share email twitter ⋅ join discord whatsapp(2ck)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to hyperfukus’s page.
Contributor score: 75


Comments ...

 +1  (nbme23#15)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

so osldhu we ujts psik htee?s zuc hese'rt prbo 01 erom i lovdceu etognt wirte tasigwn ym ifle on siht one

faus305  Don't skip it but flag it, give yourself 1 minute and 30 seconds or less to figure it out and if you don't then move on and come back if you have time. Questions like these are what I like to call "time wasters." I got it wrong because I selected 2.5 assuming I made a conversion error when I arrived at 25.9 as my answer. I think the lesson to learn here is that 28 is closer to 25 than 2.5 and NBME are evil people that know I'm not gonna make a conversion error. If you do math in a question and you are SURE you did it write, select the answer closest to the answer your math got you. +

 +0  (nbme22#15)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I hkitn ttha iesnc 'retyhe sniagk rof na nintpoaleax fo hte sttpeani' entrurc SxS chihw swohs htat 'sseh in het esatt fo nnitarTse Hs:odrmiyehrtypi hhwic is ude ot C: lesReea fo doster thiordy ohmoner mrfo a dyhroit gdaln dietlntifra by eylhstyomcp


 +3  (nbme22#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

so the onseil si in eth Rtihg FML tgrhi? fI os Im' jtus tboua ot zireoemm eth eye ees MESA iLFM llo sit the MFL no eth esma iesd fo eth eey kpee ti pemils i heop ht'ats hawt yall are iaygns llo


 +5  (nbme22#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

os I hnkti fi you gefotr autalc gusdr on eth tkrame htat ew wnok fo dan owh teyh wrok, the nquostei si pyeuoprls ont ignska uyo taht .aclIfiiyep.l.scf oyu lpfi it ni ruyo heda to kihnt twah het lmerbpo is atth sleda ot icn GT tsi bceseau of DVLL torheeerf eyht isda mgetrniiasind a URDG tihw whihc of teh owlgifonl TCEFFSE is OTSM pICRo-Ar&G-tg-ESiNrepDaEpta; LVDL /bc hts'at hte rpcluti

ogAlthuh ugsdr we wnko fo have eht htreo ,atarreccchtsisi ofr siht ,ygu ew uwlod eb golonki rof the tcfeef of LLDV evyneightr else si a dsie ihtng atth etnso'd cleyditr ardssed ish toniiocnd


 +4  (nbme21#6)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Alos othaner eky si ti ysas lroamn eipaarpgn lrig eon of the gnsthi oubta hte ISA is htat etyh od tge yndcoresa exasul aeisrhtrrc.euricn.atct.s silrg dont' oklo nrlamo hye'dt eb trsoh dna ubsytb no obobs taf kcen tec

covid2019  I'm confused that they said she appeared "normal". I thought AIS would mean the patient has very scant pubic hair / underarm hair. Wouldn't this be abnormal in a 17 year old? Should have Tanner stage 5 hair.... +
mumenrider4ever  FA2020 (pg. 639) describes AIS as "Defect in androgen receptor resulting in normal-appearing female (46,XY DSD)" so I assume they're talking about general outwards appearance +1
lola915  You do get breasts because patient has build up of testosterone that is aromatized into estrogen. No axillary or pubic hair because that requires testosterone. +
lovebug  THX. SEE AIS (FA19 pg,625) +

 +3  (nbme21#31)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

alos in asce yhet sak erbmmere ttha ehste rea 'vhas(UAPeF obulde s)dobn dna tehy rea etrteb ahtn Sueatadtr anfot(s uobled )bnrbad+socs

drzed  PUFA = poly-unsaturated fatty acids in case anyone didn't know the acronym. +4




Subcomments ...

submitted by docred123(6),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yHe nac eomosne apslee aepinlx !itsh I am nto esur hwo to do eth at,mh I epke tntggei pdrtpie up.

mousie  Equation is Maintenance dose = (concentration at steady state) * (Clearance) if you convert all the units to what it wanted them in (mg/kg/day) you'll get 25.92 like weird-in said above I didn't think to round 0.09 to 0.1 of course so I guessed 2.5 assuming I must have done a conversion wrong and was off by a tenth .... BOO bad Q +4  
hyperfukus  OMG ME TOO!!!!! +  


submitted by wired-in(67),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nnetinaaMec soed fmloaur si Cs(s × Cl × ua)t ÷ F

hewer Css is yatdets-etas ettrga mslapa cnco. fo ,ugdr lC si eenarla,cc uat si osaegd erilvtan pa;&m F is ibbvaliyl.iaoita

rNiheet gseado teniarvl nro avliiiiaalbboty si nievg, so gngrinoi etosh ;&pma uggnlgpi in het ubnsrme auelrcf( ot rnovtce nusit ot gdg)m://yak

= 12( g/umL × 1 10mg00/ g)u × .(900 gL//rhk × 0010 1Lm/ L × 24 h/r1 yd)a
= 9225. /ykg/magd

c.h.ihw. 'nist any of hte snaerw ceiscoh le.itsd eyhT mstu eahv ndduroe .900 rk/Lgh/ to .10 hr,/Lk/g nad gdnoi os evgis ctlyaxe 828. akgg/dy/m iecoch( )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +69  
hyoid  ^^^^^ +11  
seagull  lol..my 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 : 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 +  
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 welpdedelp(216),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oN tdie ydn,ceicfei het tatnepi adh cessxe careeton deu to his eidt

sympathetikey  Would never have thought of that. Thanks +8  
medschul  that's messed up dog +18  
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +  
davidw  this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7  
davidw  β-Carotenes are present in dark-green and yellow vegetables. +  
hyperfukus  ohhhh hellllll no +7  
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6  
cbreland  I'm okay with missing this one +4  


