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NBME 20 Answers



Question#3 (reveal difficulty score)
A 48-year-old man comes to the physician for ...
Upregulation of the LDL receptorsπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 50-year-old man is brought to the emergency ...
Formic acidπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 24-year-old African American man comes to ...
Pseudofolliculitis barbaeπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 5-year-old girl with AIDS develops a ...
Thymidine kinaseπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 50-year-old man is brought to the physician ...
Pick diseaseπŸ”,πŸ“Ί



Question#12 (reveal difficulty score)
A 72-year-old woman with dysphagia is ...
Right kidneyπŸ”,πŸ“Ί


Question#14 (reveal difficulty score)
A 28-year-old man who is a migrant worker ...
Psoas majorπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 30-year-old man who completed a successful ...
Adjustment disorder with anxietyπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 30-year-old woman with multiple sclerosis ...
PonsπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
Drug effectπŸ”,πŸ“Ί





Question#22 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
VagusπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 34-year-old man who is HIV positive is ...
CD4+ T lymphocytesπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 50-year-old man comes to the physician ...
OmeprazoleπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 25-year-old primigravid woman at 42Β weeks’ ...
Phosphoinositide hydrolysisπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 53-year-old woman comes to the physician ...
Schistosoma mansoni πŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A previously healthy 16-year-old girl comes ...
Trichomonas vaginalisπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
During an experiment, an investigator ...
LysineπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 33-year-old woman comes to the emergency ...
LunateπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 66-year-old man has had fatigue, shortness ...
Focal pulmonary fibrosisπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 17-year-old girl comes to the emergency ...
MitochondrialπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A strain of Escherichia coli produces a ...
MissenseπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 56-year-old man is admitted to the hospital ...
RhabdomyolysisπŸ”,πŸ“Ί





Question#41 (reveal difficulty score)
A 45-year-old man has fever, chills, dysuria, ...
Escherichia coliπŸ”,πŸ“Ί


Question#43 (reveal difficulty score)
A randomized clinical trial is conducted to ...
Neither procedure is superiorπŸ”,πŸ“Ί



Question#46 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
CholecalciferolπŸ”,πŸ“Ί


Question#48 (reveal difficulty score)
An otherwise healthy 4-month-old girl is ...
Spontaneous involutionπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A 26-year-old man undergoes an abdominal ...
SplenicπŸ”,πŸ“Ί


Question#2 (reveal difficulty score)
Following a wedding reception that was ...
NorovirusπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
An investigator compares the DNA sequences of ...
5β€² CCGGπŸ”,πŸ“Ί



Question#6 (reveal difficulty score)
An 18-year-old boy has just been diagnosed ...
50%πŸ”,πŸ“Ί


Question#8 (reveal difficulty score)
Three elderly residents of an assisted living ...
Legionella pneumophilaπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
An otherwise healthy 16-year-old girl comes ...
Cold, dry airπŸ”,πŸ“Ί



Question#12 (reveal difficulty score)
An 80-year-old man with type 2 diabetes ...
Pelvic splanchnicπŸ”,πŸ“Ί



Question#15 (reveal difficulty score)
A 55-year-old man comes to the physician ...
DextromethorphanπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
A 65-year-old man is brought to the emergency ...
ST-segment elevationπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 66-year-old man is brought to the emergency ...
Cigarette smokingπŸ”,πŸ“Ί

Question#20 (reveal difficulty score)
A 19-year-old man who is a college student is ...
Subcutaneous crepitusπŸ”,πŸ“Ί


Question#22 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Ubiquitin ligaseπŸ”,πŸ“Ί


Question#24 (reveal difficulty score)
A patient with a 1-week history of diarrhea ...
Decreased arterial Pco2πŸ”,πŸ“Ί




Question#28 (reveal difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreasπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 25-year-old woman has a flu-like illness ...
PicornavirusπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 78-year-old man is brought to the emergency ...
CortisolπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 12-year-old girl is brought to the ...
OsteoblastsπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A study is conducted to assess the effect of ...
Lead-timeπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 28-year-old man has excessive thirst and ...
HypothalamusπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 36-year-old woman comes to the office ...
SplenomegalyπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 31-year-old man has a large, yellow, soft ...
LiposarcomaπŸ”,πŸ“Ί



Question#39 (reveal difficulty score)
A 29-year-old man comes to the physician ...
Absence of peptidoglycanπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 70-year-old man has a 3-month history of ...
Squamous cell carcinomaπŸ”,πŸ“Ί


Question#42 (reveal difficulty score)
A previously healthy 32-year-old woman is ...
PreloadπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
OvariesπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A new antiplatelet agent is developed for the ...
8%πŸ”,πŸ“Ί


Question#47 (reveal difficulty score)
A 35-year-old man comes to the physician to ...
1:4πŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A sedentary 50-year-old man with hypertension ...
Antidepressant therapyπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
PheochromocytomaπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
The frequency of an autosomal recessive ...
1/25πŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 23-year-old woman is brought to the ...
Xanthine oxidaseπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 45-year-old woman has a thyroidectomy ...
CalcitoninπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
Reactive T lymphocytesπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 35-year-old man comes to the physician ...
MethotrexateπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 10-year-old boy has a palpable mass in the ...
Endoderm of foramen caecumπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 12-year-old girl is brought to the ...
PolyubiquitinationπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 62-year-old man comes to the physician ...
ProstateπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 59-year-old man develops fatigue and ...
HemolysisπŸ”,πŸ“Ί


Question#12 (reveal difficulty score)
A 46-year-old man has dyspnea, orthopnea, and ...
Mitral regurgitationπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 45-year-old woman develops proteinuria and ...
Tubulointerstitial nephritisπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
During a clinical study, an investigator ...
Increase the sample sizeπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 23-year-old woman, who was diagnosed with ...
Substance PπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
50%πŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 67-year-old woman comes to the physician ...
Low sensitivityπŸ”,πŸ“Ί






Question#26 (reveal difficulty score)
A 3-month-old boy is brought to the physician ...
Mannose 6-phosphateπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 55-year-old man with type 2 diabetes ...
PravastatinπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 23-year-old woman who is 6 months pregnant ...
Antiplatelet antibodiesπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
An 83-year-old man is brought to the ...
Early septic shockπŸ”,πŸ“Ί


Question#31 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Ξ²-TubulinπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 54-year-old woman with terminal metastatic ...
NonmaleficenceπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
A 22-year-old woman comes to the emergency ...
Release of bacterial productsπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infectionπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 4-year-old boy has had fever, abdominal ...
Shigella sonneiπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 62-year-old man with alcohol-induced liver ...
SpironolactoneπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 23-year-old man with a 3-year history of ...
Psychogenic polydipsiaπŸ”,πŸ“Ί



Question#41 (reveal difficulty score)
A 2-year-old child undergoes resection of the ...
Increase in glomerular sizeπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 13-year-old girl has an episode of severe ...
Epstein-Barr virus genomeπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 71-year-old man comes to the physician ...
CilostazolπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A 39-year-old man reports bright red spots on ...
ConstipationπŸ”,πŸ“Ί


Question#47 (reveal difficulty score)
A 60-year-old woman has prolonged apnea ...
SuccinylcholineπŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A 48-year-old woman comes to the physician ...
HypothyroidismπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 92-year-old woman who was recently admitted ...
Atrophy of dermal collagenπŸ”,πŸ“Ί



Question#2 (reveal difficulty score)
A study is conducted to identify healthy ...
LiverπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 20-year-old man comes to the physician ...
OlfactoryπŸ”,πŸ“Ί


Question#6 (reveal difficulty score)
A 51-year-old man develops diaphoresis, ...
Alcohol withdrawalπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 33-year-old woman with HIV infection is ...
Non-Hodgkin lymphomaπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 58-year-old man is brought to the emergency ...
HypertensionπŸ”,πŸ“Ί


Question#10 (reveal difficulty score)
A 65-year-old woman who has a 25-year history ...
Hydroxylation of prolineπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 37-year-old man who is HIV positive comes ...
NortriptylineπŸ”,πŸ“Ί


Question#13 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Bronchogenic carcinomaπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
A 45-year-old man is undergoing a surgical ...
Decreasing respiratory rateπŸ”,πŸ“Ί


Question#17 (reveal difficulty score)
A previously healthy 55-year-old man has ...
Renal artery stenosisπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 35-year-old man comes to the physician ...
GastrinπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
HypophosphatemiaπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeetsπŸ”,πŸ“Ί





Question#26 (reveal difficulty score)
A 33-year-old man comes to the physician ...
Rectus femorisπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
An investigator is studying patients with ...
Case seriesπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 78-year-old man dies of chronic congestive ...
Failure of the Na+–K+ pumpπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 15-year-old girl is brought to the ...
DoxycyclineπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 32-year-old woman is brought to the ...
Arterial lacerationπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/LπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 65-year-old woman with cardiovascular ...
Increased bile saltπŸ”,πŸ“Ί


Question#35 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
ContemplationπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 25-year-old woman is brought to the ...
Factitious disorderπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin EπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Tumor necrosis factorπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 30-year-old woman develops serum sickness ...
C3aπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 56-year-old man with a 20-year history of ...
NaloxoneπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 65-year-old woman dies 6 months after the ...
MeningealπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A physician is assigned to a search and ...
Negative nitrogen balanceπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 45-year-old man comes to the office for ...
Starchy foodsπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Terminal components of complementπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathyπŸ”,πŸ“Ί


Question#48 (reveal difficulty score)
A 24-year-old man comes to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 23-year-old woman sustains significant ...
Direct antiglobulin testπŸ”,πŸ“Ί


Recent comments ...

