Step I USMLE images
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Nope, De-la-Chapelle is a situation where there's abnormal crossing-over between X and Y chromosomes, generating a sperm with an X chomosome that also contains the SRY-gene.
This is a congenital mutation of the 3-beta-hydroxysteroid dehydrogenase enzyme, which leads to a deficiency in all the end-products of normal adrenal steroid biosynthesis.
In the diagram from FA, it takes out all but the top row. Leaving DHEA present, which being a weak androgen, virilizes female fetuses, but undervirilizes male fetuses.
You end up with phenotypically similar babies either way. They sorta meet in the middle with respect to the mechanism for ambiguous genitalia development.
I thought it was a cool mutation...
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will this patient most likely have:
a) diarrhea
b) elevated ESR
c) anemia
d) musculoskeletal pathologies
e) infertility
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will this patient most likely have:
a) diarrhea
b) elevated ESR
c) anemia
d) musculoskeletal pathologies
e) infertility
Musculoskeletal Pathologies. Pancoast's Tumor, can get at the brachial plexus.
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heehee I don't actually know. I chose that too so I'm hoping someone here can confirm that ulnar is correct
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Dx?
Volvulus
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Right.
Thanks, yeah I can see it's coming from the sigmoid region. But I am (or at least was) unfamiliar with the convention for describing them (GI was last year and haven't hit it in FA yet). I assumed right since it's occupying most of the right upper abdomen.
Now I know, thanks to this question.
Biopsy would be diagnostic (Hirschsprung has absent inntervation, causing backup). It would also present shortly after birth.
It would also be more like megacolon due to impaction rather than volvulus I'd think.
I think of volvulus as a twisting off of a loop of bowell.
dude, exactly what in the **** is going on here? Are they removing segments of rectal canal and distal colon.... intra-anusly..?management of hirshprung.... looks painful
why is the gapping hole at 1 mo. a good thing? They can poop now but they are totally incontinent?! why not just do a colostomy?
I gotta think the anus and rectum are spared, and that it will heal up well in the long run.
But those are some pretty intense photographs!
yeah this is correct, i have it written into my first aid, presumably from uworld, that it would mess with the lower trunk!
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Our tests were 50% images for path (w/thousands of images over the semester), and it still didn't cover what a lot of the buzz word stuff looks like / descriptions of how buzz word things actually manifest. I think UW has done a really good job of filling that info in, and hopefully the NBME's will round it out
alright, I have a good one.
30 y/o man, recently traveled to south-east asia within the last year where he remembers riding elephants and swimming in local lakes. has a hx of upper right quadrant pain and now presents with noted enlarged liver and spleen along with abdominal fluid wave on abdominal palpation.
Here is a liver biopsy. dx?
30 y/o man, recently traveled to south-east asia within the last year where he remembers riding elephants and swimming in local lakes. has a hx of upper right quadrant pain and now presents with noted enlarged liver and spleen along with abdominal fluid wave on abdominal palpation.
Here is a liver biopsy. dx?
33 yo female presents with "a lump in my throat"
ROS positive for: weight loss, increased appetite, and diarrhea.
PE: DTR's 3+ in upper and lower extremities, skin is warm and moist. A mass is palated in her neck lateral to the right and left of the cricoid cartilage.
Biopsy of the mass is performed and is shown in the attached image.
What is the most likely diagnosis?
Edit, wait for the image, I have to resize it...
ROS positive for: weight loss, increased appetite, and diarrhea.
PE: DTR's 3+ in upper and lower extremities, skin is warm and moist. A mass is palated in her neck lateral to the right and left of the cricoid cartilage.
Biopsy of the mass is performed and is shown in the attached image.
What is the most likely diagnosis?
Edit, wait for the image, I have to resize it...
Attachments
alright, I have a good one.
30 y/o man, recently traveled to south-east asia within the last year where he remembers riding elephants and swimming in local lakes. has a hx of upper right quadrant pain and now presents with noted enlarged liver and spleen along with abdominal fluid wave on abdominal palpation.
Here is a liver biopsy. dx?
shistomosomaoa mansoni, is that the portal triad?
damn, that was fast.
apparently, it can be S. Japanoicum or S. Masoni. UW said this is pipestem fibrosis and is pathonomonic for it?
edit: I dunno if that's the triad or not, your guess is as good as mine (naw, yours is probably better)
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damn, that was fast.
apparently, it can be S. Japanoicum or S. Masoni. UW said this is pipestem fibrosis and is pathonomonic for it?
All I know from FA was that masoni causes portal hypertension, which i got from the symptoms. from the pic I saw that the triad area was messed up (I think it's the portal area lol) and thats the only organism i associate w/ portal problems
That's not it either, though the cells shown in the image can become malignant.
I've made this one super tough; I couldn't answer it if I didn't write it...
Well then my attempt to make this tough, just made it a convoluted and poor question...
But now you're on the right track...
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