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Comments ...

 +5  (nbme21#19)

this is actually a UW question (14992) Peripartum cardiomyopathy manifests as a dilated cardiomyopathy, can occur during last month of pregnancy or within 5 months after delivery, pathogenesis poorly understood, but may be related to impaired function of angiogenic growth factors (e.g VEGF) or predisposed by mutations in cardiac structural proteins.

 +1  (nbme21#30)

question #15553 in UW explains this one well. Basically, C5 branches innervate Deltoid (abduction) and Infraspinatus(external rotation) and C6 Biceps (forearm flexion), so the right option should be abduction of the upper extremity.

I got it wrong though lol

 +0  (nbme24#48)

per UWorld Id 2127:

PCA supplies CN III and IV, thalamus, medial temporal lobe, splenium of the corpus callosum, parahippocampal gyrus, fusiform gyrus, and occipital lobe.

Besides the contralateral hemianopia with macular sparing... a PCA stroke can cause contralateral paresthesias and numbness(involvement of lateral thalamus), dyslexia, visual agnosia (impaired visual recognition of objects) and prosopagnosia (inability to recognize faces)

 +0  (nbme24#12)

can we consider the overdose as a suicidal attempt? if so... wouldn't she be considered as without decision-making capacity?

em_goldman  People who are suicidal still have decision-making capacity; it's not equivalent to advanced dementia or other situations where decision making is impaired. Laws vary by state; I know in my state that the maximum time for holding someone against their will is 48 hours unless a court has deemed them incompetent and designated another person as their legal decision maker, including people who are actively suicidal. My understanding of the law as a layperson is that her living will was signed along with people bearing witness to the fact that she was the one who signed it, and it was what she wanted. Ethics aside, it would be almost impossible to prove that she legally initiated a DNR in a state of suicidality that was intense enough to interfere with her decision-making capacity in that moment.

 +0  (nbme20#15)

Per UWorld; capsaicin found in chili peppers causes excessive activation of TRPV1 (transmembrane channel), which increases intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). It also causes release and depletion of Substance P, causing at first burning and erythema but over time causes decreased pain sensation.

chandlerbas  also topical Rx for post herpetic neuralgia

 +3  (nbme20#15)

Per UWorld; capsaicin found in chili peppers causes excessive activation of TRPV1 (transmembrane channel), which increases intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). It also causes release and depletion of Substance P, causing at first burning and erythema but over time causes decreased pain sensation.

Subcomments ...

be aware that the x-axis for this question is not "Km" (vitB6 is not the subtrate that's 1/[VitB6]. to simpify, because the Vmax is gonna stay the same, you just need to increase [vitB6] to get the same Vmax (aka shift to right on the x-axis). Don't be fooled around by the question writer.

poisonivy  this makes sense to me, X cannot be Km!! because if it was Km then line B would be showing a "competitive inhibitor" effect, which cannot be the case since they state that the enzyme activity increases to normal after B6 administration so it favors the reaction instead of decreases it. I got this one wrong of course, too tricky for me! +  

submitted by hajj(0),

can anyone explain this? i know median for y is higher by calculation but x has two modes so how come y has higher mode?

lispectedwumbologist  The mode in X is 32 and the mode in Y is 80 +  
lispectedwumbologist  The mode in X is 70 and the mode in Y is 80* +1  
hajj  Thank you! +  
hungrybox  Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao +2  
usmleuser007  can someone please explain the median in this +  
nala_ula  The median can be known by first assembling the numbers in order from least to greater. If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12]. Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people! +  
dubin johnson  Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks! +  
dubin johnson  I mean how is the mode for Y greater than mode for x? +1  
sgarzon15  Mode is the one that repeats the most once you list them in order +  
usmile1  Median would be the BP value that the person in the 50th percentile of each group would have. So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X. Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y. hope that isn't wrong, and helps someone! +4  
poisonivy  I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer! +  

submitted by cr(1),

why not C?. It´s not supose that it improve the efectivity of insulin?

yb_26  thiazolidinediones (pioglitazone) increase insulin sensitivity (in muscles and liver) through activation of peroxisome proliferator-activated receptor-gamma (PPAR) I think they are asking about primarily mechanism of action, that's why it is E +  
cienfuegos  UW explanation regarding the genes upregulated 1. GLUT4: insulin responsive on adipocytes/skeletal increases G uptake 2. adiponectin: cytokine secreted by adipocytes increases # of insulin responsive adipocytes and stims FA oxidation 3. PPAR family also plays significant role in pathogenesis of metabolic syndrome +  
poisonivy  Also, I think the word uptake shouldn't be right when speaking about insulin, it does increase insulin sensitivity and therefore glucose uptake +  

submitted by lsmarshall(228),

An experimental design or experimental study must have an intervention, by definition. Case-control studies are observational studies, not experimental. This question is technically incorrect. They wanted to amke a point that case-control studies are time and cost efficient since they don't require following patients over time or any resources besides reviewing/gathering information. Case series could not test this hypothesis.

Also, the wording "associated wit an increased risk" somewhat alludes to case-control studies only having the ability to find odds of an associations between exposure and outcome, but not establish causal relationship.

bigjimbo  classic nbme +  
poisonivy  totally agree, I dont understand why the right answer is Case control since that is not experimental +  

submitted by dr_jan_itor(31),

Can anyone answer why this one can't be F. Beta thalasemia major? I was thinking becaues of his anemia and the "european descent" which includes the mediteranian europeans. Unless NMBE writers think that european only means the ones with extra white people lol

dickass  European implies northern european (they even specified the patient was a person of pallor), mediterranean descent is usually implied by country of origin or by straight-out writing 'mediterranean'. +  
poisonivy  The MCV is normal, thalassemias are microcytic anemias, that hint helps to rule out the thalassemias. However, I got it wrong, not sure why it cannot be a homozygous mutation in the ankyrin gene +1  
adong  @poisonivy, other commenter pointed out it's autosomal dominant so best answer would be heterozygous +