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Welcome to apurva’s page.
Contributor score: 68


Comments ...

 +11  (nbme18#45)

THIS IS KAPOSI's SARCOMA ==> give antineoplastic

"THIS IS JUST TO LENGTHEN THIS ANSWER, NEVER EVER PAY THIS SITE, EDUCATION SHOULD BE FREE FOR ALL!"

michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +3
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!😝😂😂 +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +

 +1  (nbme24#19)

In India, our nurses are smart enough to perform PV and even to deliver the neonate!!!

I am crying due to my 60usd loss!!!!


 +1  (nbme24#28)

Lol i thought trauma would hit more superficial structure than deep.. haha

cassdawg  Literally how I answered this question cause I didn't know what dysmetria was. Convinced myself of some version of coup/contrecoup that would injure this part of the brain and got it right for all the wrong reasons. Wish I could do that more often. +
faus305  @cassdawg I did the same thing, lol. But I like to think that deep down we knew what we were doing. I knew the cerebellum was involved in balance and that this guy who just crashed his motorcycle would probably be having some balance issues. +

 +2  (nbme24#42)

I think for nbme 24, i wasted my hard earned 60 usd


 +0  (nbme24#40)

Pharyngeal arch is not same as pharyngeal floor, pharyngeal arch is mesoderm from which nerve artery muscle cartilage develop. Pharyngeal floor is from where tongue develops which is endoderm

mutteringly  However... 4th-6th pharyngeal arches do develop ACCCT (arytenoids, cricoid, corniculate, cuneiform, and THYROID). Thyroglossal duct cyst: a remnant of the thyroglossal duct that forms during the embryonic development of the thyroid gland. The thyroid gland originates from the foramen cecum at the base of the tongue and descends caudally into the neck, creating the thyroglossal duct. If the duct fails to obliterate, midline neck cysts or ectopic thyroid tissue can develop anywhere along the path of the thyroglossal duct. +

 +0  (nbme22#32)

Chronic diarrhoea == Vit D malabsorption = Hypocalcemia (say in crohns)

ACute diarrhoea = Hypernatremia, Hypokalemia, hyperphosphatemia

Dehydration can also cause hyperuricemia and ppt gout attack, but for young pt i think this will be irrelevant


 +0  (nbme21#45)

Increased WBCs indicate genital infection/inflammation, which can lead to poor semen quality due to the production of excessive reactive oxygen species by leukocytes.

Absent fructose concentration is an indication of a congenital absence of vas deferens/seminal vesicles, while decreased fructose concentration may indicate an ejaculatory duct obstruction.

pH > 8.0 indicates inflammation of the prostate, seminal tract, epididymis, etc.; pH < 7.2 indicates seminal vesicle dysfunction or obstruction of the ejaculatory ducts.


 -1  (nbme21#50)

I wonder i chose “sexual transmission” because same background of question stem was in AMBOSS stating the acute serum sickness like presentation for Hep B.

None the way, NBME wins.



 +1  (nbme21#14)

The real thing is TSH, T3, T4 and thyroglobulin cannot cross placenta. TRH, Iodine, TSI can cross. If mother has high TSH (considering primary hypothyroidism) —> Poor brain development If mother has TSI (Hashimoto) —> cross the placental barrier —Increase in thyroid gland (May present with stridor at birth.

demihesmisome  Ahhhhh Thank you. This was what I was trying to understand. +
apurva  please note that free t4 can cross the placenta +1




Subcomments ...

submitted by apurva(68),

The real thing is TSH, T3, T4 and thyroglobulin cannot cross placenta. TRH, Iodine, TSI can cross. If mother has high TSH (considering primary hypothyroidism) —> Poor brain development If mother has TSI (Hashimoto) —> cross the placental barrier —Increase in thyroid gland (May present with stridor at birth.

demihesmisome  Ahhhhh Thank you. This was what I was trying to understand. +  
apurva  please note that free t4 can cross the placenta +1  


submitted by b1ackcoffee(34),

Any good material to prepare for this kind of stuffs?

apurva  Lord Jesus +10  
ozmartini  Had to think back to my cell bio class in undergrad +  


submitted by mcl(578),
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hTis gmeai is usf.eul etNo thta teh nista uesd seamk nlimey peaapr dar.k

gieettnV si cyptali ofr siPsakn'orn aisdee.s raeA D si the tntasaibus nr.iag

oznefu  Oh nice! Thanks! +  
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +  
apurva  Saved My life +1  
john198  is this link only for MSU students??? , I can't access it . +  


submitted by niboonsh(336),
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Tsih si a asce fo cteau tsptnalran entoei.crj seewk ot homsnt arfet hte at,anpstlnr icrpeitne 8dc drn/ao dc4 t eclsl era aidcteatv nstaiag hte roond (a etpy 4 )SHR nda het noodr trstsa agnimk bnieadtios stiagna eth rltpsa.annt Tsih nrtsepse as a cvsilaitsu whti dsene leiarniittts mycotpichly ie.ilsranftt (A81F02 pg 19)1

ls3076  Actually was confused about this due to a UW explanation. UW said acute txp rejection has two types - humoral and humoral and cellular. Humoral has Neutrophilic infiltrate + necrotizing vasculitis while cellular has lymphocytosis. Can anyone simplify/explain this please? +3  
apurva  We usually look for c4d complement for humoral response in acute graft rejection. Because c4d makes covalent bond with the endothelium can can be found on staining because it is long lasting. +  


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the ftriacn cducrero 16 rhs goa, orfm 4sr1h2-2 tafre eth fainrct herte will be Rde Nsrnoue.

tsl19  FA 2018 - p. 496: ischemia -> pyknosis within 12-24 hours. +  
d_holles  yeah the infarct occurring 16 hr ago is key. i zoomed in only on the died 1 hr later +  
apurva  Me too zoomed on “1 hour later” and marked no change +  


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Teh iwLveenare rBuk oPtl si liynma eerintpredt yb sti X and Y esT.rhnptietce oisqtuen teatss that ivnigg B6 aseiscrne het vtcytiai ot nromal velesl, cwhhi amnes eht yitavtic udsloh eb teh smae as eht e.nomnca erH,l ihrte Y tipctrnee hdolus eb teh a,esm so ew era etnebwe scoeihc B adn C. A dna D od not vhea hte asem Y enrttpeic as nhagl.im reoHr nnoaeortcsnict fo B6 uaesdc iayvtcti to cebeom anlm,or adn os xamV wlli otn eb anignhcg dna ew cna lanecc A dna A.D ash a rlweo xaVm nda D ash a umch hiegrh mxaTh eV. ienrcdfefe eebnewt B and C is in hreit K.m Mnvgio ot hte lfet on eth X axsi smkea eth Km welro dan tslel uyo hatt fiayiftn si sihre ohg you ldowu tno eend emor 6B. But in ruo scea ainffyit fo the eezymn ofr B6 si leyrla lwo, hhiwc si hyw we eden a ont oerm 6B.

nI ramyus,m ew anwt het emas amxV dna a rghehi mWKe . awtn teh lmo"n"ar yactiivt seam( avxm sa maoln)r dan we ende hergih aunmsot of B6 ofr cseucss ai osfinyft of eth znmeye ofr B6 si lbyrobap eyvr lw.o

ihCoce B ash a K(m-1)/ velua slocer ot 0 hwihc maesn Km si lewor adn iytnfifa of het ymenze rof ist aurestbts si usrep T lwshoi. aemsk eness sa ngivgi erhhig anosumt of het eic"op"mtviet taserusbt 6B si il.genhp

apurva  This explanation is wrong!!! X axis is not 1/km in the question, it is 1/pyridoxal phosphate. (1/km should be 1/homocysteine) Also the question is asking about allosteric activation of cystathione synthase due to addition of pyridoxal phosphate. Which means the Km should decrease (affinity increases after addition of pyridoxine). Considering the x axis to be 1/pyridoxal phosphate, now apply simple logic of maths, increase pyridoxal phosphate = bringing line more close to zero (because it is -1/pyridoxal phosphate). +10  
apurva  Had the X axis be 1/km, the answer should be C +  


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hTe wevraneLie rBku ltoP si ylmina eeinrrdtpet by sti X nda Y tthneerp.eTisc qitesuno tasste thta ginvgi 6B cssrnieae eth tiaycvti to oamrnl s,lelve wihhc anems teh iitvycta hsulod be het same as the e ,H.lmnoeanrc ireht Y tniecterp lhosdu be eht me,sa os ew rea wneeebt oeicchs B dna C. A dna D od ont vahe eht smae Y eeicrnptt as agnrhiomHr.e l ncnsortctiaeon fo 6B sduaec yvtaciti to ocbeem anl,rmo adn os Vamx llwi tno be nhgginac and we acn aneccl A adn DA. sah a olwre Vamx and D ash a umch hriehg eTxh. aVm eerefficnd eebentw B adn C is ni ehirt Km. nviogM ot the left no eht X xsia emska hte Km weorl dna ellts you htta fiintfya si ghe rhsio oyu doulw tno eedn roem B6. tBu in our aecs ftfiinay of the ymneez for B6 is lelyra ,wol whhci si hwy we ened a otn oerm B.6

In ayrumm,s we wnat hte esma Vxam adn a gehrhi K.m We natw het "rlam"on iyiavttc e(sma xvam sa omla)rn dna ew ened heigrh smantou of B6 rfo ussecsc tysoinif fa of teh enzmye orf B6 is opyalbrb yver owl.

icCeoh B hsa a (mK/)1- vaelu rcosle ot 0 hwich anmes mK si elrow dna iafnfity of teh nyeezm ofr sti sttbauers si reups iTo.s lhw asemk ssnee as invgig hegrih nmaosut of hte tep"it"comeiv bestasutr 6B is gni.ephl

apurva  This explanation is wrong!!! X axis is not 1/km in the question, it is 1/pyridoxal phosphate. (1/km should be 1/homocysteine) Also the question is asking about allosteric activation of cystathione synthase due to addition of pyridoxal phosphate. Which means the Km should decrease (affinity increases after addition of pyridoxine). Considering the x axis to be 1/pyridoxal phosphate, now apply simple logic of maths, increase pyridoxal phosphate = bringing line more close to zero (because it is -1/pyridoxal phosphate). +10  
apurva  Had the X axis be 1/km, the answer should be C +