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Welcome to kernicterusthefrog’s page.
Contributor score: 83


Comments ...

 +22  (nbme22#33)
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esh" fseel iprahpe adn orem axlerde" arfte nsrtagit cnoi:xgkbki itsh is a TUMRAE nedeefs mihcsmnea iclssa(c btexktoo bloamntiuis, sa sah eben s)di.a ishT qnoesiut si tusj panli gow.rn I'ts tno ,sldemtneipca bceesau is't a aeyhtl,h ilsloyca cpbtclaeae oeultt atth sepmirvo rhe aitoonlme s;teta npgiucnh bags era tmena ot be nucdehp h(stu it si clayatlu ONT )rl.naute pscetmeinlDa to an octebj wuodl eb icngunhp a hoel ni erh allw, ro rgaiekbn erh asev I( sjut ekli atth e)ma.gyri Boht of stheo odulw be teetbr hatn cngnpuih rhe yf,ilma or abginkre hetri cra ndwo,wi ihcwh is wyh it's lnipsadmtcee innusc(ocuos roendtreiic fo an eiomnto to a aesfr jt.ceo)b ve,rHewo kgoxibiknc is RLTELYIAL na eelmapx ni rvsleea shcyp estxobtok fro btaunislo.im nakTh you fro nmiogc ot my DTE .lakT

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +12
happyhib_  What if, just what if. Her taking time to do lessions was actually hurting her children by her having less time to spend with them and in turn not providing good care for them. (less of a mature defense mech now). Trust me I agree completely just not best answer, but given what we are given you could argue beyond that; amboss even says "a mom showing her feelings of anger towards the child instead of the actual problem, the husband". So in a way she is not addressing her actual problem (which she COULD address). +

 +0  (nbme22#9)
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sutJ ni aces ttah yloevl liltte ouaqneti dvdoperi yb epny@kycmao snw'at etiuq gouneh rfo ,uoy 'erhse a nikl ot a emor cpeeotml onnaxlapiet by nKah yaedAm.c epHdel ,me nhwe I eodlko at hte ioeuqtan dan as,di haaw?aa


 +0  (nbme20#8)
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Tish is nto an usraem,ny hhwic is atwh mskae hsti nustoeqi so wrie:d "ars-yx of hte cseth od tno show iignn"we.d My isadgndrenutn was atth tedcnisossi ualylus ocurc in eth rpiecut of mrn,ueays ilypelaces due to .terpeiosnyhn ,oHewerv hsrapep ttsh'a ont eht csae, rpcrituaayll ni ethes adnotrfS Teyp A sositdic?esn eTh rtuceip in FA eurs ekmsa ti kolo eilk a dwdeine atrao nseamr(yu) twih a .c.end.tsiiso


 +5  (nbme20#48)
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I losa hda liuidteffcsi iwht ,tish eleycspial FAw/ igenb os dbi.rvtbeeaa erTeh si neo rdow in FA atht sphe,l dna enth I aveh a ikln fro emro niof: rg"sow riydpla nad sserergse tusoyeonlpnsa by 5-8 rseya .do"l hhiWc mesna si't oden whit ist liouonivtn spahe by the.n hTis NIBC laritec h:sepl ehT nsseLso I eardneL rmof a aoeaimHngm ilcnCi L:RTD ipard rghotw srucoc orf teh strfi ewf tmonh, owflloed yb a wfe ntmosh of er,st nda enth esyar of olnniu.iovt ceinS eht uoiqestn is akinsg hatw eanhpsp reov 5 sera,y teh oaijmtry fo atht eimt is tnspe ni niinovtoul .hspae eoHp tshi splhe.

whossayin  totally not NBME related, but I think you username is brilliant lol +3




Subcomments ...

submitted by jooceman739(25),
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tosmiabn:eaRlot

eTh iyacinpsh dais the ybo si ekylinul ot lepoevd yan ehotr sa,meonslp so he nstode' vhae eht detriihne bR tmi.tuoan

nI ihts case, he sah teh irsacpdo nre.iolotmasatb oScipard mloiaasrtenbot qeriusre owt motiasc uosntmait fo bR ni eht smae ntairel lecl.

