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Comments ...

 +1  (nbme23#32)

NMDA receptors in this case are being used for long term potentiation within the brain and out of all of there choices only this receptor uses Ca+

 +2  (nbme23#36)

He presents with an abnormal sensation of his left hand that spreads to both his left arm and face. A lesion of the postcentral gyrus would cause this as it it responsible for sensation.

 +0  (nbme23#16)

20 of the 100 men without prostate cancer have abnormal test results.

Specificity = FP/FP+TN = 20/100 = 0.8 = 80%

seagull  almost. 100/120 = 83% roughly 80%
amirmullick3  Not sure what lfsuarez and seagull above mean. Here is my explanation. Specificity = TN/(TN+FP). This test gave 20 false positives out of 100 people, and only 15 true negatives out of 50 men. Specificity also equals 1-FPrate, and here the FP rate seems 20% so 100%-20%=80%.
yb_26  abnormal test result means pt has cancer => TP = 35, FN = 15 (50-35), FP=20, TN =80 (100-20) => specificity = TN/(TN+FP) = 80/100 = 0.8 (in % will be 80%) true negatives are 80 out of 100, not 15 out of 50
bulgaine  If you replace the values from the question in the table of page 257 of FA 2019, yb_26 explanation is correct. Abnormal test = patient has cancer = test + Question says 35/50 men with prostate cancer (so all 50 have cancer) only 35 have abnormal test results, meaning that TP=35 (disease + test +) and FN= 15 (disease + test - because they do have cancer but the test was not abnormal for them ). 20/100 men without prostate cancer have abnormal test results meaning all 100 DONT have cancer but 20 show that they have cancer when its not true so FP=20 (disease - test +) and TN =80 (disease - test -)

 +6  (nbme23#19)

This patient presents with IPEX (immunodysregulation polyendocrinopathy enteropathy X-linked) which is a mutation of the FOXP3 gene which is a regulator for the Regulatory T cell lineage. It leads to the dysfunction of regulatory T-cells and the subsequent autoimunity.

 +3  (nbme23#9)

This vet is suffering from Q fever, which commonly presents with fever, elecated liver enzymes, throbocytopenia and lung infiltrates. The gram stain and culture appear to be negative because coxiella is an intracellular bacteria. He is at high risk for this infection from the inhalation of the bacteria during farm animal delivery.

 +3  (nbme23#13)

The patient is prescribed Sildenafil which caused increased cGMP levels are therefore SMOOTH MUSCLE relaxation. In this case you would want to vasodilate the deep artery to increase blood flow into the corpora cavernosa.

sugaplum  aka cavernous artery, that is what I was looking for. Did not realize it was also called the deep artery

 +3  (nbme23#12)

Patient present to the clinic with classical symptoms of tetanus. Tetanus toxin work via inhibition of GABA/glycine release from Renshaw inhibitory cells. Without these inhibitory signals on the postsynaptic neuron, they are continuously activated causing muscle tetany.

 +2  (nbme23#5)

Phase II studies test the efficacy of a drug. This second phase of testing can last from several months to two years, and involves up to several hundred affected patients.

 +2  (nbme23#26)

When patients are given Nicotinic acid(Niacin) they are told to expect common side effects to occur such as warmth and redness. One can avoid these side effects by taking aspirin

mcl  To expand on this, the flushing/warmth/redness is due to release of PGD2 and PGE2 which is why taking an NSAID helps.

 +3  (nbme23#2)

Patient presents with cervical intraepithelial neoplasia, with the most likely culprit being HPV. HPV causes this neoplasia though the creation of E6/E7 oncoproteins which inhibit p53 and Rb tumor suppressor proteins respectively.

 +4  (nbme23#7)

This question asks about the mechanism of phototherapy as it relates to neonatal jaundice. With phototherapy, bilirubin is simply converted to water soluble isomers that are then able to be excreted by the kidney. This however does not conjugate the bilirubin.

 +5  (nbme23#43)

Patient presents with both ataxia and an intention tremor on the right hand side. It is important to remember that cerebellar lesions like we see here always present IPSILATERALLY as opposed to many other CNS lesions.

 +5  (nbme23#3)

Answer E

Inorganic Phosphorus ; Parathyroid Hormone ; Calcitriol

Decreased ; Increased ; Decreased

This patient is suffering from celiac sprue, which in this case has caused Vitamin D malabsorption and therefore decreased serum calcium. The body will respond to the decreased calcium via secretion of PTH. This will then cause phosphorous wasting to occur in the proximal convoluted tubule.

 +7  (nbme23#46)

During protein translation, the ribosome bind to mRNA to initiate trasncription starting at the N-terminus. The N-terminus peptide end contains a signal recognition particle that binds to the signal recognition particle receptor on the rough ER to allow the protein to be made into the RER.

link981  Rough endoplasmic reticulum- site of synthesis of secretory (exported) proteins. Smooth endoplasmic reticulum- site of STEROID synthesis and detoxification of drugs and poisons. Page 46 FA2018

 +7  (nbme23#14)

First heart sound (S1) is generated by two heart valves: the mitral valve and tricuspid valve. Nearly simultaneous closing of these valves normally generates a single S1 sound. Splitting of the S1 sound is heard when mitral and tricuspid valves close at slightly different times, with usually the mitral closing before tricuspid

yotsubato  Then why the fuck is it describing a mitral valve sound in the tricuspid area
dr.xx  it's describing a splitting S1 — consisting of mitral and tricuspid valve closure — that is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts.

 +7  (nbme23#22)

This patient presents with a small cell carcinoma which is very common for para neoplastic syndromes. In this case the cancer is causing SIADH. Demeclocyline is a tetracycline antibiotic that is also used to treat SIADH

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine).

Subcomments ...

submitted by m-ice(116),

The patient shows no sign of cortical activity, but has some brainstem function intact, which implies she is in a form of persistent vegetative state. She has a living will that designates mechanical ventilation should be discontinued if that situation arises, so we must follow it and make not attempt to resuscitate.

lfsuarez  Why would the second part of that be correct when there is not mention of a DNR? +3  
ug123  DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +  
sherry  DNI and DNR are indeed different. But it is not the case here. The patient needs to be extubated means she did not sign a DNI or DNR in the first place. I assume her living will is more like terminate supporting treatment in a vegetative state. So there is no need to do resuscitation anyways. But I agree this is not a good question. +  
shayan  "The patient has signed the living will and is consistent with her directives" but the stem doesnt tell has what is in her living will about the extubation? we are extubating on the request of her husband? this is confusing ! +  
criovoly  I believe this question was not well constructed... it's one of those! +