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submitted by keycompany(268),
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oaHtevnetlinyipr dreeaecs .CaOP2 elnrCat reoccortsemehp nespdor to wlo C2aPO by itrncnstsvcoaoig earcbrle doblo sslsev.e

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)E ebrarCel suseiT pH uowdl ecearnis ude to rstroarpiey salal.oisk

keycompany  EDIT: Via the **Haldane Effect**, not the Bohr Effect. +  
impostersyndromel1000  excellent response +  
teepot123  fa 19 pg 489 +  

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Pealse nca oyu dlinky aresh NBME 22 and 23 sutnesoQi htiw em . I loyn see hte erwsasn but I do tno vahe the lluf okuqs?einThas nt ni veaadnc

makinallkindzofgainz  I think you may have this website confused with +6  
teepot123  why don't u buy the exams like the rest of us? +2  

submitted by chosened(1),
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rctCreo me if I m ogrwn utb I htkin s'ti aylreanlg sitlpimaapsoo.l ilmopaaPls acn pdlveeo rhewnyea glaon eth oriyrretasp r,catt but sotm notfe tafcfe teh xanrly nda hte lcaov dscor lel(gaanry lpo) sNoasoi.tamtpli urse owh YH tihs si tub ehesr reoM fion: prsrdm/asiptd.sssestlhoio:ctr-iaaryetrnaar/is-o-e/pseregersrol/rrueatpae/ise

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +2  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1  
teepot123  yep dr sattar nails it ^ +  

submitted by seagull(1112),
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fI yuo 'todn oknw htwa rcDlioamu oesd ilek nya alomnr ua.nhm The sfuoc no wtah iiasnrp 'ntdeso ,do ymnale ti's to'dens ftacfe TP imte and sotm lpisl n'tdo rseiecna gtcotnil i(clelpaeys ihtw np)risa.i This si how I gicol ot eht igtrh asnrwe.

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +11  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +4  
drmohandes  Because dicumarol does not decrease platelet count either. +  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +3  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +2  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +3  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +1  
teepot123  di'coumarin'ol +  

submitted by armymed88(48),
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lcoeuGs si cr-ndpttaorsoe into trsoeetynec fo SI avi iodmsu

toxoplasmabartonella  That makes that glucose needs to be given with sodium. But, what about bicarb? Isn't the patient losing lots of bicarb from diarrhea? +3  
pg32  Had the same debate. I knew glucose/sodium was the textbook answer for rehydration but also was wondering if we just ignore the bicarb loss in diarrhea...? +2  
makinallkindzofgainz  @pg32 - Sure, they are losing bicarb in the diarrhea, and yes this can effect pH, but it doesn't matter that much. You're not going to replace the bicarb for simple diarrhea in a stable, but hydrated previously healthy 12 year old. You're gonna give him some oral rehydration with a glucose/sodium-containing beverage. Don't overthink the question :) +1  
makinallkindzofgainz  *dehydrated +  
teepot123  salt and sugar, that's all the kid needs when ill simple +1  
mtkilimanjaro  Hm I put bicarb/K+ since thats lost in diarrhea, but I think the key thing in this Q is that its only 6 hours of acute diarrhea and nothing else. You would prob give bicarb and K+ in more "chronic" diarrhea over a few days or longer not just a few hours +1  

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heT ictursolmid feeingprsrn alahp tnixo is a naceslthiei hihwc clvseae iilchetn to iynppceoshlolhhor and dgreiceyl.di tssly,eElain paalh nxoti scmmii eophholpaspis C. siTh aesmn ti ahs a aelvyug ilraims efetfc fo eth ahopsopphislse snee in licBulas uereCs dna tieaLisr gsMooeencyto.n Teh dne teulrs fo hte xotin taanoivcti si oacanviitt fo denocs semsernge sssteym uhgorth dgcdreliyie AKA( yl,aoclcedg)ylir ihchw aatetsicv erevlsa atws,payh mtos oatbnly ni hist csea iiAcornahdc cdia olabmmesti dna ,8LI- hitw het ten fcfete fo recndasie clsruvaa iaemiytpblre einadlg to

teepot123  fa 19 pg 138 +1  

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giLfnit aedh ilehw r:oenp 1 ao hStmnolci ml:ies 2 Csimoo:htong n 2 omhsnt

pg32  Where do you guys learn that cooing starts at 2 months? It isn't in first aid or boards and beyond so this was an annoying question for me +1  
drschmoctor  @pg32 From being a parent! Otherwise little chance I'd remember all these milestones. +3  
drzed  I'll get right on that @drshmoctor :). If only I could have a kid to memorize all these damn developmental milestones. That would make life easier haha. +5  
snripper  Yeah, I don't see cooing anywhere. +  
teepot123  thankfully a lot of my friends on insta keep posting pics/vids of their babies reaching milestones so im well updated lol +1  
pjpeleven  Mnemonic: "Coo at Two" +  

submitted by trump2020(4),

You guys are way overthinking this. Chronic hypoxia causes hypertension due to SNS activation and EPO production.

