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Contributor score: 62

Comments ...

 +3  (nbme23#16)

Me reading this question stem: .....do you mean which of the following ENZYMES?

 +2  (nbme23#9)

If the abnormality was something more life threatening, wouldn't the first action be to call the pediatrician? I was thinking, limb extremity might mean something else more serious was happening too --> need pediatrician right away to dx.

tinydoc  I thought about that but then I ruled it out as with the NBME ethics questions the answer is almost never to defer to someone else. The question doesn't ever tell you what type of doctor you are for you to be referring to a different more specialized physician. Also I assume that they think if there was something wrong you could handle it.
llamastep1  Out of all the questions (UWorld,NBMEs etc.) I can only think of 1 question where you had to refer.
targetmle  even i thought pediatrician should be called as after all, every newborn is screened by pediatrician and in this case, he had abnormality! i still wonder why would gynaec comment on that!

 +18  (nbme23#4)

Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

shriya goyal  yes I answered it like that
redvelvet  me too :(
abigail  me three :(
yex  Me four :-/
link981  Slowly raising my hand as well
tinydoc  Sammmme
bullshitusmle  same here!!!:@
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia
aisel1787  me five(
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency.
alexxxx30  sammmeeeee
snripper  Dumbasses unite lmao
usmleaspirant2020  lol saaaaame!
usmleaspirant2020  lol saaaaame!

 +7  (nbme23#38)

Key words: "at this time" and "can be helpful"

The answer to this question isn't: great - now we're going to take him off the vent because you told us that's what he wanted.

nbmehelp  ^^^ exactly

Subcomments ...

submitted by sajaqua1(389),

The patient has a prior history of hysterectomy with bilateral salpingo-oophorectomy, and received external beam radiation to the pelvis. The patient now displays hydronephrosis and hydroureter, with distal ureteral narrowing bilaterally. The likeliest option is that we are seeing adhesions from previous surgery constrict the ureters, causing this.

E) Urothelial carcinoma (also called transitional cell carcinoma) is also a possibility. What makes this unlikely is the location: bilateral. The prior hysterectomy and bilateral salpingo-oophorectomy would leave scar tissue on both sides of the body, but the odds of urothelial carcinoma arising bilaterally are very slim.

A) The patient had a hysterectomy, so the odds of recurrent cervical carcinoma are also incredibly low. C) and D) Urethral condyloma and urethral transitional cell papilloma are in the wrong location to account for bilateral urethral narrowing with hydroureter.

stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect). +10  
spow  Why would the onset be 15 years later though? +2  
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor. +1  

She just completed the course of rituximab, which targets CD20 receptors. B-cell deficiency can predispose to bacterial infections.

b) BM failure is not associated with rituximab c) wrong d) wrong e) this occurs w/in 7-10 days of starting treatment, and would not occur after completing a 4-month course of rituximab.

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +11  
stinkysulfaeggs  Same. Crap. +2  

Even if you didn't which one vector was Anaplasma, I believe choice A was the only one in which both organisms shared the same vector.

stinkysulfaeggs  Agreed, that's how I made my final decision! +  
alexxxx30  yeah I literally had no clue what anaplasma was, but came to the correct answer the same way +  

Visceral leishmaniasis causes hepatosplenomegaly and most importantly, pancytopenia. It is often found in people who visit the Middle East and is transmitted by the Sandfly. Why did NBME put 2 Leishmania questions on this form lol

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +8  

Informed consent should be obtained by a provider who has sufficient knowledge to give an accurate description of the intervention, the risk and benefits, alternative treatments and to answer all of the patient's questions

stinkysulfaeggs  Hate this question though... the first thing you would have to do in this situation is refuse to do what the resident asks you to do. Then you could accompany them.... +6  
peqmd  If not for the additional "refuse to sign consent". I think the answer would have been extremely straightforward. +  

submitted by bigjimbo(29),

Episiotomy is cut from vagina to the perineal body for child birth

btl_nyc  But why is it external anal sphincter instead of bulbospongiosus? Aren't both attached to perineal body? +  
stinkysulfaeggs  Bulbospongiosus connects to either side of the perineal body. But if you go directly posterior rom the commissure you hit the anal sphincter +6  
need_answers  I just think about how women say they done ripped their asshole while giving birth +2  

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