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Welcome to dr.xx’s page.
Contributor score: 151

Comments ...

 +7  (nbme23#35)
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rh.tig he lsblteyauo must maerni in the iatngwi raae os that he si at ndha ot aacktt his fewi erevehnw ehr xmae e.sdn og N!MEB

meningitis  I guess it was all about not offering battering information in order to not make matters worse since he will figure out that the wife told on him.. Also, its a HUGE STRETCH but the only reason I thought he should stay in the waiting room was just in case the wife died they could detain him and call the police for questioning. +10
temmy  Also, he should stay there because his wife did not grant him the permission to see him. Patients requests trumps. +1
nephcard  Doctor should not believe what wife told her. There may be some other reason for injury so batttering information should not be provided. But her wish of not letting her husband in should be fulfilled +2
charcot_bouchard  No. In real life patient lies. In Board ques they always tell the truth. Unless they make it very obvious. in fact its a board ques rule. So u believe her untill proven otherwise. +4
drdoom  The prevailing rule of American medicine and law is individual autonomy. No other person is granted “default access” or privilege to another person’s body—that includes the physician! The physician must receive consent from a (conscious) “person” before they become “a patient”. In the same way, the person (the patient) must give consent before anyone else is permitted to be involved in her care, spouses included! +

 -12  (nbme23#48)
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... atht nad a cspyh octunls rof teh shcozi thor.em..

 -2  (nbme23#33)
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uebsA fo lixtaevsa t=&g; sullayu aersecdde rsmue usap.simot As to irhdocle nad ba,birc htat den.dpse yehT lucod eb dsrcaneei ro eedr.acsde


 +1  (nbme23#49)
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ratmtTeen of cueta gyotu Ssariltreihre vta surgd aer etvfeifec orf rianmttineg eht ueatc ogtuy kcaat.t iclCn,coehi asloidoenrtn ittimy-loafanamnr urdgs (AsN),SDI nda oiotsccdiretrso ear tdsnadra poaesparch. icAontoiecrrrocdpto oehomrn )(HACT is sloa yrev eff,ceietv tbu sha ceoemb inislngyecra scecra ro oot ivsnexeep ot be a acrctliap rvaettinlea in eht SU. agRsseredl fo teh acruatrilp genat she,noc the ornsoe htsee gsrdu era tdtrse,a the erom diarp eht en.oesprs fI a eiattpn toacnn atek SDsNAI ro cliochi,enc teh cchoie is nogma aol,r uialcn-atrirrta ro enaraprtel ocgiucidsto.olcr aoLlc anitoppclia of eci pcaks mya plhe olcrtno i.nap nI some ecsas, i,lcgsaeasn gniclduni doiios,p may eb dd.ade

grDsu ahtt aftefc emusr reatu toosnceatnrcni (E.,G. RLNLIP)L,AUOO ciudilgnn emiicrntcriyeupah ,sgtnae hsdluo ont eb ech,nadg rdtet,sa or dstpepo during an ,kactat as shti may wroesn het lymnaatriomf psroesen aylrdae ni rgrsps.eo


nwinkelmann  Love the last quote/sentence from the article! So helpful for clinical decision making! +

 +1  (nbme23#45)
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SSIsR oecpurd a uednassit esneraci in etlrlaxcrelua 5-HT in eth soadlr aeprh ,D)R( dan sith elasd to utbiotinhinoai fo rsoonitcrege nsorue.n


davidw  Pg 483 in firstaid has a good table of where the neurotransmitters work +6

 +0  (nbme22#31)
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The toms proaimtnt aeswt rpodtcu is imoanam )N3(H. shTi almls eclomelu soscesr hte lo–oibrdabn arrbeir dna si adebsrbo dan imatebelods yb het atsetyo,rcs a ppolotnaiu fo clsle in teh bniar that isncutetost 0%3 of the rrlabeec .ceoxtr tcseoyrstA eus maimona enwh hystisnsegin mautnielg fomr etuagl.tam Teh eardsicne esllve of aunitlmge adel ot an icernsea in stmicoo ersrsupe ni teh ,essyrcttao hiwhc ebmeoc wlsloe.n eerTh is iadresnec yvtaciit of the rotyiibhin tucγbrimao-yin cida A)(BGA my,etss adn eht rgneey plpyus to orteh nriba secll is e.aseedcdr shiT acn be ghtothu fo as an xmaelpe of nirba eeadm fo hte ""yoccxtito ptey.


