NBME Answers : bigjimbo's page

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Alcohol raises GGT. The other liver enzyme lab to remember is the 2:1 or greater AST/ALT ratio associated with alcoholic liver disease.

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langusmle ⬆️Ferritin ⬆️Leukocytosis as well +1

bigjimbo typically 2:1 AST but the ast should be around 300 so strange labs. +1

hugosavi There's an Anion Gap. mudpilEs... E: Ethanol or Etylene Glycol. +

submitted by bwdc(697), visit this page

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Unstable and hypotensive patients after blunt trauma get laparotomies (don’t put an unstable patient in the CT scanner). In addition to saline and blood products, definitive surgery is how you address the C in ABC.

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tinylilron Why not a Thoracotomy??? +3

bigjimbo no thoracotomy because thats for unstable lung injuries like persistent hemothorax. The question is tricky because it says SOB and ABDOMINAL pain. paired with the green fluid (boerhaave or pancreatic), laparotomy is a safer answer +1

beans123 I looked it up and it truly depends on where the rupture is... thoracotomy could very well be the answer for a higher up rupture even if the patient is unstable... +1

submitted by sugaplum(487), visit this page

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This kid has signs and sx of dehydration Hyaline casts due to hypovolemia resulting in concentrated urine

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welpdedelp I was thinking RBC cast due to GI illness, thought they were pointing to some sort of IgA nephritis (╯°□°)╯︵ +

bigjimbo hypovolemia causing ARF (pre-renal azotemia) leads to normal bland casts aka hyaline casts +1

submitted by sugaplum(487), visit this page

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Suspect renal artery stenosis, since he also has htn

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bigjimbo renal artery stenosis = abdominal bruit +2

submitted by wired-in(81), visit this page

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Maintenance dose formula is (Css × Cl × tau) ÷ F

where Css is steady-state target plasma conc. of drug, Cl is clearance, tau is dosage interval & F is bioavailability.

Neither dosage interval nor bioavailability is given, so ignoring those & plugging in the numbers (careful to convert units to mg/kg/day):

=(12 ug/mL × 1 mg/1000 ug) × (0.09 L/hr/kg × 1000 mL/1 L × 24 hr/1 day)
= 25.92 mg/kg/day

...which isn't any of the answer choices listed. They must have rounded 0.09 L/hr/kg to 0.1 L/hr/kg, and doing so gives exactly 28.8 mg/kg/day (choice C)

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lispectedwumbologist That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +85

hyoid ^^^^^ +13

seagull lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +10

praderwilli Big mad +10

ht3 this is why you never waste 7 minutes on a question.... because of shit like this +9

yotsubato Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +21

bigjimbo JOKES +1

cr in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it. +1

d_holles LMAO games NBME plays +3

hyperfukus magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1

jean_young2019 OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +7

atbangura They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +7

titanesxvi I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +4

makinallkindzofgainz The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +23

qball Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +1

frustratedllama Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +1

fexx 'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1

cbreland I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡 +

yesa 12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s +

chaosawaits What really grinds my gears is that 3/5 answer choices are closely related to using 0.09 instead of 0.1 (A is 25.92/10, D is 25.92*2, and B is D/10). So basically, we're supposed to know to round 0.09 up to 0.1 but also to not round 12 down to 10. Okay? +

impostersyndromel1000 so you're telling me that I did all my math correctly, got 25.92 then thought I was off by a decimal point and chose 2.5 bc 25.9 wasn't an option and I was actually correct in my math but wrong bc THEY DIDNT PUT THE RIGHT ANSWER? Why is NBME so trash? I hope real exam isnt this bad. +1

submitted by sne(59), visit this page

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I thought of it like when she gets up from a prone position, she is decreasing the blood going to her heart, so so the the myxoma causes more obstruction. Also myxomas cause tiny emboli, which can go to the systemic circulation causing mini thrombi in the brain and limbs.

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bigjimbo Left atrial myxoma can mimic mitral stenosis (thus diastolic murmur) +1

btl_nyc RVOT obstruction would cause a systolic murmur that gets louder when standing, not diastolic. +2

snripper RVOT obstruction = Hypertrophic Obstructive Cardiomyopathy which causes diastolic dysfunction (S3) not a systolic murmur. +

cmeacham Isn't RVOT obstruction essentially the same as Pulmonary stenosis? Why would it not be a systolic murmur? Plus HOCM primarily affects the Left Ventricle, not the right. +

submitted by yotsubato(1208), visit this page

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So this question is describing a guy having difficulty externally rotating his arm while the forearm is flexed. He is able to supinate while his arm is extended (because of the supinator muscle and biceps). In the rotator cuff, only the infraspinatus performs external rotation, so that is the best choice.

Biceps works fine here

Subscapularis performs internal rotation.

Supraspinatus performs abduction

Triceps provides extension of forearm.

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bigjimbo technically rotator cuff infraspinatous and teres minor do ER (but teres minor is not a answer choice0 +9

submitted by sympathetikey(1600), visit this page

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Dexamethosone suppresses ACTH = Pituitary Adenoma Dexamethosone fails to suppress ACTH = Ectopic ATCH (ex - Small Cell Lung Cancer)

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sympathetikey *ACTH +

meningitis If im not mistaken, Dexamethosone also fails to suppress ACTH = Adrenal Gland Adenoma +1

therealloureed I think an adrenal gland tumor would have low/undetectable ACTH? aka no dex suppression +16

bigjimbo Low ACTH = adrenal adenoma High ACTH, suppressible = Pituatary adenoma High ACTH, non-suppressible = SCLC +15

rozeng I thought the it's a SCLC because it took SEVERAL DAYS :S +

submitted by lsmarshall(465), visit this page

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An experimental design or experimental study must have an intervention, by definition. Case-control studies are observational studies, not experimental. This question is technically incorrect. They wanted to amke a point that case-control studies are time and cost efficient since they don't require following patients over time or any resources besides reviewing/gathering information. Case series could not test this hypothesis.

Also, the wording "associated wit an increased risk" somewhat alludes to case-control studies only having the ability to find odds of an associations between exposure and outcome, but not establish causal relationship.

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bigjimbo classic nbme +3

poisonivy totally agree, I dont understand why the right answer is Case control since that is not experimental +2

howdywhat am I subject to this kind of poor wording for the day of the exam? +1

ajss I bieleve so +2

aaftabsethi1 Why not a retrospective cohort study ? +1

joeschmo Case-control studies are largely retrospective by nature. You can retrospectively look back at samples and ask "what happened?" +

submitted by haliburton(224), visit this page

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Infliximab is a TNF-alpha inhibitor. from pubmed TNF-α has been demonstrated to have a central role in the host response against tuberculosis, including granuloma formation and the containment of disease (14,15). Notably, antibodies against TNF-α induced reactivation of tuberculosis

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bigjimbo TB can spread to psoas L1-2 often, which then goes to the actual L1-L2 vertebrae itself (Potts or osteomyelitis) +6

cbreland I get why the TNF inhibitor would cause Tb and it literally said osteomyelitis, but the question says "gram stain is negative". Does that mean it doesn't gram stain?? I read it as it having a negative gram stain and crossed out Tb osteomyelitis as a result +

jsanmiguel415 Mycobacterium doesn't gram stain due to mycolic acid in it's membrane. It'll take the carbol-fuschin stain (acid fast) or grow on a lowenstein-jensen culture but not gram +2

doctordave What threw me off was that 'she has not had fever'. Figured there's no way it could be TB +2

sexymexican888 @doctordave yeah same.... they said "She has not had fever, lower extremity weakness, constipation, bladder probs, or WEIGHTLOSS" like no fever or weight loss? How can you not have that with potts dz.. idk also wouldn't you have to have it reactivated in the lung and then spread to the spinal cord? So wouldn't you get those sx (weightless, cough, fever...) idk dumb ass nbme fuck them +

submitted by m-ice(370), visit this page

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The patient needs medical attention immediately, which eliminates obtaining a court order, or transferring her. A nurse does not have the same training and qualifications as a physician, so it would be inappropriate to ask them to examine the patient. Asking the hospital chaplain again could be inappropriate, and would take more time. Therefore, the best option among those given is to ask the patient if she will allow with her husband present.

