share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to usmleuser007’s page.
Contributor score: 397


Comments ...

 +1  (nbme24#31)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yM ndnuangdirtse si taht eth uamnroylp naocirutcli nsehgca vrye teillt in rmtes fo an atuec .IM

It si cb/ puoralynm iancolructi sha a tol omre moro to flil wiht boodl mhcu klie hte pesenl in stmre of dloob ultmic.uocana

hitW eighrh oeuvml of bldoo in opmlauynr ctlcniaruoi, rmeo boodl slsvsee aer lbae to be dcireetur lcasipyle eth expa.

hiWt mreo ciutererd oodlb esvsles = decreud repesusr td/ troiciaculn in lraelapl

sheska  yes, in boards and beyond he explain this. extralveolar vessels= arteries and veins, intraalveolar vessels=capillaries. capillaries will increase resistance because will have more blood from backup of the left atrium and will get smudged => increase PCWP arteries and veins with more blood will open more and thus decrease pulmonary vascular resistance. +

 +11  (nbme24#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ySilmp uep :mtro egyren in a tlhig awev teh emro eyklil ti si to ceuas ulalrelc (DN)A gaea.md

lrveUliotta sha essl negeyr anht Xsra-y it( ogse ghhtruo ruyo lfhse to see )!obnes

rdrOe of tlhgi ttnhersg el(lc maginagd api)yilatbc

  • -yRaX ;> VUA l(oas blea ot cusea ebuodl dtsanr )rkbea t;&g BUV (smto liyekl nlegsi nrsatd rakbe - rp)aiered

 +2  (nbme24#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

stoM inroapobts ad tcsneeoir is deon at hte CT.P It si htis roesna hyw het CPT is the mtos baellmyoaitlc cveait oprntio of the eor.hnpn

As ihst iaemg swohs, uyo nca see that btpaioorsren p;&ma neistoecr rccuso ta hte TCP

ihst smnea tath ohtb APH am;p& etnierainc ear etecdres ofr ilientiamno at teh TCP glnoa hiwt hte idalnaitdo olevmu freley eilfdetr tgrhhou hte aonb'swm secaul.p

oFurrteem;hr inInlu is nerheti cerdtees onr ese.rbbodar

hceen inulIn si retteb rof FG.R ,tBu craeetiinn is nlyrlaom euds fro RGF sa na etismeat bapyblo(r t/d eae)s


 +13  (nbme24#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Aretf omes eserrach ihst is why the terho aswersn era nccireort:

aslBa iytkceatnroe m&a;p malnai iucdal

  • rnIorccte c/b limnaa alcdiu si a noetmncpo of eht snbeatem namemreb hwcih is fdoun neeewbt hte mpeuiihetl nda unynidrleg nnivcteoec etisus (g..,e sidempire dan mesidr of hte )sk.in
  • It si a yogurlh 04 onmaentre ewid o-tnclueelctenr nzoe eenetbw hte amslap breamnme fo het sabal elcsl and eht le-tnonee(e)srdc aiamln dnase fo hte ntseebma raeme.bnm WK)I(I
  • slbaa iayentrtoeck asctaeth ot hte ebnamest bnmemrae isugn hoimeeesmmsod

urrGalna cnteeatoiykr a;&mp tmsaurt ncremuo

  • utraSmt uciuldm epaseastr these wot e.ayrsl
  • three rae no esoemomds ahtt nccteno seeht wot eyarsl
  • mIgea ofr enefrecre

aLanim aliucd &m;pa manaLi sdean -- cckli for emiga

  • boht are tpra of the netbmsea aremmneb nad otn eth epsdiimer

yenaoltMec &a;pm asbal cetykionetr --- icklc for amgie

  • era hotb neccotdne to atercoeh via ihdsac-nEre
  • it is rbyolbpa eht geadma to isht onctnenoic hatt
azibird  The stratum lucidum is only present in the thick skin of the palms, soles, and digits. So the stratum granulosum and corneum do touch in most of the body. I guess they just aren't connected by desmosomes. https://opentextbc.ca/anatomyandphysiology/chapter/5-1-layers-of-the-skin/ +
peridot  Wow if I'm understanding this correct, lamina lucida (basement membrane) is not the same as stratum lucidum (between stratum corneum and stratum granulosum). That def confused me about this question bc I simultaneously was like wait isn't this in the basement membrane but also recalled the picture in FA with all the layers. Thanks so much for the super detailed explanation of all the answer choices! +1

 +3  (nbme24#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reftA smeo ecrresha tihs is yhw teh etroh waresns rae inrot:ccre

  1. lbaas eetoyrctnaki ap&m; mnliaa laduci
  2. cncIroret b/c lmaian ialcdu is a enpntcoom of hte msntebae ebranmem hwhci is found neewteb eht limeetupih dan dnuglrieyn nvitcnceoe eustsi ..e,(g diemerspi adn ierdms fo the .i)ksn
  3. It is a yrhlgou 04 tonaemnre wdie utltnoecle-nrce ozen eetebwn hte aplmsa aemnrmbe of eht abasl llcse dna hte o(tseenrneed-l)c amainl ndaes fo hte meetasnb mr.mnaeeb I)K(WI
  4. slbaa ainetoycktre thaasect ot het sbatemne rmebanme suign emheissmmdooe

  5. lrnarGua yteiacetrnko a;mp& tsramut reunocm

  6. atumStr uildumc asaeetsrp teshe tow sry.ael
  7. eerht rae on oeosdsemm ttah ntecnoc sheet wto learsy
  8. mgeIa orf efereecnr

  9. miLana liaudc p&m;a amaLni dsnae -- clkci ofr giaem

  10. othb are aprt fo hte atebmsne nraebemm nad tno eht eridiemps

  11. aoMyentelc a;&pm sblaa erintctykeo --- cilkc rfo igmae

  12. ear ohbt edcctneon to eaeohcrt aiv ishedcEnra-
  13. ti si yoablbrp eht deagma ot hsti tnooecnnci ahtt hmgit aled ot aanomlem

 +0  (nbme24#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ilBntriseg asesedsi scuh as egspiuhmp ligursav V)P( adn msuihegpp slucaeofi PF() aer mtmenouuai diassese in whhci ieiaoos-ndttbau atterg mg.ilneoessd

  • VP si sdeuac by cgunctaliri naotoibuedatis G)(gI hatt atretg sDg3 o(giesnlemD )3 dna motmeeiss sg1D.
  • PV is idmetnfase yb rbuaalspas cshyislt,anoa or strlebsi in het uumcso ermaenmb and rtseblis in eth pe.isridem
  • PF tpisenat vaeh abuoidetnisoat htta rategt 1Dsg hitw aflesiupirc siblsrte no eth siiempdre wiht on coumsu aernmemb siuess.
  • oBht eiesdsa esrult ni a ssol of ictrketaoyen nheosiad.
  • imgpuPesh can oals be dcuesa by a lcbrtiaea otef:cniin lslbuou egmoptii is na nneoiictf uaesdc yb a cuyptolochssca mbrcetiau htat eesaeslr a txion taht evaslce eth Dg1s ecrxalularlet .dinoam

 +3  (nbme24#34)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eomS oetrh ercnneiod ikel elcls dan riordseds fro refe:encer

  1. -ppnde-pretaSal ronamtihc en(if unrlaagr lmscyot)ap in eEnrcdoni s:muotr

  2. eudryMlal yitrodh oinrccmaa

  3. eednooircnerun dpoh ycorhmonamsaorteot cmu
  4. Carniiodc mruoT nis)(tnoero --- sola( sha hsetse of iomfrnu lsl)ec
  5. llmSa lelC oimranaCc fo lnugs = m,lalS bleu ies lhtwlc tnsac ymoltaspc nad gruarnal roh= at)icmn ,atfl dapsaoh-elv ihllwtc se sanct tmcospaly and htarormcecihpy licnue

  6. allSm uBel slCle

  7. Eniwg oascmra ta(apinlcsa mlgaanitn umr)to
  8. CSC of slngu
  9. laf,t pdvahs-aeol wiehcl slt csnta lymtpcaos nda hmpreicyhctrao cneliu
happysingh  i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma .... +1
niboonsh  might want to look at fa pg 665 +

 +16  (nbme23#23)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
  1. ersnacC fo hte s,lvipe iclindgnu the ,osapetrt rdeasp to het samroublacl espin iav hte vlbrreeta soeuvn puxsel )V(.PV

    • eTh PVV ctmnisuecoam htiw a nburme of oesuvn etwrknos, nincldgui het otaprstic vsneou luepsx, hhciw eervseic teh senouv pspyul form eht rtepo,tas ispe,n nda eabddr.l

    • VVP nusr up het teiern anslip mocnlu dna tcnonces ithw het unvoes suyplp fo the aibnr via a lesavelsv eytsms ’sB(nasto esuPlx) hciwh wsalol ofr idblorntaicie wfol nda itnuarlgeo fo cnrlnartaiai rsTuripsshee. vsoeun ncooictnen to het ercalreb trlaunioicc aym hlep anxepil het ptnpeorisy of msotru ot azttseimesa to eth nira.b

  2. The VPV asol umoceiacsmtn wthi het saogyz evin ni teh cts,he whihc ilasnepx ni prat hyw rsbtea nad lngu cnrscea elutfyreqn maszaseeitt to het ccrtihao .psnei

    • miSyrll,ia ued to lyrnumaop nvseuo igeadarn oint het ftle desi fo hte rate,h glun tromsu etnof arpsde seimysalylct avi eht ailrtare etsm.ys
  3. uAthghlo hmlpy donse are hte ostm mcnoom tsesi fo stssteaami in eaerlg,n ahylpicmt rseapd ot the stkellea stseym si evry arer.

  4. hTe fpmimapoirn eluxsp rieceves ovusen dariagen morf eth ts,seti miydesidi,p and ucdsut eesrendf dan aisrdn iont hte reustilcta nsei.v


 +0  (nbme23#23)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
.3 earncsC fo het ,eplivs cugndlnii hte tpeasro,t repsad ot eht oubrcallsma piens iav helv reatrebt neusvo VxPsu l(V)p.e a. ehT VVP unomccitemsa htiw a rnumbe of eonsuv wt,kernso .i licgdunni acpei tsrthot nevosu x,uelsp hhciw esereicv eth snouve ulpspy form eth t,pesroat ienps, dan brad.ed l b. PVV snru pu hte neteri spnlai lcuonm dna ecoctnns ithw teh esuvno luppsy fo het irban via a seveavlls ysestm (stn'asoB )xePsul .i hchwi owlsla rof ioteilaindbcr flwo and eltrgoiuan fo anrcraiitanl u.rspesre  .ii iTsh svoneu ccentinoon to het relberac tnucilciaro aym lpeh lnxapei eht ptineypsro fo murots to taetessazim ot the ba.nri 4. heT VVP lsao mcmionucsaet twhi eth zosyag envi in het c,etsh ihwch ispaxlen in tarp wyh btersa dan ungl cacrens ntufqyeerl eaeaszttmsi ot hte ccorahit  ien.ps a. ,lrSamilyi ued ot upnmyaorl nvesuo irgaaend noit het tlef esid of eth th,are lung suromt feont aprdse masseilctyyl vai eht tliraaer .tsse5y.m htAglohu ymlph osnde rea eth msto moocnm siste fo iamastsste ni eaelg,rn lcaiythpm ardpes to hte eklstael emtyss is yrev ..r6re a Teh onifrpmpiam xeuspl sivceere oenvsu airadneg romf the stets,i pimiidy,esd dan utsudc freesned nda sraidn onti eht trltiueasc i. evns

 -1  (nbme23#33)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Traet shti ekil a aIPoVm re(aWyt rad,erahi acrdilrhyhoa = credude lHC in eht ulen,m pm&a; lh)aioykpeam

itsh wlli edla ot alboitmce dsaciois dt/ ossl fo iabrbc ni oolst

btl_nyc  Chloride is increased though. +
maxillarythirdmolar  This comment is gold. @btl_nyc, this is actually accute. you would expect hyperchloremia https://www.ncbi.nlm.nih.gov/books/NBK507698/ +

 +6  (nbme23#50)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Bodol oflw in isseer cssereain het ars;neetcis oobld wolf in elaapllr acseesedr het nacesteisr .()TRP

By blikncgo eht ialiulbmc nsive uoy aehv in ectprse dtlimie eth xeessc dlfoo lfwo to het etac.nlap

shTi deecurs the flwo in lplaerla ucnici;ltora shtu aesenscir eth TRP. AM(P = iaarcdc out tup times T)RP

sTih is euacbes eht laott ocrss laiosectn reaa si .rdeecdu

Fomr htis, erteh si an ceserdnia sspueerr in eth aletf aoclcuiirn.t

ehT rcboaetroerps ocdetla medyaiilmte ldaits to eht oiaibfrcunt fo teh ommnoc ocartdi rteayr wuold sesen a hhgi presseur and sceenira etrhi arfftene ngasil via N9C.

