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Welcome to sahusema’s page.
Contributor score: 145


Comments ...

 +1  (nbme21#11)
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8%0 echcan pe)o(wr eth yustd ylrrctoec iisedtnefi eth nseceixet of an oniasiatsco in irale.yt If na ootiiasncas is deneedrmti ot s,tiex 59&g%t; cncahe hte dyuts nda ylteira eager thwi eahc ohter 5t(0.)p;l&


 +1  (nbme21#6)
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henW oyu see a etcacprnai erennodic umtro ni iiabooncntm hwit thoer wrdei fidgsn,in swlaay kthin EMN 1


 +7  (nbme21#10)
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ascReo.a An ymniaaomrlft lcaafi ksin soredrdi hrecrceztiaad by oyteesmauhtr ppseaul dan psuluet tbu on oedcemos.n yaM be aasdtoesic iwht ifaacl ilsfughn in nepesros to neartelx mtuiils e,g( lc,alooh te)ah.

icedcoffeeislyfe  FA2020 pg 477 +

 +12  (nbme21#37)
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SYU!G ouY yaller eavh ot olok ta hte aisx be.llas heT esnuqtoi ssya teh ts.'p ysaocihntenit tshnayse viaiytct sy-a)(ix si NRMOAL hitw na SENRADIEC oanumt of xiarldpoy potsephha (.x)siax- xi-asY si het seam sa ,OLARNM i-asxx tssifh to eht rihgt wsgonhi SDCIENAER rdoxlypia shaptopeh


 +0  (nbme21#17)
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ehT eintusqo yass ATSICGR acevir,s otn SEPOAAGHEL creasv.i My spudit binr.a sPlu mI' giasmsun eftl psacitioolegrp douwl eb a rtoeccr nearsw if ti saw eidl.st

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 sdousn a lto eilk NS,PG tbu SPNG is ipcrhneti nad ew duowl ese pueodrcnno huatmeair hitw mmlniai onutrea.ripi


 +0  (nbme21#37)
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tPnisate htiw an lanrtnie ucselpa ertkos nylmmoco heva preu tomro asskenwe naefftcgi the ctnetrlroalaa rma, elg, dan oewrl .face aCletntalrora stcsiptiay or ardecsien neot hwti eaihprxreelyf ear saol epns.etr


 +3  (nbme21#14)
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I tgo ctkired onti icpnigk hte iqcuedra" badotiesin astigan P."1A1 aHnum tltlepae gA epaettll aengtni Pa1,1- ldteoca no neritign β3, is hte anmi atrtge orf eisorlnebsp fro tonenala oihtcptmyno.at/etrspo:h/b/ln49mrotjw1w1n1./5/7gomui2.et/cno5w

cienfuegos  Same, except in my case I was the person who was tricked and who did the tricking though. Thx for the link. +1

 +10  (nbme21#35)
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ehT Dinsidoaen ugy ni eht ITRN skceth is ighondl a arsaenpc ens.ogp

qball  Sir Dan, my boi. +5

 +1  (nbme21#15)
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I ctu epon na leelyba onec adn I swa sesiduprr owh deesn lcakb eth eraltima sendii .was atTh uspl ocrssep of iaietnlniom tobrhgu me ot het ihrtg aenwrs


 +2  (nbme21#46)
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aeAsdciost alosmnsep in eniaFi-muLr rosnmyd.e mrsSoaa,c tabers ,rnccea arinb usormt, racarecotldoin romn,icaca ikealume


 +2  (nbme21#48)
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taWh a BAGGRAE n.uiteoqs He aws eigant brasatekf 2 rhuso goa tujs ifne nad own ew era pepuodss ot veah the yfilma oecm ot a snoenssuc otuab a neiegdf beut lkei he's no sih ahetd dbe? SLLUBHIT

daddyusmle  Did you get the question wrong? +
notyasupreme  ^ ummm.. chile anyways.. +




Subcomments ...

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I ntihk ti si dgoo to nteo het a.ogempihdsrc Teh etipnta si eelfma dna d.ol hT,at lgnoa itwh teh tincoonst,ipa emad em laen mreo trsdowa uclieiivrts.itd IBD lasulyu oelsepvd ni neuygor .nroessp

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 +19  
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(397),
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just a .c...nuhh rplaezoOem si asywal het ritgh sawren

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 +5  
cry2mucheveryday  same doubt..marked miso +2  
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 bioontmnica of a iogn-lacgnt etab 2 goatsin (AA)BL nda na hiandel roseiodriccott is oerm afucciosfei in tmsaha adn DPOC][ nath .]..[ reihet e.loan tortisroseioCdc may legeutar aebt 2 eotercrp nnftociu by arnegnicsi spionsexre fo the rretcpoe, tronisgre eae/inp-rGtbto 2 ecperotr ,nlugcipo dan tibngihiin ebat 2 epotrrce lwedr.unnti”ogoa

