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Welcome to sunshinesweetheart’s page.
Contributor score: 60


Comments ...

 +6  (nbme24#32)

suspensory ligament has ovarian vessels --> ovarian artery + ureter can be damaged in oophorectomy

cardinal ligament has uterine vessels --> uterine artery + ureter can be damaged in hysterectomy


 +1  (nbme24#32)

suspensory ligament has ovarian vessels --> ureter can be damaged in oophorectomy

cardinal ligament has uterine vessels --> ureter can be damaged in hysterectomy


 +0  (nbme24#1)

macrocytic anemia (seen in blood smear) = RBC precursors can grow but not divide

oval macrocytes (seen in blood smear) = megaloblastic anemia (if they don't show neutrophil hypersegmentation)

B12 has neurologic symptoms and low methylmalonic acid while folate deficiency does not

folate is absorbed in jejunum, B12 in ileum

causes of B12 deficiency = pernicious anemia, gastrectomy, ileal resection, fish tapeworm, veganism

D) failure of MTHFR --> THF (via methyltransferase = B12 deficiency and macrocytic anemia

B) G6PD deficiency = normocytic because of incr RBC destruction; pt would show intravascular hemolysis sx precipitated by an oxidative stressor

C) protoporphyinogen oxidase deficiency = microcytic anemia because of low heme synthesis

A) decr transferrin = high ferritin = anemia of chronic disease = microcytic anemia because of low iron


 +1  (nbme24#6)

acute exacerbation of CHF leads to reduced CO --> hypervolemic hyponatremia, body perceives it as hypovolemic (so you expect high ADH) ["non-osmotic release of ADH"]

  • this pt is clinically hypervolemic (edema, rales, distended neck veins)

  • urine should be concentrated (UOsm >100 mOsm/kg) because kidneys should be fine and ADH is doing its job, just with bad information

  • if urine is dilute, it's not CHF, it's psychogenic (can be caused by schizophrenia or factitious disorder)

let's say she wasn't crazy and really was having CHF exacerbation - tx with diuretic and fluid restriction as they did--> note that you can also use vaptan drugs for CHF-related hyponatremic hypervolemia (block ADH) --> should cause the urine to be dilute which will reduce the hypervolemia and reduce salt resorption to correct the hyponatremia

random diabetes inspidius side note for psychogenic polydipsia (DI dx is hypernatremia/normal, hypovolemia, dilute urine <100mOsm/kg)

  • can also use the water deprivation test for a pt with polyuria and polydipsia

--> if urine concentrates, it's psychogenic

--> if it does not concentrate, give desmopressin and if it concentrates = central DI, does not concentrae = nephrogenic DI


 +8  (nbme24#45)

ADA mutation = autosomal recessive SCID

IL-2-R gamma chain mutation = XLR SCID

IL-2-R alpha chain (CD25) = T-reg dysfunction; assoc with autoimmunity esp. T1DM, MS

Fas ligand (CD95) mutation = no T cell apoptosis in negative selection in thymic medulla = incr circulation of self-reacting lymphocyte = autoimmune lymphoproliferative syndrome


 +0  (nbme24#30)

epi = pheochromocytoma of adrenal medulla = episodic HTN PTHrP = squamous cell carcinoma of lung (plus others) = hypercalcemia VIPoma = neuroendocrine pancreatic tumor =secretory diarrhea [WDHA (watery diarrhea, hypokalemia, achlorhydia]


 +5  (nbme24#4)

A = CN III

B = CN V

C = CN VI

D = CN VII

E = CN VIII

F = CN X


 +2  (nbme24#36)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - ADMEs = esophagitis, ONJ, atypical femoral stress fractures

  3. pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  4. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)

  5. denosumab (mab against RANKL i.e. mimics OPG)

  6. rarely calcitonin

sunshinesweetheart  IGNORE ALLLLL MY OTHER POSTS lol I just learned text boxes. brb will continue helping no one/jumping out a window +1

 +0  (nbme24#36)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)
  4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin
sunshinesweetheart  GOT IT IN LIST FORM #procrastinating +

 +0  (nbme24#36)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm 1. Ca2+/Vit D supplementation (prophylaxis) 2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) 3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) 4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin

sunshinesweetheart  ha I am bad at using websites and can't make this a list that doesn't transform into a paragraph :( sorry +

 +0  (nbme24#36)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm - Ca2+/Vit D supplementation (prophylaxis) - bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) - SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) - denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin


 +2  (nbme24#38)

p 619 FA 2019 - physiologic changes in pregnancy

incr CO, anemia, hypercoagulability, hyperventilation, incr lipoylsis and fat utilization to preserve glucose and AAs for the baby


 +4  (nbme24#46)

some fun facts 4 u hoes to rule out the wrong answers:

Arcuate nucleus aka “infundibular nucleus” = hypothalamic nucleus. Projects dopaminergic neurons to anterior pituitary gland --> inhibits PRL. One of the 4 main dopamine pathways of the brain. Prolactin also gives feedback and inr dopamine secretion via this pathway [p 487 FA 2019]

Frontal cortex = oligodendrioma [p 514 FA 2019] rare, slow growing, fried egg appearance, may present with seizures

pituitary adenoma [p 514 FA 2019] - Bitemporal hemianopia - Most commonly a prolactinoma (hyperplasia of lactotrophs) - Male: decr libido, infertility - Female: galactorrhea, amenorrhea (PRL negative feedback on hypothalamic GnRH) - Can also see hyperplasia of somatotrophs (GH) --> acromegaly, gigantism or corticotrophs --> Cushing disease

PPRF = in charge of eye movements/conjugate gaze [p 503 FA 2019] - A stroke by the basilar artery of circular willis will lead to loss of horizontal, but not vertical eye movements


 +0  (nbme24#7)

"purplish" is a frustrating word here but they key is CAVERNOUS VASCULAR CHANNELS. Port wine stain in sturge weber and salmon patch ("stork bite") are both flat lesions, not a hemangioma.

sunshinesweetheart  outcomes: stork bite/salmon patch will regress by 5-6year old or persist into adulthood; strawberry hemangioma will regress by 3-6 year old; port wine stain will regress or persist but it'll be associated with the sturge-weber stuff see the mnemonic pg 513 of FA 2019) +
sunshinesweetheart  oops correction on port wine stain outcome: "lesions become a deeper purple, and angiomatous bleeding papules and soft tissue hypertrophy often develop. Because of the propensity of these cutaneous lesions to persist and grow, treatment of cosmetically or functionally impairing port-wine stains is recommended during infancy to prevent the soft tissue and bony changes" from the link kateinwonderland posted above +

 +3  (nbme24#10)

look at FA 2019 pg. 261

in a Gaussian, 66% are within 1 SD and 95% within 2 SD

this is high yield af


 +1  (nbme24#3)

out of curiosity, why are AST and ALT high? is that saying the NRTI used was diadenosine which led to pancreatitis also?

krewfoo99  AST and ALT will not be elevated in pancreatitis, they will only be increased during liver damage. NRTI causes hepatoxicity (although FA 2018 states NNRTI causes hepatotoxicity, NRTI could also be an option considering the two classes are similar. The hepatoxicity will cause an increase in ALT and AST +




Subcomments ...

submitted by neonem(527),
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Pg 149 ni FA 2081 (roougelyN mynoaat m;ap& gohyspoiyl tniso:)ec 3 emcussl oescl teh ajw: ,stMeasre ioeaMsrp,tl eMdali ry1dteiopg esmlcu peson eht awj: aaelLtr ygpdtorieALL aer dienaenvtr by imteingalr vee,nr 3Vo:ce mninM s'M uchmn lecso( teh w,)ja 'sL eolwr ea/osrxe(lnol eth )jwa

sunshinesweetheart  p 495 in FA 2019 +2  


submitted by brethren_md(82),
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sicCasl elspe anaep in het tp.nieat atsCeosin fo heatngbir asecus tnurnloca ioyapxh and sisyctem h/ytoeiarmsnyrihcetd/rnphsuedn teahd anc sesript. OaP2 is alronm ungrdi ayd and sdcedaere unirdg espdisoe and at h.gnit asisllyaCcl eens ni eObse spetiant ushc sa teh tpetnia ni eth oetuqsin et.sm

