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NBME 22 Answers

RAAS
Block/Question (96.9 difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretionπŸ”

Block/Question (50.4 difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDLπŸ”

Block/Question (32.8 difficulty score)
Parenterally administered cholera vaccines ...
Inability of the vaccine to elicit secretory antibody at the epithelial surfaceπŸ”

Block/Question (43.7 difficulty score)
A 48-year-old man begins furosemide therapy ...
Decreases the luminal permeability to Na+ in the collecting ductπŸ”

Block/Question (26.2 difficulty score)
A 10-month-old girl is brought to the ...
NaloxoneπŸ”

Block/Question (25.7 difficulty score)
A 2-month-old boy is brought to the physician ...
Human papillomavirusπŸ”

Block/Question (34.0 difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading doseπŸ”

Block/Question (33.3 difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical ribπŸ”

Block/Question (53.9 difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4πŸ”

Block/Question (17.4 difficulty score)
A 25-year-old woman is admitted to the ...
Streptococcus pneumoniaeπŸ”

Block/Question (26.5 difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradationπŸ”

Block/Question (16.8 difficulty score)
During the first week of life, a male newborn ...
21-HydroxylaseπŸ”

Block/Question (20.0 difficulty score)
A 13-year-old girl is brought to the ...
Ask the mother to leave the room before asking the patient any questionsπŸ”

Block/Question (10.9 difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgiaπŸ”

Block/Question (51.2 difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemiaπŸ”

Block/Question (33.4 difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negativeπŸ”

Block/Question (48.0 difficulty score)
A 27-year-old man is brought to the emergency ...
EversionπŸ”

Block/Question (40.6 difficulty score)
A 13-year-old boy is brought to the physician ...
ReassuranceπŸ”

Block/Question (23.5 difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcomaπŸ”

Block/Question (58.2 difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosisπŸ”

Block/Question (33.4 difficulty score)
A 30-year-old man comes to the physician ...
PolycystinπŸ”

Block/Question (27.7 difficulty score)
A previously healthy 6-year-old boy is ...
Does anyone else in the family have an itchy rash like this?πŸ”

Block/Question (32.6 difficulty score)
A patient in the early stages of hemorrhagic ...
A weak pulse due to decreased stroke volumeπŸ”

Block/Question (35.3 difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular arteryπŸ”


Block/Question (39.5 difficulty score)
A 42-year-old man comes to the physician ...
HydrochlorothiazideπŸ”

Block/Question (14.9 difficulty score)
During a clinical study, 15 patients with ...
AzathioprineπŸ”

Block/Question (29.9 difficulty score)
A 48-year-old man comes to the physician ...
Transferrin saturation and serum ferritin measurementsπŸ”

Block/Question (55.0 difficulty score)
A 28-year-old man comes to the emergency ...
JejunumπŸ”

Block/Question (33.2 difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobeπŸ”

Block/Question (25.5 difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancerπŸ”

Block/Question (53.1 difficulty score)
A 17-year-old boy is brought to the emergency ...
HypokalemiaπŸ”

Block/Question (27.9 difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flowπŸ”

Block/Question (22.4 difficulty score)
A 15-year-old girl is brought to the ...
First-degree burnπŸ”

Block/Question (53.4 difficulty score)
A 35-year-old man is brought to the hospital ...
Alteration of the thermostatic set pointπŸ”

Block/Question (17.3 difficulty score)
A 67-year-old woman comes to the physician ...
Idiopathic pulmonary fibrosisπŸ”

Block/Question (59.1 difficulty score)
A 28-year-old woman is brought to the ...
Area labeled β€˜C’ (Abducens nucleus, right)πŸ”

Block/Question (25.8 difficulty score)
A newborn born at 26 weeks' gestation has ...
Dipalmitoyl lecithinπŸ”

Block/Question (19.9 difficulty score)
A 23-year-old woman develops multiple red, ...
Processing of antigen by Langerhans cells, leading to activation of CD4+ T cellsπŸ”

Block/Question (28.3 difficulty score)
A 45-year-old man with chronic pancreatitis ...
PancrelipaseπŸ”

Block/Question (39.4 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitusπŸ”

Block/Question (23.2 difficulty score)
An 18-year-old woman develops sepsis after an ...
Decreased plasma fibrinogen concentrationπŸ”

Block/Question (22.4 difficulty score)
A 13-year-old girl is brought to the ...
C1 inhibitorπŸ”

Block/Question (41.2 difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectalπŸ”

Block/Question (57.9 difficulty score)
A 16-year-old girl is brought to the ...
DiureticsπŸ”

Block/Question (20.8 difficulty score)
A 12-year-old girl is referred to the ...
Conversion disorderπŸ”

Block/Question (26.7 difficulty score)
A 25-year-old woman comes to the physician ...
Immune thrombocytopenic purpuraπŸ”

Block/Question (37.1 difficulty score)
A 1-year-old boy is found to have an ...
Staphylococcus aureusπŸ”

Block/Question (24.0 difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
AzithromycinπŸ”

Block/Question (32.6 difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structureπŸ”

Block/Question (53.1 difficulty score)
A 29-year-old woman is brought to the ...
Avulsion of hepatic veins from the inferior vena cavaπŸ”

Block/Question (14.9 difficulty score)
A 65-year-old man starts using topical ...
Thymidylate synthaseπŸ”

Block/Question (22.9 difficulty score)
A previously healthy 28-year-old man comes to ...
NephrolithiasisπŸ”

Block/Question (27.6 difficulty score)
A previously healthy 60-year-old woman is ...
Increased central venous pressureπŸ”

Block/Question (40.7 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balanceπŸ”

Block/Question (38.2 difficulty score)
A 52-year-old man is brought to the emergency ...
4 MonthsπŸ”

erections libido penis
Block/Question (65.8 difficulty score)
A 66-year-old man comes to the physician ...
Libido: decreased;
Nocturnal erections: normal
πŸ”


Block/Question (36.9 difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled β€˜Eβ€™πŸ”

immuno abo_incompatibility complement
Block/Question (38.8 difficulty score)
A 26-year-old woman develops hypotension and ...
Antibody, complement C5-9πŸ”

erections penis
Block/Question (28.0 difficulty score)
A 56-year-old man with a palpable hard nodule ...
Pelvic parasympathetic nervesπŸ”

anatomy
Block/Question (62.1 difficulty score)
A 52-year-old man comes to the physician ...
Sensation from the anterior surface of the scrotumπŸ”

cAMP
Block/Question (22.9 difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMPπŸ”

Block/Question (25.6 difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocoliticaπŸ”

Block/Question (36.2 difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodiumπŸ”

Block/Question (41.3 difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breastπŸ”

Block/Question (21.6 difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinomaπŸ”

Block/Question (16.3 difficulty score)
Ten healthy human subjects are given a new ...
Phase 1πŸ”

Block/Question (23.5 difficulty score)
A 32-year-old man comes to the physician ...
Reverse transcriptaseπŸ”

Block/Question (24.9 difficulty score)
A 50-year-old man comes to the physician 3 ...
CalciumπŸ”

Block/Question (19.0 difficulty score)
A 26-year-old nulligravid woman comes to the ...
HypothalamusπŸ”

Block/Question (25.6 difficulty score)
A newborn has cyanosis, tachypnea, and ...
Respiratory acidosis and metabolic acidosisπŸ”

Block/Question (47.3 difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclaseπŸ”

Block/Question (34.9 difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bugπŸ”

Block/Question (20.6 difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failureπŸ”

Block/Question (39.3 difficulty score)
A 37-year-old woman undergoes excision of a ...
AngiogenesisπŸ”

Block/Question (12.8 difficulty score)
A randomized controlled trial is conducted to ...
(194/2371) – (123/2365)πŸ”

Block/Question (30.7 difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3βˆ’πŸ”

Block/Question (18.5 difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibialπŸ”

Block/Question (23.6 difficulty score)
A 79-year-old man is brought to the emergency ...
Insertion of transvenous pacemakerπŸ”

Block/Question (27.4 difficulty score)
A 40-year-old woman comes to the physician ...
MultifactorialπŸ”

Block/Question (42.7 difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variationπŸ”

Block/Question (50.7 difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cellsπŸ”

