NBME Answers : study_dude

Subcomments ...

submitted by buttercup(18), visit this page

get full access to all content ⋅ become a member

Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.

get full access to all content ⋅ become a member

russnels What would cause the acute increase in blood glucose concentrations? +1

study_dude_guy I think this question is getting at HHS. The glucose levels are way lower than typical HHS but the patient has a fever and WBCs in the urine so MAYBE a UTI (even though it doesn't say anything about UTI symptoms) +

submitted by yotsubato(1208), visit this page

get full access to all content ⋅ become a member

The indications for blood transfusion for pelvic fracture patients are systolic blood pressure of <90 mmHg, heart frequency >130 bpm and clinical symptoms of shock. In an emergency, combined transfusion of red blood cells, plasma and platelets (6-4-1) is preferred (19).

So...... This question is bullshit?

get full access to all content ⋅ become a member

study_dude_guy I spent way too long trying to find this paper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394148/ The flow chart is the first figure In major trauma, you give 1-2 L of fluid and check for response, if they are still hypotensive you give blood products. +1

seagull This is a question of elimination. A) Epinephrine would increase his heart rate which is already at 130 B) No idea what this is- cross it off C) Recombinant factor 8 - tx hemophilia A D) reverse anticoagulation but not commonly used. PCT is used now. E) PT is hypotensive and actively bleeding in chest - makes most sense +4

prasadnadendla We can eliminate epinephrine as an answer because the patient is not having anaphylaxis or septic shock. The patient's hypotension and tachycardia are due to hypovolemia. Because they have already received a significant amount of crystalloids the next step is a blood transfusion. If too much crystalloids are infused the patient can get a coagulopathy including DIC due to dilutional thrombocytopenia. +1

submitted by yotsubato(1208), visit this page

get full access to all content ⋅ become a member

Lactose Intolerant I guess? Not Celiac. Kind of a bullshit question.

get full access to all content ⋅ become a member

study_dude_guy Had the same reaction as you and then I learned that AA is a buzz word for lactose intolerance "African American and Asian ethnicities see a 75% - 95% lactose intolerance rate, while northern Europeans have a lower rate at 18% - 26% lactose intolerance" +1

seagull I also choose Celiac's. "BuT RaCe AnD mEdICiNe DoN't Go ToGeThEr". +3

hayayah I think a key part to differentiate between celiac's and lactose intolerance in this question isn't race, it's because of the part that says "he occasionally had diarrhea after meals since 12 years old and then it got worse since starting college". If he had celiac's he'd have GI symptoms (i.e. diarrhea) any time he ate something containing gluten (which would be every single time he had a meal) since he was 12. You'd also see signs of fat or vitamin malabsorption in celiac's patients and other autoimmune symptoms. Whereas in lactose intolerance, it's much more likely he'd once in a while eat a lot of dairy and have his symptoms triggered, and then he starts college and has even less of a well rounded diet and so his symptoms get worse. +4

sahusema I agree with above, but it could just as easily of been CD and people here would have been like "JuSt cAUse He aFricaN AmErICaN DoNT MaEN he CanT haVe CEliaC." +

imtheman I dont understand how the whole college part adds into this? I thought IBD to be honest. Complete BS question. Are we to assume he eats more milk products in college? +

machetebetty My best guess re: college is the primary currency of (pre-Covid) college gatherings: FREE PIZZA. +1

jj375 Also lactose intolerant commonly begins around puberty, so that may be a buzzword. Most people can digest lactose when theyre young and then grow out of that ability and stop making enough lactase! +

submitted by endochondral1(24), visit this page

get full access to all content ⋅ become a member

why not myastehnia for this one? They put some LE weakness in the stem as well so that before respiratory depression made me skeptical of it being a pure descending paralysis and I went with MG instead .

get full access to all content ⋅ become a member

study_dude_guy I think the history just points more towards Botulism or GBS. Tbh I'm not even entirely sure why this was Botulism and not GBS +2

seagull The nausea, vomiting, and diarrhea are also good cues that this is a foodborne illness. Then the DTR are mildly dulled which won't happen in myasthenia gravis +

derpymd The confusion for me is the timeline. She consumed the food 32 hours prior and symptoms started at around 24 hours. I figured with preformed toxins, the timeline would be more similar to Staph aureus (i.e. just a few hours). The learning point for me here was that it can take 12-72 hours for symptoms to occur depending on dose. +