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Contributor score: 165


Comments ...

 +12  (nbme20#17)
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As na 1i080e0d, 1:t pepeol eedptror to vahe dise esftfec newh gktani gcioiodhhzym.lnoAHerta dor tmhe, 52 eopple 0.()0%2 hvae rtBeas cdeigsrah

neonem  I think the best way to answer this question was by process of elimination. +1
sympathetikey  That's some bullshit lol +9
karljeon  Haha I eliminated the answer by process of elimination. +20
medschul  I eliminated thiazides by process of elimination :( +1
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary +2

 +5  (nbme20#50)
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Teyh aer knaligt abotu ,facBeonl a -AAGBB tisgano ownkn ot eratt mcslue stipacitys


 +27  (nbme20#17)
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Nrheewo have I enbe bael to ndfi why the hell hist si a int.hg

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +6
breis  same^^^ +
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +
chandlerbas  you had me at its not in sketchy ;) +3
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +

 +3  (nbme20#50)
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Tereh rea entcrai ttniauossi in ihwch yuo dnto' dene ot noftiy renspta tobau ahiytngn hwne tgrinate a IT-lhcSd-is are eon of eth.m hTe aonser eibng hatt draetnute sSTI liwl scuea eomr sepadr sa ellw sa nac ldae to IPD

ibestalkinyo  Mnemonic for things not needing parental consent: Sex, Drugs, Rock and Roll (Emergency Trauma)(except HIV) +3

 +14  (nbme20#46)
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I heocs sith slyelo ueeacbs ti was so adnm ciisfpce

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program +4
karljeon  I didn't choose it because it was so damn specific. :( +43
lovebug  Could anyone explain for B) for me? because I choose B).:( +2
j44n  B.) is wrong because its never been shown to show adverse effects "any offcial data linking the drug" and the fact that it's "newly marketed" +
j44n  and because its in 5/45 patients roughly 10% of the population, that might not seem like much but most of the diseases we freak out over are in 1-2% of the population, to put that into perspective if we gave this drug to every person in the US (every big pharma wet dream) with a population of 300 million... 30 million people would have this adverse event... hope that helps +

 +5  (nbme20#14)
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ouY are aimngi ot neaceris oerwp dan uoy nac od so by ianiensrgc amslpe ezis cerued( B eo)rrr.


 +7  (nbme20#26)
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So you wkno hatt 56% of eth atad lwil fall iniwth 1SD of eht nem.a So if yuo rtasbcut 5-6010 uoy ilwl gte 35. hicWh nsema taht tobau 61% will flla veoab dna 6%1 wlli lafl elwob 1 SD. eTyh ear gkiasn ofr ohw naym lliw lafl veaob 1 .DS mI' suer rehet si a tteber wya fo nigdo t,ish tub tthsa who I gto it oll.

sympathetikey  Same! +6
sympathetikey  Except according to FA, it's 68% within 1 SD, so 34%, which split in half is 17%. +2
amirmullick3  Sympathetikey check your math :D 100-68 is 32 not 34, and half of 32 is 16 :) +8
lilyo  Can anyone explain why we subtract 68 from 100? This makes me think that we are saying its 35% of the data that falls within 1SD as opposed to 65. HELLLLLLP +
sallz  @Lilyo If you consider 1 SD, that includes 68% of the population (in this case, you're saying that 68% of the people are between 296 and 196 (1SD above and 1 below). This leaves how many people? 32% outside of that range (100-68=32); half of those would be above 296 and the other half below 296, so 16% +5

 +0  (nbme20#23)
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I swa nrogwnedi if it swa ot lwoal ofr ripltaa CNS nnpaotrteie escni the gdur si duysslpepo eodssupp to ahev NCS etfcef


 +13  (nbme20#11)
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ndoodMy/nrdoteaHcheeo anc elad ot uyneped--ednceo dvioa ni gnol temr u.se IASDsN you sloa aovdi edu ot aiartlp cfesnentefiesvi ni tuhoneriacp naip as elwl sa ulrce i.srk AsC'T ear kwonn to rttae hpauctienor aipn reyv lelw .i.(e dae,bitse ATR r)hyatep

champagnesupernova3  Drugs for neuropathic pain: TCAs, gabapentin and pregabalin +1
mangotango  SNRIs +
mangotango  also SNRIs* +1
zevvyt  methadone isn't a pain med(even though it's an opiate), it's used for opiate addiction. And hydrocodone is used for "moderate" pain and this person is in "severe" pain. +
shakakaka  Drugs for neuropathic pain: TCA, SNRI, Anticonvulsant, Opioids, Lidocaine, Capsaicin +

 +7  (nbme20#22)
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As a dsei ,eotn teh aptshpaeohs duowl aehv vatdcteia lacenncruii 8/5t7as5uBF6eEt?AhFDA4A/=DrAnhw#0onAw+.Ccssp2awiA=FDs.aA3gaA:Feo1ti6C7gr4/Feaop1iCDisdimecDh5qcplDE


 +7  (nbme20#22)
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soyporcCnile si a icnruanlcie itbihorni, chihw siam to aedeecrs LI-2

teepot123  fa 2019 pg 120 +3

 -1  (nbme20#25)
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rallonopoP is a voe-tnneclsie Beat er.klbco So uryo HR lilw eeedsacr B,)(1 hwhic wlli casue a osenytprocma caerinse ni TRP.

home_run_ball  ^ Above is partially right: Propranolol is non-selective Beta blocker: Beta1 stimulation causes inc HR, therefore blocking it will dec HR and dec Cardiac output Beta 2 stimulation causes vasodilation, therefore blocking it will CAUSE UNOPPOSED alpha1 activation --> therefore increasing total peripheral resistance. +42
amarousis  so why tf do we give beta blockers for hypertension -.- +6
dr_jan_itor  I would also add that the patient was previously on an a2 inhibitor (clonidine), which he ran out of. So he is rebounding on that with upregulated a1 receptor activity. Adding labetalol would cause a greater degree of unopposed alpha, increasing tpr +1
llamastep1  @amarousis They are used for hypertension because the hypotensive effect of the reduced CO is greater than that of the effect of the increase of TPR. Cheers. +7
hungrybox  @dr_jan_itor Adding labetalol would not cause unopposed α1 because labetalol and carvedilol are α1 blockers in addition to being nonspecific β blockers (great name btw, I love scrubs haha) +2
mw126  Beta 1 blockade in the kidney (JG cells) would also decrease renin release, which would also help with HTN. FA2019 pg 245 +
rockodude  @dr_jan_itor clonidine is an a2 agonist not an a2 inhibitor +

 -10  (nbme20#24)
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sihT a YCP 504 bnioiithr (MAIFCSSC.EOCK); tsi the O.

coccidioinmytitties  Azoles, as a class, are CYP450 inhibitors [fungal > human; to prevent conversion of lanosterol to ergosterol]. Justget is correct- a ↓pH is needed for absorption and PPI/H2RA/antacids are contraindicated. +

 +6  (nbme20#48)
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tsMo fo hte pst velsua rewe lmar.no iiDkgrnn swtan' ouaesu,rtgo DLL asw ld,mi IBM hsa nfi.e eH idd ahve NTH .uhhgot The bisgteg sirk crastof ear the tacf that eh hda eudsfefr na MI dna strtdae urfneifgs severe seeoiprnsd hietgw( ny.osseatl/)xi ,uhsT eh is rome ta krsi fro iiu.decs

sohaib111  Won't having an MI be a very big risk factor for another one ? And also if they wanted this answer (the anti-depressant), why would they just add that his LDL is inreasing in the last sentence... +14
dbg  bc they're SOBs and DOBs +22
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +1
asingh  It is because of the timeframe of mortality is 2 yrs, everything else will affect later +5
benny  mdd increase MI +
benny  Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI). +
drzed  None of the cardiovascular options would improve mortality (statins, ACEi, BB, spironolactone are the ones that have proven mortality benefit). So if they had put one of those, I think I would have chosen that, but given that the rest don't change mortality at all, I went with the antidepressants. +2
ihatetesting  My thinking was that since he had an MI, a beta blocker would improve mortality, and propranolol is also used as an anxiolytic. +2

 -1  (nbme20#35)
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I thhutog eht velri looekd eguh af too oll chwih made em utsiineiorq hte holew hdrrogaapi


 +0  (nbme20#2)
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oved[m to um]tcosmneb


 +0  (nbme20#2)
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emo[vd to ebtn]mmcous


 +1  (nbme20#18)
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ST iwll ftris dsree;cea hvr,eewo treaf 02 inm it lwil esiecran (tv)leeea


 -2  (nbme20#38)
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O,k so uyo nac aorsne stih by rdanwgi uto TREI orsr(y I nt'ac dwra ti .he)re onw,yAh uyo wnko tsi a itesrivctre rdreiosd adn lwli heav a adecseedr ,VR so aclataoyuimlt ouy nwok that VR is a nnecoomtp of FRC (R=FC .VV+RER) T,hsu FRC usdohl laos eb edsa.reecd uoY losa onkw ahtt stviiercert aieesssd rea adrihczetrcae by a tyesda sreedaec in /EVFC1FV since ohbt omctnspeon ear neeirgasd.c Tish leveas you thiw CV sdeieangrc sncie F=VC fdrceo talvi ccpiayta.

champagnesupernova3  FEV1 and FVC both decrease but FEV1/FVC actually increases because FVC decreases more than FEV1 so the ratio increases +
fluentinwhale  Excuse my stupidity but what is REIT? +1

 -7  (nbme20#17)
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tP ash mipclhotayey earv mpeivotiyrraf(ollee )iedrsord ued to cnrhoic pyohaxi ineducd yb PCDO. yeodMli telapmisaa si etrax delalurym oatespiihsoem deu ot eomibsryi.ofls eHydarreti csaimesoomhhort udwlo avhe been eornpv by a sruspani bule ant.is espiepnmryHls udlwo have seucad eesdrcdea C,sBR nda mcasdslepyoily mrodneys wodul heav hnows reAu rdso or ta.ssbl

neonem  Right, I think this would be just called "appropriate absolute polycythemia", whereas polycythemia vera is due to a malignant JAK2 mutation and would be termed a type of chronic myeloproliferative disorder. +14
utap2001  Myelodysplastic syndromes (MDS) is also called Preleukemia, myelodysplasia. in MDS, your bone marrow doesn't make enough of these healthy blood cells. Instead, it makes abnormal cells that aren't fully developed (immature). As the condition develops, your bone marrow gets gradually taken over by the immature blood cells, which don't work properly. The condition can develop slowly (indolent) or quickly (aggressive), and in some people it can develop into a type of leukaemia called acute myeloid leukaemia (AML). +

 +0  (nbme20#28)
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Als,o lcMksee owudl vhae cdsreieb toehamihezac ro uearfli ot pssa mmienouc

sugaplum  I believe failure to pass meconium is Hischsprung's Meckels don't present within the first few days of life, so meconium wouldn't be a factor FA 2019 378 +1

 +4  (nbme20#48)
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eTh berrtywasr ioahneagmsm tdne ot ogwr nad tehn domnalyr .uovelitn

medschul  My problem with this question is that a strawberry hemangioma should continue to grow until 5-8 yrs old so I did not see the answer choice "Continued enlargement as the child grows" would not be an acceptable answer as well. +10
merpaperple  I still don't get that. Over the course of the next 5 years, it will 1. continue to enlarge as the child grows, and also 2. spontaneously involute. Both answers are literally correct. +
fatboyslim  "Continued enlargement as the child grows" implies that the strawberry hemangioma will continue to grow and will not regress with time. That's why it's wrong I think +1

 +4  (nbme20#27)
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It sola keldoo xylacte like sossmhtoeci on hte -idel-tis ahd hte ltitel ensi.p tabenmEao uwold vahe dha a ubnch fo sBRC ins.die


 +19  (nbme20#20)
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B=hcyonnorhop ann xraepuEoioiyrtmp rodtisr= hnrahtclocieorab rbouitcnots rag(sies/monf nrIbdop irtyaoys) dtisror = gynlraeal tncconurc ssoobSuuiist la=hpss ttse rfo yripclo tnissoes

Wneh hrtee si a cftuaerdr rbi it lliw cause a rmuata txnreoomhap hhwic can scuae air to apcese nda eemobc tprepda durne het ikns dlngeia to urspi.ect

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1

 +10  (nbme20#13)
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Ayn anwsre tihw netserpemo is sude ot silspuyh lyon adn is vrey cceifp.si tTah yoln eaesvl nproicliai,d ihhwc is losa evdeleta ni SEL; stih si hyw sit iesevtsni utb ont sefipcci ni .hSpy

len49  False-Positive results on VDRL can be remembered by P-VDRL -> P - pregnancy, V - viral infection (EBV, hepatitis), D - drugs, R - rheumatic fever, L - lupus and leprosy FA 2019 pg 148 +

 +0  (nbme20#11)
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otAu mod eiadses aer lylusau oerhyoteszug o(r os yhet ntwa su to smaeus)

xxabi  How do you know is autosomal dominant? +3
scpomp  Hereditary spherocytosis +
fshowon  Isnt the mean corpuscular hemoglobin concentration increased in spherocytosis? Thats what through me off. +5
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF +4
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF +

 +1  (nbme20#35)
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tI ftdcaeef teh olcaiocritsnp rctat in teh scur ireebrc on eth L


 +6  (nbme20#33)
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K,O os if I ermrbmee rlcrytoce iths is het oen atth sswho eht ecaetnhrini tnpr.eta hmoitnloraicd si sloa paessd yb the h;ormte h,roeewv ti nca aehv aribelva ieepsrystvix dan oeemitcnlp ,rtcnnepeae hchiw si hyw emso seremmb were ont ctd.eaeff

hyoscyamine  Also, question said there was a deficiency in NADH dehydrogenase activity which is another fancy way of saying complex I in the mitochondria. +13
yotsubato  That unaffected male really threw me off... : ( +22
charcot_bouchard  It was pure MELAS description. the unaffected male threw me off +2
mbourne  I think the affected male on the right side is actually a helpful hint. Mitochondrial conditions can be inherited by males or females, but are only passed on through the females. +1

 +3  (nbme20#9)
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otFamor-pnrlote aiemtnde reaedrzcthcia yb lytsnoairep ehnacg is alyuuls csikP


 +6  (nbme20#29)
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Lsniye is esdu ni tienasl dna ceglnlao rcsso knnilig; it is corss kiendl yb ylsyl osediax ot maek cgaleonl rbsief

charcot_bouchard  Thats my brother from UFAP mother +2
smpate  but glycine and proline are used in elastin too. Seems like you'd have to know about desmosine though that's not in first aid. Or maybe you can infer lysine since it's charged and is probably more important in maintaining stability? +
adong  the only thing we know about cross-linking is with LYSYL oxidase, hence lysine +3

 +11  (nbme20#43)
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heT CI aulev idtcaneno 1, hihcw enmas hatt sit gisiciatfinnn

sympathetikey  Correct. Per first aid: "If the 95% CI for odds ratio or relative risk includes 1, H0 is not rejected." +1
xxabi  Ah that makes more sense, thanks! +
drdanielr  Since the OR or RR is a ratio, if the two interventions are equal the ratio would be 1. So, if the CI includes 1, they are "the same" or not stat sig diff +

 +2  (nbme20#16)
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The nosp has everns -85, os the rimlgantie udwlo eb fdeetafc reeh

masonkingcobra  Thalamic pain syndrome would involve dysesthesias on the entire contralateral body so more than just the face. Also it occurs often after post-stroke. Additoinally, these dysesthesias appear weeks/months later +12

 +1  (nbme20#44)
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I had utp sreht""asc b/c stp thta gunoerd irtbairac yugsrer are lyno dsusoppe to tea clpxemo rcsab eeavie/busl(ftr)gst and idvao msliep scrba i(..e sfebratak ad/aeeklrecb sgod)o


 +3  (nbme20#43)
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You ahve eagtinev ritnNoeg nabecla ni avsiotnart (kcal of )orteinp and tveioisp nNtrieog in sluemc bidgliun tssate ei..( li/)thcdenletehars

celeste  Nitrogen Balance = Nitrogen intake - Nitrogen loss +10




Subcomments ...

submitted by beeip(124),
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Hwo to etiefierdftna ebtneew oNvsiruor dan outrRasvi r?eeh usMt be dtareel to het teh gtcoanoisu utnrae fo teh iess?lnl

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +3  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +1  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +4  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1  


submitted by beeip(124),
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oHw to tenierfiedatf ebnwete uNiorvsro dna vuRiraost ere?h uMts be edlater ot teh teh usnotiocag naerut of eht n?lslesi

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +3  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +1  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +4  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1