NBME Answers : drmohandes's page

Retired NBME Answer Explanations

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+1 visit this page (step2ck_form8#30)

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FYI

Stenosis improves with flexion
Herniation worsens with flexion + is often acute following inciting event

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+3 visit this page (step2ck_form8#42)

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So the way I understood:

Foley catheter: in bladder, but there is no urine in the bladder.
Drain: somewhere in abdomen, but draining a fluid with same [Creatinine] as the serum. If the concentration is the same, it is not urine but probably just serum?

So there is no urine in the bladder, no urine in the abdomen, and there is bilateral hydronephrosis.

=> Both ureters ligated by accident due to Dr. LowYieldSurgeon.

(But I might be totally wrong)

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adong Yea I guess the creatinine thing helps r/o unrepaired cystotomy...who the fck clips both ureters +1

+2 visit this page (step2ck_form6#4)

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

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+1 visit this page (step2ck_form6#33)

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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.

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sassy_vulpix She has weight gain & sleep disturbances (? not sure if this is current or before medication) +2

drmohandes True, that information could point at hypoT. +1

+4 visit this page (step2ck_form6#4)

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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.

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+1 visit this page (step2ck_form6#38)

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

This is classic acute bronchitis.

Tx = supportive (NSAIDs + bronchodilators)

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+4 visit this page (step2ck_form7#3)

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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

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+5 visit this page (step2ck_form7#3)

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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

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+10 visit this page (nbme24#37)

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total T4 (or T3) = free + TBG-bound
pregnancy → TBG increase → TBG-bound T4 increase → free decrease → less negative feedback → more TSH → restore free T4 levels

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abhishek021196 Very simple explanation. Thank you +

+6 visit this page (nbme24#30)

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SIADH → euvolemic hyponatremia → normotensive / hypertensive
ACTH increases cortisol → hypertension (alpha-1 upregulation & cortisol can bind to aldosteron receptors at high concentrations)
ACTH increases aldosterone → hypertension + hypokalemia (K+ dumped in collecting duct)

If patient -only- had hypertension: ACTH more likely than SIADH.

Patient with hypertension AND hypokalemia: 100% ACTH.

Don't feel bad friends, I also had this question wrong :(...

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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. +4

rolubui NOT cholesterol I mean cortisol in zona glomerulosa +

jurrutia Yes, but cortisol can act as a mineralocorticoid at when levels are super high. +

an1 @rolubui absolutely agreed! UW has a question where they ask about the precuor of aldosterone. I chose ACTH. WRONG they said, it's angiotensin 2. And yet these NBME writes are saying that ACTH is responsible for both cortisol and aldosterone? no. +

+2 visit this page (free120#31)

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36 hour surgery:

perforated bowel
multiple facial reconstruction
ORIF of left femur

...oral acetaminophen is not gonna cut it after major surgery. Also, our opioid crisis is mainly due to overprescription/misuse in chronic pain patients.

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+4 visit this page (nbme22#9)

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Some extra thoughts on distinguishing between Roseola/Parvo. I was a little thrown off by the:

fever since 1 week
rash since 4-days
my brain → rash after 3 day fever = Roseola

However, if I had read more carefully:

rash did not spare face
no mention that fever was gone after 3 days, might still have fever
5-year old boy; Roseola usually in 6m-2year old.

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madamestep Yup I think they REALLY don't want us to be stuck on key-words. Ex: they're never going to say "Flask shaped ulcer" in the colon for E. histolytica. +

+1 visit this page (nbme22#1)

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Newly born → ligament of Treitz on the wrong side → something went wrong with rotation...

In the 10th week the midgud rotates 270 degrees counterclockwise around the superior mesenteric artery (FA2019 pg352).

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+4 visit this page (nbme22#49)

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Countertransference (FA2019 pg. 542) = doctor projects feelings about formative or other important persons onto patient (e.g. Epstein didn't kill himself).

