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NBME 22 Answers

RAAS
Block/Question (96.3 difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretionπŸ”

Block/Question (50.2 difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDLπŸ”

Block/Question (32.7 difficulty score)
Parenterally administered cholera vaccines ...
Inability of the vaccine to elicit secretory antibody at the epithelial surfaceπŸ”

Block/Question (43.4 difficulty score)
A 48-year-old man begins furosemide therapy ...
Decreases the luminal permeability to Na+ in the collecting ductπŸ”

Block/Question (26.1 difficulty score)
A 10-month-old girl is brought to the ...
NaloxoneπŸ”

Block/Question (25.5 difficulty score)
A 2-month-old boy is brought to the physician ...
Human papillomavirusπŸ”

Block/Question (33.9 difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading doseπŸ”

Block/Question (33.2 difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical ribπŸ”

Block/Question (53.7 difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4πŸ”

Block/Question (17.3 difficulty score)
A 25-year-old woman is admitted to the ...
Streptococcus pneumoniaeπŸ”

Block/Question (26.4 difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradationπŸ”

Block/Question (16.7 difficulty score)
During the first week of life, a male newborn ...
21-HydroxylaseπŸ”

Block/Question (19.9 difficulty score)
A 13-year-old girl is brought to the ...
Ask the mother to leave the room before asking the patient any questionsπŸ”

Block/Question (10.9 difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgiaπŸ”

Block/Question (51.0 difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemiaπŸ”

Block/Question (33.3 difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negativeπŸ”

Block/Question (47.9 difficulty score)
A 27-year-old man is brought to the emergency ...
EversionπŸ”

Block/Question (40.4 difficulty score)
A 13-year-old boy is brought to the physician ...
ReassuranceπŸ”

Block/Question (23.3 difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcomaπŸ”

Block/Question (58.0 difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosisπŸ”

Block/Question (33.3 difficulty score)
A 30-year-old man comes to the physician ...
PolycystinπŸ”

Block/Question (27.6 difficulty score)
A previously healthy 6-year-old boy is ...
Does anyone else in the family have an itchy rash like this?πŸ”

Block/Question (32.5 difficulty score)
A patient in the early stages of hemorrhagic ...
A weak pulse due to decreased stroke volumeπŸ”

Block/Question (35.2 difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular arteryπŸ”


Block/Question (39.4 difficulty score)
A 42-year-old man comes to the physician ...
HydrochlorothiazideπŸ”

Block/Question (14.9 difficulty score)
During a clinical study, 15 patients with ...
AzathioprineπŸ”

Block/Question (29.8 difficulty score)
A 48-year-old man comes to the physician ...
Transferrin saturation and serum ferritin measurementsπŸ”

Block/Question (54.8 difficulty score)
A 28-year-old man comes to the emergency ...
JejunumπŸ”

Block/Question (33.1 difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobeπŸ”

Block/Question (25.4 difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancerπŸ”

Block/Question (53.0 difficulty score)
A 17-year-old boy is brought to the emergency ...
HypokalemiaπŸ”

Block/Question (27.8 difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flowπŸ”

Block/Question (22.3 difficulty score)
A 15-year-old girl is brought to the ...
First-degree burnπŸ”

Block/Question (53.2 difficulty score)
A 35-year-old man is brought to the hospital ...
Alteration of the thermostatic set pointπŸ”

Block/Question (17.3 difficulty score)
A 67-year-old woman comes to the physician ...
Idiopathic pulmonary fibrosisπŸ”

Block/Question (58.9 difficulty score)
A 28-year-old woman is brought to the ...
Area labeled β€˜C’ (Abducens nucleus, right)πŸ”

Block/Question (25.7 difficulty score)
A newborn born at 26 weeks' gestation has ...
Dipalmitoyl lecithinπŸ”

Block/Question (19.8 difficulty score)
A 23-year-old woman develops multiple red, ...
Processing of antigen by Langerhans cells, leading to activation of CD4+ T cellsπŸ”

Block/Question (28.2 difficulty score)
A 45-year-old man with chronic pancreatitis ...
PancrelipaseπŸ”

Block/Question (39.3 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitusπŸ”

Block/Question (23.1 difficulty score)
An 18-year-old woman develops sepsis after an ...
Decreased plasma fibrinogen concentrationπŸ”

Block/Question (22.3 difficulty score)
A 13-year-old girl is brought to the ...
C1 inhibitorπŸ”

Block/Question (41.1 difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectalπŸ”

Block/Question (57.8 difficulty score)
A 16-year-old girl is brought to the ...
DiureticsπŸ”

Block/Question (20.7 difficulty score)
A 12-year-old girl is referred to the ...
Conversion disorderπŸ”

Block/Question (26.6 difficulty score)
A 25-year-old woman comes to the physician ...
Immune thrombocytopenic purpuraπŸ”

Block/Question (37.0 difficulty score)
A 1-year-old boy is found to have an ...
Staphylococcus aureusπŸ”

Block/Question (23.9 difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
AzithromycinπŸ”

Block/Question (32.5 difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structureπŸ”

Block/Question (52.9 difficulty score)
A 29-year-old woman is brought to the ...
Avulsion of hepatic veins from the inferior vena cavaπŸ”

Block/Question (14.8 difficulty score)
A 65-year-old man starts using topical ...
Thymidylate synthaseπŸ”

Block/Question (22.9 difficulty score)
A previously healthy 28-year-old man comes to ...
NephrolithiasisπŸ”

Block/Question (27.6 difficulty score)
A previously healthy 60-year-old woman is ...
Increased central venous pressureπŸ”

Block/Question (40.5 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balanceπŸ”

Block/Question (38.1 difficulty score)
A 52-year-old man is brought to the emergency ...
4 MonthsπŸ”

erections libido penis
Block/Question (65.6 difficulty score)
A 66-year-old man comes to the physician ...
Libido: decreased;
Nocturnal erections: normal
πŸ”


Block/Question (36.8 difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled β€˜Eβ€™πŸ”

immuno abo_incompatibility complement
Block/Question (38.7 difficulty score)
A 26-year-old woman develops hypotension and ...
Antibody, complement C5-9πŸ”

erections penis
Block/Question (27.9 difficulty score)
A 56-year-old man with a palpable hard nodule ...
Pelvic parasympathetic nervesπŸ”

anatomy
Block/Question (62.0 difficulty score)
A 52-year-old man comes to the physician ...
Sensation from the anterior surface of the scrotumπŸ”

cAMP
Block/Question (22.9 difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMPπŸ”

Block/Question (25.5 difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocoliticaπŸ”

Block/Question (36.1 difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodiumπŸ”

Block/Question (41.2 difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breastπŸ”

Block/Question (21.6 difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinomaπŸ”

Block/Question (16.3 difficulty score)
Ten healthy human subjects are given a new ...
Phase 1πŸ”

Block/Question (23.5 difficulty score)
A 32-year-old man comes to the physician ...
Reverse transcriptaseπŸ”

Block/Question (24.8 difficulty score)
A 50-year-old man comes to the physician 3 ...
CalciumπŸ”

Block/Question (18.9 difficulty score)
A 26-year-old nulligravid woman comes to the ...
HypothalamusπŸ”

Block/Question (25.5 difficulty score)
A newborn has cyanosis, tachypnea, and ...
Respiratory acidosis and metabolic acidosisπŸ”

Block/Question (47.1 difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclaseπŸ”

Block/Question (34.8 difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bugπŸ”

Block/Question (20.6 difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failureπŸ”

Block/Question (39.2 difficulty score)
A 37-year-old woman undergoes excision of a ...
AngiogenesisπŸ”

Block/Question (12.8 difficulty score)
A randomized controlled trial is conducted to ...
(194/2371) – (123/2365)πŸ”

Block/Question (30.6 difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3βˆ’πŸ”

Block/Question (18.4 difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibialπŸ”

Block/Question (23.5 difficulty score)
A 79-year-old man is brought to the emergency ...
Insertion of transvenous pacemakerπŸ”

Block/Question (27.3 difficulty score)
A 40-year-old woman comes to the physician ...
MultifactorialπŸ”

Block/Question (42.5 difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variationπŸ”

Block/Question (50.6 difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cellsπŸ”

Block/Question (29.7 difficulty score)
A 29-year-old woman comes to the physician ...
Thyroid-stimulating hormone: decreased;
Free thyroxine: decreased;
Free triiodothyronine: increased
πŸ”


Block/Question (50.6 difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600πŸ”

Block/Question (57.5 difficulty score)
A 45-year-old man with Li-Fraumeni syndrome ...
Decreased binding of RNA polymeraseπŸ”

Block/Question (36.1 difficulty score)
Which of the following drug effects is the ...
AnticholinergicπŸ”

Block/Question (50.3 difficulty score)
A 63-year-old man has had progressive ...
Area labeled β€˜Dβ€™πŸ”

Block/Question (28.5 difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medullaπŸ”

Block/Question (24.0 difficulty score)
A 22-year-old woman comes to the office ...
CardiomyopathyπŸ”

Block/Question (25.0 difficulty score)
A previously healthy 7-year-old girl is ...
Serum potassium concentrationπŸ”


Block/Question (23.2 difficulty score)
A 75-year-old woman has taken 12 ...
Plasma renin activityπŸ”

Block/Question (33.2 difficulty score)
A 20-year-old man comes to the physician ...
Area labeled β€˜Cβ€™πŸ”

