9
0完整字幕请关注喜马拉雅：方块块xxl
[.72] You get a question about a newborn. | 你遇到一道关于新生儿的题。
[.06] Right? | “对吧？”
[.22] The newborn had phenomenal abguards at birth. | 新生儿出生时阿普加评分非常好。
[.00] The newborn was completely fine. | 新生儿完全正常。
[.40] Right? | “对吧？”
[.96] Newborn was completely fine. | 新生儿非常健康。
[.44] And then. | 然后。
[.84] You know. | 你知道。
[.16] Like 12 hours after birth. | 出生后 12 小时。
[.56] 24 hours after birth. | 出生后 24 小时。
[.46] The child starts sweating with feeds. | 孩子在喂奶时开始出汗。
[.28] Right? | “对吧？”
[.62] Or the child starts becoming profoundly hypoxic. | 或者孩子开始出现严重的缺氧。
[.08] And you're giving this child supplemental oxygen. | 你给孩子吸氧。
[.02] And it's not helping. | 但没起作用。
[.18] That's a very classic presentation. | 这是一个非常经典的临床表现。
[.34] Of a cyanotic congenital heart defect. | 发绀型先天性心脏病。
[.74] Right? | “对吧？”
[.08] Of a cyanotic congenital heart defect. | 发绀型先天性心脏病的表现。
[.08] The thing is. | 关键在于。
[.76] Why do I put this under the pattern of cloaked questions? | 为什么我把它归类为“隐身题目”？
[.26] The thing is. | 事实是。
[.74] Sometimes. | 有时。
[.22] People are not. | 考生们。
[.16] They don't even pick up. | 他们根本察觉不到。
[.00] On this at all. | 完全意识不到这一点。
[.90] Because they're like. | 因为他们觉得。
[.44] Oh. | “噢。”
[.60] Everything seemed fine. | “一切看起来都挺好。”
[.88] Right? | “对吧？”
[.70] And then. | 然后。
[.02] Why did things go bad? | “为什么情况变糟了？”
[.22] That's a cloaked question. | 这就是隐身题目。
[.06] That's a cloaked question. | 这就是隐藏了考点的题目。
[.42] Another classic cloaked question example is. | 另一个经典的隐身题目例子是。
[.00] The inborn errors of metabolism. | 先天性代谢异常。
[.38] Right? | “对吧？”
[.88] So you notice. | 你会注意到。
[.74] You know. | 你知道。
[.00] The baby is completely fine at birth. | 婴儿出生时完全正常。
[.40] They go home. | 他们回了家。
[.70] Right? | “对吧？”
[.18] And then a few days. | 然后过了几天。
[.10] Few weeks later. | 几周后。
[.08] The baby just starts crashing and burning. | 婴儿的情况突然急转直下。
[.80] Right? | “对吧？”
[.16] They start becoming lethargic. | 他们开始变得萎靡不振。
[.44] They start having poor feeding. | 他们开始喂养困难。
[.54] They start having vomiting. | 他们开始呕吐。
[.34] They start having seizures. | 他们开始抽搐。
[.04] Right? | “对吧？”
[.50] Many times. | 很多时候。
[.96] They'll have a distinct. | 他们会有一个明显的特征。
[.00] Fail. | 衰竭。
[.52] Right? | “对吧？”
[.92] When you see this. | 当你看到这种情况。
[.36] Think of an inborn error of metabolism. | 要想到先天性代谢异常。
[.34] It's a kind of cloaked question. | 这也是一种隐身题目。
[.76] Right? | “对吧？”
[.10] So the fact that. | 事实上。
[.98] Something starts off right. | 事情一开始很顺利。
[.46] For a child. | 对一个孩子来说。
[.32] Does not mean that. | 并不意味着。
[.58] Things are going to stay right. | 情况会一直好下去。
[.20] Right? | “对吧？”
[.62] Because the thing is. | 原因是。
[.60] When you're in the womb. | 当你在子宫里时。
[.88] Mom. | 妈妈。
[.68] Does a lot of the heavy lifting. | 承担了大部分的代谢工作。
[.18] For you. | 为你。
[.84] Right? | “对吧？”
[.30] Literally. | 事实上。
[.88] Her metabolism handles. | 她的代谢处理了。
[.38] Practically everything. | 几乎所有事情。
[.58] Right? | “对吧？”
[.22] If the baby cannot process things. | 如果宝宝不能处理某些物质。
[.88] Guess what? | 你猜怎么着？
[.30] Just outsource your problem. | 把问题“外包”给。
[.74] To the placenta. | 胎盘。
[.46] The placenta is going to deal with it. | 胎盘会处理它。
[.68] For you. | 为你。
[.30] Right? | “对吧？”
[.00] But once the baby starts. | 但一旦宝宝开始。
[.52] Feeding independently. | 独立进食。
[.72] Metabolizing independently. | 独立代谢。
[.60] Then that inborn error of metabolism. | 那么那种先天性代谢异常。
[.16] That enzyme defect they have. | 他们所携带的酶缺陷。
[.18] It becomes apparent. | 就会变得显而易见。
[.90] It begins to show up. | 就会开始显现出来。
[.68] Right? | “对吧？”
[.12] It begins to show up. | 开始发病。
[.14] Right? | “对吧？”
[.50] So like. | 所以。
[.08] Just keep this in mind. | 请记住这一点。
[.32] This is something that. | 这就是。
[.46] Like this cloaked question business. | 这种隐身题目的套路。
[.82] Is something that shows up a lot in pediatrics. | 在儿科题目中经常出现。
[.08] Right? | “对吧？”
[.64] So like. | 比如。
[.20] You know. | 你知道。
[.42] Like PKU. | 比如苯丙酮尿症（PKU）。
[.04] A child that has PKU. | 一个患有 PKU 的孩子。
[.34] Is going to. | 将会。
[.86] Is going to be completely fine in the hospital. | 在医院里会完全正常。
[.18] But it's a few days. | 但在几天后。
[.42] A few weeks after they've gone home. | 在他们回家几周后。
[.82] You're going. | 你将会。
[.00] To start seeing problems. | 开始看到问题。
[.18] Right? | “对吧？”
[.54] Same thing with maple syrup urine disease. | 枫糖尿病也是一样。
[.66] Right? | “对吧？”
[.92] Where you have an issue with branching. | 当你的支链。
[.24] Ketoacetic dehydrogenase. | α-酮酸脱氢酶出现问题。
[.80] Right? | “对吧？”
[.00] Again. | 再次。
[.70] Child's going to be completely normal at birth. | 孩子出生时完全正常。
[.86] But as they go home. | 但当他们回家后。
[.00] As they stay home for a few days. | 当他们在家里待了几天。
[.22] You start seeing problems. | 你就开始看到问题。
[.22] Galactosemia. | 半乳糖血症。
[.00] Same deal. | 也是一样的情况。
[.50] Same deal. | 也是一样。
[.78] Right? | “对吧？”
[.08] Same deal. | 也是同理。
[.24] Galactosemia is going to be the exact same deal. | 半乳糖血症也是完全一样。
[.12] Right? | “对吧？”
[.72] Galactos 1. | 半乳糖-1-。
[.34] Phosphate urinal transferase deficiency. | 磷酸尿苷酰转移酶缺乏症。
[.16] Again. | 再次。
[.78] They start off fine. | 他们起初没事。
[.32] And then they get a few. | 然后他们喝了几。
[.06] You know. | 你知道。
[.70] Rounds of breast milk under their belt. | 几顿母乳下肚。
[.00] And then they start having problems. | 然后他们就开始出现问题。
[.70] Right? | “对吧？”
[.98] So again. | 所以。
[.26] Baby is fine at birth. | 宝宝出生时很好。
[.14] Right? | “对吧？”
[.66] Baby is fine at birth. | 宝宝出生时完全健康。
[.88] Right? | “对吧？”
[.32] And then things start deteriorating. | 然后情况开始恶化。
[.72] When you see those things like that. | 当你看到这类情况。
[.22] Think of. | 想到。
[.16] An inborn error of metabolism. | 先天性代谢异常。
[.36] Right? | “对吧？”
[.04] The thing is. | 事实是。
[.68] The USML is. | USMLE 在。
[.38] When they want to cloak things in adults. | 当他们想在成人题目中隐藏考点时。
[.58] Many times. | 很多时候。
[.50] They will give you. | 他们会给你。
[.40] Like an offshoot presentation. | 某种非典型的表现。
[.58] Of a main disease. | 某种主要疾病的分支表现。
[.10] Right? | “对吧？”
[.74] In fact. | 事实上。
[.26] Let me just. | 让我。
[.02] Maybe make this. | 或许把这个。
[.74] Pattern number three. | 归为模式三。
[.04] Cloak presentation. | 隐藏的表现形式。
[.48] Right? | “对吧？”
[.30] Offshoot presentation. | 衍生出来的表现。
[.00] Of a main disease. | 某种主要疾病的非典型表现。
[.04] Let me explain what I mean. | 让我解释一下我的意思。
[.06] By offshoot presentation. | 所谓的衍生表现。
[.76] Of a main disease. | 即主要疾病的某种分支表现。
[.20] By offshoot presentation. | 所谓的衍生表现。
[.26] Of a main disease. | 某种主要疾病的表现。
[.96] I mean that. | 我的意思是。
[.64] Hey. | 嘿。
[.22] There is a main disease. | 存在一种主要疾病。
[.02] But. | 但是。
[.64] They take an offshoot of it. | 他们提取了它的一个分支。
[.32] And test just that offshoot. | 并且只考那个分支。
[.66] That's a very good way. | 这是一个非常好的方式。
[.94] To cloak a concept. | 去隐藏一个概念。
[.96] And make people not realize that. | 并让人们意识不到。
[.76] Oh. | “噢。”
[.94] This is what this person is testing. | “这才是考题真正要考的内容。”
[.02] Right? | “对吧？”
[.52] Like I give you a classic example. | 我给你举一个经典的例子。
[.02] Of this. | 关于这个。
[.30] A good classic example. | 一个很好的经典例子。
[.18] Will be testing. | 将会测试。
[.36] Let's see. | 让我看看。
[.98] Let me try to think of an example. | 让我试着想一个例子。
[.16] Again. | 再次。
[.42] Sorry. | 抱歉。
[.74] This is kind of off the cuff. | 这是临时想到的。
[.74] So. | 所以。
[.14] I'm trying to. | 我在试着。
[.56] You know. | 你知道。
[.96] Think of an example here. | 在这里想一个例子。
[.88] But a good example. | 但一个好例子。
[.78] Will be something along the lines of. | 大概会是这样的。
[.02] Okay. | 好了。
[.58] So let's say for example. | 假设举个例子。
[.18] A person has. | 一个人患有。
[.68] A person has. | 一个人患有。
[.34] Giant cell arteritis. | 巨细胞动脉炎。
[.10] Right? | “对吧？”
[.52] A person has giant cell arteritis. | 一个患有巨细胞动脉炎的人。
[.32] And then. | 然后。
[.44] They get in an accident. | 他们出了一场事故。
[.84] And become profoundly hypotensive. | 并且出现了严重的低血压。
[.44] Right? | “对吧？”
[.36] And they tell you that. | 题目告诉你。
[.34] Hey. | “嘿。”
[.46] This person has been given fluids. | “这个人已经补液了。”
[.64] And they have been given. | “并且已经给予了治疗。”
[.42] And all that stuff. | 等等。
[.54] And it's not. | 但没起作用。
[.40] Their blood pressures are just not. | 他们的血压就是。
[.14] Budging at all. | 完全没有回升。
[.36] Right? | “对吧？”
[.34] And then you notice that the right answer is. | 然后你发现正确答案是。
[.00] Adrenaline sufficiency. | 肾上腺功能不全。
[.96] And you're like. | 然后你会想。
[.68] What in the world is this? | “这到底是什么鬼？”
[.22] Well. | 好的。
[.16] That's where you need to start making links. | 这就是你需要开始建立联系的地方。
[.36] Right? | “对吧？”
[.16] The concept was cloaked. | 这个概念被隐藏了。
[.90] By GCA. | 被巨细胞动脉炎（GCA）隐藏了。
[.98] Right? | “对吧？”
[.40] Because our friends at the NBMEs. | 因为 NBME 的出题老师。
[.26] They know that. | 他们知道。
[.48] Oh. | “噢。”
[.96] People think. | “人们会想。”
[.24] Oh. | “噢。”
[.66] GCA. | “GCA。”
[.22] You know. | 你知道。
[.26] One over 50. | 50 岁以上的女性。
[.34] Right? | “对吧？”
[.78] She has like. | 她有。
[.44] Unilateral eye pain. | 单侧眼痛。
[.72] Unilateral headache. | 单侧头痛。
[.66] Right? | “对吧？”
[.30] Sometimes. | 有时。
[.54] You may see the association. | 你可能会看到这种关联。
[.50] With polymyalgia rheumatica. | 与风湿性多肌痛的关联。
[.10] Right? | “对吧？”
[.86] That's what most people know about GCA. | 这是大多数人对 GCA 的了解。
[.58] And hey. | 而且。
[.08] You know. | 你知道。
[.56] They can go blind. | 他们可能会失明。
[.68] It's a large vessel vasculitis. | 这是一种大血管炎。
[.14] People know those things. | 人们知道这些。
[.56] That's fine. | 没问题。
[.60] Right? | “对吧？”
[.10] But. | 但是。
[.10] They can use it as a way to test. | 他们可以利用它来测试。
[.40] Adrenaline sufficiency. | 肾上腺功能不全。
[.34] Where. | 在哪里。
[.76] Where's the link? | 联系在哪里？
[.46] Well. | 好的。
[.22] Think about it. | 想想看。
[.28] When a person has GCA. | 当一个人患有 GCA 时。
[.52] They have to be on high dose steroids. | 他们必须服用大剂量的类固醇。
[.94] For months. | 长达数月。
[.36] Right? | “对吧？”
[.32] That's going to suppress. | 那会抑制。
[.48] ACTH production. | ACTH（促肾上腺皮质激素）的产生。
[.26] If you suppress ACTH production. | 如果你抑制了 ACTH 的产生。
[.82] That is literally going to stop your adrenal cortex from being stimulated. | 那实际上会停止对肾上腺皮质的刺激。
[.28] Right? | “对吧？”
[.18] But again. | 但是。
[.90] That's not a problem. | 只要你的生活压力水平没变，这就不是问题。
