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Welcome to dr.xx’s page.
Contributor score: 129

Comments ...

 +6  (nbme23#35)
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.hitrg eh suabletyol sutm armien in eth niigwat reaa os thta eh is at nahd ot tctaak his fiwe nrvwheee hre maxe og NEM!B

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. +
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 +1
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. +3
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! +

 -10  (nbme23#48)
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... that and a pshyc lnustoc orf eht ioszch tm..eo.rh

 -1  (nbme23#33)
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euAsb fo sxvaatiel ;t=&g uauslyl ceeeasdrd muesr .matoiusps sA to roecdlhi dan i,acbrb taht .eddpens yheT odulc be idenrscea or cseer.edda


 +1  (nbme23#49)
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mtneTetar of uteca ygtou ehsrtleirSaatvir sugdr rae eicftevfe orf nnirgmtteia the euatc ugtoy ttca.ak iilceCn,ohc sreitnoldaon rttny-mlaoifmiaan gsudr )N(SsAD,I nda iiorcstootrsdec are tnadards aare.cphops cdcAnrooeipcoirrtto roehnom ATC)(H si salo evry ftefveeci, tub sah eebmoc ilynrgcseani rccase or oot ivneepxse to be a pcicrtlaa ianreevltat in the .US sergalResd of hte citlarurap atnge cheons, eth oreosn tshee sgurd rea tdatres, eht mroe rapdi hte erneossp. If a intptea nconta kate DAIsNS ro ci,iloccehn the oicehc si amngo ,alro lcaar-inituratr ro nraetalper cdouirgc.cltosio coaLl alppnotiaic of iec paskc mya ehpl oocnrtl a.pni nI eosm caes,s cags,eilnas nduinigcl ,soidipo may be .edadd

uDsgr atth fctfea mresu rtaeu tncosrnncoiaet ..(EG, RLLIUOPN),LOA dciingunl ermticniryuhicape ansgte, loduhs tno eb neacd,gh ,etrdats ro dposetp during na a,tackt sa tihs aym roswne eth ymnalotifamr eresspon alyeadr ni ergprss.o


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

 +1  (nbme23#45)
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RSSIs upercod a tidssauen esraince ni auxrctaeellrl 5-TH in hte rlaods ahepr (RD), and hist lesad to utnioaibnhitio fo rrooetcnisge nesn.uor


davidw  Pg 483 in firstaid has a good table of where the neurotransmitters work +5

 +0  (nbme22#31)
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The msto tptrimoan wseat dtcopur si imamnao (.HN)3 iTsh laslm lceloemu sroescs het loo–rabndbi airrreb nad si besdarbo nda ibtodslmeae yb hte stcy,aeorts a uaotpinplo fo sellc in eht brian hatt teosnusttic %30 fo eth reaclber xoer.ct cttoArysse seu ominama wenh gisestnnsiyh nitagleum romf .tgatmluae Teh earsecnid slleev fo ngltuimea leda ot an rencsaei ni cosotim ressreup ni the rste,ocatsy hiwhc cmebeo eTreh si eendrisca tctayvii fo het bhyriiniot -biyuncramγoti aidc ABG)(A estsm,y adn eht neeryg lyppus ot roeth irabn lslec is radd.eecse ihTs cna eb tthghou of sa an emlapxe of brnia aedem of the "ixoc"tctoy t.pye

 +0  (nbme22#49)
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dMoaciinte gssaedo oldsuh be dteratti lpproytm to icehave vieeetffc npai lo.tcron


 -11  (nbme22#25)
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hTe lsc-lβe heav eveldov a nemmcsaih ot tedcte hte atmuon of isnnlui tesdor adn rdetesce dna dstjau iinulns ssestiyhn rgiydcaco.ln A rnlageu nnmaetrmbarse poietnr dcaell tesil ellc iougnaatnet 215 51(ICA),2 si a cuailcr tpra of sith ekabfdec crto.lno inunlIs ugrsnela vrelat a goln disctnae no tbulniu tasrkc obeerf nivrgira at the rhreelpipa atcni krwtoen .[52]1 eBoerf egmniocb eklidn to eht ,etlyeknosotc nuisnli rgeuasnl are oacndhre to tcina crtxoe iav 152ICA and nyr2sopihβ-hnt. onpU itatci,naov eht earnulg nreammeb ssfue niarsteytnl to teh clel enmmerab to aeslree i.unlnsi dtvEeeal +2Ca llvees ni the ietnamme itvaatec eth earospet ianpalc-μ to eeclav wyaa a ocotislcy fnretgma frmo A1CI52. Teh reef C2AI15 isyocltoc etngamrf nthe smevo ot eth lsueucn nad dsbni ot het pysaop-tdielehnsroryoth ralntnpracoiits fatroc 5TAST to tpevenr TSTA 5 mrfo nepoyth,ladrhiopso hichw ni ntru eupgtsaerul nilnusi rsricintotpan ]217[. erulacN refe CA215I oosltycci rtagfsnme saol nidb to gniuomtasyl nezemy .SAγIP The intoyoualsm of I25A1C yb PISA γ rvseeser teh indnibg of 5C21AI ot TTAS5 ]72.[1 e,ecnH eht leesear of nuniisl omfr srcoteyer ulnagres is ocnmtaidcmue ot teh unse,clu chiwh vesser as a itspoiev fecdeakb hcenaismm ot iitneati snnilui tolrinsaatn fro itagiainmnn an uetaaqde tunamo fo stoerd sln.unii


anjum  Bro wat r u doin with this explanation +1

 +3  (nbme22#6)
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ehT t estt si oen ytep fo etirafennli It si sedu to eimrdtnee erhtewh heetr is a ningfacitis feerenicdf eentweb teh neams of two .sogpru


 +6  (nbme22#45)
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As rpat of ibnerycmo elvetod,pnme hte searpcna fsmor sa wto udbs mfro the outf,egr na orimcyneb ubte atht si a rorrpsecu ot the enrtasgnlotsiiat It is rhoetrefe fo mordlneaed irg.noi


gh889  nice! I reasoned it as that most of the GI system is of endodermal origin +7
taediggity  FA 2020 pg 613 +1
mutteringly  FA 2019 pg 599 +

 +5  (nbme22#34)
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rEaptBisrn-e vursi E)(BV is irrdaec by mtos tI anc auecs svelare tsyep of ce.carn nI hytleha fdtinece l,eoepp BVE rsptessi orf ilfe in a la"t"tne tstae in B sl.cle


 +4  (nbme22#12)
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Teh rufo ypest fo uyhsrchpaldoe aer gnmoctci,mniua ncnnncamutiogm,oi xe vca,ou and lmoarn rrspues.e Daisoigns is ailylypct maed yb hacsyilp enamnatixio dan cidmale .gmgiain

cHlopdasyhure xe covua laos ferser ot an matngerneel fo aercrlbe tevslcenir dna ihsaocdrbnua escps,a nda si yaluuls edu to brnia rhoypat a(s ti csruoc in ),imtedanes ctiatp-mtosaru brnai eijrusni dna vene in mose isyctiprcah dr,esdsrio husc sa srin.hiceopzah sA sodepop to ,podeashhlyrcu isht si a pnsmtyoarcoe tnregnmaele fo hte esFs-SaCpc ni pesoesnr to inrab erchanypam ossl; ti is otn het terusl of senecraid CFS sersue.rp


 +2  (nbme22#46)
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itailnybI to klwa tannco eb xdlnaiepe yb elacdmi ateui.lovna ;==t&g vsnoroenCi esrordid

 +2  (nbme22#43)
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irHytraeed .eaonaedgmi Tpey I nad II rea audsce yb a intamotu in eht EISRN1PG neeg ahtt makes hte 1C nbtiioirh ptri.neo


 +2  (nbme22#1)
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CHF paitsnet fonet apyidls ssgni adn pmmtsosy of asneicerd vorseassinp ciere.tosn

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!!! +

 +10  (nbme22#18)
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ltuerbPa ncstiyaagmoe is hgtouth to eb a hlogoycilsaip hepneonnm,o nda is mtso onlcmymo nese ni etdibyuprm ihtw raenTn etasg 34– bpiuc iarh and uatclerits svlemou of 5 to 10 Lm ltleaylra.ib


 +5  (nbme22#23)
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lyempaoivHo si a rdeitc olss of ifeveftec gaitrunlcci ldboo omulev nlagedi t:o

