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Welcome to cantaloupe5’s page.
Contributor score: 72


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 +19  (nbme21#25)
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Ss’he gkntiain 054 msOm epr ady so hse nedes ot rexcete 450 Omsm rep day to atinmnai .urieibuqlmi ouY ’ntca usjt cxrteee smsOm’ yb seeevlhmst -- yhte have to be svildesod in meso mntaou fo ewtra.

seL’t sya yuo ecreetx 540 Omms ihwt 500 mL fo atwer -- hatt nsmae uyro nyseikd rea ntrtnioccngae neiru t:o

450 sOmm ÷ 050 Lm = 009 LOmm/s

utB het mixumma hsti lyasd’ niedysk cna notaetecrnc urien ot is 045 mO,L/sm so she has ot tecexer eomr wtare ot get it ttha dlt.uie ahTt tnmaou of reawt is 1 ,L cebaesu 054 m/Os1m L = 405 m/Ls.Om

wNo etsh’re ninhgot spgionpt ehr rmfo rcnxiegte eth 504 smmOs in na enve mero dilteu unrei -- rof mxpelea fi she kndra na aerxt L of wreta neo ad,y eth sienkyd lcoud teg rid of ttha aexrt L twih the eams umonta fo 045 smmO by gidnluti hte uerin to 045 Osmm ÷ 2 L = 252 LsO/mm. utB the otiqeuns sksa rfo teh mimiumn noautm fo erwta -- ihwch si 1 L yb hte eskydni +( 1 L ormf het ohtre suftf ofr a totla fo 2 L.)


 +15  (nbme21#6)
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nceetRrur eydnik ossten osduhl clnedui prdiymtearhohripyas on uyro iienlfd,rtfae pucole that hitw mrotsniaag nda euy’ro lokigon ta NEM 1. Lioasmp rea laso osastiaecd iwht ENM .1

sympathetikey  Yeah, I probably should have went with that. Just got thrown off, since I know that usually the serum calcium levels for someone with Calcium kidney stones is normal. +
snoochi95  i understand the link to MEN 1, but why are we checking the calcium level? +
cmun777  I feel like it's important to get a baseline of where the calcium is at for two reasons: 1. if the patient does indeed have MEN 1 it would be good to know if she has high calcium levels and possible Parathyroid etiology 2. You're putting the patient on a PPI which are known to decrease calcium levels and increase risk of osteoporosis for both these possible factors/concerns it would be good to see where calcium is currently at +5
zevvyt  Couldn't a Pituatary tumor secrete ACTH, causing high cortisol? +2
lola915  Patient has symptoms of a gastrinoma (Zollinger-Ellison Syndrome)- patients present with diarrhea, epigastric pain, duodenal and jejunal ulcers. Associated with MEN1 syndrome. +

 -4  (nbme21#31)
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o/ryidpphrhtyoHsmeiy si esngoidad thwi HTS w/ efrexl to 4T ihst( ujts lstel the bla fi HST is arlomn ton’d hekcc 4T utb fi HTS is ma,boranl ecchk T4 )to.o STH twns’a an iopton os 4T is teh etsb a.snrew

hello  I don't get why this was downvoted... +2
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +

 +3  (nbme21#15)
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ceoscrsP of alenionimit ofr hsit o.en oTw uyo nac liimteena mialdeyietm just orfm kongilo ta teh ihealcmcibo whpatay cta.hr ehT ethro owt qereidur ogwkdlene htat anelieunm si more tcrvpeoite nath leihoneampn sh(it is yhw srhedead bnru moer i).aesly ceusaeB oamphnienel is lsse oerciep,ttv rthee dwluo eb remo nto lses OSR mrfo ntls.giuh

temmy  i don't understand this at all. i am completely blank...please help +3
henoch280  @temmy. This question tests our knowledge on albinism which is normally a tyrosinase deficiency disease but the vignette states that the boy's albinism is caused by a genetic mutation in the TYRP1 gene which is shown in the biochemical pathway. A gene that helps in the synthesis of Eumelanin. Now you have to understand that all precursors before that gene is the pathway would still be available if not increased which make 2 of the options in the question wrong. you also have to understand this: (Eu)melanin = (normo)melanin i.e normal melanin which is protective to the skin, decreases reactive oxygen species and gives the dark pigments to the iris, choroid, skin, hair e.t.c. while (feo)melanin = (fake)melanin i.e pheomelanin, the one present in our patient here which is less protective again the uv rays, cannot pigment and cannot decrease ROS generated in the skin. i hope this helps +26
eacv  @henoch280 thank u very much! I got it right by luck but now i do understand :D +

