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Welcome to m-ice’s page.
Contributor score: 272


Comments ...

 +6  (nbme24#39)
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ihTs yob sah aahonalosc,pdir hwcih is ecusda yb an aomtousla ioandnmt umittnao ni ibrblotsFa rtGwoh ctaoFr cetroRpe .3 GFF ilsagnnig is denede ofr eprorp racatiegl oincn,tuf dna hoiwtut ti, hte ongl obens fo het ybod wlil nto wrgo bcuesea hte rhgtwo epalt (dema of eootndcr)ychs osde nto ntiof.ucn wre,Hove beons ttha nrogued somamruben nasoii,icstof ekil het enosb fo het ,daeh lliw rgow lo.anyrml shiT steslru ni eht aepntti hivagn tshor ieiextsemrt ihwt a mnalro izes rutkn dan lrega aedh ivateler ot the bmi.sl

mumenrider4ever  Small edit, achondroplasia is due to constitutive activation (not inactivation) of FGFR3, which inhibits chondrocyte proliferation +2

 +5  (nbme24#16)
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eTh ttnapie sseme to vhea na neincotfi edu to erhti ltevaeed ueerrmaettp dna aonlbrma cthse a-rXy. rHov,ewe etirh tuekyelco ouctn si .lwo nI idit,ando eht iepnatt has pttihesia ,C hchwi is teofn dsisaoecta whti imilsra tsranosnmiis reutso to HVI, elik turaensonvi drgu seu.

sajaqua1  Not only is their WBC count low, it is not uniform. If we assume a minimum normal WBC count of 5000 cells/mL^3, and a regular range of ~60% neutrophils, then normally a person should have ~3,000 neutrophils/mL^3. This patient has a total of 2000 cells/mL^3, with 1,800 neutrophils/mL^3. Their lymphocytes and macrophages have been whiped out. This is best accounted for by HIV. +25

 -4  (nbme24#46)
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intniVrcies is a cthcueeteramphio rudg htat estisbailz msoitcubrlue nda eptrnsev tmeh orfm d.smebnislsgai hTe lcle in the uprteic is uksct in ahe,apnas htwi iseuluotmcbr aeacdhtt ot tis srmomesho,oc ulaneb ot llup hmte taarp aeescbu ti aoncnt asemldibses sti mlcurs.etuboi

vshummy  So I get that by process of elimination cyclophosphamide, cyclosporine, doxorubicin, and 5-fluorouracil are not related to microtubules but vincristine in First Aid 2019 says it prevents microtubule formation, doesn’t stabilize it because the one that stabilizes microtubules is paclitaxel. +
vshummy  Okay, I realize now- the picture is stuck in metaphase, not anaphase. Both paclitaxel and vincristine stop the cell in metaphase but by two different mechanisms. Vincristine prevents mitotic *spindle* formation while paclitaxel prevents mitotic spindle *breakdown*. Mitotic spindle is needed to pull the chromosomes apart before anaphase begins. +12
azibird  No, I think you were right to begin with. Without spindle formation the cell should be stuck in prophase (vincristine). Without breakdown it should be stuck in metaphase (paclitaxel). Metaphase is shown here with spindle fully formed, so it should be paclitaxel. +
sars  I agree with the logic stated above. It could also be that the researchers added Drug X later on in M-phase, so therefore maybe the microtubules aren't even fully formed to fully reach metaphase. I think they're harping on "pick the best answer" +
sars  I agree with the logic stated above. It could also be that the researchers added Drug X later on in M-phase, so therefore maybe the microtubules aren't even fully formed to fully reach metaphase. I think they're harping on "pick the best answer" +

 +8  (nbme24#1)
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eoitnQus is syalblaci ignaks awth ear hte rstausebts dues het frist etsp ni eehm snythes.si In htta es,tp gylcein dna nyculisc CoA rea nmoecbdi to keam cvielalnmunioi icda.

sunshinesweetheart  p 417 FA 2019 +1
drschmoctor  p 425 FA2020 +

 +5  (nbme24#32)
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MGH ACo aRsdeucet noisthbiir etnverp eth rlive from seyinigzhtns tis now ro.ecotehlsl In rdoer to niatnima tsi ende rof l,eohctlores hte erivl ahs on ichoec by ot eiesrnca tsi LLD etroerpc rpseoniexs ni erdor to aetk lhteolrsoce orfm the ldob.o

suckitnbme  Not sure why NBME felt like they needed two questions on statin MOA on this form. +5
makinallkindzofgainz  because they didn't even realize it because they make insanely low effort practice exams with awful formatting and vague vignettes, yet here we are paying 60 bucks a pop for "high quality" exams, gimme a break. ok i'm done venting +3
madden875  stop whining. no one asked you to buy the exam^ +3

 +7  (nbme24#28)
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eTh kdoeli"olih of sniisgm na "osaiciosatn sererf ot ypTe II e.rorr eTh riks of Teyp II reror si prenrdetese yb .taeb This lcduo eb eudcnsfo whit ,epowr hhcwi is 1 - tabe.

usmleuser007  Just rereading this question without the stress, i got it quickly! Could't believe i missed something as simple as this. +2
snripper  Can't believe I spent 5 minutes on this and still got it wrong lmao. I was like, "it can't be 90% chance of missing an association, that's way too high." But I picked it nontheless... +

 +8  (nbme24#25)
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hsTi mna hsa puslsu oaarxpusd, a gisn in cwhhi odbol ersseupr reecseasd yaticasrdll nirgud iopnn.trsaii ssPuul xardsuapo si a aislscc snig of eaaipcilrdr apeomndta.

nWhe dliuf tne(fo dobl)o ahs opldeo ndurao teh e,ahtr teh etarh luegstrgs to anxped and ilfl htwi odlb.o hTsi bcoemse a gbgeir ebpomlr fro eth ightr vtnrieecl udirng itrpsnoai,ni beceusa hte ghrti edis fo hte harte icveeser scraiedne sunoev tnerru rniudg in.tnisapior eeuBasc eerth si fdliu vptennirge teh hirtg iceetnlvr fomr nagdepnxi woudrt,a het lnyo treoh lcepa ti cna xdapen ot ecocmoatamd is by hpsngui on hte etms,pu hirgnniks teh zeis fo hte left lri.vencet ihTs sscuea ecdreeads BP hwen teh tlfe vrecietln tctsnaocr rdinug hatt daacirc cylec.

sajaqua1  In addition to causing pulsus paradoxus, we see jugular venous distension, and muffled/distant heart sounds (hard to hear through the cardiac tamponade). https://radiopaedia.org/articles/beck-triad?lang=us +2

 +4  (nbme24#12)
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heT niteatp whsso no gisn fo iclrocat aiicv,tyt utb sah smeo ismbnater focitunn ntict,a hhiwc smiiepl she is ni a mrof fo trpenstise evaevitegt tat.es ehS ash a ginlvi iwll ttah igedenstsa iclcmehaan itntoliaven lhousd be detnsiudonic fi ahtt ontautiis aei,srs so ew must llfowo ti nda meak ont attemtp to saetsuti.cer

lfsuarez  Why would the second part of that be correct when there is not mention of a DNR? +10
ug123  DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +2
sherry  DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question. +
shayan  "The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing ! +4
criovoly  I believe this question was not well constructed... it's one of those! +
suckitnbme  @shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state. +
luciana  I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills +
coldturkey  @lfsuarez CPR(if the need arises) , for this patient (barb overdose and hospital setting), she will be intubated to get and maintain airway access. However ,she is against any mechanical ventilation as per her living will. Hence, we cannot perform CPR on her. +
furqanka  I too believe DNR and DNI are distinct but UW 1124 says - A DNR order indicates that a patient should not undergo CPR. this includes bls (mouth to mouth breathing, chest compression) as well as advanced cardiac life support (intubation, mechanical ventilation, defibrillation, and administering medications such as vasopressor or epinephrine). Additional wishes such as the desire to not be fed artificially or any other limitation of care can be specified. +

 +3  (nbme24#14)
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iStcpifecyi is laeuq to the bnruem fo uter veigtena ttses veor eth enmbru of true tasegeniv sulp lsfae spts:eoivi

pSce = NT N/T( + P)F


 +6  (nbme24#50)
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sThi panitte sshow snigs of ,irrcssoih hiwch is leilyk oeiscsatad whit oalrpt netproe.isnhy tPralo eohsyriptnne lliw uaesc caendires srpurees in lal evisn iingrdan otni eth oaprtl vi,ne dan anc ucaes lnbugig of etseh ievsn ta esara reweh they eetm hoset htat nrdai to the vaen v.aca enO reaa si teh mrctue adn ,unas eehrw eth epurrois areltc vein rm(fo teh rotpla ytesms) eetsm up htwi eht eldidm adn rneifroi caeltr niesv hw(hic irdan to the vlcaa )symt.se scneadrIe srueserp in hte soiprure tceral vien wlil acues orhioesdrhm ta isht citn.oaol


 +6  (nbme24#14)
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In ,ASDIH eht seveicxes HDA csuaes hte oitlccleng ctud fo the kydeni to oasrrbeb guhe stanomu of awtre thta ti uslohd rllaynmo er.cetex hTat nsema atht teh apamsl ilwl won ahve uchm more teawr aeeriltv to leotsu wlo( ats)ooiymll and hte nrieu llwi hvea chmu rmeo ltas ivaerlte ot eartw rhige(h )lliatomo.ys

frijoles  So potassium does not become diluted in SIADH? +1
ruready4this  I feel like I was overthinking this question so much for some reason!! C definitely makes the most sense but I was also wondering what would happen to potassium. Then I was thinking maybe the excess ADH would suppress aldosterone secretion and serum potassium concentration would actually be higher +1
peridot  @frijoles Aldosterone can adjust the K+ levels: too much water --> less aldosterone --> no excretion of K+, so this helps retain the K+ to a normal level. However, less aldosterone also means --> more excretion of Na+, so the hyponatremia is not corrected. +

 +18  (nbme24#18)
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Teh natptei ash sosl fo ianp dan eetetmurpra no the ihrgt idse fo ihs af.ec nteSansoi fo hte cfae si pilasearl,it os eht uessi stmu eb on teh ntea'pits rhigt ,iesd ihwch ew cna icofrnm yb iwnogkn ttah nnesoitsa of teh odby si ctraenlal,taor dna he sah tsol eftl esddi pnai and teatuprreme fo hte db.oy

Pani nad epmeetatrur nsetioans of eth bdyo is tapr fo het mioicaptnlsah t,ctra chhwi ayalws usrn trlayllea hourhgt het stnribeam. Tshi can eb mceoinrdf yb nigerbmmere htta sansioent to eth caef lsao snur yllarelta ohuhrgt teh mnti.eabsr ,oS ew nca cinofrm hsit si a rthig ideds elrlaat ianbmrtse suse.i

Teh ossl of gag xrfele adn syrsaliap fo eht vcalo cdrso lpimy apnemrimit fo acarnil snerve IX and X, obth fo whcih olazleci ot hte u.lmadle ,reeofTerh teh wnaser si hgrit aadsotrlroel d.ellaum

duat98  You're a good man. +1
charcot_bouchard  You must be handsome too +4

 +7  (nbme24#41)
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yotuomnA si the otms naiotmprt icesht rcilieppn tath esudreepss lla sr.oeth r,oeHwev it si pdileap oyln in insutsatoi ni ihhwc a pnteati mstsetndaoer ia-isnegnmkidco .cicyapat In stih tasiut,ion a eitanpt hwit davdaenc saedesi eklnuyli to be ecrdu is isergfnu eattnre,tm wcihh is sih tgihr unrde het inprelipc fo omt.uonay wevHer,o hsi nsmctmeo abotu neirnr"gut in 6 smtnho retfa gircnu rriattihs" rae sileoebq,autn nad arnatrw metrdningie if eh ash odsenici kainmg t.aicacpy It si oelsbsip atht eh ,odes cihhw is why yna iccshoe of icrofgn hftruer erteattmn on mih rea ntirrocc.e

hungrybox  These ethics questions seems so simple and yet somehow I always get them wrong. I guess deep down I'm just a scumbag. +7

 +5  (nbme24#47)
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Teh tsom notrpiamt alhtiec pipinelrc htta spuerdeess all ehorst is ytaonmo.u oFmr na lhateic nodntistp,a htsi atteipn sha eht tirgh ot ufeesr tehrrfu emnteartt sa eh is lmtlnaye mnpcteteo, ni isth ecas ni teh form fo gavhin het yrsieoartrp eroemdv. mFro a laleg sadi,tnptno eth sihcpainy si eldwlao to icsdeiunnto etmnrtaet fro a apitetn if hatt is atwh teh aneitpt .wnsta isTh is eeiftnrfd orfm soistitanu fo ichsapyni stedissa ,ieudics wcihh si oerm ccpmdiletoa nad has vrlabeia hsicte dan tylle.aig

rhsteps  isnt this considered physician assisted suicide? +1
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +3
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1
proteinbound123  In Physician-Assisted Suicide, the patient should be deemed “terminally ill” and “mentally competent” (by 2 different doctors) with less than 6 months to live (with or without treatment), he requests (written request, done twice, 15 -day interval) assistance to die and the doctor prescribes a lethal dose of a medication for the patient. If, in the meantime, the patient develops a life-threatening acute problem and requests the doctor to withhold or withdraw treatment, by the Principle of Autonomy the doctor should proceed as the patient wants. In fact, by the Principle of Autonomy, any competent patient has a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life. +1

 +12  (nbme24#17)
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llA fo het setfreua bdrescdei of hits intatpe lowud be ecpteedx fo a ae6yod-r8-l na.m hoet,rrS ssle ieesnnt gaorsms, as lewl as crsenaedi etmi eenedd teebnew esx udolc eb deerlta ot a hsitgl oprd ni otsnoteesetr hiwt ag.e eorevw,H eh eoustcnni to gowr irah llwe fet(e and ots,e) imnypgli atht eh nas'ht liarlaydmtac tsol oertstenesot tdiunropo.c isH stratpeo is htsgiyll aedrle,ng chiwh odclu myilp nbgien pasctoirt y,haappirels tbu hsit ouhlsd tno erdlcyti mpiact ihs eslaux i.countfn

cassdawg  ^BPH threw me off: he probably does have BPH (slightly elevated PSA and diffusely enlarged prostate, common in men above 50), but BPH does not typically cause sexual dysfunction as described. BPH is more associated with urinary retention and UTI, and when it does cause sexual dysfunction urinary symptoms would be concurrently present (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473005/ and FA2020 p654). +

 +5  (nbme24#38)
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A sfot slitscoy umrmru is cmnoom ni nmya pnternga mnweo edu ot a gihh umelov fo wofl anr(decesi racadci ut)t.oup heT mrmruu dstne ot go ywaa nwithi a few ewesk of lyedirve ocne hte idraacc uutpot is esolrc ot eselabni.


 +2  (nbme24#19)
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The iatntpe in tihs tnseoqui sah lucetrs aas.dhceeh Tshee edchaahse nca eb iffridtneeadte omrf ienisrgma dan nnesoit ,seadhahce as yeth dnte ot cmoe ni soieedps acossr rveleas a,yres tihw etnbsa poersdi in webene.t reultsC ashheeadc rae eftno iscbedred sa luiycirxcagtne aiulpfn (semtmseoi ealcld siu"dice h)eche"sda.a


 +5  (nbme24#41)
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Mlsporiotos is a dgosilrnntpaa gnaoal )PE2G( ttah csat on eht hcotsam ot mteoopr ucums opiercnott fo het saohcmt ,igilnn btu aosl stca ni het steuru to roaeguenc tcaorcitonn, chhiw emksa it suulfe fro ortnboai.

usmile1  perfect except it is a PGE1 analog, not 2 +2
krewfoo99  PGE2 will increase uterine tone (Pg. 270 FA 2018) +
drmohandes  Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +

 +7  (nbme24#46)
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ihsT rlgi sha lnmtgiaan yithrm,perhea a serugodan daerves tfceef fo emos thnesisceta atesng zetehraariccd by uddsne hghi vefer nad odysh.ylsbmairo Teh olyn drug magon isth ltsi htta acn escau tmanalign rephyrmheati si .onilsciculnhecy Teh erhot dgsru htta uaecs gimtnaaln reirmhpeyaht ear eth ehoatnlda agsse na(rfe,lu sfvenlraoeu, ,c)et. tub snrouit exoid edso nto esuca .it


 +9  (nbme24#12)
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MGH AoC stcaruede hirtionibs olckb teh aiibytl of het bdyo ot pecudro its won eocehtsoll.r hTe eilvr, uelanb ot keam sit onw erolscolhte dan lltis ndginee ot do sit job fo kigamn erlsot,npiiop sneed to get it mrfo smreoe.ehw ,So eth evlri esraisenc exosepnsri fo DLL erptceors to etka oemr LLD out of teh doolb for rcakgie.pnga


 +7  (nbme24#29)
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The waj pnai nad aaeedhsch ni na ldreo wmano aer emrrswooi rof proemTal eAt.iistrr hTis si a ustciilva,s ichwh oldcu eb tsbe fitndieied by mgniienertd eth yrerocthyet eiintentdamos ea.rt

vsn001  definitely was tryna look to biopsy :'( +

 +6  (nbme24#19)
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ehT ipttane edens idaemlc intnatote mimydaielte, ciwhh stinieelam tnbaniiog a truco d,roer or rnnarisfrgte h.er A esunr sdoe otn aehv hte mesa ignriatn and lifiaiatusncoq sa a ay,shicpin os it uwldo be aairtroppenpi to aks mhet to xaienme teh patn.eit gknsiA eht pilotahs iphaclna gaani dluco eb iipnararetpp,o dna dlwou tkea erom me.it feeT,heorr eht sbte otonip gnamo tesoh vnieg si ot aks hte eatntpi if seh lwli olalw htwi erh nuhbsad tenrspe.

sympathetikey  Garbage question. +44
masonkingcobra  So two men is better than one apparently +23
zoggybiscuits  GarBAGE! ? +1
bigjimbo  gárbágé +4
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +10
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +8
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +12
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +20
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +
niboonsh  This question is a3othobillah +4
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +10
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +6
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +
wrongcareer69  Garbage question +

 +8  (nbme24#1)
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shTi girl sha cironhc snmtalouorgau e,aseids in ihhwc the mnuiem ymtsse aocntn yleporpr form receitav ygnxeo piecses eddene ot klil opesyatoghdc rssg.nmaoi Tish si cysapleiel dab enwh dginael tihw aaecalts evtispio iossanrgm k(ile ahpSt,) ecueabs thsee gnaisrmso rdyalea sue saaatlec ot arekb onwd treaevci yneoxg sscep.ei eTh mtso commno aeusc of isht ocidntnio si a tuaotnim ni NPDHA ,edoiasx bsreleniosp orf the tgeniranoe of eth srdxpoeuei .rlacida

et-tu-bromocriptine  To add on: If neutrophils don't have access to NADPH oxidase, they can still use the bacteria's own hydrogen peroxidase to create ROS and kill the bacteria; however, catalase + organisms will not have this hydrogen peroxidase available (because catalase converts hydrogen peroxidase to O2 and water). So then the neutrophils are screwed and have no way of creating ROS. +6

 +8  (nbme24#41)
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roonitdxtToe, dnfou ni repffu ,shfi sintiihb imduso hc.ensanl hiTs rvtsepen eaizondaltirop fo iaarccd cslemu nda uosrenn, ihhwc sedal to thdae fi emusnodc in hghi ugenho ityqnuat. Teh mstposym aer vuage (uans,ea ,ihrdeaar ,t)heeariassp os tnsoiuesq will ende to gevi mseo omrf of htisroy abtou eitagn ta a aeepnJas aetnarrsut ro tgenai frpfsfheiu ot gvie uoy a big ihnt. eThre is eoaurnfttunyl tno mt.rtaente


 +2  (nbme24#50)
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sCae ressie is a yduts ni cwhih the erhraresces stepenr hte yriosth dan rtatenemt fo a asllm ogpur fo raiimsl n,ietstap ohtwitu rsdeciignb yna orntgsi onit pugsor ro ndianzmorao.it

drmomo  only 3 patients +1
usmile1  uggghhh not in FA ... +

 +2  (nbme24#40)
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sihT yob ahs iinmesgint acsude yb Srpte amoueneinp, teh stom oommnc ceasu of tfieoncius eimgsinnti ni len.gare Teh vcacein rfo tpSre puonme is a aoprsealcdihcy ieptnor ouencjtag civca.en heT treho mroja tiaarbec hitw a vccniae ilek ihts is .H ealizeunnf.

usmile1  also the meningococcal vaccine! +2

 +3  (nbme24#18)
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eoitimpvetC hstrbiniio iesceanr teh Km fo the srutast.be eTh mK ssetrerpen hwo aslyei a rabessttu nca dibn het eivtca eti,s htwi a wrleo mK eiseegtnpnrr eays din,ginb dna a igrhhe Km iagmnne reom ciifft.ldu fI ouy dda a teitimeovcp itbh,iniro elik nheaolt ni htis aesc, it asmke it orme fdcfituli for het naemtlho ot bdin eht teciav t,ise baeesuc ti tsum ctoepme wtih teh tenah.lo

deathbystep1  but how is ethanol a "inhibitor" of alcohol dehydrogenase? isnt the concept that both ethanol and methanol compete for the same binding site of alcohol dehydrogenase and hence ethanol displaces methanol preventing its metabolism? if ethanol were to be a inhibitor it would have to shut off the enzyme, which is does not. +
krewfoo99  @deathbystep1 Competitive inhibitor simply means increasing concentration of a particular substrate will allow more binding of the substrate to the enzyme. Thus the substrate with the higher concentration will competitive inhibit the other substrate by binding to the enzyme. It dosent necessarily shut off the enzyme +2

 +0  (nbme24#28)
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yimasDter is hte akcl fo raioctoonndi of tideennd tmsn.meveo yoarNllm ehtse emnveostm rea atrecodinod by eht r.eleeucmbl ihsT is coeldta lipfliycsace no hte n'sma rihtg sd,ei ton tohb desi,s so noyl neo eobl iwll be iejur.nd


 +14  (nbme24#20)
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Tsih manow ahs xoslmaryPa Nnroatucl o.iuHailnemogrb hsiT tsom tnefo sspreten in a noygu udatl ohw ahs piessode fo arkd niuer ni eht lddmie of hte ightn or hnwe inwkga pu in eth og.nrimn t'Is uadesc by metcolmpne tavciity elirycdt sgtnaai hte nsteipt'a now C.BRs neairCt scildliopyg aer eneded on het BCR feaursc ot tpevenr tacakt orfm pnoem,lmcte eht msot onalebt of hwchi rae D5C5 nda 5C.D9 stnPatie wthi HNP evha a ctmaois otuanitm ni hihwc heyt olts fntcuino fo a IAGP yeeznm deeend ofr oprpre eatoseipnntr dan mettthaacn of 5D59CDC5/ on eht BCR cseurf.a erofeerhT eth swnaer si a ctdeef in a cell aemenbmr acnroh .irtnepo hoWutit t,ish mentclpmoe aatktcs sB.CR

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +13
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +4

 +5  (nbme24#12)
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Tihs mwnao has a lot fo sgnsi hatt nitop torwda an intnitasel srctapiia i:ifetnonc nteecr letrav ot Paaup New niG,eau gochu dan vaelaolr i,lsitanfter hhgi lpoohisnei n,utoc adn a lotos paesml ahtt ahs a mrwo ni t.i Mtos leyikl teh tetapni ahs a rydSeoontilgs fncoeit,ni sa itsh si het ienintlast esitarpa tath sohsw larva no solto ma.pesl yiBcalasl lla iantitnesl rpsaeitsa nca eb eteatdr with dezalenBo ,durgs chsu as hnadi.eblaTezo Paiunerqtlaz lowud be orme perpaotpari fro a worm ro vlire lefuk otfii.cenn

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +7
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +6
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +4
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +

 +14  (nbme24#47)
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ehT aiptent attess ahtt she osed ton awtn a omnaorhl ormf fo rbthi .lorontc S,o eht euoiqnst is aleryl niskga iwhhc fo the on-ranhomnol soipnot si tmos eff.tcveie ehT yrkict ptra r,hee I ,hiknt is atht eth iotusqne kames oyu wtan ot tno pkci D,UI ceubesa mnya DIUs era lyaomlhorn eadb.s eHrvoew, a rooahn-mnnlo UDI, liek a orepcp ,UDI si ltsil omre ceveiftef anht hte reoth ptsonoi is.dlte

bullshitusmle  copper intrauterine devices are hormon free FA2017 page 622 +1
medguru2295  they needed to specifiy. I eliminated IUD bc patient states no hormones. +
abhishek021196  The question doesnt make sense. IUDs are typically contraindicated in nullipara because of increased risk of expulsion and intractable abdominal pain, among other things such as perforation. The pt is 22, likely to be a nullipara. Why cant we prescribe a diaphragm instead which is a non hormonal method too, and remove the vaguity of hormonal vs non hormonal IUD? :/ +3
123ojm  in practice many nullparious women have IUDs. I think this question was seeing whether you knew that some forms of IUDs are non-hormonal and that the other methods are far less effective, +
covid  IUDs are definitely not contraindicated in nulliparous women. +1

 +5  (nbme24#32)
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ihTs glri ash Mnoo esadcu by sBinre-ratpE rsuV.i hTe mspmysot aer alletrviey ue,vag utb aamnotypydphlhe kile stih luwdo be omcmno rof noM.o The CCB oshws ealvdete mep,hsycloyt gymlpiin ihst si not a ibalecrta e,lnssli os iarlv is .lkilye mbnidoCe wtih eth pyhyahnmtdlaepo, ihst keams su ywrro utoab no.oM Teh on-pMStoo test rof BVE si ahwt eth eiutsqno si rerrefngi to nehw ecisindgrb the sepeh sctyrehytreo aagii.lngutntg orFm r,eeth hist uitqnseo iresuqre ahtt yuo nkwo ttha in EBV tniino,fec BVE eftscni B l,cels btu sdoe nto caseu ethm ot obecem ba.alrmno Ie,stand C8D ,elscl iwhch aer iyeatcvl nriygt ot lilk het B ,sellc oemecb maba.ronl

medskool123  NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence. +14
kylemax  The abnormal T-cells are known as Downey type II cells (Sketchy) +3
haliburton  I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom. +2
trichotillomaniac  congrats you played yourself +3
lilyo  Soooooooo EBV infested B- cells is not considered atypical WTFF?? +
med4fun  They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells. +
aneurysmclip  oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells +

 +6  (nbme24#17)
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llA HXO enegs rae isptcaoinrntr tocafrs atth hepl egluraet obdy utolay dna erdintfef epsneoirxs fo neegs rfo aceh yodb etesg.nm

sunshinesweetheart  I got this one right but wasn't exactly sure how to rule out 'translation'. I guess just because we're talking about a gene i.e. trasncription and not miRNA i.e. post-translational modifiers? +
sars  Hox (homeodomain) genes code for homeodomain proteins which are specific transcription factors (bind to enhancers, making these activators). They promote transcription of certain genes involved in development. Thanks so much +

 +3  (nbme24#10)
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hsTi neioutsq oyln ecnocrns moewn ni eth 554-0 gae .gourp eTh oprgu has a mena fo 624 adn tsadradn itvodiaen fo .50 eo,rThreef all estoh hitw seulav rteegra ntha 269 rae lla stoeh baevo neo danastdr tv.daeoini 32/ fo all leusav no a amlonr duiritostbni era itnhwi eon tdsrndaa vnoeitdia in iheter rnocdtie.i rT,eoherfe /31 rae oueitds fo ihst ni hitree edtcinroi, anmnige /31 fo omnwe hvae a euavl less nhat 619 ro reetrga nhta .692 If we plits ttah in aflh ot yonl ocsoeh htseo earetgr hnat 2,69 we get /61 ,enowm wihch is otaub %61.

guillo12  Sorry, but there is not other way that I can understand this? +1
fulminant_life  @guillo12 basically 67% fall within 1 sd. That means that 33% are +/- >1sd. So taking only those with above 296, you only look at those >1sd above the mean which is 16.5% . The other 16.5% are those >1sd below the mean. +11
guillo12  Thank you!!! @fulminant_life +

 +1  (nbme24#6)
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Tihs itatepn ahs a atgneolls eldgdo ni het ocmmno ielb ctu.d Tohr,eerfe teh reskmra ostm yiellk to eb dvtaelee si sotigemhn form eth yrabili tt,acr teh tseb fo whhic is klenaail esthp.ahsaop hreTe dluco tlnlpeoaity be onveilaset in ATS dan TA,L tbu isth is ont teh MOTS keilly sran.we duoentUnajgc rulibinib si nto a oogd nsw,ear sabceeu eht ievlr nac tllsi uaencjtgo lal ubnlibiir, ti sjtu has essuis onw exctrngei hatt njtcogueda rfom. oS teh m'noasw TEGDAUONJC uibinribl is orme eylilk to eb evdt.eeal


 +20  (nbme24#38)
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yThe yliliepctx attse htat teh antitep ahs eneb kgtani scxese of ihs ylneriooxvhte .dnmieoiact xLeroievytonh si hte exeugsnoo mofr fo T.4 eer,hTeorf efre 4T must eb e.leadvet 4T si rnevtdoec ot 3T at stom irlhepepar ut,sisse so T3 iwll lsao eb .elevedat suBeaec het obyd hsa reom irtdoyh horeonm thna ed,eden lsse THS lliw be me,da nda teh diryoth iwll be sles a,vceti antgki up ESLS iien.od

procrastinator  I forgot that T4 is converted to T3 :( +

 +5  (nbme24#27)
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aAitodnv toinsaeyrpl rdsoeird is ccrzrdiahaete yb a iedsre fro olaics l,nirhpaiostes tub a fear fo nibeg eedctrje ro ieelfgn uteiaqaend fro .tsehor Tshi is nidtfefre fmro ioh,zidcS aecebsu dcohizSi dvldsaiuiin od tno sdeeir tlprioesihsna iwth oeshtr, dan natw ot irmane nlo.ae eTh eritickts fatindoeenriift tmghi eb nwbetee oAanitvd adn lihpcazto,yS btu phacilyzotS usidanlvidi tend to rimean doteslia secbaue of dod ni,khigtn ro "laamgic eb.s"efil





Subcomments ...

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anC yabndyo niealpx siht noe? I tpu aedetper stest sebceua I smaudes na r--ly3aeo8d omanw is an lsauuun gcraheiodpm rof .yishpils

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  


submitted by iguzman2(1),
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ert'An 1M srcpreote fnduo ni hte narib and are islepsrnbeo ofr nimoot ekins?css

m-ice  M1 receptors are for sure the major muscarinic receptor type found in the CNS, but M3 receptors are the muscarinic subtype involved in vomiting controlled by the CNS. This is definitely a random fact, but I think they also wanted you to eliminate all other options. Targeting the sympathetic system (options A and B) won't make a difference. NMDA receptors are a major receptor throughout the CNS, but they're not a target of antihistamines, and neither are serotonin receptors. We know that antihistamines target histamine and muscarinic receptors, but the H2 histamine receptor is responsible for gastrin secretion in the stomach, so the answer must be antagonism of M3 receptors. +4  
dorsal_vein  ^ First generation antihistamines definitely antagonize serotonin receptors within the CNS, which can cause weight gain and increase appetite. However, this plays little role in motion sickness. +5  
mumenrider4ever  That is confusing because scopolamine (anti-muscarinic used to treat motion sickness) is an M1 receptor antagonist +1  
pelparente  So according to amboss scopolamine is a nonspecific antiemetic. I think Sketchy probably just confused everyone. https://www.amboss.com/us/knowledge/Antiemetics +1  


submitted by neonem(503),
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I ntikh teh raoesn ouy deen ot ncetij nnaodopsrigto in htis aces si cseaebu you eedn FHS adn HL to pcurode emr.sp FSH tsesutlaim eht elrtiso cl,les ihcwh enli teh fmusiesniore usuetlb nda help hte oagrinepsamot ercopdu casttsrpoe.mey Ttorteenoses si a orcuptd fo dLiegy lcesl when erethy' sieatlmtud yb H,L so ijcgneitn tertooesnset oudlw bspsay atht tpes but it tdou'nwl eylrla elhp hwit tmspoearnss.igee e,vwreHo itncngjei RGnH oasl ed'tons eso'dnt alrley hlep ascueeb uoy deen ahtt lleisutpa GnHR ta thing to meak HL nda FHS sreaweh i-nclgtgona HGRn lsganoa ulaytacl raseecde HL adn HFS otcpniuro.d

m-ice  Adding on to the answer above. I was stuck between the gonadotropin injections and clomiphene. But, clomiphene acts to increase activity of GnRH which then exerts its effects on the pituitary. The man in this question had his pituitary removed because of an adenoma. So, he needs the FSH and LH directly. +17  
mousie  agree! Removal of the pituitary would case a deficit in Gonadotropins (LH, FSH) and therefore nothing to simulate the testes to make sperm... replacing the T with a patch would not stimulate the testes to make sperm and if his axis was intact (although its not) this would further down regulate the production of sperm. I eliminated Clomiphene because if he dosent have T to induce negative influence on the hypothalamus he will have increased GnRH and further increasing it with Clomiphene would not correct the deficit in Gonadotropins. +3  
neonem  Oh duh... that makes much more sense. Thanks! P.s. I thought clomiphene was more of a fertility drug for women, since it blocks negative feedback of estrogen on the hypothalamus/pituitary. But in men the system is under feedback due to testosterone, not estrogen. +5  


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aCn yaodybn ilpxean ihts ?neo I put reateedp estts aebeusc I umssade an 8-yareodl-3 mwaon is na unsaluu ehpaidgrcom orf h.spsiily

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  


submitted by hyoid(33),
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naC omnoese xelpnai isth –Ieo–n 'tidnd lyreal nowk htaw to ekma of the lba saul.ve rylalCe esh was kagnit too hcum ,inlisnu tub how anc uoy entafiiredfet suatitfoci sreirddo from a eytp 1 dbatciie ohw etksa oot muhc fo heitr iisunnl sedo?

m-ice  I think the trick here is that they don't mention that the daughter has a history of Type 1 DM, so she has no reason to be taking insulin at all. She's definitely receiving insulin, but we don't have any history implying she's a type 1 diabetic. That, combined with the fact that there have been multiple episodes like this one, favors that the mother is giving the daughter insulin when she doesn't need it. +11  
sajaqua1  C-peptide is produce by endogenous insulin, but is not part of exogenous insulin. She has elevated insulin, with low C-peptide, so she is receiving too much exogenous insulin. A history of recurrent episodes this year implies a behavioral issue; Factitious disorder imposed on another (also called Munchausen syndrome by proxy). +6