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Contributor score: 40


Comments ...

 +1  (nbme23#13)
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The toipamrtn thing for tsom of het htiecs nosesiuqt era ot oolk for eht rnwase erewh yuo aer ngieb eht siontsemct/ fisaolespnor hwlie negcritesp teh ti’ntaspe y,taounom neefie,ebncc cmonfeci,laeenn- .cet oMts of the hoeiccs ehre eerw rieeht ycsuactoar ro ylislcaab ngbei anme to eht it.tpean eTh coectrr hceoci is to ehlp teh ptitnae ubt lsoa etaomtvi tmhe to uoiennct ycpaihls typareh and to nlyo seu eth erimpt as ttliel as eecy.rsans A liisarm eunqtosi icw(hh I tknhi saw on NEBM 23 -- ythe rae nkdi of gldnbeni ttoehr)ge wsa teh oen erehw teh ntpieat dah stte tleurss ahtt iaicetddn he ahd crneca tbu eht rtsndiee sida ton to vrutoinya()ll llte hmi unlit the ocolosnitg amce in latre atth ,ady and hte ttpanei kades ouy atobu het lse.tsur uYo ’dton anwt ot teh lei ot het tpienta dna asy you tnd’o owkn or taht eh dos’net have enccr,a but uoy olsa dnto’ tnaw ot eb iesnboautdinr to teh seiedtrn’s aleenraob)(s erqeut.s

drdoom  @aladar Your response is good but it’s actually mistaken: You *never* lie to patients. Period. In medicine, it’s our inclination not to be insubordinate to a “superior” (even if the request sounds reasonable -- “let’s not inform the patient until the oncologist comes”) but *your* relationship with *your* patient takes precedence over your relationship with a colleague or a supervisor. So, when a patient asks you a question directly, (1) you must not lie and (2) for the purposes of Step 1, you mustn’t avoid providing an answer to the question (either by deferring to someone else or by “pulling a politician” [providing a response which does not address the original question]). +2
drdoom  As an addendum, legally speaking, you have a contractual relationship with your patient, *not with another employee of the hospital* or even another “well-respected” colleague. This is why, from a legal as well as moral standpoint, your relationship with someone for whom you provide medical care takes precedence over “collegial relationships” (i.e., relationships with colleagues, other providers, or employers). +
imnotarobotbut  @drdoom, it's not about lying to the patient but it would be wrong for an inexperienced medical student to give the patient their cancer diagnosis, or for a doctor to give a cancer diagnosis if they feel that the patient should be seen by oncology. In fact, the correct answer that the question that was referred to by aladar50 says that you do NOT give the patient their cancer diagnosis even if they asked you directly about it. +1
charcot_bouchard  Dont give it to him. DOnt lie to him that yyou dont know. Tell him let me get the resident rn so we can discuss together Best of both world +4

 +5  (nbme23#41)
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rFo the EC,G I ynatlilii tghtohu ti saw n2d deeegr pTey 1 cbuease it emdsee thta teh PR rlveatnsi reew reacginins iltnu a beat swa poer,pdd ubt if uoy kool at it clsle,oy mseo of teh P wvsae wree dnihde in the SQR oelsxcpem. fI you tcoeni htta, hten yuo can ees thta trehe rwee erlraug P vweas and aulgerr QRS x,ecmpleso btu rhete aws a otcpelem coiatnsisdoi enetwbe ehmt iwchh snema it aws dr3 gedree retah kolcb, so the wserna asw tialboan near eht AV .node

yotsubato  answer was ablation near the AV node. No it wasnt. It was ablation OF THE AV node itself. Which faked me out. +9
makinallkindzofgainz  The tangent by user "brbwhat" says that there is "pr lengthening progressively" but there is not. This is 3rd degree AV block. The P waves march out consistently at their own rate, and the QRS complexes march out at their own rate. There is complete dissociation between the P waves and QRS complexes. They have no relationship. This is exactly what you would see if you ablated the AV node. The SA node would continue to to create P waves. The bundle of His would continue to generate junctional (normal looking) QRS complexes. +6

 +7  (nbme23#13)
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So ’tseehr 001 ssedtnier, nda eth calernpeve ftera 2 erasy si 10= at teh gineignb,n 5+ in teh ifstr arye, 01+ onecds ae,ry dan -3 atth e,ahedl fro a attlo epncaevelr of 22 rdiessetn ro /22=00221 epcrent. hTs,u lcepraeven = above teh ansrtdda. oFr cencdeni,i tsi’ 15 new sacse out of 90 edrnsteis roev eth 2 esyra (001 attol irtsneesd – 10 htta dlayare dah ru)e,lcs or 15 ewn urscel rep 180 teesa⋅.rpiytan hsTi dolwu eb 83.3 wen ecsulr per 0010 ainreyt⋅esatp if yuo ealpadoxtrte ti tou -- blalsiyca 0018(10)0/ * 15 -- u,ths edncnicie = evoba the dtadarsn.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +52
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +4
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +14
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +
doublethinker  Damn, guess my reading comprehension is not "up to the standard" of the NBME writers. Smh. +
prolific_pygophilic  If you forgot that its patient years (15/180) not (15/90) you still get the right answer because they are both above 5% :). +

 +16  (nbme23#29)
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mI’ not eth btse at eht oiustaacclln fo ICCFE/F, but yllasbiac uoy rea iugnnsfi a hireytocpn uoinostl iotn eth i.alamn na,iilyItl hsit si lal ignog to og ntio teh laaltreelurxc cep,sa as nya IV unniisof will d.o Seinc it si eighrh tnha oiitocns ,ouotnsil awtre is ginog to og mofr het clnaeilrrltau acpse ot teh lrcraaxtlleeu paecs to ytr ot aeblanc it ou,t so het lautilenclarr secap llwi aehv eerecdads uoemlv adn dneasceri olaytoisml si(ecn yonl etraw is giel,vna mkagni it rmoe .ardtnoenct)ce

So yuo onkw for sure CIF muleov is sarceddee nad mootyislal eicradsn,e nad eht tearlleuxalrc uloevm will be nearsed.ci I ithnk het msylaoltoi of eht carlereltluxa acsep si teh ktrciy arpt and teh atrp whree mayeb oeosmen lese cna help wthi teh lonutsacacli ubt ycaslibla s’it nryhtpeioc gunoeh atth teh toiamsylol lilw tllis be recsia.edn

btl_nyc  Since hypertonic solution was added, osmolality has to go up. The degree of the hypertonicity doesn't really matter. The fluid flowing out of the ICF will increase ICF osmolality. Since water follows salt, the water's gonna flow only until the ECF and ICF have the same tonicity. So if the ICF osmolality went up, the ECF osmolality also had to go up, because they both need to be equal after the water is done equilibrating. +19
krewfoo99  ECF fluid is hypertonic because we infused an hypertonic solution. ECF volume is going to go up because A) we added more volume via injection B) Sodium attracts water, and since hypertonic solution was given water goes from ICF to ECF ICF volume decreases because the water is going to ECF. This causes an increase in Intracellular osmolarity, since you have more solutes compared to water (Less water to dilute it) +1
cbrazell92  Dumb question, but how were we supposed to 5% saline was HYPERTONIC? What if it was 1%? +




Subcomments ...

submitted by aladar50(40),
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So s’hreet 100 d,rnsseeti nad the elneparcev faret 2 ysaer si =01 ta eth ngiebnngi, 5+ in teh rtfis a,ery +10 edonsc yera, adn -3 hatt e,delah fro a toalt cnverpelae of 22 edtrsesni ro /22200=12 e.crnpte ushT, pernelacve = vaeob the nsrdadta. roF eneccdni,i ’sit 15 ewn aessc tou fo 09 sndeitser rvoe eht 2 ysera (100 toatl esneritds – 01 ttah edaalry dah sle,c)ur ro 15 wne ruselc rep 801 tey⋅a.ianretsp hsTi lodwu be 38.3 new escrul epr 1000 starp⋅eeiatyn if oyu ardeetlxatpo ti tuo -- lliybsaac 010(0)/801 * 15 -- ,uhst ineedincc = oeabv eth rdtsaadn.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +52  
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +4  
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2  
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7  
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3  
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +14  
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +  
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +  
doublethinker  Damn, guess my reading comprehension is not "up to the standard" of the NBME writers. Smh. +  
prolific_pygophilic  If you forgot that its patient years (15/180) not (15/90) you still get the right answer because they are both above 5% :). +  


submitted by aladar50(40),
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oS ’tsehre 010 dn,sreetsi dna eht lneraecepv tfrae 2 yaers si 1=0 ta the bgnniei,ng +5 in hte strfi ,ryae +10 ondsce ry,ea nad 3- atth dhlaee, rof a otatl anlevceepr fo 22 eterssndi or 0201/222= ncpreet. T,uhs eepcanlver = ebova het datrands. rFo endincc,ei sit’ 51 wen ecsas out fo 09 iteersnds over the 2 ysrea 010( taotl sdrteesin – 01 htat arydela dha l)cs,uer or 15 wen rscelu rpe 108 naaeptt⋅.isrey This ldwuo be .833 new scerlu rep 1000 tyaenerpi⋅tsa if uoy orxpatldetae ti uto -- icbalsyal 001/0(018) * 15 -- su,ht ecncdinei = veoba het dndsrtaa.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +52  
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +4  
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2  
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7  
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3  
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +14  
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +  
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +  
doublethinker  Damn, guess my reading comprehension is not "up to the standard" of the NBME writers. Smh. +  
prolific_pygophilic  If you forgot that its patient years (15/180) not (15/90) you still get the right answer because they are both above 5% :). +