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NBME 18 Answers

Block/Question (43.9 difficulty score)
5 yo boy, history of motion sickness
Antagonist at muscarinic-3 receptorsπŸ”

renal
Block/Question (20.7 difficulty score)
25 yo woman, polycystic kidneys
HCO3: decreased; inorganic PO4: increased; parathryroid hormone: increasedπŸ”

Block/Question (12.2 difficulty score)
67 yo man, fine resting tremor in both hands
Alpha-synucleinπŸ”

Block/Question (18.2 difficulty score)
10 yo boy, nosebleeds and easy bruising
Antibodies directed against the glycoprotein (Gp) IIb/IIIa complexπŸ”

Block/Question (30.6 difficulty score)
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyteπŸ”

Block/Question (19.6 difficulty score)
experimental animal with defect in an innate ...
Chronic gastritisπŸ”

Block/Question (14.0 difficulty score)
4 day old boy, vomited throughout night after ...
21-HydroxylaseπŸ”

renal
Block/Question (16.0 difficulty score)
68 yo man, chronically increased hydrostatic ...
Benign prostatic hyperplasiaπŸ”

Block/Question (16.1 difficulty score)
70 yo woman, increasingly severe pain in ...
Pleomorphic neoplastic cells producing new woven boneπŸ”

Block/Question (11.7 difficulty score)
22 yo man, professional cyclist
Eccentric hypertrophyπŸ”

Block/Question (17.5 difficulty score)
50 yo woman, chronic obstructive pulmonary disease
Endothelial nitric oxide synthase productionπŸ”

Block/Question (8.4 difficulty score)
Cholera toxin is a catalyst that results in ...
Concentration of cAMPπŸ”

Block/Question (14.2 difficulty score)
29 yo woman irregular menstrual periods
Provide follow-up appointments to assess the patient's progress in attaining her goalsπŸ”

Block/Question (16.8 difficulty score)
7 yo boy appendectomy
Low blood solubilityπŸ”

Block/Question (23.1 difficulty score)
52 yo man with chest pain and shortness of breath
Proximal tubule: isotonic; Macula densa: hypotonic; Medullary collecting duct: hypertonicπŸ”

Block/Question (18.4 difficulty score)
35 yo woman with pain and swelling of ...
Have a chaperone join them for the remainder of the examinationπŸ”

Block/Question (17.5 difficulty score)
60 yo man, 1 day of fever, chills, confusion ...
Vibrio vulnificusπŸ”

Block/Question (11.0 difficulty score)
45 yo homeless man found unconscious
Methylmalonic Acid: normal; Homocysteine: increasedπŸ”

Block/Question (14.0 difficulty score)
18 yo man cracked lips and sunburned skin
BarrierπŸ”

Block/Question (6.6 difficulty score)
26 yo man skiing accident
AxillaryπŸ”

Block/Question (26.7 difficulty score)
55 yo man; father and brother died of ...
Increased transcription of HMG-CoA reductaseπŸ”

Block/Question (9.0 difficulty score)
65 yo man, generalized tonic-clonic seizures
High-grade fibrillary astrocytomaπŸ”

Block/Question (20.3 difficulty score)
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11πŸ”

Block/Question (21.4 difficulty score)
19 yo woman being treated for meningococcal ...
Adrenocorticotropic hormone stimulation testπŸ”

Block/Question (11.9 difficulty score)
38 yo man, 1 week history of shortness of ...
Aortic regurgitationπŸ”

Block/Question (24.8 difficulty score)
65 yo woman, 1 week of swollen, painful knee
Uric acidπŸ”

Block/Question (14.2 difficulty score)
Researcher testing new cancer drug
Neutrophil countsπŸ”

Block/Question (20.2 difficulty score)
66 yo woman, 2 days of fever, flank pain, ...
Calcium carbonateπŸ”

Block/Question (30.1 difficulty score)
40 yo man, 1 year of orthostatic hypotension ...
Motility disorderπŸ”

Block/Question (26.3 difficulty score)
58 yo man, 4 years of recurrent cough and sputum
Pseudostratified columnar epithelial cellsπŸ”

Block/Question (8.3 difficulty score)
32 yo woman, new neurologic finding; imaging ...
Inability to abduct the eyeπŸ”

Block/Question (25.6 difficulty score)
35 yo man, 4 weeks of severe midline back pain
ACTHπŸ”

Block/Question (27.3 difficulty score)
Investigator studying vancomycin-resistant ...
Plasmid lossπŸ”

Block/Question (27.9 difficulty score)
25 yo woman, fatigue for 3 weeks
Greening reaction on blood agarπŸ”

Block/Question (13.2 difficulty score)
34 yo man, semiconscious and combative
PseudocholinesteraseπŸ”

Block/Question (11.2 difficulty score)
35 yo woman, 3 days fever and sharp chest pain
VirusπŸ”

Block/Question (10.4 difficulty score)
35 yo woman, passed out while washing dishes
K+: decreased; HCO3: increased; Anion gap: normal; pH: increasedπŸ”

Block/Question (10.6 difficulty score)
17 yo boy septic shock
alpha-1-AdrenoreceptorsπŸ”

Block/Question (37.2 difficulty score)
82 yo woman, 24 hours of constant severe ...
FibrinπŸ”

Block/Question (11.0 difficulty score)
32 yo woman, diagnosis of hyperparathyroidism
Abnormal migration of endoderm from the fourth pharyngeal pouchπŸ”

Block/Question (25.1 difficulty score)
35 yo woman with infertility
Spillage of contrast, which is normalπŸ”

Block/Question (13.2 difficulty score)
58 yo woman, 6 months shortness of breath, ...
Pulmonary hypertensionπŸ”

Block/Question (9.5 difficulty score)
35 yo woman, 2 days pain in left leg
Drug-related antibodiesπŸ”

Block/Question (15.8 difficulty score)
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxinπŸ”

Block/Question (12.6 difficulty score)
46 yo woman, 1 week of fever and joint pain
Inflammatory infiltrates in the interstitiumπŸ”

Block/Question (20.6 difficulty score)
48 yo woman, gradual onset of back pain over ...
Metastatic carcinoma of the breastπŸ”

Block/Question (20.1 difficulty score)
70 yo woman routine pelvic examination
CystoceleπŸ”

Block/Question (17.7 difficulty score)
63 yo man, 2 weeks of fullness in left upper ...
MyelofibrosisπŸ”

Block/Question (27.4 difficulty score)
33 yo man, diagnosed with epilepsy
He is medically qualified to driveπŸ”

Block/Question (16.7 difficulty score)
28 yo woman, 4 days of palpitations, severe ...
Subacute granulomatous thyroiditisπŸ”

Block/Question (25.5 difficulty score)
25 yo woman, 2 years of intermittent, ...
Accentuation of mu-opioid myenteric plexus receptorπŸ”

genetics pedigree
Block/Question (18.3 difficulty score)
4 yo boy, clumsy gait for 1 year
1/4πŸ”

Block/Question (26.7 difficulty score)
52 yo woman with breast cancer
ContractionπŸ”

derm dermatology
Block/Question (19.6 difficulty score)
47 yo woman with irregular, raised, ...
Subcutaneous tissueπŸ”

Block/Question (32.7 difficulty score)
24 yo man, 3 days of progressive numbness of ...
Myelinated primary afferentsπŸ”

Block/Question (17.5 difficulty score)
65 yo patient with lung region ...
Physiologic shuntπŸ”

Block/Question (14.7 difficulty score)
45 yo man for annual health maintenance ...
FenofibrateπŸ”

Block/Question (14.8 difficulty score)
19 yo woman, 2 days of pain in left index finger
Flexor digitorum profundus tendonπŸ”

Block/Question (21.0 difficulty score)
52 yo man, chronic pancreatitis
ColipaseπŸ”

Block/Question (18.9 difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Aortic aneurysmπŸ”

Block/Question (29.2 difficulty score)
36 yo woman, 2 weeks of fatigue, bleeding ...
Histone acetylaseπŸ”

Block/Question (12.6 difficulty score)
18 yo woman ingests 100 aspirin tablets in ...
pH: 7.32; PCO2: 15; HCO3: 8πŸ”

Block/Question (14.6 difficulty score)
45 yo man follows up 1 week after appendectomy
Gilbert syndromeπŸ”

Block/Question (13.8 difficulty score)
54 yo man, normal renal function, receives ...
CyclosporineπŸ”


Block/Question (14.8 difficulty score)
5 yo girl, 1 day severe leg pain after ...
Intestinal calcium absorptionπŸ”

Block/Question (16.8 difficulty score)
57 yo man with alcoholism
LiquefactionπŸ”

Block/Question (14.3 difficulty score)
73 yo man, 4 months poor appetite and 25 ...
Cytokine effectπŸ”

