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Welcome to link981’s page.
Contributor score: 157


Comments ...

 +0  (nbme20#2)
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vuNiorors is hte msto mmonco auces of rilva tseergtsiaontri in het ASU eud to icoavaintc.n + uvtaoiRrs si teh smto cnomom ueasc of aivrl artssngieitrote in teh sret of the w.rdlo In hsit etounqsi yuo had ot okwn eht mtos mnmoco scaeu


 +3  (nbme24#31)
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sdwroKye mofr Dr. uTocr omfr lanp:aK

  • ciRtipa-neol DAN
  • nnctiiTosrrpa- ANR
  • rontlaaTsni- onierPt
hungrybox  bruh this is like bio 101 lol +7

 +0  (nbme24#35)
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Per Ameicran unLg osi:sicaoAnt oapBonnryhcmourl yiaadpsls PD(B) is a rfmo fo ohrncci lnug desiesa ttah sffeact ernobwns ts(ymol erpa)muetr and snf.atin tI ltruses omrf edmaag ot the ngsul aduesc by mliaaehcnc aeoninttvil aot)r(eirpsr dna egmtnorl- use fo nyeogx. sotM atnisnf recveor orfm BD,P ubt moes mya hvea otrnmel-g rinhteagb .fyutilfidc + arlyrPmeute obnr tfnsani veah yerv efw ytni air acss lvie)l(oa at b.rith eTh ovlliea hatt rae petsern detn to ont be temura henguo ot fitnoncu rmo,lna dna teh itanfn esriqure orairtsypre tupoprs to btaer.eh ghlAtuho ilin,ave-fsg seeht nttmtarees nca laos ausec lnug aegmda

waterloo  per American Lunch Assoc... maaaaan what do I need to be to get this question right, a pulmonologist? +6

 +11  (nbme23#48)
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oHwrvee w,edir you evha ot rcstepe eht te'sanipt lefbies as lnog sa they ena'rt pituntg het wnnrobe ta .rmah nI ehste tpsey of essnqoiut you hvea ot ldubi siap-tpatncineihy ilsisahnrtoep bcseeua het ntetpai ghmit cmbeeo dfdofnee if you readridgs rehit eslb.eif oS hwile the noerbnw msot kyeill sah sga dna ont et"h elvi ,ey"e ccoieh E is eht taels fneoi""gndf swnrae htat seutggss tre.atmten

charcot_bouchard  Exactly. If she was cracking the egg on Baby's head u stop her lol (i am cracking up on my own jokes) +3
jesusisking  I feel it but dang, she lowkey drizzlin salmonella all over that baby +2

 +2  (nbme22#6)
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ehT isounteq wlieh usdlyipt tne,witr kass hwo nolg the s'BCR taht acryr eht OC etka to eb drveeom omfr the cn,ilrtcouia otn hwo glno hte OC tksae to eb rdomeev rofm eth CB.R tJus askngi the fslepnai of BsRC ni na diyplust ccatidopeml ywa. sA ew wkon, sCBR' lfei psan is bouat 210 syad dna enht eyht are reeomdv orfm uor ctinioa.lruc 012 ysad is abuot 4 mosnht. xNte iemt eyth iwll oarbyblp aks the BCR npiasefl in ekews or in ,hsruo who sk?onw smh


 +2  (nbme22#43)
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AF 8120 geap 071

1C rteasese tnhiriiob cnyceeifd:i sCusae ryehdtirea noagedmaie edu to garleteuudn ilkkneirvl t,icavnoiat wihch lesda ot cideesarn nikdnriya.b


 +1  (nbme22#27)
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Paeg 63 of FA 210.8 ireuPn igatsannot usrdg ae:r

6o-htzeir(piMnaPA si a grorupd fo )M-,P6 tpy,eaohecolnM n.biiirvar

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +2

 +10  (nbme22#19)
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tatmnoIrp ot know reeh is oonlc.iat rpatA fmor gnnrlaie eth ghscootlii itopndssirce hcw(hi ear gbrnio sa hs,)it saoieplna in the hpasysdii is contssietn hitw iEngw osarcm.a tssOocaeomra lntacioo is at het saytshepiM.


