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Welcome to adong’s page.
Contributor score: 82

Comments ...

 +0  (nbme23#3)

By default you should use intention to treat analysis b/c it's the most conservative.

 +0  (nbme23#32)

You can answer by process of elimination. "Competitive interactions" makes you think stimulatory NT. Cross out GABA and glycine. In the cortex so glutamate. Metabotropic would mean there's second messengers involved and the receptor would not transmit calcium. Hence NMDA.

 +3  (nbme23#27)

If you're confused by the systolic murmur look at FA2019 p.288. ASD can cause systolic ejection murmurs in the pulmonic location (can think of it as increase turbulent flow).

Of course the more important thing is fixed splitting so SMASH away.

 +0  (nbme23#45)

In addition to what has already been said I think an important point in the question was regulatory adjustments which points more towards arteriolar regulation.

 +0  (nbme23#44)

tricky image but question is asking more specifically about his visual complaints which is just "double vision" so IR entrapment is the best answer

 +2  (nbme23#10)

I don't think you're supposed to know any complicated niche piece of knowledge. You have to infer that the pt has a skin lesion and is therefore prone to skin infections, most commonly from Staph aureus.

 +2  (nbme22#49)

the patient is pregnant so not doxy. azithro is alternative (see sketchy vid)

 +7  (nbme22#44)

Dicumarol is in the coumarin family which includes warfarin. It helps if you think about warfarin's brand name Coumadin. Coumadin, coumarin, dicumarol...all the other derivatives have COUM it in some fashion

 +6  (nbme22#45)

neuroendocrine cells doesn't always mean neural crest

prolific_pygophilic  you're god damn right.... kms +

 +14  (nbme22#38)

literally know every single name they can possibly call this

djtallahassee  literally a new name every nbme +7

 +0  (nbme22#2)

from uworld: fibrates activate PPAR-alpha to increase LPL and decrease VLDL production

 +1  (nbme22#46)

uworld says somewhere that testosterone increases hematocrit, increases LDL, and decreases HDL

passplease  Estrogen increases HDL. Testosterone is converted into estrogen. Why doesnt testosterone increase HDL. Why is my logic wrong? +
avocadotoast  The woman in this vignette has an increased androgen:estrogen ratio, so the effects of testosterone on lipid levels will be greater than those of estrogen on lipid levels. Boards and beyond also states that testosterone causes an increase LDL, decreased HDL, and increase in hematocrit, which is why males with primary hypogonadism can present with anemia and the use of anabolic steroids can present with erythrocytosis. +

 +2  (nbme22#43)

got confused by the systolic pulsation of the liver but basically regurgitant blood from RV will go into RA > IVC > hepatic veins

 +1  (nbme22#8)

the question can easily be misinterpreted. it's asking for urinary pH, urinary bicarb, and urinary volume

 +1  (nbme22#30)

hit the kidney so retroperitoneal. leaves only the duodenum and splenic flexure. kidneys are more lateral structures so splenic flexure (at turn of descending colon)

jackie_chan  Basically how I reasoned too; left kidney is close to tail, not body, of pancreas so that was out, duodenum is right side, stomach is not retroperitoneal, supraadrenal gland is superior to kidney, not immediately anterior; thus leaves splenic flexure (and its also left side) +

 +1  (nbme22#7)

Pretty much if they can masturbate or get it up alone in any way their nocturnal tumescence should be normal meaning that their innervation and reflex pathways are all intact. Libido aka sex drive from what I’ve seen so far is altered by depression. So like in the question on NBME 21 the stem stated that screening for depression was negative which is why libido would also be normal in this case. If there’s ever a Q with a depressed guy and normal lab values and physical exam, most likely gonna be decreased libido with normal night erections - courtesy of /u/diffuseaxonalinjury

 +3  (nbme22#30)

you need to add an amine (nitrogen) and most biochem processes from sugar --> amine requires glutamine

 +6  (nbme22#35)

Super annoying they are using the same picture BUT you can answer with process of elimination. No mass in the picture so not nephroblastomatosis or RCC. 4 year old so not amyloidosis. Stem does not really cue you into membranous GN. Instead it talks about UTIs which would have inflammatory processes --> interstitial inflammation.

 +2  (nbme21#26)

Cecum is intraperitoneal even though it's part of the ascending colon

azibird  How were we supposed to know this? Thanks for the clarification. I picked cecum because FA says Crohn is usually the terminal ileum and colon, so I figured cecum would be the most likely vs the descending colon. +3
kevin  Yeah that's what I thought at first too. Figuring it was a tricky question, I went with descending colon because 1) ascending and descending are retroperitoneal, so we know the latter is for sure right, and 2) cecum has it's own name (ie it's different than the ascending colon), so it probably isn't retroperitoneal in that regard. You can remember ascending and descending are retroperitoneal by remembering the greater omentum wraps around the transverse colon and from anatomy lab that there's a mesoappendix, mesocecum, etc (peritoneal) +

 +5  (nbme21#8)

Euthyroid sick syndrome = levels of T3 and/or T4 are abnormal, but the thyroid gland does not appear to be dysfunctional. The classical phenotype of this condition is often seen in starvation, critical illness, or patients in the intensive care unit. The most common hormone pattern is low total and free T3, elevated rT3, and normal T4 and TSH levels.

 +2  (nbme21#39)

FA19 p.233 cortisol has a permissive effect on catecholamines

 +0  (nbme21#25)

unequal BP/pulses in the arms is a big key for aortic dissection

 +5  (nbme18#18)

Increased pressure is in the Bowman space (NOT the glomerular capillaries) so the only pathology listed that would cause backward build up of pressure is BPH

Subcomments ...

submitted by sugaplum(235),
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nyomorllpaanpeihepn si an lapah gtsanio that tstalesuim telhruar smhtoo cmlseu rncncoiotat. - from oae,tptud oerhv,ew ti oals yssa it is otn dmmoceedern anttrmtee rnoymae

ugalaxy  α1 stimulation (via α1 agonist) constricts the bladder sphincter thereby, preventing sudden bouts of micturition during coughing/sneezing (abdominal stress). +5  
sammyj98  I thought that B3 stimulation stopped urination +5  
adong  @sammyj98 B3 would facilitate bladder relaxation +  
hvancampen  @sammyj98- were you thinking of oxybutynin? (thats what I thought of!) According to FA, its used for urge incontinence not stress. +1  
drzed  Nah he/she's talking about Beta-3 receptors which are Gs coupled. Gs increases cAMP thus it would cause smooth muscle relaxation -> bladder relaxation! +  
donttrustmyanswers  From Mayo: "There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however." +1  
nreid4  @hvancampen oxybutynin is an M3 muscarinic antagonist, not B3. +  
alienfever  I thought about B3 agonist as well and got this wrong. I think maybe B3 agonist can be used for bladder (URGENCY incontinence) where the main issue is detrusor over reactivity. In STRESS incontinence however the problem has nothing to do with detrusor, so we use α1 agonist to constrict the sphincter. +  

submitted by hayayah(990),
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oCmlaobo si an eye imatlnbaory ttha orsucc eobrfe t.rhbi Teryeh' snmgisi icesep fo istesu ni rsctuestru taht mfor eht ye.e

  • Coslaombo gaicftefn eht siri, hhicw tsrule ni a ko"eel"hy reaeacpapn fo het ppli,u gnayerlle od not elda to svinoi .ossl

  • osaloCbom nilnvvgoi hte taenir trlsue in ivions slos ni cepfiics rpats fo the lvsuia eif.dl

  • Laerg eantilr ooolamsbc or hseot cteingfaf eht tpoci evner can seuac lwo s,ioinv ihwch nesam voniis ossl hatt natonc be pcmyoetlle decrrecto hiwt eslassg ro otcacnt l.eenss

mousie  thanks for this explanation! +  
macrohphage95  can any one explain to me why not lens ? +  
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss +4  
qfever  Do anyone know why not choroid? +1  
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina +2  
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +7  
mnemonicsfordayz  Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO. +  
mamed  Key here is that it doesn't affect vision- the only thing would be the iris. All others are used in vision. Don't have to know what a coloboma actually is. +1  
azibird  The extra section of that Zanki card specifically says that a coloboma "can be seen in the iris, retina, choroid, or optic disc." Don't you dare talk trash about Zanki! +1  

submitted by alexb(42),
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icenS erhte ewer lmls"a mtansou fo cumnoeim" I thgthou ti coul'ndt be aers.ita rusTn tuo sieatra 'sitn lysaaw eanecsb of ule,nm ti cna asol be lbmaanor grwornnai fo ,enulm ilagownl jtsu a asmll ontmau ot apss .th.grho.u

adong  I don't think that's true, atresia literally means closure/absence of the lumen. I also got tripped up by the meconium but that could be just GI epithelium that was shed while in utero etc. I wouldn't change your definition of atresia. +2  
srdgreen123  one thing i would say is that in the case its due to failure of recanalization and not due to failure of formation like other types of atresia, so its possible that when it was de-canalized, it was not 100% closed allowing for some meconium to pass +  

submitted by pitaziki(-5),
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Wyh si eth ewasrn fsibaiulr bvsrei nad ont srfaiiblu uiser?tt Hwo od you tunisiisdgh tenwbee hte wto fmor isth eentvtig?

gainsgutsglory  tertius is an anterior muscle and overlays the dorsum of foot as it fans out to the toes. Does not relate to the lateral malleolus. +  
adong  wrong question to post on agree with above +  

submitted by gh889(89),
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omrF okHnneydoruSheoak on e:rdidt

haWt teh utesnqio is getitng ta is hte icaehstpmyt cihan saw espad.r tI was a rrieeblt yaw of idgnorw i.t

Your antorier thpsaaumhoyl is rsilnbseope ofr gooilnc saufrtee adn si rdneu iahcpayteastpmr otr.oncl A eosnil wodlu euacs par.meehtyirh

Yoru rprsetioo ouhslytaapmh is rsseeibpnol ofr enitahg nehw y'eoru lodc and ot nergteea the vFeer psneeors nad is erdun asmhptyciet .nrtoocl A snoile olwdu uesac o.rtphemhiay

nI tihs oetnsuqi ti is mlipsy gsakin a psrnoe segt ksc,i atmlouayphsh wsa asd,epr tahw

rwAne:s aothupmsylah iwll tlsil eb ealb to aleteve ste dbyo raeterupetm ot tlaebt c.tnioenif

Hi:nt FI tyhe evgi a utisqneo isrilam to shti but oreweddr ot dinluec a iselno of het myttihcsaep esbrif or of hte lhahp,oymsuta you olwdu ni rtun OTN eb aebl ot eertgane a veref sesnpoer to iitc.fnone eTh aauhhyomstlp dlouw eb letnriye uedrn sappaartmeyhtic rtoconl

shTi sadd orem conttex to the fact eht Q astset atht het ytcsptaimhes swa drsepa

oslerweberrendu  So, this says sympathetic also spared and hypothalamus also spared. Then what was wrong with this clinical case?? +  
adong  i think the sympathetic system is actually impaired b/c it's cut before it can "outflow" least it's the only way this makes sense +3  
suckitnbme  I agree. I think the question stem is saying the sympathetics were lesioned. Not that they were spared. +3  

submitted by sinforslide(40),
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Mlea eraninlt eiaalitng g&t-; Ittcna RSY , tse,set adn rese.ttnostoe

No emelfa tinnreal eiialgatn &;g-t snrPeece fo MIF earminli(unalt no)mhoer nad ctnati toiSrle elcl tfcoinn.u

meeFal xaertlen gletnaaii ;g-t& No gerondan epsrt,en hhcwi is iuredqer orf mlae nreeltax aigtnelia f.atiormon

d_holles  Not sure I understand why T is wrong, but DHT is correct. +1  
d_holles  I thought about this some more -- DHT forms external genitalia while T forms 'male genital ducts'. That's why the correct answer is DHT, not T, since the PT had +ext genitalia, but -internal genitalia. I was thinking that the PT had CAIS, but that would lead to testes only w/o male genital ducts. See FA2019 p608. +8  
d_holles  *I meant -ext genitalia, +int genitalia +  
adong  T is wrong because you still need T to make the internal male organs which he has based off the MRI +1  

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If btho HZCT dan polo diiucsret eerw dvdeorpi as na wesnar ,hoccie trefhur ecul ttah tzch uodwl be eht ewsran eochic is hte epresnnttoia fo het ipantte ign"efel fy."nnu hisT sggsuset capeliaeyrmhc cch(psriaiyt )eosvrento iwhhc si a ieds ffetec iuuneq to .THCZ

adong  there wasn't any loop diuretics... +  
the_enigma28  Good explanation!! +  

submitted by hello(251),
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eTh Q stme stseta OXFO si a tirotcrnsapin crafto taht sdeoprsn ot ininlus slignnagi by glantrie het inpoirratctns fo becmtaiol eegns ;-&-tg erfret,eho OOFX si a nnrpicaosttir rofcat oivvndel in bsaei.lmmto sihT uslhod maek nsees eeaucbs rlceosennitirup- itavnictao ash a rloe ni egnuargilt .slieomambt

sTih Q sask ubaot vbreeieslr ysaw tath lsuinin egtesaru OXFO roatispctnnr cftora tc.viyati

qduiiUnbateiidetm- oyesiplostr si beilrverersi. amntleiiE all hoicsec pcexte fro B, ,D and H.

cenrsuIlrtpoisne- tciunnfo rouhght 3KPI ini.sgagnl PIK3 gligsinna lvevoisn hphrnaoospoilty of irseen g--t;& risnee ahopltproshoiyn is a bsiverreel .sspoerc natlieEim .H F:IY emitainr/pono daci loohpsniparhoty is lsyawa blv.reeiser

You aer tfel tihw coecihs B nda D.

OOFX is a crtotnapnriis fratoc -g-t&; cnisanrrtpiot cotasfr eaitmed nege icatyivt yb tgustlhni tweeneb eth sptamylco nda nes.uclu talgiuneRg teh antcolio of XOFO trisrontiapnc rtfcoa .e(.i pasltocym vs. l)cunesu lwli tfrerheeo ybesrelirv eudotaml ieXFa-OetdOdm ilobetacm eeng ctt.iavyi

Tish evlsea yuo thiw hte cectror asren:w eoihCc .B

adong  A better way to think about it is insulin acts through MAPK which is a serine/threonine kinase +  

submitted by strugglebus(154),
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Liyens si sued ni lsineta nda nollecga ssocr ;niilgnk ti si cross nilkde by llyys seaixdo ot meka llcogane ifsebr

charcot_bouchard  Thats my brother from UFAP mother +2  
smpate  but glycine and proline are used in elastin too. Seems like you'd have to know about desmosine though that's not in first aid. Or maybe you can infer lysine since it's charged and is probably more important in maintaining stability? +  
adong  the only thing we know about cross-linking is with LYSYL oxidase, hence lysine +2  

submitted by aj32803(2),
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wdUrol fiapycslleci syas hatt Poass basscse nesma teh enaptit liwl rreefp iexolfn to oiadv ehrgttinsc teh .cmeslu tha'sT hwy Pssoa ddi otn kema eenss to em cisen hte nitapet rereedfrp nsixetneo, chhiw odluw eb hgtstenirc otu the u.mselc

nO het oreht ndah 'sit hrgit no eht rterbvea adn 'its oseitadsca htwi .TB

adong  it's confusing but i think b/c psoas acts to flex at the hip, staying completely flat would keep the muscle from being contracted. uworld is talking about the psoas test which would end up hyperextending the psoas muscle which would elicit pain (psoas test can also be done with active flexion against pressure which would explain the not wanting to flex). +1  
kamilia20  First ideal to my mind is that:patient is a TB, TB prefer psoas +  

submitted by dr_jan_itor(64),
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nCa ynonea rnaews hwy siht eno nca't be F. eaBt haltseiaam a?rojm I aws khtninig ebacseu of hsi imaena adn teh oepanure" set"cdne hcwhi nliseudc teh adnriteiamen nupo.rease nelUss BMNE triserw nhtik ttha naeouper ylno nasme teh oesn twhi ratex etwhi leppeo oll

dickass  European implies northern european (they even specified the patient was a person of pallor), mediterranean descent is usually implied by country of origin or by straight-out writing 'mediterranean'. +  
poisonivy  The MCV is normal, thalassemias are microcytic anemias, that hint helps to rule out the thalassemias. However, I got it wrong, not sure why it cannot be a homozygous mutation in the ankyrin gene +2  
adong  @poisonivy, other commenter pointed out it's autosomal dominant so best answer would be heterozygous +  

submitted by ye2019(3),

Physical exams showed tenderness of costophrenic angles, which are the places where the diaphragm (-phrenic) meets the ribs (costo-). Not the Costovertebral angle tenderness that we think to hint renal disease.I got confused with this point.

adong  honestly think this was a typo. hot trash +2  
neovanilla  Assuming it was not a typo, how would the costophrenic angles be tender in this condition? ...From crying...? +1  

submitted by step1soon(43),

Anything upper lip + above → basal cell carcinoma

Anything lower lip → Squamous cell carcinoma

FA 2019 -pg 473

adong  it's saying upper vs lower lip. this pt has it on the nose +1  

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Tihs is AEILTLYRL eth aesm htopo hyet used ot dreesbci eht --yd4rleoa byo iwth feiufds aolcicrt orcsnsie form NMBE 8.1 nCa enmoeso alniepx 'stawh iogng no heer

lancestephenson  *Tubular atrophy, not cortical necrosis lol +  
charcot_bouchard  Can u fuckers talk about spoilers +1  
adong  same photo because the end gross pathology is the same. whether it's due to cancer or whatever the 4 year old boy had (some sort of obstruction IIRC) it ends with atrophy of the kidneys +  

submitted by hhsuperhigh(22),
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siTh si hwo ym rnbia dtrefa eliwh I asw diogn hsit .eotqns...ui I teandw to cohsoe TGB ,iecnedfyci tbu I tekp ngktnhii hatt fi GBT is f,ietdienc hatt nsame three era less or no ibigdnn erntipso ni eht lo.bdo nAd woh nca eht erfe T4 be ?amonlr uo'dhnltS eerf 4T ricnease if rheet were elss 4T ignbnid ortipe?n ...

adong  free T4 wouldn't increase because it would be sensed by the pituitary and TSH would drop until free T4 normalizes +2