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Welcome to lispectedwumbologist’s page.
Contributor score: 79


Comments ...

 +1  (nbme24#1)
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yhW wolud ti otn be maiane of chrncio esedias twih reaceddes suerm rrsfratnnei trcncn?toeinoa

lispectedwumbologist  Nevermind I'm stupid as fuck I see my mistake +
drdoom  be kind to yourself, doc! (it's a long road we're on!) +17
step1forthewin  Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency? +1
loftybirdman  I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency +18
seagull  maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well. +
vshummy  Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me... +5
gonyyong  It's a B12 deficiency Ileum is where B12 is reabsorbed, folate is jejunum The blood smear is showing enlarged RBCs Methionine synthase does this conversion, using cofactor B12 +
uslme123  Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia. +1
yotsubato  Thanks NBME, that really helped me.... +1
keshvi  the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption. +6
sahusema  I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF +
drschmoctor  Leave it to NBME to find the palest macrocytes on the planet. +4

 +0  (nbme24#22)
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How do you tuidsnsiigh ihst mfro rsacluitte o?torisn sI it utjs sbuaeec it etadrts ni the ftle knafl?

neels11  and there's no mass in the scrotum, whereas testicular torsion will have that "bag of worms" feel (along with a lack of cremaster reflex) testicular torsion usually happens in a younger age group +8
medpsychosis  @neels11 I would like to clarify a piece of information. I believe you are confusing Varicocele with Testicular Torsion. Varicocele will present with "bag of worms" feeling. While the absence of cremasteric reflex is a sign of testicular torsion. +8
johnson  This is the classic "loin to groin pain" of nephrolithiasis. +3
suckitnbme  Testicular torsion would also tend to have a unilateral high-riding testicle. +

 +2  (nbme24#13)
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Can onybady ielnapx ihts ?neo I put eedtaepr sttes ubaeesc I amssdue na 8oyae3r-l-d nmawo is an uunsual iegarmdhopc ofr .hispsiyl

m-ice  83 might seem an uncommon age, but we don't know for sure her sexual history. She only recently (8 months ago) started showing some signs of mild cognitive impairment. She has all these results implying that she has syphilis, so the most likely answer is that she has syphilis, so we should speak to her privately about her sexual history. The tests don't necessarily means she got syphilis very recently, it's possible she's had syphilis for a while and never got treated. +4
mousie  I understand that she could possibly have syphilis but I also put repeat tests because I know there are a few things that can cause false positive VRDLs but if she also has a + RPR does this make a FP less likely? And also if she has mild cognitive impairment you still discuss with her not her daughter correct ...? +4
m-ice  This definitely could be a false positive, but before we want to consider it to be a false positive, we should talk to the patient about it privately. Assuming that it's a false positive before asking the patient about it could delay treatment of her syphilis. There's a chance she didn't want to disclose her sexual history in front of her daughter or maybe she was embarrassed or didn't think it was important to mention. And you're absolutely right, she only has mild cognitive impairment, so we most definitely should talk to the patient alone without her daughter first. +3
seagull  She has dementia. She doesn't have the capacity to determine her own care (23/20 MME). I feel the daughter should have the word on the care since Grandma likely doesn't have the capacity to understand her actions. +5
sajaqua1  From what I remember, dementia is typically a combination of impaired memory *and* impaired thought processes. There is nothing to indicate that the patient has impaired thought processes, and the memory impairment is only mild. The patient can still reasonably said to be competent, and so her private information should be discussed with her alone. +10
yotsubato  Elder care homes or elderly communities actually have a high rate of STDs. Turns out, when you put a bunch of divorced/widowed adults together in a community they have sex. +7
yotsubato  Additionally, you should respect the privacy of a competent adult with "Mild memory" impairment. I know I could have mild memory impairment considering the crap I forget studying for step 1 +10
drdoom  @seagull dementia ≠ absence of competence -- the two are separate concepts and have to be evaluated independently. see https://meshb.nlm.nih.gov/record/ui?ui=D003704 and https://meshb.nlm.nih.gov/record/ui?ui=D016743 +3
wowo  also important to note, d) repeated tests is also incorrect as the microhemagglutination assay is a confirmatory treponemal test (along the same lines as FTA-ABS) https://www.uofmhealth.org/health-library/hw5839 +5
sunshinesweetheart  also.... I think we can assume that "repeated tests" means repeat VRDL, not "additional tests to rule out false positives" +2

 +2  (nbme23#25)
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eer'W vngieiw this sciel of het ilpasn rcod rmof het otbmot tir?gh Teh tefl ghitr beslal lyawas ixm em p.u

mcl  Yeah, I just stared at this again for a solid 5 minutes straight up dying. I think if we're going with the L/R labels as they are shown on the image, imagine the patient lying on their stomach with their feet pointed towards you and it should make sense. +6

 +1  (nbme23#5)
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owH is hits eth eraswn fi erhet is on ialymf thysori of rrtneecur ersuatf?rc I guhotth noeeesoigsts etceairmpf saw uatsolaom a?notdmin

seagull  Exactly!! it's an autosomal dominate disease! +7
emcee  Autosomal dominant diseases are variably expressive. Still, I think this was a badly written question (should have given us some family history). +
wutuwantbruv  Also, FA says that fractures may occur during the birthing process, which is what I believe they were going for. I don't believe these findings would be seen at birth with any of the other choices. +
d_holles  Yeah I thought I outsmarted NBME by selecting Rickets bc it said no family history ... guess I got played lol. +9
jean_young2019  Could it be a sporadic cases? Spontaneous Mutation This is a change in a gene that occurs without an obvious cause, in a family where there is no history of the particular gene mutation. OI is inherited as an autosomal dominant trait. Approximately 35% of cases have no family history and are called "sporadic" cases. In sporadic cases, OI is believed to result from a spontaneous new mutation. http://www.oif.org/site/PageServer?pagename=Glossary +6
avocadotoast  Amboss says the severe subtypes (types II, III) of OI are usually due to a new (sporadic) mutation in COL1A1 or COL1A2, while patients with the mild forms (types I, IV) typically have a parent with the condition. +

 +2  (nbme20#23)
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aCn sobmedoy espael enixalp ywh the Kap has to eb 6 idenast of ?10

masonkingcobra  Since an ionized form is charged (by definition), it will not easily cross a nonpolar lipid membrane. Thus, it is important to recognize the potential of the drug to ionize in order to predict its solubility and the degree to which it can be reabsorbed. The degree of ionization is determined by the drug’s pKa and the pH of its environment. Weak acids and bases are 50% ionized and 50% unionized when the surrounding pH equals the drug’s pKa. At 2 pH units above or below the pKa of the drug, nearly 100% of the drug is ionized or unionized. +3
masonkingcobra  Basically weak acids are best excreted in alkaline urine, but weak bases are excreted more readily in acid urine. +
masonkingcobra  In summary, because this is a weak acid at pKa 6, making the urine alkaline will result it its ionization and excretion. Ionized cant move through lipid membranes so can't get reabsorbed and is pissed out. +6
yex  Following on masonkingcobra explanation: A pKa 4-9 can be either weak acid or base. Weak acid pKa 4-7; strong acid pKa 1-3 Weak base pKa 7-9; strong base pKa above 9 Differents pHs: stomach: 1-2 duodenum: 3-5 early jejunum: 5-7 late jejunum: 7-9 ileum: >9 urine: 4.5-8 Weak acids (pKa) gets absorbed in acidic (pH) environments and cleared in basic. Weak bases gets absorbed in basic environments and cleared in acidic. THIS DOES NOT APPLY TO STRONG BASES OR ACIDS!!!! The best explanation for this is a Biochem lecture from Pass Program and it is available on YouTube, its long but it is for sure worth it!! Look for 19 Biochemistry 1 from Pass Program on YouTube. +1




Subcomments ...

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Why oludw it not eb iaamen of chcoinr eedssia twih dcdaseere ruesm rtarrsennif oenci?trcntnao

lispectedwumbologist  Nevermind I'm stupid as fuck I see my mistake +  
drdoom  be kind to yourself, doc! (it's a long road we're on!) +17  
step1forthewin  Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency? +1  
loftybirdman  I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency +18  
seagull  maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well. +  
vshummy  Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me... +5  
gonyyong  It's a B12 deficiency Ileum is where B12 is reabsorbed, folate is jejunum The blood smear is showing enlarged RBCs Methionine synthase does this conversion, using cofactor B12 +  
uslme123  Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia. +1  
yotsubato  Thanks NBME, that really helped me.... +1  
keshvi  the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption. +6  
sahusema  I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF +  
drschmoctor  Leave it to NBME to find the palest macrocytes on the planet. +4  


submitted by drdoom(647),
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eftrA hte ffuc is teid, eth elcls nad isutse tlisda ot eth ufcf iwll niteucno mocgisnun TPA (APtP;A-Tg&D,) tbu no srehf ldboo will eb leeedrvdi to e“r”alc tawh lilw be an aculcnatgium tmanuo of PDA nad rehot oea.mtbielts DPA n=Aie(oen)ds is fetsli a yporx fo otsionnpumc nda redsvi disooivlnata of tesari!re toivloEnu( is am!tsr) iIenarscgn seAdAninD/Poe ni a laclo“ renveonin”mt is a ngials ot the ydbo ttah a lto fo csomtninpuo si icrrncugo teh;er ,usht sirereta adn osrieraelt rtnallyau iatdle ot sreeianc dbloo fowl rstea adn wep“es waya” mbocealit dcu.rptbyso

lispectedwumbologist  You're a good man. Thank you. +  
drdoom  So glad it helped! +1  
seagull  very well put, thank you +1  
eosinophil_council  Great! +  
aisel1787  gold. thank you! +  
pediculushumanus  beautiful explanation! +1  


submitted by lilamk(10),
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I adem a kucyl gusse adn ehocs itsh tbu I ’ondt nktih ofr the trigh s.oserna I ougthth bemya he hsa KTB ’fdeccnBouyir/esnti lmamgnmiaba.eiAgo t,uB onw atth I ma ognig rveo it I ’swnta r.ues ldouW ttah hows a aronml lutkyeceo nried?aitleff Is ti DV?IC ndtDi’ nitkh VIDC oduwl aveh eatsnb anigrelm senertc ni mlyph eds.on atWh sele cloud ihts e?b

lispectedwumbologist  CVID presents in adulthood so it's not CVID. CVID also doesn't have absent germinal centers in lymph nodes. My dude has Bruton's agammaglobinemia +2  
sympathetikey  What @lispected said. +  


submitted by wired-in(61),
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aenMictnane edos ruomfla si (Css × lC × aut) ÷ F

werhe sCs is -taeasyedstt tategr lsaamp .oncc fo ,gdur Cl is a,lceernca uta si oseadg itaevnrl ;mp&a F is yiablvoiaal.tbii

Nehirte oeadsg vraetiln onr iatyoiiilbvaalb is egvni, os nnoirigg ethos a∓ ngigpglu ni eth msnebur leacfr(u ot ocnvret tnusi ot /)dm/gkgy:a

=2(1 m/uLg × 1 00gm/01 gu) × 9.00( gkhrL// × 0001 L1/m L × 42 /hr1 yd)a
= 2.592 ykag/mgd/

cwhi.h.. ti'ns nya of het weasnr cisheco ildt.se hyTe utms heav odedurn 900. kg/Lh/r to 0.1 //h,krLg and igodn os sevgi ylxetca 28.8 gk/mdgy/a eoc(ihc )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +53  
hyoid  ^^^^^ +11  
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +6  
praderwilli  Big mad +8  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +14  
bigjimbo  JOKES +1  
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it. +1  
d_holles  LMAO games NBME plays +1  
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1  
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6  
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +2  
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +1  
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +11  
qball  Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +1  
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +  
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1  
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡 +  


submitted by nlkrueger(33),
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ywh n,tsi' %"0 saltsb on eth helarpreip aem"sr higrt? si htis the inthdsginuisig teuufr orf tucae eui?lkame

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +5  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  


submitted by nlkrueger(33),
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.... ldowu ew arleyl aket the word fo a fnerid ohw deienytlif t'anc eb cfndeomir? I feel like hsti si miielngsda

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +9  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +20  
dr.xx  The patient has no wife, children, or close relatives... +3  
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3  
paulkarr  With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1  
suckitnbme  I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +7  
vivijujubebe  they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +  


submitted by welpdedelp(198),
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anedIescr rirnnatlicaa uresrpse taht teslurs in ssgh'uiCn rtdai of sraeceind dlboo ,euesrsrp urirrlgea ebihanrgt, nad ddiaybrarc.a us,hT hhgi 2CO siduenc iuschgn atdir dna if uyo iegv PP nhte it llwi dcdreeu CO,2 and enth ndwo egalerut hte eaptchstyim sncotaicvir.ootns ilrOlgainy het rbina ahd os hmuc OC2 tath it ezszpda out nda eirtd ot eeirncas het BP ni erdro ot phus mreo egadeyxton lodbo ot the ra.nbi

