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Comment of the Week

After the cuff is tied, the cells and tissue distal to the cuff will continue consuming ATP (ATP->ADP), but no fresh blood will be delivered to “clear” what will be an accumulating amount of ADP and other metabolites. ADP (=Adenosine) is itself a proxy of consumption and drives vasodilation of arteries! (Evolution is smart!) Increasing ADP/Adenosine in a “local environment” is a signal to the body that a lot of consumption is occurring there; thus, arteries and arterioles naturally dilate to increase blood flow rates and “sweep away” metabolic byproducts.


          —drdoom, nbme24/Block 3/Question#2

Lol of the Week

Which of the following reasons is why this question is bull?

1) Using the word "cyclic" instead of tricyclic for clarity

2) Knowing all of epidemiology of all drugs

3) having to reason out that anticholinergic effects are probably the worst over alpha1 or H1 effects to no certainty.

4) The crippling depression of studying for days-to-weeks on end to probably do average on the test.


          —seagull, nbme22/Block 2/Question#36

Help your fellow humans! (see more)

diabetes asks:
can somebody explain how energy production by glycolysis increased, since aerobic glycolysis produce 32 net ATP,compare to 2 net ATP through anaerobic glycolysis ? help answer!
diabetes  i think the stem should be "energy production by an anaerobic glycolysis "
medninja asks:
This question sounded like botulism, anybody knows why is tetanus? help answer!
hello36654 asks:
so why is "cessation of fast axonal transport" wrong? Don't myelinated axons, by definition, have fast conductance? So demyelinated axons would have "cessation of fast axonal transport", which is the answer A, right? help answer!
diabetes  i think it slows down ,no cessation .
hello36654 asks:
I understand why it's lung now, but I picked thyroid gland because often times thyroid tumors press on the parathyroid sitting above, which causes the parathyroids to secrete more Ca...can someone comment if they've read this too? help answer!
paulkarr  I personally have not read that, but I wouldn't be surprised by that fact. I think with these NBME problems though, if you can get the answer within one "step" that should be your choice. Here you can just go Squamous Cell Carcinoma with a direct action on serum calcium levels (via PTHrP). Thyroid requires a few more steps, (assuming your statement is true) so in the eyes of NBME, it ain't gonna be the right choice. Always follow the "KISS" logic!
yobo13 asks:
Can someone explain why it can't be Crohn's since that would also cause a non AGMA? help answer!
elf16 asks:
How is this different from the question on NBME 21 in which a 68-year old man also had psychogenic ED? But the answer was normal libido and nocturnal erections. help answer!
cat5280 asks:
Could someone please explain why you were able to eliminate the spinocerebellar tracts? help answer!
ergogenic22  Spinocerebellar is only responsible for Proprioception (unconscious). This patient also has reduced vibration sensation, which the dorsal column tracts are responsible for.
krewfoo99 asks:
Why would decreased movement through the cerebreal aquaduct be wrong? With all the build of blood in the CSF tract without absorption, wouldnt movement also be decreased through the aqueduct? help answer!
defalty98 asks:
Why are we complicating things? Change in the bases will destroy the palindromic sequence required for any restriction endonuclease to work. Methylation is the only option that makes sense. help answer!
jigyasa asks:
Why have you taken 180 as patient years? Isn't patient years calculated as no of patients multiplied by the number of years they suffer? help answer!
titanesxvi asks:
why not decrease CA activity in the proximal tubule? this also could lead to metabolic acidosis. help answer!
ergogenic22  carbonic anhydrase inhibitors can cause Type 2 RTA but it is not the cause here (cystinosis)
krewfoo99 asks:
Why would perforins be the wrong answer? Wouldnt accumulation of toxic proteins cause the cell to undergo apoptosis ? help answer!
ergogenic22  Bortezomib does not directly activate perforin. It directly inhibits the proteasome which → enables CD8+ T cells to initiate apoptosis → via perforin release (in essence a downstream effect).
krewfoo99 asks:
In what situations will HbH be formed (3 alpha chain deletions)? help answer!
ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH
krewfoo99 asks:
Can someone explain what the picture is supposed to show? Is it supposed to be segmented neutrophils? help answer!
titanesxvi  yes do to B12 deficiency
krewfoo99 asks:
Wouldnt the HCOM murmur be best heard in the aortic area? help answer!
krewfoo99  Correction: Shouldnt it be heard best in the left upper sternal border?
krewfoo99 asks:
Anyone know why heart sounds would be distant in COPD exacerbation? help answer!
yng  Patient is usually obese (blue bloater) --> diaphragm movement is limited --> can't take deep breaths, and in extreme cases, the chest size increased and causing distant heart sound.
krewfoo99 asks:
Anyone know why heart sounds would be distant in COPD exacerbation? help answer!
marat  Cause lungs are overextended
marat  overexpanded
krewfoo99 asks:
In boards and beyond, It is said that third degree heart block is due to block in the HIS Purkinjee system. So why would ablation of AV node cause this disease? Wouldnt destruction of part of left ventricle be a better answer ? help answer!
amirmullick3 asks:
Is this Guillain barre though? I felt it was Acute inflammatory demyelinating polyradiculopathy, discussed on page 512 FA 2019. There is no relation to C jejuni here nor does the patient have any other relations to infection such as eating something or etc. help answer!
niboonsh asks:
external carotid branch supplies the superior parathyroid glands as well........? help answer!
yng  Yes the superior part supplied by superior thyroid gland which is a branch of external carotid branch.
divya asks:
Can anyone discuss what's responsible for inhibiting the processes given as other options? help answer!
divya asks:
Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same? help answer!
sunshinesweetheart asks:
out of curiosity, why are AST and ALT high? is that saying the NRTI used was diadenosine which led to pancreatitis also? help answer!
krewfoo99  AST and ALT will not be elevated in pancreatitis, they will only be increased during liver damage. NRTI causes hepatoxicity (although FA 2018 states NNRTI causes hepatotoxicity, NRTI could also be an option considering the two classes are similar. The hepatoxicity will cause an increase in ALT and AST
paloma asks:
What about pulmonary vascular resistance? It follows the systemic vascular resistance? help answer!
cooldudeboy1  crackles are heard bilaterally so there is pulm patho which leads to increased pulm vascular resistance, since systemic blood flows into the lungs. any block in the flow ahead (lungs) will increase resistance in flow behind ( systemic )

