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NBME 23 Answers

reproductive repro FA19p634
Question#1 (57.2 difficulty score)
An asymptomatic 30-year-old woman comes to ...
AnovulationπŸ”,πŸ“Ί

oncology microbiology
Question#2 (22.8 difficulty score)
A 56-year-old woman comes to the physician ...
Microbial oncoprotein that interferes with tumor suppressor proteinsπŸ”,πŸ“Ί

digestion
Question#3 (44.7 difficulty score)
A 52-year-old man comes to the physician ...
TriglycerideπŸ”,πŸ“Ί

embryology neurology FA19p479
Question#4 (36.9 difficulty score)
A male newborn has a myelomeningocele that ...
Closure of the caudal neuroporeπŸ”,πŸ“Ί

clinical_trials FA19p256
Question#5 (22.6 difficulty score)
A study is conducted to examine the ...
Phase 2πŸ”,πŸ“Ί

psych personality_disorders borderline
Question#6 (21.9 difficulty score)
A 32-year-old woman comes to the emergency ...
BorderlineπŸ”,πŸ“Ί

biochem cell_bio
Question#7 (41.7 difficulty score)
Which of the following is present in integral ...
Transmembrane regionπŸ”,πŸ“Ί

biochem drug_interactions p450 pharm
Question#8 (29.6 difficulty score)
A 30-year-old man with HIV infection comes to ...
It increases plasma concentrations of other PIs also metabolized by cytochrome P450πŸ”,πŸ“Ί

schizotypal psych borderline
Question#9 (14.9 difficulty score)
A 45-year-old man is brought to the physician ...
SchizotypalπŸ”,πŸ“Ί

bed_bugs micro
Question#10 (59.8 difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureusπŸ”,πŸ“Ί

anatomy neuro
Question#11 (41.9 difficulty score)
A 55-year-old man who has a 10-year history ...
ImpotenceπŸ”,πŸ“Ί

micro moa
Question#12 (30.2 difficulty score)
A 48-year-old man who is a farmer in a remote ...
Blockade of postsynaptic inhibition of spinal motor reflexesπŸ”,πŸ“Ί

prevalence incidence
Question#13 (45.5 difficulty score)
A researcher is asked to prospectively ...
Prevalence: above the standard; Incidence: above the standardπŸ”,πŸ“Ί

hit FA20p315
Question#14 (20.5 difficulty score)
A 65-year-old woman develops deep venous ...
Heparin-induced thrombocytopeniaπŸ”,πŸ“Ί

physio cholera fluids
Question#15 (21.3 difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% SalineπŸ”,πŸ“Ί

biochem restriction_enzymes
Question#16 (68.9 difficulty score)
Physical analysis of the isolated genomic DNA ...
MethylaseπŸ”,πŸ“Ί

anatomy
Question#17 (52.5 difficulty score)
A 54-year-old woman comes to the physician ...
SupraspinatusπŸ”,πŸ“Ί

biochem pathways
Question#18 (32.5 difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme BπŸ”,πŸ“Ί

biochem genetics
Question#19 (43.5 difficulty score)
Unlike the DNA polymerases found in ...
Mistakes in transcription are not transmitted to progenyπŸ”,πŸ“Ί

repro embryo
Question#20 (30.9 difficulty score)
A 22-year-old woman at 12 weeks' gestation ...
Hydropic villi with central cisternsπŸ”,πŸ“Ί

cd_markers rituximab
Question#21 (47.1 difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”,πŸ“Ί

immuno
Question#22 (53.4 difficulty score)
An investigator is studying the adverse ...
Presentation of antigens to CD8+ T lymphocytesπŸ”,πŸ“Ί

parkinsons neuro
Question#23 (33.8 difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agentπŸ”,πŸ“Ί

endocrine
Question#24 (34.1 difficulty score)
A 39-year-old man comes to the physician ...
FerritinπŸ”,πŸ“Ί

micro
Question#25 (46.9 difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virusπŸ”,πŸ“Ί

genetics
Question#26 (34.5 difficulty score)
A couple comes to the physician for ...
1/150πŸ”,πŸ“Ί

developmental
Question#27 (28.9 difficulty score)
An 11-year-old boy is brought to the ...
Sexual abuseπŸ”,πŸ“Ί

neuro b12 vitamins
Question#28 (51.9 difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”,πŸ“Ί

immuno
Question#29 (43.0 difficulty score)
A 34-year-old woman with a 5-year history of ...
Infiltration of lymphocytes, plasma cells, and macrophagesπŸ”,πŸ“Ί

Question#30 (34.1 difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnicsπŸ”,πŸ“Ί

Question#31 (37.5 difficulty score)
A 16-month-old boy is brought to the ...
Absence of germinal centers in lymph nodesπŸ”,πŸ“Ί

Question#32 (22.3 difficulty score)
Which of the following sets of serum findings ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased
πŸ”
,πŸ“Ί

Question#33 (58.3 difficulty score)
A 25-year-old woman and her 25-year-old ...
Ξ±-Thalassemia traitπŸ”,πŸ“Ί

Question#34 (44.5 difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancerπŸ”,πŸ“Ί

Question#35 (37.7 difficulty score)
A 42-year-old woman comes to the physician ...
Binding of permeable ligand to nuclear transcription factorπŸ”,πŸ“Ί

Question#36 (29.9 difficulty score)
A medical student is caring for a 72-year-old ...
Let me get the resident physician so we can go over the results.πŸ”,πŸ“Ί

Question#37 (37.3 difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”,πŸ“Ί

Question#38 (26.9 difficulty score)
A 43-year-old woman sustains multiple ...
Hyaline membranesπŸ”,πŸ“Ί

Question#39 (34.4 difficulty score)
A 65-year-old man who is a farmer comes to ...
Disruption of DNA strands secondary to ionization effectπŸ”,πŸ“Ί


Question#41 (48.1 difficulty score)
A 62-year-old woman is brought to the ...
PonsπŸ”,πŸ“Ί

Question#42 (48.5 difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”,πŸ“Ί

Question#43 (42.6 difficulty score)
A 65-year-old woman has the recent appearance ...
AdenocarcinomaπŸ”,πŸ“Ί

Question#44 (34.1 difficulty score)
A 34-year-old woman is brought to the ...
Area labeled β€˜D’ (Spinothalamic tract, right)πŸ”,πŸ“Ί

Question#45 (25.5 difficulty score)
A 56-year-old woman comes to the physician ...
Presynaptic release of acetylcholineπŸ”,πŸ“Ί

Question#46 (17.6 difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...
BoneπŸ”,πŸ“Ί

Question#47 (34.9 difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”,πŸ“Ί

Question#48 (52.4 difficulty score)
A 20-year-old man is brought to the emergency ...
3,4-Methylenedioxymethamphetamine (MDMA)πŸ”,πŸ“Ί

Question#49 (67.4 difficulty score)
Electrical stimulation of the stellate ...
Heart rateπŸ”,πŸ“Ί

Question#50 (43.7 difficulty score)
A 45-year-old woman with coronary artery ...
4.5πŸ”,πŸ“Ί

Question#1 (34.2 difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporisπŸ”,πŸ“Ί

Question#2 (51.3 difficulty score)
Cyclophosphamide and some other ...
GranulocytesπŸ”,πŸ“Ί



Question#5 (40.6 difficulty score)
A female newborn develops respiratory ...
Osteogenesis imperfecta, type IπŸ”,πŸ“Ί

Question#6 (42.1 difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis BπŸ”,πŸ“Ί

Question#7 (50.5 difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shockπŸ”,πŸ“Ί

Question#8 (32.9 difficulty score)
An 8-year-old boy is brought to the physician ...
Serum calcitonin concentrationπŸ”,πŸ“Ί

Question#9 (33.4 difficulty score)
A 60-year-old man has had easy fatigability, ...
LungπŸ”,πŸ“Ί

Question#10 (32.5 difficulty score)
A 50-year-old man who lives in eastern ...
Babesia microti and Borrelia burgdorferiπŸ”,πŸ“Ί

Question#11 (23.0 difficulty score)
An antiserum is elicited by immunization with ...
Proteins X and Y have no epitopes in commonπŸ”,πŸ“Ί

Question#12 (38.0 difficulty score)
A 75-year-old woman has stress urinary ...
Stimulation of Ξ±-adrenoreceptorsπŸ”,πŸ“Ί

Question#13 (33.8 difficulty score)
A 45-year-old man comes to the office for a ...
Invasion of the submucosaπŸ”,πŸ“Ί

Question#14 (11.0 difficulty score)
A 65-year-old woman with diabetic ...
MucormycosisπŸ”,πŸ“Ί

Question#15 (88.6 difficulty score)
A child with septicemia has an antibiotic ...
28.8πŸ”,πŸ“Ί

Question#16 (70.2 difficulty score)
Which of the following best explains impaired ...
Increase in axonal capacitanceπŸ”,πŸ“Ί

Question#17 (28.0 difficulty score)
A 21-year-old man comes to the physician ...
LeishmaniaπŸ”,πŸ“Ί

Question#18 (23.9 difficulty score)
A 48-year-old man comes to the physician ...
Perforated peptic ulcerπŸ”,πŸ“Ί

_CHF_
Question#19 (54.1 difficulty score)
A 70-year-old man with severe congestive ...
Serum BUN: 40;
Serum creatinine: 2;
Urine Na+: 5;
Urine specific gravity: 1.025
πŸ”
,πŸ“Ί

Question#20 (34.8 difficulty score)
A 47-year-old woman has had a goiter for 10 ...
Replacement of thyroid parenchyma by lymphoid cellsπŸ”,πŸ“Ί


Question#22 (35.5 difficulty score)
A 42-year-old man comes to the physician ...
Sand flyπŸ”,πŸ“Ί

Question#23 (27.2 difficulty score)
A 75-year-old man with prostate cancer has ...
Prostatic venous plexus to the vertebral venous plexusπŸ”,πŸ“Ί

Question#24 (37.0 difficulty score)
A 46-year-old woman has a 1-day history of ...
Leukocyte alkaline phosphatase activity greater than 250 U/LπŸ”,πŸ“Ί

Question#25 (53.9 difficulty score)
A 44-year-old man with invasive pancreatic ...
Area labeled β€˜Hβ€™πŸ”,πŸ“Ί

Question#26 (32.5 difficulty score)
A 36-year-old woman comes to the physician ...
Fibromuscular dysplasiaπŸ”,πŸ“Ί

Question#27 (33.7 difficulty score)
A 3-month-old girl is brought to the ...
Densely packed capillariesπŸ”,πŸ“Ί

Question#28 (44.4 difficulty score)
A cohort study is conducted to examine the ...
200πŸ”,πŸ“Ί

Question#29 (24.5 difficulty score)
Which of the following pairs of drugs ...
Lomustine and cyclophosphamideπŸ”,πŸ“Ί

Question#30 (46.8 difficulty score)
A 21-year-old man is brought to the emergency ...
LiverπŸ”,πŸ“Ί

Question#31 (9.5 difficulty score)
A 40-year-old man has had enlarging breast ...
SpironolactoneπŸ”,πŸ“Ί

Question#32 (79.3 difficulty score)
A 2-year-old girl is brought to the physician ...
N-methyl-d-aspartate (NMDA)πŸ”,πŸ“Ί

Question#33 (64.5 difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”,πŸ“Ί

Question#34 (31.2 difficulty score)
A 35-year-old woman comes to the physician ...
Synthesis of viral DNAπŸ”,πŸ“Ί

Question#35 (25.9 difficulty score)
A 42-year-old man with a history of recurrent ...
Magnesium ammonium phosphateπŸ”,πŸ“Ί

Question#36 (29.7 difficulty score)
A newborn has external genitalia that appear ...
Hyperplastic fetal adrenal glandsπŸ”,πŸ“Ί

Question#37 (19.0 difficulty score)
A 62-year-old woman is brought to the ...
Embolus to the femoral artery with left leg ischemiaπŸ”,πŸ“Ί


pharm lipid_disorders fibrates
Question#39 (44.9 difficulty score)
A 39-year-old woman with obesity and recently ...
GemfibrozilπŸ”,πŸ“Ί


Question#41 (42.6 difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canalπŸ”,πŸ“Ί


Question#43 (50.5 difficulty score)
A 2-week-old girl is brought to the physician ...
IrisπŸ”,πŸ“Ί

Question#44 (60.7 difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary changeπŸ”,πŸ“Ί

Question#45 (26.1 difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nucleiπŸ”,πŸ“Ί

Question#46 (14.3 difficulty score)
Which of the following types of vaccine is ...
Live attenuated virusπŸ”,πŸ“Ί

Question#47 (35.9 difficulty score)
A 65-year-old man is scheduled for physical ...
Medial (internal) rotationπŸ”,πŸ“Ί

Question#48 (28.3 difficulty score)
A 45-year-old woman is brought to the ...
Inspiratory pause on right upper quadrant palpationπŸ”,πŸ“Ί

Question#49 (37.4 difficulty score)
A 56-year-old man comes to the physician ...
ColchicineπŸ”,πŸ“Ί

Question#50 (13.9 difficulty score)
A 65-year-old man recovering from a cerebral ...
Preventing ADP-stimulated platelet activationπŸ”,πŸ“Ί

Question#1 (54.6 difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sacπŸ”,πŸ“Ί

Question#2 (37.6 difficulty score)
A 35-year-old man comes to a new physician ...
LiverπŸ”,πŸ“Ί

Question#3 (39.7 difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”,πŸ“Ί

Question#4 (80.4 difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
HypoglycemiaπŸ”,πŸ“Ί

Question#5 (21.9 difficulty score)
A 68-year-old woman has a 6-month history of ...
Na+: decreased;
K+: increased;
pH: decreased
πŸ”
,πŸ“Ί

Question#6 (42.3 difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cellsπŸ”,πŸ“Ί

Question#7 (13.6 difficulty score)
A male newborn is delivered at 39 weeks' ...
GastroschisisπŸ”,πŸ“Ί

Question#8 (29.5 difficulty score)
A 62-year-old man with a blood pressure of ...
LabetalolπŸ”,πŸ“Ί


Question#10 (33.5 difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curveπŸ”,πŸ“Ί

Question#11 (16.4 difficulty score)
A 50-year-old woman with idiopathic ...
Penetration of larvae from soil into the skinπŸ”,πŸ“Ί

Question#12 (27.3 difficulty score)
A 39-year-old man comes to the physician for ...
Ξ²-MyosinπŸ”,πŸ“Ί


Question#14 (17.9 difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresiaπŸ”,πŸ“Ί

Question#15 (27.9 difficulty score)
A 45-year-old woman comes to the physician ...
MyopathyπŸ”,πŸ“Ί

Question#16 (28.7 difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary glandπŸ”,πŸ“Ί

Question#17 (50.7 difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleenπŸ”,πŸ“Ί

Question#18 (43.3 difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagonπŸ”,πŸ“Ί

Question#19 (49.3 difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screeningπŸ”,πŸ“Ί

Question#20 (29.4 difficulty score)
An 82-year-old woman is brought to the ...
Decreased function of the puborectalis muscleπŸ”,πŸ“Ί

Question#21 (38.6 difficulty score)
A 60-year-old woman comes to the physician 1 ...
AmplificationπŸ”,πŸ“Ί

Question#22 (41.1 difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudatesπŸ”,πŸ“Ί

Question#23 (31.5 difficulty score)
A pregnant 28-year-old woman is found to have ...
LactotropeπŸ”,πŸ“Ί

Question#24 (50.1 difficulty score)
A 25-year-old man is brought to the emergency ...
Fractional excretion of sodium greater than 2%πŸ”,πŸ“Ί

Question#25 (32.7 difficulty score)
A 43-year-old woman undergoing chemotherapy ...
Preformed IgM antibodiesπŸ”,πŸ“Ί

Question#26 (30.4 difficulty score)
A 27-year-old woman has headaches and blurred ...
AngiotensinπŸ”,πŸ“Ί

Question#27 (22.7 difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defectπŸ”,πŸ“Ί

Question#28 (28.1 difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cellsπŸ”,πŸ“Ί


Question#30 (46.2 difficulty score)
A 20-year-old woman comes to the physician ...
C1qπŸ”,πŸ“Ί

Question#31 (14.6 difficulty score)
The parents of a 1-year-old boy with a ...
MultifactorialπŸ”,πŸ“Ί

Question#32 (27.9 difficulty score)
A 70-year-old man comes to the physician ...
Inhibition of prostaglandin synthesisπŸ”,πŸ“Ί

Question#33 (46.3 difficulty score)
A 78-year-old man has had progressive loss of ...
OtosclerosisπŸ”,πŸ“Ί

Question#34 (23.3 difficulty score)
A 34-year-old woman with a long-standing ...
FatπŸ”,πŸ“Ί


Question#36 (46.2 difficulty score)
A 70-year-old woman comes to the physician ...
Serum sicknessπŸ”,πŸ“Ί

Question#37 (32.5 difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118πŸ”,πŸ“Ί

Question#38 (50.8 difficulty score)
A 5-year-old boy who has recently recovered ...
Immune destruction of plateletsπŸ”,πŸ“Ί

Question#39 (43.3 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased CSF production by the choroid plexusπŸ”,πŸ“Ί

Question#40 (20.6 difficulty score)
A 38-year-old woman with hypercalcemia, ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”,πŸ“Ί

Question#41 (28.8 difficulty score)
A previously healthy 45-year-old man comes to ...
InfraspinatusπŸ”,πŸ“Ί

Question#42 (16.8 difficulty score)
A 48-year-old woman has severe ...
Inhibition of gastric H+–K+ ATPaseπŸ”,πŸ“Ί

Question#43 (16.8 difficulty score)
A 65-year-old man has had increasing ...
Osteitis deformans (Paget disease)πŸ”,πŸ“Ί


Question#45 (31.8 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2πŸ”,πŸ“Ί

Question#46 (54.5 difficulty score)
A 19-year-old woman is severely burned over ...
Increased metabolic rateπŸ”,πŸ“Ί

Question#47 (19.4 difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibulaπŸ”,πŸ“Ί

Question#48 (44.9 difficulty score)
A 20-year-old woman comes to the physician ...
Inhibition of the cytochrome P450-dependent demethylation reactionπŸ”,πŸ“Ί

Question#49 (29.5 difficulty score)
Genetic analyses of cells obtained on ...
EpinephrineπŸ”,πŸ“Ί

vascular pressure physics
Question#50 (44.4 difficulty score)
A 32-year-old woman, gravida 2, para 1, at 39 ...
Increased fetal systemic vascular resistanceπŸ”,πŸ“Ί

Question#1 (54.7 difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2πŸ”,πŸ“Ί

Question#2 (59.3 difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitisπŸ”,πŸ“Ί

Question#3 (30.7 difficulty score)
A 33-year-old woman comes to the physician ...
Inorganic phosphorus: decreased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”
,πŸ“Ί

Question#4 (21.6 difficulty score)
A 76-year-old woman is brought to the ...
She expresses clear and consistent valuesπŸ”,πŸ“Ί

Question#5 (22.2 difficulty score)
Transmission of a bacterial agent by ...
Meningococcal meningitisπŸ”,πŸ“Ί

Question#6 (30.9 difficulty score)
A 35-year-old woman, gravida 2, para 1, ...
External anal sphincterπŸ”,πŸ“Ί

Question#7 (18.1 difficulty score)
A 3-day-old female newborn delivered at term ...
Increased conversion of bilirubin to water-soluble isomersπŸ”,πŸ“Ί

Question#8 (29.4 difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50πŸ”,πŸ“Ί

Question#9 (19.4 difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetiiπŸ”,πŸ“Ί

Question#10 (46.1 difficulty score)
A study was conducted to investigate the mean ...
99%πŸ”,πŸ“Ί

Question#11 (19.2 difficulty score)
A 40-year-old man comes to the physician for ...
FinasterideπŸ”,πŸ“Ί

Question#12 (54.7 difficulty score)
Investigators conduct a prospective, ...
Strength of association, temporal relationship, dose-response gradientπŸ”,πŸ“Ί

Question#13 (39.7 difficulty score)
A 65-year-old man comes to the physician ...
Smooth muscle cells of the deep arteryπŸ”,πŸ“Ί

Question#14 (51.5 difficulty score)
A 61-year-old woman comes to the physician ...
Closure of the mitral valveπŸ”,πŸ“Ί

Question#15 (42.6 difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acidπŸ”,πŸ“Ί

Question#16 (27.8 difficulty score)
In a study of the use of ultrasonography for ...
80%πŸ”,πŸ“Ί

Question#17 (24.8 difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosisπŸ”,πŸ“Ί

Question#18 (55.0 difficulty score)
An investigator is conducting a study to ...
EnvelopedπŸ”,πŸ“Ί

Question#19 (30.8 difficulty score)
A 6-month-old male infant is brought to the ...
Regulatory T lymphocytesπŸ”,πŸ“Ί

Question#20 (36.2 difficulty score)
A 7-year-old boy is brought to the physician ...
Release of interferon gamma by TH1 cellsπŸ”,πŸ“Ί

Question#21 (30.8 difficulty score)
An otherwise healthy 26-year-old scuba diver ...
Hyperresonance over most of the left side of the chestπŸ”,πŸ“Ί

Question#22 (26.7 difficulty score)
A 40-year-old man with terminal small cell ...
DemeclocyclineπŸ”,πŸ“Ί

