NBME Answers : impostersyndromel1000's page

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submitted by sup(19),

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Showeom I swa bale ot cviencon mfeyls thta icnrsdeae eeetsotsornt -;-t&g edesdcera serngtoe -g;t&- earsdceed egeavtni feecabkd on LSHHF/ ieroectns &tg--; dcesierna .SFH sDoe aynnoe cear to lxpiaen hyw htsi igclo si ?norgw aTsknh :)

btl_nyc The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio. +1

impostersyndromel1000 @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +

submitted by seagull(1182),

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oS lhpaa swa hte aenrsw os my utaeidgf idmn utp l"Ae.l.."w d.eon u'reoY gogni ot be a .oortcd lol

impostersyndromel1000 hope you dont have to write a prescription for me one day lol +3

submitted by cocoxaurus(52),

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slAtom gto crteidk by tshi one eebasuc somarocaeost alos eaussc ltsosobiaetc sinloe. tsaaoocrOems osmt conymlom metassietazs to lungs ohtgh.u

impostersyndromel1000 This was in pathoma, he said prostate cancer causes osteoblastic lesions and "the board examiners really want you to know that". also following the potential site of mets helps choose the answer +1

snripper Also, osteosarcoma is less common in the elderly, more common in males <20 y/o (per F.A 2020) +2

submitted by drdoom(686),

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Yuo heva to ihntk tuabo ihts nuisg eth cncoept fo AOIDCNITLON LIT.BRAYIPOB Arehtno way ot kas iths ptey of niuseoqt is ilke tsih: “I hsow oyu a ttpeani hiwt tuaopnnosse hnurpex.omaot chhWi threo tngih si tmos llekiy ot eb eurt aotbu ttah rp”sneo? rO oyu anc arhsep ti eesth wys:a

Geivn a INTOONCDI (nsuoaposent mnueop,) wath hoter iifdgnn is otms kliyle to eb teh seca?
Gevni a oplo of olpeep whit ouasstpnneo armnophtoux,e tahw htero ihngt is msto eiklly to be tuer batuo m?eth

In erhot swdor, of lla lepope who end up iwht noespustnoa enpmuo, hte most moocmn rhteo hingt abuto ehmt is ttah thye era LMAE ↦ ITNH.

If I aegv oyu a uckbte fo tnanupsoseo mnpuoe atntiesp -- dan oyu erdehca oyur ahnd in heter adn pdeull noe tuo -- hatw riasecno lowud eb erom m:conmo In uyor hnad yuo heav a keorsm or in royu adhn oyu vhae a ithn emal? stI’ eht late.rt

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 gh889(94),

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heT erswna is ued ot an tnceeipxo uodlniet erhe erhwe niainc is euds ni pts /wo setdbiea how ehva rctfeyrora ygditeraipmyhelrierc at high kirs or ash a hx fo neasi.trictap

I eraeg atht aitbfers ear sitfr niel d(an so odes atth ilcte)ra ubt EBNM asw hnogni ni no a iicpfcse pcxointee thta inaicn anc aols eb desu isnce LLVD dan TsG are hhig in trhglyriicdeirm.eeayp

eTh uel""c tehy dah saw rucrrnee"t rstipaaneitc" hcwih is ysepupldos a laed wostard nn.ciai

I asol utp icenesra ..L.HD.

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) +1

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 d_holles(145),

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noajGl eersssst eth Bodrsa vgigni eht miaekelu nqousiset waay sbead no eht gea gievn in the euqsnoti set.sm

ALL = 4-10

MLA = 5-3;91 4-590

LLC = +60

MLC = -5904

tg0r-snteart/usuhtsoam:t0k/o3n.dmdtpusfn/j/etnoa.s/ohe.l6e5doi-r3cle

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!!! +1

submitted by atstillisafraud(157),

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ikgllAyant neatsg rehmearhmo(ieltc)n eth( rtheo gsurd idelts aer ulbmrucetoi ibnhii)tsro aiscnree eth irsk of L.AM

keycompany Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +25

seagull CML has blasts too but they tend to favor mature forms. +4

kash1f You see numerous blast forms == AML, which is characterized by >20% blasts +4

keycompany The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +12

impostersyndromel1000 @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +1

sweetmed Procarbazine is alkylating as well. +

pg32 @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +3

castlblack this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +

submitted by keycompany(269),

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intitaeyolnpHerv eesarcde a2.OCP Ctelarn recspemreoocth donsepr ot wol OaP2C yb vttiscocogniarsn eraerblc bolod .slsseve

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)B Ariertal Bldoo OP2: aPO2 aschgne in eoespnrs to adeesrdec OAP,2 POI2, ro fsi.uodnfi Trehe uldow eb on gehnac ni a2PO gniurd hyropnlveiietnat tlra).eht(lcioey

C) iAalrte sererPus: sdeeeDcar C2OPa si dsoacsitae whit atinoovrnsi,tccos chwhi wolud caiseenr loobd rs.erepsu

E) erCrblea Tseisu Hp dlowu rnaesice ude ot osrrpiyeatr sakl.aoils

keycompany EDIT: Via the **Haldane Effect**, not the Bohr Effect. +

impostersyndromel1000 excellent response +

teepot123 fa 19 pg 489 +

submitted by nwinkelmann(265),

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Ie'v vnree been ogdo at gotncirven iutns :( llo so had to sak ym rbro.eht He otld em ta:th

satdeicn × dnisceta = inacsetd² = aera

,dan

ndiactse × edntaisc × csenadti = ecatinsd² × diancets = nasdicet³ = lmvueo

Gaott elov ibcpul ohsolc fro evrne nbee utgtha atht ... eshge ousyl(vobi I'ev noed teh qonaesitu adn tsfuf, jstu evner enbe lotd it atth ty/aatwh elpsmi ree.fbo) Kignwno atht ameks ngguiirf uto eth qauonite chum r:eesai

Flwo erat = iotycelv × ACS = 20 eccs/m × c2m² = m0c4³c/se

To vntoerc to i/mL,n jtus imylultp:

4m0c³ecs/ × 06 cseimn/ × 0L1,m0/0c1³ = 2400 0,L01/0 mni = .42 Lmn/i

eoHp tshi p!dhele

impostersyndromel1000 to all my public school peeps out there (and not the nice public schools in rich areas, the real public schools)... we made it! +3

angelaq11 Thankfully I was taught how to convert units, but let me tell you that I was SO lost on this one. It's USELESS to know how to do it if you (I, I mean I) don't know the damn formula xD. Obviously got this one wrong, but it's good to know that if it ever comes up again (and I know it won't) I already know it. +1

submitted by endochondral1(12),

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si tihs qnstoeiu ingask whta ew yihlpslcya pssa rgtuohh ro yb?

impostersyndromel1000 no, basically the question is testing if you know the branches of the abdominal aorta and which is closest to the renal (in this case, inferior to the renal arteries) +1

impostersyndromel1000 what you are passing by would better answer your question actually +1

submitted by endochondral1(12),

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is shit euqionst ksgani thaw ew lyhsaylpci pssa hhgurot or ?yb

impostersyndromel1000 no, basically the question is testing if you know the branches of the abdominal aorta and which is closest to the renal (in this case, inferior to the renal arteries) +1

impostersyndromel1000 what you are passing by would better answer your question actually +1

submitted by link981(139),

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Per irtsF Adi 0821 (gp 1)24 &;pam rMeck ulaMna

)a MCL si nto teh anwsre aesubce in LMC oyu eahv HIHG CWBs &apm; latPet.els nI eth smte rehet si nyol high lpt as)tb.ele sI het aernws uecbaes in tnaseiEls iohmmhoTyaecrtb we have romanl CWsB adn Bs,RC usjt hhgi l)te tlp.sace yeoliMd psmeialata srrefe ot well a liaaaptesm ni iemdylo lecsl whcih rae sbpslioa,h ,oslihnpisoe edc )t. In ylomcPyehtia raeV we aveh HGIH RCs,B sC,WB dan .lltete )easP evRcetai bo-mcoythtoissr si a veeaeldt leetaptl uonct ahtt ruccos aedosrycn to onhrate ordsderi lk:ie

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impostersyndromel1000 perfect response right here +

paloma Essential thrombocythemia presents with platelets > 1 million, not reactive thrombocytosis +

submitted by mcl(534),

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tBe-2a rpsceerto are coeldpu to sG tpnoei,rs which ttaaveci eandllyy yeccsal adn necasire MP.Ac cCicly MPA nhte asrecines ivtyicta of inrpeot naikse A, chihw aepypshtlhroso yonsmi light naihc niska,e llauttieym igntlures ni thosom ulcmse toaraneilx. etlb,olAru a 2B sagiotn, si teehorfre fuseul ni argettin ohro.mnsbpasc

impostersyndromel1000 are you able to clarify that phosphorylated myosin light chain kinase from cAMP/PKA and dephosphorylated myosin light chain from cGMP both cause smooth muscle relaxation? saw this on another Q with the nitrates causing headache so now im confused +

dubywow @impostersyndromel1000: Here is an image that summarizes cAMP and cGMP actions in smooth muscle cell very will. Hope it helps. link +1

iwannabeadoctor2 cGMP is the use of Nitrates for endothelial vasodilation; B2 is a different action, similar end result. See this diagram for the adrenergic receptor actions. https://s3.amazonaws.com/classconnection/769/flashcards/5928769/png/screen_shot_2014-11-04_at_92935_am-1497B7358A4552ACB39.png +

castlblack cAMP INHIBITS myosin light chain kinase causing relaxation according to FA 2020 pg. 317 +2

submitted by bubbles(63),

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naC osemoen iplnxea ylprreop ohw ew know thta tshi taitr slwfolo nleeiandM iescnteg dan is somoatual csrveseie adn euhmfrrorte ohw eht raspten wree g?eooetzhursy

I sdeuesg a tol on thsi equnosti and gto yculk :(

niboonsh Autosomal Dominant disorders usually present as defects in structural genes, where as Autosomal Recessive disorders usually present as enzyme deficiencies. P450 is an enzyme, so we are probably dealing with an autosomal recessive disorder. furthermore, the question states there was a "homozygous presence of p450.....". In autosomal recessive problemos, parents are usually heterozygous, meaning that 1/4 of their kiddos will be affected (aka homozygous), 1/2 of the kids will be carriers, and 1/4 of their kids will be unaffected. +28

nwinkelmann Is this how we should attack this probelm?: First clue stating endoxifen is active metabolite of Tamoxifen should make us recognize this undering first pass hepatic CYP450 metabolism? Once we know that, the fact that the metabolite is decrease suggests an enzyme defect, which is supported by patient's homozygous enzyme alleles. Then use the general rule that enzyme defects are AR whereas structural protein defects are AD inheritance patters. Once we know the pattern, think that most common transmission of AR comes from two carrier parents. So offspring alleles = 25% homozygous normal, 50% heterozygous carrier, and 25% homozygous affected, thus sister has a 25% of having the same alleles as patient (i.e. homozygous CYP450 2D6*4)? +6

impostersyndromel1000 we had the exact same thought process, so i too am hoping this is the correct way to approach it get reasoning friend +

ajss thanks for this explanation, I totally forgot about AR patterns are most likely enzymes deficiencies, this kind of make the question easier if you approach it that way, thanks +

submitted by meningitis(426),

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rcsesoP fo nnolatmieii on hits n.oe

I daeiimetln bomCyral hestoah,pp ienrnigA ued to earu yccl.e
I idemenailt APT baceesu TPA oanel 'luontwd ghneac 6FP toni mgnisoualec
GAN I ogt lykcu adn I enietamdil it ude to tis esu in MCE adn cnolgael os I td'ind nkhti ti was rlevtane and I dkin of rembedemer ti iegnb in auer ycle.c

dr.xx you mean, pure luck? :) +12

impostersyndromel1000 lol pretty sound logic here mate +1

nor16 same here, Glutamine is a NH3 (-amin) donor, so guessing made sense +

submitted by seagull(1182),

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uto of ci,oytrisu ohw mya poeple nkwe tih?s dno(t eb ysh ot sya ouy idd ro ?tdind)

yM tropyve dictuneoa id'tdn ariignn hits ni m.e

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 +12

d_holles i did not +

yb_26 I also guessed because both words start with "glu"))) +19

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?" +6

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 +17

drschmoctor Is it biochemistry? Then I do not know it. +3

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 +

surfacegomd no clue +

submitted by bubbles(63),

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rs.c-n.aoot.Sleco sditeus aceorpm a pgruo of eoplep twhi eth assdeei nda a orpgu fo ppleeo uiotthw teh aie.sdes mI' otn srue I nsaertdnud yhw ouy nac lalc eplpeo olrmynad adn llac tath a olcortn .pgrou tWha if anogm setho cadlle aodnrlym, omse of meth veha olas adh hirmregoach esos?krt

impostersyndromel1000 this is one of those Qs where you just dont over think it and focus on your first point, that they are comparing a group with the disease vs (potentially) one without it. Thats what i took from it at least (sorry fi this is too late) +3

tiagob Why is not Cohort ? since it compares groups exposed to drug X? +

djinn Cohort studies determines end of disease and CC determines begins +2