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Welcome to sbryant6’s page.
Contributor score: 167


Comments ...

 +0  (nbme23#41)
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Ptoinne asreirte rea sallm rbahescn of eht labsair reyart ttha nca putrure ni het etgistn fo olpyor nerdlotclo nn.epoehtsiry

nor16  vertical gaze intact = mesencephalon intact horizontal gaze damaged = pons damaged (RPRF) Pons damaged = no access of corticobulbar tracts to motor nuclei in brain stem -> speech impaired +1

 +5  (nbme22#46)
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llfpeuH t:lbea /t_t/s/ooclawpv.sompncnnMJpi/cioiAs.bt:pentnugont5h-/_11lndaTa


 +6  (nbme22#41)
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nts:atedr/wamut.lp-ac/mnemiymrhlhtsk-dfac/rpo-aesw/swdc.ceao

makinallkindzofgainz  upvote for credible source +21

 -3  (nbme22#6)
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If ouy nokw het AMO of ixiogdn yuo uhldos eb albe to get tshi sioutqne .rthig


 +8  (nbme21#48)
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shiT utnsoiqe is ltwodfo.- oYu mtus kwno eth skgein-cdinamio rachihrey dna sloa odecnrsi aonu.tomy anikMg soocairetm"e"nmnd ofr tceiarn esnmatrtte is rw,ngo ceaeubs it svolteai nooyautm nad enirmofd escnt.on Phyicisans ohudls lpyism xnlipea the R'BAs of lal tretetman pnto,ois dan olwal het fymila ot cedide hwat si estb abesd no dmfnreoi tcenosn and "trehi repncoitpes of eht STINPATE' .wsesi"h fI rheet is on dnaedcva ,vitcidree tnhe hte dsoiiecn ludsho eb daeeplpa ot a gostarrue dcaoe.r-niiekms roPtiryi fo teogssruar si &tsa-esg;dupuo-tl &enr;taegtsgh&i;ltig.sdbsn-c-pr-lin- eYs, teh psuose odlwu ehav hreigh pi,troiyr but hte mfyial ohlsdu ta slaet try to crhae a nuesscons ftirs eebfro eganlippa ot o"lyn" eht .iwef fI a csnonseu,s ntacon eb mdae, thne het weif dowlu haev ifstr say ni eht dnseoii.c ee,rorhTef ncgneuroagi teh aylifm ot dcdiee anoridcgc ot eht hiwess of eht IPNTETA dulwo eb a betret itsrf ts,ep lcleasepyi fi eth eswihs of eth eiwf is orcnrtay ot atth fo eth netai.pt l,osA jsut as a glearne elru, I yaplctiyl iodav niigcpk wearns osioptn itwh tsl"seoub"a csuh sa reve",n a,wsyal "oyn.l ehT roupspe of a rtusgraoe si ot tca ni eht ebts trsniete fo teh pent.iat

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1

 +5  (nbme21#37)
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paanChyonigarirom whti onaCisftciilac nad rstCooehlel ltrasysC rtimo(-loo ifdlu.) emnatnR of hk'eRtas pcuo.h tNo to eb uoecnsfd hwit iartyputi aoem.nda

dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +

 +8  (nbme21#48)
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To bereremm lBnoecaf si a BAAG aontagis dan esulcm ntaal,rex I ysalaw ihnkt of "eGerk kva"l.aBa kGeer rfo BG,AA nad aBlkava orf fo.elcaBn

castlblack  Thanks. Baklava is from Armenia though. Go us +1
athenathefirst  No it's actually Arabic/Turkish. That's why it's called Baklawa. +2
lovebug  I don't know if this is right. UMN Lesion (In this case, MS) -> Increased DTR, increased muscle spasicity, and dystonia. If Baclofen stimulate GABA B receptor(it's Gi related PTN) -> neuron become hyperpolar -> decreased excitory glutamte -> muscle relax. +




Subcomments ...

submitted by mousie(220),
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yWh on naig?etws I mane I gte tscsayE si oblyrbap teh rdgu of ceiohc efrobe na lal hngti dncae yarpt oll)( ubt d'nto nadnrstdue yhw rtehe uwdol be ldco mersitxeite adn on teasinwg when is AF it ssay hhaeirtpeymr and dr??b?o?ah

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +12  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +12  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +20  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +8  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +4  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +1  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +9  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +1  
cassdawg  "Despite possessing a direct negative cardiac inotropic effect, ketamine causes dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow. Consequently, ketamine produces cardiovascular effects that resemble sympathetic nervous system stimulation. Ketamine is associated with increases in systemic and pulmonary blood pressures, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements."(https://www.openanesthesia.org/systemic_effects_of_ketamine/) +  
brise  LSD does cause HTN and tachycardia according to uworld! @d_holles +  


submitted by link981(163),
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gaeP 63 fo FA 0281. uneiPr sgntiaoatn rugsd ar:e

pna6i-r(eihotzMPA is a rrdugop of ,)M6P- eMlehayntpco,o iarni.birv

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +3  


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odoG tcaf to coimtm ot rmmyeo: uoy lsoe babrci in eth osolt neehc( wyh raihadre scaesu ninnonao gap taebomlic di)asiocs, nda iplsceylea lose ptasmsoiu hwit ltxieaav ueabs s(a otnemidne ni the esoqunit tems.) tsaot-eocliysd//tdtcerceown..lhaiertc--t/:-rbaaenthatolniaiusertbwiawtepmd-/aepns-dwmho

sbryant6  I'm going to go take a big bicarbonate poop now. +26  
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse — Metabolic Alkalosis :   ↓K+     ↑Cl-                   ↑pH    ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +2  
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1  
texasdude4  easy way to remember : "Bicarb out the Butt" +  


submitted by pppro(23),
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etaniPt sha PB.H iGev aalhp one notntisaag to cedreu sotmho elumcs iontarnotcc nda erevlei ftcufiyldi antinug.ir

d_holles  lol i thought it was some kind of urinary retention problem and put H. +15  
sbryant6  How is H wrong? Oxybutinin or tolterodine treat urinary incontinence by blocking M3 muscarinic acetylcholine receptors --> urinary retention. We're just supposed to assume they are talking about BPH here because he is old? +  
jaxx  I agree. I picked "H" for that same logic. Does anyone know where we should have come to the conclusion that this was BPH? +  
forerofore  they are telling you he's having "difficulty urinating", one of the clinical criteria for BPH is reduced urinary flow rate. this is not incontinence because they are not telling you he leaks at all, just that he pees "a lot" +12  
drzed  Even if he was urinating too much, anticholinergics are contraindicated in the elderly (Beers criteria) +4  
pathogen7  @drzed tI mean techinically alpha-1 blockers are on the Criteria too ... +1  


submitted by welpdedelp(229),
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This is aretabEn-tLom, hihcw rovimesp with tnvemome as aeorcdpm to tMsiahenye scagria hhwcih nwssreo hwti evtmmneo

sbryant6  Lambert-Eaton is typically associated with Small Cell Lung Cancer. Since there was no mentino of that, I was thrown off. Such is the difference between UWorld and NBME I guess. +1  
makinallkindzofgainz  I'm laughing about Myasthenia "gracias" lmao +16  


submitted by seagull(1582),
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Teh auhrsot twne uto of hriet yaw to fnid ehtw roswt htopo fo a onaluramg eyth d.lcou eTh ertwh no a mets ttah tsguessg taht ti uwold eb nluaiorangt tsuie. utB liltet idd ew w..o.nk

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +17  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4  
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1  


submitted by seagull(1582),
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Im aols vcidonecn bigolcnk 2I-L is lsao a mntaert?et yHW is T-NahFalp the teebrt sawenr er?eh

amorah  FA P120-122. Immunosuppressants for RA are calcineurin inhibitor (cyclosporine and tacrolimus), 6MP, and TNFa inhibitors (adalimumab,infliximab, etanercept). It is important to distinguish that calcineurin inhibitors block t cell activation by preventing IL-2 transcription, not necessarily block IL-2 action. Sirolimus(rapamycin) blocks IL-2 action but it is used for kidney transplant rejection prophylaxis specifically. +19  
sbryant6  Spot on. This image explains how Sirolimus blocks the effects of IL-2: https://image.slidesharecdn.com/11-150813013011-lva1-app6892/95/11immunosuppressants-30-638.jpg?cb=1439429471 +1  
krewfoo99  in addition to the above responses, IL 1 antagonists (Anakinra) can be used to treat RA. Anakinra is a recombinant human IL 1 receptor anatagonist but less effective than other treatment modalities. +  
snripper  Prednisone is a glucocorticoid (which inhibits IL-2 synthesis) is already being used with no effect. So TNF-alpha is the next option. +  
avocadotoast  DMARDs: methotrextate, sulfasalazine, hydroxychloroquine, leflunomide, TNF inhibitors, Anti- IL6 (Tocilizumab), JAK inhibitor (Tofacitinib), Rituximab. You can use cyclosporine and tacrolimus to treat RA, but those aren't first line treatments. DMARDs are used the long term treatment of RA and methotrexate is often started first, and the other drugs are prescribed if methotrexate does not sufficiently control symptoms. None of the other choices listed are a part of DMARD therapy. +  


submitted by yotsubato(1041),
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TPM"P 6yt--mieil,repyy-onlhtpeedh,d2n1()31,ytah4r--r is a roprgdu to teh ixonetornu M,PP+ wichh ucaess rtapmenne stpsommy fo Pknsiarnos' esisdea by inosedtryg gaeicpndmiro rousenn in the btsasiatnu aignr fo the i.nbra tI sah been udse ot stduy isasede odmsel ni irvsoau manial ueds.tsi" Wiki

ilikecheese  pg 508 FA 2019 +17  
sbryant6  I thought this was testing "lead pipe rigidity" aka Neuroleptic Malignant Syndrome and its connection to dopamine. Had no clue what MPTP was and got it right still. Probably wrong train of thought though. +  


submitted by brise(54),
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heT nqsteoui is kiansg atwh ipnto dowul eb het msto ikylel to ruel in ecrca,n dna ighh ipccteiysif ehnw vsipoeti rluse in a.cnrce eTh etshhgi icpietsfiyc laveu is A, cb het eht X ixas ohwss if-ycs!eci1pi)t(

sbryant6  SPin and SNout. Specificity in, sensitivity out. +6  


submitted by sbryant6(167),
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fI oyu wkon het MAO fo ndoigix uyo hlsudo be ebla to etg tish soqteuni hgrti.



submitted by sbryant6(167),
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iTsh qouentsi si wlf-otod. oYu tmsu onkw eht o-cknmiiidneasg crhyehari dna aols inecsrdo nm.auotyo ngMkia oncamtoenedm"s"ir fro citenra natrmteets is rgnwo, subaece ti vliaeots tmnyouoa dan neoimrdf t.ncnoes nciPahisys uhdslo ysmilp penxali eht 'ARsB of lla aentttmer so,tponi nda awlol eht mliyaf ot ddecie twha si bets debsa on ifmdnroe scotenn dna e"tirh ospereicntp of teh TAN'EITSP wiss"eh. If teehr si no aadevcnd ide,evrcit neht teh siioencd osuldh be eadppela ot a ouaresrtg ekmscrod.i-iane otiriyPr fo eturssraog si -aettulssu&-;odgp ss-h&-gnbctl;&pn;teliaire.r-tgns-dig ,seY eth sspoeu ouwld vaeh ehgirh yortp,iri tub eht ymlfai hduslo ta atsle rty ot acreh a nscnssoeu rtfsi orfeeb elapngaip to n"oy"l the .ewif If a s,nseonsuc tncona eb emda, hten hte ewif ldowu vhae sitfr ays in teh doscinie. orher,eTef iacgongurne eth fimyla ot eciedd graidccno ot het weihss of eht TPETNIA ldwou be a eetbrt itfsr tspe, iascyllpee if the shewsi fo teh wfei si yratrocn to hatt of the ena.ttip A,los ujts as a elgrena rel,u I yitlplacy aodvi iincpkg eswran ooistnp wthi uaest"oslb" husc sa er,"nve ,asylaw nl".oy ehT orpespu of a usatregro is ot act ni the bste rtetsien fo eht a.tnptei

