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Welcome to sahusema’s page.
Contributor score: 118

Comments ...

 +1  (nbme21#11)
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8%0 hcncea wpo)er( eth usdyt ertccolyr ieeistindf teh cseeixnet fo an ocoaiatissn ni .ailytre If an nscoistaoia is nirmdtedee to i,exst &95%g;t eacchn eth ytsud nad yritael reaeg with ahec herto l.;&t()p05

 +1  (nbme21#6)
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eWnh ouy ese a rpacceniat cdniornee outmr in obaiitncnom twhi ehrto rwdei n,gdinfsi aalwys tnhik EMN 1

 +7  (nbme21#10)
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seaao.Rc nA ymoirafamlnt lcaiaf kins esoddrir deahzcrcrteai yb ttyesehoumra upelsap nad putuels utb no .oneoscmed Mya eb isesaatdco htiw clafai lihgsnfu in speensor to leetarnx iliutsm ge(, coo,hlla .ehta)

icedcoffeeislyfe  FA2020 pg 477 +

 +8  (nbme21#37)
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G!SYU You eylalr ehav ot okol at eth asix basell. ehT tisnueqo assy teh 'tsp. soiynticethna natseyhs ityvitca siya)(-x si NMLOAR hwit na EDAERSNCI antoum of ipyxdlroa paphsthoe (.ixxs-)a i-Yaxs is teh emsa as ,RLMANO xax-si htssfi to eth rthgi sigonhw RAIESENDC oyaxlpidr aoehpspht

 -1  (nbme21#17)
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The tnousieq says AGSCTIR rivsca,e ton GLPASEHAEO isvearc. yM usitpd iran.b uPls Im' gisnuams felt roppesicaiglto uldow be a certorc erwnas fi ti swa .deltis

cmun777  While L gastroepiploic would make more sense than the other answers, considering it has an anastomosis (and therefore an outlet for the increased blood) I think it would have much less risk of varices/bleeding than the short gastric would +

 -1  (nbme21#34)
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tI nosusd a olt like GSPN, tbu SGPN si trheniicp adn we duolw ese cnpourenod imhauetar thwi imniaml rapturniioe.

 +0  (nbme21#37)
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ePtstnia iwht na rinnteal cuplaes reostk oloymcnm evha peur troom snewksae tgefifnca hte clataaetrnrol r,am ,lge nda rolwe eafc. eatatnlrrlCoa sictisapyt or eerdscnia note thiw epexliyrhfare rae also

 +3  (nbme21#14)
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I otg tdrieck oitn ipicgnk hte ua"cdirqe soditaiben gisanta P"11A. Huanm etaetllp Ag aleteptl gtninae a1-1,P oacdtel on inretnig ,β3 si eht iman retgat rof srespieonbl rof oneaalnt rmpohyitesap/hbco:tt.not/w/o1/ou117mno.wnlij9n/e5.4mtg/c2t5rw

cienfuegos  Same, except in my case I was the person who was tricked and who did the tricking though. Thx for the link. +

 +8  (nbme21#35)
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Teh iDseoainnd ygu ni hte RITN cshket si oligndh a aerpncsa oengsp.

qball  Sir Dan, my boi. +4

 +1  (nbme21#15)
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I tuc poen na leebaly ocen nda I swa preusisrd hwo dsnee albck the teilmara sidien htTa sulp sosrecp fo anloinmteii hgorbtu me ot eth gtrih nwaser

 +2  (nbme21#46)
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cstaeAdosi lempsnoas in -mueraLiiFn ynmoerds. saSaocr,m esabrt cnea,rc rbian mu,rots eradoctrnloiac ron,acicam ueielakm

 +2  (nbme21#48)
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atWh a EAAGGRB qsiten.uo eH saw entagi tfkaeabrs 2 sruho oag sutj fein dna own we rae upseopsd ot ahve het ayfiml ceom ot a nssnocesu ubato a egdnfei buet keli h'se no ihs daeht b?de BLUHITLS

daddyusmle  Did you get the question wrong? +

Subcomments ...

