nbmeanswers.com will be going offline for ~hour for some updates! we’ll be right back! --the webmaster (2:17am) ❤️

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




... yex is asking for clarification on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
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submitted by yex(4)

This was on a previous NBME. How I got it? Intercostal (posterior) is how you get to the vertebral bodies; the other vessels are anterior.

... ap88 is asking for clarification on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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submitted by ap88(0)

Why can this not be papillary necrosis? Given the gross Hematuria and proteinuria with a history of analgesic use... I thought that was what this was getting at?

... t0pcheese is asking for clarification on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
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submitted by t0pcheese(0)

why is the Na normal in this patient? Everything else made sense, the high K and 17 hydroxyprogesterone.

... hyperfukus is asking for clarification on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
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submitted by hyperfukus(4)

so should we just skip these? cuz there's prob 10 more i couldve gotten write wasting my life on this one

... hello is asking for clarification on nbme22/block1/q#29 (A 28-year-old man comes to the emergency department...)
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submitted by hello(49)

Please help - how are you able to tell that the CT image is not at the level of duodenum?

I don't know what I'm looking for to compare and contrast a CT at the level of the duodenum vs the CT given in this Q.

... hello is asking for clarification on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by hello(49)

There has to be a better explanation for why ANP is wrong?

... cr is asking for clarification on nbme24/block3/q#37 (A man accidentally touches the surface of a hot...)
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submitted by cr(1)

Which type of cell we r going to find in blisters?, neutrophils?

... hello is asking for clarification on nbme22/block1/q#48 (A 1-year-old boy is found to have an impairment of...)
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submitted by hello(49)

please help -- If catalase-positive bacteria neutralize their own superoxide, why isn't it the case for catalase-positive bacteria to infections in everyone?

I'm not understanding the connection to NADPH oxidase deficiency.

hello  to cause** infections in everyone
... hello is asking for clarification on nbme22/block4/q#20 (During a study of symptomatic proximal deep venous...)
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submitted by hello(49)

Why isn't this a cohort study?

drdoom  This is a cohort study! (Since it involves splitting people into "groups"; group = cohort.) But the stem asks what "best describes" the design. So, yes, it's a cohort study but a more precise ("more specific") description is Open-label. In other words, "Open-label clinical trial" is a type of cohort study, and, in this case, "Open-label" is a more precise description of what is described in the stem.
drdoom  For a more technical explanation of "Cohort studies", see the definition from the National Library of Medicine: https://meshb.nlm.nih.gov/record/ui?ui=D015331
... hyperfukus is asking for clarification on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
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submitted by hyperfukus(4)

so the lesion is in the Right MLF right? If so I'm just about to memorize the eye see SAME MiLF lol its the MLF on the same side of the eye keep it simple i hope that's what yall are saying lol

... usmile1 is asking for clarification on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
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submitted by usmile1(8)

does anyone know what the structure E is pointing to?

thomasburton  Not sure looks like it might be free ribosomes or other such small cytosolic structure (I picked E too, thought B looked way too big!)
targetusmle  same here!! marked e thinking of it as a mitochondria
... lauri is asking for clarification on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by lauri(0)

I CANNOT VIEW THE ENTIRE QUESTION. IS THIS NORMAL?

trichotillomaniac  Hi Lauri, this is normal. We can't post the whole question due to copy right laws but you can almost always find the question you are looking for and the answer to by going to the form and then Ctrl + find -ing the age of the patient and other key words or the answer!
drdoom  HI LAURI. THANK YOU FOR DEMONSTRATING YOUR PROFICIENCY WITH ALL-CAP COMPOSITION!
... maxillarythirdmolar is asking for clarification on nbme20/block4/q#25 (A 52-year-old man is brought to the emergency...)
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submitted by maxillarythirdmolar(1)

Where does the role of B1 stimulation of RAAS come into this? Wouldn't the B1 action cause decrease RAAS? That being said, I can also understand if that's a long term thing and this is a question about the immediate effects...?

... hello is asking for clarification on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
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submitted by hello(49)

Please help

Why is valine incorrect?

An explanation below says that valine would be converted to glucose during regular metabolism?

Regular metabolism = fed state, so why would valine even be converted to glucose?

... burak is asking for clarification on nbme21/block2/q#12 (A 66-year-old woman comes to the physician because...)
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submitted by burak(3)

What does 3 narrowin means? Is that a cause of diverticulary diseases or the result?? And what is that photo means :/

... burak is asking for clarification on nbme21/block2/q#16 (A 34-year-old woman comes to the physician because...)
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submitted by burak(3)

Isn't it dependent on the location? I answered it coronary sinus because av node is located in Koch triangle; which composed of CSinus, Tendon of Todaro, Tricuspid annulus?

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node.
burak  Now it's more confusing to me:) because av bundle is more inferior to the av node.
hello  Patient has ASD --> need to repair interatrial septum. AV bundle aka bundle of His is located neart interatrial septum. Coronary sinus opens into atria but is not located near the interatrial septum
... hello is asking for clarification on nbme21/block2/q#16 (A 34-year-old woman comes to the physician because...)
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submitted by hello(49)

Please help

Mid-systolic ejection click = pulmonic stenosis

How is pulmonic stenosis related to the patient's ASD -- does ASD cause pulmonic stenosis??

burak  ASD has typically 3 associated sounds according to UW, they are all about increased blood in RA. Increased blood in RA causes more blood do ejected from tricuspid (dşastolic rumble), and more blood to be ejected to pulmonary circulation which cause pulmonary flow murmur (midsystolic murmur in pulmonary region). It even can cause pulmonary regurgitaion like murmur, but most important murmur in ASD is typically midsystolic murmur. You can check it out on FA 2018 page 284
hello  Ok, what I learned: Extra blood in the right heart (due to ASD) doesn't lead to pulmonic stenosis? Instead, it's that pulmonic stenosis = most common comorbid heart association with ASD
burak  No it's not pulmonic stenosis, it doesn't lead. Murmur associated with ASD is pulmonic stenosis-like murmur, because it's caused by excess RA and RV volume ejecting to the pulmonary arteries. So it's same location with pulmonic stenosis, and it's systolic. You get it?
hello  @burak Yep!
... ls3076 is asking for clarification on nbme22/block2/q#7 (A 66-year-old man comes to the physician because of...)
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submitted by ls3076(4)

Is decreased nocturnal erections not possible due to the incongruity between onset of symptoms and stroke (2 mos versus 3)? Agree that these questions are very vague and frustrating. Not sure where to get a good grasp on this material.

... ls3076 is asking for clarification on nbme22/block4/q#47 (A 56-year-old woman comes to the physician for a...)
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submitted by ls3076(4)

can anyone explain why (D) metaplasia is incorrect?

... dorsomedial_nucleus is asking for clarification on nbme21/block1/q#43 (A 52-year-old man is brought to the emergency...)
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submitted by dorsomedial_nucleus(0)

Is this just red-man syndrome? Direct mast-cell degranulation caused by vancomycin....and also morphine?

... sam1 is asking for clarification on nbme23/block1/q#50 (A 45-year-old woman with coronary artery disease and...)
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submitted by sam1(0)

What about the additional flow through the circumflex?

... varunmehru is asking for clarification on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
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submitted by varunmehru(0)

The mother has autoimmune thyroiditis and treatment is given for hypothyroidism only. why does it matter if the mother's TSH is high or low? Autoantibodies would still be present and they would always cause cretinism irrespective of mother hormones level. Isn't it?

... wolvarien is asking for clarification on nbme22/block3/q#20 (A 43-year-old man is brought to the emergency...)
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submitted by wolvarien(0)

I am trying to figure this out from the links provided. Can someone please explain the rational behind this question ?

p4p4y4  I believe it's that this muscle everts the foot + runs over the lateral malleolus .. But the phrasing on the question is odd
... sunny is asking for clarification on nbme22/block3/q#34 (The risk for hemorrhagic stroke from drug X is...)
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submitted by sunny(0)

why is this not a cross sectional survey? ... since we are asking at a particular time

drdoom  As Aristotle once quipped, “A ‘single-point in time’ doth not a cross-sectional study make.” The design of a cross-sectional study would not define “ahead of time” two cohorts (two groups); said another way, a cross-sectional design would not “split people into two groups.” In the design of a cross-sectional study there is only “one group”, and then you ask all members of that group some question (“Do you have asthma?”). At the end of a cross-sectional study, the authors will be able to make a statement like this: “We called 10,000 phone numbers with area code 415 at random and asked ‘Do you take Drug X?’ 500 responded ‘I don’t know’, 633 responded ‘Yes’, and 8,867 responded ’No’.”
... pparalpha is asking for clarification on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
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submitted by pparalpha(13)

Can someone please explain why it would not be glycogen depletion? I thought the question was talking about the Warburg phenomenon... so why not breakdown of glycogen to glucose?

I guess it would not explain the edema?

hello  Glygocen stores are depleted within 24h. This person has signs and symptoms of longterm nutritional deficiences.
... dr_jan_itor is asking for clarification on nbme20/block3/q#11 (A 3-year-old boy is brought to the physician because...)
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submitted by dr_jan_itor(6)

Can anyone answer why this one can't be F. Beta thalasemia major? I was thinking becaues of his anemia and the "european descent" which includes the mediteranian europeans. Unless NMBE writers think that european only means the ones with extra white people lol

... xw1984 is asking for clarification on nbme20/block3/q#11 (A 3-year-old boy is brought to the physician because...)
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submitted by xw1984(0)

I got this Q wrong. I was wondering why this patient “has no personal or family history”. Hereditary spherocytosis should be a AD disease, so, generally speaking, this diz should be seen in each generation, right?

... paloma is asking for clarification on nbme16/block1/q#14 (Lesch-Nyhan syndrome)
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submitted by paloma(0)

q= 1/100.000 (frequency in males) p+q=1 2pq=? (frequency of heterozygous)

2pq=0,00002=1/50.000

... woodenspooninmymouth is asking for clarification on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
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submitted by woodenspooninmymouth(0)

MS is a demyelinating disease. That's why I didn't pick cortex or thalamus; they are grey matter. I picked medulla because I the spinotrigeminal nerves traverse the medulla. I guess we are just supposed to assume the demyelination is happening in the pons? I don't know.

woodenspooninmymouth  Sorry, I meant to say that the pons would have the cell bodies for the pain/temp neurons, no?
... doodimoodi is asking for clarification on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
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submitted by doodimoodi(2)

Did no one notice that the Odds ratio on the top left is wrong? Am I missing something? If you calculate it, it's 6 just like the top right one....

mjmejora  thats actually really funny
... alexb is asking for clarification on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
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submitted by alexb(10)

I guess he's taking B12 supplements, otherwise he would have a symptomatic deficiency, right?

