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Welcome to aesalmon’s page.
Contributor score: 81


Comments ...

 +5  (nbme22#33)
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Ldgyei cell ,psrhaylaiep lusdoh aosl ees isrfibso dan nhoalzyntaii fo eth ubutles tub 'mi tno nsigee .i..t _ツ/¯(¯)_

meningitis  I think its there.. I thought it was the lighter red/pink material (hyaline material) And I thought the white streaks were the fibrosis like "streaked ovaries"in Turners. +

 +3  (nbme22#16)
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AF .gp 706 - afliure fo uifnos of the ylamlaxir dna meergd ldemai lsana rseeospsc ftronoa(mi fo rimaryp elata)p

meningitis  I think Cleft palate could also be due to failure of fusion of lateral and medial nasal prominences.. but since the baby had lip involvement and the lateral nasals can be seen, I went with failure of Maxillary and medial nasal fusion. Someone correct me if im wrong. +4
snripper  @meningitis this is cleft lip, not cleft palate +2

 +3  (nbme22#48)
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I elfe bmud for skngai ubt cna ooesmne eplxnia h?ist fI hsi srneapt rea of seolc ot nlmaor BMI nda rae nocrdenec uoatb shi tgiehw wyh ouwdl tyeh be liglawon ihs clraeio oputiomcnsn ot dcexee ish ygeern ptunideer?xe ( AAK etngitl eth ikd tea oto chmu nad ton iesxerec )oguehn

meningitis  That's a modern day mystery. +16
drdoom  The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend. +1
niboonsh  aka 'merica #firstworldproblems +4
makinallkindzofgainz  If you are obese, it's because you have consumed calories in excess of your energy expenditure, end of story. (there are factors that affect your energy expenditure, but the simple statement is 100% true, unless you want to argue against the laws of thermodynamics). A is the only correct answer. +1
tulsigabbard  This answer hit too close to home. +4
castlblack  I think the reason they point out the average weight of the parents is because leptin disorders are inherited. It helps you eliminate that answer choice. +1

 +12  (nbme22#36)
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pg. 312 fo FA - Acteu hasep tnrcastae trdlpuegae-u urnigd sismetyc tait:msosafnnie oe"Mr FFiHS in the C" ni,uiFoin re,reFeStbnrir gm mdoialy vAridnetiai,HCpcc -,ee .rpiteon


 +9  (nbme22#28)
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hnWe in udtbo tis bbropaly eht nipSlce niVe "(yapl sd"od - )aonjlG

jurrutia  Also, what is causing the splenomegaly? Cross out gastroduodenal A/V, gastric A/V, and pancreatoduodenal A/V since they have nothing to do with the spleen. All that's left is the splenic vessels, and you know it's a vein... +

 +6  (nbme22#19)
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eThos aisrtere go rverhewe eyth wtna - off het r,toAa nmmoco a,lisic eherrv.ew Onyl 2 etrrseu tho


 +3  (nbme22#20)
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Cilclnai rltai - morceaps tahetpruiec fbtneise of +2 etsettnmar wrana(irf sv. nd)eenaailae-lO lbptrp - otbh eht elhhta drsveroip nad teh tp ear awera fo het gurd geibn inevg

jackie_chan  How are we supposed to know in the question the patients and providers are aware that they know what they are being given? +
haydenelise  I went back and forth about it, but in the end figured that they were aware since one regimen involved subQ injection + oral med and the other was subQ injection alone with no oral placebo. +2

 +1  (nbme21#14)
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nmlyotSecep = more cbetlusipes to ueptsaadclen aiogmsrsn

I tup E. icol sa sti dceslaaptuen but hatt 'twans het omts tghir nawesr I segus?

pippylongstock  This question is asking about the ‘S’ of FA Mnemonic for S. Pneumonia “MOPS”. Strep pneumo is the most common cause of sepsis in adults. +2
emmy2k21  MOPS stands for meningitis, otitis, pneumonia, and SINUSITIS. It doesn't stand for sepsis. My guess as well is which is "more correct". It's about being able to identify encapsulated organisms and the spleen's role in immunity. Ha I chose E coli as well. +6
et-tu-bromocriptine  emmy2k21 is correct, the S is for sinusitis. I was between E.coli & Strep Pneumo, but then recalled Sketchy putting the sickle on the 'encapsulated' knight in the Strep Pneumo video; Strep Pneumo is more associated with infecting sickle cell "functionally asplenic" patients. +3
aneurysmclip  You could also recall that before splenectomy(ik this is a emergency splenectomy) we would want to give an encapsulated vaccine like the pneumococcal vaccine. this pushed me towards strep over ecoli +1

 +0  (nbme21#36)
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I ntwe cbak and etwadhc ihts incoste on aotmpha tfare intgegt eth ietqsnou nrwgo - .rD Statar ssya ttah somroahCdn dan sdmorcCarhnsaoo seari ni teh ADML,LEU dan ont teh ceox.rt eeHvwor teh qitosuen tesm setsta hatt heert si kennigcth"i of the dphisaisy nda ourntspidi of eht RTECOX htwi lcfao aaer of sariendce atiiclnfo",ccia ???

yotsubato  It arises in the medulla and *passes* through the cortex because its invasive and malignant. +12

 +2  (nbme21#37)
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nCa nyeona lxnpeia ywh iths si otn a tyurpaiti amena?od Is it sujt a ckal of trhoe s?otpmmsy

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +19
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1
teepot123  fa '19 pg 516 +




Subcomments ...

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eTh uqsetnoi asks btuoa rpteaelran oamdristntaiin of eth cnaevci enin(mga, ont ugisn the rlao oe).tru la-onNro icanevsc liwl not sltgyorn itceli gAI ree.ssnpo lra-onoN ccavnsei ton psure eflhlup in icbomangt a tug ualsocm oicntfein uchs as V. hacrloe, heerw gAI si ermo .iantsel Nto uers fi hits is eht utalca teccror i,oaensrng btu it eld ot eth trhgi .ewansr

aesalmon  I totally skipped over the word "parentally" when taking this - ugh! +15  


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sThi one saw a lettli cr.ikyt roF htis eon the eyk si the owl noiidreioad utkpa.e ishT pietatn hsa hghi 4T nda owl SHT hhcwi kasem snsee in a ptiroyhyedrh pteatni, sppaher yrou iftrs ohttugh si htta hsit eatpitn has v’eGsar eedsasi. eeroH,wv in rve’asG uyro tdoryih si begin mstuedtail to kmea rmeo yohdrit oormneh morf ahccstr dna as cshu wdoul ehav an recniaesd aioneidiodr epukta esuaebc hte rthoiyd si igirbngn ni eth urerdieq (onw adilborl)eade i.eonid isTh is wyh ti si nto rveaGs rea“ees(l of hoyitdr oremhon fomr a oitrydh mtdtuialse yb da)i”oestnb.i

oS fi sti nto vaG’ser thaw ducol it e?b roF thsi odyu’ avhe to oknw ahtt osmhiast’oH iytoidrhTsi ao(ls konnw sa onrchiC tioLychcmpy tiTrhoiydsi and is foten eerdrrfe ot sa shuc no raobd xmeas to hrwto yuo off) sha treeh spshea - itfsr ehyt rea hotpir,hyeryd enht hurty,edio hetn teh clcissa yoritohpyhd that uoy odwul eetcpx tihw wlo 4T dan hgih T.SH This wsa eht kye to tihs uoqisnt.e hTe saenor fro sthi is taht ydtiiohnatr rxepsaodei tioidsaneb in hamt’soiHso eausc teh iodythr to eralees lal fo ist dosret idohtry eoonmhr ngiamk the anittpe ephdhyroiytr fro a shtro pdrieo fo tmie. rfetA this misesva selraee fo yrotidh m,neoroh eth intbedoasi kmea meth luabne to amek wne HT and eefetorhr they ceobme ehtrdiyou rof a rotsh eiopdr dan htne rdhythiooyp chhwi uyo dulwo ectxep! enSci yteh can’t eamk new TH, eth ihrydot lwli tno eatk pu het aendooidiir dan oeterrfeh heret iwll be olw eadoiroidni tupae.k nHce,e sree“lae fo erotds otrdyhi orhmeon form a itrodhy ndlag tnlediifatr yb hmlcyote.s”yp aak Locyipcht“my sos)ahi(othm yih”id.iottsr

I khnti eresea“l of dhtyior mroheno frmo a oustalhmpymo irtydoh n”gdal is neierrfrg to osme dnik fo hydirot cecrna ni hihcw aesc yuo dwulo txcepe ehmt to be rsinebdicg a lenduo no odniriaiedo .pektua

mry​amuS ivdoe ehre and losa a gtaer etsi in l:enrage oienotos./eqereaod/inna/htiptly/rcdid/p:chgnerdu/erms

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9  
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3  
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1  
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +9  
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +  
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2  


submitted by someduck3(58),
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taF oblsleu timsinva era .KD,EA,, oS tohb D pm;&a E duloc eb eddarseec in hist t.p utB uyo eavh to wokn ttha taiminV E ciiecyndef is oatssiceda iwht iidmtlonaenye m≈ ahs eenb sesiacodta with rpotroeis clnuom .oteiamnyiednl sAol tiV E nac be vgine with meehAzilr sniatpte sa ti eslph hwti fere asld..ic?ar

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration: https://www.ncbi.nlm.nih.gov/pubmed/9012278, as does Copper (TIL): https://www.ncbi.nlm.nih.gov/pubmed/15249607 +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +  


submitted by shaydawn88(8),
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I wulod tnkih ouelorsitn onlesviv eht estm cells (pety II cunsy)om.etep Is the ncatit teebmasn ebenrmam hte wenras uebesac ti tmsiil ?pdears

aesalmon  I would also like to know if anyone can answer this question - I saw it as a Sattar "one day, one week, one month" kind of question. Its probably very simple but I still don't get it +  
bubbles  I posted a new comment explaining: basement membrane integrity is the strongest determinant of full fx recovery following pulmonary insult :) +5  
drdoom  You have to think about it this way: the basement membrane is the “scaffolding” on which [restorative] healing occurs. So, yes, stem cells (type II pneumocytes) would be involved in that healing process but they couldn’t restore the *normal* architecture (“no abnormalities”) without the ‘skeleton’ of the basement membrane telling them where to go, in what direction to grow, which way is “up”, etc. If the basement membrane is destroyed, you can still get healing, but it won’t be organized healing -- it’ll be *disorganized* healing, which does not appear as normal tissue. (Disorganized healing is better than no healing, but without a BM, the regenerating cells don’t have any “direction” and therefore can’t restore the normal architecture.) +8  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  


submitted by oznefu(21),
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mI’ ngvhia erbolut arendunntdgis hyw tsih si a ertteb ocheic tnah atePg isdaese, lcapeylise iwht het esceirnad PA?L

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +24  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +16  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by seagull(1443),
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Whhci of the nlolwogfi seonras is hyw ihts neituqos si lulb?

)1 Unigs teh rdow i"cl"cyc neadits fo tlcicryic for lrytcai

)2 wKngion all fo igliopmoyeed fo lal udsgr

3) ivahgn ot oserna tuo atht ricialcetnohgin eftescf ear pblroyab hte srotw rvoe aap1lh or 1H fceftse to no iyntcaet.r

)4 ehT nrlgppici sernseoipd of gtdsuyni orf yw-sesd-oketa no edn to albbproy od aaverge no het stte.

nlkrueger  yo, re-fucking-tweet +20  
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4  
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1  
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5  
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +  
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +  


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tnd'o be a ?cikd otn alryel eusr ahwt emor teerh si to .it ehT eanttip odsten' heva any erhto fyimal so ihts nwaom oldshu eb edensoicrd ailfmy

aesalmon  Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine? +5  
hungrybox  Yeah, I got this one wrong with the same logic as you, aesalmon. +1  
emmy2k21  I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines! +8  
dr_jan_itor  @emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase +8  
et-tu-bromocriptine  Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice. Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy. +4  
lilmonkey  I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time. +1  
docshrek  @lilmonkey can you please give the QID for the UWorld question? +2  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. +  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. P.s:it struck me as a romantic relationship as well, but it doesn't clear my doubt😓😭 +1  
drschmoctor  @jakeperalta Following the hospital policy is wrong because it would be cruel and unnecessarily rigid to deny a dying woman the comfort of her closest companion. Also, It would be inappropriate to ask the Pt to lie. What's the point of becoming a doctor if you have to follow some BS corporate policy instead of calling the shots and doing right by your patients? +1  
peridot  Ya kinda dumb that usually NBME usually tells us to never break the rules, yet here it's suddenly ok. But here the reason for this exception is that while only "family" is allowed, a lesbian relationship qualifies the "friend" as family (they just were never officially acknowledged as family/married due to stigma or state laws, which society recognizes today is dumb and outdated). It's a stupid technicality that her significant other isn't allowed to visit as a family member, so while we usually never want to break rules, this scenario follows the "spirit" of the rule. Plus it's a really extreme scenario where the woman is dying and just wants to spend her last moments with her loved one and it would be too cruel to deny someone that. There is no lie involved, which kinda leaves open the chance for the situation to be cleared up if worse comes to worst. This is different from E which is a straight up lie. Hope that helped. +  


submitted by seagull(1443),
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/gp/m/nsas0np.v/w9..ihP/:rhlne217.8clcio2tCtci/wtmwbM

sThi tacelir lfisa ot noetimn opor ainbr motendevepl in rhiEs.dtyiHmPoRY Teh rthuoa tmsu veah aetmn hHi.simPdyrtYoO

ihTs etunioqs supste me to on .den

aesalmon  I agree, the article you linked states "signs of fetal hyperthyroidism such as tachycardia, intrauterine growth retardation, cardiac failure, and the development of fetal goitre" I chose answer E during the exam - "Thyroid gland enlargement" Still trying to understand how they linked cretinism to a case where the mother's hypothyroidism was well controlled, and then asked for the sequelae if her TSH increased. Maybe increased TSH is supposed to indicate worsening hypothyroid - low T3/T4 needing to be stimulated by TSH? +