NBME Answers : brasel's page

Comments ...

+3 (nbme19#0)

Overflow incontinence is present (bladder fills then leaks slightly), so either:

1.) something blocking outflow (e.g.; BPH)

2.) impaired contraction of bladder (e.g.; damaged nerves)

Only the pelvic nerve causes detrusor contraction, so it is the only possible answer. External sphincter, pudendal nerve, and skeletal muscle all does the same thing. Hypogastric nerve helps retain urine (relaxes detrusor) so it is clearly not damaged.

solidshake I agree answer is the parasympathetic Pelvic Splanchnic nerve, but don't forget there are 2 mechanisms that are affected when it's damaged: 1. Impaired involuntary contraction of bladder and also 2. Impaired involuntary relaxation of the internal urethral sphincter. Pelvic Splanchnic nerve facilitates both of those + voluntary somatic relaxation of external urethral sphincter via pudendal nerve allows you to pee +

+0 (nbme21#11)

Power = ability to detect a difference between groups (if one exists) P value (<0.05) = probability that results were due to random chance

80% power = 80% chance of the study being able to detect symptom changes, which in this case was 0.4 (AKA 80% chance of detecting a significant p value)

Subcomments ...

submitted by hungrybox(1026),

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linwanrun1357 If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +2

champagnesupernova3 If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1

brasel also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1

submitted by wasabilateral(41),

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jotajota94 True! also, glycine is 1/3 of collagen alfa chains, so it makes sense that substitution with alanine (which is much bigger) would lead to disruption in the alpha helix formation. +

thepacksurvives Glycine is small and bendy, which allows it to form the fibrils for the triple helix +

brasel Also in general (FA 2018 pg 50) OI is from problems forming the triple helix which is secondary structure. Fortunately, they gave us something to reason with in the question (Gly->Ala) +2

submitted by amarousis(22),

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so rfo tshi eno yuo ahve ot oklo ta eht lscaioitd oobdl eepsusrr adn ahtst' teh vualse eu'roy sdpeopus to rade. ont the benumsr ni eht ocunlms. Lkie ruopg sX' doem is 70 euecasb it ahs ttha lueva 23 isme.t gurpo 'ys mdeo si 80 eausceb it spapear 20 st.emi ofr emdin,a yuo dulow vaeh to teirw the cdsitaoil nrumeb 510-20 hwo vree nmay mites it reasapp and nthe nfdi eht lmdide. crtkiy iotqu.ens

sahusema Wow. I hate this. I only looked at the number of participants and completely ignored the Diastolic BP readings +5

ma_rad Everyone commented how to get the mode right. But there is an easier way to realize that the median in Y is higher without all the calculations. If you see, the last Diastolic BP in group X is 110 (as there are ZERO people with 120). While group Y has 8 people with 120 DBP. This automatically shifts the median to the higher side. I got this wrong though at first I didn't pay attention to the "0" number at group X for 120 DBP +9

brasel I think there's another easy way to find the median without writing out every value. There are 100 total people in each group, so that means the median (if the DBPs are written in ascending order, which they are) is the 50th person. Group X: 8 + 12 + 30 = 50, so median is 70 Group Y: 2 + 8 + 10 + 20 +10 = 50, so median is 90 +7

mangotango I did it the way @brasel explained. The way @ma_rad did it could give the incorrect answer in some cases (e.g. Group X had 0 ppl with 120 BP but a ton of ppl for 110 BP etc. + Group Y had 10 ppl with 120 BP but basically none with 110 BP etc.). In this question that way worked but it's not always guaranteed since median doesn't sway with outliers, but mean does. // FA 2019 pg. 261 +