welcome redditors!to snoo-finity ... and beyond!
Choose your exam!
=> The Free 120
=> NBME 24
=> NBME 23
=> NBME 22
=> NBME 21
=> NBME 20
=> NBME 19
=> NBME 18
=> NBME 17
=> NBME 16
=> NBME 15
=> NBME 13
=> Show me all of them! (sadomasochism mode)
=> Or you can see the latest contributions
=> Or you can help answer questions!

Announcements!

Comment of the Week

After the cuff is tied, the cells and tissue distal to the cuff will continue consuming ATP (ATP->ADP), but no fresh blood will be delivered to “clear” what will be an accumulating amount of ADP and other metabolites. ADP (=Adenosine) is itself a proxy of consumption and drives vasodilation of arteries! (Evolution is smart!) Increasing ADP/Adenosine in a “local environment” is a signal to the body that a lot of consumption is occurring there; thus, arteries and arterioles naturally dilate to increase blood flow rates and “sweep away” metabolic byproducts.


          —drdoom, nbme24/Block 3/Question#2

Lol of the Week

Which of the following reasons is why this question is bull?

1) Using the word "cyclic" instead of tricyclic for clarity

2) Knowing all of epidemiology of all drugs

3) having to reason out that anticholinergic effects are probably the worst over alpha1 or H1 effects to no certainty.

4) The crippling depression of studying for days-to-weeks on end to probably do average on the test.


          —seagull, nbme22/Block 2/Question#36

Help your fellow humans! (see more)

krewfoo99 asks:
Why would perforins be the wrong answer? Wouldnt accumulation of toxic proteins cause the cell to undergo apoptosis ? help answer!
krewfoo99 asks:
In what situations will HbH be formed (3 alpha chain deletions)? help answer!
krewfoo99 asks:
Can someone explain what the picture is supposed to show? Is it supposed to be segmented neutrophils? help answer!
krewfoo99 asks:
Wouldnt the HCOM murmur be best heard in the aortic area? help answer!
krewfoo99  Correction: Shouldnt it be heard best in the left upper sternal border?
krewfoo99 asks:
Anyone know why heart sounds would be distant in COPD exacerbation? help answer!
krewfoo99 asks:
Anyone know why heart sounds would be distant in COPD exacerbation? help answer!
krewfoo99 asks:
In boards and beyond, It is said that third degree heart block is due to block in the HIS Purkinjee system. So why would ablation of AV node cause this disease? Wouldnt destruction of part of left ventricle be a better answer ? help answer!
amirmullick3 asks:
Is this Guillain barre though? I felt it was Acute inflammatory demyelinating polyradiculopathy, discussed on page 512 FA 2019. There is no relation to C jejuni here nor does the patient have any other relations to infection such as eating something or etc. help answer!
niboonsh asks:
external carotid branch supplies the superior parathyroid glands as well........? help answer!
divya asks:
Can anyone discuss what's responsible for inhibiting the processes given as other options? help answer!
divya asks:
Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same? help answer!
sunshinesweetheart asks:
out of curiosity, why are AST and ALT high? is that saying the NRTI used was diadenosine which led to pancreatitis also? help answer!
paloma asks:
What about pulmonary vascular resistance? It follows the systemic vascular resistance? help answer!
cooldudeboy1  crackles are heard bilaterally so there is pulm patho which leads to increased pulm vascular resistance, since systemic blood flows into the lungs. any block in the flow ahead (lungs) will increase resistance in flow behind ( systemic )
bronchophony asks:
Why not clinical trial? They could report a rare adverse effect in phase 4 clinical trial right? help answer!
sunshinesweetheart  there's no control group. it's just a case study. x3
sunshinesweetheart  plus clinical trials at that stage would have had tons and tons of participants (and, most importantly to rule out all the answers, control group)
md_caffeiner asks:
what to do with the NONADHERIANT BADDIES??? Intention to treat, "i had the intention to treat so i am gonna leave in this group no matter what" as treated , "he is not treated as it is so im gonna change his group to control" per protocol, "you are fired from all of it, protocols bitch" help answer!
houseppary asks:
but what is wrong with "Spirochete invasion of gastric cells"? It seems like H pylori is sometimes described as curved and sometimes as a spirochete. And "gastric cells" is general enough that I don't see why it can be wrong. There is H pylori in the gastric cells. help answer!
amphotericin asks:
Why would you not check cortisol, if you're worried for MEN1? I assumed high calcium was implied based on the renal stones help answer!
fallot4logy asks:
in the other hand , urine potassium is high enough , so if seizures =>rhabdomyolysis => myoglobinuria => ATN => high potassium excretion , why not? help answer!
inmyblood asks:
What is the letter Y indicating in the picture? is it the large intestine? help answer!
humble_station  For this answer to make sense to me, Y should be the beginning of the large intestine like the terminal ileum/cecum leading up to the ascending colon
sunny asks:
why is this so //i know its basic but still...?? help answer!
ssc505684708 asks:
What happened to this "previously healthy" young female? Why is she vomiting blood? Drinking too much alcohol? help answer!
amphotericin asks:
I put constipation because I thought the medication being described might be CCB: can someone explain why nitrates over CCB? help answer!
seracen  Wouldn't nitrates be a faster acting drug here? That was my take-away anyway. One is more acute, the other for long term maintenance.
amphotericin asks:
how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing help answer!
jean_young2019 asks:
Could someone explain why this choice is the best answer? I struggled between A and D, and picked A finally, which is "ascertain educational level and provide publications". help answer!

Recent tangents

how to rule out the others:

we would see eosinophilia, but obvi this wouldnt tell us which helminth is involved

Trichinella larvae bury themselves inside muscle tissue rather than remain in the intestine as in other roundworm infections, so stool sample tests don't often show evidence of the parasite

gram stain of stool is a pretty nonspecific test used for campylobacter enteritis; this dude doesnt have diarrhea...and lastly, xray of muscle aint gonna tell u a thang lolz

how to rule out the others:

we would see eosinophilia, but obvi this wouldnt tell us which helminth is involved

Trichinella larvae bury themselves inside muscle tissue rather than remain in the intestine as in other roundworm infections, so stool sample tests don't often show evidence of the parasite

gram stain of stool is a pretty nonspecific test used for campylobacter enteritis; this dude doesnt have diarrhea xray of muscle aint gonna tell u a thang lolz

so I thought in kids/elderly you give the diptheria-toxoid conjugate vaccine and adults you give the polysacc conjugate. why does this kid get the polysacc conjugate?

Recent comments (see more)

... krewfoo99 made a comment on nbme23/block2/q#35 (A 42-year-old man with a history of recurrent...)
 +0  upvote downvote
submitted by krewfoo99(0)

Image shows Stahorn Calculus

1) Staghorn Calculus in adults - Manesium Ammonium Phosphate 2) Staghorn Calculus in Children - Cystine

... krewfoo99 made a comment on nbme23/block1/q#22 (An investigator is studying the adverse effects of a...)
 +0  upvote downvote
submitted by krewfoo99(0)

Why would perforins be the wrong answer? Wouldnt accumulation of toxic proteins cause the cell to undergo apoptosis ?

... sangeles made a comment on nbme24/block4/q#7 (A 3-year-old girl is brought to the physician for a...)
 +0  upvote downvote
submitted by sangeles(0)

To me it sounds more like nevus simplex. The most common capillary malformation is nevus simplex, which affects more than half of infants. Nevus simplex, or “salmon patch,” lesions are pink, ill-defined patches that tend to occur in midline locations, most frequently on the nape of the neck, glabella, eyelids, nose/lips, scalp, and sacral region Historically, colloquial terms such as “stork bite” (nape) and “angel kiss” (forehead/glabella) referred to nevus simplex lesions in particular anatomical regions. Unlike PWS and most other vascular malformations, most nevus simplex lesions regress within the first 2 years of life Clinical differentiation of nevus simplex from PWS, especially on initial presentation, can be difficult. Lesions with lighter pink color, midline location, and indistinct borders favor nevus simplex. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615389/

... krewfoo99 made a comment on nbme23/block1/q#19 (Unlike the DNA polymerases found in Escherichia...)
 +0  upvote downvote
submitted by krewfoo99(0)

So basically what this is saying that DNA will be transmitted to the progeny not RNA. So DNA will replicate in the G2 phase and transfer of DNA material to progeny will occur in the M phase. The RNA may be mutated and making defective products, but this will not transmit into the progeny, thus not affecting species survival based on RNA mutations.

... krewfoo99 made a comment on nbme23/block1/q#33 (A 25-year-old woman and her 25-year-old husband come...)
 +0  upvote downvote
submitted by krewfoo99(0)

In what situations will HbH be formed (3 alpha chain deletions)?

... jandj19 made a comment on nbme21/block2/q#5 (A 2-week-old male newborn has a patent ductus...)
 +0  upvote downvote
submitted by jandj19(0)

This is a very cool concept explained in the Rapid Review pathology book, page 257.

Left-sided to right-sided heart shunts results in volume overload in the right side of the heart, which increases LV volume (preload) due to more blood returning from the right heart to the left heart. An increase in LV preload is equal more cardiac output and more work for the heart. Later in life that will lead to an eccentric type of LVH with decrease cardiac output, pulmonary hypertension and a concentric RVH due to high afterload that the right heart has to pump against.

... jucapami made a comment on nbme24/block3/q#16 (An 18-year-old woman is brought to the physician...)
 +0  upvote downvote
submitted by jucapami(0)

x-ray corresponds to a tension pneumothorax = imminent respiratory failure if untreated. Right lung is fully collapsed, increasing intra-thoracic pressure, imparing O2 exchange (due to mass effect toward left lung, and collapsed right one), hence accumulating CO2 (in blood), inducing respiratory acidosis.

... jucapami made a comment on nbme24/block3/q#37 (A man accidentally touches the surface of a hot...)
 +0  upvote downvote
submitted by jucapami(0)

https://www.ncbi.nlm.nih.gov/pubmed/6162412

"The morphological interpretations of the changes in the functional ultrastructure of the bloodlymph barrier following thermal injury seem to be an increase in the numbers of vacuoles and many open endothelial intercellular junctions..."