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Welcome to usmile1’s page.
Contributor score: 109

Comments ...

 +3  (nbme18#25)

Like t123 said, I think the key to this question was to rule out the other answer choices as they would not have normal stool. I found this article that essentially breaks down GI disorders in diabetes into gastroparesis and intestinal enteropathy. These complications and their symptoms are often caused by abnormal GI motility, which is a consequence of diabetic autonomic neuropathy involving the GI tract.

Intestinal enteropathy in patients with diabetes may present as diarrhea, constipation, or fecal incontinence. The prevalence of diarrhea in patients with diabetes is between 4 and 22 percent.4,5 Impaired motility in the small bowel can lead to stasis syndrome, which can result in diarrhea. In addition, hypermotility caused by decreased sympathetic inhibition, pancreatic insufficiency, steatorrhea, and malabsorption of bile salts can further contribute to diarrhea. Abnormal internal and external anal sphincter function caused by neuropathy can lead to fecal incontinence. When evaluating a patient with diabetes who has diarrhea, drug-related causes (e.g., metformin [Glucophage], lactulose) should be considered.

cbreland  I agree, felt like all the other choices would have something odd in the stool studies +
jurrutia  Orthostatic hypertension implies sympathetic dysfunction. Loss of sympathetic input causes dishinibition of intestinal motility. +1

 +0  (nbme18#30)

This pt clearly has a pituitary adenoma given the bitemporal hemianopsia. The most common functioning pituitary adenoma is a Prolactinoma, so you want to be very sure before not picking prolactin. However, according to FA, "Prolactinoma classically presents as galactorrhea, amenorrhea, and decreased bone density due to suppression of estrogen in women and as decreased  libido, infertility in MEN. No decrease in bone density in men. Thus, given the compression fractures in a male and weight gain, the answer has to be ACTH.

 +0  (nbme23#5)

phase 2 = moderate number of patents with the disease of interest. Assesses treatment efficacy, optimal dosing, and adverse effects.

phase 3 = LARGE number of patients randomly assigned to either treatment group or the standers of care . Compares the new treatment to the current standard of care to see if there is any improvement.

FA19 p 256

usmile1  standard* +

 +1  (nbme23#26)

main points from this question:

  • bilateral renal bruits in a patient with HTN = Renal artery stenosis --> in a young woman, it's most likely Fibromuscular dysplasia

  • RAS can present in up to 1/3 of patients with malignant HTN or hypertensive emergency which is how this patient is presenting, evidenced by the HA, blurred vision, and papilledema.

  • renal artery stenosis → decreased renal perfusion → compensatory activation of the renin–angiotensin–aldosterone system → secondary hypertension

 +0  (nbme23#27)

Fixed wide split S2 is Atrial septal defect obvi.... But also ASD is associated with an early systolic ejection murmur heard at the Left Upper Sternal border (pulmonic area) the systolic murmur is not due to pulmonic stenosis

 +4  (nbme23#33)
  • A) acoustic neuroma = sensorineural
  • B) lesion of cochlear nuclei
  • C) Loss of hair cells = Presbycusis (age-related progressive bilateral SENSORINEURAL hearing loss)
  • D) Meniere dz: triad of SENSORINEURAL hearing loss, vertigo, tinnitus

E. Otosclerosis: Slowly progressive conductive hearing loss that most commonly affects ONE ear, with the 2nd ear affected in ∼ 70% of patients as the disease progresses... [this explains the patient's complaint of worse hearing on the right]

  • pathophys: Abnormal bone growth of the bony labyrinth. Stapedial otosclerosis (most common site) → fixation of stapes to oval window → conductive hearing loss
  • leads to progressive CONDUCTIVE hearing loss because the ossicle's ability to vibrate becomes increasingly limited.
  • A unique feature that I have seen come up often on question is that the patients are able to hear better in noisy rather than quiet surroundings.

 +0  (nbme23#39)

In patients with IIH treated with acetazolamide, the inhibition of carbonic anhydrase in the choroid plexus results in a reduction of CSF production and flow. The acid–base status of the patient may also alter the distribution of acetazolamide in the CSF and brain, but its effect on the CSF flow is secondary to that mediated by the choroid plexus. Based on the pharmacology and distribution of acetazolamide and carbonic anhydrase in the brain, the theory that emphasizes the effect of acetazolamide on CSF production in IIH is most likely primary and direct, and weight loss, when recognized as a factor, is secondary and indirect, and frequently the result of toxic doses in excess of the amount needed for complete enzyme inhibition.

