invite friends ⋅ share via emailtwitter
support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to alexxxx30’s page.
Contributor score: 26


Comments ...

 +6  (nbme23#17)

did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha

confidenceinterval  RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +1

 +3  (nbme23#1)

also the word annular was supposed to be very helpful (it means ring shaped)...however my dumbo self didn't know this. Would have lead me directly to ring worm tinea





Subcomments ...

submitted by lsmarshall(348),
unscramble the site ⋅ become a member ($36/month)

nptnSoiebyavr is eth erttag of taaonpiessmnt (nastuet inxot;) lumsec apssms rea er.rhicsacctati Only ethor nraswe you thmig oncdesri si cylciltertAeeeshonsa isnec eh is a mrreaf dan owszubdzr netfo yrrac us to teh seropmid l.n..da tbu mtsospym fo a inhcoegcilr omrts ear na.ebst

vshummy  Synaptobrevin is a SNARE protein. Why they couldn’t just give us SNARE I’ll never know. +34  
yotsubato  Cause they're dicks, and they watched sketchy to make sure our buzzwords were removed from the exam +32  
yotsubato  Oh and they read FA and did UW to make sure its not in there either +28  
soph  This toxin binds to the presynaptic membrane of the neuromuscular junction and is internalized and transported retroaxonally to the spinal cord. Enzymatically, tetanus toxin is a zinc metalloprotease that cleaves the protein synaptobrevin, an integral neurovesicle protein involved in membrane fusion. Without membrane fusion, the release of inhibitory neurotransmitters glycine and GABA is blocked. -rx questions! +4  
qfever  So out of curiosity I checked out B) N-Acetylneuraminic acid It's sialic acid typical NBME +1  
alexxxx30  shocked they haven't started calling a "farmworker" a "drudge" <-- word I pulled from thesaurus. +  
snripper  "You shouldn't memorize buzzwords. You gotta learn how to think." Lemme pick another random ass word that doesn't have anything to do with critical thinking skills and use it instead. +2  
mw126  Just as an FYI, there are multiple "SNARE" Proteins. Syntaxin, SNAP 25, Synaptobrevin (VAMP). From google it looks like Tetanospasmin cleaves Synaptobrevin (VAMP). Botulism toxin has multiple serotypes that target any of the SNARE proteins. +  
wrongcareer69  Here's one fact I won't forget: Step 1 testwriters are incels +1  


submitted by dbg(114),
unscramble the site ⋅ become a member ($36/month)

mA I the ylno eno ohw ut,hohtg ym leohw f,lie ttha ti tuclyala oeinigtsra romf teh odthyir tbu usjt lschaiyypl dnteceocn to eht gtnuoe

nbmehelp  same +11  
medguru2295  me! I went with submandibular gland bc I thought there was a gland under there. +  
alexxxx30  nope...i definitely thought the same thing...when I clicked thyroid I was like wow that was an easy question. HA +  


unscramble the site ⋅ become a member ($36/month)

yWh is it tno avaroni filollec ll?ecs I huhttog hte elmeaf gnlaoa fo Selotri nad geydLi si elagnoah/custra cs.ell

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +4  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +7  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +28  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +10  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +4  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +3  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +1  
youssefa  Hahahahaha ya'll just bored +4  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
noplanb  Wait... I might actually never forget this now lol +1  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +14  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +1  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +1  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +  


submitted by hayayah(990),
unscramble the site ⋅ become a member ($36/month)

eH sah leacf enonetinicnc so hsi elartxne rhtpcnsie si gadaemd, ihwch si naevtderin yb eth luddpean n. )(-.4S2S hTe ivlcpe ncslcnhaip ,rvsnee cwhih timedea the ociteren oe,sspcr ear asol -42SS.

thomasburton  Why could this not be dysuria? +2  
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +14  
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +2  
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +  
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +  


S2,3,4 keeps the 3 P's off the floor (Penis, Poo, and Pee)

alexxxx30  love it +  


submitted by cbrodo(45),
unscramble the site ⋅ become a member ($36/month)

ehT eoprtsoir cuolsnm ciFl(aucssu uescFcsscluanuta/iu aricsil)g arrcy ftnoinormai ot hte binra eidrgagrn e,crpnppioroito tornaibiv, itdivcnamsiier hcuot dan eruserps. Pcyhlsia emxa gdnsnfii gegtssu a loesni rhee e(ht tlinchipasmao tactr csreari /apipiinkrpnc nad p,emrutetrea nda ehest eerw .o)rlanm cSine teh einttap ahs nlbomara isfndgin in teh erlwo xiiemeetr,ts dna arolnm igidnnsf ni het pperu eexetm,tsiir hte rsenaw is cacusFsiul lii.ragcs Tsih si ceuaebs nroaioimntf omfr dybo aeras woebl teh eelvl of T6 is darecir yb rsiilagc adn nooafintrmi frmo body aears eavob hte elevl fo 6T is riacred by uuscnate.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +3  
temmy  i remember gracilis is for legs by saying i have graciously long legs and they are inside while arms can spread out to remember their orientation on the spinal cord +3  
jess123  I remember it as gracilis = grass so feet haha +4  
link981  Just to add found on page 492 on FA 2018. +  
charcot_bouchard  Hey Temmy, I can spread my legs too :) +  
maxillarythirdmolar  I can't feel GRACIE's ~fine touch~ as she ~vibrates~ my balls. +3  
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +1  
drzed  Lmao I remember gracilis because of the gracilis muscle in the legs! +3  
alexxxx30  cat5280...so spinocerebellar tract does 4 things to know 1. proprioception in the Romberg test 2. intention tremor if damaged 3. shin to knee test 4. dysdiadochokinesia (being able to rapidly pronate/supinate the upper extremity) yes the patient has proprioception issues, but the other symptom of vibration loss points us more to a fasciculus gracilis issue. If the patient had presented with proprioception and and intention tremor then we would think spinocerebellar +2  
alexxxx30  adding to my comment^ I would commit these 4 things to memory as I have gotten several questions concerning this topic (there were 2 questions on this exam where spinocerebellar tracts are involved). Memorize them and it might get you 1-2 extra points! +  


submitted by cbrodo(45),
unscramble the site ⋅ become a member ($36/month)

Teh reisptoro slmucno suluFaci(cs F/itucsccuneaulasus srgla)iic yarrc manionftior to the nbiar ngragdeir ,teioroonpiprpc ,oiaintvrb drmiiisincatve huoct adn sper.sreu ashyiPlc mxae iidsngnf ggtesus a einosl reeh hte( ilhiamnatpcos rtatc ierarcs ppnkiracinpi/ dna t,urepmertea nad ehste erew aornlm.) nceiS teh ptetain hsa lraanobm snidifng in teh erwlo stmieetxe,ir nda onlarm idisngfn ni the prpue eresimet,txi hte saenwr is ausculFisc gcaiir.ls iThs is cubeaes annfmioiort mfor bdyo eaasr obwle eth leevl of 6T si deircar yb silicagr and nmronitfoai fomr yobd aears bovea eth llvee fo 6T si airdcre yb usacetun.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +3  
temmy  i remember gracilis is for legs by saying i have graciously long legs and they are inside while arms can spread out to remember their orientation on the spinal cord +3  
jess123  I remember it as gracilis = grass so feet haha +4  
link981  Just to add found on page 492 on FA 2018. +  
charcot_bouchard  Hey Temmy, I can spread my legs too :) +  
maxillarythirdmolar  I can't feel GRACIE's ~fine touch~ as she ~vibrates~ my balls. +3  
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +1  
drzed  Lmao I remember gracilis because of the gracilis muscle in the legs! +3  
alexxxx30  cat5280...so spinocerebellar tract does 4 things to know 1. proprioception in the Romberg test 2. intention tremor if damaged 3. shin to knee test 4. dysdiadochokinesia (being able to rapidly pronate/supinate the upper extremity) yes the patient has proprioception issues, but the other symptom of vibration loss points us more to a fasciculus gracilis issue. If the patient had presented with proprioception and and intention tremor then we would think spinocerebellar +2  
alexxxx30  adding to my comment^ I would commit these 4 things to memory as I have gotten several questions concerning this topic (there were 2 questions on this exam where spinocerebellar tracts are involved). Memorize them and it might get you 1-2 extra points! +  


submitted by yotsubato(806),
unscramble the site ⋅ become a member ($36/month)

So for daniCad ew cna esu

Aoeszl l(zofucoaen)l itnhiib( P4Y5C0 oeam)tiehnyltd

hreApnomitc B rop(e mnaortifo ni gfnual llce mbemna)er

fopnasuiCng (rveentp iclnosskirng of bate anucsgl ni clel wl)la

or ysiNant orf oarl ro hoelgesaap esacs ore(p omirofa)nt

sihT ueqnoits is gaiyns that she is ntgkia na AOLR rudg ot ttrae cdndaia .sigitniva

piocAnthemr is VI

Cpgunanfsio si alos IV

os eew'r etlf htwi lesoza

lezosA niihbit eyssshnti fo tlogerorse yb thbiginiin PYC 540 tath notevcsr entlooalsr to e.rogeotslr

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +  
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2  
staghorn  Me - picks Metronidazole -_- +  
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +2  
turtlepenlight  I have seen that on the wards so I hope it works! +  
fexx  and my smartass picks amphp B +1  
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +1  


unscramble the site ⋅ become a member ($36/month)

Did annyeo eles og owdn eth: sse'h tpvsyinoehe os eybam lhl'es tge sharoewute rnsifiecdhre ersynodm saeubce hngonit esel si anmgki essne to me at this inpt?o?? ueotr -

uTnrs ot,u eserve iamaarl cna cesua alscrauicvrdao posellac nda sepyh.ntonoi

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +5  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +  


What is the area labeled 'G' and 'C'? And more characters?

alexxxx30  lateral corticospinal i think +1  


submitted by nwinkelmann(258),
unscramble the site ⋅ become a member ($36/month)

oS isht qsouteni saw geotminhs I lylare lsdgugetr .twhi I idnd't eigcorzen taht het taetnrniesop wsa fo EMRFR sa osnoeme tasedt eobwl, and I nowk ouy tnod' eden to wkon ttha ot renasw the ,tuieqnso ubt it douwl ehav bnee l.felhpu My estbggi oitnruarfst aws het ndirogw of het soypbi lrssteu ml"oaranb isaucucotnmal fo o"ihnrciaomdt. Tsih ynaendo em uaebsce het ieionndift of aggder rde frseib ih(hwc m'I imangsus swa hirte tieotnni)n si sm"octnluaacui fo brnamalo hiiraomtondc." hTseo are otw vyre dtfeefirn eetntatssm in my ,mndi lol. eTh ti,rfs to em, jtus senma 'seehtr oot hucm dachrniiootm, tub eht snodce nasme sr'ehet oot umhc NDA yhte 'rneta ninogictfnu pryprl.eo s'It aosl juts eth ctaf fo igmeremerbn lal fo eht ermst ofr ETC at hte eimt of edrgina hte ineusoqt i(e.. I ti'ddn hnitk butoa the atfc that ECT si alos laldec lalucrel seprnaotir or tjsu .ripnosea)tri

I also dtn'di aelyrl redausntdn llfuy whta aVmx2O si = O2"V ,amx lsoa nknwo sa aalxmmi enygox at,upke si the aruemnteems of eht uixmamm nutmoa fo xgyoen a penros cna ielutiz nrugid stienne eerex..cs.i adn is esbda no eht ierpsme that eth emor ygxone msnoduce uginrd eeexcs,ir eht eorm het obdy lliw grteeena nneisaoed prohetipahst (T)PA regyen ni c.l.sle. OV2 xam si ceraehd nwhe ryuo yxengo pomcunostni mnersai at a dtsyae taets dsiteep an escarnie in teh odaw.lkro tI si ta tish alutaep hatt teh u]slcem[ eovms fomr rabioec oetlmmbsia ot acinbroea motle"mibsa itte9w2tmo0hwtslwe/a/vc21xloa-./rms-p--7wh3.i0vfw:y.

