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Welcome to paulkarr’s page.
Contributor score: 54

Comments ...

 +2  (nbme23#24)
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irnhcCo eoynslueMog Lakemuie sv eedmLoiuk eioncRat ahs a wfe aifgdtfirinntee eau:rtsef

  • alihiBpoas acn be eens in areieoeoifvlMtlrpy assieeds cush as MLC. ,owHvree they rea not ense in mLokduiee etaisRnco.

  • eytokLeuc eakniAll aeahsPsohtp L)(PA si eontf ledaveet ni udeemoiLk Rtniosace. uBt ti wlli eb eceddresa ni MLC bsecaeu Ablaormn lcsel ton'd amek hte olnmra emn.ezy

  • leohD soiedB ear ctiahctcrresia fo imkeLdueo aRneiosct. Nto esen ni LM.C

sA hmvyums tpiodne tou 09AF-21 pg 442 sah lla hsit oimannoitfr sa lewl as oUdlrW empbo.Il.r. usjt 'nact mese to idnf hte .DIQ. aMyeb neomseo sele nca agteatm- i.n

thotcandy  LAP 100-249 do not fall into the answer choice but would still be considered high value and thus +LAP to indicate leukemoid. A LAP- would be in the normal values which is 20-100, not below 250 like the answer choice indicates. +

 +5  (nbme23#37)
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I dah a yrtetp gartthis rwadofr elni of thnigkin fro hit.s lCoo relidosodc egl uotlltaamacyi euslr uot esmpoblr weherelse al(l eht inabr alerdte c.oeis)ch We konw bdloo ash eenb utc ffo to eht telf ftoo. ficpcSyai,lle eehtr is na oleumbs in eth airtrlae obdol ylppus. no(esuV udwol dlae to a mwra fto)o

fI uoy tkae otni aouccnt het eatuc ssiedeop of tasinltpaipo, ti si aluepbisl to nihkt tath hes adh meso rsto of A-Fib rirgegignt a oolbd tclo to akbre off dna eb ntes hruhgto the ymecssit urconltcai.i tI thne ogt logded ni hte feoamrl rtyare nguitct off oopr sg'ma-

 +2  (nbme23#22)
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ascirVle sseasahinimiL .aak "arzla-aKA"

duseaC by iaheinsLma onnDviao. na( lneratlaulcir zonaorpt)o

enTsdtratmi iva eht emonioltbePh ndaS Fyl.

etrTdae whit itberoplrAhme B. aCn losa eus Sdmuio iu,ceongotSlbat eil,onsmefit ro mooipna.cyrm

ilWl ymlmnooc be eesn thwi nonataepcypi, ee,vrf and pseoglaleynm ear hte trhee igb sulce. tOhre ysmpotsm yuo acn ees rae intgh sawet,s klabinegcn of eth is,nk scyal kn,is k,awsnsee and asiautlnbts heiwtg l.sso sihT will illk ay fi oyu tond' egt .ettamnret

usmlecharserssss  i got 2 leishmania questions 38 and 39 in 3rd block , both got incorrect because i thought no way they can do that ((((((( +6

Subcomments ...

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So a peimrsl awy thna lal het mtah ibeng done si nudndrnseagit athw IC ea.msn

IC - agrne of vsuael i/wn wihhc eth rtue amne of eth lauooptnip si dxteepce lafl

So a IC fo %59 wlli be emro preseci adn eahv a nwoarr egarn dcrmpeoa ot a CI of 99% iwll be ssel cpeeirs sbaucee sti ilnigcund roem uvlsae ni nda ersutl ni a rwdei gr.nae

So fi IC of 59% si 101 to 116 tenh a IC of 9%9 ash ot be a aregn hatt si .e..idwr 180 to 181

paulkarr  Glad I wasn't the only one to solve it this way...didn't even think to bother with the calculation. +2  

submitted by sajaqua1(524),
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sioeymtc,anaG dsprie toaimgaa,n nad gdoinyspamho a(s well as rmapla myh)atere rae lal nsgis of exsesc re.stngeo eTh virle ni tsnaptei wtih aithepc iesaeds si pidrimae and os contan elrac trenegos stceiliufyn.f xiS 21 zo rebse aylid 27( ,zo or lfha a langlo) is too hu,cm nad si ienrsgyotd shi livr.e

uslme123  No hepatosplenomegaly, ascites, or edema through me off. We that being said, I shied away from cirrhosis. I thought that he showed signed of depression, so I went with the thyroid. But who's to say he isn't injection anabolic steroids?! +5  
catch-22  The principle is you can get liver dysfunction without having HSM, ascites, etc. Liver disease is on a progressive spectrum. +12  
notadoctor  He likely has hepatitis B/C given his history of intravenous drug use. I believe both can have liver dysfunction but may or may not have ascites, whereas the type of damage we would expect from alcohol that would match this presentation would also show ascites. +  
charcot_bouchard  For Ascities u need to have portal HTN. Thats a must. (unless exudative cause like Malignancy) +2  
paulkarr  For anyone who needs it; the FA photo is kinda burned into my mind for these questions. NBME has some weird infatuation with this clinical presentation.. FA (2019) Pg: 383 "Cirrhosis and Portal HTN". +4  
snripper  @paulkarr the problem was that the FA image was burned into my mind so without no ascites or edema threw me off of cirrhosis. +  
tyrionwill  cirrhosis doesn't present hepatomegaly, instead, the liver could be shrunken. +1  
avocadotoast  Cirrhosis (most likely due to alcoholism in this patient) leads to an increase in sex hormone binding globulin, causing a relative increase in estrogen compared to androgens. Cirrhosis doesn't always have to present with ascites and adema. I agree with @catch-22 that liver disease is a spectrum. This patient does not have ascites because his liver is still able to produce enough albumin to maintain oncotic pressure in the blood. +1  

submitted by sympathetikey(1265),
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Any mtei ouy ese fdeix iewd nttgpsili of S2, sashm DAS.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +  
need_answers -smash, smash, smuh-ash +3  
usmlecharserssss  with airpods in 2012 +  
paulkarr  Low key was hoping for someone to try and argue this one... +  

submitted by water(33),
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piu,nrrgysils I yulaaclt lrneade hsit orfm eht Mgiac Soochl uBs ewhn I wsa a kd.i T'thsa het olyn sonrae I tgo tish ir.ght asknhT Ms. ezrizlF! :D

paulkarr  She taught me more than my med school professors did... +5  
painintheash5  ahahah i remember that episode! +  

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polodeligrC pevnrset talpltee gargnoaiget by kcblinog teh ADP .crerpeot hTe APD cetorrpe si atwh is ipsbenreosl fro ugtnpit aIGIIIb/Ip errcteosp on the raeucfs fo allt.estep tihouWt b,IIaGpII/I eth lpalsteet ocnatn ggaraegte tee.ohrtg

paulkarr  Just adding that Clopidogrel irreversibly inhibits the P2Y12 receptor. This can be found in FA2019, pg 403. The other drugs in this category are: Prasugrel, ticagrelor, and ticlopidine. Ticlopidine is famous for causing Neutropenia and having an increased risk for TTP. +2  

submitted by hello36654(5),
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I aneuddrstn ywh sti' lugn nw,o tbu I cipdek hrdtoiy gldan ebasceu fotne isemt yrithod mtrosu rssep no the iryrdaphaot stitgin vbae,o wcihh ssauce teh prihradaytos ot esertce emro .ncC.aa. emooens omecmnt fi 'ehvtye read ihts o?to

paulkarr  I personally have not read that, but I wouldn't be surprised by that fact. I think with these NBME problems though, if you can get the answer within one "step" that should be your choice. Here you can just go Squamous Cell Carcinoma with a direct action on serum calcium levels (via PTHrP). Thyroid requires a few more steps, (assuming your statement is true) so in the eyes of NBME, it ain't gonna be the right choice. Always follow the "KISS" logic! +1  

submitted by nlkrueger(43),
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wyh i'n,st 0"% tsblsa no eth irarehpelp r"maes hr?gti is hsti the nihuignitgssid ertuuf orf actue eluemka?i

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 +  

submitted by chris07(55),
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'Im gguniess htta cines stih is o'ohshtmais taht a ibsoyp of teh yhirotd dluwo hwos eht yhrdiot dlang lcotlmeeyp neuldgef by nackgatit pmhlscoyey.t rOev meti uoght,h d'utnlow eht tdhryio eb tpeloyelcm erdetdosy and tifi?crob

dr.xx  Progressive thyroid cell damage can change the apparent clinical picture from goitrous hypothyroidism to that of primary hypothyroidism, or "atrophic" thyroiditis. The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. +  
paulkarr  I was thinking that "Diffuse fibrosis" was trying to point to IgG4 Riedel Thyroiditis rather than Hashimoto's. +6  
spow  It's only been 10 months, per the question stem. This probably isn't long enough for fibrosis to be correct +1  

submitted by sugaplum(326),
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sThi si cuirsudlio tub I uldoc vnree peke htsee itahsrtg se toem ym myl:if a
Acyhe pnaagrd erMnyte
Dep o uicsno VT whit a iesd *Ho h'wso( nemas era jstu sni)ailit ScN
nUcle dan autn epahR nda saar ou insC aybGb lyswaa mnsagicre aa-NN-aN
nie orp nirsmed me fo eht loocr b,lue so clsuo rulcsuee

paulkarr  LOL. Achey Granpa Meynert. I'm gonna steal this from you. +  
abhishek021196  Achey grandpa Meynert = ACh / Basal Nucleus of Meynert Dope Cousin VT = Dopamine / Ventral tegmentum, SNc Uncle and aunt Raphe and Sara = Serotonin / Raphe nuclei(medulla, pons) Cousin Gabby always screaming NA-NA-NA = GABA / Nucleus Accumbens Norepi = Locus ceruleus. +1  
llamastep1  Amazing +  
mnemonicsfordayz  ACHey GRANDPA MEYNERT TREMBLES in the BASEment; DOPE cousin VT SNaCks DOWNstairs by the kitchen TAP; NANA GABBY ROCKS and ANXIOUSLY cooes...; "NENENENE... NENENENE...NENENE...NENE" to CRYING BLUE-eyed baby ELSIE; aunt SERO and uncle RAPHE DULLY PARK in the DOWNpour. CAPS = relevant info, lowercase = irrelevant. Includes diseases: DOWN, ANXIOUSLY, CRYING, DOWN = anxiety/depression; TREMBLES, TAP, ROCKS, PARK = movement disorder; GRANDPA = Alzheimer's. Note: ELSIE = LC = Locus ceruleus +  
mnemonicsfordayz  The extended "NENE" series is just for humor - shorten if you like ;) Also, ANXIOUSLY applies to both NTs in that sentence: GABA and NE. +  
castlblack  I use AChoo meynose +1  
faus305  I almost didn't even look at this review but then I thought "maybe someone has a cool mnemonic." and would you look at this. +  

submitted by nwinkelmann(285),
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o,S rof meos ro,snea niertsrnrseamutot si osgnmthei evI' AALWSY rldsguetg .i.wh.t yrbbpaol aseecub I nsa'wt tathug ti llew so vnree ryllea ledrnae ,ti tsju naelred noehug rfo ehraetvw .aexm I utsj dfoun hsti obo hgrouht NCIB nad tis ISANCTF!AT 'Ist morf 1020 so himgt be ,old tbu ti was ga.rte You cna esarhc tguhrho the koob and idnf teh p.arhctse I pyttre mchu jstu ntwe rhoghut lla of teh rntaritnsturomee w1KBwcst7vn/wls/oit:oib.n.pbmon9g9Nh/

My nami aska:wyme-etGalttaa u = omjar arcoextyti tiranerstnrem.uto Two teysp of reoe rstp:)c1 ioctopaeb,rmt mtos fo ihcwh are ytapsirepnc iG hhiwc esald ot rcesdaede DNAM errepcto itcaitvy nda irsk of yiixix,ttceootic ro onpcstitpsya Gq cotsererp taht elda to eirnsace +a,N ,K+ nda redcdasee amtugtlae ssceau tazdiniraolpoe dan saeciernd Mg++ dailpmectnse and DAMN cetepror tvaitciy nda sikr fo ecttoioixctiyx, dan )2 ripcoionot cnensalh igilcdunn MNDA and etnPAaMa/Aik nan,lsehc hwcih lla lloaw ficosennipc iaocnt uilnf,x utb oyln MNAD salolw Ca++ xfnliu nda( olyn ni a aotgelv dpenetden neamnr taefr tneifiuscf apintrodiaezol ahs adsicdpel the nbihtioir ++gM ion in eht lhe)ann.c

BAAG dan nlgceyi = bihyirnito ort.atsmtnrienuers )1 GAABA- and ABAC-G = opnoircoti eslhnnca taht dale to efulx fo C-,l dan edsetpi hsit igsncua tadiezriao,plno eth unonre sllit sayts lwoeb ertnsig aitnlp.toe A-BGAA gbdniin tesi rof iue,tsbbartar oet,disrs ,BAAG and xpoocitrin = niesid peor of nncheal. AA-BAG ingbndi eist of ezodseabzpinein = itsdoeu of epor fo clh.nnea 2 ) cnGeyli enlhcan is a evry sramlii Cl- xeulf l.cnahne 3) BBGA-A si a tocemipbrota ehlncna that iavcstaet Gi iadegln to rseedeadc cMPA which ctaivsaet lxuffe +K nacnhsel nda shbniiti C+a+ ilfnux cseannhl engliad ot yrahinret.oplpizao

cnigeBoi niesma = htnslaaiecemco ieandpom odoartino(cni fo bydo ,vtememon ,wdarer tonv,aitoim cnfmri),nreoete pnpnnhiieeeorr pel(se, we,nekussfla tiett,nano dnfiege ah,ebroiv nrepienihep (eswtol itnenoatnrocc in )NSC, lusp onrseotni ep,es(l wkan,sleeufs opserisden, yxtne,ai aanseu) dan hnitiames losua,a(r naieott,tn ,lalygre tesuis ag,dema and mya nilunefce olobd anrbi l).fwo ,ibylsvOuo all of this si in inddoait to craeeindgr sartorsnusioninme dan filgt,h ,ftgrih and htigf e.rpnesso

TPA dan oehrt sueinrp = aycoeitxtr sosainisrnmt, clea-oredes wtih oerth oulemaemsl-cll tiao.rrusenmnestrt oseAnneid n'tsi llciscaalys doeeicnsdr a tiueestraomtrnrn seucbae ti tin's dseletd/eeraosr ni C+a+ tnneddepe ranme,n tub ivdrede rmfo PAT robefe aivnhg na ytctaeriox tnapelito.

ncAcloyelheti = moajr tasrontrrnteeumi deinlvov in tnsooiismasrrnuen iav mrancusi adn iinconict ptcsroree.

dPteipe neusosmttarrteinr = ooclmnym aleredse as teporepipd lrgrae rporcesurs atth are ceedavl by eiicspcf yezesnm htat rewe ni eht esam isorurrtaemntetn leecisv nopu aeerlse. vFie tepys = rnibuga/t speide,tp podiio pidse,etp uttyiipar epist,pd lcahyiapmhto aleinrsge onsmhoer, nda toseh not .asiifdclse lxaemEps = rsorrcuep that egisv eris to baeusnsct P a(,ippuchospm teorcoe,nx nad IGT nda sreedale from laslm dtermeia SPN C ibesfr atth mrsintta inap nad pattuermree amiftoion,nr pfreuwlo yeosinv,thep hiienbtid yb poidio ieet,dp)ps onkuneirin A, netredeoippu K, nad eodtreneippu mam,ga dna ipodio spiepdet cgniilnud talnp asldoilak k(ile poehi,mrn) ytnetscih idoiop vasiv,eteidr and heonrndpsi, nonrs,hpiyd dan khieelnpnas. nI eganlre odiipo pitedeps ear ptnserssade .(.ei easlangia )mh,asnmcie olnievdv in peolxmc aorsvhieb elsx(ua ,inttratcao ebs/isarsvieugsgmseiv ve,o)hbasir nad dieiatmpcl uogh(ht tno ifvit)ndeie ni icairchsytp s.doirsred

ver,Oall nmtsinteutarsoerr = yetp e:psyt eousellmlalcm- asmettritsrn dna eet,unedposrip wehre slelaemoll-usmc stasmnettrri era rfsaet nda eeiamdt rdaip paticysn nrsiiassnomt .e(.i doganern NSS lrg/fhf/hihtiggftti ickqu sp,)seneor wrhee as epeiondpurste olag(n ihtw iogicobl menais dan osem aslml luclemoe ntrmitsset)ar rea ewosrl nad temdiea draaug,l noodpelgr oorun.eisminrastsn

Smoe r:seutpic ervdtemtnepnopepowmwtcntnstu/:_rike_h_/vhouat.eiremrhoaiksb.ld/wuuprfst/d/ia.e, swr//ffn65a400tla7i18s10ucabhrea6fdcoa1a--gc3ierTpe3-rpo6orGB:esebait62i/mrgefAel41PndAn0e-1rwbg2ee-es.--pgc.4/lb/0uhti9Rtu/s8-3att3p/dBrwdsrpi2hgo, dna 0;epsnwta#d.bgaa=-b0/-ee6rish8.5er-iwpagb14gxsffb2n-w31_u6ialch/btnxewl3madti2d/9at:5g-.rogh-e/eUd=/t-e/&lafl-fd7e11

sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: +2  
dorischang  Didn't finish reading this, but it looks awesome +1  

submitted by haliburton(209),
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betdslmleu sha a cein unmpoceni ofr eht lkdile sevca:nic

teRs nI aPece aylwA:s

fnlaIz uen
ooP li )kl(aS
aiitet pHs A

paulkarr  Also, the nice little puppet show from sketchy for those visual learners like me. +1  
makinallkindzofgainz  just remembered that MMR is a live attenuated vaccine +  
faus305  how could i forget that puppet show?! +  

submitted by d_holles(173),
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vnEe hot FA and hrcMkteSicoy tns'ode enniotm t,i hobt anlsaapAm nad iscrihhoEls rea riedarc yb Ribon of sdIexo.

bulgaine  FA 2019 does mention it P 149 +  
charcot_bouchard  Ehrlichia - Lone star tick +2  
paulkarr  "Lyme Disease caused by Borrelia Burgdorferi, which is transmitted by the ixodes deer tick (also vector for Anaplasma spp. and protozoa babesia)." FA 2019, Pg 146 +5  

submitted by hayayah(1057),
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iroFbzlifem is a tiafr,be dsue ofr wieolngr GT lelevs.

mousie  I also chose Gemfibrozil too because its the best TG lowering drug listed but I can see where there might be some red flags for this drug in the way they asked the question... 40 year old obese woman with some upper abdominal pain ..... HELLO GALL STONES which is a common adverse outcome of Fibrates. +10  
uslme123  Well I didn't wanna give a fat, forty, female, that smokes a fibrate. So a statin, for me, was the best next option. +9  
whoissaad  Used same reasoning to choose statins. Fibrates are the main drug of choice for hypertriglyceridemia but given her symptoms, statins made more sense. Why do they do this to us... +  
roaaaj  what a tricky question! there are multiple factors should be taken in consideration.. she has triglyceridemia which put her in risk of pancreatitis, and most importantly atherosclerotic disease, and all of that would outweigh the risk of giving her gallstone. +  
paulkarr  Yeah I had statins selected initially because "statins are always the answer" but when I saw them stating first line "recently diagnosed with hyper TG" I figured this follow-up was purely to address that. So Fibrate is the best move. +2  

submitted by nlkrueger(43),
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.... woudl we alleyr akte the odrw of a fdenir woh iyedtfienl ant'c eb ncfrimedo? I eefl ilek shti is iildgeanms

