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Welcome to bullshitusmle’s page.
Contributor score: 10


Comments ...

 +3  (nbme24#15)
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atcptieurhe inigizno (maotdmgianaira -Nsr;x,Dy-as yAr)a doulrabnset-d ea abeee-grkrF aiarcld fomntiroa





Subcomments ...

submitted by m-ice(326),
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Teh nteiatp tseast hatt she dsoe ton ntaw a onmolrah mrfo of hibtr .coontrl ,So hte oqsntiue si leylra nagiks chwih fo hte onhrnom-nalo onpisto is smto eeeiv.ffct hTe yktcir ratp e,her I thikn, si atht het inetsoqu emska oyu twna ot ont pikc DIU, scbeeua myan DsUI rae rolamohynl .adesb eoverHw, a oaonro-nlhmn UI,D ekil a opperc U,ID is lslti mroe eevetficf ahtn hte eotrh inopots t.lsdei

bullshitusmle  copper intrauterine devices are hormon free FA2017 page 622 +1  
medguru2295  they needed to specifiy. I eliminated IUD bc patient states no hormones. +1  
abhishek021196  The question doesnt make sense. IUDs are typically contraindicated in nullipara because of increased risk of expulsion and intractable abdominal pain, among other things such as perforation. The pt is 22, likely to be a nullipara. Why cant we prescribe a diaphragm instead which is a non hormonal method too, and remove the vaguity of hormonal vs non hormonal IUD? :/ +3  
123ojm  in practice many nullparious women have IUDs. I think this question was seeing whether you knew that some forms of IUDs are non-hormonal and that the other methods are far less effective, +  
covid  IUDs are definitely not contraindicated in nulliparous women. +5  


submitted by neonem(556),
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I knhti mstassatie asw eth steb optoin eher uecaebs rtehe are elutpilm agntlamin s.panlseo.m. ampriyr scarnec tnde ot ttasr as a esngli sasm ni eth stsuie fo .oinrgi In eht ulng, eatastssem aer oerm mocomn hnta yrmpria lampsnos.e

dbg  I seriously could not figure out whether those white opacities were actual lesions or reflections from the actual picture (flash light) ... mind went all the way maybe this is the shiny pleura so they're going after mesothelioma. smh +6  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +4  
bullshitusmle  guys something I learned from NBMEs is that if there is a clinical vignette dont even look at the images they give you ,they are all useless and time-consuming +1  
goaiable  The way i narrowed it down was that the patient had signs of weight loss since three months whereas her cough developed recently (3 weeks). If the cancer arose in the lung then I think the cough or other pulmonary symptoms should emerge earlier. +1  
almondbreeze  FA2019 pg 669 in the lung, metastasis (usually multiple lesions) are more common the primary neoplasms. most often from breast, colon, prostate, and bladder ca. +1  


submitted by keycompany(301),
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ihsT tniapet ash a eonmarupth.xo alHonvetliyerpnit si otn ohnuge ot eancmotpes ofr eth rloelav ecaseedr in gnul carfseu aea.r

_yeetmasterflex  Could the pneumothorax also cause less ventilation due to decreased lung surface, retaining more CO2 causing respiratory acidosis? That's how I got to the answer at least. +4  
duat98  I think pneumothorax would increase RR because you're probably hypoxic. Also I'm sure when you have a lung collapse on you you'd be scared and that would trigger your sympathetic so your RR will go up either way. +3  
kateinwonderland  Arterial blood gas studies may show respiratory alkalosis caused by a decrease in CO2 as a result of tachypnea but later hypoxemia, hypercapnia, and acidosis. The patient's SaO2 levels may decrease at first, but typically return to normal within 24 hours. (https://journals.lww.com/nursing/Fulltext/2002/11000/Understanding_pneumothorax.52.aspx) +1  
linwanrun1357  How about choice C, --ARDS? +2  
bullshitusmle  there is no bilateral lung opacities as you would see in ARDS +4  
jesusisking  Was thinking some sort of infection b/c of the atelectasis so picked empyema but this makes sense! +  
djeffs1  does it need to be ARDS to cause "diffuse alveolar damage"? +  


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idD eoynan slee og donw et:h se'hs evypoisetnh os mbyea lls'he gte saeowteurh edcirsirehfn rneysodm eubeasc tnongih lese is nkgmia enses to me at htsi ?oi?p?tn reuot -

Trsnu u,to eesrve iaaralm nca cueas dicuocsalaarvr lsocpeal dna nopyshniteo.

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +9  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1