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 +0  (nbme16#24)

Yeah this makes no fucking sense. Morphine is not a prodrug


 +0  (nbme16#18)

Can anyone explain why macrophage activity would be decreased in this? I wanted to pick one that had both mucus secreting activity as being increased along with increased macrophage activity with concomitant decrease in ciliary activity but this wasn't an option so I went with all increased. Since it's well-established that macrophages cause damage in emphysema (especially in smokers due to constant irritation from the smoke), how is it possible that macrophage activity would go DOWN?

kard  Mucus hypersecretion --> Induce airflow limitation in COPD "potential risk factor for accelerated decline in lung function" Cigarette smoke impairs both the phagocytic and respiratory burst function of neutrophils! Macrophages-->activated by cigarette smoke extract to release inflammatory mediators COPD--> alveolar macrophages and neutrophils are defective in their antimicrobial functions. Macrophages from COPD patients--> show reduced phagocytic uptake of bacteria. "Streptococcus pneumoniae and nontypeable Haemophilus influenzae" I Hope This Helps...




Subcomments ...

submitted by hyoscyamine(22),

I know this is just a straight up fact from FA, but couldn't ureters (transitional cell carcinoma) also be correct?

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis. +2  
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma. +  
vinnbatmwen  p631 → Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure. +1  
privatejoker  Thanks! +  
emmy2k21  It's also in Pathoma page 140 in the 2018 edition! +  


Syphilis pathogenesis is the inflammation and obliteration of the vasa vasorum (small blood vessels) that feeds bigger blood vessels like aorta, arteries, arterioles. It does not matter what the stage is, T. pallidum infects the vasa vasorum and, in the process, obliterates the nerves and blood vessels. This kills blood supply to those areas = ischemia but no pain (painless chancre). More localized in earlier stages, and in later stage, the spirochetes disseminate, so you have the aorta and spinal cord involvement but same pathogenesis. (Edit: Goljan explained this somewhere.)

privatejoker  So is the heavily implied step-wise formation of Syphilis symptoms as presented in FA complete BS then? Why break it down into stages and have us learn it as such if this is not the case in real practice? +1  
lilmonkey  Exactly, Goljan mentioned this in one of his audio lectures. All kinds of lesions in syphilis caused by vasculitis. +  


submitted by imgdoc(30),

Basically this question just asks "what is power" and asks you to explain that 80% power. Power is 1 - beta (type 2 error), basically when a difference exists and the null hypothesis is rejected is power. So if the Rx detects a mean difference of 0.4 in asthma in the patients in the treatment group, then that data falls in the 80% power range, and its significance is 95% (p<0.05), P value is just the probability of something happening by chance, so you what this to be less that 5% so whatever you observed isn't bullshit.

I hope this helped, and correct me if I'm wrong.

yssya1992  I have a question : whats the relation then between power and P value ? +  
privatejoker  This one took me a minute and was during the last block so my brain was already fried. But my reasoning was that, as stated above, since it gave you power, it is basically just a long-winded way of asking what Power is, and how this relates to p-value. P-value is the odds that the finding was due to chance alone. Obviously a p-value set to <0.05 implies a greater than 95% chance that the finding is legit. Since the power is said to be 80%, this means that there is an 80% chance that the study finding is legit, at least insomuch that it met the pre-set criteria of being 95% non-chance related. +  
sahusema  80% chance (power) the study correctly identifies the existence of an association in reality. If an association is determined to exist, >95% chance the study and reality agree with each other (p<.05) +  


submitted by neonem(268),

Sounds like a case of Li-Fraumeni syndrome - since p53 is a tumor suppressor for a bunch of cell types, mutations in this gene (as in LFS) result in a myriad of familial tumor types.

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +3  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +3  
dbg  ^ this guy cracked the code. nbme ur doomed. +1  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +1  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +  


submitted by mcl(223),

When working on acid/base disorders, it helps to look systematically at the following: (1) pH (which sadly was not given in this problem), (2) figure out which problem is primary by looking at PaCO2 and bicarb, and (3) look for any compensation (which the question doesn't ask but still).

Here, we see that the CO2 is high on the ABG. This means that patient is hypoventilating since levels of CO2 are ventilation dependent, and also that patient has respiratory acidosis. Also, bicarb is low, which implies that it's being "soaked up" by metabolic acidosis.

privatejoker  I just look at these as "what makes the most sense" and this is is sufficient in nearly every scenario. Out of the given options, the only explanation that even lines up with the given numbers is the answer choice. +  


I think it is good to note the demographics. The patient is female and old. That, along with the constipation, made me lean more towards diverticulitis. IBD usually develops in younger persons.

privatejoker  Does the obviously darkened area not point at all towards ischemia of any kind? Maybe I am blind, but I don't see anything that remotely looks like an obstructive diverticulum in this picture. I feel like I would have gotten this question correct if no picture had been provided at all because the symptoms described absolutely pointed towards diverticulitis otherwise. I actually changed my answer because of the image lol +4  
sahusema  Picture is a bullshit distractor +  


submitted by hayayah(422),

Secondary hyperparathyroidism (usually d/t chronic renal failure).

Lab findings include ↑ PTH (response to low calcium), ↓ serum calcium (renal failure), ↑ serum phosphate (renal failure), and ↑ alkaline phosphatase (PTH activating osteoBlasts).

haliburton  also remember that in renal failure, 1-alpha-hydroxylase activity is down, so there will be less activation of 25-hydroxycholecalciferol to 1,25-hydroxycholecalciferol, which is a key mechanism causing hypocalcemia. +1  
cr  why not increased 25-hydroxycholecalciferol?, with the same logic haliburton explain +  
nala_ula  Increased phosphate, since the kidneys aren't working well, leads to the release of fibroblast growth factor 23 from bone, which decreases calcitriol production and decreased calcium absorption. The increase in phosphate and the decrease in calcium lead to secondary hyperparathyroidism. +1  
privatejoker  Probably a dumb question but how do we definitively know that the ALP is elevated if they give us no reference range in the lab values or Q stem? Everything stated above definitely makes sense from a physiological standpoint, I was just curious. +  


submitted by hungrybox(250),

Macroscopically, squamous cell carcinoma tends to be off-white in color, arising from, and extending into a bronchus.

Source: Radiopedia

privatejoker  Lol am I the only one that picked Malignant Lymphoma? I thought I remembered Sattar mentioning that metastases are the most common form of cancer to be found in the lung? I tend to pick the "most common" presentation when given so little information to work with +  


submitted by hyoscyamine(22),

I know this is just a straight up fact from FA, but couldn't ureters (transitional cell carcinoma) also be correct?

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis. +2  
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma. +  
vinnbatmwen  p631 → Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure. +1  
privatejoker  Thanks! +  
emmy2k21  It's also in Pathoma page 140 in the 2018 edition! +  


submitted by aishu007(2),

can anyone explain why enterococcusfaecalis is the answer here?

priapism  Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +3  
nala_ula  My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +  
fez_karim  its says chains, so not staph. only other is entero +  
temmy  according to first aid, staph aureus is not one of the high yield bugs for UTIs +  
temmy  uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +  
privatejoker  Where in FA 2019 does it list that C.coccus is specifically in chains? +  
privatejoker  E.Coccus* i mean +  
divya  @privatejoker FA 2018 Pg 134 table +  


submitted by aishu007(2),

can anyone explain why enterococcusfaecalis is the answer here?

priapism  Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +3  
nala_ula  My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +  
fez_karim  its says chains, so not staph. only other is entero +  
temmy  according to first aid, staph aureus is not one of the high yield bugs for UTIs +  
temmy  uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +  
privatejoker  Where in FA 2019 does it list that C.coccus is specifically in chains? +  
privatejoker  E.Coccus* i mean +  
divya  @privatejoker FA 2018 Pg 134 table +