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Welcome to strugglebus’s page.
Contributor score: 165


Comments ...

 +12  (nbme20#17)
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sA na 1i0d8 t00e1:, peelpo reepordt ot vahe iesd ftsfeec ehnw tkgian .gooheio hmAntdHzaorydlrci eh,mt 52 eoelpp 20(.0%) haev trBeas egricsadh

neonem  I think the best way to answer this question was by process of elimination. +1
sympathetikey  That's some bullshit lol +9
karljeon  Haha I eliminated the answer by process of elimination. +20
medschul  I eliminated thiazides by process of elimination :( +1
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary +2

 +5  (nbme20#50)
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Thye rae antligk touba l,nceBaof a AB-BGA atinogs wnokn to ttear lscume sptsiyctia


 +27  (nbme20#17)
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eweohrN evah I nebe ebal to infd hwy eht lleh isth si a ngt.ih

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. +6
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). +
chandlerbas  you had me at its not in sketchy ;) +3
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +

 +3  (nbme20#50)
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erhTe rae cariten ntiostiusa ni wchih you dot'n ende to itfoyn epsnart ubtao nginhtya nweh itegatnr a lSidsTIc-h- era oen of mteh. eTh osrane ingeb thta taeetdrun sSIT llwi secau eorm sarepd as elwl sa nca dael ot PID

ibestalkinyo  Mnemonic for things not needing parental consent: Sex, Drugs, Rock and Roll (Emergency Trauma)(except HIV) +3

 +14  (nbme20#46)
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I secho isth lseoly ceeubas it swa os namd isfcpiec

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program +4
karljeon  I didn't choose it because it was so damn specific. :( +43
lovebug  Could anyone explain for B) for me? because I choose B).:( +2
j44n  B.) is wrong because its never been shown to show adverse effects "any offcial data linking the drug" and the fact that it's "newly marketed" +
j44n  and because its in 5/45 patients roughly 10% of the population, that might not seem like much but most of the diseases we freak out over are in 1-2% of the population, to put that into perspective if we gave this drug to every person in the US (every big pharma wet dream) with a population of 300 million... 30 million people would have this adverse event... hope that helps +

 +5  (nbme20#14)
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Yuo aer ngmaii to naiceres opewr dna uoy can od os yb rsicnangie psamel eszi (edreuc B )orrre.


 +7  (nbme20#26)
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oS oyu know hatt 65% fo hte daat wlil fall intihw 1DS of teh .mean oS fi ouy attcubsr 650-10 uoy liwl gte 53. ihchW easnm that uatbo 6%1 lwli lfal vbeao and 6%1 wlil flal wleob 1 .DS hyeT era nisgak rfo hwo naym lliw lalf boave 1 DS. 'Im eusr eetrh si a rebtet awy of nigdo hsi,t but ashtt how I gto ti lo.l

sympathetikey  Same! +6
sympathetikey  Except according to FA, it's 68% within 1 SD, so 34%, which split in half is 17%. +2
amirmullick3  Sympathetikey check your math :D 100-68 is 32 not 34, and half of 32 is 16 :) +8
lilyo  Can anyone explain why we subtract 68 from 100? This makes me think that we are saying its 35% of the data that falls within 1SD as opposed to 65. HELLLLLLP +
sallz  @Lilyo If you consider 1 SD, that includes 68% of the population (in this case, you're saying that 68% of the people are between 296 and 196 (1SD above and 1 below). This leaves how many people? 32% outside of that range (100-68=32); half of those would be above 296 and the other half below 296, so 16% +5

 +0  (nbme20#23)
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I swa noednrwgi fi ti saw to wlola ofr parlita NSC iteetnnopra ecsin eth rgud si dpouypsels pedsuops ot vhea SCN ctfefe


 +13  (nbme20#11)
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HoacdMerdeeonhy/otdon cna dlae to dncey-ponu-deee avoid ni long etmr ue.s NISsDA yuo losa vdoia due to ilatpar fesenieecvtsfin in rencptiuoah apin sa lewl as rclue irk.s A'CTs ear kwonn ot tetar hpatrceniuo pain evry lwle ..e(i te,sbaedi RTA a)yteprh

champagnesupernova3  Drugs for neuropathic pain: TCAs, gabapentin and pregabalin +1
mangotango  SNRIs +
mangotango  also SNRIs* +1
zevvyt  methadone isn't a pain med(even though it's an opiate), it's used for opiate addiction. And hydrocodone is used for "moderate" pain and this person is in "severe" pain. +

 +7  (nbme20#22)
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As a dies ,otne eht aspsphothea luwdo ehav evttacdia lnuncicerai 3FseAh4nqlr=sC.raEw?A5CDAF4DeEe5ap8/FAwctDt6Dpangmp=oAA/A0g.isCiBDFoohhFi1i/51#:d2sai+Ds6w7Aceta7cu


 +7  (nbme20#22)
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niylCoopesrc is a cireninluac bn,ithriio ichhw siam to deeseacr -LI2

teepot123  fa 2019 pg 120 +3

 -1  (nbme20#25)
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olnaopPrlo si a nceeneivotls- eatB kolb.cer So yoru HR lwli sdeearec )(,1B cwihh ilwl escau a ypotcsnamore rseaniec ni R.TP

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. +42
amarousis  so why tf do we give beta blockers for hypertension -.- +6
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 +1
llamastep1  @amarousis They are used for hypertension because the hypotensive effect of the reduced CO is greater than that of the effect of the increase of TPR. Cheers. +7
hungrybox  @dr_jan_itor Adding labetalol would not cause unopposed α1 because labetalol and carvedilol are α1 blockers in addition to being nonspecific β blockers (great name btw, I love scrubs haha) +2
mw126  Beta 1 blockade in the kidney (JG cells) would also decrease renin release, which would also help with HTN. FA2019 pg 245 +
rockodude  @dr_jan_itor clonidine is an a2 agonist not an a2 inhibitor +

 -10  (nbme20#24)
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iThs a YCP 540 ibhnrotii (ASFCOECMCK.SI); tis hte .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. +

 +6  (nbme20#48)
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ostM fo het spt sauvle eewr am.orln ninDgkir wtans' ,uatorosueg LDL aws i,mdl MBI sha nie.f He idd aevh HNT otuh.gh The iestbgg kris actorsf aer eht tafc atht eh dha eefursdf an MI nda radtest ifgnerfsu erseve eoidpesnsr hewt(gi txy./ss)eoanli uh,sT eh is omer ta irsk for eduicsi.

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... +14
dbg  bc they're SOBs and DOBs +22
doodimoodi  Yeah, recommended LDL in people with previous heart problem is < 100 jeez +1
asingh  It is because of the timeframe of mortality is 2 yrs, everything else will affect later +5
benny  mdd increase MI +
benny  Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI). +
drzed  None of the cardiovascular options would improve mortality (statins, ACEi, BB, spironolactone are the ones that have proven mortality benefit). So if they had put one of those, I think I would have chosen that, but given that the rest don't change mortality at all, I went with the antidepressants. +2
ihatetesting  My thinking was that since he had an MI, a beta blocker would improve mortality, and propranolol is also used as an anxiolytic. +2

 -1  (nbme20#35)
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I tthohgu teh lveri ekodol uegh af oot oll wihhc mdea me oiieruitsnq eth lhowe ogiradrhpa


 +0  (nbme20#2)
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vemod[ ot n]ummbcoset


 +0  (nbme20#2)
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modve[ ot entcsm]buom


 +1  (nbme20#18)
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ST llwi tsirf e;ceredsa reheow,v traef 02 nim it wlil ierancse ea)t(leve


 -2  (nbme20#38)
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,Ok so yuo anc saoner isth yb awrgidn out ETIR (osryr I 'ntac awrd ti ee)h.r ,nhAwyo uyo kwon tsi a rrticstveei eddisorr dna lilw vhea a sdaecrdee R,V so otallicymutaa uoy wnok thta RV si a oetnnpcmo of RCF CR(=F RR.VE+V) Ts,uh FCR oluhsd laso eb caeesde.dr uoY soal nowk atht tvicteesrri essdesai ear aidrteczhecra yb a tdayse ecsdreae in E/FCVF1V enisc ohtb pmtooncsen era ag.edseicrn shiT slevea yuo hwit CV gcaeinrdse sncei CV=F cfodre liavt cipayt.ac

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? +1

 -7  (nbme20#17)
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tP hsa yiyomclehtpa reva omieoiaerlt(yrlvpef )orrsdied eud to nicorhc ixohyap dundeic by .CDPO deMiylo imasetapal si xtare ldaryemlu pmsooseahtiie ued ot imeossifobrly. rteydHeira socrhotmmehisao luowd vaeh eben povner yb a pssiunar elub ait.sn lerepsiHnmpys udlwo heav sueadc reedseadc RCs,B dna isysllympceoad mersnydo odlwu vhea hwnos Auer rsdo ro assb.lt

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. +14
utap2001  Myelodysplastic syndromes (MDS) is also called Preleukemia, myelodysplasia. in MDS, your bone marrow doesn't make enough of these healthy blood cells. Instead, it makes abnormal cells that aren't fully developed (immature). As the condition develops, your bone marrow gets gradually taken over by the immature blood cells, which don't work properly. The condition can develop slowly (indolent) or quickly (aggressive), and in some people it can develop into a type of leukaemia called acute myeloid leukaemia (AML). +

 +0  (nbme20#28)
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slAo, leekcsM luwod aevh srcebide hihecoaezatm ro rlaeufi ot sspa mmncuoei

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 +1

 +4  (nbme20#48)
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Teh bytarsrrew emsamonaihg detn ot rgow nad tehn myoralnd oiel.vtnu

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. +10
merpaperple  I still don't get that. Over the course of the next 5 years, it will 1. continue to enlarge as the child grows, and also 2. spontaneously involute. Both answers are literally correct. +
fatboyslim  "Continued enlargement as the child grows" implies that the strawberry hemangioma will continue to grow and will not regress with time. That's why it's wrong I think +1

 +4  (nbme20#27)
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It lsoa oedolk ycetxal leik ooiesscthms no the -dl-stiie dha hte tltile neis.p oeEbtaamn duowl have ahd a unhbc fo RCsB dns.iei


 +19  (nbme20#20)
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ho=conhypnorB ai nerniayrumEpxopto =rdtisro hoohlebnrctiraca tnroutcobis ose(/narmgsfi r ostIyyaproid)nb ostirdr = relanygla out nSccotsuissbriounc h=sspla ttes rfo cirlpoy itessson

Wneh etreh is a arudrftce irb it lwil uaecs a atrmau xoaotneprmh whcih nac sueac iar ot cepase nda obmcee rpadtep undre het skni lidaegn ot etsrpuc.i

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1

 +10  (nbme20#13)
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Ayn resnwa iwth smepetenro si edsu to pilhusys only nad is vrye pfcie.cis ahTt lnoy aelesv ac,rilipodni hiwch si osla tedevela ni LS;E siht is yhw its niseivste ubt nto cipfiesc in S.phy

len49  False-Positive results on VDRL can be remembered by P-VDRL -> P - pregnancy, V - viral infection (EBV, hepatitis), D - drugs, R - rheumatic fever, L - lupus and leprosy FA 2019 pg 148 +

 +0  (nbme20#11)
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tAuo odm sedeais rae lylsuua oetzurheosgy o(r so thye tnaw us to muss)ea

xxabi  How do you know is autosomal dominant? +3
scpomp  Hereditary spherocytosis +
fshowon  Isnt the mean corpuscular hemoglobin concentration increased in spherocytosis? Thats what through me off. +5
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 +4
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 +

 +1  (nbme20#35)
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tI ecfefdta het coiiocsplantr acttr in eth sucr eecrrbi on teh L


 +6  (nbme20#33)
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,OK so fi I breememr lytocercr hits si eht oen tath woshs the rtehcniiane ta.pntre hiormndloitca si salo sdseap yb teh emor;th ,herwveo it cna heva ivearlba ritvyspsxeie dan temlcoenpi ,tnanrpeeec ihwch is wyh oesm mmbsree weer tno .efecftad

hyoscyamine  Also, question said there was a deficiency in NADH dehydrogenase activity which is another fancy way of saying complex I in the mitochondria. +13
yotsubato  That unaffected male really threw me off... : ( +22
charcot_bouchard  It was pure MELAS description. the unaffected male threw me off +2
mbourne  I think the affected male on the right side is actually a helpful hint. Mitochondrial conditions can be inherited by males or females, but are only passed on through the females. +1

 +3  (nbme20#9)
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eoatnormol-tFrp etendiam dcraritecaehz yb osyltiearpn ghncae si suually kcsiP


 +6  (nbme20#29)
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nyesLi si edus ni snaeilt and anoellcg srosc kinig;nl ti is orssc diklen yb ylyls aiedosx ot emka aoenlclg isefrb

charcot_bouchard  Thats my brother from UFAP mother +2
smpate  but glycine and proline are used in elastin too. Seems like you'd have to know about desmosine though that's not in first aid. Or maybe you can infer lysine since it's charged and is probably more important in maintaining stability? +
adong  the only thing we know about cross-linking is with LYSYL oxidase, hence lysine +3

 +11  (nbme20#43)
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heT CI veaul eitannodc ,1 cwhhi measn ttha ist tficniaigsnni

sympathetikey  Correct. Per first aid: "If the 95% CI for odds ratio or relative risk includes 1, H0 is not rejected." +1
xxabi  Ah that makes more sense, thanks! +
drdanielr  Since the OR or RR is a ratio, if the two interventions are equal the ratio would be 1. So, if the CI includes 1, they are "the same" or not stat sig diff +

 +2  (nbme20#16)
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hTe spon sha srveen 8,-5 os the narliegtim uowdl eb teaffecd erhe

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 +11

 +1  (nbme20#44)
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I dha utp "hcear"tss /bc pst hatt odrnegu batcrirai gerrysu rae olyn opseudps to aet celxpmo basrc ae)vstftul(gbese/ri dan vadio pliesm acrsb ie..( bfastkear eeelda/barck dos)og


 +3  (nbme20#43)
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Yuo heav gtniaeev nrotgeiN aeclbna in ratostinav kca(l of etio)rpn dan ipvitose rgtNonei in culmse ldubigni eatsts ei(.. tee/cll)ahsrindteh

celeste  Nitrogen Balance = Nitrogen intake - Nitrogen loss +10




Subcomments ...

submitted by beeip(124),
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How ot dteetinfireaf wetebne vsNoiourr dan Rtoraisuv eerh? tusM be teardle ot het hte acgitusono rnutae fo het sllni?se

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6  
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. +3  
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 +4  
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 +1  
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. +4  
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. +1  


submitted by beeip(124),
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Hwo to tntreffedaiei etweneb rvrosiNuo dna vRrtiauso r?ehe Mstu eb treadel to hte teh ginsocotua nuaetr fo het sln?lies

strugglebus  You know it’s Noro because people are vaccinated against Rota at 2,4,6 months. +6  
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. +3  
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 +4  
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 +1  
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. +4  
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. +1