tinydoc  Caused a cessation of breathing rather than a ↓ in lung volume although a patient could develop an obesity related restrictive lung disease thats not whats happening with this question. +2  
sunshinesweetheart  p 665 FA 2019 +  
syringomyelia1  p 679 FA2020 +  


submitted by sajaqua1(472),
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yPriamr itenevnopr is na teaivc pets tnake ot eahd off or gitimtae a sse-idea kitnh of nnoiaccsta.vi In shti sa,ce ti is tfeeyisll oaimtfiocind exce)isr(e ot lhpe 4030- arye odl newom t(hwgei geinabr eirsecxe cna ttigmiea priooto,soses tiefsebn fo beacrio .exicere)s

oycSaend ninrveteop is rlyae eedonittc of a isd,esae roponimgt yrael netneirvtion. Tshi olcdu uclnie ihsngt ilke HIV tegisnt reyve 6 so,mnht or ro nalanu aromg.mymaph

taTiyrer niirnnvteote si hyeprat iimgan at rgednuci oclcntmsa,iiop oignlwal ael,prse or ivngrpimo ftconun.i nbisntceeA fomr ohclloa mya eb reeh buceesa fo cntsesbua ubsae pbsl,orme ro eabecsu msoe magead isuevpyorl doen yb oacolhl annoct be etndperev. limySrila fro a lwo yhbcrdeataro tdei we may be atimtiingg hte seceftf no sltoimebma atht vahe dlyraae bnee .node

sunshinesweetheart  p 269 FA 2019 +  


submitted by famylife(82),
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To lreu otu HSDAI e:ytp mreu"S simsutopa noocratnnecit ygneaerll raneism nuhd.gance onmtveMe of osmuptisa rfom teh lelariraulnct scepa ot teh tllrxlaeuaecr speca evprtens ulliiadtno oapyieahklm. As noyehrdg isno vmoe ctllllrynare,uia ehyt aer gdxnaeech fro sosatumip in rrdoe to mnatniia et.ttcyaeeilounrlr"

reprorpsasd-e3nmwein-pace/--t8cvsp:om8ne.hh-ee6w-/y6sftpsmhs--inetamotccoa2r/t5ettawsief-wrisoauemsnr-i-nrcsueid3dsi4/flrelouo-easow0p.haidod-/mto

usmile1  Does anyone know if SIADH is associated with hypertension? I don't think it is due to the body's response of downregulating aldosterone, but if someone could verify that I would appreciate it. +  
sunshinesweetheart  @usmile1 pg 579 FA 2019 = BP can be normal or high in SIADH +  
usmlecrasherss  in SIADH GOLJAN says you have diluteonal hypokalemia +  
tyrionwill  SIADH -> excessive ADH -> water retention -> atrium excretes more ANP, ventricule excretes more BNP -> water is excreted more. So that is why not too much plasma volume increment, resulting mostly normal BP. +  


submitted by m-ice(289),
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tsQonieu si lacaslbiy skngia ahtw rae eth arebusstts udes the istrf epst in mhee nts.sheysi In tath se,tp nigcyel dan nlscyuci ACo rea bdieconm to keam nuiiclvnoliema a.idc

sunshinesweetheart  p 417 FA 2019 +2  
drschmoctor  p 425 FA2020 +  


pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - ADMEs = esophagitis, ONJ, atypical femoral stress fractures

  3. pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  4. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)

  5. denosumab (mab against RANKL i.e. mimics OPG)

  6. rarely calcitonin

sunshinesweetheart  IGNORE ALLLLL MY OTHER POSTS lol I just learned text boxes. brb will continue helping no one/jumping out a window +1  


pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)
  4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin
sunshinesweetheart  GOT IT IN LIST FORM #procrastinating +  


pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm 1. Ca2+/Vit D supplementation (prophylaxis) 2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) 3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) 4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin

sunshinesweetheart  ha I am bad at using websites and can't make this a list that doesn't transform into a paragraph :( sorry +  


submitted by drmomo(17),
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yhw natc' it eb xcelu ?oimsoqut emaby wcrhreeuai barnoicft sarsi?aiifl

sunshinesweetheart  diff presentation - that's elephentiasis +3  
sunshinesweetheart  plus filariasis isn't the same as microfilariae +  
avocadotoast  @sunshinesweetheart wucheria bancrofti shows microfilariae on blood smear. Filariasis in the name is referring to the microfilariae +1  


submitted by drmomo(17),
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why cna't ti be xucle ?qtsmioou maybe iurerahwce tfbaorinc ?fisaraiisl

sunshinesweetheart  diff presentation - that's elephentiasis +3  
sunshinesweetheart  plus filariasis isn't the same as microfilariae +  
avocadotoast  @sunshinesweetheart wucheria bancrofti shows microfilariae on blood smear. Filariasis in the name is referring to the microfilariae +1  


submitted by medstruggle(10),
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yWh is it nto irnavoa eloifllc l?cles I gthuhot eht lefaem anglao of erSloti adn ediyLg si u/caneghsatolar cs.lel

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +9  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +32  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +11  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +1  
youssefa  Hahahahaha ya'll just bored +5  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
noplanb  Wait... I might actually never forget this now lol +2  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +15  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +  


submitted by medstruggle(10),
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hyW is ti nto naraovi oielflcl lclse? I htgouht hte fmeale aaolgn of tielrSo dna iegyLd is rgcoaalaseuh/nt lc.sel

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +9  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +32  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +11  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +6  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +1  
youssefa  Hahahahaha ya'll just bored +5  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
noplanb  Wait... I might actually never forget this now lol +2  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +15  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +  


submitted by neonem(527),
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ihts atenpit sah mascpyttoim oatcri ts.nisseo Tihs cna eb ndfiieedti yb teh rlvutrnacei yoehyrprthp o(t aceesnpotm rof sernaiecd licfonuatn tofrldeaa rmof cnponnalmti-o oirtca la,)vev istlsyocimd murrum dna hte clnitaoo ta eth lonram icator raae.

rPe DepUTtao on iilanlCc nmatiasofistne of ctriAo oni:Ssste

inzssiDze" nad sepnyco — oeynpSc orcucs sa a sntergnepi ypstmom in oirmpyxpeaalt 01 tcepern of aepttsni hwit csaytptommi rseeve AS r(o yaeiatrpploxm 3 ternecp of lal nttseiap ihwt vesree A)S [.]3 Trehe rea eeasvlr opoprsde ospxetnaanli rof eiratnxeol szedznisi )rspc(oypnee or ncpeosy ni aepttins wtih ,AS hotb fo hhiwc felcret ceerasded cebarrle i.nusoferp eerunscdExcidie- alsinidavoot in hte eercsepn of an btonsuictor ihwt exidf cicdaar tuoput anc sreult in .ypnsienohot"

guillo12  What does "fixed cardiac output" signify? +1  
usmleuser007  "fixed cardiac output" might mean that with the stenosis (ie. narrowed aortic valve) there is a limited or rather reduced cardiac output. Exercise would not increase cardiac output because the stenosis is caused by a mechanical (physical) rather than a biochemical process. Therefore, At any given moment the heart can not increase its output no matter how forcefully it contracts. +5  
fallot4logy  why not option A?arterial compression ? +1  
sunshinesweetheart  @fallot4logy LVH does not lead to coronary artery compression. only reallyyyy rarely will pulmonary artery dilation cause coronary artery compression. plus that would cause angina but probably wouldnt decrease cerebral bloodflow to syncope. her murmur + LVH point us toward aortic stenosis which does cause those --> fixed CO +1  
drpatinoire  @fallot4logy LVH can cause coronary artery compression, but typically leading to coronary ischemia after exercise (i.e. stable angina in this patient). The question is asking what leads to her syncope. Syncope actually means her brain is lacking blood supply abruptly. +4  
rainlad  how do we rule out mitral valve prolapse in this case? +  
spow  @rainlad murmurs at the right upper sternal border are aortic in nature. Mitral murmurs are heard at left 5th intercostal at the midaxillary line. +  


submitted by yotsubato(841),
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dylimAo A : eesn ni oicrhcn ymitamlnarfo ntni,ocdios psiiodnoet fo liadmyo ni euitsss

B2 oumi:gcibollrn asecadsoit thwi RESD nda ognl etrm liydssai

lameinoefrtuN eo:pntir oFmr teh tceoylotkesn of nsruone (ni hyaleth viinudl)sdia

een:lPsinir csaoseadit tihw lfaailim ezimserhal iesdase

sunshinesweetheart  neurofilament also seen in neuronal tumors i.e. neuroblastoma +  


submitted by xxabi(228),
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tenSt ooirsbmtsh sv es.r-onsteis etntS smitobosrh si na cuaet ocuclonsi fo a oaoyrncr trreya tste,n whihc foten estrsul in atcue coonyarr s.nyrodme Can be dvnereept by alud paattteeilnl payrthe ro undgteulgri- ttne.ss sRetnosi-es is het rulgada naiwgronr of hte nsett mlune due ot nlitmneiao rireo,tialfpno gienrulst in igannla pstym.smo

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +2  
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +3  
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +  
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +1  


"purplish" is a frustrating word here but they key is CAVERNOUS VASCULAR CHANNELS. Port wine stain in sturge weber and salmon patch ("stork bite") are both flat lesions, not a hemangioma.

sunshinesweetheart  outcomes: stork bite/salmon patch will regress by 5-6year old or persist into adulthood; strawberry hemangioma will regress by 3-6 year old; port wine stain will regress or persist but it'll be associated with the sturge-weber stuff see the mnemonic pg 513 of FA 2019) +  
sunshinesweetheart  oops correction on port wine stain outcome: "lesions become a deeper purple, and angiomatous bleeding papules and soft tissue hypertrophy often develop. Because of the propensity of these cutaneous lesions to persist and grow, treatment of cosmetically or functionally impairing port-wine stains is recommended during infancy to prevent the soft tissue and bony changes" from the link kateinwonderland posted above +  


"purplish" is a frustrating word here but they key is CAVERNOUS VASCULAR CHANNELS. Port wine stain in sturge weber and salmon patch ("stork bite") are both flat lesions, not a hemangioma.

sunshinesweetheart  outcomes: stork bite/salmon patch will regress by 5-6year old or persist into adulthood; strawberry hemangioma will regress by 3-6 year old; port wine stain will regress or persist but it'll be associated with the sturge-weber stuff see the mnemonic pg 513 of FA 2019) +  
sunshinesweetheart  oops correction on port wine stain outcome: "lesions become a deeper purple, and angiomatous bleeding papules and soft tissue hypertrophy often develop. Because of the propensity of these cutaneous lesions to persist and grow, treatment of cosmetically or functionally impairing port-wine stains is recommended during infancy to prevent the soft tissue and bony changes" from the link kateinwonderland posted above +  


submitted by neonem(527),
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aLck fo 1C8D 1(AL-F gtinne)ri on ghtpoyceas is eht useca fo kcoueeytl neoaishd fcydeneiic ptey 1 (DA).1L niceS ceahygpsot leki ithpolseunr nad ocsmagprahe cnt'a egt uot of the dlomsaorb,et tyhe rae ckuts ni teh odl,bo neceh het cuosiyeotlks iwht CBW cunot ;&tg 010.,00 incSe hte louecetysk era tksuc ni hte oo,bld hyte 'natc mutno na feeevftic mumein ornespse aingsta itce.aarb

sunshinesweetheart  also for completeness, LFA-1 is an integrin that binds ICAM, so LAD1 results from a defect in tight binding +1  


submitted by happysingh(38),

so, the Key words that no one is mentioning : communicating hydrocephalus

the pathophys goes like this :

an inflammatory setting (i.e., subarachnoid hemorrhage) yield fibrosis / scarring of the arachnoid granulations => impaired CSF drainage

the key points / concepts they are trying to test here : 1. do you know what communicating hydrocephalus (without them telling you those words) 2. do you know what's the pathophysiology (of communicating hydrocephalus) is ?

