invite friends ⋅ share via emailtwitter
support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to tinydoc’s page.
Contributor score: 190


Comments ...

 +1  (nbme18#32)

I picked E) inhibition of TNF-a because I thought 2 years of diarrhea sounds like IBD (specifically crohns Disease without bloody diarrhea vs uc which must have bloody diarrha). I still don't see any reason why I wouldnt guess that.

tinydoc  Nevermind just saw the "typically relieved with defecation" which is a pretty big indicator of IBS. +1
pg32  I still agree with you though. This sounds like a case of IBD and I picked E to try and tone down inflammation. Giving someone an opiate for intermittent diarrhea seems kind of dumb... +
pg32  Just googled, "Indications for loperamide" and this is what came up: Imodium® (loperamide hydrochloride) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. +
gyabo92  lol, I feel dumb. I knew it was IBS (half my fam has it and just manage through dieting). Went into overthinking hyperdrive, and all it was was your standard anti-diarrheal. step has taken away all my sanity. +4

 +4  (nbme23#22)
unscramble the site ⋅ become a member ($36/month)

:JeztmuU/tIh35RstH.//fohpuby

OMA fo reopmetoso hibiotrisn for MM. DRTL: is atht they iblyaalsc kbocl the tsropemeoo ofmr iiucngftnno os ttha ommyeal sellc ncta' lceryec tsieonrp ty(he eamk a ont fo emh)t and nhew eyth t'can eb dcclerye yhte dlbui pu dan atsht toxic to the lcel adn it sedi.

ednyob ttah eth snuqieot is laybisalc gnkasi fi hte niohniiitb of pomrsootees ntis cifecsip to the Mymaole lslec and it btnidihie ertoh lc'sel oprsetseomo twah lwodu be fdcfete?e

HCM sascl I si eernpst on lal nclaeutde clesl la(l sllce in the ydob pxtcee RC)B nad tfcoinnu ot nperste deesnoguno gsenntia ot +D8C t slelc ot be ytdrdeoes (ofr plxeame irlVa DNA in na nctieedf l)cle. ehT awy they do stih si yb ngktai teh pernito ti esdne to tnerpse and ingarekb it dnwo ntio uchm lrasmle tediepp cnhasi (os ti acn itf no hte .MCHI If sith ptse saw ibethdiin ni ehtor ecsll etnh het the itonenPsrtea of CMH I duolnwt eb ebal ot repestn trhie tsnegani to CD+8 T lelsc adn traNaul iklrel c.llse as teh qtneusio ileimp.s

Teh otinequs asw peusr kricty sbaeuce if uyo ndo't nwko who oportsmeoe btiiishnro owkr thne uoy rttsa golokin orf na sewran atht uwlod ixelnpa how yteh uldwo kill tuomr lecsl as we.ll I otg ti nwrog to.o It qreeirdu ewldgkone of eth ywa MHC I eernsstp peitsedp.


 -3  (nbme23#38)
unscramble the site ⋅ become a member ($36/month)

8rw6//v/n:t9C.5p6pi2nmgas#won.Plh//0tsb!ic1=.leotm.p/ih1M100w.cc5

'evI dha a wldrou q rhwee eth trccoer poneessr swa to vreome eht elfi uspptor fi teh pnettia si nmedrdeite tno to be an nagro eoonvne.rd fi eth maylif si ytcialev aigntsa iths ie.dnsoic In my ireecpexen hte rswaen tath is omst otensh nad( ylielk ksaem ouy nsdous ikle a teltssac aohss)el si ulasuly teh rerocct eno no s.MENB I icekpd E dna I t'don see owh hist risnfde nnoipoi on ihs nvaeacdd erac drciviseet rae ta all rtleaven if eht inpatet by all ctasoun mclealyid nad lllgaey si secdoinrde ade.d


 +5  (nbme24#35)
unscramble the site ⋅ become a member ($36/month)

I nodt' tiknh ti tetsram twhheer ro tno isth asw LAS ( hhwci I istll htnik it s.)i utB ehetsr lsncaaitofsui nad ekssWaen nad taorhpy seoth aer MNLL nss.gi seerTh ooso many seyakn teqnossui ni tish mae,x tish inst one of tehm.


 +20  (nbme24#16)
unscramble the site ⋅ become a member ($36/month)

Tsih enuqitos is yrve ns,ekya ubt in neseesc tish si htwsa naiegphp.n

hTe dnteacacli orlvame fo the HTP nagsld ridung roheydmotciyt ⇒ ↓ TPH

TPH :n-yrilna oml- :bone ↑ remvalo fo ⁺²Ca dna oPahetph omrf b-enn-oi nk:deiys ↑ ²a⁺C ortbaerpinos dan ↓ ₄³O⁻P si-naptr-oe ↑obr snconroiev fo 2,5 yxyrmviHdintoa D ot 25,1 ryinvdixoHmyta D iitlaloCc(r - ectavi r)fom vai ↑ iyvitcat fo a-1 rxylysdeHao neiyfcdcie

oTefheerr a ↓ TPH owlud dael to:

⇒ ↑ OP³⁻₄ ⇒ ↓ C⁺a² ⇒ ↓ 521, myHtinoxirvyad D

ehT tqseinuo is sneyak hc(mu ekil het rset fo isht me)xa eusebac oemeons ohw sint nsgiufoc yllear ahdr or in a sruh gtihm kpci teh ointpo C hewer othppeha is ↑ and HPT is ↓ TUB ↓ 25 yaynvomriitdhx D

Tihs is ogwrn sa nlyo 521, myyrtaxoivhind D louwd be cdr,eesade teh cnsesovnroi oebfre siht rae oedn yb teh snik nhlu(gsti) dan rive.l

I ealylr wshi tyeh wdluo stpo gmnaik het nssuioqet ocfgunnis YPULER rof eth seak fo mngaki tmeh nnguciof.s tIsn ti ehougn hatt ew veha to nkwo thsi soudiulcir otnmau of n,inrfamioot otuithw hinagv ehmt eaiyotnnnlitl angmik ti aerhrd yb ngpnoiti uyo ot 1 easwnr hcoiec btu gcnagnhi a nuetmi etilad ot eamk ouy neswra ng.wro rO ugnsi a onrdma ass rentlaeunocm ofr a sedeias to dvoai minagk it oot elipms PGS(N = tropa"reliiefv N)G"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2
graciewacie9  Amen to the PSGN question. They got me on that one. lol +
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +
msw  *pointing +
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1
avocadotoast  this bs is prob why the question isnt on step 1 anymore +

 +11  (nbme21#24)
unscramble the site ⋅ become a member ($36/month)

tcnasfri uowdl eb a erom pihlaerrep gewde aephs

acsseb lutnwod be vsvaniie ot the nusrguiondr arae i thk.in

mussaouq llce is orme reacyltln dctaole

at'wns 0%10 srue ubt htsat teh etbs awsenr lthgusho tuipsd to give 0 pmtoyssm adn tujs a ric,ptue ohgnnti leik na caault licnilca nirsacoe

tsl19  Squamous cell is centrally located and has cavitation, which you can see in the pic. Similar to this one: https://webpath.med.utah.edu/LUNGHTML/LUNG068.html +4
zevvyt  I also didn't choose infarct cuz i think the lung would have a red infarct. +

 +13  (nbme21#30)
unscramble the site ⋅ become a member ($36/month)

ypeT 1 ialiamFl lpisamDeiyid g.(p 49 FA 19 )

eneiacrds GT &g;t--- nsatiapirect itpercuE / rsirutpi aaos hanXtmnd HSM

Can be udesac yb oenLrtiiopp aelpsi or ooArteipnp ICI yeiednfcic

yteh sdia taht PLL is fien os sit POA IIC

nrieapH tersaespe LPL form piarrHen Suafelt ieoMty no csaV nlotmidehuE woiallng su to estt tis tonnucfi ni eth alb.

I got ti orgwn too - uSitdp Reot zoaitimermon leclra noetiQu.s

masonkingcobra  I think you need to know that ApoCII activates LPL not necessarily know the disease +9
yotsubato  Knowing the disease makes it easier to remember the details though +2
pg32  Mnemonic for these 4 types of dyslipidemias and their causes: 1 = LP meaning LPL is deficient (or anything associated with activating LPL, like C-II) 2 = LD meaning LDLR is deficient (or anything involved in interacting with LDLR, like B-100) 3 = E meaning ApoE is defective and 4 for more (VLDL) ("more" just meaning more letters in the cause (VLDL oversecretion)) +1
castlblack  One too many chylomicrONs, two much cholesterol, threE apo E gone, 4 put the fork down fatty +1

 +14  (nbme21#31)
unscramble the site ⋅ become a member ($36/month)

tadesHmrpprihyiorya asngciu nebo oslsein is aiv Otasotlsbes ceisannirg KRAN L- sxiepnoers ot dbni ot RAKN no scetltosasO adn liasmitntgu ehmt gt-&;-- nci nBeo toonrseRpi

pg32  Picked D despite understanding the above ^^ because IL-1 is also known as osteoclast acitivating factor... +6
plzhelp123  ^ I did the same, but it appears that IL-1 activates osteoclasts in multiple myeloma. Which makes sense as that is a neoplasm of immune cells which can produce interleukins. +
caitlyncloy  can anyone explain why this the answer is "PARACRINE" stimulation?? I rule out the correct answer because i was picturing RANK and RANK L binding, which is not paracrine?! +
caitlyncloy  oh.. it seem RANK L is secreted to activate the clasts.. i was picturing it as RANKL was on the surface of the blast. reference: https://www.youtube.com/watch?v=hOIBRJeetAs +

 +12  (nbme21#49)
unscramble the site ⋅ become a member ($36/month)

ihutocrepaN aPin rfeta oretsk si tnceral sPto erskot iapn drnSmeoy

ausced by aetcraaltlron ilmactha enlssoi

gP. 405 FA19

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. +

 +8  (nbme21#10)
unscramble the site ⋅ become a member ($36/month)

Ceiyestn Urrinya :nosetS

lgexnoHaa sCstylar

oivPiste deirpoNsuistr ttes

ueD to a aetrireyhd tliiianby to roaesbrb : ine,teyCs nOirhie,tn eL,nysi nAd iinnrgeA ( LAOC ) t-&--;g- lnyO sCyieent pcreeitsipat to meka earnl ssntoe oahguhtl lal cna be oufdn ni teh i.Unre

Teh saiodgins anc be dmae abdse on eht astriacihrceCt tets htye odnn,mtiee heT xleoagHan eshap of the esonst, dna teh cfta atth ihs eorhrtb ash a irlsmia ncoiodnit ( ptniso ot thyaeerrid )

Tonsirey dna repcop dtno euasc eindyk sntsoe

aghlthou acilmuc si ryve omcmon ti hsa a efirtdfne hseap adn nt'si ngano be iietopsv rof nsousdpirriet s.tte


 +2  (nbme21#48)
unscramble the site ⋅ become a member ($36/month)

Ptx apeaprs to heav lcuMes pcstiitsya as a srltue fo .MS cSitsypati si edtetar ihwt a csmuel ealnxatr ilek oafenBcl icwhh is a ABGA io.satgn hlecanBtoa is a ieicmnmohlonCti hhicw acn be sdue ot raett iyaUrrn fntcyiosndu ni itllpeuM sosiclr.es but teh soQueint kssa atwh lwodu elph rttea hte iicttspsay.

athenathefirst  Why not mecamylamine? +
athenathefirst  Is it because it's MS? So for sure need a GABA agonist +
kevin  Never heard of mecamylamine, just know UW and FA say Baclofen, GABA-B agonist for spasticity. It's not solely because it's MS, it's just the drug they want us to know for specifically spasticity +

 +5  (nbme21#48)
unscramble the site ⋅ become a member ($36/month)

xPt appsrea ot aehv suMlec stsyitpica sa a uetlrs of MS. aicptiySst si radeett wtih a sclume lraetxna kiel Bacnefol hicwh si a GABA i.gnasto lahctenaBo is a liionCmmthoeinc whihc cna eb deus to etrat arryUin ucftnisdyno ni tlluMiep srocils.se utb the nuQtiose asks hwat uowdl help eatrt hte ct.iatpsysi

sbryant6  To remember Baclofen is a GABA agonist and muscle relaxant, I always think of the "Greek Baklava". Greek for GABA, Baklava for Baclofen. +4
sahusema  Also, acts on GABA receptors specifically in the spinal cord +1




