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Welcome to usmleuser007’s page.
Contributor score: 370


Comments ...

 +1  (nbme24#31)
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My aitnensrdugdn si tath het ylmuaoprn clnoacuitri gshncea yvre eilttl in merst of an atuec .MI

tI is b/c nylpumroa ucrnlotiica ahs a tlo erom orom to illf wtih dbloo mhuc elki the sepeln in temrs of dbolo ccl.umuiotnaa

tWhi hrhige meoluv of odlob ni myrnapolu itniaccourl, reom odlob elssvse ear blea to eb tderrecui sciyaelpl het pxe.a

With mero rritdceeu oodbl selesvs = dcreedu eurressp d/t atiicucnrlo ni raelplal

sheska  yes, in boards and beyond he explain this. extralveolar vessels= arteries and veins, intraalveolar vessels=capillaries. capillaries will increase resistance because will have more blood from backup of the left atrium and will get smudged => increase PCWP arteries and veins with more blood will open more and thus decrease pulmonary vascular resistance. +

 +7  (nbme24#37)
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pmySil u:emorpt ergeyn ni a gitlh weav the erom kliely it is to csaeu lcalurel (D)NA m.gaade

ttalUrevilo hsa slse yerneg nhta ar-Xsy (it sego ugthhor uoyr elhfs to ese nbose)!

dreOr fo tighl sehngttr (llce mianggda yicplbt)iaa

  • XyR-a ;tg& AUV asl(o lbae ot uceas ouledb andstr rbka)e tg&; BUV mso(t klyeil nesilg tarsdn bkare - reedirp)a

 +2  (nbme24#45)
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Most otbianopsr da ciesneotr is deno at hte .CPT tI si shit asrneo why het TCP si hte smto loyatlalicbem vactei ooirtnp fo teh pnenh.ro

As hist mgeai hsswo, you acn ese ahtt seanpooibrrt map;& rieenocst ccrsuo at hte CTP

stih seanm htta otbh PAH ;mp&a eeirtcnani era deectser ofr noinmalitei ta het CTP lgaon ithw hte ontialidad luovem rfeeyl ilrdefet ohguhtr teh wmasnb'o .escplau

o;urteFerrhm lnnuiI is ertenhi edcstere nro sod.eabrrbe

cneeh inlunI si retebt for FG.R Bu,t eancetinri is ylmarnlo uesd rof GFR as na measitet (brobaypl td/ es)ea


 +12  (nbme24#35)
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rAfet oesm hcarrees ihts si why the ertho nsreaws rea rocnctir:e

lasaB riettcknaeoy apm;& anmila cluida

  • octIncrer c/b ailnam lcdaui is a mpnoneoct of eth maebenst eambrnem hciwh si fdnou neetebw eht ltmeehupii adn nreidyugln otncevcein eussti e(g,.. miesrpide nda dremis fo teh .n)ksi
  • tI is a lrohygu 04 neoetnmra eidw eurote-letnlcnc oenz beentwe het smalpa bremeanm of hte saabl llsce dna hte crdeneeo)n(lts-e anlima andse of eht nmatesbe rembaen.m (KW)II
  • basla arncktiyeote ateactsh ot eht aeetbsnm mermneab iunsg osedesimmohem

lnuGarar ratknceioeyt pa;m& mstraut nucmroe

  • utrSmat ucmliud aterapses tehse otw yresl.a
  • rhete ear on dossmoeem that oetccnn tshee owt slarye
  • gemaI for rcerfeene

mianLa lidcua &a;mp inamaL sdnae -- kiccl for gimea

  • otbh era part fo eht aebmsent ernmemba dna otn eht pimeisdre

eMtncloeya ;mp&a balas etektociryn --- ciklc fro igmae

  • are obht eoncetdcn ot aetrcoeh vai Er-scahnedi
  • ti si lyarpobb eth eaamdg to isth oeoicntcnn ttha
azibird  The stratum lucidum is only present in the thick skin of the palms, soles, and digits. So the stratum granulosum and corneum do touch in most of the body. I guess they just aren't connected by desmosomes. https://opentextbc.ca/anatomyandphysiology/chapter/5-1-layers-of-the-skin/ +
peridot  Wow if I'm understanding this correct, lamina lucida (basement membrane) is not the same as stratum lucidum (between stratum corneum and stratum granulosum). That def confused me about this question bc I simultaneously was like wait isn't this in the basement membrane but also recalled the picture in FA with all the layers. Thanks so much for the super detailed explanation of all the answer choices! +1

 +3  (nbme24#35)
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reAtf mose aehcrres sthi is yhw het rheto sranswe are nrc:iotcre

  1. lsbaa tnreecoaityk &p;ma naamli ailudc
  2. ceotIrncr cb/ imalna audicl si a penmntoco of het aseebtmn enamemrb wchhi is fudno tbneewe eht ueihepimtl and dneynuirlg cecetiovnn tseius ,(.e.g diemersip and desmri of eht .iskn)
  3. tI si a oylhrug 04 tameeonnr ewdi eneteurnol-lcct nzeo wtebnee eth alpams eemrnmab fo hte lsaba lescl nda hte )oertln-(eecneds alnmai sdaen of eth stbeanme nr.ebmaem I)WI(K
  4. aslab raencyetktoi aatshcte to het ntmsaeeb brmeaenm usngi oseemmemihods

  5. lruGaarn etkiaertocyn &;pam strautm cmroneu

  6. aruStmt mduuicl rseetaaps eesth wto ye.rals
  7. etreh aer no soeomesdm atth cnectno these owt realys
  8. Imega rof nereeecfr

  9. Limnaa adlciu ma;&p maiLan esnda -- likcc ofr maegi

  10. tohb rae trpa of het mbtsenea abmeenmr adn ton hte eemsidirp

  11. ynleMectao ;pm&a labsa cotyeeitknr --- kcilc for agime

  12. aer tboh cnntdoeec ot aoertech iav Eercsa-hind
  13. it si apolrbby eht ademga to isth ooncnnetic hatt thmig deal ot mnaeaoml

 +0  (nbme24#35)
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tiigBlnsre ssseeaid husc sa suhmigppe gsvlauri (V)P dna spipmehgu scfeaulio F(P) aer nuietmoaum essdiesa in whhic -saotetudiibnao atgert enids.lsgmeo

  • VP is uaescd by tgccliuairn niatutoioebsda Ig()G ttha atgetr 3sDg osim(Dneegl )3 dna esstimome 1s.gD
  • VP si fdmntaisee yb psausaarlb alstias,yocnh or tibslres in teh muocus maemrben dan tlseirsb ni het imedrp.sie
  • FP sanpetti vahe iubtnoesdtoaai ttha ratget g1Ds ihtw ilaecsrpfui sselirtb on teh ireespidm hwit no sucmou eemnrbam sesui.s
  • tohB aeseids tlruse in a osls of itcokneyarte doinesah.
  • geimhPusp cna asol be sdeauc by a rcaitelba fneotnii:c ulsuolb pitmoige is na nnteiiofc adesuc yb a outccslpcaysoh buctemiar taht leaeress a xnoit htat eclaevs teh D1gs terlxarlualec nad.moi

 +3  (nbme24#34)
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meoS rohet corideenn keil slecl nad seodrsidr rof eeecrfe:rn

  1. papSeta-l-nepdr cotrahinm (feni unarralg olcstpm)ay in cdoeEnrni sto:rum

  2. rydlealMu hoiyrtd riaacconm

  3. odnnneurioceer oesmytdaomaoohucnctrp m rho
  4. irdiCoanc umTor irn)estnoo( --- s(loa sha esshet of minurof lsce)l
  5. laSlm leCl amnorCcai of gusln = aSl,lm eulb s chewltil cstan lympocats dan ralnurag nah)oitmc =r fa,tl -eohsavdapl ecil hltws sntca ayolmtspc nda irhmyhpoeatcrc ncleui

  6. lalSm uelB lseCl

  7. ignEw aomrcsa s(laaptanic ignalatnm mortu)
  8. CSC fo nsglu
  9. fta,l ad-olsheapv cllswtie h tcsna macsyotpl dan poeithrahcymcr neilcu
happysingh  i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma .... +1
niboonsh  might want to look at fa pg 665 +

 +16  (nbme23#23)
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  1. crCanes of eth ilpe,sv uincnidgl het ttoea,srp deraps to het aburlacmols nspie iav eth rreevtalb oevusn pxsleu .)(VVP

    • eTh VVP mncstaeimcuo htiw a umbner of nsuvoe tksrenwo, nnlidugci eth rsictoatp sounev ule,pxs hhciw screeiev hte vseuno plpsuy romf eth ,ttasrpeo i,enps and rela.bdd

    • PVV urns up teh tneeir naislp ulconm adn necoscnt tiwh het nouvse sppuyl of hte binar avi a evaslvlse ssmeyt oa’s(nstB s)xulPe hwcih losawl orf ncioaiildebtr wflo adn uelniaotrg fo crraialitann rueisshp.seTr ovneus iencntonco ot eht arreblce cuaiitnrlco mya hepl xialpen eth prnsoptyei of umosrt ot tstsaeemiza ot het .anbri

  2. Teh VPV oals uamteniocscm tiwh eht ayogsz niev ni teh s,ceht iwhhc lxpniaes ni arpt hyw brstae nad lngu crncsea feeurnqtyl itzeatmseas to eth cthocrai nie.ps

    • yial,mirSl deu to pyuarmlon uvones egdiaarn itno eth ltef eids of eht r,athe lgun musrto tnfeo sradep ielsysmyltac aiv teh eratrail s.smtye
  3. uhAghtlo mylhp ensdo aer the omst oncmom tssei fo asatmsesti ni rn,egale paitylhcm dparse to teh ltseklae mseyts si yerv .rera

  4. The infproamipm pselxu rcseeevi eonuvs rgaanide rmof teh ttssei, iydmsip,eid nda tdcusu fnedrese dna riadns itno eth serultctia ei.nvs


 +0  (nbme23#23)
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3. rCsanec fo hte esp,ivl cunglinid hte asroept,t rdaesp to eth uasablmcrlo espni iva lerer atbevth nuosev xVluPeVps .)( .a Teh VPV inmcacmstueo hwit a nebmru of vneosu wrksntoe, i. gnduilicn etpcshorta ti unesov epsx,ul whcih eeeircsv het nouvse pulpsy from eth eattrps,o s,nipe dna de.br ald b. VPV unrs pu eth rnitee isnpal ucmlon dna tnosncce iwht the snuveo syplup of teh rainb avi a slaelevvs etysms a(stn'Bso Px)sule .i whhic llaows rfo inaiidtrlobec owfl nda tiuagreonl fo tarnlicaianr  euesr.rps i.i Tsih soeuvn noicectnno to the cbreaelr ccnrlauioit yam ephl nxleipa eth yptonsreip fo ostmur ot tmtaseezais to het br.4nia . eTh VPV osla nteacoimcusm thiw teh saygzo inve in teh c,tseh whhic xnseipla in patr ywh rbtaes nad lnug earcscn lnutyfqere titasazesem ot het ahotricc ipe.s n a. mSlriia,ly deu to lpaymuonr usnove aadgrine tnoi teh eftl esdi fo the ,heatr lngu osrumt foten pdaers lsyyaelscmit vai hte iararelt t.sy5.m es hhotulAg mhypl osnde aer teh ostm onmomc siste of tstmeaissa ni ,raenelg mpaycthli epdsar ot teh esaektll setmys is yvre a.. er6r hTe ponfmripaim xelups creesevi eovusn idegrana fmro hte ietsst, pe,diydiism and tcsduu drneeefs dna raidns onti eth sceattruil eivs n.

 -1  (nbme23#33)
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etraT ihst elik a VPImoa er(tyaW eihadrra, odirlchayahr = reeucdd ClH in the nelmu, &a;pm ayoihmpek)la

iths illw elad ot cmlbaiote osciidas td/ osls fo rbicba in tolos

btl_nyc  Chloride is increased though. +
maxillarythirdmolar  This comment is gold. @btl_nyc, this is actually accute. you would expect hyperchloremia https://www.ncbi.nlm.nih.gov/books/NBK507698/ +

 +6  (nbme23#50)
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loBdo ofwl in ssieer snieacesr eth scaetes;irn olodb owfl ni alplrela ecdsaesre teh nisreacset (T.P)R

By ogibkncl eht cmibialul ievns you hvea in cseetpr mieldti eth cexses lfood owlf ot hte eptcnl.aa

iTsh edcesru eht ofwl ni alerlpal nciuro;ctial stuh isearcnse the PRT. PAM( = cidrcaa uto utp teims R)TP

siTh is beecsau eht loatt ossrc estnaicol reaa is eudecr.d

morF hst,i erteh is na sceneadri rusepser ni hte lftea .lrinoactuci

heT bretosrepcroa eatlocd lemymtadiei iasltd ot eth noratuicbif of eht ncommo idtorac rareyt wduol eenss a hhgi rssrepue nda eeisrnac irthe anfertfe snagli vai 9NC.

sTih esceduR eht tyhsseitcapm nda ricasnese the ihtapesmyrcspaat iav 10NC (ua)svg.

uThs, enrdicug eht taher !aetr

usmleuser007  correction: meant to say umbilical arteries (2 of them from the fetal heart to the placenta) +

 +0  (nbme23#1)
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hTe ontaailgets acs is crlahsipe in ,ashep adn yuulsal toealdc ni hte pperu arpt fo the ufnsud fo eht usteru. By rtipaomxeypla 9 sewek of agiatnoelts ega, eht cnmtioia sac sha peeaxndd to cpuyoc hte amrioytj of eht umloev of hte stagtianloe cs,a ylutaenvel dgieaxpnn to ueedrc het rebxeioyrmantc omcloe to a tinh early tbwneee het ioannm aemnrbme nda hte .oemermds yB ten,h hte aoeganisltt csa si lulyasu mpisly dallec eth "ctainmio ".csa

tDrielDe npvmougen emgeesyi,nrbos eht nymrebcaxtiore mlceoo r(o onorccihi yvt)cai htta itceuttssno eht losaetaingt cas si a nopitor fo het enucpctos igioctnsns of a tivayc eenwebt 'esrsHeu nmrebmea nad the hpoTo.rtbals

inugrD mrnfioato of eht rmpieivti yklo csa, emso fo the gtriigman phblstoay clsle tntedeariffie tino yhlecmemnas eslcl ahtt ilfl teh pesac wteeebn u'seHser arebmnem nda teh ,sblTrpoohat ifgornm the etiarnrecxyomb seem.rdom As otelpmedevn p,erresssog lsmal cnualea engbi ot mofr ihintw eth crintraxmeboey emmredso hhwci gelearn ot cmbeoe teh ryrebomixacent lcme.oo

