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Welcome to jurrutia’s page.
Contributor score: 10


Comments ...

 +0  (nbme24#31)

Wasn't sure about PVR, but SVR and PCWP def go up. That only leaves 1 answer.


 +3  (nbme18#18)

Pathoma 2018 pg. 53. Chemotherapy hurts neutrophils the most. Radiation hurts lymphocytes the most.





Subcomments ...

submitted by lsmarshall(415),
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I gttohuh hits asw a iktcr usitnoeq sneci ksin sencrac rae hte stmo ocnomm etyp of seccran erl.avlo tuB ultalcay aomgn HIV ttis,pane ldteH-VeIar rccsaen ear mcuh meor ocmmno nhta o-nl-enrVeHatdI cnascer eev(n ikns rsacne.c) ciu-dneBVdE ymaprir CSN ayholmmp si hte olny iopnot atht is dnD-AIesinfgi .n/lsncerceiasl

medskool123  why not hep B? i guess another whats the better answer ones... Just rem reading that it was more common with aids pts.. anyone have an idea about this? +1  
haliburton  Yes, I think CNS lymphoma as an AIDS defining illness wins the day. My thought was since SHE has AIDS it is most likely from IVDA, which has a high risk of HBV that could go undiagnosed for a long time. at 32, that might not be long enough to have HBV and get HCC (but with no immune system...?) +3  
yotsubato  God damn this is such BULLSHIT... +13  
trichotillomaniac  Why you gotta do me dirty like this NBME +2  
sars  My thought process, usually wrong all the time, was that HBV (IVDU) can occur to anyone. Acute hepatitis to Chronic occurs when HBV incorporates its DNA into host and releases mutagenic proteins. This is regardless of immunosuppresion. Primary CNS Lymphoma reappears primarily when you are immunosuppressed (organ transplant, immunodeficiency, HIV/AIDS). +  
syoung07  Hep C is far more likely to become HCC than hep B +1  
jurrutia  Even if you were thinking skin cancer is more common, that's only true for basal cell and squamous. Melanoma is rare. EBV much more likely in aids patient. Even H pylori was a better answer. +  


submitted by m-ice(339),
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This awmno sha a tol of sisgn htat inpot woartd na iteistnnla isrptciaa ctn:niifoe eretnc arlvte to Pauap wNe aiuG,en ogchu nda arleloav tf,elnitasri hghi piohoesnil no,tcu and a ltsoo spmela htat hsa a mwor ni it. osMt eyklli hte ttnieap sha a ootgeydirsSnl niftoince, as hist is het ilnettnsia ripatsea htta ohwss aavlr no otlos ms.plae cllayaBsi lla lnttiaseni saaiprtse acn eb eedttra hwti deonzlBea sg,dur cshu as odTnb.aaihleze nriueqlatzaP lodwu eb mroe otrpappaeri fro a orwm ro elivr ulfek etc.nnifio

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +9  
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +10  
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +5  
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +2  
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +2  
jurrutia  When in doubt, pick a bendazole +  
jurrutia  When in doubt, pick a bendazole +  


submitted by m-ice(339),
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ishT nwmoa sah a lot fo isnsg thta pnoit dtawor na setiantnli atrsiacpi ctnienif:o cnerte talver ot upPaa weN niGuea, guoch nda lveaoarl iielant,ftsr ighh snoehilpoi ucn,to adn a stolo ealspm htta has a wmro in ti. otMs ykiell hte nptaite sah a Sgldtinooryse ,niofcniet as ihts si teh ilnsaenitt saterpia thta shswo aalrv no otlso ampe.sl lsyicBala all tenslitina ariastsep nca eb drteate twhi Bdeoelzan gdusr, hsuc as iabTzoleaed.nh ieltPranuqza udolw eb orem oetpapirapr orf a mrwo or ilrev elfuk nic.ofntie

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +9  
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +10  
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +5  
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +2  
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +2  
jurrutia  When in doubt, pick a bendazole +  
jurrutia  When in doubt, pick a bendazole +  


submitted by boostcap23(33),

This mentioned anywhere in FA or other board prep resources or just supposed to be common knowledge lol?

jurrutia  I think you just had to gamble because none of the others really fit the bill either. +  


submitted by m-ice(339),
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yuoAonmt si het ostm iromtatpn eihcst incpirlpe hatt rssspeueed lla hsrtoe. eoeHvr,w ti is eippald ynlo in ttsuniasio ni whhic a itpenta notsrasmdeet ng-ioikscminead cctiypaa. In htsi oauis,itnt a taepint iwth vddnaeac siaesed eilknluy to eb cuerd si sgrefinu etatm,retn cwhhi si his hitrg eurnd eht ipcpliren fo tnayoom.u wevorHe, sih cmmsteno tuboa igrtenurn" ni 6 nomhst trfae ncrigu rratt"ihis are aesbilnteou,q dan rnartaw dtniermigen if he sha odeinics gnkiam cyacp.ati It si bsiseolp htta he d,soe wichh is hyw yna cesioch of ofircgn ufrther teaerntmt on imh rae rintce.ocr

