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Welcome to lowyield’s page.
Contributor score: 11

Comments ...

 +0  (nbme22#36)

my best guess for why anti-cholinergic is worse than adrenergic or histaminic was just b/c they stick atropine with diphenoxylate to prevent abuse (tbh tho idk if this logic stands at all but eh)

 +1  (nbme22#38)

just as an aside to what everyone saying, don't forget the 2 exceptions to the rule of 4s:

don't localize w/ CN5 (as seen here) b/c it is big and spans the pons and medulla

don't localize w/ the vestibular signs of CN8 b/c it is big. You CAN however localize with the sensoneural signs of CN8

usmleboy  This is the key to this Q! +1

 +0  (nbme22#47)

I think the three most reasonable answers can be put into the different boxes of rejection

Glomerular neutrophils and necrosis->hyperacute (? I usually just think neutrophils are the earlier onset things)

Lymphocytes infiltrating tubular epithelium-> Acute [<6 mo]

Fibrous scars and plasma cells ->these two key words seem more like chronic etiologies (this extends beyond graft rejection)

My best guess at the other options are:

Arteriolar C3 deposition- some sort of nephritic syndrome, whether it's SLE, PSGN etc.

Dilation of Bowman's space-post-renal obstruction

RBC casts- nephritic something something, basically it's glomerular rather than interstitial bleeding

Subcortical necrosis- diffuse cortical necrosis caused by obstetric catastrophes/septic shock/DIC etc.

 +2  (nbme18#27)

I was stuck on this one for a long time but maybe my super round about way will help someone?

you know this person has chronic bronchitis (especially cause they have cyanosis which is blue bloater vs pink puffer of emphysema). The distinguishment of pink vs blue is b/c in emphysema you have destruction of both the alveoli with the associated vasculature. Therefore there is no V/Q mismatch (pink). But in chronic bronchitis the damage is further up from the alveoli. All the other answers were in the alveoli so that's how I chose pseudostratified columnar epithelial cells.

Or maybe i'm just dum as hell and this level of overthinking is why i'm losing points on other questions

Subcomments ...

submitted by sympathetikey(980),
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iHeosnt aeiclytnato sllwao ofr roaeixlant fo eht NDA so that tatiicrpsnorn acn eecro.dp lAl tansr tiocenri acdi scsaue teh uaytscgelrno ni LPMA ot urfrteh uter,ma hwhci sueqrier NDA tnaorpristcin / otainsanrt.l

osler_weber_rendu  The questions asks for response to ATRA. Should that not be decreased transcription to treat the cancer? Which makes methyl transferase (aka methylation) the more likely answer +1  
pg32  @osler, no @sympathetikey is correct. ATRA's mechanism in treating APML is to encourage the cells to mature. Maturation would require gene transcription, meaning histone acetylases would be used. +  
nnp  but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation) +2  
lowyield  i believe the mechanism of APML is that the compound protein is ineffective at allowing for maturation of the blasts. giving ATRA allows the blasts to circumnavigate this step, relieving the backup +3  

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heT tsom otinpmtar snhti ot eht nstqoeiu ear sa f,solwol thwi #2 ngbei hte msot :ipsfceci

)1 nipetta rprseot pnia hiwt odahever iomont adn rptreos enrcrertu evdahore iotmon ginrdu .rkwo daehevrO oitmno nac egadam teh sppusisruanta ucmels due ot pmeitmgenin yb hte mnoroc.ia

2) nPai is rwsto ithw erantinl rtaintoo of teh dorlseuh - ihts is tscsnnotie twih teh nfsniigd fo eht cmne-ptya ,tset chwhi iecaitnsd a uapnapsrssuit jr.uniy

mousie  I was thinking along the lines of overhead motion - damage to the subacromial bursa which is between the acromion and the supraspinatus ... also its the most commonly injured rotator cuff m. so could have guessed this one right +1  
sympathetikey  Thanks for the explanation. I was scratching my head as to why this is correct, since supraspinatus only does 15 degrees of abduction, but you make a lot of sense. +1  
charcot_bouchard  IDK WTF i picked Trapezius +27  
ls3076  why would injury to supraspinatus cause weakness with internal rotation though? +6  
targetusmle  yeah coz of that i picked subscapularis +2  
maddy1994  ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis +3  
darthskywalker306  I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me. +1  
lowyield  saw someone post this on one of the other questions about shoulder... and it works pretty good for this there's some videos in it, this specific one for the question is the neer test +  
psay1  FA2019 pg. 438 +  

submitted by mcl(517),
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To adepnx no hi,st psgshraeohnpaoot are cmmooynl seud sa ecse,tdncisii nda toicnfun by nigdibn tlestcynsocereeahlia nda ttgea""invidac it, os to psaek. siTh stusler ni na sxsece of AhC iiwtnh hte ssapeyn, cihwh acseus ldsgue nrdmosey ni,tvgm(oi teg,isawn aairedhr -- alcliabsy tsol fo .u)lfsid hTe artemttne orf this si tlyalicyp peintoar csiu)c,aramn(niinit adn ealxmodripi f(i ngvie leayr neohug, acn a"c"evrtitae hte ea-s).hCAs ehT dagairm gienv eosd not hwos A,asChe- lyno hte hCAR-, eroehtfer D si eth esbt ea.swnr

lowyield  Also according to uworld you give atropine before pralidoxime because pralidoxime can cause an initial exacerbation (even though you might think you should give pralidoxime first because it is time sensitive) +  

submitted by jinzo(13),

I have ganglion cyst since 2012 and this shit doesn't disappears . Moreover , it may cause some pain , when I flex my wrist . So why answer is not parasthesia???

asharm10  I am sorry bus this is soo funny!! I hope your's spontaneously regresses too +1  
lowyield  Not sure exactly but my guess is that it doesn't impinge upon any major nerve (yes it can probably impinge some superficial branches of the radial) +1  

submitted by mousie(171),
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rleChoa = Flcae oge/snrlLnaii raeo = llagnaLeo opneum = NO rensop ot enrpso ynlo yb aonihilnta of teriaabc amintctaoden /eLrewmya t = tcki bitacicnnlgic oeMoe/ = hgsinra yarriestpro nad hratto teorcsines lia(asv ro .psti) ya,rGleeln ti tsake celso fo(r la,xeemp ggihounc ro sg)kisni ro ehyntgl tcctona ot easpdr htees cireaatb )FCCS( R/MD = tcki beit

smc213  Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments. +6  
dentist  So, Cholera is also p2p but Mening is more likely? +1  
usmlecharserssss  in cholera people to water => water to people +  
qball  Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person. +  
drschmoctor  but the poop water comes from people so.... +1  
llamastep1  Respiratory dropplets is easier than fecal-oral tho +1  
lowyield  Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals +1  
peridot  I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis. +  
bbr  To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly). +  

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Yuo know ’tsi an pnevedleo sivur scnie ti ’tnsdeo hdlo up ot adci or gbeni rei.dd You owkn ti csesua a evfer nad a u,ghoc hlewi fantceigf the Olny iursv raoetcyg htta ftis lla hatt inof si eth vsorricoanu easu(cs RS)AS mfor htat s.ilt

zelderonmorningstar  EBV doesn’t cause fever and cough? +  
zelderonmorningstar  Wow, just checked First Aid and it doesn’t list “cough” as a symptom of EBV. +4  
drdoom  EBV is not a “respiratory virus”; it’s a *B cell virus*. Even though you might associate it with the “upper respiratory tract” (=kissing disease), it doesn’t cause respiratory inflammation since that’s not its trope. B cells are its trope! That’s why EBV is implicated in Burkitt Lymphoma, hairy leukoplakia and other blood cancers. (EBV is also known as “lymphocryptovirus” -- it was originally discovered “hiding” in *lymphocytes* of monkeys.) So, EBV = think B cells. +20  
fulminant_life  EBV does cause pharyngeal and laryngeal inflammation along with fever, malaise, and cough and LAD. The only thing that pointed me away from mono and towards coronavirus was the patients age. +5  
nbmehelp  Can someone explain what not holding up to acid or being dried has to do with being enveloped? +  
yb_26  @nbmehelp, the envelope consists of phospholipids and glycoproteins => heat, acid, detergents, drying - all of that can dissolve the lipid bilayer membranes => viruses will loss their infectivity (because they need an envelope for two reasons - to protect them against host immune system, and to attach to host cells surface in order to infect them) +6  
lowyield  @yb_26 does that mean that non-enveloped viruses hold up better to acid/dryness? +1  
rina  yes enveloped viruses are easier to kill (see post from drsquarepants: also i think the "when dried" might refer to the fact that coronavirus is spread by respiratory droplets (don't even need to read first aid can just read the news at this point!) +2  

submitted by neonem(503),
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seeTh rea gout tar.slsyc I upospes hte btes wya ot edrainetftief sith scae mofr ouusgtoepd is ahtt eth tsrlascy ear phras p;a&m hsependeeld-a dna nto .bdmie-pdohsohar

sympathetikey  Yep. They tried to throw you off with the picture, but the wording in the stem says its a "photomicrograph" -- not exposed to plane polarized light, where you would see the negative birefringence. +14  
linwanrun1357  Why is NBME so mean to us. Do those mean a lot in clinic? +  
suckitnbme  @linwanrun1357 I highly doubt you would be looking at your own joint fluid aspirates instead of sending it to the lab. +2  
nnp  what those yellow white nodules signify? +  
peqmd  In clinic gout is typically a clinical diagnosis. If you can treat w/ NSAIDs instead of aspirate you would do that. You would aspirate if you are considering septic arthritis so you can get culture. I don't think anyone aspirate for heck of it. +  
lowyield  @nnp, the yellow white nodules are tophus which is a sign of chronic gout, characterized histologically by aggregates of uric acid crystals, can show up as skin nodules most commonly on external ear, olecranon bursa or achilles tendon (pg 467 FA 2020) +  

submitted by soscrying(8),

at my uni, we learnt that at lower GFR, loop diuretics still work. That's why you should use them in renal failure. Thiazides would not work with a GFR of <30.

qball  Dang, you actually learned something at your school? Lucky. +9  
lowyield  At our med school they teach us that Thiazide anti-HTN function is primarily from it's direct effects on vasculature rather than it's diuretic effects. Somehow directly affects the vasculature which is not well understood but this is linked to why Thiazides have greater efficacy in African American Populations. That's kinda why i figured it wouldn't be the best diuretic in this case. +  
brotherimodu  lowyield but interesting +  

submitted by usmleuser007(326),
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dnieonCcef rtvneali escnirsea whti adecsered slemap e.isz

usmleuser007  would require a a large sample size to see if there is a true difference +  
claptain  This question is bogus. CI does not always increase with decreased sample size or vice versa. Four readings with small variation would give a narrower CI than 10 readings with greater variation. The only thing you can be certain about by adding more samples is that the CI will most likely change, but which direction is uncertain. +6  
bartolomoose  Recall the formula for 95%ci Mean +/- 1.96* (SD/sqrt(samplesize)) +1  
the_enigma28  @claptain The point you made is relevant in studies involving random data. But in case of this question, the data being collected is in fact the diastolic BP. We take several readings of BP to rule out white-coat hypertension and have as accurate reading as possible. In this case, taking more readings will actually narrow down the confidence interval. The readings here represent physiological parameter, which wouldn't vary veryyyy widely in an individual. +  
lowyield  @claptain i was thinking the same thing but ended up choosing the increased because alot of NBME seems to reward the more simplistic answer than the overthinking answer +  

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diadCan si a rpta fo the anroml floar fo n,iks uocld cuesa annnitomcaoit of a eltcnra sovenu herec.tat The tuqioens ttessa ttha eht agrsinom si u,prlep dbn,ugid ddi ont enrodsp ot broad ecmtsrpu stcitbioani (aak yeht dntd'i use onleuzlcfao ro ompieitahcrn B.) yL,stal heyt woedsh it tpedla on doobl rgaa dan eethr aws on yilsoshme ihhwc talniieesm pshat (hte nylo rohte liospbse endorncet ).reeh

pcouctysrcoC sululay sveilovn tegsnnmiii ni nmdsuromicpoemmio ts.p E. coil si ramg aorepitrhsxietngvo is lyuusla dittaemtnrs by a thonr on a rose or noeesom ihwt a riyhtso of annggderi

hungrybox  Also, the yeast form of Candida is gram (+) +21  
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +1  
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +  
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +  
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +  
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2