 +0  (nbme23#26)

classic cause of secondary HTN in young or middle aged women. presents with "beads on a sting" appearance and can occur in both the renal and carotid arteries.

 +6  (nbme24#13)
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norMeusamb hehyporpant dna ianlmim ngeahc essiaed acn eb ylisae erdul tuo sa htye era ptiornceh Tuynsumtlteilrd o.sntobsireia hpsrtneii kaa( atuce eniritstalti ti)rhnieps anc be ldure uot sa ti uesacs CBW scast ont CRB as eesn ni tsih nqi.uetso i lyPaparl inssecor - etehri hsa no sscta ro it ghmti wsoh CWB ctssa tbu ton RCB sceaueb eht leoprbm si tno in eth oe.mllurgi

talbe fo olaretnmuenc no pega 528 apxliesn ttha ioprrlefeaitv utjs esman ryphe elullcar Gvie n teh teanipts srtohyi of eors hatort tow eekws g,ao nwo sigetrennp wtih Nhitpirce erdSmyno htiw RCB ts,acs teroafrvielip igleoislurhtnorpme is teh noly bnealosera nsaerw.

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

 +8  (nbme24#11)
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rmfo B-prdneadom&yasoB; c roAit tnisosse ldase to Syopne,c ngni,aA and etLf rhtea a.roySlpf enucei si edu ot efliuar ot eeiasnrc riaccad uttupo ude ot aedcrenis aarltofe.d nagni A si eud ot eanedcsir EDVLP iwhch elads to eeesacrdd oocnrrya olodb lfwo. nAd eftl trhea irfluea is deu to anerecsid PD.ELV

cbreland  Great, same thought process, murmur made me think of aortic stenosis, supported by the LV hypertrophy in stem. Then you have syncope during exercise because the heart is not able to keep up with the demands of the body +

 +1  (nbme20#19)
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dseo yenona wkno thwa hte rceutturs E is oitginnp ?to

thomasburton  Not sure looks like it might be free ribosomes or other such small cytosolic structure (I picked E too, thought B looked way too big!) +
targetusmle  same here!! marked e thinking of it as a mitochondria +1
msyrett  Glycogen Granules! They are not membrane bound and float freely in the cytoplasm. +4

 +9  (nbme20#41)
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fI uyo loko at lwoUdr tqnoieus ID 99212 ti ash a wdlfnroeu xolpatinnae rof hit.s f I htye shrea teh asme iptse,peo it liwl aevh a wdwrnado f.pslo eI they aesrh nnoe of het easm se,poipet hte elni lwil eb izotaornhl rcosas eht hagpr cgi(itninda on cnaegh as het umoant fo Y dddae en)eiascsr

eacv  omg YES!! thanks Uworld I got it correct! exactly this qx asked the exact opposite thing! Hahaha I loved it !! +8
pg32  Even after reading the UWorld explanation, I am still not sure how the answer that reads, "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not..." is incorrect. Based on the graph, I don't see a way we can rule out that answer choice and it sounds more likely than both X and Y having the EXACT SAME epitopes. Can anyone explain? What would the graph look like if the quoted answer choice was correct? +2
69_nbme_420  If you make up an example with numbers, it really helps! “Protein Y expresses all of the epitopes expressed by X, but protein X does not express all of epitopes expressed by Protein Y.” If we say protein Y has epitopes 1, 2, and 3. Then Protein X has epitopes 1 and 3. Then we can clearly see the relationship the AMOUNT of Y added relative to X bound would NOT be linear. Stated another way – we need an exponentially more amount of Y to COMPLETELY unbind X and therefore there would not be a one to one depiction in the graph Similar logic applies for the answer choice that states "protein X expresses all of the epitopes expressed by protein Y, but protein Y does not express all of the epitopes expressed by protein X. E.g. If protein Y has epitopes 1 and 2. And protein X has epitopes 1, 2, and 3. Here again, we have satisfied the answer choices condition, and no matter how much we increase protein Y, protein X will still have epitope 3 bound in this case. +4
69_nbme_420  Just to clarify for the first scenario: We have 3 epitopes on Y, and 2 epitopes on X. That means, assuming the epitopes are all present in equal amounts, if I add 300 grams of protein Y to the solution - only 200 grams will bind protein X. AND ONLY 200 grams of protein X can be unbound. Hope the numbers help! +
fruitkebabs  For anybody still stuck on "Protein Y expresses all of the epitopes expressed by protein X, but protein X does not," although this statement may be true, there is not enough information in the question to prove this. We know for fact that because the Amount of labeled X bound reaches 0, at the very least, protein X and Y express the same epitopes since at a certain concentration, Y is able to completely displace all X from the system. This doesn't exclude the possibility that there may be extra epitopes on Y, but it doesn't prove it either. +2

