Welcome to qball’s page.
Contributor score: 66
*other downers: alcohol, benzodiazepines, barbiturates
THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with.
I get that this is a good rule of thumb to help narrow down between alcohol and heroin, BUT is still not enough to answer this question. Some key features for depressants (downer) is alcohol (if we are talking mild withdraw) - tremors , diaphoresis and delirium (heavy withdraw) . For Heroin - Dilated pupils, yawning and lacrimation are key exam findings.
Dang, you actually learned something at your school? Lucky.
At our med school they teach us that Thiazide anti-HTN function is primarily from it's direct effects on vasculature rather than it's diuretic effects. Somehow directly affects the vasculature which is not well understood but this is linked to why Thiazides have greater efficacy in African American Populations. That's kinda why i figured it wouldn't be the best diuretic in this case.
This is testing our knowledge in a FAIR way. Why cant there be more questions like this instead of them trying to trick us, have poorly worded questions or have us pick the least shitty answer. End of rant.
Sir Dan, my boi.
agreed "granular deposits" rules out MCD (the only other nephrotic syndrome) because MCD is IF (-)
could someone explain why the other choices are ruled out by biopsy?
@cooldudeboy1 PSGN does have a granular immunofluorescence, but there is no previous illness or hematuria mentioned so you can rule that out. Goodpasture is classically linear IF since they're antibodies against the GBM. IgA nephropathy is mesangial IF so it would deposit more in the middle. Minimal change wouldn't show anything on IF
Totally agree w/ you Qball... I thought MPGN too, but I think Penicillamine makes it Membranous Nephropathy
Awesome explanation. Now explain it to me like I'm 5.
All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark — or erase it somehow — the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa won’t bring your presents.
Amazing explanation. Thank you!!
CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90%
Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2?
"majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way.
"live-born offspring" ← baited
why is it 50% females tho?
felt like an idiot after i figured out why i got this wrong.
This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected.
@suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0.
@suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant
One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand?
Pre-eclampsia, if not severe, can be entirely asymptomatic.
Her blood pressure is 164/102, which qualifies her as having preeclampsia.
Just to add, the ovarian artery branches from the aorta as well.
stop being an ape. evolutionize!
as a creationist i'm offended
Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum
So why is it apocrine? The dude is EXERCISING when playing football.
The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes.
How do you differentiate this from hypertonicity of the internal anal sphincter?
nvm. im dumb lol
Uworld Q ID 17004
@gh889 I made the same mistake... fecal INCONTINENCE meaning she CAN pass stool-- in fact, way too well... more than we want. Hypertonicity of the internal anal sphincter would cause constipation-like symptoms.
Great explanation, except that there was a question in NBME 22 in which the prostatic carcinoma was osteolytic. One of the commenters here looked it up and apparently it's like that 30% of the time or something. So I guess you would have to use the high output HF, normal Ca, high ALP, and mosaic pattern to "play odds" as Goljan would say.
At least they were nice enough to put Paget disease because I had no idea what osteitis deformans is.
USMLE seems to be moving away from using eponymous names... so it's a good idea to see if there is a descriptive name for diseases. For example, they don't use the word "Wegener" anymore if you have noticed, since it turns out that guy was a nazi. So now they call it by what it is -- granulomatosis with polyangitis.
What a snitch
Good thing they were at the ED cause that friend is gonna need some stitches
Nystatin does treat vaginal candidiasis but is TOPICAL.
Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow.
Me - picks Metronidazole -_-
@thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch)
I have seen that on the wards so I hope it works!
and my smartass picks amphp B
Please no one give a poor girl with a yeast infection amphoterrible
That's so infuriating I stared at this question for 20 minutes thinking I did something wrong
lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that.
this is why you never waste 7 minutes on a question.... because of shit like this
Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways...
in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it.
LMAO games NBME plays
magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer!
OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ......
They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH
I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92
The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24
Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad
'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-))
I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡
The give away is the Fever, Pancytopenia, and Hepatosplenomegaly after being bitten by an insect and developing the sore.
I got this question directly after the other visceral leishmania question and it made me second guess everything I thought I knew.
Don't forget they like to infect macrophages.
Poison Ivy/ oak /Sumak
Uworld Q ID 1133
Don't mind me. Just sippin my dumb ass soda over here.
The term "Normoblast" isn't even in first aid.
NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess.
I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us.
Metamyelocytes = Precursor to neutrophils
Siderophages = hemosiderin-containing macrophage aka heart failure cells
Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection
I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains
I can guarantee you this Q was written by some sadistic PhD examiner
To add to ^
It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH.
The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine).
And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line.
this is exactly how I reasoned through it. Were we correct in our line of thinking? We'll never knooooow
But will you ever know on the real thing?
but will you ever know in real life? you may do the right thing (given time constraints, & information available), but outcome is bad; maybe you do the wrong thing, but the outcome is good (despite your decision). how to know the difference?
For those that want to know what total red cell mass means in polycythemia and PV read the first paragraph in this article. The hemoglobin and hematocrit do NOT inform you of the total red cell mass.
Also, when Meningococcal meningitis is treated ... close contacts are also treated prophylactically whereas the others typically are not. There's also a subunit vaccine for n. meningitis due to high infectivity rate especially in crowded establishments.
So, Cholera is also p2p but Mening is more likely?
in cholera people to water => water to people
Remember the fire sprinklers from Sketchy for M. Meningitis. as respiratory droplets are the easiest to transmit from person to person.
but the poop water comes from people so....
Respiratory dropplets is easier than fecal-oral tho
Can also reason that n. meningitidis is common in college students because they live in close quarters which suggests high rate of transmission even amongst immunocompetent individuals
I can see why fecal-oral can seem like person-to-person transmission. What helped me reason it was that in countries with lots of cases of cholera, the primary reason is lack of water sanitation. Even when you google cholera, you get pictures of people collecting dirty water and how the WHO is aiming to reduce cases of the disease by improving water sources. Therefore it's more of a systemic/environmental problem rather than the fact that one person accidentally touched another person's poopy parts and then transmitted it to their own mouth, making this less of a person-to-person thing, especially when compared to another answer choice such as Meningococcal meningitis.
To add, think of the water in cholera as a reservoir. The bug is going to hang out there between infecting another person. In meningitis it seems we are going from 1 persons saliva to another. Without much of a reservoir inbetween. (might be using the word reservoir incorrectly).