... enbeemee is asking for clarification on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
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submitted by enbeemee(3)

i get why it's hyporeflexia, but why not fibrillations? it's also an LMN sign

et-tu-bromocriptine  Imagine a simple reflex arc: you have an afferent neuron, some interneuron shenanigans, and an efferent neuron (aka LMN neuron). If you damage the LMN, you will get hyporeflexia (due to damaged reflex arc) and fibrillations (because your LMN won't be able to effectively contract muscle on command). However, if you damage the afferent part of the arc, you will still get a damaged reflex arc (hyporeflexia), but your motor neuron will still be able to do its stimulating effectively, so your muscles won't show weak contractions when stimulated by a higher pathway. Kinda confusing but I hope I made it a tad simpler!
... i-de-liver is asking for clarification on nbme18/block2/q#17 (65 yo woman, 1 week of swollen, painful knee)
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submitted by i-de-liver(0)

Does anyone know why this is Uric Acid not N. gonorrhea? All I see in the micrograph are neutrophils. Is that white line in the middle of the picture that overlays the lymphocyte supposed to be the needle-shaped uric acid? Or is it because she's an old lady and usually septic Arthritis is from S. Aureus, so it would more like by uric acid and not gonorrhea since she's older?

maverick95  I struggled between those two answer choices as well. I thought that the large needle shape right in the middle was a uric acid crystal which helped push me towards Uric Acid as my answer. I also took into account that she was older (even though STIs are rampant among the elderly) she didn't really seem to have any other symptoms or history of STI/gonorrhea. I figured with her age that she just wasn't able to excrete Uric Acid enough, and got a gout. Something a pathologist told me one time was that they put the focus of the picture in the middle of the shot. So considering the uric acid-looking shape was right in the middle, I figured that's what they wanted us to focus on with the picture. Hope this helps.
i-de-liver  Ah gotcha! I guess I shouldn't have thought that the thing in the middle was an artifact lol... thank you!!
a1913  I believe it's because: 1) there is nothing given that would be risk factors for this woman to have N. gonorrhea 2) The thing in the middle is indeed an MSU crystal, just not under polarized light 3) apparently we get acute inflammation and increase in WBCs with crystal-induced arthropathies, per Table 11-2 on page 8 here (10 page document, top of page of interest will say p. 260) --> http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9781582558752_Mundt/samples/Chapter_11.pdf Also take a look at the pics on the previous page, left column for an example. I got this wrong as well, but I definitely won't again! lol
... adisdiadochokinetic is asking for clarification on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
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submitted by adisdiadochokinetic(7)

It really looks to me like her sclera have been photoshopped, anyone else notice that? xD

... cinnapie is asking for clarification on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
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submitted by cinnapie(2)

Why does every NBME have one or two erection related questions??

youssefa  Cause we all know what bout to happen to us in this exam :D
... sahusema is asking for clarification on nbme21/block4/q#48 (A 75-year-old man with dementia, Alzheimer type, is...)
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submitted by sahusema(12)

What a GARBAGE question. He was eating breakfast 2 hours ago just fine and now we are supposed to have the family come to a consensus about a feeding tube like he's on his death bed? BULLSHIT

... enbeemee is asking for clarification on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
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submitted by enbeemee(3)

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?

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells).
eclipse  actually they do use LPS as adjuvant in vaccines
eclipse  actually they do use LPS as adjuvant in vaccines
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response.
hyperfukus  some extra info in case they ask another annoying q
... whoissaad is asking for clarification on nbme21/block4/q#39 (A 46-year-old man comes to the physician because of...)
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submitted by whoissaad(8)

Where is this even from? My mind's going hay wire trying to understand this.

sahusema  Hardy Wineberg equilibrium square root 900 = 30 1/2 of all offspring will be carriers so 30*.5 = 15 simple as that
maxillarythirdmolar  this deserves a million upvotes.
... imnotarobotbut is asking for clarification on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
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submitted by imnotarobotbut(21)

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?

a1_antitrypsin  Totally agree, and they give you a slight increase in PT instead
... snafull is asking for clarification on nbme24/block2/q#36 (A 27-year-old woman comes to the physician for a...)
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submitted by snafull(1)

Can somebody explain why this is not a foreign body granuloma?

yb_26  because they mention scattered fragments of foreign material (pt presents 2 months after c-section, sutures are either removed in 1 week or dissolve in few weeks (depends on type of suture material)
... youssefa is asking for clarification on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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submitted by youssefa(6)

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"

hello  No. The order of liver damage due to alcohol is: fatty changes --> cellular swelling (cellular balooning) --> necrosis. This Q stem states to the patient consumed large amount of alcohol on a weekend -- he has acutely drank a large amount of alcohol on one weekend --> this corresponds with fatty changes
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION.
... cienfuegos is asking for clarification on nbme20/block4/q#15 (45 yo man undergoing surgical procedure)
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submitted by cienfuegos(4)

Couldn't you also decrease the FIO2? Per FA, CPP also increases to hypoxia also decreases CPP when PO2 < 50 mmHg.