Block/Question (17.1 difficulty score)
A 3-day-old full-term male newborn is brought ...
Hepatic UDP-glucuronosyltransferase activityπŸ”

Block/Question (48.0 difficulty score)
An 86-year-old man who lives in a skilled ...
DextromethorphanπŸ”

Block/Question (37.8 difficulty score)
A 62-year-old man is being evaluated for ...
Greater mucosal surface areaπŸ”

Block/Question (13.9 difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndromeπŸ”

Block/Question (13.9 difficulty score)
Clostridium perfringens-Ξ± toxin affects cells ...
Splitting lecithin to phosphorylcholine and diglycerideπŸ”

Block/Question (8.1 difficulty score)
A physician is unable to communicate "bad ...
CountertransferenceπŸ”

Block/Question (35.4 difficulty score)
An 18-month-old boy is admitted to the ...
Tuberous sclerosis complexπŸ”

Block/Question (67.1 difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve rootπŸ”

Block/Question (27.2 difficulty score)
A 30-year-old man is brought to the emergency ...
Increased serum angiotensin II concentrationπŸ”

Block/Question (25.5 difficulty score)
An obese 45-year-old woman with type 2 ...
DiarrheaπŸ”

Block/Question (47.6 difficulty score)
A 29-year-old woman has an inflammatory ...
Immune complex-mediated cytotoxicityπŸ”

Block/Question (63.9 difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin geneπŸ”

Block/Question (41.7 difficulty score)
A 50-year-old man is admitted to the hospital ...
Intracellular [Na+]: increased;
Intracellular [K+]: decreased;
Intracellular [Ca2+]: increased
πŸ”


Block/Question (12.2 difficulty score)
A 50-year-old man who is a college professor ...
It must be difficult for you to accept this diagnosis when you feel healthy.πŸ”

Block/Question (39.0 difficulty score)
A 38-year-old man who lives at sea level ...
pH: increased;
HCO3-: increased;
Volume: increased
πŸ”


Block/Question (56.9 difficulty score)
Microelectrode injection of antibodies to ...
Area labeled β€˜Cβ€™πŸ”

Block/Question (16.9 difficulty score)
A 50-year-old man comes to the physician for ...
Yes; the patient may wish to consider the money's influence on the physician's recommendationπŸ”

Block/Question (16.9 difficulty score)
A 38-year-old man with Down syndrome is ...
Contact adult protective servicesπŸ”

Block/Question (28.9 difficulty score)
An 82-year-old woman has been bedridden since ...
Carboxylation of precursor proteinsπŸ”

Block/Question (30.5 difficulty score)
A previously healthy 26-year-old woman comes ...
Acute retroviral infectionπŸ”

Block/Question (48.9 difficulty score)
A 57-year-old woman comes to the physician 2 ...
IntercostalπŸ”

Block/Question (46.4 difficulty score)
An 18-year-old man comes to the physician 10 ...
C8πŸ”

Block/Question (37.2 difficulty score)
A 27-year-old woman comes to the physician ...
Antiphospholipid antibodiesπŸ”

Block/Question (19.0 difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pyloriπŸ”

Block/Question (38.7 difficulty score)
An 85-year-old woman is diagnosed with a ...
Morphine is metabolized to active metabolites that accumulateπŸ”

Block/Question (39.6 difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathyπŸ”

Block/Question (48.6 difficulty score)
A 43-year-old man is brought to the emergency ...
Fibularis (peroneus) brevisπŸ”

Block/Question (41.9 difficulty score)
A screening test for cancer is developed and ...
Data point labeled β€˜Aβ€™πŸ”

Block/Question (43.0 difficulty score)
A study is conducted to assess the prevalence ...
Chi-square testπŸ”

Block/Question (45.3 difficulty score)
A 45-year-old woman comes to the physician ...
25%πŸ”

Block/Question (34.9 difficulty score)
An 84-year-old woman comes to the physician ...
Downregulation of E-cadherinπŸ”

Block/Question (31.6 difficulty score)
A 3-month-old girl is brought to the ...
Motor: normal;
Social: delayed;
Verbal and cognitive: delayed
πŸ”


Block/Question (34.0 difficulty score)
A study is conducted to assess the extent of ...
Type I error: No change;
Type II error: decreased
πŸ”


Block/Question (18.7 difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalisπŸ”

Block/Question (21.2 difficulty score)
A 12-year-old girl who recently immigrated to ...
PraziquantelπŸ”

Block/Question (45.1 difficulty score)
A 45-year-old man with end-stage renal ...
BicarbonateπŸ”

Block/Question (81.3 difficulty score)
Which of the following is required for the ...
GlutamineπŸ”

Block/Question (24.8 difficulty score)
A 35-year-old man is admitted to the hospital ...
Absorption of nitrogenous products from the gastrointestinal tractπŸ”

Block/Question (26.0 difficulty score)
A 25-year-old woman comes to the physician ...
Fasting insulin: increased;
Testosterone: increased;
Luteinizing hormone: increased
πŸ”


Block/Question (43.6 difficulty score)
A 22-year-old man comes to the physician ...
47,XXYπŸ”

Block/Question (27.9 difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control studyπŸ”

Block/Question (61.3 difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammationπŸ”

Block/Question (19.7 difficulty score)
A 62-year-old man comes to the physician's ...
Alternative treatmentsπŸ”

Block/Question (18.6 difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMPπŸ”

Block/Question (54.8 difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressureπŸ”

Block/Question (36.4 difficulty score)
A 52-year-old man with stable angina pectoris ...
HeadacheπŸ”

Block/Question (30.9 difficulty score)
A 49-year-old man has had the gradual onset ...
Essential thrombocythemiaπŸ”

Block/Question (32.7 difficulty score)
A 56-year-old man develops brief episodes of ...
CL x CssπŸ”

Block/Question (21.0 difficulty score)
A 62-year-old man comes to the physician for ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”


Block/Question (31.9 difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitisπŸ”

Block/Question (22.1 difficulty score)
A 35-year-old man comes to the physician ...
Prescribe permethrin for the patient and his familyπŸ”

Block/Question (55.2 difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cellsπŸ”

Block/Question (11.7 difficulty score)
A 54-year-old woman with hypertension and ...
Vasodilating prostaglandins at the afferent arterioleπŸ”

Block/Question (38.9 difficulty score)
A 10-year-old boy receives a renal transplant ...
Lymphocytes infiltrating tubular epitheliumπŸ”

Block/Question (25.0 difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobulinemiaπŸ”

Block/Question (24.6 difficulty score)
A 42-year-old man is brought to the emergency ...
Dopaminergic neurons in the substantia nigraπŸ”

Block/Question (19.9 difficulty score)
A 56-year-old woman is brought to the ...
Herpes encephalitisπŸ”

Block/Question (49.0 difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesentericπŸ”

Block/Question (32.4 difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
AcetaminophenπŸ”

Block/Question (26.8 difficulty score)
A 60-year-old man comes to the physician ...
Alveolar macrophageπŸ”

Block/Question (43.7 difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2OπŸ”

Block/Question (55.6 difficulty score)
A new virus has been isolated that causes ...
Single-stranded positive-senseπŸ”

Block/Question (16.8 difficulty score)
A population of vegetarians is surveyed to ...
t-TestπŸ”

Block/Question (28.2 difficulty score)
A 27-year-old man comes to the physician for ...
Ask the patient to identify the pros and cons of smoking cessationπŸ”

Block/Question (20.4 difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin EπŸ”

Block/Question (41.7 difficulty score)
A 5-year-old boy is brought to the physician ...
Interruption of erythrocyte productionπŸ”

Block/Question (47.6 difficulty score)
An 81-year-old man comes to the physician for ...
AtherosclerosisπŸ”

Block/Question (19.5 difficulty score)
A 26-year-old woman comes to the physician 5 ...
SertralineπŸ”

Block/Question (14.7 difficulty score)
A 73-year-old woman dies 7 years after the ...
Hydrocephalus ex vacuoπŸ”

Block/Question (16.0 difficulty score)
A 36-year-old woman comes to the physician ...
Cytosol with translocation into the nucleusπŸ”

Block/Question (44.9 difficulty score)
In patients with adenosine deaminase ...
Ribonucleotide reductaseπŸ”

Block/Question (58.9 difficulty score)
A 24-year-old woman, gravida 1, para 1, comes ...
Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytesπŸ”

Block/Question (29.0 difficulty score)
A 4-month-old boy is brought to the office by ...
Maxillary and medial nasal prominencesπŸ”

Block/Question (15.8 difficulty score)
A 62-year-old man with dyslipidemia is ...
GemfibrozilπŸ”

Block/Question (38.9 difficulty score)
A 10-year-old girl has a slightly painful ...
GranulomaπŸ”

Block/Question (39.4 difficulty score)
A 76-year-old man with a 1-month history of a ...
Anomalous origins of multiple renal arteries to each kidneyπŸ”

Block/Question (38.3 difficulty score)
During a study of symptomatic proximal deep ...
Open-label clinical trialπŸ”

Block/Question (17.5 difficulty score)
A previously healthy 45-year-old woman has ...
Thrombotic thrombocytopenic purpuraπŸ”

Block/Question (23.6 difficulty score)
A 37-year-old man comes to the physician for ...
Hyperplastic arteriolosclerosisπŸ”

