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 +0  (nbme22#5)

Can someone please explain why it would not be glycogen depletion? I thought the question was talking about the Warburg phenomenon... so why not breakdown of glycogen to glucose?

I guess it would not explain the edema?

hello  Glygocen stores are depleted within 24h. This person has signs and symptoms of longterm nutritional deficiences.

 +0  (nbme22#8)

According to BnB:

Cervical rib is an anomalous extra rib from the 7th cervical vertebrae. People with this are at risk for thoracic outlet syndrome (aka compression of nerves and vessels that leave the thorax. This occurs above the first rib and behind the clavicle).

Clinical features include:

1) brachial plexus injury (such as Klumpke palsy, which is a lower plexus injury)

2) Venous compression

3) Arterial compression

*An important anatomical correlate the scalene triangle (anterior scalene, middle scalene, above the first rib)

 +2  (nbme21#21)

inhibition of microtubule polymerization → inhibitis phagocytosis of urate crystals, leukocyte activation and migration, and cell chemotaxis.

 +2  (nbme21#47)

The inguinal part of the question points you to a a femoral hernia

Femoral hernia: uncommon type of inguinal hernia, in which intra-abdominal contents (in this case the small bowel) herniate into the femoral canal through the femoral ring

The image: strangulation: ischemic necrosis of contents within the hernia sac as blood flow is compromised due to incarceration (irreducible femoral hernia due to trapped hernia contents in hernia sac)

So, in short: femoral hernia can lead to a complication called incarceration which can lead to strangulation

 +0  (nbme21#12)

Complications of PCOS:

Cardiovascular events

Type 2 diabetes mellitus

Endometrial cancer=hyperplasia

Increased miscarriage rate

 +0  (nbme21#9)


Mechanism: selective estrogen receptor modulator (SERM) that acts as an antagonist on the estrogen receptors of the breast and acts as an partial agonist on estrogen receptors in bone and uterus. Therefore, ↑ risk of endometrial cancer and ↑ Risk of uterine sarcoma

Uses: ER or PR positive tumors (breast)

 +6  (nbme21#35)

Lead Toxicity :

Causes: disruption of heme synthesis via inhibition of ALA (aminolevulinate dehydratase)


A: Anemia

B: Basophilic stippling

C: Colic

D: Diarrhea

E: Encephalopathy

F: Foot drop

G: Gum deposits/growth retardation/gout

H: HTN and hyperurecemia

Other answers:

Zinc deficiency:

Causes: low intake, Crohn's disease

Findings: immune dysfunction, impaired wound healing (for the remodeling phase of wound healing, zinc is needed by metalloproteinases to break down type III collagen), hypogonadism, diarrhea, dermatitis, alopecia, abnormal taste and smell

Excess is rare... but can lead to n/v/d and abdominal pain

Magnesium deficiency:

Causes: congenital, polyuria, malnutrition, laxative abuse

Findings: tetany, premature ventricular contraction, increased QT interval

B12 deficiency:

Causes: vegan diet, pernicious anemia, pancreatic issues, gastric bypass surgery, malabsorption (Crohn, sprue), Diphyllobothrium lactum/tapeworm infection

Findings: macrocytic, megaloblastic anemia, neuro symptoms, increased homocysteine and MMA levels in serum

Increased Vitamin D:

Causes: granulomatous disease (sarcoidosis)

Findings: bone resorption, too much calcium, loss of appetite, stupor

 +0  (nbme21#32)

EBV (HHV-4) infects B cell through CD21.

Atypical lymphocytes on peripheral blood smear (not infected B cells, but reactive cytotoxic T cells).

"Mononucleosis": + monospot test (antibodies detected by agglutination of sheep or horse RBCs)

sbryant6  Atypical lymphocytes are CD8+ T cells, not CD4+. Remember that.

 +1  (nbme21#44)

Prevalence of disease high=high PPV=high pretest probability

NPV varies inversely with prevalence or pretest probability

p. 257 of FA

Subcomments ...

submitted by noselex(4),

Dextro vs Codeine: Both are antitussives, but dextro is more of NMDA agonist that also has opioid agonist activity. Dextro is often abused to get a similar out of body feeling due to its NMDA agonist effect. Codeine on the other other is a full-on opioid agonist. It’s also used as anti-diarrheal, so constipation is very common adverse effect.

Tiotropium is wrong because it’s not an antitussive. Also, it’s an anticholinergic which is (1) contraindicated in elderly unless really indicated, (2) a well-documented anticholinergic effect is constipation.

pparalpha  According to Sketchy and Amboss: dextromethorphan is a weak opioid receptor AGONIST and NMDA receptor ANTAGONIST (it's not an agonist). +  

submitted by neonem(251),

Sounds like a case of Li-Fraumeni syndrome - since p53 is a tumor suppressor for a bunch of cell types, mutations in this gene (as in LFS) result in a myriad of familial tumor types.

pparalpha  Li-Fraunemi syndrome = SBLA (sarcoma, breast, leukemia, adrenal gland syndrome) and occurs because of an autosomal dominant inherited mutation of p53 APC: linked to FAP (colorectal cancer) RET: linked to papillary thyroid cancer, MEN 2A, MEN 2B RB1: retinoblastoma +3  
privatejoker  The thing that threw me off was that the only connection in her FH to the above SBLA reference was the mention of a paternal cousin with adrenocortical carcinoma. The other two mentioned had brain cancers, which seem completely outside the scope of the above mnemonic. Then again, as mentioned elsewhere, I suppose the best policy on these is just to rule out the absolute wrong answers. I swear, the NBME is lying when they tell us to choose the "best" answer on some of these. What they actually mean in practice is for us to choose the least shitty. +3  
dbg  ^ this guy cracked the code. nbme ur doomed. +1  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +1  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +  

submitted by usmleuser007(110),
1. "Three HAL fans will try meth"
    a. Threonine = Three 
    b. Histidine; Arginine; Lysine = HAL
    c. Phenylalanine = fans
    d. Valine; Isoleucine; Leucine = will
    e. Tryptophan = try
    f. Methionine = meth
pparalpha  Thanks! Good mnemonic +1  

submitted by nicnac20(6),

Mixed venous oxygen tension is the amount of oxygen bound to hemoglobin as it returns to the right side of the heart after traveling to the tissues.

Decreased oxygen delivery to the tissues due to decreased cardiac output leads to the tissues extracting more oxygen from the passing RBCs than they normally would, which decreases the overall mixed venous oxygen tension.

pparalpha  A helpful equation is CO=rate of O2 consumption/(arterial O2 content-venous O2 content): Fick principle If CO is decreased, then the difference between arterial O2 content and venous O2 content is increased +2  

submitted by haldol(4),

BP is low so obviously the body will want to respond by increasing sympathetics and decreasing parasympathetics. since the BP is low, there is less pressure against the wall of the carotid sinus -- meaning less stimulation and fewer impulses. fewer carotid impulses means fewer parasympathetics

pparalpha  Hyotension will lead to decreased arterial pressure and DECREASED stretch. This leads to decreased afferent barcreceptor firing (carotid sinus and aortic arch). This leads to an increase in efferent sympathetic firing and decreased efferent PNS stimulation. This leads to vasoconstriction, increased HR and increased BP. +  
sahusema  The way I remember this, carotid massage slows the heart. So baroreceptor stimulation (more impulses) increases parasympathetic output. +  
cienfuegos  FA 2018 pg 291 has helpful image/description +