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NBME 22 Answers

RAAS
Question#1 (107.2 difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretionπŸ”,πŸ“Ί

Question#2 (56.0 difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDLπŸ”,πŸ“Ί

Question#3 (35.9 difficulty score)
Parenterally administered cholera vaccines ...
Inability of the vaccine to elicit secretory antibody at the epithelial surfaceπŸ”,πŸ“Ί

Question#4 (48.6 difficulty score)
A 48-year-old man begins furosemide therapy ...
Decreases the luminal permeability to Na+ in the collecting ductπŸ”,πŸ“Ί

Question#5 (29.1 difficulty score)
A 10-month-old girl is brought to the ...
NaloxoneπŸ”,πŸ“Ί

Question#6 (28.5 difficulty score)
A 2-month-old boy is brought to the physician ...
Human papillomavirusπŸ”,πŸ“Ί

Question#7 (37.8 difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading doseπŸ”,πŸ“Ί

Question#8 (36.8 difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical ribπŸ”,πŸ“Ί

Question#9 (60.6 difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4πŸ”,πŸ“Ί

Question#10 (19.4 difficulty score)
A 25-year-old woman is admitted to the ...
Streptococcus pneumoniaeπŸ”,πŸ“Ί

Question#11 (29.3 difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradationπŸ”,πŸ“Ί

Question#12 (18.7 difficulty score)
During the first week of life, a male newborn ...
21-HydroxylaseπŸ”,πŸ“Ί

Question#13 (22.9 difficulty score)
A 13-year-old girl is brought to the ...
Ask the mother to leave the room before asking the patient any questionsπŸ”,πŸ“Ί

Question#14 (12.3 difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgiaπŸ”,πŸ“Ί

Question#15 (56.1 difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemiaπŸ”,πŸ“Ί

Question#16 (36.9 difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negativeπŸ”,πŸ“Ί

Question#17 (53.7 difficulty score)
A 27-year-old man is brought to the emergency ...
EversionπŸ”,πŸ“Ί

Question#18 (45.5 difficulty score)
A 13-year-old boy is brought to the physician ...
ReassuranceπŸ”,πŸ“Ί

Question#19 (25.8 difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcomaπŸ”,πŸ“Ί

Question#20 (63.3 difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosisπŸ”,πŸ“Ί

Question#21 (36.6 difficulty score)
A 30-year-old man comes to the physician ...
PolycystinπŸ”,πŸ“Ί

Question#22 (30.9 difficulty score)
A previously healthy 6-year-old boy is ...
Does anyone else in the family have an itchy rash like this?πŸ”,πŸ“Ί

Question#23 (37.2 difficulty score)
A patient in the early stages of hemorrhagic ...
A weak pulse due to decreased stroke volumeπŸ”,πŸ“Ί

Question#24 (38.6 difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular arteryπŸ”,πŸ“Ί


Question#26 (43.4 difficulty score)
A 42-year-old man comes to the physician ...
HydrochlorothiazideπŸ”,πŸ“Ί

Question#27 (16.5 difficulty score)
During a clinical study, 15 patients with ...
AzathioprineπŸ”,πŸ“Ί

Question#28 (33.2 difficulty score)
A 48-year-old man comes to the physician ...
Transferrin saturation and serum ferritin measurementsπŸ”,πŸ“Ί

Question#29 (60.4 difficulty score)
A 28-year-old man comes to the emergency ...
JejunumπŸ”,πŸ“Ί

Question#30 (36.8 difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobeπŸ”,πŸ“Ί

Question#31 (28.3 difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancerπŸ”,πŸ“Ί

Question#32 (59.7 difficulty score)
A 17-year-old boy is brought to the emergency ...
HypokalemiaπŸ”,πŸ“Ί

Question#33 (30.6 difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flowπŸ”,πŸ“Ί

Question#34 (25.6 difficulty score)
A 15-year-old girl is brought to the ...
First-degree burnπŸ”,πŸ“Ί

Question#35 (60.3 difficulty score)
A 35-year-old man is brought to the hospital ...
Alteration of the thermostatic set pointπŸ”,πŸ“Ί

Question#36 (19.1 difficulty score)
A 67-year-old woman comes to the physician ...
Idiopathic pulmonary fibrosisπŸ”,πŸ“Ί

Question#37 (65.3 difficulty score)
A 28-year-old woman is brought to the ...
Area labeled β€˜C’ (Abducens nucleus, right)πŸ”,πŸ“Ί

Question#38 (28.8 difficulty score)
A newborn born at 26 weeks' gestation has ...
Dipalmitoyl lecithinπŸ”,πŸ“Ί

Question#39 (22.1 difficulty score)
A 23-year-old woman develops multiple red, ...
Processing of antigen by Langerhans cells, leading to activation of CD4+ T cellsπŸ”,πŸ“Ί

Question#40 (31.2 difficulty score)
A 45-year-old man with chronic pancreatitis ...
PancrelipaseπŸ”,πŸ“Ί

Question#41 (43.5 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitusπŸ”,πŸ“Ί

Question#42 (25.6 difficulty score)
An 18-year-old woman develops sepsis after an ...
Decreased plasma fibrinogen concentrationπŸ”,πŸ“Ί

Question#43 (24.6 difficulty score)
A 13-year-old girl is brought to the ...
C1 inhibitorπŸ”,πŸ“Ί

Question#44 (45.8 difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectalπŸ”,πŸ“Ί

Question#45 (64.3 difficulty score)
A 16-year-old girl is brought to the ...
DiureticsπŸ”,πŸ“Ί

Question#46 (22.9 difficulty score)
A 12-year-old girl is referred to the ...
Conversion disorderπŸ”,πŸ“Ί

Question#47 (29.9 difficulty score)
A 25-year-old woman comes to the physician ...
Immune thrombocytopenic purpuraπŸ”,πŸ“Ί

Question#48 (40.9 difficulty score)
A 1-year-old boy is found to have an ...
Staphylococcus aureusπŸ”,πŸ“Ί

Question#49 (27.0 difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
AzithromycinπŸ”,πŸ“Ί

Question#50 (36.6 difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structureπŸ”,πŸ“Ί

Question#1 (58.5 difficulty score)
A 29-year-old woman is brought to the ...
Avulsion of hepatic veins from the inferior vena cavaπŸ”,πŸ“Ί

Question#2 (16.4 difficulty score)
A 65-year-old man starts using topical ...
Thymidylate synthaseπŸ”,πŸ“Ί

Question#3 (25.3 difficulty score)
A previously healthy 28-year-old man comes to ...
NephrolithiasisπŸ”,πŸ“Ί

Question#4 (30.8 difficulty score)
A previously healthy 60-year-old woman is ...
Increased central venous pressureπŸ”,πŸ“Ί

Question#5 (44.8 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balanceπŸ”,πŸ“Ί

Question#6 (42.7 difficulty score)
A 52-year-old man is brought to the emergency ...
4 MonthsπŸ”,πŸ“Ί

erections libido penis
Question#7 (72.5 difficulty score)
A 66-year-old man comes to the physician ...
Libido: decreased;
Nocturnal erections: normal
πŸ”
,πŸ“Ί

Question#8 (41.1 difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled β€˜Eβ€™πŸ”,πŸ“Ί

immuno abo_incompatibility complement
Question#9 (43.9 difficulty score)
A 26-year-old woman develops hypotension and ...
Antibody, complement C5-9πŸ”,πŸ“Ί

erections penis
Question#10 (30.6 difficulty score)
A 56-year-old man with a palpable hard nodule ...
Pelvic parasympathetic nervesπŸ”,πŸ“Ί

anatomy
Question#11 (67.9 difficulty score)
A 52-year-old man comes to the physician ...
Sensation from the anterior surface of the scrotumπŸ”,πŸ“Ί

cAMP
Question#12 (25.4 difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMPπŸ”,πŸ“Ί

Question#13 (28.4 difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocoliticaπŸ”,πŸ“Ί

Question#14 (40.6 difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodiumπŸ”,πŸ“Ί

Question#15 (45.6 difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breastπŸ”,πŸ“Ί

Question#16 (24.1 difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinomaπŸ”,πŸ“Ί

Question#17 (17.8 difficulty score)
Ten healthy human subjects are given a new ...
Phase 1πŸ”,πŸ“Ί

Question#18 (26.6 difficulty score)
A 32-year-old man comes to the physician ...
Reverse transcriptaseπŸ”,πŸ“Ί

Question#19 (27.7 difficulty score)
A 50-year-old man comes to the physician 3 ...
CalciumπŸ”,πŸ“Ί

Question#20 (21.1 difficulty score)
A 26-year-old nulligravid woman comes to the ...
HypothalamusπŸ”,πŸ“Ί

Question#21 (28.5 difficulty score)
A newborn has cyanosis, tachypnea, and ...
Respiratory acidosis and metabolic acidosisπŸ”,πŸ“Ί

Question#22 (51.7 difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclaseπŸ”,πŸ“Ί

Question#23 (38.6 difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bugπŸ”,πŸ“Ί

Question#24 (22.7 difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failureπŸ”,πŸ“Ί

Question#25 (43.4 difficulty score)
A 37-year-old woman undergoes excision of a ...
AngiogenesisπŸ”,πŸ“Ί

Question#26 (14.2 difficulty score)
A randomized controlled trial is conducted to ...
(194/2371) – (123/2365)πŸ”,πŸ“Ί

Question#27 (34.5 difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3βˆ’πŸ”,πŸ“Ί

Question#28 (20.4 difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibialπŸ”,πŸ“Ί

Question#29 (26.2 difficulty score)
A 79-year-old man is brought to the emergency ...
Insertion of transvenous pacemakerπŸ”,πŸ“Ί

Question#30 (30.0 difficulty score)
A 40-year-old woman comes to the physician ...
MultifactorialπŸ”,πŸ“Ί

Question#31 (47.9 difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variationπŸ”,πŸ“Ί

Question#32 (55.9 difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cellsπŸ”,πŸ“Ί


Question#34 (57.7 difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600πŸ”,πŸ“Ί

Question#35 (62.8 difficulty score)
A 45-year-old man with Li-Fraumeni syndrome ...
Decreased binding of RNA polymeraseπŸ”,πŸ“Ί

Question#36 (39.6 difficulty score)
Which of the following drug effects is the ...
AnticholinergicπŸ”,πŸ“Ί

Question#37 (55.7 difficulty score)
A 63-year-old man has had progressive ...
Area labeled β€˜Dβ€™πŸ”,πŸ“Ί

Question#38 (31.6 difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medullaπŸ”,πŸ“Ί

Question#39 (26.5 difficulty score)
A 22-year-old woman comes to the office ...
CardiomyopathyπŸ”,πŸ“Ί

Question#40 (28.5 difficulty score)
A previously healthy 7-year-old girl is ...
Serum potassium concentrationπŸ”,πŸ“Ί


Question#42 (25.4 difficulty score)
A 75-year-old woman has taken 12 ...
Plasma renin activityπŸ”,πŸ“Ί

Question#43 (36.8 difficulty score)
A 20-year-old man comes to the physician ...
Area labeled β€˜Cβ€™πŸ”,πŸ“Ί

Question#44 (19.1 difficulty score)
A 3-day-old full-term male newborn is brought ...
Hepatic UDP-glucuronosyltransferase activityπŸ”,πŸ“Ί

Question#45 (52.8 difficulty score)
An 86-year-old man who lives in a skilled ...
DextromethorphanπŸ”,πŸ“Ί

Question#46 (41.7 difficulty score)
A 62-year-old man is being evaluated for ...
Greater mucosal surface areaπŸ”,πŸ“Ί

Question#47 (15.7 difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndromeπŸ”,πŸ“Ί

Question#48 (15.7 difficulty score)
Clostridium perfringens-Ξ± toxin affects cells ...
Splitting lecithin to phosphorylcholine and diglycerideπŸ”,πŸ“Ί

Question#49 (9.0 difficulty score)
A physician is unable to communicate "bad ...
CountertransferenceπŸ”,πŸ“Ί

Question#50 (39.0 difficulty score)
An 18-month-old boy is admitted to the ...
Tuberous sclerosis complexπŸ”,πŸ“Ί

Question#1 (74.8 difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve rootπŸ”,πŸ“Ί

Question#2 (30.0 difficulty score)
A 30-year-old man is brought to the emergency ...
Increased serum angiotensin II concentrationπŸ”,πŸ“Ί

Question#3 (27.9 difficulty score)
An obese 45-year-old woman with type 2 ...
DiarrheaπŸ”,πŸ“Ί

Question#4 (52.8 difficulty score)
A 29-year-old woman has an inflammatory ...
Immune complex-mediated cytotoxicityπŸ”,πŸ“Ί

Question#5 (72.4 difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin geneπŸ”,πŸ“Ί


Question#7 (14.1 difficulty score)
A 50-year-old man who is a college professor ...
It must be difficult for you to accept this diagnosis when you feel healthy.πŸ”,πŸ“Ί

Question#8 (43.9 difficulty score)
A 38-year-old man who lives at sea level ...
pH: increased;
HCO3-: increased;
Volume: increased
πŸ”
,πŸ“Ί

Question#9 (63.3 difficulty score)
Microelectrode injection of antibodies to ...
Area labeled β€˜Cβ€™πŸ”,πŸ“Ί


Question#11 (18.8 difficulty score)
A 38-year-old man with Down syndrome is ...
Contact adult protective servicesπŸ”,πŸ“Ί

Question#12 (32.5 difficulty score)
An 82-year-old woman has been bedridden since ...
Carboxylation of precursor proteinsπŸ”,πŸ“Ί

Question#13 (34.3 difficulty score)
A previously healthy 26-year-old woman comes ...
Acute retroviral infectionπŸ”,πŸ“Ί

Question#14 (54.1 difficulty score)
A 57-year-old woman comes to the physician 2 ...
IntercostalπŸ”,πŸ“Ί

Question#15 (51.2 difficulty score)
An 18-year-old man comes to the physician 10 ...
C8πŸ”,πŸ“Ί

Question#16 (41.3 difficulty score)
A 27-year-old woman comes to the physician ...
Antiphospholipid antibodiesπŸ”,πŸ“Ί

Question#17 (21.0 difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pyloriπŸ”,πŸ“Ί

Question#18 (42.3 difficulty score)
An 85-year-old woman is diagnosed with a ...
Morphine is metabolized to active metabolites that accumulateπŸ”,πŸ“Ί

Question#19 (44.2 difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathyπŸ”,πŸ“Ί

Question#20 (54.4 difficulty score)
A 43-year-old man is brought to the emergency ...
Fibularis (peroneus) brevisπŸ”,πŸ“Ί

Question#21 (46.7 difficulty score)
A screening test for cancer is developed and ...
Data point labeled β€˜Aβ€™πŸ”,πŸ“Ί

Question#22 (48.0 difficulty score)
A study is conducted to assess the prevalence ...
Chi-square testπŸ”,πŸ“Ί

Question#23 (50.1 difficulty score)
A 45-year-old woman comes to the physician ...
25%πŸ”,πŸ“Ί

Question#24 (38.3 difficulty score)
An 84-year-old woman comes to the physician ...
Downregulation of E-cadherinπŸ”,πŸ“Ί

Question#25 (35.2 difficulty score)
A 3-month-old girl is brought to the ...
Motor: normal;
Social: delayed;
Verbal and cognitive: delayed
πŸ”
,πŸ“Ί

Question#26 (38.2 difficulty score)
A study is conducted to assess the extent of ...
Type I error: No change;
Type II error: decreased
πŸ”
,πŸ“Ί

Question#27 (20.8 difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalisπŸ”,πŸ“Ί

Question#28 (23.3 difficulty score)
A 12-year-old girl who recently immigrated to ...
PraziquantelπŸ”,πŸ“Ί

Question#29 (49.6 difficulty score)
A 45-year-old man with end-stage renal ...
BicarbonateπŸ”,πŸ“Ί

Question#30 (90.7 difficulty score)
Which of the following is required for the ...
GlutamineπŸ”,πŸ“Ί

Question#31 (27.6 difficulty score)
A 35-year-old man is admitted to the hospital ...
Absorption of nitrogenous products from the gastrointestinal tractπŸ”,πŸ“Ί

Question#32 (28.9 difficulty score)
A 25-year-old woman comes to the physician ...
Fasting insulin: increased;
Testosterone: increased;
Luteinizing hormone: increased
πŸ”
,πŸ“Ί

Question#33 (49.5 difficulty score)
A 22-year-old man comes to the physician ...
47,XXYπŸ”,πŸ“Ί

Question#34 (30.9 difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control studyπŸ”,πŸ“Ί

Question#35 (67.4 difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammationπŸ”,πŸ“Ί

Question#36 (22.2 difficulty score)
A 62-year-old man comes to the physician's ...
Alternative treatmentsπŸ”,πŸ“Ί

Question#37 (20.4 difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMPπŸ”,πŸ“Ί

Question#38 (61.3 difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressureπŸ”,πŸ“Ί

Question#39 (41.0 difficulty score)
A 52-year-old man with stable angina pectoris ...
HeadacheπŸ”,πŸ“Ί

Question#40 (34.6 difficulty score)
A 49-year-old man has had the gradual onset ...
Essential thrombocythemiaπŸ”,πŸ“Ί

Question#41 (36.1 difficulty score)
A 56-year-old man develops brief episodes of ...
CL x CssπŸ”,πŸ“Ί

Question#42 (23.5 difficulty score)
A 62-year-old man comes to the physician for ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”
,πŸ“Ί

Question#43 (35.5 difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitisπŸ”,πŸ“Ί

Question#44 (24.6 difficulty score)
A 35-year-old man comes to the physician ...
Prescribe permethrin for the patient and his familyπŸ”,πŸ“Ί

Question#45 (61.6 difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cellsπŸ”,πŸ“Ί

Question#46 (13.3 difficulty score)
A 54-year-old woman with hypertension and ...
Vasodilating prostaglandins at the afferent arterioleπŸ”,πŸ“Ί

Question#47 (43.0 difficulty score)
A 10-year-old boy receives a renal transplant ...
Lymphocytes infiltrating tubular epitheliumπŸ”,πŸ“Ί

Question#48 (27.8 difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobulinemiaπŸ”,πŸ“Ί

Question#49 (27.5 difficulty score)
A 42-year-old man is brought to the emergency ...
Dopaminergic neurons in the substantia nigraπŸ”,πŸ“Ί

Question#50 (22.6 difficulty score)
A 56-year-old woman is brought to the ...
Herpes encephalitisπŸ”,πŸ“Ί

Question#1 (53.6 difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesentericπŸ”,πŸ“Ί

Question#2 (35.7 difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
AcetaminophenπŸ”,πŸ“Ί

Question#3 (29.3 difficulty score)
A 60-year-old man comes to the physician ...
Alveolar macrophageπŸ”,πŸ“Ί

Question#4 (48.1 difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2OπŸ”,πŸ“Ί

Question#5 (60.4 difficulty score)
A new virus has been isolated that causes ...
Single-stranded positive-senseπŸ”,πŸ“Ί

Question#6 (18.6 difficulty score)
A population of vegetarians is surveyed to ...
t-TestπŸ”,πŸ“Ί

Question#7 (31.8 difficulty score)
A 27-year-old man comes to the physician for ...
Ask the patient to identify the pros and cons of smoking cessationπŸ”,πŸ“Ί

Question#8 (22.4 difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin EπŸ”,πŸ“Ί

Question#9 (46.5 difficulty score)
A 5-year-old boy is brought to the physician ...
Interruption of erythrocyte productionπŸ”,πŸ“Ί

Question#10 (52.4 difficulty score)
An 81-year-old man comes to the physician for ...
AtherosclerosisπŸ”,πŸ“Ί

Question#11 (21.4 difficulty score)
A 26-year-old woman comes to the physician 5 ...
SertralineπŸ”,πŸ“Ί

Question#12 (16.3 difficulty score)
A 73-year-old woman dies 7 years after the ...
Hydrocephalus ex vacuoπŸ”,πŸ“Ί

Question#13 (17.6 difficulty score)
A 36-year-old woman comes to the physician ...
Cytosol with translocation into the nucleusπŸ”,πŸ“Ί

Question#14 (49.5 difficulty score)
In patients with adenosine deaminase ...
Ribonucleotide reductaseπŸ”,πŸ“Ί

Question#15 (65.8 difficulty score)
A 24-year-old woman, gravida 1, para 1, comes ...
Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytesπŸ”,πŸ“Ί

Question#16 (32.0 difficulty score)
A 4-month-old boy is brought to the office by ...
Maxillary and medial nasal prominencesπŸ”,πŸ“Ί

Question#17 (17.3 difficulty score)
A 62-year-old man with dyslipidemia is ...
GemfibrozilπŸ”,πŸ“Ί

Question#18 (43.1 difficulty score)
A 10-year-old girl has a slightly painful ...
GranulomaπŸ”,πŸ“Ί

Question#19 (43.6 difficulty score)
A 76-year-old man with a 1-month history of a ...
Anomalous origins of multiple renal arteries to each kidneyπŸ”,πŸ“Ί

Question#20 (42.5 difficulty score)
During a study of symptomatic proximal deep ...
Open-label clinical trialπŸ”,πŸ“Ί

Question#21 (19.8 difficulty score)
A previously healthy 45-year-old woman has ...
Thrombotic thrombocytopenic purpuraπŸ”,πŸ“Ί

Question#22 (25.8 difficulty score)
A 37-year-old man comes to the physician for ...
Hyperplastic arteriolosclerosisπŸ”,πŸ“Ί

Question#23 (21.3 difficulty score)
A 57-year-old woman comes to the office ...
Autoimmune downregulation of Ca2+ channels of the presynaptic terminalπŸ”,πŸ“Ί

Question#24 (27.9 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-Ξ±πŸ”,πŸ“Ί

Question#25 (28.0 difficulty score)
A healthy 25-year-old man eats a meal ...
Fusion of an intracellular vesicle with the plasma membraneπŸ”,πŸ“Ί

Question#26 (39.5 difficulty score)
A 60-year-old woman comes to the physician ...
MeningiomaπŸ”,πŸ“Ί

Question#27 (52.3 difficulty score)
A 78-year-old man comes to the physician ...
Metastatic carcinomaπŸ”,πŸ“Ί

Question#28 (44.8 difficulty score)
A 48-year-old man comes to the emergency ...
Splenic veinπŸ”,πŸ“Ί

Question#29 (28.4 difficulty score)
A 45-year-old man who is HIV positive comes ...
Disruption of the pathogen cell membraneπŸ”,πŸ“Ί

Question#30 (42.8 difficulty score)
A 27-year-old man who is a construction ...
Splenic flexureπŸ”,πŸ“Ί

Question#31 (34.8 difficulty score)
A 65-year-old man comes to the emergency ...
CracklesπŸ”,πŸ“Ί

Question#32 (42.5 difficulty score)
A case-control study is conducted to assess ...
Cannot be determined from the data givenπŸ”,πŸ“Ί

Question#33 (35.0 difficulty score)
A 38-year-old single woman with a history of ...
DisplacementπŸ”,πŸ“Ί

Question#34 (19.2 difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyteπŸ”,πŸ“Ί

Question#35 (45.8 difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜Cβ€™πŸ”,πŸ“Ί

Question#36 (25.9 difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase responseπŸ”,πŸ“Ί

Question#37 (44.4 difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophyπŸ”,πŸ“Ί

Question#38 (25.8 difficulty score)
Patients with mucolipidosis II (I-cell ...
Secreted from the cellsπŸ”,πŸ“Ί

Question#39 (43.1 difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cellsπŸ”,πŸ“Ί

Question#40 (20.4 difficulty score)
A 5-year-old boy with mental retardation is ...
Maternal origin of both chromosomes 15πŸ”,πŸ“Ί

Question#41 (31.2 difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4πŸ”,πŸ“Ί

Question#42 (14.2 difficulty score)
A 31-year-old man comes to the physician ...
DihydrotestosteroneπŸ”,πŸ“Ί

Question#43 (29.6 difficulty score)
A 44-year-old man comes to the physician ...
Tricuspid insufficiencyπŸ”,πŸ“Ί

Question#44 (45.7 difficulty score)
A 10-year-old boy has bruised easily since ...
Prolonged prothrombin timeπŸ”,πŸ“Ί

Question#45 (34.2 difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cellsπŸ”,πŸ“Ί

Question#46 (65.4 difficulty score)
A 39-year-old woman comes to the physician ...
HemoglobinπŸ”,πŸ“Ί

Question#47 (53.9 difficulty score)
A 56-year-old woman comes to the physician ...
Maintenance of basement membrane integrityπŸ”,πŸ“Ί

Question#48 (39.6 difficulty score)
An 8-year-old boy is brought to the physician ...
Calorie consumption that exceeds energy expenditureπŸ”,πŸ“Ί

Question#49 (23.1 difficulty score)
A 52-year-old man with metastatic oat cell ...
Ensure that the patient receives enough medication to control his painπŸ”,πŸ“Ί

Question#50 (46.4 difficulty score)
A 31-year-old woman in the second trimester ...
Hematopoietic stem cellsπŸ”,πŸ“Ί

Recent comments ...

... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +61 
submitted by seagull(1677)
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dDi nyenao eden to edra taht tasl tesnenec lkie 50 tsmei ucebeas teh arohut seuserf to eus bettre g.arrmma Just rtf.satgrniu

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +18
drbravojose  Actually never understand what the author saying at any time. LOL +3
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +
xmen  THEY GIVE SOMETIME WEIRD QUESTIONS DURING THE REAL EXAM !!! AND IT'S EXPERIMENTAL +
... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +57 
submitted by sacredazn(84)
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The ctponce is a uncldoetov awy fo aignsk fi ouy knwe woh VDJ tcianrboemoin w,skor ciwhh is atth ti si ualtalcy na epxamel fo etlargin het DNA fo teh TB/ tmleyoy.hcp

uShenrto tbol euhteiqnc: oS hwen hyet esu a pbeor nstaiga soem nie,gro dna onugttiutp a ezsi of 5.1 bk ro 6 b,k shti si glilnte uyo the izse fo teh NAD tngfemra in aceh cell de’ont(s earmtt fi yeth ysa J rpboe ro otsnactn ngorei ebpor, eth’yre sujt niasgy treeh’y aingtetgr osem tnucoeleid ensqeuce fdonu ni teh Ig RuoTcCl/s bate ainch sluco pevrieetlscy orf T/B s.lecl)

I ktinh eht gfsicunno rtap uclod be nwroeidgn how uyo wokn ehtwrhe yreuo’ yarptl oruhthg aaegrmnrrtnee (erwnsa cocishe B hurt )D or if it h’nats ccduorre ta lal eyt retcoc(r .w)snaer reeH, teh pcnotec si ttah B lscle guodren DV)(J rnegnaamterre ni het oenb awrm,or hlwei T lslec od it in teh hu,smty dan ti lla ahppnes ta ec.no oS a lasapm lelc ni eth olodb kile ni epltMuil yomMale dulow evah ulylf nedgoneru aioorimbntcen, hlwie a T elcl in hte bolod uclod theeir be fully euatdced a(dn evah dneihfis DJV ncotmioierb)an ro ueimmatr s’(naht atdsret )VJD.

ncieS het T llec enge saw 6 bk dna iyeldeiftn egrbig hnat the 5.1 kb n,eeg hte T ecll n’shta dournegne ircenmnotoaib .tye

trichotillomaniac  very nice explanation! +28
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +4
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
mynamejeff  Thank you! So is this because multiple myeloma produces excessive monoclonal light chain Ig? Is this the 1.5 kb gene? Whereas, T-cells that have not gone through differentiation yet and their J region includes everything (VDJ) vs. just VJ in the light chain? (FA 2020 pg 104) +
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +1
skonys  My logic was wrong but my answer correct. I am suffering from success. +
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +42 
submitted by seagull(1677)
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hhicW fo the ognfliwlo ernosas is why hsit usoietnq is ?ullb

1) ngsiU het orwd c"c"ciyl aesndti of tycriiclc ofr caytirl

2) gwnoKni lla fo iedliegopmoy of lal rdgus

3) vhiagn ot snraeo tuo atth ticeilcinrhagon ecffest era pbrbloay eth swotr orve a1lhpa or 1H etsfcef to no rye.ncitta

4) heT ppclniirg posdniesre fo stgidnyu fro e--tokdayswse on end ot rpblbayo od evaager on teh set.t

nlkrueger  yo, re-fucking-tweet +22
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +
tekkenman101  "worst to experience" is incredibly subjective lmao. +
... liverdietrying made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +35 
submitted by liverdietrying(103)
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hisT one aws a ltteli .rkicyt For sthi one eht yek is eth wlo oroddiiniea aptuke. hisT eantpti ahs high 4T dan lwo HST ichhw seamk seesn ni a thirprhodyye ,ieatpnt rpsahpe uory ifrts uhhttgo is tath isht pentati ash aeGrvs’ daess.ie evewr,Ho ni avGes’r uroy tryoihd si nibge eltmauisdt to maek mero iyrhotd hmoreon form tcsacrh nda sa cush udolw eahv an dicrsnaee oeaioriindd tpeaku acbesue eht oyrtihd si ingrignb in eth rdurqeie no(w ldbeod)aiaerl .iodnie shTi si why it si otn sareGv β€œleaeser( of hotyrid neormoh mfro a odtirhy smtiulaetd yb b)aoe.sdni”it

oS if tis ont ’esGvra hatw dlcou ti eb? orF tshi od’yu veha to owkn atth ooss’ahitHm ryTdohisiti aol(s wnonk as nCorhic tyhcciyopLm hiiortyTdis dna is ftneo freererd to sa hcus on bodra xsame to hotrw yuo o)ff hsa eethr apshse - frtsi yteh are oderh,hyitryp tnhe yeiouthrd, tehn eht cacissl yyiorhphotd htta yuo dowlu tcxeep twhi wlo 4T adn ihhg ST.H This aws teh key ot hsit isqo.eunt Teh soaren fro htsi is taht hintryoitda seeioadxrp inbsoaitde in otmiashos’H saecu eht iohtdyr to eeslare lal fo ist ordets hdytroi honrome kniamg the atetnpi yioytdrhehrp orf a srhot dporie of imet. Aftre ihts aemssvi aseleer fo hyroitd om,hroen hte einiasodbt meak htme ubeanl ot eakm wne HT dna trerhofee yeth beoecm urtdheyio orf a othrs idoerp nad ehtn odhhrtpyoyi iwhch uyo owlud e!extpc Sneci yhet atcn’ ekma nwe HT, the hryoidt iwll nto kate pu eth iodrdioinae and trhreofee heert illw eb wlo doedinoarii pe.aukt ecnH,e eeserβ€œal of dsoert dyithro mhoreno morf a yoihrtd angdl rdtfnaetiil yb sh.pe”yyomlct kaa β€œLohmpcicyty m(ooa)isshht ”hiystriitd.o

I hknit sβ€œealere of dtyihro hrenoom form a lmhatomsoypu otydrih an”dlg si iregrnfre to mseo dnki fo trhyodi rcaecn in chhiw easc you loudw eetpcx them ot be beisgirndc a donelu no reoaidndiio tap.keu

​Syamrum idoev ereh dna lsoa a eagrt esti ni geranle: dhoninr//set/dlrri:n/anieechsgactodoqp./pmydueroei/te

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +12
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2
... mcl made a comment on nbme22/block2/q#37 (A 63-year-old man has had progressive stiffness over...)
 +33 
submitted by mcl(618)
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shiT giaem is .ufeslu etNo tath hte isant uesd seakm meylni erppaa .rdka

nttVgeei is picalty for 'oPrsnanski a.ieseds rAea D si het asatnbutsi riga.n

oznefu  Oh nice! Thanks! +
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +
apurva  Saved My life +1
... keycompany made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
 +31 
submitted by keycompany(317)
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iNtnegor alneacb is a mnmesreauet of irpteon omislebmta in eht bydo. A eangvtei oreignnt aenlbac scinideta msluec s,ols sa eeicsndar atmuons fo aomin cdias aer bgnei aebtldoiemz to douprec ee.nygr hiTs nsaeiersc the noumat of inoerntg setcdree rmfo teh .oydb cueeBsa the omunta of girotnne uyo ear knigat ni is ssel nath teh nomtua of nroeitng uyo ear tnreicegs, yuo ahve a intgevae nrgionte alebnac.

hTis nam si i,alrumseodhn umtoesdae, hcatcci,e dan ahs nm.lpiubaiahoyem eseTh ialcncil isignfdn ntopi ot etnrpio tamrlonuniti ihoaswra(Kk eieas)sD, wihch suaces maeed deu ot ecsdrdaee rusme itoocnc rsserp.ue woL ioncoct eesurpsr in hsit scae is edu ot tperino lo,ss nda ecneh a evatieng ognrinte .acablen

drdoom  Nice! +22
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +4
zevvyt  also, it says that his albumin is low. +
... joha961 made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +31 
submitted by joha961(44)
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eikL rtohse haev ad,is I intkh iobaitsmnul lowdu vaeh been retbe,t btu cmpdlnaetsei fmor tsrfi aid yssa ahtt it s,i neorredtiiβ€œc of nteimoso ro msuilpes to a unrltea sporen or bojetc” os sehs’ ikginkc hre afilym yb kniikgc the a.gb

djeffs1  Not if you're sexist and think its inappropriate for women to participate in kickboxing... +
... imgdoc made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
 +28 
submitted by imgdoc(143)
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I tkhin sit hte gtrhi MFL (eara )C, not the hitgr nbdaesuc uuecnls htat si eelsdino no the srcso ctes.noi If eht nbduseca nscuuel weer ilndeseo she ltodunw' vhea aucdbniot ni ehr ftel .eey Teh MFL esidtame rcsso latk tewebne teh dsebacnu suulcen on thbo sedis ot eth MLF no teh isptpooe sdie 2( usbcdnea cie,unl 2 FML eno no caeh e)ds.i In hre ,easc rhe ihrgt MLF wsa'tn tfcinnnuigo ceehn ywh seh asw iznagg tfle but her hgirt deildm esutrc w'atns tcnnticgoa to maieetd dfrtwael eg.za

shiT tcpueri lph:se b.tnp1ne5/m0n/4oh/w/t/thg_2j:0st/-dpucehto1oFp/.tm-p2hwo-whwcapmtlau9

imgdoc  *medial rectus +
... kernicterusthefrog made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +28 
submitted by kernicterusthefrog(126)
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"esh fseel aperhpi adn mero lre"eaxd efatr inasrttg oc:ikkbigxn itsh si a RMTAEU enfesed nchmiemsa ilcsa(sc eoxtotbk iubslmaiont, sa hsa enbe da)i.s Tish osetiqnu si tusj ipnla gnr.wo st'I not alseemdnpi,ct aeebcus i'ts a yet,ahhl loyscali tecaepbacl loutet taht epmivsro rhe moenatlio t;tsea iphcunng bgsa era etamn ot eb dpchenu us(ht it is aaulyclt NOT )ae.rntlu iaecptDsmnle to an eojtbc ldwou eb ucgnhnip a oelh ni her a,lwl or kbangire erh vsae (I stuj lkie atth )ya.gmeri tohB fo tsohe dluow eb etbter htan cihnngpu erh lmi,fay ro bakirgne rtehi cra n,oiwwd hchiw si why t'si pcemladnetis ccuns(isooun recteiidron fo na toeniom ot a aesrf oj.tc)be vree,wHo ixnigckkob is ILYLRTLAE an mlaexpe in eselrva hcpsy tosxeobkt rof ta.uiobmlins haTnk yuo rfo niocgm to ym TED alk.T

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +13
happyhib_  What if, just what if. Her taking time to do lessions was actually hurting her children by her having less time to spend with them and in turn not providing good care for them. (less of a mature defense mech now). Trust me I agree completely just not best answer, but given what we are given you could argue beyond that; amboss even says "a mom showing her feelings of anger towards the child instead of the actual problem, the husband". So in a way she is not addressing her actual problem (which she COULD address). +
... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
 +25 
submitted by drdoom(957)
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lnosaciCuatl ofr add. Teh iyripbbalot of teh feahtr nibge a errcair is 32/ esnci ti is wknno ttah eh oest’dn vhae teh sadeies. hneT eth blaotpryibi fo mhi gsniaps ti on to hsi kid si 12,/ :usht

  • Pybrltbaioi fo add bigne crarire = /32
  • airPbybltoi fo add sianpgs on essdaei lelael = /21

saCilaulonct ofr omm. Whti eht bngWHarerdiy-e iliPcrpe,n oyu nca igrufe out eth baoitypirbl of the ehrtmo niegb a errca:ir

q = q0r)0t(/,140s0 = 002/1

,So 2pq = 2 * /0210 * 9019/20, hhcwi si orppxa 1010./

orF teh child to etg het leleal ofmr mo,m owt hgtsni eend ot ea:ppnh )(1 mmo ustm eb a irarcer gheeotz[reoβ€œβ€y]t dna )2( mmo mstu ssap eht elllea ot h:idlc

  • yirotblabPi of omm gbeni ierrcra = 0110/
  • rtiboyliabP of mom pisngsa on sasdeei elalel = /21

tnugiP it lal hegetrot. oNw, bconeim all ortteehg:

= (obibayrtpil of add neigb r)crarie * t(bypiaboirl fo dda ngpiass on idaesse e)lalel * ibyriol(tapb of mmo gibne ric)rare * pbiyiatbr(lo fo omm gasisnp no esdeasi )elllae

= 23/ * 2/1 * 00/11 * 2/1
= 1 in 006

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +49
niboonsh  This question makes me want to vomit +12
drdoom  lol +
5thgencephalosporin  okay wow +
tekkenman101  You can make this a lot quicker by using simple rules for autosomal recessive diseases. 1) Unaffected parent with affected lineage will be a carrier 2/3 of the time (Aa) 2) frequency in population is super low so you can ignore P and just use 2(q) in order to calculate carrier frequency. So take the square root of the homozygous recessive frequency (1/40,000) and just plug it in: 2(.005) = .01 3) The odds of their child being affected with the two parents being assumed hypothetical carriers is 1/4 (aa) or .25. Dad's carrier chance (2/3) x Mom's carrier chance (.01) x child's chance of being recessive (.25) +
... k_tron_3000 made a comment on nbme22/block3/q#19 (A 42-year-old man comes to the physician because of...)
 +25 
submitted by k_tron_3000(32)
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The trepodcnsii fo tbraliale lrweo imbl ssol fo atvonibri iilepms DMCL emdgaa, and teh snteba sDRT + Rgmreob msee to em ot be mypilngi that he lposbiys hsa beats srdoilas ofrm ihslsypi ro( onehsmtig ryev msrilia in eepotani)r.nts

sA for het ehtro ,asrnews A si gnorw eabscue ihs otmro ounfcnti is anctt,i B is rnogw cebesua iapn dna rpturetemae feitisdc ear otn emn,eitnod C is owrgn cebseau it miielps a siicfcep evenr is edppnea,rt ubt eh hsa oslt atlblarei esinstnao in shi treein wrelo itmtrseeexi

D si het srktt,ieci adn mI’ nto 010% urse, tbu I ouwld thkin oiytauhdrlpac fo eth trianeor nl)(atvre sroot owldu cseau ortmo edtcifis incse yeth cyarr mroot eee.nstffr Yuo imhtg alos epcext taht rtmoo nusdtfnyico ot eb iara,netull esnic it douwl be ykuinlel to heva a eobplmr iwht het vrene sotor no btoh i.seds alos eht CMLD is nto loctaed raen eth nritorea rosot of hte pnisal ,rcdo so if het nrtaroie rsoot eewr eetfadcf uoy yelalr nt’owuld ceextp ot ees vrarytoib sso.l

So lbysliaac procsse fo ltam,iiionen I do flee ielk yseosrn huraponety is na myrelxete aveug awrnse gtuohh adn I aswnt’ a fan of the se.touqin

keycompany  This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word β€œRadicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral). +33
hello  Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness. I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function. +16
niboonsh  Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative? +1
link981  Great explanation guys +
usmel2020  UW QID: 12035 explains what you are testing with Romberg sign +14
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +
... seagull made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +25 
submitted by seagull(1677)
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uto fo rytcisou,i how yma poelep knwe hits? don(t be ysh to ysa ouy idd ro ?dind)t

My vytpore idaneuotc dd'nti iinangr siht ni e.m

johnthurtjr  I did not +3
nlkrueger  i did not lol +
ht3  you're definitely not alone lol +
yotsubato  no idea +
yotsubato  And its not in FA, so fuck it IMO +1
niboonsh  i didnt +
imnotarobotbut  Nope +
epr94  did not +
link981  I guessed it because the names sounded similar :D +15
d_holles  i did not +
yb_26  I also guessed because both words start with "glu"))) +27
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1
jaxx  Not a clue. This was so random. +
ls3076  no way +
hyperfukus  no clue +
mkreamy  this made me feel a lot better. also, no fucking clue +1
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +8
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4
djtallahassee  yea, I mature 30k anki cards to see this bs +4
taediggity  I literally shouted wtf in quiet library at this question. +1
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +22
drschmoctor  Is it biochemistry? Then I do not know it. +5
snoochi95  hell no brother +1
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2
waterloo  Nope. +
monique  I did not +
issamd1221  didnt +
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1
amy  +1 no idea! +
mumenrider4ever  Had no idea what glucosamine was +
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1
surfacegomd  no clue +
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +
chediakhigashi  nurp +
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
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Hsi dtila ovulem saw 050 L.m ptdornEa-xeriy wsa 5+ mc dan droianristp-yen asw +.25 We weer posdepsu ot seu het eednfefcri in yiraaw uprrss,ee dna tno the rnyt-dpieairson rpalelu upsserer 2()+.0

cpimCloena = PVΞ”/Ξ” = 005 / 20 = 25 /mcLm 2HO

some-zheimers  Great explanation. In general, also a great idea to pay attention to the units. I studied Physics in undergrad and have got one or two questions based purely on following the units, when the formula slips. +23
endochondral1  is that equation in FA? +
redvelvet  yes @endochondral1, at page 651 in 2019FA +19
... bubbles made a comment on nbme22/block3/q#13 (A previously healthy 26-year-old woman comes to the...)
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For hte psepe ohw tog usocfnde no sith uetiosnq bc of rWsdl'Uo irewd toueqins on HIV varil a:dlo

caeut HIV1- :fnctniioe IHGH raivl lda,o olw bHA2IV- ine:toifcn OLW lvair da,lo olw bA (bc adntadsr VIH ayasss tdctee p42, cwihh is ont prneets no 2)HVI-

inadK eondyna I siesmd na aesy omyonmulgi pcetcon qunotsie /:

eacv  I feel you my friend! same stupid mistake over here -.- +4
step1soon  FA 2019 pg 176 +2
... yotsubato made a comment on nbme22/block2/q#31 (An unimmunized 1-year-old boy is admitted to the...)
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nI blogo,iy phsea tranoivia is a detomh orf nagiedl itwh ylpriad rvaiyng esnevnotmrni thoiwtu iingerruq draonm m.ioauttn tI vevslnoi hte ovniarita of tiorpne senepiosxr, nfryelqteu ni na -onoff ifnh,sao ihwnti dftreinef atpsr fo a etrbicala ul.pitopaon sA suhc eht pnoyepeth nca ihtwsc at qufrseeiecn thta are uhcm hrheig o(mietmses 1&)%gt; tnha acslslica tnumtioa at.ser sehaP rnvaaioti tiutosbnrce ot rieeluvcn by tngenieagr ee.nroyehetitg Alhthugo ti sha been mtso ycnmomol stiuedd in eth otxetcn of minemu ni,saoev it si bdersveo in aymn thore raaes sa lwel and is lodeepmy yb sauvoir sepyt fo btiacera, clinigudn nallmaSelo scpei.es

ihisk/oarenvaw/pitdmton.w/.hiePwsncawt_a/w:

whoissaad  is it the same thing as antigenic variation? +10
dorsomedial_nucleus  No, antigenic variation involves genomic rearrangement Phase variation can be thought of as MORE or LESS of something. An on/off switch. No DNA is being rearranged, just under or overexpressed in response to the environment. +7
makinallkindzofgainz  This isn't in Zanki, Lightyear, or First Aid, and I don't remember ever learning about this in class. Thanks NBME! :D +19
jurrutia  You wouldn't expect the difference in phenotype of a given organism in a given patient to change because of mutations. It has to be something other than mutation. Phase variation is the only option that sounded like non-mutation. +
... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
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submitted by usmleuser007(418)
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tJus emreberm:

1) s-Ttet t(ae for wt)o = skloo ta eht emna usvlea fo 2 sropgu

2) NAVOA sal(nisya of a)crniave ~ eilk -tttes btu = soklo at maen sveula of 3 ro remo rguspo

)3 Cqs-heariu = oklso ta eht )%( or ooposrrtipn etnbwee 2 or emro rgs.oup

so, ujts kolo for owh amny rgsoup igneb deedarssd nad htwa esulva eyht rea usngi (% or sname)

... seagull made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
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heT suotahr etwn tuo of retih wya ot nifd htew twros hopot fo a lurgmnaao hyet .uodcl heT wtrhe on a smet ttha sgtsegus thta ti uldow eb oanurgitanl i.uste tBu tellit idd ew ...kown

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +17
sbryant6  Got this right because the exact same question is in Uworld. +
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1
... keycompany made a comment on nbme22/block2/q#41 (A 12-year-old boy is swimming in a mountain stream....)
 +22 
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erA:swn scrednaIe ntlrCea oBdlo uVemol VCB,)( ceardeDse ,ADH Ienscedar NA.P

ehT hocoipgiaysll pesenors to ihtrheoaymp si oncttcinsisaorvo of haeepprirl esvssle ..i(e het oesn ni oyur r)esmtxeieti in na fetfor to eekp ouyr core doyb eertautrmep nlmra,o nad hust uyro asrnog nonigincftu elpprory. lPreeiarph sirtVcoocnaisnto lliw csaeenir BVC. rsdecenaI BVC illw euacs na eaircnse ni oa,perdl nda hsut suace na nraeeisc ni A/BNPPN. PNP/BAN sha bnrihtoiyi sfcetef no eht desennetol-noiRnnistoAgreA-in Stemy,s guelsntir ni aerdseecd HDA.

gokings2021  RAAS is not directly linked secretion of ADH as claimed above. Increased pressure at baroreceptors and increased central volume sensed by the hypothalamus will decrease secretion of ADH. +5
miniarnie89  another way to think about it is central vs peripheral blood. peripheral is now being vasoconstricted, so central things (heart, lungs, KIDNEYS...) will be receiving more blood. more blood in kidneys = less ADH +1
jurrutia  The excretion of free water also has an adaptive benefit in hypothermia (less mass for your body to keep warm). +
... usmleuser007 made a comment on nbme22/block3/q#45 (A 28-year-old man who is seropositive for HIV has...)
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my ltis fo nilsepd teyp llces dna :ooidntnics

  • .a -NF1
  • .b 2N-F ~ nSohaanmwc nniAt(o A) = noueCtaus airmoubeonrf ~ hghi cuytaerllil (/w lsipadngai rpttanse ithw snipgreisnrte ceenlaef-rur osenz daopVr&elsc;nybcale deoibs
  • .c mymeaoiLo uuest(r mp;&a p)osegusah
  • .d alhesMiemoto aietcno(tkyr i)stipvoe
  • e. lAaaciptsn hidroTy cancer ipi(hbcsa mpa&; gnaol thiw antgi l)lcse
  • .f relyMudla hToiryd erccan n(ca salo hvea oglnypola c)lsle
  • .g ayirmPr rciadac gsacairnoamo mn(latgain cvsrlaua nilpdes cles)l
  • h. rossOmctaaoe nbe(o )acnrce erloipcomh(p cs)lel
  • i. oigMeaninm
  • j. 'isKpoas amraocS 8V(-H)H = -tlekiSil alscruva asscep ithw pulmp pel-pehssadind mtsoarl lelcs
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +2
mcl  I love this and I love you +10
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +
... hayayah made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +22 
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ihTs si a pneitat ecas of samtuptpro ttsyhi.idiro Cna aesir pu to a aeyr efart leevdiry adn sah lhciyptymco rfitai.entl

almondbreeze  FA 2019 pg 338 +1
waterloo  Although history seems to point towards that, she has an enlarged thyroid, and in postpartum thyroiditis, thyroid usually normal in size (from FA). regardless either would have lymphocytes infiltrating. +
... keyseph made a comment on nbme22/block4/q#50 (A 31-year-old woman in the second trimester of...)
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uJts ym wot :etscn soybtolCotpa,hrt yapmrir smet si,lvlu osrloybh,yntitctoasp and asoipbttrlcho anuelca rea lla oonmsencpt of teh goiepledvn naeptalc, cihhw sispuelp het fstue ni eotru. sheeT rtsecrsutu ear lal divered omfr het tbrpolasht,o wihhc si eocsddenir oicrnm-xerbaety siteus. ticetoiaomep"H semt c"lsel is hte lony wansre ochiec htta wlodu ieiacndt laeft rspta reew e.fomrd

hlulgneoypautouhtm.adosewe.o/.rdtyy/.bsp/:oysmmlnT/p/erdehg.oxpbbir

... imgdoc made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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I tihnk oalt of oeplpe thimg vahe orev hemiesdazp hwo mioatnrpt NPA adn NPB relyla a,er eys it si marotptni ot owkn eseht eetsdpip get teceesdr by eth ltuaeanlrai/cvrtri ocmdyauimr ugdrni thrae aefrliu. ewvHreo ihetr ravleol eifnteecessfv ni agentrit hrtae aefilru si hilz,c a roerpcetp todl em htta fi NAP nda NPB rewe so luefsu in sitrnruaeis hten wyh do we iveg ?sriuceidt I'st usbeace SAAR epovwrrsoe isth eymtss ehenc cignsua ianegvet eftscef dan hte edlsens pool of threa rfae.lui AAK yhw ew veig ECA nbiohiitr.s

iKnwgno taht NPA gest etdalrnieuz by het AARS eyts,ms ew acn htfsi oru sufco bcka to hraet ilauefr ni tsih te,aipnt ehwer cdcraia tpoutu is deserca,de dngeial ot DAH nreesciot nda niyfall ldaioutlin ariyh.tenopma

almondbreeze  a concept continuously emphasized by uw, but I get always wrong :'( +2
almondbreeze  good work done! +
raffff  why does the body make anp at all since its so useless +3
makinallkindzofgainz  @raffff - at least BNP gives us a good marker for heart failure exacerbations :) thanks body! +
mannan  Yeah it's important clinically because it has a high sensitivity (if negative, rule out) for Heart failure. +
alimd  At the same time ANP inhibits renin release? +
... moloko270 made a comment on nbme22/block1/q#30 (A 42-year-old woman is brought to the emergency...)
 +18 
submitted by moloko270(69)
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FA p54.7 - nbrguni rruebb sellm toihnuacnalil cucsro sa an aura ofr rolteamp eolb spyleeip

... moloko270 made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
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slos of lfdiu gisegrtr adnesolreot otc,durnopi os tapinte wlli vahe yaatnhermperi nda hilpymaokea as a reslut

makinallkindzofgainz  dat RAAS +4
... keycompany made a comment on nbme22/block1/q#35 (A 35-year-old man is brought to the hospital after a...)
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tartnAoeil fo eth orchiastmtet set iptno is a oaahctphymli espsrco diteedma by rnnpssldoagait dna si npedndineet of het tmpsiyceaht urvsoen yesmts.

,B C, ,D and E lla eeirruq hapytmseict eenrvs ot lltiiec a ponesres.

pg32  Can anyone explain the mechanism behind shivering and the sympathetic nervous system? +2
... mcl made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
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ietpesD a eniucmr velua boo(dl pesrseu)r eibng reuda,esm tpesiatn dlowu eb dsegnaedti eihret rehepyvstine ro ni.oeomsetrvn oT my nnrt,dunsiadge eth stbe estt orf gpcnirmoa aclgteaoric svralbeai scarso gsoupr is a ich esqrau tset.

nI aocsttrn, a t-stet is sdeu to meracpo etnweeb eht asnme of two gsroup sdeau(rem birlaave mstu be teaq.uttviina)

... adong made a comment on nbme22/block1/q#38 (A newborn born at 26 weeks' gestation has...)
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submitted by adong(102)
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yieltlral onwk evrey sliegn emna hyte cna ioblspsy alcl isht

djtallahassee  literally a new name every nbme +9
skonys  I just knew Dipalmitoylphosphatidylcholine because it was super long and I thought "these fucks will prob ask for the specific name" and then yolo'd on the lecithin part +
... drmohandes made a comment on nbme22/block3/q#15 (An 18-year-old man comes to the physician 10 days...)
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submitted by drmohandes(139)
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gerniF oixelnf neod by:

  • FDP = xlofre oidgirmtu unudfpsor fle(xes I)DP
  • FSD = rxefol goiimudtr cfiiiepurslsa xfelse( P)IP

_

nonearInt:vi

  • FDS 432/5// by deiman 1-CT)5(
  • DPF 3/2 by mienad (T1-5)C
  • PFD 4/5 by lurna 18-()CT

_

rOu ettnpia 'tcna lxfe DPI fo nigr riengf β†’ P4DF β†’ anlur β†’ 1TC8-.

lynO siobpesl rnasew ew acn kipc si 8.C

... bhangradoc made a comment on nbme22/block3/q#26 (A study is conducted to assess the extent of cardiac...)
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submitted by bhangradoc(23)
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Teh lP-uaev si llasbaciy type 1 err,ro dna hyte peek eht upelva- eth smae a(t )tl0&5.; ni bhot rvseions fo eth te.eprmsnixe yB enriisncga rmnbeu fo tiaetnsp ni the ugro,p tyeh ceairnse owrpe of eth udsyt, hhciw seucerd pety II .reror

jfny21  Thank you +1
baja_blast  For more, FA 2019 p. 262 goes over Type I and II errors. +
... keycompany made a comment on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
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Flow eRat = eoVitylc x roite-nossSaclC rAea

2 ^2cm x 20 cc/mes x 60 imens/c x 1 L000,/1 cm^3 = 42. /iLnm

0,010 c3m^ = 1 L

seagull  Well, I missed this one. I don't even feel bad. +71
link981  @keycompany a small typo, 100 cm^3 = 1 L not 1000cm^3. 1000 mL^3= 1 L +
hello  @keycompany how did you edit your original comment to fix your typo? +
winelover777  Pretty sure @keycompany was correct. 1 L = 1000 cm^3. Otherwise the answer would be 24. +3
drdoom  1 centimeter is a distance. (A line.) +
drdoom  If we multiply a line by another line, we get a surface area. (A piece of paper.) +
drdoom  If we multiply the piece of paper by another line, we get volume. (A cube. A box.) +
drdoom  If we fill the box with a fluid, we will have 1 mL of this fluid. +
drdoom  If we have a thousand of these boxes, we have 1 L of fluid. +
drdoom  1,ooo mL = 1 Liter = 1,ooo centimeterΒ³ +
... highyieldboardswards made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
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torSh nsrew:a All seeng aer ptseern ni hotb B dna T lcel,s utb they reeranrga and rpssxee prrecteos tath era cfeipsci to ierht .eeialgn rThie rae ndipendteen DJV oergnsi ofr B lcle ptcoerer eotneirgna dan T lelc rterocpe aroe!nneitg hsiT ikiw laiterc shdse lhtgi no :tshi

a_tseiTi/tblmJpci/sed.rowopt:ockkDhc)#V_rntar_ligep(w/nnroiieei.e/

I too cgaltrilya sdisem hts.i. tbu ti is altulcay so slpmei thta we ear ismgsin the eortsf uhotgrh the erest e-lW-hi boht B dna T llsec uogrnde DJV reg,entrmaearn the ,V D, nad J gnees ear ETEFRFIDN ESNGE sidepte niebg gzeodainr dna hrfroeeet fdlssieaic in a msialri niafosh due ot reith deshar deen ot eegarent esdrevi rcturet.sus oT ekam mtartse omer scongnif,u thob esst of VDJ enges are on cosmooremh 1.4

Tshi is why het MENB cifsediep ttah htey era gingtag THE SEMA J GIORNE chhwi si ahtt fo eht B llec rerpotce egen J nre,goi not eht T lecl ctrpeoer eneg -btaeJ nreoig se(e iwki ct)rla.ie heT B ellc erprctoe egen si ont naerradrge ni a T e,cll if it saw, T eslcl lwoud aevh ibon!dtsiae

redstrat  This. So much this! +1
... mcl made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
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ehT iusoqnte is frgrieern ot eth shiaemxone wptaayh.

Cbmaraoly tshepopha dan neiraign rae eolnvvid ni hte auer lccey. oS si aymelangtualtte-c (GN)A (tegsearlu ndptrcooui fo aycolmabr hosthe.a)pp

... d_holles made a comment on nbme22/block1/q#15 (A 35-year-old woman has weakness and fever. When she...)
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loanjG serstess eht dasoBr vniggi teh alkueemi inseosuqt yaaw aesdb no teh age evngi ni teh uqsieont mess.t

LAL = 10-4

LAM = 13;9-5 90-54

LCL = 60+

LCM = -4905

-/fo/msd.su.c3utn.metesuljt0etaos3rna5r-hgdoehe0o/ikrn/6/nlot:psttda

impostersyndromel1000  thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +
hyperfukus  also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +3
... meningitis made a comment on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
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Tenrna setgsa tarts at TNE yersa dlo

etaSg : I

  • I si l,atf sa in ltaf h;tsec
  • I is noael, as ni no asxelu is.rah

atgeS II :2)( agest II rstsat at 11 yo/ II( ookl ilke 1)1

  • 2 lsabl t(rcutesali eenelmgr)nat
  • 2 hiras (buicp ahrsi won riaena)ppg
  • 2 esbrta sbud fmro

eagtS III :3() trsats at 13 o /y

  • fI uyo rttaeo 3, ti olkso lkie mlsal bsarste etrsB(a mdosnu ;mof)r
  • fI you qglgieus eht III ehty kloo klie rueac+oysclr ipcub ahir
  • edIcensra eispn ntlhge and zesi acn eb esedpenertr :by II -&;-tg III
    ro(yu psnie asw nhti II tbu now tis hckreti I)II

aStge VI :4() srtsat ta 14 oy/

  • triFs :igaeinm eTh I ni IV eepstersnr eth htih,g nad eth V in VI skolo lkei eth mnso ispub eeebnwt ryuo :slge
    :E ANNMGI you heva hrai ni onsm psubi )V( utb uyo heav a rdorbe andegtini hte ihar rfom wnioggr otni thshig.
  • hTe V si ,niotyp sa ni nwo hte tsasebr aer pitnoy (sdaeir aaeorl or unomd on umdn)o

tSaeg V (5:) 15 oy/

  • V has on rdbores itgaednni hira omrf riggnow toni ghshit (bipcu iarh + hgiht arih)
  • 5 eg(ssfanri ni nhdas) enatinlgtf eth earoasl ehwn bnrbgiga mhte (aearlo ealfntt at htsi estga nda on eomr "noumd no mu"d)on

meningitis  Sorry about the format, it came out wrong but I hope his helps. +1
drdoom  looks good to me! +20
gh889  According to FA2019, stage 2 ends at 11, stage 3 starts 11.5-13, and stage 4 starts at 13-15, where did you get your info from? +
meningitis  You can change it to ENDS at 11, ENDS at 13, ENDS at 14... I simply have it as a range just like you stated in a couple of them. The importance is in how the kid presents because he/she will have some things mature but others not, the age will vary in questions. +
endochondral1  stage 3 breast mound is for females not males btw +3
endochondral1  see pg. 635 in FA it just pubertal. Idk if that correlates to the same stage as females +
angelaq11  this is just too funny, I LOVE it! xD +3
snripper  While this is impressive, this doesn't help with answering the question. +1
yng  Pseudogynecomastia (False gynecomastia): this has nothing to do with puberty or hormones. Simple d/t the fast some guys have extra fat in chest area, making it look like they have breasts. The boy weight at 60 percentile while height at 50 percentile. +
... liverdietrying made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
 +15 
submitted by liverdietrying(103)
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dooG fcat ot tcimom ot m:ermoy uoy eosl bcriba ni the ostol che(en hyw raihaerd suaces nnoninoa pag eltcobima s)dcio,ias nad yepaslecli oels tiamssoup hitw vxileaat sueab s(a tdneoimne ni eth niqtuseo )esmt. earddpatcoh-rt/o..tlina:obtnynsass-ewibeacwim-tie//pswdt--wmttcdh-tlctauoireo/ehrlaenae

sbryant6  I'm going to go take a big bicarbonate poop now. +27
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse β€” Metabolic Alkalosis : Β  ↓K+ Β  Β  ↑Cl- Β  Β  Β  Β  Β  Β  Β  Β  Β  ↑pH Β   ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +2
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1
texasdude4  easy way to remember : "Bicarb out the Butt" +1
... ilikecheese made a comment on nbme22/block3/q#14 (A 57-year-old woman comes to the physician 2 weeks...)
 +15 
submitted by ilikecheese(47)
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fI ouy watn ot tnkih of sthi yp,lmis eht irsb aer ocdeentnc rorptiosyel ot eth arbevtrel luncmo. nad the asitlrtocen sinve nru neebwte ,hmet os yteh rea the cloests to eht beatrrlve lomcun.

... moloko270 made a comment on nbme22/block3/q#18 (An 85-year-old woman is diagnosed with a fracture of...)
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ireMponh si odtezilbame in teh ievlr to irphe-orucngnomu6lied- nda om,ulnro3gunehc-ir-pied tbho fo ihwch aer eecdertx by the .dienksy In hte nittgse of elrna iu,eflar tsehe lietmbtosae acn mla,cucutae tsgrlunie ni a woeinlgr of teh zirusee .dtroheshl Mnperioh hsdulo efeheortr eb used with aucntio hitw imdl rlaen nmriimetpa nda eb dadvieo in the tisetgn of eanrl luie.afr

eous:rc cne/ttl:lcemirpc--ew-oioh-crwriataep/ogpsnaachc.o6tulhssaixngttdcdwumiyeopnuoeolcgmccmo/cy-ind/-rres/i.haepico

tyhe eagv a tnhi fo rsaendeci atnierneic l,eevl pusl eldor gea nac geiv a oeswld odwn moebtsimla adn NCS stospmmy

... bubbles made a comment on nbme22/block3/q#42 (A 62-year-old man comes to the physician for a...)
 +15 
submitted by bubbles(72)
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rChionc lrean fycsien:ciifun

)1 opro tpopaehsh caareencl g-&t;- gihh seurm niroiacgn spoorsohpuh

)2 ghih rumes phspehoat gt&--; cmlpseoxe whit nedvtila ictoan aC t&--g; aC lflas

3) aC alsfl -&t;-g ritsegrg HPT isax

4) kyedni arfeiul g-&;t- redcdeaes ctvayiti of ryal1yxes-ohd at teh iedkyn -&-;tg sles toclarlici

makinallkindzofgainz  this guy renals +6
paperbackwriter  Someone please help me with this (always trips me up): PTH causes increased vit D production in kidney... are we assuming the increased PTH can't catch up with the kidney failure? Is it the level prior to PTH compensation that they want? D: +
miriamp3  @paperbackwriter what it works for me ;;;; is find the first abnormality so CKD low calcitriol (no D vit) ---> is gonna increase PTH ---> the kidney are not working (chronic, they don't tell u recently- you can;t revert a CKD so the kidney never going to catch up) --> increase inorganic phosphorus.--> always start with the problem. I also use this for celiac and types of shocks. start with the problem, and trust yourself. +3
paperbackwriter  @miriamp3 thank you! I will try out your strategy next time!! :) +1
snripper  I thought renal insufficiency -> inability to reabsorb phosphate at PCT -> decreased phosphate? +2
skonys  Can someone explain why calitriol is low? Is it just that his kidneys are fucked and he can't make it? So PTH is increasing to try to lower the phos and raise the vit d but the kidneys are like "lol, I can't" +
... d_holles made a comment on nbme22/block3/q#44 (A 35-year-old man comes to the physician because of...)
 +15 
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aDnm I flee liek ENMB ucikgnf loves secsbia ro msoe h.sti

... btl_nyc made a comment on nbme22/block4/q#35 (Nicotinic acid acts at which of the following...)
 +15 
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:A mircnlsrohtaeey adn roeth ielb cida nesrsi tenpevr eth rtuaekep of eibl iascd orfm eht ug.t

B: Ssnttai iinbhti G-AoMCH ueet,asrcd gvnepirtne hte erliv form mkgnia acnmvolei dica, a srorpruec to lcolseero.th

:C ciiNan iniocitn(c aicd) seuercd tphecai LDLV sstisheny dan also nsitbhii oisilslpy ni sdpaieo sestiu yb tbnhiginii moehonr eivetnssi a.lesip

;aD&E:mp retiFbas eeuurtalgp ionolpetpri ieplas )L,(LP enigrincsa yegtilirrcde ecclrnaea LV(LD nda inhmolocrysc are lulf of )ytilgceersdri nda sloa aeactvit sorxeempoi dt-ceirfatlreaivoroatp prorecet- ahlpa A-pRaa(PPh)l ot undiec DLH n.sthsiyse

... keycompany made a comment on nbme22/block1/q#33 (A 32-year-old woman begins to hyperventilate and...)
 +14 
submitted by keycompany(317)
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tveenlyroHtipnia creeedas 2OPaC. nCealrt mrooecprchtees dorpsen ot low CaOP2 by nirtoissogcacntv ralbeecr obdol sleevss.

A) rratAile odlBo gOenyx ionetCconntar: loBod Onyegx noaotterninCc si tlcredyi aletred to Hb enninrtatcooc and tnirstoaua 2aO(S) 1F209,A .p 365. aiV eht hoBr tEecff, ereesacdd aP2CO illw eceinsar aOS2, htsu cgrnnaiise odblo ngxoey ncc.ttoernonai

B) etlriAar dooBl 2OP: 2OPa hesancg in oneerssp to reeedascd P,AO2 O,2PI or ffisnuo.id Trhee uolwd eb on naghec in 2PaO idrugn ailnyeneipovhttr etiey.lco(rlt)ah

C) ltierAa sseuPrer: adDseecre OaP2C si aasoidsetc wiht cvsrtsiont,oaonic cwhih wdoul eaisrecn bldoo upr.srese

)E rebCarle siuTse Hp wodlu aenicres due to itysrrreaop ka.loasisl

keycompany  EDIT: Via the **Haldane Effect**, not the Bohr Effect. +
impostersyndromel1000  excellent response +
teepot123  fa 19 pg 489 +
... d_holles made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
 +14 
submitted by d_holles(198)
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I got tish eno iav osecpsr of ielto.nminai Nto sure ohw yuo aer ouppsdse ot rermbmee lal htat i.hts

... armymed88 made a comment on nbme22/block2/q#32 (A 54-year-old man who works in a delicatessen comes...)
 +14 
submitted by armymed88(46)
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fO etehs noisopt ael,vlibaa nhwaSnc llesc wdlou eb eth oynl elcls enspetr ni the .PNS cArsoty tse, licriaogm dan ioolgs rae lla NCS elscl ilate elSt escll rea ni eth eulsmc nad eresv ot ida in mulsec eraipr adn entreogeiran

yb_26  Thats myosatellite cells. Satellite cells are also glial cells that form around damaged nerve cells and lie close to neuron bodies in the CNS +16
drzed  Myosatellite cells are also called satellite cells so it is not clear which definition they were using. +2
... drzed made a comment on nbme22/block3/q#50 (A 56-year-old woman is brought to the emergency...)
 +14 
submitted by drzed(255)
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m'I a islepm m,an I see ecilnishptae adn opmreatl leob notmienlv,v I kiccl esreh.p

asharm10  hahaha true that, overthinking is the reason for getting so many questions wrong +
... bubbles made a comment on nbme22/block4/q#47 (A 56-year-old woman comes to the physician for a...)
 +14 
submitted by bubbles(72)
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astmeneB enrebmam tygeitinr si het anetreitmdn fo lful ulgn ycrroeve logwloinf uaolmpryn siultn.

mury:Sam

(1) lsso of astbenme arnemmeb gyttriein si itrialcc ni erdtmiegnni hte β€œtniop fo no n,trer”u and sbicrttoenu to het tibiinaly to ltrebssaihe namrol ulng cerahtrceuit wtih tpiooonmr of s;oirfbsi

)2( sosl fo ehtillpeai llecs, lnoleihadte elsl,c dna nmaetbes nerbmmea inregtity ni ulsua instlitetair meaionnpu adocseista hitw taipidhoci numarpyol srfiobsi salde ot drysetdoe nlgu ceertarchuit nad pealeuprt frbioss;i

3)( sfrtagrnnmoi grthwo oarf-ctΞ² si ,canseyesr utb ont ltreiyen netsc,iifuf ot oertmpo nmtreenpa fbs;irois

4)( itpnseerts ain/n/gttuynrrrtjiienai si caictrli rof the ianagopptor fo s;ofrsbii

5)( aiocidipth arylmunpo rbiosfis is na lmeaxpe of a orecsps elardet to eth nceispretse fo na (engsni)”taβ€œ, ocncrih atfmaoiin,mnl nad rifosib;s adn

)6( quunei slecl are tcrciali ceualrll plaryes in het uoitraenlg of riobssfi.

ac:on tiit.t4lwilpnm/cn/w/1taoi.s2v.cmiw:.6ts4p5hgcheC/r//2PMbn

endochondral1  any FA or pathoma or uworld correlation? +
endochondral1  or was this a random? +
taediggity  Type II pneumocytes serve as the stem cell precursors, w/out those you're more or less fucked: FA 2020 pg 661 +4
... humble_station made a comment on nbme22/block2/q#1 (A 29-year-old woman is brought to the emergency...)
 +13 
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isTh is nhaoret siuqoent tnsgite teh tpoccen fo apaltsi ayaotm.n If het gnoerus is ntligfi eth lvrei dan ehnt teh eedlb nwte omrf a samll numtao to a endusd saisevm ,ehhoemgrar yallcre htis is ilyigpnm eht elbed is ccniuorg dhbeni the revi.l

htaW utrtcsuer si inedhb het rvel?i VIC

aWht oennctcs ot the VCI form hte ?ievrl Hieptac veins

lAso teh ieda atth teh nteapti ash eneb lbeniedg rof 6 rusho sbeeacu attsh owh nglo ti ookt utnil the etaxrrypool otlpayamar asw rmeofedrp mnesa eth lbede si tosm leykil orfm a owl espuersr s...mytse uenvso etsms.y

... mattnatomy made a comment on nbme22/block4/q#35 (Nicotinic acid acts at which of the following...)
 +13 
submitted by mattnatomy(43)
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nwsrAe = C. (sceeDaerd acpihte LLVD iysshtnse)

ctnNiiioc acdi = iniacN. iniNca rwkso :by

  1. bitgnhiniI ysillopsi ohnmo(re nivistees lpsi)ea in iepdaso itess)u

  2. duRcngie eciahtp LVLD ynheissts

johnthurtjr  Well color me surprised. I was completely thrown off here. +34
miriamp3  @almondbreeze go to the cardiovascular pharmacology you will see a draw of lipid lowering agents and you will find niacin en two places ++one on the adipose tissue and the second one in the liver by the vldl production. in the text in the same page is also mention it FA 2018 pg 313. +
djeffs1  I still don't quite see how C corresponds to those 2 processes... +
... upstairs_bumblebee made a comment on nbme22/block1/q#3 (Parenterally administered cholera vaccines...)
 +12 
submitted by upstairs_bumblebee(28)
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eTh otnqseui assk baout raetraplen nrmdniaitsatoi of teh acinvce (e,ninmga tno isgnu the arlo truoe.) roNaol-n saveicnc will tno ntygsolr teciil AgI rs.esnpoe lr-noNao vicaescn ont supre uhllefp ni tcomngbia a tug scuomal neciftoin chus as V. oerchla, weher AIg is omre .ieanlst toN rseu if tish si hte altcau rtcroec gner,nosai btu ti del ot the gihrt .nasrew

aesalmon  I totally skipped over the word "parentally" when taking this - ugh! +19
... dr.xx made a comment on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
 +12 
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lrtaeubP eatgcaominys si ouhhttg to be a lilohaipysgco h,omnneoenp nad si omst lonycmmo snee in muiteprybd hwit arTnne sgeta 3–4 ipcub hira nda itlatsercu louvmse fo 5 to 10 Lm laitl.laeryb

twsm/p7.tm/i/rb5vl0n.t0he4Psnwgc/w.co:h/l3Cai/pnMc.6i

... welpdedelp made a comment on nbme22/block1/q#22 (A previously healthy 6-year-old boy is brought to...)
 +12 
submitted by welpdedelp(242)
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tI swa isacsbe, wchih is asetirmttnd ro-pspenneroo.

welpdedelp  **person-person lol +6
suckitnbme  NBME loves their scabies +16
dentist  did you get scabies from "burrows" and "night itching" +
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +
zevvyt  to summarize leafhouse: Fomites +1
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +