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Welcome to sweetmed’s page.
Contributor score: 144


Comments ...

 +4  (nbme24#48)
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PAC tro:kes aulsiV gAoisan ac[n se,e tub ont ecozngrei ceob]stj adn tiilnHsalacn,ou atnareCaltorl apomeiahni wiht uamlcar npargi,s xaielA wttouih ar[piihfaga tndioanm ipeemshheer ino.vdel]v


 +0  (nbme24#42)
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you need a aoumnitt in 2 elseall ot egt FC sei[nc ti is loauosmta ere/evis]cs


 +3  (nbme24#42)
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Lmasin form a laurnec amnermeb duusroirngn ADN. pmi ofr aucrlrutts r,puotsp nigioazgnr meo,gne reigglunat gene crpanosit.tnri cfeevietD in ragerPio dna uauslcmr thyrdps.yo


 +3  (nbme24#22)
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tcriualTse notiosr lymtso apsphne in yogun b,oys erayrl in lsuta.d Aols teh apin ratdset at eth sfkln,a hhcwi si not ohw ioontsr nipa .tsstra

j44n  I actually had testicular torsion and my pain started in my appendix area and by the time I got to the hospital it localized to my testicle +3

 +8  (nbme24#43)
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tneSt iRtsneosse crscuo omfr racs ssueti srowg reov tnset nucgais “olnimtaine aiyrhplsa”pe dna n,nroigrwa iseaihmc opymsmst urtner T:x eernvpt by nguis dgri uintelg sttsne eg. ulsS.miiro Thsoobsmir otPs eosisnts is u,Acte sentt ersevs sa sudin for bhsmutro mnrtifoao asuully 22/ gssniim .iadnmoeit x:T renvpet yb uinsg adul lineteplatta tntatemre eprrlolirdorapst[.gici/n]cigoeal+ Aertf 1 ,ryae dhtoiintenlezao fo entst srucoc nad teher si a worle rski of smort,hbu xT olrdwee ot tsuj irpni.as


 +15  (nbme24#9)
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incCyl ,E,AD and fro G1 to S nsaorttiin edam[ in .1G] yilncC B is orf G2 ot M eaiasdtintonrm[ ni .]G2


 +1  (nbme24#20)
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The mHa tset si a sett sued ni teh gsdianosi of rplosaxmay ularoctnn omrionulhgeaib .P(N)H The sett evinvslo nagplic dre ooldb sclle ni dlim ;adic a etpsoivi uslret cseinred(a BRC rg)ilyfati isteadnci NHP

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +2
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snripper  Ham test has been replaced by flow cytometry now.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. +1
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. +4

 +2  (nbme24#38)
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knTgia ssecex Leovixhrtoyen wlil esacu, rnIc 4,Tf nIrc 3T,f erdc T,SH ercd Thloadyri ndiieo akutep. xsscEe renyhotnoili naktei wlil eausc irnc T3, rcDe 4T, edcr rT,3 eDrc TH,S uacbese T4 egts ercnevdot ot 3T dan r3T ni iryp.eprhe


 +1  (nbme24#35)
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I liegt gthuhot rhe odieesrzv ulpisp wree eth po.mlebr htaW sinueg edecddi ot esu sthi hop.ot


 +0  (nbme23#21)
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eenG lanaftimiocpi si an arenceis in het rbenmu of piscoe fo a neeg ihtuotw a rrpionooptal rneaisec in ehrot .gnese ihTs nac truels morf uintdclioap fo a rogine of AND thta noiatscn a ngee hguohrt orrers in NDA rtacolniiep dan praeri inchaermy as lewl sa grothuh tosiurfuto eatcupr yb siselhf icentge nteel.sme


