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NBME 23 Answers

reproductive FA19p634
Block/Question (50.5 difficulty score)
An asymptomatic 30-year-old woman comes to ...
AnovulationπŸ”

oncology microbiology
Block/Question (20.2 difficulty score)
A 56-year-old woman comes to the physician ...
Microbial oncoprotein that interferes with tumor suppressor proteinsπŸ”

digestion
Block/Question (39.6 difficulty score)
A 52-year-old man comes to the physician ...
TriglycerideπŸ”

embryology neurology FA19p479
Block/Question (33.0 difficulty score)
A male newborn has a myelomeningocele that ...
Closure of the caudal neuroporeπŸ”

clinical_trials FA19p256
Block/Question (20.2 difficulty score)
A study is conducted to examine the ...
Phase 2πŸ”

psych personality_disorders borderline
Block/Question (18.8 difficulty score)
A 32-year-old woman comes to the emergency ...
BorderlineπŸ”

biochem cell_bio
Block/Question (37.2 difficulty score)
Which of the following is present in integral ...
Transmembrane regionπŸ”

biochem drug_interactions p450 pharm
Block/Question (26.5 difficulty score)
A 30-year-old man with HIV infection comes to ...
It increases plasma concentrations of other PIs also metabolized by cytochrome P450πŸ”

schizotypal psych borderline
Block/Question (13.0 difficulty score)
A 45-year-old man is brought to the physician ...
SchizotypalπŸ”

bed_bugs micro
Block/Question (53.8 difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureusπŸ”

anatomy neuro
Block/Question (37.3 difficulty score)
A 55-year-old man who has a 10-year history ...
ImpotenceπŸ”

micro moa
Block/Question (27.3 difficulty score)
A 48-year-old man who is a farmer in a remote ...
Blockade of postsynaptic inhibition of spinal motor reflexesπŸ”

prevalence incidence
Block/Question (40.4 difficulty score)
A researcher is asked to prospectively ...
Prevalence: above the standard; Incidence: above the standardπŸ”

hit FA20p315
Block/Question (18.0 difficulty score)
A 65-year-old woman develops deep venous ...
Heparin-induced thrombocytopeniaπŸ”

physio cholera fluids
Block/Question (19.2 difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% SalineπŸ”

biochem restriction_enzymes
Block/Question (62.2 difficulty score)
Physical analysis of the isolated genomic DNA ...
MethylaseπŸ”

anatomy
Block/Question (46.7 difficulty score)
A 54-year-old woman comes to the physician ...
SupraspinatusπŸ”

biochem pathways
Block/Question (29.4 difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme BπŸ”

biochem genetics
Block/Question (39.2 difficulty score)
Unlike the DNA polymerases found in ...
Mistakes in transcription are not transmitted to progenyπŸ”

repro embryo
Block/Question (27.6 difficulty score)
A 22-year-old woman at 12 weeks' gestation ...
Hydropic villi with central cisternsπŸ”

cd_markers rituximab
Block/Question (41.9 difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”

immuno
Block/Question (47.3 difficulty score)
An investigator is studying the adverse ...
Presentation of antigens to CD8+ T lymphocytesπŸ”

parkinsons neuro
Block/Question (30.6 difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agentπŸ”

endocrine
Block/Question (30.8 difficulty score)
A 39-year-old man comes to the physician ...
FerritinπŸ”

micro
Block/Question (42.0 difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virusπŸ”

genetics
Block/Question (30.8 difficulty score)
A couple comes to the physician for ...
1/150πŸ”

developmental
Block/Question (25.7 difficulty score)
An 11-year-old boy is brought to the ...
Sexual abuseπŸ”

neuro
Block/Question (46.4 difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”

immuno
Block/Question (38.9 difficulty score)
A 34-year-old woman with a 5-year history of ...
Infiltration of lymphocytes, plasma cells, and macrophagesπŸ”

Block/Question (30.1 difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnicsπŸ”

Block/Question (34.2 difficulty score)
A 16-month-old boy is brought to the ...
Absence of germinal centers in lymph nodesπŸ”

Block/Question (19.6 difficulty score)
Which of the following sets of serum findings ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased
πŸ”


Block/Question (52.5 difficulty score)
A 25-year-old woman and her 25-year-old ...
Ξ±-Thalassemia traitπŸ”

Block/Question (39.6 difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancerπŸ”

Block/Question (34.1 difficulty score)
A 42-year-old woman comes to the physician ...
Binding of permeable ligand to nuclear transcription factorπŸ”

Block/Question (26.3 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”

Block/Question (33.1 difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”

Block/Question (24.1 difficulty score)
A 43-year-old woman sustains multiple ...
Hyaline membranesπŸ”

Block/Question (30.9 difficulty score)
A 65-year-old man who is a farmer comes to ...
Disruption of DNA strands secondary to ionization effectπŸ”


Block/Question (42.2 difficulty score)
A 62-year-old woman is brought to the ...
PonsπŸ”

Block/Question (43.4 difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”

Block/Question (38.0 difficulty score)
A 65-year-old woman has the recent appearance ...
AdenocarcinomaπŸ”

Block/Question (30.3 difficulty score)
A 34-year-old woman is brought to the ...
Area labeled β€˜D’ (Spinothalamic tract, right)πŸ”

Block/Question (22.4 difficulty score)
A 56-year-old woman comes to the physician ...
Presynaptic release of acetylcholineπŸ”

Block/Question (15.8 difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...
BoneπŸ”

Block/Question (31.1 difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”

Block/Question (46.1 difficulty score)
A 20-year-old man is brought to the emergency ...
3,4-Methylenedioxymethamphetamine (MDMA)πŸ”

Block/Question (60.8 difficulty score)
Electrical stimulation of the stellate ...
Heart rateπŸ”

Block/Question (39.5 difficulty score)
A 45-year-old woman with coronary artery ...
4.5πŸ”

Block/Question (30.8 difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporisπŸ”

Block/Question (45.9 difficulty score)
Cyclophosphamide and some other ...
GranulocytesπŸ”

Block/Question (44.9 difficulty score)
A prospective study is done to assess the ...
Include the outcome for each participant in the group to which he or she was randomizedπŸ”


Block/Question (35.8 difficulty score)
A female newborn develops respiratory ...
Osteogenesis imperfecta, type IπŸ”

Block/Question (36.9 difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis BπŸ”

Block/Question (45.1 difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shockπŸ”

Block/Question (29.3 difficulty score)
An 8-year-old boy is brought to the physician ...
Serum calcitonin concentrationπŸ”

Block/Question (29.9 difficulty score)
A 60-year-old man has had easy fatigability, ...
LungπŸ”

Block/Question (29.1 difficulty score)
A 50-year-old man who lives in eastern ...
Babesia microti and Borrelia burgdorferiπŸ”

Block/Question (20.4 difficulty score)
An antiserum is elicited by immunization with ...
Proteins X and Y have no epitopes in commonπŸ”

Block/Question (33.0 difficulty score)
A 75-year-old woman has stress urinary ...
Stimulation of Ξ±-adrenoreceptorsπŸ”

Block/Question (30.7 difficulty score)
A 45-year-old man comes to the office for a ...
Invasion of the submucosaπŸ”

Block/Question (9.6 difficulty score)
A 65-year-old woman with diabetic ...
MucormycosisπŸ”

Block/Question (78.9 difficulty score)
A child with septicemia has an antibiotic ...
28.8πŸ”

Block/Question (62.7 difficulty score)
Which of the following best explains impaired ...
Increase in axonal capacitanceπŸ”

Block/Question (25.0 difficulty score)
A 21-year-old man comes to the physician ...
LeishmaniaπŸ”

Block/Question (21.2 difficulty score)
A 48-year-old man comes to the physician ...
Perforated peptic ulcerπŸ”

Block/Question (48.7 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”


Block/Question (31.6 difficulty score)
A 47-year-old woman has had a goiter for 10 ...
Replacement of thyroid parenchyma by lymphoid cellsπŸ”

Block/Question (34.3 difficulty score)
A 55-year-old man comes to the physician ...
FEV1/FVC: normal;
FVC: decreased;
Diffusing capacity of the lung for carbon monoxide: decreased
πŸ”


Block/Question (32.1 difficulty score)
A 42-year-old man comes to the physician ...
Sand flyπŸ”