Subcomments ...

submitted by tinydoc(190),

I picked E) inhibition of TNF-a because I thought 2 years of diarrhea sounds like IBD (specifically crohns Disease without bloody diarrhea vs uc which must have bloody diarrha). I still don't see any reason why I wouldnt guess that.

tinydoc  Nevermind just saw the "typically relieved with defecation" which is a pretty big indicator of IBS. +1  
pg32  I still agree with you though. This sounds like a case of IBD and I picked E to try and tone down inflammation. Giving someone an opiate for intermittent diarrhea seems kind of dumb... +  
pg32  Just googled, "Indications for loperamide" and this is what came up: Imodium® (loperamide hydrochloride) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. +  
gyabo92  lol, I feel dumb. I knew it was IBS (half my fam has it and just manage through dieting). Went into overthinking hyperdrive, and all it was was your standard anti-diarrheal. step has taken away all my sanity. +4  


unscramble the site ⋅ become a member ($36/month)

dDi onyaen else og wndo et:h se'sh pyiehestvon so eabym hlsl'e get shruwoeate drrehnifesic nesroymd ceebasu noitngh sele is inamgk sesne to me ta ihts iop?t??n toeru -

nTrus ,out erevse aamliar can euasc vlraarcaidcsuo allepcos nad soipynne.tho

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +5  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +  


submitted by yotsubato(806),
unscramble the site ⋅ become a member ($36/month)

iThs is a snotiuqe atoub nptitae ai.pcyrv Teh tneitpa hree is teh ihc.ld hTe poyrx rof hte aietptn si teh rohetm dan eafht.r yhTe smtu nwko ahwts w.ongr srtSie dan erotmh rae tjus looosoykl, adn pernats mya ont tnwa ot eltl meth dt(ipsu I kow,n tub w)rehvtae so oyu dnse ehmt out dna nhet tlel het tnparse eht itotsunia.

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +21  
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +9  
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +2  


unscramble the site ⋅ become a member ($36/month)

If hte lnbyrmitaoa saw setionmhg mroe life e,rhnigattne ntwolud' het trisf cnotia eb to call the ctiarpid?enia I swa tgkhnn,ii milb rxetimyte tgmih nema soimthegn eesl orem oessiru asw napphiegn oto ;g-t&- nede aicniairtedp itrgh away ot xd.

tinydoc  I thought about that but then I ruled it out as with the NBME ethics questions the answer is almost never to defer to someone else. The question doesn't ever tell you what type of doctor you are for you to be referring to a different more specialized physician. Also I assume that they think if there was something wrong you could handle it. +2  
llamastep1  Out of all the questions (UWorld,NBMEs etc.) I can only think of 1 question where you had to refer. +1  
targetmle  even i thought pediatrician should be called as after all, every newborn is screened by pediatrician and in this case, he had abnormality! i still wonder why would gynaec comment on that! +  


unscramble the site ⋅ become a member ($36/month)

kSni dvrseipo tnsilioaun dan vrpneest thea so.ls Tshi ianttpes' dbyo iwll neectsoapm rof enedcarsi erat of taeh sols yb ecsrigainn licoetbma te.ra

davidw  This is directly from Goljan I) Hypovolemic shock may occur due to loss of plasma from the burn surface (refer to Chapter 5). • Loss of protein from the plasma loss may result in generalized pitting edema. II) Infection of the wound site and sepsis may occur. (a) Sepsis due to Pseudomonas aeruginosa is the most common cause of infection in burn patients. (b) Other pathogens include methicillin-resistant S. aureus and Candida species. (3) Curling ulcers may occur in the proximal duodenum (refer to Chapter 18). (4) Hypermetabolic syndrome may occur if >40% of the body surface is burned. +11  
yex  Can someone explain why is it not increased ECF? +9  
charcot_bouchard  i picked same. Increased ECF but cant remember why. Can you explain WHY it is increased ECF? what was ur reasoning +2  
isotopes  Burns would lead to a decrease in ECF because the protection from fluid loss is absent; it can lead to shock. :) +1  
tinydoc  My reasoning behind picking ↑ ECV was that your losing fluid but not electrolytes with the burn ⇒ the ecv would have increased osmolarity, so the fluid from the ICV would be pushed the the ECV. It made sense to me at the time. I guess technically its wrong because the loss of fluids and the gain of fluids would amount to pretty much the same thing. But the insulation and heat loss thing makes sense I guess. +  
yex  Increased ECF, bc I was thinking about the edema formation.... :-/ +3  
atbangura  I picked increased ECF because burns increase the capillary permeability coefficient, but now that I am going over it I realized that increasing the permeability would only transfer plasma volume to the interstitial volume, which are both a part of the ECF so therefore ECF would not change. SMH +5  
aisel1787  thanks +  
69_nbme_420  Burns (and Diarrhea) cause ISOsmotic volume contraction; Costanzo BRS Physio +  
tiagob  in severe burned patient, also has increased fluid in third spacing or interstitial (leading EDEMA). Different extracellular space is interstitial and vascular +  
peridot  I also wanted to add, another huge job of the skin is to prevent loss of fluid. Burn patients are easily dehydrated because they've lost that barrier. This helped me lean away from increased ECV - despite the edema (from one compartment to another) as others have mentioned above, there is a loss in overall ECV due to evaporation from body. +  


submitted by mousie(171),
unscramble the site ⋅ become a member ($36/month)

Yruo iryitutpa tpactolro cslel hytoeypprhr diugrn ynengparc to rcpoeud ennsircgia nostmua of cotarilnp - atrp of eht aphpsgtoohlyyio of neha'shSe .mndy.roe.s rciasndee odlbo ossl nriudg rdyievel nca acesu isemicch sisenrco of urpytitai

tinydoc  I thought the elevated Estrogen and progesterone depress the function of Prolactin until delivery. I guess you needed to know that it decreases its function by downregulating receptors or something as opposed actually decreasing the prolactin production. I picked gonadotrophs. This was a fair question but I reasoned it out and arrived at the wrong conclusion. +5  
maxillarythirdmolar  Specifically, the estrogen is stimulating lactotrophs as progesterone is preventing the prolactin from actually working on the breasts. So it's the estrogen that is stimulating the lactotrophs to grow, and you would see the effects of this growth if it weren't for the progesterone preventing the action of prolactin (their secretory product) on the breasts. +8  
dul071  why not somatotrophs. she's understress. wouldn't that increase the production of GH +  


submitted by notadoctor(140),
unscramble the site ⋅ become a member ($36/month)

LSE is cseodaasti itwh fneideyicc fo ayler pntmeeolmc e(otgr.epsni q,C1 ,C4 2C). (FA 1,9 gp. 246)

tinydoc  Am I the only one who has never heard of C1Q? +20  
llamastep1  I knew SLE is related to low complement but when it talked about a "mutation" it threw me off. +1  


unscramble the site ⋅ become a member ($36/month)

A oslabonrmt is an mrtamieu R,CB so 'sti vaetldee ni esatst of eresidcan iopea.smoieths

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +47  
someduck3  The term "Normoblast" isn't even in first aid. +29  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +14  
tinydoc  I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +15  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +7  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +5  
fexx  I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +3  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +2  


submitted by usmleuser007(326),
unscramble the site ⋅ become a member ($36/month)

PIP ife-tecse:dsf + eedarncis sirk for .C dfif + aeIdnsrce riks rfo sper efcsintion + cna esacu ahnimygpsaeo + sreceade roipnoatsb of ,Ca2+( M+g,2 p;a&m )rnio + acreendis rksi of toiorcsotpoe iph crsraufet /(td wlo ruesm )ialcmcu

imnotarobotbut  That's not the right answer tho, the answer is the binding of PGE to it's receptor +  
tinydoc  Can someone explain to me why the PPi answer is wrong if it increases the risk of C Dif wouldnt that also cause severe diarrhea. PPIs make a lot more sense to be given to this patient in the first place. +1  
maxillarythirdmolar  Keep it simple, stupid. +1  
roaaaj  @tinydoc You are correct about PPI increasing the risk of C. diff, but there was no history of antibiotic use. +  


submitted by welpdedelp(198),
unscramble the site ⋅ become a member ($36/month)

mooehamHo,cstisr aka re"onzb teisda.be" onCatn eb oAdsind eud ot teh recmpghyleiya adn arlmno BP

alexb  I missed this bc didn't notice it was a middle-aged guy w/ just 3 year hx of Type 1 DM. +2  
tinydoc  I got it mixed up with primary adrenal insufficiency and the acth ⇒ hyperpigmentation. +10  
maddy1994  testicular atrophy &hepatomegaly helped me out to eliminate the options..when i was left with ferritin and saw pigmentation it clicked that it is hemochromatosis +3  
krewfoo99  Symptoms of Darkening of skin, liver dysfunction, diabetes, with testicular atrophy will always be hemochromatosis +2  


submitted by brethren_md(79),
unscramble the site ⋅ become a member ($36/month)

Classic epesl neaap ni the epati.nt oaCstsien of nahegitrb aesusc clnauonrt apohxyi nad cystsiem hrnhr/detnredcomsyat/iuipsnyeh haedt acn eps.rits 2OaP si nlmora rguidn dya dna aceresdde dnriug ipsoeesd dna ta githn. aslalyCslic nees ni esebO tsetpian hsuc sa hte apinett ni teh qsutonie ms.et

tinydoc  Caused a cessation of breathing rather than a ↓ in lung volume although a patient could develop an obesity related restrictive lung disease thats not whats happening with this question. +1  
sunshinesweetheart  p 665 FA 2019 +  
syringomyelia1  p 679 FA2020 +  


submitted by step420(33),
unscramble the site ⋅ become a member ($36/month)

istuoneQ etytpr humc si ikangs what ptye fo rvisu is Ma,sesle hhiwc is a vategNei sARsN .ruvsi

dragon3  is the AIDS to indicate that he can't get live vaccinations? +1  
tinydoc  Yep, also his unimmunized cousin points you to the fact that he got it from someone else who was unimmunized. +  


submitted by tinydoc(190),
unscramble the site ⋅ become a member ($36/month)

sThi sutonieq is ervy enkyas, but ni esences ihst si htswa igphnpnae.

eTh caaldeictn rlmeova of the HTP nasdgl driung cymytotrihedo ⇒ ↓ PHT

HPT :loli- n-ymrna enbo: ↑ romvael fo ²a⁺C nad hathpoPe mfro --be oinn deky:isn ↑ aC²⁺ esnpooiartbr adn ↓ ₄OP⁻³ -r taoep-↑isornb oevniocrsn of ,25 rdtyHyiaimxnov D to ,152 yarmtvdxiyoniH D Clt(iriclao - cevait r)fom vai ↑ ictivtay of a1- seyxardoyHl decefniyic

eTofrhree a ↓ PTH duowl ldea :ot

⇒ ↑ O⁻₄³P ⇒ ↓ ²aC⁺ ⇒ ↓ 21,5 trnvaoyHixiydm D

heT eqnisuot is yeasnk (chum klie eht ster of tsih ea)mx ceeaubs enesomo ohw nist fngcoius llyear rahd ro ni a sruh higmt ipkc hte tnipoo C herwe hopteahp is ↑ dan PHT is ↓ BTU ↓ 52 vtamhdnyyxiori D

hiTs si ronwg as lyon 52,1 mtyvdoyirixahn D luwdo eb acedderes, hte ocnirnsveos fbroee ihts rae deon yb hte knsi nguh()tsli dna v.ilre

I ellayr wish ethy owuld tpso namigk eht enoqisust confgisun PUYERL rof eth ksae of agnikm mhte snfo.gucni nIst ti ehnoug atth ew evah to onkw ihts uildcsuori antumo of ,mniaronfoti thwutoi nhviga meth taynnlnelotii agnmki ti rahrde by pitionng uoy ot 1 rawesn chocei utb gnniacgh a muiten iltdea to aekm ouy esnwar rw.ngo rO gsiun a aonmdr ssa tecomnenural orf a aseesdi ot avoid gimkna ti oot sleimp NGPS( = rvitfe"orplaei )NG"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1  
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2  
graciewacie9  Amen to the PSGN question. They got me on that one. lol +  
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +  
msw  *pointing +  
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1  
avocadotoast  this bs is prob why the question isnt on step 1 anymore +  


submitted by jambo2222(25),
unscramble the site ⋅ become a member ($36/month)

Is’t an csseoa.arotmo aScoram = huaogemtoesn .tsme s’It ni het gsle so inhtk how a VDT oseg ot glnu. maeS deia.

tinydoc  Perfect way to remember it. Thank you! +5  
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1  
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +10  
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +  
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +  


submitted by beeip(116),
unscramble the site ⋅ become a member ($36/month)

hiTs sha neeb a hgotu copenct orf me to g,et btu I ikhnt mI' liylfan :eehtr

Teh stem si esingibdcr irmypra anlarde cseif,nycuiifn or dni.A'sods

  • ATCH si gnibe -oddvucrepoer ot atselitmu the aendrsal to udprceo itos,colr but ehty acn't nep,osdr eierht ude ot ptyarho ro tsroedtiunc ,T(B nma:ituomeu RD4, )t.ce
  • Teh irsft 13 oinam icasd of AHTC acn eb caeldev ot orfm M,H-Sα hcihw utiamsslte eat,yenomcls gnacsiu rtemhtoyniipngpea
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7  
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10  
hungrybox  thank u for this answer +  
bilzcop  Ugh! I misread the question and chose ACTH :( +2  
cienfuegos  @bilzcop: same +  
cienfuegos  @bilzcop: let's never do it again, k? +1  
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2  
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +  


submitted by jotajota94(14),
unscramble the site ⋅ become a member ($36/month)

ghHi gsolecu dseal to eorm siuilnn opcdiunrot ni teh ufets llacre( hatt teh mhreono niilsnu is ib)oalacn -;-&-tg learg sfteu 19tg)(z,&b--;-ol spmebolr ni .albro

tinydoc  I thought that was technically a problem with the fetus and wasnt considered an obstetric complication. +3  


submitted by celeste(68),
unscramble the site ⋅ become a member ($36/month)

Teh nsnectoaollti fo tsomsymp sdnous klei ousutreb ecl.sisrso aacdriC mdyhmaboaro is a aerr inegbn tromu htat si yfenelutqr aoesasidtc wthi utrbeosu s.cosrelsi

tinydoc  Cardiac Tumors in adults -- usually myxoma Cardiac tumors in kids -- usually Rhabdomyoma ( ass. w/ Tuberous Sclerosis. ) --> its in the first aid rapid Review +12  
tinydoc  Cardiac Tumors in adults -- usually myxoma Cardiac tumors in kids -- usually Rhabdomyoma ( ass. w/ Tuberous Sclerosis. ) --> its in the first aid rapid Review +2  
arlenieeweenie  He also has seizures and pink-yellow papules, which I think they're trying to describe one of the characteristic ash-leaf or shagreen patches (doesn't sound like either of them to me lol) but that all points to tuberous sclerosis +  
pg32  @arlenieeweenie I think they are actually trying to describe angiofibromas that appear on the face in tuberous sclerosis, though I still think their description is pretty bad haha +5  
lovebug  Tuberous sclerosis. mnemonic : HAMAR(->Rhabdomyoma)TOMASS. FA19 page.513 +  


submitted by celeste(68),
unscramble the site ⋅ become a member ($36/month)

hTe ncioseoltlnat fo stomspym usnods ekli usertuob elc.rissso adCiarc moybamrhado si a raer nbeign ormut atht si leyurnfqte tiosdseaac itwh uoutrbes .iceslrsos

tinydoc  Cardiac Tumors in adults -- usually myxoma Cardiac tumors in kids -- usually Rhabdomyoma ( ass. w/ Tuberous Sclerosis. ) --> its in the first aid rapid Review +12  
tinydoc  Cardiac Tumors in adults -- usually myxoma Cardiac tumors in kids -- usually Rhabdomyoma ( ass. w/ Tuberous Sclerosis. ) --> its in the first aid rapid Review +2  
arlenieeweenie  He also has seizures and pink-yellow papules, which I think they're trying to describe one of the characteristic ash-leaf or shagreen patches (doesn't sound like either of them to me lol) but that all points to tuberous sclerosis +  
pg32  @arlenieeweenie I think they are actually trying to describe angiofibromas that appear on the face in tuberous sclerosis, though I still think their description is pretty bad haha +5  
lovebug  Tuberous sclerosis. mnemonic : HAMAR(->Rhabdomyoma)TOMASS. FA19 page.513 +