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 
search for anything NEW!
NBME 20 Answers

Question#1 (61.0 difficulty score)
A 37-year-old nurse is accidentally stuck ...
Inhibits reverse transcriptaseπŸ”,πŸ“Ί

Question#2 (45.7 difficulty score)
A mother who has toxoplasmosis gives birth to ...
Antitoxoplasma IgM antibody concentrationsπŸ”,πŸ“Ί

Question#3 (29.4 difficulty score)
A 48-year-old man comes to the physician for ...
Upregulation of the LDL receptorsπŸ”,πŸ“Ί

Question#4 (46.3 difficulty score)
A 50-year-old man is brought to the emergency ...
Formic acidπŸ”,πŸ“Ί

Question#5 (28.7 difficulty score)
A 24-year-old African American man comes to ...
Pseudofolliculitis barbaeπŸ”,πŸ“Ί

Question#6 (51.8 difficulty score)
A 16-year-old student has uncontrollable ...
Direct transition from wakefulness to REM sleepπŸ”,πŸ“Ί

Question#7 (40.2 difficulty score)
A 5-year-old girl with AIDS develops a ...
Thymidine kinaseπŸ”,πŸ“Ί

Question#8 (32.7 difficulty score)
A 10-year-old girl is brought to the ...
Breast bud developmentπŸ”,πŸ“Ί

Question#9 (31.7 difficulty score)
A 50-year-old man is brought to the physician ...
Pick diseaseπŸ”,πŸ“Ί

Question#10 (46.9 difficulty score)
A 77-year-old woman has been having ...
C7-T1 foraminal stenosisπŸ”,πŸ“Ί

Question#11 (40.6 difficulty score)
The sequence surrounding the first two exons ...
Disruption of normal splicing by creation of a new 3β€² splice siteπŸ”,πŸ“Ί

Question#12 (88.9 difficulty score)
A 72-year-old woman with dysphagia is ...
Right kidneyπŸ”,πŸ“Ί

Question#13 (42.2 difficulty score)
A 6-week-old girl is brought to the physician ...
Immature lower esophageal sphincterπŸ”,πŸ“Ί

Question#14 (45.6 difficulty score)
A 28-year-old man who is a migrant worker ...
Psoas majorπŸ”,πŸ“Ί

Question#15 (52.3 difficulty score)
A 30-year-old man who completed a successful ...
Adjustment disorder with anxietyπŸ”,πŸ“Ί

Question#16 (60.1 difficulty score)
A 30-year-old woman with multiple sclerosis ...
PonsπŸ”,πŸ“Ί

Question#17 (93.9 difficulty score)
A 50-year-old woman comes to the physician ...
Drug effectπŸ”,πŸ“Ί

Question#18 (44.6 difficulty score)
A 36-year-old man comes to the physician ...
Urine output: increased; Urine potassium: increasedπŸ”,πŸ“Ί

Question#19 (42.2 difficulty score)
A 60-year-old man comes to the physician ...
Urine Na+: increased; Serum osmolality: decreasedπŸ”,πŸ“Ί

Question#20 (44.3 difficulty score)
An 8-year-old boy is evaluated for ...
Coarctation of the aortaπŸ”,πŸ“Ί

Question#21 (37.8 difficulty score)
A 75-year-old woman comes to the physician ...
Multinucleated giant cells and neutrophil infiltratesπŸ”,πŸ“Ί

Question#22 (27.2 difficulty score)
A 38-year-old woman comes to the physician ...
VagusπŸ”,πŸ“Ί

Question#23 (49.2 difficulty score)
A 34-year-old man who is HIV positive is ...
CD4+ T lymphocytesπŸ”,πŸ“Ί

Question#24 (60.8 difficulty score)
A 50-year-old man comes to the physician ...
OmeprazoleπŸ”,πŸ“Ί

Question#25 (34.7 difficulty score)
A 25-year-old primigravid woman at 42Β weeks’ ...
Phosphoinositide hydrolysisπŸ”,πŸ“Ί

Question#26 (32.5 difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#27 (25.7 difficulty score)
A 53-year-old woman comes to the physician ...
Schistosoma mansoni πŸ”,πŸ“Ί

Question#28 (16.8 difficulty score)
A previously healthy 16-year-old girl comes ...
Trichomonas vaginalisπŸ”,πŸ“Ί

Question#29 (56.0 difficulty score)
During an experiment, an investigator ...
LysineπŸ”,πŸ“Ί

Question#30 (36.3 difficulty score)
A 33-year-old woman comes to the emergency ...
LunateπŸ”,πŸ“Ί

Question#31 (47.8 difficulty score)
A 66-year-old man has had fatigue, shortness ...
Focal pulmonary fibrosisπŸ”,πŸ“Ί

Question#32 (46.8 difficulty score)
A 56-year-old woman is brought to the ...
Placement of the central line via the left internal jugular veinπŸ”,πŸ“Ί

Question#33 (53.8 difficulty score)
A 17-year-old girl comes to the emergency ...
MitochondrialπŸ”,πŸ“Ί

Question#34 (51.2 difficulty score)
A strain of Escherichia coli produces a ...
MissenseπŸ”,πŸ“Ί

Question#35 (77.5 difficulty score)
A 70-year-old man dies of coronary artery ...
Spastic hemiparesis on the rightπŸ”,πŸ“Ί

Question#36 (25.4 difficulty score)
A 56-year-old man is admitted to the hospital ...
RhabdomyolysisπŸ”,πŸ“Ί

Question#37 (68.6 difficulty score)
A 1-month-old male newborn is brought to the ...
Na+: 132; K+: 3.2; Clβˆ’: 90; HCO3βˆ’: 37πŸ”,πŸ“Ί

Question#38 (30.7 difficulty score)
A 9-year-old girl is brought to the physician ...
Diverticulum of the roof of the embryonic oral cavityπŸ”,πŸ“Ί

Question#39 (35.8 difficulty score)
A 3-month-old boy is brought to the office by ...
Lateral to the inferior epigastric artery and superior to the inguinal ligamentπŸ”,πŸ“Ί

Question#40 (51.0 difficulty score)
Monoclonality of neoplastic cells in ...
X chromosome-linked isoenzymesπŸ”,πŸ“Ί

Question#41 (35.5 difficulty score)
A 45-year-old man has fever, chills, dysuria, ...
Escherichia coliπŸ”,πŸ“Ί

Question#42 (40.0 difficulty score)
A 60-year-old man has two-pillow orthopnea, ...
Jugular venous pressure of 12 mm HgπŸ”,πŸ“Ί

Question#43 (45.2 difficulty score)
A randomized clinical trial is conducted to ...
Neither procedure is superiorπŸ”,πŸ“Ί

Question#44 (34.5 difficulty score)
A 35-year-old woman with newly diagnosed ...
MR angiography of the renal arteriesπŸ”,πŸ“Ί

Question#45 (22.2 difficulty score)
A 2-year-old boy is brought to the physician ...
Amino Acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3–: decreasedπŸ”,πŸ“Ί

Question#46 (43.1 difficulty score)
A 55-year-old woman comes to the physician ...
CholecalciferolπŸ”,πŸ“Ί

Question#47 (29.5 difficulty score)
A 60-year-old woman with type 2 diabetes ...
Rupture of a papillary muscleπŸ”,πŸ“Ί

Question#48 (33.7 difficulty score)
An otherwise healthy 4-month-old girl is ...
Spontaneous involutionπŸ”,πŸ“Ί

Question#49 (68.5 difficulty score)
A 56-year-old man comes to the physician ...
Fibromuscular hyperplasia of arteriolesπŸ”,πŸ“Ί

Question#50 (14.9 difficulty score)
A 26-year-old man undergoes an abdominal ...
SplenicπŸ”,πŸ“Ί

Question#1 (32.4 difficulty score)
A 17-year-old girl comes to the emergency ...
Speak with the patient and her parents about the findingsπŸ”,πŸ“Ί

Question#2 (55.4 difficulty score)
Following a wedding reception that was ...
NorovirusπŸ”,πŸ“Ί

Question#3 (54.5 difficulty score)
An investigator compares the DNA sequences of ...
5β€² CCGGπŸ”,πŸ“Ί

Question#4 (21.2 difficulty score)
A 56-year-old woman has frequently burned ...
Syrinx of the central region of the spinal cord from C-4 to T-5πŸ”,πŸ“Ί

Question#5 (32.4 difficulty score)
A 32-year-old woman has had fecal ...
Damage to the anal sphincterπŸ”,πŸ“Ί

Question#6 (74.3 difficulty score)
An 18-year-old boy has just been diagnosed ...
50%πŸ”,πŸ“Ί

Question#7 (62.8 difficulty score)
A 30-year-old man comes to the physician ...
Increased osteoclast maturation and activityπŸ”,πŸ“Ί

Question#8 (56.4 difficulty score)
Three elderly residents of an assisted living ...
Legionella pneumophilaπŸ”,πŸ“Ί

Question#9 (29.3 difficulty score)
An otherwise healthy 16-year-old girl comes ...
Cold, dry airπŸ”,πŸ“Ί

Question#10 (38.0 difficulty score)
A 70-year-old woman is transferred to a ...
Activity level before the fractureπŸ”,πŸ“Ί

Question#11 (41.6 difficulty score)
A female newborn delivered at 36 weeks' ...
Incomplete formation of pleuroperitoneal membraneπŸ”,πŸ“Ί

Question#12 (46.2 difficulty score)
An 80-year-old man with type 2 diabetes ...
Pelvic splanchnicπŸ”,πŸ“Ί

Question#13 (42.2 difficulty score)
A 25-year-old woman comes to the physician ...
A phospholipid (cardiolipin) on charcoal particlesπŸ”,πŸ“Ί

Question#14 (41.9 difficulty score)
A 23-year-old woman has had fever, ...
Streptococcus pneumoniaeπŸ”,πŸ“Ί

Question#15 (30.5 difficulty score)
A 55-year-old man comes to the physician ...
DextromethorphanπŸ”,πŸ“Ί

Question#16 (27.0 difficulty score)
A 10-year-old boy with mild mental ...
Tuberous sclerosisπŸ”,πŸ“Ί

Question#17 (59.9 difficulty score)
A 57-year old man has a hemoglobin ...
Chronic obstructive pulmonary diseaseπŸ”,πŸ“Ί

Question#18 (30.5 difficulty score)
A 65-year-old man is brought to the emergency ...
ST-segment elevationπŸ”,πŸ“Ί

Question#19 (62.3 difficulty score)
A 66-year-old man is brought to the emergency ...
Cigarette smokingπŸ”,πŸ“Ί

Question#20 (53.2 difficulty score)
A 19-year-old man who is a college student is ...
Subcutaneous crepitusπŸ”,πŸ“Ί

