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Welcome to nlkrueger’s page.
Contributor score: 43


Comments ...

 +0  (nbme23#38)
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.... dwolu we layelr taek eth odwr fo a indefr how yleidetfin ncat' eb rodmicfen? I feel ekli hist si diislagmne

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +9
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +29
dr.xx  The patient has no wife, children, or close relatives... +3
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3
paulkarr  With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1
suckitnbme  I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +7
vivijujubebe  they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +

 +2  (nbme23#24)
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hyw ts,ni' 0%" lstbas on the rlpprheaie mrea"s grt?hi is tihs het gthiginsidnius teruuf ofr uceat im?ekeaul

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +




Subcomments ...

submitted by seagull(1443),
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hWhic fo teh ogflwioln saorens is hwy isht isqotune si lb?ul

)1 sUign eth rdwo lcccy"i" tieasnd of cyrliticc fro yrailtc

2) nionwgK all fo dlooieygmipe fo all grsdu

3) vihgan ot aoesnr uto atht htioiagcnelrcin csfefte era bylorbpa eht owstr vreo p1ahla or 1H fecftse ot on niya.ctret

4) ehT iicrglnpp ponsesdier of nitdygus rfo teek-ays-wods no ned to yabopbrl od vragaee on het set.t

nlkrueger  yo, re-fucking-tweet +20  
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4  
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1  
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5  
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +  
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +  


submitted by seagull(1443),
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uot fo u,cyoirtsi who amy ppleeo wenk ihst? nd(ot be yhs ot yas uoy idd ro )didt?n

My eroytpv oteuncida tdn'id agininr ihts in em.

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


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tPtenai sha a turcafer ot het efiionrr bitr.o ishT cna mgd 2V ro artnep teh RI ulecs.m Olyn RI ttreneapnm dowlu ramiip visoni.

nlkrueger  if this isn't a globe rupture than idk what is tbh +15  
mousie  the air in the center of the globe made me think rupture too ..... +3  
sajaqua1  There may be some global rupture, but impairment of one of the ocular muscles causing diplopia would still be the best explanation for this patient's double vision. +12  
catch-22  Globe rupture leads to entrapment of the IR muscle which causes diplopia. The question is asking what is causing his visual complaints, which is diplopia, not loss of vision. +2  


submitted by docred123(6),
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rAe lla seianstt/tlrerrietivctii nglu eisssade itvacdiien fo a WOL ?LODC

nlkrueger  only if it's an interstitial lung disease i believe. like polio can cause a "restrictive lung disease" but it's due to muscle effort and would expect to see a decrease in diffusing capacity (FA 2018 pg 657.2) +6  
meningitis  Construction worker, Diffuse reticular opacities screamed restrictive and low DLCO for me. Anything that either adds fibrosis to alveoli, or thickens the diameter between alveoli and alveolar capillaries will cause low DLCO. +8  
305charlie94  Actually polio is one of the restrictive lung diseases that have a normal diffusing capacity for carbon monoxide (FA 2019 p.661) +  


submitted by docred123(6),
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Hi gsyu cna mooseen aeselp lrbeaetoa no these i.idnfgsn I urntndedsa esh ash glun crneca 'htats iminepgd ehr haerat.c utB ohw si tsih rtiesearntevep of na ttioecsurvb ed?orsdir t'nreA lgun naecrsc etsrvieirct if yt?hnaign aTkhsn

nlkrueger  I agree that it's confusing but I looked at it as a physical *obstruction* since it's impinging on the airway.... but yeah idk this is weird +  
ferrero  Doesn't the trachea have cartilage rings so it wouldn't collapse which makes it seem less like a typical obstructive disorder? I'm really not sure why FVC would change because I don't see how total lung capacity or residual volume would change because those are static conditions where there is no airflow at all. I understand FEV1, peak expiratory flow, peak inspiratory flow etc. +2  
mousie  Agree this is a really tough Q but I also think I really over thought it... I eliminated all with a normal Ratio bc something obstructing would obviously produce an obstructive pattern although I don't know why FVC would be decreased. I wasn't sure about both peak expiratory and inspiration flow being decreased can someone help me with this or tell me I'm totally overthinking again.. are they both decreased simply bc theres an obstruction ..? +3  
mimi21  Yea I got confused on this question. But I guess they wanted us to look at it as a obstructive disease . If this were the case all of those function tests would dec. ( See FA ) +  
gh889  Because the obstruction is above the alveolar regions there is a decrease in air flow, not lung volumes, which would make this an obstructive pathology. +3  
charcot_bouchard  FVC here dec same way it dec in Obstructive lung disease. Read the concept of Equal pressure point of BnB. There he says in bronchitis we have onstructive pattern because inflammed airways gen more resistance. so EPP comes early. I guess here due to tracheal narrowing pressure inc downstream. which collapses smaller airway. result in air trapping. +1