Tihs eRscedu teh ypiteasmhstc nad enrisasce hte ittaphesmsarcapy via NC10 u)(gvsa.

uT,hs ecundgir hte atehr !taer

usmleuser007  correction: meant to say umbilical arteries (2 of them from the fetal heart to the placenta) +

 +0  (nbme23#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The atgsteolani sac si hprlcieas in sahep, and yululsa tolcaed in eth pepru rpat fo eht ndfsuu fo het uuestr. By paelptmoxiray 9 keesw of anagelostti gae, teh oatinmic sac sah eapnxded ot ccoyup hte tomjyrai of teh ovmlue of het ieantlgsoat ca,s lleuvnayet depinnxag ot rceude eht myrnibcraxotee eolomc ot a tihn yreal weteenb hte nnomai bnmremae dna the ds.reemmo By net,h eht tsgtoalaien cas is lyuaslu mlsypi aldlce the nma"itcio .c"as

npoteeDruvl eginDm emsyrese,gobni eht timornrecbaxye oemloc or( cioonrchi tavyic) hatt tcotstusnie het leistoagnat acs si a topoirn of eth nsuectopc tgcsnosiin of a acviyt newtbee sreHeu's bnmmerae nad het porhtaTo.lbs

nrDgiu rnomtfoai of hte tiripvemi ykol c,sa esom of eht gatinirmg batlpoysh lselc natefeeditrif otni hsnyleemmca clsle ahtt ifll eht scepa enweetb 'uresseH eerabmnm adn hte phTb,raotlos minogrf teh mxnraroetbeyci emmoes.dr sA vlepmetdoen ,eprgerosss slalm cnaaeul gbeni to rfmo iihtnw eht mtirbnoyxaecer eserodmm whhci alegren ot ecomeb teh mxieeoabntcryr cl.mooe

ehT mtxoeinarreycb oclemo sveiddi eth iertxmaocenbry smdomeer noti wto er:aysl atnxobriymecre pnroclcusnpehila srmeeo,md wichh eisl ectadnaj ot sruseeH' mnembera donura teh toudsei fo eht ievrtimpi ylok ,sac dna yrixtonecarbem aircumepsotlo d,seoermm hwhic lsie teaacjnd to hte pytrhootocstlab larey of the r.ybmeo

Teh ocicohinr vtaiyc si edoelcsn by the hrocniico a,elpt hchwi is eodocspm fo na ennri ryale of mpecolatosiur dsrmeoem nda na rueto ylare of oroshptatlb ecsl.l

-WII-K-


 +3  (nbme23#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

NVM tgo it.

usJt FIeth :Y CI asw edtast to eb ormf 1160-11 whti 9%5 dan emna fo S .o,131 on irethe there era wot SD no erthie issde fo 113 hte( nm)ae that vieg hte %5.9

3161=11- 3 nihwti D2S abeov the eman 101=1-13 3 wntihi S2D oblwe eht aemn

3 ddiediv yb the 2 SD = 5.1 epr S.D

to get rmfo 9%5 ot 99% oyu haev to icrnpooeatr noe more DS (3 DS) on treieh esdsi fo the amne (113)

eheTo;frre at %99 IC 0=1-5.11 08 15. CI .1+=6511 57.11

nRdou heets pu dna uyo tge 1801-81

tyrionwill  95%CI = M ± Z(SE) instead of SD 116-113 = 3 within 2SE, not 2SD SE = SD/extract the square root of n = SD/2 and SD = 2SE +
tyrionwill  Sorry I made a mistake, neglect the abobe +
tyrionwill  if you use Mean ± 2SD = 95%CI to know SD, then use Mean ± 3SD to only know 99.7%CI, a bit larger than 99%CI +

 -1  (nbme23#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Aciort tcDasilio rsuerse P

  • higH PRT = hhig DP
  • Hgih HR = hhgi PD
  • Hgih SV = ghih DP

rtAoci Slicosty e srrPues

  • ghiH tyirCtialotcn = ihgh SP
  • giHh SV = ighh SP
  • Lwo ieCalocmnp = hghi SP


 -3  (nbme23#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
1. Arocti iDcslaiot sPreesru 1. igHh TRP = hihg D P .2 higH RH = gihh PD 3. High VS = hghi DP 2. rcAtoi lsicoSty uessPrer 1. hiHg tlnicyrtotaiC = hghi P S .2 ghHi VS = ighh S P .3 owL nCalcpimeo = hhig PS
yex  https://cvphysiology.com/Microcirculation/M012 This helps somehow, the first part about capillary pressure. +
usmlelol  that's the exp part:: The average capillary hydrostatic pressure is determined by arterial and venous pressures (PA and PV), and by the ratio of post-to-precapillary resistances (RV/RA). An increase in either arterial or venous pressure will increase capillary pressure; however, a given change in PA is only about one-fifth as effective in changing PC as the same absolute change in PV. Because venous resistance is relatively low, changes in PV are readily transmitted back to the capillary, and conversely, because arterial resistance is relatively high, changes in PA are poorly transmitted downstream to the capillary. +

 +3  (nbme23#42)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Lkie yan of the O,PCD eht eipntta ahs a ciulfdfit mite aexhngil the pndrsiie ira (tush tis eladlc na socrtvutebi see)sadi

DOPC ulserts ni VFC aedes,erc 1FVV/FEC irota aerecse,d RCF nreescai, nad peek aytxperoi owlf er.eseadc

A mortu ro any hteor teojbc ttah dowul ceosmrsp on or waronr htsee eth iar yaw tactr oudlw stenrep sa a COP.D

ghanilIn dan ehnlixag lwodu eb tidlemi



 -5  (nbme23#38)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So sa a sipnhciay erp sith onqeisut ouy lwil go fo meos i'gorbehns srodw adn tno corinmf if eht attniep ahs an eadavdcn .iee.rdct.vi sseme klei the cdo dna het oeirnhgb era ni mseo kidn fo a edla eerh ....


 -1  (nbme23#33)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

PIP effc-e:isestd + eianrecds rksi rfo .C ifdf + Ieacnders srki fro pesr nfeioctsni + anc easuc mihoyeagnasp + adsercee pbiatorosn fo ,2(+aC +gM2, ;p&ma io)rn + eirdcsena skri of ootpioocsrte pih rrsfatceu /d(t wol rmuse cclmaui)

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. +

 -1  (nbme22#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ihTs tuqenosi ash tinhogn ot do thwi etrmpatreue he(t tvgnetie ntse'od srdsaed eht ttrepraueme of hte taewr - os dto'n susa)me

Thsi si woh uyo egt eht wne:asr

1) gnieB in eureacstpo- ro in a ngwimmis oolp pu ot the kecn iwl:l

a. nceesIasr trlCean blood emovlu r(moe oldob teurrns ot the thrgi sdie of eathr = iesncrade edorpal)

.b rescaIens ANP = dresaniec tnaoiidl of sntveeclir ~ esonrmaypoct heacinmms ot druece mlouev oovdalre

.c sdreeecaD DAH m&a;p ets-elysdn-iaoRmn = doby si in ttase fo emlvuo rvooelda mp;&a snede to dcruee cssiemyt umvoel

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +
d10s  ANP is released from atrial stretch not ventricle. +

 +1  (nbme22#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hsTi eomr ekylil to be sideciutr taerhr ntah lvitaxaes b/c

teh bla sytud oswhs a nearl nunydicotsf U(NB ap;&m neariientC aer evedetal)

Mots kielyl eht ntipeta buesad olop riieuds;tc asol owkns ot suaec ocaicottrnn oial,dskal ganol wiht lrena sormplbe chsu sa tsteiiratlin ihinrptse

endochondral1  would laxatives also have the low potassium? +1
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +12
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +

 +6  (nbme22#34)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

)1 euSciplraif e-tgdr)s(eferi = pmeEiirsd ~ psnertse as edr hski iuwtnot lsriebst

2) praiSlifeuc iraalpt nhsceskit eednoescgd(-e)r = Enxstde toni aiuesciprfl iir d)yplmslr(aeap ~ snestreP iwht esnedsr tihw el beilrrscat p&;ma e wilthcnsbha usrrpees

3) Deep ltaipar thksiscne )no-ecrsdg(eeed = xsEtdne tino epde u)rieltrc(a mriesd ~ tpnseesr sa lwyloe ro hitew skin tiwh sels gclhnnai.b aMy be bgeisnti.rl

4) Flul knechstis )drdreg(teehi- = setExdn rghtohu tenrei ismdre ~ psresetn as ffsit dna eorwwhintb/ .nsik oN li.hbncgan

)5 -dhtruFgeroee = dEenxts ohtrguh eirnet ,ikns dan ntio dlunnigeyr fat, cumesl adn noeb ~ epsrsent sa albck s;nik cdrreah tah ecwshir

endochondral1  what is rhus dermis? +4
endochondral1  nvm its urshiol +
btl_nyc  Allergic contact dermatitis because of contact with poison ivy. +
abhishek021196  Urushiol-induced contact dermatitis (also called Toxicodendron dermatitis or Rhus dermatitis is a type of allergic contact dermatitis caused by the oil urushiol found in various plants, most notably species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. +2

 +0  (nbme22#29)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nIpissnutcuoets is ralgeenyl deucas yb a okcgelab in teh GI ctatr uscade by a murt,o o,pply drilcui,vutem ro sjtu ymitbimlio at patr of eht atrc.t

)1 yM hutthgo wsa htat het tapenit ahd a kleecM mu rtclveiidu yse it phpaens ni 2 eeft rmfo het llecaiceo vlav;e ubt ahtt is ni abuto 2% of eht ilpuapoont

hpsbwz  Meckel diverticulum itself occurs in 2% of the population. Also it would present much sooner rather than in a 28 year old man. +
osler_weber_rendu  Meckels is an incidental finding in 98% patients. (only 2% symptomatic) It is a well known lead point for intussusception +1

 +7  (nbme22#21)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

1) KDPAD = scoipnstyyl 2P)C(

)2 ADPRK = tsinyirc/fluy cdboitopn )PC(F -- iislmra to oniycpytsls

PFC onepirt si undof on het irmrapy lciai fo iephtaeil ellsc of crcaltoi dna dareuyllm tieonlcglc dsuct adn sacoygihetnloc of bile uctsd

PFC critnatse wiht DDPKA ptrioen 2CP dna amy oals iaerpciptat ni tsih ltouiargne aypwath fo hte oamescnnhyoesr nntcofui of eth rpmayir clia,i acclumi agnnsg,iil and C.PP


 -2  (nbme22#20)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

asseuC

)1 lAcrusvaa scsoinre rccosu nweh odlbo lofw to a eonb is perriutentd ro deuecd.r cRduede oldob ppulys cna be sadeuc yb:

)2 itJon or nobe atrma.u nA uinr,yj such sa a discedlaot io,tjn mgiht amdaeg ebyanr oodlb .sseesvl eaCcnr mnteearstt vvininlog dnaraiito olsa nac eekawn oenb nda rahm oblod sesvl.se

3) yFtta sopeitsd in odlbo elssvs.e ehT fta iil)p(sd anc kbocl llsam loodb s,seevsl indecurg eth obdol flwo ttha esdfe oes.bn

)4 aeriCtn seds.asie cladMei dscoionn,it uhsc as ksclei clel aiaemn dna 'ceushraG idaes,es laos can ucase nidimdihes odbol wolf to bn.eo

roF otabu 25 ncretpe of oleepp twhi vcaaursla osniesc,r eht scuea of eteirunrdtp ooldb olfw si nkunw.on


 +1  (nbme22#20)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

)(A k isR otfrcsa ofr lvenodeigp rlacauvas sersiocn cleniu:d

1) mTaaru = I,nrujesi chus sa iph licosoantdi ro ,rateurcf cna aagmde aerbyn loodb selevss adn receud oobdl olfw ot enbso.

)2 tidoreS eu s= Use of -shdoiehg istoctiodersroc, ucsh as o,rnsdenipe si a mmonoc secau of lsaarcuva ern.isosc ehT nosrea si wnnknu,o ubt eno piehyhstos is htat rertdosocoicits nca isneearc dipli vleesl ni yruo blo,do cngdueri obldo olfw.

)3 veEscxies cholalo ues = imgosCnun evrasel lciolacho snkird a ayd ofr eslreva ayser olas can secau fttya tpisosed to fmro in rouy boodl e.ssevsl

4) taosBnphoehspi eus = nrgmLoet- use fo ostcdiniame to acerisen nboe nseytid imthg buitcrento ot eldponiegv rsocitsoosnee fo the .waj hisT erra aoiilcpcnmto ash rduoccre in esom poeepl dateetr ihwt ighh dsseo of htees nsetdoiicma rfo cr,naesc hucs sa eitlmlup mmayelo dna tmcseiatat ebrsat earccn.

5) ieCtnra aidlcem eaetrttnsm = anioidRat yetarhp orf necrca can nwakee .obne ngrOa nnaotasltpar,tin eypealilsc yindke rtnpaast,nl aols si itodcaasse twhi ualarcsav es.srcoin

caM dieB)(l iincsdonto siaeodtsca hitw salacavur socnrsei ucen:dil

bisnDaecearcGtiits'hatees aur P sm DVeAsSSdsiic II/eeaHty uulps m trekSshcslyeiuaote ecll ienama


 +2  (nbme22#11)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

In sseac of ildch or lutda euabs

)1 if tehre si lrcae veeeidnc such as fi a ldchi esatst thta ersptan nsiphu yb n,gitiht dcihl si oswghni aerf fo netarp ---- alcl ilcdh pctnetoiro gtrih wyaa ( t'odn dene ot wita adn as)k

2) same nhtgi gose fro the aldtu utb clla eht ludat oteponcrti rscveise

osler_weber_rendu  Does anyone not remember Dr Daugherty's lessons which said domestic violence on adults is NOT necessary to report? Instead help them find an escape route in case of an emergency and encourage them to report it themselves. +
makinallkindzofgainz  @osler_weber_rendu: Domestic violence is not the same thing as dependent adult abuse, such as a special needs adult or an elderly adult (basically anyone who depends on others for care). What you said applies IF the adult is living independently and fully capable to make their own decisions. +7

 +0  (nbme22#36)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTe ceprsso fo oenirdmf nctoens osuccr nweh monatnoiccuim teeenbw a etniatp dan yhnacpisi srultes in the aip’ttnse uhatznoriaoti ro gertaenem to gueondr a fscpeici dcameil novrntitine.e In seinkge a iapntste’ mdiornfe nocnset ro( eht oncsent of hte nai’pstte getasroru fi the ettinap kscal gcidoank-inemis caaicypt or eliedscn to ipitpaacetr ni kmgain ned,ioicss) incsyisaph du:ohls

a)( sAssse hte tipents’a bylatii ot ednaundtrs rlaveetn ceiadml omnianftroi nad hte ipsomcnaliit fo neertattm nelisatvatre dan ot akme na eie,ntpndedn rynultavo c.snoiedi

b() esPnret eaevltrn iooatfmnirn aclyeruact dan sne,sieylivt ni epikneg htwi hte te’saintp rcfneeprees rof ervngieic ldacemi oriimntoan.f The nicyhapsi housdl uidlcen minoinatrfo b:uota

ehT ngdaiioss (nhew oh)Tnk enw narteu and uopreps fo mmnedcoerde Tntnteii ehnoserv bd,uenrs ks,ris nad teepcxed sntbifee of all oontp,si dnigilucn ignorfog cmetat(trn) e moDtnceu the rmoiefdn enstcon oacsninvoter dan eht pse’itnat (or sgrt)eus’aor isecdoni in eht adlcmie dorcer ni mose aennrm. hWen teh uogp/raeaittrsent has oeidprvd fpiicsec ttiwnre nontsec, het eostncn rmof ldsohu be ulndidec in het codrr.e

In se,cgeieermn wneh a esinocid smut be eadm ,lunyretg eht apitetn si tno lbea ot acaiptteipr in dnsieoci ,gminka nda eth instep’at ugraoerst si ont aablieav,l sspyhinaic mya titneaii enemttart ohtwitu roipr iedomnrf tnesnoc. nI ushc tss,ouniati eth sinihpyca ousldh mnfrio the ruapsattrgniteeo/ ta hte ialteers pntouoiytpr adn tanboi ocnnste orf nogniog etatmtrne ni pneigke iwht shete ngeedsuiil.

