NBME Answers : step7777's page

Comments ...

+0 visit this page (nbme18#19)

get full access to all content ⋅ become a member

Of note, osteosarcoma also is the only bone tumor with a biphasic epidemiological distribution. More common in adolescents, but can also occur in elderly.

get full access to all content ⋅ become a member

drdoom also known as “bimodal” (since distribution shows two modes: in the second decade of life and the eighth) +

+1 visit this page (nbme18#47)

get full access to all content ⋅ become a member

The location is what helped me out. Left lower sternal border is LV. Mitral regurg would be at apex, PDA would be machine like, coarctation would have weak distal extremity impulses, and patent foramen ovale would be upper sternal border. The only time I've ever heard of Tricuspid regurgitation is with IVDA, which I doubt is going on with the 2 month old boy unless the mom has the propensity to shoot him up and in that case he'd probably present with a fever anyways.

get full access to all content ⋅ become a member

Subcomments ...

submitted by madden875(25), visit this page

get full access to all content ⋅ become a member

From Goljan:

Platelet problem = epistaxis, echymoses, petechia, bleeding from superficial scratches

Coagulation problem = late re-bleed, Menorrhagia, GI bleeds, hemarthroses

get full access to all content ⋅ become a member

step7777 Also that: Platelet problem = primary hemostasis = superficial bleeding Coagulation problem = secondary hemostasis = "deep" / internal bleeding +2

zevvyt i thought I read that INR was 12 and got real confused on that question +

topgunber is there a reason for the decreased PTT? or is that just a distraction +

justanotherimg @topgunber It throwed me off as well, but I found this on google- Sometimes a traumatic or difficult blood collection may result in activation of the coagulation pathway in the sample, resulting in a shortened aPTT time. So I guess it was just a distraction. +

icrieeverytiem It's still confusing. The decreased PT and PTT seemed like hypercoagulability and the only rationale to eliminate that is that he is asymptomatic. Unfortunately I picked DVT and lost an easy point. +1

athenathefirst also is subungal hemorrhage seen in infective endocarditis? +

submitted by icedcoffeeislyfe(56), visit this page

get full access to all content ⋅ become a member

I think this is a Meckel diverticulum presentation!

get full access to all content ⋅ become a member

alinton Agreed-Confused b/c Meckel Diverticulum is legit the classic example of a choristoma (p. 221 FA 2019) Maybe they're thinking gastric mucosa is a more specific answer? Idk +6

step7777 I had the same thought that Meckel's = choristoma = gastric mucosa in the small intestine... +1

submitted by thisquestionsucks(9), visit this page

get full access to all content ⋅ become a member

This question is kinda whack. Right away, I could tell this was exercise-induced collapse, which happens pretty often to runners. I picked autonomic dysfunction because I didn't realize that this is considered an "orthostatic hypotension." After a long race, runners have a decreased SVR from all of the blood flow going to muscles. Once they stop, blood pools, doesn't get back to the ol noodle and they collapse. But ffs I still didn't pick orhtostasis because I think of old people. Fuck me

get full access to all content ⋅ become a member

step7777 Not to mention orthostatics in the hospital imply a sudden change based on positioning. This patient didn't go from lying down to standing suddenly (just bitter bc I also chose autonomic dysfunction. +3

jbrito718 Hypokalemia would present with muscle weakness. Autonomic dysfxn is a decreased baroreceptor sensitivity so we would not see appropriate correction with elevated feet (over correction/hypertension would be seen). Isotonic saline would not correct hyponatremia, it would probably make it worse (dilution effect). MI would have different symptoms. +2

faili7777 @jbrito718 I think you misunderstood something. People who do marathon are really susceptible to hyponatremia. And the treatment for hyponatremia is literally '0.9% saline' because it is isotonic. So it's used to treat 'hyponatremia' +2

stenebee also chose autonomic dysfunction since I thought orthostatic hypotension had to measured in a much short time interval than 30 minutes apart like this question indicates (85/50 at first, 110/70 thirty minutes after leg elevation/saline infusion). My brain was thinking the repeat measurement would need to be within 1-5 mins for it to be orthostatic hypotension, & per AAFP "Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position." ughhhhh :) +

submitted by lae(33), visit this page

get full access to all content ⋅ become a member

chronic bronchitis causes squamous metaplasia of the pseudostratified columnar epithelium in the bronchi and bronchioles

---- these columnar epithelium normally contribute to the mucociliary clearance and smoking also damages this clearance, so can get the clue from that too

get full access to all content ⋅ become a member

donttrustmyanswers Pseudostratified columnar epithelium is only present in the bronchi. The bronchioles have simple ciliated columnar epithelium. +7

flapjacks ^you CAN trust this answer. Confirmed in FA +7

abcdefbhiximab Chronic bronchitis is due to hypertrophy and hyperplasia of mucus-secreting glands in BRONCHI where there is pseudostratified columnar epithelium. All of the other answers point to the alveolar sacs. And centriacinar emphysema only affects the respiratory bronchioles anyway while sparing distal alveoli. pg 674 FA 2020 +6

step7777 It also has to do with the Reid index, which is increased due to mucus gland tissue undergoing hyperplasia and hypertrophy in the Bronchi that is producing excess mucus. Columnar epithelium is usually glandular. pg. 660 FA 2019 +