NBME Answers : fexx's page

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submitted by masonkingcobra(408), visit this page

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In addition to the previous explanation:

She is iron deficient and celiac affects the proximal duodenum. "I Fucked Brittany" = Iron, Folate, B12 for Duodenum, Jejunum and Ileum

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krewfoo99 Great analogy lol. But just a correction, First Aid states that Celiac Disease affects distal duodenum and proximal jejunum. But you are right, it would still cause iron deficiency anemia as it affects the duodenum. +3

fexx OR you could just remember 'Iron Fist Bro' (F includes folate and fat, B includes B12 and bile salts) +8

submitted by thomasalterman(181), visit this page

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A normoblast is an immature RBC, so it's elevated in states of increased hematopoiesis.

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sympathetikey Don't mind me. Just sippin my dumb ass soda over here. +76

someduck3 The term "Normoblast" isn't even in first aid. +40

link981 NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +25

tinydoc I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +23

qball Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +14

llamastep1 Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +10

fexx I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +7

mdmikek89 Even in you didn't know what Normoblast means, it cant be any of the other answers. TEST TAKIN' SKILLZ BROS +

nerdstewiegriffin I can guarantee you this Q was written by some sadistic PhD examiner +18

submitted by wired-in(81), visit this page

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Maintenance dose formula is (Css × Cl × tau) ÷ F

where Css is steady-state target plasma conc. of drug, Cl is clearance, tau is dosage interval & F is bioavailability.

Neither dosage interval nor bioavailability is given, so ignoring those & plugging in the numbers (careful to convert units to mg/kg/day):

=(12 ug/mL × 1 mg/1000 ug) × (0.09 L/hr/kg × 1000 mL/1 L × 24 hr/1 day)
= 25.92 mg/kg/day

...which isn't any of the answer choices listed. They must have rounded 0.09 L/hr/kg to 0.1 L/hr/kg, and doing so gives exactly 28.8 mg/kg/day (choice C)

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lispectedwumbologist That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +85

hyoid ^^^^^ +13

seagull lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +10

praderwilli Big mad +10

ht3 this is why you never waste 7 minutes on a question.... because of shit like this +9

yotsubato Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +21

bigjimbo JOKES +1

cr in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it. +1

d_holles LMAO games NBME plays +3

hyperfukus magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1

jean_young2019 OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +7

atbangura They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +7

titanesxvi I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +4

makinallkindzofgainz The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +23

qball Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +1

frustratedllama Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +1

fexx 'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1

cbreland I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡 +

yesa 12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s +

chaosawaits What really grinds my gears is that 3/5 answer choices are closely related to using 0.09 instead of 0.1 (A is 25.92/10, D is 25.92*2, and B is D/10). So basically, we're supposed to know to round 0.09 up to 0.1 but also to not round 12 down to 10. Okay? +

impostersyndromel1000 so you're telling me that I did all my math correctly, got 25.92 then thought I was off by a decimal point and chose 2.5 bc 25.9 wasn't an option and I was actually correct in my math but wrong bc THEY DIDNT PUT THE RIGHT ANSWER? Why is NBME so trash? I hope real exam isnt this bad. +1

submitted by yotsubato(1208), visit this page

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So for Candida we can use

Azoles (fluconazole) (inhibit CYP450 demethylation)

Amphotercin B (pore formation in fungal cell membrane)

Caspofungin (prevent crosslinking of beta glucans in cell wall)

or Nysatin for oral or esophageal cases (pore formation)

This question is saying that she is taking an ORAL drug to treat candida vaginitis.

Amphotercin is IV

Caspofungin is also IV

so we're left with azoles

Azoles inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol.

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qball Nystatin does treat vaginal candidiasis but is TOPICAL. +2

thotcandy Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2

staghorn Me - picks Metronidazole -_- +1

alexxxx30 @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5

turtlepenlight I have seen that on the wards so I hope it works! +

fexx and my smartass picks amphp B +2

avocadotoast Please no one give a poor girl with a yeast infection amphoterrible +3

fatboyslim @alexxxx30 according to FA2020 page 153 Nystatin is only for oral. In the 2018 FA it did say it can be used for esophageal but they edited that in 2020. +

submitted by johnthurtjr(168), visit this page

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here's a google

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johnthurtjr FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face. +3

drdoom via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." https://www.medscape.com/viewarticle/773465 +3

meningitis I guess that's another reason for steroids and doping up. +8

drschmoctor For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation. +2

fexx F U testosterone! and F U NBME 22 question +1

schep I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy: +OSA +prostate cancer +hematocrit >50% +2

drdoom ^ linkify @drdoom https://www.medscape.com/viewarticle/773465 +

kayla @drschmoctor; I still think it lines up with the correct reasoning; during the menstrual phase ( in addition to loosing hemoglobin in the blood) there are also very low levels of the androgen hormones that usually serve as a stimulating effect on hemoglobin... +

abhishek021196 Fortunately, we were taught this in med school - testosterone stimulates erythropoiesis by stimulating EPO and recalibrating the set point of EPO in relation to hemoglobin and by increasing iron utilization for erythropoiesis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022090/ +