Kim! Hi! It’s your dad!πŸ‘‹ ▪ Khalilah, I’m proud of you for taking a risk for your dream.Everyone’s explanations tend to be so on-point, and the commiseration makes me feel better, too!Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!                       want to add a fly-by? email us! 😊
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NBME 18 Answers

Question#11 (reveal difficulty score)
67 yo man, fine resting tremor in both hands

Question#14 (reveal difficulty score)
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyteπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
experimental animal with defect in an innate ...
Chronic gastritisπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
4 day old boy, vomited throughout night after ...

Question#18 (reveal difficulty score)
68 yo man, chronically increased hydrostatic ...
Benign prostatic hyperplasiaπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
Cholera toxin is a catalyst that results in ...
Concentration of cAMPπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
60 yo man, 1 day of fever, chills, confusion ...
Vibrio vulnificusπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
18 yo man cracked lips and sunburned skin

Question#15 (reveal difficulty score)
38 yo man, 1 week history of shortness of ...
Aortic regurgitationπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
65 yo woman, 1 week of swollen, painful knee
Uric acidπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
66 yo woman, 2 days of fever, flank pain, ...
Calcium carbonateπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
40 yo man, 1 year of orthostatic hypotension ...
Motility disorderπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
32 yo woman, new neurologic finding; imaging ...
Inability to abduct the eyeπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
35 yo man, 4 weeks of severe midline back pain

Question#32 (reveal difficulty score)
Investigator studying vancomycin-resistant ...
Plasmid lossπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
35 yo woman, 3 days fever and sharp chest pain

Question#5 (reveal difficulty score)
82 yo woman, 24 hours of constant severe ...

Question#12 (reveal difficulty score)
58 yo woman, 6 months shortness of breath, ...
Pulmonary hypertensionπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxinπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
70 yo woman routine pelvic examination

Question#25 (reveal difficulty score)
63 yo man, 2 weeks of fullness in left upper ...

genetics pedigree
Question#33 (reveal difficulty score)
4 yo boy, clumsy gait for 1 year

derm dermatology
Question#40 (reveal difficulty score)
47 yo woman with irregular, raised, ...
Subcutaneous tissueπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
24 yo man, 3 days of progressive numbness of ...
Myelinated primary afferentsπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
45 yo man for annual health maintenance ...

Question#3 (reveal difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Aortic aneurysmπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
36 yo woman, 2 weeks of fatigue, bleeding ...
Histone acetylaseπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
18 yo woman ingests 100 aspirin tablets in ...
pH: 7.32; PCO2: 15; HCO3: 8πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
45 yo man follows up 1 week after appendectomy
Gilbert syndromeπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
54 yo man, normal renal function, receives ...

Question#35 (reveal difficulty score)
73 yo man, 4 months poor appetite and 25 ...
Cytokine effectπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
18 yo woman given general anesthesia for ...
Sarcoplasmic Ca2+ releaseπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
4 month old boy, abnormal glycogen storage

Question#45 (reveal difficulty score)
A 4-year-old boy, fatigue and irritability, ...
Microcytic AnemiaπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 55-year-old woman who is a physician is admitted
Alcohol withdrawalπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
an 83-year-old woman with systemic ...
descending colonπŸ”,πŸ“Ί

cell_bio cell_transport cell_trafficking
Question#1 (reveal difficulty score)
During a study of the regulation of ...
F (cell diagram)πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina)πŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 51-year-old woman with Graves disease ...

Question#1 (reveal difficulty score)
A 25-year old woman comes to the physician ...
3 to 8 weeksπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Cor pulmonaleπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 30-year-old woman with a long standing ...

Question#10 (reveal difficulty score)
A 4-year-old boy undergoes radiographic ...
Tubular atrophyπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 32-year-old man with an X-linked recessive ...
Type IV collagenπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 2 month old boy is brought to the physician ...
ventricular septal defectπŸ”,πŸ“Ί

carbamazepine FA20p518 neuro
Question#32 (reveal difficulty score)
63 yo woman, 2-week history of daily episodes ...
Trigeminal neuralgiaπŸ”,πŸ“Ί

respiratory lungs newborn
Question#5 (reveal difficulty score)
A 1045-g (2-lb 5-oz) male newborn delivered ...

Question#16 (reveal difficulty score)
An 8 year old boy is suspended from school ...

Question#10 (reveal difficulty score)
MI study, 500 in operation, 250 each to 2 ...
Randomized clinical trialπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
a 35-year-old woman has congestive ...
prerenal azotemiaπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
a 67-year-old woman comes to the physician ...
amyloid infiltration πŸ”,πŸ“Ί

micro derm dermatology
Question#40 (reveal difficulty score)
A 3 yo boy is brought to the physician for a ...
Complement activationπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A laboratory technician wipes down the ...
Enveloped virionπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 45 yo woman comes to the physician because ...

Question#18 (reveal difficulty score)
An 8 month old girl is brought to the ...

Question#20 (reveal difficulty score)
A 1 yo girl is brought to the physician for a ...
An integrinπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 34 yo man 3 month history of progressive ...

Question#10 (reveal difficulty score)
5 to girl is brough to physician because of ...
2 of 3πŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 45 year-old-woman with joint pain due to ...

Question#2 (reveal difficulty score)
A 72-year-old woman comes to the physician because
Extensive solar elastosisπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 6-year-old boy is brought to the physician ...
Pineal glandπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 1-year-old boy is brought to the physician ...
Dendritic cellsπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 70-year-old man has had early morning ...

Question#31 (reveal difficulty score)
A new antiplatelet agent is developed for the ...

Question#40 (reveal difficulty score)
A 30-year-old man is brought to the emergency ...
Area labeled "E"πŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
To decrease his risk for cardiovascular ...

Question#36 (reveal difficulty score)
25 yo with severe crush injuries to the chest ...
Basement MembranesπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 35-year-old man comes to the physician ...

GI liver
Question#31 (reveal difficulty score)
A 30-year-old woman comes to the physician ...

GI gastrointestinal
Question#13 (reveal difficulty score)
A 19-year-old man is evaluated for signs of ...
Heterotopic gastric mucosaπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 34-year-old man who is a potter has burned ...

Question#5 (reveal difficulty score)
A 28-year-old man is undergoing evaluation ...
Suppression of gonadotropinsπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 10-day-old male newborn is brought the physician
Chlamydia trachomatisπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
An investigator studying immune response to ...

Question#13 (reveal difficulty score)
At autopsy, the heart of a 76-year-old woman ...

Question#12 (reveal difficulty score)
A previously healthy 20-year-old woman comes ...

Question#22 (reveal difficulty score)
A 67-year-old man comes to the physician ...

Question#19 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Renal cell carcinomaπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
24 yo woman, remain in the intensive care ...

Question#1 (reveal difficulty score)
a 68-year-old man comes to the physician ...

Question#11 (reveal difficulty score)
a 17-year-old boy has septic shock that is ...

Question#29 (reveal difficulty score)
A 60-year-old man comes to the physician for ...
Renal Artery StenosisπŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
A full-term newborn has respiratory distress. ...
Left pleuroperitoneal membraneπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 42-year old man comes to the physician for ...
radial grooveπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 32-year-old woman is brought to the ...

Question#5 (reveal difficulty score)
An 18-month-old girl is brought to the ...
Parainfluenza virusπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 56-year-old woman is brought to the ...

Question#8 (reveal difficulty score)
a 17-year-old boy is brought to the physician ...

Recent comments ...

... aneurysmclip made a comment on nbme18/block1/q#26 (50 yo woman, chronic obstructive pulmonary disease)
submitted by aneurysmclip(169)
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CDOP si asullyu eistaaodcs wthi nuPlmyroa onrisp.eHynet ehT xameinre elstl yuo htta teher is a odlu uarlpymon otmpcenon of 2S :ei 2P (uoLd PS2/=2 mrluanoPy sennH.tpei)oyr C:eFv1VF si tsju raeeldt ot CP.DO ehT iuontqes is giskan tawh is AECEDDERS in hte mpnlaoruy LVSAUCRA HTOSOM .EMLCSU od ton teg fousnecd htiw eth enil gsnatti treeh si aeceddsre iffsnigdu aiyatcpc fro C.O teh soqeutin sitn' gnsaik tuabo t.hat

In yolarupnm hpirnsenyoet hrete is an inlebmaca tbwneee aviodtnsalio secnutassb adn otvsrcs.isconotra eoh rrteef uor ossodltaiavr owdlu eb deedsreac e:g icitrN Oedxi

if it kesad ceeniad,rs uoy codul og with nEtoelidhn ermbree(m het ihdotnelen atisntsnoga udse rfo t/t fo Plmu NHT ei: nensotab oys rr eagv msoe trexa ofni ubt lal of it is nimtrtaop ebacseu htey can ska itsh ccotpen ni amyn swya

... anechakfspb made a comment on nbme18/block4/q#10 (A 4-year-old boy undergoes radiographic imaging...)
submitted by anechakfspb(54)

