My reasoning for this question:

• In both situations, you see a cyclical increase in pain before receiving the injection. This could be seen if the effect was wearing off; however, if you notice, there is a decrease in pain before the injection is even given. I believe this implies that something inherent about the injection is providing pain relief.
• Furthermore, both curves follow the same path with an eventual decrease in pain, regardless of intervention.
• Maybe an additional point - I am not questioning their pain, but fibromyalgia typically shows no abnormal lab results in addition to typically coexisting with some form of mental pathology. I don't think placebo being demonstrated is far off.

Believe this one is tubulointerstitial fibrosis of the kidney:

medullary cystic disease is characterized by autosomal dominant inheritance pattern progressive and slow impairment in renal function that ultimately results in end-stage renal disease no or minimal proteinuria with a bland urine sediment medullary cysts on renal ultrasound in most cases medullary cysts are not present can see shrunken kidneys on ultrasound

Are these gottron's papules from dermatomyositis? Pareaneoplastic syndrome from adenocarcinoma, esp ovarian?

Does anyone have a good explanation for why decreased levels of inhibin is wrong? From my understanding, inhibin and activin work together, in that inhibin binds and blocks activin leading to decreased feedback on hypothalamus and activin increases FSH and GnRH production.. thus, if you decrease inhibin then you would have increased activin which would lead to increased GnRH and FSH, right? I found one article talking about it in regards to puberty, but it seems to be a hypothesis/not confirmed at this point... is that why? But still... how do I rule it out on a test?

https://www.sketchymedical.com/products/catalog

CORONAVIRUS SKETCHY

positive sense RNA virus, sun crown corona king wearing robe - encapsulated helical virus - spiraling road, helical trees sneezing and blowing king - common cold with bronchiol tree on king pointing to SARS and middle east respiratory syndrome (acute bronchitis)

This virus replicates in the cytoplasm thats why King is outside his castle (nucleus)

My dumb ass thought ketonemia was like anemia of ketones or something and thus meant low ketones so I almost put fatty acid oxidation (hypoketotic hypoglycemia). FYI ketonemia is high ketones.

Defects in fatty acid oxidation would also be corrected with the sugar additions so even if you suck at medical vocab you could rule it out.

Synaptobrevin is the target of tetanospasmin (tetanus toxin); muscle spasms are characteristic. Only other answer you might consider is Acetylcholinesterase since he is a farmer and buzzwords often carry us to the promised land... but symptoms of a cholinergic storm are absent.

As per Pathoma,

"Vascular permeability occurs at the post-capillary venule"

This is why, when you have edema, you would have gaps in the venules.

MHC class 1 peptide antigen processing > "Antigen peptides loaded onto MHC I in RER after delivery via TAP (transporter associated with antigen processing)" - First Aid 2019.

Bare lymphocyte syndrome type 2 (BLS II; affecting MHC II) is due to mutations in genes that code for transcription factors that normally regulate the expression (gene transcription) of the MHC II genes. Bare lymphocyte syndrome type 1 (BLS I; affecting MHC I), is much more rare, and is associated with TAP deficiencies.

at BMI 15 not only has she never had a period but she never had a meal.

Tfw NBME said there's no repeats on 23 and 24 and then you get a repeat.

this is how I looked at it extra cellular osmoles> intracellular so it will pull the h20 out.... then the high osmotic pull of the sugar overwhelming the SGL2 transporter in the kidney will pull the h20 out of the body dehydrating the extracellular compartment

Mixed up cytoscopy with culposcopy so I put HPV. Insert upsidedownsmileyface.jpg

i get why it's hyporeflexia, but why not fibrillations? it's also an LMN sign

Everyone who got this question right is a cop. ༼⌐■ل͟■༽

Testicular torsion mostly happens in young boys, rarely in adults. Also the pain started at the flanks, which is not how torsion pain starts.

The diagnosis is strawberry hemangioma, commonly happens in kids, often resolves on its own as they get older.

I get these VERY often. I seem to get them only after eating something that can damage the mucosa in my mouth such as hard chips (Tostitos, very jagged very pain). These are NOT cold sores (HSV). This is simply a aphthous ulcer; they can be stress induced (studying for hard test). they are very painful and do reoccur. there are no associated sx with them.

x-ray corresponds to a tension pneumothorax = imminent respiratory failure if untreated. Right lung is fully collapsed, increasing intra-thoracic pressure, imparing O2 exchange (due to mass effect toward left lung, and collapsed right one), hence accumulating CO2 (in blood), inducing respiratory acidosis.

I thought that the cognitive impairment could be the manifestation of neurosyphilis. In addition, the doctor should talk directly to the patient to check for sexual abuse.

Platelet adherence and platelet aggregation are different things and this diferrence MATTERS A LOT. Fuck you, NBME. These differences supposedly matter on some questions and not on others. Where is the consistency? Hello?

Im gonna fight this one because AGGREGATION is mediated by expression of Gp IIb/IIIa.

If your platelet increases TXA2 that means is gonna upregulate AGGREGATION by which receptor? ... Duh

Once Im done with this test and become a Pathologist Im gonna send you a copy of my journal and research on platelet aggregation mediated by TXA2 and Gp IIb/IIIa and also im gonna go over every single WTF NBME question and prove them so wrong

Maybe i should change my username before submitting this

Platelet adherence and platelet aggregation are different things and this diferrence MATTERS A LOT. Fuck you, NBME. These differences supposedly matter on some questions and not on others. Where is the consistency? Hello?

Wasn't sure about others, but mammography for general population isn't recommended until 40

just wanted to add that questions that ask small details like this make me want to carve my eyeballs out

Lung volume will decrease in obesity hypoventilation syndrome. Even though this patient is obese, he has all the clinical features of sleep apnea

Whats the difference between “heterozygous null mutation in B globin gene” and “heterozygous mutation known to cause 50% decrease in B globin gene function of one allele”?

Can someone please explain this? What is the diagnosis here?

From a girls perspective, is really hard to understand this penis/erection physiology questions

There are two mechanisms of regulating renal blood flow, the myogenic mechanism and tubulo-glomerular feedback. This question asks purely about the myogenic mechanism, which is where the afferent arteriole controls blood flow based purely off blood pressure entering the kidney, which is why decreased afferent arteriolar resistance is the best answer (the arteriole is dilating in response to the decreased blood flow in attempt to maintain normal blood flow to the kidney).