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Welcome to apurva’s page.
Contributor score: 78


Comments ...

 +13  (nbme18#45)

THIS IS KAPOSI's SARCOMA ==> give antineoplastic

"THIS IS JUST TO LENGTHEN THIS ANSWER, NEVER EVER PAY THIS SITE, EDUCATION SHOULD BE FREE FOR ALL!"

michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +3
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!😝😂😂 +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +

 +1  (nbme24#19)

In India, our nurses are smart enough to perform PV and even to deliver the neonate!!!

I am crying due to my 60usd loss!!!!


 +1  (nbme24#28)

Lol i thought trauma would hit more superficial structure than deep.. haha

cassdawg  Literally how I answered this question cause I didn't know what dysmetria was. Convinced myself of some version of coup/contrecoup that would injure this part of the brain and got it right for all the wrong reasons. Wish I could do that more often. +
faus305  @cassdawg I did the same thing, lol. But I like to think that deep down we knew what we were doing. I knew the cerebellum was involved in balance and that this guy who just crashed his motorcycle would probably be having some balance issues. +

 +3  (nbme24#42)

I think for nbme 24, i wasted my hard earned 60 usd


 +0  (nbme24#40)

Pharyngeal arch is not same as pharyngeal floor, pharyngeal arch is mesoderm from which nerve artery muscle cartilage develop. Pharyngeal floor is from where tongue develops which is endoderm

mutteringly  However... 4th-6th pharyngeal arches do develop ACCCT (arytenoids, cricoid, corniculate, cuneiform, and THYROID). Thyroglossal duct cyst: a remnant of the thyroglossal duct that forms during the embryonic development of the thyroid gland. The thyroid gland originates from the foramen cecum at the base of the tongue and descends caudally into the neck, creating the thyroglossal duct. If the duct fails to obliterate, midline neck cysts or ectopic thyroid tissue can develop anywhere along the path of the thyroglossal duct. +

 +0  (nbme22#32)

Chronic diarrhoea == Vit D malabsorption = Hypocalcemia (say in crohns)

ACute diarrhoea = Hypernatremia, Hypokalemia, hyperphosphatemia

Dehydration can also cause hyperuricemia and ppt gout attack, but for young pt i think this will be irrelevant


 +0  (nbme21#45)

Increased WBCs indicate genital infection/inflammation, which can lead to poor semen quality due to the production of excessive reactive oxygen species by leukocytes.

Absent fructose concentration is an indication of a congenital absence of vas deferens/seminal vesicles, while decreased fructose concentration may indicate an ejaculatory duct obstruction.

pH > 8.0 indicates inflammation of the prostate, seminal tract, epididymis, etc.; pH < 7.2 indicates seminal vesicle dysfunction or obstruction of the ejaculatory ducts.


 -1  (nbme21#50)

I wonder i chose “sexual transmission” because same background of question stem was in AMBOSS stating the acute serum sickness like presentation for Hep B.

None the way, NBME wins.



 +2  (nbme21#14)

The real thing is TSH, T3, T4 and thyroglobulin cannot cross placenta. TRH, Iodine, TSI can cross. If mother has high TSH (considering primary hypothyroidism) —> Poor brain development If mother has TSI (Hashimoto) —> cross the placental barrier —Increase in thyroid gland (May present with stridor at birth.

demihesmisome  Ahhhhh Thank you. This was what I was trying to understand. +1
apurva  please note that free t4 can cross the placenta +2




Subcomments ...

submitted by apurva(78),

The real thing is TSH, T3, T4 and thyroglobulin cannot cross placenta. TRH, Iodine, TSI can cross. If mother has high TSH (considering primary hypothyroidism) —> Poor brain development If mother has TSI (Hashimoto) —> cross the placental barrier —Increase in thyroid gland (May present with stridor at birth.

demihesmisome  Ahhhhh Thank you. This was what I was trying to understand. +1  
apurva  please note that free t4 can cross the placenta +2  


submitted by b1ackcoffee(50),

Any good material to prepare for this kind of stuffs?

apurva  Lord Jesus +11  
ozmartini  Had to think back to my cell bio class in undergrad +  


submitted by mcl(601),
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iTsh aegim is usfel.u oteN ttah teh siatn esud seakm eymnil apreap rdka.

ittegVen si acptyli rof aPnrsskoni' ssai.dee Aera D si hte nttsasbiua ag.rin

oznefu  Oh nice! Thanks! +  
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +  
apurva  Saved My life +1  
john198  is this link only for MSU students??? , I can't access it . +  


submitted by niboonsh(360),
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hTsi si a scae fo ctaeu plartntsan enoct.rjie skwee to mtsnoh artfe teh artslpant,n piieetncr 8cd /anrod d4c t sclel aer dvietaatc istgnaa teh oornd a( etpy 4 HRS) dan eth oodrn attrss migkna iadonbtesi nagatsi the nnala.sttpr This srtenpse as a uctailssiv ithw deens eitnraslttii imlcophctyy ai.tesirnflt 021FA(8 gp )911

ls3076  Actually was confused about this due to a UW explanation. UW said acute txp rejection has two types - humoral and humoral and cellular. Humoral has Neutrophilic infiltrate + necrotizing vasculitis while cellular has lymphocytosis. Can anyone simplify/explain this please? +3  
apurva  We usually look for c4d complement for humoral response in acute graft rejection. Because c4d makes covalent bond with the endothelium can can be found on staining because it is long lasting. +  


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teh nacfirt coruecdr 16 shr ao,g mrof 12sr2h-4 atfre the ictrafn rteeh will be deR uNsnor.e

tsl19  FA 2018 - p. 496: ischemia -> pyknosis within 12-24 hours. +  
d_holles  yeah the infarct occurring 16 hr ago is key. i zoomed in only on the died 1 hr later +  
apurva  Me too zoomed on “1 hour later” and marked no change +  


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heT ieneaLwrev Bkur toPl is nimyla rtenpdrteie yb tis X nda Y eets rhctn.Tiep ntuoqsie esastt tath vngiig 6B eraeisncs hte tiycaivt to nrmalo s,eellv hwchi measn eth iyttciav dluosh be eth ames sa eht .l nc,oearnemH irhet Y erttpenci suhold be eth e,asm so ew aer webntee coicshe B dna C. A nad D od tno avhe teh eams Y eiertctpn as mar. oHhnlrige coarcntotesinn fo B6 acsdeu caiivtyt ot oeecbm l,rnoma and so maVx illw ont be nihgagcn adn we can ncceal A and A. D has a elwro axmV and D sha a hcmu hrhieg e. hxaTmV deeinrceff ebentwe B dna C si ni rhtie Km. Mgionv to eth elft on eth X iaxs kmsae hte Km erwol dna ellst yuo tath ifniaytf is hiergsho oyu woudl ton nede roem B.6 tBu ni rou ceas aftyfini fo eht ezeymn orf B6 si lleyra ,lwo cwhih si ywh we eedn a ont omer 6.B

In uyrmsam, ew atwn eht saem Vaxm dna a erihgh WKe. m nwta the r"o"naml vtaytcii (smea avxm sa lmanro) and ew need hieghr taonmus of 6B rof escscus fynfisota i fo teh menzey for 6B si rpobbyla vyre .lwo

Coihec B sha a )1(mK-/ luaev rscoel ot 0 hwcih anmes mK si relow dan inifaytf of the eznmye ofr tsi asutbrest si rpuse o Tliwh.s mesak snees as iginvg hrgeih stnouam fo het ovpcti"eie"tm esutrtasb B6 si ipe.nglh

apurva  This explanation is wrong!!! X axis is not 1/km in the question, it is 1/pyridoxal phosphate. (1/km should be 1/homocysteine) Also the question is asking about allosteric activation of cystathione synthase due to addition of pyridoxal phosphate. Which means the Km should decrease (affinity increases after addition of pyridoxine). Considering the x axis to be 1/pyridoxal phosphate, now apply simple logic of maths, increase pyridoxal phosphate = bringing line more close to zero (because it is -1/pyridoxal phosphate). +11  
apurva  Had the X axis be 1/km, the answer should be C +  


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Teh Levniwaere ukrB oPlt si almyin prreintdete yb tsi X and Y s.hriepctet enT sntiueqo tsesat hatt igingv B6 icsnesera hte iavytcit to onrmal esel,lv hciwh anesm eth ttcyaivi sodlhu be teh esma as the co ar.nem,elnH eirth Y etctepirn uolhds be hte em,as os we are eebntew oecsich B nad .C A nad D od otn evah het eams Y crnteitep sa riHlegha nm.ro tocecnritnanso fo B6 duaecs ctyiivat ot cbeoem roal,nm adn os axmV iwll nto be cnahggni dna ew nca clnaec A dna AD . ahs a olwre axmV dna D hsa a cmhu hghrie xaheVT.m erefencdfi wbeente B dan C si ni htier K.m viongM ot eht fetl on teh X xais mekas eht Km erowl dna tllse uyo ttha tiiynfaf is hsoiegh r oyu dwluo otn eden more .B6 tuB in uor aecs atiyifnf fo hte eenzym orf B6 is aellry ol,w hchwi si why we need a tno emro .6B

nI sr,amymu ew antw eht mesa axVm dna a rgiheh em.WK anwt het al"r"mno tiacytiv (maes xavm as alronm) dna ew dnee ghhrie uanmsto fo 6B ofr usccsse nsoyiit faf fo eth neyemz ofr B6 is pbblaory eyrv owl.

eiCohc B ash a -/Km)(1 uevla loesrc ot 0 cwhhi naems Km is leorw and tifafniy of hte myzeen fro its busrastet is prsue lsTw.h oi esamk senes sa ivigng hrgihe snuatom of hte itt"mpcevi"eo sebsrtuat 6B is pgih.lne

apurva  This explanation is wrong!!! X axis is not 1/km in the question, it is 1/pyridoxal phosphate. (1/km should be 1/homocysteine) Also the question is asking about allosteric activation of cystathione synthase due to addition of pyridoxal phosphate. Which means the Km should decrease (affinity increases after addition of pyridoxine). Considering the x axis to be 1/pyridoxal phosphate, now apply simple logic of maths, increase pyridoxal phosphate = bringing line more close to zero (because it is -1/pyridoxal phosphate). +11  
apurva  Had the X axis be 1/km, the answer should be C +