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“Arrggg, here be fellow mateys seeking an explanation!”




... epiglotitties is asking for clarification on nbme20
 +0  upvote downvote
submitted by epiglotitties(27)

This isn't the scenario in this question, but I was wondering what would happen if you had told the parents the diagnosis and they didn't want their child to know?

... yogurt-dimple is asking for clarification on nbme25
 +0  upvote downvote
submitted by yogurt-dimple(2)

Am I crazy, or does the question stem imply that this was inherited paternally?

raspberry-muffin  In this question sounds like inherited paternally , but this muscle biopsy confirmed Mitochondrial inheritance. Muscle biopsy: Immunohistochemistry typically shows ragged red fibers, which are caused by sub-sarcolemmal and inter-myofibrillar accumulation of defective mitochondria in muscles (mitochondria stain red). Probably Mother has the same condition too. +
yogurt-dimple  Gotcha. Yeah, the red ragged fibers tipped me off to mitochondrial myopathy, but because the stem implied paternal inheritance, I figured there was just another disease I had forgotten about that presents with them. +
drdoom  @raspberry-muffin I'm not convinced. It is highly unlikely the NBME would write this question and expect you to "assume" mom has condition without making any mention of mom. Plus, it is simply highly improbable that myopathy is present in both mom and dad lineage. That seems off to me. +
drdoom  @yogurt-dimple, I think this a key line in the explanation: “However, there are additional mutations that affect mitochondrial RNA translation, trafficking and incorporation of respiratory protein complexes, and maintenance of the inner mitochondrial membrane that can also lead to mitochondrial myopathy.” +
drdoom  Yes, they say, "Mitochondrial diseases are strictly inherited through the mother" but this is not a mitochondrial disease — this is a "non-mitochondrial–derived" mitochondrial myopathy; yes, mitochondria are affected but the mutation is in somatic (nuclear) genes that govern the maintenance of "healthy mitochondria". This is because the mutation affects the function/operation of mitochondria but the mutation itself is in the nuclear DNA (which control something about the "quality" of mitochondria but what exactly is not yet known). +
... shelbinator94 is asking for clarification on nbme18
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submitted by shelbinator94(1)

Why couldn't this be branching enzyme impairment? They both cause cardiac symptoms (according to Amboss at least)

... kms123 is asking for clarification on free120
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submitted by kms123(2)

can someone explain why it's not degranulation of eosinophils?

fhegedus  Eosinophils (FA 2020 page 408) are involved in type I hypersensitivity reactions (asthma, allergy, analphylaxis), parasitic infections and other pathologies. They are not involved in edema formation. I hope this helps! :) +
fhegedus  Also, the patient in the question got a laceration, which probably led to a bacterial infection; so neutrophils would be predominant, not eosinophils. +
... kms123 is asking for clarification on nbme22
 +1  upvote downvote
submitted by kms123(2)

How would we rule out antithrombin deficiency?

sd22  PT, PRT, and TT normal in antithrombin deficiency. FA ‘20 pg. 428 +
sd22  PTT* lol autocorrect clearly hasn’t been studying +
... calvin_and_hobbes is asking for clarification on nbme21
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submitted by calvin_and_hobbes(2)

This Q stem was confusing to me because I thought pain>>itch for shingles. Any thoughts?

... calvin_and_hobbes is asking for clarification on nbme21
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submitted by calvin_and_hobbes(2)

"In addition to slightly decreased platelet count..." — why are plts slightly low in EBV infection/mono?

... empem28 is asking for clarification on nbme22
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submitted by empem28(1)

totally buy the answer of K+ being increased, but can somebody explain why her extreme dehydration (decreased skin turgor, excess urine output) wouldn't lead to an increase in serum [Na+]?

... sd22 is asking for clarification on nbme21
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submitted by sd22(1)

Can anyone help explain what the other options would entail?

... marcspoop is asking for clarification on nbme20
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submitted by marcspoop(3)

Anyone else jump to phenylephrine as a drug that would clear the sinus congestion and also happens to cause constipation? Just me... cool

... ekraymer is asking for clarification on nbme22
 +0  upvote downvote
submitted by ekraymer(1)

Was it wrong to see blood tinged sputum, and automatically assume its cancer? since none of the others would have caused blood tinged sputum?