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baja_blast They really had mercy here by not also including Transference as an option.... phew. +1

l0ud_minority Oh if they threw in transference I would have been fucked. I can never keep the two together. +

l0ud_minority @drmohandes no Epstein was suicided... +

+22 visit this page (nbme22#15)

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Finger flexion done by:

FDP = flexor digitorum profundus (flexes DIP)
FDS = flexor digitorum superficialis (flexes PIP)

Innervation:

FDS 2/3/4/5 by median (C5-T1)
FDP 2/3 by median (C5-T1)
FDP 4/5 by ulnar (C8-T1)

Our patient can't flex DIP of ring finger → FDP4 → ulnar → C8-T1.

Only possible answer we can pick is C8.

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+7 visit this page (nbme22#28)

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Iron accumulation causes free radical damage in organs:

liver → dysfunction / ascites / cirrhosis
pancreas → glucose intolerance (diabetes)
heart → cardiac enlargement (LVF can leads to prominent pulmonary vasculature)

Also notice patient + older brother are >40, which is when total iron body accumulates enough to cause symptoms.

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+6 visit this page (nbme22#30)

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Primary olfactory cortex is located in the temporal lobe.

clickhere

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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! +3

+5 visit this page (nbme22#45)

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Our patient has a metabolic alkalosis with (partial) compensatory respiratory acidosis.

Metabolic alkalosis → H+ loss or HCO3- gain:

vomiting: lose H+ (and lose K+/Cl-)
loop diuretics: lose H+ (and K+)

Metabolic acidosis, possible causes in this context:

diarrhea/laxatives → lose HCO3- (and K+) ; Cl- compensatory increase (normal anion gap)
acetazolamide → lose HCO3- (and K+) ; H+ also decreases but not enough to overcome the alkalosis caused by HCO3- loss
spironolactone

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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 +1

+0 visit this page (nbme22#32)

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You mostly lose HCO3- and K+ in stool.

Loss of HCO3- leads to a normal anion gap metabolic acidosis (FA2019 pg. 580 'HARDASS'), in which we also see a compensatory increase in Cl-.

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+2 visit this page (nbme22#1)

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Here we go:

decreased LV contractility (bilateral crackles)
decreased cardiac output
activate RAAS → ADH
increase sympathetic activity → more RAAS → more ADH

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+3 visit this page (nbme22#47)

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DIC, unlikely: PT/PTT normal; wouldn't just see gum bleeding
hypersplenism: would cause anemia
iron deficiency: anemia
vitamin C deficiency: wouldn't cause thrombocytopenia
von Willebrand disease: mixed platelet/coagulation disorder → would cause deep joint bleeding instead of mucosal membrane bleeding. Inherited (Autosomal Dominant), would see symptoms before. PTT can be normal/high.

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beto Bleeding symptoms in von Willebrand disease tend to occur in mucous membranes. deep joint bleeding is rare +5

castlblack New onset bleeding? Immediately rule out vWD! +1

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. +1

nafilnaf Platelet count would be normal in vWD because there's nothing wrong with the platelets themselves. +1

weirdmed51 @waterloo same thoughts same mistake +

-1 visit this page (nbme23#37)

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I tried to calculate it more precise, and messed up the answer...

Here is why:

99.7% CI = 3 SD
However: 99.0% CI is actually 2.5 SD (or 2.57 if you want to be more precise)

1 SD = 1.5 mmHg → 2.5 SD = 3.75 mmHG

This results in a 99% CI of 109.25 (113-3.75) to 116.75 (113+3.75)

Closer to answer C than B.

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+3 visit this page (nbme23#26)

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Case = Middle-aged female with severe hypertension (180/120 mmHg), and an aneurysm.

(1) Main cause of renovascular diseae in middle-aged females = fibromuscular dysplasia (FA2019 pg. 592).

(2) Also notice the -classic- 'string-of-beads' appearance of the artery: EXAMPLE

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Subcomments ...

submitted by step_prep2(66), visit this page

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Key idea: All patients should receive an annual flu vaccine
Patients should get a Tdap vaccine as an adult and then a Td booster every 10 years
All patients should get pneumococcal vaccines (PCV13 + PPSV23) at age 65, with patients under 65 with relative immunodeficiency or increased risk getting a PPSV23 (chronic heart, lung or liver disease; diabetes; current smokers; alcoholics) and patients under 65 with very high risk getting PCV13 + PPSV23 (CSF leak, sickle cell disease, asplenia, cochlear implants, HIV, chronic kidney disease, organ transplant, etc.)

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drmohandes Then why is this guy not getting the pneumococcal vaccine (62 year old smoker)? +

tinylilron Pneumococcal vaccination is not given annually +7

submitted by step_prep(148), visit this page

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In order for patient to be diagnosed with Tourette syndrome, they need to have both multiple motor tics (blinking, shoulder shrugging, sniffing, facial grimacing) and at least 1 vocal tic (grunting, snorting, throat clearing, yelling, obscenities) for at least 1 year

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cinnapie How would you differentiate it from a chronic motor tic? Just by the lac of a vocal tic? +

drmohandes Chronic motor tic = motor tic -or- vocal tic. Tourette = motor tic -and- vocal tic. +

drmohandes *Edit: motor tic = only motor // Tourette = motor + vocal +6

submitted by step_prep(148), visit this page

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In order for patient to be diagnosed with Tourette syndrome, they need to have both multiple motor tics (blinking, shoulder shrugging, sniffing, facial grimacing) and at least 1 vocal tic (grunting, snorting, throat clearing, yelling, obscenities) for at least 1 year

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cinnapie How would you differentiate it from a chronic motor tic? Just by the lac of a vocal tic? +

drmohandes Chronic motor tic = motor tic -or- vocal tic. Tourette = motor tic -and- vocal tic. +

drmohandes *Edit: motor tic = only motor // Tourette = motor + vocal +6

submitted by step_prep(148), visit this page

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Patient with risk factors for spastic bladder (MS) has presentation consistent with urgency incontinence (urge to void immediately with loss of urine before reaching the bathroom at times), which is caused by detrusor hyperactivity/instability
Stress incontinence: Loss of urine with cough or increased abdominal pressure, caused by urethral hypermobility or sphincter deficiency
Overflow incontinence: Incomplete emptying of bladder leading to leak with overfilling; patient would have increased postvoid residual

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tinydoc But why is the answer not MS? Is it just because the way the question was worded asked what is the cause of the patients symptoms as opposed to what is the underlying cause? +1

drmohandes MS is episodic, this thing is lasting for 6 months. +

osler_weber_rendu Many times MS causes a neurogenic bladder rather than overactive +1

adong Overactive bladder is a type of neurogenic bladder though. I agree that detrusor hyperactivity is just a more specific answer +1

namesthegame22 Weird wording! +

submitted by drmohandes(193), visit this page

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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.

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sassy_vulpix She has weight gain & sleep disturbances (? not sure if this is current or before medication) +2

drmohandes True, that information could point at hypoT. +1

submitted by derpymd(20), visit this page

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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.

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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. +4

icetrae Not sure why sacroiliitis is a bad answer here? +

submitted by szsnikaa(28), visit this page

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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

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drdoom your account has been upgraded to: ATTENDING +6

drmohandes that's how you do an explanation. cheers m8 +4

submitted by tinylilron(57), visit this page

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

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drmohandes Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +1

drmohandes Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +2

lubdub Agreed. I him-hawed about it, but figured the free air should tell us what to do. +1

submitted by tinylilron(57), visit this page

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

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drmohandes Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +1

drmohandes Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +2

lubdub Agreed. I him-hawed about it, but figured the free air should tell us what to do. +1

submitted by help2help(0), visit this page

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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.

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drmohandes The questions asks about treatment of the newborns that were exposed. Not the 4-year old kid. +4

jlbae If he was adequately vaccinated he wouldn't have contracted chickenpox (at least not on an NBME) +1

submitted by athleticmedic(18), visit this page

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"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.

