Welcome to bullshitusmleโs page.
Contributor score: 14
Comments ...
Subcomments ...
bullshitusmle
copper intrauterine devices are hormon free FA2017 page 622
+2
medguru2295
they needed to specifiy. I eliminated IUD bc patient states no hormones.
+1
abhishek021196
The question doesnt make sense. IUDs are typically contraindicated in nullipara because of increased risk of expulsion and intractable abdominal pain, among other things such as perforation. The pt is 22, likely to be a nullipara. Why cant we prescribe a diaphragm instead which is a non hormonal method too, and remove the vaguity of hormonal vs non hormonal IUD? :/
+4
123ojm
in practice many nullparious women have IUDs. I think this question was seeing whether you knew that some forms of IUDs are non-hormonal and that the other methods are far less effective,
+1
covid
IUDs are definitely not contraindicated in nulliparous women.
+5
neurotic999
Although all the above comments are valid, I think the point to be focused on was the patient asking for the 'most effective' alternative. Even I was leaning toward diaphragm considering she's a young patient, but I didn't feel like it fit the description of being most effective. Guess it's one of those questions where nbme expects you to pick up on subtle hints/read their minds and forego practicality altogether.
+1
dbg
I seriously could not figure out whether those white opacities were actual lesions or reflections from the actual picture (flash light) ... mind went all the way maybe this is the shiny pleura so they're going after mesothelioma. smh
+10
dbg
shiny pleura with tiiiiny granulations if you look closely. but obviously was far off
+
bullshitusmle
guys something I learned from NBMEs is that if there is a clinical vignette dont even look at the images they give you ,they are all useless and time-consuming
+1
goaiable
The way i narrowed it down was that the patient had signs of weight loss since three months whereas her cough developed recently (3 weeks). If the cancer arose in the lung then I think the cough or other pulmonary symptoms should emerge earlier.
+1
almondbreeze
FA2019 pg 669 in the lung, metastasis (usually multiple lesions) are more common the primary neoplasms. most often from breast, colon, prostate, and bladder ca.
+1
_yeetmasterflex
Could the pneumothorax also cause less ventilation due to decreased lung surface, retaining more CO2 causing respiratory acidosis? That's how I got to the answer at least.
+8
duat98
I think pneumothorax would increase RR because you're probably hypoxic. Also I'm sure when you have a lung collapse on you you'd be scared and that would trigger your sympathetic so your RR will go up either way.
+4
bullshitusmle
there is no bilateral lung opacities as you would see in ARDS
+5
jesusisking
Was thinking some sort of infection b/c of the atelectasis so picked empyema but this makes sense!
+1
djeffs1
does it need to be ARDS to cause "diffuse alveolar damage"?
+1
makingstrides
Not only that, does having a collapsed lung affect the alveoli?
+1
link981
Slowly raising my hand as well
+2
usmlecharserssss
patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia
+19
myoclonictonicbionic
I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency.
+5
anechakfspb
me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong.
+2
feanor
And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols.
+1
therapeutic ionizing radiation(gamma rays,x-rays); -DNA double-strand breakage -Free radical formation