Block/Question (7.7 difficulty score)
18 yo woman given general anesthesia for ...
Sarcoplasmic Ca2+ releaseπŸ”

Block/Question (14.3 difficulty score)
66 yo man, 1 month nonproductive cough, 6 ...
Idiopathic pulmonary fibrosisπŸ”

Block/Question (12.6 difficulty score)
4 month old boy, abnormal glycogen storage
alpha-1,4-GlucosidaseπŸ”

Block/Question (14.8 difficulty score)
35 yo man, prolonged QT interval
Outward (delayed) rectifying potassium channelπŸ”

Block/Question (8.2 difficulty score)
An investigator conduct a meta-analysis of ...
The identified loci account for a relatively small part of the variance πŸ”

Block/Question (6.7 difficulty score)
A 4-year-old boy, fatigue and irritability, ...
Microcytic AnemiaπŸ”

Block/Question (3.8 difficulty score)
A 55-year-old woman who is a physician is admitted
Alcohol withdrawalπŸ”

Block/Question (4.7 difficulty score)
an 83-year-old woman with systemic ...
descending colonπŸ”

cell_bio cell_transport cell_trafficking
Block/Question (11.5 difficulty score)
During a study of the regulation of ...
F (cell diagram)πŸ”

Block/Question (7.8 difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina)πŸ”

Block/Question (5.7 difficulty score)
A 51-year-old woman with Graves disease ...
AgranulocytosisπŸ”

Block/Question (4.6 difficulty score)
A 25-year old woman comes to the physician ...
3 to 8 weeksπŸ”

Block/Question (6.0 difficulty score)
A 17-year-old boy is brought to the physician ...
"Tell me more about your concerns about your son's height."πŸ”

Block/Question (11.5 difficulty score)
A 68-year-old man comes to the physician ...
Cor pulmonaleπŸ”

Block/Question (7.4 difficulty score)
A 30-year-old woman with a long standing ...
MacrophagesπŸ”

Block/Question (9.5 difficulty score)
During a clinical study of calcium and ...
24,25-DihydroxycholecalciferolπŸ”

Block/Question (8.3 difficulty score)
A 4-year-old boy undergoes radiographic ...
Tubular atrophyπŸ”

Block/Question (5.0 difficulty score)
A 32-year-old man with an X-linked recessive ...
Type IV collagenπŸ”

Block/Question (10.0 difficulty score)
A 45-year-old man comes to the physician for ...
Transcription Factor c-Jun: increased; Ξ²-Myosin Heavy Chain: increased; Endothelin: increasedπŸ”

Block/Question (6.9 difficulty score)
36 yo woman, recently been diagnosed with HIV ...
Continue efavirens, emtricitabine, and tenofovir with no changesπŸ”

Block/Question (6.4 difficulty score)
32 yo man, HIV infection comes to the ...
Reverse transcriptase and proteaseπŸ”

Block/Question (3.6 difficulty score)
A 2 month old boy is brought to the physician ...
ventricular septal defectπŸ”

carbamazepine FA20p518 neuro
Block/Question (3.8 difficulty score)
63 yo woman, 2-week history of daily episodes ...
Trigeminal neuralgiaπŸ”

Block/Question (10.3 difficulty score)
20 yo woman, 27 weeks' gestation ...
Inflamed maternal decidua release of prostaglandinπŸ”

respiratory lungs newborn
Block/Question (4.5 difficulty score)
A 1045-g (2-lb 5-oz) male newborn delivered ...
DipalmitoylphosphatidylcholineπŸ”

Block/Question (6.2 difficulty score)
A 2-month-old female infant is admitted ...
Double-stranded RNA, segmented

Non-enveloped

Icosahedral capsid
πŸ”


Block/Question (2.5 difficulty score)
An 8 year old boy is suspended from school ...
methylpenidateπŸ”

Block/Question (3.6 difficulty score)
35 year old ,precursor to ...
succinyl CoAπŸ”

antiscrambler
Block/Question (1.6 difficulty score)
35 year old ,precursor to ...
succinyl CoAπŸ”

Block/Question (3.9 difficulty score)
MI study, 500 in operation, 250 each to 2 ...
Randomized clinical trialπŸ”

renal
Block/Question (5.0 difficulty score)
a 35-year-old woman has congestive ...
prerenal azotemiaπŸ”

Block/Question (4.3 difficulty score)
a 67-year-old woman comes to the physician ...
amyloid infiltration πŸ”

micro derm dermatology
Block/Question (4.0 difficulty score)
A 3 yo boy is brought to the emergency ...
Positive nares culture for toxin-producing Staphylococcus aureusπŸ”

Block/Question (3.1 difficulty score)
A 3 yo boy is brought to the physician for a ...
Complement activationπŸ”

Block/Question (2.8 difficulty score)
A 35 yo man with Chagas disease comes to the ...
Loss of neurons in the myenteric plexusπŸ”

Block/Question (3.2 difficulty score)
A laboratory technician wipes down the ...
Enveloped virionπŸ”

Block/Question (3.3 difficulty score)
A 45 yo woman comes to the physician because ...
MEN1πŸ”

Block/Question (4.6 difficulty score)
An 8 month old girl is brought to the ...
EnterocytesπŸ”

Block/Question (3.2 difficulty score)
A 1 yo girl is brought to the physician for a ...
An integrinπŸ”

Block/Question (5.4 difficulty score)
A 34 yo man 3 month history of progressive ...
AntineoplasticπŸ”

Block/Question (3.1 difficulty score)
5 to girl is brough to physician because of ...
2 of 3πŸ”

Block/Question (2.7 difficulty score)
A 45 year-old-woman with joint pain due to ...
PrednisoneπŸ”

Block/Question (6.5 difficulty score)
A 72-year-old woman comes to the physician because
Extensive solar elastosisπŸ”

neuro
Block/Question (2.9 difficulty score)
A 6-year-old boy is brought to the physician ...
Pineal glandπŸ”

Block/Question (4.8 difficulty score)
A 50-year-old man is admitted to the hospital ...
Long half life of factor II (prothrombin)πŸ”

Block/Question (2.4 difficulty score)
A 1-year-old boy is brought to the physician ...
Dendritic cellsπŸ”

Block/Question (4.0 difficulty score)
In a study designed to test the effectiveness ...
Two groups with similar underlying characteristicsπŸ”

Block/Question (7.0 difficulty score)
A 45-year-old man comes to the physician ...
Pulmonary arteriovenous shuntingπŸ”

Block/Question (1.4 difficulty score)
A 70-year-old man has had early morning ...
ParoxetineπŸ”

Block/Question (3.1 difficulty score)
A new antiplatelet agent is developed for the ...
67%πŸ”

Block/Question (2.2 difficulty score)
A 30-year-old man is brought to the emergency ...
Area labeled "E"πŸ”

Block/Question (5.5 difficulty score)
To decrease his risk for cardiovascular ...
630πŸ”

Block/Question (1.4 difficulty score)
14 yo girl with T1DM is brought to the ED ...
Arterial PCO2 down Arterial HC)3- down Anion Gap UpπŸ”

Block/Question (4.5 difficulty score)
25 yo with severe crush injuries to the chest ...
Basement MembranesπŸ”

Block/Question (4.1 difficulty score)
A 35-year-old man comes to the physician ...
AdenosineπŸ”

Block/Question (3.4 difficulty score)
A 3-week old male newborn is brought to the ...
Single primary development defectπŸ”

Block/Question (4.1 difficulty score)
A 25-year-old man who has a history of facial ...
Decreased catalytic efficiency of K487πŸ”

GI liver
Block/Question (1.8 difficulty score)
A 55-year-old man of northern European ...
Hepatocellular CarcinomaπŸ”

pharm
Block/Question (2.5 difficulty score)
A 30-year-old woman comes to the physician ...
PhenylephrineπŸ”

GI gastrointestinal
Block/Question (2.5 difficulty score)
A 19-year-old man is evaluated for signs of ...
Heterotopic gastric mucosaπŸ”

Block/Question (1.7 difficulty score)
A 34-year-old man who is a potter has burned ...
SyringomyeliaπŸ”

Block/Question (1.3 difficulty score)
A 28-year-old man is undergoing evaluation ...
Suppression of gonadotropinsπŸ”

Block/Question (2.5 difficulty score)
A 10-day-old male newborn is brought the physician
Chlamydia trachomatisπŸ”

Block/Question (0.9 difficulty score)
An investigator studying immune response to ...
CaspofunginπŸ”

Block/Question (1.7 difficulty score)
X-Ray of a newborn shows ribs associated with ...
Expression of a HOX gene normally expressed only caudal to C-7πŸ”

Block/Question (1.4 difficulty score)
A 45-year-old woman comes to the physician ...
Enteroendocrine cells of the small intestineπŸ”

Block/Question (1.0 difficulty score)
At autopsy, the heart of a 76-year-old woman ...
HypertensionπŸ”

Block/Question (0.8 difficulty score)
A 16-year-old girl calls the physician on a ...
I can have one of my colleagues call you back to further discuss your concerns.πŸ”

Block/Question (1.1 difficulty score)
A previously healthy 20-year-old woman comes ...
TickπŸ”

Block/Question (1.6 difficulty score)
A 67-year-old man comes to the physician ...
ErythropoietinπŸ”

Block/Question (0.1 difficulty score)
A 14-year-old girl is brought to the ...
von Willebrand diseaseπŸ”

Block/Question (0.0 difficulty score)
A 16-year-boy comes to the physician for a ...
Schedule next routine examinationπŸ”

Block/Question (0.0 difficulty score)
A 56-year-old man comes to the physician ...
Renal cell carcinomaπŸ”

Block/Question (0.0 difficulty score)
A 62-year-old woman is admitted to the ...
Test of the stool for Clostridium difficile toxinπŸ”

Recent comments ...

... feliperamirez made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
 +20 
submitted by feliperamirez(31)
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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

baja_blast  Didn't realize I was in law school +12
... aneurysmclip made a comment on nbme18/block1/q#26 (50 yo woman, chronic obstructive pulmonary disease)
 +18 
submitted by aneurysmclip(131)

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

... match95 made a comment on nbme18/block2/q#32 (Investigator studying vancomycin-resistant <i>Enterococcus faecalis</i>)
 +17 
submitted by match95(48)
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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

azibird  Why can't this be a point mutation? +4
... match95 made a comment on nbme18/block1/q#32 (52 yo man with chest pain and shortness of breath)
 +13 
submitted by match95(48)
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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

... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
 +13 
submitted by amirmullick3(58)
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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

... azibird made a comment on nbme18/block3/q#37 (During a clinical study of calcium and phosphorus...)
 +12 
submitted by azibird(158)

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 β€œstatus” 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.

cbreland  Constanzo is the best resource, change my mind +
... donttrustmyanswers made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
 +11 
submitted by donttrustmyanswers(56)

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!

mcdumbass  This makes sense... but I don't trust your answers +8
bmd12  πŸ˜‚πŸ˜‚πŸ˜‚ +
... apurva made a comment on nbme18/block3/q#45 (A 34 yo man 3 month history of progressive rash on...)
 +11 
submitted by apurva(68)

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!"

michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +3
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!πŸ˜πŸ˜‚πŸ˜‚ +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +
... sugaplum made a comment on nbme18/block3/q#6 (32 yo woman, diagnosis of hyperparathyroidism)
 +10 
submitted by sugaplum(323)
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th4 yaahrpelgn phcuo siegv ires ot ureiorsp ysa.odrriathp
FA 0129 gp 067

... merpaperple made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
 +9 
submitted by merpaperple(19)

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.

b1ackcoffee  Brilliant question and explanation! +1
... famylife made a comment on nbme18/block1/q#45 (55 yo man; father and brother died of myocardial infarct at early age)
 +9 
submitted by famylife(86)
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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

md_caffeiner  fuck GoT, knowledge is power +
dhpainte22  Another bullshit question that should've been straight to the point. Statins increase ldl receptors and inhibit hmg coA reductase. This should be simple but nbme can't live with that :( +2
... namira made a comment on nbme18/block2/q#34 (25 yo woman, fatigue for 3 weeks)
 +9 
submitted by namira(30)
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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

... banana made a comment on nbme18/block3/q#45 (65 yo patient with lung region underventilated but well perfused)
 +9 
submitted by banana(12)

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

motherhen  When I get mixed up on dead space vs shunt, I anchor myself on the meaning of anatomic dead space: the parts of the airway that don't have associated blood vessels for gas exchange (nose, trachea, bronchi). From there I work backwards to what shunt means: blood vessels that don't have enough air. +1
... match95 made a comment on nbme18/block1/q#31 (7 yo boy appendectomy)
 +8 
submitted by match95(48)
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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

pelparente  great answer; just to add to it. Lipid solubility determines potency, not onset/offset (that is determined by blood solubility as stated above). The more lipid soluble the more potent the drug. The more lipid soluble the drug the higher the oil:gas partition (directly proportional to potency) and the lower the MAC (inversely proportional to potency). Source: Boards and Beyond General Anesthesia Neurology +2
cbreland  I really went down a rabbit hole on this one... Convinced myself that it had something to do with mask v. IV anesthesia even though I haven't seen/heard that anywhere. Taking step in a weekπŸ™πŸΌ +
jer040512  I thought a low blood:gas partition coefficient meant that it has a low solubility and therefore DOESN'T dissolve in the blood that easily. +2
dhpainte22  Think onset/offset is about blood solubility and potency of drug higher with higher lipid solubility so low blood gas coefficient has faster onset and recovery. +
... chai_md made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
 +8 
submitted by chai_md(8)
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Naiersies imgentiisned nac aled to -eeecsidWhietrFunhoarrs ysdonmre a(nrelad uycifnsfn,iiec efr,ev DI,C co)hks

overa  if there is ever a case where the organ is underperforming, you do a stimulation test. if the organ is overperforming, you do a suppression test. ACTH is really the only one that made sense with WFS (adrenal insufficiency caused by N. meningitides) in this question. +2
... merpaperple made a comment on nbme18/block3/q#5 (82 yo woman, 24 hours of constant severe lower abdominal pain)
 +8 
submitted by merpaperple(19)

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.

... ergogenic22 made a comment on nbme18/block3/q#17 (46 yo woman, 1 week of fever and joint pain)
 +8 
submitted by ergogenic22(300)

acute interstitial nephritis

keys are: urine eosinophils + NSAID use + Rash

in the setting of fever and urinary issues

... spow made a comment on nbme18/block3/q#41 (24 yo man, 3 days of progressive numbness of both feet)
 +8 
submitted by spow(29)

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.

queestapasando  Might be acute inflammatory demyelinating polyradiculopathy (FA 2019 p.512): "Most common subtype of Guillain-BarrΓ© syndrome. Autoimmune condition that destroys Schwann cells via inflammation and demyelination of motor fibers, sensory fibers, peripheral nerves..." +1
md_caffeiner  sounds really great, and i thought the same and answered the same way. but while in the exam, i had that "how THE FUCK could motor weakness be an afferent??" moment. quite frequently forget the fact that this is an nbme full of mess. lol. +1
sonofarathorn  I focused on the loss of vibration and joint position sensation. Pacinian corpuscles sense vibration. Meissner corpuscles and Merkel discs sense position. These sensory receptors are all large myelinated afferents FA 2019 p.482 +
... anechakfspb made a comment on nbme18/block4/q#10 (A 4-year-old boy undergoes radiographic imaging...)
 +8 
submitted by anechakfspb(27)

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

cbreland  And it's a different answer every time +4
... pelparente made a comment on nbme18/block1/q#39 (36 yo woman, recently been diagnosed with HIV ...)
 +8 
submitted by pelparente(16)

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)

nbmeanswersownersucks  and here comes my dumbass that read the lower CD4 count as his newer labs (instead of old) and was trying to figure out why his drug combo wasn't working.... +11
... cbreland made a comment on nbme18/block4/q#36 (25 yo with severe crush injuries to the chest and...)
 +8 
submitted by cbreland(59)

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.

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

cbreland  Say a prayer for me +
drdoom  you can include. you can exclude. or you can altogether preclude. +1
drdoom  all these words, along with β€œclaudication”, share the same Latin root: clud = claud (to shut) +
dhpainte22  Missed it for the same reason :( +1
... adong made a comment on nbme18/block1/q#18 (68 yo man, chronically increased hydrostatic pressure in Bowman space)
 +7 
submitted by adong(94)

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

michaelshain2  because the NBME said so, obvs! +
cbreland  Diabetes would have non-enzymatic glycosylation causing increased GFR and hyperfiltation. The stem is referring to increased back pressure (Inc hydrostatic at bowmans space) which alludes to decreased GFR +1
... sammyj98 made a comment on nbme18/block2/q#8 (39 yo man, polycystic kidney disease)
 +7 
submitted by sammyj98(20)

did anybody else second guess the heck out this answer just because he's got a pH of 7.2 and he's hanging out in an outpatient clinic? I haven't done my clinicals yet but it seems like this guy would be struggling..

myoclonictonicbionic  EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +5
... nwinkelmann made a comment on nbme18/block2/q#41 (35 yo woman, 3 days fever and sharp chest pain)
 +7 
submitted by nwinkelmann(282)
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AF 9210 egap 38.0 stMo nmmoco caesu fo ret/myrciaapu iitdsrricaep is ademuss to be la.vri

cbreland  Primary made me think that it couldn't be acquired from virus/bug +
... sugaplum made a comment on nbme18/block3/q#33 (4 yo boy, clumsy gait for 1 year)
 +7 
submitted by sugaplum(323)
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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

... dorsal_vein made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
 +7 
submitted by dorsal_vein(32)
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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

lokotriene  Not sure which UW questions you're referring to, but I found a couple that agree/support Fibrates for lowering isolated triglyceride elevation incase anyone wants to reference them for clarity. #11844 & #166 +
... sympathetikey made a comment on nbme18/block4/q#4 (36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain)
 +7 
submitted by sympathetikey(1244)
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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

osler_weber_rendu  The questions asks for response to ATRA. Should that not be decreased transcription to treat the cancer? Which makes methyl transferase (aka methylation) the more likely answer +5
pg32  @osler, no @sympathetikey is correct. ATRA's mechanism in treating APML is to encourage the cells to mature. Maturation would require gene transcription, meaning histone acetylases would be used. +1
nnp  but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation) +2
lowyield  i believe the mechanism of APML is that the compound protein is ineffective at allowing for maturation of the blasts. giving ATRA allows the blasts to circumnavigate this step, relieving the backup +8
... aneurysmclip made a comment on nbme18/block1/q#10 (25 yo woman, polycystic kidneys)
 +6 
submitted by aneurysmclip(131)

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

pg32  Sometimes these questions are made more difficult by trying to decipher the order in which these changes happen (first cause). In my mind, whenever I see a question on renal insufficiency, I know that phosphate in the serum will increase. In response, Ca will decrease and in response to that, PTH will increase. Lastly and unrelated, HCO3 will decrease because the kidneys aren't absorbing HCO3 as they usually do. +10
baja_blast  I also think there is decreased 1alpha hydroxylation of Vitamin D, which would increase PTH secretion +1
... elasaf@post.bgu.ac.il made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
 +6 
submitted by elasaf@post.bgu.ac.il(11)
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eisoisM β‡’1 rofm rparmyi ot rsnadocey etcmerpyatso ; iieossM 2 β†’ aercodnyS to dasrpmite

... focus made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
 +6 
submitted by focus(27)

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.

focus  Not to mention, 21-hydroxylase is the more common one! +2
... dorsal_vein made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
 +6 
submitted by dorsal_vein(32)
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  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

... aneurysmclip made a comment on nbme18/block2/q#44 (35 yo woman, passed out while washing dishes)
 +6 
submitted by aneurysmclip(131)

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

schep  Dirtyusmle has a good video on this topic if you're like me and struggle with renal https://www.youtube.com/watch?v=8codyTuFccI&list=PL5rTEahBdxV71pfkyqb3lpUMvVVFxuU-R&index=11 +
... dorsal_vein made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
 +6 
submitted by dorsal_vein(32)
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glSaelpi of astrntoc otni hte neiutproem igudrn a apolytsrrgosimhegan is lnaomr dna dneaicist tapecny fo eht pfoilnlaa bstue.

-aeiMcdl ihtPeprsra oRigaoldy

... lae made a comment on nbme18/block3/q#34 (52 yo woman with breast cancer)
 +6 
submitted by lae(19)
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hte iiradonta eahptry euacsd fbisirso dna eth sfybitoarmbslo nocct"a"rt inrudg sib,soifr guacnis the ecluosr of irywaas nda htsu lcstseeiaat

hello  Adding part of @plummervinson's comment: Contraction atelecrasis occurs due to radiation therapy, necrotizing pneumonia, or granulomatous disease +1
leaf_house  FA2020 - p680 +
... cmoralara made a comment on nbme18/block3/q#40 (47 yo woman with irregular, raised, multicolored dark lesion)
 +6 
submitted by cmoralara(6)

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)

... azibird made a comment on nbme18/block4/q#16 (an 83-year-old woman with systemic...)
 +6 
submitted by azibird(158)

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.

... azibird made a comment on nbme18/block1/q#1 (During a study of the regulation of cholesterol...)
 +6 
submitted by azibird(158)

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 ribosomesβ€”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).

nbmeanswersownersucks  I was under the impression that translation of transmembrane proteins begins with ribosomes in the cytoplasm that then translocate to the rough ER once the signal sequence is reached by the ribosome? i.e. technically translation begins in the cytoplasm but finishes in the rough ER. Am I wrong about that? +4
nbmeanswersownersucks  It was UWORLD 6544 about insulin translation. They state that the translation is initiated in the cytoplasm then relocates to the RER (d/t the signal sequence) and is finished there. So is there a difference in translation steps for proteins that are excreted like insulin and transmembrane proteins? +2
nsinghey  Same, I am not sure about this. My best guess is that since insulin is not a functional protein, it is not synthesized in the RER (even though it it excreted from the cell). Actual proteins are made in the RER +2
drdoom  @nbmeanswersownersucks @nsinghey et al. There is extensive discussion of this on an NBME 24 thread. This link will take you to the comments (just don't scroll up to spoil the answer for yourself!): https://nbmeanswers.com/exam/nbme24/939#1379 +
drdoom  also, this thread from NBME 21 discusses cell transport more generally (same warnings apply! don't scroll up!): https://nbmeanswers.com/exam/nbme21/742#257 +
... wishmewell made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
 +5 
submitted by wishmewell(30)
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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

baja_blast  FA 2019 p. 508 +
... mahesh made a comment on nbme18/block1/q#19 (70 yo woman, increasingly severe pain in right knee over 3 months)
 +5 
submitted by mahesh(5)
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roocatmOsase oagtihlclosi ap.narepcea tPaeg sseieda is neo fo ikrs crafto

spow  Looking back, I know it's osteosarcoma but the lung metastases made me think of Ewing's +
makinallkindzofgainz  Ewing sarcoma is common in boys <15 years old. This patient is a 70 year old woman. The stem notes elevated periosteum and a sunburst pattern which are characteristic of osteosarcoma. +1
llamastep1  Also "sunburst pattern" is a classic description of Osteosarcoma. +
... wishmewell made a comment on nbme18/block1/q#46 (65 yo man, generalized tonic-clonic seizures)
 +5 
submitted by wishmewell(30)
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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

hello  Correct, glioblastoma multiforme crosses through the corpus collosum. GBM is also known as a grade IV astrocytoma aka high-grade fibrillary astrocytoma +
... trichotillomaniac made a comment on nbme18/block2/q#30 (35 yo man, 4 weeks of severe midline back pain)
 +5 
submitted by trichotillomaniac(102)
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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

nnp  even prolactin causes reduced bone density +2
jmangels  I was thinking the same thing about the prolactin, but the weight gain made me lean toward ACTH +2
... ergogenic22 made a comment on nbme18/block3/q#21 (48 yo woman, gradual onset of back pain over 2 weeks)
 +5 
submitted by ergogenic22(300)

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

... sugaplum made a comment on nbme18/block3/q#40 (47 yo woman with irregular, raised, multicolored dark lesion)
 +5 
submitted by sugaplum(323)
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hte edeerp eht mloamnea sego eth eoswr het sospnirog

wishmewell  isn't the basement membrane the deepest? +
wishmewell  nvm! lol +1
lilyo  I also picked basement membrane but unlike you I haven't had a "nvm" moment. Help please. +2
mcdumbass  @lilyo Basement membrane is between the epidermis and dermis; beneath the dermis is the subcutaneous tissue +5
blah  I think some people might have picked basement membrane because we're taught once cancer goes through the BM it turns from in situ to invasive. This is correct, but subcutaneous as the others pointed out are deeper so the prognosis is worse (BM + deeper tissue). +3
... sugaplum made a comment on nbme18/block3/q#48 (52 yo man, chronic pancreatitis)
 +5 
submitted by sugaplum(323)
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lhotlrsoCee etres yerdaoshl is needde ofr rveeesrs leortslcoeh rnsrtat,po ont tierccpnaa yze.enms
- I dsmise tihs
metl9dwc2w//0op/v3mn8b7.ug/shp4w.nti:.b1inh.

... carrierose11 made a comment on nbme18/block4/q#37 (66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath)
 +5 
submitted by carrierose11(7)
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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

pathogen7  Also "fibroblastic foci" is a big buzzword for IPF, I believe. +3
... jorgejeje made a comment on nbme18/block4/q#45 (35 yo man, prolonged QT interval)
 +5 
submitted by jorgejeje(5)
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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.

nbmeanswersownersucks  **phase lol +1
... andro made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
 +4 
submitted by andro(169)

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 )

... hayayah made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
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submitted by hayayah(1056)
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realfakedreams  @hayayah - made an account just to say thank you. I appreciate that you exist. +14
... azibird made a comment on nbme18/block1/q#30 (29 yo woman irregular menstrual periods)
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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.

cbreland  Note to self: Never refer, even when that seems like the better answer +