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Welcome to skilledboyb’s page.
Contributor score: 9

Comments ...

 +1  (nbme16#1)

If you see jaundice/liver involvement in any a bone marrow transplant, usually it's Graft Versus Host Disease. Has worked thus far on every NBME and UW question.

 +1  (nbme16#37)

Though this question seems to be require that you know the flow rate equation, you can actually figure it out simply based upon the units in the question stem.

The answer is looking for a value with units of L/min. L is a volume which means it is represents a three dimensional value/distance/area. Volumes are expressed as units of length to the third power. And seconds need to be converted to minutes. Just make sure the units end up where you need them and you get the question right.

(Also, this approach works almost every time for ever calculation question on this test other than when calculating a half-life because need to multiply by 0.7 constant. Additionally, when calculating loading doses/maintenance doses with a bioavailability that is not equal to 1.)

 +3  (nbme17#12)

Just small addition to comment above:

Can also get to answer by way of elimination.

Oral Polio and Measles (part of MMR) are both live attenuated vaccines.

Diphtheria and Tetanus (both part of dTAP) are both toxoid vaccines.

You wouldn't be able to distinguish within these two categories, therefore the only answer left must be H. flu

 +1  (nbme17#41)

Typical cell marker associations in this one:

alpha fetoprotein- Hepatocellular carcinoma

hCG- choriocarcinoma or some testicular

norepinephrine- pheochromocytoma

TSH- a marker for thyroid abnormalities

Subcomments ...

submitted by time2swim(0),

I understand that damage to the area labeled E would cause issues with the corticospinal tract. However, wouldnt this damage cause UMN findings as it is before the transition to LMN in the anterior horn? In the stem we read that the pnt has LMN finding of "unable to move" So why are we seeing LMN and not UMN findings? thanks in advance

skilledboyb  Paralysis is a finding common both the UMN and LMN. The distinguishing findings are things like: atrophy (LMN): 30 minute onset not long enough to see this reflex changes, spasticity, etc: not mentioned in the stem +  

submitted by aakb(2),

what is the lesion/picture? not really sure what to even google for this.

skilledboyb  I got the feeling that this was some type of a hemorrhoid. The reason why is because they speak about constipation (risk factor for hemorrhoids) and the bigger give away is that this patient is pregnant. The uterus can compress the IVC when it gets large enough and lead to blood stasis behind the obstruction. +3  

submitted by hungrybox(974),

ACUTE alcohol inhibits CYP → Increased bioavailability of acetominophen

CHRONIC alcohol induces CYP → Induction of cytochrome P450 enzymes that activate acetaminophen to a hepatotoxic metabolite

I got this wrong because I assumed chronic alcohol meant years and years. I guess a weekend will suffice?

Honestly, fuck this problem.

lfcdave182  Yeah fuck this question. 2-3 days of something would never be considered chronic in anything else. +3  
pontiacfever  Drink a lot for a week makes you a chronic alcoholic? +  
pontiacfever  That means alcohol abuse = chronic alcoholism +1  
skilledboyb  Why would increased bioavailability of acetaminophen place the patient at increased risk of liver injury? What's dangerous about that? +  
i_hate_it_here  Metabolism of acetaminophen turns it into toxic metabolites (NAPQI) that inhibit glutathione in the liver forming toxic tissue products. FA2020 pg: 485 +1  

submitted by lpp06(27),

Hemorrhoids are dilatations of arteriorvenous plexuses in the rectum. Blockages on the arterial side will not cause the plexus to fill while venous thromboses will cause a back up of fluid.

Clues for hinting which vein are the location at the anal margin and that he was in extreme pain. External hem's will be painful, pointing towards inferior rectal as the answer since it drains below the pectinate line where external hem's are found.

skilledboyb  anyone know how to rule out middle rectal vein thromboses? +  
prostar  it is just that when both are in option go for inferior rectal vein. this is more apt. or else both are correct. +