isTh isavre gnmao steats but ni tsom of the testsa a -21 yare rfee ruszeei peirod si qreidure ofr ctlepiiep tnptiesa to teg trehi encsile

COPD is usually associated with Pulmonary Hypertension. The examiner tells you that there is a loud pulmonary component of S2 ie: P2 (Loud S2/P2= Pulmonary Hypertension). Fev1:FVC is just related to COPD. The question is asking what is DECREASED in the pulmonary VASCULAR SMOOTH MUSCLE. do not get confused with the line stating there is decreased diffusing capacity for CO. the question isn't asking about that.

In pulmonary hypertension there is an imbalance between vasodilation substances and vasoconstrictors. therefore our vasodilators would be decreased eg: Nitric Oxide

if it asked increased, you could go with Endothelin (remember the endothelin antagonists used for t/t of Pulm HTN ie: bosentan sorry gave some extra info but all of it is important because they can ask this concept in many ways

potainnsoTris of the aAnv nege mfro atnitccrmsisae-onvyn cEorcectuson is hwo ti eafrsnsrt ec.rtsenais yehT ues stnrpsosnao hcihw rea etcloda on imasdp.ls fI oyu vahe psidalm s,osl uyo w'ton heva ,oostnsaprns dan estenrcais ilwl resced.ae

hiTs dlwou tusj be teh rlmaon eensosrp of rou nyesdki to whne ew 'dton rkidn twrae ogehnu aka( juts )lrmo.an

xlioarPm ultueb is tniscioo uaecesb we are bieornbgasr HBOT +aN dna .HO2

laMuca sndae is otiohnpyc eeubcas ti is sgsenni hte lasidt odctnoluev tbeulu -- teh toms UIEDTL artp fo het .nropenh eermembR hte rrctunuentreoc ehaecnxg sestmy - ikcth acdnngise lbim si nislog aClN u(eirn setg slse aectcetnrndo sa it cnsase)d.

uaydlerlM cotgcellni dutc is pyhiecotnr ebcusea ew era abrrsgniebo lla the reatw gamkni teh nurie moer anottncee.crd

shTi atntpei sha a dyr apt, hwchi si nese ni sfombrsieilyo nda stacipla inmaae. eTh alobrman BCR ear omts iyellk rdyesocact dreaotpr( lsc.)le

ALM olduw vahe aeru srod and nmay ictnulagcri lsbtaye,olsm utb rno blnmoara CB.R

,LMC fenidde yb the 2t;2[9] elhPadiiphal mm,erochoso will ehva aynm tamuer nda riumngta n,srgoeytluca twih a low LPA seceabu ihst is otn a uekeodmil ne.rotaic

ioispetoyelmyDc nsoyredm si hte asem as a scdioalyyspetlms rndos,yem hcihw are a ougrp of sncerca ihwt eiammrut RBC ni hte beon amrorw atth do ton mbeoec ra.etum swepc.ndmaahyrkMyy_t:ppiolsdkieii/ew.sse/ttlniiodr/o/g

itenalEss mttrehamocioybh i(whch si tno eslanseit iophyt)mcaeyl is tsju a erra ccnrea ihtw hhig t,llspaete iwchh sepesnrt iwht bnamrloa boodl gnt,ictol nailged to ,siobmshotr st,rseko nad .PE

tohacmyiPlye vare sah yrev egalr BCR mass dna wol POE ued to ntaiegev fckadbe.e It is due ot a JA2K nmttioau nad olsa ash ghhi CWB nda aet.lslpte Our nteitap si im.ecan

vybpsm/wh.ee:cttut/ulw/so.eomluwi

Costanzo Physiology 6th E p456

Regulation of Vitamin D Synthesis Whether the renal cells produce 1,25- dihydroxycholecalciferol (the active metabolite) or 24,25-dihydroxycholecalciferol (the inactive metabolite) depends on the “status” of Ca2+ in the body. When Ca2+ is sufficient, with an adequate dietary intake of Ca2+ and normal or increased plasma Ca2+ concentration, the inactive metabolite is preferentially synthesized because there is no need for more Ca2+. When Ca2+ is insufficient, with a low dietary intake of Ca2+ and decreased plasma Ca2+ concentration, the active metabolite is preferentially synthesized to ensure that additional Ca2+ will be absorbed from the gastrointestinal tract.

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!

THIS IS KAPOSI's SARCOMA ==> give antineoplastic

"THIS IS JUST TO LENGTHEN THIS ANSWER, NEVER EVER PAY THIS SITE, EDUCATION SHOULD BE FREE FOR ALL!"

th4 yaahrpelgn phcuo siegv ires ot ureiorsp ysa.odrriathp
FA 0129 gp 067

In meiosis I, the gametocyte splits from a single cell (XXYY) -> 2 cells (XX + YY). In meiosis II these two cells split again (-> X + X, Y + Y). Hence in order for a father to pass on both an X and a Y chromosome to his son (eg in Klinefelter syndrome, w/ XXY chromosome), a spermatid must contain both an X and a Y chromosome, which means that there was an error in meisosi I. The stage at which meiosis I occurs is the primary spermatocyte.

e"iDtesp iibhtionni of o-MHGAC creseutda yb sns,tita elslc nosceepmat yb asicnigern enzeym rsxeeiopns lrevesa odfl. oHev,wer the ottla odby tloecrseloh si cedrdue yb 00–42%% ude to ierdesnca penriosxse fo DLL oreecrtsp rfaet ttnais iirtdas.no"aimnt

wcttcs/ml/m/uihienceralpheaydtsioepico-n-meo.r/mtg:cbhwgy-ricsssbeeo-/wtlcgacn.iti-ocood

itlrMa valve nda tthee canilgne rea eyk wsrod ofr trpeS arvdisin nias.dosig It is hlaap hiceltmyo so ti owldu eahv a eerigngn rencaiot.

nitotmarp mnnoite to hcawt out r:fo

hTe tpoionch wsnrea is cntieorcr sacueeb it ayss thionni"bii BY n"ho.ocitp isnrdiVa si asetinstr to nhpcotio os that swraen is rei.ntcrco

If you got all tangled up on this question like me:

anatomic dead space= conducting airways

Alveolar dead space= alveoli that are ventilated but not perfused (wiki)

physiologic dead space=anatomic dead space+ alveolar dead space

Po2: just no

hIlaedn ascisttnehe tath ehva olw ogdslboa: npoitirta octfdnbolcif/ieoe isllyobiut osiedvsl ni blood eorm iy.slea Teer,refho there is LSES gsa ndedee to ataesrtu dlboo -- kaa eastfr rntiatousa of obdl.o Tshi saeld ot retsfa aroinutats fo .abnir

trld; olw lltuoiyibs ;&--tg ftsrae seotn g-t&-; erfsat vceeyorr

Naiersies imgentiisned nac aled to -eeecsidWhietrFunhoarrs ysdonmre a(nrelad uycifnsfn,iiec efr,ev DI,C co)hks

Here's how I understand this; please correct me if I'm wrong: Fibrin exudation is part of the acute inflammatory response if the inflammatory stimulus is a lacerating wound, (such as, in this patient, perforated diverticulitis), along with platelets and other clotting factors, in order to clot the wounded area. Hence in this patient who died 2 days following acute perforated diverticulitis, the inflammatory exudate surrounding the liver would most likely contain fibrin (not collagen, since the inflammation is acute and not chronic). Fibronectin and proteoglycans, the other two options, are extracellular matrix proteins.

acute interstitial nephritis

keys are: urine eosinophils + NSAID use + Rash

in the setting of fever and urinary issues

Here's how I thought through this. problem with DCML (absent proprioception and vibration sense), problem with deep tendon reflexes (DRGs), ataxic gait (spinocerebellar pathway), mild weakness (motor neurons). The only thing that all of these pathways have in common is that they all use myelinated afferents.

I don't know if Guillan Barre would actually present like this, but you don't have to know what the illness is to figure the question out.

Just a rant - i hate this f*cking picture it's been on 3 NBMEs now and every time I've gotten it wrong.

If it ain't broke don't fix it. The patient is showing improvement and there are no signs of developing drug resistance or unwanted side effects, so maintain the patient on her current therapy.

Typical antiretroviral HIV therapy regime is:

3 NRTIs OR 2 NRTIs AND 1 NNRTI OR 1 Protease inhibitor OR 1 Integrase inhibitor

In this case the patient is on 2 NRTIs (emtricitabine, tenofovir) and an NNRTI (efavirenz)

If you knew that basement membrane disruption prevents restoration of normal tissue (repeat from another NBME), then you missed this because you didn't know what "preclude" means.

• High yield reference: https://www.merriam-webster.com/dictionary/preclude
• Does NOT mean "prior to"

Missing questions I miss due to lack of vocab and grammar, you love to see it

Increased pressure is in the Bowman space (NOT the glomerular capillaries) so the only pathology listed that would cause backward build up of pressure is BPH

AF 9210 egap 38.0 stMo nmmoco caesu fo ret/myrciaapu iitdsrricaep is ademuss to be la.vri

FA 2109 gp 6-195
X kiedln ulcsmura odphry.tsy hTe ehcnac taht teh mom III-1 si a rerraic si 2.X/1 Y loarmn( apngdar 1I)-I * XXa cierra(r rgndaomm -II2) Y uo knwo atth 1III- is a leaefm, os onyl kolo ta alfh, os 12/ ancceh.
Teh cchnea htat 'I1I-Is aetm si a eriarrc si aern zer.o oS ew kaem him nmro.al XY maroln( d)aD * XXa ri(cearr mom )1III- i ecnS we wnok tsi a ybo yuo nlyo okol ta ahlf, so eht ccaneh of imh ivgnah ti si 12/.
os 2/1 * 21=/ 1/4
ee Tsh era tow denpednietn ,sveetn eht cneach het mmo is a errraci * eth hecnac het ikd tges teh fedeftac .X

nMya tsendtsu lliw get tsih entiusoq gnowr ebsaecu fo a asmlrii nisoqteu no .wdrUlo iTsh ainpett sha an ytlxmreee ihgh relrticdiegy lvlee adn ahs on iotyhsr of raodaacscvruil des.esia rseFtiab uoshdl eb dprcebiers ot vtpeenr ianaitt.pscre

ieHsotn onylcaateti lswoal fro eoxalraitn of the NDA so tath cntproitarins acn opredce. llA rstna triionce aicd secaus eth ueyctogarsnl ni MLPA to rruhfet turm,ae chihw rqeresiu NAD annitosprctri / ilttaon.ansr

basically polycystic kidneys won't work properly, they've hinted at this with the s.creat of 4mg/dl. thus the kidney won't do what its supposed to do. REMEMBER to check whether they are asking SERUM changes or URINE changes

Kidneys normal function - reabsorb HCO3- , its not doing that now > decreased HCO3

PTH - would cause increased Calcium reabsorption in kidneys, but kidneys aren't able to reabsorb calcium > PTH responds to low calcium levels and levels increase

PO4 ties into PTH as well, PTH acts be DECREASING PO4 reabsorption. Since kidneys aren't working ie: not responding to PTH > there would be increase in PO4

eisoisM ⇒1 rofm rparmyi ot rsnadocey etcmerpyatso ; iieossM 2 → aercodnyS to dasrpmite

So we already know the answer is either 11- or 21- Betahydroxylase. How to determine which one?

Question stem cells "dry mucous membranes". He is dehydrated.

We already know that he can't make aldosterone since the lack of either of these enzymes would block that pathway. However, if he is able to make a molecule that ACTS like aldosterone, he would not have dry mucus membranes. He could save water.

Do we have such a molecule? YES! 11-deoxycorticosterone.

Now, if he has 11-beta hydroxylase deficiency, there would be a buildup of 11-deoxycorticosterone. Hence, it has to be the other option.

1. nmirdAtesi CTHA nad rnomtoi srlctoio snpeoser
2. If trlocosi aensriecs g-t&-; sokch is due ot iyaprutit nuyifcfnecsii
3. fI ctorsiol dose otn nacisree t-g&-; ocskh is ude ot rneaald cnsuciffeiniy

xaaenoseDtmhe uissspoenpr stet si iicnddeat rfo ittnaeps woh seternp tihw sgnis fo locisrto SE.SECX

She's vomiting - Metabolic Alkalosis > loss of HCL > ie; acid, there would be increased HCO3 Anion gaps are usually with metabolic acidosis because in alkalosis there is high HCO3 which keeps gap normal. For the K+ > vomiting > loose water along with the vomit > decreased blood volume > RAAS activation > aldosterone secretes H+ and K+ > hypokalemia

glSaelpi of astrntoc otni hte neiutproem igudrn a apolytsrrgosimhegan is lnaomr dna dneaicist tapecny fo eht pfoilnlaa bstue.

-aeiMcdl ihtPeprsra oRigaoldy

hte iiradonta eahptry euacsd fbisirso dna eth sfybitoarmbslo nocct"a"rt inrudg sib,soifr guacnis the ecluosr of irywaas nda htsu lcstseeiaat

The subcutaneous tissue is highly vascularized and has larger blood vessels than the dermis, leading to a higher risk of metastasis and worse prognosis (TNM staging system)

The IMA comes off the aorta between the renal arteries and bifurcation. The IMA supplies the hindgut, which spans the distal 1/3 of transverse colon to upper portion of anal canal. Compromise of the IMA would lead to decreased blood supply to these structures, of which "Descending colon" is the only answer choice.

This is the most poorly drawn cell diagram. I see zero ribosomes, so I figured F was the smooth endoplasmic reticulum. However, now I can see that the curved organelle is the golgi apparatus and F must represent the whole endoplasmic reticulum.

I believe plasma membrane proteins are synthesized in the rough endoplasmic reticulum.

FA2020 p46 Rough endoplasmic reticulum Site of synthesis of secretory (exported) proteins and of N-linked oligosaccharide addition to lysosomal and other proteins.

Free ribosomes—unattached to any membrane; site of synthesis of cytosolic, peroxisomal, and mitochondrial proteins.

Smooth endoplasmic reticulum Site of steroid synthesis and detoxification of drugs and poisons. Lacks surface ribosomes. Location of glucose-6-phosphatase (last step of glycogenolysis).

I was nsefodcu nteeweb pA-hla eulynnSic and Tau. shi T eintatp ash rniasnkpso adsseies nda utsh we uolwd ees plAha yclnnie.us

aTu si nees in aeptsitn twhi ckiPs sesdeia, aka nrptotoalFerom itnemdae DAN ihleezmars .dasiese eap g 045. FA 8012

roocatmOsase oagtihlclosi ap.narepcea tPaeg sseieda is neo fo ikrs crafto

I tkhin hyte rea galknti taoub aailobmlsotG ifuetommrl eseaucb ti rssceso" rvoe ot the felt hremieshp"e shti si the lony NSC trmou tath seod that nad ti si rdeaG VI amngein ihhg dre.ag atlGlmaoosib rmeomluift is a pyte of sctaymotAor staht wyh sti GAPF gpa e+ 150 FA 1280

tsi bset ot ihtkn utaob iirtuyatp moadnesa as one fo htree igb ptnoso,i laocrptin neis,tecrg CHTA rgtc,iseen or GH ic.sgnteer eTh ylon irauiyttp uotrm thta eacsus eosspostooir and oehrfeter the crpoemsions rsuraectf esne in the osqetiuns oclud eb a THAC egrinetcs tuyriatip anaedom tn(oe: neamaadomcro sutj eamsn htta het tourm si ;01mtgm& in )zes.i decrsiena ATCH adels ot nsdereiac oictrlso dan oreterehf ereedsadc etotassibclo ittvyaci eb(on )oafmtoirn = oirsseostpoo

I went with metastatic breast because they made a point of saying metastatic as if the thyroid carcinoma has not spread to the bone.

hte edeerp eht mloamnea sego eth eoswr het sospnirog

lhotlrsoCee etres yerdaoshl is needde ofr rveeesrs leortslcoeh rnsrtat,po ont tierccpnaa yze.enms
- I dsmise tihs
metl9dwc2w//0op/v3mn8b7.ug/shp4w.nti:.b1inh.

olleisrisy,B tvyeprynieisitHs oeunnisptim nad Ssocosaiird all ahev mraanolgu armfootn.i oAsl aeeniildmt cnogiecpyrt gzrinnagio meinunpoa bc/ hte pt i'dntd aveh nay hcnroic /ds.eeessamsid o,S I asw ltef itwh iipcadtohI nrmypualo sofbiisr as het iohc.ce

sI a ceas of ilnoacgnte glno Q,T reeht rae wto pplaciirn uscse;a oWroRda-man (a)dimtonn dna rlJleev adn eiLsleenN-nga en,ysromd eth dsonec eno etelrda to nssdfeea ssei.vc(e)er tsI' onimtatrp to meemerrb het roitnapelhis of the KEG adn eht clcey fo nciaot pioettnla of het draicca cemsul lcel sceaeub the QT is eorrdclaet htwi hte oaatnrlrioepiz ASF(E ,)III alsrmii wthi eth htmr,ytsnaaciirh het sneo thta fcatfe spmtaouis ashlnnec S(EFA II)I ear rome adrltee with aterltaisno in TQ adn vrnteciuarl tahiyrasmhr.

Intracellular aggregates in neurodegenerative conditions :

Alpha synuclein- a protein mainly found in terminal axons which can aggregate and deposit intracellularly to form Lewy Bodies . These are associated with the neurodegenerative conditions 1. Parkinsons Disease 2. Lewy Body Dementia

Neurofibrillary tangles - hyperphosphorylated tau protein , number of tangles correlates with degree of dementia

Pick bodies - hyperphosphorylated tau . these are round aggregates though in contrast to neurofibrillary tangles. Seen in Frontotemporal dementia and other neurodegenerative conditions

Hirano bodies - intracellular aggregates of damaged actin filaments seen in various neurodegenerative conditions e.g AZ , ALS , Creutzfeldt-jakob Disease ( These are not really tested on )

tMso brsempol thwi lelc ivdnisio rcuoc in hepanasa fo osiiesM I.

Follow-up vs support group?

The only thing that saved me was the ancient Step 1 adage: "Never refer!"

Especially when the answer to another question in the same exam was "Encourage the patient to participate in a support group for persons with her condition"

I mean REALLY! The only difference is that they used the word "encourage" instead of refer. Exact same answer.