 +5  (nbme22#25)
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mteiHisna aussce eatroierl doano,vsltaii iucasng a iplbduu fo dobol ni het llsipe.aciar hTe sirnedcae obold ni eth irilsaelapc ilwl auesc eht rpreessu ehetr to s.eir alFnttoiri is denntdpee no rrpsees,u the iehrhg eht pre,ersus hte emro the .iialtnrotf

Rermemeb oldbo flwo: nievs ot lvusene ot aesliplraic ot rrsteiolea to eeritrsa

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +14
link981  I stand corrected @yb_26. Brainfart moment 🙈 +
rockodude  lmao including a link to a teachmeanatomy page on basic blood flow +

 +1  (nbme22#17)
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anlraigM zeon pmhylamo si caudse by CRICHON IMNANF.IOLAMT H-oylriP acn aesuc ohccrni aiimfnmnolat ni teh ahscmt.o

enisptE barr riuvs si aosetcsaid wiht KTITURB mh,aypmlo the WJA oesiln in afr.icA

Gto it wrngo suacebe I ohhgtut oHyrli-P olny sucaed sitacrg n.rcace


 +11  (nbme22#40)
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reP istrF Adi 8210 (pg 412) mp&;a eMckr lnaaMu

)a CLM si nto teh rneswa ecauesb ni CLM you eavh HIHG BsWC pm;&a t.ePetalsl In teh tmes heter is oyln ighh .tbl)eat eslp Is eht nwsrea bcaeseu in ntesiElsa baoyTitecormhmh we ahev maornl CBsW nad sRB,C tsju ihgh a.lplt ts)cee oMliyed aaaptsmlei erfser ot lelw a saietaapml in myoelid lcsle ihhwc ear ,ilsphaosb oonpihlise,s cted .) nI lyhPiemyacot eVra ew evah IHHG BR,Cs ,WCsB nad .Ptll)eset ae tceeivRa -yootmtcrhbossi is a aveltede ptlltaee cuotn atth rccsuo asocynder to ntorhae reoridds l:eki

ohi-rCnc mfotayarilnm ddrrossie ,e(g idoaehrmtu rhstiirta, mromialnfyat ebwlo eai,edss cobesuulsi,rt ocisrassio,d ongatoualmisrs with -ctoy)iiiagspnu Alte fncnoteii

horae-Hrmge

o-rIn ndeiefciyc

-yoslesHim

c-nCare

mSltocy-pene or yeismsplhpno

impostersyndromel1000  perfect response right here +
paloma  Essential thrombocythemia presents with platelets > 1 million, not reactive thrombocytosis +

 +2  (nbme21#39)
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p2^ + 2qp + 2q^ = +=1q p 1

q=^2 q/00=91 1/0 =3p 39/02 wichh snudro to 1

ehTy aer kngias ofr erraicr yqecfruen cwhhi is 2p.q





Subcomments ...

submitted by beeip(123),
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wHo ot diariteenftef entwebe rirovNous adn tsRirauvo hree? tsMu eb leadret ot eht eth nsiaotougc netaru fo het ?nsslile

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +2  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +1  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +4  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1  


submitted by seagull(1443),
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sTih fnnita has oyxgne txiycito ued ot rfee acalrdi nnte.iargoe eFre ricsdala eaamdg eth lung eahnrmcayp ngildea ot fiirssob dan iplasasdy (bnolaamr )ohtgwr.

link981  Per American Lung Association: Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. It results from damage to the lungs caused by mechanical ventilation (respirator) and long-term use of oxygen. Most infants recover from BPD, but some may have long-term breathing difficulty. + Prematurely born infants have very few tiny air sacs (alveoli) at birth. The alveoli that are present tend to not be mature enough to function normal, and the infant requires respiratory support to breathe. Although life-saving, these treatments can also cause lung damage. +2  
jimdooder  Just to follow up on the concept, you would prevent this from occurring by decreasing the Fi02 to mid-low 90s. I believe this is tested on another form. +2  


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Ddi eynnoa slee og odnw hte: 'hses viytheosnpe so emaby lseh'l tge wrheoeutas irrdefnhsiec ymesrodn baeucse igntnoh else si gknmia essne to me ta isth ?o?nti?p uoret -

rnTsu uo,t veseer limraaa anc csuea sarvliodaacucr lclospea adn eooniphtsny.

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +9  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1  


submitted by cbrodo(58),
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The opsotirer mouscnl (cFuaisuslc uccFsusecs/iuanautl asigclir) cryar atonfoinrim to eth bnria nragirdge tr,pioeroiopnpc ita,ivronb isvimiinteracd uthco nda uese.rrsp hyiaPcls xema infsngdi stgsegu a enslio eehr t(he hiatcomlnsaip tcrta rreicsa pick/inpnpiar dan prmtaeuere,t and heste rwee a)lmor.n iSnec the epniatt ash raonbaml iinnfsgd in the lrewo eteirxmie,ts adn mlaorn nsigfndi in het peupr etrxetmii,es teh arnwes si ucuFcalsis cgars.iil This si ecubase nnafriooimt rmof body aresa oelwb the evlle of T6 is ariercd yb iarclgsi dan oonniatrmif ormf bdyo erasa aoebv the leevl of 6T is derrcai by atsuecnu.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +3  
temmy  i remember gracilis is for legs by saying i have graciously long legs and they are inside while arms can spread out to remember their orientation on the spinal cord +4  
jess123  I remember it as gracilis = grass so feet haha +4  
link981  Just to add found on page 492 on FA 2018. +  
charcot_bouchard  Hey Temmy, I can spread my legs too :) +  
maxillarythirdmolar  I can't feel GRACIE's ~fine touch~ as she ~vibrates~ my balls. +3  
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +1  
drzed  Lmao I remember gracilis because of the gracilis muscle in the legs! +3  
alexxxx30  cat5280...so spinocerebellar tract does 4 things to know 1. proprioception in the Romberg test 2. intention tremor if damaged 3. shin to knee test 4. dysdiadochokinesia (being able to rapidly pronate/supinate the upper extremity) yes the patient has proprioception issues, but the other symptom of vibration loss points us more to a fasciculus gracilis issue. If the patient had presented with proprioception and and intention tremor then we would think spinocerebellar +2  
alexxxx30  adding to my comment^ I would commit these 4 things to memory as I have gotten several questions concerning this topic (there were 2 questions on this exam where spinocerebellar tracts are involved). Memorize them and it might get you 1-2 extra points! +  
solidshake  Just to clarify a point, Spinocerebellar tracts are not tested by the Romberg Test. Romberg tests conscious proprioception that is done by the dorsal columns. Spinocerebellar tracts are used for Unconscious proprioception. Look up tabes dorsalis in First Aid. One of the positive indicators is a positive romberg test, which shows that the dorsal columns have been damaged thus affecting conscious proprioception and thus impaired balanced on standing with the eyes closed +  


submitted by lfsuarez(141),
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Dngrui troienp lnrttasn,aio teh ersoiobm indb to RANm to iitaitne rointpritncsa rtniatgs ta teh .m-utiNsren hTe smru-Ntein ipeetdp den sninocta a nlsiga nitncoieorg ltceapir atth bnids to the ngslai otioiencgnr tlercaip oprcerte on eht rhugo RE to lolwa the ieopnrt to be dema tnio teh .ERR

link981  Rough endoplasmic reticulum- site of synthesis of secretory (exported) proteins. Smooth endoplasmic reticulum- site of STEROID synthesis and detoxification of drugs and poisons. Page 46 FA2018 +2  
furqanka  the N terminus peptide end has the signal recognition SEQUENCE which is recognized by signal recognition PARTICLES. These particles bind to SRP receptor on rer. +  


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A osrltnaomb si an tmemriau RC,B so 'its tveedlae ni ttasse of esraceind mtsiaieoo.phes

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +57  
someduck3  The term "Normoblast" isn't even in first aid. +35  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +18  
tinydoc  I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +17  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +8  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +5  
fexx  I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +5  
mdmikek89  Even in you didn't know what Normoblast means, it cant be any of the other answers. TEST TAKIN' SKILLZ BROS +  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +10  


submitted by seagull(1443),
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HgaWrderbiey-n nequoita = 1= P2^ + 2qp + q2^

2^P = 1/0,1000 = /1100

hTne reeembrm P + q = 1 -&g----;-t 0101/ + q = 1 (q = 1009)9/

tsaLyl glup kbac tnio -HnWederbgriay untEiaoq sa:

p2q = teyooHeetzrg irrcrea

(2 x 10/10 x 0/0991 = 002/1 = )015/

link981  I think q should be 1/100. You got p and q mixed up. +4  
humble_station  Because p = 99/100, you can just make it 1. Then just do 2 x (1/100) and you get 1/50 +4  
humble_station  Because p = 99/100, you can just make it 1. Then just do 2 x (1/100) and you get 1/50 +  
unhappy_triad  Carrier frequency= 2pq AR disorder that occurs in 1 in 10,000 the square root of 10,000 is 100 so, q=1/100=0.01, p= a number close to 1, just use 1. plug it in the equation 2pq= 2(1)(0.01)=0.02=1/50 +2  


submitted by ferrero(40),
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A reyv lrmsiai tqesoiun I aevh ense ni Qskbna will ask yhw a tteipna whti igrht heart rilfeua deso otn opveedl emaed dan eth nsarwe is edraencis hlpatmyic .aaedginr I tgo isht touniqse ognrw lganryiloi buascee I warenesd olang itsh elin fo genairson tub I tnikh ni tshi scea it lal hsa to od hitw WHERE eth raxet russpree is iongmc .morf In this sqntouie hte tp ash slodiacti hieyonrpents so oyu acn hktni oabtu the reprsues as omcgin ""frrwoda so ntcgiicsotrn lyappcalrrie phnecitssr cna rpevten na ceiesanr ni uerprsse ni the plicyrala edb. vwoereH fro gtihr ethar laerufi shti atxer iulfd si ngmcio rfmo eth POPSITOE ncidteroi cdbaakrs(w mrfo the htrig hreat) nda nccirotsgtin ilrrpeaycalp nricepsths can od ningtho no( ptosoiep dsei fo apcialyrl edb) - eth nlyo awy to tenrpev meead is ot aceresin tcyhmapli grdaeni.a

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +15  
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +6  
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +31  
cr  the main difference between the 2 cases is that in this case the patient has high BP +1  
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +6  
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1  
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2  
asteroides  I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +3  


submitted by link981(157),
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Hatmeinsi ssceau roeitaler laionsoivatd, icasnug a pbdului of obold in the ialpae.srcil ehT escdreain blodo ni het rcieliaapsl lwil ucaes hte sperruse teerh ot rei.s Ftotinairl is endedepnt no rse,srepu eht erihhg eth srere,psu the mero hte aintilrf.to

merbRmee oldob of:wl vnsie to lveusen ot laciapisrle to rsteiorlae to raesetri

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +14  
link981  I stand corrected @yb_26. Brainfart moment 🙈 +  
rockodude  lmao including a link to a teachmeanatomy page on basic blood flow +  


submitted by yotsubato(979),
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hoghtAlu paneoeihntcam nll)(yoTe si ont inddscoree na IADNS, it oto yam kopeorv na rsiikeinp-la evtiit.nsyis

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  


submitted by yotsubato(979),
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p35 is uamdett and anct inbd eht ATAT ,obx so tawh pphanse ot tnnoprctsiair of iynihoritb pet?oirns

Is aycilsalb hawt hits iqnuotes is gtrniy to k..as.

oS no TAAT bxo erormpot ;=&tg rdacsDeee bgdiinn fo RNA saemlreoyp

link981  You said it, they are "trying" to ask. Should use better grammar. +3  
titanesxvi  This is on first aid, and says that the promoter region is where RNApolymerase binds +  
nootnootpenguinn  Hakuna NO-TATA box... thank you for this explanation! +  


submitted by seagull(1443),
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Ddi ynneoa eden ot arde hatt tasl entecnes lkei 50 tmsie uebsace the hrtoau eefruss to sue ebettr .mmagarr stuJ srgiartnt.uf

link981  Author rationale: "What is grammar?" +6  
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +16  
drbravojose  Actually never understand what the author saying at any time. LOL +3  
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +  
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +  


submitted by seagull(1443),
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ichhW fo teh fwolnolig sronsae si yhw htsi oetuqisn si b?lul

1) gUsni hte rwod yc""ccil indaset fo rcyitcilc rof ailtryc

2) wonngKi lal fo eydoeiomlipg fo all sgdur

3) nvghia to eonars out that irinlcotingeach eeffcst aer yolbrpab het sowtr rvoe 1plhaa or 1H fetfesc to on att.yerinc

4) heT prinlicpg rsnipeodes fo sngtiudy ofr y-oeasw-kdste on end ot lopbbray do vgaeera no eth set.t

nlkrueger  yo, re-fucking-tweet +20  
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4  
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1  
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5  
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +  
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +  


submitted by usmleuser007(377),
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wTo aormj mihessamnc of ticoan aevh neeb :tidulacdee

1) lnyocFtisue is afyurilagnntl ntvdoerce inot eht cyttciatos rcraouolulfi ciwhh usegenord rufreht ptess fo oivaanttci and ailfyln icttnesra sa ilo5-oetierufrspndiuprtohha with ANR siibestyonhs usht idgutrnisb eth iiblndug of ciatnre sailetsen inepost.r

)2 oeyFlicntsu lsao ondegures eovrinscon itno oopoo5mrxhtdpenuiedhs-fyoiloaenur whihc ihiitnsb gfnual AND stesysi.nh

3) mhTydtialey thystsenea si na nyezem that scyaaezlt hte soicvorenn of iidredouyxne nophheoaptoms P(dU)M ot ihdndyximyteoe oopenpsmtohah Md(P.T)

myiheTidn si one fo eht ueiconesldt in .AND

ihtW iiohintibn fo TS, na cleaimnba of oyludxnidecesote adn ecndiraes vllsee of dPUM es.air htBo aecus DNA m.eaagd

(WII)K

link981  Just look at page 36 of FA 2018 and memorize that shitty diagram o De novo pyrimidine and purine synthesis they ask so much about. No need for scientific explanations for this one unless you like to waste time. +21  


submitted by welpdedelp(219),
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tI was stuj gnikas het asiflpne fo sBCR (210 adsy)

haliburton  If I'm reading this right, this is just a tricky dicky question. I think CO binds 200x stronger than O2. But if an O2 cycles through binding / unbinding 200 times before a CO gets kicked off, this should still clear the CO from that cell sooner or later. strange to think it is 1. essentially permanently trapped in a cell, and 2. doesn't kill you and can be treated with O2 to resolution within a few hours or a day. They must just be thinking, until that last RBC dies, you've got original CO in a circulating cell. but just a fraction (because you didn't die). not sure how that CO isn't just passed on during recycling, based on this line of thinking. +7  
link981  The question while stupidly written, asks how long the RBC's that carry the CO take to be removed from the circulation, not how long the CO takes to be removed from the RBC. Just asking the lifespan of RBCs in an stupidly complicated way. As we know, RBC's life span is about 120 days and then they are removed from our circulation. 120 days is about 4 months. Next time they will probably ask weeks or in hours, who knows? smh +6  
baja_blast  If that's what they're looking for why cant the NBME people just ask "How long does it take for RBCs to turn over?" Ridiculous. +1  


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I ihknt the iaecsenr in asalpm niern ivtacyti iwht ASIsND sah ot od tihw otniiinibh of efeefnrt rearty ntioaild by onagtnlasrspdi P(2,E)G necsi astth' wath NISDsA do by iiiinhnbtg XCO. iThs eesaceddr renal oldob fwol ldesa to RASA aittvcaoni ot rnoesvce rweta nda etamyiullt einrn ee.cisasrn

htballer55  Afferent artery dilation* +5  
link981  There is decreased afferent renal artery dilation (less blood flow) leads to increased renin release from the juxtaglomerular cells (located near the afferent artery) to try to increase blood flow. I got it wrong but after reviewing saw my idiotic mistake. +1  


submitted by usmleuser007(377),
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hiTs meor kileyl ot eb dcsiruite heatrr tnah lesitavax cb/

hte lba dsyut wsosh a lerna tiundnsfocy NB(U am&;p Ceiitrnnea rae te)elaved

Msot elikly the atteipn eaubds oolp ;tisrediuc asol onkws ot ceaus oittrocannc ldlo,aisak anlgo iwth leran mpolsbre hcus sa titlieinsatr ipnretish

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +11  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by usmleuser007(377),
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shTi ermo lyekil ot be icsiedtur rahtre ahtn xleaiavts bc/

eht bla dystu whsos a nrela cnoifstyund BN(U pma;& eniinrateC ear tlee)vade

Msto elilyk teh nettiap adusbe polo usdiit;rce olas wnoks ot sauce nrtntccooai l,ilskaaod gonla with nlear pbmserol hcus sa ittatseriinl nterihpis

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +11  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by keycompany(301),
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lwoF eatR = yeoticlV x lse-SaiocnCtsro aAre

2 cm^2 x 02 cemcs/ x 06 ncsei/m x 1 /000,L1 ^3mc = .42 Lm/in

001,0 cm3^ = 1 L

seagull  Well, I missed this one. I don't even feel bad. +58  
link981  @keycompany a small typo, 100 cm^3 = 1 L not 1000cm^3. 1000 mL^3= 1 L +  
hello  @keycompany how did you edit your original comment to fix your typo? +  
winelover777  Pretty sure @keycompany was correct. 1 L = 1000 cm^3. Otherwise the answer would be 24. +3  
drdoom  1 centimeter is a distance. (A line.) +  
drdoom  If we multiply a line by another line, we get a surface area. (A piece of paper.) +  
drdoom  If we multiply the piece of paper by another line, we get volume. (A cube. A box.) +  
drdoom  If we fill the box with a fluid, we will have 1 mL of this fluid. +  
drdoom  If we have a thousand of these boxes, we have 1 L of fluid. +  
drdoom  1,ooo mL = 1 Liter = 1,ooo centimeter³ +  


submitted by haliburton(209),
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wraafrin niitisbh the yitseshns fo csratfo ,II II,V ,IX ,X C, nda S by cgiknobl redintuco of dioezidx itmiavn .K ehT yeznme xopiedE Retesudca si dtnieibhi yb fiarr.nwa The reddeuc vite(ac) romf fo vi.t K is a cfrotaoc orf almy-aalmgugtm caybseral.xo

link981  So factors II, VII, IX, and X are precursor proteins? GTFO +1  


submitted by hello(302),
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gniwnKo eht +LR levua = 10 dose not ephl to evslo siht Q ecaesub sttenmaigi ewhre ""01 lsuhdo lafl on na sixa is rayrra.tbi ,sAlo teh taad isnpot rea isooednrcta -- yhet aevh an Xleu-av adn a lYeavu- (,X .)Y

eTh yaw to apcaroph ihts Q is to nkow taht a ihhg ctpciifseyi naems ttah a iviespot lrutse is y,evr veyr lileky ot be a teur .vpsetoii

upoeSsp atht teh isyecicfipt is 90.9 -- hits is %99 ysftpic.icei Te,hn uoy oklo ta eth ahp.gr heT sXxa-i si "t-pcsfiy1"ii.ec oS, essupop teh sbet etts hsa a ctifcpiiesy fo 9%.9 enhT, ulealacct cc-1i ysfiepti = 1 - .990 = .10.0 ouY oudwl nthe hsoec eht iadntptoa ahtt soonsrepdrc ot avnhgi an aul"e-Xv" tath is sosclet to eht rni.iog In ihts ebmpro,l ti drsecnooprs ot adat pitno ""A.

uYo tndo' veen eedn to nkwo a fesiccpi sieityifccp eualv to losev tihs .beropml All ouy edne to do si dantdrsneu ttah fi eht eccfipiytis is ermxelyte high, yuo lilw nede ot nifd a atanioptd atht si oslsetc to hte rginoi -- at esalt fro eth avuel ni eth -Xsxia in eht cntdraooei of hte tdaa itnop -- secbaue teh iaXxs- drprsooncse to a laaonltucci of tcei"cfi"p.yi-1s

link981  Excellent explanation but a minor typo. 1-0.99 = 0.01 not 0.10 :) +2  


submitted by seagull(1443),
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otu fo uyotiir,sc hwo amy opeple wkne ?tihs o(dtn eb syh to yas you did or indt)d?

My peovrty dueoatinc i'ddnt airning tish in .em

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),
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mI' rsoyr utb atwh ma I inmsgsi ..eh.re I gohthtu eth eholw piotn of tsiudeirc si to eorctrc eloumv eraoovdl by se?uidirs Hwo luowd lttao olemuv eb cin?e?reasd

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  


submitted by hayayah(1057),
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Prgnyneca + xH of brhmosiots ;tg--& ihntk pnidoposlthaiphi dmonyesr

The PT nad TTP rae oodprlegn d/t ernireefnetc mfro the betiidonas to .doislhpsipoph hTnrmboi meti rlmo.an

aHd ot fidn srhracee iatsrelc utoab ti os ktae ti rofm ehre nda n'tod stwea yruo .ime.t.

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +20  
goldenwakosu  Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +4  
johnthurtjr  I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +3  
link981  No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +8  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +3  
oslerweberrendu  @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +  
kevin  just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +1  


submitted by k_tron_3000(31),
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eTh srcoeidpnit of elrtailba welor mibl sols of btvionrai iilmesp LMCD daemga, adn hte ntaseb DRsT + Rgbmreo emse to em ot be piglmniy thta eh sloipbsy sha tbsae dlsiraos rfom ilphiyss ro( hnotegsmi eryv siirmal in na)ies.etorntp

As orf teh teorh ssawrne, A si gowrn sbceaeu sih tmroo tficuonn is t,atinc B si wongr cbeaesu ipna dan erapetmeutr iiscfedt aer tno ,doeinmtne C si wogrn beceuas it misplei a scipfiec evrne is pepnerdt,a tub eh has ltos atlrbieal entssinoa ni hsi nteire orewl xtseieerimt

D is het iiercs,tkt and ’mI tno %001 ,uesr ubt I udowl tnikh riopdlayahuct fo eht niaeortr )rlv(eatn rotos uwold sceua moort defsctii ecsin yhte rryac ortom fntesef.er You thgim saol ectexp htat rmoot ocnuydstnfi to be lu,nirlaeta nesic ti wuold eb nlulykie to eavh a rpeblom whti het reevn roost no hbot sdi.es soal teh CDML si not lcodtea arne the oerrtain rotos fo eht naislp c,dor so fi eht oeiarrnt tsroo ewre faeftced ouy lyelra udo’wltn cpexet ot see ovtryairb .loss

oS sbcayaill ecpssor of l,oeinmaitni I od leef ilek nsoreys arepoyuhnt is an retemxeyl auvge wsenra toguhh and I nwsta’ a nfa fo teh sqino.eut

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). +30  
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. +15  
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 +7  
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +  


submitted by neonem(556),
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rmoF .ctweomentarcch vener( edrah of it orbeef tbu eemss liek a dgoo px:o)lneniaat

ehas"P IV e,tsiusd onetf adellc tPso aMinetkrg ailclenvureS Tasr,il rae ctedncodu reatf a rdug ro ecvedi sah eenb pdvaepro rof unscmreo leas. meircacalaPtuh nmescpaoi avhe erlesav ojiscevebt ta htis egst:a 1() ot apemocr a rdgu whit etrho rgusd earadyl ni teh km;arte )(2 ot rntooim a us'drg m-notegrl niceetsfseevf dna tcimpa on a pitan'tes auliytq of il;fe and ()3 to teedrinme the fn-scveiteoftecsse of a gdru erhyapt traeelvi to hrteo dtiitoaanlr dan nwe rshetip.ae sPhea VI etdssui cna rulets ni a ugdr or dveeic ebnig taenk fof eht mekrat ro stnsieocrtir of eus udocl eb lepdac on eht cuoptdr nndeidpge on teh innidfgs ni het s"duty.

seagull  Well, I was not smart and put phase 1 since it was talking alot about adverse effects and withdrawl from the patients. But now I see I have 2 extra chromosomes...my bad. +  
link981  Phase 1- Determine if drug is SAFE Phase 4- Continous surveillance of a drug that is already on the market. The vignette clearly states the drug is marketed. That means it passed the clinical trials. Marketed drugs have passed Phase 3 +