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 +0  (nbme24#5)

Inhibition of GpIIb/IIIa receptors would be the mechanism of either (FA 2020 411):

Clopidogrel, prasugrel or ticlopidine via inhibition of ADP-induction of GpIIb/IIIa by blocking P2Y12


Abciximab, eptifibatide, and tirofiban by direct GpIIb/IIIa inhibition.

A lot of questions will have very similar answer choices on the real exam, but there will always be one best answer, and decreased platelet adherence was the better answer here. As stated on many other question threads, there are plenty of tricky questions to be upset about, but this was not one of them.

 +1  (nbme24#48)

Radshopeful had a good explanation but a few typos may confuse people, so to recap:

The patient is suffering from systolic HF secondary to chronic HTN. The LV has lost contractile function (decreased LV systolic function from Qstem) which leads to decreased SV (and subsequently decreased CO since CO = HR x SV, the HR in this patient is also within normal limits). Finally, LVEDV is the amount of volume left in the LV at the end of diastole (or filling) and since the blood from systole was not able to be pumped forward efficiently (decreased SV) this leftover blood will cause this value to be increased.

 +1  (nbme22#20)

FA 2020: 463

Causes of avascular necrosis: CASTS Bend LEGS. +Corticosteroids +Alcoholism +Sickle cell disease +Trauma +SLE

+“the Bends” (caisson/decompression disease) +LEgg-Calvé- Perthes disease (idiopathic) +Gaucher disease +Slipped capital femoral epiphysis

drdoom  for bulleted lists, be sure to follow the plus sign with a space! :)

Subcomments ...

submitted by lsmarshall(267),

Zellweger syndrome - autosomal recessive disorder of peroxisome biogenesis due to mutated PEX genes. Hypotonia, seizures, hepatomegaly, early death (within 1 year). β-oxidation of VLCFA happens in peroxisomes so the child seemingly having some sort of congenital metabolic disorder with elevated VLCFAs should have been enough to get the answer without knowing about Zellweger.

jucapami  furthermore, FA 2019 pg 47 +  
tiredofstudying  Same page for FA 2020^ +  

submitted by m-ice(184),

The patient has loss of pain and temperature on the right side of his face. Sensation of the face is ipsilateral, so the issue must be on the patient's right side, which we can confirm by knowing that sensation of the body is contralateral, and he has lost left sided pain and temperature of the body.

Pain and temperature sensation of the body is part of the spinothalamic tract, which always runs laterally through the brainstem. This can be confirmed by remembering that sensation to the face also runs laterally through the brainstem. So, we can confirm this is a right sided lateral brainstem issue.

The loss of gag reflex and paralysis of the vocal cords imply impairment of cranial nerves IX and X, both of which localize to the medulla. Therefore, the answer is right dorsolateral medulla.

duat98  You're a good man. +1  
charcot_bouchard  You must be handsome too +1  

They’re giving a lot of confusing extra information here, maybe to trip us up. They just want volume of distribution, simple as that.

Vd = [drug administered] ÷ [plasma drug concentration]

First convert it all to g/L because this is how the answer will be:

administered: 80 mg = 0.08 g plasma concentration: 4 ug/ml = 0.004 g/L


Vd = 0.08 grams ÷ 0.004 g/L = 20 L

Clearance of drug is not a huge factor because the half life is so long that the drug is distributing before significant clearance occurs.

gonyyong  I think the distribution half-life and elimination half-life was saying that by the time you checked, it had fully distributed (10 half-lifes) and had not been cleared yet (super long half-life) +7  
soph  1000ug= 1mg and 1g=1000000ug so then 4ug/ml * 1g/ 1000000ug= 0.000004 g/ml 0.000004g/ml * 1000ml/L= 0.004 g/L 80mg*1g/1000mg= 0.08 g vd= 0.08g/ 0.04g/l =20L +3  
tiredofstudying  Or, like a normal human, convert 4ug/mL into mg/L ... which is 4 mg/L. 80mg/4mg/L is 20L. +1  

F**K this question!

Know exactly what the disease is without knowing what the f**king "generalized malabsorption" means!!

tiredofstudying  Hope your day got a little better after this +  

Anyone going to mention that C. perfringens has been demonstrated to have a high association with gastritis and shellfish and that parahaemolyticus is a cause of necrotizing fasciitis?

tiredofstudying  FA 2020 Pg 178. +  

submitted by nwinkelmann(187),

I just thought of a way to (hopefully) avoid getting these types of answers wrong. First, when I read them I always look for the least "asshole" answer. Then, if you're still stuck, try to put the statement into a quote that you would say to a patient as a physician, remembering that open-ended, non-judgmental questions are ideal.

The answer for this could be phrased as a question/statement by the doctor, to the family, as "Tell me more about how this impacting your family and daily life." Had it been phrased like that, I DEFINITELY wouldn't have gotten it wrong. I would have never even had the opportunity to make an assumption about the family's fighting being due to diet concerns and thus needing a nutritionist referal (which is what I chose).

usmile1  I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful. +1  
tiredofstudying  99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will +  

submitted by gh889(55),

Ketorolac is a reversible NSAID given IV, all NSAIDs have a risk of interstitial nephritis, renal ischemia, gastric ulcers, and aplastic anemia.

the best answer is renal failure b/c it is given IV and has less of a chance of causing gastric ulcers

tiredofstudying  I would also take into account that this patient has had HTN and T2DM for 20 years. His kidneys are probably shot. +  

submitted by aaaaaaa(4),

orlistat is used for weight loss (its not a statin as some people thought in the comments here). its in FA 2019 pg 294, m/c side effects are GI including diarrhea

imnotarobotbut  Thanks! It's actually page 394 +1  
tiredofstudying  FA 2020: Page 400 +  

submitted by guillo12(31),

The subscapularis muscle is very important for the Internal rotation of the humerus. The internal rotation supports the upper arm during abduction and adduction.

There are some band exercises that can help you strength the Subscapularis muscle... 1. Internal Rotation - uses medial internal rotation 2. External Rotation - uses lateral external rotation 3. Front Row - You have you hand up in front of you and with your arm extended pull back the band. 4. Side Row - You're side to the band with your hand facing the hip, pull down toward your body. (ADDUCTION)


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). +3  
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 +  
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. +