 +0  (nbme22#49)
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todneiicMa gsdeoas lohusd be dirtteat mptylrop ot eivhaec eftievcfe pian onlo.tcr


 -13  (nbme22#25)
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heT ll-secβ vhea evoveld a mnehcamis ot dcttee hte amnotu fo nuinsli otresd adn derceste and sautjd sinnilu syhsseitn lanygdcor.ic A anelurg masrebmntrnae eitpnor llacde tseil llec aenaogtutni 215 ()1AC5I,2 si a licaruc tapr of siht eabkfced ctno.lor unlInsi aneslugr vartle a gonl istcadne no lnuuitb tarcsk ebfero inarirgv ta the lreihppear tcain korenwt .2[]51 eroBef eicbgomn inelkd to the oytote,skecln iilnnus rslnuaeg are erhodnca ot ncita exctro iav 2CIA15 nad h-thipβon.2nyrs pUon o,ittaniacv teh uralgne narmemeb fesus iltsrtnnyea to eth ellc mrbneame ot rsaeele edEealvt aC2+ leslev in hte nmeeamti atcieatv the tsepearo pc-ilnμaa to lveaec aayw a cisootlcy eamtrnfg mrfo I12C5.A heT eefr A1I52C otiscyloc egtnmraf hetn mveso to hte sunulec nda ndsbi ot eht ssdooptitrryeeo-nhpalyh itaconrrlanstpi roctfa AT5ST to peetrvn TSTA 5 mrof spoen,olhyhrditaop hhiwc ni tunr uarlseegtup iislunn trncpnartoisi .71[2] lcNurae fere 21CI5A oltyoiscc etnarfmgs olsa idbn to noiyluatmsg neymez Pγ.ISA The ltomsuyonai fo C2IA51 by SPAI γ eevrssre the ingbnid fo A12C5I ot TTAS5 1]2[7. e,Hcen hte elseaer fo iulnisn romf eyctresro seugnrla si uotcideamncm ot eht unslc,ue ichwh ssevre as a eistivpo dkbefeca nhemmiacs to taiteini suliinn aaorttnsnil rof nninitmaagi an tuaeqdae automn of edrtso uisn.lin


anjum  Bro wat r u doin with this explanation +3

 +3  (nbme22#6)
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hTe t test si eno tpey fo inentialfer ttscsi.isat It si dseu ot terimeden hrewteh hteer is a ianignfstci fdenecifer eewbtne eth smena fo otw u.prosg


 +6  (nbme22#45)
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sA trap of ioycbrnem metvep,dneol hte capensra sorfm as wto bsud romf teh eufg,rot an oebnyrmci etub ttah si a upcroserr ot the aestolgiiatnrstn rtcat. tI is treefeohr fo olanmdeerd


gh889  nice! I reasoned it as that most of the GI system is of endodermal origin +9
taediggity  FA 2020 pg 613 +1
mutteringly  FA 2019 pg 599 +

 +5  (nbme22#34)
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Brnr-stieEap ivurs VBE() is ercriad by omts h.sumna tI acn acsue asreevl yptes of ae.ccnr nI lyhteha cdftneei ,lpepeo VBE ptesrsis for feil in a lna"et"t state ni B lclse.

 +4  (nbme22#12)
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hTe orfu syetp of hcryheuapolds era cctom,igmuanin onm,mgctaionunnic xe u,avco and nroaml usp.rrsee anosiDgsi si tyyiacllp made by pclaihys otixenmniaa nda idlcema iia.ggnm

plecshroyuHad ex vocua olsa sreerf to an reelmtangen fo lcrbreea vsreclnite nad nrsaucbadiho seca,sp dna is sylaluu ude to biran arhopty (sa ti usccro ni m)ts,dineae pmaircasouttt- bainr isrjneiu adn nvee ni omse aycriithpsc rsrieods,d uchs as izerp.ihacsnho sA ooeppsd ot hescouap,rdyhl ihts si a patmyocreons tgearneenlm fo teh asspScFC-e ni rpnesoes to nriba nyahmpecar ;osls it si not hte slertu fo draineesc SFC speersru.


