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Welcome to ergogenic22’s page.
Contributor score: 300


Comments ...

 +8  (nbme18#17)

acute interstitial nephritis

keys are: urine eosinophils + NSAID use + Rash

in the setting of fever and urinary issues


 +5  (nbme18#21)

I went with metastatic breast because they made a point of saying metastatic as if the thyroid carcinoma has not spread to the bone.


 +0  (nbme23#33)
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1) onkw atth Ag;tB&CC = nioucevtdc agnerhi s)2slo nvdoceituc erniagh ssol nseam sieus whti tursruect efebor hte nenri r)a3e triehenygv lese rsccuo ni hte inrne rae or ni het iabrn


 +7  (nbme22#36)
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1ts luec si ttah tsi a cvreirtiset lngu sesedai aiv het 1EV/FVFC artoi igenb a.ndceseir

etN,x the LODC is dacrdeees amnor(l is 08 to ),%021 mingnea an suise itwh het uarvenmal-opoyrlal ilcaalrpy rbiarre (a fiusfed guln oser).spc

The TC sha slccasi finndgsi rof oitiphidca muayloprn irfsosbi.

heT iacillcn pietcru e-ov(inpcrdntuo ,ouhgc BSO whti ne,eotrix )iebraefl aer ecttssnino thiw ohdapiicit lmuanryop sobrsif.i

erOllva a eyrv onn isgbuuoam sqen.uoit


 +2  (nbme22#14)
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iTsh usqtneio itellwee ltsyar eht fotneniiid of nirteaimlg uranageli

yek fdgsniin rof rtseoh

)a trpoareibli inp,a rhianreo,rh alcnortimia

)b elaratunli HA, aur,a ooabphipoht

c) upmlietl nsioesl in etmi adn cpsea

)d jwa n,aip b,esnsidnl hdceaaeh


 +5  (nbme22#28)
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inpialiosihE = prae alagtsrie epins + ppayomleeatohgensl = omesscihots smonnia


 +3  (nbme15#6)
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lradulMey hidyrot aaonircmc is ddeeinf sa:

a tgamlnnia opinrlaioefrt of lfcoialarlaupr C"" llsce taht ecretse cociiltnan

tgoyhislo shwso mlanignat utorm llsec ihnwti kinp (,ya)nilh dliymao aromst


 +2  (nbme15#15)
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Deu ot otoitcannrc" solillaoaspok" rsieutcid uscea mlouev n,ioccrttnoa ttsha wyh yuo igev .hmte

sA a ,luestr eehrt is eceiansr nsntoiienag II aeelse,r niecreas ni /Na+H+ neghcxae in teh CPT a( octniufn of rnicaees otgnsaeiinn I,)I dan hnet acrsieden 3-HOC ao,tibnersrop ldgneia ot olakliass

cassdawg  Important to remember: Loop and Thiazide diuretics cause alkalosis; Carbonic anhydrase inhibitors and potassium sparing diuretics cause acidosis (FA2020 p609) +3
cheesetouch  RE: cassdawg - FA18 p 591 +

 +3  (nbme15#36)
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Tshi otnuiseq is knaisg wtha ltfe nnaimtod ctaiocnlrui esman. I epospus it ntswa us to ifner atth het DPA is iysgunppl the airmpadhg csauefr nad VA neod.

It si ufnginsoc ot me aeebscu oaylrlmn het itRhg nrlgaaim reytra usspilep het taigmdarpciah broder tec(au g)miran fo eth .htera m'I tno sure hatt it genhcas ni left modntain crilu.taonci eFhoeurrmrt it uwlod not hbranc fof eth DP,A olagtuhh ymaeb traps fo ti are lsediupp yb hte PAD

oslA the AV oend si luppidse by eth trlaruveitriconA ladon ryare,t ihhcw nca be a hnbarc fof fo eth LCA or eht CbuL Xt ton ralyle hte PDA

.1ieobwcC/tnwc/atn9wp3:s/il//cm.7p9n5Mvgi.smr.lh/Pt3h

os nscifuong intqueso rof em but the pntoi is to nwko het csuroe fo tlef nmodanti rucctoinila ot teh APD

epiglotitties  What the heck is it with this scrambling?😡 +
5thgencephalosporin  you need to be a member to have total access to the content +

 +6  (nbme15#26)
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Auetc IM nad tmrial ureggr fr(om het rrum)mu ledsa ot LV faeirul and flobakcw of lbdoo into het n.gsul

hiTs ldase to decesiran uoplnmyra rtdahoyitsc yalciplar rsrse.upe hisT lwil dale ot xceses vuemlo iagenkl rfom eth nmyolpaur ipiraellacs toni eht itnitasrltei dna tish ilwl stnaifme sa aomluyprn emaed sekca)rc(.l

umrlPaoyn edaem iwll frrneiete itwh ags geeahcnx ingelda to xhiyp.omea

medstudent  Doesn’t this also result in decreased alveolar ventilation since the fluid blocks air from getting to the alveoli? +3
cassdawg  ^I would agree, but I think the primary cause of hypoxemia in pulmonary edema is actually the diffusion defect rather than strictly the decrease in alveolar ventilation so the better (more NBME) answer would simply be the increased pulmonary capillary pressure as this is the root cause of all of the issues in this guy's oxygenation. +
cassdawg  Another way of saying this is that if the defect was purely due to a decrease in alveolar ventilation, the A-a gradient would be unchanged and CO2 would be increased. However, since it is edema, the A-a gradient is increased because there is a diffusion defect, and CO2 is not significantly increased. +1

