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NBME 22 Answers

RAAS
Question#2 (reveal difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDL πŸ” / πŸ“Ί / 🌳



Question#5 (reveal difficulty score)
A 10-month-old girl is brought to the ...
Naloxone πŸ” / πŸ“Ί / 🌳

Question#6 (reveal difficulty score)
A 2-month-old boy is brought to the physician ...
Human papillomavirus πŸ” / πŸ“Ί / 🌳

Question#7 (reveal difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading dose πŸ” / πŸ“Ί / 🌳

Question#8 (reveal difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical rib πŸ” / πŸ“Ί / 🌳

Question#9 (reveal difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4 πŸ” / πŸ“Ί / 🌳


Question#11 (reveal difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradation πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
During the first week of life, a male newborn ...
21-Hydroxylase πŸ” / πŸ“Ί / 🌳


Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgia πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemia πŸ” / πŸ“Ί / 🌳

Question#16 (reveal difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negative πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 27-year-old man is brought to the emergency ...
Eversion πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 13-year-old boy is brought to the physician ...
Reassurance πŸ” / πŸ“Ί / 🌳

Question#19 (reveal difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcoma πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosis πŸ” / πŸ“Ί / 🌳

Question#21 (reveal difficulty score)
A 30-year-old man comes to the physician ...
Polycystin πŸ” / πŸ“Ί / 🌳



Question#24 (reveal difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular artery πŸ” / πŸ“Ί / 🌳


Question#26 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Hydrochlorothiazide πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
During a clinical study, 15 patients with ...
Azathioprine πŸ” / πŸ“Ί / 🌳


Question#29 (reveal difficulty score)
A 28-year-old man comes to the emergency ...
Jejunum πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobe πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancer πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
Hypokalemia πŸ” / πŸ“Ί / 🌳

Question#33 (reveal difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flow πŸ” / πŸ“Ί / 🌳





Question#38 (reveal difficulty score)
A newborn born at 26 weeks' gestation has ...
Dipalmitoyl lecithin πŸ” / πŸ“Ί / 🌳


Question#40 (reveal difficulty score)
A 45-year-old man with chronic pancreatitis ...
Pancrelipase πŸ” / πŸ“Ί / 🌳

Question#41 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus πŸ” / πŸ“Ί / 🌳


Question#43 (reveal difficulty score)
A 13-year-old girl is brought to the ...
C1 inhibitor πŸ” / πŸ“Ί / 🌳

Question#44 (reveal difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectal πŸ” / πŸ“Ί / 🌳

Question#45 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Diuretics πŸ” / πŸ“Ί / 🌳




Question#49 (reveal difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
Azithromycin πŸ” / πŸ“Ί / 🌳

Question#50 (reveal difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structure πŸ” / πŸ“Ί / 🌳


Question#2 (reveal difficulty score)
A 65-year-old man starts using topical ...
Thymidylate synthase πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
A previously healthy 28-year-old man comes to ...
Nephrolithiasis πŸ” / πŸ“Ί / 🌳


Question#5 (reveal difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balance πŸ” / πŸ“Ί / 🌳

Question#6 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
4 Months πŸ” / πŸ“Ί / 🌳

erections libido penis
Question#8 (reveal difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled β€˜E’ πŸ” / πŸ“Ί / 🌳

immuno abo_incompatibility complement
Question#9 (reveal difficulty score)
A 26-year-old woman develops hypotension and ...
Antibody, complement C5-9 πŸ” / πŸ“Ί / 🌳

erections penis
Question#10 (reveal difficulty score)
A 56-year-old man with a palpable hard nodule ...
Pelvic parasympathetic nerves πŸ” / πŸ“Ί / 🌳

anatomy
cAMP
Question#12 (reveal difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMP πŸ” / πŸ“Ί / 🌳

Question#13 (reveal difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocolitica πŸ” / πŸ“Ί / 🌳

Question#14 (reveal difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodium πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breast πŸ” / πŸ“Ί / 🌳

Question#16 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinoma πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
Ten healthy human subjects are given a new ...
Phase 1 πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 32-year-old man comes to the physician ...
Reverse transcriptase πŸ” / πŸ“Ί / 🌳

Question#19 (reveal difficulty score)
A 50-year-old man comes to the physician 3 ...
Calcium πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 26-year-old nulligravid woman comes to the ...
Hypothalamus πŸ” / πŸ“Ί / 🌳


