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Welcome to nor16’s page.
Contributor score: 57

Comments ...

 +7  (nbme24#32)
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tnisHimea easniescr rrovuciscaalm eprtay,bliime i..e iduFl + orsiP,etn thsi cinraesse eeprsrus in hte tiinsmtiurte gt&; yplhm flow ssnaeerci

 +6  (nbme24#31)
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OMCP si a phornemoro iepedpt hicna.

It is ldastnreat dna elrat mysenez cut tish diteppe ni eth ssdueppb.iet

nnTtorarcsiip si nwrgo (i dha shit t.)o.o. bc/ tsi nto hte NRmA that emska einfretfd ipetpde seorohnm. rooe,evMr waht I ees won ,is thta atpolostnircsatipnr dianioftomci is remo ro sels os -asnosattrtp.l mofn.iiadctio ntxe temi ew ekma ti rreotcc )-;

medguru2295  This is a perfect explanation. I never knew it was the protein modified (I initially though alternate splicing too) +1
nerdstewiegriffin  Is this an example of polycistronic mRNA? +
paperbackwriter  @nerdstewiegriffin possibly (because it says that the original mRNA results in proteins plural, BUT the mechanism for POMC derived hormones specifically is not bc of polycystronic mRNA. Polycystronic means that you get multiple protein products from one mRNA, but in this case we get multiple PROTEIN DERIVATIVES from one PROTEIN, implying that there are some modifications/reactions taking place once we've already made ONE protein which change the protein into multiple diff. products. +1

 +2  (nbme23#33)
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in ß sihaelmTaas teerh si Ab2H sciarnee nad AHb scre,esdea enev ni ß,+ arnmlo irrcotspleeesoh lersu hits uto. ames rof )-AC)

tyrionwill  Yes! The key point is the normal electrophoresis. Hemoglobin will not show any abnormalities until least one single allele of Hb fully develops mutation. alpha chain of Hb is contributed by two points within one single allele, while beta chain of Hb is made of only one point in one single allele, therefore: -- in alpha thalassemia Hb electrophoresis will be normal if only one point gets mutation, i.e., aa/a- which we call it the "minima type". If two points get mutation, i.e., cis aa/--, or trans a-/a-, the "minor type", the Hb electrophoresis will be either abnormal(Hb Barts 3-8%) or still normal. overall, we assume the parent both are the minima type, so their children have 50% chance to be the minor type, 25% to be fully normal, and 25% to be the trans minor. -- However in beta thalassemia, the mutation of one allele will lead to whole allele changed, so we just need the mutation once to generate an abnormal Hb electrophoresis result. +1

 +3  (nbme23#50)
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all sehto onn mhats gsyu h,eer nodt skip thees i,snoeqstu yrt ot garnera teh sunt,i eher yu´od yesila ndif uot ahtt uyo tujs aehv to liuy!tlmp Give ti a yrt :-)

charcot_bouchard  This was like Filtered Load ques of Renal. Where u multiply icoming fluid (GFR) with the desired substances conc (Px) so FIltered load of A is GFR x Pa Same here. Myocardial O2 supply is Blood flow x Conc of O2 in that blood flow +4
powerhouseofthecell  For us non math folk, how do you compare the mL/min to mLO2/mL to get mLO2/min? Sorry. Do you just find out that when you have the units beside each other, cross multiplying them gives you the correct one? I need to know this trick. I can't find this on google. +
abcdefbhiximab  mL/min * mLO2/mL = (mLmLO2)/(mLmin) where the mL's cancel out = mLO2/min +

 +3  (nbme23#28)
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tjsu wkno reewh hte bgi fftsu / ttoirpnma ufsft is esorr,bed ti si eth CP.T No ened to wkno RAsT

 +2  (nbme22#26)
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neo nattrmoip atsepc ont eimont:dne the " goln " 1 eyra ingbe"n" tsyriho fo eth mp.smt.os.y otn iellyk ofr anngtialm yopams,lhm sosrat or itsaasemst to tays thta alcm

fo recuso in niaiodtd ot all eroth idtnmoeen here o"tn riabn intlfitirnag .c"et

 +0  (nbme21#35)
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nsc ro,plemb anemai ho)(py adn yeikdn m.plbroe

yFnllai olny alde anc caeus all fo ti

 +6  (nbme21#42)
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ohdaotsGornp aer the /FLHHS nrocpuigd ryituitpa No rase,oiv on sroemnoh, on eecadkbf bionhti.iin

lovebug  THX for great explanation. When I first saw this question, I mistook the gonadotrophs for endometrial cell. so I Choose atrophy. (even that pt undergoes a total hysterectomy) critical mistake... +3

Subcomments ...

submitted by lsmarshall(393),
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saalrP"aetrn eaehv lfti)( uccrso dgnuir gitrh urvcnatleri hyhpeoprtry .(ie. trneneg)lmae or yevr rarley reeevs lfte aliart mrleegt"n.nae RV phryeopthry nca eb nees os lsieay ebueacs eth VR is ta hte roatrein refsuac fo eht ehcs.t

In shit tteipna dolbo mfor AL to VL eceserdas in oratasuti,n os ti is ngoig eme.oreswh rmoF hte 2O ats. ew cna cddeue there si byrlpboa a VDS asdr(nceie VR eurspsre loduw suace VHR dan resnlaaptar )avehe. ehFroutr,rm hte eengtvit si ieklyl riedcsbngi rotlaetyg of llotaf aduces( yb aeprnteiroruso pdeelmtcaisn fo eth nuidrfailnub pu.t)esm In Tet elspsl, RV ftuolwo si too sttcurobed dna itneapt estg yasioncs dan R&L;gt tgunnshi tuSsaq reaniecs R,VS ndecaegrsi L&gRt; i,htsugnn nupittg oemr lbood ohuhgrt yonpmular tiucrci nad ignerilev cn.ysaosi

seagull  i'm pretty sure your a prof and not a student. +15  
nor16  nevertheless, we are greatful for explanation! +  
niboonsh  I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml +  
anotherstudent  Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize? +1  
pseudomonalisa  This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though). +  

submitted by jus2234(18),
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Teh gprah soswh a eaecsder in epnolmaicc of the gns.ul Of the potons,i fsueidf amrplnoyu rsiisfbo is teh oyln iceoch atht is na paemxle of a viirsttrcee nlgu aiesesd iwchh wdlou secardee ciemnaoplc

nor16  asthma = emphysema = chronic bronchitits, obstructive. leaves 2 out of 5... +4  
usmile1  Common causes of decreased lung compliance are pulmonary fibrosis, pneumonia and pulmonary edema. So yes pneumonia could possibly cause the decreased compliance shown, but the vignette says the patient has "9 month history of progressive SOB." That couldn't reasonably be pneumonia, leaving diffuse pulmonary fibrosis as the best answer. +8  

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maPthao asys reeth rea 3 itghsn taht irifftedneeat lukoiemed rofm L:CM+ keueotycL anlkliea hahopspeast no(yl ni )dm+ ueokeli Bispohlsa ly(no ni + MLC) 29t(;2) onainttaclors (nloy ni MLC)

nor16  yeah but pathoma doesnt help here... +1  
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +  

submitted by sajaqua1(519),
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A adn J prnreseet het cierlag ufaccs,iuls liehw B dna I rptesnree het uaneect s.sucaulcif hgretoeT hyet ekam pu het dlarso nomliduecm-al lmnacesli trt,ac irenspoblse for nnpiiotp i,enrotcppe r,ippncoitreoop ba,nriitov nda res.peurs nIupt is ae.ltisrpali

C nda H mkae pu teh alleart ocposiairtlnc ttrac (oasl dellca eht letraal sperrinbeloac lsafu)uscc,i penberssoil rfo oromt ndocmma of ltrialpeias

D nda G rreneetps eth llaater phiaasoltmnci a.rtct tI is sebeolnisrp orf apni dan pramteuetre ouc.itdnnoc ehT tnupi isaesr in a ibml le(tf welro eireymtxt ni thsi ae)cs, tsreen oughthr eth sdroal toro ruciped(t ntbeewe J nad ),H ctdaessues dan ndecssa ta teh retoiran omcuresims stuj( ehbidn E and F,) nad llyanfi esspyasn no the cenods erdor ronneu ni teh lalrtea hompntialaics tctr.a oS het hlisapimconat tartc si nesborlepis rof altloreraactn npia dan epmraetruet .nstoisnea seuaBce our ntiepat ash olts saisennot on eth fle,t the oselin si ni eth

E dan F aer eth etoinarr sloncoipriatc ttar.c tI is lndvveoi in ootrm conoltr of ixorlmpa secsu,lm lpytliyca fo hte tru.nk

nor16  good job +5  
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3  
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +1  
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +1  

submitted by sbryant6(152),
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tiPnnoe rrasieet rae lalsm ahsbnrce fo eht raasbli traery tath nac rurtuep in eht egntits of yropol lndtlooecr nenpyteh.oisr

nor16  vertical gaze intact = mesencephalon intact horizontal gaze damaged = pons damaged (RPRF) Pons damaged = no access of corticobulbar tracts to motor nuclei in brain stem -> speech impaired +1  

submitted by notadoctor(152),
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cCiael puers is a oblpsnioatrma emosndyr ttha tslsuer ni aeoethrtras dna lrsuest in nori decifeyicn As arf sa I'm ,eaarw eonn of eth eshrot erutsl ni rnio fdeycecini .amaein (I dah areBitacl hwtgvoroer as a cselo dncoes btu I dto'n vbeilee ashtt' isoatecasd iwth nrio cfdei.)nicey

yb_26  bacterial overgrowth is associated with iron deficiency, but also with Vit B12-deficiency, so I guess pts will have macrocytic anemia +2  
nor16 Vit B12 is key here, moreover, no bloating (IBS and bacterial overgrowth with bloating). bacterial overgrowth is a close one! +1  
covid2019  I wrongly chose bacterial overgrowth, but that is wrong because Small Intestine Bacterial Overgrowth (SIBO) must be instigated by something. Commonly, anatomic abnormalities (like surgery causing blind loop syndrome, strictures, or motility disorders that allow the poop to ~fester~). +3  

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lngdAeecwok het 'setanpti yiitl.ufdcf I ahet ehtse niqssueto

nwinkelmann  Me too... also, he's had cough that's worsening for 6 months plus hemoptysis for 1 week... I didn't interpret that as "feeling healthy." The correct answer was my first choice just because it was the least "dick-ish" but to me, he didn't sound like he "felt health," so I didn't go with it. +1  
nor16  if he didnt feel healthy, why would he say something like that then... but i agree, these (especially this) question(s) are often XYZ123! +1  

submitted by meningitis(502),
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crsoPse of teiniamloin on shit en.o

  • I enlimaedti bColamry thhposea,p rniiAnge deu to earu ye.ccl
  • I litdamenei APT eebasuc TAP aonel tdwolun' eghanc PF6 ntio aemnocusgil
  • AGN I tgo uylck nda I ledmeainit ti edu ot tsi sue in EMC nda nagolcle os I 'ntdid ktinh it asw rnelevta and I iknd fo ebermrmede ti gnbie ni euar yl.ecc
dr.xx  you mean, pure luck? :) +13  
impostersyndromel1000  lol pretty sound logic here mate +2  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  

submitted by nwinkelmann(284),
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I ETHAD hsti rputc,ie sjtu ikel vneeyore ,esel oll, so I idd soem rmeo ng.diigg vyoeenrE wbloe is r,tcocer htta eht nnterstapeio is tgsguignse na sinifecuot IUsT nca esuca ecatu ,ppntehesorylii dan fi hn,ricoc esersprsgo to onci.hcr porhilyiePnets is a urbtnluastiitoleti adeisse. I dfnou hsit tonnmiroafi rdigngrae ,it adn ni eth satl apr,t ti ibecsdrse teh ssorg poolygath of oncrcih l.etpiisoyhpren omFr ym rpnteitta,eroin it suonsd ikel tawh het ecuprti si hiwsngo, btu I 'wtsan laeb to nfdi a ejest/rtbtu sa godo one oeniln yet, os I tond' konw rof .sreu

ctAue tilTluitaoeibtunrs phetsrNii: tecuA iitnalonammf of uelubts nad titsutiiremn acn eausc RFA, nad fi hte atniyamolrfm poesscr isrpsets hsit nca evlevo inot nciorch tiiuniaeuttrtlsolb iirpsnteh nad ohriccn sianrtiiltte srboisfi nda rtbuaul yrtphao wtih rsik of gsepnoriors to eetng-das nkdyie oTw rmaoj srcteogeia fo cteau lretiuulttabitison pnihsrtie rea tcaeu philreespoiytn dna cueta yeenitripysstivh itialneuitrutslbto rhpis.eitn

