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Comments ...

 +1  (nbme22#33)

One thing that always helps me remember this concept is that in the patients post brain surgery, we often HYPERventilate their vent to decrease ICP (I.E. decrease cerebral blood flow).

This is due to lower PaCO2 in the blood, and resultant vasoconstriction of the cerebral vessels.

 +0  (nbme22#9)

This question was on my MCAT and I laughed when I saw it.

Things you gave to know: cm^3 = mL , then how to convert units.

2cm^2 x 20 cm/sec = 40cm^3 / sec = 40 mL / sec

From here just convert 40 mL / sec to L / min

40 mL / sec x 1 L / 1000 mL x 60 sec / 1 minute = 2.4 L / min

 -1  (nbme22#14)

So I missed this question and I was very confused at first as to why. When I first read this question, I thought of Cladribine. Cladribine (Hairy Cell Leukemia ttx) is an adenosine deaminase inhibitor. Cladribine inhibits DNA polymerase, and I chose DNA Polymerase I as my option. Why was I wrong?

Because DNA polymerase I is the prokaryotic DNA poly, not in human lymphocytes. I glanced over the "I" when I was taking this test. If you see this question on your exam, and DNA polymerase is an option - THATS the answer, but ribonucleotide reductase would be a more indirect inhibitor of DNA.

The question also asks for DNA synthesis specifically, which further suggests RR.

These NBMEs do be tricky.

 +1  (nbme22#29)

Could someone explain why "Cardiac catheterization with stent placement" is incorrect?

My thought process was that this guy has an occlusion of his RCA --> knocking out his AV node --> 3rd degree AV block. Also his pulse is 40 which suggest a RCA infarction as well.

The reason I went with this is because he got to the hospital within 30 minutes and they put this information first and made it seem important. If his RCA could be opened up, then the damage could be reversible.

I get the pacemaker, but first I feel like you would attempt to unocclude the vessel and give it some integrity.

hajdusa  That choice is incorrect because you can't assume that he has an occlusion from the information that you have. There can be many etiologies of a heart block, and they do not have to be ischemic in nature - for example there are different microbes that can cause heart block too. Additionally, if this guy were to have an RCA occlusion you'd likely see evidence of ischemia or infarction on the ECG but the only findings we're given are bradycardia and 3rd degree block. Hope this helps! +2
mtkilimanjaro  Also, the two cardiac catherization options would ultimately result in a similar outcome. It's like how the poster above mentioned the two imaging are very similar that you can rule them out. +

 +1  (nbme22#8)

LOL. I thought they were asking for Urinary pH, but blood bicarb and blood volume.

Who in their right mind would ask for urinary pH, urinary bicarb, and urinary blood volume by saying ".... urinary pH, bicarbonate and volume"

Am I crazy?

 +3  (nbme20#48)

I just want to add that I hate this question and I am not sure why the NBME loves to use the worst grammar imaginable.

We all know strawberry hemangiomas spontaneously involute after 5-8 years... why don't they just ask this? Why do they insist on ambiguity of phrases? Why are my board exams trying to trick me with poor english?

Rant over.

 +0  (nbme20#41)

An antibody can only recognize a single epitope. Since we see the more Y added leads to less X bound, then you can reason they share the same binding sites, and Y is overpowering X.

Subcomments ...

submitted by peridot(67),

While I understand why it's hyperplastic arteriosclerosis and how it classically occurs with HTN, I was wondering why it couldn't be berry aneurysm? Is it because the question is asking which is "most likely", making C the better answer? Thank you.

mannan  Berry Aneurysm is not CAUSED by HTN. It's caused by weakening of the arterial wall (at bifurcations). Hypertensive disease exacerbates them and causes the clinical picture of SAH (worst headache of life) when they rupture. Hope that helps -- Reference: FA CNS pathology, aneurysms. +1  
usmleboy  Actually according to Goljan this is incorrect. Berry aneurysms are caused by hypertension. The weakening of the wall (no tunica media) at bifurcations is inherent in human anatomy. Basically you have to have elevated BP to cause the dilation, outside of the inherited connective tissue disorders. Hence why PKD has the berry association. However, these aneurysms present with extremely prolonged HTN, whereas our guy in this Q only has a 1 year history. The key to answering this question is recognizing that this is MALIGNANT hypertension that is relatively acute in onset. Malignant HTN = hyperplastic arteriolosclerosis (onion rings). +1  

submitted by lowyield(24),

just as an aside to what everyone saying, don't forget the 2 exceptions to the rule of 4s:

don't localize w/ CN5 (as seen here) b/c it is big and spans the pons and medulla

don't localize w/ the vestibular signs of CN8 b/c it is big. You CAN however localize with the sensoneural signs of CN8

usmleboy  This is the key to this Q! +1  

submitted by pg32(151),

How did anyone get this as T cruzi? That was literally the first answer I ruled out. She has swelling of the eye, but that is the only sx that fits. Chagas presents 10-20 years after initial infection, not two weeks later. It also doesn't present with recurrent fever, muscle aches and joint pain. I mostly ruled it out because of the time course.

castlblack  I made the same mistake. Tsetse flies only exist in africa. African sleeping sickness is named well. Chagas is only in south america/central. Leishmaniasis is found on both continents. +  
medjay7  The clinical presentation confused as hell, but I could recognize that Trypomastigote anywhere and definitely was not African sleeping sickness. +2  
usmleboy  She has the swelling of the eye, edema, and chest pain. T cruzi causes dilated cardiomyopathy (chest pain and edema), and the eye swelling (Romana sign) is pretty buzzwordy for Chagas. Also it looks like a trypanosome. +1  

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