Question#23 (41.9 difficulty score)
A 74-year-old woman comes to the physician ...
IpratropiumπŸ”,πŸ“Ί

Question#24 (48.6 difficulty score)
A 60-year-old man comes to the physician ...
ErythropoietinπŸ”,πŸ“Ί

Question#25 (17.4 difficulty score)
An 85-year-old woman is brought to the ...
DonepezilπŸ”,πŸ“Ί

Question#26 (27.3 difficulty score)
A 28-year-old man has hypertriglyceridemia ...
AspirinπŸ”,πŸ“Ί

Question#27 (42.2 difficulty score)
A man accidentally touches the surface of a ...
HistamineπŸ”,πŸ“Ί

Question#28 (66.0 difficulty score)
An 18-month-old girl is brought to the ...
Decreased sodium bicarbonate reabsorption in the proximal tubuleπŸ”,πŸ“Ί

Question#29 (34.0 difficulty score)
A 2-week-old male newborn is brought to the ...
Galactose-1-phosphate uridyltransferaseπŸ”,πŸ“Ί

Question#30 (22.9 difficulty score)
A study is planned to assess differences in ...
Cross-sectional studyπŸ”,πŸ“Ί

Question#31 (48.6 difficulty score)
A 32-year-old man who lives at sea level ...
NormoblastsπŸ”,πŸ“Ί

Question#32 (53.9 difficulty score)
A 42-year-old woman comes to the office ...
Spontaneous regressionπŸ”,πŸ“Ί

Question#33 (69.4 difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased
πŸ”
,πŸ“Ί

Question#34 (26.0 difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled β€˜Dβ€™πŸ”,πŸ“Ί

Question#35 (17.5 difficulty score)
A 17-year-old girl with type 1 diabetes ...
Acknowledge the patient's reasons for missing insulin injectionsπŸ”,πŸ“Ί

Question#36 (25.7 difficulty score)
A 40-year-old man comes to the physician ...
PostcentralπŸ”,πŸ“Ί

Question#37 (34.2 difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί

Question#38 (18.7 difficulty score)
A 45-year-old woman is scheduled to undergo a ...
Accompany the resident while the resident obtains signed consentπŸ”,πŸ“Ί

Question#39 (58.0 difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprueπŸ”,πŸ“Ί

Question#40 (34.1 difficulty score)
A 16-year-old girl is brought to the ...
Tail of the pancreasπŸ”,πŸ“Ί

Question#41 (62.9 difficulty score)
Electrophysiology of the heart is studied in ...
Ablation of the atrioventricular nodeπŸ”,πŸ“Ί

Question#42 (27.3 difficulty score)
A 12-year-old girl is admitted to the ...
MethionineπŸ”,πŸ“Ί

Question#43 (28.2 difficulty score)
A 65-year-old man develops a progressive ...
Right cerebellar hemisphereπŸ”,πŸ“Ί

Question#44 (35.9 difficulty score)
A 44-year-old man is brought to the emergency ...
Entrapment of the inferior rectus muscleπŸ”,πŸ“Ί

Question#45 (94.5 difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”,πŸ“Ί

Question#46 (40.2 difficulty score)
A female neonate is delivered at 38 weeks' ...
Rough endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (38.1 difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”,πŸ“Ί


Question#49 (31.9 difficulty score)
A 15-year-old boy is brought to the physician ...
TestosteroneπŸ”,πŸ“Ί

Question#50 (49.8 difficulty score)
A 48-year-old man has complete loss of ...
Area labeled β€˜C’ (Cranial nerve 8: vestibulocochlear)πŸ”,πŸ“Ί

Recent comments ...

... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +41 
submitted by ferrero(43)
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A eryv ilmasri tesnuioq I ahev eens in Qsanbk will kas wyh a iteapnt htiw ihrgt terha lreaifu edos ton eodvple daeme dna the wneras is iaecsrned ylhtpimac di.agnrae I ogt ihts iutqones gronw yirgolalni ebacesu I anrsdewe aonlg htis ienl of goeainnrs tbu I kihtn in ihst asce it lal sha ot od ithw HRWEE hte eartx urrspese is migonc from. nI ihst nistuoqe the pt ahs ctilsidoa iysrteennhpo so ouy nca thnki aobut hte sepsreru sa nicgmo o"r"awdfr os sigtocrntinc eiprplcalrya nsihcetpsr cna perentv na earsncie ni ursepesr in the ilplaycra ed.b wroeHve fro htirg heart fearliu isht rexat iulfd si igmocn mfor the PPOOISET nieicortd kwscarabd( mofr eht itghr trah)e and tositcgnnicr calpelpyrair pisrectnsh anc do ngtonih on( pspotieo esid fo racyplail d)be - eht oyln awy to pvtnere meaed is to cearenis yhitmplca aeargnid.

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +16
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +9
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +35
cr  the main difference between the 2 cases is that in this case the patient has high BP +1
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +6
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2
asteroides  I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +4
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +40 
submitted by yotsubato(1086)
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saW it juts em, ro ddi gea" at teons ni rase"y rpeaap HTIRG eavbo teh nubmre of it,tenasp aetrhr hatn hte an.me hchWi ecsofdun me for a dogo 3 sei.tumn

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +18
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +9
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +9
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +7
monkey  what is 36 supposed to be? +1
thomasburton  Think the number of people in that group +5
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99" +5
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +4
veryhungrycaterpillar  This is straight up tatti. I was like what muscular dystrophy is showing up with an almost biphasic age of onset between adolescence and 30s? Fucked it up. +
... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
 +39 
submitted by sajaqua1(557)
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A adn J rerepnset eth claiger a,uucfislcs eilwh B nad I pesrenetr the tecaneu cic.aflusus egehoTrt thye meak pu hte sdrola oeuclmdmla-in semlniacl ctatr, lnieobspres for itpnpoin ncoer,ipetp pcprneoitopr,oi rabotnv,ii dna .seuerrsp puItn si psilaeail.rt

C nda H eamk up eht reaaltl cltoopciriasn catrt laos( acllde hte lertaal cepieranoblrs csfs,luucai) psneisebrlo rof ootrm amcodnm fo asllriepiat mlb.si

D dan G penrerset het tlaarel ilmthcaoaipsn tctar. tI is lebospeirns rfo ainp adn tprueaertme oounndc.cit eTh nputi irasse ni a ilmb etf(l rlowe yixmetter in hsti sae,c) trnsee gothurh het salrdo orto pd(citure beweten J and )H, sesuacedst adn edascsn ta eth orarntei cmourissem tsj(u denibh E dan F), nad iyfanll assynpes no eht csonde rredo enunor ni het aalterl laniaocthimps at.crt So teh pilacoinmhats trcat si einbspsroel for ertnlaatlcoar naip and tepuretmera neoasnti.s escBeua oru ntetaip sha otsl etiaossnn on eht t,fle eht lsenoi si in eht righ.t

E and F rae teh tanriero icraolcisnpto tcrta. It si lnoivvde in rotmo toclnro fo ropilmxa lsec,smu atyipclly of hte tknu.r

nor16  good job +6
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +2
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +3
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
 +37 
submitted by hayayah(1100)
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oCmooalb si na eye iarnytmlbao atht sccruo rebfoe .brthi heeTyr' gismisn piesec fo itessu in ctuerustsr taht morf hte .eye

  • laomsCoob gfatincfe eht ,siri which tsurel ni a eo"kh"ley rpceanpaea of hte upp,il ealgrelny od ont ldea to sioivn .ossl

  • oosamlboC loivngniv hte eantri telrus in ovisni sosl in cpciiefs rtsap fo eth ivslau fid.le

  • eargL arltnie blaomocso ro hotes eaicngftf teh ocpti rnvee cna seauc owl niso,vi hhciw nemas onivis osls thta atconn eb etmcypolle rctecoerd thiw sslgeas ro otccnta elen.ss

mousie  thanks for this explanation! +1
macrohphage95  can any one explain to me why not lens ? +
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss +4
qfever  Do anyone know why not choroid? +1
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina +2
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +11
mnemonicsfordayz  Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO. +1
mamed  Key here is that it doesn't affect vision- the only thing would be the iris. All others are used in vision. Don't have to know what a coloboma actually is. +3
azibird  The extra section of that Zanki card specifically says that a coloboma "can be seen in the iris, retina, choroid, or optic disc." Don't you dare talk trash about Zanki! +2
fatboyslim  Honestly, I didn't understand what they were trying to ask...NBME has some weird wording sometimes +
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +35 
submitted by sne(49)
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ooccillAh = cpcraienta yiefcsicif.unn icn,ielLo colie, dan miilcapt acdi acn be oabrbsed tiothwu ceipcrtana slaipse scnei y'three sjut eref tftay adcis. esTcgdlieriry ened ot be nrkboe odwn by lesaips ebreof .orspabotin

Beli csiad are hte aimn dheotm ofr gintnmileia ,csteorehllo ont trpcaeacin syeemnz

rina  also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out +4
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +32 
submitted by stinkysulfaeggs(103)
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idD ynoane lsee og down he:t 'essh tnsovyeihpe so eymab lls'eh tge htsuwareoe rcefhendisri mdnrsyoe seacebu gnoithn slee is mkiagn eenss to em at ihst ?npo??it troue -

rusnT otu, vsreee iaalmra can eucsa iadsluvacroacr poesalcl and nh.oieontyps

redvelvet  me too :( +2
abigail  me three :( +2
yex  Me four :-/ +2
link981  Slowly raising my hand as well +2
tinydoc  Sammmme +2
bullshitusmle  same here!!!:@ +2
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +13
aisel1787  me five( +1
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +2
alexxxx30  sammmeeeee +
snripper  Dumbasses unite lmao +
usmleaspirant2020  lol saaaaame! +
usmleaspirant2020  lol saaaaame! +
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1
veryhungrycaterpillar  I have no idea how I got this right. +
feanor  And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols. +
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
 +31 
submitted by seagull(1677)
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athW a rirtbele .pecturi yThe thye dcveroe pu tpra fo ti ihwt ie.snl TWF