 +4  (nbme23#4)
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otnD tge seuncfdo thwi lcub f.tee lotoubfC si a rbthi etcdfe erhwe noe or obht efte are etarodt dnwiar dan ][wdwnr4.[da]o1 Teh ecftaefd tfoo and gel yam eb smralel htna the oer.h]t1[ In atbuo lhaf of teohs ef,atdefc hotb fete ear ]1lei.nvdvo[ tsoM aescs rae ont daesitoacs ihwt threo sm.orbl][1pe ttuhioW ,tameretnt ploeep wakl on eth ediss fo ihter ,tefe whhci usaces lsrmpebo hwti ]ang. wTi2eh[lk xetca csaeu is uualysl e1lcn[.ru]a A wef acsse rea iecoatssda htiw daistl horsioargrytps or ]clo[moemgney2eel.ni


 +1  (nbme23#43)
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ngriccoAd ot het reus'sN laHhte dtS,uy eth ikrs fo lymparoun aaoinomadncrec isseencar yillassutbnat rafte a gnlo nduritoa of ccoatob i:ngomsk oserskm hiwt a isrveoup smonkig tnaiordu fo 30–40 aersy aer oerm naht wetci as lkylei to oevdelp glnu nceaimrocndoaa rmpaecdo to os-vrreneeskm elvitr(ae ikrs fo rioetalpamxpy 4.;)2 a ruiadont fo mroe htna 40 ryeas sinreacse altevier ksir ot [8].5

Tshi acercn yusaull si nees aplphleirery in hte usgl,n as doopesp to alsml elcl glnu cnecar nda quumoass clle gunl a,rcnec wchhi htbo entd to be roem latrcylne l]a,]dto[c[091e agothluh it aym sola cuocr as tralecn [seil.1no]0s roF nonwknu ,osrnsea it onfet areiss ni aoeirltn to iharppeelr nulg ss.arc hTe rrcutne throye is taht eth rcsa plrobyab ordceruc eaorycdns ot teh ourt,m ehrrta anht ngsucia eth 1u.mor[t0] ehT anneomacriaocd hsa an ndicseera idncincee ni k,rmoses adn si eth smot mmocon tyep of lgun ercanc sene ni osnks-onemr dna [woe.mn01] ehT repaplehir aoitlnco fo aaccaiorndoenm in the gnusl yam be ude ot het esu fo eiftlsr in seegactrti whhci pvtreen het lrerag iaclseprt mrfo tigrenne het lfnur[gaoinita.iccl de1]]den1]2[[1e epreeD otlhnaiina of gettcaier moske srstelu ni ppilarrhee eoinsls that are often het eacs ni seaciamcadonnro of hte g.lun yGarenll,e acrcdaeononaim oswgr roem swloly adn smorf rallmes smseas anth het orthe 1tu[pses.]by0 revewoH, ti ndste ot tssmeietzaa ta na arely gas.01e[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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iearrnbcoazP desi eecftf is kliuemea. AF 2801 gpea 824

bdaines8  Perfect, that narrows it down to three answers +5

 +8  (nbme22#49)
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Teh ientpta si ni ocspeih r.eca gancoidcr to Codarn frcihes ithesc ,almepxe a amn itwh ODCP in sphocie cna eb egvni hgih deso asetpoi eevn utgohh hreet is a isrk of rrspyeroiat speodniesr abcsuee het tninte to vrlieee rufsenifg is the ithhegs oy.rpiitr


 +2  (nbme22#46)
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PciaL ailrc:isrcu asmcolus ldosf ttha exdtne ofrm ldtasi enudmoud to lprioaxm lmiue 2A180F pg 653

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

 +0  (nbme22#20)
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Hrees a dgoo igema huo:lrmmro/ltis/ct/r-eocsellpefa./eeebtlyattpaamntm/meaminn/loas/w-gcth



 +11  (nbme21#21)
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vi-ceidillhlpt0ogycCsat:h.w/s.-rtl%eod-tla2/aoimhat/Nsnmdatl

sahusema  that video was sick +

 +1  (nbme21#15)
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nEmliuane aslo lsehp eth dhocrio mtili dcuorellnotn oiecnltfer wtnhii het eye atht douwl tpelnityola sletru ni teh epotecpirn fo cunifngso miage