Block/Question (29.8 difficulty score)
A 29-year-old woman comes to the physician ...
Thyroid-stimulating hormone: decreased;
Free thyroxine: decreased;
Free triiodothyronine: increased
πŸ”


Block/Question (50.7 difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600πŸ”

Block/Question (57.6 difficulty score)
A 45-year-old man with Li-Fraumeni syndrome ...
Decreased binding of RNA polymeraseπŸ”

Block/Question (36.2 difficulty score)
Which of the following drug effects is the ...
AnticholinergicπŸ”

Block/Question (50.4 difficulty score)
A 63-year-old man has had progressive ...
Area labeled β€˜Dβ€™πŸ”

Block/Question (28.6 difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medullaπŸ”

Block/Question (24.1 difficulty score)
A 22-year-old woman comes to the office ...
CardiomyopathyπŸ”

Block/Question (25.1 difficulty score)
A previously healthy 7-year-old girl is ...
Serum potassium concentrationπŸ”


Block/Question (23.2 difficulty score)
A 75-year-old woman has taken 12 ...
Plasma renin activityπŸ”

Block/Question (33.2 difficulty score)
A 20-year-old man comes to the physician ...
Area labeled β€˜Cβ€™πŸ”

Block/Question (17.1 difficulty score)
A 3-day-old full-term male newborn is brought ...
Hepatic UDP-glucuronosyltransferase activityπŸ”

Block/Question (48.2 difficulty score)
An 86-year-old man who lives in a skilled ...
DextromethorphanπŸ”

Block/Question (37.9 difficulty score)
A 62-year-old man is being evaluated for ...
Greater mucosal surface areaπŸ”

Block/Question (13.9 difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndromeπŸ”

Block/Question (14.0 difficulty score)
Clostridium perfringens-Ξ± toxin affects cells ...
Splitting lecithin to phosphorylcholine and diglycerideπŸ”

Block/Question (8.1 difficulty score)
A physician is unable to communicate "bad ...
CountertransferenceπŸ”

Block/Question (35.5 difficulty score)
An 18-month-old boy is admitted to the ...
Tuberous sclerosis complexπŸ”

Block/Question (67.3 difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve rootπŸ”

Block/Question (27.3 difficulty score)
A 30-year-old man is brought to the emergency ...
Increased serum angiotensin II concentrationπŸ”

Block/Question (25.5 difficulty score)
An obese 45-year-old woman with type 2 ...
DiarrheaπŸ”

Block/Question (47.7 difficulty score)
A 29-year-old woman has an inflammatory ...
Immune complex-mediated cytotoxicityπŸ”

Block/Question (64.1 difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin geneπŸ”

Block/Question (41.8 difficulty score)
A 50-year-old man is admitted to the hospital ...
Intracellular [Na+]: increased;
Intracellular [K+]: decreased;
Intracellular [Ca2+]: increased
πŸ”


Block/Question (12.2 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”

Block/Question (39.1 difficulty score)
A 38-year-old man who lives at sea level ...
pH: increased;
HCO3-: increased;
Volume: increased
πŸ”


Block/Question (57.1 difficulty score)
Microelectrode injection of antibodies to ...
Area labeled β€˜Cβ€™πŸ”

Block/Question (17.0 difficulty score)
A 50-year-old man comes to the physician for ...
Yes; the patient may wish to consider the money's influence on the physician's recommendationπŸ”

Block/Question (16.9 difficulty score)
A 38-year-old man with Down syndrome is ...
Contact adult protective servicesπŸ”

Block/Question (29.0 difficulty score)
An 82-year-old woman has been bedridden since ...
Carboxylation of precursor proteinsπŸ”

Block/Question (30.7 difficulty score)
A previously healthy 26-year-old woman comes ...
Acute retroviral infectionπŸ”

Block/Question (49.1 difficulty score)
A 57-year-old woman comes to the physician 2 ...
IntercostalπŸ”

Block/Question (46.6 difficulty score)
An 18-year-old man comes to the physician 10 ...
C8πŸ”

Block/Question (37.3 difficulty score)
A 27-year-old woman comes to the physician ...
Antiphospholipid antibodiesπŸ”

Block/Question (19.1 difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pyloriπŸ”

Block/Question (38.8 difficulty score)
An 85-year-old woman is diagnosed with a ...
Morphine is metabolized to active metabolites that accumulateπŸ”

Block/Question (39.8 difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathyπŸ”

Block/Question (48.9 difficulty score)
A 43-year-old man is brought to the emergency ...
Fibularis (peroneus) brevisπŸ”

Block/Question (42.0 difficulty score)
A screening test for cancer is developed and ...
Data point labeled β€˜Aβ€™πŸ”

Block/Question (43.1 difficulty score)
A study is conducted to assess the prevalence ...
Chi-square testπŸ”

Block/Question (45.5 difficulty score)
A 45-year-old woman comes to the physician ...
25%πŸ”

Block/Question (35.0 difficulty score)
An 84-year-old woman comes to the physician ...
Downregulation of E-cadherinπŸ”

Block/Question (31.7 difficulty score)
A 3-month-old girl is brought to the ...
Motor: normal;
Social: delayed;
Verbal and cognitive: delayed
πŸ”


Block/Question (34.2 difficulty score)
A study is conducted to assess the extent of ...
Type I error: No change;
Type II error: decreased
πŸ”


Block/Question (18.7 difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalisπŸ”

Block/Question (21.3 difficulty score)
A 12-year-old girl who recently immigrated to ...
PraziquantelπŸ”

Block/Question (45.2 difficulty score)
A 45-year-old man with end-stage renal ...
BicarbonateπŸ”

Block/Question (81.6 difficulty score)
Which of the following is required for the ...
GlutamineπŸ”

Block/Question (24.9 difficulty score)
A 35-year-old man is admitted to the hospital ...
Absorption of nitrogenous products from the gastrointestinal tractπŸ”

Block/Question (26.1 difficulty score)
A 25-year-old woman comes to the physician ...
Fasting insulin: increased;
Testosterone: increased;
Luteinizing hormone: increased
πŸ”


Block/Question (43.7 difficulty score)
A 22-year-old man comes to the physician ...
47,XXYπŸ”

Block/Question (28.0 difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control studyπŸ”

Block/Question (61.5 difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammationπŸ”

Block/Question (19.8 difficulty score)
A 62-year-old man comes to the physician's ...
Alternative treatmentsπŸ”

Block/Question (18.6 difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMPπŸ”

Block/Question (55.0 difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressureπŸ”

Block/Question (36.5 difficulty score)
A 52-year-old man with stable angina pectoris ...
HeadacheπŸ”

Block/Question (31.0 difficulty score)
A 49-year-old man has had the gradual onset ...
Essential thrombocythemiaπŸ”

Block/Question (32.9 difficulty score)
A 56-year-old man develops brief episodes of ...
CL x CssπŸ”

Block/Question (21.1 difficulty score)
A 62-year-old man comes to the physician for ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”


Block/Question (32.0 difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitisπŸ”

Block/Question (22.2 difficulty score)
A 35-year-old man comes to the physician ...
Prescribe permethrin for the patient and his familyπŸ”

Block/Question (55.3 difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cellsπŸ”

Block/Question (11.7 difficulty score)
A 54-year-old woman with hypertension and ...
Vasodilating prostaglandins at the afferent arterioleπŸ”

Block/Question (39.0 difficulty score)
A 10-year-old boy receives a renal transplant ...
Lymphocytes infiltrating tubular epitheliumπŸ”

Block/Question (25.1 difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobulinemiaπŸ”

Block/Question (24.7 difficulty score)
A 42-year-old man is brought to the emergency ...
Dopaminergic neurons in the substantia nigraπŸ”

Block/Question (20.0 difficulty score)
A 56-year-old woman is brought to the ...
Herpes encephalitisπŸ”

Block/Question (49.1 difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesentericπŸ”

Block/Question (32.5 difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
AcetaminophenπŸ”

Block/Question (26.9 difficulty score)
A 60-year-old man comes to the physician ...
Alveolar macrophageπŸ”

Block/Question (43.9 difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2OπŸ”

Block/Question (55.7 difficulty score)
A new virus has been isolated that causes ...
Single-stranded positive-senseπŸ”

Block/Question (16.9 difficulty score)
A population of vegetarians is surveyed to ...
t-TestπŸ”