Question#22 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclase πŸ” / πŸ“Ί / 🌳

Question#23 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bug πŸ” / πŸ“Ί / 🌳

Question#24 (reveal difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failure πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
A 37-year-old woman undergoes excision of a ...
Angiogenesis πŸ” / πŸ“Ί / 🌳

Question#26 (reveal difficulty score)
A randomized controlled trial is conducted to ...
(194/2371) – (123/2365) πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3βˆ’ πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibial πŸ” / πŸ“Ί / 🌳


Question#30 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Multifactorial πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variation πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cells πŸ” / πŸ“Ί / 🌳


Question#34 (reveal difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600 πŸ” / πŸ“Ί / 🌳


Question#36 (reveal difficulty score)
Which of the following drug effects is the ...
Anticholinergic πŸ” / πŸ“Ί / 🌳


Question#38 (reveal difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medulla πŸ” / πŸ“Ί / 🌳

Question#39 (reveal difficulty score)
A 22-year-old woman comes to the office ...
Cardiomyopathy πŸ” / πŸ“Ί / 🌳






Question#45 (reveal difficulty score)
An 86-year-old man who lives in a skilled ...
Dextromethorphan πŸ” / πŸ“Ί / 🌳


Question#47 (reveal difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndrome πŸ” / πŸ“Ί / 🌳


Question#49 (reveal difficulty score)
A physician is unable to communicate "bad ...
Countertransference πŸ” / πŸ“Ί / 🌳


Question#1 (reveal difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve root πŸ” / πŸ“Ί / 🌳


Question#3 (reveal difficulty score)
An obese 45-year-old woman with type 2 ...
Diarrhea πŸ” / πŸ“Ί / 🌳










Question#13 (reveal difficulty score)
A previously healthy 26-year-old woman comes ...
Acute retroviral infection πŸ” / πŸ“Ί / 🌳

Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician 2 ...
Intercostal πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
An 18-year-old man comes to the physician 10 ...
C8 πŸ” / πŸ“Ί / 🌳


Question#17 (reveal difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pylori πŸ” / πŸ“Ί / 🌳


Question#19 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathy πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 43-year-old man is brought to the emergency ...
Fibularis (peroneus) brevis πŸ” / πŸ“Ί / 🌳


Question#22 (reveal difficulty score)
A study is conducted to assess the prevalence ...
Chi-square test πŸ” / πŸ“Ί / 🌳

Question#23 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
25% πŸ” / πŸ“Ί / 🌳




Question#27 (reveal difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalis πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 12-year-old girl who recently immigrated to ...
Praziquantel πŸ” / πŸ“Ί / 🌳

Question#29 (reveal difficulty score)
A 45-year-old man with end-stage renal ...
Bicarbonate πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
Which of the following is required for the ...
Glutamine πŸ” / πŸ“Ί / 🌳



Question#33 (reveal difficulty score)
A 22-year-old man comes to the physician ...
47,XXY πŸ” / πŸ“Ί / 🌳

Question#34 (reveal difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control study πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammation πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
A 62-year-old man comes to the physician's ...
Alternative treatments πŸ” / πŸ“Ί / 🌳

Question#37 (reveal difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMP πŸ” / πŸ“Ί / 🌳

Question#38 (reveal difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressure πŸ” / πŸ“Ί / 🌳

Question#39 (reveal difficulty score)
A 52-year-old man with stable angina pectoris ...
Headache πŸ” / πŸ“Ί / 🌳

Question#40 (reveal difficulty score)
A 49-year-old man has had the gradual onset ...
Essential thrombocythemia πŸ” / πŸ“Ί / 🌳

Question#41 (reveal difficulty score)
A 56-year-old man develops brief episodes of ...
CL x Css πŸ” / πŸ“Ί / 🌳


Question#43 (reveal difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitis πŸ” / πŸ“Ί / 🌳





Question#48 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobulinemia πŸ” / πŸ“Ί / 🌳



Question#1 (reveal difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesenteric πŸ” / πŸ“Ί / 🌳

Question#2 (reveal difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
Acetaminophen πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
A 60-year-old man comes to the physician ...
Alveolar macrophage πŸ” / πŸ“Ί / 🌳

Question#4 (reveal difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2O πŸ” / πŸ“Ί / 🌳


Question#6 (reveal difficulty score)
A population of vegetarians is surveyed to ...
t-Test πŸ” / πŸ“Ί / 🌳


Question#8 (reveal difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin E πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
An 81-year-old man comes to the physician for ...
Atherosclerosis πŸ” / πŸ“Ί / 🌳

Question#11 (reveal difficulty score)
A 26-year-old woman comes to the physician 5 ...
Sertraline πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
A 73-year-old woman dies 7 years after the ...
Hydrocephalus ex vacuo πŸ” / πŸ“Ί / 🌳





Question#17 (reveal difficulty score)
A 62-year-old man with dyslipidemia is ...
Gemfibrozil πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 10-year-old girl has a slightly painful ...
Granuloma πŸ” / πŸ“Ί / 🌳


Question#20 (reveal difficulty score)
During a study of symptomatic proximal deep ...
Open-label clinical trial πŸ” / πŸ“Ί / 🌳




Question#24 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-Ξ± πŸ” / πŸ“Ί / 🌳


Question#26 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Meningioma πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 78-year-old man comes to the physician ...
Metastatic carcinoma πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 48-year-old man comes to the emergency ...
Splenic vein πŸ” / πŸ“Ί / 🌳


Question#30 (reveal difficulty score)
A 27-year-old man who is a construction ...
Splenic flexure πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A 65-year-old man comes to the emergency ...
Crackles πŸ” / πŸ“Ί / 🌳


Question#33 (reveal difficulty score)
A 38-year-old single woman with a history of ...
Displacement πŸ” / πŸ“Ί / 🌳

Question#34 (reveal difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyte πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜C’ πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase response πŸ” / πŸ“Ί / 🌳

Question#37 (reveal difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophy πŸ” / πŸ“Ί / 🌳


Question#39 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cells πŸ” / πŸ“Ί / 🌳


Question#41 (reveal difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4 πŸ” / πŸ“Ί / 🌳

Question#42 (reveal difficulty score)
A 31-year-old man comes to the physician ...
Dihydrotestosterone πŸ” / πŸ“Ί / 🌳



Question#45 (reveal difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cells πŸ” / πŸ“Ί / 🌳

Question#46 (reveal difficulty score)
A 39-year-old woman comes to the physician ...
Hemoglobin πŸ” / πŸ“Ί / 🌳




Question#50 (reveal difficulty score)
A 31-year-old woman in the second trimester ...
Hematopoietic stem cells πŸ” / πŸ“Ί / 🌳

Recent comments ...

... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +68 
submitted by sacredazn(99)
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Teh tccnepo is a tonvodelcu ayw fo sakgin if uoy nekw owh VDJ ocmtbionrneia rsk,ow hwihc si ahtt it si ylculata an leaxmpe of inlagert eht DAN fo the /BT ycp.hloetmy

Sneortuh tlob qtehince:u So ewnh thye eus a prboe saiantg meos noir,ge dan ipgutntuot a zise fo .15 kb or 6 kb, hist is lngtlei yuo hte size of eth NAD engtfram ni hcea cell t’nsdo(e raetmt if they say J eprbo ro sonnctta ignroe pe,bro trye’eh tjsu ianygs th’reye enirgtagt osem cdeontluei ueencqes dnfuo ni het gI TRcCo/usl taeb hncai sucol yleetpscveri rfo /TB slc)e.l

I think the sinucognf aprt cludo be ewrnoindg how uoy nokw etwhrhe ry’ueo ylrpta turohgh rnteeramargen nwer(sa hcsoeic B htru )D or fi ti htnsa’ corruecd ta lal ety erctco(r ne).sraw ,ereH hte cpocnte is tath B lcels enourgd (DJV) mrreateengrna ni eht eonb wa,ormr lwehi T clles od it ni hte umy,ths and ti all aphsnep at ocn.e oS a asalmp ecll in eht boodl kiel in teplliMu eyMolam udwlo vhea lfluy uendoegnr boianmnctireo, iwhle a T elcl in hte dbool odcul eerthi be llfyu deacdeut na(d ahve ihfnesid JDV ono)eimcanbrit ro uiaremtm ’s(nath sattrde JD).V

enicS the T llec geen saw 6 bk and yeidneftil egrbgi ntah eth .51 bk gne,e the T clel hsn’ta edunrgnoe oeaiborctinnm ty.e

trichotillomaniac  very nice explanation! +28
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). +5
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +5
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!! +1
skonys  My logic was wrong but my answer correct. I am suffering from success. +
fhegedus  wow! this is amazing! thank you! +
... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +66 
submitted by seagull(1788)
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idD eannoy eend to aedr atht ltsa teneecsn kile 05 mtesi ecauebs teh atrouh suesfer to ues bertte maarmr.g sutJ nrgfu.atrsit

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +21
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) +
xmen  THEY GIVE SOMETIME WEIRD QUESTIONS DURING THE REAL EXAM !!! AND IT'S EXPERIMENTAL +
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +49 
submitted by seagull(1788)
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hWhic of teh olnwolgfi esorsna is ywh hsit iueosntq si lb?lu

)1 snigU hte rodw y"c"ccil idestna of itccyirlc for lriatyc

2) Kongiwn all fo mpdelgeooiiy fo all rudsg

3) nviagh ot arnseo out htat gilncinicahtoer cfftees are rbalboyp het rtwos vroe 1paahl or 1H feetfsc to on erytct.nia

4) Teh rpipclnig resopiensd of sgyntiud fro tekss--aeydwo on dne to yopablbr od agveare no hte .tste

nlkrueger  yo, re-fucking-tweet +23
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. +
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +
tekkenman101  "worst to experience" is incredibly subjective lmao. +1
... liverdietrying made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +37 
submitted by liverdietrying(111)
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ihTs eon asw a lelitt .ikrtyc Fro itsh neo hte kye is het wlo nddooaireii at.ekup hTsi ineptta sha gihh T4 and lwo STH hiwch kmsae eessn in a rpdyhiotyher aepitt,n perhspa royu sirft hhuogtt si htta tihs pineatt sah rGva’se ie.sdsae ,Hvrwoee in ’Gsrvea oury odrthyi is inbge umaltitsed ot maek meor trydioh heoonrm ormf trcshac nad as shuc uodwl avhe an arnesedic iedonaoirdi tepuak sueecba the odrhtyi is niggrnbi in hte rideqrue wn(o lebaai)erdldo noied.i sihT is wyh ti si ton esraGv serealβ€œ(e fo rthioyd hmnooer form a hrioydt leitadutsm by noside”tib.a)

oS fi tis tno Gva’res waht duloc ti ?be oFr iths odyu’ ahev ot onkw htat ’tHhsasioom otshiiyrdiT l(osa wnokn sa hnoirCc ycpymctioLh iotThdsriiy dna is eotnf edfrrere ot as schu on drabo xsema ot hotrw oyu o)ff hsa hetre heapss - tfrsi tyhe rae ropi,hthdyyre hnte ruhtdoyi,e then eht slsccia othyiphoydr ttah you dwluo ceextp htiw low 4T dan hhgi TH.S Tsih asw eht eky ot sith us.oetnqi hTe noears fro htis is tath dtrotanhiyi xirdoeeaps dneaoibtsi ni oai’Hsmhots ecsua eth rohyidt ot aesleer lla of ist rdetso orhdity oheronm mkigan hte natetpi yriohrytpedh orf a osrth epdrio fo tem.i fAert sith aevmssi leaesre fo ihyordt roe,mhon eht tbaindesoi make hmte uanlbe ot akme wen TH dna tfeerohre hyte eocebm udtyeorih fro a hsrot eoipdr nad etnh oihdhotypyr chiwh oyu odwlu ptec!xe nSiec tehy ac’tn amke new H,T hte itydroh wlli otn aekt up eth iddiioeanor dna eerrfthoe hreet lwil eb olw airdeonoiid p.ateku ,cHeen sβ€œrleeae of edsort oydtirh oemnroh frmo a ridyoht ngdal dlrttfeaiin yb se.yphmoclt”y aak β€œcyLiycpthmo osohst(ai)hm it.yh”stiirdo

I tnihk β€œaslreee fo riytdoh rooehnm fmro a aoythsmmolpu iroythd dnl”ga is rnrifeegr to mseo kndi of odtiyrh cnraec ni cwhhi esca oyu owldu xtpeec ehtm ot be sdiebicnrg a eulond no deoaorindii .upkaet

ar​muSym voeid eehr nda olsa a tgrea etsi in ne:glrea dg.ndh:h/enqr/ctoopiietlrsnydaeo/dn/pruc/teso/irieeam

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 +14
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...)
 +34 
submitted by keycompany(343)
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Neinrogt nalceba si a umemsranete fo ptoneir iaetommlbs ni het b.ody A eetngvia eiontgrn abnlace asnticedi uescml oss,l sa rdacenise tmsnuao of nioma scadi rae enbig ztdimbleoea to eodpcru .eeygnr hTis sreaescin eth onmtua of ignteorn escerdte mfor het odyb. aBceues eth oantum fo oigtnrne ouy rea anktig ni is lsse naht teh tauonm fo gretionn you ear tgersinec, yuo evah a tvgeneai eirnongt aancleb.

shiT mna is di,enhrolmasu aeem,dsout aec,cctih adn ash ebimaauypnohmi.l seeTh cianlicl diifnsgn itnpo to pnoreti mnrnoiuttali (kKirhwasao Deseisa), whchi secsau medea ude ot daderesec remus cntcooi e.esurspr owL ictnoco pursrese in hsit csae si deu ot tneirpo ,lsos nad nehec a naeetvgi igertnon .lbneaac

drdoom  Nice! +22
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 .. +5
zevvyt  also, it says that his albumin is low. +
ankigravity  A few other points related to nitrogen balance. Any patient who is growing (i.e., children, people working out and building muscle) are in positive nitrogen balance and arginine becomes an essential amino acid. +1
drdoom  @ankigravity Wow, this is technically correct! (Didn’t realize β€œessential” doesn't mean β€œcannot be synthesized by the body” but rather ”cannot be synthesized in sufficient amounts”; so what qualifies as essential is a bit of a moving target! Thanks!) +
drdoom  Here's the definition from MeSH: β€œAmino acids that are not synthesized by the human body in amounts sufficient to carry out physiological functions. They are obtained from dietary foodstuffs.” https://meshb.nlm.nih.gov/record/ui?ui=D000601 +
... mcl made a comment on nbme22/block2/q#37 (A 63-year-old man has had progressive stiffness over...)
 +34 
submitted by mcl(645)
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shTi gaeim is efulsu. eoNt hatt eth stani dues ksema ynieml apraep k.adr

Vetigten si ctiaply rof 'Paosnnkisr .edieass eraA D is eht usbsnttiaa rin.ag

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
... kernicterusthefrog made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +33 
submitted by kernicterusthefrog(133)
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s"he fesel airhppe and reom "daeelxr aretf tgntiars oxkigbikc:n hsit si a TMEUAR desenfe hnsmiacem icacs(ls obottkex lnobisiumat, sa ash eben isd).a Tsih ienoustq si jtus nlapi gonwr. 'sIt tno dmitaeple,cns ebecusa ist' a hth,elya ciylasol caebpeclta lttuoe thta svpoierm rhe tolaomien estta; pncuighn abgs rae aetnm to eb dhncpeu (usth ti is lutyacal OTN tu).alrne tDncslpmeeia ot na tjeboc douwl eb hucgnipn a ohle ni reh awll, ro ignearbk ehr asev I( tjus eikl taht mg.yira)e tohB of hesto would eb etrbet ntha gupcnhin reh iya,flm ro neigkrab hietr rca iwowd,n whihc is wyh it's lniascmteped nsococ(iusnu roctedrniie fo an itomneo ot a efsra cb)o.tej r,eHoewv xckigbnoki si LLTLEYIAR an exmpael in erlvsea phycs kotxbseot rfo aibnotmsu.li Tanhk yuo for inmcgo to ym TED klTa.

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +16
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). +1
kernicteruscandycorn  I support your assertion, fellow kernicterus +2
madamestep  I like to think of Sublimation as Regina George at the end of Mean Girls thriving at field hockey. +
... joha961 made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +32 
submitted by joha961(46)
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Like rhoest eahv ,isad I ktnih nlsatoimibu dluow veha neeb ee,bttr but eeslcmtnpaid rmof rftsi dai ysas taht ti ,is rondeiriβ€œcte of iomsneto or ispuemsl ot a ltaneru rpenso ro jtebco” os she’s nickikg erh ylifma by kcngiik eht b.ag

djeffs1  Not if you're sexist and think its inappropriate for women to participate in kickboxing... +2
chaosawaits  The sexism in some questions is thicc +
... imgdoc made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
 +29 
submitted by imgdoc(160)
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I nitkh tis the irgth LFM (aear )C, tno hte igrht nbusdaec enuulsc thta si densleoi no het ssorc ecsi.ton If eth enacsudb uncesul ewre senedloi hse ltwd'uno ehav ubnocitda ni ehr flet .yee eTh LMF aieetmds rocss atkl webteen the edanbcsu lcuseun on btoh isdes ot het LFM on het eptsioop idse 2( edcbauns cu,leni 2 LMF eno no haec ).ieds In erh sc,ea erh rhitg LFM tnsw'a cnigiuonfnt ncehe hyw esh aws iznagg eltf btu hre rigth lemdid surect wn'ast niagntctco to ideemat etdlafrw eazg.

hisT uciertp l:ephs tt.0_9n/p./spudtach5-/a0twnoh4ch/pho2gtle21bo/j/wm1Fpmh/ewumpt-tw:n-o

imgdoc  *medial rectus +1
... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
 +27 
submitted by drdoom(1107)
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oCtclnaulisa orf dda. Teh rlybitoibpa of eht athref bnieg a rrirace is /32 necsi it is wnokn tath he odt’sen ehav the de.eisas hnTe teh ritobipbyla of ihm isgspna ti on ot ihs dki is /1,2 :thus

  • aybltPbiroi of dda inbge iearcrr = 3/2
  • Pltaiybrboi fo add pgissan on dasesie lealel = 12/

cinsloaltuaC rfo mmo. tWhi het -ygbdrernHeaiW inPp,cleir ouy cna rgufei otu eht iatbypbolri fo eht toehmr bgnei a r:ircrae

q = ,s410t/rq000() = 0/120

oS, q2p = 2 * 021/0 * 092/109, wchih is prpxao .1/001

rFo the lihdc ot get hte eellla rmfo m,om wot inhgst dene ot pnpeha: )(1 mom ustm eb a rrrciea ego[z”hr]tβ€œeteyo nad ()2 mom tusm apss eht llelea ot i:chdl

  • biPlyoarbit of mmo einbg rcrreia = 01/10
  • btlioiaybPr of mmo ssignpa no eaesdis ellael = 12/

uintgP ti lla eohgtter. ow,N cimbeon all re:ohtegt

= iryobibatp(l of dda negbi r)eacirr * orpii(tlabby fo dad nigapss no esesdai )aleell * iotlb(ipyabr of mmo ebgni e)arirrc * (aypiotlibrb of omm ansgspi no saidese alle)le

= /32 * 2/1 * /0011 * 21/
= 1 in 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +51
niboonsh  This question makes me want to vomit +14
drdoom  lol +
5thgencephalosporin  okay wow +
tekkenman101  You can make this a lot quicker by using simple rules for autosomal recessive diseases. 1) Unaffected parent with affected lineage will be a carrier 2/3 of the time (Aa) 2) frequency in population is super low so you can ignore P and just use 2(q) in order to calculate carrier frequency. So take the square root of the homozygous recessive frequency (1/40,000) and just plug it in: 2(.005) = .01 3) The odds of their child being affected with the two parents being assumed hypothetical carriers is 1/4 (aa) or .25. Dad's carrier chance (2/3) x Mom's carrier chance (.01) x child's chance of being recessive (.25) +
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
 +27 
submitted by alwaysanonymous(34)
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iHs ladti uvoeml asw 050 L.m orxdantrye-Eip asw 5+ cm dan idna-nysrirpeto saw 5.2+ We weer seupspod to use het nceedffrie in aiyawr epsrersu, and ton teh tayerinns-podri uralepl rresesup 0(2.)+

cCaloenipm = ΔΔ/PV = 050 / 02 = 52 c/mmL 2HO

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. +27
endochondral1  is that equation in FA? +
redvelvet  yes @endochondral1, at page 651 in 2019FA +19
chaosawaits  any time you see the word compliance, Ξ”V/Ξ”P should immediately pop into your head. But my question is, coming from complete ignorance, is it just a coincidence that the end-inspiratory pleural pressure is equal to the difference of the needed values? +
... seagull made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +26 
submitted by seagull(1788)
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otu of ,tcioisruy hwo mya epeopl enkw siht? no(td eb ysh ot ays yuo ddi ro )idt?dn

yM pvyorte notuadcie din'dt rnigain sthi ni .me

johnthurtjr  I did not +3
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 +16
d_holles  i did not +
yb_26  I also guessed because both words start with "glu"))) +28
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?" +8
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. +5
djtallahassee  yea, I mature 30k anki cards to see this bs +5
taediggity  I literally shouted wtf in quiet library at this question. +2
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 +24
drschmoctor  Is it biochemistry? Then I do not know it. +5
snoochi95  hell no brother +1
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 +2
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
amy  +1 no idea! +
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 +
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1
l0ud_minority  No fucking clue I guessed wrong:( +


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