Block/Question (19.3 difficulty score)
A 57-year-old woman comes to the office ...
Autoimmune downregulation of Ca2+ channels of the presynaptic terminalπŸ”

Block/Question (25.7 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-Ξ±πŸ”

Block/Question (25.3 difficulty score)
A healthy 25-year-old man eats a meal ...
Fusion of an intracellular vesicle with the plasma membraneπŸ”

Block/Question (36.3 difficulty score)
A 60-year-old woman comes to the physician ...
MeningiomaπŸ”

Block/Question (47.1 difficulty score)
A 78-year-old man comes to the physician ...
Metastatic carcinomaπŸ”

Block/Question (40.8 difficulty score)
A 48-year-old man comes to the emergency ...
Splenic veinπŸ”

Block/Question (25.6 difficulty score)
A 45-year-old man who is HIV positive comes ...
Disruption of the pathogen cell membraneπŸ”

Block/Question (38.9 difficulty score)
A 27-year-old man who is a construction ...
Splenic flexureπŸ”

Block/Question (31.5 difficulty score)
A 65-year-old man comes to the emergency ...
CracklesπŸ”

Block/Question (38.6 difficulty score)
A case-control study is conducted to assess ...
Cannot be determined from the data givenπŸ”

Block/Question (31.1 difficulty score)
A 38-year-old single woman with a history of ...
DisplacementπŸ”

Block/Question (17.2 difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyteπŸ”

Block/Question (42.0 difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜Cβ€™πŸ”

Block/Question (23.6 difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase responseπŸ”

Block/Question (40.2 difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophyπŸ”

Block/Question (23.1 difficulty score)
Patients with mucolipidosis II (I-cell ...
Secreted from the cellsπŸ”

Block/Question (38.8 difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cellsπŸ”

Block/Question (18.5 difficulty score)
A 5-year-old boy with mental retardation is ...
Maternal origin of both chromosomes 15πŸ”

Block/Question (28.5 difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4πŸ”

Block/Question (12.9 difficulty score)
A 31-year-old man comes to the physician ...
DihydrotestosteroneπŸ”

Block/Question (26.8 difficulty score)
A 44-year-old man comes to the physician ...
Tricuspid insufficiencyπŸ”

Block/Question (40.9 difficulty score)
A 10-year-old boy has bruised easily since ...
Prolonged prothrombin timeπŸ”

Block/Question (31.3 difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cellsπŸ”

Block/Question (59.6 difficulty score)
A 39-year-old woman comes to the physician ...
HemoglobinπŸ”

Block/Question (49.5 difficulty score)
A 56-year-old woman comes to the physician ...
Maintenance of basement membrane integrityπŸ”

Block/Question (36.2 difficulty score)
An 8-year-old boy is brought to the physician ...
Calorie consumption that exceeds energy expenditureπŸ”

Block/Question (20.9 difficulty score)
A 52-year-old man with metastatic oat cell ...
Ensure that the patient receives enough medication to control his painπŸ”

Block/Question (42.1 difficulty score)
A 31-year-old woman in the second trimester ...
Hematopoietic stem cellsπŸ”

Recent comments ...

... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +57 
submitted by seagull(1389)
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Ddi enyano eend to aedr ttha salt esnctene eilk 50 stiem uaebsce the throua uefsrse to sue teebtr ga.rmamr sJut irsarnftu.gt

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +16
drbravojose  Actually never understand what the author saying at any time. LOL +3
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +
... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +55 
submitted by sacredazn(80)
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The teccnop si a duvootlnce wya fo iasnkg fi ouy wken who DVJ rtceianminboo ,skwor hwhic si atth ti is tullycaa an mxpeeal of tlgnriae the NDA of the BT/ pocymhel.yt

otunSehr bolt qn:chieetu oS nweh ethy use a rpobe snitgaa moes og,rnei dan iotnuguttp a eisz of 5.1 bk ro 6 b,k this is elligtn you het zsei fo hte NAD mgatfrne ni chea lelc odn’t(es treamt if htye sya J robep or aconnstt onrgie bero,p ryt’ehe sjtu nysiag yhert’e geigntatr seom icnotleude eusnqcee uofdn ni eht gI TCucosl/R aebt ihacn ulocs rseiectpyelv ofr /TB csl)l.e

I nithk eht scufognin part coudl eb inowndegr owh uyo wnko ethewrh uy’roe ltpray rhtugoh aegrreennrtam are(snw shocice B rtuh D) ro if ti ht’san drceoucr at lla ety tcercro( .nesra)w Hre,e teh etnocpc si ttah B lsecl rgendou D)(VJ maeengtrerran in eth beno ,mrarow elwhi T lcles od ti ni teh sht,muy nad ti all asenphp at c.eon oS a lsamap elcl ni the bodlo lkei in lliutMep oamyelM owudl aveh yllfu ngeduoren rcniaoei,bmotn leihw a T llec ni het loobd dlocu ihtree be uflly addeucet dn(a vhea snfihdie VJD tniroboanecim) ro utmrmiea (hnst’a sttrade )V.DJ

eicSn hte T lcel gene asw 6 bk nad idneeflity gbgire naht eth .51 bk enge, het T lcle anh’ts rnungdeoe oieinrnboatcm te.y

trichotillomaniac  very nice explanation! +26
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +4
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +4
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +40 
submitted by seagull(1389)
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Wihch of hte wolglofin asersno is why shti tuoniesq is lb?lu

)1 Ugnis teh dwor "yiccl"c snitaed fo iccrtilyc ofr acrltyi

2) gnoKniw lla fo iogyoepiledm of lal gdusr

3) hviagn to oernsa uot ttha gnhnealccortiii tfceefs era byrbolap het tswor revo ahla1p or 1H fftecse ot no .eiycrttna

)4 ehT picrilgnp esiodrneps of tysgiund fro ysew-sade-kot on nde to opralbyb od regavae on teh .stte

nlkrueger  yo, re-fucking-tweet +20
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +
... mcl made a comment on nbme22/block2/q#37 (A 63-year-old man has had progressive stiffness over...)
 +32 
submitted by mcl(577)
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This emgia si eluf.su eNot htta teh nstai dsue akmse imnley peaarp rkda.

enegttiV si cyplati ofr osPknisn'ar iedsa.es Arae D is eth bsiasutnat gnir.a

oznefu  Oh nice! Thanks! +
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +
apurva  Saved My life +1
... liverdietrying made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +31 
submitted by liverdietrying(93)
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hiTs noe wsa a ltietl icytrk. roF isth noe het eyk si hte wol dredioinoai k.tapeu Tihs iptante hsa hgih T4 adn wol SHT whchi eksam ssene in a yrrhdoytpeih tpetnai, srheapp ryuo ifrst ghuotht is thta tsih anptiet hsa a’evrsG iasd.see eoHe,vwr in Gsare’v uory hodryit is beign eitslmatud to make remo oyditrh omehrno fmor acrcsht adn as uhcs luodw veha na icesdaren eniidoaiodr ktpuea bceause teh dhrotiy si irginbgn in eth derirueq wno( dadrllaeb)eoi .dniieo Tihs is why it is nto vaGesr ele(aerβ€œs of oyrtidh onheorm mrfo a irhyotd dstuitmlea yb saeoti”dib.n)

oS fi tsi not Gas’rev wtah cuold it eb? orF tshi od’yu aevh to nkow ttha amiohstosH’ dtirohsiyiT oa(sl nwokn sa rCnoich tpyomhcyicL tdhiTiiyosr dan is ntofe rreedfer to sa uhcs no bodra eaxms ot worth yuo of)f ahs herte psaehs - isfrt eyht ear hoieyp,tyrdhr tehn t,dyhreuoi hnte hte lcaciss hoyprhtdoyi atth yuo udwol tcpeex htiw owl 4T adn hihg H.TS hsiT saw eth eyk to hsti qieotusn. heT raneos orf this si that ntarhytidoi odapreixse donbsateii in oss’hmoHtai ecusa eth rohdyti ot sereale lal fo its sdrteo drohiyt oemhnor iamkgn eth itntaep yreydhthoirp for a otrsh oripde fo mtei. frAet tish iveamss saelree of tihroyd ,onromhe eth tsniodaeib akme temh bauenl to mkea wne TH nad freeohetr yteh ceobem toyieuhdr for a hsort irodep dna tnhe tyohoprhyid ihhcw you wluod eept!xc nScei they ’anct keam wne TH, eht yrhoitd will ton akte up teh inaoiedordi dan eeofrerht hetre lwli be low oedoiidrnia k.ptuea neH,ec β€œleresae of rtodse riodyth hormoen form a yritdho gdnal aidrleftitn yb h”.sloyemytcp aak Ltiychβ€œpycmo tos(o)hiahms yhisi.o”drtti

I htikn elβ€œasree fo trydohi moorehn form a plamoymhuots ioyrtdh dgla”n si einrrrefg to smeo knid fo trdhiyo cnearc in whhci asce yuo dwoul tepecx ethm ot be edibncgirs a dnuleo on ieoanridodi kpu.tea

urmamyS​ voeid eehr adn aols a tareg stei ni arenle:g ttpecnie.:pdcnrehqd/yieehraerasmo/rnuooio//s/d/nldgit

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +9
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2
... keycompany made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
 +30 
submitted by keycompany(294)
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ointerNg lnabeac is a neemmutsare fo netopir bsaimmleot ni eht boy.d A ngtveiea onitenrg laanbec tadncesii smeclu oss,l sa dinsarece usomatn fo oanim caids ear ibneg ealoedimztb ot udecrop re.geny iTsh naeisecrs the tonuma of ninrtoeg erstecde fmro the o.dyb eBucsae the muonta of groenint oyu rea ngtaki ni si slse hatn eth mutaon fo gnerniot uyo era rcteignse, yuo vaeh a gaentevi enrtogin aaecbnl.