Jsut sa a dsie teno: retihdIne orbtltosamnsiae dten ot eb arae.lltib oriacSpd rae lleatirnua.

carls14  aren't retinal cells a type of somatic cell? Why not is the mutation not considered in the somatic cell of the child? +8  
omerta  Although this mutation would be considered somatic, I believe the question is just asking you to be specific as to which cells. If you answered "somatic cells of the child," that's quite broad and could apply to almost anything. +11  
kernicterusthefrog  I had the same struggle and thought process. +1  
eacv  There is a Uworld qx that explain this in detail> ID: 863 +3  
arcanumm  I read the answer options too fast so got this wrong. It is a somatic cell type, but somatic in general implies a higher risk for developing other cancers. The hint here is that the physician stated he is unlikely to develop any other neoplasms, so it is a specific double hit mutation in the retina. +6  
almondbreeze  wouldn't she have any possibility of developing osteosarcoma as well? :( +  
almondbreeze  did some reading and it seems like osteosarcoma only occurs in familial retinoblastoma with RB mutation +  


submitted by bubbles(63),
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etsemnaB maenmrbe etigniytr si het dnernemaitt of lulf gnlu croyerve wlfinolgo ormnyapul .nuitls

auSm:rmy

()1 sosl fo esbnamet rnembmea rntyeigti is liccitar ni drientneigm eht “pitno fo on ,urnt”er nda tonubirscet ot hte binliytia to leetsahisbr nmralo ulgn ctrcuahreiet hitw trnimoopo of ;srsfiobi

(2) slso of eihiltplea c,sell odniaheltel cll,se and sbeteman mbareemn rittgiyen ni luaus talsnirttiei amuoiennp iaestcdoas twhi iipcaitodh pyumnraol sifboris ladse ot teredsoyd nlug rccietethuar nda taupeeprl is;isfrbo

(3) tnsforaimrng wtrhog -βoafrct si scsney,ear btu otn ineetlyr ifc,iseutfn to opetrmo nemnpaetr sosifrbi;

)(4 ssneiptret tagin/irrin/aejntyuitrn si lircaict rfo the ipgoartnaop fo if;ibssro

)(5 cahoipidti ypraulmon srsboifi is na aeempxl fo a process eertald to hte sreneicptes fo na at,ne(gns”)i“ ochnirc n,ifamaotnmli nda ;sisiobfr dan

)6( uniequ celsl rea lctiraci llaerucl salrpye ni the gilnouatre of oifssi.rb

:ittiacn o../pbs4l6/mnw.wcmcoiigtelh/22C/sPnMiv.t45wc/naphrt1/:

kernicterusthefrog  Lovely +  
endochondral1  any FA or pathoma or uworld correlation? +  
endochondral1  or was this a random? +  
taediggity  Type II pneumocytes serve as the stem cell precursors, w/out those you're more or less fucked: FA 2020 pg 661 +4  


submitted by oznefu(16),
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m’I vghain lobetru rgutdsadnnien hwy isth si a etretb ceoich ntha aPegt is,desea eeacspyill twhi het rdesicena ?PAL

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +8  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +11  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +4  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by drdoom(647),
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inaolucCtasl for dad. hTe yriiopabtbl of eth fherta enigb a rearicr si 32/ csien it is kwnon atht he s’dnote have het esase.id ehTn hte ropblyiatbi of ihm gspnias it on to his kdi is 2,/1 th:su

  • byiilobrPta of add neigb creirra = 3/2
  • bilbirtPoay of add sngaisp no sdsaiee llaeel = 1/2

nlutiaclCaso for omm. tihW eht e-aeWrndiygrbH Pc,inirpel oyu nca iugfer out het loipyabrtbi of hte hortme eignb a e:arrcri

q = 010r0()4st,q/0 = 2/001

,So 2qp = 2 * 0/201 * 0/99201, whchi is aporpx 011.0/

oFr teh lihcd ot etg the lellae ofmr m,mo tow hgsitn dene to he:pnap )1( mom tums be a icrrear “]”eohtto[geryez dan 2() mmo smtu asps teh ealell to hlicd:

  • oyitaibrbPl fo mom enbig rreicar = 0101/
  • iobrtyilbaP fo omm gsnapis on sesdiae aleell = /12

gitnPu ti lal ttergoeh. ,Now oeinmcb all oteg:rthe

= bi(irolyabpt fo dda enibg a)ierrrc * ra(plbiyotbi of dda ssgiapn no diaeess la)llee * oripayt(iblb fo omm eibgn ecrirra) * aylibr(pobit fo mom naisgps no desieas l)ellae

= /32 * 2/1 * 1/100 * 21/
= 1 ni 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +22  
niboonsh  This question makes me want to vomit +9  
drdoom  lol +  


submitted by gh889(89),
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eTh rwsane is eud ot na xcntpoeei ntueolid erhe hewre nnicia is esdu ni pts /ow eabdites owh evha fyaoetcrrr irchrdemlyieiptgarey at hihg kris or sah a hx of tpaianseictr.

I eaegr atth atrfeisb era tirsf ilen n(da os dseo ahtt ica)letr ubt NMBE asw goninh ni no a icpesifc notecxpei ahtt anncii nca slao eb euds icesn LVLD dan sGT are ighh in hireiidcetymyrlgpr.ea

eTh ce""ul tyhe dah wsa ceenrru"tr carti"astnipe hwhic si lesyusppdo a ldae tosdraw .niainc

I also ptu nerceias HD....L

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) +1  
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 hungrybox(791),
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..o.S oheclteraiylt na itesdalo sacdreee ni RH dluwo asceinre CO due to c.in ol,aperd rih?tg

uBt OC asdeserec ni siht esca b/c the fcteef fo i.nc RTP is eomr eoplufwr?

kernicterusthefrog  @hungrybox: No. Isolating HR, you would look at CO like this: CO=HR*SV so if HR or stroke volume go down, CO goes down. The change in preload wouldn't affect the CO as much as the change in rate of flow. So, the decrease in CO is solely due to the beta1 blocking effect on the AV node to decrease HR. +  


submitted by xxabi(224),
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eiBnoogcrhcn rcoainacm = nlgu rccena

aTht bnige ,isad ungl oacodcreimnana layslieccifp is otdicseaas hwit epchiryphtro tsoptota,ryohhera hwich is a aipnoarlpstace odmynsre rcrdtceeazhia by aigldit bcg,bnlui lahraagtr,i jnoti ,fsueosnif adn posieotriss fo bualtru oebns

luke.10  why not systemic scleroderma since i did this question wrong and i chose systemic sclerosis scleroderma , can someone explain that ? +1  
kernicterusthefrog  My best guess answer to that @luke.10 is that: a) there's no mention of any skin involvement (which there would be in order to be scleroderma) b) Scleroderma shows pitting in the nails, not clubbing c) There would be collagen deposition with fibrosis, not hypertrophy of the bone at joints Saying that, I also got this wrong! (but put RA...) so I'm not claiming to "get this" Hope my thought process helps, though! +5  
yotsubato  This is in FA 2019 page 229 +8  
larascon  I agree with @kernicterusthefrog on this one, Bronchogenic carcinoma = lung cancer. Squamous cell carcinoma gives you hypercalcemia (new bone formation; maybe?), commonly found in SMOKERS ... +3  
waterloo  the clubbing is the symptom that takes out alot of the answer choices. It's super tricky. +  
jawnmeechell  Plus the patient has an 84 pack-year smoking history, super high risk for lung cancer +  
veryhungrycaterpillar  FA 2019 pg 229 is all paraneoplastic syndromes. There is no mention of bronchogenic carcinoma in any of them. There is adenocarcinoma, but that is most likely in non smokers, not in someone with 84 pack year of smoking history. Why does he have 5 upvotes for referencing first aid here, what am I missing? +2  
jakeisawake  @veryhungrycaterpillar sounds like bronchogenic carcinoma is a general term for lung cancer. You are right that if a non-smoker gets lung cancer it is most likely adenocarcinoma as non-smokers rarely get small cell. However, smokers can get adenocarcinomas as well. The oncologist that I shadow sees this frequently. Adenocarcinoma of the lung causes hypertrophic osteoarthropathy per 229 in FA2019 +1  
mangotango  @verhungrycaterpillar @jakeisawake Adenocarcinoma is the most common tumor in nonsmokers and in female smokers (like this patient), so adenocarcinoma would still be the most likely cancer for this pt over the others. Pathoma Pg. 96. +2  
fatboyslim  Apparently bronchogenic carcinoma is basically an umbrella term for lung cancer. Source: https://radiopaedia.org/articles/lung-cancer-3 +  


submitted by thomas(-1),
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nsrewA si Att.yersco atnePti has moabsglloati .rftoleiumm oughAtlh snnoimaeimg mya rocuc at cteesnvix,oi mgiomnsnaie era ibgenn nad etfno i.tpyosmtacam eyhT mya aeusc a/h ss,zeirue but uwdol be ueilylnk to sueca edtah in/w 6m fo steon fo h./a hTe ezis of trumo adn ocuesr of lenliss is sencotnsit tiwh eth ouresc of MBG

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +16  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by thomas(-1),
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Arenws si ctAert.soy iPetatn hsa olmlgosaitba romeiftulm. Aothlugh imgmnsniaoe amy uccro ta vixtisc,enoe niemiogmsna ear ingneb adn efont sm.apiytmoact hyTe yma cseua ah/ z,ueeriss utb dwulo be lknyueli to uscae hedat w/in m6 of onste fo h.a/ hTe size fo routm dna rouces of llsnies si sntceotnsi itwh het oucesr fo GBM

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +16  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2  


submitted by neonem(503),
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ilootzlasC is a epeohssahrdesipto ibrin;thio seadl ot enrideacs MAPc ihhwc tisinhib lelaetpt euvriancinaatotndaloi/gt lwehi osla gcnuais a.ivtdoloasin All fo teh oehtr soiotnp wrko on ethire uaerlcvsuat ro teplsatle ubt ton .ohbt

kernicterusthefrog  Just to add: cAMP activates protein kinase A (PKA), which is the more direct mediator of platelet aggregation inhibition, and of myosin light-chain kinase inhibition (which causes inhibition of smooth muscle contraction and thus vasodilation). Just in case there's a question that gets more specific than this one! +12  
brbwhat  wasn’t dypirdamole an option? +  
fataldose  I believe they also cause vasodilation by decreasing the cellular reuptake of adenosine by endothelial cells and the adenosine causes vasodilation. +  


submitted by neonem(503),
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eokunLirete 4B is a ptnote chttacoemci lcomueel for h.pterulinos cSeveeilt olss fo tish lwdou ahev no feetfc no laestl,ept tams l,slce or tnloudemieh - etehs aer rmeo peossernvi to gacnesh in X,TA2 lnhiaiorencmtopmdcc/ea aci,d nad P2,IG pseyvilc.eert

kernicterusthefrog  FA says: "Neutrophils arrive B4 others" +1  
fatboyslim  Important neutrophil chemotactic agents: C5a, IL-8, leukotriene B4 (LTB4), platelet-activating factor, and kallikrein. Source: FA 2020 page 406 +1  


submitted by xxabi(224),
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I tihkn tis atht eht CI oeintacnd eht reubnm ""0 ichhw aemks ti tayactsilislt niftisiicnnga

kernicterusthefrog  You're thinking about CI for a **mean difference** b/w 2 variables. This question talks about **relative risk**, for which 'strugglebus' correctly asserts that *a CI including 1 fails to reject the null hypothesis*. #funwithformatting +  
xxabi  Ahhhh you're right, I definitely had them mixed up! Thanks! +1  
xxabi  #biostatsisthebaneofmyexistence +3  
conradfussurefake  So am I the only one giving no shit about CI and going straight to what they're asking about. My understanding of the question is that they're asking about the difference in cosmetic results of both the procedure which are described in the stem as the same. The study isn't about wound infection rate!! +  
fatboyslim  @conradfussurefake In the beginning of the Q stem it states "A randomized clinical trial is conducted to compare WOUND HEALING and cosmetic differences...", hence wound infection will affect wound healing. But the because the CI contained the value of 1, it is insignificant. +  


submitted by sympathetikey(980),
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As tsdeta b,wleo hte tfeL urcs rercibe aws daamedg s(ee hatw ti dulsho oallmyrn olok liek wbl.e)o shiT saiotncn eht oilcicnpsoart rtcta. nieSc hte ricosplcnoiat tacrt aetsudecs ta hte uml,aled lewbo the iinbmdar tcosien reew' lookgni at, ouy lwodu see lraatlnrCtaoe t()hRig csaSitp asiespirHem

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +2  
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +10  
hello  @kernicterusthefrog Thank you. +  
mbourne  NGL, I thought the right side had the pathology lmao ty +11