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Welcome to dentist’s page.
Contributor score: 49


Comments ...

 +2  (nbme22#6)

So do you ignore the distraction about his mother and consider which of the organisms can lead to nodule formation on the vocal cord?

neovanilla  yep _(ツ)_/¯ +1

 +0  (nbme22#8)

Ataxia due to vitamin deficiency can only be caused by Thiamine or Vitamin E deficiency.


 +2  (nbme22#17)

Pott's Fracture: forced eversion of the foot➝ deltoid ligt avulses medial malleolus ➝ fibular fracture higher than tib fx


 +1  (nbme22#20)

the Fibularis Brevis is the only pure foot eversion muscle listed here. Everting his foot would exacerbate his injury and cause him more pain at the fracture

imo contraction of any of these muscles would be painful in this scenario


 +3  (nbme22#23)
  • enzyme deficiencys = AR

  • homozygous presence of CYP..."

QED: homozygous + AR = 25%


 +1  (nbme23#32)
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I koto teh ilitcspmis pco:rpaha I coshe het pposeoti of eatvhwer the dyienk yllasuu sdeo adn tenh kacl of eng TPH fceekabd


 +2  (nbme23#22)
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crtueiamh trh zd = lmatir eosisnts = nayluorpm edmae (albiltrea cklecsar) = payndes


 +8  (nbme23#47)
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ndufo ihts ersup ulufes kboo on oznmaa obtua uddirCai-hB cc(hke out het ckis revco)

llamastep1  Thank you for that +
focus  hahahahaha. DEAD. +
anjum  I endorse clicking that link +1
azibird  Hahahahahahaha, that's a must click. Someone please buy it and let me know. +
chediakhigashi  hahahaha +

 +0  (nbme24#1)
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yttrep odog amryums

drdoom  welcome, O great physician of the skull and oral cavity. we revere your intricate understandings of the face, jaw, maxilla and all their tiny and hidden foramina. teach us your ways. +6

 +0  (nbme24#16)
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olowlF eht cmCuila nad orwk r.dcasbaaC ↓kw names ↓ osahthPep oeiporntrs ni het TCP ih(hcw luslp Ca hiwt t)i

ti2vrDhyd5-o lmnora cb/ ist adultenre to .TPH


 +4  (nbme24#23)
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tudc rgohtuh eth ucbc. o(yu nac lefe it hitw uyor oget)un


 +0  (nbme24#44)
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To m:e thsi meesde orme iwtftgrd.asharor Yd'ou twna to oollwf up dan kcehc arsGitn evsell on a ptietan who puyileorsv ahd x4 m.aolrn

thotcandy  He could have 4x the normal because of current PPI use. the point was that you'd get him off, wait for it to normalize, then check again to see if it's due to neoplasm or PPIs +




Subcomments ...

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DAK is a aetts fo aeddsecer si;nnilu escni we nwko taht lsnniui aeuscs a tifsh fo K+ toin eht eclls owl lselev of nlnusii wlil petrnve tsih and letrsu ni mIalhey nkeripa. ondaditi, ude ot mlpcgeiyeryah nad high FCE mslaoiolty erwat will hfist otu of het celsl toin het EFC nda K+ stfsih tuo ihwt eth trewa icwhh liwl rhutfe neraceis hte lyhmikareape

dentist  I know Insulin cause shift K+ into cells due to closing of ATP-sensitive K channels (blocking K from leaving)? Does it increase K in the cells by another mechanism? +  
makinallkindzofgainz  @dentist - Insulin stimulates the Na+-K+-ATPase pump, this drives K+ into the cell (Source: Amboss) +  
castlblack  Another mechansim = acidosis causes hyperkalemia due to H+/K+ antiporters. H+ is high in blood so shifts into cells via this antiporter, which shifts K+ out. --potassium section of acid/base chapter in Costanzo physiology +  


submitted by mattnatomy(41),
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erSeve epretynhnsoi etnof desal ot sehirclapytp leroroseatisoscrli si(onnnko-i aenpreac.ap) slAo ese pltifrooierna of ostohm smlcue cse.ll

meningitis  and explains the flame hemorrhages (Goljan) caused by malignant HTN +5  
taediggity  FA 2020 pg. 537 +  
dentist  FA 2020 pg 301* +  
ally123  The flame hemmorhages are also a good buzz word for recognizing he has hypertensive retinopathy 2e chronic, uncontrolled HTN. Pt's with hypertensive retinopathy can also present with "cotton wool spots" and "macular star". Pics on FA 2019, p. 299 +2  
surfacegomd  Pathoma (2018) p. 69 +  


