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Welcome to ht3’s page.
Contributor score: 10

Comments ...

 +0  (step2ck_form6#7)

why can't this be chronic bacterial prostatis?...ughh the gram stain and leukocytes on UA threw me off

ht3  according to Uworld, chronic prostatitis* could be nontender +

 +0  (step2ck_form7#25)

If the chin is deviated to the right, then wouldn't the "mass" (which I assume is the tight SCM muscle) be on the LEFT side of the neck??

Subcomments ...

submitted by medicalmike(16),

This child has some sort of leukodystrophy, as evidenced by widespread white matter disease on MRI. Without having reviewed biochem recently, one can educated guess this question by recalling that fatty acids like to accumulate in white matter; white matter and peripheral nerve conduction will be messed up. Accumulation of VLCFAs specifically refers to adrenoleukodystrophy. Other diseases include metachromatic leukodystrophy, refsum, zellweger.

Abnormally decreased serum cholesterol and Acanthocytes = Abetalipoproteinemia (causes ADEK deficiency)

VitE deficiency damages spinocerebellar tract, dorsal columns, and peripheral nerves (same as Friederich Ataxia)

ht3  Good thing I know 0 biochem +  

submitted by ht3(10),

why can't this be chronic bacterial prostatis?...ughh the gram stain and leukocytes on UA threw me off

ht3  according to Uworld, chronic prostatitis* could be nontender +  

submitted by medicalmike(16),

Itchy rash and eosinophilia suggests Type I hypersensitivty reaction, a side effect of sulfonamides.

ht3  But she has been taking tmp-smx for a whole year and the rash shows up 2 weeks ago.....?? +  

submitted by step_prep3(10),
  • Young patient with concern for IBD (increased stool frequency, signs of inflammation [fatigue, weight loss], bloody stools) who presents with ill-appearance, fever, hypotension, abdominal distention and an X-ray showing dilated transverse colon, consistent with toxic megacolon in setting of ulcerative colitis
  • Key idea: Toxic megacolon associated with ulcerative colitis and C. diff colitis
  • Colonic pseudo-obstruction often seen in elderly patient who is post-op and/or received opiates, diverticulitis leads to LLQ pain in an elderly patient, and ischemic colitis leads to “pain out of proportion” in a patient with risk factors (atrial fibrillation, endocarditis, etc.)

killuashi  Would toxic megacolon only show up in one part of the bowel? Shouldn't the whole bowel be dilated in toxic megacolon and not just the transverse colon? +  
ht3  ^I thought that too but also isn't toxic megacolon painful...? or nah? +  
danielle359x  Toxic megacolon is typically most prominent in the transverse colon. According to UpToDate, 82% of cases present with pain. I feel like they didn't need to emphasize twice that the patient had no pain, but that's NBME for you... +  

submitted by step_prep3(10),
  • Young woman with a nontender thyroid mass/nodule that is 2 cm in size, requiring fine needle aspiration biopsy
  • Key idea: All thyroid nodules should be worked up with a TSH and thyroid ultrasound, with thyroid nodules greater than 2 cm in diameter or thyroid nodules greater than 1 cm with high-risk sonographic features (irregular markings, microcalcifications, etc.) should undergo fine needle aspiration biopsy
  • Key idea: The thyroid gland is highly vascular, which is why you would always use a fine-needle aspiration biopsy for evaluation
  • Key idea: Mass in the neck that moves with swallowing = Thyroid or thyroglossal duct cyst
  • Key idea: Hypofunctional or “cold” thyroid nodule has a higher risk of malignancy as compared to a hyperfunctional “hot” thyroid nodule

ht3  sooo you're saying to get TSH why would the answer not be thyroid function tests..? +1  
nbmesuxugh  I thought that too but the question is asking to establish the diagnosis not the next best step! just be careful on test because I have seen tricky questions like that +  

submitted by step_prep2(17),
  • Child with atraumatic, progressive, bilateral knee pain with elevated ESR and otherwise normal exam/labs, most concerning for initial presentation of systemic juvenile idiopathic arthritis
  • Along with many other causes of autoimmune disease, SJIA is associated with anterior uveitis
  • Key idea: Classic NBME presentation is a patient with daily spiking fevers associated with a transient pink macular rash, along with signs of inflammation of labs (leukocytosis, anemia, thrombocytosis, increased ESR/CRP)

ht3  mannn this bitch had no fever NOR rash smh +  
danielle359x  Actually this is oligoarticular juvenile idiopathic arthritis: involvement in <4 joints, usually weight-bearing joints esp. the knees; elevated ESR, usually ANA+, RF-; the oligoarticular subtype has the highest risk of all JIA for anterior uveitis. No fever or rash=NOT systemic JIA subtype (not associated with uveitis) RF- = NOT seropositive polyarticular JIA (associated with rheumatoid AKA subcutaneous nodules) Not seronegative polyarticular JIA b/c involvement is with >5 joints, although this subtype is associated with anterior uveitis as well (but to a lesser degree than the oligoarticular subtype) +  

submitted by wired-in(67),
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anicMnneeat eosd faurlom si (Css × Cl × t)au ÷ F

erweh sCs is tdeataty-ses ergatt pmlaas cocn. of u,dgr lC si c,aeclanre tau si goesda ertnvila &;apm F si

teerhNi goaeds eialrtnv nro viilolaatybibai si gi,nev so ngiignor ethos p&ma; lggginup ni hte bmrnesu clra(efu ot cnevrto ntusi ot y)kagd:mg//

1 (2= gmuL/ × 1 g/1000m ug) × 0(.90 /gkhrL/ × 1000 1/Lm L × 42 h/r1 )dya
= 22.59 ga/m/dgyk st'ni nay fo the rwsane eishcoc sleti.d Tyhe utsm aevh udrnedo .090 kg/Lhr/ ot .10 ,gLkh/r/ and oindg os sgvie lteacyx .882 //kmaggdy cohe(ci )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +72  
hyoid  ^^^^^ +11  
seagull math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9  
praderwilli  Big mad +9  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18  
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 +2  
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 ...... +6  
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 +3  
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 +2  
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 +15  
qball  Me after plugging in the right numbers and not rounding down : +1  
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +  
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😡 +  

submitted by seagull(1443),
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otu fo cit,oyusir hwo mya eepopl nkew h?sit n(odt eb hys ot asy oyu ddi ro )nitd?d

My pyorevt tacinedou tnd'di agirnni ihts ni em.

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  

submitted by hungrybox(977),
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ngLo wreans ,aahde tbu rbae whit m.e

N:ITH v ookls kndi of kiel y, seewahr k oskol ermo keil x.

nryttecp-ie = V/amx1

  • xmVa si the erpup mliti on owh fsat a nciortea is detlzcyaa yb zyesen.m

pcxetn-reti = K/1m

  • Km is a gnikran fo owh dgoo an ymzeen is at dnigbni tis ussrt.aebt An emznye htwi a rnikgan of 1 si betert at iigdnnb sit utbsesart tahn an mezyne itwh a arnkgin of .5 oLewr( Km = tbrtee zemeyn)

Noet tath x,Vma as a muesaer of anprmfc,oree cna eb rdelate grhohut myan gihsn.t Mwel,anihe Km si a ste irccarsitehact of teh zn,emey dna catnno eb .edetlra

In sthi mxelpae, teh eemzny arcreefpomn )V(axm is diseecnra yb gaenicnirs hte tivmnia oactorcf so thta it ecrashe a m"n"rloa vyacttii. rH,woeve het yzeenm si sllit rehntneyli hytsti ued to a oageictlnn ftc,ede so the Km sytsa hte s.mae

mnemonia  Awesome. +  
ht3  wait line B shows the vmax doesn't change and that the km is getting larger (enzyme is still shitty so larger km) so -1/km would be a smaller number and would approach 0 +1  
lamhtu  You say Km cannot be altered and its staying the same, but the answer of the graph demonstrates a higher Km value. Needing "higher concentrations" of the B6 for enzyme activity is another way of saying Km is higher since more is required for 1/2 vmax activity +11  
sbryant6  Yeah this explanation is wrong. +