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Welcome to usmleuser007’s page.
Contributor score: 326


Comments ...

 +1  (nbme24#31)
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yM ridnsdnegautn si htat hte orualnmyp rcanolticui ehcsagn yvre itletl ni mtesr fo na eutac .MI

It si b/c lnoyuramp airuontclci has a tol eorm oomr ot lfil wtih ldoob uhmc klei eht spelne in metrs of dobol t.culuicomana

ihtW hgerih omevul fo boold in anlroyupm cn,urlitcoia oerm odblo svlsees aer leab ot eb urtdciere plylcaesi het .axpe

itWh rome iedurertc ldoob vselses = dcdreeu prseures /dt ilaiuoctrnc in lrplaeal

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. +

 +7  (nbme24#37)
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ylpimS pmo:eu tr negrey in a ltigh eawv teh ermo lkleyi it is to acsue relualcl )DAN( e.aamdg

tllrvioeaUt sha essl neegry tnah ys-raX ti( sgoe htourgh oury lhsef ot ese ns!oe)b

Oedrr fo igthl etrhgtns l(cle migdagan )cptibilaay

  • Ry-Xa g;&t VUA (soal bela ot ucaes dlbeuo randts r)beak t&;g VUB otms( ykelil egisln tadnsr ekbar - epa)edirr

 +1  (nbme24#45)
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Mots tirspnaboo ad neiroscet is edno ta the .TPC It is siht aonesr wyh eht CPT is hte ostm maaeliboltlyc aitvce otnoipr fo eht enrhpon.

As tish mgiea swsho, oyu anc see tath brosotnpeair ma;p& renectsio ouccsr at eth CPT

sthi manes htat ohbt PHA pm;a& trcneiniae era cedsetre ofr etoiaminlin ta eth TPC lnoga iwht the iaatildndo ulvmoe yerlef fereildt hrgtuoh het saownmb' elc.pasu

h;Frrotmuree uInnil si nheerit eseetdrc ron reos.adrebb

nehec nuilIn si rbteet rof FR.G ,tuB cnianitere si lorylmna edus ofr RFG as an teisteam oabyrl(bp t/d esa)e


 +9  (nbme24#35)
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Aftre moes secrreah thsi si hwy the retoh wsarsne era :crrotceni

lBaas ktctryeeonai &ma;p anlami diaulc

  • rrcnetoIc cb/ niamla udlcia si a cetnpomon of hte atbsenem mearbemn iwchh is fuodn enetebw hte hpieutlime and ryindleugn iccontenve stuesi .ge.(, emsreidip dna ersdmi of eth ks).ni
  • It si a rlhyogu 04 teannermo idew certellnuo-tcen zoen neeewbt hte mlsapa mbremean of eht labsa lcles dan teh d(rnncteo)leee-s aimnal ndeas fo teh banseetm mnmreeab. )(IWKI
  • asbla oikynaeettcr ettscaha ot eht nesbetma bnearmme igsnu oessdihemmmoe

raGaulrn oketraeyitnc &m;ap rmsttau urmeocn

  • amutSrt ludumci sapesreat hsete wto e.lysar
  • heret rea on msdmeoose htta nocntec hetse two reslay
  • gmeaI for ecfrerene

anamLi caldiu p&a;m amLani nesad -- lccik for gemia

  • otbh ear rapt of het steemnba mbmernea dan nto the seeipdirm

Myelanecto pa&;m sabla ykntietroce --- cclik rof gmeai

  • are tohb ceedctnno to taheocer iva hnarcd-eisE
  • it is rbbapoyl het gadmae ot hist cnoeitncon thta
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! +

 +3  (nbme24#35)
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Afetr emso rceeashr htis si hyw eht eroht wasrsne aer rccetnor:i

  1. lbsaa yceeintrkota ap;m& mianal aciuld
  2. entIrrcco b/c ainlam lducai si a nnocotmep of het metbesna bmeanmre hiwhc is dfonu beenwet the iielpehmtu and ulgenyrnid ncecnitoev ieusts ge,..( ieiempsrd adn drmeis of het ni.k)s
  3. It is a glruhyo 40 ramteenno iedw etcenlotrulen-c zeno tneewbe hte mlpaas aermmebn of teh abals lsecl dna het )loresdnecnee-(t lnaami asnde of teh mbentsae reanmem.b KW(I)I
  4. abasl cnaytoreteik tcetsaah ot hte emseantb rbmeenma gnisu esoemidoesmhm

  5. luaGranr tykeniotecra m&p;a srtmtua cmnreou

  6. tSmraut icmuudl erasspaet tshee owt ae.yslr
  7. rheet are on oemdmsseo htta ctnecno heets wto reayls
  8. mgeaI rof neecererf

  9. maaLin icadul &;map mianaL densa -- ikccl orf gamie

  10. thob aer trap of hte eaesmnbt enmmrabe adn tno het erdmseiip

  11. neoaeylctM amp;& albas itrkyneotce --- lickc fro mgeai

  12. ear tobh teeoccdnn ot heerocta avi Enhcra-sdei
  13. it si blyopbar eht gaedam to hsit ieononncct atth hmgit deal to mnamaeol

 +0  (nbme24#35)
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sirBngltie sessiade chsu as hegipmups asrvilug ()PV and shpgimepu scioaufel PF)( ear uotmmineua iseasdse ni cihwh nosduttiiae-oba taetgr dein.ssogmel

  • VP is dcseua yb rnitulaigcc asuobadiiteont gIG)( that gtreat D3sg gnsDilm(eeo 3) and eesstomim sDg.1
  • PV si tdnemsfaei by psaasablur hlysoastanci, or lesribts in het smuocu mmrnbeea dna esrbtsli in hte p.emediris
  • FP eapsntti heav isiobndtateuoa that traetg gs1D iwht csrafeulipi rebisstl on eht eisdpmeir thwi on smocuu mnrebmea essisu.
  • hBto eadessi rlutes in a ossl of ocnketraiyte ioadsehn.
  • pmPhiugse anc losa eb auesdc by a itbraceal oei:nctnfi olsuubl ogpeitmi is na toifcnnei deacus by a toycussochlapc batuicrem tath lrsesaee a nitox atht lsaceve the D1gs rtaxeuealrlcl omd.ina

 +3  (nbme24#34)
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oeSm oehtr nnoeierdc klie cesll dna ordssidre for ecerrenf:e

  1. prpS-e-anatldpe rocthniam feni( anulrgra os)mcyalpt ni Enrdicneo :orumst

  2. dyelMlrau dtiorhy rmonaicca

  3. iodeernuencnro ooodchmehtrumoaoca psymnr t
  4. icanodirC Torum )rot(neosin --- l(aos ash eessht of fumorni ll)ces
  5. lSalm eCll rnaoaiCcm fo nlugs = l,mlaS ulbe welit schl tncsa alpcmosyt nda arnuragl =rmaint o)ch tf,la ahlovaeds-p ielhstwcl  snact cltpsaymo adn pccrrmiythoeha uincel

  6. allSm uleB elslC

  7. gwiEn rsacoam saicl(taanp talimagnn )muort
  8. CSC of slgun
  9. ,laft odavhaplse- sl tcwheli cnsat mpaycsolt dna ecocrhaihtrpym inluce
happysingh  i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma .... +1
niboonsh  might want to look at fa pg 665 +

 +14  (nbme23#23)
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  1. Csrneca fo hte pveis,l nuilincgd the stptoare, speard to eth raaslmcobul npsie iva eth rerabvlet osevun lpuesx .(VP)V

    • The VVP ucamsmniecot whit a neumbr of osvuen wtksnr,eo ngidcnliu teh ctaiptsro sevonu epux,ls hchiw sereivce the enousv pslpuy ofrm het toeartp,s sn,eip dan erbdlda.

    • VPV runs pu the rneeit apnlsi lcunmo and esnncotc ihwt the sneuov ypspul of hte brnia iav a eslelavsv semtsy sts’oBan( )sPlxeu wcihh oswlal ofr iactdriiboeln fwlo dna nloetrauig fo aicannltrria ersshriuTe.ps novsue cenooctnin to eht breaeclr iuntolcirca yma phel lnixepa hte ytensprpio of rmtuos ot tstsmiezaae to eth rbna.i

  2. heT VVP oals mtsocimncaue htwi hte ysgazo veni ni the t,cehs hiwch slaxneip ni tarp hwy asetbr dan ungl rasccen feutnlqrey aesimttezsa to hte iathrcco nesi.p

    • yl,aliirSm due ot anoryulpm vsneou neagirad tion eht eftl seid of the ,aehrt lgnu mosutr tnefo prased caseyyismtll iva hte lrtiarae s.yemts
  3. tohAhlgu yphml denso aer the mtso ommocn estsi fo tseasstiam in e,angrel ihylpactm esprad to eht kltesale syemts si very a.err

  4. The amifirnopmp sulxpe eeercvis uvsnoe giaedanr mrfo hte isste,t ymdeiiis,dp nad cutsdu neresfed adn asnrdi iont teh iutatcrsel eniv.s


 +0  (nbme23#23)
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3. aencrCs fo hte v,lpsei ilgnndciu hte peaorst,t srpdae to the clalsburoma penis via rh brteeleatv vsenuo peVlPV( .u)xs a. hTe VPV oimnusateccm wtih a mnuber fo uvosne ntork,ews .i idcugnlni ri phatecostt svneou uxlse,p ihwch iveerecs teh usnevo upsylp romf het r,ttpaeos si,pen nda ddeblra.  .b VPV sunr pu het ieertn lianps nlcuom and ncosnetc hwit het usnvoe lpsuyp of eth arbni iva a slvlavsee esstmy staBns(o' exlu)Ps .i hhwci sawoll fro cbenidrlitaio lofw nad ilrtonageu fo inatcarlainr psur sre.e i.i sTih sounev eonncotnic ot hte eecrbarl nctrociuial yma ehlp elxipna teh soinpyeptr fo surtom ot tmizasaeest ot eht 4ri.ba n. heT PVV laso nimcasuemtoc htiw eth gazyso evni ni eht h,scet ciwhh ixpnsela ni rtpa wyh satrbe and lgnu nescrca elfretnuqy saettzaiems ot teh ochracit nei .ps .a ly,milriSa edu ot mpanuylor useovn ndgaiera niot the flte eids fo hte arhet, ugnl otursm tfnoe dpsaer msaeyyticlsl avi hte aterrlia y. ets.m5s lAtuhgho yhlmp edons aer het tsom mmcoon tsies of tastesamsi in l,geenar cltmaihyp sdpear ot the ltseklea yssetm si ervy .ar.r 6e eTh rppimnmioaf spuxel eirevsce svuone dnaigera ormf teh sist,te sdiiyiepdm, dna ustudc fresneed and indsra otin het caleturits vi esn.

 -1  (nbme23#33)
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tareT tshi ilke a aIoVPm eWtayr( ,haeraidr oaahcidrhlry = ecedrdu HlC ni eht nulem, ;p&ma aykiohleap)m

this ilwl edla ot moabtelci isoicsda d/t osls of bbirac in toslo

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)
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oodBl lfow ni eseisr cssreiaen hte ce;trnasies obold lowf ni llplaear sasdereec eth entaeiscsr T.R)(P

yB ogbklnci hte bmlialuci nivse you heav ni tecespr ieldtim eth excses odlof lfow ot hte l.pceatna

hsiT rudeecs the wofl in laeprall u;caocirinlt uhts nrciessea hte T.RP MPA( = cadaric tuo ptu tiems RTP)

hiTs si suaebce hte talto crsso lestcoani area is deuderc.

omFr i,tsh rhete si na ecdiasner eepsrusr ni eth fltae rcliaotiucn.

heT rstpoceobrare eoatcdl ydielmeimat dsltai to hte butioaficrn fo eht mcoomn tioadrc yrrate lwodu essne a hghi spreurse and rseieanc ertih arnfeeft giasln iva .9CN

hiTs uRceesd het sstpymehtcia and neeacirss eht tpcesyihtaspaarm aiv NC01 vsg().au

Ts,uh eginudrc het herta ar!et

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

 +0  (nbme23#1)
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Teh tlasoneagti acs si crphealis ni hsp,ea nad aylsulu ldteoca ni teh upper patr of eth usdfnu of the ru.etus yB lirmxeaptapyo 9 ewske of estotialgna ,ega teh mianicot cas ash pddeenxa ot pcuoyc het yrotjaim of het leovum of teh sganoelatti cas, atleuvelyn idanepgxn ot recdue eth cberynxroaemti melcoo to a ihnt lryea nbeewte teh imnnao eenmamrb nda teh sede.romm By t,hen the nsaiatoglet csa is usullya lyipms acldel the cnm"iaoti ".sca

etiDDogureven lmpn rimoseebgnsey, hte rmcoeyirenxtab cmoleo or( ihonrccoi vtcyai) atth eutctosnsti the gsoaanetitl sca is a rotionp fo eht ceuncspot oitcinsgns fo a cvtiay wnetbee eer'usHs mrmeeban nad het bophla.orTts

Drugni ntomioraf fo eht ervitipmi koly asc, moes of the magrinitg baysthlpo slcel tnftieeareidf toni ensycehlmam secll htta llfi het ecsap neetbew r'Husees remmaneb dan teh sorb,hotlTpa foirgnm eht crxmeonrayietb .seoremmd As nepetdevlmo seorgpsr,es sllma lnuceaa geinb ot romf iwitnh eth yrcearxeimobnt rmsdemoe hchwi lenearg to bmecoe teh otmneiybxaercr m.locoe

The trxaeormbcinye olcome dseviid the crroymeitnbaex mrsemedo inot otw aey:slr eaormtrbxnyiec opnchncplsuerial odrmse,me cihhw iels ndtcejaa to rsueHs'e emnrbmea ardnou the oustide of the vprmiiite klyo ,sca and brenmxaityreco orcslpmoteiua resedo,mm ihhcw sile djneacat to teh lohytoaobtrtscp aylre fo het y.eorbm

hTe ronocciih tcayvi si dceenosl yb teh ooichicnr etlap, cihhw is espodmco fo an nrein yarel of uclaeorspmiot omrdmees nda an ouret ylera of lraptosobht ls.cle

IKI-W--


 +3  (nbme23#37)
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VMN otg .it

tuJs FeYt:Ih CI wsa tstaed to be mrfo 61-1101 hwit %95 and mean of S131.,o on teerhi teehr aer wto DS no terieh idsse of 311 te(h )mena tath igev het .95%

1=-11613 3 htwini 2SD ebavo the enam =1111 30- 3 nhitwi DS2 wbole hte mnea

3 didvied yb hte 2 SD = .51 epr S.D

to gte orfm 59% ot %99 uoy ahve ot eornicrptoa neo emro SD 3( S)D on hrieet issed fo eth enma 311)(

eeh;refTro ta 9%9 CI 5-11.=10 1058. IC .165=11+ 5.117

uodnR eetsh pu dna ouy etg 1-10188

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 +

 +0  (nbme23#45)
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tocAir silDitaco Psu erres

  • giHh PRT = hhgi DP
  • ghHi HR = ghih PD
  • iHhg SV = hhgi PD

rciotA oSyslict rr esuesP

  • ihHg rcyiotiltatCn = ighh SP
  • Hghi VS = ihhg PS
  • Low ncCmiaepol = hgih SP


 -3  (nbme23#45)
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1. Acitro satDciiol rrsPeeus .1 gHih RTP = hihg PD .2 ihgH RH = ghih DP 3. ighH VS = ighh PD 2. crioAt ylcSiots rseursPe .1 igHh totCiacylrtin = ihhg PS 2. iHhg VS = ihgh SP .3 oLw encapCimlo = hghi S P
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. +

 +2  (nbme23#42)
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kiLe nay fo the O,DPC the enitatp ash a dtffciuli iemt naxhileg eth srnpiide ira sthu( its ldacle na rsouitvtbce )iedases

DPCO sstuler in VCF ae,sedecr /1CFEVVF iator d,eesaecr RFC srinaeec, dan ekpe yeaoirxpt ofwl dears.eec

A tomur or any hoert jbotec atth wdoul opcsrmes on ro woranr heest eht air yaw cttar lwudo entrpes sa a ODC.P

liIghnan nda ghnexial uwdol be eilitmd



 -6  (nbme23#38)
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So as a yiispachn erp iths etsnuoqi ouy llwi og of oesm ri'enoghsb rswod adn ont nmfroic if the apnttei sha na nddaceva .c.iitd.evre emses ekil het ocd nda hte ohbergni rea ni emso ndki of a ldae reeh ....


 -1  (nbme23#33)
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PPI t-s:efifceeds + serecandi ksir orf C. dffi + eracIdsne iskr for rpse ciftsneoin + acn uscea hmnsiagopyea + cdeseare oainbpotsr fo (2,C+a Mg2,+ m;pa& o)inr + ncerseaid sirk fo rtoetipcosoo iph usrtercfa /(dt owl resum )lccmaiu

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)
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Tshi uostqein ahs hgitnon to od ithw rettrapmeeu (teh etgnvtei toesd'n rdsased eth metapetreru of eth ratew - so tnd'o usm)eas

shTi si who oyu get het :esanwr

1) ingBe in s-eautepcor ro ni a gsmnwiim oopl pu ot het ckne llw:i

.a enceasrsI ltnrCea doolb lvemou eo(rm odlbo nruster to hte htirg deis fo ahret = rdciaenes arpedlo)

b. Issenacer ANP = snicadere nolatdii of citesnevlr ~ ynepsmraotoc maimenhcs to dcerue eoulvm eloarodv

c. cdreDeaes ADH m;a&p ne-t-lanRoysimdse = ydob si ni taets fo mulevo raevodol m&p;a edsen ot durece ytescism umlevo

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. +

 +0  (nbme22#45)
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iTsh rmoe lkeily ot be ecitrisdu heartr tanh sealaxtvi /cb

hte bal tdysu swhos a relna nfyiudtncso B(NU map;& arinineeCt ear adeetevl)

tsoM iyellk eth ptainet usdabe oopl i;teridsuc salo oswkn to caesu cnncortoiat i,laasdlok nlgoa tihw nrlae bsmpoelr schu sa einlrttitisa sinirtehp

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. +9
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)
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)1 rSaeiuicplf tgr-ifes)eder( = eEpsmirid ~ tpssneer sa rde s ihioutntwk sebrsilt

2) ficlriSeupa pliaart knhstseic es-cdr)de(goeen = edsEtxn toin isiulcpafer iey(ldrmalapi) rps ~ Psenrset hwit sdrsnee iwht etisearlrbc l ;apm& chnish talbew rrsepeus

)3 Dpee iaalprt ktnsseihc )ee-(sedgecodrn = xnseEdt otin deep (trecua)rli remdsi ~ nseesptr sa olyewl ro iethw nski twhi lsse ilna.cbhgn aMy be .lbtiserngi

4) Fllu estschkin -ehgdrt(eirde) = ntEsexd outgrhh treeni idsmre ~ erpestsn as stffi dna ronewthwb/i is.kn oN hngaclnbi.

5) ru-ogteerdehF = netEsxd hhtguro treein i,nks nda tino relunyngid tfa, cmeusl nad eobn ~ eeptssrn sa lbakc inks; rcdhrea cwhtia hers

endochondral1  what is rhus dermis? +2
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)
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Iicsonutstepuns is gylrlneea sdauce by a lbekogca in eht IG atrct cseadu by a ,mourt ppyl,o iuleuti,crvdm ro tsuj bytilimimo at aprt fo hte .ctrat

1) My tughoht was atht the ttipnea dha a lcekeM uelmti ivdruc yse it npapseh ni 2 tefe mfro the lieleocca evl;va tbu atht is ni atbou 2% fo eht ulaonptiop

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

 +6  (nbme22#21)
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)1 DKDAP = spnstolyicy 2CP()

)2 KARDP = ofb ndotcyiticipy/unrsl (PC)F -- railsmi ot pstsnloicyy

FPC tienpor is oufnd no teh piraymr ilica fo hliiatepe ellcs fo itoarclc nad yldreulam lnegotccil stcdu adn lnoicsethyogca fo ilbe sdcut

PCF castrneti hiwt DKADP tnpoier CP2 and aym also epcariiaptt in iths aoliutegrn apythwa fo eth ncysenoresmoha ofucnnit of eht rypriam ilac,i lccuaim sln,iagngi nda PCP.


 -2  (nbme22#20)
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usCsae

1) vAulcasar niecsosr soccur ehwn oblod ofwl to a ebno is dueptienrrt ro .recudde eudeRcd oldob ylppsu nac be scduea b:y

2) iJtno ro onbe mrt.uaa An j,nyuir scuh as a ltidcdaeso tnj,oi thigm mgdaea renayb olobd lss.seev enCcar ttrtsameen ningoivlv ntoiaidar laso cna aeenkw beon adn mhar lobdo ssevles.

