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Welcome to brise’s page.
Contributor score: 44


Comments ...

 +0  (nbme23#48)

How do you rule out LSD? It also causes tachycardia!


 +0  (nbme23#18)

AKA the reason why covid can be killed with heat! B/c it is enveloped!


 +0  (nbme23#12)

I chose anything that would help show a relationship strength: got rid of anything with specificity and sensitivity in it. Leaving only D and F: Temporal relationship sounds more in line with relationship than consistency of other studied. Also how would the consistency of other studies prove anything for the relationship between intervention and child language score in this study?


 +0  (nbme23#49)

Why is it that you can use acetaminophen in aspirin induced asthma and not here? I literally chose acetaminophen bc in another nbme it said to use it in aspirin induced asthma

brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1

 +0  (nbme22#9)

Can anyone explain why complement C5-9 is listed?

drdoom  don't have the stem in front of me but the Fc “handle” of antibody allows for opsonization (by macrophages and other APCs) but more immediately it activates circulating complement -> terminating in the formation of the Membrane Attack Complex. MAC is great way to kill nonself intruders without having to wait for macrophages to mature or neutrophils to arrive. FAST ACTIN’ TANACTIN! +1
brise  Thank you so much! +1

brise  "Starches such as fried potatoes, rice and pasta may make you feel bloated or gassy and may not be well tolerated." +

 +0  (nbme15#42)

I thought that a child with down syndrome under the age of 5, had a chance of getting acute megakaryoblastic leukemia? and over 5, acute lymphoblastic leukemia?

mittelschmerz  I was stuck between those as well. My thought process was that megakaryocytosis would be mature megakaryocytes though, which would not happen in a megakaryoblastic leukemia since they are stuck in the blast stage. That left only lymphoblasts, and I presume while one may be MORE likely age 5, a patient with Down Syndrome is still at higher risk for both. +1
cassdawg  "Megaloblastosis" as in the answer choices refers to megaloblastic anemia in B12 and folate deficiency, so it is not associated with megakaryocytes or megakaryoblastic anemia! Hope this helps! +6

 +0  (nbme23#32)
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so I swa ktucs no htis beucase ihs NBU i/etennrica tiaro del me to tnihk eh dha an scitinrni lnaer n.tnsocfyiud dAn a P2IG bhiitionin doulw dela to a pnl-eraer ,azitamoe where eht NU/B ninertaiec orait ldowu eb mero thna .20 I owkn that sADISN btiniih IGS.P tuB owh aer you poesupsd ot rossc uot citunindo of ialsdt ubaurtl isiso?dca

purdude  You can cross out Distal RTA because the urine pH is 5. In Distal RTA, urine pH becomes greater than 5.5 because a-IC cells can't secrete H+ +1
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1
underd0g  @thotcandy Distal RTA is another name for Type 1 RTA, so that is the type of RTA that they are specifically referring to in that answer choice. +1
solidshake  ^agreed. Type 4 RTA is not an option as an answer. Type 4 is a result of low aldosterone or aldosterone resistance -> hyperkalemia -> impaired NH3 synthesis in the Proximal tubule -> impaired NH4 formation -> high tubule H+ -> tubular acidosis +

 +9  (nbme22#21)
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The qntieous si isngka twha point duwol eb eth tosm lekyil ot erlu ni rc,anec and ghhi iiticeyfspc hwne eoitsvip uelsr in ac.rcen ehT ehgtshi ecctfspiiiy uaelv si ,A bc teh hte X sxai sowsh !ti1sy-cf)(piice

sbryant6  SPin and SNout. Specificity in, sensitivity out. +6




Subcomments ...

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oFrtibennci is an tlerrulaxalce mtxira ,oipcgtnroley hlwie ilanm si an diniteeartme atinmlef hatt fsllipacieyc dipsoerv sutoprp to teh ecll usl.cnue ontD’ ucsoenf ilamn hwit iannilm isn(ecce atshe su l)c;elrya inmilan is liek fcnniriot,be na MCE iyrlocneptog nda a aormj npmtneoco of het balsa inlaam of eseanmtb m.serebnam

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +30  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +3  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +  
brise  @abkapoor the f is progeria? and do we need to know it for step? +  
brise  @abkapoor omg jk jk wow +  


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btnonriiFce si an trxlluecarale mrxiat leyrtg,cooinp ielwh nlaim is na imntitrdaeee inetmafl ttah apflcieilcys vsroiedp ptsurop to teh lelc usuncle. D’tno nofuesc ilamn iwht almnnii iesn(ecc teash su clyar;le) nnlaimi si liek iiren,tbnocf na CME ioypetlocrng dan a jamro pnmceonot of hte aabls ialamn fo atenemsb m.emrsenab

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +30  
dr.xx  blasphemy @masonkingcobra +1  
luciana  I clearly confused lamin with laminin, now I know +3  
almondbreeze  FA 2019 pg 48 lamin +1  
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +  
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +  
brise  @abkapoor the f is progeria? and do we need to know it for step? +  
brise  @abkapoor omg jk jk wow +  


submitted by cocoxaurus(56),
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reP OW-LUDR oeimdaoccraAnn si adiestasoc w/ guln cagnrsri lteeadr to oaolmstnurgua esedais, old CODP (nchoci)r nad egmaad edu to ncrreretu mne.iuaonp

arcanumm  Here i was thinking i was being clever by not being tricked by distractors when metastasis is more common... +6  
brise  Metastatic would have multiple lesions +  


submitted by mousie(209),
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yhW no stnigeaw? I naem I etg Eascsty si oabblpry eht gudr of heicco orfebe an lal inthg danec trayp o)l(l tbu d'ont turnnadeds hwy three oldwu eb ldco iexmetertsi adn no wntaigse ewnh si AF ti sasy miprthaeyreh adn br?o??had?

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +11  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +9  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +18  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +8  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +4  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +1  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +9  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +1  
cassdawg  "Despite possessing a direct negative cardiac inotropic effect, ketamine causes dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow. Consequently, ketamine produces cardiovascular effects that resemble sympathetic nervous system stimulation. Ketamine is associated with increases in systemic and pulmonary blood pressures, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements."(https://www.openanesthesia.org/systemic_effects_of_ketamine/) +  
brise  LSD does cause HTN and tachycardia according to uworld! @d_holles +  


submitted by brise(44),

Can anyone explain why complement C5-9 is listed?

drdoom  don't have the stem in front of me but the Fc “handle” of antibody allows for opsonization (by macrophages and other APCs) but more immediately it activates circulating complement -> terminating in the formation of the Membrane Attack Complex. MAC is great way to kill nonself intruders without having to wait for macrophages to mature or neutrophils to arrive. FAST ACTIN’ TANACTIN! +1  
brise  Thank you so much! +1  


submitted by monkd(18),
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mA I yracz ro ddi Uoldwr otn vaeh a tousinqe atht dtseta ntStsai rea the msto tveeifcfe gurd agldseserr fo saliebne spdili. ihTs clgio rhtwe my .ffo

adisdiadochokinetic  You are not crazy. I got this question wrong for the same reason but here's why I think NBME was going with fibrates. You can use the Friedewald equation to calculate LDL cholesterol from the values they give. This equation is LDL= Total Cholesterol-HDL Cholesterol-(Triglycerides/5). The Triglycerides/5 term is an estimate for VLDL. If you calculate it in this case you get an LDL of 120 which is firmly normal and thus the patient would ostensibly not benefit from statin therapy. +14  
hello36654  omg when the hell am I going to remember this equation? Jesuusssssss, this kind of details makes me want to give up on STEP +4  
almondbreeze  Her goal LDL should still be <100, bc she has 3 CHD risk equivalents (https://www.aafp.org/afp/2002/0301/p871.html#afp20020301p871-t3) CHD risk equivalent=the major risk factors that modify LDL goals 1) age(M>45, F>55), 2) smoking status, 3) hypertension(>140/90), 4) ow HDL level (<40), and 5) family history. (https://www.aafp.org/afp/2002/0301/p871.html#sec-4) +  
almondbreeze  *low HDL level (refer to table 3 of the article) +  
makinallkindzofgainz  These guys are hitting up attending-level cardiovascular risk factor calculations, meanwhile I picked statins because I think I remember that they help the heart +12  
jimdooder  So I ended up going with fibrates because of her age (39). I vaguely remember being taught that statins are really only recommended for patients >40 because the big study that came out about them was in the 40-75 age group. I think this might contribute to the question but I'm not totally sure. https://en.wikipedia.org/wiki/Statin#Primary_prevention +  
ytho  This question inspired my screen name +2  
cbreland  "Statins are always the answer", "Fat Female 40 Fertile", "Fibrates can cause gallstones". I feel lied to +  
brise  I'm not sure if this question is correct. I chose statins according to what an attending told me and UWOLRD 2, I just went back to check and on uworld 2, you only consider giving fibrates if their TG levels are above 1,000. So idk what the nbme is smoking. Or if doctors actually write these questions. +  


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I hhuogtt fo iths as uqosusam clel oiaarccnm of the nlgu asucngi narecside PrTPH dan epr.yacahimecl

d_holles  I thought this was medullary thyroid cancer but demographically SCC works better. +  
smc213  Medullary thyroid carcinoma increases calcitonin levels leading to decreased serum Ca2+ by increasing Ca2+ renal excretion. So high levels of calcitonin secreted by the tumor may lead to hypOcalcemia. Source: Pathoma +18  
brise  actually according to pathoma, you rarely see hypocalcemia even though calcitonin is high! +  


submitted by mcl(577),
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In eacs oyu wnaan og pesur nred adn edar bauto ,enlymi acncecat,pia nda rncasseet,i htis ugy seod a gdoo bjo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +21  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  
brise  Uworld 1318*** +  


submitted by brise(44),

Why is it that you can use acetaminophen in aspirin induced asthma and not here? I literally chose acetaminophen bc in another nbme it said to use it in aspirin induced asthma

brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1  


see 18636 .world

brise  I can't find this!? +  


submitted by jooceman739(26),
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asl:nmooettaRbi

heT nhpciisay sadi het yob si lkulenyi ot edvopel yan hoert n,eoaslmsp so eh nesod't ehva eth ernehdiit bR imauotn.t

In stih ea,sc eh hsa the icdsaorp o.oasetlabnirmt aSipdorc olaetrstoibmna reusreqi two coamtis atumiston fo Rb ni het easm anletir ecll.

sJtu as a sedi oet:n edIhinret mobsesittronlaa dtne ot be tabriale.l ropaSdic ear l.inauaertl

carls14  aren't retinal cells a type of somatic cell? Why not is the mutation not considered in the somatic cell of the child? +9  
omerta  Although this mutation would be considered somatic, I believe the question is just asking you to be specific as to which cells. If you answered "somatic cells of the child," that's quite broad and could apply to almost anything. +11  
kernicterusthefrog  I had the same struggle and thought process. +1  
eacv  There is a Uworld qx that explain this in detail> ID: 863 +3  
arcanumm  I read the answer options too fast so got this wrong. It is a somatic cell type, but somatic in general implies a higher risk for developing other cancers. The hint here is that the physician stated he is unlikely to develop any other neoplasms, so it is a specific double hit mutation in the retina. +7  
almondbreeze  wouldn't she have any possibility of developing osteosarcoma as well? :( +  
almondbreeze  did some reading and it seems like osteosarcoma only occurs in familial retinoblastoma with RB mutation +  
brise  But how can a 5 year old get two mutations to get retinoblastoma? In 5 years?! Obviously doctor is probably wrong LOL +  


submitted by armymed88(47),
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amyemphes lsdea ot OC2 ripnpatg iednagl ot snaricee Op2aC in eth ob,lod hwhic sgiev yuo a atysrrioepr aiscidso prr eoP lrane nooaetimpsnc llwi einsrcea adbrci abrse nda esecrdea xcone-tire iviggn uoy rideesacn crbbia ni hte boldo

meningitis  Increased blood HCO3 could have easily been interpreted as increased blood pH aswell. FOllowing your explanation, since the pt had acidosis, the increased HCO3 will just make it a normal pH. Another way to think of the question is: if there is decreased exhalation due to COPD --> increased CO2 --> increased CO2 transported in blood by entering the RBC's with Carbonic Anhydrase and HCO3 is released into blood stream. So increased CO2 -> increased HCO3 seeing as this type of CO2 transport is 70% of total CO2 content in blood. +21  
drmohandes  I thought you could never fully compensate, so your pH will never normalize. Primary problem = respiratory acidosis → pH low. Compensatory metabolic alkalosis will increase blood HCO3-, but not enough to normalize pH, it will just be 'less' low, but still an acidosis. +3  
mtkilimanjaro  I also think decreased blood PCO2 and increased blood pH are very similar (less CO2 in the blood means less acidic, pH could go up) therefore I ruled both of them out just from that +  
brise  Aka this is the Bohr effect! +  


submitted by yo(77),
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I jtsu kenw atht prsem dnee oefs,rtuc otn reus awht dseasie esocrsp sthi is hguoh.t eH asw tpryte manrol so 5a aesurtedac dento's trenesp eikl t.aht I wtnas' ersu if teerh swa nya dod ues fo het rtoeh s.reawns erhe is a ikl.n leFe fere to depx.na

glsbppeneut4wo/i2oh:c/tw...cp7aasswx_q22t/ms

Ftsocrue mseka pu 9%9 of hte cgurnide rgsua pterens in es.men hTsi grusa si ercdduop in eht nseliam elc.sesiv einmDiihsd svllee of tocufesr veah eebn nswoh to aperllla nrgnedao eicdefcniy dan eht nesteotetosr v.eell wnloFglio estntsrtoeeo erh,ptay hte lelve of eurfcots ilthAeaguocers.shn eth reoustcf tets is nto rpat fo a eournit eesmn ,aiylsnsa it is uflues in asces fo zaermpasooi ee(cnbsa of rsepm ni emns)e. nI oaieraspmoz aoedcyrsn to the eaebcns fo sevsceli ro fi eetrh si na rtu,nbtisooc no tcfusero is .ernpets In trstealuci omse,aizorpa cuofrets si nrt.espe enhW zsomaoperia and wol senme levmuo itsxe,s teh ctfesuor tset lduhos laso be no,de no a catejalutsepo euirn esmpal ot cckhe fro drtoregrae lcoujnt.aiae Tish ucscor nhwe hte jactleeau oseg toni teh adbedrl iedstan of tuo eth rahruteehT. cdeuproer rof mtneeindigr teh outmna of reotufsc in nesme ievlvnos hntaegi ensme ni a sotrng dcai ni eht eepescnr of osornrceli. truceFso esvgi a red color iSlfvoofen( acietorn) nda aym eb daer in a em.tpothore The nrolma gevaera si /mLdg531 osfe.uctr

sam.l  Thank you for the explanation. I'm still confused about this answer. I was in between Zinc and fructose. Zinc deficiency also presents with anosmia (pg 71 First Aid 2019). Fructose is used for the movement. His hormones are normal. +3  
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 https://www.fertstert.org/article/S0015-0282(16)40391-2/pdf +4  
cienfuegos  Thanks all for the info, quick note on the Zinc reply above @Sam.I: anosmia = lost sense of smell. +  
sam1  Great find yo! I believe this question was alluding to cystic fibrosis and the congenital absence of the vas deferens. Here is a link to a NEJM article about it below: https://www.nejm.org/doi/full/10.1056/NEJM196807112790203 +  
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged? +  
fatboyslim  @Sam1 but cystic fibrosis will show abnormal physical findings (clubbing, pulmonary crackles etc). The question says physical exam shows no abnormalities. +  
pg32  Confused as to how we can rule out zinc... From medicalnewstoday.com: "Zinc also plays a role in healthy sperm production. According to a 2018 review article in the Journal of Reproduction and Infertility, zinc deficiency may contribute to poor semen quality and infertility." +  
bekindstep1  @pg32 I am not sure of how Zinc contributes to sperm production, but the question was asking about abnormalities in the semen and fructose is present in the semen. Maybe zinc plays a role in sperm development before it is mixed in with semen and so one with zinc deficiency wouldn't have low in zinc in their semen perhaps, but it their blood. This is just a hypothesis though.... +  
brise  ^^ Yeah that's how I ruled it out. You can find fructose in the semen, but you wouldn't be able to find zinc in the semen! It might help the sperm, but it's not going to be chilling with them +  


brise  "Starches such as fried potatoes, rice and pasta may make you feel bloated or gassy and may not be well tolerated." +  


submitted by lfcdave182(30),

Cold temperature: Causes peripheral vasoconstriction and central vasodilation

  • Increased central blood volume --> Lower ADH due to increased blood volume through kidneys
  • Increased central blood volme --> leads to atrial stretching, increased preload --> Increased ANP release
passplease  what organs are considered "central"? I initially thought that the kidneys would not be getting more blood with most of the blood flow going to the lungs and heart +1  
brise  Same :( +  
drdoom  the kidneys are the lungs for waste products that can't be expelled via your breathe. (another way of saying this is: the lungs are like the kidneys of your mouth: instead of urinating out of your mouth, you "pee out" CO2 in the form of expired air.) tl;dr the kidneys are very vital organs!! +1  


FA 2020 pg 425

Porphyria cutanea tarda-- defect in UROD in the heme synthesis pathway that causes photosensitivity and blistering

bingcentipede  Most common porphyria, too +2  
brise  The thing that got me screwed was the "increases synthesis of compounds"; like what compounds? +  
i_hate_it_here  I swear they just love to say shit to throw us off smh +  


submitted by andro(169),

First step is to make the presumptive diagnosis of osteoporosis from the clinical vignette . ( The supposed subtype in our patient is postmenopausal osteoporosis)

After this the next step is to make an association with the lab findings The primary defect is a deficiency of estrogen . Normally estrogen decreases osteoclast activity by

  1. inducing apoptosis
  2. increased formation of osteoprotegerin a decoy molecule which inhibits activation of RANK receptors

Net effect of losing estrogen is increased osteoclast activity ,and in this question by extension RANK L concentration .

NOTE : ALP which is an indicator of osteoblast activity does not change/ increase in osteoporosis , as such avoid all options with an increase in osteoblast activity

brise  But wouldn't you need osteoblasts to have RANK L? +4  
cassdawg  You still have osteoblasts, they just aren't doing their "build bone" job so their primary activity is decreased. Rather, they are stimulating osteoclasts by increasing RANKL. Similar to how parathyroid hormone stimulates osteoclasts through osteoblasts --> the osteoblasts are involved but not in doing their "build bone" job; however you would never say you increase osteoblast activity with PTH even though they are necessary for PTH function. +3  


submitted by mcl(577),
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tantPie ihwt iebaltlar lanre ytarre ibstur dna pehoestnyrin liwl ofr user veha tiacvnoita of SAR tysems dan terohfere earcnsie ni .gitnasoinen

htuAolhg yhomtocmoocrahpe nda eunoqsntec eelvdeta metaclaonseich nac raeciesn olobd erpues,rs msysompt ear caytplliy piedoisc nad relan uitbrs are nto ilyelk to eb a.dreh ltaedevE leslve of troiseonn anc osal ecsua e,npnsrityhoe utb ew ouwdl aslo xtecpe ot see ligunhf;s lso,a ereth is nohgtin in eth stme ot acndeiti ptnatei is ignkat sSIRS ro ntemioshg eles htta lduoc sierpesdop erh to evdtleae leslve fo ei.onntsor aEedetlv elesvl of dhtryio noomehr coldu alos gvei eitnapt ieensyhn,otrp tub we lwudo sloa tepcxe rohte nsigs fo emysiphrihodrty m(eto,rrs tgwieh sols, c.)t.e

I saw a titell ndcousef if PEO uwold eb eeelvdat -- if hetre is tssoensi fo rlane rersaeti a(s tdecaidni yb eth s)ubtir the niekdsy dcoul sloa etdetc this sa iyhopax adn ramp up prundtooic fo P.EO vHee,wor I dened up onigg iwth saeintingon insce ti eesedm rome "e"ctrecno to me taht ASR ulwdo be pu. eDos yoenna onwk hwy s'it ont P?OE

brise  Wouldn't that be more long term? +3  
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +  
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2  


submitted by seagull(1389),
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hiTs is a iihkelodol o.tria L+R= Sen1s-iec/pfS

yAn leuav grteear hnat 01 r(pe frtsi a)di iatdedcin sleunssf"eu fo tasdgoicin "test icwhh si lbamrapeco to PVP rlu(nig ni a z).d nPtio ""A si hte eclosts armk ot erhew 10 loudsh eb on teh Y aix.s

brise  The question is asking what point would be the most likely to rule in cancer, and high specificity when positive rules in cancer. The highest specificity value is A, bc the the X axis shows (1-specificity)! +5  
hello  brise is correct. Knowing the LR+ value = 10 does not help in this situation because estimating where "10" should fall on an axis is arbitrary. The way to approach this Q is to know that a high specificity is will mean that a positive result is very very likely to be a true positive. In theory, suppose that the specificity was 0.99. This is 99% specificity. Then, you look at the graph. The X-axis is "1-specificity." So, suppose the best test has a specificity of 99%. Then, calculating 1-specificity = 1 - 0.99 = 0.1. You would then chose the datapoint that corresponds to having an "X-value" that is closest to the origin. In this problem, it corresponds to data point "A." +3  


submitted by mattnatomy(41),
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Clerskac erieth ieatinsdc ocihnrc ictirbnsoh ro litncsdiooona mfo(r onuiapnme or uralynopm eae.md)

iGven hatt hse'etr lony a 1 yda ysotihr fo B,OS I'm aegnnil eorm adowrts albro e.unnmiopa aeybM tha'ts soal wh'ast uciangs the 3S ta eht S?LBL fI st'i hSpta us,Aeur I gusse ew loucd be olikgno ta uatce ndiocaterisd + npoeim?uan rO Q Fev?re utB htsat' tsju ltce.ausnpio ouCld oasl just be thta hte gunl inildconatsoo si tleirnag bdloo low,f dangeil ot teh akbc pu iton eht gitRh mAtiru &am;p rcne.tleVi

brise  Patient has CHF from the S3 heart sound and has MR. You hear fine crackles in early congestive heart failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/ +15  
usmleuser007  No Infection - normal temps ; Q-fever presents with A patient with exposure to waste from farm animals who develops: a. nonspecific illness (myalgias, fatigue, fever [>10 days], b. retroorbital headache) c. normal leukocyte count d. Thrombocytopenia e. increased liver enzymes +  
saulgoodman  This patient has CHF. But it kind of sort of seems like he's presenting with a PE. +  


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Why is iths ton reaidscen nigidnb of AND measpeyo?lr

sihT antuotim udhols eucas aeclulrl vdsioiin ie ADN ericopntali dna uscae reieasdnc nnigbdi ot rgioin trilocpanie nesseqeuc ie TATA yb NAD sm.paeeroyl

brise  It's talking about mutations on the transcription of genes that inhibit the cell division. Also RNA polymerase binds to the promoter region. +  
nwinkelmann  Also, the question specifically (though in a very wordy, convoluted way) asked what the effect of the mutation on transcription was. DNA pol is not used in transcription, it is used in replication. RNA pol is used in transcription. In terms of increased or decreased binding, argining is polar/positively charged and proline is neutral/nonpolar, so there are fewer H-bonding sites, and thus decreased binding of the RNA pol. +1  
medn00b  Could this convoluted question also mean.......... that since the gene to make p53 is messed up due to the hydrogen bonds, RNA polymerase will not be able to bind to make the mRNA ... So there will be cancer? Because P53 is a tumor suppressor... lemme know thanks guys +