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Contributor score: 110

Comments ...

 +3  (nbme18#25)

Like t123 said, I think the key to this question was to rule out the other answer choices as they would not have normal stool. I found this article that essentially breaks down GI disorders in diabetes into gastroparesis and intestinal enteropathy. These complications and their symptoms are often caused by abnormal GI motility, which is a consequence of diabetic autonomic neuropathy involving the GI tract.

Intestinal enteropathy in patients with diabetes may present as diarrhea, constipation, or fecal incontinence. The prevalence of diarrhea in patients with diabetes is between 4 and 22 percent.4,5 Impaired motility in the small bowel can lead to stasis syndrome, which can result in diarrhea. In addition, hypermotility caused by decreased sympathetic inhibition, pancreatic insufficiency, steatorrhea, and malabsorption of bile salts can further contribute to diarrhea. Abnormal internal and external anal sphincter function caused by neuropathy can lead to fecal incontinence. When evaluating a patient with diabetes who has diarrhea, drug-related causes (e.g., metformin [Glucophage], lactulose) should be considered.

cbreland  I agree, felt like all the other choices would have something odd in the stool studies +
jurrutia  Orthostatic hypertension implies sympathetic dysfunction. Loss of sympathetic input causes dishinibition of intestinal motility. +1

 +0  (nbme18#30)

This pt clearly has a pituitary adenoma given the bitemporal hemianopsia. The most common functioning pituitary adenoma is a Prolactinoma, so you want to be very sure before not picking prolactin. However, according to FA, "Prolactinoma classically presents as galactorrhea, amenorrhea, and decreased bone density due to suppression of estrogen in women and as decreased  libido, infertility in MEN. No decrease in bone density in men. Thus, given the compression fractures in a male and weight gain, the answer has to be ACTH.

 +0  (nbme23#5)

phase 2 = moderate number of patents with the disease of interest. Assesses treatment efficacy, optimal dosing, and adverse effects.

phase 3 = LARGE number of patients randomly assigned to either treatment group or the standers of care . Compares the new treatment to the current standard of care to see if there is any improvement.

FA19 p 256

usmile1  standard* +

 +1  (nbme23#26)

main points from this question:

  • bilateral renal bruits in a patient with HTN = Renal artery stenosis --> in a young woman, it's most likely Fibromuscular dysplasia

  • RAS can present in up to 1/3 of patients with malignant HTN or hypertensive emergency which is how this patient is presenting, evidenced by the HA, blurred vision, and papilledema.

  • renal artery stenosis → decreased renal perfusion → compensatory activation of the renin–angiotensin–aldosterone system → secondary hypertension

 +0  (nbme23#27)

Fixed wide split S2 is Atrial septal defect obvi.... But also ASD is associated with an early systolic ejection murmur heard at the Left Upper Sternal border (pulmonic area) the systolic murmur is not due to pulmonic stenosis

 +5  (nbme23#33)
  • A) acoustic neuroma = sensorineural
  • B) lesion of cochlear nuclei
  • C) Loss of hair cells = Presbycusis (age-related progressive bilateral SENSORINEURAL hearing loss)
  • D) Meniere dz: triad of SENSORINEURAL hearing loss, vertigo, tinnitus

E. Otosclerosis: Slowly progressive conductive hearing loss that most commonly affects ONE ear, with the 2nd ear affected in ∼ 70% of patients as the disease progresses... [this explains the patient's complaint of worse hearing on the right]

  • pathophys: Abnormal bone growth of the bony labyrinth. Stapedial otosclerosis (most common site) → fixation of stapes to oval window → conductive hearing loss
  • leads to progressive CONDUCTIVE hearing loss because the ossicle's ability to vibrate becomes increasingly limited.
  • A unique feature that I have seen come up often on question is that the patients are able to hear better in noisy rather than quiet surroundings.

