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Welcome to aneurysmclip’s page.
Contributor score: 86

Comments ...

 +3  (nbme18#44)

She's vomiting - Metabolic Alkalosis > loss of HCL > ie; acid, there would be increased HCO3 Anion gaps are usually with metabolic acidosis because in alkalosis there is high HCO3 which keeps gap normal. For the K+ > vomiting > loose water along with the vomit > decreased blood volume > RAAS activation > aldosterone secretes H+ and K+ > hypokalemia

 +4  (nbme24#16)

pretty straightforward question but another thing you couldd do is figure out his lymphocyte count 5%x2000 = 100 which would line up with a low Cd4 count however you divide it

tyrionwill  Yes agree! Lymphocyte count is so low, which suggest HIV. +

 +1  (nbme24#49)

Kicked in the side 1 hour ago. diagnosed with chronic myelofibros -> extra-medullary hematopoiesis > splenomegaly; therefore easier to rupture spleen. USG showing intraperitoneal bleed. and he has LUQ guardiang and tenderness. All points to spleen

 +0  (nbme24#11)

described a classical murmur of AS (late peaking, mid systolic, radiates to carotids b/l), no lesions on angio graph, ECG - LVH d/t AS most likely. its relieved on rest, rule our b) coronary spasm, an LVH wouldn't compress coronary artery (think a bit of anatomy). Mitral valve prolapse would a mid systolic click. im sure no one picked vasopressor induced hypotension; vasopressors increase blood pressure, this pt bp is 120/80 and a transient increase wouldn't lead to syncope.

the explanation of the right answer is given in other comments, just some thoughts of mine for wrong answers

 +10  (nbme24#25)

anyone else get this wrong while the current coronavirus "pandemic" (acc to some sources) is happening? feeling reaaallll dumb rn

targetmle  yes because i thought they wont give ques on current coronavirus situation so early!! +
adamventure  I thought to myself "damn it sure would be fuckin hilarious if Coronavirus was the answer".. turns out it was and it wasn't hilarious since I got it wrong. +21
asdfjkl  no quotes needed for pandemic anymore :( big sad +7
gandon  whats a coronavirus? never heard of it +

 +2  (nbme18#15)

The pulse described is brisk upstroke and downstroke in the carotid. A classic finding in Aortic Regurgitation is Water hammer pulse, which fits the description given in the question, opposed to the pulse finding in Aortic Stenosis which is Pulsus parvus et tarsus (slow rising weak pulse).

 +14  (nbme18#26)

COPD is usually associated with Pulmonary Hypertension. The examiner tells you that there is a loud pulmonary component of S2 ie: P2 (Loud S2/P2= Pulmonary Hypertension). Fev1:FVC is just related to COPD. The question is asking what is DECREASED in the pulmonary VASCULAR SMOOTH MUSCLE. do not get confused with the line stating there is decreased diffusing capacity for CO. the question isn't asking about that.

In pulmonary hypertension there is an imbalance between vasodilation substances and vasoconstrictors. therefore our vasodilators would be decreased eg: Nitric Oxide

if it asked increased, you could go with Endothelin (remember the endothelin antagonists used for t/t of Pulm HTN ie: bosentan sorry gave some extra info but all of it is important because they can ask this concept in many ways

 +5  (nbme18#10)

basically polycystic kidneys won't work properly, they've hinted at this with the s.creat of 4mg/dl. thus the kidney won't do what its supposed to do. REMEMBER to check whether they are asking SERUM changes or URINE changes

Kidneys normal function - reabsorb HCO3- , its not doing that now > decreased HCO3

PTH - would cause increased Calcium reabsorption in kidneys, but kidneys aren't able to reabsorb calcium > PTH responds to low calcium levels and levels increase

PO4 ties into PTH as well, PTH acts be DECREASING PO4 reabsorption. Since kidneys aren't working ie: not responding to PTH > there would be increase in PO4

pg32  Sometimes these questions are made more difficult by trying to decipher the order in which these changes happen (first cause). In my mind, whenever I see a question on renal insufficiency, I know that phosphate in the serum will increase. In response, Ca will decrease and in response to that, PTH will increase. Lastly and unrelated, HCO3 will decrease because the kidneys aren't absorbing HCO3 as they usually do. +7

 +6  (nbme23#6)

what I'm thinking is, normally the perineal body is cut during a posterior episiotomy. so reading over the question again, the last line "which is at greatest risk for damage IF this incision is TORN FURTHER during delivery" Torn further being the key imo.

as for why it isn't bulbospongiosus or ischocavernosis ->

cbreland  why do I feel like this was supposed to be an easy question +

Subcomments ...

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ID is an aoniprmtt toclniicapom of emso llsuk aebs rcautrfes dan nac be teaterd iwth PDAV.D You rlpbybao emerbemr atht ihts rsowk iav eth naitvicota fo qpuaranoi lnhecns,a tbu teseh ear vdemo mofr natlclrreiaul lecevssi ot the aalpic enramemb rufcase sa a stuerl of a DPt-daeemDiAdV iresecna dataenlye sycecal iav a tisymtoralu G orpneti htat siareesnc elrutcinlalra .AcPM

aneurysmclip  Page 332 FA 2019; cAMP signaling pathway, thus increase adenylyl cyclase was best option imo +  
melchior  Page 337 FA 2020; This is working via V2 receptor, which uses the Gs pathway to generate cAMP. Reminder: V1 works via Gq. V1 is present on the blood vessel smooth muscle +5  

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arOl icevsel t(hni )hnt.i steinrlBgi rlviuscea nieslo no the .dhna No f,ever not rxpin-eapcai.tgo hTsi is epesHr oyu( may eembermr nsstdite nitgteg ipreecht tilhwwo in uory idetssu, hwcih is twah hist i).s sMto lsfko egt H1VS sa i,crndelh hhugot ybluvioos otn lal are tamsycoitp.m HSV is a laegr -serdt,ueonddlab ialern NAD

jiya   why cant this be hand foot and mouth disease cause of coxsache +2  
drachenx  Also thought it was Hand-foot-mouth an RNA virus but I did consider Herpes. Changed because I thought Hand foot and mouth would be more common. +  
llamastep1  Hand foot mouth usualy involves all 3 places (hands, feet and mouth/perioral area) and the lesions on the hand arent localized to just one finger. +1  
aneurysmclip  Hand foot mouth disease affects palms and soles. ref: FA 2019 - 150 +2  
raffff  wouldnt the history also be different for coxsakie +  
focus  I think this image is trying to show the "dew drops on a rose petal" sign on Hermes, the god of Herpes on Sketchy Micro +  
drpee  Google some images of HF&M disease. The small blisters look very different from herpetic whitlow. +  
drdoom  ^ ... some images of HF&M disease ... +  

submitted by neonem(503),
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Graleen heetm of lh:yotgpoa ahioyxp ipsmira toiviedax yisnhohoplotpar ;-&t-g sesl TAP ;&t--g sles KNa- mpup ytiviact so udsimo isbudl up in het el,cl csiunag liwlsen.g iTsh is the tsrif sep.t heTn od'yu egt teh imccula iuldubp ni hte elcl adn elunavet oarbeinac ylsci,glsoy igasunc tlcaic adci nrpiucootd nad lwreode ..Hp. ubt ihts pnesahp etrla adn i'nts eth edirtc sauec of eulcallr l,nlgiesw hchiw si tahw hte uesitqno is tr.afe

aneurysmclip  can we have a moment of appreciation for Dr Sattar +9  
makinallkindzofgainz  blessed be His name +5  

submitted by m-ice(272),
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iTsh irlg ash onMo caduse yb enia-rsprBtE suV.ri ehT sstmopym ear yvrleeatli ,eavug tub anolhhytepmapyd ikle tshi lowdu eb nomocm ofr .Moon heT CCB owhss deeetlva olyeptyhmc,s miiylgnp this is tno a bcraaeitl snsll,ie os ilrav is l.eykil menCboid tiwh hte ltpanyop,hdmeyah shti skame us owryr btuao M.ono heT opntMoS-o estt fro EVB si htaw eht otqnesiu is irnrefegr to newh idscnbiegr eth seeph rryeechosytt nnttuiagi.gagl mrFo he,tre hsti sqotneui ruisreqe hatt yuo nkwo htta in BEV ii,tonefnc BVE fetcsni B lle,cs btu esod nto sacue htem ot oecbme an.lraobm adste,In 8DC lesl,c hichw rae icyatelv tngiry to klli hte B ls,elc boceem naa.borml

medskool123  NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence. +14  
kylemax  The abnormal T-cells are known as Downey type II cells (Sketchy) +3  
haliburton  I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom. +2  
trichotillomaniac  congrats you played yourself +3  
lilyo  Soooooooo EBV infested B- cells is not considered atypical WTFF?? +  
med4fun  They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells. +  
aneurysmclip  oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells +  

submitted by drdoom(647),
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heT tesm si bindcgesir eeqsluea of ororepsit reniiorf lecrelreba etyrar ilosounc,c uesltrgni in bnWallrgee .mrondsey ’eresH a eicn cihtacesm fo het fefactde linceu dan raibn esmt orn:eigs

... dan a eim6t-un YbuuoTe idveo tath kslwa yuo gouhrth t:i


nbme4unme  Great video! Very, very solid review of brainstem anatomy. +  
suckitnbme  This image was surprisingly interpretable for NBME standards +7  
aneurysmclip  and the fact that all you needed to know was the side of the lesion to answer tbh lmao, but other than that localizing to medulla wasn't hard. +3  
medguru2295  Actually, they were quite nice. You didn't even have to know what side. There was no option for left medulla. +2  

submitted by lsmarshall(348),
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Froxle imotgurid ufounsrdp si pselnbiesro fro fliexon fo .IPD ldiaeM spetac fo the emculs chhw(i sxefle the 4ht dna h5t )ditig is duselpip yb teh nlura evern C(8, .)1T The ertlala ptesac hw(ich feexls teh d2n and 3dr dtg)ii si innevtdaer yb the aiedmn enrev cflisacelpiy het neaitror soousserenti arhnbc ,(C8 1)T. So eht qtnuisoe is iecdisrgbn a acoratlnie agimgnda het vrene luspyp to eth IDP oerxlf fo het 2dn idgti idnex( egfr.)ni siTh si ynasig teh mieald never is gneib daamged (C8 adn T;1 rwelo nutkr )

rsmciabluL /nt2d1,(s ;edmani d/r,3h4t nalur) era a gupro of mseslcu hatt lxfe at the CPM i,jtno adn eetdnx PIP dna PDI iosnt.j

Coudl remreemb as 'xolrfe umtidirog nprduoufs si nofyruodpl g'onl sienc onendts rtsnei no sIPD. mdareCop ot leorxf trgiuoidm pairscusieifl owehs nnoedt rpwas unodar 'ordsuunfp sielayrcfpliu but rssneti no .IPsP

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +10  
whoissaad  @lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific. +  
aneurysmclip  shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals) +3  
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +  

submitted by neonem(503),
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Tish ptaeitn has an auenblst mood nda a cazyr paeisn.htlori seS'h laos pttgisnli (a desefen imcmnehas hwrieen one csat keil oeeplp are llgdo-ao or b-aa)dll sa esh lakts obuta eth ainhpisyc dan erh o.wrekorsc shiT ctsrhicaarecit si tmso ymlncmoo tdsaseocia twhi errnlidebo rtpsnaoliey ddsire.or ihsT noe si ni purGo B ()"iW"ld, nolag with an,octilsai itscnioi,hr adn sccir.tinisas

medskool123  i get why its borderline now (I guess I kind of always thought suicide was the biggest part of that) but can someone tell me why its not paranoid? Is it just a matter of the "better" choice? The "youre the only one i can trust" thing lead me to that. +1  
drmomo  same here +  
aneurysmclip  Paranoid is where they don't trust anyone or are weary of people. because she said she trusts only the physician can be a bit confusing, but she describes her coworkers as jerks, not that "oh they're out to kill me, they're government agents watching me" +  
boostcap23  Splitting association with borderline in FA 2020 pg 555 and 565 +1  

submitted by ihavenolife(53),
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nAlruna rcanspae si na baoalmrn anttoiro fo teh rvnteal rncpeatcai dbu. tI clenrsice the 2nd trap of eht ddonmueu ielk a ring dna roarnws het elunm of eth dumuoden. If het ccnaeptiar nirg si hitgt nuhego ot rnraow eht muenl genuho, it adles ot i.tnomivg ehT slbuiio toivnimg mipisel hte ctnurtiobos si tsdial to eth laApuml fo re.atV

erhtO searsnw

ylrPico tsssinoe &tg-; NNOuioislb rliejpetco tni,mgiov hedosvla-epi asms ni sargiitcpe rneiog

sapaogEelh aterasi t&;g- luowd eb onn ibolsiu sa lewl. aluyusl nesnoeat pseernt hwit dgoiro,nl cohek and oivtm ihwt STIRF fineg,de isht oyb is 3 rys odl so it si leuiyn.kl

rBylaii ersatia g-;t& bFoev-ittioalbrrie urinsedotct of xehipatatcre ielb ,tduc saedl to oistshe.lacs uUslyla nbweorn twhi ce,dajuni rdka uiner nda hloicac soslot asebeuc iebl bcdeka .pu

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +  
ophmd  Curious as to why this presented at 3 years of age +  
ophmd  To answer my own curiosity; according to UWorld - most cases are asymptomatic at birth, so likely it presented when this child's organs began to increase in size (particularly the descending duodenum) +2  

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nTkah uyo BNME orf het ghih ltiqyua ispru.ect It amkse eshet sxmea sesrts fere and bl.nyaojee

sympathetikey  Feels bad man. +2  
zoggybiscuits  Those Sclera sure look blue. wow. +11  
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +9  
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +3  
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +3  
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +3  
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +4  

submitted by t0pcheese(1),
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why is the Na moarln ni isth iptenta? enhvtEgyir lese edam neess, the gihh K dan 71 nheo.ysrooetygdprrex

aneurysmclip  could be due to increased blood volume leading to secretion of ANP and thus natriuresis which would normalize serum sodium levels? that's the only reason I could think of +  
dysdiadochokinesia  My guess is that the sodium and water loss from 21a-hydroxylase deficiency would result in increased RAAS activation and production of Angiotensin II (AGII). Recall that AGII affects the PCT by upregulating Na/H+ exchangers, allowing for there Na/H2O to be resorbed, thus partially counteracting the impact of aldosterone deficiency at the collecting duct. However, I'm not sure if the effect of AGII on the PCT is great enough to entirely counterbalance the loss of aldosterone to present with normal sodium levels. +  

submitted by notadoctor(140),
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slUau rntitislaeit nneoupiitsm is het lhsotigiolca doniefinit fo pIihaoticd mlrnopuay .issibrfo We wonk atht iths atepint ash pmoyrnual ibsifros eesbuca teh enqutsoi ssetta htta eehrt si bofirsu ciekgitnnh fo eth aerlvola apets. hTsi uiqsetno wsa stju snegtti that we kwne teh retoh esanm for uPrmnoyla sFoiirs.b

aneurysmclip  Nbme back at it again +20  
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +  
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2  
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +5  
mangotango  I picked “diffuse alveolar damage” with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +1  
zevvyt  thank you swagcabana! Very good explanation and strategy! +  

submitted by aesalmon(79),
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eleoySmptcn = omre eptculbsise to acepdlntusea sgsoarmin

I upt .E loci sa tsi eatanlupcsed ubt that 'swnta eht tmso ghrti saewnr I ss?geu

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