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NBME Free 120 Answers

medicine
Block/Question (32.0 difficulty score)
A 28-year-old man comes to the physician ...
SchistosomiasisπŸ”,πŸ“Ί

Block/Question (11.4 difficulty score)
A 14-year-old boy is brought to the emergency ...
Common fibular (peroneal)πŸ”,πŸ“Ί

Block/Question (23.5 difficulty score)
A 24-year-old man comes to the office because ...
Hair follicleπŸ”,πŸ“Ί

Block/Question (12.8 difficulty score)
A 14-year-old girl is brought to the ...
Acting outπŸ”,πŸ“Ί

Block/Question (20.5 difficulty score)
A 24-year-old woman comes to the physician ...
Vascular endothelial growth factorπŸ”,πŸ“Ί

Block/Question (12.5 difficulty score)
A 63-year-old woman comes to the physician 1 ...
Calcium pyrophosphateπŸ”,πŸ“Ί

Block/Question (15.7 difficulty score)
A 55-year-old woman with small cell carcinoma ...
FilgrastimπŸ”,πŸ“Ί

Block/Question (15.3 difficulty score)
A 37-year-old woman with right lower ...
P2 louder than A2πŸ”,πŸ“Ί

Block/Question (39.0 difficulty score)
During an experiment, a Southern blot ...
Gene rearrangementπŸ”,πŸ“Ί

Block/Question (14.8 difficulty score)
During a clinical study examining the effects ...
Total peripheral resistanceπŸ”,πŸ“Ί


Block/Question (14.9 difficulty score)
A 17-year-old boy is brought to the emergency ...
PCP (phencyclidine)πŸ”,πŸ“Ί

Block/Question (21.9 difficulty score)
A 26-year-old woman is brought to the ...
Pouch of DouglasπŸ”,πŸ“Ί

Block/Question (15.7 difficulty score)
A 14-year-old girl has had nausea, ...
Microscopic examination of the stoolπŸ”,πŸ“Ί

Block/Question (13.4 difficulty score)
A 40-year-old woman comes to the physician ...
Sertoli-Leydig tumorπŸ”,πŸ“Ί

Block/Question (9.5 difficulty score)
A 45-year-old woman with systemic sclerosis ...
Diffuse interstitial fibrosisπŸ”,πŸ“Ί

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”,πŸ“Ί

Block/Question (9.5 difficulty score)
A 62-year-old woman comes to the physician ...
Decreased osteoclast activityπŸ”,πŸ“Ί

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”
,πŸ“Ί

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

Block/Question (13.8 difficulty score)
A 63-year-old man is brought to the emergency ...
Hypercoagulability from advanced malignancyπŸ”,πŸ“Ί

Block/Question (21.9 difficulty score)
A 35-year-old man comes to the physician ...
Separation of endothelial junctionsπŸ”,πŸ“Ί

Block/Question (27.5 difficulty score)
A 4-year-old boy from Brazil is brought to ...
ApoptosisπŸ”,πŸ“Ί

Block/Question (13.6 difficulty score)
A 33-year-old woman comes to the physician ...
Inactivation of cellular p53πŸ”,πŸ“Ί

Block/Question (15.5 difficulty score)
A 27-year-old man is admitted to the hospital ...
Adenylyl cyclaseπŸ”,πŸ“Ί

Block/Question (11.7 difficulty score)
A 30-year-old man is admitted to the hospital ...
Crohn diseaseπŸ”,πŸ“Ί

Block/Question (17.2 difficulty score)
A couple comes for preconceptional genetic ...
50%πŸ”,πŸ“Ί

Block/Question (12.5 difficulty score)
A healthy 22-year-old man participates in a ...
Glycogenolysis in the liverπŸ”,πŸ“Ί

Block/Question (19.6 difficulty score)
A 63-year-old homeless man is brought to the ...
C5aπŸ”,πŸ“Ί

Block/Question (19.7 difficulty score)
A 16-year-old boy is brought to the physician ...
Escherichia coliπŸ”,πŸ“Ί

Block/Question (26.4 difficulty score)
A 16-year-old boy is admitted to the ...
Hemopneumothorax, not under tensionπŸ”,πŸ“Ί

Block/Question (30.8 difficulty score)
A 20-year-old woman comes to the physician ...
von Willebrand diseaseπŸ”,πŸ“Ί

Block/Question (27.9 difficulty score)
A 2-year-old boy is brought to the physician ...
Trinucleotide repeat expansionπŸ”,πŸ“Ί

Block/Question (14.0 difficulty score)
A 31-year-old woman with type 2 diabetes ...
Ξ±-ToxinπŸ”,πŸ“Ί

Block/Question (23.1 difficulty score)
A 10-month-old boy is brought to the ...
Mediation of cell entry via a fusion proteinπŸ”,πŸ“Ί

Block/Question (11.0 difficulty score)
A 17-year-old girl is brought to the ...
Ξ²2-Adrenergic agonistπŸ”,πŸ“Ί

Block/Question (14.2 difficulty score)
A 30-year-old woman, gravida 2, para 0, ...
Formation of antibodies to RhDπŸ”,πŸ“Ί

Block/Question (11.1 difficulty score)
A 52-year-old woman begins pharmacotherapy ...
MetforminπŸ”,πŸ“Ί

Block/Question (9.4 difficulty score)
A sexually active 23-year-old man with ...
Antigenic variationπŸ”,πŸ“Ί

Block/Question (9.3 difficulty score)
A 17-year-old girl is brought to the ...
Hypogonadotropic hypogonadismπŸ”,πŸ“Ί

Block/Question (12.6 difficulty score)
A 49-year-old woman comes to the physician ...
HDL-cholesterol: increased;
Triglycerides: decreased
πŸ”
,πŸ“Ί

Block/Question (10.2 difficulty score)
A 15-year-old girl comes to the physician ...
Stimulation of the sebaceous glands by androgensπŸ”,πŸ“Ί

Block/Question (8.5 difficulty score)
A previously healthy 40-year-old man is ...
PericardiumπŸ”,πŸ“Ί

Block/Question (17.4 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”
,πŸ“Ί

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

Block/Question (7.8 difficulty score)
A 14-year-old girl with a 9-year history of ...
CountertransferenceπŸ”,πŸ“Ί

Block/Question (19.9 difficulty score)
A 23-year-old woman with bone marrow failure ...
Immune complex deposition in tissuesπŸ”,πŸ“Ί

Block/Question (31.9 difficulty score)
A 25-year-old man is brought to the emergency ...
Ribosomal assemblyπŸ”,πŸ“Ί


Block/Question (20.4 difficulty score)
A 29-year-old woman is prescribed ...
MetabolismπŸ”,πŸ“Ί

Block/Question (20.4 difficulty score)
Over 1 year, a study is conducted to assess ...
Open-labeled clinical trialπŸ”,πŸ“Ί

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

Block/Question (11.8 difficulty score)
During an experiment, drug X is added to a ...
Cholinesterase inhibitorπŸ”,πŸ“Ί

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”,πŸ“Ί

Block/Question (11.3 difficulty score)
A 72-year-old woman comes to the physician ...
EchocardiographyπŸ”,πŸ“Ί

Block/Question (14.9 difficulty score)
A 14-year-old boy is brought to the physician ...
Normal developmentπŸ”,πŸ“Ί

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

Block/Question (9.3 difficulty score)
A 22-year-old woman contacts a medical ...
He cannot date her because she was once his psychiatric patientπŸ”,πŸ“Ί

Block/Question (11.6 difficulty score)
A 73-year-old woman comes to the physician ...
Vitamin B12 (cyanocobalamin)πŸ”,πŸ“Ί

Block/Question (10.3 difficulty score)
A 45-year-old man comes to the physician ...
InfraspinatusπŸ”,πŸ“Ί

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

Block/Question (15.8 difficulty score)
A placebo-controlled clinical trial is ...
Significant findings can be reported with greater confidenceπŸ”,πŸ“Ί

Block/Question (9.4 difficulty score)
A male stillborn is delivered at 32 weeks' ...
Pulmonary hypoplasiaπŸ”,πŸ“Ί

Block/Question (34.3 difficulty score)
A 33-year-old man undergoes a radical ...
Branch of the thyrocervical trunkπŸ”,πŸ“Ί

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

Block/Question (12.7 difficulty score)
A 55-year-old man comes to the physician ...
Basement membraneπŸ”,πŸ“Ί

Block/Question (9.7 difficulty score)
A 24-year-old man is brought to the emergency ...
Foramen ovaleπŸ”,πŸ“Ί

Block/Question (13.4 difficulty score)
A 55-year-old man who is a business executive ...
SplittingπŸ”,πŸ“Ί

Block/Question (9.0 difficulty score)
A 3-year-old boy with chronic granulomatous ...
VancomycinπŸ”,πŸ“Ί

Block/Question (29.0 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Elaboration of proteases and urease with local tissue destructionπŸ”,πŸ“Ί

Block/Question (28.9 difficulty score)
A 10-year-old girl is brought to the office ...
It is a polymorphismπŸ”,πŸ“Ί

Block/Question (11.8 difficulty score)
A previously healthy 40-year-old woman is ...
Thrombotic thrombocytopenic purpuraπŸ”,πŸ“Ί

Block/Question (14.4 difficulty score)
A 17-year-old girl has never had a menstrual ...
Androgen insensitivityπŸ”,πŸ“Ί

Block/Question (24.5 difficulty score)
A 12-year-old girl is brought to the ...
Decreased activity of UDP glucuronosyltransferaseπŸ”,πŸ“Ί

Block/Question (11.3 difficulty score)
A 47-year-old woman comes to the emergency ...
Annular pancreasπŸ”,πŸ“Ί

Block/Question (9.1 difficulty score)
An 8-year-old boy is brought to the office by ...
AdenovirusπŸ”,πŸ“Ί

Block/Question (21.3 difficulty score)
A 36-year-old man with profound intellectual ...
Omental bursa (lesser sac)πŸ”,πŸ“Ί

Block/Question (19.6 difficulty score)
A study is designed to evaluate the ...
Case seriesπŸ”,πŸ“Ί

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

Block/Question (22.5 difficulty score)
A 62-year-old man comes to the physician for ...
Type I pneumocytes: decreased;
Type II pneumocytes: increased;
Fibroblasts: increased
πŸ”
,πŸ“Ί

biochem metabolism
Block/Question (14.6 difficulty score)
Six healthy subjects participate in a study ...
Fatty acid oxidationπŸ”,πŸ“Ί

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

Block/Question (10.2 difficulty score)
A 54-year-old man comes to the physician ...
Third-degree atrioventricular blockπŸ”,πŸ“Ί

Block/Question (25.0 difficulty score)
A 15-year-old boy is brought to the emergency ...
Olfactory nerveπŸ”,πŸ“Ί

Block/Question (14.0 difficulty score)
A 42-year-old woman comes to the physician ...
Parathyroid glandπŸ”,πŸ“Ί

Block/Question (10.5 difficulty score)
A new severe respiratory illness caused by a ...
Avoids the concern for reversion to virulenceπŸ”,πŸ“Ί

Block/Question (16.0 difficulty score)
A 72-year-old woman comes to the physician ...
AspirationπŸ”,πŸ“Ί

Block/Question (17.8 difficulty score)
A 25-year-old woman comes to the office ...
Cyclin-dependent kinasesπŸ”,πŸ“Ί

Block/Question (29.7 difficulty score)
A 72-year-old woman is brought to the ...
Area labeled 'C'πŸ”,πŸ“Ί


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

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

Block/Question (18.7 difficulty score)
A 32-year-old man is brought to the emergency ...
MembranousπŸ”,πŸ“Ί

Block/Question (28.6 difficulty score)
A 2-year-old boy is brought to the office by ...
DNA virusπŸ”,πŸ“Ί

Block/Question (17.5 difficulty score)
A 46-year-old woman with active ankylosing ...
Tumor necrosis factor Ξ±πŸ”,πŸ“Ί

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

Block/Question (6.4 difficulty score)
A 67-year-old woman is brought to the ...
Syndrome of inappropriate secretion of ADH (vasopressin)πŸ”,πŸ“Ί

Block/Question (27.4 difficulty score)
A 23-year-old woman comes to the physician ...
The patient's DMD carrier status is uncertain because of random X inactivationπŸ”,πŸ“Ί

Block/Question (12.3 difficulty score)
A randomized controlled trial is conducted to ...
0.2πŸ”,πŸ“Ί


Block/Question (19.0 difficulty score)
A 6-day-old breast-fed boy is brought to the ...
Galactose 1-phosphateπŸ”,πŸ“Ί

Block/Question (11.9 difficulty score)
A 14-year-old boy is brought to the physician ...
Infectious mononucleosisπŸ”,πŸ“Ί

Block/Question (15.0 difficulty score)
In a cohort study of elderly women, the ...
Statistically significant overall increase in riskπŸ”,πŸ“Ί

Block/Question (13.2 difficulty score)
A 12-year-old boy is brought to the physician ...
Patellar ligamentπŸ”,πŸ“Ί

Block/Question (11.3 difficulty score)
A 22-year-old woman comes to the office ...
BK virusπŸ”,πŸ“Ί

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

Block/Question (20.2 difficulty score)
A 30-year-old woman comes to the physician ...
The second CFTR mutation was not detected by the testing obtainedπŸ”,πŸ“Ί

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

Block/Question (6.6 difficulty score)
A technician wants to determine whether ...
Polymerase chain reactionπŸ”,πŸ“Ί

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

Block/Question (33.7 difficulty score)
After being severely beaten and sustaining a ...
Reassure the patient that her chance of becoming addicted to narcotics is minusculeπŸ”,πŸ“Ί

Block/Question (19.6 difficulty score)
A 51-year-old man comes to the office because ...
SubmentalπŸ”,πŸ“Ί

Block/Question (11.1 difficulty score)
A 31-year-old woman comes to the physician ...
Lifelong persistent infectionπŸ”,πŸ“Ί

Block/Question (11.8 difficulty score)
A 57-year-old man receives radiation therapy ...
G1πŸ”,πŸ“Ί

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

Block/Question (14.4 difficulty score)
A 53-year-old man comes to the physician ...
Superficial inguinalπŸ”,πŸ“Ί

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

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

Block/Question (23.0 difficulty score)
A 14-year-old boy is brought to the office ...
Normal findingsπŸ”,πŸ“Ί

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

Block/Question (15.4 difficulty score)
A 67-year-old woman with congenital bicuspid ...
Binding to the 30S ribosomal proteinπŸ”,πŸ“Ί

Block/Question (16.5 difficulty score)
A 22-year-old woman comes to the office ...
CD28 on T lymphocytes ⟶ CD80 on epidermal Langerhans cellsπŸ”,πŸ“Ί

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

Block/Question (15.8 difficulty score)
A 6-year-old girl is admitted to the hospital ...
MyeloperoxidaseπŸ”,πŸ“Ί

Block/Question (15.4 difficulty score)
A 7-year-old boy who lives in Kentucky is ...
Ingestion of soilπŸ”,πŸ“Ί

Block/Question (16.7 difficulty score)
A 23-year-old woman is brought to the medical ...
Orthostatic hypotensionπŸ”,πŸ“Ί

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

Block/Question (15.1 difficulty score)
A 50-year-old woman comes to the physician ...
baroreceptor outputπŸ”,πŸ“Ί

Block/Question (12.5 difficulty score)
A 27-year-old man comes to the emergency ...
gastric mucosaπŸ”,πŸ“Ί

Block/Question (8.4 difficulty score)
An asymptomatic 44-year-old man is found to ...
PetechiaeπŸ”,πŸ“Ί



Block/Question (3.6 difficulty score)
A 26-year-old woman comes to a busy ...
"Thank you for waiting. How can I help you today?"πŸ”,πŸ“Ί

Block/Question (3.3 difficulty score)
A 12-year-old boy is brought to the physician ...
Upward gazeπŸ”,πŸ“Ί

Block/Question (7.4 difficulty score)
A 52-year-old man comes to the emergency ...
Atrial fibrillationπŸ”,πŸ“Ί

Block/Question (5.8 difficulty score)
A 3-month-old boy is brought to the emergency ...
Decreased activity in the enzyme that reduces Fe3+ to Fe2+πŸ”,πŸ“Ί

Block/Question (7.3 difficulty score)
A 46-year-old woman with 2 months of fatigue ...
Adverse drug eventπŸ”,πŸ“Ί

Block/Question (4.6 difficulty score)
An 18-year-old is brought to the ED with 1 ...
TamponπŸ”,πŸ“Ί

Block/Question (7.6 difficulty score)
A 32-year-old with 2 years of abnormal hand ...
Basal GangliaπŸ”,πŸ“Ί

Block/Question (1.7 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”,πŸ“Ί

Block/Question (0.9 difficulty score)
A 65-years-old woman with asthma is brought ...
B. leukotrienes πŸ”,πŸ“Ί

Block/Question (0.4 difficulty score)
A 62-year-old man is admitted to the hospital ...
"You sound upset. Tell me a little more about that."πŸ”,πŸ“Ί

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(488)
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sA syaw,la sti’ tmsaol ebrett ot eiognr hte ietrspuc wnhe pbl.sieso hsTi eganmntle has a ctppie eucr,l whcih ew wnok si sdcuae yopntieadrlme by H. iproyl oicetnifn. .H pylroi pdrsecuo etpersaos nda yllcraitapru uee,ars ihcwh lwola ti to eircsnae the pH of ist olalc onrvnintmee by gcalnive uaer iont ,niaaomm hihwc si icotx ot acgtris cuas.om ehT turciep eesdtormatsn H ilpr,yo wchih aer ndtveei iwth ivlsre iganin.st

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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Iscean onenya esel saw higinktn eht mse:a
I swa ktucs nweebet iths dna ianrtav of onwnnku ascincfni.gie ,Hervoew vaintar of wnknuno sfcncaigeini si a eceeqnus nto a eigsln onltceideu

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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hsTi is a dba oqnseitu. aPetletl rgntaaiogge tiem binge ,alnrom ko feni I anc ees hta.t Btu WFV bszisitela tfacor 8 dna uo'yd ese na erncaise in PTT tsrfi( elni extn to WVF ni tiFrs i.A)d yWh si eihtr PTT oa?nrlm

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#21 (A 63-year-old man is brought to the emergency...)
 +13 
submitted by benwhite_dotcom(488)
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Dnto’ etl mhet lbidn ouy thiw ihst tsiatn’pe smri.ey Teh sueis fo het dya si atth he sah a DT.V ’sThat hyw eh mcea ot hte RE ni the irtfs nsetecen and awth eht asnludrout owshs at hte .edn sttineaP hwit ncacre aer rlcalebhy.gauope

focus  LOL best explanation possible. +1
... 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(488)
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giFrlae X si a CGG edlinuotiectr teprea nxseipoan redsdori ci(whh ikel nnogs’tHunit si a stte taf.i)rove Teh enamltar ceuln si eht hint to het -nkeXlid iiehatrcnn.e iAmeukis-tl raovibshe adn vtlyeriela elrga edha are oon;mmc relga ssetilect lony paerpa frtea uterpb.y

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
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eThy vahe rdbecsied wtha ouy muasse si a ilacscs ceas fo pmna.uieon uB,t PAN i’tsn an serawn c.ohice Wath het xetn btse h?nitg ehT su!eac Odl laifr eepplo dna( l)oahlocsic eolv ot teg siarnptaio piuna.neom RLL si het osmt cmnmoo is,et whhic tyhe vaeh ipdervod na(tkh y,uo ibg ecarivtl us.nhb)cor hTye vnee aegv uoy het tinh atht het paentti sha ucdfitfβ€œliy ”olw,sianlgw hcwhi is ocde fro β€œpsraietsa enwh ow.nwgl”sial

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 +
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anraCabeiepzm is a uinortoso Y5PC04 ud,enrci os uoy dulhso eb isgnsgeu laismmoetb no remtta hawt. 0CP54Y spayl na mtiaotprn leor ni otbh vniiatm D btaocanviioit nda aaeidgdntor in eht lvr.ei

mambaforstep  ahhhh i didnt know CYP450 played a role in vit D bioactivation/degradation. thanks! +5
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A enw egilrtnisb sdeaeis in na orled snopre is yyllictpa gnogi ot eb a ugseippmh oieunqt.s enTh you tsuj haev ot mebemerr eth derenfefic tneewbe olslbuu gmhidpopei sv upighesmp rasugvi.l oBsulul omipdihgep si adicacerzreht by teh slso fo eeimsmdoeomssh htta nibd niaeykctrsote to eht meeantsb nmemrbea, tlerisngu ni llaub (gib )etlsrsbi ni aersa of ifctorni hecoCi( .)A asinePtt twhi giepphmsu grivlaus seol iterh osmosedsme c(iwhh bind aotisreckyten ot ehca eo,r)th so ahtt trieh kins is epsur ablferi, cihhw utlessr ni u.noretclia uMhot luresc ear orem oconmm ni VP.

drpee  Also question suggests a negative Nikolsky sign ("The blisters do not easily break"). This suggests BP over PV. +3
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rFea = ygdamaal

tTha si lla I eadwtn to ysa btu I sgeus thta is too hsort to eb ecctdpea by teh beowr.fm

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iAeaoxrn alsde to toriohapynocdpgo nsm,diaogpohy as eth ybod alzesrei thta the liiyisposbt fo oisrnuinhg a futes is zero nad vsieg up eth tsre.pene ’sTeher a otl fo nrgispputo dat,a tub one ldohus essgu tsih sranew oecn you ared hte dwro nβ€œgt”aysm or( r”necβ€œa.)d

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raOl ilvecse thn(i t)i.nh Bsierilgtn rcsviueal nlsoei on hte d.ahn oN rvf,ee ont oxgtiapecnirap-. hiTs is eHresp oy(u amy rmebeemr edtsnits gntgtie etphceir whwilto ni royu d,siuset hchwi si twah ihts s).i tosM soklf egt VS1H as relnd,hic othhug ooiysuvlb otn lla ear stcai.ompmty VHS si a ragle ddlot,dere-basun rnieal NAD svrui.

jiya   why cant this be hand foot and mouth disease cause of coxsache +9
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. +
... waterloo made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
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submitted by waterloo(76)

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.

... 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(1044)

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#8 (A 25-year-old man is brought to the emergency...)
 +8 
submitted by benwhite_dotcom(488)

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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CSN sseoiimbaa si smto ynooirosltu ceduas yb gNiaarele rw,oielf chwih I creuoaegn uoy ot zeimoemr as the aβ€œbnetirgnia- .”bemaoa undoF ni aetrsrwh-ef sdobei of eawtr keil nsodp dan akse,l ti ahs tehre srom:f a cty,s a hropztoeito ),e(ibdoam dna a eefaalllgtbi .i.e( ahs wot lg)lflae.a Infcnoiet si vai yftooaclr llce xnoas rtghouh eht irbfrmoicr talpe ot eht rainb.

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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toeSkr iarahtrececzd yb elft eaprsheimis adn rtigh N2C1 ypsl.a droCses nnfigsdi emna a rinmbesta isel.no tgRih priatlles)ia( ,tguneo ddeeftsli- attcrar)alneo(l easnwske smena teh xiigent tigrh yllsogshpao enrev ash bnee tfefdeac witi(nh hte htrgi udll)e.am C is eht rimydpa erwhe eth icniartlocosp cartt usnr to oncrolt mclsuse iop(rr to hte dusca.stn)ieo Tish is kownn as the iamlde lelayrudm sromdeyn or jeeneriD dersnmy.o

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
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edLigy ecsll mkae or.eosestettn igdeyL clel mruots enar’t asywla gloiilypahcso ,vtacei but hotse thta are cna seuca usmn.caiiatnlzio lnosuraGa ecll uot,srm no het ethro ,adnh tssmemioe copedur eerntgso wihhc( cna dael to ucoscpeior yurtebp ni ugony srgil btu eshtoerwi mya eb c.c)uolt aotTraesm ear dbslodal that tlyycilpa have ,atf ir,ah tehet, etc. moaeschT liwl ont be on uyro .etst avOirna adrinccoi si lhiygh iuyllekn ot oswh pu on uryo et,st tub if it idd, it doulw kleyil rteesnp hwti a isaclsc ricndioac ysermon.d

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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ippaxrmoetA tgsnfai oshyolypig gim:nit eth boippssrte-taov pseha 42(-6 hsoru efatr a ael)m is tiaeddomn by oygonellgyciss. ennocesloesgiuG fomr 24 surho to 2 syad. ehTn sit.esok

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hTe rowar is tipignon ot a uopielhtnr l(meuotlibd culsu)e:n anmi fighter of eth mnieum smesty ni tceua mtlfininaoma and brelaitac otifnniec schu( as oparsiitna mop.einnu)a a5C si a coceachtmit troacf orf .NsMP

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
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nov reldWlainb esedsia si yb afr eth mots ocmonm hdneritie ebendlgi edtiisash. nlueet,ryFq eht yoln otraryolab ayamnbrliot si radicnese igldbeen mtei e(rtayllli yuo ircpk eht peitant nad ese owh gnol ti ktase tehm ot pots i.gee)dlbn nO pS,te igeblend neomw evah .VDW eengildB soyb ahev h.iplhamoie

winelover777  Agree. PTT does not have to be elevated to be VWD. +5
tulsigabbard  Welp. +
... benwhite_dotcom made a comment on free120/block2/q#23 (A male stillborn is delivered at 32 weeks' gestation...)
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nlwaglSwoi tcoianmi fldiu si a tcalcrii nptcomeno fo nlgu omledp.entve seusteF tihw vesree royisdaomiolngh rea apeudlg yb paorulnmy sopphliaya, hhcwi is teh uaesc fo taehd in sutfese obrn htiw erttPo rsmoeydn rnl(ea ssani.)eeg

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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nodeArng isnytitniisev si sucade yb a tefecvdie nnogared tercer.po TDH si oeplsibrnes for cngaeitr lmae gitaeanil grinud leatf ueslax vopmeled.etn eTh ldeafut humna eedgnr si fa.leme oS a aytllgcenie amel tantpei tiwh cmpoelet rdaongen sitevninstyii si tayelxlner chppyeltiynoal aefml.e kLca of nspesreo ot adeanrl rgasonned tnsepvre hria artmooifn nuirdg bueytpr ah.read(ne)cr

... waterloo made a comment on free120/block2/q#33 (A 17-year-old girl has never had a menstrual period....)
 +7 
submitted by waterloo(76)

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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heT rpeeiflatvior espah fo the lsmtneura ccely si elcordlnto by ntily-npcceddnee sisea.kn (iTsh eksma neses sa yneidcdn-penlcet nisksae vengor itarullvy all eaullclr diisnovi in kitoerycua c)s.ell

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 noggi ot noitp tou hatt a anmrlo tlyhaeh ikd wthi no icdrcaa syritho or ommpsyts and on mflaiy shroiyt fo sdnued raaidcc hteda orf a -ossrpertp plcayish is bypbaolr ggino to aehv a ibneng maxe on maettr hatw yuo inhtk uyo rea.h

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 +
... 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(25)

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

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

... benwhite_dotcom made a comment on free120/block1/q#35 (A 10-month-old boy is brought to the physician...)
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eH has elasmpub(yr SV)R oc.ibnsirihtol SVR si an RAN urvis ahtt tseern hte ellc iva a usiofn irpetno (whhci is eth tgerat of teh torlycpapcih nlmnlocooa oatbiynd durg a.uPv)limbzai

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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tigSpnilt is na utaeimrm eedefns ehnacmsim often yopmleed yb tsptanei hwit ldreinbreo pesrniloyat rdisreo.d nhWe tp,inilgts a opesrn fsial to ese storeh as alebpac of nagihv tboh tiovisep nad inavegte iiltseaqu; at nay ginev tiem, ’tis all or higontn.

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 raoitnel betneew the trmaui P() eavsw and teh SQR elmoxpc seamn -digeteehrdr VA okblc kaa( ”peotcβ€œmel htare bck).ol actyptSiomm nev(e faalt) dryaarbdiac nac tsu.ler na”nCoβ€œn iatalr veasw are ntpeirnmo ruluajg unovse iualstsonp atth cucro nhew eht traia dan vrltnecie nttcroac mnuyllouastise h(icw,h fo rousc,e ed’nots olamnlyr )en.apph

... melchior made a comment on free120/block3/q#7 (A 72-year-old woman comes to the physician because...)
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submitted by melchior(46)

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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ituibRamx -aiCDnt( 20) si yrunclrte nognruideg iralts rof A.S yM aesprs oinggogl tsju own hsows taht xbrimuiat oprblyab nylo has a metardoe efect,f os yboabrlp ol-dcnensie to Ta-tNnaFi ateyr.hp rb.blyPoa

eafS ot ysa rfo bdraos htta :SA FNTa t&g; 0DC2

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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tusJ abcseue se’h gnivah c)(poutdnetre xes odtn’se anem he s’noedt hvea imspel itunfeosic .nncsmioleosou The sex miilspe hes’ aols kinssig !meosneo htrasiPgnyi + phmyl denso + etigauf = mono.

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
... 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
... aejinkim made a comment on free120/block2/q#39 (A 3-month-old boy is brought to the emergency...)
 +6 
submitted by aejinkim(6)

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

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hsiT neqtsiuo si iagnsk oaubt VDJ mreergneatnar hihcw hsnepap ni het oebn m.rorwa Teh sgene ear all pcopdeh pu buaesec het B lelc si gtriny to teeeragn a qenuui nbiancoiotm ofr ist rcorepet
ems lpi t.cn.pce.os ddo ownridg

rhetCap 3 of who" teh ienumm emtyss rsowk" - eewosma obko

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
... benwhite_dotcom made a comment on free120/block1/q#10 (During a clinical study examining the effects of...)
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lTato hpperrelia siasrenetc gseo ondw igundr erseeicx sa hte riesaorelt puypnlgis mucles and insk die.atl

... benwhite_dotcom made a comment on free120/block1/q#11 (A 26-year-old man is brought to the emergency...)
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eTh oparrcoesrbte rea crsthte repctsore eh(t oemr iulfd in eht vs,esel hte roem thye re)f.i So a attipne whit maihrrogech koshc ilwl ees a esaederc in het rrotacboeerp rinifg e.art itnvAotica of SARA lwli eultrs ni idsecaenr ulsavcar tcreisasne otircstvn(oao)cisn ni reord to nniiamta dolob e.rsrepus Adn ial,lsciepar cush as oesth in het dk,eiyn llwi be erimpd rof rpitnseroo dna ton oarttiflni (no neo wsnta ot epe uot godo iutdle reiun whne ’yherte etaye)dr.ddh eLkiws,ie sytemcis lriseiapcal lwil freerp ot olhd otno aspalm dan ont tel it laek noit hte tirstnmetiiu hpicsirgta()-nd.

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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etoEhdllina ihgtt iosjn’nutc lbatryempiie si rendiseac in penoress to runyij dna initala,fmnmo ngalliwo itgnriaom fo teiwh obodl clesl adn sidnfer ot eht esit fo i.rnyju

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. +3
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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icenmdE krBiutt mylhopma nac apenph ni zarlBi as lewl sa airfAc aw(j lni,eos uyffp ac)fe. heT portochmogharip is sgenidmttraon bietglin bdoy chreogamspa, a eypt fo ercogmpaha gitcnannio mnay ,dzatgiphyeoc ipptatooc cslel in usrioav saetst of nigeaartddo.

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...)
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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 +3
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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The ’setatipn irocnch lmtainmyraof neiutnpismo is ligknli off ihs guln nyacraphme mpcdesoo( lrmyiaipr fo eytp I op)esetumyn.c pyeT II ymsc,uoeetpn ni naiodidt ot gkniam aa,tfrntsuc anc ieaectprl ni rreod to aeclrpe etyp I ycu,nmopeste so yeht ilwl be rsdae.cnie hincroC ainttestilri ntnloifamiam sletrsu in sfiirbso, echen an nasiecre ni staor.sbfbli

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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-CaoAylMonl sintbihi het agi-trmniitel teps in eht -adibatoentiox of ttayf .cdia ,gacyllioL esnrtgi lmecsu rseeuqri ssel eenryg and( suht sles dnee ofr ttyaf iadc ne)bowakrd nath tvceia .mlcseu

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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()beUltans gn.iana tMos iemtdamei metntrate is n.rito

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...)
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Nrtocaic esu rof cealyut linfpau cosnoidtin si ohtb ereansaobl adn ptitmr.ano rt-othmeSr ues tamld(emyiei lssuprcig-)tao edos nto deal to glo-nrtme ndpcedneee (ro so oepepl hvea .gott…h)uh dnA ,yes surgd iscdadt dhousl saol evreice trsaoccni ot cotnrol n.pai

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...)
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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...)
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submitted by madden875(15)

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...)
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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
... mes1717 made a comment on free120/block1/q#14 (A 52-year-old man comes to the emergency department...)
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Wedge-shaped hypodensity --> renal infarct. Kidneys receive a large amount of body's cardiac output, so they are a common site of infarction due to emboli from Atrial fibrillation.

... ibestalkinyo made a comment on free120/block1/q#2 (A 14-year-old boy is brought to the emergency...)
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submitted by ibestalkinyo(44)

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.