 +3  (nbme15#40)
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clasiCs cretuip rof nuDnehce uamulrsc sdrpohty.y hchiw si deu to tddeeel yptdrnhios .iptreno

oFrm AF: yh"oipsntrD hlpse orcanh lecmsu se,ibrf aliprmryi in ktlaelse nda aciradc e.ucslm It stnccneo eht rlatenulcrali eoloyetkcsnt ac)(tni to hte amrnaetnbemsr seipnotr α- adn sldaytrβncy-g,o whihc era ececndton ot eth leaceurlxltra xmriat C()"ME

cheesetouch  fa2018 p61 +1

 +4  (nbme15#43)
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Colo and epal eiitxresemt luesr tuo uvtesiiibdtr ecsusa ng(,rocenieu ahlanpxisya, epi)s.ct

oHoiempvylc lwdou esecbdir a csrpseo fo levoum olss (ngedible ro eayohdindt)r and lwodu otn ielpxan the ccalreks or ulaurgj evni .osnsnideit

no'td be hnrwot off yb eth mlonra retah nossdu.

baja_blast  Raise your hand if you were also thrown off by the normal heart sounds. +6
jmd2020  I think this question is poorly constructed. Cardiogenic shock would result in an INCREASE in SVR - this woman's BP is 70/40... +1
drdoom  @jmd2020 low BP does not mean the SVR isn't increased — it /is/ increased! it's just that the heart is so effed up that even massively increased SVR is not enough to maintain good pressure +2
drdoom  another way to explain: imagine you are losing blood volume at a constant rate (someone punched a tube into your aorta and draining you like a pig); at first, your heart would beat stronger (ionotropy) and faster (chronotropy) to maintain BP; at the same time, all your arterioles would constrict to maintain blood flow rates (and perfusion) to vital tissues ... but at some point you will have lost so much blood that all the ionotropy, chronotropy & SVR in the world could not save you or your BP .. your BP will plummet no matter what compensatory mechanisms your body has up its sleeve. +2
drjo  Jugular venous distension clued me into cardiogenic shock (heart isn't pumping well resulting in back up) vs the others listed, esp since obstructive shock isn't an answer choice +

 +2  (nbme15#45)
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hiTs tseiqnuo idcesrbes lelI-c ideasse ocniilsnu( lecl iidudoocssiasip/eslme teyp .I)I uYo can ellt baesuce rehet si mdexi unaocmitcalu of jknu gnrimfo eth csnnulioi bsdi.oe erOth alsoysoml eotsagr essdasei heva nicculuatamo fo eno eypt fo n.aecstusb

ylenEsa,lits erhet si a cdfete in fceted in teh nemeyz caelossctf.No1lrlnspsyiaegeytah-haro--pnum

hsiT nsaem teh phaaos6tes--mnnpheo tag antocn be eddda ot rnepi.tos tiWutoh shti ,tga rnotepsi are ytnilrcreco tens to eth uelcaxetrlalr ceaps etarhr ahtn rdeeidlve ot .eomosssly

ergogenic22  ^^correction. You can tell because there are elevated lysosomal enzymes in the plasma. This is because the proteins are not tagged with M6P and thus are excreted to the extracellular space. +17

 +1  (nbme15#49)
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A cortoh sytdu romcspea a ugrop tiwh a vnige rsxeopue g(teeatcri ok)msnig ot a ourgp uohittw chsu esxu.repo tI etnh loosk to ees fi rpoeesxu ro ksir rafcot si adassicote hiwt alrte peoltndemev of seioese. adds" giomkns eald to CDO"P

on eth rheto hnaa,d netslc-ocoar sdtuy ooslk at hstoe twhi eth dsiasee vs hwtuito ot ese fi teerh is a icderfnefe weenbte rrpoi uexopres or srki tf"dDo iarc lopeep hiwt OCPD mksoe"


 +3  (nbme15#15)
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TCL deeecrasd susegsgt eivrrtiects es.iades ilterRcua attenpr gtesugss olpuayrnm oibsrfsi

cheesetouch  fa2018 p657 +
whk123  So after seeing clubbing of fingers we have two D/D's in our mind 1)Bronchiectasis (a type of COPD in which TLC increases your lungs expand due to obstruction air can't go out from lungs so air keeps on expanding lungs) 2)Idiopathic pulmonary fibrosis why IPF is a ans here because in q stem TLC is decreased and the coarse reticular pattern (honeycomb appearance) is also a giveaway. +

 +2  (nbme15#21)
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ehS sha tormo and sroysen y.tmpmsos iThs /ro tbho sidnk fo .elimsp rHe szreseiu ear ont seebcrddi sa liccntcni/oo see,tnvomm adn diunlec opirsed fo pierdiam os.ssicecnuson hsTi suelr out eniredazgel .cinccolt/ion erTeh si a c-pitsatol aet,ts hatt lseur uot sb.nacee

sAlo the pil skniamcg si rseiaicracchtt of ,msiomtutaa chiwh si fduon ni coelxpm itrpala euisrezs

bbr  Isn't is just motor symptoms, thats why its Partial? Maybe Im conflating things here. But complex partial decoded would be: Complex (lose consciousness) and partial (just 1 area of the brain, just motor). +6
euchromatin69  simple seizure wont have altered cociousness....alt. concious = complex or generaliised +
i_hate_it_here  What's the difference between a complex partial and an absence seizure? +
kaf  Absence - they just gaze off as if they're daydreaming. +1

 +4  (nbme15#28)
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slcsaci yathnaesim vragis c.eirptu nWreoss hiwt .eus Sx enilduc dpap.oiil eIvmoemprtn thwi E.hCA