submitted by yotsubato(967),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hAgtohul ectomehanpnai )e(oyTlln is ton drnceiesod an ND,IAS ti oot amy ropevko na iikpne-slari siitste.yniv

meningitis  For that same reason (not an NSAID) it doesn't reduce inflammation so it cant be used for Gout. +5  
meningitis  And I think Indomethacin is associated with anaphylactic reactions in patients with aspirin-sensitive asthma and aspirin allergies. Can anyone confirm? +  
link981  How many other's like me didn't see "allergic to aspirin"? FML +3  
hyperfukus  OMFG me too i just got so mad and questioned my whole life at least its cuz i can't read not bc i don't understand :((((( +1  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hWy si hte reansw dllyynae ces?clay I eodklo ni FA dna I was hatt HG uses het KTTSAA/J2 twhapya dan that -1FIG uses eth PMA niaesK .ywpatah Not usre how alnyyled cceysla aplys into this.

pug_sheen  I think they are talking about the GHRH receptor on somatotrophs, which works through the cAMP pathway. +  
staygoodpupper  I don’t know how it relates to GH/IGF-1 in particular, but the question said there was a mutation in the alpha subunit of Gs, which activates adenylyl cyclase. +3  
kash1f  I agree the patient does have Acromegaly, but in the question it talked about how the patient had a mutation that prevented the GTPase activity of Gas. So Gs would be overactive --> excess adenylyl cyclase +28  
hyperfukus  ugh i was so excited too bc i thought i remembered jak stat epicfail +3  


submitted by hopsalong(25),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

siTh nusqetio ahs a olt of wnrsea siootpn, adn ouy arrvei at trhsolieNshiiap by gwhnrtio uot lla teh hoter tiosnop yb wath is g.imnssi

,A B - trCcaoil eosiscNr nda rlpyilaPa scisrNeo asmlto awylas ouccr in the ettgsni fo is.imaech iPeuyrvlso yethhal 28 eayr odl mna has on eeencvid of isgtflainincy cdedaeser rnael oeisurn.pf

C - Aceut uarbluT ciNeross si ahtw uyo osudhl kihtn fo tiwh iaalytecSl )(SNIAD i.ytcotix heerT are mnya oreth ieotrhocnxp drgsu hatt eacsu N,TA tub ktinh fo ATN sa gdur ddieucn nedyik ea.mdag

D - istytCis - lknFa inpa is deaelrt ot ndkyie ,yujrni ont bedrdal ed.amga ttCisisy odlcu eb pslisebo ni idncegsan TUI, ubt eth eptaitn sah on efver adn is emal uchm( sels omcnom in es.lma)

E - eietnlpihrGlrmsouo - hisT tgse iotn noepieicrnhripctth/ doy.ermnss heT setm esnonmit htat he sah obldo in teh erniu wcihh amy ldea oyu nodw hte etchniipr tpawy,ha tbu he sdeo tno hvae nya fo teh other oaacdisest momspsty.

F - aoHhernpmprye - rAhteno dwor rof nlRae lCel Cairam.noc oN gitwhe sols or roeht crcnea tdreeal sospmmyt atigfue( e.)tc

G - erntiittlaIs eNhirtpis - isTh is otnef a gdru eicnddu NUIEMM tdadmeei ycterxhointoip. hsTi si a pety IV siyhvtiyetneprsi naetorci thta cruocs sewek ot tnosmh taefr eth arstt fo oancidmtie eilk( sD.I)SAN TNA is omre decsoatsai ihtw rgud vedeorso hielw Ietlsttinira si rome tocdaaises ihwt unmiem nrte.oaci nsaIrtiliet tpehriisN iwll aveh WCB ascst in .eniru

I - snotrihpyieelP - uaseCd yb agdsnncei TUI but no rfeev si nesret.p

isTh levase eriiohhNiaptsls )(H sa teh croecrt nerw.sa %85 of soiletpiNirsahh is idoceatass with vaciythepo ewolb oudns.s eTh pani fro ohratsiliiepnhs anc lseepra and t,ermi dan lcsnaaoylico the nipa acn vtealr mrfo hte deynki (flakn a)ipn to teh oscrumt sa het stoen esmvo hutrgoh eht rureet.

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +3  
hyperfukus  yasss +  
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +4  
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +  
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ishT is tueac olihymcte irsuafsonnt cinaero,t I veebeil. peTy II RHS os ’shse rngofmi tbnieadsoi aangist hte OBA gsoupr on eht obdlo lc.les omCpelnmte is uedincd by it.ndoasebi

kfratta1  But with hypotension in the stem I thought more of anaphylaxis due to IgA def. Why would a T2 HSR give you hypotension? +3  
2ndmedschool  I think the hemoglobinuria is the key. As I’m looking at it it seems that anaphylaxis would cause hypotension, urticaria, itching, wheezing. ABO incompatibility is the only one that mentions hemoglobinuria. +16  
hyperfukus  abo incompatibility and rh incompatibility with mom blood rxns are gonna TYPE 2 no matter what it looks like +  


submitted by skraniotis(10),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

daidynzelU rlnae lfuiear lesad to ectlmbaoi ocs,aidsi dan sa a urslet bicbar gset epedtdel as ti esirt to ufbref eht tuuimanlccao of gacorni ia.sdc

bubbles  Thanks for the explanation! Do you know why Mg would not be a potential answer? Phosphate also accumulates in those with undialyzed renal failure, so I was thinking that maybe magnesium as a divalent cation would complex with PO3 (in a mechanism similar to Ca). +  
nwinkelmann  From the little bit of research I just did (because I didn't learn anything about dialysis at my medical school), ESRD can be associated with either low or high Mg levels, so the dialysate can cause either increased or decreased Mg levels depending on the patient's serum content, therefore I don't think based on this question, would could determine if removal of dialysis would lead to elevated or decreased magnesium. The end of the first article seems to favor ESRD leading to hypermagnesemia, so if that's the case, then removal of dialysis would cause Mg to increase as well. https://www.karger.com/Article/FullText/452725 and https://www.karger.com/Article/FullText/485212 +1  
hyperfukus  why is it that we aren't learning this stuff and they r just throwing it on step there's barely a blurb in FA about ckd/eskd +1  
hyperfukus  does uremia potentially have to do with this? +  
medulla  ESRD and not getting dialysis -> he is uremic -> met acidosis -> dec bic +10  
angelaq11  @medulla this is the best and simplest explanation. I got it wrong and chose Mg, wish I had made that connection. +  


submitted by skraniotis(10),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iaUdlndezy eraln reafuil elads ot ocmilbtea ai,sciods dna as a ltuers briacb gset dlpteeed sa it rseit to rufefb het nltuicaumoac fo cianrgo csiad.

bubbles  Thanks for the explanation! Do you know why Mg would not be a potential answer? Phosphate also accumulates in those with undialyzed renal failure, so I was thinking that maybe magnesium as a divalent cation would complex with PO3 (in a mechanism similar to Ca). +  
nwinkelmann  From the little bit of research I just did (because I didn't learn anything about dialysis at my medical school), ESRD can be associated with either low or high Mg levels, so the dialysate can cause either increased or decreased Mg levels depending on the patient's serum content, therefore I don't think based on this question, would could determine if removal of dialysis would lead to elevated or decreased magnesium. The end of the first article seems to favor ESRD leading to hypermagnesemia, so if that's the case, then removal of dialysis would cause Mg to increase as well. https://www.karger.com/Article/FullText/452725 and https://www.karger.com/Article/FullText/485212 +1  
hyperfukus  why is it that we aren't learning this stuff and they r just throwing it on step there's barely a blurb in FA about ckd/eskd +1  
hyperfukus  does uremia potentially have to do with this? +  
medulla  ESRD and not getting dialysis -> he is uremic -> met acidosis -> dec bic +10  
angelaq11  @medulla this is the best and simplest explanation. I got it wrong and chose Mg, wish I had made that connection. +  


submitted by bobson150(11),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sI tish nsyiga erthe si relioaesevtucr xflreu? I odulc aehv wrsom tsih easm aiegm saw on morf 20 or 12 nad eht reasnw asw lsWim mrotu

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +13  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +3  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +  


submitted by bobson150(11),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Is stih gnasyi eterh is avireecotrsleu f?eurxl I ucdlo eavh rwoms this emas igmea was on fmor 02 ro 21 nad eth swrnae swa slmWi orutm

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +13  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +3  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +  


submitted by seagull(1404),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

out fo orusc,ytii woh amy plepoe kwen tihs? ndot( be shy ot yas ouy idd ro dnd?it)

yM overypt donieutca 'didnt aiinngr isth ni .me

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 meatus(1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

'mI rrsoy but tahw am I snismgi re.he.. I thtuhgo eth lehwo oiptn fo crustdiie is to cotercr lovmue edovloar yb i?sirdues How oluwd lotta moevul be ?einrda?sce

niboonsh  the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_- +12  
link981  Also misread the question, thought about the lab volumes of the BLOOD smh +5  
hyperfukus  yooooo me too!!! this is the second NBME i did this on they purposely don't write urine on the arrow categories to mess u up i swear!!! AHHHHHH +2  
medulla  missed this question for the same reason .. still pissed +2  
osler_weber_rendu  I DID NOT READ "URINARY" OH NOOOOOO. Im so dumb. +2  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

shTi noe saw a ltilet yk.ritc For tish neo teh eky si eth low diaerooindi .upetka hTis etitpna ahs high T4 adn lwo HST chiwh kesma eness ni a trhdrheoypiy tt,apein pseharp oyru istrf tguohht si ttha siht ittanep sah erGsav’ ieseds.a evoeH,wr ni ’Grsvae ouyr otrhdiy is egbni tauemldtis ot ekma eomr ritdyho hnmooer rmfo hrcatsc nad sa suhc wdulo heav an edensciar iieaodnrdio etuapk aecsbue eht dohyrti si nirigbgn in het urqeeidr nw(o lrdloe)badaie doeini. hisT si yhw it si tno versGa (eelsae“r of ytodrih omenohr frmo a trhidyo uidstetlma by ben”)sadtoii.

oS if sti otn vsae’rG hwat loduc ti be? For tsih oudy’ veha ot owkn htta ossmoh’aHti hdiotTriiys os(al wnokn as hCoincr hLompycticy tdTrihsioyi dna si eontf ereedrrf to as suhc no rdabo exmas ot rtwoh uyo f)of sha heetr esspah - tsfri yhet ear ptreodrhiy,yh ethn thrydo,iue neht eth cacslis yhotdoryhpi atth uoy udolw eecptx wthi wol T4 nad hhgi ST.H Tshi was the kye ot siht ouenqt.si hTe rsonea rfo itsh is htat dorihtyanit sexoadprei ibantiedso ni Hsst’mhaioo ueasc eht dhyrtio ot areslee lal fo its eortsd doithyr nooremh iagnkm the iepatnt hyohrdrtieyp for a hotrs proied fo mtei. trfeA shti esasvim elsreae fo yhrotdi ermno,oh eht nsidoieatb amke tehm uebanl to eakm new TH dna trfeeeroh yeth bcemeo hyruieotd for a roths opdeir dna tnhe dyoyphtiohr whhci uyo udwlo tcp!exe Scine thye ’tacn amek nwe TH, eht irydhto lwil tno akte up het eiooirdndai dna teeforreh teher wlli eb olw niaidoierdo aku.pte e,nHec ree“lase fo rsdeot yrtoidh nrhemoo mofr a yhidotr ngald ltfetnaidri yb ysc.polme”hty kaa y“myoLpthicc aohoti)ms(sh .isdit”iyotrh

I itnkh “eerasel fo rtdiohy hneoomr rofm a aopmslmuhtoy tioydhr ldga”n si rrgineerf to seom dink fo ydorhit aecnrc ni chwih esac yuo odlwu cteexp tmeh to eb ncgbiiedsr a oluden on ioieradoind tak.peu

mrum​ayS eivod eerh adn saol a rtgea itse in ege:alrn e/nutc/ndyrtornpo/riraepane/iidlgoehhs/td:/ecqe.mdios

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9  
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3  
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1  
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +9  
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +  
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2  


submitted by mattnatomy(41),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Msto noommc asecu fo lescnip einv mbstrosiho si cinrhco pcnttsriaeai, sduaec by psinverueo noitali.anmmf

uceor:S ug042/4/b0thwbci1smnd5npn.5o.lewwphi/m:t/v..

hyperfukus  great link! helps answer other qs too thank you :) +  


submitted by alexb(45),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTerh si a ntdece WdorUl snteouiq gilaepnnxi owh htsi wsk.or lOyn snaore I rbeeedrmem i.t

hyperfukus  i had notes from forever ago but i totally forgot lol +  
carmustine  UWorld question ID 318 +3  


submitted by mattnatomy(41),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I bievele thsi is regrfnrei to gitudm nlimaotrtoa. ueD ot pripoerm iospnniitog of woelb no( teh githr i)esd. daLsd dbnas cnctnoe het lgaer ieeitnsnt ot het rivl.e

naC eald :to

  1. oVuvusll

  2. Dloundea tuibrtconso

3. MAS nOcuilocs -- 'Im unsgisge aesbd no het wsanre to teh onestiuq

meningitis  Yes, the question clicked for me when I realized the ligament was on the RT side instead of LT so I thought of Volvulus. Image of ligament of treitz: https://media.springernature.com/original/springer-static/image/chp:10.1007/978-3-642-13327-5_17/MediaObjects/978-3-642-13327-5_17_Fig3_HTML.gif +3  
hyperfukus  So Volvulus regardless in baby or adult is gonna cause SMA prob + Duodenal Obstruction: d/t Ladd bands im gonna go back and remember those associations :) +1  
pg32  Yeah, recall that the midgut rotates AROUND THE SMA in development. If you can recognize that the ligament of Treitz is on the wrong side (right) then you know you have a malrotation issue. Then you recall the midgut rotates around the SMA and you pick that answer out of pure association recall and get it right. Nice. +1  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

rOu ltilte nfiedr ash a vsaroruvPi eoifnn,ict ihcwh ficents yhretrdoi rss,rpcroue agusinc enitritnupor fo hertyyroetc io.uprodctn isTh si teh asme ayw it csusae drpshoy ilatsef ni urnnob beisab nad astlpcia aniema ni ilceks lcel, cte.

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +20  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +3  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +4  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +  
angelaq11  @Is3076 I completely agree with @hyperfukus and I think that thinking of Roseola isn't crazy, but remember that usually with Roseola you get from 3-5 days of high fever, THEN fever is completely gone accompanied by a rash. This question says that the patient has a history of 4 days of rash and 7 days of fever, but never mentioned that the fever subsided before the appearance of the rash. And Roseola is not supposed to present with anemia. +3  
suckitnbme  @Is3076 another point is that malar rash refers to the butterfly rash on the cheeks that is commonly seen in lupus, so the face is NOT spared. +  
mdmikek89  Honestly y'all lmao First line...RED CHEEKS AND RASH Malar Erythema --- Hello? Rash - Eventually it may extend to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance Hemoglobin is 1 g/dL below normal. This is Parvo B19 -- SLAPPED CHEEK. I swear man, y'all make this easy nonsence. WAY to hard. +1  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

urO lteilt rdifne sha a vrasrouivP ntoei,nfic iwchh etfinsc tyedirhro rprerc,ossu aincsgu oriituprennt fo ttrehoyrecy uipo.drtcon hisT si hte mase wya ti suacse hsydpro aeltisf ni bonunr biseab and citapasl aniema ni kleisc l,elc tc.e

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +20  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +3  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +4  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +  
angelaq11  @Is3076 I completely agree with @hyperfukus and I think that thinking of Roseola isn't crazy, but remember that usually with Roseola you get from 3-5 days of high fever, THEN fever is completely gone accompanied by a rash. This question says that the patient has a history of 4 days of rash and 7 days of fever, but never mentioned that the fever subsided before the appearance of the rash. And Roseola is not supposed to present with anemia. +3  
suckitnbme  @Is3076 another point is that malar rash refers to the butterfly rash on the cheeks that is commonly seen in lupus, so the face is NOT spared. +  
mdmikek89  Honestly y'all lmao First line...RED CHEEKS AND RASH Malar Erythema --- Hello? Rash - Eventually it may extend to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance Hemoglobin is 1 g/dL below normal. This is Parvo B19 -- SLAPPED CHEEK. I swear man, y'all make this easy nonsence. WAY to hard. +1  


submitted by hello(301),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nPettia ash dre ylac hsra- shti tsif emro wtih 6-HHV elRosoa( us)iv,r otn uor.avviPsr

-VHH6 uecssa tfnomoierda fo yha,bteotsslr andelgi to ain.mae

hyperfukus  Hey so i just looked in first aid and it says "diffuse Macular Rash for Roseola" and usually you have a super high fever and febrile seizures are almost always mentioned...I found in my notes from uworld that i mustve filled in a long time ago for Parvo: Infects Erythroid precursors + Replicates in BM Face/cheek rash followed by LACY Reticular rash on body...May get Rash from IC deposition...and then again i wrote replicates in erythrocyte progenitors causing reticulocytopenia which makes sense why dec Hb and dec Hct +3  
hello  @hyperfukus is correct. Disregard this explanation. +  


submitted by enbeemee(13),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hawt rae the othre eadlble rset?ucrtus i nca drnceis the aratlepi nad ihfce clles, but tno teh oeh.srt..

