share email twitter ⋅ join discord whatsapp(2ck)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to aoa05’s page.
Contributor score: 21


Comments ...

 +0  (nbme20#27)

Case series is the correct answer. This is because there is no relationship being studied here. There is one outcome of interest with is West Nile virus infection. By definition, case series study is descriptive only (no comparison group). It includes group of patients with certain disease or with abnormal sign and symptom.


 +1  (nbme20#19)

An increase in tactile fremitus indicates denser or inflamed lung tissue, which can be caused by diseases such as pneumonia. A decrease suggests air or fluid in the pleural spaces or a decrease in lung tissue density, which can be caused by diseases such as chronic obstructive pulmonary disease or asthma.


 +1  (nbme17#20)

Q46: half life (2 hrs) is the time it take for the drug concentration to half.  Since the time course is 6 hours after injection, 3 half-lives have passed.  The concentration 3 half-lives later is 0.3 mg/L.  This means at the time of injection, the concentration should be 0.3x2x2x2 = 2.4 mg/L.  Utilizing the formula mass/volume = concentration, mass (what the question is asking) = volume x concentration = 200L x 2.4 mg/L = 480 mg.


 +1  (nbme17#0)

This is a solitary mushroom like growth in the colon so by definition it is a polyp and since it is in the colon then adenomatous/tubular polyp would be the most common. The patient is 70 years old therefore he is too old to have Peutz-Jeghers syndrome and this is a solitary polyp while PJ is multiple juvenile polyposis therefore there should be many polyps in the image. The vast majority of juvenile polyps occur in children younger than 5 years of age but they can present at older ages as well. Most juvenile polyps are located in the rectum and typically present with rectal bleeding. We are not give a history of prior polyps so this is an incidental polyp in an older man. Inflammatory pseudopolyps occur in a background of injury such as ulcerative colitis and here we are not given that history and the background colonic  is normal. Hyperplastic polyps are most commonly found in 6th and 7th decade-like this patient-  in the left colon and are typically less than 5 mm in diameter. They are smooth, nodular protrusions of the mucosa.


 +2  (nbme16#44)

First, the boy had ophathalmoplegia (eye muscle problem) and hypotonia (muscle weakness), indicating that he had muscle related problems. Second, all the problems appeared to come from his mother’s side and the symptoms from different individuals of the family appeared to be very heterogeneous and diverse. All these strongly suggest heteroplasmy, a mitochondrial genetic disease, which is known to show varying degrees of expressivity owing to heterogeneity in genetic mutations in mitochondria. All the mitochondria of one person are inherited from mother’s side (from fertilized eggs) and are different from nuclear chromosome inheritance mechanism. Heteroplasmy is caused by the fact that in each human cells, there are several hundreds mitochondria. In different mitochondria, they may contain different genetic mutations. During genetic transmission, different mitochondria may end up in different eggs / fertilized eggs, leading to mitochondrial genetic disease in the offspring with varying degrees of expressivity owing to heteroplasmy

How to exclude other possibilities: In the narrative, there are genetic diseases two generations in a row in the family. Thus, it is not recessive disease. It came from his mother’s side but affected both sexes. It does not look like a penetrance issue, Additional information - MERRF syndrome (or myoclonic epilepsy with ragged red fibers) is a mitochondrial disease MERRF syndrome affects different parts of the body, particularly the muscles and nervous system. The signs and symptoms of this disorder appear at an early age, generally childhood or adolescence. The primary features displayed on a person with MERRF include myoclonus, seizures, cerebellar ataxia, myopathy, and ragged red fibers (RRF) on muscle biopsy, leading to the disease's name. Secondary features include dementia, optic atrophy, bilateral deafness, peripheral neuropathy, spasticity, or multiple lipomata. Mitochondrial disorders, including MERRFS, may present at any age

nbmeanswersownersucks  I agree with everything you said though I don't think the disease in the question is MERRF. unless I misunderstood you and you weren't saying it was MERRF but were just describing an example of a mito disease? +4
nbmeanswersownersucks  I think it is more in line with MELAS d/t the lactic acidosis and stroke +2
i_hate_it_here  Username checks out +

 +2  (nbme16#45)

here are partial clinical manifestations of the right oculomotor nerve palsy:  the right pupil is 6 mm and nonreactive to light, and adduction of the right eye is impaired. The oculomotor nerve exits midbrain through the interpeduncular fossa and goes between the beginning of the posterior cerebral and superior cerebellar arteries. Rapture of an aneurysm in the posterior communicating artery near the beginning of the posterior cerebral artery may compress the oculomotor nerve and affect its function

medstudent  FA 2020 P. 516 +
baja_blast  FA 2019 p. 529. +

 +1  (nbme16#40)

here are partial clinical manifestations of the right oculomotor nerve palsy:  the right pupil is 6 mm and nonreactive to light, and adduction of the right eye is impaired. The oculomotor nerve exits midbrain through the interpeduncular fossa and goes between the beginning of the posterior cerebral and superior cerebellar arteries. Rapture of an aneurysm in the posterior communicating artery near the beginning of the posterior cerebral artery may compress the oculomotor nerve and affect its function

aoa05  Sorry I meant to post this: Absolute risk reduction or ARR is one of the basic and simplest measures in epidemiology. Another name for this is risk difference It refers to the absolute difference in outcomes between one group (usually the control group) and the group receiving treatment. The percentage tells you how much the risk of something happening decreases if a certain intervention happens. Therefore the stoke rates among women in standard treatment was 0.12 and the stroke rate in women receiving new antiplatelet treatment was 0.04. The ARR is 0.12-0.04 = 0.08 or 8% +6

 +2  (nbme16#48)

A high stepping gate implies distal more than proximal weakness. Hammer toes are a finding in Charcot-Marie-Tooth (hereditary motor and sensory) neuropathies, most of which also feature demyelination of peripheral myelin sheaths. Slowing of nerve conduction velocities could have demonstrated the same thing less invasively.?

notyasupreme  Ask me why I thought this was Friedreich Ataxia and not CMT fml lol +
shakakaka  Why did you think that it's FA? +

 +2  (nbme16#18)

The calculation for incidence is the number of new cases divided by the population risk. Remember in this question you were told that 500 of the 2500 have already tested positive for the disease. Now, you will have only 2000 at risk for the next year. Therefore, the annual incidence would be number of new cases divided by the population at risk which is  200/2000= 10%.

mm9283  Is this not a silly question? It's assuming that those 500 individuals cannot get chalmydia again next year, but there is no reason they are still not at risk! It's not like they become immune to it +4
nnasser33  I agree. But also, this is a screening of "first-year women college students." So, one year later, would these women no longer be first-year college students? This question is so poorly written, I tore some hair out reading it. +4
meryen13  true nnasser33 but then why do we use the same 2000? those people are also not in first year. the 500 people who got chlamydia are not the only people who are second year students. :D +

 +3  (nbme16#34)

Weakness with decreased muscle bulk implies problems that include the lower motor neuron system. Decreased DTRs implies a disrupted reflex loop but the absence of sensory loss implies that it is on the motor side of the reflex loop. Of the available choices, B is the best fit. "A" is arguably true because a strictly motor polyneuropathy (such as in lead poisoning) could account for the findings, but a 3-month course could hardly be called "acute."

itsalwayslupus  I was able to deduce the right answer, but what is the specific reason against "demyelination of the corticospinal pathways"? just out of curiousity +1
lsp1992  I believe it's because damage to the corticospinal tract would be considered UMN damage, while degeneration of motorneurons is LMN damage. LMN damage causes decreased reflexes. UMN disease would cause hyperreflexia....I think. That's how I reasoned through it at least +11
nbmeanswersownersucks  I also think you can rule out peripheral neuropathy because typically that includes both motor and sensory +2
saqeer  yes but is not Achilles an S1 reflex (sacral cord) ? how does the degeneration in lumbar cord affects it ? i rule it out first thing because of this :S +
meryen13  i think she just had a dics herniation. there can be problem with temperature and sensation in some case but those are usually very severe herniations. not sure tho... but it can on your differentials. +
djeffs1  I assumed that "motoneurons of the lumbar chord" means upper and not peripheral +

 +0  (nbme24#47)

Renin concentration will be increased because feedback mechanism of renin release is due to angiotensis II (Ang II) on angiotensin type 1 receptor (AR1). That is, Ang II acting on AR1 will cause a negative feedback on the RAAS pathway. Since AR1 is blocked by ARB, this negative feedback is no longer active, triggering an increase in renin and increasing Ang II production (correct answer). Blocking AR1 will inhibit downstream actions (release of aldosterone and Ang II-mediated increase in sympathetic activation, triggering norepinephrine). Therefore, aldosterone and norepinephrine will be reduced.





Subcomments ...

unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

caorneozaIlt eeirsuqr the aiidcc eiemnnovrnt fo teh ahcomst to eb d.reasbbo eleropzaOm sitniibh teh +K+H/ mupp of hte sm,coath yrbeeth seincraegd eht tdiyica of eht thmosac. oS when eth ieattpn kesat Oempzearlo nad ecIoontlzraa retth,ego aaneorlzItoc two'n eb oebarbsd iont eth body. Tha'st hwy ti sah on ce.teff

'Its ereodmcmden to etka iscdmatione ta laste 2 uhros irrpo to tagikn an caa.tdin

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +3  
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2  
chandlerbas  just itraconazole and posaconazole +5  
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5  
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +  
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +7  
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +  
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +  


submitted by aoa05(21),

here are partial clinical manifestations of the right oculomotor nerve palsy:  the right pupil is 6 mm and nonreactive to light, and adduction of the right eye is impaired. The oculomotor nerve exits midbrain through the interpeduncular fossa and goes between the beginning of the posterior cerebral and superior cerebellar arteries. Rapture of an aneurysm in the posterior communicating artery near the beginning of the posterior cerebral artery may compress the oculomotor nerve and affect its function

aoa05  Sorry I meant to post this: Absolute risk reduction or ARR is one of the basic and simplest measures in epidemiology. Another name for this is risk difference It refers to the absolute difference in outcomes between one group (usually the control group) and the group receiving treatment. The percentage tells you how much the risk of something happening decreases if a certain intervention happens. Therefore the stoke rates among women in standard treatment was 0.12 and the stroke rate in women receiving new antiplatelet treatment was 0.04. The ARR is 0.12-0.04 = 0.08 or 8% +6