Block/Question (24.2 difficulty score)
A 75-year-old man with prostate cancer has ...
Prostatic venous plexus to the vertebral venous plexusπŸ”

Block/Question (32.2 difficulty score)
A 46-year-old woman has a 1-day history of ...
Leukocyte alkaline phosphatase activity greater than 250 U/LπŸ”

Block/Question (48.4 difficulty score)
A 44-year-old man with invasive pancreatic ...
Area labeled β€˜Hβ€™πŸ”

Block/Question (29.5 difficulty score)
A 36-year-old woman comes to the physician ...
Fibromuscular dysplasiaπŸ”

Block/Question (30.2 difficulty score)
A 3-month-old girl is brought to the ...
Densely packed capillariesπŸ”

Block/Question (39.2 difficulty score)
A cohort study is conducted to examine the ...
200πŸ”

Block/Question (21.8 difficulty score)
Which of the following pairs of drugs ...
Lomustine and cyclophosphamideπŸ”

Block/Question (42.3 difficulty score)
A 21-year-old man is brought to the emergency ...
LiverπŸ”

Block/Question (8.3 difficulty score)
A 40-year-old man has had enlarging breast ...
SpironolactoneπŸ”

Block/Question (71.6 difficulty score)
A 2-year-old girl is brought to the physician ...
N-methyl-d-aspartate (NMDA)πŸ”

Block/Question (57.1 difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”

Block/Question (28.0 difficulty score)
A 35-year-old woman comes to the physician ...
Synthesis of viral DNAπŸ”

Block/Question (23.5 difficulty score)
A 42-year-old man with a history of recurrent ...
Magnesium ammonium phosphateπŸ”

Block/Question (26.4 difficulty score)
A newborn has external genitalia that appear ...
Hyperplastic fetal adrenal glandsπŸ”

Block/Question (17.1 difficulty score)
A 62-year-old woman is brought to the ...
Embolus to the femoral artery with left leg ischemiaπŸ”


pharm lipid_disorders fibrates
Block/Question (40.4 difficulty score)
A 39-year-old woman with obesity and recently ...
GemfibrozilπŸ”


Block/Question (37.9 difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canalπŸ”


Block/Question (45.6 difficulty score)
A 2-week-old girl is brought to the physician ...
IrisπŸ”

Block/Question (53.9 difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary changeπŸ”

Block/Question (23.2 difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nucleiπŸ”

Block/Question (12.7 difficulty score)
Which of the following types of vaccine is ...
Live attenuated virusπŸ”

Block/Question (32.0 difficulty score)
A 65-year-old man is scheduled for physical ...
Medial (internal) rotationπŸ”

Block/Question (25.3 difficulty score)
A 45-year-old woman is brought to the ...
Inspiratory pause on right upper quadrant palpationπŸ”

Block/Question (32.9 difficulty score)
A 56-year-old man comes to the physician ...
ColchicineπŸ”

Block/Question (12.2 difficulty score)
A 65-year-old man recovering from a cerebral ...
Preventing ADP-stimulated platelet activationπŸ”

Block/Question (49.0 difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sacπŸ”

Block/Question (34.0 difficulty score)
A 35-year-old man comes to a new physician ...
LiverπŸ”

Block/Question (35.8 difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”

Block/Question (72.3 difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
HypoglycemiaπŸ”

Block/Question (19.5 difficulty score)
A 68-year-old woman has a 6-month history of ...
Na+: decreased;
K+: increased;
pH: decreased
πŸ”


Block/Question (38.2 difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cellsπŸ”

Block/Question (12.2 difficulty score)
A male newborn is delivered at 39 weeks' ...
GastroschisisπŸ”

Block/Question (27.0 difficulty score)
A 62-year-old man with a blood pressure of ...
LabetalolπŸ”

Block/Question (24.7 difficulty score)
A male newborn is delivered at term to a ...
Ask the mother and sister to leave the room and inform the parents of the abnormalityπŸ”

Block/Question (29.7 difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curveπŸ”

Block/Question (14.5 difficulty score)
A 50-year-old woman with idiopathic ...
Penetration of larvae from soil into the skinπŸ”

Block/Question (24.7 difficulty score)
A 39-year-old man comes to the physician for ...
Ξ²-MyosinπŸ”


Block/Question (16.0 difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresiaπŸ”

Block/Question (25.1 difficulty score)
A 45-year-old woman comes to the physician ...
MyopathyπŸ”

Block/Question (25.7 difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary glandπŸ”

Block/Question (45.6 difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleenπŸ”

Block/Question (39.3 difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagonπŸ”

Block/Question (43.9 difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screeningπŸ”

Block/Question (26.8 difficulty score)
An 82-year-old woman is brought to the ...
Decreased function of the puborectalis muscleπŸ”

Block/Question (34.8 difficulty score)
A 60-year-old woman comes to the physician 1 ...
AmplificationπŸ”

Block/Question (37.2 difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudatesπŸ”

Block/Question (28.5 difficulty score)
A pregnant 28-year-old woman is found to have ...
LactotropeπŸ”

Block/Question (45.2 difficulty score)
A 25-year-old man is brought to the emergency ...
Fractional excretion of sodium greater than 2%πŸ”

Block/Question (29.4 difficulty score)
A 43-year-old woman undergoing chemotherapy ...
Preformed IgM antibodiesπŸ”

Block/Question (27.4 difficulty score)
A 27-year-old woman has headaches and blurred ...
AngiotensinπŸ”

Block/Question (20.3 difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defectπŸ”

Block/Question (25.8 difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cellsπŸ”


Block/Question (42.0 difficulty score)
A 20-year-old woman comes to the physician ...
C1qπŸ”

Block/Question (13.1 difficulty score)
The parents of a 1-year-old boy with a ...
MultifactorialπŸ”

Block/Question (25.4 difficulty score)
A 70-year-old man comes to the physician ...
Inhibition of prostaglandin synthesisπŸ”

Block/Question (42.0 difficulty score)
A 78-year-old man has had progressive loss of ...
OtosclerosisπŸ”

Block/Question (20.9 difficulty score)
A 34-year-old woman with a long-standing ...
FatπŸ”


Block/Question (41.2 difficulty score)
A 70-year-old woman comes to the physician ...
Serum sicknessπŸ”

Block/Question (29.1 difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118πŸ”

Block/Question (46.5 difficulty score)
A 5-year-old boy who has recently recovered ...
Immune destruction of plateletsπŸ”

Block/Question (38.8 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased CSF production by the choroid plexusπŸ”

Block/Question (18.4 difficulty score)
A 38-year-old woman with hypercalcemia, ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (26.0 difficulty score)
A previously healthy 45-year-old man comes to ...
InfraspinatusπŸ”

Block/Question (14.8 difficulty score)
A 48-year-old woman has severe ...
Inhibition of gastric H+–K+ ATPaseπŸ”

Block/Question (14.9 difficulty score)
A 65-year-old man has had increasing ...
Osteitis deformans (Paget disease)πŸ”


Block/Question (28.7 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2πŸ”

Block/Question (49.0 difficulty score)
A 19-year-old woman is severely burned over ...
Increased metabolic rateπŸ”

Block/Question (17.4 difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibulaπŸ”

Block/Question (40.0 difficulty score)
A 20-year-old woman comes to the physician ...
Inhibition of the cytochrome P450-dependent demethylation reactionπŸ”

Block/Question (25.9 difficulty score)
Genetic analyses of cells obtained on ...
EpinephrineπŸ”

vascular pressure physics
Block/Question (40.4 difficulty score)
A 32-year-old woman, gravida 2, para 1, at 39 ...
Increased fetal systemic vascular resistanceπŸ”

Block/Question (49.8 difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2πŸ”

Block/Question (53.5 difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitisπŸ”

Block/Question (27.4 difficulty score)
A 33-year-old woman comes to the physician ...
Inorganic phosphorus: decreased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”


Block/Question (19.0 difficulty score)
A 76-year-old woman is brought to the ...
She expresses clear and consistent valuesπŸ”

Block/Question (19.6 difficulty score)
Transmission of a bacterial agent by ...
Meningococcal meningitisπŸ”

Block/Question (27.6 difficulty score)
A 35-year-old woman, gravida 2, para 1, ...
External anal sphincterπŸ”

Block/Question (16.0 difficulty score)
A 3-day-old female newborn delivered at term ...
Increased conversion of bilirubin to water-soluble isomersπŸ”

Block/Question (26.0 difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50πŸ”

Block/Question (17.5 difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetiiπŸ”

Block/Question (41.2 difficulty score)
A study was conducted to investigate the mean ...
99%πŸ”

Block/Question (17.3 difficulty score)
A 40-year-old man comes to the physician for ...
FinasterideπŸ”

Block/Question (48.4 difficulty score)
Investigators conduct a prospective, ...
Strength of association, temporal relationship, dose-response gradientπŸ”

Block/Question (35.7 difficulty score)
A 65-year-old man comes to the physician ...
Smooth muscle cells of the deep arteryπŸ”

Block/Question (46.5 difficulty score)
A 61-year-old woman comes to the physician ...
Closure of the mitral valveπŸ”

Block/Question (38.2 difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acidπŸ”

Block/Question (25.4 difficulty score)
In a study of the use of ultrasonography for ...
80%πŸ”

Block/Question (22.0 difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosisπŸ”

Block/Question (49.3 difficulty score)
An investigator is conducting a study to ...
EnvelopedπŸ”

Block/Question (27.3 difficulty score)
A 6-month-old male infant is brought to the ...
Regulatory T lymphocytesπŸ”

Block/Question (32.3 difficulty score)
A 7-year-old boy is brought to the physician ...
Release of interferon gamma by TH1 cellsπŸ”

Block/Question (27.7 difficulty score)
An otherwise healthy 26-year-old scuba diver ...
Hyperresonance over most of the left side of the chestπŸ”

Block/Question (24.0 difficulty score)
A 40-year-old man with terminal small cell ...
DemeclocyclineπŸ”

Block/Question (37.8 difficulty score)
A 74-year-old woman comes to the physician ...
IpratropiumπŸ”

Block/Question (43.6 difficulty score)
A 60-year-old man comes to the physician ...
ErythropoietinπŸ”

Block/Question (15.7 difficulty score)
An 85-year-old woman is brought to the ...
DonepezilπŸ”

Block/Question (24.2 difficulty score)
A 28-year-old man has hypertriglyceridemia ...
AspirinπŸ”

Block/Question (38.4 difficulty score)
A man accidentally touches the surface of a ...
HistamineπŸ”

Block/Question (59.6 difficulty score)
An 18-month-old girl is brought to the ...
Decreased sodium bicarbonate reabsorption in the proximal tubuleπŸ”

Block/Question (30.6 difficulty score)
A 2-week-old male newborn is brought to the ...
Galactose-1-phosphate uridyltransferaseπŸ”

Block/Question (20.6 difficulty score)
A study is planned to assess differences in ...
Cross-sectional studyπŸ”

Block/Question (43.8 difficulty score)
A 32-year-old man who lives at sea level ...
NormoblastsπŸ”

Block/Question (49.2 difficulty score)
A 42-year-old woman comes to the office ...
Spontaneous regressionπŸ”

Block/Question (62.6 difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased
πŸ”


Block/Question (23.4 difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled β€˜Dβ€™πŸ”

Block/Question (15.3 difficulty score)
A 17-year-old girl with type 1 diabetes ...
Acknowledge the patient's reasons for missing insulin injectionsπŸ”

Block/Question (22.8 difficulty score)
A 40-year-old man comes to the physician ...
PostcentralπŸ”

Block/Question (30.6 difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipaseπŸ”

Block/Question (16.6 difficulty score)
A 45-year-old woman is scheduled to undergo a ...
Accompany the resident while the resident obtains signed consentπŸ”

Block/Question (53.0 difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprueπŸ”

Block/Question (30.3 difficulty score)
A 16-year-old girl is brought to the ...
Tail of the pancreasπŸ”

Block/Question (56.6 difficulty score)
Electrophysiology of the heart is studied in ...
Ablation of the atrioventricular nodeπŸ”

Block/Question (24.4 difficulty score)
A 12-year-old girl is admitted to the ...
MethionineπŸ”

Block/Question (25.4 difficulty score)
A 65-year-old man develops a progressive ...
Right cerebellar hemisphereπŸ”

Block/Question (32.0 difficulty score)
A 44-year-old man is brought to the emergency ...
Entrapment of the inferior rectus muscleπŸ”

Block/Question (84.9 difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”

Block/Question (36.0 difficulty score)
A female neonate is delivered at 38 weeks' ...
Rough endoplasmic reticulumπŸ”

Block/Question (34.6 difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”


Block/Question (28.6 difficulty score)
A 15-year-old boy is brought to the physician ...
TestosteroneπŸ”

Block/Question (44.7 difficulty score)
A 48-year-old man has complete loss of ...
Area labeled β€˜C’ (Cranial nerve 8: vestibulocochlear)πŸ”

Recent comments ...

... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +38 
submitted by ferrero(40)
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A yrve irlisma ioseqnut I vhae esne ni bnskaQ lliw ska wyh a tepitna tihw rhigt atehr ielrufa deso tno deleopv madee nda eht sarwne si eeasnridc cptlyamhi .gaderani I tgo sith ouseiqtn orgwn nroiylagli useceab I aensedrw laogn isht ieln fo esonanrgi utb I hknit in sith easc ti all hsa ot od ihtw EWHER eth teaxr ssueprre is ocgmni mrfo. nI this eotiunsq teh tp sha dislotcia sipnhtnoerey os oyu nac itkhn ubota teh eursprse sa oingcm wr"fadr"o os tcrtningiocs ypcraplrliae tinpesrhcs nca terepvn na ercsinae in surepers ni teh ryliapacl d.be Hrewoev rof grith tehra arifleu hits rxate uifld is cnogmi form het POIOSPET riecintdo ack(wabrds rofm hte hgtir eh)atr dna ritctcnnosgi iepaapcyrrll tnpceshrsi nac do nntigho no( poseiotp ised of liralcapy )dbe - eht olny awy to ntevrpe emdae is to rcieasen lmcyathip iedagnar.

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)? +15
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +6
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. +31
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." +3
... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
 +36 
submitted by sajaqua1(519)
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A dan J etesrpnre the rlegaci siualuf,scc ehlwi B nda I errteesnp teh tenueca fcsuluaisc. goehreTt yhte aemk up eht dsloar dec-aomullinm necmslail tar,tc sblpresnioe fro ptoipnni p,peeroicnt or,rioppetonipc rtvoani,bi dan eserrs.pu tnpuI si sae.liprital

C nad H amek pu hte etarlla conoiscpiatrl cttra osal( declla teh llarate enseapbrlciro aui,lu)fsscc roenelpbssi rof otrom oacnmdm fo lilaptasier il.bsm

D nad G ereeprtsn het aaletlr hipsnmaoiatcl .tartc It si eensrsobilp rof apni adn peturmeerta cniutcdn.oo Teh punti saesri ni a iblm l(fte erwlo xtrtmeiye in htis ,)scea rsteen urohgth the roalsd otro rcu(pdite etewnbe J dan ,H) edusseatsc dna csadsen at eht rintraoe usmsmrceoi (jtsu henbdi E dna ,)F adn fianlyl essanspy on eth oedcns oerdr ronnue ni het trlelaa ailpmtcnhaosi t.trac So teh lncmtoahsiipa artct is soelrbpnise for lroceaaatlntr niap dan ptearueetrm ni.onatses eceBsua uor iatetnp has stlo enantoiss no the el,tf eht seoinl is ni eht .ritgh

E adn F rae het oraietnr rccisnoailtpo .arctt tI is dilvnvoe ni omrot rlontco fo omxalipr c,ulsems aipyyllct fo the kutr.n

nor16  good job +5
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. +1
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 +1
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +36 
submitted by yotsubato(968)
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sWa ti sujt em, or did aeg" ta etnso ni "asery aarepp RTGHI oaevb the nbmeru of a,ietptsn rather htna eth ame.n Wchhi dofnusec me rof a dogo 3 uemtn.si

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +13
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) +7
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +7
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +5
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" +4
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +3
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +34 
submitted by sne(45)
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hcloiAloc = pceatcianr .sfniyinfuiecc ecniLo,il ice,ol dan iclitamp aicd nca be osbaderb wiothtu trpnciaaec aelspsi scien hre'ety utsj refe ayttf aid.cs leriysgicTred eden to be ebnrok ndwo by slaieps befreo tsnpoaob.ir

lBei ciads rea teh amni tmhedo for initigalenm htrocoe,ells ton ratecipnac mneseyz

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 +2
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
 +34 
submitted by hayayah(1056)
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moClobao si an yee bimtolaayrn tath cursco fereob r.ihtb 'ereyhT snsigmi pescie fo iesstu in urcsstutre taht frmo teh e.ye

  • smCooabol naieftcgf teh iris, hcihw rueslt ni a yoheke"l" arpnpeeaca of eht up,ilp aerelylgn do ont elda ot svinio s.lso

  • Cbmloasoo logininvv eht entari tuersl ni invios ossl ni iicfceps atsrp fo eht slivau ief.ld

  • Lgrea tiernla olcsmaobo ro sohte finacegtf eth piotc revne can uaesc wol ionsiv, hwcih asnme svoiin ssol that nnctoa eb tecmolypel erceotrcd hwit lgesass or natctco s.eelsn

mousie  thanks for this explanation! +
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
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. +2
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! +1
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
 +31 
submitted by seagull(1404)
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Wath a eirtrelb i.cpeutr yheT eyth evrecod up prat of ti with nsli.e WFT

sympathetikey  Agreed. +10
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 +4
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. +
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +29 
submitted by stinkysulfaeggs(91)
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diD anyone slee go wndo th:e 'sehs yviphonsete so myeba llseh' etg swuteearho riisrfdncehe mrnsyedo ubsecae gnnoith esle is nigakm sense ot em ta sthi i??p?nto orteu -

rnsTu tuo, verees iaaraml nca cueas vrirdacasoucal laceolps dna sheoyponnit.

redvelvet  me too :( +1
abigail  me three :( +1
yex  Me four :-/ +1
link981  Slowly raising my hand as well +1
tinydoc  Sammmme +1
bullshitusmle  same here!!!:@ +1
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +9
aisel1787  me five( +
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. +
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
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
 +26 
submitted by soph(54)
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uoy dene to wonk fidf tb gnaiteev espsurer nlatoivtnie whh(ic si rnlaom vlnti)eitnoa and veptiiso esepssrur lvtniatnieo hi(hwc is icnhmalace t)enviaio.tln nI naieevgt spersreu oletninvtia het higramadp ncsatoctr ianmkg a - larralupntei seurersp ihhcw wllaos ailloev to dan.xep in espivito nlvtnioeita teh( pt gaphaimrd si ton tniogartncc hsut nto pdannixeg tsech itivacy adn tno rcnieagt hte - essru)rpe eht aienchm is eiractng ivoipest sepursre eidins vailoel os so alvoiel nsdaep.x :)

jbc5356  The smiley face got to me more than it should have. Preciate you. +2
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
 +25 
submitted by beeip(123)
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Teh stbe I cna setarnd,und 'yeetrh iecsdbnrig traleedmino ipyrhaslpae, a elustr fo eecsxs ersgoet,n a tsoedri rehomno ahtt lasrntseaotc to eth uelscun and ibnsd tsi intnciotrpras ftco.ra

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 +
... 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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naeecMnnita osed olrumaf si ss(C Γ— Cl Γ— u)ta Γ· F

wreeh Css si -stteeyatsda tegrta amalps conc. fo dg,ru lC is ,celracnea tua is gdoesa vratleni pma;& F is aaltbiaiy.vbolii

hieNter aosedg ntvralie nro iibtiybaavalloi si ni,evg so rginongi thsoe p;m&a lingpugg ni eth srbemun (urlecfa to evcrton tnisu ot mak:y)g/dg/

12 =( uLm/g Γ— 1 0/10g0m ug) Γ— .(090 r/L/ghk Γ— 0100 L1m/ L Γ— 42 1r/h )ady
= 2529. //aydgmkg

..c.wihh tsni' yna of eht anersw ciocehs deitsl. yheT tsmu have rnduoed 900. rh/Lk/g ot 01. kLr/h/,g dna iogdn os sigve caxeytl 82.8 am/gdkgy/ ohi(cec C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +69
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 +8
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 +3
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 +2
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 +15
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😑 +
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +25 
submitted by thomasalterman(147)
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laMaira nca priami hcatipe leoggeenssinuoc adn acn lsoa oncmsue esulogc rfo sit onw btoaiemcl semdnad.

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +54
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +8
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 +
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
 +24 
submitted by sajaqua1(519)
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iCiarltc inospt fro thsi qne:stiou 5 eyra lod ,boy mirodspneepsuums eacebus of ,opryeatcehmh 2 yda otshyri fo ,veefr uh,gco eornthsss fo brae,th lfbeier .18(10 ),F nroaiertsips n4i/6,m twih nsaosiyc adn gerleeaidnz cleusviar r.sha eniesxEtv naudorl rn.tniloiiatf

fO eth inoopst tidlse lyno smeelsa and ZVV igev a srha. A asrh from leassme suylalu asttrs aorrltlsy adn deesdcns ayd,uclla nda si tafl adn tseh.ormauyte yB ,tntoascr ZVV pc()ecokxihn etsprens wtih lrdegeeinza rahs htat cukyliq ntarnsoitis fomr maraulc ot larappu enth to uersvlia.c

sympathetikey  Good call. +6
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5
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. +1
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
 +24 
submitted by yotsubato(968)
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So for daCdnia ew anc ues

lozseA noacezlflo(u) ii(inbth YP50C4 myietd)atoelnh

oheimnpAtcr B r(poe ionatormf ni nfuagl lelc mm)ebeanr

Coufngipans tvnere(p slsonirnicgk of teab cgslanu ni elcl wla)l

ro astnNyi fro roal ro aeohglaesp esacs (erpo f)tiroonma

iThs uqoetnsi is ngsiay atth ehs si antgik an LRAO ugdr ot ttrae nacddia t.vinsaiig

tormepchiAn si IV

oginnfuapCs si aslo VI

so 'ewre elft thwi eslaoz

olAesz ihnibti esihstsyn of egrtsolore yb gihiinnibt PCY 045 htat senrcvot natolrolse ot .rgloeoetrs

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 -_- +
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +3
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 +2
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +24 
submitted by seagull(1404)
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Thsi si a ptye II elnaR ualrTbu Ao.ssdiic My laMecid coohSl evrNe hauttg hsti ot .me idD oyu osla go to vropety edm oshco?l mI' ssruidrpe eyth vnee vega us eittol pape.r

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +6
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 +1
... 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(1056)
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He ash afecl nteicneoncni so sih txrelnae thicsprne si ,emdaagd hhwci si trienndeav by the dlndpaue .n .-4S)(2S eTh pcivel npcisclanh ns,evre ciwhh tdeeaim hte ercnteoi s,spcero are aols 4.-S2S

thomasburton  Why could this not be dysuria? +2
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 +
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +
... welpdedelp made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +23 
submitted by welpdedelp(216)
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No iedt einid,yccfe het ptetain had sexecs oaetrnce ued ot hsi iedt

sympathetikey  Would never have thought of that. Thanks +8
medschul  that's messed up dog +18
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... +6
cbreland  I'm okay with missing this one +4
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +23 
submitted by water(33)
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ilysiugrrpns, I allcaytu elrndea ihst morf eht Miagc oolchS usB wehn I swa a .kdi aT'sth teh oyln aenros I tgo htis .rghti sThkna M.s r!zlFize :D

paulkarr  She taught me more than my med school professors did... +5
... sajaqua1 made a comment on nbme23/block1/q#18 (A 15-year-old boy has nasal polyps and develops...)
 +21 
submitted by sajaqua1(519)
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eymzEn A tsdsan in fro aoielohphspsP 2A, gtrninu hspisihpoldop in het llec erbamemn ntoi iaidcrnocah c.adsi Fmor t,here znyEme B dnstas rfo Coayyxseeoclng X),(CO ilewh enymzE C antssd ofr ynxsLoe-g5epia .-)OL5( -O5L predcsou H,EPE5-T hihwc is dtreun noit esi.neerkoltu iruktLeeoesn lpay a doblue lero in sentve eilk a,tahms aucebse thye uecas otrcnrnhtccoobioisn nees( ni tshi eat)ptni adn by ainctg sa cicaemlh rcntsatatat fro mfianmoylrta s,clle oeshw tayviict lilw socel the riaayw tufhrr.e By kncoiglb CXO leabp(msyur hwti an ASI,DN) we lavee orem fo eht atusbsetr cinrahidoca icad for L-OX5 ot lemtiuylta ortncev oint etinkuesrl.oe shTi si eth bsais rof nras,ntt-psaiiaoetmlnri-ah ihwhc is ryfnteleuq osatiecdas htiw alans lpo.spy r(sSa'tme t.a)rid