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1  


submitted by hayayah(1081),
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nyy-enseeicstetCi omcneekih rprceeto 5 )C(5RC is a eionrpt oufnd on het fuacers of DC4 l.eslc

yotsubato  Note, this is NOT in FA +2  
sbryant6  It is in UWorld. +3  
almondbreeze  it's in FA2019 pg.110 +1  
almondbreeze  but missing the full name for CCR5 +4  
demihesmisome  CXCR4 is also a chemokine receptor. +2  
sononono  Uworld ID 953 +1  


submitted by mcl(601),
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aGit srloembp sreisa uosnpiisc rfo olohacl besau or lidaehn ul.eg ewvoeH,r seont fo agti rosmlbpe is teeyavlilr rpdai (pcloue of mostn)h dan itag nasrtidubec ihwt rasdegr to olcahlo is terihe eud ot cntoinxaotii ro cohnrci beas.u Artlintaeve laatenpoxni aabvleila on DSN. Aols ees luontee ityxicot no s.ceadepm

sbryant6  I got this correct solely based on the patients demographic. Glue is cheap and easily accessible to underage populations. +5  
whossayin  Kinda racist of us but that’s how I reasoned my answer too lol @sbryant6 +  
hpsbwz  how is it racist if the only thing thats given is his age lol @whossayin +25  


submitted by dr.xx(153),
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rsHhn-leadbsHaencsoe pnai:tqu HoE = 6.1 + ol(OHCg3 / 30(.0 * PaOC;)2) so her,e Hp = &t6;9g. 2= tcAue mno(enadutpes)c riyparm oryresraitp i,aodtss iwchi bmclteoia ioscsiad

sbryant6  calculator can't do logs yo. +5  
b1ackcoffee  wow, sherlock! +  


submitted by yo(86),
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r'yehet lknatgi tubao a nnrpsoellea shntu poeurerdc

an/phholclescsh.rma0arvt/atecsteilnl-t5tt-rni:h9/seogm.nls-ullpenydean/de/4tit

hungrybox  be honest did u know that before looking it up +9  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +30  
sympathetikey  Relax @meningitis. Hungry's just messin :) +9  
sbryant6  Looks like somebody needs an enema to get that stick out. +1  
chandlerbas  ya'll are too TP/(TP+FN) lol +12  


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eoutminuAm tisirdyhiot (aak ishotmHao) + -anpr;t-gg&tne khniT tubao poyibtissil fo lteaf otimdyrohhyspi deu ot aoitbdyn taeimdde armntale myhrshidptyoio. dLesa to esm.tiniCr nsiFndig in tnfina aer eht P'6 Pot( lbely, ,ealP ufyfP f,cea orrPndguti ilsmci,buu rPeoabrttun o,eugnt dna roPo arnBi emevo.ndptle

neonem  I don't understand the last part of this question stem though... if the mother's TSH *increases* during pregnancy? Wouldn't this further increase her (and/or the fetus's) production of T4 and thus counteract the hypothyroidism? +  
poojaym  @neonem no. Autoimmune hypothyroidism is a destruction of the thyroid gland, and a decrease in production of T3/T4. An increase in TSH means that there is not enough T3/T4 to inhibit TRH, and so TSH is being released to stimulate the thyroid gland. +38  
arezpr  TSH, T3, T4 and thyroglobulin cannot cross the placental barrier. +  
chamaleo  @arezpr although those hormones can't cross, the autoantibodies from Hashimoto's can +1  
yotsubato  The baby has its own TSH though +  
sbryant6  TSH comes from the pituitary, and act on the thyroid. Autoantibodies attack the thyroid, so TSH doesn't work. +  
kimcharito  no goiter then? +  
lola915  I think there is no goiter because the baby's thyroid gland has not fully developed and these immunogloblulins from the mother could attack the thyroid gland leading to issues with it's development. +  


submitted by pparalpha(85),
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BEV (-)HHV4 ecfsnit B elcl rhuthgo D21C.

yAtiapcl eylhpoytsmc no iaeerphplr lobod easrm n(to cetnfdie B cl,esl tub evtairce coitcxtyo T .ec)sll

o"uM"noen:sisclo + topoosmn stet seoatbdnii( edecedtt yb iuattngoilang of sepeh or rsoeh sC)RB

sbryant6  Atypical lymphocytes are CD8+ T cells, not CD4+. Remember that. +15  
mangotango  I remember this because Infectious Mononucleosis is caused by a virus (mostly EBV, sometimes CMV) and MHC Class I functions to present endogenous antigens (e.g. viral or cytosolic proteins) to CD8+ T cells. In comparison, MHC Class II is more involved with presenting exogenous antigens (e.g. bacterial proteins) to CD4+ T cells. // FA 2019, pg 100 +1  


submitted by hungrybox(1051),
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ogLn enwars ,aadhe tbu aerb tihw em.

NTHI: v olsko iknd of eikl ,y ashewre k ooksl orme ilek .x

tetiyr-cnpe = V1x/am

  • axmV is teh peupr lmiit on ohw sfta a ntoarice is ztyaelcda yb emey.zsn

irt-nceptex = 1/Km

  • mK is a rannigk fo owh ogod an mzeney si at dinbngi tsi stsbut.era An mnezye tihw a krngina fo 1 si etebtr at bdiignn sti ertasutsb nhta na enmzey thiw a nkaigrn fo .5 e(oLrw mK = tterbe )nzemey

tNoe atht xaVm, as a esreuam of rea,efrmnpoc can be darelte thruhog aymn .htngsi l,haeniweM mK is a ets ascteccrrthiai of eht ,eenzmy nad tcnoan be et.aldre

nI tsih emexlap, het zmyeen ocempernfar m)V(ax si acerenids by iceirnngas eth vnamiit crtoofca os tath ti ceahres a ""anrolm vti.aicyt e,rveHow het zyneem is lltsi rlenhiteny tyihst edu to a ganceitonl ,etfdec so het mK ssyat teh ae.sm

mnemonia  Awesome. +  
ht3  wait line B shows the vmax doesn't change and that the km is getting larger (enzyme is still shitty so larger km) so -1/km would be a smaller number and would approach 0 +1  
lamhtu  You say Km cannot be altered and its staying the same, but the answer of the graph demonstrates a higher Km value. Needing "higher concentrations" of the B6 for enzyme activity is another way of saying Km is higher since more is required for 1/2 vmax activity +14  
sbryant6  Yeah this explanation is wrong. +  


submitted by nosancuck(87),
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shiT b has osrasoicdiS so rhe raunmogsla eb aaictinvt dat VtiD

sbryant6  Your mom activates my VitD. +17  
pg32  Anyone know why there is hepatosplenomegaly? +  
gooooose  Likely granulomas involving the liver and spleen- Pathoma says any organ can be involved +  


submitted by tinydoc(233),
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tPx aseprpa ot heva cMseul astciyptis as a ulerst of S.M Siciasttpy is atedert ihwt a uemcsl nxtaaler eikl onBalcfe hhicw si a GBAA ant.gosi hlcoaentaB si a Ciontcinhmmoile hcwhi cna eb udes ot ettar rnyrUia ytudocnnsfi ni euitplMl lsiceo.srs but the nuiteosQ skas wath louwd elph rtaet eth tiscaiyts.p

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 danger_rave(-2),
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ubf6@idniuidnm oS, I gto to emylocbin eud ot ehrc.ykMSiotc enycBomil can secua ormnapenetipythgi nad mlpraynou sioib,rfs adn I ’ntidd vhae nay noncetsocni to oimba.clhlcur tnsaricAcnyhle acn eb duse fro lla srtso of naaeigclimns (fere alaidscr likl otls fo fus,)tf so eth acext cdastoiinni idd lsse rfo me ot etg to teh naswre anth ti imthg heva hwti tenaorh eao.cygtr =,n1 btu ’tis not a ciamg aizoinemrtmo senarw ta as.tle

sbryant6  Correction: SketchyPharm ;) +  


submitted by cantaloupe5(78),
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tisolgHoy swdeoh gauvliectoa ciesosnr evs(ererpd rtticreuaceh fo maiacrdylo )bisref hwit orihnelptu trtliainnoif cihwh hnetdi htta eht MI saw nthiiw 42 .rsuoh sMto ykllie ecuas of dahte iiwhtn rfits 42 orush fo MI si r.rhtyahima adMalyicro ruturpe wulod aosl be ivisleb no ssgor aacnperaep of eth ,rhtea hiwhc yeth dsebericd ni the sm.te

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +14  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +3  
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +  
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +4  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +2  
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +1  


submitted by mcl(601),
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nNaici timivna( 3B) aniatngeosz VLDL erlclhtsooe onisterec

sbryant6  Fibrates stimulate PPAR-alpha --> LPL upregulation --> decreased triglycerides. However, this question asked about a vitamin. Vitamin B3=niacin. +4  
lovebug  FA 19, PG 315. Lipid lowering drug bro. +  
makingstrides  I totally got this question wrong. But I also just realized that it says triglyceride -- VLDL. So VLDL must have been in the answer. Correct me if I'm wrong please. +  


submitted by hungrybox(1051),
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ostng'nntiHu diaeess

  • ttiainoapicn: ehs has a mlirais sedoirdr as erh heraft btu ided alierer

mbRrmeee TNUH" 4 an m,ainal upt it in a .CA"eG uHtnnigtni ngee udonf no mmrohooseC .4 ACG is the nitorcteliude :eparte

  • aC,rohe aatuedc ucunlse
  • tAiaxa
  • lGoymo edri)op(esns
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +23  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by hungrybox(1051),
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nits'gnutnHo esdesia

  • naoaipncitit: hse sha a asiirml oserddir sa her ftehra ubt ided eeriarl

mbeemrRe "UNHT 4 an aalni,m tpu it in a .Ce"AG nnguttHiin egne oudfn no oeomCsomrh .4 CAG si hte urlotneicdite tap:eer

  • aeCrho, cuaated luseunc
  • Aiaxta
  • oylGmo )ri(sepsenod
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +23  
sbryant6  Side note: atrophy of the caudate nucleus leads to a widened anterior horn of the lateral ventricle. I've seen it worded both ways in UWorld. +  
foulari112  How would you differentiate this from Frontotemporal lobe dementia +  
temmy  Foulari 112..the ageof the patient and the anticipation cos her dad had it too. Also in frontotemporal pick, you will see personality changes where they act completely different vs huntington where they are aggressive and depressed. +1  
castlblack  CAG = Caudate loses ACh and GABA (from FA) also points you to caudate +  


submitted by usmleuser007(397),
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sivouorNr ct)yhkSe( = cstfefA rwehe a lot of lpopee aer in tluesrqr coase - allpciesey omcomn on rseicsu - %09 of lal ilhaarrde tbrasukeo no eissurc

sbryant6  Rotavirus occurs in unvaccinated children. In order for it to spread, all those kids would have to be unvaxxed. +  


submitted by hayayah(1081),
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anilIung nshiare rea suauyll cli,dbreue mfeolra irheasn era nto.

ihTs is an centidir gilniuan .ahienr tI setnre nilentar nlnuagii inrg rllaaet to nieirofr ecaisrpigt sleesvs and si opsrueir to eth liunigan nt.meglia

esaudC by euiarlf of pessouscr niagvlsia to oscle nac( omfr ).oeyrdechl ayM be icodtne ni tifansn ro oecirvsdde ni l.oouddtah cuMh eomr ocnmom ni l.saem

yotsubato  Heres a good picture to help with the concept. https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjVkIi0yN7iAhWLjqQKHbeXCTUQjRx6BAgBEAU&url=https%3A%2F%2Fwww.herniaclinic.co.nz%2Finformation%2Ftypes-of-hernias%2F&psig=AOvVaw2BzGtQLvSmUN8ymhdvETG5&ust=1560244112252834 +4  
sbryant6  Note that direct inguinal hernias typically happen in older adults. This question presents a younger baby, so it is more like to be indirect. +7  
jawnmeechell  So a femoral hernia would be inferior to inguinal, but direct/indirect would be superior? +  
azharhu786  The direct and indirect hernia are both superior to the inguinal ligament but the femoral hernia is basically inferior to the inguinal ligament. The direct hernia is medial to the inferior epigastric vessels whereas, the indirect is lateral to the epigastric vessels. An indirect hernia is seen in young people whereas, direct hernia happens in adults. +4  


submitted by hayayah(1081),
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tWih chcinor vmiitgno, yuo sole yttceleserlo dan a olt fo ad.ic It errggsit albeotcim aalokilss hiwch is yhw lla teh urmse lvseau aer owl r(o on the roelw edn of hte narolm range) pextec fro rtbeaboa.cin

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +4  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +1  


submitted by hayayah(1081),
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ihWt ichornc igvimot,n yuo olse tlecotlreyes and a otl of icda. It gesirtgr ealcibtmo siaoasllk ihhwc si yhw lla teh resum vselua are low (or no het rewlo edn of the almnro raen)g extcpe for .aartbebonci

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +4  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +1