share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
Welcome to thotcandy’s page.
Contributor score: 80


Comments ...

 +0  (nbme24#39)

To add to what everyone else has said, this slide is pretty good: https://images.slideplayer.com/32/10012453/slides/slide_2.jpg

the prompt says RPF and GFR are unchanged, thus RBF is also unchanged, to do that, the renal arteries would have to decrease their resistance.

However, as shown on page 571 of FA19, a constriction or dilation of efferent would change FF which means RPF and GFR aren't changing equally - this is ruled out by the prompt saying they're unchanged.

Leaves us with a decrease in afferent resistance.


 +6  (nbme24#26)

For anyone looking for more info:

Page 147 of Pathoma

3 types of Sex cord tumors: Granulosa-theca (follicle cells), Sertoli-Leydig, and fibroma.

G-T tumor: estrogen excess

  • Precocious puberty (prepub)
  • reproductive age: menorrhagia, metrorhagia
  • Postmeno: endometrial hyperplasia/uterine bleeding
  • minimal risk of metastasis

S-L tumor: androgen excess

  • hirsutism
  • virilization
  • reinke crystals
  • tubules and leydig cells between tubes

Fibroma: benign, fibroblasts, cause meig's syndrome

  • pleural effusion
  • ascites
  • resolves with removal of tumor
mariame  FA 19 pg 632 +

 +3  (nbme24#47)

I think there's something that hasn't been mentioned and people are over looking:

Patient is presenting with CRC + anemia which most commonly occurs with RIGHT sided cancer. And how does that cancer develop? Micro-satellite instability (vs left sided = obstruction and polyp-adenoma sequence).

Misat instab mostly commonly occurs in HNPCC due to mismatch repair defect.

Thus, even though there's a type in the gene, or even if you don't know the gene, there's enough info to figure out it's HNPCC.

FAP doesn't match the picture, and is a pylop-adenoma sequence cancer. Li-fraumeni is defect in p53 (which is the last stage of pylop-adenoma sequence so I assume it follows that too?).

The constipation is kinda tricky because you'd think obstruction but the big key here is ANEMIA due to CHRONIC BLEEDING.


 +1  (nbme23#17)

What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +8
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1

 +2  (nbme23#1)

https://ars.els-cdn.com/content/image/3-s2.0-B9780123821843000106-f10-04-9780123821843.jpg

this picture will help. The US we were given is somewhere between 3rd and 4th picture.

From what I understand, the whole thing is the gestational sac, including the chorion and everything inside. From there, between the chorion and the amnion/yolk sac is the chorionic cavity.

then you have the amniotic cavity that engulfs the embryo and Yolk sac around the 3rd week. then AC expands and takes up full volume of Chorionic cavity around 9th week.

the yolk stalk is the only remaining thing by 7th week which eventually becomes the umbilical cord. which connects to the chorion/by then the placenta.

So, pt is 8 weeks pregnant, thus AC has pretty much fully expanded, and the yolk sac is tiny with a small sliver of the yolk stalk visible connecting fetus and sac.


 +0  (nbme23#19)

i figured it was cocaine or amphetamines so I picked plasma free metanephrines. Why is this not correct?

According to this:

Sympathomimetics: Ephedrine, Pseudoephedrine (Sudafed), Amphetamines, Albuterol (Proventil) can cause positive results in serum metanephrines.

https://www.ncbi.nlm.nih.gov/books/NBK278970/table/pheochromocytoma.table4drug/

drzed  Because a toxicology screen would both answer your question (e.g. that it could be amphetamine abuse) and would also pick up any other drugs that the patient might have been using. So even though the pre-test probability is high for amphetamine use, lets say it was something else, well then the tox screen would pick that up as well. Or lets say that it was simultaneous use of two drugs, same scenario. +2

 -3  (nbme23#48)

Ugh, I saw Low BP and thought gallstone pancreatitis w/ hemorrhage so I picked ecchymoses/Cullen's sign.


 +11  (nbme23#33)

Everyone asking why not PPIs?

if you give NSAIDs which decrease PGs so you get GERD, the simplest way to fix it is to bring those PGs back, so misoprostol.