Also ieds eot,n 'dnot oscfu on eht ercangpny uatsst, utb owenm owh are ni eth orasutppmt odeir ear ta tlarpylicuar ighh riks of ndleiepvgo niytemahas vigasr

pakimd  why are answers unscrambled on here? +

 +2  (nbme15#47)
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dbolo ntouc wssho tedaleve olsrn,piehtu eotpuliNhr camtahtteoncs endcilu ilearatbc tdopru,cs I8-,L ,aC5 lnmrkakeili ptea-tivitctangaell crotfa adn 4LTB

dulxy071  if they asked exogenous (a product not formed by the body) the answer would have been N-fMET +
whk123  Neutrophil chemotactic agents: C5a, IL-8, LTB-4, kallikrein, and platelet-activating factor +

 +1  (nbme15#14)
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preSt Vdiisran si olar rlfo,a uscase tcuabsue aidcotrisnde eigcftfan ovplisyrue madagde ,evavls nad si otefn ioestacads ihwt laeueeqs of ltedna due.eoprcr

A) ocneioctrce nca lsao cuesa ctseuabu eotdidrcinas but htey era mgama sioheylms nad looflw GIG/U rBo)eeu rdcp eatb osyhsilme dan cesuas auectc) aebt myseihlso nda uessac ce)et au aahlp hismyoels btu yeuillkn ot sucea nserdaicdti,o acseus tmnni,sigie st,oiit omenin,upa nsiitissu - S(MPO)


 +2  (nbme15#3)
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tlaivs dan need to eb taerdet ,stfri os rtenaiop adn hetn ml.idepxaroi

mCmii.2P9lg/hnbv.trnc4ntsacw/oMp:9cw3/./w/sie.3tl0hp/

ranopitmt to note ttha rapeohgsanshopto emobce rrslibreveei at a rcantei tnoip so rxoipedlaim sdoe ltsil eend ot eb envig rlaey


 +1  (nbme15#39)
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ANQPI is a xicot ereniieatmdt is eofdrm by in lmsla stoanmu by oslbmeitam fo .manhcoaneipte pDielonte fo hticpae nluothaiteg tsoesr yb AIPQN esadl to ateuc APAP xciiyott nad cueta evirl unijr.y

cassdawg  Also relevant to the question: the CYP450 pathway is what turns acetaminophen into NAPQI, and chronic alcohol abuse is one of the inducers for the CYP pathway so it increases NAPQI production. Chronic alcohol abuse itself also depletes glutathione, increasing propensity for toxicity when acetaminophen is introduced. +
specialist_jello  my probably stupid thought process was : treatment of acetaminophen toxicity is N acetyl cystine which regenerates gluathione. so toxicity will be coz of dec glutathione. +5
i_hate_it_here  Real talk, can this site even charge for the contributions made by other people?? +1
cheesetouch  FA18 470 & 243 +1

 +1  (nbme15#6)
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asms in eht houpsegas tihw /diiuqdlliso .hpyagsIda' mi tno seur tahw eth isoth hosws tbu no hte tmboot ehtre ear omer fatl clesl dna eht pto ereht rea iwred sepcsa iwinht the lscle tihw msoe f,at so I iknht it aybem a iaghnel leruc agndeli to a uisrrec.tt

ywsana tehor apsgnhtoe ear moer saceisdota ithw oehtr itcisfnnoe

)A lssgoatenl nda nam ilaBgnchcir)oocoa hioa)escgispt vrlei c)ssbs Eae i hnikt imayirl BT nac trensep in the eivlr


 +0  (nbme15#6)
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smas ni hte uohapesgs iwth iislq/oddiul y mdagh's.Iapi tno srue tawh het stoih sowhs ubt on eht btootm tereh rea mreo tfla llsec dan hte tpo there era widre cesasp wthnii teh sllce twih oesm ,atf os I hitkn ti byaem a aneilgh eculr anlgeid ot a rut.irscet

asaywn rhote neopasthg rea more esidtsoaac tihw rtheo notniesfic

A) elosgtnasl nad oa) iocoalinBhanmccrg igas)i tchseop vrlie acbs Es)es i nhkti ilmriya TB cna enetsrp in eht rivle


 +5  (nbme15#9)
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eH sah a nodw and tuo luipp, duesca yb NC III lspa.y His geaz si edu to dosupeonp coniat fo teh traalle sructe dna eioprrsu ileo;bqu psosti eud to oievdnanert of realvot elrpabape p.iseissour

Teh loyn yniurj eilsdt ttha codul seuca a CN III yalps is rnymasue of hte PAC nirmocsepgs eth orcoarmutol .uelcnsu

cheesetouch  Compression of superior cervical ganglion -> Horner's syndrome -> ptosis, miosis, anhidrosis, would NOT have dilated pupil. +1
jmd2020  Aneurysm of the PCA would compress the oculomotor NERVE, not the nucleus (just fyi) +1
trazobone  I appreciate u cheesetouch +

 -2  (nbme13#20)
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I leiebev that the esintquo si uneissgggt teh ineptat has a eatlnmoh oeosrdve.

Frtis dAi 1820 egap MEoii"2b:nsli hFzt7pO—ie ochallo oneedhedyrgas nda is na aendttoi Fro oservdsOe of letMhoan ro e nlthyeE lg"o.lcy

The reaons I ma ueusrn si tath iiiadewpk stetas tmos iatnp tneishnr rea neskeot ro ronryhcobdsa

lae  that's correct, I don't know about what the thinner has but the clinics is methanol toxicity for sure +1

 +16  (nbme21#6)
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hmntaiorc ivategne = no arrb sedibo = osrpne with YX npetoeyg ro XO eabucse aiteynm ouy aevh more thna noe X cohmmsooer you haev a brar obyd haoitrcm(n iietpsv)o


 +5  (nbme21#10)
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N)+-l-oanaOn(H-3CiC= apg = (1+10054)-01 = 52 EmqL/

lnmaro engra for anino agp si 8 to 16 rrhET./q.fmee.o,eL vetioips naino p.ga

pH = .5,27 lamnro ernag .5-.47..7.53 oeTrfeehr csoisiad

Namorl otabnicaerb 228-,2 qsuonstie wsosh icbarb of 1.0 rfTeohree celbtimoa ossaicid

odnyiilAtlda 2OCP lnmlaroy 45-33 mm H,g qisotnue sshwo P2CO fo 32 hwit norlma P2O, htrfeeore rprirsatyeo maopcosteinn

mambaforstep  why did the stem say she had a drinking problem... is that just a distractor? +
castlblack  I think alcohol uses up all the NAD+ in its metabolism leading to increased NADH/NAD ratio. After that, TCA cannot progress and the cell is forced to use anaerobic metabolism, which increases lactate. lactate causes anion gap metabolic acidosis (L in MUDPILES from first aid) +1
nafilnaf  She may also have ingested methanol if she couldn't get her hands on regular ethanol which causes an anion gap metabolic acidosis (M in mudpiles). +1

 +7  (nbme21#18)
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lydeler ydla iwht o,slw gveorsrpsie memroy o,ssl noarml cashylpi axem, on snigs fo ers,noseipd isth is ostm ylklie hrmeezliA s.aeiesd

AECh tshiriiobn aer sedu rfo rtttneeam eucesab lzsemhireA' is sadestaoic hitw lwo .ChA sloA dues rea MDAN tcpeeorr anisngotta a)meeni(ntm


 +0  (nbme21#33)
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yhw is rnicttoope of teh ohcriod ,pslxue mrfo ealciutrrnivanrt pruuret rsadenoyc to maigerln marixt hagmrerheo otn a sipsbeol rw?nase

whoissaad  yes same question, both retinopathy and intraventricular hemmorage can occur due to high oxygen levels.. +
cienfuegos  I mistakenly chose choroid plexus too, based on wiki seems this is most common cause of IVH in term infants: IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus. However, it is particularly common in premature infants or those of very low birth weight... Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. https://en.wikipedia.org/wiki/Intraventricular_hemorrhage#Babies +
burak  choroid plexus is different than germinal amtrix +
meryen13  retinal hemorrhage is more common that IVH even if you think that it could damage choroid places secondary to germinal matrix hemorrhage. https://www.ncbi.nlm.nih.gov/pubmed/11304816 +

 +3  (nbme21#10)
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why si iiraedyphielmp rceaoynsd ot uginchs ysoendrm not a iyipoiblts?s

hello  SIADH = MC paraneoplastic syndrome of small oat cell lung cancer. Also, Cushing syndrome would cause would weight gain, skin hyperpigmentation, and hypokalemia. Not, lyperlipidemia. +1
charmrooftops  You do get hyperlipidemia in cushing though? https://www.amboss.com/us/knowledge/Cushing_syndrome So still unsure why this is not a possibility. Is it just a "more common" thing for SIADH? +2
peridot  I was debating the same thing. But yeah I guess the SIADH association is just supposed to be stronger somehow and "more common"? +

 +7  (nbme20#9)
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tP hsa sings dna Sx of yicrehlopr.tos Lrola/owmn ACTH fvsora laeetdev tsrcoloi ndtnieenpde of AC,TH mrodcefni by cakl fo epssrnoe to ashxetmdenoae noreuspsip.s anoZ ausctcfiala si iionrg fo rictsool upotcnidr.o

champagnesupernova3  They tried to confuse us saying both low dose and high dose dexamethasone didnt suppress it. But when ACTH is low you dont even need to do high dose dexamethasone test. The high dose is only to differentiate between Pituitary adenoma and ectopic ACTH production +5
hungrybox  @champagnesupernova3 fuck they got me +11
azharhu786  They got me on that question as well. I thought it was ectopic ACTH production due to some paraneoplastic syndrome and this is why Low/ high dose dexa is unable to suppress it. +1

 +1  (nbme20#2)
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PCR is an uecta ehpsa t,anrceat teesh era dthznsyeeis mrpairyil yb het iverl


 +3  (nbme20#16)
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eeS the rfsti adi rtyne on sTbuuroe scisso.elr tI is aiesasdtco htiw arcsndeie cedeincin fo leamuenpdsby tagin lcle oysrtcoamat dna ynam reoth dinonis.oct

hello_planet  FA 2019 pg. 513 +2

 +2  (nbme20#5)
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A hetscrt rnjuiy ngudir tlrihbidch lilw lusert ni gdaema to het enratelx hraeueltr dna lana nestpichrs and megdaa ot eht ddnuealp erevn -24)S.S( hTsi can dael ot eeadcrsde seonintas ni hte elepniar and iglntea aaer dna cealf ro inyaurr ienenncintoc

thepacksurvives  I think that there can also be a direct tear to the anal sphincter muscles +5
sympathetikey  A better answer choice would have been "damage to the nerves innervating the anal sphincter" but eh, ok. +20
nerdstewiegriffin  I it is due to actual tear of external and or internal anal sphincter Source uptodate +2

 +0  (nbme20#4)
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casslic for eoSgniiymaryl - truessl ni labie-talr olss of anpi nda taererpteum noetasnsi ni a kc-"pel"eia ntiosbriditu


 +5  (nbme20#23)
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ignga rlsuset in aeiecnsrd lirrtaae eifftnsss agc(neh in axrEt ueCcallrl axMrimt oopisomtnci - aercsddee sltaein, ieascrned anolcelg ;optsdii)oen SIH is olspenrebis fro 8%060- fo NHT esasc in atnetisp ;&tg 6.0 os,Al asdrdeeec plmecionca sa a tuersl fo ingga cesasu crsieenda slepu serrupse

rio19111  why not dev. of coronary atherosclerosis? +1
pakimd  @rio19111 i think the Q stem is asking in absence of any lesions of blood vessels; the number and severity of which increase with age. So with normal aging SBP should increase in isolation which may then result in the development of coronary atherosclerosis- if that makes sense +1
chandlerbas  aging causes decreased compliance in large arteries: (1) accumulation of collagen and calcium (2) degraded elastin and large arteries accumulation and it also may have something to do with lipofuschin +1




Subcomments ...

submitted by dbg(140),
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Ddi ynnoea seel dwoern TWHA NRMUOALY"P PS"SMMTOY is teh soutneiq engirfrre to?? heeTr si layritlle tno a gseinl ytmmsop eedtmonni in hte whoel ev.nttgie No cckler"sa ehard orve bhto lgun dfies"l ear tno sopmmy.st eTyh are igssn undof by the s.iyhacpni

oyeSiusrl uidnbtog eht lehwo BMEN barod stte ietrrsw gihtr wn.o Do ehyt eteyulqdaa rivsee hiter ?krwo ihTs is otn teh rtisf naihtcecl msiakte I eizlrae on eth wne .fsorm

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 +4  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1  


submitted by dbg(140),
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iDd neoayn eesl eordnw HWAT AYL"POUNMR O"YTSSPMM is eth qeniotsu rfneirger to?? eTreh is eitylllar nto a insegl smmtpyo indoeentm in het ohewl ntt.ivgee oN alc"scekr drhae voer tbho nlug efidls" are not .tmsospmy yheT are igsns unofd by eth cayspn.iih

silSyuoer tduoibng eht wheol NMBE darbo stet ertrisw htgir own. oD hyte tadyealque evesir hreit wkr?o ihsT si tno teh tfris ectilnhca miskaet I eazeilr on het ewn ro.fms

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 +4  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. https://www.medicalnewstoday.com/articles/161858#sign-vs-symptom +1  


submitted by krewfoo99(88),
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Why uodwl desdreace enmemovt thoghru the beecrarle acutdauq eb nw?rog Wthi lla eht ldubi fo doolb ni the SCF rtatc wouihtt stpa,oiornb owldnut neovmemt losa eb aceedsrde utohgrh teh a?utqcdue

ergogenic22  this would cause a non-communicating hydrocephalus with enlarging of the lateral and 3rd ventricles but normal 4th ventricle and subarachnoid space +1  


submitted by monoclonal(21),
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ehT ipotn eher is, yteh era aisgkn su ot nieiatmel eth noyl waerns htat si nto boislesp. I got ti wngr.o rade llew esfall

ergogenic22  nbme logic: "what if they all marry carrier wives" And doesn't everyone with autosomal dominant get it in the 2nd generation (unless incomplete penetrance) i feel dumb +18  
cavernosum  totally agree. what a st*pid qs! +  


submitted by krewfoo99(88),
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nI wath utnsioaist iwll bHH eb fdorem 3( plaha inahc o?dtilense)

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(88),
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hWy wolud nsfirpeor eb eth wngro srna?we tWluodn nctuialamuoc of iocxt ripsnoet aeucs hte lcle ot uedrngo stoiapops ?

ergogenic22  Bortezomib does not directly activate perforin. It directly inhibits the proteasome which → enables CD8+ T cells to initiate apoptosis → via perforin release (in essence a downstream effect). +4  
drzed  Exactly, it triggers the cells to undergo apoptosis which means that it can either be cell mediated (perforin and granzyme via FAS/FASL) OR it could also be through the intrinsic pathway (e.g. mitochondrial; cytochrome c) +  
powerhouseofthecell  Question: But how do CD8 cells have a role in this process exactly in the vignette? Is it saying that when the proteins build up, only then do CD8 cells come and instead of MHC I presenting to proteasomes, they present it to CD8 to initiate apoptosis? +  


submitted by krewfoo99(88),
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nI tahw tuionstisa ilwl HbH be mrdoef (3 lhapa inahc ednlto)ie?s

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(88),
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nI twah sansiuttio lilw bHH be odmefr (3 aahlp hcina eotlne?ids)

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by krewfoo99(88),
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In awht sionatuits llwi HHb be rodfme (3 alpha cihan ?)oesntlied

ergogenic22  one parent has 2 deletions on the same gene, the other parent has 1 deletion, and the offspring receives all three. In this question, both parents have alpha 1 deletion +  
ergogenic22  actually its possible that they both have 2 gene deletions, but regardless, a-thalassemia trait is more likely +  
ergogenic22  and someone above said Asian people are cis-2 deletion so the offspring will not receive two deletion from one parent +  
ergogenic22  ↑↑ I made a mistake by confusing trans and cis cis has deletions on the same chromosome and can pass two deletions to off spring, therefore a chance of allowing HbH +  


submitted by cat5280(3),
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duoCl oesmnoe selpea enpxail wyh uyo ewre laeb ot itaemlien eht apilerceesblonr a?tctsr

ergogenic22  Spinocerebellar is only responsible for Proprioception (unconscious). This patient also has reduced vibration sensation, which the dorsal column tracts are responsible for. +3  


submitted by mousie(210),
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nCa mosnoee elapes xplaeni iths ot e?m I 'dnto etnadrnusd ywh saritgnt eht eotrh rdug ldwou tno ncotu as oxeunicsl terric?ia

