NBME Answers : shaeking's page

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submitted by step420(32), visit this page

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This is mullerian agenesis. Normal ovaries but absent uterus.

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endochondral why not androgen insensitivity? +

shaeking I was wondering the same thing because doesn't androgen insensitivity also have normal female secondary characteristics. Was it the levels of hormones because she doesn't have abnormally high testosterone? +3

swb Androgen insensitivity has the same presentation and symptoms. What's the clue that it is mullerian agenesis instead ? +27

sugaplum Testosterone would be high if it was androgen insensitivity FA 2019 Pg 625 +22

charcot_bouchard Testo would be high in AIS. in AIS pubic hair, axillary hair doesnt devlop because of androgen insensitivity. both have normal breast dev and primary amenorrhea +2

dickass This is not androgen insensitivity because she has perfectly normal Estradiol, which means she has perfectly normal ovaries. She also has regular female levels of testosterone. +5

rockodude thank you @dickass +1

j44n Also AIS has paradoxically large boobs-> tanner stage 5 and thats not mentioned anywhere +

fatboyslim Androgen insensitivity syndrome will have high testosterone because the testosterone receptor isn't functional, therefore the body is like what the heck and starts dumping more testosterone trying to make them a male but it doesn't work unfortunately +

submitted by asdfghjkl(5), visit this page

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Anyone know why IGF-1 wouldn't be increased as well? GHRH is stimulated in hypoglycemic states.

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nala_ula Honestly, it's something that has confused me for a while. Why is it that GH secretion is stimulated by hypoglycemia? I mean, it's literally called growth hormone (for growth!), and hypoglycemia, which is basically a "starvation" state, will stimulate this hormone? +

shaeking https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529368/ This might help answer your question. I basically didn't pick IGF-1 because it would increase the uptake of glucose leading to a worsen hypoglycemic state. Didn't have a true reason otherwise. +

temmy IGF-1 is regulated by insulin. so it will be decreased because insulin levels are also low. +2

nala_ula thank you @shaeking! +

nwinkelmann I found this and it also explains to a more genetic/cellular level. Essentially, it says that starvation induces some factors that cause GH resistance and IGF1 suppression. +1

nwinkelmann Sorry forgot the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575072/ +

submitted by xxabi(293), visit this page

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Broca’s aphasia: expressive (motor aphasia) with agrammatism (pts aware that they don’t make sense) - area A Wernicke’s aphasia: receptive (sensory) aphasia with impaired comprehension (pts lack insight)

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breis Why would B be incorrect? I realize Broca is "technically lower" but A seems too low to be causing weakness of the lower 2/3 of the face? Am I missing something? +

shaeking @breis B is incorrect because of the lower 2/3 of the face weakness. B isn't located on the motor cortex but in the premotor cortex, plus it isn't low enough for the lower two thirds of the face. https://thebrain.mcgill.ca/flash/a/a_06/a_06_cr/a_06_cr_mou/a_06_cr_mou.html https://www.sciencenews.org/blog/science-ticker/homunculus-reimagined +1

cienfuegos @breis, per UW: "a/w r. hemiparesis (face & UE) bc close to primary motor cortex" +

almondbreeze B is close to premotor cortex which is involved in learned or patterned skills & in planning movements. (i.e. two-hand coordination) slide 25/37 :https://www.slideserve.com/hal/the-motor-system-and-its-disorders +

almondbreeze B is also close to frontal eye field; eyes look toward the lesion FA pg. 499 +

frijoles I incorrectly picked C. When answering this, Broca's "broken speech" was my first thought, but I figured a lesion causing a facial droop would have to involve the motor strip so I prioritized that and chalked up the speech issue to dysarthria (I understand this is more of a "slurred speech" than broken, abrupt speech, but again, I simply misprioritized concepts.). So for the record, Broca area is part of the motor cortex? +1

submitted by xxabi(293), visit this page

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Swelling of the cell (e.g., hydropic degeneration): tissue ischemia → decreased ATP production → decreased Na+/K+ ATPase and Ca2+pump activity → diffusion of Na+ and water into the cell → cellular swelling

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endochondral1 can someone explain how to cross out the other choices> +1

endochondral1 what is hydropic degneration and where do i learn about it? why is it not the loss of plasma membrane integrity? +1

shaeking Endochondral1, I had the same question. I tried figuring it out and this is what I came up with. The CHF and congestion of the lungs is reducing the amount of oxygen getting to the renal cells. With hypoxia there is decreased aerobic resp in mitochondria with decreased ATP. Without ATPase Na builds up and water follows. As far as the loss of membrane integrity. I think it would cause cellular destruction not just hydropic changes. This is my best guess. +2

charcot_bouchard Membrane damage is irreversible stage of cellular injury. if membrane is damaged cell is dying & it will shrink. or totally destroyed by inflammation. they are specifically asking hydropic changes ie cellular swelling. which is the 1st sign of reversible cell injury due to failure of Na/K pump +2

winelover777 @endochondral1 Chapter 1 of Pathoma. Also FA 2019 p207 describes hydropic degeneration without saying those exact words in the first bullet under reversible cell injury. +1

submitted by colonelred_(124), visit this page

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The diagnosis is strawberry hemangioma, commonly happens in kids, often resolves on its own as they get older.

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shaeking A strawberry hemangioma is normally pink or red (which is why it is named strawberry). The description has a flat purplish lesion which makes me think of a port wine stain on the face. How do you know to think of strawberry hemangioma over port wine based on this question stem? +4

seagull the age is key here. Newborns have strawberry hemangiomas typically on their face. Sturge-Weber could also be the case but none of the answer choices matched to that description. +1

vshummy I would agree with Sturg Webber nevus flammeus but I also noticed First Aid says it's a non-neoplastic birth mark so I should have known not to pick malignant degeneration or local invasion. Also because capillary hemangiomas don't have to be flat but the nevus flammeus is consistently flat. But I'm also reading on Wiki that the nevus flammeus doesn't regress so they must be trying to describe strawberry hemangioma even though I don't agree with their color choice... +

nala_ula Maybe (and I can only hope I'm right and the test makers are not -that much of- sadists) they would have made sure to write "in a cranial nerve 5 (either ophthalmic or maxillary) distribution" if it were Sturge-Weber. +1

j44n this is literally on every NBME along with the 10,000 ways to not get a boner +1