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




... madamestep is asking for clarification on nbme23
 +0  upvote downvote
submitted by madamestep(3)

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(1)

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(3)

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
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submitted by unknown001(1)

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
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submitted by unknown001(1)

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(1)

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
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submitted by unknown001(1)

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(3)

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(1694)

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(519)

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(519)

Why cant this taken as sexual health?

... charcot_bouchard is asking for clarification on step2ck_form8
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submitted by charcot_bouchard(519)

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
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submitted by blue4415(3)

can Gonadotrophs “hyperplasia” rather than hypertrophy?

kevinsinghkang  wondering the same +
... unknown001 is asking for clarification on nbme24
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submitted by unknown001(1)

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
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submitted by unknown001(1)

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

b12 in ileum.

this will give you the answer

... unknown001 is asking for clarification on nbme24
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submitted by unknown001(1)

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
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submitted by unknown001(1)

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(1)

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(1)

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(28)

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(3)

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

... marypoppins is asking for clarification on nbme24
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submitted by marypoppins(1)

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

... agraham416 is asking for clarification on nbme22
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submitted by agraham416(3)

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

... an1 is asking for clarification on nbme18
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submitted by an1(92)

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(4)

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(3)

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(3)

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
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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
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submitted by chaosawaits(63)

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
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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 +
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. +
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 +
... chaosawaits is asking for clarification on nbme22
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submitted by chaosawaits(63)

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
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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(519)

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(5)

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(26)

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(3)

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(1)

can nephritic syndrome be without HTN?

... athenathefirst is asking for clarification on nbme20
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submitted by athenathefirst(4)

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(132)

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
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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
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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(5)

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 ??

... skonys is asking for clarification on nbme23
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submitted by skonys(35)

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(132)

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
 +0  upvote downvote
submitted by osler_weber_rendu(132)

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. +2
... charcot_bouchard is asking for clarification on step2ck_form6
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submitted by charcot_bouchard(519)

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(35)

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(105)

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

lindasmith462  i would but I don't have room with my lamp oil down there +4
... jlbae is asking for clarification on step2ck_form8
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submitted by jlbae(105)

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(63)

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(63)

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(63)

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(116)

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
 -3  upvote downvote
submitted by ih8payingfordis(16)

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
 +1  upvote downvote
submitted by veryhungrycaterpillar(28)

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
 +1  upvote downvote
submitted by abk93(3)

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(9)

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(105)

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
... yousif7000 is asking for clarification on nbme22
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submitted by yousif7000(10)

I chose bradycardia because I thought he was prescribed beta-blocker, why did we exclude beta-blockers?

... bgreen27 is asking for clarification on nbme21
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submitted by bgreen27(6)

Can someone help a brother out? My thinking was that increased fluid in the interstitial leads to increased lymph, so I thought they were looking for something to simulates high altitude pulmonary edema or arterial pulmonary HTN, which I am pretty sure both lead to pulmonary edema. Where did I go wrong?

ali_hassan  this might be stupid but i got it right with this rationale: increase "normal" fluid (0.9% saline) in body = increase lymph flow. absolutely no medical concept to it, just logic lol +
... osler_weber_rendu is asking for clarification on step2ck_form7
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submitted by osler_weber_rendu(132)

Why in the world was the Xray taken from that angle?

... osler_weber_rendu is asking for clarification on step2ck_form7
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submitted by osler_weber_rendu(132)

Am I the only one who heard an S3 in the pulmonic area?

sizario  I believe it was a splitting of S2. It occurred during inspiration causing increase preload and delay closure of P2 +
... osler_weber_rendu is asking for clarification on step2ck_form7
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submitted by osler_weber_rendu(132)

Arent we supposed to use PCR for Herpes Simplex?

... aaftabsethi1 is asking for clarification on free120
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submitted by aaftabsethi1(8)

Can anyone tell how a hair dye affected her forearm ?

vetafig692  lmao good question! +1
chaosawaits  if you're asking that question, you're not ready to see what the pubic region looks like now +
... shakakaka is asking for clarification on nbme20
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submitted by shakakaka(14)

Anyone can explain why IgG is not correct answer ?

drdoom  Newborn immune system will not produce a robust IgG response before about 6 months of age! +2
... shakakaka is asking for clarification on nbme20
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submitted by shakakaka(14)

I understood that it was transitional cell carcinoma, and a smoking is a risk factor ( as it contains aromatic amines ) , but how about arylamine exposure? Its exposure also associated with blader cancer.

... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(19)

What about acute intermittent porphyria 2/2 alcohol? It also has painful abdomen, polyneuropathy

jmorga75  Most of the time AIP questions mention a positive family history for it, and symptoms that worsen with fasting. +
satanicdo  they have similar symptoms because lead can disrupt heme synthesis (similar pathophysiology), but AIP causes discrete attacks of pain rather than continuous symptoms. also, lead poisoning can lead to microcytic anemia and hypertension +
charcot_bouchard  Both shares neuropathy, abdominal pain and neuropsych symptoms. But AIP pains are intermittent and can be very severe. Anemia push towards lead poisoning. Absent of urine color change also push towards lead. And make ur booze in your garage/celler Heck Ya Lead poisoning +
... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(19)

Why is ALP increased? .

... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(19)

TOF is the only cyanotic disease out of the lot. RV heave is prob due to RV hypertrophy. Single S2 cuz of diminished pulmonic component, systolic murmur d/t VSD what does the systolic click signify? Pulmonic stenosis?

... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(19)

Isn't pulmonary angiography the gold standard for PE detection?

lubdub  Yep, but not needed if the pretest probability is high (think wells) and the V/Q is suggestive of PE. Thats enough evidence to treat. +1
... sassy_vulpix is asking for clarification on step2ck_form6
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submitted by sassy_vulpix(19)

what does blood pressure in 40/palpable mm Hg mean? i saw it in another question too

drdoom  systolic registered @ 40 by cuff but diastolic too low to be detected; “palpable” as in a pulse is palpable (but diastolic too low for detection) +3
... xw1984 is asking for clarification on free120
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submitted by xw1984(7)

Per FA, should aminoglycosides be used in gram negative infection? S.viridans are Gram positive.

... drmohandes is asking for clarification on step2ck_form6
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submitted by drmohandes(168)

I did not understand why you don't check renal function.

Doesn't lithium affect both thyroid and kidney? Also, she has no clinical signs of hypothyroidism, so I figured we need to check her renal function.

sassy_vulpix  She has weight gain & sleep disturbances (? not sure if this is current or before medication) +2
drmohandes  True, that information could point at hypoT. +1
... bharatpillai is asking for clarification on step2ck_form8
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submitted by bharatpillai(38)

Oh absolutely not. Primary myelofibrosis ALSO presents with splenomegaly, pancytopenia and immature myeloid cells in the periphery. WBC counts for CML are typically >50,000. WTF is this question?

stinkysulfaeggs  But he doesn't have pancytopenia, his WBC is 22,000. +1
szsnikaa  lol +
charcot_bouchard  WBC and Platelet in myelofibrosis is variable....Not always dec. i still dont know what was i thinking. should have picked the cml since the rainbow wbc panel that they described from that +
... ranchistotallylegal is asking for clarification on step2ck_form7
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submitted by ranchistotallylegal(0)

Why not HIDA? not therapeutic (ERCP is both dx + tx) + it is only used for suspected cholecystitis (not cholangitis) when U/S is equivocal.

... rahmanu is asking for clarification on nbme22
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submitted by rahmanu(2)

How do you Ddx this and allergic reaction to the sun?

I answered "first degree burn" in a more or less similar q in another nbme but got it wrong lol. WTH am I missing?

kimde  I think the key is that they don't mention any blistering. From UTD: A diagnosis of polymorphous light eruption (PMLE) is usually based upon the clinical finding of a pruritic eruption of papules or plaques on exposed skin (picture 1A-C) and the patient's history of a similar eruption occurring in spring or early summer after sun exposure and gradually improving over the summer months. It is important to exclude other photosensitive skin conditions (table 1). (See 'Differential diagnosis' below.) +
... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(43)

Where can I find this information? I have not had my ICU rotation yet. I see in First Aid Step 2CK there is some information in the Pulmonary chapter but it is a long list and what is the high yield to remember? What is a good, fast, easy to understand source that I can use?

nayyyy  UWorld QID 16112 +3
rkd  BNB video on mechanical ventilation is too good. +
... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(43)

Can anyone explain the correct answer for this one?

... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(43)

The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy?

drmohandes  Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +1
drmohandes  Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +2
lubdub  Agreed. I him-hawed about it, but figured the free air should tell us what to do. +1
... tinylilron is asking for clarification on step2ck_form6
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submitted by tinylilron(43)

Is it just me, or is this question phrased strangely?

... chosened is asking for clarification on step2ck_form6
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submitted by chosened(1)

Why not hydralazine? treats hypertensive emergency per sketchy!

ddub  for eclampsia/severe pre-eclampsia (ie pregnancy) +1
... chosened is asking for clarification on step2ck_form6
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submitted by chosened(1)

Can someone explain why this wouldn't be fat embolism and hence supportive treatment (via mechanical ventilation/ intubation)?

keyseph  Fat emboli usually occur from long bone fractures, not hip fractures. Altered mental status is also a common symptom of fat emboli, which is not seen here. Petechiae can also be present, but are not necessary to make the diagnosis. Regardless of this, this patient has a Wells score of at least 4 (HR >100, ≥3 days of immobilization, hemoptysis). If you think PE is the most likely diagnosis (I personally did), then this patient has a Wells score of 7. For any patient with dyspnea and a Wells score of ≥4, PE is likely, so you would heparinize and conduct a CTA or V/Q scan. +2
jlbae  The femur is a long bone, but I agree with everything else you said +2
lubdub  Feel free to judge, but I just realized in the last few weeks that when they say 'broke her hip' they're talking about the femur not the pelvis. +2
jmorga75  I was going to make a comment about how Fat emboli don't usually present until a at least 24 hours after surgery, but on review it seems Uworld is inconsistent. Qid 3503/4561/12173/16061 - 24-72 hours after injury, Qid 4234 and Amboss- 12-24 hours after injury. Furthermore, being pedantic has lost me more points that it has ever gotten me. +
... shastri96 is asking for clarification on step2ck_form6
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submitted by shastri96(14)

can someone please explain this ? why would we negotiate a contract with a minor ?

ronabobonafofona  Process of elimination question for me. The only other decent choice was A, but you wouldn't recommend "punishing" the patient if she doesn't comply. Maybe you just wouldn't offer her reward. Therefore, B makes the most sense. I think of it like trying to bargain with the girl -- "if you take the medication, then we'll do x for you". Something to incentivize good compliance. +2
keyseph  I agree that it was mainly by process of elimination to get to the right answer. Negotiating a contract is also the only answer that has some leeway to talk to the patient about why she doesn't believe she needs the medication. +1
jlbae  Also, we're talking about a 15F here. If you were a 15F and your physician basically said, "hey, let's write up a plan so that if you take your meds as scheduled for a week, then your mom and dad will give you a $20 Amazon gift card to save up for some new shoes" then you would hold your parents to it. YOU HAVE TO BUY ME NEW SHOES NOW BECAUSE DR. X SAID YOU WOULD IF I TAKE MY ASTHMA MEDS MOM!!!! +2
lindasmith462  its kind of a weird answer - medication contracts are typically utilized for controlled substances. its not a legal document - they're really just a written agreement btwn a physician and pt about their meds and treatment regimen, the pros/cons of adhering/non adhering to said regimen, and the actions that will be taken if the contract is broken (aka if you come in and don't piss positive for the opioids I prescribe I stop prescribing them/fire you from the practice). Probably not totally appropriate for an adolescent who doesnt have full decision making capacity yet. I think it's getting at the underlying principals of adolescent non-adherance which is that as they go through normal behavioral changes with being more autonomous in their life they attempt to "take control" of their health through non-adherance. Therefore to improve adherence it is best to "contract" with the patient and make a plan together putting them in more control over their health. +
lindasmith462  also while mental health issues may increase risk of medication non adherence in adolescents it is a normal behavioral age related change +
lindasmith462  parents rewarding/punishing her still keeps the control of her treatment out of her own hands. obvi not enough signs of other mental health conditions to start any of the meds +
daniyal_ishtiaq  what if the child breaks the contract or lies about taking the meds. there was a similar question in step1 UW and some assessment forms that said that studies shows in adolescents the best approach is to join them up in a similar group as they learn a lot from their peers. +
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