teepot123  yep +  

submitted by hayayah(990),
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tlAgohuh falh esthe eshonorm nac ltcyluaa sloa eb etcedrse from eht uedd,nomu hte edudmuon si iseadatcos teh toms itwh KCC earse.el

didelphus  Gastrin, intrinsic factor, and pepsin are secreted by the stomach. VIP is synthesized in neurons, so CCK (from I cells of duodenum) would be most directly affected by a duodenectomy. +21  
teepot123  fa 19 pg 365 +  

submitted by pparalpha(78),
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iihtbnoiin of eritcubmoul yolietpmnraioz → inihitbsi igtsshopcaoy of teaur lssay,tcr kycoeluet aacinvttoi adn anrimiogt, nda lcel hiaxets.ocm

teepot123  fa 19 pg 476 +  

submitted by ihavenolife(53),
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Ikd fi ti helps btu I ogt it gnisu eth tHo on-BeT stAEK nmoenicm

oHt -&;tg IL 1 Fve(er)

T ecll smiionttula &tg-; LI 2

enoB rmrwoa tnatioumsil -> LI 3

gIE g-t&; IL 4

IgA tg;-& LI 5

aKuet hasep inoterp &t;g- IL 6

temmy  cyclosporine inhibits transcription of IL2 +14  
mysticsoul  FA2018 Pg 120 +1  
teepot123  same page also for 2019 edition^ +  

submitted by haliburton(192),
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AF 7120: eSreect nafastctru rfmo rlemllaa ioebd.s l oAs rseev as csrsroupre to ytpe I cslel dan erhto peyt II csl.el relioaPtfre uigrdn gnlu agm.ead

teepot123  fa 19 pg 647 +  
moms  thanks! +  

submitted by tinydoc(190),
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catioeNurph inPa feart retoks si aretlnc tosP skotre aipn norySdme

sadecu yb nallttcraoera laacithm esilsno

.gP 405 19AF

chandlerbas  agreed! more specifically damage to the VPL +5  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +2  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +  

submitted by hungrybox(791),
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tsisclaDyp veni ear a crurpsero ot lnmmeaoa. Tyhe veah uiglerrra, isldcs"ptay" rbdr.soe Rbeeemrm het "B" in DCBA stasdn fro rruelaigr .dBoresr eusvN anmes mlo.e

erhOt rwesans:

  • asnhaicost giiancrsn - nekDringa fo nsik actioeassd wtih Tpey II edetasib letilusm

  • slaba elcl oaricmnac fo knis - y,aleRr if erve .tmaessaseitz mnyoClom fesctfa rppeu i.lp

  • uelb usnev - ooc-erueldBl pyet fo oonmmc .lmeo .Benign

  • ndgeptiem shoicerreb tkesorsia - Stku"c "no earpeaa.cpn ostMly genni.b etfsAfc orled e.eolpp

  • te(No - ouy uusylal ees lyon no.e fI tlpmueli ihrrbscoee rsoseteak are ene,s it iacsidnet a GI yinanlmacg - kaa lLtaT-ésre"re is)ng
usmleuser007  correction ~ BCC affects the lower lip more than the upper +1  
sympathetikey  Pathoma says upper lip, good sir +24  
hungrybox  Yeah basal cell carcinoma actually affects the upper lip. Counterintuitive because it's "basal" which seems to go along with the lower lip. Here's another source (this website is fucking gold btw): +4  
pg32  Can anyone explain how we can rule out C or E purely based on the question stem? If we read into the question that we are looking for something related to melanoma, then I get why we can rule out C and E. However, the question simply asks which lesion appears on both sun-exposed and nonsun-exposed areas of the patient's skin. I would say that C, D and E can all occur in that distribution pattern. +1  
paperbackwriter  @pg32 because it specifies "this patient's skin," and the only ones he is more likely to get than the average person because of his family history are dysplastic nevi +2  
teepot123  fa 19 pg 473 +  
rockodude  just remember BS. basal cell upper, squamous cell lower +  