 +4  (nbme21#9)
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w2sn/h8.0pg/5lhm23.tb.monvi.twpu/5/nw:dci5be

UPAV si sedu ot taetr sioisaPrs nda oitiilVg

minion7  puva also used in GVHD +

 +3  (nbme21#45)
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At gertins rmameenb atlptenoi eth MDNA prceteors ear dobkecl by .+g2M The velgtoa nedendept Mg2+ lbock is edlrveie uonp eonrozilatdpia fo het tnosacypis-tp arebnmem . Teh gdlnia edndetnpe anvtoaiict of hte MADN perrtcoe reiuqser tni-ocaaitocv yb owt adni,lgs nmylea uegatltma adn engc.lyi


 +13  (nbme21#7)
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oneleu,T eht anmi tononpcme fo ltleivoa requesalul,g c nrnsthei nad loasreo tapnis is the mosle hcinsracebplei rfo toms alnilcci iiotyxtc. hannt slIa useac na aniilti trcyixoeta gptheshuoesror n eht lraesee fo nrnpieheepi dna vtociaanit eftho idpmnoea stys,me ollowefd by eantrcl rssmeunyov tes seoidepnrs dtidaeme yb hte sue of ha Bw1pGayAAt tI sesmsiantfa a nsese of ue,hpoair iaiotetc,xn siiesiidddistbizn,ehzn aivuoerbh dan eilhiranaxot liirmas oot ahollc aicnxto,inoit tshu stiuegnlr ni spaie elphdneconcdeclyog. epat deRe iaohanslnit by eth suer ol ntgopor the notiacintxio wlil eolepvd ni e, haeshelrdrcuad e,ehpcs lido,iapp igat iaalb,motynr llne aiss,vodisuu hantalisinoluc adn dsiieitno.taonr vihlroBuaea ahencsg nda aocsrhtuctdai rieocr no ahtreb or hctilong era hluelfp culse e tcdtoet .ecass tcSpeused ssreu mya laso oal cnpofmi cuohg, tfsfuy nso,e in,nezegs lufgh,nsi lnvua tnii,oaaas,es miotigvn nda hrihtoobOhtae.p op sisng nad osstymmp fo ihatnlna ib uusdlcneea optss ro sreos in or orudna eth ejticeouhtdm,n sra,cel ysnt,ausgm ltrbyariiiti ro ct xnteybliaxeiyiia,t dna pelse ubatcsri.sned aPnit ro eorth nst noias eth ecaf, ,nsadh or tcolhes rae horte ifncrit osaod bus.ea veeSre desnysr fo ciafal iksn adn unmesumbes mrca cna aosl be a tfeuera of geetrp,pandde eorol seu fo alotilve 8uetanbsc.ss ce ltatiaifBcrinneo of hte dry nad eakcdcr niks yam ntrei usl earporil nad rpaslenia rposadme,y esmdr reiteerfesmo ot as uf’rshe“f r”h9as


 +10  (nbme21#31)
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Pian fberis rof leriPata :ualpre eivlaCcr nad lsaoCt sratp is by ltrntsaeIoc Nr,eve mDaaghaircpit dan iltManidesa via rehPicn vNeer. iRb aecg yjuirn acsesu lstoac arlulpe .ainp


 +1  (nbme21#15)
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ehT ceochciattm ostrfac cduodrpe yb emooncsyt nad tasm lescl nda the colla vntoolaidsatai ustlsetima ronipluiceth h.octxsaime olAs, lolahneedti elslc ovitaactin hurerft ersagagavt eth miaftomarnly eprsosen nda mnartiogi fo rihutnep.los ishT ldsae to na nulifx fo lunpotsierh lclloya.

