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 +0  (nbme24#4)

so his pitutary adenoma was removed, so prolly gonadotrophs were removed with it, so if you give gnrh it won't do anything as it can;t produce FSH/LH so you give fsh/lh directly to indce spermatogenesis and testo synthesis.


 +0  (nbme24#31)

It's saying a particular protein is made from this mrna, this protein is used as a precursor to produce those two hormones. so proteins once made, they need post translational trimming of N and C propeptides to be active. like trypsinogen becomes trypsin else they are just inactive protein. So any protein to work they need to go through post translational modifications.


 +1  (nbme23#28)

Phosphate is down that means something is wrong with PCT, then non anion gap acidosis that means bicarbonate is not being absorbed, glucosuria again PCT so just use your brain and choose decrease bicarbonate reabsorption in PCT


 +0  (nbme22#1)

Always know this Hypo or hypernatremia is because of change in the volume, this patient is going through heart failure, renal perfusion has gone down that leads to release of ADH cos of osmoreceptors stimulation. Now high ADH will reabsorb more free water that will lead to hyponatremia. So hyponatremia is almost always related to high ADH. I know few of you will think but RAAS system is activated too but that abosrb Na along with water but ADH just free water.


 +0  (nbme22#46)

It's an anabolic hormone, muscle mass, RBC mass will increase.


 +0  (nbme22#24)

Rheumatoid arthritis in an inflammatory process, you wanna block Tnf alpha which is a major inflammation accelerator, IL 2 blockers used for tansplant rejections, because you dont want your B and T cells proliferating, IL 2 induces differentiation of all immune cells.


 -1  (nbme22#42)

Acute phase reactants Upregulated: More FFiSH in the C Ferritin Fibrinogen Serum Amyloid A Hepcidin C-Reactive protein


 +0  (nbme22#31)

S3--> dilated cardiomyopathy (eccentric)--> systolic failure--> blood builds up--> increase hydrostatic pressure in pulmonary vessels--> exudate--> crackles


 +0  (nbme22#41)

If knee is mentioned just look for L4 and then rule out all the other options, you are left with just one option just pick it and don't think beyond.


 +1  (nbme22#20)

When you are comparing the therapeutic effects of two drugs it's a clinical trial and when both the patients and providers know which drug it's open label. Clinical trial could be done between tx/control or tx/tx. It can't be crossover as there is no wash out phase


 +1  (nbme22#23)

Unilateral periorbital swelling acute stage of chagas disease


 +1  (nbme22#25)

It,s not an infection, it's basically a healing process, angiogenesis leads to warmth and erythema,





Subcomments ...

submitted by jinzo(11),

I have ganglion cyst since 2012 and this shit doesn't disappears . Moreover , it may cause some pain , when I flex my wrist . So why answer is not parasthesia???

asharm10  I am sorry bus this is soo funny!! I hope your's spontaneously regresses too +1  
lowyield  Not sure exactly but my guess is that it doesn't impinge upon any major nerve (yes it can probably impinge some superficial branches of the radial) +  


I ruled out Paget's because Paget's is usually localized, per FA, Pathoma, B&B. Although this patient definitely fits the demographic picture, prostate cancer is definitely not the only cancer that can metastasize to the bones. Because these are lytic lesions, it's probably some other cancer that's spread to the bones

medguru2295  Possibly Multiple Myeloma. That is classic for an older person with back pain and lytic lesions in the back. +  
asharm10  osteolytic- multiple myeloma, Osteoblastic- Prostate; dont think beyond this for this exam, i have never seen a question in NBME or uworld they tried to fool us off on this concept so far. +1  
euchromatin69  u world 341 same concept +  


submitted by lisa(0),

Hints. His age + Multilple blastic lesion pointing out at metastasis. Negative protein electrophoresis ruled out Multiple myeloma

drjungly  All primary bone cancer - mc seen in age b/t 20-40 peak at 25. Prostate adenocarcinoma - mc seen age >50 yr old. Source-FA 2018 +3  
asharm10  Sometimes instead of osteoblastic they say osteosclerotic that's synonym of Osteoblastic. For multiple myeloma it's always osteolytic. +1  


submitted by oznefu(9),

I get she doubled her levothyroxine dose because of fatigue. I get that TSH is decreased. But why is free T4 decreased and free T3 increased? Wouldn’t both free T4 and free T3 be increased?

lnsetick  she doubled her triiodothyronine not levothyroxine, so she took a bunch of T3 -> feedback inhibition of TSH and therefore decreased T4 +14  
oznefu  D’oh didn’t even read that just assumed it was levothyroxine. Thanks! +1  
asharm10  NBME's give you very few buzzwords, read it super carefully!! questions like these are free points +  


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 +4  
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. +5  
asharm10  @angelaq11 same here :D +  


submitted by drzed(85),

I'm a simple man, I see encephalitis and temporal lobe involvment, I click herpes.

asharm10  hahaha true that, overthinking is the reason for getting so many questions wrong +  


submitted by bubbles(50),

Sorry if I'm being dense...why does this woman have diarrhea due to statins, diet, and exercise? I didn't really understand what they were asking for here to be honest.

.ooo.   I believe they were asking what the most common effect of statins, which is GI upset (including diarrhea). Rarely you can have hepatotoxicity and myopathy but neither of these are a side effect in the answer choices. Hopefully this helps! +1  
niboonsh  Theyre asking about the most common side effect of Orlistat - which is really fatty diarrhea +1  
asharm10  Orlistat is not a statin drug, it basically inhibits pancreatic lipase so that you absorb less fatm drug is used for weight loss. So when you are not absorbing fat you are inviting diarrhea. +1  


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