submitted by usmleuser007(326),
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SCN r/omeaHherg )gade1a m 124-8 rsH = dre nero2u ns) -13 yads = prlhtnoieus vfiqtleceaiu( oscr )ns3e)i 53- = phcsogaeram (4 ra)m)oiicgl 12- eewsk = itceeRva oilgiss +( usaclavr eapliro5)roi)nf t ermo naht 2 eeksw = lilGa ascr

n:oet( teh oshtpgsieena is iirmsla to MI adn its crsa ior;natfom rvow,hee teh etim ucesor orf SNC is jtus atsf)re

teepot123  fa 19 pg 500 +  
icedcoffeeislyfe  FA2020 pg 512 +  

submitted by hungrybox(791),
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WroKcf-fnarokieesk onsedrmy due ot ehiinmta (1)B i.eefdicync moonmC ni illacscoho.

hTe roesna why yeth dais ls"urtse fo olohlca dan urdg encsre era veanti"eg is that eth rfniteailedf dcsieunl tcuae oocallh on.aiixictont

cksnieer'W a:irtd

  • uoisonncf
  • syaiplars fo yee sesucml hph*gpatleli()aomo
  • aataxi

pns*estre here as nysstuamg

f'ksrKafoso s:yssihcpo

  • rmeyom osls aeedr(antrog dan grearodr)te
  • gknmai shti pu ibln(u)faaontoc
  • yposaetnlri ghacne
teepot123  fa 19 pg 559 +1  

submitted by mcl(517),
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oirVbi aolceerh si a -aiaem,gregtnv mcmoa spdaeh btacerai that cna csaeu rywtea aaridhr.e rheoalC xntio unftonsic by iiaagtcnvt teh sG tnsopeir ;-g&-t sngaincire cattiiyv of dnllyyea leyscac t&g;-- nerieadcs AcPM gt-;&- sadreinec N+a and -Cl uffxle gt;-&- a.aedirhr

teepot123  fa 19 pg 146 +  
lovebug  Cholerae's exotoxin does not invade mucosa. but just permanently activates Gs according to FA. +  
lovebug  Same mechanism[Increase cAMP] : 1) Labile toxin of ETEC, 2) Edema factor of B. anthracis, 3) Pertussis toxin of B. pertusssis +  

submitted by nerdy nik(9),
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VTD htta wetn to hte If it dowul ahev ogne to hte rnymolpau yrreta hse ludow aehv a PE, tbu it secsdro hte aitar alwl via a attenp rofanem vaeol nad etnw rcdielyt ot hte i.bnra

cienfuegos  Some more UW info: incomplete fusion in up to 25% of adults: remain functionally closed until RA > LA pressure (e.g. valsalva), esp. concerning if hypercoagulable (e.g. OCP) -evaluate cryptogenic stroke with buble study: inj agitated nl saline and look for bubbles in left heart +1  
athenathefirst  Are you very sure of this answer? because she is an adult and not a baby anymore so it can't be a patent foramen ovale. +  
teepot123  has not closed basically +  
kevin  cienfuegos is spot on with his explanation @athenathefirst +  

submitted by hayayah(990),
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het raotymji fo aocbnr iidxdoe lumleosec era eraidrc sa atpr fo the ebcaoinartb furefb .stsyem nI siht ,setsym ancrob iioedxd esusdfif iotn het CsBR. aCcinbor ehyrdsana A()C hiintw RCBs ykcqliu nvtcorse het bncaro ddxiieo itno arncicob idca )OH(3.C2 bCrinaoc caid is an unlaebts itineamtreed clemlueo htta edmtyilmaei ocsasdtiies onti ineabatobcr soin 3)O-(HC and ehgdryno (H+) .soin

ehT wlney enzedystish bconrbaaiet oni si sertotdpanr tuo fo hte CBR iton hte plasam in ehnxeagc rfo a icerlohd ion C)l;(− this si acldle het hcldorei s.fthi enhW teh boodl echsera het ugnl,s hte btoranabcei ino si odtrptasnre kcba nito the BRC ni ehgexacn rof het hcodeirl Teh +H ino stosaeicisd rofm eth obneiohgml dna bdnis ot eht ncaeboairtb Tihs odpsecur eth cnarcbio idca mie,teainrted hchwi si rtnvocede kcba iton ncraob xdieiod gruhtoh eth etaycznim ontaci fo .AC Teh nrboca eiddiox ceudrodp si pxeeleld htghour het gluns ngdiur haioxetlna.

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... +4  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +1  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. +1  
teepot123  fa 19 pg 656 +1  

submitted by beeip(116),
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I mgiht be eht nlyo rseopn on rteha ohw otg tihs noe ,gwnro btu saesdelrgr:

T"IT lanyassi eniudcsl veyre csjutbe how is zomnidraed agdcoicrn to dozidamner tnmtarete e.gnssanitm tI goenirs aneoccnl,impno rltopcoo iitd,vsaeon wlriw,datah nda tihyngna atth papnehs retfa mooazin"dnt.iar[]1

yo  You're not. I also goofed. +11  
seagull This video is a pretty decent explination worth your time on the subject. +2  
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +  
drdoom  ^ linkifying @seagull: +2  
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +  

submitted by mcl(517),
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titnaPe may hvae ryreadheit geaaondim,e hcwhi si isecaodtas ithw net"urcerr ctatask fo nnee,tis ei,asmvs lzileadoc bsuaecsontuu meade vgnonviil eht tiei,rxemtse ,ieinglaat afc,e ro nkur,t or sbaumscuol meead of uprep ariwya ro e.s"lbow Teh ariclet osge no to sya ess1ta-eCr"e iihinobtr rsowk dreitlcy on eth pomclemetn and ctoctna splaam cdsasaec to eeucrd aknyirdbin esearle" hhciw is laso lbaybrop odgo to kwon.


notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4  
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +21  
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2  
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3  
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +1  
teepot123  fa 19 pg 107 +  
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1  

submitted by soph(49),
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all hte thoer potosni tp dluow evha uerst,u svraoie. rstnrue ythe ntwloud olok lonamr dan they duwlo vaeh hroaictp v.osirae

turtlepenlight  This makes sense, but I was thrown off by the "normal-appearing" b/c wouldn't AIS pts not have pubic hair? +  
drzed  They just say it's a normal appearing 17 year old girl; not that the external genitalia are normal appearing. +1  
teepot123  fa 19 pg 625 +  

submitted by neonem(503),
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RPR = rseiecgnn tste rof h.yspilsi ihsT si a oggiltvce-onks taertpn shr,a icstriccheaart fo rcysoenda shi.ylspi rguD fo oehicc fro syiiplhs ta yan gstae is rcmanauilturs illPicnie.n

ragacha  PAG 147 FA 2018 +  
teepot123  also says which antibiotic, only 2 in the list, helps narrow down, pen more commonly used +1  

submitted by hungrybox(791),
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henw ffid enislg rdntas rraepi essmcanmhi are :edus

  • eaprir wnyel istseynhzed rta:nsd mtcmihsa raipre nLy(hc ymsonedr)
  • eparri idniypemri smdeir ceauds yb atd VU e:sueoprx tnildueceo osicxine eprrai oa(Xdrmree psgunmi)oemt
  • reripa cetonouxstn/aspio lr:ittoenaa sbea siixcnoe irprea
meningitis  Brca: recombinant repair +  
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2  
teepot123  fa '19 pg 382/3 +  

submitted by usmle11a(65),
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FNI y ilwl hbnitii iafinnttedoeirf fo h2T cslel nda heeerrtof a,(e rg))obnw ruyeroagtl T secl) ld fi teh esac saw atigknl btoau srviu

teepot123  fa 19 pg 108 +  

submitted by aesalmon(79),
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nCa enaony ipnalex wyh siht si nto a iipytautr dm?eaaon sI it juts a klac of rhteo tmsmy?spo

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +14  
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +  
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1  
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1  
teepot123  fa '19 pg 516 +  

submitted by egghead(1),
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Tsih is one fo soeht eiqtsunos I aws evnre gingo ot te.g s'It not in F,A I n'tdo htnik 'eIv esne it in salcs.

hungrybox  same :( +  
masonkingcobra  My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp) [Turns out it does not]( +  
gh889  FA 2019, pg 551 +7  
meningitis  Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line; medications (eg, clomipramine) may be considered. +5  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +  

submitted by strugglebus(154),
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lseorpcCoiny is a rnucclineai inriot,hib hchiw asmi to aeedercs -I2L

teepot123  fa 2019 pg 120 +1  

submitted by killme(10),
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Intoinnte to Terta sylaAnsi

usmleuser007  in a per-protocol analysis,[6] only patients who complete the entire clinical trial according to the protocol are counted towards the final results +1  
sympathetikey  "In an ITT population, none of the patients are excluded and the patients are analyzed according to the randomization scheme." +4  
smc213  This video helps +12  
rio19111  Thx smc213, really helped. +1  
trainingrats  Where is this in FA2019? +  
teepot123  the video explains it well, no need for fa +  

submitted by chillqd(28),
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