Teh naeioyremctrbx coemlo vddsiei hte iceeroytamxnrb rmodesem tnoi wot ayl:esr nrbymeeocxtair nilnupeochapsclr ,esmemrod hcwhi lise ndajeatc to u'rssHee eberanmm dornua het sietuod of teh ipitimrve kyol sca, nda mcteynxoriaerb tlmpcasreuioo sm,oremde hichw lsie dcatneaj ot the rttpoyolobsathc rleya of eht m.oreby

heT crhioiocn tiyvac si enceodsl yb het ionirhcoc pela,t wihhc si epcsmood of na nrine aeyrl of aeumstpoloicr morsemde nda na erout elary of pbosrohttal lle.cs

IWKI---


 +3  (nbme23#37)
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MNV gto ti.

tsJu eYFt :Ih CI was tsetad ot eb rofm 111160- hwti 59% and emna fo ,o3 1.S1 no erheti ehetr ear wot DS no ereiht isdse of 311 (teh a)men taht eivg the 5%.9

1=-16311 3 htwini DS2 bovae teh anem 0 131-1=1 3 htniwi 2SD boelw hte nema

3 dvideid yb the 2 DS = .15 erp DS.

to tge morf 5%9 to %99 you hvae ot ocraeproitn oen omre DS (3 S)D on eheitr siesd fo teh maen (13)1

rfhToe;eer ta 9%9 CI 011=1-5. 501.8 IC 5.1=116+ 175.1

donuR tehse pu dan ouy get 88111-0

tyrionwill  95%CI = M ± Z(SE) instead of SD 116-113 = 3 within 2SE, not 2SD SE = SD/extract the square root of n = SD/2 and SD = 2SE +
tyrionwill  Sorry I made a mistake, neglect the abobe +
tyrionwill  if you use Mean ± 2SD = 95%CI to know SD, then use Mean ± 3SD to only know 99.7%CI, a bit larger than 99%CI +

 +0  (nbme23#45)
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rictAo tlciioasD ers urPse

  • gihH RPT = hghi DP
  • ihgH HR = hgih DP
  • hiHg SV = ighh DP

rictAo icltoysS sur sreeP

  • ghHi tictnialyCrot = hghi PS
  • ghiH VS = ihhg PS
  • oLw inecpCamlo = hhig SP


 -3  (nbme23#45)
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.1 Acroit oasciiDlt eesrsPru 1. iHhg PTR = hgih DP 2. gihH RH = hhig DP .3 Hhig SV = hgih PD .2 roitAc Scsoytli Prssereu 1. higH Criottcanilyt = high PS .2 hiHg SV = hghi PS .3 owL pcmnaCleoi = ghhi PS
yex  https://cvphysiology.com/Microcirculation/M012 This helps somehow, the first part about capillary pressure. +
usmlelol  that's the exp part:: The average capillary hydrostatic pressure is determined by arterial and venous pressures (PA and PV), and by the ratio of post-to-precapillary resistances (RV/RA). An increase in either arterial or venous pressure will increase capillary pressure; however, a given change in PA is only about one-fifth as effective in changing PC as the same absolute change in PV. Because venous resistance is relatively low, changes in PV are readily transmitted back to the capillary, and conversely, because arterial resistance is relatively high, changes in PA are poorly transmitted downstream to the capillary. +

 +3  (nbme23#42)
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kLie ayn fo eht DP,OC het eitntap has a flitdufci item hnilxgae het srnedpii air ut(hs sti allcde na csteivoutrb edesis)a

PCDO erlstsu ni FCV dea,erecs VFEVF1C/ otair asd,ceree FCR inserca,e adn pkee axptoreiy olwf e.cedreas

A umrot ro nya orteh ecjbot taht duwlo pcemross no or onarwr tseeh the ira awy tacrt wulod nspetre as a CDP.O

nnIiahlg and exlgainh wludo eb ditelim



 -6  (nbme23#38)
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So sa a nicaishyp epr isth siqneotu you will go fo smoe rg'ihsbnoe sodrw dna ont normicf fi eth taeintp ahs an ancvdeda vdet..iirc.e emess liek teh cod nda eht norgibeh rae in emso dkni of a dael here ....


 -1  (nbme23#33)
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PPI escd-feti:sfe + sarceedni sikr ofr .C ffid + drnIcaees ikrs rfo prse nificteosn + nca esuca eyhpinsmgaoa + easedrec rasinpobot of 2,a(C+ +g,M2 m;&pa )irno + arcindese ksir fo soetotiocpro ihp rrsfucate dt(/ wlo rmuse )aucmicl

imnotarobotbut  That's not the right answer tho, the answer is the binding of PGE to it's receptor +
tinydoc  Can someone explain to me why the PPi answer is wrong if it increases the risk of C Dif wouldnt that also cause severe diarrhea. PPIs make a lot more sense to be given to this patient in the first place. +1
maxillarythirdmolar  Keep it simple, stupid. +1
roaaaj  @tinydoc You are correct about PPI increasing the risk of C. diff, but there was no history of antibiotic use. +

 -1  (nbme22#41)
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hTsi toeqisun sha noitgnh ot do htiw rpaturemeet (hte eetnitgv teod'sn sradeds eht earuertpemt of the tewra - os d'not seua)ms

Tshi si owh uyo tge hte awsnre:

)1 Bieng ni taec-uspoer or ni a sgiiwmnm oopl pu to teh eknc lwi:l

.a ecearIssn tnlreCa doobl lvemuo (oerm lodob etsurrn ot the thirg sedi of heatr = dariecens rlo)adpe

.b secrsInea APN = scanedire ildonati of vrstneelci ~ aotrspcymnoe mesimnach ot dercue oumelv odorleva

.c rcsdeaeDe HAD apm&; osmnsdtaRn-eiyl-e = doyb si ni taets of vlueom roeadlvo p&m;a esned ot rcedeu ssitecmy oeuvlm

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +
d10s  ANP is released from atrial stretch not ventricle. +

 +1  (nbme22#45)
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hsTi oerm eilylk ot eb dcrsietiu hetrra ahtn vtisealax bc/

teh lab suytd swhso a nrale ionctuyfnds (NBU ;&pma eierntnaiC rae del)eteav

ostM lkleiy teh itapent desbau lopo i;udietrcs soal nowks ot aucse ctnianrotoc aldksiaol, anlgo ihtw alrne pslmreob usch sa arsltttieini thnseripi

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. +11
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. +

 +6  (nbme22#34)
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)1 cSlueparifi )ef-dt(rgisree = irmiEsedp ~ pestnsre sa erd s ntikoiuthw lrbsetsi

)2 iireaSfclup rlipata ishcneskt -(decesenre)dgo = xtEsend otin fsrucipalei )myp( pradrilasiel ~ ssteePnr ihtw drseens hwti  aerltrsiebcl pa;&m calth nsewhbi esepursr

)3 eDep tparali knhsetsic do)een(regsec-d = sEnxdte itno edep ()telcruiar sdmrei ~ penterss sa eoylwl ro iwteh inks ihwt less icbg.halnn yMa be ineg.sritlb

)4 lluF eshktncis terr(ehd-g)edi = dstnxeE hghtuor einrte diersm ~ nrseepst sa sfift nda wwnbtroh/ie n.isk No nglcanib.h

)5 retudFrgeheo- = xnEedts ohhrtug erinet nsik, dna noit yignenldru a,tf lemucs nad nebo ~ neresstp as cklab sk;in erahcdr re waihcths

endochondral1  what is rhus dermis? +4
endochondral1  nvm its urshiol +
btl_nyc  Allergic contact dermatitis because of contact with poison ivy. +
abhishek021196  Urushiol-induced contact dermatitis (also called Toxicodendron dermatitis or Rhus dermatitis is a type of allergic contact dermatitis caused by the oil urushiol found in various plants, most notably species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. +2

 +0  (nbme22#29)
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nincueostIpstsu si alryeegln eadsuc by a clokageb in hte IG tacrt cudase yb a uom,rt yplo,p etruiumvid,lc ro jsut miimotliby at tpra fo eht ttcr.a

)1 My hutotgh swa that teh natptie dah a Mklece ecuuvilridm t yes it hapenps in 2 tfee ofmr the iceaoecll ;levva but ttah si ni aubto 2% of eht pouipntlao

hpsbwz  Meckel diverticulum itself occurs in 2% of the population. Also it would present much sooner rather than in a 28 year old man. +
osler_weber_rendu  Meckels is an incidental finding in 98% patients. (only 2% symptomatic) It is a well known lead point for intussusception +1

 +6  (nbme22#21)
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)1 KPDDA = lytyscsnipo 2PC()

)2 PRKDA =  osycpintclfbundrioty/i FC)(P -- asrilim ot slyytpsncio

PFC npertoi is uofdn no teh myrpair ciali fo elipheait lescl fo ccaitlro dan dlraeulym incolgltce sdtcu and tehynosilccgao of ebil stduc

PFC rnietsatc ithw KPADD netopri P2C nda yma osla piptaaricet in isht rilugtnoae whypaat of eth nerschonmyoesa cuinfton fo hte mriprya lic,ai cmlauic s,iiglgnna adn C.PP


 -2  (nbme22#20)
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aeuCss

1) Aacruasvl rsesncoi ccrsou wehn dbolo olfw to a beon is untdireertp ro dueerd.c edReudc oobdl puypsl nac eb esaduc :by

)2 nJito ro beno martua. nA nryuji, hucs sa a toiladcdes jno,it mthgi eagamd ebnayr oldob sev.sles reacnC etnsttmrea oinvnlivg oritadani aosl nac eweank bnoe dan mrah obdol .seelsvs

)3 attyF iostpsde in obodl vses.les The aft s()idipl cna kclbo llsam blodo levss,se rgdeincu eth lobod lwof atht defes eb.nos

4) rCeanti sa.sdseei eaicdMl inc,itdoons ushc as iseckl elcl aeinam dna h'scGaure e,isesad aols can eascu mieddshini ooldb ofwl ot .oebn

Fro btoua 25 prtcnee of peleop twih crslaaauv osiren,cs eth casue of irtuprdeent blood olwf is .nuownnk


 +1  (nbme22#20)
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A)( kisR stfacro ofr pgilnvoede uaaslrcva ssnrieoc ilcneud:

)1 murTaa = jIsen,ri u hsuc as ihp nsoiaiotlcd ro uatrcf,re acn edmaag benray obold esselsv dan eceurd oodlb lowf ot seobn.

)2 drtieSo u=e s sUe fo hios-gdhe ctdroci,oisrstoe usch as ni,dnorepse si a cmoonm seuac of rslavucaa nr.ssocei Teh asnore is nowkn,un but eno heoptyihss is ahtt tocoeodticssrri anc eeanrcis lpdii elvesl ni uoyr dlboo, uindcgre doolb lw.fo

)3 secEsexvi aohlclo eus = nsnuiCgom saevler cholaiclo nidrks a dya rof eslevar seary saol cna acesu ayftt spitoeds ot orfm in ouyr doblo evsl.sse

4) htanohBesiospp use = rotn-Lgem sue fo mdsniaicoet ot ncsieear nobe itendys itghm broutietcn to dlgivneope rtosssecoioen fo hte .waj iThs rare ptlioccoamni has rcrdcueo ni oems eoplep ttderae itwh hghi edsos of these stncoimiade for ecsrac,n ushc as lipmetul emymloa adn attaictems tsarbe .eccanr

)5 rtneiaC cdialme tmsarteent = aRadintoi phaytre ofr cecrna can enawke .obne rangO l,ttraopinatsann elelcpisay keinyd tnl,astnapr sloa si destoascia ihwt vrcsualaa erssicn.o

dc(iMel Ba) oicnidsnot seiaocstad hwit alvarcusa orneissc ei:ucdnl

busGstiieDtcece hnaarPa'erat si VDSieesISmcsti aA/sy HdeI psulu syckseSeltuirohetma elcl maaeni


 +2  (nbme22#11)
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In ssace fo ihcdl or ulatd usabe

)1 if trehe si ecarl edvieecn scuh sa fi a hldci tsaets atht pnsetar upnhis yb gtihni,t dlihc is woghsin arfe fo pnater ---- alcl dchil ioectnptor ihrtg waay ( 'dtno ndee ot iwat dan ak)s

)2 smea nhgit sego orf the uadtl tbu allc hte datul tnrteoipoc ecrisves

osler_weber_rendu  Does anyone not remember Dr Daugherty's lessons which said domestic violence on adults is NOT necessary to report? Instead help them find an escape route in case of an emergency and encourage them to report it themselves. +
makinallkindzofgainz  @osler_weber_rendu: Domestic violence is not the same thing as dependent adult abuse, such as a special needs adult or an elderly adult (basically anyone who depends on others for care). What you said applies IF the adult is living independently and fully capable to make their own decisions. +6

 +0  (nbme22#36)
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ehT srpceso fo fdmieron neoctsn ucrsco whne auconmmcioitn tbenewe a tiapnte nad incspiayh tlsesru in the ia’sptent itiazonrhoatu or agrenteem ot donuegr a cpeiifcs ecmaldi inn.rotietven nI kseigen a staeipnt’ meiodrfn soetncn (or het ctsonne of teh asptnite’ trragueso if eth tentpia slkac snckeoamidigni- ctaciapy or diecelns to cirapteiatp ni aknimg ceio,sdins) nypsihcias :ohusdl

(a) sesAss eth ’eiattpsn yaitlbi to ndsdunerta ntleeavr dcmelia taiiormnnof dna hte oiicnipmltsa of eatnmtret tvatsrielane adn to meak na pidneend,etn nlayrvtuo .nscdieio

(b) tsreePn avleetnr riiootannfm racuycealt and eesn,iystilv in kinpege tihw eth tn’piesta efpreneecsr rfo crnivgeei mldeica troinn.famio heT ichspyain sulodh cdnileu itfaniornom botua:

Teh siganosid enhw( Tkne )nwoh utrnae nda ropepsu fo edmecrnemod eivnTsnrihtn teoe e,rsnudb ,krssi and epxedtec bfetiens of lal soop,itn ucndnliig rifonogg tct etm)ran(e onetcmDu the rmdfeion stcnone entiosarnvco adn het t’ipstnea (or ausors’t)reg sincioed in teh adliecm ecrrdo in emos n.eranm ehWn eth rtgiturneaeoa/stp ahs pdirevdo eisfcpci tnitrwe s,ecnotn eht toennsc rmfo odhusl eb dnlcduie ni eth rdo.ecr

nI egiesm,cerne hnew a dioncesi tsmu eb edma tuel,grny het tinteap is ton aleb to aietirpcatp ni ciodsnei ,ikgman dan eth tts’pnaie ogsrrtuae is otn al,iveaabl iycapsihns yam itaetiin mttteenar wtiutho iprro fdreimon ets.nnco In suhc iattuoisn,s the hcipynias luhsod mnoirf teh etgtsaaoptirn/uer at eht ertaslie orpnttypiuo adn ionbta csneton orf gnonogi rettametn in iekgepn htiw ehste ei.udgniels

MAA Pscliniepr fo dMaicle shctE:i ,I I,I V, IIVI


 +1  (nbme22#32)
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raenlCt esurnov tysesm oeenrginaret

neUikl aehlirprpe urevons sesmyt nju,riy uirjny to eth etcarln serouvn tmssye is ton ofwdoell by ntexseiev eateoegnrri.n tI is etdiilm yb het yohiintbri fnuleseinc of eth gllia adn axerrlleltauc nrem.tnvieon heT h,ileots s-noimpnveisre htwgro onmnvintere ,si in rat,p aeredtc yb het iarimgnto of ioleentadcsi-syam iihrios,btn ,ttacysesor irotocdo,ydelnegs odedtnloiyegrco uesor,crrsp dan il.cgimoar hTe trnnneeomvi iihnwt eth SCN, ysaeplilce nlglofoiw atam,ur etracnstouc eht iarper fo nmyile nda rn.eouns tGhowr rfotasc are tno xrseepeds or sdeer-x;spere fro acnst,nie eth luetrraallcex iamxrt is cngikal nims.ialn lGali scsar dprlyia ,ormf nad eht glia calyutal eopudcr acortfs htat iibhtin nemintlaryoie nad xnoa ;arpier orf nenatcsi, ONGO and 5.-hN3TeI asxno mtseevlhes saol lseo eht anptotiel rof otwghr ithw ,gea due ot a sredaeec in G34AP r,iseesnxop mnoga thosr.e

usmleuser007  (wiki) +

 +0  (nbme22#32)
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ueoNteieornrrneag ni eht piheprlera uevonrs msyset (NS)P uoccrs to a ncaignsiitf [er].6d[ee5g] Areft an ynjriu ot eht o,anx elpirrahep nsrnueo vtiaatec a etavriy fo agngliins tswpaahy hhicw rutn on twrohpro-g n,gsee ndeagli ot erotiranmfo of a naiofcutnl woghrt once nad t.ererenognai Teh rohtgw fo sheet anxso is oals eedrgnov by cimchoettca tafrsoc cestreed frmo acnShwn cll.se uynrjI to the aelphrprei vrounse msytse liediymaemt ilctsie the iotgrnaim fo ,agceophsty ahnnwSc e,clls nda grmechsaoap to the sionle eist ni rdoer to creal yaaw redibs cush sa mgddaea utessi ihhwc is iobhrntiiy to tegeeirao.nrn eWnh a vnree aonx is seer,edv eth edn slitl etdatcha to eth lcle doby is leadleb eht xiraompl tengm,es hilwe eth roeht ned is claled eht idlats mts.ngee trfAe nrujyi, teh rilopxma edn sellsw adn eecixesnper mose rorgerdate ndeeaeng,roti but oenc eth sdrbei si lcardee, it bnesig ot tpsour axnos dan hte eenesrcp of rhtwgo socne acn eb edtetdc.e Teh ixlporma noxas rae beal to orregw as nogl as teh lcel bdoy si ctt,ina and etyh aehv adme tocactn hwit het Snchnwa llesc in eht ieurlndenao nhnecla ro eubt. aHmun naox rtghow tarse acn eahcr 2 ydm/ma in lamls vsreen dna 5 amd/ym ni aglre .4vsr]ene[ hTe idaslt e,etmgsn ewehovr, speeenexrci enlaWlrai nrteeoedgnia hniitw ruhso fo hte urjny;i eth sxano and nmelyi gearene,tde tbu the dunerunoemi meir.san nI hte leart getsas fo gaeeinortner teh mnaiingre lnedrnaiuoe tueb rtciesd noxa orghtw kacb ot the teccrro s.etagtr irgDnu iealWnlra ndgrntee,eoia wanhnSc sclel gowr ni rdrdoee nosclmu ogaln hte ldnraeiuoen b,uet gitreanc a bdan fo rgBnüen b)(oB ttha rcsoeptt adn pssreveer het niunedleora nech.lna losA, emcshrpgaoa and nnShawc llsec eselera rucoehtrpoin fostrca ttah canenhe go-.terrwh

ikw(i)

brotherimodu  That describes Schwann cells' involvement with neuroregeneration, but I don't see how it answers the question "Which cell is blocking reinnervation" +

 +4  (nbme22#2)
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Two arojm acemihsnms of tocnia hvea nbee eudtlaed:ci

)1 uFisetlyonc is lrlntungiyafa tcvedoren otin teh ttysacoitc oaulruiorclf hciwh oernugdse htfreur sspet fo tvctaiaoni adn nylilfa ttcnisera sa roldhupiefopahtesnorti5iur- twih ANR bihsnieytsos tush iutindbsrg het ndbluigi fo teniarc nssetaile ons.ietpr

2) tlynsicoueF slao nosedergu rcsoeoinvn tnoi foiotudap5ynlmdrxeoh-uohsnrpieeoo cwhih ihstibni glaunf AND yntsih.sse

3) yymlaiTdhet tseehyasnt is na myzene ahtt slaacztye eth ivnroeoncs fo inieeroxddyu menoaohptshop )Ud(PM ot hxdndeoeimyyti pohhnasotpemo P)(d.MT

yendimiTh si oen of hte tiducelsoen in .NDA

iWht ioitbinhin fo T,S an nablaemci of tdcludoxoesyeeni dna adsrceine esllve fo dPUM sie.ar Both usaec DNA m.adgae

(K)WII

link981  Just look at page 36 of FA 2018 and memorize that shitty diagram o De novo pyrimidine and purine synthesis they ask so much about. No need for scientific explanations for this one unless you like to waste time. +20

 +8  (nbme22#23)
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hrrAtdopo fcenoiistn

.a mspyTnoara zcriu = dvrideui bug

b. sarymopaonT ciuber = tsesTe fyl

c. lraMaai = lAenhpose tiouqoms

d. avlFiursiv uorGp tWe(s lNie uVisr, e)enugD = Asdee stuqimoo

.e foriceaaiMril = kblac fyl

.f Lsaianimhe sirianselizb = asnd fyl

.g iaorlBer m;pa& beaBias dxosI=e kitc

.h seRiikbac sikrbecii m;pa& lclrsanFeai siarlesntu = mDcnreoerta ckit

.i aeibRski pairzkoeiw = ilce

.j oaL alo fAica(nr eey w)omr = dere lfy

.k ehrWeraicu obictfanr = uoteqoissm

zoek816  West Nile Virus = Culex +1

 -2  (nbme22#23)
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16. rpodhorAt ntfnoesiic a. nmsTorpaay rczui = rediudiv gbu .b snyoTmropaa ecubri = setTse y lf c. iaaMrla = sheeonlAp qmso tuoi d. uviFrvaisl Gopru (seWt eilN siVur, )enDueg = dAese q tmisoou .e iieaaflicrMro = ablck lyf .f iiaenmhsLa iineblrsszai = ndas lfy g. lrroieaB a;&pm aeBsaib o=Isdxe tcik .h bskeaciiR eiicibkrs ∓a aacrislFnle rneiasustl = Dtearmrncoe tcki .i ekisiabR eiwizrakpo = icle j. aLo loa nci(fraA eey mw)ro = reed fyl k. riWuheearc tanrbcfoi = siutsem oqo


 +4  (nbme22#15)
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Pre ahamPo:t

tMos comnom in poaoplamsuetsn :mwnoe

)1 bsicrifcoyt gseahc,n tanartcduli ppmoiaall, rnmbadFoiaeo

oerM yeklil in aoesulmspanopt :e)mw1no lholydesp orutm kie(nfordlioebmaa- ))ru 2omt reatsB esarccn csdenirae kisr dt/ )1 diserncea e,ag niuatord of engresto thruughoto efil ryl(ea c,erhnmea ltae m,nuseapoe beosit)y 2) plicyaAt phspya aeirl )3 tsiFr erdgee eviatsrle

stQnieuo tessta npsserte it :aa)s 2cm firm, dntenonre smbs)a no ailxalyr enyppatldhyamoh ro inpelp dhgc)srieac exertmyl odredsneai assm htiw areirglru uantr cldiessrmeg rliarreug ciminocrfsctoliacia

os tahw anc ti e1) b: DISC = odse ton lasluyu cropued smsa

2) moeodC tyep = ihhg- radge lescl thwi neossrci pam;& iprsdtcyho failaocnistcic ta nectre of dctu

)3 getaP isaseDe = vseliovn het knis fo eht enippl gunlydinr(e ccnamaori)

4) CID = )a osmfr -euctidlk trtsecsruu t0&8(g;% fo scsa )e b) sams cedtdete yb ihlascyp nioneiamatx k(hc) ec c) llsuauy c1m or eretarg ce )ch(k d) tpsoeiDslmca mtasro = ncetvcoien iuetss nowgrgi hwit omtur (spsotrpu )otrmu ~~~ (ccekh -- rgiualerr as)nig rm )e ruldyeMla oCamenirc C)I(D = smiimc ebmniodarofa

5) LICS pam&; CIL = DO TNO dcrouep oacicicanlisft ro amss )a CIL - cslel aveh n"il-ieslefg trtpaen" ntihk fo a eaddbe celnckae dan you cut ti in iedlmd (lcak )rniaeEc-hd

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +2

 +10  (nbme22#16)
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tehMor is hg-eRn ;gt--& hes wlil egnereta aniHte1is)odR-b setuf feceafdt yb Rti-hAn if it is ihtsoRi-2p )ve even fi Reivi-POso-ht si evni,g hnet lltis oet'srmh s-tioahbdnRie wlil ttacka dunfsarset obold edu to its elslc nicingaotn 3R) h+ oefhr,etre tinO-h-vgeeRa si etsb

makinallkindzofgainz  you're not wrong, but I think it's better to have put O-negative because that's the preferred type of RBC for transfusion unless you've type and crossed your patient +
mtkilimanjaro  I think fetus is O+ but if you give them that the RBCs will still be destroyed. You want to give O- as it wont get destroyed and wont affect the fetus in any way. Similar mechanism to giving platelets to someone with TTP, HUS, etc. they just get destroyed so its useless +
tylerwill33  In utero, should give O- to avoid mom attacking again. After birth, O+ probably better. +

 -10  (nbme22#48)
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:toNe teh oiensquts ttsdae reorry"tpisa ur"tsb iggsuntesg na RUT enin.iftco

)1 ihst suerl tuo ntagyhin utb sryrartiepo cefoiinnt (non pre :otcninfie .E icl,o E. )cuiemfa

)2 GP6D iyieefndcc rmoe pssiecetlub to aectalsa petviosi omgsnrsai -- isth ersul uto lla( tsrpe agnms)riso

)3 fLet whit H. nzufeeilna a;p&m Shatp.r suaeru BHOT( are cslaaaet e)ipsitov

4) Etdelnaupcas nsogrami rea tmso cgroiecnnn newh rehet is sp.aeialn

imnotarobotbut  Respiratory burst has nothing to do with a respiratory infection. It describes the process of phagocytosing a bacteria and using NADPH oxidase/ROS to lyse it +5
belleng  Aspergillus is still in the running, it is catalase positive as well...but not a choice +

 +0  (nbme22#7)
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eeoomnS rcea ot inpaelx why im[et to -tteystsaeda ]ttnoincrnoeac is ont eht terrcco re?answ

omerta  In pharmacokinetics, steady state refers to the situation where the overall intake of a drug is fairly in dynamic equilibrium with its elimination. In practice, it is generally considered that steady state is reached when a time of 4 to 5 times the half-life for a drug after regular dosing is started. The time to reach steady state is defined by the elimination half-life of the drug. So in a patient with renal dysfunction, the plasma half-life is going to be prolonged and the time to reach steady state will increase proportionally. +11
belleng  loading dose is independent of the concentration of the drug in the plasma and the dose frequency...this is why you give a patient who is seizing a huge dose of anti-seizure meds in order to reach a theraputic range on the first dose despite the high risk of toxicity and side effects...primary objective when seizing is stoping the seizure so you want to increase the dose response curve with a massive load +
belleng  loading dose is independent of DOSE (should have said dose, not concentration in plasma) & FREQUENCY +

 -1  (nbme22#9)
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citinnA is a aefrimiomlcnt onit.rep tAαinin-c si nasyersce orf teh tcaaettmhn fo cinat eifsntalm to eht neZsi-l ni elaklset lscuem ,s1]lcl[e dna to the ednes iosbde in tosohm emsclu s2ell[]c. hTe nnotcfailu toepnri si an -ltelripnaaal demi,r hciwh osrlcsin-ks teh inht stnlfmeia ni caenadtj aesorcmes,r and fothreeer torsneaicdo tnnaoctocisr wbenete coesraserm in eth tlnaorizho .asxi

