welcome redditors!to snoo-finity ... and beyond!

Some recent contributions

... epiglotitties made a comment on nbme20/block4/q#10 (A 65-year-old woman who has a 25-year history of...)
 +1  upvote downvote
submitted by epiglotitties(1)

There is an abnormally decreased function of the hydroxylation of proline because the 2nd stage in collagen synthesis (hydroxylation of specific proline and lysine residues) requires vitamin C. Since this patient has Scurvy (vit. C deficiency), this process is unable to occur.


... donttrustmyanswers made a comment on nbme18/block2/q#8 (39 yo man, polycystic kidney disease)
 +0  upvote downvote
submitted by donttrustmyanswers(0)

Uremia = Metabolic acidosis = Bicarb is low. High respiration = Low Co2; for respiratory compensation.


... donttrustmyanswers made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
 +0  upvote downvote
submitted by donttrustmyanswers(0)

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!


... donttrustmyanswers made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
 +0  upvote downvote
submitted by donttrustmyanswers(0)

According to UpToDate:

At levels below 886 mg/dL (10.0 mmol/L), the risk of pancreatitis appears to be quite small [76-78]; however, it is reasonable to consider drug therapy at levels of 500 mg/dL (5.6 mmol/L) or above in patients with a prior episode of pancreatitis.

Bonus: They say fenofibrate>gemfibrozil always.


... xlulu made a comment on nbme24/block2/q#32 (A 35-year-old woman undergoes a left oophorectomy...)
 +1  upvote downvote
submitted by xlulu(1)

Ureter courses retroperitoneally, close to gonadal vessels-> at risk of injury during ligation of ovarian vessels. FA 2020 pg 625


... adong made a comment on nbme23/block2/q#3 (A prospective study is done to assess the relative...)
 +0  upvote downvote
submitted by adong(8)

By default you should use intention to treat analysis b/c it's the most conservative.


... adong made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +0  upvote downvote
submitted by adong(8)

You can answer by process of elimination. "Competitive interactions" makes you think stimulatory NT. Cross out GABA and glycine. In the cortex so glutamate. Metabotropic would mean there's second messengers involved and the receptor would not transmit calcium. Hence NMDA.


... hvancampen made a comment on nbme24/block2/q#7 (A 75-year-old man with a 10-year history of...)
 +0  upvote downvote
submitted by hvancampen(0)

According to lumen, "the Bowman’s capsule space exerts hydrostatic pressure of its own that pushes against the glomerulus. Increased Bowman’s capsule hydrostatic pressure will decrease GFR, while decreased Bowman’s capsule hydrostatic pressure will increase GFR.

An example of this is a ureter obstruction to the flow of urine that gradually causes a fluid buildup within the nephrons. An obstruction will increase the Bowman’s capsule hydrostatic pressure and will consequently decrease GFR."

https://courses.lumenlearning.com/boundless-ap/chapter/physiology-of-the-kidneys/


... garima made a comment on nbme20/block4/q#44 (A 45-year-old man comes to the office for counseling...)
 +0  upvote downvote
submitted by garima(1)

Because of the starchy nature of bread, rice, and pasta, after your surgery, they can form a paste in your throat that is hard to swallow without liquid. In some cases, they can block the stoma, the hole to the pouch that is your new stomach. You don’t have to completely reject these high-starch foods, but it’s best to avoid them in the beginning. When you do eat them, try to have very small portions and make sure that you only eat small bites of each.


... adong made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
 +0  upvote downvote
submitted by adong(8)

If you're confused by the systolic murmur look at FA2019 p.288. ASD can cause systolic ejection murmurs in the pulmonic location (can think of it as increase turbulent flow).

Of course the more important thing is fixed splitting so SMASH away.


... adong made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +0  upvote downvote
submitted by adong(8)

In addition to what has already been said I think an important point in the question was regulatory adjustments which points more towards arteriolar regulation.


... adong made a comment on nbme23/block4/q#44 (A 44-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by adong(8)

tricky image but question is asking more specifically about his visual complaints which is just "double vision" so IR entrapment is the best answer


... h0odtime made a comment on nbme21/block2/q#44 (A 75-year-old man has the sudden onset of partial...)
 +0  upvote downvote
submitted by h0odtime(2)

... rainlad made a comment on nbme23/block4/q#12 (Investigators conduct a prospective, community-based...)
 +1  upvote downvote
submitted by rainlad(1)

my approach to this question was to eliminate all the answer choices that mentioned specificity or sensitivity, since the data here did not provide information about any sort of screening test.

that left me with two possible answer choices: I eliminated the one about consistency of other studies, since no other studies were mentioned in the question stem.

not sure if I oversimplified things, but it led me to the right answer!


... h0odtime made a comment on nbme21/block1/q#41 (A 35-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by h0odtime(2)

Heme Mnemonics


... adong made a comment on nbme23/block1/q#10 (A 13-year-old girl is brought to the office because...)
 +0  upvote downvote
submitted by adong(8)

I don't think you're supposed to know any complicated niche piece of knowledge. You have to infer that the pt has a skin lesion and is therefore prone to skin infections, most commonly from Staph aureus.


... h0odtime made a comment on nbme21/block1/q#50 (A photograph is shown of a myelin-stained cross...)
 +0  upvote downvote
submitted by h0odtime(2)

Thoracic Cross Section Reference


... h0odtime made a comment on nbme21/block1/q#45 (An 18-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by h0odtime(2)

... h0odtime made a comment on nbme21/block1/q#36 (A 51-year-old woman comes to the physician because...)
 +1  upvote downvote
submitted by h0odtime(2)

Labels

Credit to Histo_Man/reddit


... h0odtime made a comment on nbme21/block4/q#24 (A 56-year-old man undergoes a renal transplant. Five...)
 +0  upvote downvote
submitted by h0odtime(2)

Transplant Rejections (p.119)

Transplant Types

ABCD Hypersensitivity (p.112 FA2020)


... suckitnbme made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +1  upvote downvote
submitted by suckitnbme(2)

I was stuck between mitral and aortic and went with aortic because the L ventricle looks enlarged, possibly hinting that the patient had aortic stenosis.


... mcdumbass made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
 +0  upvote downvote
submitted by mcdumbass(0)

I thought thought measuring a gas in the blood only measures partial pressure of dissolved gas in the blood


... garima made a comment on nbme20/block3/q#39 (A 19-year-old woman has severe refractory pustular...)
 +0  upvote downvote
submitted by garima(1)

I think the question asks 'if it binds to RXR, what happens?'

The retinoid X receptor (RXR1) is an intriguing and essential member of the steroid/thyroid hormone superfamily of nuclear receptors (NRs) that predominately function as transcription factors with roles in development, cell differentiation, metabolism, and cell death

which means its related with development etc


... almondbreeze made a comment on nbme22/block1/q#20 (A 49-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by almondbreeze(3)

FA 2019 pg 455 on avascular necrosis of bone: Infarction of bone and marrow, usually very painful. Most common site is femoral head (watershed zone) (due to insufficiency of medial circumflex femoral artery). Causes include Corticosteroids, Alcoholism, Sickle cell disease, Trauma, SLE, "the Bends" (caisson/decompression disease), LEgg-Calve- Perthes disease (idiopathic), Gaucher disease, Slipped capital femoral epiphysis- CASTS Bend LEGS.


... osler_weber_rendu made a comment on free120/block3/q#15 (A 46-year-old woman with active ankylosing...)
 +0  upvote downvote
submitted by osler_weber_rendu(1)

Monoclonal Antibodies are always last resort! I just use this as a general rule


... usmlehulk made a comment on nbme22/block4/q#16 (A 4-month-old boy is brought to the office by his...)
 +1  upvote downvote
submitted by usmlehulk(2)

can someone please explain this question. i thought the patient is actually having cleft lip and palate, but why is the correct answer addressing only the cleft lip.


... mrglass made a comment on nbme23/block2/q#42 (A 63-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by mrglass(2)

I figured this was a variable intrathoracic obstruction and got it wrong.

According to UpToDate, INTRAluminal tracheal obstruction is varaible, while EXTRAluminal tracheal obstruction (like in this case) is fixed.


... almondbreeze made a comment on nbme22/block4/q#34 (A 17-year-old boy comes to the physician because of...)
 +0  upvote downvote
submitted by almondbreeze(3)

uw: EBV commonly infects B cells, stimulating them to enter the cell cycle and proliferate continuously ("transformation or "immortalization"). this is accomplished when EBV-encoded activate proliferative and anti-apoptotic signaling pathways w/i the infected B cell. ... the immortalized B cells maintain the ability to secrete Ig and B-cell activation products (eg. CD23), with very few of them releasing virus particles at any one time.


... almondbreeze made a comment on nbme22/block4/q#28 (A 48-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by almondbreeze(3)

UW: the short gastric vv drain blood from the gastric funds into the splenic vein, pancreatic inflammation (e.g. pancreatitis, pancreatic ca.) can cause a blood clot w/i the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varies only in the funds


... almondbreeze made a comment on nbme22/block4/q#19 (A 76-year-old man with a 1-month history of a...)
 +0  upvote downvote
submitted by almondbreeze(3)

a good pic showing anomalous arteries in horseshoe kidney

https://www.researchgate.net/figure/A-case-of-horseshoe-kidney-with-accessory-renal-arteries-Posterior-aspect-of-the_fig1_313729399


... dartosfascia made a comment on nbme24/block1/q#42 (A 68-year-old woman with acute myelogenous leukemia...)
 +0  upvote downvote
submitted by dartosfascia(0)

Why would you give GMCSF to someone with AML?? Isn't the whole goal of treatment to knock out the granulocytes? I feel like giving someone GMCSF after they were JUST treated for AML is asking for a relapse but what the hell do I know.


... saturdaynightpalsy made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +0  upvote downvote
submitted by saturdaynightpalsy(0)

So we are just supposed to know that poodles are hypoallergenic...

I put "get an air cleaner" because I thought asking the roommate to stop smoking would be beyond the scope of the physician and since I didnt know poodles were hypoallergenic, I thought "well, even if the roommate stopped smoking, she'll still have issues because of the pet dander."

cries


... usmlehulk made a comment on nbme22/block2/q#27 (A 50-year-old man who has smoked 2 packs of...)
 +0  upvote downvote
submitted by usmlehulk(2)

can anyone please explain why option E which is increased in Urinary pH is not the correct answer. becasue hydrogen wasting is also a form of correcting respiratory acidosis.


... euchromatin69 made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +0  upvote downvote
submitted by euchromatin69(0)

pregnancy is a risk factor for acute pyelonephritis FA 2019 pg 589


... djtallahassee made a comment on nbme22/block3/q#10 (A 50-year-old man comes to the physician for...)
 +0  upvote downvote
submitted by djtallahassee(0)

Wouldn't telling the patient about the referral do more harm than good?

  1. Pt considers it a bribe and leaves
  2. Ruins study due to placbo effects
  3. Puts doc/hospital at risk for potential legal hassle.

I guess maybe I read it as a study when it really is just a referral but its not that much of a leap to think that this "experimental"" treatment is part of a study


... sammyj98 made a comment on nbme20/block2/q#35 (A 36-year-old woman comes to the office because of a...)
 +1  upvote downvote
submitted by sammyj98(3)

maybe I overthought this one, but doesn't she have free air in the bottom left? Or is that the bottom of the pleural space...


... pg32 made a comment on nbme20/block4/q#48 (A 24-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by pg32(2)

Can anyone explain why the lipase concentration is so high if there is an issue with LPL in hyperchylomicronemia?


... mbourne made a comment on nbme20/block2/q#48 (A sedentary 50-year-old man with hypertension comes...)
 +0  upvote downvote
submitted by mbourne(6)

I think that if they had something like "statin therapy" as an answer choice, we would have an argument for that as it would decrease mortality by helping prevent ANOTHER heart attack. However, I think that anti-depressant therapy will do a LOT to prevent suicide, while omega-3 fatty acids (healthy as they are) wouldn't do AS MUCH to prevent a heart attack.

The question is basically asking, "You can only prescribe one of these to keep this dude alive as long as possible. Which one will have the best chance at accomplishing that?"

Therefore, the answer should be anti-depressant therapy.


... mbourne made a comment on nbme20/block2/q#38 (A 50-year-old woman with a restrictive pulmonary...)
 +0  upvote downvote
submitted by mbourne(6)

In restrictive lung disease, literally all lung values are DECREASED ("restricted") except for the FEV1/FVC ratio. FEV1/FVC ratio may be normal or increased (increased only if FEV1 decreases a bit less than the decrease in FVC, resulting in an increased ratio).


... mbourne made a comment on nbme20/block2/q#23 (Which of the following changes in the cardiovascular...)
 +0  upvote downvote
submitted by mbourne(6)

Although everyone's arteries WILL get stiffer as we age, every single person will not develop coronary atherosclerosis and mitral stenosis. Will the valves become a bit stiffer? For sure! Will they develop "mitral stenosis"? No, that is not congruent with "normal aging".

"Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic‐diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805932/


... mbourne made a comment on nbme20/block3/q#39 (A 19-year-old woman has severe refractory pustular...)
 +5  upvote downvote
submitted by mbourne(6)

This is a mish-mash of information I can find on this subject. Can't find good info on this anywhere. I think this question sucks

"Isotretinoin has a low affinity for retinoic acid receptors (RAR) and retinoid X receptors (RXR), but may be converted intracellularly to metabolites that act as agonists of RAR and RXR nuclear receptors.

In the nucleus of a cell, retinoic acid acts as a ligand, which is a molecule that binds to a site on a specific protein, to activate two families of transcriptional factors. These two families are the retinoic acid receptors (RAR) and retinoid X receptors (RXR), which bind to genes that respond to retinoic acid. There are three forms of RARs and three forms of RXR.

Studies with in vitro rat embryos have shown that retinoids act directly on the embryo, causing those embryo to develop abnormally."


... rossiememe made a comment on nbme23/block3/q#10 (An investigator is studying two drugs, Drugs X and...)
 +4  upvote downvote
submitted by rossiememe(4)

DOSE x F = AUC x CL

(F= Bioavailability)

If dose is constant and F is increased for Drug X then AUC would increase.


... jinzo made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +4  upvote downvote
submitted by jinzo(4)

A - nucleus ( with nucleolus inside ) B - mitochondria C - RER ( you can see attached ribosomes ) D - ?? may be lysosomes E - glycogen granules


... em_goldman made a comment on free120/block3/q#15 (A 46-year-old woman with active ankylosing...)
 +4  upvote downvote
submitted by em_goldman(6)

Rituximab (anti-CD 20) is currently undergoing trials for AS. My sparse googling just now shows that rituximab probably only has a moderate effect, so probably second-line to anti-TNFa therapy. Probably.

Safe to say for boards that AS: TNFa > CD20


... adong made a comment on nbme22/block1/q#49 (A 17-year-old primigravid woman at 16 weeks'...)
 +0  upvote downvote
submitted by adong(8)

the patient is pregnant so not doxy. azithro is alternative (see sketchy vid)


... adong made a comment on nbme22/block4/q#44 (A 10-year-old boy has bruised easily since...)
 +1  upvote downvote
submitted by adong(8)

Dicumarol is in the coumarin family which includes warfarin. It helps if you think about warfarin's brand name Coumadin. Coumadin, coumarin, dicumarol...all the other derivatives have COUM it in some fashion


... adong made a comment on nbme22/block4/q#45 (An 1814-g (4-lb) male newborn is delivered in the...)
 +1  upvote downvote
submitted by adong(8)

neuroendocrine cells doesn't always mean neural crest


... em_goldman made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
 +1  upvote downvote
submitted by em_goldman(6)

I believe (pls correct me if I'm wrong) you would have similar Southern blot results seen in B cells undergoing somatic hypermutation, but that takes place in the secondary lymphoid tissue, not in the bone marrow.


... poisonivy made a comment on nbme21/block3/q#19 (A 25-year-old woman develops increasing shortness of...)
 +5  upvote downvote
submitted by poisonivy(9)

this is actually a UW question (14992) Peripartum cardiomyopathy manifests as a dilated cardiomyopathy, can occur during last month of pregnancy or within 5 months after delivery, pathogenesis poorly understood, but may be related to impaired function of angiogenic growth factors (e.g VEGF) or predisposed by mutations in cardiac structural proteins.


... blahblahblah made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +0  upvote downvote
submitted by blahblahblah(0)

Melanin in darkly pigmented skin can provide an SPF (sun protective factor) of 1.5 - 4. Amount of UV light getting through is 1/SPF, so a SPF of 4 reduces UV radiation by 75%. So the areas without this protective feature are most at risk (palms/soles).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/


... adong made a comment on nbme22/block1/q#38 (A newborn born at 26 weeks' gestation has...)
 +1  upvote downvote
submitted by adong(8)

literally know every single name they can possibly call this


... hungrybox made a comment on nbme20/block3/q#7 (A 10-year-old boy has a palpable mass in the ventral...)
 +0  upvote downvote
submitted by hungrybox(295)

The endoderm of the 3rd and 4th pouches form the parathyroid gland and the parafollicular cells of the thyroid gland.


... adong made a comment on nbme22/block1/q#2 (A 28-year-old man has recurrent pancreatitis...)
 +0  upvote downvote
submitted by adong(8)

from uworld: fibrates activate PPAR-alpha to increase LPL and decrease VLDL production


... adong made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by adong(8)

uworld says somewhere that testosterone increases hematocrit, increases LDL, and decreases HDL


... adong made a comment on nbme22/block4/q#43 (A 44-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by adong(8)

got confused by the systolic pulsation of the liver but basically regurgitant blood from RV will go into RA > IVC > hepatic veins


... hungrybox made a comment on nbme20/block3/q#33 (A 31-year-old woman receives a prescription for...)
 +0  upvote downvote
submitted by hungrybox(295)

Here's my reasoning for why the answer I chose was wrong...

Casein is a milk protein. Because most milk is pasteurized, all proteins will be denatured before consumption, and would not have any effects (Choice B).

This is in contrast to avidin, which is found in RAW eggs and binds vitamin B7 (biotin), preventing carboxylation.

...

bullshit question btw 😡


... adong made a comment on nbme22/block3/q#8 (A 38-year-old man who lives at sea level flies to a...)
 +0  upvote downvote
submitted by adong(8)

the question can easily be misinterpreted. it's asking for urinary pH, urinary bicarb, and urinary volume


... adong made a comment on nbme22/block4/q#30 (A 27-year-old man who is a construction worker is...)
 +0  upvote downvote
submitted by adong(8)

hit the kidney so retroperitoneal. leaves only the duodenum and splenic flexure. kidneys are more lateral structures so splenic flexure (at turn of descending colon)


... adong made a comment on nbme22/block2/q#7 (A 66-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by adong(8)

Pretty much if they can masturbate or get it up alone in any way their nocturnal tumescence should be normal meaning that their innervation and reflex pathways are all intact. Libido aka sex drive from what I’ve seen so far is altered by depression. So like in the question on NBME 21 the stem stated that screening for depression was negative which is why libido would also be normal in this case. If there’s ever a Q with a depressed guy and normal lab values and physical exam, most likely gonna be decreased libido with normal night erections - courtesy of /u/diffuseaxonalinjury


... adong made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +0  upvote downvote
submitted by adong(8)

you need to add an amine (nitrogen) and most biochem processes from sugar --> amine requires glutamine


... adong made a comment on nbme22/block3/q#35 (A 4-year-old boy is brought to the physician by his...)
 +0  upvote downvote
submitted by adong(8)

Super annoying they are using the same picture BUT you can answer with process of elimination. No mass in the picture so not nephroblastomatosis or RCC. 4 year old so not amyloidosis. Stem does not really cue you into membranous GN. Instead it talks about UTIs which would have inflammatory processes --> interstitial inflammation.


... poisonivy made a comment on nbme21/block3/q#30 (A 41-year-old man comes to the physician because of...)
 +0  upvote downvote
submitted by poisonivy(9)

question #15553 in UW explains this one well. Basically, C5 branches innervate Deltoid (abduction) and Infraspinatus(external rotation) and C6 Biceps (forearm flexion), so the right option should be abduction of the upper extremity.

I got it wrong though lol


... aneurysmclip made a comment on nbme23/block4/q#6 (A 35-year-old woman, gravida 2, para 1, undergoes...)
 +1  upvote downvote
submitted by aneurysmclip(4)

what I'm thinking is, normally the perineal body is cut during a posterior episiotomy. so reading over the question again, the last line "which is at greatest risk for damage IF this incision is TORN FURTHER during delivery" Torn further being the key imo.

as for why it isn't bulbospongiosus or ischocavernosis -> https://en.wikipedia.org/wiki/Transverse_perineal_muscles#/media/File:1116_Muscle_of_the_Female_Perineum.png


... samsam3711 made a comment on nbme21/block2/q#24 (A 65-year-old man dies in a motor vehicle collision....)
 +0  upvote downvote
submitted by samsam3711(0)

Esophageal squamous cell cancers are more common in smokers


... rainlad made a comment on nbme21/block3/q#12 (A 55-year-old man with hypertension comes to the...)
 +0  upvote downvote
submitted by rainlad(1)

How do we explain the bruit in this case? Also why isn't it left artery aneurysm? That seems like it would better explain the bruit


... rainlad made a comment on nbme21/block3/q#38 (A 28-year-old man develops a temperature of 39.9°C...)
 +0  upvote downvote
submitted by rainlad(1)

would we be worried about using G-CSF given that he has acute leukemia? would it stimulate growth of his cancer cells?


... umbriix made a comment on nbme21/block1/q#20 (A 10-year-old girl develops fever, malaise, and loss...)
 +0  upvote downvote
submitted by umbriix(0)

https://www.amboss.com/us/knowledge/Rabies

two different types of rabies


... umbriix made a comment on nbme21/block3/q#45 (A 28-year-old man comes to the physician for...)
 +0  upvote downvote
submitted by umbriix(0)

} Pathology – CFTR mutation - Pts usually do NOT have cystic fibrosis phenotype, but are only carriers } Presentation Low-volume, acidic azoospermic ejaculate


... hungrybox made a comment on nbme20/block1/q#5 (A 24-year-old African American man comes to the...)
 +0  upvote downvote
submitted by hungrybox(295)

I did this by process of elimination:

Acne is not itchy or painful from my experience (Choice A).

Never heard of cutaneous lupus eryhtematosus, but I'd asssume you'd have a malar rash (involving the nose/undereye area), not spread out over the cheeks, jaw, and neck (Choice B).

Keloids are just overgrown scars. Scars are not particularly itchy or painful (Choice C)

Rosacea is just redness/flushing in certain areas of the skin. Mainly an aesthetic issue. Not itchy or painful (Choice E).

tbh I was between B and D.


... hungrybox made a comment on nbme20/block1/q#30 (A 33-year-old woman comes to the emergency...)
 +1  upvote downvote
submitted by hungrybox(295)

Here's my approach (downvote if wrong):

falling on outstretched arm → usually scaphoid

BUT

scaphoid problem → pain in anatomical snuffbox

so then it goes to the next most commonly injured bone when you fall on an outstretched arm, your lunate

(which is right next to the scaphoid)


... readit made a comment on nbme21/block2/q#35 (A 4-month-old female infant is brought to the...)
 +0  upvote downvote
submitted by readit(2)

The key to this question is that the patient is 4 months old and getting water.

Newborns should NOT be getting plain water until after 6 months of age because it can cause hyponatremia --> seizures


... readit made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
 +2  upvote downvote
submitted by readit(2)

Addition to Hungrybox's explanation:

Why it's not 47,XXY:

This would be referring to Klinefelter's, which is characterized by small, poorly functioning testicles.

However, question states "morphologic studies of a biopsy specimen of the testes show no abnormalities"


... almondbreeze made a comment on nbme20/block4/q#14 (A 60-year-old man has a round, semitransparent...)
 +1  upvote downvote
submitted by almondbreeze(3)

'round, semitransparent nodules'

FA2019 p.473 says BCCs are waxy, pink, pearly nodules


... nicsar made a comment on nbme22/block2/q#21 (A newborn has cyanosis, tachypnea, and retractions...)
 +0  upvote downvote
submitted by nicsar(0)

Pco2 Is high, acidosis; Respiratory acidosis.

If Compensated well, ΔHCO3-= E(Erythrocytiv compensation)ΔPCO2/10, (1~2)(65-40)/10=2.5~5 >> ΔHCO3=15-24=-9, not compensated, even less HCO3-; Combined metabolic acidosis.

for, Kidney compensation. use 3~4 instead of 1~2 in erythrocyctic compensation. and with this, the Gap between well compensated and the case even farther.


... drbravojose made a comment on nbme22/block2/q#23 (A 32-year-old woman comes to the physician because...)
 +1  upvote downvote
submitted by drbravojose(1)

FA 2019 p156 Does anyone know how to differentiate the picture labeled Trypanosoma brucei and cruzi?


... readit made a comment on nbme21/block1/q#25 (A 28-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by readit(2)

Why is is not pseudo aneurysm?

"Aortic pseudoaneurysms typically occur as a result of trauma +/- intervention, a considered subset of traumatic aortic injury in the majority of cases. They can be acute or chronic."

https://radiopaedia.org/articles/aortic-pseudoaneurysm?lang=us


... readit made a comment on nbme21/block3/q#36 (Which of the following best explains why the use of...)
 +0  upvote downvote
submitted by readit(2)

An anti-idiotypic antibody is an antibody which binds an antibody.

As an example, an anti-idiotypic antibody be helpful for treating a naiive B cell prior to activation, which express IgM and IgD on their surfaces. This is because the anti-idiopathic antibody can bind to the IgM/IgD antibody on the surface of a naiive B cell.

Multiple Myeloma cells, however, are made up of Plasma cells, which no longer express Ig's on their surface like naiive B cells do. Thus, there is no surface antibody [aka "membrane bound surface immunoglobulin"] for an anti-idiotypic antibody to bind to.


... readit made a comment on nbme21/block3/q#16 (A 16-year-old boy is brought to the physician...)
 +0  upvote downvote
submitted by readit(2)

Why it is not MVP:

Full quotation from UpToDate: "Symptoms [... such as] various nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, and dizziness have been attributed to MVP. However, symptoms are not reliable indicators of MVP. Furthermore, symptoms frequently seen in individuals with MVP have not been conclusively determined to be more prevalent than in the general population. As an example, in a study of 147 patients referred for echocardiography for suspected MVP, the presence of symptoms was not associated with MVP on echocardiography (found in 22 percent) [43]. (See "Mitral valve prolapse syndrome".)"


... nicsar made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +0  upvote downvote
submitted by nicsar(0)

Hyponatremia from Heartfailure pt.

It should be approached from Heart faiure.

HF-> RAAs -> excessive Aldosterone, ADH; ANP escape faiure, like secondary hyperaldosteronism; Hyponatremia

https://www.wjgnet.com/1949-8462/full/v5/i9/WJC-5-317-g001.htm


... fatboyslim made a comment on nbme21/block3/q#39 (A 74-year-old woman with mild dementia is admitted...)
 +0  upvote downvote
submitted by fatboyslim(2)

4 criteria must be met to know if a patient has capacity (taken from Dirty Medicine'sYouTube channel): "ICAL"

I: patient is fully INFORMED about the decision at hand (e.g. doctor tells patient you had a lung infection which worsened and spread to your blood and you become septic then you developed cardiac arrest and we had to perform CPR on you and give you epinephrine to bring yo ass back)

C: patient COMMUNICATES their decision (e.g. explicitly says "I want to be discharged")

A: patient APPRECIATES the nature and severity of the illness (e.g. doctor tells patient you might die if you leave against our medical advice and then the doctor asks the patient to repeat it back to make sure he comprehended that fact)

L: patient can explain their decision in a LOGICAL and linear fashion (e.g. patient says his dad was in an ICU before with many tubes and blood samples being drawn and was on a ventilator and the patient doesn't want to end up like his dad)

NOTE: the patient's "logical" explanation of their decision does NOT have to actually be a good medical decision. As a doctor, you can disagree with their poor medical choice, but as long as the patient came to that decision with capacity intact, then you should respect their decision (autonomy).


... 2weekstomyexamaah made a comment on nbme22/block1/q#2 (A 28-year-old man has recurrent pancreatitis...)
 +0  upvote downvote
submitted by 2weekstomyexamaah(0)

After I did this NBME, I got QID 166 wrong (I put niacin); and now I'm not sure which is the right way to think about it. In 166, the pt has hyperTG and answer is to treat him with fibrates to prevent recurrences - idk if anyone else had this confusion.


... foxo made a comment on nbme18/block3/q#5 (82 yo woman, 24 hours of constant severe lower abdominal pain)
 +0  upvote downvote
submitted by foxo(0)

Fibrin deposition initiated by peritonitis is thought to be an important local defense mechanism because it sequesters and walls off bacterial spillage."

Rotstein 1986


... mrglass made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
 +0  upvote downvote
submitted by mrglass(2)

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine


... mrglass made a comment on nbme21/block3/q#8 (A 55-year-old woman is brought to the emergency...)
 +1  upvote downvote
submitted by mrglass(2)

Despite the patient not being intoxicated, this patient is presenting with classic findings of Wernicke-Korsakoff syndrome. Even if you figured that Thiamine deficiency wasn't likely given the history, if you know that WKS causes mammilary body atrophy, and this "mystery disease" is causing similar symptoms to WKS, you can guess that this "mystery disease" is causing mammilary body atrophy


... groovygrinch made a comment on nbme24/block3/q#21 (A 7-year-old girl is brought to the emergency...)
 +0  upvote downvote
submitted by groovygrinch(1)

For those who were wondering like me, they gave the Beta-hydroxybutyrate (a ketone body) levels in order to rule out DKA (diabetic ketoacidosis) in a type 1 diabetics and which would otherwise not be distinguishable based only on C-peptide and insulin levels


... adong made a comment on nbme21/block3/q#26 (A 19-year-old woman comes to the office because of a...)
 +0  upvote downvote
submitted by adong(8)

Cecum is intraperitoneal even though it's part of the ascending colon


... adong made a comment on nbme21/block4/q#8 (A 70-year-old woman has had recurrent pneumonia,...)
 +2  upvote downvote
submitted by adong(8)

Euthyroid sick syndrome = levels of T3 and/or T4 are abnormal, but the thyroid gland does not appear to be dysfunctional. The classical phenotype of this condition is often seen in starvation, critical illness, or patients in the intensive care unit. The most common hormone pattern is low total and free T3, elevated rT3, and normal T4 and TSH levels.


... adong made a comment on nbme21/block2/q#39 (A 64-year-old man with bronchospastic pulmonary...)
 +0  upvote downvote
submitted by adong(8)

FA19 p.233 cortisol has a permissive effect on catecholamines


... adong made a comment on nbme21/block1/q#25 (A 28-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by adong(8)

unequal BP/pulses in the arms is a big key for aortic dissection


... qfever made a comment on nbme22/block1/q#35 (A 35-year-old man is brought to the hospital after a...)
 +1  upvote downvote
submitted by qfever(5)

Hypothalamus controlling temperature set point is briefly mentioned in Pathoma 2018 edition page 13, Chapter 2 III Cardinal signs of inflammation D. Fever

Pyogenes -> macrophage release IL-1 and TNF -> increased cyclooxygenase activity in hypothalamus perivascular cells -> increased hypothalamus PGE2 -> raised temperature set point


... h0odtime made a comment on nbme20/block1/q#33 (A 17-year-old girl comes to the emergency department...)
 +1  upvote downvote
submitted by h0odtime(2)

Severity of mitochondrial diseases is directly related to the proportion of abnormal to normal mitochondria within patient cells.

Heteroplasmy having different mitochondrial genomes in a single cell.

Homoplasmy in contrast, is seen in healthy tissue where mitochondrial DNA is identical.

UWorld explanation ID 1935. For those visually inclined.


... ilovemypuppies2295 made a comment on nbme20/block2/q#29 (A 25-year-old woman has a flu-like illness (fever,...)
 +1  upvote downvote
submitted by ilovemypuppies2295(1)

What makes this coxsackie virus over Adenovirus? Both cause myocarditis which would be seen on autopsy? Is it just more common to get coxsackie?


... fatboyslim made a comment on nbme21/block1/q#43 (A 52-year-old man is brought to the emergency...)
 +1  upvote downvote
submitted by fatboyslim(2)

(From UW 11852) Some medications including opioids, radiocontrast dyes, and some antibiotics (e.g. vancomycin) can induce and IgE-INDEPENDENT mast cell degranulation by activation of protein kinase A and PI3 kinase, which results in release of histamine, bradykinin, and other chemotactic factors -> diffuse itching, pain, bronchospasm, and localized swee=lling (urticaria).


... rainlad made a comment on nbme20/block1/q#37 (A 1-month-old male newborn is brought to the...)
 +0  upvote downvote
submitted by rainlad(1)

Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis.

Persistent vomiting results in loss of HCl. The chloride loss results in a low blood chloride level which impairs the kidney's ability to excrete bicarbonate. This is the factor that prevents correction of the alkalosis leading to metabolic alkalosis.

A secondary hyperaldosteronism develops due to the decreased blood volume. The high aldosterone levels causes the kidneys to retain Na+ (to correct the intravascular volume depletion), and excrete increased amounts of K+ into the urine (resulting in a low blood level of potassium).


... mamabara made a comment on nbme22/block2/q#8 (A 73-year-old man has difficulty urinating and...)
 +0  upvote downvote
submitted by mamabara(0)

I believe the drug they are talking about here is tamulosin, which is an a1-antagonist


... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +0  upvote downvote
submitted by dr_ligma(2)

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


... toxoplasmabartonella made a comment on nbme20/block1/q#22 (A 38-year-old woman comes to the physician because...)
 +1  upvote downvote
submitted by toxoplasmabartonella(2)

CN X carries efferent to palate. CN IX carries afferent from palate.


... docshrek made a comment on nbme23/block4/q#27 (A man accidentally touches the surface of a hot...)
 +1  upvote downvote
submitted by docshrek(1)

https://www.ncbi.nlm.nih.gov/pubmed/6162412

Pathophysiology of the burn wound. Arturson G. Abstract The pathophysiology of the burn wound is characterized by an inflammatory reaction leading to rapid oedema formation, due to increased microvascular permeability, vasodilation and increased extravascular osmotic activity. These reactions are due to the direct heat effect on the microvasculature and to chemical mediators of inflammation. The earliest stage of vasodilatation and increased venous permeability is commonly due to histamine release. Damage to the cell membranes partly caused by oxygen-free radicals released from polymorphonuclear leucocytes would activate the enzymes catalyzing the hydrolysis of prostaglandin precursor (arachidonic acid) with rapid formation of prostaglandin as the result. Prostaglandins inhibit the release of norepinephrine and may thus be of importance in modulating the adrenergic nervous system which is activated in response to thermal injury. The morphological interpretations of the changes in the functional ultrastructure of the bloodlymph barrier following thermal injury seem to be an increase in the numbers of vacuoles and many open endothelial intercellular junctions. Furthermore changes of the interstitial tissue after burn trauma are of great importance. The continuous loss of fluid from the blood circulation within the thermally damaged tissue causes increased haematocrit levels and a rapid fall in plasma volume, with decreased cardiac output and hypoperfusion on the cellular level. If the fluids are not adequately restored burn shock develops. Furthermore, the burn wound provides a vast area of entry of surface infection with a high risk of septic shock. Four main principles are of utmost importance in the current management of patients with severe thermal injury, namely early wound closure, prevention of septic complications, adequate nutrition and control of the external environment.


... qfever made a comment on nbme20/block4/q#28 (A 78-year-old man dies of chronic congestive heart...)
 +0  upvote downvote
submitted by qfever(5)

Pathoma 2018 edition page 4 chapter 1 - Cellular Injury - III. Reversible & irreversible cellular injury - B.1.

I had difficulty trying to figure out what hydropic change means though...


... qfever made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +1  upvote downvote
submitted by qfever(5)

Does anyone know what are A, C, D? For C not sure if it's pointing to the ribosomes on RER.

(I'm assuming E is glycogen granules based on a comment below!)