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

Some recent contributions

... sahusema made a comment on nbme21/block4/q#35 (A 50-year-old woman is admitted to the hospital...)
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submitted by sahusema(0)

The Didanosine guy in the NRTI sketch is holding a pancreas sponge.


... sahusema made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
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submitted by sahusema(0)

I cut open an eyeball once and I was surprised how dense black the material inside was. That plus process of elimination brought me to the right answer


... sahusema made a comment on nbme21/block4/q#46 (A 14-year-old girl is brought to the physician for a...)
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submitted by sahusema(0)

Associated neoplasms in Li-Fraumeni syndrome. Sarcomas, breast cancer, brain tumors, adrenocortical carcinoma, leukemia


... sahusema made a comment on nbme21/block4/q#48 (A 75-year-old man with dementia, Alzheimer type, is...)
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submitted by sahusema(0)

What a GARBAGE question. He was eating breakfast 2 hours ago just fine and now we are supposed to have the family come to a consensus about a feeding tube like he's on his death bed? BULLSHIT


... sweetmed made a comment on nbme22/block4/q#30 (A 27-year-old man who is a construction worker is...)
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submitted by sweetmed(15)

https://www.google.com/search?q=anterior+relations+of+kidney&tbm=isch#imgrc=fRhVDG8eBSFDKM:


... ergogenic22 made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
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submitted by ergogenic22(18)

chromatin negative = no barr bodies = person with XY genotype or XO because anytime you have more than one X chromosome you have a barr body (chromatin positive)


... dontwanttofail made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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submitted by dontwanttofail(-2)

https://en.wikipedia.org/wiki/Acute_proliferative_glomerulonephritis

Directly from wikipedia:

"Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis."


... kard made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
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submitted by kard(0)

Tricyclic and tetracyclic antidepressants, also called cyclic antidepressants. The peripheral anticholinergic complaints of dry mouth, constipation, ocular side effects and urinary hesitancy are described and specific clinical guidelines for their effective management are provided.

So, most common reason for noncompliance with cyclic antidepressant therapy is its anticholinergic effect.

https://www.ncbi.nlm.nih.gov/pubmed/3290996 https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

Note: Please if im mistaken, or my approach is mistaken, correct me... Thank you


... alexb made a comment on nbme22/block3/q#21 (A screening test for cancer is developed and applied...)
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submitted by alexb(3)

The words "most effectively" confused me. I thought to myself "even if it has the highest specificity, it's not very effective if it's got super low sensitivity -- since it will miss a lot of the true +ve's (failing to rule in cancer for the ones that get missed)." That was a story I told myself about their use of the words "most effectively" lol.


... ergogenic22 made a comment on nbme21/block1/q#10 (A 34-year-old woman is brought to the emergency...)
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submitted by ergogenic22(18)

Na-(Cl-+HCO3-)=anion gap = 140-(105+10) = 25 mEq/L

normal range for anion gap is 8 to 16 mEq/L...Therefore, positive anion gap.

pH = 7.25, normal range 7.35-7.45... Therefore acidosis

Normal bicarbonate 22-28, questions shows bicarb of 10. Therefore metabolic acidosis

Additionally PCO2 normally 33-45 mm Hg, question shows PCO2 of 23 with normal PO2, therefore respiratory compensation


... ergogenic22 made a comment on nbme21/block1/q#18 (A 61-year-old woman is brought to the physician by...)
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submitted by ergogenic22(18)

elderly lady with slow, progressive memory loss, normal physical exam, no signs of depression, this is most likely Alzheimer disease.

AChE inhibitors are used for treatment because Alzheimer's is associated with low ACh. Also used are NMDA receptor antagonist (memantine)


... tinydoc made a comment on nbme24/block2/q#35 (A 55-year-old woman comes to the physician because...)
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submitted by tinydoc(32)

I don't think it matters whether or not this was ALS ( which I still think it is). But theres fasiculations and Weakness and atrophy those are LMNL signs. Theres sooo many sneaky questions in this exam, this isnt one of them.


... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
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submitted by tinydoc(32)

This question is very sneaky, but in essence this is whats happening.

