share email twitter ⋅ join discord whatsapp(2ck)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to uslme123’s page.
Contributor score: 57


Comments ...

 +4  (nbme23#39)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tish uetsqnio skeam on ssnee ot em. She has an erleytexm wol enngpoi rresspue ety sha gisns fo ndieesarc trinrnclaaai upssrree. diD hyet nmae ot put 32 mc 0???2????H??

uslme123  Standard lab values are incorrect, way to go NBME. +3
wutuwantbruv  I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg. +3
alexb  I lost a bit of time wondering about that ugh lol +1
mjmejora  I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high. +2
donttrustmyanswers  Does anyone have clarification on this question? +
llamastep1  Pseudo tumor cerebri can have normal ICP. Who knew +
tyrionwill  Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles? +1

 -14  (nbme21#20)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ryev uidtsp suqe.oitn eTh isvur swa lhineda -- abst agnh upidse wnhe eyth peles nda lo.rdo So it srpaesd ot het bianr yetldcir orfm the yoltfrcoa sytems aiv adgerretor tstonparr hoguthr .nvsree

niboonsh  yea, aeresol transmission via bat poop in caves +
len49  How do you know the virus was inhaled? Doesn't mention it. Moreover, non-bite/scratch transmission is extremely rare. +
makinallkindzofgainz  You get rabies by being bitten, not by inhaling it +
drzed  She was probably bitten by a bat; many times the bite is not recognized ('unapparent bites'), and thus the CDC recommends that even if you think you have been bitten by a bat (or that you COULD have been bitten), you should go and get active/passive immunization immediately. +
mangotango  Sketchy (and Zanki) says you can get rabies via animal bites OR aerosol transmission. In the U.S. it's most commonly through bats. It could also be through skunks (Western U.S.) or foxes/raccoons (Eastern U.S.). I remember this by thinking about how skunks smell so bad! +

 +0  (nbme21#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

VFAs' = ceesanrdi rccdaia pto .tTuuBU this isn't new rof thsi epn?rso I iewv shit sa a athre hatt ash afynlli bgenu to flia -- ddrseeeca eeifecftv liauycorcrt uomlve g;t-&- csearidne .RSV

uBt i segus uoy tanc' eavh B ferebo A -- ehwevatr \--

happyhib_  his bp was something like 130/50; with diastolic around 50 I figured he couldnt have increased SVR because his diastolic would be higher? +




Subcomments ...

unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hyW dowul it not be neimaa fo orhincc dseeias twih redeedasc umesr anrefisrrtn niatnn?ceorcot

lispectedwumbologist  Nevermind I'm stupid as fuck I see my mistake +1  
drdoom  be kind to yourself, doc! (it's a long road we're on!) +20  
step1forthewin  Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency? +1  
loftybirdman  I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency +22  
seagull  maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well. +  
vshummy  Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me... +9  
gonyyong  It's a B12 deficiency Ileum is where B12 is reabsorbed, folate is jejunum The blood smear is showing enlarged RBCs Methionine synthase does this conversion, using cofactor B12 +  
uslme123  Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia. +2  
yotsubato  Thanks NBME, that really helped me.... +1  
keshvi  the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption. +6  
sahusema  I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF +  
drschmoctor  Leave it to NBME to find the palest macrocytes on the planet. +4  
zevvyt  so i guess size is more important than color cause those are hypochromatic as fuck +  


submitted by lsmarshall(396),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nrdeie"bcPo nda sg-eihodh ellastcayis itbhini rbateonpsori fo iurc diac ni maorxpil uvtoodecnl betuul l(osa thsinibi eecrotisn fo inipnec."lli) - risFt idA 1029

uslme123  so ............... +8  
adisdiadochokinetic  So probenecid is the best answer here because they only specified acetylsalicylic acid, not the dosage, and low-dose acetylsalicylic acid has the opposite effect. +8  


submitted by welpdedelp(219),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nwhe a ellcifol s'dnote rtuurpe kaa( iolva)anuotn hnte ti illw romf a csyt.

uslme123  n premenopausal women, simple adnexal cysts (image 1) that are <3 cm in diameter typically represent normal follicles or may be a corpus luteal cyst (these may appear simple or complex) and may be considered a normal finding. Even when up to 5 cm in diameter, these simple cysts are so commonly due to normal menstrual physiology that the Society of Radiologists in Ultrasound (SRU) does not recommend follow-up when asymptomatic +7  


submitted by keycompany(301),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cna modobsey leesap lxpiaen owh ignnznooiin adntrioia sha na gnniiioz eftecf.

