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“Arrggg, here be fellow mateys seeking an explanation!”




... drdoom is asking for clarification on nbme25
 +0  upvote downvote
submitted by drdoom(1206)

Do session tokens invalidate? If I try to submit this comment later is it invalidated? Try later.

... brawamigonnagetthismd is asking for clarification on nbme25
 +0  upvote downvote
submitted by brawamigonnagetthismd(1)

Why? I though the bicep reflex would be strongest since it was not involved with the radial nerve issue.

... brawamigonnagetthismd is asking for clarification on nbme23
 +0  upvote downvote
submitted by brawamigonnagetthismd(1)

Wait, adipose tissue scars?? What the heck is this? maybe it's that 'fibro' part...Watched all that Botched for nothin'

... tamarafainblout is asking for clarification on nbme16
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submitted by tamarafainblout(1)

why cant it be A? Aren't melanocytes derived from neural crest cells?

... shak360 is asking for clarification on nbme25
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submitted by shak360(19)

(A) "Are you having any problems that you may be too embarrassed to talk about? Would you be willing to talk about them today?" is wrong because it implies that the topic is too shameful to openly discuss and discourages the patient from mentioning the issue. Physicians should avoid asking vague questions that do not directly assess for urinary incontinence.

... niboonsh is asking for clarification on step2ck_form7
 -3  upvote downvote
submitted by niboonsh(409)

so you just open a b__ up without any other workup whatsoever? stupid question

ak8  watch your mouth! i see why nbme is testing harder on ETHICS now +1
... gigantichawk is asking for clarification on step2ck_free120
 +0  upvote downvote
submitted by gigantichawk(1)

Was anyone thinking calcium pyrophosphate? Inflammatory joint, patient with RA, no organisms seen on FNA, would be treated with steroids?

gigantichawk  "Septic arthritis may be definitively established in the setting of positive synovial fluid Gram stain/culture. In patients with purulent synovial fluid (leukocyte count 50,000 - 150,000) but negative synovial fluid cultures, a presumptive diagnosis of septic arthritis can be made." Acute Calcium Pyrophosphate deposition would typically have a leukocyte count of 15,000 - 30,000 on aspiration. +
... 305charlie94 is asking for clarification on step2ck_form7
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submitted by 305charlie94(6)

Shouldn't early salicylate OD cause resp alkalosis? I thought only late salicylate OD caused increased anion gap metabolic acidosis. I chose Methanol given her eye sxs and I thought aspirin should be ruled out due to the timing of her OD

... azibird is asking for clarification on step2ck_form8
 +1  upvote downvote
submitted by azibird(279)

What does "central hilar opacification bilaterally" on x-ray represent?

sorrel1000  @azibird that confused me too. I was thinking sarcoidosis and then put constrictive pericarditis down. But now looking back, there wasn't enough support for sarcoidosis. +1
... azibird is asking for clarification on step2ck_form8
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submitted by azibird(279)

What is that black sliver on here retina?

... notyasupreme is asking for clarification on step2ck_free120
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submitted by notyasupreme(48)

What a dumb question, there's literally a UWorld question about how a girl with a hx of seizures faked one and how you need to do neuro testing if they have no post-ictal confusion. I'm sorry, why are we even entertaining this if she has NO post-ictal confusion?

... notyasupreme is asking for clarification on step2ck_free120
 +1  upvote downvote
submitted by notyasupreme(48)

I'm sorry but how the hell are you supposed to know it's vulvar when it says nothing about the vulva. I was between that and polyps, but put polyps because it was on the perineum? Like how the hell is that the vulva?

notyasupreme  lol jk, just looked it up and apparently I know shit about the female anatomy! +
jj375  I was quite confused by this too, especially since it said vulva but then said anal verge, but then also said vaginal bleeding. Here is a photo in case anyone else needs it: https://healthcare.utah.edu/huntsmancancerinstitute/gynecologic-cancer/images/vulvar-anatomy-image.jpg +
... azibird is asking for clarification on step2ck_form7
 +3  upvote downvote
submitted by azibird(279)

Agree that this question sucks. Why not go for psychodynamic psychotherapy since the patient specifically says she would like to understand why she does these things? Not a great option but still...

