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Welcome to medguru2295’s page.
Contributor score: 41


Comments ...

 +2  (nbme24#50)

they said "metaplasia"

Metaplasia= normal tissue but in an abnormal place classic example- Barrett's its NORMAL mucousa for the stomach, but in the esophagus.


 +12  (nbme24#7)

If smoking fucking the patient over is a choice, its right. NBME loves smoking cessation!


 +0  (nbme24#3)

You didn't really need to calculate Anion gap. The bicarb was EXCEPTIONALLY low. That is generally RTA. Additionally, the Cl was very high in the setting of other normal electrolytes. Additionally,. it was a s low onset (over 2 weeks) knocking out many other choices (Salicylate, Lactic Acidosis, DKA, and Alcoholic Ketoacidosis).


 -1  (nbme22#46)

TBH I only got this bc of the controversy with Lance Armstrong blood doping. IDk the mechanism at all. But, it will help you all remember this question/answer.





Subcomments ...

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o:hn’sCr ikps ios,ensl u,afsliet siurtersct dn(a teh ncnasuysere srmltraaun lnotvvieenm no )y.ihtoglos

mullerplouis  I think the histology was hinting at the granulomas.. +10  
medguru2295  Yes the histo was a granuloma.They also gave fat streaks, and mentioned ileum, and adhesions. LAY-UP! +1  


submitted by anu(4),
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awht tbuao eth asneecri in rualnmopy savruacl tnrceissae ? osndte PCPW lafl ni gmhhoaricre choks

ibestalkinyo  I think this may have something to do with hypoxic vasoconstriction? +  
medguru2295  PCWP falls because there is less blood going into the Lungs and therefore, less blood coming out (decreased preload). However RESISTANCE is a measure of how difficult it is for blood to flow. That essentially means constriction. As stated above, it is likely hypoxic vasoconstriction as well as just global sympathetic attempt to maintain BP. If it said pressure in pulmonary arteries, it would likely be decreased as the vasoconstriction cannot full compensate the blood loss! +1  
medguru2295  PCWP falls because there is less blood going into the Lungs and therefore, less blood coming out (decreased preload). However RESISTANCE is a measure of how difficult it is for blood to flow. That essentially means constriction. As stated above, it is likely hypoxic vasoconstriction as well as just global sympathetic attempt to maintain BP. If it said pressure in pulmonary arteries, it would likely be decreased as the vasoconstriction cannot full compensate the blood loss! +  
sharpscontainer  Actually I don't think this is due to hypoxic vasoconstriction. The alveolar oxygen content of the lungs remains high, so there's still a good amount of oxygen getting into the pulmonary vessels, even if less of it can bind to Hb. I think instead it's that there's tons of sympathetic stimulation from hypovolemia, so alpha 1 in the pulmonary blood vessels is activated (which is separate from beta 2 bronchodilation which is a smooth muscle thing). https://www.ncbi.nlm.nih.gov/pubmed/10378571 +8  
avocadotoast  PVR = (PAP - PCWP) / CO. There is a decrease in cardiac output in hypovolemic shock. Given its inverse relationship with pulmonary vascular resistance, we should choose an increase in PVR for this question. +2  
topgunber  in hypovolemic/hemorrhagic shock there is a decrease in systemic blood pressure , there is an Increase in TPR (it's a compensation) to maintain flow. I think it's safe to apply the same logic to the pulmonary circulation where there is decreased blood pressure there will be an increase in TPR to maintain flow. (due to the sympathetic activation from the baroreceptor reflex). As someone said, the PCWP will fall, the increase in TPR is a compensation just like in systemic circulation. There will be absorption - we wouldn't want to lose more intravascular volume when you've lost blood. I'm not 100% if its due to hemoconcentration or a severe decrease in hydrostatic pressure in the capillaries, though +  


submitted by anu(4),
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htwa aoutb het cnsaieer in lnaopryum csuaravl ristncesea ? sedton CPWP flal ni raemicrghoh khcos

