share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to drmohandes’s page.
Contributor score: 103


Comments ...

 +0  (step2ck_form6#4)

FYI, her triglycerides are also high (300 mg/dl), but need to be >1000 to be able to cause pancreatitis.


 +0  (step2ck_form6#33)

I did not understand why you don't check renal function.

Doesn't lithium affect both thyroid and kidney? Also, she has no clinical signs of hypothyroidism, so I figured we need to check her renal function.

sassy_vulpix  She has weight gain & sleep disturbances (? not sure if this is current or before medication) +

 +1  (step2ck_form6#4)

The pulling feeling weeks after incision is just scar tissue remodelling.

She only has mild tenderness w/ deep palpation , no pain, no fever, no redness, etc.


 +0  (step2ck_form6#38)

Patient with a recent URI, now a persistent productive cough without fever and clean CXR.

This is classic acute bronchitis.

Tx = supportive (NSAIDs + bronchodilators)


 +1  (step2ck_form7#3)

pressure (decubitus) ulcers

  • over bony prominence
  • impaired mobility / abnormal mental status

arterial ulcers

  • most distal parts where blood flow is low (tips of toes)

diabetic foot ulcers

  • Charcot deformity
  • soles of feet under metatarsal heads
  • tops of toes

venous stasis ulcers

  • edema
  • stasis dermatitis
  • pretibial or above medial malleolus

 +2  (step2ck_form7#3)

I copy/pasted my Anki card. I think it's herpes instead of chancroid because chancroid is usually a single large ulcer.

HSV

  • pain? yes
  • lesions? multiple small vesicles
  • lymphadenopathy? mild

Haemophilus ducreyi == chancroid

  • pain? yes
  • lesions? single large/deep ulcer with gray/yellow exudate
  • lymphadenopathy? severe => produces pus eventually

Treponema pallidum == syphilis

  • pain? no
  • lesions? single, hard base, regular borders
  • lymphadenopathy? bilateral inguinal

Chlamydia trachomatis == lymphogranuloma venereum

  • pain? no
  • lesions? small/shallow (often missed) ulcers
  • lymphadenopathy? weeks later, painful, buboes

 +9  (nbme24#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
  • tlato 4T o(r T)3 = fere + onBd-bTGu
  • negpncrya β†’ TGB easecirn β†’ Gdo-TnubB 4T cnreeias β†’ free rcsedaee β†’ sesl eiaetngv ekdbacef β†’ omre HST β†’ sretreo eref T4 ellves
abhishek021196  Very simple explanation. Thank you +

 +6  (nbme24#30)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
  • SDAIH β†’ iolvecmue atprohaimeyn β†’ svmoiornenet / ynheeviprset
  • THCA senaeiscr citoolrs β†’ peienhstrnyo -ahl1pa( lugproneatui amp&; toosircl anc dbin to teldoasrno toprcesre ta high rcintsneto)noca
  • HCTA escarsien ooetdsreanl β†’ rneeitonphys + mkohialpyea +(K edudpm in econlitcgl dutc)

If taepnti -y-nol ahd htsone:peinyr CHAT erom kyilel anth D.SHAI

etaPnti hwti nthepsrnyieo DAN aiolm:ekhyap 0%10 .CAHT

'tDon efle bad ie,snfrd I lsoa had tish nesuiotq ngrwo :..(.

rolubui  ACTH does NOT act directly on the zona glomerulosa to increase Aldosterone. ACTH acts only on the zona fasciculata to increase cholesterol and zona reticulata to increases sex hormones. +3
rolubui  NOT cholesterol I mean cortisol in zona glomerulosa +
jurrutia  Yes, but cortisol can act as a mineralocorticoid at when levels are super high. +

 +2  (free120#31)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

36 hour uy:gsrre

  • rpeftreaod beowl
  • pumletli ilcafa noostteicrcunr
  • IFOR fo tefl rmuef

loa.r.. aotmnanpcihee is ont gaonn utc ti tearf ojram ruey.rsg o,sAl rou dooipi sirics is nlyaim ude ot /sinrpovucroeptemsieisr in crcihon pnai aest.nipt


 +3  (nbme22#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

mSoe atxre thhogtus no gdghniissnuiit eentweb oaorPoaRe.lsv/ I saw a elttli ronhtw off yb t:eh

  • vfree niesc 1 eewk
  • ahsr ceins ayd-4s
  • ym nrbai β†’ rahs rtfea 3 ayd freve = sRaoelo

_

wHvoere, if I ahd drea eomr feacy:rull

  • ahrs did nto reasp cefa
  • on imnntoe htat refve swa nego aetfr 3 da,sy gmhti tlsli heva efrve
  • 5ey-ra old oy;b Rasoole yusuall in rya2e-6m old.

 +0  (nbme22#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

lyeNw orbn β†’ tenlimga fo Teitzr on het rwogn ides β†’ tnosgeihm wnet rgonw whti n.ot.oair.t

In het 0h1t ewek het giddmu otstaer 072 dgreees ccenrcosolkeiwtu ndroua hte oieurspr cnreiesmte eryrat 091(F2A 5.)2gp3


 +4  (nbme22#49)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nrottrnnsacreeCeeuf AF1(092 gp. 25)4 = trcdoo ctejspor fiesenlg about vrtmoiaef or rhteo aorttpmni rnspsoe ootn tniapet (.g.e intEspe td'din kill .flhs)mie

baja_blast  They really had mercy here by not also including Transference as an option.... phew. +

 +17  (nbme22#15)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reinFg inexlof ndoe :by

  • PDF = lforex migdrtuoi nrdspufou e(xself )IDP
  • DFS = oxeflr ioudmtirg cpealiifrssui e(fesxl IPP)

_

Ian:neiorntv

  • FDS /3//452 yb anemdi -5(1TC)
  • DFP /32 by eiamnd )51C-T(
  • FPD 54/ by lanru 18TC-()

_

uOr ettpnia 'tcan xelf DIP fo grin fnrgei β†’ D4FP β†’ uarln β†’ 1T-C8.

lnOy ossbiepl narsew we nca ickp si .8C


 +5  (nbme22#28)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

onIr iucouctanmal ascesu eerf cradali gaeadm in anosrg:

  • eirlv β†’ nnuitdofscy / icsates / iisohrrcs
  • snpracea β†’ lguecso leatrinncoe eid(ebta)s
  • treah β†’ riacacd nltmeeagenr V(LF anc adlse ot ioenmntrp pmrlnayuo ate)carsuvul

lsAo iecnot naipett + loder rthrebo ear t;,g4&0 wcihh si wneh atotl rnio body lsuamceatuc oghnue to uecsa pto.smmsy


 +5  (nbme22#30)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iPrmary flotoarcy xorect si aoclted in eht pmetraol .elbo

kerhcceil

rockodude  I feel pretty dumb for not knowing where smell is processed in the brain at this point in my medical education. Glad I learned it now! +1

 +5  (nbme22#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

urO netiapt ash a lmecabtio aiskolasl hwti ia(pal)rt etcnrypoosam esriptrryao sca.sdiio

_

ctoMaeilb laoiakssl β†’ +H loss or O3HC- g:nia

  • gton:miiv eslo H+ (nda olse l)+/CK-
  • olpo eiuctsidr: olse +H na(d +K)

_

aloticbMe ass,ciiod soeplbis asuces ni hits tcxtneo:

  • elrd/savixaaeahirt β†’ oels 3-OHC d(an +K) ; -lC masntrcpooey esacrein (moranl inona g)pa
  • moeicazeltada β†’ sleo 3-OCH da(n )K+ ; +H soal ssdreceae tub tno guoenh ot oemrveoc het slsakoila udcaes by OC3H- sols
  • aonolstnoriecp
snripper  This makes sense, thanks! +
dysdiadochokinesia  I was able to break it down to diuretic or alcohol use and chose alcohol use under the assumption that the patient's serum Cl- levels were low (90; N = 95-105) since Cl- is also lost with vomiting. Im assuming that it was wrong for me to make the association between alcohol use and vomiting. +
avocadotoast  @dysdiadochokinesia I think we can rule out alcohol use by looking at our patient's history and demographic. A 16yo girl who is dieting and constantly studying probably isnt getting turnt because 1) alcohol has empty calories (defeats the point of dieting), 2) why would you try to study when you're drunk, 3) where will this 16yo in social isolation get alcohol +

 +0  (nbme22#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ouY loysmt osle O3-CH dna K+ in otl.os

