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Recent comments (see more)

... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(1)

This is septic shock leading to pulmonary edema aka “symptoms”. The leakage is caused by LPS leading to IL-1, IL-6, TNF-alpha which increases vascular permeability! The question and answers tries to trick you into thinking it’s something else but you know she had gram neg infections and the presentation is just sequelae of septic shock!

... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(1)

Snitching to the mom would ruin your relationship with the patient. his social skills are pretty good to me if hes getting laid at his age. based on vignette, testosterone levels dont seem to be an issue. and suggesting decrease in masturbation is not medically relevant. The most lucrative next step would be to schedule next appointment like you would with any patient. Dont overthink this question. its straight forward! keep it simple!

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

FA2019, p259: Remember that prevalence / (1-prevalence) = incidence * (average duration of disease). It has nothing to do with this but I wanted to write that because I saw it written wrong on another website explaining this. This is a very simple question that I completely overthought. To answer this question, I think all you need to know is that TB is a chronic disease. Therefore incidence > prevalence. Lowering the threshold for negative results will increase the incidence of positive results. And since prevalence must always be greater than incidence, it will increase the prevalence as well. Sounds logical to me now.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

Everything else is an NSAID and contraindicated due to chronic abdominal pain. Acetaminophen is antipyretic and analgesic. It is not anti-inflammatory, but more importantly, it does not affect gastrin release or stomach mucosa.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

First-line therapy for chemotherapy-induced nausea are ondansetron and aprepitant. If she was actively vomiting due to chemotherapy, you could give metoclopramide as it is a strong antiemetic, according to UWorld, but this is written in a prophylactic sense. So go with the above mentioned.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

CO = HR*SV, HR is increasing because SV is decreasing fast. If CO output decreases, pulses will weaken. RBF decreases during SNS activation. That's why you don't have to pee while working out or until few minutes after sex.

... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(1)

Area labeled: A= mitochondria B= Golgi C= Cell membrane D=Lysosomes/vacuoles E= Cytoplasm or free Ribosomes (subjective) F= [Rough] Endoplasmic Reticulum

Precursor protein would be coming from translation of mRNA which would happen in the rough ER

... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(1)

The question hints at ADHD due to "constant motion", disruptive behaviors, incomplete assignments in school + impulsive/reckless behaviors outside of school leading to MULTIPLE ER visits from injuries.Methylphenidate (Ritalin) is tx for ADHD.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

I got this question more by ruling out everything else. Not B because no symptoms of CHS (albinism, primary hemostasis deficiency, peripheral neuropathy), not C because Streptococcus is catalase negative, not D because no symptoms of DiGeorge (cardiac defects, facial defects, no missing thymus), not F because IgA deficiency would have airway and GI infections. Recurrent ear infections doesn't seem related to IgA. That leaves me either Bruton agammaglobinemia and IgG2 deficiency. And Bruton's is more commonly seen in males. So I went with A.

... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(1)

Gynecomastia can be caused by elevated estrogen levels, decreased testosterone levels, or both. In pubertal males, adult estrogen levels are reached before adult testosterone levels. The effects of estrogen further causes increases sex-hormone binding globulins which further lowers testosterone, leading to gynecomastia (FA 2019-332; FA2020-337). Another cause of gynecomastia is hypogonadism (FA 2019-635; FA2020-649), which is what this patient seems to be experiencing .
Differentials: Kallman?, Prader Willi?,idiopathic I personally put low pitched voice, thinking his low testosterone would cause delay in deepening of his voice but I guess this varies and gynecomastia is a "better" choice in the eyes of NBME.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

I would love to know the true odds that three separate samples of the chorionic villus are made and each 3 are completely isolated genotypes and none are a mixture of both. Also, I'd like to know how often a laboratory error is. If anyone has that data, I would love to see it.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

Endometriosis explains the bleeding out of the butthole during menstruation. Furthermore, leiomyomas are estrogen sensitive, so it would be more likely to cause pain at ovulation. (FA2019, p634)

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

FA2019, p51: osteogenesis imperfecta. Patients with OI can't BITE (bones, eyes, teeth, ears).

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

Enterocytes have the highest turnover rate of any fixed cell population in the body. Stem cells for enterocytes are located in the crypts. Mature enterocytes do not stimulate cell turnover.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

This is a simple metformin MOA question (FA2019, p348). Everything before the last sentence is distraction.

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

(FA2019, p643): Sildenafil causes increased flow in corpus cavernosum, D. Rest of the answers: A is deep dorsal vein. B is areolar tissue. C is corpus spongiosum. The deep dorsal vein keeps you hard but it's increase blood flow to the corpus cavernosum that gets the fireman ready and able to put on his coat. Practice safe sex. :)

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

I don't know about you, but I got hung up on the fact that she's in her 20s and female and "recently developed" her symptoms of hyperthyroidism. Hypothyroid disorders are more common than hyperthyroid disorders and Hashimoto's disease, which is the most common hypothyroid disorder, has an initial hyperthyroidism. So I went with C "thyroid peroxidase autoantibodies." To be honest, the only thing that makes me confident it's not early Hashimoto's still is that B is also an autoantibody of Hashimoto's. And there can't be two right answers. So that leaves D "Thyrotropin receptor autoantibodies" (Grave's disease) as the correct answer. Better responses requested:

chaosawaits  So I think the only defining information that really points to Grave's and only Grave's is that her symptoms started around the time she developed nervousness and emotional lability. Since Grave's often presents in stress (FA2019, p339), it has to be Grave's. Personally, I think this is an awful question still. +
chaosawaits  Furthermore, "wide-eyed" is apparently code for "proptosis" which is another word for "exophthalmos" which is unique for Grave's disease +
... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

I think this question is only hard because it is written so vaguely that it took me a while to even understand what the question was: was it asking what was important for the virus to infect or for the body to recognize that an infection has occurred? Basically, to answer this question, all you have to understand is that for a virus to infect a cell, there has to be on the cell some receptor for which the virus can bind to. That's it. "If the virus cannot bind, you will be fine." -Johnnie Cochraine

... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(3)

See page 367 in FA2019. Trypsinogen is converted to trypsin by enterokinase/enteropeptidase, a brush border enzyme on duodenal and jejunal mucosa

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Help your fellow humans! (see more)

arthur_albuquerque asks (nbme20):
What helped me to answer this one quite easily was the following rationale: Hypercalcemia + high PTH -> "primary hyperparathyroidism" How do high PTH lead to hypercalcemia? Increasing osteoclast activity! help answer!
shaz464 asks (step2ck_free120):
Still confused.. Can anyone rule out all other options please? help answer!
sizario asks (step2ck_form6):
how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH? help answer!
embeemee asks (step2ck_form7):
what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately help answer!
embeemee asks (step2ck_form7):
i get the answer, but would a VB even be possible given her GBS+ status? help answer!
usmile1  Yes, being GBS+ is very common and is not a contrainidcation for vaginal delivery. just give intrapartum IV PCN to prevent infection in the newborn +
embeemee asks (step2ck_form7):
the change from green liquid to yellow liquid threw me off. i was thinking gastric outlet obstruction that initially let out bile until it progressed further until letting out only stomach acid? help answer!
justanotherimg asks (nbme18):
This doesn't make sense to me at all. What will change by the time of the next appoinment ???? Or are they trying to say that his behaviour is normal ??? Isn't it excessive ?? help answer!
skonys asks (nbme23):
So are we supposed to just yolo this one? wtf help answer!
osler_weber_rendu asks (step2ck_form6):
Why is this not absence seizure? help answer!
yb_26  automatisms (lip-smacking, picking at his shirt collar) are seen in complex partial seizures. Also absence seizure lasts 10-20sec, not 1-2 minutes. +
osler_weber_rendu asks (step2ck_form6):
Why not paracentesis? Sharp chest pain, JVD, enlarged globular cardiac silhouette, and nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade. help answer!
aneurysmclip  Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +
charcot_bouchard asks (step2ck_form6):
I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue? help answer!
skonys asks (nbme23):
Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients) help answer!
brandoctor asks (familymed2):
I think this is pretty clearly HSV-2 genital herpes. Just to confirm though, the blister fluid culture was negative... so that just means the test isn't very sensitive I guess, yeah? help answer!
brandoctor asks (familymed2):
Okay, but why aren't we concerned about the Benzo (and it's anticholonergic properties) in the 67yo F? help answer!
brandoctor asks (familymed2):
Why not low NPV? Since you can't say that you DON'T have strep throat if the test is negative... Does this have to do this prevalence altering NPV? help answer!
jlbae asks (step2ck_form8):
Y'aLL dOn'T KeEp BlEaCH uNdEr YoUr SiNkS??!? help answer!
lindasmith462  i would but I don't have room with my lamp oil down there +
jlbae asks (step2ck_form8):
What would make normal lochia the correct answer? Please help I suck at ob/gyn. Am I at the character limit yet? help answer!
chaosawaits asks (nbme15):
Minor question: but isn't the anatomical snuff box the triangle between the extensor pollicis brevis and the EXTENSOR pollicis longus, not the ABDUCTOR pollicis longus? help answer!
chaosawaits asks (nbme15):
How does that picture help at all? Is it just for ruling out or can you rule in H. pylori with it? help answer!
chaosawaits asks (nbme15):
Wouldn't weight gain increase afterload due to increased peripheral resistance, which also increases AR? help answer!
stinkysulfaeggs asks (step2ck_form8):
Her BP is 160/90, why is that not being addressed by the question? help answer!
jmorga75  Alcohol is a risk factor for osteoporosis and hypertension. You get a twofer when you decrease the intake +
ih8payingfordis asks (nbme18):
Why can't this be renal artery stenosis? help answer!
ngill  Renal artery stenosis in females is commonly due to fibromuscular dysplasia. You would see hypertrophy in the unaffected side, assuming it's unilateral. Additionally, the person would like have HTN with activation of the RAAS due to the stenosed side. This would increase renin and then increase aldosterone which should lower potassium. +
jbrito718  renal artery stenosis is a cause of prerenal azotemia. the main cause here is the diuretic leading to volume depletion thus causing the azotemia. Renal artery stenosis is not implicated in this question +
specialist_jello asks (nbme13):
I get HOT T Bone STEAK IL 1 for fever but 90% neutrophils, why cant it be LTB4 neutrophil chemotaxis? help answer!
dentist  i picked LTB4 i guess the question itself is "which causes the patient's fever and leukocytosis" LTB4 wouldn't be a direct cause of fever. dumb question +
veryhungrycaterpillar asks (nbme23):
I used reverso logic. Terazosin is an alpha blocker, helps with urinary retention by relaxing sphincter smooth muscle. What would help constrict the same muscle? Stimulating the same receptor. Ez pz. help answer!
abk93 asks (nbme21):
Specifically, what is the purpose of Il-1 in this question? is it just that macrophages make Il-1? doesn't appear to be involved in granuloma formation. help answer!
medstudenttears asks (step2ck_form7):
Was anyone else thinking bath salts? Why cant it be bath salt intox & withdrawal? help answer!

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