 +0  (nbme23#39)

In patients with IIH treated with acetazolamide, the inhibition of carbonic anhydrase in the choroid plexus results in a reduction of CSF production and flow. The acid–base status of the patient may also alter the distribution of acetazolamide in the CSF and brain, but its effect on the CSF flow is secondary to that mediated by the choroid plexus. Based on the pharmacology and distribution of acetazolamide and carbonic anhydrase in the brain, the theory that emphasizes the effect of acetazolamide on CSF production in IIH is most likely primary and direct, and weight loss, when recognized as a factor, is secondary and indirect, and frequently the result of toxic doses in excess of the amount needed for complete enzyme inhibition.

 +0  (nbme23#26)

classic cause of secondary HTN in young or middle aged women. presents with "beads on a sting" appearance and can occur in both the renal and carotid arteries.

 +6  (nbme24#13)
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smuaeornMb rnetyphopha adn amiinlm nghcae essedia can eb eyails duler uot as thye ear hrnticeop orsril.doaustusylnitenieTtb m hsripeitn (kaa eutac eirtttsnaili hiest)rpin nac eb urdle tou sa ti scause WCB stasc ton CBR as ense in ihts lra aplyPi sinresoc - retieh ash on sacst ro ti ightm wohs WBC tascs btu ton RBC ecbeasu hte beropml is nto in het eum.orllig

atlbe fo ramueltcnoen no agep 285 lxneaspi hatt rivrietpleoaf usjt emans yerph eculalrl e.lgoilurm G nvie eth tesipnta riohyts of eros hartto wto ekswe ao,g nwo repgneistn hitw ericthiNp Smndeoyr with CRB ac,sst plrviaefteior rseulieonothipglrm si teh lyno sberaeaonl n.weasr

medguru2295  This was my precise login. I wound up getting it by elimination. But, didn't like that answer as its uncommon in small children and the child seemingly had no risk factors. +
thotcandy  @medguru2295 FA says it's most commonly seen in children and it's selflimited vs adults is rare and can lead to renal insuff +
peqmd  They're using the broad category for PSGN, Pathoma pg 130 IIC. PSGN = Hypercellular, inflammed glomeruli on H&E stain and cross referencing the FA table mentioned hypercellular => Proliferative. +5

 +8  (nbme24#11)
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morf -oypme&;nasoBddrBa i Aotcr tnisseos edasl ot Sceyn,op ,gnAian nda Lfte tahre ycaniu.prfeleS o si deu ot rufalei to eesricna draccia uptuot ued ot eraescnid oaaferdt.l ngni aA is deu to rsacieend ELDPV ihcwh esadl to ecsdeedar ayonrcor lbdoo wlof. Adn felt rtahe elaifru is deu ot sraencdei VDE.PL

cbreland  Great, same thought process, murmur made me think of aortic stenosis, supported by the LV hypertrophy in stem. Then you have syncope during exercise because the heart is not able to keep up with the demands of the body +

 +1  (nbme20#19)
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sode naeyon wnko ahwt the utrrusect E is gtinniop ?ot

thomasburton  Not sure looks like it might be free ribosomes or other such small cytosolic structure (I picked E too, thought B looked way too big!) +
targetusmle  same here!! marked e thinking of it as a mitochondria +1
msyrett  Glycogen Granules! They are not membrane bound and float freely in the cytoplasm. +4

 +9  (nbme20#41)
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fI uyo oolk at dolrwU teisuoqn ID 21929 ti ash a lworufned tnnapxailoe rof .tihs If htye sreah hte sema eps,etopi it lwli heav a nwaodwrd f s.loepI tyhe erhas onne of teh msea p,etiosep het elin lliw eb zrnoaohlti srcaos het pgahr iin(aindtcg on gchena sa eth unamot fo Y eddad sisaceer)n

eacv  omg YES!! thanks Uworld I got it correct! exactly this qx asked the exact opposite thing! Hahaha I loved it !! +8
pg32  Even after reading the UWorld explanation, I am still not sure how the answer that reads, "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not..." is incorrect. Based on the graph, I don't see a way we can rule out that answer choice and it sounds more likely than both X and Y having the EXACT SAME epitopes. Can anyone explain? What would the graph look like if the quoted answer choice was correct? +2
69_nbme_420  If you make up an example with numbers, it really helps! “Protein Y expresses all of the epitopes expressed by X, but protein X does not express all of epitopes expressed by Protein Y.” If we say protein Y has epitopes 1, 2, and 3. Then Protein X has epitopes 1 and 3. Then we can clearly see the relationship the AMOUNT of Y added relative to X bound would NOT be linear. Stated another way – we need an exponentially more amount of Y to COMPLETELY unbind X and therefore there would not be a one to one depiction in the graph Similar logic applies for the answer choice that states "protein X expresses all of the epitopes expressed by protein Y, but protein Y does not express all of the epitopes expressed by protein X. E.g. If protein Y has epitopes 1 and 2. And protein X has epitopes 1, 2, and 3. Here again, we have satisfied the answer choices condition, and no matter how much we increase protein Y, protein X will still have epitope 3 bound in this case. +4
69_nbme_420  Just to clarify for the first scenario: We have 3 epitopes on Y, and 2 epitopes on X. That means, assuming the epitopes are all present in equal amounts, if I add 300 grams of protein Y to the solution - only 200 grams will bind protein X. AND ONLY 200 grams of protein X can be unbound. Hope the numbers help! +
fruitkebabs  For anybody still stuck on "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not," although this statement may be true, there is not enough information in the question to prove this. We know for fact that because the Amount of labeled X bound reaches 0, at the very least, protein X and Y express the same epitopes since at a certain concentration, Y is able to completely displace all X from the system. This doesn't exclude the possibility that there may be extra epitopes on Y, but it doesn't prove it either. +2

Subcomments ...

submitted by snoochi95(2),

How come you couldnt say "I dont know, but the oncologist will be seeing you later today"? Is it because technically you are ~lying~ to the patient?

drdoom  Not “technically” but actually! To say “I don’t know” when you *do* know is as lyin’ as it gets! Just remember, before a state issues you a license to practice medicine in their backyard, they look to the National Board of Medical Examiners and ask, “Should we trust this person to practice medicine here?” The NBME is in the business of telling states, “Yes, we believe this person knows enough to practice morally and competently.” Answer ethics questions with this in mind. +5  
pseudo_mona  Besides technically lying, it also probably isn't a good idea to drop the word "oncologist" to a patient before they hear they have cancer, especially as a student who can't answer any further questions about the biopsy results. +12  
usmile1  @pseudo_ shit I just realized that telling them that the oncologist will be seeing them, is essentially telling them they have cancer. Additionally, you can't lie and say you don't know. no Idea what I was thinking when I took this. +9  

mousie  Caudal = Bottom of the SC = failure to close = spina bifida and Rostral = top of SC = failure to close = Anencephaly +10  
powerhouseofthecell  I'm confused. In first Aid doesn't have meningomyelocele as failure of caudal or rostral pore to close. Is the answer Cadual because in this patient specifically, his condition takes place on L2-5 which is more caudally? +2  
usmile1  its a neural tube defect aka failure of neural tube closure +  

submitted by kentuckyfan(43),
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Nieotc tath )A scnoonctiiBrnh,tcoro )B arGaldunl rt,cienose D) ,istssilreaP )E aioldatVnios of iskn rea all urned atmsyhpatepraci .rlocotn

ehT olny aitpmytcseh olonrtc is thaer art,e hhciw ldowu n.iseearc

drzed  Vasodilation of the skin is under sympathetic control as well -- beta-2 receptors when stimulated cause vasodilation (via increase of cAMP in vascular smooth muscle). The key is recognizing that stimulation of a GANGLION of the pns will lead to release of NOREPINEPHRINE, which preferentially stimulates alpha-1 receptors. Those receptors will cause vasoconstriction. If the question asked what happens when you stimulate the adrenal medulla, the answer would be (potentially) vasodilation. This is because the adrenal medulla releases EPINEPHRINE which preferentially stimulates beta-1/2 receptors. +8  
jesusisking  @drzed Awesome explanation except I think sympathetic response induces vasoconstriction in the skin though vasodilation in the muscles! +1  
usmile1  @jesusisking yes you are correct! α1: vasoconstriction in skin and intestine ; β2: vasodilation in skeletal muscle (transmitter: only epinephrine!) +  

submitted by usmile1(110),

phase 2 = moderate number of patents with the disease of interest. Assesses treatment efficacy, optimal dosing, and adverse effects.

phase 3 = LARGE number of patients randomly assigned to either treatment group or the standers of care . Compares the new treatment to the current standard of care to see if there is any improvement.

FA19 p 256

usmile1  standard* +  

submitted by seagull(1583),
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Tshi si a cpani ak.tatc nvHytonalitirepe soprd 2OCp lgidean to a syriteorarp ilsa.klsao p2o is aterleyilv utacfdnefe tno'd( aks em o)?wh

sympathetikey  Yeah haha I had the same conundrum. +  
sajaqua1  If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected. +23  
imnotarobotbut  lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol +2  
soph  Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances). +2  
charcot_bouchard  PErioral tingling- due to transient hypocalcemia induced by resp alkalosis. +1  
rainlad  I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2 +1  
usmile1  adding onto Charcot_bouchards comment, I found this: Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany. +3  

submitted by patricknguyen(-12),
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O yetp etinptas have rrempfo IgG ntia A nait .B otN MgI obryotts"ehiin aSdl tfaer anfio"stnrsu aeirs pu ounscsiip ofr p.laayxainsh on gisn fo ;eihst-moylg&s vrfoa sanlyaxhiap eud ot AIg de=t&fyicge;icn roffetce cell si staM slcle

eclipse  they have IgG and IgM +2  
kpjk  if it had been anaphylaxis- there would have been urticaria and pruritis +2  
usmile1  wow I've never seen an answer on here be just so wrong +  

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FA 9,1 pg. 503 - May ees tlrMai ioentgrtaigur deu ot iiepdmra ltmiar aevlv srec.luo

I ayswal fndi ti tntorpima to reebemmr ttah ecno uoy etg oglayothp rsemoehwe ni het ,treha yuo acn xtpeec yglatphoo eeeywehrvr hdenib it, voer .imte

So in tsih aesc you attrs wtih HCM g&;t- ailtMr gergur g;&t- LA ioailtnd ;g-&t Ab.if t;-&g AL/VL iarflue t&-;g Pmlu edmea -g&t; RHF t&-g;

t'Is salywa a rmeatt fo t.mei

mario  wrong q bro @ maxillarythirdmolar +  
usmile1  nope right question. he just went even deeper into the answer. +  

submitted by seagull(1583),
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sTih tanipte si ipgirtnp l.salb Beertt od a ugrd enscre iwhhc semse uso.vobi

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +43  
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5  
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1  
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2  
charcot_bouchard  Lol. I got the right answer but took long time +  
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +  
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +  
targetmle  why is there basal ganglia hemorrhage? +  
dul071  Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1  
usmile1  basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +1  

submitted by sajaqua1(535),
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ueSrm ncsskies is a pTey 3 iievtrssyiyentph ctneo,air ni hihcw eht bdoy rosdsnep to einnciatg cleamid ncsestuasb dna csdpoeur esbdioniat. sTeeh snitboaide in iluoirnctca hetn nbdi ot het nniieacgt durgs dan est ffo eht melotcmepn aeds.cca dRimethauo istirahrt is oasl a ypTe 3 snieervyhiiyptts an.ritoce

)A spoostpAi fo p-aohgrscema oosstaipp is lelryngae tno a tpey of stneisvithyieryp aec.onitr B) tMas lce nrelata-undoig iths is ptra fo a ypeT 1 sieniesyptyrtvih tixeaioh,saplcy/rnnaa ni hwhci amts cesll dbin EIg on rheit u,creasf and EgI bidnngi ot eht tagetr gneiatn ncidues a ctfonmoairnlao change in teh EIg ttah stse off tmas lcle leair.ngtdonau C) arNtlau liKrel lCel ki-ilgnl lysap a yriavet fo seo,rl ncdnigilu erancc niopusssrep dna inrtuceotds of vylaril efdicten sec.ll fI tyeh ylpa a oerl in tishypiyireevt,sn it si arpt fo Tepy 2 HRS ni ichwh tyeh loduw dsnreop ot gI on teh clle sau.ecrf E) lhWee dna lfrea es-roatinc Tsih is osal a Type 1 HR.S

meningitis  I didn't pick this one because I thought Serum sickness was too systemic and RA was a more localized Type 3. Again, im overthinking things. +  
youssefa  Goljan: RA is a mixed type III and type IV immune reaction +7  
dinagohe23  I though NK cell killing was similar to T cell so and RA is also Type IV +5  
nephcard  ,blll sdouof +3  
usmile1  NK cell killing would be a type of innate immunity, not similar to memory T cells. because they did not give an example of a type 4 HSY, the answer must be serum sickness. +  

submitted by nlkrueger(44),
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hwy snti,' %"0 bslsat on het riapeprehl esra"m ?gihrt is this the itshniiigngsud urtufe rof cueat mee?iuakl

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  

submitted by m-ice(340),
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esCa sriese is a tydus in cwhhi eth rercehasrse speetrn het ythisor dna ettemarnt fo a lsaml pougr fo iamilsr stt,apine thotwiu reginbdcis yna oignrts itno usgrpo or daznoroi.tinam

drmomo  only 3 patients +1  
usmile1  uggghhh not in FA ... +  

submitted by dragon3(12),
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nCa aeynno ealpnix hwy ibtacear si ruleti,snpoh ni/uragvifl are metp?hlsyoyc I kown htsi is a tnldeanumfa

lolmedlol  i think neutrophils (in addition to lacking granzymes and perforins which are used to kill viruses and fungi) dont recognize intracellular things; viral antigens needs to be processed and presented on an MHC for the lymphocytes to recognize +7  
usmile1  also neutrophils are only seen in acute inflammation. This pt has longstanding inflammation which is associated with monocytes, lymphocytes, macrophages, plasma cells. +4  
usmlecrasherss  Neutrophil come and goes quick like day or two , after that rest of immune cells take care +  

submitted by m-ice(340),
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Tshi oyb ash egiinitnsm udaecs by epStr onpemuneai, the tmso omnmoc eucsa of iocfieustn itgsinimen ni ange.erl ehT viacnce rof tpreS mpeoun is a sdphaecircaylo pinrote noetcjgua vcianc.e hTe orthe raomj bareitca hitw a canveci leik iths si H. eieulnnafz.

usmile1  also the meningococcal vaccine! +3  

submitted by famylife(94),
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Pseha III aliClinc iTlra e(rp AF 120,9 p. 2:)56 garLe renmub of tesntapi ndrlyaom gdsaeins theier to eth teaetmntr rneud gennitaitisvo ro ot eht aasdrntd of cear or( l)p.oebac

usmile1  also just to verify, there is no such thing as phase 0 right? +  
madojo  Not that i know of or is in FA +  
llamastep1  I've heard animal testing is called phase 0. +3  

submitted by nwinkelmann(297),
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Dsoe noynea veah a ogdo oaipelxnnta ofr yhw dcreseead slevle of hnibini is gon?rw From ym ddgrnnint,uesa hininbi dna iiatncv wrok teoerg,ht ni htat ihnibni sdibn dan solkcb aiitncv lnidgae to dcaedeers dfcabeek no hhmltasoupya and acivnti nasseiecr SFH nda HGRn n..pdctoiuor u,hts fi yuo rasdeeec hinnbii nhte uoy luwod heav ednrseaci naitciv ichhw udwol adel to nsereidca GRnH nda F,SH gh?tri I noudf noe ilrtace klanitg uobta ti ni esrgadr to r,pbyetu ubt ti msese ot be a tethssyipoh/on renfdomic at stih ..p.iton si ttah hyw? Btu t.s.i.ll how od I ulre it out no a ?stte

yb_26  I also picked decreased inhibin. may be it was one of the "experimental questions", which are not even counted on the real exam +1  
artist90  Inceased FSH will lead to spermatogenesis and spermiogenesis NOT Increase in Testosterone which is causing increased Height of this pt +6  
artist90  Inhibin B only has negative feeback on FSH not GnRH. see the diagram on the topic of semineferous tubules in FA. Testosterone has a negative feedback on BOTH LH and GnRH +1  
usmile1  Kind of like how nocturnal pulsatile GNRH release occurs during sleep to stimulate growth (FA page327), the same thing happens for puberty. Pg 325 in FA, "pulsatile GnRH leads to puberty and fertility." It doesn't explicitly state during sleep, but pulsatile release of GnRH leading to pulsatile release of LH and FSH will lead to puberty. Puberty starts in the brain, its onset really has nothing to do with decreased inhibin levels which happens in the testes. hope that makes sense! +3  
sars  From what I understand, inhibin is only released by granulosa cells when FSH levels are high. This is a boy. Next off, this question is about puberty, which is due to pulsatile GnRH leading to large amounts of LH and FSH, leading to large amounts of dihydrotestosterone (males) and estradiol (females), and eventually secondary characteristics of puberty. The increased pulse of estrogen and testosterone leads to GH release, which is metabolized into IGF-1 in the liver. This leads to long bone growth from what I understand, which is not much. +  
cassdawg  @sars inhibin B is also released by sertoli cells in males and will feedback to inhibit FSH release, its not just a female thing. Also, there is actually an inhibin B pubertal surge in both females and males that corresponds to maturation of the granulosa and sertoli cells, respectively. Hormones are wack. +  
j44n  I think youre just supposed to see that he's starting puberty and know that the nocturnal pulses are involved +  

submitted by m-ice(340),
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ihTs wnmao sah a tol fo sisgn ahtt niotp ratowd na ltnaiienst iptsriaca :oecinnfti treenc eralvt ot puaaP Nwe iGeu,na uhgoc dan valrelao tiei,artsfln hgih poelihnosi n,ucto nda a ostol lspaem atth sha a owmr ni .ti osMt kellyi eht ipntate sah a gstrileodynSo eonicfint, as isht is the leinttasin tsaarpie ahtt swhso lvaar on olots yaBiscall lal niaisetltn srpatiase can be dtrteea hwit eaelndoBz sgdur, csuh sa eoaanizhTebd.l tuenalqzaiPr uldow eb moer rippraapeot rof a romw or veilr kfuel .cnniifeot

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +9  
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +10  
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +5  
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +2  
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +2  
jurrutia  When in doubt, pick a bendazole +  
jurrutia  When in doubt, pick a bendazole +  

davidw  If the Infarct was on the right side they you would have a decrease in PCWP +  
usmile1  yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up. +6  

submitted by m-ice(340),
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toiMpolsros is a alngoitdarpsn naaglo GE)P(2 that ctas on eth omtacsh to eoortpm ucusm itpeorntoc of teh tshmaoc ,lgnini ubt saol atsc ni the utesur ot aorecuegn otnacncrito, chhiw ekams it lefsuu for

usmile1  perfect except it is a PGE1 analog, not 2 +2  
krewfoo99  PGE2 will increase uterine tone (Pg. 270 FA 2018) +  
drmohandes  Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +  

submitted by jus2234(20),
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The gaprh whsso a caeredse in nimelcapoc fo the .sguln fO hte n,poitos deuffis lpuymnoar riofssbi si het nloy cehoic hatt is an eexmalp of a vsitreeirct nlgu sidesea hhciw udwol ereedsac cleimncpao

nor16  asthma = emphysema = chronic bronchitits, obstructive. leaves 2 out of 5... +4  
usmile1  Common causes of decreased lung compliance are pulmonary fibrosis, pneumonia and pulmonary edema. So yes pneumonia could possibly cause the decreased compliance shown, but the vignette says the patient has "9 month history of progressive SOB." That couldn't reasonably be pneumonia, leaving diffuse pulmonary fibrosis as the best answer. +10  

submitted by mousie(220),
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sI 54 miuetsn oto lgno ot be alycnhapicta nda odulw hte enaebcs fo hsar rrcaiitua,( ti)ruursp OR i?aycatalnchp

hayayah  Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours. (pg 114 of the 2019 FA has a list of them ordered by time) +8  
hayayah  (also allergy / anaphylactic presents with more skin findings (urticaria, pruritus) +7  
seagull  The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer. +7  
charcot_bouchard  Guys anaphylactic reaction to whole blood doesnt occur much except for selective IgA defi. so look out for prev history of mucosal infection. And it can have all feature of type 1 HS inclding bronchospasm. +5  
soph  I saw hypotension and though anaphylaxis........ -.- +  
usmile1  Chest Xray showed "bilateral diffuse airspace disease". This is much more indicative of TRALI than anaphylaxis which would have wheezing and possibly respiratory arrest but no actual damage to the lungs. Additionally there was no urticaria or pruritus one would expect to see with anaphylaxis. +5  

submitted by nwinkelmann(297),
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I jtsu thothug of a way to euhll)ypfo( idvoa itggent ehets eptsy of nseraws nwro.g trs,iF hwen I aedr ehmt I ywlsaa kolo fro het atesl ""hoselsa r.newas hn,eT fi 'reouy ilstl k,utcs yrt to tup eth eesttatmn noit a uqtoe tath uyo odlwu ays to a apitnte as a phi,ycains birmmeneger atht d,edep-neon tlnmn-ngdjoaeu unoqetssi are .ldaie

The aersnw rfo hits oludc be adehrps sa a e/tnoiuemsqnasttet yb teh droc,to ot teh ,amlyfi as llTe" me orem oatub owh hsti pgicmitan yruo lamyfi and lyida ".feil Hda ti eebn rsdepha klei a,htt I DYNFTLIEEI ndt'ouwl aevh ontget ti .rngwo I lwuod ahve vneer even dha hte onuitrpytpo to amek na nuoptasmsi bauot hte fslyiam' intgfhgi negib edu ot dtie enscrnoc adn tsuh einendg a nrtutstiinio refelar cwi(hh is whta I o.chs)e

usmile1  I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful. +4  
tiredofstudying  99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will +3  

submitted by lsmarshall(417),
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i"rA s"drpotle onsusd ikle srtrrieypao vsliaa( or rtwa)e lsto.pedr oliataInhn fo otpmolaxas tcssooy ni cat cfese n'tis quiet the smea; not ot sya I kown xealcyt wtha hte stoocys are ehidnal sa t(usj icoirosmpcc ydr tca ppoo t.e?ri)cpasl onIgesitn of erndoukcoed emat ot etg eht cysst si eatlcryni a TRO fro t.aaoslopxm

slmaxoToap as CRTHO sha driat fo sepuhlhcaod,ry rceraleb ofltnsiiiccaac (eraer,tarbl)nci nad .oisrronthtceiii tetioohicirsnir nac be in tnlcieonga MVC ro a.oxlpotismoss rvirtaeiluncePr cccaafolsiiitn aer ni CMV. Colnniatge CMV slauylu ahs inhreag s,ols ,uisezesr eeaclhtip ahrs, lb“reuryeb miu”ffn ,srah ie,tinisoorhtrci nda lanieeirrructvp ifo.ccniistlaca

usmile1  also note that toxoplasma can cause the "blueberry muffin" rash (also rubella can as well) +  
raddad  So looking at the CDC website, it looks like "accidental ingestion of oocysts after touching cat feces" is the route you were talking about in the first paragraph, so inhalation of air droplets is wrong inherently. +2  
zevvyt  is his small head common is Toxoplasma? +  

submitted by famylife(94),
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oT urel tou DSHIA :ypte eumS"r upmtisoas tcecononnrati alrygenel simaner ncdauegh.n emnMevto of assotpuim ofmr eht rleuartaillcn apecs to teh tcaxlarlleeru ceaps tepnvres ladulitnoi yemha.ailokp sA dygenohr oisn veom ylluerl,trialcna they rae cxaedhneg fro aositupsm in oredr ot maitnani lratite.uet"eoylrnc


usmile1  Does anyone know if SIADH is associated with hypertension? I don't think it is due to the body's response of downregulating aldosterone, but if someone could verify that I would appreciate it. +  
sunshinesweetheart  @usmile1 pg 579 FA 2019 = BP can be normal or high in SIADH +  
usmlecrasherss  in SIADH GOLJAN says you have diluteonal hypokalemia +  
tyrionwill  SIADH -> excessive ADH -> water retention -> atrium excretes more ANP, ventricule excretes more BNP -> water is excreted more. So that is why not too much plasma volume increment, resulting mostly normal BP. +  

submitted by monoloco(136),
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mAeinyt you evha a snpreo who psbmu hreti dh,ae setg kcab pu, and nteh hsa seevre sesuis or deis lkei 6 hosur taelr -- oyu aveh yrlouefs na ldraiupe mmoeaaht romf etcrlaoina ot hte ldmedi IAMEELNNG y.reatr nolja(G laeryl iepzesshma taht uyo ondt' wcrse up dan csltee demdli uoY onwk ti ash to be an riaaetlr nlratacoei since eth ruda is tthilgy reedhda ot eht suls'lk enirn .ercaufs aGlojn ederefrr to ish nxrceeieep hiwt ti as gndinee sirepl to oermev the udra ormf het sluk;l rhpgic,a tbu it idrvse eht potin meh.o Tnetngi esen on TC si cebsuae het leudirap eammhato tgse sktuc webteen the tusure nls.ei hWne it gnesama to rakbe pats one of hte sueutr sline, ti si my rtidangesnnud ttha htne si nhew ouy tge ervsee s,lqeauee kile tdhae ro ervweha.t

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11  

submitted by haliburton(215),
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iths si a vcieclra inlpsa rdco esintc.o hte cnteaue caicfulsus si itacnt U)E( rntbaivoi nda iroopnec,prpiot utb eth wieht esotcin si eth clgaire csfsuaucil LE)( and is .ddagmea I ihtnk teh eratall toonpri that is nveuen si ustj a.ra/inuftrcattal

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at you can see that the closer to the center = legs, while further away = arms. +4  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +13  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  

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Ok I egt atth if 050 adlayer ahev hte sdsiaee hent teh isrk polo si opeddpr to 0020 ntsdsute utb hte ueontiqs iyfclsliecap yssa atth het ttes si ndeo a yaer ale.i.r.ft 005 elpeop had maiya,hcdl uyo owdul ertta m.hte uoY no'td ecembo eiunmm to adhmilacy afert fineoctni os thye owudl go kbac toni eht srki ,oplo iannemg het oplo dwuol ertrun ot 5.200 hTe nesarw olhdus be 8,% tsih asw a bda n.tqisueo

thepacksurvives  Yeah, this was my issue. I got it wrong because of this-- still don't understand the logic bc you can get chlamydia multiple times +6  
hungrybox  FUCK you're right. Damn I didn't even think about that. That's fucking dumb. I guess this is why nobody gets perfect scores on this exam lol. Once you get smart enough, the errors in the questions start tripping you up. Lucky for me I'm lightyears behind that stage lmao +9  
usmile1  to make it even more poorly written, it says they are doing a screening program for FIRST YEAR women college students. So one year later, are they following this same group of students, or would they be screening the incoming first years? +5  
dashou19  I think the same at first, but after a second read, the question stem said "additional" 200 students, which means the first 500 students don't count. +  
santal  @hungrybox You are me. +2  
neovanilla  @usmile1 I was thinking the exact same thing... +1  
happyhib_  I agree this is a trash question; I was like well if this is done yearly for new freshman the following year would be of the new class (but the word additional made me go against this). Also you could assume that they were treated and no longer have the disease... I dont like it honestly but know for incidence they want you to not include those with disease so i just went with dogma questions on incidence to get to 10% +  

submitted by hajj(0),
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nac noynae lpexnai tshi? i ownk neidma fro y is ihrgeh yb iulotclcnaa tbu x ash wot soemd so who oemc y sah rhghie dm?oe

lispectedwumbologist  The mode in X is 32 and the mode in Y is 80 +  
lispectedwumbologist  The mode in X is 70 and the mode in Y is 80* +1  
hajj  Thank you! +  
hungrybox  Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao +4  
usmleuser007  can someone please explain the median in this +  
nala_ula  The median can be known by first assembling the numbers in order from least to greater. If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12]. Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people! +  
dubin johnson  Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks! +  
dubin johnson  I mean how is the mode for Y greater than mode for x? +1  
sgarzon15  Mode is the one that repeats the most once you list them in order +  
usmile1  Median would be the BP value that the person in the 50th percentile of each group would have. So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X. Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y. hope that isn't wrong, and helps someone! +4  
poisonivy  I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer! +