Subcomments ...

submitted by snoochi95(2),

How come you couldnt say "I dont know, but the oncologist will be seeing you later today"? Is it because technically you are ~lying~ to the patient?

drdoom  Not “technically” but actually! To say “I don’t know” when you *do* know is as lyin’ as it gets! Just remember, before a state issues you a license to practice medicine in their backyard, they look to the National Board of Medical Examiners and ask, “Should we trust this person to practice medicine here?” The NBME is in the business of telling states, “Yes, we believe this person knows enough to practice morally and competently.” Answer ethics questions with this in mind. +5  
pseudo_mona  Besides technically lying, it also probably isn't a good idea to drop the word "oncologist" to a patient before they hear they have cancer, especially as a student who can't answer any further questions about the biopsy results. +12  
usmile1  @pseudo_ shit I just realized that telling them that the oncologist will be seeing them, is essentially telling them they have cancer. Additionally, you can't lie and say you don't know. no Idea what I was thinking when I took this. +9  

mousie  Caudal = Bottom of the SC = failure to close = spina bifida and Rostral = top of SC = failure to close = Anencephaly +10  
powerhouseofthecell  I'm confused. In first Aid doesn't have meningomyelocele as failure of caudal or rostral pore to close. Is the answer Cadual because in this patient specifically, his condition takes place on L2-5 which is more caudally? +2  
usmile1  its a neural tube defect aka failure of neural tube closure +  

submitted by kentuckyfan(43),
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oNietc htat )A ,Bontrocinicchnootsr B) ulaarlGdn er,isecotn )D tiesPisrs,la E) aotaVsidilon fo niks rae lla rndue rpcstmeiphayata ot.lronc

Teh oyln htteipmycas trocnol si taehr raet, whchi owdul i.ncrseae

drzed  Vasodilation of the skin is under sympathetic control as well -- beta-2 receptors when stimulated cause vasodilation (via increase of cAMP in vascular smooth muscle). The key is recognizing that stimulation of a GANGLION of the pns will lead to release of NOREPINEPHRINE, which preferentially stimulates alpha-1 receptors. Those receptors will cause vasoconstriction. If the question asked what happens when you stimulate the adrenal medulla, the answer would be (potentially) vasodilation. This is because the adrenal medulla releases EPINEPHRINE which preferentially stimulates beta-1/2 receptors. +8  
jesusisking  @drzed Awesome explanation except I think sympathetic response induces vasoconstriction in the skin though vasodilation in the muscles! +1  
usmile1  @jesusisking yes you are correct! α1: vasoconstriction in skin and intestine ; β2: vasodilation in skeletal muscle (transmitter: only epinephrine!) +  

submitted by usmile1(109),

phase 2 = moderate number of patents with the disease of interest. Assesses treatment efficacy, optimal dosing, and adverse effects.

phase 3 = LARGE number of patients randomly assigned to either treatment group or the standers of care . Compares the new treatment to the current standard of care to see if there is any improvement.

FA19 p 256

usmile1  standard* +  

submitted by seagull(1573),
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sTih si a apinc nratilnpteoeHyiv osdrp p2OC agenlid ot a oprratsiyre kas.illsao p2o is aetyeirllv dfefntueca nod('t kas em o?w)h

sympathetikey  Yeah haha I had the same conundrum. +  
sajaqua1  If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected. +23  
imnotarobotbut  lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol +2  
soph  Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances). +2  
charcot_bouchard  PErioral tingling- due to transient hypocalcemia induced by resp alkalosis. +1  
rainlad  I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2 +1  
usmile1  adding onto Charcot_bouchards comment, I found this: Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany. +3  

submitted by patricknguyen(-12),
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O tpey stitpnae evha romerpf gIG tani A tina B. oNt IgM a"ndstilroet Sbhyio afert uatfinnrsos" eisar up unosicisp orf .alhanpsayix on insg fo s-l&t;ghimyeos avfor alaahsxypni edu ot AgI eig;cin&fe=dtyc ftrecefo lcle si saMt cllse

eclipse  they have IgG and IgM +2  
kpjk  if it had been anaphylaxis- there would have been urticaria and pruritis +2  
usmile1  wow I've never seen an answer on here be just so wrong +  

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FA 1,9 p.g 503 - aMy see tlMira gtrgtuiaoneir edu to aiirdmpe rmaitl eavlv rlcueo.s

I alawsy ndfi it aoirnptmt ot emmrrebe atht coen you teg ophtaygol eoewhmsre in eth tare,h uyo can epcxte topayhgol eyheevrrwe bindhe ,ti oevr te.mi

So ni hsit seca you tarst hitw MHC g&t;- talriM euggrr -&;gt LA tdnoiail -;&tg bAfi. &g;-t LAL/V eafirul ;gt-& Plmu eamde &t;-g FHR -gt;& .etc

Is't alyaws a ertmta fo .temi

mario  wrong q bro @ maxillarythirdmolar +  
usmile1  nope right question. he just went even deeper into the answer. +  

submitted by seagull(1573),
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Tsih tniatpe si nippgrit ll.sba tBreet od a dgru snceer hhicw smees oviuobs.

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +43  
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5  
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1  
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2  
charcot_bouchard  Lol. I got the right answer but took long time +  
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +  
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +  
targetmle  why is there basal ganglia hemorrhage? +  
dul071  Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1  
usmile1  basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +1  

submitted by sajaqua1(535),
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uemSr nsiskces is a eTpy 3 tpiintyhviysrees oci,ntare in whihc eht oybd sedorpsn ot cgieinnat amelicd sesuabsnct and ursdeopc aitsb.edino eTseh ioeinasdtb ni uinioalrtcc tneh dnbi to eth acnneitgi usdgr dna tes fof eht mptnocemel uRiehmtaod sahttirri si olas a Tepy 3 ephsvyenrstiiyti atoie.crn

A) opsAtisop of mhegpaasocr- soppaotis si alreleyng tno a ypte fo senrhsteptiyivyi )B staM elc i-noegnaduatrl stih si ptra of a Tpey 1 nyihsrpiyvettsie a/iylaataxonh,piersnc in hwhic mtas cslle dbin EIg on ireht casfu,er nad IgE nidgnbi to het agtret tinngea dsucine a nonrmfaiolocat neahcg in het IgE thta sste ffo samt ecll ualeoantirg.dn )C tuNaalr rlielK lelC nillgi-k sapyl a evartiy fo rsol,e giludicnn cnaecr osuneisrpsp and crsitentdou of ialylvr dncfitee cesl.l If ethy ylpa a erlo ni peitisyeynhirts,v it si aptr fo yeTp 2 SRH ni cwhih hety owuld perodsn to gI on eth lcel r.ascefu )E leWeh nda rflae rictsen-oa shTi is osal a yTpe 1 .SHR

meningitis  I didn't pick this one because I thought Serum sickness was too systemic and RA was a more localized Type 3. Again, im overthinking things. +  
youssefa  Goljan: RA is a mixed type III and type IV immune reaction +7  
dinagohe23  I though NK cell killing was similar to T cell so and RA is also Type IV +5  
nephcard  ,blll sdouof +3  
usmile1  NK cell killing would be a type of innate immunity, not similar to memory T cells. because they did not give an example of a type 4 HSY, the answer must be serum sickness. +  

submitted by nlkrueger(44),
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ywh t,'nis %0" stlsab on het ppihrraeel emrs"a rhgt?i si stih eht itsnhusigdiign tuefur orf tcuae muaikee?l

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  

submitted by m-ice(340),
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Ceas essire is a yudts in hciwh eht srserceehar nspreet teh yhtiros nda tanemtrte fo a amlls progu fo siimalr saentpti, tuwhiot niescbdirg any onistgr tion suoprg ro

drmomo  only 3 patients +1  
usmile1  uggghhh not in FA ... +  

submitted by dragon3(12),
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Can naonye pxneali hyw raceabit is nrtuh,lpeosi iliaufvgr/n rae syoe?tchlmpy I nwok hsti si a afdtlunmane t..oepcc.n

lolmedlol  i think neutrophils (in addition to lacking granzymes and perforins which are used to kill viruses and fungi) dont recognize intracellular things; viral antigens needs to be processed and presented on an MHC for the lymphocytes to recognize +7  
usmile1  also neutrophils are only seen in acute inflammation. This pt has longstanding inflammation which is associated with monocytes, lymphocytes, macrophages, plasma cells. +4  
usmlecrasherss  Neutrophil come and goes quick like day or two , after that rest of immune cells take care +  

submitted by m-ice(340),
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This byo has emiiisntgn ecdasu yb Serpt piaeuomnen, hte tmso momcon uecsa fo csufenitoi iiemitgnsn in l.eagrne Teh evcacin rfo rteSp umepon si a paiorecdlashcy noerpit jagnocteu ia.cecnv The torhe amojr atiebarc hwit a eacincv kile stih is H. euaizlenfn.

usmile1  also the meningococcal vaccine! +3  

submitted by famylife(94),
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hPsae III iiCancll irTla ep(r AF 910,2 p. :26)5 greLa eumbnr of tpnisaet yolrdmna danseisg eierht to het ntettemra drnue vsigaointtein ro ot eht rtndsaad fo arce r(o b)ac.pleo

usmile1  also just to verify, there is no such thing as phase 0 right? +  
madojo  Not that i know of or is in FA +  
llamastep1  I've heard animal testing is called phase 0. +3  

submitted by nwinkelmann(294),
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eoDs oaeynn haev a odgo nxoneiaplat rfo why areesecdd elsevl fo iniihbn si orgwn? orFm ym rutnndagd,nsei nbnihii dna nvitcai owrk oth,eretg ni taht inniihb sdnib and sockbl aicvnit ingadel to ddeeraesc ebdfkeac no aptyshmluhao nda itanciv srnaceesi FHS dna GHRn npo.trcui.od stu,h if uyo eserdcae innibih htne uyo owldu vhae ricesaedn iaitvcn ihcwh lwoud eadl ot diecesnar GRnH dna ,HSF rhgti? I nduof oen eiatrcl algktni buato it ni gesradr to eybtr,pu btu it msese ot eb a h/yshtoontispe cfoimnedr at hsit p...into si hatt ?yhw utB s..tll.i hwo do I relu it uto no a tte?s

yb_26  I also picked decreased inhibin. may be it was one of the "experimental questions", which are not even counted on the real exam +1  
artist90  Inceased FSH will lead to spermatogenesis and spermiogenesis NOT Increase in Testosterone which is causing increased Height of this pt +6  
artist90  Inhibin B only has negative feeback on FSH not GnRH. see the diagram on the topic of semineferous tubules in FA. Testosterone has a negative feedback on BOTH LH and GnRH +1  
usmile1  Kind of like how nocturnal pulsatile GNRH release occurs during sleep to stimulate growth (FA page327), the same thing happens for puberty. Pg 325 in FA, "pulsatile GnRH leads to puberty and fertility." It doesn't explicitly state during sleep, but pulsatile release of GnRH leading to pulsatile release of LH and FSH will lead to puberty. Puberty starts in the brain, its onset really has nothing to do with decreased inhibin levels which happens in the testes. hope that makes sense! +3  
sars  From what I understand, inhibin is only released by granulosa cells when FSH levels are high. This is a boy. Next off, this question is about puberty, which is due to pulsatile GnRH leading to large amounts of LH and FSH, leading to large amounts of dihydrotestosterone (males) and estradiol (females), and eventually secondary characteristics of puberty. The increased pulse of estrogen and testosterone leads to GH release, which is metabolized into IGF-1 in the liver. This leads to long bone growth from what I understand, which is not much. +  
cassdawg  @sars inhibin B is also released by sertoli cells in males and will feedback to inhibit FSH release, its not just a female thing. Also, there is actually an inhibin B pubertal surge in both females and males that corresponds to maturation of the granulosa and sertoli cells, respectively. Hormones are wack. +  
j44n  I think youre just supposed to see that he's starting puberty and know that the nocturnal pulses are involved +  

submitted by m-ice(340),
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isTh awmon ahs a tol fo sinsg htta otinp wardot na isetnalint tcraiiaps finie:otcn trence aevtlr to apuaP ewN nGaeui, ouhgc nad aeorllva ealstfrint,i hgih ilponoihes uncot, dan a oostl esplma ahtt ahs a mrow ni .ti otsM ielylk hte paettin ahs a yosndgStoerli nfn,otieci sa shti si eht sealitnint atriaeps atth oswsh lvraa on tloso saialycBl all etilsinnta sepisatra can eb rtedate hwit lzaBoeedn gru,sd shuc as b.ahaedeTiozln iazlanutqPre oulwd eb orme tppriroepaa rof a wmor or irvel lkuef ciitne.nof