en:eecrrf imi/ww.poChllw:.25tttg/nMn5ps5bm2c/1ahr./nevi/s1.Pc/c

bronchophony  Why not complement activation? +1
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
an_improved_me  Thats not exactly true for a couple reasons. I saw a UWorld question that said something along the lines of an ApoProtein being useful b/c it binds the urate crystals, and makes it less likely for the crystals to be opsinized/recognized by neutrophils. Therefore, Abs do play a role. Secondly, you can have activation of coplement via the alternative pathway, which does not require ABs. +

 +2  (nbme21#24)
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atFty gChnae in vieLr [2/2 hHig NDHA mdae by AHD nda AlDdH t&g-; isinhbit FA tinidooxa, pmdaiire irtpepolnio elsmbsay dna ttin&egs-e;cor AF las]eutca.ucm


 +3  (nbme21#32)
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slUau artlttnsiiie amnenuoip )PU(I si a fmor of lgnu saedies edharazcricet yb ssorviergep nrigascr of boht un1l.[gs] ehT agsrirnc orbifsis)( sveoilvn eth otnsgupipr morwrafek e)iirt(tusmnit of eht .lung UPI si huts fieiasscdl as a ormf fo itietstranli nulg ieds.esa eTh term ""lsauu efesrr ot the fcat thta IUP si teh sotm nmcomo ofrm fo lsttiritneai riib.sosf ie"nmouPn"a ctsniedia glu"n io"y,mbatnrla ihwhc iuncdsle rfsibsoi and onmn.ialftmai A ermt lvrpyieosu esud rfo PUI ni the Biishrt ieuatlretr si orcegtypicn bsiogrifn estlalvioi CF)A(, a mrte tath ash lfenla out fo vfroa cinse hte iascb inlryenudg hogypolat is now thughot ot eb irsb,oifs tno fan.liominatm The term uasul sitrtilnteia sutnipienmo )UP(I hsa slao tofne bnee s,ued but na,iga teh iis-t trpa fo hatt eanm mya zemaeievhposr .fnalomaimtin othB IPU dan CAF have enbe ciddebsre sa yysosmonun wthi thadciioip mnploaruy isfrs.ibo


 +3  (nbme20#37)
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A radpi eunocdrti fo issctea si enfto hcapdimcelso pmiyls wiht eht aniidodt fo odlswe-o raol ucdesirti ni eth tateuinpot .sngteit s-eFlnitir edtcriiu ratyhpe rfo iicchrrto ctsiase is het ibdnmeoc seu fo ooeprnsiancotl (enoA)ldtac and eosmeriufd (xasL)i - lnCdeavl lniCic





Subcomments ...

submitted by sattanki(71),
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Catn’ lhep mhcu no eht tcexa ironnegsa ,wyh ubt hteer rea a efw lUrdoW utsiensoq no shit erwhe fi a eetnano has lphye,oycamgi osietks adn mhmn,peiayeaorm a riocgna iacd srodride sdoulh eb deptusecs roo(pcipni caid or iahymlotnclme dci).a essL suicpisuos of na TRA csuea ygchlpmieoay si not hciteiraccarst fo th.ta

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(601),
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nI aecs ouy nanwa og usepr dren adn raed about l,yimne ,ccciaantaep and srcste,iena stih guy eosd a oodg job.

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. +22  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +1  
brise  Uworld 1318*** +2  


submitted by nwinkelmann(297),
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oS, orf soem r,eaons rtartmuoenrtsnise si omnehgtsi vI'e SAWYAL reutggdsl .th..iw bolbyapr ebucase I an'tws hatgtu ti lelw os rvnee yllrea arlndee ,it utjs dnreeal oghnue rfo weveathr m.aex I stju fudno sith boo urthogh BCIN and ist TI!AACSFNT st'I mfor 0120 os mhtig be d,lo tbu ti wsa etrga. oYu acn rcseha ohruthg eht okob dna difn hte actrh.pes I ypertt muhc just wnet huhtgro all fo hte tmrrreeunsntaoti reapc.ht l/snNpt.tohw.Kv/nbkci9mw.h7//09oBg1sw/noib:.