sympathetikey  Agreed. +16
catch-22  Start at the pontomedullary junction and count from superior to inferiorly (or medially to laterally): VI, VII, VIII, IX. +3
yotsubato  I looked at the left side (cause the nerves arent frazzled up). Saw 7 and 8 come out together nicely. Then picked the right sided version of 8 +11
lolmedlol  why is it not H or I on the right side; the stem says he has hearing loss on the right side, so the lesion should be ipsilateral no? +2
catch-22  You're looking at the ventral aspect of the brainstem. +10
catch-22  ^Also, you know it's the ventral aspect because you can see the medullary pyramids. +1
amarousis  think of the belly of the pons as a pregnant lady. so you're looking at the front of her +5
hello  which letter is CN IX in this diagram? +
miriamp3  there is no VI nerve. That's the thing. The VI nerve should be in the angle between the pons and the medulla. Parallel to the pyramid. It goes V then VII and then VIII. I make the same mistake and I thought it was the picture but there is no VI par in the photo. They know We count from superior to inferior. +
jesusisking  Don't G and H lowkey look like VII and VIII? I chose H b/c of that +
ljennetten  G and H are CN VII and VIII on the left side, while this guy has right sided hearing loss. CN VI is not labeled in this photo, but is the smaller nerve that arises medial to CN VII and us cut most of the way up the pons. +1
prolific_pygophilic  Mother Fuckers took this with a disposal camera then deep fried it. What is this grainy ass picture +1
soccerfan23  There's over a million pics of the brainstem on the internet and of course, the NBME picked the worst quality, most blurry one for this Q. +
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
 +29 
submitted by soph(70)
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oyu ndee to ownk ffid tb avntigee erssprue iniavtloent cwhi(h si amlron )ttnilevnoia nad itiopvse srssepuer tvientloina (hhcwi is nleamcicha tenln.otaiiv) In egtevani euesrspr annioettlvi het ghaapidmr stcnroact akigmn a - arelpitnralu eprssuer cwhhi lwsalo aioellv ot pxaen.d in vtesiopi onlvintaiet et(h tp hmapgdrai si ont nticacgotrn thus otn xigdpanen hetcs vatiyci nda tno eticrnag the - urespr)se het acehnim is tcreanig spoievti srsueepr sdieni velalio os os ovelali .ednapxs ):

jbc5356  The smiley face got to me more than it should have. Preciate you. +6
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
 +27 
submitted by beeip(129)
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Teh bste I nca snue,dntadr eh'reyt cidbsreing lmdateneior aprlpehysai, a sluetr fo secxse tnoge,esr a idrstoe oerhonm ttha ternaoasslct to hte uclunse dan snbdi sti nrtnaricsipto .fctrao

mousie  My exact thinking also! +7
sympathetikey  Ditto. +
meningitis  My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things? +
criovoly  You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS +4
feochromocytoma  The question stem says it's glandular hyperplasia "without" atypia It's just due to increased levels of estrogen causing the hyperplasia +4
faus305  This is a bunch of scientific mumbo jumbo +1
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +27 
submitted by seagull(1677)
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hTis si a etpy II eRaln urTubal dcs.iAsoi My ailMdec oScolh eeNvr thtgau itsh ot .em dDi uyo aosl og ot vyterpo med holocs? I'm uiresprsd yhet eenv egva su ioltte aeppr.

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +11
yotsubato  I didnt have physiology in my medical school. None, zip, zero, none. Nor did I have biochem. They said "you learned all this shit in undergrad, youll memorize it again for step 1 and forget it promptly" and then just moved on. +9
jcmed  In the Caribbean thats 1 thing we were given... lots and lots of toilet paper +2
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +26 
submitted by thomasalterman(161)
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iaraMla cna piaimr tipaehc enclsgneogeusoi nad can asol uconems oguecsl ofr tsi nwo tbolceami smaddne.

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +57
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +9
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: https://labmedicineblog.files.wordpress.com/2018/06/mal3.jpg?w=840 Life-cycle: https://www.cddep.org/wp-content/uploads/2017/06/malaria-life-cycle_4-1440x1080.jpg +1
dul071  i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia. +
curlycheesefriesguy  I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
 +26 
submitted by yotsubato(1086)
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oS rof Cdniada ew nca esu

olszeA c)au(eoozfnll in(iihbt 5PYC40 naetyie)mtdloh

cnmproitAhe B (rpoe fmionoatr ni falnug lecl renmbm)ea

gnsfoCnupai (pervnet gkicrnoslins of eatb cslnuag in lecl lal)w

ro Nintays ofr laro or lahpaseeog scaes pe(ro foanimr)ot

Tshi nteqsoiu is sgnayi tath she is ngitka an AROL dgru to artte adiadcn gniastivi.

ntmAerohcip si VI

nCgnufsaoip is sloa IV

os ere'w tfel twih loesza

zoAels iinbhti sytisehsn fo eootseglrr yb tnniibhigi YCP 450 htta coesnvrt lontosreal to rroesog.tle

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +1
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2
staghorn  Me - picks Metronidazole -_- +1
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5
turtlepenlight  I have seen that on the wards so I hope it works! +
fexx  and my smartass picks amphp B +2
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +3
fatboyslim  @alexxxx30 according to FA2020 page 153 Nystatin is only for oral. In the 2018 FA it did say it can be used for esophageal but they edited that in 2020. +
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
 +25 
submitted by sajaqua1(557)
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lactiriC onstpi for tshi qnesiuo:t 5 erya odl o,by usmsespiuedonpmr bueecsa fo tymeceph,oahr 2 day ihotysr of r,eefv ,huocg htossresn fo rte,bah rfielbe 180.(1 F), psnstaoierri nim/,64 tiwh ncisasoy and zelendegiar rliaecvus rhs.a eivtExnes rdlunoa infi.tlnoatir

fO eht opitsno litdes olny laeemss and VVZ evgi a asrh. A arhs orfm selames uyslalu ttrass llayorrts dna snceddse uyllcd,aa adn is tlfa adn yeusatet.mohr By toarcnst, VZV c)e(pihkconx eessntrp whit lgazedeienr arhs tath qyliuck asnsitoritn rfom lmarcua to appular enth to acvliuse.r

sympathetikey  Good call. +6
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +6
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +2
... wired-in made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
 +25 
submitted by wired-in(67)
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Mnaanetecni dsoe faulomr si sC(s Γ— lC Γ— tua) Γ· F

whree sCs is tdtstaa-esye atrget pamlas .cocn fo ud,gr Cl si neaecrlc,a aut si aogeds etvnlair a;mp& F si bbiioa.ailvltiay

ethireN asgoed nalrvtie rno liaivbytbiloiaa si vngie, os ogngirin eoths ;am&p pungggli in hte rsbmenu a(rlcfue ot rvcenot uisnt ot :/agdymkg/)

=2(1 uLm/g Γ— 1 0g0/1m0 )gu Γ— .090( /gk/hrL Γ— 0100 1Lm/ L Γ— 42 h1/r y)ad
= 25.92 /daggmk/y

hchw.i.. nt'si any fo hte rewnas hescioc e.ildst yeTh umts veah roddune 009. kL/g/hr ot 0.1 Lr/g/kh, adn iodgn os eivgs ctxyael 828. ymk/adg/g ocieh(c C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +76
hyoid  ^^^^^ +11
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9
praderwilli  Big mad +9
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +9
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18
bigjimbo  JOKES +1
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but iΒ΄d appreciate if someone could explain it. +1
d_holles  LMAO games NBME plays +2
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +5
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +3
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +20
qball  Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +1
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😑 +
yesa  12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s +
... welpdedelp made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +25 
submitted by welpdedelp(242)
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oN tide ec,yiceifnd het apeintt ahd xseces entreaoc ude to ish etdi

sympathetikey  Would never have thought of that. Thanks +9
medschul  that's messed up dog +20
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +
davidw  this is directly from Goljan "Dietary Ξ²-carotenes and retinol esters are sources of retinol. Ξ²-carotenes are converted into retinol. (a) Increased Ξ²-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7
davidw  Ξ²-Carotenes are present in dark-green and yellow vegetables. +
hyperfukus  ohhhh hellllll no +7
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +7
cbreland  I'm okay with missing this one +4
veryhungrycaterpillar  That was fucking stupid. I've known this excess carotene fact since 8th grade due to a friend getting it, but I still wouldn't have thought of it. I went with anemia, figured it had to be folic acid since B6 would have shown up sooner than four years. UGH. +
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +25 
submitted by water(38)
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,grlnpiyruiss I aatlyulc nealder hsti rfom eth gicaM lShooc uBs nhwe I aws a kid. 'saTth hte ynol esoanr I got isth rghti. Thknsa .sM F!ziezrl D:

paulkarr  She taught me more than my med school professors did... +5
... hayayah made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
 +23 
submitted by hayayah(1100)
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eH ahs cealf oeneinncctin so ihs erletanx prtinhcse is gaad,mde wihch is itevradnne yb hte eaudplnd .n SS.-)2(4 Teh pcvlie claisncpnh sreenv, chhiw emaeidt teh oenetcri ,oecpssr aer salo 4S-.S2

thomasburton  Why could this not be dysuria? +3
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +16
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +3
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +2
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +
... sajaqua1 made a comment on nbme23/block1/q#18 (A 15-year-old boy has nasal polyps and develops...)
 +23 
submitted by sajaqua1(557)
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neyzEm A dsastn in rof ohlpishaepsPo ,A2 riutngn ipoohphlsdsip ni eht llec raneebmm iont hnaoadcirci dsi.ca orFm tree,h enmzEy B tsadns ofr aeCoxyoseyclgn )(OXC, ewilh zneymE C dtssna ofr ioLngeayspx-5e O()5L.- L5O- dsupecor E5,TP-EH which is etrund tion i.eunleokerst netuiLokeesr ypal a ebdolu erlo ni sevtne ilke aasmht, uebsace eyht ceuas cronotinnohccirbtso nse(e in siht atpen)ti and by nagitc sa ehmilacc astacntartt rfo maytmanrfoli selcl, osehw citayivt lilw leocs eht yaawir u.rtrefh By lbnokcgi XOC (pbesmuryla ihwt an AN,)DIS ew eleva emro of eth ettsasbur iohaairncdc aicd fro -OX5L to utmlilaeyt tncevor oitn kersuio.netle hsiT si het bsisa rfo ea-n-irntslmotnraaa,phisti hchwi is qyteluerfn dtisacsaoe wiht nlsaa pyso.pl 'samSe(rt tair.d)

Fxshrplaekw/g3t9re/re5.95otiTtlawmc//:l/wu4t.c

)D iPcoacsltnyr sseanhyt . E) eonmTbaorxh tayhesns

... sajaqua1 made a comment on nbme23/block1/q#28 (An otherwise healthy 82-year-old man is brought to...)
 +23 
submitted by sajaqua1(557)
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rirooesPt ordc morysned roucsc ued ot natcfirion fo eht rptosroei fhal fo hte nplsia ,crod frmo ooluscinc of hte epotorrsi anlsip rteayr. ruO epaitnt eresnpst tihw aedrcesed ensistano to rkpiipcn boewl eth velel of the esnke sa lelw as aglwnik htiw a dd-eawseib ig,at lleiyk ciingndati ossl of inpir.opecporto eTh tipenta si lsao cmenia hwit gmts-nhdyeepeer nuir.lhopets

tpseHneemregyd plntuhoeirs rea ylycaplit ucesda by na biiaynitl ot akem enuogh A,DN sucead yb a clak of arsneceys reposrucrs adn smtinvai ingldicun 9B fol()aet and 12B m.ila)bnc(ao fI teh tntaeip is tlefoa cfteeidin, ew ees eeelavdt icoyetosmhne ie.efcdyicn fI the atteinp is 2B1 nec,fidite ew ees eatdelev ilyemontcmahl idca nda tescynmoieoh vellse. ontomrsypeehyeiiamcH can rsciaene sth.mioosbr ibhsoTsmor ni teh ptserioro psialn yaretr acn escua rtrsoeoip cord ymdsnroe. nI nioa,ddti aclk of imnatvi B12 imisrap ymline omtiorfna and desal ot Sueabcut omdiCebn girte,nDoeaen hihcw asefcft eth amtaipcoinhSl rctta tgonu(iancc fro sreaceedd ikprcnpi ,sn)naiteos npctiroaliCos rTac,t dan sraoDl dMlleaonmuCi- eincLumss Tartc n(ccingutoa rfo het duedrce .irtoepooincprp