AAM nresicipPl of claedMi ics:htE I, I,I ,V IIVI


 +1  (nbme22#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reltnaC envsrou ytmess tnnoireageer

iUklne eaherriplp rovseun mteyss iyjr,nu jynrui ot eth alnecrt suevorn meytss si tno edfolowl yb eesxneitv nrng.aeeeorti tI si telmidi yb teh nyiiorihtb ilceesfnun of teh galil dan lxltuerrlceaa emieo.trvnnn hTe ehsl,oti pnoinssemire-v hgrotw niveremotnn si, ni r,atp trdecea by the gtnmoiria fo -ltyedmcsiasienoa irntobhs,ii eayottssr,c togerdydios,leocn locdgoniyroeedt surresc,rop dan aii.comlgr eTh notiemnrven inhtiw eht ,NCS eliyespacl lgwfoolni m,aaurt teatunoccsr teh rerapi of elmiyn and onnu.rse thwoGr octfrsa rea not xesedsrep ro peerxer-des;s orf iaencnts, eht crlralxelutae trmaxi si glacnki .msnianil lilGa sacrs ilrdypa mf,ro nad eth lagi ltcylaau coeudrp rtsfoca tath tniiihb mionteayelrin adn oxna ;ieaprr orf snceta,ni OGNO dna 5Ih.3eT-N nosax evshsemtel laos esol eht ltaptoien rof wothgr iwth ge,a deu ot a eecdares ni G3PA4 pxrseesoin, aomgn sth.oer

usmleuser007  (wiki) +

 +0  (nbme22#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aunrntreioereeNog in eth prpeaihrle usenvor etsysm P()NS ocsurc to a iitcfinansg der.5e]g[e[6] reftA an uyrnij to teh onxa, larpherepi sunnero eavattci a tyraive of ggsialnni waspthay hwich rnut no wp-tgroorh nsgee, ldiange ot ftanomreoir fo a fannutoilc thwrog ocne adn eitornaeg.ren heT gorthw fo heset oaxns is laso ogdernve by eaoiccchttm sctroaf rtscdeee mrfo awnhScn llcs.e Injyur ot teh rieaelhppr vrsoune ssmtye mailedytmie cietisl het angomirit of cpgths,ayoe cnSnhwa ,cesll dan hragmaspoce to teh eilnso seti in rroed to lcera wyaa sridbe usch as ddgaaem seuist hwhic si ihtryoiibn ot oeenanrgtier. hWen a enver axon si re,esdev hte edn stlil adaectht to teh llec oybd si eldebla eth lprxomia tmenges, eilwh eht horte end si adecll het isdalt .sentegm rfeAt uj,ynri teh mraixolp dne sellws nad snrcpeeeexi eosm rtrgareeod gteano,ednier btu enoc eth eisrdb is ae,lrecd ti beigns to suptro xasno and teh scneeper fo rogwht esocn can be .edcdeett hTe iloaxmpr onxas rea able to grwore sa lnog sa teh ellc oybd is ct,itna nda heyt aevh edam ntctoac iwht eht hwnnacS lescl in the ledieaurnno enanclh ro teub. unmHa nxao orhgwt rtaes anc herac 2 ad/mmy ni alslm snerve dna 5 ymm/ad in lgare .nee[r]v4s The sdialt mt,esgen e,hovwre esneipcreex lWrenilaa enrdeonaeitg wtniih souhr fo eth ;yjirnu eht oxnsa adn emynli ndeaeg,tere utb eht muinuedonre marsn.ie nI hte rleat egtass fo tgrnrnaeoeei eht maeinnrig ndnlieeauor eutb ridtesc nxoa wtrogh cakb ot teh rrotcce rett.ags uirgDn Wnarlalei eeitengrdno,a Swhcnna elscl rwog in rdeoerd ncolusm nolga eth duelioearnn ,bteu ngtcriae a ndab fo eBgnnrü B()ob htat ttrpecos adn esrpsevre eht ronledeiaun lcehn.na ,lsAo pmaorechsag dna ahwcnnS clles rsleeea notcohriurep rtsafoc thta nnceahe -.errgohtw

)(iwki

brotherimodu  That describes Schwann cells' involvement with neuroregeneration, but I don't see how it answers the question "Which cell is blocking reinnervation" +

 +4  (nbme22#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

wTo arjmo sanmeimshc of iatonc evha been u:taldediec

)1 Fnuecyitlso is raulalgyitnnf tnevcodre tino het tytaiostcc iuorfauolrlc hchiw resoengud refrthu pesst of itonacvtai nad anyillf ntsitraec sa pofoehadlp-siiurroiunrht5te iwth NAR thiosiynessb uhts rindsbgtiu hte lgdinuib fo tcenrai naissleet nresopti.

2) oyculiFetsn soal ruoenesdg ivooncesrn niot pni5hofuaeeoptodmlehyrrdouosn-oix hhwci ihibtnis unlfag DNA ss.nyihset

3) Tiydatlyhem ytaseenths is an meyzen thta zcyetsala the ovniseonrc of yodieunxdire hsmooetpoanhp PdM()U ot teenhxoiymiddy ptnhsmhaoopeo )T.(MPd

imhnyeidT si eno of eht niotledusce in N.AD

tiWh iitnohbnii fo TS, na cemilaban fo luixsdneeyocetdo nda nidcreeas veslel of PMUd asie.r tBho saecu ADN dm.gaae

)IW(IK

link981  Just look at page 36 of FA 2018 and memorize that shitty diagram o De novo pyrimidine and purine synthesis they ask so much about. No need for scientific explanations for this one unless you like to waste time. +21

 +9  (nbme22#23)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

dporhtrAo senftncoii

a. arpmaonTsy rizuc = viduedir ubg

b. oyTrmnpsaoa biucer = Tsetse lyf

c. Mariala = eohnApesl tuimqoso

d. viirasFvul uroGp (stWe Niel ,rsiVu )nueeDg = eAsde iooqmtsu

e. alcraiirMoife = labkc lyf

.f hLnasiiaem rbiiazeslnsi = nsad yfl

.g rrBlaieo ma&p; isaBeab deIo=xs kitc

.h iacebiskR rikbcisei p&ma; nelcFialsra sranlesuti = ercomarteDn ktic

.i Raiisekb aroizpkiew = ilce

.j Lao ola (aAcnfir yee )morw = eerd lfy

.k hcWeuerari iboncartf = simueqstoo

zoek816  West Nile Virus = Culex +1

 -2  (nbme22#23)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
61. Arphrtodo ceniisfont .a nmpraayTos crizu = idiurdve ubg .b nsoyporamTa cebrui = etTses f yl .c aaarliM = pAsoleehn quis omto d. Fuvsiliarv upoGr s(teW lieN sVui,r ge)nDue = Asede otmsui qo .e lfaioiariercM = kcbal fy l .f iamneiasLh ariezisbnsli = asdn yfl .g rBoerlai m;pa& Beaabsi xso=dIe ktci .h cRiskeabi cbeisirik ap;m& aFnecsailrl ltisseranu = nrreDectmao itkc .i isaiRekb erkwiazipo = lice j. oLa alo ciaAfnr( eey )omwr = ered fyl .k ciareWruhe natircbof = sqomi ouset


 +4  (nbme22#15)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Pre Pmo:haat

Msto ommcon in npeosamluspaot men:ow

1) ociytsfibrc hgsaecn, taltuaicrnd p,laomiapl ianboedarmoF

oMer klyiel in eotapusaopnsml we):mo1n lhdopsyel uotrm emae-ka(oinlrfbiod 2o ))umrt teBsar casernc sinraeced irsk td/ )1 snerdieac ge,a rinotuda fo gnseeort urhoogtthu iefl e(aylr ,hcmerane late ,pueoenams )ioseybt )2 ylpicAta pehispyaarl )3 itFrs eeregd aevslitre

sQniuote tastse etpnsesr it :asa) c2m ,mirf trdneeonn ms )bas on ylliaxra loyanhepmapdthy or pelpin r)cah ecgdis xmtrelye anrioeedds ssam wiht lrrargiue scmlriudt gaesner ireurlgra cniasolmicfoitccrai

os thwa can ti 1:) be SIDC = deso ton llsuyau dopuecr ssam

2) omCdeo epyt = hgh-i agred elscl tihw ieosnscr ∓a opdyrthics acocascntifili ta cenrte fo tcdu

3) aPegt eieDsas = ovisevnl eht kisn fo teh lpenip uldien(nryg nmiaccoa)r

4) IDC = a) rmfso utld-iekc usttrreusc (%&t8;g0 of sa)sec )b smas dttceeed yb lpihsacy xneoimaitna c(ech)k )c yaslluu 1cm ro ergetra ech(kc ) d) oesismtplacD msrtoa = oneivtncec uessit ioggwrn iwth torum tosprpu(s m)uotr ~~~ ehc(ck -- garreruli ) agrimns e) dyealMurl Ceimarnoc D()IC = misimc oomdeabfarin

)5 CLSI a;pm& ICL = DO ONT cdroepu lafonciitsacci or mssa a) ICL - slelc vhea egfllii-s"ne eantrpt" hnkti fo a badede nlkacece dan you cut ti in ielddm c(lka andh)rie-cE

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +3

 +10  (nbme22#16)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oMhret is gRh-ne -gt;-& hse lliw etrgaeen H1biae)Rs oditn- eufst aftfeecd by nitRh-A if it is so e)Rt2-iiphv enve fi oPOiieRhts--v is ine,gv ehnt isltl tem'hsro b-ihaonstiRde llwi taatck fetassunrd odolb ude ot tis slcel nntiiancgo 3+ )hR ,efoererth -hg-eteOvRian is best

makinallkindzofgainz  you're not wrong, but I think it's better to have put O-negative because that's the preferred type of RBC for transfusion unless you've type and crossed your patient +
mtkilimanjaro  I think fetus is O+ but if you give them that the RBCs will still be destroyed. You want to give O- as it wont get destroyed and wont affect the fetus in any way. Similar mechanism to giving platelets to someone with TTP, HUS, etc. they just get destroyed so its useless +
tylerwill33  In utero, should give O- to avoid mom attacking again. After birth, O+ probably better. +

 -10  (nbme22#48)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Not:e the eosqisntu ttseda rpstroeyra"i sbut"r gugsgenist na URT oteinicn.f

)1 itsh elurs out ntnyhagi tub arsyrepiotr ciiotnfne on(n erp etcnif:nio E. oc,il E. uie)mafc

2) DGP6 idceynfiec eorm euicstesbpl to ealaastc vpisiote rangmssio -- shit esurl out all( perst smosarng)i

)3 tLef thwi .H neizanufel &pma; aSt.phr usraue HTO(B era aaasltec soei)pitv

4) adsutpaEnlce riagmnso rea smto niecngrcon ehwn teehr is .lsapniea

imnotarobotbut  Respiratory burst has nothing to do with a respiratory infection. It describes the process of phagocytosing a bacteria and using NADPH oxidase/ROS to lyse it +5
belleng  Aspergillus is still in the running, it is catalase positive as well...but not a choice +

 +0  (nbme22#7)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nmSoeoe aecr to pexlani ywh meti[ to styeesadatt- oocntcrinten]a si ont teh cotrecr eras?nw

omerta  In pharmacokinetics, steady state refers to the situation where the overall intake of a drug is fairly in dynamic equilibrium with its elimination. In practice, it is generally considered that steady state is reached when a time of 4 to 5 times the half-life for a drug after regular dosing is started. The time to reach steady state is defined by the elimination half-life of the drug. So in a patient with renal dysfunction, the plasma half-life is going to be prolonged and the time to reach steady state will increase proportionally. +11
belleng  loading dose is independent of the concentration of the drug in the plasma and the dose frequency...this is why you give a patient who is seizing a huge dose of anti-seizure meds in order to reach a theraputic range on the first dose despite the high risk of toxicity and side effects...primary objective when seizing is stoping the seizure so you want to increase the dose response curve with a massive load +
belleng  loading dose is independent of DOSE (should have said dose, not concentration in plasma) & FREQUENCY +

 -1  (nbme22#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ntiinAc is a tcmrlmifiaoen rointp.e -tAiicnnα is esasecrny ofr hte ntehtaamtc of acnti melsfitan ot hte Zs-line ni kstleela emscul 1[sl],lec and to hte edsne dosebi ni sohmto msuelc 2s][lec.l eTh oltcfinaun nreoipt is an npltraeaa-lil emid,r ihcwh srosskcinl- the hnit sfmtielna ni actedjan scoes,raemr adn troehfree oortniedsac tisrocncaton ntwebee eearrsmcso in het hzrtanooli ais.x

ehT onr-ciscanoerm sαant-i,nic oeeddnc by AN1TC dan 4T,CNA era lidwey esedrse.px ACNT2 ieonpexsrs is odfun in otbh aarcdic adn ektllase cmeu,sl seaherw 3CNAT si iditeml ot het ate.rlt hoBt send fo hte oddepsarh- iit-cnanα dreim atnnoic gcnidanini-bt dnmsao.i

sttMaouni ni TCNA4 acn sceua teh yknied eissead lcaof nseegmatl rsogolslroimecseul G)SS(.F

)I(WIK


 +22  (nbme22#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ym ilst fo islenpd pyte lcels adn dnoitosnic:

  • a. F1-N
  • b. F-N2 ~ owcnahnamS (nAiont A) = aseoCtunu afirermnuoob ~ gihh uatlcielrly /w( gdailinasp ternpats htwi ensriptnigesr u-rcfnelaeer nezos bcyo&derllVpn;aacse isedob
  • .c aLmyomoei su(uetr &am;p )agsuhsope
  • d. molaiMeetsho trkea(tiynco s)eipoitv
  • .e inlatspcAa iToyrhd acrcen hcbi(aspi ma&;p ogaln twhi itang lec)sl
  • f. yuaMldlre Thodiyr caenrc (anc aols hvea pynllogao cs)lle
  • .g iaPyrmr cdciraa snooaamacrig imangta(ln vulcrsaa depsnli )lcels
  • .h Ooaoseramcts ob(en cecnar) m(corhiepopl esc)ll
  • i. maigoMnnie
  • j. aKp'isos rcSaoma (-H)HV8 = lSlitek-i laucarsv casesp whti ulmpp pisslde-dpneha troslam lscel
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1
mcl  I love this and I love you +9
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +

 +0  (nbme22#22)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

1) lsAainys fo nrcieava si a uecrrdpeo seud rof cionrgpam maleps eansm to ees fi hreet is ftsucinief nedcviee ot renfi htat hte naems fo the nrodprecnoigs ntolupapoi sitdinstuoirb laso reifdf.

)2 rehWe -sttet ecrmaop loyn wot ns,iritiotbsud iaanlssy fo cveaanir si laeb to rpoamce anmy. • atWh sdoe eht o-neawy rtap ?eanm It is noe ntepdneed rabivela wys(laa ncns)uutoio dna xtlycea eon ennndpetdei evlarbai lasay(w lrto)aa.gciec A nislge idtnpeedenn ilarbeva anc vhea myna ve.lles


 +0  (nbme22#22)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sv/rantaaes/tlne/:adrwtstnpwiaehas.wwddhr.ae-/-stto


 +23  (nbme22#22)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

stuJ b:mrremee

)1 tt-esT eat( rfo )tow = koosl at the maen avselu fo 2 pgruos

2) ONAAV (nayaissl of vnei)cara ~ leki s-ettt ubt = lkoso at nmae lavsue fo 3 ro orem sgruop

3) rasC-qhuei = lokos ta teh %)( ro noirpsrpoto bweeent 2 or ermo ospurg.

so, tsuj kolo rfo woh nmay ourpsg bigne rdeesdsda nda ahwt vaesul yeth rea sugin (% ro esnma)


 +11  (nbme22#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

1) EBV = iBtkrut phoa,mmyl dikHngo oaymhlp,m aaysgnronlhepa rcanocima, °1 NCS phaymolm in( oopmrcminedmoimus tiesnt)ap

)2 VBH ;amp& CHV = tleleplarcuaoH nicacmoar

VH)38-H = Ksoipa ascrmao

)4 =VPH calCrvie and lnnepa/aeli mcnriaaco stpe(y ,16 ),18 dhae dan nkec crcnea

)5 H. orlypi = Gircsta omeocicnaardan dna MTAL ohmlpamy

)6 VL-1TH = tudlA lcTe-l mhulmpeaoimeyalk/

)7 vreLi lkufe ins(olorhcC snns)esii = lhncicanCgamraoooi

)8 sahsoimcotS iauemmabtoh = deadrBl crecna assuuom(q ell)c

some0217710  Aren’t both H.pylori and EBV associated with gastric lymphoma? +3
baja_blast  You're right that EBV is associated with gastric lymphomas, but this is specifically asking about marginal zone lymphoma (or MALToma) which is associated with H. Pylori, not EBV. https://www.ncbi.nlm.nih.gov/pubmed/11552717 +1

 +0  (nbme22#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

1) lbeal D V(LLD -&t;-IgDL g-t;&- D)LL = atginynh ahtt arnciedes LPL = aeisrtbF hihwc seu aap-PPRhlA x(R) rae oogd ta cgndiure LV];[DL trfeeh,roe less VDLL mnsea oemr DIL.

)2 DLVL -&g;-t aftty cdai nxoadiito = iusgn stfa )AsG(T rof eynreg rood cnitup eHer g-aAPRPamm yplsa a lreo= ihcwh rae Tlooehsniniiedziad a(los aelldc zsiotglen)a aer a scasl fo emeindisc tath yam be sued fro het aermetttn of tepy 2 ae.etbdsi yThe rae olas dogo at rucignde rsume ATGs

teoN DVLL ear very rchi in sTGA


 +9  (nbme22#31)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sJut tone why hetro swesrna rea tno oerccrt:

  1. pngyEoi&ssophn;b na crinaedes rnneocsea of ivoec suonsd dreha whne ngaclutsiatu eht lgnus, otfne dascue yb gunl tdnnooiaoscli dna rsf.ibsio

    • a. tI si eud ot decnhane onnsriitsmas of eqfnryghcihue- oudsn rassoc ldif,u usch as in mnaboral ungl tsues,i wtih owerl cenuesfqeir telefird .tou
  2. deWpsehir luyoosfs;tbri&rreqnpeepc to na nrcedsiae desunosl i&prbdspngeiebos;onwnt&spn;fh nirgud oltascuuitna ihwt a sctsotpohee on teh gnlu difels on a ep’iatnts .rotso

    • a. Uyualsl psonek ndusso fo e&mpiews;nesaph;plo&rbsvudbn by hte netatpi ulodw ton eb eadhr yb hte aicncilni slnagtuiatcu a ungl ldeif hitw a os.eceptshot

    • .b vHerweo, in asear fo eth nglu eerwh trhee n;pgss&niubl dcnotsiooln,ia ethes iheserpwd eksopn sosund by teh ipettan u(chs as agisyn )nt-neyi’nin‘e ilwl be lycrela aehdr uhghrto het tesosh.optce

    • .c hsTi iseancre ni uosnd sisxte bseeuac ondus tevarls frsaet and thus whit loewr osls fo intiyents uogrthh luiqdi or lisod iduf“l( a”sms ro osild“ m,sa”s pyere,isvlcte ni eth ln)gu sersvu esosgua a(ir in hte n)ulg aed.im

    • d. eiresWhdp orctiyluopeq is a nililcca sett ypylitlca erfdroemp igrdun a admlcie ilsphacy onetiimaanx to eteavula rof het nresceep ofsl;b&unnpg naodisntil,oco iwhch duclo eb suedca yb arcnce ol(isd sms)a or naoumnipe ildfu( )amss.

titanesxvi  why not wheezing? +
miriamp3  @titanesxvi because the dx is CHF +
leaf_house  I get why crackles are more likely in CHF, but wouldn't it also cause whispered pectoriloquy, if fluid allows better transmission of sound? +

 +7  (nbme21#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

)1 eVry pamnirtto ot onte htta aca-ySshT asisdee ahs meor eesvstnii rtlesat mo(r)o rfeexl in teneoasn hwit dicesaenr ahde eremicc.crnfeu

)2 rFyba esdeias = tedn ot hvae -vuoilaasdui etcsdfe /wo ilrev nmtoeivelvn

)3 kpaNecmnii-n eaedssi = neiama m;&ap anoiphoyt thiw falaxreei


 +1  (nbme21#4)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ernSie prypahotohisnlo lwli deeucr silui'nsn ffatsec. It astc no eth nysteoir iaekn.s


 +6  (nbme21#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nencdCiefo vaertnil reiecnssa htiw reddaeces lmasep .izes

usmleuser007  would require a a large sample size to see if there is a true difference +
claptain  This question is bogus. CI does not always increase with decreased sample size or vice versa. Four readings with small variation would give a narrower CI than 10 readings with greater variation. The only thing you can be certain about by adding more samples is that the CI will most likely change, but which direction is uncertain. +8
bartolomoose  Recall the formula for 95%ci Mean +/- 1.96* (SD/sqrt(samplesize)) +1
the_enigma28  @claptain The point you made is relevant in studies involving random data. But in case of this question, the data being collected is in fact the diastolic BP. We take several readings of BP to rule out white-coat hypertension and have as accurate reading as possible. In this case, taking more readings will actually narrow down the confidence interval. The readings here represent physiological parameter, which wouldn't vary veryyyy widely in an individual. +
lowyield  @claptain i was thinking the same thing but ended up choosing the increased because alot of NBME seems to reward the more simplistic answer than the overthinking answer +

 +11  (nbme21#40)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
.1 peEmalx of cracinueat utb yhiglh ceseipr 
    .a 500 naspteti negsie a aicaurrplt trdooc fro a alacprurti enills2.
s xalmpeE fo etcaaurc ubt 
iciempres    .a 01 naptties edorgun a enrngisce ta a allm 
.3 Btho rtaAuecc and eiescrp 
    .a 500 isttnepa hghi( cspoei)irn udoegnr a nceinergs hig(h auyarccc ~ on asbi ro msteicsy r
r)roe

 +2  (nbme21#7)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ladnIeh glue is meor ylliek hnta aochlol /cb fo sti asee of ssecac for a rinom nad ileetvar ebaus poalnteti ni het ega o.gupr


 +20  (nbme21#43)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
  1. osbd osmloHet(asi ):ngotiltc iWithn hte frsit efw mnseitu fo ,yrnjui
    1. ietlsp naetl het boold gnieb ot iskct to eht nidurej iest.
    2. ihsT tiscaaevt het etslta,elp ngciuas a few tnihgs to apn.hpe
    3. heyT ecnhga into an asrpumooh sp,hea eomr lietubas ofr gci,tlnto adn ethy eeesalr hlcmceia gianlss ot tporemo inc.ogltt
    4. Tsih ltserus ni eth ticiavatno nf ,fioibr hwcih frmso a shem dna tacs as le"g"u to ndib tpltalsee ot chae heot.r
    5. hsiT asemk o ltatctha  esesrv ot pglu the abekr ni het blodo es,lsev ger/pivoglinenwstn hurefrt e[.g6]bedil[n5]

  2. lit:fmnIaanom Drguin stih ashpe, dmaadeg and edad ecsll ear delcrea ou,t nalgo iwht berciata nda horet tseaphogn ro rdebis.
    1. isTh hpansep uthhgro hte rssceop pos oyc,gfthaiso ewerh hitew lobod lselc tea"" dsebir by nluinfgeg t.i 
    2. dea-vPteedlteril orwtgh rotfsrcaea  selreaed iotn teh nwduo atht cueas hte ionrgtaim and oidvnsii of sclel iundrg eht oepfvriltaire spah.e

  3. ortiofariPnel o(hgrwt of enw uts):esi nI htsi ,noleaongannepioo otcgdesi ,sasgsnreaihuiligl pt,n ea otur,saie ioftsmn lz,ailieatpineioht dan nowud caniotncrto ccr.ou
    1. nI eoinegngsias, alsrucav eatndieholl lsecl frmo enw olbod essse.vl
    2. In plofaibsria and otlaairnngu ssiuet irs,botsoifoltman a wbfrrgo adn rfom a ,enw rvrius lalxeetrlclaonpoia xtC)ari( EMm yb geritcxen lcengalo tednnobnif.iar c
    3. tyrunCeolr,cn lpieitelehoin-tirzaa fo hte priimdese sc,curo in hhwiteelhpialc i fll erecrteaiolsp dan w''aclr tapo the ounwd d,be divrongpi oevrc rfo eth ewn teis.su
    4. nI nwudo tlra,  mesyodretnconaiabcsotorbesfic eth zies of hte ndwou by inpggipr hte woudn gdees nda arinctcotgn unsig a seihmmnac ahtt semlbeesr ahtt in soohtm lcsmue .lcsle
    5. nehW the ecsll' esrlo ear elsoc to oeecl,mtp eeenddnu lcles eusor.pts agnipdoo
  4. itoanMrtau ngi:(rmleoed) iDrugn tmoaniurta nad ,lmegidoren

    1. olncagle si rlaegndie anlog tseinon ,lsnei nad lcles hatt are no egnrol ddeene aer edevorm by doprmemrga lcel ahe,dt ospost.a ropi

  5. eppAoartmxi miset of eht dnrfteife ashpes of ndwou ,h1ea[lwnh0ii ]tg edafd reavsiltn mrngika alsbsainutt in,aarivto pgdnenied mynail on donuw zesi dan laenihg iot,ncsndio but iagme esod nto uldceni armoj primenaistm tath cia sucrcneoh w.unods
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +

 +4  (nbme21#36)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

rarnahCoosomcd = imanly csftaef het aaxli ktoensle hant hte nupparedlcai tesenolk

ohnodcnEamr = ylnima efcastf hte asdhn nad tf;ee aer ctsy ielk


 +1  (nbme21#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aCn omneeos leeaps pexnila why tc'an oolchal eb rtreocc ni sthi gstneti?

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +12
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +6
lovebug  and FA2019 page 538. +

 +5  (nbme21#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

einleatss nimoA ciads AA()

)1 duAslt ereirqu 9 AA() = aleb ot kema grinean avi uera l ey2c)c hrClined erqeriu 01 )A(A = ehyt era tslli pdg vl3oi)ene iWth KUP isntreyo ebemosc esnaesitl ni hobt ldsuta and dcrehnli


 +8  (nbme21#24)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA per 1 A)F ttfya aflonrntiiti 2) allrucle nnaolilbog )3 luevnate inosserc

hyperfukus  thanks u saved me time in looking that up :) +
violethall11  Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic . +
mumenrider4ever  FA2020 pg. 391 +

 +8  (nbme21#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)
.1 eTrhe" ALH fsna lwil yrt mhte
"    a. nhneeroTi = erhTe 
    .b i;isHietdn nnir;Aieg enLisy = A
HL    c. nahylPnelniae = afs
n    .d nlaVi;e ;osueienlcI Liecnue = will
    e. yhpTrtopna = t
yr    f. nhMoeietin = h
tem
pparalpha  Thanks! Good mnemonic +1
b1ackcoffee  best mnemonic +

 +25  (nbme21#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

fI oyu 'ldotcun emrrebem ihcwh wree ieas;esnlt ehnt tvatareinle uoldw vhea been ot ieraezl hatt riwgnog ecrdhinl ened lcsle ot i.vdedi shTi qrrseiue AND iailcnrpote nda .aroatilstnn fO chwhi teh cnleuic cadi etyhmi si itpa.nomtr tI rqesruie a ehmtly r.estrnaf

shiT is hreew nmeheinoti somec .in eMeonthiin noimbesc itwh PAT ot form SAM (a tehlmy odnro)

whossayin  That’s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2

 +4  (nbme21#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

flIal esel ali:fs etno htta terho waesrn chesoic rae DCOP ystep

dragon3  (except sarcoidosis) +2
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: https://pubs.rsna.org/doi/full/10.1148/rg.306105512) +
lovebug  Restrictive VS Obstructive ! very good point! THX! +
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1

 +0  (nbme21#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

emmereRb )1 oipivttmece nihbtsorii ~ sienl orCss at c syene)2r-itt mciptioetN-veno nibitsrhoi ~ on nlie csros


 +5  (nbme21#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

SNC omrrehaHge/ agmd )a1e 284-1 Hsr = erd 2nueson )r 1-3 syda = ipoulnesthr aivqeuilf(cte csei))rnos3 35- = mgarcpoahse i al)mgi)4cr(o 12- kwese = veeicRta isliogs +( rsacavul ooiialn tfe))pr5r rmoe thna 2 skeew = lliaG srac

te(:no eth sasgpiohteen si riiasml ot IM nad sti srca mai;frnoot veroe,hw eht temi oucres for NSC si usjt ts)erfa

teepot123  fa 19 pg 500 +
icedcoffeeislyfe  FA2020 pg 512 +

 +0  (nbme21#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

orF C:CR A(s rpe OWDRL)U

irStcmmey brtlleaia rloew meyxtrite pnttigi edema and rtoouuts mnoadbali esivn era ignoneccrn rof ier nrnaoif vean acva C)V(I otscntriu,bo ihwhc, ni het sgietnt of a e-ftesdldi aflkn ,msas lssnesgeg arut lcle c)oR(cirmCaa nC twih onsntiexe oitn het I.V C CRC ccsnotua orf %0&9;tg fo all iealiamgsnnc irgsani ni teh dekiny dan is hglihy codiessata twhi mknsig.o  iaet tsnP ihwt CRC lciaslylcas vaeh a tidra of flkan npia, aaleplpb a,mss dna r,iahtmeua gutahlho anym iramne yttsmmcipoaa lnitu the sdseiea si dRcCea .vadCn si a iylhhg arauslcv mutor vesaihn atdt eth aelrn  neivni pu ot %25 of sca. es VIC rcittobonsu anc rccuo ude ot ruaniatilmln eetoxnisn nda ohbmrsut fnoioatmr, hartre ntha assm fetcfe mofr the urtmo flesi t.

Teh tuisctobnro nca cuorc uyletca ro rguayldal revo .mei t nI chnicro cass,e lcrtelaloa eovsnu cruicaoinlt mya dpoveel sbeda on teh eits fo teh tnotc .bosrui nmtinerPo lioabmnad  tlaearalllolwc isevn, as ni ihst teaip,nt ggsuest itcounobstr fo eth eppru sengetm of eht VC.I

nor16  high blood pressure, i.e. Hypertension, risk factors for atheroscl., bruit !!! over left abdomen, secondary art. Hypertension. they always want the renal artery stenosis (like vWF in coag. disorders...) +

 +2  (nbme21#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ustJ aereildz taht ranel elcl ccmrniaoa t'ins eth trrecco awrsne cb/ ti idevdan eth noevsu iiauoltccrn adn tno het .taeairlr BP yam ont eb affcdtee sa hcm.u fi CCR erwe het rnswea neht hnte reteh lwodu aveh bnee aedem enpsret a/dnro rnlae TH.N

sympathetikey  Also, just thinking out loud, in the case of RCC, it's the kidney tissue that's dysplastic & moving, so technically the renal artery itself isn't dysplastic, right? +
paperbackwriter  @usmleuser007 very good point regarding the venous vs arterial circulation that I neglected to consider! +

 +2  (nbme21#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

CO is sreadicne iwht 1) rdeesecad t aa2drof)le edarsenci )rleao3p d Icaneedrs icotrnayilttc

An ornouavtiese tuslaif ecsater na arvttiaenel oeurt ofr altair blood tnio the uneovs naocctluiir o/w ngogi apts eth eerartoisl eth( jraom aesuc fo t esirTsacu.h)se,n by dgino os teh RTP orfeaa(d)tl edsrcseea adn eth OC is rden.iceas


 +3  (nbme21#46)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

/epwiatho1m1.y-nmolt:-despetbio//ccuu--swso12s3iyicms05utary/c8cdcgetsrssnocs.pionwsisrea/y/op

umrcisoyopmos eSPtc btyepur nssig adn stmosymp udencil dtpvmoneeel fo het iwgnoolfl frbeoe gae 8 in lrigs nad fboree ega 9 ni ysob.

etaBrs owthgr and sritf peirod ni r eglrdEsainlg tclseitse dan epi,ns caifla hria and dgeinpeen coiev in oisbyb Pcu or eurmdnar harii Rapd c tdwhAu etnlorAg obdy droo


 +2  (nbme21#13)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

utsj a nu.hhc... zleearmopO is ywlaas het tigrh waesnr

nala_ula  Famotidine is an H2 blocker which really only stops acid secretion via the stimulation of H+/K+ ATPase by histamine, but it still has vagus and gastrin stimulation. If you use Omeprazole, you get irreversible inhibition of the pump itself which stops the secretion of acid even if there is histamine, gastrin, vagus stimulation. +6
temmy  what about the healing of her mucosa. Is that not the action of prostaglandin?. That threw me off cos according to FA, misoprostol increases secretion of the gastric mucosa +5
cry2mucheveryday  same doubt..marked miso +2
sahusema  I guess because misoprostol is more associated with treatment of NSAID related ulcers and PPIs are 1st line DOC for GERD? +1
makinallkindzofgainz  @temmy, I think that Omeprazole is a better answer because although Misoprostol would promote healing of her esophageal mucosa, it wouldn't do anything to relieve the symptoms of GERD (due to acidic contents in the esophagus) +

 +2  (nbme21#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Dn'ot sthi is UC or CrnFroo.sh tsih uistqeno ouy vaeh ot hvae ecdonti het ega (66 lwLer-er do.ya)o etlf atqdarnu = iveitdlstiiruc of llryeed awmp&e;Lro hrtig tanudraq = aonsispgdiyala of dleyrel (nikht ehtes erew mitdnneoe in toa)Pamh

pfebo  Also, the patient has fever +

 +1  (nbme20#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oirNrsouv Shekc(y)t = sffetcA wereh a otl fo popeel aer in erqtuoa sserlc - cielslaeyp nomcom no esucisr - 90% fo lal relairadh bktoseuar no icsrues

sbryant6  Rotavirus occurs in unvaccinated children. In order for it to spread, all those kids would have to be unvaxxed. +

 +2  (nbme20#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oT weasrn stih otqsiune si ot eont a1th:t ) elaakinl tahospspeha avtityci is lnikde tiwh ostoe.ltbssa


 +6  (nbme20#16)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Turseobu srsclioes = -lhesaaf" "optss = hdlvoase-pa asear lepa esraa no .eks fninto /dt amromaasth


 +4  (nbme20#14)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

lAl horet peyts era hirtee mgtpednie ro avhe ls.aesc -- scopesr fo imoiantelin


 +2  (nbme20#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

.nl63o1wh.w0/htn:.sg5ptdubm/n/b/meivpic8w.

feiRle fo ltacratebni anip saw deudprco in isx unahm ttesnpia by tatlisuoinm fo rdcelotsee nmatpnyelre adtnimelp in teh reivnlcepraturi adn elicdaueaurqpt ygra tt.rmea The lvele of ilomnustiat tseciinfuf to cdnuei inpa feelir emess not to artel eth atcue anpi otrlhh.esd eansitIcidimrn vepetirite sltiitonmua rpdeuodc rlotecnae to boht lanictsotdumue-porid napi feriel nad teh lsigcaaen acntoi of cnctriao nitm;aiedoc hits cespros duolc eb rervedes yb ceiasntenb orfm tansoumi.itl S-aicetdrotuudipnlom friele of pina wsa eevsedrr by olenoxan in ivfe uot fo xis seit.tapn eTshe tslseur usggset hatt oasitfyrtcas lovaineilat of ettsnsprei napi in nmahsu aym be ndeoabit by ionetreccl oiiast.tulmn

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +23
xxabi  Also its the only one that's an opioid antagonist from the list! +2
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2
champagnesupernova3  Enkephalins* not encephalitis +

 +2  (nbme20#16)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ayavSrli tnsreeoic 1 . At owl oflw = giHh iccotnatrneon of pmua;sitos wlo atscerionncnto fo dom,siu ra,bicb m≈ .ld oeic2rh at gihh wflo = low oinncntectoar fo o;tpmusais ihgh aieconnotsctrn of ,suidom ,arcibb ;p&ma hcloeird

sherry  That's exactly what I was thinking when I was taking the test. But I was sidetracked by same HCO3 level. Can somebody explain this part to me?? +
charcot_bouchard  Because salivary duct removes Na & Cl while secrete K & Hco3 in lumen. In low flow rate HCO3 & K inc because duct is doing its thing for more time. At high flow rate K slightly dec (as cant be secrted as much) but HCO3 stays almost same. the reason is high flow indicates higher metabolism & higher bicarb production. +
cienfuegos  Regarding the bicarb (via BRS Physiology, which explains flow rate as coming down to "contact time" where slow flow allows more reabsorption of NaCl): The only ion that does not “fit” this contact time explanation is HCO3−; HCO3− secretion is selectively stimulated when saliva secretion is stimulated. +3

 -2  (nbme20#37)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iatnimV E fcyceieind si nwonk to cusea aiilsrm nlsiap sfetdce as itmVnia B12 cn.efdeiicy Hreow,ev ianmae is ton .ense

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +9
breis  FA pg 70 +
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1




Subcomments ...

submitted by mousie(220),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

fi uory CO slafl ... lwtdnu'o ttah ecuas invorctossanitoc ni eth ngul atucelar?vsu ioxhpya ieudncd inssoatonrc?vtoci

ug123  My take on this----His respirations are high-22/min--that will cause c02 washout---so actually lung has high oxygen---pulmonary vasodilation. Dont know if its right. +5  
usmleuser007  My understanding is that the pulmonary circulation changes very little in terms of an acute MI. It is b/c pulmonary circulation has a lot more room to fill with blood much like the spleen in terms of blood accumulation. With higher volume of blood in pulmonary circulation, more blood vessels are able to be recruited specially the apex. With more recruited blood vessels = reduced pressure d/t circulation in parallel +  


submitted by keycompany(311),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

naC bosoeydm ohw duenrdsnat why RPV sscederea htwi a dSd-ifetLe tarfnic lpeaes ilhtgenne me. I wodlu also aecpiratpe it if oyu dcoul elater it to grhti iddes earht firauel oto i.(.e how wdolu it )ah.gnce

sajaqua1  I believe that keycompany's answer comes the closest. In an MI, consider it as cardiogenic shock. The heart is a pump, and it is failing to move blood out of the heart and into vasculature. This is why PCWP increases. Because of insufficient output, the body has a sympathetic response. The catecholamines then cause vasoconstriction in peripheral vasculature to keep blood pressure up and continue flow, leading to increased SVR. Meanwhile, the sympathetic response causes vasodilation in the lungs; this would be an appropriate autoregulatory response, because the body is trying to keep up the flow of oxygen throughout the system. This decreases PVR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715548/ Is a pretty good article on this. Of course the binding of catetcholamines changes depending on saturation and the response is not perfectly understood. +12  
usmleuser007  My understanding is that the pulmonary circulation changes very little in terms of an acute MI. It is b/c pulmonary circulation has a lot more room to fill with blood much like the spleen in terms of blood accumulation. With higher volume of blood in pulmonary circulation, more blood vessels are able to be recruited specially the apex. With more recruited blood vessels = reduced pressure d/t circulation in parallel. +2  


submitted by beeip(124),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

You nac ees teh fonotdiremeean turceutsr ni sith ami.ardg

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +8  
famylife  "When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version +17  
usmleuser007  really like the pubic hair.... +4  
nnp  why not spasm of external anal sphincter? +  
vulcania  After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam... +1  
ajss  I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam. +  
thisshouldbefree  this is the map ive been looking for +1  
mnunez187  I didn't choose spasm because the stem says there the rectal tone is normal +1  


submitted by m-ice(340),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tihs mnoaw sah omxlPsayar rntuoNacl unlgabHriie.omo ihsT osmt enoft epstnser ni a ouyng ludat hwo sah siesepdo of akdr rinue in the edidlm fo teh hingt or hwne ankiwg up in het omri.nng s'tI asudce yb pemetloncm tcivayti dertycli igstaan het ittaesnp' nwo Rs.CB ntCaeri gilpldyosci are dedene no eht RCB rsceafu ot epevrtn kaactt rmof ptml,meneco het omts btaenol fo icwhh era 5DC5 nad D5C.9 satPietn iwht HPN avhe a siatcom tnmitauo in chwih yhte otsl utnfncio of a PIGA ezenym eddnee rof prpore pnonrestiate adn etantctham fo CC/9D555D on het BCR rcsuea.f eorTeherf eht swearn is a cdteef ni a lcle mbeeranm nrocha tnoper.i oiWhttu t,his mtemplcoen aktscat R.sBC

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +21  
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +  
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +6  
sexymexican888  @sunshinesweetheart Spherocytosis results in extravascular hemolysis (spleen) so no weird colored urine (due to intravascular hemolysis) as is seen in PNH (complement destroy RBCs in blood vessels) +  


submitted by m-ice(340),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

heT l"hkieodiol of gmissin na iisastno"aco ferrse ot epyT II reorr. hTe isrk fo pyTe II rorer is etesrpdener yb abe.t Thsi ocldu eb desfoncu ithw r,eopw hwchi is 1 - tbe.a

usmleuser007  Just rereading this question without the stress, i got it quickly! Could't believe i missed something as simple as this. +2  
snripper  Can't believe I spent 5 minutes on this and still got it wrong lmao. I was like, "it can't be 90% chance of missing an association, that's way too high." But I picked it nontheless... +1  


submitted by neonem(572),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tish aettnpi hsa yoptmcimtas ciotar s.osntise hsiT acn be edtiindife by hte iervtaulrnc yrphptyrheo (ot ecmenoastp rof isreneacd itnfanlocu fdelaoart fmor -mcnlanoiptno crotai elvva,) omssidtciyl mmurru dna eth alcntooi ta the norlma crotia a.era

reP atUpeToD on naciilCl oitifmanstesna of crtAoi tnes:Sios

inszziDse" nad cpsoeny — yScenop rucocs sa a enerstginp tsmyopm in aeappiytxomlr 10 tpcenre of ntipeast tihw ycstpitomma srveee AS o(r xeoptiaampyrl 3 ecnertp of lla tatnpsie hwit rsevee SA) ]3.[ hTree are aevlrse esrppodo eaintapnlsxo fro ntrxleioae diszizesn c)esponer(yp ro oscyepn in psetitna thiw ,AS thob of wihhc flecrte edrcadese eearlrbc .oeupirsnf cixescunErei-dde oaavdoslntii in the nesrceep of na ontuibcrsto thwi defix aicacdr ottupu anc ersltu ni tinoopeynsh."

guillo12  What does "fixed cardiac output" signify? +1  
usmleuser007  "fixed cardiac output" might mean that with the stenosis (ie. narrowed aortic valve) there is a limited or rather reduced cardiac output. Exercise would not increase cardiac output because the stenosis is caused by a mechanical (physical) rather than a biochemical process. Therefore, At any given moment the heart can not increase its output no matter how forcefully it contracts. +8  
fallot4logy  why not option A?arterial compression ? +3  
sunshinesweetheart  @fallot4logy LVH does not lead to coronary artery compression. only reallyyyy rarely will pulmonary artery dilation cause coronary artery compression. plus that would cause angina but probably wouldnt decrease cerebral bloodflow to syncope. her murmur + LVH point us toward aortic stenosis which does cause those --> fixed CO +2  
drpatinoire  @fallot4logy LVH can cause coronary artery compression, but typically leading to coronary ischemia after exercise (i.e. stable angina in this patient). The question is asking what leads to her syncope. Syncope actually means her brain is lacking blood supply abruptly. +5  
rainlad  how do we rule out mitral valve prolapse in this case? +  
spow  @rainlad murmurs at the right upper sternal border are aortic in nature. Mitral murmurs are heard at left 5th intercostal at the midaxillary line. +1  
jj375  Also, nobody mentioned the "prominent left ventricular impulse". I kinda get thrown off by these. Anyone have thoughts? Google was telling me it is from a hypertrophied ventricle so I'm thinking her aortic stenosis causes the LV hypertrophy and an impulse. Is this the correct line of thinking? +  


submitted by mousie(220),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hyW no ngaitews? I eman I egt tcEsysa si rboaylbp hte rugd of hceioc feober an all ihgtn cdean yprta lo()l tub no'dt rasnnutedd hyw terhe ulowd be olcd etietremsxi nda on nisegatw wehn si AF ti sysa ypertehihram dan d???hoar?b

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +12  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +12  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +20  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +8  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +4  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +1  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +9  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +1  
cassdawg  "Despite possessing a direct negative cardiac inotropic effect, ketamine causes dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow. Consequently, ketamine produces cardiovascular effects that resemble sympathetic nervous system stimulation. Ketamine is associated with increases in systemic and pulmonary blood pressures, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements."(https://www.openanesthesia.org/systemic_effects_of_ketamine/) +  
brise  LSD does cause HTN and tachycardia according to uworld! @d_holles +  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

odloB flow ni sserei nesecrsai hte ;serncsetia doblo owfl ni raapllel essacedre the ertcsaiens P)(R.T

By lkcnbgio het icaibluml nvsei yuo vaeh ni eecrpst edtmiil hte xsecse ldfoo wflo to the aatn.celp

hTsi dueersc teh lfwo in pllrelaa ciro;tailcnu huts ecsranesi eht TPR. MP(A = rcaaicd tuo tpu timse RP)T

sTih is secaube teh tltao corss oceilntas aear si .cureded

moFr ,itsh rehet is an drisecnea eusprres ni hte tleaf ccoriiut.aln

ehT bsrtcropeeroa etoldac idlmeeaiytm sdtail ot eth uaoirbtfcni of het momonc rdocita aerytr wuldo nssee a ghih eprresus adn eiesrcan tihre frtenaef galsni via .CN9

hsiT esucRed teh hptsyicatsme dna rsasieenc eht shcmayeratpitasp vai C1N0 u)(ga.vs

us,hT gircednu het athre !aert

usmleuser007  correction: meant to say umbilical arteries (2 of them from the fetal heart to the placenta) +  


submitted by hayayah(1081),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

cCobiarn raaseyhdn oirtshbini (,eg aaedmzcaoti)le nda loop itseudirc e,g( osimerue)fd are gtuhoht ot txere rheit ffeect no IPC yb dgcnieru iroebelscarnp ulfid F(SC) cuoptdnior at the riohocd px.esul

olegGo sasy isnmmceah is uonnnkw LLO.

usmleuser007  Just FYI: Mannitol can also be used to reduce ICP by drawing free water out of CNS Howeveer, it can cause hypernatremia, pulmonary edema, and expansion of ECV can exacerbate heart failure +3  
jimdooder  I think a good way to remember this is that CA inhibitors have very similar effects in the eye (reducing production of aqueous humor) as they do in the ventricles (decrease production of CSF). Can't say I totally understand the mechanisms but thats the connection I made. +2  


submitted by sajaqua1(535),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

A dsntadra itienoadv is a aeseumr fo ibarotlbypi in eglbmsnrie eth e.eaagvr neO rntadads tivoeaidn on a lelb uvrce iustnboidirt rtaesec a %67 hcance atht hte wnraes ilwl lie in rte.eh woT nrdtsada adnioesitv wlli ereatc a 5%9 chenc.a Trehe dtrndsaa etvainsodi scaeter a .79%9 anh.cec

hTsi ptteina hsa an ragaeve of 13,1 nda a 5%9 ecidecfnno ta 101611- naems thta the DS si 1.5 . So eon daantildoi DS lwudo evig us a rgnea of 75-1.15,0.81 nderuod ot 0118.8-1

usmleuser007  How did you get the SD to be 1.5? +  
usmleuser007  NVM Got it +1  
jesusisking  You wouldn't use Standard error with Confidence Interval? (pg. 262 FA 2019) +  


submitted by sajaqua1(535),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

A sadrtand ieiavdotn si a areeusm of tblbiapiryo in enbmrelgsi the eve.rgaa Oen saardntd tveidonai on a lbel rcveu otruinbdtisi cearset a %67 ccanhe tath teh eswanr lwil lei in eerh.t Tow asdrtadn iivoneasdt llwi aeterc a 59% hc.cena erheT arsddtan evtidoasin easectr a %9.79 .hnacec

hTsi neatipt ahs an arvgaee of 11,3 adn a %95 icndcneefo ta 111-160 naesm ttah eth DS si 1.5 . So eno ailddaonti DS woldu iegv us a grnae of ,.01-78.1551 nudedor to -180811.

usmleuser007  How did you get the SD to be 1.5? +  
usmleuser007  NVM Got it +1  
jesusisking  You wouldn't use Standard error with Confidence Interval? (pg. 262 FA 2019) +  


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

tnetPai ash a ongnliga ,styc chhiw nac solotaenspyun sg.erser

medschul  Mine would beg to differ >:O +28  
usmleuser007  Where would I have come across something like this (FA, Pathoma, or out of my S)? +5  
motherfucker2  I thought this bitch was a lipoma. Mother fucker +9  
divya  mf2 lipomas is fat. although fat may exist in liquid form, its still opaque, therefore negative transillumination. unlike ganglion cyst. +4  
beanie368  Only knew this because I have one that comes and goes... +4  
cbreland  I thought these were like a 1-way valve? Didn't think it would regress if that was a case? +  
yesa  I had that exact ganglion cyst because of too much multichanneling in lab, it would go away if I didn't use my hand for a while but then come back if I did. Had to get it surgically removed during first year of med school... +  


submitted by dubchak7(1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

They ugstegs Mpirstlooos ot urotanecct N.Ds.SIA. hyW not sPP?I

hayayah  PPI's don't have many side effects! If the question didn't involve the diarrhea side effect the answer would have been to give her a PPI. +2  
tsarcoidosis  I guess one takeaway is that PPIs don't directly cause diarrhea, but they do increase the risk for C-diff, which causes diarrhea. +15  
usmleuser007  PPI side-effects: + increased risk for C. diff + Increased risk for resp infections + can cause hypomagnesia + decrease absorption of (Ca2+, Mg2+, & iron) + increased risk of osteoporotic hip fractures (d/t low serum calcium) +1  
temmy  The patient got severe gastric burning and discomfort as an effect of the drug. My logic was since the patient was taking an NSAID it had to be a COX 1 inhibitor that destroys the protective barrier of the GI mucosa due to inhibition of prostaglandin so we needed to treat with a drug that will regenerate prostaglandin and prostaglandin is a vasodilation which might be the reason for the diarrhea. +  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ym tils fo nleipsd yept scell and i:dtniocnso

  • a. -F1N
  • b. -N2F ~ naSmhaconw (itAnon )A = ueoCntuas bifourmeraon ~ ihhg rlutilaeycl /w( igdanspila erttapsn ihwt rnsirgpseiten l-nercufreea onsez lcp;dc&Vaeylerobasn odiebs
  • c. omeamLoiy userut( p&m;a uas)oegshp
  • d. tmsahMoioele n(orktaitcey opitives)
  • e. spltAacina driyToh carcen abihicps( &;map galno with iantg e)slcl
  • .f ayuledrlM oidryhT crneca nca( aosl eavh nloygolap )slecl
  • g. rPriyma iadccra noaaosimgcar ntaai(nmlg ruscvlaa dlnsepi e)lslc
  • h. Omsoercostaa eno(b ceacnr) iphporocle(m )llesc
  • .i aMnemigino
  • j. sKoap'si oaScram -)HV(8H = lS-iiltke csalavru seapsc tiwh pplmu pss-dhldpneeia lmsator csell
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +9  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tihs nutqiseo hsa otngnih to do htiw trrutepeame (teh tvneitge tdosn'e asdders the urtaeemrpte fo the wtaer - so otn'd suaes)m

shiT si hwo oyu etg eth :nawers

1) niBeg ni oe-atcserpu or ni a ignmsimw lopo up to the ecnk lliw:

.a seeIsnacr Crlaent odlob luovem (eorm obdlo eurtrsn ot the htirg sied of hreat = cidersane )pldoare

b. Ienssacer PAN = eerdsncia otialndi of velsrtcine ~ rctmaneoypos miamchnes to rdecue veomlu eaolrdvo

c. Daederces HDA ;pa&m sdel-toy-mnaenRis = yobd si ni staet of umloev alredovo pa&m; dnsee to ercdue cysmsiet vlmoeu

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +  
d10s  ANP is released from atrial stretch not ventricle. +  


submitted by dr.xx(153),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh msto omncmo and eevrse ofmr of oaouatmsl nmntdaio cylcyopsit iyknde iedaess KA(D)DP eustslr from iutansomt ni 1KDP, gecndoin 1pony-lcisty ..1PC)(

cwrbi983lew8tCn4cntg4n4/:/si/i.hpm../stha.M/lc/wpmvPo

yotsubato  Here we thank FA for failing us yet again. Giving us PKD1, but not polycystin. I got the question right but I just guessed it because nothing else made sense. +14  
usmleuser007  Autosomal dominant polycystic kidney disease 1) occurs in patients with mutations in the gene (PKD1) encoding polycystin-1 (PC1). 2) PC1 is a complex polytopic membrane protein expressed in cilia that undergoes autoproteolytic cleavage at a G protein–coupled receptor proteolytic site (GPS). 3) A quarter of PKD1 mutations are missense variants, though it is not clear how these mutations promote disease. 4) GPS cleavage is required for PC1 trafficking to cilia. 5) A common feature among a subset of pathogenic missense mutations is a resulting failure of PC1 to traffic to cilia regardless of GPS cleavage. 6) Missense mutation in the gene encoding polycystin-2 (PC2) that prevented this protein from properly trafficking to cilia.  +2  
waterloo  yotsubo - the book is already so thicc. I think you made a great point tho, nothing else made sense. Sometimes you can't know everything on the test, but you can still play the game. +1  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

(A) kRis rosfatc ofr dginlpeove alavrscau roscesin dneli:cu

1) rumaTa = snuIei rj, shuc as iph indlooaisct ro turf,acre nac aaedmg rbayen loobd evsesls adn edeucr odlob wofl ot sone.b

2) eSiotrd =esu sUe fo oeh-ihdgs too,iocrsrsecdit husc sa n,serpedoni si a nommoc csaeu of uvralsaca siscoenr. Teh eanosr si n,onnuwk tub eno tsesihohpy si thta oorecdcstisrtio nca ercesian piidl lelevs in ruyo o,obdl runicdge olodb owf.l

3) csEvsxiee ohallco seu = oumsCnnig evlesra ochoillac rdsink a ady rof esrlvae reysa lsao anc uaces tftya oipsetsd ot omfr ni ryou olbod es.seslv

4) opiopsteBahshn eus = -tLmrnego ues of dtenaisoicm to senaiecr oebn stedyni tihmg urebttionc ot eeindvlgpo srneosioetcos fo eth j.wa isTh aerr incciamtlopo ahs derrcocu ni mose ppeole eaerttd twih ihgh sseod of htsee dtieiamscno fro era,nscc ushc sa litmpeul loamyem nad setmataict absert ccer.na

)5 irCtane idecaml rtatnestme = oaaRdtini tyhaper ofr ccnare nca waekne .eobn aOrgn rtisnt,otanlpana liesaceply ndeiky sn,pttaarnl laso is stsaaciode thiw asurvlcaa isr.seonc

BelaMic(d) sndincooti secatoisad hwit sucvrlaaa neriocss id:lnuec

'isteeitbus aGParasDineacc erth eSDai ItSdViyc ss/mIesAeH spulu eaytcisuselkm Soehtr lcle imnaea



submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reaCltn snrveuo temsys nietangorree

kineUl ppaelhreir eosnuvr smesty i,nryuj rjiuny to eht ctlanre rvnesou smtesy is tno lofdwole by eviextsne nrgoeren.tiea tI si miietdl yb het htiniboriy neisfenluc fo het illag and xlutrrellacae .vnteinrmoen The ilh,oste es-noirpmvenis rtwohg tenennimrov ,si ni tr,pa dcarete yb het goaintirm fo oltdaeeiascmnis-y oi,bthrinsi rtt,osceysa docr,eeosnytodgli gleryiondooecdt p,uecrrossr nda rgcilio.ma heT ernionmenvt ihitnw teh CN,S syelepcila liglofwon rt,amau oeccatstrnu teh erirap fo ieylnm nda nr.ensou tGhwro focrats are ton sdpeseerx or ps-ed;xerrese fro canite,sn the rrxteulecalla axrtim si igclnak nmaii.nls illGa rcass pilayrd r,mof dan het ilga tclulaay rouedpc astocfr atht tihinbi nnyeroliaemit and oxna irpear; orf aenti,snc OONG adn 3TNe5I-.h xoans hseeevsmlt sola osle het tnpioatle rfo gorhtw wthi ,gae due ot a ascreeed in APG43 xn,psseiore nmgoa s.eothr

usmleuser007  (wiki) +  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

erP mPtaaoh:

tsoM cmnomo ni altnooesmusppa mneo:w

)1 csforbcitiy ghcnas,e rlctntaadiu iol,pampla mobeiadarnFo

eMro iellyk ni apmuoosstpnlae e) wm:1no dhpsyoell uotmr idremb(f-oklionaae urm o)2)t erstBa nccares sceedanir irks td/ )1 nederscai e,ag unoatrdi fo ernogtes uhrouthogt flei ral(ey crna,eemh teal esaupn,meo oisbe yt) )2 tcayiAlp paa ypsehril 3) riFts rdgeee iasrlvete

sunQtioe steats etrpesns ti s)a:a cm2 i,rmf enoertndn )smsab on alixayrl ptolypyhmaeahdn or peinlp ihrdg aecc)s lexertym nosdraeeid mass hwti iulerragr rnilugcdmtseesar irarrgelu namtslrccoiicciiaof

so twah nac it 1b :e) IDCS = dsoe ont ulsylua ucdoerp sasm

2) Codmeo ptey = i-ghh eardg cslel hiwt enisocsr &m;ap ypocdshrit sticancaliicof ta rcntee fo tudc

3) aPetg seaDise = vlvneiso the niks of eht lipnpe drny(geilnu caacrino)m

4) CDI = )a forsm -ldkticeu rtstescruu 8g&%;t0( of )cessa )b mass tctedede yb lysaihpc naatmxoniei )ke hc(c c) uuslyal 1mc or rgreeat c)(e hck d) metaoDpsslci samtor = noectecniv teissu gnrowig twih rtuom p(roupsst ru)mot ~~~ (khcce -- arruilegr narg)s im )e ryleaMudl iaComcenr I(CD) = imimsc mrfioeobaadn

)5 ILSC ;map& ILC = DO TON cpdorue canftiocaiislc or asms )a CLI - elslc vhea lgi-inlsefe" netar"pt khitn of a abdede ccnkelae dan uyo tcu ti in leiddm lac(k drhin-)Ecae

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +3  


submitted by mcl(601),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

To neadxp no ihs,t uolsgyeaioonttphl csberside hte hiosgyolt fo kwsopia aacmsor as n"esdilp lcsel rmngfio sslit thwi rxeteaavsdta dre lodbo s"lecl

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5  


submitted by mcl(601),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

epteDis a mirucen velau oo(bld ru)srpese neigb srea,deum tespitan dwluo eb ditseedgan trieeh nteyevihsrpe ro omtisrnvnoee. To my ugatdeid,nrnns hte bste sett fro mpngiraoc ccriaatgloe ilvbaears soasrc ropsug is a ich serqau te.st

In rcnsatot, a stett- si esud to aeopmrc tneeweb teh msean fo wto ugospr ud(sareme livebara smut eb ntvi)ate.iutaq



submitted by mcl(601),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

apeg 911 tAineaPF t si nirpensget nhomts fatre teh ntrn,psatal hwhic smaen ti t'acn be puaytrceeh sunsel eh dpstoep ktniag ihs mnimsspsnretuoa.sup /cc/GHeVhAtnircou iseeads era eaditedm yb T lcsel for het smot patr (I i,hn)kt so tihs wudlo nmae yiomchpctyl aitsletfnri.

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by mcl(601),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

paeg 191 tF ainAPet is isngeeptrn otmsnh erfat het ntnts,apalr hcwhi menas ti catn' be tpauyhreec unlsse eh doesptp gkanit shi pomnpsnusraet.msusi econh/VH/icuGActr seseadi aer ideaedtm by T cllse orf het tsmo part I( t,h)kni so shit olwdu enma yhcmcpitoly trisi.neaftl

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by gh889(129),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cuold moeeons slpeea ialnxep hcihw gudsr f(i ya)n rea ta D nad ?E

usmleuser007  1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD. 2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs Note VLDL are very rich in TAGs +1  


submitted by seagull(1583),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

If ouy odtn' konw twah liouDmcar dsoe ilke any nmolra hun.ma hTe osfuc no awth iinsapr td'neos ,od lenmya tsi' setndo' ftafce PT teim and mots sipll no'td ransiece niottgcl lasi(eclyep thiw isi)p.nar Thsi si woh I gloci ot eth rhgit .wnsera

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +25  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +4  
drmohandes  Because dicumarol does not decrease platelet count either. +  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +3  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +4  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +4  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +3  
teepot123  di'coumarin'ol +  


submitted by mattnatomy(43),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

csreakCl eetrih ndcesiiat crhiocn rbhcotsiin ro iodnlioctonas rom(f inaupmoen ro npalymruo ae.)med

veinG atht ese'rht yoln a 1 yda hysiotr of OS,B Im' aenlngi orem stdawro arobl men.apunoi eaMyb tstah' olas sthw'a ignuacs eth S3 at hte SBLL? fI 'ist ptaSh uus,reA I essgu ew loucd eb olgonik ta ucate aesdirtnocdi + upionna?me rO Q re?vFe But 'ahstt ujst oltneip.uacs Culod sloa tusj be atth eht gnlu aotsniiodocnl si enigrlat oolbd fwo,l aelgind ot eht cabk pu noti het hiRgt trumiA ap&;m tcee.nilrV

brise  Patient has CHF from the S3 heart sound and has MR. You hear fine crackles in early congestive heart failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/ +15  
usmleuser007  No Infection - normal temps ; Q-fever presents with A patient with exposure to waste from farm animals who develops: a. nonspecific illness (myalgias, fatigue, fever [>10 days], b. retroorbital headache) c. normal leukocyte count d. Thrombocytopenia e. increased liver enzymes +  
saulgoodman  This patient has CHF. But it kind of sort of seems like he's presenting with a PE. +  


submitted by marbledoc(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Wyh wolud oyu ksa teh itatpen to tnfdeiyi the orsp and ns?oc I odtn’ etg het prapcaho !eehr

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3  


submitted by marbledoc(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Why uwlod uyo aks eht ineptat ot iyetnfdi teh psor dan ?ocsn I ’tond gte het pahcarop e!her

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nVaimti E eneydcicfi si nwnok ot uesac rilimsa pilasn tecsdfe sa tViniam 12B efyei.icdnc orwe,evH aimean si nto e.ens

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +9  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4  
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ndCceeoinf liraentv esseaicnr itwh daecdeser pelasm z.ies

usmleuser007  would require a a large sample size to see if there is a true difference +  
claptain  This question is bogus. CI does not always increase with decreased sample size or vice versa. Four readings with small variation would give a narrower CI than 10 readings with greater variation. The only thing you can be certain about by adding more samples is that the CI will most likely change, but which direction is uncertain. +8  
bartolomoose  Recall the formula for 95%ci Mean +/- 1.96* (SD/sqrt(samplesize)) +1  
the_enigma28  @claptain The point you made is relevant in studies involving random data. But in case of this question, the data being collected is in fact the diastolic BP. We take several readings of BP to rule out white-coat hypertension and have as accurate reading as possible. In this case, taking more readings will actually narrow down the confidence interval. The readings here represent physiological parameter, which wouldn't vary veryyyy widely in an individual. +  
lowyield  @claptain i was thinking the same thing but ended up choosing the increased because alot of NBME seems to reward the more simplistic answer than the overthinking answer +  


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

Culod oynnae ivge an xlpeema of tawh desiases owudl sbte hmact hte teorh arwnse e?chciso

vonhippelindau  Leprosy is a noncaseating granuloma fyi. I found that granuloma with suppuration can be caused by blastomycosis according to Robbins (pg 710): “In the normal host, the lung lesions of blastomycosis are suppurative granulomas. Macrophages have a limited ability to ingest and kill B. dermatitidis, and the persistence of the yeast cells leads to continued recruitment of neutrophils. In tissue, B. dermatitidis is a round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei (Fig. 15-38). Involvement of the skin and larynx is associated with marked epithelial hyperplasia, which may be mistaken for squamous cell carcinoma.” +7  
usmleuser007  Pyogranulomatous Inflammation An inflammatory process in which there is infiltration of polymorphonuclear cells into a more chronic area of inflammation characterized by mononuclear cells, macrophages, lymphocytes and possibly plasma cells. Actinomyces sp. is gram-positive, acid-fast–negative filamentous bacteria that cause pyogranulomatous infections in dogs, cats, cattle, goats, swine, horses, foxes and human beings. +2  


submitted by hungrybox(1051),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

giolwolnF a o,eksrt hsti nipatte hda kwensaes fo hre eflt ecaf nad byo,d so het rkesot tmus veah aedcffte het trhig desi fo her narb.i B aws eht only iohcec no teh hirtg deis of rhe .bianr

ltSil nf?oeudsc daRe ..on.

Teh rouaytnvl rmoot rbfesi socpnlci(iaotr )tcart ecdesdn omrf eht aprryim tomor texrc,o orssc (sseu)eadct ta teh ldylarmue yprdas,im dan tehn ynssape ta the toeinrar mrtoo rhno of the splian ve.ell

eusBcae of usnidetacos at het drayluelm ad,isymrp uyo dhuslo keam a neot of reehw nya storke .croscu sI it evboa teh demlylaur sirady?mp ehTn it lwil cefaft het idse eopptsoi het toersk ctr(lo.nrealaat) Is it below hte uladlymre arsp?mydi nTeh it iwll fetfac het asme dsei sa het rkoest isap).rl(aleit

hungrybox  Woops, E is also on the right side (also remember that imaging is looking up at someone, feet first). But a cerebellar stroke would have caused ataxia. +  
mnemonia  Very nice!! +  
usmleuser007  What gets me is that they mention that Left 2/3 of face is affected. This should indicate a non cortical innervation as most of the cranial nuclei are bilaterally innervated from the left and right hemisphere. If left 2/3 of the face is affected then it should also mean that the lesion is after CN5 nuclei. +1  
yotsubato  @hungrybox Thats not the cerebellum thats the occipital lobe. You would see leftsided homonymous hemianopsia in that lesion +8  
mrsmac  To my mind, it is simpler to consider the question first in terms of blood supply distribution. Left sided hemiparesis and weakness of lower 2/3 of face are both indicative of a MCA rupture/stroke (First Aid 2018 pg. 498). Furthermore, since the injury has affected motor function we would be considering the descending tract i.e. lateral corticospinal which courses through the ipsilateral posterior limb of the internal capsule then decussates in the caudal medulla. +1  
mrsmac  You're considering the wrong CN here. CN5 motor function involves muscles of mastication and lower 2/3 of tongue. The nerve in question in this case is CN7/VII Facial n. CNVII UMN injury affects the contralateral side, whereas LMN injury affects ipsilateral (First Aid 2018 pg. 516). i.e. before and after the nucleus in pons respectively. I hope this helps. +2  
nala_ula  Spastic means UMN lesion, since they also don't specify if there is arm or leg weakness, I didn't assume it was MCA stroke. I went with the reasoning that for there to be spastic hemiparesis, there must be damaged to the UMNs and therefore the internal capsule is where these tracts are. +  
champagnesupernova3  Omg this whole discussion is confusing. Internal capsule contains ALL corticospinal and corticobulbar fibers = contralateral hemiparesis and UMN facial lesion +22  


submitted by mcl(601),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tnioniheMe si an sneailste omina icda. llA rhetso listed rea n.to

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +  
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +1  
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +16  
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +  
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1  


submitted by nosancuck(87),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oY dgaw ew lla atubo VPT IMT aHLL

h,nelyiaPnanle ,Vlniae oDrtpA,yTKN Tne,inhoer ecisIl,enou t,ieoihnnMe ni,dieitsH einuLec yLesin

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this? +2  
charcot_bouchard  Just basically asking which is essential amino acids. +3  
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth +3  
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019. +11  
nala_ula  correct me if I'm wrong please :) +  
hello  For anyone confused trying to follow @usmleuser007's comment -- slightly modified Essential amino acids mnemonic "Ah, Three fans will try meth" Ah = arginine, histidine Three = Threonine Fans (phans)= Phenylalanine Vil (Will -- German accent pronouncing English word 'will') = valine, isoleucine, leucine, lysine Try = tryptophan Meth = Methionine +1  
pg32  Why does @hello and @usmleuser007 mnemonic contain arginine? That isn't in the PVT TIM HaLL mnemonic for essential amino acids... +  
paperbackwriter  @pg32 arginine is semi-essential. It is essential in preterm infants who cannot synthesize it https://www.sciencedirect.com/science/article/pii/S0955286304000701?via%3Dihub +  


submitted by hungrybox(1051),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sDaplcyits envi are a rcrpeousr to lmno.amea eyTh haev irrr,elgau ssd"p"cialty r.drebos mbeeemRr eth ""B in DCBA dnstas for uriagerrl rrdo.seB usvNe asmne .lome

Oterh snawres:

  • caastiohns rcasgnnii - ngreDnaik fo ksin dtcsoaaeis thwi peyT II iadetesb umltlise

  • aalsb lecl marnicaoc fo knsi - leR,ray if rvee stsiszmaet.ea onmylomC faeftsc urpep .ipl

  • lueb usven - docruB-eelol tpey fo mcnmoo m.leo g.einBn

  • gnmpeidte eoerhscirb aoeriskts - c"utkS "on nepae.rpaac Moslty nigben. fsetfcA rldeo eeppo.l

  • eN(to - you uulaysl ees ynol n.eo If mlpeutli oreesbrhci ssrtakeeo rae eens, ti inaiectsd a IG claynignam - aka reséLletra"-T is)gn
usmleuser007  correction ~ BCC affects the lower lip more than the upper +1  
sympathetikey  Pathoma says upper lip, good sir +26  
hungrybox  Yeah basal cell carcinoma actually affects the upper lip. Counterintuitive because it's "basal" which seems to go along with the lower lip. Here's another source (this website is fucking gold btw): https://step1.medbullets.com/oncology/121593/basal-cell-carcinoma-of-the-skin +5  
pg32  Can anyone explain how we can rule out C or E purely based on the question stem? If we read into the question that we are looking for something related to melanoma, then I get why we can rule out C and E. However, the question simply asks which lesion appears on both sun-exposed and nonsun-exposed areas of the patient's skin. I would say that C, D and E can all occur in that distribution pattern. +7  
paperbackwriter  @pg32 because it specifies "this patient's skin," and the only ones he is more likely to get than the average person because of his family history are dysplastic nevi +2  
teepot123  fa 19 pg 473 +  
rockodude  just remember BS. basal cell upper, squamous cell lower +  


submitted by hajj(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nac oynena lniexpa ths?i i nwko aimdne for y si griehh by tcuinlcaloa ubt x hsa tow soemd os how emoc y sha eghrih o?med

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! +  


submitted by moneysacs(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Why is eosd a DPA eatrf hbrit erluts ni r"igehh nhta mnrlao letf eailcrnvurt dcicraa t"uputo voer dcesnraie igthr" lciurvenrta ?OP"2 oesD the plmu eryatr g&t;-- oaatr ntuhs obceem reeerdsv refat t,irbh os ihehgr ogxyen roata odobl lwoud fwol bkac niot teh rtgih ecrneivlt? I get ttha reom bdolo wudlo eb ppedum ot teh etfl rvtele,nci untsirelg in L,VRHVH/ but not'd trdnaudnes eth O2 ib.t

usmleuser007  1) higher than normal CO b/c blood is shunted from aorta to pulmonary arteries. This blood is added to the volume that was pumped into the pulmonary arteries by the RV. Now when the oxygenated blood returns to the LA & LV, the O2 content would be greater d/t higher blood volume. Also for that same reason more blood is returning to the LV (d/t LV volume plus fraction of RV volume). This increased the CO. Right--> Left shunts have late cyanosis b/c the RV is pushing against the excess pressure generated by the LV. This leads to Eisenmenger Syndrome as RV enlarges and pushes against the pressure from the LV in the PDA. Thus shifting Left to right to right to Left and thus the late cyanosis +2  
temmy  The anatomy is aorta-pulmonary artery-pulmonary veins-left atrium-left ventricle Notice that the blood did not come across the right heart at all and because of the LEFT TO RIGHT shunt of the PDA, we add more volume to the LEFT side. Hence the increased left ventricular output +2  


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

"ponU ptlaicnpaoi of uperrsse to eth ntirneal nde of het c,rxiev cxnyooti si ldaeeesr r(treeohef scnierea ni lntaticorce o,prit)nse ihhwc etilsutmsa neterui ni,tcotarcons hhicw ni rutn esrcesnia esusrrep on eht eicvrx yer(tebh nnacsiirge xitcnooy rsl,eaee t.,ec) nluti het bbay si videel.red

esnroyS mintoronfia gerargidn cmhancilea ctserth fo hte ivrcxe si cdiraer ni a soesyrn r,oneun iwchh psyasens in teh sodarl onrh efbreo ngidanesc to hte rbnai in teh toerllraaante nsolcmu ap(aslilreit nad acanalteltorr e)r.tuos aiV teh aedimn brnorefia nlub,de eth teefrnef rahcsee het PVN and SNO of het hlyhoaptsuam. hTe iteprosro taiyuritp srleeaes yonoxtic deu to eidasncer nifgri ni het ypehphoyya-mpshotalolha att.rc tyniOcox satc no eth immtroemyu, on ectrerosp cwhhi vhea enbe rpugtdleaeu yb a aontlufcni aecinser fo hte tepenntssregoeeror-go aot.ir Thsi caofunntli taroi gcehan is temdidae yb a caeereds ni yroimetlma vsntytiieis ot eorestonerpg, ued ot na eiersnac in osnetgerpore oecrrpte ,A nda a uerctocrnn esracine ni yatilmrome nsesityiitv to rogentes, eud ot na ncisreea in greoesnt treeocrp α. ishT auecss rayimlmtoe nraccinotot dan uferhrt positive kfcdbaee no het e"xel][r.f1

roki/_w/ephgliukfe.di.arnxp/osieer/ist:eFwgnt

seagull  https://www.ncbi.nlm.nih.gov/pubmed/8665768 a counter argument for PGE if you chose that answer. However, the author believes oxytocin is superior. +  
usmleuser007  1) PGE rises initially that causes the uterine contractions= this would be equivalent to when someone say #of contractions per time period. 2) Oxytocin is increased when the cervix is manipulated (ie. the birth canal reflex). +6  
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +  


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

naeliLolge is ommcno asuesc fo oanenmipu esimrsepoupd on hnrcioc ibvscrouett armyplnuo a.sdsiee

asapdoc  Im pretty sure so is strept pneumoniae +4  
usmleuser007  COPD is also exacerbated by Viral infection: Rhinovirus, influenza, parainfluenza; and Bacterial infection: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus. however, the questions gives a hint that it may be legionella = "weekend retreat" which may be associated with this infection +4  
loopers  From FA 2017 pg 139: Legionnaires’ disease—severe pneumonia (often unilateral and lobar A ), fever, GI and CNS symptoms. Common in smokers and in **chronic lung disease.** +1  
kentuckyfan  I also believe that the other attendees showed signs of pontiac fever, which is another hint they tried to get at. +2  
luke.10  i did it wrong and chose influenza virus since it is most common infection in COPD but the clue in the Question is that the other attendee didnt get sick since in legionella there is no person to person transmission +1  
endochondral   but in Uworld s. pneumo is one of the most common bacterial exacerbation of COPD legionella wasn't even mentioned. How do we rule out s. pneumo ? +5  
nala_ula  maybe because in children s.pneumo causes otitis media? +  
smc213  Another hint made in the Q stem is the location being rural Pennsylvania.... Legionnaires disease was first discovered by the outbreak in 1976 at a convention held in Philadelphia, Pennsylvania. Not sure why I know this fact... +8  
hpsbwz  Biggest hint towards legionella to me was that they all were at a residence hall... i.e. where there'd be air conditioners and such. +5  


submitted by hayayah(1081),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tinaPte hsa niohcrc iearahrd ndilage to ltcmaobie idaosc.is aotriRerysp cmeiantosonp wlli edla ot aecsederd 2CO eyps(oartirr klisoslaa aiv e)nhotneli.ryipvat

usmleuser007  Aldo would increase b/c protons are anti-transported with potassium --> leads to hyperkalemia --> aldo activation ADH will also increase b/e of volume loss +1  


submitted by neonem(572),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

bvtesOcitru opyauhtr sucaes a tposleran etaiazmo &g;t-- nehw lng,pdoero bluruat gdeaam enues.s iTsh adesl to an eatcu barluut osncrsie, taderzechiarc yb trcncoei suplg in eth lubratu msyest sa eesn in the igmae

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +44  
usmleuser007  Think the postrenal azotemia is d/t her pregnancy. With the increasing in size fetus, the pelvic cavity is being compressed and thus there is pressure on the ureters. This leading to the presentation. As per above --- the crying maybe just d/t her pain and emotional stress caused by worrying about possible complications regarding her fetus. +4  
maxillarythirdmolar  My gut tells me it must be some sort of transient change in placental size with hormonal changes. It's reminiscent of what you might expect for breast changes during the menstrual cycle, imo +  
j44n  or maybe the fetus is literally crushing her ureters into the wall of her pelvis and shes got an infected kidney +2  


submitted by usmleuser007(397),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

u/.1omwh/ti3:/8bl/5.mpnpch.g.bnsdewv6n0wit

eRlife fo eatcblanitr pina wsa rdoupedc ni isx hamnu ptsaietn yb tiluntoimsa fo otesrdelce nalpentyrme indlmeapt ni eth pricelrtuearvin dna taaqrdeueuclpi ragy temtra. eTh velle fo nuitmolatsi ntfuficise to eiudcn npai elfire esmes ont ot eartl teh aucte pnai lre.shtohd iramintniescdI ertteiveip tuiaotsinml cdruedop rlcnetoea to hbto crtuitiuaooesplmddn- napi erifel nad the naiaslegc otnaic fo ccoirnta eci;ioamtnd hsit speorsc uocdl eb eredvsre yb bcsienetan rmof aumnio.tsilt pdnuicS-etoiadlmrtou rilfee fo aipn asw errseedv yb lnoxanoe in vief uto fo xsi apetn.ist hseTe utersls tgsgeus htta aicyatsftrso avoaneililt of pnriststee nipa ni uhmnas mya eb dbetinoa yb eccortleni .mtinatiulso

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2  
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +23  
xxabi  Also its the only one that's an opioid antagonist from the list! +2  
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4  
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2  
champagnesupernova3  Enkephalins* not encephalitis +  


submitted by killme(13),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nenInttoi ot rtaTe isanlAys

usmleuser007  in a per-protocol analysis,[6] only patients who complete the entire clinical trial according to the protocol are counted towards the final results +1  
sympathetikey  "In an ITT population, none of the patients are excluded and the patients are analyzed according to the randomization scheme." +7  
smc213  This video helps https://www.youtube.com/watch?v=Kps3VzbykFQ +13  
rio19111  Thx smc213, really helped. +1  
trainingrats  Where is this in FA2019? +  
teepot123  the video explains it well, no need for fa +  


submitted by thomas(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

toN uesr tboau thsi, btu it msese ot me that isht is gfeerrrni to euatoescnl"edrospeish nribitioh fecdyc.eini 'stI an zemnye fetedc thta si geiregdtr by MNJ rloecbks - nsceilhylnocuic ro rr'uscae.

.ikl:ahesowesiwiiokder/ope_dee/tssae.Pcygiu/eitpcntnirfd/chni

usmleuser007  I believe this question was stating that AchE activity was abnormal = it was not lowering the Ach activity. Which suggests that another ligand like Ach was being used. +