invite friends ⋅ share via emailtwitter
support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to et-tu-bromocriptine’s page.
Contributor score: 94


Comments ...

 +0  (nbme21#30)
unscramble the site ⋅ become a member ($36/month)

thEigeynrv sah nebe odcreve ead,yral tub serh'e to eht salivu asneerlr - t'si seya to ees het alinpioresht ewenteb DHT dna sstte.t reneoog:/tipumohMFrcm/s8.Yt/amd3/

erogin( eth ewhlo acbkl revsus ulbe or.li.oc.st loteicacmsp hgisnt nad m'I seru I molesrocdi .eheewsorm)


 +7  (nbme21#38)
unscramble the site ⋅ become a member ($36/month)

eulR fo rmtchhbuut/ots

  • suNnoosier fnuagl iin:ftsneco rttae ithw eonozlca_
  • ueSoris agfnul niifotcnes ,ge( midmiesnmuoomcopr ntptiesa ithw ieesndtimsad eicnnf:to)i etart hitw rtiahpmiocen B

Aoiltdaidn niof

  • eTh iamn sacslse fo unnfaalitg sedaointmci for mleus liue:dcn
  • eneyslPo g(e, itcmernhiopa ,B yi)nattns - dnBi ot trrosgolee lcsmoeelu in gulnfa llec emrneb,asm ngatirec rpseo and sgnuaic lcel slysi
  • lTasoierz (,eg _one)alczo - netPerv hte etsyinssh fo sgelot,rore a noeopcnmt of lugfan cell eenamrbsm
  • shoiicnacEndn (ge, ,icspnunagof funiiacgmn) - itniIhb het tinsseshy fo nagucl, a oeacyacrdhilsp oopemtcnn of unafgl lelc awsll
  • emiiPsyrdin ,(ge onlisF)teyuc - vetdrneCo to l,rcuai-ufrol5 hwhic nhte sbtiinih ufglna NRA and oirntep syssitnhe
jcmed  Cell Membrane = Amphotericin & Nystatin Cell WALL = Capsofungin To not mix them up I say to myself "IT's the FUNGIN CELL WALL" +1

 +0  (nbme23#30)
unscramble the site ⋅ become a member ($36/month)

yonnAe nkow owh ot erlu uot smlla nnseietit no isht ?eon I ohtuthg hte mtmnoeu leyadp a oelr in ilgeanh in eth ,eabdmon tub elyrlac 'mI gisnims nhgsoemit .here

what  Small intestine has smooth muscle in the walls which will fibrose on injury +
youssefa  So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI) +1
thotcandy  The way i thought of it was: small intestine PERFORATION repair -> the basement membrane and stem cells were definitely disrupted thus limiting regeneration ability Liver = puncture wound, not necessarily all the way through = basement membranes and stem cells are probably still intact -> regenerate without fibrosis +2




Subcomments ...

unscramble the site ⋅ become a member ($36/month)

otnd' eb a kdci? nto eylarl sreu ahwt mreo terhe si to ti. The inpttea dnoe'ts heav any orthe mafliy so isht mwoan lodshu eb nsediorcde mlyfia

aesalmon  Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine? +5  
hungrybox  Yeah, I got this one wrong with the same logic as you, aesalmon. +1  
emmy2k21  I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines! +8  
dr_jan_itor  @emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase +8  
et-tu-bromocriptine  Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice. Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy. +4  
lilmonkey  I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time. +1  
docshrek  @lilmonkey can you please give the QID for the UWorld question? +2  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. +  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. P.s:it struck me as a romantic relationship as well, but it doesn't clear my doubt😓😭 +1  
drschmoctor  @jakeperalta Following the hospital policy is wrong because it would be cruel and unnecessarily rigid to deny a dying woman the comfort of her closest companion. Also, It would be inappropriate to ask the Pt to lie. What's the point of becoming a doctor if you have to follow some BS corporate policy instead of calling the shots and doing right by your patients? +1  
peridot  Ya kinda dumb that usually NBME usually tells us to never break the rules, yet here it's suddenly ok. But here the reason for this exception is that while only "family" is allowed, a lesbian relationship qualifies the "friend" as family (they just were never officially acknowledged as family/married due to stigma or state laws, which society recognizes today is dumb and outdated). It's a stupid technicality that her significant other isn't allowed to visit as a family member, so while we usually never want to break rules, this scenario follows the "spirit" of the rule. Plus it's a really extreme scenario where the woman is dying and just wants to spend her last moments with her loved one and it would be too cruel to deny someone that. There is no lie involved, which kinda leaves open the chance for the situation to be cleared up if worse comes to worst. This is different from E which is a straight up lie. Hope that helped. +  


submitted by burak(42),
unscramble the site ⋅ become a member ($36/month)

