitivity Syndrome

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22-

For the women between the ages of of 50-54
Mean serum cholesterol = 246 (with SD of 50)

If we add 1 SD above the mean, it will us 296 (246 + 50), and if you look at the normal distribution curve, at 1 SD above the meane, 84% of these women will have serum cholesterol BELOW 296 and 16% will have ABOVE 296 mg/dL.

https://upload.medbullets.com/topic/1010...normal.jpg

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24- The referring to Cholecystokinin(CCK)

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25-Patient got Disseminated Intravascular Coagulation, during which platelets and clotting factors get consumed formimg clots, as you can note by the given labs.

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Hey, for # 14 I finally figured out that AMP is an allosteric activator because it binds to the y-subunit of AMPK, resulting in the activation of catabolic pathways and the inhibition of anabolic pathways to regenerate ATP. As for #17, the diagnosis is Diaphragmatic paralysis. In fact according to Medscape, it says that in bilateral diaphragmatic paralysis, the accessory muscles assume some or all of the work of breathing by contracting more intensely. An increased effort in the struggle to breathe may fatigue the accessory muscles and lead to ventilatory failure. This would explain why the patient on the vignette had the left sided chest pain and difficulty with breathing. Also, the phrenic nerve innervates the diaphragm and is responsible for helping with the breathing too.

Thanks a lot Metformin500mg, for helping me with answering and explaining the majority of the questions I posted on here. Once again you are such a sweet heart and God bless you till infinity and beyond!

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You are welcome.

17- This is a classic presentation for "Primary Sponataneous Pneumothorax" in a Young MALE patient (page 663 FA 2018). On the given x-ray, note that, on the left side of the patient there is a thin white pleural line and there are no lung markings beyond it (black out). so the answer is "Loss of negative intrapleural pressure"



For "Diaphragmatic Paralysis", one of the clinical scenarios would be a "Pancoast Tumor", impinging on phrenic nerve resulting in ipilateral diaphragmatic paralysis (ipsilateral phrenic nerve palsy) and the chest x -ray will show "Elevation of Hemi diaphragm" on the affected side. (google image it)

Also take a look at chest x-ray for "Pneumoperitoneum" (not only how the x-ray look like but also how the patient can get that).

Also x-rays for Hiatal hernias and congenital diaphragmatic hernia.

These are alll high yeild.

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Thanks again metformin500mg, you are so nice