k9r3helFwawuTgcrola///c49twt:.im/seetr/pl.t55x

)D Pyraisoctncl sestahny . E) hobremxanTo teayhssn

... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
 +21 
submitted by thomasalterman(147)
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Seh tjsu mtolcdepe hte eucsor fo ubritm,xia icwhh tarsegt 0CD2 tepo.rrsce cBll-e einciefycd anc isdpsepero ot iatlcarbe .isoefnnitc

b) BM laefiur is ont icasstodea wiht icaxrb)mti u dnr gow) )rowgen thsi ocscur /inw 071- dyas of ianttgrs tntre,meta dan lwdou nto urocc aefrt nogptmciel a ot4nmh- oursce of x.iurimabt

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#28 (An otherwise healthy 82-year-old man is brought to...)
 +21 
submitted by sajaqua1(519)
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etiosPorr ocdr sedyornm sruocc deu to nancroftii of hte psrteooir ahfl of het pinsal r,doc ormf lioccsonu of the stpoirroe liansp y.raret urO eittnap epssetnr thwi rdaeescde nsiotaens to prnpkcii lwoeb het eevll of eht eesnk sa well as knglwai whti a aeesdd-ibw ,agit lylkei ntiiagdicn lsos of opprtnoieio.rcp ehT ipatetn si soal caneim hwti symgndpe-eteerh ntlsphou.ire

eesendyrHgmpet otuhlnipers aer lyplcayit csdeua yb na lybniitai ot ekam ghunoe DNA, cesadu yb a ckal of acesnseyr rcosepursr nda isimntva ildginucn 9B atf()eol dan B12 n.b(aco)lmai fI hte ptintae si flaote ftnidei,ce ew see eldvatee oicyetmhoens dc.eifenyci If hte ipetatn is 12B ,tdiniceef we see aveetedl mnatiylhlomec cdia nad hsnotmeiecyo vel.lse pyreitiosHohemecamny acn naiersec ombros.itsh brooishTsm in het otrsproei snipal yrreat nac ecsua erposrito dcro snoym.dre In tii,dnoad akcl fo itnavmi 12B ipmsari mliney rtiomanof nad daels to ucuSatbe dminbeCo ge,nDretneoai hwchi cfsteaf eth aSliipmcatnho ctrta a(coiungtnc orf eraddesec ipknprci s)osat,inen caoitnsCpiolr ,artTc nda aDsrol Cdaln-eMuoilm smsLunice trcTa (ccnangouit for eht duedrec t.eoiopropicrnp

)A orriteAn odrc edmr-nsoy ossl fo mtroo amomc,nd sa elwl as teibrllaa olss of aeth nad pi,na eth ineatpt sha nto olts rmoto nntiocfu, so ti cnaton be s.iht B) lteCnar rcdo omny-sdre rpsetsen sa a ntanoicombi fo otomr nda yrsnoes ls,os sluaylu itwh berldad .focnntdyisu sihT penitat edos nto dpaliys rootm lsso ro aelrdbd tcdyfsuno.in C) odcmieHr esnmdyro- soAl ealcld u-dqoSwerr,aBn this si ptoclmee juriyn ot treehi hte lfte or trhgi eids fo eth npisla do.cr tI tseepsnr hwti rtmoo ndcyitsunof nad xelrfe nofcsyutnid ililytepsaarl at the velle fo teh s;olien lsos fo pprue mtoor namocmd eowlb hte liosen lrialyletaisp tc(assip seri;)asp slso of laosrd eor-nauccildrm anesnsito llasieyltirpa at and eblow eth nlei;os dan lsos of napi nad tptermereau snteoains tlaarolctylenar 2 to 3 aeterrvb lbweo hte .eoinsl )E yaSgeretnm -nrdmyeso a taclnngioe eiularf ot ldpoeve trap of eth aipsnl drco. Teh nwe etons of ymsmtpso ta 28 rsaye lod eamsk iths na nlylieku idsgs.i,aon

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. +1
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
... 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(519)
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eTh atpient ash a iropr rihosyt of cymoethyetrs wtih iarlaltbe cortioooseghy-opp,naml dan ieedverc telnxera bame inoidarta ot the is.elpv heT patteni now dylapiss oiyphohsrderns nad dotryr,uereh wiht lstida elrueatr nrrganwio at.ilablyrle ehT leileikts niptoo si ttha ew are neegis sdonaiesh mofr suriepov gruyres csiotntrc hte r,sueter giunsca ht.si

E) iolterhUal raacmcnio sla(o lcdael lantoranstii ecll rioamncca) is lsoa a otspbis.yili tWha smake htis ilnleuky si hte cna:iloto laeri.tbla ehT prrio ctromeysheyt dan tabiearll p-mooopenyaholstricog luwdo velea rsca essiut on bhto esdis of het obd,y utb the ddso of utalhoelri acaicmrno rsgiina llriteyabla aer very sm.li

A) hTe anieptt dha a tye,resthyomc so the odds fo neterucrr vlaicrce acncorima era losa rylcdineib o.lw )C dan )D lUtrerah oomdlacyn dan hratuler oalinnaitstr cell applmailo aer in het ngowr liaoocnt to tcoucan for bieatallr utrlareh noangiwrr hwit ruerr.edtohy

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). +13
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
... praderwilli made a comment on nbme23/block2/q#10 (A 50-year-old man who lives in eastern Minnesota...)
 +21 
submitted by praderwilli(63)
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tnWsa' sure aobut aiestick,tR tbu I wnek rbnio fo dexsoi saw on hsi yelrictc ni eht osatrehtn nda gttnegi orteudrt yb hte riemvpa seb.ba

mimi21  LMFAO facts ! +8
... cocoxaurus made a comment on nbme23/block1/q#43 (A 65-year-old woman has the recent appearance of a...)
 +20 
submitted by cocoxaurus(56)
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Pre UWD-LOR Aaoeoacrmdinnc is aoaecssitd w/ ungl ngicarrs edelart to mnloaaourstgu d,eiesas ldo PCOD rohnci)(c adn aagdme edu ot rneerurct niomupan.e

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_(100)
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buitlatrtAbe skri = ecidiencn in esdoxep – eeccnidni ni oexnusdep

= ,/100003 )sr(ksmeo - 00/,0330 n(merkn)ooss
= 3.00 - 100.
= .200 (so eht eiarutattblb rsik si tbuoa )2%

yiplngpA it to a poitplaonu fo 010:0,0

= 2.00 * ,00100
= 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. +1
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. +10
... 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(210)
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diMaofnar tbsahiu + acMousl resuaonm + ckNe smsa = MEN 2B (MP)M Po,he lleuaydMr htyirod CA niliCacotn( igsc,)enrte cmoluas orsumean

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 +1
... mcl made a comment on nbme23/block3/q#28 (A 10-year-old boy sustains an abrasion on his left...)
 +19 
submitted by mcl(579)
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snoBu qckiu eeriwv

... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +19 
submitted by smc213(124)
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oT be eclplymote ealcr!

hTsi nitapet hsa sstnyiioCs a arer ltsoomuaa reeviecss somysoall gsoetra drosidre and mtos mmoonc asuec of oncnFai rdmsoney in cidrnhl.e Cstysoinis is sictseym and lsead ot cesityn ytlcasr itsespdo ni llsec dan stesusi ugoohtruht eht dy.ob

hgolhAut ssoliWn aseisde acn elda ot S,F het ltrscays ni het aneorsc edos otn rrotleeca thiw lisWnso eid.ssea
M roe oifn: i1wn8.h1v/.4otrM.:ce6iaspw//bsntClt.gn4//mlimccPp/hw0

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
... sajaqua1 made a comment on nbme23/block3/q#38 (A 5-year-old boy who has recently recovered from an...)
 +18 
submitted by sajaqua1(519)
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The rwmroa howss rerrcspuso to y,heeyttrsocr as llwe as yramaoet.egsykc ishT is to show oyu atth the esius in'st tuecndon,oprruid hcihw naems ahtt we rae nlsogi CRB nad tellaespt owrehseem ie ucnis.tdroet htTa luers out D dna .E erheT is onngith ot iicndaet ath the clhdi sah eddaenitsims erbiousstcul B.() At iths otpin ew are tlef hitw A ro C. A wodlu nadteiic Didmnaiesste natrvlaIsuarc lCaniogutoa I)(DC ro eisthomng lisiarm, chiwh duwol srutle ni lwo tepleltas dan CRB btu ew wodul loas ees lrbmnoaa RBC keli tsthyscsocie "hltm(ee" l.cles) eW rae pyxilitecl otdl ttah eth tsoychreetry are ccorohomnrim dna mnyiotccro. or,Hewev memuni itutedncors fo tteaplsel elinaxps ti all- teh ctstinroeud fo llstpeaet saedl ot eoms amehgrrhoign dan os a opdr in C,RB dna PTI cclyssialal erssia ertaf a nteecr ueppr esipratroyr rtcat vlria tec.fioinn

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. +6
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. +
... 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(519)
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eBcaeus hte bb'yas emtohr ahs Tepy 1 ieebstaD mtuie,lsl ti is epbsluial ttha htey ahd veeeldat obodl gloecus lseelv uirgdn ro slroyht erobef i.trhb lInusni eosd otn ocsrs eth apet,lanc ubt olugecs odes, os rgdinu rhtbi het oatnene ldwou vahe eben hp.cycyigelrme hiTs dulwo eald to teh aanlnoet aenpsrca riesnelga nnl,siui nrdviig cslueog iton celsl nad ntingur down oieeglnsngscuoe; thsi is ywh the byab is mgochpycylie rtgih own.

B) dsDecerea cygglone rneinncoa-ctto I tdon' nkow teh gyleocgn eaintcnnootrc cpearomd ot an autdl inpeta,t btu a reedaces in gecnyolg cocoatnntnrie wodlu naeiictd /sooegglngyluecc eelra,se hihcw lodwu ont eb a ygcyceolhmip eats.t C) esrecdDae elyncgog shtsaeyn -aticiytv sraeecdde gylocgen sehsatny yctviati csntaiide reneyg saimaoblt,c dan dluow leda to hhgrie mseru eocguls evls.le D) rDadsceee srmue ilninsu enta-ocintocrn eecdasdre merus nsilnui uwodl edla to egihhr levsel of legocsu ni usmre. E) seIcaendr eursm illniesn-uik wgroht roaf-ct IGF odes ton bndi nelrya as lwle to iisnunl crroestep as nlunisi ,seod dna os lwodu eahv to eb ni eetmexlry hghi inccnrsooantet ot ehav hsti tfefce. GFI si sisctdoaae ihtw itmcaso gwroht and smlceu etpl.vmendeo

yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +3
alexb  Also explains why he's 12 pounds. +3
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. +2
... sajaqua1 made a comment on nbme23/block3/q#5 (A 68-year-old woman has a 6-month history of...)
 +17 
submitted by sajaqua1(519)
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ishT ntetiap sha sideprdwae crotnustdei fo both lraeand nasg,ld hciwh amens atht ehs lwli olse obth ehr cmdosricailornetoi dna rhe oltrsco.icigdcuo Teh osls fo teh troislncocirdiaome nad the effect on eth eiksndy si awth is egibn sttdee .ehre hneW tsrelooneda si iouncinngtf nad tadub,nan it sah vaeelsr iitcclra ofnctunis on hte phnon.er iFstr, ti epulruatseg /NKa++ PeAsTa nerpseixos on eht taabelolasr berame,mn hiniasgbltse a orstng clilhctcoeemera tgnadrei thta tbeter rsabosb ,Na+ ehwli the saidecner aniclearulrtl K+ narnneitcotoc smaek ti areesi ot esol K+ omrf hte cell onti hte lum.en eneorosAdtl aslo leugatresup the pseroxsein fo heeiipatll smidou nhelcsan )N(CaE no hte ecociltngl ct,ud igsbernabor orem .Na+ Fyllani, dlentroaeso cserenias nxipeeross of +H sTPaseA no ecte-alipnlaardhta selcl of teh ltonglccei du,tc chiwh aer oeerplssbin ofr tcngsiree +H is(ht si part fo naccrnttioo skasali.lo)

ithW eth ssol fo erloadtn,ose we ilwl ese a dessecaer +aN/+K iegratnd adn dederscae aN+ ointorpb;esra stih delsa ot sdreecaed rmesu umsodi dna enaecdsir rsume upi.astmso At hte aesm i,etm tno exiessnpgr H+ sseAPTa lliw eald to +H otn nibge e,cseretd enagicrt a more diccia vitonenmern p(H illw sde.)aeerc

abhishek021196  Very well written explanation. Bravo +2
... sympathetikey made a comment on nbme23/block4/q#21 (An otherwise healthy 26-year-old scuba diver has...)
 +17 
submitted by sympathetikey(1252)
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aHdr to see deu to poor ctperui quiylat, ubt adseb on athw I uodcl e,es ti sseme eilk a oenntuaossp uhtmoxonearp ot em de(abs on teh lkca of lugn grnakim no eth telf pocmrdae ot teh tgrih ies)d.

feTr,rohee enisc teh glun si d,tefedal lla oyu owuld aveh in teh ltef sdie fo hte noep ayt,vci ihcwh wudlo kaem het elft sdei ren.sesytonrhap

sugaplum  FA 2019 pg667 +14
... imnotarobotbut made a comment on nbme23/block2/q#17 (A 21-year-old man comes to the physician because of...)
 +16 
submitted by imnotarobotbut(160)
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Vsrcliea meiilhaisssan casesu oteenmaaglospelyph dna tsmo pny,rimtlota iaonnapy.tpec tI is tenof nodfu ni oepelp ohw isvti hte elidMd atEs and is dttnsiratem by het nf.dSyla Why did MBEN upt 2 Laniaehmsi etsuonqis no isth fmor lol

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +11
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. +
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. +
... usmleuser007 made a comment on nbme23/block2/q#23 (A 75-year-old man with prostate cancer has...)
 +16 
submitted by usmleuser007(370)
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  1. scCeanr of teh siepvl, gcliunnid eth srt,petoa earsdp to eth omasubcrall ispen iav the rrevlbtea uvnsoe uxsple (VP.V)

    • The PVV tomcmciasune whti a rbmneu fo neuovs ekowrsnt, dlncnigiu eht cistratpo snuvoe e,luxsp hwhic sveeceri het eosunv lsppuy rmfo the tt,aespor sipne, adn dbe.dalr

    • VVP unrs pu het ietrne nialps mnuocl nad osnctecn htiw het nevous uslypp fo teh arbni via a asvslleve tseysm ’Bnssao(t )xulPes chhiw olwlsa for edntilaroibic flwo adn ulnotaeirg fo canrraatinil ruspihesr.sTe onesvu iccntnoeno ot the rlraeebc tniorliucac yma lpeh xanelip teh yinortespp of ortsum to tsaaeszemit ot the bi.rna

  2. eTh VPV lsoa oncctemaumsi htiw het gosazy vine ni het ,hcset hwich asilpexn in prta hyw tasbre nda nulg narcces lfqtureyen asmeizsteta to the rtacohic sei.np

    • ,llrSamyii ude ot normauply unsoev reagdina iont hte tfel desi of teh rheta, lngu utorms tnofe sarped ssamtlyyleci avi teh rrlaeait smtse.y
  3. lAthohgu yplhm dsoen rae hte tsmo mmnooc eists fo siestasmta ni rneae,lg pichltamy pdrase ot eth atlseelk ymsets si eyrv e.arr

  4. eTh mniprmoafpi splxue creveies uvneso dairgnae ormf eht ,sistet ,idiiempyds nda cstduu eefendsr nda nsiard oint hte sertlaticu ivnse.

... mcl made a comment on nbme23/block3/q#26 (A 27-year-old woman has headaches and blurred...)
 +16 
submitted by mcl(579)
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ienPtat hwit britleaal leanr raetry rtsbui and iyeronpensht lwli ofr esru vahe caaiittovn of ASR ymtess and thfreeoer aiseecnr in gnsaitneoin.

utghlhAo hapocmyotochrome dan noesuteqcn edatelev imahaoecctlesn nac irnecsae blodo sereprsu, otmsmspy ear yctlaiypl iosdipce nad rlane rtbisu ear tno iyekll to eb .rehad evlEtdae lsvlee fo nsoerinot acn laos cusae si,rytoeehpnn tbu ew dowul oasl cexpte ot see ;ugnflihs a,sol teerh si nhtiogn in hte smet to etindiac tnaipet is tgikan sSSIR or hiosntmge lsee tath lcudo espperdios erh to dtevleea ellvse of toosnnr.ie dltavEee svllee fo ohrdtyi hremono cloud asol ievg npattei tpsn,enyoeirh but ew oludw lsoa pxecte rhote isngs fo iyriotmdhpryhse mro,(ters tighew ,loss ..)tec

I wsa a letlit udcenfos if POE would eb levtdeea -- if ehret si sssoneti fo leran setaeirr sa( taenicddi by the ti)busr het ndesyki doucl osal tdcete itsh as aiohpyx nda apmr up cnooiprutd fo .EPO revw,eHo I needd up ngigo tihw ngtsiaineon inces it smeede omre "ecctnoer" ot em htat RSA dlwou eb u.p sDeo ynnoea wnok why tis' ont OE?P

brise  Wouldn't that be more long term? +3
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
... 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 tno the tseb at het iauntalolcsc fo CFC,IF/E ubt llcbaaysi oyu aer sfgnniui a hrycenptoi onsotlui toni het .aminal tinIylila, ihts is lla noggi to go otin eth ucrrllexateal es,pca as yna VI nsnoiifu liwl od. ncieS it si ighreh tanh ioonistc tisnluo,o tware is ginog to go ofmr teh iualalrntrecl csaep to teh alcuxreerlatl apsce to yrt ot neabalc ti ,uot so the arlieulcrtlna csape llwi heav ddaeerecs lmvoeu dna necdsaeri mlioltysoa enisc( olyn arwet is gnai,vle mngaki it mero redn).taecotcn

So uoy wonk ofr user FIC oluemv is rseaedced adn olysltaimo idn,reecas nda teh eruteacllalrx mlouev lliw be recesda.ni I nikht hte ooltlaisym of the xtllelarecuar secpa si teh itcykr trap dna eth trpa eehrw meaby onseeom eels nac eplh with teh atonsaucllci ubt yilacbsal s’it etrypchoin nhgoeu atth the motlyioals illw llits eb acsr.eneid

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. +18
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
... thomasalterman made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
 +16 
submitted by thomasalterman(147)
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inPatet has clemthypyiao vera, sa edvcdenie yb rocoeytsist,yhr arnog,sctiyoslu adn sedcaeahh map&; s.ziniesd POE si ecaeddesr eud ot icr.shyestoyrto aeeecsrDd LPA dlowu tdiiacne ML,C tno V.P

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. +9
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. +3
... youssefa made a comment on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
 +15 
submitted by youssefa(124)
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hPta:amo - teyschyLmpo rea eth otms nvisitsee slcel to ewhol ydob odtiranai - sulerGatycon inlyaM( i)noesrluhpt rea urcyaltarilp revy seisevnti ot htimecocpueahert inllkagyta antsge irien(qgur -FGSC lhrosyt r)efat

arcanumm  Always think of NEUTROPENIA when chemotherapy is treating rapidly dividing cells (a small fever is an ER visit for these patients). +6
... sympathetikey made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +15 
submitted by sympathetikey(1252)
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hTogu oisntq.ue

Rclale tath inenatMem lmze(hsia'er dr)gu si a ADNM peRtceor nosittngaA ahtt lpehs tvnpere coixitytexcto by glciBnok aC+2 nyert. tshTa' owh I mmbereer isht.

... yotsubato made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
 +15 
submitted by yotsubato(968)
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Tish si a qstoeuni utabo ienpatt iap.vryc ehT epittna ereh is eth lch.di eTh pryxo ofr eth naitpet si eht mteroh dna raeth.f eTyh sumt wokn wahst wogrn. rsiSet dna rmthoe ear tujs lo,ksooloy dna nratesp aym otn wtna to tell thme ds(tuip I ,wnok but eharv)wet so ouy dens thme uot dna tenh etll hte rspneat hte asiiou.tnt

dr.xx  agreed +
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +25
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. +9
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +4
... sympathetikey made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
 +15 
submitted by sympathetikey(1252)
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nAy temi you ees iexfd wdei ignlittps of 2S, hassm ADS.

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... +
... yotsubato made a comment on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
 +15 
submitted by yotsubato(968)
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Yhae re,su slte evig eth ygu ohw atsnw to pkee hsi dikc orinkgw and eb vciratttea sdrwoat ewnom estreiinFad dan lyomclpete nuri ish sttserneeoto eeslvl dna igve imh a lpmi ic,dk nam sob,ob and drecadese cnoarfepmer in tros.ps

seiSemtmo eht NEBM reylal stuj eksma me ska ?yWh

Tiolacp nxiiimdlo wldou be ywa ttrebe tbu on ythe ntow tpu atth sa a heiocc

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 +
... sympathetikey made a comment on nbme23/block4/q#30 (A study is planned to assess differences in...)
 +15 
submitted by sympathetikey(1252)
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siggteB ucel aws ttah trhee saw no meti feram ve.gin eohere,Tfr thsi eesms ot eb a ic"lse ni teim" t,yusd hchwi ilnse pu tihw srosc lcsaeiont t.sudy

paulkarr  Damn, epi at it again... +4
... chris07 made a comment on nbme23/block1/q#10 (A 13-year-old girl is brought to the office because...)
 +14 
submitted by chris07(54)
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Bed busg hteveelmss aer otn nnkwo to eb rsarrcei of ilsen,ls ubt eyth cna leaev hcyti .tesib heT rgil si kleyli to ctachrs seeht ,sibet adaerb the kins, nad htus asenirce hte irsk fo a hptsa iskn tnniicfoe eis(nc thpsa arusue si teh tsmo omonmc nski ciontfein e)ghtpnao

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +6
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1
frijoles  So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich +13
anechakfspb  @frijoles - Hey if it makes you feel any better I put HIV too, with my reasoning being that they feed on blood...and HIV is transmitted via bodily fluids. Whoops! +
... nwinkelmann made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +14 
submitted by nwinkelmann(284)
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So, fro esom eao,nrs rtmreeitanrostnsu is oinhsmtge ev'I SAWLAY gsdlreugt .t.wih. bpabroly ubeaecs I san'wt hgutat ti ellw so vnere rallye dnleaer i,t utsj reeldan ghnoeu fro evewarth x.mae I tusj onfdu tshi boo grohtuh ICNB adn tis ASATT!IFNC It's fmro 0012 so mghti eb o,ld utb ti saw graet. ouY cna escahr hruthgo teh ookb nda nfid hte t.ehasrpc I yprtte chum jtus wetn hughtor lal of teh trtmrutorsanenie c.eptrah t0wws1kilv/.Bbiobwp9./hnhg7o./oNn//mcK.:t9sn

yM inma us k-aamatlGat:wtyaee = rmjao tarecotyxi tno.atirreumsnrte woT eytsp of e croet)rps1: mitpae,rtoboc msto fo hichw era yrsnipeaptc iG hhicw sedla ot deaedsrec MAND peterrco ctitivya nda risk fo yoitocittxii,cex ro tptinysaopsc Gq rorstcepe tath lade ot isnaerec a+N, K,+ nad rsdeceead eaamtuglt csaseu odetopnraiailz nad rideanesc gM++ ilptsdameecn adn ADNM ertpoecr tiviycta nda kirs fo cxtotiiy,tcoxei and 2) ociiorontp clehnnas glndiuinc MNDA nda AaePnAitMk/a sn,chlnae hhcwi lla wlaol fpniienoscc cnoait xlinuf, tub oynl MDNA awsoll aC++ uflixn a(nd only in a levgtoa eedepndnt ennmar tafer nsftfuieci zpliaiodtnareo ahs cpsideadl eht oirtibhin M+g+ nio ni eht enhna.c)l

AGAB dna eylincg = rbntiyiohi esem.tsrianotrrtun 1) BAA-GA nda ACGAB- = pniootcoir slanhecn htta ldae ot elfxu fo C,l- adn pteieds iths scganiu pdarniltzae,ioo eht unnero sltli ssaty lwobe gnietsr pi.ntolate -AAAGB ningdib etis rfo u,atbrtiseabr tsd,reosi BAGA, nda ponoitircx = nediis eorp fo .cenanlh GABA-A gdininb etis of epdieobinzseanz = udtiseo fo oerp of lh.nneac ) 2 Gcnylie lhcanen is a very masiirl lC- xuelf .alncnhe ) 3 ABGBA- is a arbpcttomoei ecalnhn that tiacveast Gi giadlen to esedcerad cPMA hwich acasittve elfuxf K+ nnlacehs nad hibnsiit aC++ uxilnf nahcnesl aeilgdn to iely.hronaroazppti

cioigeBn imsaen = nlamcaeioehcts oedapimn aon(tniodcoir fo ydob ,emnoemtv radwr,e tto,voimnia ofm)encirt,enre ihnppnoerenire selpe(, ufnkel,saews atnt,ineto ediegfn veohir,ba nheprnpeiie loets(w otcaerotnicnn ni CS)N, uspl ntoineors es,l(pe asweuslk,enf s,senerpdio ,eiytxan asaue)n and heiitsman ,loauas(r oan,tntite a,geylrl utises amae,gd nda aym neicunfel oobld riabn owl.f) vos,yulbOi lal of tish is ni inditoad to rraceinegd msnrtnaieoiruosns nda h,ltigf fhgtri, dna gihtf ep.ensros

APT dna ohtre eisuprn = tarxietyoc ,asrnsiosmint doa-leceers ihwt terho lceeolalmslm-u eusteitarmtronsnr. ienAneods sit'n laiasclscyl dsoendecri a ittrarunrmneoets csuaebe ti isn't olsderartede/es ni +Ca+ enpdntdee enr,man ubt eeddrvi morf PAT bforee nhiavg na ctyoetrixa taetnoi.pl

Aloctyelecnih = oajmr uorrrtenmniattse elnvdiov ni etronsmoiuisrnsan iav scnraium nad nciotcini tesopcerr.

pPtedie enmttstsrnarreuio = mocmloyn ersdelea sa rpedppieot grlrae prroussrec that are vdaclee by fscpicei yzesnme hatt eewr in eht seam tteainuneorsrtmr viceles onup e.alrsee Five tpyes = /abgintru sed,pptie ioidop pite,psed ityuptari ipdep,ts lhtmapyoaihc aeinlregs ho,smoner adn tsohe otn cfase.slidi saxmEelp = reocrpurs ttah vsgei isre to usntcsabe P u,ms(cpoipaph ner,toexoc nda IGT and dlresaee mfor sallm aderetmi PNS C berisf that smttnria inpa and meepaetrtur am,iorfntnoi ewolufrp yohtneeis,pv nbdtihiei by piodoi edetsi)pp, inkenroinu ,A piprnotudeee K, adn peredtpoienu amm,ga and oodiip itedppes inugncild apltn oaksildal (lkie po)h,mienr ethiscnty ipidoo edesivvrita, and edo,ipnhsnr nnd,riohyps nad iek.hplaesnn In elnager iodopi iedtepsp ear sseaetpsdnr (.i.e aealgnais a,ime)shncm oldievnv ni exmolpc hrsiaeovb (lsexau ,aocritantt asvgsir/sgemeiubevsis hr,ovesiba) and pmdlieiact huth(og ton e)eviiitdfn in itcacshyrip r.rdieossd

le,alOvr trsmtueaenritosrn = tpye spe:ty llesamecmluol- srteimatnrst adn uintpr,epoedse ewhre ellmslmcua-loes mststntaierr rea etasrf dan teamdie dirap ycstnpia snosnmiatsri .(i.e rdaoengn SSN fih/hifgtrtgfhl/igt iucqk )ess,orenp erhwe as ietnpedrouesp lano(g thwi bicogiol neisma nad meso lmals uelelmco rat)tsetnimsr rae orlews nda dteiema gd,lraau eogpoldrn nntruieao.nrimssso

oeSm rts:uiecp /euwip/uhsen_oit.ro_uhecewtwer.oins/smtnt/ipttdaeebahdpmnaer:_t.kmprdvfkvu/rlo, ahe/p66-e6Tg:/iagr-afe7Ap4o-0a/b/eee4u3esawb0i0tr0plasi2-hhrebnBowg-r2s-oA1cdt-4nr/u6tsl10cag8/i/f.d3rrap-l3piffcoRcrrt2e5ndtG81bPmeduBwi3e9ts1sg.1, and -aloi1==t-s6#a:5l5se/egrwdp-whetfbda/f-u1exh7-Ucrn1sfgt2a;gdaend8_etpnta2erw&/-i-./xaehi0w.b4a1e.bibfl3b3-ml90/ggd6/

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 +1
... seagull made a comment on nbme23/block3/q#19 (A previously healthy 32-year-old man is brought to...)
 +14 
submitted by seagull(1404)
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ihTs itatenp si pritignp .lblas erettB do a urgd rnecse cwihh ssmee .ubiosvo

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +37
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 +
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +
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) +1
... lfsuarez made a comment on nbme23/block4/q#22 (A 40-year-old man with terminal small cell carcinoma...)
 +14 
submitted by lfsuarez(141)
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hsiT ptaeitn ntrsseep ithw a mllsa llce rmoaicanc wichh si vrey moncom fro arpa aoscpieltn omysnde.rs In sthi eacs eth aeccnr si sacngui ASH.ID loyeDeeimccln is a centiacetylr incttbiaoi atht is loas dues to teatr SAIDH

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). +13
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +3
... brolycow made a comment on nbme23/block2/q#19 (A 70-year-old man with severe congestive heart...)
 +13 
submitted by brolycow(27)
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He hsa ertah eluafri cihwh dlase to a aedescer ni rnael dbool flwo nda aenrpler .eaoiamzt nI eepnarrl ait,moeaz :BNCrU tario is g&=;t ;20 ocntAativi fo eht SAAR ssetmy deu to teh eaperlrn zotaamie amesn thta the psce vrag is ighh ta 5.012 adn eh si nogdilh tnoo msioud so riyaurn iuodms wlli be low l2&;0(,t aNFE 1t;%.)&l

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. +7
benzjonez  Very helpful video for acute kidney injury: https://www.youtube.com/watch?v=bMp6IxDKK2Q +7
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 +
... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
 +13 
submitted by alexxxx30(44)

did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha

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 +
... jrod77 made a comment on nbme23/block4/q#17 (A 24-year-old man has a grade 3/6 systolic murmur....)
 +13 
submitted by jrod77(27)
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ehT lysscoit peusserr fecnfdiree ewnebte hte ltef neecrtvli nad hte atroa ni tihs .pt si yrtpte gtainnfisci, hWraees ni a rlnaom hreat ohste licsytso euesprssr oslduh eb juts buaot .luaqe This sithn at hte ftac hatt teh tlfe viereclnt sha to ptu ni atlo fo rkow to uhps huhotrg het rcaito elav.v Ttha eartx userrpes geso into nnpgieo the alvve adn soed ont apprea ni hte a.rtoa

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˜” +
... thomasalterman made a comment on nbme23/block4/q#29 (A 2-week-old male newborn is brought to the...)
 +13 
submitted by thomasalterman(147)
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enaPtti si reurtnc b,ra-esfted os ew can liamineet freosctu fersuot(c is onduf in oeynh nda ifurst nad moes ,rmuoafl utb nto ni tesbra lmi)k. aiPttne ahs gurendic ecsanbsstu tbu no egloscu in het ,nueir so eh utms soem snocleuon-g ar.sgu My fletifanedir fro cuignerd ocslngoeun- gssura in eth eiurn si osdedrsir tcroefsu ateobmmlsi ro ceasogtal eb.aisltomm eW ahve idmlneatie eo,rtscfu os ttah lsvaee su hwti alnioatksegca ncdfeeicyi or lcscais tagliaacom.es

sympathetikey  & Galactokinase deficiency would be much milder. +6
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). +1
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) +6