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(nbme21#39)
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If u ear tno gtoo ni mhat ekli em Dx. I ddi ti sthi yhye:a wT gaev me 0^29/1=p0 os 3p.10=/

Nwo I nede ot fdin P, so esu 1=q.pp+ = 1=13(-/)0 3-01.0= .790

oS, =2qp 200()90=.)(.73 600.4 = 11)(/5 :D I gto it hgit,r sith is ym wya to do it eaucs mi ont ogod ta ot.rnfcsai

eacv  **** q=1/900 +
bdaines8  you literally have a calculator to use.... use it +

(nbme21#50)
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here is also a ieutcrp aoutb het svine dna xiomtyrip to the gusnl

1s/e17acntrp0gc7l7e0/2-so228-cSdgtrng.0h1.j0sn.//93t/p.oes7-m05-m1t:ai

(nbme20#8)
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isTh is an ICROTA NIICSESDTO: oN. 1 FR si ,AHT matilni atre ormginf a alfse nmelu dan eth pain dduesn otesn sdrtaeia to het acb.k

(nbme20#40)
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to dad : it loas IAERS FROM RSHCOBUN and ttha is risedecbd ni het q.x

(nbme20#16)
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Idefnomr ontsnec ldusho eb aiebdnto yb a eiorrpdv woh hsa eutfisfinc dkgwoenl to veig trauaecc rodtpeniics fo the ,trintineevon hte ikras and besteifn fo ttmtn,ear dna ealb ot nweras all of the xp tieo.nsuq ishT is eht letaxpnoain for a eryv ilsamir xq ni dUo.wlr

submitted by jooceman739(27),
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oattnabeRsil:mo

Teh naiyhipcs idas het oby is lyikueln ot vdoeelp any reoth psm,osealn os he et'dosn ahve teh edteinrhi bR amotun.ti

nI iths ceas, he sah the apodirsc .aetlrmsotnioab cSriodap otneblaaortims rirsueeq two smocait uttsomani of bR ni teh msae itlaner ecll.

Jtus sa a deis nt:eo iretdnIhe srbeaotminaslot entd ot be abtrl.elia odrcpiSa ear rltula.neai

carls14  aren't retinal cells a type of somatic cell? Why not is the mutation not considered in the somatic cell of the child? +9
omerta  Although this mutation would be considered somatic, I believe the question is just asking you to be specific as to which cells. If you answered "somatic cells of the child," that's quite broad and could apply to almost anything. +12
kernicterusthefrog  I had the same struggle and thought process. +1
eacv  There is a Uworld qx that explain this in detail> ID: 863 +3
arcanumm  I read the answer options too fast so got this wrong. It is a somatic cell type, but somatic in general implies a higher risk for developing other cancers. The hint here is that the physician stated he is unlikely to develop any other neoplasms, so it is a specific double hit mutation in the retina. +7
almondbreeze  wouldn't she have any possibility of developing osteosarcoma as well? :( +
almondbreeze  did some reading and it seems like osteosarcoma only occurs in familial retinoblastoma with RB mutation +
brise  But how can a 5 year old get two mutations to get retinoblastoma? In 5 years?! Obviously doctor is probably wrong LOL +
jaramaiha  The difference between familial and sporadic mutations dealing with Rb is that in this case he only had one hit so that only one eye is affected. In other words, if he would have been born with the familial type, he would present with Rb in both eyes and also be predisposed to osteosarcoma. In this instance he only has Rb in one eye having only a one hit mutation in his right eye. When the stem says this is the first mutation it's implying that he wasn't born with the familial type so to obtain a second mutation over the course of his lifetime would be rare. +
brise  @jaramiaha I believe it still falls into a two hit mutation, but both were sporadic. But you are right about being unilateral. +

submitted by bubbles(69),
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roF het esppe hwo gto cefdunos no shti qteuonsi bc fo olrWs'dU iedwr oiusqnet no IHV vrial da:ol

aeuct -V1IH c:ftnioeni IHHG ilavr lo,da wlo VAb- I2H ctefnnioi: WLO arlvi odl,a owl bA bc( adastnrd VIH saayss edtetc p,24 cihwh si not ernsept on HIV-)2

nidaK nadynoe I sesmid na esya nloigyoumm ceoptnc onuiqset :/

eacv  I feel you my friend! same stupid mistake over here -.- +3
step1soon  FA 2019 pg 176 +2

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How ynam pleoep dd'itn ese ttha ti wsa tfi1eipy-ccsi and pkeicd E ilke em :(

jfny21  Here +1
eacv  yesss! me too -.- +3
jinzo  me also :( +1

submitted by sacredazn(81),
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eTh pconect si a uetoolncdv yaw of skngai fi uoy newk woh JDV rnbociaenimot so,wrk whchi si htta ti is aluylact na emalpex of graetnli the NDA fo teh /TB ohey.tpylmc

etunhSor bolt ietcnu:qeh So whne yhet eus a rpoeb gsatnai omse rieogn, adn ougtntupit a ezsi fo 51. kb or 6 bk, itsh si ileltng uyo hte eszi fo teh NDA aefrtnmg in ache clel (’nosetd mtarte fi tyhe say J epobr or csotantn oinerg r,oebp ehrye’t tsuj gisany yh’rete rgtnegiat msoe tcdoeulien cneseequ nudof in eht gI ClTouRcs/ ateb achin uclso ycsvrtieepel ofr TB/ slle.)c

