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Comment of the Week

Stent thrombosis vs re-stenosis. Stent thrombosis is an acute occlusion of a coronary artery stent, which often results in acute coronary syndrome. Can be prevented by dual antiplatelet therapy or drug-eluting stents. Re-stenosis is the gradual narrowing of the stent lumen due to neointimal proliferation, resulting in anginal symptoms.

          —xxabi, nbme24/Block 4/Question#43

Lol of the Week

The semantics of this question made me vomit blood.

One day a patient will look me in the eyes and ask, "Where are tripetides broken down?" I will smile at them and say, "the intestinal mucosa and not the duodenum." They'll smile back and I'll walk away and think of this moment as I jump from the window.

          —seagull, nbme24/Block 2/Question#48

Help your fellow humans! (see more)

charcot_bouchard asks:
I get why its lateral but dont all cranial nerve except 4 arise Ventrally? WTF they add this Dorso before lateral? help answer!
meatus asks:
I'm sorry but what am I missing here... I thought the whole point of diuretics is to correct volume overload by diuresis? How would total volume be increased?? help answer!
cocoxaurus asks:
BUT why is the serum potassium normal? I was able to narrow it down to RTA, because none of the other answer choices made much sense, but the potassium had me second guessing myself. Can someone explain that lab finding? Thanks! help answer!
stepbystep asks:
does some mind explaining why this isn't a tear in the sciatic nerve? help answer!
keshvi asks:
i counted both the prevalence and incidence using patient - years. Is it incorrect to use patient years for prevalence? help answer!
whossayin asks:
the question was very poorly worded in my opinion, anybody else agree? help answer!
whossayin asks:
why can't "organification defect in T3 and T4" be the answer? help answer!
niboonsh asks:
SWIM phase one - is it Safe? phase 2 - does it Work? phase 3 - any Improvements? phase 4 - stay on the Market? help answer!
niboonsh asks:
i got this question right but why couldnt it be ginko biloba? help answer!
kernicterusthefrog asks:
Just in case that lovely little equation provided by @keycompany wasn't quite enough for you, here's a link to a more complete explanation by Kahn Academy. Helped me, when I looked at the equation and said, whaaaa? help answer!
sup asks:
Why not PGI2 by way of ASA? Especially given other answer choices of proteins C + S: doesn't warfarin also suppress these? help answer!
moo asks:
if the lungs were clear to auscultation and the kid even said he doesn't want to be on the team anymore why couldn't it be malingering? help answer!
sup asks:
Somehow I was able to convince myself that increased testosterone --> decreased estrogen --> decreased negative feedback on LH/FSH secretion --> increased FSH. Does anyone care to explain why this logic is wrong? Thanks :) help answer!
hmorela asks:
Why is it that the answer isn't also glossopharyngeal since you test CN IX by saying "Ah" also? Please help! Thanks!! help answer!
pseudorosette asks:
Why is it that the pulmonary capillary wedge preesssuree is increased? on pg. 307 of FA 2019 it says it can be increased or decreased :/ help answer!
usmleuser007 asks:
Someone care to explain why [time to steady-state concentration] is not the correct answer? help answer!
fulminant_life asks:
Why is it 99% and not 95%? It asked for onset of disease at less than 9 years of age. I'm clearly missing something here help answer!
yotsubato asks:
Yeah sure, lets give the guy who wants to keep his dick working and be attractive towards women Finasteride and completely ruin his testosterone levels and give him a limp dick, man boobs, and decreased performance in sports. Sometimes the NBME really just makes me ask Why? Topical minoxidil would be way better but no they wont put that as a choice help answer!
yotsubato asks:
Arent we NOT supposed to use ipratropium in old people? help answer!
lamhtu asks:
Stem should maybe say some lesions are lytic and some are sclerotic. Breast mets to bone is mixed type according to FA? If you go off the mets being purely lytic, one could think thyroid carcinoma is the correct primary tumor. help answer!
gh889 asks:
Could someone please explain which drugs (if any) are at D and E? help answer!
ilikecheese asks:
High X is bound when low Y is added, and low X is bound when Y is added. So MAYBE they are competing for the same binding spot/epitope due to this relationship (epitope= antibody binding site) ?????????? help answer!
yotsubato asks:
Why cant this be laxatives? Both would cause metabolic alkalosis with hypokalemia... ? help answer!
yotsubato asks:
p53 is mutated and cant bind the TATA box, so what happens to transcription of inhibitory proteins? Is basically what this question is trying to ask... So no TATA box promoter => Decreased binding of RNA polymerase help answer!