  • A piad,r ekaw, ethrayd eslpu deu ot reecadsde dobol wlfo mdneicbo itwh traadicaych
  • loCo, ylmacm insk due ot itvcaooocstsinnr dan litiuonatsm fo nonsiricoaocsvtt
  • Riadp dan lohsalw aegnbhrti due ot yapihtmtsce overnus stesym mtiaulstnoi and isacidos
  • tehmpryaiHo ued to cersedaed efnursoip nad iataenrvoop fo wetas
  • hsrtiT nad dry ho,mtu ued ot dfilu ptenielod
  • dClo dna tldoemt ikns edvoL(i e)sctariurli, lselcpaeiy tiie,exrtems ued ot eiifcfiunstn rospnuefi fo the niks


 +2  (nbme22#21)
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The smot oommnc nad everes rfmo of uoslmtoaa aniontmd iptyoccyls dnkyei iaseeds PD)(KAD estrlsu morf umiatntso in 1,KPD dnngcieo onscl1iytp-y 1)P..(C


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. +12
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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genaCoinlt renldaa leaayshrpip ued to d2o1h-aysxelyr e.dyciiencf


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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Sveee,r pilrday lvgieonv etdsnemasdii lvnarcsiuarta uoltoiancga ()DCI saucse ycomnptrtehibo,oa pnotedlie of palmsa ilcouogtnaa tcrsaof dan en,iiobfrgn adn libne.deg


 +3  (nbme22#2)
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esbFrita edcesear eydetcrgisril by gnedurci the untoopidrc of DVL.L

 -1  (nbme21#17)
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rMoe :synfefullerfAt ot rcitgsa csir.aev heT enrfsaeft to GV ocme omfr elft ciatrsg v,ein rthso rgtscia sveni dan psroertoi tcgsair niev eth eltf atgcris veni nmalyi unoseitrctb to rmniotaof fo racadic sciarev eesawrh het torhs ticasrg vein nad ersroopit citargs vnie oitcunrtbe to iafonrmto of uadlnf .evcrais aetosdIl ctigars esrvcai aer oerm liykle to eb detlaer ot pecrgioapslotei nv.eis


 -2  (nbme22#5)
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rlNaom rieyrsotpra erta for a 01 othnm odl g;t& 50 ebarhst per n.mutei

xeaoolnN lsuohd be iegvn in the epsecenr of arstroperyi ndeissorep and aym eirrueq tdpaeree dns.ogi


 +7  (nbme22#20)
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RIM si gyhhil sieietn,vs i,ecsifcp dna auractec in eth ntiteodec of .NVA

w-hiedgte1T sigm:ae VNA mtso fenot estepsnr ihwt a irnetcc,sec nlkiierg- ro llew edinefd bnda fo lwo nailgs nhtiiw eth sprueiro ontorip of eth dhbrlaousnc oealmfr eadh nobe w.arrom ihsT nabd is thtoguh ot stpreerne eth eivtrcae earictefn wetenbe eht tecrcnio and etaervrpia nszoe, and actllypyi sdexten ot hte hosncrbdaul te.pal


 +2  (nbme22#47)
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The rmlkahal of PTI si lditsoae noheitar.ocybmtpo


jboud86  Refer to page 419 in FA2019. +1
hello  @dr.xx Compared to what? +

 +3  (nbme22#13)
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guDnri tsih itlaini reun,tocen ew bthselsia whta teh trnaeps' occsnenr a,re obinta a liayfm oryi,sth nda aks taobu eiorpsuv idmceal ombsrelp. sTih ngbsie het iirsttonan morf reptan to nete as the limecad ih.ositrna eW exnt ska pratnse ot iatw in the nwtigai rmoo os ttah ew can epask laryietpv hitw teh .snetcldaoe We ieriwnvte eth deeotalsnc nloa,e roemfpr a slcipahy nntieiaxamo hwti a hoea,crnep dna enht itevin teh renastp bcka onti het ormo ta eth nlcsoocniu fo the ivtsi ot isduscs rou


 -6  (nbme21#9)
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Hnassh-Hesdlreacbeno tHupioE:q an = 16. + C3gO(lHo / 0(3.0 * 2)O);aCP os ereh, Hp = =&t; 9.g62 utecA )oencu(tadmsenp rraimyp toyirrerpas i,ih oasstdwic bclmteaoi siodicsa

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

 +8  (nbme21#49)
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cMlomluus otgosincuma si dsecua by a svxirupo cadlle het lculmmosu ocmstguaoin rsvui MV).(C nI tauob %01 of eth ,seacs maezec oeevsdlp anruod teh snsel.oi.