Recent tangents

i thought in this way - all prostaglandins in this world help liquids to go ( eye aqua , afferent arteriole, etc) angina is due to ischemia , so something has to do with obstruction of fluids in this case blood , i exclude leukotrienes cause they has nothing to do with ischemia , and since its not leukotrienes only answer is TXA2

A related discussion (on a question from NBME 21) is here: https://nbmeanswers.com/exam/nbme21/714

Recent comments (see more)

... diabetes made a comment on nbme23/block2/q#4 (An 18-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by diabetes(3)

can somebody explain how energy production by glycolysis increased, since aerobic glycolysis produce 32 net ATP,compare to 2 net ATP through anaerobic glycolysis ?

diabetes  i think the stem should be "energy production by an anaerobic glycolysis "
... resolutestorm made a comment on familymed1/block0/q#27 (A 62-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by resolutestorm(0)

The person is presenting with symptoms of CHF (dyspnea on exertion, pitting edema) as well as b/l basilar crackles all of which indicate a fluid overloaded state. In addition, there is cardiac dysfunction with improper pumping of the blood. Due to decreased cardiac output, the body perceives this as a "hypovolemic" state and causes the release of hormones like ADH and Renin in an effort to reabsorb water to bring the volume up. While the patient is having extracellular fluid accumulation (edema) the arterial blood volume is low which is what causes the "hypovolemic" state.

... resolutestorm made a comment on familymed1/block0/q#17 (A 56-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by resolutestorm(0)

rash seems to be that of shingles. Age range also matches up. Antiviral is the best option

... resolutestorm made a comment on familymed1/block0/q#5 (A 62-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by resolutestorm(0)

I believe that metformin is contraindicated due to Patients with renal disease having a higher chance of lactic acidosis. This patient has increased BUN and Cr indicating renal disease

... lovely made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
 +0  upvote downvote
submitted by lovely(0)

It appears that both the genitofemoral nerve (genital branch) and the ilioinguinal nerve both are external to the spermatic cord and at the superficial inquinal canal. Depending on location of the genitofermal nerve makes a difference for what it innervates. It appears that the genitofemoral nerve (genital branch) innervates the lateral anterior surface of the srotum, while the ilioinguinal nerve innervates the anterior surface of the scrotum.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503924/

Google also says that the genital branch of the genitofemoral nerve can innervate the sensation of the skin of the anterior surface of the scrotum. Does it appears that either nerve choice would lead you to the correct answer?

... lovely made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
 +0  upvote downvote
submitted by lovely(0)

Sources of nitrogen can be meat, eggs, and dairy product which he wasn't eating. The man had a low nitrogen intake but was still excreting nitrogen. Therefore, he had a negative nitrogen balance. A prolonged negative nitrogen balance may lead to a decrease in the plasma protein level, edema, anemia, lowered resistance to infection, increased susceptibility to certain toxic substances, the development of fatty liver or perhaps other serious sequel

... divya made a comment on nbme20/block3/q#10 (A 59-year-old man develops fatigue and decreased...)
 +0  upvote downvote
submitted by divya(1)

FA 2019 Pg 415

Prosthetic heart valves and aortic stenosis may cause hemolytic anemia secondary to mechanical destruction of RBCs.

... paulkarr made a comment on nbme23/block2/q#24 (A 46-year-old woman has a 1-day history of...)
 +0  upvote downvote
submitted by paulkarr(1)

Chronic Myelogenous Leukemia vs Leukemoid Reaction has a few differentiating features:

  • Basophilia can be seen in Myeloproliferative diseases such as CML. However, they are not seen in Leukemoid Reactions.

  • Leukocyte Alkaline Phosphatase (LAP) is often elevated in Leukemoid Reactions. But it will be decreased in CML because Abnormal cells don't make the normal enzyme.

  • Dohle Bodies are characteristic of Leukemoid Reactions. Not seen in CML.

As vshummy pointed out FA-2019 pg 424 has all this information as well as UWorld problem...I just can't seem to find the Q.ID. Maybe someone else can tag-team in.