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Welcome to medpsychosis’s page.
Contributor score: 83


Comments ...

 +19  (nbme24#8)
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The yaw I utoghht uaobt it asw a eittll mroe mlis.iitspc eW ues non ielvtcese beta oecbslkr e(g.. )olonlPrroap fro eht terttanem of tinseelsa m.rreot oferrhTee a eatb tagonis wlodu avhe eht oepsotpi fce,eft aka cesau or neaechn rm.reto

hungrybox  Genius +2
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +1

 +10  (nbme21#6)
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hisT atnetpi feeildinyt hsa susdrieiola .osCSc in tesnqoui e ni:fmAc-asrt amAnicer hreFeme-mlEt yaa Nd-oila mtaeBsluro ilraH ocdnacli HatpAhpe-aeyymer (ued ot ytαysee-airmxehaldd–o1d imnvtia D vaitictoan ni ocagehrsamp.)

FA 2081 .P( 5)86

icedcoffeeislyfe  FA2020 pg 676 +
lovebug  and FA2019 pg 662: Vit.D usually activated in Kidney. but They can be also activated by Macrphage like this case. +




Subcomments ...

submitted by m-ice(272),
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hTe ieptnat dsnee aidclem ttetinano mitieaedy,ml chwhi ieniatsmel tbogiinna a rocut orre,d ro anfetrsrirng her. A unesr dseo ton aevh het mesa nintriga nad aniltfiiacuoqs sa a nah,csiyip os it owlud be roapniarepipt ot ksa hetm to aeximne eth ieptnt.a Asnkig teh iltahspo aancilph aniag dluco eb rpptrponaii,ae nda ulwdo aekt remo .emit Teehoerf,r the bset potnio gnoma etosh given is to sak eht tiptnae if esh ilwl oawll whti rhe ausnhbd prete.sn

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 +  


submitted by medskool123(22),
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can esoemon xapnlie yhw this is nto ia?drtnusonct Lats mneb I said ogacnnjiuot dna ogt ti rnwog rfo r..snuitaodctn isht eno I ays nstrdntuoaic dan sit ocjuitgann.o

pseudorosette  I would say because this happened between two bacteria, but in transduction what causes the acquisition of bacterial resistance is coming from a bacteriophage, which is a virus that infects bacteria, but that is never hinted at the question! +4  
medpsychosis  Quick Overview of the involved topics and answer choices that are relevant in this question: Transduction: Involves phage, cleaves DNA and takes a part with it as it is packaged. Generalized is when is happens by accident. Specialized is an excision event. Transformation: bacteria takes up naked DNA around it and incorporates it therefore becoming "transformed" e.g. (SHiN) S. Pneuma, H. Influenza type B, and Neisseria. Transposition: Jumping from one location to another within same bacterial organism (e.g. from chromosome to plasmid) Conjugation: Above mentioned plasmid gets transferred from conjugal bridge from one bacteria to another. +13  
wowo  FA2019 p130 +  
zbird  Easy here...first both are G-ves which likely have a sex pilus and if cultured together as in this case transfer their plasmid. Transduction need phage. Transposition is exchange of genetic material inside the bacteria b/n the dna and the plasmid or vv (FA2019) +  


submitted by neonem(503),
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ihsT si taceu hmloceiyt atsfnonrisu aiceno,rt a pyte II sepntstyiivheiyr eehrw mpfdroer-e MIg idtnbsieoa dibn to pbilmtncioae BOA tsanenig on norod BCsR, hiwch cueass asvrtancialur os.eilmhsy Rh iiytnbcpitoam,li leki dcenlloreo_ ds,ia scoem meor tnoi lyap hitw ltyiihtpo-ibRamc of acnnepryg adn it si deu ot IgG isdb,itneao ichhw omer eotfn sacue vasraexutlarc myohislse isnce pncesil phrgsacomae hvea teohs F-acga-mRm scperetor ot nibd hevrweta gGI ash gah.ctu ruvxsacaaltrE st'oden uscae thta oysn,nhoptie f,ever nfakl inap sdaeiatsco hiwt ionhormlgeiuba iecsn the ragaeschomp hdlo no ot het rgdedead BRCs nad oenrcvt ti ot eilri,bdvin ihcwh acn easylf eb ercextde yb het .rilve

mousie  Could you help me with understanding why this isn't a Type I HSR? I understand that ABO incompatibility is Type II HSR but I don't know how to tell the difference between a patient who is IgA deficient and having a Type I Reaction to an infusion vs ABO incompatibility .... +4  
sympathetikey  @mousie - https://imgur.com/QH5rCEX Basically, think of Type 1 HS like a normal allergic reaction (itchy, wheezing, etc.). Whereas, with ABO incompatibility you get the question's presentation. +6  
medpsychosis  When it comes to Acute hemolytic transfusion reactions, they are Type II hypersensitivity and divided into Intravascular (ABO) and Extravascular (host Ab against foreign antigen on donor RBC). The differentiating factor between them is simple. Intravascular (ABO) will present with hemoglobinuria alongside all the other common symptoms (fever,hypotension, tachypnea etc.) Extravascular hemolysis will stand out with Jaundice as one of the presenting symptoms. Hope this helps! +4  
cassdawg  Also just to add: Rh incompatibility causes a delayed hemolytic transfusion reaction, this reaction was immediate so it is indicative more of the ABO blood group incompatibility (FA2020 p114 has all the blood transfusion reactions) +  


submitted by neonem(503),
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ihsT aeitpnt aces snusdo lkei he ash onir nceyfediic naaemi ei(nmaa, low coi,hreattm ciicoctmry) mrof a GI deeb.l oT egt shit iuqnseot hr,tig you had ot ermbrmee htat the tow mjaro eitehnidr IG reancc neydmsrso rea APF ed(u to uaottmni in APC egne, wihch si a oumrt poseprrsus e)nge nda hnycL srnymdeo AKA hidraterye snnopsi-yoolp lateccorol iocacmran )NCH(PC, usedca by a mitnotua ni a bmurne NDA mhastcim erarip eg,nes of whit MHS2 is a rmoe mcmono one.

heT mhesminsac of trhei rcamaiocn meldoenevpt ear dnrietffe; ni APF, uormst aseri orfm a molrna t&-g-; aamoend g-;-t& inmaaorcc cnqeuese ewhli in CN,HCP ousrmt isear ormf ha'tws wnnko as a iitmlsrcaeloet tisinblyati htpawy,a dlginea ot ssaepuntoon afmiontro fo a ccamniaro not( dpcdeeer by a ninebg losein ikel an ..edaon.a)m Yuo ndid't ened to nowk hits to teg htis qnsueoit igt,hr utb lntiefydie odgo to kwon.

medpsychosis  To make it even simpler, if you narrowed it down to FAP vs HNPCC and looked at the image provided in the question, you'd see it's less likely to be FAP due to absence of numerous polyps which would be expected. So HNPCC would be your best choice! +3  
yb_26  I always get Li-Fraumeni and Lynch syndromes confused :/ +1  


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Why si it otn anroiva efilclol ?elscl I uotgthh teh leefma ongala fo Sertlio nad Lidegy si a/cgolhrusenaat lce.ls

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +4  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +7  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +28  
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 +10  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +4  
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. +6  
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? +3  
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" +1  
youssefa  Hahahahaha ya'll just bored +4  
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 +4  
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 +1  
noplanb  Wait... I might actually never forget this now lol +1  
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!" +14  
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. +1  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +1  
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 +  


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Hwo od ouy uiidgstsihn htsi fomr iautesltrc ostr?ino Is ti ustj ueesbac it esdrtta in eth eftl n?flak

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


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PTH si seeircdan ecuseab rmsue alccmui is l.ow sacuBee HTP is r,deneicas hpuropososh is cda.eesedr eTh aownm in labenu to brsboa tnimavi D a( fta lbsuoel iva,mti)n os cticilalro is daseerdce no( imtivan D ofr the yednik to titvcaae iotn tl.cic)lrioa

gabeb71  What does this have to do with the Celiac Sprue? +1  
medpsychosis  I believe they were explaining the reason for the mentioned "mild osteopenia" in the pt presentation. +  
meningitis  No, I think this person got confused with another question about celiac sprue, PTH, Calcitriol, and Vit D (it was an arrow type question). +  
diabetes  explanation for decreased bone density . +  


submitted by mcl(517),
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ocAdcirng to isht rppe,a niiunsl itshniib apalh selcl fomr erisgaenl uaolg.gnc Tshi si teh ertneavl ieurgf mofr hte p.pear

medpsychosis  There are three ways that Glucagon secretion is stimulated: +(1) a stimulatory effect of low glucose directly on the alpha cell, +(2) withdrawal of an inhibitory effect of adjacent beta cells, and +(3) a stimulatory effect of autonomic activation. The response of Glucagon to hypoglycemia is diminished in T1Diabetes. Hence in this pt, the impaired release of Glucagon allows for prolonged Hypoglycemia. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005043/ +8