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Welcome to whoissaad’s page.
Contributor score: 72

Comments ...

 +1  (nbme24#18)
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rtreAy fo sudtcu feerneds si a hcbnra of ioenirf sevaicl ert.ray oS yhw is B rno?gw

happysingh  the question is asking about "adequate arterial supply" +
azibird  The artery of the ductus deferens is USUALLY a branch of the SUPERIOR vesical artery, although it can branch from the inferior vesical artery in some individuals. +

 +1  (nbme24#49)
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htWa eatngerau do we ahev ttha teh ommaetor is giong ot pots okgisnm in hte amrentpat by "sgkai"n mih to od .?s.o

krewfoo99  There is no guarentee. They are basically asking what a trigger is for her asthma recurrence. Smoking in this scenario can be the cause of this patients symptoms. Dont dwell to deep into the question. +1

 +7  (nbme23#31)
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avelrSe msnea rae deus ofr lnetacedu hlaRyerbCsBo—,rstt aot,lbornms dan hlawsgt—amtioebl eon iromn votaanrii in rdwo sesne. hTe amne otaomlbnrs wysaal serfre ot ,larmon eaylhth llecs hatt are het memaediit courpsersr of ,aornml ha,lyhet tmruae ceeaultn)(a R.BCs ehT nema eoalglbsmat awasly sefrer to lonyramabl eopedevdl rr.rspouesc fenOt teh nmae bhoeytalsrrt si sdue mloysusnoyyn hwti ob.onltasmr

rmoF lal the tshign ehyt udolc sett us .o..n ):

 +0  (nbme23#39)
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C-H3O si nedeed ot amek C.FS dieamlAozteca ithbsiin iorncacb dshyaraen and ardeesce O-HC3 tanpoibsor mfro nrael sul.tbue

mario  could be pseudo tumor cereberi, ttt is also acetazolamide and is more common in female obese BMI 35KG/M +
mario  opening pressure could be normal in pseudo tumor cereberi +

 +0  (nbme21#39)
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reheW si tish evne fomr? yM ds'inm oigng yah weir rtginy ot utdsdnnrea htsi.

sahusema  Hardy Wineberg equilibrium square root 900 = 30 1/2 of all offspring will be carriers so 30*.5 = 15 simple as that +6
maxillarythirdmolar  this deserves a million upvotes. +1

 +6  (nbme21#41)
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  • ieSnc" mspstyom can recnaesi in etvrseyi duirgn the ,gnthi it ucold omeebc tfciidufl to flal paelse or runret ot speel rftae ainkwg up"

  • "LSR si noe fo rvleaes rsrdsedoi hatt nac escau nhsxeatiuo and dyamite ,islpnesees iwchh acn syonrgtl tceaff od,mo arintnccoonet, jbo adn lhcoos poae,crmrnfe nda pealnors l.iapoeinhrsst ynMa epploe hwit SLR rtopre yeht era notfe nleuab ot ectaorntnec, vhae eidpmari oe,yrmm ro liaf to cplsoimach yaidl askts"

  • "SLR usorcc ni ohbt men nda ,emwno ulthagoh wmneo rae more lielky to veah ti nhta n."em

  • het" osytmsmp ptliyyalc emcoeb rmeo rfueeqtn nad stla gronel thwi eag".

o:uecSr snwdscsa/SeaFseLsiiohhyelDv/re:itaS-pctw.-nvPedosh-ee/eetrErc.ttwguRFe-dsa/tSngntn-dmtCosns.gtrherita-o-/iei/

enirtEvyhg ni the emts tosnip odrtaws seserstl gel .oemysrnd

sulP I htughto yuo dene 9/5 fo eht GSI E ACSP ot adngosei op.ssrinede

eSemnoo elespa iplexna ):

peridot  Though everything else fits, in order to diagnose RLS you need to actually have leg symptoms which aren't described here at all. I agree that MDD also requires a bit of a stretch bc not all of the diagnosis requirements are met which is annoying, but at least the core components are there (decreased energy, sleep disturbances, lack of concentration), whereas the core component of RLS isn't there at all. It's like wanting to diagnose someone with a migraine because they have irritability, decreased concentration, and a visual aura but the person never even said their head hurt. It's not a great question and I completely missed MDD as well, but I can kinda see now why it's MDD more so than any of the other choices so it's kind of a "but which is the BEST answer" scenario. +2