... calvin_and_hobbes is asking for clarification on nbme20
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submitted by calvin_and_hobbes(2)

Due to its pink staining, I thought B was smooth muscle surrounding the corpus cavernosum. But I suppose that the cells composing the CC are contractile by themselves? And my assumption would make the penis a giant muscle — which it most certainly is not...

... calvin_and_hobbes is asking for clarification on nbme20
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submitted by calvin_and_hobbes(2)

Why is the T normal in this patient? I would have predicted underlying infection — ie, fever — before even "early" septic shock. I selected septic shock purely for the intractable low SVR despite fluids but want to understand more about the absence of fever... Thanks!

drdoom  Elderly (and immunocompromised, generally) do not mount robust fever responses to bacteria and other microorganisms; in elderly, this probably has to do with “declines” of the innate immune system (your macrophages, dendritic cells, monocytes, &c., just don't function as well as they used to). In other words, if you (1) wiped out someone's immune system and then (2) injected bacteria into their bloodstream, you wouldn't observe any fever either. The presence of a “typical” (normal) fever in an elderly or immunocompromised patient can be a super concerning sign: they might have a raging infection on the inside. +
drdoom  ^from the article: “Absent or blunted fever response in the elderly. There is ample evidence that a blunted fever response to a serious bacterial, viral, or fungal infection suggests a poorer prognosis than does a robust fever response [13]. In addition, there is a substantial body of data, mostly from animal models, that fever—through its effects on immune function—may be an important host defense mechanism [14]. Roughly 20%–30% of elderly persons with serious bacterial or viral infections will present with a blunted or entirely absent fever response [2,3,15].” +
... iwannabedonewiththis is asking for clarification on nbme21
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submitted by iwannabedonewiththis(1)

just as a general question, would there be low levels of 1 25-(OH)2 ?

sd22  Yes, kidney has 1-alpha hydroxylase which converts 25-HCC to 1,25-HCC. CKD -> low 1-a-OHase activity -> low 1,25-HCC +
... peachespeaches is asking for clarification on nbme21
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submitted by peachespeaches(2)

I agree that Serum K decrease is the better answer, but wouldn't Urine K also decrease once blood sugar goes down with insulin treatment (i.e. osmotic diuresis would lessen)?

... freemanpeng is asking for clarification on nbme24
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submitted by freemanpeng(6)

No one talks about AR? That's much more unlikely in this case than XR

... epiglotitties is asking for clarification on nbme18
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submitted by epiglotitties(27)

I understand that feedback inhibition isn't working and is why ACTH is undetectable/low (and why there is no change after dexamethasone), but wouldn't cortisol levels increase after dexamethasone? Or does dexamethasone not count as cortisol when quantifying serum levels? pls help

misseili  This patient has Cushing Syndrome and as you stated their feedback inhibition is hampered. Low-dose dexamethasone causes a decrease in cortisol in normal individuals but not in those with Cushing Syndrome, only high dose dexamethasone causes a decrease in cortisol with Cushing Syndrome. Add'l info: In ectopic ACTH (ie Small cell lung cancer) high dose dexamethasone leads to no change in cortisol. Pathoma 2020 Pg 171 +2
... freemanpeng is asking for clarification on free120
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submitted by freemanpeng(6)

The key is when her legs up, Bp normal and symptoms free. In contast, When standing up(running), low Bp and syncope. And Low volume is surly the MMC. It's just so weird. "retrospective posture change"??

... madamestep is asking for clarification on nbme24
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submitted by madamestep(16)

Anyone else get this right because they get them so often from absolutely uncontrolled stress?