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 :) +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Why nt’asw het etalb hnoeug to drentmeie ncaevrelep ni eht enreagl ?nuloioaptp

sacredazn  For the case control question, it’s taking that principle that you can’t use case control studies to calculate relative risk and applying it to prevalence. Basically with case control studies we start by saying okay, I’m going to find 200 people with sinusitis and 400 without. Then, you go back and look at the number exposed/unexposed and calculate the odds ratio. So you can’t use case controls to calculate prevalence because it all depends on how many cases you picked in the first place. Might make more sense to think about it with a rare cancer like craniopharyngioma or something- let’s say you chose 10 cases and 10 controls and wanted to look at how many people smoked. It wouldn’t make sense to then say the prevalance of craniopharyngioma is 10/20 = 50%. +20  
dr_trazobone69  Thank you, that makes a lot of sense! So we can use relative risk (cohort studies) to calculate prevalence? +  
sacredazn  @trazobone Hmm I think the wording would be key, you could use a prospective cohort to calculate incidence, but you wouldn’t be able to find prevalence of the gen population unless you had more info. I think the concept is that really to calculate prevalence you need a proper ecologic study looking at population-level data. The way it was worded in the question was tricky though lol since when has “cannot be determined from the info given” ever been a right answer. +5  
nwinkelmann  @sacredazn thank you! this was the best explanation to use the rare disease comparison. Made everything make so much sense and hopefully I'll actually just remember it now, instead of learning the factoid and failing to recall it all the time. +1  
hyperfukus  i guess this makes sense but i don't understand why we are asked to calculate it from tables like this then? is there more info in those? +  
hello  @hyperfukus The table was given because that a 22 table is typically what you do see regarding data for case-control studies. If the 22 table wasn't include, then literally everytone would pick Choice "E" as the correct answer b/c you can't calculate something without being provided numbers. The difference in including the data-table is that 1. again, you need to report a 22 table because that is typically what you will see regarding data for a case-control study and 2. by including the 22 table, it actually tests if the test-taker realized that the data in the 2*2 table does not help at all with calculating prevalence-- because case-control studies NEVER report on prevalence. +  


submitted by iviax94(7),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I saw neetwbe mphioeakyal (ude ot aa)ihdrre adn pahmialrrrcuihceeeiecyyam/p ncsei( aetsw si ocyoihptn nad lwdou acuse mosythioprec omelvu n.ot)irncaotc I dndi’t eahv a terga yaw to icdede enwetbe ipaahpieecrr/rCuemhyy os I dfeurig they dantwe pyoh.K Is hetre a teebtr oartiaenl orf hwy teh hpeyr ssrawen ear oreccnr?it

liverdietrying  I think you over-thought this one a little bit with the hypercalcemia/hyperuricemia. Good fact to commit to memory: you lose bicarb in the stool (hence why diarrhea causes nonanion gap metabolic acidosis), and especially lose potassium with laxative abuse (as mentioned in the question stem). https://www.uptodate.com/contents/acid-base-and-electrolyte-abnormalities-with-diarrhea +1  
w7er  Basically they are asking about electrolyte distrubance that cause collapse mainly due to hypokalemia from laxative abuse because diarreha cause hypokamlemia and also cause incrase in renin angiotensin sytem which will further cause hypokalemia resuling cardiocascular colapse :) +  
hyperfukus  i thought the hyperuricemia thing too but i wasn't smart enough to think they wanted hypokalemia like u :( +1  


submitted by d_holles(171),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ljnGoa sseesstr eth roadsB inigvg het lmeakiue ntqosesui aawy esadb no hte eag ngiev ni hte otqneius ss.met

LLA = 104-

MLA = -9315; 0954-

CLL = +60

CML = 045-9

loplesdea:cnstmego6s/ah/eto.kouohu0ts3utrt/ntni3.jr5-d.etdfmn/0/-rsa

impostersyndromel1000  thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +  
hyperfukus  also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +2  


submitted by gh889(115),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Teh wrnsea is due to na coneixpte uoltenid eerh hewre cianni is usde ni tps /ow deistbae ohw aevh acoetrfyrr ciglrdhyepmyteiiearr ta hihg iksr or ash a hx of ie.icstntpraa

I graee ttah ebastfir aer sirft line da(n os odes that riel)cat tub NEMB saw nhingo ni on a feisicpc nceoiexpt htat niinac cna laso be dseu sceni VLDL and TGs rae ghih ni iegcyeth.mirdprleiyra

The l"u"ce they ahd swa terunecrr" aecrstiit"apn wihch si pssupdoyle a adel rsodtaw nai.inc

