NBME Answers : impostersyndromel1000's page

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submitted by sup(20),

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wmoeSho I asw bale to coivcenn emlyfs ttha saieedcrn ttoentreoses &--;gt deedcaesr ntseergo t--;g& dredseace ievnaget akdcbefe on HL/FHS nsicrotee -t;-g& eirnesdca FHS. seDo oeanyn raec ot xpelani hyw isht cgloi si gwnr?o kTasnh :)

btl_nyc The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio. +1

impostersyndromel1000 @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +

submitted by seagull(1443),

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So hpaal aws eht ewrsna so ym duegtfia mnid put wl""eAl... ned.o Y'oure igngo to eb a .otodcr lol

impostersyndromel1000 hope you dont have to write a prescription for me one day lol +4

submitted by cocoxaurus(56),

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ostAml gto ecrtkdi yb htsi one eucsbea ootrsmaseaco alos acuses stclistooeba i.osnle crsetOmooaas smto loyonmcm emaiasteszts to unslg tgohuh.

impostersyndromel1000 This was in pathoma, he said prostate cancer causes osteoblastic lesions and "the board examiners really want you to know that". also following the potential site of mets helps choose the answer +2

snripper Also, osteosarcoma is less common in the elderly, more common in males <20 y/o (per F.A 2020) +2

submitted by drdoom(819),

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Yuo aehv to nkhit atbou hist gnuis eth ecptnoc of NLIOAIOCNDT Y.LTRIOIPBAB tAorenh awy to kas tsih ypte fo noeqtisu si ikle i:sht I“ swoh oyu a etnatpi whit upesoonnats oxuaphrnmeot. Whihc orhte gitnh si tsmo eyillk to be reut btaou atht osp?”ner Or uoy can ehpras it seeht a:wys

ivneG a CTONOIDIN (nnesotsaopu nouemp), htwa thoer indgnif is sotm lieylk ot eb eht ?saec
nGevi a ploo fo peloep iwht ontpeunasos pmhtxn,oeoaru ahtw eorth nghit si tmso eklyil to be etur oubta m?het

nI rteho wdosr, fo lla ppleeo who den pu wtih apuosnsonet p,nouem eht stmo ncmomo oerth ignht otuab mhte si atth they aer LEAM p;a&m TNIH.

fI I eavg you a uebtck of sonsaounpte peumno atnpiset -- adn uoy daerhce oyur hnda in ereht adn leludp eno out -- atwh roaceins wlduo be rmoe :mcoomn nI ruoy nahd oyu veah a smreok or ni oury nahd you veah a htni ?aelm ’Its hte .ttreal

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 gh889(117),

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eTh awrsen is due ot an ctieenpox eluiontd rehe wheer ainnic si sude ni tps w/o iebsetad who vaeh tafryrcoer teiregadpicmhielyryr ta hgih srki or ash a hx of tne.iaprsacti

I ereag thta atebifrs ear ftsir inel n(da os sode atth eri)tacl tbu EBNM swa ngiohn in no a ifcsiecp enepixoct atth anicni nca laos be usde nesci VLDL adn GTs rae ihhg ni rheyicmrlyagertpei.id

ehT cl"eu" yhte ahd swa rcerneut"r sprnitcia"eat icwhh si dlseouypps a dlea adwsrto inac.in

I oals upt sinarcee H....LD

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 d_holles(173),

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aGnloj ssrseest eth daBrso gginvi eth keuiamle uoisseqtn awya daseb no eth gea iegnv in eht inquetos em.tss

ALL = 41-0

LAM = ;319-5 -5940

CLL = 0+6

LMC = 9-045

f/t/u5srsenmd3aputgsonleoo-osre6tscaak.03d.dtho/rue0nji.tlh:/e-mt/nt

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 atstillisafraud(187),

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ilAntkgyla egntsa emaleiemrcotn)h(rh te(h thoer usdgr dlsite rae irutmelbcou niiosh)btri arneesci eth rksi of AML.

keycompany Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +27

seagull CML has blasts too but they tend to favor mature forms. +4

kash1f You see numerous blast forms == AML, which is characterized by >20% blasts +8

keycompany The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +12

impostersyndromel1000 @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +1

sweetmed Procarbazine is alkylating as well. +

pg32 @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +3

castlblack this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +

jurrutia @keycompany, how did you know it had to be of myeloid origin? +

submitted by keycompany(301),

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neiHpvteioyrantl eercesda 2POaC. entralC eecrcmrpoesoht snerdpo ot olw aOCP2 yb tciovcrgsinanost elercrba blodo .ssesevl

)A retArila dooBl xngeOy itnconnotrCea: Boodl gOnexy ncaronoittnCe is erildtcy arteled ot Hb ioornencnactt adn uatrotnias 2OS()a F29,01A .p 356. iVa hte hoBr cffEte, dcadeerse a2OPC will saceienr ,OSa2 htus icgniraesn odlbo ngxeoy cintntnr.ecoao

B) iteaArlr lBdoo O2P: OPa2 snchaeg in nroeesps to srdeeedac 2A,OP PI2,O or f.uoinidfs Theer dluwo be no cehgan ni 2aPO gniudr hoenyntiietarplv (hy)et.rceilolat

)C Aerilat ruePerss: aesedrDce PO2Ca si dtoaisacse wthi oiv,ctsaotsnnoric hwhci oudwl iaesnrce ooldb s.esrrpeu

E) erCelabr esusiT pH udlwo eieacrns due ot iasrporrety akolisas.l

keycompany EDIT: Via the **Haldane Effect**, not the Bohr Effect. +

impostersyndromel1000 excellent response +

teepot123 fa 19 pg 489 +

submitted by nwinkelmann(285),

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ev'I enevr eebn ogod ta rgtoecnvni iunst :( llo os had ot ask ym ohte.rbr eH tldo me hatt:

caentdsi × cadentis = stneaidc² = eaar

,adn

itecsdna × ienscdta × ceaitdsn = aecstind² × niadcste = csdaitne³ = mvoelu

aGtto oevl uplbci lsooch orf eernv nbee tgthau htta ... gehes ovolybu(is vI'e edon eth eutsqanio adn f,suft sutj reven neeb dolt ti ahtt h/tatayw eipmls )erfb.eo inKngow ttah mseka giirugnf uto het noqietua hucm r:seeia

woFl aert = veyltioc × CSA = 02 c/smec × cm2² = m04c³e/sc

oT ventorc to Lnm/i, utjs ipumly:lt

mc04³c/es × 60 sicemn/ × 00cLm11,0/³ = 0024 01L/00, mni = .42 /iLnm

peHo ihts eldep!h

impostersyndromel1000 to all my public school peeps out there (and not the nice public schools in rich areas, the real public schools)... we made it! +3

angelaq11 Thankfully I was taught how to convert units, but let me tell you that I was SO lost on this one. It's USELESS to know how to do it if you (I, I mean I) don't know the damn formula xD. Obviously got this one wrong, but it's good to know that if it ever comes up again (and I know it won't) I already know it. +1

submitted by endochondral1(15),

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is tihs oiusnetq ankigs thwa we lyclsyhapi asps ogtruhh ro yb?

impostersyndromel1000 no, basically the question is testing if you know the branches of the abdominal aorta and which is closest to the renal (in this case, inferior to the renal arteries) +1

impostersyndromel1000 what you are passing by would better answer your question actually +1

submitted by endochondral1(15),

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is this isotquen aiknsg tahw ew clyslhypai saps ghurhot or ?by

impostersyndromel1000 no, basically the question is testing if you know the branches of the abdominal aorta and which is closest to the renal (in this case, inferior to the renal arteries) +1

impostersyndromel1000 what you are passing by would better answer your question actually +1

submitted by link981(157),

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ePr Frtis idA 0128 (pg 421) m&;pa rkMce naulMa

)a MCL is ton het nawsre aeebcsu in CLM oyu aveh HIGH sCWB ;mp&a etaletlsP. In the mets hteer is oynl ihhg )att esl.bpel sI the wesnar asbcuee ni tslsaeniE oaTmtobyrhchime ew hvea rlnoam WsBC nad ,BRsC tsuj hhgi sct e.lae)lpt ldeyiMo almapeaits refres to llew a sitamlepaa ni idylmeo selcl iwhhc rae poa,lihssb spioil,eosnh td).ec nI ohacyymPelti Vera ew eavh HHGI ,RCsB BWsC, nda )estPl eaetl. eieRtvca ybmiohorts-soct si a tveeaedl ltatpeel cnuot atth srcuco sayncoedr to etonahr odrsidre e:kil

o-icCrhn lonmrmiayaft dsedrorsi eg,( uomerdiath si,rtithra mrafoyamtinl lebwo aesse,id rcuueblssti,o sicarsdo,sio naatugrlosmiso ihwt -ae)gsutitiolc iAnyp iifntneco

era-Hemorhg

on-Ir iedceyfinc

osHsli-eym

anCcer-

toScepen-mly or slmseippynho

impostersyndromel1000 perfect response right here +

paloma Essential thrombocythemia presents with platelets > 1 million, not reactive thrombocytosis +

submitted by mcl(586),

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ta-e2B crtresoep are oedlucp ot sG eron,ptsi cwihh atecativ yadlnlye cascley and sinceaer .PMcA yciCcl MAP tneh raiessnec tctivaiy fo triopen naeski ,A cwihh teplspohyorsha ymsino lthgi nciha i,sanek lyatmtluie iselntugr ni otshmo elscmu orni.aexatl ouebltlrA, a 2B ia,tonsg is hrfeteore lesufu in antgietr oabs.onrscphm

impostersyndromel1000 are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation? saw this on another Q with the nitrates causing headache so now im confused +

dubywow @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +2

iwannabeadoctor2 cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +

castlblack cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +3

submitted by bubbles(67),

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nCa esnmeoo nexaipl prlypeor who we know taht sith itatr slwofol eidnalMne eiscentg nda si oalotsamu erssevice dna mturoerhrfe hwo the rsepatn wree tzsgroe?uyeho

I deusegs a tlo no sthi tuonesiq dna ogt kycul (:

niboonsh Autosomal Dominant disorders usually present as defects in structural genes, where as Autosomal Recessive disorders usually present as enzyme deficiencies. P450 is an enzyme, so we are probably dealing with an autosomal recessive disorder. furthermore, the question states there was a "homozygous presence of p450.....". In autosomal recessive problemos, parents are usually heterozygous, meaning that 1/4 of their kiddos will be affected (aka homozygous), 1/2 of the kids will be carriers, and 1/4 of their kids will be unaffected. +36

nwinkelmann Is this how we should attack this probelm?: First clue stating endoxifen is active metabolite of Tamoxifen should make us recognize this undering first pass hepatic CYP450 metabolism? Once we know that, the fact that the metabolite is decrease suggests an enzyme defect, which is supported by patient's homozygous enzyme alleles. Then use the general rule that enzyme defects are AR whereas structural protein defects are AD inheritance patters. Once we know the pattern, think that most common transmission of AR comes from two carrier parents. So offspring alleles = 25% homozygous normal, 50% heterozygous carrier, and 25% homozygous affected, thus sister has a 25% of having the same alleles as patient (i.e. homozygous CYP450 2D6*4)? +6

impostersyndromel1000 we had the exact same thought process, so i too am hoping this is the correct way to approach it get reasoning friend +

ajss thanks for this explanation, I totally forgot about AR patterns are most likely enzymes deficiencies, this kind of make the question easier if you approach it that way, thanks +

submitted by meningitis(512),

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eoPsrcs of mintaioenil no itsh o.ne

I itmeeaildn myCloabr ,ehpapshto Ainreing eud to auer .celyc
I mneildeita TPA esacbue ATP elnoa o'tlndwu ghacne P6F tino usolgniecam
ANG I got ykclu dan I eleimtndai ti ude to ist use ni CME dna lgaelnco os I 'itddn nhikt ti wsa nrtlavee and I dkni fo eremmedber it niebg in uare eccl.y

dr.xx you mean, pure luck? :) +13

impostersyndromel1000 lol pretty sound logic here mate +2

nor16 same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +

submitted by seagull(1443),

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tuo of siyric,otu hwo amy opeelp ekwn ?tshi t(ond eb hys ot ysa you ddi or ?itdn)d

My etyopvr anoeicutd idnt'd irnngia iths in 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 bubbles(67),

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ocoael.sStn.c-o.r itssude rpeamco a grpuo of elpoep ihwt teh dsiesae nad a orpug fo leppeo ituhotw teh aseside. I'm tno ruse I trneanusdd hyw uoy can allc lepeop yadmlron and call taht a olncort pr.uog tWha fi mngao eosth dellca mlarondy, eosm of htme vhea sloa had hagomriechr ssrkteo?

impostersyndromel1000 this is one of those Qs where you just dont over think it and focus on your first point, that they are comparing a group with the disease vs (potentially) one without it. Thats what i took from it at least (sorry fi this is too late) +3

tiagob Why is not Cohort ? since it compares groups exposed to drug X? +

djinn Cohort studies determines end of disease and CC determines begins +2