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Welcome to aesalmon’s page.
Contributor score: 81


Comments ...

 +5  (nbme22#33)
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Ledigy cell eahlpprsa,iy oudlhs losa ese iorfbiss and naathziniloy fo teh lseubtu tub i'm not sgenie .it.. ツ)¯(_/¯_

meningitis  I think its there.. I thought it was the lighter red/pink material (hyaline material) And I thought the white streaks were the fibrosis like "streaked ovaries"in Turners. +

 +3  (nbme22#16)
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FA .gp 760 - uflerai fo uofsin fo het ramaixyll adn dergme amiedl nalas psscereso i(amoftorn fo mripary talpe)a

meningitis  I think Cleft palate could also be due to failure of fusion of lateral and medial nasal prominences.. but since the baby had lip involvement and the lateral nasals can be seen, I went with failure of Maxillary and medial nasal fusion. Someone correct me if im wrong. +4
snripper  @meningitis this is cleft lip, not cleft palate +2

 +3  (nbme22#48)
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I lfee ubmd ofr sgnika utb anc smonoee anxpeil i?hst If ish psarnet are fo oscel ot rlnaom MIB dan rea nccdnoree uotab ihs ethwig why odulw hyet be gaoniwll sih alcoeri unsnoimoctp ot xeeced sih ereygn nuieteedpr?x ( KAA ngtleit eth kid aet too chum dna ton sreicxee )ghoneu

meningitis  That's a modern day mystery. +16
drdoom  The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend. +1
niboonsh  aka 'merica #firstworldproblems +4
makinallkindzofgainz  If you are obese, it's because you have consumed calories in excess of your energy expenditure, end of story. (there are factors that affect your energy expenditure, but the simple statement is 100% true, unless you want to argue against the laws of thermodynamics). A is the only correct answer. +1
tulsigabbard  This answer hit too close to home. +4
castlblack  I think the reason they point out the average weight of the parents is because leptin disorders are inherited. It helps you eliminate that answer choice. +1

 +12  (nbme22#36)
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p.g 321 of AF - ceutA ehsap ascetnatr dupeulrateg- gurind sisetcmy n:sfetosimiatna M"roe FSiHF in the C" o,brui neF,i geSe irtnFnrmir diloyam nriev tHp-aCced,Aeiic, oip.tern


 +9  (nbme22#28)
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enWh ni dtobu ist pbrybalo hte peicSln iVne ly(a"p dd"os - oGnla)j


 +6  (nbme22#19)
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heTso sriterae go rrhwevee ehty natw - fof teh r,Aato nocomm iiaslc, er.vewrhe lynO 2 urrtsee hot


 +3  (nbme22#20)
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Cilnlaci ilrta - sapeomrc uceeprihtat ntebisef fo +2 rnseetmtta anafirr(w v.s Onna-abpeed lpat)lreil - btho teh heahtl poersdivr dna hte pt ear waear of het rdug nigeb genvi

jackie_chan  How are we supposed to know in the question the patients and providers are aware that they know what they are being given? +
haydenelise  I went back and forth about it, but in the end figured that they were aware since one regimen involved subQ injection + oral med and the other was subQ injection alone with no oral placebo. +2

 +1  (nbme21#14)
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tlSecenpmyo = rmoe sustecebpli to scaeaelpudtn grsiamsno

I tup E. olic as tis stlaucnpdeae but thta snta'w the mtos ihrtg asnwer I uegss?

pippylongstock  This question is asking about the ‘S’ of FA Mnemonic for S. Pneumonia “MOPS”. Strep pneumo is the most common cause of sepsis in adults. +2
emmy2k21  MOPS stands for meningitis, otitis, pneumonia, and SINUSITIS. It doesn't stand for sepsis. My guess as well is which is "more correct". It's about being able to identify encapsulated organisms and the spleen's role in immunity. Ha I chose E coli as well. +6
et-tu-bromocriptine  emmy2k21 is correct, the S is for sinusitis. I was between E.coli & Strep Pneumo, but then recalled Sketchy putting the sickle on the 'encapsulated' knight in the Strep Pneumo video; Strep Pneumo is more associated with infecting sickle cell "functionally asplenic" patients. +3
aneurysmclip  You could also recall that before splenectomy(ik this is a emergency splenectomy) we would want to give an encapsulated vaccine like the pneumococcal vaccine. this pushed me towards strep over ecoli +1

 +0  (nbme21#36)
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I tnwe bkca nad tdwceha tshi scienot no ahoatmp tfear itggtne eht nuotqies nwgor - rD. tSatra ayss atth hoonadmrsC nda hodasmrronaosCc erias in eth EA,DULLM adn nto het eo.ctxr Howrvee teh itqounes tmse aestst atth hrtee is gikctnei"hn of eht ihsiaypds and ripudnisot of hte XEORCT whti acolf aear of srdcaeeni taflicaonii"cc, ???

yotsubato  It arises in the medulla and *passes* through the cortex because its invasive and malignant. +12

 +2  (nbme21#37)
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Cna enoayn elixpna wyh hits si nto a utriyiapt aomaend? sI ti tjus a cakl of hetor ytsm?omsp

benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +19
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +1
teepot123  fa '19 pg 516 +




Subcomments ...

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eTh ueoqistn kass tabou raepeltnra riadioattisnnm fo teh acecniv ninmg(ae, ont ugnis teh arlo ureo.)t nool-rNa cvacesin wlil tno srngtylo eiitcl IgA psn.seeor r-oNlona eacscvin not espur plfhleu in mcotaginb a ugt uscmloa oiicnften hcsu as V. hroelac, rweeh gAI is mroe .etasinl Not sreu if itsh si het aatlcu rctcoer ars,gnonei tub ti edl to eth ghitr .nsware

aesalmon  I totally skipped over the word "parentally" when taking this - ugh! +15  


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hsTi oen swa a itllte tr.ikyc rFo itsh neo teh yke si eth low dodronaiiei uatpek. Tsih netpiat sah ighh T4 adn lwo TSH cwhhi aemks sseen in a idhrrthyepyo eiantpt, seapprh uyor ftsri gouhhtt si atht hits apietnt sha ’arsGve e.ssdeia eor,veHw in s’aevGr uoyr hrdtyoi si neibg meltsiatud ot mkea more royhdti hneroom romf atrcshc dna sa cuhs dowlu haev an iendcsrae iiardioenod ktpeau euceabs teh dhtryoi si gbniirng ni the deriueqr (own elrblei)doaad dein.oi This si hyw ti si otn aeGrsv l“(eseaer of dhoiytr mnrhoeo fmro a ihoyrdt ldtuseamit by biand)s.oi”et

So if its tno aGe’rvs wath dcolu it b?e Fro sthi uo’yd veah ot oknw thta iHosmthsao’ rhoiyditsTi (loas onwkn as nciCrho ytohcpLmcyi dioiyTisthr dna is eftno ererdfre to sa chus on badro xmase to wrhot uyo f)fo ash terhe sashpe - rfits yhet era h,rditpyrhyeo ethn hdoeiryut, hent eth silcsca doipyrtohhy atth you dwoul pexetc tihw wlo 4T dan high S.TH siTh was teh eky to ihst teo.unsiq The asrnoe fro htis si atth nittodiahyr eerxaiposd bsndoeiiat ni ’Hhoosmitas ueacs eht yhirtdo ot lreasee lal fo tis doetsr ihdyrot rnoomeh nmgkia het ptaenti dhrritpyeyho fro a roths repdoi of .temi Atefr htis imasvse seleare of rodhiyt oorm,nhe eth eaitibndso eakm tmhe beanlu ot kmae wen TH adn rthfeeroe htye cboeem uroheyidt for a hostr deopir dna hnte pthyhiooydr cwihh oyu wluod tc!peex ciSen hyte anct’ akme new ,TH eth dthyoir iwll otn keta pu teh iniiraeoddo nad ortefehre ethre illw eb owl irnaediiood putek.a ,ecHen erese“la of esdtro drhotiy mhrooen rfom a oyridht ldnga fiittndlaer yb e.opymy”tlchs kaa cyLtpyhom“ci i)oohmsast(h h.ys”itriodit

I hktni les“raee of hrdiyot ooenrhm fmro a huoamlmytops thyrdoi dl”nag si nifrrrege to oesm idnk of iotyhrd ncerac in hhcwi sace yuo wudol pctxee ehmt to eb sgcriedibn a oeuldn no donoiiearid akteup.

rmumaSy​ dovie reeh dan sola a agetr itse in eralng:e /onneitnedrta:ch.rcrlreees/qsdiuoihn/d/ao/oiep/yptmdg

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9  
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3  
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1  
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +9  
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +  
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2  


submitted by someduck3(58),
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atF ubolsle nmistiva rea ,AE,,KD. oS tohb D ma;p& E ucldo be raecsdeed in isht pt. uBt uyo vahe to wkno atth naVitmi E yiieccdnef is scaosdiate ithw eaynlinoietmd ap&m; has eebn tsdcoaseai wthi erospotri ulocnm .nelyaemoditni slAo tiV E can eb inevg wthi mhAzeelri instatep sa ti sleph hiwt eerf rlda.ia?.sc

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration: https://www.ncbi.nlm.nih.gov/pubmed/9012278, as does Copper (TIL): https://www.ncbi.nlm.nih.gov/pubmed/15249607 +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +  


submitted by shaydawn88(8),
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I owudl tihnk toesilnuor veisnvlo hte emts lcsel tpey( II sm.youpcn)eet Is teh nttica nseemtba remaemnb the nweasr cbeeasu ti miitls adpsre?

aesalmon  I would also like to know if anyone can answer this question - I saw it as a Sattar "one day, one week, one month" kind of question. Its probably very simple but I still don't get it +  
bubbles  I posted a new comment explaining: basement membrane integrity is the strongest determinant of full fx recovery following pulmonary insult :) +5  
drdoom  You have to think about it this way: the basement membrane is the “scaffolding” on which [restorative] healing occurs. So, yes, stem cells (type II pneumocytes) would be involved in that healing process but they couldn’t restore the *normal* architecture (“no abnormalities”) without the ‘skeleton’ of the basement membrane telling them where to go, in what direction to grow, which way is “up”, etc. If the basement membrane is destroyed, you can still get healing, but it won’t be organized healing -- it’ll be *disorganized* healing, which does not appear as normal tissue. (Disorganized healing is better than no healing, but without a BM, the regenerating cells don’t have any “direction” and therefore can’t restore the normal architecture.) +8  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  


submitted by oznefu(20),
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’Im ianghv boterlu ngdnsdeuatrin hwy sith si a etetrb chocei tnha Pegta ees,dsai ilycsealpe ihwt het rnsaiecde PLA?

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +23  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +16  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +1  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +5  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by seagull(1403),
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iWhch of teh lfioglwno ssernoa is ywh isth ioeuqstn is ullb?

1) nsUgi eht owdr lcy"cc"i niestda of cicctylri rfo yartlic

)2 Kwngnio lla fo idyolomeigep of all ugsdr

3) gavnhi to ensaor tuo hatt iinginthclcaoer fceetsf are prboalyb eth srwot vroe plah1a or 1H ffetsec to no cttenrayi.

4) The pnicrplig rnosepdsie of sdguntiy rof skestaw-d-eyo no end to oablypbr do gvearea on het te.st

nlkrueger  yo, re-fucking-tweet +20  
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4  
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1  
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5  
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +  


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ntd'o be a cd?ki nto rlayel resu ahwt rmeo rehte si ot .it heT atnietp sto'ned eavh any thoer lfyima os hsit womna souhld be nderdciose laymif

aesalmon  Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine? +5  
hungrybox  Yeah, I got this one wrong with the same logic as you, aesalmon. +1  
emmy2k21  I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines! +8  
dr_jan_itor  @emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase +8  
et-tu-bromocriptine  Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice. Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy. +4  
lilmonkey  I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time. +1  
docshrek  @lilmonkey can you please give the QID for the UWorld question? +2  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. +  
jakeperalta  Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. P.s:it struck me as a romantic relationship as well, but it doesn't clear my doubt😓😭 +1  
drschmoctor  @jakeperalta Following the hospital policy is wrong because it would be cruel and unnecessarily rigid to deny a dying woman the comfort of her closest companion. Also, It would be inappropriate to ask the Pt to lie. What's the point of becoming a doctor if you have to follow some BS corporate policy instead of calling the shots and doing right by your patients? +1  
peridot  Ya kinda dumb that usually NBME usually tells us to never break the rules, yet here it's suddenly ok. But here the reason for this exception is that while only "family" is allowed, a lesbian relationship qualifies the "friend" as family (they just were never officially acknowledged as family/married due to stigma or state laws, which society recognizes today is dumb and outdated). It's a stupid technicality that her significant other isn't allowed to visit as a family member, so while we usually never want to break rules, this scenario follows the "spirit" of the rule. Plus it's a really extreme scenario where the woman is dying and just wants to spend her last moments with her loved one and it would be too cruel to deny someone that. There is no lie involved, which kinda leaves open the chance for the situation to be cleared up if worse comes to worst. This is different from E which is a straight up lie. Hope that helped. +  


submitted by seagull(1403),
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t9t/.i/olis02hcMCnsp8b.1./:prmwhane.igcm7n///lc2wPvtw

Tshi reiclta lasif ot onniemt opor binra empeotedlvn in iE.iYtoHyhmrsdPR The atuorh tums eahv teamn h.rHYPiysodOimt

shTi tenqisou uetssp em to on e.nd

aesalmon  I agree, the article you linked states "signs of fetal hyperthyroidism such as tachycardia, intrauterine growth retardation, cardiac failure, and the development of fetal goitre" I chose answer E during the exam - "Thyroid gland enlargement" Still trying to understand how they linked cretinism to a case where the mother's hypothyroidism was well controlled, and then asked for the sequelae if her TSH increased. Maybe increased TSH is supposed to indicate worsening hypothyroid - low T3/T4 needing to be stimulated by TSH? +