The crersni-nmocoa αtani,nc-si deconde by 1CATN nad AC,N4T rea ieydlw .prsedxsee A2TNC spseoxiner is nduof ni othb dcariac dan ektlsela ecm,sul eewsrha TAN3C is idltemi ot teh ela.ttr hotB sned of eth spd-herdoa ncαt-iina dmrie actnoin itniaci-ngbdn ndsaim.o

ntMtsoaiu ni NACT4 nca ecsua het enkyid eidssea laofc lengasetm ooscorlllmeersgisu S.G(FS)

K)(IWI


 +22  (nbme22#45)
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my tlsi fo iedlnps ypte lslec nad insconit:do

  • a. N1-F
  • b. F-N2 ~ cawhSnonam iA(tnno A) = ouauCnets oiboarmfnreu ~ ghih tlcyulralei w(/ iginsadpla trneptas htiw rtngeisirsenp cnrl-erefeua senzo lbescanp;deyVo&lcar desboi
  • c. oLiyomeam u(teusr p;am& aepo)hgsus
  • .d omslMoiteeah ei(otnytcakr tiepio)sv
  • .e atspicanlA hryoTdi ccaenr hscbiia(p am&p; naogl whit antgi cls)el
  • .f ulMrdayle hyodirT necacr ca(n loas vaeh npogoayll lcles)
  • .g rarPymi acaidrc ormangsciaoa natmnlgia( avaluscr dpilnes cl)sle
  • h. eatsoOcamors bone( rcan)ce mpo(hlcreipo slc)le
  • i. Maoiinnmeg
  • j. ass'ipoK camoraS VHH)(-8 = i-kSellti sarulcav ssacpe itwh lpump he-pienldsspad sotalrm lslce
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1
mcl  I love this and I love you +4
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +

 +0  (nbme22#22)
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1) nlAyisas fo neacvria si a oerpdeurc dues ofr rpngicaom pemasl asnem ot ese fi erteh si ctiunefsif dineeevc to nerif ttha eht mnaes of het rredcoosngnpi tiopoulnap ursitsodibtin losa eidfr.f

2) Where ttest- rpemcoa ynlo otw urostdbs,iinit sylanias of necvaria si ealb to pcremao .mnya • aWht deos eth -eyanow tapr emn?a tI si one deentndpe vibealar (aaswly snoconit)uu nad telxcya oen tdpeindeenn arvbiael ylaw(sa g.coclreaati) A lnsige edineetpnnd abivrela cna ehav ynam eesvll.


 +0  (nbme22#22)
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wssast/wt/tinh.ee:ae/saorrwathdd.d/prla--twstvnanae


 +23  (nbme22#22)
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uJst me:eermbr

)1 -ttTes (eat orf )otw = ooslk ta eht mean sevual of 2 ogusrp

)2 AONVA ya(nislsa fo cea)rianv ~ lkei s-ettt but = olsko ta naem avlsue of 3 or ermo rspgou

)3 uaehC-riqs = oloks at eht (%) or sonioptorrp tbwneee 2 ro erom ourps.g

s,o ujst olko ofr woh many osgrup bigen dadredsse dna waht vaselu yeth ear nugis (% or naes)m


 +11  (nbme22#17)
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)1 BEV = Buttrki ayml,opmh ikngdHo omympa,hl rlaoaaenygsnhp nari,cmoac °1 SCN apmmolyh n(i noommdesmoirpcuim titap)nse

2) VBH m&pa; CHV = uealplHoerlcta conaircam

VH8-H)3 = iasKop orascma

)4 HVP= Cleiarcv and elnnealap/i nroaamicc st(epy 6,1 18), head nad nekc encacr

)5 .H loyrip = cstariG ccraamendaooin nad MLAT opmamyhl

)6 H1TLV- = dluAt -clleT yeamopeamull/ihkm

)7 irLev kuelf linsco(rohC )neissnis = ohmngCniariaocoalc

8) tssoohSimca aomihtumaeb = arBeddl cnraec ms(ouqaus cl)el

some0217710  Aren’t both H.pylori and EBV associated with gastric lymphoma? +3
baja_blast  You're right that EBV is associated with gastric lymphomas, but this is specifically asking about marginal zone lymphoma (or MALToma) which is associated with H. Pylori, not EBV. https://www.ncbi.nlm.nih.gov/pubmed/11552717 +1

 +0  (nbme22#35)
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1) aebll D LDV(L &L-;-gItD &g;t-- LDL) = ihygnnat ttha eeiacsdrn LLP = berFasti whchi sue ahaPpPRl-A xR() are good ta rngceudi V]L[DL; rhfee,erto ssel LDLV snmae reom I.DL

2) LVLD g;-t-& ytaft dica tndixoaio = ignsu asft GAs)T( orf ngreye r npootudci eHre A-aPPmaRgm spaly a ero=l wchhi aer liieoohzsinnTaeddi a(sol llecda g)atlieznso aer a aslcs fo isecneidm taht yma be sdeu ofr het ttetearnm of pyte 2 asedbite. Thye rea laos dogo at gunicred usrem TAsG

eNot VDLL aer yrev ichr in TAsG


 +9  (nbme22#31)
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Jsut oent wyh horet wearssn era ton trcco:re

  1. obis;ynEposhg&np an cdneaersi enrsoeanc of civeo soduns ahder hnew ultctnauagis teh lusng, etnfo desuca yb nglu onaisilotoncd adn isirsobf.

    • a. tI is due to hcenneda ismsnrasiont of unhe-ihyfqgrce ounsd sacsro fu,lid hsuc sa in lbomaarn ulng esutsi, iwth lwreo qisrcneefue ieerltfd otu.
  2. srepdheWi ere;lpsou&pyistfobqcerrn to an reedincsa lendsuso nfephboisdr&enpsnp;togs&inw;b dnguri tuntliasaocu ihtw a tetpeoosshc no eht lgnu eifsdl on a pnasteit’ tor.so

    • .a aullysU peonsk ndossu of lsiborwdp;&bpshn&;mesvaeuenp yb hte eanptit loduw ont eb aehdr by eht ilancnici aalsgunutitc a gunl ifdel thwi a ctsht.oposee

    • .b orvH,wee in earas of het nlug hewre eehtr bnp;u&sslngi ocndanoi,istlo ehste espwhried onskep snusod yb eht tptniea cus(h as ysiagn tynei’nne-i)‘n wlil eb carelyl rhaed rohghut eht pooctsts.hee

    • .c ishT naiscere ni dnous iextss acueebs oudsn vrtlase srftae dan utsh iwht wroel lsso fo ietysnitn hhorgut ldiiuq ro doisl “iuldf( ”ssam ro l“soid sams,” ,peervteiclys in het )lgun essruv ougssea a(ri ni eht lg)un d.maie

    • .d Wpedehsri rltuocpyieoq si a illccnai estt pytallyic oefpemdrr ugndir a mdailce ilsychpa oniaaimtexn to ueavalet rof eht erespnce npgusf;&blno o,oisoncntilad hihwc lcodu be ecausd by cnreac (iolsd ss)ma ro oimpnnuea di(lfu .sa)ms

titanesxvi  why not wheezing? +
miriamp3  @titanesxvi because the dx is CHF +
leaf_house  I get why crackles are more likely in CHF, but wouldn't it also cause whispered pectoriloquy, if fluid allows better transmission of sound? +

 +7  (nbme21#2)
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)1 yreV omainprtt ot tneo atth Tsycha-aS esdesai hsa more ieetsivsn rslteat ()oorm felxre ni osnetean ihwt nrceeaisd adeh nc.iefreuerccm

)2 Fybar esdesai = tned to vhae idiuul-aavos tcdfsee w/o rlvie nmvineetlvo

3) nkmaNn-iciep aeisdes = minaae p;&ma yaotnipho whit arixfeael


 +1  (nbme21#4)
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erenSi ooshplyhnptorai illw creedu uss'ilnni c.afetfs tI satc no hte teriosyn na.esik


 +6  (nbme21#17)
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iednoCefnc eavlrnti cisseenra hwit asddeerec mpsale .zsei

usmleuser007  would require a a large sample size to see if there is a true difference +
claptain  This question is bogus. CI does not always increase with decreased sample size or vice versa. Four readings with small variation would give a narrower CI than 10 readings with greater variation. The only thing you can be certain about by adding more samples is that the CI will most likely change, but which direction is uncertain. +7
bartolomoose  Recall the formula for 95%ci Mean +/- 1.96* (SD/sqrt(samplesize)) +1
the_enigma28  @claptain The point you made is relevant in studies involving random data. But in case of this question, the data being collected is in fact the diastolic BP. We take several readings of BP to rule out white-coat hypertension and have as accurate reading as possible. In this case, taking more readings will actually narrow down the confidence interval. The readings here represent physiological parameter, which wouldn't vary veryyyy widely in an individual. +
lowyield  @claptain i was thinking the same thing but ended up choosing the increased because alot of NBME seems to reward the more simplistic answer than the overthinking answer +

 +11  (nbme21#40)
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.1 xeamElp fo ccueanatir ubt hhylgi reepics 
    a. 050 ttineaps eseign a tuaracrpil ootrcd rof a cprrltauia s
ll2neis. pEamxle fo cueraatc utb piris
eemc    .a 10 tstipena dneorgu a insgrnece ta a amll 3
. Both cAercuat adn csieper 
    .a 500 tensptia hgh(i rs)cienpio goudnre a enscginre gi(hh carayucc ~ no asbi or syitsmec 
oer)rr

 +2  (nbme21#7)
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endhaIl elgu is moer ellyik anth olocahl c/b fo ist esae fo csaces ofr a onimr nad vteealri basue teiolntap ni the age rpuog.


 +20  (nbme21#43)
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  1. osaHbs t(mooldise n:tot)ilcg nhtiiW eht rtsfi few semuint fo uji,ynr
    1. istnlap leet eht ldoob igbne ot tckis to hte jrnuedi ti.se
    2. shTi atatceisv hte ,pteasetll nsgucia a efw thsing ot app.enh
    3. hTey nhecga tion na umsprohoa ,aepsh more uibselat orf ngliotct, dna htey erelsea icmlahec lnsasig ot mteorpo tticlgno.
    4. siTh etuslrs ni eht vcttaainio ff rboi,ni cihhw msrof a semh dan tacs sa eug""l to bdin alpestlte to ceha het.ro
    5. hsTi meask ha tttalco  vesers to ulpg teh aebkr in the ooldb el,vses inngnpt/osvwelgrei frthreu 5ge[.[d6]nl]bie

  2. naf:Inmioatlm rgDnui stih phea,s egadamd nda adde celsl rea aledcre ot,u anglo hiwt aibracte dna roteh aopnsghte or rib.eds
    1. ihTs ehppasn gurhtho eth socrpes co,fthgais osoyp wreeh iwhte olbod sellc ea""t eibrsd yb eiufggnln t.i 
    2. tereev-aPtildedl rwhtog frracosaet  elerdeas tnio eth douwn htta caues teh armtgnoii dan ivodnisi of elcsl ndugir eht reptoeiivflar .shpae

  3. rtiniafoPorel horg(tw of new ss):tieu In iths hgndie iinoslaecitonpn,agarel,l inoopaunasg, ossg tee orstuetmain sif,o oialnhtiizeetlpai, dna ndwou oancoittrnc r.cuoc
    1. nI ineniase,osgg cslaurav ehdaleltion cllse mrfo wne dbloo .vssesel
    2. nI isaopfialrb and aguilaontrn sisetu blifbooamrtsfgrwts,or a noi adn mfro a nw,e aneuerrrlol axilslavtocpi )mMCi(t xarE yb trgenexci olcneagl notdia.f cnerinb
    3. yoretnCnulcr, pn-alerieelatohitiiz fo the ipemrdeis ,rucocs in  hplcwiiehhlteai steapcf lleriloer and 'lw'arc topa the dunow bde, vopniigrd orvce orf eth enw tseis.u
    4. nI oudwn canoroiebstrse,d omcy itbraftlsnoeca eht siez fo hte nwudo yb giipgpnr eth dwuon geeds nad roatcgnntci sunig a eihanmsmc tath belemerss htta in tooshm leucms .lscel
    5. hneW hte lelcs' esrlo rea lceos ot mote,lpec nneudede cesll grsnaeusopi t.oopd
  4. oatnraiMtu dnlrmgo:eei() unDgri raaitntoum adn noieedrlgm,

    1. ganolelc is gelnaderi oagln eotinns ns,eli and llecs ttha rea no lroegn edeedn rea rdevemo by moarmpregd elcl a,tdhe oisrotp .psoa

  5. poemapxrAti mesit fo eth rfnitdeef phseas of owdun wnh1tii][gla, 0eh dadef tivsneral rakgnmi nstaliubsta vraointi,a ndpgeined lnyima on owdun zesi adn gnalehi tid,oioncsn but maegi dseo nto dneuicl rjoam tarmeimsinp thta oaicne uscrhc uodsnw.
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +

 +4  (nbme21#36)
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aroadCnsoomcrh = malyin eftfsac the ilaax nklteseo hatn eht plpceanriadu oeeknlst

mEanhcodnor = imnlya ffetcsa teh adshn dan ;efte rea syct lkei


 +1  (nbme21#12)
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aCn seoenom salepe iexlapn wyh 'cnat laholco be teorcrc in shit tgei?snt

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +11
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +5
lovebug  and FA2019 page 538. +

 +5  (nbme21#17)
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eistlsaen nmoiA daisc AA)(

1) stlAdu ieerrqu 9 ()AA = ebla ot mkea egnnira vai uear el)2 ycc lednhCri urereqi 01 (AA) = etyh are lltsi ge l)idpneo3v Wtih PUK srnyieto meosceb leitsnesa in bhto duaslt nad edinlrhc


 +7  (nbme21#24)
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As erp F 1A) ytaft oatinilniftr 2) ularllec glonanobli 3) nauevlte cisosnre

hyperfukus  thanks u saved me time in looking that up :) +
violethall11  Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic . +
mumenrider4ever  FA2020 pg. 391 +

 +8  (nbme21#17)
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.1 "erThe ALH asnf ilwl ytr m
eth"    a. rTeonihne = ehTer 
    .b itHesiid;n i;iengnAr yensLi = HL
A    c. nlayhilenaPne = f
san    d. Vai;lne Iesolue;inc uieecnL = 
liwl    .e hntTpoapyr = 
tyr    f. nniieeotMh = 
hmte
pparalpha  Thanks! Good mnemonic +1
b1ackcoffee  best mnemonic +

 +22  (nbme21#17)
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If oyu ctn'ould rbeermme whhic rewe et;sslniea tnhe ereatnvalit duwlo veah nebe to alzeeri ttha ngiorgw ldcherni edne clesl ot iivd.ed Tihs rsquerie ADN oetinaipcrl and srt.aonatlni Of wchhi eht iuclenc cdia iytmhe si mt.ntoirpa tI rqruesei a hyltem tsrfr.nae

ihsT si wreeh emiohennit mesco .in hinntiMeoe mnoicesb hiwt ATP to fomr ASM a( leythm )nrodo

whossayin  That’s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2

 +4  (nbme21#32)
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allfI eesl a:sifl enot thta terho asenrw ichesco are CODP eystp

dragon3  (except sarcoidosis) +2
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: https://pubs.rsna.org/doi/full/10.1148/rg.306105512) +
lovebug  Restrictive VS Obstructive ! very good point! THX! +
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1

 +0  (nbme21#37)
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berRmeem 1) imeietvtcop isihtionbr ~ slnie rsCso ta )sni e-ytrt2ec oe-vNneciptmito ihonrbtsii ~ no niel sorsc


 +4  (nbme21#9)
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CSN rmheareoH/g ) ge1amda -8142 rHs = rde ounrnes)2 1-3 adys = rnoptilhseu eiqlfuacietv( c)3noessr )i 3-5 = rmoechaapgs )mo (ail4gcir) 12- esekw = tiaeveRc lgsoisi +( aarsucvl er5portlf))oniia mreo atnh 2 eeksw = aGill acsr

onet(: het senoeaihgspt si salimri ot MI and sti rsac ;tronmfiao wehreov, het eitm cersuo ofr CSN si tjsu )raestf

teepot123  fa 19 pg 500 +
icedcoffeeislyfe  FA2020 pg 512 +

 +0  (nbme21#12)
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For C:CR s(A rep R)DOWLU

cStymemir albaetlri lower tiyretexm gtipnit edaem nad utortosu mnobailda snive ear ncengncrio rof nfi enraori anev caav )VIC( ,nucrtbisoto hich,w in the tgitens of a -stlededif alnfk sa,sm gtas ngsureesl cell iCnr(c )CmcoaRa ihtw exsneonit noti hte CVI . CRC sctauocn for g%&;t90 fo lal gncnlseamaii isnraig ni het keindy adn is liyhgh icsaasdeot iwth k .ismngo et Pnsati iwht CCR ycslllaaics have a ridat fo naklf aip,n plapebal smas, dna itaum,rahe oghultha anym niearm timcoasmpayt lnuit eth dsaiese is evC daca.RdnC is a hhglyi valrasuc umrot asa tnivdthe teh ranle ivnne i up to 5%2 of  aessc. VIC ouositbcntr anc rucco due to rallnuiintma nesinoext nda tmroubsh ,ifntraoom trerha tahn sasm fecfet ofmr eht rutom e tis.fl

hTe unsbcttorio can rucoc uytaecl ro allgduyar vore te.im  In rcochni ,secas eaclotlral noeuvs rccoialnuti mya pdlvoee dseab on eth siet of hte .rb nsuocotti Ptnenorim albmadino c lwoleaallratl ivn,es sa ni hsti tteiapn, sgtegsu urtotiocsbn fo teh urppe smgnete fo the IC.V

nor16  high blood pressure, i.e. Hypertension, risk factors for atheroscl., bruit !!! over left abdomen, secondary art. Hypertension. they always want the renal artery stenosis (like vWF in coag. disorders...) +

 +2  (nbme21#12)
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sutJ eilaezrd ahtt nrela lcle ncaocamir i'nts the orcrcte reswna cb/ it enidvda hte uovnes unocltiarci and ton het ralrai.te BP yam nto eb ceedatff sa cuhm. if RCC eerw the sawnre hten thne rhtee ulowd vaeh enbe edmea srteepn dr/ona enlar .NHT

sympathetikey  Also, just thinking out loud, in the case of RCC, it's the kidney tissue that's dysplastic & moving, so technically the renal artery itself isn't dysplastic, right? +
paperbackwriter  @usmleuser007 very good point regarding the venous vs arterial circulation that I neglected to consider! +

 +1  (nbme21#35)
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OC si enridacse htwi )1 ecrsdeead le ao)tfad2r cridnsaee dra l3po)e aIncersde tyircoatcitnl

nA naoietvouesr tusafil etserac na leatartvien eourt for arilta loobd iton eht nosevu ticrcilunoa /ow gnogi apst hte loetrasier the( omraj caues fo T)c.aseuert,s nhsi yb nidgo os teh RPT ataolefdr)( recassdee and the CO is cenirade.s


 +3  (nbme21#46)
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tctmb0pcooaeci/dpdmorsyctoys8ee-i21u-rrp-3otiss/o/1sw.cl:neswspc/oai-sty.c5wshi/msayn/isg1uune

ScmooPsieo struypmc ybepurt nsisg dan mymopsts necludi edtopmnvlee of eth flolonigw obfere ega 8 ni lisgr nda reefob eag 9 ni osy.b

tarsBe thgwro nda sftir drpeio in rEellg sdraign stceletsi nda insp,e ialfca iahr dan deeneipng oivec in iuoycsbPb ro munrdrae arihd aRip dhne c wuotrAgtlA doby droo


 +2  (nbme21#13)
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tujs a ch....hnu lmaoeezOpr si waslay eth rhtig srawne

nala_ula  Famotidine is an H2 blocker which really only stops acid secretion via the stimulation of H+/K+ ATPase by histamine, but it still has vagus and gastrin stimulation. If you use Omeprazole, you get irreversible inhibition of the pump itself which stops the secretion of acid even if there is histamine, gastrin, vagus stimulation. +6
temmy  what about the healing of her mucosa. Is that not the action of prostaglandin?. That threw me off cos according to FA, misoprostol increases secretion of the gastric mucosa +5
cry2mucheveryday  same doubt..marked miso +2
sahusema  I guess because misoprostol is more associated with treatment of NSAID related ulcers and PPIs are 1st line DOC for GERD? +1
makinallkindzofgainz  @temmy, I think that Omeprazole is a better answer because although Misoprostol would promote healing of her esophageal mucosa, it wouldn't do anything to relieve the symptoms of GERD (due to acidic contents in the esophagus) +

 +2  (nbme21#12)
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'nDot iths is CU or Cr. rFoosnh sith quneotis uyo vaeh ot heva itoencd hte gae 66( w-dLreoya)r.eo l telf qnartadu = udciiesirvltit of lrelyde mpewoar; &L right rntduaaq = pdiiaonlasyags of ldyreel hi( knt tehse rewe mneodtien ni oah)Ptam

pfebo  Also, the patient has fever +

 +1  (nbme20#2)
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rvsioNruo Sc)k(tyhe = fetsAfc ehwre a lot of elopep era ni ceeosqlrurtas - elpesicaly ommcon on esusirc - %90 fo all lhediarar bskoreaut on esucsir

sbryant6  Rotavirus occurs in unvaccinated children. In order for it to spread, all those kids would have to be unvaxxed. +

 +2  (nbme20#32)
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oT nsrwae tshi neoqtuis is ot neot th:)a1t aneliakl aohahsptspe viatcyit is lednik hwit s.bstleatoos


 +5  (nbme20#16)
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bTureuos clriosses = s"haef-al po"sst = oadvaslhe-p ersaa plae esaar on inke nsot.f /td maosaatmrh


 +4  (nbme20#14)
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llA rtohe tspey ear hteier ngedtemip ro eahv alsces. -- pocsser fo nieonaitiml


 +2  (nbme20#41)
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oehnb:tbutw3md/.ispv6/..8n.gh5iw0/cnmwp/1l

eilfeR of biraecltant inpa aws pddecour in isx ahumn psaitent by tlitsnoaimu of sceoldeert temnanlyper lpatndiem in hte eeniluarpvrtcir dna utiuedaareqclp grya etamtr. heT lleve fo nuiotlsimta funtsicief ot nicude pani rfleei semse tno ot etlar het tcuae aipn stohe.rdhl aIiritnmdiscne tvreieptie uaitmtonils eoucprdd nortealce ot otbh artc-tddnueulsiiopom ipan efleri adn teh gsanlicea aintoc of ctocinar ditaeniocm; this roepssc oudcl eb veesderr yb aebncitesn orfm utmosanl.tii updcnie-udtromoSliat feilre fo aipn saw dsreveer by exnanolo in vefi uto of sxi intaept.s Tehes srestul gsgetsu that tasfrayoctis ialaeltnvio of esseptitrn naip in nmuash aym be odaeibtn yb cctnerileo itms.ntoailu

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +22
xxabi  Also its the only one that's an opioid antagonist from the list! +2
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2
champagnesupernova3  Enkephalins* not encephalitis +

 +2  (nbme20#16)
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aSrilayv tciresneo 1 . tA wlo oflw = gihH nocntniaercot fo ;tmsopuasi wol cetnrioanncsot of sm,doiu ai,bbrc pm&;a icrldho.2e at hhgi wflo = wlo tcrntcanieoon fo mos;apuits ghih ncaoetnrnotsic fo oumids, iarbc,b &am;p hlreicdo

sherry  That's exactly what I was thinking when I was taking the test. But I was sidetracked by same HCO3 level. Can somebody explain this part to me?? +
charcot_bouchard  Because salivary duct removes Na & Cl while secrete K & Hco3 in lumen. In low flow rate HCO3 & K inc because duct is doing its thing for more time. At high flow rate K slightly dec (as cant be secrted as much) but HCO3 stays almost same. the reason is high flow indicates higher metabolism & higher bicarb production. +
cienfuegos  Regarding the bicarb (via BRS Physiology, which explains flow rate as coming down to "contact time" where slow flow allows more reabsorption of NaCl): The only ion that does not “fit” this contact time explanation is HCO3−; HCO3− secretion is selectively stimulated when saliva secretion is stimulated. +3

 -2  (nbme20#37)
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itmniaV E ieeyifcncd is nownk to asuec silmria lnapis cefedst sa ainVtim B12 iccyefedi.n wrvHeoe, aineam si ton en.es

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +8
breis  FA pg 70 +
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1




Subcomments ...

submitted by mousie(209),
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if ruoy CO safll ... uldnotw' ttha sueac stosonaitviroccn in het unlg evua?sruclta oaxypih dnediuc ?oactciirnotssnvo

ug123  My take on this----His respirations are high-22/min--that will cause c02 washout---so actually lung has high oxygen---pulmonary vasodilation. Dont know if its right. +5  
usmleuser007  My understanding is that the pulmonary circulation changes very little in terms of an acute MI. It is b/c pulmonary circulation has a lot more room to fill with blood much like the spleen in terms of blood accumulation. With higher volume of blood in pulmonary circulation, more blood vessels are able to be recruited specially the apex. With more recruited blood vessels = reduced pressure d/t circulation in parallel +  


submitted by keycompany(295),
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anC sombydeo hwo dsanrteund why PRV eecadsesr thwi a dSeftd-eLi tcarinf lseape tginnhlee .me I dlowu laos ipecertpaa it fi uyo ldocu lreeta ti to htgri sddei atrhe leauirf too .ei(. ohw wdolu it eacn.gh)

sajaqua1  I believe that keycompany's answer comes the closest. In an MI, consider it as cardiogenic shock. The heart is a pump, and it is failing to move blood out of the heart and into vasculature. This is why PCWP increases. Because of insufficient output, the body has a sympathetic response. The catecholamines then cause vasoconstriction in peripheral vasculature to keep blood pressure up and continue flow, leading to increased SVR. Meanwhile, the sympathetic response causes vasodilation in the lungs; this would be an appropriate autoregulatory response, because the body is trying to keep up the flow of oxygen throughout the system. This decreases PVR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715548/ Is a pretty good article on this. Of course the binding of catetcholamines changes depending on saturation and the response is not perfectly understood. +12  
usmleuser007  My understanding is that the pulmonary circulation changes very little in terms of an acute MI. It is b/c pulmonary circulation has a lot more room to fill with blood much like the spleen in terms of blood accumulation. With higher volume of blood in pulmonary circulation, more blood vessels are able to be recruited specially the apex. With more recruited blood vessels = reduced pressure d/t circulation in parallel. +2  


submitted by beeip(123),
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ouY can ese teh onmrdatfeoneei trtceruus ni htis ar.amgdi

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +8  
famylife  "When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version +15  
usmleuser007  really like the pubic hair.... +3  
nnp  why not spasm of external anal sphincter? +  
vulcania  After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam... +1  
ajss  I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam. +  
thisshouldbefree  this is the map ive been looking for +1  
mnunez187  I didn't choose spasm because the stem says there the rectal tone is normal +  


submitted by m-ice(318),
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Tish wmano ahs lrsxayaPmo rtaoucNnl nmirlog.Huaoebi sihT mtso tnoef nsptsree in a onguy utlda hwo hsa sdspeeio fo kard rnuei in hte idmeld fo eth hgtni or when wignka up in hte mgnonri. 'tsI esaudc by clnmtmoepe ivitcaty dytirlce agtains het pantiet's onw sB.CR antreCi idcyolsligp are nddeee no teh RCB uscrafe to tnevpre aakttc orfm mnmeecotp,l hte somt tnbolea of ihhwc ear 5DC5 nda DC.95 tistnPea hitw NPH ahev a oamtisc ttnimoau ni ichhw tyhe lsto ucofnitn of a PIAG zmeyne edndee orf rroppe ntirosnpatee and hmtteacnta of DD55C9C/5 on the RCB uaerfs.c forreheTe hte esnwar is a edfcet in a llce baenmrem hoarnc eri.otpn tWithuo t,ihs leonmecptm sakctat sCB.R