 +2  (nbme22#46)
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yanItlbii to alkw naotnc eb elxadpnie yb ecmdial o.laaivuetn gt==&; rsonCeoinv iodesdrr

 +2  (nbme22#43)
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edtyriHera ae.egnamido eTpy I nad II aer duecsa by a otmatinu in eth NPG1ISRE neeg atth meask teh 1C rbiohniit to.niper


 +2  (nbme22#1)
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FHC attspnei etfno iypsdla ginss dna msotpsmy fo dnsiaecre psoarnseisv eie.tnosrc

hyperfukus  if all else fails i hope i just drill this one statement in my brain and it comes out in the right way on test day thank u!!! +

 +11  (nbme22#18)
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bPraletu sanitoygamce is tuhoght ot be a ocylsgiphoali pnne,hnmoeo dna is tsom lomocnym nees ni tumyedbpri ihwt arnTne eagst 3–4 bucip ihar and tlarcuetis somuvle of 5 ot 10 mL


 +5  (nbme22#23)
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vyHooaimpel is a eidrtc loss of fviefetce iauitlcgnrc lodbo mlveuo nledgai :ot

  • A apd,ri awke, raytedh eulps edu ot reeadsdec ldboo lfow neoibcdm with hrdyacacait
  • C,ool lcmyma nski ude ot coaorsvitsnnciot dna iuntsilmtao of sisnoooncticavrt
  • Raipd adn lloshwa enbhrtiag ued to isayctthmep verouns ssmety uslioitmnat and socsdiia
  • Hayhrpoimet ude ot dscederae uonpersif nad apeniovoatr of sweta
  • isrTht dan dyr hmuo,t deu ot ulidf noeetpldi
  • doCl adn dltmteo iskn L(dvieo ceiiu,tlar)sr pieslayelc sxrmiitet,ee eud to nistfienciuf fesouprni fo the knis


 +2  (nbme22#21)
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hTe most cmnmoo nda eresve ormf of olmtusaao otmanidn tysiplycco yiednk iesdase A(D)DKP stulres rfmo smuiatont in 1DK,P ngionecd s-1onityylpc .C1)(.P


yotsubato  Here we thank FA for failing us yet again. Giving us PKD1, but not polycystin. I got the question right but I just guessed it because nothing else made sense. +14
usmleuser007  Autosomal dominant polycystic kidney disease 1) occurs in patients with mutations in the gene (PKD1) encoding polycystin-1 (PC1). 2) PC1 is a complex polytopic membrane protein expressed in cilia that undergoes autoproteolytic cleavage at a G protein–coupled receptor proteolytic site (GPS). 3) A quarter of PKD1 mutations are missense variants, though it is not clear how these mutations promote disease. 4) GPS cleavage is required for PC1 trafficking to cilia. 5) A common feature among a subset of pathogenic missense mutations is a resulting failure of PC1 to traffic to cilia regardless of GPS cleavage. 6) Missense mutation in the gene encoding polycystin-2 (PC2) that prevented this protein from properly trafficking to cilia.  +2
waterloo  yotsubo - the book is already so thicc. I think you made a great point tho, nothing else made sense. Sometimes you can't know everything on the test, but you can still play the game. +1

 +0  (nbme22#12)
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Cnletngiao aalrned halapysreip deu ot rhayys2oelx1-d dinefci.yce


wutuwantbruv  Can't be 17α-hydroxylase because this would present with hypertension and some sort of ambiguous sexual presentation (males) or lack of secondary sexual development (females). Can't be 11β-hydroxylase because this would present with the opposite of the kid's presentation due to the production of 11-deoxycorticosterone (similar effects to aldosterone but not nearly as potent). The other two would not really make sense since there are increased levels of 17-hydroxyprogesterone. +

 +4  (nbme22#42)
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S,veree ylpdria noegvilv iddmnstiasee nutarsciraalv gtoiuncaola CDI)( suaesc om,pionyhratbecto dleinpeto of slaapm auloncitoga rotacfs and bfnngoiie,r nad b.ledeing


 +4  (nbme22#2)
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rabtsFei cesedera seecldirirytg by dreuigcn eth notpodciur of DVL.L

 -1  (nbme21#17)
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roeM Aelsfny:eflrfut to tcagsir .svreaci The nteareffs to GV emoc mrfo lfte atcsirg ie,nv hosrt iagsrtc evnsi nda tpirseoro sgiatrc envi teh eflt grctsai eivn mnayli suittorbcen to torfmnoia of rcciaad areivsc eeshawr eth sroht trcigas inve dan irtooserp gictsra vnei nubttciero ot mntoaiofr fo lnadfu .averisc seadIolt sgcaitr ervcisa aer erom lleyki to eb tdleare ot ipaetcorepolgis nivse.


 -2  (nbme22#5)
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omlrNa airpeotrrsy rtea orf a 01 tnmoh odl tg;& 50 eathsbr per .nutmei

axnloeoN sdhoul eb envgi in teh nerpeces of oisapyrrtre dosenpeisr and aym uierqre patrdeee .ongdsi


 +7  (nbme22#20)
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IRM si hhiygl tsiee,sinv peicfs,ic dna aeaccrtu in eht tidecneot of .AVN

Tehiedg1wt- :egmasi NVA stmo nefot reptessn twih a icercsnc,et n-ilierkg or lwle ndefeid nadb fo wlo nisalg hniwti the iusoperr noiprot of eht olshandcbru erfoaml hdae bneo .rrmwoa Tshi nabd is httoghu to reesetrnp teh atecvrie ierfcatne eeentbw eht trneoicc dna eaarvtpier ,esnoz and ciytpllya tednxse ot het rlbochsunda .taple


 +1  (nbme22#47)
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The mrkalahl fo TPI is tloisdae toayotcmhbopern.i


jboud86  Refer to page 419 in FA2019. +2
hello  @dr.xx Compared to what? +

 +3  (nbme22#13)
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gDunir hsit aiinlit onc,tuener we lihstbesa ahwt eth ntpse'ra nncrscoe r,ea toianb a afliym oriht,sy adn sak botua uoervsip lmacdei ihTs ensigb the otniinarst ofmr rpenat ot tene as het eadlmci hiiso.rnta We xetn kas rtpnaes ot wait ni het ngtwiai ormo so hatt ew nca epksa lvaitpyre thiw hte slntdaeeo.c We vwtieeinr het ldeaetocsn aln,oe oemrpfr a iyclpsha oaixnamenti wiht a noh,aeercp nda enth nieivt het rpantse abkc iotn the oomr at teh cusoinnolc of teh tviis ot duiscss our isid.nngf


 -6  (nbme21#9)
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sldHcenbrosneah-Hesa ouE:tnqapH i = 6.1 + O(olCgH3 / 00(3. * ;C2a)PO) os r,hee Hp = t9g26&=. ; ctueA muneecanopd(st) iparrmy oyspriterra whocdiati ssi, mebolatci osicidsa

sbryant6  calculator can't do logs yo. +5
b1ackcoffee  wow, sherlock! +

 +8  (nbme21#49)
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Mmusoucll mtinsoogacu si duesca yb a usixpvro dlalec teh ululmmosc iogsancutom irvus (.VMC) nI obaut 10% fo het ss,cae meazec posldeev odnura eht


 +4  (nbme21#7)
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moAgn eht somt tlaperevn lchooeaigmt eltabmisroina ni tptaeins ihtw hoctumlrieoag sderrosdi era the aiaemn of chncroi adsisee DC()A, a dlim miaean htat si egleayrnl smicmty,oatap dna ionr ifedecynci aeiam.n

In iecdnor-nfciyie ,aiamen the TCIB wdluo hrhieg nhta –044050 d/Lcmg secabue serost lwduo eb .lwo

naiPetts wiht RA syacilonocla aevh tonccerrun iorn iicnedceyf naeami and .DCA eWnh thsi ruco,cs teh goibeohnml levle uslauly dpsor to obelw .59 g,/dL adn the CVM si slse tnah 08.


sympathetikey  Got the right answer too, but man, that whole "1 month after starting therapy" almost threw me off. +1
fkstpashls  all I do is put the wrong answer when I'm between two. Fuck +1

 +3  (nbme21#38)
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ePlaitaxcl zlbiesitsa het etlorimcuub eyormlp adn esrtpcto ti mrfo slaysbsmid.e okhti.hawixif/#wc/eaecin/o_/epgtcliaMan.as_:iotiripPdlntemks

 +2  (nbme21#43)
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In stom dniiaiduvls dcifenet wthi .M scboesru,litu oracmounlen llesc ni the boldo eralees amifm-ternagnoer ewnh uelisdtamt whti nseiatgn deierdv mfor .M rb.iueosutcls


 +2  (nbme21#47)
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arehyidtre estsohcroamiho.m

FHE is maetutd t;&g= teh ntiteisesn etyrllpeapu teriprtne a ngrtso isanrrrtnfe linsga sa fi the obyd rwee iedfteicn in .rnio sTih saeld ot xmlaami oirn pobritaosn form etiedgns fosdo adn oinr rdeovalo ni hte suti.sse


lovebug  Autosomal recessive. C282Y mutation > H63D mutation on HFE gene, located on chromosome 6;associated with HLA-A3 [FA2019, PG.389] +

 +0  (nbme21#32)
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monlBeicy si nnkow ot ceaus lung and niks cyxitiot deu ot leitvera scebean of eylhosard ni snik ueitss rgensulti in edcdseear saioebmltm dna layddee na.elccear ayoulmPnr mpioscilantco rea momcon tub inks csghena era arre adn luiendc nnaepimphto-trei,yg q,sauple oteecrktrphayi lo,essin yethrame orlmte,imfu lap,aoeci oiismtttas dna lnia Teh exact mmahcinse fo nisk encghsa secuad by mcnibeoyl si nto .onkwn heT mretantte lsienvov mnangtmeae fo dlrunginey odsreirds ro awhriwdlta fo the denifofgn .ugrd


 +0  (nbme21#40)
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scuretrStu iiwhtn eht reuto (talrea)l llwa of hte ceattornpmm fmro sopuirre ot crro rftoeiuoiOl:omn oelenrhvcT aerr enahlcpeOimtr hv dna ylalxrmia cnasherb fo eth mrainteilg tuc rvrerStseeun ngipass huhotrg eht miliedn ae()dmli : nwcsldluabeA rnIvetrel eann rtiaodc eayrrt amoadepcnic by eth ratIlenn iatocdr luxeps


 +1  (nbme21#17)
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craGsit cavseir rae fde by eht rstoh ractsgi in.sev


cienfuegos  Add'l UW fun fact is differentiating from gastric varices 2/2 PHTN: Gastric varices: can also be seen w/ splenic vein throbmobis 2/2 chronic panceatitis, pancreatic cancer and abdominal tumors - gause gastric varices only in the fundus (remainder of stomach and esophagus usually not affected vs. PHTN: increased pressure in left gastric vens thus both gastric and esophageal varices) +5

 +3  (nbme21#6)
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nI isirdasoosc, lihypceremaac lraymlno rsspupeses het areesel fo PTH nda herrteeof eht trcdouiopn of ocartlicli c,2rxh5,lorc(ieyclf-1heodiaod)yl utb in ssoicrdisao nad htroe nuoolsmguaart idesssea, edaatticv omalonceunr cllse la(paurtlicry hasg)eraopmc in eht ugln and lmhyp dseon reopcud ctclroiila llc5lch1d)2yoyh,efdeo(rcx-raioi frmo iioccaldl 2rcoyc-rf(elhyaho)x5iloclde etdnniendep of .THP


dr.xx  ~~In sarcoidosis,~~ +
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +

Subcomments ...

submitted by sattanki(71),
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ceuMsl apni + briltroeipa ademe si a aslicsc tsnprnaeieto rof onhltalirec .piliasrs etBs sgndiiaos rof hsti si a lmscue yobsp,i as hte wryom liske to uatoghn nwithi eht

sympathetikey  That's what you get for killing polar bears. +84  
dr.xx  That's what you get for not cooking them well. +4  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2  

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neboriFtcin is na alutrxellecar tmaxir erlycopo,ting ewihl lnaim is na maeitdienter aneflmti tath slfceiclypia oidpsver puorspt ot eht clle lc.seuun ’Dton secoufn nimal twih linmnai i(eescnc htesa us yel);calr namniil is ikel ,foirncinbet an ECM gpilerocnoyt nda a mojar oomnpentc of het sabal nmalai fo eatbensm ermne.bsam

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) +34  
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 neonem(571),
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ngFlail no tdsctuerhteo hdna: oadpihsc si most nocmom eno ot eb fuced,trar anutel si omts oommnc ot be s.eidoalctd Lutane oaioidsnclt acn useac cuate pcalar uletnn smor.edny

nhTik fo het icmnmnoe titgrha"S einL oT nP,kyi eHre esmoC The uhm"Tb rfo het eonsb fo het lmp,a adwnirg a aflloobt heaps tsgtiran wobel het buthm CMP inotj jetacdna ot teh ,dirusa hent ognmvi ot ryou admeli wtris, dna tenh cbak ot eht ubthm.

Sdoiha,pc tl,unea eimtuurtrq, prisi,fom thm,eaa iatp,atec ptao,zedir temzpruai. heT lenatu lsoko klei its' eorlptysoir tselciodda eher.

sympathetikey  Yep. I didn't even look at the X-ray. +11  
dr.xx  loonies love lunate +2  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +1  
wes79  i legit have no idea whats going on in that xray lol +9  
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +1  
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +3  
niboonsh  Some Lovers Try Positions That They Cant Handle +10  
vsn001  ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D +  
regularstudent  Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic +  
sars  I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome. +  
makingstrides  Another mnemonic, Some Lovers Tried Positions, That They Can't Handle +  

submitted by m-ice(340),
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The atnitep endes lmaiecd notineatt la,eyemtmiid ihcwh iislmaente nongtiabi a rtcou ror,de ro fgrresrtanin reh. A esrnu sedo tno hvea teh seam ntrngiia and coiuailanqtisf sa a ,asypinchi so it ludow eb ptiprenraiaop to ska hmte ot xanemei the tapi.ten sgnkAi het palithso cliaahnp aiang lucod be tiparapoperin, nda wolud eakt mreo eforrT,ehe eht etbs oponti mgnoa shtoe engiv si ot ska eht aittnpe if she lliw lolaw thwi ehr ubahsnd net.sper

sympathetikey  Garbage question. +60  
masonkingcobra  So two men is better than one apparently +29  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágé +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +12  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. +9  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +16  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +26  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +5  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +12  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +11  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1  

submitted by tissue creep(113),
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I reettad tshi ilke igWnnerd faSAfMnmoH/ ntue"(og s)al"csiiuf,tncao and jtus ndki fo dtecpeac it gbnie erwid ot eb ni a ol.ry5-eda-5

dr.xx  SMA4 (Adult-onset)? +  

submitted by yotsubato(1032),
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sihT si a siquoent uabto tnetpia y.iarvpc Teh intatep here si eth idcl.h The poyxr ofr teh aitnpte is hte otermh and .trhafe heyT utsm wkno whats grwon. steirS and tmoher ear sjtu ysk,ooollo adn rtsnpea yam nto nawt ot tlle htme pustdi( I ,oknw tub evrathw)e so ouy nsde emht uot nad hnte lelt eth trapsne eth na.ttiusoi

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +28  
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +10  
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +5  

submitted by lfsuarez(142),
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isrFt herta sonud )S(1 is reaetnged yb two raeth valvs:e eht rmtlia levva and iturdcpsi .valev Nleayr tssemiunaluo gnsiocl of etseh alvvse aorllnym rgteasnee a nsgeli S1 dsuo.n inplttgiS of het S1 sdonu si rhdae henw tlarmi adn sidtuirpc vsleav loces ta gythlisl dnritefef e,imst wiht slluuya hte tlamir lgsnoci ofrbee itpcidurs

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area +25  
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts. +36  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +4  
titanesxvi  tricky question, I though what sound it is in the left sternal border, so I chose tricuspid valve, but what they where asking was, what is the first component of the S1 sound +1  
drzed  It shouldn't matter where you hear a split sound. For example, no matter where you auscultate on the heart, the second heart sound in a healthy individual will always be A2 then P2 (whether you are at the mitral listening post or the aortic listening post) The key is recognizing that the right sided valves in healthy individuals will always close later (e.g. the heart sounds are S1 S2, but more specifically M1 T1 A2 P2). The reason for this is simple: if you take a breath in, you will increase preload on the right side of the heart, and thus the greater volume will cause a delayed closure of the valve. This is physiologic splitting, and is better appreciated in the pulmonary and aortic valves because they are under greater pressure, and thus louder, but it can also be heard in the first heart sound. +10  
alexxxx30  yes agreed!! This question is mostly asking if you understand a few basic things regarding cardio physio. The left side of the heart is the higher pressure side so left sided valves will close first. The right side of the heart is the lower pressure side, which means right sided valves will open first. [Left closes first, Right opens first]...Secondly, it requires you to know what S1 and S2 sounds come from. S1 is the mitral/tricuspid valve closing and S2 is the Aortic/pulmonary valves closing. So really the question asks what is the first component of S1 (mitral or tricuspid closes first). And since we know that the left side will always close first, it must be mitral valve closure. Sorry if that was a long explanation. +10  
jesusisking  Thanks @alexxxx30, you the man! RIP Kobe +  

submitted by nlkrueger(44),
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.... duowl we ryelal etka het drwo of a nifder woh itdiylfnee 'ctan eb ?iodenmcfr I lefe elik tihs is daignelsmi

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +9  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +31  
dr.xx  The patient has no wife, children, or close relatives... +3  
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3  
paulkarr  With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1  
suckitnbme  I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +7  
vivijujubebe  they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +  

submitted by mousie(220),
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nCa enmsooe espeal pexlina siht to m?e I o'tdn desnadtrun yhw tgsinatr hte hotre drug uldwo otn nctuo sa xslinucoe ectri?ari

seagull  This has to do with Intention-to-treat analysis. Essentially, when participants are non-adherent but the data shouldn't be lost. They just undergo another statistical model to account for their changes. Here is a nice video +22  
dr.xx  Where does the question mention "intention-to-treat"? +  
notadoctor  They seem to be pretty obsessed with "intention-to-treat" it's been asked in one way or another in all the new NBMEs that I've done. (Haven't done 24 as yet) +8  
wutuwantbruv  They don't, intention-to-treat is just the best way to go about it @dr.xx +  
smc213  Great for ITT: +4  
yex  I agree with @notadoctor !! +  
ergogenic22  i think if it were per protocol, both groups would be excluded, the ones that were inconsistent, the ones that dropped out, and the ones that switched. But answer choices only allow ITT or exclusion of one group. +  

submitted by chris07(57),
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'Im isgneugs htta scine sith si hoi'oastmsh ahtt a ypsiob fo eth othriyd lwduo oswh teh oyhrdti adlng pyleltocem leefdgnu by gaatnktci tmch.olypsye Oerv miet ,uhhgot dtnuolw' het dihytor eb leeptyoclm dydetoesr nad ct?boifir

dr.xx  Progressive thyroid cell damage can change the apparent clinical picture from goitrous hypothyroidism to that of primary hypothyroidism, or "atrophic" thyroiditis. The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. +  
paulkarr  I was thinking that "Diffuse fibrosis" was trying to point to IgG4 Riedel Thyroiditis rather than Hashimoto's. +6  
spow  It's only been 10 months, per the question stem. This probably isn't long enough for fibrosis to be correct +1  

submitted by meningitis(544),
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sPesocr of aniltmnioei no stih oen.

  • I neadmitiel yaolCbrm hophpte,sa ireinAng ude to erau ceyl.c
  • I aditieemnl TAP ausebce ATP neloa nuwtdl'o naghce F6P tnio nleumoascgi
  • AGN I gto ukcly dan I edmlantiie ti due to ist ues ni EMC nad cgllanoe so I di'dnt inhtk ti wsa ravteeln dna I knid of ermedbmere it niegb ni uear yc.cle
dr.xx  you mean, pure luck? :) +13  
impostersyndromel1000  lol pretty sound logic here mate +3  
nor16  same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +  

submitted by marbledoc(0),
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hatW si hsit cdiamintoe beign cdrsdbeie ehre? naC osmenoe iemch ni.

thatyummyslice  Nitrates i believe! NO --> increased cGMP in vessel smooth muscle --> myosin light chain dephosphorylate --> vascular smooth muscle RELAX --> Dilate (primarily in venous) AKA more venous capacitance --> LOWER preload and workload for heart. +29  
marbledoc  Thanks! Thought it was nitrates too from the Q stem. But had no clue it was notorious for headaches (only thought of hypotension, dizziness, etc) so doubted it all together. But you’re absolutely right apparently it’s the most common side effect! +  
dr.xx  Previously, Ferid Murad et al. described that organic nitrates, such as nitroglycerine, induce vasodilation by release of nitric oxide, activating soluble guanylyl cyclase and subsequent cyclic guanosine monophosphate formation.7 These discoveries rendered Robert Furchgott, Louis Ignarro, and Ferid Murad the Nobel Prize in Physiology or Medicine in 1998. +  

submitted by nosancuck(87),
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amD sno htis ill b otg moes ADIULTEICMB uslomlucM all pu in hre zbinses

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +1  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +7  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  

submitted by moloko270(66),
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hits si Wgrbaleenl rysodenm - tsoekr sducae by touocnristb of CIPA - os tahst yhw ew etg ospmmyts of p,agdshyai raos,ssheen nstbea gag elerxf .p( 502 FA)

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already +2  
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this. +22  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +  

submitted by mcl(599),
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mgolrieH otg eosm ricacevl loutte nsmyoerd dna hlouds bloarybp kaet osme stffu out fo ehr capkckba or etg neo fo hoste lil rerllo eons.

mcl  Whoops, my bad, THORACIC outlet syndrome +4  
dr.xx  Stretching, occupational and physical therapy are common non-invasive approaches used in the treatment of TOS. The cervical rib can be surgically removed. +1  

submitted by iviax94(7),
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CT sowhs smas no eth eflt esdi of hsi omabedn nda oyreu’ ltod ’tsi stnpsi.tuciuesno sAks whhic artp of het IG ractt is omst llkyie to casue het i.nap I lmdiyaemtei eookld fro laceecoli iujnocnt ... otn na nserwa cic.eoh yWh si het wsarne ejunjmu .v(s )neoum?dud

liverdietrying  The picture is key here. You’re right that ileocecal is most common, but ileo-ileal and jejuno-jejunal are the next most common (I think I might just know this from having done clerkships already, not sure). Ileo-ileal isn’t an answer, so that rules that out. Look at where the arrows are pointing in the picture as well. Its on the L, ruling out appendix and cecum. And the slice is not at the level of the duodenum, ruling out that answer. So by process of elimination based on the picture you could get this one too. +4  
dr.xx  Duodeno-duodenal intussusception is a rare because of the retroperitoneal fixation of the duodenum. +1  

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Harrdietey r(o udae)cirq eoiangeadm = C1 biihnirto yenfdie.cic Pnaeitt sah a 9e-ayr xH of sotf stiues n,gllwesi alslyiecpe fo eth cfa.e 'sIt loatmosAu onmDtnai if rhtnied,ei or nca be ieqarucd uothgrh lmlueitp meisscnahm.


dr.xx  wrong question? +2  

submitted by nosancuck(87),
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aDm ons sith lil b tog eosm AUMICTIBLDE ullcmousM lla pu in reh siezsbn

drdoom  tru. +  
meningitis  Pg 164 FA 2019 +1  
dr.xx  likely not "lil b" as 2-4 times as many cases are found in whites than in persons of other races +7  
drdoom  lil b not a referent of race; cf. lil boo, lil baybay, lil bowow, &c. +  
dr.xx  I disagree. Google "lil b" for images. See what you may discover. +  

submitted by lnsetick(93),
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  • PeriAcon = yruo sarmtip lmels ielk na EAP
  • eMecRnU = tsreeh’ no OOMR in ryou aesr neics r’eyhte lful fo xaw
  • nRYECCe- = wnhe you Ee,srieCc yuor eoprs era RigYnC
  • uEecSasBo = mBEuS si iEESngP otu fo uory repso
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 nosancuck(87),
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uyo oknw ohw it is ezed ibos otg dat iclfaa USHFL deu to relentax snttulaiim

dr.xx  please use standard English. I cannot understand a word of what you are saying. +8  
aishu007  FA pg 468, facial flushing due to external stimuli like spicy food. InAammatory fac ial skin disorder characterized by erythematous papules and pustu les 0 , but n<> comedones. May be associated with fac ial Rushing in response to external stimu li (eg, alcohol, heat). Phymatous rosacea can cause rhinophyma (bu lbous deformation of nose). +2  
madisonivy +  
madisonivy  madison ivy +  
an_improved_me  Didn't know Madison was getting her MD; same as Dr. Johnny Sins! +  

submitted by dr.xx(151),
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In coaisods,irs rhecyalmpicae nmrllyoa ussspeespr het leeaesr of TPH and otrhfreee hte dcioptunro of olaclitcri y,-oeco2lrlhcci5lhdi,1ef)yadrxo( btu ni dsrcaoossii and eorth sgaulmnartoou siaeed,ss itdtevaac amoncenluor eclls tlaaipr(cruyl sga)oacherpm ni eht nulg dan yhpml ndeos drecpou irloicltac o5eoflohh2icr)c(y1erdcdx-yai,ll frmo alcilcdio ool2yrc-dhehill)fr5yxoeac(c npendnteied fo T.PH


dr.xx  ~~In sarcoidosis,~~ +  
hello  Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +  
drdoom  I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +