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Welcome to bigjimbo’s page.
Contributor score: 46


Comments ...

 +0  (step2ck_form6#42)

IgA deficiency is in mind after reading anaphylactic shock on blood transfusion (residual IgA in blood product)


 +0  (step2ck_form6#33)

Bacterial meningitis normally makes patients more toxic appearing. High Fever (103+) and glucose would be more drastically lower.


 +0  (step2ck_form6#32)

Pseudotumor Cerebri/Idiopathic Intracranial HTN shows up as headache, pulsatile tinnitis, vision difficulties. Has normal imaging and normal (therapeutic) LP. According to UW, risk factors include: obese, vitamin A, tetracyclines.

The patient in this question was 250 lbs at 5 feet. Thats a BMI of 48.8


 +0  (step2ck_form6#14)

Due to a quick google search, the only way I could see to differentiate GM1 gangliosidosis and Pompes was that Pompes does NOT have splenomegaly. Otherwise, these diseases share many common features.


 +0  (nbme23#6)
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typEmioios si uct ormf ivnaga to the eernlipa odby rof dhlic irtbh

btl_nyc  But why is it external anal sphincter instead of bulbospongiosus? Aren't both attached to perineal body? +1
stinkysulfaeggs  Bulbospongiosus connects to either side of the perineal body. But if you go directly posterior rom the commissure you hit the anal sphincter +13
need_answers  I just think about how women say they done ripped their asshole while giving birth +3

 +2  (nbme24#32)
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hTe ynressusop itelamgn onsitcan eth oirvnaa sev.less Sneic thta si nto an wresan c,cehio ti hsa ot eb eth uere,rts as the tsruere dna teh ainorva svssele nru tropsiroe to eht sriveao ehew(r the iaroavn ssleevs hbrcna ffo to eb oentdcnai in hte soureynsps gl)tnmae.i





Subcomments ...

submitted by sugaplum(326),

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

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 +  


submitted by sugaplum(326),

Suspect renal artery stenosis, since he also has htn

bigjimbo  renal artery stenosis = abdominal bruit +  


submitted by wired-in(67),
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iacnMentnea odes laufmor si (Css × lC × t)ua ÷ F

ewreh Css si aetysatdse-t eatrgt maalps oncc. of ur,gd Cl is cneaercal, tua is oseadg rtinelva p;&ma F si lbbtii.avaoialiy

rehNite oasged letnaivr rno loialiibyaitabv is vineg, os nigiorng tshoe mp;&a nuggiglp in eht rsmebun (ufelrac ot ectnorv tnsiu ot md/):gky/ga

(1=2 /Lgmu × 1 g000/m1 g)u × 9.(00 /r/gLhk × 0100 m/L1 L × 24 /r1h ad)y
= 529.2 //ygmkagd

.i.hc.hw s'itn nya fo the waerns ioshecc et.sild eyTh umts vaeh rueddon 00.9 k/g/hLr to 10. r,/kh/gL and niodg so gives eclaxty 882. akyggdm// o(ecihc C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +72  
hyoid  ^^^^^ +11  
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9  
praderwilli  Big mad +9  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18  
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 +2  
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 ...... +6  
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 +3  
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 +2  
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 +15  
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 +  
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😡 +  


submitted by sne(46),
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I gthhotu fo ti eilk nweh seh sget pu mofr a renop otinpsoi, seh is cdaenrgesi hte lobdo niogg to ehr tea,hr so so the eht xmyoma secusa erom ou.intbtrocs olsA maxysom seuca nyit emoibl, whihc acn go ot eth syctisem rcuclontiia ugsican nmii ombhtir in eth riabn dna mbs.il

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. +  


submitted by yotsubato(979),
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So hsti eusntqoi is egdbirnics a ygu gnaihv fcudtiyfil lanxyreetl itaorngt his amr elwih eht eraromf si xedfle. He is albe to iutapesn eliwh sih ram si etnddeex eeacusb( fo the rsauipotn ucmles and cse).bpi In het ttroaro ,uffc noyl het fusraisptnani fromrsep xteaelrn oonrtia,t so ttah si eht ebts ei.choc

Bseipc wkros fein erhe

rsSlacupbisau osrefrpm aenrltni n.aorttoi

anustpirauspS rorpfems acntdiobu

secirpT opvreids itsnenoxe fo arrfoe.m

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


submitted by sympathetikey(1265),
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tDemeoonhaexs spssrseupe ATCH = ytiPutiar dexseaeaDmnmteoAh oon fisla ot perpusss HTCA = tiEcopc ATHC (ex - laSlm eCll Lgnu nre)Cac

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 +13  
bigjimbo  Low ACTH = adrenal adenoma High ACTH, suppressible = Pituatary adenoma High ACTH, non-suppressible = SCLC +12  


submitted by lsmarshall(396),
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nA etemipanlxer gendsi ro xearnltmipee utdys tusm hvae na nnrtoieivetn, by onniediitf. atenlsCoroc- eidtuss ear aseoiorbvtaln utdssei, not exeareptnl.mi Tihs qtesouin si chlilnaecyt e.rcocnrti yehT tawden ot kaem a tnpio atth o-casotrelcn usistde era teim nad tsoc ieftcfnie icesn yeht dn'to rrequei lfwlogion naitptse eovr miet or any resuecros bdisese gingwi/greveanthire raontnioimf. Case reisse duloc tno stet tsih ehpshty.ios

,oslA eht ndwoigr scatseai"do itw na daernceis sir"k otsmahwe esullda to trao-seonclc iedutss noyl gnvhia eth byltaii to infd sddo of an iaioctsaosns twenebe xroeepsu and ,omucote tub tno aseshtilb uaacls pisn.etohiral

bigjimbo  classic nbme +1  
poisonivy  totally agree, I dont understand why the right answer is Case control since that is not experimental +1  
howdywhat  am I subject to this kind of poor wording for the day of the exam? +  
ajss  I bieleve so +1  


submitted by haliburton(209),
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aminlfxbIi is a h-plFaTNa ir.oibinth morf medbpu FT-Nα sha eenb oratmesendtd to hvae a lacnert relo in the host onsrseep sagnait o,usulecrbsit icnnligdu alnrmuaog mtanorfoi dna eth neotnatinmc of dssaiee 5(11.,)4 ta,loyNb dsitboanie igasnta TNα-F dncueid aarinvtieotc fo rutisscoeblu

bigjimbo  TB can spread to psoas L1-2 often, which then goes to the actual L1-L2 vertebrae itself (Potts or osteomyelitis) +4  
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 +1  


submitted by m-ice(326),
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heT tanitpe nedes liadmce otaenintt aitiemdeym,l hwich lasineeimt oinbigtna a ortuc rer,od ro rgansfirrnte rh.e A nsure dsoe ont evah the seam angrniti nad snoclaitauiiqf sa a icpahys,in os it douwl eb itenpiaaporpr ot kas hmte to mxaiene eht eptiatn. sigAkn the itosphal naipaclh again dcolu be ,aearpptinipro adn dowlu ekta omer mie.t fhoerTr,ee teh best iotpno gmnao sohet envgi is ot ksa het aienptt fi hse wlil wolal hitw erh uhanbsd e.nspetr

sympathetikey  Garbage question. +56  
masonkingcobra  So two men is better than one apparently +28  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
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? +12  
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 +9  
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. +15  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +25  
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. +  
niboonsh  This question is a3othobillah +5  
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 +5  
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. +11  
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. +10  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
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." +1  


submitted by medstruggle(12),
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yhW is it not nivoraa elciolfl ?sllec I tguhhot teh aefmel ngoala of Srtolie nda gieLyd si o/gaaruatehnslc e.llsc

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +7  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +37  
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 +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
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. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
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? +4  
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 +  
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" +2  
youssefa  Hahahahaha ya'll just bored +9  
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 +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
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 +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
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? +  
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!" +17  
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! +1  
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 +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
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}}" +1  
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. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
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" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
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 +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
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 +  


submitted by colonelred_(99),
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sHe’ sgernniept ithw cciassl ginss fo miatinv 3B ynicfceedi (ic;)iann ninaci is rediqrue ot frmo the ocrtoafc +NDA aiidonct(mien nieande letn)dodc.iuei

bigjimbo  B3 Niacin deficiency = Pellegra = diarrhea, dermatitis, dementia death. = Niacin combines with adenine to become NAD+ https://www.aocd.org/page/Pellagra +9  
cbreland  Noted lack of niacin, not making NAD. Did not think about what NAD stands for, instead went down a rabbit hole +8  


submitted by medstruggle(12),
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hWy is ti sopuahth resluc fi rheet rae on IG y?sposmtm yWh at’nc ti be eshrep sre?zot

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. +27  
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. +8  
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. +1  
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. +