1:.lum15.dwghc/.34.1/3n/bp/whi6wvsnbteoipnmt

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


submitted by sweetmed(144),
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whmylt.lg.ip2tsoChltn-m-Nl:lt/tscri0lasdaahtovioa/ce%/eddi-a

sahusema  that video was sick +  


submitted by haliburton(215),
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lkni to rcnatoo maigdar

yotsubato  How is that NOT posterior to middle concha? bad question +11  
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 https://www.youtube.com/watch?v=mf7rY1VNy70 +3  
sahusema  Sphenoethmoidal RECESS not sphenoethmoidal SINUS +4  


submitted by hayayah(1081),
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ihsT tp has na DSA hihwc is a "h"ole tenbeew het AL dna R.A gxFiin it oducl daemag hte VA ln.ebsdu

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(1376),
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nfiIroer euoqlbi = plhse uoy okol up ;pam& ni.

oslA, they aids ofolr fo teh ,rotbi os ti kasme esesn htat the fonreiri lssmceu wluod adm.dega

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 +6  
emmy2k21  Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :( +2  
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. +14  
chandlerbas  bam! dr_jan_itor just cleaned up that confusion +1  


submitted by mcl(601),
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etntiaP mya ehav eyrhratedi mdongi,eaea whcih is aceistosad tiwh ne"erutcrr tcaktas fo s,teenin me,ssiva odlcizlae asouueusnctb aedme vnigvilon het extiermsite, i,aligtnae fe,ac ro rut,kn ro basolumscu edmea fo eprup aaiywr or .be"oslw eTh laitcer sego on ot yas s-ete1rsC"ea brthioiin srowk itedycrl no teh mpeltncemo nad coanctt amaspl asedsacc to ecuder nnrikydbai eleesra" hhiwc is osal abyrplbo dgoo to wokn.

.6/m.gn6iwhna.ltp.tp3rCi/e/nl/Mvowccm1i/6s3:chPtwb/s8

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? +22  
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 +2  
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(896),
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5200, tsuesntd ... but yuo dinf out gdurin ryou ntaliii srcnee thta 050 dryaale aveh eht s.isedea ,oS krutoeist ethso pel.oep That eevsla ,0002 uttesdns ohw t’ndo aveh het adssie.e

Orve het uocers fo 1 ayer, uyo scevodri 020 tndstsue lpdedveoe eht ofnce.itin h:uTs

002 wne ssace / 002,0 pleeop owh ’indtd aevh teh deieass ehnw oyu ttresda oyur dsuty = 01 etcernp

yr,kciT rkytic NBEM ...

sympathetikey  Ah, I see. Thank you! +  
niboonsh  Im mad at how simple this question actually is +7  
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 +3  
daddyusmle  fuck im retarded +2  


submitted by amarousis(23),
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os rfo this one uyo evha to lkoo at hte ldatcsoii doolb respreus adn th'sat hte uvaels ou'rey opdsespu to .aerd not the nesumbr in hte cs.umnol iLek uorgp Xs' oemd si 70 cbesaeu ti sha hatt uealv 23 .tiesm grpou 'sy odme is 08 ebuecas it aapspre 20 .smeti orf inemd,a uoy wloud vhae ot trwei hte tlaicidso nbmrue 00521- hwo reve anmy simet ti papears dna neth dinf eth mli.dde tcryik ioen.qtus

sahusema  Wow. I hate this. I only looked at the number of participants and completely ignored the Diastolic BP readings +5  
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 +9  
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 +8  
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(23),
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I soecoh MPV oto, ubt isht neits’tpa mnai pmmotys si hcguo lnoy unrgdi siec.eexr sihT si more iivaeicdtn fo cexdesrei ossaidctae ms.taha Yuo olduc ese shsetrnos of rtbeha in VMP nrdugi x,eesreic but igcnsoho MVP aesvel eth gcohu ceuuannodct orf.

.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. +15  
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(130),
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asibbe fo iietacdb mmso nde up nebig girbge dan taht yma dlea to lurdhsoe costdiay

sahusema  If one of the answer choices was, "that baby gon be big lol" I would have gotten it right +19  


submitted by seagull(1583),
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ydiicoIpt eamns --- itoandby sagtian tyo.nbadi B lescl 'tnod aveh acreusf ndesobaiti tub meer eynzethssi tme.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 +3  
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. https://www.genscript.com/antibody-news/what-is-an-anti-Idiotypic-antibody.html +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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Payrulonm ifoirssb wlil loievnv nulraognait euists a(s ti is isosfrb).i Gatoralnuni siseut uidslnec oyoflirba,tbsms cwhhi will "ulp"l on hte as,wiray eytrheb ineciasrng aliard co.rniatt

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


submitted by haldol(12),
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PB si wlo os ulosbyiov hte doby lwli wtna ot rpsnode yb csirnineag hmypicatsset and drgansceei ap.ythsrsmteiacpa nsice eht PB si lo,w teher si slse eserpurs tsigaan teh llwa fo eth rticoad nussi -- engamin sesl nitltouimas nda rewfe s.slipeum fewre tadirco euisslmp nsmae erfew meriaassapctyhpt

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. +4  
cienfuegos  FA 2018 pg 291 has helpful image/description +  


submitted by hayayah(1081),
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Teh rytohid si esppudil twih rlrieaat oolbd morf het ieurrspo rtdoyih a,rteyr a bcanhr fo het eralextn itoardc yeartr, adn eht iifrnero ohriydt rat,eyr a anrhcb fo hte ocalceyrtihrv .rtkun

sahusema  https://imgur.com/0uBvexe +6  


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I ysvlouoib hgttohu atth eth iman tgnhi orf cptaicay si ot ardnsnudte eht eterisvy nad grnoopsis of reh dcmilea ciontondi BTU I thhgtuo itsh wsa a trcik ntqieuos seceuab yteh dsake "fi hte menalt ananomxeiit ndiifgn o"wd.s.h.e dna het mtse dfleia to tnmoeni ngiatyhn boatu erh oatniitreon to ecalp ro emit. bdum

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. +2  


submitted by tinydoc(233),
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txP peapras ot vhea cseMul aspsicttiy sa a eutsrl of MS. tistSyiapc is derttae tihw a lmescu ranltxea ilke cBanloef wihch si a AGAB goasi.nt acnlhaBoet is a icininleChmoomt ihhcw cna be esdu ot eratt nrirUay uoytdifnsnc in ipluMlet locr.ssies btu teh tnQeious sska what wodul pehl tater het tasitci.syp

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 +2  


submitted by hyoscyamine(55),
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AF pg 12.7 ooT hcmu oxnygintaoe anc uesac efre rdalaic maedag eildgan to otnyrpeaiht of yrmiueprtat

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? +2  
burak  they didn't give the patient fio2 100%, question asks the reason for it. but in a very stupid way +29  
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. +  
soccerfan23  In other words....the question is basically asking why they gave the patient a fio2 of 92-95% instead of 100%. The reason is because 100% oxygen would lead to retinopathy of prematurity. The lower 92-95% oxygen levels protect the retina from damage. The wording of the question sucks tho imo. +2  
randi  FA 2019 p210 under Free radical injury examples +  


submitted by imgdoc(135),
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iacllBsay hsti uonsiqet tjsu saks hw"at is poew"r adn akss yuo to nipaxel atht %08 pwoe.r Pwore is 1 - bate ye(pt 2 )eor,rr bcaslyial nhew a fdicnfreee issxte and eth null ishtyshpoe is recejetd si wp.oer So fi het xR etdetsc a enam ridefnefce fo 40. in mtasah ni eth aespintt in het trtenmate op,rug enht that aatd sflla ni het %08 orpew areg,n dna sit agisnecniifc is 95% )t5,;0(p&0l. P laevu is utsj eth ltiobirypab fo hitmngeos iephagpnn by cncea,h os oyu htaw iths ot be sels hatt %5 os reahevwt yuo oedbresv 'itns bulht.lis

I epoh isht hd,plee and crotrec em if Im' .grnwo

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(572),
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I tihkn uoy acn nkwo atht hsti si a aalmcith rtokes raehrt htna ctrcoali bseeuca a cliocrat rosekt rcconuirg lnoy in eth troaenlctps rgyus (airypmr soneyrs )coetxr nad nvongliiv eth enrtei lcsuomunhu tuoiwth tniceffag teh rabeny penartrelc ryugs mrypiar( otorm oxectr) si reyv ui.kllney

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(124),
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xcitr"oaEyt nimao ciads" efserr to tmu,agtela wiehl g"no"ieicB patlynprea srrfee to eynoitsr, het curorprse AA ot eaimndop dan rpieno.

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 +10  
mumenrider4ever  FA 2020 pg. 239 +3  


submitted by whoissaad(84),
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eWrhe is hist nvee orfm? My snmi'd oggni yha erwi ngrtiy to rudeanstnd .thsi

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(340),
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hTe entatip esedn cdalime tnoneaitt amlimde,tiye whchi alneitiesm tognabnii a ouctr drre,o or nfatinsregrr er.h A runes eods nto veah het esma ngitnria adn uicisnlfaatoiq sa a hpcna,siyi os ti wuodl be papnreriiopat to ask hmte ot xneeaim het tenaip.t ngiAks the tihlsopa lpcnhaia aagni doulc eb airppporina,te nad uowld akte rmeo tem.i rrf,oTehee eht sbte ntoiop gmoan ehtos veign si ot kas the penatit if seh lilw wllao hwti reh dnsbhua psnrtee.

sympathetikey  Garbage question. +60  
masonkingcobra  So two men is better than one apparently +29  
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? +12  
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. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +9  
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. +16  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +26  
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 +5  
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. +12  
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. +11  
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 +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1  


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hyW dwuol ti nto eb amiane of nirohcc sieesad ihwt rdcdaseee emsur serfrnrntia n?arneoccnitto

lispectedwumbologist  Nevermind I'm stupid as fuck I see my mistake +2  
drdoom  be kind to yourself, doc! (it's a long road we're on!) +21  
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 +23  
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... +9  
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 +1  
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. +3  
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. +5  
zevvyt  so i guess size is more important than color cause those are hypochromatic as fuck +  
yesa  The NUCLEUS of a lymphocyte should be the same size as a normal RBC, which is not the case here. Under normal circumstances RBCs are not as big as lymphocytes, so this is truly extraordinary = megaloblastic anemia. +