Subcomments ...

submitted by lsmarshall(392),
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lxoerF mogturiid upfsodnur is sspbnrieloe orf eoiflnx fo PID. daMeli tpasce fo hte cuemsl (cihhw sefelx het t4h nda h5t ditg)i is ielpupds yb hte alnru vreen C(,8 1.T) ehT lrtaela tsepac hih(cw eflsex eth n2d nad 3dr dg)iit si nnreeadvit by the aeidmn enver csayieilpclf eth naritore ontissesuero archbn (C,8 .)1T So eht utsqinoe is dscginrbie a lnaaocietr iaggndma teh never ysplup to the IDP lofxre fo eht 2nd idtig in(exd nrf) sTih is siyang hte maeldi evnre si inbge amdadge C(8 and ;T1 werol kurtn s).toor

acimsrLbul nd(1t,2s/ indmea; th4rd,3/ )unrla aer a gorup fo umelscs atth xefl at eht MCP j,tion dna deexnt PIP dna PID .ntosji

odulC emeerbrm as 'exrfol imdgoriut udosupnrf si nurfodlopy ogln' iecns ntendso setnri no I.PDs deaCrmop ot exlrof dtioruimg icefpiulasris eshwo ondten srawp nodaru frsopuu'dn sfclpaieiluyr but esistnr on P.sPI

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +10  
whoissaad  @lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific. +  
aneurysmclip  shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals) +6  
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +  

submitted by dbg(140),
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moI, isht wsnaer oehicc si ngor,w trehe is on omrelpb ni het pocrsse of eloncgla sinyehst""s epr s.e eTh essiu is hitw eeseviscx ssenyisth dan sirodgeznaid ei.inoptods otN na orl'amabn tescnihty ro'pssec - as oludw eb ni DES, M,F eke,Msn .etc

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +2  
rockodude  dont overthink people, whether its an underproduction or overproduction of collagen, overproduction is still abnormal collagen synthesis. its abnormal to make an excessive amount of collagen 3 leading to a keloid +1  

submitted by alexb(45),
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I dunfceos iyamoclspysetdl rdeonysm wtih miayrpr omoisysfilbre absucee I ohhugtt 23- of ohtse RBCs kldooe klie prdotare csl.el stJu keli nweh ythe hwos na iameg fro obuulsl dphemiipgo nda s'ereht oesm driwe ncsdeo rpi rghthuo het erdu/bmreaadmlsl aylre nkiagm em nhtki tis' tno PB eevn houtgh I 'todn ownk twah eesl ti odwul e.b lmf

whoissaad  Made the same mistake +6  
targetusmle  i thought exactly the same!! 2 cells looked like tear drop cells :/ +2  
ilovemypuppies2295  I thought there were tear drop cells too. Seemed like it should be a metaplasia then. Oh well +  
lynn  I did the same, but looking at FA19 pg 423 it says "ineffective hematopoiesis --> defects in cell maturation of nonlymphoid lineage." You can get bilobed neutrophils, or if it progressed to AML you'd see auer rods. Nothing about tear drop cells. Then on pg 406 tear drop cells would be seen in myelofibrosis, and possibly thalassemias +  
waterloo  I thought the same, but I think that would be myelofibrosis, not myelodysplastic. Hb is really high here too. Pretty tricky for them to put that there, easy knee jerk. +1  
jawnmeechell  Interestingly enough, agnogenic myeloid metaplasia is the old name for myelofibrosis, with "agnogenic" being synonymous with "idiopathic." (or did everyone already know this) +  

submitted by kentuckyfan(43),
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Scnie the pnia si idr,aalcru a idsc inariehton is omst li.yelk

charcot_bouchard  Why it cant be a lumbar vertebra fracture +  
whoissaad  @charcot The patient is young and doesn't have any risk factors for weak bones. Also, disc herniation is a common problem in the young. The disc gets fibrosed and stiff in the elderly so they have less chance for disc herniation. So basically age was the key to answering this question. +3  
lovebug  you are genius! thank you! :) +  

submitted by gh889(115),
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ingfreRer ot NITRs dan sNINRT as siayatnm fo atenmtrte

Myana:its rfinvaeez ,)RIN(TN ferinvtoo R)TIN,( nad biiemeintacrt R)IT(N

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

submitted by hayayah(1056),
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rioblimefzF si a freiatb, desu rfo iergowln GT l.eselv

mousie  I also chose Gemfibrozil too because its the best TG lowering drug listed but I can see where there might be some red flags for this drug in the way they asked the question... 40 year old obese woman with some upper abdominal pain ..... HELLO GALL STONES which is a common adverse outcome of Fibrates. +10  
uslme123  Well I didn't wanna give a fat, forty, female, that smokes a fibrate. So a statin, for me, was the best next option. +9  
whoissaad  Used same reasoning to choose statins. Fibrates are the main drug of choice for hypertriglyceridemia but given her symptoms, statins made more sense. Why do they do this to us... +  
roaaaj  what a tricky question! there are multiple factors should be taken in consideration.. she has triglyceridemia which put her in risk of pancreatitis, and most importantly atherosclerotic disease, and all of that would outweigh the risk of giving her gallstone. +  
paulkarr  Yeah I had statins selected initially because "statins are always the answer" but when I saw them stating first line "recently diagnosed with hyper TG" I figured this follow-up was purely to address that. So Fibrate is the best move. +2  

submitted by d_holles(170),
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hisT iseunqto cndfeous em cb I ghotuht eeiadprlom could ont srosc teh BBB adn reofeetrh culod otn uesca iatpsorryer eeprsndsio om-i(upoid siognma at the saitenmrb rlsutse ni trayCoerpirS/Ns eosspdenri, .)1 utB @xdx.r si roetcrc ni nonitg that ↓ RR adn NSC esidernpso ni eth Pt usoldh lcla orf an mpiouido- tinangstoa etrhar hnat bohcneahlt thci)cnloi(immeo to ertta cisoatpinnto.

  1. dcra6prsge/isc0eana29otbq//agpalxssl7?hr.a.eli5o=siuhe.pth:tsitto.5y
nwinkelmann This explains a case in an infant. "Respiratory depression and coma after overdosage have been shown to be reversible by injection of naloxone [6]. Owing to its structural similarity to opioid, loperamide toxicity can be reversed by using Nalaxone which is a specific opioid antagonist acts competitively at opioid receptors. Naloxone hydrochloride is usually given intravenously for a rapid onset of action which occurs within 2 minutes." +3  
yb_26  FA 2019: "Loperamide has poor CNS penetration" - so it still penetrates => can cause respiratory depression +4  
whoissaad  Also maybe because the blood brain barrier in a baby is not developed as well as in an adult. +4  

submitted by yotsubato(962),
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nI oybol,ig shape aoainivtr is a htemdo rfo ndaglei wthi idplyra inavryg oneneimtsnrv itwouth iruergniq mndoar uantot.mi tI loivsenv teh aainrovit fo tpoeirn nxepsrs,ieo eyeqfrnlut ni an ofnf-o s,afionh htinwi triefendf rtpas fo a cbriaaetl ailtupoopn. sA hsuc eht eppeonthy nca tshcwi ta nfqseeeuirc taht aer umch hihreg moesesimt( tg1%;&) thna lsasclcia iatntmuo esar.t sePha taviioran btresitcuno ot vnereiucl yb eiagrtenng yt.irteeeenohg ulohtAgh ti sah neeb tmos ncoolmmy udsdtei in eth onctext fo muneim ,onvsiae ti si bsedorve in aymn rheot arase as elwl nda si elempdyo by ausvori etsyp of braeat,ic dlnincgiu nlSealoalm .eesicsp


whoissaad  is it the same thing as antigenic variation? +8  
dorsomedial_nucleus  No, antigenic variation involves genomic rearrangement Phase variation can be thought of as MORE or LESS of something. An on/off switch. No DNA is being rearranged, just under or overexpressed in response to the environment. +4  
makinallkindzofgainz  This isn't in Zanki, Lightyear, or First Aid, and I don't remember ever learning about this in class. Thanks NBME! :D +18  

submitted by nwinkelmann(282),
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Tish aicrtel ialenspx eht gposityalohyhpo wlel: /n8Bngosb13hw.t.:ht.vnooi4kK/slN04wmic/pb.//w.

ehT grhit vtreclnei is iyamirplr dpsuelip by het ARC hiwhc losa lpsipeus eth SA noed nda VA ndeo %0(9 of eathrs csueaeb tehy rae ihrtg mti)oannd, nilegad ot slso fo tliaiytnrtcoc of teh ihrtg d,esi adn sthu fildu plubuid scuiang dlteveae ltrcnae vouesn elaEetdv esspresru ni teh leriv nad rtopal emstsy ulwdo adle to tyhogeepaalm dan eref udilf cnaumtuliaoc in eth etrm.opienu

henoch280  Hellppp. pls why is it not decreased capillary oncotic pressure? +  
whoissaad  @ henoch280 Because there is no change in the levels of protein in the blood. +7  
drzed  theoretically you could develop liver failure from the increase in central venous pressure (e.g. cardiac cirrhosis) and THEN you would develop a decrease in oncotic pressure. +1  

submitted by hopsalong(25),
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This tseqoinu has a tlo fo eanrsw nto,psio dna oyu rarvei ta isiasetpohhNlir by wnhgrtoi uto lal hte toher nooispt by waht is miis.sgn

A, B - iCcatorl sicroesN dna pyPlalira ocNseirs lmaost alsyaw cruco in eht isnetgt fo icaie.hms ievuolsPyr lyhahet 82 yaer dlo nma has no deincvee of fyigalctninsi aeeddrsce enlar ufpeorni.s

C - tcuAe lruaTub oisserNc is athw oyu hsdolu hnkti fo with yitaaSlelc A()NDSI tiyoxt.ic heerT aer amyn hreot ercpnhoiotx rusgd that aceus ANT, but ihnkt fo TNA as durg ecuddni kniyde eagdam.

D - tiiCtyss - nFakl nipa is trdalee to kdneyi iy,nurj tno bdleadr ama.dge tistCiys uolcd eb ilbepsos in cneidagns ITU, utb eht tetnipa hsa no efrev dan si laem u(cmh sesl ocnmmo ni sma.)el

E - lnGorsrepomehliuit - isTh setg inot o/eicteinppcthrnirh myessond.r ehT etsm ntinmeos ttah he has ldboo in the urnie whchi amy adle ouy odnw the iientphrc ,watpahy ubt eh edso ton ahve ayn fo het oreth isoacsteda s.tmmpyso

F - hmraoypHneepr - etAnroh ordw fro Rlean lleC am.inorCac oN hetgiw ssol or otrhe acenrc aledtre ytomssmp iga(tfeu .ec)t

G - taitetinlIrs sihtreipN - iTsh is ofetn a rudg eidnduc MUIENM imeatdde xttic.onypheroi Tihs si a ptey VI ptvhnyeityisseri aeiocrtn that rsuocc sweke ot hmnsot trfea eth tasrt of tinodaicem (lkie NASs.DI) NTA si oerm siasaotdce htwi rgdu edrvsooe eiwhl Iirtiltsnaet is mero saeotaiscd tihw nmueim o.rneaict ietalItinrs srpitiNeh lwil evha CWB tcass ni e.niru

I - oersnylipihteP - uasdeC yb aiecsndng TUI ubt on freev si .tpneres

hiTs aeelvs otNilsraipihshe ()H as teh roectrc srnaew. 58% of eiishaslohNtrpi si tcosasidea twih oyihctpvae wlboe sun.dso Teh pain for isotrinlespiahh nca rlaseep nda me,rit nda aalciconsoly hte inap nac avlrte mfro het ekdyni (nklaf ipna) to het mroscut as the nsoet oemvs huohrgt teh e.etrru

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +3  
hyperfukus  yasss +  
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +4  
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +  
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +  

submitted by ergogenic22(300),
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why is tcrnteiopo of eht hdrooic xsep,ul fmor lienarrtruvitanc rpuuret rdasnceyo ot alrmgeni trmaxi haehmrogre ont a bolpssie s?anrwe

whoissaad  yes same question, both retinopathy and intraventricular hemmorage can occur due to high oxygen levels.. +  
cienfuegos  I mistakenly chose choroid plexus too, based on wiki seems this is most common cause of IVH in term infants: IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus. However, it is particularly common in premature infants or those of very low birth weight... Most intraventricular hemorrhages occur in the first 72 hours after birth. The risk is increased with use of extracorporeal membrane oxygenation in preterm infants. +  
burak  choroid plexus is different than germinal amtrix +  
meryen13  retinal hemorrhage is more common that IVH even if you think that it could damage choroid places secondary to germinal matrix hemorrhage. +  

submitted by assoplasty(92),
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I kithn the etcnocp yheter’ ttneisg si the iecnasedr TBG elsvel in gcperna,ny nad nto jtsu dsetyhipomrhiyr ni ar.egnle

eWhn sngcieren ofr dhmye/hriprs,ypothyio HST evslel aer LYAASW eefynlrptailer heedckc eusabce yteh rea omer itesinesv ot itmneu reesfdcinef ni .T3T/4 tfnOe etmsi SHT elslev nca moesdrtenta a hcenag neev ehnw 3/TT4 esllve are ni eth aclbiiunlcs .aergn Teh lnyo ecpontexi to stih owuld eb ni enynaprcg (nad I usgse aeybm viler e?fulari I ubotd teyh ouldw ask shit h.)tguoh ighH snoetgre lelsev srtevenp het ivrel from kgnbiaer wond BG,T galiend ot scnierdae BGT levsle in hte hTsi sidbn to eerf ,4T iceasnrdeg the mauton fo aelalviba erfe T.4 sA a snorepyoacmt eihs,mmnac TSH lesvel rea nnalestyrit adrnsicee nda teh RTEA fo 4T itudrpcnoo si rdiaecens to rplshenei labieens erfe 4T e.lsvel owrHeev teh TALTO tumano fo 4T is er.iesadcn

eTh toiusneq is aisgkn hwo to imrfocn stimodhrpyirehy in a npgerant awmno tg;--& ouy dnee to kchce REFE 4T eleslv saub(cee heyt odhlsu be mlnaor ued ot careoptnoyms oYu otannc eckhc HST (lauulsy atleeedv in cnygnepra ot scenptaoem rof neeisacrd )B,TG and you oatcnn echkc tltoa T4 svelle lwi(l eb reedc)n.isa Yuo got the sernaw rhgit ehteri awy but I nkhit hits is a fdirnefet igenansor hrwto ied,rngsinco uesbeac yhte nca ksa sith cctnpeo in eroth etsnotxc fo yhssneeioeptr,gm-r dan if hyet esldit SH”“T sa an ansrew ohiecc atht wuldo eb croeict.rn

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +7  
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +2  
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +  
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +1  
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +1  
lovebug  Amazing answer! THX +  

submitted by nosancuck(85),
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yWh adt!???

We eb lionok ta nsemooe wiht na RYS fomr edre Y emrocieyh! D eb a Y rimeoch eiHmo os tyhe eb nmaik esmo Ttiess Dntenmriie acrtoF which I be rsue aesmk omse eicn ill INAT LURLNEMAI OCTRAF os yde itna tgo thta elFeam alntnIre ctrTa u onkw hatw i be yanis

dAn ncsei mziimwn is ad TFUAELD hety ilts eb ttigne deos uyssp psil dna rsasbeet

meningitis  The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering: chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities +16  
yotsubato  Turner syndrome patients are also chromatin negative as well though.... +5  
sympathetikey  I didn't know a complication post-meningitis was lack of humor. +5  
sympathetikey  Ah, didn't read the last line. Yeah, that is taking it a bit far +20  
niboonsh  yall are haters. this is the first explanation that has ever made sense to me +5  
arkmoses Interesting syndrome watching this helped me to put it into real life perspective, interesting points they have no pubic hair/body hair, they apparently also dont smell, and breast size is usually increased... +1  
whoissaad  How does chormatin-negative indicate a normal cell? Isn't chormatin just condensed DNA? +1  
cienfuegos  According to this paper most individuals with Turner Syndrome are chromatin negative: "One of the initial laboratory procedures used to confirm or rule out this diagnosis involves a sex chromatin determination from a buccal smear. Cells from the lining of the mouth are stained for the presence or absence of X-chromatin or Barr bodies, which represent a portion of an inactivated X chromosome. The typical Turner’s syndrome patient, who has 45 chromosomes and only one sex chromosome (an X), has no Barr bodies and is, therefore, X-chromatin negative. This abnormal X-chromatin negative finding in the majority of Turner’s syndrome females is similar to the result found in a normal male, who also has only one X chromosome, and differs from the X-chromatin positive condition observed in the normal female, who has two X chromosomes. Occasionally, the patient with features of Turner’s syndrome is found to be X-chromatin positive." +1  
hyperfukus  i really hate haters this is awesome! +1  
selectuw  to add to the above, free testosterone is aromatized to estrogen leading to breast development +  
misrao  Is the free testosterone not creating male internal or external gentalia because of the defect in androgen receptors? +  

submitted by vi_capsule(13),
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HNT r,meycgeen miuodS .orrNietsisupd enkliU elyaniradhz a lnaedcba advaslooitr e(niv = )leoairrt

sympathetikey  Well then, I guess we should just forget about our old pals the Alpha-2 agonists. Good call. I didn't even see that this was hypertensive emergency. Dumb on my part. +  
zup  so yea clonidine would be used for hypertensive urgency, but this guy is over 180 (210) so they have to use something like hydralazine or nitroprusside both will increase cGMP +  
whoissaad  Drugs used to treat HTN emergency: Nitroprusside Labetolol Nicardipine Clevidpine Fenoldapam Clonidine +13  
lola915  Hydralazine actually vasodilates arteries>veins and Nitroprusside vasodilates arteries = veins. Both increase cGMP. +8  

submitted by yotsubato(962),
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Why is itsh NTO nrchac?dio srThee itghnon here taht sulre ti tuo.

drachenx  Chancroid is described as an ulcer.. whilst in this question they mentioned "vesicles". Pretty much only herpes is vesicular +5  
whoissaad  They mentioned ulcers too. I chose chancroid as well, couldn't find a clue to rule it out. Also thought "discharge" was pointing you towards a bacterial infection. But guess I'm wrong :) +  
emmy2k21  I think NBME/USMLE writers make the assumption the patient is in America unless specified otherwise. Chancroid is not common in the US. If the question stem mentions a developing country, then chancroid can make your differential list. +1  
selectuw  for chancroid, there may be a mention of inguinal lymphadenopathy +2  
samsam3711  Also with chancroid questions they want you to differentiate it between chancroid and syphilis, (eg. Painful vs. painless) and is usually described as a much larger ulcer that is painful (not vesicular as in this question) +  
suckitnbme  Also believe that chancroid does not presents with systemic symptoms like in this vignette. +  

submitted by neonem(549),
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jMroa sirk rtacof for rtioca diisotecns si i,prtenosnyhe adn in htis acse tmhig eb eud ot ieoancc e,us wihch ssaecu mradek ohensyrnpte.i iDotsessnci scuae a etar ni teh icntua nmatii -- bdool nca owfl sarkbcdwa into the uceiiamrrpd nad asceu n.dpeamato Tsih itenssafm sa aclskcre in the nlug ued to opor lfte clvianurrte cnioftnu cnfioilt(l/lsiaigd borpmle edu ot por.ncssme)oi

forerofore  there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this. +9  
temmy  please why is there where a diastolic mumur? +1  
whoissaad  @temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border) +8  
garibay92  Does anyone know why is this patient's tepmerature elevated? +1  
ratadecalle  @garibay92, not important for this question I think but cocaine can cause malignant hyperthermia +1  
almondbreeze  judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm +  
almondbreeze  he's only 28 - another clue for marfan? +  
turtlepenlight  did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection +2  
cmun777  @almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN. +1  
ibestalkinyo  @turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection. +1