 +4  (nbme21#7)
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nAmgo eth tmso rpvatneel cihoagotmle asabitnerimlo ni tatesipn hitw grhloiutaeocm sdrroides rea teh eimnaa of ncrihco asedise D)A(,C a mdli nmaeia thta si lerenygal ,pmstoiyacmat dna inro cdicefyine m.naaie

nI dinyniciofece-r enam,ai het BICT dluwo rhighe tanh 00–4504 Lgcmd/ usabcee etrsos uwlod eb l.ow

tinsPtae tiwh AR oalyconcasil ahev rntunrccoe roin niyefidcce einmaa dan CAD. nWhe this occsr,u teh ligenbomoh leelv uauylsl dposr to welbo .95 gd,/L adn het VMC is lsse ahtn .80


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

 +3  (nbme21#38)
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xelPilaatc istabziles the utbrulmeioc oreympl nad etrcsotp ti orfm edsem.ietak_oleesiooatgc/ntlii/.irpa/cfhM#ihc:Pwwipntk_ais/nxad

 +1  (nbme21#43)
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nI sotm uidiiavnsld cifnteed with M. olsutur,ecisb anrocluomne selcl in eht ldboo saeeelr enrmrtfamo-gaeni henw mtitsaledu ithw nisgtnea dderevi morf .M buseitrclsuo.


 +2  (nbme21#47)
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htdrariyee risomteoscoa.hmh

FEH si ettamud t;g=& hte ettninsise uypalrleept enrtteirp a rtgson tsnrnrfaeir lgisan as fi hte odby erwe tnfiiceed in orn.i shTi dsale ot imamlax iron opbinatsor omrf geisntde oodfs dan iron veldaoro ni eht se.itsus


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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nyBeioclm si nwonk ot ceaus glnu nda iskn tixiycot deu to aeevtlir csebaen fo rydaslheo ni iksn suseit gnulriest ni eacrdseed slaiombtem adn aeyddel acenlrca.e mlyauPrno isocpocnltami rea onmcom utb nksi esnhcag rea rera dan ndilecu atnmepoirhgeniy,pt- uepasql, eparotryietckh ,einloss myrtheae mmiulr,ofte aeaco,pil sotttasmii adn inla .egsachn The ectxa esnchimma fo nkis hnsecag dcaesu yb yibcenoml si ton oknnw. hTe rmtteneat lvnisoev eaemnamtng fo ngdlrneuiy oidsserdr or dawrhtilwa fo eth nifedgonf drug.


 +0  (nbme21#40)
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trSrcuutes nhtiwi teh eortu etlal)(ra llaw of eht mrcteomptan rofm soerprui ot Oi:onm rtlocuioeofrr nalcrhe Torerev rcalnpie mehOtvh and aamliyxrl abeshcrn of teh reigmnitla vreeteutsrcruSn aigssnp uthrgoh hte iienmld m(lde)ia :cbnuAalel sdw nvIrealr etnen trdacio rreyat caocpdimena by teh rtnleIna racidto xupels


 +1  (nbme21#17)
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cirsGat acirvse rae edf yb teh thors gtiasrc nivs.e


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) +3

 +3  (nbme21#6)
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In iasds,iooscr rahempliyaecc anlyrlom psrspeuess het ereales of HPT dna oferhetre the otnroducpi of ccllroiait ifyerllhrde(-,o,a5lycc)i1xho2cdo btu ni orioassisdc dan erhto trsunaomauogl ,idaseses etitvdcaa moonrlacuen leslc ltyrcirpuaal( rgaop)hamsec in het gnlu adn hympl odsne ceourpd liialctrco ecehridiord,)o5f2-l(yhcly1locxa fomr dalocclii hyf2xeahrlc5-rloe(cldiooy)c ntenniddepe fo P.TH


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(56),
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eMuscl pian + peralbiorit eadem is a sicscal trinsentopae fro rclenhltoai tsBe giaosnsid rfo this is a lcsume ,ysbiop as eth yowrm eslik ot uhtango iinhtw the slmsec.u

sympathetikey  That's what you get for killing polar bears. +52  
dr.xx  That's what you get for not cooking them well. +3  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2  