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 +11
... feliperamirez made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
submitted by feliperamirez(31)
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hTsi varesi gnoma tatses btu ni smot of eht etatss a -12 aeyr erfe iueeszr opeidr si requerdi rof iltpeceip psttneia ot teg hriet ecneils

baja_blast  Didn't realize I was in law school +26
... match95 made a comment on nbme18/block2/q#32 (Investigator studying vancomycin-resistant <i>Enterococcus faecalis</i>)
submitted by match95(51)
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oinTaprsnosti of teh vnaA gnee mfor ieisataonvcnyncmrs-t esoucrtonccE si ohw it rnasrefts eyTh seu stsapnonros hhcwi aer edtacol no ds.apsilm If uoy vhea dmiplsa s,los you wto'n hvae ropsnsats,no nad nessctriea ilwl eade.cres

azibird  Why can't this be a point mutation? +6
thrawn  FA says transposition is responsible for antibiotic resistance and plasmids are for transferring the genes of toxins (though UW says also antibiotic resistance). Make up your minds sheeple +
mariame  The most common Vancomicin resistant genes, vanA and vanB are found in a transposon. These have been transferred from Enterococcus to a multidrug resistance plasmid in Staph aureus. the super multidrug resistance plasmid now contains resistance genes against lactams, vancomycin, aminoglycosides, trimethoprim, and some desinfectants. +1
... azibird made a comment on nbme18/block3/q#37 (During a clinical study of calcium and phosphorus...)
submitted by azibird(200)

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 +
... apurva made a comment on nbme18/block3/q#45 (A 34 yo man 3 month history of progressive rash on...)
submitted by apurva(82)

THIS IS KAPOSI's SARCOMA ==> give antineoplastic


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 +
ih8payingfordis  The reason why this isn't Bacillary Angiomatosis is because the stem states that the rash is NOT painful. In BA, the rash is painful! +1
... match95 made a comment on nbme18/block1/q#32 (52 yo man with chest pain and shortness of breath)
submitted by match95(51)
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ishT uodlw sjut eb the onmalr epsserno of ruo diknesy ot when ew dt'on rikdn trewa ognuhe a(ka utsj naro)ml.

Polmixar lutueb is ticioson esebauc we aer abieognsrrb BTHO +Na nda H2.O

aMluca eansd si ichoonpty ceasueb ti si gsinsen eth dlsait lvcntuedoo teulub -- eht tmso IDLUTE atpr of teh h.nrneop ebemmRre eht ettncrueonrurc gaehcxen ystems - khtci sninadcge iblm is nglois aClN eru(ni egts slse crotectennda sa ti essnd)ac.

duaeyMllr tnlileccog cudt si ntoecrpihy ecabeus we rea bnbrirogesa all het trwae aikmgn teh nriue rome ctec.tnedrona

... merpaperple made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
submitted by merpaperple(27)
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In eiimoss ,I eht ygmetateoc sisplt morf a igslne lecl )YY(XX -&;gt 2 cells X(X + .Y)Y In osiemis II htsee tow llesc pislt aniag g;(t-& X + X, Y + Y.) Hneec in rrode rfo a arfhet ot sasp on htbo na X adn a Y socoehromm ot shi nos (eg ni nelelerfKti rdmey,nso /w YXX hercomm),soo a ipdasertm stmu inntaoc tboh na X adn a Y mohceroo,ms icwhh aesmn htat erhte swa na errro ni isismoe .I eTh tsage at ihchw ieossim I scrcou si the myaprir capmotte.reys

b1ackcoffee  Brilliant question and explanation! +2
jbrito718  PICTURE PLEASE +
... ergogenic22 made a comment on nbme18/block3/q#17 (46 yo woman, 1 week of fever and joint pain)
submitted by ergogenic22(351)
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auect ieaitrsnlitt eirstpihn

ekys are: euinr ilihnososep + SNADI seu + Rhas

ni eht stinget of evrfe dna ayruirn iesssu

ih8payingfordis  FA 2019 pg 591 +
... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
submitted by amirmullick3(61)
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iThs aenttip ash a ryd pat, ihcwh is esen in mblsoieiyrofs dna tlcasipa amai.en The nbramalo CRB era msot yillke dscraoyect oaedrp(tr .eclls)

LMA ludwo have euar dsor nda yanm cacrintilug lt,saselmoby but nor onmaarlb .RCB

C,ML eddeinf by eth t;9[22] adhahieiPpll ecos,hmormo will have ymna ermuta nda mtrinagu rayncelts,ugo whti a olw ALP causbee siht si tno a kloedmieu tcie.aorn

ysiomlypeDicoet orsynedm si teh easm sa a lisseycymdlsptoa dny,oesmr ihwhc ear a rogpu of cacensr whit etrmiamu BRC in eth enob omrraw ahtt do tno emceob s/d.ktlposMoesnwpe_d:w.yit/hecamikpsiyy/loati/erniirgd

slsiEeatn mbeoriycamhotht h(cihw si ton ltnssaiee etcyip)oaylmh si tjus a earr arcecn ihwt ihhg eetpa,tsll hchwi eprestns twhi alrboamn blood itl,ntocg diengal ot iso,mosthrb sres,tko dan E.P

mlyahcotPeyi arev hsa evry ragel CBR mass nda olw EPO eud ot eegvniat bdae.efkc It is ued ot a 2AJK otinatum nda sola sha ihgh WBC adn sl.eeattpl rOu panetti si ainem.c