A) Aornrite rocd en-odyrsm lsso fo ormot mcm,naod sa ellw as alearitbl sosl fo ahet dan ian,p teh tntipae sah otn lots tromo it,cuofnn so it naonct be th.si B) nteralC docr ymrs-oned tepernss sa a mciiotnanbo fo omtro nda nsysero o,sls luulsay twih dbdaerl nnus.tdyifco hTsi naiptte edos otn iydaspl romot sslo or dblarde nutnsio.cyfd C) ordimecH -dsnermyo osAl llacde Sn,dB-uqorwera this is poltmcee jyinur to ierthe hte letf ro irhtg seid of hte plansi dco.r tI srpenste wtih oormt ouycnntfdis dna flexre idntucsoynf taylpllriieas ta het vlele fo teh seoi;nl sslo fo erppu mroot onamcmd wbloe eth lonsei lalilyeiatspr (sictspa eaps;)rsi sslo fo lasdro mrcdeanriuolc- esnanisto rstyeaipllali ta nda lwoeb hte e;lnosi dan ssol fo npia nda rereueattpm saoitesnn ralynalocteartl 2 ot 3 atrvbree wbleo the olens.i E) gSryeetmna -enomdsry a olgnintaec frueali to podeelv rtpa of eth nsapil .ocrd ehT new noest of ytmmossp at 28 syear dol kmesa sith an uileynkl s,gs.idaoni

yb_26  amazing, thank you! +
aisel1787  great explanation +
rockodude  sensation to pinprick is DCML tract. SCD affects spinocerebellar (not spinothalamic), corticospinal, and DCML. otherwise good explanation. +2
azibird  Sensation to pinprick is not dorsal column-medial lemniscal tract, it's spinothalamic tract. So this patient has a lesion of the dorsal columns, spinothalamic tract hypersegmented neutrophils, and anemia. What the hell is going on? How is this just posterior cord syndrome? Spinothalamic is not posterior cord. +4
makingstrides  Like most of these questions, pick the closest/ best answer. For reasons above, this is the best one. +
skonys  FA19 pg69 says B12 deficiency causes SCD AND parasthesias. This patient has progressive numbness/decreased pinprick, ataxia (spinocerebellar & DCML). Also it's important to remember that B9 and B12 both have megaloblastic anemia but B9 DOESN'T have neurological symptoms. +
... praderwilli made a comment on nbme23/block2/q#10 (A 50-year-old man who lives in eastern Minnesota...)
 +23 
submitted by praderwilli(70)
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ta'snW resu outab ,ksetciRati but I kewn brnoi fo dosexi asw no ihs crtcelyi ni het tothrnaes adn tgtgien rdtrutoe yb teh mripeva s.beab

mimi21  LMFAO facts ! +11
... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
 +22 
submitted by thomasalterman(161)
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Seh sujt ecdpletmo eht srceuo fo ,rtaxumbii chhiw tarsetg 0CD2 r.srtcoeep leBc-l ifieneccyd cna esdoepispr to abeictral nstcnife.io

b) BM ierfual si tno edsoicatsa itwh xuirt bciam) )gonrdw wg oer)n htsi rcocsu ni/w 107- asyd of nrittgas nt,rmetate nda dowlu nto cuorc faetr pegtonlcim a t4-honm eroucs fo ruim.iabtx

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +20
stinkysulfaeggs  Same. Crap. +2
medstudent22  Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization. Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded. +1
... sajaqua1 made a comment on nbme23/block1/q#42 (A 68-year-old woman comes to the office because of a...)
 +21 
submitted by sajaqua1(557)
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ehT itnepat ash a porri syrtiho of oyercstehytm thwi btraieall ooroto-camo,phygeslnpi dna eevcdrie lraetxne eabm tiadaionr ot het i.evpsl eTh itteapn wno yaslpsid edonpsrihyshro nda r,eryeuohdtr whit tasldi rueltear nawornrgi leiatraly.lb hTe ielkislet tnioop is taht we era gnseie dssaehino ofrm uisvreop yrugesr ttocncirs teh terr,sue igascnu .sthi

E) airUtllheo crnamcoai alo(s leadlc nrtaitolinsa lelc acionacr)m si aosl a bipsltiosyi. What eskam tish eillkuny is teh toanclo:i iralaelt.b ehT rirpo htsyrmeoctey and ltlaeibra lso-omaecoioyptponhgr owldu elave arcs issute no htbo disse fo eth ybod, btu het odsd fo ahleurtilo iccoanram igsrain aibtllyaerl rae eyrv ims.l

)A hTe itpaent dah a tehm,yyercsto os eht sddo fo rrnctueer clvricea naicracmo aer salo crdlbeynii .wlo C) and D) trelahrU naoyomlcd dan lauterrh ataisinlornt lcel lalamppio rae ni eht nrwog lnactoio to occtanu fro iaaelltrb rlahteru raonirwgn ithw etedorhury.r

stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect). +14
spow  Why would the onset be 15 years later though? +3
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor. +3
yesa  My understanding is the cancer risk with radiation is late-onset, a decade or more after the fact +
fatboyslim  Why does she have increased daytime and nighttime urination? I couldn't figure that part out. +
... mcl made a comment on nbme23/block3/q#28 (A 10-year-old boy sustains an abrasion on his left...)
 +21 
submitted by mcl(618)
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snBuo iqkcu ievwer

... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +21 
submitted by smc213(151)
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oT be loetcmpyel rel!ca

iThs iettnpa has issontsyiC a erra atolumsoa ecvsieesr lmsolaosy tsaroeg drdrisoe nda omst moomcn secau fo Fnacoin eodynsmr in nrih.ecdl isiCyntsos is sscetmiy nda esald to cetsiny aystlcr itdespos ni lclse nad seutiss gtthuouhro het .yodb

lAutoghh sisnlWo dsseiae cna adle ot ,FS the slrcyats ni eht areoscn dose otn caretoerl ihwt lsWnsoi se.sdaei
Mreo fo:in v1nigttaomcc1b./C.rw//0/weh.shn/cl.Mlpiwpni6stm:P84/4

highyieldboardswards  Thank you! You are a legend for figuring this out! +
paulkarr  Appreciate you. +
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT =Β IncreasedΒ excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1
... cocoxaurus made a comment on nbme23/block1/q#43 (A 65-year-old woman has the recent appearance of a...)
 +20 
submitted by cocoxaurus(55)
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ePr LOW-DRU ainaAoccnmorde is casoatsdie /w unlg sgricran aederlt to nuguroalsmato es,daeis dol OCDP irh)cn(oc and mdaage due to nrtrecure anemi.pnuo

arcanumm  Here i was thinking i was being clever by not being tricked by distractors when metastasis is more common... +6
brise  Metastatic would have multiple lesions +
... colonelred_ made a comment on nbme23/block2/q#28 (A cohort study is conducted to examine the...)
 +20 
submitted by colonelred_(111)
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bltttiAuabre iksr = dininceec ni xdpeeos – ncdecieni in spexonued

= 00/001,3 smkseo)r( - ,3000/03 okoes)rm(nns
= 300. - 010.
= .020 (so hte taulirbaebtt srik is uoabt )%2

Apyipgnl it ot a otoipnpaul of 00:,100

= 0.02 * 00,001
= 002

charcot_bouchard  What if i tell you this is a ques of Attributable risk % in exposed? AR= 0.02 / IR in exposed (30/1000) = 0.6667 30 case in 1000. So 300 case in 10,000 0.6667 x 300 = 200 or in another word 66% cases of 100 lung cancer cases in smokers is actually due to smoking. so in 300 cases of smokers 200 is actually due to smoking +4
charcot_bouchard  This is a mind fuck. Lemme tell u guys if any consolation while doing the ques during test i did it with AR = 0.02; NNH = 1/0.02 = 50. 50 persons smoke to cause 1 cancer. 10K smoke to cause 200 cancer. +3
ls3076  Sorry if this is a stupid question. Why is it incorrect to simply apply the same proportion (30 cancer per 1000 smokers) to 10,000 smokers? +2
krewfoo99  @is3076 Thats exactly what is did. I still dont understand how that is wrong. But i guess they want us to think about it in terms of AR +
hhsuperhigh  @Is3076 and @Krewfoo99, If a person doesn't smoke, the natural risk of getting lung cancer is 30/3000=1%. The smoker's risk is 30/1000=3%. This 3% is not purely contributed by smoking, but mixed with the natural risk. So for calculating the pure contribution made by smoking, you should use 3%-1% which is 2%. And this 2% is the pure contribution of smoking. Not all smokers get lung cancer, the same thing, not all lung cancer among smokers are attributed by smoking. They may get lung cancer anyway despite smoking or not. +16
... mousie made a comment on nbme23/block2/q#8 (An 8-year-old boy is brought to the physician by his...)
 +19 
submitted by mousie(237)
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oniMfarda tsahuib + oalMscu umanosre + kcNe sasm = ENM 2B M)MP( hP,oe udlMryale oirtdyh AC i(ilnonctCa es,tecnrg)i salumco ansroume

thotcandy  I knew it was MEN2B but forgot medullary ca of Thyroid is parafollicular/c cells which means Calcitonin, not T3/T4 Other answers: AntiThyroglobulin: Hashimoto's (or other thyroiditis) Dexamethasone suppression test: positive/suppressed in pituitary adenoma (acth secreting), negative/unresponsive in Adrenal hyperplasia/adenoma (suppressed by high dose) or ectopic acth (unresponsive to high dose) Serum TSH test: for papillary or follicular ca, thyroid adenomas are usually cold but could also cause HyperT TSHR antibodies: graves disease, hyperT +2
... sajaqua1 made a comment on nbme23/block3/q#5 (A 68-year-old woman has a 6-month history of...)
 +19 
submitted by sajaqua1(557)
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ihTs ettnapi hsa arewepdids otitercdsnu fo otbh nlerada lasndg, ihchw senma thta ehs lilw leos thob hre nrialcomcdstreoiio dna reh g.rduictooclosci hTe sosl of eth oeorcontsdcimiarli nad eht teeffc no teh dyeksin is hwta si gebni tetsed r.ehe nheW erlostnaode si tnigicnnfou nda ,tbandanu it sah esarlve rliaictc niutocfns no hte ronpnh.e t,isFr it eeuarpsuglt N+Ka/+ aePsAT roesxipnse no teh tslraalbaoe ,anbeemrm ebtnilgaishs a gnsrto ciareotcleelchm ratdegni ttha ebtert bsboasr aN+, ehwli teh escidnear ulralnietlacr +K otionrncancet amkse ti seraie to eosl K+ ofrm teh ellc oitn het leunm. oeslontdAre slao ruepgaltsue teh oseixprens of eitellhipa sdioum ashcnnle )EaNC( no eth tcilgonecl utdc, raisrbongeb mroe N.+a iFny,lla lreondasteo secresnia ieposxenrs of +H aAssTeP on ealchedaraa-pltnti cslel of teh ecinollgtc udc,t hhiwc ear obeisnsrlep ofr tgecersni +H ihst( si prat of cncnrttaooi )ks.loliasa

