NBME Answers : asapdoc's page

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submitted by stapes2big(16), visit this page

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I’m not sure about this one but the way I thought about it was that since the confidence interval included 1, it was not significant. And thus p value must be above 0.05

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tea-cats-biscuits That makes sense! +

asapdoc Had the same reasoning +24

jkan I get that it's not significant, but why is it 0.05<p<1 and not p>1.0 +12

jkan nvm, it's can't be greater than 1 because then it would have a negative% confidence interval which cannot happen (Think if p>0.05 means at least 95% within confidence interval) +12

charcot_bouchard p=0.05 means theres 5% chance null hypothesis is true. p=1 means theres 100% chance null hypothesis is true. >1 means >100% chance which isnt possible. +14

wowo p is a probability, so can't be greater than 1 +11

noname @charcot_bouchard, that is not a good interpretation of p-value. A better interpretation of p=0.05 would be: If in reality there is no increase in risk (RR=1), and if we replicated the same study of the same sample size many different times, then we would expect to find a risk ratio of (X) only about 5% of the time. +2

submitted by karljeon(140), visit this page

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Vitamin E deficiency causes hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination.

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karljeon Can anyone explain why the serum lactate dehydrogenase (LDH) level was elevated? +

asapdoc Vitamin E is an antioxidant. Thus a deficiency can cause hemolytic anemia. +6

sympathetikey @karljeon Intravascular hemolysis = LDH release from RBCs +4

submitted by allinthistogether(1), visit this page

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Legionella is common causes of pneumonia superimposed on chronic obstructive pulmonary disease.

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asapdoc Im pretty sure so is strept pneumoniae +4

usmleuser007 COPD is also exacerbated by Viral infection: Rhinovirus, influenza, parainfluenza; and Bacterial infection: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus. however, the questions gives a hint that it may be legionella = "weekend retreat" which may be associated with this infection +5

loopers From FA 2017 pg 139: Legionnaires’ disease—severe pneumonia (often unilateral and lobar A ), fever, GI and CNS symptoms. Common in smokers and in **chronic lung disease.** +2

kentuckyfan I also believe that the other attendees showed signs of pontiac fever, which is another hint they tried to get at. +3

luke.10 i did it wrong and chose influenza virus since it is most common infection in COPD but the clue in the Question is that the other attendee didnt get sick since in legionella there is no person to person transmission +2

endochondral but in Uworld s. pneumo is one of the most common bacterial exacerbation of COPD legionella wasn't even mentioned. How do we rule out s. pneumo ? +5

nala_ula maybe because in children s.pneumo causes otitis media? +1

smc213 Another hint made in the Q stem is the location being rural Pennsylvania.... Legionnaires disease was first discovered by the outbreak in 1976 at a convention held in Philadelphia, Pennsylvania. Not sure why I know this fact... +10

hpsbwz Biggest hint towards legionella to me was that they all were at a residence hall... i.e. where there'd be air conditioners and such. +6

stresssweat it says that other people developed pneumonia without needing to be hospitalized and that some people were asymptomatic. You would think walking pneumonia - Legionella +

submitted by beeip(141), visit this page

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How to differentiate between Norovirus and Rotavirus here? Must be related to the the contagious nature of the illness?

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strugglebus You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +8

beeip @strugglebus: I didn't know about the vaccine schedule. Thanks! +1

strugglebus As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +5

asapdoc @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +5

savdaddy its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +

savdaddy ***after the initial outbreak +1

eacv for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +4

link981 Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +2

submitted by hayayah(1212), visit this page

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Case of arteriolosclerosis.

Hyperplastic arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle ('onion-skin appearance')

Consequence of malignant hypertension (>180/120 w/ acute end-organ damage)
Results in reduced vessel caliber with end-organ ischemia
May lead to fibrinoid necrosis of the vessel wall with hemorrhage; classically causes acute renal failure (ARF) with a characteristic 'flea-bitten' appearance

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masonkingcobra From Robbin's: Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture. +1

asapdoc I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +26

uslme123 I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +1

hello The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +36

yotsubato hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies) +10

smc213 Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names. Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls. http://www.medlink.com/article/fibromuscular_dysplasia +3

smc213 *sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries. https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd +2

momina_amjad These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN! Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years) If it was the consequence, the presentation is still not classical! -_- +2

charcot_bouchard Poor controlled HTN is the cause here +1

charcot_bouchard Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +1

submitted by bobson150(28), visit this page

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Is the grey supposed to be a suture? If not why would this not be wound healing therefore granulation tissue?

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asapdoc If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld. +5

dentist granulation tissue is a part of the normal wound healing process, and happens within the first week. +

castlblack I agree I looked at that grey blob and thought foreign body --> granuloma +