3) ttFya pdtssoie ni obdol esslsve. ehT fta i)ldi(sp acn okblc llmas odlob eesvssl, uidnecrg teh blodo lwof ahtt esfed n.ebos

4) eiCartn iase.seds ldaeMci i,nonitscdo chsu sa kciles elcl maiaen nad u'sGecarh a,sdseei osal nac cusae nhdidiesim bolod lfwo ot nbo.e

roF tbauo 25 ptenrce fo eoeppl ithw avcusrala cnreo,iss teh eascu fo tpirrnteued oobld fwol si knn.nouw


 +1  (nbme22#20)
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)A( sikR rcfatos rfo inepldveog lruacsvaa enisoscr :cdnleiu

1) aTmura = nse,irj uI hscu sa iph oasiiocdntl ro ,cerfutar can dagaem bneary olodb seselvs adn reecdu odlob lwof ot oe.nsb

)2 terSdio us=e Use of diohsheg- dir,etiootsrsocc uhsc as dnporneeis, is a mcnoom asceu of aaacrlsuv rsio.nces heT sreano si ,nounnkw tbu oen sophityesh si atth ortsicoeisdrtoc acn ceiasenr ilpid sellve ni uroy oo,ldb egirdcnu loobd fowl.

)3 evceEsxis ohlaclo eus = gnCmsinou esrelav clliachoo nidksr a day fro everlas asrey lsao anc secua fatty eoispsdt ot fmor ni yuor olobd ssvlees.

4) snhpohBpsatoie use = rogLn-met esu of misantecdoi to aicersen ebno endytis imgth enrbitctou ot dpvnieoleg ossrnseetioco fo teh .jaw hTsi erra lcatioonicmp sah rcdourec ni oems eeoplp tdreaet hitw hghi sodes of eshte imoinetcdsa for arsncce, uhcs as ulmelitp leomyma dan mseaaittct aestrb nc.arce

)5 Ctirnea limcead rtnatsemte = iondatRia apethry orf necarc anc weakne eon.b rganO itnantralpas,nto lpaecylies eyidkn l,tnanrtaps olsa is asieoctasd hiwt aasvulrca s.coneisr

ecBMi( a)dl idontnisoc ossadateci tiwh uaraalcvs cnessoir eilcund:

racr'tDhui PtbnssaiseeceaiaeGt ImiiAyesedSIac s stDSV/eH spuul tc usltskmoihareeeSy clle eimnaa


 +2  (nbme22#11)
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nI aescs of lchdi ro adtlu eubas

1) fi teerh is lerac idveence such as if a idclh stsaet htta trspena ipsunh by tinigt,h cdhil si wnhsgio faer of natper ---- llac hldic tocrnpiteo rhigt waya ( otdn' nede ot awti and ask)

2) ames night egso rfo teh tudal tub lcla teh utadl ectooitrpn csrsieev

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. +6

 +0  (nbme22#36)
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heT scposer fo nermifdo tnsonce srcocu wneh coiainmtucnom wtnbeee a ntiepta dan yncpaiish esrlust ni teh sanipett’ rhioziuottana ro eatngrmee ot grenduo a psecciif ameildc rottnnnv.eeii In sigeekn a t’ptisnea nmediorf nsetocn or( eth sonetcn fo hte ’entistpa targosure if teh pttiaen lcaks -giekiamdoncsin pyiaccta or eedclins ot paieracitpt in ikgamn ind)e,cioss cihpnsiysa lush:od

a)( ssAsse hte anietts’p yliabti ot dnesndtrua netvarel cidmlea nimftnaoior adn eht cspnmaiiitlo fo ttraetnem ravsettelnai nad ot meak an tenneen,dpid lvntaouyr eoisic.dn

b() reePnst eaetnlrv finaitmnroo cyercutala and ileyvtisn,se ni eekipgn hitw het na’ptstei rsreenfpece for egicviren dcimael noiofntm.ira Teh spychanii sulhdo ldiceun inoaniformt oa:tub

The sgioiasdn (ehnw onTw hk)ne trunea nad suoprpe of mderedecmno Tneinrvthnestoi e bnsedu,r ,iskrs dan etdxpece inesbfet fo lla sinoto,p gluicidnn rfignogo )(tt aecremtn mueotnDc het iedfnorm otnencs icstonanrveo and eth ets’ptnai o(r sua)rt’orseg ednicsio in hte cdaleim cerdor ni msoe mn.earn Wnhe hte guattipaeor/srnet has irpdeodv iiepsccf rtetiwn c,esnnto eth ncnteos orfm oduhsl be ldcenudi in eth cer.rdo

In ,eiegnrmesce ewnh a doinceis tmus be emad eytl,rugn eht taiepnt is tno blea to iaicrtappet ni dicnieos makni,g dan the epstai’nt ueostgrar is ont l,aivlaeba acsnsyhiip may iiieantt eeattrnmt wutohti ioprr nordmife eoc.ntsn nI hcus aoui,tstisn het ihypcains hsdoul mofinr eht /epeatsttrngraiou ta het raeeistl poorupyntit adn anitob netscno rfo ngnoigo taenrtemt ni enegpik whit seeth gel.ieidsnu

MAA incsiPeplr of lceMdai th:cEis I, ,II ,V VIII


 +1  (nbme22#32)
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ealnrtC eovnsru mstyes nagtrneieero

lUkein lehpeirpra usnrvoe syetms njyiu,r yinjru ot eht ntrlcae oseuvrn eymsts si ton ollfewdo yb vtnxeiees .eneterarogni tI si diimetl yb the ibntiihyor sinecflenu fo eht gilal dna lareelctlxuar onnvtreine.m eTh tlihoe,s np-risvesoneim wogrht tnoeirvenmn s,i in aprt, eearctd by hte imrionatg of i-mlnseeaictodyas ,itbnhirosi ,sctserotay ,oedonsecrolidgty ogledretyincood ur,eocprrss nad ogiilr.cma Teh mvenioternn itiwnh het ,SCN pcailseely lglinoowf tmaa,ur seotcutrcan teh aierpr of nlyemi nda r.oesnnu woGrht rocstfa ear ont pxsdeeser ro ;r-pssxdeeeer fro caeitsn,n het reultallxraec rmtxai si gnliakc mslinnai. iallG csrsa pydrali rmof, and teh alig atcullay rupdeoc tfsroac thta inbtiih liaityonnmere nad xnao rei;rap for ientc,san NOOG dan TN3-5hIe. anoxs temhlsevse osal selo het palteiont ofr whrgto iwth ge,a eud ot a creeesad ni P3GA4 ernoixes,sp omagn .otrshe

usmleuser007  (wiki) +

 +0  (nbme22#32)
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uneoeogetenrrNiar ni eht rehalpeirp osvnreu myetss ()SNP corsuc ot a giinisactfn re.]e][6[ed5g eAfrt an ynrjiu ot eht oxa,n leaepirphr sonrneu avttcaei a eiyvatr fo innsliagg ywpahsat hwhci nutr no w-htorgpor neegs, ldaenig ot trmanoerofi fo a ultafcnino rtoghw neoc dna rer.eiategonn eTh trwgho of heets xsona si soal eovgdner yb ctmoiccetha fcorats ceseedrt frmo nchSwna llsec. rnIjyu ot hte preheprlia vesnoru tyesms ayitmdmiele leiistc eth niimatorg fo seg,tochayp awnnchS ,lelcs nda scghpmaaore to teh snieol stie in rerdo to eclar waya siberd husc sa aeagdmd siuste cihhw is iinriboyht ot .egernretoina Wneh a rveen xaon is evede,sr het edn llsit cedhatat ot teh lecl oybd is ealblde the aolprimx ,enmtegs wlieh het oerht edn si alelcd hte saltid msn.eetg fAter i,jynru hte airlmpxo edn lswels adn esxrecipnee soem rgardoeetr ,odtgnneiaree tub coen het rbisde si ,elcader ti gebins to uortsp aosxn dna eht seeencrp fo tgrwho csoen anc be edc.etedt The oplxamri aosnx rae bela to oregrw sa nogl as hte clel doby si tcta,ni adn htey haev eadm ctacnot ihtw hte hawcnSn lelsc in het ournaeielnd chnnale or tbu.e munHa xaon rtgwoh estra can ercha 2 mdmy/a in slalm eevrns adn 5 yamd/m in lrgea ev4.]en[rs heT stalid m,etnegs h,owreve nceerspxiee iaalnerlW aeidnoegentr thinwi uhsor of hte riuny;j the xnosa and leimny adere,enetg tbu the iueodreunnm res.mnia In hte aeltr gsaste of ieanerngetor hte naieirngm uredanoeiln tueb tsicdre xona whgrto acbk to eth erocctr grtets.a nDgrui aWalilnre ne,nidegaoetr hSannwc csell rwog ni rordeed cmlouns glnao hte eiounderlan ,ebut irgctnae a anbd of nĂŒnBerg )B(ob atth rotpstec and resprevse teh deiulnroane cnh.ealn ,sAol hcoagpaersm dna cShanwn lslce sleeera turipocehnor storacf that naeehnc otrgwe-r.h

kiw()i

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)
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owT mjaor csaishmenm fo ncoait hvea enbe e:dacudltei

1) lyicFoeusnt si ntnlygrlfaiua centoderv into eth yticstctao fulcriulooar hcihw ndeurgose etfhrur tepss of cavnottiia and finyall aertntcis as n-ao5tpirderolhfuhustipioer twih NRA ysiethnsbios suht rsiigubdnt het udiilbgn of rntciea enislaste .snoetpir

2) seFynoultci losa ngeosrdeu nsvrcoenoi oint pooirur-oesmhfopoel5noyahdtxnieud cihhw nsiitbhi gnlufa DAN sihtys.nes

)3 eimtyhyTdla antetyhsse is an zenmye ttha tyaazlecs eht nseioonvcr of xdidrueenoiy otphmaepsoohn )MU(dP ot ddinxeyhoeimyt noheaptomhspo (.PTM)d

hiymTedin is one fo hte ctuelnisdeo ni D.NA

tiWh ihtbnioiin of ,ST an cambinlea of delioetoexsucnyd and cinerdesa lseevl fo UMPd s.riae Boht uacse DAN maged.a

WK(II)

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. +13

 +8  (nbme22#23)
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roohrAptd innfcsteoi

.a ynarspaTmo izucr = diiudrev gbu

b. omaraoynpTs cburei = teseTs ylf

.c larMiaa = Aseolneph uqimoost

d. vislviFrau proGu (seWt lNei ,rsiVu eDgn)eu = edseA mosuoiqt

.e foriaiiaelrcM = acklb yfl

f. mhiiLnaeas silnbsaiizer = ansd lfy

.g Blreraoi mpa&; sbBiaea exd=Iso tikc

.h ibiceskaR eikisibrc mp&a; aaceilslrFn sltaseiunr = mcaoeDrrnet cikt

i. bisaReki ekpiwiorza = ceil

.j oLa ola fniac(rA eey rmwo) = erde lfy

.k ruhcariWee bcrfatoin = soqtmioseu

zoek816  West Nile Virus = Culex +1

 -2  (nbme22#23)
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.61 dohAprtor tesionncif a. arsmpTanyo riczu = vrudiied gu b b. amnpoysroTa uiebrc = eTsest ylf c. ialarMa = eAlsehopn u osqimto .d risuvialvF pouGr es(Wt Neil ,rsuVi ueeDn)g = eAeds q ooumtis .e cfrriaMiealio = lcakb lyf f. Lshianmaei isliinrebzsa = ansd fly .g Brerilao pma&; seabaiB eosx=dI kict .h icbaesiRk csbikriei ;pm&a srlaeciFnal srsanuitle = Dterrncmeoa citk i. isiakbRe reaiokwizp = eicl j. Loa alo nAcf(air yee rw)mo = rede fly k. ueWicrreah icfatbnor = ioose uqtsm


 +3  (nbme22#15)
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ePr hmatoaP:

otsM coonmm in olsuamnsopaetp on:mwe

1) csfbticryio a,ngches attnulacrdi aloa,mlppi Forimbneadao

Moer iyklle ni eapmtauoponsls e)m: wn1o yshlloedp omrtu kiel-famrb(dnoaioe tm)ru2o) ertBas cecsnra nseirdcea kris t/ d 1) carendise ,ega rinodatu of soneegrt houthurgto eilf (ayler ncae,rehm laet enuapeosm, eo tby)is 2) acpAityl ippea sylrha 3) itFsr geeerd ervitales

Qetuoins sseatt npsteers ti :saa) 2cm ,fimr donernnet )ssmb a on yaillrxa tdeampahohypynl or pnliep d)ech sacgir xemetylr enoiaeddsr ssma iwht rrulaergi mestnruclae gdrsi rrreuialg occaicacnimirtloifs

os awht cna it 1e b:) SCDI = sdeo not yulsula uepdorc assm

2) omeCod tepy = -ihgh degra cllse thiw cesnisro a&;pm ptihcyrsod alccifocnaisit at ertnec fo ctdu

3) gePat aesseDi = vivoelns hte ksin of teh eplpni (ninuyrledg mao)ccnrai

4) IDC = a) fsrmo tlkeucd-i curussetrt 80t%;(g& of s)aces b) ssma tteecedd by cishyapl mxotaeianni k)ehcc( c) lsyauul m1c ro rregate hk)cce( d) ltsoacpismDe ormast = tnccevnieo esstui ggnwoir wtih omurt top(rpssu mtu)or ~~~ ekch(c -- elrirargu raim)gsn )e erudlMyal ocienCmra (DCI) = imsimc nbmraoaoifed

5) ILSC pa;m& CIL = OD TNO dcreupo iitaaiflcnocsc or smas a) LCI - lcles haev finl-lge"ise tpt"erna ithnk of a abeedd ckneacel nad uoy ctu ti ni deidml ca(lk Eaei-hd)rnc

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +2

 +10  (nbme22#16)
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otrMeh is eR-gnh t-;g-& esh wlil eaenegrt Rit Hebasno1i)-d utfse daceeftf yb itRA-hn if ti is h)ipv-sR2ioe t enev if hRiPsvte-O-io is vig,en nhet sllti hes'omtr nhosetbiaiRd- lilw tkatca fssdruetan odolb ude to tis sclel ngoniancit R3 h+) frteo,here iaeR-et-hvngO is sbte

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)
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Nto:e eth iusoestqn edatts tre"soriaypr "tbsur gtggiseusn an TRU cti.enonif

)1 htsi ulrse otu tynhgnia btu erposriraty eiictofnn (onn pre tnicenio:f .E cl,io .E eaiuc)fm

2) GPD6 yfedncicie meor ilsceetbups to actaslea topievsi i ssmoagrn -- sthi luesr uot la(l sretp )asimrgson

)3 teLf wthi .H uelnzeifan ;ap&m .tparSh uasure (BHOT ear taesacla )etiospvi

4) aedaEsptlcun aimgnrso rea otsm nogenrcnci nhwe tehre is inel.saap

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 +4
belleng  Aspergillus is still in the running, it is catalase positive as well...but not a choice +

 +0  (nbme22#7)
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oenSemo aerc to lpaenix why t[eim ot eayda-eststt rnenoto]tincca is ton eth trorecc sean?wr

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 +

 +0  (nbme22#9)
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nAtinci is a iflmtanorecim enorpt.i tn-Aincαi si seeayrncs for eht anthmtacet of ancti iaetflsmn ot teh Znl-esi ni elkatsel eculms [e1]sl,lc adn to teh dnsee boeids ni ostomh ulescm sce2]l.l[ ehT ilufnntcoa rtpoein is na aitplan-llare mired, ihchw csin-sslrok eht ihtn sntefmali in tjendaac ecors,asmre nad teoererhf stoaonecird atcorcotnins tnweeeb rrsoecesma ni eth olanihzrto s.xai

eTh nio-asermrcnoc ta-n,scnαii ecndode by A1TCN nad CTNA,4 ear idylew eeres.dxps CNA2T ipreexsnso is donfu ni hbto cardaic dan leatleks us,mcel rweehas CN3TA is deiitml to teh .reattl othB sdne fo the adpos-hrde inaαnic-t meird ninotac ain-tgnidbcni nmoa.dis

tantouMis in ATN4C cna cesau eht nedyki daissee laocf slnteegma reroiulsmllecgssoo .GSS)(F

K(IWI)


 +20  (nbme22#45)
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ym lsti fo dnlisep tyep llecs nda :nisotniocd

  • a. F1-N
  • b. -2FN ~ onawSachmn ni(otnA A) = tsuuaCeno rnofmiouaerb ~ ghih yllrclueiat /(w nplaasgidi epansttr with esirtsepngrin lr-efacreeun snoez rccsV;londaeye&abpl isbode
  • .c yoLomiema eus(tur &p;am oeahgs)spu
  • d. Mtomloesaehi tioa(ykternc otipievs)
  • .e Aalpsnatci hTidory cncera bhp(cisai a± lgaon tihw gtina )eclsl
  • f. elyMludar ohrdiTy cnaerc (acn aols veha ypoogllna lcle)s
  • .g ramyirP icadrac aoimaonracgs atimn(nagl asrclvau npesdli slcel)
  • h. stOrecaomosa enbo( a)ncerc cpml(ropieho cles)l
  • .i moennaiMig
  • .j sp'Kosai cmraoSa )V8H-(H = ellSitk-i varusalc pcsesa thiw umppl aelsphs-enipdd raolstm cllse
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 +2
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +2
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +

 +0  (nbme22#22)
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1) Assanily fo acavienr si a cdreorepu deus fro prcminoag mlpsea nesam ot ese if three si sincuftife nevceied ot fienr ahtt teh esnam of eth gicprersnnodo lpaotniopu doriutisnsbit lsao .dffrie

)2 Wheer e-ttts acmepro nlyo wot ttioidrinubs,s lssayani fo ceanirav is albe to ecrmpao .yanm ‱ thaW esdo eht e-wanyo tpra ?eamn It si one epteddnen belivraa w(alysa suc)uoinnot and ectxyla eno eednntipned lbvaiear awal(ys cc.l)aegiorat A neslig inepeddetnn aveialbr anc evha yamn ees.llv


 +0  (nbme22#22)
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/t/e/an:weraaaptnw-tstielss-wsaadhote./wtr.dranhdsv


 +21  (nbme22#22)
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stuJ reb:mreem

1) -seTtt eta( orf )wto = soklo at eht nmae euvlsa fo 2 ropusg

2) NAOAV aasyin(ls fo aeaiv)cnr ~ keil -ttest tub = lskoo at mean usvlae of 3 ro erom rpsuog

3) iC-esuqhra = kolso at het %)( ro tsroonroppi enbweet 2 or emro p.gsoru

,so jtsu look rfo woh yanm upgros bieng esddderas and ahtw sualve teyh era gusni (% ro e)msna


 +11  (nbme22#17)
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1) EBV = titkruB hly,amomp nodHigk ayp,lhmom ahnlnsgoeraypa acmc,aroni °1 SNC olmhpmya ni( pusomiminmdeoorcm entaps)it

2) VHB &p;am HCV = uHotcperellaal anmircoca

V3)8HH- = asopiK aacroms

4) V=HP aclCriev adn neailna/lpe rainccaom syep(t 6,1 8,)1 ahed adn kenc crcane

5) H. lroiyp = rcsiGta aaniodaonmccre adn ATML malympho

6) VTL1-H = dlAtu ll-Tce eeuaomlm/yapihmlk

7) iLevr fuekl s(chnoirlCo nsensis)i = aCocrlicaioaomhnng

)8 osSitsahocm taabhmoieum = lBraded acecnr susoam(uq lce)l

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)
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1) laelb D DL(VL L-ID;&t-g -t;-g& LLD) = nhiagtny ttha ercidensa PLL = saebFrti ichwh esu AphPa-aPRl (Rx) era gdoo at duiecgrn LV[L;D] htoeref,re essl LVDL namse mreo .DIL

)2 LVDL -;-> aftty daic dxtniiaoo = inugs atsf A(GsT) rof nygeer onu icpotrd reHe AgmRPPaam- yspal a elor= ichhw aer loeisznddaineihToi (loas alelcd egtislnoa)z era a alscs fo sinmeiced ahtt amy eb used rfo eth atetrtnme of epty 2 .sdieeatb Tyhe ear salo good ta dnreuigc usrem AsTG

tNoe VLDL era ervy rhic ni AsGT


 +9  (nbme22#31)
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tusJ tnoe wyh rheto rsewnsa ear tno or:rctec

  1. pnnsbp&ogs;yiEoh na eiscdenra nornescea of civoe undsso hread nhwe usaancgutilt hte ngsl,u entfo eusacd yb ungl clisanoioodnt dan sfr.osibi

    • .a It is ude ot dnhneaec insinmsastro of qehru-fhecigny nusod ascrso ,udilf uhcs sa ni maalrbno nlgu sst,eiu iwth elowr enuieefrcsq rildtfee uot.
  2. redeshpWi ftlnisebsrp;r&poecyuqero to an criaensde ussolden inbrhe;&n;sppnotbfipw&eossdgn gudinr auatoctiulsn hitw a ecotsostpeh no teh nugl diself on a tnisae’pt t.oors

    • .a alUysul npoeks ossdun of lpd&brhpwnesins;masv;ueoeb&p yb teh itpanet uwlod otn eb redha by teh ilnccanii isnaatucultg a glnu fidel tiwh a teocth.spose

    • .b oHrwve,e ni sreaa of eth ngul herew rethe gspn&l;ubnsi cooonn,liidtas seeth phdwesrie epsnko odunss by eth tniatep s(hcu sa aynisg -nyte’n‘eiinn) will be elylcar rhdea hutorhg the hstse.ceotop

    • c. ihTs serienac ni snudo isxtes seubaec usdno esrvalt traesf dan tsuh whit orwle slos of iytsintne otuhghr iqulid ro lsodi “f(dliu assm” or diso“l sm”,sa ev,psltecriye ni het ug)nl ssrveu gsesoua (air ni eth lg)un iemda.

    • .d erhsieWdp yqcrtpoiuelo is a linacilc etts lacylitpy eoprfmder ugrdni a edmliac aphicyls niexoiatnma to leeauvta for hte reeescpn lon;sub&gfpn stonc,ionadoil chwih odluc be asduce by crance (olids )amss or mpneaouni iud(fl sms.)a

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)
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)1 ryeV ttnamorpi ot eont hatt ayhs-TcSa essaide sah ermo nvieseits latster (oor)m elrxfe in saenonte hiwt eaidenrcs daeh ericeucer.cmnf

)2 bFrya saeedis = nedt ot vaeh duliiovuas-a stecfde w/o elvri oilnnemevtv

)3 Nn-imipnckea asseedi = maenia a;pm& inpohoaty ihwt fxearalie


 +1  (nbme21#4)
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Snieer ospanihholyrotp lwil cedreu nls'iisnu fatcf.se tI ctsa no the nrstoeyi nkes.ai


 +6  (nbme21#17)
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Cnodcfeien elivrant iaeessrcn iwth ededecsra amlsep ize.s

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. +6
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 +

 +10  (nbme21#40)
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1. lxEmape of cnieartauc utb hiylhg eiprcse 
    a. 005 ainpstte gieens a uitrrlacpa oordtc orf a aptrcruail elnssi2.l
 lpEmxea fo aaucterc btu m
pericise    .a 01 psittnae uneogdr a erceinnsg ta a allm .
3 ohBt Aeurcact dan seprcie 
    .a 500 iestatnp hhig( icrpio)sen uogernd a gncnrseei hgi(h rcaaucyc ~ no asbi or citsseym r
)roer

 +2  (nbme21#7)
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nlaIhde luge si rome elylik naht olahlco cb/ of ist aees fo ccasse rfo a ormni and eltrvaei uesba lnteiopat in het gea g.rpou


 +20  (nbme21#43)
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  1. msoedoHtls bsa(oi iotgtcln): tWnhii het stfri efw umitsen of jinyru,
    1. eattnesi lpl teh lodob nebig ot istck to het erdnuij tsei.
    2. shTi esitcavat eth l,etpelsta sniacgu a few stignh to npaep.h
    3. yehT hangec oint an hapoorsum se,hpa moer useablit rfo ,cgiottnl and yhet ealerse clhciaem slnagis to rptooem .ntlitgoc
    4. iThs rlustse in the actontviia ifibfrn ,o hciwh osmrf a mhes dna astc as "ge"lu ot ibnd tptlalsee ot hace t.hoer
    5. ishT ksame ttalh at co esersv ot upgl het baekr in teh oobdl se,vles itnrweolinsnpggve/ tferrhu [[e]degnb6i5].l

  2. nl:mamfInaito Dgrinu hits ,psahe admdaeg dna dade elscl era raeldce ,uto olang iwht etarciab and horet gaesohpnt or dbeir.s
    1. Tsih neapphs touhhgr eth scopsre fp ,ghoyosctosai ewhre wtieh oldob lcsle eat"" rbeids yb fuglniegn .t i
    2. dlteeivel-erdPat ogrtwh afr reotcas adlresee iton hte onwud htta auecs eht gianirmot dan doiinsiv of csell dgunir het ifevarrteoipl espah.

  3. tafnleriioPor gowt(rh of nwe s)usie:t In hsti oolnenagnditl , ihprsgsaa sei sonigpe,glcietoannaue,o ofatetiimusnrs, o etian,ilozhpeliita dna nuodw ttnnoaciorc u.cocr
    1. nI aoensing,geis arauvlcs lheolateidn lcsle rmfo nwe odblo svesl.se
    2. nI plfribaiaos and agtournlina sueits  wtrsobiafgboaritoosn r,flm adn rmfo a w,ne lxneriaoaastlluoicvl rper  tmCaM)(rxEi by xteegcrni oglclean  n.roicebdanftni
    3. teCo,ucnnrryl r-etpeelziiiihnaotal fo het pmesiierd rosc,uc ni  ilalhpcweehihti efipralel lcetsor nad r'w'acl poat the wnuod ,bde vprioidgn vreco rfo eth wne estsiu.
    4. In unwod iabalodsrttcsiroonc  bet,nfmyeocesra hte zsie fo het wunod by rppingig het wdoun deges and cacrtnigtno nsuig a asmnemihc that eerseblsm ttah in sothom esclum celsl.
    5. enhW the escl'l oresl rae eslco ot mecelo,pt eednndeu sclel goorpao .suiedntps
  4. ornauMaitt lo:imre(gd)en riguDn mnauriotta and leroe,dimgn

    1. egnclloa si neegadlri gloan tonesin i,lsne nad slecl htta aer on gnolre eeednd aer evdreom by pmmdorgare llce h,deta .pp oooasrist

  5. xtmoarippeA tsmie of the feidnetrf pessah of oundw n el[thaiiw,]01gh dfdae eialvnsrt ankgrmi luanstitasb vn,iatraio niegeddpn ymnali on douwn sezi nad halnieg o,dniinocst utb iameg oeds nto ciueldn jmora iemnriaptsm htta ansocreicc uh osu.dnw
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +

 +4  (nbme21#36)
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hdonscCararomo = ymalin fetcfas eht axlai otlnksee tnah the peipnclrauda oenlkest

mEohncrdoan = nyimla easctff hte ndsha adn ;efet rea ytsc keli


 +1  (nbme21#12)
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aCn sooemen elpase xiepaln hyw cna't ohlclao be octcrer in ihst tn?tsgie

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +10
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +5

 +5  (nbme21#17)
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teisealsn mioAn dacis A(A)

1) uAdtls riqereu 9 (AA) = bela to amek gearnni via eura 2eyl)cc enlrdhCi iqerure 01 ()AA = eyth rea tslli )vpnldeg3 oei With UPK ryotnise cebosem taissnlee ni tohb ultsda dna lhdciner


 +7  (nbme21#24)
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As erp 1 A)F ftayt lnottanifrii 2) rclllaue bnlainoglo )3 eunvltea csesirno

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 +

 +7  (nbme21#17)
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1. Teeh"r LAH sfan llwi ryt "t
meh    a. Terenhnio = eTerh 
    .b ;Hidinseit grei;nAin syiLen = LAH
    c. aieanPhlyneln = fsna
    d. i;nlaVe ;eclnuIioes icLnuee = 
liwl    e. ntTapoyprh = rt
y    .f nenoMtiihe = meth
pparalpha  Thanks! Good mnemonic +1
b1ackcoffee  best mnemonic +

 +19  (nbme21#17)
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fI uyo lu'ncdot mmeerbre hicwh ewre atlises;en nteh enativrleat ouwld evha eneb to rielaez tath wniggor lerihdcn ened elscl to .ddiive Tsih rqusriee NAD picietralon dan .ntaslntiora Of chhiw hte uenccil cdia ytemih is tmontr.iap It rqieeusr a hyelmt raesntr.f

This si rweeh hemitninoe cesom ni. ntnhoieMie coisbnme iwht APT ot mrfo ASM (a ehytml o)odnr

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 :) +1

 +4  (nbme21#32)
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aflIl else fsla:i toen ttah treoh rwsaen ioeccsh era COPD seytp

dragon3  (except sarcoidosis) +1
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! +

 +0  (nbme21#37)
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embRerme 1 ) poeettivmci iihintorbs ~ nelis Crsos at t)ecnrie2st y- nimieoepcv-tNto shobitnrii ~ no elin rssco


 +4  (nbme21#9)
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NSC ghorH/emrae gam1a e)d -8241 sHr = edr n r2suoe)n 1-3 adsy = housplteinr (qlefaictieuv 3seocr s)i)n 35- = aaepohmcsgr )gamoir4l(c) i -12 eswke = Rceaeivt igslsio (+ ucarslva irofiepa)l5)n tor erom atnh 2 ewkse = ilaGl asrc

o:ten( het sphgstoeaien si sraiiml to IM nda tsi acsr r;ifontoam wevhero, the mtie uoecrs orf CNS is tujs es)tfra

teepot123  fa 19 pg 500 +
icedcoffeeislyfe  FA2020 pg 512 +

 +0  (nbme21#12)
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oFr CCR: As( epr )WLODRU

ctymSremi lebraital oerwl txmrieety tgitinp dmeea nda utstoruo badlmiona evins are egnironncc rof frnro inaei vaen cava )V(CI inoct,rbusto whc,ih ni the geisttn fo a iesdfl-etd ankfl s,mas  uterslegnssga elcl )arnca CCo(mRic ihtw xeiontsne tnio the  VIC. CCR tcncaous rof %;g&9t0 fo all elnisgnmcaai rinsaig ni eht kendiy nda is yhglih tseasdciao wiht so imk.gn tiaes Pnt wthi CCR lsaiaclsylc vaeh a dtira of lknfa aip,n elpplaab sm,as nad ehaarit,um uhtghalo naym minare sptoimtmaacy niltu het eisesda si .cC dRndavCae si a gyihhl cravsaul omurt itavneta shd het enrla vienni  pu ot 5%2 of  s.seca CIV totonbicurs nac orcuc eud ot llmtnuaaiirn xteonesni dan bsuohrmt nfrmoto,ai rrathe nhta ssma tffece ofrm eht umrot t.iefl s

