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Welcome to privatejoker’s page.
Contributor score: 42


Comments ...

 -2  (nbme16#24)
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haeY htsi maeks on kgfunci es.sne ehiMprno is otn a goudrpr

cyrus_em  @privatejoker Morphine 6-glucuronide is an active metabolite of morphine +
cyrus_em  Data from clinical studies suggest that M6G contributes significantly to the analgesic effect observed after long-term morphine administration. 2–4 Animal studies show profound and long-term antinociception and respiratory depression after M6G injections (especially when given centrally) through its action at the μ-opioid receptor +1

 +4  (nbme16#18)
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aCn anoeny pxiaenl hwy arepchgamo yvtiacit owldu be eeedadsrc ni sit?h I dntaew to ckpi one that adh thob smuuc seertgcni ivittayc as nibge dceraiesn laogn hwit ecdarsnei gocapearhm tcyitaiv wtih ctionaocntm seecrade in yariilc tiycvtia btu tsih swan't an tpnoio os I twne hwti lal rdance.esi Sncei si't iwbllds-setlheea ttha cemaphsgoar useac egamad in mmesapyeh icayes(lpel ni ksesrom due to tctanons ititirnoar frmo teh ok,sm)e who si it isbolpse htat pgaoraehmc yiactvti wuold go WDO?N

kard  Mucus hypersecretion --> Induce airflow limitation in COPD "potential risk factor for accelerated decline in lung function" Cigarette smoke impairs both the phagocytic and respiratory burst function of neutrophils! Macrophages-->activated by cigarette smoke extract to release inflammatory mediators COPD--> alveolar macrophages and neutrophils are defective in their antimicrobial functions. Macrophages from COPD patients--> show reduced phagocytic uptake of bacteria. "Streptococcus pneumoniae and nontypeable Haemophilus influenzae" I Hope This Helps... +22




Subcomments ...

submitted by hyoscyamine(55),
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I onkw siht is usjt a iahgrstt pu tacf form A,F tub n'lctduo esuerrt innotr(stilaa lelc oarcnac)mi sola be octrc?er

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis. +8  
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma. +  
vinnbatmwen  p631 → Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure. +4  
privatejoker  Thanks! +  
emmy2k21  It's also in Pathoma page 140 in the 2018 edition! +1  


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Sihspily gipnatoesehs si teh aimftminnlao dan lotbirtoaein of hte vasa usvmaro lmlsa( ldboo eslevs)s ahtt sedef biegrg oolbd esvssle like taao,r rier,etsa o.etlerirsa tI odes tno tmetar thaw hte tgeas is, T. mpldiaul scetfin teh asva oamvrsu ,dna ni eth pce,ross tbetairleso het snvere and lobdo .eesssvl siTh lslki oldbo slpupy to ohest seraa = ceiihams btu no ianp anissl(ep aern).hcc oreM iaozcldle ni ierlear aets,gs adn ni alret east,g hte hrpecetsiso eteaissn,mdi os uyo veha eth oarat nad aiplns odcr vvnolitenem ubt asem tp.gehesiason td(:Ei lojaGn peaelxdni hsit shmrwe.e)eo

privatejoker  So is the heavily implied step-wise formation of Syphilis symptoms as presented in FA complete BS then? Why break it down into stages and have us learn it as such if this is not the case in real practice? +4  
lilmonkey  Exactly, Goljan mentioned this in one of his audio lectures. All kinds of lesions in syphilis caused by vasculitis. +3  
lovebug  I know it's silly question. but Could anyone give an why answer is lymphocyte and plasma cell not neutorphiles.? bc syphilis is a bacteria, not virus. +  


submitted by imgdoc(132),
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llyBiasac ihst eusqntoi just skas "ahwt is woepr" dan ksas ouy to inlpxea ahtt 80% pewr.o eroPw is 1 - baet (ypte 2 roerr), licblasay hewn a reefcednif eistsx adn teh nlul spestohhiy is jetderce si wp.eor oS fi teh xR edectst a amen cdefirnfee fo 4.0 in sahmat ni teh ntteaspi in eht ametentrt rup,og ehnt taht atda lflsa ni eht 0%8 owpre ngrea, dan sit sneiifngciac is %59 ),.tl(;05p0& P uvlea si ujst eht ribtlyiaobp fo imetngohs innphepag yb ce,cnha so you athw isht ot be sesl hatt 5% so tveaerhw uoy obrvsdee isn't l.iutslhb

I hpeo tish ,dephle dna ocerrtc me fi Im' on.grw

yssya1992  I have a question : whats the relation then between power and P value ? +  
privatejoker  This one took me a minute and was during the last block so my brain was already fried. But my reasoning was that, as stated above, since it gave you power, it is basically just a long-winded way of asking what Power is, and how this relates to p-value. P-value is the odds that the finding was due to chance alone. Obviously a p-value set to <0.05 implies a greater than 95% chance that the finding is legit. Since the power is said to be 80%, this means that there is an 80% chance that the study finding is legit, at least insomuch that it met the pre-set criteria of being 95% non-chance related. +  
sahusema  80% chance (power) the study correctly identifies the existence of an association in reality. If an association is determined to exist, >95% chance the study and reality agree with each other (p<.05) +1  


submitted by neonem(549),
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dsSuon ekil a aces fo miF-iranueL dnoermys - eisnc 53p is a ourmt repssrspuo for a bunhc fo lcle y,stpe mnoutiats in tsih eegn (as ni )LFS tesrlu ni a adimry of mlfaiial umtro eps.yt

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 +9  
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. +14  
dbg  ^ this guy cracked the code. nbme ur doomed. +5  
cienfuegos  @privatejoker: I feel the pain. Quick FYI: UW includes brain in the associated tumors. +3  
hyperfukus  we can just make her thing SBBLA and hopefully never get this wrong again +9  
jakeperalta  @privatejoker: according to UW, Li Fraumeni includes SABBB(sarcoma/adrenocortical/breast/brain/blood(leukemia)) +2  
ac3  side note: RB1 = retinoblastoma with an increased risk of osteosarcoma +  
lukin4answer  TP53 associated with SBLA + Brain tumor + Anaplastic Thyroid ca + Transitional cell ca. -UW +  


submitted by mcl(578),
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eWnh wknoigr on icd/esaba sddei,rros it splhe ot look catyeyltamisls ta hte lw:gfnlioo )1( pH hwci(h ldysa swa nto nvige ni ihts e,o)rmbpl 2() fegiur uot whhic pmborle is iryrpam yb koinlog at Pa2CO nad c,ibbra and 3() ookl orf nya tonsmeapicon chwh(i teh eqsounit tendso' ksa utb sillt.)

rHee, we ees thta het 2CO si ihhg on het .BGA Tshi masen taht tatneip si lnypnivageiohtt nceis ellesv fo CO2 rea vlettinoani detnepde,n nda slao ahtt tetaipn has ptroaersyri dasoisci. sAl,o cabirb is owl, hhciw eplmsii ahtt its' ibgne asdeok" u"p yb tceiabmol odaicssi.

privatejoker  I just look at these as "what makes the most sense" and this is is sufficient in nearly every scenario. Out of the given options, the only explanation that even lines up with the given numbers is the answer choice. +  


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I hktin ti si oogd to enot eht e.gmahisrcdpo eTh anpteti si alfeme nda l.do tTa,h gonal thwi the titsioo,npcna emad me laen remo astwodr uvstiiic.drliet BID layuslu lesveodp ni rognyeu eprnss.o

privatejoker  Does the obviously darkened area not point at all towards ischemia of any kind? Maybe I am blind, but I don't see anything that remotely looks like an obstructive diverticulum in this picture. I feel like I would have gotten this question correct if no picture had been provided at all because the symptoms described absolutely pointed towards diverticulitis otherwise. I actually changed my answer because of the image lol +19  
sahusema  Picture is a bullshit distractor +2  
lola915  From what I've seen on practice tests and advice i've gotten is that often if the picture is given along with an already complete clinical picture it's often a distractor. I also was going between ischemia and diverticulitis but then remembered that clinical signs in the vignette trump everything else. +1  
alimd  they dont give a fuck about pictures +  


submitted by hayayah(1056),
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Seordynac athdypehpriyasrmori yusaull( dt/ orcihnc ralne e).urifla

abL idnsigfn licuend ↑ PHT pe(nssoer ot wlo ,ca)clium ↓ rmsue imlccua lr(nae earf)lui, ↑ serum hspopeath (lnear e)lif,uar and ↑ naliealk oshtahpapes HTP( icgvaatnit sost).teoBsal

haliburton  also remember that in renal failure, 1-alpha-hydroxylase activity is down, so there will be less activation of 25-hydroxycholecalciferol to 1,25-hydroxycholecalciferol, which is a key mechanism causing hypocalcemia. +2  
cr  why not increased 25-hydroxycholecalciferol?, with the same logic haliburton explain +  
nala_ula  Increased phosphate, since the kidneys aren't working well, leads to the release of fibroblast growth factor 23 from bone, which decreases calcitriol production and decreased calcium absorption. The increase in phosphate and the decrease in calcium lead to secondary hyperparathyroidism. +1  
privatejoker  Probably a dumb question but how do we definitively know that the ALP is elevated if they give us no reference range in the lab values or Q stem? Everything stated above definitely makes sense from a physiological standpoint, I was just curious. +1  
fatboyslim  @cr the question asked "the patient's BONE PAIN is most likely caused by which of the following?" Increased levels of 25-hydroxycholecalciferol might exist in that patient, but it wouldn't cause bone pain. PTH causes bone pain because of bone resorption +1  
suckitnbme  @privatejoker ALP is included in the standard lab values +  
makinallkindzofgainz  @privatejoker ALP is listed under "Phosphatase (alkaline), serum" in the lab values +1  
pg32  Why does AlkPhos increase in renal osteodystrophy? The PTH would be trying to stimulate bone resorption (increase osteoCLAST activity), not bone formation (osteoBLAST activity). +  
drzed  @pg32 the only way to stimulate an osteoclast in this case (e.g. via PTH) is by stimulating osteoblasts first (thru RANKL/RANK interaction), thus ALP increases. +1  


submitted by hungrybox(966),
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cacosl,liycpoarM sqmuaous ellc riaconmac entds to be -fweoihft ni roclo, iragnis ,fmor nda nteindxeg oint a snuohcb.r

eo:cuSr iepidaoRad

privatejoker  Lol am I the only one that picked Malignant Lymphoma? I thought I remembered Sattar mentioning that metastases are the most common form of cancer to be found in the lung? I tend to pick the "most common" presentation when given so little information to work with +2  
blueberrymuffinbabey  but metastases typically present with multiple lesions so I think at least in exams when it's showing you a solitary lesion, think a primary tumor. +3  


submitted by hyoscyamine(55),
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I wnok thsi is sutj a ritstgha up tcfa rmfo FA, btu lt'ducno tserrue stiirtnlanoa( lelc ai)rccaonm losa eb r?rcetoc

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis. +8  
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma. +  
vinnbatmwen  p631 → Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure. +4  
privatejoker  Thanks! +  
emmy2k21  It's also in Pathoma page 140 in the 2018 edition! +1  


submitted by aishu007(3),
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cna enoyan lenxpia wyh actecociroucasenslfe si hte easrnw er?eh

priapism  Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +6  
nala_ula  My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +  
fez_karim  its says chains, so not staph. only other is entero +  
temmy  according to first aid, staph aureus is not one of the high yield bugs for UTIs +1  
temmy  uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +  
privatejoker  Where in FA 2019 does it list that C.coccus is specifically in chains? +  
privatejoker  E.Coccus* i mean +  
divya  @privatejoker FA 2018 Pg 134 table +  
jennybones  @privatejoker Enterococcus is Group-D STREP. Streps are arranged in chains. +1  
santal  FA 2019 Page 639, too. +  
backwardsprogress  Enteroccocus is also a pretty common cause of chronic prostatitis, which was the give away in the prompt if you didnt know the characteristics of entero: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715713/ +  


submitted by aishu007(3),
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nca aenyon pxalnei wyh fasunrcoelciceoeastc si eht nwears r?eeh

priapism  Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +6  
nala_ula  My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +  
fez_karim  its says chains, so not staph. only other is entero +  
temmy  according to first aid, staph aureus is not one of the high yield bugs for UTIs +1  
temmy  uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +  
privatejoker  Where in FA 2019 does it list that C.coccus is specifically in chains? +  
privatejoker  E.Coccus* i mean +  
divya  @privatejoker FA 2018 Pg 134 table +  
jennybones  @privatejoker Enterococcus is Group-D STREP. Streps are arranged in chains. +1  
santal  FA 2019 Page 639, too. +  
backwardsprogress  Enteroccocus is also a pretty common cause of chronic prostatitis, which was the give away in the prompt if you didnt know the characteristics of entero: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715713/ +