potentialdoctor1  Exactly. To add to this, communicating hydrocephalus can be subdivided as follows: Normal-pressure hydrocephalus: Chronic/gradual decrease in CSF reabsorption at arachnoid granulations, usually due to calcification due to aging. CSF accumulates slowly, so ventricles are able to widen without causing an important increase in intracranial pressure. Symptoms occur due to compression of periventricular white matter tracts ---> Wacky, wobbly, wet High-pressure hydrocephalus: Acute decrease in CSF reabsorption at arachnoid granulations, usually due to inflammatory state in the subarachnoid space (eg, meningitis, sub-arachnoid hemorrhage). CSF accumulates suddenly, causing an acute-onset increase in intracranial pressure +7  
sunshinesweetheart  not to take away from your perfect explanations, but if it were a woman with neck stiffness and fever (rather than circle of willis rupture) that could lead to increased CSF production, right? I think that's the only case where CSF production would increase. Also I think decr absorption in arachnoid granulations in that situation as well so it'd be a shit question +  
peqmd  If anyone like me also got "decreased absorption in choroid plexus", as their wrong answer it's because the choroid plexus doesn't "absorb" it produces. +6  
alienfever  FA 19 p510 +1  
alienfever  If anyone chose F, communication hydrocephalus is caused by decreased absorption and not increased production. FA 19 p510. +1  


Why not clinical trial? They could report a rare adverse effect in phase 4 clinical trial right?

sunshinesweetheart  there's no control group. it's just a case study. x3 +2  
sunshinesweetheart  plus clinical trials at that stage would have had tons and tons of participants (and, most importantly to rule out all the answers, control group) +  
servage  I totally thought it was phase 4 of a clinical trial as part of post-market surveillance. Smh. +  
loaloagubba  For phase 4 they report to the said findinds and adverse to the FDA via a portal not to a journal. +  


Why not clinical trial? They could report a rare adverse effect in phase 4 clinical trial right?

sunshinesweetheart  there's no control group. it's just a case study. x3 +2  
sunshinesweetheart  plus clinical trials at that stage would have had tons and tons of participants (and, most importantly to rule out all the answers, control group) +  
servage  I totally thought it was phase 4 of a clinical trial as part of post-market surveillance. Smh. +  
loaloagubba  For phase 4 they report to the said findinds and adverse to the FDA via a portal not to a journal. +  


submitted by m-ice(289),
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The tnetiap sende dclimae nnoeattit yaldm,emiite hcwih leatsenmii ognatibni a curot rro,de ro fsairtrrengn .ehr A ernsu deos not have eht esam tinngrai dna iicqnulaifstoa sa a yhncisai,p so ti wluod be poirepparinta ot aks tmhe ot xnemiea teh .tnaitpe iAskgn the lashiotp anpihacl aagni luocd be ptipa,rnoirpea nad wludo aket mreo tie.m Tofeeh,err the stbe onipot aonmg ohtse vngie is ot sak het itpntea if hes lilw lwloa twhi reh ansbuhd sn.prete

sympathetikey  Garbage question. +46  
masonkingcobra  So two men is better than one apparently +23  
zoggybiscuits  GarBAGE! ? +1  
bigjimbo  gárbágĂ© +4  
fulminant_life  this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect? +10  
dr.xx  I guess this is a garbage question because what hospital, even small and rural, does not have a female physician on staff. NBME take notice -- this is the 2010s not 1970s. https://images.app.goo.gl/xBL4cK31ta7nG4L39 +8  
medpsychosis  The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no. +12  
sahusema  I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh +22  
sherry  I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask. +  
niboonsh  This question is a3othobillah +4  
sunshinesweetheart  this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol +5  
drmohandes  I think this NBME24 is a waste of $60. On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying. On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions. +10  
myoclonictonicbionic  @sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam. +7  
korahelqadam  All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess +  
sars  This is a very fair question. I agree with sunshinesweetheart above. That is all. +  
wrongcareer69  Garbage question +  
alimd  well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes." +  


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naC oynaybd lxnaeip siht en?o I put atdepere ettss cebeaus I sudmsea na eord-lya83- onmwa si na uuanlus gireodpcham fro .siiylsph

