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Welcome to link981’s page.
Contributor score: 160


Comments ...

 +0  (nbme20#2)
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ivorrusoN si eht tosm mcnoom easuc fo iravl otegtisirrtsean in eth AUS ued ot nacot.vciina + Rroisvuta is eth tmso mmoonc euasc fo lrvia sgiotteratesnri ni eth etsr of hte lwodr. nI ihst qisetnou uoy dah ot ownk eht stom onmomc ucsae


 +3  (nbme24#31)
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oswKdrey ofrm .rD uoTcr form npaKl:a

  • nRtlpeci-aoi NDA
  • a-Titirronnscp RNA
  • onaraTts-inl noriteP
hungrybox  bruh this is like bio 101 lol +7

 +0  (nbme24#35)
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ePr carenimA Lngu oAtssoi:ianc prrmcaynnhoBlouo isdayspla BD)P( is a omfr fo ccrnhio lngu sidaees atht cfstaef neswbonr syo(mlt mrreepuat) dan sf.anint It tussrel form gaeadm to eht unlsg csadeu by hminlaeacc otavtenlnii rier()otpras and nge-rlmot esu of eo.xgyn tsoM istnanf cvoeerr rofm PD,B but msoe yma aevh egnr-molt ebtrihgna ifydftu.cli + yePrlmuraet nrbo nitnsaf heva eyrv ewf nyit air sasc i(lo)vael ta btrhi. The lieoval atth are ntperse dnet to tno be teruma hueogn to tocufnin nloam,r adn eht anifnt reirusqe triorapesyr orpputs to tba.rhee othghAlu ifglise-v,an eshte tsaenemttr nac loas uscea lung amgaed

waterloo  per American Lunch Assoc... maaaaan what do I need to be to get this question right, a pulmonologist? +6

 +11  (nbme23#48)
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owvHeer we,rid uyo avhe to rsepect teh isttaepn' flisbee sa olng sa teyh etra'n unpttig teh nnwebor at ramh. In teshe tpeys of istsequno ouy vhae to dibul pthiiypas-antenci islspaoenihrt bseucea eht tnetiap mghit ecmboe deffdeno if oyu rgradsdei hetri ls.ebeif So hwiel eth bwonren msto lkeyli hsa gsa nad tno eh"t vile e,"ye oicehc E si hte elsat n""idgfoenf asrnew htta tgsuegss e.etmnrtta

charcot_bouchard  Exactly. If she was cracking the egg on Baby's head u stop her lol (i am cracking up on my own jokes) +4
jesusisking  I feel it but dang, she lowkey drizzlin salmonella all over that baby +2

 +2  (nbme22#6)
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hTe isneoutq whlei tdlspiuy wet,rint kass how ngol eth RsBC' ttah yarcr het OC take ot be reedvom fmor teh laiuictn,cor not ohw lnog teh OC kstea ot eb rvdemoe orfm teh RB.C usJt knisag hte seainlpf of RCBs ni an ustilpyd pdtcelicaom ay.w sA ew wn,ok s'BCR ilfe asnp si utbao 120 ysad adn enth thye rea eoevmdr rmof uor nutaioc.lcir 021 dyas si tabuo 4 hmt.osn eNxt imet htye ilwl bboaprly kas het CRB lfaenisp in ekswe or ni so,hur ohw konws? smh


 +2  (nbme22#43)
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AF 0218 agep 017

1C erestesa boiiinrth :ciydneeicf ausseC rtyhreieda eeodamngai deu to uaetndluegr vierlliknk ito,ticavna ihhwc sdela ot icrsenade .abrninidky


 +1  (nbme22#27)
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egaP 63 of AF 21.08 Pnueir aaintnostg urdgs :era

PizA(a6trheioMn-p is a ourdrgp fo M-,P)6 eo,atohclMyepn rvnib.iair

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +3

 +10  (nbme22#19)
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oItaptnrm ot konw ereh is nlitcaoo. paAtr mrof nanrlgie the higoloctis sdoiitsnpecr (chhwi rea gnibro sa hts),i epalinsoa ni teh ysdaiihps is onitcssnet hitw wEgin sr.caoma Ooamcsesatro toicoaln si ta eth yp.eisshMta


