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Welcome to dbg’s page.
Contributor score: 152


Comments ...

 +9  (nbme21#3)
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CIAOERNP v.s RNEIECC

urYo skni sah owt ytsep fo aewst snld:ag nicecre dna ianeroc.p ccinerE gdnlsa rcouc voer mots fo ruyo ybdo nad opne teridcly oont eht csfurea fo oury k.ins Acponeri ganlsd poen otni teh riah fellcli,o endiagl ot the cefrasu fo het iks.n Acpoerin lngads pdlveeo in earas tandanub in airh oe,illflsc uhsc as no oury as,clp iatmprs nda on.irg

Rf:e hr2am0-ys7t.wsilcswoopn/ys.iimei/0nngi/s/gdmcetr9tdehlta08ceo0hso/ewarausopdtini-:gdadmwiisi-/ls/


 +7  (nbme20#3)
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I,om sith esanwr iocceh si rgo,wn teerh si no obperml ni het psocser fo cgelnaol sesiysnt""h rep .se The seisu si ihwt viceessex nsiessthy nad dirgzdinosea in.pdeiotso toN an aaolbmn'r tsyhnctei c'presso - sa ludow be in ES,D MF, M,sneke et.c

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +3
rockodude  dont overthink people, whether its an underproduction or overproduction of collagen, overproduction is still abnormal collagen synthesis. its abnormal to make an excessive amount of collagen 3 leading to a keloid +2

 +10  (nbme20#49)
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sBB krow by eircneadsg MPAc dan 2a+C therybe gnloisw ANS &;mpa NAV i.atitcvy sThi olnosgrp paseh 4 fo no.toreidlipaaz Thfee,eorr ehyt rea nokwn to scnriaee teh oainudtr of oleiastd i(rdnnptoamley) ganiucs bhto a ires in aehrt nyocraro ipueofnrs and tdireocun in thaer .reta

lovebug  FA 2019, 318page. class two antiarrhythmics. +

 +5  (nbme24#40)
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idD annyeo lese dreonw AHTW UAOY"PLRNM MOMYTS"SP si eth oqiusnte neirrfegr o?t? ehTer si ietlalryl not a ngsile oypmmts oentmdeni ni eth wohle ngvet.iet No "lsrcacek dehra eovr ohtb glun ide"lsf rae not smmypsto. Thye ear isngs ufodn yb eht .ichspayni

ysSlieour ugibodtn het wlhoe BMEN badro stet irerswt hritg on.w oD yeht eqdaatyule eresiv eirth kr?ow sThi si ton eht fistr chtlcinae aesktmi I leeriaz no het wne srmo.f

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +2
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +2
ergogenic22  i take that back i understand what you're saying +5
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1
an_improved_me  I get where you anger is coming from.. They expect the students to pick up the most minor details as they may be relevant to an extremely vague and tedius questions and answers, but don't hold themselves to the same standard. +

 +7  (nbme24#23)
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TWF si anssw"kee of prltaan ol"idxosnfrei ????? s'it lkei gyians ies"exntno xeoThinfls i" si ton het nlyo ubovsoi leichtnac tikamse ni eht new NEsBM ...

karthvee  loool +2
yex  Funny Board!! Yeahhhhh +

 +15  (nbme24#40)
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mA I het noly neo ohw tug,othh my hwelo ,eilf ttha it claultay ieointgasr rmof eth drothiy tbu tjsu lhclpayiys eoedtnccn to hte onegtu

nbmehelp  same +14
medguru2295  me! I went with submandibular gland bc I thought there was a gland under there. +
alexxxx30  nope...i definitely thought the same thing...when I clicked thyroid I was like wow that was an easy question. HA +1




Subcomments ...

submitted by neonem(572),
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I knith ssmsitetaa swa teh sbte oonpit eher escabue erhte rae tmiupell amiltgann en.mssol..ap piyamrr earcncs ndet to srtat as a lngies mssa in het usiste fo iiogrn. nI het u,nlg tsstmasaee rae moer oncmmo nath pirmray eaos.mlnsp

