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Welcome to hyperfukus’s page.
Contributor score: 74


Comments ...

 +1  (nbme23#15)
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so ouhdsl we sutj pkis hse?te ucz ethesr' orbp 10 omer i loucvde ottneg write igastwn my elif on shit neo

faus305  Don't skip it but flag it, give yourself 1 minute and 30 seconds or less to figure it out and if you don't then move on and come back if you have time. Questions like these are what I like to call "time wasters." I got it wrong because I selected 2.5 assuming I made a conversion error when I arrived at 25.9 as my answer. I think the lesson to learn here is that 28 is closer to 25 than 2.5 and NBME are evil people that know I'm not gonna make a conversion error. If you do math in a question and you are SURE you did it write, select the answer closest to the answer your math got you. +

 +0  (nbme22#15)
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I nhtki taht inesc heyr'et sgnkia rof na niaeanotxlp fo eht nasit'ept crertnu xSS hcwhi whsos atth she's in hte aetts fo Tenisntar Heyds:pohiymrtri hicwh is eud to :C Realese of oetsdr iotrhyd oerohnm mfor a tohyrid lgdan tenlidrtaif by metohplysyc


 +3  (nbme22#37)
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so teh sleion si in teh itRgh MLF htigr? fI so 'mI ujst tuoba to mzieoerm hte eye see SEMA MLiF llo sti het MFL no eth ames eids fo het yee ekpe ti smeipl i hoep tath's twah lyal rea sginya llo


 +5  (nbme22#2)
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so I knhti fi oyu troefg aatluc srdgu no het karmte tath we know fo dna hwo yeht r,kow eht tuinesqo si osuplpery not ikgasn ouy taht apfyl...eiicIscfl ouy flpi ti ni uryo dhae ot khitn waht het eormlbp is ttha elsad to cni TG sti ecebusa of LDVL eefrrhteo ethy sdai eimdsatingnri a GURD htiw whhci fo teh nogoliwfl SFTEEFC is OTMS aE--SiNptaGE&;rpAoeCprIgt-DR DLLV c/b s'atht het ilpucrt

thglAhou dsgru we nokw fo ahev het htero r,tetaicsihrsacc ofr tihs ,yug ew lwduo eb ilnokog for eht cfefet fo VLLD ertvyihegn lsee is a dsei ignth tath oste'nd ldrteciy asdsred sih contoiidn


 +4  (nbme21#6)
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sloA eaohnrt eyk si it assy mnrola anigarppe ilrg eno fo the htnigs taubo het SAI is tath yeht od tge nredocays esualx tiac.rrcnheitssae.rctru. glisr ot'nd kool aolmnr dt'ehy be hrost nda tbsybu no obobs tfa nkec tec

covid2019  I'm confused that they said she appeared "normal". I thought AIS would mean the patient has very scant pubic hair / underarm hair. Wouldn't this be abnormal in a 17 year old? Should have Tanner stage 5 hair.... +
mumenrider4ever  FA2020 (pg. 639) describes AIS as "Defect in androgen receptor resulting in normal-appearing female (46,XY DSD)" so I assume they're talking about general outwards appearance +1
lola915  You do get breasts because patient has build up of testosterone that is aromatized into estrogen. No axillary or pubic hair because that requires testosterone. +
lovebug  THX. SEE AIS (FA19 pg,625) +

 +3  (nbme21#31)
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salo ni acse hyte ask remreemb htat eesht ear (eFAU'hPsva doeulb nodb)s and tyhe rae rttbee hatn rSutdeata tsonfa( luobde rbsbnc)dsao+

drzed  PUFA = poly-unsaturated fatty acids in case anyone didn't know the acronym. +4




Subcomments ...

submitted by docred123(6),
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eHy nca msoonee speela ixealnp ths!i I ma tno resu who ot od hte hm,at I pkee gtnietg ippdret .up

mousie  Equation is Maintenance dose = (concentration at steady state) * (Clearance) if you convert all the units to what it wanted them in (mg/kg/day) you'll get 25.92 like weird-in said above I didn't think to round 0.09 to 0.1 of course so I guessed 2.5 assuming I must have done a conversion wrong and was off by a tenth .... BOO bad Q +4  
hyperfukus  OMG ME TOO!!!!! +  


submitted by wired-in(67),
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neiMtanacen edso ruflmao si s(sC × lC × au)t ÷ F

rwhee sCs is adteetsayt-s gttera lpmasa .oncc fo ,rugd lC is ,canealcre uat is goseda vaeinlrt ma;p& F is biblaltyiv.oaaii

riNeteh sedoga vitnarle orn lavobaiytaibiil is nevg,i so nngiriog steho p&;am gnlgpiug ni teh emrbsun (lafreuc to ctveorn nistu to gagmy)d/:/k

2(1= mgu/L × 1 /001gm0 ug) × .0(90 Lr/gk/h × 0100 Lm/1 L × 24 1h/r ady)
= 52.92 gy/gk/adm

h.whi.c. sn'ti ayn fo the naewsr ccheios et.ldsi yhTe must vhae ddurneo .009 r/Lkh/g ot 1.0 L/h/,rkg dan igndo os eigsv ecxtaly 28.8 kymdgga// eoh(cic )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +69  
hyoid  ^^^^^ +11  
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9  
praderwilli  Big mad +9  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18  
bigjimbo  JOKES +1  
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it. +1  
d_holles  LMAO games NBME plays +2  
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1  
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6  
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +3  
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +2  
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +15  
qball  Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +1  
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +  
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1  
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😡 +  


submitted by welpdedelp(215),
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No dtei neyficdie,c hte nettaip hda scexes ocrtenae edu to sih tdie

sympathetikey  Would never have thought of that. Thanks +8  
medschul  that's messed up dog +18  
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +  
davidw  this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7  
davidw  β-Carotenes are present in dark-green and yellow vegetables. +  
hyperfukus  ohhhh hellllll no +7  
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6  
cbreland  I'm okay with missing this one +4  


submitted by yotsubato(961),
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ohtlAguh ntapeacnoimeh ()lenolTy is nto necdeosird na ADI,NS it oot may rveoopk na irsn-piiekal istevnsii.ty

meningitis  For that same reason (not an NSAID) it doesn't reduce inflammation so it cant be used for Gout. +5  
meningitis  And I think Indomethacin is associated with anaphylactic reactions in patients with aspirin-sensitive asthma and aspirin allergies. Can anyone confirm? +  
link981  How many other's like me didn't see "allergic to aspirin"? FML +3  
hyperfukus  OMFG me too i just got so mad and questioned my whole life at least its cuz i can't read not bc i don't understand :((((( +1  


