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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

easiest thing to do - try to justify STUPID NBME answers. But i think we missed important part that 35% of body's surface is almost both legs , so next few days body will try to remove all toxins , balance extracellular and intracellular fluids, make new cells for parts its possible, make granulation tissue , try to not lose body's heat , basically do a lot and things that way increasing metabolic rate (through stress hormones and TSH PDGF , EDGF , Colony stimulating growth factor , VEGF etc.)

if problem is the bone => bone conduction will be better , if problem is the nerve air conduction will be better

i thought in this way - i imagenet cell put in salt water , so water from cell will go out because nature like equality and water from cell trying to make that equality thus making solute inside the cell become thick aka high osmolar , second part of the answer is salty water still water

Recent comments (see more)

... humble_station made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
 +0  upvote downvote
submitted by humble_station(11)

Notice drop of O2 saturation from LA (95%) to LV (70%) & equal O2 saturation between LV (70%) & RV (70%) --> VSD is present

Notice the pressure of the RV (120/6) – Normal RV pressure is 25/5 which indicates increased pressure because of the increased volume of blood coming from the LV through the VSD

Grade 4 murmur is a palpable thrill most likely due to RVH from the overloaded work

... diabetes made a comment on nbme23/block2/q#7 (A 45-year-old man is brought to the emergency...)
 +0  upvote downvote
submitted by diabetes(3)

bleeding + pressure down +pulse up equal hypovolemic shock

... groovygrinch made a comment on nbme20/block3/q#36 (A 4-year-old boy has had fever, abdominal cramping,...)
 +0  upvote downvote
submitted by groovygrinch(0)

Like many here, I was between E. Coli and Shigella but went with Shigella because of the daycare center history. I associate EHEC E. Coli with bad burger meat and it seemed unlikely to me that they would be whipping up burgers at the daycare (Usually everyone brings their own lunch to daycare) .

... sajaqua1 made a comment on familymed1/block0/q#4 (An 11-year-old boy is brought to the physician...)
 +1  upvote downvote
submitted by sajaqua1(228)

Pt is an 11 yo M, 2 days of nasal congestion and sore throat. Coughing and sneezing productive of green mucus. There is postnasal drainage of copious yellow-green mucus, and enlarged tonsils.

This patient has a head cold, with postnasal drip that is causing his cough. Antiviral therapy (E) is not directed against the Rhinovirus. The patient does not show signs of bacterial infection which would require antibiotic therapy (F), namely tympanic membrane bulging and ear pain. There is no fever to indicate sever infection or sinus tenderness to indicate an X-ray of the sinuses is warranted (D), or that culture of discharge would change current treatment (C). Because this infection is self-limited and the child can blow their nose, sinus lavage in the clinic is not necessary. (B).

... diabetes made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
 +0  upvote downvote
submitted by diabetes(3)

12Mg/ml=12mg/L 120.09=1.08 mg/hr/kg 1.0824=25.92 mg/day/kg the nearest nanswer is 28.8

... rolubui made a comment on nbme23/block4/q#14 (A 61-year-old woman comes to the physician for a...)
 +0  upvote downvote
submitted by rolubui(0)

The way I remember it, S1: Mitral & tricuspid bc blood goes from atria to ventricles then from ventricles to outside the heart --> S2. Now, when you have a Split S1 the way I think about is that when you inhale you have extra blood coming into the right side of the heart so the tricuspid valves closes later and causes a split S1 upon respiration. Hope that helps.

... 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(1)

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.