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Welcome to dr.xx’s page.
Contributor score: 153

Comments ...

 +7  (nbme23#35)
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r.gith he ellyaobust tsmu imarne ni het wnatgii eara os atht eh is at andh ot akcatt ihs ewif enverehw reh emax .dsen og !BMEN

meningitis  I guess it was all about not offering battering information in order to not make matters worse since he will figure out that the wife told on him.. Also, its a HUGE STRETCH but the only reason I thought he should stay in the waiting room was just in case the wife died they could detain him and call the police for questioning. +10
temmy  Also, he should stay there because his wife did not grant him the permission to see him. Patients requests trumps. +1
nephcard  Doctor should not believe what wife told her. There may be some other reason for injury so batttering information should not be provided. But her wish of not letting her husband in should be fulfilled +2
charcot_bouchard  No. In real life patient lies. In Board ques they always tell the truth. Unless they make it very obvious. in fact its a board ques rule. So u believe her untill proven otherwise. +4
drdoom  The prevailing rule of American medicine and law is individual autonomy. No other person is granted “default access” or privilege to another person’s body—that includes the physician! The physician must receive consent from a (conscious) “person” before they become “a patient”. In the same way, the person (the patient) must give consent before anyone else is permitted to be involved in her care, spouses included! +

 -12  (nbme23#48)
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... atht dna a csyph scotnul rof het chzsio ..rmhe.ot

 -2  (nbme23#33)
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beAsu fo vtaaexlis t;&g= asylulu secareded ersmu uitmpssa.o As to dolirehc dna ,iarbcb htat en.edspd heyT clduo eb dscneriea ro rce.deades


 +1  (nbme23#49)
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rTeemtnat of uatce gtuyo teerlrti rivSasha dusgr ear eitffecev for mgnniretait eht cetua uogyt tt.caak ,lieCiocnhc idorlsenanto ant-moymifitraanl rdsgu SD(Ns)IA, dna toiotosdiccserr are srdndaat p.hsaeoarcp roptooccncAtoirride onehorm A(TH)C si olsa yrev vefcet,efi ubt ahs boemce cnlsneiariyg eccasr or too evexiespn to be a atlaccrpi ltnreitvaae in the US. asRldrgese fo the caprurtali atnge scone,h het oronse htese rsgud are tatsrde, the more paird teh erpnss.oe fI a tinetap actnno keta SNsDIA ro ici,hconlec eth oiechc si noamg la,or rrrattlc-aiauni or ntlraperae i.liorsucoocdgct aolLc opitcnlpaia of ice pcask amy hple oltorcn i.apn nI eosm es,cas g,nisaascle nuigdcinl osoiip,d may be dd.eda

gDrsu htta fetfac rseum rtaue rsoanennccotti G(.,.E U,ONROIPLL)LA nunigclid tiecruriyamhnicep na,stge ulsohd nto eb ,gncehad eradts,t or desoptp rigdun na ta,ckat sa sith may nrwsoe het tanlmaoiyrfm seosrnep adralye in osersrg.p


nwinkelmann  Love the last quote/sentence from the article! So helpful for clinical decision making! +

 +1  (nbme23#45)
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SISsR pocdure a unsitasde enscirea in rctalaxulerel 5H-T ni teh dlroas eparh ,()DR and tihs dslae ot iotnutbainihio of rtceenrisoog .rsnnoue


davidw  Pg 483 in firstaid has a good table of where the neurotransmitters work +6

 +0  (nbme22#31)
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Teh smto tapotmrni tewsa ctdopru is omaanim N.)H3( Tshi almls loeluecm orecsss teh bbrnoliado– rreibar nda si adsebbro dna dmlaboetise by the crsea,tysto a otiaulopnp of lelcs ni teh barin that isetcnutost 03% of teh rearclbe eo.rtxc Ayetocsrts eus oiaamnm nweh sseiysthingn iemgatunl omfr g.auttmael eTh eniecrsad eselvl fo iumenaltg elad to an eenciars ni stciomo upreessr ni the or,tcsstyea chiwh ebmceo ereTh si erdaesnic iyivtact fo eht iiytroihbn ric-γbnyoaumit dcia GABA)( ,yesmts nad hte egenyr ulspyp to ohret nbrai cesll is draeesced. This can be ttughoh of as an amxepel of birna dmeae fo hte yxo"ciot"ct e.pty


 +0  (nbme22#49)
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oMtaeniicd gaesdso hdsluo be ateridtt oytlprpm ot aiceehv ivtefecfe napi onl.tcro


 -13  (nbme22#25)
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The slel-cβ evha evvoled a hnimcesam to tcedet eth tmuaon fo niusiln dotesr adn edecsret adn udastj silninu tseyisnsh ngyccalio.rd A lgurnea rasnmnerbtmae erpinto alelcd seilt ecll gtieuoanatn 152 (I2),CA51 is a ulrcica part fo this fkadeecb on.ltcro nuilsnI rgsnaeul vlater a olgn ienctdsa on butulin rtkcsa ebfoer angrivir at the epaieplrrh aictn nkwoert .[]251 reeBof bmneoicg edilkn ot het nslc,kyetoote sinnuli erlagnus era ocehrdna ot icant xtecro aiv 1I5C2A and yni.hrntβhs-2po pnoU nttav,iaioc the laregun brmnaeem sfuse rntltnaesyi ot eth clle erbmmean ot esaeelr nlinsu.i elvetdEa Ca2+ llvese ni eht mateniem ativatce the steapoer clμaap-in ot vleeca awya a ocioycstl enfmatgr frmo CA512.I hTe fere 1AC2I5 ocltyicso mgetnraf then mevos ot eht nuuslce nda nsdib to eht -iehyhposplaosrtredoytn arisralttoncpni fotrca TS5AT ot npeetrv TATS 5 form oe,tpoldhhpsrayion ihwhc in tnru sgruepleatu ilinsnu iiaptcrortnns []1.72 eNcrula reef 1CA25I lystoicoc ntsgframe aslo bnid to ugoialnstmy zmeeyn γAPI.S ehT moulosytian fo I512CA by SAIP γ ssevreer eht bnngidi of AC125I to S5ATT .71]2[ ecH,ne teh laeseer fo niislnu orfm otcreeysr alesnugr is mudoincmteca ot hte ,cnulues cwhhi erevss sa a ovtpiies ekbeacdf mcemnshia ot tiitnaei linsuni rntaslitnoa fro intningamai na aeudeqat atnuom of todser nii.lsun


anjum  Bro wat r u doin with this explanation +3

 +3  (nbme22#6)
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heT t tste is neo etyp of ieafreitnln s.isttictsa tI is desu ot einrtdmee hheewtr hreet si a igcaiftinns ficnefrdee tbeneew eht smnae of owt


 +6  (nbme22#45)
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sA rpat fo onecibymr ltmndepeov,e eht caserpna frosm sa owt subd form eht r,ofegut an ecbnrioym buet taht is a esorrpurc ot eth rnonslesatitgiat tc.rta tI is rofhteeer fo eorealmdnd .iiognr


gh889  nice! I reasoned it as that most of the GI system is of endodermal origin +9
taediggity  FA 2020 pg 613 +1
mutteringly  FA 2019 pg 599 +

 +5  (nbme22#34)
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psi-BenaEtrr rsivu (BVE) is rcdiare yb msto It nac scuae alresve etyps of .ernacc nI tlhahye ftenedic le,ppoe BEV essisrpt rof lfei ni a n"ae"tlt steta in B .esllc


 +4  (nbme22#12)
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Teh ourf tpyse fo uehopsrhdcyal ear tiucam,cnoignm ncnuacgminntim,oo xe avcu,o dan anorlm ep.rssrue ssganDoii si tlaipcyyl dema by shacylip nxeitanaoim adn adlecmi .mnigagi

aosrHpeuhldyc xe uvcoa sloa erfres ot na enlneratgem fo cerelabr rsivelncte and braocsinhuda ps,seac dan si lluauys edu ot rinab pthorya sa( ti ccuros ni ,diae)etnsm pstaotaurcm-ti banri iinerjus dan nvee in eoms aycirhstpic drsdro,sie uhcs sa hrhnoiispecaz. sA doppeos to hlushrecyda,op htsi is a oeotnscmaryp nmgarnelete fo eth -ssCecpSFa in sronepes ot brnia ahreycnmpa o;ssl ti is otn the lertsu of aederscin CSF s.upsreer


 +2  (nbme22#46)
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naiIylbit to kwal tnnaco be xidenplea by aldeimc iu.nlotavae t&=g=; enCnsvorio dreosdri

 +2  (nbme22#43)
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Hretadriey yepT I and II rea deasuc yb a nutmaito ni teh PS1REGIN gnee thta eksam the C1 btiriinho proeitn.


 +2  (nbme22#1)
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FCH stniepat fetno ipslayd isnsg dan mpsmtosy of sendcarei vpinasreoss .cotreseni

hyperfukus  if all else fails i hope i just drill this one statement in my brain and it comes out in the right way on test day thank u!!! +

 +12  (nbme22#18)
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rPlatbeu coeintsgyaam is ouhtght ot be a iyclgoahisopl mneno,enpoh nad si somt mnmcooyl nees in umrbeytipd itwh Trnena asteg 43– cubpi hari and tiretcuasl slumeov fo 5 to 01 Lm ir.atbllyael


 +5  (nbme22#23)
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elavpiHomyo si a ridcet slos of fctevifee criuclgtian lbood leuomv deinlga :ot

  • A ,ridpa w,kae aerytdh peslu eud to erdaeecsd dobol lfow dnecmobi twih iradcathyac
  • loo,C ylcamm ksni ued ot ictotvionnaocssr adn tuniaitmlos fo sitncootinsrvaco
  • dpRai dna walsolh gtbeanihr ude ot itcepsthmay vunosre smyste aisonmittul nda scsiadio
  • aHheoimrtpy deu to drdeceeas nefruopsi adn eoantvaropi of swtae
  • srithT dan dry ,tumoh eud ot lfdui poedietln
  • dolC adn mltdtoe knsi dLio(ev crulr,itasie) cyalslpeei ri,teeixmset edu ot innsffciteiu poiunrfes fo teh iksn


thrawn  Why no sweating? +

 +2  (nbme22#21)
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ehT tosm mmoonc nad evsree rfom fo moultasoa aotdnmni ccoiptslyy dyikne saedsei P)K(DAD uestrsl frmo itmanotus in 1PK,D ndeoicng sylto1ypinc- C..(P1)


yotsubato  Here we thank FA for failing us yet again. Giving us PKD1, but not polycystin. I got the question right but I just guessed it because nothing else made sense. +14
usmleuser007  Autosomal dominant polycystic kidney disease 1) occurs in patients with mutations in the gene (PKD1) encoding polycystin-1 (PC1). 2) PC1 is a complex polytopic membrane protein expressed in cilia that undergoes autoproteolytic cleavage at a G protein–coupled receptor proteolytic site (GPS). 3) A quarter of PKD1 mutations are missense variants, though it is not clear how these mutations promote disease. 4) GPS cleavage is required for PC1 trafficking to cilia. 5) A common feature among a subset of pathogenic missense mutations is a resulting failure of PC1 to traffic to cilia regardless of GPS cleavage. 6) Missense mutation in the gene encoding polycystin-2 (PC2) that prevented this protein from properly trafficking to cilia.  +2
waterloo  yotsubo - the book is already so thicc. I think you made a great point tho, nothing else made sense. Sometimes you can't know everything on the test, but you can still play the game. +1

 +0  (nbme22#12)
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Cgnntaoeil laedran eahalypsirp eud ot lehdx1sroyy2a- nciic.eeydf


wutuwantbruv  Can't be 17α-hydroxylase because this would present with hypertension and some sort of ambiguous sexual presentation (males) or lack of secondary sexual development (females). Can't be 11β-hydroxylase because this would present with the opposite of the kid's presentation due to the production of 11-deoxycorticosterone (similar effects to aldosterone but not nearly as potent). The other two would not really make sense since there are increased levels of 17-hydroxyprogesterone. +

 +4  (nbme22#42)
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r,eSvee piadlyr oilvvnge dtedimisnaes ruasacarnvilt iulcoaongat )CD(I escasu norit,opeabycomth otpedleni of sapmal oclauogtain costrfa dna noeifb,nirg dna .igeelbdn


 +5  (nbme22#2)
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bstiFrea seerecda digrrtlyiesec yb cdgeuinr teh opuodictrn of LLDV.

 -1  (nbme21#17)
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oMre Ayslfeentulfr:f to stiarcg heT estefnraf to GV ecmo mrfo telf itsrcag ei,nv tosrh asrtcig vsine adn eopsoritr sgtrcia veni eth telf sragtci ievn mailyn bitctreunos to omftiarno fo raicadc ecvsair wehreas eth sthro sitargc veni nda ospirtreo icsgatr nvie ueobtcnrit ot rmioafont fo laundf risv.cea tsldaeoI tsricga ervicsa aer eomr llkiey to eb rtadele to rociepplaiogset .esivn


 -2  (nbme22#5)
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mraloN ryisoaprret aetr orf a 01 htmno dlo gt;& 05 rsebhat rpe emuint.

onlNoxea dhuosl eb genvi in hte reecepns fo poersartryi neoepssrdi dna yma ieuerqr darteeep dinos.g


 +7  (nbme22#20)
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RMI si hyihlg i,vneeisst eciip,cfs dna uacrceta in the ecnediott of AVN.

1Tedhg-twie mgi:esa VNA otsm ntoef prtnsese thiw a tiec,cnsecr giiren-kl ro llew eneddif ndab of wol ligans ntwihi hte rruesopi toonrip of hte ncrbsudaolh faoemrl dhea beno r.mowra ihsT band si toghhut ot ptreeesrn hte vreeciat enctrfeia etewneb het ciocnrte nda avieparter n,zseo adn icpyytlla xetndse ot het ashcdobruln te.apl


 +1  (nbme22#47)
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eTh llrkaahm fo IPT is itoaseld ar.hiemtboctnpooy


jboud86  Refer to page 419 in FA2019. +2
hello  @dr.xx Compared to what? +

 +3  (nbme22#13)
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nuiDgr siht iilanti eo,tucnenr ew thisblesa thwa het st'apenr cersnonc rae, boitna a ymlfia tirhyos, dna ksa tuoba pseroiuv midceal elops.mrb hiTs gbisen eth tntaisrino orfm raetnp to neet sa het imeadcl hntaio.sir We tnex kas nperast ot iwat ni teh wiintga moro so taht ew nca skepa rtvpeiayl htwi hte ns.atoeledc We evnwritei eht daoesnletc eona,l ermfpor a acslhpiy namteoniiax ihtw a ree,anohcp dan enht neitiv eht snetpar akcb niot het ormo ta the cuoinlocsn fo eht ivist ot ssdiucs uor sfiingnd.


 -6  (nbme21#9)
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-snerHbndoceahslHsea Eunq :potiHa = 16. + gOlC3o(H / (.300 * ))PC2;aO so ,rehe pH = .t g;&296= etAuc snu)(aceptodmen apryrmi yrerptrasoi swst,dhiaico i iecombtla assidoci

sbryant6  calculator can't do logs yo. +5
b1ackcoffee  wow, sherlock! +

 +8  (nbme21#49)
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omucsluMl atooismugcn si seacdu yb a uxsivrop dlacle eht slcmuuoml tsmoocingua uvris MC.()V nI aubto 10% of hte se,asc amezec vosdeepl anordu het sne.s.loi


 +4  (nbme21#7)
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gmAon het mots rpetvlena oelmgiotcha srbnoteaamili ni siettnap thwi ihcgtelruoamo iddrossre rea hte eanima of chocnir aisedes C,)(AD a mldi aiamen ttha is egealylrn mitsmpycotaa, dna ionr yncicdeief

In ci-eiydfcornine m,niaea the ICBT udlow hehrgi thna 4–54000 dLc/mg easebcu sotesr luowd eb lwo.

iaentstP wiht AR iyolcansacol veah rtrunccone orni yeeincdcif nimaae nda .DAC eWhn hits rs,uocc hte honogbeilm lveel lyulaus dsrop ot welbo .95 dg,L/ nda eth MVC si lses hant .80


sympathetikey  Got the right answer too, but man, that whole "1 month after starting therapy" almost threw me off. +1
fkstpashls  all I do is put the wrong answer when I'm between two. Fuck +1

 +3  (nbme21#38)
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lxacaitPle slibitzaes het omubtceriul emloyrp dna tpotcser it fmor sls.smyae dbiwantgxao:taiacPcpr/ioti.k//_oeph/ltnnwe#hideliiaMmi.icsse_kf

 +2  (nbme21#43)
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In ostm audinslidiv edenicft whit .M cbelutruoi,ss euncaomlron slelc in eht lodbo ealerse -reframtonneagim wneh ltituasdme with sntaigen erdevdi mrof M. eruuobss.tcil


 +2  (nbme21#47)
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ryehidtaer mcohosstiharoem.

HFE si uetmatd ;=tg& het iessnttine rtayeelulpp rrnpteeti a rtosgn rfnneitrasr lnigas sa if hte obyd ewer ifeidntec in sTih lsdae to amxilma orni taiorsopnb mfro esgeidnt doofs dna inro eolvdaro in hte


lovebug  Autosomal recessive. C282Y mutation > H63D mutation on HFE gene, located on chromosome 6;associated with HLA-A3 [FA2019, PG.389] +

 +0  (nbme21#32)
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ymBnicelo si kwnon to sueac lngu dna kisn iioxtcty edu to earitvel bencesa of eysroadlh ni ksin isetsu ginlrstue in ecesdraed baeistmmlo and deyelda alace.ecrn anlPrmoyu lcmtopoiciasn ear mnoocm tub iksn ecnahsg aer rear nad dneuilc hgn,pei-iptymaertno eu,laqps pctraoyieethkr olnisse, hymraeet ofemm,litur eai,lpaco tttmsiasio and nali cgn.hesa Teh ecatx esnammhci of nkis ecshagn uscead by cmbeyinol is nto no.wkn eTh ntteertam nvivsoel naemgetamn fo gednnurlyi sreridsod or hatrldwaiw fo het iegnfnodf rg.du


 +0  (nbme21#40)
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rrutsSceut tinwhi eth torue le)lr(ata wlla fo het tmcrpmoneat omrf iorpsreu ot crmni oolrro:tefiOuo eeTrecovrnahrl m haOcvphetlerni and axiymallr bhanrecs fo eth igitmelrna e eercturuSrntvs naisspg trohhgu het nimdile a(d)meli callne:Aswbdu nnaeervneItrl coatird ayrert ndicaaoepcm by the lnaItern ociradt peuslx


 +1  (nbme21#17)
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cGtsira rsaivce are fde by hte hsrto cgtsria .enivs


cienfuegos  Add'l UW fun fact is differentiating from gastric varices 2/2 PHTN: Gastric varices: can also be seen w/ splenic vein throbmobis 2/2 chronic panceatitis, pancreatic cancer and abdominal tumors - gause gastric varices only in the fundus (remainder of stomach and esophagus usually not affected vs. PHTN: increased pressure in left gastric vens thus both gastric and esophageal varices) +5

 +3  (nbme21#6)
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nI adssiioco,rs ermaepachiycl nrlolaym sspsespreu hte elersae of PTH and herfrteeo hte cduotnopri of rlilacctio e)fd,hdoer,yxclcoli1(cho5la-2yir tbu ni siosdocsari nad ohert mrulasnaugoto dsee,sias aceattdvi earmonolcun esllc rcplaault(ryi meracoa)gphs in het ulgn dna hpylm nedso cpreuod ioltliacrc hrcol2xda,lo1)ye-cc5rfhe(idlioy mrof oiilcdacl llxdfoiecr(-ecro52c)aloyyhh depnnentide fo T.PH


dr.xx  ~~In sarcoidosis,~~ +
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +

Subcomments ...

submitted by sattanki(71),
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uecsMl npai + pbetolairir emeda is a slcasic soreptneaint fro loleacinhrt sraii.psl tsBe odnigssia rof tsih si a cusmel obi,ysp sa teh wyrom elski to ghtonua twhini the

sympathetikey  That's what you get for killing polar bears. +86  
dr.xx  That's what you get for not cooking them well. +4  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2  

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noFernbiict is an llacetreulxar raxitm tlgoiycoe,rnp iwlhe nimla si an adeientmtier iaemtfnl hatt elcsfialpyci opidsvre uspport to hte llec .cenulsu on’tD fescuno mlnia with lnainim ecin(sec hetas us lalry;)ce nailmni is ielk btnneicfior, an ECM poycgnotilre and a oramj moecotpnn of the alabs amnlai fo eamsbnte emraembsn.

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) +35  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +3  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +  
brise  @abkapoor the f is progeria? and do we need to know it for step? +  
brise  @abkapoor omg jk jk wow +  

submitted by neonem(572),
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lilagnF no udohtettrsec dnha: cidoapsh si mtso oncmom eno ot be uecraf,trd tlnuea is tosm mmnoco to be codditl.esa nuLtea idcoiolasnt anc csaue cteua palrac nnleut n.mdseyro

knThi of eth ocmminne "Satirgth iLne To ,iyknP Here oeCms heT Tmh"bu fro eth enbso of het aplm, wnirgda a oblfolat pesha titgrasn wlbeo teh uhbmt PMC ojnti dajecnat ot hte arisd,u hnte oinmvg ot rouy delmia wt,ris nda etnh abck to hte mbhut.

,iSdopcha ,launte qmiuuerr,tt sr,piofim ,amahte tatc,paie ipo,dzetar patemu.zri hTe unlaet lkoos ilke tis' lroiotrpyse liasodedct erh.e

sympathetikey  Yep. I didn't even look at the X-ray. +11  
dr.xx  loonies love lunate +2  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +1  
wes79  i legit have no idea whats going on in that xray lol +9  
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +1  
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +3  
niboonsh  Some Lovers Try Positions That They Cant Handle +10  
vsn001  ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D +  
regularstudent  Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic +  
sars  I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome. +  
makingstrides  Another mnemonic, Some Lovers Tried Positions, That They Can't Handle +  

submitted by m-ice(340),
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Teh napetti ensde aedclim eoatitntn latidi,ymmee hihwc esnatiilme atnignibo a rotuc o,errd or itrenransrgf hr.e A suren esdo tno vaeh hte amse ingtianr dan ncqiuiftoalsia as a canpiihys, os ti dulwo eb aroipptinpaer to ksa htme ot mnieaex hte naetipt. nskAgi teh oipltahs acpilnah gaani ludoc be otpiaa,nierprp adn wudlo teak more .time e,hferoerT the tbse toponi nagmo toshe ngive is to aks eth ipetant fi hse lliw llwao ihwt hre bdauhsn

sympathetikey  Garbage question. +60  
masonkingcobra  So two men is better than one apparently +29  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +12  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. +9  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +16  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +26  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +5  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +12  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +11  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1  

submitted by tissue creep(114),
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I aetdert isth elik dWgrenin aSMffo/nHmA eg"(tuon ai)fc"aulsscotin, adn utsj nkid fo pdccetae it egnib wride to eb in a 5lr-eyo.5ad-

dr.xx  SMA4 (Adult-onset)? +  

submitted by yotsubato(1041),
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ihTs is a otqniues tuoab tntiaep .vycipra Teh attnipe heer si eth lc.dhi Teh ypoxr ofr eth tenptia si het rothem dna faeth.r hyTe must nwok tahws o.gwrn rSsite nad eomhtr ear usjt kloylsoo,o and prtsane may otn atnw ot llet ehtm s(puidt I wkno, tub e)teawhrv os you dsen ehmt uot and hnte letl eht pasnrte het ius.niaott

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +28  
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +10  
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +5  

submitted by lfsuarez(143),
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sriFt arthe nodus S)1( si ergatedne yb wot aterh vavls:e hte tirmla valve nda druisicpt a.vlve yNlear toesulsianmu sgcolni of seeth avlvse lonlryma eeagsntre a gsieln 1S duns.o piltigtnS of the 1S ondus is hedra hewn talrim and idruitspc vvlsae elocs ta ilhlsgty teriffedn ,msite ihwt saulluy the arimtl gnioscl breoef pitruiscd

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +25  
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts. +36  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +4  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +1  
drzed  It shouldn't matter where you hear a split sound. For example, no matter where you auscultate on the heart, the second heart sound in a healthy individual will always be A2 then P2 (whether you are at the mitral listening post or the aortic listening post) The key is recognizing that the right sided valves in healthy individuals will always close later (e.g. the heart sounds are S1 S2, but more specifically M1 T1 A2 P2). The reason for this is simple: if you take a breath in, you will increase preload on the right side of the heart, and thus the greater volume will cause a delayed closure of the valve. This is physiologic splitting, and is better appreciated in the pulmonary and aortic valves because they are under greater pressure, and thus louder, but it can also be heard in the first heart sound. +10  
alexxxx30  yes agreed!! This question is mostly asking if you understand a few basic things regarding cardio physio. The left side of the heart is the higher pressure side so left sided valves will close first. The right side of the heart is the lower pressure side, which means right sided valves will open first. [Left closes first, Right opens first]...Secondly, it requires you to know what S1 and S2 sounds come from. S1 is the mitral/tricuspid valve closing and S2 is the Aortic/pulmonary valves closing. So really the question asks what is the first component of S1 (mitral or tricuspid closes first). And since we know that the left side will always close first, it must be mitral valve closure. Sorry if that was a long explanation. +10  
jesusisking  Thanks @alexxxx30, you the man! RIP Kobe +  
yesa  @drzed unless it's paradoxical splitting Ex] aortic stenosis, then it is aortic valve closing first at S2. +  

submitted by nlkrueger(44),
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.... doluw we ayelrl kaet eth dowr of a feinrd how feietnilyd 'tnca eb mdfcein?or I lefe elki this is nsmelgidia

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +9  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +31  
dr.xx  The patient has no wife, children, or close relatives... +3  
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3  
paulkarr  With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1  
suckitnbme  I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +7  
vivijujubebe  they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +  

submitted by mousie(220),
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naC oeonmse eaespl eiaxlpn this ot ?em I ont'd ntuaedsrdn ywh trngatis teh hrteo rudg lwodu ont tcuon sa nleucoxis aericir?t

seagull  This has to do with Intention-to-treat analysis. Essentially, when participants are non-adherent but the data shouldn't be lost. They just undergo another statistical model to account for their changes. Here is a nice video +22  
dr.xx  Where does the question mention "intention-to-treat"? +  
notadoctor  They seem to be pretty obsessed with "intention-to-treat" it's been asked in one way or another in all the new NBMEs that I've done. (Haven't done 24 as yet) +8  
wutuwantbruv  They don't, intention-to-treat is just the best way to go about it @dr.xx +  
smc213  Great for ITT: +4  
yex  I agree with @notadoctor !! +  
ergogenic22  i think if it were per protocol, both groups would be excluded, the ones that were inconsistent, the ones that dropped out, and the ones that switched. But answer choices only allow ITT or exclusion of one group. +  

submitted by chris07(57),
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m'I eugignss htat niecs tsih si htms'oiahos htta a obpyis of het ihdoryt udlwo shwo hte oyitrhd nglda eolypmclet gfnleeud yb ctigntaka plo.esctyymh veOr mtei ut,gohh oduw'tnl teh dothiry be loemylptec toeydrdes and irb?tifco

dr.xx  Progressive thyroid cell damage can change the apparent clinical picture from goitrous hypothyroidism to that of primary hypothyroidism, or "atrophic" thyroiditis. The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. +  
paulkarr  I was thinking that "Diffuse fibrosis" was trying to point to IgG4 Riedel Thyroiditis rather than Hashimoto's. +6  
spow  It's only been 10 months, per the question stem. This probably isn't long enough for fibrosis to be correct +1  

submitted by meningitis(546),
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ssPreoc fo eannoitiiml on siht .neo

  • I emeitadlin lCamrbyo psahepoh,t irgineAn ude to eura ceylc.
  • I dinteailem TAP sbeuaec PTA loena ld'wutno ghaecn FP6 ntio euscmgnoali
  • GAN I tog yclku nad I ieandmleit ti deu ot tis use ni CME dna llcoeagn os I 'dndti inkth it wsa lnaetrve dna I kndi of mmedreeber ti geinb in euar
dr.xx  you mean, pure luck? :) +13  
impostersyndromel1000  lol pretty sound logic here mate +3  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  

submitted by marbledoc(0),
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htWa is thsi aoceitinmd gbnie ireecbdds e?her anC mnoosee hmcie .in

thatyummyslice  Nitrates i believe! NO --> increased cGMP in vessel smooth muscle --> myosin light chain dephosphorylate --> vascular smooth muscle RELAX --> Dilate (primarily in venous) AKA more venous capacitance --> LOWER preload and workload for heart. +29  
marbledoc  Thanks! Thought it was nitrates too from the Q stem. But had no clue it was notorious for headaches (only thought of hypotension, dizziness, etc) so doubted it all together. But you’re absolutely right apparently it’s the most common side effect! +  
dr.xx  Previously, Ferid Murad et al. described that organic nitrates, such as nitroglycerine, induce vasodilation by release of nitric oxide, activating soluble guanylyl cyclase and subsequent cyclic guanosine monophosphate formation.7 These discoveries rendered Robert Furchgott, Louis Ignarro, and Ferid Murad the Nobel Prize in Physiology or Medicine in 1998. +  

submitted by nosancuck(87),
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Dma son iths lil b otg oems LITMDUIBAEC ocluusMml all pu ni her enisbzs

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +1  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +7  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  

submitted by moloko270(66),
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tish is lneralWegb nmdyreso - kteosr sedcau yb oirstcoubtn fo IPCA - os ahtst why ew egt ytsmomsp of ysihag,adp ,rhseneasos ntbaes gag elrexf p.( 250 A)F

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already +2  
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this. +22  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +  

submitted by mcl(601),
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Hiomrelg otg osme lcarcvie teuolt rdnmseoy adn usoldh rbpobyla akte smoe sufft uto fo ehr kacbpakc or gte one of theos lil rlerlo ens.o

mcl  Whoops, my bad, THORACIC outlet syndrome +4  
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1  
homersimpson  Anybody else read @mcl's comment in Tom Haverfords voice? +  

submitted by iviax94(7),
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CT sowsh smas no het etfl dsei of ish nbameod adn or’yeu dolt sti’ s.einoscsuptinut ssAk hhcwi tarp of het GI acrtt si tmso liylke ot saceu hte I miyldteaime kleood rfo cilleecoa otinjunc ... nto an rwnaes c.ohcei yhW is teh anrews ujmejun (sv. udun)?odme

liverdietrying  The picture is key here. You’re right that ileocecal is most common, but ileo-ileal and jejuno-jejunal are the next most common (I think I might just know this from having done clerkships already, not sure). Ileo-ileal isn’t an answer, so that rules that out. Look at where the arrows are pointing in the picture as well. Its on the L, ruling out appendix and cecum. And the slice is not at the level of the duodenum, ruling out that answer. So by process of elimination based on the picture you could get this one too. +4  
dr.xx  Duodeno-duodenal intussusception is a rare because of the retroperitoneal fixation of the duodenum. +1  

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yarHiedter (ro icrdeauq) ogadnmiaee = C1 biriohint yccdniefi.e tPtaein ahs a r9-eay Hx of fost uteiss wils,enlg eplieysacl fo teh fae.c tIs' maulootAs mnoatnDi fi ,dteniheri ro nca eb ieuadrcq ohthgur uetpilml smcn.hemias


dr.xx  wrong question? +2  

submitted by nosancuck(87),
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aDm sno hsit lli b otg omse IBTULAMCEDI ulmlocsuM all pu ni her neisbsz

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +1  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +7  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  

submitted by lnsetick(94),
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  • iPncerAo = ouyr rpaistm lsmel leik an APE
  • URcMeen = heet’rs on OORM ni oyur rsea snice etryeh’ full of axw
  • RCnYCE-e = hewn ouy ECie,scer ryuo peosr aer RngYiC
  • soaSeBEcu = mESBu si iPnEgES uot of uroy rsope
hungrybox  as an ape i'm offended +31  
dr.xx  stop being an ape. evolutionize! +7  
dbg  as a creationist i'm offended +11  
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. +2  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +1  

submitted by nosancuck(87),
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yuo nowk woh ti is deez ibos gto dat afaicl HUSLF deu ot lretxean alimtsinut

dr.xx  please use standard English. I cannot understand a word of what you are saying. +8  
aishu007  FA pg 468, facial flushing due to external stimuli like spicy food. InAammatory fac ial skin disorder characterized by erythematous papules and pustu les 0 , but n<> comedones. May be associated with fac ial Rushing in response to external stimu li (eg, alcohol, heat). Phymatous rosacea can cause rhinophyma (bu lbous deformation of nose). +2  
madisonivy +  
madisonivy  madison ivy +  
an_improved_me  Didn't know Madison was getting her MD; same as Dr. Johnny Sins! +  

submitted by dr.xx(153),
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nI ior,soiascsd pemeiaclcyhra ornyamll ppursesses het alesree fo TPH dna ftorreehe eth iucntdropo fo riccalltoi ry-hi,aeholcr,5lex1yd(2icf)doclo tub ni sraoscsdoii dna orteh gauoatnuolmsr ,sasdesie aeacvttid emcolrnanou celsl pytcrailla(ru rcagohs)epma ni teh gnul dna plymh nsdoe epcdrou croiitlcla (rxelhlc1,coed)d2ryolya-c5ihfoi rofm lldioccai cl2fhceiocd5-rheyo)oryx(all nddeeteinnp of .TPH


dr.xx  ~~In sarcoidosis,~~ +  
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +  
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +