This patient has a pneumothorax. Hyperventillation is not enough to compensate for the overall decrease in lung surface area.

x-ray corresponds to a tension pneumothorax = imminent respiratory failure if untreated. Right lung is fully collapsed, increasing intra-thoracic pressure, imparing O2 exchange (due to mass effect toward left lung, and collapsed right one), hence accumulating CO2 (in blood), inducing respiratory acidosis.

Thank you NBME for the high quality pictures. It makes these exams stress free and enjoyable.

empty can test isolates the supraspinatus tendon impingement between the acromion and humeral head and finds weakness of the supraspinatus muscle. it is performed by asking the pt. to abduct the arm in the scapular plane at 90 degrees with the arm extended with the the thumb point downwards and asked to abduct the shoulder against resistance. this will reproduced pain and indicate a positive empty can test and indicate supraspinatus tendinopathy

2 months old w/ holosystolic LLSB murmur -- ONLY holosystolic murmurs are mitral regurg, Tricuspid regurg, VSD PDA - continuous machine like murmur

Since she has regular 28-day cycles, ovulation will happen on day 14. In the follicular phase before ovulation, estrogen rises to the point of the LH surge while progesterone stays low. After ovulation on day 14, progesterone rises and estrogen will gradually rise as well.

Weakness with decreased muscle bulk implies problems that include the lower motor neuron system. Decreased DTRs implies a disrupted reflex loop but the absence of sensory loss implies that it is on the motor side of the reflex loop. Of the available choices, B is the best fit. "A" is arguably true because a strictly motor polyneuropathy (such as in lead poisoning) could account for the findings, but a 3-month course could hardly be called "acute."

Inability to maintain an erection = erectile dysfunction. So now the question is "Why?"

Fatigue, difficulty sleeping, difficulty concentrating is starting to sound like depression. "Difficulty concentrating" might be interpreted as impaired executive function or the beginnings of vascular-related dementia (dementia related to small but numerous cerebral infarcts), but on Step 1 dementia will be blatant (i.e., "lost his way home," "wandering," etc.).

Depression is actually common after a debilitating event like stroke, as you might expect. With depression comes a loss of sexual interest and desire—that is decreased libido.

One can make the argument that a "vascular patient" might have some issues with his "pipes" (arteriosclerosis, parasympathetic/sympathetic dysfunction) and, for this reason, nocturnal erection should be decreased; but note that nothing is mentioned about long-standing vascular disease (no hx of hypertension).

As a result, the best answer choice here is C. (Libido decreased but nocturnal erections normal.) The big question I have is, how the heck does this guy know he's hard when he's asleep!!? :p

Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

empty can test isolates the supraspinatus tendon impingement between the acromion and humeral head and finds weakness of the supraspinatus muscle. it is performed by asking the pt. to abduct the arm in the scapular plane at 90 degrees with the arm extended with the the thumb point downwards and asked to abduct the shoulder against resistance. this will reproduced pain and indicate a positive empty can test and indicate supraspinatus tendinopathy

Although botulism blocks ACh release, it wouldn't have effects on mpp and the response to exogenous ACh provided to the synaptic junction. The potentials would be the same as it would normally be. The epp difference was disclaimed in the question stem.

Process of elimination is the only way to get this answer without Savant levels of autism, as some bowtie wearing doucher who wrote the question probably has.

Cancer is unilateral almost all the time, DM doesn't make sense for any reason, HTN itself wouldn't cause milky boobs, and mast cells degranulating doesn't make milky boobs either. So, and because many drugs can have milky boobs, you're left with drug effects by process of elimination.

Psoas sign - pain with hip extension

It can also present in adute appendicitis

Pt has diabetes inspidus.

If urine concentrates with administration of ADH analog, the kidneys are responsive and the problem is with ADH production in the hypothalamus or release in the post. pituitary.

GnRH agonists like Leuprolide are effective for patients with breast CA because if given in a continuous fashion, they downregulate the GnRH receptor in the pituitary and ultimately decrease FSH and LH.

EPO --> RBC's

TPO (romiplostim --> Platelets

G-CSF (filgrastim)--> Myeloblasts (neutrophil, basophil, eosinophil)

INFy --> granulomas

IL-8 --> neutrophil chemotaKxis

As @yotsubato mentioned, pt has neutropenic fever. That is priority for someone undergoing chemo.

! I hate these with a burning F***ing passion. Thumbs up if you agree

Question is asking what part of the kidney secreted renin.

order of thinking:

1. Renin is made by the JG cells
2. JG cells are "juxtaglomerular" to the glomeruls aka right next to the glomeruli (furthermore, they actually are modified smooth muscle cells of the AFFERENT arteriole FA pg 577)
3. Glomerulus is in the renal corpuscle. "renal corpuscle is the blood-filtering component of the nephron of the kidney. It consists of a glomerulus - a tuft of capillaries composed of endothelial cells, and a glomerular capsule known as Bowman's capsule"-wikipedia
4. Renal cortex "contains the renal corpuscles and the renal tubules except for parts of the loop of Henle which descend into the renal medulla" -wikipedia

TLDR; if renin is secreted by JG cells and JG cells are in the glomeruli which is in the renal corpuscle which is in the renal cortex, then JG cells are in the renal cortex so RENIN WILL BE HIGHEST IN CORTEX

Like others have said, I think sublimation would have been better, but displacement from first aid says that it is, “redirection of emotions or impulses to a neutral person or object” so she’s kicking her family by kicking the bag.

Answer = C. (Decreased hepatic VLDL synthesis)

Nicotinic acid = Niacin. Niacin works by:

1. Inhibiting lipolysis (hormone sensitive lipase) in adipose tissue)

2. Reducing hepatic VLDL synthesis

Explanations for this are too complicated. Think of it like this:

You've got a piece of mutated DNA that is able to be digested by a restriction endonuclease, that means the DNA was transcriptionally available to begin with. AKA it was not methylated, because as we know, methylation = heterochromatin which is transcriptionally inactive. that means methylase was mutated

Only other plausible answer was DNase, and if it was mutated it would be inactive, not overactive.

Inability to maintain an erection = erectile dysfunction. So now the question is "Why?"

Fatigue, difficulty sleeping, difficulty concentrating is starting to sound like depression. "Difficulty concentrating" might be interpreted as impaired executive function or the beginnings of vascular-related dementia (dementia related to small but numerous cerebral infarcts), but on Step 1 dementia will be blatant (i.e., "lost his way home," "wandering," etc.).

Depression is actually common after a debilitating event like stroke, as you might expect. With depression comes a loss of sexual interest and desire—that is decreased libido.

One can make the argument that a "vascular patient" might have some issues with his "pipes" (arteriosclerosis, parasympathetic/sympathetic dysfunction) and, for this reason, nocturnal erection should be decreased; but note that nothing is mentioned about long-standing vascular disease (no hx of hypertension).

As a result, the best answer choice here is C. (Libido decreased but nocturnal erections normal.) The big question I have is, how the heck does this guy know he's hard when he's asleep!!? :p