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Contributor score: 199


Comments ...

 +9  (nbme24#28)
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ameistyDr ( ,osla niiaisokddeyads nad tinintoen to)errm is ltarela lurmeblcee. )(E.

ixatAa si a rmelobp with het ctalern bcellremue D() ro ta elast tstha het btse I ocldu oecm up twi.h

ronald-dumsfeld  I actually think D is pointing at the Flocculonodular lobe. See here: https://en.wikipedia.org/wiki/Flocculus_(cerebellar)#/media/File:Human_brain_midsagittal_view_description.JPG So a lesion at D would present with Nystagmus +3
urachus  flocculonodular is medial (central). but yes it'll have nystagmus and truncal ataxia +
faus305  Lesions of the lateral regions (cerebellar hemisphere) of the cerebellum affect the lateral body (dysmetria, fall toward injured side). Lesions of the medial region (vermis, floculonodular lobe) cause medial (truncal) ataxia. Oversimplified but these rules help me answer most questions about the cerebellum. +

 +62  (nbme24#35)
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ahnkT ouy NBEM orf the hhig liyqtua rsc.tupie tI skema eetsh exsam rsesst reef nad ea.enyoblj

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +20
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +13
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +6
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +5
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +7
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +5
rockodude  everyone hates on nbme, but they're showing you a picture zoomed in of her eyes and she has a history of multiple fractures/bad wound healing at the age of 4, I feel like OI should at least be a consideration based on the overall clinical picture +1
feochromocytoma  Yeah I got it right, it's just funny that they don't use higher quality pictures for the exam +1
djeffs1  that is clearly a malar rash... oh wait nvm just pixellation +3

 +65  (nbme24#42)
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I ilek tsih toeiuqns ebesacu ti sniemdr me hatt mxrsieena khtin cjtsoeb nca sxiet ni 2 die.ssnnimo


 +5  (nbme22#11)
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nNnPe-miacik eDsseia sprtesen hwti mltaen neoatrtiard, dliip lneda (foam escll) in oben wrmaro dan yrhrec rde tpso on aucla.m oN hylpsannisgmeoei uertsls in ubidulp fo eslmnphyioing hihcw bidlsu up ni harcaps.ogem

meningitis  "Pick your **Big** **Foamie** **Zeibra** nose with your Sphinger" Choose options with the letter I. SpIngomyelin, Sphingomyelinase, bIgorgans (hepatomegaly etc), zeIbra bodies, Foam cells +1

 +7  (nbme22#38)
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emPrie has on surctatanf

nAeosgtinni II - atgrdeeen in mpyvheoiloa

otililypDma itecnlhi aka planlttdmolihichyshpeiiaolyopd lugn fnratscuta

noiildasotthPspholyi h5ptpao,i4ehsbs- kaa P2IP Gq petrcoer wyhaatp

napdshePotryislhei evldni-vo in tnirsicni oappstsoi wnhe eseoxdp no aetrllcxulaer sfcaseru

ihngmeSnolpiy - cmesoops eymlin dan laso has lreos in lsinag ua,octrtsnndi stpsaoop.i ict:niheL niSlognyhepim ariot ;&2gt dtcisneia reaumt elaft nusgl.

endochondral1  how are we supposed to know that dipalmitoyl lecithin is the same thing as dipalmitorylphosphatidylcholine +6
qfever  FA 2019 page 647 Pulmonary surfactant is a complex mix of lecithins, the most important of which is dipalmitoylphosphatidylcholine (DPPC). Also: Screening tests for fetal lung maturity: lecithin- sphingomyelin (L/S) ratio in amniotic fluid (≥ 2 is healthy; < 1.5 predictive of NRDS) +19

 -8  (nbme22#48)
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sneuoQti is nisgak touab dnauseptlcae nrsiosgam nfiitnceg DCG tian.tpse Eloi.c si sola epdacunlesta. Cna oynnea daexnp no i?hst

keycompany  Step pneumonia is the most common pathogenic organism in CGD, and the most common cause of pneumonia, otitis media, meningits, and sepsis. While CGD are at an increased risk of encapsulated E. coli infections, however, they are at MOST risk for S. pneumo. This is kind of just a memorization fact that you need to know about S. pneumo. +
keycompany  Sorry english is clearly not my shit, but you get the point +
biliarytree220  CGD is susceptible against catalase-positive organisms (FA 109), of which S. aureus is the one to look out for. It's not about encapsulated organisms, like I had it confused in my head. +6
.ooo.   You are completely right about E.Coli being encapsulated and is also a CAT+ organism and patients with CGD would have an increased risk of infection for both S. Aureus and E. Coli. How you narrow down the two is the most common infections are S. Aureus and Aspergillus (FA 109 like mentioned above) and also using the pneumonic "Cats Need PLACESS to Belch their Hairballs" (FA 128) Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E.Coli, Staphylococci, Serratia, B cepacia, H pylori +11

 -1  (nbme22#25)
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setamHini suesac lrlcyiaap roiertrala olitandi (eecdsrea cadraensi)s(teceersin seseuprr in teh laplaicry csebuae efefsrent nriame hte mase zi)es itamsniHe laos eniasercs laarclyip mpeira.bietyl


 -3  (nbme22#23)
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gsiAuuomb nioqetus tub in ueecabs ti si aeyrl ,ocshk htree si tno gohuen etim to vetatcai teh RSAA ot craisene iekdny .supoeifrn

makinallkindzofgainz  This is not an ambiguous question. It makes perfect sense. +5
khaleb  In early shock you have increased SVR due to vasoconstriction. This would cause increased flow to the kidney. I could be wrong but I think what makes that answer incorrect is NOT that RAAS hasn't been activated yet. It is what is causing vasoconstriction via Angiotensin II. What is possibly wrong about that answer is that it says via sympathetic stimulation. I do think it is a little vague between those two answers though. Because you can get sympathetic activation of the RAAS system causing vasoconstriction and blood shunted to vital organs such as the kidneys. Bottom line is you can't argue with weak pulse during hypovolemic shock.... so an obvious right answer. You could make a case for the increased blood flow to the kidney though. +2
zqatan  @makinallkindzofgainz no need to dismiss the question... so pretentious +

 +5  (nbme22#31)
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ightWe loss - nkith a tceiayHopcmneanrr - HADIS rmof llams clle ugln nceecr adEma + DVJ - SVC dromesny

peridot  I was thinking lung cancer secreting SIADH, resulting in hyponatremia. But because the question asked specifically about the cause of the facial edema, I put hyponatremia (answer choice C). I was wondering how you guys were able to differentiate between C. hyponatremia and E. lung cancer? Thank you! +1
mannan  The first thing that crossed my mind was SVC syndrome from the cancer obstructing the R brachiocephalic vein preventing venous blood from returning to the heart (and staying in the facial area). Also I assume Hyponatremia would be equivalent to decreased body volume so there wouldn't be edema. FA Renal physiology section has a good chart on what happens during electrolyte imbalances (hypo and hyper) +1
mannan  @peridot +1
peridot  I was thinking that hyponatremia would be more loss of osmotic pressure --> edema, but I definitely see the argument for a mass that's simply blocking blood flow. Thank you! +
jaramaiha  only thing affecting osmotic pressure is albumin, which would be more towards liver cirrhosis. The body will attempt to maintain a Na+ of 140 with various mechanisms, but doesn't contribute to osmotic pressure. +

 +11  (nbme22#15)
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kiytgnlAal snaetg lteomremh)rin(ceah te(h eohrt rugsd ltides aer oiuuclrbmte nrsiihtbo)i eraiesnc eht skir of L.MA

keycompany  Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +27
seagull  CML has blasts too but they tend to favor mature forms. +4
kash1f  You see numerous blast forms == AML, which is characterized by >20% blasts +9
keycompany  The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +12
impostersyndromel1000  @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +1
sweetmed  Procarbazine is alkylating as well. +
pg32  @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +3
castlblack  this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +
jurrutia  @keycompany, how did you know it had to be of myeloid origin? +




Subcomments ...

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staM sllec rag,neudelat gucirndpo eihmistan cwhih carttast lhiopsi.osen ehT aelry eastg fo an leacrgli aeinroct si mtas lcel ded,atemi tub teh laet aesgt (gdcuninil cuusm )doouirtcpn si dtimaede by seils.nhoipo

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +17  
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +5  
ajss  where do i find this info?? +  
paperbackwriter  @ajss pg 112 of first aid 2019, under type I hypersensitivity. Immediate --> mast cells releasing histamine and tryptase, late--> eosinophils and leukotrienes recruited via chemokines +2  
graciewacie9  Wow, i missed the fact that the question is asking for the RESULT of the reaction, NOT the cause of the reaction. Mast cells cause the initial reaction, eosinophils would be the result of the eosinophils. *facepalm +6  
greentea733  @graciewacie9 SAME UGH +  
lba9587  Pathophys (as far as I understand it)...Mast cell degranulates, thus the phospholipid bilayer et. Al are left behind and needs to be degraded. Who comes in? Our good friend eosinophils, as they contain Major Basic Protein (responsible from breakdown of expired mast cell). Note, you can tie this in to the delayed Leukotriene effects of an allergic rxn, as the bilayer is also broken down by arach. Acid. (See this link to support my credibility https://images.app.goo.gl/3cUF3ZVc7qy8uxAi9) +  
mutteringly  who else looked up what T21 pills were +3  


submitted by beeip(124),
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Iitabnily ot taeevel eth atpale tgsusesg gamead fo eht asguv n.erev

.F CN( )X

atstillisafraud  I guess F is the vagus nerve. Thanks to NBME I am also training to become a mind reader. +35  
seagull  Thanks to the NBME I have crippling depression +41  
drdoom  bonus cadaver diagram via @mcl +2