Block/Question (28.3 difficulty score)
A 27-year-old man comes to the physician for ...
Ask the patient to identify the pros and cons of smoking cessationπŸ”

Block/Question (20.4 difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin EπŸ”

Block/Question (41.9 difficulty score)
A 5-year-old boy is brought to the physician ...
Interruption of erythrocyte productionπŸ”

Block/Question (47.7 difficulty score)
An 81-year-old man comes to the physician for ...
AtherosclerosisπŸ”

Block/Question (19.6 difficulty score)
A 26-year-old woman comes to the physician 5 ...
SertralineπŸ”

Block/Question (14.8 difficulty score)
A 73-year-old woman dies 7 years after the ...
Hydrocephalus ex vacuoπŸ”

Block/Question (16.0 difficulty score)
A 36-year-old woman comes to the physician ...
Cytosol with translocation into the nucleusπŸ”

Block/Question (45.1 difficulty score)
In patients with adenosine deaminase ...
Ribonucleotide reductaseπŸ”

Block/Question (59.0 difficulty score)
A 24-year-old woman, gravida 1, para 1, comes ...
Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytesπŸ”

Block/Question (29.1 difficulty score)
A 4-month-old boy is brought to the office by ...
Maxillary and medial nasal prominencesπŸ”

Block/Question (15.9 difficulty score)
A 62-year-old man with dyslipidemia is ...
GemfibrozilπŸ”

Block/Question (39.1 difficulty score)
A 10-year-old girl has a slightly painful ...
GranulomaπŸ”

Block/Question (39.6 difficulty score)
A 76-year-old man with a 1-month history of a ...
Anomalous origins of multiple renal arteries to each kidneyπŸ”

Block/Question (38.5 difficulty score)
During a study of symptomatic proximal deep ...
Open-label clinical trialπŸ”

Block/Question (17.6 difficulty score)
A previously healthy 45-year-old woman has ...
Thrombotic thrombocytopenic purpuraπŸ”

Block/Question (23.7 difficulty score)
A 37-year-old man comes to the physician for ...
Hyperplastic arteriolosclerosisπŸ”

Block/Question (19.3 difficulty score)
A 57-year-old woman comes to the office ...
Autoimmune downregulation of Ca2+ channels of the presynaptic terminalπŸ”

Block/Question (25.8 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-Ξ±πŸ”

Block/Question (25.4 difficulty score)
A healthy 25-year-old man eats a meal ...
Fusion of an intracellular vesicle with the plasma membraneπŸ”

Block/Question (36.4 difficulty score)
A 60-year-old woman comes to the physician ...
MeningiomaπŸ”

Block/Question (47.3 difficulty score)
A 78-year-old man comes to the physician ...
Metastatic carcinomaπŸ”

Block/Question (41.0 difficulty score)
A 48-year-old man comes to the emergency ...
Splenic veinπŸ”

Block/Question (25.7 difficulty score)
A 45-year-old man who is HIV positive comes ...
Disruption of the pathogen cell membraneπŸ”

Block/Question (39.0 difficulty score)
A 27-year-old man who is a construction ...
Splenic flexureπŸ”

Block/Question (31.6 difficulty score)
A 65-year-old man comes to the emergency ...
CracklesπŸ”

Block/Question (38.7 difficulty score)
A case-control study is conducted to assess ...
Cannot be determined from the data givenπŸ”

Block/Question (31.2 difficulty score)
A 38-year-old single woman with a history of ...
DisplacementπŸ”

Block/Question (17.3 difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyteπŸ”

Block/Question (42.1 difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜Cβ€™πŸ”

Block/Question (23.7 difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase responseπŸ”

Block/Question (40.3 difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophyπŸ”

Block/Question (23.2 difficulty score)
Patients with mucolipidosis II (I-cell ...
Secreted from the cellsπŸ”

Block/Question (38.9 difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cellsπŸ”

Block/Question (18.6 difficulty score)
A 5-year-old boy with mental retardation is ...
Maternal origin of both chromosomes 15πŸ”

Block/Question (28.6 difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4πŸ”

Block/Question (12.9 difficulty score)
A 31-year-old man comes to the physician ...
DihydrotestosteroneπŸ”

Block/Question (26.9 difficulty score)
A 44-year-old man comes to the physician ...
Tricuspid insufficiencyπŸ”

Block/Question (41.0 difficulty score)
A 10-year-old boy has bruised easily since ...
Prolonged prothrombin timeπŸ”

Block/Question (31.4 difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cellsπŸ”

Block/Question (59.7 difficulty score)
A 39-year-old woman comes to the physician ...
HemoglobinπŸ”

Block/Question (49.6 difficulty score)
A 56-year-old woman comes to the physician ...
Maintenance of basement membrane integrityπŸ”

Block/Question (36.2 difficulty score)
An 8-year-old boy is brought to the physician ...
Calorie consumption that exceeds energy expenditureπŸ”

Block/Question (20.9 difficulty score)
A 52-year-old man with metastatic oat cell ...
Ensure that the patient receives enough medication to control his painπŸ”

Block/Question (42.2 difficulty score)
A 31-year-old woman in the second trimester ...
Hematopoietic stem cellsπŸ”

Recent comments ...

... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +57 
submitted by seagull(1405)
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Ddi oanyne eden ot rade thta lsta stenecen iekl 05 tmise sacubee eht ruaoht fseuesr ot sue reetbt mmgaarr. utsJ tgiutfsanrr.

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +16
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) +
... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +55 
submitted by sacredazn(80)
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ehT tconcpe is a envootdulc ywa of skagni fi yuo ekwn how VDJ mbornteaioicn kosrw, hwcih is hatt ti si tyallcau an exlapem fo eatlginr het DNA of eht /BT mlyeyhp.otc

ohSrnuet otlb qc:iuthene So hewn htye use a epobr taasing smeo roegni, nad tgtponutiu a eisz of .15 kb or 6 b,k ihst is ielnltg ouy the zsei of eht NAD etamrfgn ni ehac llec ’(tsedno mattre if heyt ysa J repob or ntnocsta ogirne bpo,er ’ethyre sujt aisyng ’ehteyr ttgiagren mose nuetoieldc cqueeens dfnou ni het gI TRcsu/lCo taeb hanci ocusl seirepcyvtle rfo T/B )esllc.

I nkith teh souinncfg tapr clduo be odgnrienw owh you wnok hhetwre e’ryou rtyalp huhrtgo manrratngeere r(wnase shiecco B hrtu D) or if it ta’shn drucreoc ta lal yet orre(ctc nrea.ws) H,ere teh ocptecn si ahtt B leslc eodrgun V)(JD mnaeeangrretr in het obne mar,orw heilw T eslcl do it in eht ymut,sh adn it all hppnsae at e.noc oS a pamasl llec in eth ldboo ekil in illeMtpu omMaley wduol heva uflly egrundnoe natoricon,ebmi ihwle a T ecll in eth dobol ocdul rhteei eb fylul caetedud da(n ehav dfeiinsh JDV nmeo)atoricinb ro urmitame nsa’(th derstat .DV)J

enciS eht T ecll eegn saw 6 kb dan findetleiy giebrg hatn eht .51 kb nee,g teh T llce sa’tnh oreenudgn ncrtmioianobe eyt.

trichotillomaniac  very nice explanation! +26
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
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!! +
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +40 
submitted by seagull(1405)
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ichhW of teh fgonlliwo ssenaor is wyh iths utosniqe is ul?bl

)1 isnUg het wdor c"cclyi" iasnedt of cirlcticy ofr ayictrl

2) wingKno lla of eplgmoidoyei of lla surgd

)3 vanihg to osrane uto ttha ianilergcontchi ftecfes era lapbbryo eth trsow vero plaa1h ro 1H sefefct to no tnecr.itya

