share email twitter ⋅ join discord whatsapp(2ck)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 
Welcome to nwinkelmann’s page.
Contributor score: 282


Comments ...

 +7  (nbme18#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

AF 2901 pgae 83.0 toMs moncmo scaue of peamryitr/cua sadricipetir is dmesuas ot be aril.v

cbreland  Primary made me think that it couldn't be acquired from virus/bug +

 +2  (free120#21)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

fI uoy idt'dn ardudensnt the estts in teh mtse, thsi ulosdh hp:el

Urnie cdguneri sntabcseu :tets /scnsetcepytioontmns.eertnpu-hmood/ii/irmylng/iovcnn-ouss-na-sa--ecshd/lfiumdr:gagd.drtsuac

esucGlo xodasie tes:t scalzteay eht iaoidnotx of csgouel ot hgyoednr dan tl-a-ooctaDnu.ldceeog-nl fI ether si no oesulcg restnep ..ei( tiwh caigmlta,ae)so the etts liwl eb ivtngeae eebacsu eterh is igtnohn rof the stet ot .yaalctez

drpee  TLD-Watch? Reducing sugars include galactose, lactose, and fructose. +4

 +2  (free120#23)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

In eacs naeyno si oisucur uotba the rohte :etsmr I htink stpaosoip dan tpirocoesns are afrily nleaeobzcir,g but I dah no eluc tawh osstpi,yms tssso,io and oocssni erew. sStipmsoy = iccshime ecll ehad.t oiOtsss = nboe imarftnoo h(du! hwy ddint' I eemmrerb ath,t o)ll. sosciOn = omi.ieantac

amc  correction Oncosis= ischemic cell death Symptosis= emaciation +2

 -6  (nbme24#13)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So .cl.t.ly.aau dcMpeesa sysa ahtt PGNS anc rregviopses ot a vrieteiafporl seugoerirlnmtiholp sheniacmm adn os feipraivtoerl hpoomriulsetigrnle sluodh be nisreceddo as a feaenitdrlif oiisnsagd ofr P.SNG

dh5m5is/-0pe8etavtolede.ca/ioit98e:v/rrem6wc:i#/csp.emaenc "heT prseence of etuca dkniye iyrunj amy ssguegt an etnetalar iiangssod g,e( rfbremtoroeaiavnilepm nomieoltpighslurer ,NPMG[] -ohlinönHheccneS aprpuru ,S[H]P syitscme uupsl usheosmattyer ]S)E[L or a vresee or rwogisenn AGSPN, scuh as oeevdrsb ni hesto whti crteiscnce lihpmognutoirlrsee or drpiyla rgsisroevpe so.millgpinerh.ou.tre narDflfteeii D:gsonsiai siTh ceunlsdi most rohte ypste fo hlhooidcd ielp.mudrgtsrooeelhni seheT ndeucli AIg ahrhtp,pnyeo mibomorvareilnerpfaet e,ptgnlriismuloohre reateiyrdh ,tsehniirp dan teorh rsfom of fottepucinossi nleerp"r.hmugtlsoioi

Incloryali heg,uon tish mtsu be tahw teyh reew kasi,ng e..i smatopolcinic of SNPG, eeucbsa SBMOAS roh(anet Spte oruecs)re tcyildre nkdlei teh boave iaertcl I nuodf orebef lgknooi thrfear nad mogcni assrco eht SSMOAB scitne.o


 +5  (nbme24#42)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

.o..S I ndit'd onkw ahwt ti was os I okloed ti .up.. dan ,tielg uganmr si rapt of ..sla......ntp.. ey?rlla! llo

cinnapie  We out here treating plants!! +6

 +2  (nbme24#33)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

esoD ynonea aehv a odog naaipoxetln ofr wyh eeesdcrda slelev of biniinh si ognwr? ormF my eanunsdtind,gr inhnbii adn ticvain wrok eetorg,ht ni taht ninhibi sibnd dna olckbs iavtnic gdalien ot deesdacre eacdefbk no auhotapyhlms dan cvintia sniacerse HFS dan GnRH uinp.cotodr. tsu,h fi ouy eceedsra iibnnih etnh oyu dwoul heav edsnrcaei aivtcin hciwh woudl dale ot ceidaensr HGRn adn FHS, gth?ri I ufndo oen areiclt itngkla botau it ni dgrsrea to upe,btyr tub ti seesm to be a o/hneyptshoist remcofndi ta hsit pno..ti. si htta wy?h uBt .tis..ll ohw od I ruel ti uto on a ttes?

yb_26  I also picked decreased inhibin. may be it was one of the "experimental questions", which are not even counted on the real exam +1
artist90  Inceased FSH will lead to spermatogenesis and spermiogenesis NOT Increase in Testosterone which is causing increased Height of this pt +6
artist90  Inhibin B only has negative feeback on FSH not GnRH. see the diagram on the topic of semineferous tubules in FA. Testosterone has a negative feedback on BOTH LH and GnRH +1
usmile1  Kind of like how nocturnal pulsatile GNRH release occurs during sleep to stimulate growth (FA page327), the same thing happens for puberty. Pg 325 in FA, "pulsatile GnRH leads to puberty and fertility." It doesn't explicitly state during sleep, but pulsatile release of GnRH leading to pulsatile release of LH and FSH will lead to puberty. Puberty starts in the brain, its onset really has nothing to do with decreased inhibin levels which happens in the testes. hope that makes sense! +3
sars  From what I understand, inhibin is only released by granulosa cells when FSH levels are high. This is a boy. Next off, this question is about puberty, which is due to pulsatile GnRH leading to large amounts of LH and FSH, leading to large amounts of dihydrotestosterone (males) and estradiol (females), and eventually secondary characteristics of puberty. The increased pulse of estrogen and testosterone leads to GH release, which is metabolized into IGF-1 in the liver. This leads to long bone growth from what I understand, which is not much. +
cassdawg  @sars inhibin B is also released by sertoli cells in males and will feedback to inhibit FSH release, its not just a female thing. Also, there is actually an inhibin B pubertal surge in both females and males that corresponds to maturation of the granulosa and sertoli cells, respectively. Hormones are wack. https://pubmed.ncbi.nlm.nih.gov/15319819/ +
j44n  I think youre just supposed to see that he's starting puberty and know that the nocturnal pulses are involved +

 +1  (nbme24#28)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eirDsmyta = ioctrdnoindoias fo epnnd,la traynoluv nemmvoest (my won sword fro the drfefeint isnnfgid and udse iafciplcsyel to lhep me rmeerebm )aocniotl toodellrnc by eth esiorotrp boel of het sephemerih cwhih edos dpalnen uvytralon vme.notem ,lAso teh ehphreimse is the eyppriher of eht ,ublcreeelm adn it laeds wiht nnepdl,a yaurltnov vtoemnmes fo the ephirryep ..(ei li)bm.s I otg htsi morf this maieg ihwt ymrmeo ps:ti :1il4c2.leee.oi/wl/meos3.-ncw/e/ettpe0unhmmwmsdbcrmst/wom0cohm.

Oehtr ulphefl lkn:is

  1. Pyrtet deeildta ytoan:am im_dr/hm.ke/aabimoprsow0g/.2/to0fc-gndl_t3p_/M:wwe.mhiedt

  2. nrecaItteiv eits all botau the eulmrcblee (cnh:m.hcthrueapp5el.is/suc/edm/aett30ertmbnthtn/u/.ocs/.), tbu hte sotm pfhulel terpiuc ofr em was sthi eon (oteut/:W/3ss//umcm/hmids.tao_iskd.ntpce.mpbeegipag/a/nerey_jsrmta3eh.Nic_-E5/gurgcnh)


 +2  (nbme24#18)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

shTi is reptty taerg :too /d-iycile-lteehthmintrte-esc/ht:aandtus-vsy/omfer.mm/pvdie/emaytoaetsepopsetsii/ps


 +10  (nbme24#24)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I jtsu ttuhogh of a wya to eouyhl(plf) aiovd teggint sehet ytesp of awessrn .norwg tFirs, hwne I edra tmeh I swylaa lkoo rof het tlsea ssohl"e"a sa.nrew h,nTe fi u'yroe litsl tk,scu try to tpu hte entmsttea otni a ueoqt taht ouy uwdlo say to a entipat sa a ihiyn,cpsa rmeermgenbi hatt npn,do-edee lu-tnejmdnonag stonueqsi era eldia.

Teh ewasnr rof ihts olduc eb ephdras as a esnt/aotinmtqeeuts yb eth cot,odr to eth mf,layi sa lT"le me mreo ubota who shti mnpigtcai rouy yiaflm nad ldayi .lie"f Had ti been shedrpa klei taht, I FIETYEILDN 'tdlnuwo aveh gonett ti onrw.g I dulow ehva vneer vnee hda teh ttrounppyio to aekm na iaonsusmpt tubao eht maylfsi' htgfigin bineg ued ot teid crsnneco nda htus igeennd a intoiunstitr relerfa hhw(ic si wath I eo)sch.

usmile1  I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful. +4
tiredofstudying  99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will +1

 +0  (nbme24#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

esoD eanyno nwok woh ot erul otu ?E 'Iev vnere laerden tbuao smriomgsraconi iiylsepclfca igcnttaavi a ce'lls MACs, tub henw I oldoke it p,u I udnfo stih crleita (//iet.mocwMp3:nv/sw7nn.5t/t/hr0ilpihlP.g/b3cCcma.w9s.) ehT talirec otd'sne clspfelciiay otinmen olpuimmdas as gisnu ,it utb leresva fo teh ureoescsr fro het liecart o.dse


 +1  (nbme24#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nduoF tshi agetr uonmetcd ihwt siedsl obuta het nefiefdtr ogtpn:hase /i.mnmigSs/tPprottn.h9cr/sha3e_p9i2-e/d0_gf1p2gGnb0s1a:tpaparcnrrc0/S


 +1  (nbme23#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

'eHsre a RGAET ovdie xgeinilnpa rdntloausu idnnfgsi fo egny.apncr 95:@7 si a etgar cutripe so afr whti llabes of teh yolk cas, tlsoaaegint scka, tlafe olpe, nad amno.in eOn gtinh eth sprnoe aipnnlgexi sida atht I tuhogth ouldw be dogo to keep in dmni si thta eht lkoy csa slkoo eikl a creiohe iedsin the ttoieaslgna s.ca os,lA siht seti hsa a ubcnh fo ucpitrse as lle:w sgmfuga-aresseraltihipsiitdt=aps/rotto./c:editn/aler/rr?.

zpatel  what video? +7
usmlecharserssss  porn video how they make this embryo and yolk sac +1
samsam3711  Shorter video that explains this pretty well: https://www.youtube.com/watch?v=01mMBDEthV8 +5
focus  @samsam3711 that video is BOMB. Thank you!!! +

 +1  (nbme23#4)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

S..o. v'eI nebe ryntgi ot eufrig ihst tuo and I ihntk I gto it...

One of eth anim acrlaeenc qeenisuhct by eth oybd si sratxevulacra yishlmeso by het SE.R myislHeos fo BRsC delsa to dtleeeav emsur LHD ebusc(ae sBCR aevh hhig notsuam fo tacltea ngdhyeoaedres iwhhc is seleeadr onti meusr rtfae e.ish)lsmoy Isadcreen LHD nac hent aedl to reeicnsad vtpuaery to leaactt iesocnnv,or chiwh odluw epeledt the ydbo of taprveyu nda lead ot neiardesc bearoanci gsyli.soycl As het croseps nietoc,sun yiphlegyaomc slstuer due ot iztvlaeoniouirt of ersmu gsoeluc.

I rgeae itwh yattboos@u ttah stih is a hibsltlu eniustqo rof Step 1 h(ueofylpl ti wsa tirreed beacuse it aws na nmpelateierx ueqoinst ta eht teim nad on neo eknw ti, l.)lo mI' gdla htta I asw leab ot tyr ot riugfe out spibsoel inheposesg,at toguhh. ahtT si lbrpyoba yhw it saw seak,d ewhn it wsa sde,ak ot eernmdeti if ustndets docul VEYR crllicyait hktin uobta all of hte ltnccimapoiso fo ariaalm adn wtha ostpncmlociai setoh raigoinl ptoonsiciacml udolc dlea ot, tusj by nwko nlaomr hiygligpsslaot/phyooopyoyh of teh obd.y I emca to eesht usoiccsonln desab on tinuptg hrtetego fimoroaintn mrfo svaleer fo mdoaAnr Hsnagsu'aud eodivs (407@-:4:30 _fs/upxuoh=4wm/wvwc?ydatt.eW/wg.boht:rz_ctw, .&eaopz0tvydwTus6=/a6/spxp;binLtw?c;ivueesXtKh/hwwtapQoetlmU=bDwuOccaZDgt:EyqVm.omqKePLFC&is2S=ymTL1).


 +2  (nbme23#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTe nshitg thta ceonusfd I/em :gtoofr nhtolzoira azeg dan istacrdyrh c.heeps

The norlatzohi egaz si a ctnbaominoi of sngilsa neetwbe RPFP aa(amrndipe nnietop alriurcet otrfamoin), MLF, dan hoetr sinoiv lircnaa .eesnrv PPFR is leclyso odctael ot teh MF,L cihwh si in teh rlaods pos,n so a alsbrial erraty nica,ftr e.i. lrnveta onps ,nrtacfi 'wotn eollctmeyp iiinhtb eth ,PPRF dan thus why esom haolntzrio zgae nntioucf is eabllaa.iv

Dciyhtsrar cepehs = ecdtfe ni aortclnituai fo ehcpes lmainy due to ormot vsemnmoet fo hepc,se os eebascu STC nad BTC are dpieiamr in aisbrall trraey losnie, it aemsk ssene taht hte rotom contunif fo hecesp uldow aosl be mri.apide


 +5  (nbme23#33)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I ndouf a eiutpcr ighwons the snnisasrmito yb two uhzysegreoot haalp asmaltiesha raitt sania doi-si)eecn(lt n,rstepa adn imoidfde it ot soal whso the hiiernnctae by otw rzooeuysehtg alahp shmaalistae iarcfna atreotnl()sndei- astepn.r ereH ouy g:o Uge1/wed.i:OqiopVso9g14n2.Hoo/W9cRmIudeTw7p=ld8vcdtQhTJtEwhJnv?/Pr

makinallkindzofgainz  broken link +1
drdoom  broken link +

 +11  (nbme23#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

AF 0192 pgea 453: anogliGn tysc = uldlFldi-ief lwigesnl lnygoriev njtoi ro dtonne ehtah,s smto lyomncom ta het oldrsa ieds of the w.irst resisA frmo hinerionat of dnees veioncetnc ui..stes

AF 'sendot sdicssu r-mglnoet nr/ocsis.usrgeopo

Per sthi etirlac (c/c7b.PinCh/os/atn2wgm/nww2/0rtc4:ivh/ppms..e8M.6iltl), eth lnggnaoi yssct diful si deu ot rrturciaelx-taa ncium lodpetr icclt.noauuam tI olas idneisatc 0%5 edugnro eannoopusts lrso.eotnui nO tnaax,eimion rwtsi gaolnngi rae asuyull –12 mc icctsy eu,rrtscuts lfieegn cumh kiel a imrf brbeur labl that si ellw detrehet ni eacpl yb ist htmettacan ot the lgeunridyn noitj pculesa ro oendtn hste.ha eTreh si on eatocdasis hwmrta ro myeharte nad the tcsy iyldaer tuaisnlnrasm.etli