yM anim tmGa-aue:wsltyeaatka = jmrao tryicoxaet trti.smrertauenno woT yetps of 1 re)c:rtpose poctteimb,oar omts fo chiwh rae tyesrciappn Gi chhiw lesad to rsadeedce MNDA prrocete aviicytt dna irks fo cittixi,xytocieo or spstaoynpcit Gq rpseretco htta alde to ecrnasei ,+aN +K, adn serdaceed mutlatgae suacse eadrpzitoinaol dna rieaesncd Mg++ niealstdmecp nda DMNA rrcepteo taiciytv nad risk fo xtitceyoiiocxt, dna )2 oioircptno hlncenas ncludngii DMAN adn ai/aMPAkentA hs,eacnnl hhiwc lla lalwo niisefponcc tnaioc ,iuxnfl ubt nyol MNAD slwalo aC++ xinluf and( ylon in a oevlgta enedpendt namner feart siuecffint poatrndioizeal has adpicdles eth hitibrnoi +gM+ oni ni eht )e.nlcahn

GABA adn cgnylei = yntiirhiob rsomitertr.eansunt 1 ) GB-AAA adn GAC-AB = rpcootinio ascnlnhe thta dlae to xflue of -,Cl adn epestdi shit gnaisuc eodopl,aaitnrzi hte renuon ltsli tssya woelb sgtiren npil.ttaoe -AABGA bnidngi ites ofr rteaabusbir,t rodise,ts B,AAG nda otirpocxni = nieisd peor of eanclh.n -GAAAB bngndii tsei fo szenoeaznebpiid = edisuto of rpeo fo .hlnaecn )2 eynGlci hcenaln si a yvre amirlis Cl- elfxu nncal.he )3 AB-BGA si a etoricmtaopb lcehann atth saietcvat Gi laigdne ot cddsareee APcM hcihw tisavctea efuflx K+ lnahsnce adn nisihbti C+a+ xnlufi ahnescnl ldignae to azyepaln.iptrohiro

iceBogni eansmi = ecnslaocmthaei adoimpne nioc(ndootair of odyb memt,eovn erwr,da tn,ooiimtva ericf,m)rtneeon erenehrnpoinpi eplse(, eaeulsw,nfks tont,teani gnefedi iervb,aoh eniehpniepr wlot(es trnteccinonao in N),SC lspu isrtnoeno l,sp(ee klneesfuaw,s poedseirn,s yt,anxie n)eausa and siatimhne lsuor(,aa otet,tnnai yla,glre esutsi ga,aedm and mya nfclnuiee doolb bianr lfow.) oOu,yislbv lla of tsih is in iddainto to rdiraegcen osrerinsoamiutsnn dan hf,tilg rfit,hg nad thfgi oepsrn.se

APT dan throe irsenup = ytictxaoer ,omsansritnsi e-oedacesrl twhi rothe omsm-lclelulae ueionrtrtaess.tmnr snAeednoi 'ntsi scyscilaall isnreodced a tomnsuetneitrrra eeaubcs ti s'tin /odleesdreratse ni C++a enpdentde an,rnme tub edvdrei mrfo APT erfbeo vgnhai na axeoricytt .etaotplin

eohitynAccell = mjaro ristmeunrrtaoetn olnivedv in sinrnorouaemstins via niauscmr nda icntinoci tcsor.pree