Teh rocsuotnibt nac curco yutlaec or alyadrglu voer etmi.  In hconicr scse,a atcoellrla neosvu ocratuinlci amy oplveed saebd no eth eist of teh biotrcsn .uto nmiornetP mabilanod llolwraatelacl  e,nivs as in tish ae,ttpni egtssgu trtsobuonci of the ppeur emgsent fo teh CV.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)
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sJut aielrezd ttah lnrae llec norccamai 'tisn hte ctcrero eransw /bc it vndiaed the vuneos aucirotciln adn not eht ite.alrra BP mya nto eb efctdfea as hmuc. if RCC eewr het awnres hnte tnhe teher dlwuo aehv bene emdea stpnree anro/d anrle H.TN

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! +

 +1  (nbme21#35)
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CO is nrideaces ithw ) 1 ddaeresce f2a erl)atod csaideren 3rdpe)ola eaIesnrcd ciiralonytttc

nA aurvenotisoe fisuatl craeest an ienatvterla oerut for taairl bodlo otin het nvsoue aoirnultcic ow/ gongi tsap hte ileterorsa (eth mroaj scuea of tehsTe)nuisr,cs.a by oding so hte RPT edrl)aaoft( ssrdeaece and eth CO si cdsnreie.a


 +3  (nbme21#46)
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pwtsinrwoseiua/cmcs.51sbsoe/-so3snss-t8-woh-dyciu2/:lgceid1/uescsrpnpaop1/er0iomotctmiycya/yt.

PuoSictmcosym opres yueptbr gsins dan postmmsy educinl teempdoelvn fo het wnliloogf eerbfo aeg 8 in sigrl nda eerofb aeg 9 in .oybs

eBarst wotrhg nda trfsi deopir in egldas nrEgilr tsltiscee dan ,pinse iclaaf ahri nad geepndnie vieco ni ociyPbsub ro armduenr prhdRaiia ocunAtehtAl wgd r ydbo ordo


 +2  (nbme21#13)
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tsju a uhn..c..h oepmrezOla si yswlaa het rgiht enwars

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 +4
cry2mucheveryday  same doubt..marked miso +1
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)
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on'Dt htsi is CU ro sooFhr. Cnr hits iqtueson uyo vahe ot haev cnoited hte aeg (66 o-) rdlwoaey.erL eflt narudqta = ticsiliiruvtde fo leeldyr awoLem p;r& irhgt tuardqan = pisnyaigdsaaol of edrlely (tnik h teseh weer eneintdmo in oaPhat)m


 +1  (nbme20#2)
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rusoNvroi eySk(hc)t = fAtsfce herwe a lot of pelpeo rea in lsorece qtruas - elailyscpe ocomnm no sciruse - %09 of all adlharier ortkeaubs no cuisser

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

 +2  (nbme20#32)
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oT nwrsae itsh nsqoiuet is to ento :ah)tt 1 neialalk taaohphessp tiicaytv si inkled wiht seblsoso.att


 +5  (nbme20#16)
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bsuueroT lssicosre = aeh"f-sal pt"oss = -ldhoaevsap aesra pale esraa on e.sn itnofk dt/ tahomsrmaa


 +4  (nbme20#14)
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lAl hrote ystep rae eehtir mgnpitede ro aehv cs.sale -- orsspce fo ianitiomlen


 +2  (nbme20#41)
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/no/u5peg./td..hs.:6ichbn1wwl0tvbp3mmni8w/

Rleife fo ebcalitnrat pnia asw dpecoudr in six umnha tstpeani by initoamuslt of screledeot rynpnteaeml ndpltiaem in eht lurptciirearnev and qeprieactuldua rgya emt.rat hTe lelev of tsnmuliaito istfecinfu ot cndeui naip rfeeli sesme tno ot aertl the uceat iapn orehhd.tls iteancrsmIdiin evpetierit tuailsnomti udecrpod entoarlce to thob tdeidupal-toicrsumno naip efreli adn het icaalegns taocin of toanrcic dnmicoat;ei this prsosec culdo eb rsrveede by btscnneeia from i.nstlatmuio ilidu-puncteadormtSo feirle fo ianp asw reeevsdr yb naoxlnoe ni vife tuo of ixs tptensai. Thsee stelsur stsuegg that sfcstrytaiao oaantveilli of rsisepnett ipan ni asmhun mya eb tnibeaod yb cciotleern .oinuatsimlt

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. +21
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)
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rvliSaya neotsirce 1. At olw lwfo = Hgih octtcnneianor of smt;ipsaou lwo asrinncncteoto of odu,sim r,caibb m&pa; .iohe2crdl ta ighh lfwo = lwo nratnnoteicco fo usopa;mtsi hghi eoinatrnosccnt fo imo,sud ,abbcir ma&p; ldrihcoe

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. +2

 -2  (nbme20#37)
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mVtnaii E yfineccied si okwnn ot usace asliirm anipls fsecdte sa Vantimi 2B1 i.efyceidcn wv,eroeH naeiam is ont n.ees

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. +6
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(171),
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fi yoru CO lalsf ... twn'ldou htta auesc notcsviotncioras in the ungl eus?uavrlatc ohaiypx ndeuidc taosoni?sivtncroc

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(268),
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nCa ymesbood who strnddaeun why RVP aerceessd tiwh a feitdLSed- iftcnra leapes nehinlget .em I duwlo lsoa pcpatierea ti if ouy ludco ateler it to tgrhi didse earht ifuarle oot i(.e. woh ldouw ti gacn)eh.

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. +10  
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. +1  


lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +6  
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 +13  
usmleuser007  really like the pubic hair.... +2  
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 +  


submitted by m-ice(272),
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isTh wnoam ahs aoPasylrxm ocnaulrtN iinegubomrHo.la siTh tsom otnef rnpetsse in a ynoug udlat owh ahs dessioep fo drka uiern ni eht mddeli of teh tihng ro enwh wiakng pu in teh gio.nnrm ts'I ucsade by meletcopmn iyicattv tcelrdyi againts het sttien'ap own .BRsC ntiaCer isicdgpolyl era deende on the BRC fusrace to ptrvnee tactka rmof cmempe,nlto eth otsm aoblnte of ciwhh rae D5C5 nda .C9D5 asetPnti with HPN heav a tmaoisc mtiotuan ni iwhhc yeht lsot fcontuin fo a IAPG nmzyee ndeeed ofr orperp eetositnrpan dan athnamtcte of 5C5C5D/D9 no eht BCR s.caufre efTheorer the rwnsea is a fedcte in a llce merambne rchnao r.enoipt uotithW ,tshi mcpmntolee ttkcasa sR.CB

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +13  
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 +4  


submitted by m-ice(272),
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The ooledhkl"ii fo iismnsg na coas"aiositn eresfr ot Tyep II .roerr eTh srik fo pyeT II reorr si rtepreeends yb bea.t iThs cuodl be deosucnf hwit ,epwro wichh is 1 - btea.

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... +  


submitted by neonem(503),
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iths etitpna ahs ysttaomcmpi aticro tissneos. sihT cna eb dntidieeif by eht venrlucitra yprhrehopty o(t npcseoatme for ncasderei atnclnoifu afdoterla from mpnl-tnoaonci taocir v)leav, itodlyissmc umumrr nda hte conalito at teh anomrl acitro a.rea

rPe epDToatU on cCiainll meisnoaitfatns of Aocrit Snsiotes:

ii"Dnezzss dan yscopne — oyeSnpc crscuo sa a nrnteiesgp omsptym in aoprmtxaepliy 10 tprneec of spainett htwi omatpsyitcm rsveee AS ro( axmpitoyarlep 3 eetrcnp of all nitseatp twih ereves A)S ].3[ reehT rae earelsv opdresop apextnoinlas rfo otnxiereal dezisnsiz peypsec)n(or or eocpnsy ni sptntaei iwht A,S tohb of cwhih tefcrel daderesec crbelera opsren.fiu sdcr-eEeexcdnuii adisationvol in hte ecnrspee of na ootbctiruns with xiefd accarid opuutt nca rltesu ni otipyosenh.n"

guillo12  What does "fixed cardiac output" signify? +  
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. +4  
fallot4logy  why not option A?arterial compression ? +1  
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 +1  
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. +2  
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. +  


submitted by mousie(171),
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hyW on ?stnewagi I mnea I gte tcayssE is lyabprbo the rudg fo cheoci erfobe an all htnig encad ytrpa (l)lo utb o'ndt srdetnduna hyw ereht wudlo be ocld tixtrmeeeis adn no nategwis enwh is FA ti sasy mheierrypaht dna ?h??ard?bo

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. +7  
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. +9  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +16  
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 +7  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +3  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +8  
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. +  


submitted by usmleuser007(326),
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ooBdl flwo in ersise cniessare hte act;ssnreei odlbo owlf in lalerapl aesesdcer het nsaesctrie )R(.PT

By ikclgonb hte liumibcal isenv you hvea in scrpeet limdeit eht ecxsse foodl lfow ot het ctaeln.pa

ishT dcsueer the owlf in eaalllrp lncc;uriotia huts eraicssne eht TRP. (AMP = adccira uot ptu estim )TRP

isTh si ebcesau the altto ssroc atclnsoie arae is er.uedcd

ormF sh,ti hetre is na edecnrias perrsesu in hte atelf tiar.nocclui

eTh ebcooaerptsrr eltcado ialmidmeeyt sdtlia to eht nufaboctiir fo the mnocmo iodctra yrrtea lwdou eessn a ihhg sespurre adn aerinesc itehr eeanfrft islagn vai .9NC

ishT deseuRc het hetcsmsitypa dan crnesieas the aaramypsetpcshit iav 10CN ugas().v

Tsh,u runcgedi eht aethr !aetr

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


submitted by hayayah(990),
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robcnCia ahneyrsad iobrtishni (e,g mcetd)zieoaala dna polo edisirctu eg,( ersmufedoi) aer hugotth ot teerx hietr fefect no PIC by griuecdn clairrbseepon ufild )S(CF tnoopridcu ta hte chiodro suxel.p

oelGgo sasy micanesmh si kwunonn L.OL

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(462),
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A aadntsdr niaitoevd is a amurees of ityprblibao ni lmerngsbie eth aegve.ar nOe nsdadrat ndatevoii no a lelb ecuvr ditiuobtrnis rscatee a 6%7 ccenha taht het seawrn ilwl eli in teher. woT ansdartd inestaidvo lwil aetecr a 9%5 nchea.c heTre drsantad vinseoatid etcrsae a %97.9 nc.ehac

Tihs iattpne sha na reegava of 31,1 and a 95% oefcdnicen ta -101161 manse taht eht DS si 51. . So neo idiaaldton DS owuld vgei us a agren fo 05,5.11-.718 ruoddne to 810.181-

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(462),
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A drdstana ieonadivt is a eaesrum of yibpoarlbti ni rmlnsbegei het regea.va nOe rsdanadt etoidainv on a blel ucrve nituiobidsrt eartecs a %76 ecncah htta the werans ilwl lie in eh.ter owT draadnts etadnivsio lliw rtceea a 59% acc.hne ehTer nratasdd nvdoseaiti tesearc a 979%. .hanecc

iThs pnaiett has an veregaa of 311, nad a %59 onfccnedei ta 16110-1 nsaem htat eht DS si 51. . oS eon ioadndtlai SD douwl egiv us a aegrn of -0,11851.7.5 dnuerod ot 881-10.1

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) +  


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

nitPeat has a oggnnlia ,syct chiwh nac tapeooyssunln eresgr.s

medschul  Mine would beg to differ >:O +21  
usmleuser007  Where would I have come across something like this (FA, Pathoma, or out of my S)? +4  
motherfucker2  I thought this bitch was a lipoma. Mother fucker +5  
divya  mf2 lipomas is fat. although fat may exist in liquid form, its still opaque, therefore negative transillumination. unlike ganglion cyst. +3  
beanie368  Only knew this because I have one that comes and goes... +3  
cbreland  I thought these were like a 1-way valve? Didn't think it would regress if that was a case? +  


submitted by dubchak7(1),
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ehTy suggest ioosMprtlso ot urntctoeca D...IASNs yhW tno PPsI?

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. +1  
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. +8  
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(326),
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my tils of dlpsnie ytep lsecl nad oiocsin:tdn

  • a. F1N-
  • .b N2F- ~ whocnamnaS onAit(n )A = utnesouCa mroirabuefon ~ hhgi atuiclyellr /w( splndagiia aspnettr hitw siinetrprengs c-urenleeraf oezsn cedbeyao;&caVnspllr eodbis
  • .c moLeoimay etuusr( &;pam eshs)augpo
  • d. oeohateMimls kcona(teiytr iesovt)ip
  • e. iActnslpaa irydTho cacner (bapiihcs a;&mp anogl whti ngita ecl)sl
  • f. aluylerMd iroThyd acernc anc( sola aveh laonpyglo cll)es
  • g. iParmry caaidcr mnsaacgriooa (nmngatial vlusarac lndspie s)llce
  • .h tcOmsasareoo en(bo ecnr)ca m(peroicloph slcle)
  • .i oMmeiginan
  • j. Koas'isp coaamSr -H8)HV( = llikte-Si vrcalsua pessca whit upmpl hlase-ipsednpd tmsarol llecs
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 +2  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +2  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  


submitted by usmleuser007(326),
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sTih uiqesotn sah htognin to od hiwt eetupemrart ht(e engevitt etodsn' sesdadr the eematrpertu of teh etraw - so od'nt sea)ums

This is woh yuo get eht er:swan

)1 iBgne in esraotu-pce ro ni a mgsiinwm pool up to eht ckne l:iwl

a. neIssrace rlnCtae dbolo voluem (mroe ldobo tnreusr ot het tigrh esid of raeth = srdiceane dr)poeal

.b eIcssrane NAP = ndesicrae dliainto of tlceersvin ~ easomtrponyc smenciham ot rcudee uvoelm avedloro

.c adserceDe HDA p&m;a amesl-ontiRsn-yed = oybd is ni etast fo meoulv odarevol ;map& edsen ot duerec styismec uemlov

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(129),
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eTh most cmomon nad eeervs frmo fo laumoosat dniomnta ocyclptsiy iekynd esadeis (KAP)DD esturls mrof iunsttmoa in ,1PDK necodnig tp1ol-sicyyn P)1(C..

w/wm.Pt3p4..c4/lm8ocMplreg/n8ta9v.4hbsti:C/isniwc/n/h

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. +12  
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(326),
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()A kRsi catfros for npeveldoig ulaascvar oensrisc dnlicue:

1) Tarmau = i,esr unjI such sa phi ntsdalcioio ro erar,cfut acn egmada bareyn boldo velsses nda ecdeur dbool folw ot nbeso.

)2 todeSir =us e esU fo -dsheogih osirticeoc,odtsr hcus sa dni,pserneo si a oncomm secua of aslvarauc csrnios.e The nraeso is ,wnnnuko tub noe hhsiyoetsp is atth ttsdrocirescioo can encsaeir iidlp eevsll ni ryou ,lodbo driecgun lbdoo oflw.

)3 eicesxsEv ochoall ues = nCnmogusi learsev iacoolclh dksnir a yda rfo slearev syrae lsao nac cuase ytfta pdssetoi ot fomr in ouyr dlboo ees.ssvl

4) npsahtoiopeshB seu = e-mLgnort esu fo adomncstiei ot aeierncs nebo itdnesy thgim notbiutrec ot dvoiengepl erosnestcosoi fo eht w.ja Tsih arer mopilcoctani sha rcedrcuo ni osem peeolp dtretea thiw ihhg odses fo teehs icsmadinteo rfo n,ecsrca shcu as pltuimle mlaemyo and etascamtti arsetb ccern.a

)5 teranCi maecdli attesnrtem = doiitnRaa aryehtp fro cncrea nca weenak .ebno nOgar a,rnniaapltsotnt ielcyepasl inykde laaspt,trnn also si ioatacseds whit arascualv neorcsis.

ic BaM()dle scnitdoino atossadice hwit aaruavscl sncroesi cuidl:ne

'cariiiutnDe arheeGabtt scPases A iaimdst/e HeeDsISVISscy puuls r cSisueohtyksleemat lcle ieamna



submitted by usmleuser007(326),
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ltCerna ureovsn ssteym ognetrinaere

ikUnle prherilpae onsveru msyset juiryn, jyinur to eth tncarle suvrone tssyem si not oelwoldf by xenvitees rnr.agoenitee tI is tiieldm by teh nrbtioihiy lfeucsienn fo teh laigl nda erxluaacrllet ninenrvemo.t hTe tle,hsoi sier-pnsminoev ghwtor invnntreoem ,is in tp,ra racedte yb eht atmirnigo of ymae-anctesisliod bti,orsnhii a,ystorcste r,ooigleydencosdt ydoolrteoigdcen use,oprscrr dna g.aomclrii hTe rinnoenevmt inwhti het ,NSC leispyacel fgwolnoli a,ruatm oacrscutetn het iarrpe fo ymlnei dna ne.suonr otwGrh oafctsr rae not preesxsde ro ese-s;pderexr rof tnnseic,a the crrxtaelulale aimxtr si ilnckag nmnilasi. lGlai csars lraydip ,omfr and eth lgai ltylaacu urdcope aofcrts ttha inhitbi meeiayrnlnito nda xnao p;aerir for tnesa,nci OONG dan eN5I.-hT3 sxona tsmesvehle osal eslo the aoietpnlt orf howtrg hwit gae, edu ot a sreedaec ni P34AG ro,xepinsse gnaom othrs.e

usmleuser007  (wiki) +  


submitted by usmleuser007(326),
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erP oh:aPtam

tosM ommcno ni smsolenouappta wom:ne

1) sbociciyfrt anhces,g alcanidtrut lpa,lpmiao aidraneoobFm

Mreo iyelkl in lpespsaomuoatn m w:o)ne1 dlleposhy rtumo rabaokoiime-nef(dl rmu )o)t2 seatBr nsarecc edcnrisea risk d/t 1) eiresndac age, tuonadir of eetnsrog tuurhoghot ilef l(reya c,rmeaenh tlea pouaem,nse tieb)yos )2 Aycaiptl raesippalyh )3 istrF eedger svareeilt

uQitsneo esttsa rsteesnp it a as:) c2m m,fri nrnodtnee ams )bs no arlixlay ehymlaatnopyhdp ro lnpiep )ahgcsr deic eymeltxr ioadsndeer assm hwit erlaiurgr srecdentlsaum rig rerulargi cmnasciacicforliiot

os htaw cna ti b1 e): ISCD = odse not auuylsl cprdeou asms

)2 oodCem type = ihg-h drgea elcsl hwit nioerssc m;p&a tshicdorpy anflsiioictacc at eenctr fo dtuc

3) ePtga seeasDi = silveovn eht nkis of eht leinpp nyre(inldug cai)nrmoca

)4 ICD = a) mosrf ci-kdulet rutesutscr (&80;t%g of se )sca )b amss detedcte by aschyilp nmeaainixto )cehck( c) sluauly cm1 ro gateerr cck()he d) lacisDmoestp omtasr = ccieentovn utssie rgingow ihwt rtomu pstpou(sr ut)orm ~~~ check( -- iearrrulg anmi rg)s )e yudlarelM enmaCcroi )IDC( = msmcii afmidarbenoo

)5 ISLC &;pam CIL = DO NOT oudecpr acilicsnitoacf ro mssa )a ICL - elscl vaeh g"i-lfnilees tpa"etrn ikthn of a eeddab kcelneca dna yuo cut ti in ddieml (lakc crh-Ede)nia

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +2  


submitted by mcl(517),
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To napxde on thi,s esghtollunyopatio drsbsecei hte sitylhoog of okapiws orcamsa sa sipl"end llecs rgfmion tsils htwi asetxvarteda red oldbo sclle"

mcl  lul i don't know why i spell kaposi like that, my b +8  
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 +4  


submitted by mcl(517),
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eieDpst a rimnuec avuel b(dloo e)sspurer nibeg dsea,emur atptensi owlud eb ngdstedaei irethe tsyinveperhe or ove.nismntore To my guns,etannridd eth sebt tset rof romapcnig ciaegalortc arvseiabl saosrc urospg is a ihc eqrusa t.set

nI an,rcotst a stt-te si deus ot merpoac teebnwe the manes of two oupgsr edrms(uae iablarve mtsu eb qi.anttauetv)i



submitted by mcl(517),
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apeg 911 FtaeAt nPi si pnienetrgs hnstmo tefar hte ,lrpnatsatn cwhhi ensma ti tcna' eb epuherycat unlsse he psedpot ngtaki hsi samsr.pntemnpsuisuo cerc/iGuot/AVHcnh iadsese rae meaddtie yb T lcsel orf eht mtos part (I i)htn,k so sthi wlduo amen hcoyycmpilt ifriatnselt.

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) +1  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by mcl(517),
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page 119 PtAatFnie is eegrsnintp osnhmt teafr hte rnsaptlna,t whchi amnes it ta'nc be puayhecrte sensul eh tpeosdp agtkin hsi nsmeup.tunpassiosrm A/e/ocuGtcnVcriHh ssidaee rea iademedt by T sllce orf eht msto part (I ,intkh) os iths ulowd enma opcyiylcthm atfs.iilrent

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) +1  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by gh889(89),
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luCod mnoosee ealesp lanexpi ihhwc sgurd (fi a)yn aer at D and ?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(1112),
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If uoy odnt' onwk whta Dolciaumr dose ikel nya ranmol a.umnh heT cfous no wtah iinpras oedns't o,d meynal tsi' stdeon' ftaecf TP imet and msto lpils od'nt aiernces olcnitgt pis(eelalyc tihw isi.n)rap shiT is owh I oicgl ot teh gthir r.nesaw

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +11  
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. +2  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +3  
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 +1  
teepot123  di'coumarin'ol +  


submitted by mattnatomy(41),
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lakcCser ehetir eiaitndcs nrcicoh ntchiborsi or odlinosatnoic ro(fm oeuaminpn ro pnauloymr aeed)m.

nviGe taht 'erhets only a 1 dya isorhty of ,BSO 'Im elniagn mero atworsd bloar oumnp.naei Maybe sttha' oasl aht'sw giscnua the 3S at eth ?LSLB fI sit' hapSt sAue,ru I gsuse ew uldco be nklogio at eucta ocdtrsaidnie + oumepnin?a rO Q er?vFe tuB t'htsa jsut u.esonticpla ludoC osla stju be atht hte ulng toicaionnslod is nrietgal odlob olfw, gidenal to the bakc up oint eht gihtR mtAiur &;pma Ve.cnrteli

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/ +14  
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),
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Why lwuod oyu ska eth taietnp ot intdyfei the sorp dan ?cons I dt’no gte teh acoharpp hee!r

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... +4  
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  


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Wyh dluow you ksa het tptiena ot dftniiye the ospr dan ?ocns I t’odn gte the rpaphcao r!ehe

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... +4  
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  


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aiitVnm E iniycfceed si nwnok ot aescu sialrmi lnpias ctfesde as maintVi 2B1 yiciednec.f w,vHeero aanemi si ont ene.s

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. +6  
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(326),
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fdocnienCe retvalni eecniassr with ereedsacd selpam eis.z

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. +6  
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(16),
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doCul yaenno egiv an xapemel fo tahw esdesias uwldo steb catmh hte rohte rwanes cecshi?o

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-ÎŒm 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.” +1  
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. +  


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lgowFolin a oet,srk thsi einttpa had knesswae of hre flet cafe dan ,odby so het rokste sutm avhe tdecfafe eth ightr sedi of hre nib.ra B was teh nlyo hcoice on eth gitrh idse fo hre nrb.ia

itllS dfu?neosc aeRd ..on.

heT naurvtoly troom rfiseb ricol(tconapsi tcat)r esecdnd frmo teh pyriram oromt r,xteoc rscso s(e)auedstc at het yredamllu dsryia,pm nad hent aysneps at het rteiroan morot onhr of eht sanlip level.

uaecBes of seoucsatnid ta the dmelaurly ,idspyamr ouy uhlosd eakm a teno fo wheer ayn sotekr c.sucro Is ti evaob eth leldryaum ?imrdpyas nThe it iwll aefcft eht esid etpsopoi the sterko n)rlet.al(orcaat sI ti lbewo teh lmureyadl idspym?ar ehTn ti lwli tfcefa teh eams idse as eht tsroek ).piei(sraltal

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 +7  
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 +15  


submitted by mcl(517),
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itMonieenh is an lniaetsse omian dcia. All rsoeth sidtel rae t.on

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? +  
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +7  
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(74),
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Yo adwg we lal oubta TPV ITM aLLH

,Pnaynhnelieal nlea,iV TpyrtNoK,AD nehne,irTo Is,elnocuei ioeihnM,net s,itiidnHe enciuLe Lyseni

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. +9  
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(791),
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lstacsyiDp nvei are a rceuporrs to malmon.ea yhTe veha rri,urlega cstdlay""spi brreos.d meeRebmr eth ""B in DCAB satnsd orf grareiulr .srdoerB veuNs eanms melo.

therO aners:ws

  • ontachsasi ninrcaigs - aeniDkrng of ksin aietcassod with yTep II betsidea ullsteim

  • aslab llec maaicronc fo nski - Relar,y fi evre tamzes.saetsi lnoymoCm csfftae ruppe .lpi

  • lebu uesnv - roeBe-doucll etpy of nocmom o.mle i.Bgenn

  • igtdempen ibehrscore tsrkaioes - "cuSkt "no raepnaa.ecp Moystl ngbn.ei cAsftfe ordel .epepol

  • No(et - uyo auullsy ese olny ne.o If pmlluiet rcrehbosei tksersoae ear e,esn it icitsenda a GI ayngimancl - aak -Lre"Ă©rtTsale )gnis
usmleuser007  correction ~ BCC affects the lower lip more than the upper +1  
sympathetikey  Pathoma says upper lip, good sir +24  
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 +4  
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. +1  
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),
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anc anynoe naliexp ?ihst i wkno emaidn orf y si hhregi yb nloaultaicc btu x hsa wto dsmoe os who cemo y sah higher de?mo

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(1),
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Why si dose a DAP traef itrbh luster ni grhh"ei ahtn oamrnl ltef irnlevatruc cdricaa utpo"tu rvoe ndaecires h"itgr uailnctrver O?"P2 oDes het umpl eatyrr t-;g&- aroat unsth eecobm deerresv rtfae rbti,h so hregih yogexn roaat odbol owdlu fowl cbak itno het hrtgi ieterl?vnc I tge htat eorm boodl ludwo be pdumep to teh tfel netivcler, rgsnuitle ni /VRVHLH, btu to'dn rdenuasdnt the O2 ibt.

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  


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"npUo pnlocitapai of usseerrp to teh relinant ned of teh x,vcrei tcoixoyn si eelsdrea rfee(eohrt sneecair ni onraceilctt tnps)eor,i cwhhi ttmsleaius neutrie ,oittnsancocr hiwch in nrtu sresaniec preusers no het riexcv et(eyhrb nagnriices oxtinoyc eresela, )c,.te nutli hte baby si ree.edivdl

yoesnrS rnmifooanit grnrgdiae ncecahialm hsrctet of teh xivcre is aecirrd in a sorseyn u,nrneo chihw espyasns ni hte rodsla nohr beorfe deisacgnn ot the airbn ni teh onalattearelr cnlousm leirlspaati( and aorelctltnara otsr.)ue Vai hte naeidm onbaerfri nbdul,e eth enfefert hreasce the PNV adn NSO of the .usoaptmhhlya hTe speoriort ptyaturii lesaeres xoticnyo ude ot idrescnea infrgi ni eht o-paheaoaotlphshymphlyy actr.t yxontcOi scat no teh emotiurmmy, no rroetcpse ihcwh avhe eneb eretdlaupug by a ilnoaftnuc acsnieer of the etesrnsoeetgogpre-nor .oatir ihsT lntiucanof rtoia gnecah si dideetam yb a eeeadscr in mayimletro tyiesvnsiti ot teepngrsooer, deu to na nicesera in egoornrtpsee oetecrrp A, dan a cnerocrutn ciaeensr in oamrtielym vsestniyiit ot oengtres, due ot na eecirasn in gsrneeot epecrotr .α hiTs asescu aoteymriml atcirnnocot dan freutrh ipsitoev efbadcke no eth [1r.eef"lx]

s/kdiihor:p./oiuensewepeeti_F/wil.g/gkraxfrnt

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). +4  
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +  


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engoiellLa is ommonc sseuac fo pieaonumn eupsrsdomeip on ronihcc sbioetrcvut armunpoyl eiseasd.

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 +  
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 ? +3  
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... +5  
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. +4  


submitted by hayayah(990),
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ianePtt ahs nrchcio ahredrai ialendg ot etmblcaio ssiac.odi yesRroapitr oamspictnone lwli dlae ot seearecdd O2C iaers(oyprtr allsiakso iva .ieh)ttnaprolieynv

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(503),
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rebtusviOtc hporytua sauecs a ptneroasl ezmatioa -g-&t; wenh d,goenolpr atblruu amdega esensu. siTh lsead to an etcua arlubtu nrcisseo, trieeahraczcd by irectnoc pslgu in het rutuabl smeyts as nsee ni eth agiem

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +21  
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. +3  
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 +  


submitted by usmleuser007(326),
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//dnumihw35evt.hc.t6nn/i.:/pms.pb0l1wbgwo8

leReif fo cntlrbtaaie pain asw derodcup in isx anhmu tntsepia by souimntlait of sreeoltdce eymplnrnaet tmpadenil in the pcvirrialueretn nad catlpiduureeaq rgay tm.reta The elvle of nuatiimsotl inefcifust ot uinedc pnai feeirl messe tno ot rltea eht cetau inpa lohterdhs. mtaeInrcisndii vptteeirei iulaotmstin decopdru eralceton to htbo sultdorido-unacmietp iapn reeifl and eht aescgalni nciota fo oticncra mi;ncdtoaie ihst espsocr ocudl be seedrvre yb tesinabnec rmfo toanimiu.lst doiSadri-etlumutocnp elerfi fo pani asw erdrseev by anloonxe in vfei out fo six aenttp.is sheeT surslte tsgesug htta ctiroyaatsfs nlvaaitoeli of irpetesnts aipn in hmusna amy be iaeobdnt by ocetcrinle utnalmits.io

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. +21  
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(10),
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totInienn to rteaT nsyasAli

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." +4  
smc213  This video helps https://www.youtube.com/watch?v=Kps3VzbykFQ +12  
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(-1),
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oNt rsue btoau shti, btu ti msees ot me ttah iths si ererrignf to lupresochaeeds"inseot hiirtbion cfcyene.iid t'sI na zyneme fteced htta si ertigergd by JNM lrsekcbo - hlclnosinuceyic ro rc'aeru.s

p/_Pestwte/.godiiksikiuiiecelewechenfosaetsroyd.an:dicprh/n/i

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. +