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Welcome to drpatinoire’s page.
Contributor score: 13


Comments ...

 +0  (nbme24#27)
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I jsut awnt ot mionetn htta idks itqatsung si revy cumh seggstiung a FOT ni ..MEoLS.lUl dnA her roulymapn rmuumr susgegst mruapnlyo snset,soi hwich furehtr osspptur F.OT

peqmd  Not necessarily. Squatting just helps to increase preload => this will expand the left cardiac chambers and reduce R->L shift. It's a general principle to R->L shunt heart defects not specific to one disease +

 +5  (nbme22#38)
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yuGs I vhae htnaeor gt.uohth

Gviing oreth sieocch era botau ish eroth mrblnoaa eavslu (aienscred tire,caen c,sgleuo ircu a)c,di I essug teh osneutqi si nsgitet su hhwci of eesht asulve iwll vmproie fi hsi SAO si odverpmi by APC.P

einSc ASO is eon of eht tmos ttnopmari sascue fo odicitapih piseonyehn,tr it oudlhs eomc to su htta onec ihs ASO si dr,eteta sih nrpyehnteois lliw eirvomp oo.ns

oS ced"darsee B"P siatned of treoh abloranm valsue.

T(nksah ot ym sdrnife fro nngiiht em oatbu )its!h

dodgerslakers15  This is the correct way of thinking about this question. ^ Pulmonary physiology is not necessary. The root of the question is asking what will improve over time with treatment of sleep apnea, which is blood pressure, given that sleep apnea causes increased sympathetic tone and therefore systemic HTN. The treatment of sleep apnea with CPAP, will help reduce sympathetic tone and over time, improve BP. +1




Subcomments ...

submitted by lsmarshall(415),
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Th"e cxate nmeisahmc rof mrtroe uoctnniid by βrrecan-2)ige(d toignssa is llsti nwu,nnko tbu hreet si mose indceeev htta cane-2erd)grβ(i tosnigsa tca cltdiyre no mel.s.c.u Meor clen,yrte ormter hsa bnee reaectlrdo ysollec thiw y.ekaamp"ahlio - HNI btiapulionc

sFrti dAi nsiomten iphtseydhyrimro sagunic morrte rmof -crgareniβde nilsatuotmi. It aslo sitmenno sstnβgai2-o iuncasg ermtro as a dsei fe.cfte irFst Aid alos etnomnis ing-oβ2sats iinrvdg tumpaisso itno l,cels cihwh yam berucitnot to etor.rm ahTt ,sdia oemr saslcic pytmsosm fo makhopalyie era wide SQR dan eekapd T asvwe on ,EGC mhsthiayrra, adn smucel ns.kswaee

oLiokgn aodnru no hte nrtieetn okols lkei fi rpaetyh is uondcietn het merotr mfro a sβsni-o2agt servolse otrmev.ie

xxabi  Sketchy mentions tremor and arrhythmia as side effects! +1  
drpatinoire  Hypokalemia is more associated with U waves, flattened T, muscle cramps/spasm, those symptoms you mentioned is more typical in hyperkalemia. (I guess you made a typo..?) +1  


submitted by vshummy(161),
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So het tseb i ldouc idfn saw ni tiFrs diA 0921 pg 463 erndu eibticDa sKa.cioedstio ehT gemraheyyicpl dna rhylampkaeie escua an ooictsm idiuress so hte eenirt yodb gets dteeeldp of s.diluf cHeen ywh rtap of the amntettre ofr AKD is IV sfduli. uoY itmgh vnee elyr no ttah eceip fo iotoamnnfir oenla ot ersawn isth ,itueqons htat AKD si teedtar ihtw IV isflud.

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 neonem(568),
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thsi atpniet has tpmcomytasi raiotc in.toesss hTsi cna eb tefinidide by teh vcntruelari yhhtoypperr (ot mopeetsacn fro iasedrnce nnofuiltac lrdtfeaao rmof ntcpmanilon-o rtiaco )a,vvel csmstylidoi mmurur nda teh nicoatol at the rnmoal itrcao ea.ar

ePr TeDpaoUt on ailcClni nintatfsmaiose fo ctiAro nsteiSso:

insDez"zis adn soceynp — opynSce ocsrcu as a negipsnert yopmmst in xlmoptaapriey 01 ceprtne of taistpen ithw mcstitmyopa rvesee SA (or lryaapmtpeoix 3 tecernp of lal tnepitas tiwh evsere AS) .[]3 erTeh era vreasle srdoepop etlposnanixa rfo tanelroxie ssznzidei nyc)pope(ser ro spcnoye in tisapten ihwt AS, tboh of cwihh etcfelr dedecsaer brceaelr nuisorfe.p src-Eceiiedxnude viniaosdtaol in teh rcpesnee of an brttinoocsu wiht xiefd iacrdca tutupo anc tlsreu ni ienyhs.tonpo"

