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Welcome to md_caffeiner’s page.
Contributor score: 37


Comments ...

 +0  (nbme18#32)

yo sketchy veterans.

do you remember that loping back and forth lop eared rabbit that was increasing the phasic segmentation and therefore icreasing stool transit time?

This is it now.


 +5  (nbme20#5)

https://imgur.com/a/lCFnj1e FA19 P489 Cerebral cortex regions


 +9  (nbme20#12)

what to do with the NONADHERIANT BADDIES???

Intention to treat, "i had the intention to treat so i am gonna leave in this group no matter what"

as treated , "he is not treated as it is so im gonna change his group to control"

per protocol, "you are fired from all of it, protocols bitch"

johnfred4  I'm just gonna make an Anki cloze card directly from this +

 -2  (nbme20#17)

FA19 P592: Renovascular disease: Renal impairment due to ischemia from renal artery stenosis or microvascular disease.  renal perfusion (one or both kidneys) Ž INC renin Ž INC angiotensin Ž HTN. Main causes of renal artery stenosis: ƒ Atherosclerotic plaques—proximal 1/3rd of renal artery, usually in older males, smokers. ƒ Fibromuscular dysplasia—distal 2/3rd of renal artery or segmental branches, usually young or middle-aged females. Clinically, patients can have refractory HTN with negative family history of HTN, asymmetric renal size, epigastric/flank bruits. Most common cause of 2° HTN in adults. Other large vessels are often involved

FA19 P 596: Angiotensin- converting enzyme inhibitors Captopril, enalapril, lisinopril, ramipril. mEChANism Inhibit ACE Ž DECR AT II Ž DECR GFR by preventing constriction of efferent arterioles. INCR renin due to loss of negative feedback.


 -3  (nbme20#3)

this question is gramatically wrong, just move on. i did not and wasted maybe 5 minutes. just know that when you decrease chol. , there is no chol. left, so LDL regulating people open more receptors to balance the chol. back to its normal.

md_caffeiner  and if you dont even remember what makes what, just know that when ldl is getting into the cell via ldl r., it is going directly to make some chol. +2

 +2  (nbme20#33)

Easy AF explanation for doing mitoch. q's: Mothers have diseased children; Fathers don't

Dont forget this trick.





Subcomments ...

submitted by famylife(77),
unscramble the site ⋅ become a member ($36/month)

ie"pDste hnitoiniib of ACoG-MH trudcease by nsts,tai slcle ansemopect by egrcsninia enmeyz npsxerieso saelrve ldf.o roH,weve het latto dbyo olcteolsehr is eueddcr by 2%%4–00 ued to sncrdieea oesinsperx of DLL pstcrroee rfeta stnati smn.i"iraoiadntt

/uoywra/hmpeegl.crmwtst/gioor-lpdcte-cnt-ayenei:is.bntlwsochiiecmotococ-ges/cmibadi/hs-c

md_caffeiner  fuck GoT, knowledge is power +  


submitted by spow(24),

Here's how I thought through this. problem with DCML (absent proprioception and vibration sense), problem with deep tendon reflexes (DRGs), ataxic gait (spinocerebellar pathway), mild weakness (motor neurons). The only thing that all of these pathways have in common is that they all use myelinated afferents.

I don't know if Guillan Barre would actually present like this, but you don't have to know what the illness is to figure the question out.

queestapasando  Might be acute inflammatory demyelinating polyradiculopathy (FA 2019 p.512): "Most common subtype of Guillain-Barré syndrome. Autoimmune condition that destroys Schwann cells via inflammation and demyelination of motor fibers, sensory fibers, peripheral nerves..." +1  
md_caffeiner  sounds really great, and i thought the same and answered the same way. but while in the exam, i had that "how THE FUCK could motor weakness be an afferent??" moment. quite frequently forget the fact that this is an nbme full of mess. lol. +1  


submitted by bingcentipede(120),

Good explanation on reddit: https://www.reddit.com/r/step1/comments/d8aqj5/spoiler_nbme_16_hey_can_anybody_advice_how_to_get/

