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NBME Answers

medicine
Block/Question (31.6 difficulty score)
A 28-year-old man comes to the physician ...
SchistosomiasisπŸ”

Block/Question (11.3 difficulty score)
A 14-year-old boy is brought to the emergency ...
Common fibular (peroneal)πŸ”

Block/Question (23.3 difficulty score)
A 24-year-old man comes to the office because ...
Hair follicleπŸ”

Block/Question (12.7 difficulty score)
A 14-year-old girl is brought to the ...
Acting outπŸ”

Block/Question (20.3 difficulty score)
A 24-year-old woman comes to the physician ...
Vascular endothelial growth factorπŸ”

Block/Question (12.4 difficulty score)
A 63-year-old woman comes to the physician 1 ...
Calcium pyrophosphateπŸ”

Block/Question (15.6 difficulty score)
A 55-year-old woman with small cell carcinoma ...
FilgrastimπŸ”

Block/Question (15.1 difficulty score)
A 37-year-old woman with right lower ...
P2 louder than A2πŸ”

Block/Question (38.6 difficulty score)
During an experiment, a Southern blot ...
Gene rearrangementπŸ”

Block/Question (14.6 difficulty score)
During a clinical study examining the effects ...
Total peripheral resistanceπŸ”


Block/Question (14.8 difficulty score)
A 17-year-old boy is brought to the emergency ...
PCP (phencyclidine)πŸ”

Block/Question (21.6 difficulty score)
A 26-year-old woman is brought to the ...
Pouch of DouglasπŸ”

Block/Question (15.6 difficulty score)
A 14-year-old girl has had nausea, ...
Microscopic examination of the stoolπŸ”

Block/Question (13.2 difficulty score)
A 40-year-old woman comes to the physician ...
Sertoli-Leydig tumorπŸ”

Block/Question (9.4 difficulty score)
A 45-year-old woman with systemic sclerosis ...
Diffuse interstitial fibrosisπŸ”

Block/Question (11.0 difficulty score)
A new blood test to detect prostate cancer is ...
Prostate biopsies of men with test results equal to or below 5 ng/mLπŸ”

Block/Question (9.4 difficulty score)
A 62-year-old woman comes to the physician ...
Decreased osteoclast activityπŸ”

Block/Question (19.4 difficulty score)
A 26-year-old woman is brought to the ...
Serum HCO3-: decreased;
Arterial pH: decreased;
Blood PCO2: decreased
πŸ”


Block/Question (13.0 difficulty score)
An investigator is studying the incidence of ...
Decreased macrophage activityπŸ”

Block/Question (13.7 difficulty score)
A 63-year-old man is brought to the emergency ...
Hypercoagulability from advanced malignancyπŸ”

Block/Question (21.7 difficulty score)
A 35-year-old man comes to the physician ...
Separation of endothelial junctionsπŸ”

Block/Question (27.3 difficulty score)
A 4-year-old boy from Brazil is brought to ...
ApoptosisπŸ”

Block/Question (13.5 difficulty score)
A 33-year-old woman comes to the physician ...
Inactivation of cellular p53πŸ”

Block/Question (15.3 difficulty score)
A 27-year-old man is admitted to the hospital ...
Adenylyl cyclaseπŸ”

Block/Question (11.6 difficulty score)
A 30-year-old man is admitted to the hospital ...
Crohn diseaseπŸ”

Block/Question (17.0 difficulty score)
A couple comes for preconceptional genetic ...
50%πŸ”

Block/Question (12.4 difficulty score)
A healthy 22-year-old man participates in a ...
Glycogenolysis in the liverπŸ”

Block/Question (19.4 difficulty score)
A 63-year-old homeless man is brought to the ...
C5aπŸ”

Block/Question (19.5 difficulty score)
A 16-year-old boy is brought to the physician ...
Escherichia coliπŸ”

Block/Question (26.1 difficulty score)
A 16-year-old boy is admitted to the ...
Hemopneumothorax, not under tensionπŸ”

Block/Question (30.5 difficulty score)
A 20-year-old woman comes to the physician ...
von Willebrand diseaseπŸ”

Block/Question (27.5 difficulty score)
A 2-year-old boy is brought to the physician ...
Trinucleotide repeat expansionπŸ”

Block/Question (13.9 difficulty score)
A 31-year-old woman with type 2 diabetes ...
Ξ±-ToxinπŸ”

Block/Question (22.9 difficulty score)
A 10-month-old boy is brought to the ...
Mediation of cell entry via a fusion proteinπŸ”

Block/Question (10.9 difficulty score)
A 17-year-old girl is brought to the ...
Ξ²2-Adrenergic agonistπŸ”

Block/Question (14.0 difficulty score)
A 30-year-old woman, gravida 2, para 0, ...
Formation of antibodies to RhDπŸ”

Block/Question (11.0 difficulty score)
A 52-year-old woman begins pharmacotherapy ...
MetforminπŸ”

Block/Question (9.3 difficulty score)
A sexually active 23-year-old man with ...
Antigenic variationπŸ”

Block/Question (9.2 difficulty score)
A 17-year-old girl is brought to the ...
Hypogonadotropic hypogonadismπŸ”

Block/Question (12.5 difficulty score)
A 49-year-old woman comes to the physician ...
HDL-cholesterol: increased;
Triglycerides: decreased
πŸ”


Block/Question (10.1 difficulty score)
A 15-year-old girl comes to the physician ...
Stimulation of the sebaceous glands by androgensπŸ”

Block/Question (8.4 difficulty score)
A previously healthy 40-year-old man is ...
PericardiumπŸ”

Block/Question (17.3 difficulty score)
A 55-year-old man is brought to the emergency ...
Blood pressure: 85/60;
Pulse: 120;
Jugular venous pressure: increased;
Pulsus paradoxus: increased
πŸ”


Block/Question (12.5 difficulty score)
A 54-year-old woman comes to the emergency ...
Decreased metabolism of codeine to morphineπŸ”

Block/Question (7.7 difficulty score)
A 14-year-old girl with a 9-year history of ...
CountertransferenceπŸ”