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irbieontnFc is an altxlralrecue ritamx tygoolpecrin, ihlew ilamn si an reidetamenit tifmenal hatt aypsliieccfl eirposvd rotppus to teh lcel usel.cun Dno’t cuosfen ilmna tiwh limanin csecei(n tesah su eac;llyr) mnilina is leik iofe,ntnbcri an EMC lyoctrnopeig and a rajmo mnoecotpn of eth laabs nalaim of mbnestae ea.mrmebsn

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) +17  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +2  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
gandon  I used to kill and rob people before I found Lamin. He died for my sins on the Cross and changed my life. +  

submitted by neonem(503),
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lnlFgai on cuoeredhttst :ahdn dohicpas is smot nocomm neo ot eb u,terdarcf letnau is msto comomn to eb scldi.edoat nLeuta ndsoticilao acn uasec aeutc aclrpa tnenlu d.nremyso

ikThn fo het moinnemc g"trithSa ineL oT k,inPy eHre Cesom ehT ub"Thm rfo the osenb fo eht ,lpam anrwdgi a afllobot ashep atirgsnt oewbl het btumh CPM jniot aecjtdan ot eth ,sruaid nteh gvmoin to rouy imdlea ,trwis and hetn back ot teh .umbht

chSpoad,i tnlaue, tu,rmriqtue sori,mipf atehm,a atiecatp, oirtzpd,ea eza.turpmi heT uetanl osolk lkie tis' rioeyoslrpt oseciltdda her.e

sympathetikey  Yep. I didn't even look at the X-ray. +7  
dr.xx  loonies love lunate +2  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +  
wes79  i legit have no idea whats going on in that xray lol +8  
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  
doctorevil  She Looks Too Pretty, Try To Catch Her is a mnemonic that works for me. +  
niboonsh  Some Lovers Try Positions That They Cant Handle +7  
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. +  

submitted by m-ice(272),
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hTe eantpit denes aimldce nateoitnt eeiit,lmyamd hwich setimailen tbonniaig a ucort o,redr or astfnrrrgine .erh A snrue esod ont vahe hte seam anirntig dan cfniiuoisalqta sa a cpshyna,ii os ti wulod be naappoerrtpii ot sak temh to emeinxa teh tnatpie. skAign the tapolshi lphnaica agani cluod eb trperapaiio,np nda uldwo taek rome .mite eefTer,roh eht sebt otinop nagmo ohtse ingve is ot sak eth aptinte fi esh wlil lwloa hwit hre bnduhas pn.reste

sympathetikey  Garbage question. +44  
masonkingcobra  So two men is better than one apparently +23  
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? +10  
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. +8  
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. +12  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +20  
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 +4  
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. +10  
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. +6  
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 +  

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I edretat hits lkie ngieWdrn n/ffMSHaAom g"(uonte ,atisuisfaon"c)cl nda tusj kdin of eadctepc ti begni iwred to eb ni a 5l-oa.ye5r-d

dr.xx  SMA4 (Adult-onset)? +  

submitted by yotsubato(806),
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Thsi si a estuoniq tobau ipettna r.paycvi eTh ieatnpt ehre is hte hd.lic ehT oxpyr rof eht teptnia si the orhtme dan hTye stmu oknw ahtws or.nwg itSser nad hmrtoe ear jtus oolkolsoy, nda trepnas yma otn ntwa to tlle etmh tudisp( I ,wonk tbu eerwv)ath os oyu sedn ehtm uot adn tneh letl hte neptras eth .ittsnuioa

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +21  
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. +9  
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +2  

submitted by lfsuarez(132),
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irsFt erhta udnso (1)S si negtdeare by otw earht levas:v the ltiamr avlev nda rcsidiutp lNayre stmileousnua gsloinc fo shete velavs aloylmnr enseetagr a nsglie 1S Silitgpnt of the 1S nsudo si dareh hnew tilamr and utcsdiipr sevlva scloe at tyghllsi ffteidner tm,sei hiwt yluausl the tiarlm glocsin fobere itdpcsiru

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +18  
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. +20  
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 +3  
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. +7  
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. +7  
jesusisking  Thanks @alexxxx30, you the man! RIP Kobe +  

submitted by nlkrueger(33),
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.... wldou we eallyr kaet the orwd of a dnfeir woh eiteifnyld ct'an be mce?ifrodn I fele ekil htsi si elminsdiga

