need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (“predict me!”)

Welcome to medpsychosis’s page.
Contributor score: 147


Comments ...

 +0  visit this page (step2ck_form6#45)
get full access to all contentbecome a member

Homemade whiskey and moonshine require brewing and boiling in metal pots. This can cause the release of high levels of lead into the solution and in turn to the individual once consumed. Given that the symptoms are pretty vague and could fit more than one answer choice, I believe the NBME is encouraging us to start making our own homemade whiskey and moonshine so we can learn these things hands on!!!! Who's in?

https://www.cdc.gov/mmwr/preview/mmwrhtml/00016616.htm

get full access to all contentbecome a member

 +2  visit this page (step2ck_form6#26)
get full access to all contentbecome a member

PCP Intoxication: Violent/abnormal behavior, confusion, disorientation, amnesia. may have hallucinations/psychosis. Hypertension, Tachycardia. In cases of overdose -> vertical nystagmus

LSD: Optical hallucinations, illusions, depersonalization, flight of ideas, confusion

Another one that has been showing up in UWORLD: Inhalants glue, paint thinners, etc

Px w/Dizziness, confusion, lethargy within ∼ 30 minutes of use Nystagmus, muscle weakness, tremor, hyporeflexia, ataxia Lingering odor of inhaled substance Overdose: coma and death (due to respiratory depression)

Source: AMBOSS

get full access to all contentbecome a member

 +33  visit this page (nbme24#8)
get full access to all contentbecome a member

The way I thought about it was a little more simplistic. We use non selective beta blockers (e.g. Propranolol) for the treatment of essential tremor. Therefore a beta agonist would have the opposite effect, aka cause or enhance tremor.

get full access to all contentbecome a member
hungrybox  Genius +6
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +7

 +11  visit this page (nbme21#6)
get full access to all contentbecome a member

This patient definitely has Sarcoidosis. Clues in question stem: -African American Female -Erythema Nodosum -Bilateral Hilar Adenopathy -Hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages).

FA 2018 (P. 658)

get full access to all contentbecome a member
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 medicalmike(82), visit this page
get full access to all contentbecome a member

Calcifications in anterior lumbar spine = atherosclerosis in abdominal aorta, a risk factor for AAA. Acute onset pain indicates rupture or impending rupture. BP can be low-normal due to tamponade by retroperitoneal location of abdominal aorta.

note: calcifications in anterior lower thoracic spine = chronic pancreatitis

get full access to all contentbecome a member
medpsychosis  Just a clarification: It is anterior TO the lumbar spine or anterior TO the lower thoracic spine. These calcifications are not in the spine itself. +


submitted by m-ice(370), visit this page
get full access to all contentbecome a member

The patient needs medical attention immediately, which eliminates obtaining a court order, or transferring her. A nurse does not have the same training and qualifications as a physician, so it would be inappropriate to ask them to examine the patient. Asking the hospital chaplain again could be inappropriate, and would take more time. Therefore, the best option among those given is to ask the patient if she will allow with her husband present.

get full access to all contentbecome a member
sympathetikey  Garbage question. +71
masonkingcobra  So two men is better than one apparently +33
zoggybiscuits  GarBAGE! ? +2
bigjimbo  gárbágé +5
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? +17
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 +11
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. +21
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +29
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. +1
niboonsh  This question is a3othobillah +11
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 +9
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. +15
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. +16
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +3
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +2
wrongcareer69  Garbage question +1
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +3
beto  okay, touch me when my husband looks. are they preparing for threesome?? fckn question +
fatboyslim  I'm a Muslim man and I got it wrong. I chose B lol. I thought by her saying I don't want to be examined by a man stays true regardless of whether her husband is there to not. I guess it doesn't hurt to ask her what would make her feel more comfortable if it allows a male doc to examine her. +


submitted by medskool123(31), visit this page
get full access to all contentbecome a member

can someone explain why this is not transduction? Last nbme I said conjugation and got it wrong for transduction.. this one I say transduction and its conjugation.

get full access to all contentbecome a member
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! +5
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. +21
wowo  FA2019 p130 +1
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) +
impostersyndromel1000  how much time do you really save by saying G-ves instead of gram negs or negatives +
unknown001  can someone explain why it isnt transposition. reason why it isnt transformation is there is nothing in the broth that will cleave the bacteria, to have naked dna that can be picked up +


submitted by neonem(629), visit this page
get full access to all contentbecome a member

This is acute hemolytic transfusion reaction, a type II hypersensitivity where pre-formed IgM antibodies bind to incompatible ABO antigens on donor RBCs, which causes intravascular hemolysis. Rh incompatibility, like colonelred_ said, comes more into play with Rh-compatibility of pregnancy and it is due to IgG antibodies, which more often cause extravascular hemolysis since splenic macrophages have those Fc-gamma-R receptors to bind whatever IgG has caught. Extravascular doesn't cause that hypotension, fever, flank pain associated with hemoglobinuria since the macrophages hold on to the degraded RBCs and convert it to biliverdin, which can safely be excreted by the liver.

get full access to all contentbecome a member
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 .... +16
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. +10
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! +11
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) +4
ooooopss  I just wanna say God bless all of you cuzI needed this +2
drdoom  ^ linkify @sympathetikey https://imgur.com/QH5rCEX +1


submitted by neonem(629), visit this page
get full access to all contentbecome a member

This patient case sounds like he has iron deficiency anemia (anemia, low hematocrit, microcytic) from a GI bleed. To get this question right, you had to remember that the two major inherited GI cancer syndromes are FAP (due to mutation in APC gene, which is a tumor suppressor gene) and Lynch syndrome AKA hereditary non-polyposis colorectal carcinoma (HNPCC), caused by a mutation in a number DNA mismatch repair genes, of with MHS2 is a more common one.

The mechanisms of their carcinoma development are different; in FAP, tumors arise from a normal --> adenoma --> carcinoma sequence while in HNPCC, tumors arise from what's known as a microsatellite instability pathway, leading to spontaneous formation of a carcinoma (not preceded by a benign lesion like an adenoma)... You didn't need to know this to get this question right, but definitely good to know.

get full access to all contentbecome a member
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! +7
yb_26  I always get Li-Fraumeni and Lynch syndromes confused :/ +1


submitted by medstruggle(21), visit this page
get full access to all contentbecome a member

Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

get full access to all contentbecome a member
colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +16
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +6
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +13
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +42
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 +13
bigjimbo  LOL +1
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6
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. +10
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2
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? +6
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 +1
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" +3
youssefa  Hahahahaha ya'll just bored +11
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 +6
nbmehelp  I dont get it +1
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +2
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +1
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +1
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +1
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 +3
noplanb  Wait... I might actually never forget this now lol +4
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +1
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? +1
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!" +22
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! +2
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 +2
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +1
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}}" +2
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. +3
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +3
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" +2
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +1
drdoom  the tradition lives on +2
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 +1
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +1
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +1
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 +1
niftykoala  As an extra piece of information, I would like to add that Bungee Gum possesses the properties of both rubber and gum. +
neurotic999  Oh I get it! Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens. Makes alot more sense now after reading it a hundred times. Thanks guys! +
rdk3434  okay , this actually made my day and i also learned that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens!!productive +
laravonter  Since it has been a month, I feel the need to remind all that sertoli-leydig cell tumors are notorious for producing lots of androgens +
thisisnewgg  FCGSLCTWANFPLOA +


get full access to all contentbecome a member

How do you distinguish this from testicular torsion? Is it just because it started in the left flank?

get full access to all contentbecome a member
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 +12
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. +22
johnson  This is the classic "loin to groin pain" of nephrolithiasis. +9
suckitnbme  Testicular torsion would also tend to have a unilateral high-riding testicle. +
an1  testicular torsion has high riding testis, that would have been a prevalent finding to push this towards TT +


submitted by stangstumpster(-3), visit this page
get full access to all contentbecome a member

PTH is increased because serum calcium is low. Because PTH is increased, phosphorous is decreased. The woman in unable to absorb vitamin D (a fat soluble vitamin), so calcitriol is decreased (no vitamin D for the kidney to activate into calcitriol).

get full access to all contentbecome a member
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(671), visit this page
get full access to all contentbecome a member

According to this paper, insulin inhibits alpha cells from releasing glucagon. This is the relevant figure from the paper.

get full access to all contentbecome a member
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/ +9
xmen  FA 2019 p 324 insulin decrease glucagon release +
xmen  FA 2019 p 325 Glucagon Secreted in response to hypoglycemia. Inh ibited by insu lin, hyperg lycem ia, and somatostatin. +


search for anything NEW!