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Contributor score: 144


Comments ...

 +4  (nbme24#48)
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PAC oser:tk uViasl Aongias n[ac se,e ubt otn zeongrice ejtobsc] nda intania,sculoHl antlarotelaCr aihmioaenp hwti carmlau apg,nsri xialeA wtuitho r[hapgafaii miodnant prsmehieehe .vdelo]nvi


 +0  (nbme24#42)
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uyo edne a umtoiant in 2 llsleae ot gte FC ne[cis it si oltamaous eiv/sesc]re


 +3  (nbme24#42)
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maLsin romf a ucnlaer menbamer isrondnrguu .ADN pim for ucrtrtuasl os,ruppt gioaznrign ne,emog gnaiugltre eneg t.nrnsiotapcri fveeceitD in gPerario dan culmarus ypsdot.hry


 +3  (nbme24#22)
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sraliTuect irsoton omtlsy epansph ni guony b,yos layrre in ldstua. Aols the anpi etasrtd ta teh fas,kln iwchh si ton owh irtoons niap ss.tart

j44n  I actually had testicular torsion and my pain started in my appendix area and by the time I got to the hospital it localized to my testicle +3

 +8  (nbme24#43)
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tntSe sinetRssoe csruoc omfr rsca usteis gwsor vore sentt icangsu ta“nmoilein plir”yaehaps adn wrinng,roa aicmseih opmymsst trnrue :Tx ptenvre by nusig irgd tueilng essntt eg. Sosi.uriml brsomhsoTi otsP siesonts si ,tceAu tsent seesvr sa sidun rof mohtburs imtnoraof sululya 2/2 isnmgsi toaniei.md xT: epvnret yb gsuin adul attnleplteai nattmrtee iocgdge[lc.riroioslrppn/+ealr]ati eAtfr 1 ray,e lohneandzotieit fo tnets csrcou adn rhtee si a lorwe rkis of truso,mbh xT werleod to tusj iipns.ar


 +15  (nbme24#9)
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cnyCli DE,,A and rfo 1G ot S oriantsnti daem[ in 1.G] ciCnly B si rof G2 to M otaeirmntsaind[ in .G]2


 +1  (nbme24#20)
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Teh aHm etts si a tste sdue in eth iadgosnsi fo lorampysax nlonratuc ubgimloeoraihn N)(H.P heT tets lsoeivvn lcagipn edr dolob eclsl in imdl ic;da a tsivipoe luetsr i(esncerda CBR )irfgltyai iidntesca HNP

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +2
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snripper  Ham test has been replaced by flow cytometry now.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. +1
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. +4

 +2  (nbme24#38)
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nkTiga cssxee oyetnirvhxeoL lliw asu,ce cIrn fT,4 crnI fT,3 dcre TSH, rcde iryhTdalo oiinde upate.k xescsE ryotohlenini nkieat wlli useac rcin T3, Drce 4T, cder r,T3 Drce S,TH uasecbe 4T setg cntedrveo to 3T adn r3T ni epyi.rpehr


 +1  (nbme24#35)
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I letig outthgh erh sdezveiro sppiul wree teh bolrm.pe haWt nusige cdideed ot sue tish .oohtp


 +0  (nbme23#21)
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eeGn iptmonafiacil is na ncersiea ni het ebnumr fo ipecso of a eegn wotiuht a onporptloair scnaerie ni ohrte e.gsen shTi cna stlrue rfom otciipnadlu of a igeron fo ADN that onnisatc a eeng ohtgruh serorr ni DAN nitrpoceali nda riarpe iranmyhce sa ellw sa roghuth trosoiftuu tcpaeru by elshfis tgeicen leen.esmt


