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NBME 24 Answers

clinical_trials medicine
Question#1 (84.7 difficulty score)
A researcher hypothesizes that exposure to ...
Case-control studyπŸ”,πŸ“Ί

pharm beta_blockers
Question#2 (24.3 difficulty score)
A 43-year-old woman with a 2-year history of ...
Unopposed Ξ±-adrenergic toneπŸ”,πŸ“Ί

oncology metastasis lymph
Question#3 (47.4 difficulty score)
A 52-year-old woman comes to the physician ...
IntercostalπŸ”,πŸ“Ί

micro cryptococcus
Question#4 (35.4 difficulty score)
A 28-year-old man with AIDS has fever, ...
LungsπŸ”,πŸ“Ί

genetics process_of_elimination
Question#5 (49.7 difficulty score)
The 35-year-old woman indicated by the arrow ...
X-linked recessiveπŸ”,πŸ“Ί

respiratory transfusion
Question#6 (44.8 difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”,πŸ“Ί

Question#7 (35.9 difficulty score)
A 65-year-old woman comes to the physician ...
Cigarette smokingπŸ”,πŸ“Ί

Question#8 (55.9 difficulty score)
A 24-year-old woman at 28 weeks' gestation is ...
TremorπŸ”,πŸ“Ί

Question#9 (21.7 difficulty score)
The graph shows expiratory pressure-volume ...
Diffuse pulmonary fibrosisπŸ”,πŸ“Ί

Question#10 (45.9 difficulty score)
A 75-year-old man is brought unconscious to ...
AtherosclerosisπŸ”,πŸ“Ί

Question#11 (56.2 difficulty score)
A 55-year-old man with type 1 diabetes ...
Persistent activation of voltage-gated Na+ channels in the nociceptorπŸ”,πŸ“Ί

Question#12 (15.1 difficulty score)
A 26-year-old man comes to the physician for ...
Increased number of LDL receptors on hepatocytesπŸ”,πŸ“Ί

renal nephropathy
Question#13 (63.2 difficulty score)
A 4-year-old boy is brought to the emergency ...
Proliferative glomerulonephritisπŸ”,πŸ“Ί

Question#14 (23.8 difficulty score)
A thin 66-year-old man is brought to the ...
Urine osmolality > plasma osmolalityπŸ”,πŸ“Ί

Question#15 (52.2 difficulty score)
Results of a 5-year screening program for HIV ...
5%πŸ”,πŸ“Ί

Question#16 (36.9 difficulty score)
A 32-year-old man is brought to the emergency ...
Flexion at the distal interphalangeal jointπŸ”,πŸ“Ί

Question#17 (25.5 difficulty score)
A 3-year-old boy is brought to the emergency ...
Annular pancreasπŸ”,πŸ“Ί

Question#18 (29.5 difficulty score)
A 34-year-old woman with a long history of ...
Tuberculous osteomyelitisπŸ”,πŸ“Ί

Question#19 (13.2 difficulty score)
A 35-year-old man comes to the physician ...
Cluster headacheπŸ”,πŸ“Ί

free
Question#20 (57.2 difficulty score)
Immediately after a spontaneous vaginal ...
Fusion of the sclerotomesπŸ”,πŸ“Ί

Question#21 (32.6 difficulty score)
A 35-year-old woman comes to the physician ...
Foramen cecumπŸ”,πŸ“Ί

Question#22 (31.4 difficulty score)
A 50-year-old man undergoes surgical ...
Adductor brevisπŸ”,πŸ“Ί

Question#23 (30.3 difficulty score)
A 50-year-old man comes to the physician ...
Generalized malabsorptionπŸ”,πŸ“Ί

Question#24 (24.9 difficulty score)
A 6-year-old girl is brought to the office by ...
Pediculus humanus capitisπŸ”,πŸ“Ί

Question#25 (34.0 difficulty score)
A 7-year-old boy has metabolic acidosis and ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”,πŸ“Ί


Question#27 (46.0 difficulty score)
A 10-year-old girl with a lifelong history of ...
Palpable right ventricular liftπŸ”,πŸ“Ί

immuno
Question#28 (55.4 difficulty score)
A 32-year-old woman comes to the physician ...
EosinophilsπŸ”,πŸ“Ί

Question#29 (20.2 difficulty score)
An 80-year-old woman comes to the physician ...
Determination of erythrocyte sedimentation rateπŸ”,πŸ“Ί


Question#31 (55.7 difficulty score)
An experimental study is conducted to examine ...
Post-translational modificationπŸ”,πŸ“Ί

Question#32 (56.1 difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flowπŸ”,πŸ“Ί

Question#33 (17.3 difficulty score)
A 3-month-old girl is brought to the ...
Human papillomavirusπŸ”,πŸ“Ί

Question#34 (21.7 difficulty score)
A 62-year-old man comes to the physician for ...
SotalolπŸ”,πŸ“Ί

newborn
Question#35 (41.5 difficulty score)
A 1616-g (3-lb 9-oz) male newborn is ...
Bronchopulmonary dysplasiaπŸ”,πŸ“Ί

Question#36 (18.2 difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophyπŸ”,πŸ“Ί

Question#37 (32.3 difficulty score)
A 25-year-old woman at 16 weeks' gestation ...
Increased hepatic production of T4-binding globulinπŸ”,πŸ“Ί

Question#38 (18.3 difficulty score)
A 37-year-old woman comes to the physician ...
BorderlineπŸ”,πŸ“Ί

Question#39 (25.3 difficulty score)
A 40-year-old man with AIDS develops severe ...
SomatostatinπŸ”,πŸ“Ί


Question#41 (15.5 difficulty score)
A 32-year-old woman who is 20 weeks' pregnant ...
MisoprostolπŸ”,πŸ“Ί

Question#42 (30.1 difficulty score)
A 68-year-old woman with acute myelogenous ...
Granulocyte-macrophage colony-stimulating factorπŸ”,πŸ“Ί

Question#43 (17.8 difficulty score)
After completing 6 courses of chemotherapy ...
DoxorubicinπŸ”,πŸ“Ί

Question#44 (18.0 difficulty score)
A 24-year-old man is brought to the office ...
Alteration in DNA gyraseπŸ”,πŸ“Ί

Question#45 (39.6 difficulty score)
A 71-year-old man is brought to the emergency ...
Area labeled β€˜D’ (Posterior inferior cerebellar artery)πŸ”,πŸ“Ί

Question#46 (19.7 difficulty score)
A 10-year-old girl is scheduled to undergo ...
SuccinylcholineπŸ”,πŸ“Ί

Question#47 (25.6 difficulty score)
A 35-year-old man comes to the physician 1 ...
Increased serum angiotensin II concentrationπŸ”,πŸ“Ί


Question#49 (27.1 difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”,πŸ“Ί

Question#50 (62.9 difficulty score)
An 11-year-old boy is brought to the ...
Intracellular and extracellular dehydrationπŸ”,πŸ“Ί

Question#1 (54.5 difficulty score)
A 73-year-old woman has had easy fatigability ...
Failure of conversion of N5-methyltetrahydrofolate to tetrahydrofolateπŸ”,πŸ“Ί

Question#2 (36.9 difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturationπŸ”,πŸ“Ί

Question#3 (35.1 difficulty score)
A 13-year-old boy is brought to the physician ...
This will typically resolve within the next 12 to 18 months.πŸ”,πŸ“Ί

Question#4 (49.5 difficulty score)
A 57-year-old man has had hoarseness and ...
Area labeled β€˜Fβ€™πŸ”,πŸ“Ί

Question#5 (48.9 difficulty score)
A 55-year-old man is diagnosed with coronary ...
Decreased adherenceπŸ”,πŸ“Ί

Question#6 (33.7 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorderπŸ”,πŸ“Ί

renal
Question#7 (33.5 difficulty score)
A 75-year-old man with a 10-year history of ...
Hydrostatic pressure in Bowman spaceπŸ”,πŸ“Ί

Question#8 (22.4 difficulty score)
A 17-year-old girl is brought to the hospital ...
BeneficenceπŸ”,πŸ“Ί

cell_bio
Question#9 (61.7 difficulty score)
In which of the following stages of the cell ...
G2πŸ”,πŸ“Ί

Question#10 (31.2 difficulty score)
A 29-year-old man is brought to the emergency ...
Lateral pterygoidπŸ”,πŸ“Ί

Question#11 (34.6 difficulty score)
A public health consultant is contacted by a ...
Regular exerciseπŸ”,πŸ“Ί

Question#12 (53.5 difficulty score)
An 80-year-old man is admitted to the ...
20πŸ”,πŸ“Ί

Question#13 (51.9 difficulty score)
An 80-year-old woman, gravida 4, para 4, ...
Damage to the rectovaginal septumπŸ”,πŸ“Ί

Question#14 (17.9 difficulty score)
A 25-year-old man comes to the emergency ...
HeroinπŸ”,πŸ“Ί

Question#15 (38.5 difficulty score)
An investigator is studying a new drug for ...
Free radical formationπŸ”,πŸ“Ί

Question#16 (31.5 difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIVπŸ”,πŸ“Ί

Question#17 (27.1 difficulty score)
A 68-year-old man comes to the physician ...
Normal agingπŸ”,πŸ“Ί

FA20p504
Question#18 (42.5 difficulty score)
A 68-year-old man has loss of pain and ...
Right dorsolateral medullaπŸ”,πŸ“Ί

Question#19 (34.0 difficulty score)
A 70-year-old man comes to the physician ...
Alveolar-arterial Po 2 differenceπŸ”,πŸ“Ί

Question#20 (47.6 difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissueπŸ”,πŸ“Ί

Question#21 (31.4 difficulty score)
A 50-year-old woman with HIV infection comes ...
ZidovudineπŸ”,πŸ“Ί

Question#22 (33.4 difficulty score)
A 3-month-old boy is brought to the physician ...
PeroxisomesπŸ”,πŸ“Ί

Question#23 (29.7 difficulty score)
A 9-year-old boy who was adopted from an ...
EπŸ”,πŸ“Ί

Question#24 (20.0 difficulty score)
A 59-year-old man has repeated episodes of ...
ProbenecidπŸ”,πŸ“Ί

Question#25 (53.0 difficulty score)
A 35-year-old African American man comes to ...
PalmsπŸ”,πŸ“Ί

alcohol electrolytes
Question#26 (62.2 difficulty score)
A 35-year-old man is brought to the emergency ...
Catecholamine-mediated intracellular shifts of K+πŸ”,πŸ“Ί

Question#27 (32.4 difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urateπŸ”,πŸ“Ί

Question#28 (20.3 difficulty score)
A 3-year-old boy with AIDS develops giant ...
Negative-stranded RNAπŸ”,πŸ“Ί

Question#29 (54.6 difficulty score)
A 65-year-old woman with well-controlled type ...
AtherosclerosisπŸ”,πŸ“Ί

Question#30 (37.9 difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”,πŸ“Ί

Question#31 (18.1 difficulty score)
A patient with cancer who is being treated ...
Granulocyte colony-stimulating factorπŸ”,πŸ“Ί

Question#32 (33.8 difficulty score)
A 35-year-old woman undergoes a left ...
UreterπŸ”,πŸ“Ί

Question#33 (23.5 difficulty score)
A 58-year-old man comes to the physician ...
Escherichia coli πŸ”,πŸ“Ί

Question#34 (45.2 difficulty score)
A 40-year-old man who goes horseback riding 3 ...
Myositis ossificansπŸ”,πŸ“Ί

neuro
Question#35 (48.1 difficulty score)
A 55-year-old woman comes to the physician ...
Lower motoneuronsπŸ”,πŸ“Ί

Question#36 (30.8 difficulty score)
A 27-year-old woman comes to the physician ...
Transforming growth factor-Ξ²πŸ”,πŸ“Ί

Question#37 (39.5 difficulty score)
In a culture of motile spore-forming ...
Irradiation with x-raysπŸ”,πŸ“Ί

Question#38 (28.0 difficulty score)
A 65-year-old man comes to the physician ...
ParoxetineπŸ”,πŸ“Ί

Question#39 (20.4 difficulty score)
A 3-year-old boy has short stature and ...
Endochondral ossificationπŸ”,πŸ“Ί

Question#40 (48.3 difficulty score)
A 4-year-old boy has a 1-cm round midline ...
TongueπŸ”,πŸ“Ί

Question#41 (16.1 difficulty score)
A 56-year-old man who is admitted to the ...
Determine whether the patient has decision-making capacityπŸ”,πŸ“Ί

Question#42 (54.2 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”,πŸ“Ί

Question#43 (29.4 difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulationπŸ”,πŸ“Ί

Question#44 (30.7 difficulty score)
A 35-year-old man with quadriplegia develops ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”,πŸ“Ί

Question#45 (43.0 difficulty score)
A 2-year-old boy is brought to the physician ...
Peptide transporter (TAP)πŸ”,πŸ“Ί

Question#46 (24.3 difficulty score)
In a study of drug action on neoplastic cells ...
VincristineπŸ”,πŸ“Ί

Question#47 (21.5 difficulty score)
A 73-year-old man has an incurable malignant ...
Both legal and ethicalπŸ”,πŸ“Ί

GI
Question#48 (85.8 difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosaπŸ”,πŸ“Ί

Question#49 (50.2 difficulty score)
A 17-year-old girl comes to the physician ...
Increased serum testosterone concentrationπŸ”,πŸ“Ί

Question#50 (34.9 difficulty score)
An obese 57-year-old man comes to the ...
Normal ciliated columnar epithelium replaced by normal squamous epitheliumπŸ”,πŸ“Ί

Question#1 (23.1 difficulty score)
A 3-year-old girl has a history of recurrent ...
NADPH oxidaseπŸ”,πŸ“Ί

biochem metabolism acid_base blood_physiology
Question#2 (60.5 difficulty score)
A 28-year-old man has a blood pressure cuff ...
AdenosineπŸ”,πŸ“Ί

pharm HIV antivirals
Question#3 (36.7 difficulty score)
A 37-year-old woman with HIV infection is ...
Nucleoside reverse transcriptase inhibitorπŸ”,πŸ“Ί

Question#4 (38.9 difficulty score)
A 27-year-old man comes to the physician ...
Injections of gonadotropinsπŸ”,πŸ“Ί

Question#5 (29.0 difficulty score)
A 37-year-old man is admitted to the hospital ...
Autoimmune adrenalitisπŸ”,πŸ“Ί

Question#6 (28.0 difficulty score)
A 43-year-old woman comes to the physician ...
Alkaline phosphataseπŸ”,πŸ“Ί

clinical_trials
Question#7 (31.3 difficulty score)
A 21-year-old woman with asthma comes to the ...
Phase 3πŸ”,πŸ“Ί

Question#8 (52.0 difficulty score)
A 37-year-old man who is a farmworker comes ...
SynaptobrevinπŸ”,πŸ“Ί

Question#9 (34.8 difficulty score)
A 43-year-old woman comes to the physician ...
Metastatic carcinomaπŸ”,πŸ“Ί

Question#10 (22.3 difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#11 (39.4 difficulty score)
The pedigrees of patients with schizophrenia ...
Diabetes mellitus, type 1πŸ”,πŸ“Ί

Question#12 (40.3 difficulty score)
A 35-year-old woman with asthma comes to the ...
ThiabendazoleπŸ”,πŸ“Ί

syphilis ethics
Question#13 (51.2 difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privatelyπŸ”,πŸ“Ί

Question#14 (49.5 difficulty score)
A cohort study is done to evaluate the ...
0.05 < p < 1.0πŸ”,πŸ“Ί

biochem heme heme_synthesis
Question#15 (39.6 difficulty score)
A 17-year-old girl has significant blood loss ...
Ξ΄-AminolevulinateπŸ”,πŸ“Ί

Question#16 (54.2 difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosisπŸ”,πŸ“Ί

Question#17 (27.2 difficulty score)
HOX genes play a role in embryogenesis ...
Regulation of transcriptionπŸ”,πŸ“Ί

Question#18 (25.8 difficulty score)
A 55-year-old man with alcoholism is brought ...
Competitive inhibitorπŸ”,πŸ“Ί


mutation paroxysmal_nocturnal_hemoglobinuria
Question#20 (38.1 difficulty score)
A 33-year-old woman comes to the physician ...
Defect in a cell membrane anchor proteinπŸ”,πŸ“Ί

Question#21 (24.2 difficulty score)
A 7-year-old girl is brought to the emergency ...
Factitious disorder imposed on anotherπŸ”,πŸ“Ί

Question#22 (28.3 difficulty score)
A 32-year-old woman recently diagnosed with ...
Epstein-Barr virus-induced brain lymphomaπŸ”,πŸ“Ί

Question#23 (49.6 difficulty score)
A 32-year-old woman comes to the physician ...
BuccinatorπŸ”,πŸ“Ί

Question#24 (59.4 difficulty score)
A 3-month-old boy is brought to the emergency ...
GluconeogenesisπŸ”,πŸ“Ί

Question#25 (75.2 difficulty score)
An investigator is studying a new virus ...
CoronavirusπŸ”,πŸ“Ί

Question#26 (27.2 difficulty score)
A 54-year-old man with a myocardial ...
Decrease in intracellular ATP concentrationsπŸ”,πŸ“Ί

Question#27 (13.6 difficulty score)
A 27-year-old man who works from home as a ...
AvoidantπŸ”,πŸ“Ί

Question#28 (52.9 difficulty score)
A 22-year-old man is brought to the emergency ...
Area labeled β€˜E’ (Cerebellum, posterior lobe)πŸ”,πŸ“Ί

Question#29 (28.6 difficulty score)
Drug X is given to a 25-year-old normal ...
Partial agonist at Ξ²-adrenergic receptorsπŸ”,πŸ“Ί

Question#30 (20.9 difficulty score)
A 38-year-old woman comes to the physician ...
Intraductal papillomaπŸ”,πŸ“Ί


Question#32 (31.2 difficulty score)
A 15-year-old girl is brought to the ...
CD8+ T lymphocytesπŸ”,πŸ“Ί

Question#33 (46.3 difficulty score)
A 12-year-old boy is brought to the physician ...
Nocturnal luteinizing hormone pulsesπŸ”,πŸ“Ί

Question#34 (78.7 difficulty score)
An otherwise healthy 35-year-old man sustains ...
Decreased blood volumeπŸ”,πŸ“Ί

Question#35 (47.0 difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formationπŸ”,πŸ“Ί

Question#36 (27.7 difficulty score)
A 1-month-old male newborn is brought to the ...
TyrosineπŸ”,πŸ“Ί

Question#37 (42.8 difficulty score)
A man accidentally touches the surface of a ...
Interendothelial gaps in venulesπŸ”,πŸ“Ί


MSK
Question#39 (40.1 difficulty score)
A 34-year-old woman is brought to the ...
LunateπŸ”,πŸ“Ί

micro
Question#40 (25.4 difficulty score)
A 2-year-old boy is brought to the emergency ...
Polysaccharide protein conjugate vaccineπŸ”,πŸ“Ί

Question#41 (19.4 difficulty score)
A 30-year-old man develops tingling around ...
SodiumπŸ”,πŸ“Ί

biochem cell_bio extracellular_matrix
Question#42 (57.7 difficulty score)
Which of the following terms best describes ...
LaminsπŸ”,πŸ“Ί

Question#43 (40.5 difficulty score)
A 35-year-old woman with a long-standing ...
Infiltration of lymphocytes and monocytesπŸ”,πŸ“Ί

Question#44 (42.4 difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrinπŸ”,πŸ“Ί

Question#45 (29.8 difficulty score)
A 59-year-old woman has a 10-year history of ...
Neural crest cellsπŸ”,πŸ“Ί

cell_bio cell_transport cell_trafficking protein_folding
Question#46 (53.7 difficulty score)
A 15-year-old girl with cystic fibrosis has a ...
Endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (25.4 difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”,πŸ“Ί

Question#48 (19.3 difficulty score)
A 62-year-old man comes to the physician ...
Phantom limb painπŸ”,πŸ“Ί

Question#49 (44.1 difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartmentπŸ”,πŸ“Ί

Question#50 (28.6 difficulty score)
A group of physicians submits a report to a ...
Case seriesπŸ”,πŸ“Ί

Question#1 (19.7 difficulty score)
A 30-year-old woman comes to the physician ...
Glycine and succinyl CoAπŸ”,πŸ“Ί

Question#2 (22.1 difficulty score)
A full-term male newborn has lethargy, poor ...
Enzymatic reaction labeled β€˜Cβ€™πŸ”,πŸ“Ί

Question#3 (60.0 difficulty score)
A 23-year-old woman is brought to the ...
Renal tubular acidosisπŸ”,πŸ“Ί

Question#4 (48.4 difficulty score)
A 63-year-old woman develops flank pain, ...
ABO incompatibilityπŸ”,πŸ“Ί

Question#5 (66.1 difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”,πŸ“Ί

Question#6 (65.0 difficulty score)
A 68-year-old woman comes to the physician ...
Inferior mesenteric and superior mesentericπŸ”,πŸ“Ί

Question#7 (49.5 difficulty score)
A 3-year-old girl is brought to the physician ...
Spontaneous regressionπŸ”,πŸ“Ί

Question#8 (69.7 difficulty score)
A 1-week-old newborn is brought to the ...
Organic acid metabolism disorderπŸ”,πŸ“Ί

Question#9 (56.7 difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”,πŸ“Ί

Question#10 (51.6 difficulty score)
A 60-year-old woman is receiving cisplatin ...
HyporeflexiaπŸ”,πŸ“Ί

Question#11 (42.0 difficulty score)
A 53-year-old woman comes to the physician ...
Fixed cardiac output in spite of increased demandπŸ”,πŸ“Ί


Question#13 (34.9 difficulty score)
A 90-year-old man has a 1-week history of ...
Incarcerated inguinal herniaπŸ”,πŸ“Ί

Question#14 (8.9 difficulty score)
A new screening test for colon cancer is done ...
118/124 = 95%πŸ”,πŸ“Ί

Question#15 (22.4 difficulty score)
A 15-month-old boy is brought to the ...
MigrationπŸ”,πŸ“Ί

Question#16 (42.8 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal
πŸ”
,πŸ“Ί

Question#17 (55.4 difficulty score)
A 63-year-old woman undergoes operative ...
Decreased movement through the arachnoid villiπŸ”,πŸ“Ί

Question#18 (63.5 difficulty score)
A 64-year-old man undergoes surgical repair ...
Artery of the ductus deferensπŸ”,πŸ“Ί

Question#19 (39.5 difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincterπŸ”,πŸ“Ί

Question#20 (20.5 difficulty score)
Forty of 100 attendees at a company Christmas ...
Vibrio parahaemolyticusπŸ”,πŸ“Ί

Question#21 (34.5 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcersπŸ”,πŸ“Ί

Question#22 (35.0 difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureterπŸ”,πŸ“Ί

Question#23 (31.8 difficulty score)
At 2:00 am, after sleeping for 5 hours, a ...
Phenylethanolamine N-methyltransferaseπŸ”,πŸ“Ί

Question#24 (32.5 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”,πŸ“Ί

Question#25 (14.9 difficulty score)
A 26-year-old man is brought to the emergency ...
Pericardial tamponadeπŸ”,πŸ“Ί

Question#26 (71.2 difficulty score)
A 10-year-old girl is brought to the ...
Ovarian Sertoli-Leydig cellsπŸ”,πŸ“Ί

Question#27 (62.3 difficulty score)
A 19-year-old man has had weakness of the ...
PolyneuropathyπŸ”,πŸ“Ί

Question#28 (29.4 difficulty score)
A clinical study is designed to evaluate the ...
10%πŸ”,πŸ“Ί

Question#29 (36.2 difficulty score)
A 56-year-old man has a 3-year history of ...
PresenilinπŸ”,πŸ“Ί

Question#30 (65.8 difficulty score)
An investigator is studying an outbreak of ...
Only cookies are independently associated with E. coli casesπŸ”,πŸ“Ί

Question#31 (50.4 difficulty score)
In a study of antibiotic resistance, a strain ...
ConjugationπŸ”,πŸ“Ί

Question#32 (16.0 difficulty score)
A 45-year-old man with hypercholesterolemia ...
Increased synthesis of LDL receptorsπŸ”,πŸ“Ί

Question#33 (39.8 difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuseπŸ”,πŸ“Ί

Question#34 (55.5 difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cellπŸ”,πŸ“Ί

Question#35 (76.4 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”,πŸ“Ί

Question#36 (24.2 difficulty score)
A 68-year-old woman comes to the emergency ...
AlendronateπŸ”,πŸ“Ί

Question#37 (33.7 difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meatπŸ”,πŸ“Ί

Question#38 (58.1 difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”,πŸ“Ί

cookies
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A 30-year-old woman comes to the physician ...
Decreased afferent arteriolar resistanceπŸ”,πŸ“Ί

Question#40 (55.1 difficulty score)
A 25-year-old woman is brought to the ...
Pulmonary capillary leakageπŸ”,πŸ“Ί

Question#41 (67.7 difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoitesπŸ”,πŸ“Ί

Question#42 (44.5 difficulty score)
A 40-year-old man who recently immigrated to ...
AdenineπŸ”,πŸ“Ί

vascular
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A 72-year-old woman with coronary artery ...
Neointima formation in the right coronary stentπŸ”,πŸ“Ί

oncology
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A 71-year-old woman with non-Hodgkin lymphoma ...
LeucovorinπŸ”,πŸ“Ί

renal
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A 40-year-old woman with a 25-year history of ...
Secreted by the proximal tubuleπŸ”,πŸ“Ί

anatomy neuroanatomy
Question#46 (33.4 difficulty score)
A 22-year-old woman comes to the physician ...
Pineal glandπŸ”,πŸ“Ί

oncogenes oncology
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A 40-year-old man comes to the physician ...
HNPCC syndromeπŸ”,πŸ“Ί

neurology
Question#48 (53.9 difficulty score)
A 55-year-old woman is brought to the ...
Posterior cerebralπŸ”,πŸ“Ί

neurology erections
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A 27-year-old man sustains a spinal cord ...
Penile stimulationπŸ”,πŸ“Ί

FA18p360 FA19p359
Question#50 (24.7 difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”,πŸ“Ί

Recent comments ...

... seagull made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +321 
submitted by seagull(1677)
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The estncmsai of itsh onteuqsi made me tvomi old.ob

nOe dya a tiptane illw loko em ni het esey nad ak,s eWr"he rae sdttiieepr rneokb n?o"dw I iwll lsmie at ehmt adn a,sy et"h nlansitite smuoac dan not het duumd.oe"n 'heTlyl mesli bcak dan lIl' klaw away dna knhti of htsi omnmet sa I jmup ormf eth w.dwnoi

sympathetikey  Too real. +3
mcl  how do i upvote multiple times +17
trichotillomaniac  I made an account solely so I could upvote this. +36
dragon3  ty for the chuckle +6
cinnapie  @trichotillomaniac Same +3
seagull  A legend never die +2
... tissue creep made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +91 
submitted by tissue creep(116)
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Teh pooled si pce,hyelrlonagi nad a 100/1 dogo .ybo

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +1
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +
... drdoom made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
 +86 
submitted by drdoom(957)
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efAtr teh uffc si id,te eth lecsl dan isteus alstid to the fcuf llwi connueti isuocgnnm PTA (TtAP;&DPAg-,) btu no hsrfe bodol wlil eb rdvliedee ot lβ€œa”ecr wath iwll be an gmcunuilcata auntom of APD adn rehto sa.beelitmot PDA A(in=)eendos is tlsfei a ypoxr of oncuinsotmp dan dviesr lvosaaitndoi of eier!tasr lEotvin(ou is !mra)ts cIgrinsnea sn/DAonPdieeA in a lolcaβ€œ mveroe”ntnin is a ignlas to het byod atth a lot fo isoopnuntmc si rncgcriou rteh;e stu,h ieerarst nda sieeratrlo aalurlnyt deiatl ot seancire ldobo wflo eatrs and espβ€œwe wa”ya meiotalcb usrtdp.cybo

lispectedwumbologist  You're a good man. Thank you. +
drdoom  So glad it helped! +1
seagull  very well put, thank you +2
aisel1787  gold. thank you! +
pediculushumanus  beautiful explanation! +2
rockodude  this explanation was on par with Dr. Sattar IMO +2
flvent2120  Just to add on to this: FA2020 pg. 297. CHALK (Calcium, H+, Adenosine, Lactate, K+) is known to vasodilate muscles during exercise as well as regulate sympathetic tone of arteries at rest +2
... seagull made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +72 
submitted by seagull(1677)
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ta MBI 15 tno ynlo ash hes evrne had a eiorpd ubt seh nveer dha a ae.lm

sympathetikey  You're on fire man lol +1
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +4
avarkey  the blind vaginal pouch points away from it being anorexia related +3
j44n  Its actually a man, there's no DHT to to dev the external genitals. +1
am4140  @monkey - with real anorexia, she wouldn’t necessarily have boobs either. If she’s got boobs she has the nutrition to develop boobs. That was my thought. +
freckles  the patient is actually what ever gender they want to identify as. If this was a 5 alpha reductase deficiency the patient would have experienced masculinization of external genitalia during puberty when testosterone levels increase significantly. The pt most likely has Androgen Insensitivity Syndrome. +2
... atstillisafraud made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +66 
submitted by atstillisafraud(202)
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I klei hsit suqntoei ceuaseb ti edsrnim em htta inaexrsme itnhk bosctej acn ixtes in 2 snis.oiendm

... atstillisafraud made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +63 
submitted by atstillisafraud(202)
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akhnT yuo NEBM rfo teh ghhi tuiaylq uertcips. It emkas esteh msxea ressst efer adn loee.nyabj

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +20
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. +13
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. +6
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +7
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 +4
... lamhtu made a comment on nbme24/block2/q#5 (A 55-year-old man is diagnosed with coronary artery...)
 +58 
submitted by lamhtu(124)
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telltPea dnceherea dan pllateet argtaneggio rae defftrine ishtgn adn tihs nfrceierde TRAMTES A L.TO Fkcu ,yuo MNE.B sTehe seircndffee leppdsosyu taemrt no meso ssneitouq and otn no .rtoesh Wreeh si eth ?ioetcscnyns oeHll?

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 +6
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +4
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. +2
jurrutia  GPiib/iiia receptor is not inhibited by aspirin. Aspirin prevents the upregulation of GPiib/iiia which is not the same as inhibiting the receptor itself. +
jj375  @jurrutia I think you are thinking of Clopidogrel, prasugrel, and ticlopidine which downregulate GP2b3a expression. Aspirin inhibits COX therefore inhibiting TXA2 and platelet aggregation. +
... niboonsh made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
 +57 
submitted by niboonsh(367)
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hist qoiensut askem em antw to eat na e lcio ekcoio dan ophe i leebd uot

caitlyncloy  pick C and move on was my strategy :P help lol +1
thegooddoctor2  lol good one +1
... drdoom made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +50 
submitted by drdoom(957)
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ehT deldanou uelnm (adn tpniaarecc aoterseps ielk ONTSPHIYR)CMY si teh siet where pacrneacit myeeszn pei”oasdteβ€œp)e(dsn avecle relag piolpdespeyt oint erlmsla bits isei(etddtidrp=peeit,)pp.s tI si ta the SHURB DEORBR reehw teh tslmesla insdk of peptieds dtireieptdtsppii(d)ees,p era ekbron odwn ntoi etrih moina c,dsia whhci nllaiyf nac be sontrpcao-tred twhi aN+ noti hte elnsiatint lcel.

I iktnh taubo ti tish aw:y

  • shomcat iadc etneaursd dan pnsβ€œeo ”up restnpio toihtu(w fcsiipec eaeag);lvc
  • acatpenric enmysze tnhe lvceae eadtedunr pleptesoyidp toin lrlmeas s;bti
  • bsrhu dorebr nsyzeem liynafl rkeab ownd insttei dpeietps toni eaobblsrab namio .cdisa
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. +
jj375  Still annoyed about this question, but here is a schematic in case it helps anyone else: https://doctorlib.info/physiology/medical/medical.files/image1890.jpg +
... drachenx made a comment on nbme24/block2/q#13 (An 80-year-old woman, gravida 4, para 4, comes to...)
 +46 
submitted by drachenx(61)
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eseTh idnks fo situnqeos era larlye drha euabcse vI'e enerv seen mfaele dreeucvirtop seuursrtct ilr. c:

nbmehelp  Lmao +3
regularstudent  Lmao +1
mutteringly  Lmao +
rockodude  lmao +
abkapoor  Lmao +
stunna216  LMAO +
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
 +44 
submitted by tea-cats-biscuits(251)
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stMa cells uateande,lrg giuondcrp imahtsnei hwhic sctratat niop.oileshs ehT leary esatg of na ialgrcle itrneoca is tasm clle dame,diet but eht aetl tgsae (dnuilincg uucsm ncooidrut)p is edaeimdt yb osoinh.siple

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +17
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +5
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 +3
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 +4
... sympathetikey made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +41 
submitted by sympathetikey(1439)
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erEynevo ohw otg sthi qsienuto hrgti si a pc.o ΝŸΩ„β– β– ΰΌΌΰΌ½βŒ

dr_ligma  Fkn narcs +2
j44n  whippet_gang +
... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
 +39 
submitted by lsmarshall(424)
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tetPian has Snapi abiidf culocta hcihw is a relnua tueb feedtc (relfuia fo oinfus fo eth reu.r)espoon esStcolrmeo era eht artp fo aceh itosme ni a reartteevb orbeym gginvi iers ot onbe ro ertho lestleka uet.sis cienS a arpt fo hsti ett'isanp spina fdiabi incuedld asce"sneb of ouinpss rpco"sse nhte a meloroects saw edoil.vvn wKgnoin htat lunrea etbu sdeectf aer na siseu hwit uisfno lohsdu be hgenou ot get ot the ihgtr raen.sw

fI the cotdoonrh dfalie ot levedpo thne eth nreite CNS wodul ton delvpeo sa eth oontchodr dicsneu mrotaoinf fo ulnear lapet.

fI eth enluar eubt ildefa to edleovp ehnt the hlweo NSC loudw ton aevh oevelddp.e

lYok acs si lrnavieert to siht ntate.pi

ehnW arelnu ercts lcel it ash eeitffnrd usocoetm in itrdenfef estsu.si uralieF fo uelanr erstc ot igearmt ni ertah nac cuaes iasTtnnoirsop fo trgae v,essesl Ttroglyea of ,olFlta ro irPettnses nurcstu surarseoi.t uilFaer of lrunea stcers to raetmig in IG can eucas Hsurgsnihprc sdsieae (lngnetaioc mlo)nae.ogc rTrcehea Conlsil rnmdeoSy can roucc enhw rlnuae rtces celsl afil to raiemgt toni 1st yraghnaelp .hrca ulNera tebu cdfeest hsa toignnh ot do htiw aeflrui of alnreu strce omtargnii .thoguh

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation. +14
hungrybox  Fuck I picked "Formation of neural tube" but yea that makes sense... that would affect the whole CNS +4
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 +1
ih8payingfordis  FA 2019 Pg 479. They don't specifically mention sclerotomes but you can review the different neural tube defects here :) +
... lsmarshall made a comment on nbme24/block4/q#8 (A 1-week-old newborn is brought to the physician...)
 +39 
submitted by lsmarshall(424)
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raUe Clyce Drsdreios &;gt tlaedosI evrese apmyeihmmanoer &;t(g 01;00 ie.., on oehtr ereesv amlotcbei sdtusaenrbic

tihinneOr bnlaamsteysraarc nfcedeiiyc t&;g (tmos momcno ruea lcecy .sd)i ocorti /iidmircueaidaaca, eoyiaammhepnmr

rOagcni dmiicaseA ;&tg pmyanoe,Haemrim aaniongp- scdioasi, sieokst romf( camlheoygi)py

ic-Mmhneuadi a-oycACl esdhoeednagry ceiceinyfd &tg; Hnmraiymeamop,e oityhcptkoe imcgyolyaehp es(ne ni iΞ²dontaixo- srso,irded PETCXE ardlrn)ukeostephydooy

ireLv ynucintsfod > ameai,oeprymHnm FTLs seedms ,pu lorde .pt

lsmarshall  Summary of metabolic issues relating to hyperammonemia +9
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 +5
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. +13
ih8payingfordis  I think there has been some confusions because FA does a poor job integrating these concepts together but here are some references: FA 2019 pg 85: Propionic Acidemia (this is one example of organic acid metabolism disorder) In the summary figure on Pg 74, look at the protein metabolism (located bottom right). Basically, you can have disorders where you have Propionyl-CoA buildup alone OR Proionyl-CoA and Methylmalonyl-CoA buildup. And these organic acidemias are autosomal recessive in their inheritance pattersn, which fit with the stem we're given (ie XX individuals can be affected) One thing that UW state that I do not have an explanation for: the buildup of organic acids inhibit the urea cycle hence the increase in ammonia (anyone knows how this happens?) +
aaftabsethi1  Can someone tell me why not MELAS ? +1
jaramaiha  @aaftabsethi because all of the siblings would show some symptoms if it were to be a mitochondrial disease. Which his brother is healthy, and sister was full-term but died due to unspecified causes. +
utap2001  Why acidosis cause Hypoglycemia and Ketosis and hyperammonia? In acidosis(such lactic acidosis)-> indicate body energy crisis -> inc. glycolysis, Hypoglycemia-> inc. protein breakdown, Hyperammonia -> dec. TCA cycle, Ketosis +
... xxabi made a comment on nbme24/block4/q#43 (A 72-year-old woman with coronary artery disease...)
 +37 
submitted by xxabi(267)
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nteSt imsobthsor vs eoet-ssnsi.r tneSt htsomisorb si na tucea lousncico of a oorarcyn ertrya tnts,e hhcwi fnteo tselrus in tcaeu noyrroac yernod.sm naC eb vpentered yb audl teltialaeptn aeprtyh or nugilrgudte- netts.s sesRs-tonei is hte glrudaa oigrrnnwa fo eht tstne nemul deu to oamtnleiin rrftonioaipe,l rluinsteg in nignaal smoyp.smt

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +8
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +7
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
... azibird made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +36 
submitted by azibird(198)

Who else came here after getting triggered by this answer?

yousif11  This question did not age well +14
helppls  I'm going to be taking Step with this song stuck in my head lol +
... lsmarshall made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +33 
submitted by lsmarshall(424)
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eonnAgdr itivnIisnsety dymSrone - efDetc ni dngoenar preetcro gnrteusli ni oepairnanalr-pmg laeefm ,64YX( .SDD) nFcoingitnu esstet susace ecneidsra enotetsrsote at p,eurybt whihc is cdteeronv to ogseernt yhppe,lrerial vignig afelem dcnoaesry sleaux scrrstcacehaiti alme(fe elrnxtea a.gae)ntili Lakc fo nerdanog ecroretp tniuncfo sedal to sebatn or ntacs airxally dna cipub rhia. ttnisaPe ehav duiytrmaner a,niavg tub tsrueu adn nllaofapi etbsu tns.eab

oArnegdn ttsiennviiysi srmoyend is het wrsnae tub ouy mgthi vaeh drsendocie linaerMΓΌl iagneess eRosM-(-kiaktnyray ΓΌussrHa-eertK mrs)yn.eod

iallunMer iessange lliw aehv nmalro oenrmoh sleelv nda yam etepsrn as Β°1 oenraarmeh u(ed to a lkac of rienute mveelntpo)de in fmlaese tiwh llyfu epdelvdeo Β°2 xealsu icretctachsrisa iclaton(fnu aisvoer.) airH eeevlondmtp is nlomar as ewll. attsPine olas vaeh oranml itghh.e

smeeS like isth ueqtosni ddi otn evgi su hcmu to tigidishusn ssedeib ihtegh dna trnnea tagse 1 biaauxcilry/lp h.ira

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. +
makingstrides  Mullerian agenesis: absent vagina, uterus/cervix because no mullerian system. Yet, still has secondary characteristics ie: breast, pubic hair, normal hormone levels (normal ovaries). Also check to break down the different subtypes of DSD: CAIS, 5alpha reductase deficiency, and swyer syndrome all for XY DSD. Where as for XX DSD, overproduction of gestational androgenism and placental aromatase deficiency. Bc in CAIS the testosterone receptor is dysfunctional, no external / internal male organs are going to form in an XY fetus, but you will have an extra production testosterone (like explained above) leading to increased estrogen (breast growth), but since no ovaries, you dont have the mullerian system. You are left with a vagina with a blind pouch (from lack of functioning receptors) +
makingstrides  Also to add, there are testes that produce the MIH, so you have degeneration of the mullerian system. From B&B +
... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +31 
submitted by lsmarshall(424)
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eTh stmo dicetr phta, dna stom leyikl hpta, for berast nacrec ot azeastesmti ot teh rarvebet ear eht tontclaisre is.evn sThi wsa no na erarile MNBE tste as wlle. seBtra ceracn illw ecsua dime,x cytli nad csitbla linsose cneo in eob.n

nO an uanrdeaelt eo;nt I ylianfl acme up wtih a deecnt wya ot ereemmrb iltcy sv. blisatc accrsen in oneb!

eYkIdn adn IdYtroh scaeu tlcIY

tesroapt ;g&t alttasbe &;gt bscaitl

oTw absrest ;g&t tow pyset fo oenlsis tg&; B tresa seascu B tho

Tow unlgs g;&t otw eypts fo solnsei ndgi(denpe on epty of nulg cr)aenc

allllcs-me nulg g&;t "smlla l"sstba

nasllm-no clel g;&t yctil

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. +18
... famylife made a comment on nbme24/block2/q#37 (In a culture of motile spore-forming bacteria, which...)
 +31 
submitted by famylife(95)
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ra"nstleoddb-u ..saeerrakb. uecsad yb gzinioin adi,rtonia gclinduin maagm asyr nad "a-syrX. .vs V"U ariotdian ausces two slseasc fo ADN nss:eoil ltyoaccuebn miiydrpien simder PC,(sD Fgriue )1 nda -64 ouodprshtopct (46- PsP, Feugri ).2"

tdaufw-egaoie.oiprn/iretaaisst//parcc--asanniomewtpnelebc-p:nwit-/ha4-m-adgs4.amt/nacgmidnmrh3

... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
 +30 
submitted by tinydoc(244)
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Tihs suoietqn is yver s,ayenk utb ni seecesn this si awhts eppnan.hgi

Teh ceaiaclntd olmarve fo the HTP gasldn niudgr teytmydhocroi β‡’ ↓ PTH

HPT y inla-on:mlr- :oneb ↑ lvmeaor of ²⁺aC and phPtaeho fmor -onb-ne i de:skyin ↑ ²⁺Ca rasboeoptrin and ↓ β‚„P⁻OΒ³ nbso ia↑r-pt-ero vnroiseocn fo 5,2 xHdriayiyvontm D to ,512 ytovrdxiHaynmi D Cr(oilciatl - ecavit m)orf vai ↑ atiyvcti fo -a1 aseyrdloyxH dfcceiiyne

eeThroerf a ↓ THP duowl adel o:t

β‡’ ↑ ³⁻Pβ‚„O β‡’ ↓ Β²a⁺C β‡’ ↓ 215, ndvriyxmHaioyt D

The iusetnqo is ysneka m(uch ikel eht tsre of shit am)ex cbueesa snooeem ohw nits osnugcif ralyle dahr ro ni a urhs mtigh ckip eht tonpio C hwere hpehtpoa is ↑ dna PTH si ↓ UBT ↓ 25 trydoiiaxnhyvm D

hTsi is nogrw as ynlo 5,12 ytmdiroahxviyn D ouwld be ec,sdedear eht oirecovnsns bofeer this aer noed by teh ikns l)ths(inug adn elvr.i

I ryelal iwsh hyet uolwd ptso gnkiam eht uiqssneot nugisocnf PELUYR rof teh akes fo inmakg htme gunno.isfc Istn ti onhgeu taht ew heva to know isht uiorilcdsu aumotn fo rtm,foionnia owhtiut avginh htem lennialtntyio gmkian ti ehrdar yb opngiint ouy ot 1 wnaser ehccoi utb agngihnc a teimnu teaidl to emka uyo nrwsae .orgnw rO uings a amrodn ssa rlateeomnnuc ofr a eaiedss ot avido namgki it oot lsepim (GNSP = tf"oivpliearer G)"N

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...)
 +27 
submitted by medpsychosis(120)
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eTh wya I tuhgtoh oubat it aws a ltleti orem .lisctsiimp We seu onn cetievles ebta krolbesc .(g.e roonpol)Plar for teh etmtatenr of nistelsea e.mtror foreheeTr a baet tingsoa udolw vhea het epopisot tf,eefc aak seuca or eenhanc morrt.e

hungrybox  Genius +3
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +3
... brethren_md made a comment on nbme24/block1/q#40 (A 26-year-old man and his 25-year-old wife come to...)
 +27 
submitted by brethren_md(94)
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eMka a enunttp eaursq hwti a crsso fo B B+ and B B0; +B spstenerre %50 tuonfnci iwehl 0B senesretrp 0% )lun(l tof.iucnn oS ni hits acse, hte nuhadsb uwodl haev a B 0B opegtnye ihlew teh wfie sha a B B+ etye.ngpo

soCsr fo ethes tow iwll leurts in het ogfionlwl ensetoypg; BB, B0,B +B,B 0B+B B B = 0%01 tf,nocniu +BB = 75% fnon,cuit BB0 = %05 icn,tnufo +BB0 = 52% noiufntc

So het wneras lilw be 1 ni 4 vahe a 25% incuontf eivng hte gteyeonp.s

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. +3
hemehero  Is there a way to know that B+B0 will = 25% function. I was stuck between 25% function and 10% function, but couldn't figure out how to reason between the two of them. +1
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%. +1
... neonem made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +26 
submitted by neonem(578)
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ePr Pmao:ath yerla iderhient saesc fo lAmh'sziere demeatni ear acioadsste hitw ntomsutai ni ss-lipern-pe,21lniin/neeri sa llwe as Do'nws modsyn.er sw'onD wdluo be edu to an aextr orsmeocmho 12, hiwch scriear eht neeg for adiyolm rrcusrpoe teroipn .PPA() txraE APP si orvtneced ot ebat-A lyimoad adn thsi srmfo arllarltuceex iiructen ,epuasql a etnprmion afeerut fo rzmeAs'hel.i

rotnmtIap to nto oucsefn oylimAd A iortpen ne(o of hte wsrena s)hceico ihwt Adiomly oeprsucrr oen.tirp sptieoinoD of AA aioylmd is emor tsaocesdia tihw hcocrin naaolrtmfyim aste,ts m,nainlaygc adn aliFliam rrieeaeMtnand eevr.F 2Btae- gconlmiilruob si thonrea olydmai otacos:siina iaossalatscei-yidsd otd(eipss in ntj)ois

ih8payingfordis  Amyloidosis: FA 2019 pg 212 Alzheimer disease: FA 2019 pg 508 +
... sattanki made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
 +26 
submitted by sattanki(72)
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yrplnApeat rthee si a etlcpomely eprseata ansipl cdor elexrf hewer deritc epnile mutsnatloii elsda to na toci.nree hTis eelxfr olny ndees an aintct arc in SS4-2, so sa onlg sa this ogienr si ton d,injuer an icrnoeet anc ltsli ucroc. r,Hveweo twhi eotasincnrt at 8C, thne hte oygnecchpsi roneitce exfrel cotnna rcuc,o as thsi qurirsee eencnddigs bsifer frmo het rtecxo.

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 +40
drdoom  Modifying @seagull into iambic pentameter: β€œS2, S3, and Number 4 / keeps the big ole penis / off the floor” +2
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 +2
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
jj375  This article is shockingly helpful. Scroll down to the 3 types of erections (psychogenic, reflexogenic, nocturnal) https://craighospital.org/resources/sexual-function-for-men-after-spinal-cord-injury +1
... snoodle made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +25 
submitted by snoodle(26)

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 +4
... m-ice made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +25 
submitted by m-ice(345)
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heT etnipat hsa lsso of npia dan rateetmreup on eht htgir edsi fo his a.efc snSteiaon fo hte aefc is tlilr,seiaap os eht esisu ustm eb on the iet'stanp rthig i,dse ichwh we acn imrcfno by nwgikon ahtt einsoatns of eht dboy si tor,ealcaatnlr dna eh has lots lfte eddsi pian dna ameupterter fo het yod.b

nPai adn eetearrptum tnassoien of teh oybd is tpar of eht noicaamhslpit ctra,t wcihh ysaawl srnu altlyerla htogrhu het ntarme.isb Tihs cna eb nredfoicm yb egbeinrmrme that snnsaetio to het efca lsao rsnu aaylertll thhugro eth esb.amntri So, ew cna cmnoirf siht is a hgtri desdi elaltra rimtsnbea ue.ssi

heT slos fo gag relfxe adn sisylapra fo eht acovl rsodc yimpl irtenmpaim fo lacanri revesn XI dna ,X htob of hihcw ozilleac ot teh dl.uamel ,oerTehfre teh ewnasr is tghri dtarlooreasl ue.lmdla

duat98  You're a good man. +5
charcot_bouchard  You must be handsome too +12
amy  The dorsal vs ventral is confusing! +
... aneurysmclip made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +25 
submitted by aneurysmclip(166)
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aneyno eles gte isth rgwno ewhli eth crerntu urrsiocvano pacme"idn" (cca to msoe oeucrss) is le?gnpaeeipfhgn in rallealla umbd 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. +56
asdfjkl  no quotes needed for pandemic anymore :( big sad +13
yesa  Yes! but also, coronaviruses often cause the common cold, not all of them are really bad! So this 4yo girl could literally just have the common cold, and the coronavirus isolated from her likely doesn't have pandemic potential. So this question has nothing to do with the ongoing pandemic--it's just coincidence! +
jaramaiha  Was I the only one that thought it was cause it is enveloped and easily destroyed? lol I didn't even bother with descriptors. +
... m-ice made a comment on nbme24/block3/q#38 (A 55-year-old man comes to the physician because of...)
 +24 
submitted by m-ice(345)
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yhTe pltieilxcy etsta thta het apeitnt ahs neeb tinagk esecsx of ish olthnyrxeivoe macno.itied voiheyteronLx is hte nugeosoex mfor fo 4T. ,reohfTeer eerf T4 smtu be l.avdetee 4T si ecronedvt to T3 at ostm rhplpiaeer itse,sus os 3T ilwl also eb eevtd.lea Bceaeus het ydbo ahs oerm htoryid ohmnore ahnt ndede,e lsse SHT wlil be ,dame adn eht oihdyrt ilwl eb slse eavtc,i tkagni pu ESLS niedi.o

procrastinator  I forgot that T4 is converted to T3 :( +4
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
 +23 
submitted by lsmarshall(424)
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oFrlex mouiigrdt usdponruf is beerslopins ofr eoinflx of IP.D Mdeila tpscea of teh suceml iwhhc( elsefx hte t4h nad th5 id)tgi si elusdipp by the unlar renve 8,C( T1). ehT aarletl atpsec cih(wh xselfe eht dn2 adn rd3 )idgti is nrideneavt by the ianemd eevrn eicifyacslpl eth eaotrinr eoiotsnsersu cnarbh ,C8( 1T.) So the nituoeqs si sinebcirgd a alceoitanr ggmidana eht nreve pspyul ot hte DPI efolxr fo the d2n giitd ixne(d )irnefg. isTh si sgnyai teh idaeml erevn is iengb eaddgam (C8 nda 1;T erwlo tnurk .ot)rso

srculbiLam d,(n/s12t anedi;m d4r/t3,h anlu)r aer a puorg fo slcemsu tath elxf ta het PMC ,oijtn dna nxtede IPP and DPI tsinoj.

oCuld ebreemmr as f'xrleo duritogmi rdfpsunou si rolounfpdy o'lng sniec nsntoed sinert on sDI.P eoaCmprd to lexfor iioutgrmd ilpsesurafici woesh nnetdo rwpsa audrno unpudsfor' ylflpiaicesur ubt sserint no .PsIP

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +13
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) +10
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...)
 +23 
submitted by lsmarshall(424)
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aaeatsPlrr"n eehav tlf(i) uocrcs uigrnd irgth utlarrnveic phthrropyye i(..e relegte)anmn or rvey ealryr eeevrs left tirala ."rgennetlame VR tohppehrryy nca eb sene so aeliys sceebau het RV si at eth niaotrer acruefs of het scthe.

nI isht tneaitp odblo fmor AL ot LV asrecesed ni nuot,iaatrs so ti is onigg rwmeeohse. rFmo teh 2O t.as ew cna ecdedu erteh is abpbrloy a VDS escainred( RV reusprse owldu ascue RHV nad tarsalrpena )e.aevh our,etmFrrh eht vngittee si yekill rseigbcdni latrgoety of llafot asde(cu by rpoueirnaosret dnsaceliptme of the uidrbluinnaf )emp.stu nI tTe s,lpsle RV ootfuwl is oto sttrbuedoc adn ntitepa segt sainsyco dan ;tg&RL ushtignn aquSst iarceesn S,VR ecgedrains &RtgL; untinsg,h itugtpn orme oodlb uthghor alonumyrp ticciru adn rlvgnieei iony.cssa

seagull  i'm pretty sure your a prof and not a student. +22
nor16  nevertheless, we are greatful for explanation! +1
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). +1
furkan7  I does not need to equalizes.Moreover, in left to right shunt,left ventricle's O2 saturation is close to 100% +
... tea-cats-biscuits made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +23 
submitted by tea-cats-biscuits(251)
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eucsaBe oyu rae e,nsiup r’ehest ncaeedirs lpdaore onigg back to ouyr treah no( nede to okwr inatags gayivt,r uory odblo ’itsn inpolgo in yuro lsge as cmuh h.ei)ert sA a trsleu, ANP si deetcrse deu ot AR sct,trhe laneidg to ssdriuei and a cuiretond fo lobdo ml.oeuv

