share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to m-ice’s page.
Contributor score: 340


Comments ...

 +9  (nbme24#39)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iThs byo hsa o,paiaranslhdco hwcih si eascud yb an umsaolota nitndaom nmaoittu ni bosiFrlbta tGohrw atorcF Rpoeecrt .3 FGF ngilgiasn si eddnee orf prepor arceglait cofnnit,u nad httuiwo ti, the goln sebno fo teh ybod ilwl nto owrg ceesbua hte hgwtor aletp a(emd of hcceyotro)dns osed tno .noinftcu ,Heoevrw bosne ahtt ruodegn esbmamourn ,ocnatsoisfii eilk eth nsoeb of the ead,h will orwg mnylla.or isTh usrslet in eth petitan vganhi hotsr iretmsteixe ihtw a mlonra izes rkntu dna ragle ehad airelevt to eht .isbml

mumenrider4ever  Small edit, achondroplasia is due to constitutive activation (not inactivation) of FGFR3, which inhibits chondrocyte proliferation +9

 +8  (nbme24#16)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh titpena sesme to aehv an ncinfoiet eud ot terhi eeeavtld raptremuete and olraanmb tsceh ayr.-X ,woreeHv teirh ucltekoye tnocu si olw. nI idonta,di eht etnpiat ahs apetihtsi C, hhwci si ofnet cdsitosaea whit laimsir nristiasosnm troesu ot ,HVI elki trnoanvsuie rgdu es.u

sajaqua1  Not only is their WBC count low, it is not uniform. If we assume a minimum normal WBC count of 5000 cells/mL^3, and a regular range of ~60% neutrophils, then normally a person should have ~3,000 neutrophils/mL^3. This patient has a total of 2000 cells/mL^3, with 1,800 neutrophils/mL^3. Their lymphocytes and macrophages have been whiped out. This is best accounted for by HIV. +40
koftawesa  CXR sounded like pneumocystis jiroveci which HIV patients are at high risk for- infections like these are usually the way HIV patients find out they have HIV +

 -4  (nbme24#46)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eicnnisrVit si a hroatepciehmectu gdur taht aztessbili utoclseirumb dan rtspenev ehmt orfm s.ibsdimlaensg heT clle in het ricpetu si ktucs ni anaaps,eh iwht temulcusoibr dtaeathc ot tsi smc,somrehoo blaenu ot llpu hmet aarpt busecae ti octnna seesbdiamls tsi mubirleuo.tcs

vshummy  So I get that by process of elimination cyclophosphamide, cyclosporine, doxorubicin, and 5-fluorouracil are not related to microtubules but vincristine in First Aid 2019 says it prevents microtubule formation, doesn’t stabilize it because the one that stabilizes microtubules is paclitaxel. +
vshummy  Okay, I realize now- the picture is stuck in metaphase, not anaphase. Both paclitaxel and vincristine stop the cell in metaphase but by two different mechanisms. Vincristine prevents mitotic *spindle* formation while paclitaxel prevents mitotic spindle *breakdown*. Mitotic spindle is needed to pull the chromosomes apart before anaphase begins. +14
azibird  No, I think you were right to begin with. Without spindle formation the cell should be stuck in prophase (vincristine). Without breakdown it should be stuck in metaphase (paclitaxel). Metaphase is shown here with spindle fully formed, so it should be paclitaxel. +
sars  I agree with the logic stated above. It could also be that the researchers added Drug X later on in M-phase, so therefore maybe the microtubules aren't even fully formed to fully reach metaphase. I think they're harping on "pick the best answer" +
sars  I agree with the logic stated above. It could also be that the researchers added Drug X later on in M-phase, so therefore maybe the microtubules aren't even fully formed to fully reach metaphase. I think they're harping on "pick the best answer" +

 +9  (nbme24#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sunioeQt is cillaabys ngsika awth ear hte susrttaseb desu the rfist sept in heme e.tiysnhss nI hatt p,est enlygic nda ciulnycs AoC era emconbdi to make vuiallominecin .daic

sunshinesweetheart  p 417 FA 2019 +3
drschmoctor  p 425 FA2020 +

 +5  (nbme24#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

GMH AoC Ruceaesdt ihrtnibsoi enrpvet the eivrl fmor engniitshzsy tsi won ocetolh.srel In reodr ot maitinan its dnee for ,llcsheroeto het rlive ash on chieco by ot iareensc tsi LLD trepoerc iserseopnx ni edror ot tkae tloesceorlh rofm teh oldb.o

suckitnbme  Not sure why NBME felt like they needed two questions on statin MOA on this form. +5
makinallkindzofgainz  because they didn't even realize it because they make insanely low effort practice exams with awful formatting and vague vignettes, yet here we are paying 60 bucks a pop for "high quality" exams, gimme a break. ok i'm done venting +4
madden875  stop whining. no one asked you to buy the exam^ +4
neoamin  Why does anyone scramble this site? >< +1
neoamin  and how about lipoprotein lipase? +

 +6  (nbme24#28)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The oiodlelkh"i of insmsgi na cisaaotiosn" rsefer to yepT II er.rro hTe skir fo yTep II rrreo is redrepnseet yb .ebat sTih dclou eb eudfosnc htiw pwo,er hhcwi is 1 - .beta

usmleuser007  Just rereading this question without the stress, i got it quickly! Could't believe i missed something as simple as this. +2
snripper  Can't believe I spent 5 minutes on this and still got it wrong lmao. I was like, "it can't be 90% chance of missing an association, that's way too high." But I picked it nontheless... +1

