NBME Answers : surfacegomd's page

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+0 visit this page (free120#10)

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Exercise physiology (UWorld)

Increase muscle activity causes:

Venous constriction --> increase preload
Increase cardiac contractility and HR

Both --> increase cardiac output

Resting muscle and splanchnic vasoconstriction
Arteriolar dilation within muscles (lowers total systemic vascular resistance)

Both --> increase blood supply to active muscles

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+1 visit this page (nbme22#44)

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The qx asks for the direct tributaries following the vein that is producing the hemorrhoids, in this case internal hemorrhoids because they are painless.

(Amboss) Internal hemorrhoidal plexus -> superior rectal vein -> inferior mesenteric vein -> splenic vein -> portal vein -> ICV

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miajoseph the question doesn't mention pain, you should assume they're internal due to the patient's cirrhosis (portal system) +

+1 visit this page (nbme22#32)

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FA 2020 654

"Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response higher LH:FSH, higher androgens (eg, testosterone) from theca interna cells, and decrease rate of follicular maturation producing unruptured follicles (cysts) + anovulation"

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surfacegomd correction FA 645* +

+0 visit this page (nbme17#40)

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FA 2020 page 563 OCD Obsessive-compulsive disorder treatment: CBT and SSRI's. Second line: clomipramine and venlafaxine.

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+0 visit this page (nbme17#0)

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FA 2020 page 561. Recurrent episodes lasting more than 2 weeks.

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Subcomments ...

submitted by welpdedelp(270), visit this page

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It was scabies, which is transmitted person-operon.

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welpdedelp **person-person lol +9

suckitnbme NBME loves their scabies +23

dentist did you get scabies from "burrows" and "night itching" +1

pg32 My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +1

leaf_house @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +1

zevvyt to summarize leafhouse: Fomites +3

surfacegomd FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +1

submitted by mattnatomy(46), visit this page

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Severe hypertension often leads to hyperplastic arteriolosclerosis (onion-skin appearance). Also see proliferation of smooth muscle cells.

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meningitis and explains the flame hemorrhages (Goljan) caused by malignant HTN +5

taediggity FA 2020 pg. 537 +

dentist FA 2020 pg 301* +

ally123 The flame hemmorhages are also a good buzz word for recognizing he has hypertensive retinopathy 2e chronic, uncontrolled HTN. Pt's with hypertensive retinopathy can also present with "cotton wool spots" and "macular star". Pics on FA 2019, p. 299 +2

surfacegomd Pathoma (2018) p. 69 +

madamestep @ally123 I think the best buzzword for hypertensive retinopathy here is "190/135 mmHg" +

submitted by seagull(1933), visit this page

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out of curiosity, how may people knew this? (dont be shy to say you did or didnt?)

My poverty education didn't ingrain this in me.

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johnthurtjr I did not +3

nlkrueger i did not lol +

ht3 you're definitely not alone lol +

yotsubato no idea +

yotsubato And its not in FA, so fuck it IMO +1

niboonsh i didnt +

imnotarobotbut Nope +

epr94 did not +

link981 I guessed it because the names sounded similar :D +18

d_holles i did not +

yb_26 I also guessed because both words start with "glu"))) +30

impostersyndromel1000 same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1

jaxx Not a clue. This was so random. +

ls3076 no way +

hyperfukus no clue +

mkreamy this made me feel a lot better. also, no fucking clue +1

amirmullick3 My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +10

mrglass Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +6

djtallahassee yea, I mature 30k anki cards to see this bs +6

taediggity I literally shouted wtf in quiet library at this question. +2

bend_nbme_over Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +25

drschmoctor Is it biochemistry? Then I do not know it. +5

snoochi95 hell no brother +1

roro17 I didn’t +

bodanese I did not +

hatethisshit nope +

jesusisking I Ctrl+F'd glucosamine in FA and it's not even there lol +

batmane i definitely guessed, for some reason got it down to arginine and glutamine +3

waterloo Nope. +

monique I did not +

issamd1221 didnt +

baja_blast Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +2

amy +1 no idea! +

mumenrider4ever Had no idea what glucosamine was +

feeeeeever Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1

surfacegomd no clue +

schep no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +

kernicteruscandycorn NOPE! +

chediakhigashi nurp +

kidokick just adding in to say, nope. +

flvent2120 Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1

l0ud_minority No fucking clue I guessed wrong:( +

submitted by surfacegomd(3), visit this page

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FA 2020 654

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surfacegomd correction FA 645* +

submitted by haliburton(224), visit this page

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no tonsilar tissue is a huge clue here. total lack of Ig which causes recurrent infections after 6mo (maternal IgG is gone). LN and tonsils are minor/non-existent. (FA 2017).

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angelaq11 I totally hated this Q! I almost completely overlooked the "no tonsillar tissue", and thank God I didn't because that's the clue that made me change my answer. I had CGD (yeah, I know, S. pneumoniae not catalase +), but it said that he had muuultiple infections since birth. And I took to heart that "since birth" thing, because, isn't Bruton supposed to present with infections from around 6moa? I hope I don't screw this up next week +2

surfacegomd @angelaq11 I thought the same thing!! because it said "since birth" I thought Ok this is not Bruton :( +