... famylife made a comment on nbme18/block1/q#45 (55 yo man; father and brother died of myocardial infarct at early age)
submitted by famylife(96)
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"Detpesi itonihiibn fo HMGAoC- urceetsad yb tsa,nsit lecls ptenaecmso yb nrinacgsie neymez iosxrenpes leeasrv fdol. rw,Hevoe hte atotl obdy eletrohclos si dcdeeru yb %00–%42 eud ot dreseianc eeirxposns fo DLL erercostp frtea staitn ttrn"iaiai.ondms


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 :( +4
jurrutia  I think they want to test not just your understanding of how statins work, but also the basic principle that when you block X the body tries to compensate by upregulating X. +4
... donttrustmyanswers made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
submitted by donttrustmyanswers(65)
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eTh ilapfnlao etubs sldhuo akle ntctosra ebcesau etehr is a gpa bneteew ilalpnfoa beuts nda ayvo.r Ie.. if heert si on sai,pglle hatt ensma rethe si a lgabokec = yirnfilitt!e

mcdumbass  This makes sense... but I don't trust your answers +12
bmd12  πŸ˜‚πŸ˜‚πŸ˜‚ +
... cbreland made a comment on nbme18/block4/q#36 (25 yo with severe crush injuries to the chest and...)
submitted by cbreland(122)

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 +1
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) +1
dhpainte22  Missed it for the same reason :( +1
dremosq  Pathoma pg 4. Irreversible cellular injury.. The HALLMARK of irreversible injury is membrane damage. +1
randi  guess I gotta make an Anki card for the definition of preclude then +
... wishmewell made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
submitted by wishmewell(46)
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I swa esdnofuc eneebwt pah-lA neliSnucy nad u.Ta ihTs ptteina sha nkproassin saeiedss nad uhst ew wulod see plhaA cilsn.enuy

uTa si eesn ni istetnap htwi cikPs ssediea, aka Fpomlroaetornt etdmaine NDA srhaemzile ieades.s pe ga 54.0 AF 0812

baja_blast  FA 2019 p. 508 +
jbrito718  The gross image also shows the medulla, where you can see some darkness around the edges, reprentative of the substantia nigra which is affected in Parkinsons. Another hint +
... sammyj98 made a comment on nbme18/block2/q#8 (39 yo man, polycystic kidney disease)
submitted by sammyj98(27)
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did ayondyb slee odnsce ssegu eht ekch uot this ensarw tsju auscebe e'hs ogt a Hp fo 27. and ehs' gghnian tou ni na ieuttoatnp ni?ilcc I eahnt'v eond ym sclcanili tye tub ti meess ekli shti uyg olduw eb gr.lgn.sgtiu

myoclonictonicbionic  EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +5
... namira made a comment on nbme18/block2/q#34 (25 yo woman, fatigue for 3 weeks)
submitted by namira(33)
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Mtrali vealv nad teeht cienalgn rea key odwsr orf pSetr irnsiadv sgnoas.iid tI si lapha mctiehyol os ti wdlou evah a nigenegr r.nocatei

otnapmtri nmotine to wtach out f:ro

eTh hitpocon aewrns is ccntorrei abcuese ti ssya hioiinn"tbi BY tpno"oihc. disVrain is srinatset ot tcinohop os hatt eswran is o.rtrneicc

... sugaplum made a comment on nbme18/block3/q#3 (17 yo boy septic shock)
submitted by sugaplum(415)
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FA 9012 pg 242 am&p; nbb ovedi
AD ta wol eosds d1 atesdli nlear es,vless
mmei du b1 tgnasoi = ioipnorcot dan cooiptohcrn
ghih osesd a1 sotagin = oosistnocrtcianv

... sugaplum made a comment on nbme18/block3/q#6 (32 yo woman, diagnosis of hyperparathyroidism)
submitted by sugaplum(415)
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th4 aeanhrlgpy puohc siveg rsei ot rirsepuo oihysaarpr.dt
AF 1209 gp 067

... banana made a comment on nbme18/block3/q#45 (65 yo patient with lung region underventilated but well perfused)
submitted by banana(15)
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If oyu tgo lla gtnldae up on itsh iqnsueot elik :me

itmaocna edad ec=aps oudntgncci wisyara

oalrlveA daed =aceps oivllae atht era etindetlva tbu tno pfdeures ()ikiw

cgihoisolpy dead secaac=nitapmo aedd ecs+pa eolavral edad cepsa

:2oP ujst 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
... nwinkelmann made a comment on nbme18/block2/q#41 (35 yo woman, 3 days fever and sharp chest pain)
submitted by nwinkelmann(313)
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AF 0921 paeg 308. soMt nmomco uceas fo apumrtcraiye/ rdiecspriati is dasemsu to eb r.vial

cbreland  Primary made me think that it couldn't be acquired from virus/bug +4
... aneurysmclip made a comment on nbme18/block2/q#44 (35 yo woman, passed out while washing dishes)
submitted by aneurysmclip(169)
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'hSes miogvtin - cibaeloMt ialslAkos > ssol of CLH ;> ei; cida, rhtee ulwdo be direcaens 3HCO Aonni spag rae allsuuy itwh alctmebio dscsiaio ueebsca in aliloassk ehetr is ihhg HCO3 cwhih kepes apg .mnalor o Fr teh K+ ;gt& toigmivn ;tg& soeol etwar lgnao wtih hte voimt tg&; esdeearcd dloob emuvlo ;g&t SRAA nciaaoitvt g;&t eorndlasoet ecetrses +H nda +K t&;g pmyaolkhaie

schep  Dirtyusmle has a good video on this topic if you're like me and struggle with renal +1
... merpaperple made a comment on nbme18/block3/q#5 (82 yo woman, 24 hours of constant severe lower abdominal pain)
submitted by merpaperple(27)
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'eHser woh I euantsdnrd sh;it espeal rtrceco em fi I'm nwrg:o ibniFr aoxiutdne is arpt fo eht uacte ftiaamrnyolm reeopsns fi eht yrialafmomnt lsituusm si a licetranag onuwd, scu(h a,s in ihts aei,tptn deofeaprrt vilrdciuiteist), oglna ihwt laettspel dna htroe gnottilc osrf,cta ni rrode to loct eth neudwdo .raea nHece ni hist enpiatt woh eddi 2 adys onlolgifw cetua oearterfdp rcdeisvttl,iiiu the tylfoaminram xdauete drnriusguon hte rievl ulodw otsm liklye oinncta ribifn (ont nclelaog, esnic eth aitmnilafnom si ectua dna otn )chr.cnio cieiFrobnnt dna ytnolerpgos,ac teh toerh wto pnos,oit aer ellrtecaarlxu arxmti tprsoie.n

... spow made a comment on nbme18/block3/q#41 (24 yo man, 3 days of progressive numbness of both feet)
submitted by spow(41)
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re'eHs woh I ohgtuth htguorh roebpml iwth LCMD snbae(t ertrooipoppnci and bvtroaini ,ee)ssn rpleobm iwth edpe dotnne eexeflrs s(DGR), ctaixa agit lacpeenrsroelb(i ha)aywtp, imld eesakwsn r(toom .e)usnonr ehT lnoy gtnih thta lla fo tsehe ywptahsa ahev ni monocm si taht ehyt all sue meniyatlde retesn.aff

I d'not kown if linulGa eBrra wdluo lutaalyc eetrpns eilk st,hi ubt uyo 'ndot vhae to onkw awht the inlsels si to rufieg eht eiuoqtns .uto

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..." +3
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. +4
2059nyc  It could be explained by the lack of the sensory component for the DTR and not the motor neurons? +2
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 +1
mgadda  the question asks the most likely explanation for the SENSORY findings +4
aaftabsethi1  Can anyone explain numbness and tingling ? Isnt that through unmyelinated fibres? +1
... sympathetikey made a comment on nbme18/block4/q#4 (36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain)
submitted by sympathetikey(1446)
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iotsHen tlineoctaay woalsl orf ierolnatax of het NAD so htta tsrrpconaitni can eerdocp. All ranst nicierto icad csueas eht coulernstgay in AMLP ot urtefrh aeumrt, hhwci qisreure NAD cniiropntrtsa / ntaoatilsrn.

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 +7
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. +6
nnp  but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation) +3
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 +12
... chai_md made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
submitted by chai_md(8)
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iesrieasN eidmestnigni nca eald ot -ehrueWteieFrcsoihdsanr syoemndr lrenaad( seniuiyifc,cfn eve,fr CD,I hk)sco

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. +4
... dorsal_vein made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
submitted by dorsal_vein(35)
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ynMa tessutdn iwll etg isht iesonqut rwgon esuaebc fo a lrsiaim eustoniq no l.oUrwd Thsi paniett has na etermxlye ihgh erltdgryceii lvele nda ahs no rtohsyi of aidcsaalvrurco Fiatrbes odhuls eb edrrcpeisb to eevntrp ptaaretcnii.s

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 +
username  Talking about in situations where the patient has cardiovascular event, serum lipid values show OKAY cholesterol levels but increased triglycerides. Q will ask what to add to patient's regiment. In this case, if answer choice throws you fibrates, you'll want to bite, but if patient has cardiovascular disease, you're going to want to go with statins +2
... pelparente made a comment on nbme18/block1/q#39 (36 yo woman, recently been diagnosed with HIV ...)
submitted by pelparente(25)

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.... +19
thrawn  Amused +
... anechakfspb made a comment on nbme18/block2/q#37 (A 45-year-old man comes to the physician because of )
submitted by anechakfspb(54)

This is describing hereditary hemorrhagic telangiectasia (FA 2019 p. 312). It is also known as Osler-Weber-Rendu syndrome. It is an autosomal dominant disorder of blood vessels. Findings include blanching lesions (telangiectasias) on skin and mucous membranes, recurrent epistaxis, skin discolorations, AV malformations, GI bleeding, and hematuria.

cbreland  Wow, I was completely lost on this one, thanks! +27
jbrito718  What helped me figure this out was the finger clubbing. This sign indicated hypoxia. Along with what I thought were micro-clots of small vessels (now I know are telangiectasia) would most likely cause increased shunting in the lungs. +
thegout  UW added questions about this pathophys recently. Megakaryocytes mature into platelets in the pulmonary circulation,so if blood bypasses the lungs in any way( COPD,CF,AV shunting,congenital heart defects) immature megakaryocytes enter blood stream, these megakaryocytes actually cause the clubbing by secreting growth factors like PDGF.And the bleeding spots are just a complication of lack of mature platelets in blood. So any time you see clubbing, you should know the pathophysiology involves megakaryocytes. +1
... made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
submitted by
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iiosMse 1β‡’ fmro rrmyipa to nacodysre ratoetepymsc ; iMsesio 2 β†’ daoecyrnS to epridmtas

... t0pcheese made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
submitted by t0pcheese(7)
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yhw is the aN monlar in thsi apteit?n iEeynrvght else adem esse,n eth hgih K nda 17 xeh.poyyorrtdesroegn

aneurysmclip  could be due to increased blood volume leading to secretion of ANP and thus natriuresis which would normalize serum sodium levels? that's the only reason I could think of +
dysdiadochokinesia  My guess is that the sodium and water loss from 21a-hydroxylase deficiency would result in increased RAAS activation and production of Angiotensin II (AGII). Recall that AGII affects the PCT by upregulating Na/H+ exchangers, allowing for there Na/H2O to be resorbed, thus partially counteracting the impact of aldosterone deficiency at the collecting duct. However, I'm not sure if the effect of AGII on the PCT is great enough to entirely counterbalance the loss of aldosterone to present with normal sodium levels. +
... focus made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
submitted by focus(35)

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
... adong made a comment on nbme18/block1/q#18 (68 yo man, chronically increased hydrostatic pressure in Bowman space)
submitted by adong(103)
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ernsIcaed supreers si ni teh wnmoaB capse TO(N teh rellauromg ilisa)cprael os eth noly ohoaptgyl tdlise hatt woudl asceu dabkarcw lubdi pu fo eprusrse is PBH

michaelshain2  because the NBME said so, obvs! +1
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
... match95 made a comment on nbme18/block1/q#31 (7 yo boy appendectomy)
submitted by match95(51)
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hanlIed nehcaesitts htat hvea wlo gbla:osdo roaniptit /occftiiedbeonlfo styiloliub vsesidol ni boldo orme Troer,hfee hrtee is SESL sga nedede to atarsute ldboo -- aak teasfr raotuansti of olbdo. isTh ldsae to saerft rnttsaouia of narib.

;tlrd lwo yloiuislbt ;-gt-& atersf nsoet &-tg;- tefsar ycoevrer

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 +5
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. +
jurrutia  Just to drill point home further: consider halothane, high lipid solubility (so high potency) and high blood solubility (slow onset). If you want fast onset, low solubility is the key. +1
... dorsal_vein made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
submitted by dorsal_vein(35)
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  1. irdiAmstne ACHT nad mntioor orotsicl nsesoper
  2. If isrcolot raissence ;t&g-- hcoks si eud ot ipartituy iufennccsyiif
  3. If sloitocr seod tno sacieren -&-g;t sckho is edu ot anlarde syieucnifnicf

teoeashxaneDm sinposupres tste si danieticd orf epittnsa hwo spenert hwti nsgsi fo icorslto .CSEESX

... dorsal_vein made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
submitted by dorsal_vein(35)
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laegpiSl of sntocrta noit eth uerpotienm rigudn a relsspganoihoymgrat si nrloma adn tiedcsain pencyat of eth alplfinoa se.btu

eadilMc- rhtesParip iaoylRodg

... sugaplum made a comment on nbme18/block3/q#33 (4 yo boy, clumsy gait for 1 year)
submitted by sugaplum(415)
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FA 9201 gp 916-5
X idlkne uslrcaum rops.tyhyd heT ahencc ttha het mom 1II-I is a rracier si 1./2Y X ra(olmn nadaprg )1I-I * XXa reiar(cr grdnomma -2I)I oYu onwk htta I-1II si a alf,eem so loyn oolk at ,alfh os 2/1 cnh.cae
Te h ncceha atth II-'I1s tame is a erraicr si arne .ozre oS we akme ihm l.naomr YX lmrnao( Dad) * XaX rerrcia( mom II-)I1 enc Si ew wnko sit a byo uyo loyn okol ta af,hl so het cnheca fo mhi vaingh ti si /12.
os 2/1 * 2=1/ /41
hee sT are wto depdeennnit seevn,t eht hencac the mom si a rrireac * the necahc eth ikd esgt teh fetadcef X.

aaftabsethi1  Explain it to me like i m 5 years old +2
aaftabsethi1  Also they asked about the β€œmale” fetus . So that should be 1/2 . M i missing something? +1
tobias  @aaftabsethi1 love the reference! +1
tobias  also the answer would be 1/2 given that we know it's male but that would only be if we knew for sure that his mum was either a carrier or affected. We know his grandmother is an obligate carrier seing as the pregnant woman's brother is affected. So, the pregnant woman has 1/2 chance of being a carrier +2
jdc_md  its 1/4th because theres a 1/2 chance the mom is a carrier and theres a 1/2 chance she gives her bad gene to her son. the question stem tells you shes having a boy. if the stem did not identify the fetus gender and just asked what is the chances that a boy will have duchennes then the correct answer would be 1/8 because (1/21/21/2)= chances intereted from grandma, chance mom passes it, chance its a boy. +
... lae made a comment on nbme18/block3/q#34 (52 yo woman with breast cancer)
submitted by lae(28)
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het adintraoi yhatrep uceasd ofsibsri dan hte lftairyombsbos ct"ntc"aor iurgnd biossfri, anicgus eth ulsrcoe of asyirwa and stuh setalctiesa

hello  Adding part of @plummervinson's comment: Contraction atelecrasis occurs due to radiation therapy, necrotizing pneumonia, or granulomatous disease +1
caitlyncloy  fa 19- 666 +1
leaf_house  FA2020 - p680 +
... azibird made a comment on nbme18/block4/q#16 (an 83-year-old woman with systemic...)
submitted by azibird(200)

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.

hemoglobin_  just to add, the marginal artery of Drummond is the collateral blood supply between SMA and IMA that protects the intestine from ischemia +
... azibird made a comment on nbme18/block1/q#1 (During a study of the regulation of cholesterol...)
submitted by azibird(200)

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!): +
drdoom  also, this thread from NBME 21 discusses cell transport more generally (same warnings apply! don't scroll up!): +
brise  The question is saying where is it initially produced? It is produced in the RER, therefore F. Not asking where it's production starts- asking where is it produced etc. +3
chj7  I'm not sure if this is what the question was trying to ask but technically the "polypeptide" is initially sequenced in the cytosol; once the N-terminal signal sequence is synthesized, SRP translocates ribosomes to the rER where translation continues/completes and the "protein" is folded/formed in rER. (I like UW #757's diagram on this) So if they truly mean where the precursor "protein" is initially formed, rER is correct. But honestly the above is a way too complex form of thinking that I feel would NOT help on the actual exam and most likely strays away from the learning objective of this question; more likely the question writers were trying to distinguish btw proteins translocated to the rER (membrane proteins, secretory proteins, ER/Golgi/lysosomal proteins) vs. proteins that are synthesized by free ribosomes (cytosol/nucleosol proteins, peroxisomal/ some mitochondrial proteins). +
... drdoom made a comment on nbme18/block2/q#28 (A 68-year-old man comes to the physician because of...)
submitted by drdoom(969)

Responding to @azibird’s comment:

Backfilling of blood from the lungs into the R ventricle is stretching out the R side (dilation) and also remodeling the heart via hypertrophy (the heart has to pack on mass to eject the ever greater amount of blood piling up from lungs). Dilation of the R ventricle β€œpulls apart” the leaves of the tricuspid valve=lower left sternal border; when the heart is in systole, the tricuspid valves don’t make good contact and blood rushes from high pressure compartment (RV) to the low pressure (RA) == pansystolic murmur

The tricuspid murmur gets worse with inspiration because when you ask someone to take a good, deep breath, the diaphraghm (a very strong muscle, indeed) pulls the entire thoracic cage down and outward (expansion) β€” including the heart! Because the heart β€œgets pulled from all directions”, the tricuspid leaflets make even less contact == bigger hole == more pronounced murmur during systole.

The point of maximal impulse (the heart apex) is way below the xiphoid because this guy’s heart is so big from the years of dilation and hypertrophy β€” that’s also why S2 sounds are distant: the great vessels (and their valves) are buried even deeper than usual, so you can’t hear them snapping shut (aortic & pulmonic valves; S2=β€œdub”).

heart sound areas =>

... aneurysmclip made a comment on nbme18/block1/q#10 (25 yo woman, polycystic kidneys)
submitted by aneurysmclip(169)
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bcaylilas olpcscyity eidnyks wotn' okwr olepr,rpy veey'ht ntidhe ta this wiht the r.ctase fo d mus4ghl./t hte eidykn w'tno do tawh tis sppeuosd to o.d REEERMBM ot ceckh eehwhtr tehy era kaigsn MRUES hnsgcea or IUNER agcshen

yni dseK rnlmao funtcion - orrebsab 3HO-C , its not oidng htta now t&g; sddeacree HO3C

PHT - wodlu eascu edeinasrc liamCcu aepiorsortbn in nieskd,y tub dsniyke 'raetn aleb to rebbraso cacluim t&;g TPH oderspsn ot wol calumic evlsel dna leeslv eraesicn

O 4P stie ntio PHT as lle,w HTP scta be NCSRAEGEID PO4 bron.terpiosa eSinc esikydn 'enrat riokwgn ei: ont sdpgoinren to HPT &t;g eetrh odwlu be ciaseenr in P4O

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. +13
baja_blast  I also think there is decreased 1alpha hydroxylation of Vitamin D, which would increase PTH secretion +2
freebie  This questions is testing the consequences of renal failure --> "MAD HUNGER" mnemonic in FirstAid +
... ergogenic22 made a comment on nbme18/block3/q#21 (48 yo woman, gradual onset of back pain over 2 weeks)
submitted by ergogenic22(351)
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I wtne tihw iateatstcm sabtre seabecu yhte made a nopti fo yigsan ctsmtiteaa sa fi hte iyhdtro iarcnmaoc sha nto daprse ot hte ne.ob

... sugaplum made a comment on nbme18/block3/q#40 (47 yo woman with irregular, raised, multicolored dark lesion)
submitted by sugaplum(415)
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eht deepre the lmamnaeo gose teh ersow hte prisngoos

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 +6
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). +5
... sugaplum made a comment on nbme18/block3/q#48 (52 yo man, chronic pancreatitis)
submitted by sugaplum(415)
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Ceehotollrs trees syhraeldo is edeedn fro sseeervr oltlsceorhe ,sotpntrar ont rapcintcea eenmz.ys
- I sdseim hits

... carrierose11 made a comment on nbme18/block4/q#37 (66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath)
submitted by carrierose11(8)
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Belyris,olsi nptivisstiyeryeH mnnitospieu dan ssaroicoSdi lal evah ongraauml rmt.afnoio sloA naltmdieei nroiccgpeyt nrongiziag pnoenaimu cb/ teh tp nt'ddi hvae ayn hncoicr esmisasedds.e/ oS, I was telf hwti htocadiiIp aroylupnm ossbiifr sa eht heicc.o

pathogen7  Also "fibroblastic foci" is a big buzzword for IPF, I believe. +4
... motherhen made a comment on nbme18/block1/q#40 (A 3 yo boy is brought to the physician for a...)
submitted by motherhen(51)

This is describing Hyper IgM syndrome; without CD40 ligand, T cells are unable to provide the secondary signal to activate B cell class switching. This prevents IgM from switching into IgD, G, E and A, and thus an accumulation of IgM - hence the name "hyper IgM" - and deficiency in the rest (causing infections like S.pyogenes early in life, PCP, cryptosporidium and CMV).

Note in this question the cause of Giardia infection from lack of IgA (lack of mucosa/GI protection) must be distinguished from Selective IgA Deficiency. Lack of CD40L ligand defines it as Hyper IgM syndrome.

Answer choices:

  • Complement activation= IgM and IgG

  • Cross placenta= IgG

  • Attach eosinophil Fc receptor= IgE

  • Attach mast cells= IgE

  • Easy secretion across mucosa= IgA

jer040512  To further add: IgG opsonizes +2
... aakb made a comment on nbme18/block1/q#33 (A 50-year-old man is admitted to the hospital after)
submitted by aakb(24)

warfarin inhibits epoxide reductase which prevents gamma carboxylation of NEW vitamin K dependent clotting factors. the therapeutic efficacy of warfarin is delayed until prexisting/OLD factors get consumed, which usu takes at least 3 days.

Therefore, it will not affect the PT for at least three days because the old factors are still around. Since factor II has the longest half life, it takes the longest for the old factor II to go away/get used up and that is why the PT has not increased yet in this patient.

mariame  I am confused, he has had already 2 days with Heparin, and Heparin enhances anti thrombin which inhibits thrombin. +2
... andro made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
submitted by andro(213)

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 )

... mahesh made a comment on nbme18/block1/q#19 (70 yo woman, increasingly severe pain in right knee over 3 months)
submitted by mahesh(5)
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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. +
... azibird made a comment on nbme18/block1/q#30 (29 yo woman irregular menstrual periods)
submitted by azibird(200)

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 +
chj7  Take this with a grain of salt but I felt like a treatment plan with goals should be tailored to the patient and would require a physician to assess performance/make modifications. A support group could provide mental support when facing a disease but seems not individually-targeted enough for trying to get a patient to stick to a dietary/exercise treatment plan. I have to admit I did really self-doubt when I saw the 2 questions on the test. +