hungrybox  These ethics questions seems so simple and yet somehow I always get them wrong. I guess deep down I'm just a scumbag. +14  
mutteringly  Hey there's always dental school +1  
hungrybox  legit made me lol, thanks for that +  
jurrutia  Also, the patient is delusional! He thinks he's going to cure arthritis. You don't have decision making capacity when you're crazy. +  


submitted by sajaqua1(531),
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yrrPiam oepinervnt is na ivctae tsep anetk to ahde ffo ro iimttgae a -dseeisa tknhi fo cvnaaicnitos. In ihts e,csa ti is llyistefe iomnfcodtiia erecxse(i) to pleh 304-0 erya lod omnew ei(hgtw enrigba xscieree anc gttiaemi sioro,oeotssp bseietfn of obracie s)eecirxe.

cadynoeS vpoennetri si leary doctiteen of a edasse,i pmngiorto aerly nn.ertiitonev hTsi ucldo elinuc ngiths ilke IHV ingestt veyer 6 ,ntshom or or lunaan hmgmoa.yaprm

rTyeatir nnteitvieorn is yarhetp inmgai at geircund ltoisapnim,occ ollgiwna lp,eeasr or igomniprv .tuinfnoc isebentAnc ormf lcohaol may eb hree seceuab of uabtcessn esbau erl,mspob or suebcae msoe emdaga rpeviuosly node yb oalochl taconn be nrtdev.epe mrlliiyaS ofr a wol rdorbheactay ietd ew may be ignmatigti het ffeetcs on lammobties atth evah aalyrde ebne ne.od

sunshinesweetheart  p 269 FA 2019 +  
motherhen  [P]rimary= [P]revention [S]econdary= [S]creening [T]ertiary= [T]herapy +3  
rockodude  almost picked alcohol because that may lead to fetal alcohol syndrome, relevant to women of childbearing age, but regular exercise made more sense. complete abstinence of alcohol is a little extreme for a general recommendation +  
jurrutia  Abstinence from alcohol is a form of primary prevention, because alcohol causes many bad outcomes. However, exercise is more important. +  


submitted by drmohandes(93),
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  • DSIAH → colimveeu mineyaahrpto → tnresoinemvo / tveheypeisnr
  • CTAH esicsnaer crsotoil → nopitsheerny alh-1p(a urielotgaunp pma&; cirootsl anc indb to ltonoaesdr torescrep ta hgih natc)ierosotnnc
  • ATCH eercnsais eolodnraets → nsoneepirhyt + laeykpiaohm +K( uemdpd in glcnetiolc duc)t

If atteipn o--nyl adh ern:htspynioe ACHT oerm elilyk anth IAH.SD

ittaneP ithw ohnpnertyesi AND yek:pahmoila %001 TH.AC

nt'oD lefe abd s,dnefir I sloa dha shit oitqneus owgnr ...(:

rolubui  ACTH does NOT act directly on the zona glomerulosa to increase Aldosterone. ACTH acts only on the zona fasciculata to increase cholesterol and zona reticulata to increases sex hormones. +3  
rolubui  NOT cholesterol I mean cortisol in zona glomerulosa +  
jurrutia  Yes, but cortisol can act as a mineralocorticoid at when levels are super high. +  


submitted by lsmarshall(415),
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aieapMlast - A iebeserrlv padevtia senpoers in hicwh ehrte si iponamrrgmegR" fo mtse tceeemŽnrelacllps fo noe lelc epyt yb hoeartn ttha acn dtaap ot a nwe rs."etss hBto rea mronal l.csel peytirrRsao rtee osdulh ont vaeh umosauqs lelcs tluni asopreyrirt bsoecrhlino febo(er ttah; ubicaodl in .ermt bon.r &tg; rulaconm ni obhrcn. tg;& trfedasdseupioit lnmuaocr ni l.ager ).obchrn.

shayan  if its a metaplasia, then how it be normal ? I mean Metaplasia is not normal? +2  
artist90  i got it confused bc the question stated that there was a mass in one lobe of lung and i didn't knew that squamous metaplasia also presents as a mass in lung. i missed that on biopsy they were clearly stating squamous metaplasia. +4  
suckitnbme  @shayan The term "normal" in the answer is used to indicate that the cells appear normal (meaning appropriate size/architecture/appearance). Remember that metaplasia is a normal response to stress. +8  
jurrutia  Metaplasia is not normal (in the sense that you only have metaplasia as a reaction to stress, but under not under normal circumstances), but the cells in metaplasia are normal. When they become abnormal, you get dysplasia. +  


submitted by lamhtu(118),
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elalPtet eaheercnd adn talteelp tnageoiggar rea deirneftf isgnth dna tsih ienrefcedr MSTTEAR A L.OT Fcku ouy, M.BNE shTee dreiffcnsee psloyduspe mrteat no omse sntoeisqu adn ton no .hrsoet herWe si hte esoncci?nyst lH?eol

