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 +6  (nbme20#17)

As an edit: 108,001 people reported to have side effects when taking Hydrochlorothiazide. Among them, 25 people (0.02%) have Breast discharge

neonem  I think the best way to answer this question was by process of elimination.
sympathetikey  That's some bullshit lol
karljeon  Haha I eliminated the answer by process of elimination.
medschul  I eliminated thiazides by process of elimination :(
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary

 +3  (nbme20#50)

They are talking about Baclofen, a GABA-B agonist known to treat muscle spasticity


 +12  (nbme20#17)

Nowhere have I been able to find why the hell this is a thing.

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away.
breis  same^^^
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia).

 +1  (nbme20#50)

There are certain situations in which you don't need to notify parents about anything when treating a child--STIs are one of them. The reason being that untreated STIs will cause more spread as well as can lead to PID


 +4  (nbme20#46)

I chose this solely because it was so damn specific

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program
karljeon  I didn't choose it because it was so damn specific. :(

 +1  (nbme20#14)

You are aiming to increase power and you can do so by increasing sample size (reduce B error).


 +2  (nbme20#26)

So you know that 65% of the data will fall within 1SD of the mean. So if you subtract 100-65 you will get 35. Which means that about 16% will fall above and 16% will fall below 1 SD. They are asking for how many will fall above 1 SD. I'm sure there is a better way of doing this, but thats how I got it lol.

sympathetikey  Except according to FA, it's 68% within 1 SD, so 34%, which split in half is 17%.
amirmullick3  Sympathetikey check your math :D 100-68 is 32 not 34, and half of 32 is 16 :)

 +0  (nbme20#23)

I was wondering if it was to allow for partial CNS penetration since the drug is supposedly supposed to have CNS effect


 +6  (nbme20#11)

Hydrocodone/Methadone can lead to dependence--you avoid in long term use. NSAIDs you also avoid due to partial ineffectiveness in neuropathic pain as well as ulcer risk. TCA's are known to treat neuropathic pain very well (i.e. diabetes, ART therapy)

champagnesupernova3  Drugs for neuropathic pain: TCAs, gabapentin and pregabalin

 +2  (nbme20#22)

As a side note, the phosphatase would have activated calcineurin https://www.ecosia.org/images?q=calcineurin+phosphatase#id=2E5AEA65CD7AADC5FADD1C144FFFAD3B7068FDAA


 +2  (nbme20#22)

Cyclosporine is a calcineurin inhibitor, which aims to decrease IL-2


 +0  (nbme20#25)

Propanolol is a non-selective Beta blocker. So your HR will decrease (B1), which will cause a compensatory increase in TPR.

home_run_ball  ^ Above is partially right: Propranolol is non-selective Beta blocker: Beta1 stimulation causes inc HR, therefore blocking it will dec HR and dec Cardiac output Beta 2 stimulation causes vasodilation, therefore blocking it will CAUSE UNOPPOSED alpha1 activation --> therefore increasing total peripheral resistance.
amarousis  so why tf do we give beta blockers for hypertension -.-
dr_jan_itor  I would also add that the patient was previously on an a2 inhibitor (clonidine), which he ran out of. So he is rebounding on that with upregulated a1 receptor activity. Adding labetalol would cause a greater degree of unopposed alpha, increasing tpr

 -5  (nbme20#24)

This a CYP 450 inhibitor (SICKFACES.COM); its the O.

coccidioinmytitties  Azoles, as a class, are CYP450 inhibitors [fungal > human; to prevent conversion of lanosterol to ergosterol]. Justget is correct- a ↓pH is needed for absorption and PPI/H2RA/antacids are contraindicated.

 +0  (nbme20#48)

Most of the pts values were normal. Drinking wasn't outrageous, LDL was mild, BMI has fine. He did have HTN though. The biggest risk factors are the fact that he had suffered an MI and started suffering severe depression (weight loss/anxiety). Thus, he is more at risk for suicide.

sohaib111  Won't having an MI be a very big risk factor for another one ? And also if they wanted this answer (the anti-depressant), why would they just add that his LDL is inreasing in the last sentence...
dbg  bc they're SOBs and DOBs
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez
asingh  It is because of the timeframe of mortality is 2 yrs, everything else will affect later

 +1  (nbme20#35)

I thought the liver looked huge af too lol which made me requisition the whole radiograph


 +0  (nbme20#2)

[moved to subcomment]


 +1  (nbme20#2)

[moved to subcomment]


 +0  (nbme20#18)

ST will first decrease; however, after 20 min it will increase (elevate)


 -1  (nbme20#38)

Ok, so you can reason this by drawing out REIT (sorry I can't draw it here). Anywho, you know its a restrictive disorder and will have a decreased RV, so automatically you know that RV is a component of FRC (FRC= RV+ERV). Thus, FRC should also be decreased. You also know that restrictive diseases are characterized by a steady decrease in FEV1/FVC since both components are decreasing. This leaves you with VC decreasing since FVC= forced vital capacity.

champagnesupernova3  FEV1 and FVC both decrease but FEV1/FVC actually increases because FVC decreases more than FEV1 so the ratio increases
fluentinwhale  Excuse my stupidity but what is REIT?

 -2  (nbme20#17)

Pt has polycythemia vera (myeloproliferative disorder) due to chronic hypoxia induced by COPD. Myeloid metaplasia is extra medullary hematopoiesis due to myelofibrosis. Hereditary hemochromatosis would have been proven by a prussian blue stain. Hypersplenism would have caused decreased RBCs, and myelodysplasic syndrome would have shown Auer rods or blasts.

neonem  Right, I think this would be just called "appropriate absolute polycythemia", whereas polycythemia vera is due to a malignant JAK2 mutation and would be termed a type of chronic myeloproliferative disorder.

 +0  (nbme20#28)

Also, Meckels would have describe hematochezia or failure to pass meconium

sugaplum  I believe failure to pass meconium is Hischsprung's Meckels don't present within the first few days of life, so meconium wouldn't be a factor FA 2019 378

 +2  (nbme20#48)

The strawberry hemangiomas tend to grow and then randomly involute.

medschul  My problem with this question is that a strawberry hemangioma should continue to grow until 5-8 yrs old so I did not see the answer choice "Continued enlargement as the child grows" would not be an acceptable answer as well.

 +2  (nbme20#27)

It also looked exactly like schistosome on the slide--it had the little spine. Entamoeba would have had a bunch of RBCs inside.


 +9  (nbme20#20)

Bronchophony= pneumonia Expiratory stridor= tracheobronchial obstruction (mass/foreign body) Inspiratory stridor = laryngeal obstruction Succussion splash= test for pyloric stenosis

When there is a fractured rib it will cause a trauma pnemothorax which can cause air to escape and become trapped under the skin leading to crepitus.

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema.

 +4  (nbme20#13)

Any answer with treponemes is used to syphilus only and is very specific. That only leaves cardiolipin, which is also elevated in SLE; this is why its sensitive but not specific in Syph.


 +0  (nbme20#11)

Auto dom disease are usually heterozygous (or so they want us to assume)

xxabi  How do you know is autosomal dominant?
scpomp  Hereditary spherocytosis
fshowon  Isnt the mean corpuscular hemoglobin concentration increased in spherocytosis? Thats what through me off.
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF
charcot_bouchard  yes, would be inc in prev NBME. But this is batshit nbme 20. U have to identify spherocytes without central pallor in PBF

 +2  (nbme20#35)

It affected the corticospinal tract in the crus cerebri on the L


 +3  (nbme20#33)

OK, so if I remember correctly this is the one that shows the inheritance pattern. mitochondrial is also passed by the mother; however, it can have variable expressivity and incomplete penetrance, which is why some members were not affected.

hyoscyamine  Also, question said there was a deficiency in NADH dehydrogenase activity which is another fancy way of saying complex I in the mitochondria.
yotsubato  That unaffected male really threw me off... : (
charcot_bouchard  It was pure MELAS description. the unaffected male threw me off

 +2  (nbme20#9)

Fronto-temporal dementia characterized by personality change is usually Picks


 +3  (nbme20#29)

Lysine is used in elastin and collagen cross linking; it is cross linked by lysyl oxidase to make collagen fibers

charcot_bouchard  Thats my brother from UFAP mother

 +2  (nbme20#43)

The CI value contained 1, which means that its insignificant

sympathetikey  Correct. Per first aid: "If the 95% CI for odds ratio or relative risk includes 1, H0 is not rejected."
xxabi  Ah that makes more sense, thanks!

 +2  (nbme20#16)

The pons has nerves 5-8, so the trigeminal would be affected here

masonkingcobra  Thalamic pain syndrome would involve dysesthesias on the entire contralateral body so more than just the face. Also it occurs often after post-stroke. Additoinally, these dysesthesias appear weeks/months later

 +2  (nbme20#44)

I had put "starches" b/c pts that undergo bariatric surgery are only supposed to eat complex carbs (fruits/vegetables) and avoid simple carbs (i.e. breakfast cereal/baked goods)


 +3  (nbme20#43)

You have negative Nitrogen balance in starvation (lack of protein) and positive Nitrogen in muscle building states (i.e. children/athletes)

celeste  Nitrogen Balance = Nitrogen intake - Nitrogen loss




Subcomments ...

submitted by beeip(62),

How to differentiate between Norovirus and Rotavirus here? Must be related to the the contagious nature of the illness?

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +  


submitted by beeip(62),

How to differentiate between Norovirus and Rotavirus here? Must be related to the the contagious nature of the illness?

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +  
beeip  @strugglebus: I didn't know about the vaccine schedule. Thanks! +  
strugglebus  As an addendum, you know it’s not staph aureus b/c that is rapid onset within 4 hours. +  
asapdoc  @Beeip If you go to the vaccines page in first aid it gives you all the high yield vaccinations. I didnt realize to correlate that page to a lot of questions until I got this answer wrong +  
savdaddy  its norovirus b/c it can survive ~2 weeks without a host, which is why we see family members with symptoms 3 days after the initial virus. +  
savdaddy  ***after the initial outbreak +  
eacv  for me this was a discart qx: 1.Giardia lamblia not showed steatorrhea and it needs medication to go away. 2. Rotavirus normally in unvaccinated kids. 3. Shiguella VERY inflammatory stool test do not show anything 4.S areus is very FAST 2-6 hr after eat the contaminated food. +  
link981  Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause. +