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Welcome to sweetmed’s page.
Contributor score: 123


Comments ...

 +4  (nbme24#48)
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PAC erksot: ausilV anoiAsg a[nc ees, tub ont ceirgzeon tsbc]oej dan siHunoaln,cailt oleaalatrrtCn eiiaaponhm thwi cuaamlr isrpn,ag Aeaxli uiwotht raigpfa[iah nnamtido eeesmiprheh ov.vi]endl


 +0  (nbme24#42)
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yuo dnee a namttoiu in 2 lellase ot egt FC [sienc it si tumooalas r]e/eivcsse


 +1  (nbme24#42)
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anmiLs orfm a aecnlur rnmbaeme sgurnniodru A.DN mpi orf csurrlttau ospprut, gonaniirzg gn,oeem tgagrulien enge ist.nntracripo etceeDvif ni gireaoPr adn lrsmcuau hdprtyoys.


 +1  (nbme24#22)
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Tucrtlsaei nitroos loymst phasepn in yongu yosb, ylerra ni uts.dal lAso eth ianp rattdse at eht k,sfaln wcihh is ont hwo stooinr iapn .tssrat


 +7  (nbme24#43)
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tnSet senRoiests scrocu orfm cras tiesus swrgo vreo etnts caugins e“molaitinn ryep”siapahl adn onganrw,ri imahcies pmtossmy rutern :xT prnevet yb gnuis idgr gnliteu setsnt .ge irium.lSso rimhooTsbs oPts esotissn is ,Autce tntse esrsve sa insdu fro tsoruhbm moatnfiro lulysau /22 isgmisn nteidma.oi xT: vrenetp yb nusig dula illaetptntea enetttarm rnrdgo+[iorsceilgprll/opaic]ita.e frteA 1 y,ear etoinnzeohltdai of entst rcscuo and teehr is a relwo krsi of osmubht,r Tx eeoldwr ot sjtu sina.ipr


 +11  (nbme24#9)
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ynlciC ,D,EA dan for 1G ot S sinrtaniot meda[ ni 1G.] lyCnic B si ofr G2 ot M soaramtdii[nten ni ]2G.


 +1  (nbme24#20)
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The amH test si a etts dsue in teh ndisiagos of losmpxayar trclnunao eiulbniohomrag (H.)PN ehT stte evnvilso aciplgn rde dloob clsel ni ildm dcia; a oetisipv sletur i(sedrneca RCB fgtrylai)i sntcaeidi NPH

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +1
pathogen7  FA2020 added the Ham test to PNH I believe! +
pathogen7  Whoops no sorry I am wrong. They did add something called the EMA test to spherocytosis though. +
snripper  Ham test has been replaced by flow cytometry now. So fck off, NBME. +
pseudomonalisa  I remember it like this: PNH occurs at night due to mild respiratory acidosis (slower respiratory rate), which activates complement which destroys RBCs. The test is essentially doing the same thing, putting cells into an acidic environment -> dead RBCs. +1

 +2  (nbme24#38)
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igTnak scxsee hxvoinyorLeet iwll ,saecu ncIr ,4fT Icnr ,fT3 edcr HST, cerd yTdahirol onedii aupk.te sEcsxe neoyionlihtr tnikea wlil uaces ricn T3, eDrc ,T4 dcre ,Tr3 cDre H,ST bseucae 4T estg oevdnertc ot 3T dna T3r in herp.pryie


 +1  (nbme24#35)
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I lgeti ogthuth reh ioezrsedv psiplu ewer eth rmoepl.b htaW seuing edcddie ot ues ihts oh.pot


 +0  (nbme23#21)
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eenG iiamniflpcaot si an iarcseen ni eth mnbure fo ispoec fo a eeng utohiwt a nppoarotlior crinseae in ohert s.geen Tshi nca tsrleu rmof ctonpaiduil fo a irogne of AND that inosnact a egen gtohhur rosrer in ADN icireolaptn dna aerrpi raenicmyh sa lwle sa ruhohgt iftusortuo aetucrp yb hefslis tgcenie lente.sem


 +4  (nbme23#4)
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oDtn egt sfuocend itwh ublc .etef obfotlCu si a hrtib fected heewr one or btho eetf rea arttdoe wdainr dna 1[]darw]4.[nodw eTh ecfafetd ofto and gle amy eb amslelr tanh hte o[t1h].er In uotba hlfa fo esoth cdafet,fe thbo fete rea .div]lnveo1[ sMot scsea are otn cdiseaoats ihtw roteh ]olbr1ps.em[ uhitotW temret,atn lppoee lkwa no eth sdise of ihrte fete, wchhi esscau eropslmb with gel[n]ih2aTk .w actex ecuas si ulyuasl rc]e1[.lnau A few eascs are estaidaocs iwht tsidla pyhgrirasotsro or cnygeool.mme[ielen]2


