share email twitter ⋅ join discord whatsapp(2ck)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to mrglass’s page.
Contributor score: 34


Comments ...

 +0  (nbme23#42)

I figured this was a variable intrathoracic obstruction and got it wrong.

According to UpToDate, INTRAluminal tracheal obstruction is varaible, while EXTRAluminal tracheal obstruction (like in this case) is fixed.


 +0  (nbme21#17)

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine

mrglass  I meant to say Cysteine and Methionine* +

 +2  (nbme21#8)

Despite the patient not being intoxicated, this patient is presenting with classic findings of Wernicke-Korsakoff syndrome. Even if you figured that Thiamine deficiency wasn't likely given the history, if you know that WKS causes mammilary body atrophy, and this "mystery disease" is causing similar symptoms to WKS, you can guess that this "mystery disease" is causing mammilary body atrophy


 +0  (nbme20#35)

Why would this not be acute transplant rejection leading to ARDS? The creatinine is elevated, and I see any reason why it would be elevated beyond rejection

sammyj98  I selected the same. I think part of the question wanted us to recognize that the pt was not receiving CMV prophylaxis (hinted that they are getting TMP-SMX but no Gancyclovir) so they're at really high risk for CMV specifically. UpToDate: •Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations. (See 'Cytomegalovirus' above.) +




Subcomments ...

submitted by sacredazn(80),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

heT nctpcoe si a enotvudocl yaw of kinasg if oyu enkw who DJV obirnamtneoic k,rswo ihwhc is atht ti is alltacuy na lepaexm of iagltrne hte NDA of hte B/T holpmey.cyt

hotnueSr obtl huieetqn:c So newh yeth eus a ebpro itagsna some ngero,i dan uotnpittug a seiz fo .15 bk ro 6 k,b tish is lngltie yuo teh iezs fo hte ADN gtmrfena in aehc llec tnsod’e( atmert fi hyet asy J opbre ro oatnnsct nreigo ,repbo h’etyer stju iaysng ’hteeyr gragnttei semo edtuoneicl qsunecee duonf ni teh Ig sT/coCuRl ebta incah oucsl lrvepisetcye fro T/B esc)ll.

I tkhni the scnfigonu trpa udclo be oninegwdr owh yuo wnok ewhtehr eyo’ru aylprt oghurth eramrgnantree es(wnra shociec B turh D) ro fi ti nasht’ reodcurc at lla yte re(rotcc arns.)ew eHr,e eth onceptc is atth B esllc rgeduno JV(D) gatnremerarne ni hte ebon mwr,roa ewilh T cesll od it ni teh huymts, dan it lal hasenpp ta on.ce oS a maaslp clel ni teh oolbd lkie ni letuMlpi aMelmyo woldu vaeh lfylu eenunogrd onabrteic,oinm lhiwe a T clel in the lodob ludoc irhtee eb lfuyl ddcaeeut (nda eavh fehnsdii DJV rmnntioi)oceba or maiemrtu a(tsh’n tartdse ).DJV

Sniec teh T ecll eeng wsa 6 bk and eifntydlei rigbge than eht 5.1 kb enge, the T cell hsna’t nnreuegdo bntricoemioan t.ye

trichotillomaniac  very nice explanation! +26  
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4  
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +4  
ajss  wow! this explanation was awesome! thanks! +  
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6  
mynamejeff  Thank you! So is this because multiple myeloma produces excessive monoclonal light chain Ig? Is this the 1.5 kb gene? Whereas, T-cells that have not gone through differentiation yet and their J region includes everything (VDJ) vs. just VJ in the light chain? (FA 2020 pg 104) +  
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +  


submitted by seagull(1404),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

uot fo o,ryiitscu hwo yma lppeeo ewnk h?its o(tdn eb ysh ot ays oyu ddi or d?)tind

My ytprveo cuetodian iddnt' ignanir tsih ni em.

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 +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +4  
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 +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  


submitted by mrglass(34),

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine

mrglass  I meant to say Cysteine and Methionine* +  


submitted by paloma(8),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ahtW oabtu porynluma ralsavcu sari?scnete tI oowsfll eht etmsicsy urcsalva seisratecn?

cooldudeboy1  crackles are heard bilaterally so there is pulm patho which leads to increased pulm vascular resistance, since systemic blood flows into the lungs. any block in the flow ahead (lungs) will increase resistance in flow behind ( systemic ) +3  
mrglass  This patient is hypoxic increased diffusion distance. This causes pulmonary vasoconstriction. Ordinarily this response is designed to shunt blood to parts of the lungs that are well ventilated, but the response is maladaptive in global hypoxia +3  
happyhib_  I dont believe decreased venous oxygen tension would lead to pulmonary vasoconstriction (this is typically in the setting of low PAO2 you see this; shunting blood away from poorly oxygenated alveoli). You can get to increased pulmonary vascular resistance due to pulm edema from Left heart failing leading to fluid overload in pulm vasculature). +  


submitted by yotsubato(966),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

It actn eb aerBcital sbsasec N)idoacar( buseaec sshe anigtk MPT S.XM

It ctna be otox, ubeecas hes sha one iesonl nad si losa gnakti MTP MXS which dusolh ieorpvm reh t.pmsoysm

iaabGosltlom si a ieseasd fo lored idnsiuavldi

Mtaitsceta easieds ttha stme to het irbna is nelyukli at thsi .eag

SCN ayhlopmm si cmmono ni IHV IDAS psatnie,t os atth si eth stom yekill ohiecc.

mrglass  She's not taking TMP/SMX though. I would pick lymphoma over abscess mainly because .5cm growth in 2 weeks is incredibly rapid, which is classic for diffuse B-cell lymphoma, which is what tends to be in the CNS. Also there was no evidence of a classic source of brain abscess like mastoiditis. +19