NBME Answers : myoclonictonicbionic's page

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Air and fluid = hydropneumothorax. If that fluid is blood (s/p stabbing), it’s a hemopneumothorax. Lack of mediastinal shift indicates that it’s not under tension.

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d_holles @benwhite_dotcom how can it not be under tension if air is entering the pleural cavity? +2

nwinkelmann Because the stab wound isn't functioning like a flap, meaning the air can escape. The reason a tension pneumothorax occurs is because the wound acts as a flap, where on inspiration it is open and air enters, but on expiration is closes and traps the air. +13

groovygrinch Also if there was tension, there would be a mediastinal shift. +17

t123 Also the gastric bubble is elevated, actually suggesting lower pressure. Mediastinum shifts require more pressure, but the gastric bubble confirms it. +2

myoclonictonicbionic I was overthinking and thought they're implying that the stomach bubble is the air-food level that was seen on the Xray. +4

cheesetouch umm air-fluid*^ lol +2

chaosawaits Can someone please explain the significance of the stomach bubble? +

submitted by stinkysulfaeggs(125), visit this page

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Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

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redvelvet me too :( +2

abigail me three :( +2

yex Me four :-/ +2

link981 Slowly raising my hand as well +2

tinydoc Sammmme +2

bullshitusmle same here!!!:@ +2

usmlecharserssss patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +19

aisel1787 me five( +1

myoclonictonicbionic I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +5

alexxxx30 sammmeeeee +

snripper Dumbasses unite lmao +

usmleaspirant2020 lol saaaaame! +

anechakfspb me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +2

veryhungrycaterpillar I have no idea how I got this right. +

feanor And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols. +1

submitted by thomasalterman(181), visit this page

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Complement is important for removing immune complexes, so patients with complement deficiencies *(c1-c4) are more likely to develop SLE. C1q is a better answer than than MBL (D) b/c the MBL pathway is triggered by bacteria.

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myoclonictonicbionic Thats the reason I put MBL, because the question mentioned that it got worse when she went to the beach so I was thinking some sort of contact with bacteria may have exacerbated her immune system. +

thotcandy @myoclonictonicbionic i think that's just the typical SLE photosensitive malar/butterfly rash +1

dna_at FYI it is less to do with immune complex clearance than it is to do with clearance of apoptotic debris. The overload of apoptotic autoantigens contributes to loss of tolerance -> SLE. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764694/#S4title +2

submitted by t123(32), visit this page

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This question is really testing what the different types of diarrhea show. Key is "stool shows no abnormalities". In malabsorption, exudative, osmotic, and secretory diarrhea, your poop would be weird in some way. A motility disorder is the ONLY type here that would cause normal poop.

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myoclonictonicbionic How would stool be different in secretory or osmotic diarrhea? They state that he has loose stool which could also indicate osmotic/secretory diarrhea. I think they are trying to hint that he has diabetes for 26yrs therefore he has diabetes enteropathy and therefore motility issues +6

takayasuarteritis I'm with you on this. I think it's a myenteric nerve plexus issue from long-standing diabetes. +14

drpee Neuropathy makes sense for T1DM, I guess I just expected a motility issue to cause constipation rather than diarrhea... +19

mnunez187 Moving too fast or moving too slow +

an1 @drpee yeah same, UW mentioned that damage to enteric nerves in DM leads to constipation, so I thought the motility disorder should have constipation +

submitted by sammyj98(39), visit this page

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did anybody else second guess the heck out this answer just because he's got a pH of 7.2 and he's hanging out in an outpatient clinic? I haven't done my clinicals yet but it seems like this guy would be struggling..

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myoclonictonicbionic EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +5

submitted by sattanki(82), visit this page

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Apparently there is a completely separate spinal cord reflex where direct penile stimulation leads to an erection. This reflex only needs an intact arc in S2-S4, so as long as this region is not injured, an erection can still occur. However, with transection at C8, then the psychogenic erection reflex cannot occur, as this requires descending fibers from the cortex.

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lsmarshall Just saw a good summary of nerves/vessels involved saying, "pelvic parasympathetic fibers from S2-S4 can cause cavernous arteriole vasodilation via the cavernous nerve without of central stimulation." +8

seagull S2-3-4 keeps the penis off the floor +45

drdoom Modifying @seagull into iambic pentameter: “S2, S3, and Number 4 / keeps the big ole penis / off the floor” +3

myoclonictonicbionic I can assure you the validity of answer (speaking from experience) +2

raddad https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ Under the "autonomic control" header +2

llamastep1 I've always wondered how quadraplegics got it up. I guess their girls help em lol +

jj375 This article is shockingly helpful. Scroll down to the 3 types of erections (psychogenic, reflexogenic, nocturnal) https://craighospital.org/resources/sexual-function-for-men-after-spinal-cord-injury +1

submitted by m-ice(370), visit this page

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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.

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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 studentdo(10), visit this page

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The major motion of Psoas major is flexion of hip. This patient is held in "rigid extension", hence he does not want to flex. Psoas is the only muscle on this list that connects the lumbars to lower extremity "holds his right lower extremity"

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myoclonictonicbionic The qstem said "lower extremity in rigid extension" which made it sound like extension at the knee joint rather than at the hip. Confusing wording +2

j44n if you lay on your back and kick your leg straight up this is lower extremity extension, hes doing that to prevent any weight being placed on his psoas, I know because ive had psoas problems before and you will do ANYTHING to keep your hip from flexing (like doing a sit up or pulling your knees toward your chest) getting in and out of a car was a nightmare +