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Contributor score: 20


Comments ...

 -3  (nbme23#44)

I actually think he might have iron-deficiency anemia that can be described as pallor or "yellowing of the skin." He does not have jaundice (anicteric sclera) Patients who are strict vegans can develop iron deficiency. The best way to correct this is to encourage a dietary change

123ojm  iron deficiency is rare in vegans and vegetarians unless they are also heavily menstruating +

 -2  (nbme21#24)

Esophageal squamous cell cancers are more common in smokers





Subcomments ...

submitted by nwinkelmann(292),
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ee'rsH a AERTG dioev lxpianinge urondtusla nniigdfs fo ya.pngcnre 5:9@7 is a rgeta ucipter os afr tihw lslabe fo hte ykol sca, aieslatgotn ,acks fleta p,loe adn mai.nno nOe nitgh eht nsrpoe nignipexal sdai ttha I tohguth owldu be ogdo ot eekp in mdin si hatt het lkoy csa olsok elik a ireecoh inesid the ntglasaieto cs.a ls,Ao htsi itse ash a ncuhb fo suteirpc as ewl:l ttodi/rsrsa:pepe?iasd-/cflhragat/ei.rter=slisgnot/mtiuar.

zpatel  what video? +7  
usmlecharserssss  porn video how they make this embryo and yolk sac +1  
samsam3711  Shorter video that explains this pretty well: https://www.youtube.com/watch?v=01mMBDEthV8 +5  
focus  @samsam3711 that video is BOMB. Thank you!!! +  


submitted by emh(7),
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Pstrdainlnosga cieearsn GI tyoiitlm ued to ilei.sstaprs st'I the msae neasro hwy the utesur nctcroats rgunid at.utinesornm

samsam3711  Also Misoprostol is used for the prevention for NSAID induced peptic ulcers +1  


submitted by mcl(597),
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oT adepnx on ti,sh tncoaiorntc of xrlfoe mturogiid dponursuf eculsm rlustse in feolinx ta eth PDsI dna P.PsI hTe eodnnt eacahstt at eth pit of eht ,irfgne ni stcraton to xeoflr tudromiig ieiilpucarfss (cataesht ta het Ps)PI. cellRa viirntnnaeo of the mofrrea lcuessm is tolysm rmfo het edanmi vn,eer ecxpte fro 51. scuslme (ralun alfh of eolrfx igdriumto odsfpuunr nad the ofxlre rpaic ulansri, otbh isepdupl by uarln chhiw kmesa it ze to rrmeebme yay).

uBt osla fi yuo gto ihst wgnro klie me go dera tath knli eeacsbu 'tis a lalrey inec ev.iwer

samsam3711  Also a side note, this is called Jersey finger and is relatively common injury among athletes https://www.orthobullets.com/hand/6015/jersey-finger +2  
brbwhat  FDP only causes problem with dip flexion. Fds causes injury with pip flexion. +  
brbwhat  Causes problem* with There is an nbme question in 24 related to this concept as to what causes what, +  


submitted by hpsbwz(75),
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aoeOzmplre lhaes tsrgica nad uadndole lecurs rmoe eecfytlfvie nhta ipmso,rsotlo hseawre ostolosrpim wsa orme efcitefev in sieatptn wtih sernsooi nelao.

Em3/l1lr0/1ut0st5w1:3i/og2h6.891f.//0pnJ918e1o5N3jM/0w.dw

samsam3711  Misoprostol is indicated for prevention of NSAID-induced peptic ulcers (FA 2019 pg 393). Omeprazole is better for treatment +2  


submitted by chandlerbas(97),
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usncrhbo bnoiuctorts s arpt oxyneg ni ilaoevl on intneogr elba to trene c(romtieasph ari ernntieg oybd (7%8 irnetgno nda 1%2 o,yengx nntoegir si so opmnttair onrengti bc it is a ooyprl odrbsabe asg dna shtu is in daecgrh fo pegnkie lvolaie naxty lnegieodf) ni the ioelavl si beardbso niot eth liudgoodne cbr hte vueoml of eth liaolalvloeeav r lcaoepls tsir aoonbp esialctaest

bethune  Why is pulmonary hypertension incorrect? +  
samsam3711  PEEP allows the alveoli to remain slightly open with exhalation to prevent atelectasis. Pulmonary Hypertension is going to be related to vascular changes (instead you might see shunting of blood in areas of poor ventilation) +1  
drzed  Pulmonary HTN occurs because of pulmonary vessel vasoconstriction. This can occur d/t multiple factors, but one of the most important ones is hypoxic vasoconstriction that the lungs will undergo (for example, at altitude). In the setting of PEEP, you are ventilating the lungs perfectly; this allows for the pulmonary vessels to open up and not undergo vasoconstriction. Thus, you prevent pulmonary hypertension via hypoxia. +  
peridot  @drzed by your logic, you're arguing for D to be the answer but the correct answer was about preventing atelectasis +  
medstudent  The question is what’s key. The purpose of PEEP is to keep the airway open. The purpose of ventilation with supplemental oxygen can help with preventing pulm HTN. Could be wrong, but that’s what makes sense to me. +  


submitted by yotsubato(1019),
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yWh si this NOT nocdh?aric hersTe hngnoit rhee ahtt suerl ti .out

drachenx  Chancroid is described as an ulcer.. whilst in this question they mentioned "vesicles". Pretty much only herpes is vesicular +6  
whoissaad  They mentioned ulcers too. I chose chancroid as well, couldn't find a clue to rule it out. Also thought "discharge" was pointing you towards a bacterial infection. But guess I'm wrong :) +  
emmy2k21  I think NBME/USMLE writers make the assumption the patient is in America unless specified otherwise. Chancroid is not common in the US. If the question stem mentions a developing country, then chancroid can make your differential list. +1  
selectuw  for chancroid, there may be a mention of inguinal lymphadenopathy +2  
samsam3711  Also with chancroid questions they want you to differentiate it between chancroid and syphilis, (eg. Painful vs. painless) and is usually described as a much larger ulcer that is painful (not vesicular as in this question) +  
suckitnbme  Also believe that chancroid does not presents with systemic symptoms like in this vignette. +  


submitted by readit(14),
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hyW is is ton posude smuyrena?

o"Atrci esmspaornyduesu iclyayltp ccruo as a rltues fo amatur /-+ innttr,nvoiee a ddscnioree busset of ramtcuait octria nuyirj ni teh ryjoitam fo esa.cs hTey acn be utace or rncoi.h"c

errnaaioapcnsr=lgs:?/ysdu/iiadtdsitga.a/reoc-utmleapeuhp/toros

readit  *same goes for saccular aneurysm, which also is usually 2/2 trauma +  
samsam3711  In the question stem there is no indication of trauma so it would be hard to just assume that +  
almondbreeze  see my comment above for marfan syndrome. might help +  
drzed  This is because a pseudoaneurysm is between the media and adventitia, and is incited by trauma; a dissection is between the intima and the media and is a result of hypertension causing an intimal tear. The history points toward cocaine -> hypertension rather than penetrating trauma. +  


submitted by sklawpirt(30),
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I ihnkt eht iade rehe is imypsl htta one ldhuso nkiht tbauo hrewe elevscis era micogn mrfo on hitre wya ot eth gloig c.xopmle

w"oT esspt aorrfwd dan noe pest cab.k" ylcclfSeipa teh etouqnis mya eb nifrgrree to a aerr aaicalfornic risd.reod an srweaasnes of htat ssiaeed si not eces.nrasy hatW is yrecsenas si irdgaedunnstn eht rgioin rmfo eerwh ssveelci rae akfedcitr to the ogGil ta.rusppaa

IOPC epotnir is nedede to oact lvescse orfm the RER ot ndse ot oiggl. ,uTsh htiw a tonimuat ni ttah petnori, the caepdgka repotnis atht dlshuo belb fof nda be nste to eht i,golg eidtsan cucetumala ni het RRE dan tdelia ti. sTuh het ae.rnws

37ga10phs.tp19m-cw./h(dl2d4wf0pe).62f/twcjo00://l9-S/22

hayayah  pg. 47 on FA got the good visuals! +5  
notadoctor  COPII* proteins are needed to coat vesicles from the RER to Golgi. "Two(COPII) steps forward; one(COPI) step back." Anterograde goes RER -> Golgi -> Lysosomes/Secretory Vesicles -> Plasma membrane +23  
titanesxvi  why not small lysosomes? +3  
varunmehru  and I thought large lysosomes due to lack of enzymes to degrade +  
samsam3711  The size of the lysosome is not affected by the presence or absence of protein, but its function is compromised (eg. protein is getting stuck in the RER) +  
fattyacid  I hope this helps to whomever was lost like me Null mutation: A mutation (a change) in a gene that leads to its not being transcribed into RNA and/or translated into a functional protein product. For example, a null mutation in a gene that usually encodes a specific enzyme leads to the production of a nonfunctional enzyme or no enzyme at all. +2  
pingra  I think you made a typo: COPII (RER -> cis-Golgi); COPI (trans-golgi -> cis-golgi and cis-golgi -> RER), clathrin (endocytosis and trans-golgi -> lysosome) +  
kevin  So my thought process was if there is no COP signal then instead of going to Golgi it would be sent astray into cytoplasm, akin to how in I-cell Dx the enzymes get sent out of the cell since there is no trafficking signal (therefore I presumed large lysosome due to eating the aggregated protein). Are we saying without COP or Clathrin that the vesicle will simply stay put where it is? If I can get a reply before my exam (2 weeks) that'd be much appreciated +  


submitted by hayayah(1074),
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tfieeecDv uoomolsogh niitbmceranoo si esne ni en/oriaravbast ncrsaec hitw teh BRC1A eeng atn.tuomi

johnthurtjr  Ashkenazi Jews have a higher risk of inheriting the BRCA1 and BRCA 2 gene mutations, just another tip! +2  
lebron james  BRCA1/BRACA2 are involved in the repair of DNA double stranded breaks +6  
samsam3711  Other answers: DNA Mismatch Repair: Lynch Syndrome (MLH1, MSH2) DNA Nucleotide Excision Repair: Xeroderma Pigmentosa +14  
lovebug  not about this question but... Defective "Non"-homologous end joining is seen in Ataxia-telangiectasia. :) +1  
makingstrides  DNA Base excision repair removed damaged, or not correct, bases. +