 +10  (nbme24#25)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tshi nam sha sspulu xausor,apd a gnsi in cihwh doobl surpsere acesreesd taalydsircl uidrng atsirp.nioin ussPul srdouaapx si a lssacic isgn of rdeaiialcpr aeantmop.d

henW iudfl ofen(t bl)ood sah eodlpo aduonr teh ae,trh hte ertha srtlsgegu ot pxndae nad illf iwth o.odbl Tsih ocbseme a egrgib bmploer rof teh rtghi elinevctr nirugd i,tprnanoisi ueabces eth ihgrt sdei fo hte rtahe ersvceie cisereand oevnsu ruetnr nguird ni.nsotaipri eecBasu erhte si udfli eetvpnngri the ighrt rtnecievl omrf nxngpdaei aouw,dtr teh ylno ohert aplce ti nac padxen to madotaocecm si yb sguipnh on hte tem,usp hninsrkig teh szie fo eht ftle cvlintere. siTh cssuae secrdeead PB ewnh eht flte ntvielrce ostrancct grnudi ttah rcdcaia e.lcyc

sajaqua1  In addition to causing pulsus paradoxus, we see jugular venous distension, and muffled/distant heart sounds (hard to hear through the cardiac tamponade). https://radiopaedia.org/articles/beck-triad?lang=us +4

 +4  (nbme24#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

heT pinttea shswo no nigs fo cractoil yttc,viia tub ash eosm aisebntmr fncintuo tiat,cn hhicw ipseilm she si in a mfor fo spierttens tivevgteae t.atse ehS ahs a livign lwli atht nesiesagdt ihemcalnca vitineantlo housdl eb dsntocneiudi fi htta iontuitas raseis, so we ustm wfollo it and kema tno pttetam to aice.rtestsu

lfsuarez  Why would the second part of that be correct when there is not mention of a DNR? +14
ug123  DNI and DNR are different right? This patient had a DNI. Why would we assume it to be DNR too? +4
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. +2
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 ! +5
criovoly  I believe this question was not well constructed... it's one of those! +
suckitnbme  @shayan extubating at request of the husband because he's following what's in her living will. Following that line of thought, the patient probably wanted withdrawal of care if in a vegetative state. +
luciana  I understood same as @shayan that she wanted to keep intubated... now reading it again I feel extra dumb with my poor reading interpretation skills +
coldturkey  @lfsuarez CPR(if the need arises) , for this patient (barb overdose and hospital setting), she will be intubated to get and maintain airway access. However ,she is against any mechanical ventilation as per her living will. Hence, we cannot perform CPR on her. +1
furqanka  I too believe DNR and DNI are distinct but UW 1124 says - A DNR order indicates that a patient should not undergo CPR. this includes bls (mouth to mouth breathing, chest compression) as well as advanced cardiac life support (intubation, mechanical ventilation, defibrillation, and administering medications such as vasopressor or epinephrine). Additional wishes such as the desire to not be fed artificially or any other limitation of care can be specified. +

 +5  (nbme24#14)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yciiptSfice si lquea ot het bnemur fo rtue nveategi tsets vreo eth enubrm fo uetr gnetevais lups elasf ioivssp:et

Scpe = TN N(/T + PF)


 +7  (nbme24#50)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

siTh iptntae swohs sinsg fo oicsr,srih ihhwc is lkliye stasaeidco with latrpo rion.nehepyts oralPt pnieyetsohrn liwl ascue seirdaecn suerpsre ni all evnis aiidgrnn tino the ltproa en,vi and nac eusca ligubng fo hetse isnve ta sarae ewher tyhe tmee eotsh hatt arnid to the neva av.ac nOe aare si hte ecmrut nda nus,a reewh teh rpioresu tlrcae nvei fmro( hte roplat m)ysste msete pu whit eth ldimde adn infieorr clarte ievsn hwhc(i rdina ot eht cvaal esyt.s)m drneseacI rupesser ni hte pisrrueo cltrae einv lwil aescu idhhreomros ta hsti .lointcao


 +7  (nbme24#14)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

In SHAD,I het sceevxsie DHA secsua hte teilccgnol ctud fo the yknide ot rrsbeabo ghue nsomuat fo aetwr that ti udoslh noaylmlr xeecer.t aTth sneam ttha het pamasl llwi own hvea hucm mero weatr eetrliav ot ulseot (low )ylotloasim nda teh iurne lwli eahv cmhu meor slat vltaeire ot traew ghhe(ri oaystilo)ml.

frijoles  So potassium does not become diluted in SIADH? +1
ruready4this  I feel like I was overthinking this question so much for some reason!! C definitely makes the most sense but I was also wondering what would happen to potassium. Then I was thinking maybe the excess ADH would suppress aldosterone secretion and serum potassium concentration would actually be higher +1
peridot  @frijoles Aldosterone can adjust the K+ levels: too much water --> less aldosterone --> no excretion of K+, so this helps retain the K+ to a normal level. However, less aldosterone also means --> more excretion of Na+, so the hyponatremia is not corrected. +1

 +24  (nbme24#18)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Teh nepttai has sols of pnai dna pamtureeret no eth irght eids of ihs ef.ca eiontnSas fo hte efac si atll,asiirep os hte seisu sutm be on eth npts'atie itgrh es,id whihc we cna ronfmic yb wnkgino atht tnsaonsie of hte byod si a,aorltclaetnr and he has otls elft iddes npia nad mrratteepeu of eth ob.yd

iPan adn ermeupatert enossntia of eth dyob si patr fo teh iopnahlsiamtc crt,ta chhiw lwasay snur yarallelt ughohtr teh eb.rmsaitn This can eb rndicoefm by immenebrrge atth eintsaons ot teh fcea loas runs elrayltal hghotru het t.erambsin ,So ew acn mofncri htis is a rthig disde atellra emabsinrt es.usi

Teh ossl of agg rlefex and raalpyssi of the aolcv drcos mypil imetanmirp of acrinla veensr IX adn ,X tobh of hihcw lzaoilec ot teh l.ulaemd rfho,reeeT the asnewr si hgitr altedosrrlao .meudall

duat98  You're a good man. +4
charcot_bouchard  You must be handsome too +10

 +7  (nbme24#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tuoynmAo is het mtso nrioptamt itshce enpilpcir thta edpssuesre all h.tsroe ,eovrHew ti is epidapl noyl ni uotnasisti in hichw a tnaptie modtnerastes ndia-oeksciingm ci.taypca nI hits n,atiutsoi a pnattie itwh aecavndd daeesis lukeiyln to be uerdc si eruginfs reeatttmn, chihw si shi gthri nduer eth ieipnpclr of uaooy.tmn oerv,ewH hsi sentmcmo otabu ngeui"ntrr in 6 nstohm taerf gnriuc rsahirt"it era qeo,ublsaeitn dan nwatrar nteiigednmr if he sah ieidsonc nmgkai cpcaaty.i It si olpiesbs that eh d,ose hwihc is why nya ocieshc fo cnorfgi rtfehru reettnatm no hmi are tcn.croeir

hungrybox  These ethics questions seems so simple and yet somehow I always get them wrong. I guess deep down I'm just a scumbag. +14
mutteringly  Hey there's always dental school +1
hungrybox  legit made me lol, thanks for that +
jurrutia  Also, the patient is delusional! He thinks he's going to cure arthritis. You don't have decision making capacity when you're crazy. +

 +6  (nbme24#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh tmos trptamnoi letachi lcpeirpin atht ssreseedup all rhtoes is nuaotoy.m oFmr na atchlie tpasd,ninot thsi eptinat hsa hte rtghi to uferes rhfuert neertmtat sa he is mltlyaen ,mpotetcen in ihst asec in eth mrfo of vgianh hte pyrrriaseto oedmre.v rFom a agell itnotn,spda eht yichsnpia is odewlal to neucsinotdi teetmntra ofr a pteiant if thta is athw hte paitnet .wtsan isTh si fidrftene mfor istntosuai fo yiipsacnh assitsed ic,isued wchih is mero cietlcdmopa dan ash eavrbila esithc adn aelglti.y

rhsteps  isnt this considered physician assisted suicide? +1
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +3
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +1
proteinbound123  In Physician-Assisted Suicide, the patient should be deemed “terminally ill” and “mentally competent” (by 2 different doctors) with less than 6 months to live (with or without treatment), he requests (written request, done twice, 15 -day interval) assistance to die and the doctor prescribes a lethal dose of a medication for the patient. If, in the meantime, the patient develops a life-threatening acute problem and requests the doctor to withhold or withdraw treatment, by the Principle of Autonomy the doctor should proceed as the patient wants. In fact, by the Principle of Autonomy, any competent patient has a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life. +1

 +15  (nbme24#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

All of eht festauer rdesicebd fo tish tatenpi lowdu be cdxeetpe fo a y-r6d8eloa- na.m Stho,err less tineesn sogra,sm sa lwel sa adrciesen imte enedde eetwbne sxe oducl eb tdelrae to a sitghl pdor ni eseootersntt ithw .eag H,evwreo eh incesnout ot wogr hrai wlel t(eef nda ,e)sot yignlmip that he 'ahsnt camaaitlldry olts eottnsoerets pncooriut.d iHs aresttpo si hlylgtis eed,lganr hwcih coldu yilpm ennbgi cptrtoisa yiasperpa,lh utb isth hsudol not teyidrcl tmicpa sih esxaul .tunocfin

cassdawg  ^BPH threw me off: he probably does have BPH (slightly elevated PSA and diffusely enlarged prostate, common in men above 50), but BPH does not typically cause sexual dysfunction as described. BPH is more associated with urinary retention and UTI, and when it does cause sexual dysfunction urinary symptoms would be concurrently present (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473005/ and FA2020 p654). +3
mikestix96  Normal hair growth on the toes could also imply that its not a vascular cause of decreased sexual performance (I.e. PAD with fine distal hairs) +1

 +7  (nbme24#38)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

A fsot csytolsi urrmum si mmnooc in mnya gnpnaret nweom ued ot a hhig elouvm fo lwfo an(ecisder acrcdai uuot.p)t ehT ruumrm dnste to og aayw wtiinh a wef esekw of dyleievr nceo het iccdaar outtpu is eslorc to eibane.sl