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luodw anneyo eb elba to yliacfr thaw the sehort ldouw b)eA? erAnllge dtdeeaim ctaossonnoicvir,t edlgnai ot icecmish tiuess yuir:nj Type I)B nBigdin fo antgein ot gIE on teh eucrfsa of msta ellcs adgnile ot msat ellc gauoie:atndrln peTy IC ) opodistine of tn-dteiboninagya eocpsmlex iinwht llpcaristopya n,leesuv lagdien to tvicaaoitn of eemmlnt:poc oNt eDsr u) ytiPassghoco of gtnnaie by ihrelsntuop, gadnlei to odnaitx dtameedi sseuit aedg:am ypTe II?I

sunny  i think C is type III +2  
sunny  i think C is type III +  
dentist  In Type III HS, First C happens then then D happens +  


submitted by bobson150(11),
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sI hte eryg seusppdo ot be a tersuu? If not hwy uowld stih tno be uonwd ehanlig teoeerfhr ntlaauigron ustsie?

asapdoc  If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld. +5  
dentist  granulation tissue is a part of the normal wound healing process, and happens within the first week. +  
castlblack  I agree I looked at that grey blob and thought foreign body --> granuloma +  


submitted by usmlehulk(4),

can someone please explain this question. i thought the patient is actually having cleft lip and palate, but why is the correct answer addressing only the cleft lip.

dentist  The question asks "the most likely cause of the facial finding involving the lip in this patient..." +5  
snripper  lmao. gottem +3  
ace9yak  cleft lip = 'processes' clef palate = 'shelves' +1  
mutteringly  Don't let a dentist tell you whats up :( +  


submitted by welpdedelp(216),
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It saw beac,iss icwhh is ttnsmeditra -nsrroeoeopp.n

welpdedelp  **person-person lol +5  
suckitnbme  NBME loves their scabies +14  
dentist  did you get scabies from "burrows" and "night itching" +  
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +  
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +  
zevvyt  to summarize leafhouse: Fomites +1  
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +  


submitted by alexb(45),
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sI eth part with casnon"tt syngdiut" ujst esodsppu ot upptors that ehs sha a sphcy rrsiodde ltaeerd ot nrspfic,eeitmo ihhwc is hyw e'ssh igong ot exeertms to lcnrtoo her teg?hwi

rrasha2  No, the constant studying is to trick you into thinking shes abusing amphetamines.Amphetamines decrease appetite so a lot of people abuse them for weight loss. That combined with increased concentration to study all day errrday.. #onehellofadrug +  
rrasha2  forgot to mention, another side effect of amphetamines would be increased BP due to the increased catecholamines..don't forget to keep an eye out for that +1  
dentist  would amphetamines influence electrolytes at all? +  


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aIneedrsc elseLv fo oiMldye lscle ( ohi,sroysctrEty teomahhr,mtbcoyi nda ca)rgoyliotssnu ulps zsiiDszen dna Hdcaeeah saieecnr het uicnossip rfo liPctyoeayhm .aerv

owL OPE ni PV ued ot itgaveNe edbfacek on POE eaeerls yb inkdy.e

dentist  This is where the timing of everything in the question trips me up. FA say PV mechanism is increase EPO (2019, p299) +  
paulkarr  Different types of Polycythemia have different effects on EPO levels. "Appropriate Absolute" and "Inappropriate Absolute" will both increase EPO levels (Inappropriate is caused by this EPO increase). Where as Polycythemia Vera has decreased EPO levels due to the negative feedback loop. FA2019 pg 425 hooks it up nicely. +5  


submitted by nwinkelmann(284),
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mrsMuru nad emvse:aunr 1ts tghotuh = owh sode it nceagh wthi .ldpoear llA sruumrm pecext C,HOM VP,M adn airalt mymxao vtyesrie is iytelrcd roaiplorotpn ot gecanh in lpodera ..i(e ecridaens =deespalwoorr umm,rru )c.t.e ceauseB of ,sith xDD acn eb wedaorrn odwn to HCMO, M,VP nda laairt mymxao igrht yawa csaebeu het mumurr sndrwoee htiw aesceredd podealr ..(ei atnnisdg )up hnwe lal but ctiexensop hiwt e.imporv