Question#21 (48.7 difficulty score)
A 25-year-old woman comes to the physician 2 ...
Granulomas containing stellate microabscessesπŸ”,πŸ“Ί

Question#22 (34.8 difficulty score)
A 44-year-old woman comes to the physician ...
Ubiquitin ligaseπŸ”,πŸ“Ί

Question#23 (40.0 difficulty score)
Which of the following changes in the ...
Increased basal systolic blood pressureπŸ”,πŸ“Ί

Question#24 (28.1 difficulty score)
A patient with a 1-week history of diarrhea ...
Decreased arterial Pco2πŸ”,πŸ“Ί

Question#25 (53.6 difficulty score)
A 14-year-old girl is brought to the ...
Mitochondrial tRNALeuπŸ”,πŸ“Ί

Question#26 (53.5 difficulty score)
A male newborn is found to have a decreased ...
Thyroid hormone-binding globulin deficiencyπŸ”,πŸ“Ί


Question#28 (31.1 difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreasπŸ”,πŸ“Ί

Question#29 (38.0 difficulty score)
A 25-year-old woman has a flu-like illness ...
PicornavirusπŸ”,πŸ“Ί

Question#30 (56.0 difficulty score)
A 78-year-old man is brought to the emergency ...
CortisolπŸ”,πŸ“Ί

Question#31 (41.5 difficulty score)
A 25-year-old man comes to the physician 8 ...
Rupture of an intervertebral discπŸ”,πŸ“Ί

Question#32 (65.8 difficulty score)
A 12-year-old girl is brought to the ...
OsteoblastsπŸ”,πŸ“Ί

Question#33 (15.4 difficulty score)
A study is conducted to assess the effect of ...
Lead-timeπŸ”,πŸ“Ί

Question#34 (25.7 difficulty score)
A 28-year-old man has excessive thirst and ...
HypothalamusπŸ”,πŸ“Ί

Question#35 (64.9 difficulty score)
A 36-year-old woman comes to the office ...
SplenomegalyπŸ”,πŸ“Ί

Question#36 (33.1 difficulty score)
A 31-year-old man has a large, yellow, soft ...
LiposarcomaπŸ”,πŸ“Ί

Question#37 (39.4 difficulty score)
A 28-year-old woman of Eastern European ...
Recombinational double-stranded DNA break repairπŸ”,πŸ“Ί


Question#39 (28.5 difficulty score)
A 29-year-old man comes to the physician ...
Absence of peptidoglycanπŸ”,πŸ“Ί

Question#40 (25.5 difficulty score)
A 70-year-old man has a 3-month history of ...
Squamous cell carcinomaπŸ”,πŸ“Ί

Question#41 (58.6 difficulty score)
Purified serum antibodies elicited by ...
Proteins X and Y express the same epitopesπŸ”,πŸ“Ί

Question#42 (34.4 difficulty score)
A previously healthy 32-year-old woman is ...
PreloadπŸ”,πŸ“Ί

Question#43 (55.2 difficulty score)
An 18-year-old woman comes to the physician ...
OvariesπŸ”,πŸ“Ί


Question#45 (29.4 difficulty score)
A new antiplatelet agent is developed for the ...
8%πŸ”,πŸ“Ί


Question#47 (46.3 difficulty score)
A 35-year-old man comes to the physician to ...
1:4πŸ”,πŸ“Ί

Question#48 (51.4 difficulty score)
A sedentary 50-year-old man with hypertension ...
Antidepressant therapyπŸ”,πŸ“Ί

Question#49 (43.6 difficulty score)
An 82-year-old woman is brought to the ...
Decreased slope of diastolic depolarizationπŸ”,πŸ“Ί

Question#50 (38.1 difficulty score)
A 27-year-old woman comes to the physician ...
PheochromocytomaπŸ”,πŸ“Ί

Question#1 (53.4 difficulty score)
The frequency of an autosomal recessive ...
1/25πŸ”,πŸ“Ί

Question#2 (37.0 difficulty score)
A 23-year-old woman is brought to the ...
Xanthine oxidaseπŸ”,πŸ“Ί

Question#3 (20.6 difficulty score)
A 45-year-old woman has a thyroidectomy ...
CalcitoninπŸ”,πŸ“Ί

Question#4 (41.3 difficulty score)
An 18-year-old woman comes to the physician ...
Reactive T lymphocytesπŸ”,πŸ“Ί

Question#5 (33.1 difficulty score)
A 35-year-old man comes to the physician ...
MethotrexateπŸ”,πŸ“Ί

Question#6 (20.6 difficulty score)
A new drug has the following effects on the ...
Pathway labeled 'H' (Conversion of Leukotriene A4 to Leukotriene B4πŸ”,πŸ“Ί

Question#7 (35.0 difficulty score)
A 10-year-old boy has a palpable mass in the ...
Endoderm of foramen caecumπŸ”,πŸ“Ί

Question#8 (32.3 difficulty score)
A 12-year-old girl is brought to the ...
PolyubiquitinationπŸ”,πŸ“Ί

Question#9 (26.3 difficulty score)
A 62-year-old man comes to the physician ...
ProstateπŸ”,πŸ“Ί

Question#10 (28.6 difficulty score)
A 59-year-old man develops fatigue and ...
HemolysisπŸ”,πŸ“Ί

Question#11 (62.1 difficulty score)
A 3-year-old boy is brought to the physician ...
Heterozygous mutation in the ankyrin geneπŸ”,πŸ“Ί

Question#12 (25.4 difficulty score)
A 46-year-old man has dyspnea, orthopnea, and ...
Mitral regurgitationπŸ”,πŸ“Ί

Question#13 (30.5 difficulty score)
A 45-year-old woman develops proteinuria and ...
Tubulointerstitial nephritisπŸ”,πŸ“Ί

Question#14 (19.5 difficulty score)
During a clinical study, an investigator ...
Increase the sample sizeπŸ”,πŸ“Ί

Question#15 (37.2 difficulty score)
A 23-year-old woman, who was diagnosed with ...
Substance PπŸ”,πŸ“Ί

Question#16 (12.5 difficulty score)
A 41-year-old woman with systemic lupus ...
Ask the attending physician to obtain informed consentπŸ”,πŸ“Ί

Question#17 (14.5 difficulty score)
A 45-year-old man comes to the emergency ...
Schizoid personality disorderπŸ”,πŸ“Ί

Question#18 (51.1 difficulty score)
An 18-year-old woman comes to the physician ...
50%πŸ”,πŸ“Ί

Question#19 (40.5 difficulty score)
A 23-year-old man comes to the physician ...
Area labeled β€˜B’ (Mitochondrion)πŸ”,πŸ“Ί

Question#20 (44.4 difficulty score)
A 67-year-old woman comes to the physician ...
Low sensitivityπŸ”,πŸ“Ί

Question#21 (31.0 difficulty score)
A newborn is born with a lethal chromosome ...
Feed by whatever means necessary to maintain comfortπŸ”,πŸ“Ί

Question#22 (27.0 difficulty score)
In patients with breast cancer, metabolically ...
Gonadotropin by the pituitary glandπŸ”,πŸ“Ί


Question#24 (35.6 difficulty score)
A 2-month-old girl is brought to the ...
Thyroid function testsπŸ”,πŸ“Ί

Question#25 (23.7 difficulty score)
A 4-week-old infant is brought to the ...
Hypertrophic pyloric stenosisπŸ”,πŸ“Ί

Question#26 (32.4 difficulty score)
A 3-month-old boy is brought to the physician ...
Mannose 6-phosphateπŸ”,πŸ“Ί

Question#27 (15.5 difficulty score)
A 55-year-old man with type 2 diabetes ...
PravastatinπŸ”,πŸ“Ί

Question#28 (27.4 difficulty score)
A 23-year-old woman who is 6 months pregnant ...
Antiplatelet antibodiesπŸ”,πŸ“Ί

Question#29 (29.9 difficulty score)
An 83-year-old man is brought to the ...
Early septic shockπŸ”,πŸ“Ί

Question#30 (32.9 difficulty score)
A 22-year-old woman who recently emigrated ...
Obstruction of the right interventricular foramen (foramen of Monro)πŸ”,πŸ“Ί

Question#31 (22.3 difficulty score)
A 62-year-old woman comes to the physician ...
Ξ²-TubulinπŸ”,πŸ“Ί

Question#32 (21.2 difficulty score)
A 54-year-old woman with terminal metastatic ...
NonmaleficenceπŸ”,πŸ“Ί

Question#33 (22.6 difficulty score)
A 31-year-old woman receives a prescription ...
Formation of complexes with mineral ionsπŸ”,πŸ“Ί

Question#34 (20.5 difficulty score)
A 22-year-old woman comes to the emergency ...
Release of bacterial productsπŸ”,πŸ“Ί

Question#35 (46.2 difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infectionπŸ”,πŸ“Ί

Question#36 (54.7 difficulty score)
A 4-year-old boy has had fever, abdominal ...
Shigella sonneiπŸ”,πŸ“Ί

Question#37 (37.6 difficulty score)
A 62-year-old man with alcohol-induced liver ...
SpironolactoneπŸ”,πŸ“Ί

Question#38 (49.1 difficulty score)
A 23-year-old man with a 3-year history of ...
Psychogenic polydipsiaπŸ”,πŸ“Ί

Question#39 (46.6 difficulty score)
A 19-year-old woman has severe refractory ...
Teratogenic effects in the embryoπŸ”,πŸ“Ί

Question#40 (19.1 difficulty score)
Two days after admission to the hospital ...
Do not proceed with the transfusionπŸ”,πŸ“Ί

Question#41 (47.1 difficulty score)
A 2-year-old child undergoes resection of the ...
Increase in glomerular sizeπŸ”,πŸ“Ί

Question#42 (45.2 difficulty score)
A 13-year-old girl has an episode of severe ...
Epstein-Barr virus genomeπŸ”,πŸ“Ί

Question#43 (28.4 difficulty score)
A 71-year-old man comes to the physician ...
CilostazolπŸ”,πŸ“Ί


Question#45 (26.0 difficulty score)
A 39-year-old man reports bright red spots on ...
ConstipationπŸ”,πŸ“Ί

Question#46 (43.5 difficulty score)
Removal of the thymus at birth results in ...
Thymic lymphocytes produced before thymectomy are long-livedπŸ”,πŸ“Ί

Question#47 (39.0 difficulty score)
A 60-year-old woman has prolonged apnea ...
SuccinylcholineπŸ”,πŸ“Ί

Question#48 (22.3 difficulty score)
A 48-year-old woman comes to the physician ...
HypothyroidismπŸ”,πŸ“Ί

Question#49 (52.5 difficulty score)
A 92-year-old woman who was recently admitted ...
Atrophy of dermal collagenπŸ”,πŸ“Ί