.tl.tjmkfswKa3g-m/cqpAgo.5eZpUpssde//btgi/:ArJha:mSCi

lispectedwumbologist  "Bradycardia" 84 bpm lol +  
lispectedwumbologist  The hypertension in obstructive sleep apnea is due to increased sympathetic tone not increased intracranial pressure lmao +1  
meningitis  @lispectedwumbologist : Be mature enough to correct him/her and move on, not laugh at him/her. +12  


submitted by welpdedelp(198),
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nescerIad antaiaclrinr esrrueps thta ssrutle in sus'gnhiC rdati fo edscnreai odblo r,epsusre auerlrgir bgentrha,i dan ab.rirdaydac suT,h hhig O2C secuidn nhguics raitd and fi uoy vige PP tenh ti llwi erdedcu OC2, and hent wdno eargluet eht htmtecaspyi cios.voacrsotinnt rynOillaig the nbria dha os uchm 2CO that ti zsazedp uot nda terid to ceirnaes teh BP in roder to uhps orme atyedngxeo ldobo to eht irabn.

Ja/.jclg/:pKZ.kg/r-iit/hpsgtSsUoAqCA.m3smte:dawbpme5f

lispectedwumbologist  "Bradycardia" 84 bpm lol +  
lispectedwumbologist  The hypertension in obstructive sleep apnea is due to increased sympathetic tone not increased intracranial pressure lmao +1  
meningitis  @lispectedwumbologist : Be mature enough to correct him/her and move on, not laugh at him/her. +12  


submitted by rocmed(-1),
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at'Cn nrela elcl aornacmci sueca oansivin fo hte nearl t,eyrar sorgtcbuint odobl owfl ti(rlsngeu in a iu,brt) hytreeb laugeigpuntr AARS dna anisrgicne oobld sru?prese

lispectedwumbologist  It is but RCC tends to present later in life (6th or 7th decade). In a 55 year old smoker, atherosclerosis of the renal artery is am much more common cause of bruits +  
seagull  Hypertension is also a risk factor of an atherosclerosis leading to more inflammation. Eventually dilation (aneurysm) might occur... if im wrong then ignore this +1  
seagull  Hypertension is also a risk factor of an atherosclerosis leading to more inflammation. Eventually dilation (aneurysm) might occur... if im wrong then ignore this +  
illogical  Renal Cell Carcinoma has a tendency to invade the Left Renal **Vein** (Pg 134, Pathoma 2018). Thus it has an association w/ obstructed drainage of the Left Spermatic Vein leading to a varicocele. Renal artery stenosis is more commonly due to atherosclerosis (almost 85-90%) or fibromuscular dysplasia. +15  
ratadecalle  With RCC and renal vein invasion you would see B/L lower edema and venous collaterals in the abd wall (Uworld). Also he has a severe headache and confusion which are signs of a hypertensive emergency. +1  


submitted by hajj(0),
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can onaeyn xaipnle tsh?i i wkno andmei rof y is rehghi yb nticoauacll tbu x sha owt osedm os how oemc y has ehgirh ed?mo

lispectedwumbologist  The mode in X is 32 and the mode in Y is 80 +  
lispectedwumbologist  The mode in X is 70 and the mode in Y is 80* +1  
hajj  Thank you! +  
hungrybox  Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao +4  
usmleuser007  can someone please explain the median in this +  
nala_ula  The median can be known by first assembling the numbers in order from least to greater. If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12]. Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people! +  
dubin johnson  Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks! +  
dubin johnson  I mean how is the mode for Y greater than mode for x? +1  
sgarzon15  Mode is the one that repeats the most once you list them in order +  
usmile1  Median would be the BP value that the person in the 50th percentile of each group would have. So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X. Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y. hope that isn't wrong, and helps someone! +4  
poisonivy  I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer! +  


submitted by hajj(0),
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nac naynoe pxliena ?ihts i okwn damnei ofr y si ghheir by olccaiualtn btu x hsa tow doesm os how mcoe y ahs grihhe mdoe?

lispectedwumbologist  The mode in X is 32 and the mode in Y is 80 +  
lispectedwumbologist  The mode in X is 70 and the mode in Y is 80* +1  
hajj  Thank you! +  
hungrybox  Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao +4  
usmleuser007  can someone please explain the median in this +  
nala_ula  The median can be known by first assembling the numbers in order from least to greater. If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12]. Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people! +  
dubin johnson  Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks! +  
dubin johnson  I mean how is the mode for Y greater than mode for x? +1  
sgarzon15  Mode is the one that repeats the most once you list them in order +  
usmile1  Median would be the BP value that the person in the 50th percentile of each group would have. So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X. Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y. hope that isn't wrong, and helps someone! +4  
poisonivy  I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer! +