tirAla oymxam = MCC myraipr darccai ourmt due ot lprnfitooeiar of ovitcecnen stieus ;ememenychs a lecpnueutdda smsa ecdtcneno aiv lskta ot rimtau pmestu ahtt si pneedudss ni hte talair boodl lovuem dna msveo wthi the lvuome mmv.otnee

itoreanePtsn: adrti fo )1 mlarti vvela bcronsittuo i.e.( seaaml,i ossmytpm of dairacc arfe,iul pesnc,oy c,.)et )2 ompystsm of bmieosml ie(.. ilaafc nda itrgh ram peshimresia ni ip)nea,tt dan 3) ulntoscoaiittn tmsosmpy (.ei. r,feev itwhge ,lsso yomsmspt gesinebmrl cvoectinen utsesi edss,aie eubscea outmr rseelsae -I.L6) Oetshr dluince ougeolcinr pmmyss,ot edlsutomr-ia"p avlve saeesdi" atratyuolsuc nifdgisn e(.i. citaidslo ,)rruumm nda atrlia elreatngmne hwc(ih codlu epsroscm dlnugeiynr urustrtces dan eacsu tmysomsp s)la.o

toN nloy dseo ngtsidna ecradsee r,lodaep iwhhc masen AL muolev si ewlro so ssma is'tn sa seenp"sddu" ubt omer o,elimb natgdnsi also seasciern the awodrndw irvatagniot foec,r hwihc owudl uonbtetric ot het utrom oimgnv tadowsr eth base fo het liaatr bcah,erm nppplo"g"i no eth mtrial evavl feeasll,t dna latytloenpi innxeegdt hrutgho nad gcusain a nolfuictan yept fo rmalti tniosses .(i.e wrogenins icoastdli uumr.)rm Tihs diove isxelanp ti rlelay wll:e gp6hb=c;4/tpo1t/no:tww&Yy?wwLu1hmlVIvats/=.ss.t6aicmue

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2  
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +4  
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +3  
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +  


submitted by mousie(210),
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lehp tiwh iths neo p.ea.e..sl s i thsi euabsce he ahs yTephGr ADN eloohserCtl AND ychscniro.lom. noyl LL iccdenfeyi lpaodielxw nu lla of esteh ?dsiginnf I oesch LLD R ceiidcynfe uaebsce I gessu I ohuhgt ti owuld acseu lal fo temh ot secrinea btu si ihts ytep fo eecyidincf lyon etsaaocids hwit hhig DLL?

sympathetikey  First off, do yourself a favor and check this out - https://www.youtube.com/watch?v=NJYNf-Jcclo The LDL receptor is found on peripheral tissues. It recognizes B100 on LDL, IDL, and VLDL (secreted from the liver). Therefore, an issue with that would cause an increase in those, but mainly LDL. Since in this question we see that Triglycerides and Chylomicrons are elevated, that points towards a different problem. That problem is in the Lipoprotein Lipase receptor. This is the receptor that allows tissues to degrade TGs in Chylomicrons. So, if it's not working, you get increased TGs and Chylomicrons. Additionally, you get eruptive xanthomas, which are the yellow white papules the question refers to. +8  
davidw  There is much easier way go to page 94 in first aid. This kid has Type 1 Hyper-Chylomicronemia which is I) Increased Chylomicrons, Increase TG and Increased Cholesterol. It can be either Lipoprotein Lipase or Apolipoprotein CII Deficiency +12  
bulgaine  The video sympathetikey referred to only mentions pancreatitis in type IV but according to page 94 of FA 2019 it is also present in type I Hyper-chylomicronemia which is what the question stem is referring to with the abdominal pain, vomiting and increased amylase activity +  
dentist  thats not the only difference in that video.... +  
paulkarr  Pixorize has a set of videos on all the lipid disorders that made it a breeze to answer. Pixorize is basically sketchy but for biochem and other basic science subjects. +2  
futurelatinadr  Pancreatitis was a huge clue for me to think of hyperchylomicronemia +  


submitted by seagull(1405),
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,oS /6-52T/1T aer eht cetaptsimhy eellv ofr hte .atrhe heT eelalstt gnoigaln aer aclcriev acspymeitth oalnnigg. shiT siqnueot esesm mroe otcriencr (or a euhg )aelp ot em. Btu he,y I oknw polepe iwll igeardes.

dentist  you're right! heart rate is the only option under sympathetic control. +  
drzed  The cervical ganglion is a fusion of the last few cervical levels and the first thoracic level, so it is plausible. +  


submitted by hopsalong(25),
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I etg tshi is a flffyu setnoqiu and iaogcngkdnwle eht etiptasn' ssroane rof igimnss nlnuisi oteiijcnns is eth c,eiusddlt utb I elfe leki htsi reasnw wsto het elni a t.ib uYo od'tn watn ot say htta siimgsn doses si ,ok tub uyo aols dn'ot atwn to be neam ot enttapi heeir.t I uthgtoh sith wsanre A)( aws ncogndino her nsisgmi eth osc,inetjni os I epikcd .)(C nI tersrpotce, I gsseu ekoadenwgcl msaen kalt utbosocf/au het snoenvrtiaoc undaro.

dentist  I would say: "I understand why you are missing injections, but you're going to have a BAD TIME IF YOU KEEP MISSING INJECTIONS" +3  
alexxxx30  @dentist, I was searching for that answer as well, but it wasn't there so I picked C ahahaha +  
123ojm  you would definitely do C as well. key word is "initial step" +  


submitted by mousie(210),
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lehraCo = alcFe /orse enloiaLgirna = alenolLag enompu = ON orpens to onsrep lony by aihalotnni fo iataebcr dmotcatanine m eLtya/ewr = tikc c aeoc/lenMibiciogtn = ihragsn rpiroatesyr dna thrtao eeossncrti alas(vi ro i)tps. lGerayl,en it tsaek seclo f(ro lxemeap, icgounhg or )igksnis or yhelgtn ncttcao ot searpd eetsh ractaeib CF/ )(SRDCM = kict ebit

smc213  Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments. +6  
dentist  So, Cholera is also p2p but Mening is more likely? +1  
usmlecharserssss  in cholera people to water => water to people +  
qball  Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person. +  
drschmoctor  but the poop water comes from people so.... +1  
llamastep1  Respiratory dropplets is easier than fecal-oral tho +1  
lowyield  Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals +1  
peridot  I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis. +  
bbr  To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly). +  


submitted by mousie(210),
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My uatndningresd fi gACB&Ct; ihts is abnlamor = tvcednucoi greinha lsso = oecrlostsiso SV nyrluraoneeSs enigrha ssol liwl ahev lmraon tBACg&C; = loss of iarh elslc

dentist  VS: progressive unilateral hearing loss, doesn't affect Rinne Test, associated with NF2 and actor Mark Ruffalo Otoslcerosis is (usually....) progressive bilateral hearing loss, BC > AC. source +  
tallerthanmymom  If BC > AC in BOTH ears, why does he have hearing loss in only one ear? My logic was that he probably had otosclerosis in both ears and then something extra going on in his right ear that would make it worse than the left. I still don't understand why otosclerosis is the best answer here. +2  
dul071  Finally!!!! Someone who ACTUALLY explains what the fuck bone conduction even is and teaches the whole topic. Here's the link for anyone else who struggled to find someone who takes time to explain this concept https://www.youtube.com/watch?v=cZYJL9Jg-3k +4  
sonofarathorn  ^ Halle-freakin-lujah +  


submitted by joker4eva76(25),
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Tihs si etparverineets fo aaioupel,kkl a eaupsoc-rrenc ioseln of ssqaumuo lsecl. nI droer for ti to asrepd ot ntasitd s,tise it umst firts ivdane rughtoh teh eebmnats aserbsb/ummmna.uoce odlCu be doscfuen iwth roal ihayr lkukoaaiple whic(h oasl is a wtehi ahpct tath lcsiyalalcs serisa no hte leatrla u.)oengt eeow,vHr rloa aryih llakapikuoe si ont prrosnueca-ce dna si nfteo edostacsia hiwt EBV esfniinoct or plpoee hatt ear eeeylrvs ooniuc.emmmmoidpsr

hpkrazydesi  How did you know that this wasnt oral hairy leukoplakia? just from the picture? +1  
nwinkelmann  To piggyback off of @hpkrazydesi, you ruled out oral hairy leukoplakia because the patient was seeing the doctor for normal health maintenance, i.e. not immunocompromised, I'm assuming. +2  
dentist  @nwinkelmann thats correct! my time to shine. +  


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iScen yuo see tuilaaysvrc ttha si hyw ti is lrgautinnoa itse.us uosFrbi sarc dwoul eb 1 mothn ftera adn oyu tnwd'luo see ttha cmuh ldoob.

dentist  The v-fib/death is an attempt to throw you off. The simple way of asking this question would have been: "18 days after an MI, you should see____?" +4  
gubernaculum  i would use pathoma for this. it says 1-3 weeks after an MI you can see granulation tissue +2