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sympathetikey Garbage question. +71

masonkingcobra So two men is better than one apparently +33

zoggybiscuits GarBAGE! ? +2

bigjimbo gárbágé +5

fulminant_life this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +17

dr.xx I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +11

medpsychosis The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +21

sahusema I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +29

sherry I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +1

niboonsh This question is a3othobillah +11

sunshinesweetheart this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +9

drmohandes I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +15

myoclonictonicbionic @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +16

korahelqadam All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +3

sars This is a very fair question. I agree with sunshinesweetheart above. That is all. +2

wrongcareer69 Garbage question +1

alimd well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +3

beto okay, touch me when my husband looks. are they preparing for threesome?? fckn question +

fatboyslim I'm a Muslim man and I got it wrong. I chose B lol. I thought by her saying I don't want to be examined by a man stays true regardless of whether her husband is there to not. I guess it doesn't hurt to ask her what would make her feel more comfortable if it allows a male doc to examine her. +

submitted by medstruggle(21), visit this page

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Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

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colonelred_ Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +16

brethren_md Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5

sympathetikey Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +6

s1q3t3 Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +13

masonkingcobra Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4

mcl Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +42

mcl But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +13

bigjimbo LOL +1

fallenistand Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6

medpsychosis So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +10

charcot_bouchard Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2

giggidy Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +6

subclaviansteele Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +1

cinnapie I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +3

youssefa Hahahahaha ya'll just bored +11

water Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +6

nbmehelp I dont get it +1

redvelvet how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +2

drmomo what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +1

sunshinesweetheart hahahaha this made my day #futurephysicians #lowkeyidiots +1

sunshinesweetheart @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +1

deathbystep1 i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3

noplanb Wait... I might actually never forget this now lol +4

drmohandes Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2

lilmonkey Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +1

drpatinoire Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +1

dr_ligma The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +22

minion7 after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +2

djtallahassee My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2

medguru2295 Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +1

peqmd Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +2

paperbackwriter Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +3

alexxxx30 just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +3

peridot I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2

mbate4 According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +1

drdoom the tradition lives on +2

jamaicabliz Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +1

abkapoor Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +1

faus305 Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +1

djeffs1 the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +1

niftykoala As an extra piece of information, I would like to add that Bungee Gum possesses the properties of both rubber and gum. +

neurotic999 Oh I get it! Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens. Makes alot more sense now after reading it a hundred times. Thanks guys! +

rdk3434 okay , this actually made my day and i also learned that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens!!productive +

laravonter Since it has been a month, I feel the need to remind all that sertoli-leydig cell tumors are notorious for producing lots of androgens +

thisisnewgg FCGSLCTWANFPLOA +

submitted by colonelred_(124), visit this page

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He’s presenting with classic signs of vitamin B3 deficiency (niacin); niacin is required to form the cofactor NAD+ (nicotinamide adenine dinucleotide).

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bigjimbo B3 Niacin deficiency = Pellegra = diarrhea, dermatitis, dementia death. = Niacin combines with adenine to become NAD+ https://www.aocd.org/page/Pellagra +12

cbreland Noted lack of niacin, not making NAD. Did not think about what NAD stands for, instead went down a rabbit hole +18

submitted by medstruggle(21), visit this page

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Why is it aphthous ulcers if there are no GI symptoms? Why can’t it be herpes zoster?

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colonelred_ It’s just canker sores, they come and go. I think in herpes the gingivostomatitis really only happens when you first get infected. After that you just get recurrent cold sores. +4

hyoid Herpes zoster is not the same as herpes simplex virus. +31

bigjimbo you would see dermatome rash in zoster +3

kateinwonderland cf) Just in case someone wanted to know the causative organism of aphthous ulcers :The precise cause of canker sores remains unclear, though researchers suspect that a combination of factors contributes to outbreaks, even in the same person. Unlike cold sores, canker sores are not associated with herpes virus infections. +9

charcot_bouchard Herpes Zoster doesnt cause gingivostomatitis. Herpengina can cause vesicular lesion in mouth but happens to children in summer season by entero virus +

drdeeznuts1 I'm wondering if this could be a mild case of Behcet syndrome without genital involvement +

sherry It sure can be Behcet or Pemphigus if the q provides us with more info. Canker sores just come and go for years with unclear mechanism. Also herpes zoster is shingles by VZV, not HSV1. +2

avocadotoast Most pictures on google show herpangina being present on the hard palate/throat, while aphthous ulcers are commonly on the lower lip. I think his lack of genital lesions are pointing us away from herpangina. +

drdoom Anyone still curious about the pathophys of aphthous ulcers can check out the thread above: https://nbmeanswers.com/exam/nbme24/964#4853 +