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Welcome to strugglebus’s page.
Contributor score: 154


Comments ...

 +11  (nbme20#17)
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sA an 0et d0i8:1,01 pelpeo rtodpere ot vahe ides tfeecsf hnwe ktgnai iz AhgodhoadioHctromy.lren ,meth 52 eolppe ).0(0%2 eavh rBsate icedhgrsa

neonem  I think the best way to answer this question was by process of elimination. +1
sympathetikey  That's some bullshit lol +4
karljeon  Haha I eliminated the answer by process of elimination. +18
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 +1

 +4  (nbme20#50)
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yehT era ktglnia toaub f,acnleoB a BB-AGA nsiogta nknow ot taetr lsecmu sasipcityt


 +24  (nbme20#17)
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hNewore vaeh I neeb abel to difn hyw teh lehl tihs is a ignh.t

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  (nbme20#50)
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erTeh era nrecait tatoinssui ni cihwh you nd'ot ened ot fynito nrpesta utboa ynhtagin ewhn itteagnr a -dsSi-hcITl rae oen fo .htem eTh anesro egbin ttha eendturta SIsT wlli acseu ermo psared as elwl as nca aedl ot IDP

ibestalkinyo  Mnemonic for things not needing parental consent: Sex, Drugs, Rock and Roll (Emergency Trauma)(except HIV) +2

 +13  (nbme20#46)
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I seohc iths oeslly sbacuee ti wsa os dman speccifi

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. :( +28

 +5  (nbme20#14)
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uYo are amnigi to eranceis wproe dan oyu nac od os by cnrniaegis plemsa eszi u(reedc B .reor)r


 +6  (nbme20#26)
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oS yuo wkno thta 6%5 fo het daat llwi fall tihwni D1S fo eth e.nma So fi you abtsturc 15600- yuo wlli etg .53 ciWhh aemsn taht obuta %16 lwil lfal vaoeb nad %16 wlli allf blowe 1 D.S eyTh aer iagskn orf how nmya ilwl lafl eavob 1 S.D 'mI rseu rehte is a ertebt ywa fo iodng thi,s tbu ashtt owh I ogt it l.ol

sympathetikey  Same! +1
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 :) +6
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% +4

 +0  (nbme20#23)
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I was rnegwdino if it swa ot lwola rof raplita SNC pnrtieenoat encsi het ugrd si oesypsludp pueospds ot ahve NCS ecffet


 +13  (nbme20#11)
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ddaeoneh/MyodtHeonorc nac edla to y-nuecndedeope- avdoi ni nolg remt .use DINsSA ouy oals oivda eud to aatilrp fcenitievsenfes in poarnhuteci pain as llwe sa cerlu krsi. CATs' rea ownnk ot ertat tuenpciraoh pani rvey wlle (.e.i tsbieae,d ATR rae)phty

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. +

 +6  (nbme20#22)
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sA a sdei otne, the aahpptohess dulwo hvea vaecadtti cilnueranci DlsCresF1iEDa78De4DwsAAA6FFcgiusm+FDpAEa62iea/5:t1deihAr4o.a7gi#cs/to=n5pp/FBqCcA53wtoaDh=AACnh0?.w


 +6  (nbme20#22)
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Cesicyoponrl si a creanunclii otir,ihibn ihwch asmi ot draeesce 2-IL

teepot123  fa 2019 pg 120 +1

 +0  (nbme20#25)
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oanoPolrpl si a lt-ceneovinse teaB okb.rcel So oruy HR lliw eesedrac B(1), whchi lilw ecuas a ytmroaecposn snerecia ni PT.R

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. +35
amarousis  so why tf do we give beta blockers for hypertension -.- +5
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. +4
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 +

 -9  (nbme20#24)
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iThs a CYP 054 rinohibit (KCC.SFEOIASMC); ist hte .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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sMot of teh tps vuales weer .raonlm rkinnDgi 'asntw et,ruugooas LDL aws mild, IMB sah .enfi eH ddi aveh HTN hoh.ugt Teh gbtsgie irsk tcarosf are het cfat atht eh ahd fusedefr an MI nda saerttd niuferfsg rveese oenesisrdp ihet(wg e.t)liosas/xny T,shu he is orem at riks rof cdi.iseu

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... +12
dbg  bc they're SOBs and DOBs +9
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +
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 hhgttou eth irvle odoekl gueh af too llo hhwic adme me rqtiinuoies hte leohw dirgophraa


 +0  (nbme20#2)
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[vmeod to m]utmenbcso


 +0  (nbme20#2)
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oev[md to mntuco]ebsm


 +1  (nbme20#18)
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TS wlli frist drc;seeea r,veehwo tefra 20 min ti llwi ecnsirea teele)a(v


 -2  (nbme20#38)
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Ok, os uyo nca sernoa thsi by dwnargi tou ITRE y(sror I cta'n radw ti erh).e ,whAoyn oyu nokw its a ieirersttvc rrdiesdo adn liwl ehav a eesdcraed ,VR os utiaolaytlmac uoy wokn htta VR is a opennmcot of FRC CFR=( RER)VV.+ sT,uh FCR lhusod lsao be sdec.draee oYu slao wnok hatt cesetrrvtii sadsiese era eaadercrizcth by a ayteds ardeeecs ni VVFEF1/C ecisn htbo mcoesnopnt era cneedi.srag sThi velsae you twhi VC dgaceisner icsne =VFC crfode tiavl pt.iaacyc

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 sah meohycyapilt vrea f(ieptvyoremoarelil )dioesrdr edu to rcchnoi ahyoxpi udicedn yb .DOPC ediyolM itmalspaea si txrea lymaeurld msatsoheipioe edu to bfsoyirlmeios. iraretdyHe coeoaositmhhrsm ludwo have nebe opnerv by a unpriass uble stnai. mleeiysspHrpn uldwo vahe aseduc eersdedca ,CsBR and aclpyysmioedsl myensdro dowul hvea hwosn ruAe dosr ro lbtass.

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. +12

 +0  (nbme20#28)
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lsAo, kelesMc dlowu heva sberidce chiomeazteha ro erifaul to apss imomeucn

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 retsaywrbr angsaommehi edtn ot rgow nad ehtn myroadnl i.otenlvu

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. +8
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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tI loas ooledk catxley eikl mcoshstsoie on eht -diitl-es dah teh ttllie npise. eabatmoEn uowdl haev dah a cbhun fo sCRB i.isend


 +18  (nbme20#20)
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yophBnhnoor=c pyupimo aEreronatxni odsit=rr iatcorhhernbolac utrcbosinto sfes/(irgmona ayip b)nyIrdtoors orirtsd = rgneyaall oi trcucuonsbsSintsuoc a=hslps etts fro coylpri snseotis

eWhn etreh is a drtferuac ibr it lilw useca a mrtaua ratxohmpoen ihhwc acn uacse ria to peseac nad bemcoe ppadert uednr het snki nedaigl to peut.icrs

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +1
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 ernwas hiwt tpremeneso is udes to psiushyl lnoy dna is eyvr eicfcip.s hatT only laeves ilpiacnodri, hhiwc si oals eveldeta in E;SL this si hyw tis istivense but not csecpifi ni p.hSy

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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otuA omd iesasde are ulsyula htgyseuooerz or( so tyhe tanw su to muse)as

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 atfdeecf teh ctocrlpsiioan tatcr in the sucr ribcere no het L


 +6  (nbme20#33)
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O,K os if I rmrembee ylrotcrce this is the one htat howss eth rneinacheti rtanp.te oholicnimadtr si osal adseps by het hme;otr rvheoew, ti anc hvae areivlba svxtriespiey dna lioecpnetm eence,ntpar hwhci is hwy eoms mmeebsr ewer not .effedatc

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... : ( +19
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. +

 +3  (nbme20#9)
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Foep-almnotrrot aitdneem tadhzcrriceae by lsnrpaiyeto anhceg si uylasul Piskc


 +5  (nbme20#29)
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Lisyen si esud in anetsli dan nllagoce sscro gin;lkni ti is scosr ileknd yb ylsly axdosei to mkea ecgalnlo isbfre

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 +2

 +11  (nbme20#43)
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heT IC lauev ntadoneic ,1 hiwhc msaen ttah its aiiifgicnstnn

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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eTh onsp ash rsevne 85-, so het etlrainigm uodlw be ftaecdfe rehe

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 +3

 +1  (nbme20#44)
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I dah utp as"htcs"er /bc stp htat udrnego raibctiar resurgy are nloy spseoupd to tea lxepcmo brsca glteibes()uavesf/rt dna daivo msilep arcbs i(.e. stbrakaef lerecdaeabk/ gdso)o


 +3  (nbme20#43)
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uYo eahv ineagvte rNgteoni lcnabae in vnstritaoa k(cal of tnrpei)o dna isietvpo grionNet in selmcu bgdniuil ststae (..ei /)hhelnatisceteldr

celeste  Nitrogen Balance = Nitrogen intake - Nitrogen loss +4




Subcomments ...

submitted by beeip(116),
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wHo to trefdieentafi tenbeew vosorNuir dna iutRvoasr ?heer tusM be erlated ot eht eth ncatsiugoo raneut fo eth n?silles

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +5  
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. +2  
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. +2  
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(116),
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oHw to rdnffititeeae nebweet oirsuorNv dna vstRouiar re?eh tusM be tadeler to het hte usongatoic runtae of teh sls?ilen

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +5  
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. +2  
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. +2  
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