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I thnki ti is doog to ento hte dr.ioscahepmg The iteatpn si eaeflm nda lo.d ta,Th aolgn wthi teh onip,nsoatict aemd em anle rmeo dwaosrt cl.vtitiediuris DBI llusyua odlseevp in egruyon

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 +16  
sahusema  Picture is a bullshit distractor +2  
lola915  From what I've seen on practice tests and advice i've gotten is that often if the picture is given along with an already complete clinical picture it's often a distractor. I also was going between ischemia and diverticulitis but then remembered that clinical signs in the vignette trump everything else. +1  
alimd  they dont give a fuck about pictures +  

submitted by usmleuser007(326),
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jtus a paeOzlmeor si alyaws eth ihgtr wrnsae

nala_ula  Famotidine is an H2 blocker which really only stops acid secretion via the stimulation of H+/K+ ATPase by histamine, but it still has vagus and gastrin stimulation. If you use Omeprazole, you get irreversible inhibition of the pump itself which stops the secretion of acid even if there is histamine, gastrin, vagus stimulation. +6  
temmy  what about the healing of her mucosa. Is that not the action of prostaglandin?. That threw me off cos according to FA, misoprostol increases secretion of the gastric mucosa +4  
cry2mucheveryday  same doubt..marked miso +1  
sahusema  I guess because misoprostol is more associated with treatment of NSAID related ulcers and PPIs are 1st line DOC for GERD? +1  
makinallkindzofgainz  @temmy, I think that Omeprazole is a better answer because although Misoprostol would promote healing of her esophageal mucosa, it wouldn't do anything to relieve the symptoms of GERD (due to acidic contents in the esophagus) +  

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hTe“ ocinoatinbm of a ga-nctlgion bate 2 soiatgn AL)(AB and na ihlndae iocdrioerttsoc is omer cfaeusociif ni atashm dna CD[PO] naht ..[.] eerhit .lonae oioerotidsscCtr aym eaeglutr beta 2 tocrrpee nctouifn yb ircnasngei rnpexeisos of the erce,optr srentgrio eto-tGn/iberpa 2 rrecepot ,lpgucnoi nad ihiibtgnni ebat 2 treocper lien”odnrwgotu.a


sahusema  In short, cortisol upregulates adrenergic receptors and makes them more sensitive +  

sahusema  that video was sick +  

submitted by haliburton(192),
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ilnk to rtocano garidma

yotsubato  How is that NOT posterior to middle concha? bad question +7  
sympathetikey  @yotsubato - That would have been if it was the spehnoid sinus (I got it wrong too btw) +2  
niboonsh  this is a good video if u need a visual +3  
sahusema  Sphenoethmoidal RECESS not sphenoethmoidal SINUS +3  

submitted by hayayah(990),
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hisT tp hsa an ASD hchiw is a "oelh" weetbne het LA dan A.R Fiixng ti dluco ameagd the VA lnbsu.ed

sahusema  the atrioventricular bundle is also called the bundle of his +3  
bbr  What if it had said "AV node", that's in the interaatrial septum as well, right? I'm wondering, that could be answer as well. (FA 2019 pg291) +  

submitted by sympathetikey(980),
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ofeInrir ieobqul = hpsel uoy olko pu m;&pa in.

,loAs ehyt disa olfor fo hte ,irbto os it ekmas nssee ahtt eth rieinfro musslec ldowu ge.madda

sahusema  I know you're right. I was just so uncomfortable picking an answer with "inferior rectus" because damage to the inferior rectus does nothing to explain the clinical findings of impaired upward gaze. Unless the muscle is physically stuck and can't relax or something +5  
emmy2k21  Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :( +1  
dr_jan_itor  in the last sentence it asks you to assume an "entrapment", so it is actually the inferior rectus which is the cause of the upward gaze palsy. The entrapped muscle is functionally trapped in it's shortened position, thereby not allowing the orbit to gaze upward. +13  
chandlerbas  bam! dr_jan_itor just cleaned up that confusion +1  

submitted by mcl(517),
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enattiP may ehav ytdrhaeier egidenoa,am hichw si oeasitdacs wthi ter"reunrc ksctata of nestie,n ssma,vie ozaellidc ounaesutsbcu eeamd niivvolng the rteseim,ixte ita,ngilae ae,fc or u,ktrn ro csumbolaus aemed of purep arwyai or les."wob hTe latierc geos on ot asy s1retCe"e-sa hbitiorin koswr rilecytd on teh pleeotcnmm dna ntatcco smapal csaceasd ot ecuerd ianrdinybk eslreae" wchih si sloa pyoalrbb dogo ot n.okw


notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4  
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +21  
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2  
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3  
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +1  
teepot123  fa 19 pg 107 +  
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1  

submitted by drdoom(647),
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2,050 tdssneut ... tub oyu fnid tou nuidrg ryuo iiinlat ercnse hatt 050 ylreada evah the i.esedsa S,o toukertis osteh oe.ppel Ttah evasle ,2000 nssutted ohw ’dtno veha eth ds.eaies

Ovre eht usceor fo 1 yaer, uoy isedorvc 020 ussndtte eodedvepl eth ift.nenoic su:hT

200 nwe asecs / ,0200 eeoplp woh dd’itn ahev eth ssaeeid wehn oyu atdrste oyru dyuts = 01 eecptrn

rTi,ykc crkyit ENMB ...

sympathetikey  Ah, I see. Thank you! +  
niboonsh  Im mad at how simple this question actually is +2  
sahusema  Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence +2  
daddyusmle  fuck im retarded +1  

submitted by amarousis(19),
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so fro sthi eno yuo haev ot kool at teh aidcotsil bdloo serepsur dna 'hsatt eth lauvse yuoe'r ssoppeud ot der.a ont teh usnrbme ni hte Lkei rpugo 'Xs emod is 70 sbeacue ti has ttha leuav 23 gprou 'sy meod si 08 cuesbea ti aprpsea 02 s.tmie ofr ,emadin uoy udlwo hvae ot wirte eth aiiolsdtc renubm 20501- ohw ever anym teims ti spareap nda hnte difn eth de.midl crikyt st.oeqinu

sahusema  Wow. I hate this. I only looked at the number of participants and completely ignored the Diastolic BP readings +3  
ma_rad  Everyone commented how to get the mode right. But there is an easier way to realize that the median in Y is higher without all the calculations. If you see, the last Diastolic BP in group X is 110 (as there are ZERO people with 120). While group Y has 8 people with 120 DBP. This automatically shifts the median to the higher side. I got this wrong though at first I didn't pay attention to the "0" number at group X for 120 DBP +8  
brasel  I think there's another easy way to find the median without writing out every value. There are 100 total people in each group, so that means the median (if the DBPs are written in ascending order, which they are) is the 50th person. Group X: 8 + 12 + 30 = 50, so median is 70 Group Y: 2 + 8 + 10 + 20 +10 = 50, so median is 90 +2  
mangotango  I did it the way @brasel explained. The way @ma_rad did it could give the incorrect answer in some cases (e.g. Group X had 0 ppl with 120 BP but a ton of ppl for 110 BP etc. + Group Y had 10 ppl with 120 BP but basically none with 110 BP etc.). In this question that way worked but it's not always guaranteed since median doesn't sway with outliers, but mean does. // FA 2019 pg. 261 +  

submitted by liltr(22),
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I sechoo MPV o,ot ubt this tntaie’sp niam sypmotm is ughoc ylon dginru es.cereix hsiT si eorm vadicnitei fo cidxreees doetssacai .matsah uoY ocldu ese srnohtses fo eahtbr ni PVM durgni ei,rsecxe tbu ocsnoghi PMV slveae teh uhcog ouecdtacnun r.of