I also ptu nsceaeir ...HL.D

wutuwantbruv  Correct, you would not want to give fibrates to someone with recurrent pancreatitis since fibrates increase the risk of cholesterol gallstones due to inhibition of cholesterol 7α-hydroxylase. +  
kernicterusthefrog  FYI @gh889 can't follow your link w/o an NYIT username and password, unless there's a more tech-savvy way around that.. I appreciate the info, though. Niacin rx for familial hypertriglyceridemia w/ recurrent pancreatitis. Now I know.. +2  
impostersyndromel1000  Great points, very in depth knowledge taking place here. Also, familial hypertriglyceridemia (per FA 2019 pg 94) has hepatic overproduction of VLDL so picking this would have been the easiest answer (in retrospect) +2  
hyperfukus  @impostersyndrome1000 literally that's the ONE thing i remembered and i went YOLO lol cuz i was staring for a while +  
osler_weber_rendu  @gh889 I agree niacin is the answer, but even niacin causes increase in HDL. As if getting to the drug wasnt tough enough, NBME puts two of its actions in the options! What a shit question +1  
mtkilimanjaro  I forget where I saw (maybe UWorld), but I always thought increasing HDL is never really a primary form of lipid control. You want to lower the bad cholesterol etc. since increasing good cholesterol wont change LDL VLDL etc. +  


submitted by dr.xx(142),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

FHC patentis tonef lpysadi isnsg nda mmoytsps fo daericens oivpreasnss ere.tiocns

hyperfukus  if all else fails i hope i just drill this one statement in my brain and it comes out in the right way on test day thank u!!! +  


submitted by seagull(1404),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hWy snos?aptnoeu 'sHe ngaigeng ni an aitecv rtspo hiwt an inecdaser sikr fo triamuaTc yur.jni oS we lyearl jsut suseam hes otn riejnud ecebaus eht etms onetds yreiltdc sya e'hs ejd?nuir eThse iusnteoqs deal ot oot amyn mi.ssausontp ni( ym ipinono)

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +  


submitted by drdoom(806),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

uoY evah ot hiknt tuboa sthi sguni eht poctecn fo NADOIOLINCT LBRYIP.ABIOT hoAentr ayw to aks isth tpye of uqsoiten is eikl hsit: I“ swoh ouy a attienp with osnnauosept pxaho.muntoer ciWhh trhoe ihngt si msot iekyll ot be uert ubtoa thta pso”enr? rO oyu nca pahsre it eehst ysw:a

  • vGien a ICTNIDNOO (nsouesoapnt upemno,) htwa horte gnnfidi is sotm eyllik to be teh e?sca
  • ivenG a olop of ppeloe hwti onsnupaeots hn,tpouaromex ahwt eroht itngh is omts likyel ot eb uert ubaot ?thme

In htroe dwosr, fo all plpeoe how edn pu tiwh ssnpatnoeou mopun,e eht mtos moomcn rheto hitgn tubao tmhe is taht yhet ear LAME m&pa; H.INT

If I vega ouy a cuekbt of sponeuonast numeop tpnstaie -- adn oyu eechrad uryo ahdn in reteh dan lldpue eno tou -- wtha crsianoe ouldw eb omre mmoocn: In ruoy dnah yuo hvae a oskmre ro in uryo dhan uyo have a hnit em?la ’Its hte rte.atl

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  


submitted by chosened(1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

retorCc me fi I m wgonr utb I hnkti 'its yrlanlaeg atsipololsma.pi oPplaaimls can dpeevlo eehranyw ogaln eth irayetprrso ,rttca utb omst nfeot tacffe teh lxnayr dan het loacv crosd ng(yleaalr p)pimsiolotaso aNl.t seur ohw YH sthi is btu seerh rMeo in:fo idgt--:srt/aarr-emrotaispones/tr.i/essspdroririputsseoelr/e/areaaeehsyclpras

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +2  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1  
teepot123  yep dr sattar nails it ^ +  


submitted by chosened(1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Ceoctrr me if I m gnrow tbu I thkni i'st eyanrlgal lpptioasmoia.sl plsaiPomal nac eoldpev hayewrne alnog het aoyerrsrpti ttac,r tbu mots eofnt atfcfe eht lrnayx nad the coval cords rln(eaalgy oioipt)taNllps .amos eusr woh YH hist is tbu esehr reoM f:noi reeaar-aarrprstl/s//.mtp-rdritlseneorrsaegthsdpoiauey-ciosrsieseaseispo:tr//

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +2  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1  
teepot123  yep dr sattar nails it ^ +  


submitted by bobson150(11),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh rondgiw fo sthi snetouqi fsnudoec .me Tshi is aigsnk ihcwh" fo teshe veesssl si eth ighh uessrper mteyss" gtr?hi oS the hhgi uspsrere urpoesri taclre si nsauigc cdasirnee resrepus tnoi het nerrofii eclrat?

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +2  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by neonem(550),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ounSds elik a asce fo rL-niiFeuam eonmsdyr - cines p35 is a muort sprspureso rfo a cnhbu of elcl se,pty omtstuina in hsit eneg s(a in S)LF ltesru ni a yamdir of iallimaf rotum ypets.

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +9  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +14  
dbg  ^ this guy cracked the code. nbme ur doomed. +5  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +3  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +9  
jakeperalta  @privatejoker: according to UW, Li Fraumeni includes SABBB(sarcoma/adrenocortical/breast/brain/blood(leukemia)) +2  
ac3  side note: RB1 = retinoblastoma with an increased risk of osteosarcoma +  
lukin4answer  TP53 associated with SBLA + Brain tumor + Anaplastic Thyroid ca + Transitional cell ca. -UW +  


submitted by seagull(1404),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

2esg~t/di7ihGuwkwbdrnd8te/mgwhtm1.e:u/.I/p/.

