Recent comments ...
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ferrero made a comment on
nbme23/block4/q#45
(A 32-year-old man has a diastolic blood pressure...)
seagull
The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)?
+19
mousie
Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank)
+9
sympathetikey
My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance.
+40
cr
the main difference between the 2 cases is that in this case the patient has high BP
+1
link981
So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions.
+8
hello
@ferrero what are you talking about? lymphatic drainage is the wrong answer...
+1
hello
ok never mind. i got it. hard to understand b/c it was a big block of text.
+2
asteroides
I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly
"Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange.
For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure."
+6
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yotsubato made a comment on
nbme23/block4/q#10
(A study was conducted to investigate the mean age at...)
fulminant_life
Definitely was the same for me. I was so confused for like 5 mins
+20
d_holles
dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36)
+9
mellowpenguins
Are you serious. NBME strikes again with shitty formatting.
+9
yex
OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/
+7
monkey
what is 36 supposed to be?
+1
paulkarr
Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99"
+6
arcanumm
Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting.
+4
veryhungrycaterpillar
This is straight up tatti. I was like what muscular dystrophy is showing up with an almost biphasic age of onset between adolescence and 30s? Fucked it up.
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handsome
how did you get the 99 what is your solution ? hehe
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sne made a comment on
nbme23/block1/q#3
(A 52-year-old man comes to the physician because of...)
rina
also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out
+6
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sajaqua1 made a comment on
nbme23/block1/q#44
(A 34-year-old woman is brought to the emergency...)
jimdooder
Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped.
+4
larry
A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral.
C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs.
+2
larry
D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right.
E and F are the anterior corticospin
+3
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hayayah made a comment on
nbme23/block2/q#43
(A 2-week-old girl is brought to the physician by her...)
mousie
thanks for this explanation!
+1
krewfoo99
@macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss
+5
qfever
Do anyone know why not choroid?
+1
adong
@qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina
+3
irgunner
That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up
+12
mnemonicsfordayz
Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO.
+2
mamed
Key here is that it doesn't affect vision- the only thing would be the iris. All others are used in vision. Don't have to know what a coloboma actually is.
+5
azibird
The extra section of that Zanki card specifically says that a coloboma "can be seen in the iris, retina, choroid, or optic disc." Don't you dare talk trash about Zanki!
+3
fatboyslim
Honestly, I didn't understand what they were trying to ask...NBME has some weird wording sometimes
+1
weirdmed51
@azibird ...upvoting @irgunner cos you went crazy there buddyπ
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stinkysulfaeggs made a comment on
nbme23/block3/q#4
(A 31-year-old primigravid woman at 32 weeks'...)
link981
Slowly raising my hand as well
+2
usmlecharserssss
patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia
+16
myoclonictonicbionic
I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency.
+3
anechakfspb
me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong.
+1
feanor
And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols.
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soph made a comment on
nbme23/block2/q#40
(A 22-year-old man is brought to the emergency...)
jbc5356
The smiley face got to me more than it should have. Preciate you.
+6
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seagull made a comment on
nbme23/block4/q#50
(A 48-year-old man has complete loss of hearing in...)
catch-22
Start at the pontomedullary junction and count from superior to inferiorly (or medially to laterally): VI, VII, VIII, IX.
+3
yotsubato
I looked at the left side (cause the nerves arent frazzled up). Saw 7 and 8 come out together nicely. Then picked the right sided version of 8
+12
lolmedlol
why is it not H or I on the right side; the stem says he has hearing loss on the right side, so the lesion should be ipsilateral no?
+3
catch-22
You're looking at the ventral aspect of the brainstem.
+11
catch-22
^Also, you know it's the ventral aspect because you can see the medullary pyramids.
+1
amarousis
think of the belly of the pons as a pregnant lady. so you're looking at the front of her
+5
hello
which letter is CN IX in this diagram?
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miriamp3
there is no VI nerve. That's the thing. The VI nerve should be in the angle between the pons and the medulla. Parallel to the pyramid. It goes V then VII and then VIII. I make the same mistake and I thought it was the picture but there is no VI par in the photo. They know We count from superior to inferior.
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jesusisking
Don't G and H lowkey look like VII and VIII? I chose H b/c of that
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ljennetten
G and H are CN VII and VIII on the left side, while this guy has right sided hearing loss. CN VI is not labeled in this photo, but is the smaller nerve that arises medial to CN VII and us cut most of the way up the pons.
+1
prolific_pygophilic
Mother Fuckers took this with a disposal camera then deep fried it. What is this grainy ass picture
+1
soccerfan23
There's over a million pics of the brainstem on the internet and of course, the NBME picked the worst quality, most blurry one for this Q.
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beeip made a comment on
nbme23/block1/q#35
(A 42-year-old woman comes to the physician because...)
mousie
My exact thinking also!
+7
meningitis
My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things?
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criovoly
You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS
+5
feochromocytoma
The question stem says it's glandular hyperplasia "without" atypia
It's just due to increased levels of estrogen causing the hyperplasia
+4
faus305
This is a bunch of scientific mumbo jumbo
+1
chaosawaits
^^ I read your name as "ugly chromocytoma" and if that was intentional, buena onda
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water made a comment on
nbme23/block2/q#44
(A 4-year-old boy is brought to the physician by his...)
paulkarr
She taught me more than my med school professors did...
+5
meryen13
I think that cartoon is one of the reasons I'm a medical student! lol
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wired-in made a comment on
nbme23/block2/q#15
(A child with septicemia has an antibiotic clearance...)
lispectedwumbologist
That's so infuriating I stared at this question for 20 minutes thinking I did something wrong
+82
seagull
lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that.
+9
ht3
this is why you never waste 7 minutes on a question.... because of shit like this
+9
yotsubato
Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways...
+20
cr
in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but iΒ΄d appreciate if someone could explain it.
+1
hyperfukus
magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer!
+1
jean_young2019
OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ......
+7
atbangura
They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH
+6
titanesxvi
I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92
+3
makinallkindzofgainz
The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24
+21
frustratedllama
Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad
+1
fexx
'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-))
+1
cbreland
I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8π‘
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yesa
12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s
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chaosawaits
What really grinds my gears is that 3/5 answer choices are closely related to using 0.09 instead of 0.1 (A is 25.92/10, D is 25.92*2, and B is D/10). So basically, we're supposed to know to round 0.09 up to 0.1 but also to not round 12 down to 10. Okay?
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impostersyndromel1000
so you're telling me that I did all my math correctly, got 25.92 then thought I was off by a decimal point and chose 2.5 bc 25.9 wasn't an option and I was actually correct in my math but wrong bc THEY DIDNT PUT THE RIGHT ANSWER? Why is NBME so trash? I hope real exam isnt this bad.
+1
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thomasalterman made a comment on
nbme23/block3/q#4
(A 31-year-old primigravid woman at 32 weeks'...)
yotsubato
Truly a bull shit question... Its not in FA, Sketchy or Pathoma
+60
meningitis
I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman.
+11
dul071
i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia.
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curlycheesefriesguy
I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness
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An asymptomatic 30-year-old woman comes to ...
Anovulation π / πΊ / π³