To leur otu eth rheto pstno:io

.A ePr eth beoav elci,atr etehs 'trean ealryl tsycs cseebua etehr si no i:nilgn tI" uldsho be zdimhesaep thta sicne no laysvoni nglini sesitx ni teseh tru,rsseuct tyeh anncot be cdafsseiil as retu s.tcsy guhToh rethe are flcao aarse of uosnuimc nregneieaodt in hte sytc all,w tierehn ingasctifin olbalg geednaeirvet csh,egan sosrenci orn nmiaoarytmlf aegnsch hnitiw teh tpeusdscoy or sroudnruign sssuite aehv ebne etsodreatmn"d = A si ngrwo sa ti udo'lnwt hvae amntnigla n.etpaoitl

.B slynHteo not rsue how to eulr htis narswe uot eeusbca fi ti escdosrpme eth srfcaluipie ariadl neerv ebrnha,sc oticllhtereya it cdluo ecusa .aahsissepter hTat enbig ,siad teh pulcoe fo aisrectl vIe' dera veha nlyo ntcdedaii noptalite hepaetirsas ued to onggialn tycs negib ude to sarold ,tcyss TNO ralov .ctyss C . deBas no teseh ipcrtsue (typhit0co/lh3jtbc/./:, ih4ttCly3/lobp/:H0t./, y./BV3k0/pt/hrtilbtF:, dan tyh/Ztt/bahq0i3:lp./N), varlo gnonilag scyst (sa ihts epiantt ahs) od not cusae nrexetos rliuuteacmn evren netapr,nmte and sthu rae inukelyl to oepucrd aldira neerv pay.sl sl,oA het aadrli eevrsn solecs ot a voral giolanng scy,t esem to be secunauot sa posopde to ro,omt os fi etyh idd secua n,oicoesmspr it owdul liekly lnyo aeld ot rsnsoey fitecdi, ont otmro ti.ceifd

D. esY, %50 easnsontyuolp e.ergrss

E. yvisitSno = on eabucse it is ont an ntioyfamrlma idiocnnto

apc  One thing to correct, this is a dorsal cyst (not volar). Dorsal normally doesn't have compression sx, but volar can be in contact with neurovascular structures (median nerve or radial artery) & may need ultrasound-guided aspiration +7

 +11  (nbme23#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

smruMur adn meurnv:ase t1s hgtouht = ohw osed it aenhcg tihw aer.lodp All summrru cptxee OHM,C ,VPM dna arlita amxomy rtivysee is dlciryte roaoppnirlot to gecanh ni roedapl i(.e. idreneacs weerodar=ospl m,umrur )ec.t. ueeBasc fo th,si DxD can be oawdenrr wodn to CO,MH ,VMP and aitalr moayxm hrtig aayw cbuesea eth rmumur ensdeorw thiw rcedeaeds ralodpe i.(.e tsnindga u)p enwh all ubt pcoetxesin iwth emopiv.r

Alrita ymmxoa = CCM mrpirya ardacic mutro eud ot eroartlnioifp of vieotcncen iuests mhesm;eneyc a tleaecuddnpu amss necdoctne iva atkls to tiramu uepmts ttha si sdnsuepde in het lirtaa doblo uloevm and mvseo whti hte lmovue et.mmnevo

nPsaioteetr:n iartd fo 1) tirlma vleav ctsoinuobtr .e(i. smeaali, otypmmss of dccriaa eirulaf, ysoecn,p c),.et )2 msmtyspo of mmielobs (.e.i flacai nda rghit arm iehirspesma in etai),ntp nad )3 uttnaicnstoiol mmstspoy i(..e e,evrf ewtihg so,ls msopmtys librmnsgee ennoecticv iusest aesidse, euasbec mtoru alressee -IL.6) hrseOt encluid iogcnoerlu mo,spymts tesdro"au-plim evval "daessei yuocturaatls niifngds ei(.. isalioctd um)r,rum adn ilatra nemltgneare hci(hw ldocu soespmrc rugynendil truscetsur dan scuae sosmyptm .a)lso

otN only osde asdtnign dereaecs a,dprole iwchh samne LA moveul is lerow so smas nis't as pddseusn""e but roem lbiome, indgtasn osla asnecseri the nwdodrwa naivaigtrot ce,ofr hhciw ulwod btuiecrtno to eht muort vimngo wtsoard eht aebs of eth raatli mac,erhb ""lonpppig on eth mtirla avvle flat,esel dan atotyieplln etgdninex hghuotr nda ignausc a nftulnoiac peyt fo ltimar oeinssts ie..( rinwseong doitclias ur.rmu)m Tish eovid xilaespn ti yrleal lwle: 1l/Yttiv41b/aut.cmLsh&=asewgow=t6:nmVosywcI6p/ht?;w.pu

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +4
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +3
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +

 +11  (nbme23#33)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I yltraille juts elazdeir ywh sthi tosnieuq csfndueo em so ucmh (nad 'vIe erdit to gerfui ti otu a oclupe fo ,etmsi oll). I lte the locluoaiql noniditeif of ilabumi .ei(. otmin)vgi tscki ni my ,dinm ttah I gtfoor hte atluca lamcied nnoeitidif = rnalom BIM 8(t);1&g + bgine inaetg dna pniuggr (ewhre ngripug luodc be cnudide vnoiitgm or iudeitrc sue or avaxelti ues andr/o isxeeevsc ieeecrs).x oS ,rlylea ahwt siht qtuisone swa ikgsan si mypsli athw is het tyretoelcel blenaac of cxiesvese ea?hdarir GEE!Z I eadm it os cuhm drhera ni my aehd wnhe rngyit to nesarw it gr.yaoliinl

Dairrhae casseu -nanioonn pag ..ei( ihehcymre)crolp eblicmaot ods.scaii oStol daroyetlpninm cnosanit 3OC-H dna ,+K os seiesvxec eahardir = vceisxsee ssol of HOC3- and K.+ idheClro eesvll in hte emsru ilwl eb adcneersi ued ot hte lmrona -H/lO-3CC umei,biluqir so sa nteviega gcaerh sadsitipse eud to lsos of ,O3-HC -lC wlil ecarsine noecgcrtri het o-ga.inanp

drdoom  Bulimia comes from Greek "ravenous hunger"; the term is a literal concatenation of the words for ox (bous) + hunger (limos). So, in Greek, bou-limia is literally "ox hunger", which is a nod to how the word is used in medicine = perpetual and insatiable appetite for food (the very "opposite" of vomiting). +4
abhishek021196  I agree with your reasoning but the classic case description of Bulima lists electrolyte disturbance of HypOkalemia, HypOchloremia, and Metabolic Alkalosis, along with other things like parotid hypertrophy and dorsal hand calluses due to the induced vomiting. I tripped up there. :/ FA 20 Pg 567 +
llamastep1  Take home lesson: reasoning > memorizing +2

 -2  (nbme23#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

thernAo ywa to oolk :ta tish iquetnso si ialnessylte gisakn tahw is eth CMC esid cetffe fo mrcuphtoheteaice negast ni agerln?e nAersw = noeb warmro prsiusonpes htus affscte rguol.sactney


 +5  (nbme23#13)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

reP pmoia.olnohsytclnoeg

eLkupalkaio = ksri osatfcr idnlceu elma re,gdne -0074 reyas lod, mkog,nis itWhe tchpa ro ulap,qe 5 mm or ,remo on laor mcuuos seembamnr atht otcnan eb rvoedem yb a,risnpgc nto deu ot tahrone aseseid tentiy hsuc sa nlhiec lsapnu ro adcsinaisid adn not seerdver yb emaorlv fo itirsantr and ilsneo tsum eb nrediodecs searucrencop inlut norpev eriwhtoes. Pmennatargli ioslen arntfstairmnoo lwodu edal to nsoivnia of eht .auoubmssc

iMrco = Vesria oisillacoythlg ormf oc,issaatnh soir,erhkeastpy sapayisdl or moarnicac in tius teaad(siosc twhi lyocypehtms adn prh.em)cosaag hiTs eailrtc aenxsilp it chmu eterbt nad sah tpseu:irc er:6ca8wvehi4p7tidema/vls64o.m1ps#er/mentiea/cetc.ei0o/cd-. adBse no hsti leticar dan het ,rucsiept dI' yas teh oitsh dslei in the enuoqist is at tleas arodetme uumssqao alspiad.ys

raHyi oLaeipkalku = tei,hW elonutnfc estahcp fo fuffyl iayh(r) cmuso,a irtebal,al nlaog leratla o,ngeut nda tdiascaseo twih +HVI atsienpt SDIA( yma aprape hintwi 2 - 3 )yraes utb allyctua ued to VEB intofnice

otiHs = tekHoyrtcrpeai oalr uacosm ued to pgnlii fo rotaktiec suasqumo ,itluehmipe wdoyCr etpy A nnreitlucraa sci,isnunol nllaBoo lsecl thiw ratigaomnin of nhiatomrc ac(unrle bn)egdai; EBV entrsep in laerc esllc fo sniopus lay,re aralvebi ,itkoiosclyso deiepsmusrop adCidan nnfoiiec,t othiutw flanmaiymtor s.nerospe

roFm trcupise nd(a hsit d:ovie hSqoh/extpIb1y86/v/tKuuu.t:s pimatstem ),21:2 ayihr kpaleiaoukl ash a lihyglt steniad dnab fo sellc "nbolla "esllc ni eth armustt ponmssui chihw is rehwe hte BVE i.slev It oolsk mhuc eedfinrtf hnta eth tosih diles ohsnw in teh quis.tneo

yb_26  great explanation, thanks for sharing! +
cathartic_medstu  on point +

 +4  (nbme23#4)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So tshi qonsuite wsa ogtemnshi I aylelr grseldutg itwh. I 'ditdn goeirczne thta eht reetstonipan swa fo FRMRE sa seomoen edtsta e,bowl adn I nkow uoy 'otdn nede ot onwk atht ot nesarw het qsuoitn,e btu ti wdoul veha eebn .ufhlelp yM stbigge otsnrtrfuia swa eth ndworgi of the sopiby tsesulr almnroab" mtuunociclasa of mcthd.nrioa"oi ihTs onedayn em beecusa the dniieiontf of arggde der sifreb hi(wch 'Im aumssing aws tireh ntnointe)i si maosnc"uacilut fo raalbnmo rodmitoai.ch"n oheTs are wot veyr ieftredfn atseetnmst in my ,ndim ol.l ehT i,rstf ot ,me sutj ensma r'heset oot chmu doc,rhtnomaii but hte socned easnm streh'e too umch NDA tehy ntera' tcnfoungnii p.rropyel 'sIt asol sutj eht afct of mrbenermgie lla of teh srtem rfo ETC at teh tmei fo darnige the usinotqe (ei.. I nd'dit tnhik aoubt the tcfa ttah CET is olas clelad lllcauer rpeaintrso or usjt iroi.pnarst)e

I aols t'ndid yralel dtnrndeaus fulyl wtha Oaxm2V is = V2"O mxa, also konnw sa xmiamal neyogx ptuak,e si het tsnemeraeum of eth mimuxam atmnuo of gyxone a nsepor anc ietiuzl riugdn etnnesi .ree.i.secx adn is esbda no teh mseripe hatt the ermo goenxy nuodmsec nuridg ersix,eec teh roem eth odby lilw greaetne oeasdnein rpsatpoehhit AT()P grenye in ll.s.e.c OV2 max is eadrche henw oryu eyxgon nsnupocomti seiamrn at a esyadt astte eptdesi an ceanesir ni eht rao.dklwo tI si ta ihts eautalp atht hte cuesl[m] vosem mofr ribeaco bmteismoal to ocrabeian tieaslmb"om 91s0to2.wefix-aea.pw7wm-:vor///hy2t3s0cltw-htvli-mw.

adBes ulrepy no htsi ioif,dtnnei rewhe m2xVaO = lnteeasilys eht mtei ta hhiwc ebrcaoi hiwtcses ot eicraonab ,osiniptrrae ym rnpenitioeattr fo too umhc oaidtmhrcnio sv too hmcu nda bda atdihorirnmco dn'dit ea,mttr secabeu veen hnwe teh oihcdtrimoan are ngtnuifnico ylperpro, ehyt rache a oiptn nda sthicw to caebi,oanr tuhs fi rtehe swa oto muhc lronam rcoina,ohitdm shit wodlu ocruc esartf cuaesbe ehert wdlou be reom alevrlo acluller iraiptneors cnc,riugo innmeag teh body luwdo shtcwi ot brenaaoci adn ultzeii socsiyilgl to ltatace rof rgen,ey sotp iiuilgnzt eth rtcdnoi,iahom adn tuhs 2aVOmx duolw reseae.dc

OW..HVRE.E. cebueas htsi is a FREMR t,eoquisn eht derro fo tevens is a etiltl een,diftfr espdeti teh ouceomt egbni eth smea t(a alest ts'tah owh I radteusdnn t.i) S,o I hntik eth eyk to nya draoinotmhcli erirodsd is rmegibnrmee ahtt teh tnsuomtai aer osamlt cyalrenit ggion to afftec na doendec ntoripe dan utsh a ndceyifcie fo ttah ptneri.o One ctiealr tath I oudfn sida atht het RtNA tsmuiaotn s(a in R)FERM :eusac tdpisru" holirdacnoimt ripetno nystie,hss ecsnraideg het yatictiv fo elCxomp I dan to a seersl tnxtee mpolxCe .I..V hichw adcrsseee riiparnseot and srloew ontrop n,pmipug lamliyarctda cngsieeadr the mbmranee etaionptl and nrtoop cierhtecacllome elonittap rtegdian asscor the rmdcitohnaoil enirn bne.armem Teh ptnoro alrcitlomeecche etaponlti iednagtr is het driingv rofce ofr APT stnhyesis nad sgadeceirn ti stsilabnltuya lesowr eth maalmix ater of APT ssisntyeh". 9s0lr.12.ex.ue6oot//w:sb7/me6h/l.1fnl9iin.od/r16/14jly..4-i1.al3pbi090t2y0cf30

aBeds on my nindndraegsut fo axediiotv tlhopophros,nyia O2 mopotinnscu .ei(. tgikna eht tcloeenr rmfo ecolxmp VI adn pigtnut ti no /12 2O ot atrece 2HO nda +H iedvrs het ptrono ratndeig hihwc esidvr TAP p.tricundoo Tu:hs icdfneite rrpiteryaso oindaotix .(ie. NtmAD aunmittso of het TEC zen)syem lsead to dwloere O2 cpinmtunoso (os orwlede OV2 x)am wihch ehnt dalse to olewred ATP oidctunp,ro nda suht defeiecvt a.ndotirmhcio e,hTn eedwrol cohanridolmti fctounin sleda ot ceeeddasr boaceir nisaieoprtr hngitnus TPA oucridtnpo to beaonirca ioeps,tirnar rvdeni yb soslci,yylg dan thus iiangscner alteact esllv.e

epHo ihts lhp!se sihT okot em AYW OOT ONLG to uirgef ot,u lo,l utb fleouhypl I vrnee riaegknf oegftr t,i .llo

,sAlo fi yuo nawt nay roem edignra, I yaflnil ofndu na carltie ahtt lacluayt yfull espnaixl het eimhoacbcil and gyhyshioapolpot fo oalmiiodhctnr misp:teayoh /2e2/c.5/btuir2t4o:/amalcanp/p3r46/17ci1h/ie3.cm3dtsoa/

roSyr s'ti os lng!o

djtallahassee  lol yea. I thought they were trying to say there was an abnormally large amount of mitochondria present which made me get the opposite answer :/ +1
alexxxx30  no I so agree. The grammar was completely wrong (clearly whoever wrote the question needs to work on english). This was very frustrating to me because I recognized that it was ragged red fibers, but then the wording made me doubt my own knowledge (thinking how could the test writer mess that up?). abnormal accumulations either means too much or too little. accumulations of abnormal mito means thee mitochondria is faulty. Correct grammar is putting the adjective right next to the word it is describing. So this was definitely wrong and I share your sentiment. This really frustrated me! +1
azibird  Definitely a mitochondrial myopathy, but I actually don't think it's Myoclonic epilepsy with ragged-red fibers (MERRF). This normally entails Myoclonic jerks, Generalized seizures, Cerebellar ataxia, and Dementia (according to Amboss). Maybe it's CPEO (chronic progressive external ophthalmoplegia): progressive extraocular ophthalmoplegia with bilateral ptosis. Not sure which one would account for her poor exercise tolerance. Either way, recognizing it's mitochondrial is enough. +

 +10  (nbme23#42)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

8@h98g aeuec"sB hte notcostrbui si aobev the aallover gerions ehret is a esdarcee ni ria ,wlfo nto gnlu eom,lsvu hhiwc luwod aemk hits na tvbstuceoir goyo"thlpa is hte mtso plefhul ninolepa.axt fI you knwo eht msto asbic atidioogpyshnhtlfnoi/opiye of vursctoitbe sv rirstetecvi whc(ih I d,o juts ni'tdd in htta tsmo mepfisdlii a,)yw nteh you acn urgfie ninagyth tuo. fI tmhiegsno si pamigncti iwyaar fwol = tbtsve,oriuc if smotegihn si iiptnmacg wryaia oulvem = eitsrcivt.er ANHKT U!OY

burningmoon  How about emphysema? airway volume changed but it's obstructive. +2
almondbreeze  i think OP meant to say that something DECREASING airway volume = restrictive +3
jgraham3  I think they mean if something is impacting LUNG volume (ie. expansion/compliance) = restrictive Airway disorder --> obs. / Parenchymal disorder --> res. With emphysema the airway collapses (obs.) before they are able to exhale fully thus the air is trapped +
dna_at  Just to be clear, this is not a classical obstructive lung disease affecting the small airways, as it is above the carina (trachea). This is better classified as a fixed upper airway obstruction. See the flow loop here for "fixed obstruction" - it came up in IMED UWorld so maybe familiarize yourself with the image since it is unique! https://www.grepmed.com/images/2948 +3

 +14  (nbme23#32)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

S,o rfo osme orsne,a rmtstaoureetrinns si toeignmhs 'vIe WYLASA sgdretugl .th.w.i boarlbyp bescaeu I antsw' ttuagh ti lwel os reenv eralyl alnedre t,i utsj enlarde nuegoh orf aerehwvt m.axe I sjtu uondf hsti boo htorhgu NICB dna sti NTAS!AICFT stI' rmof 1002 so mtihg eb o,ld ubt ti wsa agert. uYo nac rsahce houhtgr het boko nad ifdn het aphtersc. I tytper chmu tsju wtne hrgohut lla of eth tmounreritrtneas .aptrceh oN:swho01/ln/t//.n79iwpBKbic.bn9svko.hwmtg/.

My inma tmyet:sGla autw-aekaa = marjo etircyxato utnittra.eerrsomn woT etyps of : p1ocrsreet) bpettrocoia,m ostm fo ihcwh aer pecnasyript iG whhci daesl ot deecdresa DAMN trcoerpe cvtyiita adn iksr fo xoiitxcieotciy,t or asyicopttpns qG eerotcrsp ttha adle ot escearni Na,+ +,K dan eedsdcear ugelmttaa asesuc otalionpzierda nda rdsiecena +M+g lentacdpemis adn ADMN rretecop atiivyct dna risk of xetitt,iyiooxcc nad )2 otconprioi csnaenhl niudgincl MDAN dan At/AaaekMniP ann,elhcs hcwhi lal aolwl nccefsoinip otanic i,fxnul utb ynol MNDA wllosa +Ca+ fuixln dan( nyol in a gotlvae dptendene enanmr ftear icfetsiufn orteldioiazapn ahs adildpces eth biihtorni +g+M oni in het .hnle)nca

AABG nda liynecg = irytiibhon seumti.tnrrnearots )1 AAGAB- nda -AGCAB = crnitoiopo nsnhaecl that lade ot eluxf fo -lC, nad tpeides hist uaiscng eiian,pdarotlzo the oeunrn istll yssta eblow ersitgn l.totaenip -AAAGB ndnigbi site fro rtrbiauae,tbs dstorsi,e A,BGA adn ixcoonirpt = ieisnd erpo fo enc.nlah AAA-BG ngindib teis of edniispbazzoeen = utedsoi of roep of lneahcn. 2 ) lyeGinc ahnlcen is a eyvr iilasmr lC- xfleu cane.nlh )3 BG-AAB si a iotbtoemprca lnnaehc taht caatsvtie iG neidlag to eecsadred cPAM ichwh vaitsetca fexflu +K hnanlecs and itsnhiib Ca++ nifuxl achlnesn edlinga ot eyprpzaoirlh.notai

cogeiinB smanie = aoeicsctaenlmh maonipde raionoconi(dt of doby o,tnemvme wre,adr n,aotivtmio ,eieortrcnnemf) ppihreeenoninr (,eslpe fuswklsnae,e ,tonattnie idgeenf hba,oeirv eppnehrniie slt(oew onntnoticreac ni N,SC) lspu onntosire elps,e( e,aksseuwnfl nsso,eredip ietn,axy ensua)a dan itnaihesm aauso,l(r ,ttetoiann r,lglaey usiste m,eadag nda mya ncunlfiee bdool rabin .lwf)o ysoivulbO, all fo hist is ni ddinoait ot icreradgen smisnntrsouineroa dan ,ilfhgt gfti,hr nad ghfti sene.pros

ATP and herto uernpis = tcxoiyatre stismsnn,iaro crlsaedeo-e tihw trheo oelmsc-elumlal ensuoirtrasentr.tm sniAneode in'st cslysaailcl coseddnire a nmrutntstrieearo eausebc it nits' dleastee/erords in aC++ ednendpet nen,amr ubt ideedvr mofr ATP eefbor iahvgn an oetxrtyaci to.lapetni

tlAncleeyoich = omajr rtaeemotrunnirts envviodl in omsoitsrsnunnaeri iav nsmaurci nad coiitincn poec.rerst

epPidet etrtimuesannrostr = mnoyomcl reeselda sa epippedotr egarrl cruprssero htta ear ceedavl yb isefccip yeznsem ahtt reew ni het mase aeonrmntestrtiru icevels onup slea.eer eivF ypste = na/iutgbr ,etspedip opidio ditpspee, iprytuait dp,eptis haaimcoyhltp ailenregs roesmonh, and oehts nto .islesicfad seaplmEx = eusprrocr hatt esivg ersi ot utcessnab P ca(somp,ppuhi o,xrtoence dna GIT dan lesredea mrfo slaml taeriedm NSP C brefis hatt nsitmart pina nad prutreemaet rniiotm,oanf lwfpoeru shi,enyetopv iinithdbe by oipdio dete,i)psp rkouineinn ,A eudeprpteion ,K dan dporiuepeten mma,ag dna dpoiio tiedepsp nucdlniig tpaln aliasdokl (ilek ienhopr,m) ntciyhets ipdioo rav,stdeivei dan nosdehr,ipn yi,srdhponn nad ahpen.isklne In laeerng pidioo detppies ear dsnpaestsre .e(i. leaiagnsa mcmae,)sihn vielnovd in xloecmp rhisbeaov eusalx( n,traoactti sevusgvibgieerisssma/ roae,sbi)vh adn pdtaecimli ugt(hho nto tne)ifdeivi in phicirystca resid.rdos

rae,llOv ttresnrastrinuemo = tpye sye:tp eoel-cmulslaml eiarstttsrmn and nteopespur,ied ewher llml-lsmuocesea atrsntrsietm rea stfare adn ateidem iapdr ycsanipt rinnaistsoms .(.ie godannre SNS lggihhih/trgt/ifftf kciqu esrps,)eno wrhee as doitppseueenr a(ngol iwth lgboiioc nmeais adn omes msall ecmulelo trmtn)tsriase rea eworsl nda aetmedi aa,rgldu lrdpoogne smsuoanni.nrrtiseo

eSom p:ritceus iutmhae.vnt/srkeicmo/ospkvd/whneudurenboan.a_lpt/eisfe_tttri._rphem/eurwopw:dt, p3ssB/sg-0ses6ddhglp8oelr2t/3-mbrg75-d.--o/nc0b-/eoG1fi-e3ateta32/r/be046p0sir4ecaati6h1ir:.eg0ntBpwAn1i9o6rhrlRu8/carwdawA4Tpe1rf-efbtficauae2gP1u, nda e.tn=7tg_ga0a-fa3xg84/wb5rdn#ngt-bat/0i6bcs-le:b&sfl-eh1g1/1=p/hldpxruwe/seob-22hi;r5-aee3m.ewfa.a61d-ii9al/Ufd-tdew

sweetmed  This is amazing. thank you +
sweetmed  This is amazing. thank you +
paulkarr  Woah... +
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +2
dorischang  Didn't finish reading this, but it looks awesome +1

 +0  (nbme23#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

S,o ni enacgiehrsr ihts tfr,heru I ierdgfu uto a awy to luer teh otehr eswenasr ut.o erP sith itarlec, ts.w0m/lh/ttncpb3awnCl.wii/M/8hcv3nPp8sm/6gc:4e/i.or., alhormu imyecraahlpec fo camnanyigl is uasecd yb 4 smiemhscna twhi sexces rPTHP eoertiscn bigne CM.C xEsesc PTHPr irtnsoece uoccrs ni msuu"asoq lcel c,snarec rraniyu trcta nacscre nelar( encrca adn dblarde a,ecrc)n sebtar ,nraecc ooHnndgknsi' a,ylmopmh nda rnoiava ccnera ncuctao rfo het ymoaijrt of inisaamlnegc gdalnie to hiamprcelacey aiv HT.P"Pr ehT rhoet 3 cesusa ilunecd hcerapeicaylm ardscnoye to covirudoprnteo of oaccilti,r eoiltcyots sstesaemta, nad HPT eiaetddm hcieaymplacer paaoyhitrdr( oricanmac and itecopc dn)uoiorptc. losA, FA noyl stneimon PTrHP in rrsdega ot CCS of guln and eanrl elcl rcno.macia

rPastt,eo ocon,l dna crpnitecaa csraecn rea remo moynocml rdeimnoaao,accn nda lses ylkile ot lreease PHPr,T dan hrytodi racecn is lsoa ssle yl,kile tguhoh I idd dfni oen ctlraei tath nduof HTPrP aedeersl yb all fo teseh aesrncc os I dtn'o kno.w I eguss mI' tjsu gogin ot og hitw SCC of lugn bgnie MCC of PrPHT auhmlor ylaaemhepcicr fo m,cignnlyaa ulps npe'astit cihegdormpsa s'(06 am.)le


 +0  (nbme23#7)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I dufon ihst butao dseair C:IP netoPnatisr"e of sdriae nanrtiliarac rsurepes = e,haehcda aallip,epmde sumvoaaing,iet/n rswoe in the rmoingn as IPC iasers unridg eht tnihg as a qeneucnsoce of ce,ncmbyroe a esri ni 2PCO nruidg lesep sudace yb rpireysarto pseeridso,n adn rlpbyoab a cedesaer ni FCS so,ptiarbon lrppyauil ,itdoinal pio,tss ridepima a,zeg eryroiprtas eirarigry,tul ,SMA nda hensacg ni B,P H,R nda syaportrrie trpnaet era lyluusa tael ssgin fo isdrea CPI and edtelar ot ebrtsmina trtsnoiodi ro micsaei".h

ojt:/u2h3/j/st_mnpco37m./ntc/peb1.t/nlsinpp


 +4  (nbme22#4)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tihs liertac anxlseip hte lgpyhoapistoyho :wlel cwsolhbbno4B1i/ni.3w8.pKtwt/:ksN/ov0g4./m/nh..

hTe rhtig rnleectvi si arprlmiyi pupelsid by hte ARC whhci aols pisesplu teh SA dneo dan AV oedn 9%0( of aherts acubsee hyet are tighr ,nioamn)td liengad to lsso fo anycrlittoict of het hrtgi ,sied nda suth iufdl udiblpu nsaguic eedaetvl renlatc esnouv suser.pre vtaledeE ueerspsrs ni teh veilr dna oalprt syemst wudlo aeld ot lgaeoephtyma adn free udlif ncuaumcliato in eth tmr.eniupeo

henoch280  Hellppp. pls why is it not decreased capillary oncotic pressure? +
whoissaad  @ henoch280 Because there is no change in the levels of protein in the blood. +7
drzed  theoretically you could develop liver failure from the increase in central venous pressure (e.g. cardiac cirrhosis) and THEN you would develop a decrease in oncotic pressure. +1

 +1  (nbme22#7)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oS, I hhttoug isht oiqtesun swa uerps gaevu dan tno re.t.g.a that being sa,di higvna toetgn ti nrwog and otn rlayel ihvagn a odgo iepxatlnnao rfo hte enas,wr I idd a llttie ecsrhear and fnoud tish ier:tlac t0la.0srt1Rhoo1./o/nj1ri5.gwp./3/p61.07da.d1h/sauST1:./4wwf

shiT asw hte niam socconl:uni e"hT ltssrue fo het nerpets ytu,sd idame at gnsesaiss hte tfecfes fo rkeots on sxulea tnufnncgo,ii lveare a scnitfnigai needicl ni b,doili caitlo ,cfuqeyrne eualxs rus,aloa dan tasiticsofan htwi axules flei in ohtb kertos aitsntpe dna theri ups.oess heT srentpe tsursle olas eosndratemt thta serddrois of saxlue cinsnutfo rae tmso sicnnlyiagitf oeidsctasa hwit iorauvs oschpilycaso tas,cofr cshu as e’stipatn lergnea uedaittt rotadw xayseui,tl earf of pmcenteio, nda atliyib ot csiussd uxt,ieyals as ewll sa itwh het eredge fo oetkpostrs niacutolnf dbyiiastli. eoeov,Mrr sleaux iunndsyftoc swa eerltad ot eth csneeper dan egeder of sdeporenis, asidtbee lemsitl,u nad sccirauadvolra etnm.iodcia The toiylgeo or olticano of the kesotr nda eht gnered or alamirt tasuts of hte sanettpi eerw nto sosdtacaei itwh shncaeg in tsteoprsok yutsxeial in titapnes in eth nerteps utdy."s

oiLgonk ta the nistoqeu an,aig I'm igusengs eht u"iategf nad dciufgilfnti pgeseinl dna ernanctgt"noic enteatsmt was sesoudpp to eb a leuc rfo r,oenpsesdi sipeclaely sneci ti dtstera atref sih oke.rts Aos,l no sylaphic metoaiairlbsn gteussg fcoguinitnn si cttian nda tshu onnctualr tneosicre uowdl eb erseeprvd la.omlynr hsTi is tsju ps.duti

ls3076  appreciate this kind of effort to look up journal articles but honestly this is not really what nbme answers is for... we should be able to get the answer from process of elimination/basic science concepts and not from looking up studies as we obviously can't do this on the test +

 +7  (nbme22#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eI'v rneve nebe good at ecigvnonrt snitu :( lol so dah ot ask my rbrht.eo eH ltod em :taht

ndcsieat × ncadiset = estcdain2 = raae

na,d

acnidtse × nsdetiac × stdcniea = scnaeidt2 × dctesani = ecdsaitn3 = ovumle

aGtot lveo iublcp shlcoo rfo evrne nbee ahttug tath ... hsgee ubloivyso( Iev' ndeo hte uoaeinstq dna ,sutff utjs neerv eneb ldto ti hatt ah/atywt emlsip foe.eb)r inwogKn taht smkae uigingfr otu the oenqaitu hcmu a:reies

Fwol ater = tcoeyilv × ASC = 20 /cescm × m2c2 = cm043cs/e

oT vorcnte ot iLn,/m sjtu lmuytli:p

4m0c3c/se × 06 isnmc/e × cm10L,001/3 = 2004 10L0,/0 mni = .42 Lim/n

peHo htis dhl!pee

impostersyndromel1000  to all my public school peeps out there (and not the nice public schools in rich areas, the real public schools)... we made it! +3
angelaq11  Thankfully I was taught how to convert units, but let me tell you that I was SO lost on this one. It's USELESS to know how to do it if you (I, I mean I) don't know the damn formula xD. Obviously got this one wrong, but it's good to know that if it ever comes up again (and I know it won't) I already know it. +1

 +1  (nbme22#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sHre'e mose mgidopeleoyi otmafnrinoi tubao essonntuapo epn:ousm hTere era otw iskd,n yaipmrr snoueoatsnp pnosume (PP)S and decansyor S(S.)P sSPP ocurc ni oepepl dega 03-02 sa,yre htiw a peak ncicndeei si in the yaler 0,2s si aeryrl eroevdsb ni poeelp orled htan 04 ,raesy whit a meal ot aelfme aotir of .:216, nad omts yenrufeqlt crcsou ni ,ltal inth mne, hgthuo ismkgon rsscnaeei skir enve efur.rth SPsS ruocc ni atnepsti whit ngelrydnui ugnl nosnic,dito hucs sa /PedlDCoOr anetsti.p fI the eip'ttsna iogemdchpar swa edolr dan dha otsihry of glnu isdse,ea but ahtt tns'wa na pto,noi nhet I htnik gnsmkoi wludo eb eht ripaatrpoep hcicoe ceebaus igonkms is eth gsiegbt srki acofrt orf edlngnyiru glnu ontoid.icns

adrniegRg hte ,umraat tirautcam inruyj poemsun mtos mnlymoco rcuco ued to ormto cveileh etadicsn hewre treeh is nurjyi (ie.. rrftuace) to secht awl,l nad hitw abtsl rieuins.j Ahougthl eht sueqoitn dd'itn psiecfy the etcsh lalw saw ivod of asrcfe,tru it oals id'dnt ays scfrruate erew tersen,p os I nhitk ti duwol be fsae to smaeus atht hte sioionlcl yirjun 'itddn avhe onhegu forec to auesc hte en,ompu scyleealpi twih kegpien ni dnmi eht egmldioipye of pimayrr auoospstnne upen.mso

At sle,at shti is my uhttgoh rossecp ngihva chrrsadeee it omer, .nwo


 +4  (nbme22#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oFrm etDaUTop: AESSPEIGTHON

ekiL mtos hotre suaecs of emhpayo,itran ehatr iaurlfe irmaisp hte ytiabil ot eceetrx neseigtd wrtae yb cinsneriag tcirnuidaite omhnero svele.l enhW diracac tuoptu dan smecsiyt olbdo eesuprrs are ,dceeudr iep""mhcoyvol hnemoo,rs chsu sa inenr wht(i a ebnuqtssue eerscani in isanneitngo II namo)o,ifrt iuarittndice rmoehno H)(,DA and irpnrhenpen,ioe erospdn 3[]1.- thAouhlg dstaeouem stanpiet htiw rhtea auelfri heva aesnedirc apamsl nda lcextlrlauare ufdil lvuoe,ms the dbyo sepveecir veolmu oetlndpei ddeu(rce teevifcfe raaetrli obdlo vme)olu ncsei eth owl adacicr potuut eserescda het srspreeu gpiefurns eht esorecarbprto in the caitdro siuns dan hte relna afrentef ilteTo r.hreae redege of hrmrulaeouon ocatiiavtn is eaerlyngl atederl to the yvtreeis of riaacdc costdfnni,uy sa sesadses yb tfel aventurlcir cietenjo cntfioar or uotfncalin scsla ].[2 hTe mrulroeonuah ghncsae liitm thob uosdmi and erwta cxintoree ni an ttpmeat ot unrret perusifno respsreu ot .roamln HDA saerlee detcriyl shncaene waret aietsproorbn in teh otlclcnige l,subute serehaw egntnainiso II adn erinrphnpneeoi imlti aldits raewt ilreyved dan( erbtyeh wreta itoen)cxre by eowgrnli the eomlrgarul ilttarniof rate ue(d ot a redmak tndiceoru ni aenlr peni)ousfr dan yb sgiicennra loxipmra smidou dna etwar rbiraotoneps .][4 nI ,idnotdia both het wlo daaccri utputo nda ghhi sinognenita II slleve aer tnoetp istmliu ot trstih, ageldni ot cnadeenh aewtr tnk.iae

yhn:#stioieoprncm-shs.ttaw/ta-ettputtnt.fr/haoatne/awduiae/n-itehmpi-Ho-ecwwl2pr


 +2  (nbme22#50)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I kwno thta teplcmoe oemls do nto naointc eftla issteu .e.i( oynl cchiroino v,illsu l,bsohtrtocyapot dna tsiyyhoptosblcroasnc) dna trilpaa leom as tflea sistue, rioonhicc slliu,v otpbhlocrsttyao, nda nbpaolyshoystcrto.ci yvbiuoOsl iomciapeeotth mest elcsl rae eltfa patrs as yeth utnr toin dolob clse,l tub wtha is hte rleolav idtnoniief fo ealft a?sprt


 -1  (nbme22#46)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I ntprrdieete hte einttap ot ahev COPS u(shsirm,it ,rmaeearohn viraano s)msa ughhot teh epusr edtvleae tosneroestet si rmoe ngconnrcie rof cnre p(er sith learic:t shl/9w/0.p6:tn./tml1mv/gn6.iwrCnbt0.Pi7cwpMcoase/hic/.) fI eht teniapt ash P,OSC hse si yliekl eoesb dan ta ghrieh rkis for NDFLA hichw acn eb tidssaocae iwht edealtve aaiklnle soph,ahatspe idipl umuoati,calnc dan eltdevea oettsentse,ro tbu ton DUE to niorangedc ctffese me"sr(u ranegndo vleesl reew nto csidasteoa whit hte esenercp fo .NLDFA siTh si cdiiltyern ocnmfeidr htwi our ulrest on .psheynoetp ,eNmyla rheet is on ndecrfefie in ANFDL eenalpevrc tbeenwe yaghrenopicnder, dna nrcnnraeynoh-iegodp ro pevuordertci OPCS tonsey.epph ALNDF is ddcroeseni a tapeihc onncpeomt of ciaobelmt normysed tihw a rnatlec cotngaihep elor fo niusnil catrseesin ttah also seffatc het avoyi-onroihttua-aalppayhritm saxi in bstsjecu wtih P.S..CO yeoHngaecndirrp atset mya eb ude ot ininusl sci"tenasr.e yWltp2tb/GFKi/ht.y:j/).

Thn,e as dsia by y,c@nlt-b vdaetele ttneressetoo in a leefam is oceedvtnr ot sgrneoet and esnerot nad cfbekdae iisnhibt hte ashhoymptalu eailndg ot ddecseare SHF nad HL llev,es tub HSF is teidbhini orm,e so ethre si an dseecinra FS:LHH itaro.

Fyil,nal irgaredgn SAP (wcihh sdeo crocu in o,ewmn hwo ?wken oll,) het ielotarnroc wnbteee senrtsteetoo dna PAS in emn is tlisl ttyrep keew in( thsi dtuy,s ehter asw oynl a otorinrclea nad a kwae eon ta atth, atrfe eiatirlvuamt ssnilyaa sjngitdau fro rlvesae nhtisg /gMtriCiscp03pv./.5/hmP:5twaetn4l0/sm/nl.obh6w/wn.cic) so teerh is eldnfetiyi not a ctanreoroil in enwo.m ervw,Hoe rep tish dysut (p6e/tvpg/t8.b1o:.0.n/iun4mdbl9n/w.2c/himhwws) heret yma be na aossinoaitc neetweb irtaecn dronsgnae on(t eesototrtn)es dan SAP in o.mewn


 +0  (nbme22#19)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nCa omeneos lpaeixn woh to reul out het ehotr enasrw coshe?ric

warbyparker1  you can r/o SMA because as kidneys ascend they get stuck low in the INFERIOR MA (L3 level). So I guess there should be no problem w SMA +3
hello  I think friability of vascular tissue would indicate in inflammatory process (the one I can think of is strawberry cervix) -- so i think that's why you can rule out choice C. +1
avocadotoast  You can rule out multiple ureters with abnormal courses because the ureteral development relies on the ureteric bud. There will multiple ureters if the ureteric bud divides before it comes in contact with the metanephric blastema. Horseshoe kidneys are simply due to fusion of the lower poles and don't involve the embryonic tissues, so those two processes are not likely related. +

 +0  (nbme22#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

shiT is a doog itnonaiam veido of lineritabaoms fo gtu ooianttr CMS(UI SI EW,RID l:l)o uodcTw?mTegTbQEyst.whv2wt8to:5c/.J/=wu/hpta nad trpa 1 fi uoy wtan to ees a godo inmiaonat fo eht olnrma ugt rnitoato la(so widre ,sucmi e..i is eht mea,s ol)l: /wU.t?vtuhme/yv:cwt9bZGwodaawpuo4h./tYscw=x


 +2  (nbme22#15)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ehT enailptxnoa yb rniidvtryeglie plsu eht aleionpatxn ni eht rtelaic tepdos wolbe (P:.swmtCtt6neM9pw4iroi.ncgcliv8/w/l.bm9pn/h/.4cs//h9a) ear teh sebt, tusj nede to be coebdmni ):. The rtdilieeaffn asigsodni tlbea 1 (/lp/Ss/:coT/1-/werh91.eMtCebhi.e?nm0.cn.ly-4wPtp-/a086O=rwljtt9lsbB49vic1crMog/boi0Lmnno4/ttap) lpliicyeacfs fisdntieie eht octnindoi ni htsi nstqiuoe sa upaotrtpsm ois.dtihtyri

tlimleUyta, if ouy kwno thta imotoiypyshrdh hsa a nattsrine ohihpeiysmrdtyr apehs (ude ot nueoamumti oursciedttn of eth lcesl cwhih alyrdea had oedrpfrem HT adn os it aws rladeees opun )coitnetsdru orfebe hpthmioryosyid cnutifinn(ongon csell so 'tnca taek pu d)ieoin and that oyihtpmidsohyr is a ilcpytcmyho nitntiaigfrl iriyhsti,otd uyo wlil onkw teh wnsaer. I dah a rdah etim nridndgseautn isth at trfis ceseaub we oge/anaedtsiaveul ebdas on teh ensecerp fo -taPTnOi bA, but hte dlyerginun gpihteoaesns fo eht tidoryh ucoditsnert is tdllmaeiec-de epty( VI p)einshyvitsteriy nto bA iteadedm pey(t II yitspyhs)inerviet eikl evgars. mtsaoio'sHh = mchytloipcy tifloirtinna ihtw iealnmrg ectrens (ichwh anc amonftsrr ot B llce a)mlmpyho with lutherh elscl ikrnep( alyptsomc l)s.lec


 +4  (nbme22#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tyucepreaH = mutsnie ot ohusr, tsoh rdepmerfo Ab taisnag gfatr nhtiedloela cell Ag = tpconemilm caait,nivot etioaldheln m,egaad ninmofilamta nhwiti( teh ss,ueti OTN nmtitte,siuir) gnolittc d,cecaas isemhicc sisneocr dan st.iobmrhos thmHu/r/kpimhn.Reutltyd.cjplibsmiecy/K/Acr.aostt:is/pp

tuecA = kswee ot omstnh = trgaf Ag sactevtai ohst 4CD dan C8D T cllse dnageil ot clhampaenyr llec ,aegmda aitesltirtni pohycmliytc rtnaifinlit,o dna stiideo.hiatlne t/tmtyKiM.Ro/ieyhpascbdoAklm/nlr./riupsc.depmi/ts:tpjh

iCrochn = mtsnho ot yesra, chrocin HTD t(yep IV ypystsnehvtirie)i oeicnrta ni lvsese lwal ndgaile ot amtlnii thmsoo sclmue ellc ofneroritailp adn lvesse isoncolc,u thiw sboypi hngsoiw rdraenow aacurvsl lenmu nda evsxeinte somoth muls.ce

VDGH = rftag ecsll (tmso llcaiypty ebno rrwamo tasrpsantn)l gneocerzi ohst slecl as il/ogefsfrne adn alde ot ntoeurcitds of otsh seutis aelgidn ot ,rsha j,ciednua aradi,ehr nad GI eograherhm htsi( usccro eaebscu tmso oenb waromr starpnltan tsnaitep ahve duroeneng full oaiirnatd wihch aaksctt eht rpaiyld pgoidnivr clles smot (.i.e ,nsik GI ucsmoa, ai,rh ayeotshtp)ec os atfgr ctoruntseid of stoh lslce ni eohts asear deasl ot smsyp)otm.

s/cspttotu.cip/hpm:/m.


 +3  (nbme22#39)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I ufdon thsi enwh rtingy ot eddruansnt hwy dsercniea ON aedusc daeeh:hsac etrstinaiitNtsr/e aer a vyer mmcono ahdhaeec and ieaimnrg odof gegsritr M)(bWeD dna resia inrcti xoeid .selelv hiHg vseell fo tcirni xdeio rae adoescasit thwi greainim y.)td(uS seaHeachd dna mriseniga ear losa vrey mmnooc ni oinstmceida ttha oobst ctiirn ,doeix ushc a gvaiar d(ysu)t, tub ti si crleanu wyh tish psnap.he heT aglirnio ssthyphoie saw htat intcri xedio ssanrieec bldoo svesle eisz and gtrrgesi a mr,neiagi tbu teh viagra udyst dna osthre repvsoddi h.ist erNwe tidessu on nircti exdio howss tath ti eecniassr hte pideetp ()RPGC htat si conediserd pbenlsesiro for ngirgetrig israigmen (dtuy)S frtae iarescens ni fniaoltanm.mi Bscaeue rnctii ixoed is aedstcsaoi nnrgieeouc inoflatnimam ds,eisesa 'sit elkyil atth hcsaeahed nda sirmgaine orfm crinit oxedi rea a rigwnna nisg fo thsi flantmmnioai (.ydtu)S

hTe hcerarse si scabaiyll itastgn ahtt airentts aeris iircnt deoxi selvle dan ihgh nctiir xdoie svllee aeeicnsr ialtnnmamifo and dacsaeehh nad amersiig.n ,eovwerH eth cteax rasoen why this eppnhsa is uknnn.wo

a-enhwos-cectdahw:aoqss-..y/esuaWthpdeotir-ac//wmhurt

taediggity  Goljan and FA mentioned this as Monday Disease for people who worked in industries that heavily used nitrates, where they would build tolerance during the week and then get a headache when they went back to work on Monday +3
nootnootpenguinn  Just to add to this- one of the side effect of NG when given to patients with MI is "massive headache"! That's how I the question right! +
mumenrider4ever  This is similar in how triptans induce vasoconstriction which is used to treat migraines +

 +1  (nbme22#9)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sThi knli has a dealelb crotenel iocsmecpor iaegm of aiccadr cymeysot ilke het stqeonui next to a ontoarc egmia, os 'sit ylarle epfh.llu eTrhe si soal a oodg .nsdpriceoit lSrcol lla teh yaw dwno ot the tasl igu.efr

fa1toat_olveocsgsnri.8CbpOh71uenuertr4ilvkeen3/e_/uo//sg8pe/yethcM.1cewitashr1fl=stwe:t_ew?iwol_t3_


 +4  (nbme22#36)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

AF 9201 eagp 6:24 A cpsreso no(t tsju a /giuetrtcdenun)saom :thrra qeuiset r:coDlussei iscoisnsud fo rtinptene onfmritniao sngi(u ealcidm irtrp,rneete dndie)fe ,e :etnUgdinsdrna abltiyi to mpnrodc,ehe :iptayCca tiyilba to eoarns a dn kame n,es'o own nciosidse niitsc(d t ofmr eoecctn,pem a legla n)niea,emoidttr :noseruinlVtas merofde mofr nceocori dna unpmintao.lai

atsePitn must have na elntilitgne nrnstneidguad fo hitre dsgoainsi nda eht ensirfs/kbteis fo sdpporeo trmtentae nad vtainaertle sti,pnoo cniuglnid no tea.nrttem


 +6  (nbme22#35)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I EHATD ihst etpcui,r jsut ekil oneverye seel, ,llo so I idd smoe rome i.gigndg yroeneEv bolew si rre,ccot atht teh nnesirettapo si nusegsgtgi an iiofnsutec rcsso.ep UsTI anc saeuc tucae ,ylepoihsetprin and if ,crchnio grseposres ot o.ichrcn Piroisnetheply si a itaiutbluttirleson diess.ea I found ihts inoaimfrnto gdarngier it, and ni teh tlsa artp, ti becssdeir teh sgrso yoapolthg fo ohinccr ihenrl.ioyeppst rFom my inrnot,irtetaep it osnsdu leki waht eth itcpeur is ghiowsn, btu I wn'tas ebal ot fdin a trj/tusebte sa odgo neo lnione eyt, os I 'dton know for .seru

ceuAt tusiinoitelublrtaT ihei:prsNt uAtce atimifamnlno fo suteblu and ietiuritmnst anc aucse FR,A nad fi eht timyaamlrnfo csoepsr iersptss tish anc lvoeev nito cnohcri ttlsloabreniiuutti isnierhtp dna onihrcc asitrtleinit sobfirsi dan rbuulta rtpyaoh iwht iskr fo rrssiogoenp ot atsegnd-e nekyid e.essaid Two aromj cgoteiaesr of autec ioalttbieirtuutsnl htiiprsen aer cteau loerhietpnipsy nad teuca ethsitvipiesyryn enitttluiabrotlisu .rinptehsi

tuAce :oheiynsilptepr usCdae yb cberltaai nceotifni omst clyomnmo E. cloi ntfeicin.o pnviystriseietHy iuoaibtrtsuenttlil h:ietrsipn sCadeu by an eirllgac se,sonepr fro pl,eaemx ot a urdg or htoer busetsancs ahtt are itd,egnes uhsc as ablhre .emrseedi

By raf eht mtos mmcono outer of itnoniecf in aucte eopniityehrpls is an cidasnegn otfennici in the unayirr ttcar, ofr lxp,aeem ddvreie rmof a iarbtelac rebdlad ft.nnicieo tcAeu plntspreyioeih = xevesetni nxlufi fo NMsP whtini hte stnrmuett,iii butlseu utstu,b(l)ii nad ensuml fo utusebl C(BW at)ssc (pb:lttyi/D/Pt.yiJ/2hB).

tiWh epeneistcrs or cernecreru fo eatcu trspieyn,epiloh eht asidese ecosrps lovsvee iton rccionh epeplihnotr,isy chiwh lsauuyl is cacmaopiend yb admrke eoisrno of het priyplala itp lgeintrus ni ialndtoi of teh dcaejatn cxlay (ial.ec)tscisa

heT omst iaahestccirtrc aoocpghtil eastufre fo nicchro oetypliihsnerp rea het osgrs sgecanh ni the kidney ihwt sd-orbabeda casrs ni eht ramnyhcepa yviognler rseaa fo cctilaor dna meldarluy tryhpao ihtw tdeajcan ec.sislcaita ,oAsl eth pnstetaenoir stsgusge nr,dhpihoesrsoy nad morf my ,aerrshec rdoroyshshpe,ni nwhe eeior,hvsccr/n can cributetno ot eth emdkar osls fo rcxote and sbossiirac/sfr of teh uemalld (euaET7t/m/Lm/hL/RR.:lM0.ptsN0adAtpNhEhAbuhw.ed.tHet) dna aiecslsitac chhw(i I ntkih is ntpseer on this .up)itcre ihsT is teh estcosl iutepcr hitw rsidontpeic I loucd ifdn ahtt smhcate het mste eaosenrntipt .i(e. ourrreydteh adn hryhrsnsepiod,o utigsesgng rlatvcroesueie fxrleu ganedli ot efointcin rfmo "a glno asntndgi uoosinrtctb l(orbbpya eg"c)inotnla os klleyi rfmo a ldhi)c /:uA.tpmdtuRsLh/RLmb8eNh0l/tEad/hHNwaM0Eht..T.Ateep.

,lsoA ot emontni on the eorht eommcnts rssxgeepni oisrutranft htta teh msae cutriep saw seud fro osutmr dan trlubua rayh,otp ormf thaw I ard,e taht srsgo gyph,aloto is eht lgnaere ppanarceea of retdeoyhrru ued to rtvsocieubt aouhytpr (e..i abulutr p,yhator /iconrsbrfiirgas,s eslstcylicaxicaa/ o,ltaidni nda tnih lcacroit mir deu to yhaot.pr noelhyPio.maltgonoc yass tath teh tlcacisseia si gtaergexade in less verees ptcsrsa/laeia itstooubrcn nesci FRG si nto eespprsusd utw/togacsm/..vhkuclspie.ttphiooi/iowrotttdnolmny/l:ethsbceywp.)

eHop isht spelh eer!oynve It rseu heedlp m,e tbu toko YAW oot goln to nddet,saurn llo.

nor16  nice job, but i dont think you need all this for these questions +4
alimd  next step is to do randomized trial) +1

 +0  (nbme22#1)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Per pdaeiikiW: heT ierpstc exl,fre a eepd onednt exlrfe, is a rfeelx as it itsilce ionlryvatun ootnitacncr of the eticpsr iraicbh clmuse. tI is iatitined yb teh crevliCa (of teh ecnk egionr) linpsa eenrv 7 rneev root eth( sllma ngeetms fo het reven tath eegersm ofrm eth pilsan rc.)do hTe lefrxe is tdeets sa prat of hte ollcragueoni atinoeanxim to sessas the oernyss dan moort htywsapa iwinth eht 7C dna C8 isnpla vsnere.

loAs, morf a eirfntefd eitwe:sb Teh preitcs rlxeef is deatdmei by het C6 dna 7C enver ,ortos tlaypnorednmi by .7C fe.en.o/lcmoanlrs/dus/ee/ms/eluopiieudeh:e.ttsfmtruthgsydb/rrm.ypuxunr.


 +3  (nbme21#2)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nI saec nnoaye is a edsne as I am nad juts tdi'nd nmdrrmeaustb/deerne atwh aexclyt etopiryxra owfl is = .VFE1 nI trtseirvcei osodc,nitni 1EFV si rnoalm or encerdasi edu ot seeadecrd .CFV tIatintreisl srifobis = dcneresai wyiaar rmahpanyec sofdafcl odarun eth aiw,syra iwhch si wtah dsovepir adairl tonar.cti heT egarrte the iraald ao,tincrt eth eworl eth oiplglnasc e,cfor nda os arxoyrptie oflw is neaid.srce

champagnesupernova3  FEV1 is increased due to greater recoil of the lung tissue. FEV1/FVC is increased bc of that and bc of decrease in FVC +
mangotango  But I thought with restrictive diseases, the FEV1 dec a little and FVC decreases a lot, yielding an FEV1/FVC ratio that's normal or increased?? +1

 +0  (nbme21#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oS I elkdoo tnio sith trfuerh oot ebscaeu I tpetyr cuhm wonk htginno atuob eth emak pu of .nsmee omrF het rearcesh I ,ofudn sa sa aedtts weblo by o,y erfstocu is het msot rtapmtnio sottcitunne of mesen ni etrms or msepr fuc.tionn oBlew is niooartminf I unfod ot dreasds het rtoeh snwera chois.ec

iZnc feycnedcii in( )rsue,m rpe FA, ahs nebe lacmidiept ni dyeadle uwodn hnaelig, eerpspdsus umiyt,inm laem oymidpsagohn, sdacedree adutl hiar lla,ra(xiy aci,alf ,upbc)i eyisgs,dua onmasai, rtmtidicasrmoea taapereihctno (etdefc in teninaltis znic oaso),rbptni dna yam isrsppoede to hlccoialo his.rcsiro AF di'dnt fyesipc het evlsel ni eht ms,nee btu rep the wolbe ctrail,e emlansi izcn tetocnn asw fdoun to eahv rno coertoalnir ot rmemn/epses .v/lec/yvetliatiect I d'tno nokw if erw'e ossepupd ot wkon ath,t ubt won I ,od .lol i/pt7h:.b.tg0cpou3nildbesv7.55/nmw/wmn./h3w.

As xnurgyhbo eimdonet,n ilseulnem is nylo tedoeninm coen in AF sa a ettatnemr rof ate,ni so I ldoeok ntoi ti rerfuh.t ilSnmuee is a nnteoct of snee,m ubt vleles rayv os hcum ttah ti rvsees no pgroostnci lccinla recvaenle to rltfiyentii, rpe isth atl:cier /sw2ud/bgvpthb/e.o.5n03c2ip.:n/wwt.1h3imnlm.

oT erul uto all fo hte earsnws auebesc( I n'itdd yallre kwon ynnihtag toabu eht taqylui of em),esn I dunof tsih "By at-sstici,stt rhtee saw on icnfigiasnt cneeirfdef in the eemns Na aeinctonrcnto aonmg het rdeefftni usgpro 7( prgsuo alott sebda no semrp ou)n,ct tangindici het incatniinigfs rloe fo aN ni msrep ".ilti.yomt ib/./mb2pnnu/5ov:.in1.2m7pesht1ghd./wwcltw.

al,iynFl I notd' nktih teh hla5p-a sduacerte enymez is yltacalu ni sne,em btu I uodlc eb owg.rn itErhe wy,a it u'dnwotl be raobamnlly vateedel ro owl fi eht tsteonertseo eellsv ear rom.lan


 +7  (nbme21#45)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So I ekdloo oitn sthi urfhert oto esaebuc I ptryet ucmh okwn gthonin atobu eht ekma up of eme.ns Fmor eht rhrecesa I dfuo,n as sa atesdt below yb ,oy uoesfrct is hte tosm rnttamipo ottunesncti fo meens in esrtm or emprs oncuntfi. eowBl is oinotirnamf I dounf ot desdras hte torhe nesrwa c.eoshic

Zinc ifcneecdiy n(i ,er)ums per ,FA ash neeb mcitdpalei in dlaedey ouwdn ,elingha erssupdeps umtimny,i amel dao,nsgmophyi daesreecd tauld airh yl(,rlaiax fi,caal ,c)pibu ssiauygd,e isna,aom otrdmtiairamsec cohieatnapret dtce(fe ni tsitelnian iczn isarpo,bont) dan yma odseepiprs to cilacoloh ri.ichrsso AF dndit' eipsycf eht evllse in the m,nese btu erp hte blwoe itarec,l enslmia cniz toentcn was ounfd ot ahve nor octnirearol ot esp/mmeesrn t/tyi./eceatlelvivc I dno't wkon fi 'ewre dpsosupe to kwon ahtt, utb won I ,od .llo uv7d//oshwb/nhbt0p5mn/5.n:i7ptie3.w.3l.cgmw.

sA xouhrynbg one,tmnide slleuimne si ylno enmitenod cone in AF as a ettteanmr rfo etna,i os I eodklo onit ti .frerhtu lnmeeuSi si a cenntot of emsne, but veslel rvay so hucm hatt ti essrve no oiropcgsnt alclicn ercelvena ot tni,ytlriief per tshi etr:cila hvhw:i3bn5b.e1.02/dmnu/3/gl.2wpst.m/powncti.

To uler tou all of het srseanw ce(esuba I di'dtn leyarl kwon nthnyaig obtua hte iuaqtyl fo n),emes I dounf isht By" cttttiis,sas- eterh asw on nsnitfiacig nriecdffee in hte ensme Na nneortcitnoac omgan teh ffrndeiet gorpus (7 sgorpu tlota esbad no mrpes uo,ctn) cdanniigti hte gsncfiiatinin lore of aN in srpme tm..oili"yt .1eipp/d/7cgv.in5muhwb/lo.h1n2mnst/:2.wtbw.

ynFl,ila I do'nt ktnhi eth aph5-al eacursedt enmzye is cutaayll in nm,ees utb I could be nrw.go thrieE y,aw it wlu'dtno be lyarbmlnao eevlaedt or low if hte otnersetseot eslevl rea mlra.no

bartolomoose  as per goljan, selenium is involved in glutathione peroxidase +
chandlerbas  selenium has a role in glutathione peroxidase. excess selenium = garlic breath, hair loss, and nail changes, might see peripheral neuropathy. deficiency (pt on TPN) = dilated cardiomyopathy +
chandlerbas  also zinc aids in sperm motility https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773819/ thats why i chose zinc but whateverrr im over it +

 -1  (nbme21#41)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

If uoy sglgrute twhi Bocmieh dna et'vhna drhea of ooMf ritenisyUr,v I uolwd ghiyhl oerdnmecm ckignhec it out. eTh leowb noniraotmfi I ogt orfm this iov:ed 8a-o-e/9y/mheeffyhxl-du-:titesnv/tlc-edupcrprt-/ubror/us3lremaas/s-mosi.a6oscoistm-srket-uosnrtieih-tme4s6rap/hayrsppoeecpoarmc-ioposan.yic1ast3c dan ist' tg.ear

pyriaohrP cutaane radat = AD atmtuino fo pnopoorugiernrhy s,orlcdbxaaeey isht si the CCM of ipr,pyaorh dna it epnstres in -040s.s5

naiM tyomsmp fo spvyeiooittinhst lgaiedn ot kisn ae/lulsiebtisnlsolbe/rs ued ot kisn pigreyrophnnso nbeig xoddeiiz yb ghtil ot pinhsyporr hatt gdmaae hte nki,s dna herot nisk ignnsfdi of rhetptnpcryiieasyhgo/iohster.inmp

A key eueftar si loesspib vlrei spomerlb edu ot eaasictdso ppatriicniteg cotars.f CMC gttiirieppnac srftaoc = vsseixeec tEOH and OsPC ucsebea fo YC0P45 scirnude incrgdue msrue emeh eellvs ot be itdizlue in eth ewn 4C5YP0 s,emyzne suth lgusntimtia LAA ahtnsesy deu ot edcsdreea eehm bhii.otniin rOeth tegctirniiapp tarofsc eniudlc vailr eht,iitpas sylaepiecl aphtiiest C, dan xsesec nrio sa in thomsheosmia.roc eeTsh nac deal ot eedvtael SAT adn LAT .slevle

othrneA nsgi si rdka "-ipnt"wroe roldoce iurne wihhc ipnk cufeeorssl rudne ooWd h.ilgt btnsAe mtpsmoys = mdaalobni pnai nda SCN lmrpbseo baucese LAA adn GPB do otn acluu.etmac utAldeamcuc tpodsruc = yirprhopnuor ,III uypinorgeoprhron ,III hpruipyonrro I, nda hrogennrruyopopi .I

etamTernt = nus uperexos d,iaoaevnc rmvaelo fo ripagptciiten coastfr, mobothl,pey ncoloriuheq hwich( cna idbn and elad to noeecritx fo inc.lutmus)aaco osiPrgson = leet.lnxec


 +8  (nbme21#47)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

edreePgi = DXL no(t lal aerngisnote aeteffdc = Xdink,-el fafetcs aslem adn sfaleem llymiiasr = t.dinnam)o

fAefdtce shtreaf = 01%0 ssotnimriasn to etars,gdhu 0% masnossniirt ot ssno.
d efAtfec estrmoh = 5%0 to tdgrae,shu %05 nsmissoitanr to Bh o.sston rpatesn atcefefd = 010% sitosmsnarin to grsaduhte (eud ot 'hftaers X rmooech)osm, 05% rsnsoastmnii to sons (deu ot thsomr'e X homtohorBo )cme.s sntreap eacdftef ahec itmtnsartnig btho ot rgtdhaue gu(sozyoohm ute)hradg = 50% nad meor r.eesve

fI intconodi is lronyfumi tflaa ot lemsa ni ,uetor hetn teh 05% fdefecat deasb no msiatnrsion (sa vaeob) wlil ied in ue,tro and eht 50% tno eefdaftc illw aehv lvei s.tbrih ishT ,esmna krsi of laefme ginbe dfcaetef = %05 nda srki of vlo-ibrne mlesa gnbei edfatefc = .%0

divakhan  I believe its not XLD, had it been there would still be 25% chance of males to be normal according to the Punnett square. (FA 2020 Page 59. +
divakhan  ^ 50% chance of being normal.. which is NOT in the answer, it said 0% chance in males! +
divakhan  Plus you'd see disease in EVERY generation if it was Dominant. For it to be XLD, the father I,1 would have transmitted it to his daughter. Instead the parents are carrier in Gen I. so its XLR disease (II, 3 being a homozygous XLR female) +
plzhelp123  This is X-linked dominant (think Rett syndrome), if it were x-linked recessive, a female would need to have 2 affected x chromosomes to be symptomatic, which would mean her father would HAVE to be symptomatic as he has only one X chromosome, which is impossible as he would have perished in-utero. The reason the answer is 0 in males is because the question asks specifically about live-born males. If it had asked what is the risk of the fetus being affected then it would be 50% in males (but that 50% would not survive to birth) +2

 +0  (nbme20#7)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Dose aonney kwon het iiingnfesacc of ynotcoem tmityo?il


 +11  (nbme20#28)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

isTh snapexli it rlylae elwl thwi a ec:rptiu ptsemth1loA:slo/atwPipt./y/iaeh..mti/wlAnogsdmldl0tatl2a.//hwshuf.

oHiycrdp gchane = eno fo het aryel ssnig fo rlcaleul rtnoaneeeidg ni esensrop to iynjur ttah rlsetus in matioaucucnl of ratew ni teh clle. ihsaHeciioy/amxp aesdl ot eaedsce ni cioreab inrieastrpo ni eht ritmanchidoo dna deasecrde ATP ocnpuoirtd edu to eifular of the ++NaK/ AseTaP lneadgi to a+N dan atewr snfidfiou nito het e.cll vilanduIid luutbe elcls paarep lnswoel nad "e"mytp ihtw alsmot ldocuecd nmuel, llmuuersgo is lh.palrceyreul

dickass  it's basically from pathoma chapter 1: cellular injury causes swelling +5
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 +




Subcomments ...

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

Ari dan uldif = moendyr.rhuotaopxh fI thta udfli is odbol /sp( gbans)bti, its’ a mmtuhoaoerxh.oepn ckLa of imseaitnlad fhtis sednticia ttha ’its ont reund in.osent

d_holles  @benwhite_dotcom how can it not be under tension if air is entering the pleural cavity? +1  
nwinkelmann  Because the stab wound isn't functioning like a flap, meaning the air can escape. The reason a tension pneumothorax occurs is because the wound acts as a flap, where on inspiration it is open and air enters, but on expiration is closes and traps the air. +10  
groovygrinch  Also if there was tension, there would be a mediastinal shift. +9  
t123  Also the gastric bubble is elevated, actually suggesting lower pressure. Mediastinum shifts require more pressure, but the gastric bubble confirms it. +1  
myoclonictonicbionic  I was overthinking and thought they're implying that the stomach bubble is the air-food level that was seen on the Xray. +3  
cheesetouch  umm air-fluid*^ lol +1  


submitted by radshopeful(17),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh scalcsi sedi ftceef of rinchtnsaaceyl si delitad htapymiroay.odc iThs nsoequti udclo vhae tgtneo kyicrt fi you htoguht the pmoyaulnr otsmsypm eewr eud to eht gurd wichh dlouc eahv dle oyu to nymoeclbi scaseu( uopnamryl s)fibisro but sthee orluaypnm tysommsp were otms lekiyl a setrlu of tdadiel pyaomaodhrycti glanedi ot HF adn ryopanlum e.mdea

nwinkelmann  What is the clue that this is not pulmonary fibrosis? How do I decide between Doxorubicin and Bleomycin? +  
ilikecheese  Also both bleomycin and methotrexate cause pulmonary fibrosis, so that helped me rule both those out and focus on the HF instead of the pulmonary symptoms +4  
adisdiadochokinetic  The S3 gallop and enlarged heart together are very strong evidence for heart failure. It's much more likely for heart failure to cause interstitial edema than for pulmonary fibrosis to directly cause heart failure. +8  


submitted by colonelred_(99),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eodoLk it up nad noudf htta ueeascb eyuor’ ni a pusnie itisopon for a olng etmi ’eyuor onigg ot hvea rsidanece sonuev trrneu chihw aesld ot drseincea O.C Tsih nagyvietle dkasfecbe no R,AAS idnagle to sdreeacde oadoresnt.el As a leu,srt ruy’eo inggo ot vhea resiaendc desuriis wchih adesl ot cdaersdee bdool nda lamasp mulo.ev

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4  
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +7  
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3  
yotsubato  You gotta be preggers to compress your IVC +5  
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1  
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5  
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4  
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +  
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +  


submitted by neonem(549),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

aiFngll no utotrecehtsd nah:d cdapiosh si smto moonmc one ot eb rca,derftu uatlne si mots nmmoco to be .dlastdicoe eatLun iitnsacoold can usace ueatc aprlac utnenl .sydonemr

nhkiT fo teh oemimcnn art"hgSti Lien To ,Pikny Hree esCom The umhb"T ofr eht eobns fo the mlap, dgnairw a ltafbool pesah rgistnta elwob eth htbum PCM jtnoi cadntaje to the d,isrua enth mvonig to uoyr aldeim srti,w nda htne kbca to hte b.utmh

cSi,apodh etalun, muu,tqrteri imrsiopf, ,mtaahe ceit,apat atrpzido,e u.mtiprzae heT luaten osokl liek sit' srtryeoolip cedsldatoi .ereh

sympathetikey  Yep. I didn't even look at the X-ray. +9  
dr.xx  loonies love lunate +2  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +1  
wes79  i legit have no idea whats going on in that xray lol +9  
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +1  
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +3  
niboonsh  Some Lovers Try Positions That They Cant Handle +9  
vsn001  ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D +  
regularstudent  Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic +  
sars  I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome. +  


submitted by cocoxaurus(56),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

TBU ywh si het smreu uimptosas rnalom?

I saw aleb to oanwrr it ndwo to R,AT sabucee oenn fo hte rtoeh eswran ohccsie dema cumh eessn, tub eth iapousmst ahd em sonced ggeiunss e.msfly nCa omnsoee paiexln atht lab iid?gnfn Tsankh!

subclaviansteele  My take is that hes not super acidotic and the K is at the low end. +  
nwinkelmann  see the comment by @zbird, which explains that the urine anion gap is important (which I took to interpret as more important than the serum K+ level, lol, because the normal K threw me off too). +  


submitted by sattanki(68),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tereh rea owt ssenammhic fo tngaurlegi nelar bolod wol,f hte oiecmygn maihencsm dan blaguo-uoturellmr eekdfac.b hiTs uqitneos assk rpyule auotb the ngoimcey em,inmhacs hhwic si hrwee het nereffat oilaeetrr oonrsctl dobol lfwo abdes ulyrep ffo lobdo rpersesu gintneer het i,yekdn wcihh si hyw earsedcde tfearfne orlaraerti tencissrea si eht steb nerwas t(he etoralier si dtilniag in roneesps to het dsceredae bdool flow ni attepmt ot initaanm oamnrl lodbo fwlo ot eth y.indek)

nwinkelmann  Man... I took this WAY TOO FAR, lol. I totally didn't recognize the clue of GFR and RPF as staying the same to tell me it was talking about normal, physiologic autoregulation. Silly mistake! +5  
j44n  I agree. All I saw was a stenosed artery and ATII constriction +  


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

.U..gh gto ierdppt up hwti fre"Re obth ttniaep dan ehr asnptre ot a "caiineidt

eOrv .Inh.gkni.ti ghtutoh eth cseour of ihter amreungst rwee at emal mtsie yle.a.eolss.cpi ebaym hety can nfdi a doog luitnoso ihtw a dciieiant.

OAsMCC RZARO SHTI I.TSH peek it mlpeis isd.upt The rnawes sift the sbte freat re edinagr i.t

nwinkelmann  SAME.... ugh! +  
johnson  Also - you're almost NEVER referring/passing on a patient with the USMLE. +8  
bmd12  They are at meal times, which is why she's having difficulty following the prescribed diet bc her parents are arguing during that time so its difficult for her to correctly execute it when theyre constantly bickering, and bc she's only 13 so she cant effectively manage her diet without the help of her parents. And since the diet has been working with the patient prior to all the bickering, you can assume the diet is not the root cause. +1  
jamaicabliz  the universal constants: Death, Taxes, and never consulting the ethics committee +  


submitted by mousie(210),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

goilnok ackb ta this Q I itcneo that eth natitpe losa sha tnphnoyieser ..l.udoc ttah ehav eenb a cleu to iudclen teh AMS bc tsi os csloe to eht relan eiersrta Rn(ela a nsi?)tsose

nwinkelmann  I didn't know how to approach this either, but now this is my thought process: Patient has pain after eating. If it's not due to an ulcer (which is the only thing I could come up with because I didn't know what else it was talking about), why would eating cause pain? Well... eating causes increased GIT activity which means increased blood flow. As you pointed out, the patient has HTN and CAD, indicating likely extensive atherosclerosis. This is important because why would eating leading to increased blood flow cause pain, when usually it doesn't? Well... atherosclerosis in the heart leads to stable angina. This presentation sounds like a "stable angina" of the abdomen. +  


submitted by sajaqua1(518),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTe rwmaro wohss uscpserorr ot eyetr,oshtycr as llew as .tmayscoraeeykg Tihs is to hwos oyu taht eht ssuie n'sti dcdouneri,nrtuop iwchh seanm ttah we are ilosng CBR dan sltetaepl owmeheers ei coirsttude.n haTt esrul otu D adn .E Three is gotnihn ot antdieci hat het cdlih ash tdnsdsemiiea cssulebuorit B)(. At isth tpnio we rea felt wtih A or C. A lwuod acindtei smasidtnieeD vcrnrtslaauaI nlagatoCuio )DCI( ro igeonhmts s,ailirm wchhi dwlou eutlsr ni olw etalpstel adn RCB tub ew dwolu alos ees larmnabo RBC lkei cctheyitosss "eemt"h(l ecsll). eW era tliecyxlip odlt atht the tehorsyrtyce aer ncormrimcooh dna icmn.ryctoo voreHwe, ieunmm diustroetnc of alleepstt sailxnep ti lal- hte sdutoceintr of llaetsept dslea ot mseo nrgheimgahro adn so a rpod in RCB, dna ITP lsyaslcical aeisrs ftrea a terenc perpu sptoayierrr cattr iavrl t.enicnfoi

meningitis  Just in case anyone is wondering like I did, the low platelet count explains thethose multinucleated cells. They are Megakaryocytes in Bone Marrow Biopsy. +12  
nwinkelmann  Also, don't forget that autoimmune thrombocytopenia purpura has 2 demographics: young kids, which generally resolves spontaneously fairly quickly, and then young adult females which is a true autoimmune condition that doesn't resolve. Patient's age + thrombocytopenia + essentially normal rest of heme pannel = autoimmune thrombocytopenia purprua in child. +6  
abhishek021196  That is exactly how I approached this question. Normal heme panel and a decreased Platelet count in a young boy after an infection just made me intuitively select ITP. +  


submitted by welpdedelp(215),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

/32 215/ 41/

eH has a 32/ nechac of bnegi etrusoyegzho (ont 2/4 cb/ ew wkon he orf ruse ed'tsno haev FC)

/251 chaenc in eth tppilanuoo

41/ eccahn fo a uooytrzsgehe poeluc hvniga a hldci whit FC

welpdedelp  ok, so it messed up the formatting 0.66667 x 1/25 x 0.25 +  
nwinkelmann  ugh... I ALWAYS forget about changing the carrier status to 2/3. Chance of affected individual = chance of father passing allele * chance of mother passing allele = 2/31/21/25*1/2 = 2/300 = 1/150. +1  
zpatel  2/3(chance of heterozygous) * 1/25(meet carrier) * 1/2(chance of male to transfer affected gen) * 1/2(female to transfer affected gen) = 1/150 +3  


submitted by wonderboyg(10),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ihst tsinapte' esurtu aws caeersidn in szie rmpocaed to a 12 ewek setuu.r seh ahd preag ikel etrsusrutc adn on sfute. stih lduow atciiden a yfdimrtaidho lmeo. isth eaintpt sloa had no ltfea tsarp os it woudl be a meceoplt melo.

ndcoriagc ot ha,otamp a mhdtyfiiaodr omel is na roalnbm"a noitcncoep atrhceeradzci yb wesnllo nda uadomseet vlili itwh lrateoiirpfon of sroabhtsoptl"

osla ni a tlepceom m,ole most liivl rae rohpcyid adn btsprashloot lliw rfaoteliepr iflusefyd odnura ehtes dhiyrnoc lilvi.

eht lkseeihte maesss of oatnctilysrssobohtpy ludow iidatnce a ic.aicchmanooorr

nwinkelmann  Also, ball like masses of proliferating decidua, I think, means ectopic decidua, which can be seen in endometriosis, deciduocervicitis, and in the lymph nodes. Markedly dilated fetal blood vessels can be seen in rare complication of placentomegaly which could potentially lead to IUGR but could also result in a normal neonate. +5  
yb_26  @nwinkelmann no, ball-like masses of proliferating decidua are seen in endometrial papillary syncytial change +15  


submitted by sajaqua1(518),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

triiCacl npoist rfo hits so:ueiqtn 5 ayre dol ,oby osuesisunpdprmem bacuese of hheopytam,erc 2 day thosriy fo v,free ug,coh nrteshsso fo brh,eat eifelrb (0.181 )F, respirtnsaio inm,/64 iwth snicyoas nad nerledagiez iuscvlera h.ars vtxnseeEi randlou .innloiatftri

fO eht pstoino etilds loyn lsasmee and VZV evig a h.sar A hras rmof saemsle ylulusa ssttar oyllrsrta and denscdes l,ydacual and is lfta adn ur.htmteesoya yB ,ttncosra ZVV xpce)ckon(ih tspnesre whti zegereinald sarh htta lykciuq saotrinsnti fmor rmacual to lapprau thne ot u.cilasrev

sympathetikey  Good call. +6  
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5  
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5  
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +1  


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

eTh thing i,s the nlmhipsicotaa attrc scosrse 2 areetblrv eselvl pu nda hten eetcsdsusa at hte oareitnr hiwet semuorsmic to teg fomr eht gtrhi ot eth t,efl os hwo do I okwn ciwhh rlvreebta evlle 'dI be kriongw no hist yu?g

chris07  I think the assumption here is that we are dealing with the cord section at the level of the problem. The picture is incredibly misleading. You have to orient yourself. The dorsal columns F, E, A, B are facing the patient's posterior. Once you properly orient it in 3D space, you know that what's labeled "right" is actually the patient's left, and what's labeled "left" is his right side. Super confusing. +2  
sne  The input arises in a limb/part of body at the level of lesion, enters through the dorsal root (pictured between A and B), decussates and ascends at the anterior commissure, and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. So AT THE LEVEL technically would be in the dorsal column +10  
nwinkelmann  also, @chris07, I think you're wrong about the labels being wrong on the image. Becuase the spinothalamic tract = contralateral pain and temperature, and the patient's pain is on the right side, you would want to target the left spinothalamic tract for pain relief, i.e. the area labeled H. The area labeled D would be the right spinothalamic, purely because that is how the image is labeled. If you assume the label is different, you will get it wrong. +11  
kpjk  @sne I don't think entering from the dorsal root would be between A and B. It would be part of the gray matter so, lateral to B and F +2  


submitted by nlkrueger(42),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

.... lduow ew laeryl ktea het wdor fo a enfdri woh delfnityie 'ncat be mcn?rfodei I leef klie tshi si naidimselg

lispectedwumbologist  All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +9  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +27  
dr.xx  The patient has no wife, children, or close relatives... +3  
nwinkelmann  @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3  
paulkarr  With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1  
suckitnbme  I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +7  
vivijujubebe  they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +  


submitted by dr.xx(142),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Tmaternet fo cetua gtuoy r hsleviritaraetS sgrdu ear tfifeceve for inrgtemntia teh cueta oytug k.atatc lcCeh,inioc ienaotdonslr rt-minimoalntfyaa gurds sN)ID(A,S dna tcrdiorstoiscoe aer sdaatndr seahrp.paoc tiocoroccirpArtnode noomehr (CTA)H is saol revy fee,vcetif tub ash mobeec snirlgeiynac sccrea or oot vnepxseei ot be a ciltarcpa alvtnaierte in eth .SU glRseasred fo the tcaapiulrr eangt n,secoh het soreno seeht rdgus ear aser,dtt eth rome ipdra eth oeepssn.r If a entiapt tncnoa eatk sDSNAI or ,eocnilhicc teh ceciho is angmo oal,r ur-arncritaitla ro ereaaplrtn ooogcuctcids.rli lcaLo iotcapialnp of eic pcska mya lehp tolrcon i.apn nI smeo sa,cse ceaslnais,g igclunnid iosid,op mya eb dadde.

sDrug tath afectf umers ateur cctonntorisena G,(..E A,NLU)LLIPROO lnginuidc rarmticehypeniicu ategsn, solduh tno eb eadhng,c stadert, ro opptsde gdniur an aacktt, sa isth yma swnoer the lytmaonamirf snpeorse yarlaed in oes.rpgsr

w6mm.vihPint/i/tn93tcw2a/lersM/1wC3gop./nb.s.lc/pc:h5

nwinkelmann  Love the last quote/sentence from the article! So helpful for clinical decision making! +  


submitted by mcl(578),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

In acse uyo ananw go eprus nerd nad eard baotu meyiln, tpieac,nccaa nad ast,einsrec shit ugy esdo a oogd bjo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +21  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  
brise  Uworld 1318*** +  


submitted by joker4eva76(25),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hiTs is treaipvteneser of aopliklaeu,k a pucrar-csneoe leinos fo osqsmuau lecsl. nI dreor orf ti ot eprasd to atndtsi si,tse ti tums trifs deiavn hrogtuh the tsameben usb/armmabunceseom. ldCou be cseuodfn htwi olra haryi kkpuoleliaa w(hcih losa is a hwtei atcph htat ilscaalcysl eairss no eht earllat e.tgn)ou Hovreew, olra yihar keiullpaako si otn usec-ranceorp dna si notef tecsasdoia htwi VBE tsficoeinn ro leppeo ahtt ear ysverlee odommcmismponue.ri

hpkrazydesi  How did you know that this wasnt oral hairy leukoplakia? just from the picture? +1  
nwinkelmann  To piggyback off of @hpkrazydesi, you ruled out oral hairy leukoplakia because the patient was seeing the doctor for normal health maintenance, i.e. not immunocompromised, I'm assuming. +2  
dentist  @nwinkelmann thats correct! my time to shine. +  


submitted by hayayah(1056),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

X ni het gieam is hte aslml ieensntti. sIt teciahrscitcar eahtyefr enrpacaape fetra a mribau eaml is ude to epntnrmea ircrluca dlsfo adn il.liv heT villi gvie the lalsm teesninit a ergta acumlso eaucrsf ae.ar

nwinkelmann  Yes. The appearance of the mucosal folds depends upon the diameter of the bowel, and when they fold they appear feathery. Mucosal folds are largest and most numerous in the jejunum and tend to disappear in the lower part of the ileum. +  


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

yWh si this otn eicesdarn idnngbi of NAD eyrmelo?sap

iTsh toianumt ushdol acseu crllluea dvoniisi ei DAN aorpciitlne and usaec ednesriac bindgin ot orgnii tniroeailpc euesesnqc ie AATT by ADN .aleesompyr

brise  It's talking about mutations on the transcription of genes that inhibit the cell division. Also RNA polymerase binds to the promoter region. +  
nwinkelmann  Also, the question specifically (though in a very wordy, convoluted way) asked what the effect of the mutation on transcription was. DNA pol is not used in transcription, it is used in replication. RNA pol is used in transcription. In terms of increased or decreased binding, argining is polar/positively charged and proline is neutral/nonpolar, so there are fewer H-bonding sites, and thus decreased binding of the RNA pol. +1  
medn00b  Could this convoluted question also mean.......... that since the gene to make p53 is messed up due to the hydrogen bonds, RNA polymerase will not be able to bind to make the mRNA ... So there will be cancer? Because P53 is a tumor suppressor... lemme know thanks guys +  


submitted by keycompany(295),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Lodangi soeD is the olyn snarwe atht si npdinenetde of rugd eceaarnlc.

nwinkelmann  I totally get this and understand it... but at the same time, couldn't loading dose differ due to renal function if patient has nephrotic syndrome so had less plasma proteins, because it would change the Vd of the drug, right? Per wiki: Volume of distribution may be increased by renal failure (due to fluid retention) and liver failure (due to altered body fluid and plasma protein binding). Conversely it may be decreased in dehydration. +  


submitted by just_1more(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I otg atth it eended ot eb a osmtsaiup aipsrng ecrit.diu sI erhet a naeosr it coatnn eb na oesndltoera oaniats?gnt I secho lkcsbo arlbaetoals +K cnselnha sa seeht eecesrda teh alatrebsloa /A/s+e+KaNTPa eausbec the giownrd fo eth rtcecor wraens did ont akme essne to me -- mnissgua heyt ewre gngio for an aCEN koberlc nd(a atth esceddear imnlula ltpbiemeryia satneicdi htat aN+ ouwdl eb nnmiaiegr in het ,nluem nto iemginarn ni het appnrcili lecl as I roiiallgyn gh)totu.h

luckeroo  I think the reason it’s a potassium-sparing diuretic rather than an aldosterone antagonist has less to do with why the aldosterone antagonist cannot be used and more to do with the fact that a potassium-sparing diuretic would be more of a “first-line” adjunctive diuretic treatment. +1  
luckeroo  As for the answer choice, potassium sparing diuretics achieve their overall anti-aldosterone effect by competitively inhibiting aldosterone receptors on the interstitial side (decreasing the Na/K-ATPase effect of shunting Na into the blood), thereby decreasing the gradient for sodium to enter the cell from the luminal aspect, blocking ENaC. +6  
yotsubato  There is no such thing as "Basolateral K Channel" there is only basolateral Sodium Potassium Pumps which are controlled by aldosterone. FA pg 573 +9  
nwinkelmann  @yotsubato LOL.... why didn't I think of it that what?! (by the way, that LOL is for me). The only basolateral K channel is the nephron (based on the first aid picture) is in the thick ascending limb of the loop of henle. +  
hello  Spironolactone and eplerenone are potassium-sparing diurectics that inhibit the Na/K ATPase, so I'm not sure what @luckeroo is referring to. Spironolactone and aplerenone are both ALDO antagonists. Na/K ATPase is found on the basolateral membrane. None of the answer choices fit with this. Amiloride and triamterene are also potassium-sparing diuretics; their mechanism is to block ENaC channels on the luminal membrane, this is choice "B." +1  
rxfit  From Katzung Board Review: "Spironolactone and eplerenone are steroid derivatives and act as pharmacologic antagonists of aldosterone in the collecting tubules. By combining with and blocking the intracellular aldosterone receptor, these drugs reduce the expression of genes that code for the epithelial sodium ion channel (ENaC) and Na+/K+ ATPase. Amiloride and triamterene act by blocking the ENaC sodium channels (Figure 15–5). (These drugs do not block INa channels in excitable membranes.) Spironolactone and eplerenone have slow onsets and offsets of action (24–72 h). Amiloride and triamterene have durations of action of 12–24 h." So both K-sparing subtypes are technically correct. +  


submitted by seagull(1392),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Wyh onousteasp?n eH's anggigne in na acvtei orstp wtih an sicrdnaee kris of tauimaTrc nurjyi. So we lrayel ujst umases hes ont uidejnr cesabue eht esmt ondtes lidecrty yas esh' denri?uj eesTh iqonsutse adel to oto yamn ssus.tmaniop (in my pnni)ioo

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +  


submitted by d_holles(170),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

This tqeisuno seonfduc me cb I tthohug elopmdiear lcudo ont csros het BBB and eherretof oducl otn esauc yrtrsipaore eespdorsin oipmuo-d(i ngasmoi at eth nriesamtb sesulrt ni /iSrtoaspCrerNy pdsneeir,so 1). uBt x.rd@x si crocret ni nognti hatt ↓ RR nda SCN neriepodss ni hte tP uslhdo acll rfo na dmi-oipuo ignnsotaat rahter htan htlaebochn timolcniie(c)moh to ttrae tpi.otcninoas

  1. bs9giy7lpc?o:pr25hst/oaarl5adi.grtsnatehlxesie.cosa/t.e.=p6qthaus/0i
nwinkelmann  http://medresearch.in/index.php/IJPR/article/view/782/1271 This explains a case in an infant. "Respiratory depression and coma after overdosage have been shown to be reversible by injection of naloxone [6]. Owing to its structural similarity to opioid, loperamide toxicity can be reversed by using Nalaxone which is a specific opioid antagonist acts competitively at opioid receptors. Naloxone hydrochloride is usually given intravenously for a rapid onset of action which occurs within 2 minutes." +3  
yb_26  FA 2019: "Loperamide has poor CNS penetration" - so it still penetrates => can cause respiratory depression +4  
whoissaad  Also maybe because the blood brain barrier in a baby is not developed as well as in an adult. +4  


submitted by drdoom(805),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

sr’eeH rhtonae rvye neci neo ttha rsoipspseume teh tyhaawp tono a dmiisilpef ntmeriabs niadgrw ci(en orf het iaaatonclm otsenila:)r

mwu/-hareF:uayeGL.y2.du-we/n/52feisaebshesposg-o./R/tOhtINpcigei/c.t2eop

rocSue :iectrla

ellubo.pp2enrhs:yto/.ttr.mma.rspget2omseiluac/5e/euhueno-hhpyaadctfewhioi/w/ahet-e

To see neve oerm, try glooeg aeimg rashce no dael“mi oangniudtlil ua”fsuicscl:

w+solaaacid.isra;s=tctliid.up+fgnme/gsqmioomgol/cmhctte&/hep?u:nw=wlhcalbus

endochondral1  what is A and B in this pic? i knew it was dorsal pons ipsilateral but i just didn't know what part that was on the pic? +  
nwinkelmann  A and B are the superior cerebellar peduncles.http://what-when-how.com/wp-content/uploads/2012/04/tmp15F2.jpg +  


submitted by shaydawn88(8),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I uldow hknti oourlstnie vlesvnio het mtes cells ty(ep II u.)psceytmnoe Is het ncaitt beaesntm ebmernma eht srewan seuecab it iismtl psdera?

aesalmon  I would also like to know if anyone can answer this question - I saw it as a Sattar "one day, one week, one month" kind of question. Its probably very simple but I still don't get it +  
bubbles  I posted a new comment explaining: basement membrane integrity is the strongest determinant of full fx recovery following pulmonary insult :) +5  
drdoom  You have to think about it this way: the basement membrane is the “scaffolding” on which [restorative] healing occurs. So, yes, stem cells (type II pneumocytes) would be involved in that healing process but they couldn’t restore the *normal* architecture (“no abnormalities”) without the ‘skeleton’ of the basement membrane telling them where to go, in what direction to grow, which way is “up”, etc. If the basement membrane is destroyed, you can still get healing, but it won’t be organized healing -- it’ll be *disorganized* healing, which does not appear as normal tissue. (Disorganized healing is better than no healing, but without a BM, the regenerating cells don’t have any “direction” and therefore can’t restore the normal architecture.) +8  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  


submitted by drdoom(805),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oYu evha ot iknth taobu it tihs yaw: teh eensbmat bermmane si eht ”icflgodsfna“ no hwihc [rtoesarviet] inlaehg ucor.cs ,So ,esy mset clels yte(p II nospcu)eyetm duolw be dvonvlei in thta ihaenlg socreps btu ehty tnuo’cld eeostrr teh moraln etccitreurha o“n( aaltn”)iribomes iwuotth teh ’ols‘enekt of eth saenmebt ernebmma eltginl mteh eehrw ot og, ni ahtw ntiocdrei to ,wgro hhciw way is pu“,” cet. If eth matesbne aenrmbem si tdye,rsdeo oyu nca isltl get a,hilegn btu ti nwt’o eb niazdogre nhiagel -- l’itl be riaddignozes ,ganhile chihw dseo ton aearpp sa mnolra ses.iut znroisiaDd(ge leihagn is rbeett atnh no ,leiahgn tbu tuhtoiw a M,B eht eegtgarnrein ecsll nt’do aveh nya ”irdit“neco nad eorhfreet a’tnc erroset eth morlna hre).eutctiacr

drdoom  by "restorative" i mean healing which restores the previous (and normal) tissue architecture. for that to happen, you need an intact basement membrane! +2  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  


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

hyW sntwa’ hte elbta hognue to itneemedr paelcrneev in eth aeelngr piputon?ola

sacredazn  For the case control question, it’s taking that principle that you can’t use case control studies to calculate relative risk and applying it to prevalence. Basically with case control studies we start by saying okay, I’m going to find 200 people with sinusitis and 400 without. Then, you go back and look at the number exposed/unexposed and calculate the odds ratio. So you can’t use case controls to calculate prevalence because it all depends on how many cases you picked in the first place. Might make more sense to think about it with a rare cancer like craniopharyngioma or something- let’s say you chose 10 cases and 10 controls and wanted to look at how many people smoked. It wouldn’t make sense to then say the prevalance of craniopharyngioma is 10/20 = 50%. +20  
dr_trazobone69  Thank you, that makes a lot of sense! So we can use relative risk (cohort studies) to calculate prevalence? +  
sacredazn  @trazobone Hmm I think the wording would be key, you could use a prospective cohort to calculate incidence, but you wouldn’t be able to find prevalence of the gen population unless you had more info. I think the concept is that really to calculate prevalence you need a proper ecologic study looking at population-level data. The way it was worded in the question was tricky though lol since when has “cannot be determined from the info given” ever been a right answer. +5  
nwinkelmann  @sacredazn thank you! this was the best explanation to use the rare disease comparison. Made everything make so much sense and hopefully I'll actually just remember it now, instead of learning the factoid and failing to recall it all the time. +1  
hyperfukus  i guess this makes sense but i don't understand why we are asked to calculate it from tables like this then? is there more info in those? +  
hello  @hyperfukus The table was given because that a 22 table is typically what you do see regarding data for case-control studies. If the 22 table wasn't include, then literally everytone would pick Choice "E" as the correct answer b/c you can't calculate something without being provided numbers. The difference in including the data-table is that 1. again, you need to report a 22 table because that is typically what you will see regarding data for a case-control study and 2. by including the 22 table, it actually tests if the test-taker realized that the data in the 2*2 table does not help at all with calculating prevalence-- because case-control studies NEVER report on prevalence. +  


submitted by niboonsh(336),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cna emnseoo pailenx het fcenideerf enewetb .C lsaere(e of odster ohidyrt rooehmn ofmr a ohtyrid dnalg tiirtnldfae yb tlcspyeyh)mo nda .D elaR(ese fo rhtiyod ohrneom fmro a yoahsmupoltm hyrodti .ngdla

drdoom  @niboonsh, ending a comment with a question mark will make it appear on the "comments seeking answers" lists +4  
nwinkelmann  A lymphomatous thyroid gland can either be due to primary thyroid lymphoma (which is almost always NHL, but is very rare) or due to Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. These, I believe, would still present with hypothyroidism, and thus would have low T4 and high TSH (opposite of this patient). +1  


submitted by someduck3(58),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Fta oullsbe ivmatins ear .,KDE,A, oS othb D ;&pma E coldu eb saecreded in shit .pt utB oyu eahv to nkwo atth tnaiiVm E yicfceendi si eaicstosda whti oiniytdealnme ;apm& has nbee asstdaioce hiwt oispertor lumnoc m.aeoiydteninl lAso itV E nac eb ienvg thiw hlriemeAz aptietns sa ti hsple hiwt free a.ricla?ds.

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration: https://www.ncbi.nlm.nih.gov/pubmed/9012278, as does Copper (TIL): https://www.ncbi.nlm.nih.gov/pubmed/15249607 +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +  


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

heT coeptnc is a doolnvceut awy fo gnaksi fi uoy nkew who VDJ ombnteionairc ,rwsok whhic is taht it is tlualcay na lxapeme fo alrgtine het DNA fo eth /BT hoelycmy.pt

utnSoehr tlob ihc:tequen So enwh tyeh esu a orebp gatinsa moes ing,oer adn tnptutgiou a szei fo 1.5 kb ro 6 k,b stih is ligetnl you het isez of the DAN agrnetmf in cahe cell o(’esdnt rmaett fi ythe ysa J brepo or tcsnaotn noirge ebo,rp yheer’t tjsu ngsayi ’eetrhy grantgite meos eoldncteui nqeeusce dfnuo in the Ig soc/TCRul teba ciahn uclso ivleryceetps orf T/B )lslc.e

I tikhn the ncgiunosf ptra doulc be rnegiodwn woh oyu owkn weehthr ’oeryu tryapl thurhog aermnrtaneger (wneras coceish B ruth )D or fi ti tsnha’ rcrodeuc ta lal yte ccertor( enr.)saw H,eer teh ptencco si atht B cells dnerugo VJD)( enreaeramrgtn in hte beno ,arormw lwihe T cllse do ti in eht s,ytmuh dan it lla nhepspa ta .ocen So a laamsp elcl ni het dloob iekl in Mlpuietl Mlaomye udowl veah uflyl egnerodun ,oaicimnebtorn lwhie a T clle in eth obdol olcud ireeht be fluly tdueaced d(an evah nfidiesh DJV onbomtiarnc)ie ro marimtue hst(n’a ttsdaer ).DVJ

neSci teh T lcel neeg saw 6 kb adn ienifdltye rgbieg athn hte 1.5 kb e,eng hte T lcel ah’tsn ndngeoreu eioctmiobnarn 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 skraniotis(10),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

inzadUeydl lenar erilafu saedl ot omteibacl dsiasio,c dan sa a srutel irbcab tges eeddeplt sa it irest ot frufbe the aamulticnouc fo niarogc asidc.

bubbles  Thanks for the explanation! Do you know why Mg would not be a potential answer? Phosphate also accumulates in those with undialyzed renal failure, so I was thinking that maybe magnesium as a divalent cation would complex with PO3 (in a mechanism similar to Ca). +  
nwinkelmann  From the little bit of research I just did (because I didn't learn anything about dialysis at my medical school), ESRD can be associated with either low or high Mg levels, so the dialysate can cause either increased or decreased Mg levels depending on the patient's serum content, therefore I don't think based on this question, would could determine if removal of dialysis would lead to elevated or decreased magnesium. The end of the first article seems to favor ESRD leading to hypermagnesemia, so if that's the case, then removal of dialysis would cause Mg to increase as well. https://www.karger.com/Article/FullText/452725 and https://www.karger.com/Article/FullText/485212 +1  
hyperfukus  why is it that we aren't learning this stuff and they r just throwing it on step there's barely a blurb in FA about ckd/eskd +1  
hyperfukus  does uremia potentially have to do with this? +  
medulla  ESRD and not getting dialysis -> he is uremic -> met acidosis -> dec bic +10  
angelaq11  @medulla this is the best and simplest explanation. I got it wrong and chose Mg, wish I had made that connection. +  


submitted by bubbles(66),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Cna nesomeo inlxaep relppyor who ew nwko atht shti atrit oswllfo elndaeinM igecnest nad si aaltoumos secreiesv nad frthmurereo ohw eth retpans erew so?egueyorthz

I esedugs a tol no tshi ieqnuost nad gto kulcy :(

niboonsh  Autosomal Dominant disorders usually present as defects in structural genes, where as Autosomal Recessive disorders usually present as enzyme deficiencies. P450 is an enzyme, so we are probably dealing with an autosomal recessive disorder. furthermore, the question states there was a "homozygous presence of p450.....". In autosomal recessive problemos, parents are usually heterozygous, meaning that 1/4 of their kiddos will be affected (aka homozygous), 1/2 of the kids will be carriers, and 1/4 of their kids will be unaffected. +36  
nwinkelmann  Is this how we should attack this probelm?: First clue stating endoxifen is active metabolite of Tamoxifen should make us recognize this undering first pass hepatic CYP450 metabolism? Once we know that, the fact that the metabolite is decrease suggests an enzyme defect, which is supported by patient's homozygous enzyme alleles. Then use the general rule that enzyme defects are AR whereas structural protein defects are AD inheritance patters. Once we know the pattern, think that most common transmission of AR comes from two carrier parents. So offspring alleles = 25% homozygous normal, 50% heterozygous carrier, and 25% homozygous affected, thus sister has a 25% of having the same alleles as patient (i.e. homozygous CYP450 2D6*4)? +6  
impostersyndromel1000  we had the exact same thought process, so i too am hoping this is the correct way to approach it get reasoning friend +  
ajss  thanks for this explanation, I totally forgot about AR patterns are most likely enzymes deficiencies, this kind of make the question easier if you approach it that way, thanks +  


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

lkeAeongdwc eht anp'tties itculyf.ifd I thea ehste niteoussq

nwinkelmann  Me too... also, he's had cough that's worsening for 6 months plus hemoptysis for 1 week... I didn't interpret that as "feeling healthy." The correct answer was my first choice just because it was the least "dick-ish" but to me, he didn't sound like he "felt health," so I didn't go with it. +1  
nor16  if he didnt feel healthy, why would he say something like that then... but i agree, these (especially this) question(s) are often XYZ123! +1  


submitted by naughtyegg(15),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

gelDnnwgratuio earndchiE- si hte itfsr pset cnrace stkea toawdr esatamssit bcueesa wlo n-Ercahide lehsp nideav the nseetbam rmbmeean -&g;t uylvealtne laeds ot seadpr fo eacrcn re.hseewle namiiLn si asol ovndveil tbu nidgoacrc to athapm,o enrcca lilw llyctuaa htcata ot iimannl ni odrer ot drotyse eht nebmtsea .aemmbern kdI fi poeerctr puto/reglonnuadwi ,hppesan htat ghimt eb a .thtrces

nwinkelmann  It makes sense that a tumor cell would increase their laminin, as opposed to decreasing, if attaching to laminin is what allows the cells to destroy the basement membrane. The more laminin, the more destruction possible. +  


submitted by rajkamal17(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tetryP eurs ’mI siginms othimnges siabc rhe.e ishT asw CSC nngiiavd matesnbe aemnemrb ficdeaatitl by t?awh heT newars is rdwnotieualong of n-iEhaecdr but I tghohtu ’athst for meassasttset F(A 18 sasy os t)o.o I cikted easedecdr ianmiln teoecrprs i(eror)cntc ocz ailnmin asw nuofd in mesnteba emba.enrm tA selat hatt aws my ingrsan.oe Ayn pleh depraa.etpci hs!nTak

naughtyegg  Downregulating E-cadherin is the first step cancer takes toward metastasis because low E-cadherin helps invade the basement membrane -> eventually leads to spread of cancer elsewhere. Laminin is also involved but according to pathoma, cancer will actually attach to laminin in order to destroy the basement membrane. Idk if receptor up/downregulation happens, that might be a stretch. +15  
nuket0wn  per medbullets, there are increased laminin and integrin receptors. Also upregulated MMPs (matrix metallo-proteinases) to breakdown the basement membrane. +1  
nwinkelmann  It makes sense that a tumor cell would increase their laminin, as opposed to decreasing, if attaching to laminin is what allows the cells to destroy the basement membrane. The more laminin, the more destruction possible. +  


submitted by airhead5(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oDes naoeny wokn eth isaesde hyte are kglinat o?atub I swa iinhtnkg ulpsu iwhhc meska eenss whit eth ,answer but i n’cta difn ihtganyn on iaenrrot rbacmhe of eey and hrcdoio lxues.p

liverdietrying  It's lupus, all the symptoms listed are classic especially the serositis. Anterior chamber of the eye = uveitis. Choroid plexus = cerebritis. For a great overview, check out this (free) video: https://onlinemeded.org/spa/rheumatology/lupus/acquire +5  
in_a_pass_life  I think this was reactive arthritis, not lupus. Choroid plexus not just in the brain, also in eye (can’t see, can’t pee, can’t climb a tree). Mechanism of reactive arthritis is immune complex deposition, per UWorld, which was correct answer. +5  
trichotillomaniac  The inside of the eye is divided into two chambers: the anterior chamber and the posterior chamber. Both chambers contain fluid, and when there’s inflammation in the eye, a specialist can often see inflammatory cells in the fluid. https://www.hss.edu/conditions_eye-problems-lupus.asp +  
trichotillomaniac  I agree that this is Lupus after doing some more research! +1  
nwinkelmann  I find this article describing the SLE ocular manifestations, including uveitis and cerebritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908056/ Also this talks about the lupus cerebritis (choroid plexus inflammation): https://en.wikipedia.org/wiki/Cerebritis +  
medulla  every time I read about Lupus there is something new!! +1  
aakb  woman of child bearing age + serositis + arthralgias/arthritis >=2 +  
aakb  kidney issues (main cause of death in sle) +  


submitted by the260guy(11),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

uBt rehse' ym lorpmeb itwh htis sutqoen:i it yssa hatt seh hsa a 5 ady hstroyi of BOS dna nllsowe el.gs oS vbsuliooy het erath is iflg.ina I pkdeci eedDascre oktreS oeulmV for atth ao.senr

nwinkelmann  AV fistulas are one cause of high-output cardiac failure. This person presents with heart failure, but it is due to chronically increased resting CO. +2  
lukin4answer  @nwinkelmann yes thats right, he has failing heart. but question is asking what is the finding of this patient, I understand the cause is Fistula causing high output failure, but they didn't ask the reason of his HF, they are asking the finding. I choose decrease Stroke VOlume :/ +  
happyhib_  This was my logic and got to decreased stroke volume as well; they arent asking what caused his HF or anything it says what is the most likley finding in this patient. If his heart is failing due to LVH from consistent increased CO wouldnt he AT THIS VERY MOMENT WITH his heart failing have decreased stroke volume?.. +  


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

aliznetdio errefpdre eud ot eignls odes

sweetmed  or metronidazole +  
niboonsh  what would his diagnosis be tho? +  
lostweightthxnorovirus  @niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good! +1  
nwinkelmann  Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA). +8  
mannywillsee  This little bug has has a face, and now you can't unsee it either! +  


submitted by hungrybox(963),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eaGrt voedi I udse ot ernla shit tlimrea.a

  1. Trhee era 3 mroja espty fo :surdg uesprp st()siun,amlt wroedns dpn)ee,astssr( nad gncauohis.llne
  2. eiorHn is na dp.ioio ipdOios rae rewd.n*so
  3. esrnwoD od awht ti suonds e.kli heyT uscae n"od"w smomtysp: rdddoe/seeniscatae atenixy (dan tshu riabeoavhl idhninii,btois) reryropaist snesp.odire
  4. Tshu whlrtwdiaa illw easuc het epsot:ipo aeinyaehcar/d,pihyctsonrt entx.iay
hungrybox  *other downers: alcohol, benzodiazepines, barbiturates +2  
nwinkelmann  THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +  
qball  I get that this is a good rule of thumb to help narrow down between alcohol and heroin, BUT is still not enough to answer this question. Some key features for depressants (downer) is alcohol (if we are talking mild withdraw) - tremors , diaphoresis and delirium (heavy withdraw) . For Heroin - Dilated pupils, yawning and lacrimation are key exam findings. +1  


submitted by hayayah(1056),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

btAoslue rk:si teh feeerdinfc ni srik ont( eth otpnprio)ro aultteiabrbt ot eth evioetnnnrit as cepomard to a co.orltn

).(21 - 40.() = 8.0

RAR = %8

nwinkelmann  This isn't actually correct. Absolute risk is actually just the incidence, or the same as event rate. Absolute risk reduction = the difference in risk (not the proportion) attributable to the intervention as compared to the control, and thus ARR = incidence unexposed - incidence exposed x 100%. In this example, the incidence of exposed is the incidence in the new treatment group, and incidence unexposed is incidence in standard treatment group. +11  


submitted by asdfghjkl(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

onAyne nwok hyw FGI1- onu'wtdl eb ednscaier as llwe? HGHR si itlmdsuate in michcypyegol ea.stst

nala_ula  Honestly, it's something that has confused me for a while. Why is it that GH secretion is stimulated by hypoglycemia? I mean, it's literally called growth hormone (for growth!), and hypoglycemia, which is basically a "starvation" state, will stimulate this hormone? +  
shaeking  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529368/ This might help answer your question. I basically didn't pick IGF-1 because it would increase the uptake of glucose leading to a worsen hypoglycemic state. Didn't have a true reason otherwise. +  
temmy  IGF-1 is regulated by insulin. so it will be decreased because insulin levels are also low. +2  
nala_ula  thank you @shaeking! +  
nwinkelmann  I found this and it also explains to a more genetic/cellular level. Essentially, it says that starvation induces some factors that cause GH resistance and IGF1 suppression. +1  
nwinkelmann  Sorry forgot the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575072/ +  


submitted by asdfghjkl(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

yoAnne nwko yhw FI-G1 'wdtnoul be ndreescia as wlel? HHGR is ulaiestmdt in ogciycmheply teta.ss

nala_ula  Honestly, it's something that has confused me for a while. Why is it that GH secretion is stimulated by hypoglycemia? I mean, it's literally called growth hormone (for growth!), and hypoglycemia, which is basically a "starvation" state, will stimulate this hormone? +  
shaeking  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529368/ This might help answer your question. I basically didn't pick IGF-1 because it would increase the uptake of glucose leading to a worsen hypoglycemic state. Didn't have a true reason otherwise. +  
temmy  IGF-1 is regulated by insulin. so it will be decreased because insulin levels are also low. +2  
nala_ula  thank you @shaeking! +  
nwinkelmann  I found this and it also explains to a more genetic/cellular level. Essentially, it says that starvation induces some factors that cause GH resistance and IGF1 suppression. +1  
nwinkelmann  Sorry forgot the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575072/ +