Tihs mna is ,hrmosldenaui dmee,saotu hc,icctae nda ahs yobpliahmimnau.e hseTe calnlici isnindfg ptino ot neorpti rilniontumta arhwiakosK( eaDssie), wihch ucssae aedme ued ot eecredasd smeur ctoiocn ersue.spr woL oticnco eessuprr in hsti easc si edu ot troeipn o,sls adn ehcen a gineetav eintngro el.abnac

drdoom  Nice! +15
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +3
zevvyt  also, it says that his albumin is low. +
... joha961 made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +30 
submitted by joha961(43)
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keLi rothes eavh i,das I nthki tnombusliia dolwu vahe nebe ttre,be ubt lpditemenacs ofrm isrft dia ysas tath ti ,is iβ€œirreenodct fo noetoims or sisumlep ot a rnuaelt sorpne or ctobje” os h’sse inkgikc reh fliyma by gkiknic the ba.g

djeffs1  Not if you're sexist and think its inappropriate for women to participate in kickboxing... +
... kernicterusthefrog made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +27 
submitted by kernicterusthefrog(107)
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he"s slefe aprheip nad roem lx"rdeae etfra agsnttri ok:ibignckx hsit si a RTUEAM sdeenef emasmnihc a(lscsic oxoetkbt smutnaiboil, as hsa bnee i.ad)s hTis tnosuqei si utsj apnil ogrw.n tI's not eciapdtn,lesm eaebcsu i'ts a ,lythhea oslcialy accteblaep tleuto hatt omevspir reh aolnitoem ;state icpgunhn sbga rae emant to be cpdnueh u(hts it is acaylult TON ).etrlnua telcsapemDni ot an btjoec odwlu eb nupgcnhi a elho ni her llw,a or irnakgbe reh vesa I( tsju ekli ttah mriye).ga tBoh of tsoeh wdluo eb ebetrt atnh uhnicgpn erh l,ayfim ro inkgbear treih rca wwd,ion hiwhc is why tis' lipnedtescam (iocscsnuuno eocdrenriti of an tonemio to a esrfa to)jbce. roHewv,e ikgiobnkcx si LLAILTYER an xeamlep ni aresvle sphcy eotxstkob ofr itsnb.lamoiu aThkn uoy ofr omingc ot my TDE .Tlka

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +13
happyhib_  What if, just what if. Her taking time to do lessions was actually hurting her children by her having less time to spend with them and in turn not providing good care for them. (less of a mature defense mech now). Trust me I agree completely just not best answer, but given what we are given you could argue beyond that; amboss even says "a mom showing her feelings of anger towards the child instead of the actual problem, the husband". So in a way she is not addressing her actual problem (which she COULD address). +
... imgdoc made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
 +26 
submitted by imgdoc(132)
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I tiknh tsi the rhgit FML ea(ra ,C) otn eht ithrg scudnaeb sculnue ttah si ienosdle no the rssoc nos.eict fI teh cdsnbaue sleuunc erwe sideonel ehs l'utwdno evha acbidtoun in reh ltef ye.e hTe FLM emtasdie srosc ltka eenbewt hte ncbaueds sneuucl no othb iesds to the LMF on het opiostep esdi (2 sabncude cu,ieln 2 FML oen on haec ds.)ei In her eas,c erh irhgt MFL nwt'sa utgoncnfiin nhcee ywh esh swa ganizg letf but erh irhtg demlid rtecsu ast'wn octcngaitn ot imeedta fldrwtea ze.ag

sTih repucit leh:sp ehw:t-hucm.4jboth-Ft-mtd95wot2pan0g/1wpchptan.p//ens02u/ootl_m1w/p/h/

imgdoc  *medial rectus +
... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
 +24 
submitted by drdoom(801)
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Cuancliotasl fro dad. hTe lptaibryobi fo teh ahtref beign a irecrra si /32 iecns it si owknn taht eh ’denost vhae eht .adesise Then hte iolribatybp fo mhi pssaign it on ot shi dik si 2/,1 :thsu

  • obtliybarPi fo add enigb ciaerrr = /32
  • irblbtPoiay of add pigssna on iseadse elleal = 12/

lcCaoialstun fro omm. hitW eth -WnirHgdyarbee lPc,nerpii yuo acn uiregf uto hte lboiaytibrp of the retohm begni a :rraicre

q = q0004,/0(rs1t) = 01/20

o,S pq2 = 2 * /0201 * 0021/99, wihch si xoappr 1./100

roF het hcdli ot teg eht eaelll rofm ,mom otw nigsth eend ot p:hapne ()1 omm ustm be a rrerica toozgtyr”[]eβ€œehe dan )2( mmo sutm pssa het alleel to l:cihd

  • oybbrilPait of mom gbine recrria = 100/1
  • rbyPbliotia fo mom asnspgi no sediase laeell = /12

uPgnit it lal trteeohg. No,w nmiobce lal ehtt:oger

= pta(iilyrbbo fo dad ngbie rrcai)re * iral(bbiytpo fo add nsgaips on sdaesie ea)elll * itorbbliay(p of mmo eibng er)ircra * rb(tiopailyb fo omm sigsanp no sedaeis )aellel

= 32/ * 21/ * 0/101 * /12
= 1 ni 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +35
niboonsh  This question makes me want to vomit +11
drdoom  lol +
5thgencephalosporin  okay wow +
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
 +24 
submitted by alwaysanonymous(29)
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iHs ialdt emvuol asw 005 .Lm pEntieyoadr-xr asw 5+ cm and roieptynnsdi-ra was 2+.5 eW erew supesopd ot sue the renefficed ni iyrawa ,serrepsu nad nto eht reds-yoanprinti lrpulae uesperrs )2.(0+

inpcomeCal = Ξ”V/Ξ”P = 005 / 20 = 52 cm/Lm O2H

some-zheimers  Great explanation. In general, also a great idea to pay attention to the units. I studied Physics in undergrad and have got one or two questions based purely on following the units, when the formula slips. +23
endochondral1  is that equation in FA? +
redvelvet  yes @endochondral1, at page 651 in 2019FA +9
... k_tron_3000 made a comment on nbme22/block3/q#19 (A 42-year-old man comes to the physician because of...)
 +23 
submitted by k_tron_3000(30)
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hTe dpoietrcins fo ieartallb rwleo blmi osls of avionbrti splimei CMDL dg,maea nad teh nsetba TDRs + emgorRb smee to me to be piyiglmn ttah he lyspbosi ahs ebsat sroidasl frmo ihlsisyp (or hsneomgti reyv mlsiari in )e.etiopatrnsn

As for eth hroet anse,swr A is rwnog ueascbe hsi rtoom ncuntofi is t,caitn B si gworn acuebse pnia nad tumetrraepe defictis are otn e,enitodmn C is orwgn usbacee it ilpimse a ccpsfiie veren is enedar,tpp utb eh sah oslt eialbrlta senatnsoi ni shi nretei weorl termeisetxi

D is hte triice,tsk and I’m ton %010 r,ues utb I wdlou ktinh ohapyradlctui fo the rotrneai ltnre)(va tsoor ldwou ecasu toomr edtcifis nesci ehty ryacr ootmr .nfeeersft Yuo htmig olas etxecp atth mtoor yiustoncfdn to be rnultil,aea iscen ti oduwl eb ueinklly to aevh a mplbore wiht hte veren orsto no ohtb sed.si olsa hte CLMD is not tcodlae earn eht rainreto troso of eth napsil r,doc so fi the roaentri orots rewe fedtfcae uyo lrelay l’dunotw etcepx ot ese brtayirvo ls.os

oS iyalacbsl ecspsro fo tim,eloinain I do elfe klie yonsesr rhupoenyat si na lxyermete eauvg wnesar ghhuto dna I n’wsta a nfa of het eo.tnuqis

keycompany  This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word β€œRadicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral). +29
hello  Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness. I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function. +14
niboonsh  Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative? +1
link981  Great explanation guys +
usmel2020  UW QID: 12035 explains what you are testing with Romberg sign +4
... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +23 
submitted by usmleuser007(370)
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utJs mreber:em

1) eTt-ts at(e for two) = ksloo at hte anme uevsla of 2 pgrous

)2 OVAAN (ssiyanal fo aieavc)rn ~ eilk sttet- btu = ksolo ta nmea evsalu of 3 or remo pousgr

3) e-iqahCrus = solko ta teh )%( ro rrotpnsopio ewnteeb 2 or roem r.psuog

,os ujts okol for ohw aymn pugors gbein aedserdsd dna hawt lasuve hyet are nusig %( or mnsea)

... seagull made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +23 
submitted by seagull(1389)
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uot fo ,iisrucoyt how may oelepp wkne tihs? dtn(o eb syh ot say uyo ddi or td)dn?i

yM pyetvro tuaedinoc 'tndid aringni tsih ni m.e

johnthurtjr  I did not +1
nlkrueger  i did not lol +
ht3  you're definitely not alone lol +
yotsubato  no idea +
yotsubato  And its not in FA, so fuck it IMO +1
niboonsh  i didnt +
imnotarobotbut  Nope +
epr94  did not +
link981  I guessed it because the names sounded similar :D +14
d_holles  i did not +
yb_26  I also guessed because both words start with "glu"))) +26
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1
jaxx  Not a clue. This was so random. +
ls3076  no way +
hyperfukus  no clue +
mkreamy  this made me feel a lot better. also, no fucking clue +1
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4
djtallahassee  yea, I mature 30k anki cards to see this bs +4
taediggity  I literally shouted wtf in quiet library at this question. +1
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21
drschmoctor  Is it biochemistry? Then I do not know it. +4
snoochi95  hell no brother +
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +1
waterloo  Nope. +
monique  I did not +
issamd1221  didnt +
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1
mumenrider4ever  Had no idea what glucosamine was +
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1
surfacegomd  no clue +
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +
chediakhigashi  nurp +
... seagull made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
 +23 
submitted by seagull(1389)
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The truaohs tewn uto fo htier awy to idnf whet rowst hopot fo a rgolmuaan etyh odlcu. Teh etrwh no a emst ahtt tgsuessg ttha it duwlo eb trnnogiaual .utsei But elittl ddi ew onw.k..

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +17
sbryant6  Got this right because the exact same question is in Uworld. +
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +4
haniainabox  Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1
... yotsubato made a comment on nbme22/block2/q#31 (An unimmunized 1-year-old boy is admitted to the...)
 +22 
submitted by yotsubato(961)
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nI ,gyioolb pshae oaiianrtv si a temhdo rfo neigadl htwi yilprda vyrgnai tnsmeoennvir uhitowt ireiqngru ronmda itao.tmun It lvvsioen the nvioartia of iroetnp essexopr,ni qntleyuerf ni na oon-ff hfs,naio ihntwi iftdrefen ptsra fo a cibetrlaa ioauntlpp.o As chus teh hpetoypne can ticswh at rqneifueecs atth aer chmu ghrihe tsiesmom(e g&)%1t; thna sialcclas iamttoun esatr. Phase avniitaro inucbtstore to rvilceneu by ggtneierna hnge.toierytee tlhAgouh ti has bene otms clmonoym uedtdsi ni hte ncteotx fo mmneiu niv,osea it is oevrsbed in mayn otrhe areas sa lewl adn si yepolmed yb raousvi petsy of brea,atci inulncgid Slnemlaalo .ssepcei

kssat/pno_r.i/aawnieovni/hw/.tamwewPdw:ciht

whoissaad  is it the same thing as antigenic variation? +8
dorsomedial_nucleus  No, antigenic variation involves genomic rearrangement Phase variation can be thought of as MORE or LESS of something. An on/off switch. No DNA is being rearranged, just under or overexpressed in response to the environment. +4
makinallkindzofgainz  This isn't in Zanki, Lightyear, or First Aid, and I don't remember ever learning about this in class. Thanks NBME! :D +18
... keycompany made a comment on nbme22/block2/q#41 (A 12-year-old boy is swimming in a mountain stream....)
 +22 
submitted by keycompany(294)
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rAnw:se rcaneseId lrntCea dooBl moVule B,)VC( deacreDes AD,H crsenedaI PA.N

Teh yoscghlopliia opesesrn to iaptehmrohy is cotosrocvtsinani of iphelarrep lssesev (ei.. eth seno in yrou )esimitexter in an toferf ot peek oryu eroc dyob earpretemtu nml,rao nda usth ryuo gasnor cgutfnionni .elrpopyr alhirePpre nstVonrccaoitois wlli csnreeia BCV. dceIesran BCV llwi asuec na encesiar ni paelrdo, nad hust aeucs an secneria in BNPPAN/. PPNANB/ hsa itbryhioni fcetesf no eth oRnAeetlnneoneoss-i-rndnitigA ,teSmys igntslure in esdcdraee ADH.

gokings2021  RAAS is not directly linked secretion of ADH as claimed above. Increased pressure at baroreceptors and increased central volume sensed by the hypothalamus will decrease secretion of ADH. +3
... usmleuser007 made a comment on nbme22/block3/q#45 (A 28-year-old man who is seropositive for HIV has...)
 +22 
submitted by usmleuser007(370)
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ym ltis of spnidle eytp secll nda cosidnton:i

  • .a N1F-
  • b. N2-F ~ nwaahoncmS nAn(tio A) = unesouatC ioroafnmebur ~ ghih yiucatrelll /w( ldisagpani steaptnr ithw iirnrpgneetss ucnerearlef- szeon cadrb;cpeyalVnso&el sibdeo
  • .c aomLmioye truu(se amp&; segsauoh)p
  • .d Meoileomahts roecanitkty( eoi)sivtp
  • e. plicansaAt hToydri anccer p(csihaib ap&;m ngola ihtw tanig ce)sll
  • .f yarleduMl Thioyrd nccera na(c aols evha laygonopl )clels
  • g. mPyiarr dacarci omranaacogis i(lamngtan uavcrals ipensdl el)lcs
  • .h soatamoOrecs bn(oe eca)rnc oppheicm(lor el)lsc
  • .i anMgnimeio
  • .j 'ssiKoap acoSmar V8H-()H = -likiStle ucasvral casspe with lumpp eddlhna-psespi oltmras lescl
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1
mcl  I love this and I love you +4
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +
... bubbles made a comment on nbme22/block3/q#13 (A previously healthy 26-year-old woman comes to the...)
 +21 
submitted by bubbles(66)
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rFo eht pespe who tog ouncfsed on hsti uesotiqn cb of W'soUdlr riewd etsiuonq on IVH vairl dola:

ueatc 1IHV- tifiocnen: HGIH iavlr dl,ao owl 2-VbAIH i:nncoefti LOW livra ol,ad owl Ab b(c sadrdnta VIH ysassa etcdte 4p,2 wihhc si otn tsneerp on 2IV)-H

diaKn deaynno I iesmsd an yeas oulgmoynmi ceocpnt usnqtioe /:

eacv  I feel you my friend! same stupid mistake over here -.- +3
step1soon  FA 2019 pg 176 +2
... hayayah made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +21 
submitted by hayayah(1056)
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ihsT is a ettpnai cesa of traspmutpo yirtosdhi.it Can sarei pu to a erya eftar veirdely nad hsa yclyoihpctm .tifrtleina

almondbreeze  FA 2019 pg 338 +1
waterloo  Although history seems to point towards that, she has an enlarged thyroid, and in postpartum thyroiditis, thyroid usually normal in size (from FA). regardless either would have lymphocytes infiltrating. +
... imgdoc made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +20 
submitted by imgdoc(132)
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I intkh laot fo pelpoe igmht eavh vroe piszdeaemh how nmttpirao NAP nad NPB ryaell ,rea esy it si taimtrpon to okwn eetsh ppsdteie get etrcedse yb eht eintractalrialvr/u iraumdcoym dgrnui arhet fa.rilue evwreoH irhte elolvar encesseeitffv in tatinerg ehrta aiueflr is c,zlhi a rpteporec ltdo em thta fi PAN dna PBN ewre so ufeslu ni ssuanrieitr nhte ywh do ew ievg t?esiciudr 'stI ucbesae ASRA spewvrroeo tihs esystm neech ngiuacs enaetvgi stffcee nda teh ldsnsee ploo of htrae elfa.iur AKA ywh we eigv ACE os.riiinthb

gnKnwio htat NPA tseg uideeanrlzt by eth SARA ys,tsem we can ihsft our fuocs bkac ot htrae uilearf in tish at,eptni reehw icacadr tuotpu is aderec,sed egaidnl to ADH rsiceonte adn lfalyin ialtldunoi rotinhapea.ym

almondbreeze  a concept continuously emphasized by uw, but I get always wrong :'( +2
almondbreeze  good work done! +
raffff  why does the body make anp at all since its so useless +3
makinallkindzofgainz  @raffff - at least BNP gives us a good marker for heart failure exacerbations :) thanks body! +
mannan  Yeah it's important clinically because it has a high sensitivity (if negative, rule out) for Heart failure. +
alimd  At the same time ANP inhibits renin release? +
... keyseph made a comment on nbme22/block4/q#50 (A 31-year-old woman in the second trimester of...)
 +20 
submitted by keyseph(33)
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Jstu ym otw enstc: prtabtoo,otClsyh yrrmipa etms uvs,ill ,rlnbthpctyyaiootoss dan brltocahiopst ecaulan era lal nmctpenoso fo hte ienvepoldg lantcaep, iwhhc lepipuss the etusf in eor.ut eehsT rscuuetsrt rea lla dderiev morf het ,hotpblsator wichh si iescednrdo rebcnti-xmaoery ste.siu tpeetiHmc"iaoo mtse "elscl is hte nlyo waersn hiceoc atht udlwo edniiact eaflt apstr ewre rdmoe.f

shlopawsgbm/hyne.tnoduy.eaxmm/.elrdeepry.lT.g/oiortu/doubop:b/shypt

... keycompany made a comment on nbme22/block1/q#35 (A 35-year-old man is brought to the hospital after a...)
 +18 
submitted by keycompany(294)
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eoAlitntra of hte soceitrtmhat tse itnop si a lchoaphiamyt pcrsoes aeemdtid by rlodanptnagsis nda si deeindnnept of eht hytcatspime rosvune stsmye.

B, ,C D, nad E lla rrueqei hmtpitacyes revens to iilctel a roe.espsn

pg32  Can anyone explain the mechanism behind shivering and the sympathetic nervous system? +2
... mcl made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
 +18 
submitted by mcl(577)
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tpeseiD a icenrum aulve dlboo( rpe)sresu ebign ,duasrmee tiaesnpt lduwo eb aeddnitsge eehrit pevhietyensr ro rmnns.otieeov To ym dnerdsgnniua,t eht ebts test fro rocminpag racltogciae avaslireb rsasoc ropgus is a chi euqras ste.t

In tnotc,sra a -stett si sedu ot ceamrop ewetben teh smnae of otw rguspo rda(sumee ravablie tums eb it)ta.vunetqia

... moloko270 made a comment on nbme22/block1/q#30 (A 42-year-old woman is brought to the emergency...)
 +17 
submitted by moloko270(64)
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AF 7.45p - ugnrnbi urrbeb smell uaaicntnhloli rocucs sa an uaar orf mtlarope leob eyeiplps

... moloko270 made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
 +17 
submitted by moloko270(64)
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sols fo lidfu tesgrirg drsaeooltne todnriucpo, so ptaietn wlil vaeh haneirpayemrt dna mpheaiaoylk as a reulst

makinallkindzofgainz  dat RAAS +4
... drmohandes made a comment on nbme22/block3/q#15 (An 18-year-old man comes to the physician 10 days...)
 +17 
submitted by drmohandes(83)
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geirFn eoxifln neod yb:

  • DFP = lrxoef rdgmiuito udnufsorp elxe(fs DP)I
  • SFD = oexrlf moiurdgti claesipsifiru (eslxef PI)P

_

rievant:nnoI

  • DFS ///2435 yb iendma T(-C)51
  • PFD 32/ by namdei 15)CT-(
  • DFP 5/4 yb luran )(T18-C

_

urO eitantp a'cnt flex DPI fo ignr fngeri β†’ PD4F β†’ rlnua β†’ 8-.TC1

lOny bsieolps aenswr we cna pcik si C8.

... bhangradoc made a comment on nbme22/block3/q#26 (A study is conducted to assess the extent of cardiac...)
 +17 
submitted by bhangradoc(21)
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hTe -Pevula si lbyasaicl epty 1 rr,ore dan tehy epek eht avpeu-l eth msae a(t )&l05;t. in thob eiorsnsv of teh iesenmtr.xpe By escinngria urbnme fo stitenap ni eht ,orgpu htye cnirseea orepw of teh tdsu,y whhic csduere ptey II e.rorr

jfny21  Thank you +1
baja_blast  For more, FA 2019 p. 262 goes over Type I and II errors. +
... adong made a comment on nbme22/block1/q#38 (A newborn born at 26 weeks' gestation has...)
 +16 
submitted by adong(94)

literally know every single name they can possibly call this

djtallahassee  literally a new name every nbme +9
... mcl made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +16 
submitted by mcl(577)
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eTh seuoiqtn si grrfeerni ot the ihaemnoexs waya.thp

ymoabCrla oesaphthp dna inraegin ear dvnievlo ni het eura leycc. oS is mta-nleycalttguae (AG)N eutseag(lr dcotonriup of cobaarylm shtopa.ep)h

... keycompany made a comment on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
 +15 
submitted by keycompany(294)
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owFl taeR = loVeycit x cnCorsia-eStsol rAea

2 c^2m x 20 c/mces x 06 msnc/ei x 1 1L00/0, 3cm^ = 24. mi/Ln

,1000 3mc^ = 1 L

seagull  Well, I missed this one. I don't even feel bad. +53
link981  @keycompany a small typo, 100 cm^3 = 1 L not 1000cm^3. 1000 mL^3= 1 L +
hello  @keycompany how did you edit your original comment to fix your typo? +
winelover777  Pretty sure @keycompany was correct. 1 L = 1000 cm^3. Otherwise the answer would be 24. +3
drdoom  1 centimeter is a distance. (A line.) +
drdoom  If we multiply a line by another line, we get a surface area. (A piece of paper.) +
drdoom  If we multiply the piece of paper by another line, we get volume. (A cube. A box.) +
drdoom  If we fill the box with a fluid, we will have 1 mL of this fluid. +
drdoom  If we have a thousand of these boxes, we have 1 L of fluid. +
drdoom  1,ooo mL = 1 Liter = 1,ooo centimeterΒ³ +
... liverdietrying made a comment on nbme22/block1/q#32 (A 17-year-old boy is brought to the emergency...)
 +15 
submitted by liverdietrying(93)
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odoG fact ot mmitoc to oem:mry yuo sloe bbairc in hte lsoto ne(hec why eahrrida ucessa nanoonni gpa ebcmalito o,s)siadic dna aeliyelspc sole psimosaut ithw vatiaxle uabse sa( oeentndim ni eth enisotuq )e.smt r-ter/tn.-adoaws:aspdoehaon-rd-beeoila--ry/acsalhcustiepnbttadli.tmtcnewiotcwe/t/hiwtem

sbryant6  I'm going to go take a big bicarbonate poop now. +24
happysingh  i would suggest that you look into it a bit more. Why ? Had an nbme question (which confused the shit out of me) cuz, Bluemic Pt. who was abusing Laxatives (had the up & down arrows) and this is what it gave : Laxative Abuse β€” Metabolic Alkalosis : Β  ↓K+ Β  Β  ↑Cl- Β  Β  Β  Β  Β  Β  Β  Β  Β  ↑pH Β   ↓HCO3- so one of the points of distinction IS the increase in Cl- with laxative abuse (vs. vomiting, which was a knee-jerk reaction when i hear bulimia) +1
lola915  I thought diarrhea causes Non anion gap metabolic acidosis @happysingh +1
... bubbles made a comment on nbme22/block3/q#42 (A 62-year-old man comes to the physician for a...)
 +15 
submitted by bubbles(66)
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rniCcho ernal cfsiceinfuni:y

)1 poro eohppshat rceecnlaa ;tg&-- ghih meurs aniirgcno hrhppsoosou

2) hhig esmur hephatops -;t&-g osxepceml wiht iatvdnle nicota aC t;-g-& aC sflal

3) aC salfl -&;t-g sgiegtrr PHT sxai

4) inedky alrifeu ;-&tg- sedecaedr ttacyiiv of y1o-rsyedaxhl at eth neidyk &t;-g- elss lriiccalto

makinallkindzofgainz  this guy renals +6
paperbackwriter  Someone please help me with this (always trips me up): PTH causes increased vit D production in kidney... are we assuming the increased PTH can't catch up with the kidney failure? Is it the level prior to PTH compensation that they want? D: +
miriamp3  @paperbackwriter what it works for me ;;;; is find the first abnormality so CKD low calcitriol (no D vit) ---> is gonna increase PTH ---> the kidney are not working (chronic, they don't tell u recently- you can;t revert a CKD so the kidney never going to catch up) --> increase inorganic phosphorus.--> always start with the problem. I also use this for celiac and types of shocks. start with the problem, and trust yourself. +2
paperbackwriter  @miriamp3 thank you! I will try out your strategy next time!! :) +1
snripper  I thought renal insufficiency -> inability to reabsorb phosphate at PCT -> decreased phosphate? +2
... d_holles made a comment on nbme22/block1/q#15 (A 35-year-old woman has weakness and fever. When she...)
 +14 
submitted by d_holles(170)
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jGnlao erstesss eht aBords vgngii hte eeulimka oiusnqste aywa esabd on het gae nvieg in het qntiuseo .stmes

LAL = 04-1

AML = 5913;- 9-504

LLC = 60+

LCM = 50-94

tdo6llsur/re/-djar.d/ohp03oettck:aeus-tnto.emfmthgssoet05u3nn/snia./

impostersyndromel1000  thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +
hyperfukus  also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +2
... keycompany made a comment on nbme22/block1/q#33 (A 32-year-old woman begins to hyperventilate and...)
 +14 
submitted by keycompany(294)
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poyaeneitHintrvl deaersce .aPO2C leartCn hcerrmstecoope rdsneop ot wlo O2aCP by vttgcnosircansoi cearbelr blood le.sessv

)A aAlrrtie loBod gnxeyO ntniorencCato: Bdool nxgOey oetiCornnntac is rictedyl eatlred ot bH cotraeotcinnn nda rusintaato O2aS() AF91,02 p. 653. Vai eht oBrh fceEtf, adeecdser 2CPOa iwll sriecnae aOS2, tush sngreciian olobd gnxeoy nctinn.roeoatc

B) irArleta ldoBo 2OP: aO2P hacnsge in orpesnes ot crdaeedse P2,OA 2I,PO or fusi.fdnio herTe luwod eb on ncgeha ni OPa2 grnuid topaiiyeerhvnntl yocr)ellihtet(a.

)C tlaierA sPrruese: ereacdesD C2aOP is saaodcstei thwi irnnosvsao,oitcct hwhic owudl aeenrcis oobld reupessr.

E) ebCrelar seTuis pH wuodl ienscare deu to ptrsroayrie ioss.lalka

keycompany  EDIT: Via the **Haldane Effect**, not the Bohr Effect. +
impostersyndromel1000  excellent response +
teepot123  fa 19 pg 489 +
... armymed88 made a comment on nbme22/block2/q#32 (A 54-year-old man who works in a delicatessen comes...)
 +14 
submitted by armymed88(47)
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fO eesht tiposno avlbilae,a nnhwcaS slecl owldu eb eth nlyo elcls seetnrp in eth .NSP sA,ttsye cor mlarcoigi nad ogsoli aer lla SNC esllc lle ateSti ellsc era ni het lucmes dan evrse to dai ni clmeus erapir and rinagroeenet

yb_26  Thats myosatellite cells. Satellite cells are also glial cells that form around damaged nerve cells and lie close to neuron bodies in the CNS +15
drzed  Myosatellite cells are also called satellite cells so it is not clear which definition they were using. +1
... ilikecheese made a comment on nbme22/block3/q#14 (A 57-year-old woman comes to the physician 2 weeks...)
 +14 
submitted by ilikecheese(39)
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If ouy ntaw to nhtki of isht y,limps eht bisr are eneocctnd yroeoriplst to het retlvbrea .uclmno dan eht ttnaecsriol ensiv rnu wneetbe ,hmet os thye rea eht tocessl ot teh ebatvrrel locmnu.

... meningitis made a comment on nbme22/block1/q#18 (A 13-year-old boy is brought to the physician for a...)
 +13 
submitted by meningitis(499)
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Tnenra tsgeas astrt at TNE eyras odl

eStag :I

  • I is tl,fa as in lfta steh;c
  • I si nealo, sa in on auxles rsahi.

Sgtae II 2:)( sgtea II tsrsta at 11 /yo I(I oklo leki 11)

  • 2 aslbl (atsecultri ameent)regln
  • 2 ihras ucipb( aisrh own anpegprai)
  • 2 sbaret dbsu fmor

agSet III (3:) tsrast ta 13 yo/

  • If yuo ttreao 3, it klsoo kiel malls btsresa (Barset mosudn );mfor
  • fI you guieglsq teh III tyhe look like ccersu+aorly piucb ahri
  • drIcsenae senip ehnltg and iesz cna eb repeeretnds y:b II &g-;-t III
    ruo(y insep was nthi II utb own sti cerikth III)

atSeg IV :(4) ttassr ta 14 /o y

  • stFri ia:ngmie Teh I in VI rrpestseen hte thhig, adn hte V in IV sokol kiel eht snom bpsui bwneeet uyor e:gsl
    E: ANGNIM uyo vhae aihr ni onsm bispu )(V btu yuo eahv a roberd dntgaiein eht hrai ormf rgowngi ntio ig.htsh
  • ehT V is tinpo,y as ni onw the sbersat are tynopi (rsiade lroeaa or nuomd on um)odn

tSaeg V ():5 15 yo/

  • V ahs no drebsor ngenaidit rhai ofmr ronwigg oint ghiths bi(cup ahir + higth hir)a
  • 5 rssifneag( ni asdnh) ngntatielf the rsoeala nweh ngrabgib tmhe e(aarlo nelaftt at iths esatg dan no emor udm"on no omnu")d

meningitis  Sorry about the format, it came out wrong but I hope his helps. +1
drdoom  looks good to me! +15
gh889  According to FA2019, stage 2 ends at 11, stage 3 starts 11.5-13, and stage 4 starts at 13-15, where did you get your info from? +
meningitis  You can change it to ENDS at 11, ENDS at 13, ENDS at 14... I simply have it as a range just like you stated in a couple of them. The importance is in how the kid presents because he/she will have some things mature but others not, the age will vary in questions. +
endochondral1  stage 3 breast mound is for females not males btw +2
endochondral1  see pg. 635 in FA it just pubertal. Idk if that correlates to the same stage as females +
angelaq11  this is just too funny, I LOVE it! xD +2
snripper  While this is impressive, this doesn't help with answering the question. +1
yng  Pseudogynecomastia (False gynecomastia): this has nothing to do with puberty or hormones. Simple d/t the fast some guys have extra fat in chest area, making it look like they have breasts. The boy weight at 60 percentile while height at 50 percentile. +
... humble_station made a comment on nbme22/block2/q#1 (A 29-year-old woman is brought to the emergency...)
 +13 
submitted by humble_station(67)
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ihTs is tanrheo niqteuos sitgnet the petconc fo paislta .aomatny If hte nreugso si niigltf hte evlir adn htne het ebedl tnew rfmo a small tuanom ot a sduend vaseims rhagoh,emre elyarlc hsti is milgniyp the bdele si urconcgi bdnhie eth evirl.

tahW tetcruurs si dinhbe eth vie?rl IVC

thaW ntcncose to the ICV fomr eth vel?ri tHiaepc evisn

oAls hte iead atht het tnteiap sha eben ednbelgi for 6 hosur aecebus hstta woh nogl it took tnilu het reotloxyapr mryptlaaao wsa romfreedp nesma eht lbeed is mots lyielk romf a olw erussrep tsmy.e..s veonsu yss.tme

... d_holles made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
 +13 
submitted by d_holles(170)
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I tog shit neo aiv crpesos of atnoi.iielmn tNo resu hwo you aer puedossp ot eeerbmmr lal atht tsih.

... highyieldboardswards made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +13 
submitted by highyieldboardswards(13)
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rShot rnws:ae All negse aer rstenpe ni htbo B and T l,lsce but they erngaearr nad xepsres rperestoc ahtt era picefcsi ot erthi eg.lniea Tirhe aer deenipntned VDJ iognres for B lcel terpreoc ireaegnnot nda T elcl crtreope trgaio!enne sThi ikwi elriact hdses ilgth on s:ith

pp)JVlltnwii(/e/thsiniiegwse.oa_cr_tmo:rdcnerebr.ioe#tTck/p/akD_oi

I oot argtclylai imedss .h.its ubt ti is alulycat os mplesi ttha ew ear sminsig eht tsoerf hugtroh het trsee eiW-l -h boht B dna T llcse guronde DJV gmtnerera,naer het V, D, adn J eensg era NDTFEIFRE EESNG sdetipe bgnie rzinadoge dan reeforhte lsiefcdasi in a lsariim ahifson edu ot rtihe drseha dnee to agrnteee eridesv uttesc.rrsu oT ekam startem mroe o,ifnucngs hbot sest of DVJ eseng are no smmoochroe .14

shiT is hyw teh BNEM iecfpdesi ttha ythe rae tgnaigg HTE ASME J GONEIR ichwh si atth fo eht B lcel oteprerc nege J ,goreni ont eth T elcl coetrrep ngee eatb-J ieonrg ee(s kwii .rtl)ecia eTh B clel proectre neeg is nto aargnrrdee ni a T l,cle fi ti as,w T lscel wloud aehv bnisideot!a

redstrat  This. So much this! +1
... d_holles made a comment on nbme22/block3/q#44 (A 35-year-old man comes to the physician because of...)
 +13 
submitted by d_holles(170)
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amDn I fele kile MBEN fickgun osvle bsacsie ro esom hit.s

... drzed made a comment on nbme22/block3/q#50 (A 56-year-old woman is brought to the emergency...)
 +13 
submitted by drzed(206)

I'm a simple man, I see encephalitis and temporal lobe involvment, I click herpes.

asharm10  hahaha true that, overthinking is the reason for getting so many questions wrong +
... btl_nyc made a comment on nbme22/block4/q#35 (Nicotinic acid acts at which of the following...)
 +13 
submitted by btl_nyc(55)
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:A nhotlesmaeyircr nda etorh ilbe aicd snresi penrevt het trpuaeek of libe dcias rfom eth tg.u

:B iSsntta nitihib CMHG-oA ercadetus, vtprnginee the virle from miankg eliaoncvm cai,d a esrprorcu to seoehll.rcot

:C nciiaN ci(oincnti ai)dc ceduesr hticape VLDL hnysstise dna alos nhisitib pisolyisl in aeisopd esutis yb tnhiibgnii eohmrno vitnisese .eilaps

D;:&aEmp Fbetasir egpelarutu iilptenroop eslpia (P,LL) cearisnngi idylcrtreieg naeaccerl (LVLD nda ysnolormcihc era lful of ledytc)sirrgie and slao ecvattai iemoreopsx oiftrrvtip-reoletadaac ctor-erep lhapa aRPhp-la)P(A ot ueindc DLH tsnsy.iesh

... bubbles made a comment on nbme22/block4/q#47 (A 56-year-old woman comes to the physician for a...)
 +13 
submitted by bubbles(66)
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Bnametse bneemram eriytignt is eht metintrdnea fo lful lugn rceeyovr wnioofgll pmynarulo tlnisu.

ry:aumSm

()1 slos of etbsmane mreneabm ygirtenit is itcilacr in mnidgrnetie eth β€œiptno of no r”r,tnue dna sirbocunett ot teh nyliiiatb ot rtelbesaish rlmona ulng ecthucitraer hiwt toroponim of irbosif;s

)2( lsos fo pltlieeahi csle,l hieeoltdnla ,sllce dan tnesmeab eemrmban ierttgnyi ni ualus eatnliistrit nniemauop esadctoisa whit idhctoiaip murypnaol rfibsosi ldsea ot ertodsyed lugn terchicterau nad uetparelp bss;rifoi

)3( insrftargmno ogtrwh rafcΞ²ot- is nysr,ecaes ubt ton linrteey stf,ifueinc ot omtorep epntarmen ;ibiofssr

)(4 psttenrsie ijtnugtinanein/tyrri/ra si ctrcaiil fro the pioogpnrtaa fo bifsiso;r

)(5 oapcdtiihi nuaryompl bfsisoir si an expmela fo a orsescp eaedltr ot het cietnpserse fo na iges(),t”nanβ€œ hiccnor ,aonilmnaitfm dna siribof;s nad

6() iunuqe clsel aer icrcilta clllerau psleary in the ounrgelita of fbor.ssii

init:co tawie/l.ncnmt//.i/st6ai2mcPc/ph4ontgh.5vl21b:rp/w4sw.CM

endochondral1  any FA or pathoma or uworld correlation? +
endochondral1  or was this a random? +
taediggity  Type II pneumocytes serve as the stem cell precursors, w/out those you're more or less fucked: FA 2020 pg 661 +4
... meningitis made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
 +12 
submitted by meningitis(499)
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I laos ughhtto teh asem sa @lusebbb, tub onw tnrygi to "jst"uyfi isth tyirck EBNM qni:eusot I thnik itsh volveres no teh ftac hatt teh titepan ahs a IHGH dolob rspsreue imgenna we uoshld focsu no na swrena htat liseaxpn ohtb enaecrids BP dan Hlpvmiyeoao :(.ei edasicern DAH hhiwc crsaossiocvttn nda olas rabsobs frw-taee,er othb of hihwc isaecnre PB adn sceua .epiomlvy)hao

aMybe if hits tpienat were tepdnedcamseo htwi LWO BP, neo oucdl tiknh reom utabo .PAN

I lstil ikhtn isth oeitsunq is OOT crkyit.

meningitis  Sorry, hyponatremia* right? +
mantarayray  I think that it's not ANP because ANP will cause a loss of Na but water will follow (they usually go together), whereas ADH will cause absorption of only water and will cause hyponatremia except only thought this post getting the question wrong :") +4
mantarayray  Oops sorry the formatting is confusing: I think that it's not ANP because ANP will cause a loss of Na but water will follow (they usually go together), whereas ADH will cause absorption of only water and will cause hyponatremia. +2
pg32  @mantaray pretty sure you are right and that is the only way to get this question correct. Remembering that Na concentration really is a measure of water balance is key. If the pt is hyponatremic, that just means they have too much water in the blood, which is caused by ADH. If the patient was hypoVOLEMIC, that might mean they are losing too much Na. This is illustrated by pts with SIADH. They are hyponatremic, but euvolemic, meaning that they have too much water (hyponatremia from the ADH) but their Na balance is ok (due to excretion of Na via ANP/BNP) +
avocadotoast  We need to be thinking about how heart failure is a condition with a low effective circulating volume. Our patient had an MI and now his heart cant keep up with the volume (low CO), leading to congestion. When congestion occurs, water is pushed into the interstitial spaces and isn't circulating in the arterial system. For that reason, the body ramps up the RAAS and ADH despite an actual increase in body water. This is a non-osmotic release of ADH. At this point plasma sodium levels are determined by relative intake and losses and hyponatremia is common in these patients because of that. Also, ANP and BNP don't hold a candle to the RAAS. +
... welpdedelp made a comment on nbme22/block1/q#22 (A previously healthy 6-year-old boy is brought to...)
 +12 
submitted by welpdedelp(215)
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It saw ascisbe, cwhih is sretnitatdm seoopnrr.po-ne

welpdedelp  **person-person lol +5
suckitnbme  NBME loves their scabies +14
dentist  did you get scabies from "burrows" and "night itching" +
pg32  My question is where do you get scabies originally? I knew it was transmitted person-to-person, but thought it has to originate somewhere (a pet possibly?) so I went with pets. The internet only seems to say that you get scabies from another person with scabies, so the question remains: where do people contract scabies from? +
leaf_house  @pg32 , long quote: + "Sarcoptes scabiei mites seek the source of stimuli originating from the host when they are off the host but in close proximity to it. This behavior may facilitate their finding a host if they are dislodged from it and contaminate the host environment. Thus, direct contact with an infested host may not be required for humans and other mammals to become infected with S. scabiei. In the case of human scabies, live mites in bedding, furniture, toys, and clothing can be a source of infection. Sarcoptes scabiei var. hominis have been recovered from laundry bins in a nursing home." + from here: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2234-1 +
zevvyt  to summarize leafhouse: Fomites +1
surfacegomd  FA 2020 p.161 "transmission through skin-to-skin contact (most common) or via fomites" +
... hopsalong made a comment on nbme22/block2/q#3 (A previously healthy 28-year-old man comes to the...)
 +12 
submitted by hopsalong(25)
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ihTs tqsiueon sah a lto of nrwsae oi,tnspo dna you evirra ta pisashleroihiNt by nrihtgwo uto lal teh hoetr oisnpot by awht is imsi.ngs

,A B - Cicortla sceisNro nad lpryilaPa isroNces tmalos waysal occru in hte gtisetn of mcahsi.ei serlvuioPy lhythae 82 yaer dol nam sha on edievcen fo lisctifiangyn edracdees rnela sufn.repoi

C - ucAte abruulT creNsois si what oyu odsluh tnkih fo ithw clylataeSi )DANS(I c.tiyxoti eTreh are aymn ertho iecnpthroxo sgdur thta caues N,AT utb tihkn of ATN as durg ndcuedi enkyid .eadgma

D - ysistCit - nlFak inpa si alerted to kinedy uy,jnir ton eaddlrb g.damea sCtsyiit oclud eb lpisesob in nagscdine ,TUI tub eth eattnpi has no ervfe adn si elma uh(cm sesl nomocm in a).lsem

E - lplesierGortnihmou - This tesg iotn rert/piocchithipnne rssdyonem. eTh mets itennmso atth eh hsa bdolo in eht rieun whchi yma edal oyu nowd the ptciihern twaahy,p utb he sedo otn ehav nya fo hte other eoaatdiscs soptmym.s

F - Hoehamprnpyer - rnhoAte odrw rfo leanR elCl mr.oaCcnai oN iwehgt ossl ro teohr crcean ealretd tmmypsso (ftaegiu t.)ec

G - tItnetislrai priesNthi - iTsh si tenof a drug eundicd MIEUMN edimetda thpecty.ooniixr sTih si a ypte IV pinsehretyytsivi ritoneca ahtt sccruo keesw to mnhtso frate hte ratts fo oeitcnmiad (lkei DsI)A.NS ATN si moer eoactdssai ihtw gurd erosvdeo liwhe nletiaIsrtti is mroe itsoacedsa tihw imemun t.enricoa etrisatInil ephrsNiti iwll hvea WCB tascs in r.ienu

I - ohiilPsereptny - aCusde yb edagsnnci UTI tub on efrve si nts.pree

siTh elavse aishpiishrNoelt H)( as teh ectcorr naers.w %58 of rpisiNhsiloeath is tseoaiascd wiht hiatpoevyc ewlob odss.nu ehT aipn for petslanroiihihs nca elparse dan i,temr and aiclyonsaclo eth ianp nca evrlta omrf hte yndeki a(flnk nipa) to eht cmoutsr as het otsen ovmes hguorht eth .rerute

whoissaad  Great explanation. Always found it hard to differentiate between ATN and AIN due to NSAID use. This made it clear. Thanks! +3
hyperfukus  yasss +
dubywow  "occasionally writhes in pain" -- as a guy who has had a kidney stone, writhing in pain definitely hits the mark. Picture yourself knees on the ground, face on the couch, screaming incoherently while the paramedics are there because you can't control your own body movement and don't know if you're dying or whatnot from the canonball sized hole that (may or may not be) in your flank. Then imagine one of the paramedics is your premed study buddy. Never forget writhing and nephrolithiasis and premed study buddies. You will forever get this question correct in the future. +4
bharatpillai  i swear to god ive done a similar question on the usmlerx qb and they answer was renal papillary necrosis. which is why i got it wrong :( +
targetmle  i also remember that uw ques which got me this ques wrong. i think in that ques,patient sibling or he himself had sickle cell +
... yotsubato made a comment on nbme22/block3/q#9 (Microelectrode injection of antibodies to Ξ±-actinin...)
 +12 
submitted by yotsubato(961)
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reAa C is erwhe the pag icjnsonut eeetnbw aircacd tysceyom r.ea pGa nctnuosJi rea ufdon no the aasplm rbemeanm fo eth ardaicc .cymyeot

hTe qeiounst si lscbaalyi igknsa erhew eth saalpm nbmmerea si htiw a nucbh of eoihmbc boomumjumb yuo dton haev to tdsra.endun

... moloko270 made a comment on nbme22/block3/q#18 (An 85-year-old woman is diagnosed with a fracture of...)
 +12 
submitted by moloko270(64)
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poherMni is ideeoazbtml in the lvire ot nrmehor-uicoineudplg6- nad mongu3en-l,prcehrii-udo tboh of cihhw era tdcrxeee by eht ekiys.nd nI het tiegnts fo lnaer afuirl,e etesh leobitsatme nca mutclu,aaec esrtuilng ni a wegnrlio of teh eeuizsr hsrledh.ot ieohrnMp uolhsd erfeother be usde itwh outcian twhi idml rlean menpiimrta adn eb vedodia ni eht tengtsi of erlna a.fleriu

:ucrsoe eprcce.mhpg/ywutrlccgieihptlsnt-i--anurmoahmpw/epadoeadnhodnitocio-c6ylrsucc/.cosawgoi/asen/iclitoco-ec:re-tmx

htey evga a inth fo necidrsea eiictnrnea lee,vl psul dlore gae nca veig a dsewol nodw smaebimtlo and CNS smtympso