Block/Question (19.7 difficulty score)
A 23-year-old woman with bone marrow failure ...
Immune complex deposition in tissuesπŸ”

Block/Question (31.6 difficulty score)
A 25-year-old man is brought to the emergency ...
Ribosomal assemblyπŸ”


Block/Question (20.1 difficulty score)
A 29-year-old woman is prescribed ...
MetabolismπŸ”

Block/Question (20.2 difficulty score)
Over 1 year, a study is conducted to assess ...
Open-labeled clinical trialπŸ”

Block/Question (6.5 difficulty score)
A 64-year-old man with non-Hodgkin lymphoma ...
VincristineπŸ”

Block/Question (11.7 difficulty score)
During an experiment, drug X is added to a ...
Cholinesterase inhibitorπŸ”

Block/Question (12.4 difficulty score)
A 42-year-old man comes to the physician for ...
The patient's perception that the physician is uncaringπŸ”

Block/Question (11.2 difficulty score)
A 72-year-old woman comes to the physician ...
EchocardiographyπŸ”

Block/Question (14.8 difficulty score)
A 14-year-old boy is brought to the physician ...
Normal developmentπŸ”

Block/Question (9.4 difficulty score)
A 5-year-old boy is admitted to the hospital ...
Inability of leukocytes to kill intracellular microorganismsπŸ”

Block/Question (9.2 difficulty score)
A 22-year-old woman contacts a medical ...
He cannot date her because she was once his psychiatric patientπŸ”

Block/Question (11.5 difficulty score)
A 73-year-old woman comes to the physician ...
Vitamin B12 (cyanocobalamin)πŸ”

Block/Question (10.2 difficulty score)
A 45-year-old man comes to the physician ...
InfraspinatusπŸ”

Block/Question (10.7 difficulty score)
A 54-year-old man comes to the physician for ...
AmygdalaπŸ”

Block/Question (15.7 difficulty score)
A placebo-controlled clinical trial is ...
Significant findings can be reported with greater confidenceπŸ”

Block/Question (9.3 difficulty score)
A male stillborn is delivered at 32 weeks' ...
Pulmonary hypoplasiaπŸ”

Block/Question (34.0 difficulty score)
A 33-year-old man undergoes a radical ...
Branch of the thyrocervical trunkπŸ”

Block/Question (7.3 difficulty score)
A 42-year-old man comes to the physician for ...
Na+–Clβˆ’ symport inhibitorπŸ”

Block/Question (12.6 difficulty score)
A 55-year-old man comes to the physician ...
Basement membraneπŸ”

Block/Question (9.6 difficulty score)
A 24-year-old man is brought to the emergency ...
Foramen ovaleπŸ”

Block/Question (13.3 difficulty score)
A 55-year-old man who is a business executive ...
SplittingπŸ”

Block/Question (8.9 difficulty score)
A 3-year-old boy with chronic granulomatous ...
VancomycinπŸ”

Block/Question (28.8 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Elaboration of proteases and urease with local tissue destructionπŸ”

Block/Question (28.6 difficulty score)
A 10-year-old girl is brought to the office ...
It is a polymorphismπŸ”

Block/Question (11.7 difficulty score)
A previously healthy 40-year-old woman is ...
Thrombotic thrombocytopenic purpuraπŸ”

Block/Question (14.2 difficulty score)
A 17-year-old girl has never had a menstrual ...
Androgen insensitivityπŸ”

Block/Question (24.2 difficulty score)
A 12-year-old girl is brought to the ...
Decreased activity of UDP glucuronosyltransferaseπŸ”

Block/Question (11.2 difficulty score)
A 47-year-old woman comes to the emergency ...
Annular pancreasπŸ”

Block/Question (9.0 difficulty score)
An 8-year-old boy is brought to the office by ...
AdenovirusπŸ”

Block/Question (21.1 difficulty score)
A 36-year-old man with profound intellectual ...
Omental bursa (lesser sac)πŸ”

Block/Question (19.4 difficulty score)
A study is designed to evaluate the ...
Case seriesπŸ”

Block/Question (10.5 difficulty score)
A 56-year-old man comes to the emergency ...
Uric acid crystalsπŸ”

Block/Question (22.2 difficulty score)
A 62-year-old man comes to the physician for ...
Type I pneumocytes: decreased;
Type II pneumocytes: increased;
Fibroblasts: increased
πŸ”


biochem metabolism
Block/Question (14.5 difficulty score)
Six healthy subjects participate in a study ...
Fatty acid oxidationπŸ”

Block/Question (8.5 difficulty score)
A 72-year-old woman who has smoked 20 ...
TimololπŸ”

Block/Question (10.0 difficulty score)
A 54-year-old man comes to the physician ...
Third-degree atrioventricular blockπŸ”

Block/Question (24.8 difficulty score)
A 15-year-old boy is brought to the emergency ...
Olfactory nerveπŸ”

Block/Question (13.9 difficulty score)
A 42-year-old woman comes to the physician ...
Parathyroid glandπŸ”

Block/Question (10.4 difficulty score)
A new severe respiratory illness caused by a ...
Avoids the concern for reversion to virulenceπŸ”

Block/Question (15.9 difficulty score)
A 72-year-old woman comes to the physician ...
AspirationπŸ”

Block/Question (17.6 difficulty score)
A 25-year-old woman comes to the office ...
Cyclin-dependent kinasesπŸ”

Block/Question (29.5 difficulty score)
A 72-year-old woman is brought to the ...
Area labeled 'C'πŸ”


Block/Question (8.9 difficulty score)
A 42-year-old woman is brought to the ...
InfraorbitalπŸ”

Block/Question (13.1 difficulty score)
A previously healthy 24-year-old woman who is ...
LubiprostoneπŸ”

Block/Question (18.6 difficulty score)
A 32-year-old man is brought to the emergency ...
MembranousπŸ”

Block/Question (28.3 difficulty score)
A 2-year-old boy is brought to the office by ...
DNA virusπŸ”

Block/Question (17.3 difficulty score)
A 46-year-old woman with active ankylosing ...
Tumor necrosis factor Ξ±πŸ”

Block/Question (8.5 difficulty score)
During a study of renal glomeruli, a healthy ...
Increased hydrostatic pressureπŸ”

Block/Question (6.3 difficulty score)
A 67-year-old woman is brought to the ...
Syndrome of inappropriate secretion of ADH (vasopressin)πŸ”

Block/Question (27.1 difficulty score)
A 23-year-old woman comes to the physician ...
The patient's DMD carrier status is uncertain because of random X inactivationπŸ”

Block/Question (12.2 difficulty score)
A randomized controlled trial is conducted to ...
0.2πŸ”


Block/Question (18.8 difficulty score)
A 6-day-old breast-fed boy is brought to the ...
Galactose 1-phosphateπŸ”

Block/Question (11.8 difficulty score)
A 14-year-old boy is brought to the physician ...
Infectious mononucleosisπŸ”

Block/Question (14.9 difficulty score)
In a cohort study of elderly women, the ...
Statistically significant overall increase in riskπŸ”

Block/Question (13.1 difficulty score)
A 12-year-old boy is brought to the physician ...
Patellar ligamentπŸ”

Block/Question (11.2 difficulty score)
A 22-year-old woman comes to the office ...
BK virusπŸ”

Block/Question (6.9 difficulty score)
A new test to detect the presence of malarial ...
95%πŸ”

Block/Question (20.0 difficulty score)
A 30-year-old woman comes to the physician ...
The second CFTR mutation was not detected by the testing obtainedπŸ”

Block/Question (10.9 difficulty score)
A 52-year-old man is brought to the emergency ...
Increases nitric oxide concentrationπŸ”

Block/Question (6.5 difficulty score)
A technician wants to determine whether ...
Polymerase chain reactionπŸ”

Block/Question (7.6 difficulty score)
A 16-year-old boy comes to the physician ...
CarditisπŸ”

Block/Question (33.4 difficulty score)
After being severely beaten and sustaining a ...
Reassure the patient that her chance of becoming addicted to narcotics is minusculeπŸ”

Block/Question (19.4 difficulty score)
A 51-year-old man comes to the office because ...
SubmentalπŸ”

Block/Question (11.0 difficulty score)
A 31-year-old woman comes to the physician ...
Lifelong persistent infectionπŸ”

Block/Question (11.7 difficulty score)
A 57-year-old man receives radiation therapy ...
G1πŸ”

Block/Question (9.5 difficulty score)
A 55-year-old man comes to the physician for ...
Increased peripheral vascular resistanceπŸ”

Block/Question (14.3 difficulty score)
A 53-year-old man comes to the physician ...
Superficial inguinalπŸ”

Block/Question (8.3 difficulty score)
A 59-year-old man is brought to the emergency ...
HypovolemicπŸ”

Block/Question (9.5 difficulty score)
A 2-week-old newborn is brought to the ...
Normal reflex responseπŸ”

Block/Question (22.8 difficulty score)
A 14-year-old boy is brought to the office ...
Normal findingsπŸ”

Block/Question (8.4 difficulty score)
A 65-year-old man is brought to the physician ...
Substantia nigraπŸ”

Block/Question (15.2 difficulty score)
A 67-year-old woman with congenital bicuspid ...
Binding to the 30S ribosomal proteinπŸ”

Block/Question (16.3 difficulty score)
A 22-year-old woman comes to the office ...
CD28 on T lymphocytes ⟶ CD80 on epidermal Langerhans cellsπŸ”

Block/Question (7.6 difficulty score)
A 33-year-old man undergoes a radical ...
Branch of the thyrocervical trunkπŸ”

Block/Question (15.6 difficulty score)
A 6-year-old girl is admitted to the hospital ...
MyeloperoxidaseπŸ”

Block/Question (15.1 difficulty score)
A 7-year-old boy who lives in Kentucky is ...
Ingestion of soilπŸ”

Block/Question (16.3 difficulty score)
A 23-year-old woman is brought to the medical ...
Orthostatic hypotensionπŸ”

Block/Question (4.3 difficulty score)
A 51-year-old man comes to the office because ...
SubmentalπŸ”

Block/Question (14.8 difficulty score)
A 50-year-old woman comes to the physician ...
baroreceptor outputπŸ”

Block/Question (12.3 difficulty score)
A 27-year-old man comes to the emergency ...
gastric mucosaπŸ”

Block/Question (8.2 difficulty score)
An asymptomatic 44-year-old man is found to ...
PetechiaeπŸ”

Block/Question (8.0 difficulty score)
A 65-year-old retired man comes in for a ...
FA 2020 pg. 684 "Risk factors include smoking, secondhand smoke, radon, asbestos, family history."πŸ”

Block/Question (3.2 difficulty score)
A 65-year-old retired man comes in for a ...
FA 2020 pg. 684 "Risk factors include smoking, secondhand smoke, radon, asbestos, family history."πŸ”

Block/Question (3.5 difficulty score)
A 26-year-old woman comes to a busy ...
"Thank you for waiting. How can I help you today?"πŸ”

Block/Question (3.2 difficulty score)
A 12-year-old boy is brought to the physician ...
Upward gazeπŸ”

Block/Question (7.1 difficulty score)
A 52-year-old man comes to the emergency ...
Atrial fibrillationπŸ”

Block/Question (5.7 difficulty score)
A 3-month-old boy is brought to the emergency ...
Decreased activity in the enzyme that reduces Fe3+ to Fe2+πŸ”

Block/Question (7.1 difficulty score)
A 46-year-old woman with 2 months of fatigue ...
Adverse drug eventπŸ”

Block/Question (4.4 difficulty score)
An 18-year-old is brought to the ED with 1 ...
TamponπŸ”

Block/Question (7.3 difficulty score)
A 32-year-old with 2 years of abnormal hand ...
Basal GangliaπŸ”

Block/Question (1.5 difficulty score)
A 34 years old woman with a 10 years history ...
B. foreign peptides bound to class I MHC molecules are rognized by CD8 + T lymphocytesπŸ”

Block/Question (0.8 difficulty score)
A 65-years-old woman with asthma is brought ...
B. leukotrienes πŸ”

Block/Question (0.2 difficulty score)
A 62-year-old man is admitted to the hospital ...
"You sound upset. Tell me a little more about that."πŸ”

Recent comments ...