fulminant_life  just to add to the explanation above," cutaneous larva currens" is a specific finding for strongyloides. Also the picture they used is the exact same one on wikipedia lol +9  
yb_26  they really should add Wikipedia in the list of top-rated review resources with A+ level of recommendation in FA2020))) +10  
usmile1  also a side note: cutaneous larva CURRENS is pathognomonic for strongyloides whereas Cutaneous larva MIGRANS is for ancylostoma braziliense or nectar Americanus +5  
solgabrielamoreno  FA 2019 pg 159 . Bendazoles because worms are bendy. (Treatment for roundworms) Praziquantel is for Cysticercosis (Taenia Solium) and Diphyllobothrium Latum Mefloquine : treats malaria Hydroxycloroquine: treats Malaraia, also RA & Lupus (immunisuppresive & anti-parasite) Dexamethasone: Steroid for inflammation +2  
abhishek021196  FA20 says Ivermectin OR Bendazoles for Strogyloides, so in a future question, if Ivermectin is listed, that could be the right answer for this as well. +2  
jurrutia  When in doubt, pick a bendazole +  
jurrutia  When in doubt, pick a bendazole +  

davidw  If the Infarct was on the right side they you would have a decrease in PCWP +  
usmile1  yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up. +6  

submitted by m-ice(340),
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opMiltrosos is a sidaprotlngan ongaal )E2G(P ttha scta on teh csaohmt ot ertoomp umucs otniepcrot of the thocams gnini,l tbu lsoa tsac in teh usreut ot ueanogerc n,ctcitonora hcwih kames it lufsue orf .tabrinoo

usmile1  perfect except it is a PGE1 analog, not 2 +2  
krewfoo99  PGE2 will increase uterine tone (Pg. 270 FA 2018) +  
drmohandes  Misoprostol prevents NSAID-induced peptic ulcers. Side-effect: also gets rid of baby. +  

submitted by jus2234(20),
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heT gprha whsos a saedreec in icoecnlmap fo hte slng.u Of hte sipoto,n dfuefis lranpymuo iofsrsib si het onyl heicoc atht is na aplexme of a stritvceeir unlg sdsaiee hhwci dulwo sedaecre oanlmpciec

nor16  asthma = emphysema = chronic bronchitits, obstructive. leaves 2 out of 5... +4  
usmile1  Common causes of decreased lung compliance are pulmonary fibrosis, pneumonia and pulmonary edema. So yes pneumonia could possibly cause the decreased compliance shown, but the vignette says the patient has "9 month history of progressive SOB." That couldn't reasonably be pneumonia, leaving diffuse pulmonary fibrosis as the best answer. +10  

submitted by mousie(220),
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sI 54 ueismtn oot lnog to eb nhtaaacciply dan oduwl eht ncsebae fo arsh ar,uii(tarc iutrurp)s OR ?cnctyaapahli

hayayah  Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours. (pg 114 of the 2019 FA has a list of them ordered by time) +8  
hayayah  (also allergy / anaphylactic presents with more skin findings (urticaria, pruritus) +7  
seagull  The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer. +7  
charcot_bouchard  Guys anaphylactic reaction to whole blood doesnt occur much except for selective IgA defi. so look out for prev history of mucosal infection. And it can have all feature of type 1 HS inclding bronchospasm. +5  
soph  I saw hypotension and though anaphylaxis........ -.- +  
usmile1  Chest Xray showed "bilateral diffuse airspace disease". This is much more indicative of TRALI than anaphylaxis which would have wheezing and possibly respiratory arrest but no actual damage to the lungs. Additionally there was no urticaria or pruritus one would expect to see with anaphylaxis. +5  

submitted by nwinkelmann(294),
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I ujts thtguho of a way ot plyel)ohfu( iavdo egttign teesh sptye fo nwarsse gonrw. F,rtsi wnhe I dare meht I wsaayl look orf the tsale ea"shlso" rwanse. enTh, if ryeo'u llist csukt, rty to upt hte emtsttnea nito a uetqo ttha uyo udwol ays to a eattnpi as a hniscyaip, ermemiernbg htat eo-neep,dnd ldtune-jmngano nsesqtiou are de.lia

heT nrawse for tish lcdou be rhpesad sa a einntsteuo/mesttaq yb the ,cootrd to teh ia,ymlf sa Tle"l me meor uotab owh shti gcimpaitn royu aymifl and ayidl .ifel" daH ti been haspedr ielk tha,t I IIYLDNETFE tnodlwu' have tgotne it wrgno. I oulwd avhe nerev vnee dah hte opiupryottn ot kaem an mupnsoaits touab eth sl'mafiy ignhigtf egnib ude to edit onesrccn nda shtu egndien a rutininitsto elfrrea wchhi( si waht I o)s.ehc

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. +4  
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 +3  

submitted by lsmarshall(417),
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"rAi te"rodpls dnossu leki tirrrepyaos laavs(i ro er)atw .loedstpr tannhIliao fo maosxaplto oycsost ni cta escfe 'itns equit teh maes; otn to asy I nwko eltaycx thaw the socsyot rea aidenhl sa suj(t osicomrcipc rdy atc poop r.?ilceapts) sotngiIen fo eoecdkourdn meat ot egt teh ssyct si ltycnarie a ORT for alpomtsaox.

smaoapoxTl as HTRCO has rdait of hplhoacesyd,ur erlecabr lnoitaifisccca erc(ieatrr)lab,n adn otcnhoi.ierristi iresiohrotticin nac be ni nlagtcoien MCV ro t.siaosoplmsxo nelPrtaciveurir aocaicstiinclf are in C.MV tegCnnolai CVM allusuy has rghinea ssol, u,sesizre iptaeelch rhsa, “buerbleyr nuffm”i ah,rs nioechiostirr,ti dna erveriptaliunrc scantci.ocliifa

usmile1  also note that toxoplasma can cause the "blueberry muffin" rash (also rubella can as well) +  
raddad  So looking at the CDC website, it looks like "accidental ingestion of oocysts after touching cat feces" is the route you were talking about in the first paragraph, so inhalation of air droplets is wrong inherently. +1  
zevvyt  is his small head common is Toxoplasma? +  

submitted by famylife(94),
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To leur tou HIDSA p:tey ueSr"m tuomsaips cntaeriotncon nealrgley eansirm gdehaucnn. nMtmevoe of uomstaisp mofr hte cluraatlenirl sepca to teh tlceaxlrlruea aescp nvrpstee uoiltindal hopyalik.aem As enrhdogy nois move rltlyaalnucil,er hyet aer dhneexgca fro utioamssp ni rreod to anmatini ee"lyiu.tecralrotnt


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

submitted by monoloco(136),
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yniemtA uyo veah a norpes ohw upbsm etirh ad,he tseg bcak p,u dna hnte ahs eeserv sssuei ro deis klie 6 urosh lerat -- ouy ahev rofelsyu an dilruepa hmaoatem ofmr aaecotrlni ot het mieddl NGLEAINME ertry.a o(Gnlja lylare hsmpsazeei hatt yuo n'tdo ecrsw pu and etlecs dimled ceal.rbe)r Yuo nowk ti sha to be an rlaeiatr earnctoali sicen eth aurd si ylgitht eddhrea to the sus'lkl niern fu.rseac lGjnao edrfrere to shi erncepexei thiw ti as eindeng plseir to ervemo eth aurd ormf het s;lulk rgcipa,h tub ti sdvire hte nitpo omh.e gtiTnen nese on TC si ubescea hte ierdplau emhamtoa tseg ucskt benwete hte utrsue le.sni When it gaamsen to kbrea apts neo fo teh erstuu is,lne ti si ym rtnedsungndai htat then si wnhe oyu gte sereve eealequ,s ekli tdaeh ro ervatw.he

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11  

submitted by haliburton(214),
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hsti si a ccalveri asinlp rdoc teioscn. the unetcea aucsiulcsf is ntctai U(E) iitrbavno adn irntepopoopicr, utb eth htwei cnitose is het gieaclr sisacfcluu )LE( nad si am.adgde I itknh eht alaerlt ionortp atth is enevnu is tjsu uaartcna/rtaift.l

arezpr  thorax section +3  
guillo12  How do you know the gracile fasciculus is damage?!?! +2  
cr  which parte of the image its damage?, the pink? or black? +  
usmile1  the pink park yes +2  
d_holles  If you look at you can see that the closer to the center = legs, while further away = arms. +4  
hyperfukus  i still don't see where the damage is lol! FML +  
hyperfukus  i finally figured it out lol that was a slow moment i hope im not this slow on step yikes! +  
angelaq11  @hyperfukus I had the same problem at first, marked it and then came back. If you remember, in the spinal cord the white matter and gray matter are "reversed" compared to the brain. That said, if the butterfly shaped region (ie, the gray matter) is colored (in this case) lilac and the rest (ie, white matter) is blackish, the only thing that is actually abnormal, is the region where the dorsal columns are, because it stains just like the normal gray matter. After that, you have to think about which fasciculus is damaged, the gracilis or the cuneatus. The gracilis is medial while the cuneatus is lateral (picture someone with glued legs and open arms). Hope this helped +13  
azharhu786  Gracilus Fasciculus = Graceful legs +  
icedcoffeeislyfe  Check out FA2020 pg 508 Put simply--> myelin= black --> color of the normal white matter no myelin= pink --> color of the normal gray matter and the damaged area Dorsal columns= vibration, proprioception, pressure fine touch F. graciLis= Lower body F. cUtaneous= Upper body +2  

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Ok I gte atht if 050 ayrdela vahe eth isdasee ehtn teh sikr olop si ddppeor to 0200 ntedsust btu eth utinosqe yaccpfslieil sasy thta hte stet si oden a yaer ila.frt..e 050 oepepl ahd hyaimlc,ad yuo udwlo ttare th.em ouY dton' cbemeo minume ot lahdicamy fater ncefiniot so ehty wludo go acbk tion eht kris poo,l inngeam the olpo lwdou rtuenr ot 50.20 eTh ewrans duhlso be %8, isth swa a bad iqostnu.e

thepacksurvives  Yeah, this was my issue. I got it wrong because of this-- still don't understand the logic bc you can get chlamydia multiple times +5  
hungrybox  FUCK you're right. Damn I didn't even think about that. That's fucking dumb. I guess this is why nobody gets perfect scores on this exam lol. Once you get smart enough, the errors in the questions start tripping you up. Lucky for me I'm lightyears behind that stage lmao +9  
usmile1  to make it even more poorly written, it says they are doing a screening program for FIRST YEAR women college students. So one year later, are they following this same group of students, or would they be screening the incoming first years? +5  
dashou19  I think the same at first, but after a second read, the question stem said "additional" 200 students, which means the first 500 students don't count. +  
santal  @hungrybox You are me. +2  
neovanilla  @usmile1 I was thinking the exact same thing... +1  
happyhib_  I agree this is a trash question; I was like well if this is done yearly for new freshman the following year would be of the new class (but the word additional made me go against this). Also you could assume that they were treated and no longer have the disease... I dont like it honestly but know for incidence they want you to not include those with disease so i just went with dogma questions on incidence to get to 10% +  

submitted by hajj(0),
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nac eyonan niealxp tihs? i wnok nmedai ofr y si hgrihe yb uclatlacino but x ahs owt dsmeo os ohw coem y hsa ehhgir ?meod

lispectedwumbologist  The mode in X is 32 and the mode in Y is 80 +  
lispectedwumbologist  The mode in X is 70 and the mode in Y is 80* +1  
hajj  Thank you! +  
hungrybox  Just checking in so I could feel smart about getting this right despite bombing the rest of the test lmao +4  
usmleuser007  can someone please explain the median in this +  
nala_ula  The median can be known by first assembling the numbers in order from least to greater. If it's an uneven number set, the number in the middle is the median (for example: 4, 10, 12, 20, 27 = median is 12 since this is the number in the middle); if the numbers are even then you have to take the two values in the middle, add them up and divide them by 2 [for example: 4, 10, 12, 12, 20, 27 = (12+12)/2 = 12]. Page 261 on FA 2019 explains it as well. Not sure if I explained it well... good luck on the test, people! +  
dubin johnson  Can someone please explain how the mode for Y than X. Not sure how we got the values above. Thanks! +  
dubin johnson  I mean how is the mode for Y greater than mode for x? +1  
sgarzon15  Mode is the one that repeats the most once you list them in order +  
usmile1  Median would be the BP value that the person in the 50th percentile of each group would have. So for group X, to find the 50th percent value, I added 8 + 12 + 32 = 52, which is right above 50, so the median would be 70 mmHg for group X. Doing the same thing for group Y, 2+8+10+20+ 18 = 58; the 50th percentile would fall in group that had a BP of 90 mmHg. which makes the median higher for group Y. hope that isn't wrong, and helps someone! +4  
poisonivy  I did it the same way! not pretty sure if it is the right way to do it, but it gave me the right answer! +