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Welcome to link981’s page.
Contributor score: 139


Comments ...

 +0  (nbme20#2)
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uNovosrri is eht mtso ocmmon easuc fo rliav teagrtorissneit ni het USA ude to invc.ctnaiao + viutorRas si teh most oncmom ceuas of vairl aeitignrtstroes in teh sert of het rlod.w In stih oituneqs uoy had to okwn hte tmso cmoonm ucsea


 +3  (nbme24#31)
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eyswKord mrof Dr. ucTor rmof pa:anKl

  • iotepacR-iln NAD
  • tpincra-nsTroi ARN
  • naoTiat-nrsl noriPte
hungrybox  bruh this is like bio 101 lol +6

 +0  (nbme24#35)
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rPe amAircne Lgnu tAooacss:nii hpumacorrloBynon asadsylpi D()PB si a from fo cornhci glnu sedasie atth sfcfeat nbwesnro lsytmo( ep)tuermra and ti.nafns tI ulsters fmor gemdaa ot teh nglus dsuaec yb eciachnalm ilottenivna petrr(iaosr) nad l-reomngt sue fo nxeo.yg soMt afnnits ecvorer ormf ,BDP tub omes mya have -rtomlgen rhnbaietg uc.tiyidflf + mlryePauetr orbn nstfina heva vrey few ynit ira sacs la)io(elv at ri.thb eTh eoaillv atth aer senetpr etnd ot otn eb reumta goehnu ot nocutnfi ,moarnl nda het naiftn riqrsuee rrpyasreito rptpsou ot eehb.tar huoltAhg gs,ilefiavn- sheet taseentrmt nca saol ecasu ungl mgdaae

waterloo  per American Lunch Assoc... maaaaan what do I need to be to get this question right, a pulmonologist? +5

 +11  (nbme23#48)
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eevrwHo iwrde, oyu eavh ot eercpts eht seatn'itp feiebsl as long sa etyh tea'nr ttpnigu teh ronebnw at .amhr In htsee esytp of iseqsotnu uoy hvae to uibld aeiihtisca-nppnyt neisihatplros eueabcs het iatnpet mgith ecmebo odeefdfn fi oyu drgredsia reith e.eslibf So hlwie eth rnbwnoe tmos lliyek ash sag adn tno het" ivel ,"eye ocecih E is teh tesla ign"o"nfdef wrnsae ahtt egustsgs eeatmt.tnr

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) +3
jesusisking  I feel it but dang, she lowkey drizzlin salmonella all over that baby +2

 +2  (nbme22#6)
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ehT qnesutio eliwh silyudpt irnt,wet sska how long het 'BsRC thta acrry the CO eatk to be oemedvr mofr eht croacln,itui not owh lgno teh CO teaks ot eb vrodeem romf the C.BR sJut ksnaig eth slanepif fo CBsR in na iutdsply pcotceidmla ya.w As we ,okwn RsCB' lfie npas is butoa 012 sdya nda enth etyh are eremodv mfor oru ciucaoln.itr 201 dsya is tuabo 4 .homstn xtNe eimt tyhe illw lpobabry aks the BCR lsienafp in ekews or ni ,rshuo ohw nsko?w hsm


 +2  (nbme22#43)
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FA 1280 apge 701

C1 teassree tiinrhiob cne:cidyfei uasseC etiyrdreha eamnogiead ued to ueutgdalner ivernillkk ciaiv,otant hwihc sadel to aencidser kirn.banyid


 +1  (nbme22#27)
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egPa 36 fo AF 8.210 euPirn ntniaoastg dugrs :aer

MAhrnti(ep-aPozi6 si a rdoprgu of 6,-)MP ctephnyaoe,Mlo iir.vnrabi

sbryant6  I forgot what the MP stood for in 6-MP, so I chose methylprednisolone. Silly mistake. +1

 +9  (nbme22#19)
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notrtamIp to kwno hree si .tconolai traAp frmo ngilenar hte ogsiohitcl nidirpestsco iwch(h aer rongbi sa )tshi, lspaaonei ni het ipashydsi si cseotnsnit ihwt ingwE cmsraoa. Omcoosstaare aocntilo si at eht tsae.piyhsM


 +5  (nbme22#25)
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aHtismien ssueca lreiotare ltnisaaoidv,o uncasgi a dblipuu fo odbol in het l.ilscpaiaer hTe ancesdrie oodbl ni eht ielcralasip lwli auecs the rrpeseus heret ot sire. nrlaFitiot si dtdnepnee no u,ssreper the hihger the p,ssrreue the eomr teh nttafrlo.ii

eeRbrmme odlob fw:lo esnvi to esevunl ot alsraielpic to rloereatis to rrsiteae

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +8
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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aMnagirl oezn oplmamhy is sceadu yb IORHCCN MANOMFNI.AITL i-loPrHy acn uecas rnihcoc fnnlmoaimtia in het so.thacm

tsepinE rrba ursvi is taaoiscsde iwht IBURKTT yo,mlpamh eht WJA eisonl ni fi.Arca

Gto ti rwngo eecausb I hugotht roy-lHiP lnoy dseauc tgaicsr canerc.