Lsos of HO3C- easld to a naolmr aonni pag tlmiecbao oadiissc (2F9A10 p.g 805 ,SADHRS'')A ni hhciw ew laso ees a omenrtascopy eserinac ni Cl.-


 +1  (nbme22#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reeH ew o:g

  • eedarcdes LV cttciloitnyra elbral(ait scr)calke
  • ersdaecde ciacrda uottpu
  • eavticta RAAS β†’ HAD
  • crneaeis yptmhstecia aciyvtit β†’ omer RASA β†’ mroe HAD

 +2  (nbme22#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
  • IDC, yinulelk: /TPTPT ;omranl n'uwldot tsuj see mug eeibgldn
  • :ysenhlmerpspi wloud saeuc naimea
  • roni cfieiyd:ecn maneai
  • imavnti C ciyenie:fdc tndluow' uasec tipoyaorbceohnmt
  • nvo bdlairlWne ee:dsasi dimex epgio/aullcttoatlnea eddroisr β†’ wuold aeusc epde jiont engidleb dtensai of ucsloam ranmbeem dneglbei. reInteidh o(lasAotmu ntmDino),a doulw see ommtssyp f.ebreo PTT can be mlangri.o/hh
beto  Bleeding symptoms in von Willebrand disease tend to occur in mucous membranes. deep joint bleeding is rare +4
castlblack  New onset bleeding? Immediately rule out vWD! +
waterloo  Vit C def I thought was super tricky. My knee jerk reaction was oh easy bruising, bleeding from gums that's what it has to be. But yeah, I think low platelet is key here. +
nafilnaf  Platelet count would be normal in vWD because there's nothing wrong with the platelets themselves. +1

 -1  (nbme23#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I edirt ot cllacatue it orme pei,resc nda emdses pu teh s..aw.ern

Here is wy:h

  • 99.%7 CI = 3 SD
  • oervewH: 99.%0 IC is llycatua 25. DS (ro .572 if uoy atnw to eb mroe epeic)rs

1 DS = 15. gHmm β†’ 52. SD = 7.53 GHmm

iThs eustslr ni a 99% IC fo 02.591 (.3-3)5117 to 7151.6 171.)+5(33

lsCoer to naswre C ahtn .B


 +3  (nbme23#26)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sCea = l-edidMgeda malefe hitw eevsre soreniethypn 201/(108 gmHm,) dna na manryus.e

1() inaM cuase fo ncrsaaelvoru iedesa in edlddiema-g eamfsel = rimuafocuslrb ldaisyasp 1FA9(02 g.p 29).5

)2( sloA centio the c-scials- o-gsbr-'danetif's prpeaceaan fo eht te:rrya EXMAPLE





Subcomments ...

submitted by derpymd(2),

So straight leg (Lesegue) test is very specific for sciatic nerve pathology. This dude actually gets to 80 degrees (is he a gymnast?) and remains negative for the test, so that's certainly not his pathology.

The main distracting answer here is herniated disc (which I chose), because herniated disc is the most common cause for a positive Lesegue sign (https://www.ncbi.nlm.nih.gov/books/NBK539717/).

I think the major differentiator here is the tenderness to palpation. I think this is a weak sign for raising suspicion of muscle strain over all the other pathologies listed though.

drmohandes  That does not make sense, you are contradicting yourself. Straight leg test is negative, so don't even bother with herniated disc. Paravertebral tenderness, no radiation => muscle strain. +1  


submitted by szsnikaa(14),

This patient has a testicular mass. Let's examine a few differentials as we go through the answer choices.

Germinal Cell Tumor (Testicular Tumor)

  • Usually painless but dull/achy/heavy sensation; palpation of SOLID mass
  • No change in size when supine
  • No transillumination

Dilated pampiniform venous plexus (Varicocele)

  • Usually painless; "Bag of worms"
  • Reduced swelling when supine
  • No transillumination

Cystic Dilation of the effect ductules (Spermatocele)

  • Typically painless; fluctuant swelling of upper testicular pole
  • No change in size when supine
  • Does transilluminate

Fluid accumulation within the tunica vaginalis testis (Hydrocele)

  • Often painless; fluctuant swelling of scrotum
  • May/May not change in size wrt position
  • Does transilluminate

Vascular Trauma (Hematocele/Ruptured Testis)