uslme123  "technically non-ionizing, can produce photochemical reactions that are damaging to molecules by means other than simple heat. Since these reactions are often very similar to those caused by ionizing radiation, often the entire UV spectrum is considered to be equivalent to ionization radiation in its interaction with many systems (including biological systems)." -- https://en.wikipedia.org/wiki/Non-ionizing_radiation#Near_ultraviolet_radiation I'm guessing NBME reads wiki lmao? +3  


submitted by sympathetikey(1265),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

dMa ta lyfems fro ihgngnca my eraws.n

tuFayl cligo eamd me rwdneo fi thnigti yoru adhe owdlu duecsa rdiesnace ICP ,so ilke a sgnciuh eluc,r uoy lwduo gte rcadinese auVgs evrne ctaiityv dan bymea adbcirydaar + ponoy.hinest uBt I usegs eht AASR tseysm duwol aveh aeetouctrdcn tath nda useadc tacrniotvicossno rove 42 ,suhor os loHocepymiv okshc si eiyeitdlnf eth ebts heoi.cc

ywAsla lhsudo go hwti teh uobsiov wrnsae :)

seagull  I had the idea that this was a neurogenic shock and increasing intracranial pressure could affect the vagus too. I think the question really wants us to go that direction. +13  
uslme123  The Cushing reflex leads to bradycardia! +4  
purdude  Wait I'm confused. I thought hypovolemic shock leads to an increased SVR? +2  
littletreetrunk  apparently, there's a thing called sympathetic escape that can happen after a while (i.e. he's been out for 24 hours): Accumulation of tissue metabolic vasodilator substances impairs sympathetic-mediated vasoconstriction, which leads to loss of vascular tone, progressive hypotension and organ hypoperfusion. +  
littletreetrunk  also also if he hit his head he could have loss of sympathetic outflow from a hypoxic medulla which could lead to vasodilation, which further reduces arterial pressure, but this was a hard one for me lol. I also put increased ICP wah. +  
catch-22  Any lack of sympathetic outflow/increased vagal outflow should reduce HR, not increase it. Further, you would expect brainstem signs if there was hypoxia to the brainstem. For example, if you had damage to the solitary nucleus, you wouldn't be able to regulate your HR in response to reduced BP. Since this patient has reduced BP and increased HR, this indicates that the primary disturbance is likely the reduced BP. He's also been in a desert for 24+ hours so. +3  
charcot_bouchard  In a patient who develops hypotension following high-energy trauma, neurogenic shock is a diagnosis of exclusion that is made after hypovolemic and obstructive cardiogenic shock have been ruled out! Plus Absent Bradycardia rules it out +2  


submitted by hayayah(1057),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iFlizrofemb is a ratbe,fi desu rfo rnweigol GT lvsel.e

mousie  I also chose Gemfibrozil too because its the best TG lowering drug listed but I can see where there might be some red flags for this drug in the way they asked the question... 40 year old obese woman with some upper abdominal pain ..... HELLO GALL STONES which is a common adverse outcome of Fibrates. +10  
uslme123  Well I didn't wanna give a fat, forty, female, that smokes a fibrate. So a statin, for me, was the best next option. +9  
whoissaad  Used same reasoning to choose statins. Fibrates are the main drug of choice for hypertriglyceridemia but given her symptoms, statins made more sense. Why do they do this to us... +  
roaaaj  what a tricky question! there are multiple factors should be taken in consideration.. she has triglyceridemia which put her in risk of pancreatitis, and most importantly atherosclerotic disease, and all of that would outweigh the risk of giving her gallstone. +  
paulkarr  Yeah I had statins selected initially because "statins are always the answer" but when I saw them stating first line "recently diagnosed with hyper TG" I figured this follow-up was purely to address that. So Fibrate is the best move. +2  


submitted by joker4eva76(25),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTe sqntiuoe smet si ieibscrdng a hdoiitcnmalro dassi,ee hcwhi monmlyoc espertn hiwt catilc osi.disac eehTr si na sierncea in aonbcaeri rosmf of yenegr icrtpoudon ygoyill.sc)s( Teh hctoiodnmrai era fuaylt, so thye n’atc use eht dne rpcoudt of olgysliscy eptyrv)au( ni .CTA sanedIt eprauytv si utdenhs revo nda si dseu yb DHL (tctleaa eyasdo)gnrehed to eaegretn ptuey.vra

dA:esi alRcle that DHL esus HNAD nda resengaet .+ADN ceicDfnyie of DLH acn elda to ossl fo toangerreein of ADN+ dan tbiniish oy.syllgsic

drdoom  ... pyruvate is shunted over and is used by LDH (lactate dehydrogenase) to generate lactate*. +3  
chris07  It's hinted in the answer, but I would like to clarify: max O2 consumption is decreased because O2 is consumed in the Electron Transport Chain, which occurs in the mitochondria. With the mitochondria not working, the ETC cannot work, and thus there is less demand for Oxygen. +17  
masonkingcobra  Mitochondria are the powerhouse of the cell +51  
uslme123  Apparently ragged red fibers are the result of coarse subsarcolemmal or intermyofibrillar mitochondrial accumulations.. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mitochondrial-myopathy +2  
mnemonicsfordayz  As @chris07 said, less O2 is being consumed in the ETC... but I also was thinking that the diaphragm is a muscle and if the mitochondria in her diaphragm are also not functioning, then she's not breathing properly and less O2 is being inhaled and therefore decreasing her oxygen consumption. Is that totally off base or am I just grasping at straws here? +  


submitted by uslme123(57),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hisT qesiunto esakm on senes ot .me Seh sah an mxrtleeey wol niogpne rrspseue ety has sisng of ndacsreei iaianltcnarr srrsp.eeu dDi eyth anme ot put 32 cm ?H0???????2?

uslme123  Standard lab values are incorrect, way to go NBME. +3  
wutuwantbruv  I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg. +3  
alexb  I lost a bit of time wondering about that ugh lol +1  
mjmejora  I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high. +2  
donttrustmyanswers  Does anyone have clarification on this question? +  
llamastep1  Pseudo tumor cerebri can have normal ICP. Who knew +  
tyrionwill  Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles? +1  


submitted by sajaqua1(524),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

,ticaenGsaomy pedsri g,tiamaoan nad mopagosdnihy (sa llew sa rpamal m)htreeay era lal ngiss fo sxscee rosgen.te Teh lreiv ni tsatpine hiwt picateh aseidse is aieipmrd dna os onncta eracl gstenroe iniytecflf.us Sxi 12 zo srbee daliy 72( ,oz or lahf a )golanl si too ,cuhm and is ngetsydiro ish levir.

uslme123  No hepatosplenomegaly, ascites, or edema through me off. We that being said, I shied away from cirrhosis. I thought that he showed signed of depression, so I went with the thyroid. But who's to say he isn't injection anabolic steroids?! +5  
catch-22  The principle is you can get liver dysfunction without having HSM, ascites, etc. Liver disease is on a progressive spectrum. +12  
notadoctor  He likely has hepatitis B/C given his history of intravenous drug use. I believe both can have liver dysfunction but may or may not have ascites, whereas the type of damage we would expect from alcohol that would match this presentation would also show ascites. +  
charcot_bouchard  For Ascities u need to have portal HTN. Thats a must. (unless exudative cause like Malignancy) +2  
paulkarr  For anyone who needs it; the FA photo is kinda burned into my mind for these questions. NBME has some weird infatuation with this clinical presentation.. FA (2019) Pg: 383 "Cirrhosis and Portal HTN". +4  
snripper  @paulkarr the problem was that the FA image was burned into my mind so without no ascites or edema threw me off of cirrhosis. +  
tyrionwill  cirrhosis doesn't present hepatomegaly, instead, the liver could be shrunken. +1  
avocadotoast  Cirrhosis (most likely due to alcoholism in this patient) leads to an increase in sex hormone binding globulin, causing a relative increase in estrogen compared to androgens. Cirrhosis doesn't always have to present with ascites and adema. I agree with @catch-22 that liver disease is a spectrum. This patient does not have ascites because his liver is still able to produce enough albumin to maintain oncotic pressure in the blood. +1  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ts’I teacu olcloah uminsnotopc os faytt ngecha more iek.lyl luaCrlle iwglsnel diaitncse haliccolo titesaihp iwchh risueqre crochni hloclao pcmutoonsni ee(S AF 0219 gp .538) tA etlsa s’ahtt eth oglic I edsu ot cpik yttaf gaech.n

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +40  
nc1992  I think it's just a bad question. It should be "on weekends" +16  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +20  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +12  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tsI’ eucta ocloalh coumnoistpn os tatfy cnhgea rmeo llyik.e ulerCall egllnisw eiaindtcs ochliloac titiphaes iwhch rsuqiree hrcinco alolohc utmsoonnipc See( AF 9102 gp 58.3) tA etsal tths’a eth iocgl I esud ot ikcp ayttf ghaec.n

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +40  
nc1992  I think it's just a bad question. It should be "on weekends" +16  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +20  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +1  
fkstpashls  some asshole in suspenders and a bowtie definitely wrote this q, as I've seen both acute swelling and fatty change be used to describe one episode of drinking. +12  
msw  short term ingestion of as much as 80gm of alcohol (six beers) over one to several days generally produces mild , reversible hepatic steatosis . from big robin 8th edition page 858. Basically to develop alcoholic hepatitis with cellular swelling etc you have to have sustained long term ingestion of alcohol while steatosis can develop with a single six cap . hope that helps . ps i got it wrong too . +1  
msw  six pack8 +  
mariame  After even moderate intake of alcohol, lipid droplets accumulate in hepatocytes increasing with amount and chronicity of alcohol intake. (...) Fatty change is completely reversible if there is abstention from further intake of alcohol. The swelling is caused by accumulation of fat, water and proteins. Therefore this will occur later. From big Robins 9th pg842. +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

My tuhothg asw tath siht si nmdieec shutpy ofrm eusol n[o a s,rueic rhas ynol on eth t,rukn aaaltrihr]g

uhhT?gtso

otsHen,yl vnee fi it is ugdnee swa hte msae nesawr ughsr imeoj

uslme123  I did too ... but It looks like the timing fits better for denge. +  


submitted by liltr(22),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I hooecs VPM ,oto but htis ’seaniptt naim ypostmm si cuogh olny diurng icrs.exee isTh is emor ieiavctndi of sieedxrec odeistaacs smta.ha uoY lcoud ese sshrostne of trheba in VPM gidrnu erexsiec, tub socgonih MVP aevlse the uoghc ecnoautcund rf.o

.ooo.   I agree! Also, At the end of the stem, the question is which of the following best explain the patients symptoms? Not physical exam findings. Since this patient is coming in with a chief complaint of SOB while playing sports exercise induced asthma is the best choice. Hopefully that helps. +14  
uslme123  I mean... couldn't increased BP during exercise worsen his MVP and give him SOB? +  
uslme123  (by causing slight regurg) +1  
yotsubato  "Lungs are clear to auscultation" +6  
sahusema  But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for? +  
cienfuegos  I incorrectly chose malingering and am wondering if the fact that he presented (although it doesn't state who brought him in/confirmed his symptoms while exercising) makes this less likely despite the fact that he clearly states "I don't want to play anymore" which could be interpreted as a secondary gain? Also, regarding the MVP, I'm wondering if the fact that these are usually benign should have factored into our decision to rule it out? Thoughts? +2  
cienfuegos  Just noticed that he has FHx, game changer. +1  
kimcharito  clear lungs, they try to say no cardiogenic Pulm. edema, means is not due to MVP shortness of breath while doing sports and no shortness at rest makes me to think more asthma induced by exercise) +1  
pg32  Isn't exercise induced asthma usually found in people running outside, especially in cold weather? I feel like that is how it is always presented in NBME questions, so this threw me off. Not to mention the MVP. +  
happyhib_  it took me a little; the FHx really pushed me to exercise induced. I was also looking at malingering but there wasnt a real reason to push me to this (as a doctor it would be sad to be like hes faking it becasue he doesnt want to play sports with out being sure first; led me away because there wasnt enough pointing there). Also MVP could be slightly benign and is very common and usually no Sx and his lungs were clear as was rest of exam. All pushed to Asthma +  
mittelschmerz  I think MVP on its own shouldnt cause SoB with cough (in a question, I'm sure it could in the real world). In the world of NBME questions where you need to follow the physiology perfectly, you would need some degree of MR that lead to LV dysfunction/vol overload, and theres no pulmonary edema nor an S3 that point us towards that. Malingering would have to be faked for gain, and theres no external gain here or evidence that he's faking symptoms. You would also need to r/o physical illness before diagnosing malingering, which hasnt been done. Cold weather is certainly known for exacerbating EIA and are the exam buzzwords, but any exercise can absolutely be a trigger +2  


submitted by liltr(22),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I esohoc VMP oto, ubt htis nt’sapeit ianm mpsotmy is cgohu ynlo nudgri .ecxisree Tihs is emor tvieidanic of exrsdicee saatieocsd taam.sh Yuo ldouc ese torssnesh of heratb ni VMP grindu sece,erxi btu nisohgoc VPM esvael eth guhoc etoccunnadu rof.

.ooo.   I agree! Also, At the end of the stem, the question is which of the following best explain the patients symptoms? Not physical exam findings. Since this patient is coming in with a chief complaint of SOB while playing sports exercise induced asthma is the best choice. Hopefully that helps. +14  
uslme123  I mean... couldn't increased BP during exercise worsen his MVP and give him SOB? +  
uslme123  (by causing slight regurg) +1  
yotsubato  "Lungs are clear to auscultation" +6  
sahusema  But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for? +  
cienfuegos  I incorrectly chose malingering and am wondering if the fact that he presented (although it doesn't state who brought him in/confirmed his symptoms while exercising) makes this less likely despite the fact that he clearly states "I don't want to play anymore" which could be interpreted as a secondary gain? Also, regarding the MVP, I'm wondering if the fact that these are usually benign should have factored into our decision to rule it out? Thoughts? +2  
cienfuegos  Just noticed that he has FHx, game changer. +1  
kimcharito  clear lungs, they try to say no cardiogenic Pulm. edema, means is not due to MVP shortness of breath while doing sports and no shortness at rest makes me to think more asthma induced by exercise) +1  
pg32  Isn't exercise induced asthma usually found in people running outside, especially in cold weather? I feel like that is how it is always presented in NBME questions, so this threw me off. Not to mention the MVP. +  
happyhib_  it took me a little; the FHx really pushed me to exercise induced. I was also looking at malingering but there wasnt a real reason to push me to this (as a doctor it would be sad to be like hes faking it becasue he doesnt want to play sports with out being sure first; led me away because there wasnt enough pointing there). Also MVP could be slightly benign and is very common and usually no Sx and his lungs were clear as was rest of exam. All pushed to Asthma +  
mittelschmerz  I think MVP on its own shouldnt cause SoB with cough (in a question, I'm sure it could in the real world). In the world of NBME questions where you need to follow the physiology perfectly, you would need some degree of MR that lead to LV dysfunction/vol overload, and theres no pulmonary edema nor an S3 that point us towards that. Malingering would have to be faked for gain, and theres no external gain here or evidence that he's faking symptoms. You would also need to r/o physical illness before diagnosing malingering, which hasnt been done. Cold weather is certainly known for exacerbating EIA and are the exam buzzwords, but any exercise can absolutely be a trigger +2  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I get htat tshi swerna ohceic si eth toms bcaliaem ranew.s

utB oynhslet eth ayw tyeh dseak teh neqositu "ti is omts oapairtprpe fro eth nahiispcy to rddsase eth sieus fo a ndigeef ubte in hicwh of hte nololgifw n"nermas

My agrsnneoi w:sa .eorleb.wl.fe eth myialf acn neev ibegn ot aegru awth od od n'tod uoy heva ot orseopp a ilmdace a/egamaerenentmtntmt stagrety? hhciw is ywh I tenw wtih "emocdmren a .b.e.u"t

home_run_ball  Like what is the learning objective of this question? On first aid if you go by the Surrogate decision maker priority: you do spouse first...so like wtf nbme? +13  
uslme123  I think it's because there isn't a legally appointed health care surrogate in this case. The family hierarchy is only an "ethical suggestion." +1  
nala_ula  According to first aid, there is an order to who makes decisions when the patient is not able to and hasn't left any directives. My issue was the same as home_run_ball, since they specifically asked about the feeding tube and not "who is supposed to make decisions now" even though that is also warped since the spouse has precedence. +1  
badstudent  If you look at the wording for the rest of the recommend a tube option ("because feeding will be more efficient and prevent starvation") it seems like you would be persuading the family to move forward with a feeding tube for their ease and convenience rather than proceeding with a feeding tube to avoid the possible dangers of an aspiration pneumonia. A family that is visiting daily likely doesn't mind any challenges associated with feeding. Instead it would be more important to recommend a feeding tube to avoid risk. Dumb questions for sure, just wanted to explain why i ruled that answer out. +  


submitted by hayayah(1057),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aesC fo .iilrolrsesecsotaor

iaypcpslrHte seossorrleltoricai nvlvosie ehngikintc of slsvee llwa by lpreyhsiaap fo shmoto usmcel -nnos'ni(kio anepr'cepa)a

  • sqeennCceou fo mainlagnt rnnohsiyetpe /0g&t(218;01 w/ cateu gdo-raenn aaem)dg
  • lsRuset ni ercdued evlsse rebilac ihtw nraoeng-d iemciahs
  • aMy edal ot dfriioibn nirossce fo eht evessl lalw wthi reahhmo;reg slcllascyai suecsa cueat reanl uiaflre FA()R thiw a tsithreacircac tee'al'tf-ibn nppreeaaac
masonkingcobra  From Robbin's: Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture. +  
asapdoc  I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +16  
uslme123  I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +  
hello  The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +23  
yotsubato  hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies) +7  
smc213  Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names. Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls. http://www.medlink.com/article/fibromuscular_dysplasia +1  
smc213  *sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries. https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd +1  
momina_amjad  These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN! Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years) If it was the consequence, the presentation is still not classical! -_- +1  
charcot_bouchard  Poor controlled HTN is the cause here +  
charcot_bouchard  Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +  


submitted by hayayah(1057),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

cesuavnalroR adesesi si eht mots omnmco seuca of °2 NTH in tldas.u naC be /dt meihiacs omrf nrela eissosnt ro aslcrrivamuoc d.seesia anC hare arlne utsrbi arlalte ot lubiscumi.

Mani ascseu fo laren eraryt o:estnsis

  • lstAioerhccetro qloupleaixpsr—am d1r/3 fen alor ary,etr usylalu ni edolr ,almes sermosk.

  • oumrFisrbulca tlsdaaasiyp—ldis r32/d flren ao yrtare ro ametlnges en,srbhac ls yuauluygon ro -meedagddil meef.sla

aLb svelau daesb fof:

  1. oestnSis aderecsse lobdo wfol to usmglrul.eo
  2. rJrleulagtmoaux pprasatua A)G(J erssnpod yb ngcrseiet ,enrni ciwhh tonrvsce angieeognnsnoit ot agiintsnnoe I.
  3. nnostinegAi I is onrcedetv ot naninioetsg II (A)TII yb ninoeatnigs ecgtrnivno ezmnye CEA( -ni- sgnu)l
  4. IIAT arsesi dbloo esserpur yb ()1 rtocciangtn taeorlrira mtoosh c,umles rnganiesic atlto hepierpalr rcnitsseea and (2) tgprnoomi lanerad raeelse fo l,doteoanrse hhciw scneseria braoitonsrep of osuidm ewr(he Na+ gose 2HO iwll wollof) in hte asiltd nocudleovt lubute innadx(pge almpsa uo.em)lv Can dale to eaokphylmai e(nes in teh albs ofr sith uoti)qsen
  5. eadsL ot THN wtih rcseednia msaalp irnne dna ilaaltrnue oytahpr du(e to lwo obold lwfo) of teh effecdta ek;dyni nhierte ateefur is nees in rapiyrm senhinroytpe
uslme123  So both causes would result in increased aldo and MR is the only way to differentiate the two? +2  
hello  @USMLE123 I think both are causes of renal artery stenosis and that could be seen via MR angiography. It is asking what could help DIAGNOSE this patient -- and her most likely cause of the findings is fibromuscular dysplasia. So, yes, MR angiography would look different for the 2 different etiologies and thus could can be used to differentiate the two from one another. However, epidemiologically, we are looking to diagnose her with the suspected most probable cause. +8  
yotsubato  @USLME123 I think measuring Aldosterone is an incorrect answer because you already know its increased due to low K. Knowing she has high Aldosterone wouldnt provide you evidence for a final diagnosis. +4