The accidental removal of the PTH glands during thyroidectomy ⇒ ↓ PTH

PTH normally: --in bone: ↑ removal of Ca²⁺ and Phophate from bone --in kidneys: ↑ Ca²⁺ reabsorption and ↓ PO₄³⁻ reabsorption --↑ conversion of 25, Hydroxyvitamin D to 1,25 Hydroxyvitamin D (Calcitriol - active form) via ↑ activity of 1-a Hydroxylase deficiency

Therefore a ↓ PTH would lead to:

⇒ ↑ PO₄³⁻ ⇒ ↓ Ca²⁺ ⇒ ↓ 1,25 Hydroxyvitamin D

The question is sneaky (much like the rest of this exam) because someone who isnt focusing really hard or in a rush might pick the option C where phophate is ↑ and PTH is ↓ BUT ↓ 25 hydroxyvitamin D

This is wrong as only 1,25 hydroxyvitamin D would be decreased, the conversions before this are done by the skin (sunlight) and liver.

I really wish they would stop making the questions confusing PURELY for the sake of making them confusing. Isnt it enough that we have to know this ridiculous amount of information, without having them intentionally making it harder by pointing you to 1 answer choice but changing a minute detail to make you answer wrong. Or using a random ass nomenclature for a disease to avoid making it too simple (PSGN = "proliferative GN")


... kard made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
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submitted by kard(0)

Might be this way, correct me please if my approach is mistaken. So in the Stem we have a Painful nodule, (Due to 10weeks ago Sutures) So im thinking on Suture granuloma, that forms a lesion (Painful Nodule) arround the non-absorbable suture material.


... alexb made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
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submitted by alexb(3)

First Aid 2019 page 622 stimulatory growth effects of testosterone include red blood cells. I think they expect us to know this.


... enbeemee made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
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submitted by enbeemee(0)

i get why it's flagellin, but is the specific reason that LPS is wrong is because it's just not how the vaccine is made? LPS would also elicit an immune reaction, right?


... alexb made a comment on nbme22/block4/q#8 (A 6-year-old boy who recently emigrated from Russia...)
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submitted by alexb(3)

I think there's a UWorld question describing how cystic fibrosis can cause fat soluble vitamin deficiency and how a Vit E def in that context might manifest similarly to B12 def. (Also in first aid)


... alexb made a comment on nbme22/block4/q#1 (A 2-day-old full-term female newborn suddenly...)
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submitted by alexb(3)

There is a decent UWorld question explaining how this works. Only reason I remembered it.


... whoissaad made a comment on nbme21/block4/q#39 (A 46-year-old man comes to the physician because of...)
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submitted by whoissaad(1)

Where is this even from? My mind's going hay wire trying to understand this.


... imnotarobotbut made a comment on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
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submitted by imnotarobotbut(13)

This is a bad question. Platelet aggregation time being normal, ok fine I can see that. But VWF stabilizes factor 8 and you'd see an increase in PTT (first line next to VWF in First Aid). Why is their PTT normal?


... nwinkelmann made a comment on nbme18/block2/q#41 (35 yo woman, 3 days fever and sharp chest pain)
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submitted by nwinkelmann(25)

FA 2019 page 308. Most common cause of acute/primary pericarditis is assumed to be viral.


... snafull made a comment on nbme24/block2/q#36 (A 27-year-old woman comes to the physician for a...)
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submitted by snafull(1)

Can somebody explain why this is not a foreign body granuloma?


... whoissaad made a comment on nbme21/block3/q#41 (A 75-year-old woman comes to the physician's office...)
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submitted by whoissaad(1)

Source: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet

Everything in the stem points towards restless leg syndrome.

Plus I thought you need 5/9 of the SIG E CAPS to diagnose depression.

Someone please explain :)


... youssefa made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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submitted by youssefa(1)

Wouldn't acute alcohol consumption even in moderate amount cause reversible hepatic cellular injury characterized by cellular ballooning? It should be the right answer unless the question stem means "Weekends"


... cienfuegos made a comment on nbme20/block4/q#15 (45 yo man undergoing surgical procedure)
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submitted by cienfuegos(0)

Couldn't you also decrease the FIO2? Per FA, CPP also increases to hypoxia also decreases CPP when PO2 < 50 mmHg.


... enbeemee made a comment on nbme21/block1/q#36 (A 51-year-old woman comes to the physician because...)
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submitted by enbeemee(0)

what are the other labeled structures? i can discern the parietal and chief cells, but not the others...


... sugaplum made a comment on free120/block3/q#13 (A 32-year-old man is brought to the emergency...)
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submitted by sugaplum(9)

For reference FA 2019 pg 613 has a good image to see this


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

Can anyone tell the effect of aspirin on a blood lab value (i.e PT,PTT,Fibrin product)?


... feliperamirez made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
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submitted by feliperamirez(0)

I do understand that the principal nucleus of the trigeminal nerve is located at the pons. But since this patient is having trigeminal neuralgia wouldn't you be disrupting the pathway involved in pain and temperature, which in this case would be the spinal nucleus (located in the medulla)?

Besides, I found this at an article

A recent hypothesis attributes the pain of trigeminal neuralgia to a central mechanism involving the pars oralis of the spinal trigeminal nucleus.[5]

https://www.ncbi.nlm.nih.gov/books/NBK539729/


... sbryant6 made a comment on nbme22/block1/q#46 (A 12-year-old girl is referred to the emergency...)
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submitted by sbryant6(7)

Helpful table: http://innovationscns.com/wp-content/uploads/Ali_MJ15_Tab1.png


... sbryant6 made a comment on nbme22/block4/q#41 (A 65-year-old woman with a 20-year history of...)
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submitted by sbryant6(7)

https://www.peacefulmind.com/crystals-dermatomes-and-chakra/


... katsu made a comment on nbme20/block4/q#36 (A 25-year-old woman is brought to the emergency...)
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submitted by katsu(0)

In the pancreas' beta cells, proinsulin splits apart to form one molecule of C-peptide and one molecule of insulin.

C-peptide testing can be used to help evaluate the production of insulin made by the body (endogenous) and to help differentiate it from insulin that is not produced by the body but is taken exogenously and so does not generate C-peptide.


... yb_26 made a comment on nbme23/block1/q#14 (A 65-year-old woman develops deep venous thrombosis...)
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submitted by yb_26(8)

More simple from FA 2019: Heparin-induced thrombocytopenia is due to development of IgG antibodies against heparin-bound platelet factor 4 (PF4) Antibody-heparin-PF4 complex activates platelets => thrombosis and thrombocytopenia


... ergogenic22 made a comment on nbme21/block4/q#33 (A female newborn delivered at 26 weeks' gestation is...)
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submitted by ergogenic22(18)

why is protection of the choroid plexus, from intraventricular rupture secondary to germinal matrix hemorrhage not a possible answer?


... ergogenic22 made a comment on nbme21/block4/q#10 (A 64-year-old man is evaluated for cough, dyspnea,...)
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submitted by ergogenic22(18)

why is hyperlipidemia secondary to cushing syndrome not a possibility?


... sugaplum made a comment on free120/block2/q#31 (A 10-year-old girl is brought to the office by her...)
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submitted by sugaplum(9)

Incase anyone else was thinking the same:
I was stuck between this and variant of unknown significance. However, variant of unknown significance is a sequence not a single nucleotide


... yb_26 made a comment on nbme23/block1/q#12 (A 48-year-old man who is a farmer in a remote area...)
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submitted by yb_26(8)

... sugaplum made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
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submitted by sugaplum(9)

This question is asking about VDJ rearrangement which happens in the bone marrow. The genes are all chopped up because the B cell is trying to generate a unique combination for its receptor
simple concepts... odd wording

Chapter 3 of "how the immune system works" - awesome book


... yb_26 made a comment on nbme23/block1/q#7 (Which of the following is present in integral plasma...)
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submitted by yb_26(8)

O-linked glycosylation of secreted and membrane bound proteins is a post-translational event that takes place in the cis-Golgi compartment after N-glycosylation and folding of the protein


... yb_26 made a comment on nbme23/block1/q#27 (An 11-year-old boy is brought to the physician by...)
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submitted by yb_26(8)

... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
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submitted by smc213(13)

To be completely clear!

This patient has Cystinosis a rare autosomal recessive lysosomal storage disorder and most common cause of Fanconi syndrome in children. Cystinosis is systemic and leads to cystine crystal deposits in cells and tissues throughout the body.

Although Wilsons disease can lead to FS, the crystals in the corneas does not correlate with Wilsons disease.
More info: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841061/


... cry2mucheveryday made a comment on nbme21/block1/q#26 (A 62-year-old man who is a farmer comes to the...)
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submitted by cry2mucheveryday(0)

i fell for bleeding from lesion at chose psoriasis but psoriasis pts experience itching. Also, the distribution is not characteristic.


... charcot_bouchard made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
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submitted by charcot_bouchard(12)

Apparently theres role of sympathetic system in psychogenic erection and its comes from T11-L2. So if patient have transaction at L5 they lose reflex erection but still retain psychogenic one.

ABove T9 transaction cause loss of psychogenic erection


... adisdiadochokinetic made a comment on nbme22/block3/q#21 (A screening test for cancer is developed and applied...)
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submitted by adisdiadochokinetic(0)

How many people didn't see that it was 1-specificity and picked E like me :(


... adisdiadochokinetic made a comment on nbme22/block3/q#47 (A 10-year-old boy receives a renal transplant from a...)
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submitted by adisdiadochokinetic(0)

Can anyone explain why Fibrous scars with plasma cells is not the correct answer?


... katsu made a comment on nbme20/block3/q#8 (A 12-year-old girl is brought to the physician for a...)
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submitted by katsu(0)

Atrophy in myocytes. Atrophy is due to cytoskeleton degradation via ubiquitin-proteasome pathway.

Polyubiquitination: The binding of many ubiquitin molecules to the same target protein. Polyubiquitination of proteins is the triggering signal that leads to degradation of the protein in the proteasome. It is polyubiquitination that constitutes the "kiss of death" for the protein.


... katsu made a comment on nbme20/block3/q#40 (Two days after admission to the hospital because of...)
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submitted by katsu(0)

It's called patient consent, you've probably heard of it


... cafeaulait made a comment on nbme20/block2/q#7 (A 30-year-old man comes to the physician because of...)
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submitted by cafeaulait(0)

I believe this stem may be inferring MEN 1 syndrome - possible gastrinoma (peptic ulcer disease dx), parathyroid adenoma, and pituitary adenoma (causing SIADH). But, you don't need to even know this to get this right - just asking the effect of high PTH on the system - causes increased osteoclast activity as well as maturation.


... katsu made a comment on nbme20/block3/q#4 (An 18-year-old woman comes to the physician because...)
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submitted by katsu(0)

Patient has infectious mono. Atypical lymphocytes (reactive CD8+ T-cells) are seen on blood smear for infectious mono.


... sbryant6 made a comment on nbme22/block3/q#6 (A 50-year-old man is admitted to the hospital...)
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submitted by sbryant6(7)

If you know the MOA of digoxin you should be able to get this question right.


... stinkysulfaeggs made a comment on nbme23/block1/q#16 (Physical analysis of the isolated genomic DNA from a...)
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submitted by stinkysulfaeggs(3)

Me reading this question stem: .....do you mean which of the following ENZYMES?


... stinkysulfaeggs made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
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submitted by stinkysulfaeggs(3)

If the abnormality was something more life threatening, wouldn't the first action be to call the pediatrician? I was thinking, limb extremity might mean something else more serious was happening too --> need pediatrician right away to dx.


... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
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submitted by stinkysulfaeggs(3)

Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.


... adisdiadochokinetic made a comment on nbme22/block2/q#26 (A randomized controlled trial is conducted to assess...)
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submitted by adisdiadochokinetic(0)

Absolute risk reduction = (Risk in control) - (Risk in experimental). In this case, the risk in the control group is calculated by the number who had an infarction (194) divided by the total (194/2371). Likewise, for the experimental group, (194/2365). This is answer choice B.


... adisdiadochokinetic made a comment on nbme22/block2/q#48 (Clostridium perfringens-α toxin affects cells and...)
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submitted by adisdiadochokinetic(0)

The clostridium perfringens alpha toxin is a lecithinase which cleaves lecithin to phosphorylcholine and diglyceride. Essentially, alpha toxin mimics phospholipase C. This means it has a vaguely similar effect of the phospholipases seen in Bacillus Cereus and Listeria Monocytogenes. The end result of the toxin activation is activation of second messenger systems through diglyceride (AKA diacylglycerol), which activates several pathways, most notably in this case Arachidonic acid metabolism and IL-8, with the net effect of increased vascular permeability leading to edema.


... adisdiadochokinetic made a comment on nbme22/block2/q#18 (A 32-year-old man comes to the physician because of...)
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submitted by adisdiadochokinetic(0)

This question is so annoying but this explanation is supported by several papers.


