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Comments ...

 +2  (nbme24#18)

Lateral Medullary Syndrome (Wallenberg) - see FA for more details. Symptoms for this syndrome match up with what is being presented.


 +2  (nbme24#36)

TGF-Beta is an important fibroblast growth factor. Pathoma Ch2, page 20.


 +4  (nbme24#23)

Vitamin B12 is the distractor in this question because it also causes a broad-based, ataxic gait and decrease in vibration. But - Vitamin B12 will not have symptoms like Hemolytic Anemia (decreased hemoglobin, increased LDH). Vitamin E = answer, see below for explanation.

gonyyong  Also the MCV was normal, not megaloblastic like you would see in B12 deficiency

 +4  (nbme24#2)

Classic sleep apnea in the patient. Cessation of breathing causes nocturnal hypoxia and systemic hypertension/arrhythmic/sudden death can persist. PaO2 is normal during day and decreased during episodes and at night. Classically seen in Obese patients such as the patient in the question stem.

tinydoc  Caused a cessation of breathing rather than a ↓ in lung volume although a patient could develop an obesity related restrictive lung disease thats not whats happening with this question.

 +9  (nbme24#40)

Make a punnett square with a cross of B B+ and B B0; B+ represents 50% function while B0 represents 0% (null) function. So in this case, the husband would have a B B0 genotype while the wife has a B B+ genotype.

Cross of these two will result in the following genotypes; BB, BB0, BB+, B+B0 BB = 100% function, BB+ = 75% function, BB0 = 50% function, B+B0 = 25% function

So the answer will be 1 in 4 have a 25% function given the genotypes.


 +3  (nbme24#6)

Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute lung injury (ALI) during or within six hours after blood product administration in the absence of temporally-associated risk factors for ALI.


 +2  (nbme24#35)

Stupid question, honestly just take your best guess and move on lol.

seagull  ░░░░░░░░░░░█▀▀░░█░░░░░░ ░░░░░░▄▀▀▀▀░░░░░█▄▄░░░░ ░░░░░░█░█░░░░░░░░░░▐░░░ ░░░░░░▐▐░░░░░░░░░▄░▐░░░ ░░░░░░█░░░░░░░░▄▀▀░▐░░░ ░░░░▄▀░░░░░░░░▐░▄▄▀░░░░ ░░▄▀░░░▐░░░░░█▄▀░▐░░░░░ ░░█░░░▐░░░░░░░░▄░█░░░░░ ░░░█▄░░▀▄░░░░▄▀▐░█░░░░░ ░░░█▐▀▀▀░▀▀▀▀░░▐░█░░░░░ ░░▐█▐▄░░▀░░░░░░▐░█▄▄░░░ ░░░▀▀▄░░░░░░░░▄▐▄▄▄▀░░░ THis Question ░░░░░░░░░░░░░░░░░░░░░░░

 +6  (nbme24#46)

tumor of Pineal Gland (Pinealoma) causes Parinaud Syndrome (vertical gaze palsy)

neonem  Due to compression of the superior colliculus in the tectum, I believe
wowo  FA2019 p516

 +4  (nbme24#9)

Onchocerca Volvulus via female blackfly. Black flies, black skin nodules, "black sight" (aka Blindness). Question stem here describes the black nodules seen in Onchocerca.


 +0  (nbme24#6)

Chronic Mesenteric Ischemia aka intestinal angina. Main clues are postprangial epigastric pain, weight loss. Usually due to Celiac (a), SMA, or IMA atherosclerosis.

neonem  What's tough about these answer choices though is that you have 2 different viable combos.
codyluvr95  The ectatic aorta might also mean AAA below the renals, affecting the IMA,
sherry  Also since there is this ectatic aorta, the arteries involved need to be adjacent to one another. If there is a choice as in celiac and SMA, it could also be correct.

 +0  (nbme24#3)

Requires knowing how to calculate an anion gap - look it up. In this case, it is a normal anion gap metabolic acidosis. Know the mneumonics MUDPILES and HARDASS. Renal Tubular acidosis is the only answer choice that is an example of a normal anion metabolic acidosis.

mousie  Anion Gap: Na - (Cl + HCO3) = normally around 10-12
seagull  good to know. I keep looking up the urine values but all it said was "varies", then I threw my computer and yelled "does that vary Mother F****ers. I do feel better now.
_yeetmasterflex  glad I wasn't the only one who got very pissed off at the urine values
fulminant_life  Usually the first thing I look at is whether or not the Cl- is high. Generally if the Cl- is high its going to be a normal gap
henoch schonlein  i think they gave you the urine values bc you can calculate the URINE anion gap which is (Na + K - Cl). In this case the Urine Anion Gap is positive (5). Boards and Beyond mentions that a positive UAG is due to Renal Tubular Acidosis Type 1 (inability of alpha intercalated cells to secrete hydrogen ions). just another approach to answer this q




Subcomments ...

submitted by neonem(227),

Just had to know that NRTIs (specifically the nucleosides) cause lactic acidosis

brethren_md  Also NRTIs are hepatotoxic, cause the increased liver enzymes seen in the patient. +2  
sherry  Actually, NNRTIs are more well-known for hepatotoxicity. But I guess NRTIs is the next best option for this one. +1  


The answer is hyporeflexia because the afferent arc of the muscle stretch reflex has to go through the dorsal rami and dorsal root ganglia. Dumb question, I know, but it’s the only answer that made sense. If you hurt the DRG, you not only lose afferent somatic sensory fibers, you also lose the sensory bodies involved in the various reflexes.

You can also get hyporeflexia from damaging the efferent neurons that innervate the muscle (like a LMN), but as you know these are in the anterior horn and ventral rami.

ankistruggles  Thanks! I agree with you. +  
brethren_md  Great explanation. +  
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +  
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +1  
charcot_bouchard  Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/ But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia +  


Why is it not ovarian follicle cells? I thought the female analog of Sertoli and Leydig is theca/granulosa cells.

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +8  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +5  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +2  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
youssefa  Hahahahaha ya'll just bored +  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +