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NBME Answers

medicine
Block/Question (20.8 difficulty score)
A 28-year-old man comes to the physician because of a 1-year ...
Schistosomiasis

Block/Question (8.4 difficulty score)
A 14-year-old boy is brought to the emergency department ...
Common fibular (peroneal)

Block/Question (16.0 difficulty score)
A 24-year-old man comes to the office because of a 2-day ...
Hair follicle

Block/Question (10.0 difficulty score)
A 14-year-old girl is brought to the physician after her ...
Acting out

Block/Question (14.5 difficulty score)
A 24-year-old woman comes to the physician for a follow-up ...
Vascular endothelial growth factor

Block/Question (8.9 difficulty score)
A 63-year-old woman comes to the physician 1 day after the ...
Calcium pyrophosphate

Block/Question (11.6 difficulty score)
A 55-year-old woman with small cell carcinoma of the lung is ...
Filgrastim

Block/Question (10.9 difficulty score)
A 37-year-old woman with right lower extremity edema is ...
P2 louder than A2

Block/Question (27.2 difficulty score)
During an experiment, a Southern blot analysis is done by ...
Gene rearrangement

Block/Question (11.0 difficulty score)
During a clinical study examining the effects of exercise, ...
Total peripheral resistance

Block/Question (19.7 difficulty score)
A 26-year-old man is brought to the emergency department by ...
Arterial baroreceptor firing rate: decreased;
Systemic vascular resistance: increased;
Pulmonary vascular resistance: increased;
Systemic capillary fluid transfer: absorption


Block/Question (10.8 difficulty score)
A 17-year-old boy is brought to the emergency department 30 ...
PCP (phencyclidine)

Block/Question (15.4 difficulty score)
A 26-year-old woman is brought to the emergency department ...
Pouch of Douglas

Block/Question (13.3 difficulty score)
A 14-year-old girl has had nausea, intermittent diarrhea, and ...
Microscopic examination of the stool

Block/Question (10.0 difficulty score)
A 40-year-old woman comes to the physician because of a ...
Sertoli-Leydig tumor

Block/Question (7.9 difficulty score)
A 45-year-old woman with systemic sclerosis (scleroderma) ...
Diffuse interstitial fibrosis

Block/Question (9.6 difficulty score)
A new blood test to detect prostate cancer is evaluated in ...
Prostate biopsies of men with test results equal to or below 5 ng/mL

Block/Question (7.5 difficulty score)
A 62-year-old woman comes to the physician because of low ...
Decreased osteoclast activity

Block/Question (17.0 difficulty score)
A 26-year-old woman is brought to the emergency department 3 ...
Serum HCO3-: decreased;
Arterial pH: decreased;
Blood PCO2: decreased


Block/Question (11.5 difficulty score)
An investigator is studying the incidence of the common cold ...
Decreased macrophage activity

Block/Question (10.2 difficulty score)
A 63-year-old man is brought to the emergency department ...
Hypercoagulability from advanced malignancy

Block/Question (15.3 difficulty score)
A 35-year-old man comes to the physician because of pain and ...
Separation of endothelial junctions

Block/Question (19.6 difficulty score)
A 4-year-old boy from Brazil is brought to the physician ...
Apoptosis

Block/Question (10.4 difficulty score)
A 33-year-old woman comes to the physician because of a 2-day ...
Inactivation of cellular p53

Block/Question (11.6 difficulty score)
A 27-year-old man is admitted to the hospital 45 minutes ...
Adenylyl cyclase

Block/Question (8.8 difficulty score)
A 30-year-old man is admitted to the hospital for evaluation. ...
Crohn disease

Block/Question (12.4 difficulty score)
A couple comes for preconceptional genetic counseling because ...
50%

Block/Question (9.4 difficulty score)
A healthy 22-year-old man participates in a study of glucose ...
Glycogenolysis in the liver

Block/Question (13.8 difficulty score)
A 63-year-old homeless man is brought to the emergency ...
C5a

Block/Question (13.9 difficulty score)
A 16-year-old boy is brought to the physician because of a ...
Escherichia coli

Block/Question (18.1 difficulty score)
A 16-year-old boy is admitted to the emergency department ...
Hemopneumothorax, not under tension

Block/Question (21.8 difficulty score)
A 20-year-old woman comes to the physician because of a ...
von Willebrand disease

Block/Question (18.9 difficulty score)
A 2-year-old boy is brought to the physician for a well-child ...
Trinucleotide repeat expansion

Block/Question (10.3 difficulty score)
A 31-year-old woman with type 2 diabetes mellitus comes to ...
α-Toxin

Block/Question (15.3 difficulty score)
A 10-month-old boy is brought to the physician because of a ...
Mediation of cell entry via a fusion protein

Block/Question (8.4 difficulty score)
A 17-year-old girl is brought to the emergency department 15 ...
β2-Adrenergic agonist

Block/Question (10.5 difficulty score)
A 30-year-old woman, gravida 2, para 0, aborta 1, at 28 ...
Formation of antibodies to RhD

Block/Question (8.7 difficulty score)
A 52-year-old woman begins pharmacotherapy after being ...
Metformin

Block/Question (7.3 difficulty score)
A sexually active 23-year-old man with multiple sex partners ...
Antigenic variation

Block/Question (7.2 difficulty score)
A 17-year-old girl is brought to the physician by her mother ...
Hypogonadotropic hypogonadism

Block/Question (9.6 difficulty score)
A 49-year-old woman comes to the physician for a follow-up ...
HDL-cholesterol: increased;
Triglycerides: decreased


Block/Question (7.7 difficulty score)
A 15-year-old girl comes to the physician because of a ...
Stimulation of the sebaceous glands by androgens

Block/Question (6.8 difficulty score)
A previously healthy 40-year-old man is brought to the ...
Pericardium

Block/Question (12.8 difficulty score)
A 55-year-old man is brought to the emergency department ...
Blood pressure: 85/60;
Pulse: 120;
Jugular venous pressure: increased;
Pulsus paradoxus: increased


Block/Question (10.6 difficulty score)
A 54-year-old woman comes to the emergency department because ...
Decreased metabolism of codeine to morphine

Block/Question (6.3 difficulty score)
A 14-year-old girl with a 9-year history of type 1 diabetes ...
Countertransference

Block/Question (14.1 difficulty score)
A 23-year-old woman with bone marrow failure is treated with ...
Immune complex deposition in tissues

Block/Question (21.9 difficulty score)
A 25-year-old man is brought to the emergency department ...
Ribosomal assembly

Block/Question (9.1 difficulty score)
A 42-year-old woman comes to the physician because of ...
Thyroid-stimulating hormone: decreased;
Total thyroxine (T4): increased;
Free thyroxine: increased;
Thyroid-binding globulin: normal


Block/Question (14.0 difficulty score)
A 29-year-old woman is prescribed carbamazepine for ...
Metabolism

Block/Question (14.7 difficulty score)
Over 1 year, a study is conducted to assess the antileukemic ...
Open-labeled clinical trial

Block/Question (5.4 difficulty score)
A 64-year-old man with non-Hodgkin lymphoma comes to the ...
Vincristine

Block/Question (8.6 difficulty score)
During an experiment, drug X is added to a muscle bath ...
Cholinesterase inhibitor

Block/Question (10.7 difficulty score)
A 42-year-old man comes to the physician for a follow-up ...
The patient's perception that the physician is uncaring

Block/Question (9.6 difficulty score)
A 72-year-old woman comes to the physician because of a ...
Echocardiography

Block/Question (10.0 difficulty score)
A 14-year-old boy is brought to the physician for a physical ...
Normal development

Block/Question (8.1 difficulty score)
A 5-year-old boy is admitted to the hospital because of a ...
Inability of leukocytes to kill intracellular microorganisms

Block/Question (8.0 difficulty score)
A 22-year-old woman contacts a medical student and asks if he ...
He cannot date her because she was once his psychiatric patient

Block/Question (8.5 difficulty score)
A 73-year-old woman comes to the physician because of a ...
Vitamin B12 (cyanocobalamin)

Block/Question (7.9 difficulty score)
A 45-year-old man comes to the physician because of right ...
Infraspinatus

Block/Question (8.3 difficulty score)
A 54-year-old man comes to the physician for a follow-up ...
Amygdala

Block/Question (12.6 difficulty score)
A placebo-controlled clinical trial is conducted to assess ...
Significant findings can be reported with greater confidence

Block/Question (7.0 difficulty score)
A male stillborn is delivered at 32 weeks' gestation to a ...
Pulmonary hypoplasia

Block/Question (23.0 difficulty score)
A 33-year-old man undergoes a radical thyroidectomy for ...
Branch of the thyrocervical trunk

Block/Question (6.2 difficulty score)
A 42-year-old man comes to the physician for a follow-up ...
Na+–Cl− symport inhibitor

Block/Question (9.7 difficulty score)
A 55-year-old man comes to the physician because of a 2-week ...
Basement membrane

Block/Question (8.1 difficulty score)
A 24-year-old man is brought to the emergency department 40 ...
Foramen ovale

Block/Question (10.0 difficulty score)
A 55-year-old man who is a business executive is admitted to ...
Splitting

Block/Question (7.9 difficulty score)
A 3-year-old boy with chronic granulomatous disease is ...
Vancomycin

Block/Question (20.4 difficulty score)
An otherwise healthy 45-year-old man comes to the physician ...
Elaboration of proteases and urease with local tissue destruction

Block/Question (20.1 difficulty score)
A 10-year-old girl is brought to the office by her mother ...
It is a polymorphism

Block/Question (8.1 difficulty score)
A previously healthy 40-year-old woman is brought to the ...
Thrombotic thrombocytopenic purpura

Block/Question (10.1 difficulty score)
A 17-year-old girl has never had a menstrual period. Physical ...
Androgen insensitivity

Block/Question (17.3 difficulty score)
A 12-year-old girl is brought to the physician because of a ...
Decreased activity of UDP glucuronosyltransferase

Block/Question (10.0 difficulty score)
A 47-year-old woman comes to the emergency department because ...
Annular pancreas

Block/Question (7.1 difficulty score)
An 8-year-old boy is brought to the office by his mother ...
Adenovirus

Block/Question (14.8 difficulty score)
A 36-year-old man with profound intellectual disability is ...
Omental bursa (lesser sac)

Block/Question (14.0 difficulty score)
A study is designed to evaluate the feasibility of ...
Case series

Block/Question (9.4 difficulty score)
A 56-year-old man comes to the emergency department because ...
Uric acid crystals

Block/Question (15.1 difficulty score)
A 62-year-old man comes to the physician for a follow-up ...
Type I pneumocytes: decreased;
Type II pneumocytes: increased;
Fibroblasts: increased


Block/Question (10.8 difficulty score)
Six healthy subjects participate in a study of muscle ...
Fatty acid oxidation

Block/Question (7.4 difficulty score)
A 72-year-old woman who has smoked 20 cigarettes daily for ...
Timolol

Block/Question (7.5 difficulty score)
A 54-year-old man comes to the physician because of episodes ...
Third-degree atrioventricular block

Block/Question (17.0 difficulty score)
A 15-year-old boy is brought to the emergency department by ...
Olfactory nerve

Block/Question (10.1 difficulty score)
A 42-year-old woman comes to the physician for a routine ...
Parathyroid gland

Block/Question (7.8 difficulty score)
A new severe respiratory illness caused by a newly identified ...
Avoids the concern for reversion to virulence

Block/Question (11.4 difficulty score)
A 72-year-old woman comes to the physician because of a 3-day ...
Aspiration

Block/Question (12.4 difficulty score)
A 25-year-old woman comes to the office because of a 6-month ...
Cyclin-dependent kinases

Block/Question (22.5 difficulty score)
A 72-year-old woman is brought to the emergency department by ...
Area labeled 'C'

Block/Question (7.8 difficulty score)
A 4-year-old boy is brought to the physician because of slow ...
Calcium: decreased;
Inorganic phosphorus: increased;
1,25-dihydroxycholecalciferol: decreased;
Erythropoietin: decreased


Block/Question (7.8 difficulty score)
A 42-year-old woman is brought to the emergency department ...
Infraorbital

Block/Question (11.6 difficulty score)
A previously healthy 24-year-old woman who is a college ...
Lubiprostone

Block/Question (14.3 difficulty score)
A 32-year-old man is brought to the emergency department 30 ...
Membranous

Block/Question (19.3 difficulty score)
A 2-year-old boy is brought to the office by his mother ...
DNA virus

Block/Question (12.8 difficulty score)
A 46-year-old woman with active ankylosing spondylitis comes ...
Tumor necrosis factor α

Block/Question (6.6 difficulty score)
During a study of renal glomeruli, a healthy animal kidney is ...
Increased hydrostatic pressure

Block/Question (5.5 difficulty score)
A 67-year-old woman is brought to the emergency department 30 ...
Syndrome of inappropriate secretion of ADH (vasopressin)

Block/Question (18.3 difficulty score)
A 23-year-old woman comes to the physician for genetic ...
The patient's DMD carrier status is uncertain because of random X inactivation

Block/Question (9.2 difficulty score)
A randomized controlled trial is conducted to assess the risk ...
0.2

Block/Question (5.5 difficulty score)
A 35-year-old woman comes to the office because of a 3-day ...
Explain that the patient does not need the MRI and that it is not appropriate to misrepresent her examination findings

Block/Question (13.7 difficulty score)
A 6-day-old breast-fed boy is brought to the emergency ...
Galactose 1-phosphate

Block/Question (9.0 difficulty score)
A 14-year-old boy is brought to the physician because of a ...
Infectious mononucleosis

Block/Question (10.8 difficulty score)
In a cohort study of elderly women, the relative risk ratio ...
Statistically significant overall increase in risk

Block/Question (9.4 difficulty score)
A 12-year-old boy is brought to the physician by his mother ...
Patellar ligament

Block/Question (9.7 difficulty score)
A 22-year-old woman comes to the office because of a 3-day ...
BK virus

Block/Question (5.9 difficulty score)
A new test to detect the presence of malarial antibodies by ...
95%

Block/Question (14.5 difficulty score)
A 30-year-old woman comes to the physician because of a 2-day ...
The second CFTR mutation was not detected by the testing obtained

Block/Question (8.0 difficulty score)
A 52-year-old man is brought to the emergency department 30 ...
Increases nitric oxide concentration

Block/Question (5.8 difficulty score)
A technician wants to determine whether cytomegalovirus (CMV) ...
Polymerase chain reaction

Block/Question (6.7 difficulty score)
A 16-year-old boy comes to the physician because of a rash on ...
Carditis

Block/Question (23.9 difficulty score)
After being severely beaten and sustaining a gunshot wound to ...
Reassure the patient that her chance of becoming addicted to narcotics is minuscule

Block/Question (13.8 difficulty score)
A 51-year-old man comes to the office because of a 6-month ...
Submental

Block/Question (9.8 difficulty score)
A 31-year-old woman comes to the physician because of a ...
Lifelong persistent infection

Block/Question (8.8 difficulty score)
A 57-year-old man receives radiation therapy for a squamous ...
G1

Block/Question (8.5 difficulty score)
A 55-year-old man comes to the physician for a routine ...
Increased peripheral vascular resistance

Block/Question (11.1 difficulty score)
A 53-year-old man comes to the physician because of a 6-month ...
Superficial inguinal

Block/Question (7.4 difficulty score)
A 59-year-old man is brought to the emergency department ...
Hypovolemic

Block/Question (8.3 difficulty score)
A 2-week-old newborn is brought to the physician for a ...
Normal reflex response

Block/Question (15.9 difficulty score)
A 14-year-old boy is brought to the office for an examination ...
Normal findings

Block/Question (7.4 difficulty score)
A 65-year-old man is brought to the physician by his daughter ...
Substantia nigra

Block/Question (8.3 difficulty score)
A 67-year-old woman with congenital bicuspid aortic valve is ...
Binding to the 30S ribosomal protein

Block/Question (8.4 difficulty score)
A 22-year-old woman comes to the office because of a 4-day ...
CD28 on T lymphocytes ⟶ CD80 on epidermal Langerhans cells

Block/Question (4.1 difficulty score)
A 33-year-old man undergoes a radical thyroidectomy for ...
Branch of the thyrocervical trunk

Block/Question (6.0 difficulty score)
A 6-year-old girl is admitted to the hospital because of a ...
Myeloperoxidase

Block/Question (5.8 difficulty score)
A 7-year-old boy who lives in Kentucky is brought to the office
Ingestion of soil

Block/Question (6.2 difficulty score)
A 23-year-old woman is brought to the medical tent 2 minutes after
Orthostatic hypotension

Block/Question (2.7 difficulty score)
A 51-year-old man comes to the office because of a 6-month ...
Submental

Block/Question (3.7 difficulty score)
A 50-year-old woman comes to the physician for a follow-up...
baroreceptor output

Block/Question (2.7 difficulty score)
A 27-year-old man comes to the emergency department....
gastric mucosa

Block/Question (1.9 difficulty score)
An asymptomatic 44-year-old man is found to have HIV infection
Petechiae

Block/Question (0.9 difficulty score)
A 65-year-old retired man comes in for a health maintenance...
FA 2020 pg. 684 "Risk factors include smoking, secondhand smoke, radon, asbestos, family history."

Block/Question (0.6 difficulty score)
A 65-year-old retired man comes in for a health maintenance...
FA 2020 pg. 684 "Risk factors include smoking, secondhand smoke, radon, asbestos, family history."

Block/Question (0.7 difficulty score)
A 26-year-old woman comes to a busy
"Thank you for waiting. How can I help you today?"

Block/Question (0.1 difficulty score)
A 12-year-old boy is brought to the physician because of a 2-month
Upward gaze

Recent comments ...

... benwhite_dotcom made a comment on free120/block2/q#30 (An otherwise healthy 45-year-old man comes to the...)
 +16 
submitted by benwhite_dotcom(328)
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As as,yawl ’sit tslaom etbret to rneogi eth tsrpiceu when ssplibe.o hsTi leanntmeg hsa a cptipe lrceu, ihwch we wkno is aucsed lamidpnreeyot yb .H yrplio feito.nnci H. opliyr pucersdo saeeorstp adn apcruarillty a,usree ihchw lawlo it ot srnaicee the Hp fo ist colla oemtnivenrn by cgnlvaei arue itno nia,omam cihwh si itxco ot grticas mcou.sa eTh eirptuc edorttsaesnm H p,iroly icwhh rea etveind with viselr t.gniasin

joonam  Hey bro, thank you so much for your contributions on these free 120 questions. Your advice on test taking strategies for step 1 have been very helpful. +18
luciana  "Elaborated enzymes by H. pylori may also contribute directly to epithelial cell injury. Ammonia produced through urease activity may be toxic to gastric epithelial cells. H. pylori protease and lipase degrade gastric mucus and disrupt the phospholipid-rich layer at the apical epithelial cell surface, allowing for cell injury from back diffusion of gastric acid." https://www.ncbi.nlm.nih.gov/pubmed/9394757 +2
luciana  I got tricked :( Thought the damage was due to destruction of local somatostatin cells with increased gastrin and acid production... but this is actually the mechanism of duodenal ulcers development related to H. pylori But makes sense, so thats how the somatostatin producing cells are destroyed lol +4
drpee  "Hyperacidity and gastric ulcer development" is also sort of true, but this is hinting at the mechanism for DUODENAL ulcer development from H Pylori. Irritation in the stomach leads to G Cell hyperplasia, increasing acid secrection which causes downstream ulceration. +2
itsalwayslupus  Did anyone else pick the hyperacidity answer just because the correct answer had "local tissue destruction" in it? I figured that H. Pylori was non-invasive, so would not directly damage the tissue it is localized too +2
... sugaplum made a comment on free120/block2/q#31 (A 10-year-old girl is brought to the office by her...)
 +13 
submitted by sugaplum(245)
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aecsIn yonnae lees aws ghntknii eht mase:
I swa utcsk ewebetn hist dna atrvnai fo nnuowkn iac.nifcgiesn vHrewoe, tinraav fo nnuokwn gicsaecninfi is a eeecquns otn a enlsgi cdeuolneit

nbme4unme  Thank you for explaining, I selected the unknown significance answer as well! +2
... imnotarobotbut made a comment on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
 +10 
submitted by imnotarobotbut(139)
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hisT si a adb qiet.nuso teltPael rgogagitaen emti genbi lanomr, ok fine I nac ese .atth uBt FWV lziaetisbs toarfc 8 nad yo'ud ese na esaricen ni TTP srft(i elin nxte to FWV in rstiF A.)di hWy is ethri TTP lonma?r

mambaforstep  yeah but if they gave you an increase in PTT then Hemophilia A could have been a valid answer choice. so they prob showed a nl PTT to differentiate vWF dz from hemophlia A +
drpee  VWD only sometimes presents with a slightly increased PTT. Don't let those anki facts steer you wrong... Plus all the other answers make no sense. Afibrinogenemia? That means literally no fibrinogin (PT and PTT would be infinitely increased). Hemophelia? Or vitamin K deficiency? Those are coagulation factor disorders so they would present with deep bleeding and large bruising. (Unlike platelet disorders, including VWD, which present with mucosal bleeding, petechiae, and heavy menses). VWD is actually the ONLY one that makes sense. +
... benwhite_dotcom made a comment on free120/block1/q#21 (A 63-year-old man is brought to the emergency...)
 +9 
submitted by benwhite_dotcom(328)
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tn’oD let htem dilbn uyo twhi isth asent’tip ersm.yi The ieuss fo the ady si htat he sah a .TVD ’Tsaht hyw eh acme to eht RE in eth rtfsi enensetc dna tawh het utolnadrsu howss ta the den. tantiePs ithw necarc aer eyhpaeo.cugbrlal

focus  LOL best explanation possible. +
... benwhite_dotcom made a comment on free120/block1/q#33 (A 2-year-old boy is brought to the physician for a...)
 +9 
submitted by benwhite_dotcom(328)
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rialFge X is a GGC niueotirtcedl aterep nxpinseoa rsroddei (ihcwh elki nonsHi’gnttu si a etts oerfia.tv) hTe leranatm enulc is the tnhi ot teh nXdklei- ihe.inraetcn mkAitisu-el iasrhevob and aeyrtivlel glrae edah rae om;mcon glear scislttee noly aperpa tefar eurpy.bt

... benwhite_dotcom made a comment on free120/block2/q#26 (A 55-year-old man comes to the physician because of...)
 +9 
submitted by benwhite_dotcom(328)
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A ewn egsritlnib idsasee ni an reold esnorp is tliypacly ggnoi to eb a spigpuehm qt.nieous Tehn you jtsu evha to rembmree hte cnfedeiefr enwbtee uolsulb podhmegiip sv gpsemphui rsgauvli. lusluoB mdipgheipo si riehzadtccera yb eth ossl of oemmiessohdsme tath ndib aocytsnekiter ot het sneetamb rme,nameb leutsinrg ni ballu bgi( stblrsei) ni seara of fiirntoc iohceC( A.) tniPsate tiwh pgsmuihep riusgval sloe htier dssooeemms hcw(ih bndi ktercsatiyeno ot haec heto)r, so that trihe snik si usrpe aiflerb, chhiw etsusrl in ntroliauce. hMtuo lsecur rae roem ocmnmo in V.P

drpee  Also question suggests a negative Nikolsky sign ("The blisters do not easily break"). This suggests BP over PV. +1
... benwhite_dotcom made a comment on free120/block3/q#7 (A 72-year-old woman comes to the physician because...)
 +9 
submitted by benwhite_dotcom(328)
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They hvae iedsecdbr thwa yuo eamuss is a aclscsi seac fo mpuoanien. t,Bu PAN nits’ an enrasw c.choie tWah teh tnxe sbte i?tngh heT !eucsa dOl lfair eeoplp nad( hsialoclo)c evlo ot etg apoiairtsn nnameupoi. LRL is het mtso cmonom stie, whhic tyeh avhe diepvdor nk(tah ,you gib lrvceati cu).nsrbho Teyh vnee gave yuo eht tinh htta eht iepatnt has “dytifufilc ,lnwowlsa”gi chhiw si doce rof pietsaa“sr enwh o.lsag”nilww

... benwhite_dotcom made a comment on free120/block1/q#40 (A 17-year-old girl is brought to the physician by...)
 +7 
submitted by benwhite_dotcom(328)
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noarAixe eldsa to tpoidoyhgonoprca sadmnyopiho,g sa teh dboy alrzsiee taht teh soliptbisiy of irunsignho a ufest is ozer and isvge up teh esrepn.et Tseeh’r a lto fo inouprpstg dat,a utb one dsluoh ugess iths awersn ceon yuo ared the rdwo t“ygsm”an o(r drn“c.ea)”

... benwhite_dotcom made a comment on free120/block2/q#21 (A 54-year-old man comes to the physician for a...)
 +7 
submitted by benwhite_dotcom(328)
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reFa = adglyaam

tTha si all I ntaewd to yas tbu I sgesu atth si oto rtsho to eb cedetpac by eth ef.ombwr

... benwhite_dotcom made a comment on free120/block3/q#4 (A 15-year-old boy is brought to the emergency...)
 +7 
submitted by benwhite_dotcom(328)
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NCS biaisaesmo is tsom yroiuosntol ecasdu yb ageelNiar wifle,or cihhw I argoneeuc oyu to zimemoer sa het nne“rgaat-iib aome.ba” uodFn in feera-wshtr eisodb fo aetrw lkie npdos dan ksela, ti ash there fros:m a ,ytsc a etpihozotor ,ombd)ia(e adn a flltaegilabe .i(e. has wot lf.)lgeaal octneinfI si aiv locratyof clle xosna ouhtghr eth mrcbrifroi lpate to teh rinba.

mullerplouis  To add to this it causes Meningoencephalitis. Look out for confusion and brain signs mixed with signs of meningitis. Only a handful of organisms that cause both. +2
osler_weber_rendu  Am I the only one who thought portal of entry cant be through a nerve and just ignored all the nerves? +19
luciana  @osler_weber_rendu I thought the same... I knew it was through cribriform plate, but not that was actually through the nerve +6
paperbackwriter  @osler_weber_rendu yeah same here, otherwise would have been a much simpler question +
melchior  In line with the thinking above, SketchyMicro teaches it as if it just passes through the cribriform plate, ignoring the nerves. Wikipedia says that it actually enters the nerves, then passes through the plate. +2
... waterloo made a comment on free120/block2/q#33 (A 17-year-old girl has never had a menstrual period....)
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Just to add to explanation. Answer is not congenital adrenal hyperplasia, because pt has normal breast development and normal external genitalia. most common type 21-hydroxylase def would have precocious puberty or clitoral enlargement. Questions says patient has normal appearing external genitalia. 17a-hydroxylase def would lead to ambiguous genitalia in XY and in XX there would be no secondary sexual development because lack of sex steroids. But again, question says pt has normal breast development and external genitalia. In 11B-hydroxylase def, XX would have virilization, again not applicable here.

ectodermal dysplasia would have more characteristics like abnormal teeth, other abnormal findings from ectodermal layer.

a psych disorder could throw you off, maybe patient is not eating enough and is not having a period. But they said normal female body habitus, so I think that seems less likely compared to androgen insensitivity.

Sex chromosome mosaicism made me think of Turner Syndrome. There is a unique body habitus for Turner Syndrome so makes this a wrong answer.

