and we’re back! with BRAND SPANKIN' NEW tangents!
welcome redditors!to snoo-finity ... and beyond!
Choose your exam!
=> Medicine 4 FRESH!
=> Family Medicine 1 FRESH!
=> 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!


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)

kimcharito asks:
it is normal irradiation to the RIGHT neck? what does it mean? help answer!
soph asks:
ok but why is blue nevi wrong? i thought q asks lession in both exposed and unexposed areas. help answer!
yex asks:
This was on a previous NBME. How I got it? Intercostal (posterior) is how you get to the vertebral bodies; the other vessels are anterior. help answer!
ap88 asks:
Why can this not be papillary necrosis? Given the gross Hematuria and proteinuria with a history of analgesic use... I thought that was what this was getting at? help answer!
t0pcheese asks:
why is the Na normal in this patient? Everything else made sense, the high K and 17 hydroxyprogesterone. help answer!
hyperfukus asks:
so should we just skip these? cuz there's prob 10 more i couldve gotten write wasting my life on this one help answer!
hello asks:
Please help - how are you able to tell that the CT image is not at the level of duodenum? I don't know what I'm looking for to compare and contrast a CT at the level of the duodenum vs the CT given in this Q. help answer!
hello asks:
There has to be a better explanation for why ANP is wrong? help answer!
cr asks:
Which type of cell we r going to find in blisters?, neutrophils? help answer!
hello asks:
please help -- If catalase-positive bacteria neutralize their own superoxide, why isn't it the case for catalase-positive bacteria to infections in everyone? I'm not understanding the connection to NADPH oxidase deficiency. help answer!
hello  to cause** infections in everyone
hello asks:
Why isn't this a cohort study? help answer!
drdoom  This is a cohort study! (Since it involves splitting people into "groups"; group = cohort.) But the stem asks what "best describes" the design. So, yes, it's a cohort study but a more precise ("more specific") description is Open-label. In other words, "Open-label clinical trial" is a type of cohort study, and, in this case, "Open-label" is a more precise description of what is described in the stem.
drdoom  For a more technical explanation of "Cohort studies", see the definition from the National Library of Medicine:
hyperfukus asks:
so the lesion is in the Right MLF right? If so I'm just about to memorize the eye see SAME MiLF lol its the MLF on the same side of the eye keep it simple i hope that's what yall are saying lol help answer!
usmile1 asks:
does anyone know what the structure E is pointing to? help answer!
thomasburton  Not sure looks like it might be free ribosomes or other such small cytosolic structure (I picked E too, thought B looked way too big!)
targetusmle  same here!! marked e thinking of it as a mitochondria
lauri asks:
trichotillomaniac  Hi Lauri, this is normal. We can't post the whole question due to copy right laws but you can almost always find the question you are looking for and the answer to by going to the form and then Ctrl + find -ing the age of the patient and other key words or the answer!
maxillarythirdmolar asks:
Where does the role of B1 stimulation of RAAS come into this? Wouldn't the B1 action cause decrease RAAS? That being said, I can also understand if that's a long term thing and this is a question about the immediate effects...? help answer!
hello asks:
Please help Why is valine incorrect? An explanation below says that valine would be converted to glucose during regular metabolism? Regular metabolism = fed state, so why would valine even be converted to glucose? help answer!
burak asks:
What does 3 narrowin means? Is that a cause of diverticulary diseases or the result?? And what is that photo means :/ help answer!
burak asks:
Isn't it dependent on the location? I answered it coronary sinus because av node is located in Koch triangle; which composed of CSinus, Tendon of Todaro, Tricuspid annulus? help answer!
hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node.
burak  Now it's more confusing to me:) because av bundle is more inferior to the av node.
hello  Patient has ASD --> need to repair interatrial septum. AV bundle aka bundle of His is located neart interatrial septum. Coronary sinus opens into atria but is not located near the interatrial septum
hello asks:
Please help Mid-systolic ejection click = pulmonic stenosis How is pulmonic stenosis related to the patient's ASD -- does ASD cause pulmonic stenosis?? help answer!
burak  ASD has typically 3 associated sounds according to UW, they are all about increased blood in RA. Increased blood in RA causes more blood do ejected from tricuspid (dşastolic rumble), and more blood to be ejected to pulmonary circulation which cause pulmonary flow murmur (midsystolic murmur in pulmonary region). It even can cause pulmonary regurgitaion like murmur, but most important murmur in ASD is typically midsystolic murmur. You can check it out on FA 2018 page 284
hello  Ok, what I learned: Extra blood in the right heart (due to ASD) doesn't lead to pulmonic stenosis? Instead, it's that pulmonic stenosis = most common comorbid heart association with ASD
burak  No it's not pulmonic stenosis, it doesn't lead. Murmur associated with ASD is pulmonic stenosis-like murmur, because it's caused by excess RA and RV volume ejecting to the pulmonary arteries. So it's same location with pulmonic stenosis, and it's systolic. You get it?
hello  @burak Yep!
ls3076 asks:
Is decreased nocturnal erections not possible due to the incongruity between onset of symptoms and stroke (2 mos versus 3)? Agree that these questions are very vague and frustrating. Not sure where to get a good grasp on this material. help answer!
ls3076 asks:
can anyone explain why (D) metaplasia is incorrect? help answer!
dorsomedial_nucleus asks:
Is this just red-man syndrome? Direct mast-cell degranulation caused by vancomycin....and also morphine? help answer!
sam1 asks:
What about the additional flow through the circumflex? help answer!
varunmehru asks:
The mother has autoimmune thyroiditis and treatment is given for hypothyroidism only. why does it matter if the mother's TSH is high or low? Autoantibodies would still be present and they would always cause cretinism irrespective of mother hormones level. Isn't it? help answer!

Recent comments (see more)

... kimcharito made a comment on nbme23/block3/q#22 (A 54-year-old woman with rheumatic heart disease is...)
 +0  upvote downvote
submitted by kimcharito(3)

it is normal irradiation to the RIGHT neck? what does it mean?

... link981 made a comment on nbme20/block2/q#2 (Following a wedding reception that was attended by...)
 +0  upvote downvote
submitted by link981(23)

Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause

... soph made a comment on nbme21/block3/q#25 (A 32-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by soph(9)

ok but why is blue nevi wrong? i thought q asks lession in both exposed and unexposed areas.

... soph made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
 +0  upvote downvote
submitted by soph(9)

all the other options pt would have uterus, ovaries. turners they wouldnt look normal and they would have atrophic ovaries.

... yex made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by yex(4)

This was on a previous NBME. How I got it? Intercostal (posterior) is how you get to the vertebral bodies; the other vessels are anterior.

... eacv made a comment on nbme21/block4/q#39 (A 46-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by eacv(2)

If u are not goot in math like me xD. I did it this way: They gave me p^2=1/900 so p=1/30.

Now I need to find P, so use p+q=1. p= 1-(1/30)= 1-0.03= 0.97

So, 2pq= 2(0.97)(0.03)= 0.064 = (1/15) :D I got it right, this is my way to do it cause im not good at fractions.

eacv  **** q=1/900
... medulla made a comment on nbme22/block3/q#29 (A 45-year-old man with end-stage renal failure is...)
 +0  upvote downvote
submitted by medulla(0)

Renal Failure: MAD HUNGER Met Acidosis Dyslipidemia Hyperkalemia Uremia (inc BUN etc) Na/water retention (HF, pulmonary edema, HTN) Growth retardation and developmental delay Erythropoietin failure (anemia) Renal osteodystrophy

... maxillarythirdmolar made a comment on nbme16/block4/q#11 (78 yo man, 1 month fever, chills, fatigue, 5.4 kg weight loss)
 +0  upvote downvote
submitted by maxillarythirdmolar(0)

You should be thinking of something like Enterococcus. They had a GU procedure and subsequent cardiac issues.

When I hear soft S1, i think that the patient must have had a issue with the closing of either the mitral or tricuspid valves. Playing odds, this should be the mitral valve. You also here an early diastolic murmur, so you might be thinking volume overload (S3).

... ap88 made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
 +0  upvote downvote
submitted by ap88(0)

Why can this not be papillary necrosis? Given the gross Hematuria and proteinuria with a history of analgesic use... I thought that was what this was getting at?

... minhphuongpnt07 made a comment on nbme20/block3/q#32 (A 54-year-old woman with terminal metastatic...)
 +0  upvote downvote
submitted by minhphuongpnt07(0)

super vague question ! Dr denies assisting suicide=> nonmaleficience do everything he can to manage her pain => beneficience

... drdoom made a comment on nbme23/block3/q#35 (A 31-year-old woman comes to the emergency...)
 +0  upvote downvote
submitted by drdoom(165)

The prevailing rule of American medicine (and law) is individual autonomy, otherwise known as liberty. In American law, no other person, professional or otherwise, is granted “default access” or privilege to another person’s body—that includes the physician! (It even includes spouses! That’s why, in American law, you can be married to someone and still be charged with sexual assault/rape; marriage ≠ your spouse surrendering “bodily rights”.) The physician must receive consent from “a (conscious) person” before they become “a (conscious) patient”. In the same way, the person (now, patient) must give consent before anyone else is permitted to be involved in his or her care—spouses included!

... tinydoc made a comment on nbme23/block1/q#22 (An investigator is studying the adverse effects of a...)
 +1  upvote downvote
submitted by tinydoc(39)

MOA of proteosome inhibitors for MM. TLDR: is that they basically block the proteosome from functioning so that myeloma cells can't recycle protiens (they make a ton of them) and when they can't be recycled they build up and thats toxic to the cell and it dies.

beyond that the question is basically asking if the inhibition of proteosomes isnt specific to the Myeloma cells and it inhibited other cells' proteosomes what would be effected?

MHC class I is present on all nucleated cells (all cells in the body except RBC) and function to present endogenous antigens to CD8+ t cells to be destroyed (for example Viral DNA in an infected cell). The way they do this is by taking the protien it needs to present and breaking it down into much smaller peptide chains (so it can fit on the MHCI. If this step was inhibited in other cells then the the Presentation of MHC I wouldnt be able to present their antigens to CD8+ T cells and Natural killer cells. as the question implies.

The question was super tricky because if you don't know how proteosome inhibitors work then you start looking for an answer that would explain how they would kill tumor cells as well. I got it wrong too. It required knowledge of the way MHC I presents peptides.