 +1  (nbme23#43)
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incdgrAco to teh Nuress' altHeh Stduy, het sikr of olarpymun eoacaoacrndnmi rsiecsaen ilanytsubtsla areft a nglo uoaindtr fo taoccbo smino:kg ressmok whti a iouvsrep kmoigns orntdaiu of 0403– yeasr are erom nhta wteic sa ilelyk to eoepvld nulg eaimcorcannado acdpmero to vsrmnereso-ek vl(reteai irks fo xprpameayltoi ;.)24 a durotian fo mreo ahnt 04 esyar ncesreisa iavreelt kirs to .][85

hisT narcce ulausly is eesn yleeprairlhp ni eth sl,ung sa odopeps to slmla lcle nlgu acrcne nda uomqssau clel ulng cce,rna hhwci bhto tned to be eomr necyrtall d0e9o1lc,a][]t[ hhgaulto ti amy lsao rocuc as rtaclne 0se]onls[1i. roF knunnwo n,raosse it nfteo aisres ni erloiatn to reelhrpiap ngul rssc.a heT etcurnr retohy is htat teh rsca apbrolby croedcru yocasrned ot hte r,mtuo arrthe than aunicgs teh r0].1u[tmo eTh oraoaeancdimcn ash na ceiedrnsa cnneiiedc ni ksros,em dan is eht msot onmmco yept of ugnl ecanrc ense ni ses-nokmrno nda ew.]m[on10 eTh ipaelhrper olicanto of oeirnaancdomac ni eht nslgu mya be ued ot the seu fo tilfsre in itegasrcte ihwch tevnepr the lgarer aseptcril omrf nitrngee eht fcnlg[a.cinturiloai e[[]dnde]1e121] eeDerp aalhtniion fo rceeattig mkeso ulsetrs ni rrepplhaie oneslsi that ear efnot teh caes ni naoadomrnsaceci of the un.gl ,lGrnlaeey moiroencacdaan rwsog emro lyswol nad sromf ellasmr measss naht the rteho [e0by1uspt.]s e,oewrHv ti dtens to esitzeatams ta an raely 10sg[ea].t

peridot  This is super interesting, I was wondering wha the heck the scar had to do with anything! Thank you! +

 +3  (nbme22#15)
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abrnPazicreo dise eftcef is ekuliea.m AF 8021 peag 482

bdaines8  Perfect, that narrows it down to three answers +2

 +6  (nbme22#49)
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Teh tietpan si ni scephoi .cera ogrcaincd ot nrdoCa fscrihe tchise xa,emelp a man wtih OCDP in hpiesoc nca be gnive hhgi soed potasei vnee ohguht rehet si a iksr of sryoatiperr pidsseonre eebsacu hte tnntie to verelie fergufins is the thghise rot.ripyi


 +1  (nbme22#46)
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LacPi ri:ascrcuil ucsmaols dosfl ttha nexedt rfom listad dmoednuu ot plmarxio lumie 0A2F18 gp 653

paperbackwriter  not sure why you were downvoted... correct (maybe pg number wrong??) +

 +0  (nbme22#20)
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sreHe a good gaeim /lrctryt/b/timeo.sluphr-nmwmstas:/eia/naallhmefpaeleg/taotcclmeot-/eomn



sahusema  that video was sick +

 +1  (nbme21#15)
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nElmeuani lsao lepsh eth hioorcd ltmii uennoodtlcrl eciftrnelo wntiih het eey taht ouwdl iyptatellno reltsu in eht rpceontipe fo scuinfnog emiga


 +4  (nbme21#9)
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/ihmcw8.5bhlvne0p3s2p:tbnd..w/t5.n/o2ui5/mwg

VUAP is sdeu ot retat arsssiPoi and oVltiigi

minion7  puva also used in GVHD +

 +3  (nbme21#45)
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At ertnsig ermmbena ottepalni the MNAD etecprrso ear lkoedbc yb .2M+g hTe gvlteao ednedpnet 2g+M clbok si reeilvde npou zdiirnatapeool fo the ot-csypsptani emrneabm . heT iangld endpteden tantciaovi of the DANM ecprrteo riureeqs titaoi-cvacno yb wto snlag,id menlay tgtaaemul nda i.necygl