Essentially, A = mucinous glands (foamy cytoplasm) B = parietal cells (stain eosinophilc, P ar I etal cells stain PInk w/ a fried egg appearance. Additionally, they're above chief cells C = chief cells (stain basophilic, super dark, and below parietal cells)

md_caffeiner  reddit: Its not about histology knowledge, you just need to know two things about parietal cells - they are eosinophilic on histo and they are located more superficially compared to chief cells (super basophilic, labeled as C). If you know chief cells are C, mucinous glands are A due to the foamy cytoplasm, the answer has to be B. +  
md_caffeiner  reddit2#You're exactly right (although I would say it is histology knowledge). Gastrin stimulates both parietal and chief cells but only parietal cells release hydrogen ions (and chloride ions - to make HCl). ArtiomK is right about the staining and location of parietal cells being highly acidophilic (pink) and predominantly at the apical part of the gastric gland - they're often described as having a fried egg type of appearance (big, round cytoplasm [egg white] with a central, round [yolk] nucleus). Chief cells produce pepsinogen (enzyme) so display the basal basophilic (purple) staining and they're found predominantly at the base of the gastric gland. So, it's a mix of theory and practical understanding - knowing the structure and function of the gastric gland and then the practical histology of the gland (and its cellular composition). +  
md_caffeiner  dont go to reddit and get distracted for 15 minutes lol +3  
deberawr  it's better than redownloading tiktok and getting distracted for 3 hours lol (don't do what i did its embarrassing) +  


submitted by bingcentipede(120),

Good explanation on reddit: https://www.reddit.com/r/step1/comments/d8aqj5/spoiler_nbme_16_hey_can_anybody_advice_how_to_get/

Essentially, A = mucinous glands (foamy cytoplasm) B = parietal cells (stain eosinophilc, P ar I etal cells stain PInk w/ a fried egg appearance. Additionally, they're above chief cells C = chief cells (stain basophilic, super dark, and below parietal cells)

md_caffeiner  reddit: Its not about histology knowledge, you just need to know two things about parietal cells - they are eosinophilic on histo and they are located more superficially compared to chief cells (super basophilic, labeled as C). If you know chief cells are C, mucinous glands are A due to the foamy cytoplasm, the answer has to be B. +  
md_caffeiner  reddit2#You're exactly right (although I would say it is histology knowledge). Gastrin stimulates both parietal and chief cells but only parietal cells release hydrogen ions (and chloride ions - to make HCl). ArtiomK is right about the staining and location of parietal cells being highly acidophilic (pink) and predominantly at the apical part of the gastric gland - they're often described as having a fried egg type of appearance (big, round cytoplasm [egg white] with a central, round [yolk] nucleus). Chief cells produce pepsinogen (enzyme) so display the basal basophilic (purple) staining and they're found predominantly at the base of the gastric gland. So, it's a mix of theory and practical understanding - knowing the structure and function of the gastric gland and then the practical histology of the gland (and its cellular composition). +  
md_caffeiner  dont go to reddit and get distracted for 15 minutes lol +3  
deberawr  it's better than redownloading tiktok and getting distracted for 3 hours lol (don't do what i did its embarrassing) +  


submitted by bingcentipede(120),

Good explanation on reddit: https://www.reddit.com/r/step1/comments/d8aqj5/spoiler_nbme_16_hey_can_anybody_advice_how_to_get/

Essentially, A = mucinous glands (foamy cytoplasm) B = parietal cells (stain eosinophilc, P ar I etal cells stain PInk w/ a fried egg appearance. Additionally, they're above chief cells C = chief cells (stain basophilic, super dark, and below parietal cells)

md_caffeiner  reddit: Its not about histology knowledge, you just need to know two things about parietal cells - they are eosinophilic on histo and they are located more superficially compared to chief cells (super basophilic, labeled as C). If you know chief cells are C, mucinous glands are A due to the foamy cytoplasm, the answer has to be B. +  
md_caffeiner  reddit2#You're exactly right (although I would say it is histology knowledge). Gastrin stimulates both parietal and chief cells but only parietal cells release hydrogen ions (and chloride ions - to make HCl). ArtiomK is right about the staining and location of parietal cells being highly acidophilic (pink) and predominantly at the apical part of the gastric gland - they're often described as having a fried egg type of appearance (big, round cytoplasm [egg white] with a central, round [yolk] nucleus). Chief cells produce pepsinogen (enzyme) so display the basal basophilic (purple) staining and they're found predominantly at the base of the gastric gland. So, it's a mix of theory and practical understanding - knowing the structure and function of the gastric gland and then the practical histology of the gland (and its cellular composition). +  
md_caffeiner  dont go to reddit and get distracted for 15 minutes lol +3  
deberawr  it's better than redownloading tiktok and getting distracted for 3 hours lol (don't do what i did its embarrassing) +  


submitted by bingcentipede(120),

Phenylephrine is an a1>a2 agonist, given as a nasal decongestant. Thanks Sketchy Pharm

md_caffeiner  I thought exactly the same,thoe brothers in sketchy, but then thought "spring?Sneezing? This is an asthym q and the answer shoud be b agonist" Too much thinking... +1  


submitted by huyhoa1qh(-3),

2,3-BPG created in RBCs during glycolysis. The production of 2,3-BPG is increased when oxygen availability is reduced, as occurs in chronic lung disease, HF& chronic exposure to high altitudes. Elevated levels of 2,3-BPG decrease Hb O2 affinity, allowing the release of more O2 in the peripheral tissue

md_caffeiner  you gad one job +  


submitted by medbitch94(29),
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tiiccnA uupprar sutselr omfr xotnsraiavtea of odobl tnoi hte .dreims shTi omnneonhpe is ude to eht sink aptryoh dan eht rfiigtayl of the oodbl esselsv ni ederlyl uva,indlsiid ihwch si btcxeraaeed yb ocicnhr usn ro.sexeup tciiAnc aupurpr noilses ear etdaclo no nu-soeepdxs ,raaes klei the r,sam cefa, nad n.cke

nSki yraohpt ni seromaopirtods is deu ot na ilrntaatoe fo leo,gnalc ramsiil to taht hhwic si seen in .sssoeptooori sThi eundrconop snik pyrthao caedsu by eth nh-ogaigotp skema het emaldr craasuvl tonrkew yver nsseeivit to eht gtestihsl ramtua or haisegrn efo.cr

md_caffeiner  Google actinic purpura, look through 5-10 images, and you get the idea. +10  


submitted by hayayah(990),
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RHGn niosagts eilk leuLderoip ear fvecfitee for ntepsiat wtih rsbeta AC auesbce if inevg ni a ootnusinuc ainoh,sf hyet ldunaoerwtge hte HGRn ctpoerer ni eth rtayiupti and titayllmeu receesad SHF nad .HL

md_caffeiner  Quick question: FA19 691 says Leuprolide ClINICAl USE is Uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility... I guess all except infetility(pulsatile?) are used as continuous? +1  


submitted by xxabi(224),
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Vniac nad tnpal ksalodali inbd nuit-u,Blb hhwci ibsihitn hte ftmiaorno or ysaissdlebm ro teci,srmoulub tlrsi.evepyce

md_caffeiner  Vinca is a plant alkaloid and it has vinblastin, vincristine, which bind β-tubulin and inhibit its polymerization into microtubules Paclitaxel hyperstabilizes and prevents breakdown, its not a Vinca alkaloid. (FA+Wikipedia) +  
md_caffeiner  What I mean is they are both derived from plants. +  


submitted by xxabi(224),
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icnVa nda alpnt sldoaliak ndib Bnltuib-u, hcwih iihbnits the rfnamtioo or dyeamssbsil or cuoterbml,sui litypseevr.ec

md_caffeiner  Vinca is a plant alkaloid and it has vinblastin, vincristine, which bind β-tubulin and inhibit its polymerization into microtubules Paclitaxel hyperstabilizes and prevents breakdown, its not a Vinca alkaloid. (FA+Wikipedia) +  
md_caffeiner  What I mean is they are both derived from plants. +  


submitted by dickass(78),

Paclitaxel hyperstabilizes polymerized microtubules (made up of alpha- and beta- tubulin)

md_caffeiner  And clinical use is in breast and ovarian CA (FA19 433) +2  
len49  TAXes stabilize society. +  
alimd  Tarzan: taxanes (e.g. paclitaxel, docetaxel, cabazitaxel. SKETCHY +  


submitted by hayayah(990),
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heT yonl mite you resufatns a eshJ'havo Wsitesn tenptia is when eht panitet is a nmori 1l(;t&8 aseyr )ld.o

medstudent65  I get why the answer is not to proceed but simply stating at admissions you dont want blood products means nothing without proper paperwork being signed. +  
md_caffeiner  @medstudent65 From what I recall paperwork is needed for example: if the pt is unconscious and wife says that he is Jehovah's Witness. +  


submitted by xxabi(224),
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ieBl lasts elhp seilosdv lsnltoegas htta have dofemr in eth dadlralbg,el uesd in iensptta rayrrcefto to greyrsu or epefrr ot davoi .ti

xxabi  To add, bile salts are amphipathic which allows for the emulsification and solubilization of lipids in an aqueous environmen +3  
md_caffeiner  To add more for people like me who dont even know what amphipathic means:, am·phi·path·ic /ˌamfəˈpaTHik/ (of a molecule, especially a protein) having both hydrophilic and hydrophobic parts +4  


submitted by nwinkelmann(257),
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ihTs xeisanpl ti rlelya elwl twih a itur:epc isl.wPm0aaA.pAm/wdhiy.///2.auohstt/lgo:h1itplmlloaltft/swtensdhte.

Hpydiroc ancgeh = eno fo eht erlay isgns of lrlcleua edrogtaenien in noespsre ot yiujrn tath ulrsest in lomtnaciuauc of trewa in the clle. x/iihoymeacHisap aslde to ecasdee in roacbie nreistprioa ni het oichionmrdta adn caeddsree PTA dnpiootucr edu ot uerlifa fo eht KaN/++ PAasTe lnegdia to N+a nda wtear dfsiuinof tnio the l.lce dnIuiadvli ebluut cells arpeap oslewln nad "ym"etp twih altmso dlduceco emu,ln smruoelgul is l.lrcpaeueyrhl

dickass  it's basically from pathoma chapter 1: cellular injury causes swelling +4  
md_caffeiner  @dickass you why arent you on every q stem? +1  
mangotango  do you mean "causing failure of the Na+/K+ ATPase" instead of "due to failure of Na+/K+ ATPase..." ? The low ATP is due to dec aerobic respiration, I believe. +1  
fatboyslim  @Mangotango yes exactly. Na/K ATPase stops working due to the lack of ATP. I think nwinkelmann mixed it up +  


submitted by md_caffeiner(37),

this question is gramatically wrong, just move on. i did not and wasted maybe 5 minutes. just know that when you decrease chol. , there is no chol. left, so LDL regulating people open more receptors to balance the chol. back to its normal.

md_caffeiner  and if you dont even remember what makes what, just know that when ldl is getting into the cell via ldl r., it is going directly to make some chol. +2  


submitted by rio19111(8),
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sDi:osanig aPudinsemmiumnoet AF( 901,2 )569

+aamnmH =tipgCuenSrsi no iccaard asatnoutilcu

Eo:ltgyoi tuonsasoenp (edu ot tpreuur of aolmnpuyr bl)be ro 2° e,g( aatu,rm ieitaco,ngr oeaeBvrha d.resyomn)

md_caffeiner  also look on FA 667 traumatic pnx where it says "rib fracture" +1  


one does not simply “walk into mordor”