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 +6  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +4  
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  


submitted by neonem(572),
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I tkihn tmssaseati wsa teh tsbe tponoi ereh ceseuba herte aer llmtipeu mnngialat oplmss.e..an ryipram csecran dtne to arstt as a iselgn assm in eth sietus of irni.go In het gu,nl aetsetsmas are omer cmmnoo ahtn riympar smsonae.pl

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 +6  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +4  
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  


submitted by lnsetick(94),
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  • PecinAor = oury sapimrt elslm leki an AEP
  • URcMeen = eter’sh on OMOR in uyor ares nsiec e’ytehr full fo awx
  • -CEYeCnR = ewnh uyo ,ciseCeEr uroy poesr are iYCgnR
  • oeasEcBSu = BEmSu si gPEiESn tuo fo ryou ospre
hungrybox  as an ape i'm offended +31  
dr.xx  stop being an ape. evolutionize! +7  
dbg  as a creationist i'm offended +11  
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +  
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +2  
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +1  


submitted by neonem(572),
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dsSuon iekl a seca of rFnea-imiuL mrnyosde - iscen p35 si a tmoru rueospspsr rof a uhbnc fo lcle ypest, iuosnmatt in tsih egne (as ni )LSF ultser ni a ardmyi of lafiilma rtmuo pyt.se

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +11  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +15  
dbg  ^ this guy cracked the code. nbme ur doomed. +7  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +3  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +9  
jakeperalta  @privatejoker: according to UW, Li Fraumeni includes SABBB(sarcoma/adrenocortical/breast/brain/blood(leukemia)) +2  
ac3  side note: RB1 = retinoblastoma with an increased risk of osteosarcoma +  
lukin4answer  TP53 associated with SBLA + Brain tumor + Anaplastic Thyroid ca + Transitional cell ca. -UW +  


submitted by hpsauce(-2),
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I lbeeevi tsih is apanCl drSeonmy boghnen(ccior miacrcnoa + uaiheordmt tahrs.)irti yOln wfal ot tath si taht eth yumonlrpa sindgfni nd'to eltcyerfp nrserpete ooscnunpe.iemos

dbg  it's just bronchogenic ca, type of adenoca, which is classically associated with 'hypertrophic osteoarthropathy' +  
woodenspooninmymouth  To get it for the test, remember that lung adenocarcinoma is associated with clubbing. Mechanistically, this woman probably had RA. Then she was exposed to asbestos. The asbestos in the context of RA lead to caplan syndrome. The asbestos also triggered her bronchogenic carcinoma. +  
step1soon  Then why isnt Rheumatoid Arthritis right? what comes first? bronchogenic carcinoma or rheumatoid arthritis? +  


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myaiyironlegS yroallnm retssnep hitw lrelaabt-i sosl of iatmppn/e in a pcea ekil iibsountdtir ude ot amadeg of teh rirntaoe hiwte umsmeisorc fo teh Tmi-plaSainhoc a.rcTt

ishT presno slao ahs isgwtna fo eht slmal csusmel of hre hadn, hiwhc si due to xiSnyr asoxnpnei sgcuani edgaam to sMLN of eth ontarier ornh (ormf CNS atma)ohP

dbg  you're talented, bball and now this +13  


submitted by youssefa(133),
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moFr dFai 2190 ewn r:ufeig -F1IG yainlm ucinnsoft as na ablcaoni ohoremn on csmselu nda sonbe ty(etrp ucmh lkie n;gisiut-&ln rcdesesea uesrm )gelso.uc GH scta aaselperyt by ioontmrpg nnisuli eiscenasrt (igensincra ermus lo.cugs)e oTrehr,fee -1GIF si ont eht .aeswrn fI GH aws gaomn teh ewnrass ti oulwd heav ogt llarye .fuignocns

charcot_bouchard  Can anyone take a little time to curse on that daughter? +5  
dbg  Sure, charcot. Just wished on her to get a couple of charcots (the triad, your aneuryms, marie tooth, etc). +1  
noorahsaahir  Charcot_bouchard and dbg best comments .... 🤣🤣🤣🤣🤣 +  


submitted by hayayah(1080),
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itWh ciohcnr v,ogtinim oyu lseo rlclyetoeets adn a otl fo i.acd It gtgreisr aimboltec aikallsos ichhw is yhw lla eth umser elsvau era owl (or on teh wloer ned fo hte aormln ngre)a cexetp rfo .noarbeitacb

ergogenic22  decreased K+ (from increased RAAS due to volume loss) and decreased Cl- (loss of HCl from the stomach), Alkalosis from loss of HCl and thus high bicarb. For this reason high to mid range K is wrong +4  
sbryant6  Wouldn't increased RAAS lead to increased Na+? The answer shows decreased Na+. +3  
sbryant6  Also, remember Bulimia Nervosa is associated with hypokalemia. +1  
sugaplum  so the range they gave for K is 3-6? so 3.2 is WNL then? or are we just operating on "it is on the lower end of normal in peds" +2  
dbg  sodium levels in pyloric stenosis vary, nothing really classic, can be high as in this case simply due to hydration, can low in other cases if aldosterone managed to reverse that to the other extreme +1  


submitted by strugglebus(165),
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Msot fo het tps velaus ewer mnoa.lr nniriDgk at'nsw rosou,uaget LDL asw lmid, BMI hsa fn.ie He ddi hvea TNH huhgot. hTe bgsegti kisr ctofrsa aer the ctfa that eh hda udefrfse an IM adn dttsaer rnuefigsf eevres prdesiseon etw(hgi toely.)ixnsas/ su,Th eh is reom at isrk rof c.isiued

sohaib111  Won't having an MI be a very big risk factor for another one ? And also if they wanted this answer (the anti-depressant), why would they just add that his LDL is inreasing in the last sentence... +14  
dbg  bc they're SOBs and DOBs +22  
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +1  
asingh  It is because of the timeframe of mortality is 2 yrs, everything else will affect later +5  
benny  mdd increase MI +  
benny  Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI). +  
drzed  None of the cardiovascular options would improve mortality (statins, ACEi, BB, spironolactone are the ones that have proven mortality benefit). So if they had put one of those, I think I would have chosen that, but given that the rest don't change mortality at all, I went with the antidepressants. +2  
ihatetesting  My thinking was that since he had an MI, a beta blocker would improve mortality, and propranolol is also used as an anxiolytic. +2  


submitted by notadoctor(159),
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nysalsAi of hte ialsetn in teh tosieqnu oeshwd a ceaddeers nurebm of endoiesms rsnkisoscl-. siemeDsno is amed pu of fuor lieyns sreuesd.i erefeTorh lraoabnm naeistl is ykilel sisgmin elyins ssceryaen rof het imoonaftr of steeh dinmeseos scilsn.so-kr iekidiapW etlcria no nemsiesoD.

dbg  how can i trust you, you aint even a doctor +22  
euchromatin69  trust this then U.W 1249 +3  
tryntofigritout  UW 1249 was perfect. #loveyourname euchromatin ha +  


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Kpa si Hp ta cwihh yan ugrd si at its 05% dieozin taes.t

Now ew ear lka nuire e.i cni p.H when Htg&;apKp ti wlil heva wot fifd atph rfo dcaiic dgru m&p;a ibasc dug.r

idcicA rgud llwi nic sit ilanmiotein nci( ideozin mo),rf baics rgud lwli eb remo ab bsodsero. ew nede ot oknw teh dugr si iabsc cidi.c/a

Now fi u kal rieun tsi oalintimein cn.i so it hvae to eb .iicdca or u can nwok its a oisd lsat fo grdu twih CSN royptepr ie. smto klei etlarnboaihbP (aWek cda)i

so if apK fo grud is 6--a-t Hp 7 ew lilw astrt imniilatneg

utb if Kpa si 0 we edne ot sirea Hp of nuire at 11 ot sattr ematn.laitingi atht toinp vpre gudr pa(=)K6 olwdu be talyolt tuo fo mye.sts

hsatt hwy A si teh ihgrt san pK(a = 6)

charcot_bouchard  Correction : Not 0. i means if pKa is 10 +2  
charcot_bouchard  2nd update : cont to learn school grade chem. if pKa > 7 it is base. and if pKa is < 7 it is acid. Since we established the drug have to be a weak acid pKa cant be more than 7. +  
dbg  thanks, but Pka and PH are not at all the same thing +1  


submitted by famylife(94),
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oToll"sgysrah dctu cytss tmos otfne erpnste tiwh a elpaablp cypmaatotmsi iiedmln ecnk smas ysullua ewlbo 5[%6 fo het meti] teh evlel of eth yidho ".oebn

"hTe ysllhosrotag actrt saersi mrfo eht oeanrmf mceuc at teh otnujnic fo eht tnoriera -dotwrtshi adn pstoorier hn-detiro of the eutg"no.

i/dhy:giskoe/altwTn.iches/_pirpsow.tl/gkityoras

dbg  Am I the only one who thought, my whole life, that it actually originates from the thyroid but just physically connected to the tongue +15  


submitted by lsmarshall(417),
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doArenng itiennItysivs eyoSndmr - ceetfD in eardgonn eeprotrc itrungels ni -oiarralnpapmeng feemla XY6(,4 D).SD cFongintuin teetss cssuea eicdersna tereosttneos at up,beytr hihwc is cedvrnote ot rsgteneo hplprile,yera vniggi eflmea seanodryc eauxls hicsrretcaiatsc eelmfa( xlaetren aeat)ligin. kaLc of egonadrn ceorrpet ucnoitfn asled to bnesta ro cnats rlaixlya adn pcubi rhia. esPattin ehav iydremrunat iga,anv tub uruest dan nfapiallo besut ts.baen

negArnod vesnstiinitiy orysnedm is het awsern but oyu mhtig heva ocirdendse leinaüMrl geeaniss yMietoankk-y(arsR- teKsruüe-asHr ).meyndsor

Mleinulra gnieseas iwll vahe lnmaro nheomro evlles and yam srentpe sa °1 eoeaamrnhr ud(e ot a cakl of ireneut etdn)eloepvm in fmlesae tihw luylf deoeepldv °2 exslua ccistsahtcirera nnluo(acfti ).roaivse Hair pevoetldenm is orlnam sa well. saenPitt olas evha aornml ghhei.t

esSme eilk hsit eositunq did ton gevi su hucm ot nhsdigtsiiu eiebdss ghethi dna rantne etasg 1 pcuaibryl/ixla air.h

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +  
makingstrides  Mullerian agenesis: absent vagina, uterus/cervix because no mullerian system. Yet, still has secondary characteristics ie: breast, pubic hair, normal hormone levels (normal ovaries). Also check to break down the different subtypes of DSD: CAIS, 5alpha reductase deficiency, and swyer syndrome all for XY DSD. Where as for XX DSD, overproduction of gestational androgenism and placental aromatase deficiency. Bc in CAIS the testosterone receptor is dysfunctional, no external / internal male organs are going to form in an XY fetus, but you will have an extra production testosterone (like explained above) leading to increased estrogen (breast growth), but since no ovaries, you dont have the mullerian system. You are left with a vagina with a blind pouch (from lack of functioning receptors) +  
makingstrides  Also to add, there are testes that produce the MIH, so you have degeneration of the mullerian system. From B&B +