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Welcome to xw1984โ€™s page.
Contributor score: 8


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 +1  visit this page (nbme23#33)
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English is not my first language.

I think the reason that not using PPI is the Q mentions other adverse effects than gastric burning:

"... has severe gastric burning and discomfort... THESE adverse effectS".

Therefore, I guess PPI can relieve gastric burning but not discomfort, so we give the patient what he is lack of.

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 +0  visit this page (free120#1)
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Per FA, should aminoglycosides be used in gram negative infection? S.viridans are Gram positive.

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 -1  visit this page (nbme17#27)
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I think the unaffected 1,3 (I, female) is due to incomplete penetrance

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 +1  visit this page (nbme24#30)
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The OR in the upper left 22 table is incorrect, which should be 6 (726/36*2 =6), not 1. This means the OR of "ate cookies" does not change after stratification by "drank milk", so "drank milk" is not a confounder, and "ate cookies" is independently asso w/ EHEC outbreak.

On the other hand, OR for "drank milk" changed a lot (from 3.9 to 1.0), which indicates "drank milk" might be a confounder and, therefore, is not independently asso w/ EHEc outbreak.

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 +1  visit this page (nbme24#5)
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English is not my first language, but would it be possible that adherence is not equivalent to adhesion and somehow interchangeable to aggregation? I feel like doing a reading comprehension test, not USMLE.

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 +0  visit this page (nbme21#17)
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Right gastroepiploic V can also be drained into its counterpart on the left, but short gastric V does not have anastomoses, so the varices of short gastric V leads to bleeding.

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 +4  visit this page (nbme20#11)
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I got this Q wrong. I was wondering why this patient โ€œhas no personal or family historyโ€. Hereditary spherocytosis should be a AD disease, so, generally speaking, this diz should be seen in each generation, right?

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step1soon  I was thinking the same! +
wuagbe  Several genetics questions on NBME20 appear to be trying to throw us off by changing the descriptions of inheritance, leaving us to assume incomplete penetrance, smh. +




Subcomments ...

submitted by krewfoo99(115), visit this page
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Wouldnt the HCOM murmur be best heard in the aortic area?

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krewfoo99  Correction: Shouldnt it be heard best in the left upper sternal border? +
usmlehulk  In FA 2018 page 303. patients with HOCM presents with MItral regurgitation due to impared mitral valve closure. Hence this explains the murmur. +1
xw1984  I think this was mentioned in Gojian's lecture, around Austin-Flint murmur +


submitted by mcl(671), visit this page
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PCOS is associated with abnormal production of sex steroids, including dysfunction of estrogen production and progesterone. Chronically elevated levels of estrogen can cause endometrial hyperplasia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917599/

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meningitis  Why isnt it endometriosis? Could someone help me out on this? +2
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +1
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +1
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +34
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +2
lovebug  FA 2019, page 631 +1
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. โ€œPullingโ€ sensation in groin. FA 2019, pg 632 +1
xw1984  Isn't option G, Leiomyomata uteri, associated with high estrogen level? Per FA 2020, fibroid is estrogen sensitive. +2
ownersucks  @xw1984 gross image would show multiple whorled masses +1


submitted by notyasupreme(48), visit this page
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Just wondering if someone could explain the difference between collagen and elastin for this one? I thought either or could be used for tensile strength. Anyone have clarification, don't know why collagen is the best answer!

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notyasupreme  Lol, never mind I realize, it's a scar and that's type III collagen! +6
meryen13  type III is whats usually present but then it gets replaced by collagen I in the scar tissue to add more strength. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352699/ +1
i_hate_it_here  It is also the disulfide bonds that add to tensile strength of collagen, while the inter-chain fibril cross-linking that leads to elastins elasticity FA2020 pg: 51&52 +
xw1984  I think the Q emphasized postoperatiive. Maybe the production of elastin does not increase much comparing to collagen. +
topgunber  i think they would refer to elastin in cases of arteriolar compliance +


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