 +13  (nbme21#7)
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nle,oueT hte imna ncmtnopeo fo tleiaolv rqleuelca,s ug sninthre adn oolrase tnapsi si eth hcemnsrebp laesicoli rof mtos llcncaii oiixttyc. htsnIlaan ceasu na tnailii tyeacoixrt senrs hgoptheoru teh aeleser fo hieprneneip and ttocniaavi ofthe peoadinm ,ymtses owllfdeo yb arlntce vsoeyru tmsnes pnisdoeres aedietmd by teh eus fo AGt aAhp1aBwy tI sieanmsa fst a eessn of hop,ruaie t,ncitaixoe endhtbssdiinzz, isiiied roevbhuai and ilaaneirhxot misilar tohllcoao inxinati,tooc uths nsrgleuit in daeh.dycoesielnlcpocge pn teadepR e natiohlsina yb teh ruse otonropl g teh oicitxinonat lwil pdveoel ni hh,lescaradedrue ehcp,es iilapod,p gait rno,almatiby iauos v,ueslidsln inocnlushaailt and teiniadsono.itr hriBealauvo csehgna adn oouarcrrctistiecdh a no abhret ro iognhtlc ear fupllhe uecls ode cttte ace.ss cdSstpeue esrsu aym olsa cplofa nmio og,chu ftuyfs ,sneo eznni,esg fhng,islu liv,ia aants,saoenu tvomgnii dna tpahboe.o Oihropth insgs nad pmtymsso of nlaiatnh cubeaeu nilds stosp or sesor ni ro odnuar eth minoet ,djehtcu rcs,ela yamusgts,n bilrtryatiii or axeeiitnttalyxiciby, dna peels detsaic.rubns tniPa or etrho nsstniao hte efac, ,dansh ro htelosc are retoh i dctfoarsnoi es.abu ereveS ndyssre fo ailacf ikns and umsmams nbeecur nac olsa eb a ateufre fo n ,ptdgoeraepdreeol ues fo ltivelao nassts eu.b8c Be crateitoncalfiin fo eht ryd and akcerdc isnk amy n lruiets rlrpoaei nda espilnara r,ydpsemao eemesmrford iseter to as “rsu’hffe ”as9hr


 +9  (nbme21#31)
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Pain bsfrei rfo Peaiarlt ulear:p alrciCve nad lasCto aptsr is by tIoncarslet vreNe, ihgimpaatcDar nda esdaitiMaln iva Phecnir eNre.v ibR agec nyrjiu cusesa tcasol eurlpal .anip


 +1  (nbme21#15)
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heT occatcimteh aftscro edorpcud by yonscmeot and atms lescl and the allco ittldsoavaiaon mielstutsa tnohercilupi xoimest.cha lso,A hdtoianleel lcels itocavtani errftuh ggarsateva the anriyftomlam noeerssp nda rgniaimot fo hoe.tlpunrsi Thsi asled ot na fulxin of rinloepsthu lacy.oll

cn:ereref c:/srcvw1lhl/5nm/h1cMbpCi./.inpe22wo.s5gPaw./it5tn/mt

bronchophony  Why not complement activation? +
joyceeepan  the way i though about it was: you need antibodies (IgG/IgM) to activate the complement system. But there's no such a thing as an anti-gout antibody. (and it is not an infection neither) +1

 +2  (nbme21#24)
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Ftaty neCgah ni vierL [/22 hHig ADNH dmae by DHA dan HDAdl ;t&g- sitnbhii AF ioxnadoti, pedmirai iorleptiopn ebsyamls nda &tegteir-on;cs FA tc.esamculua]


 +3  (nbme21#32)
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auslU ititilnraste noniupema I)P(U is a romf of lung desaies crdtheeiacarz by gvirseespro nricsgra fo htbo gus[1.nl] eTh isranrcg ib(sori)fs elvvosin teh sntgrpuiop frwmeroka unitmrite)tsi( of the gu.nl IUP si suht saciseldfi as a mrfo of ttlitirensia lugn .esdsaei hTe trem sulu"a" serrfe to teh ctfa hatt UIP si het otsm mooncm mrof fo nieitstitlra ssrfioi.b oiPueann""m tesaincid gnlu" iot,nlmbya"ra wchih lsedcinu iriossbf dan iimntfa.oamnl A etmr voyeprusil dsue rfo UIP in teh hsriiBt etrulriate si tcnypoecgri sbrfignoi tvliialeos (F,A)C a mtre htat sah eallnf uot fo rafvo iescn eth acbis gnnyeildru aytlogohp si now huhtotg to eb fo,ibriss ton oafaitli.mmnn heT tmer aluus iietlrtsatni inopunismet (I)UP sha osal tfneo enbe de,us btu iaa,ng eth ii-st tapr fo that mena yam seahrzpivoeme omai.alfntimn tBoh IUP dna FAC ehav eneb creibesdd sa syunonoyms htwi dhtiipioac upmaronly is.isobfr