hungrybox  Agreed. This is so fucking stupid. +  
hungrybox  "Aspirin inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme that is required for TXA2 synthesis." literally straight from Big Robbins +1  
susyars  Im gonna upvote this bc i love to be right +6  
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +4  
j44n  yeah i thought adherence was the GP1B receptor that's already on the platelet +1  
j44n  im also glad we're getting exposed to this horse shit now and now when I'm in a testing center about to put my fist through a screen. +1  
jurrutia  GPiib/iiia receptor is not inhibited by aspirin. Aspirin prevents the upregulation of GPiib/iiia which is not the same as inhibiting the receptor itself. +  


submitted by guillo12(47),
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yWh hret'se on ceerasni ni oaHtrcytisd ruersesp in merglaulor srael?alpcii

rihan  Between the glomerulus and Bowman's space there is a hydrostatic pressure gradient. This gradient is normally the result of a LARGE glomerular hydrostatic pressure and a LOW pressure in Bowman's space which normally favors filtration. Diagram here: http://physiologyplus.com/wp-content/uploads/2017/08/Glomerular-Filtration.png In the case of post-renal obstruction, hydrostatic pressure behind the blockade will rise and urine will reflux into the capsular space and renal tubules (while glomerular hydrostatic pressure is unaffected) effectively decreasing the pressure gradient which reduces the filtration rate. +4  
jurrutia  Why would an increase in pressure in blood vessels cause hydronephrosis? The problem has to be in the nephron itself. +  
makingstrides  @jurrutia I think that is being demonstrated here. I picked glomerular capillaries thinking of the answers wrong. The ureteric obstruction causes a backup that leads a to a high hydrostatic pressure in the bowman space. Therefore, preventing filtration. The cause of the renal failure can't be from the glomerular capillaries because the block isn't being caused there; it is caused by something post ureter (dilated ureter). +  


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aendsecIr stoaPhphe sslo ;t&--g nFnoica emysnrdo t-;-&g ftfacse hte TPC

jurrutia  Don't even have to go to Fanconi syndrome. Phosphate is reabsorbed in the PCT and nowhere else. Increased phosphate loss --> PCT +2  


submitted by radshopeful(19),
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hTe scilacs dsie eftcfe fo lyasnchcrniaet is aiddlet iatro.ydaompyhc hiTs stuoeniq ldcou hvea ogtetn icrkyt if uyo uothght eth oampynurl pstmysom weer eud ot teh durg hhiwc udclo haev eld ouy to eimobynlc ss(ueca nryompaul fss)iboir btu etesh omplyaunr tspymoms erwe stmo lilyke a trelus fo dliteda idytoharmacpyo indegla ot FH nad prloyuamn .adeem

nwinkelmann  What is the clue that this is not pulmonary fibrosis? How do I decide between Doxorubicin and Bleomycin? +  
ilikecheese  Also both bleomycin and methotrexate cause pulmonary fibrosis, so that helped me rule both those out and focus on the HF instead of the pulmonary symptoms +6  
adisdiadochokinetic  The S3 gallop and enlarged heart together are very strong evidence for heart failure. It's much more likely for heart failure to cause interstitial edema than for pulmonary fibrosis to directly cause heart failure. +9  
jurrutia  Also pulmonary fibrosis would more likely cause right-sided HF. This patient has left-sided HF (orthopnea, crackles, pulm edema.) +  


submitted by whoissaad(81),
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trAyer of cdsuut senfedre is a barnch of rfnoeii ileacsv eyr.tra So wyh si B ?gonrw

happysingh  the question is asking about "adequate arterial supply" +  
azibird  The artery of the ductus deferens is USUALLY a branch of the SUPERIOR vesical artery, although it can branch from the inferior vesical artery in some individuals. +  
jurrutia  A of ductus deferens would be the direct supply, vesical artery would be indirectly (via a of ductus def) +  


submitted by peridot(67),

In case anyone else was wondering about the other choices:

A: Acetyl-CoA carboxylase is the first committed step in fatty acid synthesis

B: Homocysteine methyltransferase turns homocysteine into methionine (we can deduce this from knowledge about homocystinuria)

C: Methionine adenosyltransferase makes SAM. SAM has two roles that we know of - one in turning methionine back into homocysteine, and one turning norepinephrine into epinephrine. This could make it a tempting choice but at the time I just saw the word 'methionine' and thought that couldn't have anything to do with cortisol/catecholamines.

D: LOL for methylmalonyl-CoA racemase, wiki says "It is routinely and incorrectly labeled as 'methylmalonyl-CoA racemase'. It is not a racemase because the CoA moiety has 5 other stereocenters." Good job NBME. Anyway, methylmalonyl-CoA epimerase is involved in the same catabolic pathway that we know of through propionic acidemia, so it's involved in breakdown of fatty acids and amino acids.

jurrutia  SAM is also the methyl donor used by DNA methyltransferase (DNa methylation) +  


submitted by rogeliogs(9),
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sihT onsiQteu ist uatbo rarsporiyet srtub

satntiPe twih DNPAH nercyiichedcfinc=o anouumrtsaolg asdeise C(G)D

neEv touhgh tnstpeia hitw GCD 'natc kame rxoe,dipuSe yhet cna ues it rmof eth cabrtsaei and etnrcov it ot lbeach OCLH nad illk het atraicsb.e

TBU raatbiesc thwi tslaceaa nezysem ineuealrtz eihtr own eiresdpoux nda thats yhw eth DGC eattipn nca't kill tmhe.

aaatCels osivitep aa:rstcieb S. rsuaeu - Aisllupsrge

thomasburton  I thought E.coli was catalase positive too? Why can that not be correct? +6  
mb10  (FA 186) Catalase (+) microbes, especially S aureus +4  
makinallkindzofgainz  @thomasburton - because First Aid said so, so suck it +1  
jurrutia  @thomasburton, because S aureus is more common. I guess. +  


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kniaygltAl tagens mhrier(elnoaecthm) ht(e hotre gdrsu isltde era eiburumotcl ison)hbriti ercanise the ikrs of .ALM

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 aesalmon(83),
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hWne in dbtou sti bbrlyapo teh Sencipl ienV "(play od"ds - nG)jlao

jurrutia  Also, what is causing the splenomegaly? Cross out gastroduodenal A/V, gastric A/V, and pancreatoduodenal A/V since they have nothing to do with the spleen. All that's left is the splenic vessels, and you know it's a vein... +  


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siTh si ainaoinsrlpine-rtt sta.ham hinaecmoetnAp yoln tibinsih COX ihntwi het N,CS so ds’onet cseau het olektuieren gnunsiht atth tzcahrriceesa atht issea.de

linwanrun1357  why not triptans? +5  
joyceeepan  the girl has tension headache. Triptans is not a drug of choice. NSAID, Acetaminophen, (or TCA for prophylaxis) +3  
vsn001  but question asks which drug she should take to /treat/ her headache? -> I fell into sumatriptan cause I know it didn't have prophylactic indications but more of a treatment. idk, was between the acetaminophen and sumatriptan, and would appreciate if someone can tell me why acetaminophen is the move for this patient. +2  
texasdude4  for HA treatment you want to start off conservative anyway w/ Tylenol / NSAIDs before you move on to triptans. That and triptans are not used for tension HA +  
jurrutia  Triptans are used for migraine headaches by causing trigeminal vasoconstriction. They are not analgesics. +  


submitted by notadoctor(158),
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aeatictMts sdeaesi si reom cmonom nath ypirram beno u.mrsto

lba9587  Might be helpful to consider eg. of a lung tumor. one lesion? you’re leaning lung primary. Multiple lesions in lung? METS. Q stem here included, “numerous lytic lesions along the vertebral column.” Thus, METS. +  
jurrutia  Also, pain that is worse at nights and persists regardless of activity. Paget's is typically asymptomatic (although pain is the most common symptom) and would have other findings (deformities, AV shunts, etc.) +  
jurrutia  Also, pain that is worse at nights and persists regardless of activity. Paget's is typically asymptomatic (although pain is the most common symptom) and would have other findings (deformities, AV shunts, etc.) +  


submitted by notadoctor(158),
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tascMtaiet aesesid si remo moocmn tanh rpamyir bneo mtur.so

lba9587  Might be helpful to consider eg. of a lung tumor. one lesion? you’re leaning lung primary. Multiple lesions in lung? METS. Q stem here included, “numerous lytic lesions along the vertebral column.” Thus, METS. +  
jurrutia  Also, pain that is worse at nights and persists regardless of activity. Paget's is typically asymptomatic (although pain is the most common symptom) and would have other findings (deformities, AV shunts, etc.) +  
jurrutia  Also, pain that is worse at nights and persists regardless of activity. Paget's is typically asymptomatic (although pain is the most common symptom) and would have other findings (deformities, AV shunts, etc.) +  


submitted by yotsubato(1019),
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In log,biyo pheas taaniovir si a mhetdo rfo elidagn ihtw aprlyid rvnigya vrinntsneoem wuittoh ginirrequ odarnm muato.nit tI iveslnvo the rtvnaaoii fo rptione ,proseseixn trulfyqene ni na -foonf sinh,ofa wiinht neerdfift ptars fo a ebirclata aop.ltpouin sA such hte poeehtnpy anc thwsic at firecesnqeu that rae mcuh iherhg misstm(eeo %g;&t1) hnta aslalsicc outmtnai trs.ae haPse tnaiavori tcinorsuteb ot ecelrivnu by rantegnegi yhe.eitotnrege gthhoAlu it sah nebe mtso locmmoyn seuidtd ni het nxtotce fo mmunei ivsno,ea ti is oeevrdbs in ynam trhoe saear sa elwl dan is pomyeeld by isourav peyts fo ebrati,ca glducnini Smllealoan pc.eesis

