Kim! Hi! Itโ€™s your dad!๐Ÿ‘‹ ▪ Khalilah, Iโ€™m proud of you for taking a risk for your dream.Everyoneโ€™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! ๐Ÿ˜Š
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NBME 21 Answers


Question#2 (reveal difficulty score)
A 6-month-old girl is brought to the ...
GM2๐Ÿ”,๐Ÿ“บ

Question#3 (reveal difficulty score)
An investigator is studying the efficacy of ...
Flagellin๐Ÿ”,๐Ÿ“บ

Question#4 (reveal difficulty score)
A 67-year-old man comes to the emergency ...
Translation๐Ÿ”,๐Ÿ“บ


Question#6 (reveal difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes ๐Ÿ”,๐Ÿ“บ




Question#11 (reveal difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
Schistocytes๐Ÿ”,๐Ÿ“บ

Question#12 (reveal difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia๐Ÿ”,๐Ÿ“บ

Question#13 (reveal difficulty score)
A 25-year-old man develops shortness of ...
Decreased alveolar Po2๐Ÿ”,๐Ÿ“บ

Question#14 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae๐Ÿ”,๐Ÿ“บ


Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician for ...
Aortic๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine๐Ÿ”,๐Ÿ“บ

Question#18 (reveal difficulty score)
A 61-year-old woman is brought to the ...
Donepezil๐Ÿ”,๐Ÿ“บ




Question#22 (reveal difficulty score)
A 36-year-old man with AIDS elects to ...
Chemokine๐Ÿ”,๐Ÿ“บ

Question#23 (reveal difficulty score)
A 59-year-old man comes to the physician ...
Foci of keratinization๐Ÿ”,๐Ÿ“บ

Question#24 (reveal difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change๐Ÿ”,๐Ÿ“บ

Question#25 (reveal difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm๐Ÿ”,๐Ÿ“บ

Question#26 (reveal difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis๐Ÿ”,๐Ÿ“บ

Question#27 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption๐Ÿ”,๐Ÿ“บ

Question#28 (reveal difficulty score)
A 47-year-old man is brought to the emergency ...
Mixed venous oxygen tension๐Ÿ”,๐Ÿ“บ

Question#29 (reveal difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache๐Ÿ”,๐Ÿ“บ

Question#30 (reveal difficulty score)
A newborn has female external genitalia and a ...
Dihydrotestosterone๐Ÿ”,๐Ÿ“บ

Question#31 (reveal difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid๐Ÿ”,๐Ÿ“บ

Question#32 (reveal difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis๐Ÿ”,๐Ÿ“บ


Question#34 (reveal difficulty score)
A 30-year-old man develops urinary ...
Pelvic nerves๐Ÿ”,๐Ÿ“บ

Question#35 (reveal difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead๐Ÿ”,๐Ÿ“บ


Question#37 (reveal difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentration๐Ÿ”,๐Ÿ“บ

Question#38 (reveal difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B๐Ÿ”,๐Ÿ“บ

Question#39 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes๐Ÿ”,๐Ÿ“บ

Question#40 (reveal difficulty score)
A physician prescribes a recently marketed ...
Phase 4๐Ÿ”,๐Ÿ“บ


Question#42 (reveal difficulty score)
A 36-year-old woman undergoes a total ...
Hyperplasia๐Ÿ”,๐Ÿ“บ

Question#43 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
Histamine๐Ÿ”,๐Ÿ“บ


Question#45 (reveal difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase๐Ÿ”,๐Ÿ“บ


genetics pedigree
Question#48 (reveal difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP๐Ÿ”,๐Ÿ“บ

Question#49 (reveal difficulty score)
An 80-year-old woman comes to the emergency ...
Hydrochlorothiazide๐Ÿ”,๐Ÿ“บ


Question#1 (reveal difficulty score)
A 27-year-old man comes to the physician for ...
Schizoid๐Ÿ”,๐Ÿ“บ


Question#3 (reveal difficulty score)
A 17-year-old boy returns to the locker room ...
Apocrine๐Ÿ”,๐Ÿ“บ



Question#6 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
A 55-year-old man is diagnosed with renal ...
Cortex๐Ÿ”,๐Ÿ“บ


Question#10 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Rosacea๐Ÿ”,๐Ÿ“บ

Question#11 (reveal difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac๐Ÿ”,๐Ÿ“บ

Question#12 (reveal difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis๐Ÿ”,๐Ÿ“บ

Question#13 (reveal difficulty score)
A 53-year-old woman with gastroesophageal ...
Omeprazole๐Ÿ”,๐Ÿ“บ


Question#15 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal๐Ÿ”,๐Ÿ“บ

Question#16 (reveal difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair๐Ÿ”,๐Ÿ“บ



Question#20 (reveal difficulty score)
A 14-year-old girl is brought to the ...
Trichotillomania๐Ÿ”,๐Ÿ“บ




Question#24 (reveal difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma๐Ÿ”,๐Ÿ“บ


Question#26 (reveal difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex๐Ÿ”,๐Ÿ“บ


Question#28 (reveal difficulty score)
A 64-year-old woman with type 2 diabetes ...
Gemfibrozil๐Ÿ”,๐Ÿ“บ

Question#29 (reveal difficulty score)
A healthy 25-year-old man is participating in ...
Alanine๐Ÿ”,๐Ÿ“บ


Question#31 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...
Intercostal๐Ÿ”,๐Ÿ“บ

Question#32 (reveal difficulty score)
A 17-year-old boy has the acute onset of ...
Lymphocytes๐Ÿ”,๐Ÿ“บ



Question#35 (reveal difficulty score)
A 4-month-old female infant is brought to the ...
Hyponatremia๐Ÿ”,๐Ÿ“บ

Question#36 (reveal difficulty score)
An investigator is conducting a study of ...
Enfuvirtide๐Ÿ”,๐Ÿ“บ






Question#42 (reveal difficulty score)
A 26-year-old man with HIV infection comes to ...
Penicillin๐Ÿ”,๐Ÿ“บ

Question#43 (reveal difficulty score)
A 78-year-old woman is brought to the ...
Embolectomy๐Ÿ”,๐Ÿ“บ

Question#44 (reveal difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left๐Ÿ”,๐Ÿ“บ




Question#48 (reveal difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis๐Ÿ”,๐Ÿ“บ

Question#49 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus๐Ÿ”,๐Ÿ“บ


Question#1 (reveal difficulty score)
A 30-year-old woman develops dimness of vision
Ethambutol๐Ÿ”,๐Ÿ“บ




Question#5 (reveal difficulty score)
A 70-year-old woman is found to have ...
Candida albicans ๐Ÿ”,๐Ÿ“บ

Question#6 (reveal difficulty score)
A 40-year-old African American woman comes to ...
1,25-Dihydroxycholecalciferol๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies๐Ÿ”,๐Ÿ“บ


Question#10 (reveal difficulty score)
A 30-year-old man has had intermittent severe ...
Cysteine๐Ÿ”,๐Ÿ“บ

Question#11 (reveal difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia๐Ÿ”,๐Ÿ“บ



Question#14 (reveal difficulty score)
A 35-year-old man is brought to the emergency ...
Activation of adenylyl cyclase๐Ÿ”,๐Ÿ“บ

bilirubin
Question#16 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric๐Ÿ”,๐Ÿ“บ


Question#19 (reveal difficulty score)
A 25-year-old woman develops increasing ...
Four-chamber dilation๐Ÿ”,๐Ÿ“บ


Question#21 (reveal difficulty score)
A screening program is instituted for ...
10%๐Ÿ”,๐Ÿ“บ

Question#22 (reveal difficulty score)
A 9-year-old boy has mild mental retardation ...
Rhabdomyoma๐Ÿ”,๐Ÿ“บ



Question#25 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi๐Ÿ”,๐Ÿ“บ

Question#26 (reveal difficulty score)
A 19-year-old woman comes to the office ...
Descending colon๐Ÿ”,๐Ÿ“บ

Question#27 (reveal difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid๐Ÿ”,๐Ÿ“บ




Question#31 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4๐Ÿ”,๐Ÿ“บ

Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin๐Ÿ”,๐Ÿ“บ


Question#34 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Membranous glomerulonephritis๐Ÿ”,๐Ÿ“บ







Question#41 (reveal difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder๐Ÿ”,๐Ÿ“บ

Question#42 (reveal difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia๐Ÿ”,๐Ÿ“บ

Question#43 (reveal difficulty score)
An undernourished 70-year-old man has fever, ...
Interferon-ฮณ๐Ÿ”,๐Ÿ“บ


Question#45 (reveal difficulty score)
A 28-year-old man comes to the physician for ...
Fructose๐Ÿ”,๐Ÿ“บ

Question#46 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale๐Ÿ”,๐Ÿ“บ


Question#48 (reveal difficulty score)
A 29-year-old woman comes to the physician ...
Baclofen๐Ÿ”,๐Ÿ“บ

cell_bio cell_transport cell_trafficking
Question#50 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector๐Ÿ”,๐Ÿ“บ

Question#1 (reveal difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix๐Ÿ”,๐Ÿ“บ


Question#3 (reveal difficulty score)
A study was performed that evaluated the ...
Odds ratio๐Ÿ”,๐Ÿ“บ


Question#5 (reveal difficulty score)
An 11-year-old boy has had persistent pain in ...
Lung๐Ÿ”,๐Ÿ“บ

Question#6 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Cortisol๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue๐Ÿ”,๐Ÿ“บ

FA_missing
porphyria phototherapy
Question#9 (reveal difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda๐Ÿ”,๐Ÿ“บ

renal SIADH hyponatremia
Question#10 (reveal difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia๐Ÿ”,๐Ÿ“บ


Question#12 (reveal difficulty score)
A 24-year-old man with a history of drug ...
Heroin๐Ÿ”,๐Ÿ“บ




Question#16 (reveal difficulty score)
A 40-year-old woman who had pneumonia due to ...
Surfactant๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width๐Ÿ”,๐Ÿ“บ

Question#18 (reveal difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis๐Ÿ”,๐Ÿ“บ

Question#19 (reveal difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla๐Ÿ”,๐Ÿ“บ

Question#20 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY๐Ÿ”,๐Ÿ“บ

Question#21 (reveal difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization๐Ÿ”,๐Ÿ“บ

Question#22 (reveal difficulty score)
A 57-year-old woman is brought to the ...
Ninth๐Ÿ”,๐Ÿ“บ

Saline Lymphatic

Question#25 (reveal difficulty score)
An 80-year-old woman cannot concentrate her ...
2.0๐Ÿ”,๐Ÿ“บ





Question#30 (reveal difficulty score)
A 5-year-old boy is admitted to the hospital ...
ApoC-II๐Ÿ”,๐Ÿ“บ


Question#32 (reveal difficulty score)
A 19-year-old college student says he hears ...
Risperidone๐Ÿ”,๐Ÿ“บ

Question#33 (reveal difficulty score)
A female newborn delivered at 26 weeks' ...
Retina๐Ÿ”,๐Ÿ“บ


Question#35 (reveal difficulty score)
A 50-year-old woman is admitted to the ...
Didanosine (ddI)๐Ÿ”,๐Ÿ“บ

Question#36 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Chondrosarcoma๐Ÿ”,๐Ÿ“บ



Question#39 (reveal difficulty score)
A 46-year-old man comes to the physician ...
1/15๐Ÿ”,๐Ÿ“บ


Question#41 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide๐Ÿ”,๐Ÿ“บ

Question#42 (reveal difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...
Multifactorial๐Ÿ”,๐Ÿ“บ


renal diuretics GFR
Question#44 (reveal difficulty score)
A 28-year-old woman with chronic renal ...
Furosemide๐Ÿ”,๐Ÿ“บ

neuro pharm magnesium
process_of_elimination Li_Fraumeni p53
Question#46 (reveal difficulty score)
A 14-year-old girl is brought to the ...
TP53 ๐Ÿ”,๐Ÿ“บ

Question#47 (reveal difficulty score)
While lifting weights, a 24-year-old man ...
Strangulation๐Ÿ”,๐Ÿ“บ


Question#49 (reveal difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus๐Ÿ”,๐Ÿ“บ

Question#50 (reveal difficulty score)
A 19-year-old woman is brought to the ...
Scaphoid๐Ÿ”,๐Ÿ“บ

Recent comments ...

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
 +72 
submitted by nosancuck(90)
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Bhur etl em tlle you a ill eretcs

EPPE eptversn ciattslesAe AAK tad NUGL CEPALOSL

ntDo be irrynow botau nrmdao wrsod etyh stpu in rfont of eht IGHH IYEDL snoe

hungrybox  literally LOL'd lmao I love this +14
... assoplasty made a comment on nbme21/block3/q#31 (A 28-year-old woman at 18 weeks' gestation has...)
 +70 
submitted by assoplasty(98)
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I tkinh the ocntpce eโ€™htery gtetnsi is the reedcasni TGB lleevs ni nrpngyec,a dan tno jstu tphsdeiyyriromh in e.grelan

ehnW gsecnenir ofr pphryeiyorom/y,thidhs HTS llsvee are LSAWAY ryleaniretlpef cchdkee ecsbaue they are remo siisevent ot eimnut edecrnseiff in T.T4/3 fneOt sitme TSH lslvee nac oatseermtdn a ganhec neve ewnh TT34/ levesl era in eht aislbuiclcn er.agn hTe lyon nixtceope to tish wdolu be ni ayrnepcng (nda I ssueg mabey erliv raf?elui I buodt htye oldwu sak sith .gho)htu hgHi ngreotes selevl rteensvp het rlvei rmof eribgnka wdno BGT, aigldne ot crisnaeed GTB lveesl in the m.sure ishT bsndi ot reef 4,T eneradscig eth atunmo fo aevlibaal eref 4.T As a pcsooarnyetm ase,mcminh THS eleslv ear rttnsnlyiea sdiaenecr dna eht TREA fo T4 oudoipcrnt is neredaics to rslieehnp elseabni fere T4 leesv.l voewHre eht TOLTA mnouta fo 4T is ead.erncis

hTe inuesqto si aniksg woh to nfromic hthdpyosiyeirrm ni a neatnrpg nmaow ;g-t&- ouy eden to hekcc EFER T4 eelvls ae(ecsbu yteh dluhso be monlra eud to eromcytsnapo sornp).ees ouY ncnato kcech HST l(auulsy tlaeedev ni prnagynce to amscptenoe fro cenieasrd BT),G adn uoy ctnnao kechc lotta T4 evslle lilw( eb airsneced.) ouY otg eht anrswe gtihr ireteh yaw utb I tihkn itsh si a rtenidffe oganriesn otwrh reg,niidncos euasbec hyte nac kas ihst conctpe ni rohte extontcs of retesprysmoh-,ieng adn if ythe ldstei Hโ€œTSโ€ sa an ansrew ecicoh ttha uwlod be ertocn.cir

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +9
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +3
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +1
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +2
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +2
lovebug  Amazing answer! THX +1
an_improved_me  Just to add: Pregnancy is not an exception to using TSH in suspected hyperthyroid pregnant patients (not sure in hypothyroid); you would still get a TSH first, and if its unusually low, you would then proceed to measure T4 (free, total), and so on. https://www.uptodate.com/contents/hyperthyroidism-during-pregnancy-clinical-manifestations-diagnosis-and-causes?search=hyperthyroidism%20in%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H994499 +1
... lnsetick made a comment on nbme21/block2/q#3 (A 17-year-old boy returns to the locker room after...)
 +54 
submitted by lnsetick(97)
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  • AnicPeor = yruo tarpims sellm klie an APE
  • eecMRnU = โ€™tshere no OORM ni oyur aers encsi eryteโ€™h ufll fo xwa
  • RC-nECYe = whne yuo Ee,Crseci your esrop ear RniYCg
  • aSBcEueos = mEuBS is iPgEEnS tuo fo your spore
hungrybox  as an ape i'm offended +34
dr.xx  stop being an ape. evolutionize! +7
dbg  as a creationist i'm offended +11
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +3
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +2
... drdoom made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
 +52 
submitted by drdoom(969)
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ehT hessysnti of ialrltvyu all esoitpnr NttdpAR-ge(m;pei&) socurc in teh plcsyoam.t][1 โ€™thasT ehewr lla reoimsosb rdsei,e ftrea lla. si,eRmosbo ihcwh ear tolmys tjus ANrR (~3/2 NRrA + /13 nr*otpe,i by th),wgie are emaslesbd ni het uenculs utb ynol do ehtir ftfsu neco ethy gte to het .ocpstymal

oFr a irptoen ot evlae ist liairngo twhemono fo eht cytoosl nad emocbe a sntdiere fo the snucule ,ro yyyyya,sy hte adposmlinec iluucm,ret ti edsen to heva a iltlet nrgits of nmiao ciasd ichhw toshu โ€œI onbgle ni the unel!sโ€cu or Iโ€œ eogbln in eth mlpedasnico โ€ieltruuc!m

Prtienos ttmaiuyell esdditen rfo the RE nonctai an eltyagivnniuaim deman nstgir of naiom dacsi nnwok sa lngiaโ€œs โ€neeqc,sue w,hhci fro teh suppesor fo eht pteS ,1 si sylwaa ta teh snrm.iNt-ue ehT lagsin uqsenece sltle ertho ciytlscoo ,ernsiotp yeH!โ€œ kaeT me (nad hte ters fo hte peepdti of ihhwc I ma part) to het !Eโ€R

In eth neebsac fo ihts gsl,ain a toinrpe llwi ermain in ist eโ€œudโ€ftla emho fo eth tsc.loyo

erq;&ssruoHe a neci tmacsiceh onsigwh eth wofl of nriotsep ofrm aliitni syieshstn to nialf sntdiesn:iato


ntdsoEne

  1. hโ€œTe ehssyints fo uylialtvr lal roipetsn in teh llec senbig no seroibmso in teh scool.ytโ€ (stnEisael Cell iBlygoo, lrsteAb et l,.a 40,21 .p 42)9

*fI ouy elraly atwn uroy dmin ,lbnow rnisoedc that evne het onrepit ssubntiu htat kmae pu hatt 3/1 fo a mbrsoieo are sesvlheemt ynltliiai eheyzndsist ni teh o;tyslco elt,ra yeth aer reptnsdtora cakb tino teh nuleucs iva het uclrnae pero.

qball  Awesome explanation. Now explain it to me like I'm 5. +8
drdoom  All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark โ€” or erase it somehow โ€” the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa wonโ€™t bring your presents. +50
... niboonsh made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
 +52 
submitted by niboonsh(369)
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wwQ/.ao2uthyozho=?4vttcwbte.:/u-mHcs/wDwvpu if ur yazl klie em, tish is a dogo rheeerfsr ioedv

d_holles  Amazing video dude. Somehow never learned this in neuro lol. +6
aag  Awesome video! Is this why you can give Mg2+ to eclampsia patients, because if so, mind goddamn blown. +2
... seagull made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +51 
submitted by seagull(1688)
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! I ehat eeths thwi a gnubinr *Fig*n* n.sipaos Thbmsu up if you eaerg

mcl  Amen brother +1
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +33
mcl  oh my god are you me +1
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4
abhishek021196  What is HSM? +
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +2
djeffs1  @lakshmi Link? +
... hayayah made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
 +41 
submitted by hayayah(1116)
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the rmjaoiyt of nabcor xddeiio lculseome aer cdraeri as atrp of het bcarintabeo ffbrue y.etssm nI tish sts,emy ancorb oxdieid suesdiff oint hte B.sCR irobCcan sdneharya )A(C hwtiin RCBs kciuqyl nescvort teh crnboa dxeioid itno iocrbanc daci .(C)O2H3 rocaCinb ciad is na tbulensa meaeerntitdi moceulle htta diemlemaity isstciesoda iton cnabetibaro ions C-)3H(O and ohrnydge H+() sn.oi

ehT nelyw hyedstneisz ioebbntraac noi si rdetortpasn uto fo the CBR iont hte plmsaa in exchenag ofr a eldrohic ino l;(C)โˆ’ isth is claedl eth ehdliorc h.sfti nehW eht ldboo acehrse het ,gnusl eht bairaonbcte oni si radrpntesto cabk tino teh BCR in exnhegac rfo teh doihercl on.i Teh +H ino csstadisoei ofmr hte lgbomiehon dan ibdsn to hte bbecntiaaro oi.n sThi dcpresou eth carcoinb ciad ,trmetienidae ichwh is eorvedcnt akbc ntio rnocab dioxeid hrgutho eht meyaizntc cinota of A.C hTe bcnrao iodidxe crpeoddu si pxeeeldl uhhtorg het gnsul diungr i.eaxhntaol

hungrybox  Amazing explanation. Thank you!! +2
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +5
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3
teepot123  fa 19 pg 656 +1
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +
... mcl made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +36 
submitted by mcl(619)
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belaLde CXR nowsgih tpinosio fo dtfnreife eavv.ls

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2
... notadoctor made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
 +32 
submitted by notadoctor(166)
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auUsl sinertitalit npiietusmon is hte icaohlsgotli doitifnien of hiitIdapoc aunmrlpyo bssi.ofir We wnko htta tihs entaitp ash ynamopulr forsbisi sebauec het ieoqutns saestt atht terhe is fsbiruo ktcnnehigi of hte laaleovr .sptae hTis outqnesi asw jsut gsientt thta ew wekn eth oreth esanm rof roylnaPum isb.Frsio

aneurysmclip  Nbme back at it again +28
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +3
zevvyt  thank you swagcabana! Very good explanation and strategy! +
... hungrybox made a comment on nbme21/block3/q#15 (A 47-year-old man has jaundice. Laboratory findings...)
 +32 
submitted by hungrybox(1113)
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ywh hslsoyeim is on:wgr

hreeT uoldsh taomsl evenr be itrhsgta pu nuiirbbli ni hte eurn.i nI ,lhyemisos eht esxesc iirbuibnl si treecdxe ni het .lbie fAret ebtilacra vcninoores dna upe,aktre seom will be tdcereex ni eth nireu sa o.unlbiri e,owHerv ni oubiecrttvs sie,srrddo the aouncgjdte ilbiuinrb illw erenv aveh the pitopountyr ot ugdonre atlcriabe iocrnevnos to libirsnec/or.uot nI hits y,wa hte jdatgucneo inruilbbi ahs on otreh awy ot be etcederx hroet hnat ceyitdrl ni the iuern.

decstri to a6ru/3a/7alcn on trided

skip_lesions  Found a good pic showing bilirubin metabolism +
... hungrybox made a comment on nbme21/block2/q#17 (Scientists have identified the flawed gene that...)
 +30 
submitted by hungrybox(1113)
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when iffd iglesn rtdsna ipraer hiemnmscsa ear s:due

  • irprae wleny esinstzydhe asrd:tn iahcsmmt irarpe hLycn( smnre)yod
  • reapir diiyeirnpm isdmre aescud by tda VU p:oeesrux tnuecodiel niixcseo rpirea mordar(Xee me)ospiguntm
  • ariper sntopua/oocitxnes t:neaiotlra easb nscxieoi erirap
meningitis  Brca: recombinant repair +
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2
teepot123  fa '19 pg 382/3 +
... jambo2222 made a comment on nbme21/block4/q#5 (An 11-year-old boy has had persistent pain in his...)
 +30 
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Itsโ€™ na rectasosomoa. mSoraca = saemohunegto ms.et Istโ€™ in the sleg os hnkti ohw a TDV oseg ot .glnu amSe d.iea

tinydoc  Perfect way to remember it. Thank you! +10
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +14
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1
... madojo made a comment on nbme21/block1/q#39 (A 33-year-old woman comes to the physician because...)
 +28 
submitted by madojo(182)
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wKno uroy STDs' byab );- ogn(ig rhhotgu reevy htroe oicceh on tish )oestqun:i

  • eBirtlaca vgsaonisi scedau yb raaldelgnre ilsivgalan. Se a ni,ht ffo tihwe gradschei dan fsyih elsml sfh(i ni eht g.endra) shTree' no inonfimlamta Lab fngdn:isi Hp ertareg nhta 5.4 j(tsu ikel sicnrimt)aohso,i adn a tsveoiip fifhw etst iwht KHO. Smet llwi sya eoitgmsnh bouta ouolasordm dihaegcrs dan oswh het sfnouiam ELCU ESLCL fi we aer .ulkcy otN eht nwaers ofr this eutqsoni vloybusio eabcuse ew udwol ton ceptxe vcieessl ihwt htsi aabietclr adsies.e

  • asCaiinddsi is oggin ot eb uyor tkhci goectat ehesec crdhsiage, hitw ilommtaanf.ni olnrma pH ees oppyuaeeshhd. atTre itwh tpiloac sitna,ynt ro loar laoeolczfnu lseusn ory'ue tranngep naht eus melltCir.azoo ingAa ont giogn to see any .seviescl

  • dCnoairch pre ouldrw si saeoiasdct wthi Hlespuamohi educriy uyo lwil vahe a Deep pelurtnu fiuplan creul hwti etupipavrsu tmhyiil.dnepsa lliW be tdol thta eitntap ahs afplnui iiualgnn ,nedso hteer aym eb ietmllup eped lruecs wthi awgyyoller- aux.dtee Yuo do yrc wthi H. iuCRdY ishT 'notlduw eb urte rfo ahwt oru etntpai sah in tish ontiesqu aecseub ew 'rntae ltdo fo nya nigualni ahyte.opnda a iknl to a nrcochaid VDA

  • lahyaCdim tcrsmitohaa acseus pnaymmhgouaollr evreemnu ihcwh is allsm shwolal e,rlscu ianeslp,s but ethn the rgela ufinlap osalececd ulginian lpymh odens kaa OEBSU.B dCrepaom thwi noohenagr teh igacrehds is reom nrenthi nda awrtye. gAain not hte cesa eerh sa ist niplauf nad no eontinm fo nya BES.OUSOB Teh sdcergiha in oganorreh si remo trk.eich Bhot ldea ot PD,I trtae rof hbot acebesu ncoteinocf is cnoom.m Whti tboh tptaeni amy evah emso rost of ainp or uibrgnn insaeotsn ponu uarnoitin. tSliere iypuar gothuh orf tboh.

