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Welcome to dbg’s page.
Contributor score: 152


Comments ...

 +9  (nbme21#3)
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NPORCEIA vs. CENREIC

uorY insk hsa tow styep fo wtsea ag:lnsd cecnire adn poa.crine necciEr sgldna crocu ervo otms fo yuro oybd adn epno ertdcily onto eth ersucaf of uroy nsi.k ipArenco ndgsla nope tnoi the hria ,fecllilo gndalei ot eth fsacreu of the .nksi rencoApi dnslag vdpeloe in easra tuaabdnn in riha ilflc,oels ucsh as no uyor lcs,ap psamtri and o.grin

e:fR /sswtm8eh0gemnieu-ap/eadcnmtilg0o-o:cd0-ewp/ail.whwyl0iin/sdsnrtiimtsigyo7srs9scd/2rsotao./ai/ihd


 +7  (nbme20#3)
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I,om htsi wsrena ecohci is wrnog, reeth is no plemobr ni teh erssopc fo noalecgl "tyensshis" rpe s.e The uesis is iwth viseeesxc neyhssits nad rsdnziaodeig odp.esintio tNo na mla'obarn tsteinhyc esrscop' - sa dluwo be in E,SD MF, sMeken, .cet

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +3
rockodude  dont overthink people, whether its an underproduction or overproduction of collagen, overproduction is still abnormal collagen synthesis. its abnormal to make an excessive amount of collagen 3 leading to a keloid +2

 +10  (nbme20#49)
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sBB owrk yb geniedracs cPAM adn +aC2 tybrehe olswnig SNA p;&am NAV tctyia.iv iTsh lronopsg pesah 4 of iaaotnzdo.rpeli Terrefohe, ehyt are owknn ot niaceser het aouditrn fo oadtiesl ()oadnrltmepyin iascung boht a eris ni ahtre cyanoror ofipnsreu dna rocituedn in traeh r.eta

lovebug  FA 2019, 318page. class two antiarrhythmics. +

 +5  (nbme24#40)
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diD aoyenn lsee nrdeow WTAH NLRAOY"MPU SPYMOST"M si eht soentiqu rgreeinfr t?o? eheTr si rlytllaie ton a enlgsi ypmstmo odmnetein ni het wheol eti.egnvt oN acr"ekslc herad oerv hobt lung s"ldief are otn mspsymot. yTeh aer nsgis dofnu by het siypaci.hn

eslySroui dtuigbno het leohw MENB borda ttes rrstwie rthig o.wn oD yhte tladeayeuq veeirs rtihe owk?r sTih si ont eht frsti hntecilac mekitsa I eezailr no het wne s.fomr

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +2
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +2
ergogenic22  i take that back i understand what you're saying +5
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1
an_improved_me  I get where you anger is coming from.. They expect the students to pick up the most minor details as they may be relevant to an extremely vague and tedius questions and answers, but don't hold themselves to the same standard. +

 +7  (nbme24#23)
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TFW si esksewan" of antlpra florxdsiion"e ????? t'si iekl ngasiy ox"instnee if"xshTli neo si otn eth ynlo obisuvo tnlceaihc kmseita in teh ewn BNMsE ...

karthvee  loool +2
yex  Funny Board!! Yeahhhhh +

 +15  (nbme24#40)
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Am I het oyln neo woh otuthhg, my elwho i,efl atth ti ylcutlaa ianrogesti omfr eth rhoitdy tbu tjsu ashyipyllc ecnendoct ot eht nouegt

nbmehelp  same +14
medguru2295  me! I went with submandibular gland bc I thought there was a gland under there. +
alexxxx30  nope...i definitely thought the same thing...when I clicked thyroid I was like wow that was an easy question. HA +1




Subcomments ...

submitted by neonem(572),
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I hintk asmasteits wsa eth tesb nooitp rhee scueeab hreet rea uelilmtp igamtanln .e.npolssa.m yrairmp cecsarn tdne ot ttras as a snleig msas in eth etsusi fo io.rngi In het lgun, esaemtstsa ear eomr omcnmo than praiyrm selapsno.m

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 neonem(572),
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I inkth taassietsm asw eth best oonitp here ubceaes reeth ear lmiptule lantmanig amso.sp.n.le rmraiyp ceacnrs ntde to rtast as a nsglei assm in teh suetsi of irgion. In hte g,nul seaestmtas aer rmeo omonmc naht rpymari onssaepm.l

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 lnsetick(94),
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  • rceinAPo = oruy srimtpa lslme ielk na APE
  • MeeURnc = hestre’ no ROMO in uory saer cenis er’htye lluf fo awx
  • eCEYnCR- = nwhe ouy ,eiCErcse ruyo eorsp are RCniYg
  • EoeaScBsu = uBEmS is niSEgPE out of oyur opers
hungrybox  as an ape i'm offended +31  
dr.xx  stop being an ape. evolutionize! +7  
dbg  as a creationist i'm offended +11  
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +  
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +2  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +1  


submitted by neonem(572),
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sodSun ilke a asec of mF-eiiranLu rosedynm - cesin 53p is a murto rusperopss for a cbhnu of cell ptse,y mnsitatou in ihst egen (as in FS)L tuserl ni a rydmia of lfmaalii murto t.peys

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +11  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +15  
dbg  ^ this guy cracked the code. nbme ur doomed. +7  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +3  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +9  
jakeperalta  @privatejoker: according to UW, Li Fraumeni includes SABBB(sarcoma/adrenocortical/breast/brain/blood(leukemia)) +2  
ac3  side note: RB1 = retinoblastoma with an increased risk of osteosarcoma +  
lukin4answer  TP53 associated with SBLA + Brain tumor + Anaplastic Thyroid ca + Transitional cell ca. -UW +  


submitted by hpsauce(-2),
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I vleebei sthi si Calpna odSnyemr chorgn(bnecoi mroaicnac + uihredmtao t)ri.ithras lnOy lawf to atth is that hte murnypaol ingdsifn dtn'o prtyeelfc ersrteepn snce.posomeuoni

dbg  it's just bronchogenic ca, type of adenoca, which is classically associated with 'hypertrophic osteoarthropathy' +  
woodenspooninmymouth  To get it for the test, remember that lung adenocarcinoma is associated with clubbing. Mechanistically, this woman probably had RA. Then she was exposed to asbestos. The asbestos in the context of RA lead to caplan syndrome. The asbestos also triggered her bronchogenic carcinoma. +  
step1soon  Then why isnt Rheumatoid Arthritis right? what comes first? bronchogenic carcinoma or rheumatoid arthritis? +  


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ynilmySeogria lomlayrn tseerspn twhi r-ablaelit ossl fo mn/ppeait ni a peca ekil iinduirbostt deu to amaedg of eth rotaneir tewhi esimscroum fo hte lcionamTpiSha- atTrc.

Tshi enspro saol hsa wgtnsia of het slmal sluescm of erh dh,an wihch si eud ot nxySir oesaxipnn nigscau mgeaad to NsML of hte nraetiro ohrn of(mr CSN )Phmaota

dbg  you're talented, bball and now this +13  


submitted by youssefa(133),
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omrF daFi 9102 new fireg:u FG-1I lminya nnstifcou sa na aniocbal ehnromo no euscmsl nad sbeon trypte( cuhm liek usil;igt&n-n saseceedr erums l)geo.csu GH csat realeptasy by gnropimot sniluni nacsetesri (aegninrcis mruse ce)lo.gsu eero,heTfr 1IG-F is otn hte aw.rnse If GH swa maogn eht srawsne ti luowd haev got leraly nfisn.ucog

charcot_bouchard  Can anyone take a little time to curse on that daughter? +5  
dbg  Sure, charcot. Just wished on her to get a couple of charcots (the triad, your aneuryms, marie tooth, etc). +1  
noorahsaahir  Charcot_bouchard and dbg best comments .... 🤣🤣🤣🤣🤣 +  


submitted by hayayah(1081),
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iWth nocchri nitvo,img ouy elso tcreoytleels adn a otl of aic.d tI itegrgrs mcitableo allakisos which si hwy lla teh mrseu uvelsa era wol (or no teh owrle dne fo het onrlma grnea) pcexte ofr crob.tbneaai

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +4  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +1  


submitted by strugglebus(165),
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tosM of teh pts auvels rewe nro.aml riknniDg twn'as g,oaesuotru LDL saw idlm, IBM ash fie.n He ddi hvae TNH htuhg.o hTe tisgbeg krsi fasorct ear the acft tath eh hda fresedfu na IM nda dtstera gefsunfir reeves rnoeespdis (itwghe noit/leay)xss. hus,T eh is emor ta ikrs for u.cediis

sohaib111  Won't having an MI be a very big risk factor for another one ? And also if they wanted this answer (the anti-depressant), why would they just add that his LDL is inreasing in the last sentence... +14  
dbg  bc they're SOBs and DOBs +22  
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +1  
asingh  It is because of the timeframe of mortality is 2 yrs, everything else will affect later +5  
benny  mdd increase MI +  
benny  Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI). +  
drzed  None of the cardiovascular options would improve mortality (statins, ACEi, BB, spironolactone are the ones that have proven mortality benefit). So if they had put one of those, I think I would have chosen that, but given that the rest don't change mortality at all, I went with the antidepressants. +2  
ihatetesting  My thinking was that since he had an MI, a beta blocker would improve mortality, and propranolol is also used as an anxiolytic. +2  


submitted by notadoctor(159),
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islaAysn of teh saintel ni eth oequnsit wsedoh a eeardcdes nebumr fo desenoims sl.koinc-ssr eeDsnoims is mead pu of rofu ylsien usr.desei efrTeeohr nmaalrob inaetsl is ikyell gsiisnm liensy eceasynrs orf teh mftoaorni of sehte semesndoi oilcsskr-n.s kdWiapiie tcliera no eDmsoenis.

dbg  how can i trust you, you aint even a doctor +22  
euchromatin69  trust this then U.W 1249 +3  
tryntofigritout  UW 1249 was perfect. #loveyourname euchromatin ha +  


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pKa si Hp ta hcwhi any gudr si ta sti 0%5 ozndiie etsat.

woN ew aer kla uneri e.i nic p.H nweh ptpaHgK;& it illw ehav wot iffd apht orf ccidia rgdu ;p&ma abisc u.grd

iccidA udrg lliw inc tis eitlnmnoiai (nic iznedio mfo)r, isabc dgru lilw eb ermo s bs.daroebo ew need to wkon het dugr si absic ad/i.cci

woN fi u lka uirne tis iletinmiona i.cn so ti hvae ot eb d.icaci or u anc wkon ist a diso slat of udgr whit CSN retyppor .ie somt ekil naitePlrbaobh W(kea d)cia

os fi paK fo rdug is -a-6-t Hp 7 ew lwli rttsa lteimngniai

tbu fi pKa is 0 we nede to eiasr Hp of uneri at 11 ot tsrat ematnn.aiiitlg atth pntoi pvre grud =K)a(6p duwlo eb tytolal tou of yes.stm

tstha why A is the hrtgi san ap(K = 6)

charcot_bouchard  Correction : Not 0. i means if pKa is 10 +2  
charcot_bouchard  2nd update : cont to learn school grade chem. if pKa > 7 it is base. and if pKa is < 7 it is acid. Since we established the drug have to be a weak acid pKa cant be more than 7. +  
dbg  thanks, but Pka and PH are not at all the same thing +1  


submitted by famylife(94),
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oagols"rlhsTy tcdu ycsts somt ofnet snrtepe thwi a leblaapp topsytacamim mneiidl cekn ssma llyuusa ewbol 65%[ fo eht it]me eth eelvl of eth ihody b.eo"n

"The arhgtylssool ractt siesar omrf teh fmornae mceuc ta eht nctoijnu fo eth areronti -howitsdtr and irretsoop ritdohen- fo het ot.un"eg

./:/oti/tkshc_hkor.liesgTgsaliyaodswprwtepi/iny

dbg  Am I the only one who thought, my whole life, that it actually originates from the thyroid but just physically connected to the tongue +15  


submitted by lsmarshall(417),
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Arnednog tssiviinIenty dSermony - fecetD in aneorgdn eoterrcp uegrtnils ni oa-irpraapnlmeng fmlaee X,(64Y ).DSD tcinogniFun eetsst ssueac esedncria osnreseettot at brpyut,e hihwc si neetdrocv ot geonsret epa,hpiylrrle ignivg laeemf eronycsda lasexu cseacsiairttcrh ea(mfle nlxarete lgni.)aitae Lkac fo rnagnoed eoeprtrc ftuoncni dasel ot enastb or ctsan alxlryai nda pibcu ihra. Ptsniaet eavh enaimrturyd agnvi,a utb seurtu nad lniplfoaa subte b.asent

edgnAnro yiiinittsenvs onsedmry is hte nrsewa utb ouy gitmh ahve recodidsen nieüarMll saesnegi oiaRnay(rtyM--kkse easeK-Htsrruü syr)mnd.eo

lruleniaM insseaeg will vaeh omrnla romhoen elslve nad may nrstepe as 1° aeraormehn de(u to a alkc fo eunerit netmdpelvo)e in emfeasl twhi uyllf leeveddop °2 leasxu icharsetritacsc iannfoul(tc vsraoi.)e Hrai ovemndeltpe si almnro as l.lwe tianesPt laso eahv mnrola theg.ih

Semes elki ihts ieqnusto ddi tno vegi us cuhm ot sniugsidith dseseib ehitgh nad nnaret taegs 1 lirau/pcablyix ira.h

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +  
makingstrides  Mullerian agenesis: absent vagina, uterus/cervix because no mullerian system. Yet, still has secondary characteristics ie: breast, pubic hair, normal hormone levels (normal ovaries). Also check to break down the different subtypes of DSD: CAIS, 5alpha reductase deficiency, and swyer syndrome all for XY DSD. Where as for XX DSD, overproduction of gestational androgenism and placental aromatase deficiency. Bc in CAIS the testosterone receptor is dysfunctional, no external / internal male organs are going to form in an XY fetus, but you will have an extra production testosterone (like explained above) leading to increased estrogen (breast growth), but since no ovaries, you dont have the mullerian system. You are left with a vagina with a blind pouch (from lack of functioning receptors) +  
makingstrides  Also to add, there are testes that produce the MIH, so you have degeneration of the mullerian system. From B&B +