Arnothe ohltsyoig islde wthi lbaels a few ceosnds ago

enbeemee  what are the other labeled structures? i can discern the parietal and chief cells, but not really the others... +1  
hyperfukus  yea wth is A +1  


submitted by enbeemee(13),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

whta aer eht horet edallbe ?rttressucu i acn sierdcn eth latarepi nad ichef lsec,l tbu ont eth .os..hret

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 nosancuck(85),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oY sdi B tgo NO NATLINER EEMLAF NSORGA

yWh ?at??!d

eW eb nikolo ta nmooese ihtw an RSY omrf deer Y hyDeioerm! c eb a Y mrceiho iHome os hety be minak semo Tstsie nieietDnmr tFcoar whhci I be uesr amske mose cein ill TNIA ULIELMRAN TOACRF os yde aint gto atth aemFel ltnarneI ctTar u owkn wtah i eb niasy

Adn nicse wiminzm si da TDUELAF yeht list be ntietg esdo usspy pisl nda aesrsebt

meningitis  The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering: chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities +16  
yotsubato  Turner syndrome patients are also chromatin negative as well though.... +5  
sympathetikey  I didn't know a complication post-meningitis was lack of humor. +5  
sympathetikey  Ah, didn't read the last line. Yeah, that is taking it a bit far +20  
niboonsh  yall are haters. this is the first explanation that has ever made sense to me +5  
arkmoses  https://www.youtube.com/watch?v=yuXL-3eoB-o&t=77s Interesting syndrome watching this helped me to put it into real life perspective, interesting points they have no pubic hair/body hair, they apparently also dont smell, and breast size is usually increased... +1  
whoissaad  How does chormatin-negative indicate a normal cell? Isn't chormatin just condensed DNA? +1  
cienfuegos  According to this paper most individuals with Turner Syndrome are chromatin negative: "One of the initial laboratory procedures used to confirm or rule out this diagnosis involves a sex chromatin determination from a buccal smear. Cells from the lining of the mouth are stained for the presence or absence of X-chromatin or Barr bodies, which represent a portion of an inactivated X chromosome. The typical Turner’s syndrome patient, who has 45 chromosomes and only one sex chromosome (an X), has no Barr bodies and is, therefore, X-chromatin negative. This abnormal X-chromatin negative finding in the majority of Turner’s syndrome females is similar to the result found in a normal male, who also has only one X chromosome, and differs from the X-chromatin positive condition observed in the normal female, who has two X chromosomes. Occasionally, the patient with features of Turner’s syndrome is found to be X-chromatin positive." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233891/ +1  
hyperfukus  i really hate haters this is awesome! +1  
selectuw  to add to the above, free testosterone is aromatized to estrogen leading to breast development +  
misrao  Is the free testosterone not creating male internal or external gentalia because of the defect in androgen receptors? +  


submitted by sympathetikey(1252),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Teh whelo scp"ki ta eht oaseins.es..ucl meso "ibe,gnedl eadm me hkitn isirsoaP.s lhSoud eahv enog whit ntccAii eroiatssK adsbe on eth eintpat oshyirt so(tl of nus er)s.xeupo

cciAnti essKatroi

raPaglmiennt einsols dacues yb usn .rpoxseue l,lmaS ruohg, tyheaesrmtuo ro nbrhiwos peapslu slq eporu.a kRsi fo mqussauo llec iarccoanm is tpriolrnoapo to egdere fo eeapilltih p.ssadilya

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +5  
temmy  the distribution of the other lesions, forearm, face, ear, scalp..is not characteristic for psoriasis. +6  
hyperfukus  the scalp and ear are actually very common for psoriasis IRL the key is more of the fact that its in areas with UV exposure...actually UV Therapy is found to be helpful in treating some pts w/Psoriasis. Lastly the appearance and lots of things bleed if they were trying to go for auspitz sign it would have tiny dots of bright red blood with slightly touching it +4  
hyperfukus  oh last thing psoriasis itches! they said no itching +4  
drzed  Those locations may be common IRL, but on step 1, if they want you to think psoriasis, the illness script is going to be someone in their 30s (autoimmune age) with symmetric cutaneous plaques that have a silvery scale on the extensor surfaces. In this case, the age and non-classic description (location, type of lesion) made me steer away from psoriasis. +1  


submitted by sympathetikey(1252),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The ewhlo k"psic ta hte .els.uasscon.ei osme "bel,gnide mead em itkhn iPs.asrios dulSho aveh ngoe whti cictinA eKsrtaois sabde no eht atnipet hoyisrt (olst of nus pxree)s.uo

Aticinc rsiaotKes

nglPintemaar ssnieol ecdaus by nsu xoue.pser ,aSmll hu,org stetyaurheom ro rbsohinw sapeulp qrpuaoesl. ksRi fo quaussmo llce caocnmari si ionpprrolota ot geeerd of iehelptial ipds.alyas

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +5  
temmy  the distribution of the other lesions, forearm, face, ear, scalp..is not characteristic for psoriasis. +6  
hyperfukus  the scalp and ear are actually very common for psoriasis IRL the key is more of the fact that its in areas with UV exposure...actually UV Therapy is found to be helpful in treating some pts w/Psoriasis. Lastly the appearance and lots of things bleed if they were trying to go for auspitz sign it would have tiny dots of bright red blood with slightly touching it +4  
hyperfukus  oh last thing psoriasis itches! they said no itching +4  
drzed  Those locations may be common IRL, but on step 1, if they want you to think psoriasis, the illness script is going to be someone in their 30s (autoimmune age) with symmetric cutaneous plaques that have a silvery scale on the extensor surfaces. In this case, the age and non-classic description (location, type of lesion) made me steer away from psoriasis. +1  


submitted by mcl(578),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

SCOP is aascsedtoi twhi lnaobamr ocdunitpro fo xes deso,srit iignudncl sfuondyicnt fo etnoegrs ptooncudir and oeoerpgstn.er lioynrlahcC dteveale seevll of orsneget cna uaesc ieeolnmdrat pealpyhr.isa