.ooo.   I agree! Also, At the end of the stem, the question is which of the following best explain the patients symptoms? Not physical exam findings. Since this patient is coming in with a chief complaint of SOB while playing sports exercise induced asthma is the best choice. Hopefully that helps. +12  
uslme123  I mean... couldn't increased BP during exercise worsen his MVP and give him SOB? +  
uslme123  (by causing slight regurg) +1  
yotsubato  "Lungs are clear to auscultation" +6  
sahusema  But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for? +  
cienfuegos  I incorrectly chose malingering and am wondering if the fact that he presented (although it doesn't state who brought him in/confirmed his symptoms while exercising) makes this less likely despite the fact that he clearly states "I don't want to play anymore" which could be interpreted as a secondary gain? Also, regarding the MVP, I'm wondering if the fact that these are usually benign should have factored into our decision to rule it out? Thoughts? +2  
cienfuegos  Just noticed that he has FHx, game changer. +1  
kimcharito  clear lungs, they try to say no cardiogenic Pulm. edema, means is not due to MVP shortness of breath while doing sports and no shortness at rest makes me to think more asthma induced by exercise) +1  
pg32  Isn't exercise induced asthma usually found in people running outside, especially in cold weather? I feel like that is how it is always presented in NBME questions, so this threw me off. Not to mention the MVP. +  
happyhib_  it took me a little; the FHx really pushed me to exercise induced. I was also looking at malingering but there wasnt a real reason to push me to this (as a doctor it would be sad to be like hes faking it becasue he doesnt want to play sports with out being sure first; led me away because there wasnt enough pointing there). Also MVP could be slightly benign and is very common and usually no Sx and his lungs were clear as was rest of exam. All pushed to Asthma +  
mittelschmerz  I think MVP on its own shouldnt cause SoB with cough (in a question, I'm sure it could in the real world). In the world of NBME questions where you need to follow the physiology perfectly, you would need some degree of MR that lead to LV dysfunction/vol overload, and theres no pulmonary edema nor an S3 that point us towards that. Malingering would have to be faked for gain, and theres no external gain here or evidence that he's faking symptoms. You would also need to r/o physical illness before diagnosing malingering, which hasnt been done. Cold weather is certainly known for exacerbating EIA and are the exam buzzwords, but any exercise can absolutely be a trigger +2  

submitted by temmy(115),
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aesibb fo daeitcib somm nde up negib irebgg dan htta mya alde to ouhlersd acstiydo

sahusema  If one of the answer choices was, "that baby gon be big lol" I would have gotten it right +14  

submitted by seagull(1112),
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ioiIypctd eansm --- nibyadot tansiag iadny.obt B clsle ntd'o heav uarfsec snedibtiao tub rmee etyhniessz mte.h

hungrybox  This is wrong. PLASMA cells (mature B cells, the ones found in multiple myeloma) secrete antibodies, but IMMATURE B cells have antibodies that haven't switched classes yet (IgM and IgD). +5  
hungrybox  To clarify - immature B cells have antibodies attached to their membrane. +  
seagull  I should have clarified that I was speaking about mature B cells. Thank You +2  
sahusema  So because MM has mature B cells, exogenous antibodies can't attach to them. Am I getting that right? +  
cienfuegos  What is an Anti-Idiotypic Antibody? As shown in figure 1, an anti-idiotypic (Anti-ID) antibody binds to the idiotype of another antibody, usually an antibody drug. An idiotype can be defined as the specific combination of idiotopes present within an antibodies complement determining regions (CDRs). A single idiotope, is a specific region within an antibodies Fv region which binds to the paratope (antigenic epitope binding site) of a different antibody. Therefore, and idiotope can be considered almost synonymous with an antigenic determinant of an antibody. +1  
cienfuegos  @sahusema: almost exactly correct, but it's important to note they are talking about idiotypic antibodies specifically because by definition these bind the "idiotype" of another antibody (see definition above) +  