Wiht teh sosl of a,elntrdeoso we lwil see a essreaecd +aN/+K nieartdg dna ddcersaee +aN e;arboirpostn hsti edlas to ecesadrde merus smiduo dan esadreinc usmre ossu.taipm tA het mesa emi,t tno peignresxs +H PesAsaT lilw deal ot H+ ont genib ce,etrdse cnrteiag a remo ciidac einneonvmtr (Hp illw .ardeces)e

abhishek021196  Very well written explanation. Bravo +2
... sajaqua1 made a comment on nbme23/block3/q#38 (A 5-year-old boy who has recently recovered from an...)
 +18 
submitted by sajaqua1(557)
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eTh aomrwr hsows suprrcseor ot ceoytyesrt,rh sa lwel sa agmsy.ecyraekot Tish is to hsow you htat teh seuis 'tsin u,dndpotruceorin hwchi mnesa that we era isgoln BRC dna altslteep ehoeswrem ei enstourc.itd That rusle out D dna .E herTe is ihnnotg ot ctdenaii hta the dhcli sha nimdsdtsieae lrstbusoeicu .)B( At tish iptno ew ear tfle hwti A or C. A ludwo iacidten enmsaiDtsedi srtrIaanlcauv tnalCaoouig ICD)( or mntsoeigh maiil,sr wchhi dowul tluser ni lwo lsteltepa dan CBR tub ew odwlu laos see laormabn BRC ikel hitccysoesst (hete""ml )lc.sle We era liplectixy ldto thta het ehetsoycyrrt are onrrmomcioch nda inmcryoo.ct Hvoe,rew nmmiue suicorntedt fo tteleplsa spelaxin ti l-al teh tsecudrnoti fo alelestpt lesad to mose eoharngrighm nad so a drpo in ,BRC adn TPI cayliaclssl esiasr trefa a nertce urpep trapyseiorr atctr ialvr fiieno.nct

meningitis  Just in case anyone is wondering like I did, the low platelet count explains thethose multinucleated cells. They are Megakaryocytes in Bone Marrow Biopsy. +12
nwinkelmann  Also, don't forget that autoimmune thrombocytopenia purpura has 2 demographics: young kids, which generally resolves spontaneously fairly quickly, and then young adult females which is a true autoimmune condition that doesn't resolve. Patient's age + thrombocytopenia + essentially normal rest of heme pannel = autoimmune thrombocytopenia purprua in child. +7
abhishek021196  That is exactly how I approached this question. Normal heme panel and a decreased Platelet count in a young boy after an infection just made me intuitively select ITP. +
... youssefa made a comment on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
 +17 
submitted by youssefa(141)
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mPto:aha - oepcLmtyhsy aer het msot eissnitve slcle ot owehl odby atraidion - loGycersunta i(nalyM hrnesiutlp)o rea lpcrutiarayl yrve sivitsnee to hcephectueimtora naglitakyl agsten nuriiqer(g SF-CG htysrol a)erft

arcanumm  Always think of NEUTROPENIA when chemotherapy is treating rapidly dividing cells (a small fever is an ER visit for these patients). +7
... imnotarobotbut made a comment on nbme23/block2/q#17 (A 21-year-old man comes to the physician because of...)
 +17 
submitted by imnotarobotbut(168)
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aersiVcl emahslsiiains eaucss egmthylaepnosalpoe nda msto ltaopmitrn,y aeoy.inpanpct tI si ontfe uodnf in lepope hwo ivits the deilMd Etsa and is dtrtsnietam yb the lfnSday. yWh did ENMB utp 2 asanLimieh ussetoinq no tsih rfmo oll

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +12
rongloz  I got both questions within 5 questions from one another! I was seriously doubting my answers haha +1
faus305  Visceral Leishmaniasis affects about 0.001% of the world population each year so it only makes sense to have two questions on it. https://www.cdc.gov/parasites/leishmaniasis/epi.html#:~:text=For%20cutaneous%20leishmaniasis%2C%20estimates%20of,to%20400%2C000%20or%20more%20cases. +2
underd0g  How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia? +
faus305  @underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa. +1
jaramaiha  Sketchy for the save :) +1
srmtn  also if they say pancytopenia...they could have mention anemia in order to make us answer malaria +
... usmleuser007 made a comment on nbme23/block2/q#23 (A 75-year-old man with prostate cancer has...)
 +17 
submitted by usmleuser007(418)
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  1. erCasnc fo eth iesvpl, nicudgnli eth er,astpot spaedr to het almabucolsr ipsen aiv eth travelreb ouvnes sxelup V.V)(P

    • heT PVV uinetcoscamm hiwt a bmneru of suevno k,onewtrs nigncduli hte ipostctra vonesu xel,pus chhiw evceseir eht uovnse lppsyu form eth arttpeso, epsn,i adn ldrba.de

    • VVP srnu up eth rnetei linpsa uomlnc nda teosnncc iwht het ensuvo spuypl fo the banir via a vllsevesa msteys so(nats’B lsxP)ue whhic laowsl rfo dnocbileiiatr lwof nad nulariotge of ntclaianriar reirphssusT.e nvoseu ntocineonc to hte leabecrr onairlcuict yma eplh aiexpln the iopnpesryt fo tosumr to eemaaszsitt ot het nraib.

  2. eTh VPV soal tcmaciomsune twih het yzgsoa eivn ni hte ,ctshe hwich xsainple in patr ywh rstbae and gunl cnaecsr lrenteyquf eszmeasiatt to teh acorciht pni.se

    • lSm,yliria edu to uanopmlyr neusvo adeargni toin the eflt eisd of het ,tarhe ugnl usotrm nofet epdasr ystialelcmsy iav hte laraeirt stsem.y
  3. guhloAht mlyph nsedo rea teh omst mconom sitse of siestmsata in legaern, mphylcita radsep ot the tkselael sysetm si eryv ea.rr

  4. eTh npmmorafpii xlsupe ivsereec osuven gerndaai ormf het sttesi, mydeiipi,sd dna stuudc frdseene adn rainds noti het iasuettlrc isne.v

... sympathetikey made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +17 
submitted by sympathetikey(1439)
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uhTog .suneqoti

cllRea atth Mteaniemn ereza(m'lhsi )rgdu is a ADMN Rpeotrec stnAitoang tath psleh vnpeter extxttiyococi by oBcgnlki 2C+a rntye. a'tshT woh I rmermebe ihts.

veryhungrycaterpillar  https://www.jneurosci.org/content/10/3/909.short Great little read, and this is the paper they pretty much based this question on. +
veryhungrycaterpillar  Linked the wrong paper. Meant to link this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867560/ +
... sajaqua1 made a comment on nbme23/block3/q#3 (An 18-hour-old male newborn is 61 cm (24 in) long...)
 +17 
submitted by sajaqua1(557)
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seceaBu eht ba'ybs tmeohr ash epTy 1 ieaDsteb lu,mltise it is puealblsi htta hyet ahd aelevtde obldo cgleous eselvl nidrug or lsrthoy beerof i.bhtr Islunin sdoe ton orscs the nplaeta,c tbu ecgulso es,od os idugnr ibtrh hte antoene wdlou avhe eebn m.ilygecreyhcp hsTi wuodl dela ot het eoaatlnn apcserna lsangeier iilsnun, rivgndi oelcsug inot sclle nad ngnuitr ndwo ieesnncgolu;oegs htis si hyw eth aybb is yciymegolhpc htrig .won

)B readeeDsc lnyecggo rtccneioon-tan I t'dno wkno the ocgnlyge tccirtenonnao mredaocp ot na lduta atnpiet, btu a reesacde in oyeggnlc reaotcitncnno loduw ainectdi oelu/yelgcscggon salre,ee icwhh owlud tno be a cylgimeopyhc ts.eta )C cdsaereeD nyolgcge yehtssan -iitctvya rdsaeeecd nggyolce shetsyna tivatcyi sindeciat gneyer slobicaat,m nda ouwdl elda to hierhg rmuse leuocgs l.svlee D) rDeaesdce ursem unsniil nnora-occnteti caeddrese urmse liuisnn uldow dale ot hgehir leevls fo ucoelgs in mur.se E) neaecrsdI reums inlu-iilknse trwgoh cofart- IGF seod tno bidn yaenlr sa lwle ot siuniln potresrec sa nnliius oe,sd and so lwudo avhe ot be in rtmeeylex gihh estcornoiannct to have tish ceft.fe GFI is soestdicaa hwit mostaci owrght adn lmescu leope.dtenvm

yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +6
alexb  Also explains why he's 12 pounds. +4
krewfoo99  Also, think of it like this: Insulin causes hypoglycemia, thus this baby must have increased insulin. It is also an anaobolic hormone which is clear by the babys weight. Insulin increases glycogen synthase activity, and causes an increase in concentrations of glycogen. Decrease in insulin would do exactly the opposite +1
tyrionwill  fetus of a mom with DM will develop pancreatic beta cell hyperplasia, which leads to insulinemia trying to reduce the blood glucose. after birth, the excessive blood glucose will be automatically withdrawn while the insulin at that moment is still high, which leads to hypoglycemia. +3
... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
 +17 
submitted by alexxxx30(57)
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idd nnoaey sele evha ot dreera htsi sitoqeun reaelvs m?etis Teh mignujp bakc and orhft mfor "sthi nepdehap efrbe,o 1 ewek arf,et 6 kesew rtaf"e nhet this ppedenah to,ayd the"n hits epneahdp 6 eekws otp"ops aegv me iwhpsla.h elTl hte trsoy in oe!drr ahha

confidenceinterval  RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +1
faus305  Quentin Tarantino wrote this one +1
homersimpson  Some Westworld Season 1 Shit +1
... mcl made a comment on nbme23/block3/q#26 (A 27-year-old woman has headaches and blurred...)
 +17 
submitted by mcl(618)
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tentPia wthi llbrtaeai elanr rryeta bsriut nad siynptrheone ilwl ofr srue vahe vioaactint of SRA mssyte adn hrfroeeet cniesera ni niita.gesonn

hgutAlho ohroopmtmyheccoa nda ecqostnnue eeatledv elnaticchmoaes nac naeiescr oldbo ssupee,rr spommsty era tliyyaplc eoicpdsi nad ranle btuirs ear ont eilykl ot be .eahdr dtvEeeal lsvele of tnosioner cna salo ceusa syeo,rneiphnt utb ew ldowu losa tecpex ot ees iuhgfls;n ,laso rehet si onnihgt ni hte stme to dicaniet epntita is aikngt sIRSS ro msngoeiht esle hatt duolc iedsesporp her ot dvaetele sellve fo e.osnnrito aEeetlvd sellev fo rhdioty mohreno oudcl also gevi eptiant ieoterynhs,pn btu ew dlouw loas teepcx htroe nsisg of syphtehyirdoimr eo,(rrtsm witheg ls,so )e..ct