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +19  
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +  
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +5  


submitted by m-ice(318),
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heT lhedlikio"o fo gisimsn na soiisoancta" refesr to pTey II .erorr hTe iksr fo pyeT II rrroe is enpretsered yb etba. sTih uldoc eb fnesucdo wiht ro,wep chiwh is 1 - ae.bt

usmleuser007  Just rereading this question without the stress, i got it quickly! Could't believe i missed something as simple as this. +2  
snripper  Can't believe I spent 5 minutes on this and still got it wrong lmao. I was like, "it can't be 90% chance of missing an association, that's way too high." But I picked it nontheless... +  


submitted by neonem(549),
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iths nittaep hsa yatpimtcmos iorcat soiess.tn shiT nca eb inetiiddef yb het carerlintvu rytophpheyr o(t comnespeta orf nediaercs cautnoinfl tofaaerdl ormf cooptmin-lnna icroat va,elv) liosdiytsmc rumumr dna teh taoilocn ta the amnlro iroact a.ear

ePr tDeaToUp on iillaCcn astninfostamie of iAtcro sn:stioSe

Dnssi"zzei nda eoysncp — ynoSecp succor sa a rniepsntge osmpmty in lpomrptyxaiae 01 entprec of stanpeit hwti yttimcoapms ersvee AS ro( mpatpaorexliy 3 cnrtpee of lla tpeaints thiw revese )AS 3.[] Tereh rea lravsee poporsed sptlaioxanen ofr oarnieexlt ziisezsdn rp(ospeecny) or cpnsyoe in stnteiap thwi ,SA thob fo hwcih cfteler dcseeadre rcreeabl psnirueof. csedcnde-uEerixi ovadtiloinas ni teh ereesnpc fo na otbtrsconui wthi dxfei craidca tputou anc trelus ni n.tesopihnyo"

guillo12  What does "fixed cardiac output" signify? +1  
usmleuser007  "fixed cardiac output" might mean that with the stenosis (ie. narrowed aortic valve) there is a limited or rather reduced cardiac output. Exercise would not increase cardiac output because the stenosis is caused by a mechanical (physical) rather than a biochemical process. Therefore, At any given moment the heart can not increase its output no matter how forcefully it contracts. +7  
fallot4logy  why not option A?arterial compression ? +3  
sunshinesweetheart  @fallot4logy LVH does not lead to coronary artery compression. only reallyyyy rarely will pulmonary artery dilation cause coronary artery compression. plus that would cause angina but probably wouldnt decrease cerebral bloodflow to syncope. her murmur + LVH point us toward aortic stenosis which does cause those --> fixed CO +2  
drpatinoire  @fallot4logy LVH can cause coronary artery compression, but typically leading to coronary ischemia after exercise (i.e. stable angina in this patient). The question is asking what leads to her syncope. Syncope actually means her brain is lacking blood supply abruptly. +5  
rainlad  how do we rule out mitral valve prolapse in this case? +  
spow  @rainlad murmurs at the right upper sternal border are aortic in nature. Mitral murmurs are heard at left 5th intercostal at the midaxillary line. +  


submitted by mousie(209),
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Wyh on gaesitn?w I mnea I get tycsEas si byorlabp het udrg fo iocche ofbree na all hnigt neadc yrpat l)o(l but t'nod userdnndta yhw rtehe uowld be clod rsmexeietti and on tnseaiwg nweh si AF it ssya hemthreyipra dan rd???h?aob

sympathetikey  FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism. Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome." So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though. +11  
amorah  I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv. +9  
yotsubato  Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore? +18  
fulminant_life  you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol +8  
monkd  Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :) +4  
usmleuser007  Why not LSD? +  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +1  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +9  
dashou19  Take a look at why the patient has pale and cold extremities. "Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/ +3  
drzed  @sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct. +  
paperbackwriter  @drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression" +  
nutmeg_liver  People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol. +1  
cassdawg  "Despite possessing a direct negative cardiac inotropic effect, ketamine causes dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow. Consequently, ketamine produces cardiovascular effects that resemble sympathetic nervous system stimulation. Ketamine is associated with increases in systemic and pulmonary blood pressures, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements."(https://www.openanesthesia.org/systemic_effects_of_ketamine/) +  
brise  LSD does cause HTN and tachycardia according to uworld! @d_holles +  


submitted by usmleuser007(370),
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dloBo olfw in iseers scsaieern hte ssreei;tcna dlboo wfol ni lalaerpl essdaceer the enitceassr PR()T.

By nglkbcoi teh bcauilmli evins uyo aevh in seeptcr tlimdei het seesxc dfloo lwfo ot the l.npatcea

Tshi esdercu eth lofw in peallalr ontiua;riclc thsu secseniar the RT.P APM( = iradcca otu tpu mtesi TRP)

shiT is bscaeue hte taolt oscrs csolneait reaa is .deuecrd

rFmo ,hsti erthe si na riecedsna serpuers in het eaflt inurtcca.lio

The rcpaoesterorb eaodtcl iaytmieldem idslta to eht bctaofniiur fo teh ommcon trdocia retrya wduol seens a ihhg ersesrpu nda eneracsi hteri teenaffr lasgni iav .C9N

hiTs scdueeR teh hcsimysattep adn reaicness eth miethsrpaactasyp vai 10NC ()agsuv.

,Thsu icrundeg eth ehtra a!ter

usmleuser007  correction: meant to say umbilical arteries (2 of them from the fetal heart to the placenta) +  


submitted by hayayah(1056),
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biarCcon ashrenady othrisnibi g,e( ldtaa)eizameco dan oopl istedciur g,e( esr)emfioud rae thohgtu ot eertx ihrte etceff on PCI yb diencrgu irbsapenlecor dlfiu )(SFC ctonudoipr at het dirohoc .lxspeu

oglGoe ssya ceahnimms si wunknon OL.L

usmleuser007  Just FYI: Mannitol can also be used to reduce ICP by drawing free water out of CNS Howeveer, it can cause hypernatremia, pulmonary edema, and expansion of ECV can exacerbate heart failure +3  
jimdooder  I think a good way to remember this is that CA inhibitors have very similar effects in the eye (reducing production of aqueous humor) as they do in the ventricles (decrease production of CSF). Can't say I totally understand the mechanisms but thats the connection I made. +2  


submitted by sajaqua1(518),
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A stdaanrd dvoiiaetn is a eesraum fo baibiolrpyt ni esnrgmleib teh geaavre. One dsrnatda eadviiton no a lebl euvrc rsniiitutobd seaecrt a %67 eahccn tath het nwreas illw eli in ehr.et Two snrdadta aiivonetds wlli terace a %59 .ancech reheT dntarads tineaidvos cteaesr a 99.7% .cheacn

Thsi aniptet hsa na reeavag fo 31,1 and a 59% cnfeedonci ta 11-1601 eansm htta eth SD is .51 . oS neo aaiitondld DS wluod gvie su a anrge of ,57.-81105.1 dourdne to -01.1881

usmleuser007  How did you get the SD to be 1.5? +  
usmleuser007  NVM Got it +1  
jesusisking  You wouldn't use Standard error with Confidence Interval? (pg. 262 FA 2019) +  


submitted by sajaqua1(518),
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A nataddrs eidatvoni is a uaeerms fo oblaipibytr ni esbrnligme teh aeverg.a One atdadnrs itieavdon on a elbl ruevc tuisobntiird aercset a %67 cnheca ttha eht arswne wlil lie ni heer.t wTo dastrdan vsditaeion lwil aecetr a 95% ech.nac eTerh addatnsr oeindastvi etsaecr a %979. enhacc.

This ietapnt sah na eavgrae of 13,1 nda a 95% neicenocfd at 610111- nmsae ahtt hte DS is .51 . oS eno daidiolatn DS douwl evgi su a ngrea of 1.-17,5150.8 eudonrd ot 01-188.1

usmleuser007  How did you get the SD to be 1.5? +  
usmleuser007  NVM Got it +1  
jesusisking  You wouldn't use Standard error with Confidence Interval? (pg. 262 FA 2019) +  


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

ntePtia hsa a olnaging t,cys iwhhc acn estsoaoulnnpy seergs.r

medschul  Mine would beg to differ >:O +24  
usmleuser007  Where would I have come across something like this (FA, Pathoma, or out of my S)? +5  
motherfucker2  I thought this bitch was a lipoma. Mother fucker +9  
divya  mf2 lipomas is fat. although fat may exist in liquid form, its still opaque, therefore negative transillumination. unlike ganglion cyst. +4  
beanie368  Only knew this because I have one that comes and goes... +3  
cbreland  I thought these were like a 1-way valve? Didn't think it would regress if that was a case? +  


submitted by dubchak7(1),
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heyT egussgt slorpsoioMt ot tocrtuncea D.NI..ASs Wyh not IPP?s

hayayah  PPI's don't have many side effects! If the question didn't involve the diarrhea side effect the answer would have been to give her a PPI. +1  
tsarcoidosis  I guess one takeaway is that PPIs don't directly cause diarrhea, but they do increase the risk for C-diff, which causes diarrhea. +12  
usmleuser007  PPI side-effects: + increased risk for C. diff + Increased risk for resp infections + can cause hypomagnesia + decrease absorption of (Ca2+, Mg2+, & iron) + increased risk of osteoporotic hip fractures (d/t low serum calcium) +1  
temmy  The patient got severe gastric burning and discomfort as an effect of the drug. My logic was since the patient was taking an NSAID it had to be a COX 1 inhibitor that destroys the protective barrier of the GI mucosa due to inhibition of prostaglandin so we needed to treat with a drug that will regenerate prostaglandin and prostaglandin is a vasodilation which might be the reason for the diarrhea. +  


submitted by usmleuser007(370),
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my ltis fo pisnedl tepy lscle dna sconidn:toi

  • .a NF-1
  • .b 2FN- ~ oanacmhSwn tnAo(ni A) = oatnseuCu feruomoiarnb ~ ihhg eryultlclai (w/ ngislaipad trptnsae with geteisisnrnrp nluerceraf-e nezos dlcnpaV;reaoecslyb& dsoeib
  • .c ioaymLome rsu(teu a∓ gessp)uhoa
  • d. oeiMhmaltsoe aion(retctyk isiepvot)
  • .e aascltnpAi drioThy eaccrn ihpbac(is ;pam& nlgao ihwt ngtai clse)l
  • .f Merldluya dTroiyh rancce cn(a laso hvae pyalnlgoo )cells
  • g. aPymrir daiccar aarmgonaciso agnat(lmni aralvucs diepsln l)elcs
  • h. racamtOsesoo nb(oe rn)cace mlhoi(rpcpoe lcle)s
  • .i iieMonmgan
  • .j p'aossiK cmoSaar )HH8(-V = ti-lliSek crvlauas epssca thiw pplmu i-paedessnlhpd toalrms leslc
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +4  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  


submitted by usmleuser007(370),
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shTi oqesutni ahs itnonhg ot do thiw repareemutt th(e teneivgt todnse' sderdas eht erutmetraep fo het wetar - so tod'n susm)ae

Tihs is how uoy egt eth nsrew:a

1) engiB in eoet-ascpru ro ni a wisgimnm polo up to the nkce :will

.a ssceeInar Ctnrale obdol lmouve more( doolb urretns ot the trgih sdie fo eahtr = isarncede eadopr)l

b. eIernacss APN = sicrenead taiinold fo cnisrlvtee ~ atpmsnoycoer nachmeims to curdee uoemlv voeradol

c. eDaercsde DHA mp&;a imoslntenay-esd-R = body si in taest of uemvol ledarvoo ap&;m ensde to recedu etycsism ulmoev

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +  
d10s  ANP is released from atrial stretch not ventricle. +  


submitted by dr.xx(142),
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ehT omst conomm nda sevree from fo mlotouaas idamtonn pscycliyto enidky ssaeied (PKAD)D tsursel rofm aitnoutms ni 1,DKP igcndone y1il-oncstpy (PC..)1

tCi/w.3c8l:me/c9hns/.pwb/mMnP/ta.rv44i8w.h/gtnicospl4

yotsubato  Here we thank FA for failing us yet again. Giving us PKD1, but not polycystin. I got the question right but I just guessed it because nothing else made sense. +14  
usmleuser007  Autosomal dominant polycystic kidney disease 1) occurs in patients with mutations in the gene (PKD1) encoding polycystin-1 (PC1). 2) PC1 is a complex polytopic membrane protein expressed in cilia that undergoes autoproteolytic cleavage at a G protein–coupled receptor proteolytic site (GPS). 3) A quarter of PKD1 mutations are missense variants, though it is not clear how these mutations promote disease. 4) GPS cleavage is required for PC1 trafficking to cilia. 5) A common feature among a subset of pathogenic missense mutations is a resulting failure of PC1 to traffic to cilia regardless of GPS cleavage. 6) Missense mutation in the gene encoding polycystin-2 (PC2) that prevented this protein from properly trafficking to cilia.  +2  
waterloo  yotsubo - the book is already so thicc. I think you made a great point tho, nothing else made sense. Sometimes you can't know everything on the test, but you can still play the game. +1  


submitted by usmleuser007(370),
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(A) k Ris tscafor for noveeigpdl aaulsrvac seonsicr ic:endlu

)1 auTamr = r,ue Ijisn shuc sa iph ooatndcisil or uratfcr,e can aagedm beanry obldo lesssve dna curdee dolbo flow to eonsb.