ucteA :iriosephpnelty aueCds yb biralceat ncftoiein tmos lcmomnoy .E iocl cfion.enti yvsitriietHspeyn ottillsnruebuaitit :netrihips dsuCea yb an lacglier esr,npeos fro al,exemp ot a ugrd or eroth utebnscsas htat era eind,esgt hscu as blrahe

yB fra het omts oncmom oetru fo itonenfic in eucta tnpyilreosheip is an cngsdnaei inoientfc ni hte aurynri r,tcta fro mexpae,l reddiev romf a beltiarca aedblrd utAce ihppotnreiyesl = envetiexs unxilf of PMsN wntiih eht st,miiernttui beuults )ltutiis(bu, and nsmuel fo sbutelu B(WC sc)sat (/thbPyB//t.tyJDi:pl2i.)

hWti sptrecsenei or eerrucnecr of cueta hryt,ispepinole the seeasdi erscspo vveoesl toni icncorh o,ihpnrlysitpee wchih lauslyu is mcopdniacea by kdaerm osenrio fo eth prapailly itp iglerstun ni ltiiaodn fo het dcanjtae ylcxa i(tlaa.)cescis

The sotm iihrcaecttrcas topocliahg rutfseae fo cirhocn ppleeyiotrshin ear eth ssrgo ghnscea ni het yeiknd ithw e-dbasdarbo csasr in teh mnyaphcrae lnirveygo asrae of itccaolr dan amellyudr troayph whti ajcetdan caetlsiicas. A,sol the aotpistrenen tsusgesg hnryioess,rphod nda rfom ym srea,rche rsnhid,phrysooe nwhe csh,vornerc/ie nac rebntuotci ot hte mdaekr sslo fo xcoetr dan irfssioacrbs/s of hte aemudll (eeAd/7ALwmabt:/tN.lsuhdT/ut.mN0L.aeHtR.tM/phERhphE0) adn eisacctilas hci(wh I ihtnk is nsteper no tihs piretc.)u This is het oelssct tricpeu itwh ticsorndiep I colud fnid thta esmhtac the esmt astrnitneoep .(i.e yhrtoruedre dan s,orpihrhdeonsy iegtsgsung iersouerlecatv xlreuf gdenali to finontiec ofmr "a lngo nsatidgn bnustoitorc poayb(rbl "ltnoic)enag os lyleki omfr a di)clh /pdAMuLeahad0LNmbhpwNms/R.etA/

loA,s ot mtenion on eth hrote ntcmoesm xrnsgieesp ianutrrtfso atht the emsa euctirp asw euds rof somtur adn rbulatu ytorha,p ofrm htwa I r,eda atth rgoss o,atgolyph si eht gnelrea neeraapcpa fo dyteouerrrh ude ot urbtciosetv hrpoatuy (e..i utlruab oar,hytp faisrr/ic,iosbgnrs cxetiy/cacasaslil di,naotil nad ihnt rcitclao rim eud ot p.hytrao yo.hoPnlogitcnlemoa ysas htta eth ssliaeictac is aeargdtgeex in lses ervese aasplercatis/ oucobnsttir cneis GRF is not desrupsspe ubutcmro:/lhp.edt/itvohy..khslweygittosantcenipmlwop/tt/ocswio.)

Hpeo isth lephs e!evryeno It seur ledehp ,me ubt toko YAW oot glno to ,rddsetnuna lo.l

nor16  nice job, but i dont think you need all this for these questions +4  
alimd  next step is to do randomized trial) +1  

submitted by luckeroo(7),
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ywh was isth mgzfobireil adn tno ani?nci I swa uylkc dna ,dgueess ubt I hhtguto ncinai nemoibdc ulocd osla gigtrre hayyop?tm

.ooo.   Gemfibrozil is a CYP450 inhibitor causing an increase drug concentration of statin which would lead to the adverse side effect of myopathy. Not sure about niacin in combination with statin but believe this would be more likely to occur. Hope this helps! +1  
yb_26  yes, it can be seen with niacin and esetemibe as well, according to UWorld. But first choice in such questions is always fibrates. +  
nor16  number one no-go combi is statin+fibrate here +3  

submitted by mguan1993(8),
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acn sooeenm ixpnlea yhw teh renasw si not eandlra nald?g I eefl eik fi danarle ldnga asw eth usise ereth dwluo slao eb ecedesdra iontctansrocen fo ,FSH L,H adn eorgsnte ?irght

mguan1993  ^nvm had a brain fart and go adrenal gland mixed up with anterior pituitary lmao +4  
nor16  ovaries are #1 estrogen producer no estrogen no lubricant = dyspareunia no estrogen and no fsh/lh --> there must be a "higher" problem, up there in the brain +3  
pg32  I agree that hypothalamus is the most logical answer, but if she had overactivation of the adrenal gland (cortisol secreting tumor), that could also inhibit GnRH and cause these same symptoms. +  
drzed  @pg32 the physical examination would not be normal with either a ACTH or cortisol secreting tumor. +  

submitted by niboonsh(336),
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i otg isht neqituos htigr utb wyh ncudtol ti eb kgoni lbboa?i

nor16  and why no therapy, i.e. cognitive training` +  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +2  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +  
tryntofigritout  Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha +5  
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." +3  

submitted by enbeemee(13),
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i gte ywh 'tsi lfn,ilaelg btu is eht fieccisp esnroa tath LSP is gnrwo si secbuea 'ist utsj not owh eth ncacive is a?dme SPL uwdlo osla tiliec an mienmu ncietra,o gt?hir

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +3  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +2  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +2  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  
jp1003  I think it's because Neisseria does have LPS. They have LOS instead. +  
jp1003  *does not have LPS +  

submitted by ragacha(14),
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EPAG 942 AF 0218 AAMDEG IN DARSOL UNOCLM nu(tionf ra:e e,spresur nivtioa,br einf thcou, epopitn)roipcro SPENSAY 1 : .N cLrgiae ( rLweo ,ydob g)eLs AND N. ncUaeust eU(rpp bdoy, )arsm

nor16  Cuneatus = Cervical, write into columns CG ( fron left to right) Cuneatus, Gracilis (CG) +1  

submitted by neonem(550),
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isTh is a esca of teuac guot. uiooMdonsm traue lystcsra ear nakte up by trouh,epnlis elading ot na ecuat atalrmmfnoyi itonrace. lselcT- er'ant alreyl veivldon ni uotg r(emo imrdaetouh aitt.srihr)

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy. +3  
temmy  the way i thought about it was how did the neutrophils get there? the answer is via increased vascular permeability +14  
nor16  they, unfortunately, did not ask " how did neutrophils get there" but " whats the cause of the swelling " not to confuse with " what causes the swelling " +1  
divya  absolutely right temmy. that's how i thought about it too. +  

submitted by usmleuser007(370),
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roF RCC: (sA rep DOWL)UR

emSyitrmc ilrblaeat wolre etxyimtre ptiignt eedma dan tuootrus imadbaoln sveni era nrnncecoig for nor enraiif vean cvaa ICV)( usorit,ncbot chi,wh in het ntgtsei fo a ifesetl-dd nfkla amss, asr stnggsleue ecll Cr)mo Caan(Rcci tiwh tnensoiex oitn het I C.V CCR tscoanuc rfo %;gt9&0 fo all eicmnganlasi niisrga in the dinkye adn si yhglih sdiseaoact whti mo. sking niPtt sea wtih RCC calclssliay heav a itdra fo lfnak ,pian aellappb sam,s nad a,rtiaehmu hgtuhoal ynma mainre atscytmpmoai uitnl the adssiee si RenCv.cCadad is a lyighh scavrual trmuo aavidt etnsh eth nerla vnenii  pu ot 5%2 of c IVC otrobuistnc nac ccour due to anrialtiunml tsnoexien nad thubomrs tiroomf,an heratr than smas ctffee fmro teh omrut  fe.tsil

ehT outtcbsinro nca ruocc lyeatcu ro aulraylgd revo met.i  nI iocnhrc css,ae taalelcolr uveosn tnruciaicol amy epvoedl ebasd no the iset of eth rsbo.noi tuct nPetmionr ioaabdlmn aeaowlllt clalr sne,vi as ni sthi ,ietpnta ugssget ntbisuooctr fo hte erpup mtegnes of eth C.IV

nor16  high blood pressure, i.e. Hypertension, risk factors for atheroscl., bruit !!! over left abdomen, secondary art. Hypertension. they always want the renal artery stenosis (like vWF in coag. disorders...) +