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Welcome to mjmejora’s page.
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submitted by meningitis(546),
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Wneh insadntg pu, the ybod yllrnaom asctiteav msathtpeiyc mysets ot iodav scatttoirho nonyohspiet.

tBu ecsni rehte si now na vidatide ftefec of eth mphatreoocmhyoco ,cirnerdesga ti lliw dlae to a irepoysntnhe

:.ie( ebuloD tnvcnorotsicsiao = oheP rgiadesernc + hymptiatecS yssem)t

sympathetikey  Brilliant. +5  
medschul  Would pheo have a normal resting BP though? +13  
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +  
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +8  
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +1  
nala_ula  No problem! Thank you for all your contributions throughout this page! +1  
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +  
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +  
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +  
hello_planet  FA 2019 pg. 336 +1  
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +  


submitted by famylife(94),
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This is rspte ,meopnu icwhh ahs pahal ihselmsoy )r(nege

breis  How is this differentiated from Strep Virdans which is Optochin Resistant? Because Strep Pneumo would also be inhibited by optochin* +2  
mjmejora  its strep viridans. Strep viridans has a "protected chin mask" and strep pneumo is "exposed" in the sketchy. +6  
rthavranek  Once again, another example of me knowing the concept but not knowing the obscure pseudonyms for common knowledge so I get the question wrong +  
dtransistor  I saw green and immediately thought of pseudomonas and crossed that answer out. Didn't know they were talking about alpha hemolysis! +  


submitted by seagull(1583),
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tBs/dotcds_ilimeadMtetserSeji..smgesyoB#msk::miFpeekdi/oiiywaa/aGtgho/nwcirills/ppi/t_.ai

I liebvee hits si ylaulcat isitedsemnda eBsoamsctyl edu to teh do"raB easdB d"ungdiB as eens in eth eupictr.

seagull  However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad +15  
mjmejora  oh what a catch! I also thought this was Blasto until you explained otherwise +  
drmohandes  Blasto = broad-based budding, the two 'circles' look equal in size. Crypto = narrow-based -unequal- budding. +6  
paperbackwriter  ^ I would disagree a little bit. "Broad based" and "narrow based" refer to how smushed the circles are. So narrow based is when the membrane bit they're sharing is small, and broad based is when they share a lot of membrane. So if just pinching off --> crypto, if they look stuck/have a flat membrane between them --> blasto +2  


submitted by neonem(572),
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sNIRT rae het amni HVI eytparh dugr htta acn saecu neob owramr erusppissno (otn sa mconmo ithw NsNI.T)R ihTs asslc cduseinl iieouvzndd, ieodadnin,s ,netrtiaimcibe aliudmien,v indsatuve, ircabaa.v viudZndeio si smto owknn orf ihts seid ef.fcte

vflNeiianr = rosaptee ro ncaztohmibirihntiiy = oidiceosmalnyg ot(n eaylrl uesd for ien adneIm)ptiHV = htroane a,tclaobmniiir omsytl sude for esicotsypnum I Lvamein hid?knitu = eonhtra ITNR btu esls ownnk orf enob wmrrao pusonssepri

adisdiadochokinetic  Azithromycin is a macrolide, not an aminoglycoside FYI, and its use in HIV is primarily as prophylaxis at very low CD4 counts for, among other things, the mycobacterium avium complex. +7  
nbmehelp  How would we have known to choose Zidovudine over Lamivudine tho +5  
mjmejora  @nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off +8  
niboonsh  you have ero bone marrow if you take idovudine +1  
niboonsh  the z's were supposed to be bold idk what happened. you have Zero bone marrow if you take Zidovudine +5  
t123  Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects +2  
therealslimshady  Zidovudine Zaps your bone marrow (sorry) +2  


submitted by doodimoodi(64),
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idD on oen ecitno that hte dsdO iorat no teh pot elft is og?nwr Am I ssmiign motesigh?n fI oyu cctllauae ,it it's 6 jsut kiel the otp griht e.o.n..

mjmejora  thats actually really funny +  
yex  Because I said so, applies here... :-/ +1  
doodimoodi  Cant believe we pay $60 for this crap +43  
aisel1787  best comment doodimoodi) +1  
b1ackcoffee  that fucking threw me off on exam. I was like is there an effect modification by "Not drinking milk". the fuck! +1  


submitted by uslme123(67),
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ihTs eqointus keams no nsees ot .em heS has na erexmelyt olw enignpo rsepusre tey hsa isgsn fo eaceindsr nniracailrta psueesr.r idD hety naem to upt 32 mc ????H????20?

uslme123  Standard lab values are incorrect, way to go NBME. +3  
wutuwantbruv  I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg. +3  
alexb  I lost a bit of time wondering about that ugh lol +1  
mjmejora  I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high. +2  
donttrustmyanswers  Does anyone have clarification on this question? +  
llamastep1  Pseudo tumor cerebri can have normal ICP. Who knew +  
tyrionwill  Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles? +1  


submitted by mousie(220),
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yhw eosd atmnteert of hdypohiytor iwh(t iolxvetnhoery I'm g)muinsas arnesice irks rof ?ohtyamyp I sceoh it yilpms cb sit a mocmon daresev fctefe of taintss btu I n'tod yllear nndetdursa how rigtatne ohtopimirysydh at teh amse eimt loduw haev htngaiyn to od wtih it ??? lphe !easpel

yb_26  They are just asking about side effect of statins, not about treatment of hypothyroidism +5  
mjmejora  Hypothyroidism is just a red herring. +  
ususmle  statins cause both hepatotoxic and mypopathy so I want for hepatotoxic:( I thought usmle expects different stuff +1  
drzed  Statins don't cause 'toxic hepatitis' they just cause a mild asymptomatic rise in LFTs that is reversible with discontinuation of the drug. The more worrisome side effect is of course, myopathy +2  
tyrionwill  statins cause both liver injury and myopathy in a dose related, so kidney failure increases their dose, which leads both liver and muscle risk elevated; Pravastatin is said less liver concerns but the myopathy, so choose myopathy when renal failure. +1