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 +5  (nbme24#28)

Dysmetria ( also, dysdiadokinesia and intention tremor) is lateral cerebellum. (E).

Ataxia is a problem with the central cerebellum (D) or at least thats the best I could come up with.

ronald-dumsfeld  I actually think D is pointing at the Flocculonodular lobe. See here: https://en.wikipedia.org/wiki/Flocculus_(cerebellar)#/media/File:Human_brain_midsagittal_view_description.JPG So a lesion at D would present with Nystagmus
urachus  flocculonodular is medial (central). but yes it'll have nystagmus and truncal ataxia

 +25  (nbme24#35)

Thank you NBME for the high quality pictures. It makes these exams stress free and enjoyable.

sympathetikey  Feels bad man.
zoggybiscuits  Those Sclera sure look blue. wow.
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.
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" .

 +26  (nbme24#42)

I like this question because it reminds me that examiners think objects can exist in 2 dimensions.

 +3  (nbme22#11)

Niemann-Pick Disease presents with mental retardation, lipid laden (foam cells) in bone marrow and cherry red spot on macula. No sphingomyelinase results in buildup of sphingomyelin which builds up in macrophages.

meningitis  "Pick your **Big** **Foamie** **Zeibra** nose with your Sphinger" Choose options with the letter I. SpIngomyelin, Sphingomyelinase, bIgorgans (hepatomegaly etc), zeIbra bodies, Foam cells

 +5  (nbme22#38)

Premie has no surfactant

Angiotensin II - generated in hypovolemia

Dipalmitoyl lecithin aka dipalmitoylphosphatidylcholine lung surfactant

Phosphatidylinositol 4,5-bisphosphate aka PIP2 Gq receptor pathway

Phosphatidylserine -involved in intrinsic apoptosis when exposed on extracellular surfaces

Sphinogmyelin - composes myelin and also has roles in signal transduction, apoptosis. Lecithin: Sphingomyelin ratio >2 indicates mature fetal lungs.

endochondral1  how are we supposed to know that dipalmitoyl lecithin is the same thing as dipalmitorylphosphatidylcholine
qfever  FA 2019 page 647 Pulmonary surfactant is a complex mix of lecithins, the most important of which is dipalmitoylphosphatidylcholine (DPPC). Also: Screening tests for fetal lung maturity: lecithin- sphingomyelin (L/S) ratio in amniotic fluid (≥ 2 is healthy; < 1.5 predictive of NRDS)

 -6  (nbme22#48)

Question is asking about encapsulated organisms infecting CGD patients. E.coli is also encapsulated. Can anyone expand on this?

keycompany  Step pneumonia is the most common pathogenic organism in CGD, and the most common cause of pneumonia, otitis media, meningits, and sepsis. While CGD are at an increased risk of encapsulated E. coli infections, however, they are at MOST risk for S. pneumo. This is kind of just a memorization fact that you need to know about S. pneumo.
keycompany  Sorry english is clearly not my shit, but you get the point
biliarytree220  CGD is susceptible against catalase-positive organisms (FA 109), of which S. aureus is the one to look out for. It's not about encapsulated organisms, like I had it confused in my head.
.ooo.   You are completely right about E.Coli being encapsulated and is also a CAT+ organism and patients with CGD would have an increased risk of infection for both S. Aureus and E. Coli. How you narrow down the two is the most common infections are S. Aureus and Aspergillus (FA 109 like mentioned above) and also using the pneumonic "Cats Need PLACESS to Belch their Hairballs" (FA 128) Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E.Coli, Staphylococci, Serratia, B cepacia, H pylori

 +0  (nbme22#25)

Histamine causes capillary arteriolar dilation (decrease resistance)(increased pressure in the capillary because efferents remain the same size) Histamine also increases capillary permeability.

 -3  (nbme22#23)

Ambiguous question but in because it is early shock, there is not enough time to activate the RAAS to increase kidney perfusion.

makinallkindzofgainz  This is not an ambiguous question. It makes perfect sense.

 +6  (nbme22#31)

Weight loss - think cancer Hyponatremia - SIADH from small cell lung cancer Edema + JVD - SVC syndrome

 +7  (nbme22#15)

Alkylating agents (merchlorethamine) (the other drugs listed are microtubule inhibitors) increase the risk of AML.

keycompany  Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts).
seagull  CML has blasts too but they tend to favor mature forms.
kash1f  You see numerous blast forms == AML, which is characterized by >20% blasts
keycompany  The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies
impostersyndromel1000  @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company
sweetmed  Procarbazine is alkylating as well.
pg32  @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen?

Subcomments ...

Mast cells degranulate, producing histamine which attracts eosinophils. The early stage of an allergic reaction is mast cell mediated, but the late stage (including mucus production) is mediated by eosinophils.

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +9  
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +1  

submitted by beeip(91),

Inability to elevate the palate suggests damage of the vagus nerve.

F. (CN X)

atstillisafraud  I guess F is the vagus nerve. Thanks to NBME I am also training to become a mind reader. +14  
seagull  Thanks to the NBME I have crippling depression +22  
drdoom  bonus cadaver diagram via @mcl +2