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 +0  (nbme24#3)
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subclaviansteele  My take is that hes not super acidotic and the K is at the low end. +
nwinkelmann  see the comment by @zbird, which explains that the urine anion gap is important (which I took to interpret as more important than the serum K+ level, lol, because the normal K threw me off too). +

 +11  (nbme24#6)
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honey-crusted lesion  Great explanation! There's also a slide about this in the 100 Anatomy Concepts pdf but doesn't go into as much detail as this explanation. Thanks! +
djtallahassee  Good explanation but I think an AAA would be more likely superior mesenteric and hepatic. the SMA and IMA are more than 3 cm apart (L1 to L4ish), Triple A affecting both would be very large. I blew this question because I saw 3cm and jumped to AAA, didnt even see it was a sclerosis thing. Put the two closest arteries and moved on +

 +2  (nbme24#33)
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moxomonkey  ain't nobody got time for that +6

 +20  (nbme23#43)
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arcanumm  Here i was thinking i was being clever by not being tricked by distractors when metastasis is more common... +6
brise  Metastatic would have multiple lesions +

 +1  (nbme22#16)
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impostersyndromel1000  This was in pathoma, he said prostate cancer causes osteoblastic lesions and "the board examiners really want you to know that". also following the potential site of mets helps choose the answer +2
snripper  Also, osteosarcoma is less common in the elderly, more common in males <20 y/o (per F.A 2020) +2
homersimpson  Osteosarcoma causes lytic bone lesions @cocoxarus +

 +1  (nbme22#41)
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Subcomments ...

submitted by bubbles(70),
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Can snemooe ocdlu iaexpnl to em woh htis si ucqonlveyilua roebuust iserclsos etesdip 1N-F dna WgS-utrrbeee osla itpesnegnr with nkis le,sniso nmteidhygepop ,sceluma dan erize?ssu

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cocoxaurus  This question was tricky! Tuberous sclerosis= Hypopigmented= Ash leaf spot (The skin lesion in NF is Hyperpigmented- Cafe au lait and in Sturge Weber it's a port wine stain (also not hypopigmented). I'm assuming that the SINGLE raised flesh colored lesion is a Hamartoma (The angiofibromas in NF1 are typically multiple). Although both Tuberous Sclerosis and Sturge Weber are both associated with seizures, I used all the other stuff to narrow it down to the correct answer. Also, don't forget that there is Incomplete penetrance and variable expressivity in Tuberous Sclerosis. So I think the lack of family history of "seizure or major medical illness" was there to throw us off. +18  
bubbles  Thank you! :) I thought I really knew my congenital disorders, so I was a little annoyed when they trotted this question out +8  
pg32  @cocoxaurus I believe the single raised flesh-colored lesion is actually a Shagreen patch, which helps you arrive at TSC as the diagnosis. +1  

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Eveyreewhr I dounf UTp(oeatD and valrese esppr)a sdai hte gknsmoi si eht itbeggs krsi arfotc orf anptsnoeous raomx,eotpuhn iwth oybd basiuth nda rdnege bengi a lsseer sr.ik mA I ujst pyetmolcel auemirdngnntsids teh ienst?uqo

imresident2020  Yes smoking is a risk factor but not the best option among the choices given. Check FA, it says that it occurs more in tall thin young males. Smoking isn’t even mentioned. Tall & thin males are more at risk because they have more negative intrapleural pressure. Check Uworld for this. +  
drdoom  You have to think about this using the concept of CONDITIONAL PROBABILITY. Another way to ask this type of question is like this: “I show you a patient with spontaneous pneumothorax. Which other thing is most likely to be true about this patient?” Said a different way: Given a CONDITION [spontaneous pneumo], what other finding is most likely to be the case? Still other words: Given a pool of people with spontaneous pneumothorax, what other thing is most likely to be true about them? In other words, of all people who end up with spontaneous pneumo, the most common other thing about them is that they are MALE & THIN. If I gave you a bucket of spontaneous pneumo patients -- and you reached your hand in there and pulled one out -- what scenario would be more common: In your hand you have a smoker or in your hand you have a thin male? The latter. +  
cocoxaurus  Rupture of pulmonary blebs are a common cause of spontaneous pneumothorax in young adult males that are tall and thin. I know it's also associated with smoking, but gender and body habitus seemed like the more likely answer here since the patient is a young male. +1