I swa a tletil cnfuodse fi PEO olwdu eb deeevlat -- if eehtr si osstsine fo rnlea iarertse as( adidietcn by het srubi)t eth seydikn ucdlo salo edectt this as oxyiahp dan mpar up uodtpnroic of .EOP ev,Hwero I neded pu gigon twih songaeintni nseic ti esmdee eomr eoctnec"r" to em htta ARS lodwu eb .up osDe eynano nwko wyh t'si nto E?PO

brise  Wouldn't that be more long term? +4
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2
... sympathetikey made a comment on nbme23/block4/q#21 (An otherwise healthy 26-year-old scuba diver has...)
 +17 
submitted by sympathetikey(1439)
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rHad ot ese deu ot roop cpetrui iylt,aqu but deabs on athw I duocl ,ees it sseme kiel a soauspnoetn oahuxemrtnpo to em dabs(e on eth clka of lgun kiarmgn on hte tefl rpdeaomc ot eth rthig d.i)se

,orhTeefre cnsei hte ngul si delde,taf lal oyu ldouw have ni het etlf eisd of hte peno tcvia,y hcwih lwoud emak eht tfle desi yarts.eprnsneoh

sugaplum  FA 2019 pg667 +16
... yotsubato made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
 +16 
submitted by yotsubato(1086)
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siTh si a niosuteq utboa tnpteia praiyc.v hTe iptatne reeh is eth .dhicl Teh orxyp rfo eht anptiet si hte thrmoe and .tarfhe yhTe stum nwok twahs r.ngwo ersitS adn roemth are ujst yoooo,klls and transpe mya ont atnw to ltle hmte dpi(stu I now,k utb eavtrwh)e os uyo nesd ehmt out and tehn eltl het etnsrap the nais.iotut

dr.xx  agreed +
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +29
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +11
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +8
... aladar50 made a comment on nbme23/block3/q#29 (A 50-kg (110-lb) experimental animal receives 1 L of...)
 +16 
submitted by aladar50(40)
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’mI ton het ebst ta the ilcsaocnault fo FCCE,/FI tub albcaylsi ouy rae finsiung a ehoprtcyni nolstuio onti hte .lainma latyii,nIl sith si lla gniog to go itno hte lxltrcaluerae acep,s sa any IV fnnisoiu liwl o.d Since ti si egihhr than ncotiios uiosln,ot ewtra si ingog ot og fmor hte tlruiclalerna peasc ot eth araxeuellcrtl pesac ot rty ot aalcbne it ,uto os teh rlilnratlecua asecp lilw veha decedesar eumvol nad deracenis imylsoaotl n(ceis oyln wrtae si ev,anlig ikamgn it eorm oncrttene.)cad

oS you knwo rfo rseu CFI evouml si desedcear adn aooyilsmlt reic,dsena dna the texcrrellalua olevum wlil eb r.scedneai I hnkit het amooiyllst fo het talxcurelelar escap si het itrcky rapt dan eth rpta hewer beyam msenoeo lsee nac lphe with eht llotucsainac but bsalliacy ’ist hyiertcpon ohngeu atht eth oollmyasti liwl istll eb ascd.renei

btl_nyc  Since hypertonic solution was added, osmolality has to go up. The degree of the hypertonicity doesn't really matter. The fluid flowing out of the ICF will increase ICF osmolality. Since water follows salt, the water's gonna flow only until the ECF and ICF have the same tonicity. So if the ICF osmolality went up, the ECF osmolality also had to go up, because they both need to be equal after the water is done equilibrating. +20
krewfoo99  ECF fluid is hypertonic because we infused an hypertonic solution. ECF volume is going to go up because A) we added more volume via injection B) Sodium attracts water, and since hypertonic solution was given water goes from ICF to ECF ICF volume decreases because the water is going to ECF. This causes an increase in Intracellular osmolarity, since you have more solutes compared to water (Less water to dilute it) +1
btl_nyc  0.9% saline is isotonic. When "normal saline" is given to a patient in a hospital, it's 0.9%. I think that's something you're expected to know. The good news is that now you do. +
... yotsubato made a comment on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
 +16 
submitted by yotsubato(1086)
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Yhae us,re ltes eivg hte guy hwo watsn ot keep ish ckdi gokiwrn nad eb ectrittvaa rdtwsao nwoem eadinrsFeit nda lyemplocte iurn ish eooesetsrtnt eelslv adn iegv ihm a lpim ckid, nam obbs,o nad ceaesdrde recnfapmeor ni rpsost.

eomtsmeiS het ENMB lryael sjtu esakm em kas hyW?

Tpaolic ioixidlnm oduwl be ywa eetbtr tbu no tyeh ontw tup ttha as a hoicec

anjum  To clarify: the lack of DHT production caused by finasteride leads to gynecomastia and ED. The other options are synthetic androgens. Totally agree that this question goes against the benevolence vs. maleficence that we've been taught in medical school +
... jrod77 made a comment on nbme23/block4/q#17 (A 24-year-old man has a grade 3/6 systolic murmur....)
 +16 
submitted by jrod77(30)
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The oiclysst errusspe fefdrceeni weeebnt het left leevitrcn dan eht oaart ni iths p.t is ttyepr sigcn,infiat reWsaeh in a aromln hatre estho lsyiotsc rserspuse houdsl be ustj buoat el.auq hisT intsh ta the tfac ahtt het lfet eivctlnre sah to put ni olta fo rwko to psuh ohrthgu teh iocart vveal. taTh atxer ersrpues ogse toni ninpego hte vlvea adn oesd ton aeppra ni hte o.atra

divya  why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6
leaf_house  @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005156 +
cbreland  @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gunπŸ˜” +
jbrito718  @divya I think it has to do with the fact that the left ventricle is pumping so hard that some RV hypertrophy may occur since they contract simultaneously. Chronic aortic stenosis will eventually reflect backwards, causing increased pulmonary vessel resistance. +
... thomasalterman made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
 +16 
submitted by thomasalterman(161)
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tPniaet sah hoapiyeylmtc rav,e sa eencdidev by t,eoyohirsctsry ogu,sinrtscloya nda edsahaehc mpa;& .sidziens OEP si drsecadee edu ot cery.tohsoiysrt eeercasdD PLA ulodw edaitnci CLM, not PV.

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +4
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +10
arcanumm  Tricked me. I knew right away that it was PV, but I thought PV would crowd out normal cell creation (e.g. decrease platelets). So apparently crowding out normal cells is just a quality of AML/CML? +1
drzed  More AML. Remember Sattar always stresses that all the myeloproliferative disorders are expansions of ALL lineages, ESPECIALLY "xx" (depends on which one, for CML it'll be granulocytes, for PV it'll be RBCs etc). They're called MYELOproliferative because all the myeloid linages go up, but one will be increased more than the rest. In this case, it is the RBCs. +5
... nwinkelmann made a comment on nbme23/block4/q#47 (A 43-year-old woman comes to the physician because...)
 +16 
submitted by nwinkelmann(311)
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rmMuusr and :rsunvemea s1t tgthhou = how deos it chgane hwit le.odapr All rsummru tpeexc OCH,M M,VP dna raliat oxammy tsreievy is dirylect oraplotonrip ot hgncea ni pdoarle .ei.( rendaseic owesorld=rape rrummu, .e.)ct saueecB of st,hi DDx cna eb rnodrawe nowd to MHOC, ,VMP dna atilar mxamyo tirhg waya eabuces teh urrumm dosnrewe tiwh sacdedere rlpdoae ..e(i itsnagnd pu) whne lla btu xtocesepin wiht imrvpe.o

altAir myaoxm = CMC mpyrria raadcci mruot ude to iaronprtlieof of ecneivonct ssteui mnyehce;mse a pctnduuledea mass ecncneotd iav aklst to atrimu tpmues atth si npdsesued in eht lriaat obodl vlmeou dna ovsem hwti eth vluome emmnvoet.

nos:rnaetePti rtdia fo )1 ltmair vvlae outcotnsirb .e.(i lesai,ma mmyspost fo idracac fri,ulae escop,yn )c.e,t )2 psmsoymt fo oeimlmsb ie(.. afacil dan ighrt mar serhaeipmsi ni p,tnia)et nda )3 ttslontciauino momssytp .(ei. erfve, wethgi s,osl tyosmpsm nbmreisgel tcnveoncei seusit edise,sa sebaceu umrot rlseaese 6.L)I- ehrtOs dleicun ienucrlogo ymst,pmos mp-"leritudosa avlev dssee"ai tcuuortsyala nsfiindg (.i.e ioidalcts mruu,)mr nda tirala nleermantge wic(hh ocdul sprocmse nnudrgiyle sestrtrucu dan acsue yopmssmt .)loas

otN onyl oesd sgtainnd eedasrec edro,lpa hihwc nmsae AL vleumo si wlroe os msas 'itns sa "dep"dneuss tub roem ,leimob atdnngis laso iecensras teh arnodwdw aioatrgtnvi ce,rof wihch wudlo teitrcnubo ot teh toumr mvinog dtswaro the sabe fo eth aartli ahcbm,re igppp""nlo on eht tailmr valev slfeelt,a nad yttleloanpi gnidtenxe rutghoh nad cuingas a nifaolnutc tpey fo atrmli onissste i.(.e rnwosieng oicstaild .)muurmr This ovdie exailpsn ti ylaelr ll:ew ?hpstL6==oiVabc4Yveswa1ml;oghymp.wIttt6tcs&uw1/:/.u/wn

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +7
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +4
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +1
... nwinkelmann made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +15 
submitted by nwinkelmann(311)
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o,S for eoms ,nreosa otrsarrtntmieesnu si hmstinego evI' WYLAAS sdlugterg ...htwi obalrbyp uaseebc I stwan' tghaut ti elwl so rveen rayell realden t,i sutj redaeln gneohu fro ehavwrte eam.x I tujs fodun ihst obo uothhrg BICN nda tis NTS!IAACTF tI's fmro 1200 so mihtg be ,dlo utb ti asw eg.rat Yuo can rhesca hrohgut the obok dan nidf teh ctar.hspe I tpyetr uchm jstu twen hrothug lal fo eht smtunoertntirrae cetrpha. /m/oihtkb/oKpw99.sgn.nwibtNnho1.0Bl.:cs7w/v/

yM ainm yusewtma aa-Gleat:kta = amjro yxicttroea enurroirtentmst.a woT espyt fo es: tp)1ercro iatoecrm,obpt stmo of hwhic rae ceyantppisr iG hhiwc dlsea ot cdadrseee AMDN eoeptcrr vtiiytac dna ikrs fo ,tiioticeotxyxic or csnspayottip qG rtorspeec atth ldae to eresncai ,+Na K+, nda rdesaeecd mtgtaluae sceusa izaoldotrieapn nda scndiaree M++g ncseitmedpla nda NDAM pctrreeo iaivttcy and sikr fo xiocyi,ottictxe and )2 icootpirno nhsnalec dunliginc ANMD adn t/iaknaAMPAe snnlac,eh hwich lal awlol ncnficsopei aoctin ufnlix, but lyno DNAM solwla ++aC ulifnx (nad loyn in a taoegvl dpdeteenn nreman reaft ituffesnic azitrnelopdaio sah icasddlep hte htbniioir Mg++ ion ni hte ln.c)ehna

BAAG adn celngiy = itinhibyor rrensmttuernsioa.t 1 ) -BGAAA dan BC-AAG = tcpoiioonr senhclna taht adle to lufxe fo ,lC- and eptides hist ugnsica nezi,atarpldooi teh reunon lilst tssay owlbe sgnerit tponeialt. ABAAG- diinbng esit rof sattebia,brru d,itseors ,ABAG dan itxioncpor = isiend reop of hcen.nla -AGABA inbnidg tsie fo sdenpzbezeiinao = edosiut fo pero fo nalcenh. )2 cylneGi canhnel is a eyrv iilrams -lC felxu ce.nalhn 3 ) B-AGBA is a tmtaeobicpro nenachl atht ttcvesiaa iG dlnaegi ot edascdere McAP cwihh tcevisata ufxelf +K ncelshan and iiibtnsh aC++ fixlnu hnenlcas enadilg to aieorlnzprphty.aoi

iiogcBne enamsi = eehtamalcoscni adipenom naodroitoi(cn of ydbo tmeve,nom waerd,r tmtvna,oioi c,)renmoeefrnit preienhpeonnir e,lspe( nf,laksuseew e,ntotnait igdfnee hr,beaivo nppieehnier t(oselw cnnatocornite in S),CN ulps nosroinet s,(pele ussw,ekfealn srsonpeed,i yxatne,i euas)an nda shiteiamn (ulsar,oa nattoni,et ya,elrlg tsseiu g,amaed nad aym ennuelfci doolb nabri .ow)lf obOuls,vyi lal fo ihst si ni dtoaidin to rnricgaeed ousrnnoesmrtsinai dna filh,tg tfg,irh dan tgihf prosene.s

PTA nad thore npseriu = iayetcrtox nrissaiosm,nt elaeds-oerc htiw eohtr uloslemmel-lac .etatsieuosrnntrmr Annedeiso 'nsti lclayasicsl eisreodcdn a rrretouinnmsteat ubeeasc it 'nist ssrraoeded/etel in ++aC dneeentdp ,nemarn tbu revddie rfom PTA reobef ngvaih an yceittrxao enlapoitt.

yllAthcnoieec = amroj atrruemnstonirte ldoveinv in rnrusanoemitsnios avi imcanrus dan icintnioc rtecso.rpe

iedetPp mtsrtntenorsreiau = mynoocml seadeerl as ppipdeeort rlgare spresrcrou ttah rae ldaecev by ceipsfic mynszee thta erwe ni eht mase nntturrstoemiaer ecvlise ounp rleease. veFi pytes = r/ungibat e,eptspdi dooiip ,teidsppe airtpytiu tidpes,p icphyothaaml gasnerile ooh,smren nda setho nto sfidcs.alie lmsepEax = roprusrce that ivseg ersi ot ansstbcue P hspupom(aip,c ntre,oocex nda ITG nad edlreaes orfm amlls emdirtae SPN C sbiefr tath srtitnam apin dna treatpmuree onmr,iatfion efrwpluo ev,ospeiythn hebtidini yb idpooi t)dep,spei iuinrkenon A, depueirpneto K, and neruoptieedp ,aagmm adn opiido tepedspi dignncuil lapnt adlalikso keil( mpi)noh,er scihetnty ioopid tii,vesradve and ,nrdhnipsoe dsyonirhn,p nad hpe.sinaeknl nI nalreeg idioop dipeepts rae sesdstprena (e.i. gsnialaae s,ncmiaem)h vnodliev in pexmcol rabivesoh a(lsxue ttoianctar, mv/ievesgsgiisesabrus saoehr,vi)b adn limctpdaei (guothh otn dtevfiie)ni in ciiarphctsy eddosis.rr

lOev,lar tsetnomrsraetnuir = tyep y:stpe u-lmolcllmseae tnssaetrtmri nda uer,deppetsnoi werhe aelosmsl-ulcmel rtstasenmtri aer afrest dan aeitdme pdrai itypsnac smisniasnrot .(i.e rogennda SSN tfhrh/tfgi/gihligtf iucqk epns)rs,oe hwree sa erdsetponepui la(ogn htiw cgboioli siamne nda smeo lsaml lmeeuloc iatnrttms)sre rea rswloe dan atemeid dag,laur olreopdng smenoionurasrts.in

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sweetmed  This is amazing. thank you +
sweetmed  This is amazing. thank you +
paulkarr  Woah... +
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +2
dorischang  Didn't finish reading this, but it looks awesome +2
... sympathetikey made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
 +15 
submitted by sympathetikey(1439)
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nAy meti you ees dexif wdei tintgipls of 2S, hasms SDA.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +
usmlecharserssss  with airpods in 2012 +
paulkarr  Low key was hoping for someone to try and argue this one... +
... lfsuarez made a comment on nbme23/block4/q#22 (A 40-year-old man with terminal small cell carcinoma...)
 +15 
submitted by lfsuarez(146)
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Tshi aniptte rtpesnes iwth a sllam elcl rmaccoain cwhih si very nmoomc for para castielnop o.dyrsnmes In sith aecs eht carcen si gisnuca HA.IDS ocnDelelcyeim si a tilccnatryee cbinittoai htat si asol used to eartt DHISA

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +17
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +4
... sympathetikey made a comment on nbme23/block4/q#30 (A study is planned to assess differences in...)
 +15 
submitted by sympathetikey(1439)
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ggseBti ucle saw ttah erhte saw no itme afemr n.egiv eere,forhT htsi sesem ot eb a c"slie in iem"t s,dyut whchi leins pu tihw cross nascloite stuy.d

paulkarr  Damn, epi at it again... +5
... brolycow made a comment on nbme23/block2/q#19 (A 70-year-old man with severe congestive heart...)
 +14 
submitted by brolycow(30)
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eH sah arhet eruifal chiwh sldea to a sedreeca ni laenr odobl wfol dna lperearn taae.moiz nI eprrlnea iaot,mzea UNr:CB irtoa si tg;&= 2;0 ovAittniac fo het RASA tyssem due ot eht leerpanr azitemoa enmas hatt eth ecps vgar is ghhi ta 1.250 adn he is ligohnd tnoo sdoumi so ynairru oudism lliw be low l&02;,t( NFEa ;1&.%)tl

brolycow  I just usually remember from class that spec grav 1.001-1.010 is considered dilute urine, and anything 1.025 and above is concentrated. For this question specifically, I think I remember there only being one option that even had the ratio >=20, all of the others were like 15 or less, so just have to rule them out. +9
benzjonez  Very helpful video for acute kidney injury: https://www.youtube.com/watch?v=bMp6IxDKK2Q +9
notadoctor  Another explanation that helped me is that inability to concentrate the urine means something is wrong with the kidneys. If you have dilute urine, or the spec gravity is between 1.001-1.010 in someone with low urine output it suggests something is wrong with the concentration mechanisms of the kidney. Because this person had congestive heart failure we were already looking for something that matched up with prerenal azotemia so we can pretty much get rid of all the answer choices that suggest other azotemias. Then finally to get the precise answer I looked at the BUN/Cr ratio which you would expect to be high(>= 20). +
drdoom  @mikay92 is this the OnlineMedEd video you're referring to? -> https://youtu.be/EWFgzVtMN50 +1
drdoom  aha! there is an updated AKI video but you need an OnlineMedEd (free) account to view it: https://onlinemeded.org/spa/nephrology/acute-kidney-injury/acquire +
... seagull made a comment on nbme23/block3/q#19 (A previously healthy 32-year-old man is brought to...)
 +14 
submitted by seagull(1677)
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sTih tpnitea si ngtrppii sabll. rtBete od a rdug cenres cwhhi essme oisovbu.

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +45
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2
charcot_bouchard  Lol. I got the right answer but took long time +
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +1
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +1
targetmle  why is there basal ganglia hemorrhage? +
dul071  Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1
usmile1  basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +2
... thomasalterman made a comment on nbme23/block4/q#29 (A 2-week-old male newborn is brought to the...)
 +14 
submitted by thomasalterman(161)
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tanPtie is rnteruc ,rs-ebdtfae so we acn mtlniiaee tfsoucer ftro(csue si nudfo ni onyeh and ftiurs nad osme mrao,ful tbu nto in sbatre mkl)i. atinetP ahs ucingdre ucsnbsstea tbu no lucegso ni eth ,inuer so eh sutm smoe uocon-nsgel .asurg yM ifeelandrfit for giducrne olcgnsneu-o rssgau in het eniur is sderorsid outescrf ltemisamob or oastlgeac mlsoembi.ta eW aevh ieeitnmald et,cfuosr os htat eeslva us wthi ncgtoasilekaa cnyfdiieec ro scascil gei.sacaoltma

sympathetikey  & Galactokinase deficiency would be much milder. +8
smc213  Big was soybean formula not giving any issues. Soy-milk can be used as a substitute formula in patients with Classic Galactosemia since it contains sucrose (->fructose and glucose). +3
almondbreeze  @oslerweberenu G6PD - increased RBC susceptibility to oxidant stress (eg, sulfa drugs, antimalarials, infections, fava beans) -> hemolysis; has nothing to do with presence of reducing sugar +1
makinallkindzofgainz  @almondbreeze; Glucose-6-phosphatase deficiency is Von Gierke disease, they are not referring to G6PD deficiency (an entirely seperate disease) +8