 +3  (nbme20#37)
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A pdair uenidrcto of casseit is nofet plahosimcecd mpsyli wthi eht idoidtan fo sdolwe-o alor derciutsi in eth iautpnttoe nettigs. enist-lFri ituderic eparthy orf ictoihcrr sceitsa si teh cidenmbo eus of nlrconoasteopi )(lnotcaAed nda edimreuosf (ixLas) - lalCnved licinC





Subcomments ...

submitted by sattanki(56),
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’tanC elhp hcum no the texca roeinsnga yw,h tub rteeh era a fwe orWlUd nqistoues no htis hwere fi a eatenno sha micelayg,hopy oseksit nda ayamnhe,oerpmmi a arnocgi idca sirdeodr dusolh be ueepdssct ioopnirc(p dcia or ohmacntiymlel da)c.i Lsse ipssiosucu of an RTA ucaes ayeghpmycoil is not tseacriaritchc fo ha.tt

sweetmed  Im assuming because N-acetylglutatmate is an allosteric activator of CPS I needed in urea cycle. and N-AG is made of glutamate and acetyl coA. So in organic acidemias, all the acetyl CoA is being used to make ketones for energy since gluconeogenesis is messed up. So Urea cycle doesnt work as well and NH3 accumulates +3  


submitted by mcl(517),
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In aces uoy nwana og persu dren nda eadr obaut nmlye,i ct,aaaiccpen nad s,enacsrtei isth ugy deso a godo bjo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +18  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  


submitted by nwinkelmann(258),
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o,S orf mose ran,eso ntrouimasneettrsr is eogminsht eI'v WSAALY gsledutrg .hiw.t. ropbalby ebesauc I wsnat' uttgah it llew so vreen ellyar raldeen i,t usjt nerleda nehoug rfo atervhew xe.am I tusj nduof stih boo urgthoh NCBI dan tis !CANFATIST s'tI mofr 0021 os higtm eb ld,o but it was gtrae. uoY acn scahre rhougth teh oobk and nfdi eth aetrsh.cp I ytrtpe umch juts enwt hrghtuo lla of hte aisteurottmnnrer che.trpa /nwo/tbkKmng9lNips/oh./0.b19w/i.snoh.twvcB7:

My nmai stmteywtaaG:ka- laaue = moarj xyeotartci trntrtomneeu.rais Tow epyts of cse:reptr o)1 rbio,otcaeptm omts of wichh rea nperpayitcs iG ihwch eldas to deeedascr MDNA reptoecr yvitaict adn ikrs of iteotticixoixcy, or tcnsiysapotp qG eeorprcst hatt edal ot eernaisc ,+aN K+, and decdsreae ateumgatl aucess niioapardletzo dan eacsindre M++g edipltasmcne dna MADN rceotrpe icyavtti nda kisr fo eccyxoto,xitiit adn 2 ) porncotoii seclnnah ilicgudnn MNAD and Pa/AknateMiA cneashnl, cwhhi lal loalw fonniciecsp notiac lfn,xiu utb lyno NMAD swllao Ca++ flxiun (nad loyn in a toglaev deneptedn nmaner reaft esiiffnctu dtzpaioloernai has dapceslid het iibnohrti +Mg+ oin in the )eann.lch

AABG nad yngielc = iiinohrytb esrstrern.tanimtou )1 ABGA-A nad BC-AGA = ioinocrtop aehlsnnc htat elda ot ulefx of l-C, adn tpisede tihs ciunasg rpiiatnezo,aodl hte ureonn stlli astys lboew niegsrt t.apltieon ABGAA- nnidigb iest rfo r,aibtertausb eistor,sd AABG, adn rixntioocp = ndsiei pore of calh.enn AAAGB- igdnnib iest fo eannbspiizeoedz = isedotu fo rpeo fo lne.cnah 2) yGlecni nnalehc is a evyr israilm -Cl exufl cnela.nh 3) BBG-AA si a tricbooeapmt enachln atht itvtaseac Gi elngida ot ecderdesa cAMP wchhi ivasctate ulffxe K+ enachlns dan iistbhin Ca++ lxfinu alnhensc eidglna to r.ioionazphlpeaytr

oeciingB iemnas = snccmteeahioal peonmiad nodaooiir(nct fo ybdo ntmmeevo, awr,rde tit,vinomao rcftrn,oe)emein nirpierpehenon sl(e,pe swfeanuslke, aittotnn,e gdeefin heroav,ib npneeehiirp los(twe tcnceroninota in C,S)N puls ontsieorn ,leps(e lkueawen,sfs rseods,peni inxyt,ea eaasnu) nda nmteiahis (suroa,al tteonnt,ai lle,gray uisste ,agamed adn amy nlefceinu obodl ainrb o).wlf Oobulvs,yi lla of stih si in tdaiidno ot iardrngeec utosinorinmssaren dna lit,fgh ,hrigtf nad htigf re.osespn

TPA dan orteh iesrpun = rcaextyito stirmnsi,oans cearesldoe- iwth hrote mlllul-omeseac trmranoi.turenetss ednAoesni 'isnt llaasisclcy rdceiesndo a mnetarenotrutrsi ebaucse it s'tni atdo/erseldsree ni a+C+ etdenndpe nnream, btu edveidr orfm TAP obrfee ihnvag an trxetycoai atpiolten.

llihcAyencote = mojra itsnatnrutreermo vvidenlo ni uaimsinrtsneosnro vai ucamnrsi dna nciinocti recrot.pse

piedteP esiratutmtrrosnne = omnlycom eserelda sa pteorppedi garlre urserpsorc thta era vladeec by eccspiif ezmenys ahtt ewre ni the esam rtonaeuirnsttemr ecsliev ounp ee.lears eviF petys = n/iurabtg ptdspei,e podiio ip,psdtee ruiytpita ipd,teps mplyachiatoh aeslgerni ,nohsrmoe dan stoeh ton selda.fisci Elsemaxp = sprocreru ttah iesgv seir to eutnbscsa P iuphmopa(s,pc cereotn,ox adn TGI nad dereaels orfm llmsa editaerm SNP C bifres that rsnatmit nipa dna remtaptereu ,nmaritfinoo rwflepuo iovsh,petyen tdnibeiih by pooidi ,)dsptipee nkoiirunne A, eoeuetprpidn K, dna eepreodtnuip mam,ga nda oiiopd ppisteed inldcuign lnpta klaiolads ile(k omer)iphn, nceshyitt pioido rdavveeitsi, dna ihpose,dnrn pdnyon,hrsi nad nlhnesik.pae In neregla iopdio pseedipt rea rneapdtsses .e.i( gnaaeilsa s,nmhceia)m lvndeovi ni plxmceo ehasovbri (lexusa aarttcnot,i svbamiveire/ssigesgus irves)bo,ah dna litepdmiac oug(hht nto ft)ienidvie in cathcpyisri sriedsord.

rl,velOa rrnstmunertosaeti = epty ts:pey ea-lmlcouemlsl estrnirtsmat adn enruiedtpo,pes wehre mllclamesl-oeus strmsinrteta rae rsefta dan ieedamt paird cyptsnia saininmsrots ei..( nrdgenoa NSS itithgrlfgg/hffthi/ ckqiu ,)epronses rewhe as eturdsoenpiep ngo(al hitw icooilgb amines nad some mlsla eeuocllm ertmt)ssrtnai ear oelrsw adn dmeaite ,laudgra ldonopger ininssu.oasrrtonem

Some tucire:sp ersmpdeoitkpthwwr_erm:/tk/iphn//ueuoecidnsenuta.umtbeor._ant.apfoe_vil/sthrdvw, pptaene:re94di0eaai85t1ea-T/1rhlrasfftrc3e/ro2fRds/mt-g8-e6eB/bs31o-0sdp7fAbr4db.u3i1agcla-c0u4s2-ewtr3g/u0/6gl-beair2nt6chiAsp1hrg60P-wionwGBe/.op, dan tibfif-gU/d:tab/w5/4aan;wirfed--t.18s3tf/cb5-6dhlrr/0l2-=sednesa#x1g-bmg&ahh61lexp1w7apb._tgn/loeug-.e3diw9=0-aee2ae

sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +1  
dorischang  Didn't finish reading this, but it looks awesome +  


submitted by nwinkelmann(258),
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sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +1  
dorischang  Didn't finish reading this, but it looks awesome +  


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yakinltglA gtaens rri)oelenmtehmah(c ht(e otehr drgus dlstie era licmurotbue inribsito)h csrneaei eht ksir of M.LA

keycompany  Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +25  
seagull  CML has blasts too but they tend to favor mature forms. +4  
kash1f  You see numerous blast forms == AML, which is characterized by >20% blasts +4  
keycompany  The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +12  
impostersyndromel1000  @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +1  
sweetmed  Procarbazine is alkylating as well. +  
pg32  @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +3  
castlblack  this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +  


submitted by usmleuser007(326),
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hsTi reom ilklye to be eiidustcr arhrte ahtn xtiealvsa /bc

hte lab utsdy hwsso a renal oiytunsncdf NU(B map&; teCainiern rea e)edavelt

stMo elyilk the eptiatn seudba opol rtueidsci; lsoa onwks ot csaue noanctoitrc aslkdi,alo agnol wthi nearl elspborm hucs sa taitintreisl shnpeiirt

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +9  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by oznefu(16),
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Im’ vgainh elbruto nutndndisareg yhw isth is a rbeett icoech hnat tegaP seeias,d eypalleics htwi eht eiasedcrn LPA?

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +8  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +11  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +4  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by haliburton(192),
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klni to tcooran igdaarm

yotsubato  How is that NOT posterior to middle concha? bad question +7  
sympathetikey  @yotsubato - That would have been if it was the spehnoid sinus (I got it wrong too btw) +2  
niboonsh  this is a good video if u need a visual https://www.youtube.com/watch?v=mf7rY1VNy70 +3  
sahusema  Sphenoethmoidal RECESS not sphenoethmoidal SINUS +3  


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hwit CTP you rea oppsesdu ot daivo cssivxeee uhtgnlis dna UV usxero.ep eMslnhoeaxt aksem ryuo ksni more lebcstupise to UV ghti.l

notadoctor  Wouldn't UV light also be contraindicated in Vitiligo? +4  
sweetmed  Phototherapy with photochemotherapy (PUVA) is a well-known and well-studied modality for the treatment of psoriasis, which involves systemic or topical administration of chemicals known as psoralens and administration of ultraviolet light in increasing dosages after requisite time gap. PUVA is also used in the treatment of widespread vitiligo with moderately good results, though it is being surpassed by ultraviolet B (UVB), which is equally or slightly more efficacious with fewer side effects. +8  
dashou19  Honestly, I didn't even know what Methoxsalen is, just chose the right answer because I know you can not give UV light to people with PCT... +9  


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onteidlazi dreerferp ued to gsleni does

sweetmed  or metronidazole +  
niboonsh  what would his diagnosis be tho? +  
lostweightthxnorovirus  @niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good! +1  
nwinkelmann  Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA). +2  
mannywillsee  This little bug has has a face, and now you can't unsee it either! +  


submitted by hayayah(990),
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yB gea 57, het tyumhs si ettlli oerm ahtn tfayt .ustsei ternyFotlua, teh yutshm ocrseudp all of oyur T cesll yb eht iemt uyo eahrc buy.tpre heTy are lligenv-od nda 'tshta ywh uoy cna osel yruo ystmuh hituwot epiimanrtm of yrou enmmui .mysste

sweetmed  Memory T cells live for six months or less in healthy humans (Westera et al., 2013), whereas naive T cells can live for up to nine years +5  
whossayin  so the bone marrow does not take the role of the thymus? +1  
dr_jan_itor  @sweetmed, does that mean that if someone loses their thymus, they would develop imunodeficiencies appx 9 years later as the naive T cells have died off? +7  
hpsbwz  @dr_jan_itor no, because once all of the thymocytes become T-lymphocytes, they are stored in lymphoid organs until they're needed. this is why removal of the thymus in MG does not cause any immune system deficiency. +5  
peridot  @dr_jan_itor From wiki: "Thymic involution results in a decreased output of naïve T lymphocytes – mature T cells that are tolerant to self antigens, responsive to foreign antigens, but have not yet been stimulated by a foreign substance. In adults, naïve T-cells are hypothesized to be primarily maintained through homeostatic proliferation, or cell division of existing naïve T cells. Though homeostatic proliferation helps sustain TCR even with minimal to nearly absent thymic activity, it does not increase the receptor diversity." +3