ibestalkinyo  I think this may have something to do with hypoxic vasoconstriction? +  
medguru2295  PCWP falls because there is less blood going into the Lungs and therefore, less blood coming out (decreased preload). However RESISTANCE is a measure of how difficult it is for blood to flow. That essentially means constriction. As stated above, it is likely hypoxic vasoconstriction as well as just global sympathetic attempt to maintain BP. If it said pressure in pulmonary arteries, it would likely be decreased as the vasoconstriction cannot full compensate the blood loss! +1  
medguru2295  PCWP falls because there is less blood going into the Lungs and therefore, less blood coming out (decreased preload). However RESISTANCE is a measure of how difficult it is for blood to flow. That essentially means constriction. As stated above, it is likely hypoxic vasoconstriction as well as just global sympathetic attempt to maintain BP. If it said pressure in pulmonary arteries, it would likely be decreased as the vasoconstriction cannot full compensate the blood loss! +  
sharpscontainer  Actually I don't think this is due to hypoxic vasoconstriction. The alveolar oxygen content of the lungs remains high, so there's still a good amount of oxygen getting into the pulmonary vessels, even if less of it can bind to Hb. I think instead it's that there's tons of sympathetic stimulation from hypovolemia, so alpha 1 in the pulmonary blood vessels is activated (which is separate from beta 2 bronchodilation which is a smooth muscle thing). https://www.ncbi.nlm.nih.gov/pubmed/10378571 +8  
avocadotoast  PVR = (PAP - PCWP) / CO. There is a decrease in cardiac output in hypovolemic shock. Given its inverse relationship with pulmonary vascular resistance, we should choose an increase in PVR for this question. +2  
topgunber  in hypovolemic/hemorrhagic shock there is a decrease in systemic blood pressure , there is an Increase in TPR (it's a compensation) to maintain flow. I think it's safe to apply the same logic to the pulmonary circulation where there is decreased blood pressure there will be an increase in TPR to maintain flow. (due to the sympathetic activation from the baroreceptor reflex). As someone said, the PCWP will fall, the increase in TPR is a compensation just like in systemic circulation. There will be absorption - we wouldn't want to lose more intravascular volume when you've lost blood. I'm not 100% if its due to hemoconcentration or a severe decrease in hydrostatic pressure in the capillaries, though +  


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otH utb l,ifcloitlsui t’is a hignt. lslClicayas oedumsoap.ns

medguru2295  I hate myself for overthinking this one. The first thought in my head was "hot tub folliculitis" but my dumbass didn't pick follicle. +10  
hungrybox  @medguru2295 same bro same +  


submitted by m-ice(339),
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ehT ittpena ssetat ttha hes odse ton atnw a nraoolmh omrf of ihrbt tcn.olro ,oS het qustineo is ylarel kigans ichhw fo the nnronmloho-a itsopon is omst e.fevictfe heT kricty rpat ,eerh I ,tnikh is that eht qteiuons meska you twan to not kcip UDI, eseubac yman IsDU rea olohramynl abes.d vwreH,oe a onmhannol-ro DUI, lkie a rpoecp D,IU si sllti mreo efievcfet ahnt teh horet iopntso stlde.i

bullshitusmle  copper intrauterine devices are hormon free FA2017 page 622 +2  
medguru2295  they needed to specifiy. I eliminated IUD bc patient states no hormones. +1  
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. +5  


submitted by yotsubato(1019),
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dClo iar idseunc ahtmsa skatat.c

creniesgaD sruoce aodl wtno pelh

aiTnkg striesod si oto hucm ofr nwo

ongMvi ckab ot eht rdmso si ont bveail

irA eclersan nodt owrk houegn

oDnt teg rdi fo het oodG eoBy

nmikoSg rosodni is itsgugidsn

sherry  Stress can actually be a trigger for asthma. I think the problem here is that she has alwasys carried a heavy course, while the disease just started recently. +7  
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +1  
qiss  Also her symptoms started 3 months ago and she moved in with a roommate who smokes indoors 3 months ago. +2  
jrish  But wouldn't the smoke on the roommates clothes still cause significant asthma problems? +  


submitted by tissue creep(112),
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ehT oedplo is oh,yeginlrlpcae dan a /0101 ogdo oy.b

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +  
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +  


submitted by dbg(149),
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mA I the yoln one hwo ouhght,t ym lehwo ,flie atth it layclaut insoatgrei ofrm hte yrihdto ubt tjsu plylyaihsc todecnenc ot hte ugeont

nbmehelp  same +14  
medguru2295  me! I went with submandibular gland bc I thought there was a gland under there. +  
alexxxx30  nope...i definitely thought the same thing...when I clicked thyroid I was like wow that was an easy question. HA +1  


submitted by yex(102),
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Thsi was no a versuoip ME.BN owH I tgo ti? lecInttraos pr)o(sertio is ohw uoy get ot hte evrabtrel beod;si hte orhet eessvls ear aro.enitr

medguru2295  this was nearly word for word on NBME 22. Slightly different wording maybe? +  


submitted by usmile1(109),
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brmnauoeMs oahyprpnhet and iamnmli hnagce sdiaese cna eb leaiys udrle uto sa htey are oirpnhetc tlsoilss tmnyetn.euirTadruboi siniepthr aka( aetcu irettanlitis tpnis)rhie can eb ulder uot as ti cessua WCB ascst otn CBR as ense ni thsi .unsitqeo pallayirP srinosec - hteier hsa on sctas or ti hgitm hows BWC catss tub otn RBC ceaebsu teh pmeobrl si ton in hte lmlu.reigo

ebtla fo rcunenematol no agep 825 pasilenx ttah areevoftirpli jsut nasem ypehr lllauerc .logriumel i nveG teh tsntapie ihrosyt of eosr tthroa otw kesew ,oag nwo gnrtepisne ihtw hpictrNei edonSymr tihw CBR stsac, iepoalitfverr eoiogrrueilmhtnslp is hte oynl aeealorbsn rwn.sae

medguru2295  This was my precise login. I wound up getting it by elimination. But, didn't like that answer as its uncommon in small children and the child seemingly had no risk factors. +  
thotcandy  @medguru2295 FA says it's most commonly seen in children and it's selflimited vs adults is rare and can lead to renal insuff +  
peqmd  They're using the broad category for PSGN, Pathoma pg 130 IIC. PSGN = Hypercellular, inflammed glomeruli on H&E stain and cross referencing the FA table mentioned hypercellular => Proliferative. +5  


submitted by drdoom(874),
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hTe tsem si bnerdicsgi aesuleqe fo ooteiprsr erofniir lrbaeleecr earrty lounci,soc nlgerutis in lbarengelW ydsmnre.o ’ersHe a niec cimetshca fo hte efdecfta cilune nad nbrai mste o:nsireg

ytuptBAmgtstS3vx/e:p.esrgd1lpgf/hi_a/9iotij.c/8/ma.m

... nad a e6m-tnui oeYubuT oidev tath aklws uyo hurhgto ti:

Bvu.tohc?_wuw1ctgto3pt=m.9w:/atshSA8y//ebwp

nbme4unme  Great video! Very, very solid review of brainstem anatomy. +  
suckitnbme  This image was surprisingly interpretable for NBME standards +13  
aneurysmclip  and the fact that all you needed to know was the side of the lesion to answer tbh lmao, but other than that localizing to medulla wasn't hard. +4  
medguru2295  Actually, they were quite nice. You didn't even have to know what side. There was no option for left medulla. +3  


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astM lescl ag,aertdenul icrupgnod hienaimst hhicw csttaart l.pniohsoies ehT alrye aegst of an gearcill teconira si tsma cell me,dieadt ubt hte late gseat icdnn(iglu umscu )rpcndoiotu is eeitddam by h.nospioiels

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +17  
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +5  
ajss  where do i find this info?? +  
paperbackwriter  @ajss pg 112 of first aid 2019, under type I hypersensitivity. Immediate --> mast cells releasing histamine and tryptase, late--> eosinophils and leukotrienes recruited via chemokines +2  
graciewacie9  Wow, i missed the fact that the question is asking for the RESULT of the reaction, NOT the cause of the reaction. Mast cells cause the initial reaction, eosinophils would be the result of the eosinophils. *facepalm +6  
greentea733  @graciewacie9 SAME UGH +  
lba9587  Pathophys (as far as I understand it)...Mast cell degranulates, thus the phospholipid bilayer et. Al are left behind and needs to be degraded. Who comes in? Our good friend eosinophils, as they contain Major Basic Protein (responsible from breakdown of expired mast cell). Note, you can tie this in to the delayed Leukotriene effects of an allergic rxn, as the bilayer is also broken down by arach. Acid. (See this link to support my credibility https://images.app.goo.gl/3cUF3ZVc7qy8uxAi9) +  
mutteringly  who else looked up what T21 pills were +3  


submitted by nor16(58),
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COPM si a eornrhopmo dteippe hain.c

tI is aensdatrtl dna artel eezsnmy uct htis pieetpd in teh psbeuei.ptds

nispTocnrtrai is gonwr i( dah shti oo..t). /bc its ont the NARm that kamse tefdrfien tipepde mo.nhorse ee,orMrvo twha I ese now si, ttah rcpaoptotnrlnasitsi timnfiodoaci si mreo or sles .ici.gns.lp so -prsltstta.oan iat.finoocidm txne mtei ew aekm ti rrtecco -;)

medguru2295  This is a perfect explanation. I never knew it was the protein modified (I initially though alternate splicing too) +1  
nerdstewiegriffin  Is this an example of polycistronic mRNA? +  
paperbackwriter  @nerdstewiegriffin possibly (because it says that the original mRNA results in proteins plural, BUT the mechanism for POMC derived hormones specifically is not bc of polycystronic mRNA. Polycystronic means that you get multiple protein products from one mRNA, but in this case we get multiple PROTEIN DERIVATIVES from one PROTEIN, implying that there are some modifications/reactions taking place once we've already made ONE protein which change the protein into multiple diff. products. +1  


submitted by lsmarshall(415),
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"mesmoesoD calMua( ahdsner)e - A lltcoclee--l onnntiecco ttha seiovrdp rruasctult popsurt ithw emtainiteder nalsmeit,f cuiparllaryt in esistus ttha egondur nccmleiaah etsssr (,ge.. ks,ni cirgast tsieus, .)adrbdel ecCtnnso sorecteyitnak ni teh ttmrusa opuisnms of the "emipers.di - MBOASS

sympathetikey  This is why I was looking for some answer indicating keratinocytes in the stratum spinosum...instead they just gave a bunch of bs choices. +29  
roygbiv  I'm confused because I also know that S. aureus cleaves desmoglein in the stratum granulosum, so why is it specifically this answer? +2  
duat98  desomosomes connects cells to cells. hemidesmosome connects cells to basement membrane. +3  
medguru2295  I think what this is really asking is can you tell Pemphigus Vulgaris from Bullous Pemphigoid Vulgaris (question)- Attack on DESMOSOMES- this separates some keratinocytes from others (ie some in basal layer from ones above). Pemphigoid- attack on HEMIDESMOSOMES- this means separation of the keratinocytes from the basement membrane. +2  


submitted by jejunumjedi(30),
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Teh dbool aerms sctpide ucSffrehn gs.nipptli nudoF eht xctea image no hte ebw ihtw oixlntna:epa

lsaep/gmo/c/s3~xc/_i/Pt.a2te/ttpiaj.4plvs_ai:/sei/rdh/m2pcuobe.bhvept.v

doctorboomboom  Hey thanks for finding the image! Do you know why the answer can’t be Chloroquine resistance? I was b/w that and formation of hypnozoites. +5  
jejunumjedi  I think it's just that Schuffner stippling and hypnozoites are both specific to vivax and ovale species. These species could be chloroquine resistant or sensitive, but if you have Schuffner stippling or hypnozoites, you can definitively say that it's either vivax or ovale. +3  
sherry  Species with hypnozoites is not called chloroquine resistant. Chloroquine-resistant species means trophozoite/schizont cant be killed by chloroquine. We dont have enough info to decide whether the spp in the q is resistant/sensitive. But we do know he moved from Honduras to USA 1 year ago. +3  
soph  UW: in africa most malaria species are resistant to chloroquine. he is from hondruas +4  
randios  Can anyone explain the 1-week history of fever? Ruled out vivax and ovale due to 48 hr cycles. Or did they just throw that in as an unspecific symptom. +1  
dr_ligma  unspecific symptom probably +  
mcm94  how I know that is an infection by vivax/ovale ? if there's nothing that says about tertian fever? +  
medguru2295  While it COULD be Chloroquine resistant, its not likely. This patient is likely infected with Vivax or ovale (not Falciparium) why? 1. Honduras (Falcip would be Africa) 2. Sx 1 year later (Liver form Vivax or OVale) 3. As many mentioned, Schuffer bodies Falciparium tends to be the species resistant to Chloroquine. Typically, Chloroquine is given for Vivax & Ovale (typically with something else- Atovaquone, Dapsone etc) to cover Liver Falciparium (no Liver form) is generally Chloroquine resistant (B) and therefore covered with Atovaquone/Proguanil. You do need 8-14 days of tx after coming for Falcip bc it can remain in the Liver for a few days (just not a dormant hypno form). To cover the "week of fever" question- its re-emergence of her sx. They probably just did not want to say cyclic to make it trickier. +4  
flvent2120  Looks like it's been touched on, but you could answer this solely based on the fact that it's been one year since living in Honduras. While it MAY be chloroquine resistant, it IS dormant. Test taking skills would be to choose the answer you can't argue with +  


submitted by medstruggle(12),
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yWh si it ton inaarov fliocell ce?lsl I huhtotg the laefem aogaln of leoirtS nda eiydgL si gatlcnhusraea/o .slecl

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +38  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +18  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  


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I edulr uto saetP'g cesebua aePgst' is yuasllu ed,oclzila rep ,FA aPa,hmot BB.;map& lghhAuto hist pntetia lyfiteiend sitf eth ohegdmpiacr r,iteupc reapsott cearcn si etylndfeii ont eht olny ecanrc tath cna saatitzeesm to teh eo.nbs ecBsuae ehest rae cylti o,essnli tsi' bablroyp mseo hetor ccnear aht'st sedrpa ot eth oesbn

medguru2295  Possibly Multiple Myeloma. That is classic for an older person with back pain and lytic lesions in the back. +  
asharm10  osteolytic- multiple myeloma, Osteoblastic- Prostate; dont think beyond this for this exam, i have never seen a question in NBME or uworld they tried to fool us off on this concept so far. +1  
euchromatin69  u world 341 same concept +  
skuutnasty  I'd like to reiterate what's stated above... dx NOT MM in this question because MM is PRIMARY not METASTATIC @ bone (answer reads: metastatic carcinoma) <3 +  


submitted by oznefu(22),
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Im’ vhnagi trboule usndrgindetna yhw tshi si a ettrbe cochei thna agPte edas,ise eayclepsil tiwh hte disernace ?ALP

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +26  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +17  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by lodododo(1),
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Te’hrse a loWrUd soeniuqt no tish. cnOe the heylhat oxna trracste adn eth istdla )irn(duje xoan ,adeeeergnts e’hetsr a hbnuc of yimnel ebrdsi ni eth ayw that aisrnem trehe for a nolg .teim iThs lcsbok ierenaengtro of hte aon.x

alacran763  Reinnervation *is* assisted by schwann cells, but the process is very delicate. After Wallerian degeneration, the schwann cells basically have to line up perfectly along where the nerve is supposed to grow, but it does not happen perfectly and the schwann cell disorganization often prevents proper reinnervation. +14  
dantescuttlefish  I thought the Uworld question said that in the CNS myelin debris is there for months even years....the PNS it gets cleared much quicker. +2  
medguru2295  That's exactly what the Uworld question said. I missed it with that exact logic. I think it must be that it was only 6 months ago so even In the PNS, there was not enough time to regenerate. +  


submitted by monoloco(136),
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eAnnoy eles rgeuif uto ohw a srnueog setg ish danh iiedns eht tatiepn eepd ogeuhn to lasuve eth ehtipca vesin from hte CIV nirgud a LMA?RTOOPAY fBslfea e.m

mesoform  I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description. +4  
kimcharito  aorta is also behind of liver... +1  
medguru2295  I also didn't realize the surgeon's hands would so deep in he could touch the IVC on a Lappy....kinda eliminates the point of a Lappy.... +  
iwannabeadoctor2  "A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity." Exploratory laparOTOMY very different than LaparoSCOPY, which is what I think you may be confused about. One is a gaping hole from which you can observe everything, and the other uses tiny incisions and scopes. Even still, a hand port used during laparoscopy can allow for digital manipulation of organs as needed. +2  
bbr  I dont think the physician caused the avulsion, I think it was there already and he grazed the area. Causing it to fully avulse and break what ever clotting was going on. +