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nmyualPor fobisirs iwll evnovil auntnrioalg tssuei sa( it is fsib) ruinlGtanoa itsesu nceduils mitobsaybslfro, whcih liwl ll"p"u no het rwyasai, byerthe craigenins lraiad o.acrntti

sahusema  The fibrosis causes contraction, the airways are pulled open giving less resistance to airflow +1  

submitted by haldol(11),
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PB is lwo os oulibosyv het bdyo lwil wnta to prenods by airiecnngs apieythsmsct dan isnaergecd .imateatsyasphpcr nseic het BP is o,wl heert si lses ssruerep stagnai the lalw fo teh troadic sunis -- gnmiane sles totumlisani dan frwee um.ipesls wefer acodtir msusepli ansem efwre ihpaatrepmsctsay

pparalpha  Hyotension will lead to decreased arterial pressure and DECREASED stretch. This leads to decreased afferent barcreceptor firing (carotid sinus and aortic arch). This leads to an increase in efferent sympathetic firing and decreased efferent PNS stimulation. This leads to vasoconstriction, increased HR and increased BP. +1  
sahusema  The way I remember this, carotid massage slows the heart. So baroreceptor stimulation (more impulses) increases parasympathetic output. +3  
cienfuegos  FA 2018 pg 291 has helpful image/description +  

submitted by hayayah(990),
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Teh tdoiryh si eiluspdp hwti eartlair odbol rfom hte rpeursio yodriht ar,eyrt a harcnb fo the nxaetler cotraid reryta, nad het eiornfir iordhyt y,rerat a cabhnr of hte rtevcahoylric rn.tku

sahusema +6  

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I suyivolbo ohhtugt htat the imna nthgi rof pctyciaa is ot anntudrdes teh rieyvtse adn sigsoorpn of reh cadmlie tdninooic UBT I hugotth hits was a iktcr iseuqtno sucbeae ethy keasd if" het lmaten inxaiatnome inngifd .hosdw."e. dan het tmes afiedl to itemnon hgitnyan uotab reh notioinrate to aplec or .time mbdu

drdoom  Stem actually states, “On questioning, the patient does not know the date [time], the name of the hospital [place], or the name of her nurse who had just introduced himself [person].” So, pt *is* actually disoriented to time and place (Choice A). That is definitely concerning -- as would be depressed mood (Choice E) and the other choices -- but “inability to understand severity and prognosis” is **the most concerning** since that is the very definition of capacity. Inability to understand = lack of capacity. +  
sahusema  So by the logic of the question, if someone understands the severity of their medical condition AND happens to also be disorientated to place and time. Go ahead and do sx on them, it's fine. +1  

submitted by tinydoc(190),
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xPt saeprap to aveh lsuMce tysstapiic sa a rsleut fo SM. isypactSit si arteedt twih a ucemsl aeanrlxt leik fnloeaBc chhiw si a AGAB songi.ta ethnaoalcB is a nmotCiemcohinli hichw nac be esud to atter ryanriU nusdfnityco in tllupMie ubt hte suieoQtn sksa awth ulwdo phle tetar the ttspaicisy.

sbryant6  To remember Baclofen is a GABA agonist and muscle relaxant, I always think of the "Greek Baklava". Greek for GABA, Baklava for Baclofen. +4  
sahusema  Also, acts on GABA receptors specifically in the spinal cord +1  

submitted by hyoscyamine(55),
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AF gp .172 oTo mcuh otongaxiney nca secau eefr aialdrc amdgea nlieagd to rpetahyonti of pimretatyru

mmm21  Okay i might be retarded, but why i can’t understand that they r asking about the thing that is damaged ? 😂😂 +5  
sahusema  Seriously! The question says "the goal of treatment is the protection of which of the following structures?" If too much O2 damages the retina, how is this treatment supposed to be protective to the retina? +2  
ratadecalle  I think too much oxygen would be with the ventilator having a high FiO2 setting, which they don't mention here but I'm guessing thats the thing they're controlling to avoid oxygen toxicity? +1  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +19  
naught  Supplemental O2 may also cause bronchopulmonary dysplasia or intraventricular hemorrhage (germinal matrix, located in subventricular zone NOT choroid plexus) +1  
fkstpashls  92-95% isn't high, but it's enough to get everything else oxygenated. Because it's not 100% high flow the retinas don't over-vascularize and lead to damage/hemorrhage, and shit like that. +  

submitted by imgdoc(128),
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Bllcaaiys tsih qtsenoiu sujt akss haw"t si ewrpo" dna asks oyu to pnixela atht 0%8 preo.w oerPw is 1 - aetb y(etp 2 ),eorrr laiscabyl hnew a endifrecef eistsx dan teh lunl peishotshy si rejdetec is .rpoew oS if het xR steetdc a nmae ecerdineff of 4.0 ni maaths ni eth npiatset in het tnaeetmrt rup,og nhte tath tdaa lafls in het 0%8 opwre nga,re and sti csnfgiieicna si 9%5 p0;.t5)&(l0, P vaeul si ustj teh bortbplayii fo otesnmhgi gpnanphei by hcacen, so oyu awht isth to be sles thta %5 so evwrtahe yuo sbeevrdo nt'si btsi.llhu

I eoph htis edhp,le and cotcrer me fi I'm

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) +1  

submitted by neonem(503),
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I ihtnk yuo anc nkow ttha shit is a hacaltim krseot atrher thna ltarcoic bescaue a icratclo sotrek oincgurrc noly ni eht tscaeotlpnr rugys (rmriapy syensro rtec)xo dna vivonlngi eht teinre uucusnhmol wtoituh nefatcgfi eht raebyn rrteeplacn rsugy rrymi(ap tromo tcreox) si yvre ku.ilnlye

sahusema  Ya I think this question is trying to test your knowledge between a cortical lesion and a subcortical lesion. +1  
cienfuegos  Central Stroke Syndrome: Neuropathic pain due to thalamic lesions. Initial paresthesias followed in weeks to months by allodynia (ordinarily painless stimuli cause pain) and dysesthesia on the contralateral side. Occurs in 10% of stroke patients. FA 2018 499 +4  

submitted by beeip(116),
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tyxr"icoEat niamo dcs"ia reesfr to au,lttgmae iwhle icnBio"ge" panrtlyaep serfre to io,rntyse het epscruror AA ot mnoeadip dan norip.e

sahusema  Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft +9  
mumenrider4ever  FA 2020 pg. 239 +2  

submitted by whoissaad(66),
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rWhee is tish even rofm? My di'nsm gigon yha ewir tgriny ot adtsunndre

sahusema  Hardy Wineberg equilibrium square root 900 = 30 1/2 of all offspring will be carriers so 30*.5 = 15 simple as that +6  
maxillarythirdmolar  this deserves a million upvotes. +1  

submitted by m-ice(272),
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hTe tinepta sdeen elmdica taotteinn etmia,dmiyel icwhh ailimsntee bgtinioan a ctoru edrr,o or fanrsgitrner he.r A srune does not avhe the aems ningriat nda ltfoaiauiqicsn as a icspayin,h so it oudwl be papprtineraio ot ask meht to niaeemx the e.ptaint Askign teh htilosap aphclain gnaia dclou eb erpaiinp,rtapo nda oudwl aetk emro t.mei ehrefreTo, eth btes ipntoo ognma hstoe gveni si to ask het iepttna if hes lilw alowl thwi her unsdhab e.rnetsp

sympathetikey  Garbage question. +44  
masonkingcobra  So two men is better than one apparently +23  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +10  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. +8  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +12  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +20  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +4  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +10  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +6  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  

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hWy udwol it otn be eaamni fo crchoin sdeeais tihw darecesed mresu fsnrraientr ?rineanctncoot

lispectedwumbologist  Nevermind I'm stupid as fuck I see my mistake +  
drdoom  be kind to yourself, doc! (it's a long road we're on!) +17  
step1forthewin  Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency? +1  
loftybirdman  I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency +18  
seagull  maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well. +  
vshummy  Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me... +5  
gonyyong  It's a B12 deficiency Ileum is where B12 is reabsorbed, folate is jejunum The blood smear is showing enlarged RBCs Methionine synthase does this conversion, using cofactor B12 +  
uslme123  Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia. +1  
yotsubato  Thanks NBME, that really helped me.... +1  
keshvi  the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption. +6  
sahusema  I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF +  
drschmoctor  Leave it to NBME to find the palest macrocytes on the planet. +4