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Welcome to beeip’s page.
Contributor score: 116


Comments ...

 +4  (nbme24#43)
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anC oaeynn nlpieax hwat eye'rth tiggnte at hee?r oHw can hehecobltan eb neaiictdd dan no?ccaetadriitnd

sniperx3  I think it's because Bethanechol acts on M3 receptors which can treat her urinary problems but it might exacerbate her asthma symptoms since there are M3 receptors on the lungs. +30
suckitnbme  I definitely had to read this question multiple times to understand it. +1
brotherimodu  I read it like 6 times and gave up +1

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +6
famylife  "When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version +13
usmleuser007  really like the pubic hair.... +2
nnp  why not spasm of external anal sphincter? +
vulcania  After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam... +1
ajss  I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam. +
thisshouldbefree  this is the map ive been looking for +

 +4  (nbme24#4)
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tiiIlyanb ot elaevte hte lpaate tguesgss daamge of het vguas .neevr

F. NC( X)

atstillisafraud  I guess F is the vagus nerve. Thanks to NBME I am also training to become a mind reader. +24
seagull  Thanks to the NBME I have crippling depression +29

 +23  (nbme23#35)
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heT estb I can tuandsne,dr rythee' ednrcibsgi midleaetnor ylrpahepsai, a ltseru of esesxc ogen,esrt a reitsdo ooehnrm ttah ssnttcloaera to eht nlsuceu dan dbnsi sit rarosciniptnt troac.f

mousie  My exact thinking also! +6
sympathetikey  Ditto. +
meningitis  My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things? +
criovoly  You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS +4
eve1000  Could this be due to the PTEN gene being linked to endometrial hyperplasia? +
feochromocytoma  The question stem says it's glandular hyperplasia "without" atypia It's just due to increased levels of estrogen causing the hyperplasia +1

 +2  (nbme21#42)
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[mdveo ot oce]tsmmnbu


 +19  (nbme21#4)
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I mitgh eb hte lyno operns no areht woh otg shit one w,orng but :eslradgsre

"TIT aslniays iulcnesd veery tcsejbu woh is mdoearzdin ndcogacir ot rzmadeodni naemtetrt nt.siagnems It reognis nmelonpoi,acnc ooltcorp ndosei,ivta iwahawr,dlt adn ganhytin thta ahspnep eaftr raoznd.im"toain[]1

yo  You're not. I also goofed. +11
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject. +2
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +

 +4  (nbme21#36)
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iThs ewivre ussseggt ttha nhaecnmdoro dan orahcnsrmoodac ear anlbeu ot be eefditfridatne on oystilogh neoal. crAingdco ot uttOhbrselol:

elni"ku cea,nmnodroh mtos admcscnroshraoo haev ncoeacamnhlni- pnia erts( niap nda tnuaonlrc na"ip)

uesGs isht odsingsai is adem no tsi.rohy


 +16  (nbme21#34)
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ao"ttriyxEc manio caid"s sferer to mtelugaa,t eiwlh "Bgi"ocnei pyantlarpe frrese ot enryi,ots the usrrcopre AA to nidmaoep nda inr.poe

sahusema  Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft +9
mumenrider4ever  FA 2020 pg. 239 +2

 +19  (nbme21#6)
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hiTs ahs nbee a outhg eptncoc for me ot get, tbu I knith 'mI ilfnlya rh:tee

The etsm is iecnrbidsg rapirmy aaelndr yecfnuncisf,ii ro sdd'osAn.i

  • HACT is enibg eduvorecpord- ot taemustli eth asalrden ot rdpuoce oclsio,rt tbu heyt cn'ta drsno,pe ireeht eud to hptroya or tcseudrtnoi (BT, tumuaomei:n RD4, et).c
  • eTh sifrt 31 oanmi isacd fo HTAC nac eb avlecde to mrof αS,MH- whihc milteatsus lnyeo,temsac auincgs rtinomygphinatpee
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10
hungrybox  thank u for this answer +
bilzcop  Ugh! I misread the question and chose ACTH :( +2
cienfuegos  @bilzcop: same +
cienfuegos  @bilzcop: let's never do it again, k? +1
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +

 +0  (nbme20#2)
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ovedm[ ot nsmcm]ubteo


 +2  (nbme20#2)
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owH to edaniierttfef eenbwte ourriosNv and uvRrotais r?ehe tusM be redtael ot eth teh isootcngua teraun fo eth s?lisenl

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +5
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +2
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +
savdaddy  ***after the initial outbreak +1
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +2
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1

 +11  (nbme20#35)
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Lveir skool ttepyr nsedzriolma- to m.e icP erhe ofr nmropcoais


 +7  (nbme20#36)
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tAarp form het einl in FA ifrrneecnge NPM trtainlfie in ehSilgal, erthe is on way ot fifdtertneeai ehre teweenb it nda E. oCli. eapCh .htso

merpaperple  As best I can understand, what they are trying to get at is that "EMB stain showing neutrophils" -> "EMB stain NOT showing organisms" -> more likely Shigella than E Coli. If a special culture for an organism (e.g. EMB for E. Coli) shows no organisms but only inflammatory cells, i.e. neutrophils, that means that organism is not present. If that's the point here it's kind of a trick question, as we all would have gotten it right if they had just said "EMB showed no organisms." I guess the takeaway is that the point of a special culture is binary - you are looking for a specific organism, and it is either there or it isn't. +

 +0  (nbme20#21)
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I olsa swa tnghikin M. uiamv ehe,r ubt rnsispeiyyvitthe nunompsteii smees to tfi wtih het rugrnloueilaarct cahesn.g


 +1  (nbme20#44)
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ohtuTgh htsi dlowu be egsinhmot gdngaerir t"iiacbrra rgru"eys, ubt n,eop tjus "no cayhtrs ,sodof ceubsae e'oruy dc-ipeb.teira"

hello  Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods. +
yotsubato  such a BS question IMO +4
yotsubato  such a BS question IMO +
breis  I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption.. +4
teetime  This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +1
dr_jan_itor  Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled. +1




Subcomments ...

submitted by beeip(116),
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How ot fttneiiadfeer newbtee vuooNsrri nad srtvuoRia eer?h tuMs be aledret to the the utsngioaco anetur of hte lslen?is

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +5  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +2  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +1  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +2  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1  


submitted by halux(4),
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nca mose oen elpase eiaxpnl yhw is teh iasrepp?haly

beeip  Loss of negative feedback from resected ovaries leads to gonadotroph hyperplasia. +2  
halux  so, the explanation is that in the absence of Estrogen negative feedback inhibition to LH and FSH, this leads to Gonadotrophs Hyperplasia at the Pituitary resulting in elevated LH and FSH secretion levels? I get busted by this one :/ Thanks in advance! +4  
nala_ula  @halux exactly, there's no negative feedback telling them there is an increase in the hormones (since there are no ovaries) so gonadotrophs work in overdrive to keep stimulating the gonads via FSH and LH. +