m-ice  83 might seem an uncommon age, but we don't know for sure her sexual history. She only recently (8 months ago) started showing some signs of mild cognitive impairment. She has all these results implying that she has syphilis, so the most likely answer is that she has syphilis, so we should speak to her privately about her sexual history. The tests don't necessarily means she got syphilis very recently, it's possible she's had syphilis for a while and never got treated. +5  
mousie  I understand that she could possibly have syphilis but I also put repeat tests because I know there are a few things that can cause false positive VRDLs but if she also has a + RPR does this make a FP less likely? And also if she has mild cognitive impairment you still discuss with her not her daughter correct ...? +4  
m-ice  This definitely could be a false positive, but before we want to consider it to be a false positive, we should talk to the patient about it privately. Assuming that it's a false positive before asking the patient about it could delay treatment of her syphilis. There's a chance she didn't want to disclose her sexual history in front of her daughter or maybe she was embarrassed or didn't think it was important to mention. And you're absolutely right, she only has mild cognitive impairment, so we most definitely should talk to the patient alone without her daughter first. +3  
seagull  She has dementia. She doesn't have the capacity to determine her own care (23/20 MME). I feel the daughter should have the word on the care since Grandma likely doesn't have the capacity to understand her actions. +5  
sajaqua1  From what I remember, dementia is typically a combination of impaired memory *and* impaired thought processes. There is nothing to indicate that the patient has impaired thought processes, and the memory impairment is only mild. The patient can still reasonably said to be competent, and so her private information should be discussed with her alone. +11  
yotsubato  Elder care homes or elderly communities actually have a high rate of STDs. Turns out, when you put a bunch of divorced/widowed adults together in a community they have sex. +8  
yotsubato  Additionally, you should respect the privacy of a competent adult with "Mild memory" impairment. I know I could have mild memory impairment considering the crap I forget studying for step 1 +11  
drdoom  @seagull dementia ≠ absence of competence -- the two are separate concepts and have to be evaluated independently. see https://meshb.nlm.nih.gov/record/ui?ui=D003704 and https://meshb.nlm.nih.gov/record/ui?ui=D016743 +3  
wowo  also important to note, d) repeated tests is also incorrect as the microhemagglutination assay is a confirmatory treponemal test (along the same lines as FTA-ABS) https://www.uofmhealth.org/health-library/hw5839 +5  
sunshinesweetheart  also.... I think we can assume that "repeated tests" means repeat VRDL, not "additional tests to rule out false positives" +2  


submitted by m-ice(289),
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ishT nmwao has rPasaolxym oNlcurtan raoHieigluonb.m ihsT otms tonef etnsrsep ni a goynu udtal owh sah sdeepios of ardk ineur in eht dmdiel of eth gihtn ro wneh aiknwg up ni het rongmi.n Is't ecsuda by eltmmnpcoe tictyvia rdylceti ingtasa eth eapnist't own RC.sB Cneatir lslocpdigyi are endeed no eht RCB escruaf ot rtvenpe kctaat ormf eempotnm,cl teh stmo olanteb fo whhic ear C5D5 dan C59.D neiPstta whti PHN vhae a ticmaso montaiut in ihwhc tehy tslo cuntnfoi of a IPAG nyemze edneed fro reoprp aertnoesnpti and atmantethc fo /D5DC559C no eth BRC .ecuasfr Theerfeor eth swaern si a fdctee ni a cell enmmreba raonch e.itporn uhtiWto st,hi lmcoeepmnt aktscat C.RBs

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +16  
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +  
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +5  


submitted by jkan(22),
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tpiepecd- is wol tiwh ensogxeou uisnil.n (epdei-tcp dmae sa a cuporydtb of silnniu pconiudtro in eht betrp oa)yddee vsitis+ high usilno+nwli =ep-petdic sxooeueng nisilnu beus.a nI a l&-c;gidth tusiitfoca by yrxop

sunshinesweetheart  ugh, I feel like a child could misuse their insulin by accident without proper supervision. Totally thought she had T1DM and not enough guidance on how to use the meds. annoying +3  
peqmd  I couldn't rule out if the child was trying to get swole and had a shady dealer. +3  
alwaysdivs94  Sorry, where doesn't it talk about insulin abuse in the question? I thought she was administered for an acute exacerbation of heart failure? +  


submitted by m-ice(289),
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All HOX sgeen rae opirrnitnctsa rotsacf ahtt hlep urtaeelg dbyo aloytu nad irntdeffe exsinpseor of seneg fro heca dboy mest.nge

sunshinesweetheart  I got this one right but wasn't exactly sure how to rule out 'translation'. I guess just because we're talking about a gene i.e. trasncription and not miRNA i.e. post-translational modifiers? +  
sars  Hox (homeodomain) genes code for homeodomain proteins which are specific transcription factors (bind to enhancers, making these activators). They promote transcription of certain genes involved in development. Thanks so much +