cienfuegos  Obviously not the BEST option in this scenario, but seems like it could work unless I'm missing something.
... enbeemee is asking for clarification on nbme21/block1/q#36 (A 51-year-old woman comes to the physician because...)
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submitted by enbeemee(3)

what are the other labeled structures? i can discern the parietal and chief cells, but not the others...

hyperfukus  what is A?
et-tu-bromocriptine  According to this source, they're mucous neck cells (secrete acidic fluid containing mucin); compare this with mucus produced by surface mucous cells, which is alkaline. http://www.siumed.edu/~dking2/erg/GI082b.htm
hyperfukus  i gosh i see now! thanks so much :) so if it's Pink=Parietal but not granules got it thank you :)
... zpatel is asking for clarification on nbme22/block4/q#44 (A 10-year-old boy has bruised easily since...)
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submitted by zpatel(3)

Can anyone tell the effect of aspirin on a blood lab value (i.e PT,PTT,Fibrin product)?

... ergogenic22 is asking for clarification on nbme21/block4/q#33 (A female newborn delivered at 26 weeks' gestation is...)
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submitted by ergogenic22(28)

why is protection of the choroid plexus, from intraventricular rupture secondary to germinal matrix hemorrhage not a possible answer?

whoissaad  yes same question, both retinopathy and intraventricular hemmorage can occur due to high oxygen levels..
cienfuegos  I mistakenly chose choroid plexus too, based on wiki seems this is most common cause of IVH in term infants: IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus. However, it is particularly common in premature infants or those of very low birth weight... Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. https://en.wikipedia.org/wiki/Intraventricular_hemorrhage#Babies
burak  choroid plexus is different than germinal amtrix
... ergogenic22 is asking for clarification on nbme21/block4/q#10 (A 64-year-old man is evaluated for cough, dyspnea,...)
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submitted by ergogenic22(28)

why is hyperlipidemia secondary to cushing syndrome not a possibility?

hello  SIADH = MC paraneoplastic syndrome of small oat cell lung cancer. Also, Cushing syndrome would cause would weight gain, skin hyperpigmentation, and hypokalemia. Not, lyperlipidemia.
... adisdiadochokinetic is asking for clarification on nbme22/block3/q#47 (A 10-year-old boy receives a renal transplant from a...)
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submitted by adisdiadochokinetic(7)

Can anyone explain why Fibrous scars with plasma cells is not the correct answer?

... stinkysulfaeggs is asking for clarification on nbme23/block1/q#16 (Physical analysis of the isolated genomic DNA from a...)
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submitted by stinkysulfaeggs(8)

Me reading this question stem: .....do you mean which of the following ENZYMES?

... stinkysulfaeggs is asking for clarification on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
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submitted by stinkysulfaeggs(8)

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.

tinydoc  I thought about that but then I ruled it out as with the NBME ethics questions the answer is almost never to defer to someone else. The question doesn't ever tell you what type of doctor you are for you to be referring to a different more specialized physician. Also I assume that they think if there was something wrong you could handle it.
... stinkysulfaeggs is asking for clarification on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
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submitted by stinkysulfaeggs(8)

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.

shriya goyal  yes I answered it like that
redvelvet  me too :(
abigail  me three :(
yex  Me four :-/
link981  Slowly raising my hand as well
tinydoc  Sammmme
... impostersyndromel1000 is asking for clarification on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
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submitted by impostersyndromel1000(4)

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?

... dbg is asking for clarification on nbme24/block2/q#23 (A 9-year-old boy who was adopted from an African...)
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submitted by dbg(17)

WTF is "weakness of plantar dorsiflexion" ????? it's like saying "extension flexion" This is not the only obvious technical mistake in the new NBMEs ...

karthvee  loool
... davidw is asking for clarification on nbme24/block3/q#33 (A 12-year-old boy is brought to the physician by his...)
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submitted by davidw(9)

Is this found in other resources other then Pub med articles?

... enbeemee is asking for clarification on nbme22/block3/q#45 (A 28-year-old man who is seropositive for HIV has...)
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submitted by enbeemee(3)

sketchy says that kaposi's has infiltrating lymphocytes, so why would large aggregates of atypical lymphocytes be incorrect?

... et-tu-bromocriptine is asking for clarification on nbme23/block2/q#30 (A 21-year-old man is brought to the emergency...)
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submitted by et-tu-bromocriptine(8)

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.

what  Small intestine has smooth muscle in the walls which will fibrose on injury
youssefa  So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI)
... enbeemee is asking for clarification on nbme22/block2/q#8 (A 73-year-old man has difficulty urinating and...)
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submitted by enbeemee(3)

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?

yb_26  acetylcholinesterase inhibitors are used in treatment of urinary retention, not urinary frequency
... mguan1993 is asking for clarification on nbme23/block2/q#11 (An antiserum is elicited by immunization with...)
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submitted by mguan1993(2)

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

yb_26  check UWorld #12299
... mguan1993 is asking for clarification on nbme23/block1/q#32 (Which of the following sets of serum findings is...)
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submitted by mguan1993(2)

Does being recently diagnosed vs having CKD for a while change this answer? the "recently diagnosed" part threw me off

smc213  @mguan1993 yes it does! With secondary hyperPTH due to CKD = incr. phosphate, dec. Ca2+ and incr. PTH. This can then progress to tertiary hyperPTH from longstanding secondary hyperPTH as a result of parathyroid HYPERPLASIA --> autonomously (refractory) functioning parathyroid. This will actually lead to INCREASED Ca2+, and significantly INCREASED PTH. Treatment would be surgical removal of the parathyroid glands. Sources: DIT and FA18 p340
... nwinkelmann is asking for clarification on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
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submitted by nwinkelmann(54)

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.

... alexb is asking for clarification on nbme22/block2/q#30 (A 40-year-old woman comes to the physician because...)
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submitted by alexb(10)

It seems like a lot of the systemic autoimmune diseases are multifactorial. Is there a general rule for this?

ls3076  Really good observation
... amarousis is asking for clarification on nbme23/block1/q#28 (An otherwise healthy 82-year-old man is brought to...)
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submitted by amarousis(9)

But doesn't subacute combined degeneration lead to impairment in DCML, spinocerebellar and corticospinal tract? I get the ataxic gait - DCML/spinocerebellar. But the sensation to pinprick, wouldn't that be the spinothalamic tract? That is not usually affected in subacute combined degeneration.

... imnotarobotbut is asking for clarification on nbme20/block4/q#21 (A 47-year-old woman comes to the physician because...)
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submitted by imnotarobotbut(21)

How would you know that it isn't wool sorters disease?

cienfuegos  FA 2018 137: inhalation of spores leads to flu-like symptoms that progress quickly to fever, pulmonary hemorrhage, mediastinitis and shock, with imaging possibly showing widened mediastinum
... nwinkelmann is asking for clarification on nbme22/block4/q#50 (A 31-year-old woman in the second trimester of...)
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submitted by nwinkelmann(54)

I know that complete moles do not contain fetal tissue (i.e. only chorionic villus, cytotrophoblast, and syncyciotrophoblasts) and partial mole as fetal tissue, chorionic villus, cytotrophoblast, and syncyciotrophoblast. Obviously hematopoietic stem cells are fetal parts as they turn into blood cells, but what is the overall definition of fetal parts?

... nwinkelmann is asking for clarification on nbme22/block4/q#19 (A 76-year-old man with a 1-month history of a...)
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submitted by nwinkelmann(54)

Can someone explain how to rule out the other answer choicers?

warbyparker1  you can r/o SMA because as kidneys ascend they get stuck low in the INFERIOR MA (L3 level). So I guess there should be no problem w SMA
hello  I think friability of vascular tissue would indicate in inflammatory process (the one I can think of is strawberry cervix) -- so i think that's why you can rule out choice C.
... alexb is asking for clarification on nbme22/block1/q#45 (A 16-year-old girl is brought to the physician...)
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submitted by alexb(10)

Is the part with "constant studying" just supposed to support that she has a psych disorder related to perfectionism, which is why she's going to extremes to control her weight?

rrasha2  No, the constant studying is to trick you into thinking shes abusing amphetamines.Amphetamines decrease appetite so a lot of people abuse them for weight loss. That combined with increased concentration to study all day errrday.. #onehellofadrug
rrasha2  forgot to mention, another side effect of amphetamines would be increased BP due to the increased catecholamines..don't forget to keep an eye out for that
... dragon3 is asking for clarification on nbme24/block3/q#43 (A 35-year-old woman with a long-standing history of...)
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submitted by dragon3(3)

Can anyone explain why bacteria is neutrophils, viral/fungi are lymphocytes? I know this is a fundamental concept...

lolmedlol  i think neutrophils (in addition to lacking granzymes and perforins which are used to kill viruses and fungi) dont recognize intracellular things; viral antigens needs to be processed and presented on an MHC for the lymphocytes to recognize
... dragon3 is asking for clarification on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
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submitted by dragon3(3)

I almost picked asking the roommate not to smoke in the apartment, but then I figured that's beyond the scope of the doctor... another person said taking steroids would be too much for now, and I suppose that's because the asthma is well-controlled with her inhaler rn? (that's what I had picked)

sherry  I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications.
et-tu-bromocriptine  Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc."
... nwinkelmann is asking for clarification on nbme20/block2/q#7 (A 30-year-old man comes to the physician because of...)
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submitted by nwinkelmann(54)

Does anyone know the significance of monocyte motility?

... dragon3 is asking for clarification on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
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submitted by dragon3(3)

What's the difference between reactive granulocytosis vs lymphocytosis?

whossayin  Yes I’m at a loss for this one too. Still can’t figure out how we’re expected to differentiate those based on this slide shown. The only logical explanation that I can think of is that reactive lymphocytes may be seen in LYMPHOMAS as opposed to granulocytes which are seen in LEUKEMIAS Such a shitty way to trick us, hah!
henoch280  reactive lymphocytes are seen in EBV infection. you would see lymphocytes in the slide not neutrophils FA2018 pg 165
whossayin  That makes sense.. but was the question talking about EBV infections or hematological malignancies? Just a vague question I wasn’t really sure what exactly was it trying to teach us, I guess the reactive lymphocytosis just threw me off! Anyways, thanks for the clarification buddy!
ratadecalle  They way I thought about it was: Granulocytes: multi lobed nucleus Lymphocytes: single lobe
hello  @whossayin - it's not reactive lymphocytosis because there are no buzzword type symtoms of EBV in the Q stem. Also, reactive lymphocytes look way different.
... mguan1993 is asking for clarification on nbme22/block2/q#20 (A 26-year-old nulligravid woman comes to the...)
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submitted by mguan1993(2)

can someone explain why the answer is not adrenal gland? I feel ike if adrenal gland was the issue there would also be decreased concentrations of FSH, LH, and estrogen right?

mguan1993  ^nvm had a brain fart and go adrenal gland mixed up with anterior pituitary lmao
nor16  ovaries are #1 estrogen producer no estrogen no lubricant = dyspareunia no estrogen and no fsh/lh --> there must be a "higher" problem, up there in the brain
... d_holles is asking for clarification on nbme22/block3/q#31 (A 35-year-old man is admitted to the hospital...)
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submitted by d_holles(29)

Can portal HTN contribute to hepatic encephalopathy?

... guillo12 is asking for clarification on nbme24/block2/q#7 (A 75-year-old man with a 10-year history of...)
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submitted by guillo12(12)

Why there's no increase in Hydrostatic pressure in glomerular capillaries?

rihan  Between the glomerulus and Bowman's space there is a hydrostatic pressure gradient. This gradient is normally the result of a LARGE glomerular hydrostatic pressure and a LOW pressure in Bowman's space which normally favors filtration. Diagram here: http://physiologyplus.com/wp-content/uploads/2017/08/Glomerular-Filtration.png In the case of post-renal obstruction, hydrostatic pressure behind the blockade will rise and urine will reflux into the capsular space and renal tubules (while glomerular hydrostatic pressure is unaffected) effectively decreasing the pressure gradient which reduces the filtration rate.
... endochondral1 is asking for clarification on nbme22/block1/q#24 (A 48-year-old man with renal artery stenosis...)
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submitted by endochondral1(4)

is this question asking what we physically pass through or by?

impostersyndromel1000  no, basically the question is testing if you know the branches of the abdominal aorta and which is closest to the renal (in this case, inferior to the renal arteries)
impostersyndromel1000  what you are passing by would better answer your question actually
... endochondral1 is asking for clarification on nbme23/block4/q#41 (Electrophysiology of the heart is studied in an...)
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submitted by endochondral1(4)

I thought ablation of the av node was a tx for a fib not heart block?

... cr is asking for clarification on nbme21/block1/q#21 (A 40-year-old man with type 2 diabetes mellitus...)
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submitted by cr(1)

why not C?. It´s not supose that it improve the efectivity of insulin?

yb_26  thiazolidinediones (pioglitazone) increase insulin sensitivity (in muscles and liver) through activation of peroxisome proliferator-activated receptor-gamma (PPAR) I think they are asking about primarily mechanism of action, that's why it is E
cienfuegos  UW explanation regarding the genes upregulated 1. GLUT4: insulin responsive on adipocytes/skeletal increases G uptake 2. adiponectin: cytokine secreted by adipocytes increases # of insulin responsive adipocytes and stims FA oxidation 3. PPAR family also plays significant role in pathogenesis of metabolic syndrome
... amarousis is asking for clarification on nbme20/block2/q#41 (Purified serum antibodies elicited by immunization...)
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submitted by amarousis(9)

so how would the graph look for protein x expresses all of the epitopes expressed by protein y, but protein y does not express all of the epitopes expressed by protein x?

drw  then some anti-X cannot relocate to Y even Y is added at whatever high dose. at this condition, the line can never touch the axis-Y. on the contrary, if Y express all epitopes on the X, but X does not express all epitopes on the Y, that means some Y epitopes are not seen on X. at this condition, I don't know what will be the line looked like.
... canyon_run is asking for clarification on free120/block3/q#9 (A 72-year-old woman is brought to the emergency...)
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submitted by canyon_run(0)

I can’t seem to find a similar image online that describes exactly what the other areas are covering. Any help?

benwhite_dotcom  See this image (Fig.6) from https://teachmeanatomy.info/neuro/brainstem/medulla-oblongata/ A and D, for example, would reflect lesions that cause what is called lateral medullary syndrome (Wallenberg syndrome).
canyon_run  Thank you! Would E then be the inferior vestibular nucleus based on that linked image? Also, is hypoglossal involved in the stem because of damage to the nerve fibers themselves rather than the nucleus?
benwhite_dotcom  I think the level in the teachmeanatomy link is a bit off from the NBME image. I assume the NBME is showing E as the hypoglossal nucleus (https://en.wikipedia.org/wiki/Hypoglossal_nucleus). Yes, it’s the fibers. The nucleus is ventral.
... sherry is asking for clarification on nbme20/block2/q#10 (A 70-year-old woman is transferred to a...)
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submitted by sherry(3)

This is the second best choice I was gonna take during the exam. I thought Age was better since FA indicated decreased estrogen and old age are the reasons for bone resorption. Can somebody explain to me why Age could not possibly be the answer?

kard  I solve it like this: So age is 70 (already, nothing we can do to change it), is asking about a predictor of success in the Rehab process (So basically, what this patient did in matter of activity, life style, etc. to have a Good rehab process). So From all the answers the, Activity level is the most likely choice because of the, increase in Bone density(Specially Weigh bearing) and OsteoBlastic activity.
... benwhite_dotcom is asking for clarification on free120/block3/q#13 (A 32-year-old man is brought to the emergency...)
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submitted by benwhite_dotcom(30)

Blood at the meatus is the red flag (see what I did there?) for urethral injury, which should be evaluated for with a retrograde urethrogram. The membranous the most commonly injured by fracture. In contrast, the spongy urethra is most likely to be injured during traumatic catheter insertion or in a straddle injury.

canyon_run  Should we just assume that a pelvic fracture implies a membranous urethral injury? I was between membranous and spongy and I ended up choosing spongy because of the perineal bruising and fact that the patient was riding a motorcycle (and therefore susceptible to straddle injury).
benwhite_dotcom  Yes. You should think of spongy as the penile urethra, hence the predisposition to catheter-related trauma.
... kentuckyfan is asking for clarification on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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submitted by kentuckyfan(13)

I get why the mixed venous oxygen tension decreased. However,, isn't the systemic vascular resistance also decreased?

yb_26  no, decreased CO => peripheral vasoconstriction => SVR will be increased
yssya1992  No SVR will increase due to RAAS and SAN thats why we decrease afterload in HF treatment ( ACEI, ARBs )
snafull  Wouldn't pulmonary vascular resistance also be decreased here due to pulmonary vasodilation in the setting of an MI?
cienfuegos  @snafull: my initial thought is that we would see pulmonary vasoconstriction because of the relatively low oxygen tension (that results from the low cardiac output).
... niboonsh is asking for clarification on nbme22/block4/q#20 (During a study of symptomatic proximal deep venous...)
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submitted by niboonsh(55)

I am confusion. why wouldnt this be a cross over study?

shokay  there is no washout period and the order of drugs given isn't switched
... charcot_bouchard is asking for clarification on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
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submitted by charcot_bouchard(38)

I get why its lateral but dont all cranial nerve except 4 arise Ventrally? WTF they add this Dorso before lateral?

... meatus is asking for clarification on nbme22/block3/q#8 (A 38-year-old man who lives at sea level flies to a...)
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submitted by meatus(1)

I'm sorry but what am I missing here... I thought the whole point of diuretics is to correct volume overload by diuresis? How would total volume be increased??

niboonsh  the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_-
link981  Also misread the question, thought about the lab volumes of the BLOOD smh
hyperfukus  yooooo me too!!! this is the second NBME i did this on they purposely don't write urine on the arrow categories to mess u up i swear!!! AHHHHHH
medulla  missed this question for the same reason .. still pissed
... cocoxaurus is asking for clarification on nbme24/block4/q#3 (A 23-year-old woman is brought to the emergency...)
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submitted by cocoxaurus(22)

BUT why is the serum potassium normal?

I was able to narrow it down to RTA, because none of the other answer choices made much sense, but the potassium had me second guessing myself. Can someone explain that lab finding? Thanks!

subclaviansteele  My take is that hes not super acidotic and the K is at the low end.
nwinkelmann  see the comment by @zbird, which explains that the urine anion gap is important (which I took to interpret as more important than the serum K+ level, lol, because the normal K threw me off too).
... stepbystep is asking for clarification on nbme20/block2/q#31 (A 25-year-old man comes to the physician 8 hours...)
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submitted by stepbystep(0)

does some mind explaining why this isn't a tear in the sciatic nerve?

sugaplum  It is a very thick nerve, so I think it is hard to tear without physically cutting it. Also if it tore you would have tibial and common fibular nerve symptoms as well. You would see sensory numbness and tingling along the dermatome also the mechanism of injury is focused on spine so a disc rupture is more likely
... keshvi is asking for clarification on nbme23/block1/q#13 (A researcher is asked to prospectively investigate...)
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submitted by keshvi(4)

i counted both the prevalence and incidence using patient - years. Is it incorrect to use patient years for prevalence?

... whossayin is asking for clarification on nbme20/block3/q#39 (A 19-year-old woman has severe refractory pustular...)
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submitted by whossayin(2)

the question was very poorly worded in my opinion, anybody else agree?

niboonsh  yea it was a dumbass question, whoever is writing these questions is undoubtedly a crazy genius but homeboy (or homegirl...homeperson?) needs a few grammar lessons.
yex  I agree. We know that it is a teratogen, but how does that question directs you to think about teratogenic effects instead of something physiologic?
dr_jan_itor  The questions in the NBMEs by default are reject questions. So highly selective to be awful questsions. I am recieving regular heads up that the stems on the real thing lately are like 10-12 lines long. So these questions are not anywhere near like the test. NBME has f'd us good for this particular round of practice forms.
... whossayin is asking for clarification on nbme20/block2/q#26 (A male newborn is found to have a decreased blood...)
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submitted by whossayin(2)

why can't "organification defect in T3 and T4" be the answer?

sugaplum  I think if it was organification defect you wouldn't have a normal T4 level in the serum.
... niboonsh is asking for clarification on nbme21/block1/q#40 (A physician prescribes a recently marketed drug for...)
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submitted by niboonsh(55)

SWIM

phase one - is it Safe?

phase 2 - does it Work?

phase 3 - any Improvements?

phase 4 - stay on the Market?

... niboonsh is asking for clarification on nbme21/block4/q#38 (A 62-year-old woman is brought to the physician by...)
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submitted by niboonsh(55)

i got this question right but why couldnt it be ginko biloba?

nor16  and why no therapy, i.e. cognitive training`
... kernicterusthefrog is asking for clarification on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
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submitted by kernicterusthefrog(17)

Just in case that lovely little equation provided by @keycompany wasn't quite enough for you, here's a link to a more complete explanation by Kahn Academy. Helped me, when I looked at the equation and said, whaaaa?

... sup is asking for clarification on nbme22/block3/q#12 (An 82-year-old woman has been bedridden since...)
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submitted by sup(1)

Why not PGI2 by way of ASA? Especially given other answer choices of proteins C + S: doesn't warfarin also suppress these?

imnotarobotbut  Protein C and S are ANTI-thrombotic, so although Warfarin does decrease them, they wouldn't decrease the patient's risk for thrombosis
epr94  the question ask "suppression" of which one will decrease risk of thrombosis if you suppress C and S which and anti-thrombotic you get thrombotic
... moo is asking for clarification on nbme21/block3/q#16 (A 16-year-old boy is brought to the physician...)
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submitted by moo(0)

if the lungs were clear to auscultation and the kid even said he doesn't want to be on the team anymore why couldn't it be malingering?

amarousis  malingering would be a conscious faking of symptoms to avoid being on the team. he wouldn't have the mid-systolic click and he would probably complain of his symptoms all the time and not just limited to during exertion.
temmy  malingering is also doing it for some external gain. which was not indicated in the stem
garibay92  Also, patients with asthma are usually asymptomatic at the time of physical exam unless they are examined precisely during the attack.
... sup is asking for clarification on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
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submitted by sup(1)

Somehow I was able to convince myself that increased testosterone --> decreased estrogen --> decreased negative feedback on LH/FSH secretion --> increased FSH. Does anyone care to explain why this logic is wrong? Thanks :)

btl_nyc  The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio.
impostersyndromel1000  @sup, i did the same thing. Had no idea testosterone and androgens can increase epo
... hmorela is asking for clarification on nbme20/block1/q#22 (A 38-year-old woman comes to the physician because...)
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submitted by hmorela(3)

Why is it that the answer isn't also glossopharyngeal since you test CN IX by saying "Ah" also? Please help! Thanks!!

sinforslide  I believe that the arrow pointed to the uvula; uvular deviation would be testing for CN X palsy. CN IX's only motor innervation is the stylopharyngeus. (Not testing for gag reflex!)
... pseudorosette is asking for clarification on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
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submitted by pseudorosette(1)

Why is it that the pulmonary capillary wedge preesssuree is increased? on pg. 307 of FA 2019 it says it can be increased or decreased :/

giggidy  Depends on where the infarct is I guess? Crackles in lung base means increased left sided pressure and therefore PCWP. At least that's how I thought of it.
... usmleuser007 is asking for clarification on nbme22/block1/q#7 (Two patients, a 54-year-old man (Patient X) and a...)
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submitted by usmleuser007(84)

Someone care to explain why [time to steady-state concentration] is not the correct answer?

omerta  In pharmacokinetics, steady state refers to the situation where the overall intake of a drug is fairly in dynamic equilibrium with its elimination. In practice, it is generally considered that steady state is reached when a time of 4 to 5 times the half-life for a drug after regular dosing is started. The time to reach steady state is defined by the elimination half-life of the drug. So in a patient with renal dysfunction, the plasma half-life is going to be prolonged and the time to reach steady state will increase proportionally.
belleng  loading dose is independent of the concentration of the drug in the plasma and the dose frequency...this is why you give a patient who is seizing a huge dose of anti-seizure meds in order to reach a theraputic range on the first dose despite the high risk of toxicity and side effects...primary objective when seizing is stoping the seizure so you want to increase the dose response curve with a massive load
belleng  loading dose is independent of DOSE (should have said dose, not concentration in plasma) & FREQUENCY
... fulminant_life is asking for clarification on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
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submitted by fulminant_life(19)

Why is it 99% and not 95%? It asked for onset of disease at less than 9 years of age. I'm clearly missing something here

cbrodo  @fulminant_life because the mean age is 3.8 with a standard deviation of 1.8. An age of onset of 9 years is nearly 3 standard deviations above the mean. Therefore, since we know +/- 2 SD covers 95% of the bell curve, it must be higher than that. The only option higher than 95% is 99%.
charcot_bouchard  Yes 9.2 was the upper limit for 99% CI. I picked 95 first because i thought 2.5% would be out of this range. But changed ans because it should be less than 2.5% because 9.2 is so close to 9. Also they are asking CLOSEST to which of the following?
... yotsubato is asking for clarification on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
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submitted by yotsubato(207)

Yeah sure, lets give the guy who wants to keep his dick working and be attractive towards women Finasteride and completely ruin his testosterone levels and give him a limp dick, man boobs, and decreased performance in sports.

Sometimes the NBME really just makes me ask Why?

Topical minoxidil would be way better but no they wont put that as a choice

... yotsubato is asking for clarification on nbme23/block4/q#23 (A 74-year-old woman comes to the physician because...)
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submitted by yotsubato(207)

Arent we NOT supposed to use ipratropium in old people?

amirmullick3  Who said not to use it in old people? Remember "I pray that tio can breathe soon" and tio is an old uncle in spanish but its also the other drug, tiotrropium.
drdoom  discussion of anticholinergics & elderly also discussed at some length (but different context) here: https://www.nbmeanswers.com/exam/nbme22/1288
guillo12  Ipratropium does not penetrate the blood-brain barrier, so I think this is why it can be given to old people. https://www.rxlist.com/duoneb-drug.htm#clinpharm