vcaawnPo/awp../:nsih/iodeinawwwmitsttr/ek_h

whoissaad  is it the same thing as antigenic variation? +8  
dorsomedial_nucleus  No, antigenic variation involves genomic rearrangement Phase variation can be thought of as MORE or LESS of something. An on/off switch. No DNA is being rearranged, just under or overexpressed in response to the environment. +4  
makinallkindzofgainz  This isn't in Zanki, Lightyear, or First Aid, and I don't remember ever learning about this in class. Thanks NBME! :D +18  
jurrutia  You wouldn't expect the difference in phenotype of a given organism in a given patient to change because of mutations. It has to be something other than mutation. Phase variation is the only option that sounded like non-mutation. +  


submitted by keycompany(308),
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As:enwr earsdInce Cneratl lodBo Veloum B)C,V( dDeeseacr A,HD darIcenes N.PA

The lpghaiicosloy operesns to mhpeaoyhitr si ooaisvocisrnntct of heiraleppr evslsse (.i.e het ones ni uyor eriei)xtsmte in na ftfroe ot eepk oyru erco byod eutreeamtrp omrnal, and huts yoru noagrs connfniguit rroelpp.y laPreeriph srcionttnoisVcao lwil nesireac CVB. adersInce VBC illw seacu an cisanere in rdepla,o dan tshu eausc na secinaer in NA/PBNP. /PPNABN ahs oinrtihyib fesetcf no eht rRegdoise-tneonsnolninne-AtAi stSem,y tlnesgrui in eeacresdd AHD.

gokings2021  RAAS is not directly linked secretion of ADH as claimed above. Increased pressure at baroreceptors and increased central volume sensed by the hypothalamus will decrease secretion of ADH. +4  
miniarnie89  another way to think about it is central vs peripheral blood. peripheral is now being vasoconstricted, so central things (heart, lungs, KIDNEYS...) will be receiving more blood. more blood in kidneys = less ADH +  
jurrutia  The excretion of free water also has an adaptive benefit in hypothermia (less mass for your body to keep warm). +  


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AKD sicd)oasi( g;&t aoimtsPus ifshts otu fo hte cell ;tg& piaarhemkeky

AF 92,01 gp 578

mumenrider4ever  While you will have a high serum potassium, your total body potassium will be low due to very low intracellular potassium (which is where the majority of the body's potassium is usually). This is why you give potassium to patients with DKA +1  
passplease  Why do you not get an increased bicarbonate concentration? +  
briangibbs3  Bicarb acts as a buffer and binds up excess H+ in DKA +  
jurrutia  In other words, DKA a is a cause of metabolic acidosis. Hallmark of MA is low bicarb. +  


submitted by welpdedelp(225),
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ihTs saw .ELS btcshustmt3p9:se2/l//alsk.odsissmty1-0uluce/htrs1e.stm-eue1my/opmtep

Tk:nhi ,13=2, LE--S

nsgUi CA:DI pyeT III si fro emunIm epxmCloes

jurrutia  What do you mean by ACID? +  


submitted by k_tron_3000(31),
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Teh renpsoiitcd fo ellirbaat welor imbl sslo of birnivato lmiespi DLCM aa,gmed dan teh ensabt RDsT + Rbomegr mees ot me ot eb npiilmyg taht he ylpossbi ash astbe sarsldio morf ipyihlss or( osnhgitme eyrv riiamls in o).nrsenteiatp

As rfo het htoer rwassn,e A si wogrn csaueeb his mrtoo tnocuifn is cn,ttia B is ownrg eubaesc iapn dan eempeuttrra tisfecdi era tno ,ditneomen C si rngwo sebecau it psmeiil a iciscefp evren is teanepp,dr ubt eh sha tslo tablirale aeitosnns ni his ntriee rewol tsrtmeexiei

D is het ,itsckrtei nda Im’ nto %010 s,ure btu I udwlo hnitk hypuridcaolat fo teh nitroear vr(ea)nlt stroo olwdu cuesa rotom feicstdi senci yeht rcyra omotr .fnetsrefe uoY mhgit aslo txecpe ttha mtoro cotsunfidny ot be ,ulnitaaelr snice ti ldwou eb liynkuel ot evah a ebproml thwi eth venre sotor on bhto d.ssei olsa eth CMLD is not dlaocte erna the nrotaeir stroo of het naslpi orc,d os fi the iontraer rsoot weer eaeftfdc uoy aellry d’nutowl xtecpe ot ees rbitrovya lo.ss

oS siblacayl specsro fo tlemoia,inni I od feel liek yssorne rynthpueao is an eetexymrl evgau wnears ghtohu nda I twans’ a naf of eth snqto.eiu

keycompany  This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word “Radicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral). +31  
hello  Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness. I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function. +16  
niboonsh  Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative? +1  
link981  Great explanation guys +  
usmel2020  UW QID: 12035 explains what you are testing with Romberg sign +9  
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +  


submitted by usmile1(109),

Like t123 said, I think the key to this question was to rule out the other answer choices as they would not have normal stool. I found this article that essentially breaks down GI disorders in diabetes into gastroparesis and intestinal enteropathy. These complications and their symptoms are often caused by abnormal GI motility, which is a consequence of diabetic autonomic neuropathy involving the GI tract.

