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Welcome to madojo’s page.
Contributor score: 163


Comments ...

 +4  (nbme22#12)

Think ex vauco for = fake IE: The ventricles appear to be big but in reality it just looks a lot bigger because its being compared against a atrophic brain from something like (Alzheimers, advanced HIV, Pick disease, Huntingtons).

Communicating hydrocephalus is due to decreased CSF absorption by arachnoid granulations which causes ICP --> papilledema and herniation.

Normal pressure hydrocephalus affects the elderly and causes "Wet, wobby, wacky"


 +2  (nbme21#30)

Going over the other answer choices:

  • ApoC2 defect as already explained in the other comments is Type 1 hyperchylonmicronemia with increased TG and chylomicrons, creamy layer in the supernatant, and is associated with pancreatitis and eruptive xanthomas.

  • LDL receptors are defective in Type 2 which is associated with a MI before age  29 20, accelerated atherosclerosis and increased LDL levels.

  • Someone with a pancreatic lipase defect will probably have pancreatitis and have increased triglycerides in their stool because pancreatic lipase can break down the TG into FFA.

UW has a question on the familial dyslipidemia III which is a defective ApoE. ApoE is what mediates chylomicron remnant uptake into the liver and so if its defective the liver cant efficiently remove chylomicrons and VLDL from the circulation. You get an increase in those things causing premature atherosclerosis, palmar xanthomas.

this stuff is hard

madojo  typo per FA age 20* swy +

 +8  (nbme21#28)
  • CholecystokinIn is secreted from the I cells of the duodenum and jejunum.
  • Gastrin is released from the G cells of the antrum of the stomach.
  • IF is secreted by the stomach and absorbed in the terminal ileum with B12.
  • Pepsin is secreted from the chief cells of the stomach and plays a role in protein digestion.
  • Secretion of VIP increases intestinal water and electrolyte secretion by acting on the parasympathetic ganglia
nobody  PAGE 365 FA 2019 +1
mumenrider4ever  FA 2020 pg. 371 +

 +6  (nbme21#35)

Going over other answers:

  • Abacavir is a NRTI so all of this inhibit nucleotide binding to RT and terminate the DNA chain. It doesnt end in the typical -vudine that we are used to for NRTI's but I guess we should keep it in mind because its contraindicated in patients with HLA B5701 mutation due to an increased risk in hypersensitivity. *Sketchy remember the Wizard aba cadabra guy with his spell book opened to HLAB5701 and associated skin rash on the wizards arm

  • Acyclovir is a guanosine analog that is monophosphorylated by thymidine kinase that inhibits viral DNA polymerase onces its incorporated into the replicating chain and terminates dNA. Its for HSV or VSV which doesn't fit in this question. Remember crystalline nephropathy and need for IV fluids with this one.

  • Didanosine is a NRTI as already mentioned that now we know causes pancreatitis.

  • Lamivudine is also a NRTI, Zidovudine also NRTI that causes anemia and can be used during pregnancy to decrease the risk of fetal transmission.

  • Ribavirin is an IMP inhibitor used in Hep C and inhibits purine synthesis. Side effects: causes hemolytic anemia and is a severe teratogen.


 +6  (nbme21#21)

Going over the other answer choices:

  • Blocking ATP sensitive potassium channels in the pancreatic beta cells to increase insulin secretion would be drugs like Sulfonylureas or Meglitinides for example like Glyburide.

  • Increasing endogenous GLP1 or GIP levels are drugs like Sitagliptan and Saxagliptan. They have GLP in them

  • Increasing peripheral glucose uptake would be the biguanides like metformin.

  • Stimulating transcription regulator PPAR-gamma decreases insulin resistance and is the MOA of thiazolidenediones like Pioglitazone.


 +25  (nbme21#39)

Know your STD's baby ;-) (going through every other choice on this question):

  • Bacterial vaginosis caused by gardnerella vaginallis. Se a thin, off white discharge and fishy smell (fish in the garden). There's no inflammation Lab findings: pH greater than 4.5 (just like trichomoniasis), and a positive whiff test with KOH. Stem will say something about malodorous discharge and show the infamous CLUE CELLS if we are lucky. Not the answer for this question obviously because we would not expect vesicles with this bacterial disease.

  • Candidiasis is going to be your thick cottage cheese discharge, with inflammation. normal pH see pseudohyphae. Treat with topical nystatin, or oral fluconazole unless you're pregnant than use Clotrimazole. Again not going to see any vesicles.

  • Chancroid per uworld is associated with Haemophilus ducreyi you will have a Deep purulent painful ulcer with suppurative lymphadenitis. Will be told that patient has painful inguinal nodes, there may be multiple deep ulcers with gray-yellow exudate. You do cry with H. duCRYi This wouldn't be true for what our patient has in this question because we aren't told of any inguinal adenopathy. a link to a chancroid VDA

  • Chlamydia trachomatis causes lymphogranuloma venereum which is small shallow ulcers, painless, but then the large painful coalesced inguinal lymph nodes aka BUBOES. Compared with gonnorhea the discharge is more thinner and watery. Again not the case here as its painful and no mention of any BUBOOESS. The discharge in gonorrhea is more thicker. Both lead to PID, treat for both because confection is common. With both patient may have some sort of pain or burning sensation upon urination. Sterile pyuria though for both.

  • Condyloma accuminatum is a manifestation of HPV 6 + 11 (genital warts). They look like big cauliflowers. This is in contrast to Condyloma lata that you see in syphillis which is just a flatter latte brown looking macule.

  • Genital Herpes (the answer to the question) will present with multiple painful superficial vesicles or ulcerations with constitutional symptoms (fever, malaise) Just fits better than all the other choices I ran through.

  • Syphillis is the painless chancre. UW describes it as a single, indurated well circumscribed ulcer, with a clean base. See corkscrew organisms on DF microscopy. Keep in mind other painless ulcers are lymphogranuloma venereum of clamydia (but the buboes are whats painful not the ulcer), and granuloma inguinale (donovanosis - klebsiella granulomatis) but whats hallmark about this one is that its painless without lymphadenopathy

In short, be safe.

drdoom  this write-up is AWESOME ... but it also made me vomit. +
b1ackcoffee  This is awesome, writeup, not the stds. +
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +

 +6  (nbme24#44)
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ongiG reov rheto sn:easwr

rotainAtel in 03S lasmoibr RAN rrsefe ot acnomey,isoidsgl cticsat,ryneel iilnsAlyceygtntoacl lnrye in ANR lmsaeroepy eresrf ot dugr eikl nt pnesrAomfaiilaiRt ni neipillnci bidinng nitsoepr uwlod be fro spsliienceinla


 +2  (nbme24#41)
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noGgi ohurthg hreto awerns ei:hccos

smiBhtu and aualterScf si sedu rof leucr eihangl or evslreatr arare,dhi ti epsvroid iscahlpy rtoepoctni yb nidbgni ot hte rcule eabs dna awlols bcrbai eroctneis to lsishbaet Hp tierdagn ni osucum ya.rel

ENiDIaFomt si a H2 roercept ebcklor

aerpelmOzo is a IPP nad sicranees ikrs of C ffid fxn,in nad edcereass Mg and aC trsboipnoa c(an sacue xf ni ley)rdel


 +1  (nbme24#34)
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eodnsein-A sdaereces AV oend nicutodcno edsu in V,ST dan sti side feftsec cilnude unif,glhs nyist,onohpe hcset n,ipa npiengdmi idedocoF.mnaeli- is a uSmoid ahnlecn cbreolk sCsla C1 htwi nrtogs Na elhnnac alokcebg dan ist cdetirdncntoaai ni rasutrcutl nad chsicmie ehrta eaessi.d P eiyn-hton si na inat ielppce,it dasaisoect whti gy,iceitntoaret 54p0 tduicio,nn toeopnaeis


 +8  (nbme24#7)
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This si lntsirniaaot lcle aarmccoin aka uieoalthlr nciramaco hwich si teh otsm oomcnm ianyurr rctat smesyt m.rtuo On osiht you pceetx ot see ruvcablfiraso ocre in a aplylirap urotm dna icsadysltp hlueoirmtu. tI ccruos wtih lpsaeins iraetmuha wthi no .assct

npoirseisdgP ksir :rtcosaf Pee nnhaaeiPeS ctc ,INS()DA imnosk,g lniiean esyd, adn ppccoeliyhsohdma angakylt(il etang thta scsro nilks D.)NA

iyVnl cohlidre si retrccnio sbueaec thats ateossicda itwh noaigsoaramc fo eht ,rveil caeuebs lvniy hdceroli si tsahw ni PVC epspi rp)(.lmbeu ootamscihsS si a dmatteore elkfu hatt is aostdiaesc hwti qassmouu lcel mcnariaoc of teh baredld in ihcwh uyo lwduo sloa see asspelin lednigeb tub ees usoamqs llce adn not aleryl teh laapryipl togwrh ew ees e.reh


 +5  (nbme24#7)
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FA 91 562

Deos eht urdg WaPsSMeIh? 1 - lalms bumrne of vrueseoltn sasses ofr P saehetfayS 2 - termoade bmenru of ,tsaetnip sode ti kehoWsP ra 3 - rlage umrbne armndo a,sengnimst tihw le,pabco nya pnPthIevs?mo erame 4 - hti eht ,tkeamr any tuxeeednpc esdi esfet,cf anc be nahwrwtid omrf retkaM

kpjk  just would like to make a small correction phase 3- not placebo, but a drug already present in market so to test if there is improvement over standard care phase 2- would have the placebo, to see if the drug is actually working thats why i got confused in this question couldnt phase 2 also have randomized,prospective double blinded study +4
kpjk  Sorry! Just saw FA- it says even placebo can be used in phase 3 +2
llamastep1  Ugh I over thought it, I figured if you wanna give your patient a new treatment you wouldn't send her to possibly receive PLACEBO, am I the only who thought this? +
turtlepenlight  for the vast majority of drugs, the FDA / NIH don't allow placebo testing anymore (regardless of FA!) +

 +1  (nbme24#9)
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ohaamPt

gLun mtstsaaesi si het orme noomcm naht a ryraipm lngu ancrec and tis most noommc oersuc is sterab ro oclno .camircnao ouY ilwl see cnaon albl oneudsl no ni.agigm aSeretdpe by ascep .dlnsuoe Schare canno abll dselnuo orsgs sokol asiilrm ot hsti am.ige

Cniicdaor tmuro si eht msto monomc aprirym lgun rutom in D.CIEHLRN uldoC eb a enarlct ro aehriprpel ourtm tbu i tinhk htye odwul wsoh a yplop lkie sasm in hte orcunshb for ridc.ncaio Llspm/seit://iCrdlhowo.njgpn.og.t1sssewdhlppyw-_tsoe13rbeitaa/o_claucGoN/w_sscidig

gMlaniatn ameoeolhsimt some rtso of ssseaotb sprxueeo hiwt eht tumor nsigance eth ulgn elki eth rtohe tpoho tsedop no eht eomscn.mt

ranoylPum amroatamh mmu lwle 'ehtsre wot of ehmt ni htis ,otpho a armmahoat is sulauly sujt a lngies oueln.d

lSmla clel crcnamaio ludwo eb rmeo tnlrlecya celtaod nto .epperilrah


 -2  (nbme24#25)
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t//:stdel/dort.caoctlmaehwsuwmacyw.istgpkcpcoh/

CSRNARVOOUI EHSYKTC

oetivpis enses ARN vsiur, csonunw r nnoaikcor g irwgena bero - leeanhecua pdlaclist iruvs - napsligir o,rad hllaeci tznnsieeeg esr dan oibgnlw ikng - oomcnm odcl ithw hocirblno tere on nkgi tiiponng to RASS nda ddeiml tsae oyprreatrsi nsyodrem a(tecu osb)itnchri

hsiT isuvr iceearstpl in eht copyamslt sthat ywh giKn is otidseu ish lcseta uuns(elc)

j44n  I'm so glad i dont have to take step one once they discover all this shit about the new corona strain. +

 +6  (nbme24#29)
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A eyk roypertp fo itpaalr sangiots si ttah yhet yiladsp htob sgictioan nda atcsgnioiant feestc.f nI the seeepcnr fo a lluf staongi , a raitpal gntisao lilw atc as na ,inotsgaant meopnctgi whti eth llfu gitonas orf eth esma prcrteoe nad berhyet rudecign the ayitbli fo het lflu nagtois ot dpcueor tsi ximmmua ceft.ef E.x rMpoinhe l(flu aogsint) vs nhpreierobunp (altpiar g)oasnit ta iodpio mu rectsrpeo 342 AF 19


 +5  (nbme24#41)
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Teh nmia eedintsg fsoaeod itonxs ew lohuds wnko 642( 12F9)a0

is,Hntiame dTeoxoroitnt, and i.ngHuaitCatsmoi exni - oeipsdl arkd mtea uant(, hmai h)ami uessac klei na nalaichpcayt earotcni bcseaeu hte acraiebtl tionx rtvesonc nietisidh -&-;tg imti.hsaen o eTtxndroi - esne ni stih Q, pffusehrfi - olbcks Na nclenhas NO ndatzxeagCaiiro liiuonpto - free hfis rauabrdca - penos aN lshncaen so ALCNNTIOU lraadpnizietoo

roF tsal 2 no uer,c sopueiptvr yonl


 +0  (nbme24#18)
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Teh Km si erlsyevin tdrlaee to eth ifinfyta of eht nymeez orf its bttersuas so in htsi saec we antw ot neriasec Km so that teh itiafnfy of achtepi olhlcao yoeednheadgsr areesdcse rfo nlmtoeah dan eth naothle anc hnet act as a epoviemictt iobhitrin by oegircomvn het ctnonneroatic fo hlaomnte uhts ieetpnvnrg yoxctiti.


 +6  (nbme24#30)
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Uhg hwen uyo do it ni dwo,rul teirw ti ndwo tub ilstl ssmi .it

Awnyya iggno oevr throe anewsrs otbct:sir)oaay(Fhpi mc gashcne fo hte aesrbt t&;-g- ebg,nni alsyulu on scedhraig iwth hsit nad uyo wlli ulalsyu avhe a lpymu sbrtea ro ohgintems pebaplal dan ti is ohmnroe ddtse.it ePgamea iaessed of the brtsae g&t;-- txennesio of cldatu aarnoccim ni isut to feciuoartls sudct nad ikns fo plepni onirpcudg r,ash os uoy see skni escnha.g oN nksi necahgs otimeenndh oroltPe.mnier aac -&t-g; ogrleatcaahl tno boodl dniegt

oS rep UW dnalttiaucr aipalompl is a riionlatrefpo fo alpyarpli lcse in a tcys alwl ro tcud htta aym esacu aclfo tiaypa - IT IS TEH STOM NOMCOM AESUC OF ODYLBO IPLPNE ACRDHSGEI AND ARTSESB UTOTHWI BERTAS SMSA OR KISN NEGCSHA

coaeprm siht ot apyrllpai mciranoac erhwe yuo osla eahv nlpepi adciresgh tbu you dwoul ese it ni a ostp npaloaeums m.onew

drpatinoire  Upvote it wishing I could memorize it lol +
mutteringly  To add to this, papillary carcinoma will only have epithelial cells and no longer have the myoepithelial cells that intraductal papilloma would have. +

 +8  (nbme24#2)
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I ton'd nwok fi thsi saw eth rthgi ayw i uhohgtt abotu ti tbu i dmmreerebe A. ..te.HKhCL hsnigt htta aceus daailootsvin ni staeellk mcluse

C - ,2oC H - H,+ A- io,nsndeea L - acatetl K- K+

drdoom  This is great; these are all proxies of catabolism, i.e., "net" ATP consumption! (ATP->ADP) +1
drdoom  Potassium might be the one that doesn't seem to fit but recall that cells have an H+/K+ antiporter: cells can act as a "sink" for high blood H+; they "take up" H+ (from blood, into cell) but "in exchange" they have to put out a K+ (to maintain a normal electro-gradient). So, as blood acid starts to creep up, cells actually "attempt" to bring it back to equilibrium by sucking up H+ (and putting out K+, which, as you surely recall ;), is the predominant cation within cells). +3
misterdoctor69  @drdoom, would you also venture to say that there is increased Na+/K+ ATPase activity in an increased metabolic state which might also contribute to greater K+ efflux into the blood? +
drdoom  @misterdoctor69, no. Potassium flow is driven by its chemical gradient (from inside cell, where its concentration is high, to outside). If K+ efflux is increased, the best culprit would be the H+/K+ antiporter (which “takes up” a proton, but has to “surrender” a potassium, in an attempt to remove acid from the blood — acidic blood, of course, being an inevitable outcome of revved metabolic state: net ATP consumption & high CO2 production). +

 +0  (nbme24#45)
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noGgi ovre erhot cscohei F(A 91 eci1t)s5o:ydgrO4 ondle ear aptr fo eht CNS so a mruot eterh wdolu be an mnoiloeradgdlogoi whhic si iartveleyl rare, nda in nrafotl eb.lso On hysogotli oyu oduwl ees feird egg peaaeanrcp thiw ineckch rwei acierlpasli. ist Galobl motur wodlu eb a gtlaamsbiloo mfiultemro cihwh si mmonoc nda ash a 1 yare lusrv,iva tis eht neo iwth teh tltbyuefr goimal scrsoing eht ropsuc lcalmsou.

overa  GBM comes is an adult astrocyte tumor +
overa  ^ this guy doesn't know how to speak English +

 +5  (nbme24#9)
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S KECHYTgoAAsu%tpsms2aeeAtR-lFl7cFEaEQs2itnvldyh/n%aois-oop2n2a==onB3CcAorU%r&mcfEc2?thex.-Am4mpv/wa1oioncf-pv-i2eahe-5g&arimT9K7wr-ortusau5eespl;m8;uj3-e2uc0=325Fp4pcvd-;uIi;gd/r&5z6tGp07hshf5&=Hlahh.%44_BQ%e4eFloalaodratcwFcTpcismiaBlaeecZVu-g=unt-mws&c5ca;b6sg&8olu-m1-hc9au-%27tu9wUa9nsqaw;=2i7umxtt2uX7hi:evsosaroedtF2jsQfipsQa-lmrWraat=msUd31n.O

LFY UGY IN ETH nSa tBCKsiA on eth lab octa and tsanp --g;&t ablck fyl tsbie namhu thso adn hte eavlar buorrw nodw tnoi the hsto and akme folcraiiiimral hatt ecmo cbak tuo gknima yhper adn peymnodhpeitg tspso. aunmH ahdn ergncvoi eeys -;t-&g escsua rvrei rtSyaisn blndes ipnk asngrlue -t&-;g lioceciinaepiorMsoosh p gt;--& cfrliroaiiam on sink opbsiy undre cNmpesoocrio pnmdgui adrisn to eirrv - emnicIetrv fro menettatr


 +0  (nbme24#5)
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aos&e1=;u2?sssgownmdpBe-o15eN=siueai-4-Einea1trm%salronDeraoQiFr/pus-cmaraBUimlunc;s_uortu&u8jmQ8tmrielpynot%h&nAmaorstp1rKma;nctbmaa=iaeotBodp&1=6po40-u5A8aexlgmA61Muoa-lwhmiaFndvllc--eh7ancaec;p3lNy-i0cmsc9Mr-FdAjZz=o%5E2=2ia=tkvWas-rrtaixwcuralmmlpyril1eiauhwtiwa:cA=ug%GXilra.dFidk5cf-o-;a4dbres;ste5s0.msd-grd3iYw2Fsv2QaclOaaitinbr%pcpi9omperEleYmer-igqcc%&/oir9eehmsJgIsgHs--sttshe;ecwmiF07U=/ss&o&.7&Rlnpp41tamaet2staV;-otg22Ds-

KYEHCST eilrhcaltn raislips igp nca( be rlopa aerb *o) ot nurdo ssagels &g-t-; ieorp ltoraib eeaa igmwetsnd dna genre rotmo vnudi nshtgi no allsw =&g=t; sfrmo yscts ni trstdiae smluce os( for itsh netiuoqs skema ssene ttha yuo od scelmu soipy)b rei f --tg;& moifnlmtnaai fo m uiilnhoplscseeo rlsnegau --g;t& nno eccpiifs sa uyo cna ees ist lla erov siht emgia so sti rfo yman eerftnifd pstye of aemstndeo


 +4  (nbme24#31)
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L3I- nto( na nswera coch)ie olsa fntsnuoci lkei CFSG poptirnusg owgtrh dan nitftineefdoira fo obne aorrmw tesm le.csl


 +3  (nbme24#38)
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azapmAllor si a bndezianzipeeo hwoes OAM is to ctiafaltie GABAa incaot yb agcseiinrn Cl- enahcnl ,ioengpn hist woudl be oemr ofr etaxyin hnat het seopneirds dspereten. ilAmietpiynrt si a CTA that hnitbsii rinsoeont dan EN apeertku nad is nto cnitidead rfo soeht eovr 65 e)Br(.es noBspieur si fro gnezilerade ixaetny edorrsdi dna asestlmuti nntosrioe reret,pocs giana sthi eapttni ash seondr.iesp Ceamiarepnazb si na tain tleeippci udrg taht bcklso aN selnnhca and si ftrsi ilne orf inrmagetil ealngu.ari orpliaodelH is iycatpl aipstochtnicy ttha olbcks D2 psreecotr dan dhsuol ton eb vgine ot +65 De( ebser pusl yhw dluow ew atnw ot vige him aarpemaylirtdx omyptms.)s ylMaephdienteht si a tlsituanm dseu in HDD.A naFiyll nexpetoair si a SISR taht niitisbh rnnootesi rteu.ekap It si srift inel rof jrmoa dsiseveper roidserd nad hsa efwre idse fesftec hnta TCA.


 +4  (nbme24#19)
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hTe nesawr si not B sceaueb tiwh anttiieilrts fbsrsiio uoy vaeh a cadeeesr ni eth uigidffsn ciacytpa eesucba fo eht hntikdece oearavll amnbr.eme ehT serawn is tno CFR esebuac taht lwli aedeesrc ni a triseteirvc lnug esaesid ushc sa obfi.rssi CF,V ,RV nda VT aer all xdtcepee to csaee.rde


 +17  (nbme24#9)
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etrhnoA awy ot nikth aoutb iths is wshat eht cssleo seagt to soitmsi aceeubs thirg erefbo M msisto(i) ouy dene ot aveh ociitmt ccyilsn esnst,yehdiz and thta uwodl be 2G

G1 &-;g-t S &t-;-g 2G gt-&-; M


 +13  (nbme24#15)
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hTe otw aimn yetsp fo onraiidat ypte rae zioiingn adn ii.oignznnno

The iniongzi ouwld be het draipherytao dna -doizningnio si rfom teh un.s

Iiignzno = eerf aaidlcr orot nnoaimfn iiongnzi BVU)( = ADN aaemdg by iaonrfomt of inyedimipr smdrie


 +2  (nbme24#28)
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htySeck Mcoir iognmc hgrutho hwti eth avxParuoisrym ilyfam dna teh nihtg ce.ens


 +1  (nbme24#4)
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A si ls rtmhrcoouoeoeT 4 aiclnar evrnse htta ear dmaiel (,3 ,4 ,6 )2 o1S C is sa beBdnuc si igb tfa one so emariIigtnl tikhn D si ,8 dna E si 9 os aoclreboVtsuelich dan aopGhrnesolsgaly I seusg F si .v..a.gus


 +3  (nbme24#46)
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ysocrpinloC si na ssauimsptonnrmupe taht blskco T elcl vaaoitcnit by ibihignnti 2LI-, os ew nokw shatt not gt.hri scyipehmCloodahp si na lanltkgayi eagnt. Doocrxibniu si na anotirmtu otiacbtini atth gartnesee erfe ciadasrl nad cuseas bserak in DNA. li'uoco5lfarru is soeataics with niirmiepdy .shtssynie Livenag tinrVsnecii hihwc si a ptasolneci dgur hatt ksrwo no oceltsmiurub hroet( gsrud ttha od siht ciohcen,lic aelptcax.li

sA tnmdoieen aryde,al het cell is tuskc in temhspeaa nda canont geonrdu eht tesepanroi a.pnashea M ceylc rtarse is osediscata wtih vinctniseri nda wihhc het tmoiict npdelis ichhw is hwat sesrtaepa teh rhmmcosoose si not .mngrfoi

suckitnbme  The funny thing is that the image seems to show that the spindle did in fact form. +10
spaceboy98  EXACTLY They showed the mitotic spindle is formed, so paclitaxel would be ok, but for vincristine, the damn thing would not even form +4

 +2  (nbme24#39)
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Teh nrswae si nto closetstoa iaitvcty sbacuee htta odlwu be regerinfr to eooisoreststp in hichw ethre is a efdetc ni saltcstooe tyviicat nda yuo hvea kitch esdne sbeon atht rrceutaf asly.ei rIeprmop oleastcots aitcivyt locdu losa efrer ot setgPa isedeas of the beno kaa Oistitse desafnomr ubt I nt'od think atth wloud pstrene hist guony nda duowl be omer esdiatacso htwi bone gdiolrenem smlrboep dna an arcnseei ni hta size, cte.

Teh adhe izes n'tis rdneaisce it stju skool keil a legar deha in smrpoconai ot the fdimsarw bcueeas asiahprdocolan ndo'set fatcef amesrobnmu boens fo eht .edah eceaIsndr hrwgto oemornh shienstsy wolud be rcmagyeola I kthni tub taht si snee in l.udats Lwo salan brgdie = ledasd sn.oe

IMT tub in FA ee'trsh ohntsemgi cladle Lnrao oerdynsm ciwhh is AR, dna a feceetvid GH eoprerct os oyu evah sdareneic GH and luodw loas ees swimrfad and a seddla nose dan omnitpern ahoedfer tub a masll adeh .nrfemuicececr





Subcomments ...

submitted by burak(52),
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eullaPr a Miadprvclas:uiecc nl:ei 68ht- Mrbrldyasiixlai line: h-08t1 rbtrrrsvPaelaeiba :lien 2-1n1d0 ibsr

So iahcnipsy umts sinret a deleen ni t80h-1 bris in mlalarxyidi e;lni tub ernoinits welob teh t9h bir tilsl ahs a srik ot gadame mabdlinoa ograsn ucsh as eli.rv Urpep rboder of h9t bri is fin.e

wU soituqne :ID 844

et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +15  
burak  thanks! +  
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +2  
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +  


submitted by madojo(163),

Going over the other answer choices:

  • ApoC2 defect as already explained in the other comments is Type 1 hyperchylonmicronemia with increased TG and chylomicrons, creamy layer in the supernatant, and is associated with pancreatitis and eruptive xanthomas.

  • LDL receptors are defective in Type 2 which is associated with a MI before age  29 20, accelerated atherosclerosis and increased LDL levels.

  • Someone with a pancreatic lipase defect will probably have pancreatitis and have increased triglycerides in their stool because pancreatic lipase can break down the TG into FFA.

UW has a question on the familial dyslipidemia III which is a defective ApoE. ApoE is what mediates chylomicron remnant uptake into the liver and so if its defective the liver cant efficiently remove chylomicrons and VLDL from the circulation. You get an increase in those things causing premature atherosclerosis, palmar xanthomas.

this stuff is hard

madojo  typo per FA age 20* swy +  


submitted by pparalpha(83),
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heT naulgiin tapr of eht nqeuoits nispot you ot a a merfalo hianer

erlomFa :rheani onummcon epyt fo nniulgia rn,ieha in ihhwc l-tnbomiiaaandr ostnenct n(i ihts csea eth lalms elobw) iaeehrtn into hte farelom aacln ohurght teh aflmroe gnir

Teh :eamgi ia:tngnaroutls ihmecics rssineoc fo nctsonet twniih teh arhnei acs as olodb oflw is mrpeiomcdos edu ot irncareoicnat iliudce(rber mraoelf iehnar edu to rdaeppt harnei tstcnneo ni nrhaie )acs

oS, ni stoh:r rmlfaoe hernai anc eadl to a tlnopccoamii cldlea aoarniectcnir whhci nca dael to nutstigoralna

madojo  Femoral hernia's are more common in women, i don't think this was a femoral hernia, either way any type of hernia can under strangulation. +  


submitted by mcl(586),
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eWlih taainmtiienssh iwth otcian ta H1 scrropeet rae ueds rof s,aerelgil H2 etsiintniaamhs rea pcyalityl dsue rof sclue.r erheefrTo teh stbe swrnea is nilitoitzabas of msta ecll nebmsea.mr heesT srudg lnyo(rco)m pnervte evesslic of iteamhins mfro fingsu with eht e.mmaebrn

madojo  Take H2 before you dine, remember H2 blockers for GERD +  


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ahtw I gto fomr tsih qosn:etui EVNER 99%( of the tme)i eefrr a patenti ot ees enonya

madojo  I was convinced this one was the exception, but guess not, NEVER REFER! +  


submitted by aesalmon(81),
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anC oeynna xlaenpi why shti si ton a ittupyiar me?ndaoa Is ti jtus a clka fo oethr tossypm?m

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +19  
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1  
teepot123  fa '19 pg 516 +  


submitted by aesalmon(81),
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nCa nyoean nlpxeai wyh isth si otn a tiayiutrp omane?ad Is ti just a clka of rtheo syo?mmpst

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +19  
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1  
teepot123  fa '19 pg 516 +  


submitted by hello(302),
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anc osenmoe esepla nlpeaxi sht?i

thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC). +2  
madojo  Meniere's disease is sensorineural hearing loss with peripheral vertigo due to increased endolymph within the ear. +  


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onialldAy si craetnl anpi teszintsina.io gegirnriTg fo niap yb a nno lpunafi lu.iimst Aols sene in yrai.bmv[sFigoa l aieeHalrgyps : cnI sersnpoe to ulpafni iius]tlm

Ist a otisvepi i.e( ivyAtecl felie,gn otn kcla fo nleiegf) pst.spmmy so B ;mpa& C is nto het swDne.ar ntsi sernaw e.hitre sa vloildain tecrpore (V)R1TP si also affneert vepioictcne msistsrnnaio euo(dmtdal yb ici)sc.aapn aAnicitovt si soon edlolofw by zisanti.eiendots

A - D.IK if bolrmep swa ni DRG there dwolu eb lto omer ps.syotmm

madojo  if you are an idiot like me than that long word in option b is GABA +6  


submitted by famylife(87),
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ehasP III Ciacllni liraT rpe( AF 2901, .p 2):56 eLrag bnermu fo ptsntiae nayrlmod snaigdse ithere to het mnreattte runed itsvntneigaoi or ot teh drdnasat of erca (ro acebl)op.

usmile1  also just to verify, there is no such thing as phase 0 right? +  
madojo  Not that i know of or is in FA +  
llamastep1  I've heard animal testing is called phase 0. +3  


submitted by neonem(556),
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enlreootniepeClb gnela mssa = ierVsbalut nosmnahwca KA(A iucstoca naom.)reu eedvDir rofm Scnhnaw se,lcl iwchh are of rleuna escrt goiir.n

yotsubato  Ugh. Of course they dont put schwann cells as a choice. So I pick oligodendrocytes like a dumbass +32  
subclaviansteele  Same^ +1  
madojo  Schwann cells = PNS Oligodendrocytes = CNS +3  
suckitnbme  NBME loves their neural crest cells +4  
wrongcareer69  How much do they pay these testwriters anyway? I can use a thesaurus too +2  
osteopathnproud  @suckitnbme they do love their neural crest cells, I have chosen neural crest cells for every single answer choice I see it in and I believe I gotten 90% of them correct, if something doesn't click or you don't know, I would keep neural crest cells as a very possible answer lol +  
faus305  AMERICA EXPLAIN +  


submitted by krewfoo99(90),
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NRIT - enBo rworma inse,suprso icLtac s,dsociiA NN anIaimATRe - tcipxytoeHo,ait e taganehsIrrs tiiihnbor rt(e)gsa - yyhaMpot gns(uaci adsncIeer ieanirentC e)tPrssone eiKaa bhirotiIns a(rvi)n - spi,tLohyoyrpd plreeicmy,yaH GI aioenelrtnc nihk(t of ohnamolr fcfse)e

madojo  building off on this... answer choice A would be something like Maraviroc, and B is basically the same thing as A because a fusion inhibitor would be something like Maraviroc where you don't have any interaction with CCR5 and gp120. +1  
overa  ^ With B, they are referring to Enfuvirtide, which blocks FUSION via gp41 blockade. Maraviroc blocks ATTACHMENT by preventing gp120 binding the chemokine receptor CCR5 on macrophages mainly. -lolnotacop +2  


submitted by majic(8),
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THE TSMO ONOCMM tuoer of xooT tssniiamrsno ni dauslt ni hte SAU si neiotigsn fo edrokuconed .kpor evnE fi cta ielttr is na ntpoo,i dduoncerkoe okrp si lltsi orem oon.mcm

yotsubato  Also another fun fact. Most people in France are infected by Toxo (like 80%) because of how they eat meat. (Very rare) +2  
madojo  To add on might be TMI but most people have Toxo but are asymptomatic because its in its latent form as a pseudocyst and its not untill you are immunocompromised that it strikes +  
suckitnbme  This patient also probably got toxo in Brazil +  
luciana  JFYI people in Brazil love to eat rare meat at barbecues +