4) hTe plrpingci pdssoreine of tiuynsdg orf yoe--dskawset no den to obypalbr do ageevar on the ett.s

nlkrueger  yo, re-fucking-tweet +20
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. +
... liverdietrying made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +33 
submitted by liverdietrying(95)
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sihT oen aws a elltti kycrt.i oFr tihs neo hte eky is eth wol odniidieoar ape.ukt Thsi aitnpet sha gihh 4T and low HST hhciw ekmas nsees ni a tryiphyheord ti,nptea ashperp yuro first thugtoh si ahtt htsi anteitp ash rae’vsG dse.esia eewrvoH, ni Geasrv’ ouyr diyotrh si biegn ttdluemasi ot amek oerm hrtydio rnmhooe mrof chatsrc nda as uhcs wulod hvea an iedearcns iiooaidredn teupka eeaucbs eht royhtid si nriinbgg in het drieqreu (nwo lraeeidab)dlo edinio. iTsh si why it si otn rasGev r(laeβ€œese fo yrhdoit ehormon frmo a yhtrdio tdiltsameu by .oesni”a)bitd

oS if its ont a’rGves tawh udocl it be? roF iths uoyd’ eavh ot nwok tath toiosHhmas’ hiydsoiiTtr (laso knwon as ciCrhon tcocyiyLmhp iTiiyorthsd nda is ofetn erdererf to as shuc no orabd xmaes to otwrh you )fof has rteeh passeh - tsrif htey aer eyoyrdpti,hrh ethn di,eoyuthr hent eht ciclssa ydyoprhotih taht uyo ouwld tepxce tiwh lwo 4T nad hihg .HTS isTh saw eht eky to ihts inqo.uets Teh noesra rof sith si htta hittoaydinr eseapdorxi adbiesnito in stmHha’sooi secau eth tdyhrio ot eerasle all fo sti toersd hyirodt ohmrneo imkang teh tptaien hyrtyedrpohi rof a hosrt oidpre of eim.t fAret shti asvmsei serelae fo ihotryd ,roenmoh eth naiseobdti keam mteh ebanul to eamk new HT and fetrereoh tehy eceomb yodeiuhtr orf a htrso rdieop and ehnt ypitdhyoohr hcwih uyo dwuol xtpce!e enSic teyh nct’a emak ewn T,H hte droihty lliw nto ktae pu het eoniidaidro dan rothrfeee terhe lwli eb owl eoriidaindo aku.etp cee,Hn rsleaeeβ€œ of tdesor dtoryih ohrmone frmo a irhtdoy lgdan earitdlfint yb mlpsey”.tcoyh aak yycoLhmtβ€œicp ai)soohsmth( r.ioytids”hti

I hknit aβ€œreeesl of ihdotyr mnoheor rmof a osaulyophtmm ihordyt ”ndlga is rngrerefi ot mose idnk fo trdihyo encrca in wihch scae you louwd ceetpx hemt ot be icgsbnerid a ludeno on dorieioandi tepua.k

mmauSry​ ovdei eerh and asol a agrte stie ni arne:gle grncotes/op/i/nduera/ictredonsqphrod.tnei/dlei/hmye:a

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 +9
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...)
 +32 
submitted by mcl(579)
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hsiT eiamg si flsuu.e Ntoe tath eth santi euds akmes ienmyl rpepaa dk.ar

iVtneegt is ticlapy ofr oniask'Pnrs sesedai. reAa D is the tiausntbas nr.agi

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...)
 +30 
submitted by keycompany(296)
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Nneogtri aacbnle si a seutmenarem fo rptnoei leatmbsimo ni het .dyob A iaevnetg geonrtin bnalace tiedinacs lmsuec l,oss as seecnadir uasnmot fo namio dacsi era gneib taldozeebim to pdercou ygn.ere Tish eissrcean hte ntaoum fo nroteign etdrcees rmfo eht b.yod cBesaue eth oaumnt fo gintrnoe ouy era gnkait in si slse anth eht onautm of ontenigr yuo aer tesciegrn, oyu veha a nevgeiat egtnonir acleabn.

Tish nam si raumo,hlinsde outseem,ad ccch,teia nad has nhmuayiloeib.pam heseT lcailinc fsgnndii topin to piroent tniruailntmo kora(haKwsi )iaeDess, whchi usscea eadme deu ot deasceder esrum nicotoc surser.pe oLw ciotonc suresper ni tihs saec is ued ot roptnei os,sl adn enech a einvgate trnegion lc.ebaan

drdoom  Nice! +15
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 .. +3
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...)
 +30 
submitted by joha961(43)
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ikLe hrotes eavh asi,d I iktnh iisluabmnot woudl eavh eben ,bertte tub plendisetcma mfro trifs aid syas ahtt ti si, β€œdceirnteoir fo ootniems ro leipumss to a trelaun onepsr ro jbecto” so s’seh nkigikc hre alymfi yb kcngiki hte agb.

djeffs1  Not if you're sexist and think its inappropriate for women to participate in kickboxing... +
... kernicterusthefrog made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +27 
submitted by kernicterusthefrog(107)
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eh"s flees hipaepr nda eorm dle"xaer atefr tigrntsa ognbik:ckxi tish si a TAMUER efnsede emmicnahs s(iacslc obktoetx atumiobilsn, sa sha neeb .)dais ishT tsuienoq is stju laipn wognr. tI's ont iplemtncdesa, ecuabes sti' a aehthyl, oalsilyc apltcaeecb teluot htat mrivpoes rhe enimlotao sta;et ncinuhpg absg aer naemt to be ndcehup st(uh it is yaucllat TON nl)rute.a emetcpDisaln to an jboetc udwol eb pnungich a eolh in her allw, or anikergb reh seva I( sutj lkie htta i.mger)ya oBth fo tsoeh doluw be ttrebe ahtn cpiguhnn erh fy,lmai or kabgneir rtihe acr on,wwid whchi si hyw i'st ectdpeianmls ni(ssonuocuc eoiiecrdrtn fo na toemino ot a arsef tje)c.bo Heveorw, xikinkbgoc si LREALILTY na laemxep ni eelvars pshyc tkobesotx rof lusoatb.miin nhTak oyu ofr onicmg to my DTE .Tlak

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). +
... imgdoc made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
 +26 
submitted by imgdoc(132)
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I nkthi its hte gtihr FML reaa( ,)C otn eht ghtri uncadbse nclsuue atht si ndseioel on het rcsso tc.esino fI eth nadeuscb ecnulus weer indleeso seh tlnuo'wd ehva nbaotdcui ni her elft eye. Teh MFL deeaimst ossrc tlka ebweten hte aunbdecs ulcnsue on hbto seids to eht LMF no het pestpioo ieds (2 benasucd cinuel, 2 FML neo on ceah esi).d In hre ,easc hre igthr LMF sta'wn goniniunctf ceenh ywh esh asw ingzag etfl btu her thigr emiddl ecurst tsnaw' toccganitn ot atiemed arfdletw aze.g

Tihs iuprcet :ephls p/1mphheh-mwaa/tt01t/pot_wFcst/o.np-/uog/l/ct29den0pm-4.5onhuh:ww2jbt

imgdoc  *medial rectus +
... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
 +24 
submitted by drdoom(806)
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aCultlocnias ofr dda. hTe iibtyalbpor of the hafert geibn a ceriarr is 32/ isnce ti is nwkno taht he es’tdno avhe hte sdeiea.s henT the tyalbrbpoii fo mhi gspasni ti no to ish kid is /12, th:us

  • tyriboibaPl of dad eignb riracre = 23/
  • baoyiPlbitr of add igspnas on saeside ellael = /21

luolncsataCi rfo mom. ihtW eth nHd-reWbyirage ,ercplinPi oyu anc ergfui tou eht lbptybrioai fo eth otmehr eginb a i:arrcer

q = r40(t/001)sq,0 = /0012

,oS p2q = 2 * 1/200 * 9290/01, ichhw si roppax 0.011/

orF teh idhcl to etg eth ealell mfro ,omm two itshgn need ot ppnh:ae 1() mom tmsu eb a rrareci β€œoeeyt”[g]hzeort nad 2() omm mstu asps eht elllae ot ih:dlc

  • iaybrlPotbi of mmo igneb eairrcr = 0110/
  • obarlPbytii fo mom gianpss on aeisdse ealell = 21/

niutgP it all treetohg. owN, ceobimn all :ogethtre

= yibpiaobrl(t fo add giebn a)errirc * rbblayoi(tpi of add nisagsp no sidesea eae)lll * lyribao(ibtp fo mmo bnige aerircr) * lbport(baiiy of omm ssanipg no sieeasd )llleea

= /23 * /12 * 1/001 * 1/2
= 1 ni 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +35
niboonsh  This question makes me want to vomit +11
drdoom  lol +
5thgencephalosporin  okay wow +
... k_tron_3000 made a comment on nbme22/block3/q#19 (A 42-year-old man comes to the physician because of...)
 +24 
submitted by k_tron_3000(31)
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heT eiindcsortp of lrblataie eowlr lmib osls fo tvnorbiia mlipeis DLMC magd,ea and eht nbteas sDRT + obgRmre esme ot em ot be imnpyilg that eh psislyob hsa esbat ioldasrs rfom lhpissyi r(o iesohmntg evyr rsimila in setp.nao)trein

As orf teh rohet w,esnsar A si gwonr eucseba hsi moort ntuoicnf is anc,itt B si gorwn bscueae ianp dan eetartepmur tecifdsi rea ont teeomd,nin C si rwngo ueacesb ti ipsieml a fsipceci envre si epedtpa,rn tbu eh sah sotl rltbielaa aniosntse ni his eeitrn owrle imtxtereise

D is hte eiki,ctsrt nda ’Im nto 100% ruse, ubt I uowld nhtki oadyhriluapct fo eth aoenirtr ra)evlt(n srtoo ldouw suace omtro tdecfisi ensic tyhe crayr otrmo re.tsefefn ouY gmhti laso ceeptx ahtt motro dyinuncfsto ot be arl,tuliena sneci ti uowdl eb kileluyn to veha a mblrope hwit het evrne oorts no bhto i.sesd also eth CLMD is nto ecadtlo earn het aoirentr ostro fo het naipsl crdo, os fi teh ernaitro rsoto reew ecedffta oyu learyl ltundw’o ctpxee ot ees vairotbyr sl.os

oS lyaisblac coesrps of ,nlomainitei I od elfe leki yesosrn teynauphro is an myrexelet vgeua wenrsa tughho nad I sawnt’ a anf of eth stenoqui.

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). +30
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. +15
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 +5
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
 +24 
submitted by alwaysanonymous(30)
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Hsi aidlt eovmlu swa 005 m.L oripen-aExrtdy wsa 5+ cm nda ns-tryernaidipo wsa 2.+5 eW eerw eudopsps ot ues teh efdfecreni in aywria uprerses, dan ont the -rdniiyenrostap prlalue reurssep 2+(.0)

mlienCoapc = VΞ”/PΞ” = 050 / 20 = 52 mcmL/ O2H

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 +9
... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +23 
submitted by usmleuser007(370)
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Jsut e:mrrmebe

1) Tte-ts et(a rof tow) = ksloo at het aemn sluaev of 2 usogpr

2) AAVNO sysn(alia fo vienaca)r ~ ekil tt-ets utb = kloso ta anem vlsaue of 3 ro oerm urpogs

3) s-uiChaeqr = ksool ta het ()% ro ripoprontso eenebwt 2 or orem ours.gp

s,o stuj ookl for hwo aymn gpusro ngbie rdesddeas nad twha vlueas heyt era nigus (% or ase)mn

... seagull made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +23 
submitted by seagull(1405)
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out of ysroiti,uc hwo mya eppeol knew siht? td(no eb ysh ot sya oyu ddi ro i)ddtn?

My yptroev oicutdane ndtd'i grninai hsti ni .em

johnthurtjr  I did not +1
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 +14
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?" +7
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 +21
drschmoctor  Is it biochemistry? Then I do not know it. +4
snoochi95  hell no brother +
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 +1
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
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
... seagull made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
 +23 
submitted by seagull(1405)
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eTh uraohts enwt uot fo rethi wya ot ndif thew rwtso topho fo a lagnoumra teyh uocl.d heT etrhw on a tems ttha gguestss ahtt ti duwol be gnnalrtiuao iuest. tuB eliltt idd we .o..wnk

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
... yotsubato made a comment on nbme22/block2/q#31 (An unimmunized 1-year-old boy is admitted to the...)
 +22 
submitted by yotsubato(968)
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In gb,oyoil aeshp vratoiain si a ehmodt ofr aglnied iwth dyrilap rigavny rnsetoevnmin thtiowu iginqrure dornam .mtouitan tI noevisvl the naiivrtoa of nrtopie eeros,nxisp qlreenytfu in an oonff- f,oainsh wihint ndfeerift rstpa of a becaatilr nupapo.oitl sA husc the nyeopethp anc iswcth at rienfsueceq tath era hcum gheihr emmiosets( g1t%;)& htna lliscacsa atouinmt s.tare aPesh ariitvano noutsircteb to eivnrlecu yb tarengeing t.yoteergehein gtlAhuho ti sah ebne stom onoylmmc idstedu ni teh tnoecxt fo umnemi nisevao, it is dovreseb ni myan oerth reaas as wlel adn si mydpolee by ivosrau etpys fo ,aebtirca liinndcgu lmoSelnaal eeiscps.

w/oPhknnawews/tt:_/wc/teroaanm..isiiviwpahd

whoissaad  is it the same thing as antigenic variation? +8
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. +4
makinallkindzofgainz  This isn't in Zanki, Lightyear, or First Aid, and I don't remember ever learning about this in class. Thanks NBME! :D +18
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. +
... keycompany made a comment on nbme22/block2/q#41 (A 12-year-old boy is swimming in a mountain stream....)
 +22 
submitted by keycompany(296)
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wnse:Ar nedcraeIs ltnarCe Blodo uelomV (V,)BC srDecdeea AHD, ncedIrsae .ANP

heT holsaciylipog osreepsn ot iohmayphter si tintsvsrncoicooa of rheieapplr ssleevs ..e(i hte nseo in yruo ttxrimeseei) in na eftrof ot ekep yrou roec ydob tmrpeaueter om,rnal adn sthu ruyo rgnaso cintnuniofg pro.ylerp rhiprleePa itnscnicaVosotor will eiercans CBV. nrIeadces BCV iwll saeuc an ricanese ni aerd,plo adn stuh uaecs na ecirasen in BPNN/AP. APNP/NB sha biioyihrtn ecsftfe on the nilsntRieeAeest-nnA-ondrngoio ey,tSsm rentgiusl ni rcdsedeea DAH.

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. +3
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...)
 +22 
submitted by usmleuser007(370)
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my ltis fo ilnesdp ytpe llesc dna nios:tdonic

  • .a FN-1
  • .b F2-N ~ whoSnnacam n(otnAi )A = Cueotnsua beofuonrrmai ~ hhig yllelticaru w/( ngdalpaiis tpesntra thwi igenrrpnsiste rnlauee-ercf eonzs bnlyrap;aclVcdseo&e sobied
  • .c emoyoaiLm use(tru &p;ma hga)eusspo
  • .d oahmliMteose tcn(tkyeraio si)potvie
  • e. lpanisacAt hdioTyr eccnar ahcspii(b pam;& nalog itwh tngai lle)sc
  • f. dryluMeal orTidyh ecarnc a(cn saol aveh paonlyolg clel)s
  • g. Pmiryar ciadarc caasnoiamrog mlnga(tani avurcsal leinspd )eclsl
  • h. roamoOetassc b(neo n)aercc emrpoilh(pco s)ecll
  • i. nnmogiaMei
  • j. sspoiKa' aomacrS (H8)H-V = -liSkeitl caluarvs psecas with ppulm hdaiplsn-despe oasrmlt sllec
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1
mcl  I love this and I love you +4
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 +
... bubbles made a comment on nbme22/block3/q#13 (A previously healthy 26-year-old woman comes to the...)
 +21 
submitted by bubbles(66)
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rFo the epsep hwo otg sufdcone no tihs unoqitse bc of ldUWor's iderw qneiostu no HIV avlir o:ald

atcue I-HV1 :tcniinofe HGIH liavr ,aold olw bHVA2 -I :fieoitncn WLO ailvr ,odla owl Ab b(c daarstnd HVI asssay detetc 4p2, hwchi si not snrtepe on )2I-HV

anKid anoydne I disems na ayse iglomnoumy tcpecon qsnuoeit :/

eacv  I feel you my friend! same stupid mistake over here -.- +3
step1soon  FA 2019 pg 176 +2
... hayayah made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +21 
submitted by hayayah(1056)
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shTi is a tanepit esac of tppmotsura iytoidrit.hs naC resai up ot a yera frtea leredvyi dan ash hcpctoiylmy eialrtfn.ti

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...)
 +21 
submitted by keyseph(36)
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tsuJ ym two :etnsc lCoptyra,ototbsh yrramip tesm vlius,l hssoitbynrpot,tyloca nad tcoihtbsplaor ecnuaal are lla oconmstnpe of eth dlingeopev ptanelca, hhiwc epulspsi teh fesut in etro.u ehesT tuetruscsr aer all eidrevd mrof eht soolhtbtrp,a hhwic si dscrineoed xertcyraobi-enm tu.isse peicatiotm"Heo stem sllec" si the nloy senarw cehico ttah ouldw icadtein ealft sarpt ewre mrfeod.

onoeh.ngl/p/ddoemo.lteauxpbysutpyra/rom.o.srbw./hes:dyitulTg/phymbe

... imgdoc made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +20 
submitted by imgdoc(132)
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I itknh aolt of plepoe mhigt evah reov psahedizme how ntipamtro ANP nad PBN yllare ,are eys it si trpmanoit ot kwno tsehe iepptdse egt ecdrstee yb the ltnrrtaaicaler/uiv rammuociyd duigrn rhtae .lfruaie eoHerwv ireth aevollr einvfeecsfets in aritengt rheta reilfau is ,zhcil a eppetcror lodt em htta fi NAP nad NPB eerw os uslfeu in nreiarustis thne yhw do we gvei ?iicedsrut ts'I easucbe RASA rveoeporsw hsti mysset ceenh aiucsng aentgive fecfste and hte ndseles pool of aethr efru.lai AAK why ew igve CEA ostirinbih.

iwonKgn taht ANP segt edrtenazuli yb het SAAR tes,smy ew nac sfhit our usfco akbc ot rhaet eafriul ni htsi paeitt,n hrwee aicardc ouputt is ederc,eads gneilad to HAD otcirenes and ailylfn ltiuldnaio ma.iathnroepy

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? +
... keycompany made a comment on nbme22/block1/q#35 (A 35-year-old man is brought to the hospital after a...)
 +18 
submitted by keycompany(296)
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rnAtoailet of teh caehoitrttsm set ntoip si a hmhylatocaip pescosr edetimad by osrpstaninlgda dan is dedenpetinn of the smceitatyph rusoven ytssem.

,B C, D, nad E lla ieqrreu hmteatsciyp ernvse to iictell a .eeorpnss

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...)
 +18 
submitted by mcl(579)
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tisepDe a mcnirue vulae oo(dbl p)seusrre benig rdemea,us epniatst uldwo be sdneeiatdg reiteh vsheiyrtenpe ro isevmno.etrno To ym eniadn,gnutdrs eth etbs estt rof cponiarmg tegiacorlac ielsbarva scsaro gsorup is a hic qsruae e.tst

In crasnt,ot a ets-tt is sude ot cmoreap tneebwe eth menas of tow gurosp ma(eserdu airlbave stmu be iuvqae.ani)ttt

... moloko270 made a comment on nbme22/block1/q#30 (A 42-year-old woman is brought to the emergency...)
 +17 
submitted by moloko270(64)
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AF 4.5p7 - ngbnriu uberbr sllem ocllhtaininau crcsou sa na raau ofr almotepr obel eplpeyis

... moloko270 made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
 +17 
submitted by moloko270(64)
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olss of fludi strrggei ooenetrdsal cndpr,oitou so naiettp iwll heav aeamhyeptrirn dna amoyephkali sa a ltresu

makinallkindzofgainz  dat RAAS +4
... drmohandes made a comment on nbme22/block3/q#15 (An 18-year-old man comes to the physician 10 days...)
 +17 
submitted by drmohandes(84)
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rgienF lfnxioe edno b:y

  • FPD = exorlf tdrigoimu runusdfpo (esfexl )DIP
  • DSF = refoxl ugritodmi sirulfpasieic fl(exes )PPI

_

tnIvoirn:nea

  • FSD 3///245 by anemdi 5(T)1-C
  • FDP /23 yb ieadnm ()-CT51
  • DPF /45 yb nurla 8T(1-)C

_

rOu tpniaet nca't lxef DPI fo ignr fnrgie β†’ 4PDF β†’ urnal β†’ -C1.8T

Olyn oepslibs rsnawe we acn icpk is .8C

... bhangradoc made a comment on nbme22/block3/q#26 (A study is conducted to assess the extent of cardiac...)
 +17 
submitted by bhangradoc(21)
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The ePluva- is albyasilc tepy 1 r,rreo nad etyh peke hte lp-euav het amse at( ;0<.)5 ni tobh srseivon of the etereisx.npm yB ngairceins benurm of taintpes ni teh ,ruogp yteh iceersna oerpw of the ,dysut hihwc dsecreu pety II .rroer

jfny21  Thank you +1
baja_blast  For more, FA 2019 p. 262 goes over Type I and II errors. +
... adong made a comment on nbme22/block1/q#38 (A newborn born at 26 weeks' gestation has...)
 +16 
submitted by adong(94)

literally know every single name they can possibly call this

djtallahassee  literally a new name every nbme +9
... mcl made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +16 
submitted by mcl(579)
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Teh qniesotu is eerrirgnf ot the mnhxeeaois pth.away

rmbaalCyo ohphtaeps dna nnegiiar aer oldvinev ni the reau cyelc. So is taclymagneetu-lat A)NG( a(lgrueset unricptdoo fo ybloarmac h.pohasept)

... keycompany made a comment on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
 +15 
submitted by keycompany(296)
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Fwol etaR = oticyVel x Caso-rstenScloi eAra

2 c^2m x 20 cm/sce x 60 e/msnic x 1 0/0,L01 mc3^ = 42. iLm/n

0,001 cm3^ = 1 L

seagull  Well, I missed this one. I don't even feel bad. +55
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 +
... liverdietrying made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
 +15 
submitted by liverdietrying(95)
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doGo cfta ot momtic ot omyr:me uoy loes baricb ni het sotlo (eehnc wyh aiahrdre acsuse onnainno gap elobamict dias),sico nda lecsaepliy olse atiospusm wiht taxaivel aeubs s(a eondientm ni the eqtinsou tme).s /-ar-t/tlnsu-oe:reotp/citobaaoorltaidtpehcmerwaawa/.dintey-dhheanmestw-stinbcdw.cstle-i

sbryant6  I'm going to go take a big bicarbonate poop now. +24
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) +1
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1
... bubbles made a comment on nbme22/block3/q#42 (A 62-year-old man comes to the physician for a...)
 +15 
submitted by bubbles(66)
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hiorCnc nelar nyfi:cinuecsfi

)1 oorp hhaostpep arnelaecc g&-;-t hhgi rumes aconrigni ospuohrohsp

)2 hghi ermsu hetpsaoph ;-t&g- ocexmelps hiwt idevantl contia aC ;t&-g- Ca sllfa

)3 aC lsafl &-t-g; rsgtgire HPT sxai

)4 eidnky ifaulre g;-&t- seeadrdce cytiaitv of xhsreoa1lydy- at eth dynkie g--&;t lsse lcioatricl

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. +2
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
... d_holles made a comment on nbme22/block1/q#15 (A 35-year-old woman has weakness and fever. When she...)
 +14 
submitted by d_holles(171)
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anlGoj erssetss het Bsodar vniigg het emaeluki osqitesun aywa desba on het ega eigvn in eht niequtso ss.emt

LAL = -410

AML = 9;531- 4095-

LCL = 0+6

LMC = 5904-

/grja6henn0toeldstsuodahimluso.:/str.knft./da5ptee3e-c3/-onmo/ttsru0

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!!! +2
... keycompany made a comment on nbme22/block1/q#33 (A 32-year-old woman begins to hyperventilate and...)
 +14 
submitted by keycompany(296)
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noelytivrnpietHa escreaed O.P2Ca tlaneCr coestrpeceomhr drenpos ot wol 2aPCO yb inocanrcsgstoivt rlereabc lobdo sesel.sv

)A rreitlaA odlBo eygxnO nircoeaConttn: ldooB Oxegyn Coeoaitntcrnn si yeriltcd eedtalr ot Hb cttncronnaoei nad uairtsntao O(2Sa) 0219,FA .p 635. aiV eht hroB Efcfte, redeeasdc PC2Oa llwi escnreia aS2O, hstu isngaecrni lbodo xoegny tnoan.orccntei

B) lAirtear olBod OP2: Oa2P esghcna in oserensp to daeecerds OP,A2 ,IP2O ro sfd.iunfio eTerh lwodu eb on ganhce ni OPa2 drguni ttironvyiahlpnee rtoehllyiac)(t.e

C) riaeltA Persurse: eDedcaser OC2Pa si secotasida wthi s,oiosittcnavocnr ichhw ldowu saicenre bolod .pessrure

)E aerebrCl eissuT Hp dolwu eisancre due ot iyrrotraspe saalk.osil

keycompany  EDIT: Via the **Haldane Effect**, not the Bohr Effect. +
impostersyndromel1000  excellent response +
teepot123  fa 19 pg 489 +
... armymed88 made a comment on nbme22/block2/q#32 (A 54-year-old man who works in a delicatessen comes...)
 +14 
submitted by armymed88(47)
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Of ehest spioont vlael,baia Snhwcan cslle wuodl be het ynol lescl entresp ni the .PNS sos,At cyter igaormlci dan looisg aer lal SCN slelc Stallteie sclel rea in eth lumsec and resve to dai in msuecl epirar dna otnegainerre

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 +15
drzed  Myosatellite cells are also called satellite cells so it is not clear which definition they were using. +1
... ilikecheese made a comment on nbme22/block3/q#14 (A 57-year-old woman comes to the physician 2 weeks...)
 +14 
submitted by ilikecheese(39)
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If oyu atnw to ikhnt fo shit lmsyi,p het rbsi era entdnoecc poriseyotrl to het ertrvbale .unmloc nad the tresilocatn neisv nur wnebete the,m so hyet rea eht sotecsl to eht eablrvrte mn.ocul

... meningitis made a comment on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
 +13 
submitted by meningitis(502)
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Tneanr gtasse astrt ta TNE syera odl

gaeSt I :

  • I si aftl, sa ni tafl ectsh;
  • I is nel,oa sa in no uxales ir.sha

tagSe II :)2( gtesa II sratts at 11 /yo I(I olko klei 1)1

  • 2 albls a(tlstcueir emlrntaenge)
  • 2 arshi cuipb( ahsir wno rgip)eanap
  • 2 tbaser sbdu rmfo

Saetg III ):(3 srtats ta 13 o /y

  • If ouy ertato ,3 it looks ilek mlasl brsesat re(taBs onsdmu mf;ro)
  • If ouy qlgigesu the III eyth olok lkie +rreyclosacu icpub irha
  • Isanecedr iepsn gtlehn adn zeis nac eb dentsreerep :yb II g&--t; III
    r(uyo pisne asw nhti II utb nwo its richtek III)

aegSt IV ():4 ttrass ta 14 / yo

  • tirsF i:maigne The I in IV enrstspree hte ighht, adn eth V in IV ookls lkie the noms ipsbu etnwebe yuro selg:
    NG IE:MNA oyu evha rahi in osmn sbpui V)( but yuo avhe a ebdror inaidtgne het ihar frmo gwingor inot ihgts.h
  • ehT V is ipntoy, sa in wno the setasrb rea yotpin e(idasr aorale ro dunom no odnu)m

eatgS V 5(): 15 o/y

  • V sha no obrersd tdngeaini ihar from gorgwni otin hitsgh ciupb( arhi + hhigt )hari
  • 5 sagrfen(is in as)dhn eilgftnant eht leoaasr hwen agibbrng tmhe lra(eoa nlttfae ta hsit tagse dan no eomr duom"n on noudm)"

meningitis  Sorry about the format, it came out wrong but I hope his helps. +1
drdoom  looks good to me! +15
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 +2
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 +2
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. +
... humble_station made a comment on nbme22/block2/q#1 (A 29-year-old woman is brought to the emergency...)
 +13 
submitted by humble_station(68)
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siTh is toehrna esutqino ntsteig eht onteccp fo plsiaat .oamtyan fI eht ursngeo si nlitifg het ivler and neth teh ebdle ntwe fmor a allms tmnuao ot a deduns seiasmv ehrrheoam,g rceylal iths si lmignpiy het eledb is ucgirnco dhenib eth ie.rvl

Waht trcurtesu si debhni eht vleri? CIV

Whta nnctcose ot eth IVC rfmo eth vlrei? cepatiH viens

lsoA eht daei tath eht ttipnea ahs bnee beilegdn ofr 6 ohrsu abcesue thsta owh logn ti otko inlut hte oexrlaryotp amptyroaal asw perdoferm samen hte eedbl si msot lekiyl morf a lwo rseesupr ..sty.sem uovnse y.tmess

... d_holles made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
 +13 
submitted by d_holles(171)
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I otg isht eon iav cspsroe of imiinoalnte. Not sure how uoy are edusppso ot ermebmer lal atht tsh.i

... highyieldboardswards made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +13 
submitted by highyieldboardswards(13)
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hStor e:narws lAl nesge ear eetspnr ni otbh B nad T c,lels tub tyhe aergrnrea adn essxrpe tesrrceop ahtt rae eccpiisf ot ehtir lgan.eie Thire era intpeddenen DJV sgneroi orf B elcl orcrtepe nnagiteroe dna T clle oetprcre gn!eaorenti hisT kwii letirca sdhse higlt no hit:s

rpaohbeipe(kp//n/lsno/cii:_terJiere#awknw__lroei.c)iDtVidctst.mTgo

I oto rtlaaiclyg seidsm .h.tsi but ti is caauyltl os spilme atht ew rea missngi het fsoter uthorhg hte teser -hiWe-l tohb B nad T lclse ruonegd DJV a,enrtaegrmnre het ,V D, nda J ngsee era IEDTFREFN GENES tdesepi einbg darozngie dan orhtrefee flsadiecis ni a riaslim foniash ued ot ethri ashder ende ot eeeratng edresiv rer.tucsstu To keam atestrm mroe fgincs,uno hotb tsse fo DVJ neegs ear no coohosrmme 4.1

hiTs si hyw eth MBNE psfeiidce hatt htye aer gntggia HTE MAES J ORNEIG hihwc si ahtt fo the B llce oeceprtr nege J orgein, tno teh T clel erprcote nege ab-Jte grioen se(e kiiw l.tceri)a heT B clle peorcret egen si ont darrarneeg in a T lel,c if ti was, T clsle wdoul haev itdnsaeobi!

redstrat  This. So much this! +1
... d_holles made a comment on nbme22/block3/q#44 (A 35-year-old man comes to the physician because of...)
 +13 
submitted by d_holles(171)
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amDn I fele keil NMEB cifgkun oselv ecbaiss or emso ths.i

... drzed made a comment on nbme22/block3/q#50 (A 56-year-old woman is brought to the emergency...)
 +13 
submitted by drzed(206)

I'm a simple man, I see encephalitis and temporal lobe involvment, I click herpes.

asharm10  hahaha true that, overthinking is the reason for getting so many questions wrong +
... btl_nyc made a comment on nbme22/block4/q#35 (Nicotinic acid acts at which of the following...)
 +13 
submitted by btl_nyc(55)
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:A ceioestrrmnhlya adn hoter bile cadi sirnse tvprnee teh keeauprt of lieb siadc omfr eth tug.

:B Stastin intbihi -CGoMAH te,asrudce gnnetviper het irlev rmfo kgnaim mlvoiaenc aidc, a recurrsop to eeso.lclohtr

:C iNinca iiont(ncic caid) rdecesu heipcat LLDV yitssshne dna asol ibnsiith pysioslil in edsoipa sustie yb tbniiihing ormoenh vineiests elips.a

aE:pD&m; tFiraebs rpletageuu rptieniloop laipse LL(,)P girnacsien eietdycgirrl lraceecna LLD(V nda ylosmcocrhni rea lulf of t)esirreiycldg nad laos etatcavi iempsxoero ldiiatrcteaovtorp-frea er-opertc halpa )alpP-(ahPRA to dcienu DHL e.snthisys

... bubbles made a comment on nbme22/block4/q#47 (A 56-year-old woman comes to the physician for a...)
 +13 
submitted by bubbles(66)
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etemaBsn ambmneer ntgiyiret is the eeantnmdtri of flul ugln cerervoy owofgnlli umnpolayr litnus.

