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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)

enbeemee asks:
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? help answer!
whoissaad asks:
Where is this even from? My mind's going hay wire trying to understand this. help answer!
imnotarobotbut asks:
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? help answer!
snafull asks:
Can somebody explain why this is not a foreign body granuloma? help answer!
youssefa asks:
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" help answer!
cienfuegos asks:
Couldn't you also decrease the FIO2? Per FA, CPP also increases to hypoxia also decreases CPP when PO2 < 50 mmHg. help answer!
enbeemee asks:
what are the other labeled structures? i can discern the parietal and chief cells, but not the others... help answer!
zpatel asks:
Can anyone tell the effect of aspirin on a blood lab value (i.e PT,PTT,Fibrin product)? help answer!
ergogenic22 asks:
why is protection of the choroid plexus, from intraventricular rupture secondary to germinal matrix hemorrhage not a possible answer? help answer!
ergogenic22 asks:
why is hyperlipidemia secondary to cushing syndrome not a possibility? help answer!
adisdiadochokinetic asks:
Can anyone explain why Fibrous scars with plasma cells is not the correct answer? help answer!
stinkysulfaeggs asks:
Me reading this question stem: .....do you mean which of the following ENZYMES? help answer!
stinkysulfaeggs asks:
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. help answer!
stinkysulfaeggs asks:
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. help answer!
impostersyndromel1000 asks:
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? help answer!
dbg asks:
WTF is "weakness of plantar dorsiflexion" ????? it's like saying "extension flexion" This is not the only obvious technical mistake in the new NBMEs ... help answer!
davidw asks:
Is this found in other resources other then Pub med articles? help answer!
enbeemee asks:
sketchy says that kaposi's has infiltrating lymphocytes, so why would large aggregates of atypical lymphocytes be incorrect? help answer!
et-tu-bromocriptine asks:
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. help answer!
enbeemee asks:
would an acetylcholinesterase inhibitor work as well to relieve the symptoms? but just because he's 73yo, we're supposed to assume it's due to BPH and give an a1 inhibitor? help answer!
mguan1993 asks:
For completeness sake, could someone explain the other wrong answer choices in graph form? I can easily visualize the right answer but for some reason can't picture the other choices help answer!
mguan1993 asks:
Does being recently diagnosed vs having CKD for a while change this answer? the "recently diagnosed" part threw me off help answer!
nwinkelmann asks:
Another way to look at: this question is essentially asking what is the MCC side effect of chemotherapeutic agents in general? Answer = bone marrow suppression thus affects granulocytes. help answer!
alexb asks:
It seems like a lot of the systemic autoimmune diseases are multifactorial. Is there a general rule for this? help answer!

Recent comments (see more)

... ergogenic22 made a comment on nbme21/block1/q#10 (A 34-year-old woman is brought to the emergency...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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")

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X
... kard made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
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...)
 +0  upvote downvote
submitted by whoissaad(0)

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...)
 +0  upvote downvote
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)
 +0  upvote downvote
submitted by nwinkelmann(25)

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