 +6  (nbme22#25)
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enasitimH saescu lorteriae ildv,iaonatso sacignu a ldbpuui fo dbolo ni het alcispaelir. The eiecdansr doolb in eth aprclilasei illw sceua eth surepsre reteh to .esir oFlirttain is dntepende no pesserr,u eht ehghri the surres,pe het rome eth oinfalit.rt

Rmbeemre obldo fl:wo envsi ot evulens to acsrplileia to eerlsoatir ot ieatresr

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +15
link981  I stand corrected @yb_26. Brainfart moment 🙈 +
rockodude  lmao including a link to a teachmeanatomy page on basic blood flow +

 +1  (nbme22#17)
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igaMlran zeon yphamlmo si usadec yb OCCIRNH LAIMTI.FNANOM iyH-Porl can asceu nocchri aimfoianmntl in the o.actshm

pietEns rrab uvirs is coadsteias itwh TUITKRB pmymoal,h the JWA oinsle in icfrAa.

Gto ti onwgr aeubces I hoghutt HP-rioly lyno dsueac sacitrg raccen.


 +11  (nbme22#40)
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Pre isrtF idA 2108 g(p 241) ap&m; erkcM auaMln

)a LCM is tno het erwsan ubseeca ni LMC you heva HGHI WBsC ;ma&p lseaPtelt. nI teh mest ether is lyon hihg bpat.ls)etle sI the wnaesr sbeeuac in lEetasnsi meryhitomhoTcba ew veha lnroam CBsW adn sCBR, sjtu gihh lct lea)est.p yedMoli ieamltaaps rfeers ot llwe a alepsmitaa in ymdolie slcle chhiw rae apsihls,bo ,oopnihlessi ) e.dtc In acmhyileyPot Vare ew eavh GHHI BsC,R sCW,B adn t.eaPl) tsele eectaviR mbohorssyti-tco si a dlaeveet ttlalepe tcnuo atht rucosc casdyoren ot oenhrat idorresd :ielk

h-rinoCc mnymlatoarfi ddorssire ,(ge ohdrmtaeiu srtii,rhta anmatomlryfi bweol isesade, itlucobsesru, oaioi,srsdcs aonislamrstoug with li)tngcasiue t-pyoiA nencioift

grareeohm-H

I-rno cdniyeefci

H-elssmyio

nrc-aCe

tp-celSoemyn ro nlempsphiosy

impostersyndromel1000  perfect response right here +
paloma  Essential thrombocythemia presents with platelets > 1 million, not reactive thrombocytosis +

 +2  (nbme21#39)
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^p2 + qp2 + q2^ = 1 qp=+ 1

q2=^ /9q 0=01 30p=/1 0923/ icwhh onrsud ot 1

yehT aer gasnik for crrriea nqeyfercu hichw is .2pq





Subcomments ...

submitted by beeip(124),
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wHo to taefifedeitrn ewnetbe sorirovuN adn vuaiRtros ?ereh suMt eb tealrde ot the eht cnogusoait eurtna of teh le?isnls

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


submitted by seagull(1566),
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hsTi afinnt sha gnxeoy oitxyict deu to efre ilcdraa inentgare.o eFer idalsacr maaged het guln nymaacerhp adglnie to siirsbfo and isypadsal (nbmloraa g.wt)rho

link981  Per American Lung Association: Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. It results from damage to the lungs caused by mechanical ventilation (respirator) and long-term use of oxygen. Most infants recover from BPD, but some may have long-term breathing difficulty. + Prematurely born infants have very few tiny air sacs (alveoli) at birth. The alveoli that are present tend to not be mature enough to function normal, and the infant requires respiratory support to breathe. Although life-saving, these treatments can also cause lung damage. +2  
jimdooder  Just to follow up on the concept, you would prevent this from occurring by decreasing the Fi02 to mid-low 90s. I believe this is tested on another form. +2  


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diD yaoenn sele og odwn eht: 'shse voyepsenthi so ybmea llh'se gte euhtowaesr nhdsrerceifi reonysdm cbeuase nthinog eels is gniakm seens to me at tsih ?io?p?tn etoru -

rsnTu ,tuo eevrse alamair cna sacue ciaoralrasuvdc ocealpsl dan pneoynhso.ti

redvelvet  me too :( +1  
abigail  me three :( +1  
yex  Me four :-/ +1  
link981  Slowly raising my hand as well +1  
tinydoc  Sammmme +1  
bullshitusmle  same here!!!:@ +1  
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +12  
aisel1787  me five( +  
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +1  
alexxxx30  sammmeeeee +  
snripper  Dumbasses unite lmao +  
usmleaspirant2020  lol saaaaame! +  
usmleaspirant2020  lol saaaaame! +  
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1  


submitted by cbrodo(60),
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heT ipoeosrtr nusolmc siuFalsccu( ceuatciuas/suFlcusn i)lsirgac arcry roiintmoafn to the nbari inarergdg rcpoonpoit,prei i,voarbitn meatiinriiscdv cthuo and eresu.psr lsahiPyc axme ifdsgnni ggesust a ioslne reeh h(et osniialhcmpta ctrat crearsi rppnc/kiaipni nad eruteamr,pet dna htsee eerw am)o.rnl icneS eht tetpain sah mbalnoar iinfnsgd ni eht eolwr im,teesrietx and alnrmo isngifnd ni het urpep ,etixretmies teh rwesna si slsFacucui iis.cgarl ishT is eseucba inofinrtamo ofmr body erasa oebwl teh velle fo 6T is dcarrei by iacrsgli nad nfaontioirm rmfo dyob earsa bevoa teh lleev of 6T si aicrrde by uesatucn.

kai  kick Goals (gracilis) with your feet Cook and eat (cuneatus) with your hands +3  
temmy  i remember gracilis is for legs by saying i have graciously long legs and they are inside while arms can spread out to remember their orientation on the spinal cord +4  
jess123  I remember it as gracilis = grass so feet haha +4  
link981  Just to add found on page 492 on FA 2018. +  
charcot_bouchard  Hey Temmy, I can spread my legs too :) +  
maxillarythirdmolar  I can't feel GRACIE's ~fine touch~ as she ~vibrates~ my balls. +3  
cat5280  Could someone please explain why you were able to eliminate the spinocerebellar tracts? +1  
drzed  Lmao I remember gracilis because of the gracilis muscle in the legs! +3  
alexxxx30  cat5280...so spinocerebellar tract does 4 things to know 1. proprioception in the Romberg test 2. intention tremor if damaged 3. shin to knee test 4. dysdiadochokinesia (being able to rapidly pronate/supinate the upper extremity) yes the patient has proprioception issues, but the other symptom of vibration loss points us more to a fasciculus gracilis issue. If the patient had presented with proprioception and and intention tremor then we would think spinocerebellar +2  
alexxxx30  adding to my comment^ I would commit these 4 things to memory as I have gotten several questions concerning this topic (there were 2 questions on this exam where spinocerebellar tracts are involved). Memorize them and it might get you 1-2 extra points! +  
solidshake  Just to clarify a point, Spinocerebellar tracts are not tested by the Romberg Test. Romberg tests conscious proprioception that is done by the dorsal columns. Spinocerebellar tracts are used for Unconscious proprioception. Look up tabes dorsalis in First Aid. One of the positive indicators is a positive romberg test, which shows that the dorsal columns have been damaged thus affecting conscious proprioception and thus impaired balanced on standing with the eyes closed +  


submitted by lfsuarez(141),
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ruDgni ineoprt ,irnlttnosaa hte rmbisooe dnbi ot ANRm to nititiae snrtnciptoiar garntist at het is-nNtumer. ehT Nrn-sietmu dppteie nde tninsaoc a ilasgn gnitiroecno irtcpeal htta dsbin ot the sigaln roictnginoe pltrcaie ectreopr on eht gruoh ER to llaow eht otpinre to eb made nito the RR.E

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 +2  
furqanka  the N terminus peptide end has the signal recognition SEQUENCE which is recognized by signal recognition PARTICLES. These particles bind to SRP receptor on rer. +1  


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A sonmbrtalo is an taermmui BRC, so s'ti evaltdee in esatst fo eesdcanri hmtosiaio.pees

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +61  
someduck3  The term "Normoblast" isn't even in first aid. +36  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +19  
tinydoc  I wish they would stop making it so every other question I know the answer and I can't find it among the answer choices because they decided to use some medical thesaurus on us. +18  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +8  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +6  
fexx  I got it right but would it hurt them to put RBCs? Medicine is hard as it is. No need to make the exams more complicated. I doubt my pt is ever going to as me if his/ her normoblasts are going to increase if they go hiking in the mountains +6  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +13  


submitted by seagull(1566),
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edgerbyHWn-iar enuoqita = =1 2^P + p2q + 2^q

P^2 = /0010,01 = /1010

enhT rmmebree P + q = 1 --g;--t&-- 01/10 + q = 1 q( = 910/0)9

atlsLy uplg ackb oitn eirdWeHbg-aryn nEtuiaoq :sa

p2q = eeoogtztHeyr aercrir

2( x 110/0 x 09/910 = 200/1 = /)150

link981  I think q should be 1/100. You got p and q mixed up. +4  
humble_station  Because p = 99/100, you can just make it 1. Then just do 2 x (1/100) and you get 1/50 +4  
humble_station  Because p = 99/100, you can just make it 1. Then just do 2 x (1/100) and you get 1/50 +  
unhappy_triad  Carrier frequency= 2pq AR disorder that occurs in 1 in 10,000 the square root of 10,000 is 100 so, q=1/100=0.01, p= a number close to 1, just use 1. plug it in the equation 2pq= 2(1)(0.01)=0.02=1/50 +4  


submitted by ferrero(40),
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A vyre irslmai tnuioeqs I ehva esen in bsaQkn lwil sak hyw a itnpeat wiht rgiht htrea eufrial esdo otn peodlve eamde nda hte nsreaw is encirdaes itlcahpym .nigraeda I got tihs qiuotsne gnwor yillnaogir aesuecb I swandere oalng hist lien of gseraonin tub I hintk ni ihts aecs it all ash ot do whit EEWHR eth txrae seusrerp is coimgn fmor. In hits ioqenuts eth tp ash litcdoais ysohtnpeneri os oyu nac inkth abtuo the epseurrs sa gcimon rr"wo"daf so niciogscnrtt prirapllcaey chiretsnsp acn evertnp na aceernis ni rueepsrs ni het rpycllaia .bed oreewHv for thgir rteha alurife stih retxa iudlf is iognmc rfom eht TPOSOEPI neioidtrc csrw(dabak fomr het igrth a)treh nad cscongtnirit yalilrrceapp thsrseincp nca od hginnot on( pposiote iesd of llpciraay bed) - eth ynlo ywa ot pntever eedam si to erseicna aiplcyhtm adg.renia

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +15  
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +6  
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +31  
cr  the main difference between the 2 cases is that in this case the patient has high BP +1  
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +6  
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1  
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2  
asteroides  I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +3  


submitted by link981(160),
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iastmnHie ssaeuc tlreiraeo viltd,aosoain isgunca a ibuudlp of lbdoo ni eth si.lpiarcael heT irasdcnee obodl in het lialarsepci wlil ecsua eth erpesrus reeth to sier. ioaltFrint is entnpeded on pe,ersurs eth ihrheg teh s,puseerr hte roem hte no.tlaiftri

Rremmebe ldobo :olwf sinev ot elunesv ot liaraesicpl to aersliotre to eserirat

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +15  
link981  I stand corrected @yb_26. Brainfart moment 🙈 +  
rockodude  lmao including a link to a teachmeanatomy page on basic blood flow +  


submitted by yotsubato(1032),
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hlothuAg hnotpmeacaeni (lT)nyoel si not cderodsien an DIANS, it oto yam kpevoor an lirnieksaip- ntiivy.etsis

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  


submitted by yotsubato(1032),
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5p3 is udetmta dan tanc bndi eht TAAT ,oxb os htwa nphapes to rnicanistotpr fo itbniiohry stien?rop

Is slcblayai awth tish stinqeou si gnryti ot s.a..k

oS on ATTA oxb rpeomort =;tg& ecDeersad nibding fo RAN yeoareslpm

link981  You said it, they are "trying" to ask. Should use better grammar. +3  
titanesxvi  This is on first aid, and says that the promoter region is where RNApolymerase binds +  
nootnootpenguinn  Hakuna NO-TATA box... thank you for this explanation! +  


submitted by seagull(1566),
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idD oanyne eedn ot reda thta astl enntesce ekli 05 miets ueabesc eth rthuoa eerfssu ot esu ertteb .gmmaarr sutJ ifgtutna.rrs

link981  Author rationale: "What is grammar?" +6  
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +17  
drbravojose  Actually never understand what the author saying at any time. LOL +3  
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +  
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +  


submitted by seagull(1566),
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hWhic fo teh flooligwn srosean is yhw tsih eotuqins is lu?bl

1) insUg the wdor "cyclc"i estanid fo lcrcciyti fro yctilar

2) Knwgoni lal of ileeigoopmdy of lal surgd

)3 ghivan ot rsaeno tou hatt encointlgarcihi etceffs ear pralbybo het swort oerv 1alpha ro 1H tcfesef ot no rtaceniyt.

)4 hTe cnpprglii orsenpeisd fo gyidnust orf -wekyat-ssoed on edn to oayrblpb do ergavae no het st.et

nlkrueger  yo, re-fucking-tweet +21  
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4  
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1  
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5  
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +  
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +  
tekkenman101  "worst to experience" is incredibly subjective lmao. +  


submitted by usmleuser007(397),
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oTw ojram ashimsmcen of atnico aveh nebe tdlud:ieeac

)1 iuonFycltes si aagliryftunln dotevrnce tnio hte cytiastcto uoiocrrullaf hcwih drgnuoees refruth tesps fo tacaiointv dna yillfan srtcnaiet as nro-ptphi5riehsiroaoeufdtlu hiwt NAR hisetysobnsi uhts dsntibguir eht nbuilgid of rinetca ielnessat ti.nrsoep

)2 nFuieosltcy alos egdrnesuo ooernsvinc oitn oolermsx-eonudhyhoupo5ofridaenitp hicwh sitinbih nlafug AND hyse.snist

3) Taletmhiyyd sentshyate si na ymznee tath szetyalac eth vnoesircno fo dneyuerixodi apnhooosmhpet UP(M)d to eyedxmyioidnth poehhmnpaoots PdT(.)M

ymihieTdn is noe of eth eeidsocunlt ni NA.D

tihW iitonnbhii of ,ST na maienablc of soeeduodnleixcty nda esdeiracn lesevl of PdMU .sriae tBoh seuac NAD gme.daa

K)(WII

link981  Just look at page 36 of FA 2018 and memorize that shitty diagram o De novo pyrimidine and purine synthesis they ask so much about. No need for scientific explanations for this one unless you like to waste time. +21  


submitted by welpdedelp(227),
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tI was usjt kinags hte nleasfpi fo sBRC 120( ady)s

haliburton  If I'm reading this right, this is just a tricky dicky question. I think CO binds 200x stronger than O2. But if an O2 cycles through binding / unbinding 200 times before a CO gets kicked off, this should still clear the CO from that cell sooner or later. strange to think it is 1. essentially permanently trapped in a cell, and 2. doesn't kill you and can be treated with O2 to resolution within a few hours or a day. They must just be thinking, until that last RBC dies, you've got original CO in a circulating cell. but just a fraction (because you didn't die). not sure how that CO isn't just passed on during recycling, based on this line of thinking. +7  
link981  The question while stupidly written, asks how long the RBC's that carry the CO take to be removed from the circulation, not how long the CO takes to be removed from the RBC. Just asking the lifespan of RBCs in an stupidly complicated way. As we know, RBC's life span is about 120 days and then they are removed from our circulation. 120 days is about 4 months. Next time they will probably ask weeks or in hours, who knows? smh +7  
baja_blast  If that's what they're looking for why cant the NBME people just ask "How long does it take for RBCs to turn over?" Ridiculous. +1  


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I hiktn the iaeecnrs ni apslam neinr yctaiitv hwti DsINSA has ot do tiwh tibniionhi fo reefetnf reyart idtoanli yb nsltrndogaaisp GP,E2)( isecn t'asht whta DSINAs do by nbitinhiig .XCO sTih adsceeerd alren dobol olfw elsda ot SAAR iniavaotct ot eovrsnec earwt adn miullyetat enrin seserca.ni

htballer55  Afferent artery dilation* +5  
link981  There is decreased afferent renal artery dilation (less blood flow) leads to increased renin release from the juxtaglomerular cells (located near the afferent artery) to try to increase blood flow. I got it wrong but after reviewing saw my idiotic mistake. +1  


submitted by usmleuser007(397),
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sihT orme eykill to be dstiurcei rehrta ahnt siaxvtlea c/b

het lab stduy wsosh a eanlr tsnniyfdocu NB(U amp;& anitiCenre rae taedel)ev

soMt keiyll hte tptiena besaud olop t;icurseid losa swokn ot asceu aricotntonc soldkaial, noalg hiwt nrlae mrblpeso csuh sa taintetslrii ithspinre

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +12  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by usmleuser007(397),
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shiT oemr yilekl to be cseitridu ertahr nhta evxlaatis c/b

hte abl tdsyu owssh a leran ynfncdutsoi (UNB p&am; rtnCniiaee era vlaeeted)

stoM elyilk teh paintet ubsead oopl ecstir;diu osla wonks to aceus raioctoncnt iosaakd,ll aglon with lrane roeplbsm ucsh sa rlteianstiti ersihntpi

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +12  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by keycompany(310),
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oFwl Raet = ieycolVt x SreCilco-nssato aAre

2 m2c^ x 20 /smcec x 60 enimcs/ x 1 L0001/, c3^m = 24. Ln/mi

0010, cm3^ = 1 L

seagull  Well, I missed this one. I don't even feel bad. +64  
link981  @keycompany a small typo, 100 cm^3 = 1 L not 1000cm^3. 1000 mL^3= 1 L +  
hello  @keycompany how did you edit your original comment to fix your typo? +  
winelover777  Pretty sure @keycompany was correct. 1 L = 1000 cm^3. Otherwise the answer would be 24. +3  
drdoom  1 centimeter is a distance. (A line.) +  
drdoom  If we multiply a line by another line, we get a surface area. (A piece of paper.) +  
drdoom  If we multiply the piece of paper by another line, we get volume. (A cube. A box.) +  
drdoom  If we fill the box with a fluid, we will have 1 mL of this fluid. +  
drdoom  If we have a thousand of these boxes, we have 1 L of fluid. +  
drdoom  1,ooo mL = 1 Liter = 1,ooo centimeter³ +  


submitted by haliburton(214),
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raaifrwn hbiiints teh tsnsyhesi fo ofsacrt II, IV,I X,I ,X C, adn S by kilocgbn terciuodn of didezxoi vanmtii K. ehT mezeyn pexEodi udceeaRst si iitnehidb by wafairnr. The deuderc v)ce(ait from of t.iv K si a ootrcfca for uglgtalmymaam- ecbrsalxoa.y

link981  So factors II, VII, IX, and X are precursor proteins? GTFO +1  


submitted by hello(313),
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nKiwngo the RL+ leauv = 10 does otn hlpe to vselo hits Q seuceba giamnttise reweh "10" dhsluo flla on na xias is .rarabiryt As,ol het tdaa tosinp rea onriodetsca -- ythe vaeh na vlXe-ua and a elu-avY ,(X Y).

eTh ayw to pcrapaoh hsti Q si ot knwo ahtt a hihg cespiyfitci amsen that a vsiepito rsletu si veyr, rvye ellyki to eb a teru eospvt.ii

pupoSes thta het iccepfyiits si .990 -- htis is 9%9 piiyfces.cti neh,T you ookl at eth h.rgap eTh Xisx-a si iiif."y-stp"ecc1 S,o peuosps eht tseb etst sah a etisiycfcip of .9%9 T,hen tlucclaae s1fiy itpe-icc = 1 - .990 = .1.00 Yuo ldwuo hten scohe eht atndtpaoi taht doscprneros ot ihnvga an uXe-""avl htta si lscoset ot het orgn.ii In hist rl,ompeb it sncrsoderpo ot atad tponi ."A"

uYo not'd enev eedn to owkn a ficiecsp ficstyicpie avule to slveo sthi l.peobmr lAl you ened ot do is nuadetsdrn thta fi teh ciiiyfsecpt is eeryeltmx ,ghih ouy lwli nede to infd a ntpiodtaa that is lcotess ot het nogiri -- at setla rfo hte avleu ni eth i-saxX in het onrtaeodic of teh aadt tinpo -- esauceb teh a-Xsix ersrpdosnco ot a icacnltolau fo fics"etic.yp-"1i

link981  Excellent explanation but a minor typo. 1-0.99 = 0.01 not 0.10 :) +2  


submitted by seagull(1566),
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uto of ortsu,ciiy how yam ppeoel eknw it?sh dnto( be ysh ot asy uoy did ro tin?d)d

yM eotpvyr ednuotaic t'ddni rgnaiin isht ni .me

johnthurtjr  I did not +3  
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"))) +27  
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. +5  
snoochi95  hell no brother +1  
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 +2  
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 +1  


submitted by meatus(1),
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'mI sryor but thaw am I isinmsg e.r.he. I guhtoht the hwole toipn of sieirdutc is to cretroc euolvm rvdeaolo yb i?ssirdue wHo oldwu altot louevm be icrn?ees?ad

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  


submitted by hayayah(1077),
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gPyanncre + xH fo oimtbsrhso -gt;&- tinkh lipnhoaiptioshdp esydnmro

Teh TP dna PTT ear glrdonpoe /dt cnireetfener omfr het dnebitisoa ot .shipsphpldioo Thnmibro imte oanr.lm

aHd ot indf ecrehasr stlreiac tobau ti so tkae it ofmr ehre dan t'dno tweas ryou ie.m..t

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +22  
goldenwakosu  Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +4  
johnthurtjr  I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +3  
link981  No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +8  
yb_26  UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +3  
oslerweberrendu  @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +  
kevin  just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +1  


submitted by k_tron_3000(31),
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heT orspctieidn fo aiabrltel oelrw lbmi lsso fo inivotrab mepisil CLDM gaed,ma nad eth anbtse TRsD + Rogmber esem to me to eb inygpiml taht he solbpiys sha esabt idrsalos omfr ihplsysi ro( tmoheisgn ryve lasirmi ni ).sertpennaito

As orf het tehor n,wssera A is onrwg sbaeeuc hsi mroot coiftunn is a,ctitn B is wngro sbceeau naip and mureeraetpt icefsdit rae nto nnmeieo,td C is nrgwo asceeub it lipemsi a ceicfisp veenr si ppraen,ted utb he sha sotl eabtalilr osneaitsn in shi einrte wrelo txiiesetrem

D si teh i,ckrttsie dan mI’ not 0%10 ,rseu tbu I luowd htnik autrloidaychp fo hte rtionaer atrlne()v rosto dowul caeus tomor ciifdtse siecn htey racry tmroo rn.seeftef ouY mthig slao xtepce ttah motor cfsoitundny ot eb ilnareta,ul csine it uldow be unklieyl to evah a lrpboem twhi eht vener tsroo no hobt .issde sola eth DMLC si ton tdeaolc enra het inerrota stoor fo hte lnsaip c,dro so fi hte reonirta oostr wree fdetcfea uoy rllaey tlou’wdn xtecep to see ybrvraito sso.l

So yiaalbslc pesscro of ienntaio,mli I do efle leik osnsery peyhaoturn si an ytrexlmee eugva raeswn uothhg adn I sn’atw a nfa of hte oqs.etinu

keycompany  This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word “Radicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral). +31  
hello  Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness. I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function. +16  
niboonsh  Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative? +1  
link981  Great explanation guys +  
usmel2020  UW QID: 12035 explains what you are testing with Romberg sign +11  
jurrutia  "Radiculo-pathy" comes from latin terms meaning "root-disease". +  


submitted by neonem(571),
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mFro ewcteno.armccht neerv( harde of ti fobeer utb smese iekl a odgo nex:opn)alati

aP"she VI ssu,iedt foten clldae tPos tegManrik Slveuclinaer isTarl, rae odtcdecnu reaft a gurd ro divece has nebe aepvordp ofr soecrmnu asl.e lmhaaPreuccita psociamen have vlreeas sijocevteb ta ihst sgate: )(1 ot orpcema a udgr hiwt orthe rsugd ledaary in hte te;rmak (2) ot rotnimo a us'drg tnrolmge- nifeetevcsefs nda tcpaim on a ia'tentsp aqutlyi of f;eil nad 3)( to irmdnetee het stesecn-tsvoefifce fo a gdru trepyha leetairv to orhte liaittanrod nda wen thepresia. ahsPe IV ssitdue cna srtelu ni a gdru ro vdieec ngibe natek fof hte metkra ro isntcestoirr of sue ducol be leapdc no hte tucropd dngepinde no teh findnsig ni teh t.dy"us

seagull  Well, I was not smart and put phase 1 since it was talking alot about adverse effects and withdrawl from the patients. But now I see I have 2 extra chromosomes...my bad. +  
link981  Phase 1- Determine if drug is SAFE Phase 4- Continous surveillance of a drug that is already on the market. The vignette clearly states the drug is marketed. That means it passed the clinical trials. Marketed drugs have passed Phase 3 +