Recent comments (see more)

... charcot_bouchard made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +0  upvote downvote
submitted by charcot_bouchard(1)

I get why its lateral but dont all cranial nerve except 4 arise Ventrally? WTF they add this Dorso before lateral?

... niboonsh made a comment on nbme22/block3/q#20 (A 43-year-old man is brought to the emergency...)
... sugaplum made a comment on nbme20/block2/q#21 (A 25-year-old woman comes to the physician 2 days...)
 +0  upvote downvote
submitted by sugaplum(1)

B Hensele- Cat Scratch in immuno-compotent - http://www.pathologyoutlines.com/topic/lymphnodescatscratch.html Bartonella henselae in Immuno-compromised- Baciliary angiomatotsis Looks like kaposi sarcoma "Diffuse neutrophilic infiltrate" FA 2019 177

... sweetmed made a comment on nbme21/block2/q#21 (A 35-year-old woman undergoes flexible...)
... sugaplum made a comment on nbme20/block2/q#15 (A 55-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by sugaplum(1)

Synthetic codeine analog, has mild Opioid effects when used in high concentrations. Hence constipation FA 2019 671

... sugaplum made a comment on nbme20/block2/q#34 (A 28-year-old man has excessive thirst and polyuria....)
 +0  upvote downvote
submitted by sugaplum(1)

These always tripped me up:
+ Polydipsia= responds to water deprivation, low serum Na
+ Central= responds to vasopressin, high serum Na
+Nephrogenic = responds to nothing, normal serum Na

... sugaplum made a comment on nbme20/block2/q#26 (A male newborn is found to have a decreased blood...)
 +0  upvote downvote
submitted by sugaplum(1)

This is apparently congenital thyroid binding globulin deficiency

"Thyroxine-binding globulin deficiency — Thyroxine-binding globulin (TBG) deficiency is characterized by low serum total T4 but normal free T4 and TSH; the diagnosis is confirmed by measuring TBG concentrations. These infants have normal thyroid function and do not require treatment." - uptodate *can't find in FA, maybe it is in there somewhere?

... niboonsh made a comment on nbme22/block3/q#47 (A 10-year-old boy receives a renal transplant from a...)
 +0  upvote downvote
submitted by niboonsh(2)

This is a case of acute transplant rejection. weeks to months after the transplant, recipient cd8 and/or cd4 t cells are activated against the donor (a type 4 HSR) and the donor starts making antibodies against the transplant. This presents as a vasculitis with dense interstitial lymphocytic infiltrates. (FA2018 pg 119)

... meatus made a comment on nbme22/block3/q#8 (A 38-year-old man who lives at sea level flies to a...)
 +0  upvote downvote
submitted by meatus(0)

I'm sorry but what am I missing here... I thought the whole point of diuretics is to correct volume overload by diuresis? How would total volume be increased??

niboonsh  the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_-
... imnotarobotbut made a comment on nbme23/block1/q#32 (Which of the following sets of serum findings is...)
 +0  upvote downvote
submitted by imnotarobotbut(0)

Secondary hyperparathyroidism due to chronic renal failure. Low Ca, high phosphate and high PTH. FA 2019 page 342

imnotarobotbut  Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that.
... imnotarobotbut made a comment on nbme23/block1/q#36 (A medical student is caring for a 72-year-old man...)
 +0  upvote downvote
submitted by imnotarobotbut(0)

A medical student shouldn't be the one giving someone a cancer diagnosis. This is a really sensitive issue and the results should be given by someone with higher authority like a resident or attending. At the same time, you shouldn't lie to the patient and say that the results aren't back yet if they are. Best thing to do is deflect the conversation and follow up with the resident..

drdoom  It isn’t so much “someone with higher authority” as it is someone with a license! Without a license, an individual is not permitted legally to provide clinical interpretations, as that would constitute the (unlawful) practice of medicine!
... imnotarobotbut made a comment on nbme23/block1/q#15 (A 26-year-old man who is a Peace Corps volunteer...)
 +0  upvote downvote
submitted by imnotarobotbut(0)

The treatment of cholera is mostly supportive - you want to rehydrate the patient by giving them an isotonic saline since they're losing a lot of fluids.