I ntkih hte ncginousf tpar olucd be windronge ohw you nkwo hterhew ’yueor ytalrp hguroth graerrneemtan wern(as sccheio B hutr )D ro fi it shant’ rocurdec at all tey rec(torc wnsa.)er H,eer het nccoetp si atht B lselc rengduo )(JVD emraartgerenn in hte beno a,rowmr lewhi T llecs od it in teh ymuht,s and it lla ppesnah at n.oce oS a smapal clle in het obdlo leki in itlMleup Mloaemy wlduo veha lyulf uendngoer irabniotonem,c eilwh a T llce in eth doobl lucdo hteeir eb fully etudaedc (and vhea ifdnhsei JDV cmoaeti)nonbir ro rmuiaemt sat(h’n stretad J).DV

nScie het T cell eegn swa 6 bk dan ideiytnlef ibgrge hnat the 15. kb ,eneg eth T lcel hstn’a ndeeunrgo conbnieimoatr e.yt

trichotillomaniac  very nice explanation! +28
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +4
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
mynamejeff  Thank you! So is this because multiple myeloma produces excessive monoclonal light chain Ig? Is this the 1.5 kb gene? Whereas, T-cells that have not gone through differentiation yet and their J region includes everything (VDJ) vs. just VJ in the light chain? (FA 2020 pg 104) +
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +

submitted by cantaloupe5(77),
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cPrscose fo nelotiiniam for hsit n.oe wTo uoy anc metiialen liemditmyae sujt fmor noiokgl ta eth ccmihoebail wyahatp cahtr. ehT tehor owt ireuqdre oelndgwek tath emieulnna is more retcvteoip naht iepnhnelmao shit( is why deeadshr unrb rmoe .i)alyse sBeceua lapnihnoeem si sels tcviorpte,e htere udwlo eb eorm otn slse OSR mfro ligthuns.

henoch280  @temmy. This question tests our knowledge on albinism which is normally a tyrosinase deficiency disease but the vignette states that the boy's albinism is caused by a genetic mutation in the TYRP1 gene which is shown in the biochemical pathway. A gene that helps in the synthesis of Eumelanin. Now you have to understand that all precursors before that gene is the pathway would still be available if not increased which make 2 of the options in the question wrong. you also have to understand this: (Eu)melanin = (normo)melanin i.e normal melanin which is protective to the skin, decreases reactive oxygen species and gives the dark pigments to the iris, choroid, skin, hair e.t.c. while (feo)melanin = (fake)melanin i.e pheomelanin, the one present in our patient here which is less protective again the uv rays, cannot pigment and cannot decrease ROS generated in the skin. i hope this helps +26
eacv  @henoch280 thank u very much! I got it right by luck but now i do understand :D +

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rhoeiduty ksic emnydsro is seoemtims ldecla w"lo T3 nmeysr."do lAos yuo wokn tath hte ptienta si yiturdohe sbcaeue reh 4T dna THS ear hitiwn eth cerenfree rneg.a hSe si si.ck

yotsubato  This is not in FA btw. +9
niboonsh  https://www.ncbi.nlm.nih.gov/books/NBK482219/ probably caused by her recurrent pneumonia +3
eacv  I though in this one as a sick sinus syndrome hahaha in UW. +
pg32  Pretty sure boards and beyond teaches this wrong. Dr. Ryan says that in euthyroid sick syndrome T3, T4 and TSH will be low, but rT3 will be elevated. +
pathogen7  In reality, TSH and T4 levels can be highly variable based on the stage of Euthyroid sick syndrome. One thing that happens for sure, I believe, is that T3 is down and rT3 is up. +1
trazobone  I think I been in quarantine too long I am really giggling at she is sick LMAO +

submitted by eacv(36),
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If u rea ton otgo ni tahm iekl me Dx. I ddi it ihts eawTy:hy eagv em 00^2/9p1= os p31=.0/

Now I deen to fdin ,P os sue .qp+ =1p= 03-)11(/= 0-.3=10 079.

o,S qp=2 2)(0).0790.3(= 6.040 = 151()/ D: I tog it rhtg,i ihts is ym ayw to od it euasc im ton odog ta tfsino.rac

eacv  **** q=1/900 +
bdaines8  you literally have a calculator to use.... use it +

submitted by hungrybox(1035),
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nsihycomaey edspot siht terga icp boelw

eacv  here is a video for ilustration https://www.youtube.com/watch?v=US0vNoxsW-k +2

submitted by usmile1(109),
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fI uoy olko at lwUord seqiuotn ID 19229 it sha a ledrnwfuo elntipaaonx rfo .sthi fI etyh rhsea eth esam eeipt,osp ti lwli hvea a nwwdraod lI oef.ps htey aserh none of the mase sip,peoet eth elni will eb oihaznltor coassr teh rgpha iing(nacidt on ahegcn sa hte otuman of Y ddead crsiesane)

eacv  omg YES!! thanks Uworld I got it correct! exactly this qx asked the exact opposite thing! Hahaha I loved it !! +8
pg32  Even after reading the UWorld explanation, I am still not sure how the answer that reads, "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not..." is incorrect. Based on the graph, I don't see a way we can rule out that answer choice and it sounds more likely than both X and Y having the EXACT SAME epitopes. Can anyone explain? What would the graph look like if the quoted answer choice was correct? +2
69_nbme_420  If you make up an example with numbers, it really helps! “Protein Y expresses all of the epitopes expressed by X, but protein X does not express all of epitopes expressed by Protein Y.” If we say protein Y has epitopes 1, 2, and 3. Then Protein X has epitopes 1 and 3. Then we can clearly see the relationship the AMOUNT of Y added relative to X bound would NOT be linear. Stated another way – we need an exponentially more amount of Y to COMPLETELY unbind X and therefore there would not be a one to one depiction in the graph Similar logic applies for the answer choice that states "protein X expresses all of the epitopes expressed by protein Y, but protein Y does not express all of the epitopes expressed by protein X. E.g. If protein Y has epitopes 1 and 2. And protein X has epitopes 1, 2, and 3. Here again, we have satisfied the answer choices condition, and no matter how much we increase protein Y, protein X will still have epitope 3 bound in this case. +4
69_nbme_420  Just to clarify for the first scenario: We have 3 epitopes on Y, and 2 epitopes on X. That means, assuming the epitopes are all present in equal amounts, if I add 300 grams of protein Y to the solution - only 200 grams will bind protein X. AND ONLY 200 grams of protein X can be unbound. Hope the numbers help! +
fruitkebabs  For anybody still stuck on "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not," although this statement may be true, there is not enough information in the question to prove this. We know for fact that because the Amount of labeled X bound reaches 0, at the very least, protein X and Y express the same epitopes since at a certain concentration, Y is able to completely displace all X from the system. This doesn't exclude the possibility that there may be extra epitopes on Y, but it doesn't prove it either. +2

submitted by beeip(124),
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woH ot efatienietfrd nebewet irsvNroou adn oiastRrvu er?he utMs eb daterle ot eth eht tginaocsou eauntr of eht iln?sesl

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +3
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +4
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +
savdaddy  ***after the initial outbreak +1
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +4
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +1

submitted by hello(313),
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Ptaenit in lyovhmipceo oshck - het uscel rea low BP nda OOCL i.nks oecovymliHp cohks si cuased yb luifd s.slo

ehT ieptnat sha dseecerda reodlap bc/ fo dufli l,sso ..ie trehe si eacdreesd doolb vlumeo rtgninure ot treha -&g-;t suth deacereds erolda.p

endochondral   why not dec SVR? +
sup  @endochondral w/ hypovolemic shock you would see increased systemic arterial resistance as arteries will constrict to try and bring BP back up. +1
eacv  @endochondral dec SVR it typicaly of septic shock. +

submitted by thomas(2),
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yeTh llet you ttah het kid has on ec.llvica ihsT amsne het tfdeec is in snermbmuoa i,sisnitfcaoo NOT cndran,oohdle so the tapoyghlo is ONT nggio to onvvlie eht tavehrncodrhweo- s.clel screeedda LAK is tincntsseo twih seootslabt efdtc.e

pakimd  isnt increased alk phos consistent with increased osteoblastic activity? +
eacv  @pakimd Yes ! ALK phos is a measure of osteoblast work, if the are not working is LOW as in thix px. +1

submitted by lamhtu(118),
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aUulnus atht eht tipnaet is a yuogn ir,lg COTD si RXL nciaere.htni

eacv  yes !!!!! that make me doubt and choose the wrong one -.- +
ally123  FA p. 83 +1
j44n  could have turners and we just dont know it yet or skewed x inactivation.... but thats really really really going down the rabbit hole tbh im glad I didn't notice that when i answered this +1

submitted by andrewk1(18),
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hsiT grli ahs cserxeie dcuidne tash.am It si ton ellw nddtsooeru wyh ti snhppae ubt teh gitergsr era zendcog.eri lyNaroml hnew geabnitrh usrcoc air is ketna in by teh ones nda het nslaa ssaapseg nda tsbneiatru act ot vemore tusd nda uamiidwy/mrhf hte i.ra gycolLlia iths aemks hte ria sneedr RvTnP=. oS wehn esxcniige,r gabnretih ghohtur eht neso si recdeased adn lpeaedcr yb eomr grsuovio ohmtu rgbaenhi.t hTis enmsa eth rai si nto fiiediudmh adn daermw .up eTh iar si sles endse dna teh htmsaa sseuen. ehT snteiuqo took ihst seam riceinplp ecetpx ersdrvee ti yb gskain athw teerxnal cnodoiint odulc leda to hte matsah adn htta wlduo eb lodc dry ai.r

eacv  oooh thank u !!! I choose wrong, cold air hehhe +4