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Comments ...

 +0  (nbme23#33)

I just realized there were solid arrows and dashed arrows in the image. Is there a significant to the dashed arrows vs the solid arrows?

faus305  The solid lines are the correct answers. lol jk but not really +

 +3  (nbme23#41)

Anki Card I made: Vagina = {{c1::Stratified squamous}} Cervix = {{c1::Stratified squamous --> simple columnar (endocervix)}} Uterus = {{c2::simple columnar}} Fallopian tubes = {{c2::simple columnar}} Ovaries = {{c3::simple cuboidal}}

brotherimodu  For some reason I don't trust you +12
focus  ^^^ haahahaha. Thankfully the patients aren't seeing these usernames +

 +0  (nbme23#25)

What is the area labeled 'G' and 'C'? And more characters?

alexxxx30  lateral corticospinal i think +3

 +0  (nbme23#42)

"disproportionate reduction in the peak expiratory flow rate or maximum minute volume compared with the forced expiratory volume in one second (FEV1). It should be noted, however, that there can be a significant loss in airway cross-sectional area before the textbook flattening of the inspiratory or expiratory loops are visualized."

https://www.uptodate.com/contents/clinical-presentation-diagnostic-evaluation-and-management-of-central-airway-obstruction-in-adults?search=tracheal%20obstruction&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H793418750

mamed  google fixed upper airway obstruction - the spirometry curve shows decreased inspiration and expiration. A lower airway obstruction just blunts expiration. Extrathoracic blunts inspiration. +

 +0  (nbme18#8)

Uremia = Metabolic acidosis = Bicarb is low. High respiration = Low Co2; for respiratory compensation.


 +12  (nbme18#9)

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!

mcdumbass  This makes sense... but I don't trust your answers +9
bmd12  😂😂😂 +

 +0  (nbme18#46)

According to UpToDate:

At levels below 886 mg/dL (10.0 mmol/L), the risk of pancreatitis appears to be quite small [76-78]; however, it is reasonable to consider drug therapy at levels of 500 mg/dL (5.6 mmol/L) or above in patients with a prior episode of pancreatitis.

Bonus: They say fenofibrate>gemfibrozil always.





Subcomments ...

submitted by aladar50(40),
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oS ehrtse’ 010 it,nessred dan teh lepevcenar farte 2 sraye is 01= at eth ngn,igbien +5 ni het first ,eayr +01 eodnsc er,ay adn -3 htta ee,hadl orf a oatlt erlvncapee of 22 sreetnsid or 2222=0/01 eent.pcr uhs,T cepvlarnee = oevab hte tddsanar. roF ,encnidcei i’ts 51 ewn escsa tou of 90 sdsnteeir oerv het 2 eaysr 0(10 aotlt eidssenrt – 01 thta reaayld ahd )crsel,u ro 51 wne ulsrce pre 081 eptitna.e⋅syar ishT uldow be .383 ewn crules epr 0010 ⋅aneaptirsety fi yuo opexaarlttde it tuo -- cysalibla 8)110(/000 * 15 -- uhs,t neincicde = baove the tadsdnar.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +52  
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +4  
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2  
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7  
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3  
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +14  
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +  
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +  
doublethinker  Damn, guess my reading comprehension is not "up to the standard" of the NBME writers. Smh. +  
prolific_pygophilic  If you forgot that its patient years (15/180) not (15/90) you still get the right answer because they are both above 5% :). +  


submitted by thotcandy(79),

What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +  
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +8  
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1  


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Teh nitpaet has NAT dnrseyaoc to enral cs.himaie eDu to ruulbta eosirn,sc the ieatptn lwil heav na lveetdae .NFea heT it'npseat ureni wlli aols eb ,lediut ubt this iwll be rtelcedfe by eht owl nerui l,aotmyilos not het aNFe

mousie  Hypotension can also cause pre renal azotemia with a FENa <1%.... How do you know this is ischemic ATN and not hypotension induced Prerenal Azotemia? +11  
sympathetikey  I had the same thought as you @mousie, but I think "azotemia" and low urine output push it more towards ATN (looking back; I got it wrong too). Plus, the initially MVC / muscle damage probably caused some tubule injury by itself. +2  
ajo  This might help clarify why the pt. has ATN rather than pre renal azotemia. The question did mention, though subtly, that the bleeding was controlled. That most likely indicates that his hypovolemia has been corrected. Developing azotemia 24 hrs after correction of hypovolemia is more suggestive of ATN (since he doesn't have hypovolemia anymore). I hope that helps and feel free to correct me, if I am wrong. +40  
ajo  In addition to my earlier comment, I just noticed the question also explicitly mentioned that he was fully volume restored. Which is consistent with my earlier assumption! +14  
gh889  Although initially, hypotension causes prerenal azotemia, the volume correction pushes you away from prerenal azotemia. but they want you to remember that in hypovolemia, the kidneys are also becoming ischemic, and so development of azotemia 24 hours later is more indicative of intrarenal azotemia due to ATN +  
sugaplum  for anyone who wants to see it: FA 2019 pg591 +1  
divya  i'm confused about one thing. if the tubules aren't working like they should, the bun:cr ratio falls right? doesn't that essentially mean azotemia reduces too? +  
osler_weber_rendu  Lets all take a moment to admire how shit this question is "Bp 90/60.""Repeated episodes of hypotension in the OR" and still the answer is ATN +4  
donttrustmyanswers  @osler_wever_rendu ATN can be caused by ischemia. +2  


submitted by uslme123(65),
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ihTs etuoqnis samek no snese ot me. eSh has na tyelxeerm lwo geionnp sepsreru ety ahs sisng of irdnaeces lacrinairtna u.esprser Did tyeh enma ot upt 23 cm ???H?2?0????

uslme123  Standard lab values are incorrect, way to go NBME. +3  
wutuwantbruv  I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg. +3  
alexb  I lost a bit of time wondering about that ugh lol +1  
mjmejora  I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high. +2  
donttrustmyanswers  Does anyone have clarification on this question? +  
llamastep1  Pseudo tumor cerebri can have normal ICP. Who knew +  
tyrionwill  Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles? +1  


submitted by tamey(-1),
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i ocseh liuetpimsememr(odn lcmarnou )piuteemilh sa i ouhthtg by rhe gae ehs is sllit miaegsnuttrn dan hte deeddSh trdonmeemui si ofudn ni eth ciraevcl gorei,n why to!n!!!

donttrustmyanswers  I think they key word here is "originates." The simple columnar epithelium starts in the cervical canal, and continues on throughout the uterus until you get to the ovaries. +  


submitted by sugaplum(372),
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polalhnieyeronpnmap is an hplaa sogtina that tatesumsli aehtlurr sothmo cmusel .tniocroatnc - orfm o,aeuptdt ve,erwoh it asol ssya ti is otn doecdnmmree entetrmta onreyam

ugalaxy  α1 stimulation (via α1 agonist) constricts the bladder sphincter thereby, preventing sudden bouts of micturition during coughing/sneezing (abdominal stress). +6  
sammyj98  I thought that B3 stimulation stopped urination +5  
adong  @sammyj98 B3 would facilitate bladder relaxation +  
hvancampen  @sammyj98- were you thinking of oxybutynin? (thats what I thought of!) According to FA, its used for urge incontinence not stress. +1  
drzed  Nah he/she's talking about Beta-3 receptors which are Gs coupled. Gs increases cAMP thus it would cause smooth muscle relaxation -> bladder relaxation! +1  
donttrustmyanswers  From Mayo: "There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however." +1  
nreid4  @hvancampen oxybutynin is an M3 muscarinic antagonist, not B3. +  
alienfever  I thought about B3 agonist as well and got this wrong. I think maybe B3 agonist can be used for bladder (URGENCY incontinence) where the main issue is detrusor over reactivity. In STRESS incontinence however the problem has nothing to do with detrusor, so we use α1 agonist to constrict the sphincter. +1  


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uCdol meeoosn peinalx ywh itsh heoicc si het tsbe sewna?r I ugterldsg ntebewe A nda D, dan cdeipk A ynil,lfa cihwh si tieasrn"ca lidtnoaaeuc ellev nda evproid pbiasnil".tuco

donttrustmyanswers  It isn't A, because research shows that understanding of information (i.e. eating good and exercising) isn't enough to cause change. Why it is Provide F/U, over support group, IDK. +6  
thisshouldbefree  because it says "refer" and u never refer +2  


submitted by lae(21),
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rcnhoic ibirnhocts asceus aosqumsu aaatisepml fo het dpstiisdretauefo uanoclmr eheitupiml ni eht coirbhn nad hebcorlison

---- seeth uoarnmlc tieuemihlp mroalnyl nebtrctoiu to eth lmycaruioci nelrcceaa and noikgsm osla dmeasag hsit n,lreeaacc so can egt hte eclu rfmo atht oto

donttrustmyanswers  Pseudostratified columnar epithelium is only present in the bronchi. The bronchioles have simple ciliated columnar epithelium. +4  
flapjacks  ^you CAN trust this answer. Confirmed in FA +1  
abcdefbhiximab  Chronic bronchitis is due to hypertrophy and hyperplasia of mucus-secreting glands in BRONCHI where there is pseudostratified columnar epithelium. All of the other answers point to the alveolar sacs. And centriacinar emphysema only affects the respiratory bronchioles anyway while sparing distal alveoli. pg 674 FA 2020 +4  
step7777  It also has to do with the Reid index, which is increased due to mucus gland tissue undergoing hyperplasia and hypertrophy in the Bronchi that is producing excess mucus. Columnar epithelium is usually glandular. pg. 660 FA 2019 +  


The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!

mcdumbass  This makes sense... but I don't trust your answers +9  
bmd12  😂😂😂 +