... bfinard1 is asking for clarification on nbme20
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submitted by bfinard1(2)

Can someone explain why cardiac output is high in septic shock?

drdoom  Bacteria and bacterial components (like LPS) in circulation trigger massive release of cytokines (Interleukin-1, Interleukin-6 and TNFa), resulting vasodilation. Heart rate increases to maintain decent BP. +1
bfinard1  Is stroke volume not affected by that massive vasodilation? I would think if venous system is vasodilated then you'd have reduced EDV from reduced blood flow to heart +
zedora  Both of you are correct. In septic shock there is a massive vasodilation. In order to compensate for the reduced blood pressure, there is an increased heart rate. Now, keeping this in mind, what is the CO formula? CO = HR x SV Right? Lets say under normal conditions HR is 60 & Stroke volume is 50. Your cardiac output = 60 x 50 = 3000. Now in septic shock, your heart rate is massivly increased but your stroke volume is decreased minimally. So lets plug in the numbers. Lets say, under septic shock, HR = 150 & stroke volume is now 30. The cardiac output is now gonna be = 150 x 30 = 4500, hence your CO is increased. In Septic Shock, the heart rate is massively increased compared to the amount of SV decreased. +
drdoom  @bfinard1 By vasodilation, I almost exclusively mean arterial vasodilation. When it comes to CV, I always work backward from “first principles”, and in my view the first principle of the CV system is, “Maintain pressures to maintain good flow.” All other accommodations of the CV system (changes in inotropy[strength], chronotropy[time], vasoconstriction and vasodilation) are in *service* to maintaining flows. Without good flows, you get the thing human tissues like the least: not lack of oxygen but accumulation of CO2 (and the acidity that goes with it). +
drdoom  So, all that was a long-winded way of saying that Cardiac Output will remain high when the body is producing higher-than-desired levels of CO2 (when organs and the immune system have gone into overdrive to respond to a threat or to address decompensation in some other part of the system); the plummeting of Cardiac Output heralds the beginning of the end. It signifies that the stresses being imposed on the body exceed the capabilities of the system. +
... duckhunter324 is asking for clarification on nbme18
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submitted by duckhunter324(3)

What would a rupture of the fallopian tube look like then? Compared to normal spillage..

epiglotitties  I was wondering the same thing +
... sunnyside is asking for clarification on nbme20
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submitted by sunnyside(1)

Can anyone justify why they did not describe an increased MCHC? FA 2019 says spherocytosis has high MCHC, and they did not even have it on the upper end of normal.

... peterngo1994 is asking for clarification on nbme22
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submitted by peterngo1994(1)

The thing that threw me of was the 74% neutrophil count. Does anyone have an explanation for this?

drdoom  Neutrophil count is different than neutrophil percentage (%). Percentages can be influenced by changes in volume, e.g., if the patient is dehydrated, percentage by volume can be skewed. +
... unknown007 is asking for clarification on nbme22
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submitted by unknown007(-3)

how do you guys "displace" your feelings when you're among the 2 percent that chose the wrong answer ? :-P

... unknown007 is asking for clarification on nbme22
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submitted by unknown007(-3)

question why does metablic acidosis have low bicarb and respiratory acidosis high bicarb ,

when the essence of the bicarb in both cases is to neutralize the acidity ???

... madamestep is asking for clarification on nbme23
 +1  upvote downvote
submitted by madamestep(16)

Remember that medullary carcinoma of the thyroid is medullary. So it's between the follicles. What's between the follicles in the thyroid? C cells that secrete calcitonin.

... daplatesofmetal is asking for clarification on nbme23
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submitted by daplatesofmetal(3)

What is TARNATION is going on here!?

... freemanpeng is asking for clarification on nbme21
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submitted by freemanpeng(6)

Can anyone explain what "diplopia" implies? I got sutck by"these clinical findings" (thinking upward gaze+ diplopia....) Or is "Diplopia" just a unspecific word in exam??

... madamestep is asking for clarification on nbme21
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submitted by madamestep(16)

Why don't we see a decrease in the size of the prostate gland? Is it a difference between atrophy vs. apoptosis?