Ptdpeei nmtsteuseirtnraro = yomcnoml desaeelr sa pprtpdeoie arrlge ecssprruro ttha are vaeecdl yb fiesipcc yneezms thta ewer in the mase iattrneeomtsnrur vleicse nuop e.selear eivF styep = /iugntbar ptpd,eise opioid pdisptee, rypuiaitt isppedt, maatcyhihopl esgarinle senmor,oh nad hsteo nto ieflsdsa.ci maxlespE = porurcrse thta vesgi seir ot stnubecas P ohspamu,p(cip otoner,cxe and GIT and ersdleea rofm slmal emtadire NPS C sibefr ttah rtamstin iapn nda tempretreua irafioonmt,n frewuplo hseop,nteviy nihidebti by odpiio s)pidpete, nonirknuie ,A tpeodepeiurn ,K nad deenpeitrpuo aa,gmm nad opidio piteedsp ncudigiln pltna idasokall e(lik onep)h,rmi ctyienths pdoiio e,vrivasidet and nopsrendi,h dphniyos,nr dan eh.nlpnaksie In rgeenla oodpii tideppse aer esrsspedtna .ei(. snalaagie m,aein)smhc nvevdilo in poxmecl rebhaosvi xsu(ale rtintatoc,a issimeaesrvseib/gvugs vsb,hi)orea and iimepdctal ht(oguh ton fiedeivit)n in iatshircycp esirrd.sdo

Ol,alrve retrnurtotmesnisa = ypet t:psye ualmslell-moec sinemrttsrat dna rpsiedeue,ontp eehrw ol-lcasmmleules isttmsraentr era strefa and meadeit iarpd tycnisap timinossasrn i(e.. dnargoen SNS igg//ihhgtthflrffti ikqcu e)nos,srep rhewe as dtespeoinpeur oagl(n wiht gbooliic masien adn soem almls lelemcou imt)arerststn are orwsel adn miaeetd rgau,adl dlepnorog nno.imsseuorrnsiat

Soem :prtsecui tl.miedepniu//soetrtovpoebriatu/naw_ntdkrmhavwipreu_dom/ewtch_t.frnhese:pu./ks, ep8-a0c8a//cde0ro-au1e3w4-bsla4waT/relpg1dargr-i-oesAigdmeGAsnrd-B1tPe.i542biu:1aphsltu-a0r20io/eh-Bgc3s/9o6tf3perr7.gi1ceebnp3/hn62bf6R/f0wsft6trt, nda a=wp7t.md;ebbfgae/5:gxtb-.idli-d-e4&h/g=sant-Utf.69-wr-p/da1eaas0/ea2eiblw1d/1f5fc68e1h#riglanngeth33we-/ru-ol_20xsb

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 +2  
dorischang  Didn't finish reading this, but it looks awesome +2  


submitted by nwinkelmann(297),
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So, fro omse naer,so rtnstrosirumetena si oghtniesm eIv' WAYLSA ugdserltg .wh..it rplbbyao eeasubc I tnsa'w tuhgat ti wlle so renve laelyr eedranl it, sujt erenlad ngoheu fro heearvtw .emax I tujs nodfu tshi oob hoguthr NIBC nad sti TTS!CNAFAI 'tIs ofmr 1200 so htmig be ,odl tbu it swa a.etrg Yuo nac hresac hohtgur hte ookb nda infd teh .rctaeshp I ytertp much tusj entw tohhgur lla fo hte ureotiarmtrntnes ct.pahre nwo9..wwi.7B//itKohn//90l/bgshtnpNcobv:m1s.k

My mian kw:yutaaGsla-matee at = amjro iteyxrtcoa rr.teiottursnaenm owT ysetp of rp:oe1tcres) ,tocerbapomit sotm fo hwhci are pyeiacrtpns Gi hcwih dslea ot ecdseeadr ANMD trepcreo aytvciit nda sirk of yciiix,tootexitc or ynoptiatcpss qG ersrepoct hatt lade to arsecien ,aN+ K+, nda daderesce glatuetma uscase lrzoieatandiop nda csdeearin +Mg+ tinmcepsaedl adn DMNA teorrpce iacittvy nda riks of tyictxixcoie,ot nda )2 nopiicroto eclsahnn lgcdnuini AMDN nad /PatniakAAMe necashn,l hciwh all lalwo fpnecoinics octnia u,xnilf but only ANMD alsolw a++C uiflnx dna( yoln ni a lveotag dptenened enranm fetra itffesciun ioedotraipzanl sha salcpdied eth inibhtori ++Mg nio ni eht .nnehalc)

ABAG dan nlceygi = ohiiytnrib .nsoutitrrnatrsmee 1) ABGA-A nad GB-ACA = icnoorptoi hnalecsn ttah leda to ueflx of -Cl, adn pdeesit tish saicngu poezat,rialoidn teh roneun llist styas oewbl srgient teilpato.n GA-BAA inbidng tise fro r,baseiauttbr ,eotdrsis GABA, dna oioitrnpxc = inside eorp fo helca.nn -BGAAA inbindg tsie of eaznedbsiionzpe = ituoesd fo rpoe fo enc.hlan ) 2 nylGeci nehlanc si a vyer rimsila lC- ueflx celahnn. ) 3 G-ABBA si a cpaeotombtir enhlcan ahtt tateavics Gi ignaedl to ecdsderae MAcP ihcwh aettsciav elfuxf K+ elsnncah dan itinisbh Ca++ ulfnxi cnnshale alneidg ot oaoalppr.ihrinezyt

ogBienci einasm = aeotchaemsicnl omedipna rooctdanoi(in fo oybd tmneomev, d,eawrr a,vnmtoioti tn)ec,nemerifor rphniepreoienn lse(e,p unfsl,kwesae onttt,iaen digeefn iao,bvher rnppeneihie setolw( aitroentncnco in ,NCS) spul sorieotnn elsp,e( sf,wnslekaue pesseod,inr y,tieaxn ansae)u dan iihstmena (rlosu,aa ,ittnnetao lyglra,e usties md,gaae nad mya feunilcne doblo brnai .lo)wf li,vOuoybs lla fo this si ni ioadidtn ot iercnerdga easnrrmtnisuisoon dna ti,hlfg ftrihg, and tfhgi es.ropnes

PAT nda rothe nrsepui = etiyarcxto asmtisn,nrsoi -roecselead hwit ethro lma-sloeumcell arum.rettoreinnsts sndAnieeo tsin' aalislsccly oesnedcrid a rrttotnrmuainese ueebasc it 'stni reseedolr/datse in Ca++ eepdedtnn arenm,n tbu rdideve rmof APT oebfre iagvhn na xyticeraot t.petiolan

cyctoeiAllhen = amojr nristtreonmtreua ivledvon in nisnootirnrsameus avi ncirsuma nad cinnticoi te.ocerprs

etpePid nsusniamoetrerttr = momoylnc esrlaeed sa eopdierppt grreal ospuerrcrs hatt rea dvaeelc yb icifspce nezsyem htat ewre in eth aesm rtisneortatumern csleiev ounp .elsaree vieF epsty = n/tbrigua spet,iped iopodi pi,tspede ttiuapryi i,dpestp hythpciamlao rsleeniag ons,hmero nad hstoe ton sf.daeiicls lpeExams = srcuprreo ttah egvsi resi to tseusncba P u(mihp,paopsc e,etcrnxoo nad GTI adn eaeerdsl rmfo smlal aieermdt SNP C sebfir tath rismtatn pani nad tetreumraep anrmitoiofn, feowplur ytveop,sheni iiedtbihn by diopio sdt,)eeppi ikernnnuio ,A teieeuponpdr K, and euippeetornd ma,mga nda idipoo epdsipet niuicdngl antlp dlaaklosi le(ik ,mehpnroi) yiteshntc oopiid videia,rtves dan inrhen,odps dhon,sipyrn dna penhs.nklaie In nelager diioop pisetedp rae pessaesnrdt (ie.. saganeali mhcea,mn)si lovneidv in lexmopc hvsorbaei l(eausx intoa,ttrca ssbgesivevmsaiegis/ru rsveai,b)oh adn ldcpmeiiat h(hgtuo nto ivnie)itedf ni sypiiccthar edrdorsi.s

rlvaeOl, nirrrttstneeuosam = ytep se:tpy m-lulscoalmlee niratsmtestr dan ,nedusrepepoti rehwe -seoasmlllumcle stirsnattrme ear arfest nda edmetia aidrp cytnpias ismsaistnrno ie(.. ngdaeron SSN ghhhftti/irg/ffltgi kucqi rpees,)son hwere as nsdeeoptiurep galo(n ihwt gliciboo eimsan dna omse lslam eeoumcll reniastsmtrt) era slwero and itaedem uar,lgad gpnolrode mrn.nsiotssirnouae

Semo ut:eprsci h/snkdwai_dmtupurek/wonrn/aeuosohmeideosth:pteip/tcebtv.frt_mnwtir./elrapuve_., 2gArf/pTds.bgi-0seu--/1t5reapceefsAf73/4w9enih0-13rpripaoin3-4itihuBwdo8rgug0tll/efartca.GBaag6ereP/s1pbw/tr:tbe-1Rmln40cc-hoba62seso/a8e-3d661d20r, adn 4f-laleg-twes/1nd5s5e2-d/:i/_c9-ab--dbpUw/f3e;-t67lg=xfhx0-.d=or1rrm.bhe#3efnsaeb10b2t.&/8tga/gadaiwwagh1aeiteni6upl

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 +2  
dorischang  Didn't finish reading this, but it looks awesome +2  


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iglAyaklnt agstne hre(eoicrehmltam)n e(ht terho srdug sldtei era lobetmuriuc tnhriii)osb racisnee hte rksi of ML.A

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). +27  
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 +9  
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 +  
jurrutia  @keycompany, how did you know it had to be of myeloid origin? +  


submitted by usmleuser007(397),
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Tsih eomr ylleki ot be utscidire ehratr nhat ialetsxva cb/

eth abl tdusy hossw a lnear ncfyitdunos UN(B &p;ma nCiraiente rea vtdlee)ae

toMs kielly the iettapn buadse oopl uscie;rtdi salo kswno to auesc otconnticra o,dikaalsl gnlao whti alern pblmeors suhc sa tniaiistrtel eshiirpnt

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. +12  
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(22),
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’Im hvaing rbultoe nnarnedutigsd ywh itsh is a ebttre occieh tahn aPegt asdiees, aeclilypes tihw teh nidaceesr ?PLA

zelderonmorningstar  Paget’s would also show some sclerosis. +5  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +28  
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. +17  
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 :( +1  
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. +5  
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(215),
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kinl to oatocnr iramdag

yotsubato  How is that NOT posterior to middle concha? bad question +11  
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 +4  


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whit PTC you rae pusposed ot oiavd ssxiveece ihngutls nad VU ees.xourp aeMhnsolxet kesma oyur ksin meor csuetlsepbi to UV t.hgil

notadoctor  Wouldn't UV light also be contraindicated in Vitiligo? +5  
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... +11  
sarahs  what about tcell lymphoma which also has cutaneous lesions? +  
shieldmaiden  @notadoctor UVB from the sun is contraindicated. PUVA is actually used for vitiligo therapy +  


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tlaoienzdi ferprdree due ot elsgni seod

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). +10  
mannywillsee  This little bug has has a face, and now you can't unsee it either! +  


submitted by hayayah(1081),
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yB aeg 75, hte sythmu si telilt emro hnta attyf usiets. lFtoeu,tyarn the ymthus sepduroc lla fo uroy T elcsl yb eht tiem uyo rchea ruyetbp. They aer lievdln-og dna sath't ywh yuo can eosl oury uhystm wioutth mmrieaiptn fo uoyr miuenm myts.es

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 +8  
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? +8  
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. +6  
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