... adong is asking for clarification on step2ck_form8
 +2  upvote downvote
submitted by adong(144)

they really copied and pasted this sh!t on nbme 6-8 huh? couldn't afford another heart sound smh

... adong is asking for clarification on step2ck_form7
 +1  upvote downvote
submitted by adong(144)

they really copied and pasted this sh!t on nbme 6-8 huh? couldn't afford another heart sound smh

... notyasupreme is asking for clarification on step2ck_form6
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submitted by notyasupreme(48)

Cardi B voice: WHAT WAS THE REASON for the goddamn Gram - stain, like whyyyyyyyyy. That's why I put prostatitis, even though the non-tender prostate threw me off. Damn, these questions are really just read the first and last sentence huh?

... notyasupreme is asking for clarification on step2ck_form6
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submitted by notyasupreme(48)

I think I thought too deep into this, but isn't the cause of post-op fever on days 3-5 UTIs? I just remembered the mnemonic, but I guess I was thinking too deep..

abelaia  probably classic overthink. likely to do with the type of blood culture grown. Staph vs. E. coli. +
... groovygrinch is asking for clarification on step2ck_form7
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submitted by groovygrinch(39)

I thought with the whole <6 months or less thing he would qualify for hospice care in a skilled nursing facility? I am the only one who thinks it's a dick move to question this guy's decision making?

... joeschmo is asking for clarification on nbme24
 -1  upvote downvote
submitted by joeschmo(0)

If the directives state mechanical ventilation be discontinued it's implied that she would rather die. Why would anyone try to resuscitate when a decision has been made to pull the plug?

... epiglotitties is asking for clarification on nbme20
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submitted by epiglotitties(29)

This isn't the scenario in this question, but I was wondering what would happen if you had told the parents the diagnosis and they didn't want their child to know?

... yogurt-dimple is asking for clarification on nbme25
 +1  upvote downvote
submitted by yogurt-dimple(3)

Am I crazy, or does the question stem imply that this was inherited paternally?

raspberry-muffin  In this question sounds like inherited paternally , but this muscle biopsy confirmed Mitochondrial inheritance. Muscle biopsy: Immunohistochemistry typically shows ragged red fibers, which are caused by sub-sarcolemmal and inter-myofibrillar accumulation of defective mitochondria in muscles (mitochondria stain red). Probably Mother has the same condition too. +
yogurt-dimple  Gotcha. Yeah, the red ragged fibers tipped me off to mitochondrial myopathy, but because the stem implied paternal inheritance, I figured there was just another disease I had forgotten about that presents with them. +
drdoom  @raspberry-muffin I'm not convinced. It is highly unlikely the NBME would write this question and expect you to "assume" mom has condition without making any mention of mom. Plus, it is simply highly improbable that myopathy is present in both mom and dad lineage. That seems off to me. +
drdoom  @yogurt-dimple, I think this a key line in the explanation: “However, there are additional mutations that affect mitochondrial RNA translation, trafficking and incorporation of respiratory protein complexes, and maintenance of the inner mitochondrial membrane that can also lead to mitochondrial myopathy.” +
drdoom  Yes, they say, "Mitochondrial diseases are strictly inherited through the mother" but this is not a mitochondrial disease — this is a "non-mitochondrial–derived" mitochondrial myopathy; yes, mitochondria are affected but the mutation is in somatic (nuclear) genes that govern the maintenance of "healthy mitochondria". This is because the mutation affects the function/operation of mitochondria but the mutation itself is in the nuclear DNA (which control something about the "quality" of mitochondria but what exactly is not yet known). +
... shelbinator94 is asking for clarification on nbme18
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submitted by shelbinator94(1)

Why couldn't this be branching enzyme impairment? They both cause cardiac symptoms (according to Amboss at least)

... kms123 is asking for clarification on free120
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submitted by kms123(2)

can someone explain why it's not degranulation of eosinophils?

fhegedus  Eosinophils (FA 2020 page 408) are involved in type I hypersensitivity reactions (asthma, allergy, analphylaxis), parasitic infections and other pathologies. They are not involved in edema formation. I hope this helps! :) +
fhegedus  Also, the patient in the question got a laceration, which probably led to a bacterial infection; so neutrophils would be predominant, not eosinophils. +
... kms123 is asking for clarification on nbme22
 +1  upvote downvote
submitted by kms123(2)

How would we rule out antithrombin deficiency?

sd22  PT, PRT, and TT normal in antithrombin deficiency. FA ‘20 pg. 428 +
sd22  PTT* lol autocorrect clearly hasn’t been studying +
... calvin_and_hobbes is asking for clarification on nbme21
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submitted by calvin_and_hobbes(2)

This Q stem was confusing to me because I thought pain>>itch for shingles. Any thoughts?

... calvin_and_hobbes is asking for clarification on nbme21
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submitted by calvin_and_hobbes(2)

"In addition to slightly decreased platelet count..." — why are plts slightly low in EBV infection/mono?

... empem28 is asking for clarification on nbme22
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submitted by empem28(1)

totally buy the answer of K+ being increased, but can somebody explain why her extreme dehydration (decreased skin turgor, excess urine output) wouldn't lead to an increase in serum [Na+]?

... sd22 is asking for clarification on nbme21
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submitted by sd22(2)

Can anyone help explain what the other options would entail?

... marcspoop is asking for clarification on nbme20
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submitted by marcspoop(3)

Anyone else jump to phenylephrine as a drug that would clear the sinus congestion and also happens to cause constipation? Just me... cool

... ekraymer is asking for clarification on nbme22
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submitted by ekraymer(1)

Was it wrong to see blood tinged sputum, and automatically assume its cancer? since none of the others would have caused blood tinged sputum?

... calvin_and_hobbes is asking for clarification on nbme20
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submitted by calvin_and_hobbes(2)

Due to its pink staining, I thought B was smooth muscle surrounding the corpus cavernosum. But I suppose that the cells composing the CC are contractile by themselves? And my assumption would make the penis a giant muscle — which it most certainly is not...

... calvin_and_hobbes is asking for clarification on nbme20
 +0  upvote downvote
submitted by calvin_and_hobbes(2)

Why is the T normal in this patient? I would have predicted underlying infection — ie, fever — before even "early" septic shock. I selected septic shock purely for the intractable low SVR despite fluids but want to understand more about the absence of fever... Thanks!

drdoom  Elderly (and immunocompromised, generally) do not mount robust fever responses to bacteria and other microorganisms; in elderly, this probably has to do with “declines” of the innate immune system (your macrophages, dendritic cells, monocytes, &c., just don't function as well as they used to). In other words, if you (1) wiped out someone's immune system and then (2) injected bacteria into their bloodstream, you wouldn't observe any fever either. The presence of a “typical” (normal) fever in an elderly or immunocompromised patient can be a super concerning sign: they might have a raging infection on the inside. +
drdoom  For more: https://academic.oup.com/cid/article/31/1/148/318030 +
drdoom  ^from the article: “Absent or blunted fever response in the elderly. There is ample evidence that a blunted fever response to a serious bacterial, viral, or fungal infection suggests a poorer prognosis than does a robust fever response [13]. In addition, there is a substantial body of data, mostly from animal models, that fever—through its effects on immune function—may be an important host defense mechanism [14]. Roughly 20%–30% of elderly persons with serious bacterial or viral infections will present with a blunted or entirely absent fever response [2,3,15].” +
... iwannabedonewiththis is asking for clarification on nbme21
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submitted by iwannabedonewiththis(1)

just as a general question, would there be low levels of 1 25-(OH)2 ?

sd22  Yes, kidney has 1-alpha hydroxylase which converts 25-HCC to 1,25-HCC. CKD -> low 1-a-OHase activity -> low 1,25-HCC +
... peachespeaches is asking for clarification on nbme21
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submitted by peachespeaches(2)

I agree that Serum K decrease is the better answer, but wouldn't Urine K also decrease once blood sugar goes down with insulin treatment (i.e. osmotic diuresis would lessen)?