Suymmr:a

)1( ossl of msentabe nembearm yntigiret is tairiccl ni deeigitnnmr hte itnβ€œpo of no nru”,ret nad sortcnutebi ot eth iiblynati ot absrlisethe larnmo lung crtcieuetarh ihwt pooomntri fo ifrs;isob

)(2 olss fo lhaitlipee ,sclel alhleeiodnt eslcl, and asneetmb beemnram tynegirit ni sluua tianiilertst umpainone datiseosca htiw iotiichpad uanorylmp bsrofiis daels ot tdoeyders ugln eteitahurrcc dan eparuptel irosbifs;

)3( mrgtosiafnnr gwrtho Ξ²-foarct is nesrcyes,a ubt otn ilrtenye teufisi,fnc to roptmoe ptrnmnaee iofb;rssi

)4( etetrssnip nrtitnugnyjirnaai/teir/ si ticrcial orf hte apogiarnotp of soir;bfsi

5)( iiodpahcit uyaoprlnm sbfsioir is an leemaxp of a ssorcpe edlarte to teh itenrepsecs fo an ,neβ€œs(git”an) rcocnhi itno,ifanmlam dna ;fbiorsis nda

(6) unqeiu elscl are tclcairi luellarc yrelpsa in eht neutgrloai of iorssb.fi

ttiin: aocn.2/spi/wtPsi1mw5./c.C:pimltthcb.vwon/64hnce/2grMal4/

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
... meningitis made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +12 
submitted by meningitis(502)
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I olsa tthguoh het maes as bubs,@bel btu own ntigry to sti"f"jyu htsi tciyrk NBEM uieotn:sq I htikn isth vevlsroe on teh fatc taht eht ttianpe hsa a GHHI obldo essreupr aienngm ew loudhs fcous on an snrwea atth psailexn tobh redecisan PB dan oliyHpomvae .(:ei idncaeesr AHD hciwh inascsotocrtvs and osal bssrabo erf,waet-re thob fo whihc nsieacer BP adn esacu oyl)vahoeip.m

Maybe if siht ptntaie erew omaepdtsnceed ihtw LWO PB, neo dulco think mreo obtua PAN.

I lsitl hitkn tshi sieqtonu is OOT .kictry

meningitis  Sorry, hyponatremia* right? +
mantarayray  I think that it's not ANP because ANP will cause a loss of Na but water will follow (they usually go together), whereas ADH will cause absorption of only water and will cause hyponatremia except only thought this post getting the question wrong :") +4
mantarayray  Oops sorry the formatting is confusing: I think that it's not ANP because ANP will cause a loss of Na but water will follow (they usually go together), whereas ADH will cause absorption of only water and will cause hyponatremia. +2
pg32  @mantaray pretty sure you are right and that is the only way to get this question correct. Remembering that Na concentration really is a measure of water balance is key. If the pt is hyponatremic, that just means they have too much water in the blood, which is caused by ADH. If the patient was hypoVOLEMIC, that might mean they are losing too much Na. This is illustrated by pts with SIADH. They are hyponatremic, but euvolemic, meaning that they have too much water (hyponatremia from the ADH) but their Na balance is ok (due to excretion of Na via ANP/BNP) +
avocadotoast  We need to be thinking about how heart failure is a condition with a low effective circulating volume. Our patient had an MI and now his heart cant keep up with the volume (low CO), leading to congestion. When congestion occurs, water is pushed into the interstitial spaces and isn't circulating in the arterial system. For that reason, the body ramps up the RAAS and ADH despite an actual increase in body water. This is a non-osmotic release of ADH. At this point plasma sodium levels are determined by relative intake and losses and hyponatremia is common in these patients because of that. Also, ANP and BNP don't hold a candle to the RAAS. +
... welpdedelp made a comment on nbme22/block1/q#22 (A previously healthy 6-year-old boy is brought to...)
 +12 
submitted by welpdedelp(216)
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tI aws bas,cise hwihc is stretdamint .epprrooesonn-

welpdedelp  **person-person lol +5
suckitnbme  NBME loves their scabies +14
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" +
... hopsalong made a comment on nbme22/block2/q#3 (A previously healthy 28-year-old man comes to the...)
 +12 
submitted by hopsalong(25)
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This qtiouesn sah a olt fo wsrane opton,si adn uyo vrriea at sphthNilioreais by rhtowgin tuo all eth rtheo tponios by wtha is ii.ssmgn

A, B - tCiloacr rcsioseN adn yiPpalalr cesoNris matslo awslya ocrcu in hte esittng of si.himeac rPlvsyioeu hhetayl 82 ryae dlo man hsa no evnedeic fo gaticnilisfyn adecersed reanl p.isfouern

C - cAute rbluaTu oicrNess si hatw you dusohl tnhki fo hitw Scilyeaalt I(AS)ND ctyxit.oi reTeh ear yanm otrhe hitoxnpoecr gruds hatt ascue TA,N tbu khtni fo NTA sa grud nediduc eikndy m.gadea

D - stiitCys - nlFka ipan is atrleed to edikyn juyirn, ont ldebdra aeg.adm sitCisyt dlouc eb ilebspso ni cinasdneg T,UI utb teh taitpne ash no eevfr adn is emla hc(mu ssel mnomco in me)las.

E - lontoreiphrseuGlmi - Tshi tseg otni rpoirceihnpte/cinht .sremondys ehT mtes snnmoite htta eh has odbol in the iuner hichw yma aeld uoy nwod het inpthicer ta,ahypw but eh osde ton hvea nya fo hte horet asdsicaeto mtsoym.ps

F - poyarpeHhrnem - noAtrhe rdwo rfo Raenl elCl rCianmo.ca oN wigteh ossl ro ehtro arecnc edlreat smymotsp tae(uifg ec.t)

G - seittnritlaI hpeNirsit - hisT is tfeno a rdgu deunicd NIMMUE etdedima ytoh.otenrpxici This si a pety IV istnhiseyvyrpite acietrno taht ccorus swkee ot mshton faetr eth rsatt fo mioeacindt e(ikl .ASDs)IN NAT si emro taisceadso wtih grud oovesedr lhwei tiIsertnliat si mero tcdesaoais ithw mineum .iecaotnr ilIiettansr tiNpisehr liwl hvea CWB ascst ni rnuie.

I - eothlsPnyirpie - duseCa by escgninad UIT but on refve is entspr.e

sihT seleav lripisotsNiahhe H)( as eth cctrreo nseraw. 5%8 fo hhatpiisiorsleN si aaitcsdseo tiwh aihytovepc weolb .unssdo ehT pani fro sinrsphahiteloi cna epsealr and mter,i dan olnaislccoya the aipn can laevrt form eth kyidne klafn( inp)a ot eht tcosurm as the osnte vsmoe orghtuh hte ue.ertr

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +3
hyperfukus  yasss +
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +4
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +
... yotsubato made a comment on nbme22/block3/q#9 (Microelectrode injection of antibodies to Ξ±-actinin...)
 +12 
submitted by yotsubato(968)
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aeAr C is erhew eht gpa nticjousn tewbnee ciraadc etysomcy e.ar aGp cuontJins ear onufd no hte pmaals mmbenare of eht cradcai .yocmtey

ehT iusonqet is alybcsali gnskia hewer eth lpmsaa emeranbm is hitw a unchb of chmbioe oubmbomjum oyu odnt aehv ot andtdur.nes

... moloko270 made a comment on nbme22/block3/q#18 (An 85-year-old woman is diagnosed with a fracture of...)
 +12 
submitted by moloko270(64)
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Mohripen si teilbdaeozm ni eht eilrv to 6oinln-ui-epurodmhcgre nad gmpe-eon,diurchou3i-rnl obht of whhci aer recexetd by het .sydiekn In hte ttgensi fo ealrn uleifr,a eseht esttmobiael nac etcaumlc,ua inetrgsul in a irelngow fo het eirzsue .shdheoltr Moprnhei ohdlus reteehrfo be sedu whti auincto htiw limd ranle mptmnrieai nad be iaovded in het setngit of enarl ura.ilfe

or:uesc cw-aiuclahoaomp-rtlxswhcstdisewiciopygcrp.eicco/h/c/cpncc-eto-:re-ogmuanopnltelrheirdtmete6dosy/ociau-ig.mnna/

yhte vaeg a nthi of aecednrsi arienientc ,leelv puls derol ega anc gvie a osewld dnow esimtoambl and CSN tymsmsop