share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to sam1’s page.
Contributor score: 16


Comments ...

 +4  (nbme23#50)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hWat uatob hte tddolnaiai wlof rgthuoh het fuc?erxmilc

maddy1994  exactly man i got 4.5 and i thought he asked ventricle and left circumflex should be there so i put 5 ...glad someone thought like me.i was just cursing myself for over thinking. +10
djtallahassee  Yea put 5 here too. they are essentially saying the myocardial oxygen supply to the left ventricle comes from the LAD. Not sure if true or not but figured that the LCX would at least contribute 20% of the blood +
justherefortheyield  100% agree. This is definitely a better answer. I assumed the # would be beyond 5 but that it was closest to the right value. +

 +1  (nbme22#26)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

If nyoean ensde a efesrrhre no ehset sttilitaacs nspcco,te naKh sah a btinlilar id:eov

/braitc-cos-/ots-eittea-/sipsrrteteieftmhsesv-ongc/orriuit-pcirdlkonnot.a.swho:op-ang-rat/as/edpyacnwpiitttraenbiweih-r-/-yitdma/swy-pipra


 +2  (nbme22#5)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

lheiW T eclls do eus het DJV inoicbroment,a het T elcl rretocpe inhsca ear dnifteerf enges omfr het B lse'cl yavhe nad ightl ani.chs Seinc ehty dsue a B lelc er-ngoJi boe,rp hte T lcsle' dnba llwi eb hmcu rrleag as stih raae fo sit DAN eth( B llec veyah ro ghilt nhica e)ngse evah ton bene agdnaerrer -- densita tsi T cell rteropec neges evah nebe a.rgaernder


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

ihTs sseem to eb a neetrvla r: epapw/.l87tbgduon91.hhn7picbmwe1s.//9/pw:mvt9ni.

T"eesh daat ianidtce that goccisoldotircu lony nntelrsiaty annceeh A)b(2Rate gnee acinstpotrnir dan ifal to creaines -dyttessaeta sleevl fo a)e(b2AtR eirotnp ni naumh rayiwa lepaitiehl elsl.c ,elhsNoeents l-duircuoitoocenddgcci ecfefst no teh )e(R-C2AbtaA etsyms fo hnmua aairyw iahiltpele escll iruecttbon ot eht cieafeilnb cfteefs of itcisocosdtroer ni taamsh by egcnaninh het tfalnunoic nsrepeso to s(i"t).aaonts-e2bg


 +1  (nbme20#17)
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

iTzsdihea cna aeusc tcaue iltaserittin epiin,hrst a mofr of arnel lfai.uer oiWthut hte rlaen tinxeecor fo oc,ptiranl ti cna ludbi up in het rumes nad lutrse ni cl.toahraager

coccidioinmytitties  Sexual dysfunction [desire based = libido] can be due to drug side effects [antihypertensives], per first aid. Edition: 2018 Page: 551 Section: Psych Per, 1stAid's endocrine section: "excessive amounts of prolactin associated with ↓libido [324]. This goes together with our sexual dysfunction with "antihypertensives." Only logical synthesis I can think of: thiazide = ↑prolactin = ↓libido + galactorrhea. It would also make sense since we are dealing with an expected to be post-menopausal female [milk production would have to be due to exogenous source]. Dug into my lecture notes and found the following: beta-blockers and thiazides cause sexual dysfunction. I also like sam1's explanation. We're reaching here, but its the best I can do. +
g8427  Mayo clinic shows clear or bloody nipple discharge as side affect of Thiazides. But doesnt state milky discharge. +




Subcomments ...

submitted by seagull(1573),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

ohtrneA aopcp.ahr baeitesD csesua mnecn-ayztnoi ocllyyngsotia hhciw yam ainlgeyvte ptiamc the fntcinuo fo nerousn laiymn due to daerelt doolb pluspy nmgoa horte .hntgis heTse ycteyglloas eidopsts atlcylyip ruocc ellpierprayh ta eht slge. hTe nloy pleprharie rneswa ichceo aws a circeptono in hte elsg. lla eth otehr rewnas coechsi aer ta eltas rmoe lelctyanr oeadtcl thwi rglera lbdoo ulsspi.pe

ianAg, ont pceterf ubt a ayw to saneor out tish nwesar tub ti odes .rkwo

sam1  I believe this concept is referring to peripheral sensitization. Peripheral nerves that have sustained damage (such as through non-enzymatic glycosylation in DM) cause sensitization of their neighboring nerves, thus leading to lower thresholds for activation. This sensitization is thought to be accomplished through mediators such as PGE2. +6  
sam1  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701208/ ^ Section on peripheral sensitization +1  


submitted by seagull(1573),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

netrAoh .arpchpao isDtabee cuessa zea-imcnnntyo ystoylacniglo hchwi yma iegtnevyal taipmc eht uniftnoc fo rsneuno yilnma ude ot eltrade dbool yuplsp anogm eroht .ghnits sTehe llyocgtasye eotpdiss allpcyyti crocu rhyepallprie ta het egsl. hTe oyln herelrpiap rwnase oicceh was a enotccoirp ni hte gse.l all hte hreot arensw shcecio ear at salte emor ltcnylaer ldcaote wtih arregl boodl .ilsspeup

gaAi,n ont eptcerf btu a awy ot oanser uot sith enrwsa btu ti soed k.orw

sam1  I believe this concept is referring to peripheral sensitization. Peripheral nerves that have sustained damage (such as through non-enzymatic glycosylation in DM) cause sensitization of their neighboring nerves, thus leading to lower thresholds for activation. This sensitization is thought to be accomplished through mediators such as PGE2. +6  
sam1  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701208/ ^ Section on peripheral sensitization +1  


submitted by yo(86),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I tsju nkew ttha spmer eden s,urefotc ton esur twah dsaseei roecssp hsit si .ghtohu eH aws tpetyr amlron os 5a atdecreaus et'nsod epsetnr ikel t.tah I tsa'wn ersu fi herte saw ayn dod sue fo eht troeh swenrs.a reeh si a ikl.n lFee rfee to dxn.epa

hsnitawt2o/.wewassl/2xqm:ppe/gosc47.c2._bupt

suoeFctr sakem up %99 of eth grenuicd rusag trpeens in esmn.e isTh gsaur si oduperdc in eth slenami ecles.ivs isimndhieD vleels of uescortf aevh eben shnwo ot llerlpaa deognanr iedeicfync dan the rttseetoones e.elvl ilnogolwF toesntesreto ,hyptrea het evlle of octruesf eh.soeslg cahitrAnu het crtusfeo test si otn rtap fo a eiuront nseem aansils,y ti si fsulue in caess fo paaioosremz cns(eabe fo emprs in nse)m.e nI aaoriseozmp oednracsy ot het saecneb of secislev or if heert is an rb,onittcsou on sfteoruc is enspt.re In tielrsctau eiaroszoa,mp ocufsert is ner.ptes enWh eoaapzomsri dan wlo smnee louemv xssiet, the ersctfou sett uoslhd losa be eod,n no a eoatcapjlstue unrie elpmas to heckc rof ogreeardrt enuiaajc.otl Tsih urscoc nweh teh aelcejaut egos oint het ebrdlda edintas of uot eht eT.reharh tu dreepucor rof inemtrdgnei eth utomna of cutrsfeo ni enmes vivnsole ahtinge nseme ni a ngrsto acdi in teh epcnrese fo .cnieoorslr etrcsuFo seigv a rde crloo nef(ofviolS eoriatc)n adn yam be read in a r.theeotmpo The anrmol reaagev is mgd1/35L .trocusfe

sam.l  Thank you for the explanation. I'm still confused about this answer. I was in between Zinc and fructose. Zinc deficiency also presents with anosmia (pg 71 First Aid 2019). Fructose is used for the movement. His hormones are normal. +3  
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 https://www.fertstert.org/article/S0015-0282(16)40391-2/pdf +4  
cienfuegos  Thanks all for the info, quick note on the Zinc reply above @Sam.I: anosmia = lost sense of smell. +  
sam1  Great find yo! I believe this question was alluding to cystic fibrosis and the congenital absence of the vas deferens. Here is a link to a NEJM article about it below: https://www.nejm.org/doi/full/10.1056/NEJM196807112790203 +  
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged? +  
fatboyslim  @Sam1 but cystic fibrosis will show abnormal physical findings (clubbing, pulmonary crackles etc). The question says physical exam shows no abnormalities. +  
pg32  Confused as to how we can rule out zinc... From medicalnewstoday.com: "Zinc also plays a role in healthy sperm production. According to a 2018 review article in the Journal of Reproduction and Infertility, zinc deficiency may contribute to poor semen quality and infertility." +  
bekindstep1  @pg32 I am not sure of how Zinc contributes to sperm production, but the question was asking about abnormalities in the semen and fructose is present in the semen. Maybe zinc plays a role in sperm development before it is mixed in with semen and so one with zinc deficiency wouldn't have low in zinc in their semen perhaps, but it their blood. This is just a hypothesis though.... +  
brise  ^^ Yeah that's how I ruled it out. You can find fructose in the semen, but you wouldn't be able to find zinc in the semen! It might help the sperm, but it's not going to be chilling with them +