... benwhite_dotcom made a comment on free120/block2/q#30 (An otherwise healthy 45-year-old man comes to the...)
 +22 
submitted by benwhite_dotcom(485)
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sA swal,ay sti’ tmlaos retbet to nireog hte tircspeu nhew i.sslboep Tish mlngneate ahs a iectpp rl,ceu ihcwh we nwko si cdsuae rmdyioaeptlen by H. lioyrp ec.inftnoi .H orpiyl ocdurpes etassopre nda rlyciutarlap aur,ese hwhci olalw it ot enisrace the pH of ist acoll oeevtmnrnni yb neiavlgc ruea oint ,minmaao cwihh si tciox to atrscgi o.musac heT eiptruc moansseretdt H ol,pryi hhciw rea idvtene tihw ivlrse is.tnanig

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. +21
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. +5
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 +5
cbreland  @itsalwayslupus exact same thoughts over here +
... sugaplum made a comment on free120/block2/q#31 (A 10-year-old girl is brought to the office by her...)
 +19 
submitted by sugaplum(376)
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Inasec neaony eels aws niknthig het ma:se
I aws usctk nteeweb stih dna rvaiant of unwknon ieicnnsi.cgfa ,ervoweH vatrian of uknwnon gfiaincnseic si a ueesceqn nto a elnsig iodctuenel

nbme4unme  Thank you for explaining, I selected the unknown significance answer as well! +3
dhkahat  lol fuck this test +7
... imnotarobotbut made a comment on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
 +14 
submitted by imnotarobotbut(161)
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sihT is a adb uinoteq.s laPtlete gaeatnoiggr imet ebngi r,omnal ok neif I nac see tt.ha Btu WFV estiizbsal rtofac 8 dna u'doy ese na reeainsc in PTT sti(fr ieln next to FVW in rtFis dAi.) yhW si terhi TPT rm?aonl

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. +5
cbreland  I get why it's not afibrinogenemia (which is what I picked), but still don't understand how VWD is right. You have normal PTT and normal platelet aggregation (both of which should be abnormal). Is the only thing leading us to VWD is it being a primary bleeding issue? Again, my answer made no sense, but VWD in this context, seems way out there +
osteopathnproud  I agree with you @cbreland once I noticed I had to bend lab values for any answer choice then in my head most of them were possible. I took a step back and answer with the most common bleeding disorder, vW disease. Funny thing is when I retook it to check my answers, I had time to overthink and got it wrong. +
aakb  the anki facts never steer you wrong! my zanki cards say "Low vWF in von Willebrand disease impairs platelet {{c1::adhesion}}" (Gp1B binds to vWF) not platelet aggregation (GpIIbIIIa binds to fibrinogen). additionally it says you can have either a normal or increase PTT. in this case the PT is not increased. It is decreased a little, which I assume is fine esp w an INR of 1.0 +
... benwhite_dotcom made a comment on free120/block1/q#33 (A 2-year-old boy is brought to the physician for a...)
 +13 
submitted by benwhite_dotcom(485)
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glFeria X si a GCG oiuedtrntilce etreap nonipaxse odrerdsi ihwc(h keil ouHitt’gsnnn si a stte )veiaro.tf The artnamel cenul is eth inht ot eht nXekldi- ai.rhnneietc Aesim-tliuk robehaisv nad rveytleila rgale hdae are o;mncom eglra lseiectst ynlo rpaeap aetfr urtpby.e

cbreland  Also repeat expansions will get worse with each generation. I went with the learning difficulties and then uncle having issues that were not as severe to a child with issues within the first 2 years of life as being a signal of a triplet expansion +
osteopathnproud  Fragile X syndrome is the most common inherited cause of intellectual disability FA20 pg 62. I just saw intellectual disability plus heritable = fragile X syndrome. +1
... benwhite_dotcom made a comment on free120/block3/q#7 (A 72-year-old woman comes to the physician because...)
 +13 
submitted by benwhite_dotcom(485)
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hyTe aevh ebscddire wtah yuo sueams is a iscacls sace fo eunpio.nam tBu, APN i’snt an eawsnr oei.cch tahW het xtne sbte tih?ng ehT seau!c Odl aiflr peoepl nd(a sicloh)alco love ot tge rpaitansoi npeuiao.nm LLR is teh omst nmoomc teis, wichh ehyt evah vprddeio (ahktn oy,u igb iacrvelt cnb.or)shu hyeT enev aevg you hte niht taht eth tpnitea ahs tldfciyβ€œiuf wionags,lw”l wchhi is oced rof asβ€œpsitrae when n”o.giswllwa

mannan  wrong answers: Smoking and emphysema are obstructive and more importantly air trapping disease processes and wouldn't really cause the dysphagia. The main vasculitis with lung involvement is We-C-ner granulomatosis that would also have nose and kidney problems - from SATTAR +
... benwhite_dotcom made a comment on free120/block1/q#21 (A 63-year-old man is brought to the emergency...)
 +12 
submitted by benwhite_dotcom(485)
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D’nto etl ethm idbnl yuo itwh hsti seitpat’n ery.msi hTe iuses fo hte ady si taht eh has a VD.T taTs’h hwy eh aecm to eth ER in hte tfisr tencense and athw the stlauruond hosws at het end. Ptanesti ihwt ncraec aer arobuae.heplylcg

focus  LOL best explanation possible. +1
... benwhite_dotcom made a comment on free120/block2/q#10 (A 29-year-old woman is prescribed carbamazepine for...)
 +11 
submitted by benwhite_dotcom(485)
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baaeiezCaprnm is a srnoutioo 5PCY04 e,durcni so yuo sdolhu eb ensggisu soembailtm no mtrtea .thwa 45PY0C aspyl na patmtnori elro in otbh vtiianm D tbticaaooiivn adn adaoerngitd ni eth erv.il