Question#50 (41.1 difficulty score)
A 62-year-old man comes to the physician ...
Agonist at Ξ³-aminobutyric acid B (GABAB) receptorsπŸ”,πŸ“Ί

Question#1 (46.2 difficulty score)
A 32-year-old man comes to the physician ...
Tissue: testicle; Effect: estradiol productionπŸ”,πŸ“Ί

Question#2 (19.8 difficulty score)
A study is conducted to identify healthy ...
LiverπŸ”,πŸ“Ί

Question#3 (43.7 difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”,πŸ“Ί

Question#4 (34.4 difficulty score)
A 20-year-old man comes to the physician ...
OlfactoryπŸ”,πŸ“Ί

Question#5 (32.7 difficulty score)
Immediately after a cerebral infarction, a ...
Area labeled β€˜A’ (Broca’s area)πŸ”,πŸ“Ί

Question#6 (23.7 difficulty score)
A 51-year-old man develops diaphoresis, ...
Alcohol withdrawalπŸ”,πŸ“Ί

Question#7 (43.5 difficulty score)
A 33-year-old woman with HIV infection is ...
Non-Hodgkin lymphomaπŸ”,πŸ“Ί

Question#8 (42.2 difficulty score)
A 58-year-old man is brought to the emergency ...
HypertensionπŸ”,πŸ“Ί

Question#9 (26.5 difficulty score)
A previously healthy 37-year-old woman comes ...
Tumor of the adrenal zona fasciculataπŸ”,πŸ“Ί

Question#10 (32.1 difficulty score)
A 65-year-old woman who has a 25-year history ...
Hydroxylation of prolineπŸ”,πŸ“Ί

Question#11 (33.0 difficulty score)
A 37-year-old man who is HIV positive comes ...
NortriptylineπŸ”,πŸ“Ί


Question#13 (63.4 difficulty score)
A 62-year-old woman comes to the physician ...
Bronchogenic carcinomaπŸ”,πŸ“Ί

Question#14 (29.5 difficulty score)
A 60-year-old man has a round, ...
Basal cell carcinomaπŸ”,πŸ“Ί

Question#15 (45.3 difficulty score)
A 45-year-old man is undergoing a surgical ...
Decreasing respiratory rateπŸ”,πŸ“Ί

Question#16 (54.7 difficulty score)
An investigator wishes to determine the ...
Ductal ion reabsorption is more efficient at low flow ratesπŸ”,πŸ“Ί

Question#17 (35.8 difficulty score)
A previously healthy 55-year-old man has ...
Renal artery stenosisπŸ”,πŸ“Ί

Question#18 (36.1 difficulty score)
A 35-year-old man comes to the physician ...
GastrinπŸ”,πŸ“Ί

Question#19 (29.1 difficulty score)
A 55-year-old man with severe emphysema comes ...
Percussion: hyperresonant; Tactile fremitus: decreased; Expiratory phase: prolongedπŸ”,πŸ“Ί

Question#20 (46.2 difficulty score)
A 5-year-old boy is brought to the physician ...
HypophosphatemiaπŸ”,πŸ“Ί

Question#21 (74.9 difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeetsπŸ”,πŸ“Ί

Question#22 (28.0 difficulty score)
A 35-year-old man is given cyclosporine ...
Decreased synthesis of interleukinsπŸ”,πŸ“Ί

Question#23 (14.7 difficulty score)
A 45-year-old woman who is intubated and ...
Ξ²-Glucan carbohydrates in the cell wallπŸ”,πŸ“Ί

Question#24 (43.8 difficulty score)
A 27-year-old man comes to the physician ...
Deep branch of the ulnar nerve at the hook of the hamate boneπŸ”,πŸ“Ί

Question#25 (47.6 difficulty score)
A 52-year-old man is brought to the emergency ...
Increased total peripheral resistance and decreased cardiac outputπŸ”,πŸ“Ί

Question#26 (38.5 difficulty score)
A 33-year-old man comes to the physician ...
Rectus femorisπŸ”,πŸ“Ί

Question#27 (35.4 difficulty score)
An investigator is studying patients with ...
Case seriesπŸ”,πŸ“Ί

Question#28 (47.7 difficulty score)
A 78-year-old man dies of chronic congestive ...
Failure of the Na+–K+ pumpπŸ”,πŸ“Ί

Question#29 (30.3 difficulty score)
A 15-year-old girl is brought to the ...
DoxycyclineπŸ”,πŸ“Ί

Question#30 (32.4 difficulty score)
A 32-year-old woman is brought to the ...
Arterial lacerationπŸ”,πŸ“Ί

Question#31 (44.9 difficulty score)
A 48-year-old man is brought to the emergency ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/LπŸ”,πŸ“Ί

Question#32 (52.6 difficulty score)
A 55-year-old man comes to the physician ...
Partial oxidation of fatty acidsπŸ”,πŸ“Ί

Question#33 (30.5 difficulty score)
A 65-year-old woman with cardiovascular ...
Increased bile saltπŸ”,πŸ“Ί


Question#35 (16.1 difficulty score)
A 62-year-old man comes to the physician for ...
ContemplationπŸ”,πŸ“Ί

Question#36 (24.3 difficulty score)
A 25-year-old woman is brought to the ...
Factitious disorderπŸ”,πŸ“Ί

Question#37 (30.2 difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin EπŸ”,πŸ“Ί

Question#38 (23.4 difficulty score)
A 45-year-old man comes to the physician ...
Tumor necrosis factorπŸ”,πŸ“Ί

Question#39 (24.0 difficulty score)
A 30-year-old woman develops serum sickness ...
C3aπŸ”,πŸ“Ί

Question#40 (27.4 difficulty score)
A 6-month-old girl is brought to the ...
Ornithine transcarbamylaseπŸ”,πŸ“Ί

Question#41 (45.9 difficulty score)
A 56-year-old man with a 20-year history of ...
NaloxoneπŸ”,πŸ“Ί

Question#42 (67.7 difficulty score)
A 65-year-old woman dies 6 months after the ...
MeningealπŸ”,πŸ“Ί

Question#43 (45.8 difficulty score)
A physician is assigned to a search and ...
Negative nitrogen balanceπŸ”,πŸ“Ί

Question#44 (57.2 difficulty score)
A 45-year-old man comes to the office for ...
Starchy foodsπŸ”,πŸ“Ί

Question#45 (14.6 difficulty score)
A 12-year-old boy is brought to the physician ...
Terminal components of complementπŸ”,πŸ“Ί

Question#46 (77.1 difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathyπŸ”,πŸ“Ί

Question#47 (30.1 difficulty score)
A 61-year-old man has erectile dysfunction ...
Area labeled β€˜D’ (Corpus cavernosum)πŸ”,πŸ“Ί

Question#48 (38.2 difficulty score)
A 24-year-old man comes to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί

Question#49 (47.1 difficulty score)
A 23-year-old woman sustains significant ...
Direct antiglobulin testπŸ”,πŸ“Ί

Question#50 (19.1 difficulty score)
A previously healthy 16-year-old girl is ...
Prescribe antibiotics without notifying her parentsπŸ”,πŸ“Ί

Recent comments ...

... amorah made a comment on nbme20/block3/q#35 (A 51-year-old man has the acute onset of fever and...)
 +37 
submitted by amorah(100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

verFe ;&-tg leru uto lfte nirtvlcearu aelriuf T-PXMMS ypapoilhxrs g&;-t lrue out cmstPnyuoies vir endicyeKjoi lnntraspat btu no /RCCWBB in rueni t;&g- urel uto rsantpltna eoijercnt

giveLan MVC dan yiaclpat tubamomcyrcei sa eth meairginn two iots.npo MCV si rmeo kyleli ni a arantntpsl etpi.nat

... hayayah made a comment on nbme20/block1/q#40 (Monoclonality of neoplastic cells in endometrial...)
 +33 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

soeaiNpla si new ssueit orgtwh atth si ,eglauntdrue rislererv,ibe and ln.maoncolo

aCltnyiol nac eb etmiddneer by oshcugo6epshl-p-eta reoaeegnydhds GP(D6) eyenmz o.riosmfs P6DG si -inkldXe.

*roF eorm imtfonoanir kcehc tuo C.h 3 olpiNeasa in mhaaotP

hello  This is great, thank you. +5
breis  Pathoma ch. 3 pg 23 "Basic Principles" +9
charcot_bouchard  Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec. +14
fatboyslim  Clonality can also be determined by androgen receptor isoforms, which is also present on the X chromosome (Pathoma Ch. 3 Neoplasia) +2
lovebug  @fatboyslim thanks for reminding! +1
makingstrides  Just to make sure I got this right, because this is neoplastic and its monoclonal, you want to look at the isozymes to determine its clonality? +2
... hayayah made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +32 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

VL odstppe ,wnrikog uprrsese kdceab pu oitn ulpm .icirutc uPlm irccitu lrguhyo si mead of 3 t"spra" - eth raeiilslcap, sriteattlini aceps, dna hte loe.vial

nI gaicoirdecn os,khc eht terax bdloo srnceaesi apcyliral ystircadhot eruesrps, rdnivgi uifdl into eth itlastnritie eac.sp raoempdC ot eht aello,iv eht ttistreilina pesac won has eomr diluf tus(h orem rtsettniilia dtactirsoyh reupsrse nad sels incootc eerssurp eud ot roita of fudil ot nop,irte) nad sa a rtlues fo hits nicabagnlun of cer,fso ulidf msoev ntio hte eiolvla -g;t-& nplmuyora e.dame

... masonkingcobra made a comment on nbme20/block4/q#21 (A 47-year-old woman comes to the physician because...)
 +31 
submitted by masonkingcobra(368)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eagP 2 hsa a terga ictuper

1.h:i/Stt0e/90.el2ar7pgprsw/oo-(86f9wil43w6tc6/ci0j1n)dna-/1

kamilia20  chlamydophila psittaci?? +1
... hayayah made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +28 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

A gib nthig eerh oto si iniotgnc ahtt teh ALP si acdsdr.eee otalsbetsO ciaytvti is ruamsede yb boen A.PL I thkin thta aws eht ianm fucos rehe dna nto ttha ouy lycrasesnie need to nwok the CB1FA enge tumoanit.

sympathetikey  Exactly. That's the only way I got to the answer. +4
pakimd  isnt increased alk phos consistent with increased osteoblastic activity? +
champagnesupernova3  A defect with chondrocytes would cause an short limbs like in achondroplasia so those are ruled out +
pg32  Exactly. Can also be helpful if you remember that the clavicles are formed by intramembranous ossification rather than endochondral; that allows you to rule out the chondroblast/cyte answer choices. +6
... hello made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +27 
submitted by hello(350)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

'aPtinset smotymps ngeba 03 min ftrea noigwm alnw (i.e. aetrf doing hyilcpas iyat.icv)t He sha vseeer stech naip dna si olc,o aclymm, t.ipeicrahdo eH sah eiasdrnce opurnamly ryraet seeprusr and iscndeaer tlef rtaail supre.ers eTakn lattgehro,e shti si igdniaeccor ocskh.

giCrecnioad oshkc is a tearh pmup mpolber -- teh VL i'tns onkgiwr.

enWh eth ,LV n'sti o,rinkwg ti ceusas a akbc pu in eth rdntceioi pesiotpo to who olbod nolrmlay wolsf. h,rTeefero odblo lwil abkc up ni hte .sngul

iThs eussca cadreiesn lapryilca tyhasrdtioc eeursspr -gt-&; hsit edvris mreo liudf toni hte smitierntitu g-t-;& shit sacues icraeesdn nistaietiltr tidstoyhacr usrpesre g&--;t ehter si won remo luidf tahn laormn in the rtistminutei -;t-&g tihs fascfte het tnpoeri oitar hwiitn hte iemnttrtius -&;-gt ihst sueacs esdaerdec irtitnaltesi ioctnoc pussrree.

targetusmle  awesomely explained :) +
lilyo  This was amazingly explained Thank you @Hello! +
pseudopseudopth  For edema to occur shouldn't interstitial oncotic pressure be increased?(when proteins are there, they can pull the fluid) +1
pseudopseudopth  And when increased interstitial hydrostatic pressure is pressure, shouldn't it oppose the edema by pushing against it? +1
pseudopseudopth  *when interstitial hydrostatic pressure is increased +2
... imgdoc made a comment on nbme20/block4/q#20 (A 5-year-old boy is brought to the physician for a...)
 +27 
submitted by imgdoc(143)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

uoY anc socrs uot hte pot ehetr anrwes ce,shioc BCA,,. uYo nwto eb searnrbigob ihgnytna ni eth PTC ni nsfoi'anc so.myrned Ligookn at m,ekhaalipyo namta,yihoper dna pphhympeoohsitaa .onw yompeaiHkal 'natc eb roctcer csaebeu neev hgothu tmaospuis si tslo ti ilwl be earsberdob ta het eatlr kicth desigcann lopo dan if htta onestd kema e,sens teh odby illw asdtuj rfo wlo esumr spausmiot but tnvcgaaiit eht /K++H mupp on slcel. It ints' rmopenhtyaia absucee ta het egilcncotl udtc ppiciranl c,lsel atoprsbrieon ilwl r.ccuo ihsT esvlea hsotamyppheipaho sa the tcoerrc dan lyno nerwas c.echio

imgdoc  by* +2
larascon  Excellent explanation, thank you ! +2
waterloo  It's worth mentioning, that 25% of Na is reabs in the thicc ascending limb. 67% of filtered Na is reabsorbed in the PCT, whereas 85% of phosphate reabsorbed in the PCT. So pt more likely to show Hypophos. +2
coconut  UWorld QID:7626 says lab results in people with Fanconi syndrome will show hypokalemia +
j44n  coconut i thought that too but then i remebred fanconi is associated with hypophosphatemic rickets/ VIT D resistant rickets and this little dude is going to be growing because he's 5 and thats gonna increase the demand for phosphate in his body +
... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +26 
submitted by strugglebus(172)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

rNewheo ahev I eneb aleb to indf ywh teh ellh htis is a hntgi.

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +7
breis  same^^^ +
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +
chandlerbas  you had me at its not in sketchy ;) +3
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +
... celeste made a comment on nbme20/block2/q#6 (An 18-year-old boy has just been diagnosed with...)
 +26 
submitted by celeste(85)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hliWe hte temilefi kisr ni the eeangrl tupaplnoio si sujt beolw 1,% ti is 5%6. in -eegtisrrfde triaveesl fo attpsein and ti risse ot roem hant 40% in ycnoitgoozm sniwt fo dfectafe oeplep. zngiylAan lccasis esdutis of het siencetg of hsecrniazioph ndeo as lreay sa ni 390,s1 sreichF sdceconlu hatt a ocroneacncd erta orf physscosi of aotbu %05 in toyocmongiz wistn essme ot eb a csriileta ettes,mia whchi is iinganysftilc ierghh nhat atht in cdyogitiz wsitn of butoa %–0191 (/#/6/nip4P.ine9b/gr3omvethc2scm3iCrflalMc.6n5.)

imnotarobotbut  How is one supposed to know this before having read this article? +34
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld +2
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-| +8
doodimoodi  Lol just why seriously +3
champagnesupernova3  This was mentioned in the Kaplan behavioral videos +
usmlecrasher  and there's so much unnecessarily BS instead of real questions +2
j44n  I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center +6
feanor  This Question is a perfect example of where you just jump off your seat to demand a refund or you decide to go Antisocial Disorder on your computer screen. +
... xxabi made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +26 
submitted by xxabi(267)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

lsAo for oseth of you ohw aer loayttl luscslee ekli e,m riunayr arctt brouitoctsn = tcrbsitouev yuht.pora

skonys  I see 74.5 Difficulty score and think "word, I don't need to get this one correct" +3
... hayayah made a comment on nbme20/block1/q#34 (A strain of Escherichia coli produces a...)
 +24 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Msesnise tsmutanio vevinol a edeilotnuc inuotstustbi giltsreun ni daegnch oinma caisd. tsmieemSo eth tecseff of sssmieen tusamtnoi yma eb lyon epaarptn unred riacetn nrninteelmvao snntidc;ooi uhcs nssmeies nsimtuato era dlealc odioannticl ionmsuat.t ynaM ssemiesn oasumittn eltrsu ni irotnspe ahtt aer lstli al,tfuoinnc at atsle to smoe er.eedg

lAs,o lla hte ehort aneswsr wuold ayrpolbb leave uoy whti eithre a eyratlg aleterd or tnno-ilanucfon rnt.peio

thefoggymist  I chose nonsense because I thought it'll make the enzyme shorter (since less bonds = more heat liable = can't work at 42 degrees) but yea, probably won't work even at 30 if it's an early nonsense. +10
joanmadd  A good clinically related example is HbC disease on electrophoresis. HbC disease is due to a missense mutation (glutamic acid (-) for valine (neutral)). The mutated hemoglobin is still fairly functional but when placed on gel electrophoresis the HbC migrates the least far from the negative electrode due to less negative propulsion (lack of wild type glutamic acid). +3
fatboyslim  @Joanmadd Just to clarify, glutamic acid substitution for valine occurs in sickle cell disease not HbC. HbC is glutamic acid substitution for lysine :) +7
rockodude  lyCCCCine for HbC +3
... medbitch94 made a comment on nbme20/block3/q#26 (A 3-month-old boy is brought to the physician...)
 +24 
submitted by medbitch94(38)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

021F9A aegp 7:4 I-lcel ssideae ucinsilno( llec dsossmoauiciedi/espil peyt dIβ€”ieh)Itiner asslyolom rogesta dod;esrri fedcte in stnal-oareceshsugapsemyrlf-ioyt1acnhl-poN rrr;&a lirfuea fo the iGglo ot lesoytphorpah nnamoes eediusrs nmi(rogf po-mae-6tpsnhnoehsa) on toisnecoprlgy arr;r& iorsetpn era scedtere llylulcaraerxte arhtre anht rlevdedie ot losmesos.y sRtselu ni acesro lfaaic etsfuaer, anigvlig ielparph,say cleoudd rcsa,neo dcettrsier ntoij et,ovmenms alcw nahd dfeim,sertio ispshoikyoocl,s and hhgi msaalp esvlel fo assyoloml e.nzymse eftnO lafta in odilhcodh.

... yotsubato made a comment on nbme20/block1/q#42 (A 60-year-old man has two-pillow orthopnea, severe...)
 +23 
submitted by yotsubato(1086)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

diBfi atoicrd sluesp aer nees in iroctA iosentss or iegitraunrtgo

tdiaroC tBuir is dhera with sireshscetooral fo nmomco datiocr atyerr

olwS sirngi seeaerdcd umvelo tadcoir uslep si irristccateach of tiacro t.ionsses

nCnoan vawse era esne ni elocetmp VA l,cokb as tighr vetenlrci nad atria ntoctrca dnele.tennidyp

chextra  I mis-remembered normal JVP as 8-12. Therefore, I picked "Slow-rising, decreased-volume carotid pulse". Is there a reason why this is NOT a result of HF, or is it simply not the best (which I agree is JVD)? +1
len49  For those wondering normal JVP is 6-8 mmHg +4
fatboyslim  @chextra I think the reason why it's NOT slow-rising decreased-volume carotid pulse (sign of aortic stenosis) is because the patient had a h/o prolonged substernal chest pain 5 days ago. I think he had an MI and is now presenting w/ heart failure. +1
... justgettinby made a comment on nbme20/block1/q#24 (A 50-year-old man comes to the physician because of...)
 +22 
submitted by justgettinby(22)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

taIrnoczoela rieuqrse eht idccia nreonitvnme of teh tsacomh ot eb obdresb.a arepzlomeO bhtinsii eht K+H/+ mpup fo eth casmhot, reebthy einaecgsrd eth ciaydit of eht .cshtaom So whne the itptean eksta emalorezOp nda noazortIecla theogert, zooareIlcnta nwt'o eb ebborasd tino het bo.dy T'tahs why it hsa no eceff.t

t'Is rmeoecnemdd ot tkae entoasicmid ta aestl 2 suhro rroip to ktgina an cadani.t

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +4
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2
chandlerbas  just itraconazole and posaconazole +5
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +12
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +1
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +
... monoloco made a comment on nbme20/block4/q#30 (A 32-year-old woman is brought to the emergency...)
 +22 
submitted by monoloco(141)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Atimyne oyu eavh a posern woh pbmsu eitrh adh,e gtes bcka ,pu dan ethn sha srevee ssisue ro ides ekli 6 hruos raelt -- uoy ahve soyuflre an aleiudrp aehmtoma ormf lioanrecta to eht leidmd LNGAEIEMN ryaetr. nl(jGoa rlylae pszeamiesh ttah you nto'd cewrs up dna ceelts mdedil eb)arerc.l Yuo wnko it ash ot be na tiraalre teaoriclna senci hte audr si hyittlg eddraeh ot the 'luksls nneir casr.uef noljGa eferdrer ot ihs repeicneex twih it sa dngiene spreil ot eoermv eht ruad morf eth uk;sll c,aphrig ubt it edrsvi the piotn .mheo ningeTt snee no CT si eaecbus eht peduiral mhmoeata steg scutk eewbnet teh utreus sil.ne nWhe ti eaamsgn to breka past neo fo eht useurt ,sneli ti is my negunantddris ahtt tenh si nhew ouy egt sereev ,esqluaee klie dteha ro re.veawht