... freemanpeng is asking for clarification on nbme24
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submitted by freemanpeng(7)

No one talks about AR? That's much more unlikely in this case than XR

... epiglotitties is asking for clarification on nbme18
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submitted by epiglotitties(29)

I understand that feedback inhibition isn't working and is why ACTH is undetectable/low (and why there is no change after dexamethasone), but wouldn't cortisol levels increase after dexamethasone? Or does dexamethasone not count as cortisol when quantifying serum levels? pls help

misseili  This patient has Cushing Syndrome and as you stated their feedback inhibition is hampered. Low-dose dexamethasone causes a decrease in cortisol in normal individuals but not in those with Cushing Syndrome, only high dose dexamethasone causes a decrease in cortisol with Cushing Syndrome. Add'l info: In ectopic ACTH (ie Small cell lung cancer) high dose dexamethasone leads to no change in cortisol. Pathoma 2020 Pg 171 +2
... freemanpeng is asking for clarification on free120
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submitted by freemanpeng(7)

The key is when her legs up, Bp normal and symptoms free. In contast, When standing up(running), low Bp and syncope. And Low volume is surly the MMC. It's just so weird. "retrospective posture change"??

... madamestep is asking for clarification on nbme24
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submitted by madamestep(17)

Anyone else get this right because they get them so often from absolutely uncontrolled stress?

... bfinard1 is asking for clarification on nbme20
 +1  upvote downvote
submitted by bfinard1(3)

Can someone explain why cardiac output is high in septic shock?

drdoom  Bacteria and bacterial components (like LPS) in circulation trigger massive release of cytokines (Interleukin-1, Interleukin-6 and TNFa), resulting vasodilation. Heart rate increases to maintain decent BP. +1
bfinard1  Is stroke volume not affected by that massive vasodilation? I would think if venous system is vasodilated then you'd have reduced EDV from reduced blood flow to heart +
zedora  Both of you are correct. In septic shock there is a massive vasodilation. In order to compensate for the reduced blood pressure, there is an increased heart rate. Now, keeping this in mind, what is the CO formula? CO = HR x SV Right? Lets say under normal conditions HR is 60 & Stroke volume is 50. Your cardiac output = 60 x 50 = 3000. Now in septic shock, your heart rate is massivly increased but your stroke volume is decreased minimally. So lets plug in the numbers. Lets say, under septic shock, HR = 150 & stroke volume is now 30. The cardiac output is now gonna be = 150 x 30 = 4500, hence your CO is increased. In Septic Shock, the heart rate is massively increased compared to the amount of SV decreased. +
drdoom  @bfinard1 By vasodilation, I almost exclusively mean arterial vasodilation. When it comes to CV, I always work backward from “first principles”, and in my view the first principle of the CV system is, “Maintain pressures to maintain good flow.” All other accommodations of the CV system (changes in inotropy[strength], chronotropy[time], vasoconstriction and vasodilation) are in *service* to maintaining flows. Without good flows, you get the thing human tissues like the least: not lack of oxygen but accumulation of CO2 (and the acidity that goes with it). +
drdoom  So, all that was a long-winded way of saying that Cardiac Output will remain high when the body is producing higher-than-desired levels of CO2 (when organs and the immune system have gone into overdrive to respond to a threat or to address decompensation in some other part of the system); the plummeting of Cardiac Output heralds the beginning of the end. It signifies that the stresses being imposed on the body exceed the capabilities of the system. +
... duckhunter324 is asking for clarification on nbme18
 +2  upvote downvote
submitted by duckhunter324(3)

What would a rupture of the fallopian tube look like then? Compared to normal spillage..

epiglotitties  I was wondering the same thing +
... sunnyside is asking for clarification on nbme20
 +0  upvote downvote
submitted by sunnyside(2)

Can anyone justify why they did not describe an increased MCHC? FA 2019 says spherocytosis has high MCHC, and they did not even have it on the upper end of normal.

... peterngo1994 is asking for clarification on nbme22
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submitted by peterngo1994(1)

The thing that threw me of was the 74% neutrophil count. Does anyone have an explanation for this?

drdoom  Neutrophil count is different than neutrophil percentage (%). Percentages can be influenced by changes in volume, e.g., if the patient is dehydrated, percentage by volume can be skewed. +
... unknown007 is asking for clarification on nbme22
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submitted by unknown007(-3)

how do you guys "displace" your feelings when you're among the 2 percent that chose the wrong answer ? :-P

... unknown007 is asking for clarification on nbme22
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submitted by unknown007(-3)

question why does metablic acidosis have low bicarb and respiratory acidosis high bicarb ,

when the essence of the bicarb in both cases is to neutralize the acidity ???

... madamestep is asking for clarification on nbme23
 +1  upvote downvote
submitted by madamestep(17)

Remember that medullary carcinoma of the thyroid is medullary. So it's between the follicles. What's between the follicles in the thyroid? C cells that secrete calcitonin.

... daplatesofmetal is asking for clarification on nbme23
 +2  upvote downvote
submitted by daplatesofmetal(3)

What is TARNATION is going on here!?

... freemanpeng is asking for clarification on nbme21
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submitted by freemanpeng(7)

Can anyone explain what "diplopia" implies? I got sutck by"these clinical findings" (thinking upward gaze+ diplopia....) Or is "Diplopia" just a unspecific word in exam??

... madamestep is asking for clarification on nbme21
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submitted by madamestep(17)

Why don't we see a decrease in the size of the prostate gland? Is it a difference between atrophy vs. apoptosis?

... jr123 is asking for clarification on nbme22
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submitted by jr123(-1)

I still didn't get why it isn't fibularis longus. Because it evert as well as planterflex??? THANK YOU

... unknown001 is asking for clarification on nbme21
 +1  upvote downvote
submitted by unknown001(9)

ATTENTION DEFICIT- hyperactivity disorder.

how do we improve the attention deficit in that kid ? by increasing dopamine and norepi levels in the brain.

dopamine and norepi= biogenic amines

funstory. newyork times once reported abuse of stimulants by students so they can have an academic advantage by improving attention

... unknown001 is asking for clarification on nbme21
 +0  upvote downvote
submitted by unknown001(9)

low retic count= marrow not working .

what can explain this ? parvo virus affecting the hematopoetic stem cells , hence the low retic count,

think of the low retic count of giving a picture of a failing marrow

... unknown001 is asking for clarification on nbme21
 +0  upvote downvote
submitted by unknown001(9)

here is a copy pasted link .

first, high tsh = hypothyroidism

How can hypothyroidism affect me and my baby? thyroid hormones are important to your baby's brain and nervous system development, untreated hypothyroidism—especially during the first trimester—can cause low IQ and problems with normal development.

... unknown001 is asking for clarification on nbme21
 -1  upvote downvote
submitted by unknown001(9)

what is collagen ? a secondary protein structure.

when you remove glycine, the most abundant amino acid , from the precursor molecule will you get a proper secondary structure ? NO

unknown001  ignore this +
drdoom  can you elaborate? what's wrong with your comment? +
... blue4415 is asking for clarification on nbme16
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submitted by blue4415(4)

A discontinue consumption of all alcoholic beverages is wrong； Is that because what She drinks is wine ? Not take it as alcohol?

... cassdawg is asking for clarification on nbme22
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submitted by cassdawg(1780)

If the patient is taking calcium acetate (a phosphate binder), why is his phosphorus level increased?

... charcot_bouchard is asking for clarification on step2ck_free120
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submitted by charcot_bouchard(574)

why not prophylactic anitbiotics?

akjs16  That bothered me, too. According to Cecil, Prevention throught vaccination is the best option for the long-term control of meningococcal disease. Chemoprophylaxis can only control localized outbreaks. There must be some articles, but I'm too lazy to find them. +
... charcot_bouchard is asking for clarification on step2ck_form8
 +0  upvote downvote
submitted by charcot_bouchard(574)

Why cant this taken as sexual health?

... charcot_bouchard is asking for clarification on step2ck_form8
 +1  upvote downvote
submitted by charcot_bouchard(574)

Why cant this taken as sexual health?

namesthegame22  An operation >> sexual advice/contraception/STD testing +
... jda2674 is asking for clarification on step2ck_form6
 +1  upvote downvote
submitted by jda2674(5)

So we're expecting a topical retinoic acid to clear her acute acne within 3 weeks? don't topical retinoids cause purging often?

... blue4415 is asking for clarification on nbme21
 +1  upvote downvote
submitted by blue4415(4)

can Gonadotrophs “hyperplasia” rather than hypertrophy?

kevinsinghkang  wondering the same +
escherichia95  Hormonal stimulation will lead to production of new cells from stem cells i.e. hyperplasia. Hypertrophy is gene activation, protein synthesis and production of organelles. +
... unknown001 is asking for clarification on nbme24
 +0  upvote downvote
submitted by unknown001(9)

in my opinion , this was one of the most difficult questions . why ? the answer is soooooo simple that you might be mislead thinking "naaaahh cant be that easy ...nbme .. you playin witme hun?? imma choose the most complex answer and shove it in your face"

student chooses VIP, and afterwards locks him self up with his new record level low self esteem

... unknown001 is asking for clarification on nbme24
 +1  upvote downvote
submitted by unknown001(9)

how to rule out iron def. ? iron is absorbed in deodenum and proximal jejunum .

b12 in ileum.

this will give you the answer

madamestep  I fucked brittany: Iron, Folate, B12 +1
... unknown001 is asking for clarification on nbme24
 +1  upvote downvote
submitted by unknown001(9)

dont be distracted with timing. both can start within minutes.

how to rule out ?

anaphylaxis lung finding > WHEEZE. (question stem = no wheeze)

... unknown001 is asking for clarification on nbme24
 +0  upvote downvote
submitted by unknown001(9)

this is a bonus question.

when odds ratio is 1, meaning no association,

odds ratio> 1, whihc in this question is 6, means association

where is odds ratio ? a) at the ate cookie-didnot drink milk column. hence the answer, only cookie independently ass. with e coli

... unknown001 is asking for clarification on nbme24
 +0  upvote downvote
submitted by unknown001(9)

RESOURCE : CDC Malaria species: P. vivax 93%, P. falciparum 7%.

WHY HYPNOZOYES ? 2 reasons

  1. schuffner stippling ( that wierd cell with lots of blue glitters)

  2. HONDURAS ( 93 percent are vivax)

unknown001  https://wwwnc.cdc.gov/travel/destinations/traveler/none/honduras +
... jatsyuk38 is asking for clarification on nbme21
 +0  upvote downvote
submitted by jatsyuk38(2)

doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything...

... lilmonkey is asking for clarification on step2ck_form6
 +0  upvote downvote
submitted by lilmonkey(63)

Small Cell - Central. SIADH. Squamous Cell - Central. PTHrP. Adeno - Peripheral. Clubbing (EGF). Carcinoid - Bronchi? Flushing (Serotonin).

... forkyeaa is asking for clarification on nbme21
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submitted by forkyeaa(1)

why is the MCV elevated in this question when it's supposed to be normocytic non hemolytic aplastic anemia?

... kstudy is asking for clarification on step2ck_form8
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submitted by kstudy(9)

this is a great example of why I struggle with this silly nbme and steps. Are we testing knowledge here or semantics?

merpaperple  It's important that we learn to be as pedantic as possible, that's what makes for good doctors +
cbreland  Truer words were never spoken +
... marypoppins is asking for clarification on nbme24
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submitted by marypoppins(1)

Why can't it be choice E? I assumed the patient had bipolar.

... agraham416 is asking for clarification on nbme22
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submitted by agraham416(5)

am i the only dumb one who thought it was angioedema cause of the ACE inhibitor? totally neglected all other information.

dwdelva8  I did the same thing, but she had been on that ACE inhibitor for 15 years so I guess it would be strange for it to all of sudden cause symptoms +
... an1 is asking for clarification on nbme18
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submitted by an1(114)

Holosystolic: MR, TR, or VSD

Lower left sternal border (the left border is Erb's point, beneath that is the Tricuspid area) --> TR or VSD

Whats more common? VSD (by far!!)

If they had mentioned the mum having BPD or taking pills for a psych disorder, then TR could be a big contender.

... agurl1000 is asking for clarification on nbme23
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submitted by agurl1000(5)

This might be a straightforward answer, but I was wondering why the patient would have a decreased inspiratory flow? Because to my understanding, people with obstructive diseases have trouble breathing out, not in.. Could someone explain to me why it decreases?

rdk3434  okay so i had the same doubt which is why i got this question wrong , but then i had this eureka moment , in uworld there's repetitive images about obstructive and restrictive disease volumes and they always show TRACHEAL STENOSIS along with that , this question is somewhat like tracheal stenosis presentation , just google lung flow volume tracheal stenosis! hope this helps! +1
... agraham416 is asking for clarification on nbme15
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submitted by agraham416(5)

How do we tell the difference between uncompensated respiratory acidosis and compensated?

... agraham416 is asking for clarification on nbme15
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submitted by agraham416(5)

I understand why the answer is B-Lactamase prod., but can someone explain why alterations in the PBP in incorrect?

... dnazmzm is asking for clarification on step2ck_free120
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submitted by dnazmzm(2)

I thought the baby was bitten by lizard then I didn't know what Saccharomyces cerevisiae was, so I thought it was something related to a lizard lol!!! too imaginative?

charcot_bouchard  DO NOT PICK SOMETHING U NEVER HEARD OF. Unless u absolutely sure that none of others are not the answer +
... chaosawaits is asking for clarification on nbme23
 +8  upvote downvote
submitted by chaosawaits(92)

Who else read that last sentence 100 times and still had no idea whether it was even English or not?

... michik92 is asking for clarification on free120
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submitted by michik92(2)

Can someone please clarify why this wasn't myasthenia gravis?

There weren't any upper motor neuron signs in the question stem.

j123  Fasciculations = UMN sign +
gabriellerenai  ^ no fasciculations are a LMN sign, flaccid paralysis with twitching (fasciculations) is LMN lesion FA 2019 pg 517 +3
gabriellerenai  but to answer the original question, MG usually presents with fluctuating (rather than progressive) weakness in extraocular and bulbar muscles before signs in limbs so it would be odd to not mention diplopia, dysphagia, trouble chewing etc. Additionally the fact that it is progressive leans toward ALS rather than fluctuating (MG). Also if you were still between ALS and MG, MG = middle aged woman while ALS is a middle aged man. +1
gabriellerenai  ooooo my bad dysphagia is mentioned but the progressive feature, enough to put him into a wheelchair still stands out to me as ALS, and dysphagia and aspiration are often what leads to death in ALS +1
... chaosawaits is asking for clarification on nbme22
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Can someone please explain why this is not hypercholesterolemia? It also presents with HSM and there are numerous foam cells. Since hypercholesterolemia also presents with pancreatitis, couldn't that explain recurrent vomiting? FA2019, p94. Thank you for your responses!

chaosawaits  I mean Type I familial dyslipidemia (hyperchylomicronemia). Am I correct in assuming that the most differentiating presentation is the developmental delay? +
... imtheman is asking for clarification on step2ck_form7
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Why wouldn't a bone morrow transplant prevent this? Technically not wrong...?

... testingforlegal is asking for clarification on free120
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testing for legal, any terms and conditions to sign?

... charcot_bouchard is asking for clarification on step2ck_form7
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If its intrinsic defect HTF urinalysis is normal with no casts?

... ali_hassan is asking for clarification on nbme21
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How does 500 men with various urological conditions result in a precise estimate? Wouldn't the variety of values due to various degrees of illness reduce precision and cause a wider variety?

Maybe I overthought it

... weirdmed51 is asking for clarification on nbme22
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Any other conditions where pulsation in the liver can be found ?

... agraham416 is asking for clarification on nbme18
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I eliminated this answer because the mother already stated her concerns, which was that he's shorter than the father's height and about him not having a growth spurt. Is that not a concern?

... failingnbme is asking for clarification on nbme24
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can nephritic syndrome be without HTN?

yiqi  I got wrong for the same reason!!! +
... athenathefirst is asking for clarification on nbme20
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How do you know the answer is not E? I chose E because I thought of ATN :( Someone help please

lovebug  I am not sure. but I thought E) multiple wedge-shaped cortical infarct . could be induced by multiple embolism of artery. or complete blocks of small artery junctions..(blockage of blood junction) but this case was hyperplastic arterioloscelrosis. +
... osler_weber_rendu is asking for clarification on step2ck_free120
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Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway

len49  Pick the best answer of the choices, not necessarily what you would do in real life. +1
drdoom  @len49 Sure, but in that case you’re not saying much about /why/ “Skeletal survey” is the best answer choice from the NBME-frame-of-mind. Can you elaborate? +
drdoom  @osler My guess is that a skeletal survey is what “clinches” evidence of ongoing abuse, since skeletal surveys can reveal bone and tissue injury at /varying (time) stages of healing/, which is the kind of evidence CPS is going to need to establish a PATTERN of abuse and discredit claims like “this was just a one-time ‘accident’.” +
... stunna216 is asking for clarification on free120
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why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion?

csalib2  heads up, i think you’re in the wrong question thread +1
... arthur_albuquerque is asking for clarification on nbme20
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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!

... shaz464 is asking for clarification on step2ck_free120
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Still confused.. Can anyone rule out all other options please?

len49  A. Conducting a nursing in-service won't help because they do not have the ordering power, that should rest on the person writing prophylaxis prescriptions/orders. C. Not feasible for every patient (not every patient is well enough to be ambulatory. Moreover ambulation only helps so much; patients at high risk for thrombus (for instance like this patient who is hypercoagulable due to malignancy, recent surgery) need bigger guns. D. LMWH is not appropriate for all post-op patients. For instance, inappropriate for people who may be actively bleeding, patient with previous diagnosis of HIT, patients with ESRD as it is renally cleared E. It is not an isolated case, as you know DVT provoked from long hospitalizations and post-op patients is pretty high and taken pretty seriously. +1
... sizario is asking for clarification on step2ck_form6
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how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH?

adong  FSH/LH wouldn't be the answer to why her libido is low tho +
... embeemee is asking for clarification on step2ck_form7
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what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately

adong  if this presentation were not as severe it would just be "allergic" as opposed to anaphylactic +
... embeemee is asking for clarification on step2ck_form7
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i get the answer, but would a VB even be possible given her GBS+ status?

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 +1
... embeemee is asking for clarification on step2ck_form7
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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?

... justanotherimg is asking for clarification on nbme18
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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 ??

elasticscatter  It said the next ROUTINE examination (like, his next yearly checkup). Basically, it's saying carry on as usual and don't do anything differently based on this info. +1
... skonys is asking for clarification on nbme23
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So are we supposed to just yolo this one? wtf

... osler_weber_rendu is asking for clarification on step2ck_form6
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Why is this not absence seizure?

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. +1
... osler_weber_rendu is asking for clarification on step2ck_form6
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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.

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. +3
encarnme  Do you mean pericardiocentesis? Paracentesis would be used for ascitic fluid. +5
... charcot_bouchard is asking for clarification on step2ck_form6
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I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue?

one does not simply “walk into mordor”
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