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Contributor score: 147
Comments ...
sunny
Also it(blockers) hides signs of hypoglycemia which are tremors.
+7
lovebug
and FA2019 pg 662:
Vit.D usually activated in Kidney. but They can be also activated by Macrphage like this case.
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Subcomments ...
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.
+
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
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
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
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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.
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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
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)
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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
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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
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
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
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
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
@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.
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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!
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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
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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
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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.
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an1
testicular torsion has high riding testis, that would have been a prevalent finding to push this towards TT
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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.
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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).
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diabetes
explanation for decreased bone density .
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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
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xmen
FA 2019 p 325
Glucagon Secreted in response to hypoglycemia. Inh ibited by insu lin, hyperg lycem ia, and somatostatin.
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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