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Comments ...

 +0  (nbme23#1)

the key here is (asymptomatic) the only amswer is anovulation


 +0  (nbme23#19)

pupillary dilation ,hypertesion ,tachycardia,seisure ,wakefulness are typical for amphetamines intoxication.


 +0  (nbme23#49)

how is adrenal medulla has ACH nicotinic receptor which are ligand-gated Na/k channeles ? muscarinic ACH receptors are G-protein-coupled receptors.

gdupgrant  epinephrine acts on alpha or beta adrenergic receptors which are all G protien receptors. muscarinic receptors are also G coupled but Acetyl choline wasnt an answer choice. In the adrenal medulla the chromaffin cells are kinda like modified post ganglionic neurons and have nicotinic receptors.

 +0  (nbme23#44)

orbital floor fracture lead to entrapment of IRM leading to diplopia,we can see air in the orbit plus displacement of eye tissue and the muscle in maxillary sinus .


 +0  (nbme23#7)

bleeding + pressure down +pulse up equal hypovolemic shock


 +0  (nbme23#15)

12Mg/ml=12mg/L 120.09=1.08 mg/hr/kg 1.0824=25.92 mg/day/kg the nearest nanswer is 28.8


 +0  (nbme23#4)

can somebody explain how energy production by glycolysis increased, since aerobic glycolysis produce 32 net ATP,compare to 2 net ATP through anaerobic glycolysis ?

diabetes  i think the stem should be "energy production by an anaerobic glycolysis "
blueberrymuffinbabey  yeah that's the bit that tripped me up too. i get that there would be increased glycolysis in general to compensate for lack of TCA function but...the fact that it says "energy production by glycolysis" is kind of misleading/confusing.

 +0  (nbme22#50)

i was hesitated between neurofibromatosis type1 and tuberous sclerosis ,the two have skin + brain lesions ,AD,but the first has 100% penetrance ,optic gliomas ,hperpigmented cafe-au-lait spots,no seizure,so seond is the answer.


 +0  (nbme22#11)

The pampiniform plexus, testicular artery, cremasteric artery, artery of the ductus deferens, lymphatic vessels, testicular sympathetic nerves, and ductus deferens all run deep to the internal spermatic fascia. The ilioinguinal nerve runs on the superficial surface of the external spermatic fascia The ilioinguinal nerve is a sensory nerve that innervates the skin over the groin region, the medial aspect of the thigh, the upper part of the scrotum and the penile root. It is normally encountered during open repair of inguinal hernia.


 +1  (nbme24#44)

When ZES is suspected, the initial test recommended is a fasting serum gastrin (FSG) determination in the absence of antisecretory therapy (Sensitivity- 98–100% in ZES patients various series. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757869/


 +0  (nbme24#13)

RBC casts===> glomerulonephritis the only option there.


 +0  (nbme24#18)

this question they gave you the answer (osteomyelitis).


 +2  (nbme24#17)

simply the blood inside the CSF become blocked through arachnoid granulations ==> decrease absorption of CSF==>communicating hydrocephalus.


 +1  (nbme24#40)

U(UtI) ==> sepsis ==>ARDS==>INCREASE alveolar capillary permeability ==> hypoxemia ==> hyperventilation ==>hypocapnia





Subcomments ...

PTH is increased because serum calcium is low. Because PTH is increased, phosphorous is decreased. The woman in unable to absorb vitamin D (a fat soluble vitamin), so calcitriol is decreased (no vitamin D for the kidney to activate into calcitriol).

gabeb71  What does this have to do with the Celiac Sprue? +1  
medpsychosis  I believe they were explaining the reason for the mentioned "mild osteopenia" in the pt presentation. +  
meningitis  No, I think this person got confused with another question about celiac sprue, PTH, Calcitriol, and Vit D (it was an arrow type question). +  
diabetes  explanation for decreased bone density . +  


submitted by hello36654(0),

so why is "cessation of fast axonal transport" wrong? Don't myelinated axons, by definition, have fast conductance? So demyelinated axons would have "cessation of fast axonal transport", which is the answer A, right?

diabetes  i think it slows down ,no cessation . +  
gdupgrant  Because fast axonal transport refers to the transport of vesicles containing neurotransmitters or some kind of cell product up and down microtubules in the axon. It isn't related to actual electrical signal transduction. +2  


submitted by diabetes(7),

can somebody explain how energy production by glycolysis increased, since aerobic glycolysis produce 32 net ATP,compare to 2 net ATP through anaerobic glycolysis ?

diabetes  i think the stem should be "energy production by an anaerobic glycolysis " +1  
blueberrymuffinbabey  yeah that's the bit that tripped me up too. i get that there would be increased glycolysis in general to compensate for lack of TCA function but...the fact that it says "energy production by glycolysis" is kind of misleading/confusing. +  


submitted by keycompany(160),

Urinary tract infections are the most common acquired cause of Vesicouteric Reflux (VR) in children. VR can lead to Reflux Nephropathy, which is characterized by chronic tubulointerstitial inflammation with fibrosis and scarring, leading to renal failure.

lancestephenson  Can someone please explain what's going on in this picture? This is the SAME PICTURE used in NBME 20 and 21 with one of them being a 66 y/o with urothelial cell carcinoma and the other being tubular atrophy. I just don't know anymore +13  
spacepogie  I'd be happy to send them a gift card to purchase more stock images of kidneys for use in future exams... +4  
diabetes  i think VR should lead to bilteral kidney damage and here only left kidney is affected.should we suppose that right kidney also is affected ? +1  


submitted by neonem(334),

This patient isn't hypoventilating, they're HYPERventilating, hence the PCO2 < 40 mm Hg.

Let's walk it backwards: They are hyperventilating to compensate for the metabolic acidosis caused by widespread hypoxia. Hyperventilating allows you to blow off more CO2.

Why are they hypoxic? The person is hypoxic due to inflammation and acute respiratory distress syndrome from the pneumonia. All the cytokines from the inflammatory cells cause increased pulmonary capillary leakage, which blocks up the alveolar membrane so that O2 can't get through to the blood.

Why do they have metabolic acidosis in the first place? No oxygen --> no electron transport chain and no TCA --> lactic acidosis.

diabetes  no pneumonia it is UTI +1