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Welcome to cmun777’s page.
Contributor score: 28


Comments ...

 +2  (nbme24#1)

I think the key on this question is recognizing how much "most time-efficient" jumps out in the question stem - a pretty unique thing to be specifically asking. Going off that and the fact they want to look at exposure -> outcome, by far the fastest approach would be to find people who currently have the dz in question and then just ask them if they have a previous exposure aka case-control.

an_improved_me  I feel like you just described a prospective cohort? Find ppl with the disease (same populatin and outcome), and then see if they had a similar risk factor; then follow them to see if they had a risk factor. Case-control would be: Have two groups of people, some with the Dx, others without. See if there is a difference in proportion that have/don't have a risk factor Someone please correct me if i'm wrong? +




Subcomments ...

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aCn soeenom xpinlae why teh anewsr lutdc’on be n?apnlnhaeelyi

donutsnduodenums  The kid has albinism, which is due to decreased tyrosinase activity. If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability, musty body odor, etc., in addition to his fair complexion. +19  
zelderonmorningstar  I see, so if it was PKU he wouldn’t just be presenting for a routine examination. It would be one of those “oh crap what’s wrong with my baby” ones. +15  
wowo  FA2019 p83 +  
nbme4unme  Just a note that UWorld says phenylketonuria patients ALSO have albinism, it's just that the neuro sx and musty order are giveaways. +4  
pathogen7  Technically, albinism is a problem processing DOPA, and not tyrosine, no? I always associated "tyrosine processing defect" with ochronosis, which is why I didn't choose tyrosine. Guess I'm wrong. +2  
cmun777  @pathogen7 you're not wrong it is specifically DOPA but would any of the other answer choices make any sense over tyrosine? +4  
qiss  @pathogen7 also yes- you can't make DOPA because of a defective tyrosinase enzyme. This enzyme also metabolizes tyrosine into DOPA before it metabolizes DOPA https://www.google.com/search?q=tyrosinase&sxsrf=ALeKk021WaFQzRNr99BZVujxqRii-GzV6g:1585781210231&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjzt-itp8joAhVDMqwKHUGYC3wQ_AUoAXoECBgQAw&biw=1280&bih=720#imgrc=MyxHLTV0gV7BKM +  
qiss  link fixed hopefully +1  


submitted by neonem(571),
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diabetes  no pneumonia it is UTI +3  
makinallkindzofgainz  The infection from the UTI spread to her lungs +  
makinallkindzofgainz  this is essentially urosepsis, one of the leading causes of sepsis +1  
cmun777  UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability) +17  
peqmd  urosepsis +  
snripper  lmao I read it as upper respiratory tract infections, too. +3  
thisshouldbefree  she has an increased A-a gradient. +  


submitted by sahusema(145),
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cmun777  While L gastroepiploic would make more sense than the other answers, considering it has an anastomosis (and therefore an outlet for the increased blood) I think it would have much less risk of varices/bleeding than the short gastric would +  


submitted by hungrybox(1044),
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hungrybox  jesus this answer was probably too long i'm sorry +9  
meningitis  I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks. +14  
amirmullick3  This is what NBME should be providing with each question's correct answer! Thanks hungrybox! +1  
amirmullick3  @hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."? +1  
pg32  Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides? +  
cmun777  @madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx +  


submitted by cantaloupe5(77),
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tueRerncr enkiyd tenoss dluhso udilcen midaopypashtrhierry no ruoy neeiai,tfrldf uceopl ttha hwit atimrgonsa dan ur’yoe nkigloo ta MNE .1 ipsomaL are sola idcsaotsea tiwh EMN 1.

sympathetikey  Yeah, I probably should have went with that. Just got thrown off, since I know that usually the serum calcium levels for someone with Calcium kidney stones is normal. +  
snoochi95  i understand the link to MEN 1, but why are we checking the calcium level? +  
cmun777  I feel like it's important to get a baseline of where the calcium is at for two reasons: 1. if the patient does indeed have MEN 1 it would be good to know if she has high calcium levels and possible Parathyroid etiology 2. You're putting the patient on a PPI which are known to decrease calcium levels and increase risk of osteoporosis for both these possible factors/concerns it would be good to see where calcium is currently at +5  
zevvyt  Couldn't a Pituatary tumor secrete ACTH, causing high cortisol? +2  
lola915  Patient has symptoms of a gastrinoma (Zollinger-Ellison Syndrome)- patients present with diarrhea, epigastric pain, duodenal and jejunal ulcers. Associated with MEN1 syndrome. +  


submitted by hayayah(1079),
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hraCette cep:atnmle

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hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +30  
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +12  
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +  
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +5  
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1  
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +  


submitted by neonem(571),
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rMoja iskr ftorca rof aotric sdnsiocite is styeh,poniern nda in tihs aesc hgitm eb eud ot acconie us,e hwchi euassc kedarm nns.heytriepo cnossieDtis uesac a erta ni het aunitc iinatm -- boold anc fowl dsbakwrac oint eth cipdaumreri and uscea oaa.mtnpde hsTi samtnefsi sa cskarcel in hte ugln ude to oopr flte cuetnrviarl foinnuct toii(liflinldgsca/ pmlrobe ued ot o.sencrmopis)

forerofore  there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this. +9  
temmy  please why is there where a diastolic mumur? +1  
whoissaad  @temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border) +8  
garibay92  Does anyone know why is this patient's tepmerature elevated? +1  
ratadecalle  @garibay92, not important for this question I think but cocaine can cause malignant hyperthermia +1  
almondbreeze  judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm +  
almondbreeze  he's only 28 - another clue for marfan? +  
turtlepenlight  did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection +2  
cmun777  @almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN. +1  
ibestalkinyo  @turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection. +1