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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)

alexxxx30 asks:
did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha help answer!
drschmoctor asks:
How does one differentiate factitious disorder from being thirsty w poor impulse control? help answer!
jinzo asks:
I have ganglion cyst since 2012 and this shit doesn't disappears . Moreover , it may cause some pain , when I flex my wrist . So why answer is not parasthesia??? help answer!
donttrustmyanswers asks:
I just realized there were solid arrows and dashed arrows in the image. Is there a significant to the dashed arrows vs the solid arrows? help answer!
donttrustmyanswers asks:
What is the area labeled 'G' and 'C'? And more characters? help answer!
alexxxx30  lateral corticospinal i think
justherefortheyield asks:
Per multiple sources: measles can be vesicular and also can lead to giant cell pneumonia in the immunocompromised. ?!?!?!? help answer!
justherefortheyield asks:
Couldn't hypoalbuminemia lead to hypercholesterolemia? I recall sittar talking about this in the context of proteinuria but couldn't this still apply? help answer!
frustratedllama  I thought so too but did a little digging and turns out this happens in nephrotic syndrome bc low oncotic pressure directly stimulates apolipoprotein B synthesis. They still don't know why lol. But in burn victims there's actually increased lipid metabolism, so nothing to do with hypercholesterolemia.
dr_pepper asks:
Quick google search reveals that methylphenidate works by inhibiting dopamine and NE reuptake, Am I missing something here? How is this "release of biogenic neurotransmitters"? help answer!
ibestalkinyo asks:
Anyone find it strange that the NBME loves to write questions where physicians are alcoholics? help answer!
b1ackcoffee asks:
exactly how does maternal hashimoto can cause cretinism? help answer!
snoochi95 asks:
How come you couldnt say "I dont know, but the oncologist will be seeing you later today"? Is it because technically you are ~lying~ to the patient? help answer!
drdoom  Not “technically” but actually! To say “I don’t know” when you *do* know is as lyin’ as it gets! Just remember, before a state issues you a license to practice medicine in their backyard, they look to the National Board of Medical Examiners and ask, “Should we trust this person to practice medicine here?” The NBME is in the business of telling states, “Yes, we believe this person knows enough to practice morally and competently.” Answer ethics questions with this in mind.
pseudo_mona  Besides technically lying, it also probably isn't a good idea to drop the word "oncologist" to a patient before they hear they have cancer, especially as a student who can't answer any further questions about the biopsy results.
targetmle asks:
if the option had SMA and celiac trunk, would that be correct? help answer!
targetmle asks:
Shouldn't we first address the issue by correcting her glucose levels by readjusting insulin and then see what are the problems? help answer!
the_enigma28 asks:
Is there any drug which would cause enhancement of cell membrane permeability to chloride? It seems like the MOA of ETEC & V. cholerae adenylate cyclase toxins and somewhat that of Ivacaftor used in cystic fibrosis. help answer!
the_enigma28 asks:
Can anyone explain what does "lost her pep" means? help answer!
drdoom  `pep` actually comes from `pepper`; to `pepper` something (including a food dish!) is to make it more vigorous, to give it more kick, to vitalize it. so, to “lose one’s pep” is to lose one’s vitality, feel fatigued, feel lackluster, etc. https://www.etymonline.com/word/pep
hungrybox asks:
Fucking NBME test writers lmao Me: "Wait... isn't the answer 25.9? How come I don't see it here." NBME: "Oh yeah, we rounded it." Me: "To 30? I don't see that here, either..." NBME: "No, to 28.8" help answer!
tyrionwill  When I got 25.9 and found nothing exactly matched, I guessed that the maintenance dose might be a bit more due to the bioavailability. So this antibiotic probably was not an I.V. formula, but an oral one, with a roughly 90% BA.
haozhier asks:
I chose corticotrope because I thought during pregnancy women have more cortisol. Can anyone explain it for me? Thanks! help answer!
haozhier asks:
I chose C because I thought it has been four weeks so it must have been acute tubular necrosis. Can anyone explain? Thanks! help answer!
miriamp3  @haozhier if you are deciding to think that he had a ATN because of the 4 weeks.. then he should be by now in the recovery phase(polyuria, Bun/cr fall) But he is with HF and his urine output has progressively decrease. So AKI prerenal HF Bun/cr >20. the only one is D. Don't get confused with the rest of the information.
jesusisking  I thought the same thing so chose C as well!
thotcandy asks:
What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid? help answer!
baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead.
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15
thotcandy asks:
Everyone asking why not PPIs? if you give NSAIDs which decrease PGs so you get GERD, the simplest way to fix it is to bring those PGs back, so misoprostol. Just simply -PGs --> +PGs help answer!
hungrybox  This is the best explanation IMO Also makes me feel like an absolute idiot
vinniewolf17 asks:
Anyone going to mention that C. perfringens has been demonstrated to have a high association with gastritis and shellfish and that parahaemolyticus is a cause of necrotizing fasciitis? help answer!
tiredofstudying  FA 2020 Pg 178.
snoochi95 asks:
Does anyone know why this is not Chronic rejection? They both fit within the time frame. help answer!
hombremasorca asks:
Anyone find a problem with the stem? Seems to me that it doesn't help to state "however, his father's sister and children are unaffected". We already know the mutation runs in the mother's side, right? It seems like that statement doesn't discard nor confirm any inheritance pattern. Why would we care about the patient's father's side? help answer!
banana asks:
I thought (incorrectly, obviously) that histone kinase also allowed transcription to proceed? help answer!
banana  Just kidding, dead wrong: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469451/ histone-P demarcates DNA breakage for repair

