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Contributor score: 18
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Comments ...
dickass
European implies northern european (they even specified the patient was a person of pallor), mediterranean descent is usually implied by country of origin or by straight-out writing 'mediterranean'.
poisonivy
The MCV is normal, thalassemias are microcytic anemias, that hint helps to rule out the thalassemias. However, I got it wrong, not sure why it cannot be a homozygous mutation in the ankyrin gene
Subcomments ...
nala_ula
perhaps it's more to do with the fact that he can get erections when masturbating, outside of nocturnal erections which are not mediated by sexual desire. So his libido must be intact since he has sexual desire evident in being able to masturbate.
+ 2019-06-16T20:30:38Z
nala_ula
At least, that's the way I saw it.
+ 2019-06-16T20:30:47Z
home_run_ball
"Testosterone concentration is within the reference range" and the fact that he has no difficulty masturbating = normal libido. Low testosterone would contribute to low libido And if he had low libido he would have difficulty masturbating
+ 2019-06-19T19:19:51Z
thisisfine
The way I made the decision about normal vs. decreased libido is also that he presented to his doctor due to difficulty maintaining an erection while trying to have sex - meaning he has the libido to try to have sex. Does that make sense?
+1 2019-07-01T20:00:30Z
btl_nyc
It also says there are no signs of depression, which would cause the low libido after his wife died.
+ 2019-07-04T01:06:27Z
temmy
two years is a enough time to mourn...just saying
+ 2019-07-10T22:17:49Z
temmy
thisisfine, it makes absolute sense. That is the same way i saw it
+ 2019-07-10T22:20:35Z
dr_jan_itor
He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine (can crank his meat)
+ 2019-08-02T19:29:36Z
sahusema
I know you're right. I was just so uncomfortable picking an answer with "inferior rectus" because damage to the inferior rectus does nothing to explain the clinical findings of impaired upward gaze. Unless the muscle is physically stuck and can't relax or something
+3 2019-07-19T16:30:57Z
emmy2k21
Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :(
+1 2019-07-21T01:01:43Z
dr_jan_itor
in the last sentence it asks you to assume an "entrapment", so it is actually the inferior rectus which is the cause of the upward gaze palsy. The entrapped muscle is functionally trapped in it's shortened position, thereby not allowing the orbit to gaze upward.
+6 2019-08-02T19:23:40Z
chandlerbas
bam! dr_jan_itor just cleaned up that confusion
+ 2019-11-09T22:59:38Z
d_holles
Yeah the negative EtOH screen threw me off
+1 2019-07-01T23:57:26Z
dr_jan_itor
Why cant it be early alzheimers and hippocampus? She could easily have been a former prominent physician and member of city council. Am i supposed to assume that simply because shes disheveled and poor hygeine that she must be an alcoholic homeless person? It also mentions no symptoms of nystagmus, ataxia, etc.
+1 2019-08-02T18:47:17Z
kimcharito
it said broad based gait and nystagmus
+1 2019-08-09T21:41:09Z
lilmonkey
She is/was an alcoholic and appears pretty much homeless, just not drunk at this moment.
+ 2019-10-19T22:25:38Z
hungrybox
Also, the yeast form of Candida is gram (+)
+4 2019-05-31T01:16:00Z
dr_jan_itor
I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense.
+ 2019-08-02T18:39:50Z
lilmonkey
I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one.
+ 2019-10-19T23:08:06Z
meningitis
More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico).
Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities.
+6 2019-06-04T21:44:35Z
nala_ula
I'm shocked that I found a fellow puerto rican on this site! Good luck on your test!
+ 2019-06-17T00:55:13Z
namira
dont be shocked! me too! exito!
+1 2019-06-22T23:08:12Z
dr_jan_itor
I was thinking that its Murine typhus transmitted by fleas
+ 2019-08-02T18:27:35Z
monique
I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection.
+ 2019-11-18T05:44:30Z
jakeperalta
Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience.
+ 2019-11-29T15:27:44Z
aesalmon
Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine?
+ 2019-05-30T04:08:59Z
hungrybox
Yeah, I got this one wrong with the same logic as you, aesalmon.
+ 2019-05-31T20:21:17Z
emmy2k21
I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines!
+2 2019-07-19T23:59:06Z
dr_jan_itor
@emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase
+2 2019-08-02T17:36:51Z
et-tu-bromocriptine
Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice.
Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy.
+1 2019-08-09T01:06:07Z
lilmonkey
I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time.
+ 2019-10-18T17:19:51Z
docshrek
@lilmonkey can you please give the QID for the UWorld question?
+ 2019-11-24T02:22:51Z
jakeperalta
Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall.
+ 2019-11-29T19:07:34Z
jakeperalta
Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. P.s:it struck me as a romantic relationship as well, but it doesn't clear my doubt😓ðŸ˜
+ 2019-11-29T19:09:37Z
niboonsh
rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018
+5 2019-06-21T23:48:12Z
dr_jan_itor
what if the alcoholic just has a concurrent rhinovirus infection ;)
+1 2019-08-02T17:02:01Z
niboonsh
yea it was a dumbass question, whoever is writing these questions is undoubtedly a crazy genius but homeboy (or homegirl...homeperson?) needs a few grammar lessons.
+1 2019-06-24T02:13:01Z
yex
I agree. We know that it is a teratogen, but how does that question directs you to think about teratogenic effects instead of something physiologic?
+2 2019-07-03T21:50:22Z
dr_jan_itor
The questions in the NBMEs by default are reject questions. So highly selective to be awful questsions. I am recieving regular heads up that the stems on the real thing lately are like 10-12 lines long. So these questions are not anywhere near like the test. NBME has f'd us good for this particular round of practice forms.
+ 2019-07-30T13:29:39Z
sweetmed
Memory T cells live for six months or less in healthy humans (Westera et al., 2013), whereas naive T cells can live for up to nine years
+2 2019-06-02T23:10:57Z
whossayin
so the bone marrow does not take the role of the thymus?
+ 2019-06-23T09:11:28Z
dr_jan_itor
@sweetmed, does that mean that if someone loses their thymus, they would develop imunodeficiencies appx 9 years later as the naive T cells have died off?
+2 2019-07-30T13:27:44Z
hpsbwz
@dr_jan_itor no, because once all of the thymocytes become T-lymphocytes, they are stored in lymphoid organs until they're needed. this is why removal of the thymus in MG does not cause any immune system deficiency.
+1 2019-08-13T21:49:14Z
hello
Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods.
+ 2019-06-04T03:44:00Z
yotsubato
such a BS question IMO
+3 2019-06-10T12:43:14Z
yotsubato
such a BS question IMO
+ 2019-06-10T12:43:15Z
breis
I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption..
+2 2019-06-12T22:39:47Z
teetime
This isn't right because the bariatric surgery will cure the prediabetes. It's dumping.
+1 2019-07-20T20:39:05Z
dr_jan_itor
Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled.
+1 2019-07-30T13:21:06Z
home_run_ball
^ Above is partially right:
Propranolol is non-selective Beta blocker:
Beta1 stimulation causes inc HR, therefore blocking it will dec HR and dec Cardiac output
Beta 2 stimulation causes vasodilation, therefore blocking it will CAUSE UNOPPOSED alpha1 activation --> therefore increasing total peripheral resistance.
+13 2019-05-30T00:13:36Z
amarousis
so why tf do we give beta blockers for hypertension -.-
+3 2019-06-30T19:40:06Z
dr_jan_itor
I would also add that the patient was previously on an a2 inhibitor (clonidine), which he ran out of. So he is rebounding on that with upregulated a1 receptor activity. Adding labetalol would cause a greater degree of unopposed alpha, increasing tpr
+1 2019-07-30T13:05:54Z
llamastep1
@amarousis They are used for hypertension because the hypotensive effect of the reduced CO is greater than that of the effect of the increase of TPR. Cheers.
+ 2019-12-01T04:37:06Z
He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine