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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)

inmyblood asks:
What is the letter Y indicating in the picture? is it the large intestine? help answer!
sunny asks:
why is this so //i know its basic but still...?? help answer!
ssc505684708 asks:
What happened to this "previously healthy" young female? Why is she vomiting blood? Drinking too much alcohol? help answer!
amphotericin asks:
I put constipation because I thought the medication being described might be CCB: can someone explain why nitrates over CCB? help answer!
amphotericin asks:
how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing help answer!
jean_young2019 asks:
Could someone explain why this choice is the best answer? I struggled between A and D, and picked A finally, which is "ascertain educational level and provide publications". help answer!
hhsuperhigh asks:
The diet is prescribed, so no need to refer to dietician anymore. It is a case of the patient non-compliance of diet. But why can't advise the parents to stop bickering? help answer!
niboonsh asks:
is no one else concerned about the fact that theyre giving a beta 2 agonist to a woman whos 28 weeks pregnant.......? help answer!
lilyo asks:
I had the same question regarding this. I know that external hemorrhoids rarely bleed and internal hemorrhoids present as painless bleeding so in my mind I knew I was being asked about internal hemorrhoids. However, superior rectal--> inferior mesenteric vein--> portal vein, can anyone tell me why the answer was superior rectal and not inferior mesenteric? help answer!
humble_station asks:
The question is asking if you did an immunohistochemical labeling of the neoplasm what are you going to target with the use of antibodies. Basically you want the antibodies you have labeled binding to what? Since this is ZES -- a gastrin secreting tumor -- you want antibodies to gastrin to see where exactly this tumor is coming from help answer!
amphotericin asks:
How does OSA lead to peripheral edema and loud S2? help answer!
futuredoc  Hypoxia leads to pulmonary vasoconstriction and therefore pulmonary HTN. This can lead to the peripheral edema. Furthermore pulmonary HTN can present with a loud S2.
happysingh asks:
i kinda of feel "odd" asking this question : but the patient had an MI 6 months ago, so why would it be unlikely that he was told to "restrict salt, restrict fluids (water) " ?? Guess what i'm asking is : what makes choice E such an unlikely choice (JVD, bi-basilar crackles, peripheral edema) ? & @meningitis : his bp is 135/82 mmHg ... why is that "HIGH" ?? help answer!
hhsuperhigh asks:
This is how my brain farted while I was doing this question.... I wanted to choose TBG deficiency, but I kept thinking that if TBG is deficient, that means there are less or no binding proteins in the blood. And how can the free T4 be normal? Shouldn't free T4 increase if there were less T4 binding protein? ... help answer!
cathartic_medstu asks:
Labetalol = "alpha"-"beta"-lol From Sketchy Andrew Yang for president. is it 50 characters yet? help answer!
hello asks:
Why are "rotator cuff tear" and "rotator cuff tendnitis" wrong? is it bc both of these would show impingement sign? is there a way to DDx one from the other? help answer!
hello asks:
why is plasma oncotic pressure wrong? help answer!
hello asks:
which letter is CN IX in this diagram? help answer!
hello asks:
can someone please explain this? help answer!
thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC).
hello asks:
What's the echymoses supposed to be a clue about? Does this patient have DIC? Does DIC always cause hypovolemic shock? help answer!
drdoom  Disseminated intravascular coagulation (DIC) is a syndromic definition. (See tangent.) It does not “always” lead to shock but shock is definitely a possible sequela (since, by definition, DIC = “systemic thrombotic process”; anything systemic should get you a little worried), and so a patient with DIC should be monitored closely!
cathartic_medstu asks:
Can someone correct my reasoning here: I was thinking positive airway pressure will increase alveolar ventilation and decrease hypoxia induced pulmonary vasoconstriction. Thus, RV after load would decrease => more preload to LV and more cardiac output. Then wouldn't BP decrease? Any help is appreciated. Thanks. help answer!
dai89 asks:
isn't candida yeast form under body temperature? why the picture shows a mold form? help answer!
drmomo asks:
why can't it be culex mosquito? maybe wuchereria bancrofti filariasis? help answer!
anu asks:
why is option D ) there is an increased likelihood of statistically significant findings... wrong ? help answer!
anu asks:
what about the increase in pulmonary vascular resistance ? doesnt PCWP fall in hemorraghic shock help answer!