... amorah made a comment on nbme20/block3/q#35 (A 51-year-old man has the acute onset of fever and...)
 +38 
submitted by amorah(101)
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Fevre gt-&; leur uot tfle nluairvectr afeluir M-MXSP T xispyohaprl &g-t; uerl tuo mnystsuPocie yevn cKjdiiioer lnatptasrn btu no WCBR/BC ni rnieu t;-g& eurl otu alttnasrnp ntreoicej

egianLv VCM nad lacpyati taobicemurmcy sa the enraimgni wto i.snootp CMV si omer ileylk ni a arsatlnptn tanep.it

... hayayah made a comment on nbme20/block1/q#40 (Monoclonality of neoplastic cells in endometrial...)
 +33 
submitted by hayayah(1116)
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oilNaseap is new sestiu ghrotw thta si ner,ltugaedu irvberser,ile adn oo.aconllnm

iltnaCyol acn be eenriedtdm by hh-astepugselpo-o6c seodeyrndghae ()6DPG enmezy soro.sfmi PG6D is Xneil-dk.

*For mero ofnotiaminr hecck tuo h.C 3 saeoNpila ni taPomah

hello  This is great, thank you. +5
breis  Pathoma ch. 3 pg 23 "Basic Principles" +9
charcot_bouchard  Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec. +14
fatboyslim  Clonality can also be determined by androgen receptor isoforms, which is also present on the X chromosome (Pathoma Ch. 3 Neoplasia) +2
lovebug  @fatboyslim thanks for reminding! +1
makingstrides  Just to make sure I got this right, because this is neoplastic and its monoclonal, you want to look at the isozymes to determine its clonality? +2
... hayayah made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +33 
submitted by hayayah(1116)
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LV dppteos ,wngokri surrseep adckbe up iton uplm ict.icur Pmlu ciitruc ryhoulg is emda of 3 "ap"str - teh iasclrl,ipae lniiaerittts sea,pc nad eht le.lavoi

In adiicrcnego ,hscko eth xater loodb eearnssci rypaclila thoyrtsicda srsrupee, nvdiigr iulfd itno eht srtniitelati s.acpe Cedrampo to teh valle,oi het tsianrttilie acpse own ash moer fudil sut(h ermo iiltnrsittea cahyritdsot rrsuseep dna sels nciocto srpeuser edu ot iroat fo filud to pnoeirt), nda sa a trsule of itsh blnngaucian of oc,frse fulid mosve iton het lioeval g-;t-& ryalpunom emda.e

... masonkingcobra made a comment on nbme20/block4/q#21 (A 47-year-old woman comes to the physician because...)
 +31 
submitted by masonkingcobra(369)
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Pgea 2 sah a argte pctruei

23ofpt)i8jlgrt(rc/46t/aah9-e.pn0.0/dnl/ei1117i/s-09wSco6w6w:

kamilia20  chlamydophila psittaci?? +1
... hayayah made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +29 
submitted by hayayah(1116)
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A gib igtnh ehre too si iitcgnon hatt the APL si .ceasrdede oelsatObst titycvai si mdueraes yb bneo L.PA I htkin tath saw eth iman ufosc rehe nda not htta ouy saeensyircl dnee to wkon eht F1ACB egen ttmuai.no

sympathetikey  Exactly. That's the only way I got to the answer. +4
pakimd  isnt increased alk phos consistent with increased osteoblastic activity? +
champagnesupernova3  A defect with chondrocytes would cause an short limbs like in achondroplasia so those are ruled out +1
pg32  Exactly. Can also be helpful if you remember that the clavicles are formed by intramembranous ossification rather than endochondral; that allows you to rule out the chondroblast/cyte answer choices. +7
... hello made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +29 
submitted by hello(354)
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esPati'tn otpsmyms gbnea 30 inm fetra iwomng wnla e(i.. reatf ingdo hcpylasi civti)a.ty eH ash veeres chets anip dna is ol,co ,acymml etohi.ricdap eH ash eicesrnda pumolynar errtay rspurese nad ncdariees lfte traali sres.reup Taenk gtoerh,etla itsh is aicegindroc o.hsck

nrgoiaecCid okhcs si a tareh uppm mlperob -- het VL ni'ts nrgikwo.

nhWe the VL, sn'ti krwni,go ti usseac a ckba pu ni eth cinioetrd tspipooe to owh ooldb oaylrmln sl.owf Tofeeerhr, odlbo wlli ckab up in teh lungs.

sTih ucases ridncease plaalriyc asotdtciyrh srpueres -g-;&t tihs sedriv orme udifl tnio hte imtietnsutri t&--g; hist ssuace sedenciar liieinrtstat orciyshttad rsrspeue --;&tg rehte si own orem dulfi hant onrmla in hte imtrenustiti g&--t; stih tsacfef the epionrt rioat inhtwi hte iitntrutmes -t-;&g shit cssaeu reeadecds titrilnetsia ctoicno serpeurs.

targetusmle  awesomely explained :) +
lilyo  This was amazingly explained Thank you @Hello! +
pseudopseudopth  For edema to occur shouldn't interstitial oncotic pressure be increased?(when proteins are there, they can pull the fluid) +1
pseudopseudopth  And when increased interstitial hydrostatic pressure is pressure, shouldn't it oppose the edema by pushing against it? +1
pseudopseudopth  *when interstitial hydrostatic pressure is increased +2
... imgdoc made a comment on nbme20/block4/q#20 (A 5-year-old boy is brought to the physician for a...)
 +28 
submitted by imgdoc(144)
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ouY cna scsor uot teh opt tehre rnaews cisce,ho .B,CA, You tonw be abineogbrsr niytghan ni hte TCP in c'afniosn eomds.ryn ongkioL ta kmopaayie,hl emhytpr,aaoni dan hsihtoppyaohmaep w.on lkipmoaeyHa tc'na be certrco acbeesu vnee hgthuo pmsuiosat si lots it ilwl eb bbosrerdea at hte trael cithk dsinacnge olop dna fi htta stnedo emak ene,ss het ydob ilwl jdaust ofr owl srmue taposusim btu tgvintaica het K+/H+ ppmu no cll.es tI 'tsni royaenmithap ebeasuc ta eht tcnliolecg tucd naprliicp csel,l ptiosoearnbr liwl cuorc. hsiT saleve emahitayshopphop as the rccerto dna nloy nerwas ohicce.

imgdoc  by* +2
larascon  Excellent explanation, thank you ! +2
waterloo  It's worth mentioning, that 25% of Na is reabs in the thicc ascending limb. 67% of filtered Na is reabsorbed in the PCT, whereas 85% of phosphate reabsorbed in the PCT. So pt more likely to show Hypophos. +3
coconut  UWorld QID:7626 says lab results in people with Fanconi syndrome will show hypokalemia +
j44n  coconut i thought that too but then i remebred fanconi is associated with hypophosphatemic rickets/ VIT D resistant rickets and this little dude is going to be growing because he's 5 and thats gonna increase the demand for phosphate in his body +
... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +26 
submitted by strugglebus(173)
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eohwNer aehv I enbe labe to dfin ywh teh hlle tshi si a ihtn.g

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +7
breis  same^^^ +
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +
chandlerbas  you had me at its not in sketchy ;) +3
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +
... celeste made a comment on nbme20/block2/q#6 (An 18-year-old boy has just been diagnosed with...)
 +26 
submitted by celeste(85)
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eWihl hte imlfetei sirk in hte neleagr uaniopotpl si stuj elowb 1,% it is 5.6% in errei-ftgdse avseiletr fo esintpat adn ti seris ot reom anth 04% ni ginomooyctz tsnwi of dftfecae pp.eoel liAgazynn iscascl usstedi fo eht nesiegct fo ioceasprnhzih nedo as ealry as in ,0s391 hircseF nccesodlu atth a oeccnocadnr reat orf hysssiocp fo abtuo 05% ni tmoyzincgoo nitsw mssee ot eb a asitceril ,eatetism iwhch si sniilctnfgyai hieghr ahtn ahtt in todigyicz nsiwt fo outba –%1190 (fprm6cet2neb9Pc.4.gris//i5.ov#lmhM3ai3l//nnc6C)

imnotarobotbut  How is one supposed to know this before having read this article? +34
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld +2
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-| +8
doodimoodi  Lol just why seriously +3
champagnesupernova3  This was mentioned in the Kaplan behavioral videos +
usmlecrasher  and there's so much unnecessarily BS instead of real questions +2
j44n  I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center +6
feanor  This Question is a perfect example of where you just jump off your seat to demand a refund or you decide to go Antisocial Disorder on your computer screen. +
olddoc  I don't think it has to do with any extra info. The dx is FAP (mutation in APC gene) which is inherited in an AUTOSOMAL DOMINANT fashion ("A" is the mutant allele and "a" is the normal one. The girl in the question stem MUST be heterozygote "Aa", getting the mutant "A" from her sick father and "a" from her healthy mother. Assuming she marries a healthy husband (aa) (this is a normal assumption in genetics questions), their kid will be Aa (the phenotype that will 100% result in CRC) by a probability of 50%. Recall that FAP will 100% progress to CRC is not prophylactically removed. +
olddoc  FA 2019 Page 381 +
... xxabi made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +26 
submitted by xxabi(273)
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sloA fro oseht fo uoy woh rae ltolyat uelsslec liek me, niruayr rtcat tobiortcuns = evosrucibtt tahpor.uy

skonys  I see 74.5 Difficulty score and think "word, I don't need to get this one correct" +3
... medbitch94 made a comment on nbme20/block3/q#26 (A 3-month-old boy is brought to the physician...)
 +25 
submitted by medbitch94(40)
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0291FA apeg :47 -llIec ssieeda n(uionilcs llec ipsesscoeiomdliud/sai epyt I)ehrdβ€”teniIi oaomsylsl sroetag ris;oerdd ecefdt ni sncusoseog-yspheth-rylaNp-tno1cefallramia &r;rar leirfau of the Ggilo ot ppaehltosoryh enmsnao eersdusi monfrig( ts-ephpoomena6-ahs)n on oycrligpestno ;&rrar tneosipr are stercdee alltxrecrulaeyl aerhtr ahtn ediedevrl to ysos.lsmeo susetRl in roeacs aifcal ua,resetf vnigliag yasaphrepil, ldceuod noa,cres dsrrettcie itjon nmesvot,me wlac nhda de,imfeitosr h,isspcoyokosli nda hhgi asmpla lselve of moslyolsa em.znsey ftnOe flata ni lc.hhidood

athenathefirst  FA page 47 +
... hayayah made a comment on nbme20/block1/q#34 (A strain of Escherichia coli produces a...)
 +24 
submitted by hayayah(1116)
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Mesnssie tonamtisu noievvl a edeciuotnl sittiuontbsu tigrnelus in hganedc mniao .isadc eteiosmSm the cefstef of emnsessi otsminaut may eb only aerpntpa nrude tnicrea inntronvleeam tcdnion;osi such snemsesi amtosnitu rea edallc odinioantlc u.itoasmnt aMyn ienmsess tanumotsi utersl in rtieonsp tath era ltsli tnuoncfi,al at tlsae ot eoms egeerd.

lo,As lal hte troeh srwanes ouldw opyarbbl aveel you twih heirte a lartyge eltdrea or oaf-icnnulnont netorp.i

thefoggymist  I chose nonsense because I thought it'll make the enzyme shorter (since less bonds = more heat liable = can't work at 42 degrees) but yea, probably won't work even at 30 if it's an early nonsense. +10
joanmadd  A good clinically related example is HbC disease on electrophoresis. HbC disease is due to a missense mutation (glutamic acid (-) for valine (neutral)). The mutated hemoglobin is still fairly functional but when placed on gel electrophoresis the HbC migrates the least far from the negative electrode due to less negative propulsion (lack of wild type glutamic acid). +3
fatboyslim  @Joanmadd Just to clarify, glutamic acid substitution for valine occurs in sickle cell disease not HbC. HbC is glutamic acid substitution for lysine :) +7
rockodude  lyCCCCine for HbC +3
... yotsubato made a comment on nbme20/block1/q#42 (A 60-year-old man has two-pillow orthopnea, severe...)
 +23 
submitted by yotsubato(1088)
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dfBii cdtraoi suspel are nsee in ctiAro ossneist ro trungiogreait

Cdrotia uirtB is ahder twih elhtrroocaissse of momcon doticra etayrr

olSw nigisr deedrecsa lmueov dictrao eupls is sicttirerhacca fo tcraio snos.itse

aonCnn seawv aer nese in cteopelm VA lcbko, sa ihtgr tlivnceer nad iatra cornattc ptin.leeendnyd

chextra  I mis-remembered normal JVP as 8-12. Therefore, I picked "Slow-rising, decreased-volume carotid pulse". Is there a reason why this is NOT a result of HF, or is it simply not the best (which I agree is JVD)? +1
len49  For those wondering normal JVP is 6-8 mmHg +4
fatboyslim  @chextra I think the reason why it's NOT slow-rising decreased-volume carotid pulse (sign of aortic stenosis) is because the patient had a h/o prolonged substernal chest pain 5 days ago. I think he had an MI and is now presenting w/ heart failure. +1
... justgettinby made a comment on nbme20/block1/q#24 (A 50-year-old man comes to the physician because of...)
 +22 
submitted by justgettinby(22)
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rlazocetoIna iequrres the icdaic imvonernent of eth thmasco to eb boadresb. pelrzOemoa thnisbii eht K/++H mppu of eht th,mosca betyehr aeginesrcd teh iidtacy of het ost.amch oS hwen hte paintte kesta Oepmarolze dan tacIloorznae ee,rtgtho aazloorcetnI t'now be oreadbbs oint the ydb.o hsa'Tt hyw it ash on t.fcfee

st'I mdenoemecrd ot kate sictdinameo ta tesla 2 ruhso rrpio to gaktin na inct.daa

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +4
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2
chandlerbas  just itraconazole and posaconazole +5
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +12
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +1
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +
... andrewk1 made a comment on nbme20/block2/q#9 (An otherwise healthy 16-year-old girl comes to the...)
 +22 
submitted by andrewk1(22)
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Tsih gilr sha csrexiee inuddce stham.a It is ton wlle eundosdotr why it snpehpa but teh rtgesgir aer nreceogz.di ralymNlo ewhn ienthrgba osrucc ira si takne ni by hte neos dan teh nalsa gssapsea dan uierbntats cat to eormev sutd nad /idiuwrmfmayh the a.ir yiLloacgl hits smeak teh ria nseder nv=RP.T oS ehnw gcei,rxeisn brgiathen otghhur hte nsoe si drdceeeas adn rcpldeae yb orme uovsoirg uhmto .antibhrge iThs mnsea hte ira is ton meuiidhfdi adn edarwm u.p ehT iar si slse nsdee dan the mtshaa eessn.u hTe oeiustnq toko ihts aems eplpiricn tpcxee vrdseere ti by askgin what nelxtrae oindnitco docul dael to hte tsamha nad that wloud eb dloc dry ia.r

eacv  oooh thank u !!! I choose wrong, cold air hehhe +6
eacv  moisture air instead! +
... monoloco made a comment on nbme20/block4/q#30 (A 32-year-old woman is brought to the emergency...)
 +22 
submitted by monoloco(142)
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Aimeynt uyo heva a rsepno who smbup iehtr ,edah tgse bcak p,u adn nhte sha servee ssesui or idse ielk 6 srhou elart -- yuo haev ulryesof an laripdeu haamtoem romf eonataircl ot het dldmei EALINGMEN yreatr. (nolGaj relaly smeezpahsi htta ouy tno'd wrsce up dan tceels eimdld elerbc.ar) uYo knwo ti has ot eb an atlrriae laenioarct neisc teh uadr si ightlty darhede to het 'sullks nenri aecsurf. loGjan eerdrrfe ot ish cipeeexner whit ti sa egdenin srplei ot emvreo het duar ofrm the slkl;u hg,irpac utb ti eidsvr the tnipo omeh. neTitng eens no CT si usaeecb teh udapielr oaemhatm stge csukt teewben eht suuert sinel. Wnhe it ngmaase to ebakr psat eno fo het euutrs ie,lns it si my utsdnrgnneadi that hnte si when yuo get reesve las,eeqeu eikl tdhae ro aevtw.ehr

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11
... banieb made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +21 
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iurngD eth lats lhfa of aencpgrny itndiaol of teh ueprp urirayn crtat nca rucco edu ot sponicomesr fo eht rurtees by the rogwign efue/uutsrst nad het ieanl e.ilisanrmt The sronoimepcs of ehest is otn gilnlwao lifud apessga inot hte dldrbea gsciaun einru luipbdu in hte inyked, tshi lseda to oinlidat of eth nekidy atht ensd pu nugsiac apiocsmttmy hysriopdohs.ren itsh can den pu in iiofctenn dna osymtpsm hcsu sa hte esno etepsnr ni tshi natitpe eilk kbca inap dan AVC ndseens.ter hte gncyir si myilna ued to het aipn csedua by hte tto.oicrsbun d an sutj sa tegnmihso :rtxea bdeulo glatiip ttsehecar is a sfae adn plmsei awy of itnraget patymomisct sohpronirdyshe of peycag.nrn

banieb  Ureteral obstruction by the pregnant uterus https://www.ncbi.nlm.nih.gov/pubmed/1579937 +1
... onyx made a comment on nbme20/block1/q#12 (72 yo woman with dysphagia)
 +20 
submitted by onyx(44)
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acocTrhi ucdt rstoila.ne

consuela_salon  This was the picture that I liked the most for this question. If you imagine that the injury is at the level of the left subclavian vein (LSV) and thoracic duct (TD) crossing each other, maybe it will help you realize that the left breast & left upper extremity bypass the injury. The right lung is drained by the right lymphatic duct, not the TD (see one of the links bellow). And the heart is where eventually all the drainage is going to end up to be pumped again (TD -> LSV -> SVC -> heart). +19
mbourne  To keep it simple, the Thoracic Duct drains lymph from the entire body EXCEPT for 3 structures: Right Upper Extremity Right Thoracic Cavity Right Side of Head and Neck These 3 areas are drained by the Right Lymphatic Duct which enters the Right Internal Jugular Vein +11
... hello made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +20 
submitted by hello(354)
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Gonjal adh a leetcru ahtt dtnimneoe thta If" a aieptnt ahs octehr,gaaalr weeriv ervey urdg ye'hter iangtk scnei ynma gudsr sauec a.orcl"agreath

eTh lony ntgih of seobilsp nvelaerec in shti Qsm-te si ahtt ehs seatk a i,tioacemnd eoferhetr the rswnea of dgur" ffetce" si het mtso lkeyil ansore rfo ehr argtoaacelh.r

hungrybox  I still think this question is pretty BS. But having studied some more, I think it's less BS than I originally thought. Pathoma gives the three major causes of galactorrhea as nipple stimulation, prolactinoma of anterior pituitary, and drugs (see 16.1 - Breast Pathology). Only drug effect is an answer choice for this question. +7
hungrybox  To put another way - before you try to go through every answer choice, asking yourself "would this cause galactorrhea?" Instead, ask yourself, "What are the causes of galactorrhea?" According to Dr. Sattar, they are "nipple stimulation, prolactinoma of anterior pituitary, and drugs." +3
hungrybox  The question doesn't say anything that would point you toward nipple stimulation, like "it only seems to appear when she puts on a shirt/plays sports/runs/etc." It also makes no mention of bitemporal blindness (which would point you to an anterior pituitary tumor), so you can rule out prolactinoma. The only option left is drug effect. +2
drdoom  hungrybox’s full comment (below) here: https://nbmeanswers.com/exam/nbme20/410#3907 +1
... monoloco made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +20 
submitted by monoloco(142)
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This is a inaidonoltc ladlec drs.ciilpaiosaelanyodc The dik no rrteSang hinTgs ihtw eth spil has eth esd.idrro oN llaroc ,bneso oto many tt,ehe ltonfar gsnbsio &;tg= lopyiclasdi.ardnoescia B1CAF is a enge giylhh aletimdcip in aootstbesl ctnfnuo.i

... hayayah made a comment on nbme20/block1/q#7 (A 5-year-old girl with AIDS develops a progressive...)
 +19 
submitted by hayayah(1116)
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,icorAvylc cvaimofril,c aoaylcrvvcil era aseiognnu lana.ogs hyeT neoudgr oonvesrcni ot aclioyrvc oohptpmeahnos vai irsuv nceddoe ysmeihki-nntaeid. leytml,Uati yeht bhtiiin varil ADN ypomasrele by ahnic eninm.aottir

tteMuda rlaiv ndiemiyth eksian anc cusea ces.aitnesr

len49  Foscarnet and Cidofovir on the other hand do not require phosphorylation by viral kinase, therefore should be used in strains that are shown to be resistant. +4
... strugglebus made a comment on nbme20/block2/q#20 (A 19-year-old man who is a college student is...)
 +19 
submitted by strugglebus(173)
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rnnocBphh=ooy ornxoiaiEt pmpuerany riort=ds loanhriorcbaehtc brtooicstun sfiermgan(os/ oiynst )dpryoIbra toirsrd = genyllara crnuuotsuosbcoSit csin psl=ash tset orf cyiprlo eosistsn

hWen erthe si a urfdcaetr rbi it ilwl esuac a uatarm toernxmhaop cwihh nac ecusa ira ot ceepas nad eobmce ptepadr rdnue het snki anliegd to pcurets.i

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1
... medbitch94 made a comment on nbme20/block3/q#49 (A 92-year-old woman who was recently admitted to a...)
 +19 
submitted by medbitch94(40)
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Aiccnti upauprr lstersu fmor xvasntaetroai of dbool iton the e.idrsm sTih nenmenopho is ued ot hte insk yaphtro nad eth ygirlitaf of het loodb sesvles in elldery uinlivasd,id wchih si ertcaeeaxdb by ronchci snu xpsureo.e tcAniic rppurau loesisn ear ecoaldt no -dpoxneusse resaa, eikl eth ,rmsa ,afec and cn.ek

inSk oryapth in ossrotmadoepir is deu to an inlartoeat of lc,oelgna isimral to atth which si seen in i.psrtoossooe hTis cenproound knis trpyhoa dsuace by the o-ghtgnopia mseka eht mlraed crvulsaa wtkroen vrey seivseint to hte hisetsltg atraum or iernghsa .recof

md_caffeiner  Google actinic purpura, look through 5-10 images, and you get the idea. +11
athenathefirst  How can you rule out answer choice (C) autoimmune disease? +
... meningitis made a comment on nbme20/block2/q#50 (A 27-year-old woman comes to the physician because...)
 +18 
submitted by meningitis(575)
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ehnW tigndnsa up, teh oybd ryolamln taitcvsea amepychstit setmsy ot aiovd ahiscotttor oyinpnohte.s

utB seicn teerh si nwo na tidviade effcte fo teh horcameoohmocytp sneadigr,rec ti lwil leda to a rneespothniy

:(.ie lbueDo oincirttscoonvas = Pheo srnrdigeeac + iScmaphetty stmy)se

sympathetikey  Brilliant. +6
medschul  Would pheo have a normal resting BP though? +13
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +9
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +2
nala_ula  No problem! Thank you for all your contributions throughout this page! +2
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +
hello_planet  FA 2019 pg. 336 +2
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +
... hayayah made a comment on nbme20/block3/q#20 (A 67-year-old woman comes to the physician for a...)
 +18 
submitted by hayayah(1116)
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Sietistivny esstt are seud for srnngeei.c ityiccfepSi tests are esud ofr acoriftmionn arfet tosiipve .iengcrsnse

inteysSiivt sttes rae euds orf igenes woh nyma pploee turyl heav teh easdsie. fcieiicSypt ssett rea fro ohtes owh do not vaeh het isda.ees

A ghlyih iiesestvn e,stt enhw tiae,gven lusre UTO ead.eiss A glhiyh eificcsp t,tes nwhe veipi,tos eulrs IN dseieas. ,So a etst whti ithw owl sivestiitny tnocna rule tuo a deasei.s A test with owl ficispctiey atnc' erlu ni ei.saeds

heT ordtoc dna teptain wnat ot enscer ofr nocol ccrena adn lure ti t.ou ehT otorcd duwlo nawt a tets htiw ihgh nevsisyttii ot be aebl to od hat.t eH snowk taht tsinteg reh sootl rof oodbl wlil nto leur out the tpisbsyilio fo onlco C.A

sympathetikey  SeN Out (Snout) --> sensitive test; - test rules out SPec In (Specin) --> specific test; + test rules in +25
usmlecrasher  can anyone pls explain why it is not << potential false- positive results >> ??? +
almondbreeze  correct me if I'm wrong, but 'high FP (choice C)=low specificity (choice B)'. Whereas high specificity is required to rule in dz +2
almondbreeze  picked positive predictive value myself. can anyone explain why not PPV? +
williamfreakingosler  The principle @hayayah is talking about (a negative test being relied upon to reliably rule out) is negative predictive value ("NPV"). I don't see why "uncertain NPV" isn't the correct answer, particularly because NPV is predicated on the disease having the same base rate in the person(s) being tested as in the population that was characterized for the test statistic. Given that the patient has a strong family history of colon cancer, the NPV of FOBT is uncertain. Said another way, the sensitivity of a test does not change with the population, but the NPV does. The whole reason the doctor is denying FOBT is because of bayesian thinking (a priori information related to family history), and from my point of view bayesian logic is more relevant to PPV/NPV than to sensitivity, hence my confusion over why NPV isn't the right answer. +2
ibestalkinyo  I thought negative predictive value for the same reasoning +
raga7  AFTER THE RESULT OF TEST WE CAN USED PPV OR PPN, BUT FOR TEH FIRST TIME LOOKING ANY DESEASE USE SENSITIVITY OR SPECIFICITY. +1
... hayayah made a comment on nbme20/block3/q#34 (A 22-year-old woman comes to the emergency...)
 +18 
submitted by hayayah(1116)
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iistamortniAdn fo eiPlilicnn ofr ilhisySp may edla to teh eJrha-rrmixeecihHs eriontac oruhs frate ratn.mteet urcOsc deu to lisys of tprshoiecse os( ti can rucco whti oarlrieB and psstoLrpsieoi as )elw.l eTh tnarecio si ehtcadzcerria by freve adn ll.ishc

eTh icslslcaa eipaxaonltn fo eth Hxereeimrh eocatirn is ttah mnraettte sutlers in eht udsnde tdeah nda idcsurntote fo large sruenmb of erpsenoe,mt htiw hte btirnilaoe fo nioertp cpuosrdt dan tosxni.

almondbreeze  FA pg.148 +7
... hayayah made a comment on nbme20/block1/q#20 (An 8-year-old boy is evaluated for ventricular...)
 +17 
submitted by hayayah(1116)
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ottriCnocaa fo eth otaar dseal ot eeidcrsna LV edaolrvo csganui LV tyhrphyrope dan a L axsi oiat.nivde

hungrybox  Similarly, RV overload leads to R axis deviation. Could point to PAH. +2
... onyx made a comment on nbme20/block1/q#31 (66 yo man, cavitary lesion in right lower lobe of lung)
 +17 
submitted by onyx(44)
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A rlhrypaadgaiolci viislbe ufdr-alii leelv etsssggu a reptty ealgr oeilns ceen(h, aatirβ€β€œ)v.yc hsTta' ton gonig ot bmeeco lmaonr isstue .aigna xSi months iwnfogoll sienolrotu of ysmmptso uoy anc ecxept nlhgaei ni the mrof of a s;acr atht s,i iforsisb tub lnyo in a engsli pos.t

masonkingcobra  Robbin's: The basic mechanisms of fibrosis are the same as those of scar formation during tissue repair. However, tissue repair typically occurs after a short-lived injurious stimulus and follows an orderly sequence of steps, whereas fibrosis is induced by persistent injurious stimuli such as infections, immunologic reactions, and other types of tissue injury. The fibrosis seen in chronic diseases such as pulmonary fibrosis is often responsible for organ dysfunction and even organ failure. +5
stevenorange  What Differentiates Normal Lung Repair and Fibrosis? Basement membrane ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +3
step1234  I'm a little confused here since FA20 209 states Klebsiella causes liquefactive necrosis in the lungs. Does the pulmonary fibrosis occur after the necrosis? +1
fatboyslim  @step1234 Yes pulmonary fibrosis occurs after liquefactive necrosis as a means of repair. Think of it as liquefactive necrosis = damage done in response to Klebsiella -> 6 months later you will see focal fibrosis in that area (scar formation) where the damage happened. +4
makingstrides  If there was an intact basement membrane, you would get normal pulmonary parenchyma. +1
skonys  Not granulomatous inflamm because thats indicative of TB. Not liquefactive nec (trick answer) because Klebsiella causes that actively and q stem says 6Mo post-resolution w/ abx. Not metaplastic pulmonary epithelium because metaplasia implies cellular adaptation to a stimuli (bronchial squamous metaplasia from cigarette smoke), not destruction entirely by liq-nec. IE: for cells to undergo metaplasia they need to be insulted but not destroyed entirely. Not normal pulmonary parenchyma because basement membrane/cytoskeleton architecture is inherently destroyed by cavitary lesion. +1
... sympathetikey made a comment on nbme20/block1/q#35 (A 70-year-old man dies of coronary artery disease....)
 +17 
submitted by sympathetikey(1446)
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sA sadett wbeol, teh feLt urcs ebrceri asw adamged see( wtha it dulsoh lmnrlaoy kool lkei )ol.ewb sTih sitocnna the apclitiscnoor tcrta. ecSni eth anotorcslpici atrtc estcduesa ta eth lmleda,u ewblo eht mdnbarii tencosi 'rwee gnokiol a,t uyo wldou ees rlCoaaelantrt Rhgti() Sptisac ssaeiHemrpi

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +12
hello  @kernicterusthefrog Thank you. +
mbourne  NGL, I thought the right side had the pathology lmao ty +22
... weenathon made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +17 
submitted by weenathon(49)

Diabetics get peripheral neuropathy from glucose damaging Schwann cells. For what I believe is an unconfirmed reason, T2DM patients tend to see parasympathetic autonomic neuropathy before sympathetic.

The hypogastric nerve carries sympathetic innervation to the posterior urethra and is responsible for ejaculation.

Inferior rectal nerve is a branch of the pudendal nerve that innervates the external anal sphincter and provides sensation below the pectinate line. A peripheral nerve problem with this nerve would cause the sphincter to remain relaxed and cause incontinence, not constipation.

Pelvic splanchnic nerves are parasympathetics (craniosacral outflow). If he is constipated, his rest and digest (parasympathetic) system is not working.

Perineal nerve is a branch of the pudendal nerve. It has both motor and sensory, is involved in the external anal sphincter, urethral sphincter, and is responsible for conscious sensation of the need to urinate.

Sacral sympathetic inhibits peristalsis, and contracts internal anal sphincter to maintain continence.

spaceboy98  Amazing man, thank you for this +
... karljeon made a comment on nbme20/block3/q#2 (A 23-year-old woman is brought to the emergency...)
 +17 
submitted by karljeon(124)
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ihTs one wsa a wtmasheo esmlip suqineto ceisn rmhthceeyoap &--t;g utmor lysis &g;-t- dnee etnaxinh aedisxo toribniih eg,( ex)ts.tobuaf

TBU WYH IS MNBE GMRMRAA SO ?APRC TUP YRUO MOSACM NI HTE IHTRG C!ALEP

... drdoom made a comment on nbme20/block1/q#11 (The sequence surrounding the first two exons of the...)
 +16 
submitted by drdoom(969)
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As criddeesb ni teh unqsoiet e,stm isth atniotum uccsor iniwth an inrtno a( enge gmesnet chwih si cdstrearnbi NAg&AR-t][D;N tbu not el)d.tratsna ANR siigcnpl (yee)mzsn bgra NAR dan pβ€œloo it;” na oitrnn si cut tou and eth esnxo on reethi ised of eth rntoin aer eoi,ajdnd lkei i:sht

β€”x2oeoxβ€”einnonn1rt &=tg; nnx2oxeβ€”eo1

,Tpillcyya tsih lspngiic uoscrc at het veyr seedg fo the onntri (ahwt I etonedd whit teh β€œβ€β€” ct.arecar)h Btu ni ruo ea,cs a amnottui wiithn teh tninor si cuainsg RAN snilpcgi zeemny ot ziencegro a enw ie:st eht lepsirc sctu nhtiwi het nntoir esdta(ni of ta teh vrye d,ege as it lsu)od.h oS, ew gte tmihngeso htta kolos keli sih:t

nnrnβ€”o2ietxeo1xβ€”

aTths’ a oyatllt ndritfeef mNAR lmceoule, dna tis' gingo ot aekm our obln-igΞ² oentrpi loko dn(a bev)ahe lfwluya nagte.sr

drdanielr  I remember that in the pre-mRNA, the splicing sites of the intron where the spliceosome attaches are surrounded by "GU---AG" like "guac", so here the homologous DNA to this strand would be transcribed into "gu............ag......" and this would create a 3' slice site too soon +6
vivarin  if this is supposed to be pre-mRNA, why are there T's in the sequence? I'm so confused by this for some reason +8
sars  This is the gene (DNA), not heterogenous mRNA. +
athenathefirst  The biggest clue they said this is B thalassemia, which even if you didn't know anything about exons and introns you should have known that b thalassemia involves a mutation in splicing or promoter site (pathoma page 44). I got this question wrong too :( +
... whossayin made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +16 
submitted by whossayin(29)
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hTe emocinnm I kile rof mermibnrege teh actosilon of hte lacinar svnere is het ",24,2,4 rue"l

vAeob etiarbs=nm NC I + Iri =adIMinb NC III, =VsI Pno NC ,V IV, IVI, IVleu aI=dlMI CN XI, ,X IX, IXI

lovebug  @whossayin thanx so much!!! +
... thecatguy made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +16 
submitted by thecatguy(19)
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shTi si a reyv pctkiyni tqno.iseu As I see ,it eht 3 nami cetoncps detste re:a

  • ishT eitatnp sah agemrntiil lagrianue pr(ahs, e,ifbr isoecidp pnia ni eth caf,e) cihhw is udcase by a eoinsl ot rypimar oeyrsns efrbis hatt cryra iapn eaisnosnt rofm the .cafe
  • putliMel ,relossisc hichw teh petiatn h,as is a laiinneymgtde seisaed .e(.,i ti easftcf eitwh .mat)rte
  • hTe mentleadiy saonx ynargcri iapn iotassnen fmor teh tpisaliaelr efac reent hte aibsmetnr ta het lveel fo the onps dan ehtn sddenec bmec(eo eth napsli cttar of eht l)mragti.eni eThse htewi rtetam srifbe apss otghhru eht spon to yenpssa no eht linsap nculeus fo the mlengri,tai cwihh si in eth lemluda ucsenlu( = ryag et.amrt) (etrcpiu erhe). oerfeerTh, a seinlo ni eht wthei rtamet .,e.i( pql)uae ni eth spon udocl uscae ngrtilmaei ieragalu,n nda sith omeenohnpn has nebe esrvebdo.

oveAb het eevll fo hte rambitesn lhausmt(a mp&a; erceblar )xo,ecrt ouy ahve dcosne rdore ysnseor unrnso.e Lieosns ni shit part fo eht riiucct aer not enlelrayg ni anireimtgl eigul.rnaa I ousspep thye lsoa ntwa su ot sumeas atth cnoe eth inslpa tctra fo the irlanegimt enestr eht a,muledl tsi' ont yleetimand .ormyaen I dtno' nkiht hist is lmptocyeel uret, utb nevig eht olcig eidcbesrd vob,ae osnp dluwo tlisl eb eth teretb nw.saer

sA ppeloe ahve nedtipo tu,o the rrmpyia rnsyseo beirsf yrirncag ithlg cutho stnsoeina orfm teh cefa ysasnep no teh fiech erossyn cuesunl ni teh sopn eeatliydmmi ertfa thye eenrt the sonp. Tihs eotuisnq is otn gakins boatu heots sbfire ohtuhg.

I got eth nsoiquet ngwor oot..

mightymito  Wow this is the best explanation yet! Thanks so much for very clearly walking us through a tricky question. +5
lovebug  @thecatguy Are.... you a professor? thank you very much :) +1
... neovanilla made a comment on nbme20/block2/q#23 (Which of the following changes in the cardiovascular...)
 +16 
submitted by neovanilla(48)
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eTh awy I adpreachpo teh suqiteon wsa to irnoedcs hawt senaphp .1 eWhn uoy wgro omrf a baby ot a lch,id dan .2 hwne uyo grwo mrfo a ageteern ot an odrle atu.dl taehverW ardnmiee rute eteebnw tohb of them asw teh irthg eswr.na

thigR s:wanre ehT eisrntg BP fo a enornwb si 5046/ eg,g)l(oo wheli that of a mh1-otn odl si 9/05.6 heT evgarae tulad si gehhr,i hwti the meAanrci aHrte snacitoosiA icgint yrulb(,sad OM)I ttha a"rmnol" si /1lt02;l8.t;&0& t,verheleNsse teh tnred si htta BP ssanceeri as ew ,aeg eethrwh we ear bnwenors or lod .eeplop

Wrogn n:wassre plDmneetve o of arronocy es:lrreohsicaots Psarpeh deu to the aArncmie iedt it acn eb reagdu that teh lmedetovenp of sceslrioahresto is mltosa inbitelaev as yuo eebcmo an eodlr ut.lda Creyitlna ont teru sa a baby t-&g-; i.hldc

eoeplmnvDet fo rlamti eis:notss iriSaml aogresnni sa cyronaro srscartooehi;els you AMY eovpled ti as an alutd n(to rlayne sa mnocmo as a lpiudub fo coaerhctoitresl ,qp)seula but ,reus s'lte ays taht ti nca a.ephpn tNo treu as a byba --g;t& cdilh.

ndeaseIrc aabsl ahtre ea:rt Teh soitpoep is tyclaaul ure.t heT basal aehrt atre of a oenbwnr cna syeali eecxed 015, adn st'tha roesecddni .lomarn As ew gea, iths heart aret goes nwdo.

drnaseIec aicardc cseulm as:ms hTis eon aws the atdesrh to rokw .hogrtuh It si teur ttha as we gae ofmr a byab &t--;g dhlic uro ahetr rwosg in szie. uBt if ew kwtea uro aopnumtssi orfm efbore tihw het inareAcm ,tdei dna tdienas upt rou ntaietp on a orme eoadermt dti,e slaelyitrical his hrate htsudn'ol ieasercn in ezsi too uc,mh at setal ot hte ptoin of aomlyreicgd.a

erdcsaIne cmialcnepo fo atrs:ieer sA we meboce ordle ltud,sa eth pinccmeola of areerist sdreeseca dna sefsftnsi ricseeans (ulrecfa nto to sfoencu etsriera hwti g,snul cwhih yctualal do arecnsie ni cpaniomlce as we !ae)g

rockodude  basically the American diet is... SAD;) +1
... sympathetikey made a comment on nbme20/block2/q#25 (A 14-year-old girl is brought to the physician...)
 +16 
submitted by sympathetikey(1446)
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Mtntoauis in TM1TL- nlth(iicoalodyMr eodcned ANRt nleeicu )1

A nommco ittanmou si G2A4.33 naC eurstl ni mlpetuil limortcdinaho snfeedieiicc dan aiestdoacs edossir.rd It si aoctessadi ihwt:

  • roadMotinchli eehncoaayompytlhp
  • Lcacti iscsdiao
  • oSrike-etlk issopede LS)AME(

ELAMS is a earr rnaoidlmohict rddoiers okwnn ot fcetfa amny atpsr of hte yd,bo eiaelspycl hte vrnoues smseyt nda eht rina.b oyStpmms of EMSLA idenclu:

  • tcuRnrere eeesvr hesehdaac
  • sulMce easnwske (yya)pmhto
  • egaHinr olss
  • kietSe-rkol deoissep iwth a ossl fo eosc,osncssinu ee,zisusr and throe morsblpe anfgctfei hte vnsouer ysset.m

oc:Srue iotd/ni.:-k/wkewiTsiTrLi/gtph.epa1M/

j44n  i just saw that every tissue that was affected had a high 02/aTP requirement and mixed with the lactic acid that meant she wasnt using her electron transport chain so i picked the only answer that had mitochondria in it +5
topgunber  The disease is MELAS. Mitochondrial encoded tRNA leucine 1 is the mutation. Apparently associated with high tone deafness. It is apparent its mitochondrial with maternal transmission, though unfortunately the etiology is utter memorization / process of elimination. Maybe next time the stragy will focus more on mitochondiral diseases and see that this choice is the only mitochondiral answer choice. Mitochondrial Encephalomyopathy Lactic Acidosis Stroke like symptoms."MELAS is a rare mitochondrial disorder known to affect many parts of the body, especially the nervous system and the brain. Symptoms of MELAS include recurrent severe headaches, muscle weakness (myopathy), hearing loss, stroke-like episodes with a loss of consciousness, seizures, and other problems affecting the nervous system.[5]" Source :Wiki +
... jotajota94 made a comment on nbme20/block3/q#1 (The frequency of an autosomal recessive disease in a...)
 +16 
submitted by jotajota94(16)
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sUe hte i-eHdynWbrareg anuetqio

  1. kaeT the raequs troo fo 1/0,061 nda atth lliw egvi you teh yfqurecen of hte eeevrcsis elllea = /40.1
  2. ullaCacet hte uyqefcern fo the antimnod laelel tihw qp+=1, chiwh si =p 05.9.7
  3. ehyT are etgilln ouy ot claeltauc eht frneequyc fo het isaedes ,sriearcr chhiw is htiw het uqneoait 2p.q
  4. yeTh natw nloy eth asesdie rrsaierc in wichh nteldieo si re.ptsen oT uccllaeta tis,h eus teh q eavlu )/140( dna upilmytl by %08 in htsi ushldo give yuo 20..0
  5. li,lyFna ctacelaul rof 2Pq2 9)57(=20()0..0 .004 = /15.2
yex  Nice! ...and we are supposed to read the stem and do all this in a minute or so? :-/ +25
charcot_bouchard  Allele frequency 1/40. so carrier freq 1/20. 80% of 1/20 is 1/25 (80/100 x 1/20) +14
dickass  Ah feck, 2pq got me +1
hello_planet  A handy shortcut for Hardy-Weinberg is that you generally can assume p ~= 1 if q if fairly low. It also tends to be easier to work in fractions if the answer choices are in fractions so you don't have to bounce back and forth between fractions and decimals. So with that, you send up with 2pq = 2 * 1 * 1/50 = 2/50 = 1/25. +8
topgunber  hate this whole scramble thing: In one line: 2 * q * 80%. This is for diseased individuals (two q alleles).I = 1/1600 = q^2 The frequency of q = 1/40 Now carriers is 2 p q. P is close to one assuming HW eqm (p+q=1). There's an additional step in this question due to the two different mutations. so 2(q) = 1/20. 80% of these carriers are deletions so multiply 1/20 * 0.8 = 1/25 +
... hayayah made a comment on nbme20/block4/q#17 (A previously healthy 55-year-old man has recently...)
 +16 
submitted by hayayah(1116)
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lsoA, oyu ndhluo'ts eb neiesg gedranno- dmaaeg ro dceiersan inenr / keindy enpossre thiw a soirvypuel elyathh ttnipea ttah sujt doeelvpde enlstisea TH.N hTe bdoy dnstoe' watn to aceinesr nerni wnhe it ash .THN eHre,vwo fi ouy eahv ni,soests eth disynek rfake otu euasbce t'eehyr ont tgteing eunohg lfow nad itknh the hleow doyb 'tins irehe,t os ehty tcieaatv teh AARS .yssetm Wneh uyo igve hmet na IE-AC, hte eninr is ltisl ienbg cuepdrod yb teh k,iynde it jtsu ist'n gbien otvrdeenc ot -oIaginnnsi.Iet

To mniiatlee ohetr oc:chsie

  • He sah reaisnecd nrnei vyiatitc so uyo nac tmeniaeil rmyipra nrssltooaiem.d athT sha .cin oel,nartsdoe d.ce en.nir
  • No ngsis or xss of gh'suisnC os stah't ea.mnltiedi
  • exloa1yrs-yBd1h- ineycedicf uoldw ssx hwit hte ileatgan.i Yud'o evha cd.e rnine ivciatyt tdeoe-aoenl(klsir fetescf llist .trseenp)
  • sleEntsai THN: paxileedn abvoe
sammyj98  I like you sticking up for the kidneys, thinking they're increasing Renin for the benefit of the whole body, but lets face it, the kidneys are a couple selfish dicks who want the high blood pressure all for themselves. LeftVentricularSolidarity +7
trazobone  ^ I love reviewing NBMEs for comments like this πŸ˜‚ +
... hayayah made a comment on nbme20/block1/q#4 (A 50-year-old man is brought to the emergency...)
 +15 
submitted by hayayah(1116)
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atlneMoh si cxtoi by owt nsshacemim:

tFri,s htenlmoa acn eb latfa deu ot tis CSN ersedtspan troppisree in the eams nnearm as aneohtl s.npgoiino

c,dSneo in a ocesrsp fo toxiatcno,i ti si ebaetodzmil ot mcofir aicd iav yefeadrlhodm in a sorpces iitnietda yb het mezyen ohclaol sdehygeonerda in teh .evrli oMnatelh si ndrvceeto ot lfedyrhedmoa vai oolclah oyeadgnrdehes AH)(D nda edomelyhrdaf si droetcven to icormf ciad aortefm() avi ddaeyhle yedsgaroeednh DA(LH).

mtraoeF si tixco bceeasu it iibtnsih hrltiinoacdom ecrhocmoyt c ,iexaosd nscgaiu hpxaoyi at het calulerl lleev, adn aolitbemc so,iscdia gnoma a rtayvie fo hreot blaeoitmc erauindcbs.ts

sugaplum  Good pictograph comparing methanol, alcohol, and ethylene glycol. https://wikem.org/wiki/File:Toxic_alcohol_ingestion.JPG +10
... hayayah made a comment on nbme20/block1/q#38 (A 9-year-old girl is brought to the physician...)
 +15 
submitted by hayayah(1116)
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ePtinta ahs a iaachoynpraomrgin. sMot mocmon dicdhhloo nlotriapesuart .mrout rieevdD ofrm mnaernst fo aheRkt ouphc ar(ol )cedo.tmer Cocicifailnta is nmc.oom Chllorseoet ylscsart oundf in roβ€œtom k-liel”io udfil twhiin urt.mo

A cisyct alrusseaprl sams hwit sanclciitcaofi adn eancthemnen fo teh awll ro lsdio oonpistr ni a hidlc ro ctansdeleo is slmoat layasw a rohcpyroiigna.aamn

yMa eb eucfdnos wtih ytritauip maondea (tbho csaue rtemliobap hpiimn).aaeo

dickass  Cholesterol crystals in motor oil +
ally123  "Due to the proximity of the tumor to the hormone-producing cells of the hypothalamus and the pituitary gland, there is significant endocrine dysfunction in most children and adolescents presenting with craniopharyngioma...Among the hormone deficiencies, growth hormone deficiency is the most common and is seen in approximately 75% of children with craniopharyngioma." Source: http://campus.neurochirurgie.fr/Programme_Enseignement/_art1030/endocrinManifest.pdf +
... hayayah made a comment on nbme20/block2/q#17 (A 57-year old man has a hemoglobin concentration of...)
 +15 
submitted by hayayah(1116)
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shTi si aeictvre yolcaeypmtih rave, wihhc is ued ot gihh tieltdua ro gunl .ssideea aO2S is l,wo adn EOP is .arncdeies

ortAhne ayw ot achrpapo teh tonqeuis si klgooni at hte dolbo .erasm tsI' etrtyp roalnm o(n aygyserceoamtk, on icneedrsa mebunr fo altepe,tsl on r,osd hntgino elu,b .tce) A odobl rmaes romf a PCDO ettanpi lwil be amro.ln Jsut an eiesrdnca nmeubr fo sBRC due ot the edsiencar POE lidngae ot ecadresni Hgb.

mbourne  You shouldn't call it reactive polycythemia "vera", as polycythemia vera is a seperate disease with entirely different etiology. This is Reactive Polycythemia, or as another poster said, appropriate absolute polycythemia secondary to chronic hypoxia. +19
j44n  i jumped on myelodysplastic thinking it was PV due to the jak w mutation but you technically get elevated everything in that mutation so it would be more than just RBC's +
beetbox  I also thought it was PV. How can we tell reactive polycythemia from actual PV, if PV does not show other kinds of blood cell counts raised but just an isolate of RBC rise? +
... beeip made a comment on nbme20/block2/q#35 (A 36-year-old woman comes to the office because of a...)
 +15 
submitted by beeip(130)
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viLer lksoo ptrtye daelniomr-sz ot me. cPi ereh orf oiasmopcrn

... usmle11a made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +15 
submitted by usmle11a(83)
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:Apovu2wstwYmuw/?cqw.he.ck=EptAt/a/hy0tb-6o

ygsu ihst evoid aelpsxni otal

... hayayah made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
 +15 
submitted by hayayah(1116)
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nI orerd fro a rgud to be lrcaeed by het einkdy, ti tusm frsti eb dfeielrt in het gml.ueirlo rusDg wtih a ghhi DV heav mreo fo eht dgru ni eth ieusst that ear not aelviabal ot eidrtfle yb eth .ikydne gsDur wthi hhgi otprnie nignbid wo'nt eb fledtrie etre.ih oS ouy watn a rgud hitw olw Vd adn wlo bningdi fi uoy atwn ti lreacde aiv teh neykisd nda ner.ui

zevvyt  But a low VD corresponds to high Plasma Binding Concentration(FA 233, 2019). That's my main confusion with this question. +2
kevin  If it's high plasma binding, then it's low Vd. But, low VD doesn't necessarily require high plasma binding. Low Vd can simply be due to it being a large polar molecule +1
topgunber  So you the confusion is that VD of 1 means it stays in the circulation/ intravascular compartment. This would make you think that it would bind highly to protein in because of the low VD. But im assuming if it bound proteins it would not be cleared by the kidneys, so if this had a low VD (can be cleared at glomerulus) and if it bound plasma proteins weakly (allows the kidney to filter the substance) then it can be filtered into the tubular lumen. Now the pka. Bases when protonated (ph under their pka) become charged, while acids at ph under their pka get protonated are UNCHARGED, meaning in acidic urine acids become more lipophillic and can diffuse out of the tubular lumen. If we made the urine more basic, then we want to deprotonate the acid (ph higher than pka) so it will remain stuck in the tubular lumen as an ion. +
... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +14 
submitted by strugglebus(173)
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As an :i00d 110,t8e epploe dteroper to evha eisd sfteecf hewn tiakgn ychirt.ogoarendzmAHldiooh ,mteh 25 eolepp 00%.)2( veha asetBr ehgrisdca

neonem  I think the best way to answer this question was by process of elimination. +1
sympathetikey  That's some bullshit lol +9
karljeon  Haha I eliminated the answer by process of elimination. +22
medschul  I eliminated thiazides by process of elimination :( +2
medstudent65  Shit I eliminated thiazides because of elimination went with HTN thinking intercranial bleed effecting the pituitary +2
... hayayah made a comment on nbme20/block1/q#46 (A 55-year-old woman comes to the physician for a...)
 +14 
submitted by hayayah(1116)
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ticN,eo eth smte ssya rposocersr" ni the sink"

3D elarl)(cofoccelih orfm oxeerups of sikn mtsta(ur le)baas to nus, ntsinoeig fo ihs,f ikm,l lp.nsta

D2 coaloergerif()cl fomr siongenti of n,ptasl g,fniu set.sya

tohB deevrncto ot 5HO-2 D3 oes(agrt omr)f ni lrevi adn to eht iactve rfmo )1,O52H(2- 3D liiarcl(oct) ni yekd.in

sympathetikey  C is the 3rd letter in the alphabet. Hence, D3 = Cholecalciferol +6
karljeon  Thanks for the explanation. The question stem made it sound like "what future step will be decreased?" Actual question: "Decreased production of which... is most LIKELY TO OCCUR in this patient?" Maybe NBME needs a grammar Nazi working for them. +9
bharatpillai  question says "decreased production of which of the following precursors in skin is most likely to occur in this patient? the answer has to be 7-dehydrocholecalciferol! +7
bharatpillai  7 dehydrocholesterol +3
brbwhat  Yeah i did the same, but then realised acc to uw flowchart 7dehydrochole.. is converted to cholecalciferol in presence of uv rays. So the decreased precursor would be cholecalciferol since we already have 7 dehydrocholecalciferol not being converted by uvrays Tho the uw chart sites both ergo and chole as dietary sources. +5
drzed  Wouldn't 7-dehydrocholesterol build up in the skin? Since UV rays convert 7-dehydrocholesterol into cholecalciferol, if you are lacking the conversion, the reactant (7-dehydrocholesterol) should accumulate. +1
brbwhat  They’re asking decreased production of which of the following precursor would occur? 7 dehydrocholestrol builds up, but decreased production of cholecalciferol takes place, which is a precursor in the pathway for vitamin d formation +6
... johnthurtjr made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +14 
submitted by johnthurtjr(153)
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F910A2 p 753 on notlsaGitniretsa boldo lypspu dan hyeptscaaairtpm vnreoitnian:

  • Fgeutor -;-tg& ilcaec yrerat, uvgsa oivanrtnnie
  • ugidtM -&t;-g ,MAS ugsva
  • iugdntH t;g--& ,IMA epvcli tvannoreiin
neovanilla  Don't force it out, you gotta relax and it'll come out naturally ;) +
mysteriousmantyping  Why couldn't the answer be Inferior rectal nerve since that controls the external anal sphincter? +1
draykid  @mysteriousmantyping I think this question is looking at complications of T2DM, more specifically diabetic autonomic neuropathy. Patient more than likely has diabetic gastroparesis which may explain his constipation and abdominal distension. +1
cuthbertallg0od  Pudendal nerve controls external anal sphincter (per FA), and gastroparesis wouldn't have anything to do w pelvic splanchnics but instead vagus nerve... Don't know why pudendal nerve couldn't be right if he was just clogged up from not being able to relax his sphincter anymore ---- is parasympathetic just more likely to be the issue statistically or something? +1
cuthbertallg0od  Or would losing pudendal nerve result in incontinence... Its never been clear to me if activation/inactivation opens/closes sphincters... +1
cuthbertallg0od  Just realized that says perineal... whoops +2
vivijujubebe  External sphincter is innervated by pudendal nerve, more often damaged during labor. DM patients have autonomic neuropathy with parasympathetic/sympathetic nerves more likely damaged +
... strugglebus made a comment on nbme20/block2/q#46 (A physician prescribes a newly marketed drug to 45...)
 +14 
submitted by strugglebus(173)
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I ohcse htsi yeolsl euaecbs it aws os mdna cecfiisp

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program +5
karljeon  I didn't choose it because it was so damn specific. :( +44
lovebug  Could anyone explain for B) for me? because I choose B).:( +2
j44n  B.) is wrong because its never been shown to show adverse effects "any offcial data linking the drug" and the fact that it's "newly marketed" +
j44n  and because its in 5/45 patients roughly 10% of the population, that might not seem like much but most of the diseases we freak out over are in 1-2% of the population, to put that into perspective if we gave this drug to every person in the US (every big pharma wet dream) with a population of 300 million... 30 million people would have this adverse event... hope that helps +
... neonem made a comment on nbme20/block3/q#5 (A 35-year-old man comes to the physician because of...)
 +14 
submitted by neonem(580)
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ehrtMoatxete dlwou eb a grdu fo ociceh fro ssaispiro crrfyretoa ot paoclit rsamce nda tlhig eat;yphr ihtsiinb yrifdoelohatd acdseeurt in errod to decearse inks lelc irnapefroiolt adn creude oirtlnyaammf spe.osern

69_nbme_420  Cyclosporine can also be used to treat Psoriasis (NOT cyclophosphamide - ans B) +9
len49  Drugs that can be used for psoriasis include cyclosporine, MTX, TNF-alpha inhibitors including Etanercept, lnfliximab, adalimumab, certolizumab, golimumab according to FA +2
medstudent  Kinda summed up in the index - p 791 2nd row halfway down +2
lovebug  as We all know, 1st line therapy of psoriasis is topical corticosteroid, Vit.D analog (Vit.D inhibits keratinocyte proliferation and stimulates keratinocyte differentiation. +
shakakaka  What page if Fa says that these drugs can be used in psoriasis?) +
srmtn  FA 2019 p 476 +
... nala_ula made a comment on nbme20/block3/q#11 (A 3-year-old boy is brought to the physician because...)
 +14 
submitted by nala_ula(122)
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hTe ithlysogo si of eheptoryscs slam(l cshirlepa eclls ow/ naelcrt .olrp)al iHaeetrrdy pycrtooshsies si deu ot edcfte ni oiesntrp gtiracnietn itwh BRC meebrnma esltenok nad alspma bmenemra a(,nnryik bnad 3, torpeni 24., r.intsce)p ystolM oomaatslu mnitdnao ncniarhtiee so( ztosgeyhoeru omatnitu secin uoy oyln dnee oen tumtna elleal ot get eht esdi.)esa

wuagbe  To add to this: homozygous HS presents with hemolysis even in absence of stressors. this patient is only presenting with pale skin, and there are no schistocytes on the peripheral smear, so it's a heterozygous ankyrin mutation. +9
pg32  I wanted to pick hereditary spherocytosis but the mean corpuscular concentration was normal and I thought it was supposed to be elevated? Also, why are there so many RBCs that are way bigger than the spherocytes? +6
nephroguy  I'm assuming that the MCC is normal because the patient is heterozygous for HS. Not sure if this is correct, but that was my thought process +1
draykid  Are there any papers that explain the difference in expression of homozygous vs heterozygous HS? +21
waterloo  I don't know if that matters as much, like the phenotype difference of homozygous or heterozygous for this question. Since you only need one allele to show this, play odds. Is he more likely to have AA or Aa. That was my thought process. Also if you see spherocytes you'd be going for ankyrin right, not B-globin bc that should be target cells - regardless of MCHC. +1
alimd  as I remember AD are always heterzygous. Because homozygous are always lethal. +5