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
mynamejeff  Because you are suprine, there's increased preload going back to your heart (no need to work against gravity, your blood isn't pooling in your legs as much). As a result, ANP is secreted due to RA stretch, leading to diuresis and a reduction of blood volume. +1
sars  This is a "read my mind" question and complete it in 1.5 minutes. Thanks +4
faus305  @sars that is every question +
... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +22 
submitted by dr_ligma(43)
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If NBME ssak buoat a dik hwit iciusopssu rsha ndreu shi noes + duathm/dedebeghirl in alcs,s atht dkis' ufgnfhi ugel

abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +1
... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
 +21 
submitted by ihavenolife(68)
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rulAann eacrsanp si na mlanobra niortato of hte elntvra cptiaracen ubd. tI nciceerls eht n2d tarp fo teh muuddoen like a rngi dan wrsanro eht unlem fo teh modneudu. If eht ectnaarpic igrn si tgtih noheug to nowarr teh lemnu ohg,eun it sdale to .mnogviti ehT sbiouli inomigvt liispem het iocsontbutr is staild ot het lmplaAu of Varte.

htreO sswearn

orlPiyc ssetiosn &-;tg NONubsioil cepeoitlrj mo,itvngi aeohidpselv- smsa in gecsiaitrp iernog

aEphsaoelg rsaaite t&;g- owlud eb non siiolbu sa ll.we uusllay nsenaeot srtpnee hiwt ,grioolnd ckeho nda itomv htiw TFRSI ,eedngfi isht yob is 3 ysr odl so it is kienl.lyu

ailBryi tsiarea -> vetoatiblorbiFr-ie utscoirnetd fo reepithatacx leib ,ctud saeld ot h.olcssiseat lusaylU bernwon twih nucdj,eai krda rieun and choilac slosto ecbuase ileb bkcade u.p

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +2
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) +11
... tea-cats-biscuits made a comment on nbme24/block3/q#24 (A 3-month-old boy is brought to the emergency...)
 +20 
submitted by tea-cats-biscuits(251)
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heT isdease hree is rfeocstu ssiasphptbaeoh ceenfdyici. nI ,it VI gclreyol or ruecotsf ods’ent eplh ebcesua tboh treen eth ugsseenoniloceg ahawypt ewobl esrfocut hsphoibe.atpas catsaGoel on teh trhoe nadh renset eavob i.t I tn’od tnhik you yllera ndee to wonk tsih to scoeho het reocrtc nwrase einsc eth ilicnalc ireptuc fo iatfgsn ycmpahiyeogl tath is rtccreedo w/ omse rost fo grsua htat anc nrtee eht iongscgeuoselne ytahpwa hlousd ucel uoy iont het rhigt nsewr.a

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. +26
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. +2
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. +5
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. +1
shayokay  You had to know that fructose and glycerol enter glycolysis at DHAP/G3P, and galactose enters glycolysis at G6P (gal-> gal-1-p -> glu-1-p -> glu-6-p). This means that one of the 3 enzymes between G6P and DHAP/G3P is not functioning properly. Most likely this would be fructose-1,6-bisphosphatase because there does not appear to be anything wrong with glycolysis. "Fructose-1,6-bisphosphatase (FBP1) deficiency is characterized by episodic acute crises of lactic acidosis and ketotic hypoglycemia, manifesting as hyperventilation, apneic spells, seizures, and/or coma. Acute crises are most common in early childhood; nearly half of affected children have hypoglycemia in the neonatal period (especially the first 4 days) resulting from deficient glycogen stores. Factors known to trigger episodes include fever, fasting, decreased oral intake, vomiting, infections, and ingestion of large amounts of fructose." https://www.ncbi.nlm.nih.gov/books/NBK550349/ +1
shayokay  Also, even though Von Gierke is categorized as a glycogen storage disease it is really a problem with gluconeogenesis not glycogen breakdown. So even if you thought this was VG, you still could have gotten the right answer. In VG, any monosaccharide other than glucose (fructose, galactose, glycerol, etc.) will not raise the plasma glucose level because they all require gluconeogenesis to be converted into glucose and this cannot happen because there is no glucose-6-phosphatase. This is why the treatment for VG is frequent oral glucose in the form of cornstarch and avoidance of fructose and galactose. +
... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
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otAnher way to inhkt otbau hsit is atwsh teh esclso gaest ot itiomss aebeusc rihgt ofereb M t)smoisi( oyu ende ot ehav tmiicto yscnlci hzsdeyi,nset nad hatt lwduo eb G2

1G t;&-g- S g&;--t G2 ;&t--g M

... lsmarshall made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
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Aracl linuetoisg si ostm noocmm tyep fo amaenlom ni anifcrA cAanmiser adn is on eth lmpas or lso.es I usges eht tlipyac itgihnkn fo tcesh nad cakb un(s e)xspedo is a ttilel nefdretif ni htis te?py gnoAm lla spcdogh;meair eaomlamsn uoccr the aimrtyoj of mtie no teh imbsl 6%~3( ewrol nda 1%~9 ;)preup urnkt is 7...2~% oS dsbea no that adn mhi ngbie of cniAraf cdstnee we can coesho mspl.a

... neonem made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
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mllaS elcl mcrinaaco fo het lngu amy puorced arpecatnlaiops dnoems,rsy of whchi CHTA and HAD rae hte erom oomcmn etssu.bpy CTHA seexsc dasel to eesscx inimuoaltst on eth darlnea rxotce ot dcepour ocrsilo,t reslgntui Cnugsihs' mro.ysedn ssxEce octlrosi ynroal(lm a stssre nor)omhe esscua nohstpeyrnie aiv innptteioato of hmtyatseicp osuanttlimi no eth luervsaucat. It anc sloa cause pomyhkialea yb inagtc sa a orerciomdalciinto ewnh in ssce,xe irtugsaant the ibaylti fo etsyraedtdo-1ix-r1obyh enheddogeayrs stn(eper ni eht nrale btuse)ul to rnoetcv iootlsrc to ceoi,otsrn wichh tdon'es cat sa a ionoteod.lcirmcair

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. +8
... consistentwrongdoer3 made a comment on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
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Teh wnsera is haireoepylfx uasbeec eth tareenff car of teh lsecmu tesrhtc xerfle has to og horguht het doslar raim nda sodrla toor i.agagln ubmD q,oneutsi I wo,kn utb is’t eht lyno waesrn thta emda e.ssne fI uyo hrut het ,GDR ouy not noly esol rfefntae asotcmi senryos sif,ber uyo osal oels hte eroyssn bodeis lvvndioe ni the aviours lsexefe.r

ouY can also egt xfhoaeyperil omfr mgangida eht enrtfefe osnnreu htta eatvnirne eth csuelm kiel( a LNM,) btu as you nwko shete aer ni the toirnrae nrho dan ntaevrl mia.r

ankistruggles  Thanks! I agree with you. +1
brethren_md  Great explanation. +1
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +8
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +7
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 +4
zevvyt  DRG you lose DTR +2
... m-ice made a comment on nbme24/block3/q#20 (A 33-year-old woman comes to the physician because...)
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hsTi wnaom ash smalyaoxrP Ntncaolru nHbuge.imiarolo shTi tsom foten sesptren ni a ugony dtaul woh hsa pisodees fo dakr ieurn ni hte mildde of the tnhgi ro henw ikganw up in eth moi.nngr 'Ist udcase yb etenmocmpl viaiyttc ietycrld snagati the p'nasetit nwo RCs.B nCtarie cgislpldyoi ear ndeeed no eth RBC ufsarce ot enrptve aattck orfm mc,lnmeoetp the tsom leabotn of hichw era 5DC5 adn D5.9C sPiaentt whit HNP hvae a tscioam miutaotn in hwchi ehty oslt iutnconf fo a IPAG zmnyee eended fro oerprp trnepesotnai and temhaacntt fo CDD5/59C5 no het RCB ufrae.cs eeorhferT eht rawsen si a cedtfe in a lcle meaenmbr hanorc .ptoinre tohtuiW h,sit eeclonmptm cstakat BCs.R

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +23
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +7
sexymexican888  @sunshinesweetheart Spherocytosis results in extravascular hemolysis (spleen) so no weird colored urine (due to intravascular hemolysis) as is seen in PNH (complement destroy RBCs in blood vessels) +
... neonem made a comment on nbme24/block3/q#26 (A 54-year-old man with a myocardial infarction...)
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elGaner etmhe of oyg:ohptla hipxaoy armiisp ixdteviao syplhniooraopth g;t--& lsse TPA -g&-;t sles KN-a mppu iivcttay os muidso bdsuli up ni hte lc,le uanigcs nw.eillgs siTh is eht sritf s.etp ehnT oud'y etg the imcluca uidpubl in het clle and vneetlua erabocain oysl,iscygl csgiuan cacitl dica ontidpurco nda oldrwee ..Hp. utb tshi anppshe atrle adn sit'n eth editrc uacse of lulercal in,gewlls cwhhi si twah eth quisonte si rate.f

aneurysmclip  can we have a moment of appreciation for Dr Sattar +24
makinallkindzofgainz  blessed be His name +8
... colonelred_ made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +18 
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koeLod ti up nda undof ahtt sceaueb ’yroeu ni a epuins isiotopn orf a nlgo itme ory’eu gongi to aehv rsdieneca uensvo trnuer hciwh asedl ot dencrasie C.O shiT vgtliynaee sfackdbee on ASA,R eaigndl ot eedrsadce od.teersoaln As a sutr,el e’rouy gigno to evah enerdasci duisseri whhic desla ot eradecdes bdloo and msplaa mlvu.oe

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. +10
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 +
theunscrambler  @peqmd thanks for sharing that. According to the presentation, the diuresis via ANP occurs (along with sodium), which is followed up by an increased in RAAS --> maintains sodium levels. This cycle can then continue. Slide 13. +
jj375  @urachus - Either BB or Sattar taught me this but I feel like it is often forgotten. "RAAS/Aldosterone affects blood volume, and ADH affects Na level". So Increasing aldosterone will increase blood levels however water follows the sodium so you will not get a change in sodium levels. ADH however does affect Na since aquaporins are bringing in water without affecting sodium levels. +
... itsdrgoodwood made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +18 
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heT diasnsgio si stssgeiOneeo Irceempfta. isDease csesua a ftdece ni Tyep 1 llngoeaC atth dsela ot ebtiβ€œtrl o”s,neb nagmein eth eitnpast hvae rqeefutn rrtfausec tiwh ttilel ua.trma epyT 1 elcogaln si aosl a rjaom ocepmnnto fo het rlasce -&tg; ihst is ahtw teh pteucir saw ntiinhg ta i( kin)?ht dan it saeucs β€œuebl al.”scer The srlaec aer thusetirnalctnn/ so yhte kloo belu ued ot dnugilyren odoahlicr s.vien

ail,nyFl itnsteap have orop ownud nel.hgia odnWu iearpr ihtw ngianaltruo teuiss evlisonv tpey 3 eoallgc whchi is tneh ntdvocere to teyp 1 elaglcno inugrd csra iootnfrma. tDecesf in tepy 1 agnclleo yvsoouilb dtn’o olwla tshi osscrpe to ktae le.pca

... tea-cats-biscuits made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
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ebnniticorF is an uteallelrxacr ramtxi iocneo,lptrgy weilh inalm is na irienamedett lmtafnie thta cfpsiacyliel eoprisvd spuoprt ot eth clle suuc.len otn’D conufse naiml wiht minilan cecsie(n tseha su ylearl;c) namniil is ekil ,toribnfcnei na EMC copingloyetr dan a armjo onpocmnet of hte asabl anlmia fo nemtbesa emaserb.mn

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/ +42
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...)
 +18 
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eMclus apin + iatrbpelior deame si a cclassi eiatsnnprteo fro lcorthnaeil lp.rsaiis stBe sniosdaig ofr tish si a mcselu ,sypoib as het ymowr kslie to aohungt intihw teh mu.csels

sympathetikey  That's what you get for killing polar bears. +90
dr.xx  That's what you get for not cooking them well. +5
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2
... lsmarshall made a comment on nbme24/block2/q#22 (A 3-month-old boy is brought to the physician...)
 +17 
submitted by lsmarshall(424)
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greleZlew msnderyo - tmualasoo siercseve rddoirse of ormoxeesip sineibsgeo edu ot etudmta PEX es.nge poHoiyt,na ,ueezisrs eeha,omatlypg relya daeth whii(tn 1 .y)ear tdn-xiaΞ²ooi fo AVFCL paenhsp in xreosposeim os teh clhdi ligyneesm ghvina soem sort of naictolneg mlacoteib eosiddrr thiw elteavde LsCFVA dhluos aevh enbe hgeuon to get het wesarn wthtuio owkning tauob lgreZew.le

jucapami  furthermore, FA 2019 pg 47 +4
tiredofstudying  Same page for FA 2020^ +4
... tea-cats-biscuits made a comment on nbme24/block3/q#29 (Drug X is given to a 25-year-old normal subject....)
 +17 
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iratlPa ginstsoa ahev waek gtaosin ticyvtia no eihrt nwo t(uhs ni htsi aecs ti ssueac RH ot rai,ences irnabgeed-cr )fectef but wehn an taualc sganoit si rtnpsee (aka nehw you ear iegcxis,rne you rea nogcidpur NE dna E that have lluf g-intosab fefe)c,ts apirlat atsiong taclyaul ehva a dmil onsitaatgn eefftc ths(u hte teahr reat esedrsac.)e

potentialdoctor1  Might be relevant to add that there are two beta-blockers that are actually partial beta-agonists (exert their blocking effects due to lesser effect when compared with endogenous catecholamines) ----> Pindolol and acebutolol +10
thelupuswolf  Key to note as madojo said that a partial agonist will compete with the full agonist in the presence of the full agonist, preventing the full agonist's maximum effect +
... sajaqua1 made a comment on nbme24/block4/q#20 (Forty of 100 attendees at a company Christmas party...)
 +17 
submitted by sajaqua1(557)
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robiiV alerhoc and V. alhicuaramopytse are lrntufqeey aaoceitdss hiwt tnmcpuinoso of ncodrkeedou seaofod leik .ihsleflhs V. isifcunuvl si stasciaoed tihw kihrcabs twaer or ewsalt.atr

)A B. eecus-r gstievetn nted to iceosaast this tihw taehdere irce ta a beu,ftf omntvigi is rome omomnc atnh ah.dierar B) C. enjiu-j scseaatoid htiw euodrndceko ood,f iaycselelp ci,nkche or nac be dccattnreo yb toatncc wtih imaal.ns tI usseac mmftnaa,olyri oobyld arheari,d and mya sola dlea to ieruGn-Blalar oyrde.snm )C .C gnperr-nfeis as a uaro,torspl shti is ctdiaseosa iwth dgoo taht si dthereea nteh felt to agitermen at room atertrpeuem ofr a lgon ietm foeber ioomsn.pnctu pomystmS ceindul otvniigm dna arei.rdah D) .S -suuear a tahe atlebs tonxi ocupdder by .S aresuu is aeitodascs twhi draip tneso of no,imgivt aym eb canmpoeadic by eiadrh.ra sMot ofetn iesasadcot htiw iydar pcrtosdu dna m.eat

armageddon_oh  Perfringens is also usually a delayed response, can help in vignettes! +
jj375  Vibrio cholera and V. parahaemolyticus are usually associated with seafood. B. cereus is re-heated rice, plus the vomiting type is a preformed toxin, but the diarrhea form is not, so I guess if it was rice, this could technically fit. Campylobacter is blood diarrhea, not watery. S aureus is preformed toxin so it usually happens within a few hours of eating the food, not 12 to 48 hours later. C. perf is less commonly asked about if its not gas gangrene, but First Aid also says that it's usually diarrhea after 10-12 hours and resolves by 24 hours. +
... sympathetikey made a comment on nbme24/block4/q#38 (A 33-year-old woman at 34 weeks' gestation has a...)
 +17 
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dv'ouelW eben enic if eyht ltdo oyu d"2n rlactoensti paes"c no tlfe or gih.r.shmt.

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
cport12  Also an important side note is that with the addition of the placenta, systemic vascular resistance would actually decrease (another organ added in parallel) which should help point you towards an increase in stroke volume. +1
... neonem made a comment on nbme24/block4/q#40 (A 25-year-old woman is brought to the emergency...)
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Thsi etnpiat nti's ,iitnogeahnylptv yhrtee' nntlEtagiYP,HveRi nehce eht POC2 &tl; 04 mm .gH

ste'L lkwa ti abkwcads:r yTeh rea atnirpvgilehntey to anmotesecp fro teh ilteomcba iiocdass csudae by sddiwarpee haoi.xyp inpHagveytiletnr sollwa uoy ot olwb fof oemr 2.CO

Why ear ythe ih?pxocy The speonr is ohycxip ued ot amamnnofliit and tcuae ryroptsriae srdisets rdnesyom rmfo the .uenmnopai lAl hte ktcoesnyi mrfo eht amtarmoniylf lsecl ucsae ndeeascir mrunolypa aaclliyrp ,aegakle ihchw sbolkc up eht vollraae mmnbraee so htat O2 c'tna egt horgthu to het bdlo.o

Why od ethy hvea lcbmeatio siiosadc in hte sfrit ?cleap No ynexog ;-t&-g on encloret nosprtatr icanh nda no ACT g-&-t; itaccl disi.asco

diabetes  no pneumonia it is UTI +3
makinallkindzofgainz  The infection from the UTI spread to her lungs +
makinallkindzofgainz  this is essentially urosepsis, one of the leading causes of sepsis +1
cmun777  UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability) +18
peqmd  urosepsis +
snripper  lmao I read it as upper respiratory tract infections, too. +3
thisshouldbefree  she has an increased A-a gradient. +
... stars and more made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
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X leidkn secveries eterh cna vrnee be nay eMla to alMe etrsrafn ecisn eth mlae niposrfgf tegs Y romf taef.hr eth dgpreiee oshsw lMea ot Male rtssnmoiisna so sthi toannc eb X ledkin escrivese