NBME Answers : brbwhat's page

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submitted by step420(32), visit this page

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Other kidney Hypertrophies due to increased stress --> not hyperplasia bc not cancerous

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masonkingcobra Above answer is incorrect because hyperplasia can be either physiological or pathological. Prolonged hyperplasia can set the seed for cancerous growth however. Robbins: Stated another way, in pure hypertrophy there are no new cells, just bigger cells containing increased amounts of structural proteins and organelles. Hyperplasia is an adaptive response in cells capable of replication, whereas hypertrophy occurs when cells have a limited capacity to divide. Hypertrophy and hyperplasia also can occur together, and obviously both result in an enlarged (hypertrophic) organ. +51

johnthurtjr FTR Pathoma Ch 1 Dr. Sattar mentions hyperplasia is generally the pathway to cancer, with some exceptions like the prostate and BPH. +4

sympathetikey Tubular hypertrophy is the natural compensation post renal transplant. Just one of those things you have to know, unfortunately. +2

charcot_bouchard Isnt Kidney a labile a tissue & thus should undergo both. This ques is dipshit +

brbwhat Dr Sattar says, kidney is a stable tissue, at least pct is as seen in ATN. But I read, basically kidneys are mostly formed whatever number of nephrons have to be formed by birth, after that they can only undergo hyperplasia aka increase in size/or regenerate if need be in case of atn. We cant have more number of nephrons. +3

mambaforstep @brbwhat , do you mean kidneys can only undergo hyperTROPHY? +4

j44n .... you're not making more cells..... so it cant be hyperplasia +

submitted by mcl(671), visit this page

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To expand on this, contraction of flexor digitorum profundus muscle results in flexion at the DIPs and PIPs. The tendon attaches at the tip of the finger, in contrast to flexor digitorum superficialis (attaches at the PIPs). Recall innervation of the forearm muscles is mostly from the median nerve, except for 1.5 muscles (ulnar half of flexor digitorum profundus and the flexor carpi ulnaris, both supplied by ulnar which makes it ez to remember yay).

But also if you got this wrong like me go read that link because it's a really nice review.

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samsam3711 Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +4

brbwhat FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +

brbwhat Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +

submitted by mcl(671), visit this page

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But also if you got this wrong like me go read that link because it's a really nice review.

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samsam3711 Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +4

brbwhat FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +

brbwhat Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +

submitted by susyars(41), visit this page

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Is it me or this question is worded weird?

“this cells are most likely to closely resemble which of the following types of normal respiratory tract cells“

Like, you dont have normally neuroendocrine cells in the lung

Maybe i miss understood this question, i knew exactly what they were talking about, but the way they set the last sentence really drives me LOCA

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brbwhat I SCRATCHED OUT NEUROENDOCRINE FOR THE SAME REASON! +3

brbwhat I SCRATCHED OUT NEUROENDOCRINE FOR THE SAME REASON! +

abhishek021196 They are talking about Kulchitsky cells = pulmonary neuroendocrine cells (PNEC). These are the cells from which NE tumors of the lung i.e. small cell ca arise from. +12

submitted by susyars(41), visit this page

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Is it me or this question is worded weird?

“this cells are most likely to closely resemble which of the following types of normal respiratory tract cells“

Like, you dont have normally neuroendocrine cells in the lung

Maybe i miss understood this question, i knew exactly what they were talking about, but the way they set the last sentence really drives me LOCA

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brbwhat I SCRATCHED OUT NEUROENDOCRINE FOR THE SAME REASON! +3

brbwhat I SCRATCHED OUT NEUROENDOCRINE FOR THE SAME REASON! +

abhishek021196 They are talking about Kulchitsky cells = pulmonary neuroendocrine cells (PNEC). These are the cells from which NE tumors of the lung i.e. small cell ca arise from. +12

submitted by hayayah(1212), visit this page

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Notice, the stem says "precorsors in the skin"

D3 (cholecalciferol) from exposure of skin (stratum basale) to sun, ingestion of fish, milk, plants.

D2 (ergocalciferol) from ingestion of plants, fungi, yeasts.

Both converted to 25-OH D3 (storage form) in liver and to the active form 1,25-(OH)2 D3 (calcitriol) in kidney.

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sympathetikey C is the 3rd letter in the alphabet. Hence, D3 = Cholecalciferol +6

karljeon Thanks for the explanation. The question stem made it sound like "what future step will be decreased?" Actual question: "Decreased production of which... is most LIKELY TO OCCUR in this patient?" Maybe NBME needs a grammar Nazi working for them. +11

bharatpillai question says "decreased production of which of the following precursors in skin is most likely to occur in this patient? the answer has to be 7-dehydrocholecalciferol! +7

bharatpillai 7 dehydrocholesterol +3

brbwhat Yeah i did the same, but then realised acc to uw flowchart 7dehydrochole.. is converted to cholecalciferol in presence of uv rays. So the decreased precursor would be cholecalciferol since we already have 7 dehydrocholecalciferol not being converted by uvrays Tho the uw chart sites both ergo and chole as dietary sources. +6

drzed Wouldn't 7-dehydrocholesterol build up in the skin? Since UV rays convert 7-dehydrocholesterol into cholecalciferol, if you are lacking the conversion, the reactant (7-dehydrocholesterol) should accumulate. +2

brbwhat They’re asking decreased production of which of the following precursor would occur? 7 dehydrocholestrol builds up, but decreased production of cholecalciferol takes place, which is a precursor in the pathway for vitamin d formation +10

submitted by krewfoo99(115), visit this page

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In boards and beyond, It is said that third degree heart block is due to block in the HIS Purkinjee system. So why would ablation of AV node cause this disease?

Wouldnt destruction of part of left ventricle be a better answer ?

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brbwhat Had the same doubt, Read the part again and found this. Type 2 Is caused when purkinje is hanging by a thread and therefore some impulses conducted, some not. Chb is caused by purkinje not conducting impulses from san, some lower pacemaker ie purkinje or his is depolarising by itself hence venrticles beat independently. There is BLOCK in purkinje for conduction from san. Among options the only thing that establishes this block is avn ablation. +

submitted by neonem(630), visit this page

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Cilostazol is a phosphodiesterase inhibitor; leads to increased cAMP which inhibits platelet degranulation/activation while also causing vasodilation. All of the other options work on either vasculature or platelets but not both.

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kernicterusthefrog Just to add: cAMP activates protein kinase A (PKA), which is the more direct mediator of platelet aggregation inhibition, and of myosin light-chain kinase inhibition (which causes inhibition of smooth muscle contraction and thus vasodilation). Just in case there's a question that gets more specific than this one! +14

brbwhat wasn’t dypirdamole an option? +

fataldose I believe they also cause vasodilation by decreasing the cellular reuptake of adenosine by endothelial cells and the adenosine causes vasodilation. +

submitted by hayayah(1212), visit this page

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Notice, the stem says "precorsors in the skin"

D3 (cholecalciferol) from exposure of skin (stratum basale) to sun, ingestion of fish, milk, plants.

D2 (ergocalciferol) from ingestion of plants, fungi, yeasts.

Both converted to 25-OH D3 (storage form) in liver and to the active form 1,25-(OH)2 D3 (calcitriol) in kidney.

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sympathetikey C is the 3rd letter in the alphabet. Hence, D3 = Cholecalciferol +6

bharatpillai question says "decreased production of which of the following precursors in skin is most likely to occur in this patient? the answer has to be 7-dehydrocholecalciferol! +7

bharatpillai 7 dehydrocholesterol +3

submitted by usmle11a(102), visit this page

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legionella : very common in advanced age, COPD, immunosuppressed patients and " going back from a residence hall" which probably had a contaminated AX system (basically fits every one in the Q)

adeno X : would present with conjunctivitis, throat pain ... flu virus: not everyone got the disease RSV: no children strep pneumo: would target a larger population of healthy people as well.

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bharatpillai why would they say that the only people who didnt get affected by the disease were people on steroids (lupus nephritis and severe asthma) couldnt have been rsv since it causes croup in children. strep pneumo would cause fever and other systemic signs. i went for adenovirus because uworld says most common causes of copd excacerbation are viral infections... +4

brbwhat I went for adeno forr the same reason. I guess the MAIN HINT is that this is not a copd exacerbation. Since people without prexesting copd also had pneumonia, also people with copd exacerbation will have different presenting symptoms, here it was told, that we are told that dx was penumonia. People with copd exacerbation wouldn’t be diagnosed with pneumonia if it was an adenovirus infections. +4

j44n adenovirus doesnt cause pneumonia its just makes the current COPD sx worse +1

j44n the SLE and asthmatic patient were both considered slightly immunosupressed or theyre just more likely to get something (SLE pt= your B cells are too busy making Ig's to kill your kidney, and the asthmatic is on corticosteroids that aopotose your t cells) but they're not COPD patients so the pneumonmia wont be as severe, all in all legionella causes really really bad pneumonia in COPD patients and less severe (pontiac fever) in those with mild immunosupression +5