NBME Answers : hhsuperhigh's page

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+10 visit this page (nbme23#19)

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"His friends believe there may have been drugs at the party", period. lmao...

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aisel1787 ahahaha +

qball What a snitch +12

bend_nbme_over Good thing they were at the ED cause that friend is gonna need some stitches +2

+1 visit this page (nbme23#33)

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My guess for not choosing PPI is because the duration of drug-using. PPI increases the risk of C. diff by long-term using which considered as over 1 year of using. This pt should have used the second drug less than 4 weeks according to the question. So PPI is unlikely to cause C. diff diarrhea within this short period of usage, especially when this pt is not immunocompromised, or using antibiotics.

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+0 visit this page (nbme24#24)

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The diet is prescribed, so no need to refer to dietician anymore. It is a case of the patient non-compliance of diet. But why can't advise the parents to stop bickering?

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therealslimshady I remember Boards and Beyond said that you never want to pick any statements that sound "scolding", plus it couldn't be much help to just say "stop arguing", it's better to find out information on what's causing the arguing so that you can stop it entirely, which choice B will allow you to do. +

tyrionwill stress is the thing to worse the condition of DM, and will be better after being seen, comforted, and accepted. +

+1 visit this page (nbme20#26)

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This is how my brain farted while I was doing this question.... I wanted to choose TBG deficiency, but I kept thinking that if TBG is deficient, that means there are less or no binding proteins in the blood. And how can the free T4 be normal? Shouldn't free T4 increase if there were less T4 binding protein? ...

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adong free T4 wouldn't increase because it would be sensed by the pituitary and TSH would drop until free T4 normalizes +3

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submitted by colonelred_(124), visit this page

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Attributable risk = incidence in exposed – incidence in unexposed

= 30/1,000 (smokers) - 30/3,000 (nonsmokers)
= 0.03 - 0.01
= 0.02 (so the attributable risk is about 2%)

Applying it to a population of 10,000:

= 0.02 * 10,000
= 200

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charcot_bouchard What if i tell you this is a ques of Attributable risk % in exposed? AR= 0.02 / IR in exposed (30/1000) = 0.6667 30 case in 1000. So 300 case in 10,000 0.6667 x 300 = 200 or in another word 66% cases of 100 lung cancer cases in smokers is actually due to smoking. so in 300 cases of smokers 200 is actually due to smoking +5

charcot_bouchard This is a mind fuck. Lemme tell u guys if any consolation while doing the ques during test i did it with AR = 0.02; NNH = 1/0.02 = 50. 50 persons smoke to cause 1 cancer. 10K smoke to cause 200 cancer. +4

ls3076 Sorry if this is a stupid question. Why is it incorrect to simply apply the same proportion (30 cancer per 1000 smokers) to 10,000 smokers? +2

krewfoo99 @is3076 Thats exactly what is did. I still dont understand how that is wrong. But i guess they want us to think about it in terms of AR +1

hhsuperhigh @Is3076 and @Krewfoo99, If a person doesn't smoke, the natural risk of getting lung cancer is 30/3000=1%. The smoker's risk is 30/1000=3%. This 3% is not purely contributed by smoking, but mixed with the natural risk. So for calculating the pure contribution made by smoking, you should use 3%-1% which is 2%. And this 2% is the pure contribution of smoking. Not all smokers get lung cancer, the same thing, not all lung cancer among smokers are attributed by smoking. They may get lung cancer anyway despite smoking or not. +21

submitted by sugaplum(487), visit this page

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This is apparently congenital thyroid binding globulin deficiency

"Thyroxine-binding globulin deficiency — Thyroxine-binding globulin (TBG) deficiency is characterized by low serum total T4 but normal free T4 and TSH; the diagnosis is confirmed by measuring TBG concentrations. These infants have normal thyroid function and do not require treatment." - uptodate *can't find in FA, maybe it is in there somewhere?

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hhsuperhigh The only thing I can relate to this is FA P331 " TBG in pregnancy, OCP use (estrogen increases TBG) increases total T3/T4", so here is the opposite situation, which TBG decreases, and total T3/T4 decreases... +16

jawnmeechell Goljan talks about this (around 33 mins into his endocrine lecture) in relation to increased androgens causing decreased TBG +3

sarahs why isnt it maternal antithyroid ABs? +2

sexymexican888 @sarahs I think if it was antithyroid ABs (hashimotos) TSH would be high +

srmtn @sarahs because it would be cretinism (+ physical findings) = thyroid disgenesis, ectopy or hypoplasia. the thyroid of the baby would not be able to make thyroid hormones at all. this baby has decreased T3 and T4 and normal free T4. +