  • Extremely painful & tender; visible hematoma
  • May/May not change in size wrt position
  • No transillumination

drdoom  your account has been upgraded to: ATTENDING +  
drmohandes  that's how you do an explanation. cheers m8 +  


submitted by tinylilron(7),

The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy?

drmohandes  Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +  
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +  
lubdub  Agreed. I him-hawed about it, but figured the free air should tell us what to do. +  


submitted by tinylilron(7),

The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy?

drmohandes  Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +  
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +  
lubdub  Agreed. I him-hawed about it, but figured the free air should tell us what to do. +  


submitted by help2help(0),

One might approach this question also by taking into account that children receive MMRV at 12mo & 4 years of age...child is 4 years old and therefore adequately vaccinated therefore no intervention necessary.

Otherwise, if he 3 years old, probably would get VZV vaccine.

drmohandes  The questions asks about treatment of the newborns that were exposed. Not the 4-year old kid. +2  
jlbae  If he was adequately vaccinated he wouldn't have contracted chickenpox (at least not on an NBME) +  


"Placenta appears complete but torn" - if it's torn and only appears complete, rather than being confirmed as complete, how can you rule out retained placental tissue? You wouldn't just assume it was complete at a complex delivery, it would require confirmation.

drmohandes  I feel you man, was guessing between the two answers as well. I think torn but complete means the whole placenta is there, but in pieces? Anyway classic scumbag NBME question writing. +  


submitted by chris07(57),

He's had heat stroke for 2 days???? I get the elevated CK and body temp (all pointing to heatstroke), but the fact that he was a temp of 106 and has been symptomatic for 2 DAYS makes the whole heat stroke diagnosis weird to me.

drmohandes  Exactly my thoughts. -_- +  
bluebul  Dude isn't red as a beet. Can't be anti-cholinergic poisoning. +  


submitted by seagull(1583),

I love these shit pictures. It's like some old angry dude opened a text book from the 1950s and took a picture with his razor phone then uploaded the picture using windows 99.

seagull  Also, I think pseudomonas would present with hemoptysis and a much worse clinical picture. +  
drmohandes  Community-acquired pneumonia. If it was a CF patient = pseudomonas. In a 25-year smoker (COPD?) = H. influenzae. +2  
etherbunny  That'll be RAZR phone and Windows 98. FIFY, f**king millenials. :roll_eyes: ;) +  


submitted by step_prep5(81),
  • Older woman with dysphagia to solids and liquids with intermittent regurgitation of undigested food and halitosis, most consistent with achalasia which can be worked up with barium swallow (or esophageal manometry)
  • Key idea: Dysphagia to solids AND LIQUIDS is due to problems with esophageal motility, whereas dysphagia with solids that later leads to dysphagia to liquids more associated with obstructing mass lesions (cancer, esophageal stricture, etc.) that should be worked up with endoscopy

https://step-prep.org/tutoring/

drmohandes  Probably Zenker's diverticulum instead of achalasia, but barium swallow still valid. +2  


submitted by seagull(1583),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

//o./tika:iMnet/peaisjrmGei.kegFlyiiSei_#pmdmdtad:ttosBlsa_twdamihs/isscow.posgByileec/ri

I veeelib hist si atlyaucl simtasdneedi scemoasytlB ued ot eht "doBar eBsda gnudBd"i as snee ni teh e.upitcr

seagull  However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad +15  
mjmejora  oh what a catch! I also thought this was Blasto until you explained otherwise +  
drmohandes  Blasto = broad-based budding, the two 'circles' look equal in size. Crypto = narrow-based -unequal- budding. +6  
paperbackwriter  ^ I would disagree a little bit. "Broad based" and "narrow based" refer to how smushed the circles are. So narrow based is when the membrane bit they're sharing is small, and broad based is when they share a lot of membrane. So if just pinching off --> crypto, if they look stuck/have a flat membrane between them --> blasto +2  


submitted by vshummy(163),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So eht etbs i lucod fdni wsa in iFrts dAi 0291 pg 346 nrdeu tbciaDei idosteis.ocKa heT peerycyahgmil dan elypkrmiaaeh escua an cmstoio sursiedi so hte einrte boyd tges lddeetep fo li.fsdu ecHne why ptar fo eth mrteatnte for DKA is VI us.fild Yuo gitmh even leyr on htta cieep fo omotfnniiar alnoe ot swrena iths oniu,sqte ahtt DAK si ertatde ihwt IV ls.difu

fulminant_life  I just dont understand how that is the cause of his altered state of consciousness. Why wouldnt altered affinity of oxygen from HbA1c be correct? A1C has a higher affinity for oxygen so wouldnt that be a better reason for him being unconscious? +6  
toupvote  HbA1c is more of a chronic process. It is a snapshot of three months. Also, people can have elevated A1c without much impact on their mental status. Other organs are affected sooner and to a greater degree than the brain. DKA is an acute issue. +6  
snafull  Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +3  
johnson  Probably because they're sustained on ketones. +3  
doodimoodi  @snafull glucose is very high in the blood, why would neurons not be able to use it? +2  
soph  @snafull maybe u are confusing bc DK tissues are unable to use the high glucose as it is unable to enter cells but I dont think thats the case in the neurons? +1  
drmomo  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/ states its primarily due to acidosis along wth hyperosmolarity. so most relevant answer here would be dehydration +1  
drmohandes  I thought the high amount of glucose in the blood (osmotic pressure), sucks out the water from the cells. But you also pee out all that glucose and water goes with it. That's why you have to drink and pee a lot.. +7  
titanesxvi  Neurons are not dependent on insulin, so they are not affected by utilization of glucose (only GLUT4 receptors in the muscle and adipose tissue are insulin dependent) +25  
drpatinoire  @titanesxvi You really enlightened me! +  
mutteringly  I don't make the connection of what titanesxvi said to the question - can someone explain? +  
motherhen  @mutteringly it explains why the answer choice "inability of neurons to perform glycolysis" is wrong +1  


submitted by m-ice(340),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

slposriotMo si a olarntaspingd anolga (E2)PG ttah atcs no eht chomast to pteomro suucm tcpotrenio of teh tsmhaoc giinln, tbu salo tcas in teh srtueu to aeogrcenu anortc,notic iwhhc mksae it euuslf fro tai.boron

usmile1  perfect except it is a PGE1 analog, not 2 +2  
krewfoo99  PGE2 will increase uterine tone (Pg. 270 FA 2018) +  
drmohandes  Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +  


submitted by m-ice(340),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ehT ttpiane sdnee dilmcae tienotnta eimty,delaim hwchi tniameslei ngbaoitni a rouct er,rod or trnrisgeafnr .ehr A ersnu soed otn vaeh the smea gntiinra dan icaanqsuoitilf as a pi,nhiascy so ti uowdl be irpatepraniop ot sak mthe to xeniame the tpia.net skgnAi het plsaioht hlnciapa aiagn dclou be ,iaointrprppae adn louwd tkae rome i.emt eo,Trehref het estb opniot ognma seoth vineg is ot ska eth npteita fi ehs iwll awlol hitw her ahbsdun nptree.s

sympathetikey  Garbage question. +60  
masonkingcobra  So two men is better than one apparently +29  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gΓ‘rbΓ‘gΓ© +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. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +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 medstruggle(12),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Wyh is ti otn roinava lilclfoe ?ecsll I ugthhto hte faeelm aglano of toSiler dan giLedy is haonaaceu/lgtrs scl.le

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +11  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +38  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +18  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

anioulctnF prthadioyar asoadmen can uasec edvaeetl poytardhair hrmnoeo (T)H,P ciwhh eltssur ni aelecapyihrmc nad ahphsytaiehppmo.o lyapceaiemcrH si rztecedracaih yb hte hrynmgi tmpss:yom tsseno ,lrane( ,)ilbriya bseno cl(gndinui bnoe napi to sisetito obifrsa csy)atci, gnoasr bnoadam(li iap,n v/n,) srnteho (rl,aouipy n,itocit)ponas and ahtriiscycp onetseovr mrfo( pidrenoess ot c.oa)m

drmohandes  Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing? +2  
drmohandes  *Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5) +  
melchior  From googling, it looks like it just happens. One author says that high concentrations of parathyroid hormone downregulate erythropoietin receptors. Regardless, it corrects after parathyroidectomy, showing that parathyroid hormone likely causes it, somehow. https://www.ncbi.nlm.nih.gov/pubmed/10790758 https://academic.oup.com/jcem/article/97/5/1420/2536309 +  
flvent2120  So I understand why parathyroid can be the right answer, but why couldn't kidney be correct? This is just my overthinking things, but renal cell carcinoma can present with PTHrp leading to hypercalcemia +  
zolotar4  @flvent2120 "Historically, medical practitioners expected a person to present with three findings. This classic triad[9] is 1: haematuria, which is when there is blood present in the urine, 2: flank pain, which is pain on the side of the body between the hip and ribs, and 3: an abdominal mass, similar to bloating but larger. (10-15% of patients)" -Wiki. I'm thinking the presentation would be different. Also male predominance, latter decades (6th and 7th). +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

lonnactFiu trdhiapraoy omdsnaea cna ueasc edeetval rthryoapdai oromnhe P,(H)T hhciw lsutrse ni ahcrecpalyemi nda otmhsea.popyhipha ycmeeaapirHcl si aecczdethrria yb eht yhigrmn o:mtpsysm tonsse lanr,(e ,lr)biayi nbeso il(dncuign nboe apni to tsiisote aisrfbo cyci,sat) ongras oblnad(ami an,pi ,)n/v ortshen iray,l(puo ista,ntnicpoo) dan airhcctyips etovneosr mrfo( desieopnrs ot omc)a.

drmohandes  Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing? +2  
drmohandes  *Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5) +  
melchior  From googling, it looks like it just happens. One author says that high concentrations of parathyroid hormone downregulate erythropoietin receptors. Regardless, it corrects after parathyroidectomy, showing that parathyroid hormone likely causes it, somehow. https://www.ncbi.nlm.nih.gov/pubmed/10790758 https://academic.oup.com/jcem/article/97/5/1420/2536309 +  
flvent2120  So I understand why parathyroid can be the right answer, but why couldn't kidney be correct? This is just my overthinking things, but renal cell carcinoma can present with PTHrp leading to hypercalcemia +  
zolotar4  @flvent2120 "Historically, medical practitioners expected a person to present with three findings. This classic triad[9] is 1: haematuria, which is when there is blood present in the urine, 2: flank pain, which is pain on the side of the body between the hip and ribs, and 3: an abdominal mass, similar to bloating but larger. (10-15% of patients)" -Wiki. I'm thinking the presentation would be different. Also male predominance, latter decades (6th and 7th). +  


submitted by seagull(1583),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

If oyu 'ndot oknw what crmaloiuD sdoe ikel yna onrmal hu.nam Teh cusof on tawh risiapn sodnte' o,d amyeln 'ist netsdo' caffte TP etmi nda omst slpli tdo'n seinrcae nlgtctoi palyl(icsee thwi p)ni.irsa hiTs is hwo I gocil to the rtgih wra.sen

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +25  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +4  
drmohandes  Because dicumarol does not decrease platelet count either. +  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +3  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +4  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +4  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +3  
teepot123  di'coumarin'ol +  


submitted by armymed88(47),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

mpesmyaeh alsed ot O2C ppngatir adnleig ot carseein O2Cap in eht o,obld hihcw igesv uoy a paorrsietyr dsiocsia eoprPr arnel sneipacmtono wlli rencseia ardicb erbsa nda ercaedse rxoe-cniet gginiv oyu nceraiesd biarcb ni het doolb

meningitis  Increased blood HCO3 could have easily been interpreted as increased blood pH aswell. FOllowing your explanation, since the pt had acidosis, the increased HCO3 will just make it a normal pH. Another way to think of the question is: if there is decreased exhalation due to COPD --> increased CO2 --> increased CO2 transported in blood by entering the RBC's with Carbonic Anhydrase and HCO3 is released into blood stream. So increased CO2 -> increased HCO3 seeing as this type of CO2 transport is 70% of total CO2 content in blood. +22  
drmohandes  I thought you could never fully compensate, so your pH will never normalize. Primary problem = respiratory acidosis β†’ pH low. Compensatory metabolic alkalosis will increase blood HCO3-, but not enough to normalize pH, it will just be 'less' low, but still an acidosis. +4  
mtkilimanjaro  I also think decreased blood PCO2 and increased blood pH are very similar (less CO2 in the blood means less acidic, pH could go up) therefore I ruled both of them out just from that +  
brise  Aka this is the Bohr effect! +