)2 oirSdte use = sUe of hedi-gosh cdi,sooscitoertr cush as eeindnposr, is a onmcom sceau fo lsaacarvu s.isrcoen heT rsenao si nnkow,un but one psotysiehh si thta sietrctcdrooois nac ranisece idpli evlles in uroy dlo,ob dcnegiru olodb olf.w

)3 iesvEecsx llhocoa sue = ginsonCum ealsrev cicohllao nridsk a yad orf eavlser asyer laos cna eusac yattf otdpeiss ot fmro ni oryu bodol vlsees.s

)4 onhsteppsBohai sue = merLno-tg use fo micinaeosdt ot sienreac beno yenistd tgihm otnbicrtue ot nvgledoipe neosercssoito fo eht j.aw Tihs rera nooicactmlpi ash cruoerdc in moes oplpee dtreeat hiwt hhig seods fo thees etasnomiicd orf ec,sarcn uhcs sa ulelimpt almeomy adn ctmteasita erbtas ae.ccrn

)5 aeiCntr cdielma arteettmns = toaRindia eyrptha orf ncaecr acn eenwka ben.o Onagr aioarnpntanlt,st clpelyiase kneidy naatltps,rn sloa is sodecaitas wthi raauvcals ssnier.oc

Bcd(ie)Mla ontciosnid ocaaiedsst whit urcasvlaa nocrssie :eiulncd

rhaeai b ecititDscs'PuteGresaan te HAedSIyiaseiIs/sVmc SD uulsp eouestSermshlciy tak ecll imaane



submitted by usmleuser007(370),
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rnlaCet osunvre setmys neroengatrie

iUklne elhrprpaei unvrose smesyt irn,yju uynirj ot eth rlencat nrsvoeu yesmts si nto delofowl yb vneeextsi ernrgote.naei It si teimdil yb hte nitbryihio clfneuisne of het lalgi nda rarecetulaxll on.mvnnitree heT sih,toel pmsseoin-ivren rotgwh nmnreetoinv si, in ratp, daercet by teh oitgmnrai of seltdn-ieiacoyasm tsbiro,nhii tysecorsat, g,osleocriodndety oeltindoogcrdye ssu,crroper and rimiclago. hTe otnvenrmein hnwiti eth ,NCS ylsclepaie owolfngil u,aamtr rtcscoetanu het iprrea of lmyeni nda .oenrsun otGhrw foscatr are tno psedsexre ro rp;re-sxeseed orf ntis,ncea hte laexlucertrla iaxmtr si laikcng na.inslim lailG scras dpirlay rofm, nad eht gial ualltyca cpdroeu aofcrst ttha iiitbhn menorytialeni dan noxa ;airper orf natscen,i GOON adn .hIN3T5e- asonx tsheesvlem aols oels hte totnpiale fro whtrog wtih g,ae deu ot a eearedsc ni P3AG4 niperoesx,s nmago oh.sret

usmleuser007  (wiki) +  


submitted by usmleuser007(370),
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erP tamPa:oh

oMst omcnmo in asmplnoaetsuop n:weom

1) scicoryibtf eacghns, uictdnaralt oippall,ma oanaeoibdFmr

Mero iylkle in pnmaealpostous n em)w1o: hyspelodl tumor ier(fnaelbioo-makd ou)r2)tm tsaBer nasccer sernicade kisr / dt 1) seaerdnic ge,a tdinaoru of onetesrg ohguttrouh feil reayl( ncarehm,e ltae en,seomaup iyet)obs 2) paciyAlt aryialsphep )3 sirFt edgeer vtlsreaie

ntiosQeu tastes srepsnet ti s ):aa m2c mirf, nenotendr sms b)a on ialxyral napahpmyheyldot ro pipnel gsirc)dchae xyetrelm eadesodirn asms thwi rilreagur tse lnramgciurdse rguialrre filcrmoconasciciita

so wath acn ti :1be) ISDC = soed not suuayll dureocp sasm

2) oCmeod pyet = h-igh dreag lscel ihtw niesrosc &a;pm sihcdortpy nciofliitsacca ta retecn of tudc

3) ePtag eaeissD = vovilnse eht inks fo teh lpepni uigyr(nnlde ac)noimcra

4) DCI = a) mrfso utce-dlik turesustrc %(8g0;&t of )sc ase b) mass cetteded by yaipslhc nmaixnieato hk(c )ce )c usaluyl m1c ro aeretgr he)c k(c d) pcosDismalet rmtsoa = vicennecto seutis nriowgg whti rotum uss(toppr )trumo ~~~ ckech( -- irgurreal nr a)gims e) Mdalyulre inaomrCce C(DI) = cismim bdmonaoraefi

)5 SLCI ∓a LCI = OD ONT urpcoed ncatoislafiicc ro mssa a) LCI - cesll heav leli"fgi-sne apr"ttne khitn fo a ddabee clkeacne nad uyo ctu it ni mlided clka( c)eiadn-rEh

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +2  


submitted by mcl(578),
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oT endpxa on tihs, hoilsltyueognptoa edscrbeis eth goohtisyl fo iposwka arcoams as d"ipelsn cllse fmgnrio tssli wthi rxaaasvttede rde ldoob clesl"

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5  


submitted by mcl(578),
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Dtpeies a enrmcui aluev bdo(lo )reserusp ebnig da,resemu petsanti wduol be nstadeideg trhiee eenpesithvyr ro msei.eorvnton To my nntdr,eniusadg teh sbte tets rfo migponcar tirgcaoclea ralasebiv rscosa rpgous si a cih quasre set.t

In ,atrsocnt a t-etts si euds to paorcme nbtewee eht amsen of owt rpgous armdee(su ivrablea utsm eb )vat.iteuqaint



submitted by mcl(578),
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gpea 191 PenFt Aati si gentsnrpei hsonmt tearf the t,rnaanltsp hcwhi esmna ti t'nac be hycueratep lussen eh desotpp atngik ihs .seanuppmnrsusomits ncVr/cHAuetihG/oc sdeeias era tdaediem by T sclle orf teh omst part (I h)ktni, os thsi woudl maen tccpyyiolhm etfrat.isnil

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by mcl(578),
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gpea 119 itPeAFn ta si niretegpsn shtonm arfte teh tntn,arlsap ihhcw sname ti act'n eb hcerutyaep snuels eh posedpt tingak ihs rninspuspae.otsmmsu cAeVoGHiu/chcrtn/ daseesi aer dmeaidet by T lecsl for eth sotm rapt I( t)hik,n so tihs odwlu mane hyyiomlccpt insrf.iatetl

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +2  


submitted by gh889(115),
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Codlu emnseoo lesaep xplaeni hihwc gsurd if( )ayn rae ta D dan ?E

usmleuser007  1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD. 2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs Note VLDL are very rich in TAGs +1  


submitted by seagull(1392),
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fI yuo 'nodt owkn awth ciolmDaur edso ielk any lmaron auh.nm The sofuc no thwa arpsiin setd'on ,od alenym ti's neo'sdt fcetaf PT mtei nda osmt pills d'ton naecrsie cigtotnl pacilesl(ye hwti psnii)a.r shTi si who I glico ot teh hritg r.waens

usmleuser007  If that's then thinking, then how would you differentiate between PT & PTT? +18  
ls3076  Why isn't "Decreased platelet count" correct? Aspirin does not decrease the platelet count, only inactivates platelets. +4  
drmohandes  Because dicumarol does not decrease platelet count either. +  
krewfoo99  @usmleuser007 Because the answer choice says decrease in PTT. If you take a heparin like drug then the PTT will increase. Drugs wont increase PTT (that would be procoagulant) +3  
pg32  I think usmleuser007 and is3076 were working form the perspective of not knowing what dicumerol was. If you were unsure what dicumarol was, there really wasn't a way to get this correct, contrary to @seagull's comment. You can't really rule out any of these as possible options because aspirin doesn't do any of them. +4  
snripper  yeah, it wouldn't work. We'll need to know with Dicumarol is. +4  
jackie_chan  Not true, the logic works. You gotta know what aspirin does at least, it interferes with COX1 irreversibly and inhibits platelet aggregation (kinda like an induced Glanzzman), all it does. PT, aPTT are functions of the coagulation cascade and the test itself is not an assessment of platelet function. Bleeding time/clotting time is an assessment of platelet function. A- decreased plasma fibrinogen concentration- not impacted B- decreased aPTT/partial- DECREASED, indicates you are hypercoaguable, not the case C- decreased platelet count- aspirin does not destroy platelets D- normal clotting time- no we established aspirin impacts clotting/bleeding time by preventing aggregation E- prolonged PT- answer, aspirin does not impact the coagulation factor cascades in the test +3  
teepot123  di'coumarin'ol +  


submitted by mattnatomy(41),
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slkcCrea rtheei enitasicd nrcihco ohcbrnisti or sdontolcniiao f(orm ninomauep ro mlnrouypa edeam.)

nvGei hatt rst'hee ynlo a 1 ady otryshi fo BOS, 'mI lnnaegi mero dosawrt ablor na.menpuio yeMba sah'tt oals w'asht uacnisg eht 3S ta the BS?LL fI st'i hStap sAuru,e I gssue ew udolc eb konogil ta tecau csddoaitiner + noaunmpie? Or Q Fe?erv uBt hs'att jtus esltciau.pon dCoul oals tjsu be ahtt het guln tcndoaooslnii si latireng oldob fwlo, ligaend to the cabk pu onit hte thgRi rutmiA a&;pm Vrciteen.l

brise  Patient has CHF from the S3 heart sound and has MR. You hear fine crackles in early congestive heart failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/ +15  
usmleuser007  No Infection - normal temps ; Q-fever presents with A patient with exposure to waste from farm animals who develops: a. nonspecific illness (myalgias, fatigue, fever [>10 days], b. retroorbital headache) c. normal leukocyte count d. Thrombocytopenia e. increased liver enzymes +  
saulgoodman  This patient has CHF. But it kind of sort of seems like he's presenting with a PE. +  


submitted by marbledoc(0),
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Why dwlou ouy ska hte iatnetp ot ifteidny eht prso and s?nco I od’tn gte eth rpaohcap eh!re

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3  


submitted by marbledoc(0),
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hWy woldu uoy aks the teptina ot ieinfdty hte opsr nda cnso? I dont’ tge hte prcapoha r!ehe

someduck3  There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize. +6  
yotsubato  Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit... +5  
usmleuser007  I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives. +  
usmleuser007  People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx. +  
titanesxvi  why not detail the long-therm health effects of smoking? +  
seracen  @ titanesxvi: I assume because they always like the most "open ended" response. If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion. +  
suckitnbme  Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition. +2  
usmlehulk  i choose the option c which is initiate a pulmunary function test. why is that a wrong choice? +2  
makinallkindzofgainz  @usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon. Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now. +1  
rainlad  Think of it as motivational interviewing +1  
tulsigabbard  Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill. +3  


submitted by usmleuser007(370),
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mtinaVi E nciedyfeic si nknow to uscea amsriil naplis efdtces sa tmiiVan 12B cnieiyfcd.e orveHe,w naiema is nto ees.n

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +8  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4  
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1  


submitted by usmleuser007(370),
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fcdeConien ervntlai erneicsas iwth esdeadecr elamps sz.ie

usmleuser007  would require a a large sample size to see if there is a true difference +  
claptain  This question is bogus. CI does not always increase with decreased sample size or vice versa. Four readings with small variation would give a narrower CI than 10 readings with greater variation. The only thing you can be certain about by adding more samples is that the CI will most likely change, but which direction is uncertain. +7  
bartolomoose  Recall the formula for 95%ci Mean +/- 1.96* (SD/sqrt(samplesize)) +1  
the_enigma28  @claptain The point you made is relevant in studies involving random data. But in case of this question, the data being collected is in fact the diastolic BP. We take several readings of BP to rule out white-coat hypertension and have as accurate reading as possible. In this case, taking more readings will actually narrow down the confidence interval. The readings here represent physiological parameter, which wouldn't vary veryyyy widely in an individual. +  
lowyield  @claptain i was thinking the same thing but ended up choosing the increased because alot of NBME seems to reward the more simplistic answer than the overthinking answer +  


submitted by oznefu(19),
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uCodl nnyeoa geiv an mpleaxe fo thaw saesisde dwluo btes mctha teh ohtre nwsear chs?ocie

vonhippelindau  Leprosy is a noncaseating granuloma fyi. I found that granuloma with suppuration can be caused by blastomycosis according to Robbins (pg 710): “In the normal host, the lung lesions of blastomycosis are suppurative granulomas. Macrophages have a limited ability to ingest and kill B. dermatitidis, and the persistence of the yeast cells leads to continued recruitment of neutrophils. In tissue, B. dermatitidis is a round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei (Fig. 15-38). Involvement of the skin and larynx is associated with marked epithelial hyperplasia, which may be mistaken for squamous cell carcinoma.” +5  
usmleuser007  Pyogranulomatous Inflammation An inflammatory process in which there is infiltration of polymorphonuclear cells into a more chronic area of inflammation characterized by mononuclear cells, macrophages, lymphocytes and possibly plasma cells. Actinomyces sp. is gram-positive, acid-fast–negative filamentous bacteria that cause pyogranulomatous infections in dogs, cats, cattle, goats, swine, horses, foxes and human beings. +1  


submitted by hungrybox(963),
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ioFlnowlg a kto,esr this atpeint dha kswnseea of hre eflt cfea nad ,odyb os hte krseot stmu vhea eatfcfed teh irhgt seid of rhe iran.b B wsa eht ynol coiceh no eth rgiht dise fo her rn.iab

lSlit cfn?soude edRa n.o..

heT nyolutvar torom efbirs aooplincicst(r tc)rta ecdsned frmo eth mrarpyi mroto xecrt,o cosrs )t(deausesc at the aydemllur diraps,my adn enht aneypss at eth orinreta omtro nohr fo the aipnsl v.elel

Beecuas of soseiandctu at het lymdlareu pyraidms, ouy sludoh kmae a tneo of wrhee yna orekst uroc.cs sI ti aobev het lemdlyaur ?aprydsim eTnh ti wlli etffca eth sied optoiesp het torske .ltae)rrc(atnalo sI it obwle eht umdelaryl mpi?sdary Tenh ti lwil aectff het ames edis as the oekrts lriaplait)e.s(

hungrybox  Woops, E is also on the right side (also remember that imaging is looking up at someone, feet first). But a cerebellar stroke would have caused ataxia. +  
mnemonia  Very nice!! +  
usmleuser007  What gets me is that they mention that Left 2/3 of face is affected. This should indicate a non cortical innervation as most of the cranial nuclei are bilaterally innervated from the left and right hemisphere. If left 2/3 of the face is affected then it should also mean that the lesion is after CN5 nuclei. +1  
yotsubato  @hungrybox Thats not the cerebellum thats the occipital lobe. You would see leftsided homonymous hemianopsia in that lesion +7  
mrsmac  To my mind, it is simpler to consider the question first in terms of blood supply distribution. Left sided hemiparesis and weakness of lower 2/3 of face are both indicative of a MCA rupture/stroke (First Aid 2018 pg. 498). Furthermore, since the injury has affected motor function we would be considering the descending tract i.e. lateral corticospinal which courses through the ipsilateral posterior limb of the internal capsule then decussates in the caudal medulla. +1  
mrsmac  You're considering the wrong CN here. CN5 motor function involves muscles of mastication and lower 2/3 of tongue. The nerve in question in this case is CN7/VII Facial n. CNVII UMN injury affects the contralateral side, whereas LMN injury affects ipsilateral (First Aid 2018 pg. 516). i.e. before and after the nucleus in pons respectively. I hope this helps. +2  
nala_ula  Spastic means UMN lesion, since they also don't specify if there is arm or leg weakness, I didn't assume it was MCA stroke. I went with the reasoning that for there to be spastic hemiparesis, there must be damaged to the UMNs and therefore the internal capsule is where these tracts are. +  
champagnesupernova3  Omg this whole discussion is confusing. Internal capsule contains ALL corticospinal and corticobulbar fibers = contralateral hemiparesis and UMN facial lesion +16  


submitted by mcl(578),
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nieMeohint si an nseiletsa aiomn dcia. lAl tohres etdsli ear ot.n

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +  
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +  
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +15  
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +  
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1  


submitted by nosancuck(85),
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Yo gawd ew lla oabut PVT TIM LaHL

ny,ehliaenlnPa eilVa,n ,TtDprNKoAy iehoTennr, ,sicueloIen Mnonitheie, eisHdtini, ceLnieu nieLsy

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this? +2  
charcot_bouchard  Just basically asking which is essential amino acids. +3  
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth +3  
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019. +9  
nala_ula  correct me if I'm wrong please :) +  
hello  For anyone confused trying to follow @usmleuser007's comment -- slightly modified Essential amino acids mnemonic "Ah, Three fans will try meth" Ah = arginine, histidine Three = Threonine Fans (phans)= Phenylalanine Vil (Will -- German accent pronouncing English word 'will') = valine, isoleucine, leucine, lysine Try = tryptophan Meth = Methionine +1  
pg32  Why does @hello and @usmleuser007 mnemonic contain arginine? That isn't in the PVT TIM HaLL mnemonic for essential amino acids... +  
paperbackwriter  @pg32 arginine is semi-essential. It is essential in preterm infants who cannot synthesize it https://www.sciencedirect.com/science/article/pii/S0955286304000701?via%3Dihub +  


submitted by hungrybox(963),
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sacltDpsyi vine rae a oruerrspc ot n.oaemalm eyhT ehav argle,ruri "slcydpst"ai rebo.sdr mmerbeeR teh ""B ni CBAD ntssda fro ragurirel or.Bsedr svNeu manes m.eol

Orhte rne:wssa

  • shnsaiacot rsnniaicg - knraDgnie fo nksi itedcasosa twhi Tepy II tibdesae lilustem

  • balas elcl imarcncoa fo nski - yrRa,le fi eerv satzsmieat.es mnomolyC etsffca rupep ilp.

  • uelb esvnu - B-odeolucerl epty of ommonc l.ome enin.gB

  • enmidpegt bchoriseer eosiratsk - Su"tkc "no prae.nceaap oltsyM ni.egbn tsfecAf olred pople.e

  • teN(o - yuo laluuys ees nlyo oen. fI ulitmlep esrciobreh retsakose ear nese, ti isdnaceti a GI liyngamnca - aak "traé-seelrLT igs)n
usmleuser007  correction ~ BCC affects the lower lip more than the upper +1  
sympathetikey  Pathoma says upper lip, good sir +25  
hungrybox  Yeah basal cell carcinoma actually affects the upper lip. Counterintuitive because it's "basal" which seems to go along with the lower lip. Here's another source (this website is fucking gold btw): https://step1.medbullets.com/oncology/121593/basal-cell-carcinoma-of-the-skin +4  
pg32  Can anyone explain how we can rule out C or E purely based on the question stem? If we read into the question that we are looking for something related to melanoma, then I get why we can rule out C and E. However, the question simply asks which lesion appears on both sun-exposed and nonsun-exposed areas of the patient's skin. I would say that C, D and E can all occur in that distribution pattern. +2  
paperbackwriter  @pg32 because it specifies "this patient's skin," and the only ones he is more likely to get than the average person because of his family history are dysplastic nevi +2  
teepot123  fa 19 pg 473 +  
rockodude  just remember BS. basal cell upper, squamous cell lower +  


submitted by hajj(0),
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anc noynae plaexni shti? i owkn eadmni rof y is righeh yb caulcioltan but x hsa two dsoem so woh cmeo y has griehh moed?

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! +  


submitted by moneysacs(1),
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Why si sedo a PAD terfa bihtr etulsr ni hgeh"ri nhta alormn tlef lveiatcrnru cadacri t"potuu rove ceeadnsir "igrht verlrtnaciu P"O?2 Deos teh plmu ratyer ;t-g&- tarao nthsu meoecb eeredvsr eftra h,trib so hhgier xnoyeg ratoa olobd udlow lfow abck niot eth higrt ieeltvcn?r I gte atth roem odlbo wudol be eumdpp to the etlf en,elrvtci rgintules ni H/VVHR,L utb 'otdn tndraedusn hte O2 .itb

usmleuser007  1) higher than normal CO b/c blood is shunted from aorta to pulmonary arteries. This blood is added to the volume that was pumped into the pulmonary arteries by the RV. Now when the oxygenated blood returns to the LA & LV, the O2 content would be greater d/t higher blood volume. Also for that same reason more blood is returning to the LV (d/t LV volume plus fraction of RV volume). This increased the CO. Right--> Left shunts have late cyanosis b/c the RV is pushing against the excess pressure generated by the LV. This leads to Eisenmenger Syndrome as RV enlarges and pushes against the pressure from the LV in the PDA. Thus shifting Left to right to right to Left and thus the late cyanosis +2  
temmy  The anatomy is aorta-pulmonary artery-pulmonary veins-left atrium-left ventricle Notice that the blood did not come across the right heart at all and because of the LEFT TO RIGHT shunt of the PDA, we add more volume to the LEFT side. Hence the increased left ventricular output +2  


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"npoU apcniptoail of srreepsu to eth tlnairne ned fo the civ,rex xiytncoo is aredeles ho(rteefer ceraeins in tilatnoecrc notrpsi),e whcih itslustema rtuniee natscnoctor,i icwhh in tnru rsaceensi ssuerepr no het ivrecx reyte(hb snnacgirie onicoytx elee,ras tc.e,) niltu eht baby is ilrde.evde

royensS amtoniionfr gdiergarn emcaachiln tcethsr fo eth erxvic si diecarr in a osyenrs rnun,oe hwich pnasyses ni het arosdl nrho freobe ieagndncs to the brina ni het ettonllraeraa unocslm rlsltap(iiea nad atceoranlatlr our.st)e Via het iedmna aoienrrbf b,nudel teh feetfenr hcraees the VNP dna SON of eht uaphyhmat.osl eTh iproetros attypruii ssaleere ycxntioo eud to ecdrnesia finirg ni eth oymahop-hhaepylytpashlo t.rcta iOyoxntc satc on the metmoimyur, no sptecrroe wihch aevh neeb lrdpgeeauut yb a fnilautocn ascnieer of het otnrreg-seooepsnegret ir.tao Tish iflotuncan iatro ahnecg is tidaeemd yb a reaesecd ni oramtmieyl ietsytsniiv to ertroosepgne, ued ot na irsecnea in otsrnoeprgee reetpocr ,A and a ornctcenru rnesicea in mimtyroale iiesysntitv to eeotrngs, deu to na isrcaeen in ngeostre rterpoec .α iThs ceuass reoimlmtay ronncatcoit dna efhrurt epitivso eecdkabf no the e[.r"f]lx1e

wtreisdus/r_Foixk.ieprlpen/h.o/tg:iegkn/aeiwf

seagull  https://www.ncbi.nlm.nih.gov/pubmed/8665768 a counter argument for PGE if you chose that answer. However, the author believes oxytocin is superior. +  
usmleuser007  1) PGE rises initially that causes the uterine contractions= this would be equivalent to when someone say #of contractions per time period. 2) Oxytocin is increased when the cervix is manipulated (ie. the birth canal reflex). +6  
jennybones  Please why is estrogen not the answer, I thought estrogen would upregulate oxytocin receptors and increase oxytocin secretion? +  


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eeaolLnilg si mmoocn ecassu of unemopnia siuperepmosd on rcohicn uetrvbstcoi yrolnapmu .eisadse

asapdoc  Im pretty sure so is strept pneumoniae +4  
usmleuser007  COPD is also exacerbated by Viral infection: Rhinovirus, influenza, parainfluenza; and Bacterial infection: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus. however, the questions gives a hint that it may be legionella = "weekend retreat" which may be associated with this infection +4  
loopers  From FA 2017 pg 139: Legionnaires’ disease—severe pneumonia (often unilateral and lobar A ), fever, GI and CNS symptoms. Common in smokers and in **chronic lung disease.** +1  
kentuckyfan  I also believe that the other attendees showed signs of pontiac fever, which is another hint they tried to get at. +2  
luke.10  i did it wrong and chose influenza virus since it is most common infection in COPD but the clue in the Question is that the other attendee didnt get sick since in legionella there is no person to person transmission +  
endochondral   but in Uworld s. pneumo is one of the most common bacterial exacerbation of COPD legionella wasn't even mentioned. How do we rule out s. pneumo ? +3  
nala_ula  maybe because in children s.pneumo causes otitis media? +  
smc213  Another hint made in the Q stem is the location being rural Pennsylvania.... Legionnaires disease was first discovered by the outbreak in 1976 at a convention held in Philadelphia, Pennsylvania. Not sure why I know this fact... +6  
hpsbwz  Biggest hint towards legionella to me was that they all were at a residence hall... i.e. where there'd be air conditioners and such. +4  


submitted by hayayah(1056),
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tPetain sha hinocrc eaidrhra ndgaiel ot icmletboa siiod.cas Rayrrpetosi npsenicamtoo lliw alde to esdderace 2OC rraot(pseiry loiassakl iav aytvo.eilnri)tephn

usmleuser007  Aldo would increase b/c protons are anti-transported with potassium --> leads to hyperkalemia --> aldo activation ADH will also increase b/e of volume loss +1  


submitted by neonem(549),
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iustOertvcb tapruhoy ecsusa a rltnpaose taazeiom -&;-gt nehw nrleopgod, alurtub maegad eseuns. hisT laesd to an etacu butualr nseiorcs, tdhicecraarze yb cneciort pugsl in the tulubra ymsset sa ense in teh iemga

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +37  
usmleuser007  Think the postrenal azotemia is d/t her pregnancy. With the increasing in size fetus, the pelvic cavity is being compressed and thus there is pressure on the ureters. This leading to the presentation. As per above --- the crying maybe just d/t her pain and emotional stress caused by worrying about possible complications regarding her fetus. +4  
maxillarythirdmolar  My gut tells me it must be some sort of transient change in placental size with hormonal changes. It's reminiscent of what you might expect for breast changes during the menstrual cycle, imo +  
j44n  or maybe the fetus is literally crushing her ureters into the wall of her pelvis and shes got an infected kidney +1  


submitted by usmleuser007(370),
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vmh.8/g3bd./st.celw65n/0:oiuwp.1nm/biwthnp

ieRlef fo tbaelcrnita pani asw pdcuerdo ni ixs hmnua netsaipt yb tuiimotnasl of eesetclodr reantypnelm lnapimetd in teh rlvtpirieeuracn and reueutpacadqli rgya tem.art Teh llvee fo tumanotlisi nfuteicfsi ot diecnu naip lieefr esmse otn ot lerta the cueta apin hdotlse.rh aidIcmenstirni titriveepe luiianmstto peddoucr acetlrnoe to ohbt indtlsa-oeduoitrcump ipan ifrele and eht egsiaancl atnioc fo cicnroat mnceidai;to stih eorscps odulc be vrsreeed yb iscnaeenbt orfm umtinsoilt.a oidceamr-luoutiSntpd eflrie of ipan wsa evrrsdee yb anonoexl ni eivf uot of xis t.etiapsn Teshe suertls tgusseg ahtt cyafttsorisa eilnaailovt of epsrtinest aipn ni msahun yam be iboatned yb tciecenrlo ialtoiutnm.s

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2  
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +22  
xxabi  Also its the only one that's an opioid antagonist from the list! +2  
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4  
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2  
champagnesupernova3  Enkephalins* not encephalitis +  


submitted by killme(13),
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nitonItne to eTart Aniyasls

usmleuser007  in a per-protocol analysis,[6] only patients who complete the entire clinical trial according to the protocol are counted towards the final results +1  
sympathetikey  "In an ITT population, none of the patients are excluded and the patients are analyzed according to the randomization scheme." +5  
smc213  This video helps https://www.youtube.com/watch?v=Kps3VzbykFQ +12  
rio19111  Thx smc213, really helped. +1  
trainingrats  Where is this in FA2019? +  
teepot123  the video explains it well, no need for fa +  


submitted by thomas(0),
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oNt uers auotb siht, tbu ti esesm to me ttha tish is feinrgrer to rlpehood"seeeiutscsna notibrhii ncieife.ycd 'Ist an zeneym cdefte taht is etdrgrgei by MJN rlekocbs - lociucshcynenil or er'sr.cua

k/u.i.hrpstcci/rnea/do:detiowdihileiisPneat/neksfgeecywie_ops

usmleuser007  I believe this question was stating that AchE activity was abnormal = it was not lowering the Ach activity. Which suggests that another ligand like Ach was being used. +