Intestinal enteropathy in patients with diabetes may present as diarrhea, constipation, or fecal incontinence. The prevalence of diarrhea in patients with diabetes is between 4 and 22 percent.4,5 Impaired motility in the small bowel can lead to stasis syndrome, which can result in diarrhea. In addition, hypermotility caused by decreased sympathetic inhibition, pancreatic insufficiency, steatorrhea, and malabsorption of bile salts can further contribute to diarrhea. Abnormal internal and external anal sphincter function caused by neuropathy can lead to fecal incontinence. When evaluating a patient with diabetes who has diarrhea, drug-related causes (e.g., metformin [Glucophage], lactulose) should be considered.

https://www.aafp.org/afp/2008/0615/p1697.html

cbreland  I agree, felt like all the other choices would have something odd in the stool studies +  
jurrutia  Orthostatic hypertension implies sympathetic dysfunction. Loss of sympathetic input causes dishinibition of intestinal motility. +  


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ist setb to nhkti abuot ttypiarui danaosme sa eno of reeth gbi pioos,nt claoptrni eecr,stgin TCHA gicsr,tene ro GH nrecge.tsi The nlyo arytitupi utmor htat aussec oootripesoss nda rheoeertf het pcomeosnsri sutcfrare sene ni eht esqiusnto coudl eb a HTCA rntceiseg tpaiiuryt nadmeoa t:oen( cmromoaenaad usjt enmas taht teh uormt is g&tm01;m in e.)izs neadreisc HATC slead ot rieesndca rtsicool and efrorethe ceddreesa stcbaelsioot ttiavcyi ob(ne ornf)oiatm = iospseoortso

nnp  even prolactin causes reduced bone density +2  
jmangels  I was thinking the same thing about the prolactin, but the weight gain made me lean toward ACTH +2  
jurrutia  Prolactinoma reduces bone density due to suppression of estrogen. However, that wouldn't explain weight gain. +  


submitted by ootscoot(13),

I was split between B & D, but ultimately ended up going with B because emergency contraception needs to be taken within 72 hours of unprotected sex to be effective. Waiting a whole weekend for her regular doctor to get back to her might make her miss the window (& would cause a ton of stress for her over the weekend). This just was my reasoning, not sure if it's actually correct

utap2001  Also another one principle: never refer. +  
jurrutia  Never refer, always resolve. Recommending to call women's health clinic leaves it to the patient to resolve. Having colleague call back is more actively resolving. +  
jurrutia  Never refer, always resolve. Recommending to call women's health clinic leaves it to the patient to resolve. Having colleague call back is more actively resolving. +  


submitted by ootscoot(13),

I was split between B & D, but ultimately ended up going with B because emergency contraception needs to be taken within 72 hours of unprotected sex to be effective. Waiting a whole weekend for her regular doctor to get back to her might make her miss the window (& would cause a ton of stress for her over the weekend). This just was my reasoning, not sure if it's actually correct

utap2001  Also another one principle: never refer. +  
jurrutia  Never refer, always resolve. Recommending to call women's health clinic leaves it to the patient to resolve. Having colleague call back is more actively resolving. +  
jurrutia  Never refer, always resolve. Recommending to call women's health clinic leaves it to the patient to resolve. Having colleague call back is more actively resolving. +  


submitted by match95(49),
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lnhadIe iteshteancs taht eavh wol :sagdolbo itnpaorit ictdoloo/fneibcef biilulotys sesvidlo in oodlb orme .eylsai e,eerhforT hteer si LESS ags dneeed to eaaurtts blood -- aak etarfs nsuoaitart fo .olobd hsTi seald ot erstaf tsanouatir of aribn.

t;rld lwo iltylosuib -;-tg& ftresa teons ;tg&-- arefst cveeoryr

pelparente  great answer; just to add to it. Lipid solubility determines potency, not onset/offset (that is determined by blood solubility as stated above). The more lipid soluble the more potent the drug. The more lipid soluble the drug the higher the oil:gas partition (directly proportional to potency) and the lower the MAC (inversely proportional to potency). Source: Boards and Beyond General Anesthesia Neurology +5  
cbreland  I really went down a rabbit hole on this one... Convinced myself that it had something to do with mask v. IV anesthesia even though I haven't seen/heard that anywhere. Taking step in a week🙏🏼 +  
jer040512  I thought a low blood:gas partition coefficient meant that it has a low solubility and therefore DOESN'T dissolve in the blood that easily. +2  
dhpainte22  Think onset/offset is about blood solubility and potency of drug higher with higher lipid solubility so low blood gas coefficient has faster onset and recovery. +  
jurrutia  Just to drill point home further: consider halothane, high lipid solubility (so high potency) and high blood solubility (slow onset). If you want fast onset, low solubility is the key. +1  


submitted by wishmewell(33),
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nI my oonpiin htis si inadk uedr as an taiiln ta.inco fi eth rsonpe insnueoct ot og acbk to eht ,iotcp I dwolu sya vihgna a eoacnerph ludwo p.ld.ki .e.h ywh uItprennigtr the ptitnae whti a remo taeulrn opcti tnis hte naesrw

wishmewell  NVM! i read the question again. The patient has visited already 4 times with cheif complains regarding sexual organs in a short period of time. According to FA page 262 (2018) at this point a chaperone should be added, if this doesnt help then the patient needs to be forwarded to another physician. +1  
groovygrinch  Can someone explain why " Tell the patient that it is common for patients to fantasize about their physicians" is wrong? +5  
mumenrider4ever  @groovygrinch I don't think it's normal for patients to have sexual fantasies about their physicians lol +8  
abcdefbhiximab  @groovygrinch lmao +1  
kindcomet  im dying of laughter +  
jurrutia  Switching to a neutral subject doesn't "address the problem". Never refer, always address the problem. +  


submitted by famylife(93),
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"eieptsD hnitiboiin of oC-HMGA eaudetrsc by sais,ttn scell temcopaesn by ecgrisanin ynemze onsieesrxp saerevl ldof. Heovewr, het tltao ydbo lelorctoehs si decedur yb %–4020% deu ot csideraen siesoxrnpe fo LLD rorpseetc freat ntsita "rtnadtiai.mnsio

sltwpuseg-cmsi/mtoceconecns.reo//icpgnioobsab.ec/hmi:thc-iadrtyem/ew-lw--oitidrycghlctoa

md_caffeiner  fuck GoT, knowledge is power +  
dhpainte22  Another bullshit question that should've been straight to the point. Statins increase ldl receptors and inhibit hmg coA reductase. This should be simple but nbme can't live with that :( +2  
jurrutia  I think they want to test not just your understanding of how statins work, but also the basic principle that when you block X the body tries to compensate by upregulating X. +2  


submitted by match95(49),
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Iumnme ohacnprymootitbe FA( ,7210 pg )540 - sceasu nristecotdu fo llntdapeateobyti- lmpoecx by elnsep enaigdl ot reedcsea ni atelelpt TNAQYUTI nda riaecndse gkcreotaysmaey on beno arwrmo bipsy.o

ellie0124  anti-GpIIb/IIIa antibodies +  
baja_blast  FA 2019 p. 419 +  
jurrutia  May be secondary to viral illness... +  


submitted by cassdawg(1101),

He has an upper motor neuron lesion which is causing paralysis on his left lower side, so he will have hyperreflexia on this side. Thus the deep tendon reflex will actually be increased/strongest in his left achilles tendon initially after the accident. [FA2020 p529]

jurrutia  Wouldn't he also have hyperreflexia in the right brachioradialis, which is innervated by the radial nerve? Since the patient's right radial nerve was severed, he should also have an UMN lesion with hyperreflexia in the right brachioradials? +  
kbizzitt  A radial nerve lesion is a LMN lesion (hyporeflexia). You can basically divide it by pre-anterior horn, and post-anterior horn of the spinal cord. After the synapse at the anterior horn it becomes a lower motor neuron. Before that (along the spinal cord and up back up to the motor cortex) is considered upper motor neuron. +2  
jurrutia  Duh, of course! Dumb mistake. Thanks +1  
an1  So if it's UMNL, why couldn't the right patellar tendon show hypereflexia as it was also in the initial injury? +1  
solangelroma  the only paralysis for right cerebral cortex injury (UMN) is the left lower extremity - the radial lesion (LMN) is for the humeral shaft fracture. the tibial fracture is also right. UMN gives hyperreflexia, LMN hypo. +  


submitted by cassdawg(1101),

Wegener granulomatosis, also called granulomatosis with polyangiitis, is a vasculitide that commonly presents with the triad of focal necrotizing vasculitis, necrotizing granulomas in the lung and upper airway, and necrotizing crescentic glomerulonephritis (FA2020 p 314 and 596)

Wegener is associated with chronic sinusitis, hemoptysis, and PR3-ANCA (antineutrophil cytoplasmic antibody, formerly called c-ANCA).

None of the other answers are associated with ANCA except Churg-strauss syndrome. Churg-strauss syndrome (also called eosinophilic guanulomatosis with polyangiitis) is associated with MPO-ANCA (formerly called p-ANCA). However, Churg-strauss does not have lower respiratory involvement, hemoptysis, or patchy lung opacities on CXR.

j44n  All ANCA's are against proteins in the cytoplasm, they were intentionally vague and wanted you to ddx this off of clinical pres +1  
jurrutia  Churg-Strauss can affect the lungs, but not the upper airway. +1  


I think that this is osteogenesis imperfecta based on the hx of several fractures that occurred during birth.

From FA2019, pg. 51: Manifestations can include--multiple fractures with bone deformities and minimal trauma; may occur during the birth process

OI is caused by gene defects in COL1A1 and COL1A2; most common form is autosomal dominant with decreased production of normal type 1 collagen.

cheesetouch  OI does have macrocephaly https://rarediseases.org/rare-diseases/osteogenesis-imperfecta/ +2  
cheesetouch  FA2018 P 51 +  
peteandplop  If you've ever seen Unbreakable, the main villain (Mr. Glass) has OI and is born with many broken bones--memorable scene to remember this disease (https://youtu.be/5E69-oJ7TDc?t=100); Other memory device, OI = bONEs for Collagen Type ONE +6  
jurrutia  But what explains the poor skull mineralization? OI does not affect mineralization. +  


submitted by cassdawg(1101),

He has an upper motor neuron lesion which is causing paralysis on his left lower side, so he will have hyperreflexia on this side. Thus the deep tendon reflex will actually be increased/strongest in his left achilles tendon initially after the accident. [FA2020 p529]

jurrutia  Wouldn't he also have hyperreflexia in the right brachioradialis, which is innervated by the radial nerve? Since the patient's right radial nerve was severed, he should also have an UMN lesion with hyperreflexia in the right brachioradials? +  
kbizzitt  A radial nerve lesion is a LMN lesion (hyporeflexia). You can basically divide it by pre-anterior horn, and post-anterior horn of the spinal cord. After the synapse at the anterior horn it becomes a lower motor neuron. Before that (along the spinal cord and up back up to the motor cortex) is considered upper motor neuron. +2  
jurrutia  Duh, of course! Dumb mistake. Thanks +1  
an1  So if it's UMNL, why couldn't the right patellar tendon show hypereflexia as it was also in the initial injury? +1  
solangelroma  the only paralysis for right cerebral cortex injury (UMN) is the left lower extremity - the radial lesion (LMN) is for the humeral shaft fracture. the tibial fracture is also right. UMN gives hyperreflexia, LMN hypo. +  


submitted by drdoom(874),
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nilIybtia to maiintan an nterecio = teelecir foynctsdinu. So won the isonqtue si "Wy?"h

Fugaet,i flyfiuictd slegpine, yifdtfciul corntgntncaei is sgainttr to odnus ilek sndeespori. "fytuDicilf t"cnrgcnianteo hitmg be tdtpeenreri as pdireima eeveictxu onctnufi or hte nbinsegnig of v-atadeuarllserc inmedeta aeedtmi(n etrdale to small utb runmouse aerrbcle as,c)ritnf tub no peSt 1 tdieenam will be altnabt (i.e,. lsot" his ayw m",heo dag"n,rni"ew e)c..t

ssorieeDpn si yacalult onmomc erfta a ianbititdelg neevt klie t,kseor as uyo ihmtg pc.texe hWti esposindre osemc a ossl of xelsau rstntiee nad rtethaei—sd si dcseredea ibdoli.

eOn nca mkea the gaetunrm ahtt a lruaacvs" "tatpnie ghmit aveh oesm iessus wtih ish pp"sei" as(oorrcrsetl,siei ittpemairhycpmch/yatepsaast ntfscioudny) nd,a ofr this anroes, lanurtcno crnteioe odshlu eb edercseda; but teon hatt iohngnt is mennedtio utaob niglg-annosdt uavsarlc daieses on( hx fo esyinhpte.)nro

As a e,ltrsu the tbes naewsr ceocih reeh is C. o(bLdii eeseddarc but ratcunlon reicnseot orn)l.am ehT igb queisnot I heva i,s who het hkec odes sthi gyu kwno hs'e drha nwhe eh's se!?le!pa :p

cbay0509  thank you +1  
ilikedmyfirstusername  there are several UWorld questions about psychogenic ED with the answer being normal libido and normal nocturnal erections, idgi +11  
djeffs1  Yeah NBME says its C, but I still think with a recent stroke you can't bank on normal nocturnal erections... +  
drdoom  @djeffs nocturnal erections happen at the level of the spinal cord (S2–S4)! a “brain stroke” (UMN damage or “cortical damage”) would not kill your ability to have nocturnal erections! https://en.wikipedia.org/wiki/Nocturnal_penile_tumescence#Mechanism +  
drjo  fatigue, difficulty sleeping and concentrating could be depression or hypothyroidism both of which can cause decreased libido +  
jurrutia  @djeffs1 when you say NBME say's it's C, how do you know that's the official answer? Did NBME post the answers somewhere? +  
djeffs1  in the versions I purchased from them they highlight the correct answer in the test review +1  
shieldmaiden  For me the keyword in the stem is "maintain"; he can maintain an erection, therefore nocturnal erections must be normal. Libido, on the other hand, is psychologically driven, so if he is depressed (trouble sleeping, concentrating, fatigue, recent major health problem) then the strength towards any kind of desire, including sexual, will be low +