... jr123 is asking for clarification on nbme22
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submitted by jr123(-1)

I still didn't get why it isn't fibularis longus. Because it evert as well as planterflex??? THANK YOU

... unknown001 is asking for clarification on nbme21
 +1  upvote downvote
submitted by unknown001(7)

ATTENTION DEFICIT- hyperactivity disorder.

how do we improve the attention deficit in that kid ? by increasing dopamine and norepi levels in the brain.

dopamine and norepi= biogenic amines

funstory. newyork times once reported abuse of stimulants by students so they can have an academic advantage by improving attention

... unknown001 is asking for clarification on nbme21
 +0  upvote downvote
submitted by unknown001(7)

low retic count= marrow not working .

what can explain this ? parvo virus affecting the hematopoetic stem cells , hence the low retic count,

think of the low retic count of giving a picture of a failing marrow

... unknown001 is asking for clarification on nbme21
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submitted by unknown001(7)

here is a copy pasted link .

first, high tsh = hypothyroidism

How can hypothyroidism affect me and my baby? thyroid hormones are important to your baby's brain and nervous system development, untreated hypothyroidism—especially during the first trimester—can cause low IQ and problems with normal development.

... unknown001 is asking for clarification on nbme21
 -1  upvote downvote
submitted by unknown001(7)

what is collagen ? a secondary protein structure.

when you remove glycine, the most abundant amino acid , from the precursor molecule will you get a proper secondary structure ? NO

unknown001  ignore this +
drdoom  can you elaborate? what's wrong with your comment? +
... blue4415 is asking for clarification on nbme16
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submitted by blue4415(4)

A discontinue consumption of all alcoholic beverages is wrong; Is that because what She drinks is wine ? Not take it as alcohol?

... cassdawg is asking for clarification on nbme22
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submitted by cassdawg(1752)

If the patient is taking calcium acetate (a phosphate binder), why is his phosphorus level increased?

... charcot_bouchard is asking for clarification on step2ck_free120
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submitted by charcot_bouchard(537)

why not prophylactic anitbiotics?

akjs16  That bothered me, too. According to Cecil, Prevention throught vaccination is the best option for the long-term control of meningococcal disease. Chemoprophylaxis can only control localized outbreaks. There must be some articles, but I'm too lazy to find them. +
... charcot_bouchard is asking for clarification on step2ck_form8
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submitted by charcot_bouchard(537)

Why cant this taken as sexual health?

... charcot_bouchard is asking for clarification on step2ck_form8
 +0  upvote downvote
submitted by charcot_bouchard(537)

Why cant this taken as sexual health?

... jda2674 is asking for clarification on step2ck_form6
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submitted by jda2674(2)

So we're expecting a topical retinoic acid to clear her acute acne within 3 weeks? don't topical retinoids cause purging often?

... blue4415 is asking for clarification on nbme21
 +1  upvote downvote
submitted by blue4415(4)

can Gonadotrophs “hyperplasia” rather than hypertrophy?

kevinsinghkang  wondering the same +
escherichia95  Hormonal stimulation will lead to production of new cells from stem cells i.e. hyperplasia. Hypertrophy is gene activation, protein synthesis and production of organelles. +
... unknown001 is asking for clarification on nbme24
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submitted by unknown001(7)

in my opinion , this was one of the most difficult questions . why ? the answer is soooooo simple that you might be mislead thinking "naaaahh cant be that easy ...nbme .. you playin witme hun?? imma choose the most complex answer and shove it in your face"

student chooses VIP, and afterwards locks him self up with his new record level low self esteem

... unknown001 is asking for clarification on nbme24
 +1  upvote downvote
submitted by unknown001(7)

how to rule out iron def. ? iron is absorbed in deodenum and proximal jejunum .

b12 in ileum.

this will give you the answer

madamestep  I fucked brittany: Iron, Folate, B12 +1
... unknown001 is asking for clarification on nbme24
 +0  upvote downvote
submitted by unknown001(7)

dont be distracted with timing. both can start within minutes.

how to rule out ?

anaphylaxis lung finding > WHEEZE. (question stem = no wheeze)

... unknown001 is asking for clarification on nbme24
 +0  upvote downvote
submitted by unknown001(7)

this is a bonus question.

when odds ratio is 1, meaning no association,

odds ratio> 1, whihc in this question is 6, means association

where is odds ratio ? a) at the ate cookie-didnot drink milk column. hence the answer, only cookie independently ass. with e coli

... unknown001 is asking for clarification on nbme24
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submitted by unknown001(7)

RESOURCE : CDC Malaria species: P. vivax 93%, P. falciparum 7%.

WHY HYPNOZOYES ? 2 reasons

  1. schuffner stippling ( that wierd cell with lots of blue glitters)

  2. HONDURAS ( 93 percent are vivax)

... jatsyuk38 is asking for clarification on nbme21
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submitted by jatsyuk38(2)

doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything...

... lilmonkey is asking for clarification on step2ck_form6
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submitted by lilmonkey(36)

Small Cell - Central. SIADH. Squamous Cell - Central. PTHrP. Adeno - Peripheral. Clubbing (EGF). Carcinoid - Bronchi? Flushing (Serotonin).

... forkyeaa is asking for clarification on nbme21
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submitted by forkyeaa(1)

why is the MCV elevated in this question when it's supposed to be normocytic non hemolytic aplastic anemia?

... kstudy is asking for clarification on step2ck_form8
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submitted by kstudy(4)

this is a great example of why I struggle with this silly nbme and steps. Are we testing knowledge here or semantics?

merpaperple  It's important that we learn to be as pedantic as possible, that's what makes for good doctors +
... marypoppins is asking for clarification on nbme24
 +0  upvote downvote
submitted by marypoppins(1)

Why can't it be choice E? I assumed the patient had bipolar.

... agraham416 is asking for clarification on nbme22
 +1  upvote downvote
submitted by agraham416(4)

am i the only dumb one who thought it was angioedema cause of the ACE inhibitor? totally neglected all other information.

dwdelva8  I did the same thing, but she had been on that ACE inhibitor for 15 years so I guess it would be strange for it to all of sudden cause symptoms +
... an1 is asking for clarification on nbme18
 +2  upvote downvote
submitted by an1(111)

Holosystolic: MR, TR, or VSD

Lower left sternal border (the left border is Erb's point, beneath that is the Tricuspid area) --> TR or VSD

Whats more common? VSD (by far!!)

If they had mentioned the mum having BPD or taking pills for a psych disorder, then TR could be a big contender.

... agurl1000 is asking for clarification on nbme23
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submitted by agurl1000(5)

This might be a straightforward answer, but I was wondering why the patient would have a decreased inspiratory flow? Because to my understanding, people with obstructive diseases have trouble breathing out, not in.. Could someone explain to me why it decreases?

rdk3434  okay so i had the same doubt which is why i got this question wrong , but then i had this eureka moment , in uworld there's repetitive images about obstructive and restrictive disease volumes and they always show TRACHEAL STENOSIS along with that , this question is somewhat like tracheal stenosis presentation , just google lung flow volume tracheal stenosis! hope this helps! +1
... agraham416 is asking for clarification on nbme15
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submitted by agraham416(4)

How do we tell the difference between uncompensated respiratory acidosis and compensated?

... agraham416 is asking for clarification on nbme15
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submitted by agraham416(4)

I understand why the answer is B-Lactamase prod., but can someone explain why alterations in the PBP in incorrect?

... dnazmzm is asking for clarification on step2ck_free120
 +0  upvote downvote
submitted by dnazmzm(2)

I thought the baby was bitten by lizard then I didn't know what Saccharomyces cerevisiae was, so I thought it was something related to a lizard lol!!! too imaginative?

charcot_bouchard  DO NOT PICK SOMETHING U NEVER HEARD OF. Unless u absolutely sure that none of others are not the answer +
... chaosawaits is asking for clarification on nbme23
 +8  upvote downvote
submitted by chaosawaits(86)

Who else read that last sentence 100 times and still had no idea whether it was even English or not?

... michik92 is asking for clarification on free120
 +1  upvote downvote
submitted by michik92(2)

Can someone please clarify why this wasn't myasthenia gravis?

There weren't any upper motor neuron signs in the question stem.

j123  Fasciculations = UMN sign +
gabriellerenai  ^ no fasciculations are a LMN sign, flaccid paralysis with twitching (fasciculations) is LMN lesion FA 2019 pg 517 +2
gabriellerenai  but to answer the original question, MG usually presents with fluctuating (rather than progressive) weakness in extraocular and bulbar muscles before signs in limbs so it would be odd to not mention diplopia, dysphagia, trouble chewing etc. Additionally the fact that it is progressive leans toward ALS rather than fluctuating (MG). Also if you were still between ALS and MG, MG = middle aged woman while ALS is a middle aged man. +1
gabriellerenai  ooooo my bad dysphagia is mentioned but the progressive feature, enough to put him into a wheelchair still stands out to me as ALS, and dysphagia and aspiration are often what leads to death in ALS +1
... chaosawaits is asking for clarification on nbme22
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submitted by chaosawaits(86)

Can someone please explain why this is not hypercholesterolemia? It also presents with HSM and there are numerous foam cells. Since hypercholesterolemia also presents with pancreatitis, couldn't that explain recurrent vomiting? FA2019, p94. Thank you for your responses!

chaosawaits  I mean Type I familial dyslipidemia (hyperchylomicronemia). Am I correct in assuming that the most differentiating presentation is the developmental delay? +
... imtheman is asking for clarification on step2ck_form7
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submitted by imtheman(1)

Why wouldn't a bone morrow transplant prevent this? Technically not wrong...?

... testingforlegal is asking for clarification on free120
 -2  upvote downvote
submitted by testingforlegal(-1)

testing for legal, any terms and conditions to sign?

... charcot_bouchard is asking for clarification on step2ck_form7
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submitted by charcot_bouchard(537)

If its intrinsic defect HTF urinalysis is normal with no casts?

... ali_hassan is asking for clarification on nbme21
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submitted by ali_hassan(8)

How does 500 men with various urological conditions result in a precise estimate? Wouldn't the variety of values due to various degrees of illness reduce precision and cause a wider variety?

Maybe I overthought it

... weirdmed51 is asking for clarification on nbme22
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submitted by weirdmed51(30)

Any other conditions where pulsation in the liver can be found ?

... agraham416 is asking for clarification on nbme18
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submitted by agraham416(4)

I eliminated this answer because the mother already stated her concerns, which was that he's shorter than the father's height and about him not having a growth spurt. Is that not a concern?

... failingnbme is asking for clarification on nbme24
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submitted by failingnbme(3)

can nephritic syndrome be without HTN?

yiqi  I got wrong for the same reason!!! +
... athenathefirst is asking for clarification on nbme20
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submitted by athenathefirst(9)

How do you know the answer is not E? I chose E because I thought of ATN :( Someone help please

lovebug  I am not sure. but I thought E) multiple wedge-shaped cortical infarct . could be induced by multiple embolism of artery. or complete blocks of small artery junctions..(blockage of blood junction) but this case was hyperplastic arterioloscelrosis. +
... osler_weber_rendu is asking for clarification on step2ck_free120
 +1  upvote downvote
submitted by osler_weber_rendu(145)

Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway

len49  Pick the best answer of the choices, not necessarily what you would do in real life. +
drdoom  @len49 Sure, but in that case you’re not saying much about /why/ “Skeletal survey” is the best answer choice from the NBME-frame-of-mind. Can you elaborate? +
drdoom  @osler My guess is that a skeletal survey is what “clinches” evidence of ongoing abuse, since skeletal surveys can reveal bone and tissue injury at /varying (time) stages of healing/, which is the kind of evidence CPS is going to need to establish a PATTERN of abuse and discredit claims like “this was just a one-time ‘accident’.” +
... stunna216 is asking for clarification on free120
 -3  upvote downvote
submitted by stunna216(-1)

why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion?

csalib2  heads up, i think you’re in the wrong question thread +1
... arthur_albuquerque is asking for clarification on nbme20
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submitted by arthur_albuquerque(1)

What helped me to answer this one quite easily was the following rationale:

Hypercalcemia + high PTH -> "primary hyperparathyroidism"

How do high PTH lead to hypercalcemia? Increasing osteoclast activity!

... shaz464 is asking for clarification on step2ck_free120
 +0  upvote downvote
submitted by shaz464(1)

Still confused.. Can anyone rule out all other options please?

len49  A. Conducting a nursing in-service won't help because they do not have the ordering power, that should rest on the person writing prophylaxis prescriptions/orders. C. Not feasible for every patient (not every patient is well enough to be ambulatory. Moreover ambulation only helps so much; patients at high risk for thrombus (for instance like this patient who is hypercoagulable due to malignancy, recent surgery) need bigger guns. D. LMWH is not appropriate for all post-op patients. For instance, inappropriate for people who may be actively bleeding, patient with previous diagnosis of HIT, patients with ESRD as it is renally cleared E. It is not an isolated case, as you know DVT provoked from long hospitalizations and post-op patients is pretty high and taken pretty seriously. +1
... sizario is asking for clarification on step2ck_form6
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submitted by sizario(1)

how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH?

... embeemee is asking for clarification on step2ck_form7
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submitted by embeemee(1)

what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately

... embeemee is asking for clarification on step2ck_form7
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submitted by embeemee(1)

i get the answer, but would a VB even be possible given her GBS+ status?

usmile1  Yes, being GBS+ is very common and is not a contrainidcation for vaginal delivery. just give intrapartum IV PCN to prevent infection in the newborn +1
... embeemee is asking for clarification on step2ck_form7
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submitted by embeemee(1)

the change from green liquid to yellow liquid threw me off. i was thinking gastric outlet obstruction that initially let out bile until it progressed further until letting out only stomach acid?

... justanotherimg is asking for clarification on nbme18
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submitted by justanotherimg(4)

This doesn't make sense to me at all. What will change by the time of the next appoinment ???? Or are they trying to say that his behaviour is normal ??? Isn't it excessive ??

elasticscatter  It said the next ROUTINE examination (like, his next yearly checkup). Basically, it's saying carry on as usual and don't do anything differently based on this info. +
... skonys is asking for clarification on nbme23
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submitted by skonys(51)

So are we supposed to just yolo this one? wtf

... osler_weber_rendu is asking for clarification on step2ck_form6
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submitted by osler_weber_rendu(145)

Why is this not absence seizure?

yb_26  automatisms (lip-smacking, picking at his shirt collar) are seen in complex partial seizures. Also absence seizure lasts 10-20sec, not 1-2 minutes. +1
... osler_weber_rendu is asking for clarification on step2ck_form6
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submitted by osler_weber_rendu(145)

Why not paracentesis?

Sharp chest pain, JVD, enlarged globular cardiac silhouette, and nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade.

aneurysmclip  Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +1
encarnme  Do you mean pericardiocentesis? Paracentesis would be used for ascitic fluid. +3
... charcot_bouchard is asking for clarification on step2ck_form6
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submitted by charcot_bouchard(537)

I want to know how everyone exclude cocaine....i ruled it out because of 6 hours mark...any other clue?

... skonys is asking for clarification on nbme23
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submitted by skonys(51)

Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients)

weirdmed51  Let him breathe first and think of imaginary cough later ( isn’t even mentioned )! +
weirdmed51  Her* +
... brandoctor is asking for clarification on familymed2
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submitted by brandoctor(0)

I think this is pretty clearly HSV-2 genital herpes. Just to confirm though, the blister fluid culture was negative... so that just means the test isn't very sensitive I guess, yeah?

... brandoctor is asking for clarification on familymed2
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submitted by brandoctor(0)

Okay, but why aren't we concerned about the Benzo (and it's anticholonergic properties) in the 67yo F?

... brandoctor is asking for clarification on familymed2
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submitted by brandoctor(0)

Why not low NPV? Since you can't say that you DON'T have strep throat if the test is negative... Does this have to do this prevalence altering NPV?

... jlbae is asking for clarification on step2ck_form8
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submitted by jlbae(117)

Y'aLL dOn'T KeEp BlEaCH uNdEr YoUr SiNkS??!?

lindasmith462  i would but I don't have room with my lamp oil down there +5
... jlbae is asking for clarification on step2ck_form8
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submitted by jlbae(117)

What would make normal lochia the correct answer? Please help I suck at ob/gyn. Am I at the character limit yet?

... chaosawaits is asking for clarification on nbme15
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submitted by chaosawaits(86)

Minor question: but isn't the anatomical snuff box the triangle between the extensor pollicis brevis and the EXTENSOR pollicis longus, not the ABDUCTOR pollicis longus?

... chaosawaits is asking for clarification on nbme15
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submitted by chaosawaits(86)

How does that picture help at all? Is it just for ruling out or can you rule in H. pylori with it?

... chaosawaits is asking for clarification on nbme15
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submitted by chaosawaits(86)

Wouldn't weight gain increase afterload due to increased peripheral resistance, which also increases AR?

imgdoc  In pregnant women, afterload decreases, regardless of weight change. +
leap1608  weight gain would decrease the preload and in pregnancy the afterload decreases as placenta is connected in parallel with the system. hence weight gain would not lead to accentuation of murmur +
... stinkysulfaeggs is asking for clarification on step2ck_form8
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submitted by stinkysulfaeggs(120)

Her BP is 160/90, why is that not being addressed by the question?

jmorga75  Alcohol is a risk factor for osteoporosis and hypertension. You get a twofer when you decrease the intake +3
... ih8payingfordis is asking for clarification on nbme18
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submitted by ih8payingfordis(29)

Why can't this be renal artery stenosis?

ngill  Renal artery stenosis in females is commonly due to fibromuscular dysplasia. You would see hypertrophy in the unaffected side, assuming it's unilateral. Additionally, the person would like have HTN with activation of the RAAS due to the stenosed side. This would increase renin and then increase aldosterone which should lower potassium. +
jbrito718  renal artery stenosis is a cause of prerenal azotemia. the main cause here is the diuretic leading to volume depletion thus causing the azotemia. Renal artery stenosis is not implicated in this question +
... specialist_jello is asking for clarification on nbme13
 -1  upvote downvote
submitted by specialist_jello(28)

I get HOT T Bone STEAK IL 1 for fever

but 90% neutrophils, why cant it be LTB4 neutrophil chemotaxis?

dentist  i picked LTB4 i guess the question itself is "which causes the patient's fever and leukocytosis" LTB4 wouldn't be a direct cause of fever. dumb question +1
... veryhungrycaterpillar is asking for clarification on nbme23
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submitted by veryhungrycaterpillar(29)

I used reverso logic.

Terazosin is an alpha blocker, helps with urinary retention by relaxing sphincter smooth muscle. What would help constrict the same muscle? Stimulating the same receptor. Ez pz.

... abk93 is asking for clarification on nbme21
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submitted by abk93(5)

Specifically, what is the purpose of Il-1 in this question?

is it just that macrophages make Il-1?

doesn't appear to be involved in granuloma formation.

... medstudenttears is asking for clarification on step2ck_form7
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submitted by medstudenttears(1)

Was anyone else thinking bath salts? Why cant it be bath salt intox & withdrawal?

... lm4 is asking for clarification on step2ck_form8
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submitted by lm4(21)

okay soooo 40 participants is too low of a sample size- but 80 back in the new B-adrenergic drug vs. albuterol question was fine? is there like a magic sample number that is considered large enough?

... thrawn is asking for clarification on nbme18
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submitted by thrawn(12)

Why skills training???????????????????????????

... goverbeek16 is asking for clarification on nbme17
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submitted by goverbeek16(4)

What I don't get is that the anterior hypothalamus is responsible for cooling and this involves the parasympathetic nervous system. So, how is the parasympathetic nervous system not active in this person as well?

thatmd  I also got this one wrong because I was also thinking it was a heat stroke question. But I think because we were not actually given his body temperature (>40C for heatstroke), we need to focus on the fact that this dude was running a marathon on a "hot day" without adequate hydration as evidence by his low BP. +
thatmd  FA2020 pg505 +
... jlbae is asking for clarification on step2ck_form6
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submitted by jlbae(117)

What's going on here? Thought this was lactose intolerance → secretory process??

lubdub  Yea, this one made me think more than I'd hope lactose intolerance would have. If the lactose can't be broken down (by the lactase in the brush boarder) then it stays in the lumen (malabsorption) letting all the gut bugs digest it (make gas) and allowing for osmotic diarrhea. Osmotic =/= secretory +4
jlbae  Ah ok, ty. That makes sense. It's kinda coming back to me from M2 GI lectures now lol. So then an example of secretory would be a viral gastroenteritis where electrolytes are being actively secreted into the GI lumen. +1
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