Recent comments (see more)

... bharatpillai made a comment on free120/block2/q#19 (A 73-year-old woman comes to the physician because...)
 +2  upvote downvote
submitted by bharatpillai(7)

Subacute combined degeneration never produces exagerated reflexes. It's one of the causes of babinski + with absent ankle reflex.

... asharm10 made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +0  upvote downvote
submitted by asharm10(0)

Always know this Hypo or hypernatremia is because of change in the volume, this patient is going through heart failure, renal perfusion has gone down that leads to release of ADH cos of osmoreceptors stimulation. Now high ADH will reabsorb more free water that will lead to hyponatremia. So hyponatremia is almost always related to high ADH. I know few of you will think but RAAS system is activated too but that abosrb Na along with water but ADH just free water.

... asharm10 made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
 +0  upvote downvote
submitted by asharm10(0)

It's an anabolic hormone, muscle mass, RBC mass will increase.

... asharm10 made a comment on nbme22/block4/q#24 (A 39-year-old woman with rheumatoid arthritis comes...)
 +0  upvote downvote
submitted by asharm10(0)

Rheumatoid arthritis in an inflammatory process, you wanna block Tnf alpha which is a major inflammation accelerator, IL 2 blockers used for tansplant rejections, because you dont want your B and T cells proliferating, IL 2 induces differentiation of all immune cells.

... asharm10 made a comment on nbme22/block1/q#42 (An 18-year-old woman develops sepsis after an...)
 +0  upvote downvote
submitted by asharm10(0)

Acute phase reactants Upregulated: More FFiSH in the C Ferritin Fibrinogen Serum Amyloid A Hepcidin C-Reactive protein

... asharm10 made a comment on nbme22/block4/q#31 (A 65-year-old man comes to the emergency department...)
 +0  upvote downvote
submitted by asharm10(0)

S3--> dilated cardiomyopathy (eccentric)--> systolic failure--> blood builds up--> increase hydrostatic pressure in pulmonary vessels--> exudate--> crackles

... asharm10 made a comment on nbme22/block4/q#41 (A 65-year-old woman with a 20-year history of...)
 +0  upvote downvote
submitted by asharm10(0)

If knee is mentioned just look for L4 and then rule out all the other options, you are left with just one option just pick it and don't think beyond.

... asharm10 made a comment on nbme22/block4/q#20 (During a study of symptomatic proximal deep venous...)
 +0  upvote downvote
submitted by asharm10(0)

When you are comparing the therapeutic effects of two drugs it's a clinical trial and when both the patients and providers know which drug it's open label. Clinical trial could be done between tx/control or tx/tx. It can't be crossover as there is no wash out phase