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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. +4

sahusema For NBME questions, I've found that whatever is told in the findings section of a stem should be taken as 100% true even if it's an incomplete description, super confusing, or misleading. So placenta complete? → uterine atony +2

submitted by chris07(69), visit this page

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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.

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drmohandes Exactly my thoughts. -_- +1

bluebul Dude isn't red as a beet. Can't be anti-cholinergic poisoning. +3

submitted by seagull(1933), visit this page

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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.

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seagull Also, I think pseudomonas would present with hemoptysis and a much worse clinical picture. +2

drmohandes Community-acquired pneumonia. If it was a CF patient = pseudomonas. In a 25-year smoker (COPD?) = H. influenzae. +8

etherbunny That'll be RAZR phone and Windows 98. FIFY, f**king millenials. :roll_eyes: ;) +5

submitted by step_prep5(246), visit this page

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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

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drmohandes Probably Zenker's diverticulum instead of achalasia, but barium swallow still valid. +11

usmile1 ehh, theres nothing given in the question that would suggest a diagnosis of Zenker's diverticulum over achalasia. Halitosis, dysphagia for solids and liquids, and regurgitation of undigested foods can be seen with achalasia. Thus, a barium is needed +

link981 @usmile1 actually there is something in the question that suggests Zenker's diverticulum over achalasia. "OCCASIONALLY REGURGITATES UNDIGESTED FOOD", but yeah you need to confirm the diagnosis and the next best step would be a Barium Swallow. +

submitted by seagull(1933), visit this page

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https://en.wikipedia.org/wiki/Blastomycosis#/media/File:Blastomyces_dermatitidis_GMS.jpeg

I believe this is actually disseminated Blastomyces due to the "Broad Based Budding" as seen in the picture.

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seagull However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad +17

mjmejora oh what a catch! I also thought this was Blasto until you explained otherwise +2

drmohandes Blasto = broad-based budding, the two 'circles' look equal in size. Crypto = narrow-based -unequal- budding. +8

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 +4

jbrito718 I was also struck by the similar presentation to Blasto even though mucicarmine points straight to Cryptococcus. regardless, both are primary in lungs so I was safe picking that answer +1

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So the best i could find was in First Aid 2019 pg 346 under Diabetic Ketoacidosis. The hyperglycemia and hyperkalemia cause an osmotic diuresis so the entire body gets depleted of fluids. Hence why part of the treatment for DKA is IV fluids. You might even rely on that piece of information alone to answer this question, that DKA is treated with IV fluids.

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kbland https://step1.medbullets.com/endocrine/109032/diabetic-ketoacidosis-dka +3

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? +8

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. +10

snafull Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +5

johnson Probably because they're sustained on ketones. +6

doodimoodi @snafull glucose is very high in the blood, why would neurons not be able to use it? +3

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? +2

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 +3

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.. +10

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) +33

drpatinoire @titanesxvi You really enlightened me! +2

mutteringly I don't make the connection of what titanesxvi said to the question - can someone explain? +1

motherhen @mutteringly it explains why the answer choice "inability of neurons to perform glycolysis" is wrong +2

jbrito718 The real question is does HbA1C even alter O2 affinity? +

submitted by m-ice(370), visit this page

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Misoprostol is a prostaglandin analog (PGE2) that acts on the stomach to promote mucus protection of the stomach lining, but also acts in the uterus to encourage contraction, which makes it useful for abortion.

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usmile1 perfect except it is a PGE1 analog, not 2 +6

krewfoo99 PGE2 will increase uterine tone (Pg. 270 FA 2018) +1

drmohandes Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +3

submitted by m-ice(370), visit this page

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The patient needs medical attention immediately, which eliminates obtaining a court order, or transferring her. A nurse does not have the same training and qualifications as a physician, so it would be inappropriate to ask them to examine the patient. Asking the hospital chaplain again could be inappropriate, and would take more time. Therefore, the best option among those given is to ask the patient if she will allow with her husband present.

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sympathetikey Garbage question. +71

masonkingcobra So two men is better than one apparently +33

zoggybiscuits GarBAGE! ? +2

bigjimbo gárbágé +5

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? +17

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 +11

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. +21

sahusema I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +29

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. +1

niboonsh This question is a3othobillah +11

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 +9

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. +15

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. +16

korahelqadam All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +3

sars This is a very fair question. I agree with sunshinesweetheart above. That is all. +2

wrongcareer69 Garbage question +1

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." +3

beto okay, touch me when my husband looks. are they preparing for threesome?? fckn question +

fatboyslim I'm a Muslim man and I got it wrong. I chose B lol. I thought by her saying I don't want to be examined by a man stays true regardless of whether her husband is there to not. I guess it doesn't hurt to ask her what would make her feel more comfortable if it allows a male doc to examine her. +

submitted by medstruggle(21), visit this page

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

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colonelred_ Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +16

brethren_md Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5

sympathetikey Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +6

s1q3t3 Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +13

masonkingcobra Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4

mcl Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +42

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 +13

bigjimbo LOL +1

fallenistand Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6

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. +10

charcot_bouchard Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2

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? +6

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 +1

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" +3

youssefa Hahahahaha ya'll just bored +11

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 +6

nbmehelp I dont get it +1

redvelvet how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +2

drmomo what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +1

sunshinesweetheart hahahaha this made my day #futurephysicians #lowkeyidiots +1

sunshinesweetheart @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +1

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 +3

noplanb Wait... I might actually never forget this now lol +4

drmohandes Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2

lilmonkey Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +1

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? +1

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!" +22

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! +2

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 +2

medguru2295 Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +1

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}}" +2

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. +3

alexxxx30 just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +3

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" +2

mbate4 According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +1

drdoom the tradition lives on +2

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 +1

abkapoor Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +1

faus305 Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +1

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 +1

niftykoala As an extra piece of information, I would like to add that Bungee Gum possesses the properties of both rubber and gum. +

neurotic999 Oh I get it! Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens. Makes alot more sense now after reading it a hundred times. Thanks guys! +

rdk3434 okay , this actually made my day and i also learned that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens!!productive +

laravonter Since it has been a month, I feel the need to remind all that sertoli-leydig cell tumors are notorious for producing lots of androgens +

thisisnewgg FCGSLCTWANFPLOA +

submitted by bwdc(697), visit this page

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Functional parathyroid adenomas can cause elevated parathyroid hormone (PTH), which results in hypercalcemia and hypophosphatemia. Hypercalcemia is characterized by the rhyming symptoms: stones (renal, biliary), bones (including bone pain to osteitis fibrosa cystica), groans (abdominal pain, n/v), thrones (polyuria, constipation), and psychiatric overtones (from depression to coma).

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drmohandes Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing? +5

drmohandes *Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5) +2

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 +2

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 +2

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). +2

aaa1 "Functional parathyroid adenomas can cause elevated Parathyroid (PTH) , which results in hypercalcemia and myopathies (?) Hypercalcemia is characterized by the following symptoms: stones, bones, groans, thrones, and psychiatric overtones" I decoded 90% of it +2

submitted by bwdc(697), visit this page

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drmohandes Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing? +5

drmohandes *Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5) +2

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If you don't know what Dicumarol does like any normal human. The focus on what aspirin doesn't do, namely it's doesn't affect PT time and most pills don't increase clotting (especially with aspirin). This is how I logic to the right answer.

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usmleuser007 If that's then thinking, then how would you differentiate between PT & PTT? +29

ls3076 Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +5

drmohandes Because dicumarol does not decrease platelet count either. +1

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) +5

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. +5

snripper yeah, it wouldn't work. We'll need to know with Dicumarol is. +5

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 +6

teepot123 di'coumarin'ol +1

submitted by armymed88(49), visit this page

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emphysema leads to CO2 trapping leading to increase paCO2 in the blood, which gives you a respiratory acidosis Proper renal compensation will increase bicard reabs and decrease excretion- giving you increased bicarb in the blood

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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. +27

drmohandes I thought you could never fully compensate, so your pH will never normalize. Primary problem = respiratory acidosis → 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. +7

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 +1

brise Aka this is the Bohr effect! +2