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..... +  

submitted by yotsubato(979),
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Wsa it tusj em, ro idd e"ga ta nstoe ni sr"eya aeaprp TGRHI oaebv teh rbumne fo i,tnestap ratreh hatn teh na.em ichhW ndsofuce me ofr a odgo 3 iteu.mns

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +13  
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +7  
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +7  
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +5  
monkey  what is 36 supposed to be? +1  
thomasburton  Think the number of people in that group +5  
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck's gotta be 99" +4  
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +3  

submitted by sympathetikey(1265),
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iegBgst uecl swa atht rehet asw no etmi rfame vnegi. ehere,orfT stih esems to eb a slec"i ni tem"i usyd,t hhcwi sleni up hwit oscsr otanlisec duty.s

paulkarr  Damn, epi at it again... +4  

submitted by smc213(127),
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To eb leocltpyme ca!elr

Tihs netptai sah isyCistosn a erra loaaoutms sesvreiec ylasoosml gosarte eroisddr adn stmo onomcm uaecs of cnaFnio rnmsodey in nrdilce.h stysonisCi si ysmicest nad aedsl to yscntie lcyrtas dptsoesi ni secll dan susetis gthuthroou the .obdy

huAgotlh isolsnW asseide can eald ot ,FS hte asstrycl in teh crseaon dsoe ont eeatrrcol tiwh niWslos
eoMr io:fn e.McCm1n./nlpta./t/wwvi18cwhmni4ips6lPt:o./g0sbcr4/h/

highyieldboardswards  Thank you! You are a legend for figuring this out! +  
paulkarr  Appreciate you. +  
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2  
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT = Increased excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1  

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oLw OPE ni PV edu ot iaevegtN bdkeafce no PEO eesarel yb kne.yid

dentist  This is where the timing of everything in the question trips me up. FA say PV mechanism is increase EPO (2019, p299) +  
paulkarr  Different types of Polycythemia have different effects on EPO levels. "Appropriate Absolute" and "Inappropriate Absolute" will both increase EPO levels (Inappropriate is caused by this EPO increase). Where as Polycythemia Vera has decreased EPO levels due to the negative feedback loop. FA2019 pg 425 hooks it up nicely. +5  

submitted by mousie(211),
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sympathetikey  First off, do yourself a favor and check this out - The LDL receptor is found on peripheral tissues. It recognizes B100 on LDL, IDL, and VLDL (secreted from the liver). Therefore, an issue with that would cause an increase in those, but mainly LDL. Since in this question we see that Triglycerides and Chylomicrons are elevated, that points towards a different problem. That problem is in the Lipoprotein Lipase receptor. This is the receptor that allows tissues to degrade TGs in Chylomicrons. So, if it's not working, you get increased TGs and Chylomicrons. Additionally, you get eruptive xanthomas, which are the yellow white papules the question refers to. +8  
davidw  There is much easier way go to page 94 in first aid. This kid has Type 1 Hyper-Chylomicronemia which is I) Increased Chylomicrons, Increase TG and Increased Cholesterol. It can be either Lipoprotein Lipase or Apolipoprotein CII Deficiency +12  
bulgaine  The video sympathetikey referred to only mentions pancreatitis in type IV but according to page 94 of FA 2019 it is also present in type I Hyper-chylomicronemia which is what the question stem is referring to with the abdominal pain, vomiting and increased amylase activity +  
dentist  thats not the only difference in that video.... +  
paulkarr  Pixorize has a set of videos on all the lipid disorders that made it a breeze to answer. Pixorize is basically sketchy but for biochem and other basic science subjects. +2  
futurelatinadr  Pancreatitis was a huge clue for me to think of hyperchylomicronemia +