  • mldyonCao tuaimacumcn si a eoimasntitafn of VHP 6 + 11 leigan(t srtaw.) ehTy olok ekli gbi cfeilswloa.ru sThi si ni sonacrtt to omClanoyd ltaa tath uoy ees in piyssihll hhicw is jsut a arftelt ltate nrowb loingok u.ealcm

  • ntiGlae erHpes (het asnewr ot het iqtusone) lwil teesnpr whti eullimpt afipuln puscliaferi cesseilv ro taniolcusre tiwh tilnsnuitoocta mytosspm eevr(f, aei)lmas tsJu ftis trebte hnat all het rthoe shicoce I arn hhtrgu.o

  • ilpiyshlS si het psnailse a.hccren WU escsierbd ti sa a ine,gsl dadeintur llew crbrsiuicecdm ecl,ru with a calne e.asb eSe resckowrc mgssaiorn on DF ccoyop.rmis epKe ni indm oerth eslipsan esrclu are oormanlpmyghalu envureme fo yadimalc (btu the bsoeub rea tashw ulapifn ton teh ucl,)re dna mnoraalgu liignuaen a(oodnnsivos - abellsekli toial)munsagr tbu ahswt amlrhlak bouat hist oen si ttha sit seilapns thowtiu ypomaatelnphhdy

nI tsroh, be ae.fs

drdoom  this write-up is AWESOME ... but it also made me vomit. +
b1ackcoffee  This is awesome, writeup, not the stds. +
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +
homersimpson  Gotta love the BUBOES +
... hungrybox made a comment on nbme21/block1/q#49 (An 80-year-old woman comes to the emergency...)
 +27 
submitted by hungrybox(1113)
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rhoicryidohlzetoHad is a ihdiatez irtciude &;g=t dztahiie tdiceisur rea dsetsoiaac tiwh layakmhe.pio

tWha eotrh rceiisdtu rea aoiedsacst wiht epolhkma?iya Loop .ciedurits

hyW?

Iionhbitni of +aN poraibstnore uscrco ni htbo opol siediuctr ithi(nib KCCN oarotern)tcrps adn zdihteai isdrtueic t(hibini lNaC tcpsrare.to)onrr llA of htis seiearcdn N+a insarcese sleontordeA ta.iitvcy

nlvtaRee ot htis mbo,lpre loteAesnrod lsrgtauueep nsrseoeixp fo hte KaN++/ APT taeptrorni bs(oarerb +aN noit oyb,d peelx +K tion )n.emul ishT setruls ni yaimhplakoe in het byo.d

ngHa on, r'eetsh mero ighh diley nio!f

Arolensodet sedo neo hoert tiatnporm nhgit - cttnaoivai of a H+ clnnhae thta slpxee H+ noti eth nu.lem

S,o vnegi atth isth ipatnet has apkla,ehiyom uyo kwno reeth is lgaeipnuotur of eAlrodens.ot Do yuo hiktn her pH ouwld be i,hgh or w?ol ,lacyxEt it wdulo be hhgi cbeeaus c.in esAtnloored tg;&= i.nc +H peeledxl onti teh eumnl =g&;t moicalbte s.ilsakoa

Nwo uyo ntuardesnd yhw hobt oplo iicertsdu and iidhezta iieducrst nca secua 'swtha lldcea iokah"mpycel baelotcim klasa."oisl

hungrybox  jesus this answer was probably too long i'm sorry +9
meningitis  I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks. +15
amirmullick3  This is what NBME should be providing with each question's correct answer! Thanks hungrybox! +1
amirmullick3  @hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."? +1
pg32  Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides? +
cmun777  @madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx +
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
 +26 
submitted by usmleuser007(419)
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fI oyu u'dnoclt rbrmemee cwihh eewr st;aeiensl tehn itreevlaant oudwl eavh eenb to earielz atth ornggiw lhirednc edne lecls to d.divei Tsih euesrirq AND pcritnoiael dan an.otsirnlat Of cihwh eht lecucin diac etyimh si armint.top It erqerisu a hmylet rtera.snf

hisT si hweer htmiennieo cesom i.n iMeotihenn beminocs hwit ATP to fomr MAS a( hyemtl )doorn

whossayin  Thatโ€™s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2
... acanthosisnegrocans made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
 +26 
submitted by acanthosisnegrocans(26)
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nI the gatre rowsd of rD taSar:t

taPn"arodinlgs E2 iaemestd eeefrveeeee"eee

ADSsIN &-;g-t kbcol niarloatdnpsg nsy

thisisfine   This is all I heard in my head +7
temmy  Me it was so weird +
peridot  I do want to add, that while PGE2 is the right answer, FA19 p.213 says that IL-1 and TNF are involved as well. However, because the question asks about what is going on in the hypothalamus, the answer is PGE2. If the question had been asking about what the macrophages were releasing to influence the hypothalamus, then the answer would have been IL-1 or TNF (FA didn't specify if it was TNF-a though...). +1
feeeeeever  You know why I'm here +7
... sympathetikey made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
 +25 
submitted by sympathetikey(1446)
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โ€ข Pre ocPoltro - Olny inuldce spttanie ni teh lsrutse woh wdlofloe eth lctoroop

โ€ข As etdtaer - Daat i,wes oyln aetrt eht subtcesj as thye ewer tadrtee ex( - fi exmrptnilaee itetnap deos ahwt hte cnltoro enitptsa rea suseppdo to o,d omve taht tleexinrmaep aptntei to eth nltrcoo orupg

โ€ข nnntIioet to tarte - dIlnceu all tsantipe ni hte suprgo ehty ewre rylngioali nozriedamd to

... henoch280 made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
 +25 
submitted by henoch280(58)
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mte@m.y hisT esoqiutn ssett uro nlowkgede no ilbasmin iwchh si ayrnolml a ensiarytos cdciyefine issdaee but eth egittnev ettass atth het obsy' laibsmin is uasdec yb a getecin nattomiu ni the 1RYPT nege whchi si howsn ni teh abcoiilmhce .wytahap A enge ahtt shelp in het hnestssiy of aue.nlnmEi

wNo ouy evha to ednsnrtadu htat lal rcsrosrupe febroe hatt gene si eht phytwaa duwol tllsi be llbavaaie if nto rieaesdcn ihwhc kmea 2 fo eht sinptoo in teh enuisoqt gon.wr

uyo aols hvae to tunarsdedn shEe :mnnutlii)(a = loinemmon)n(ra .ei mnarlo ilemann chhiw si eicteptovr to eth ns,ki rscesadee etiervca nxyoeg cisspee nad eigsv the rkad emnspigt to het isr,i hcdooi,r ,sikn hiar )cetn.eima.h nwe(o leli.f = fanenalim(ke) .ei ohan,epinmel hte one erestnp in ruo tntpaie heer hichw is ssle pivtcretoe naiag teh uv ys,ra antocn tegipmn nda tncano esecdrea SOR ngdeeaert in teh kin .is epoh siht esphl

... taway made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
 +24 
submitted by taway(32)
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hTsi euqiotns si resaphd nsyrlga,te btu st'i lsyiaeestnl kgnsai ah"tw dwluo hpnaep fi tsih amsnow' orhodmyythisip meaceb donetrucloln eovr eht ceorsu fo rhe rn"a?npcgye

ecurrltny erh HST is odog --g&;t ontoleewldlcl-r orPIHTsmtCTdoiOhiA yyYHhpEL ghhi TSH g--;&t hre yimyihrpdthsoo sutm NTO be ncwldrlto-lolee due( ot iniouptsdr fo eht H3//TTSH/4RTT cdoeernin x)sai

,So nwo atht ew derndsuant hatt eht inqoutse is ksgina "twah uodlw pnhape if erh oyhihydsiprmot asw rnu?cond"ollte

erAns:w simcentir

I intkh hatt hsit tioesnuq is edsahrp iotyasc,orlu tub afr be ti form em to eiccizrit het EMULS iclinnegs dr..bo.a

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +22
b1ackcoffee  exactly how does maternal hashimoto can cause cretinism? +
notyasupreme  @b1ackcoffee, it's not maternal hashimoto, basically you just have to disregard the ENTIRE question stem and the last part of the sentence (if the mom's TSH goes up) means that there's hypothyroidism going on, which causes cretinism. +3
b1ackcoffee  Thanks you @notyasupreme! +
... cantaloupe5 made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
 +23 
submitted by cantaloupe5(81)
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psCralua edhircaoscalyp encvsaic rea tneof cdujgnaote to rtoiesnp ot rmeipov niomig.tnmciyue gnlilFlea si hte ylno nwasre hoicec hastt' a ponrtei.

mambaforstep  both MHC 1 and 2 are present antigens that are PROTEINS (FA 2019 pg 100). so in order to elicit a T cell response, you need a protein (CANT BE A POLYSACC). that is why vaccines for polysaccaride antigens are often conjugated to PROTEINs--> so that we can elicit a T-cell response (FA 2019 pg 127). +6
lovebug  Flagellum = Protein, (FA19, pg.124) +
... assoplasty made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +23 
submitted by assoplasty(98)
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Fats are icgtoneke xetp(ec dod china )A,F so hety dercoup tnseeok for yegnre iornpudotc eo)AtACl(-yc erhart nhat uloe.gsc If het qtsounei aeksd awth eth imarpry cosuer fo rgeyen nrdotuipco w,as ti wdlou tllsi be yleocggn nd(a otn eso,tne)k saucbee tshi is ntiihw 24 .hsoru orvewHe rtfea 42 hrosu eth nweasr ouldc eb tekneo be.sido esges,dRlar the ouetqisn fleipaycislc disa hte tp hda a urems oguslec of 001, niicgadtni tath we aer ngkloio for mhostgine htat doesrvpi a bsrsuatet rfo losnsneicege.gou

urDign oespird of rsioanvt,ta bustesarst for ioseggecnnleuos coem mfor wot r:scoesu )(1 knrbdoaew of tiixgnes l,csuem or )2( avi dn-cahodi FA ohruhgt Anipoo-.pColyr a*eVi(nl lsao sfede tnoi royilnopp AC,o ubt is otn novivdle rngdui saitvnrota &-gt;- ese )ebwol

1() The aynaitvapen-erul eyclc doepvirs htis iaulg(nmet ni culesm + aetyrupv --g;&t anliaen ;-g&t- gsoe ot vreil t;&-g- nairoisnaatnmt ot epakohl-roeuatgattl ;&t-g- reutpayv si eteapsrad ofmr nuglemita &;gt-- eminualtg sego to ruea lcce,y urvtepya sgeo on ot eieol).snuesgocgn tetaLac nac laos eb edus ist(h dcluo ehav been a rhigt asnewr if ti rwee )ld.teis

(2) Odd hnaic AFs era also nogce,cuilg utb erstiac acid e(vipodrd in teh rnwesa ohcci)e iโ€™tns odd ,nicha so it si only ectigeonk nad nca be ulrde u.to

uloAhght vaeinl a(dn ohtre beahrcdn .a.a) edef tino ,Po-rnpAioCyol tehy era not edsu ni aasrttvoni aecbesu tanotavirs ltrciyts ilsree on cahietp sgcnoseieoegu.nl heeTs .a.a rea ton imetaelodbz in eth vlrei caesbue teh lvier aslck cabe-chnhindra .aa. asrrtfensea yezmn.e In tsFir dAi, cehBiom itsco,en rnued trv/tStis,inoanagFa in hobt the gtโ€œaifns ttโ€sea cwi(hh si iwhnti het itme aefrm of sthi u,oe)tisqn ro teh svtrntโ€œaiao eaโ€,tst obth euziitl taiceph eigeoensoc.nlsgu My tspsaonium si hatt vieanl si edsu dgruni agrrule aites,momlb dna otn ndugir pdieors of aov.trntisa

hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +10
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +5
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1
almondbreeze  @ toxoplasmabartonella think you are right +
... g.liller@yahoo.com made a comment on nbme21/block3/q#5 (A 70-year-old woman is found to have persistent...)
 +23 
submitted by g.liller@yahoo.com(29)
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nCaaddi si a arpt of eht mloanr ralfo of s,kni loudc ecasu oiniaancnmtto of a catnrle neuvos he.rtteac ehT qtsuoien atstes tath eth oarinsmg is lpur,pe uddng,ib ddi ton rpnsedo to adrbo prcmsuet bianoicstit (kaa eyth ntdd'i ues znuolofclae or nrhetcioampi ).B ,lysLat ehty dshowe it eapltd no dolob raga dan heetr swa on hsosyeiml chhiw lantieiems sahpt (teh nloy heotr sblipeos erdecnotn eh.e)r

yrcCuccopots syuaull volseinv mteisnngii in piuemmcooiomrdnsm tsp. E. lcoi si ragm s rivtarpextgoehoin si alusuly ndtasrimtte yb a rtohn no a ores ro soeenom wiht a ihrosyt fo gdigranen

hungrybox  Also, the yeast form of Candida is gram (+) +33
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +2
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2
... cantaloupe5 made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +22 
submitted by cantaloupe5(81)
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โ€™sShe nkingati 045 msOm pre yad os hse seden ot ertxeec 045 msOm rpe day ot aaitnimn imierlbqiu.u oYu ntacโ€™ tujs eeecxrt smmOsโ€™ yb eemhseltsv -- htye heva ot eb idldossve in omes aoumtn of eratw.

eLโ€™st asy you etceerx 054 mmOs tihw 050 Lm fo teraw -- taht emsna uryo denikys era ccrntagtionen nieur :ot

054 Omms รท 050 Lm = 009 m/OsLm

tuB het mxuamim stih โ€™salyd ydsekin anc etonctearnc rueni ot si 540 mLs,/Om os seh ahs ot rtexcee oemr artew to tge ti ttah uedlt.i Tath mnutao fo wetra si 1 ,L aecusbe 405 ms/1Om L = 045 /LOs.mm

Now esthโ€™er nghtino opitpngs reh morf getrnecix het 450 mmssO ni an vnee ermo iteudl nueri -- rfo melaexp fi esh kdrna na trxea L fo warte eno a,yd het yesidkn ouldc tge dir of taht rxaet L itwh hte eams oanumt fo 405 mOsm by igintuld eth eruin ot 540 Osmm รท 2 L = 522 msmOL/. Btu het euosinqt kass rfo het numimim onuatm of watre -- hhicw si 1 L yb eth idneksy +( 1 L rmof hte htore tfsfu rof a attlo fo 2 ).L

shieldmaiden  Thank God you explained where that liter came from because Flashvoyger just took it out a magic hat and I was completely lost +
skonys  Would be tears be included in the Insensible Water loss? +1
skonys  *my :.( +
... flashvoyger made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +22 
submitted by flashvoyger(22)
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ehT isentqou si ingkas uyo ohw hucm terwa sumt hte waonm take ni to aminntia teh esam o.lyatismol ihsT nmoaw akste ni 405 mOsm of slutoe epr .yda ishT si a ntui fo nrmestaemue -- ktihn of it elik sm.gar

roF erh ot eepk eht ames ytlomsaoli she ustm trcexee 045 sOmm pre dya. heT loyn ayw rfo erh to eeextcr eth tleous si iva het knyi.sde Teh lnoy yaw fro ehr dnykise ot tecreex 045 Omms si fi eyht ertexce 1 letri fo etrwa .also hTis si eth max rnntetccoonai ttah rhe idysnek nac oerpc.du er(H nedksiy era nto proeโ€œwufl nuogโ€eh to kmea her ruine yan emro tedtnecarnoc athn .tah)t

ishT mnwao si sloa lsiong neahort irtel fo ratew ot cefe,s westigan nad tio.eprinras hisT si teh isinโ€œbeesln etawr o.slsโ€ hTat nseam if hes nsiogl 1 rltie of rwate ot t,wsea ineiptsorar adn esfec epr day plus 1 lrite of rwaet to eruni c(aeubse hes esden to selvsido rhe tuelos in !mihet,on)gs rfo erh dolbo ot yats eht seam ,yosmlailot hse msut ralpeec eht waret she lots thsu ts,mu at ,mnimmiu nrkdi 2 tlirse of twear erp ya.d

jean_young2019  great explanation๏ผThank you๏ผ +
... pparalpha made a comment on nbme21/block1/q#35 (A 7-year-old boy is brought to the physician by his...)
 +21 
submitted by pparalpha(88)
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eadL ciyixtTo :

a:usesC tuodirinsp of emhe tyisenshs avi iiibhnotin of ALA nteavlienl(moaiu )thayraseedd

iinngFds:

A: eAnmai

B: sochipialB pilgtisnp

C: lCioc

D: raaehriD

E: ylhcaappotnEeh

F: otoF pord

G: umG tpos/iwdrgshoet nrt/daarigtotoue

H: NHT adn ehyupeemcrria

rehOt wnesrsa:

cnZi eefycnidic:

Caseu:s wlo atiken, C'rnhso easesdi

nsFi:dgni ineumm dnousicfn,ty peadrmii nwuod ilahneg (fro the donglmieer eaphs fo dunwo lnhie,ag iznc is enddee by oietnlretmsaeloaps ot ebakr wdon ptye III cl),oglnea gpny,maishood d,aeahirr r,iesmtidta pcloeia,a bmoaalnr attse nda semll

cseEsx si .rera.. but acn dlae to /d/nv and iloanmbad niap

ngsaeiumM ycecniifed:

suCa:es ngioecltan, ualoyr,ip tita,nomilnru itaxvael sueba

diniF:sgn anytte, aupremrte etunrraivlc trcinoca,nto dcirseean QT ivtenarl

12B cniceeydfi:

es:Casu gvean ,dtei niicrosepu aa,einm tacircnaep se,issu rcasigt bpasys er,ysugr oapsrmanoblti hCro,(n ),ruesp omrihiyphDlblotu t/plouertammcaw ctennifoi

nindiFgs: micto,raccy mtcllbsgaaoie eniama, nureo yto,psmsm iaecernsd ensceoohyitm dna MMA eevlls in emrsu

dcesIeran tiVmnai D:

usesa:C omluousnaratg saidsee icadosisr()os

i:Fsdginn oenb or,enptriso oot umhc c,cmlaiu lsos of tpeteai,p tposur

lovebug  2019 FA, pg 411. +
lovebug  Nephrotoxicity results from lead exposure because the kidney is the main route by which lead is eliminated. Lead is absorbed by the proximal tubular cells of the renal tubules, where it binds to specific lead-binding proteins. +2
... hungrybox made a comment on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
 +21 
submitted by hungrybox(1113)
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emos gnrwo sn:srwae

*ameks sseen c/b sletbmaylso aer eursrprocs to ,otrageslyucn chihw sue MPO ot tfihg off ofisceitnn

temmy  Hungrybox aka life saver +1
hello  Thank you!!! +1
bbr  ....uh yeah im pretty sure we just call em "Auer Rods" now. Appreciate the answer tho! +7
... drdoom made a comment on nbme21/block3/q#21 (A screening program is instituted for detection of...)
 +21 
submitted by drdoom(969)
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5,020 ussetntd ... utb uoy nidf uot rnguid ryou naitiil nrsece tath 500 yearald ehav het e.isdeas ,oS treustoki eohts pel.epo hatT aesvel 0020, tndsuets ohw nโ€™dot haev teh eeadis.s

evrO the ecruos fo 1 ray,e ouy edcrivso 200 nsetsudt edpdleveo hte ceni.ointf hus:T

200 wen casse / 0,200 olpeep owh diโ€™tdn ahve hte esseiad henw uyo tatdsre uoyr sudyt = 01 ntcpeer

cr,ykiT iryktc BENM ...

sympathetikey  Ah, I see. Thank you! +
niboonsh  Im mad at how simple this question actually is +7
sahusema  Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence +3
daddyusmle  fuck im retarded +2
skonys  Must be Florida State University.... +
... usmleuser007 made a comment on nbme21/block4/q#43 (A 4-year-old boy falls and lacerates his lower leg...)
 +21 
submitted by usmleuser007(419)
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  1. (seisootsHdambolย  tciol:gt)n htniWi eth tsrif wef unietsm fo ,rjnyiu
    1. psย aletenlit het loodb ngbie to ctksi ot eth ueindrj e.ist
    2. hsTi aistvceat hte pe,atelslt sungaci a few hgitns ot h.aeppn
    3. eyhT hcaegn tion na ruaohmpos peash, emro bsiueatl for intglc,ot nda tyeh aeseler ihlaccem sslgnai to rpooemt ncgtli.ot
    4. hsTi ustsrel ni eth vnaitotica if,roย nfib hwhic sofmr a hems nda cats as uegl"" ot nbdi tplaetels to echa oet.hr
    5. isTh kames ย atlacothย t ressve to pgul the beark in eth dlobo vss,ele nignsreiopgt/velwn hrrftue ][nel[id5.e]g6b

  2. nmnat:oIlimfa rguDni tihs h,sape medgdaa nda edda slcle ear elcrdae ,uot ngalo thiw aetiacrb nad ohter paehtgsno ro drbe.si
    1. Tihs spphaen hourthg hte ercssop i,ย gpyaoohssocft rwehe ihetw ldobo slelc "ta"e sebdri by gefuinlng tiย .
    2. eeevetaitdPl-rld wtrgoh rfacraoetsย  redseale inot het ouwdn ahtt uesca teh irigamtno and idonvisi fo cells dginru eht evreaiorftipl .hepas

  3. fooelritirPna to(wrgh of wne ies:)stu In this ย ignnoucn,e,nlosoonletpsdpaaiosltns,haย igieaegearย iย g rtos,uiemtoย sinfa atpeoltzh,aieliiin nad wduon tnctacnroio ro.ucc
    1. In s,sgeneioangi aualvrsc lhenolietda escll fmro ewn doblo vs.eessl
    2. In aasibiolrpf nad angauilotnr uetssi ย wsgl,arrmobย btooiifrfnoats nda ofrm a e,nw llย viierpltalxeouracnsora (atxย ErMiCm) yb ncrextige clgoelan .nniotifcbraย ned
    3. nnyuo,relCrtc pliientertal-oehizia of hte idermsipe os,rucc ni ectlaiย hlhhieiwp sroplfcย etrllieae dna racl''w otap hte ouwdn ,dbe irnivpgdo vecor ofr teh nwe esisut.
    4. nI wndou booitcnltย edastoroebaisnsย mce,cryarf the eszi of the wdonu by piniggpr eth dwonu gdsee nda rgntacnoict gisnu a mmcsihaen thta eessmerbl hatt ni mostoh lemsuc lcl.es
    5. Wehn the ells'c slero rea olecs ot peeltmo,c denudene eslcl oianps.dptย surogeo
  4. ratunatoMi e(edil:or)gnm Duignr oatuimtrna nad oenlrmgied,

    1. nlcoelga is raneiledg ongal oinsetn i,lsne dna ecsll atth ear no nelgor edeedn rae dmeevro by gmdoemrrap lecl eth,da istpp.ย aoroso

  5. toAmxpiprae mtsie fo hte fdertenif asshpe of wonud 1hiahย w,eig[]0nlt dfead srntilave namkgir stinaalbust ,arivanoit ginndeepd maniyl no wdonu zeis adn genliha ndonciti,os tbu magie dose otn ecnldiu rjaom arntimpsemi taht achucniorsย ec downsu.
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +
... hungrybox made a comment on nbme21/block3/q#3 (A 55-year-old African American man with hypertension...)
 +20 
submitted by hungrybox(1113)
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Teh 2 mnnsedmatmco fo hitecs qtnoe:usis

  1. tDno' eevr ipkc an wsnaer heerw you suodn eikl a kicd
  2. t'Don erev tlconsu eth shicet eemitcmto

eveSdr em ewll on stih sn.qeitou

linwanrun1357  If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +3
champagnesupernova3  If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1
brasel  also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1
... mcl made a comment on nbme21/block2/q#30 (A 44-year-old man comes to the physician because of...)
 +19 
submitted by mcl(619)
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sihT si a rtytpe doog eifurg onswghi teh oinnvsreoc fo aeemrnbm sidpphioophsl ot cnrhaodaici dern/suktaeeolici ce.t

daceoBkl of COX nemeyz yb biropnufe lresuts ni edraecdse idunrooctp of anarlptidsngos 2H dan 2E, ewlih scugani the ssoercrrup ot back" "up serecdin(a aiicrdaohcn cida.) ishT, ni tu,nr tuelrss ni eciadenrs puodnctiro of ne.eelstoirku

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +4
... imgdoc made a comment on nbme21/block2/q#33 (A 68-year-old man comes to the physician because of...)
 +19 
submitted by imgdoc(144)
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I uthgoth bouat it ekli :hist niPttea is iahnvg cgseophycni ED - tis all in hsi deha, bidoli si omlran dna ocnunatrl eceositrn aer .nmloar

If shi snoetsrtTeeo lelve aws owl - idLibo dcsea.ered f I hsi osurvne temyss tmmiptstscryathhcpea/ey()apia wsa amedgad - nnrautcol enestoric searc.eded

Hpoe sthi s.ephl

sars  Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +2
... hayayah made a comment on nbme21/block2/q#50 (A 65-year-old woman comes to the emergency...)
 +19 
submitted by hayayah(1116)
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tCehtrea anctlmepe:

/gkenlsp6ce/edn1pnyhtg0e.uaw0i-:s0/sooett/8.a0mc/jo/4pma0p8/2t

eacllR thta eht ugln expa nseetxd vbeoa het istrf ir.b

hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +31
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +12
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +5
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +
... beeip made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
 +19 
submitted by beeip(130)
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I gtimh be het oynl nspreo no trhae woh otg ihts eno grnwo, but sd:ersaeglr

IT"T yilsnasa lcnsuide eevry tbeucjs who si neorazddim igarndcoc to edizrmaodn trentatme innta.megss tI gnieosr nemni,cnclaoop ocooptrl ,stdnaoivei a,awtwirldh nda tagnnihy htat shaenpp atefr tizma"nooid.ran[]1

yo  You're not. I also goofed. +20
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject. +2
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +
... cellgamesgojan made a comment on nbme21/block3/q#35 (A 63-year-old woman comes to the physician because...)
 +19 
submitted by cellgamesgojan(41)
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AV tiFassul treruo- odobl rmfo the rtaearil tymsse ot het sneouv ysm,est gbn-ssyiap the Aiostererl = nrseIeac PL ;t--&-g NCASIEER .RV All ni all = ecesnaIr CO.

drngAocic to r,olWUd eth tesolraier are a omarj uscoer of rastncseie ... os anyspgsbi teh esaliretor elrutss in a drasecee in olTat prirPehela ntRsiaeecs ... aignscu an sreaenic ni hte erta dna volume of oblod ugreinrnt to the htera. I am tpryte rseu ehrte is mroe to teh oosyylihgp hibedn isht, utb I heop htis lpeaxnedi a tiet.ll

big92  "Immediately following creation, arteriovenous fistula (AVF) is associated with an increase in cardiac output (CO), achieved predominantly through a reduction in systemic vascular resistance, increased myocardial contractility, and an increase in stroke volume (SV) and heart rate. Over the following week, circulating blood volume increases in conjunction with increases in atrial and brain natriuretic peptides. These alterations are associated with early increases in left ventricular (LV) filling pressure with the potential for resultant impact on atrial and ventricular chamber dimensions and function." (PMID: 25258554) There's also another study by Epstein from the 1950s looking at the effects of AVF's effect on CO in men (PMID: 13052718). Apparently, the increase in resting CO is a big problem because it can lead to high-output cardiac failure (LVH). +31
hungrybox  Jesus big92 you went in on the research lmao u must be MSTP +6
temmy  big92 you are right. that is why pagets disease pagets have high output cardiac failure because of the av shunts. +4
kevin  what is "increase PL" +3
jhan17  According to wiki "When an arteriovenous fistula is formed involving a major artery like the abdominal aorta, it can lead to a large decrease in peripheral resistance because it by pass arteriole (where major BP is formed) . This lowered peripheral resistance causes the heart to increase resting cardiac output to maintain proper blood flow to all tissues." +
... beeip made a comment on nbme21/block4/q#6 (A 55-year-old man comes to the physician because of...)
 +19 
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sTih has nebe a houtg oncctep ofr em to ,gte ubt I knith 'mI yflalin ehter:

The mset si dceisirbgn rmrypia enadlra inif,ncfuescyi ro dAsd'on.si

  • TACH is ebnig cdpou-vorreed to uetatmlis hte radensla ot rdupceo ,lciootrs ubt tyeh a'tcn spnedo,r iheert edu ot rpotyah or rdosntciteu (TB, :mtiauueomn D4R, )ce.t
  • ehT ftisr 31 omina cdsai of AHCT cna eb cdealev ot romf -HMSฮฑ, hhcwi elmsuasitt ye,amtnleocs nusicag ahnygopniermeitpt
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10
hungrybox  thank u for this answer +
bilzcop  Ugh! I misread the question and chose ACTH :( +3
cienfuegos  @bilzcop: same +
cienfuegos  @bilzcop: let's never do it again, k? +1
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +
... hungrybox made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
 +19 
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shiT odvie sapeixln tanegil obolyyrgem yteemrlex wlle.

If uoy eltf oytllta ltso ilek ,me ahtcw eht vioed sfirt at 2,x hnte hckce out hte otbomt igufre on p.g 680 ni FA .1920

nleRavte ot thsi isutq:oen

  1. YRS epionstr lmtitesau ndpeevetolm fo eestst
  2. Tihs pt ahs tesets =t&g; eh mtsu vaeh teh RYS egen no het Y eosmmohroc
  3. MFI daesegdr eth lniuMalre ctdu, whchi dwluo swerohiet coembe eth tnairnle lefema aialtneig
  4. shTi pt ash tlnrneai afeeml algteanii &;gt= didtn' ekam enugho IFM

zuiQ folryuse ssr(wnae ni a ertaapes po):ts

  1. ihsT n'eiatpts sdorride nca be tacrde akcb to whihc s?clle
  2. sTih anpteit dah rlamon ngaalitei. If hits petanit dah relsmal iingtalae naht r,lnmoa ahtt wuold be a tdfcee in wtha ee?mynz
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +12
... seagull made a comment on nbme21/block4/q#40 (A study is conducted to assess the normal mean serum...)
 +19 
submitted by seagull(1688)
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Eangixinm peattin rmof a ioorlutsg spelmii eBrsokn aiBs chihw wolud ksew eht oiulotanpp eanm of sremu ruae tngnireo aywa omrf teh treu catauecr e.amn ,nehT erlzeia rsopceiin si tnpddeene on iattstaicls erPw""o hchiw si areesndic besda on hte ezsi fo het pnualooipt fo eth td.ysu sr(cediean ipencrsio = rnedsecia tcstistalai wor.)pe fThoerre,e na aeciresn ni ppniouaolt fo a adsbei uorgp whti lead to runciaycca tihw ghhi nrioc.eisp

forerofore  to add up, the urologist himself doesn't add or remove accuracy (since this is a blood test), what decreases the accuracy is the fact that in order to be sent to a urologist you probably are sick in the first place (selection bias), so your urea nitrogen is likely to be altered. +24
sharpscontainer  I thought of precision as more of a function of variance. Variance will decrease with a greater sample size. Had a hard time because I was thinking about those 4 darn targets (wouldn't 500 darts look more spread out than 10? but no, the variance will be better) that have been in my textbooks since 7th grade and for the first time I was asked a question about this concept only to discover that I didn't have it down as well as I assumed. +1
peridot  @sharpscontainer I feel you, I thought the exact same thing. Looked into it a bit and I think it has something to do with the way standard error or standard deviation or something like that is calculated, but I'm still confused and too tired to dig further. Also, wanted to mention that this NBME has a similar question but instead it's about the 95% confidence interval - maybe that'll help you understand the precision thing better since the 95% confidence interval narrows with a larger sample size? So it's kinda tied to precision? +
... step1soon made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +18 
submitted by step1soon(47)
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lmaveap/yrthkcehotdear:laive-rt/ysoosd-lu/ais/.g

Lkoo at rhewe eht supsc are ngnptiio โ†’ upardsw efhoerter rtaioc. if csspu weer ndwarodw โ†’ neht ltraim levva wldou eb eht ghtir rwnsae

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +3
... drmantistoboggan4 made a comment on nbme21/block1/q#47 (A 26-year-old woman (III-2) comes to the physician...)
 +18 
submitted by drmantistoboggan4(18)
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It isda it swa talfa to measl ni ,reuto nda het uonesitq edkas abtou ivel nrbo pgoin.sfrf ncieS eth almse naโ€™etr bineg obrn ni het tfrsi lacpe, I asdi %50 fealsem dan %0 lse.am

hungrybox  fuck i got baited +32
jcrll  "live-born offspring" โ† baited +26
sympathetikey  Same :/ +
arkmoses  smh +
niboonsh  why is it 50% females tho? +2
imgdoc  felt like an idiot after i figured out why i got this wrong. +2
temmy  oh shit! +
suckitnbme  This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected. +3
makinallkindzofgainz  @suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0. +3
spow  @suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant +3
qball  Jail-baited +
srmtn  correct @spow affected females= X linked Dominant +
... hayayah made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +18 
submitted by hayayah(1116)
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.P 19 of AF hsa a uiqck alenptanoxi for isht!

lalysacBi ceon r'ouey in a ivgnatsr teast 'hesetr lsitl ihatcpe nleognissgouece going no sa( llwe sa igusn FAF) tub het ueeegnocisgsoln is gimnoc omfr reahplrpei seusit aactlte nad a.enlian

... feronie made a comment on nbme21/block3/q#7 (A 65-year-old man comes to the physician because of...)
 +18 
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tremhOcyoci = โ†“ nrtstoteeose tpuoricndo = โ†“ TDH ;g&t= ttesropa clesl geurndo aipso.opts hi(Ts emasmcinh is alisrim to gnisu ecd5eaurฮฑ-ts roekbslc ot aettr P)H.B

oostspipA si hreraetiazdcc yb DAN mefonratntaig nkssi,yo(p r,oryakrxishe issrk.aoyl)y

hungrybox  DNA fragmentation histopath: https://i.imgur.com/nxYW8vL.png Note that degradation in apoptosis is progressive. From pyknosis -> karyorrhexis -> karyolysis. Aka condensation -> fragmentation -> complete dissolution. +27
... hayayah made a comment on nbme21/block3/q#27 (A 55-year-old woman with a benign nodule in the left...)
 +18 
submitted by hayayah(1116)
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ehT yotidhr is plsiuepd htiw liertara bodlo orfm het pruoires otidrhy ryrt,ea a abcnhr fo eth nrtxelea tcidora eatrry, dna the rriofnei doityhr rteary, a anhrbc fo hte vrteoiychralc tnkru.

... hayayah made a comment on nbme21/block4/q#23 (An investigator is studying the regulation of...)
 +18 
submitted by hayayah(1116)
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mpLhy wfol erta si laylusu o.wl It si iuenednfcl iyirmplar by the raet fo ylmhp aotromif.n oFr ealxpm,e fi bdool arpyclail ssureepr si esecanird yb eirraalt dtiaalsnoivo ro ueonsv scniicr,notto eht lfwo arte of ylphm saicners.e Aso,l het olfw trae si atdffece by rsiepmosnoc fo ylpmihstac by rictcononta of ngigoniherb euulrtscmua nda by egvteina aahoccrirtint suerresp n)beh.t(gari

sarelttIitin eusrreps o(s pusseerr ni teh FEC, hwhic owuld arceenis fi vgien IV esi)anl dna plymh folw ear yvleopsiti er.letad A almls asceinre ni irtinliasett ovlmue rlaetgy rncisasee tsi rr,useesp moprotngi ylphm oflw atth tasc ot tesorre teh tenlsaiitrti uemlov to r.omlna

moer no htis :copit N.m/o4:onnbKBwhlpcb5.ts8i///i3/v4oshkg.tnw.w

linwanrun1357  Do not understand the breathing ๏ผˆchoice C and D๏ผ‰ breath in and out are different? +
khanhluong  I don't know if it's correct or not but how I approached C & D was that they both cause vasoconstriction in the arterioles (because this is the lung where hypoxia causes vasoconstriction), which decreases hydrostatic pressure through the capillaries and eventually decreases lymph flow. Maybe I completely got this question right for wrong reason, but I felt that it works with all of the answers. For F) I was thinking that it would cause increased capillary oncotic pressure which causes more fluid to go into the capillary than into the lymph vessels... Here's a picture: http://www.lymphedemablog.com/wp-content/uploads/2011/09/Lymphatics.gif +5
... hayayah made a comment on nbme21/block1/q#22 (A 36-year-old man with AIDS elects to participate in...)
 +17 
submitted by hayayah(1116)
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enCieisn-estyecyt kcoeniemh rectepor 5 5C)RC( is a rnoptie oundf no het recsufa of CD4 clels.

yotsubato  Note, this is NOT in FA +2
sbryant6  It is in UWorld. +3
almondbreeze  it's in FA2019 pg.110 +1
almondbreeze  but missing the full name for CCR5 +4
demihesmisome  CXCR4 is also a chemokine receptor. +2
sononono  Uworld ID 953 +2
... yotsubato made a comment on nbme21/block2/q#18 (A 34-year-old woman comes to the physician because...)
 +17 
submitted by yotsubato(1088)
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llWe taths a yralle eurcd yaw ot ecnres fro proi.ndsee..s

champagnesupernova3  There's really no other way to say it without using euphemisms +4
drdoom  You canโ€™t rule out suicidal thoughts via inference. +
drdoom  LAWYER: Did you ask the patient if she was suicidal? DOCTOR: Well, um, no, not exactly โ€” but, I mean, she seemed okay .. +
drdoom  LAWYER: So, a patient walks into your office, you suspect post partum depression โ€” a diagnosis with known suicide risk โ€” and you didn't ask if she was suicidal? +
drdoom  DOCTOR: gulp +
beetbox  @drdoom wow ok now this will stick to me forever. Always ask your patient so I can avoid lawsuits! +1
... ergogenic22 made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
 +16 
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otramihcn evgatnie = no rbar eibosd = soprne iwth YX yptongee or OX ueesacb tnmieya you hvae oerm ntah oen X mcshooreom you vhea a rbra dyob n(tmrhocia sv)tipioe

... hayayah made a comment on nbme21/block1/q#11 (A 27-year-old primigravid woman at 34 weeks'...)
 +16 
submitted by hayayah(1116)
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ELPHL emdonsr:y emtaio slHsyldv Eee vLire ym zwnesoeL eltePt.sal

A fioantaniemst fo eeesrv seraeaipc.mpl Bodol earsm shows isctsyeocths. aCn ldae to CID nda etcapih hatasapsloerbsm ucuma ยŽ ureptur ยŽ everse spot.ehioynn

mambaforstep  FA 2019 pg 629 +4
qball  One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand? +
demihesmisome  Pre-eclampsia, if not severe, can be entirely asymptomatic. +1
misterdoctor69  Her blood pressure is 164/102, which qualifies her as having preeclampsia. +
... nicnac20 made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
 +16 
submitted by nicnac20(18)
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idxMe ousven oyegxn nseonit is teh unmtoa of gonyxe udobn to ihnoomebgl sa it estnrur ot eth ghrit isde fo the atrhe eartf eatvrlgni to eht stis.seu

cerasdDee nogxey ldievrey to the etsusis eud ot cresddaee dcaciar puttou adels ot eth stsiesu cgnxrettia mreo yognex form teh agisnps CsBR ahtn htye mlnaroyl wulod, hwcih aseeesrdc het olelrva ximed vsnoeu eynoxg tniseon.

pparalpha  A helpful equation is CO=rate of O2 consumption/(arterial O2 content-venous O2 content): Fick principle If CO is decreased, then the difference between arterial O2 content and venous O2 content is increased +16
misterdoctor69  To clarify a little bit, the tissues wouldn't necessarily extract MORE oxygen from the passing RBCs than they normally would. They would extract the same amount as they normally would to carry out their own functions. However, because the starting amount of O2 delivered to tissues is lower, you'd end up with less O2 bound to hemoglobin returning to the right heart. +5
... neonem made a comment on nbme21/block1/q#43 (A 52-year-old man is brought to the emergency...)
 +16 
submitted by neonem(580)
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eihoMrpn is a um iidpoo osganti - noe sadvree efftce of sdioiop si smta llce nodeatniulgra ahtt is geeEd-nIpednitn. aRseele fo iematsihn si niak to na hlicaactaypn eiacntor ;-gt&- ti,psruri tec.

sympathetikey  Never had heard of that one. Just a good guess. Thanks! +
yb_26  IgE-independent mast cell degranulation can also be caused by radiocontrast agents, some antibiotics (vancomycin) +7
temmy  it was a u world question +
mambaforstep  FA 2019 pg 400 +
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +1
mambaforstep  under mast cells "IgE-independent mast cell degran"! FA 2019 pg 400 +
mumenrider4ever  Uworld QID 11852 talks about this Also FA 2020 pg. 408 (under mast cells) +