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 +20  
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(171),
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nCa emesoon lesepa nlepxai tshi ot e?m I dont' sddnutarne why iagtntsr teh etorh durg uwdol not cnotu sa lseixunco r?riitcae

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 +15  
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(43),
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I'm ngssgeiu htat sienc thsi si mshs'ahoiot htta a byisop of the yidotrh wolud hsow hte oyhdtri dgaln mlepyoclet fdelguen by atgncaitk .cohylyetpsm rvOe meit uh,ogth no'lutdw the tirydoh eb omytepllec yesdoretd dna ifbroti?c

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. +5  
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(413),
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sercPos of oetnaliimni on tshi .eno

  • I edmalietin oybalrmC heopsp,ath Arnniegi edu to earu ecyc.l
  • I leiteanmdi TAP eabcsue APT oalen nowutd'l acghen 6FP otin nmoaisgceul
  • GNA I otg klycu dna I iiamedtnel it deu ot tis ues in CME and llacgneo so I t'nddi kntih ti swa rlnvatee nad I kdin fo bmrereemed ti gienb in eura cc.yel
dr.xx  you mean, pure luck? :) +12  
impostersyndromel1000  lol pretty sound logic here mate +1  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  

submitted by marbledoc(0),
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haWt is itsh tnomcdaiei ingbe ebcedrisd hee?r naC seonemo himce ni.

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. +14  
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(74),
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amD sno hsit lli b got soem IDEMBLUCTAI lmoMsuluc all up in hre snsebiz

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 +4  
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(60),
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siht is elrlebWagn mordsney - krteso cuadse by onbitrotucs fo AIPC - os sthat ywh ew etg pmstosym fo ,siadyphga s,hserenaso tsaenb gag fexerl .p( 205 AF)

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. +10  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +  

submitted by mcl(517),
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ilegormH gto emos alicvcer oelttu deonsyrm and slohdu baolybpr etka emso fusft uot fo ehr cpakcakb or teg noe of othes ill roller .nseo

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  

submitted by iviax94(7),
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CT ssowh assm no eth etfl sied of sih doebman dna eu’yor dtlo ist’ upns.iousntsicet kssA hhiwc rpat fo eth GI ttcra is tsmo ylklei ot acseu teh .pian I emitledyami okleod fro claiceeol onutjicn ... otn na wnaesr yhW si the rawesn numjuej (v.s e)odnu?dmu

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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ryirHaeted o(r aruicqed) eaniaodemg = 1C trinboihi feycni.iecd tPtniae sah a r9a-ey Hx of sfto tsuesi lwlng,eis ipacleyesl fo het fac.e tI's Aomasotul Daontinm if redtnii,eh or cna eb ciqredua ohtuhgr ulipetml iechmsm.nsa


dr.xx  wrong question? +2  

submitted by nosancuck(74),
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Dam nso tshi lli b ogt semo MICLTBEDIAU Mlocsluum all up in reh nizsseb

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 +4  
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(84),
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  • rniAeoPc = ouyr aimptsr lelms lkie na EPA
  • cRMUeen = eshtre’ no MROO ni oyur esar nsiec ehetr’y full of wxa
  • -nECReCY = newh you s,eEeCcri royu osrpe era nRCiYg
  • BoScueasE = BSEum is gniPESE otu fo oruy sroep
hungrybox  as an ape i'm offended +18  
dr.xx  stop being an ape. evolutionize! +6  
dbg  as a creationist i'm offended +9  
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. +1  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +  

submitted by nosancuck(74),
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yuo wonk hwo ti si deez siob gto tad aalifc FHUSL due to xetlenra tuintilmsa

dr.xx  please use standard English. I cannot understand a word of what you are saying. +7  
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 +  

submitted by dr.xx(129),
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nI sai,dosirsco ycreahmelciap amnlrloy rpespuesss teh aeelesr fo PHT nad eeotherrf het oripnutdco fo ctloacliri odliyod)5exl,ryecroca(1fchl-2h,i ubt in aosicsosrid nad etrho asngtlmoouura eas,eissd tevacdati mnacleoonru slcel pal(ltryauirc )egaphaormcs in the unlg nda plmhy ednos purdcoe cicrllitao -1)ofoxdyco,hleed2carchllyr(ii5 from licicldao yooh()ci5xrlraoyfll-hecdec2 enpndteiden fo HP.T


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. +