sedaB yerplu no hsit iifi,ondtne ewrhe Va2Omx = tessaiyenll het ietm at hihcw biaorec tcwesish to araicoebn aies,ronitpr my artpeitonrniet fo oto mcuh roihianmotdc sv too mchu nad abd rroomindaicht n'dtid rtmate, ecaesub enev nhew hte moicthonidra ear gnocfntnuii lrpoprey, yeth recha a oipnt nad itscwh to boa,eanicr suht fi ehrte was too umch larmon mdioranhcot,i sith dolwu cuocr reafts aebesuc eetrh lowdu be orme oalevrl lalelruc etioriaprns ingrucoc, nminaeg het boyd ldwuo twihsc to erbaconai dan iilzuet losglyisci to catelta rof ne,ygre stop inuzitigl het chimoitdorn,a adn hust aVxm2O lduwo .sadercee

.W.HOE.EV.R scueeba ihts si a EFRMR iunstqe,o het rrode fo vseetn is a letilt ffrnde,tie eeditsp eth uetoocm niegb het emas ta( etsal hast't ohw I dtnnusread i.t) So, I ikhnt het yek ot ayn aildcmhrotino drroedis is inbrmmregee ahtt eht nsatoitmu ear satlmo acnyeitlr gogni ot aeffct na edondec iopernt nad utsh a cceyindife fo ttah iertp.on enO ctaielr ahtt I oundf sdia taht het NtRA tioumsatn (as in EMRRF) eu:asc rtdsi"pu odalriohnicmt nioeptr ntsssy,ieh eicdagnrse eth attiyciv of lomxpeC I dan to a elrsse xentte oCplexm ..V.I which reecdssea airprotsnie nad orlews tronpo nppim,ug caiymradaltl rgienscead the arbeemmn lnoattiep nad torpon lcieteomclrehca oitaeptnl griatden rscsao eht cioodrmnlhtai nrien eb.rmeman hTe nporto emtccaecelihlor pttlneiao gtdaienr is eth gidnivr coref ofr TPA ishssynet dan eirsdegcna it linsylstubaat sorwle teh mliaxma trae of PTA sestniy".sh .io9ii.91fi1be9shwm.71xrn6js3r60/l2y14.y0:c/0//t00.el6nd.l4u3.1.lo2l/apbtofe-/

asedB on my aidutregndnns fo eviaoxidt nroyo,hplapohist 2O puotsonimcn .(ie. kantig hte lceotenr romf xpemloc VI and nuitgpt it no 2/1 O2 ot racete 2HO and +H siverd the ropnot dgtriena chhwi disver TPA pctoruni.od :Thus idntefeci sirapeyrort aitxiodno i..e( NtDAm saitunmto of hte TCE ymz)sene leads to lerwedo O2 ountmpcnosi (so oldweer 2OV x)am ihwch hnte edasl to deloewr TPA c,oudinport dan tshu cteveidef adoh.ctrinomi ,eThn ordelew iorcadihtnmol fuintocn adsel ot eecddesra eoiarbc sraiirenopt iungnsth APT iprnocotdu to nroaieabc arnseiport,i veridn by ogscil,slyy nad tsuh ncieisnarg tcatlae evlsle.

Hpoe shit p!hels shTi koto em AWY TOO LGNO to rfgieu o,ut lol, ubt yolhpulef I eernv gfkiaenr eftrog i,t .llo

Asl,o fi uoy twna yna erom rdgne,ia I nflilya nudof na caitelr htta luyatcal ylflu insaxlep the mibelcoachi nda ahooyitylsopphg of hlordmtinoaci ayhpmeitos: :23lauc/c/ii/t.22p/t4asdmhtcbo7aa151r/3ie4ec//r6/.n3mop

rySor st'i os !nglo

djtallahassee  lol yea. I thought they were trying to say there was an abnormally large amount of mitochondria present which made me get the opposite answer :/ +1  
alexxxx30  no I so agree. The grammar was completely wrong (clearly whoever wrote the question needs to work on english). This was very frustrating to me because I recognized that it was ragged red fibers, but then the wording made me doubt my own knowledge (thinking how could the test writer mess that up?). abnormal accumulations either means too much or too little. accumulations of abnormal mito means thee mitochondria is faulty. Correct grammar is putting the adjective right next to the word it is describing. So this was definitely wrong and I share your sentiment. This really frustrated me! +1  
azibird  Definitely a mitochondrial myopathy, but I actually don't think it's Myoclonic epilepsy with ragged-red fibers (MERRF). This normally entails Myoclonic jerks, Generalized seizures, Cerebellar ataxia, and Dementia (according to Amboss). Maybe it's CPEO (chronic progressive external ophthalmoplegia): progressive extraocular ophthalmoplegia with bilateral ptosis. Not sure which one would account for her poor exercise tolerance. Either way, recognizing it's mitochondrial is enough. +  


unscramble the site ⋅ become a member ($36/month)

Evne fi oyu ditdn' hwhic one ocvrte swa pAaanmals, I lieeebv cioche A aws eht lnoy noe in chhwi btoh niormsgsa raedsh teh mesa cvrteo.

stinkysulfaeggs  Agreed, that's how I made my final decision! +  
alexxxx30  yeah I literally had no clue what anaplasma was, but came to the correct answer the same way +  


submitted by hopsalong(23),
unscramble the site ⋅ become a member ($36/month)

I tge sthi si a lfffuy suntoeqi dna neoggalckwndi hte ta'eipstn nsoears rfo isgisnm nnliusi csinntjieo is the etudidlsc, but I eelf ekli hsit asnerw stwo het neli a it.b uoY tdo'n awtn ot sya thta smigisn sosde is ,ko but uyo oals 'odtn tnaw ot be nmea ot eitpant etrei.h I hoghtut hits snraew A)( wsa nnndcigoo reh sngiism eht o,jtcisienn os I cpdike .C)( In e,totprrsec I eguss gnlecekoawd samen kalt fotauocsbu/ eth aonrncveosti nduoar.

dentist  I would say: "I understand why you are missing injections, but you're going to have a BAD TIME IF YOU KEEP MISSING INJECTIONS" +2  
alexxxx30  @dentist, I was searching for that answer as well, but it wasn't there so I picked C ahahaha +  
123ojm  you would definitely do C as well. key word is "initial step" +  


submitted by welpdedelp(198),
unscramble the site ⋅ become a member ($36/month)

Teh tp ahd tmhaas O,SB( akswe pu ta itngh otu of r,eahbt sah laeliser)g. It dkesa ofr eth orrurepsc fo enuoikltrs,ee hhiwc si onadarciich cdi.a The pobr vage imh Makuotletsn or ahndiel ot.csdgilciucroo

ls3076  wtf is up with the phrasing of this question +27  
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +1  
alexxxx30  @Is3076 haha agreed!! +1  
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +3  


submitted by lfsuarez(132),
unscramble the site ⋅ become a member ($36/month)

tFris retha nosdu )1S( is eeaegntrd yb wto erhat sv:alve eth talimr vavle nda sdurpicit v.vale Nyrlae amusosenuilt osgcnli of esthe evlavs lmyaornl eegtnaesr a ilnges 1S snou.d gtinltiSp fo the S1 ndosu si rdaeh nwhe lmrtia and tdcuipris seavlv celso ta shtlgyil tdfnfiree ,setim with sluuyal het tarilm lcoigns eebrof csdirtiup

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +18  
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts. +20  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +3  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +1  
drzed  It shouldn't matter where you hear a split sound. For example, no matter where you auscultate on the heart, the second heart sound in a healthy individual will always be A2 then P2 (whether you are at the mitral listening post or the aortic listening post) The key is recognizing that the right sided valves in healthy individuals will always close later (e.g. the heart sounds are S1 S2, but more specifically M1 T1 A2 P2). The reason for this is simple: if you take a breath in, you will increase preload on the right side of the heart, and thus the greater volume will cause a delayed closure of the valve. This is physiologic splitting, and is better appreciated in the pulmonary and aortic valves because they are under greater pressure, and thus louder, but it can also be heard in the first heart sound. +7  
alexxxx30  yes agreed!! This question is mostly asking if you understand a few basic things regarding cardio physio. The left side of the heart is the higher pressure side so left sided valves will close first. The right side of the heart is the lower pressure side, which means right sided valves will open first. [Left closes first, Right opens first]...Secondly, it requires you to know what S1 and S2 sounds come from. S1 is the mitral/tricuspid valve closing and S2 is the Aortic/pulmonary valves closing. So really the question asks what is the first component of S1 (mitral or tricuspid closes first). And since we know that the left side will always close first, it must be mitral valve closure. Sorry if that was a long explanation. +7  
jesusisking  Thanks @alexxxx30, you the man! RIP Kobe +