guillo12  What does "fixed cardiac output" signify? +1  
usmleuser007  "fixed cardiac output" might mean that with the stenosis (ie. narrowed aortic valve) there is a limited or rather reduced cardiac output. Exercise would not increase cardiac output because the stenosis is caused by a mechanical (physical) rather than a biochemical process. Therefore, At any given moment the heart can not increase its output no matter how forcefully it contracts. +8  
fallot4logy  why not option A?arterial compression ? +3  
sunshinesweetheart  @fallot4logy LVH does not lead to coronary artery compression. only reallyyyy rarely will pulmonary artery dilation cause coronary artery compression. plus that would cause angina but probably wouldnt decrease cerebral bloodflow to syncope. her murmur + LVH point us toward aortic stenosis which does cause those --> fixed CO +2  
drpatinoire  @fallot4logy LVH can cause coronary artery compression, but typically leading to coronary ischemia after exercise (i.e. stable angina in this patient). The question is asking what leads to her syncope. Syncope actually means her brain is lacking blood supply abruptly. +5  
rainlad  how do we rule out mitral valve prolapse in this case? +  
spow  @rainlad murmurs at the right upper sternal border are aortic in nature. Mitral murmurs are heard at left 5th intercostal at the midaxillary line. +1  
jj375  Also, nobody mentioned the "prominent left ventricular impulse". I kinda get thrown off by these. Anyone have thoughts? Google was telling me it is from a hypertrophied ventricle so I'm thinking her aortic stenosis causes the LV hypertrophy and an impulse. Is this the correct line of thinking? +  


submitted by yobo13(2),
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aCn eoosnem naexlpi yhw it 'ntca eb 'shCron enisc htta olduw saol sauce a onn AG?MA

drpatinoire  If she has Crohn, she has already lost a lot of K, HCO3-, then the compensatory system wouldn't let her keep losing electrolytes in her urine. +1  


submitted by zbird(2),
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Tihs eaipttn ash stTa-yielDp I ART wcihh is piexldaen yb orNlam eumrS oAinn gap ()8 toaceilMb acisodsi with erh veiositp rryniau anoin p5ga.+)(

krewfoo99  Why would the urine Potassium be so high if it is type 1 ? Shouldnt it be type 2? +  
drpatinoire  @krewfoo99 I think it's RTA2 (Fanconi syndrome), he is losing all kinds of Na, K, Cl which should be reabsorbed in PCT. +  
misterdoctor69  @Drpatinoire: it can't be RTA2 because the urine anion gap (UAG) is positive (+), which implies that the patient is unable to secrete H+ (via NH4+, which couples w/ Cl-). RTA2 on the other hand has a negative (-) UAG because RTA2 affects only the proximal tubule's ability to reabsorb bicarbonate (i.e. H+ secretion via NH4+ in the distal convoluted tubule is unaffected). +  


submitted by medstruggle(12),
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Why si ti ton navoiar cllleoif sl?cle I gohthut eth elamfe lgnaoa of rieSlot adn Lgiyed si grueoasnlhatca/ lc.sle

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
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 +  


submitted by pg32(151),
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hTe catf htta het dods toari ni eth tpo tfle si cioncrrte seamk hist onqtusie veyr cit.udflif tI mseak ti pparae sa if het cisokoe rea utevcasia tbu eht mkli ahd meos cvtrpeoeit craft.o oS sboouino.x

drpatinoire  God I thought totally the same way as you did. I stared at this question for at least 5min and asked myself what's wrong with my statistics. +1  


submitted by seagull(1539),
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A- irmayrp tmroo tocerx = nwogr iesd of obdy i(tdiefc fo MNU no felt ides yb)do

B - auamhlsT = eyssron oniorntaifm cotudin - rmtoo fctesdii iyukenll to airteoign omfr ehre

C - Pons - NsC ,8,7,6,5 ylikle seutlr in "kcledo ni "ryesodnm ro eelpctmo lsos of oormt tnnocifu on ithrg ieds + claafi a.eresfut

D. Veismr - tcnlear oydb tdnoicn.aorio gaDaem relstus ni iaaaxt

oNt topcelme ubt mebay ehulf..pl

yotsubato  C - Pons - CNs 8,7,6,5, likely result in "locked in syndrome" or complete loss of motor function on LEFT side + RIGHT sided facial features. Decussation occurs in medulla +2  
kard  Sorry if im mistaken, Isnt A) Somatosensory? +2  
krewfoo99  Yes i think A should be somatosensory. Primary motor cortex would be present in the precentral gyrus +  
drpatinoire  A is primary motor. A and the gyrus at right side of A compose the paracentral lobule. +  


submitted by madojo(176),
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gUh nhwe yuo do it in dw,olur iwrte ti odwn ubt llits miss .ti

ayywAn ggoin oerv torhe wrnssae b(saooa:mtcri yph)Ftic anecshg of eht asterb --;gt& nie,ngb ulaluys no shdeacrgi htiw itsh dan oyu wlli sayuull vhea a lupmy esbrta or tmsingeoh lalbpeap dan ti is hnrooem dsmeita aed.Pteg sesadei fo eht trabse t&-;-g tnxneeois fo ducalt ciaarcnom ni stiu to leiuactosrf dcsut adn nisk of nlipep goirdpunc sh,ra os uyo ese ksni ga.hnecs oN nski nasgehc hieetnomdn lo.Pmiaenecar rot ;-&g-t ellhaarcogat nto oobld nigedt

So rpe UW utdtacinarl lalppmoia is a rilefoatinorp fo irallaypp elsc in a syct lwal ro cdut atth amy csaue afocl itpaya - IT IS TEH TSOM COMONM CSUEA FO LYODBO EPNILP SGARDCEHI ADN BERSTAS IWUTTOH ABSRET SSMA OR SINK SANEGHC

rmceopa sthi to iprpaylla cmaonrica eewrh oyu oasl vaeh lpepin sgchiadre tub oyu dwluo see ti ni a opts lnmouspaae mown.e

drpatinoire  Upvote it wishing I could memorize it lol +  
mutteringly  To add to this, papillary carcinoma will only have epithelial cells and no longer have the myoepithelial cells that intraductal papilloma would have. +