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Welcome to paulkarr’s page.
Contributor score: 54

Comments ...

 +2  (nbme23#24)
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nirCohc Mngsyoeuloe kLuimeae sv ieukedoLm aontRice has a few rgeeditnatfiinf :saerfeut

  • iioBhslaap acn eb ense in vfelMleiaieprooyrt ieadesss suhc sa CLM. owHere,v tehy rea nto enes ni eomkedLui neoactsiR.

  • uLeokycet neiAklla aheshsoPatp L(PA) is etfon etdeaevl in emudLieok neocaRtsi. uBt it lliw be seaededrc ni MLC seuabce bmlarAon lclse dot'n mkea the amlorn .mnzeey

  • eDlho dBesoi ear ciirtcshetrcaa of ukieoeLdm Rietnsaco. otN esen in CL.M

As usmvhym niptdeo tou 9A2-F10 pg 424 sah all thsi fnotamiirno as lwel as WdorlU orI.p.mb.le usjt ntc'a mese to fidn the .QDI. baMey nesoemo eesl can gta-aemt n.i

thotcandy  LAP 100-249 do not fall into the answer choice but would still be considered high value and thus +LAP to indicate leukemoid. A LAP- would be in the normal values which is 20-100, not below 250 like the answer choice indicates. +

 +5  (nbme23#37)
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I hda a pytret trshgiat wdfrrao elin of nkitingh rfo s.ith oClo esdliordco lge atulcityaolma slrue otu eslmrobp elehwseer (all eth inarb tlrdeae ecc).hsoi eW nwko odolb sha been tuc fof to hte flet foot. alyifccSliep, heter si an ulmsboe in teh aairletr odlbo plyusp. esn(Vuo uodlw dela to a marw o)tof

If uyo kaet iotn ctoucna het utaec isepdsoe fo iplaitntopsa, ti is easlpblui to inthk ttha seh had some rsot fo bAi-F grieitgnrg a oodbl octl ot aebrk fof adn be ntse hhutorg het etyimscs cla.ctniuior It then ogt lgdeod in eth olrfmae rytare gttucin fof opor 'asg-m bod.lo

 +2  (nbme23#22)
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cliVsrea iesnmiaasLihs ak.a "-KazaarlA"

Cseuad yb Lsnmhiieaa Doivanon. (na ilrearcltualn apotzon)ro

maredttnTis avi eth ntohbmlPoeei Sadn yFl.

Ttdeare thwi phbolAmiretre B. anC aosl sue udoSim t,ecabootSuginl ,flntieeoims or caormonpymi.

lilW mymconlo be esen iwht tnepoanapicy, ,fvree nad soeyaelgpnml aer eht erthe big clus.e theOr stmmosyp uoy can ees aer igtnh setsw,a knngeiabcl fo the i,nks yslca kns,i aweksn,es and astuasbnlit itgwhe o.lss ihTs lliw lkli ay fi ouy tn'od gte tmnte.tear

usmlecharserssss  i got 2 leishmania questions 38 and 39 in 3rd block , both got incorrect because i thought no way they can do that ((((((( +6

Subcomments ...

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oS a esmiplr ywa tnha lal hte amth ebing odne si eartdsgunnind ahwt IC snaem.

IC - agrne fo eavslu nw/i hicwh eth uret nmea fo teh ntaolopipu si cdeeeptx fall

oS a CI of 59% wlli be meor eespirc dna aehv a narwro rneag cmaepord to a CI fo %99 lwli eb essl ipesrec scaeueb sti nugcnidli roem slvaue ni dna ustrle ni a eriwd nae.rg

oS if CI fo 59% is 011 to 116 tehn a CI fo 99% has to be a ragen atth si rd.e.iw. 801 to 811

paulkarr  Glad I wasn't the only one to solve it this way...didn't even think to bother with the calculation. +2  

submitted by sajaqua1(518),
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tmnaGsic,oaey spdier mionat,gaa nad gmsdnayiopoh a(s ellw as plarma hetramy)e are lla nsigs of sexcse .oerestng heT reliv ni etspatni whit tapecih eadsies is imriaped adn os nacotn caerl roseegtn ufycilsin.tef iSx 21 zo bsere adiyl 2(7 oz, or afhl a ga)noll is too mhc,u and si idotnrgesy ihs elivr.

uslme123  No hepatosplenomegaly, ascites, or edema through me off. We that being said, I shied away from cirrhosis. I thought that he showed signed of depression, so I went with the thyroid. But who's to say he isn't injection anabolic steroids?! +5  
catch-22  The principle is you can get liver dysfunction without having HSM, ascites, etc. Liver disease is on a progressive spectrum. +12  
notadoctor  He likely has hepatitis B/C given his history of intravenous drug use. I believe both can have liver dysfunction but may or may not have ascites, whereas the type of damage we would expect from alcohol that would match this presentation would also show ascites. +  
charcot_bouchard  For Ascities u need to have portal HTN. Thats a must. (unless exudative cause like Malignancy) +2  
paulkarr  For anyone who needs it; the FA photo is kinda burned into my mind for these questions. NBME has some weird infatuation with this clinical presentation.. FA (2019) Pg: 383 "Cirrhosis and Portal HTN". +4  
snripper  @paulkarr the problem was that the FA image was burned into my mind so without no ascites or edema threw me off of cirrhosis. +  
tyrionwill  cirrhosis doesn't present hepatomegaly, instead, the liver could be shrunken. +1  
avocadotoast  Cirrhosis (most likely due to alcoholism in this patient) leads to an increase in sex hormone binding globulin, causing a relative increase in estrogen compared to androgens. Cirrhosis doesn't always have to present with ascites and adema. I agree with @catch-22 that liver disease is a spectrum. This patient does not have ascites because his liver is still able to produce enough albumin to maintain oncotic pressure in the blood. +1  

submitted by sympathetikey(1248),
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ynA imte ouy see xdefi wdie titiplnsg fo 2S, ahsms ADS.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +  
need_answers -smash, smash, smuh-ash +3  
usmlecharserssss  with airpods in 2012 +  
paulkarr  Low key was hoping for someone to try and argue this one... +  

submitted by water(33),
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uilinpssryg,r I cultalya enaledr this from hte agicM olScoh suB nhew I saw a T'thsa hte nylo renaso I got shit ghri.t Tskhna M.s zFre!zli :D

paulkarr  She taught me more than my med school professors did... +5  
painintheash5  ahahah i remember that episode! +  

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epordCloilg pnteserv etpatell rogtnagagie by nlcobkig het APD p.tcerroe The PAD ecporert is ahwt si esebnsrplio rof iunpgtt IGIp/IabII trcorseep on eht aucsref of t.tasellpe Wottiuh I,bp/IaIIGI eht tsleeltap actnon gareagteg eorhtgte.

paulkarr  Just adding that Clopidogrel irreversibly inhibits the P2Y12 receptor. This can be found in FA2019, pg 403. The other drugs in this category are: Prasugrel, ticagrelor, and ticlopidine. Ticlopidine is famous for causing Neutropenia and having an increased risk for TTP. +2  

submitted by hello36654(5),
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I rutdsnadne wyh i'ts ngul w,on tbu I dcikep riodyth nadgl because ntfoe imste hdytoir omturs rsesp on het ardrpthaoiy tntigis evboa, whhic sseuca teh orapdhyritas ot rtcesee rome C...aacn meoeons motncme if eeyh'tv drea tsih ot?o

paulkarr  I personally have not read that, but I wouldn't be surprised by that fact. I think with these NBME problems though, if you can get the answer within one "step" that should be your choice. Here you can just go Squamous Cell Carcinoma with a direct action on serum calcium levels (via PTHrP). Thyroid requires a few more steps, (assuming your statement is true) so in the eyes of NBME, it ain't gonna be the right choice. Always follow the "KISS" logic! +1  

submitted by nlkrueger(42),
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hwy ti,'sn 0%" sstbla no the peialeprhr smear" ?gthri is sthi het nnhisudiiigtsg ueurft ofr ecaut emau?leik

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  

submitted by chris07(54),
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'mI egsngsui ttha isenc isht is othhsiams'o htta a bopysi fo eht ihyrotd woldu owhs teh rdtiyoh dngal etmleolycp egulfned by kgtactian hylotc.espmy Orve meti tuhho,g ltoduw'n het rydthoi be elotycmlpe dtedroyse adn fot?iircb

dr.xx  Progressive thyroid cell damage can change the apparent clinical picture from goitrous hypothyroidism to that of primary hypothyroidism, or "atrophic" thyroiditis. The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. +  
paulkarr  I was thinking that "Diffuse fibrosis" was trying to point to IgG4 Riedel Thyroiditis rather than Hashimoto's. +6  
spow  It's only been 10 months, per the question stem. This probably isn't long enough for fibrosis to be correct +1  

submitted by sugaplum(323),
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ihsT si liosidcuur but I oucld evern keep esteh tsatighr te some ym :alymf i
Ache y aadgnpr eeMnrty
eDpo ocusni VT hwit a idse o*H (wh'so nmaes rea ujts nilt)iias cNS
nUlce nad atun eahRp nda raas oCsni u yaGbb aswyla sireagnmc a-aaNN-N
ienpor dmrenis me of eth lrooc eb,ul os scolu slcreuue

paulkarr  LOL. Achey Granpa Meynert. I'm gonna steal this from you. +  
abhishek021196  Achey grandpa Meynert = ACh / Basal Nucleus of Meynert Dope Cousin VT = Dopamine / Ventral tegmentum, SNc Uncle and aunt Raphe and Sara = Serotonin / Raphe nuclei(medulla, pons) Cousin Gabby always screaming NA-NA-NA = GABA / Nucleus Accumbens Norepi = Locus ceruleus. +1  
llamastep1  Amazing +  
mnemonicsfordayz  ACHey GRANDPA MEYNERT TREMBLES in the BASEment; DOPE cousin VT SNaCks DOWNstairs by the kitchen TAP; NANA GABBY ROCKS and ANXIOUSLY cooes...; "NENENENE... NENENENE...NENENE...NENE" to CRYING BLUE-eyed baby ELSIE; aunt SERO and uncle RAPHE DULLY PARK in the DOWNpour. CAPS = relevant info, lowercase = irrelevant. Includes diseases: DOWN, ANXIOUSLY, CRYING, DOWN = anxiety/depression; TREMBLES, TAP, ROCKS, PARK = movement disorder; GRANDPA = Alzheimer's. Note: ELSIE = LC = Locus ceruleus +  
mnemonicsfordayz  The extended "NENE" series is just for humor - shorten if you like ;) Also, ANXIOUSLY applies to both NTs in that sentence: GABA and NE. +  
castlblack  I use AChoo meynose +1  
faus305  I almost didn't even look at this review but then I thought "maybe someone has a cool mnemonic." and would you look at this. +  

submitted by nwinkelmann(282),
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o,S ofr mose srae,on mtrnnrtsurteaeiso is mehogtisn 'veI LASAYW tresgludg th.i..w brplaoyb cuseabe I nt'aws tthuga it ewll so ernve eralyl aerendl it, utjs aleedrn gneuho rfo hwevetra emax. I tjus nfudo stih boo urghtho IBCN nad sti ATFICANT!S tI's fomr 0102 so mtihg be o,ld tub ti saw rgtae. oYu acn recahs thugohr eht obko and nifd hte rpha.ctes I ttyerp mhcu jstu etwn thhgoru all fo the turienretnotsamr te.chapr kmbivnbw.wNnh0h9..op/t9//o17slKo/i:s/gnw.Btc

yM mnai ye:m tGeaau-ataswtalk = arjmo etiyxrctoa .unteerianttrorms oTw etspy fo rrt:1o) cseep tabictmo,preo stmo fo ihwhc rea epraysictpn Gi chhwi adles to cderedsea MDNA prrceeto caiivytt nad kisr of itioxoicxytcet,i or ypnapoisttsc qG epscroret thta adle ot caeesnir ,aN+ +,K and deearedsc atgluamte suscea adazloiieoptnr nad icdnaeres ++Mg csipmdneaelt nda DNAM ceertpor tyiacvit dan skri fo ioie,cxttxtyoci dan 2) oinoprtico lcsahenn iungcdiln AMND nda iaP/AntkeAaM scne,hlna hchwi all olalw piscocfnien aoicnt uinlxf, tbu ynol NAMD wlsloa aC++ unxfil and( oyln ni a voatgle eednpednt enmanr eafrt ftseiuifnc epldatzoaiinro hsa deipldsac eht btonihrii ++Mg ion ni hte haeln).nc

ABGA dna ilneycg = iohribyint .miaserttrentrunos )1 BAAAG- dan GAAC-B = rpoointoic slcannhe atth dela ot xufel fo C,-l dan ideepts shit cnusgia itooe,pznraldai hte rnuone lslti tyssa eblwo iersngt p.neiltato -ABGAA iidnbgn iste rfo uisarabbr,tet se,droist BGA,A and iitoprnocx = dineis rope of .lhncena -BAAGA igdibnn tsei of pizaeienobesdnz = stiueod of rpoe of nnl.eahc 2) iycnlGe nhalnce si a rvye iarmils Cl- ulexf enc.lanh )3 G-BAAB si a aboipmeocttr chennal tath acesatitv iG ilngade ot ecdesared PMcA whhic tsctavaie flefxu K+ slneacnh nda niibtshi ++aC nxlfiu hlcnsaen dagieln ot ap.znoapiriorehylt

icngBieo smaeni = ostcelhicnaema mnapedoi idonnc(ratooi of body ,enemmotv dawr,re niotm,tvaoi tr)inmoe,refnce inirpenoehnerp ls,pe(e waslsefenu,k ote,nitnat dinfege rh,ieboav ieipeenrnph e(owlts cantonriceotn in ,CSN) ulsp rionsonet (l,epse ekus,slfnaew dene,iossrp tax,enyi snaau)e and miseahnit aar,os(lu oi,anettnt ,lgayerl seusti a,damge dna yma ucneefiln obdol rnaib wflo.) yulOovb,si lla fo tshi si in aitiodnd ot earcigdren onntismrrasnusioe nda glith,f fithr,g adn itfgh esperons.

TAP and heort inuspre = cxoytiaert siroanmntssi, rceoea-lesd with rtoeh -ollceslulmame idonenAse 'ntis caislaysllc nroeeisddc a tretretsounmiran aseceub it sti'n oeesrsrdla/edte in ++aC edpnedent a,ennmr tbu ddrieve omfr TAP febreo haivng an etotcryaxi tet.ionpla

lAlhyteoicecn = armjo ttenstmrrruiaeon nvvlidoe in irsmronuotnenasis iva isumncar dan iccnitino .reteropsc

dePpeit tinnrmtrusotraees = ylommnco deerelas as etpiepprod erlgra rousrescpr ttha ear dvleaec by csefiipc yseznme hatt wree in hte maes etaitemrtnsnroru lcevies poun .aeserel iFev tspey = ni/rgubta es,tdpipe pdioio eidpspe,t ayutipirt di,sptpe aihlcmtyohap gnsireela n,smroeoh adn hetos not ecsaisi.fld apEselmx = cposeurrr hatt egivs rise to cbsasetun P ha(ppui,smocp txoe,nroec dan ITG nad resledae ormf lmlsa eriadmte NSP C ferbsi ahtt inramtts pnai nda eprmraetetu iorfoit,nnam rewuolfp pvthyes,oeni idnthebii yb dipioo teids)pe,p kuiinronne ,A oeupernedipt ,K dan rtpedeiopeun g,aamm nad oidipo ptiepsed ngcdlinui naltp kaiosllda l(eki np),eroimh ciyehttns oiidpo srae,vivited dan pinroesnh,d ,hpsnrnodiy nda hlanks.pieen In gaelern dipioo etpdseip aer pasendesstr .(.ei aiensaagl ens),amcmih envlidov in lxompec osvbiahre laes(ux ttoanracit, gesamsvivriisee/gsusb siavbhr,o)e dna cdaiemiltp hot(hug not )tfiniiedve in siicparchty rdosis.erd

a,rllOev aieetrumssotrtnrn = type tseyp: lmolelu-eslmac stritstenarm dna ote,srnpiepdue eehwr l-lllmmscsoeuea rsrttmitnsae era raetfs nad aeiedtm ardip icypsant aostnsinrims (.ie. egadnnor SSN i/rththfghgifgtlfi/ uqcik oee,s)nspr wreeh sa psdentueproie nol(ga hitw lociogib samein adn meos malls clemelou tt)insramtser aer ewrlos adn idtemae ,lugraad dongrpeol .mnssrrnsoantoeiui

Soem :rsuctpie totanapk_aerdc.slespripitu/rdevn.punmtk/eefhim_o:/rd/wosmnrtiheehuwwo/t.e_vtub, 0aPr/8gBgh:rimnAsArc2po.6w6f3ia1fR9uudgnsdccottrd/24rb/lrb8t--1e3d7/s/h3ae-eir6ee0ls1ecpu3604-tpairo-04t0lss/bTgiphefptfagnaewa/oaBe1w5r.2be-i--1Ge, dna o#hb1e1eb/fil62;fpdwg.gu3c5:-e9ahd1ad-ipbm-ge0-xwblf2-/dente7a=/le3.s8=t/dax_nh6b4e-rlt5/nif-tUsgs-&trwig0ara1/

sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: +2  
dorischang  Didn't finish reading this, but it looks awesome +1  

submitted by haliburton(208),
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sbulelmted sha a ecin encminoup fro eth dellki vein:scca

tRse In cePea wysAa:l

Inn flaeuz
ioloP Skl()a
iH eitptas A

paulkarr  Also, the nice little puppet show from sketchy for those visual learners like me. +1  
makinallkindzofgainz  just remembered that MMR is a live attenuated vaccine +  
faus305  how could i forget that puppet show?! +  

submitted by d_holles(170),
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Even hot AF nda ckrSoeiychtM tod'sen etnmoni t,i hbto laasnaAmp nda Ehrsislioch rea aerdirc by oinbR of eIdxos.

bulgaine  FA 2019 does mention it P 149 +  
charcot_bouchard  Ehrlichia - Lone star tick +2  
paulkarr  "Lyme Disease caused by Borrelia Burgdorferi, which is transmitted by the ixodes deer tick (also vector for Anaplasma spp. and protozoa babesia)." FA 2019, Pg 146 +5  

submitted by hayayah(1056),
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fbemliForiz si a re,tbafi dues for lneoriwg TG vlele.s

mousie  I also chose Gemfibrozil too because its the best TG lowering drug listed but I can see where there might be some red flags for this drug in the way they asked the question... 40 year old obese woman with some upper abdominal pain ..... HELLO GALL STONES which is a common adverse outcome of Fibrates. +10  
uslme123  Well I didn't wanna give a fat, forty, female, that smokes a fibrate. So a statin, for me, was the best next option. +9  
whoissaad  Used same reasoning to choose statins. Fibrates are the main drug of choice for hypertriglyceridemia but given her symptoms, statins made more sense. Why do they do this to us... +  
roaaaj  what a tricky question! there are multiple factors should be taken in consideration.. she has triglyceridemia which put her in risk of pancreatitis, and most importantly atherosclerotic disease, and all of that would outweigh the risk of giving her gallstone. +  
paulkarr  Yeah I had statins selected initially because "statins are always the answer" but when I saw them stating first line "recently diagnosed with hyper TG" I figured this follow-up was purely to address that. So Fibrate is the best move. +2  

submitted by nlkrueger(42),
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.... wluod ew arelyl taek the owdr fo a fiednr who leinieytdf n'atc eb drnc?mioef I eefl klei hist si limengisda

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 yotsubato(963),
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saW it jtsu me, ro did eag" ta tnoes in erasy" appear HIGRT oeabv eht urenbm of ean,tptsi ethrra tnah hte .nmea hchWi nsfuodce em ofr a godo 3 imun.tes

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +13  
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +7  
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +7  
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +5  
monkey  what is 36 supposed to be? +1  
thomasburton  Think the number of people in that group +5  
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck's gotta be 99" +4  
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +3  

submitted by sympathetikey(1248),
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ggisBet eclu was hatt ehetr swa no meti ermaf fehrr,eoTe hits messe to be a lci"se ni m"iet td,suy ihchw eilns up hwti osrcs esailtnoc dutys.

paulkarr  Damn, epi at it again... +4  

submitted by smc213(124),
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oT eb meyltlcpoe ral!ce

Tish tepanit sah sCniitossy a aerr aslotmoau isesceevr yamslloos roagest rordised nad tmso mocnmo saeuc of iFcnona ydoemnsr ni dirnechl. inisyotCss si sscyimte nda ladse ot itycnes srlcyta speidots in clsle and tussise hrotgoutuh teh yd.ob

thluAohg nsilWos esdiaes can elda to SF, het ytarslcs in hte ensaocr esod ont reolarcte ihtw oisnlsW aise.des
roe M in:of lcng:40tn.tc8M/1vawhnoim.prhP/.wC6./b//slwieti4mc1sp/

highyieldboardswards  Thank you! You are a legend for figuring this out! +  
paulkarr  Appreciate you. +  
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2  
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT = Increased excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1  

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oLw OEP in VP ude to tgNaivee abfdeeck no EPO reaesle yb yknedi.

dentist  This is where the timing of everything in the question trips me up. FA say PV mechanism is increase EPO (2019, p299) +  
paulkarr  Different types of Polycythemia have different effects on EPO levels. "Appropriate Absolute" and "Inappropriate Absolute" will both increase EPO levels (Inappropriate is caused by this EPO increase). Where as Polycythemia Vera has decreased EPO levels due to the negative feedback loop. FA2019 pg 425 hooks it up nicely. +5  

submitted by mousie(209),
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sympathetikey  First off, do yourself a favor and check this out - The LDL receptor is found on peripheral tissues. It recognizes B100 on LDL, IDL, and VLDL (secreted from the liver). Therefore, an issue with that would cause an increase in those, but mainly LDL. Since in this question we see that Triglycerides and Chylomicrons are elevated, that points towards a different problem. That problem is in the Lipoprotein Lipase receptor. This is the receptor that allows tissues to degrade TGs in Chylomicrons. So, if it's not working, you get increased TGs and Chylomicrons. Additionally, you get eruptive xanthomas, which are the yellow white papules the question refers to. +8  
davidw  There is much easier way go to page 94 in first aid. This kid has Type 1 Hyper-Chylomicronemia which is I) Increased Chylomicrons, Increase TG and Increased Cholesterol. It can be either Lipoprotein Lipase or Apolipoprotein CII Deficiency +12  
bulgaine  The video sympathetikey referred to only mentions pancreatitis in type IV but according to page 94 of FA 2019 it is also present in type I Hyper-chylomicronemia which is what the question stem is referring to with the abdominal pain, vomiting and increased amylase activity +  
dentist  thats not the only difference in that video.... +  
paulkarr  Pixorize has a set of videos on all the lipid disorders that made it a breeze to answer. Pixorize is basically sketchy but for biochem and other basic science subjects. +2  
futurelatinadr  Pancreatitis was a huge clue for me to think of hyperchylomicronemia +