welcome redditors!to snoo-finity ... and beyond!

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




... inmyblood is asking for clarification on nbme22/block2/q#46 (A 62-year-old man is being evaluated for rectal...)
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submitted by inmyblood(0)

What is the letter Y indicating in the picture? is it the large intestine?

... sunny is asking for clarification on nbme18/block2/q#18 (Researcher testing new cancer drug)
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submitted by sunny(0)

why is this so //i know its basic but still...??

... ssc505684708 is asking for clarification on nbme20/block2/q#42 (A previously healthy 32-year-old woman is brought to...)
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submitted by ssc505684708(0)

What happened to this "previously healthy" young female? Why is she vomiting blood? Drinking too much alcohol?

... amphotericin is asking for clarification on nbme22/block3/q#39 (A 52-year-old man with stable angina pectoris begins...)
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submitted by amphotericin(0)

I put constipation because I thought the medication being described might be CCB: can someone explain why nitrates over CCB?

... amphotericin is asking for clarification on nbme22/block3/q#16 (A 27-year-old woman comes to the physician because...)
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submitted by amphotericin(0)

how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing

... jean_young2019 is asking for clarification on nbme18/block1/q#30 (29 yo woman irregular menstrual periods)
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submitted by jean_young2019(0)

Could someone explain why this choice is the best answer? I struggled between A and D, and picked A finally, which is "ascertain educational level and provide publications".

... hhsuperhigh is asking for clarification on nbme24/block4/q#24 (A 13-year-old girl who has a 6-year history of type...)
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submitted by hhsuperhigh(1)

The diet is prescribed, so no need to refer to dietician anymore. It is a case of the patient non-compliance of diet. But why can't advise the parents to stop bickering?

... niboonsh is asking for clarification on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
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submitted by niboonsh(65)

is no one else concerned about the fact that theyre giving a beta 2 agonist to a woman whos 28 weeks pregnant.......?

... lilyo is asking for clarification on nbme22/block1/q#44 (A 52-year-old man with a history of alcoholic...)
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submitted by lilyo(0)

I had the same question regarding this. I know that external hemorrhoids rarely bleed and internal hemorrhoids present as painless bleeding so in my mind I knew I was being asked about internal hemorrhoids. However, superior rectal--> inferior mesenteric vein--> portal vein, can anyone tell me why the answer was superior rectal and not inferior mesenteric?

... humble_station is asking for clarification on nbme20/block4/q#18 (A 35-year-old man comes to the physician because of...)
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submitted by humble_station(0)

The question is asking if you did an immunohistochemical labeling of the neoplasm what are you going to target with the use of antibodies. Basically you want the antibodies you have labeled binding to what?

Since this is ZES -- a gastrin secreting tumor -- you want antibodies to gastrin to see where exactly this tumor is coming from

... amphotericin is asking for clarification on nbme24/block2/q#2 (A 45-year-old man comes to the physician because of...)
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submitted by amphotericin(0)

How does OSA lead to peripheral edema and loud S2?

futuredoc  Hypoxia leads to pulmonary vasoconstriction and therefore pulmonary HTN. This can lead to the peripheral edema. Furthermore pulmonary HTN can present with a loud S2.
... happysingh is asking for clarification on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by happysingh(2)

i kinda of feel "odd" asking this question : but the patient had an MI 6 months ago, so why would it be unlikely that he was told to "restrict salt, restrict fluids (water) " ??

Guess what i'm asking is : what makes choice E such an unlikely choice (JVD, bi-basilar crackles, peripheral edema) ?

& @meningitis : his bp is 135/82 mmHg ... why is that "HIGH" ??

... hhsuperhigh 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 hhsuperhigh(1)

This is how my brain farted while I was doing this question.... I wanted to choose TBG deficiency, but I kept thinking that if TBG is deficient, that means there are less or no binding proteins in the blood. And how can the free T4 be normal? Shouldn't free T4 increase if there were less T4 binding protein? ...

... cathartic_medstu is asking for clarification on nbme23/block3/q#8 (A 62-year-old man with a blood pressure of 220/160...)
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submitted by cathartic_medstu(3)

Labetalol = "alpha"-"beta"-lol

From Sketchy

Andrew Yang for president. is it 50 characters yet?

... hello is asking for clarification on nbme23/block4/q#2 (A 60-year-old woman with type 2 diabetes mellitus...)
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submitted by hello(59)

Why are "rotator cuff tear" and "rotator cuff tendnitis" wrong? is it bc both of these would show impingement sign? is there a way to DDx one from the other?

... hello is asking for clarification on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
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submitted by hello(59)

why is plasma oncotic pressure wrong?

... hello is asking for clarification on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
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submitted by hello(59)

which letter is CN IX in this diagram?

... hello is asking for clarification on nbme23/block3/q#33 (A 78-year-old man has had progressive loss of...)
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submitted by hello(59)

can someone please explain this?

thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC).
... hello is asking for clarification on nbme23/block2/q#7 (A 45-year-old man is brought to the emergency...)
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submitted by hello(59)

What's the echymoses supposed to be a clue about? Does this patient have DIC? Does DIC always cause hypovolemic shock?

drdoom  Disseminated intravascular coagulation (DIC) is a syndromic definition. (See tangent.) It does not “always” lead to shock but shock is definitely a possible sequela (since, by definition, DIC = “systemic thrombotic process”; anything systemic should get you a little worried), and so a patient with DIC should be monitored closely!
... cathartic_medstu is asking for clarification on nbme22/block3/q#38 (A 73-year-old man comes to the physician with his...)
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submitted by cathartic_medstu(3)

Can someone correct my reasoning here:

I was thinking positive airway pressure will increase alveolar ventilation and decrease hypoxia induced pulmonary vasoconstriction. Thus, RV after load would decrease => more preload to LV and more cardiac output. Then wouldn't BP decrease?

Any help is appreciated. Thanks.

... dai89 is asking for clarification on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
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submitted by dai89(0)

isn't candida yeast form under body temperature? why the picture shows a mold form?

... drmomo is asking for clarification on nbme24/block4/q#9 (A 10-year-old boy who was adopted from the...)
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submitted by drmomo(0)

why can't it be culex mosquito? maybe wuchereria bancrofti filariasis?

... anu is asking for clarification on free120/block2/q#22 (A placebo-controlled clinical trial is conducted to...)
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submitted by anu(1)

why is option D ) there is an increased likelihood of statistically significant findings... wrong ?

... anu is asking for clarification on free120/block1/q#11 (A 26-year-old man is brought to the emergency...)
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submitted by anu(1)

what about the increase in pulmonary vascular resistance ? doesnt PCWP fall in hemorraghic shock

... whoissaad is asking for clarification on nbme24/block4/q#18 (A 64-year-old man undergoes surgical repair of an...)
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submitted by whoissaad(10)

Artery of ductus deferens is a branch of infeior vesical artery. So why is B wrong?

happysingh  the question is asking about "adequate arterial supply"
... whoissaad 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 whoissaad(10)

What guarantee do we have that the roommate is going to stop smoking in the apartment by "asking" him to do so..?

... kimcharito is asking for clarification on nbme23/block3/q#22 (A 54-year-old woman with rheumatic heart disease is...)
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submitted by kimcharito(4)

it is normal irradiation to the RIGHT neck? what does it mean?

... soph is asking for clarification on nbme21/block3/q#25 (A 32-year-old woman comes to the physician because...)
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submitted by soph(12)

ok but why is blue nevi wrong? i thought q asks lession in both exposed and unexposed areas.

... 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(11)

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?

biaancadb  I was confused about this too. Only thing I had to go on is that I wrote down from somewhere that you see papillary necrosis in middle-aged adults and that it's uncommon in children (except those with sickle cell). Also I'm assuming PSGN is technically a proliferative glomerulonephritis since on FA pg. 578 the definition of proliferative is "hypercellular glomeruli", and for PSGN, you see hypercellular glomeruli on LM (due to leukocyte infiltration).
... 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(7)

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(59)

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(59)

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(59)

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(59)

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
angelaq11  It is a cohort, just as @drdoom said, but it isn't an "Observational" one.
... 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(7)

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(10)

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(59)

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(4)

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(4)

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(59)

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(8)

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(8)

can anyone explain why (D) metaplasia is incorrect?

angelaq11  because metaplasia would be a transformation of the normal architecture of the respiratory epithelium to one that does not belong there, in response to chronic irritation. This woman had pneumococcal pneumonia that was correctly (and I dare say promptly) treated, so she suffered an acute rather than a chronic insult.
... 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
angelaq11  I didn't actually know this one. I just ruled out everything except the fibularis muscles, and then to be quite honest, I think I had never heard before of the tertius one, so...I chose brevis.
... 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(15)

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(10)

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

dickass  European implies northern european (they even specified the patient was a person of pallor), mediterranean descent is usually implied by country of origin or by straight-out writing 'mediterranean'.
... 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?

step1soon  I was thinking the same!
... 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(4)

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
yex  Because I said so, applies here... :-/
doodimoodi  Cant believe we pay $60 for this crap
... 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(12)

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(4)

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
cr  i had the same problem, Whats about the fever?, could be present in gout?
... 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(10)

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
niboonsh  lmfaooooooo
... 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(20)

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(4)

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(10)

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(23)

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(12)

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(7)

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.
step1soon  Its primariy driven by PCO2! only when O2 levels drop <50 mmhg is when the body responds to low O2 pressures
... 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(4)

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(4)

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(38)

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(38)

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.
charmrooftops  You do get hyperlipidemia in cushing though? https://www.amboss.com/us/knowledge/Cushing_syndrome So still unsure why this is not a possibility. Is it just a "more common" thing for SIADH?
... 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(10)

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(9)

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(9)

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(9)

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
bullshitusmle  same here!!!:@
... 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(20)

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
yex  Funny Board!! Yeahhhhh
... 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(11)

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(4)

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

titanesxvi  Bcz I think vascular is the key thing here, whereas atypical lynphocytes would be more of EBV
... 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(14)

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(4)

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(75)

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(12)

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(23)

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(75)

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(75)

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(12)

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(4)

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
usmile1  also neutrophils are only seen in acute inflammation. This pt has longstanding inflammation which is associated with monocytes, lymphocytes, macrophages, plasma cells.
... 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(4)

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(75)

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(4)

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(33)

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(14)

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.