share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to zelderonmorningstar’s page.
Contributor score: 78


Comments ...

 +0  (nbme24#36)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nCa msoeoen enlixap ywh eth enwsra ’ldotcnu be y?nenaaellnhpi

donutsnduodenums  The kid has albinism, which is due to decreased tyrosinase activity. If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability, musty body odor, etc., in addition to his fair complexion. +19
zelderonmorningstar  I see, so if it was PKU he wouldn’t just be presenting for a routine examination. It would be one of those “oh crap what’s wrong with my baby” ones. +15
wowo  FA2019 p83 +
nbme4unme  Just a note that UWorld says phenylketonuria patients ALSO have albinism, it's just that the neuro sx and musty order are giveaways. +4
pathogen7  Technically, albinism is a problem processing DOPA, and not tyrosine, no? I always associated "tyrosine processing defect" with ochronosis, which is why I didn't choose tyrosine. Guess I'm wrong. +2
cmun777  @pathogen7 you're not wrong it is specifically DOPA but would any of the other answer choices make any sense over tyrosine? +4
qiss  @pathogen7 also yes- you can't make DOPA because of a defective tyrosinase enzyme. This enzyme also metabolizes tyrosine into DOPA before it metabolizes DOPA https://www.google.com/search?q=tyrosinase&sxsrf=ALeKk021WaFQzRNr99BZVujxqRii-GzV6g:1585781210231&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjzt-itp8joAhVDMqwKHUGYC3wQ_AUoAXoECBgQAw&biw=1280&bih=720#imgrc=MyxHLTV0gV7BKM +

 +0  (nbme24#34)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yWh is teh wasenr dcsaredee dolbo lmvueo sa poseodp ot eaeddescr aplams diosum ninraoottcnce?

tea-cats-biscuits  I think it might just be what NBME feels “decreased plasma sodium concentration” means, since through the mechanism that BV is lowered in bedrest, you would definitely have a decreased plasma sodium concentration compared to not-bedrest. However you won’t be presenting with any pathologic signs of hyponatremia because the Na+ would still be maintained in normal limits. Low blood volume is the cause of one of the main pathologic states associated w/bedrest -- cardiac deconditioning and postural hypotension once out of bedrest. Seems like poor wording though. +4
mnemonia  Remember that changes in sodium concentration over a long period time need to be due to a water dysregulation problem (like SIADH, polydipsia, HF, etc.). Here we just have physiologically increased effective circulating volume, and the body will compensate by diuresing, and since Na+ (and K+) are regulated ions, their plasma levels will not fluctuate. +5




Subcomments ...

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

Why is hmcaeatpeoinn eth oretcrc senarw orhet naht scperso fo eoi.aliitmnn NsSIDA cna eb udse fro itnosne AH dan es’hs oot lod ofr eRye neymoSrd (i neam eylacnlthci hsse a dcihl cnsei eshs 1,;7t&l utb otn a scascil uitcepr at al.l) I’m c.odnsfue

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction. +  
gainsgutsglory  @zelderon But what’s the pathophys here? +  
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +3  
pfebo  Acetaminiphen is only antipyretic and analgesic. Does not have anti-inflammatory action like NSAIDs, so it is the most appropriate to treat a headache in a patient with aspirin-induced asthma. +  
pfebo  Also, it is inactive peripherally so less probability of adverse effects +  


submitted by lnsetick(94),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Hwo rae yuo eabl to ellt htat hte TC ieslc is not ta eht eevll of nouu?ddem

zelderonmorningstar  I think the small intestine narrows as you go along, so jejunum would most likely intuss into the duodenum. +  
yotsubato  Duodenum is fixed to the retroperitoneal wall, and also has lots of named vessels attached to it, along with the pancreaticobiliary duct and ampulla. It cant really intussuscept. +  
gh889  You should also know that the duodenum is almost purely on the right side of the body +31  


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

m’I invgah ueltorb ndatiseunndrg yhw itsh is a erttbe oecihc nhat gaPet ,diseaes eecylaispl wiht het decranies ?LAP

zelderonmorningstar  Paget’s would also show some sclerosis. +5  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +28  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +17  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by aladar50(40),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So hreste’ 001 idser,tsne and eth pcrelaevne rtfea 2 seyar is 01= at teh nginbe,gin 5+ ni het trisf r,eya 0+1 cndsoe ay,er and 3- atht deh,ela fro a olatt vpareeecln fo 22 sdrenesit or =/1222020 .epnterc ,sTuh lrcneeepva = vbeoa the ndtasrad. roF dicn,necie i’st 15 new aecss uot fo 90 sredeinst orve hte 2 sraye 100( otlat tsisnrdee – 01 ahtt aeradly hda el,cr)us or 51 enw lrseuc rep 810 yniaptst.aee⋅r iTsh dluow eb 338. wne reslcu rpe 0001 in⋅ryasttaeep fi ouy ltapteadrxoe it out -- llayicasb /1108)0(00 * 51 -- tsuh, nieenccid = ovaeb the adadrtns.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +53  
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +4  
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2  
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7  
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3  
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +15  
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +  
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +  
doublethinker  Damn, guess my reading comprehension is not "up to the standard" of the NBME writers. Smh. +  
prolific_pygophilic  If you forgot that its patient years (15/180) not (15/90) you still get the right answer because they are both above 5% :). +  


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

nCa eonomse pilxena ywh eth renswa c’ntdolu eb na?hyeipnllaen

donutsnduodenums  The kid has albinism, which is due to decreased tyrosinase activity. If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability, musty body odor, etc., in addition to his fair complexion. +19  
zelderonmorningstar  I see, so if it was PKU he wouldn’t just be presenting for a routine examination. It would be one of those “oh crap what’s wrong with my baby” ones. +15  
wowo  FA2019 p83 +  
nbme4unme  Just a note that UWorld says phenylketonuria patients ALSO have albinism, it's just that the neuro sx and musty order are giveaways. +4  
pathogen7  Technically, albinism is a problem processing DOPA, and not tyrosine, no? I always associated "tyrosine processing defect" with ochronosis, which is why I didn't choose tyrosine. Guess I'm wrong. +2  
cmun777  @pathogen7 you're not wrong it is specifically DOPA but would any of the other answer choices make any sense over tyrosine? +4  
qiss  @pathogen7 also yes- you can't make DOPA because of a defective tyrosinase enzyme. This enzyme also metabolizes tyrosine into DOPA before it metabolizes DOPA https://www.google.com/search?q=tyrosinase&sxsrf=ALeKk021WaFQzRNr99BZVujxqRii-GzV6g:1585781210231&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjzt-itp8joAhVDMqwKHUGYC3wQ_AUoAXoECBgQAw&biw=1280&bih=720#imgrc=MyxHLTV0gV7BKM +  
qiss  link fixed hopefully +1  


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

uYo onwk is’t na onpedleve rsuvi icsen it nto’esd hldo pu to adci or benig ddeir. oYu nkow it easusc a rvfee dna a c,ghou iwelh fagtcnefi teh n.ralyx Onyl rsuvi goetycra ttah itfs all htat fion si eht rriuocosnva eucas(s )ARSS fomr ttha i.tsl

zelderonmorningstar  EBV doesn’t cause fever and cough? +1  
zelderonmorningstar  Wow, just checked First Aid and it doesn’t list “cough” as a symptom of EBV. +4  
drdoom  EBV is not a “respiratory virus”; it’s a *B cell virus*. Even though you might associate it with the “upper respiratory tract” (=kissing disease), it doesn’t cause respiratory inflammation since that’s not its trope. B cells are its trope! That’s why EBV is implicated in Burkitt Lymphoma, hairy leukoplakia and other blood cancers. (EBV is also known as “lymphocryptovirus” -- it was originally discovered “hiding” in *lymphocytes* of monkeys.) So, EBV = think B cells. +27  
fulminant_life  EBV does cause pharyngeal and laryngeal inflammation along with fever, malaise, and cough and LAD. The only thing that pointed me away from mono and towards coronavirus was the patients age. +7  
nbmehelp  Can someone explain what not holding up to acid or being dried has to do with being enveloped? +  
yb_26  @nbmehelp, the envelope consists of phospholipids and glycoproteins => heat, acid, detergents, drying - all of that can dissolve the lipid bilayer membranes => viruses will loss their infectivity (because they need an envelope for two reasons - to protect them against host immune system, and to attach to host cells surface in order to infect them) +10  
lowyield  @yb_26 does that mean that non-enveloped viruses hold up better to acid/dryness? +2  
rina  yes enveloped viruses are easier to kill (see post from drsquarepants: https://www.nbmeanswers.com/exam/nbme23/1161). also i think the "when dried" might refer to the fact that coronavirus is spread by respiratory droplets (don't even need to read first aid can just read the news at this point!) +3  


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

ouY knwo tis’ an vdeeolpne siuvr cinse it tsodn’e dohl up to daic or genbi rd.ied uYo onwk ti seasuc a efevr nda a hougc, wlieh ecantffgi the ryn.lxa ylnO urvis gcotyrea atht isft all atth fnio is hte vrsoaicuonr saecs(u SS)RA omfr htat lit.s

zelderonmorningstar  EBV doesn’t cause fever and cough? +1  
zelderonmorningstar  Wow, just checked First Aid and it doesn’t list “cough” as a symptom of EBV. +4  
drdoom  EBV is not a “respiratory virus”; it’s a *B cell virus*. Even though you might associate it with the “upper respiratory tract” (=kissing disease), it doesn’t cause respiratory inflammation since that’s not its trope. B cells are its trope! That’s why EBV is implicated in Burkitt Lymphoma, hairy leukoplakia and other blood cancers. (EBV is also known as “lymphocryptovirus” -- it was originally discovered “hiding” in *lymphocytes* of monkeys.) So, EBV = think B cells. +27  
fulminant_life  EBV does cause pharyngeal and laryngeal inflammation along with fever, malaise, and cough and LAD. The only thing that pointed me away from mono and towards coronavirus was the patients age. +7  
nbmehelp  Can someone explain what not holding up to acid or being dried has to do with being enveloped? +  
yb_26  @nbmehelp, the envelope consists of phospholipids and glycoproteins => heat, acid, detergents, drying - all of that can dissolve the lipid bilayer membranes => viruses will loss their infectivity (because they need an envelope for two reasons - to protect them against host immune system, and to attach to host cells surface in order to infect them) +10  
lowyield  @yb_26 does that mean that non-enveloped viruses hold up better to acid/dryness? +2  
rina  yes enveloped viruses are easier to kill (see post from drsquarepants: https://www.nbmeanswers.com/exam/nbme23/1161). also i think the "when dried" might refer to the fact that coronavirus is spread by respiratory droplets (don't even need to read first aid can just read the news at this point!) +3