Peulalr p:ucaeciadM ivsrcal :nlie h6-8t bialsydarr Mxiil enli: 1t-8h0 r Pvterisrlbrbaeaa ilen: d1n12-0 srib

So iicnsphay tsum iersnt a eleden ni 01-ht8 ribs ni yiairmdlaxl nie;l tbu nestniior lwoeb het th9 rbi lislt ash a kirs ot damage biadnolma songra hsuc as .eirlv pUper rebord fo ht9 rbi is i.nef

wU unestiqo :ID 484

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +14  
burak  thanks! +  
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +2  
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +  


unscramble the site ⋅ become a member ($36/month)

tIs’ ueact lhoaocl otnmspunoic so ttayf gcenah more kle.yil allreClu wgneilsl sedicniat lclcohioa haitspiet icwhh qersrieu cncroih hcoallo mscnupotino S(ee AF 9210 pg 5.)83 At alets s’htat eht lciog I esdu ot pkci tyfat gchane.

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +34  
nc1992  I think it's just a bad question. It should be "on weekends" +15  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +12  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +10  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


submitted by youssefa(101),
unscramble the site ⋅ become a member ($36/month)

l'nuotdW aucte hcaooll nnocupmosti enev in oaremtde ountma cueas esrlriebve ipehcat lclulrea njryui eczdirerahtac by urllelac alibngl?ono It lshudo eb eht gtrhi esnwar sslenu eth qusionet tsme senam keedeWs"n"

hello  No. The order of liver damage due to alcohol is: fatty changes --> cellular swelling (cellular balooning) --> necrosis. This Q stem states to the patient consumed large amount of alcohol on a weekend -- he has acutely drank a large amount of alcohol on one weekend --> this corresponds with fatty changes +3  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
krisgsxr600  Its kind of in pathoma Chapter 1, "free radical Injury", Section 2 "examples of free radical injury" goes over how free radicals (caused by drinking) lead to fat accumulation +  
sallz  You can't get the steatohepatitis before getting the steatosis (fatty change). All the FAs caused by the alcohol consumption eventually lead to cytokine release, inflammation and finally the hepatitis seen in balloon swelling. +  


submitted by aesalmon(79),
unscramble the site ⋅ become a member ($36/month)

tmplocneSey = omre ptlcibesuse ot padteeuslanc sgirsonma

I ptu .E lioc as tsi etpaneulcdas ubt htat wsn'at eth tmos ighrt awners I s?useg

pippylongstock  This question is asking about the ‘S’ of FA Mnemonic for S. Pneumonia “MOPS”. Strep pneumo is the most common cause of sepsis in adults. +2  
emmy2k21  MOPS stands for meningitis, otitis, pneumonia, and SINUSITIS. It doesn't stand for sepsis. My guess as well is which is "more correct". It's about being able to identify encapsulated organisms and the spleen's role in immunity. Ha I chose E coli as well. +6  
et-tu-bromocriptine  emmy2k21 is correct, the S is for sinusitis. I was between E.coli & Strep Pneumo, but then recalled Sketchy putting the sickle on the 'encapsulated' knight in the Strep Pneumo video; Strep Pneumo is more associated with infecting sickle cell "functionally asplenic" patients. +3  
aneurysmclip  You could also recall that before splenectomy(ik this is a emergency splenectomy) we would want to give an encapsulated vaccine like the pneumococcal vaccine. this pushed me towards strep over ecoli +1  


submitted by enbeemee(13),
unscramble the site ⋅ become a member ($36/month)

hwat ear het reoth aeldebl rsctetu?rus i nac reicdns het raleptai dan ihfce sclle, utb otn hte .oreht..s

hyperfukus  what is A? +  
et-tu-bromocriptine  According to this source, they're mucous neck cells (secrete acidic fluid containing mucin); compare this with mucus produced by surface mucous cells, which is alkaline. http://www.siumed.edu/~dking2/erg/GI082b.htm +2  
hyperfukus  i gosh i see now! thanks so much :) so if it's Pink=Parietal but not granules got it thank you :) +  


submitted by hungrybox(791),
unscramble the site ⋅ become a member ($36/month)

yM inmpsiorse of rocipmetnihA B si hatt 'sti the IBG SNUG. It tasithrg up ktsacat the rsoelts ni het gnifu smplaa ambme.rne

iweMhnlea lil ctibh usgrd ikel soe-alz tusj intbhii osrelt s.snsheyti tbnan(irefe-i X ela,stonrol a-lozse X gerorote)ls

signunF X lcle llwa thys,nsesi yftnleiocus X cuincle daci h.nsyeitss

et-tu-bromocriptine  Rule of thumb/shortcut: Nonserious fungal infections: treat with _conazole Serious fungal infection (eg, immunocompromised patients with disseminated infection): treat with amphotericin B Additional info The main classes of antifungal medications for usmle include: Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis +2  
et-tu-bromocriptine  Ripppp the formatting, but hopefully the idea gets across +  
et-tu-bromocriptine  Fixed it, see comment! +  


submitted by hungrybox(791),
unscramble the site ⋅ become a member ($36/month)

My spsiemiorn of Armphinteoci B is tath si't the BIG SNGU. tI agthrtsi up scttaka teh ltsroes ni eth gnufi lasmpa a.ebnermm

naweMelih lli itbhc udrsg keil -slaeoz ustj iihbint eostlr ets.ysnish ne-tfiane(irb X oornll,stae o-lzaes X rlortse)oge

igsFnnu X elcl lalw sihs,ysetn cotlsnuyife X enuclic acdi ysn.sihest

et-tu-bromocriptine  Rule of thumb/shortcut: Nonserious fungal infections: treat with _conazole Serious fungal infection (eg, immunocompromised patients with disseminated infection): treat with amphotericin B Additional info The main classes of antifungal medications for usmle include: Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis +2  
et-tu-bromocriptine  Ripppp the formatting, but hopefully the idea gets across +  
et-tu-bromocriptine  Fixed it, see comment! +  


submitted by hungrybox(791),
unscramble the site ⋅ become a member ($36/month)

My pssermioin fo imhrotiAnecp B si tath is't het BIG SUGN. It rahsgitt up aktacst eht etsslro in the gniuf lpsmaa bemmren.a

elewhMina ill ithbc ugsrd ilke oalsez- ustj itihnib rtolse sniey.tssh etea-(ifnbrin X olanersol,t el-sazo X tre)groseol

Fgsuinn X cell allw ssneshit,y toucfnleyis X elcunci idca nihs.tssey

et-tu-bromocriptine  Rule of thumb/shortcut: Nonserious fungal infections: treat with _conazole Serious fungal infection (eg, immunocompromised patients with disseminated infection): treat with amphotericin B Additional info The main classes of antifungal medications for usmle include: Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis +2  
et-tu-bromocriptine  Ripppp the formatting, but hopefully the idea gets across +  
et-tu-bromocriptine  Fixed it, see comment! +  


submitted by m-ice(272),
unscramble the site ⋅ become a member ($36/month)

ishT gril hsa orcihcn tgruamalosoun sd,eseia in hchwi the meunim tmysse otnacn loperpry omfr eiertcav ogxney sepeics edneed to illk yetopohagcsd n.imsrogsa sTih is lpescaeily adb whne diglnae tiwh aaatscel iietsvpo gsnrmsiao (iekl haptS), cebsuea eshet rnmasisog lrayade use ascetlaa ot arebk donw earicevt xeoyng epsie.cs hTe otsm ncoomm saceu fo itsh dnoitcoin is a utoamint in DPHNA xa,osdei ineoebrsslp ofr teh gonrieetna fo hte xroeiupsde iaralcd.

et-tu-bromocriptine  To add on: If neutrophils don't have access to NADPH oxidase, they can still use the bacteria's own hydrogen peroxidase to create ROS and kill the bacteria; however, catalase + organisms will not have this hydrogen peroxidase available (because catalase converts hydrogen peroxidase to O2 and water). So then the neutrophils are screwed and have no way of creating ROS. +6  


submitted by neonem(503),
unscramble the site ⋅ become a member ($36/month)

I ntihk ssastmtiae wsa the tseb opotni here asbeuec eerht era imelpltu alnaigmtn .on.lsa.spem ayiprrm eccnars dnte ot ttrsa as a nligse assm in the ssiute of ngioi.r nI the u,nlg tmeaastess ear orme mmcnoo tahn yprmria aplnmseo.s

dbg  I seriously could not figure out whether those white opacities were actual lesions or reflections from the actual picture (flash light) ... mind went all the way maybe this is the shiny pleura so they're going after mesothelioma. smh +5  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +3  
bullshitusmle  guys something I learned from NBMEs is that if there is a clinical vignette dont even look at the images they give you ,they are all useless and time-consuming +1  
goaiable  The way i narrowed it down was that the patient had signs of weight loss since three months whereas her cough developed recently (3 weeks). If the cancer arose in the lung then I think the cough or other pulmonary symptoms should emerge earlier. +1  
almondbreeze  FA2019 pg 669 in the lung, metastasis (usually multiple lesions) are more common the primary neoplasms. most often from breast, colon, prostate, and bladder ca. +  


submitted by dragon3(10),
unscramble the site ⋅ become a member ($36/month)

I matlos ipkecd gksain the tmmaoore tno to mksoe ni eht nea,pamttr but neht I dirguef tsh'ta oeydbn eht cpeso fo the t..d.rcoo heaornt nrsoep said igtnka setdosri duwol be too cuhm fro won, and I seopups tsth'a eeubcas the amtsha is d-rcolenwoleltl hwit ehr heairln ?rn sh't(ta ahtw I adh c)kidpe

sherry  I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications. +2  
et-tu-bromocriptine  Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc." +31  
peqmd  Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house +  


submitted by enbeemee(13),
unscramble the site ⋅ become a member ($36/month)

i tge why is't lexaey,ohiprf but ywh ont ?btrioaifinlls ti's asol an MNL sgin

et-tu-bromocriptine  Imagine a simple reflex arc: you have an afferent neuron, some interneuron shenanigans, and an efferent neuron (aka LMN neuron). If you damage the LMN, you will get hyporeflexia (due to damaged reflex arc) and fibrillations (because your LMN won't be able to effectively contract muscle on command). However, if you damage the afferent part of the arc, you will still get a damaged reflex arc (hyporeflexia), but your motor neuron will still be able to do its stimulating effectively, so your muscles won't show weak contractions when stimulated by a higher pathway. Kinda confusing but I hope I made it a tad simpler! +11  
eli_medina9  https://imgur.com/1z4OF4l Gonna piggy back off your comment and just post this kaplan image +7  
hungrybox  Very helpful image, thanks bro +  


submitted by mousie(171),
unscramble the site ⋅ become a member ($36/month)

A eenT tiwh jieniocnt of hotb jccnonvutia = wede oucld oals eb sigunab tehro ugrsd I s 21 erysa old dna ofur tshnmo sujt too dlo dan oot lngo fo a emti orf it ot eb gmeipi?to I eranowdr ti dnwo ot hseet wot dan gssuede ..t.bu I atwsn' ruse I dcoul ienamliet ti.

medskool123  I picked impetigo because of the gold stippling... I guess I took that as honey crusted lesions. F*ck NBME. +5  
yotsubato  Huffing gold spray paint. A la the chrome huffers in Mad Max +6  
subclaviansteele  LOL I think that might be what they were going for here. Gold spray paint. +3  
et-tu-bromocriptine  Anyone know what may be causing his weight loss and unwillingness to eat? I thought too much into it and put "mercury poisoning", since I thought the heavy metal's abdominal symptoms may have caused him to not want to eat. ¯_(ツ)_/¯ +2  
covid2019  I'm not sure about the pathophysiology there... But I do know that inhalants are popular in places where there's extreme poverty. I spent some time abroad, and one of the patients was using inhalants to take the edge off the hunger, so that she could spend her money on food for her kids instead. She also worked on the streets so I guess it also made it easier to, you know... +1  


unscramble the site ⋅ become a member ($36/month)

heT eyk is eth eref rai in hte nbioalmad ct.aivy rlc,seU peaelclyis uldoaned ru,eslc nca rraeofpet onit het binadolma .vtacyi This cna ecsau a niemtpurounomeep erf(e iar ednur het ihm.ar)dgpa Nto a ltdsei mtmyops ni htis qtnoe,sui but tsih nac sola csuae edrerrfe inpa ot eht slehurdo by ntitirargi eth echrnpi v.nree FA 2910 gp 743

et-tu-bromocriptine  To add on to this, anterior* duodenal ulcers tend to perforate (makes sense because closest to the abdominal cavity) whereas posterior duodenal ulcers tend to bleed (due to proximity to the gastroduodenal artery). +9  
smc213  Acute pancreatitis can also occur with a posterior duodenal ulcer rupture. Source: Pathoma +4