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NBME 24 Answers

clinical_trials medicine
Block/Question (73.5 difficulty score)
A researcher hypothesizes that exposure to ...
Case-control studyπŸ”

pharm beta_blockers
Block/Question (21.1 difficulty score)
A 43-year-old woman with a 2-year history of ...
Unopposed Ξ±-adrenergic toneπŸ”

oncology metastasis lymph
Block/Question (41.8 difficulty score)
A 52-year-old woman comes to the physician ...
IntercostalπŸ”

micro cryptococcus
Block/Question (31.6 difficulty score)
A 28-year-old man with AIDS has fever, ...
LungsπŸ”

genetics process_of_elimination
Block/Question (42.9 difficulty score)
The 35-year-old woman indicated by the arrow ...
X-linked recessiveπŸ”

respiratory transfusion
Block/Question (39.9 difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”

Block/Question (30.7 difficulty score)
A 65-year-old woman comes to the physician ...
Cigarette smokingπŸ”

Block/Question (49.4 difficulty score)
A 24-year-old woman at 28 weeks' gestation is ...
TremorπŸ”

Block/Question (18.9 difficulty score)
The graph shows expiratory pressure-volume ...
Diffuse pulmonary fibrosisπŸ”

Block/Question (40.2 difficulty score)
A 75-year-old man is brought unconscious to ...
AtherosclerosisπŸ”

Block/Question (49.4 difficulty score)
A 55-year-old man with type 1 diabetes ...
Persistent activation of voltage-gated Na+ channels in the nociceptorπŸ”

Block/Question (13.3 difficulty score)
A 26-year-old man comes to the physician for ...
Increased number of LDL receptors on hepatocytesπŸ”

renal nephropathy
Block/Question (55.6 difficulty score)
A 4-year-old boy is brought to the emergency ...
Proliferative glomerulonephritisπŸ”

Block/Question (21.0 difficulty score)
A thin 66-year-old man is brought to the ...
Urine osmolality > plasma osmolalityπŸ”

Block/Question (45.4 difficulty score)
Results of a 5-year screening program for HIV ...
5%πŸ”

Block/Question (32.3 difficulty score)
A 32-year-old man is brought to the emergency ...
Flexion at the distal interphalangeal jointπŸ”

Block/Question (22.5 difficulty score)
A 3-year-old boy is brought to the emergency ...
Annular pancreasπŸ”

Block/Question (26.1 difficulty score)
A 34-year-old woman with a long history of ...
Tuberculous osteomyelitisπŸ”

Block/Question (11.7 difficulty score)
A 35-year-old man comes to the physician ...
Cluster headacheπŸ”

free
Block/Question (50.2 difficulty score)
Immediately after a spontaneous vaginal ...
Fusion of the sclerotomesπŸ”

Block/Question (29.0 difficulty score)
A 35-year-old woman comes to the physician ...
Foramen cecumπŸ”

Block/Question (28.0 difficulty score)
A 50-year-old man undergoes surgical ...
Adductor brevisπŸ”

Block/Question (26.5 difficulty score)
A 50-year-old man comes to the physician ...
Generalized malabsorptionπŸ”

Block/Question (22.3 difficulty score)
A 6-year-old girl is brought to the office by ...
Pediculus humanus capitisπŸ”

Block/Question (29.9 difficulty score)
A 7-year-old boy has metabolic acidosis and ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (22.3 difficulty score)
An 80-year-old woman with poorly controlled ...
Hematocrit: decreased;
Serum parathyroid hormone: increased;
Serum calcitriol: decreased
πŸ”


Block/Question (39.9 difficulty score)
A 10-year-old girl with a lifelong history of ...
Palpable right ventricular liftπŸ”

immuno
Block/Question (48.9 difficulty score)
A 32-year-old woman comes to the physician ...
EosinophilsπŸ”

Block/Question (17.9 difficulty score)
An 80-year-old woman comes to the physician ...
Determination of erythrocyte sedimentation rateπŸ”


Block/Question (49.6 difficulty score)
An experimental study is conducted to examine ...
Post-translational modificationπŸ”

Block/Question (49.5 difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flowπŸ”

Block/Question (15.3 difficulty score)
A 3-month-old girl is brought to the ...
Human papillomavirusπŸ”

Block/Question (19.1 difficulty score)
A 62-year-old man comes to the physician for ...
SotalolπŸ”

newborn
Block/Question (37.1 difficulty score)
A 1616-g (3-lb 9-oz) male newborn is ...
Bronchopulmonary dysplasiaπŸ”

Block/Question (16.2 difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophyπŸ”

Block/Question (28.0 difficulty score)
A 25-year-old woman at 16 weeks' gestation ...
Increased hepatic production of T4-binding globulinπŸ”

Block/Question (16.2 difficulty score)
A 37-year-old woman comes to the physician ...
BorderlineπŸ”

Block/Question (22.2 difficulty score)
A 40-year-old man with AIDS develops severe ...
SomatostatinπŸ”

Block/Question (43.2 difficulty score)
A 26-year-old man and his 25-year-old wife ...
One in four will have 25% Ξ²-globin function and may require occasional transfusionsπŸ”

Block/Question (13.7 difficulty score)
A 32-year-old woman who is 20 weeks' pregnant ...
MisoprostolπŸ”

Block/Question (26.6 difficulty score)
A 68-year-old woman with acute myelogenous ...
Granulocyte-macrophage colony-stimulating factorπŸ”

Block/Question (15.7 difficulty score)
After completing 6 courses of chemotherapy ...
DoxorubicinπŸ”

Block/Question (16.1 difficulty score)
A 24-year-old man is brought to the office ...
Alteration in DNA gyraseπŸ”

Block/Question (35.3 difficulty score)
A 71-year-old man is brought to the emergency ...
Area labeled β€˜D’ (Posterior inferior cerebellar artery)πŸ”

Block/Question (17.6 difficulty score)
A 10-year-old girl is scheduled to undergo ...
SuccinylcholineπŸ”

Block/Question (22.4 difficulty score)
A 35-year-old man comes to the physician 1 ...
Increased serum angiotensin II concentrationπŸ”

Block/Question (25.5 difficulty score)
A 70-year-old man is brought to the emergency ...
Stroke volume: decreased;
Left ventricular end-diastolic volume: increased;
Cardiac output: decreased
πŸ”


Block/Question (23.8 difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”

Block/Question (55.2 difficulty score)
An 11-year-old boy is brought to the ...
Intracellular and extracellular dehydrationπŸ”

Block/Question (48.2 difficulty score)
A 73-year-old woman has had easy fatigability ...
Failure of conversion of N5-methyltetrahydrofolate to tetrahydrofolateπŸ”

Block/Question (32.8 difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturationπŸ”

Block/Question (30.5 difficulty score)
A 13-year-old boy is brought to the physician ...
This will typically resolve within the next 12 to 18 months.πŸ”

Block/Question (44.0 difficulty score)
A 57-year-old man has had hoarseness and ...
Area labeled β€˜Fβ€™πŸ”

Block/Question (43.1 difficulty score)
A 55-year-old man is diagnosed with coronary ...
Decreased adherenceπŸ”

Block/Question (29.6 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorderπŸ”

renal
Block/Question (29.6 difficulty score)
A 75-year-old man with a 10-year history of ...
Hydrostatic pressure in Bowman spaceπŸ”

Block/Question (20.1 difficulty score)
A 17-year-old girl is brought to the hospital ...
BeneficenceπŸ”

cell_bio
Block/Question (54.6 difficulty score)
In which of the following stages of the cell ...
G2πŸ”

Block/Question (28.1 difficulty score)
A 29-year-old man is brought to the emergency ...
Lateral pterygoidπŸ”

Block/Question (30.5 difficulty score)
A public health consultant is contacted by a ...
Regular exerciseπŸ”

Block/Question (47.4 difficulty score)
An 80-year-old man is admitted to the ...
20πŸ”

Block/Question (46.0 difficulty score)
An 80-year-old woman, gravida 4, para 4, ...
Damage to the rectovaginal septumπŸ”

Block/Question (15.9 difficulty score)
A 25-year-old man comes to the emergency ...
HeroinπŸ”

Block/Question (34.0 difficulty score)
An investigator is studying a new drug for ...
Free radical formationπŸ”

Block/Question (27.8 difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIVπŸ”

Block/Question (24.1 difficulty score)
A 68-year-old man comes to the physician ...
Normal agingπŸ”

FA20p504
Block/Question (37.2 difficulty score)
A 68-year-old man has loss of pain and ...
Right dorsolateral medullaπŸ”

Block/Question (29.9 difficulty score)
A 70-year-old man comes to the physician ...
Alveolar-arterial Po 2 differenceπŸ”

Block/Question (42.0 difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissueπŸ”

Block/Question (27.8 difficulty score)
A 50-year-old woman with HIV infection comes ...
ZidovudineπŸ”

Block/Question (29.9 difficulty score)
A 3-month-old boy is brought to the physician ...
PeroxisomesπŸ”

Block/Question (26.5 difficulty score)
A 9-year-old boy who was adopted from an ...
EπŸ”

Block/Question (17.8 difficulty score)
A 59-year-old man has repeated episodes of ...
ProbenecidπŸ”

Block/Question (46.1 difficulty score)
A 35-year-old African American man comes to ...
PalmsπŸ”

alcohol electrolytes
Block/Question (55.7 difficulty score)
A 35-year-old man is brought to the emergency ...
Catecholamine-mediated intracellular shifts of K+πŸ”

Block/Question (28.6 difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urateπŸ”

Block/Question (18.2 difficulty score)
A 3-year-old boy with AIDS develops giant ...
Negative-stranded RNAπŸ”

Block/Question (48.0 difficulty score)
A 65-year-old woman with well-controlled type ...
AtherosclerosisπŸ”

Block/Question (33.4 difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”

Block/Question (16.0 difficulty score)
A patient with cancer who is being treated ...
Granulocyte colony-stimulating factorπŸ”

Block/Question (30.6 difficulty score)
A 35-year-old woman undergoes a left ...
UreterπŸ”

Block/Question (20.9 difficulty score)
A 58-year-old man comes to the physician ...
Escherichia coli πŸ”

Block/Question (41.1 difficulty score)
A 40-year-old man who goes horseback riding 3 ...
Myositis ossificansπŸ”

neuro
Block/Question (43.3 difficulty score)
A 55-year-old woman comes to the physician ...
Lower motoneuronsπŸ”

Block/Question (27.3 difficulty score)
A 27-year-old woman comes to the physician ...
Transforming growth factor-Ξ²πŸ”

Block/Question (35.1 difficulty score)
In a culture of motile spore-forming ...
Irradiation with x-raysπŸ”

Block/Question (24.9 difficulty score)
A 65-year-old man comes to the physician ...
ParoxetineπŸ”

Block/Question (17.9 difficulty score)
A 3-year-old boy has short stature and ...
Endochondral ossificationπŸ”

Block/Question (42.0 difficulty score)
A 4-year-old boy has a 1-cm round midline ...
TongueπŸ”

Block/Question (13.7 difficulty score)
A 56-year-old man who is admitted to the ...
Determine whether the patient has decision-making capacityπŸ”

Block/Question (48.1 difficulty score)
A 3-week-old female newborn is brought to the ...
The patient has another mutation that was not included in the previous analysisπŸ”

Block/Question (25.9 difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulationπŸ”

Block/Question (26.7 difficulty score)
A 35-year-old man with quadriplegia develops ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (38.1 difficulty score)
A 2-year-old boy is brought to the physician ...
Peptide transporter (TAP)πŸ”

Block/Question (21.4 difficulty score)
In a study of drug action on neoplastic cells ...
VincristineπŸ”

Block/Question (19.1 difficulty score)
A 73-year-old man has an incurable malignant ...
Both legal and ethicalπŸ”

GI
Block/Question (77.2 difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosaπŸ”

Block/Question (44.3 difficulty score)
A 17-year-old girl comes to the physician ...
Increased serum testosterone concentrationπŸ”

Block/Question (31.2 difficulty score)
An obese 57-year-old man comes to the ...
Normal ciliated columnar epithelium replaced by normal squamous epitheliumπŸ”

Block/Question (19.5 difficulty score)
A 3-year-old girl has a history of recurrent ...
NADPH oxidaseπŸ”

biochem metabolism acid_base blood_physiology
Block/Question (53.6 difficulty score)
A 28-year-old man has a blood pressure cuff ...
AdenosineπŸ”

pharm HIV antivirals
Block/Question (32.6 difficulty score)
A 37-year-old woman with HIV infection is ...
Nucleoside reverse transcriptase inhibitorπŸ”

Block/Question (34.0 difficulty score)
A 27-year-old man comes to the physician ...
Injections of gonadotropinsπŸ”

Block/Question (25.9 difficulty score)
A 37-year-old man is admitted to the hospital ...
Autoimmune adrenalitisπŸ”

Block/Question (25.1 difficulty score)
A 43-year-old woman comes to the physician ...
Alkaline phosphataseπŸ”

clinical_trials
Block/Question (27.6 difficulty score)
A 21-year-old woman with asthma comes to the ...
Phase 3πŸ”

Block/Question (46.2 difficulty score)
A 37-year-old man who is a farmworker comes ...
SynaptobrevinπŸ”

Block/Question (31.2 difficulty score)
A 43-year-old woman comes to the physician ...
Metastatic carcinomaπŸ”

Block/Question (19.8 difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”

Block/Question (34.8 difficulty score)
The pedigrees of patients with schizophrenia ...
Diabetes mellitus, type 1πŸ”

Block/Question (36.2 difficulty score)
A 35-year-old woman with asthma comes to the ...
ThiabendazoleπŸ”

syphilis ethics
Block/Question (45.3 difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privatelyπŸ”

Block/Question (43.5 difficulty score)
A cohort study is done to evaluate the ...
0.05 < p < 1.0πŸ”

biochem heme heme_synthesis
Block/Question (34.8 difficulty score)
A 17-year-old girl has significant blood loss ...
Ξ΄-AminolevulinateπŸ”

Block/Question (47.8 difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosisπŸ”

Block/Question (24.0 difficulty score)
HOX genes play a role in embryogenesis ...
Regulation of transcriptionπŸ”

Block/Question (22.8 difficulty score)
A 55-year-old man with alcoholism is brought ...
Competitive inhibitorπŸ”

Block/Question (45.5 difficulty score)
A 23-year-old primigravid woman at 22 weeks' ...
Ask the patient if she would allow the examination if her husband is present at all timesπŸ”

mutation paroxysmal_nocturnal_hemoglobinuria
Block/Question (33.7 difficulty score)
A 33-year-old woman comes to the physician ...
Defect in a cell membrane anchor proteinπŸ”

Block/Question (21.4 difficulty score)
A 7-year-old girl is brought to the emergency ...
Factitious disorder imposed on anotherπŸ”

Block/Question (25.2 difficulty score)
A 32-year-old woman recently diagnosed with ...
Epstein-Barr virus-induced brain lymphomaπŸ”

Block/Question (44.8 difficulty score)
A 32-year-old woman comes to the physician ...
BuccinatorπŸ”

Block/Question (52.4 difficulty score)
A 3-month-old boy is brought to the emergency ...
GluconeogenesisπŸ”

Block/Question (66.2 difficulty score)
An investigator is studying a new virus ...
CoronavirusπŸ”

Block/Question (24.3 difficulty score)
A 54-year-old man with a myocardial ...
Decrease in intracellular ATP concentrationsπŸ”

Block/Question (12.2 difficulty score)
A 27-year-old man who works from home as a ...
AvoidantπŸ”

Block/Question (47.1 difficulty score)
A 22-year-old man is brought to the emergency ...
Area labeled β€˜E’ (Cerebellum, posterior lobe)πŸ”

Block/Question (25.5 difficulty score)
Drug X is given to a 25-year-old normal ...
Partial agonist at Ξ²-adrenergic receptorsπŸ”

Block/Question (18.4 difficulty score)
A 38-year-old woman comes to the physician ...
Intraductal papillomaπŸ”


Block/Question (27.4 difficulty score)
A 15-year-old girl is brought to the ...
CD8+ T lymphocytesπŸ”

Block/Question (40.8 difficulty score)
A 12-year-old boy is brought to the physician ...
Nocturnal luteinizing hormone pulsesπŸ”

Block/Question (69.5 difficulty score)
An otherwise healthy 35-year-old man sustains ...
Decreased blood volumeπŸ”

Block/Question (41.7 difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formationπŸ”

Block/Question (24.6 difficulty score)
A 1-month-old male newborn is brought to the ...
TyrosineπŸ”

Block/Question (39.0 difficulty score)
A man accidentally touches the surface of a ...
Interendothelial gaps in venulesπŸ”


MSK
Block/Question (36.2 difficulty score)
A 34-year-old woman is brought to the ...
LunateπŸ”

micro
Block/Question (22.5 difficulty score)
A 2-year-old boy is brought to the emergency ...
Polysaccharide protein conjugate vaccineπŸ”

Block/Question (17.3 difficulty score)
A 30-year-old man develops tingling around ...
SodiumπŸ”

biochem cell_bio extracellular_matrix
Block/Question (51.4 difficulty score)
Which of the following terms best describes ...
LaminsπŸ”

Block/Question (36.2 difficulty score)
A 35-year-old woman with a long-standing ...
Infiltration of lymphocytes and monocytesπŸ”

Block/Question (38.2 difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrinπŸ”

Block/Question (26.1 difficulty score)
A 59-year-old woman has a 10-year history of ...
Neural crest cellsπŸ”

cell_bio cell_transport cell_trafficking
Block/Question (46.1 difficulty score)
A 15-year-old girl with cystic fibrosis has a ...
Endoplasmic reticulumπŸ”

Block/Question (22.8 difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”

Block/Question (17.1 difficulty score)
A 62-year-old man comes to the physician ...
Phantom limb painπŸ”

Block/Question (39.2 difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartmentπŸ”

Block/Question (25.2 difficulty score)
A group of physicians submits a report to a ...
Case seriesπŸ”

Block/Question (17.3 difficulty score)
A 30-year-old woman comes to the physician ...
Glycine and succinyl CoAπŸ”

Block/Question (19.7 difficulty score)
A full-term male newborn has lethargy, poor ...
Enzymatic reaction labeled β€˜Cβ€™πŸ”

Block/Question (53.7 difficulty score)
A 23-year-old woman is brought to the ...
Renal tubular acidosisπŸ”

Block/Question (42.9 difficulty score)
A 63-year-old woman develops flank pain, ...
ABO incompatibilityπŸ”

Block/Question (58.0 difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”

Block/Question (58.1 difficulty score)
A 68-year-old woman comes to the physician ...
Inferior mesenteric and superior mesentericπŸ”

Block/Question (43.8 difficulty score)
A 3-year-old girl is brought to the physician ...
Spontaneous regressionπŸ”

Block/Question (62.0 difficulty score)
A 1-week-old newborn is brought to the ...
Organic acid metabolism disorderπŸ”

Block/Question (50.7 difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”

Block/Question (45.7 difficulty score)
A 60-year-old woman is receiving cisplatin ...
HyporeflexiaπŸ”

Block/Question (37.1 difficulty score)
A 53-year-old woman comes to the physician ...
Fixed cardiac output in spite of increased demandπŸ”


Block/Question (31.3 difficulty score)
A 90-year-old man has a 1-week history of ...
Incarcerated inguinal herniaπŸ”

Block/Question (7.9 difficulty score)
A new screening test for colon cancer is done ...
118/124 = 95%πŸ”

Block/Question (19.9 difficulty score)
A 15-month-old boy is brought to the ...
MigrationπŸ”

Block/Question (37.5 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal
πŸ”


Block/Question (49.0 difficulty score)
A 63-year-old woman undergoes operative ...
Decreased movement through the arachnoid villiπŸ”

Block/Question (57.0 difficulty score)
A 64-year-old man undergoes surgical repair ...
Artery of the ductus deferensπŸ”

Block/Question (35.5 difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincterπŸ”

Block/Question (18.1 difficulty score)
Forty of 100 attendees at a company Christmas ...
Vibrio parahaemolyticusπŸ”

Block/Question (30.4 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcersπŸ”

Block/Question (31.0 difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureterπŸ”

Block/Question (28.0 difficulty score)
At 2:00 am, after sleeping for 5 hours, a ...
Phenylethanolamine N-methyltransferaseπŸ”

Block/Question (28.5 difficulty score)
A 13-year-old girl who has a 6-year history ...
Discuss further the impact of the patient's illness on the familyπŸ”

Block/Question (13.1 difficulty score)
A 26-year-old man is brought to the emergency ...
Pericardial tamponadeπŸ”

Block/Question (62.7 difficulty score)
A 10-year-old girl is brought to the ...
Ovarian Sertoli-Leydig cellsπŸ”

Block/Question (54.9 difficulty score)
A 19-year-old man has had weakness of the ...
PolyneuropathyπŸ”

Block/Question (25.7 difficulty score)
A clinical study is designed to evaluate the ...
10%πŸ”

Block/Question (31.8 difficulty score)
A 56-year-old man has a 3-year history of ...
PresenilinπŸ”

Block/Question (58.4 difficulty score)
An investigator is studying an outbreak of ...
Only cookies are independently associated with E. coli casesπŸ”

Block/Question (44.7 difficulty score)
In a study of antibiotic resistance, a strain ...
ConjugationπŸ”

Block/Question (13.9 difficulty score)
A 45-year-old man with hypercholesterolemia ...
Increased synthesis of LDL receptorsπŸ”

Block/Question (35.2 difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuseπŸ”

Block/Question (48.9 difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cellπŸ”

Block/Question (67.7 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”

Block/Question (21.7 difficulty score)
A 68-year-old woman comes to the emergency ...
AlendronateπŸ”

Block/Question (29.7 difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meatπŸ”

Block/Question (51.6 difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”

Block/Question (37.7 difficulty score)
A 30-year-old woman comes to the physician ...
Decreased afferent arteriolar resistanceπŸ”

Block/Question (48.5 difficulty score)
A 25-year-old woman is brought to the ...
Pulmonary capillary leakageπŸ”

Block/Question (60.7 difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoitesπŸ”

Block/Question (39.3 difficulty score)
A 40-year-old man who recently immigrated to ...
AdenineπŸ”

vascular
Block/Question (47.7 difficulty score)
A 72-year-old woman with coronary artery ...
Neointima formation in the right coronary stentπŸ”

oncology
Block/Question (33.3 difficulty score)
A 71-year-old woman with non-Hodgkin lymphoma ...
LeucovorinπŸ”

renal
Block/Question (22.4 difficulty score)
A 40-year-old woman with a 25-year history of ...
Secreted by the proximal tubuleπŸ”

anatomy neuroanatomy
Block/Question (29.5 difficulty score)
A 22-year-old woman comes to the physician ...
Pineal glandπŸ”

oncogenes oncology
Block/Question (20.5 difficulty score)
A 40-year-old man comes to the physician ...
HNPCC syndromeπŸ”

neurology
Block/Question (47.2 difficulty score)
A 55-year-old woman is brought to the ...
Posterior cerebralπŸ”

neurology erections
Block/Question (57.6 difficulty score)
A 27-year-old man sustains a spinal cord ...
Penile stimulationπŸ”

FA18p360 FA19p359
Block/Question (22.2 difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”

Recent comments ...

... seagull made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
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hTe mtscieasn fo ihst ioesqtnu dema me tvmio loo.db

enO day a ptineta iwll okol me ni eht seye and ,sak hW"eer rae pedriestti bnorke wn"o?d I liwl esiml ta tehm dna sy,a "teh inetlsntai msuaoc adn otn the o"de.udmun l'yleTh ismel cbka dan 'lIl lkaw aawy dan ihtkn of hits mtonme sa I mpuj orfm hte n.owidw

sympathetikey  Too real. +2
mcl  how do i upvote multiple times +15
trichotillomaniac  I made an account solely so I could upvote this. +29
dragon3  ty for the chuckle +6
cinnapie  @trichotillomaniac Same +3
seagull  A legend never die +1
... drdoom made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
 +82 
submitted by drdoom(806)
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efrAt het fcuf si eit,d hte eslcl and eiutss sidlat ot het ucff will otneinuc nngiuomcs ATP (P-&ATtAgPD;), btu on fsrhe odblo ilwl be vilddreee ot ”rlaecβ€œ wtha ilwl eb an ucacltmaunig otnuam fo PAD dna hoter ib.ametetosl APD nAdoe)iens(= is isflte a rpyox of moonsintpcu dan vdisre valadooiitsn fo irrtease! uo(otnvEil si mta)r!s rcngIseani dDsniAoPeen/A ni a β€œaocll rtm”veonienn si a lansgi ot teh bydo hatt a lto of unsnpicomot is rcogrnuic ereht; ,huts irsaerte nad eloatrsrei aynrtuall aedlti ot rcaeiens ldobo fowl rseat adn epβ€œsew ”away itbmcolae ucdboprsty.

lispectedwumbologist  You're a good man. Thank you. +
drdoom  So glad it helped! +1
seagull  very well put, thank you +1
aisel1787  gold. thank you! +
pediculushumanus  beautiful explanation! +2
rockodude  this explanation was on par with Dr. Sattar IMO +1
... tissue creep made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +79 
submitted by tissue creep(104)
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hTe odpleo si pea,hgloneicyrl adn a /1010 odgo oyb.

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +
... seagull made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +68 
submitted by seagull(1405)
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ta IMB 15 ont ylon ash she vrene dha a drepoi btu she vnree adh a mael.

sympathetikey  You're on fire man lol +
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +2
avarkey  the blind vaginal pouch points away from it being anorexia related +1
j44n  Its actually a man, there's no DHT to to dev the external genitals. +1
... atstillisafraud made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +63 
submitted by atstillisafraud(187)
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I keil isht qunsotie aecseub it mnredis me taht emraeixns iknht cetbojs anc texsi ni 2 dnoisnmise.

... atstillisafraud made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +58 
submitted by atstillisafraud(187)
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aTkhn oyu BMEN fro the hihg aqyluti is.cpertu tI samek ethes esaxm stsrse rfee and jbeoylaen.

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +18
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +12
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +6
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +4
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +6
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +5
rockodude  everyone hates on nbme, but they're showing you a picture zoomed in of her eyes and she has a history of multiple fractures/bad wound healing at the age of 4, I feel like OI should at least be a consideration based on the overall clinical picture +1
feochromocytoma  Yeah I got it right, it's just funny that they don't use higher quality pictures for the exam +1
djeffs1  that is clearly a malar rash... oh wait nvm just pixellation +2
... lamhtu made a comment on nbme24/block2/q#5 (A 55-year-old man is diagnosed with coronary artery...)
 +54 
submitted by lamhtu(113)
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aeltPtle cdeeaernh adn plteetal aetnigorgag are erdifentf stnihg dna hits dfreneceir ERATTSM A OLT. Fcku ouy, .ENBM esTeh sdeffreienc syodplspeu rmteta on smeo stuqinoes and tno no h.torse hWree is het ?ynoenccists eHo?ll

hungrybox  Agreed. This is so fucking stupid. +
hungrybox  "Aspirin inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme that is required for TXA2 synthesis." literally straight from Big Robbins +1
susyars  Im gonna upvote this bc i love to be right +5
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +3
j44n  yeah i thought adherence was the GP1B receptor that's already on the platelet +1
j44n  im also glad we're getting exposed to this horse shit now and now when I'm in a testing center about to put my fist through a screen. +1
... drdoom made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +48 
submitted by drdoom(806)
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ehT ludaedno lenum adn( acrctapein tssraeope like HSONYTMYP)RIC si eth iets herwe ptcanircae mynesze sadsiteoβ€œ(dnep”)ep acevel agrel isppytpodele tnoi alslemr stbi iediprts)sp=t,pipe.deietd( It is ta het SBURH DREROB hreew the eslsmatl nidks fo sditpeep ti(dpeedtes)rdt,eispppii aer bnoerk down ntio ihtre maoni sa,cdi whhic iflyanl cna eb opred-arostctn wthi Na+ tion het tnineitsal .ecll

I hitnk oubta it shti :awy

  • omchsat idca ruaetdnes dan neβ€œsop pu” rptiseno ou(wihtt ccipsife a)v;legaec
  • epnrccatia zyensem nhet acleve ednadruet otpyieledspp nito rsmllea s;tbi
  • bhusr dreobr smezeny anflily reabk dwno tneisit isetpdpe tino sbalaoebrb miaon .csaid
regularstudent  Isn't the brush border still part of the intestinal lumen? Don't the amino acids enter into the intestinal cell (the "intestinal mucosa")? +
drdoom  @regularstudent No, the lumen is literally the cavityβ€”the empty space. +
... niboonsh made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
 +48 
submitted by niboonsh(336)
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sthi tequnsoi kmsae me watn to tea an e ciol oikeco nda eohp i eedbl tou

caitlyncloy  pick C and move on was my strategy :P help lol +1
thegooddoctor2  lol good one +1
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
 +39 
submitted by tea-cats-biscuits(212)
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atsM llecs ua,arlgdneet giuordncp stieihnma whhci atttrcsa ohliopenis.s heT layer tsgae fo na rlicgale nrtaceio is smta cell de,daemti but the late tseag cln(uiigdn usmuc tdrniupc)oo is dmedeati by seooi.plhins

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +15
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +4
ajss  where do i find this info?? +
paperbackwriter  @ajss pg 112 of first aid 2019, under type I hypersensitivity. Immediate --> mast cells releasing histamine and tryptase, late--> eosinophils and leukotrienes recruited via chemokines +2
graciewacie9  Wow, i missed the fact that the question is asking for the RESULT of the reaction, NOT the cause of the reaction. Mast cells cause the initial reaction, eosinophils would be the result of the eosinophils. *facepalm +6
greentea733  @graciewacie9 SAME UGH +
mutteringly  who else looked up what T21 pills were +2
... lsmarshall made a comment on nbme24/block4/q#8 (A 1-week-old newborn is brought to the physician...)
 +39 
submitted by lsmarshall(393)
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raeU Celyc irrdDseos t&;g olsIated reeevs emmeaihyornmpa ;(t&g 0100; i.,e. on herto esvere oaceimtlb uidnseacbrst

tinrhOeni rmcaybsrtlaaeasn iienfeyccd &;gt mt(so mocnmo erau eccyl .ids) roiotc i/umeadcaiiacdira, aohnrpaiyememm

gOcnira eamsAcdii ;> nypmrieomm,eaaH g-anoipan icasodis, soketis (mfor )ylehyimaopcg

a-unidmeMhic caylA-Co hoedneaegsydr ifeiedccyn t&;g yarmempHon,imae cohkitteypo gcloypeihmya seen( in tdaiiΞ²xnoo- s,errodsdi PTEEXC pdykrtrsloouyheen)dao

riveL ydstfcunino ;g&t mepimmae,ryHoan LsFT esdesm ,up relod .pt

lsmarshall  Summary of metabolic issues relating to hyperammonemia +7
seagull  i'm leaning towards Ornithine transcarbamylase deficiency. +3
notadoctor  Not sure why this isn't considered a mitochondrial disorder since the issue is Ornithine transcarbamylase deficiency in the mitochondria? +2
charcot_bouchard  if it was mitochondrial disorder no one would escape +3
wowo  figure in OTC deficiency, they might have to explicitly mention the orotic aciduria AND typically presents earlier, around 24-48hrs of life after they've fed (at least per BB) + also per BB, propionic acidemia and MM acidemia have an onset of weeks to months and lead to build up of organic acids --> acidemia in addition to hyperammonemia (not sure why, but several aa enter the TCA cycle via propionyl CoA --> methylmalonyl CoA --> succinyl CoA, but now this is defunct d/t enzyme deficiencies...?). Anywho, propionic acidemia described on FA2019 p85, but doesn't list hyperammonemia +2
artist90  i think it cannot be Ornithine transcarbamylase deficiency bc it is XR disease. this pt has a healthy 2yr old brother which rules out X-linked recessive disease correct me if i m wrong +4
artist90  it is 100% Propionic acidemia Uworld Q-id: 1340. it is an exact copy question of uworld. i got it wrong bc i forgot these are organic acids. But i am still confused on 2 things 1-how does acidosis cause Hypoglycemia and Ketosis. 2-why is Ammonia elevated in these pts bc urea cycle will be fine? +
yb_26  1) hyperammonemia is seen in all urea cycle disorders except arginase deficiency 2) organic acids directly inhibit urea cycle => hyperammonemia (from UWorld) +1
yex  According to UW, there is another question # 1341. This one refers to methylmalonic acidemia (ORGANIC ACIDEMIA). HYPOGLYCEMIA results from overall increased metabolic rate leading to increased glucose utilization and direct toxic (-) of gluconeogenesis by organic acids. The presence of hypoglycemia leads to increased free fatty acid metabolism that produces KETONES, resulting in a further anion gap met acidocis. Finally, organic acids also directly (-) the urea cycle, leading to HYPERAMMONEMIA. +10
... drachenx made a comment on nbme24/block2/q#13 (An 80-year-old woman, gravida 4, para 4, comes to...)
 +35 
submitted by drachenx(49)
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ehesT sdink fo sioutnesq ear eylalr rdha uaebsce I've eernv esne flaeme cvpideoruetr cstrtuesur .rli c:

nbmehelp  Lmao +3
regularstudent  Lmao +1
mutteringly  Lmao +
rockodude  lmao +
abkapoor  Lmao +
... sympathetikey made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +35 
submitted by sympathetikey(1253)
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eoerEvny who tog iths qsnteoui rhtgi is a pc.o β– ΰΌ½ΰΌΌβ– ΝŸΩ„βŒ

dr_ligma  Fkn narcs +2
j44n  whippet_gang +
... xxabi made a comment on nbme24/block4/q#43 (A 72-year-old woman with coronary artery disease...)
 +35 
submitted by xxabi(251)
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Snett ohrsmbtois sv etrion.sses- tSten sbtmooirsh is na catue nioculocs fo a rrnyocao eyrrta nes,tt hwihc tnfeo rulstse ni uceat noaroryc eyosrnm.d Can be rnvtepeed yb uadl lapltaetietn eyhatpr or genuuritldg- tntes.s ssetoeiRns- si hte algruda aoirwrnng fo eth tents nulme ued ot nitlmionae ,ieprltioofrna igruntels in aanlgin pmyssm.to

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +3
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +4
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +2
... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
 +33 
submitted by lsmarshall(393)
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aPnteit has aniSp badiif ucaoltc whchi is a ulnare teub eetdcf f(ruaile of ifnsou fo eth o)ounsr.rpee cSesomrolet aer the arpt of ache msieot in a ebattrerve byeorm gvigin sire to enob ro otehr saketell tussei. cnSie a ratp fo tshi itpeast'n iasnp aiibfd liuencdd can"sebse of spnoisu oe"csprs nteh a eooelmcsrt asw vvieon.ld innwKgo ttha lurena uebt festcde are na isseu hwit soufin oluhsd eb eoungh to teg ot teh irtgh as.wner

If teh otohrocdn adflie ot epoeldv tneh eth tirnee CSN wulod not oevelpd sa het ocoodntrh ineudcs arnotmfoi of lnuera lpea.t

If het unarel beut faedli ot dvlepeo tenh teh ewohl SCN luwod tno hvae doled.vpee

Ylok sca si leertivrna ot thsi atn.ipet

eWnh luarne scert ecll it ash ideertfnf omcutose in teeirdffn utie.sss lFiruea of nuelra tesrc to meairtg ni ahtre anc uesca rnTsnaspotoii fo terga ssesl,ev Trayetlog of ,tlFola ro srPitesnet ctnuurs sorstua.ier ilFruae of rnaleu tecssr ot gmatire ni GI can csaeu rsicrghHupns desesai tecgnaonil( g.oc)maleon cheTrrae Cnllosi ydoernmS cna urcoc whne nreaul scret lescl alif to reatgmi toin 1ts payelhgran arh.c eNlaur betu defcste hsa nothign ot do thwi afluier of lenaru etscr itogmrian tuohg.h

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation. +12
hungrybox  Fuck I picked "Formation of neural tube" but yea that makes sense... that would affect the whole CNS +3
ruready4this  I also never heard of sclerotomes and I chose that and then switched it to formation of the neural tube because I thought that was close enough ugh close enough is not the right answer +
... azibird made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +30 
submitted by azibird(158)

Who else came here after getting triggered by this answer?

yousif11  This question did not age well +4
... lsmarshall made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +29 
submitted by lsmarshall(393)
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gAnonred nyesinstiitIv nmyderSo - Dteecf ni oagdnenr peeorcrt rnuietgsl in prplimnanrgaao-e emlfae 4(Y6X, ).DDS ninotincgFu teetss sucsea iarenecsd roensteettos at petrb,yu hwhci is edntvcroe to rnsogeet lrapeypel,rhi ggiivn fmelae ncdyerosa lauxes crttcrcsehiaasi emafl(e enlertxa iaeatil)g.n kLca fo orngnaed certroep uctinnof eadsl to bsnaet or atsnc xiyllaar dan icpub ihra. tPensati haev manrduerity ag,inva ubt utsuer adn lnaflapoi tbesu batn.es

Ardngeon tsyniivsnteii srmeydon si eth wrsnea utb uyo igtmh ehva esedodcrin ΓΌellMrnai igesenas eyki-ksnMarRa(-tyo KaΓΌrsrs-teHue .d)emnyrso

uMlrelani iesgnesa lliw vahe ramoln omnreoh lelvse nad mya pnesrte sa Β°1 erhoneamra d(eu ot a calk fo ereniut vnoedleemp)t in faesmle wthi llyfu veopeeldd Β°2 axluse cecsarciatsrtih uiltcnfao(n oaev)i.rs Hrai enoevtldmpe si omlnra sa lle.w naiPetst lsao evha mrlaon hethi.g

sSeem like tshi ueinsoqt did otn gvei us ucmh ot iuhtdnsgisi eeisdsb hgtihe adn narnte tgesa 1 crai/ypxulabil rih.a

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +
... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +28 
submitted by lsmarshall(393)
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ehT mots rteicd ,ahtp dan tmos yilkel htp,a rfo bersta rcaecn to tizsmeataes ot het reravetb are het caotisrlten i.vens Tish wsa on an rarliee EBNM tset as lelw. esBart cacren lwli eucas ime,xd ctliy nad taclisb oesnsil oecn in obe.n

On an anedrutael ;oten I lnalify cmea pu twih a etcdne way ot mrmberee tilyc v.s tsaiclb ascrnce ni b!eon

IYeknd dan doIYrth csaeu YIlct

resttpoa t;g& etabatsl tg&; tcisbla

Two betassr t;&g wot yetps fo sslineo t&;g B raste eascus B toh

owT lusgn g;t& wto spyet fo nleoiss dpng(ednie on tpey fo lgun ecn)arc

acesll-llm ulng &g;t "lslma sbtsl"a

-snmnlaol llec t;g& clyit

artist90  VEINS: 1-Intercostal veins drain into Azygous vein which drains into SVC BUT some blood from this Azygous vein is also draining into BATSONS VERTEBRAL VENOUS PLEXUS how the breast cancer metastasizes to vertebral column. 2-Internal thoracic(mammary) vein drains directly into Brachiocephalic vein. 3-Lateral thoracic vein drains into Axillary vein which drains into Subclavian vein which drains into Brachiocephalic vein. ARTERIES ARE DIFFERENT: Subclavian artery----branches into---Internal thoracic(mammary) artery---Intercostal arteries. Internal thoracic artey is used for CABG if there is 1 vessel block. +15
... famylife made a comment on nbme24/block2/q#37 (In a culture of motile spore-forming bacteria, which...)
 +28 
submitted by famylife(86)
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ust-ald"enodrb areks.earb.. eudacs by innzgoii ,roniaaidt ludigninc gamam rysa adn a"-srXy. .vs "VU daitrinao suscae owt saclsse of NDA esnoisl: ycaluotecnb miepndiiry smedir DCs,P( rFguie )1 adn -64 opopcoutshdrt (64- sP,P iFrgue 2".)

dasfasncasiaunreobtd//w-p-gw/cmi-n:rwi4seai.ea-iocnlhiongtdnam3t/pmaaat-pmcmheipt.4re-/-gernta

... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
 +28 
submitted by tinydoc(223)
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hiTs usonqeti is vyer kne,sya tub in neseces thsi is tawhs npenhipag.

eTh aadntlciec mvaoerl fo the PTH dlgnas irdung octyiyhordtme β‡’ ↓ HTP

PHT lr:i-m aynlo-n ben:o ↑ emrvloa fo aΒ²C⁺ and hhpotPae fomr no-ei -nb ykn:side ↑ C²⁺a opertrnbiosa nad ↓ PO⁻₄³ osetapon-r↑br i- inocsorven fo 5,2 ryiiytoxvdanHm D to ,125 triHoiynxvdyma D Ctlaci(rloi - ticeva r)mfo avi ↑ tiaviyct of a1- srxayoHdyel cecdinyief

reofrheeT a ↓ TPH dowlu dlae ot:

β‡’ ↑ β‚„OP³⁻ β‡’ ↓ a⁺CΒ² β‡’ ↓ 21,5 vnmoydyxHrtiai D

Teh tsoeiuqn si eynska m(hcu ikel the tesr of shti xam)e eeuasbc mosnoee who tsni ocifsung lyarel darh ro ni a hurs htmgi pcki eth ipoton C whree phothaep is ↑ nda HPT is ↓ TBU ↓ 52 royyxnvadmtihi D

sTih si wongr sa nlyo ,215 mhiaondiryxvty D olwud eb ,radesdece het rvsinooscne bfroee itsh era oned yb teh snki uthsl(n)gi nad .vriel

I rlelay iwhs htye owldu stpo namkgi eth soueqnsti nuofgscin YLUREP rfo eht eska fo gankmi meth cof.unigsn stnI it hoguen atth ew haev ot wnok siht csriduluoi taoumn fo itra,nofimon iuwhtto aigvnh ehtm itonlinnleyat gikmna it ehradr yb inintpgo uoy to 1 nreasw cocieh tub anhgingc a miunet latied ot kema you senwar n.ogrw Or sigun a rdoanm ass nmerucoaetnl rfo a seadsie ot dviao gimank ti oto emlpis (SNGP = elovrarife"pit )NG"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2
graciewacie9  Amen to the PSGN question. They got me on that one. lol +
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +
msw  *pointing +
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1
avocadotoast  this bs is prob why the question isnt on step 1 anymore +
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +
... medpsychosis made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
 +26 
submitted by medpsychosis(110)
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Teh ayw I othhugt butao it asw a etiltl rmoe cmistip.sli eW sue non lcieetsev beat cbleokrs g..e( oaPolrno)rpl rof the ernettamt fo aietselns ot.remr Tofeerhre a btae nsoitag uldow veha teh petsoiop cft,efe aka seuca or ceanehn me.torr

hungrybox  Genius +3
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +3
... sattanki made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
 +25 
submitted by sattanki(69)
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rnltpyepaA htree si a eloytelcpm starpaee lnpisa crdo xrleef weehr credti ieenlp tntmloaiusi leasd to na ceoren.it ihTs xrelef olyn dseen na attnic arc in -2S4,S so as nglo sa hist egionr si not nidrju,e na octriene cna llsit .roucc oeH,werv hwti tnroeaictsn at ,C8 hent teh ceshgocnypi ecotiren freexl aoncnt ,ccrou sa htis irqeseru degdeicnsn irbsfe mrfo eht eroxtc.

lsmarshall  Just saw a good summary of nerves/vessels involved saying, "pelvic parasympathetic fibers from S2-S4 can cause cavernous arteriole vasodilation via the cavernous nerve without of central stimulation." +7
seagull  S2-3-4 keeps the penis off the floor +35
drdoom  Modifying @seagull into iambic pentameter: β€œS2, S3, and Number 4 / keeps the big ole penis / off the floor” +1
myoclonictonicbionic  I can assure you the validity of answer (speaking from experience) +2
raddad  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ Under the "autonomic control" header +1
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
... brethren_md made a comment on nbme24/block1/q#40 (A 26-year-old man and his 25-year-old wife come to...)
 +24 
submitted by brethren_md(87)
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eaMk a ntnpuet resauq wthi a soscr fo B B+ dan B ;B0 +B eserrenpts %50 cfonniut iwehl 0B tpsrsereen 0% )(llnu c.nfotnui oS in isht aes,c hte hbndasu lowud haev a B 0B petngoye lihwe the iwfe ash a B B+ ypn.tgeoe

Crsos fo eesht two will lruest ni teh lilfogwon ygnoeepts; BB, 0B,B +BB, 0+BB B B = 0%10 tcnoiu,nf B+B = 57% tfcn,ionu 0BB = 05% foctniun, B+B0 = 25% foucntin

oS eht rwaens lwil eb 1 ni 4 hvea a 52% nfitocun gievn eth sgpoyente.

tyrionwill  how about the choice of D: 1 in 4 have 50% function, which is true. shall 50% function needs transfusion? +
tyrionwill  In FA, it defines beta thalassemia into minor (HbA2 >3.5%) and major (both HbF and HbA2 go further up), and the major needs transfusion frequently. How can we take this classification based upon quantitive way like in this question? how much percentage of function left does not need a frequent transfusion? +
azibird  D says one in TWO, not one in FOUR. +2
neil_simmons  The question says the mother has a mutation known to cause 50% decrease in beta-globin gene function of one allele. So if one allele is working at 50% (B+) and the other allele is working at 0% (B0), then that would mean that particular set of alleles would function at 25%. +
... m-ice made a comment on nbme24/block3/q#38 (A 55-year-old man comes to the physician because of...)
 +23 
submitted by m-ice(321)
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heTy xlpiectyil attes that hte anttepi has nbee igatnk cseesx fo ish elooythxvreni .acnmdiieto ihoxoenrvetyL is hte nugooeesx romf fo T.4 To,eerefrh fere 4T mstu eb ele.vetad T4 is retceodvn ot 3T ta most eraprplhie s,ituses so 3T lwil aosl eb eetva.led esBcaue eht yobd sah emor iytordh monoehr htan ,eneedd lsse THS lliw eb ,mdae nad eth rtyidho llwi eb sles vaite,c giatnk up SSLE n.deiio

procrastinator  I forgot that T4 is converted to T3 :( +1
... m-ice made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +22 
submitted by m-ice(321)
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heT pnaitte ash sosl of ainp dna tpeuerteamr on hte grthi iesd of his fc.ae anesntoiS fo teh acef is aipsi,trlela os hte isuse umts be no teh ipsatnte' rtihg d,eis ihhwc ew nca nriocmf yb igkwnno ttha eosnansti fo het bdoy si r,ottallrcneaa nad eh ahs tslo etlf deisd pani dan tptueraemer of eht .ybdo

aiPn nda eputraertme ensntsiao fo teh boyd si tapr of teh scmontiiphala t,atcr hwcih ywsala nusr ellrytala gurhhot het eabsnrim.t siTh anc eb dcmrfnoei by mbnireergem tath osntnesia ot eht acfe loas surn ayltrlale utgorhh hte .rsbniatem oS, ew nac fmronci stih si a girht esdid tllraae eirsbmtan .useis

heT sslo of agg rxelfe nda prasailys fo teh lovac rdcos pymil emipamrnti of rcnaail nersve XI and X, thbo fo hwich zoelcila to eth alu.lmed rheo,erfTe eth nesraw is higrt lsdarlrteooa maleud.l

duat98  You're a good man. +2
charcot_bouchard  You must be handsome too +7
... aneurysmclip made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +22 
submitted by aneurysmclip(135)

anyone else get this wrong while the current coronavirus "pandemic" (acc to some sources) is happening? feeling reaaallll dumb rn

targetmle  yes because i thought they wont give ques on current coronavirus situation so early!! +
adamventure  I thought to myself "damn it sure would be fuckin hilarious if Coronavirus was the answer".. turns out it was and it wasn't hilarious since I got it wrong. +45
asdfjkl  no quotes needed for pandemic anymore :( big sad +13
... neonem made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +22 
submitted by neonem(550)
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ePr :Phmaaot rlaye idreheitn aescs fo 'liermhesAz naeidtem ear isaacsedto ihtw uaitmnots ni /sni1selienlni,-r-irpp2ene as llew as os'Dnw yrnmed.os sDnow' duwlo eb deu ot na xaetr smromoceho 21, whihc ierarsc the geen rof idaylmo prroesucr onteirp (PA.P) rEatx APP is cvdteeorn ot e-atbA moylaid nda htis sfmor cllraeltraexu ieurtinc ,slpuqea a tmoinnerp atfuree fo ielrehAz's.m

ttponrmaI ot nto ecsfuon iyoAlmd A peotnir (eno fo eht rnewas ceosci)h whit omlAidy csuorerpr rpieon.t Dooeisintp of AA limoyad is oerm adtceosias tiwh chnoirc fnrtmilamyoa ttea,ss ngc,iyanlma dna Fmlilaia etdeiaaMrnenr .Fvere 2Ba-et irnliocbgumol si oherant loamdyi isoantsoca:i -lssieiaaiytassdcod pss(deito in )tosjin

... tea-cats-biscuits made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +21 
submitted by tea-cats-biscuits(212)
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suceeaB yuo era isepnu, eh’rest enrieadsc aeodrlp going kbca to ryuo aterh (on dnee to rkwo snatgia vgai,rty rouy dlboo tisn’ nlgioop ni yrou elgs as cumh he)rite. sA a rtsul,e NAP si etsredec deu ot AR cshrtte, enidlga to redisius nda a outdrinec of oldbo vlumeo.

urachus  When the person is lying down (supine position), gravitational forces are similar on the thorax, abdomen and legs because these compartments lie in the same horizontal plane. In this position, venous blood volumes and pressures are distributed evenly throughout the body. https://www.cvphysiology.com/Cardiac%20Function/CF017 +
thelupuswolf  RAAS trumps ANP though, so the dec. in RAAS as said by colonelred_ is likely going to have more of an effect than ANP. +1
lola915  If you have an increase in ANP wouldn't natriuresis occur and cause a decrease in blood sodium? +2
sars  This is a "read my mind" question and complete it in 1.5 minutes. Thanks +2
faus305  @sars that is every question +
... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
 +20 
submitted by ihavenolife(66)
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lnnurAa cparnaes is na ornblmaa oarnttio fo teh vntlaer apicecratn u.db tI eiecrsncl het 2nd tarp fo eth dedunmuo lkie a rnig adn nsorwra the meuln of the unoeddum. If het aantierccp irgn is httig nuoheg ot rnarow the nmeul hnu,ego it adsel ot tiniovmg. eTh oluiisb mnitgivo ipleism the inuosottcrb is itlads ot eht Alaumlp fo Vt.era

eOhtr snwreas

riolPyc issesnto -g&t; NONoslbiiu prjlieocte ,ivintgmo eievd-hplsao smsa in gpcirsaiet oinger

eaEghopasl rateisa &g;t- uolwd eb onn libsuoi as lwl.e auuysll oenneast epsnter itwh oid,lnogr khoec nad ivtmo tiwh RTFSI edgfie,n iths yob si 3 sry lod os ti is uyk.lniel

aBliiry ataeirs g-&t; trblieat-boirioveF tinrosdutec of eietrpaahtxc elib duct, dsael ot essctalos.ih ulyaUls nnberwo htwi ducanj,ei dakr uenir dna olhicac otosls ueacbse ileb ecakdb up.

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +
ophmd  Curious as to why this presented at 3 years of age +3
ophmd  To answer my own curiosity; according to UWorld - most cases are asymptomatic at birth, so likely it presented when this child's organs began to increase in size (particularly the descending duodenum) +10
... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +20 
submitted by dr_ligma(38)

If NBME asks about a kid with suspicious rash under his nose + lightheaded/dumber in class, that kid's huffing glue

abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
 +19 
submitted by lsmarshall(393)
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exorFl gomudirit spruufnod si nisporseebl rfo oelfxni of ID.P diMale cstepa fo eth elscum h(hwci esxfel the t4h nad th5 itg)id is espdlpui by het ulran renve 8(C, )1T. hTe talalre tsapec iwhhc( elsefx hte nd2 and 3rd giid)t is nireadnvte by het eidnma nevre ypfliclesaic het neroirta seoiustorsne brncha ,C8( ).T1 So eht niuqteos is idsgbcenri a ecnliroata imngdaag eht enevr yuppsl ot eth DIP rfloex of teh d2n idigt dx(nei )ferig.n isTh is gaisyn the meilda vnere is ebnig madagde (8C adn T;1 orlwe urntk oto)r.s

almscbLrui (t,2d1ns/ ai;endm /,h43rtd alr)nu rea a ugpor fo semcsul ahtt felx ta the MCP n,ijot adn edxent PIP adn IDP nots.ij

dCuol mberemer as orfxl'e dtigiumor rouufsnpd is onldyupfro 'olng cesni denosnt ienrst no .sIPD apmdCroe ot lfeorx oumtiirgd felipsciasriu wseho neontd rspaw rnuoad opdnufu'rs ecasyfrpiulil tbu trnesis on sPIP.

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +10
whoissaad  @lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific. +
aneurysmclip  shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals) +6
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +
... lsmarshall made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
 +19 
submitted by lsmarshall(393)
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"esaPraanrlt vheea il()tf cusrco dnigru ithrg inrucvltare eyrrpyphtoh ..i(e ngle)netaerm ro eryv ryearl veerse tlef aratil ang"ete.lnrem RV eyrprhohytp nca eb ense os iseayl ebaeusc eht VR is ta teh inotrear feurasc fo eht ct.ehs

In hits ptiaent dolob mfro LA to VL serdcseea ni aat,trosniu os ti si oggni m.werheeos ormF hte 2O sta. we nca deuced erthe si ybobrlap a DVS edea(crnsi VR rssrpeeu wduol acuse HRV adn anlarstrape )e.veah rormerFthu, eth engivtte is ekylil csibdgerin orgyletat of olaftl cade(su yb irsnrrtoeoepua sepnatdmclie of eht nuudabinlfir tspme)u. In Tte s,lplse VR twufloo si oto secotbrtdu nda tptaein estg yasoincs nda LRt;g& unginsht sSuqat seiancre R,SV sdaencegri ;tLR&g ihs,untng tgipunt omer lbodo ghohrut prolanmyu citircu dan eivgnlrei asscni.yo

seagull  i'm pretty sure your a prof and not a student. +15
nor16  nevertheless, we are greatful for explanation! +
niboonsh  I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml +
anotherstudent  Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize? +1
pseudomonalisa  This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though). +
... snoodle made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +19 
submitted by snoodle(20)

just wanted to add that questions that ask small details like this make me want to carve my eyeballs out

j44n  This is the shit that keeps me up at night +1
... lsmarshall made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +18 
submitted by lsmarshall(393)
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clAra ioglieunts is toms mcnoom ytpe of anmeoalm ni airAfnc Amanceirs nad is on teh psalm ro elsso. I gessu het ylptaic tniknghi of hetsc nda akbc s(un epxe)dos si a etltil dienrftef ni siht p?yet oAmgn lla edmpgarsihoc; oasmnalem oucrc teh atiyojrm of ietm no eht msbil 3~(6% reowl dan 1~%9 reppu;) utrkn si .~.27.% So adbes no htat nda imh iebgn of nraAfic eedcstn ew cna oehcos pms.al

... neonem made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
 +18 
submitted by neonem(550)
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lalSm llec mcinaarco of teh nugl yma odercup ealraopctapnsi me,rdysnos of hiwhc HTCA and HDA are het roem cmmoon .uetsbspy HACT secsex sdlea to cseesx miunaosttli no eht dnreala rxecot to ceudrop rtcoolis, istrngule sgih'sunC somdry.en eEcsxs soctolri alryln(mo a ssrset o)neorhm esusca rynoinehespt iav tiotnotiaepn of yhsetacmpti onuilmattis on eht aruucl.esavt It acn also uecsa pyioaalekhm by nitgca as a eootnioimccaildrr ehwn in sc,xsee agitaurtsn eht litbyia of ryeyx1o1ds-redbh-aiott asderngyodhee snerte(p ni the lnrae blsutue) to rtovnec lorsocti to ocesotr,ni hchiw sden'to act sa a cteodr.lmaioniroic

therealslimshady  Adding some ways to eliminate the other answer choices for good measure: B) ADH can be secreted by small cell lung cancer (SCLC), and would cause SIADH, but that does not manifest with hypertension or hypokalemia. C) Epinephrine can cause hypertension (a1 effect), and hypokalemia (via stimulation of the Na/K-ATPase), but is secreted by pheochromocytomas rather than SCLC. D) PTHrP does not cause hypertension or hypokalemia, and is secreted by squamous cell carcinoma of the lung, not SCLC. E) VIP can cause hypokalemia through diarrhea (see VIPomas in First Aid), but not hypertension, nor is secreted by SCLC. +6
... tea-cats-biscuits made a comment on nbme24/block3/q#24 (A 3-month-old boy is brought to the emergency...)
 +18 
submitted by tea-cats-biscuits(212)
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The esadsei ereh is ecotrufs sahashtsbppieo niic.cyedef nI it, VI ygclorle ro euotrcfs n’etsod phle caeuesb bhot tneer eht ocgeusoneegnlsi tpahywa oeblw fsorectu spaphtieh.oabs telasocGa on het trohe dhan eertsn obvea .ti I odn’t hinkt uoy allrey ende to onwk shti to cehoos hte crrtoce wesnar scnie the cllacnii iptuecr fo gitfsan heyypmoilgca ttah si ecedrocrt /w esmo otrs of aursg tath can eentr het eneosgignlsouec athpywa duhsol ucel ouy tnio eht grhit sera.nw

neonem  I don't think you could have *totally* ruled out the other answers - I picked glycogen breakdown because it sounded kind of like Von Gierke disease (glucose-6-phosphatase) to me: characterized by fasting hypoglycemia, lactic acidosis, and hepatomegaly since you're not able to get that final step of exporting glucose into the blood. However, I guess in this case you wouldn't see that problem of glycerol/fructose infusion not increasing blood glucose. Nice catch. +24
vshummy  I think you were super smart to catch Von Gierke! Just to refine your answer b/c I had to look this up after reading your explanation, von gierke has a problem with gluconeogenesis as well as glycogenolysis. So they’d have a problem with glycerol and fructose but also galactose since they all feed into gluconeogenesis before glucose-6-phosphatase. Great thought process! +22
drmomo  glycerol and fructose both enter the pathway thru DHAP and glyceraldehyde-3-ph. Galactose enters thru Gal-1-ph to glu-1-ph conversion +2
linwanrun1357  In this cause (fructose bisphosphatase deficiency.,),fructose should help to increase serum glucose, bcz it can become into glucose-6-P by hexokinase. Therefore, this question makes me confused.... +
krewfoo99  According to uworld, fructose infusion will not increase blood glucose levels in Von Gierkes Disease as well +
atbangura  I believe Von Gierke is not a plausible answer choice because a galactose infusion would still not see an elevation in glucose levels. Remember, galactose could be converted to galactose 6 phosphate, but in order to complete gluconeogenesis and allow glucose to leave the Liver for an increase of its concentration in the blood, the patient would still need glucose 6 phosphatase which is eliminated in Von Gierke. +1
lilyo  So what disease is this??? I mean couldnt we have just answered the question based on the fact that the patient responds to galactose being infused and we know that galactose feeds into gluconeogenesis?? I am so confused. +1
djtallahassee  Its Hereditary Fructose intolerance right? gets sick after fructose and I guess glycerol can jump in via aldolase B on this pathway via page 74 of FA2019. It looked like a fructose thing to me so I just marked out the other ones and moved on. +1
paperbackwriter  @djtallahassee I was wondering same, but hereditary fructose intolerance also results in inhibition of glycogenolysis :/ confusing question. +
amt12d  A much simpler way to think about this, without trying to figure out a diagnosis, I looked at the time frame for when the child was presenting. He has eaten poorly for 3 days, by now, his glycogen breakdown is gone. His body would be trying to make glucose, therefore, gluconeogenesis is impaired, not glycogen breakdown. +2
tyrionwill  if fructose kinase is not available (fructose intolerence), then some fructose may go to F-6-P by hexokinase, then goes to G6P if gluconeogenesis is needed. however this patient's fructose kinase was intact, so no fructose would have go to F6P, so there would be no blood glucose increment after injection of fructose. +
... itsdrgoodwood made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +18 
submitted by itsdrgoodwood(18)
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heT sdsgiioan is gneosesseitO metcaIf.rep sseDiea uscsea a etfdce in ypeT 1 naCglloe ttha lsdae ot tliβ€œetrb n”os,eb gmiaenn het istpnaet heav eetqunrf cerfsatru ithw eltlti tu.mara pyeT 1 aloengcl si olas a rmaoj eontcponm fo teh lesrca &t-;g ihst is waht the criptue aws gihtinn at i( hk?nti) nad ti saseuc eubβ€œl sacl.e”r Teh slearc era atnuicln/nthetsr os hyte loko buel ued to dngiyrlenu adorilohc ivs.en

ll,yFnai statniep heav oorp ouwnd hn.laieg onWdu iarrpe hwit nauoaltnrgi uitess islovvne etpy 3 lalogce hhciw si ehtn vrenectod ot yetp 1 ogcllean nurigd srca ainotofmr. seDtcef in yept 1 lgolneac uiylobovs ’tond owlal sthi orsspec to ktae cpa.el

... seagull made a comment on nbme24/block2/q#6 (A 50-year-old woman is admitted to the hospital for...)
 +17 
submitted by seagull(1405)
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iThs is a neic ohpacapr ot iifdnyitegn nad ntitgaer ofcsiaitut .ireodsrd

Oin:xsprg:=vc+o.2lp=cXwbhbFhrbcR&oestaoaoh+m6khqg#8psm=ts/.w6akm/atig/Melcdtc?wet

cinnapie  Not all heros wear capes +
privwill  Mother of mine strongly believes in this method of treatment... +8
aisel1787  lmao +1
... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +17 
submitted by madojo(160)
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oethnAr yaw ot inkht ubtao hsti si hawts het slocse taesg to isositm usceeba tirgh efebro M sm)tsi(io ouy need to ahev iomictt cslincy dhsesz,teyin and tath udwlo eb 2G

G1 -g;&t- S -;-t&g 2G &-tg-; M

... lsmarshall made a comment on nbme24/block2/q#22 (A 3-month-old boy is brought to the physician...)
 +17 
submitted by lsmarshall(393)
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weegelrlZ orensmdy - ouatsaolm esescvrei srdroeid fo peoomrsxie geiibnoses ude to ttdaume EXP .segne panyiot,Ho reuzssi,e paeem,ohatylg yrael edaht h(itiwn 1 ry)ea. d-xioaΞ²noit fo ALFVC ensppah ni imeospxoers so hte icdlh emesilgny vaghin osme stor fo netalgicon bcoliemat osrdidre htiw etvdaeel FACsVL hdulso ehav been uhengo ot get teh waensr thuwtoi onwkgin oubta Zwelerg.el

jucapami  furthermore, FA 2019 pg 47 +4
tiredofstudying  Same page for FA 2020^ +4
... neonem made a comment on nbme24/block3/q#26 (A 54-year-old man with a myocardial infarction...)
 +17 
submitted by neonem(550)
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rGnelea etmeh of hyapgloot: iaxhopy mipairs dtiexvioa syrtoopaonphihl t&-;-g sesl TPA -;gt&- sesl NK-a mpup vcyttaii os iodsmu uidbls pu ni eth el,lc gicnsua l.gwlsine hiTs si the frsti e.spt Thne 'udyo etg hte clmcaiu bdulpiu ni het elcl nda tulnaeve eoarncbai sli,yosycgl asiuncg tlccia cida oiucorpntd adn ldeeowr ..p.H tbu hist nhspaep leart dna ni'st het derict csuea of raulllec islewngl, hihcw si ahtw eth eqstinou is fa.rte

aneurysmclip  can we have a moment of appreciation for Dr Sattar +18
makinallkindzofgainz  blessed be His name +5
... colonelred_ made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +17 
submitted by colonelred_(100)
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oedoLk it up adn dfuon tath ucaeseb yeruo’ ni a ipnues soioinpt for a nglo mtei ouyer’ ngiog ot ehav ersaincde svunoe untrer hichw laeds ot eaicdsern O.C iTsh yteevagnil keesbfcda no A,ARS ialndeg to scddearee latn.deoeros sA a stl,eur ’yuore oging ot avhe eeirsndca reiisdsu ihchw edlas ot dreaeecds bdool adn spmaal vl.oeum

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +7
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3
yotsubato  You gotta be preggers to compress your IVC +5
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +
... tea-cats-biscuits made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +17 
submitted by tea-cats-biscuits(212)
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beinctrFoin si na arcullrelatxe ixatmr ie,coolntyrgp elwih amiln si an damieertiten lnfaetmi atht lsepfcylciia spdieovr stupopr ot eth ecll .nuscleu ntD’o oesuncf mianl itwh nnimlia e(necisc teahs us ayl;rle)c laninim si leik bnreitofi,cn an MEC tcyonrlioegp nda a mroja ocemntonp fo eht sabla aimnla fo smtbneea e.smbenarm

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +30
dr.xx  blasphemy @masonkingcobra +1
luciana  I clearly confused lamin with laminin, now I know +3
almondbreeze  FA 2019 pg 48 lamin +1
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +
brise  @abkapoor the f is progeria? and do we need to know it for step? +
brise  @abkapoor omg jk jk wow +
... sattanki made a comment on nbme24/block4/q#5 (A 45-year-old man comes to the physician because of...)
 +17 
submitted by sattanki(69)
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esucMl npai + tpeliraorbi eadem is a alcicss atrnotineeps rfo tenlioachrl sis.rlpai setB disansoig ofr hsti si a csmeul pi,bsoy sa teh ywrmo ilesk to onatugh tiwnhi hte slu.mesc

sympathetikey  That's what you get for killing polar bears. +74
dr.xx  That's what you get for not cooking them well. +4
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2
... consistentwrongdoer3 made a comment on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
 +17 
submitted by consistentwrongdoer3(17)
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The srenwa is lrfeyxiapeoh basucee hte fetnearf car of hte cslmeu stctehr erelxf ahs to og gruhhot eht doarls mair and ordsal troo .aagnlig mDbu seqoti,nu I o,wnk btu tsi’ hte lnoy asnwer taht maed snese. If uoy rtuh hte D,GR ouy otn onyl elos enteffar staiomc esoynsr es,bfir you oals lseo eth eryonss osbdei ovnlevdi ni het soivrua eexesl.rf

Yuo acn lsoa egt xelpfiayheor rfom namgdaig het nftefere nrsnuoe taht eeivntrna het mesucl ke(li a ,MLN) but sa uoy wnok heest are ni the etrraion onrh dan rvlneta .amir

ankistruggles  Thanks! I agree with you. +
brethren_md  Great explanation. +
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +6
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +4
charcot_bouchard  Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/ But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia +3
zevvyt  DRG you lose DTR +
... sympathetikey made a comment on nbme24/block4/q#38 (A 33-year-old woman at 34 weeks' gestation has a...)
 +17 
submitted by sympathetikey(1253)
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Wuldov'e eneb ienc fi teyh dolt uyo 2d"n litetsronac casep" on eftl or rimhgth..s.

paperbackwriter  It wouldn't have mattered because the murmur is due to increased stroke volume, not anything mechanically wrong with the valves. If they had said A or P then it might have actually caused more confusion (stenosis etc.) +6
... stars and more made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
 +16 
submitted by stars and more(16)
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X ilendk vceiesrse hrtee can renve be nay alMe to elaM rnafster cnsie eth aeml girpofnfs gste Y mrof tehrf.a het peeridge owshs leaM to leaM irssonstnami os thsi nocnta be X dnlkie eirsvseec

... lsmarshall made a comment on nbme24/block2/q#45 (A 2-year-old boy is brought to the physician because...)
 +16 
submitted by lsmarshall(393)
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CMH saslc 1 detipep tnineag prngscseio ;tg& "ignAtne sdepitep ddleoa onto HMC I in RRE ratfe eeyldrvi aiv APT pts(ornarter tcasediaso wiht egntani rcneso)g"isp - Frsit idA .9201

Bare hepyclmoty snodeyrm peyt 2 BL(S I;I tefcnfiag MCH I)I is edu ot tituaosmn ni enesg atth doec rof tirpncoarsnit foscatr atth mlronayl glareuet het oenxessipr nege( tnc)poitrarins fo the MHC II nsge.e rBea mlheoyytpc dsmyoenr ytpe 1 SL(B ;I tfiacfnge HCM I,) is cmhu omer e,rar nda is ceasidtaso whti PTA secd.nifeeici

tyrionwill  in the question, it says absence of MHC-I presenting cells. I guess the meaning is lack of MHC-I. IF TAP is missing or dysfunction (bare lym syn type-1), MHC-I should be there, however Ag cannot be loaded to the MHC-I. Can anyone help me to understand more. +
peridot  @tyrionwill From wiki: "The TAP proteins are involved in pumping degraded cytosolic peptides across the endoplasmic reticulum membrane so they can bind HLA class I. Once the peptide:HLA class I complex forms, it is transported to the membrane of the cell. However, a defect in the TAP proteins prevents pumping of peptides into the endoplasmic reticulum so no peptide:HLA class I complexes form, and therefore, no HLA class I is expressed on the membrane. Just like BLS II, the defect isn't in the MHC protein, but rather another accessory protein." +
j44n  i hate this question because MHCI is on all nucleated cells. So this person is literally a bag of RBC's +1
soccerfan23  @j44n Not quite. It's true that MHC I is on all nucleated cells. Because of the TAP mutation, these cells don't express MHC I on their membranes. But these cells still exist. That is what is meant when the vignette says "flow cytometry shows absence of class I MHC-expressing cells. +
... neonem made a comment on nbme24/block3/q#4 (A 27-year-old man comes to the physician because he...)
 +16 
submitted by neonem(550)
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I tkinh het rnoase oyu ende ot ejtnci roasgndiptnoo in this cesa si scbaeeu ouy eend FHS and HL to doupecr re.smp HFS autismstle hte etloirs c,lesl wchih lien the furneiomesis busetlu dan phle eht pmoragetasion dcreoup eypstectao.srm etssroeoeTnt si a utdporc fo gLeidy lecsl nweh eht'eyr ltdsuaetim yb H,L os njtgceini teeooerstnst owldu sypbas hatt espt tbu ti nt'duolw elryal hple whti ioes.gnamreptses vH,reewo etniijngc nRGH laso dt'eson o'nstde llreay ephl easuceb uyo dnee thta ispleltau GnHR ta hintg to keam HL dna HFS awesehr nggl-ctoain nRHG aonsalg tlaucyal csdeeear LH nad SHF tprnd.cioou

m-ice  Adding on to the answer above. I was stuck between the gonadotropin injections and clomiphene. But, clomiphene acts to increase activity of GnRH which then exerts its effects on the pituitary. The man in this question had his pituitary removed because of an adenoma. So, he needs the FSH and LH directly. +21
mousie  agree! Removal of the pituitary would case a deficit in Gonadotropins (LH, FSH) and therefore nothing to simulate the testes to make sperm... replacing the T with a patch would not stimulate the testes to make sperm and if his axis was intact (although its not) this would further down regulate the production of sperm. I eliminated Clomiphene because if he dosent have T to induce negative influence on the hypothalamus he will have increased GnRH and further increasing it with Clomiphene would not correct the deficit in Gonadotropins. +4
neonem  Oh duh... that makes much more sense. Thanks! P.s. I thought clomiphene was more of a fertility drug for women, since it blocks negative feedback of estrogen on the hypothalamus/pituitary. But in men the system is under feedback due to testosterone, not estrogen. +6
... sajaqua1 made a comment on nbme24/block4/q#20 (Forty of 100 attendees at a company Christmas party...)
 +16 
submitted by sajaqua1(519)
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ibViro alhceor nad V. aimaehrlycuspota ear qeyufrtlen daoaesistc hwit smonpuointc of dkoeduceron edsoaof lkei hlihl.esfs V. iuuncvfisl si soatsdacie hiwt abrshkic aewrt ro tlaawts.er

)A B. uscree- etvsngtie ndet to tsieaosac hist hwit reatedhe ierc ta a tue,fbf tivgoimn si emor mmonco anht ahr.rieda B) .C jiu-nej aietsdsoac hitw nuoeeddrock d,oof lasleecpiy iccneh,k ro acn eb arecontdtc by ontccta tiwh asmlia.n It scaesu mtfaloiayrmn, doylbo ahiedar,r nda yma loas ldea ot anaer-lGlBiru ysdmre.on C) C. fnepnis-errg as a lrsotouapr, this is ceodsatisa whit oodg tath is aedethre ehnt lfet to gmtraneei at omro emeeputrtar rfo a ongl meti oberfe nocnps.imtuo moSsypmt nedulic ntoiigvm nad hr.aaderi )D .S sur-uae a teah atsebl xiont dordpuce yb S. ruause si esdosactai thwi idpar toesn of m,oingivt mya be neimpcocaad yb hara.erid osMt nofet oaisdcetas itwh yarid trdopcsu nad mat.e

armageddon_oh  Perfringens is also usually a delayed response, can help in vignettes! +