share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to mutteringly’s page.
Contributor score: 10


Comments ...

 +0  (nbme24#46)

This is from amboss: Mutated CFTR gene (ΔF508 mutation) → misfolded protein → defective protein is retained in the rough endoplasmic reticulum (rER) for degradation → ATP-gated chloride channel is absent on the cell surface of epithelial cells throughout the body (e.g., intestinal and respiratory epithelia, sweat glands, exocrine pancreas, exocrine glands of reproductive organs)


 +2  (nbme23#27)

Answer is not C) Cavernous vascular spaces because that is specifically talking about cavernous hemangiomas - often asymptomatic but involving deeper tissues of body, primarily in liver (abdominal pain and RUQ fullness) and brain (can cause intraparenchymal hemorrhage).


 +0  (nbme23#41)

UW Question Id: 1976 Testing a very similar concept and provides a great explanation for this!





Subcomments ...

submitted by madojo(176),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Uhg hnew you od ti ni rwluod, iwetr it ondw ubt isllt isms .it

aAyynw gnigo oevr rhtoe nserwas i)h: (yaocmcipratFbsto gahnsce fo eth baestr -t;g&- g,ibenn uayllus on argheiscd twih hits and uyo lilw llusayu hvea a yplmu betras or noeshgimt paaplelb dan it is enoorhm dt sgdeem.ePiaat eesdias fo eth asertb tg&;-- tenesnixo of luadtc rcncmiaoa in tius ot clutsarfoei studc dna iskn fo nlpiep dcruginpo ,srha so uyo see skni ean.hgcs No kins agsnhce deotmhnien tcreir enPlmo.oaa g-&;-t aohegcllrtaa ton odlob itndeg

oS erp UW dintaraluct ailpplamo si a rflepiaiotonr fo apllapiry lsce ni a tysc lalw ro udtc atht mya ecuas fcola tpaayi - TI SI EHT TMSO OMOCMN UASEC OF OLBDYO IENLPP DCSHARIGE ADN ETASRSB TITHWUO SBTEAR SAMS OR ISNK SAEHGCN

ocperma ihst to yaplalpir mconiacar erweh ouy soal ahve nlipep gieshdcar tub you ludwo ees it ni a tpos slmepnuaoa ew.nom

drpatinoire  Upvote it wishing I could memorize it lol +  
mutteringly  To add to this, papillary carcinoma will only have epithelial cells and no longer have the myoepithelial cells that intraductal papilloma would have. +  


submitted by m-ice(339),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tonomAuy si hte tsom oianttprm cihste cipelinpr atht updesresse lla r.hsoet r,wHeevo ti si lppaied olyn in ttoisunisa in whchi a niatpte dneesramtsto siman-iieodgnck ycaacpt.i In isth ts,ouiatni a peitant wiht aecavndd deisase ulnkiyel to eb eudcr si nirfsuge ne,mtatetr cihwh is sih hrtgi rudne het nrcepiipl of o.yantomu v,eorHwe hsi mnsoetmc atoub ntn"rgeuri ni 6 onshmt ratfe ngiucr iisttrhar" era ti,laesoqebnu nad wrraatn indgmteneir if eh sha seoidicn mgakin c.cyaptai tI is pobissle taht he esod, hichw is hyw any ocihsce fo oncrfgi htrfuer menttrtea on imh aer rroccne.it

hungrybox  These ethics questions seems so simple and yet somehow I always get them wrong. I guess deep down I'm just a scumbag. +14  
mutteringly  Hey there's always dental school +1  
hungrybox  legit made me lol, thanks for that +  
jurrutia  Also, the patient is delusional! He thinks he's going to cure arthritis. You don't have decision making capacity when you're crazy. +  


submitted by drachenx(54),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTseh sdikn of tsisqnueo aer ellyra ahrd cusaebe ve'I enrve eesn mfleea tropuicvdree stsrcreutu l.ri c:

nbmehelp  Lmao +3  
regularstudent  Lmao +1  
mutteringly  Lmao +  
rockodude  lmao +  
abkapoor  Lmao +  
dang90  LMao +  


submitted by apurva(73),

Pharyngeal arch is not same as pharyngeal floor, pharyngeal arch is mesoderm from which nerve artery muscle cartilage develop. Pharyngeal floor is from where tongue develops which is endoderm

mutteringly  However... 4th-6th pharyngeal arches do develop ACCCT (arytenoids, cricoid, corniculate, cuneiform, and THYROID). Thyroglossal duct cyst: a remnant of the thyroglossal duct that forms during the embryonic development of the thyroid gland. The thyroid gland originates from the foramen cecum at the base of the tongue and descends caudally into the neck, creating the thyroglossal duct. If the duct fails to obliterate, midline neck cysts or ectopic thyroid tissue can develop anywhere along the path of the thyroglossal duct. +  


Congrats on ruining this site. Let’s make students pay to collaborate with each other via comments

petereallyreallysucks  S FSKj E FlSKd fe +2  
mutteringly  Dif Asdf eti-4f s APSpasld pqdfmlvzae +1  
mutteringly  Dif Asdf eti-4f s APSpasld pqdfmlvzae +  
hatethescramble  And during a pandemic when rates of unemployment, suicide, and cancelled Step exams are at an all-time high. Wondering if the creator of this site always intended to have student contributors build it free then charge, or if the pandemic and riots were have been just so inspiring. Don't mind if I pay for this site to take the test I pay for the school I pay for just so I can finally help people as broke as me access healthcare. +  
hatethescramble  test for for* the school; sorry for the grammar but I'm just a L!tTlE FrU$tR8d +  


Congrats on ruining this site. Let’s make students pay to collaborate with each other via comments

petereallyreallysucks  S FSKj E FlSKd fe +2  
mutteringly  Dif Asdf eti-4f s APSpasld pqdfmlvzae +1  
mutteringly  Dif Asdf eti-4f s APSpasld pqdfmlvzae +  
hatethescramble  And during a pandemic when rates of unemployment, suicide, and cancelled Step exams are at an all-time high. Wondering if the creator of this site always intended to have student contributors build it free then charge, or if the pandemic and riots were have been just so inspiring. Don't mind if I pay for this site to take the test I pay for the school I pay for just so I can finally help people as broke as me access healthcare. +  
hatethescramble  test for for* the school; sorry for the grammar but I'm just a L!tTlE FrU$tR8d +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Mast slelc euedr,lnagat uopgrdnci mnaehtisi wihhc tscatrat iolses.hionp eTh rylea aestg fo na gearicll troeniac is atsm elcl ,iedametd btu teh etal esgta ig(ilcndnu uumsc cuoido)trnp is dediamet by p.soihenisol

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 vshummy(161),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So eht steb i locdu dfin asw ni Ftris Aid 0291 gp 643 unrde eibctiaD .icasesdtKooi eTh eyeharymlgicp dna hmerpikaaley ecsau an ciotmos dsiieusr so eht enteir ybdo etgs dpeetedl fo fi.sldu ceneH hwy tpra fo het emtntreta ofr AKD si IV ludi.fs Yuo gmhti evne yelr no that ceipe of ntamofrinoi loane to rnewas shit nitsqoeu, taht KAD is teredta iwth VI ifl.sdu

fulminant_life  I just dont understand how that is the cause of his altered state of consciousness. Why wouldnt altered affinity of oxygen from HbA1c be correct? A1C has a higher affinity for oxygen so wouldnt that be a better reason for him being unconscious? +6  
toupvote  HbA1c is more of a chronic process. It is a snapshot of three months. Also, people can have elevated A1c without much impact on their mental status. Other organs are affected sooner and to a greater degree than the brain. DKA is an acute issue. +6  
snafull  Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +3  
johnson  Probably because they're sustained on ketones. +3  
doodimoodi  @snafull glucose is very high in the blood, why would neurons not be able to use it? +2  
soph  @snafull maybe u are confusing bc DK tissues are unable to use the high glucose as it is unable to enter cells but I dont think thats the case in the neurons? +1  
drmomo  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/ states its primarily due to acidosis along wth hyperosmolarity. so most relevant answer here would be dehydration +1  
drmohandes  I thought the high amount of glucose in the blood (osmotic pressure), sucks out the water from the cells. But you also pee out all that glucose and water goes with it. That's why you have to drink and pee a lot.. +7  
titanesxvi  Neurons are not dependent on insulin, so they are not affected by utilization of glucose (only GLUT4 receptors in the muscle and adipose tissue are insulin dependent) +25  
drpatinoire  @titanesxvi You really enlightened me! +  
mutteringly  I don't make the connection of what titanesxvi said to the question - can someone explain? +  
motherhen  @mutteringly it explains why the answer choice "inability of neurons to perform glycolysis" is wrong +1  


submitted by haozhier(17),

Can someone please explain to me: If the posterior 1/3 of the tongue is developed from 3rd and 4th pharyngeal arches, why is it wrong to choose pharyngeal arch?

therealslimshady  Welcome to NBME +2  
mutteringly  First time? (meme) +2  
drdoom  That would be like choosing “blastula” if it were an option: it's not wrong but there's a more precise answer. +  
pontiacfever  That is wrong. They're indicating towards thyroglossal duct/thyroid which originates from Pharyngeal pouch not arch. secondly, they're asking that the mass originated from which structure. So, as we know it is associated to foramen cecum which is related to tongue. +  
drdoom  @pontiacfever, i believe you’re responding to @haozhier’s original comment, yes? +  
pontiacfever  @drdoom, yes the original comment by @haozhier +1  


submitted by temmy(129),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hWat fo fi eth nacrec si a iatloelhru creacn ni the rdeladb ued to roiaiadtn ayte.hpr udowl ti tno esauc alrisim nigss

charcot_bouchard  Chance of bilateral ureteral ca is very rare. Also preincipal r/f for transitional cell ca is Smoking not radiation +  
peridot  Hi temmy, yes it sounds like it would. There is a similar question from NBME 21 for those who have already taken that one (https://nbmeanswers.com/exam/nbme21/744). In that one, it's cancer in the uterus instead of bladder, but it's the same concept - the cancer can spread from the uterus into the bladder, or compress on the bladder, leading to bilateral hydroureter and hydronephrosis. So basically the takeaway point from that question and this question is that we learned a few things that can lead to bilateral hydronephrosis and hydroureter: 1. bladder cancer 2. uterine cancer 3. surgical and radiation treatment of cancer in that region, leading to bilateral fibrosis of the ureters. +2  
peridot  Whoop just realized that urothelial carcinoma is a possible answer choice here. Well, I'm lost.... :x +  
abcdefbhiximab  Urothelial carcinoma presents as painless hematuria with risk factors (i.e. smoking, aniline dyes) +1  
mutteringly  In addition, the wording says "distal ureteral narrowing" which wouldn't happen with bladder cancer +  


Just remember Point, Squeeze, and Shoot

Erection - Point Parasympathetic NS (pelvic splanchnics S2-S4)

Emission - Squeeze Sympathetic NS (hypogastric nerve T11-L2)

Ejaculation - Shoot visceral and Somatic nerves (Pudendal nerve)

FA19 pg. 609 (nice)

llamastep1  Emission, as the first phase of ejaculation, is a sympathetic spinal cord reflex and is defined as the deposition of seminal fluid into the posterior urethra. Ejaculation or expulsion is due to the combined action of sympathetic and somatic pathways. +  
mutteringly  actually on page 613 FA19 lol +  


I think the reason they are being such little turds and calling it dipalmitoyl lecithin instead of DPPC is because there's a thing called the lecithin-sphingomyelin ratio which needs to be high in order to indicate that the fetal lung has matured. Both lecithin (DPPC) and sphingomyelin are present in fetal lungs, but the amount of lecithin shoots way up towards the end of gestation, raising the L:S and indicating lung maturity.

mutteringly  naw they just turd +1  


submitted by usmlehulk(4),

can someone please explain this question. i thought the patient is actually having cleft lip and palate, but why is the correct answer addressing only the cleft lip.

dentist  The question asks "the most likely cause of the facial finding involving the lip in this patient..." +5  
snripper  lmao. gottem +3  
ace9yak  cleft lip = 'processes' clef palate = 'shelves' +1  
mutteringly  Don't let a dentist tell you whats up :( +  


submitted by dr.xx(150),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA arpt of eyromcbni eetemopldvn, eht eacpasrn fomsr sa wot dsub mofr het tfgureo, an rmceoyinb betu that is a rrspcoeru to the nolsaiteagsitrtn at.rct It is trfeoeehr of medaendorl iiro.gn

Pno#rhte/pic/wvepssigakwnendioaDi:aeer.lt/tk.e/imp

gh889  nice! I reasoned it as that most of the GI system is of endodermal origin +9  
taediggity  FA 2020 pg 613 +1  
mutteringly  FA 2019 pg 599 +