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rtoekS raahcrteecdzi yb tfel esmiirhpaes dan tirhg NC12 sya.pl edrCsso fidgsinn mane a amsteinbr esi.nol ghiRt pisr)eital(al gntu,eo deis-dfetl aaaoetclr)tlr(n ssewkean emsan eth gxetini thgri soohlgpasly reevn ash enbe dtfeecaf wih(tin eth ghrti lua.dle)m C is hte rmpyadi hrwee het tlairccpoisno trtca nurs ot oolnctr messclu orrip( ot het iaoutcnsd.)es Tshi si nnowk as eht idmlae eryamllud oymderns ro iDrjenee mde.rnyso

d_holles  It seems to me that the brain stem problems can all be answered using the Rule of 4s rather than memorizing the actual brain stem histology. +9
llamastep1  Yeah I think so too! With the right CN12 palsy you already know it has to be medial (factor of 12) and that would be enough to answer this question. The hemiparesis just confirms that its a medial lesion (starts with M). I know many of us like to really understand the concepts not just use these "tricks" but hey if it works it works. +2
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Oalr eliscev thni( .h)tni eristgnBli cuiarlvse lsoein no the n.ahd No e,efrv otn iiganxortpapec-. This is erHspe uo(y yma emerrmeb sietdnst tgtengi hpicrete wtliowh in oryu ,ussitde hwihc is thwa stih s.)i tsoM kflos teg VSH1 as hlr,dince htguho osvuloiyb not lal are tpymm.acoits VHS is a gelar erud,db-elnosadt raenil DAN .viurs

jiya   why cant this be hand foot and mouth disease cause of coxsache +2
drachenx  Also thought it was Hand-foot-mouth an RNA virus but I did consider Herpes. Changed because I thought Hand foot and mouth would be more common. +
llamastep1  Hand foot mouth usualy involves all 3 places (hands, feet and mouth/perioral area) and the lesions on the hand arent localized to just one finger. +1
aneurysmclip  Hand foot mouth disease affects palms and soles. ref: FA 2019 - 150 +2
raffff  wouldnt the history also be different for coxsakie +
focus  I think this image is trying to show the "dew drops on a rose petal" sign on Hermes, the god of Herpes on Sketchy Micro +
drpee  Google some images of HF&M disease. The small blisters look very different from herpetic whitlow. +
... em_goldman made a comment on free120/block3/q#15 (A 46-year-old woman with active ankylosing...)
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Rituximab (anti-CD 20) is currently undergoing trials for AS. My sparse googling just now shows that rituximab probably only has a moderate effect, so probably second-line to anti-TNFa therapy. Probably.

Safe to say for boards that AS: TNFa > CD20

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ndtheEloila ihttg snn’ocijtu pltbeiiyemar is eanrcieds in epseorsn to iujnyr dan ,lonamatmiifn glaniwlo troimnaig of tiweh odlob sclle dan dsrnfei ot teh esti fo nruy.ji

jesusisking  Thank you! +
focus  Ugh I was thrown off by "disruption of vascular basement membranes" since it seemed similar to the correct answer but I can see how "separation" would be a normal, expected response of the body that is needed vs. "disruption" would be traumatic and abnormal... please correct me if I am wrong! +
blah  @focus reasoning sounds right. I nearly picked that but the other choice sounded better. Just semantics. +
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tpepoxiAmar natfgis olghipsyoy ingi:mt teh p-opattsrsovieb hspae -62(4 usroh earft a leam) si noitmedad yb .onlgisgcoelysy eulgeosconieGns rmfo 24 orhus ot 2 da.sy nehT eis.skot

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ehT orraw is tnnoigpi ot a pohurnltie eb(omdtulli usluc):ne niam hitrfeg fo hte numeim tymess in cutae tloafmininma dan ciaartebl cnionitfe hc(us as aanoiiprst nua.oem)pin a5C is a tcihmcaoect forcta fro MsPN.

ibestalkinyo  Other chemotactic factors include IL-8 and LTB4 +3
... benwhite_dotcom made a comment on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
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nov bieanllWdr iedseas si yb rfa het stom ocmomn irithende edilengb sahsedi.ti qeteF,lnury eth ynol obrtorayal ylbanmtoair is sicrdenea eigedbnl etmi ltylria(le oyu icprk eth apittne and see owh lngo ti estak htem ot otps gndbee)il. nO teSp, lenedgib nomew have W.DV eBglnide syob heva olhhapieim.

winelover777  Agree. PTT does not have to be elevated to be VWD. +3
tulsigabbard  Welp. +
... hungrybox made a comment on free120/block2/q#7 (A 23-year-old woman with bone marrow failure is...)
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submitted by hungrybox(832)

This whole question is on the different types of hypersensitivity. (pg. 113 FA2019)

eosinophil degranulation → Type 1 hypersensitivity (mast cells early, eosinophils/others later)

widespread apoptosis of B lymphocytes → B lymphocytes are involved in Type 2 hypersensitivity. Widespread apoptosis would not occur. If anything, B cells would proliferate?

Cytokine secretion by natural killer cells → NK cells use perforin and granzymes to induce apoptosis in type 2 hypersensitivity. (Not sure if they secrete any relevant cytokines...)

immune complex deposition in tissues → serum sickness (Type 3 hypersensitivity)

polyclonal T-lymphocyte activation → type 4 hypersensitivity

... benwhite_dotcom made a comment on free120/block2/q#10 (A 29-year-old woman is prescribed carbamazepine for...)
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ambnCrzaaeiep si a usoinrtoo 0P4Y5C dunr,cei os uyo odushl eb eunissgg smeaotbiml no etartm h.atw 0P5Y4C yalsp na otrtipamn leor in bhto amtinvi D oobicvtinitaa dna eoatnadrdgi in eth l.vire

mambaforstep  ahhhh i didnt know CYP450 played a role in vit D bioactivation/degradation. thanks! +
... bharatpillai made a comment on free120/block2/q#19 (A 73-year-old woman comes to the physician because...)
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Subacute combined degeneration never produces exagerated reflexes. It's one of the causes of babinski + with absent ankle reflex.

melchior  From googling it, it seems that B12 deficiency can produce either hyperreflexia or hyporeflexia. This makes sense, because it causes both UMN lesions (causing hyperreflexia), but it also affects the afferent pathways. https://www.hindawi.com/journals/crinm/2013/159649/ +1
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Spittlngi si an tmermiau esfedne shcmiaemn oefnt edlympoe yb attpsnie hwit ndebeirlor ayotieprlns dsdrer.oi neWh tsigpiltn, a sorenp lisfa ot ese otrhes as bclaepa of hignva ohtb itsvipeo adn vteieang siueltqa;i ta any iveng m,eti s’ti lla or tonhi.ng

d_holles  Got this one wrong -- thought it was acting out. +1
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rengnAdo esitntvsyiiin is csudae yb a eeviedcft nongreda peort.erc THD si sseioenprlb fro tagcnrei emla lgaiainet dirnug fteal aeluxs vdm.poleeent The default manuh reengd is la.feem So a gyeetlicanl leam neaittp ithw ctmeelop raengdon nsiiitvinesyt is nltxleryae oayhpitleyplcn .ameefl kcaL fo rnosespe ot ealradn goenndsar tpseevrn irah oniatrmof diunrg pbertuy rern.eac)d(ha

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’Im noigg to oiptn otu tath a rlnamo eahlhyt ikd ihwt on acrdaic yihosrt ro mpotmyss and no falmiy tsyorhi fo nsdeud ircaadc tadhe fro a eospprrs-t phlsyaic is bpolybra igogn ot haev a niengb axme on tteram hatw oyu nihkt oyu ra.he

the260guy  What a weird question. I could definitely hear a fixed split heart sound. And it was loudest over the pulmonic valve too which makes it even more of a dirty question. But I guess what I was actually hearing was an S3 heart sound. +5
wutuwantbruv  @the260guy I believe the splitting is being heard only during inspiration, making this normal physiologic splitting. Perhaps that's just my ears. +7
angelaq11  don't have adobe and couldn't download it, so I just chose whatever, but your explanation suddenly makes me feel dumb but grateful! Loving your tips! @benwhite_dotcom +
blah  @the260guy Have to agree with wutuwantbruv. I interpreted this as a physiological splitting, had the opportunity to hear it in a newborn as well. +1
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dgyieL elcsl ekma ttrt.oeosnsee eLigdy cell osumtr at’rne lwyaas aclolpsgihoyi a,vcite ubt stohe ahtt aer nca sauce tiilnais.acmzonu Gnoarlsua lcle tsmou,r on teh eohrt nda,h eeimsmsto ropduce oetresng c(hiwh cna dlae to icuesrpoco brputye in onugy rglsi utb towheseri yma be )cuolc.t esoaaTtrm rea slobddla ttha latpcyiyl heav f,at ahr,i ,ehett etc. aeochsmT lliw ont eb no ryuo e.tts aarvOni inicraocd si ghhiyl keyllinu ot hswo up on ryou etst, btu if it ,ddi ti wolud iyelkl rensept htiw a ialcscs rdcinocai soye.mrdn

sugaplum  FA 2019 page 632 +
divakhan  because................"Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" NBME 24 -#13 Qs explanations/comments on this website, has led me to choose this answer! :D +7
... benwhite_dotcom made a comment on free120/block1/q#23 (A 4-year-old boy from Brazil is brought to the...)
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mcideEn itkurtB alpymhmo anc pphena ni raizBl as well sa irafcA j(aw elosi,n pfyfu a.)fec hTe copgahophritrmo si ttanndremoigs lbigntie dybo phmergscoaa, a pyte fo amghaepcor angnitcnoi mnay zpiacg,edtyho ippotacto lscle ni vsoruai tsetas of daeigdrnoa.t

weenathon  For anyone else who was wondering why a cancer was undergoing apoptosis (classically we think of cancer EVADING apoptosis), apparently it's due to the myc mutation classic in Burkitt Lymphoma. While myc causes the cell to proliferate, it also induces apoptosis - hence the tingible bodies containing apoptotic cells. (https://www.ncbi.nlm.nih.gov/pubmed/8247541) +
itsalwayslupus  Also just for people who watch boards and beyond or pathoma (I don't remember which exactly it is from), the "stars" in the "starry night" appearance of Burkitt's (what is being shown here) are lighter because the the cells are dying/gone via apoptosis (supposed to be the "holes" in the "night sky" lol). +
... benwhite_dotcom made a comment on free120/block1/q#35 (A 10-month-old boy is brought to the physician...)
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He ahs ayepm(rsulb VRS) roiinolcit.shb RVS si na NAR irvsu htat rnsete the lcle vai a infuos inreopt w(cihh si eht tgrate fo het loiytpaccphr nmooallonc tnidyabo gdur izbavlia.)mPu

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iThs oetnisqu is a ittlle ibt SB, in atth htere is ngtoihn in the semt ta lla ot kmae ouy rfien this eliicyfc.salp aWth eth oneuiqts is igynrt ot ksa is twha srtcfoa ecasu artplemcica iusts ni ge.nerla lWehi isopralofnes nmeeintpcoec is a scaeu, elepop lveo to idscsus nad( the sboadr elvo to tste) rpoo aiiyshpnc niuioamocmntc dna clak fo tyapemh as root c.easus

angelaq11  THANK YOU! here I was thinking I was the only one. I chose the incompetent physician xD +5
arcanumm  I was on the fence here, but what led me to the correct answer is simply that a question based on an incompetent physician has really no teaching point for our purposes. +
sharpscontainer  Though let's everyone be real, if the patient is poor, they are muuuuch less likely to have access to legal means for a malpractice suit. If only the USMLE cared enough to test us on social determinants of health... +1
... benwhite_dotcom made a comment on free120/block3/q#1 (Six healthy subjects participate in a study of...)
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o-lCnolaAMy hsitbini teh raniimige-ttl espt in eht eotbado-xtnaii fo tfyta dca.i yiLa,lgloc inetrgs cmslue esuerriq less egynre na(d hsut sesl dnee rfo tfaty dica owkdb)rnae ntah ictvea um.lecs

zpatel  it inhibits Carnitine acyltransferase-1 in beta-oxidation. +4
melchior  FA 2020 pg 89 +
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ehT frtaoileipevr asphe of het tsnruelma ceylc is cotrlendlo by enntpencidyde-lc na.iksse i(Ths skame eessn as yd-deeecltnninpc inskeas rngvoe lltyruvia all lclalreu isoidnvi in eucryaktoi )llsce.

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loBod ta teh smateu si eht erd gfal (ees tawh I did t?hree) rfo trhaerlu ryij,nu hcwhi odlshu eb lueeadatv ofr twhi a trergoadre .rumtgeorarh heT mseonabmru hte omst lynommoc diernju yb uc.efrrat In ,onctstar hte ngposy eutrrha is smto yillek to eb iednujr rdngiu auttaimrc teahtrce sirtonein ro ni a sdelatdr irynj.u

canyon_run  Should we just assume that a pelvic fracture implies a membranous urethral injury? I was between membranous and spongy and I ended up choosing spongy because of the perineal bruising and fact that the patient was riding a motorcycle (and therefore susceptible to straddle injury). +
benwhite_dotcom  Yes. You should think of spongy as the penile urethra, hence the predisposition to catheter-related trauma. +5
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uJst esaebuc h’se nvaghi )oedce(rttnup sxe ntso’de mena he ntd’oes eahv spelim ouenficsti oonumsc.liesno hTe exs pelmiis s’he sola giskins omoesen! nPrigtsahiy + ylphm edson + fatigeu = o.nmo

titanesxvi  The triad of classic symptoms for infectious mononucleosis is lymphadenopathy (swollen glands), splenomegaly (large spleen), and exudative pharyngitis accompanied by high fever, malaise, and often hepatosplenomegaly (large liver and spleen) +1
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nA sddo atrio erertga ahnt 1 geissnfii iescnsear ddos, kr,is lhokoeldii -- icwveerhh oyu fererp ot acll .ti If het %95 cdnofcniee avlteinr gnaer oesd ton cdilnue 1, etnh eht cnfireedef si slcayatltiist tscaiingnfi ht(ghuo otn rnyecslasei clianillcy fea)ungn.lim

tallerthanmymom  Can someone explain why it is an increase in risk rather than a decrease? Also, relative to what? Do we just assume it is relative to people who do not exercise regularly? +
banana  Uncertain about this, but I think from my memory of the question that the above explanation should say "relative risk" and not odds ratio. The relative risk is the (number women fractured/total exposed)/(number women fractured/total unexposed):: therefore, >1 means that more women got fractured when they exercised. (FA 2020, 258) +
drpee  Same risk: RR = 1 (theoretical). Lower risk: RR < 1. Greater risk: RR > 1 +
blah  I got confused by the question because I was bringing in my own biases (i.e. doesn't exercising decrease the risk of fractures in this population of women?). If you simply read the question as what does a RR>1 mean? No doubt you'll get the correct answer. +1
... ibestalkinyo made a comment on free120/block1/q#2 (A 14-year-old boy is brought to the emergency...)
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Injuries to the lateral portion of the knee and fibula often commonly injure the common fibular/common peroneal nerve. Functions of the common fibular nerve include: sensation of the dorsum of the foot, dorsiflexion and eversion of the foot.

... waterloo made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
 +3 
submitted by waterloo(58)

You can look at this question strategically.

  1. Southern blot --> so DNA.
  2. they are using an endonuclease to transfer bits, this doesn't really mean anything to you yet.
  3. cDNA is probing for single immunoglobulin-constant region.

That's important, because now you know they are looking at the constant region of immunoglobulin aka Fc of the heavy chain.

So why is this cDNA that encodes Fc, lighting up only once in other tissues, but the same cDNA lights up multiple times in lane 2 (bone marrow)? This is because, at the bone marrow random recombination of light or heavy chain occurs, and our cDNA is present in different random combinations with light chains. That specific cDNA sequence they used didn't change between the tissues or even within the bone marrow, and it will only bind to the one gene sequence. The fact it's lighting up multiple times tells you that the same sequence is present, your question is why so many times.

Also a side note, southern blots are time consuming, so labs use other methods to do the same thing (like PCR), but southern blots are still the best when it comes to checking immunoglobulin and T cell receptor gene rearrangement.

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Thsi notiuseq si gnksia aoutb JDV nmretnrgeeara cwhhi pnahspe ni eth bnoe awr.rom The esneg are all dhceppo up cesbeua the B lecl si gtriny to eeatreng a iquune mitcaiobnon for tsi etorcpre
lsmpe i psoc.cet..n odd ionrgwd

tehCarp 3 of "woh eht uemmin mysets "wkros - eaeowms okob

varunmehru  in the question stem, they are asking about a constant region. VDJ rearrangement is for the variable. It doesn't make sense :( +1
sallz  Both the constant (heavy chains) and the light chains undergo gene rearrangement. The heavy chain undergoes V(D)J random recombinations, while the light chain undergo VJ random recombinations. So gene rearrangement could work for both regions. +5
azibird  The constant region does not undergo recombination. That's why it's called constant. It's just right next to the variable region though, so they get expressed together as one protein. That's why the constant-labeled DNA region is variable length here. +1
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The repsoboretarc rae thtcrse cetroresp th(e rmeo dulif in the evess,l eth orem htye f)eri. oS a tetpani ithw rrgaimhecoh kchos will ees a dreaesce in teh eacbeotporrr ifnrig ear.t atAonviitc of RAAS lwil tlrues in edcrnseai saruclva etenssaric ioscisnco(varon)tt in erdor to ntianami blodo rssree.pu Adn lriep,scaali hscu as eohst in the ,ekdiyn illw eb iredmp rof reopnotsri dan not iflnitarot (no oen nwsta to pee tuo gdoo edliut eiurn nhwe ’rhetye eatd.hryd)de ,keswLiei eisysmct aipaclriels ilwl rrfpee ot dlho tnoo aampsl nda ton tel it keal toni hte nsurimetttii -nch)t.adsprgii(

tallerthanmymom  Another thing contributing to the increased SVR is increased SNS tone and decreased PNS tone. When BP is low --> Afferent BR firing decreased ---> Efferent SNS firing increases, and PNS decreases --> the inc in SNS tone stimulates a1 receptors ---> Inc SVR BUT, I don't understand what is causing the increase in the PVR because I always thought that inc SNS tone should be causing vasodilation in the lungs and that is why PCWP is decreased. +1
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heT trygir“mao grsiisupneo raalipen as”rh c(i)k is asilcsc orf roedn,lyitsogs a icaptasri nrwdmuroo draecuiq romf tanvatdlcnmar-iaeeo iso.l etglnodisyoSr aarlev nca woobrr ene(hc eht rs)ha nda nca ritegma ot hte IG tratc nad yla tehir gegs, hichw hnte tcahh in eth nensittie dan scaue deah.rari emtaTntre si tIimcnvere (dna if nt,o zemedloaennbol.b)eaezadl/ kihegCnc eht osltos orf vleraa is het tmos tsvnieise .etst astPreia flei clscye rae gross.

benwhite_dotcom  As an addendum, I believe this is larva currens (https://en.wikipedia.org/wiki/Larva_currens) in the setting of strongyloides infection and not Cutaneous larva migrans. Strongyloides, unlike CLM, explains the diarrhea, weight loss, and not just the eosinophilia. CLM is generally limited to the skin and typically appears first in hands or feet (whatever touches soil) with perianal involvement being significantly less common. Stool studies are unnecessary in CLM, which is primarily a clinical diagnosis. The other information in the stem is there for a reason. See this nice comparison page: https://www.derm101.com/therapeutic/cutaneous-larva-migrans-larva-currens/introduction/ +2
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hiisleRnoatp twih mrrfeo antispte rae eenrlglya endfwor on, but heetr’y laeeplysci peatmrcoibl fi het naieptt swa a ciysrhiacpt ,tnetpia as teh pweor imblaaenc of eht eraap-trtntpitcienio npiahitserol dna rnnafoitoim het idvrerpo si ryvip to sceabue of irhte tpneiat arce eliovnmvten elcrudep a ehhyalt nbelcada tiephrlsinao fo auqe.ls

osler_weber_rendu  But what if she hot? +2
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TPT sha a lsccias at:epdn riiotahcacgpinmo eyimlhcto ,eiamna oohcbtritm pu,purar ,erefv ealrn ir,felua oognceliru tnrlmeiobasai .(SA)M vhnreeWe you ees a nqeiostu werhe the npietat selyudnd hsa a olt ggnio ,on cseiornd P.TT

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entttenImtir aja/ilideeiiiuhubbnpcrerymn in an hiteerows hayhtle iiidlvadnu is ipalcty of tiebGrs’l dy,rnmoes hwcih is cedusa by the ecreeadsd yctaitiv of PDU oyuneesstlarfagnoucs.lrr

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submitted by focus(18)

A mnemonic I use:

cohoRt - R for risk case serIes - I for intervention case contrOl - O for outcome

"Cohort study A study in which a defined group of people (the cohort) is followed over time, to examine associations between different interventions received and subsequent outcomes.

Case series Observations are made on a series of individuals, usually all receiving the same intervention, before and after an intervention but with no control group."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513097/

Case control "[...] an outcome of interest is first defined and then subjects are selected with (cases) and without (controls) the designated outcome. The investigator then looks back in time to compare the two groups for a risk factor or other exposure or treatment of interest. Therefore, the case-control study design is inherently retrospective."

Source: https://academic.oup.com/neurosurgery/article/84/4/819/5237441

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No eitralno bweeten eth iutrma )P( awvse adn the SRQ xmceopl nmaes trrehgedeid- VA cklbo (aak “pomc”etel eraht klbc.)o imSytcmpoat enev( )ftala baararcidyd anc e.utsrl C”oan“nn iatalr saewv aer oninmtepr ujgrual senvuo ssantpioul ttha orccu newh teh tiraa dan eiletnrcv cncortat otassyeillnumu (wic,hh fo ,eucsor den’tos mylnolar pn)p.hea

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sdetlSaerre-ts loweb uesssi, imsetoems tub ton aswayl arlnlattyivee vnvioigln tohb hridaare adn sp,tocinoitan aer a allhkmar of lareiibtr boelw odsynemr B)(IS. A aginodsis of ue,nliocsx mtso fo het esmt is glhepni ouy rlue uot mreo suseroi uesiss. pe,bnoustoirL wihhc is a fytta aidc htat cdniuse slinoos-ettfogn laniitesnt oen,tesircs is rdpoeavp fro hacpiioitd pnnois,icoatt tmos nooclymm ni hte tnxteoc of BSI nad ro casrodney ot tiaope esu. hTe hoert gsudr deitls era rfo olytimfrmaan elowb aissede (DB.)I

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ahtW ew ehva rhee is a eaniglcton nricotnleea to rbtsae l:imk scgali,atemao in hcwih eht doby tonnca ecnrvot etsgclaao to gseculo lurtiesn(g ni an ancuctiomlau fo coGatesla app1t)hosh-e. hyTe enht slti hte indsfign adn tetss ueds to esodnagi .it acsoeLt (het rihcddesaiac ni )klim si cooedspm of aeuactooggslescl+.

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ttrsdocogSh-aOel si osla nkwno sa istysaippho fo teh biilta btre.ulec Ist’ due to chocnir atisse/tostinrrir at eth rteiinnso fo het plaalter todenn no eht bailit re.ulbtec ’tIs sccllysalai ense in seeegratn dogin rettiviepe oriovgsu yiiatctv n,guirnn( p)jnimug. ehT griodrahpa etneoasrtmsd isacscl taogemfiatrnn fo het itlbia crebletu hwi(ch isnt’ earynsesc to einerozgc ot gte eht utneqios crc)r.eto

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KB vursi eirtonaactiv si a ceusa of lraen admage appt-ltnsrntoas ni eth igttsen fo meinmu usp,iossnper osal kwnon sa KB eona.prhphty ameTtrtne is a ourteicdn ni enmmui ,ueronppsssi olawngli eht obdy a nceahc to fhtig ckab. Teh irvsu nac esacu a eiollckd- UIR ysromden with rfvee.

kekescc  in FA, BK = bad kidney +1
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a()enstlUb .ganain Mots iiatdemem atretntem si .irotn

melchior  Nitrates, such as nitroglycerin, increase nitric oxide, which then increases cGMP (not cAMP) +
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rNitcaoc sue orf laucety nafiulp ocitdisonn si both nleaesrboa adn nrapitmt.o htrmtoSre- seu ie(demmiatly icpaugtrso-)ls osed tno deal ot rtnolemg- cddneneepe or( os eopepl veha …tght)hu.o ndA ye,s rguds aciddst douslh sloa vreicee cctinsaro to nolorct pina.

drdoom  prefer “patients with hx of substance abuse” over more conveniently typed but less redemptive “drug addict” +8
sugaplum  I don't see why switching her to oral pain meds when she is ready would be incorrect. Clearly she is worried about being on the pain meds, I feel making a proclamation that she has a low risk of addiction would be profiling just because she doesn't have a history. The opioid epidemic also affects people who didn't have a previous history of drug abuse. Just a thought, not trying to push any buttons. Maybe I am thinking to hard about this, but I don't see the clear A vs B line for this question. +31
nbme4unme  @sugaplum I thought the exact same thing as you and chose the acetaminophen answer accordingly. I maintain that I am correct, my score be damned! +5
sushizuka  I had a similar question on UW and the explanation stated that the correct answer choice was the only one that addressed the patient's concern and answered her question. The rest were just alternative treatments, so they were incorrect. But I too answered with oral pain meds. +2
angelaq11  couldn't agree more with you all. I chose acetaminophen because opioid abuse is NO joke. The crisis is still going strong because of answers like this... +1
houseppary  I ruled out oral acetaminophen because they described in great detail the severity of her injuries, and indicated that she wasn't even fully conscious/aware when she asked this question about opioids. Rather than expose her to more pain, and possibly worsen her long-term pain prognosis, by switching to acetaminophen too early, in this case it makes sense to keep her comfortable because she's very seriously injured and not even fully lucid. It's kind to reassure her in this case. +1
anastomoses  I appreciate all of the passion for the opioid crisis, and the wording of the answer is definitely not ideal. However, PAIN is also very real, and there is no way acetaminophen alone would cut it in a case like this, not "as soon as she can take medications orally." Maybe I'm lucky to have 6 months in clinicals before STEP or had a mom who just went through urgent spine surgery for breast cancer mets, but there is a time and place for opioids and this is clearly one of them. Thank you for coming to my ted talk. +2
llamastep1  I agree with anastomoses, cmon guys have you ever had serious pain? oral acetaminophen is NOT enough for that type of pain. +1
melchior  As argument against the oral acetaminophen answer choice, it says "switch the patient to oral acetaminophen boldas soon as she can take the medication orallybold" This means you're just waiting for her swallowing inability from the facial fracture surgery to come back, which might not have much to do with her pain, and so it seems somewhat arbitrary. +
drpee  Maybe logically/clinically A is true, but this seems like a "patient communication" question to me and I could NEVER imagine A being a good way to phrase this point IRL. +1
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submitted by 69_nbme_420(20)

Aminoglycosides (Which inhibits 30S) are coupled with cell wall active agents - e.g. Penicillins, Vancomycin

(Sketchy Reference on Aminoglycoside Sketch: Beta-lactam bomb!!)