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Welcome to xxabi's page.
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Comments ...

 +22  (nbme24#43)

Stent thrombosis vs re-stenosis. Stent thrombosis is an acute occlusion of a coronary artery stent, which often results in acute coronary syndrome. Can be prevented by dual antiplatelet therapy or drug-eluting stents. Re-stenosis is the gradual narrowing of the stent lumen due to neointimal proliferation, resulting in anginal symptoms.


 +1  (nbme24#47)

ARBs result in the following changes: increased renin, increased Ang I, increased Ang II, decreased aldosterone and unchanged bradykinin

famylife  ...and just to clarify, they directly inhibit the Ang II receptor (AT1) https://www.drugs.com/mmx/losartan-potassium.html

 +5  (nbme24#45)

Creatinine clearance slightly overestimates GFR because creatinine is moderately secreted by PCT


 +4  (nbme24#18)

Arteries of the spermatic cord - testicular a., ductus deferens a., cremasteric a.

roygbiv  https://i2.wp.com/obgynkey.com/wp-content/uploads/2017/06/A302767_1_En_1_Fig2_HTML.jpg?w=960
roygbiv  Omg I keep adding comments instead of a post LOL

 +2  (nbme24#33)

Most common cause of acute prostatitis in older men is E. Coli, and then Pseudomonas.

charcot_bouchard  Grandpa is monogamous. Sexual history was just to throw u off

 +1  (nbme24#2)

Starting beta blockers before alpha blockade in pheochromocytoma is contraindicated. Beta blockers cancel out the vasodilatory effect of peripheral beta-2 adrenoceptors, potentially leading to unopposed alpha-adrenoceptor stimulation → vasoconstriction → hypertensive crisis.


 +3  (nbme24#23)

NE is converted to EPI via PNMT, which is induced by cortisol.

wowo  FA2019 p83

 +0  (nbme20#13)

Non-treponemal tests are sensitive, but not specific - RPR, VRDL


 +0  (nbme20#28)

Swelling of the cell (e.g., hydropic degeneration): tissue ischemia → decreased ATP production → decreased Na+/K+ ATPase and Ca2+pump activity → diffusion of Na+ and water into the cell → cellular swelling

endochondral1  can someone explain how to cross out the other choices>
endochondral1  what is hydropic degneration and where do i learn about it? why is it not the loss of plasma membrane integrity?
shaeking  Endochondral1, I had the same question. I tried figuring it out and this is what I came up with. The CHF and congestion of the lungs is reducing the amount of oxygen getting to the renal cells. With hypoxia there is decreased aerobic resp in mitochondria with decreased ATP. Without ATPase Na builds up and water follows. As far as the loss of membrane integrity. I think it would cause cellular destruction not just hydropic changes. This is my best guess.
charcot_bouchard  Membrane damage is irreversible stage of cellular injury. if membrane is damaged cell is dying & it will shrink. or totally destroyed by inflammation. they are specifically asking hydropic changes ie cellular swelling. which is the 1st sign of reversible cell injury due to failure of Na/K pump

 +0  (nbme20#45)

Terminal Complement (C5-C9) Deficiencies increase susceptibility to recurrent Neisseria bacteremia. Patients most often present with recurrent meningitis.


 +0  (nbme20#5)

Broca’s aphasia: expressive (motor aphasia) with agrammatism (pts aware that they don’t make sense) - area A Wernicke’s aphasia: receptive (sensory) aphasia with impaired comprehension (pts lack insight)

breis  Why would B be incorrect? I realize Broca is "technically lower" but A seems too low to be causing weakness of the lower 2/3 of the face? Am I missing something?
shaeking  @breis B is incorrect because of the lower 2/3 of the face weakness. B isn't located on the motor cortex but in the premotor cortex, plus it isn't low enough for the lower two thirds of the face. https://thebrain.mcgill.ca/flash/a/a_06/a_06_cr/a_06_cr_mou/a_06_cr_mou.html https://www.sciencenews.org/blog/science-ticker/homunculus-reimagined
cienfuegos  @breis, per UW: "a/w r. hemiparesis (face & UE) bc close to primary motor cortex"

 +1  (nbme20#24)

Bicycle handlebar injury traditionally damages ulnar nerve @ the hook of the hamate bone


 +1  (nbme20#3)

Statins decrease cholesterol synthesis, which indirectly Statins indirectly cause increased LDL receptor expression on hepatocytes (increases LDL clearance from circulation).


 +5  (nbme20#8)

I was under the impression that this was an aortic dissection, due to "severe chest pain" as well as the false lumen in the aorta. And HTN is the #1 risk factor for aortic dissection. Someone correct me if i'm wrong, but I think this is aortic dissection rather than aortic aneurysm.

chefcurry  I believe so, FA 2018 pg 299
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension
breis  FA 2019: 301

 +3  (nbme20#47)

The duration of action of Succinylcholine is determined by its metabolism by plasma cholinesterase. So if there is abnormal plasma cholinesterase (=psuedocholinesterase), it will lead to delayed metabolism of succinylcholine as well as mivacirum, heroin, and cocaine.


 +2  (nbme20#13)

Bronchogenic carcinoma = lung cancer

That being said, lung adenocarcinoma specifically is associated with hypertrophic osteoarthropathy, which is a paraneoplastic syndrome characterized by digital clubbing, arthralgia, joint effusions, and periostosis of tubular bones

luke.10  why not systemic scleroderma since i did this question wrong and i chose systemic sclerosis scleroderma , can someone explain that ?
kernicterusthefrog  My best guess answer to that @luke.10 is that: a) there's no mention of any skin involvement (which there would be in order to be scleroderma) b) Scleroderma shows pitting in the nails, not clubbing c) There would be collagen deposition with fibrosis, not hypertrophy of the bone at joints Saying that, I also got this wrong! (but put RA...) so I'm not claiming to "get this" Hope my thought process helps, though!
yotsubato  This is in FA 2019 page 229
larascon  I agree with @kernicterusthefrog on this one, Bronchogenic carcinoma = lung cancer. Squamous cell carcinoma gives you hypercalcemia (new bone formation; maybe?), commonly found in SMOKERS ...

 +9  (nbme20#46)

Also for those of you who are totally clueless like me, urinary tract obstruction = obstructive uropathy.


 +1  (nbme20#33)

Bile salts help dissolve gallstones that have formed in the gallbladder, used in patients refractory to surgery or prefer to avoid it.

xxabi  To add, bile salts are amphipathic which allows for the emulsification and solubilization of lipids in an aqueous environmen

 +0  (nbme20#31)

Vinca and plant alkaloids bind B-tubulin, which inhibits the formation or disassembly or microtubules, respectively.


 +2  (nbme20#7)

This is a thyroglossal duct cyst. The tyroglossal duct may persist and result in a thyroglossal duct cyst (occurring in midline near hyoid bone or at the base of the tongue), thus will classically move up with swallowing or tongue protrusion.

The foramen cecum (of the tongue) is the normal remnant of the thyroglossal duct


 +1  (nbme20#47)

PDE-5 inhibitors (e.g. sildenafil, tadalafil) are indicated for ED by way of increasing blood flow in the corpus cavernosum (labeled D) of the penis


 -3  (nbme20#43)

I think its that the CI contained the number "0" which makes it statistically insignificant

kernicterusthefrog  You're thinking about CI for a **mean difference** b/w 2 variables. This question talks about **relative risk**, for which 'strugglebus' correctly asserts that *a CI including 1 fails to reject the null hypothesis*. #funwithformatting
xxabi  Ahhhh you're right, I definitely had them mixed up! Thanks!
xxabi  #biostatsisthebaneofmyexistence

 +1  (nbme20#33)

Lead time bias is caused by early detection being confused with increased survival. early detection makes it seem as though survival has increased, but the natural history of the disease has not been impacted.





Subcomments ...

Can someone please clarify the answer. Is decreased adherence same as decreased aggregation? Wouldn;t inhibition of the IIb/IIIa receptor prevent aggregation?

xxabi  I'm not completely sure...but I think its because its aspirin, and aspirin doesn't work on IIb/IIIa receptors. That's why i picked decreased adherence of platelets, figured that was the closest thing to decreased aggregation that still made sense with aspirin's mechanism of action. Hope that helps! +  
ihavenolife  Aspirin irreversibly inhibits COX which leads to decreased TXA2. TXA2 normally is a vasoconstrictor and induces platelet aggregation, so aspirin inhibits platelet aggregation by downplaying TXA2 not by interacting with IIb/IIIa receptor. (Source FA and UWorld) +3  
fallenistand  In this case, inhibition of COX-1 by aspirin will also reduce the amount of precursors for vascular prostacyclin synthesis, provided, for example, from adhering platelets https://www.ncbi.nlm.nih.gov/pubmed/9263351 +  
niboonsh  inhibition of IIb/IIIa receptor is the moa of a completely separate class of drugs - Glycoprotein IIb/IIIa (abciximab, eptifabide, tirofiban) +  


submitted by radshopeful(12),

This patient has decompensated left heart failure. Decompensation occurs because of the hearts inability to keep up with demand any longer. This leads to a decrease in SV mainly because of a contractile issue which leads to a decrease in CO (CO = SV x HR). Lastly, the LVEDV will be decreased because the SV is decreased leaving more blood in the left ventricle after systole since it cannot be pumped forward. Hope this helps!!

xxabi  Great explanation - I think you have a minor typo, LVEDV will be increased* bc SV is decreased +6  
smoothie  More blood left in the ventricle after systole is LVESV. I thought LVEDV increases because more blood remains after systole and on top of that blood from left atria from diastole is now also added. +  


submitted by xxabi(87),

I think its that the CI contained the number "0" which makes it statistically insignificant

kernicterusthefrog  You're thinking about CI for a **mean difference** b/w 2 variables. This question talks about **relative risk**, for which 'strugglebus' correctly asserts that *a CI including 1 fails to reject the null hypothesis*. #funwithformatting +  
xxabi  Ahhhh you're right, I definitely had them mixed up! Thanks! +1  
xxabi  #biostatsisthebaneofmyexistence +1  


submitted by xxabi(87),

I think its that the CI contained the number "0" which makes it statistically insignificant

kernicterusthefrog  You're thinking about CI for a **mean difference** b/w 2 variables. This question talks about **relative risk**, for which 'strugglebus' correctly asserts that *a CI including 1 fails to reject the null hypothesis*. #funwithformatting +  
xxabi  Ahhhh you're right, I definitely had them mixed up! Thanks! +1  
xxabi  #biostatsisthebaneofmyexistence +1  


submitted by ameanolacid(12),

Atherosclerosis is the MOST common cause of renal artery stenosis...with fibromuscular dysplasia being the SECOND most common cause (even though it is tempting to choose this option considering the patient's demographic).

xxabi  Is there a situation where you would pick fibromuscular dysplasia over atherosclerosis if given both options? Thanks for your help! +2  
baconpies  Atherosclerosis affects PROXIMAL 1/3 of renal artery Fibromuscular dysplasia affects DISTAL 2/3 of renal artery +9  
gonyyong  Why is there ↓ size in both kidneys? This threw me off +  
kateinwonderland  @gonyyong : Maybe because narrowed renal a. d/t atherosclerosis led to renal hypoperfusion and decrease in size? +  
drdre  Fibromuscular dysplasia occurs in young females according to Sattar Pg 67, 2018. +1  
davidw  Normally you will see Fibromuscular dysplasia in a young female 18-35 with high or resistant hypertension. She is older has a history type II DM predispose you to vascular disease and normal to moderate elevation in BP +1  


submitted by lsmarshall(188),

"The exact mechanism for tremor induction by β(2)-adrenergic agonists is still unknown, but there is some evidence that β(2)-adrenergic agonists act directly on muscle... More recently, tremor has been correlated closely with hypokalaemia." - NIH publication

First Aid mentions hyperthyroidism causing tremor from β-adrenergic stimulation. It also mentions β2-agonists causing tremor as a side effect. First Aid also mentions β2-agonists driving potassium into cells, which may contribute to tremor. That said, more classic symptoms of hypokalemia are wide QRS and peaked T waves on ECG, arrhythmias, and muscle weakness.

Looking around on the internet looks like if therapy is continued the tremor from a β2-agonists resolves overtime.

xxabi  Sketchy mentions tremor and arrhythmia as side effects! +1  


How do you know he has an incarcerated inguinal hernia and not fecal impaction?

sattanki  So as far as I understand, you don’t really get a bulging, defined abdominal mass with fecal impaction. Much more likely to see this with a hernia. +2  
xxabi  Fecal impaction can be palpated in the abdomen, since it'd be accumulating in the rectum and colon, not the groin. Hope that helps! +5  
pseudorosette  a little late but they also mention that the mass had bowel sounds hence it was an incarcerated bowel! :) +1  


submitted by strugglebus(68),

The CI value contained 1, which means that its insignificant

sympathetikey  Correct. Per first aid: "If the 95% CI for odds ratio or relative risk includes 1, H0 is not rejected." +1  
xxabi  Ah that makes more sense, thanks! +  


https://www.ncbi.nlm.nih.gov/pubmed/301658

Relief of intractable pain was produced in six human patients by stimulation of electrodes permanently implanted in the periventricular and periaqueductal gray matter. The level of stimulation sufficient to induce pain relief seems not to alter the acute pain threshold. Indiscriminate repetitive stimulation produced tolerance to both stimulation-produced pain relief and the analgesic action of narcotic medication; this process could be reversed by abstinence from stimulation. Stimulation-produced relief of pain was reversed by naloxone in five out of six patients. These results suggest that satisfactory alleviation of persistent pain in humans may be obtained by electronic stimulation.

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +  
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. +3  
xxabi  Also its the only one that's an opioid antagonist from the list! +1  
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. +1  


https://www.ncbi.nlm.nih.gov/pubmed/301658

Relief of intractable pain was produced in six human patients by stimulation of electrodes permanently implanted in the periventricular and periaqueductal gray matter. The level of stimulation sufficient to induce pain relief seems not to alter the acute pain threshold. Indiscriminate repetitive stimulation produced tolerance to both stimulation-produced pain relief and the analgesic action of narcotic medication; this process could be reversed by abstinence from stimulation. Stimulation-produced relief of pain was reversed by naloxone in five out of six patients. These results suggest that satisfactory alleviation of persistent pain in humans may be obtained by electronic stimulation.

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +  
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. +3  
xxabi  Also its the only one that's an opioid antagonist from the list! +1  
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. +1  


submitted by strugglebus(68),

Auto dom disease are usually heterozygous (or so they want us to assume)

xxabi  How do you know is autosomal dominant? +1  
scpomp  Hereditary spherocytosis +  
fshowon  Isnt the mean corpuscular hemoglobin concentration increased in spherocytosis? Thats what through me off. +  
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF +1  
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF +  


submitted by celeste(30),

Amiodarone, a class III antiarrhythmic drug, has multiple effects on myocardial depolarization and repolarization that make it an extremely effective antiarrhythmic drug. However, amiodarone is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone's high iodine content and its direct toxic effect on the thyroid. (uptodate.com)

celeste  The "**iod**" part of am**iod**arone reminds me of it's high **iod**ine content. +2  
xxabi  I think of it as the trifecta - gotta monitor LFTs, PFTs, and Ts (thyroid) when on amiodarone! +1  
sinforslide  Also, the patient presented with Afib; this might've been caused by transient hyperthyroidism as a prelude to Hashimoto's. In this case, if you give Amio, you'd cause serious hypothyroidism! +  


submitted by xxabi(87),

Bile salts help dissolve gallstones that have formed in the gallbladder, used in patients refractory to surgery or prefer to avoid it.

xxabi  To add, bile salts are amphipathic which allows for the emulsification and solubilization of lipids in an aqueous environmen +2  


submitted by hayayah(376),

Patient has medullary carcinoma. Malignant proliferation of parafollicular "C" cells that produce calcitonin and have sheets of cells in an amyloid stroma.

xxabi  Just to add - patient likely has MEN 2A or 2B with the presence of medullary thyroid cancer and pheochromocytoma +2  
sympathetikey  @xxabi Was going to say the same thing. +