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 https://www.youtube.com/watch?v=Kps3VzbykFQ&t=7s +18  
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: https://www.youtube.com/watch?v=Kps3VzbykFQ +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 titanesxvi(77),
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why ton eacrdees CA vtiytaci in eth pmxloira uet?ulb ihts aosl ouldc lead ot ecmlbitao dcoass.ii

ergogenic22  carbonic anhydrase inhibitors can cause Type 2 RTA but it is not the cause here (cystinosis) +  
doublethinker  Yeah, I said CA too. Problem is that CA deficiency wouldn't lead to lack of reabsorption of all the ions listed. +  


submitted by seagull(1393),
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tpnSmceleyo psettnia era lrenvulabe antsgia utpelnsceaad g.sirnsamo Wihhc nocylmom dnecilu pSter ,nuPmoe ieNa,isres .H .fazeIlnun

ergogenic22  although Pseudomonas, Klebsiella are also encapsulated, strep pneumo is more common for pneumonia in a 25 year old F without other comorbidities +5  


submitted by sunny(4),
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HWY NTO YSaEd,n hnet shrae the eomyn wtih hte yatpeni so he noedst' doutb uyro i.tsoevm

ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment +  
ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment, which I don't know why that would be wrong +  
dubywow  Bribery is only good for doctors. Can't bribe patients. That's illegal. Kind of like how NCAA gets paid a lot, but student athletes get nadda. Still the TLDR is it always ethical to disclose financial incentives when they relate to anything that may affect your decision on how to treat a patient. +2  


submitted by sunny(4),
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WHY TNO ,dYnaES ehnt reash het enymo hiwt eht nyatpie os eh don'ste toudb uory vmsot.ei

ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment +  
ergogenic22  because then it is as if you are paying the patient to enroll in the experimental treatment, which I don't know why that would be wrong +  
dubywow  Bribery is only good for doctors. Can't bribe patients. That's illegal. Kind of like how NCAA gets paid a lot, but student athletes get nadda. Still the TLDR is it always ethical to disclose financial incentives when they relate to anything that may affect your decision on how to treat a patient. +2  


submitted by ergogenic22(300),
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siTh iutnsoeq dirsbseec ecIl-l adessei uoicn(lisn clel ieooiis/aeusscimlpdsd ptey .)II ouY nca llte abcuees rethe is dmixe ioclanuautcm of ujkn omrgnif the uliocisnn es.dobi rehOt allyoomss roasget sesesiad aehv nuiouaalcctm fo noe type of sesnuatb.c

lsiayle,tEsn heret si a teedcf ni dcetfe ni teh zemeyn m.pfuoaly-nearnptNsoaec-iatssor-g1lecyhlsh

ishT masne hte nshotopsh-6epeaam-n atg onnatc eb adedd to stpi.oenr utWihto tsih at,g rtniesop rea yrliorcncte tesn ot teh alretulacrelx pcsae eharrt hnta eildeedrv ot oossslmy.e

ergogenic22  ^^correction. You can tell because there are elevated lysosomal enzymes in the plasma. This is because the proteins are not tagged with M6P and thus are excreted to the extracellular space. +17  


submitted by mcl(578),
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tineaPt yam veha rahydreite maadei,goen wchih si desotaasic hiwt enr"recutr ttskcaa fo nnetes,i viase,ms zdaloiecl bsaucsnueuot maeed vgolivnni het teemeiixs,rt eti,aglnai feca, ro un,krt or luobsuamsc eadem fo ppure awryai or "sowbel. hTe tlcreai ogse on to say "1Cee-arsset inotibhir korsw cerdlyti on het cnmpetlmoe nad occntat pmaasl adsaescc ot duerec irndinabky rleseae" hicwh si loas robplbya good to oknw.

/oea1mp/ni/38it/:mMwgPh.si.rt66Cbwt6cnh/.pnlcw.3vlc/s

notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein. +4  
youssefa  Based on many sources hereditary angioedema does NOT cause a rash (urticaria) which is a main differentiating point between angioedema and allergy. This mislead me in this question. Any clarification? +22  
ergogenic22  +1 on the above because uptodate states that c1 esterase inhibitor deficiency, both acquired and nonhereditary, are both non-urticarial, non-pruritic, and that is confirmed by the above linked article +2  
sahusema  Question writer probably didn't know the difference between cutaneous urticaria and subcutaneous edema. +3  
almondbreeze  same. got it wrong bc the pt didn't have sx of hereditary angioedema - swollen lips and eyelids +2  
teepot123  fa 19 pg 107 +  
beloved_bet  According to Amboss "Mast cell-mediated angioedema Often associated with urticaria and pruritus Other associated with clinical findings of allergic reactions (see type 1 hypersensitivity reaction) Presents within 30 minutes to 2 hours after exposure and resolves over hours to days" +1  


submitted by temmy(126),
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eelaps phel cgriocand ot itsrnew atniuqoe the atpneit sha a lornma niona pga

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +1  


submitted by temmy(126),
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selpea ehlp nicaogcdr to wnetirs tuqnoiae the neaiptt hsa a olramn naoni agp

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +1  


submitted by hayayah(1056),
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the imratoyj of ocbarn ieddoix meoulelsc are rrciead sa ratp fo hte obaciebratn eubffr ey.tsms nI htis tse,msy oarcbn deoiixd ssdeffiu tnoi eth BCs.R bciConra nrysdhaae )(AC wniiht CsRB cluqkyi recovtsn eth norcab xoiddie oint cnbcoria dcia 2OC(.3)H ancbiCro caid si na tabsulne temitandiere uloecmle ahtt dtmemiylaei isisacetosd onit nocrbitbeaa nsoi -O)CH(3 dna oredyhng ()H+ n.iso

ehT nlyew eiyzdentshs rcaeobtbnia noi si trnosrpadet tuo of the BCR toin eth mlpasa ni hcenaxeg orf a hclidero oni −(;l)C iths is lclade eth elhdrcoi .sithf eWhn het obdol eerashc eht l,gsun eht iartecbanob ino si ottrrspaden kcba iotn eht CRB ni nexagche for eht rodlheci nio. eTh H+ ion seosaiticds fmor eth bhoeongiml nda bdisn ot het abtbcrionea ion. shTi duceposr eht inoccarb acdi ttminie,aered wcihh is evectndor kabc oint bcoran xoeiddi htohrgu eth iamytenzc oiantc fo A.C eTh aorcnb ddoiiex dropuecd is exeeldpl tohrugh eth lusng udnigr ailoehx.nat

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +5  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3  
teepot123  fa 19 pg 656 +1  


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heT tpneiat rdueeffs rmfo eunImm aehoT.biotromcypn touadianseitob taisnag teh ygreipclntoos 3B2G/PA.

On sbl,a ylolu’ :ese ncerseia ni yg;trokycamaese no eth uoeqitns mtes tyr’ehe eesbrdcid sa er“ar tbu al”reg. koseetgMyycraa are nto uees.spdpsr

ergogenic22  isolated thrombocytopenia (low platelets) should be highly suggestive of ITP https://www.aafp.org/afp/2012/0315/p612.html +2  
pg32  I agree that in ITP you will see an increase in megakaryocytes, but where did you see that in the stem? Platelets being, "rare but large" doesn't mean megakaryocytes, does it? Also... can anyone explain why she was anxious but alert and had petechiae distal to the blood pressure cuff? +  
meryen13  @pg32, I'm not too sure about the "anxious but alert" but I think they might wanted to mention she is oriented so in case there was no lab values, you would guess that she is not extremely anemic or something. and about the petechia with the cuff and the tooth brushing bleeds, that is a sign of platelet problems because its a superficial bleed. if you saw deep bleeds like joint bleedings, think about coagulation pathway problems (like hemophilia) +2  
zevvyt  "rare" means thrombocytopenia. "Large" means there are megakaryocytes to make up for the thrombocytopenia +2  
lovebug  FA2019, page419 +1  


submitted by hungrybox(963),
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Tsih veido xlinespa naitgel gmooberyly exeerymtl w.lel

If uyo eflt yllotta tosl liek m,e ahwtc het divoe ftsir at 2x, hnet chcek out eth otbmto gfurei no gp. 068 in FA 2.091

neRtavel to hsti qnesi:tuo

  1. SYR posietrn teliuamts ovledeetpmn fo tsetes
  2. iThs pt ash ssteet ;t&g= he tums have eht RYS neeg no hte Y hooscremmo
  3. IFM dsedaegr hte eairlulnM dt,cu iwchh wuodl hosrteiwe ecbemo eht etraniln faleem inagelait
  4. shTi pt ahs lntreina amleef inaaietgl ;&=gt dd'itn aemk gnhoue FIM

Qziu solerfuy enswrsa( ni a aaspteer :opt)s

  1. ihsT ntiaspet' erisdrdo can be tedarc kbac to cihhw llces?
  2. Tish tieaptn ahd namrlo agantiiel. fI sthi tiaetpn hda rlaelms alaiegitn ahtn mrlnao, hatt ulwdo be a tedcfe ni wtah mne?yez
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +11  


submitted by usmleuser007(370),
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ntaVimi E ecceiidfyn si nnwok ot useca isilamr snlaip ecdfest as taimiVn 12B enicd.ifyec wove,Her ieaanm si ont ens.e

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +8  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4  
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1  


submitted by xxabi(248),
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I asw dnrue eth osnipreism htat shit aws na tcirao ,tniseocisd deu ot vers"ee csthe ianp" as well sa the lsaef muenl ni hte aotr.a And HNT si hte #1 ksri acoftr rof otciar niecssdtio. moeSeon cecorrt me if im' r,nwgo tbu I itkhn ihst is troaic cdnoestsii rethra tnha citora us.eyanrm

chefcurry  I believe so, FA 2018 pg 299 +3  
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension +2  
breis  FA 2019: 301 +  
pg32  First Aid says that aortic dissection causes widening of the mediastinum and is due to an intimal tear, so I thought it wasn't an aortic dissection. Can anyone help me understand why First Aid was wrong in this case? Thanks! +3  
nephroguy  @pg32 The question stems states that there is no widening of the Aorta, not the mediastinum. Widening of the mediastinum is seen in dissection while widening of the aorta is seen in aneurysm. Also the intimal tear creates a false lumen between the intima and media. Hope that helps! +9  
j44n  https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.312436 pictures worth a 1,000 character limit +  


submitted by sympathetikey(1248),
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ctrDie ilntionlbgAu = ciDrte mbsooC Tset

tstecDe sinbedaito dnbuo ceyrtidl to RsBC. Heolysmis otms lelyik eud to ogmthsnie in teh dtauessfnr lobod (ont seur ywh it toko 4 swkee enwh yepT 2 SH is soupepds to be irukqec utb e./)w

ergogenic22  there is a delayed onset hemolytic transfusion reaction which should be evaluated with direct cooms test. https://www.ncbi.nlm.nih.gov/books/NBK448158/ +5  
hungrybox  such a dumb question wtf +25  
sonichedgehog  takess longer due to slow destruction by RES +  
baja_blast  Dang, I didn't know that was the same thing as a direct Coombs test. I guess it makes sense in hindsight. Thanks! +  
sars  Theres a UWORLD question with a table displaying the different types of hemolytic reactions. Don't know the question ID. Agree with delayed hemolytic transfusion reaction due to formation of antibodies against donor non ABO antigens. Typically presents as an asymptomatic patient or mild symptoms (jaundice, anemia). Different from an acute hemolytic transfusion reaction, which is against ABO antigens. +1  
tomatoesandmoraxella  The Uworld table is in question 17780 +1  


submitted by hayayah(1056),
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oogunlGaa:cm rTmuo of raitecpnac α slecl asgŽcuin na oeocrurnivdopt of gugnaocl.

nPertess whit s5:D’

  • lmtr(ierocincDatestiy gytrairom ah)mretye
  • ibeDsate iamhr)ygyeecl(p
  • VDT
  • nncDiglie wgtieh
  • neisrDspoe
killme  And the sixth D: Diarrhea +8  
ergogenic22  a) CAT1 and CAT2 are important enzymes of fatty acid beta oxidation. Glucagon upregulates this process b) glycogen formation is inhibited by glucagon, so that glucose can be used by cells c) acetyl CoA carboxylase is used for fatty acid synthesis and thus decreased by increased glucagon d) glucagon increases ketogenesis +53  
dermgirl  Basically, they want to know what is the function of glucagon. +1  


submitted by hayayah(1056),
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hyisdbsmoRalyo can ntseerp liookgn lkei a ydkein yjurni (it anc alde to tcuae bauturl onsrcsie sa ).lewl Teh lereclyttoe dfnnigis aer sjtu lkie realn afueirl c(In. K,+ nic. P,O4- dec. a)C

To deintfreeafit eenbwte yiloosmardhybs nad kdyien ryj,niu ouy cehkc het erinu ot ees fi ether ear any RBC.s In ilmssyooyhbadr tereh aer no free BCsR ni the nurei.

ergogenic22  "Crush injury" is a buzz word for rhabdo +11  
ibestalkinyo  The mechanism by which AKI occurs after rhabdomyolysis are due to free radical formation. Other urine finding include blood on dipstick, but as hayayah said, no frank RBCs. +1  


submitted by ark110(1),
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But awth si hte neferefcdi bwnteee pntooi A nad nootpi C 213;( ;9.4 90; )53

sympathetikey  K+ shouldn't increase. It's moving into cells due to metabolic alkalosis. +  
home_run_ball  In the parietal cell of the stomach Hydrogen ions are formed from the dissociation of carbonic acid. Water is a very minor source of hydrogen ions in comparison to carbonic acid. Carbonic acid is formed from carbon dioxide and water by carbonic anhydrase. The bicarbonate ion (HCO3−) is exchanged for a chloride ion (Cl−) on the basal side of the cell and the bicarbonate diffuses into the venous blood, leading to an alkaline tide phenomenon. +1  
ergogenic22  RAAS increases from volume loss, and thus more aldosterone leads to low K+ +1  
sinforslide  Three reasons for hypokalemia. First, some K+ is lost in gastric fluids. Second, H+ shifts out of cells and K+ shifts into cells in metabolic alkalosis. Third, ECF volume contraction has caused increased secretion of aldosterone. +3  


submitted by hayayah(1056),
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iWht rihcnco gvm,ioint oyu oels eleylotecsrt nad a olt of icd.a tI gsgrreti cetlimabo aslkoslai wichh is wyh lla het uerms sauvel ear wlo (or on teh worel ned fo hte moanrl gnar)e eexctp ofr .betbnaaicro

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 hayayah(1056),
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hTis si an eemxpla of nlSei.shg seHpre ipsxlem nda epresh sertzo sesviru sceau narlmabo llec nivoiids in eerlipdam s,ecll nda ihts tesrcae licuutladtmene ginat l.ecsl

A ankTz srema wghiosn etniculdteuaml ignta ellcs is icteriacrastch fo elaValrci otreZs Vuirs fi.oitcnsne (HSV will have maislir n)nsi.dfig

ergogenic22  other identifying terms for herpes: Single dermatome (does not cross the midline), painful (burning and itching),and lesions in multiple stages. +3  
redvelvet  and why neutrophile infiltration, is it a thing? or just a distracting thing? +1  
charcot_bouchard  Neutrophil comes into party always first. but it was distracting for me too. +6  
dulxy071  Regardless if it can help resolve the issue, neutrophil will always be the first responder +2  


submitted by hayayah(1056),
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trittPsisoa si actrhreaiczed yb uayrdsi, cune,ryfqe gyneu,rc lwo kabc pin.a mra,W ,reednt lgnradee stt.oreap

eAcut lticbaera osisript—ttain elrod men smto oonmcm ritmbcaeu is E. ocl.i

ergogenic22  In young men it could be chlamydia but the question stem makes no mention of sexual activity, so it is e. coli +11  
charcot_bouchard  First this guy isnt older! He may incite Daddy issue but not older. At this age people tend to be more monogamous so E Coli the more likely answer. But again cont NBME 20 trend this one was pretty vague too. +1  
monkey  They classify at 35 year old (<35 = Chlamydia or Neisseria and > 35 = E.coli) +3  
mbourne  I put Pseudomonas, as that is a cause of prostatitis in older men, but it is less common than E. coli. Just keep that in mind, if E. coli wasn't an answer choice, the answer should have been Pseudomonas. If he was a younger male, then Chlamydia would have been acceptable. +3  
brotherimodu  @mbourne I think Pseudomonas is the more common etiology for acute prostatitis in the elderly (>65ish for exams), whereas E.Coli is the more common etiology in adults 35-64yo +  


submitted by monoloco(132),
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rAnalnu rsncaeap si eht loyn wensar thta octnsauc for the eibl ni het tm;iov of eht i,soecch ti si eht yonl ortbicuntso isatld to rheew blie ertens eth IG .rattc

ergogenic22  Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +  
sympathetikey  Correct. Might cause pain due to ectopic gastic tissue. +3