... yb_26 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
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submitted by yb_26(8)

Wilson disease => Fanconi syndrome => metabolic acidosis (type II (proximal) RTA)


... stinkysulfaeggs made a comment on nbme23/block2/q#38 (A 78-year-old man is found unresponsive in his yard...)
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submitted by stinkysulfaeggs(3)

Key words: "at this time" and "can be helpful"

The answer to this question isn't: great - now we're going to take him off the vent because you told us that's what he wanted.


... yb_26 made a comment on nbme23/block4/q#16 (In a study of the use of ultrasonography for the...)
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submitted by yb_26(8)

abnormal test result means that test detects cancer =>

here is my 4/4 table: [https://www.reddit.com/r/usmlestep1/comments/ccul3w/biostat_question_from_nbme23/]


... nwinkelmann made a comment on free120/block3/q#21 (A 6-day-old breast-fed boy is brought to the...)
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submitted by nwinkelmann(25)

If you didn't understand the tests in the stem, this should help:

Urine reducing substance test: https://study.com/academy/lesson/reducing-vs-non-reducing-sugars-definition-comparison.html

Glucose oxidase test: catalyzes the oxidation of glucose to hydrogen and D-glucono-delta-lactone. If there is no glucose present (i.e. with galactosemia), the test will be negative because there is nothing for the test to catalyze.


... nwinkelmann made a comment on free120/block1/q#23 (A 4-year-old boy from Brazil is brought to the...)
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submitted by nwinkelmann(25)

In case anyone is curious about the other terms: I think apoptosis and necroptosis are fairly recognizable, but I had no clue what symptosis, ostosis, and oncosis were. Symptosis = ischemic cell death. Ostosis = bone formation (duh! why didn't I remember that, lol). Oncosis = emaciation.


... henoch280 made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
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submitted by henoch280(1)

@temmy. This question tests our knowledge on albinism which is normally a tyrosinase deficiency disease but the vignette states that the boy's albinism is caused by a genetic mutation in the TYRP1 gene which is shown in the biochemical pathway. A gene that helps in the synthesis of Eumelanin.

Now you have to understand that all precursors before that gene is the pathway would still be available if not increased which make 2 of the options in the question wrong.

you also have to understand this: (Eu)melanin = (normo)melanin i.e normal melanin which is protective to the skin, decreases reactive oxygen species and gives the dark pigments to the iris, choroid, skin, hair e.t.c. while (feo)melanin = (fake)melanin i.e pheomelanin, the one present in our patient here which is less protective again the uv rays, cannot pigment and cannot decrease ROS generated in the skin. i hope this helps


... zbird made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
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submitted by zbird(1)

@lsmarshall Thanks for sharing BCa met via venous routes spreading through the batson plexus which is a network of veins receiving from azygos vein. The azygos receiving from intercostal veins that drains the breast. Which makes intercostal right


... mario made a comment on nbme13/block4/q#7 (Mouse melanoma, B-16, highly metastatic)
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submitted by mario(0)

this cells should be stem cell transplant, so homing is the environment that accept them and nourish them with growth factors to mature


... nwinkelmann made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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submitted by nwinkelmann(25)

So actually.... Medscape says that PSGN can progressive to a proliferative glomerulonephritis mechanism and so proliferative glomerulonephritis should be considered as a differential diagnosis for PSGN.

https://emedicine.medscape.com/article/980685-overview#a5: "The presence of acute kidney injury may suggest an alternate diagnosis (eg, membranoproliferative glomerulonephritis [MPGN], Henoch-Schönlein purpura [HSP], systemic lupus erythematosus [SLE]) or a severe or worsening APSGN, such as observed in those with crescentic glomerulonephritis or rapidly progressive glomerulonephritis... Differential Diagnosis: This includes most other types of childhood glomerulonephritides. These include IgA nephropathy, membranoproliferative glomerulonephritis, hereditary nephritis, and other forms of postinfectious glomerulonephritis."

Ironically enough, this must be what they were asking, i.e. complications of PSGN, because AMBOSS (another Step resource) directly linked the above article I found before looking farther and coming across the AMBOSS section.


... nwinkelmann made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
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submitted by nwinkelmann(25)

So... I didn't know what it was so I looked it up... and legit, granum is part of plants.......... really?! lol


... nwinkelmann made a comment on nbme24/block3/q#33 (A 12-year-old boy is brought to the physician by his...)
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submitted by nwinkelmann(25)

Does anyone have a good explanation for why decreased levels of inhibin is wrong? From my understanding, inhibin and activin work together, in that inhibin binds and blocks activin leading to decreased feedback on hypothalamus and activin increases FSH and GnRH production.. thus, if you decrease inhibin then you would have increased activin which would lead to increased GnRH and FSH, right? I found one article talking about it in regards to puberty, but it seems to be a hypothesis/not confirmed at this point... is that why? But still... how do I rule it out on a test?


... nwinkelmann made a comment on nbme24/block3/q#28 (A 22-year-old man is brought to the emergency...)
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submitted by nwinkelmann(25)

Dysmetria = discoordination of planned, voluntary movements (my own words for the different findings and used specifically to help me remember location) controlled by the posterior lobe of the hemisphere which does planned voluntary movement. Also, the hemisphere is the periphery of the cerebellum, and it deals with planned, voluntary movements of the periphery (i.e. limbs). I got this from this image with memory tips: https://www.medicowesome.com/2013/04/cerebellum-mnemonics.html.

Other helpful links:

  1. Pretty detailed anatomy: http://www.fmritools.com/kdb/_Media/image002-3_med_hr.png

  2. Interactive site all about the cerebellum (https://nba.uth.tmc.edu/neuroscience/m/s3/chapter05.html), but the most helpful picture for me was this one (https://nba.uth.tmc.edu/neuroscience/m/s3/images/copyright_marked_images/5-3_NEW.jpg)


... nwinkelmann made a comment on nbme24/block4/q#18 (A 64-year-old man undergoes surgical repair of an...)
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submitted by nwinkelmann(25)

This is pretty great too: https://teachmeanatomy.info/pelvis/the-male-reproductive-system/testes-epididymis/


... nwinkelmann made a comment on nbme24/block4/q#24 (A 13-year-old girl who has a 6-year history of type...)
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submitted by nwinkelmann(25)

I just thought of a way to (hopefully) avoid getting these types of answers wrong. First, when I read them I always look for the least "asshole" answer. Then, if you're still stuck, try to put the statement into a quote that you would say to a patient as a physician, remembering that open-ended, non-judgmental questions are ideal.

The answer for this could be phrased as a question/statement by the doctor, to the family, as "Tell me more about how this impacting your family and daily life." Had it been phrased like that, I DEFINITELY wouldn't have gotten it wrong. I would have never even had the opportunity to make an assumption about the family's fighting being due to diet concerns and thus needing a nutritionist referal (which is what I chose).


... nwinkelmann made a comment on nbme24/block4/q#41 (A 30-year-old man who is a migrant farm worker comes...)
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submitted by nwinkelmann(25)

Does anyone know how to rule out E? I've never learned about microorganisms specifically activating a cell's CAMs, but when I looked it up, I found this article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC395703/). The article doesn't specifically mention plasmodium as using it, but several of the resources for the article does.


... nwinkelmann made a comment on nbme24/block4/q#41 (A 30-year-old man who is a migrant farm worker comes...)
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submitted by nwinkelmann(25)

Found this great document with slides about the different pathogens: http://ncasmbranch.org/meetings/2019SprPpts/2019-03_Spring_Garcia.pdf


... impostersyndromel1000 made a comment on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
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submitted by impostersyndromel1000(1)

so its reassurance bc some boys can have mild breast development at 13? I've never heard or seen this before can someone please clarify. Basically reassuring that this is (relatively) normal?


... sugaplum made a comment on nbme23/block2/q#45 (A 61-year-old man is prescribed fluoxetine for major...)
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submitted by sugaplum(9)

This is ridiculous but I could never keep these straight so meet my family:
Achey grandpa Meynert
Dope cousin VT with a side Ho* (who's names are just initials) SNc
Uncle and aunt Raphe and sara Cousin Gabby always screaming Na-Na-Na
norepi reminds me of the color blue, so locus ceruleus


... temmy made a comment on nbme21/block1/q#8 (A 52-year-old woman is admitted to the hospital...)
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submitted by temmy(8)

I agree with what has been said but also note that the patient called her internist to help her address the conflict between the two physicians which has gotten her worried. That is her desire. And from what i have gathered, where possible, the patients wishes should be met.


... redvelvet made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
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submitted by redvelvet(1)

If you want to take a look for the clinical importance of the hexosamine pathway & products: https://www.sciencedirect.com/topics/neuroscience/hexosamines


... impostersyndromel1000 made a comment on nbme22/block1/q#39 (A 23-year-old woman develops multiple red,...)
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submitted by impostersyndromel1000(1)

would anyone be able to clarify what the others would be? A) Allergen mediated vasoconstriction, leading to ischemic tissue injury: Type I B) Binding of antigen to IgE on the surface of mast cells leading to mast cell degranulation: Type I C) deposition of antigen-antibody complexes within postcapillary venules, leading to activation of complement: Not sure D) Phagocytosis of antigen by neutrophils, leading to oxidant mediated tissue damage: Type III?


... zbird made a comment on nbme24/block4/q#3 (A 23-year-old woman is brought to the emergency...)
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submitted by zbird(1)

This patient has Distal-Type I RTA which is explained by Normal Serum Anion gap (8) Metabolic acidosis with her positive urinary anion gap(+5).


... charcot_bouchard made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
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submitted by charcot_bouchard(12)

pKa is pH at which any drug is at its 50% ionized state.

Now we are alk urine i.e inc pH. when pH>pKa it will have two diff path for acidic drug & basic drug.

Acidic drug will inc its elimination (inc ionized form), basic drug will be more absorbed. so we need to know the drug is basic /acidic.

Now if u alk urine its elimination inc. so it have to be acidic. or u can know its a sodi salt of drug with CNS property i.e most like Phenobarbital (Weak acid)

so if pKa of drug is 6---at pH 7 we will start eliminating

but if pKa is 0 we need to raise pH of urine at 11 to start eliminating.at that point prev drug (pKa=6) would be totally out of system.

thats why A is the right ans (pKa = 6)


... dbg made a comment on nbme24/block4/q#40 (A 25-year-old woman is brought to the emergency...)
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submitted by dbg(1)

Did anyone else wonder WHAT "PULMONARY SYMPTOMS" is the question referring to?? There is literally not a single symptom mentioned in the whole vignette. No "crackles heard over both lung fields" are not symptoms. They are signs found by the physician.

Seriously doubting the whole NBME board test writers right now. Do they adequately revise their work? This is not the first technical mistake I realize on the new forms.


... dbg made a comment on nbme24/block2/q#23 (A 9-year-old boy who was adopted from an African...)
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submitted by dbg(1)

WTF is "weakness of plantar dorsiflexion" ????? it's like saying "extension flexion" This is not the only obvious technical mistake in the new NBMEs ...


... dbg made a comment on nbme24/block2/q#40 (A 4-year-old boy has a 1-cm round midline mass just...)
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submitted by dbg(1)

Am I the only one who thought, my whole life, that it actually originates from the thyroid but just physically connected to the tongue


... davidw made a comment on nbme24/block3/q#33 (A 12-year-old boy is brought to the physician by his...)
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submitted by davidw(3)

Is this found in other resources other then Pub med articles?


... enbeemee made a comment on nbme22/block3/q#45 (A 28-year-old man who is seropositive for HIV has...)
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submitted by enbeemee(0)

sketchy says that kaposi's has infiltrating lymphocytes, so why would large aggregates of atypical lymphocytes be incorrect?


... et-tu-bromocriptine made a comment on nbme23/block2/q#30 (A 21-year-old man is brought to the emergency...)
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submitted by et-tu-bromocriptine(1)

Anyone know how to rule out small intestine on this one? I thought the omentum played a role in healing in the abdomen, but clearly I'm missing something here.


... sugaplum made a comment on nbme23/block3/q#41 (A previously healthy 45-year-old man comes to the...)
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submitted by sugaplum(9)

always remember them in order with formula, SITS=AEEI
and the two on the END are AD-DUCTION


... soph made a comment on nbme23/block2/q#1 (A 26-year-old woman comes to the physician because...)
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submitted by soph(2)

Toto the dog (tinea can be spread through animals) was with the Three little munchkins, the Tinea tin man and with the wizard wearing turbin in the dermaophyte forest :)


... coolcatac made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
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submitted by coolcatac(4)

Plus, all the other options are not associated with B2 agonist, so just by process of elimination, tremor is the only one left


... coolcatac made a comment on nbme24/block2/q#43 (A 35-year-old woman has difficulty urinating 2 days...)
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submitted by coolcatac(4)

They are asking, in a complicated way, the mode of action of Bethanechol. All the other options are not muscarinic receptors except parasympathetic stimulation.


... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
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submitted by soph(2)

you need to know diff bt negative pressure ventilation (which is normal ventilation) and positive presssure ventilation (which is mechanical ventilation). In negative pressrue ventilation the diaphragm contracts making a - intrapleural pressure which allows alveoli to expand. in positive ventilation (the pt diaphragm is not contracting thus not expanding chest cavitiy and not creating the - pressure) the machine is creating positive pressure inside alveoli so so alveoli expands. :)


... soph made a comment on nbme23/block2/q#4 (An 18-year-old woman comes to the physician because...)
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submitted by soph(2)

pt with progressive muscle weakness--> resp muscles not working --> decrease oxygen consumption. no oxygen= no aerobic metabolism --> increase venous lactate, also you keep doing anaerobic glycolysis since you cant go to TCA --> increase energy production via glycolysis :)


... coolcatac made a comment on nbme24/block2/q#34 (A 40-year-old man who goes horseback riding 3 to 4...)
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submitted by coolcatac(4)

https://www.medicalnewstoday.com/articles/320718.php

"Myositis ossificans usually occurs where a person has experienced a single traumatic injury, such as sustaining a hit while playing football or soccer that causes a deep muscle bruise.

It can also happen when there is a repetitive injury to the same area, such as in the thighs of horseback riders. Very rarely, myositis ossificans can occur after a severe muscle strain."


... temmy made a comment on nbme21/block1/q#1 (A 24-year-old woman with sickle cell disease comes...)
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submitted by temmy(8)

Healthy people who get sick with parvovirus may have a subclinical illness with athralgias as the only symptom. But sickle cell patients and patients with decreases hematopoiesis will develop[ bone marrow failure because the virus affect the hematopoietic stem cells leading to aplastic crises and inability for the bone marrow to adequately compensate hence the low reticulocyte count. parvovirus causes..slapped cheeks in kids hydrops fetalis in fetus, aplastic crises in sickle cell and arthralgias in other patients.


... temmy made a comment on nbme21/block1/q#10 (A 34-year-old woman is brought to the emergency...)
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submitted by temmy(8)

please help according to winters equation the patient has a normal anion gap


... temmy made a comment on nbme21/block2/q#27 (A 47-year-old woman with psoriasis comes to the...)
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submitted by temmy(8)

And never pick an option that makes you sound critical


... temmy made a comment on nbme21/block2/q#27 (A 47-year-old woman with psoriasis comes to the...)
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submitted by temmy(8)

when in doubt, pick an open ended question. They give the patient an opportunity to express themselves with prompting from the doctor


... temmy made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
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submitted by temmy(8)

Almost failed this question but i kept hearing Dr Sattar screaming prostaglandin E2 FEEEEEEEVER


... cbrodo made a comment on nbme18/block1/q#10 (25 yo woman, polycystic kidneys)
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submitted by cbrodo(9)

Renal damage from PKD can ultimately cause chronic renal insufficiency. This impairs the ability of the kidney to excrete phosphorus and reabsorb HCO3. Elevated phosphate levels in the blood triggers release of FGF-23 from bone, which lowers vitamin D production and decreases calcium absorption in the intestine. The resulting hypocalcemia and hyperphosphatemia will lead to an increase in the secretion of PTH.


... sherry made a comment on nbme24/block4/q#3 (A 23-year-old woman is brought to the emergency...)
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submitted by sherry(2)

Diarrhea in HARDASS can lead to metabolic acidosis as well. On second thought I decided to take crohn disease cuz I figured the clinical picture is more intermittent with potassium disturbances. I guess I just overthink due to the lack of other physical abnormalities.


... charcot_bouchard made a comment on nbme20/block1/q#6 (A 16-year-old student has uncontrollable sleepiness,...)
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submitted by charcot_bouchard(12)

Narcolepsy has one of the following 3 chraracter - 1. Cataplexy 2. dec orexin in csf 3. REM latency <15 min

its ass with (not dx criteria( Hypnagogin/pompic hallcination. Sleep paralysis