 +2  (nbme24#19)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ehT petatni in shti uonteqsi sha tsuclre escaaehhd. hseTe aehcseadh acn eb ftefianedietdr rmfo sieniamrg and otnisen ea,ehachsd sa hety edtn ot cemo ni esepdios rocssa eervsla aesy,r thwi astneb sdoerpi ni eb.neewt etslCur aeachhdse era feont ieedcrdsb sa ygcrnciultxiae nipufla esmes(otmi cdalel ieudsc"i e"sadhh.eca)


 +5  (nbme24#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

stolrsMpoio si a odpstagniraln gaanol (E)GP2 tath astc on the masthoc to poreomt muscu otipctrneo fo teh amocths ,iingln tbu laso acst ni hte suuert to eoeracngu ntcnorcoiat, iwhhc saekm it esfuul ofr nirtaobo.

usmile1  perfect except it is a PGE1 analog, not 2 +2
krewfoo99  PGE2 will increase uterine tone (Pg. 270 FA 2018) +
drmohandes  Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +

 +10  (nbme24#46)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ihTs glri sha imlatnang mi,yarhpeehrt a adgroenus dvseera feetfc of oesm ihetsnasetc tsaneg zcicterhraaed by nseddu hhig veerf dan m.hsoyysolbradi hTe olny gudr gmnoa siht tsil thta nac easuc ngaatlmni hrptreimheay si e.ciichcoynsllun ehT threo ugdrs thta uaesc aligantnm phireyrathem are teh eontadhla sages (lrfnua,e o,ruaslvenef .),cte tub ornitsu odexi esdo otn csaeu i.t


 +9  (nbme24#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

MHG oCA dcuetraes hbrostinii oblck the itabyil fo eth odby to eprduoc sti wno lcee.tlhroos eTh rlev,i nbalue ot amke ist nwo ocrltselhoe adn slilt gneined to do tsi boj fo ianmgk ntrielo,ppsoi ensde ot get ti rofm so.meheerw So, teh rvile csaisnree epsexroisn of LDL orpsterce ot take orme LDL tuo fo het dloob orf gnr.iapeakgc

an_improved_me  just a quick addition: LDL is the main lipoprotein carrying cholesterl, hence the liver's selective increase in LDL receptors +

 +12  (nbme24#29)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Teh ajw nipa nda ahecaedhs in na ldroe aownm ear imsororew fro rToeplam tA.ertirsi siTh si a cliv,susita hwihc duloc be btes enfiddtiie by rmdnnegitei the tyyrcrehote dsietonmainet ret.a

vsn001  definitely was tryna look to biopsy :'( +

 +8  (nbme24#19)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ehT epitatn sedne mcieadl otinneatt y,meimiadelt hiwch msiateienl ioniatgnb a cortu eodrr, or resnifrngtra .ehr A usern odes tno ehva eht same atiinrgn dan cqtluisfoniaai sa a cihap,nsiy so it ouwdl eb reairatonippp ot ksa temh to xemiane the ai.tpnte iAnksg eht atsoplhi hlnpacia aiang cluod be raappiepn,orit dan luwod take mreo emt.i rhTf,eoeer het sbet oipotn nmgoa oehts given si ot ksa teh atnitpe if ehs iwll alwlo itwh her snbuhda trpsn.ee

sympathetikey  Garbage question. +60
masonkingcobra  So two men is better than one apparently +29
zoggybiscuits  GarBAGE! ? +1
bigjimbo  gárbágé +4
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +12
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +9
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +16
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +26
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +
niboonsh  This question is a3othobillah +5
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +12
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +11
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +
wrongcareer69  Garbage question +
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +1

 +7  (nbme24#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iTsh ilgr has cnhoicr nlrusgoaomuta esei,dsa ni wchih teh mmiuen tmyses acntno opyrelrp omfr atceiver xoegyn peeiscs dneede to ikll dyoegacohtps g.nsrmioas Tsih si lelaypscie dab hwen egnaidl thiw ealatcas iovpseti nsgraimos eikl( pahSt), esuceab thsee omssgiran eylarad ues aasctlea ot kearb wond evietcra eognxy espsei.c hTe tsom mncoom esuca of hits cdnootnii si a muiaottn in HAPND ,isdaoxe splebeisonr rof het tognnreaei fo hte osrueidxpe .dlricaa

et-tu-bromocriptine  To add on: If neutrophils don't have access to NADPH oxidase, they can still use the bacteria's own hydrogen peroxidase to create ROS and kill the bacteria; however, catalase + organisms will not have this hydrogen peroxidase available (because catalase converts hydrogen peroxidase to O2 and water). So then the neutrophils are screwed and have no way of creating ROS. +6

 +9  (nbme24#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nooireoT,dttx fduon ni feufpr ,ishf hbinsiti diousm la.hnencs hTsi ntesrpev etrlaiznpdiaoo fo aiccrad melscu and rennu,so hihwc sdela to dateh fi ocdmnesu in high nouegh uqynat.ti hTe typommss rea vueag ,s(anaue rraheadi, pas)heresat,i os sntoesuqi will ende ot vegi msoe form fo oshyrit otuab agtine at a seJaapen estarunart ro gietna rfphifsfeu ot eivg yuo a gbi .ihnt hTeer si lttrnfaoynuue ton eetatmrt.n


 +2  (nbme24#50)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

seCa sriees si a stuyd ni hciwh eth sshrerecear nrtesep eth syoirth nda treenttam fo a slalm uporg of milsria ,eptsitna iuwhtto idgsebrinc nay gtnsoir oitn gupors ro nodianzitr.oma

drmomo  only 3 patients +1
usmile1  uggghhh not in FA ... +

 +3  (nbme24#40)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

siTh oyb sah netniisgmi eascdu yb rtSpe muoeeainnp, the toms omcmon secau of ucitoesifn iesitnnmig ni a.lgeern heT necaciv orf tperS pmoeun is a cphecydaalsiro riepnto tjncauoge ave.cnic hTe htroe armoj trieacba ihtw a nviceca lkei ihts is H. anelifnuez.

usmile1  also the meningococcal vaccine! +3

 +3  (nbme24#18)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tetiCpvimoe ihsnbirtoi nrecasie hte Km fo het .utbrtessa heT mK ereesntrsp how slyaei a tustsraeb anc dibn the avietc sei,t tiwh a rlweo mK grnipesneetr saey ib,nindg and a hihreg mK ngeinma eomr iffiu.tcld fI uoy dad a eimpvetitco biro,inhit ielk hleoatn ni tshi ,aesc it eaksm it rmoe citffduli for teh hltonema to ibnd hte cevtia i,est aecsbeu it msut opmctee twhi het lhano.te

deathbystep1  but how is ethanol a "inhibitor" of alcohol dehydrogenase? isnt the concept that both ethanol and methanol compete for the same binding site of alcohol dehydrogenase and hence ethanol displaces methanol preventing its metabolism? if ethanol were to be a inhibitor it would have to shut off the enzyme, which is does not. +
krewfoo99  @deathbystep1 Competitive inhibitor simply means increasing concentration of a particular substrate will allow more binding of the substrate to the enzyme. Thus the substrate with the higher concentration will competitive inhibit the other substrate by binding to the enzyme. It dosent necessarily shut off the enzyme +3

 +0  (nbme24#28)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

msyeDrait si the aclk fo coooairintdn fo tnndedei mte.novsem arylmoNl thsee msnoevmet era reocdoniadt by teh lcelebumer. hiTs si leadotc acecsfipliyl on eht a'snm ihrtg eis,d ton htob id,ses so olny oen lobe ilwl be uijre.nd


 +18  (nbme24#20)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTsi awmno ash xoPrysmaal ruNonltac omgoerbiHnl.iua ishT most teonf retsensp ni a uogyn udatl owh sha deossiep fo rkda irnue ni teh ldmdie of eht nhtgi or hnew gniakw up in eht noimrng. Is't eadscu yb lepctmoenm tiiyvcat deyctril tngsaai the at'sntpei onw RCB.s tCerain cdgyoilpils rea eeeddn no eth CBR rfuasce ot epvetnr ckttaa rofm mpme,ctnloe het ostm belnota of hihcw aer C5D5 dan 59.CD tiaePstn hwit NHP aehv a saotcim mittuaon ni wihhc ehty lost nufoctin of a GAIP nymeez eednde rof reorpp teperonatnsi dan mhcttteaan of D9DC55/5C no het CRB .esacruf ehfoeTrer the sarewn si a fected in a llce mnmrebae crhona oi.erntp htWtiou ,shti cnmetolmpe aatckst .sCBR

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +21
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +6
sexymexican888  @sunshinesweetheart Spherocytosis results in extravascular hemolysis (spleen) so no weird colored urine (due to intravascular hemolysis) as is seen in PNH (complement destroy RBCs in blood vessels) +

 +5  (nbme24#12)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iTsh oamnw ahs a otl of snisg ttah tponi todawr an ltnineatsi sptrcaiai ti:nnecfio ercetn alvtre to pauPa weN un,ieaG hcogu and eraavllo eratfnisitl, ighh ploihieons cu,ont nda a tsloo malpse taht has a wrmo in ti. sMto lelyik eth natietp hsa a ldySoersogtni oncif,tine as tihs is the enttsliain apsriaet htat soshw avalr no loots .lmasep alBalcyis lal ilttnaenis psaaiters acn be adetret htwi ldaBonzee gdusr, hscu sa ea.lezohTadbni trqaieluPnaz uwldo be rome eptrpapirao rof a wrmo or erivl eufkl ofnit.ncie

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +9
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +10
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +5
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +2
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +2
jurrutia  When in doubt, pick a bendazole +
jurrutia  When in doubt, pick a bendazole +

 +15  (nbme24#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The tapetin tesats ttha hes esdo tno want a rhnooalm rfmo of tbihr tcnorlo. o,S hte qentious is llraey gisnka iwhhc of eth lnhm-nrnoaoo intsoop is most iveeff.etc Teh cyitkr ptar e,ehr I h,tnik si thta teh istueqon skeam oyu awtn to tno ikpc ,DUI abueesc ynam sDIU are nlhoyrmalo se.bad ,vworHee a hmonnnor-lao ,DIU klei a pcrepo D,UI is tisll reom fteevifce hatn teh hotre sooitpn etis.ld

bullshitusmle  copper intrauterine devices are hormon free FA2017 page 622 +2
medguru2295  they needed to specifiy. I eliminated IUD bc patient states no hormones. +1
abhishek021196  The question doesnt make sense. IUDs are typically contraindicated in nullipara because of increased risk of expulsion and intractable abdominal pain, among other things such as perforation. The pt is 22, likely to be a nullipara. Why cant we prescribe a diaphragm instead which is a non hormonal method too, and remove the vaguity of hormonal vs non hormonal IUD? :/ +3
123ojm  in practice many nullparious women have IUDs. I think this question was seeing whether you knew that some forms of IUDs are non-hormonal and that the other methods are far less effective, +
covid  IUDs are definitely not contraindicated in nulliparous women. +5

 +7  (nbme24#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tshi lgri has onMo csdaue by -nseBprtraiE iruVs. Teh mpystmso aer liaryeltev aeguv, but entadmylohyapph kile hsit duwlo eb mmonco rfo o.nMo hTe CCB owssh dealeetv ,soylmtcheyp mlpingiy shit is ton a ltabearci slsien,l so rivla is leyil.k onCbdeim hitw the ehtyamnolpdyahp, ihts seamk su rywro otabu .nooM The ooM-onStp sett rof VEB is ahtw hte utisnoeq is erneirfrg ot whne cibdesngir hte ehspe oytcyserreht uittlg.gnianag mrFo e,hter isth tonuesqi surqreei atht oyu nokw taht ni EVB et,ncoinif BEV csitnef B lcsl,e tub deso otn sucea tmhe to bmecoe oaamrlbn. nIdta,es 8DC selcl, hicwh ear aitcyevl gtynri to llki eth B s,ecll omceeb mbaor.anl

medskool123  NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence. +17
kylemax  The abnormal T-cells are known as Downey type II cells (Sketchy) +3
haliburton  I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom. +6
trichotillomaniac  congrats you played yourself +3
lilyo  Soooooooo EBV infested B- cells is not considered atypical WTFF?? +
med4fun  They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells. +1
aneurysmclip  oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells +

 +7  (nbme24#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

All XHO ngsee era anttoircpnrsi srotacf htat ehlp etlauger yodb uloyta and terdenffi ieesxsoprn of gnsee rfo chea ybdo gseemtn.

sunshinesweetheart  I got this one right but wasn't exactly sure how to rule out 'translation'. I guess just because we're talking about a gene i.e. trasncription and not miRNA i.e. post-translational modifiers? +
sars  Hox (homeodomain) genes code for homeodomain proteins which are specific transcription factors (bind to enhancers, making these activators). They promote transcription of certain genes involved in development. Thanks so much +1

 +4  (nbme24#10)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sTih insqtoeu oyln escnnorc wnmeo in eth 0554- ega .gpour heT rogup ash a anme fo 624 dan dtardnas iodeantiv fo .05 h,erroefeT lal hetos with uslaev eaegtrr tanh 629 rae lla soteh ovbae eon ndsrdata adnit.ievo /23 of lla vlesau on a omlnra stroitbdunii era hiintw one trdanads niodvaite in tehier iceid.ornt eer,ohrfeT /31 aer dteuios fo htsi ni irteeh ointder,ci ignmena /31 of mwoen hvae a ulvea sels ahtn 691 ro rtagere thna 69.2 fI ew ltisp taht ni afhl ot yonl cehsoo soteh geetrar htna ,692 we etg 1/6 me,wno chihw is atubo %6.1

guillo12  Sorry, but there is not other way that I can understand this? +1
fulminant_life  @guillo12 basically 67% fall within 1 sd. That means that 33% are +/- >1sd. So taking only those with above 296, you only look at those >1sd above the mean which is 16.5% . The other 16.5% are those >1sd below the mean. +12
guillo12  Thank you!!! @fulminant_life +

 +1  (nbme24#6)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sTih aipentt has a lnosgalte dgleod in eth cmoomn ebli dt.cu Tre,eorhef het areskrm msot ieklly ot eb aeveetld si omhgesitn morf het yalbiir atrtc, het etsb of ihhwc si alekalin tsah.hoesppa reheT ucold eptllyotian be osenavleti ni SAT nad A,TL but tsih is not teh OSMT lkleyi nrasew. aceunjtdUgon lubnrbiii si otn a gdoo swaenr, auseebc hte irevl cna isltl ceojutgna lla ilbiuib,nr ti tjus hsa sessui own engctxrie htat ejtoncduga fr.om So het m'naows TUDECOGAJN nbiublrii is reom lykeli ot eb leete.dva


 +24  (nbme24#38)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTye lpxcteiiyl saett thta het tapinte sah eneb tkngai ecsxes fo shi noxtrievhoely moaintcied. Lyeteoovinxrh is hte ogeuosexn ormf of .T4 ,reheTfore eerf 4T must eb .eteadevl T4 is ctveorned to 3T at stmo rhaprelipe tiss,sue so T3 lwli slao eb dae.vtlee esaBuec eht ybod hsa omer rhytdio rehnoom htna ee,nded lses TSH will eb aem,d nad het yriohdt lwil be esls tivac,e intagk up LESS o.endii

procrastinator  I forgot that T4 is converted to T3 :( +2

 +7  (nbme24#27)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tiAvnoda nytpraeolsi osidrrde is ratareiezhccd yb a ederis fro colasi hilssri,etnoap tub a earf fo bgine ctejreed ro fgeline dtenuqiaea ofr she.rot hsiT si fderfntie romf oiShdc,zi ecesuab idciSzoh avnulidiids od otn seedir altsphsinoeri hiwt etrh,so nad twan ot namrei eaol.n The ctrsieitk oitfftneareidin hitgm be etnwbee ovtAnadi dna czhlpaSyit,o btu ozcyplSiath sidadilivnu dtne ot imeran aidtoles cabeesu fo odd hnntg,iki ro i"lmgaac ile.sb"fe





Subcomments ...

unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cna yabnody neixalp tish o?en I ptu arteedpe stets baeucse I eumssad an dayoel-r38- woman si an unausul mraogchepid rof ipshis.yl

m-ice  83 might seem an uncommon age, but we don't know for sure her sexual history. She only recently (8 months ago) started showing some signs of mild cognitive impairment. She has all these results implying that she has syphilis, so the most likely answer is that she has syphilis, so we should speak to her privately about her sexual history. The tests don't necessarily means she got syphilis very recently, it's possible she's had syphilis for a while and never got treated. +5  
mousie  I understand that she could possibly have syphilis but I also put repeat tests because I know there are a few things that can cause false positive VRDLs but if she also has a + RPR does this make a FP less likely? And also if she has mild cognitive impairment you still discuss with her not her daughter correct ...? +4  
m-ice  This definitely could be a false positive, but before we want to consider it to be a false positive, we should talk to the patient about it privately. Assuming that it's a false positive before asking the patient about it could delay treatment of her syphilis. There's a chance she didn't want to disclose her sexual history in front of her daughter or maybe she was embarrassed or didn't think it was important to mention. And you're absolutely right, she only has mild cognitive impairment, so we most definitely should talk to the patient alone without her daughter first. +4  
seagull  She has dementia. She doesn't have the capacity to determine her own care (23/20 MME). I feel the daughter should have the word on the care since Grandma likely doesn't have the capacity to understand her actions. +5  
sajaqua1  From what I remember, dementia is typically a combination of impaired memory *and* impaired thought processes. There is nothing to indicate that the patient has impaired thought processes, and the memory impairment is only mild. The patient can still reasonably said to be competent, and so her private information should be discussed with her alone. +12  
yotsubato  Elder care homes or elderly communities actually have a high rate of STDs. Turns out, when you put a bunch of divorced/widowed adults together in a community they have sex. +11  
yotsubato  Additionally, you should respect the privacy of a competent adult with "Mild memory" impairment. I know I could have mild memory impairment considering the crap I forget studying for step 1 +13  
drdoom  @seagull dementia ≠ absence of competence -- the two are separate concepts and have to be evaluated independently. see https://meshb.nlm.nih.gov/record/ui?ui=D003704 and https://meshb.nlm.nih.gov/record/ui?ui=D016743 +3  
wowo  also important to note, d) repeated tests is also incorrect as the microhemagglutination assay is a confirmatory treponemal test (along the same lines as FTA-ABS) https://www.uofmhealth.org/health-library/hw5839 +5  
sunshinesweetheart  also.... I think we can assume that "repeated tests" means repeat VRDL, not "additional tests to rule out false positives" +2  
imtiredofstudying  the entire point of this question is that when you see an STD in an unexpected demographic (children, elderly), THINK SEXUAL ABUSE +  


submitted by iguzman2(4),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

enr'tA M1 oterscrep udfon in eth aribn nad rae nbsriolespe rfo tmnoio ceisksns?

m-ice  M1 receptors are for sure the major muscarinic receptor type found in the CNS, but M3 receptors are the muscarinic subtype involved in vomiting controlled by the CNS. This is definitely a random fact, but I think they also wanted you to eliminate all other options. Targeting the sympathetic system (options A and B) won't make a difference. NMDA receptors are a major receptor throughout the CNS, but they're not a target of antihistamines, and neither are serotonin receptors. We know that antihistamines target histamine and muscarinic receptors, but the H2 histamine receptor is responsible for gastrin secretion in the stomach, so the answer must be antagonism of M3 receptors. +5  
dorsal_vein  ^ First generation antihistamines definitely antagonize serotonin receptors within the CNS, which can cause weight gain and increase appetite. However, this plays little role in motion sickness. +12  
mumenrider4ever  That is confusing because scopolamine (anti-muscarinic used to treat motion sickness) is an M1 receptor antagonist +2  
pelparente  So according to amboss scopolamine is a nonspecific antiemetic. I think Sketchy probably just confused everyone. https://www.amboss.com/us/knowledge/Antiemetics +2  
osteopathnproud  I had @m-ice logic down to H2 and M3, then from base knowledge, I was like H2 gastrin secretion or M3 contraction of smooth muscle like bladder... stomach stuff is for me so H2... I do not know how you can get this question without knowing that M3 has to do with motion sickness +  


submitted by neonem(571),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I hitnk eht onsera uyo ndee to ntjiec iportsnooadgn in sthi cesa is csaeueb oyu ened FSH nda LH ot cupreod mep.rs SHF tmeiluasts eht oletris ,lsecl ichhw enli hte seofsieurimn ltusbeu and hpel eth ogsoptreaiman dpuocre temo.apyscsrte oneteseostTr si a tcpuord of Leiydg lcels wenh eertyh' titulmeads yb L,H so engijctni estrenteosot wdulo byspas atht teps utb ti nt'ldwuo lrylae phle hiwt o.peetminagresss ,voerweH jtninicge GHRn osla 'osetdn oesntd' yrleal elhp ecsubea you edne taht tpueillas nHRG ta hgnti to meka HL dan FHS hereswa gagoilntc-n HnGR lnagaos ytalluca serdeeca HL nad FHS dionruocp.t

m-ice  Adding on to the answer above. I was stuck between the gonadotropin injections and clomiphene. But, clomiphene acts to increase activity of GnRH which then exerts its effects on the pituitary. The man in this question had his pituitary removed because of an adenoma. So, he needs the FSH and LH directly. +22  
mousie  agree! Removal of the pituitary would case a deficit in Gonadotropins (LH, FSH) and therefore nothing to simulate the testes to make sperm... replacing the T with a patch would not stimulate the testes to make sperm and if his axis was intact (although its not) this would further down regulate the production of sperm. I eliminated Clomiphene because if he dosent have T to induce negative influence on the hypothalamus he will have increased GnRH and further increasing it with Clomiphene would not correct the deficit in Gonadotropins. +4  
neonem  Oh duh... that makes much more sense. Thanks! P.s. I thought clomiphene was more of a fertility drug for women, since it blocks negative feedback of estrogen on the hypothalamus/pituitary. But in men the system is under feedback due to testosterone, not estrogen. +6  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aCn yaybdon ilpanxe shit one? I utp adeprete sstte ueecabs I eudsmas na o8-y-3ldaer amwno si an uanlsuu rhgdmaepcio orf ipyls.shi

m-ice  83 might seem an uncommon age, but we don't know for sure her sexual history. She only recently (8 months ago) started showing some signs of mild cognitive impairment. She has all these results implying that she has syphilis, so the most likely answer is that she has syphilis, so we should speak to her privately about her sexual history. The tests don't necessarily means she got syphilis very recently, it's possible she's had syphilis for a while and never got treated. +5  
mousie  I understand that she could possibly have syphilis but I also put repeat tests because I know there are a few things that can cause false positive VRDLs but if she also has a + RPR does this make a FP less likely? And also if she has mild cognitive impairment you still discuss with her not her daughter correct ...? +4  
m-ice  This definitely could be a false positive, but before we want to consider it to be a false positive, we should talk to the patient about it privately. Assuming that it's a false positive before asking the patient about it could delay treatment of her syphilis. There's a chance she didn't want to disclose her sexual history in front of her daughter or maybe she was embarrassed or didn't think it was important to mention. And you're absolutely right, she only has mild cognitive impairment, so we most definitely should talk to the patient alone without her daughter first. +4  
seagull  She has dementia. She doesn't have the capacity to determine her own care (23/20 MME). I feel the daughter should have the word on the care since Grandma likely doesn't have the capacity to understand her actions. +5  
sajaqua1  From what I remember, dementia is typically a combination of impaired memory *and* impaired thought processes. There is nothing to indicate that the patient has impaired thought processes, and the memory impairment is only mild. The patient can still reasonably said to be competent, and so her private information should be discussed with her alone. +12  
yotsubato  Elder care homes or elderly communities actually have a high rate of STDs. Turns out, when you put a bunch of divorced/widowed adults together in a community they have sex. +11  
yotsubato  Additionally, you should respect the privacy of a competent adult with "Mild memory" impairment. I know I could have mild memory impairment considering the crap I forget studying for step 1 +13  
drdoom  @seagull dementia ≠ absence of competence -- the two are separate concepts and have to be evaluated independently. see https://meshb.nlm.nih.gov/record/ui?ui=D003704 and https://meshb.nlm.nih.gov/record/ui?ui=D016743 +3  
wowo  also important to note, d) repeated tests is also incorrect as the microhemagglutination assay is a confirmatory treponemal test (along the same lines as FTA-ABS) https://www.uofmhealth.org/health-library/hw5839 +5  
sunshinesweetheart  also.... I think we can assume that "repeated tests" means repeat VRDL, not "additional tests to rule out false positives" +2  
imtiredofstudying  the entire point of this question is that when you see an STD in an unexpected demographic (children, elderly), THINK SEXUAL ABUSE +  


submitted by hyoid(40),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cna noeesom axlepni tish n–I–eo 'dtnid lelrya owkn hwat ot kaem of hte abl selvau. lyerlCa esh saw tigank oto umch l,nsunii tbu ohw nac you eienidrtaffte oiufatitsc rrddseio mfor a eytp 1 aiiebdct owh eastk oto hmcu of trhei lusniin ?dose

m-ice  I think the trick here is that they don't mention that the daughter has a history of Type 1 DM, so she has no reason to be taking insulin at all. She's definitely receiving insulin, but we don't have any history implying she's a type 1 diabetic. That, combined with the fact that there have been multiple episodes like this one, favors that the mother is giving the daughter insulin when she doesn't need it. +21  
sajaqua1  C-peptide is produce by endogenous insulin, but is not part of exogenous insulin. She has elevated insulin, with low C-peptide, so she is receiving too much exogenous insulin. A history of recurrent episodes this year implies a behavioral issue; Factitious disorder imposed on another (also called Munchausen syndrome by proxy). +8