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Contributor score: 14

Comments ...

 +0  (nbme23#33)

I just realized there were solid arrows and dashed arrows in the image. Is there a significant to the dashed arrows vs the solid arrows?

 +1  (nbme23#41)

Anki Card I made: Vagina = {{c1::Stratified squamous}} Cervix = {{c1::Stratified squamous --> simple columnar (endocervix)}} Uterus = {{c2::simple columnar}} Fallopian tubes = {{c2::simple columnar}} Ovaries = {{c3::simple cuboidal}}

brotherimodu  For some reason I don't trust you
focus  ^^^ haahahaha. Thankfully the patients aren't seeing these usernames

 +0  (nbme23#25)

What is the area labeled 'G' and 'C'? And more characters?

alexxxx30  lateral corticospinal i think

 +0  (nbme23#42)

"disproportionate reduction in the peak expiratory flow rate or maximum minute volume compared with the forced expiratory volume in one second (FEV1). It should be noted, however, that there can be a significant loss in airway cross-sectional area before the textbook flattening of the inspiratory or expiratory loops are visualized."


 +0  (nbme18#8)

Uremia = Metabolic acidosis = Bicarb is low. High respiration = Low Co2; for respiratory compensation.

 +1  (nbme18#9)

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!

mcdumbass  This makes sense... but I don't trust your answers
bmd12  😂😂😂

 +0  (nbme18#46)

According to UpToDate:

At levels below 886 mg/dL (10.0 mmol/L), the risk of pancreatitis appears to be quite small [76-78]; however, it is reasonable to consider drug therapy at levels of 500 mg/dL (5.6 mmol/L) or above in patients with a prior episode of pancreatitis.

Bonus: They say fenofibrate>gemfibrozil always.

Subcomments ...

submitted by aladar50(32),

So there’s 100 residents, and the prevalence after 2 years is =10 at the beginning, +5 in the first year, +10 second year, and -3 that healed, for a total prevalence of 22 residents or 22/100=22 percent. Thus, prevalence = above the standard. For incidence, it’s 15 new cases out of 90 residents over the 2 years (100 total residents – 10 that already had ulcers), or 15 new ulcers per 180 patient⋅years. This would be 83.3 new ulcers per 1000 patient⋅years if you extrapolated it out -- basically (1000/180) * 15 -- thus, incidence = above the standard.

zelderonmorningstar  Okay I feel like an idiot cause I thought: Above the Standard = Doing a good job keeping old people from getting ulcers. Thumbs up. Below the Standard = I wouldn’t let my worst enemy into your ulcer ridden elder abuse shack. +29  
aladar50  @zelderon Ohh damn. I could totally see how one could view the answer choices that way. I think it is important to read how they are phrased - they are asking if the center is above THE standard or below THE standard. The “standard” is an arbitrary set point, and the results of the study are either above or below that cut off. Maybe if it was “above/below standards” that would work. Also, being above the standard could either be a good thing or bad thing. If say you were talking about qualifying for a competition and you have to do 50 push ups in a minute, then being above=good and below=bad. In this case, having more ulcers than the standard = bad. +1  
saynomore  @aladar Thank you!!! but how did you get the 15 new ulcers per 180 patient⋅years? I mean I understand the 15 part, but not the second part ... hence why I messed this up, lol :| +2  
aladar50  @saysomore Because the study is looking at 100 residents over a period of 2 years. Since 10 already had the disease at the start, when looking at incidence you only include the subjects that have /the potential/ of developing the disease, so 90 patients over 2 years. This would be 90 patient⋅years per year, or a total of 180 patient⋅years over the course of the study. +7  
sympathetikey  @zelderonmorningstar I thought the same exact thing. Had the right logic, but then just put the backwards answer. +3  
kai  I wonder if they chose this wording on purpose just to fuck with us or if this was accidental. My guess is there's some evil doctor twirling his thumbs somewhere thinking you guys are below the standard. +12  
symptomatology  Got it wrong!messed up in understanding options, Btw, 15/90 is somewhat 16 percent and their standerd is 50/1000 5 percent!.. this is how i knew that incidance is way up! +  
donttrustmyanswers  Patients with an ulcer are not immune to getting new ulcers --> You should include all patients at risk. But either way, the answer is the same as long as you can read NBME speak. +  

submitted by thotcandy(19),

What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +  
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +3  
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1  

The patient has ATN secondary to renal ischemia. Due to tubular necorsis, the patient will have an elevated FeNa. The patient's urine will also be dilute, but this will be reflected by the low urine osmolality, not the FeNa

mousie  Hypotension can also cause pre renal azotemia with a FENa <1%.... How do you know this is ischemic ATN and not hypotension induced Prerenal Azotemia? +5  
sympathetikey  I had the same thought as you @mousie, but I think "azotemia" and low urine output push it more towards ATN (looking back; I got it wrong too). Plus, the initially MVC / muscle damage probably caused some tubule injury by itself. +2  
ajo  This might help clarify why the pt. has ATN rather than pre renal azotemia. The question did mention, though subtly, that the bleeding was controlled. That most likely indicates that his hypovolemia has been corrected. Developing azotemia 24 hrs after correction of hypovolemia is more suggestive of ATN (since he doesn't have hypovolemia anymore). I hope that helps and feel free to correct me, if I am wrong. +17  
ajo  In addition to my earlier comment, I just noticed the question also explicitly mentioned that he was fully volume restored. Which is consistent with my earlier assumption! +10  
gh889  Although initially, hypotension causes prerenal azotemia, the volume correction pushes you away from prerenal azotemia. but they want you to remember that in hypovolemia, the kidneys are also becoming ischemic, and so development of azotemia 24 hours later is more indicative of intrarenal azotemia due to ATN +  
sugaplum  for anyone who wants to see it: FA 2019 pg591 +1  
divya  i'm confused about one thing. if the tubules aren't working like they should, the bun:cr ratio falls right? doesn't that essentially mean azotemia reduces too? +  
osler_weber_rendu  Lets all take a moment to admire how shit this question is "Bp 90/60.""Repeated episodes of hypotension in the OR" and still the answer is ATN +3  
donttrustmyanswers  @osler_wever_rendu ATN can be caused by ischemia. +1  

submitted by uslme123(22),

This question makes no sense to me. She has an extremely low opening pressure yet has signs of increased intracranial pressure. Did they mean to put 32 cm H20?????????

uslme123  Standard lab values are incorrect, way to go NBME. +2  
wutuwantbruv  I think they mean to put mm Hg. Normal CSF pressure is about 100-180 mm H20 which equates to about 8-15 mm Hg. +2  
alexb  I lost a bit of time wondering about that ugh lol +1  
mjmejora  I thought there must be an obstruction in the ventricles somewhere preventing csf from getting to the spine. so pressure is low in spinal tap but in the head it must be really high. +  
donttrustmyanswers  Does anyone have clarification on this question? +  
llamastep1  Pseudo tumor cerebri can have normal ICP. Who knew +  
tyrionwill  Hi, mjmejora, MRI did not see anything abnormality, couldn't this mean that there was no obstruction in the ventricles? +  

submitted by tamey(0),

i chose endometrium(simple columnar epithelium) as i thought by her age she is still menstruating and the Shedded endometrium is found in the cervical region, why not!!!!

donttrustmyanswers  I think they key word here is "originates." The simple columnar epithelium starts in the cervical canal, and continues on throughout the uterus until you get to the ovaries. +  

submitted by sugaplum(153),

phenylpropanolamine is an alpha agonist that stimulates urethral smooth muscle contraction. - from uptodate, however, it also says it is not recommended treatment anymore

ugalaxy  α1 stimulation (via α1 agonist) constricts the bladder sphincter thereby, preventing sudden bouts of micturition during coughing/sneezing (abdominal stress). +5  
sammyj98  I thought that B3 stimulation stopped urination +5  
adong  @sammyj98 B3 would facilitate bladder relaxation +  
hvancampen  @sammyj98- were you thinking of oxybutynin? (thats what I thought of!) According to FA, its used for urge incontinence not stress. +  
drzed  Nah he/she's talking about Beta-3 receptors which are Gs coupled. Gs increases cAMP thus it would cause smooth muscle relaxation -> bladder relaxation! +  
donttrustmyanswers  From Mayo: "There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however." +1  

Could someone explain why this choice is the best answer? I struggled between A and D, and picked A finally, which is "ascertain educational level and provide publications".

donttrustmyanswers  It isn't A, because research shows that understanding of information (i.e. eating good and exercising) isn't enough to cause change. Why it is Provide F/U, over support group, IDK. +1  

submitted by lae(6),

chronic bronchitis causes squamous metaplasia of the pseudostratified columnar epithelium in the bronchi and bronchioles

---- these columnar epithelium normally contribute to the mucociliary clearance and smoking also damages this clearance, so can get the clue from that too

donttrustmyanswers  Pseudostratified columnar epithelium is only present in the bronchi. The bronchioles have simple ciliated columnar epithelium. +1  

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!

mcdumbass  This makes sense... but I don't trust your answers +3  
bmd12  😂😂😂 +  

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