 +9  (nbme22#40)
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ePr tsFir idA 0182 gp( 1)24 m;ap& ceMkr nauaMl

)a LCM is ton het ensarw eusebac in LMC ouy evah IHHG BWCs &am;p elPt.eatsl In eth setm eerth is ynol hihg slt.) pebteal Is hte aernws ebaceus in Eletinssa bomhryehaTcoimt we ehav anrlmo CsBW dan sCBR, jtus hgih c.teplat)sle leMyoid amaeatspil srerfe ot llwe a esatpmlaai in omdilye sllec chwih rea hbso,liasp ilhsoipsne,o tce.d ) In mPeytoilacyh aeVr ew veah HGHI B,sRC W,BCs nad .ae )Ptteelsl tivcaeeR h-yobsotctrsimo si a aedelvet leeplatt onutc thta curocs radeynosc ot rnaoteh soedrrdi keil:

ihorCn-c aymafmtirlon isdoresrd g,(e admthouier isatrhri,t rlmofyatinma wlebo ieae,sds cuueiltorsbs, iscssiao,dro gmunaaorsotils ithw )alpniiceysottA-g ui intofenic

rgm-reoHeah

oIrn- ncdeyecifi

seoy-msiHl

nrceC-a

yotnScel-pme ro ospielsmynph

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

 +2  (nbme21#39)
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p^2 + q2p + ^2q = 1 =+qp 1

=2q^ 01 9=0/q 0p= /31 /2093 wchhi unsdor to 1

heTy era iasnkg for rareirc qyceefnru hchwi si .pq2





Subcomments ...

submitted by beeip(118),
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wHo to fitaenieedrft eewebnt ouisNorvr nad ruRsvoati hee?r Mtsu be alteerd to eht hte gioausntco uarent of hte isnesl?l

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +5  
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. +2  
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. +2  
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(1181),
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sihT intanf ash xoegny tiocyitx due to erfe alicadr earge.nonit eeFr laaisrcd gadame hte guln aaprmhncye gieldan ot fibssroi and apssidyal (larabonm r)wgoh.t

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. +  


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Ddi aonney slee og odwn t:eh e'shs eivnhtyspoe os yeabm e'hsll gte ueahroeswt enrdhrecifis nodrseym caeusbe igohnnt seel is naigkm sense ot em ta tihs ?ot?in?p eotru -

nrusT ot,u ervees miaalra acn scuae olcravdraaiusc solcalep and phn.tneysioo

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 +6  
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. +  
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(45),
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hTe orrsoeipt ulcsnom suisua(lFcc utsaccasnusec/iFulu islica)gr rryca onaoiifrnmt ot het nairb rdneirgga rocneppir,otipo vbrniita,o isimadtcireniv cthuo dna rsersep.u Pcysialh xeam igfinsdn gugtsse a nloeis erhe het( ahmlcpnostiia ttacr aerrsci nipai/pincpkr nad mup,eetraret adn shete reew lran.m)o eSnci eth ntatipe ahs rmaanbol ngfinsid ni het lorew eeism,xeittr and armonl iinngsdf in the peupr ett,misieexr eht aersnw is csuFusilac scrgilai. sihT is ubsecae foiatornnim fmor dybo arsae welob eth vleel fo T6 si rrdaeic yb ircglsia dan ninmforoita mfro oydb eraas oaveb eht elevl of 6T si riercad yb scnuutea.

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 +3  
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! +  


submitted by lfsuarez(134),
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riDgnu pietnor ni,nattsroal eth boremsoi idnb to mANR to aietntii nnoriirtactps tsgatinr at eht im.tNseur-n ehT nNirutes-m ptedpie den inosntca a sligan reoinconigt rlctpiae ttah ibsdn ot the naisgl ritongecnoi prtcilae trcerpeo on eth ohugr RE to lolaw eth perntoi ot eb aedm ntoi het .RRE

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. +  


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A roboaltsmn si an memituar BC,R os its' dlevteea in eatsts of nsearcdie tas.oepohesmii

sympathetikey  Don't mind me. Just sippin my dumb ass soda over here. +51  
someduck3  The term "Normoblast" isn't even in first aid. +31  
link981  NBME testing your knowledge of synonyms. Have to know 15 descriptive words of the same thing I guess. +15  
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. +15  
qball  Metamyelocytes = Precursor to neutrophils Siderophages = hemosiderin-containing macrophage aka heart failure cells +7  
llamastep1  Theres a UWorld question about Parvovirus B19 that mentions "giant pronormoblasts" that helped me make the connection +5  
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 +3  
nerdstewiegriffin  I can guarantee you this Q was written by some sadistic PhD examiner +2  


submitted by seagull(1181),
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ar-rebeHWyding oeuitnqa = =1 P2^ + pq2 + q^2

^P2 = 0/1,0010 = 01/01

henT rrmbeeme P + q = 1 t;---g-&-- 1/100 + q = 1 (q = 1099/)0

Llstya upgl bcka nito Widye-rHnbraeg itEqonau s:a

q2p = eHtooztygree iraerrc

2( x /1100 x 0/9910 = /1200 = )501/

link981  I think q should be 1/100. You got p and q mixed up. +3  
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 +1  


submitted by ferrero(38),
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A ryve larsiim ouqtinse I aehv snee in bnasQk lwli aks ywh a teiatnp tihw htgri aterh euirfla oeds ont vdlepoe eeadm adn hte ernaws si acrediens clhmptayi ign.raeda I gto sith iustqone rnowg rnllioigya ueescba I ardsneew lngao stih lnei of ensgoairn ubt I nktih in thsi easc ti lal sah to do tiwh WREHE eth aextr repessur si iconmg mfor. nI shit usiqoetn the pt sah itsaldcio tesieynonprh os ouy can hkint btauo het eersursp sa cngmio o"rd"arfw os itgrntcicosn yclperriapal nsstrhicep nca nevpert an aceeirsn ni prsueres in hte rypalcial ebd. veHowre rfo tigrh atreh lrifeau shit aexrt lfudi is cogmni orfm hte EOIPTSPO ictroinde kcabr(dasw mrfo het hrtig hrtea) adn tnioccgnistr plelycrpiraa restshinpc nca od hngnoit (no piesoopt iesd of apliaylcr de)b - hte noly ywa ot ptnreve deeam si to neseicar lthyampci .angeiard

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)? +14  
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +2  
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." +2  


submitted by link981(139),
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mHesiiatn eusasc toiearelr vdastoin,oial niusagc a udibupl fo loodb ni eth eirsacllip.a eTh saniedrec bdloo ni eth eilcrpalias wlli sceua het eresuspr trehe ot .seri ratitniloF si eeddntenp no prur,sees eht hgrieh hte ,pserrsue the omre teh .nraiittfol

erebeRmm blodo o:fwl viens to ueneslv ot aesiprllaci ot eaertslori ot rrieetsa

yb_26  agree in all, except the blood flow - it is right the opposite [https://teachmeanatomy.info/the-basics/ultrastructure/blood-vessels/] +8  
link981  I stand corrected @yb_26. Brainfart moment 🙈 +  
rockodude  lmao including a link to a teachmeanatomy page on basic blood flow +  


submitted by yotsubato(842),
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lthhAoug aiepceomntnha Tlloe)(ny is nto eerniodsdc an DSNA,I ti too mya oorkvpe na kpeii-rlnsia inytev.sisti

meningitis  For that same reason (not an NSAID) it doesn't reduce inflammation so it cant be used for Gout. +4  
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(842),
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35p si utdatem dan ntca idnb eht TATA o,xb so ahwt pshenap ot nrrtpitncaios fo tyibhiiron ?inesrtpo

sI cilbasayl twha itsh nestouqi si ytgrin ot .a.sk.

oS on TTAA obx moporrte =;&tg cdrDeeaes gnndiib of NRA mopaeelrsy

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(1181),
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diD aenony eend ot read ahtt tsla eseencnt iekl 05 tisem sabucee teh oahtur esrfesu ot sue btteer aramr.mg utJs gtur.ifnrsta

link981  Author rationale: "What is grammar?" +6  
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +11  
drbravojose  Actually never understand what the author saying at any time. LOL +2  
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(1181),
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Wchih fo the onlgilfow ersnoas is ywh ihst esitqonu is bu?ll

1) nUigs the drow "lcccyi" deitans fo criylticc rfo cltariy

2) ngKionw lal of elomoeypgiid of lla gsurd

3) gvinha to anerso tuo thta caonhtcgirniiel cesfeft rea rlabbpoy the rtsow vreo 1hapal ro 1H sefeftc to no .rcieantyt

4) Teh ilpprignc spirndoese of tgsuidyn ofr dwk-taesyos-e on den ot yblboapr od egavaer on hte ste.t

nlkrueger  yo, re-fucking-tweet +16  
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. +  


submitted by usmleuser007(337),
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wTo joram cmhmssaein of tcinoa ehav eenb uaciddee:lt

)1 uslnyeocFit is tfanyglarulni tnrvdeeco iont teh catytstoic cilururfaolo iwhch onsgudeer rteufhr stpes fo oniatvacti and fiallyn arisentct as -dreeruhlh5ipotfrtopsunoiai with NAR tensbsoiyhis uhst drstiuingb eth bndlugii fo tcranei nlestasei itpnreos.

2) iylsonucteF alos uerosdgne nsovnoerci onit mrehyol5hoeniounfspeoodtx-iuadopr cihhw thsbiini lafugn NDA syissn.hte

3) eymtTayildh tasteyhnse si an zeyemn ttha tclesaazy het ircesoovnn fo eeirydiduxno nteoohmhpsapo M)d(PU ot dioiyemytdnhxe astpeohohomnp PM.T)(d

minieydhT si eno of het tcdelionseu ni D.AN

itWh tiinbnoiih of ,ST na aenlaibcm fo tondeiuxesdcyloe dna nieasrcde lleves fo UMdP airs.e Bhot ecusa NDA daae.mg

KI()WI

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. +14  


submitted by welpdedelp(203),
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It saw usjt akngis the afisepln of sCBR (021 )dsya

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 +6  
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. +  


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I nitkh hte aerseinc ni slampa nneir itcativy thiw DAsISN has to do ihtw niinthiiob fo tnerfeef yeratr loitdain yb dlagnrioansspt )2E(GP, nicse s'ttah ahtw sNIASD od yb ingnitbihi .COX iTsh adcdersee neral dbolo wflo sdeal ot SARA vationtica to nsecorev rwate dan mutlteaily rinne irssancee.

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(337),
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hTsi oemr iylkle ot be itriedcsu ahertr tanh axtaevsil bc/

teh bal tysud soswh a renal tnuoydfsicn U(NB p;ma& eienCnitra are dvetea)le

tosM yikell teh itnetpa edsbau oopl ersiti;dcu asol sonkw to ecsau orinnttacoc oaiadsl,kl naglo ithw arlne rsoeblpm hcus sa trlniiaetits etiipnshr

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. +9  
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(337),
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iThs remo ilelyk to be uitscrdie arhetr hnat xlavsiaet c/b

the bal ytdus shsow a lerna dncysnuotif BUN( p&;ma iCntreeina rae eetadve)l

Mots lkylei eth iattepn buades olop t;iicsdeur loas onskw to aesuc ticotonrnac oa,sdiklla oglan twih anrel bpsoerml ucsh as rttlitnisaei hitesnrpi

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. +9  
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(269),
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owFl eRat = tioylceV x on-ctrSClesoisa rAea

2 mc^2 x 02 cc/sem x 06 /emicns x 1 ,001L0/ c3^m = 42. Lm/ni

000,1 mc^3 = 1 L

seagull  Well, I missed this one. I don't even feel bad. +37  
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. +1  


submitted by haliburton(197),
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aiawnfrr iihtibns hte ssntieyhs of foascrt ,II ,VII XI, ,X C, adn S by ognbilck uetirdocn of eizdodxi viitnma K. Teh enezym idEoxpe sutadeRec is ibehtndii yb arw.nrafi Teh duecerd a(e)tivc mofr of .vti K si a roocctfa rof lmmuyglgaam-ta .alseyorxacb

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


submitted by hello(259),
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nnwoKig het L+R euval = 10 edso not phle ot losev isht Q scuebae nagmititse ehewr 1"0" lshudo alfl on an saix si aarbitry.r slo,A eth atda points rae nirostceoda -- thye evha an -euvXal nda a lu-Yaev (,X Y).

ehT yaw ot caaorphp htsi Q is to ownk ttah a hghi yfpiictcsie saenm atht a isteopvi trlsue si er,vy yevr elyikl to eb a teru ito.isvpe

Spospeu atht teh scyipfiicte si .990 -- sthi is 99% icysftpiei.c nhTe, ouy ookl ta hte g.arhp hTe ai-xsX si ip"i1tse.cy"-fic ,oS sppeuos the sebt ttes has a ceisfytciip fo 99.% nThe, laltacecu cpse-1iiifcty = 1 - 9.09 = .010. oYu uoldw htne esoch het npitatoda htat sserrodpnco ot inahgv na uvX"ae"-l hatt si eolstsc ot the iinrog. In ihst bplr,ome it ceondsosrpr to adta pnoti A.""

Yuo nd'ot vnee need to knwo a iiesfccp tiiypsfciec aveul ot vleso ihst bp.ermol All uyo eden to od is utnnasdrde atht fi eht ifptiieccys si eleermytx ,ihhg uyo liwl ndee to nfdi a aptointda hatt si stosecl to het niigor -- at lseta fro the uvale ni eht sX-xia ni eth oiroatednc fo hte dtaa otnpi -- ascueeb teh xXi-as reosdcnsorp ot a anoictlclau fo "fc.it"i1ipcs-ye

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


submitted by seagull(1181),
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out of ,icsryotiu ohw mya pepoel nwek t?ish dnto( eb yhs to say uyo idd ro d?idtn)

My ervotpy aountcied 'ndidt riniang tsih in me.

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 meatus(1),
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I'm sryro tbu hwat ma I iimsgns e.rh..e I hghutot eth hlweo niotp of uiierdstc is to coertrc uveoml dvoroela by eussdri?i How dwolu altto mvouel eb rae?csd?ein

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(1000),
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gPnrcayne + xH of hrsobtmsoi -g-t;& kihnt hlsidiaooptnphpi somerdyn

heT PT nda TTP era lerpongod t/d ncrenrieetef ormf teh tbdinasoei to hdhioip.sppols Trihmnbo meti .monlra

aHd to dnif chseaerr strcilae uabto it os taek it fmro here nda 'dont astew yuro im...et

monoloco  yeah, i’ve never heard of antiphospholipids increasing PT time ... +15  
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 +6  
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(27),
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ehT soitidnecrp fo lbtlreaia oewlr lbmi sosl fo boivnirat ispmlei LDCM damae,g nda eth seatnb DRTs + ogRremb emse ot em ot eb igpynilm ahtt eh lposbysi has tsbae lsrdsaio mfor liisyshp o(r geoshitnm eyvr rsliami ni )airntsteoe.np

As ofr eth other a,nswrse A is owrgn caebues hsi troom ifontncu si ,iatntc B is gwron abecseu pnai nda turemtrpeea sfictide ear not nemndti,eo C si nrogw seubeac it lpimies a feicscpi neevr is ptapede,nr tbu he ahs otls tallribea istesnoan ni ihs eenitr wroel stmextiriee

D si hte rteckisti, nda ’Im not 001% ,ersu btu I lowdu thikn hlaciutoardyp of teh rraioent rnatev)(l troso ldouw ausce omort ictesfdi cnies yhte yracr omrto .nrefseeft oYu thmgi laos texepc ttah rmoto ninucdtsyfo ot eb ainetllra,u escin it dwluo be ilukeynl ot ahve a eplobmr ihwt hte reevn storo on tohb ss.die salo the CMDL is tno datoecl near the nrrotiea oorst of the lsiapn c,rdo so fi teh tneorari oostr erew aecftedf you ylearl onutdl’w etxpce to ese oirbravyt ss.ol

oS lcilyasab rcoepss fo ,tioimlenain I od lefe ekil noyress npayrhuoet is an reeetxylm euvga nsarew huhtgo nda I t’aswn a naf of eht t.onquesi

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). +23  
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. +13  
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 +1  


submitted by neonem(527),
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oFrm tcam.herccwnoet rnv(ee ahder of ti rbofee tub meses kile a dgoo )tp:naenolxia

hs"ePa IV u,esdsti nteof edlacl ostP ntaerikgM luecSvienlra ilra,sT ear cudncdeto erfat a udgr or eicevd ahs nebe pedrapov rfo rueoscnm a.els crueaithaaPmlc msnaeciop veah lseaerv ejebovsitc at htsi gtsa:e 1() to opeacmr a rgdu htwi orhte sugrd yearald in hte ka;mter 2() ot otonmir a d'ursg mtnolr-ge evcifstsnefee dna atmcip no a nsttpi'ae taqyliu of f;lei nad 3)( ot iteremedn het cesttf-sceveoefnsi fo a rgud hteyarp everlati to ohetr rnaiitoladt nda wne eri.ahetps Phaes IV eiutdss anc tlersu in a gurd ro ecidev bngei taenk off eht tmeark or teriosrtnics fo eus loduc eb cdaepl on het cupdrto epdndeing no the sgninfdi ni the u.tdy"s

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 +