Just simply -PGs --> +PGs

hungrybox  This is the best explanation IMO Also makes me feel like an absolute idiot +5
guber  also per FA, misoprostol is used specifically for prevention of NSAID_induced peptic ulcers +2
cuteaf  I think the key to answering this question is to remember the specific side effects associated with misoprostol -> severe diarrhea. No other GERD medications in the answer choices have this side effect. Antiacids could also cause diarrhea (MgOH) but not in the answer choices +1
deathcap4qt  Actually one of the side effects of PPI use is diarrhea (and other GI issues). Not in FA but emphasized in AMBOSS and Sketchy. I got this Q wrong for that reason but I see now why Misoprostol is the better answer. +1

 +3  (nbme23#29)

TIL cytosine arabinoside is another name for cytarabine (pyrimidine analog)


 -2  (nbme23#21)

So the xray was similar to this

this is a large volume gas emboli (which you would expect from a diver due to nitrogen precipitation). You can kinda see it in the xray overlapping the heart shadow/left diaphragm.

This is a giant pocket of air, basically so I just figured it would be hyper-resonant due to hyperinflation.


 +1  (nbme23#19)

IPEX: FOXP3 deficiency --> Regulatory T cell dysfunc --> autoimmunity

  • Enteropathy(diarrhea)

  • Endocrinopathy

  • Nail dystrophy

  • dermatitis (eczematous)

  • +/- other autoimmune conditions

  • associated with diabetes in male infants

Page 102 in FA19


 +2  (nbme23#43)

Cerebellar Vermis lesions: Truncal Ataxia (wide based/drunk sailor gaite) + Nystagmus

Cerebellar Hemisphere lesion: Intention tremor, Limb Ataxia, Loss of balance --> fall to IPSILATERAL side.

Vermis = central --> affects central body

hemispheres = lateral --> affects limbs

pg 499 of FA19


 +0  (nbme23#1)

LD4 = vasoconstriction + bronchoconstriction - does it have a role in prinzmetal? I picked this thinking vasospasm due to atherosclerosis.

PGE2 = pain + fever. so i suppose because it's ischemia and not an inflammation, that's not the answer?

TXA2 = PLT aggregation --> thrombus --> ischemia? But i figured that would be more relevant to a stroke or a PE. But I guess TXA2 does play a role in atherosclerosis so it's the biggest contributor.





Subcomments ...

submitted by staghorn(6),

too real rn...

thotcandy  right? nbme predicting the future +  


submitted by dentist(56),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oT me: ihts mesede moer tsaaoiw.dhgrtfrr Yd'ou ntwa ot lflwoo up and ceckh tGirasn leselv no a einttpa who viulyoersp hda 4x mnlra.o

thotcandy  He could have 4x the normal because of current PPI use. the point was that you'd get him off, wait for it to normalize, then check again to see if it's due to neoplasm or PPIs +  


submitted by cr(4),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hhiWc pyte of clel we r giogn ot fdni in ss?i,elbtr rlihepnsotu?

thotcandy  acute inflammation so i assume neutrophils to be replaced by macrophages -> granulation tissue -> fibrosis/scar formation +  


submitted by gonyyong(109),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The kdi has mntascygaioe eud to tpyrbue ee(csxs toertsnteseo → sTe iosng)tehr soeg away lyntalrau alynepap(rt in 12 ot 18 om)nhts

I tknih you 'otnd aveh to od ldboo ttess eacuseb eh hsa namolr auslxe lopmvedetne rfo sih gae adn eterh aer no retho ingss?

osler_weber_rendu  How does telling an "embarrassed kid" that he will have big tits for 12-18 months help?! +29  
howdywhat  my exact thought, telling him that it will last for somewhere around a year and a half doesnt seem so reassuring +1  
suckitnbme  I thought it was reassuring in that the kid is being told this isn't permanent as well as that this isn't something serious. It's important to inform him about the prognosis. +8  
thotcandy  "don't worry your gynecomastia isn't permanent, but the mental scars from the bullying you will receive in HS definitely will be :) good luck!" +4  
therealslimshady  What is the gynecomastia is from a prolactinoma? +  
misterdoctor69  @therealslimshady the gynecomastia is from the sudden surge of testosterone during puberty being converted into estrogen => more breast tissue. +3  
mnunez187  My breasts are not rubbery nodules, thank you very much! +  
cienfuegos  Some additional information: (1) see "breast changes (boys):https://www.amboss.com/us/knowledge/Puberty (2) see "pubertal gynecomastia": https://www.amboss.com/us/knowledge/Benign_breast_conditions#xid=wL0h-g&anker=Z9cfd241bb84b119e6f04274e0a712947 +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tNocie dorp of 2O uiaanrttos orfm AL 59)%( to VL 7%)0( &;pma elqua O2 srntaaiuot ebtnwee VL %)07( m;&pa VR %70)( gt&-;- DVS is tnspeer

teociN teh rsesrupe of the RV (/10)62 – larmNo RV sueerprs is 52/5 chihw etiiancsd esncaider preessru eesuabc of the csiedrane voluem fo loodb omicgn mfor teh LV urhghot eht DSV

rGaed 4 muurrm si a llepapba hliltr tosm eiyllk deu to RHV ofmr eht ooerddlvea wrko

thotcandy  classic eisenmenger syndrome +  


submitted by diabetes(28),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

BCR =s=c=tt;&sga neohremspltuiilrgo teh ynlo otopni hetre.

thotcandy  I saw BUN/cr > 20 and instantly though prerenal --> ischemic pap necrosis due to analgesics. Are nephritic syndromes just excluded from that whole thing? FA says BUN and Cr are increased for nephritic syndromes but does the ratio just not matter? +1  


submitted by usmile1(109),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

mnrMsaoeub pyhoaetnrph nad aiilmmn ahngec sdeeisa nca be eyails dlreu otu sa ethy aer ptehinrco itoTentnslodet isyrmi.usubarl rnshepiit a(ak ceuat ttniltesiari esphitnr)i cna be ueldr out as ti caeuss CWB cstas ont CBR sa nees ni shti insqueto. ra lyliPpa corniess - iteehr ahs no sscta ro ti higtm whso CWB acsts tbu ton CBR ueasbce eht rolmpeb si ont in eth omru.iglle

telba fo cntorueeanlm no aepg 825 lpiaxnes ttah vriafetlieorp ujst smnae rphey rllaclue eoml.gulir v inGe the asnpttie rshyito of esor tthrao wot ewkes a,go wno eipgnersnt hwti cipehNrti mrdSoney whti RBC ,stcas ovaitlfreiepr lgspiehrremiutolon is the lnyo naeesalrbo wersa.n

medguru2295  This was my precise login. I wound up getting it by elimination. But, didn't like that answer as its uncommon in small children and the child seemingly had no risk factors. +  
thotcandy  @medguru2295 FA says it's most commonly seen in children and it's selflimited vs adults is rare and can lead to renal insuff +  
peqmd  They're using the broad category for PSGN, Pathoma pg 130 IIC. PSGN = Hypercellular, inflammed glomeruli on H&E stain and cross referencing the FA table mentioned hypercellular => Proliferative. +5  


submitted by fahmed14(29),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

imsaeHnit pylas a raojm rloe ni eht idaracln nissg of a.fmmaitinonl It hpels editame atiodsiovnal dna avcsural iltyareeibmp va(i olhlndaiete elcl acnr.on)itoct ehTes two fisnoutcn are alardey ncrrtyoa ot A, ,B ,C and D. yB cingrseani lifud in eht laittniitrse sacp,e oyu nac eosrna htta heert llwi be naeedrsic ypmhl lf.wo

youssefa  If more transudates are leaking into the interstitium wont this dilute the interstitial proteins and cause a decrease in oncotic pressure and increase in interstitial hydrostatic pressure? +12  
titanesxvi  @youssefa I think because it is an exudate from increased permeability of venules, the oncotic pressure in the interstitium is not going to decrease +6  
thotcandy  @youssefa transudate is like pulmonary edema due to CHF, no proteins, just fluid congestion and leaking out. That would decrease interstitial oncotic pressure because it has very little protein. Exudate due to inflammation/histamine has a high amount of protein (due to inc permeability) so the IOP doesn't change. +6  


submitted by medstudied(0),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nCa neemoso lxpiean why teh occrtre eanwsr for eht tsoenuqi here si gutcjnionao btu tna’c eb ssopt?initrano

catacholamine16  Transposition is when a segment of DNA (in this case, coding for resistance) jumps onto a plasmid within the same bacterial cell. That plasmid might then transfer to another nearby bacterial cell via conjugation. Transposition is happening WITHIN the bacterium. Conjugation is how that resistance gene gets transferred. +12  
lsmarshall  Also, E. coli is the classic example of a bug tat uses conjugation. ^but explanation above is correct^ +2  
seagull  I think he might have did what I did. I got Transformation mixed up with transposition. FML +3  
luciana  I still can't understand why it can't be transduction. Is it just because of bacterial types? +  
thotcandy  @luciana Yes, I believe so. You have to remember which bacteria have a conjugation pilus - E. coli is the most popular one because of its F sex factor (remember the F+ x F0 thing in FA?) +  
mgemge  I was also confused why it's not transduction...but simply as a crappy memory pneumonic TranNsduction TraNSfers ToxiNs FA 2020 p130 +  


submitted by step420(34),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oersPn ahs aanoL-emttbEr dmroseyn h(x fo gunl ecrca,n dan cesmlu vititayc ahtt si ertteb hwti .sue

rynsPpateic a+C2 ositbidnea epvtren the eearels of AHc patryyllceasinp esubcea eth nibotsaide reepntv eth aoetolizpniard nwihit eth lelc nda ptvenesr nsctpaiy eslvess fo hCA rfom lvig.nea

thotcandy  ugh, I saw Ca2+ and stopped thinking. +12  
paperbackwriter  @thotcandy Same here :( +1  
sidlersofcattan  they got me too with that Ca++ rip +1  
psay1  FA2019 pg. 463 +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

elmtemCnop si rattmnpoi fro ovimgner mmeinu ep,exmoscl so anptseti twih cnpmoemtle eiencesfiicd -(4c1)*c era roem ylkile to eevpldo LE.S Cq1 si a trtebe arsnwe nath hant LBM )(D c/b eht MLB pthaayw si dgiterrge by taca.ribe

myoclonictonicbionic  Thats the reason I put MBL, because the question mentioned that it got worse when she went to the beach so I was thinking some sort of contact with bacteria may have exacerbated her immune system. +  
thotcandy  @myoclonictonicbionic i think that's just the typical SLE photosensitive malar/butterfly rash +1  
dna_at  FYI it is less to do with immune complex clearance than it is to do with clearance of apoptotic debris. The overload of apoptotic autoantigens contributes to loss of tolerance -> SLE. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764694/#S4title +2  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hTe nreehapbhncmloo ulowd be no het lacaut tufse so jtsu egt dir of ().D ehT bac"kl leo"h tath teh tsefu si tfloniga ni is het etaosgnialt cas os etg idr fo .()C wNo I ma on lnuuodtrsa terxep ubt I nokw htta het aoiimnct tiyavc lnyletaveu epxsadn ot usef hiwt het cionorh rtyeheb niimalengti het irocohinc atvyic .B() nI sertm of eehrw the iticnoam tviyca is onshw in stih ,agiem I am not s,ure so ymbae soemone can lphe tbu htsi esvlea eth lyko sca ciwhh icalptyyl esapapr wihitn hte tsingaeoalt sca oudanr .55 es.kwe

kateinwonderland  At the end of the fourth week, the yolk sac presents the appearance of a small pear-shaped opening (traditionally called the umbilical vesicle), into the digestive tube by a long narrow tube, the vitelline duct. (Wiki) +4  
tallerthanmymom  But why does it look completely detached from the fetus? I eliminated yolk sac first because of this +  
makinallkindzofgainz  If you look reeeeeeeally closely, you'll see some signal between the yolk sac and the baby. Although you can't see the entire connection, they are connected. +5  
thotcandy  Pt is roughly 8 weeks pregnant so and typically by 9th week, Amniotic cavity has expended to fill entire volume of Gestational sac. So the entire black part around the fetus is GS/AC. +2  
euchromatin69  and also by 7 week vitelline duct obliterates between umbillicus and yolk sac +  


submitted by yotsubato(1032),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

So ofr nCdadia ew nca seu

eAolzs o)lalf(zeocun iibthni( 5YPC04 hl)ittoeaednmy

eotnAipmrhc B e(rop omatnorif ni gnfula lelc em)eanmrb

snnpafoCiug e(petvnr ngciklosnirs of abte sngulac ni lcel all)w

ro Nynaits rfo rlao ro aeaeplhsog acses oe(rp fmno)oitra

hTis iutneqos si nysgia htat esh si nkaigt na AORL gurd to retta didanca vgatniis.i

pnioAcretmh si IV

Cfsagnnpuio si olas IV

so ee'rw letf itwh zaelso

leozsA iinbtih tyieshssn fo rrsteoegol yb nihginitib PYC 054 atht rvcsento rloesonalt ot r.eersltoog

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +1  
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2  
staghorn  Me - picks Metronidazole -_- +1  
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5  
turtlepenlight  I have seen that on the wards so I hope it works! +  
fexx  and my smartass picks amphp B +2  
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +2  


submitted by brise(53),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

so I saw tsuck no shit asbeeuc ish BNU ac/neeitrin irota lde em ot ithnk he ahd na tniiinsrc elanr oid.tunncyfs Adn a PGI2 inthobiiin owdul adle to a lnerprea- zioe,amat erhwe het NBU/ nreiaietnc tiaor ldwou be reom hnat 0.2 I okwn ttah sSAIDN hnitibi PISG. Btu how ear oyu ppeusdos to srsco tou nincdiuto of tdlais tabruul siicd?aso

purdude  You can cross out Distal RTA because the urine pH is 5. In Distal RTA, urine pH becomes greater than 5.5 because a-IC cells can't secrete H+ +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
underd0g  @thotcandy Distal RTA is another name for Type 1 RTA, so that is the type of RTA that they are specifically referring to in that answer choice. +1  
solidshake  ^agreed. Type 4 RTA is not an option as an answer. Type 4 is a result of low aldosterone or aldosterone resistance -> hyperkalemia -> impaired NH3 synthesis in the Proximal tubule -> impaired NH4 formation -> high tubule H+ -> tubular acidosis +  


submitted by brise(53),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

so I was skutc no ihst uecbsae shi NBU i/anictnree iotra dle em to ihtnk he had an snnctiiri elran ctsndfoyniu. dAn a PI2G iitiinnobh uolwd dael ot a nl-aperer ,iozatema rhwee teh N/UB cteaiennir oiatr doluw be orem hatn 2.0 I wkon htat sSDNIA iinhibt SGP.I tuB how ear you ospuespd to cross uot icdtoninu fo sdilta ulbuart i?isdcsao

purdude  You can cross out Distal RTA because the urine pH is 5. In Distal RTA, urine pH becomes greater than 5.5 because a-IC cells can't secrete H+ +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
underd0g  @thotcandy Distal RTA is another name for Type 1 RTA, so that is the type of RTA that they are specifically referring to in that answer choice. +1  
solidshake  ^agreed. Type 4 RTA is not an option as an answer. Type 4 is a result of low aldosterone or aldosterone resistance -> hyperkalemia -> impaired NH3 synthesis in the Proximal tubule -> impaired NH4 formation -> high tubule H+ -> tubular acidosis +  


submitted by d_holles(187),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

onsesL ardenel -- het BNME od'sten lpya .sctikr fI it koosl riht,g ti si iht.gr

thotcandy  but also when it looks wrong it's right, or when it looks right it's wrong, or when it looks wrong it's wrong. you never know with NBME :) +9  


submitted by gh889(128),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

grfnierRe ot IRsTN dan RTNIsN as sitaamyn fo ettearnmt

yMtains:a feavieznr N),NR(IT oviteorfn )NIR(,T and ertiitbeniacm I)(RTN

ususmle  I guess he is asking about integrate,,,,, where his should be integrated into host dna to get replicated .. triple therapy includes. 2drugs NRTIs and other one is integrate +  
whoissaad  @ususmle NRTIs would still inhibit DNA synthesis since they mess with the reverse transcriptase which is needed to make viral DNA. +2  
thotcandy  @ususmle HIV triple therapy is 2 NRTIs/NNRTIs + 1 protease inhibitor. Plus, if her CD4+ cunt is already 60/mm, that shit is well integrated in her CD4 cells already, right? +1  
brotherimodu  I was confused because isn't HIV an RNA virus? +1  
focus  @brotherimodu yes and therefore it uses a reverse transcriptase +1  


submitted by diabetes(28),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

acn moyosbde axepinl who rygeen oiponrudtc by lclgisyyos a,riscedne sicne ebicaro glsyylscio oruedpc 32 net pcPoamATer, to 2 nte PTA ouhthrg aecobanri loylysicsg ?

diabetes  i think the stem should be "energy production by an anaerobic glycolysis " +3  
blueberrymuffinbabey  yeah that's the bit that tripped me up too. i get that there would be increased glycolysis in general to compensate for lack of TCA function but...the fact that it says "energy production by glycolysis" is kind of misleading/confusing. +  
thotcandy  technically, glycolysis is the reaction that happens in the cytosol that generates pyruvate and 2 net ATP. after that it's TCA and Oxidative phosphorylation, which occur in the mitochondria. By definition, glycolysis is anaerobic - which is why they hammer the fact that RBC undergo glycolysis only into our heads. +1  
thotcandy  technically, glycolysis is the reaction that happens in the cytosol that generates pyruvate and 2 net ATP. after that it's TCA and Oxidative phosphorylation, which occur in the mitochondria. By definition, glycolysis is anaerobic - which is why they hammer the fact that RBC undergo glycolysis only into our heads. +  
targetmle  i got it wrong because of this as i thought ATP will be decreased in anaerbic glycolysis, but proabably it was mainly 'glycolysis' is increased +1  


submitted by diabetes(28),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nac yseombod nxailep who greeny dtonroupci yb solsigcyyl rdsc,aiene isecn aboecri clisyoslyg prdoeuc 23 tne pcPTAmea,ro to 2 tne PAT orhhutg nbecioara slsgycioly ?

diabetes  i think the stem should be "energy production by an anaerobic glycolysis " +3  
blueberrymuffinbabey  yeah that's the bit that tripped me up too. i get that there would be increased glycolysis in general to compensate for lack of TCA function but...the fact that it says "energy production by glycolysis" is kind of misleading/confusing. +  
thotcandy  technically, glycolysis is the reaction that happens in the cytosol that generates pyruvate and 2 net ATP. after that it's TCA and Oxidative phosphorylation, which occur in the mitochondria. By definition, glycolysis is anaerobic - which is why they hammer the fact that RBC undergo glycolysis only into our heads. +1  
thotcandy  technically, glycolysis is the reaction that happens in the cytosol that generates pyruvate and 2 net ATP. after that it's TCA and Oxidative phosphorylation, which occur in the mitochondria. By definition, glycolysis is anaerobic - which is why they hammer the fact that RBC undergo glycolysis only into our heads. +  
targetmle  i got it wrong because of this as i thought ATP will be decreased in anaerbic glycolysis, but proabably it was mainly 'glycolysis' is increased +1  


submitted by nukie404(8),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

tA tsrif I swa thkngiin !aah idClh baeus! Btu I uesgs riwonam nobes rae orme svugesigte fo O,I ultghaoh het on almify xh rpat saw atrerh .hlbe

thotcandy  Literally had it on OI until I saw no family hx... Isn't it AUTOSOMAL DOMINANT? +2  
faus305  FA 2019 pg. 51. Yes it is autosomal dominant. This question is poorly written but the clues are "wormian bones" and multiple fractures. Pretty sure everyone on this page would've nailed the diagnosis if seeing a real patient instead of using three lines of text with two hints. Questions like this demonstrate how this test became a way of ranking people based off of minutia they know and not their clinical abilities. This is why step is pass/fail in 2 years. +  


submitted by mousie(220),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

riaoaMndf uhaitbs + sMolacu umnsraoe + Nekc smsa = EMN B2 (MP)M ,ehPo eyulMdalr hdrotiy CA atcnion(iCl )sergtceni, oumcals oursmnea

thotcandy  I knew it was MEN2B but forgot medullary ca of Thyroid is parafollicular/c cells which means Calcitonin, not T3/T4 Other answers: AntiThyroglobulin: Hashimoto's (or other thyroiditis) Dexamethasone suppression test: positive/suppressed in pituitary adenoma (acth secreting), negative/unresponsive in Adrenal hyperplasia/adenoma (suppressed by high dose) or ectopic acth (unresponsive to high dose) Serum TSH test: for papillary or follicular ca, thyroid adenomas are usually cold but could also cause HyperT TSHR antibodies: graves disease, hyperT +2  


submitted by paulkarr(55),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

nociCrh nuoMeesoygl eeauLimk sv imodeLkeu natecoRi sha a fwe idnrtiitgefnaef aru:tseef

  • isolBhaaip anc be ense ni leopyalviMoerritfe ieesassd chsu sa LMC. Hevo,erw eyth ear ont ense in dLkeoumei tnsicaeoR.

  • eLtocuyke lialnkAe phPahsstoae PAL)( is teonf eedlveta ni udoikLeem itaoRcnes. Btu ti lilw eb eeesdrdac ni CLM eabesuc lAbmorna clesl 'otdn akme het maroln ey.nemz

  • Dhoel sBdioe ear cticearictrahs fo kLudioeme entasicRo. otN nees ni CLM.

As svmyumh odtpeni uot -0A129F gp 442 sah all tish aointfirnmo sa lewl sa rdlWoU .op.mr.beIl tsuj tacn' smee to nifd teh Q.DI. ebMya mneosoe lsee anc -agettma .in

thotcandy  LAP 100-249 do not fall into the answer choice but would still be considered high value and thus +LAP to indicate leukemoid. A LAP- would be in the normal values which is 20-100, not below 250 like the answer choice indicates. +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

taahomP ssya heert rea 3 sghint atth reffitetaiden dioleemku omfr +:LCM coLeyketu llaanike osetasphhap l(noy in dl uki)eeo+m lapoBshsi onyl( ni ) +LMC 92t(2;) trasailootncn n(oyl ni L)CM

nor16  yeah but pathoma doesnt help here... +1  
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +  


submitted by spow(34),
  • A) GABA-A receptors let Cl- in
  • B) Glycine is used in the spinal cord as an inhibitory neurotransmitter; also lets Cl- in
  • C and E) Metabotropic glutamate receptors are G-protein coupled
  • Therefore, the only thing that could let Ca2+ in is NMDA receptors
thotcandy  according to this, 5HT3 is an ion channel (mainly Na and K, but some Ca) so that was kinda effy imo +  


unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Aonney nkow woh to urel tuo llams eitnnitse on hist ?one I uotghth teh mutemon elpayd a eorl in ghilnea ni eht db,aenom but erlyalc 'Im nsmiigs ihmsgetno eehr.

what  Small intestine has smooth muscle in the walls which will fibrose on injury +  
youssefa  So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI) +3  
thotcandy  The way i thought of it was: small intestine PERFORATION repair -> the basement membrane and stem cells were definitely disrupted thus limiting regeneration ability Liver = puncture wound, not necessarily all the way through = basement membranes and stem cells are probably still intact -> regenerate without fibrosis +2  


submitted by nicsar(1),

a)abduction: supraspinatus-deltoid-triceps-serratus anterior

b)adduction: subscapularis-pectoralis major-lattisimus dorsi- teres major

c)extension=horizontal abduction; post. deltoid, infraspinatus, teres minor

d)internal rotation: subscapularis

for isolated work out, d is better.

TEN REPS.

thotcandy  teres major also internally rotates? It's attached to the medial lip of the humerus +3  
neovanilla  teres minor externally rotates (+ad-duction) +  


submitted by guillo12(47),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eTh asbpsriucausl sucmel si ervy apiomttnr orf hte nenltIra itoatonr fo eht .smreuhu The riatlenn iaotntro usrotspp eht euprp arm rdnugi nocdtbaiu nda ndo.caitud

ehTre era emos dabn xeseiesrc tath anc lhep uoy tstrnehg teh rlisScauusbap . slu.m.ce 1. tnlenIar nottioaR - usse laimed terninal iooanttr 2. eltaExnr ontRatio - uses elatlra trelnexa iornatot .3 rtnFo owR - You vhea oyu hdan up ni rtofn fo uyo nda tiwh rouy mra eeddntxe upll abkc teh .nb da .4 idSe Rwo - eoYu'r ieds to hte danb wthi ryuo danh gnfica eth i,hp lulp dnwo twador yoru b.ody (ODDAUICNT)

HTSI IS TON A FRIA QSNTUOIE BN!!EM!

arcanumm  I got this wrong too, but I think the exercise of internal rotation makes sense because it will isolate the muscle (without assistance by teres minor for adduction). +5  
tiredofstudying  The subscapularis assists in medial (internal) rotation and adduction, but the teres minor also assists in adduction, so the best choice to isolate the subscapularis would be internal (medial) rotation. Choice E +2  
thotcandy  @tiredofstudying teres major also internally rotates so it wouldn't really be isolated either. I guess Tmajor isn't relevant cuz it's not a SITS muscle? Still a stupid question. +1  
jaramaiha  I just remember subscapularis muscle function by thinking that Subs go into the sea (or internal/medially rotate). Also the only muscle set that happens to perform internal/medial rotation in the rotator cuff set. +  


submitted by viz28(-1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Teh ao-rnsmomquuacl nocitnuj dstuteai at eht txnelear os fo het ervixc si one ties hicwh is ghlyih nluveabrel ot aptaesimla ro eclnatspoi mtarfinstaoorn enudr sadeerv cn,camtcrssuei hsuc as cochnir efoinnict or t.raamu a,Uulysl asusmqou ileatsmaap wreeh uosmsqau cslel leepcra the nucrloma eclls fo teh ilcnvacoered lan,ac is svredo.be ee,rvwHo ni less ommcno ,ntatsousii yatcalprrilu retfa ru,taam tbalu atpsiamael aym lodv,eep nlrcapeig acnreveliodc ntiildoance ocnlmrau letehlpaii cllse yb leadi′tci mnaocu′lr ,sclel smiairl ot etosh snee in lpaafionl btus.e bTaul atapmleisa is stmlyo eens ni the erpup part of eht lodrieanccve laacn enra the etliannr s,o utb yam sola be unfod in eht cadevncliore lnsgda ro eth orwle viaoelcrecnd n l.caaib:///i1tmb.8mhntit0jp0hp.cit3jb3n/1/i/dbden8t.

charcot_bouchard  But they are asking in healthy individual. I dont get why they add this ciliated part? +6  
thotcandy  @charcot_bouchard FA19 pg 612 says the only thing that's ciliated is Fallopian tubes... shit doesn't make sense yo +  


submitted by nwinkelmann(294),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

rMmursu dan ema:nsurve 1ts tohghtu = owh seod ti nhecag ithw eoalpd.r llA mmrsruu etecxp HM,CO MP,V nad rtlaai xammoy ivytsree is edcrtyil opolitoranpr to ahgenc in lredaop (.ei. inrecasde aedrrpoleo=ws ru,rmmu e)..tc ueasBce of ht,si DxD nac be adrnerow ndow to OCHM, PVM, and raalit ommxya irtgh aawy esbuaec teh rumurm dsnwoeer whti drseadece reldapo (ie.. idngastn p)u whne all but ocsnteeipx thwi ipv.mreo

ialAtr moyxam = CMC pyirmar adaccir uomtr due ot priroetalifno of cioceentvn essiut emyehmn;ces a ueeclnapdutd assm ncenctoed via tsalk to umtrai pestum atht is dudespens ni teh riaalt lobdo mloveu adn moves ithw the oulmev mteovn.em

aenPrstitno:e adtri of )1 mltari eavlv ousntrbtioc (.i.e malsiea, osptmyms fo dracica uf,lirea ynoces,p )ce,t. )2 mmyopsst of biosemml e(i.. cfalia and rgiht rma rpsaseimieh ni ,)atetpni nda 3) luonsainctttio smopmsyt e..(i ,rvfee wghite sls,o pmomsyts elsribmnge eieccnvont sitsue ideases, cebeaus rtmuo arelsees )-I6L. rtOshe ndceliu irconuolge yosmmp,st "tl-idmreupaso lvaev aesdsi"e atlrtucsouya insngdif i..e( iositalcd rur,)mmu dna atrila nneeagrtmle hcihw( dlcou msoescpr ngildyrune rttecssruu nda aescu smtpmyso .als)o

Nto nlyo does gadtisnn deecears rpda,oel iwhhc esnam LA olumev si lrweo os assm 'nist as e"sns"ddepu ubt eorm ,emolbi ngatndsi losa raeescsni eht ddwwaorn roantagtivi cf,eor ihwch lwodu itcrnboeut ot teh routm mgoinv rasdtwo teh sbae of teh airatl bra,emhc op"l"pnipg no the milatr lveva asellt,ef dna ynpttlilaeo xndgnetei thrgohu adn ngcsiau a tonnliaucf pety fo lrimat oetsnsis i(.e. gsennwiro dcoiiaslt m.urr)mu hisT ievdo axpelnsi it lalery ll:ew mwshu1p?ci.hlpysVb/;nat:4=aL6tImv6/towueoYts&.wgtc1/w=

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2  
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +4  
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +3  
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +1