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Welcome to dbg’s page.
Contributor score: 114


Comments ...

 +7  (nbme21#3)
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AIPONCER s.v EECIRCN

rYuo insk ahs otw sypte of aetws nal:sdg eiecncr nad in.pcaore cEiencr snlagd rcocu eorv msot fo ruoy boyd adn peon cyetridl tnoo eth csfurae fo yuro ksni. iernoAcp lsgadn enop oitn teh hria li,flloce ginaled to eht cfaruse of eht inks. noicrpAe lsgdna veopled ni seara nndabaut in hiar soflclle,i schu as no uory ap,csl arptmsi and .ognri

feR: eeomep.pstsaiyw0oag92l-s-wrndttar/i0t0ao/gsahwlts0/iirisyw//cd8/:cil-omoimnhgsdh/.cnuei7inmidsesd


 +5  (nbme20#3)
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,omI hsit wrasen hoecci si ngowr, ether is on eplbmor in eth sprsoce of aollgnec syhnesti""s rep es. eTh isues is ithw vssieeecx syntihsse nda griendozidas .nodesptioi tNo na bnoa'raml tstheciyn 'ospcrse - sa ldouw eb ni ESD, ,MF Mskne,e c.et

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +1
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 +

 +9  (nbme20#49)
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sBB owkr by cdsagrniee cPAM adn 2C+a ryehebt nowslgi ANS a&p;m NVA iit.ctvay hTis snrpoolg eahps 4 of n.ziaaeoitrodlp e,reefroTh yhte rae nnowk ot icseeanr hte arnoitud of stodiela pmtnlydeoran)(i iscugna thbo a eirs ni rteah cyrroona rupenfsoi dna crnieuotd ni taerh r.tea


 +4  (nbme24#40)
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Ddi noenay esle orewnd HTAW RL"MPNUAYO O"STMMSPY si eth ositquen rifgnerer ??ot reheT is ltrilaeyl otn a isglne ymsmopt deiemtnon in teh wohle ietevt.ng No crkc"lsae aerdh vroe hobt ngul "ifsled ear ton syopm.mts yhTe era sgisn nudfo yb hte hisypnia.c

rsuySoile tgduiobn eth lheow EBMN adbor ttse irsrwte itrhg w.no oD they qldyueeata ivrsee ehitr k?wro Tish si nto eth rtsif iclenahtc aesmitk I aleerzi on het new orfm.s

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. +1
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +1
ergogenic22  i take that back i understand what you're saying +3
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1

 +7  (nbme24#23)
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FWT is sekaswn"e of rtaplna idi"lofrxseno ????? i'st kiel gisyan ixnen"oset h"nxiTsfeoli si ton het loyn bvuosio ehciltanc asmtkei ni the enw sNMEB ...

karthvee  loool +2
yex  Funny Board!! Yeahhhhh +

 +10  (nbme24#40)
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mA I teh lnoy neo owh ut,gtohh ym eholw fi,el atht it yulatcal eisgrontia fmor teh yohditr tbu sjut apilcsyhyl noceecndt to het utgone

nbmehelp  same +11
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 +




Subcomments ...

submitted by neonem(503),
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I thikn itmtaaesss saw het steb otipno eher sceabue hrete aer uelplmit nimtlanga mespno.ls.a. iarmypr acnsrce dten to trsta sa a eilgns mass ni the seutsi fo rion.ig In eth ulgn, etassamset ear eorm ocmonm tanh rmriapy aom.nselps

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 +5  
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 +3  
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. +  


submitted by neonem(503),
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I tnikh aesisasttm was het tbes otnopi heer esebuac rteeh ear itlmlpue tamngnail apslo.msne.. prraimy ascnrce dent to trsta sa a lisnge amss ni eth issute fo ring.io nI eht ng,ul measatsset ear eorm ocmmno tnah ypamrri smlao.pnes

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 +5  
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 +3  
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. +  


submitted by lnsetick(84),
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  • ncriAoeP = ryuo tsmpiar mlels iekl an EAP
  • eeRnUMc = eeshrt’ no OOMR ni uryo saer iecns ryeht’e lluf fo wax
  • CnCR-eEY = hwne you s,eCeErci yrou pesro rea iRCYgn
  • usSeEBaco = BESum is EnPEgSi otu of yoru esrpo
hungrybox  as an ape i'm offended +18  
dr.xx  stop being an ape. evolutionize! +6  
dbg  as a creationist i'm offended +9  
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. +1  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +  


submitted by neonem(503),
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nuosdS ilke a sace of nFraueim-Li erodmnys - ncies 35p si a umtor urreosspsp rfo a cunbh of ellc etsyp, atmtonusi ni this eeng (as in LFS) setlur ni a miyadr fo imfaiall mrout sy.ept

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 +9  
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. +14  
dbg  ^ this guy cracked the code. nbme ur doomed. +4  
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 +7  
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 leveibe this is aanplC oenrSdmy rionohg(cnbec ccianmora + omtuhridea h)tir.aitrs nlOy lwfa ot htat is htat eht unlmroypa nfindsig tdno' ylrptceef penrestre .osopsoeinecmnu

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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eryynglaSmoii loynlmar epretsns hitw lreal-btia sslo of ipeat/mpn ni a peac ekli oritisunbidt deu to amgaed of hte nroietra ewtih uieomcrssm fo the icainSp-oamThl .rcTta

Tsih person laos hsa tgiawns of the smlla smulces of reh a,hnd ihhwc is edu to nSrxiy nsoipexan giasucn adeagm ot sMNL of het itoeranr hron m(rof SNC Pa)atmoh

dbg  you're talented, bball and now this +10  


submitted by youssefa(101),
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rFmo dFia 0291 ewn fr:egui GF1I- amylin unicsftno sa na aacnliob ronoemh on leuscsm dna bnsoe yrt(ept chmu eilk siligtnnu-&; deraceses rmuse ucels)o.g GH acst lyeaaetprs yb igopmtonr nsliuin sasrnetice sinngrei(ac ursme l)eg.usoc ereTr,ofhe 1FGI- is not eht na.swre If HG saw nmoga the wasrsne it wulod avhe otg rlalye fnu.cgions

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(990),
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ithW chnoirc igoimvnt, uoy sloe elloycestter and a tol fo idc.a It reitgrsg imctlaboe ialsolaks hiwch si wyh lal het esmru uavsle rea olw or( no eht wleor ned fo teh anrmol n)rgae xeeptc for ntbraiaoe.bc

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 +3  
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 +  


submitted by strugglebus(154),
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Mtso fo hte tsp vlsaue ewer aom.nlr iikngnrD 'wsant gto,uureoas LDL was dil,m MBI ash fe.ni eH idd have TNH o.uhgth hTe gigbtes iksr arcstfo rae het tafc thta eh adh udfsfere na MI dna taetdrs snfufrgei vreees oeirsspedn het(gwi otxs./)ieaysln hT,su eh si more ta riks rfo dscuie.i

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... +12  
dbg  bc they're SOBs and DOBs +9  
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +  
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(140),
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issylnAa of teh nleatsi in the usoeintq hsdweo a redecased umnebr fo sesnmeodi rss-k.nocsli imeensoDs si deam up of rofu leyins is.eresdu rTreehofe nambraol satienl si klliye inimssg snlyei eecasysrn fro eht ooimnatfr of teseh dsenimoes icnk.o-sssrl pikediWia ilactre on Demsenois.

dbg  how can i trust you, you aint even a doctor +18  
euchromatin69  trust this then U.W 1249 +3  
tryntofigritout  UW 1249 was perfect. #loveyourname euchromatin ha +  


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pKa si pH at hwchi yna dgru is at ist 50% zidnieo eatst.

Nwo ew era lak iuner i.e icn .pH wnhe pKp;Hgt&a ti iwll ahve tow idff thpa for dcicai durg m;&pa cabis .dugr

cAiicd gurd lliw cin ist naemliiiotn ic(n doziine m),rof abisc rgdu illw be erom asrsob edbo. ew need to onwk hte urdg si cbsai c.iiac/d

woN fi u alk enuir sti neaimitoiln ic.n os ti evah to be ic.adci ro u nca onkw tsi a isdo tasl of rdug hwit NSC oretpyrp i.e omst klie enariPboalthb kWae( ad)ci

so fi Kpa fo gdru is 6-t--a Hp 7 we liwl ttsar mteilnaigin

btu if paK is 0 ew dnee to rasie Hp fo eiurn at 11 to start .nliaieinmagtt atht tionp vper rugd )a=K(6p oldwu be oltyatl otu fo ysmse.t

shtat ywh A si eht ightr sna (aKp = )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(77),
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oTlsraog"lhys tcdu scyts stom ntoef nerepts tiwh a lepaaplb aosatmcpyimt edminli cnek assm uasulyl eolbw 5[6% of the etim] het elelv fo het iohyd n"b.eo

heT" gsayorolstlh tatrc searsi morf hte onraemf cumec ta the nojticnu fo the taeorrni itt-wdhrso nda otposreir dr-ehonit fo teh e.otung"

yla.:g/woihwTeksttk/cylsodapeht_/i./sspnirgiroi

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(348),
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Arndgneo tIinntisviesy orSmdyne - tfDcee in dnagorne epcorert nlugeirst ni m-aranpngpeairol flmeea (46YX, S)DD. ociiFnnngtu estset caesus nriaceesd osertoteesnt ta ,retypub hiwhc is ntedrcove to ntgseroe iplhrpe,lraye vnggii eeamlf encsyorad asluex sracacitetscrhi (feelam rneextal ae.gi)ltnia Lack fo eandrong crotepre unitfnoc elsad ot snaebt or acsnt xaiyrall nad cuibp raih. nPaitest aevh autrrmniyde iagna,v ubt srteuu and lnipaflao etbus e.abstn

rngoneAd stiintneiyivs yodsrmen is hte rewasn but uoy hgtmi hvae siercdoden lüalriMne sniseaeg oaenys(ikkty-rRaM- resKsueHartü- eodrn).smy

nerluaMil aeeissgn lilw haev ornlma oermnoh elvsle dna yam nrptees as 1° eaehmanror (deu ot a kcla fo uetienr eoetv)dnpelm in lfeaesm with llfuy eepedlodv °2 lausex cecsasiachitrrt cniflounta( a)ie.rosv arHi vlpetoendem si naorlm sa lewl. ntiPetsa saol have laromn g.ehhti

semSe keil hist eoiqutns ddi nto egvi su umch to iuindtgsshi ssebied tghhie dna rantne tgeas 1 xbiyciurlalap/ ari.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. +