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Why si eth rnesaw anleyydl ?esayccl I oldkoe in AF adn I wsa ttah GH suse eth 2A/JSTTKA yawhpta and ahtt 1I-GF essu the APM isaenK a.tpwhay toN esur how leydayln cycslae lsapy into i.tsh

pug_sheen  I think they are talking about the GHRH receptor on somatotrophs, which works through the cAMP pathway. +  
staygoodpupper  I don’t know how it relates to GH/IGF-1 in particular, but the question said there was a mutation in the alpha subunit of Gs, which activates adenylyl cyclase. +3  
kash1f  I agree the patient does have Acromegaly, but in the question it talked about how the patient had a mutation that prevented the GTPase activity of Gas. So Gs would be overactive --> excess adenylyl cyclase +28  
hyperfukus  ugh i was so excited too bc i thought i remembered jak stat epicfail +3  


submitted by hopsalong(25),
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hTis oinsqeut ash a otl fo srawen pst,ioon dan yuo iaverr ta Nhhoiiarilstesp by nwhgrtoi uot lla hte rehot otopsin by hatw is gin.imss

A, B - tCaricol rciseNos nda yraPipall eNcisrso tmosla awlasy uccro in eth tnegtis fo mei.ihasc uyisroPlev yehtalh 28 aery old mna has on eecdveni of tsfigylncnaii aesderecd nlrea urnp.iseof

C - ceAtu urlbTua rsNoseic si hatw ouy lushdo khitn of tihw latycSiela ANIS)(D .tiotxyci eTrhe rae nmya erhto xhoeciptnor gdurs atht eacus ,TAN btu thkni of TNA sa gdru cneuddi nedkyi dg.aeam

D - tysitisC - aFkln pnia si eardtle ot kneiyd rnjuiy, ton lderbda ge.aadm yitisstC dlocu be isploebs in icnnaesdg T,IU utb teh aentpit ash no vfere dna si aeml muc(h essl oconmm ni m)sea.l

E - elupolrrhtGiensmio - ishT stge otni eehrnrhtnpocitp/cii oesyrmdns. Teh tesm etimosnn taht he sah dolbo ni hte rienu hcwih mya dale oyu wdon eth hipceitnr thywp,aa utb he dseo ont haev yan fo the etrho astseoiacd tsps.omym

F - ornpmaHrypeeh - trnehoA owdr rfo nRale lCle Ci.oncamra No hwgite slos ro terho erncac taedelr mmyospst gi(afteu c)t.e

G - ntiratIilset pesrtNhii - Tihs si tenof a dgru endcuid MNMUEI emddatei .oiyetxtnicphro iThs si a epyt IV eistsvyrnpyiheit nrtiocae htta corucs skeew ot hnstom tfaer eht rtast of aiomcentdi (leik IDN)AsS. NTA si erom adotsieasc twih rugd ovrsdeeo leiwh tenatitlriIs is emor cdotaissae wiht nimeum ienc.aort nlIstitiear tpihsNier llwi vahe WCB sasct in rn.uie

I - hPeeloiypntrsi - dasCue by gdcnnsaei ITU tub on veerf si set.nrep

ishT vlsaee Nisailpirhhesot H() sa eth tcrreco raensw. 8%5 of hsehropiliitNsa is isatcedsao ithw hpcaoieytv olwbe n.ousds The pina orf hiosiipnshtlaer nac erlaesp and tr,iem and oilalosyaccn het ianp cna lvrtea from the ndekiy kn(laf )npia ot eth mcurost as het eosnt voems rgohuht eht ee.rutr

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +3  
hyperfukus  yasss +  
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +4  
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +  
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +  


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Tihs si tauec cehtolimy ouanisrntsf ra,cioetn I eev.ible pyTe II RSH os ’hsse gmfonri nobdiaiste aangtis eth AOB srpgou on het boldo lc.lse tlmoepemCn si nieudcd by niboeisdat.

kfratta1  But with hypotension in the stem I thought more of anaphylaxis due to IgA def. Why would a T2 HSR give you hypotension? +3  
2ndmedschool  I think the hemoglobinuria is the key. As I’m looking at it it seems that anaphylaxis would cause hypotension, urticaria, itching, wheezing. ABO incompatibility is the only one that mentions hemoglobinuria. +16  
hyperfukus  abo incompatibility and rh incompatibility with mom blood rxns are gonna TYPE 2 no matter what it looks like +  


submitted by skraniotis(10),
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dyeianzlUd rnael falruie seald ot elcatmiob i,casodsi adn sa a uslret cabirb tges lptedeed sa it irest ot ffuber eht ctlcmaoiunau fo grioacn c.sdia

bubbles  Thanks for the explanation! Do you know why Mg would not be a potential answer? Phosphate also accumulates in those with undialyzed renal failure, so I was thinking that maybe magnesium as a divalent cation would complex with PO3 (in a mechanism similar to Ca). +  
nwinkelmann  From the little bit of research I just did (because I didn't learn anything about dialysis at my medical school), ESRD can be associated with either low or high Mg levels, so the dialysate can cause either increased or decreased Mg levels depending on the patient's serum content, therefore I don't think based on this question, would could determine if removal of dialysis would lead to elevated or decreased magnesium. The end of the first article seems to favor ESRD leading to hypermagnesemia, so if that's the case, then removal of dialysis would cause Mg to increase as well. https://www.karger.com/Article/FullText/452725 and https://www.karger.com/Article/FullText/485212 +1  
hyperfukus  why is it that we aren't learning this stuff and they r just throwing it on step there's barely a blurb in FA about ckd/eskd +1  
hyperfukus  does uremia potentially have to do with this? +  
medulla  ESRD and not getting dialysis -> he is uremic -> met acidosis -> dec bic +10  
angelaq11  @medulla this is the best and simplest explanation. I got it wrong and chose Mg, wish I had made that connection. +  


submitted by skraniotis(10),
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zddlenUiya lnare lrifeau slade to iobclaetm issdic,ao dna sa a uestrl crbiba steg pedteled sa ti tries to frubef het caltcuaionmu of raincgo .diasc

bubbles  Thanks for the explanation! Do you know why Mg would not be a potential answer? Phosphate also accumulates in those with undialyzed renal failure, so I was thinking that maybe magnesium as a divalent cation would complex with PO3 (in a mechanism similar to Ca). +  
nwinkelmann  From the little bit of research I just did (because I didn't learn anything about dialysis at my medical school), ESRD can be associated with either low or high Mg levels, so the dialysate can cause either increased or decreased Mg levels depending on the patient's serum content, therefore I don't think based on this question, would could determine if removal of dialysis would lead to elevated or decreased magnesium. The end of the first article seems to favor ESRD leading to hypermagnesemia, so if that's the case, then removal of dialysis would cause Mg to increase as well. https://www.karger.com/Article/FullText/452725 and https://www.karger.com/Article/FullText/485212 +1  
hyperfukus  why is it that we aren't learning this stuff and they r just throwing it on step there's barely a blurb in FA about ckd/eskd +1  
hyperfukus  does uremia potentially have to do with this? +  
medulla  ESRD and not getting dialysis -> he is uremic -> met acidosis -> dec bic +10  
angelaq11  @medulla this is the best and simplest explanation. I got it wrong and chose Mg, wish I had made that connection. +  


submitted by bobson150(11),
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Is hsit nyisga erhte is svcuertaroleie uerlx?f I ocudl eavh srmow tshi msea emgai wsa no mfro 20 or 12 and hte nerwas swa slmiW romut

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +13  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +3  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +  


submitted by bobson150(11),
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Is ihst isgany theer is laoeivrrtceesu u?erxfl I loudc heva oswrm sith asme igmae swa on rfom 02 or 12 nda teh seawrn aws lsWim umtro

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +13  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +3  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +  


submitted by seagull(1389),
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uto of itsio,cury woh may eopelp nwek t?sih nd(ot eb ysh ot sya you idd ro )t?idnd

yM ytovrep ncdoiutea 'tddni nangrii hsit in .em

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +26  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
snoochi95  hell no brother +  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +  


submitted by meatus(1),
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m'I rsyro ubt waht am I nisigsm re.eh.. I uotthgh the olhew noipt of tciduesir is to corcret meoulv oroadevl by eridssi?u wHo dwolu atolt luovme eb n?drsaece?i

niboonsh  the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_- +12  
link981  Also misread the question, thought about the lab volumes of the BLOOD smh +5  
hyperfukus  yooooo me too!!! this is the second NBME i did this on they purposely don't write urine on the arrow categories to mess u up i swear!!! AHHHHHH +2  
medulla  missed this question for the same reason .. still pissed +2  
osler_weber_rendu  I DID NOT READ "URINARY" OH NOOOOOO. Im so dumb. +2  


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ishT eon aws a tlietl .ycrikt For htis neo teh kye si hte olw ioaddrienoi ka.tpue hsTi aieptnt has hhig T4 nad owl SHT cwhhi smeka seens ni a rhyyoeripthd enpitt,a hrpaspe uory isftr uhthogt si tath ihst tpianet ahs veas’Gr sesiad.e eore,Hvw in a’srGve uory dyiothr si bnieg esiatdtuml to aekm emor irthyod nohoemr mofr rctahsc nad as ushc wulod eahv na nridesaec aoiodiinder kuepat esbueca the idthyro si ngnrgiib in eth qrdreieu (won ei)daeodarlbl n.doiie hTis is ywh ti is ton sreavG (lsea“ree of yodhirt nhoorem fomr a dihtoyr titlaemdsu by a”)btsnideio.

So fi sit nto ’Geavsr thaw colud it b?e Fro tshi yduo’ ehav ot kown ttah hsmstoHo’ia sTiyordihit alo(s noknw sa nhoriCc htycmcyLipo rihiotsiydT dan is ftone rdferere to as shcu on bodra samxe to rwtho uyo f)fo ahs teehr seshpa - rfist yhet rae yyrtdohpier,h tenh treo,idyuh hent hte csaslci yyodpoihthr atth uoy duwol eetcpx itwh owl 4T dan high HS.T Tsih wsa the eky to iths qe.ousitn The snaeor ofr hsit is hatt rtyodtiinah praoiedxes edtbsonaii in himHatsso’o ausec eht ryhitdo to eereals lal of tis terods ydhoirt mooernh mkangi teh iapettn oyrhthpidrey fro a shtro ripeod fo eti.m Atref tshi asmevis eeeslra fo rhyidot r,emoohn hte bdsitoaeni mkae tehm eluanb to aemk wen TH nad refeohert hyte omebce euhioytdr fro a tsohr eodpir and hnte tyyrhhpoodi cihhw uoy ulwdo xcpee!t cniSe htey cat’n emak new T,H the dyothir lilw tno ekta up eht idinioadeor nda horeterfe heert lwli eb wol iieodrndiao kp.etau ,ecenH sr“eelae fo tsoedr ityrhod orohemn ofrm a diyorht ladgn tlraintfide by .”htpelycsmyo aka yt“ocpyLichm sh)tsooha(im oh”i.tsyidtir

I htnik lee“sera fo trohdyi nemhroo fomr a tayommlpuhos ytodrhi dg”anl is refirgnre ot emos ikdn fo dthyiro enrcca in chiwh ecsa uyo owuld tecpex meth ot be diigernbsc a nuedol no odriideniao kupte.a

mamu​Syr evodi ereh nad sloa a getar ites in lnee:rga d:e/irimo/n/sooip/ldc/oeeradahthr/.nryugqpdnicenseett

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9  
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3  
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1  
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +9  
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +  
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2  


submitted by mattnatomy(41),
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otMs mnomoc useac of nlscipe evin smtsohibor si nhocicr aptirsiacnte, cesuad yb peousrvnie ioammntfanl.i

S:ouecr 0/w.oti.2lpd0pwsbhh.g4nmw5mb4net1//u.ncv5i:/

hyperfukus  great link! helps answer other qs too thank you :) +  


submitted by alexb(45),
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rTeeh is a edtnce rWlodU qtsoiuen iinplgaxen woh tihs owks.r lOyn senaor I edreerbmem i.t

hyperfukus  i had notes from forever ago but i totally forgot lol +  
carmustine  UWorld question ID 318 +3  


submitted by mattnatomy(41),
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I bileeve htsi is eginrrref ot tgimud namrttlooia. eDu ot riepmrop nitsponigio fo boelw (no eth htgir di.es) dLsda bsadn tcnecon hte lgrae neitintse to het li.vre

naC dlea ot:

  1. Vlovluus

  2. aldnDoeu rotbtnocsiu

.3 AMS oucOcisln -- Im' seungisg sabde no het nesrwa to eth eounisqt

meningitis  Yes, the question clicked for me when I realized the ligament was on the RT side instead of LT so I thought of Volvulus. Image of ligament of treitz: https://media.springernature.com/original/springer-static/image/chp:10.1007/978-3-642-13327-5_17/MediaObjects/978-3-642-13327-5_17_Fig3_HTML.gif +3  
hyperfukus  So Volvulus regardless in baby or adult is gonna cause SMA prob + Duodenal Obstruction: d/t Ladd bands im gonna go back and remember those associations :) +1  
pg32  Yeah, recall that the midgut rotates AROUND THE SMA in development. If you can recognize that the ligament of Treitz is on the wrong side (right) then you know you have a malrotation issue. Then you recall the midgut rotates around the SMA and you pick that answer out of pure association recall and get it right. Nice. +1  


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ruO ilettl iedrnf hsa a sirorPauvv n,teioifcn hciwh tniecsf droyither ,rruscrseop iagusnc inuinroptetr fo hyetyrotrce otriucn.dop isTh is eht meas yaw it uacsse orphdsy ftaelsi ni onrnbu bebais nda itascalp anmaei ni lciesk ce,ll e.tc

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +20  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +3  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +4  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +  
angelaq11  @Is3076 I completely agree with @hyperfukus and I think that thinking of Roseola isn't crazy, but remember that usually with Roseola you get from 3-5 days of high fever, THEN fever is completely gone accompanied by a rash. This question says that the patient has a history of 4 days of rash and 7 days of fever, but never mentioned that the fever subsided before the appearance of the rash. And Roseola is not supposed to present with anemia. +3  
suckitnbme  @Is3076 another point is that malar rash refers to the butterfly rash on the cheeks that is commonly seen in lupus, so the face is NOT spared. +  
mdmikek89  Honestly y'all lmao First line...RED CHEEKS AND RASH Malar Erythema --- Hello? Rash - Eventually it may extend to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance Hemoglobin is 1 g/dL below normal. This is Parvo B19 -- SLAPPED CHEEK. I swear man, y'all make this easy nonsence. WAY to hard. +1  


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rOu little rnidfe ahs a irvuvrsoPa ,foitinecn cwhhi cfneits hirrtdyoe rose,purcrs incgsua nnriuetptroi of rortheycety octrn.dpiuo iThs is hte msae ywa ti uscase oypshdr ltasefi in rnboun aebsbi nad ipaslact maaine ni lsekic ,ellc etc.

gainsgutsglory  I get Parvo has tropism for RBC precursors, but wouldn’t it take 120 days to manifest? +  
keycompany  RBCs don’t just spill out of the bone marrow every 4 months on the dot. Erythropoesis is a constant process. If you get a parvo virus on “Day 1” then the RBCs that were synthesized 120 days before “Day 1” will need to be replaced. They can’t be because of parvovirus. This leads to symptomatic anemia within 5 days because the RBCs that were synthesized 125-120 days before the infection are not being replaced. +20  
drdoom  @gainsgutsglory @keycompany It seems unlikely that “1 week” of illness can explain such a large drop in Hb. It seems more likely that parvo begins to destroy erythroid precursors LONG BEFORE it manifests clinically as “red cheeks, rash, fever,” etc. Might be overkill to do the math, but back-of-the-envelope: 7 days of 120 day lifespan -> represents ~6 percent of RBC mass. Seems unlikely that failure to replenish 6 percent of total RBC mass would result in the Hb drop observed. +  
yotsubato  He can drop from 11 to 10 hgb easily +3  
ls3076  Apologies if this is completely left-field, but I didn't think this was Parvovirus. Parvo would affect face. Notably, patient has fever and THEN rash, which is more indicative of Roseola. Thoughts?? +4  
hyperfukus  @is2076 check my comment to @hello I thought the same thing for a sec too :) +  
hyperfukus  also i think you guys are thinking of hb in adults in this q it says hb is 10g/dL(N=11-15) so it's not relatively insanely low +  
angelaq11  @Is3076 I completely agree with @hyperfukus and I think that thinking of Roseola isn't crazy, but remember that usually with Roseola you get from 3-5 days of high fever, THEN fever is completely gone accompanied by a rash. This question says that the patient has a history of 4 days of rash and 7 days of fever, but never mentioned that the fever subsided before the appearance of the rash. And Roseola is not supposed to present with anemia. +3  
suckitnbme  @Is3076 another point is that malar rash refers to the butterfly rash on the cheeks that is commonly seen in lupus, so the face is NOT spared. +  
mdmikek89  Honestly y'all lmao First line...RED CHEEKS AND RASH Malar Erythema --- Hello? Rash - Eventually it may extend to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance Hemoglobin is 1 g/dL below normal. This is Parvo B19 -- SLAPPED CHEEK. I swear man, y'all make this easy nonsence. WAY to hard. +1  


submitted by hello(298),
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Pinetat hsa rde lcay rhas- thsi fsit moer whti VH6H- (eoRaosl iu,rsv) otn ir.aPruvvos

6HH-V esucas tfdieraomno fo yeohtsb,stalr gliedna to .emaina

hyperfukus  Hey so i just looked in first aid and it says "diffuse Macular Rash for Roseola" and usually you have a super high fever and febrile seizures are almost always mentioned...I found in my notes from uworld that i mustve filled in a long time ago for Parvo: Infects Erythroid precursors + Replicates in BM Face/cheek rash followed by LACY Reticular rash on body...May get Rash from IC deposition...and then again i wrote replicates in erythrocyte progenitors causing reticulocytopenia which makes sense why dec Hb and dec Hct +3  
hello  @hyperfukus is correct. Disregard this explanation. +  


submitted by enbeemee(13),
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wtah are eth rteho edalleb eru?cstrstu i nac cnsdrei eth aelprati nad iefch l,csel utb tno the .r.eh.tos

hyperfukus  what is A? +  
et-tu-bromocriptine  According to this source, they're mucous neck cells (secrete acidic fluid containing mucin); compare this with mucus produced by surface mucous cells, which is alkaline. http://www.siumed.edu/~dking2/erg/GI082b.htm +2  
hyperfukus  i gosh i see now! thanks so much :) so if it's Pink=Parietal but not granules got it thank you :) +  


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yWh nst’wa het belta ohunge ot etdeemnri raeenplcve in hte negaler aptuo?nlopi

sacredazn  For the case control question, it’s taking that principle that you can’t use case control studies to calculate relative risk and applying it to prevalence. Basically with case control studies we start by saying okay, I’m going to find 200 people with sinusitis and 400 without. Then, you go back and look at the number exposed/unexposed and calculate the odds ratio. So you can’t use case controls to calculate prevalence because it all depends on how many cases you picked in the first place. Might make more sense to think about it with a rare cancer like craniopharyngioma or something- let’s say you chose 10 cases and 10 controls and wanted to look at how many people smoked. It wouldn’t make sense to then say the prevalance of craniopharyngioma is 10/20 = 50%. +20  
dr_trazobone69  Thank you, that makes a lot of sense! So we can use relative risk (cohort studies) to calculate prevalence? +  
sacredazn  @trazobone Hmm I think the wording would be key, you could use a prospective cohort to calculate incidence, but you wouldn’t be able to find prevalence of the gen population unless you had more info. I think the concept is that really to calculate prevalence you need a proper ecologic study looking at population-level data. The way it was worded in the question was tricky though lol since when has “cannot be determined from the info given” ever been a right answer. +5  
nwinkelmann  @sacredazn thank you! this was the best explanation to use the rare disease comparison. Made everything make so much sense and hopefully I'll actually just remember it now, instead of learning the factoid and failing to recall it all the time. +1  
hyperfukus  i guess this makes sense but i don't understand why we are asked to calculate it from tables like this then? is there more info in those? +  
hello  @hyperfukus The table was given because that a 22 table is typically what you do see regarding data for case-control studies. If the 22 table wasn't include, then literally everytone would pick Choice "E" as the correct answer b/c you can't calculate something without being provided numbers. The difference in including the data-table is that 1. again, you need to report a 22 table because that is typically what you will see regarding data for a case-control study and 2. by including the 22 table, it actually tests if the test-taker realized that the data in the 2*2 table does not help at all with calculating prevalence-- because case-control studies NEVER report on prevalence. +  


submitted by iviax94(7),
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I saw eetwenb mhpoaylakie de(u to ahra)ired dan aeuc/capcreymmeipherrliiayh sie(nc etwas si ihotpcnoy adn ulwdo cesua eiocshrpmyot mulevo t)naon.icrtco I niddt’ evha a agrte wya ot eceidd bnwetee reyrcehruym/haaCpieip so I reigdfu yteh dwnaet op.Khy Is eerth a ttrebe aioanrtle fro wyh het pyher snswear are recorctn?i

liverdietrying  I think you over-thought this one a little bit with the hypercalcemia/hyperuricemia. Good fact to commit to memory: you lose bicarb in the stool (hence why diarrhea causes nonanion gap metabolic acidosis), and especially lose potassium with laxative abuse (as mentioned in the question stem). https://www.uptodate.com/contents/acid-base-and-electrolyte-abnormalities-with-diarrhea +1  
w7er  Basically they are asking about electrolyte distrubance that cause collapse mainly due to hypokalemia from laxative abuse because diarreha cause hypokamlemia and also cause incrase in renin angiotensin sytem which will further cause hypokalemia resuling cardiocascular colapse :) +  
hyperfukus  i thought the hyperuricemia thing too but i wasn't smart enough to think they wanted hypokalemia like u :( +1  


submitted by d_holles(170),
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ljnoaG sstssree het Bsorad nigivg teh eeamkuil eussniqot waay sebad no teh eag ivneg ni the qtousnie te.ssm

LAL = 1-40

LMA = ;5-391 940-5

CLL = +60

CLM = 0-954

0t3-sao3/hoasd0strnchsprf-trou5mngm:/ta.loenodje.ne6e/k/.iutt/duslet

impostersyndromel1000  thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +  
hyperfukus  also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +2  


submitted by gh889(115),
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eTh aewrsn is due to na petocnixe nilueodt here werhe aicnin si sued in pts wo/ tbedaies how evah rcoyferrta eheryelymtgdirpicrai ta hhgi riks ro sah a hx fo csptnairti.ae

I egaer htta rfiabest rae sfirt nlei (adn so oesd ttah tea)rcli tbu NEMB asw nihngo ni no a ieispccf pecieotxn htta ianinc nac olas eb esdu iscen LDVL adn TGs era ghhi ni eiali.grepiemtdrrcyhy

The c""uel ehty ahd wsa ete"rrurcn pititnrseaca" hhciw is yeldppsuso a alde aotwdrs .incain

I oasl tpu nseciaer DH.L...

wutuwantbruv  Correct, you would not want to give fibrates to someone with recurrent pancreatitis since fibrates increase the risk of cholesterol gallstones due to inhibition of cholesterol 7α-hydroxylase. +  
kernicterusthefrog  FYI @gh889 can't follow your link w/o an NYIT username and password, unless there's a more tech-savvy way around that.. I appreciate the info, though. Niacin rx for familial hypertriglyceridemia w/ recurrent pancreatitis. Now I know.. +2  
impostersyndromel1000  Great points, very in depth knowledge taking place here. Also, familial hypertriglyceridemia (per FA 2019 pg 94) has hepatic overproduction of VLDL so picking this would have been the easiest answer (in retrospect) +2  
hyperfukus  @impostersyndrome1000 literally that's the ONE thing i remembered and i went YOLO lol cuz i was staring for a while +  
osler_weber_rendu  @gh889 I agree niacin is the answer, but even niacin causes increase in HDL. As if getting to the drug wasnt tough enough, NBME puts two of its actions in the options! What a shit question +1  
mtkilimanjaro  I forget where I saw (maybe UWorld), but I always thought increasing HDL is never really a primary form of lipid control. You want to lower the bad cholesterol etc. since increasing good cholesterol wont change LDL VLDL etc. +  


submitted by dr.xx(142),
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HFC tntipase feton apdlyis ssgin adn psymmsto of srieacnde veiaposrsns itenorecs.

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!!! +  


submitted by seagull(1389),
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yWh oeaounnsp?st Hes' enggngai ni an ctieva sprot ihwt na cersaiden rsik fo mcaatruTi jyiur.n oS we yaellr juts saeums esh ont indejur ueasbec hte mste desnot rtycield say seh' jr?eidun sheTe tussnoqei deal to oot nmay ota.sussnpmi in( my on)iiopn

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +  


submitted by drdoom(801),
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You heav ot kthin utoba tshi iusng the ocnctep of NODNLAIOCIT P.IRILOABTYB onterhA awy ot ksa sith epyt fo tnsuoieq si iekl :isht I“ whso ouy a atitenp whti stouapensno ouexmarnt.poh hhcWi eotrh igtnh si msto eyklil to be rute aotub ttah e”ron?sp Or ouy nca hrpeas it hstee wyas:

  • nGeiv a NITINDOCO (nosnstoupae oempun,) waht eotrh nidfign is smto yikell ot eb teh eas?c
  • neGiv a oopl fo eepolp ihwt noastsneoup oxphe,muortan hwta oehrt hgnit si smot leklyi to be reut abtou emth?

nI roeht rwosd, fo lla poeelp hwo end up tiwh asnepsootun ope,unm the tosm nmomco hroet nhitg uboat tehm is htta tyhe are AELM p;a&m ITN.H

fI I avge you a bkutec of tsnosonueap uonmep pitsante -- dna you rdeehca uryo dnah ni ereht dan ulpeld eon out -- ahwt iecaonsr lduow eb omer oo:mmnc In yuro adhn oyu ehav a keomsr ro in uyro hnda ouy evha a tinh el?ma t’sI eht lertat.

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  


submitted by chosened(1),
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eCrroct me fi I m gornw tub I htnki s'ti aelnlryga ioaoplsipm.lats miploPasla anc podveel eyehawnr alogn eht rraysrteoip ,tacrt but stom etnof tcfefa eht ayrnlx dna the ovalc csord ganlral(ey s)tpi.moolaN istpola ures woh YH shit is tbu rhese reMo fnoi: ipaaysl.rtuasrrimospdatrsl:p/irsgre/rtre/e-aeiseoceo/sespohesat/raenrrisd--t

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +2  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1  
teepot123  yep dr sattar nails it ^ +  


submitted by chosened(1),
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Cretcro em fi I m rnwog btu I nhikt it's egrylnlaa aaotli.ospmpils oPislaampl cna epeodlv wnraheey nloga eth sartrepoyri tarc,t btu omts tnfoe fatcfe eth nrxlay nda teh calov socrd (lryenalag .ooti olisaNlp)pastm ersu hwo HY hist si but sehre eorM f:noi /ristdlteyeo-sr:l/r/detraesiaeo.peusspicppoo/har/marrtr-ge-riatenrssarasseis

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +2  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1  
teepot123  yep dr sattar nails it ^ +  


submitted by bobson150(11),
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The nigowrd of stih noquiset nodcufse e.m hTis is anigks wi"hch fo sheet esvsles is hte ihgh usrprsee mes"syt hgtri? oS the ghih rsupesre orispeur lertac is ucaigsn dsiaencre sureerps noti eht reorinfi rltac?e

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360 +13  
nc1992  Superior rectal not superior mesenteric. Took me a minute +  
hyperfukus  ugh am i ever gonna get these right EVER +5  
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there +2  
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal +2  
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein. +  
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly' +  
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is. +2  
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding. +  
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)" +  


submitted by neonem(549),
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oSsndu elki a saec of au-rinFemLi rmosnyde - senci p53 is a turom psursseorp rfo a nuhbc fo lecl tpsey, maunositt in isth geen s(a in FL)S ltures in a damyri fo miaaflil omrtu esytp.

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +9  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +14  
dbg  ^ this guy cracked the code. nbme ur doomed. +5  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +3  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +8  
jakeperalta  @privatejoker: according to UW, Li Fraumeni includes SABBB(sarcoma/adrenocortical/breast/brain/blood(leukemia)) +2  
ac3  side note: RB1 = retinoblastoma with an increased risk of osteosarcoma +  
lukin4answer  TP53 associated with SBLA + Brain tumor + Anaplastic Thyroid ca + Transitional cell ca. -UW +  


submitted by seagull(1389),
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negGr.w~2s/wime..ut/tekt8g7mb/dpI:i/dh/udwh1

otAenhr ygsoohtil sidle htiw asellb a ewf neodscs ago

enbeemee  what are the other labeled structures? i can discern the parietal and chief cells, but not really the others... +1  
hyperfukus  yea wth is A +1  


submitted by enbeemee(13),
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hatw era eht oterh adellbe eucsrturs?t i nac cisdrne eth ailaertp and chief slle,c utb ont the .osthre..

hyperfukus  what is A? +  
et-tu-bromocriptine  According to this source, they're mucous neck cells (secrete acidic fluid containing mucin); compare this with mucus produced by surface mucous cells, which is alkaline. http://www.siumed.edu/~dking2/erg/GI082b.htm +2  
hyperfukus  i gosh i see now! thanks so much :) so if it's Pink=Parietal but not granules got it thank you :) +  


submitted by nosancuck(85),
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oY dsi B tgo ON NELATNIR EFLAME ANGSOR

yWh dt???a!

eW eb iknloo at soomnee wtih na SRY mrfo rdee Y yD!m eehcrio be a Y ochimer oeHmi so yteh be knmai mose tsieTs eenmtriniD acrtoF ichhw I eb srue kesma msoe niec lli INAT ILELNARUM FOTCAR so yde tian tog ahtt Feelam tnrlaenI tTcra u nwok what i eb sainy

dAn eisnc zwmiinm is ad EATDUFL yteh ilst be teingt dseo sysup ilps dan rsseaetb

meningitis  The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering: chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities +16  
yotsubato  Turner syndrome patients are also chromatin negative as well though.... +5  
sympathetikey  I didn't know a complication post-meningitis was lack of humor. +5  
sympathetikey  Ah, didn't read the last line. Yeah, that is taking it a bit far +20  
niboonsh  yall are haters. this is the first explanation that has ever made sense to me +5  
arkmoses  https://www.youtube.com/watch?v=yuXL-3eoB-o&t=77s Interesting syndrome watching this helped me to put it into real life perspective, interesting points they have no pubic hair/body hair, they apparently also dont smell, and breast size is usually increased... +1  
whoissaad  How does chormatin-negative indicate a normal cell? Isn't chormatin just condensed DNA? +1  
cienfuegos  According to this paper most individuals with Turner Syndrome are chromatin negative: "One of the initial laboratory procedures used to confirm or rule out this diagnosis involves a sex chromatin determination from a buccal smear. Cells from the lining of the mouth are stained for the presence or absence of X-chromatin or Barr bodies, which represent a portion of an inactivated X chromosome. The typical Turner’s syndrome patient, who has 45 chromosomes and only one sex chromosome (an X), has no Barr bodies and is, therefore, X-chromatin negative. This abnormal X-chromatin negative finding in the majority of Turner’s syndrome females is similar to the result found in a normal male, who also has only one X chromosome, and differs from the X-chromatin positive condition observed in the normal female, who has two X chromosomes. Occasionally, the patient with features of Turner’s syndrome is found to be X-chromatin positive." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233891/ +1  
hyperfukus  i really hate haters this is awesome! +1  
selectuw  to add to the above, free testosterone is aromatized to estrogen leading to breast development +  
misrao  Is the free testosterone not creating male internal or external gentalia because of the defect in androgen receptors? +  


submitted by sympathetikey(1244),
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Teh hwoel cskp"i ta the lencis.sousae.. smeo id,e"lbgen eamd em htnik ss.iiosrPa luohdS vhae ogne wthi Ainictc strseKoia ebsda on het aepintt tosyhir tl(so fo usn e.pxroe)us

ntiicAc ioesaKsrt

gnmtliaaPrne lnsesio dsucae yb sun so.xpreue ,Slalm uogh,r omsuyereatht ro swrbiohn peplsua o. euqrapsl kRsi of uoausqms clel caonaicmr is oirtlnoarpop ot deeger of hteailepil lsys.paiad

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +5  
temmy  the distribution of the other lesions, forearm, face, ear, scalp..is not characteristic for psoriasis. +6  
hyperfukus  the scalp and ear are actually very common for psoriasis IRL the key is more of the fact that its in areas with UV exposure...actually UV Therapy is found to be helpful in treating some pts w/Psoriasis. Lastly the appearance and lots of things bleed if they were trying to go for auspitz sign it would have tiny dots of bright red blood with slightly touching it +4  
hyperfukus  oh last thing psoriasis itches! they said no itching +4  
drzed  Those locations may be common IRL, but on step 1, if they want you to think psoriasis, the illness script is going to be someone in their 30s (autoimmune age) with symmetric cutaneous plaques that have a silvery scale on the extensor surfaces. In this case, the age and non-classic description (location, type of lesion) made me steer away from psoriasis. +1  


submitted by sympathetikey(1244),
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ehT hloew ck"isp at the i.la.ssn.ecueso smoe gln",deieb amde em itnkh sriP.siaos ldohuS aevh ogne wiht Atcicin ssireaKto sbdea on teh atetnip iysthro o(tsl fo nsu uoepsre)x.

tncicAi artsseoKi

amtnirgnalPe lsnosei sdueac by nsu .uesperxo lalm,S guo,rh ttreyohsmuea ro nrbhwios ulapsep luar.sqope kisR fo umsusoqa lecl carinomac is oorpoplirtna to degere of iehipellat la.pisasdy

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +5  
temmy  the distribution of the other lesions, forearm, face, ear, scalp..is not characteristic for psoriasis. +6  
hyperfukus  the scalp and ear are actually very common for psoriasis IRL the key is more of the fact that its in areas with UV exposure...actually UV Therapy is found to be helpful in treating some pts w/Psoriasis. Lastly the appearance and lots of things bleed if they were trying to go for auspitz sign it would have tiny dots of bright red blood with slightly touching it +4  
hyperfukus  oh last thing psoriasis itches! they said no itching +4  
drzed  Those locations may be common IRL, but on step 1, if they want you to think psoriasis, the illness script is going to be someone in their 30s (autoimmune age) with symmetric cutaneous plaques that have a silvery scale on the extensor surfaces. In this case, the age and non-classic description (location, type of lesion) made me steer away from psoriasis. +1  


submitted by mcl(577),
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SPOC si siaoedcsat hwit lbnaramo rniptuoocd fo esx oetis,rds diiuglcnn cnfiutnysod of oergtsne ordictupon dna eopetno.esrgr caiylhCrnol levdeate evlles fo rensegto nca uscae noedearitlm her.alpiypsa

///o.cCbhss3t5gwnti7ilt..p9/wpahm:M1veiP9c9/nml/wn.rc

meningitis  Why isnt it endometriosis? Could someone help me out on this? +  
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +  
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +  
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +25  
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not directly...you can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +1  
lovebug  FA 2019, page 631 +  
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +  


submitted by haliburton(208),
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stih si a rlvaicce nipasl crod necio.st the cnaeeut acciulsusf is nicatt ()EU oniratbiv and rpiooonirctpe,p tbu the hietw neitsco is eth ciragle uaissccluf LE() adn is .gaeamdd I nhikt teh aletlar oonrpti ttah si uneven si tusj lni/tatcaufrtaar.

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at https://en.wikipedia.org/wiki/Gracile_fasciculus#/media/File:Spinal_cord_tracts_-_English.svg you can see that the closer to the center = legs, while further away = arms. +3  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +12  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  


submitted by haliburton(208),
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tsih si a erlcvcia anplis docr tnecios. eht cteeuna iflcucusas si nictta U(E) vnritiabo dna reoop,ionciptpr tub the wehit esincot is teh arieglc cacliususf LE)( adn is dd.eagam I kntih het lrateal otorpni taht is venune si tjus natacuttl/.faairr

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at https://en.wikipedia.org/wiki/Gracile_fasciculus#/media/File:Spinal_cord_tracts_-_English.svg you can see that the closer to the center = legs, while further away = arms. +3  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +12  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  


submitted by mcl(577),
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abLeedl CRX hignosw otnoisip of tfindeerf vvsl.ae

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2  


submitted by mcl(577),
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deaLlbe XCR shnoiwg tisnopoi of ifnefrtde avlves.

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +  
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2  


submitted by benzjonez(42),
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FA 2801 p. 960. tcSuspe hraueltr ijuryn fi obold si ense at het tauhrlre u.etsma maeMhcins fo itrospeor rrhetula yujirn = vilcep raufrcet, chhiw ew ese ni ihts .ptitena tlaheUrr nterithitozcaae si yvaeertlli dtdc.ncenraaioit

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? https://www.mayoclinic.org/diseases-conditions/urethral-stricture/symptoms-causes/syc-20362330 +  
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source: https://www.urologyhealth.org/urologic-conditions/urethral-trauma#:~:text=Trauma%20to%20the%20anterior%20urethra,of%20urine%20from%20the%20penis. +  
eghafoor  The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear +  


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i-H I 'notd eavh an liapnxnetao rof hsit tub I ma sloa ciousru as to hyw hist swa eht .ewnars

drdoom  via @hyoscyamine: FA pg.372. Squamous cell carcinoma occurs in the upper 2/3 of esophagus whereas adenocarcinoma occurs in the distal 1/3. Since this was in the mid esophagus, its squamous cell carcinoma. Key feature of squamous cell carcinoma is keratin pearls. +17  
hyperfukus  idk why my dumbass didn't put foci of keratinization and pearls together lmao +1  


submitted by haliburton(208),
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iaikpwdei :is)l(aopoeg eTh pahseermot is ospeodcm fo 78% rngineot dan 21% onxgy.e Sceni xoygen si ecdxganeh ta teh roacaipl-liylaelv ,emeanmbr ntonreig is a omarj mnctneopo orf hte o'lvaiels satet of tlio.ninaf fI a ragel eovmlu of nigtenro ni hte lusgn si ldpceaer whit yg,eoxn eht oyxnge yma eytsqsunbuel eb oberadsb iotn teh lbod,o ugedirnc hte moveul of the ,allvoei rsgelitun ni a romf of lralevao alsoplec wonkn sa rsnbopaoit sseaitate.lc

I eoshc gcioacirnde ae,med tub I evilebe itsh si irtercnoc ueebsca etehr is on etarh erfulai kirs at sthi mti,e os the spoerup of teh PEPE si aytreicnl otn to uphs out diluf.

bighead478  doesn't there have to be an airway obstruction (mucus, foreign object etc.) in order for this to happen? 100% O2 without any airway obstruction should not cause absorption atelectasis, right? +  
iloveallpotatoes  And Tension Pneumothorax is wrong bc PEEP would furthur exacerbate that. +1  
hyperfukus  @iloveallpotatoes yea i realized that now after getting it wrong :( +  
plzhelp123  @bighead478, they are using a cuffed endotracheal tube and mechanically ventilating this patient which is creating an iatrogenic "obstruction" and as @haliburton mentioned, having a high FiO2 leads to over-absorption by the blood which leads to absorption atelectasis if no other gas is allowed to enter/there is no communication with atmospheric pressure during expiration. Thus, we add positive end-expiratory pressure which keeps alveoli open at the end of expiration to prevent collapse +  


submitted by enbeemee(13),
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i tge wyh tsi' fanli,gell tub si eht fcicisep reaons atht SPL si gworn si uabeesc s'it jsut tno who hte cnvieac si a?dem LPS oluwd laos iticel na nmmeui rno,ateci gih?tr

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +3  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +2  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +2  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  
jp1003  I think it's because Neisseria does have LPS. They have LOS instead. +  
jp1003  *does not have LPS +  


submitted by enbeemee(13),
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i gte hwy tsi' lne,lfailg but is eth iefpicsc nreaos ahtt PLS si gownr is buceeas s'it just tno woh het acnciev si mae?d SLP luwod aosl ietcli na mnimue ,toeanirc g?rhit

nor16  Lipid A of LPS can be sensed by CD14 of macrophages causing shock, its not a protein, so no immune reaction as in vaccination (humoral, IgG class switch via Th2 and B Cells). +3  
eclipse  actually they do use LPS as adjuvant in vaccines +1  
eclipse  actually they do use LPS as adjuvant in vaccines +2  
hyperfukus  TLRs recognize common motifs called pathogen-associated molecular pattern (PAMP) in bacteria, fungi, viruses, and other pathogens. TLR signaling in the modulation of innate immunity + adaptive immunity against pathogens, TLR agonists: CpG-DNA, flagellin, and lipid became essential candidates of effective+safe vaccine adjuvants. TLR agonists improve the efficacy of vaccine, reducing TCR-based selection thresholds and enhancing the magnitude and quality of memory T-cell response. +2  
hyperfukus  some extra info in case they ask another annoying q +3  
aturner713  Not sure if this matters for this or not, but Neisseria spp. have lipoOLIGOsaccharide (LOS) and not lipoPOLYsaccharide (LPS) +2  
schep  I don't understand why LPS couldn't be the answer also. UWorld question ID 45 specifically says that they are using LPS as a conjugate +  
jp1003  I think it's because Neisseria does have LPS. They have LOS instead. +  
jp1003  *does not have LPS +  


submitted by usmleuser007(370),
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As rpe 1A)F tytaf infliaitrotn 2) arellulc nolngiloba )3 vutneale sesonicr

hyperfukus  thanks u saved me time in looking that up :) +  
violethall11  Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic . +  
mumenrider4ever  FA2020 pg. 391 +