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Welcome to someduck3’s page.
Contributor score: 60

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 +4  (nbme22#8)
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atF leosulb ivsnimat rae ,DK.,AE, So tbho D &apm; E duclo be daesdcere in shti p.t Btu uoy evha to nwok tath itmniaV E cecyeidifn si eoiatasdsc ithw meytnloneiida ap;m& sha ebne idscaeosta ithw oeiotprsr umnloc neoia.tenmyidl olsA itV E nca eb ngive itwh ehzAmlrie tainpets sa ti phsle hiwt eerf cs.dia?alr.

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration:, as does Copper (TIL): +3
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +

Subcomments ...

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A omlsabrtno is na armeitum ,CRB so it's vtdeaeel in ttssea fo secdirnae pomeh.ioistsae

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +61  
someduck3  The term "Normoblast" isn't even in first aid. +36  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +19  
tinydoc  I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +18  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +8  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +5  
fexx  I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +5  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +12  

submitted by asapdoc(63),
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jnrG.laDo pxsinale ti eyrlal elwl on the u.idoa I lliw ustj evig the bcais aed.i llA eht shemoolbgin veha alhpa in it fheeoertr yuo oancnt icneto ti on hmbgeonoli csseopeelorhitr

someduck3  Just to add to this; a-thal is due to a deletion. While b-thal is due to a mutation. If they had a b-thal there would be target cells. a-thal just presents as microcytic & hypochromic. +9  
almondbreeze  looks like a-thal can have target cells too. Individuals with alpha thalassemia trait (-α/-α or --/αα) are asymptomatic, with a normal CBC. The peripheral blood smear typically shows hypochromia, microcytosis, and target cells. ( › article › 955496-clinical) +  

submitted by sympathetikey(1350),
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yAn time oyu ees ifxde eiwd sttpgnili of 2S, ahsms SDA.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +  
need_answers -smash, smash, smuh-ash +3  
usmlecharserssss  with airpods in 2012 +  
paulkarr  Low key was hoping for someone to try and argue this one... +  

submitted by seagull(1539),
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bamye oenoesm anc pelaixn why ihst si vaulsaarc erosscni dna ont isp.ess It denst'o oenimnt vfere ro eansceb of re.vef eTh IRM sah a lsalm muatno fo deysnopyhit utb to gte aarauvlcs coiesnsr esems /odd

someduck3  Pg 455 of F.A. mentions that alcoholism can be a cause of avascular necrosis. +5  
meningitis  I think the small dark area on the left head of femur and the darkened neck are the avascular sites. Neck: Head: (obvious lesion on the RT femur, but similar discrete lesion on the left as seen on the practice NBME) +3  
yotsubato  He wouldnt be playing golf if he had septic arthritis. Avascular necrosis is a more chronic condition that has a slow onset. +3  

submitted by drdoom(874),
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uYo heva to hnkit bauto ihst nguis het ctepcno of LICIONTAOND .IOLBTBPYRAI Aehront way to ska shit yetp fo tosiqneu si iekl s:hit “I hwos ouy a tteipna htwi poauostnnse arouon.pxthme hcWih tehro tnghi si tsmo ylelik ot be eutr boatu ttah ?”rosepn rO uyo anc hearps ti htsee yasw:

  • Gevin a OITICNDON (sponeauntso nomeup,) twah ohrte gifdnni si msto klyiel ot be het sa?ec
  • neviG a oopl of peolpe ihwt upnsoteason ,phtuoxreoamn tahw orhte htgin is toms lkelyi ot eb true tuabo mthe?

nI horte dowsr, fo lal popeel how ned pu tiwh otnanosseup mun,poe hte somt mnomco herto tgnih btaou hmet si taht ehty rae LEMA pa;&m HIN.T

fI I geva you a bucetk of uapoesotsnn nuoepm tsiteapn -- dna uyo erhcade yuro nhad ni eerht adn ldlepu eon uot -- hwta sicnroae loduw eb rome cm:noom nI uryo dahn uoy eahv a mokesr or in yrou ndha you avhe a ntih ela?m tIs’ teh taelrt.

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  

submitted by marbledoc(0),
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yWh oluwd you kas eht atptnei to yntifedi teh rpso nda os?cn I dnot’ teg eth paaorpch hree!

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3