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Welcome to sweetmed’s page.
Contributor score: 123


Comments ...

 +4  (nbme24#48)
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PAC orke:st siaVul nogaAsi [acn e,es ubt not zeiornceg ]ctjesbo nad Hnln,alcuotiais retlaoatarlCn pieanoahim hwti acmuarl r,sangpi leAaix hwottui gaiafirpah[ admntoni ehserehmipe loev]idn.v


 +0  (nbme24#42)
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yuo eedn a itonamut ni 2 aslelle to tge FC siec[n it is loatsmoau ces/sirev]e


 +1  (nbme24#42)
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ainmsL ofrm a nalucre benrmema dinuougrnsr DA.N mpi rfo ulturrtasc ,topsrup nnzigoragi eeo,mng nagreliutg gene acropnisrnti.t vftDeeiec ni gireoPar nda sclurmua o.rpydyhts


 +1  (nbme24#22)
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ercsulitTa roinost sylmto penphsa in gyonu oysb, rleyar ni sault.d Alos hte inpa etadtrs ta het skanl,f ihhcw is ont how inosrot pnai attr.ss


 +7  (nbme24#43)
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Stnte sRseniotes cscuro mfro sacr sstuie osrwg erov tntes ancisgu i“teliamonn eahs”yripapl and ornirganw, icmiseha smptoyms reuntr T:x ptnreev yb sniug rdgi gtenilu stestn e.g Si.oimusrl irhToombss otsP soiesnts is eAu,ct tnets ervsse sa udsni rof umohtsrb ofaonmtir uayluls /22 msnigis oandtm.iie T:x penvrte by ugnsi adul teltptnealia tmretenta /ra]iti[ronrg.doagce+iilcelsoplrp tAfer 1 ,aery aholnietdentizo of stnte uccosr dna tehre is a eowlr ikrs of tmsrbohu, xT lerwdoe to jtus .isnrpia


 +11  (nbme24#9)
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lincCy ,,EAD nda for 1G ot S otnrtnasii dme[a in G]1. linycC B is ofr 2G to M rdtitaemisao[nn in ].G2


 +1  (nbme24#20)
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Teh Hma ttes si a tste dsue ni the oadigsisn of oyxlasrpam noarlutcn onmolahiiebugr (N.H)P hTe ttse vvsolnei gialpcn red olobd lselc in lmid i;dac a vpsioite sulter (dirsaence RBC irgltiyfa) aiditsnec HNP

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +1
pathogen7  FA2020 added the Ham test to PNH I believe! +
pathogen7  Whoops no sorry I am wrong. They did add something called the EMA test to spherocytosis though. +
snripper  Ham test has been replaced by flow cytometry now. So fck off, NBME. +
pseudomonalisa  I remember it like this: PNH occurs at night due to mild respiratory acidosis (slower respiratory rate), which activates complement which destroys RBCs. The test is essentially doing the same thing, putting cells into an acidic environment -> dead RBCs. +1

 +2  (nbme24#38)
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aknigT eexscs oxntiveyLhero wlli ea,csu Icrn ,4Tf Inrc Tf,3 edrc STH, ercd ahoydTrli ndeoii peak.tu sEesxc leoyiinonthr itkane lilw eucsa rinc 3,T Dcre ,4T ercd r3,T Dcre S,HT usceeab T4 egst erovntced to 3T nad rT3 in rpphye.rei


 +1  (nbme24#35)
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I liteg ugtthoh rhe dzroeeivs pupils weer het omlrpeb. tWha isegun diddece ot seu isht ohp.ot


 +0  (nbme23#21)
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Geen caimioalptnif si na cesrneai in hte enbrmu fo epiocs of a nege hwottui a ialonrrpoopt airesenc ni etrho ngse.e ishT anc suterl frmo dnpicitluoa of a inroeg fo NDA taht otnncsia a enge ghhuotr erorrs ni AND pnoarcltiei dna erpari mraeicynh sa ellw as orthhug itfutuorso ctaprue by slfehis egicetn telmnees.


 +4  (nbme23#4)
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oDnt etg coefudsn wtih blcu .efet uCtloobf is a hibtr fdeetc ehewr noe ro tohb feet rea oaertdt wdinra nda ]rdnww[d]4.a[1o eTh ecfefdat foot adn gel yma eb learlsm tnha het 1.]toh[re nI tbuoa hfla fo ehost ceadft,fe hobt ftee rea evdv.l][ino1 Mots esasc ear ont iaotsdseca htiw ertoh p]eob.l1s[mr tuhWtoi ttem,trane eelpop akwl on het esids fo iehtr e,fte hwich acsuse lbmroesp wiht T]glwka ehi[n2. xacte acsue si ulsuayl ]nlra.uec[1 A wfe sceas era ctssoiadea twhi slidat hrsogryariopts ro eo[lyemcoen.mnelg2]i


 +1  (nbme23#43)
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gdnArocic to het s'Nesur letaHh Syt,ud eth iksr fo pmrouylan iarncdaeoonacm seecarins btuslataislny eafrt a ongl drtnioua fo ootbcca mins:ogk rsmskoe hwti a vupiseor knosimg dnrotuia fo 430–0 esayr rea mero than cweti sa ykleli to ledvope guln ioamracaedcnno repmdoac ot skeevnose-mrr tlv(iraee ksir fo trxplpyoeimaa ;).42 a rdntouai fo remo htna 04 earys eeasricsn vealteir rkis to 5[.8]

shiT crenac lsualyu is seen elirpprhaeyl in hte sung,l as odseppo to alsml elcl lugn accren dna samusuoq ecll ngul ,raccne hcwhi ohtb nedt to eb omre lcnyealtr d9[ac0t,e[l]o]1 laohught ti yam lsao ccruo sa latnerc .e0lnois[s1] Fro nkuonwn rsa,ones it tnfeo erssai in ilrneato to pirleharpe nlgu acss.r heT renrcut yroeht is htat het acrs prlbaoby rourdcec yescodarn ot het ,turom etrarh tahn cgasuin eth r0[tm.o1]u eTh eamnnrcdiaacoo has na ecriasdne inneecdci in m,oressk dan si het stom momcon type of ulng nacecr sene ni kme-nsonros adn 10[]enm.ow The lrpeipraeh tcoiaonl fo macniaoodrenac ni het lguns aym be eud to eth seu fo ftilser in ecgsrietat hwihc prenvet hte erragl pcerasilt frmo eignenrt eth uiiilanocfgtcnalr[. eed[1nd]]e2][11 peDree aithilonan of iearegttc eomks lresstu in apriperlhe enlioss hatt rae eofnt eht ceas ni coracaenasniodm fo eth ng.lu eneyrla,Gl coaraaedonnmic oswgr mero lwloys adn mofsr llrmesa sesasm athn teh rothe p0s]ysbt.[ue1 Hewrveo, it sdnet ot ztieasmtase ta na larye es[gta]01.

peridot  This is super interesting, I was wondering wha the heck the scar had to do with anything! Thank you! +

 +3  (nbme22#15)
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aePzibonarcr edis ffceet is a.ekiluem FA 0281 gaep 482

bdaines8  Perfect, that narrows it down to three answers +2

 +6  (nbme22#49)
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hTe eitpant is ni pcioshe rce.a ccinrgdao ot dornaC srihecf ishcte e,pxlaem a man whit OPDC in eiohcps cna be gnive hhgi odse potiase eenv htoguh eethr is a iskr fo roirtsarpey ssidnepore sbuceae the tntien ot leeervi nfeuigrsf si the ihhgtes .ortripyi


 +1  (nbme22#46)
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aPciL :aurcrclsii smausclo osfdl ahtt ndexte ofrm tsilad deuoumnd to mlrpoxia mulei 2FA018 pg 365

paperbackwriter  not sure why you were downvoted... correct (maybe pg number wrong??) +

 +0  (nbme22#20)
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Heers a odgo aeimg cgua/itt.inb/wrcmmtle/h-tooels:epsmmyf/ptlhnaoeealslman-//rocamre/tleat



sahusema  that video was sick +

 +1  (nbme21#15)
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nmnaElieu salo hslep teh oidhcor iimtl dlontoeclrnu infceteolr hiwitn the eye that udowl ltatynpelio lusret in eth nerctoeppi of sfcnonugi agiem


 +4  (nbme21#9)
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2t2.0/hbn3h/w8pm:cg5t.ui5nib/vol5.wsp.nd/emw

APVU is duse ot etart ssPraiosi dan ogViliit

minion7  puva also used in GVHD +

 +3  (nbme21#45)
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At sntgier brmneema loeitatnp the DAMN rcpertsoe rea bleckdo yb 2g.M+ eTh vaeotlg ptddennee g2+M cklob is eidrevle pnou aialozetoinprd fo eth anpptssoitc-y eanembrm . hTe dlagni edepedtnn naaciitvot fo het AMND cerpoter ureiesrq oo-tiicncatav yb two gsain,dl lemnay mgaettlua nda .niclyge


 +13  (nbme21#7)
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Tuleo,ne eth mani oocnmnpet of ilaotlev ula,e ceruqgsl srintneh nad oesarlo iapstn is the bocih sllsneeaimecpr orf smot alnlccii o.iyittxc alahntnIs ecsua an iinitla xroeaictty hhorutssr goeepn the aserele fo pnheriniepe and naivttaoic hfe ot emopdnai yess,mt ooedwllf by calnert usymoer esvnts eessinpdor taedmide by hte use of wGBap1haA Ayt It fsni measats a nesse of io,euhpra ien,txotica iniiii ztsnh,seedbizdsd ohirvubae and naetoiarxlih milaisr allcoo oth ntxnoii,tcaio tsuh nselgtrui ni spygeececloen.n cdhdloaip apetRd ee ntnsohlaiia by eht sreu ogonpot rl the itocxiatnoin ilwl lodevpe in adheurs,a ceehdlr eespch, ,ilipapod tgai abyl,omanitr iuv d,sslslnoeiua shcalnoiiutaln adn i.dtnsanooeiirt oiaralvehuB nsahecg dna es huarraicocrdcitot no aertbh or tnglhico rae lheufpl sucel deteotct .assce edctSpsue essur mya saol n oampciflo oghu,c yfsftu ose,n nsg,eienz lghin,ufs nsasvltn,auii,eaoa tigvonim dan ptpaOihr oh.thbooe ngsis nda mysptmso fo hanltain cnauseu bldei pstos or rsseo in ro dauonr teh etmindhcoujet, ,elrcas nmtaysugs, itbirlyiirta or incetlyxibieat,iatx y and peesl dntsiasr.ceub aintP ro ehrto ntinss oa het cfe,a hd,nsa ro thsloce are hroet ifnoacorsit d esu.ab erevSe serdnsy of iaaflc niks and mu samuemecsnbr nac osal eb a uraefet of ,pr dpeelnreeoatogd use fo vealotli sn8ssbt.ce au lBecaani fntioricet fo teh dry and rcacdek niks yam r ntsliue orapilre dan iaseanrpl smry,aodep essimderoetr erfem ot sa r“h’feufs sh9ra”


 +9  (nbme21#31)
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naiP sbirfe for iPretaal pa:erul avrCciel nad aColts sarpt is yb Irlscaoettn v,eNer ataDiimapchrg and dsMiinaalte vai ehiPcrn .reNev iRb cgea ryjniu usscea lotacs laelpur p.ian


 +1  (nbme21#15)
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heT cthimaecoct fcrotas drdecupo by notcoeysm nda atms slcle nad teh aolcl aliitodnatsavo etstlimsau culineritoph oacsxehm.it Ao,ls dlahlnteioe lecsl octviiaant heturrf rseagvtgaa eth onlymmarfiat nroepess and aimirontg fo pohul.tsnier Tish sleda ot an lnfxui of etnplhosuir clo.yall

frre:ence 2wi2.5/.crshllotnC:5/pts.ictie/Pmba/gm11cnvnh/wwp/M.5

bronchophony  Why not complement activation? +
joyceeepan  the way i though about it was: you need antibodies (IgG/IgM) to activate the complement system. But there's no such a thing as an anti-gout antibody. (and it is not an infection neither) +1

 +2  (nbme21#24)
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Ftaty hgnCae in vLier 2/2[ higH NAHD mdea yb HAD nad dlHDA gt-;& itsbiinh FA ixodoanti, aemiridp eipptrooiln syalsebm and sergcon;t-tei& FA ]uamc.atuelcs


 +3  (nbme21#32)
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usalU tliriianttes oeuaimnpn )P(IU is a rfmo fo ugnl eseasid rhtciaczadere yb ospievrsgre crsnairg fo tboh l][s.n1ug The isgcanrr rso(bisf)i ivnevlso teh pinugstrpo krfwmreoa mtniisitru)e(t fo eth .gunl PUI si tsuh flsicesdia as a ofrm of tsiirtlnatie nlug adesis.e ehT temr a"uus"l fesrer ot hte ftac ttha IUP si hte most mncmoo rfom fo tailirtnstie si.osibfr a"miPnne"ou stiedncia "nglu binatyro,"alm hhiwc udneslic bfrsiios nad tminl.fnioaam A mrte uilpyerovs edsu orf UPI ni the stBhiir trurtlaeie si tonyicergcp inosbfgir estiilvloa ),FC(A a trme atth ahs nfelal uot fo avrof csein het aisbc rygunielnd tpyogaohl is won thothug to eb so,biifsr ont mnfanmia.olit Teh rtme uausl ttnreiiiltas oiisntnpeum (IPU) ash osal ntfoe eneb sed,u utb ,iaang eht si-it ratp of taht maen mya vmesreiazpeoh oinmafan.imtl tBoh UIP adn CFA aevh nbee rdiesecdb sa ynyousmson htiw oihdipcati rluympnoa .osrfbiis


 +3  (nbme20#37)
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A rdaip rnceoidut of scetisa si otenf coliadchepms iympsl htiw teh adiiodnt of wedsol-o aolr crtiisedu ni the eipttaotun st.eigtn ines-tlrFi rticieud heyatrp orf rorchitic sesctai si hte cmebodni eus of pancsiotnooelr t)(cAlndeao adn soerimufed a)xiLs( - vClaeldn incCil





Subcomments ...

submitted by sattanki(56),
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Ca’nt lhpe uchm on hte xcate oainegrns w,hy utb eethr are a few WUlord sqeusonti no thsi ewreh if a neoeatn ash cilphegyom,ay tsiokse nad yonaerpaim,mehm a ogcarni adic sredordi uolshd eb sceutedps pnro(iopic idac ro maimeolnlchty )ai.cd sLes posicuuiss of an TRA scaeu hgiecoyalmyp is otn tciircstheaarc fo .that

sweetmed  Im assuming because N-acetylglutatmate is an allosteric activator of CPS I needed in urea cycle. and N-AG is made of glutamate and acetyl coA. So in organic acidemias, all the acetyl CoA is being used to make ketones for energy since gluconeogenesis is messed up. So Urea cycle doesnt work as well and NH3 accumulates +3  


submitted by mcl(517),
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In csea uoy anwan og persu nder dan adre oabtu y,ilmen paccnc,aaeit dna ens,trieasc this ygu eosd a gdoo jbo.

nwinkelmann  This really helped me, at least the pictures did. Here's my interpretation of the pictures in not super scientific terms: capacitance is like the "capaciy" to keep ions close to the membrane. Myelin puts a barrier between the ions in the conductive environment (ECF or ICF) and the nerve membrane. The higher the capacitance, the closer the ions are to the membrane, so it's like the charge effect is "more potent" so harder to change the membrane potentia, whereas if the ions are farther from the membrane, the charge effect is "less potent" so easier to change the membrane potential and thus easier to depolarize. Thus, with myelin, there is decreased capacity of the ions to be close to the membrane, so in demyelinating conditions, the ions can be really close to the membrane, i.e. higher capacitance. +18  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  


submitted by nwinkelmann(257),
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o,S rfo mseo ra,neso utesrinsmnettarro si gmetshnoi v'Ie YAAWLS ggrelusdt .i.wth. broybalp beacues I wn'tas ahugtt it lwle os ernev rlelya edarnel it, tsju adeelrn uhnego for ehtawvre ax.em I usjt doufn ihts obo ortghuh NCIB adn tis TCAASNTFI! I'ts fomr 0021 os tigmh be ,dol utb it asw geatr. ouY nac hacres rhotuhg eht okob nad indf eht sepctahr. I typter mhuc juts wnte trhuogh all of hte atrrsnrteeonitmu te.charp wo.KiBm0so/w9Nbvhg/tl/ct.bnn/k1i7snho.p/.9w:

yM mani awGaatat ueem-ak:tlsy = aormj cxerittoya ettusntoreirm.anr wTo tpsey fo 1:trsprc oe)e birte,mtapcoo somt of hhciw era rcpiyasepnt iG ihwhc edals to eredecsad NDMA petcrore tyciatvi nad rksi fo iicotcioex,xttyi or ctissntpyapo Gq rercstope taht lead ot eaincesr aN,+ K,+ dan eaeserddc tlmageuta aecssu itoaapzoilrnde dna edracnsei ++gM ncaltepseimd dna MDNA coererpt tvyciait dna isrk of cxitoyt,itcoixe nda )2 icnioorpto lsahncen gndiiucln DMAN dan aAnk/ePMAati ,nheclasn ichhw lla owlla epoininccsf ncotai ,infxul tub nlyo MADN llwosa +C+a ufnlix and( olny in a eotgavl nedpenedt rnamne fater cfistniufe zoetaaproiidnl has sdleacipd the bhiirtion M+g+ ino ni the hcnaen.)l

GBAA dan niyecgl = itoihrnbyi rrarnns.totmtseuie 1) AAGBA- nda BA-CAG = otorniopic heslnanc hatt edal ot ulxfe of -lC, dan sietpde ihts anusicg ,adlnritzoapoei het unrnoe tllis assty wolbe eisngrt lpoeit.tna G-BAAA gbindni tsei rfo ,sibraeturatb dso,ertis ,AABG dan onroitixcp = snidei epro of hclena.n AAA-GB bgidinn siet of oepnzzeidabsine = itedosu of epro of achnlen. 2) cGniyle eanlnch is a evry mislira C-l xfleu enclhan. )3 GA-ABB si a roteobaictmp neahcnl atht stiavacte Gi gadeinl ot edesecdar PAMc whihc aectstvia xuleff K+ hlaesnnc adn ibhnsiti ++aC iflnux anecslnh lidngae to yi.tpioonpaherrzal

Biingeoc neiams = anhlecatecomis dapmneoi tcinnoaridoo( of odby nvem,etmo dra,wre moit,nvtaoi orneitrefmnc),e rnhniinepeerpo e(,leps flaukw,esens niteaotnt, gneiedf rho,evbai eripnnipehe el(wsot ortcnncaenito in ,CNS) lups nnosoiter (eslp,e k,sfuelneasw sreenio,sdp ent,aiyx aune)sa and ihmitsane a,us(loar ,etntanoit arleyg,l utiess ,mdaega dna amy liefencnu blodo airbn wlo.)f ,luoOsyibv lal fo tshi is ni tniaoidd to erdniargce meontoniniusrsasr and l,hitfg ,ifhtrg dan gtihf esrs.onep

TPA nad etorh sinuper = tyexrciota ams,toinisnsr olecaerd-se thiw oreth ualeemlsolcml- s.srnmatroutneetri eAnoineds sit'n cllsiycalas isrcddeeno a rsueairnnmrottet uabeecs it tni's rldedeostera/es ni ++aC eneeddntp nr,neam tbu dvreide omrf TAP fobere ivgnha an rxoaetyitc tplienaot.

oeehlyAiltccn = ajmro rineusrettrtmano vnoevdli ni nsmnotssniireoaur aiv rsucmian dna ticincion srrcept.eo

ePdetip asisetnrenrumtort = monycolm ledesaer sa teopprdpie lrearg rossreucrp that rea dalceev yb cscepfii neezyms htta erew in eth ames turnrsitotearenm lseveic oupn l.eaesre vFei yptes = nrgt/abui p,episedt opiido tpiesd,pe uptiityar te,ipdsp ocyhapathlmi eiganserl rsoeo,mhn dan tehos ont icsfsliae.d Exmsleap = rousercpr htta esvig eirs to tsnbuaesc P ucpphi,osapm( xr,ecetoon and ITG nda reeledas romf masll edaetmir NPS C frbsie htta nrtsaitm inpa adn erpmueterat nnmori,oaift wpolufer eyhsvieo,ptn eitibhdin yb poiodi tppide)es, nknnoeruii ,A peeinorpduet K, adn nedupreiopet ,ammga dna opiiod edtspiep iunigdcln naptl lalkoidas kei(l oehr,mi)np cstyneiht diipoo vdvsieare,it adn son,nrdepih poshdrnn,iy nad lenipse.kahn In rglnaee ipodoi tidesepp aer apsdsenerts e..i( snaagaeli masnhmcie,) voidvenl in ocpexml ehoavsibr sulxea( natic,tator rbeivsamsgeisus/esgiv svhob,ia)re dna dclpieamti uthh(go ont eeif)vntdii ni yprithiaccs eds.rrsodi

vOer,lla srumettnrairetsno = ytpe teys:p el-oumellalmsc ntrsamrestti dan pseentider,uop hwere cmulma-ossleell tsitsramenrt are efarts and metidea piard ptcnaysi irsoamsnntsi ei..( nnegdora NSS hlifh/gttgtgfifrhi/ qckui nos,e)esrp herwe sa peeuosntpdrie nglao( whit cobigilo samien and moes almsl oeecumll tetsirmntsr)a ear owrlse dan teeamdi ,raaludg pooerldng rsueastm.osiniornn

meSo r:scuepti _rvomtnwnwmer/hpdt/tnshfei_vcot.rkedu/ees:i.owpeehrl/mianab.oruutkettpd/pus_ai, bibRepshu12tuiso2lrT-bscmrgd6lce-iuA/4ra1lfG-ai-1ebee/.0-e8/ea0org9trfpoPBecra53phgA-aeag0/0c7683f:26pBwrn3dt//p4-owws.g-dfsti0dia3sha/t11ten4errn6, nda 6-hxw;1a:wepg6i/0-wtg2f-7da5/eiaualdfed/efeUpeaab2db35shdtmt-.r/i-fgl8nasc-bog.re.h0s#_nlr1t1=lg=b/3tnb&/e14iwe-xa-9

sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +1  
dorischang  Didn't finish reading this, but it looks awesome +  


submitted by nwinkelmann(257),
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sweetmed  This is amazing. thank you +  
sweetmed  This is amazing. thank you +  
paulkarr  Woah... +  
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +1  
dorischang  Didn't finish reading this, but it looks awesome +  


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kaAllygnit egastn hmearm(o)rictlneeh (hte otehr ugrsd itsled era curumlioteb i)iihosrbnt ecrsaien eth risk of L.MA

keycompany  Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +25  
seagull  CML has blasts too but they tend to favor mature forms. +4  
kash1f  You see numerous blast forms == AML, which is characterized by >20% blasts +4  
keycompany  The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +12  
impostersyndromel1000  @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +1  
sweetmed  Procarbazine is alkylating as well. +  
pg32  @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +3  
castlblack  this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +  


submitted by usmleuser007(326),
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sThi meor eillyk ot be ctediisru teahrr ahtn etsvilaxa cb/

eht lba dsyut sohsw a rlena yidnosntfuc BNU( &apm; rtiCneeani are )daleteve

tMso yllike het tantipe uabsde ploo eds;crtuii salo nwkso ot aseuc nocnaticotr olliksaad, oagnl hwit leanr mpeosblr scuh sa isttielanrit itrenpish

endochondral1  would laxatives also have the low potassium? +1  
link981  My question exactly. And what if they were taking Potassium sparing diuretics? Then laxatives would be more likely or am I mistaken? +  
link981  Also creatine is normal, it's at the higher limit of normal so we can't say there is renal dysfunction. The BUN is elevated because patient has metabolic alkalosis with respiratory acidosis. +  
sweetmed  very important to Remember this: Diarrhea causes metabolic acidosis[from bicarb loss in stool], vomiting & loop diuretics cause metabolic alkalosis. +9  
hello  @usmleuser007 not sure your approach is the best way to think about it. The serum Cr is at the upper limit of normal (1.2). And, even if you calculate the ratio of BUN/Cr, it's 21, which would be a PRE-renal issue. +  


submitted by oznefu(16),
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m’I gnviah orleubt dtnngdnruaise hwy shit si a tbreet cceiho ahnt atPeg deis,aes lilyacpees whit teh iedrcsaen L?PA

zelderonmorningstar  Paget’s would also show some sclerosis. +4  
seagull  ALK is increased in bone breakdown too. Prostate loves spreading to the lumbar Spine. It's like crack-cocaine for cancer. +8  
aesalmon  I think the "Worse at night" lends itself more towards mets, and the pt demographics lean towards prostate cancer, which loves to go to the lumbar spine via the Batson plexus. I picked Paget but i think they would have given something more telling if they wanted pagets, histology or another clue +1  
fcambridge  @seagull and aesalmon, I think you're a bit off here. Prostate mets would be osteoblastic, not osteolytic as is described in the vignette. +11  
sup  Yeah I chose Paget's too bcz I figured if it wasn't prostate cancer (which as @fcambridge said would present w/ osteoblastic lesions) they would give us another presenting sx of the metastatic cancer (lung, renal, skin) that might point us in that direction. I got distracted by the increased ALP too and fell for Paget :( +  
kernicterusthefrog  @fcambridge, not exactly. Yes, prostate mets tends to be osteoblastic, but about 30% are found to be lytic, per this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ Additionally, the night bone pains point to mets, and Paget's is much more commonly found in the cranial bones and appendicular skeleton, than axial. This could also be RCC mets! +  
sweetmed  I mainly ruled out pagets because they said the physical examination was normal. He would def have other symptoms. +4  
cathartic_medstu  From what I remember from Pathoma: Metastasis to bone is usually osteolytic with exception to prostate, which is osteoblastic. Therefore, stem says NUMEROUS lytic lesions and sounds more like metastasis. +4  
medguru2295  If this is Metastatic cancer, it is likely MM. MM spreads to the spinal cord and causes Lytic lesions. It is NOT prostate as stated above. While Adenocarcinoma does spread to the Prostate, it produces only BLASTIC lesions. +  


submitted by haliburton(192),
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lkin ot nocator diamgra

yotsubato  How is that NOT posterior to middle concha? bad question +7  
sympathetikey  @yotsubato - That would have been if it was the spehnoid sinus (I got it wrong too btw) +2  
niboonsh  this is a good video if u need a visual https://www.youtube.com/watch?v=mf7rY1VNy70 +3  
sahusema  Sphenoethmoidal RECESS not sphenoethmoidal SINUS +3  


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twhi CPT ouy ear dsppusoe ot oaivd eicxeevss htsnuilg dna VU seexop.ur xaheleoMsnt skame rouy iskn oerm eebiscptuls to VU il.hgt

notadoctor  Wouldn't UV light also be contraindicated in Vitiligo? +4  
sweetmed  Phototherapy with photochemotherapy (PUVA) is a well-known and well-studied modality for the treatment of psoriasis, which involves systemic or topical administration of chemicals known as psoralens and administration of ultraviolet light in increasing dosages after requisite time gap. PUVA is also used in the treatment of widespread vitiligo with moderately good results, though it is being surpassed by ultraviolet B (UVB), which is equally or slightly more efficacious with fewer side effects. +8  
dashou19  Honestly, I didn't even know what Methoxsalen is, just chose the right answer because I know you can not give UV light to people with PCT... +9  


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dozaetiiln rdfreerep deu to genisl does

sweetmed  or metronidazole +  
niboonsh  what would his diagnosis be tho? +  
lostweightthxnorovirus  @niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good! +1  
nwinkelmann  Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA). +2  
mannywillsee  This little bug has has a face, and now you can't unsee it either! +  


submitted by hayayah(990),
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By aeg 5,7 het tyuhsm is ttelli more tahn tfaty tsiu.es lrnFyuet,aot eth humyst opeducsr lla of yruo T celsl by het eitm uoy aehrc rpbyet.u They ear dligevnl-o and 'hastt yhw ouy acn osle uoyr ytumhs hwuitot mineirmtpa fo yuor iunemm tys.sem

sweetmed  Memory T cells live for six months or less in healthy humans (Westera et al., 2013), whereas naive T cells can live for up to nine years +5  
whossayin  so the bone marrow does not take the role of the thymus? +1  
dr_jan_itor  @sweetmed, does that mean that if someone loses their thymus, they would develop imunodeficiencies appx 9 years later as the naive T cells have died off? +7  
hpsbwz  @dr_jan_itor no, because once all of the thymocytes become T-lymphocytes, they are stored in lymphoid organs until they're needed. this is why removal of the thymus in MG does not cause any immune system deficiency. +5  
peridot  @dr_jan_itor From wiki: "Thymic involution results in a decreased output of naïve T lymphocytes – mature T cells that are tolerant to self antigens, responsive to foreign antigens, but have not yet been stimulated by a foreign substance. In adults, naïve T-cells are hypothesized to be primarily maintained through homeostatic proliferation, or cell division of existing naïve T cells. Though homeostatic proliferation helps sustain TCR even with minimal to nearly absent thymic activity, it does not increase the receptor diversity." +3