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Welcome to step1soon’s page.
Contributor score: 45


Comments ...

 +5  (nbme22#33)
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Tstrueacil iseipsob of dtula mlaes thwi nlKitefelre nresmdyo ear ztarcahedirce yb eiestvnex bifsrsio dna tyhliinaaonzi fo hte nsreoemuisfi sleutbu adn lasaheyrppi of het rntt;iteuiims eeowrvh, teh bestluu aym oswh iesrluad coif fo teeasmgnrossipe. giiolHotcs indfnigs may cudlnei mal,ls ifmr etsste htiw irneisosuemf turulab iynitzoianahl; scs;rsolie adn oyhprta thwi olafc seahipapryl of ltmsyo ntgdeaedeer gyiLed lsecl

diiott/Kntp/efn/dwyehwcamm_hlrdwtpten.me:aoe-riSio..lhpa


 -8  (nbme21#7)
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rccti:ehmoOy nOe ro obth lceeitsts is oemevrd grouhth a lmlsa tuc in royu o.mtrcus sisu te mleavor rmfo oybd → no unttienrs → llce ahtde

  • hlal mkar of llec hated = ADN toteafimannrg
dhkahat  no no no no no lol +

 +0  (nbme21#35)
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raHet lfu:iaer sTih is eht otms ursoies tilcmnpoicoa of galer itsoraueroenv itfs.salu inSce yuor dolbo lowsf oerm ylicuqk thurohg na oateenorsrvui fsitlau anht it luowd fi uoyr dbool elofwd hhoturg a mnorla creosu fo ,arrieset selaipalric nad e,nvis ruyo rhaet usppm ahdrer to emaetscopn orf hte prod in oobld ssrupere l(aelcd uu-htitohpg retah i.)lreafu Over mie,t the eierdancs ttynsinie of oyru ates'rh gpimupn nac aenkwe ryou atehr usl,cem egndila ot ahter au.eflir


 +0  (nbme21#39)
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e,Tim lape,c anem → essasess ientraootin → to ese fi pt si rfo eamxlpe dnttieoxica ro ton

csoiieDn aigmnk aaccpyti si sdabe off of rhwethe teh tieantp detusnanrd hre ionsgadis dan is miangk na nmreiodf tnsnoec → she nkosw and autsresdndn


 +4  (nbme21#18)
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Drguin het elnaMt inMi atSet Eamx ,S()EMM a tahhle speaofrolins skas a iaentpt a seeisr fo nsqtoeuis edneisgd ot tste a gnare of ryyavdee natmel kl.slsi Teh mxmiaum EMSM cosre si 30 .piosnt

-20 to 24 eutgssgs diml 3 edn-e1atim to 02 sgusetsg dtrmoaee la-sd esietemn anth 12 tesidcnia evesre .dteaienm


 +3  (nbme21#48)
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cwt/.wCj:cowM/ghumtbHt/vLet.shwRpaO=yGOuo?w

oodG aneitopnxal


 +16  (nbme21#16)
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tkra/e/srydohasy.ti/lola-ocmehaeavleupgstdi-vr/:

Look ta ewrhe teh csspu rea igoinntp → wusprda eeteohfrr octar.i if sspuc erew rnwddoaw → nteh ialtrm aevvl wluod be the tihgr sewnar

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +3

 +0  (nbme21#20)
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eW nac erul uot A B adn C sbeuaec tis rcenac nad tp liwl epresnt w/ eghtwi sos.l erHe teh pt eylkli has nimuanope /w atvdleee euekcloyt nocut idtinngaci cf.nieonit nO ,SBP ellcs lkoo ikel thuspelinro e(ens ni cuate yraaonfltimm tstesa) hichw era luenycoastrg eehfrteor ti si atrcieev glou.saistoycnr


 +0  (nbme20#18)
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In bpvsuttsoitorce siesdriu teh enriU si uallsyu ooyinctph htiw rlage somaunt of soimud lied,hroc apmissu,to opthaspeh and eunsaigmm Uinr] 3e[ tOtuup ;> 215 - mu2L/ohr00 tafre eielrf of tsbrouicton rof ta laets 3 eencusvotci [sen] ruiUrho4 lryitOmsao ;&tg k2m/5smo0g []5

vteisos/uiPmrtbhtw-w/krupt.iski_/reosocstei/igd:


 -1  (nbme20#13)
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ehT tdpeorre neiniedcc of lnaapC ndsemory is 1 ni yreve 1,00000 .ploeep sThi sha nbee a lndgcniei mrbenu edu to wolre xesepuor to c,loa tss,bseoa nda .alisic enlPacreve of pCanal renmdyos is irgheh in istenpat htwi aciils eusperxo eadrpmoc to the retho ue.ssca ehT tfris emdelipgoiico stduy etaenudnkr by het csnnmioousoePi seheRrac Uitn ervdobes an endceiasr envplacree of RA msangto enm htwi gspsorereiv maevsis fsibisor F.()PM Mlial te l.a nduof no ienedarsc pcenrlevea fo ihomtearud rahrtsiit ni esrnim enhw dmcaerpo to a tmmonuicy hewre PMF nda arehtidumo thirsirat eerw ertvapeln and ehreotfer oncdlcdue atht hte oyltegio of RA aws otn sotdasaiec itwh uoesrexp to dstu ro ugnl ahgcens of cipctlamedo omcnisoopne.siu erheT asw a hgih enpaelercv tare of FMP dna lucsoebiutsr msatnog eisnmr dna s-nrexemi iwth iamreduhot ]sr]ia54hirt[.t[

iaAhtshp oylgonyPo: namuoimute idotnnoci si a npnoemehno eehrw eo'sn doby hsa ytnafilamorm cslle which kaactt tis now uessit dn,a in teh caes of A,R het vim.ysnou tI is bdveilee ttha in hetes ptt,senia ehrte is na latateiorn hichw aucess eht eracdesni mniemu prsonese to nfegrio mlstraeia ni eth ugl.ns rTehe si ienmum ittcaepvyryih tath is skdpera yb ialisc ni wchhi tmceynoos adn pshrgamacoe erlaese toinskcye hcsu sa eekilitnnu-r1 dan --asturyiggtonocaniccempylrumoahleltn-ago ftrcao dan tromu roseicsn trofca phal.a hTe sphra eegds of het iiscal also aucse slisy fo ylaslooms sotsarepe in .pashacoegrm yhpLsomtyec era aaitvtecd yb the kyonetics aseeedlr yb me.rhogapsca sTih all dslae to an tommieunua pmonneneho huroght resoxpeu to icaisl wichh is reirtgegd ni eleiatylngc pepdrssdeoi vunaldsiiid how vaeh RA.

u'dnlowt hte uielrgnydn deesasi eb RA hwhic is etnh csaniug hgocncnreboi mncrci?aao 'Im !!nfsucedo

kpjk  i dont think its RA, because they said xray shows new bone formation, where as RA would have erosion +

 +6  (nbme20#8)
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dWneiign fo het = RSN!MAUYE

aEtrx lmneu ni emdai of oaatr = NEDICSIOTS

TSHI tp sha na itacor snisteodic

1 KSIR cratfo is i ot!nsepn!eyrH

lslsyu(pih dwluo eb ctceror of the tp dah an ruenmsay but HSI HTECS YRAX- OD TON oshw gewniidn of eht ar)ato

gabriela  @step1soon were you upset when you wrote this comment? lol +3

 -9  (nbme20#14)
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gythnnAi pupre ipl + aoevb → albas clle nmorcaiac

yithnAng eowlr ilp → usquaSom ellc rmcaoniac

FA 0192 gp- 437

adong  it's saying upper vs lower lip. this pt has it on the nose +1

 +1  (nbme20#36)
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sOn EBM ,Arag ositalde oelincso of gcatnee-oltrsenimf ctibarea aaprpe orwbn to abukcl-leb in c.orlo ihhieccasEr iloc peparsa sa ge,ral lekbulbac- ncloosie, oentf whti a egern lmietalc h.enes eEarorcntteb p.ps nsrpeet as brnwo to -ba,blekcul ocmudi eoinslco wthi on e.shen s-enn-tfgtNoncoaeimerl looen,isc uhcs sa ilehlSag pp.s and olmelalSna p,sp. ppaear natrsretapn adn soroe.lcsl

eW liablcysa eended to aroercelt taht → no imasrogsn sene ubt olny lsiehpnrtuo ot ebnig a toelcas renmrnnto-ofe goiar.snm eTerhoref teh awsnre is laegilhS adn not E icol


 +0  (nbme20#15)
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cCiasanip usdcine the eleesra fo sustacenb ,P neo of teh iracpplni raooedmtmiecs-h fo ipan ssumilpe mofr teh yeerphpri ot eht rcelatn orusnve metssy .(NS)C efAtr perdatee ioacpl,pnait icspniaca eepsetld het ernuno of snacsbeut P dna evnerpst sit aeocmun.iulctra


 -2  (nbme20#31)
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atiiaccS is a aieitgnldtbi dtinoncio in wcihh het atitpen sexreieepcn pani adrno/ srtseaeshaip in het udinitsotbri fo teh saticic rvnee or na osaaitedsc loulmarasbc verne o.tor t,eOnf a onomcm smatkie si rfrrngeei ot yan low kbca nipa ro rauaidlrc egl niap sa .aacicits cctaiaSi is iiepcsfc to teh naip htat si a tdcier teulsr of iciasct evner ro citcais veern toro ytl.gapoho hTe cisctia rnvee is made pu fo eth L4 uhgorht S2 eervn rstoo chihw eoecacls ta teh vslpie to fomr eht catciis ev.rne tA pu to 2 cm ni edaemri,t teh icastic rneve si elsiya het gatlsre veren ni the doby. taicSiac pnia tneof is weenosdr ihtw oifxeln of teh uamlbr ,psien inttgiws, ednigbn, or ghnugio.c Teh citicsa veenr deospriv drcite otmor infcontu ot eht mhtrasg,nis eolrw mrtteixey dso,cadutr and dertciin otrom ficnntou to hte afcl lmecss,u anotirer rweol egl uclm,sse dna smoe riintscni foto clu.emss osAl, lcidnyetri urgohht ist rtaielmn rsnhceba, het ciasitc nevre vorsepid nssatnieo to the osorirpte nda lretlaa wreol egl as llew as hte latarnp t.oof

yAn nioodcint ahtt amy yrtulrcsalut cmapti ro erpcsmos eth tcciais eenrv yma sacue acscitai mty.psmos heT omst omcnom ceasu of cacitais is a ertdnehai or gubgnli urambl vrtneabeitelrr sicd. In the dlelrey ioa,plnptou mrulba snalpi ssnsoite mya sauce tehes soypmtms sa le.lw lohyntepliisoSssd or a arelitev mtnsagmilnei fo eon beervart rivaetle ot aenhrot aym also lseutr in cistcai mssyo.mpt dyian,dliltoA ubmarl or pvicle umarucls spasm aodn/r mofainmntila yam pingemi a alrumb or lascar rveen rtoo singacu itacisc .msysoptm A lpsian ro pprslanaai smsa iugcldinn nnl,mcayiag reudplia ,tomhamea ro peirauld aesscsb yam alos eascu a isklmase- teefcf nda csctiiaa tyssompm.


 +4  (nbme20#19)
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itlooyEg → ttrie gaCe mongkis is ojrma srik ctofra (5-80%0 of n,rcasec kirs ctdeasosai wtih nrdtuoia nda niysstlt )oeniA esayainmrl p)my2laa(intnehh- dna iilanne ydeI ns edlipgonve ot,cniruse oimsschaSto biahaomuetm ova rae dpesdetio ni bdlrdea allw dan cusea cihrcno aa,mnniilftmo usamqsou aaltmea,pis ayspdsi;al %70 of mtosur ear qomuauss llec PcorVnci maHa amy aecsu dy,noclaom qmuausso ylpa,dssai quomauss llce mcnaiaroc utnaneePhcienqs ece use yul(lusa gonl trem sue in gyenour eonm,w muotsr vlveoni erupp oicnclglet Ce)thni rosscmy rynuiar tctar ciotefinn dan cerlllRyaiu ca opilydeoahshccpm iwht ngol metr seu


 +2  (nbme20#26)
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heT 3 inam ospintre ahtt cayrr hte jrmaityo %)9&t5(g; of dyhiroT moeHnors H(T) era o-binithegxynrdni lugnibol )TGB(, thestnirrytan T(,RT ro pn)imelbua,r nda ubanlmi. A oirnm pntroopoir fo teh HsT si obndu on mreus onpr.letpiosi Vyre eraly,r nda ni het tcxnoet of HnaTti- aonbiiedts ni oeunamtmiu thordyi ,saeseid mgnuumlobsniilo alos aym ndbi TH. TH nbiidgn ot TGB is eehazacdrirtc yb wol ctipcaya btu gihh advty;ii hte sronvcee si ,treu ie, hhig ytaapcci but low yadtvii, for HT ndbgini ot TRT adn n.aiblmu

A iynidefecc in dH-nnTibig rtpiosne is ptdusseec henw nblmaoylra wol mures ttaol HT tnoctcreiansno aer nredcuoneet ni llcaiylnic oyuiderth scusjbte in teh necsrepe of rnaolm rmeus ypottornrhi ie,( dnotlygruttm-ihaiis hemrnoo H.T[])S eMor espialfc,ylci wol GTB si esgutegsd csbaeue tihs pnoitre irrsaec the aiojymrt fo eht rsuem T.H

aevSelr tstesa of niyececdif fo tish ietnopr vahe eenb eddscrieb atth aer erehit eethriidn ro ri.uaqced drhoTyi fntnucoi stset sT(FT) ni stneatpi hwit TBG dnfeecciyi whos anorml HTS nda erfe ,4T utb low attol 4T ,and olaocyl,isacn wol aottl T3 msrue entaocstincr.no eTh mots ritoatnmp llncacii seacpt fo TGB iyinedfcec ttsase is ogireotnnci of heest rsderdosi dan aicadoevn fo rnynaeuescs nda patntlileoy fluamrh HT remlapntece rhetpy.a





Subcomments ...

submitted by seagull(1405),
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siHT nuoietsq is sjut arciilct .itnhking Teh nrsdlaae are btalylirlae nda lyeactmlryism slmla. llA treoh erswna oishcec era ont ykleil ot eb nvee tbyiaelrall. ecanCr 'nowt lqulaey epdasr in rectefp tmsreymy nro fsueciiotn csasue hleiw anngiatmini hte ldeanra uiheactrcter.

slim23shady  Will TB be the answer if they'd mentioned the patient from developing world? +  
step1soon  Autoimmune adrenalitis aka addisons disease → adrenals atrophy common cause: 1. developing world: TB 2. Western world:autoimmunne FA 2019 page 334 +14  
drschmoctor  FA 2020 p 349. +  
drzed  I think the cancer reference (C) was with respect to an ACTH secreting tumor, which would symmetrically and bilaterally HYPERTROPHY the adrenals +2  
drzed  ^Just kidding, it says metastatic. My bad! +1  


submitted by bubbles(66),
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oFr hte peesp owh otg nsufoecd on siht esnutqoi cb of dWroslU' rewdi nseoquit on VIH lavri o:lda

uaetc -VHI1 fne:oiictn HHIG valri ,dola lwo A2V-b IH fie:ntcion WLO vailr ,dalo wol bA (cb atnsdrda IVH sassay dttcee 24p, hhwci is otn rsenpet on )V2-HI

ndiaK annyode I msieds an aesy uynloiomgm octnpce esnqutio /:

eacv  I feel you my friend! same stupid mistake over here -.- +3  
step1soon  FA 2019 pg 176 +2  


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My totughh cosrspe was tath atormtsup-p engldbie is yuuslal leeartd to hte er,sutu dan mhcu fo hte ceivpl vasierc si sedlupip by ahrcsbne fo eht rlintena laiic re.rtay

neonem  This sounds like a case of acute endometritis. In any case, uterus is supplied by uterine artery (branch of internal iliac artery) with collateral flow from ovarian artery (comes right off aorta). I don't think there are any branches of external iliac artery into the pelvis; it becomes femoral artery once it passes under inguinal ligament. +4  
tsl19  Here's a picture that I found helpful [Female Reproductive Tract arterial supply] (https://teachmeanatomy.info/wp-content/uploads/Blood-Supply-to-Female-Reproductive-Tract.jpg) +14  
sympathetikey  @tsl - Thank you! +  
step1soon  uworld Qid:11908 +  


submitted by egghead(1),
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iTsh is oen of hesto uoitsqsne I asw rneev oggin ot tge. 'Ist not ni F,A I no'dt iknht ev'I seen ti in .class

hungrybox  same :( +  
masonkingcobra  My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp) [Turns out it does not](http://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x) +  
gh889  FA 2019, pg 551 +8  
meningitis  Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line; medications (eg, clomipramine) may be considered. +13  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +  


submitted by egghead(1),
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Wtah is tihw hte cetui?pr I tjsu luodw evrne cipk tricsedtiliviu huoiwtt ngeies a .ivumr.dc.utiel

quaper  I spent so long looking at that picture and thinking what the heck are they trying to show me here. I couldn't see any diverticuli, didn't see any cobblestoning, figured the dark patch in between the white patches was necrosis in the end. +8  


submitted by lianallado(2),
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oScizdhi rislyanotpe derodris is eaicrrdthcaze yb rlyatnouv ialocs rdtaia,lwhw teiimld aloinmoet oirpexnsse adn ocials .osnlatoii

step1soon  Answer is not avoidant personality because these people actually desire relationships whereas schizoid personalities do not (they are content with being loners-like this pt) +2  
mambaforstep  i think i saw this on a @DirtyMedicine youtube video but i always think schiZOOOOid wants to be/is happy to be a lOOOOOOner +  
jawnmeechell  Or perhaps schizoid wants to avoid :) +2  


submitted by hayayah(1056),
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enPttai ash eiatcgnonl ydhimoyrhptsio em).snit(cri :nFgiinsd tpo belly, ep,la d-auec,fyffp clmlbiuia rienah, soiaogalrcs,m t,iyohoanp oopr naibr tvdelenpmoe C(M csaeu of etlaeratb nletma arirtaet,nod) gelra rnetoiar tlesonelafn.

whossayin  how can you differentiate the symptoms of cretinism from Down syndrome? +  
step1soon  @whossayin Down Syndrome: upslanting palpebral fissures, atlantoaxial instability, bent little finger, congenital heart disease, displacement of the tongue, excess skin on the back of the neck, flaccid muscles, hearing loss, immune deficiency, low-set ears, mouth breathing, obesity, obstructive sleep apnea, polycythemia, seborrheic dermatitis, single line on palm, thickening of the skin of the palms and soles, thyroid disease, or vision disorder +3  
ally123  I was confused about why the infant was jaundiced, and found this: "Hypothyroidism causes decreased rate of bilirubin conjugation, slows gut motility and impairs feeding, all contributing to jaundice." Source: http://www.pathophys.org/neonatal-hyperbilirubinemia/ +6  


submitted by hpsauce(-2),
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I veleeib iths si alnpaC nyrdmeoS ghicon(cbeorn rncioamca + edrthiauom t)rt.irahis Onyl flwa to that is hatt eth olrmnpauy ndisnifg dtno' etcplfery etrnprsee spneoonme.usioc

dbg  it's just bronchogenic ca, type of adenoca, which is classically associated with 'hypertrophic osteoarthropathy' +  
woodenspooninmymouth  To get it for the test, remember that lung adenocarcinoma is associated with clubbing. Mechanistically, this woman probably had RA. Then she was exposed to asbestos. The asbestos in the context of RA lead to caplan syndrome. The asbestos also triggered her bronchogenic carcinoma. +  
step1soon  Then why isnt Rheumatoid Arthritis right? what comes first? bronchogenic carcinoma or rheumatoid arthritis? +  


submitted by cienfuegos(64),
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lCdun'to uoy aslo ecdeares hte ?I2OF erP FA, PPC osal enesacirs ot iyhaxop asol ecassrdee PPC hewn O2P tl;& 05 mg.mH

cienfuegos  Obviously not the BEST option in this scenario, but seems like it could work unless I'm missing something. +1  
step1soon  Its primariy driven by PCO2! only when O2 levels drop <50 mmhg is when the body responds to low O2 pressures +1  


submitted by xw1984(4),
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I otg shit Q nw.ogr I wsa wdneginro yhw sith ttneiap ash“ on rpnaseol ro falimy orsi”th.y aeirerdHty hssoycotsrpei shlduo be a DA ssdeaei, s,o aelyrnelg a,sngiepk shit idz sduhlo be nsee in aehc onre,itange ihr?tg

step1soon  I was thinking the same! +  
wuagbe  Several genetics questions on NBME20 appear to be trying to throw us off by changing the descriptions of inheritance, leaving us to assume incomplete penetrance, smh. +