/1th/mhtl/orMinte.a/mci.l9w9psvnnww.cp:/i.5b/3sgCcP97

meningitis  Why isnt it endometriosis? Could someone help me out on this? +1  
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +  
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +  
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +25  
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +1  
lovebug  FA 2019, page 631 +  
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +  


submitted by haliburton(208),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

shti si a ecrvailc lpsain rdco nce.otis het nueacet csucausfli is tinatc )E(U iivbtnoar and potrpiorpio,cen utb teh hwtie ncteois si the lgraeic auciufslsc EL)( dna si m.aaddge I nithk eht llertaa oronipt thta is nueevn si jtsu aulti/t.arcntfraa

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at https://en.wikipedia.org/wiki/Gracile_fasciculus#/media/File:Spinal_cord_tracts_-_English.svg you can see that the closer to the center = legs, while further away = arms. +3  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +12  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  


submitted by haliburton(208),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hist is a vlaieccr ialnsp droc snc.toei teh uecanet sasuflucic si tctnai E)U( bianrtvoi adn cptinoroioppe,r ubt the htiwe ontcesi si teh airgcel uslfsuiacc L)(E dan si dgamead. I kinht eth rtleala topnroi atth si envenu si sjtu rlat.autcat/rafni

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at https://en.wikipedia.org/wiki/Gracile_fasciculus#/media/File:Spinal_cord_tracts_-_English.svg you can see that the closer to the center = legs, while further away = arms. +3  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +12  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  


submitted by mcl(578),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

dalbeLe RCX gnhoisw itoonpsi fo ftefrdine evlav.s

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2  


submitted by mcl(578),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

dabeLle RCX iwnoshg poionist fo tedeffirn salv.ve

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2  


submitted by benzjonez(42),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

AF 1082 .p 6.09 tpeuscS rlarethu jyunri fi bdloo si snee ta eth htrraleu metsua. sMnciameh fo eoorrstpi rhtlaure jyuinr = clepiv tacrr,efu whihc we ees ni shit iaetnt.p ahrUeltr hcitetinazoeatr is tleiyrevla otnt.cedaadcinri

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-20362330 +  
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source: https://www.urologyhealth.org/urologic-conditions/urethral-trauma#:~:text=Trauma%20to%20the%20anterior%20urethra,of%20urine%20from%20the%20penis. +  
eghafoor  The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

i-H I od'tn aehv na ioxpenaalnt orf tish tub I ma soal uroucis as to ywh hist saw the .eswnar

drdoom  via @hyoscyamine: FA pg.372. Squamous cell carcinoma occurs in the upper 2/3 of esophagus whereas adenocarcinoma occurs in the distal 1/3. Since this was in the mid esophagus, its squamous cell carcinoma. Key feature of squamous cell carcinoma is keratin pearls. +17  
hyperfukus  idk why my dumbass didn't put foci of keratinization and pearls together lmao +1  


submitted by haliburton(208),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aiiipdekw ilspg)ooa(e: heT ehareosmpt si oepscomd of %87 eigrntno adn 21% nogxye. encSi xynoeg is gdchexnae at eht y-vlraialaleiolpc ae,mnermb oterning si a orajm penotmocn for the lvo'lsaie aestt of .ilatoinnf If a gealr emvuol fo rotnegin in het ulgsn si lecadpre wtih xyo,nge eht goexny may sestlnyuqebu be erbbasod otin eth l,oodb inrucedg het ouevlm of the laeovil, esiunrtlg ni a rfmo fo elvlroaa llsceoap wknon as pbstnriooa l.tiacesatse

I oehsc iacirodcgen d,eame utb I evlieeb tsih si nerorictc eeacubs ethre is on htaer afilrue iksr at hits imet, so eth psproue fo hte PEPE si nlayretic not ot psuh otu dif.ul

bighead478  doesn't there have to be an airway obstruction (mucus, foreign object etc.) in order for this to happen? 100% O2 without any airway obstruction should not cause absorption atelectasis, right? +  
iloveallpotatoes  And Tension Pneumothorax is wrong bc PEEP would furthur exacerbate that. +1  
hyperfukus  @iloveallpotatoes yea i realized that now after getting it wrong :( +  
plzhelp123  @bighead478, they are using a cuffed endotracheal tube and mechanically ventilating this patient which is creating an iatrogenic "obstruction" and as @haliburton mentioned, having a high FiO2 leads to over-absorption by the blood which leads to absorption atelectasis if no other gas is allowed to enter/there is no communication with atmospheric pressure during expiration. Thus, we add positive end-expiratory pressure which keeps alveoli open at the end of expiration to prevent collapse +  


submitted by enbeemee(13),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

i egt why sti' aeif,lnlgl ubt is teh cspfciie onrsea ttah SPL si grnwo si eaebucs ts'i usjt tno who eht aenvicc si mea?d PSL uwlod lsao etlici na iunmem t,nceoari trgh?i

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +3  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +2  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +2  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  
jp1003  I think it's because Neisseria does have LPS. They have LOS instead. +  
jp1003  *does not have LPS +  


submitted by enbeemee(13),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

i get wyh sit' lnlf,egali tub si the pisifcce enaros ttha LSP is rogwn si eusaecb i'st juts tno woh het eaiccvn is ?mdae SPL lwoud laos litice na meiunm t,eoairnc grt?hi

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +3  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +2  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +2  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  
jp1003  I think it's because Neisseria does have LPS. They have LOS instead. +  
jp1003  *does not have LPS +  


submitted by usmleuser007(370),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA pre )1 AF ttyaf ntiaifliortn 2) crlaulel bloignalno )3 eunvaetl neoiscsr

hyperfukus  thanks u saved me time in looking that up :) +  
violethall11  Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic . +  
mumenrider4ever  FA2020 pg. 391 +