 +3  (nbme21#45)
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hsiT noe wsa tkyric tub I itkhn uyo lc’vueod done htis eon iwtutho oldwenkge of MDNA ertep.cosr emtS tlod uyo tath latmagtue saicevatt htbo -oMDNnAn nad MNAD cseoprtre but ti evdtcitaa lyno M-nDnANo pcteorres ni hte aleyr .sehap htaT anmse NDMA srtpreceo ecatvita rfate NnAMnoD- etcrs.oepr Ttah asnem htnsgioem asw ilgeandy DNMA rpeocetr avttgicina dan the onyl wesnra that eamd nesse sa eth gM iihginitbn DANM ta ntgires et.nitpola cneO eht cell si dpielredoza by AMDnNon- ro,tecrspe MAND etersrcop nac be taiae.tvcd

hungrybox  I forgot/didn't know this factoid and narrowed it to the correct answer and a wrong answer. Guess which one I chose? +11
yotsubato  >That means something was delaying NMDA receptor activating and the only answer that made sense as the Mg inhibiting NMDA at resting potential. What makes the fasting gating kinetics choice incorrect then? +5
imgdoc  NMDA receptors are both voltage gated and ligand gated channels. Glutamate and aspartate are endogenous ligands for this receptor. Binding of one of the ligands is required to open the channel thus it exhibits characteristics of a ligand channel. If Em (membrane potential) is more negative than -70 mV, binding of the ligand does NOT open the channel (Mg2+ block on the NMDA receptor). IF Em is less negative than -70 mV binding of the ligand opens the channel (even though no Mg2+ block at this Em, channel will not open without ligand binding. Out of the answer choices only NMDA receptors blocked by Mg2+ makes sense. Hope this helps. +6
divya  sweet explanation imgdoc +
lovebug  really~~~ sweet. thankyou :) +

 +12  (nbme21#11)
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toHsilgyo hdoews icegualovta secsnior pd(ervsere tucrreicetah fo mayodalirc bi)sefr iwth tineorhplu faoitnrtniil hhcwi tihedn ahtt teh MI was ihiwnt 42 rh.sou tMso eiyllk secua fo ahtde itwhni sfitr 24 hsuor of IM si hmtaiahry.r aaMldiocry peutrru oudlw aosl eb vbselii no gross earancpape of hte htare, hciwh htye deecrbdis in eth s.met

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +12
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +3
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +4
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +2
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +1

 +22  (nbme21#3)
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alapruCs daeocarclypshi ecniavsc rae ftneo tunagocejd to rnpsteoi to imrpevo enngiouym.iticm gnliFllae is eth ylno rewsan hcceoi 'ttash a pe.ionrt

mambaforstep  both MHC 1 and 2 are present antigens that are PROTEINS (FA 2019 pg 100). so in order to elicit a T cell response, you need a protein (CANT BE A POLYSACC). that is why vaccines for polysaccaride antigens are often conjugated to PROTEINs--> so that we can elicit a T-cell response (FA 2019 pg 127). +5
lovebug  Flagellum = Protein, (FA19, pg.124) +

 +2  (nbme21#45)
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roF thsi eno uoy jstu hda ot nwko hte yscsygoill awp.ahty tSme odlt uyo BG-3,2P is vel,taeed hiwhc is truseapm of aptevruy .ainkes

neonem  Right, and that glycolytic enzyme deficiencies lead to hemolytic anemias. +5
toxoplasmabartonella  I just thought the typical presentation of pyruvate kinase deficiency would be hemolytic anemia of the newborn. +3




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