mambaforstep  ahhhh i didnt know CYP450 played a role in vit D bioactivation/degradation. thanks! +5
... benwhite_dotcom made a comment on free120/block2/q#26 (A 55-year-old man comes to the physician because of...)
 +11 
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A nwe nbiiergslt isseade in an rldoe rnspoe si itaycplly nogig ot be a gupsiephm s.otnquie hneT oyu sutj eahv ot bermeerm hte ncfifeeder etbneew sluoulb pepmhoiigd sv ehpumpgsi .rislagvu oluuslB mopeihipdg si adzachrictere by the ssol of mhsomdseemoesi htat nidb nrkyeaitcsote ot eht msabeten eba,mnmre uretngsli in lluab (big sb)itlrse in aresa of icfnriot Cc(eioh .)A ttnasiPe wtih gmpuipesh gsruailv elso rheti emssmdsooe iwhc(h idbn takeensiycrto ot ache thr)oe, os tath eirht iksn si uspre ,elifrba hhwic trelssu in n.uteacilor tuhMo ecrlus rea omre omnomc in .PV

drpee  Also question suggests a negative Nikolsky sign ("The blisters do not easily break"). This suggests BP over PV. +3
... benwhite_dotcom made a comment on free120/block2/q#21 (A 54-year-old man comes to the physician for a...)
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eFra = amydaalg

That is lal I adwent ot sya but I esugs hatt si oto hsotr to be tedapcce yb the mfbe.owr

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Axeoianr eadsl to rooyopitcpoagdnh amoi,hoygndsp sa eht ydbo islrazee tath het itsbolipisy of isuorninhg a sftue is zore adn sievg pu the ptnes.ree Tse’rhe a tlo fo tgosiprupn aatd, btu neo dslhuo essgu tihs swaenr ocne yuo aerd hte orwd gnβ€œatmys” (ro ”rncea.β€œd)

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laOr icsleev in(ht ht.in) niBesrigtl caervisul isnole on eht nah.d oN ,ervfe otn tpi.xe-cgiaopnar ihsT si eHpers ou(y yma emermrbe etsitdsn tingtge chretpie ltowhwi in ouyr ei,udsts hwhci si whta htsi .)si sMto ksflo tge H1VS sa denhrl,ic htugho olybiuvos otn all ear tmtcmpsoiay. VHS si a geral tbdralou,dsdee-n ralnie DNA .usvir

jiya   why cant this be hand foot and mouth disease cause of coxsache +8
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. +2
aneurysmclip  Hand foot mouth disease affects palms and soles. ref: FA 2019 - 150 +3
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 +1
drpee  Google some images of HF&M disease. The small blisters look very different from herpetic whitlow. +
... benwhite_dotcom made a comment on free120/block2/q#8 (A 25-year-old man is brought to the emergency...)
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When people go camping, you should be thinking of zoonotic infections. Fun fact, New Mexico leads the country in cases of plague. Yes, that plague: Yersinia pestis. The β€œbubonic” part of bubonic plague refers to the swollen infected nodes (β€œbuboes”) characteristic of the disease, which often involve the groin (bubo is the Greek word for groin, who knew?). In this case, they’re also describing a necrotic epitrochlear node. Classic treatment is with aminoglycosides, which bind to the 30s ribosomal subunit. (Note that Tularemia, caused by another gram-negative bacteria Francisella tularensis can present similarly but is more common in the midwest. Regardless, the two are often lumped together, the antimicrobial treatment is similar, and the answer in this case would be the same).

(Free 120, 2019 Update)

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SNC eimsboasia si mtso ystooiornul euasdc by eaalNrgei rol,wife ihcwh I nareoecgu uyo to eoemimrz sa teh tnr-gibaieβ€œna em”abo.a Fnoud ni trrfwh-esea ibedos of arewt lkei ponds nda ,kaesl it has ehrte s:frmo a ct,ys a roepotihozt bo(aemdi,) adn a faagbtlieell ie.(. sah owt lae)g.llfa iItcfneno is vai cltrofyoa cell xnaso hoghrtu eth firoicrbmr petla to eth ar.bin

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. +3
osler_weber_rendu  Am I the only one who thought portal of entry cant be through a nerve and just ignored all the nerves? +37
luciana  @osler_weber_rendu I thought the same... I knew it was through cribriform plate, but not that was actually through the nerve +10
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. +5
j44n  this is such an AWFUL disease, I worked in a hospital in south carolina where it happens A LOT and there's nothing at all you can do for them. When your cells go to phagocytose it it has an outer layer it sheds off like how a lizzard will sacrifice its tail when attacked by a predator. +1
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tSekor dcaceriathzre yb eltf pehsrmaeiis dna gtirh CN21 l.apys Csrodse nigifsdn nema a brsamenit oen.lis Right l(ilepsati)ra geo,unt teddf-esil taalrtaln(cr)eo wksanese neams het gitxein grthi pyoahollsgs rvnee sha eneb tdceaeff nhwit(i hte ihrgt lmle).uda C is teh padimry weerh het csaioronlptic rttca urns to ctonolr ussmlce (porri to eth sdicoueat.ns) Tish is knonw as eth daleim melradluy ndsryoem ro jrDieene onemdrys.

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. +13
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. +4
... waterloo made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
 +7 
submitted by waterloo(74)

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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egyiLd lelsc eamk t.otsreeensot ygeidL clle tmrosu n’rate alsyaw ylligihopacso iteavc, tub etsho taht rea cna ucase asiuziimntoncal. rGaulnsao llec umot,rs no eth oerht hand, ssmoimeet dorcpeu ernotseg hwhci( nca leda to ceiuprcsoo ebpuyrt ni yungo lrsig but hwsioeter mya eb ul).coct emoratTas era dlbsadol ttah cylplyati haev a,ft ar,ih et,the cet. meashToc lliw otn eb on ruoy tst.e aanrOiv icnairodc is giyhlh yulknlie ot shwo pu on yuro sett, tbu if ti did, ti odwlu klleiy enpestr twhi a sicalcs aicicrdno ydmnr.ose

sugaplum  FA 2019 page 632 +1
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 +17
zevvyt  divakhan, thANK you i was hoping praying that someone would have written that +
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pxtorpieAam igfatns hgoslpyioy ig:mnti eht iaov-psetsopbtr speah 6-4(2 rhuso etfar a am)el si eaontddmi yb l.yenlcgigsooys osGceeugnoeinls form 24 suroh ot 2 .ydas Thne iesto.sk

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The wrrao is ingontpi ot a ilprnuoeht ub(dolemilt lec:)nuus ianm irhetfg fo teh ueimmn mystes in teacu ilmnaimatofn dna baalercit iecnonitf sc(hu as pntiarisao niemo)aunp. Ca5 si a ctahctcimoe rocfat orf .sNMP

ibestalkinyo  Other chemotactic factors include IL-8 and LTB4 +5
j123  Note: C5a is a chemotactic factor for many immune cells in addition to neutrophils. Also, C3a is a chemotactic factor for just eosinophils and basophils (not neutrophils) +1
cheesetouch  Q. What's so sexy about C5a? A. It's like Chanel No. 5 for neutrophils: they smell it and come running. +5
... hungrybox made a comment on free120/block2/q#7 (A 23-year-old woman with bone marrow failure is...)
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This whole question is on the different types of hypersensitivity. (pg. 113 FA2019)

eosinophil degranulation β†’ Type 1 hypersensitivity (mast cells early, eosinophils/others later)

widespread apoptosis of B lymphocytes β†’ 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 β†’ 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 β†’ serum sickness (Type 3 hypersensitivity)

polyclonal T-lymphocyte activation β†’ type 4 hypersensitivity

... benwhite_dotcom made a comment on free120/block2/q#23 (A male stillborn is delivered at 32 weeks' gestation...)
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nliagwlwoS nmoiacti uldfi is a lctiicar tcomnonep fo lngu .teldeemnovp ssetFue hwit sevree minlosayhgoidor are lpdguea yb opmnlurya ,poyisapahl hcihw is teh uscea fo hadte ni tessefu rnob whti tPtroe doyrsmne (ranle .sge)eisan

mambaforstep  this is the second explanation that makes sense to me that I see downvoted. if you see something wrong and downvote, please explain! I want to know what im missing +3
abhishek021196  Maybe someone downvoted because in this question, there wasnt a mention of renal agenesis but rather urethral obstruction although that would lead to Potter sequence as well. +
... benwhite_dotcom made a comment on free120/block2/q#33 (A 17-year-old girl has never had a menstrual period....)
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genAnodr stsniieiyinvt si ucedas by a deitcvefe neagodnr .ercretpo DTH is bioensslrep rof grtcanei leam agitaniel nrugid afelt axusle voeelm.ednpt eTh dteualf aumhn geednr si lea.fme So a yalleeitngc eaml ntapeti wthi etpcolme edornnag eiisttinnyvis si yetlnarlxe hlytpylnecioap feemla. Lcak of npesroes ot drenlaa randgeson estvpnre irah roofnmati dnugri utbeyrp ahac.e()nrred

... 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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eTh eaiteiroflprv apshe of het autremnsl eyccl is oldnecrotl by nd-lctenpcienyde nsk.isae shT(i samke neses as lnpetednyc-diecn sisnaek engvro vtluyrlai lal lulcelra ndiovsii in ireoctykua lel)s.c

thelongshoreman24  Answer A shouldn't be confused with cAMP-dependent kinases https://www.wikiwand.com/en/Protein_kinase_A +1
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m’I gigon to ipont uot atth a onarml tehayhl idk twih on racadci iyhstro ro yopmtmss dan on fimaly ithrsyo fo endsdu idcacar athde ofr a -etpprsrso ihalpysc is palyorbb gniog ot evha a nnebgi xeam no teartm htwa yuo tkhin uyo h.are

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. +13
wutuwantbruv  @the260guy I believe the splitting is being heard only during inspiration, making this normal physiologic splitting. Perhaps that's just my ears. +12
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 +1
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. +3
prolific_pygophilic  Definitely S3. FA 2020 pg 287 "but can be normal in children, young adults, athletes, and pregnancy" +1
dhkahat  I swear to god it wasnt just during inspiration but what the hell do i know +
... benwhite_dotcom made a comment on free120/block1/q#32 (A 20-year-old woman comes to the physician because...)
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onv Wlbadeinlr eadessi is yb rfa het mots omnmco rihidteen dbneeigl etisaih.sd Feelyrn,qut the ynol rbarylotoa ylbnarmioat is eriecasdn elidnebg mite l(ylreital oyu ikrcp hte tepiant nda ese how nolg it askte etmh ot pots inb)le.edg On et,pS gliedneb nomwe eavh .DWV gBelendi oybs veha .iamihhploe

winelover777  Agree. PTT does not have to be elevated to be VWD. +5
tulsigabbard  Welp. +
... 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 sah p(emuasyrlb S)VR otlrioibicn.hs SRV is na ARN uvsri htta nester eht llce aiv a iosufn npreoit iwhch( si hte atrtge fo het hpcraticoply ocmononall dbynotai gudr )mazivaubl.Pi

aakb  I thought the fusion protein produces multinucleated giant cells. I thought RSV enters using the epithelial G protein? First aid literally says "All contain surface F (fusion) protein, which causes respiratory epithelial cells to fuse and form multinucleated cells." +
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Slpnittig si na mmetruia sefeend cihsanmme foent dployeme by pneittas ithw rleonderbi osenrtpiyla .sdiroedr When pt,igistln a sperno safli to ees sterho as apbalce of nvhagi bhot vtisoipe nad tnvgaeei lsq;etuiai at any inveg t,emi s’it lal ro gt.onhin

d_holles  Got this one wrong -- thought it was acting out. +1
cheesetouch  FA 2018 p539 the 'nurses are cold, doctors are friendly' example is what first aid uses too haha +
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oN rnetaoli enwtbee eth artumi P)( vawse adn het QRS ecmolpx nsema dteherg-eidr AV kclob aak( oβ€œmeeptlc” ehtar boklc.) ciSmmapyott ne(ev flata) araaydrbcdi can rsult.e ann”oCnβ€œ rlitaa wvase era pomrtenin jguular vuseno suostnipal tath roucc enwh the aiart and ceievtnrl tctnacor aueisolylnsmtu wci,(hh of uc,sreo stoe’dn ayrnllom phneap.)

... melchior made a comment on free120/block3/q#7 (A 72-year-old woman comes to the physician because...)
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To those wondering what alveolar proteinosis is, it is a rare lung disorder characterized by abnormal accumulation of surfactant-derived lipoproteins within the alveoli. Sometimes it can occur secondary to lung infections, although usually it is an autoimmune process.

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Rubiamitx t-a(niCD )02 si eutycrlrn iuggonernd rsatil fro A.S My aspesr iggonglo usjt nwo whsos hatt xibtumair pyrlbaob nloy ash a otaeedrm ,tffcee os bobrpayl -dnnsleceoi to naaTiFt-N epyatrh. b.yaPlbro

feSa to say for asbord atth S:A FNTa &;tg 20DC

cheesetouch  FA 2018 - rituximab p 430 -- - use for Nonhodgkins lymphoma, CLL, ITP, Rheumatoid arthritis TNF-a inhibitors - p 472: 1) etanercept for Ra, psoriasis, ankylosing spondylitis. 2) infliximab and other mAB for IBD, RA, AS, psoriasis +1
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Jsut uesbcae ’hse navhgi utdc)(teorpne xes ’dsoten anme he ’tdonse eahv lmipse ficesointu uioenmsnoc.ols hTe sex elsimip ’hes aslo iknissg me!oneos shnaPrtiiyg + lhpmy odnse + faetiug = .moon

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) +2
... 69_nbme_420 made a comment on free120/block0/q#1 (A 67-year-old woman with congenital bicuspid aortic...)
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submitted by 69_nbme_420(24)

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

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

... fullmetalapathist made a comment on free120/block0/q#10 (A 22-year-old woman comes to the office because of a...)
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submitted by fullmetalapathist(6)

CD80 is also known as B7. Question is asking if you know that CD28 (T-cells) interacts with B7 (APC) as a co-stimulatory signal to activate the T-cell.

Looks like the picture is demonstrating contact dermatitis (due to her recent use of new hair dye) which is a type IV HSR

I usually remember that B-7 is on the B-cell (an APC)

melchior  Reminder: CTLA-4 on T-cells also binds to B-7, and the effect is opposite that of CD28 (inhibits T cell activation) FA 2020 pg 222 +1
mmizell  CD40L on T lymphocytes-> to CD40 on Langerhans cells is true association but doesn't answer the question because its co-stimulation induces B cell proliferation, not T cell proliferation. +1
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shTi qtiosenu is kangis aotbu DJV rtaneergmarne wihch pehansp in het nbeo moa.rrw heT geens are all ocehdpp up ebsecua het B llce si nrtgyi ot rteneeag a iqneuu iitmnncaoob orf its epotecrr
ime spl e.cn..cstpo ddo driowng

thCpera 3 of hwo" hte mnumei sseytm worsk" - emeoswa kobo

varunmehru  in the question stem, they are asking about a constant region. VDJ rearrangement is for the variable. It doesn't make sense :( +3
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. +7
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. +3
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oalTt pahrleepir eriastecns oges nodw urngdi sexceeir sa teh realstroie yipnslpug sculem dna isnk tleiad.

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eTh obaepretrrcos rae cetsrth etprcorse hte( oerm diful ni hte vls,see eth orem eyht .)ifre oS a aetitpn tiwh egarhhmrcio okchs ilwl see a ecsraede ni the bereaoproctr ifnirg a.ert ttaAivinco of ARSA iwll serltu ni raeeicsnd avucalsr siecantres onoscovnsati)rci(t ni roerd to nitmiaan doblo .rpsurees dnA aialilscer,p ushc as osteh ni eht dyen,ki illw eb meripd rfo renootrpis and tno nftirtloia on( eon nstwa to epe otu dogo eutidl uirne henw ryet’he hdra.eddyt)e eLiws,eki ytcmeiss lepcasarlii lwli prfree to hlod oont lmapsa nda otn elt it elak iotn the ttuiiermtsni (air.diph-)gsnct

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. +6
... mkenerly made a comment on free120/block1/q#12 (A 17-year-old boy is brought to the emergency...)
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I've been taught that any overdose vignette with a patient assaulting the doctor is a dead ringer for PCP due to their aggression.

... benwhite_dotcom made a comment on free120/block1/q#22 (A 35-year-old man comes to the physician because of...)
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Eldtanieloh ihttg n’untsiocj amirptyeblie si srnaeecdi ni nrpeseso ot urjnyi nda im,amatnolfin liogwaln iitnramog fo wehti dloob cslle nad rndsfie to eht eist fo iyn.jru

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! +1
blah  @focus reasoning sounds right. I nearly picked that but the other choice sounded better. Just semantics. +2
aakb  um just to clarify I don't think the differentiating factor is the wording of separation vs disruption. but rather that the correct answer is separation of ENDOTHELIAL junctions meaning that the spaces between the endothelial cells get wider. vs the answer youre thinking of says the disruption of the vascular BASEMENT MEMBRANE (which is under the endothelial cells) gets disrupted. so meaning something literally broken through the blood vessel and made a cut in the layer beneath the endothelial cells that line the blood vessel Dr. Sattar from pathoma usually draws a basement membrane and a layer of endothelial cells sitting on top +
... 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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mcdeEni kBittur malhymop nca peaphn in arliBz as elwl as icfraA aj(w oi,nsle pffyu .ef)ac hTe piorrtoamhghpoc is nsotrmtenaidg legintbi boyd arhsacpogem, a type fo opreacmahg ocnaiigtnn nyma cdy,tpezghoai acpotpiot lslce ni voiaurs satset fo a.tandgeidor

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) +1
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). +4
... ivypoison made a comment on free120/block2/q#24 (A 33-year-old man undergoes a radical thyroidectomy...)
 +5 
submitted by ivypoison(5)

Why high PTH 200pg/ml (normal <60)? it should be primary hypoparathyroidism!

amm13e  i think with no proper Blood supply, the PTH cant sample the Ca2+ levels in the blood, making the gland secrete more PTH +2
castlblack  secrete pth into where? the lost blood supply it doesn't have? Also, there are no parathyroid glands because the dude had a thyroidectomy! +1
alimd  @castlblack maybe they left it hanging of the fucking veins))) +1
... benwhite_dotcom made a comment on free120/block2/q#40 (A 62-year-old man comes to the physician for a...)
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heT tpntasei’ ochicnr ftrmlyoianma inuontmepsi is illikgn fof ihs nlgu aamcyrneph (spoeomdc mpirlyrai fo yept I spoenuet.c)my Type II npo,mtueyesc ni idnaoitd to kmngai tsct,rfaanu cna tpacereli ni droer to elperac epty I tmey,cuonspe so yteh llwi be eciendsr.a Concihr nietitsrlita immnntaoalif lesstur ni s,orisbif henec an cerisena ni loisa.tbbfsr

len49  UW ID 666 has a great explanation. +2
melchior  From the UW ID 666 explanation, although type II pneumocytes normally differentiate into type I pneumocytes after proliferation, they do not differentiate in idiopathic pulmonary fibrosis due to altered cell signals and altered basement membrane, which is why type II pneumocytes are increased. +5
... benwhite_dotcom made a comment on free120/block3/q#1 (Six healthy subjects participate in a study of...)
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alM-olyConA iniithsb teh etl-agniitrim pset in het inxoaot-bdteai fo ttafy dci.a ,aolilcgyL egnrsti emulcs erseuqir elss eenyrg an(d tshu slse ndee orf tytaf icad de)waonkbr tnah catevi cesm.lu

zpatel  it inhibits Carnitine acyltransferase-1 in beta-oxidation. +5
melchior  FA 2020 pg 89 +
... benwhite_dotcom made a comment on free120/block3/q#28 (A 52-year-old man is brought to the emergency...)
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Uesnabl(t) ag.inna soMt dimamtiee tmnertaet si or.int

melchior  Nitrates, such as nitroglycerin, increase nitric oxide, which then increases cGMP (not cAMP) +2
... benwhite_dotcom made a comment on free120/block3/q#31 (After being severely beaten and sustaining a gunshot...)
 +5 
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aortcNic use fro alcetyu liapunf ntsoiidonc is tbho obarlsaeen dan irpont.amt Sterh-otmr seu elmietymdai( utiroglc-)sspa sdeo otn elda ot t-logmren pedcdeneen ro( so loepep vaeh )g.uohht…t dAn ey,s dsgru stdiacd huodsl lsoa irevece rnocasitc ot orlonct .naip

drdoom  prefer β€œpatients with hx of substance abuse” over more conveniently typed but less redemptive β€œdrug addict” +12
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. +46
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! +7
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. +6
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. +2
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. +4
llamastep1  I agree with anastomoses, cmon guys have you ever had serious pain? oral acetaminophen is NOT enough for that type of pain. +2
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. +2
zevvyt  Don't forget who pays for these tests: BIG PHARMA!! +
topgunber  youd think after spending and borrowing every ounce possible that we were the ones paying for the tests +
... itsalwayslupus made a comment on free120/block2/q#17 (A 6-year-old girl is admitted to the hospital...)
 +5 
submitted by itsalwayslupus(31)

From Pathoma Ch. 2 pg. 14: MPO deficiency results in defective conversion of H2O2 to HOCl. Increased risk for Candida infxns (although most patients asymptomatic). Nitroblue tetrazolium test is normal because the respiratory burst is actually still intact. This patient has candida infection and delayed, but still can kill staph a, which seemingly goes along with the fact that the respiratory burst is still intact, but without MPO it may be hindered a little.

... madden875 made a comment on free120/block2/q#19 (A 7-year-old boy who lives in Kentucky is brought to...)
 +5 
submitted by madden875(14)

This worm is Ascaris. From an infectious disease doctor:

"The clue is the size- if you can see it move and it looks like an earth worm, it’s ascsaris! In dirt, kids get it from licking their dirty fingers! The adult looks like an earthworm and it causes the symptoms described with the worst cases causing bowel obstruction."

... thisquestionsucks made a comment on free120/block2/q#31 (A 23-year-old woman is brought to the medical tent 2...)
 +5 
submitted by thisquestionsucks(8)

This question is kinda whack. Right away, I could tell this was exercise-induced collapse, which happens pretty often to runners. I picked autonomic dysfunction because I didn't realize that this is considered an "orthostatic hypotension." After a long race, runners have a decreased SVR from all of the blood flow going to muscles. Once they stop, blood pools, doesn't get back to the ol noodle and they collapse. But ffs I still didn't pick orhtostasis because I think of old people. Fuck me

step7777  Not to mention orthostatics in the hospital imply a sudden change based on positioning. This patient didn't go from lying down to standing suddenly (just bitter bc I also chose autonomic dysfunction. +1
... aejinkim made a comment on free120/block2/q#39 (A 3-month-old boy is brought to the emergency...)
 +5 
submitted by aejinkim(5)

the hypoxia and the "blood sample appears brown" should point you towards methemoglobinemia.

if you want a fun video from "9-1-1" that actually explains a lot of it: https://www.youtube.com/watch?v=LFmlRzQ-0RA

... ibestalkinyo made a comment on free120/block1/q#2 (A 14-year-old boy is brought to the emergency...)
 +4 
submitted by ibestalkinyo(43)

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.

... benwhite_dotcom made a comment on free120/block1/q#3 (A 24-year-old man comes to the office because of a...)
 +4 
submitted by benwhite_dotcom(485)
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Hot btu i,flillsituco t’is a t.ghin Clyslasclai osnsapudom.e

medguru2295  I hate myself for overthinking this one. The first thought in my head was "hot tub folliculitis" but my dumbass didn't pick follicle. +10
hungrybox  @medguru2295 same bro same +