 +4  (nbme23#4)
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Dtno tge oedusfcn ihtw lcub ft.ee lfutoCbo is a hribt efdcet eerhw noe or bhot etef rea atdeotr wiadrn and o][[4w.naddr]w1 hTe efcdtefa otfo dna gel amy eb ralelsm nhta the o1rht[]e. nI aoubt fahl fo osteh tafced,ef obth etfe ear voe.n]vild[1 oMst cases era ton tdseicaoas iwht torhe .lr]o[b1pmes Whoitut aente,mrtt oeeppl kalw no teh sseid of hietr ,etef hicwh essacu mplbesor tiwh n[ .wkl]ehTagi2 xtcea usace is yulluas nral[.e1]cu A few esacs are cstdioeasa with sdilat iahgsroryporst or 2[].eocmomnelnelieyg


 +1  (nbme23#43)
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irgcoAndc ot het suser'N etlHah ty,uSd eht rksi fo youalrpnm cmonardoieacna cnssreeai bltsytasnlaiu ratef a onlg ntoardui fo otacboc skmgno:i osrmkse htwi a epurvosi minksgo ardtouni of 004–3 yaesr era mreo nath eicwt sa yilkle ot oevepdl lngu cancarimenoaod opmadrce to eresnrk-mveos vtaerli(e kirs of alpmoetaypirx )2.;4 a otdiruan of rome hant 04 reays enracseis leetiavr skir ot []5.8

hTsi rencca uaullsy si nees heilearryppl in the nglsu, as peosopd ot lalms lcel ugln racecn dna musauqos cell nugl era,ccn whhic thob ntde ot be more cnellytra de[,91otl]]c0a[ autolhhg ti mya lsao ucorc as nlaertc so1en.s]l0i[ Fro knnwuon saorsn,e it nteof arssei in lartonie ot herapplrei nlug .sarsc Teh rrectnu oeyrth is tath the csra bolrpyba udrecorc oacnsryde ot het uo,rtm earthr hant nsuigca eht .r]1t[o0um ehT ricnaamoadoenc has an einrecsad niicnceed in sskorme, dna is hte ostm noommc peyt fo ugnl ecrnac esen in orosenksm-n dna .]e10omw[n eTh reihleppra acnitolo fo anioamcecaodnr ni hte ungsl amy eb deu to het use fo fitserl in reestaitcg chhiw vneprte eth larrge itacslrpe ofrm nniergte teh l[.atoicnarclingiuf 12ne[1]]ed1]d[e eeDepr nhinaloiat fo eegtairct eskom srlesut in prpaerihel enslois htat aer fntoe eht sace in naoncemicosrada fo hte ugn.l erayellnG, cmnncaaieodora orgsw rmoe lslowy adn omsrf arsleml asmses athn hte trheo y0teub.[1]pss weroveH, ti detsn to maiesttsaez ta na layre [0t.eg1a]s

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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zcbirnaarPoe esdi cftfee is miaee.klu FA 8120 eapg 428

bdaines8  Perfect, that narrows it down to three answers +5

 +8  (nbme22#49)
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Teh iapentt is ni hcepsoi a.rec ocadrcgin ot rnoadC iscfher tcesih a,emlxpe a nma tihw DCPO in ceopihs nac be evign ighh osed astepio neve hhoutg htere is a isrk of irreaoysrtp sdnprisoee csuebea the itnnte to relieve esrifugnf is the ghthesi ytroii.rp


 +2  (nbme22#46)
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LaPic ac:uilscrir cumolssa sfdlo tath edetnx mfor ialtds nudumdoe ot amxproli umeil A2F180 pg 356

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

 +0  (nbme22#20)
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eresH a odgo egmai lael/en/rlp/mleoatms:lam/cl/eg-ehnirortuiecamom/tma/wt-ttpyecohtbsnafs.



 +11  (nbme21#21)
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mhCll-altmy2shaatisNi/to/entdr0vgci.:aeos-ho-wdad%cp/lli.tlt

sahusema  that video was sick +

 +1  (nbme21#15)
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nanmiueEl asol peslh hte hodrioc limit ltondrluoenc rlncitfeeo hitniw teh eye tath doluw ynitelatlop urtsel ni teh iteecopprn of csiounfgn gaemi


 +4  (nbme21#9)
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s0/.tgc2i/v85ob/.nwp3ewpl.nhbw:/5utih2mmd5n.

AUPV is sued to etrat roiaiPsss and gViiilto

minion7  puva also used in GVHD +

 +3  (nbme21#45)
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At intresg ammnbere inaplttoe het NDAM erocsretp era obdkecl yb g2.+M heT teoalvg deepenndt +gM2 lkboc is diveeler nupo oaeizdlarnipto of het s-ytipnostcap mrmnbeea . eTh ildnga npeedentd aitvctaoni fo eht MNAD peecrtro qreisure aocaviicotnt- by two ,dlsanig aenmyl tmtealuag dan cieg.ynl


 +13  (nbme21#7)
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uenTel,o eht anmi ctmenopno of oavellti s ucl,uaerqleg siehnnrt dna loroeas aptsin si the laeehociepmrilsncb s orf osmt cilnclia y.oiitxtc Isalanhtn sceau an niltiia eraxtyotci uth oegosrprhsne eth seelrea of nerepphneii dna cttviaaoni eth of damipeon mt,ysse wlleodof by lcreatn nssees uvotyrm eresinodsp mdtadeei by eth ues of h1w ByAatAapG It stas eimsafn a enses fo rhpuaeoi, ,xiteitcano binidihiezsi te,dssidzn ioubhevra dan ahoxleiaitnr iimarsl calhooo tl tx,iatinnoioc hstu senurtilg ni l diposoencyehelacg.dncpe pee dRate naislonhati by hte rseu orpgnolot het iicoxtintnao wlil oeeldvp ni ar,e hulesracdhed ,csehep ioapdlip, atig nirytlbma,ao iuisvons,llauesd niiltuansocahl nad ttorsio.dnenaii auaBlrvhieo gcnesha dan iaccsucr thordeotira no hraebt or cilghton aer fleluhp ucsel etoc dtte e.scas csepduSte essur yam aslo omopfal cni ,gcuho suytff ,neso ,sgnzenie suilg,hfn ala ,ainae,otnuvssi vmtioign adn ooh ptaOotrph.hibe isnsg nad smpmoyts of lahntian enadecbus liu ostps ro ssero ni ro onruad the joett,cnmud ehi ea,srlc msg,atsnuy iyliabiirrtt ro axycn ,xbtlitaiteieiy nad eleps nsrtcebdusia. Ptnia ro hrtoe at snsnio teh eafc, ,ndhsa ro tlchseo rea herot taiifn orcsdo a.eusb rveSee sdreysn of caflai snik nda s emmesucnburam anc alos be a eturfae of gpeooalt,nrde pedre ues of olleivat sbs8 caet.nus cttaaoiBrei eicnlnf fo eht yrd nad kerccad knsi yam tnsiulre rplreoia dan nrliaaeps y,mapedosr toerimsfdere esmer to sa ’f“fsheru a”hrs9


 +10  (nbme21#31)
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Pian irebsf rof tPaealri :paulre viCrleac dan sCtalo prtas is by ralctnotIse ,eNrve Dhgptmcraiaai dan dsMiaaetinl via riPchen vrN.ee Rbi acge yunrji csseau talcso aruepll .inpa


 +1  (nbme21#15)
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hTe ematocitchc ftscoar pucdedor yb ntcsmooye dan satm slelc nda hte lcoal tasnoaolavitdi eiststalum lctporunhiie scoixea.mth s,lAo ehtnliolaed ecsll aaioitnvct efrhurt ggarsavtea the rymtiaolanmf ernssope dan inrmotiga of ire.lhsnuotp hisT lsdea ot na lfxnui of ehpisonrlut olaly.lc

ecrfee:rn snMt.acl1/2/5.nphlC/m/r.Pip/bitwgemhoc2it15v./:wcw5ns

bronchophony  Why not complement activation? +1
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
an_improved_me  Thats not exactly true for a couple reasons. I saw a UWorld question that said something along the lines of an ApoProtein being useful b/c it binds the urate crystals, and makes it less likely for the crystals to be opsinized/recognized by neutrophils. Therefore, Abs do play a role. Secondly, you can have activation of coplement via the alternative pathway, which does not require ABs. +

 +2  (nbme21#24)
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Ftyta agChne in vLire /[22 hgiH HAND eamd by HAD adn AHlDd tg-&; tiisihbn FA odi,xatnio iapdmrei ertpooilipn sbmyalse nda nr&;seotge-tci FA ]mest.uaalcuc


 +3  (nbme21#32)
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alUsu atieitrtnlsi ipnenmuoa ()UPI si a ormf of nglu issdeea aehrcrtdieacz yb srvrsoegipe rsgncira fo htbo g1.]l[usn eTh crigarns s(rbis)oif lvevions hte rppgtsouin wkfremrao ttini(utms)rie fo eht ugl.n IUP si uhts asicdselif as a mrof fo titinretails nlug eid.ases heT ermt u"sla"u sfreer to hte ctfa taht IUP si hte smot ncmomo form fo nrtetisaiitl iibos.fsr um""Ponnaei tcniesida "ulgn ly,mib"aornta chhwi elndsciu ssrbiofi adn itnaamoin.flm A mert yoeplvursi ueds orf UIP in teh tshirBi aruertietl is yipctconrge nbifrsgio olltveisai AC,)F( a remt atth hsa efalnl tuo of vaofr isenc hte aibsc ygileurdnn ylphogtao si wno hhogtut ot eb irisosb,f ton mlianiftma.on eTh mret lusau atesintlirit ieitnpmsuno I)(UP ahs olas ftoen been ed,su utb n,iaag eht tisi- rapt fo ttah mena amy zmiaheopsreev mnfomi.alnita tBho PUI and ACF haev nebe cedrbeids sa ymoysunosn itwh adiphiitco plyrnmauo fsoisir.b


 +3  (nbme20#37)
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A drpia ruitcedon fo tesisca si enoft mapsceoclhdi ipmysl tiwh het dnitidoa fo ldesoo-w alro rtsudiiec ni eth natpeuitot ten.tisg seFtlini-r rdeutici hrtypae rof otcrcrhii setsiac si hte dbecinmo sue of enntoplaoorcsi ae)tdA(lcno nad rifedmuoes xai)(Ls - lCaedlvn nilcCi





Subcomments ...

submitted by sattanki(71),
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Cant’ hlpe umch on eht caxte snioagnre y,wh btu ether rae a few dorWlU sseutioqn no tish whree fi a aeneton ash ial,ygmpchyeo seiksto nda nmirme,pyeoamah a orgacin iacd resdirod lsudho be eesudtpcs n(ipicropo daic or mleiotmnyahlc )ida.c Lses isicususpo fo na TAR acsue cpgyhyelioam si nto erchatsiaticcr fo .tath

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(598),
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nI aesc you waann og pseur endr dna aedr outab ,emilny niec,ccapata dna siers,ctaen sthi guy oesd a odgo 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. +21  
sweetmed  this helped a lot! +  
roaaaj  Well explained! +  
euchromatin69  or see u world 917 same concept +  
brise  Uworld 1318*** +1  


submitted by nwinkelmann(293),
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,So ofr emos anreo,s eoirsrnnratusmett is tgienmsoh 'Ive LSWAAY retlsdgug .hi.tw. alrypobb eebusca I tw'sna thgaut it lwel so renve rylela reaeldn i,t sujt enleard euhnog fro whraetve mxe.a I sjut noudf hist oob gtrohhu ICNB dna its ASTFIACNT! 'tIs ofrm 1020 os hgimt be ,ldo but it saw atrge. ouY cna aresch trghhuo eht boko nad fnid the st.rpahec I yrptet hucm sjtu ntwe ohgthur all fo eth onrtenesairtutmr acpthe.r Bs/nnn.wmth1hw.wg0oNk9bii.tbol//9cp/:oK.v7s/

yM niam yk wateaeaasa:tutGml- = ajrmo toxretyaic rtnestraonmiue.rt wTo ytpse of e)sre:t1rpco aercot,ptbomi tmos fo hwich era inrpsectpay Gi cihwh adels ot seaedcrde NMAD ortceper caittyvi nda krsi of etoixiicotyi,txc or ypntotsascip qG rrcospete ahtt ldea ot eenacrsi ,a+N +,K dna eareedcds amealtugt caessu ritndoeoaipalz adn rseindcae ++Mg ecsdpamelint nda MDAN orcprete itvcayti and iskr fo tytciitxcixo,oe adn )2 rnooicipto slnnchae dngluinci NMAD adn PtekA/ainaAM slcnanhe, hhwci lal wallo nieoifcpsnc oitnca xfu,inl tub ynlo NADM wllaos Ca++ ixufnl a(dn nloy in a taglove edntenedp renman aretf usncfiefit tdzaonaiirpeol ash pseaddcil the iitobrnih gM++ oni in eht ncna).hle

BGAA and ngeciyl = htiirnbyoi rnettosm.tusrriena ) 1 A-ABGA dna C-GABA = ipionrotoc snhaenlc ttah aedl ot xeful fo ,-Cl dna eitsped hist ucgisan aondteoiprza,li hte unnero tslli tysas bewol gsrntei aentlip.ot BG-AAA dbnigni etis for braiurteas,tb detosr,is AA,GB and toioricxnp = eiidns poer of anhc.len -AAAGB dnngibi esti fo espizaeindnebzo = oitdeus of repo fo ln.nehac 2) eilncGy ennlahc si a very almrsii -lC xfleu naehl.nc )3 AAB-BG is a paomcertoibt lcennah atth vstietaca iG niegadl to asceederd MPcA wcihh vetctiasa ufeflx +K nhscneal dna btinisih +aC+ ulinxf alnschne enilgad to prtealoray.ziopnih

iecBiogn siamne = eehinsoaalmtcc aoidnpem raoooi(inctdn of dyob m,evoenmt a,erwdr ,ttoaoviimn eetnm)rnio,rcef nppnoeirnierhe (l,esep a,sksnefweul ineta,otnt eindgfe veioahrb, hiereppinen toswe(l ionnoctcnreat in CN),S upls nrteoonsi p,els(e lsfwu,kneeas eidsesn,opr n,exayti ua)sena and iienhasmt lo,au(ras ,ntenoatti elyla,gr sseuit mdeag,a dan mya nfniuceel oobdl brani o)l.fw oOu,ilbvys all of siht is in tdiiodan to cragdnerei nuimnsoestrasnoir dan tgh,fil itg,rhf nda htigf oren.spse

APT nda rhote pursine = yocrtetiax snsmirstn,oia csr-oeaeeld htwi hetro llu-elmlmseoca t.tiaseoumenstnrrr ednnAseoi 'nist slscacyaill eedsrnocid a nieerottrasutnmr seaucbe ti t'ins od/rereeetdssla in ++aC eeetpdnnd aenmn,r tbu rdieved rmof TAP oeferb avihgn na ocexiytart ltna.tipeo

ntecyeclhiAol = raomj toentierruntsram nvdilveo ni nniarssnomuteosri aiv arisumnc nda iconnciti ereostr.cp

epdtPie sosnrtuaemtnrtrei = lonommyc reslaeed as eieptropdp alrreg perrsuorcs ahtt rae vldceae yb ipiseccf eneszym ttha erew in het meas nrtremnsttoiraue eivlsec uonp leeas.re ievF eypst = rgbnt/iau ei,psptde diopio seip,epdt uitiayrtp ,peisdtp yhaplomahtic elriseang r,eoosmnh dan tohes ont ceil.adifss peEmsxal = rcrrpusoe thta gsvie iesr to snbsaetuc P (apsichpm,pou ecteoo,rnx and GTI and rsdeleea rmfo lsaml rdaimete NSP C bfrise tath irtmntas ianp and utteerpemar nmnoitoifa,r oeprulfw iehtepys,nvo tiehbdiin by pidoio ,eipdpts)e orneniunik A, iopueetdpern ,K nad dieounreptep mmaa,g dna pioodi ietdepps gcnludini ltpna adkliolas (elik )homnepir, scetnyhti oipdoi etvr,aidievs and ,soiperdnnh sridnhpno,y nda kinehpselna. In grleean opiiod pepdesti aer arsspdstene ie.(. nalseagai ,mhaisce)nm eiovnldv in pcxlmoe erbisoavh (auxsel taaitontrc, rigvibgeaeussisves/sm ,vah)oriseb dan tdimcaliep uohtgh( otn fvieidinet) in pthcaysicir redsi.srod

Ovlle,ar isstntumroerarnte = ypet :etysp smoe-ualeclllm rmasserttint nad uoedptseprein, herew lceso-mlmallesu tnimrrsastet aer afstre dan maedeti apdir yncipsat monrsisisatn e(..i nnrdogea NSS ithlgfhrtfitfh//igg qcuik ,nsee)rsop rwehe as deiepreopnust go(lan hitw bogciilo samine and meos allsm ulecolem atrmsen)rtist rea wesorl nda eedmita ragldu,a olegordpn turesinsaroonns.mi

Soem ctu:sprei /kpdkteapred:etrwu_irwsl./owmavte./opcn_u/hdii/._vehftprnteersbuihmnaoeuntomts, 74tl8acfhaasdluts1rs3wi0epiB0ed2--aeswo6f6A/s120/nghsert00/Tg6t3p-/2ib:Rtebd3m3rnpfg9ct/6-icirpoge-ebcfpa1A4/a.-dlgarwoar5PBe-bnie8o/u1here.Gru1r4-, dna g-;la.3a0b1#i2-n/awa:le/i=a/we95etddor/teef6b-l--e7/3emtb-6-h2ra1exn&bcfttsxga/lui0h8swd-isgd.fg1hdw_ng=f.bp1Ur45pea

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 +2  
dorischang  Didn't finish reading this, but it looks awesome +2  


submitted by nwinkelmann(293),
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oS, orf eosm ersona, eituanetsrmrorstn si itgoeshnm v'eI SLAAYW sgutlregd h.twi.. yabborpl besaceu I st'nwa ughtat ti llwe so vnere raylle eerladn ti, ujts arldene oeugnh ofr vehwtare xae.m I sutj nuofd shit boo ghhourt NIBC nda ist TASI!FANCT tsI' mrfo 2001 os ghmit eb ,old btu it asw teagr. Yuo nac srceha hrhguto eth koob dna infd teh hseta.cpr I rpetty mhuc utsj nwet hughrto lal of teh sanrrttrioenmteu phtcea.r 0v//.wnitsnnwB../lhbc/NK1sio9/wbomgok:7.th9p

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henoecllAciyt = orjam esitneturrramnto evnovldi in snreoisnsmrnoauti avi mncarsui nda ninctocii opt.errsce

tpediPe strntieseuaotnrrm = omolmcny eedalers as eeprdppoit arelrg souerscrrp htat are aeedlcv yb cfepisci enesymz tath were ni het asme enaorettirmstrnu esvelic nuop esela.er Feiv spyte = aui/tbgnr d,pepesit oioipd ,sitpepde riytpaitu s,etipdp tcalmoiphhay angerlsei enhsmroo, and setho ont aiclfsdesi. mEeasplx = rpcrusero tath sgvei eisr ot tsaubecns P ops(aphm,cipu eornoxtc,e nda ITG nda erealesd mrfo llsam ridmatee NPS C ibsref atht ismnttar naip nda earmpeurtte afinrniom,to prelfouw oentvsyihpe, bhinidite by dopioi )pdptsiee, rnieuikonn A, drneteepopui K, and pnopruitdeee a,mgma dna ioopid pedtispe cudinngil atpln iladoaskl elik( phe)ri,omn siyctetnh idopio ia,dsrveetiv dna hp,snneordi drnsn,oiyhp and pe.heilnnsak In enalegr pdiioo edptsiep aer ntsredpasse (..ie naeagalsi emnsai)ch,m vvnidoel in pmleoxc osbheirav ulsae(x t,ioaacnttr siersguvevibags/smsie re)hiavbso, nad cidetmailp utgoh(h otn enid)ivtfei in tpcysircahi odeis.srrd

lelarOv, tsstmrrntiunaeoer = pety pe:syt lmeuollalcesm- esrritttanms and reee,uitpdnspo erhwe scl-olmlmeusale mnttiarsrset era rtafse nad etdeaim rpdia tnypasic aoisntnsirms (..ei nrgdeano SNS /tgfihghfiirtlgfht/ cikqu pss,rene)o wrhee sa eeupidsnpoter gonal( tiwh bigcoiol nismea and emos allsm mcoeellu tmitrrsnats)e rea lwseor nad teediam alga,dur opglrdoen inrrsostosnin.ueam

moSe :ucpserit oedwacstnmour/puh.eute_/aribus_oh/trdtwerkttsphpode/nve/kwepnnme_i:fmi.tl.ivar, d4i6sa12ccef-tpbbRaaag6ut-a9PdB8ci-o1d/2-e.ew4r6sgel000glren.h5s37rolgun/raiateo84gbetA-rG/s3bp-3crA/ismhe/w3/uorhsewdn2fT0p-1efetr/60f-ip11:traipB, and flf2/6&-0ur9ednfaec.g-taxgs:n0selige2gtwi5hleh-wpa/apb=t-/a1l/.eeta1e47rf_r5d3#1bUd/-anb.xdeahg=btiww-1d;-68-mb/os3i

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 +2  
dorischang  Didn't finish reading this, but it looks awesome +2  


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tyAglkilna aenstg m(tco)herrlenihaem eh(t treoh drsug sedtli rae tcluibeumor thbi)oriisn encsaeri eth kisr of MLA.

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). +27  
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 +8  
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 +  
jurrutia  @keycompany, how did you know it had to be of myeloid origin? +  


submitted by usmleuser007(396),
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shTi more llkeiy ot be scudirtei aertrh ntah axsilevta bc/

eht lba tsdyu osshw a eanlr nyidnftsocu (BNU & aCenrienti ear taede)elv

sMot leylik eht tpnteia aeusdb olpo eidirut;sc lsoa wnsko to ueacs tatcornicno lasdoi,kal agnol hwti elnra esplbomr cshu sa tiniirttlsae pishtinre

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. +12  
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(22),
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m’I vanghi tuerlbo euansddgirnnt wyh sith is a bretet hoccie atnh Ptage siaeesd, ysaileecpl twhi the srecnaedi PLA?

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. +27  
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. +17  
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 :( +1  
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. +5  
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(214),
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nikl ot nrootac agmadir

yotsubato  How is that NOT posterior to middle concha? bad question +11  
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 +4  


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hitw TCP ouy are ospdsepu to iodva iseexcvse nihstlug nda UV e.poxesru antexosMhel easmk your nsik roem secspibtleu ot UV thli.g

notadoctor  Wouldn't UV light also be contraindicated in Vitiligo? +5  
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... +11  
sarahs  what about tcell lymphoma which also has cutaneous lesions? +  
shieldmaiden  @notadoctor UVB from the sun is contraindicated. PUVA is actually used for vitiligo therapy +  


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aliendzoti eedrfrper deu to igelns sdeo

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). +9  
mannywillsee  This little bug has has a face, and now you can't unsee it either! +  


submitted by hayayah(1076),
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By age ,57 het muysht is ltleti orme atnh ttayf esut.is aut,ynlFrteo hte smutyh osrecpud lla of uryo T lsecl yb eth time you chare teb.yrup yheT rae -gdeilolvn adn t'asth yhw yuo acn oles ruoy yshtmu twtiuoh mpeimatirn of ruoy enmmiu symst.e

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 +8  
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? +8  
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. +6  
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