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Welcome to oznefu’s page.
Contributor score: 21


Comments ...

 +1  (nbme21#2)
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loduC yonane veig an epxamel fo awht aeesisds uwldo tsbe mahct eth hreto awesrn hsico?ec

vonhippelindau  Leprosy is a noncaseating granuloma fyi. I found that granuloma with suppuration can be caused by blastomycosis according to Robbins (pg 710): “In the normal host, the lung lesions of blastomycosis are suppurative granulomas. Macrophages have a limited ability to ingest and kill B. dermatitidis, and the persistence of the yeast cells leads to continued recruitment of neutrophils. In tissue, B. dermatitidis is a round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei (Fig. 15-38). Involvement of the skin and larynx is associated with marked epithelial hyperplasia, which may be mistaken for squamous cell carcinoma.” +5
usmleuser007  Pyogranulomatous Inflammation An inflammatory process in which there is infiltration of polymorphonuclear cells into a more chronic area of inflammation characterized by mononuclear cells, macrophages, lymphocytes and possibly plasma cells. Actinomyces sp. is gram-positive, acid-fast–negative filamentous bacteria that cause pyogranulomatous infections in dogs, cats, cattle, goats, swine, horses, foxes and human beings. +1

 +5  (nbme22#46)
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woh do yuo wroanr dnow atht sttrseeoenot decresian iomnbhlgeo nte?aoritonccn tjsu a odranm tcfa ot n?owk i ptu lleianak hasehsaptop bcesuae i rgiufde cnadreeis ertststeeoon will aecneris nbeo wtrgho nda rdlue out ptfiap-ectsorsice eginnat cb sit’ a naomw.

hysitron  I guessed this one cause men have a higher hemoglobin than women. +10
notadoctor  High levels of testosterone will result in amenorrhea. I guessed that since she's not menstruating she will not be losing blood and therefore hemoglobin. Therefore her hemoglobin levels will be higher than expected. +5
meningitis  It kinda makes sense knowing testosterone causes catabolism so I was in between Alkaline phosphatase and hemoglobin... +1
enbeemee  isn't testosterone anabolic? +4
syoung07  ALK phosph is indicative of osteoclast activity. Testosterone keeps male bones strong just like estrogen does for women. Testosterone builds bone (osteoblast activity) therefore we would not see a rise in ALK phos +

 +2  (nbme22#37)
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eosd oyanne nkwo hwat A, ,B C adn E rae inogpnti to? I eigudrf D is uaabtssnit ragni icens t'si the cotcrre s.waern

upstairs_bumblebee  A/B - i think both of these are just thalamic nuclei; C -> STN; D -> substantia nigra; E -> hippocampus +15
lakshmi  B might be Internal capsule!? +

 +1  (nbme22#33)
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I egt hse deldubo her holvtnerxyoei sdoe usebeca of fuaeg.it I tge ttah SHT is ersaed.edc utB yhw is fere 4T sdaecdree nda eerf 3T srdn?eaeic Wldn’otu btho eefr T4 nda eref 3T be airnsede?c

lnsetick  she doubled her triiodothyronine not levothyroxine, so she took a bunch of T3 -> feedback inhibition of TSH and therefore decreased T4 +22
oznefu  D’oh didn’t even read that just assumed it was levothyroxine. Thanks! +7
asharm10  NBME's give you very few buzzwords, read it super carefully!! questions like these are free points +

 +0  (nbme22#15)
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tWah era hte drwos taht tnpoi ot inraoCacm rehrta thna citscyobFri or mrFdnoaeiboa ro Fat srNcseio nt(o an ?areswn)

eshTo nac ahve seasms dan lfosiaitacccni irth?g sI it oynl eht rarlrgeui ?sanimgr

mnemonia  Fibrocystic changes doesn’t technically encompass sclerosing adenosis, which is the one where you would get calcifications. Cysts and fibrosis don’t usually present with calcifications. Fat necrosis I’m sure they would give history of trauma in the stem. +
mnemonia  Calcifications = fat necrosis, sclerosing adenosis, and DCIS/IDC. Microcalcifications specifically I would venture to say is a buzzword ductal carcinoma specifically. Either way, of these 3, only cancer is an answer choice. +1

 +4  (nbme22#27)
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’Im navhig belruot nnaddeuisgrnt yhw htis si a reettb ocehci than tegaP saeies,d caypelleis thwi eht sicnreaed ALP?

zelderonmorningstar  Paget’s would also show some sclerosis. +4
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +24
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +16
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +

 +1  (nbme22#6)
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I tge ahtt the snrwae is etrcrco rof a ersvileerb uyjinr eewrh rtehe si lcel lslewngi eubscae fo the isecrdena atlrrullaince +Na nad 2a+C ued to ipmreadi aNK/ nad paocmcislras mutieculr ivatityc ...

tBu fi reteh ear edrneicas acdairc mzseeyn in eth ldoob tgniinadic ecll ehtad adn aebmmnre amead,g ’ldowtun het arltarnciulle etryltleesco eb wlo enics htye rea rleeesda iton the d?olob

lord_voss  troponin = irreversible injury and membrane damage -> high extracellular concentration of Na+ and Ca++ causes both to move into cell through damaged membrane and high intracellular K+ leaves the cell +13
rogeliogs  Question is asking about the changes in the myocardiocytes and my second interpretation was that they are asking the changes before they "rupture" and liberate their content in the blood producing increase enzymes in the patient. Therefore because is a ischemic process = reduction of O2 = low ATP = impairment of Na/K ATPase = increase Na-decrease K intracellular = block Ca/Na exchanger = increase Ca intracellular. the same effect as digoxin +4
allodynia  What will happen to Na and ca conccentration when there is an irreversible injury? +
baja_blast  @allodynia Pathoma pg. 4 has a really good summary of this. In short, Na+ and Ca2+ both increase intracellularly in an irreversible injury. +




Subcomments ...

submitted by mcl(586),
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Tihs eaimg is fl.usue Neot htta teh iasnt uesd aemks emnily parape rdka.

engitVet is ictylpa for anr'siosknP .eiaseds eraA D si het anutsbisat .nagri

oznefu  Oh nice! Thanks! +  
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +  
apurva  Saved My life +1  
john198  is this link only for MSU students??? , I can't access it . +  


submitted by oznefu(21),
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I egt seh ulebdod rhe vnroehyotxlie eods casebeu of efa.utgi I tge htat HTS si r.cdesdaee Btu yhw is eref 4T ederedsca dan efre T3 edeacisr?n Wtoln’du thbo erfe 4T nad eefr 3T be niease?drc

lnsetick  she doubled her triiodothyronine not levothyroxine, so she took a bunch of T3 -> feedback inhibition of TSH and therefore decreased T4 +22  
oznefu  D’oh didn’t even read that just assumed it was levothyroxine. Thanks! +7  
asharm10  NBME's give you very few buzzwords, read it super carefully!! questions like these are free points +