Recent comments (see more)

... inmyblood made a comment on nbme22/block2/q#46 (A 62-year-old man is being evaluated for rectal...)
 +0  upvote downvote
submitted by inmyblood(0)

What is the letter Y indicating in the picture? is it the large intestine?

... burningmoon made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +0  upvote downvote
submitted by burningmoon(0)

Water(1) 1Kg water=1L water 450mOsm/kg water=450mOsm/L water Min H2O needed to dissolve 450 solute by kidney is 1L water Water(2) Other (feces et al.)=1L Total: water(1)+ water(2)=2L

... eli_medina9 made a comment on nbme23/block3/q#36 (A 70-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by eli_medina9(0)

Maybe they went with serum sickness (a type III hypersensitivity rxn) on this question based on the serology used to diagnose RA. Pts with RA have antibodies to immunoglobulin G (IgG), called rheumatoid factors (RFs). It makes some sense that upon these rheumatoid factors reacting with "self" circulating IgG, immune complexes would form that would later deposit in tissues (explaining in part the extraarticular manifestations seen with RA, ex. rheumatoid nodules, pleuritis, pericarditis etc..)


... felxordigitorum made a comment on nbme24/block1/q#15 (Results of a 5-year screening program for HIV...)
 +0  upvote downvote
submitted by felxordigitorum(1)

Exclude the intake year. Add all the positive results (400+250+300+300+250 = 1500). Divide 1500 by the total number of patients from the start of the incidence period, year 1, so 6000 ---> 1500/6000=0.25, this is the average across all 5 years. For annual, divide 0.25 by the number of years, 5 --> 0.25/5 = 0.05 --> 5%.

That's how I got it.

... sunny made a comment on nbme18/block2/q#18 (Researcher testing new cancer drug)
 +0  upvote downvote
submitted by sunny(0)

why is this so //i know its basic but still...??

... emh made a comment on nbme23/block4/q#35 (A 17-year-old girl with type 1 diabetes mellitus...)
 +0  upvote downvote
submitted by emh(0)

You need to acknowledge and discuss the reason for missing. Some people - young women mostly, intentionally restrict insulin therapy to lose weight. It's called diabulimia. They manage their glucose levels right before the blood draw so that their glucose is normal on the labs, but the HA1c doesn't lie.

... tamey made a comment on nbme23/block2/q#41 (A 44-year-old woman, gravida 2, para 2, comes to the...)
 +0  upvote downvote
submitted by tamey(0)

i chose endometrium(simple columnar epithelium) as i thought by her age she is still menstruating and the Shedded endometrium is found in the cervical region, why not!!!!

... tamey made a comment on nbme23/block4/q#8 (A 36-year-old nulligravid woman and her 40-year-old...)
 +0  upvote downvote
submitted by tamey(0)

disease prevalence is 1/10000 which means q square=1/10000 thus q=1/100 and since they are asking about carrier frequency which is 2pq, p is always assumed 1 this will lead to 211/100=1/50

... emh made a comment on nbme23/block2/q#33 (A 68-year-old man who has been treated for the past...)
 +0  upvote downvote
submitted by emh(0)

Prostaglandins increase GI motility due to peristalsis. It's the same reason why the uterus contracts during menstruation.

... emh made a comment on nbme23/block2/q#28 (A cohort study is conducted to examine the...)
 +0  upvote downvote
submitted by emh(0)

Some of the cases of cancer in the smoking population will be due to a factor other than smoking. The question is asking about the cases that are due to smoking specifically.

... rob121 made a comment on nbme24/block3/q#27 (A 27-year-old man who works from home as a software...)
 +0  upvote downvote
submitted by rob121(0)

Actual medical school lecture was good for something - Avoidant: Charlie Brown Schizotypal: Luna Lovegood from Harry Potter SchizOID: aOID

Psych personality disorders easier when remembering a movie/TV show.

... kolivera made a comment on nbme21/block4/q#34 (A healthy 8-year-old boy is brought to the physician...)
 +0  upvote downvote
submitted by kolivera(0)

Biogenic amine NTs are: DA, NE, Epi, Histamine, & Serotonin