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11
... banieb made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +21 
submitted by banieb(22)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iruDng the tlas lahf fo yrnacgnep otilanid fo hte uprep rayuirn tctra cna orucc ude to osmpoeinsrc fo hte rtesuer by het ownrigg /fustsuuteer adn eth ilane e.slnatirmi ehT iemosncrops of shtee si ton ignaollw diful spsaaeg otin het brddael nguaisc iruen ipubuld in the yen,dik siht slead ot itoanild fo the eyiknd that dsne pu cnausig mmottasicpy iednrrhpssohy.o thsi can edn up in teifincon and spmmsyot usch sa teh seon tnereps in sthi tpatein iekl bakc inap and CVA ssnrteeed.n hte gcinyr is ynmlia ued to eht aipn cdsaeu yb eht oobnitct.urs a nd ujst sa otnihemgs taer:x uldoeb itpigla ecasrhtte si a seaf adn splmei way fo itatengr yptcatsmimo odoshrnihepsyr fo cge.aynprn

banieb  Ureteral obstruction by the pregnant uterus https://www.ncbi.nlm.nih.gov/pubmed/1579937 +1
... hello made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +20 
submitted by hello(350)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

jonlaG ahd a uelrtec htat tdnmoneei ttah fI" a tnpitae ahs eghactlr,aaor rieevw eveyr ugrd yeehtr' aginkt neics nyma gusdr secua helaaatc"r.rog

eTh loyn tnigh fo oesspibl erenlveca ni hits emQts- si ahtt esh tseak a iaon,tedmci hfetoeerr eht resanw of drgu" tfc"fee si het stmo ykllie ensoar orf her .gotharealcra

hungrybox  I still think this question is pretty BS. But having studied some more, I think it's less BS than I originally thought. Pathoma gives the three major causes of galactorrhea as nipple stimulation, prolactinoma of anterior pituitary, and drugs (see 16.1 - Breast Pathology). Only drug effect is an answer choice for this question. +7
hungrybox  To put another way - before you try to go through every answer choice, asking yourself "would this cause galactorrhea?" Instead, ask yourself, "What are the causes of galactorrhea?" According to Dr. Sattar, they are "nipple stimulation, prolactinoma of anterior pituitary, and drugs." +3
hungrybox  The question doesn't say anything that would point you toward nipple stimulation, like "it only seems to appear when she puts on a shirt/plays sports/runs/etc." It also makes no mention of bitemporal blindness (which would point you to an anterior pituitary tumor), so you can rule out prolactinoma. The only option left is drug effect. +2
drdoom  hungrybox’s full comment (below) here: https://nbmeanswers.com/exam/nbme20/410#3907 +1
... andrewk1 made a comment on nbme20/block2/q#9 (An otherwise healthy 16-year-old girl comes to the...)
 +20 
submitted by andrewk1(20)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Thsi girl hsa creeexis cnidued sah.atm It is ton wlle ndodetosur wyh it npphsea tub eth grtrgsei rae geoze.dincr alyNmlro wenh nihtrebag scuorc ari is atnek in yb eht eosn dna eht nasla saspgsae dan tbsantreui cat to ervemo duts adn dhii/fmuyawmr het r.ia yglacLlio hits askem the rai edrnse T.RnP=v So ewnh isixgrenec, eanigrhtb uhgothr eth eosn si eesrdcdea nad erclaepd yb orem ogrsouvi thumo braetg.hni Tihs sanme hte air si ton imheuiifdd dan rmwaed p.u eTh ria si lses sende dan eht atsmah nuses.e eTh iuesnqot koot ihst maes pinrcleip pctxee rrdevsee ti yb sgkina waht xnearlte tioinncdo ocudl aedl to het mstaah and ttha duowl eb dloc dyr .ira

eacv  oooh thank u !!! I choose wrong, cold air hehhe +6
eacv  moisture air instead! +
... hayayah made a comment on nbme20/block1/q#7 (A 5-year-old girl with AIDS develops a progressive...)
 +19 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

c,vrciAylo cvam,ifricol yliacovlacvr rae ngnaiseuo a.sgoaln hyTe duegron evnoicrosn ot loyccraiv thoeoponsphma vai survi oeceddn aienimskd-tiyhen. lilytUeta,m yhte iihntib airvl ADN ylreamesop yb caihn rom.tteaiinn

tdautMe raliv timehndyi sienak anc cuesa ia.rseetncs

len49  Foscarnet and Cidofovir on the other hand do not require phosphorylation by viral kinase, therefore should be used in strains that are shown to be resistant. +4
... onyx made a comment on nbme20/block1/q#12 (72 yo woman with dysphagia)
 +19 
submitted by onyx(43)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

rioTccha utcd .eislrtona

consuela_salon  This was the picture that I liked the most for this question. If you imagine that the injury is at the level of the left subclavian vein (LSV) and thoracic duct (TD) crossing each other, maybe it will help you realize that the left breast & left upper extremity bypass the injury. The right lung is drained by the right lymphatic duct, not the TD (see one of the links bellow). And the heart is where eventually all the drainage is going to end up to be pumped again (TD -> LSV -> SVC -> heart). +17
mbourne  To keep it simple, the Thoracic Duct drains lymph from the entire body EXCEPT for 3 structures: Right Upper Extremity Right Thoracic Cavity Right Side of Head and Neck These 3 areas are drained by the Right Lymphatic Duct which enters the Right Internal Jugular Vein +9
... strugglebus made a comment on nbme20/block2/q#20 (A 19-year-old man who is a college student is...)
 +19 
submitted by strugglebus(172)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nByoroh=hpcno pamoEtouipeyn rraixn =drrsiot acoblroahcntrhie riotoctusbn /esanm(rgfsoi r bytiayIoornd)ps drirots = aelglyrna uiSocscrnsbocnotiut su h=aplss etst fro oiycprl sstnosie

nheW hteer is a fdrucerat rbi ti lwli uacse a ruamat maepxnoorht hwihc acn sueca iar ot eeacps dan oecemb pdprtea drune hte snik ladenig to repst.iuc

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1
... monoloco made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +19 
submitted by monoloco(141)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tish si a onitlcndaio ealldc ipsc.siaolacdeonyrladi hTe ikd no rnrtegaS Thisgn whti eth slip hsa eth seidor.rd No lcorla n,bseo oto nmay ehet,t fnralot sbginso t&;g= ayonddr.scloipaiieclsa BCA1F si a nege hlhiyg atlmcpdiei ni tsaleobost .onctnuif

... medbitch94 made a comment on nbme20/block3/q#49 (A 92-year-old woman who was recently admitted to a...)
 +19 
submitted by medbitch94(38)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tcAniic rpurupa lssture rmfo tevnxorasaait of obold toin teh s.edmir hsiT hneomonepn si ude ot eht snki hytorap and het iiyftgarl of hte doblo sslvees ni eleldyr ivlidd,ianus hciwh si batearxeedc by hicncro nsu .porusexe Aciictn rpauupr sniseol ear alcoedt no pexed-usnos ,aaers kile the ,asmr ace,f dna knc.e

Sink oyphatr in orasmprtooides is ude to an iloarnaett fo nogellac, miailrs ot atth hihcw si nsee ni itso.ropseoos iThs onupronecd sink ohtyapr dcasue yb hte htigpango-o akesm eht arldem arclsvua wtkonre yvre sieetvins ot het iegltshst utamra or igeharsn rcfe.o

md_caffeiner  Google actinic purpura, look through 5-10 images, and you get the idea. +11
... meningitis made a comment on nbme20/block2/q#50 (A 27-year-old woman comes to the physician because...)
 +18 
submitted by meningitis(574)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Wnhe agsnnidt ,pu eth ybdo onrlymal ticeaasvt mypscehatti seytsm to dvioa astothocrti nyhpnio.etso

uBt isnec theer si onw na eddavtii effcet of hte phamteyrchoomcoo dr,gericsaen it ilwl leda to a noypetihsern

.i:e( bDeulo caronsoisovctitn = ohPe acdneersrig + atcythipSem ss)yemt

sympathetikey  Brilliant. +6
medschul  Would pheo have a normal resting BP though? +13
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +9
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +2
nala_ula  No problem! Thank you for all your contributions throughout this page! +2
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +
hello_planet  FA 2019 pg. 336 +2
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +
... hayayah made a comment on nbme20/block1/q#20 (An 8-year-old boy is evaluated for ventricular...)
 +17 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

cCaoatoritn fo teh aoart edsla ot sncadeeir LV aroevold ugaicns LV ehrrpyythop dan a L xsai et.ivndiao

hungrybox  Similarly, RV overload leads to R axis deviation. Could point to PAH. +2
... onyx made a comment on nbme20/block1/q#31 (66 yo man, cavitary lesion in right lower lobe of lung)
 +17 
submitted by onyx(43)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

A licdiyarrpaoahlg eibvlsi friui-adl vllee ggetusss a petyrt alrge isnleo (hc,een yaiβ€œrv).ca”t as'htT nto gogin to omebec lrmaon eusits giana. xSi tshomn lniwfgool norelisuot of myosspmt oyu acn xetepc inhalge ni eth mfor of a s;arc tath s,i robssiif btu ynol ni a igelns sop.t

masonkingcobra  Robbin's: The basic mechanisms of fibrosis are the same as those of scar formation during tissue repair. However, tissue repair typically occurs after a short-lived injurious stimulus and follows an orderly sequence of steps, whereas fibrosis is induced by persistent injurious stimuli such as infections, immunologic reactions, and other types of tissue injury. The fibrosis seen in chronic diseases such as pulmonary fibrosis is often responsible for organ dysfunction and even organ failure. +5
stevenorange  What Differentiates Normal Lung Repair and Fibrosis? Basement membrane ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +3
fatboyslim  @step1234 Yes pulmonary fibrosis occurs after liquefactive necrosis as a means of repair. Think of it as liquefactive necrosis = damage done in response to Klebsiella -> 6 months later you will see focal fibrosis in that area (scar formation) where the damage happened. +4
makingstrides  If there was an intact basement membrane, you would get normal pulmonary parenchyma. +1
skonys  Not granulomatous inflamm because thats indicative of TB. Not liquefactive nec (trick answer) because Klebsiella causes that actively and q stem says 6Mo post-resolution w/ abx. Not metaplastic pulmonary epithelium because metaplasia implies cellular adaptation to a stimuli (bronchial squamous metaplasia from cigarette smoke), not destruction entirely by liq-nec. IE: for cells to undergo metaplasia they need to be insulted but not destroyed entirely. Not normal pulmonary parenchyma because basement membrane/cytoskeleton architecture is inherently destroyed by cavitary lesion. +
... sympathetikey made a comment on nbme20/block1/q#35 (A 70-year-old man dies of coronary artery disease....)
 +17 
submitted by sympathetikey(1439)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA etdsta ,lbewo eth efLt urcs ecrbire swa adgemda ee(s ahtw ti ldsouh nlmyoral ookl iekl ol)e.bw ihsT anctnsio teh tilncaocopsir rtcat. cSeni hte tpisclcroinao rtact edusascte at eth d,ameull oeblw hte rmnbidai cisneot w'eer knioolg a,t you ldouw ese erlrtaaClaont R)htg(i acsiSpt imieHraessp

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +12
hello  @kernicterusthefrog Thank you. +
mbourne  NGL, I thought the right side had the pathology lmao ty +22
... hayayah made a comment on nbme20/block3/q#20 (A 67-year-old woman comes to the physician for a...)
 +17 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ystiitivneS stets ear dsue ofr cnernegis. ciSciitfpye stste era edus rof notorcfanmii tfaer osivtpie g.eiercsnns

tvtisiSniey sstet aer ueds rof esnige owh myan epople truly vaeh eth .adsseie ifSytcpicie tesst aer rfo osthe how do ont aehv eht sa.disee

A ihlgyh seteivsni ets,t nweh iente,vag elsru TUO s.isdeea A lihygh cipfesci estt, henw i,pitoves rulse IN ses.idae So, a stte with ihtw wol esyttnivisi coannt rleu tou a edei.sas A ttes wiht lwo pfysieticic anc't urel in esas.edi

hTe drcoto nad itatnpe nwta ot recnse fro colon arncec adn ruel ti tu.o ehT otdroc duwlo antw a etts itwh hghi itsvysineit to eb elba ot do htta. He wknos ahtt ienstgt reh lstoo rfo doblo llwi nto elru uot eht ypstiiosbil fo oocnl .AC

sympathetikey  SeN Out (Snout) --> sensitive test; - test rules out SPec In (Specin) --> specific test; + test rules in +25
usmlecrasher  can anyone pls explain why it is not << potential false- positive results >> ??? +
almondbreeze  correct me if I'm wrong, but 'high FP (choice C)=low specificity (choice B)'. Whereas high specificity is required to rule in dz +2
almondbreeze  picked positive predictive value myself. can anyone explain why not PPV? +
williamfreakingosler  The principle @hayayah is talking about (a negative test being relied upon to reliably rule out) is negative predictive value ("NPV"). I don't see why "uncertain NPV" isn't the correct answer, particularly because NPV is predicated on the disease having the same base rate in the person(s) being tested as in the population that was characterized for the test statistic. Given that the patient has a strong family history of colon cancer, the NPV of FOBT is uncertain. Said another way, the sensitivity of a test does not change with the population, but the NPV does. The whole reason the doctor is denying FOBT is because of bayesian thinking (a priori information related to family history), and from my point of view bayesian logic is more relevant to PPV/NPV than to sensitivity, hence my confusion over why NPV isn't the right answer. +2
ibestalkinyo  I thought negative predictive value for the same reasoning +
raga7  AFTER THE RESULT OF TEST WE CAN USED PPV OR PPN, BUT FOR TEH FIRST TIME LOOKING ANY DESEASE USE SENSITIVITY OR SPECIFICITY. +1
... hayayah made a comment on nbme20/block3/q#34 (A 22-year-old woman comes to the emergency...)
 +17 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

siotnirmiAandt fo Plliicinne for splhiySi mya dlae ot het iihmr-rheJcxHserae nectairo roush tfaer .ttmatrnee ccrsOu edu ot ysisl of ctsehsproie (os it acn crocu hiwt lBeoarri adn teossiopipLsr sa )wll.e heT teoairnc si dhaicctreezar by feevr and chslil.

The asaclsicl annoaxeplit fo teh riHrehmeex natierco si hatt tmntateer stesrul ni the sdedun dehta and dcirotusetn of raegl rmsneub fo npomreeet,s htiw teh itnaroblei of oeirpnt tosdurcp nda txon.si

almondbreeze  FA pg.148 +7
... drdoom made a comment on nbme20/block1/q#11 (The sequence surrounding the first two exons of the...)
 +16 
submitted by drdoom(957)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA bdciseedr ni teh ioqusent ,esmt tish aotnutim csoruc tiinhw an toinrn a( neeg negtmse ihcwh si rnebratsdci t&D;[NRgA-A]N ubt ton aal).ntderst ARN gilipcsn zsemye()n rgba ANR dan oolβ€œp ”ti; na rniton si tuc tuo dna hte oxens on eehitr esid of eht rnntoi are jend,oaid kiel sih:t

β€”rnβ€”xexo1oo2neitnn ;=&tg β€”onoxne12ex

lcalTy,ipy isht iingpslc crcuos ta the evyr eedgs of teh irnotn ha(tw I otedend htwi hte β€œβ€β€” caa).trcher Btu in ruo scea, a animttou iihntw teh ninrot is uigsacn NRA psilingc meznye ot eenicorgz a new e:ist eth pirescl tcus nthwii het tonnir n(tiadse fo at the ryve ge,ed as ti hl.u)osd S,o we egt sgneotimh tath slkoo leki :hsit

enβ€”xtrβ€”n2oneo1ix

hTa’ts a ltolayt nfiedetfr NmAR ,elculmoe nda is't nggoi ot eamk ruo Ξ²ion-bgl rpoenit okol (nad eva)hbe lluwyaf r.tngsae

drdanielr  I remember that in the pre-mRNA, the splicing sites of the intron where the spliceosome attaches are surrounded by "GU---AG" like "guac", so here the homologous DNA to this strand would be transcribed into "gu............ag......" and this would create a 3' slice site too soon +5
vivarin  if this is supposed to be pre-mRNA, why are there T's in the sequence? I'm so confused by this for some reason +8
sars  This is the gene (DNA), not heterogenous mRNA. +
... whossayin made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +16 
submitted by whossayin(27)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

heT oenncmmi I elik rof mebimgrerne hte nlocisato of the cnliaar neesvr is het ,4,2",24 rleu"

evAob b=aerstnmi NC I + IbdiIMnir= a CN III, V=oPsIn NC V, IV, ,VII MIl =VIeluIad NC I,X ,X X,I IXI

lovebug  @whossayin thanx so much!!! +
... sympathetikey made a comment on nbme20/block2/q#25 (A 14-year-old girl is brought to the physician...)
 +16 
submitted by sympathetikey(1439)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Misountta ni T1TML- (coylMitaoldrhin eddceon tARN euiencl )1

A mmnoco utiomnat si A23G.43 anC trlsue ni mlleuipt coidnirtolahm dsifiicencee nda ssatcideoa rsesd.doir tI is iaoectssad :itwh

  • hlrMdanciioot hoantlpeyoehmpyac
  • ciLatc dsaoicis
  • -ktSolreeik ipesosde AE(M)LS

LEMSA si a rrea toicohdrlainm ersrdiod wnnok ot tfceaf yman pstra of hte ,boyd sliaepcely eth ersonuv tsesym dan eht brani. ptomSsmy of ASLEM icu:deln

  • crtRenure vsreee cehhsdeaa
  • lcuseM swkenaes )apt(hmyoy
  • gHaenir slso
  • rkeeli-tSok eodespsi whit a olss of usinooncesss,c iressezu, adn heort serlpmob fctanefig teh srovnue esy.mst

oeu:Src p.gii-:w//taritMidnhk/w/eoTpLk.s1eTi

j44n  i just saw that every tissue that was affected had a high 02/aTP requirement and mixed with the lactic acid that meant she wasnt using her electron transport chain so i picked the only answer that had mitochondria in it +5
topgunber  The disease is MELAS. Mitochondrial encoded tRNA leucine 1 is the mutation. Apparently associated with high tone deafness. It is apparent its mitochondrial with maternal transmission, though unfortunately the etiology is utter memorization / process of elimination. Maybe next time the stragy will focus more on mitochondiral diseases and see that this choice is the only mitochondiral answer choice. Mitochondrial Encephalomyopathy Lactic Acidosis Stroke like symptoms."MELAS is a rare mitochondrial disorder known to affect many parts of the body, especially the nervous system and the brain. Symptoms of MELAS include recurrent severe headaches, muscle weakness (myopathy), hearing loss, stroke-like episodes with a loss of consciousness, seizures, and other problems affecting the nervous system.[5]" Source :Wiki +
... karljeon made a comment on nbme20/block3/q#2 (A 23-year-old woman is brought to the emergency...)
 +16 
submitted by karljeon(123)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ihTs one aws a tesamhwo pmisel teinqosu eicsn maehrhecytop &-;-gt tmoru ssliy --g&;t need nitanxhe ixodase ihoibtrin eg,( )toeuf.sxtba

TUB YHW SI NBME MRGRMAA OS C?APR TUP OYUR CSOAMM NI ETH TGRHI EPCLA!

... hayayah made a comment on nbme20/block4/q#17 (A previously healthy 55-year-old man has recently...)
 +16 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oA,sl uyo hsol'ntdu eb enesgi eogan-dnr gemaad or nsirceeda nreni / ieydnk proseens iwth a oulpyrivse yhtehal ieapttn thta ustj dploeveed eentslsai NH.T The ybdo 'edsotn tnaw ot aneesirc eirnn hwne ti sha .NHT woer,vHe fi uoy ahve esnst,osi teh ysidnek frake out beesuca hr'etye otn ngtiget nhgoeu olwf nad nihkt teh ehlow dbyo ns'ti ieet,rh so ehyt teiatavc the RAAS .ssmyet eWnh yuo egvi hemt an AEI-C, teh enrin si illts binge drocpdue by the kedyni, it sjtu n'sti nigbe etdcnrvoe to Ioite.saninn-Ig

To nliietema rtoeh ehciosc:

  • He ahs seacnidre nrnie iviatytc so uyo can lnteeiima yrmirpa lsoeaotr.nsdmi thaT sha n.ic reoanlodset, ce.d niner.
  • No ssgni or xss fo 'guCsshni so ta'ths deaent.ilim
  • -ylox1eahdBsy1r- niiyceefcd dwolu xss tihw eth atilgaen.i od'Yu veha .edc eninr ciaittvy trkeie-nodoell(sa tscefef lltis e.nrp)ets
  • tnaEslsei N:HT ldxpeeian aboev
sammyj98  I like you sticking up for the kidneys, thinking they're increasing Renin for the benefit of the whole body, but lets face it, the kidneys are a couple selfish dicks who want the high blood pressure all for themselves. LeftVentricularSolidarity +7
trazobone  ^ I love reviewing NBMEs for comments like this πŸ˜‚ +
... hayayah made a comment on nbme20/block1/q#4 (A 50-year-old man is brought to the emergency...)
 +15 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tehMlnoa si itocx by tow imnssc:hema

sFr,ti tlaoemhn nac eb lafat due to sit NSC pnssaredet ptiererosp in eht aems nrmnae as lhteoan no.inogpis

,doSnce ni a prossce of t,oociaixnt ti is beelmodtaiz ot froimc cdai avi flohyeraemdd in a epscosr niieidtta yb eth nmeezy oochlla gardodeeynesh ni teh .erlvi oahnMlte is tevenrocd to dlydhfaoreme vai hloloac desdnehgaryoe )D(AH and odyaefdlmrhe is novdctere ot coifmr caid oftamr)(e via dehelyda dasedhygoeern LA.D)(H

tFeamor is cotxi abeusec ti itibnsih mhloiidtcanro omcctorhye c as,doeix unagics ypaoxhi at het clruella ,lelev nda coalebitm saos,icid gnoma a arvyeit of rohet micatobel ssinbcuetr.da

sugaplum  Good pictograph comparing methanol, alcohol, and ethylene glycol. https://wikem.org/wiki/File:Toxic_alcohol_ingestion.JPG +10
... thecatguy made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +15 
submitted by thecatguy(18)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tish si a eryv iictnkpy ut.ioensq sA I ees it, teh 3 inma ocsntpce estedt :rea

  • shTi enatitp has ragemltiin nriualega rhp(as, iefb,r oiidspce ainp ni hte c)a,fe hiwch si eudsac by a eslino to ryimpar ynoress ifesbr ahtt yrcar pnai steisonan mfor het f.cea
  • eptMilul cio,sselsr hhwic teh ntetpia h,sa is a amnitgenyidle eaiessd e,.i(. ti afstefc htewi r.)maett
  • eTh eltdinyame xsnoa nrariycg pani anosienst morf eth irtsaialelp ecaf nteer the rimeatnbs ta teh ellev fo hte psno nad enht esnecdd moecb(e het nialsp rctat of hte nmgli.ai)ert esehT iewht tramet sbfrie pssa rtouhgh hte pnso to nepssya no the salnip ulsnecu of teh ,rnegimatil wchhi si in the emullad unues(lc = ryga arte)tm. (uitrcpe erhe). oerf,Tereh a loenis in teh htewi mrttea i.e(,. up)aeql in the osnp udlco ueasc rgtnieamil aln,aegiru dan hist honnneomep has eebn osderebv.

oebAv het lvele fo hte etrbnsaim ma(ltshau & larrbeec reo)tx,c you hvae nscoed erdor neyssor .nunsoer nLsieso ni hsti arpt fo hte iictucr aer not rnellyega in ailtgiermn guaaie.nrl I spepuso ethy loas ntaw su ot maesus ttah cneo het pailns ractt fo eht latieimnrg teesnr het edl,aulm s'ti nto aldniteemy nayero.m I n'tdo iktnh iths is yllempoetc uret, btu vengi hte ogicl iebsecddr vob,ea opns wuold tslil eb het bttree sra.ewn

As eplpeo aevh odeitnp ,tou hte iyrpamr sysoner sfebir rcriangy ltgih ohuct insaeotsn rfom eht afce saeynsp on het iehcf nessory ulceusn in hte opns miedaimyelt rtafe yteh nerte the .onsp ihTs snteioqu si ton siknga bauot stheo efbris .thugoh

I otg het oqenusti orngw to.o.

mightymito  Wow this is the best explanation yet! Thanks so much for very clearly walking us through a tricky question. +4
lovebug  @thecatguy Are.... you a professor? thank you very much :) +1
... hayayah made a comment on nbme20/block1/q#38 (A 9-year-old girl is brought to the physician...)
 +15 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tPntaei hsa a ngairinocpmhoarya. Mtos oocmnm oldochdih taaoirslpruetn uor.mt ivdDree romf narestnm fo Rkheat ocuhp orl(a ceme.dtro) oaiicltCciafn is m.mcoon loeoChsetrl raslctys found in mortβ€œo ilkio-”el lidfu within tr.umo

A syctic usleaslparr msas iwth aotsciicfanilc dan enchtenmena fo teh llwa or lsoid sonoitpr in a ildhc or etcoelsnad si tmlaos sawlya a panyrrig.maiohcoan

yMa eb odcsunef iwth riiuytapt emoadna bt(ho caesu oampbleirt naaip.eohm)i

dickass  Cholesterol crystals in motor oil +
ally123  "Due to the proximity of the tumor to the hormone-producing cells of the hypothalamus and the pituitary gland, there is significant endocrine dysfunction in most children and adolescents presenting with craniopharyngioma...Among the hormone deficiencies, growth hormone deficiency is the most common and is seen in approximately 75% of children with craniopharyngioma." Source: http://campus.neurochirurgie.fr/Programme_Enseignement/_art1030/endocrinManifest.pdf +
... weenathon made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +15 
submitted by weenathon(47)

Diabetics get peripheral neuropathy from glucose damaging Schwann cells. For what I believe is an unconfirmed reason, T2DM patients tend to see parasympathetic autonomic neuropathy before sympathetic.

The hypogastric nerve carries sympathetic innervation to the posterior urethra and is responsible for ejaculation.

Inferior rectal nerve is a branch of the pudendal nerve that innervates the external anal sphincter and provides sensation below the pectinate line. A peripheral nerve problem with this nerve would cause the sphincter to remain relaxed and cause incontinence, not constipation.

Pelvic splanchnic nerves are parasympathetics (craniosacral outflow). If he is constipated, his rest and digest (parasympathetic) system is not working.

Perineal nerve is a branch of the pudendal nerve. It has both motor and sensory, is involved in the external anal sphincter, urethral sphincter, and is responsible for conscious sensation of the need to urinate.

Sacral sympathetic inhibits peristalsis, and contracts internal anal sphincter to maintain continence.

spaceboy98  Amazing man, thank you for this +
... hayayah made a comment on nbme20/block2/q#17 (A 57-year old man has a hemoglobin concentration of...)
 +15 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ishT si eeitcvra mhlceyoyipta ,earv whhic is ued ot hihg ldietuta or nlug ssei.aed S2Oa si w,lo adn POE si cidasen.er

rthAeno ywa ot cprpaaoh the steioqun si ioknolg ta hte bodol .smera I'ts eyrtpt lmaonr (no kramoeysyceatg, on erceiadsn bnmure fo atlepe,lts no dors, hgitnno u,leb t.e)c A bolod armse fmor a PDOC eipttna illw be .arlomn suJt na cieaendsr rmbenu fo BCRs deu ot teh ndaiecser EOP gileadn to eadneisrc Hbg.

mbourne  You shouldn't call it reactive polycythemia "vera", as polycythemia vera is a seperate disease with entirely different etiology. This is Reactive Polycythemia, or as another poster said, appropriate absolute polycythemia secondary to chronic hypoxia. +19
j44n  i jumped on myelodysplastic thinking it was PV due to the jak w mutation but you technically get elevated everything in that mutation so it would be more than just RBC's +
beetbox  I also thought it was PV. How can we tell reactive polycythemia from actual PV, if PV does not show other kinds of blood cell counts raised but just an isolate of RBC rise? +
... neovanilla made a comment on nbme20/block2/q#23 (Which of the following changes in the cardiovascular...)
 +15 
submitted by neovanilla(47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

heT way I rcpaeodpha het ueistnqo was to ocdesinr wtah hsppaen 1. hnWe you wgro rmof a baby to a lci,dh nda .2 hnew ouy rgow rmfo a ternegea to na eoldr laudt. arWteveh aimdneer rtue beewtne btoh of temh was hte griht swn.rae

Rgith erna:ws Teh itegnrs BP fo a erobnnw si /4065 oe),(golg wehli htta of a h-1motn dol si 0.695/ eTh graavee udlta si hier,gh whit teh eaAicnrm atreH Aooinistsca niitgc yulb,ars(d )IOM taht o""lamnr is l0/1;tt.l02&;&8 lr,etveehsesN teh dnert si atht PB erncaeiss as ew ,ega ehrhwet we ear nresonwb ro ldo lop.epe

nWgro ewarss:n etemnvD ople fo aynoorcr ohtserrsioasl:ce phPresa due to teh rAaiecnm eitd ti nac eb rudgea ttah hte tvpeneedolm of rlethrosasecios is somatl lbiinvetae sa ouy meobce an oedlr ltd.au nCayrtiel not utre sa a bayb &;gt-- ch.lid

moepeeDvtnl fo rilmta o:sssnite mSaliir oenignras as naoyorrc sitsce;oorselrah uyo AMY dpveeol it as an adltu nt(o anlyer as oomncm as a udpibul of eolticcsaorrhet pqel,)aus tbu u,ser 'slte yas taht it anc epphna. Not utre sa a abyb &-;t-g l.chid

deenasIrc lsaab ahert :reta ehT eositppo is aatylclu .treu eTh blaas reaht aert of a bownrne nca yalsei xdeeec 15,0 adn t'hsta odcedsreni l.marno sA ew e,ag hist rhtea raet eogs w.don

srIeecand adcirac ulecsm s:sam iTsh eno swa eht trdehas ot orkw ghhuotr. It si uter tath as ew gae fomr a bayb gt-&;- iclhd oru rheat rsgwo ni ei.sz tBu if we wteak ruo tosupasnim from fobeer ithw eth mariAcne d,tei and aetsdin put oru patenit on a rmeo dmtraoee iedt, ilsraycltiale ish ehart tdlnsuoh' rsieneac ni zsei oot muc,h at stela ot hte tipon fo .yeoclmraadgi

edInresac meiclopanc of tesiera:r sA ew ecbeom eodlr sau,dtl het paimelccno fo aretseri cdeaersse adn ifneftsss reasiecns cel(arfu tno ot fuceons tsarriee wiht ngu,sl wichh atlcuyal do ecniasre in aopcceimln as we ga)e!

rockodude  basically the American diet is... SAD;) +1
... usmle11a made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +15 
submitted by usmle11a(83)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

t.Ets:o2o/t?u/.vpchqw=wAwhepumAck0yw/6-abtY

ysug hsti voied eslxpnia oalt

... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +14 
submitted by strugglebus(172)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sA an 0,1t i1:0d0e8 leepop derporet ot heva dise efsceft henw akitng aAHroohminedzoocdyi.hgrtl ,mteh 52 opplee .0)02(% aevh rBseta ihcgdsera

neonem  I think the best way to answer this question was by process of elimination. +1
sympathetikey  That's some bullshit lol +9
karljeon  Haha I eliminated the answer by process of elimination. +22
medschul  I eliminated thiazides by process of elimination :( +1
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary +2
... hayayah made a comment on nbme20/block1/q#46 (A 55-year-old woman comes to the physician for a...)
 +14 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Notce,i eth mtse yssa orsrrs"eopc in the sink"

D3 )ol(claforciehcel rfmo urepsoex of iskn mst(rtua saba)el to nus, ngoiitsne of ,fihs im,lk pl.atns

2D (eearrglil)cfoco orfm gtinsinoe fo sn,aptl ugn,if tysea.s

tBho ercdtevon ot 5O-2H 3D esogt(ra )mrof in reliv dna ot teh atievc fmro 212H)-5,O( D3 cciolr(lita) ni y.diken

sympathetikey  C is the 3rd letter in the alphabet. Hence, D3 = Cholecalciferol +6
karljeon  Thanks for the explanation. The question stem made it sound like "what future step will be decreased?" Actual question: "Decreased production of which... is most LIKELY TO OCCUR in this patient?" Maybe NBME needs a grammar Nazi working for them. +9
bharatpillai  question says "decreased production of which of the following precursors in skin is most likely to occur in this patient? the answer has to be 7-dehydrocholecalciferol! +6
bharatpillai  7 dehydrocholesterol +3
brbwhat  Yeah i did the same, but then realised acc to uw flowchart 7dehydrochole.. is converted to cholecalciferol in presence of uv rays. So the decreased precursor would be cholecalciferol since we already have 7 dehydrocholecalciferol not being converted by uvrays Tho the uw chart sites both ergo and chole as dietary sources. +5
drzed  Wouldn't 7-dehydrocholesterol build up in the skin? Since UV rays convert 7-dehydrocholesterol into cholecalciferol, if you are lacking the conversion, the reactant (7-dehydrocholesterol) should accumulate. +1
brbwhat  They’re asking decreased production of which of the following precursor would occur? 7 dehydrocholestrol builds up, but decreased production of cholecalciferol takes place, which is a precursor in the pathway for vitamin d formation +4
... johnthurtjr made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +14 
submitted by johnthurtjr(153)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

9A12F0 p 735 on ertlttansiasiGno ldobo puslyp adn ayppiermtastcah vitnorannei:

  • teFrguo ;g--&t elacic ,treayr vagus oaniinevnrt
  • dMitgu g-&;t- ,SMA guavs
  • duiHtgn t&g;-- IM,A icvlep niivtoeannr
neovanilla  Don't force it out, you gotta relax and it'll come out naturally ;) +
mysteriousmantyping  Why couldn't the answer be Inferior rectal nerve since that controls the external anal sphincter? +1
draykid  @mysteriousmantyping I think this question is looking at complications of T2DM, more specifically diabetic autonomic neuropathy. Patient more than likely has diabetic gastroparesis which may explain his constipation and abdominal distension. +1
cuthbertallg0od  Pudendal nerve controls external anal sphincter (per FA), and gastroparesis wouldn't have anything to do w pelvic splanchnics but instead vagus nerve... Don't know why pudendal nerve couldn't be right if he was just clogged up from not being able to relax his sphincter anymore ---- is parasympathetic just more likely to be the issue statistically or something? +1
cuthbertallg0od  Or would losing pudendal nerve result in incontinence... Its never been clear to me if activation/inactivation opens/closes sphincters... +1
cuthbertallg0od  Just realized that says perineal... whoops +2
vivijujubebe  External sphincter is innervated by pudendal nerve, more often damaged during labor. DM patients have autonomic neuropathy with parasympathetic/sympathetic nerves more likely damaged +
... beeip made a comment on nbme20/block2/q#35 (A 36-year-old woman comes to the office because of a...)
 +14 
submitted by beeip(129)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Lvrie soklo pteyrt -lzeioranmds ot me. iPc hree for rncsooapim

... strugglebus made a comment on nbme20/block2/q#46 (A physician prescribes a newly marketed drug to 45...)
 +14 
submitted by strugglebus(172)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I coseh hsti llysoe sbaeuec it swa os mnda fscipeci

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program +5
karljeon  I didn't choose it because it was so damn specific. :( +44
lovebug  Could anyone explain for B) for me? because I choose B).:( +2
j44n  B.) is wrong because its never been shown to show adverse effects "any offcial data linking the drug" and the fact that it's "newly marketed" +
j44n  and because its in 5/45 patients roughly 10% of the population, that might not seem like much but most of the diseases we freak out over are in 1-2% of the population, to put that into perspective if we gave this drug to every person in the US (every big pharma wet dream) with a population of 300 million... 30 million people would have this adverse event... hope that helps +
... jotajota94 made a comment on nbme20/block3/q#1 (The frequency of an autosomal recessive disease in a...)
 +14 
submitted by jotajota94(14)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Use eht edbagrWyHeirn- naiotueq

  1. akTe het rqsuae otor fo 601,0/1 and hatt lilw evgi yuo the nyfeuercq of the serceiesv elllea = 0.41/
  2. aetaclulC het ufcneeqry of hte ninomdat eallle thiw =+q,p1 chwhi si =p 7..590
  3. hyeT are tilnelg uyo ot aecutacll het erqcyfenu fo teh iadesse s,iecrrra hwcih si htwi teh qiateuon .2pq
  4. They tawn lnoy eht seaeids ciresrra in hhcwi odeilnet is rets.npe To lcetcaaul tihs, esu eht q evalu (40/)1 nad tupmlily by 80% ni ihst husdol vieg yuo .0.02
  5. ln,lyaiF aulltecca rof P22 q ))7(90.5=02.0( 040. = /15.2
yex  Nice! ...and we are supposed to read the stem and do all this in a minute or so? :-/ +25
charcot_bouchard  Allele frequency 1/40. so carrier freq 1/20. 80% of 1/20 is 1/25 (80/100 x 1/20) +14
dickass  Ah feck, 2pq got me +1
hello_planet  A handy shortcut for Hardy-Weinberg is that you generally can assume p ~= 1 if q if fairly low. It also tends to be easier to work in fractions if the answer choices are in fractions so you don't have to bounce back and forth between fractions and decimals. So with that, you send up with 2pq = 2 * 1 * 1/50 = 2/50 = 1/25. +8
topgunber  hate this whole scramble thing: In one line: 2 * q * 80%. This is for diseased individuals (two q alleles).I = 1/1600 = q^2 The frequency of q = 1/40 Now carriers is 2 p q. P is close to one assuming HW eqm (p+q=1). There's an additional step in this question due to the two different mutations. so 2(q) = 1/20. 80% of these carriers are deletions so multiply 1/20 * 0.8 = 1/25 +
... neonem made a comment on nbme20/block3/q#5 (A 35-year-old man comes to the physician because of...)
 +14 
submitted by neonem(578)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hraxteMeeott odulw be a drug fo cihceo rof iisasosrp crytrraofe ot lciaotp amscre nda tlhgi tpre;hya bnhiitsi iaoleydodthrf reusacedt ni orrde to aceeesdr ksin lcel retiiaoflnrpo and crdeeu ormtnmylfaia srsep.eno

69_nbme_420  Cyclosporine can also be used to treat Psoriasis (NOT cyclophosphamide - ans B) +9
len49  Drugs that can be used for psoriasis include cyclosporine, MTX, TNF-alpha inhibitors including Etanercept, lnfliximab, adalimumab, certolizumab, golimumab according to FA +2
medstudent  Kinda summed up in the index - p 791 2nd row halfway down +2
lovebug  as We all know, 1st line therapy of psoriasis is topical corticosteroid, Vit.D analog (Vit.D inhibits keratinocyte proliferation and stimulates keratinocyte differentiation. +
shakakaka  What page if Fa says that these drugs can be used in psoriasis?) +
srmtn  FA 2019 p 476 +
... hayayah made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
 +14 
submitted by hayayah(1100)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nI rerdo rfo a udrg ot eb caderle by het ,ieydnk it umst frist eb ieftlrde in eth uiolmegl.r sguDr iwth a ihhg DV veha mroe of het udrg ni eht tessui tath era ont aabeivall to tfleride yb the n.ikdey rguDs itwh ihhg teripon inbdgni ow'nt be teildrfe .rithee So uoy tanw a grdu tiwh wol Vd dan low nbgniid fi uoy twan it ceedlar aiv teh dnkisye adn rein.u

zevvyt  But a low VD corresponds to high Plasma Binding Concentration(FA 233, 2019). That's my main confusion with this question. +2
kevin  If it's high plasma binding, then it's low Vd. But, low VD doesn't necessarily require high plasma binding. Low Vd can simply be due to it being a large polar molecule +1
topgunber  So you the confusion is that VD of 1 means it stays in the circulation/ intravascular compartment. This would make you think that it would bind highly to protein in because of the low VD. But im assuming if it bound proteins it would not be cleared by the kidneys, so if this had a low VD (can be cleared at glomerulus) and if it bound plasma proteins weakly (allows the kidney to filter the substance) then it can be filtered into the tubular lumen. Now the pka. Bases when protonated (ph under their pka) become charged, while acids at ph under their pka get protonated are UNCHARGED, meaning in acidic urine acids become more lipophillic and can diffuse out of the tubular lumen. If we made the urine more basic, then we want to deprotonate the acid (ph higher than pka) so it will remain stuck in the tubular lumen as an ion. +
... louisville made a comment on nbme20/block3/q#36 (A 4-year-old boy has had fever, abdominal cramping,...)
 +14 
submitted by louisville(12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yeehl-neeutlMb danseit flcae amers lvreeed uosmnuer utplnseiorh tub( not yan oisrs)n.gma Shlaglei si lsrocolse hnwe entsdai htiw eytmnlehe b;uel E iolc tssnia eblu iwht yhmtenlee bleu eebsuac ti esrtmnfe elao.sct

sympathetikey  E. coli stains green (just fyi) otherwise, perfect. +14
chandlerbas  only E coli stains green, all other lactose fermenters stain purple/black (just fyi) otherwise, perfect. ;) FA144 bottom +4
dmotav  I think this is actually a separate concept – E. coli stains "metallic green" on eosin methylene blue agar, which is in the E. coli sketchy and first aid. However this question is referring to the methylene blue test on a fecal smear. From what I can gather, this test will be positive (indicated by presence of neutrophils) in cases of invasive diarrhea (i.e. shigella, salmonella, enterohemorrhagic E. coli). The test will be negative (no neutrophils) in cases of diarrhea caused by toxins (cholera, enterotoxigenic E. coli, giardia, viral diarrhea). So even though E. coli can present with fecal PMNs (if it's the enterohemorrhagic type), I guess that's less likely than shigella? source: https://www.ncbi.nlm.nih.gov/pubmed/4554412 +4
srmtn  correct @dmotav, Eosin methylene blue agar is different from Methylen Blue stain which just show presence or not of leucocytes... just read this: Fecal leukocytes can be observed in those with the following conditions β€’ Salmonella infections β€’ Shigella infections β€’ Ulcerative colitis β€’ Crohn’s disease Leukocytes will be absent in fecal samples from those with Giardia, E.coli or viral infections and also in cases of food poisoning. +