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NBME 23 Answers

reproductive FA19p634
Block/Question (50.3 difficulty score)
An asymptomatic 30-year-old woman comes to ...
AnovulationπŸ”

oncology microbiology
Block/Question (20.2 difficulty score)
A 56-year-old woman comes to the physician ...
Microbial oncoprotein that interferes with tumor suppressor proteinsπŸ”

digestion
Block/Question (39.5 difficulty score)
A 52-year-old man comes to the physician ...
TriglycerideπŸ”

embryology neurology FA19p479
Block/Question (33.0 difficulty score)
A male newborn has a myelomeningocele that ...
Closure of the caudal neuroporeπŸ”

clinical_trials FA19p256
Block/Question (20.1 difficulty score)
A study is conducted to examine the ...
Phase 2πŸ”

psych personality_disorders borderline
Block/Question (18.7 difficulty score)
A 32-year-old woman comes to the emergency ...
BorderlineπŸ”

biochem cell_bio
Block/Question (37.1 difficulty score)
Which of the following is present in integral ...
Transmembrane regionπŸ”

biochem drug_interactions p450 pharm
Block/Question (26.4 difficulty score)
A 30-year-old man with HIV infection comes to ...
It increases plasma concentrations of other PIs also metabolized by cytochrome P450πŸ”

schizotypal psych borderline
Block/Question (13.0 difficulty score)
A 45-year-old man is brought to the physician ...
SchizotypalπŸ”

bed_bugs micro
Block/Question (53.7 difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureusπŸ”

anatomy neuro
Block/Question (37.2 difficulty score)
A 55-year-old man who has a 10-year history ...
ImpotenceπŸ”

micro moa
Block/Question (27.2 difficulty score)
A 48-year-old man who is a farmer in a remote ...
Blockade of postsynaptic inhibition of spinal motor reflexesπŸ”

prevalence incidence
Block/Question (40.2 difficulty score)
A researcher is asked to prospectively ...
Prevalence: above the standard; Incidence: above the standardπŸ”

hit FA20p315
Block/Question (18.0 difficulty score)
A 65-year-old woman develops deep venous ...
Heparin-induced thrombocytopeniaπŸ”

physio cholera fluids
Block/Question (19.1 difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% SalineπŸ”

biochem restriction_enzymes
Block/Question (62.0 difficulty score)
Physical analysis of the isolated genomic DNA ...
MethylaseπŸ”

anatomy
Block/Question (46.6 difficulty score)
A 54-year-old woman comes to the physician ...
SupraspinatusπŸ”

biochem pathways
Block/Question (29.4 difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme BπŸ”

biochem genetics
Block/Question (39.1 difficulty score)
Unlike the DNA polymerases found in ...
Mistakes in transcription are not transmitted to progenyπŸ”

repro embryo
Block/Question (27.6 difficulty score)
A 22-year-old woman at 12 weeks' gestation ...
Hydropic villi with central cisternsπŸ”

cd_markers rituximab
Block/Question (41.8 difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”

immuno
Block/Question (47.1 difficulty score)
An investigator is studying the adverse ...
Presentation of antigens to CD8+ T lymphocytesπŸ”

parkinsons neuro
Block/Question (30.5 difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agentπŸ”

endocrine
Block/Question (30.7 difficulty score)
A 39-year-old man comes to the physician ...
FerritinπŸ”

micro
Block/Question (41.9 difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virusπŸ”

genetics
Block/Question (30.7 difficulty score)
A couple comes to the physician for ...
1/150πŸ”

developmental
Block/Question (25.6 difficulty score)
An 11-year-old boy is brought to the ...
Sexual abuseπŸ”

neuro
Block/Question (46.3 difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”

immuno
Block/Question (38.8 difficulty score)
A 34-year-old woman with a 5-year history of ...
Infiltration of lymphocytes, plasma cells, and macrophagesπŸ”

Block/Question (30.0 difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnicsπŸ”

Block/Question (34.1 difficulty score)
A 16-month-old boy is brought to the ...
Absence of germinal centers in lymph nodesπŸ”

Block/Question (19.5 difficulty score)
Which of the following sets of serum findings ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased
πŸ”


Block/Question (52.4 difficulty score)
A 25-year-old woman and her 25-year-old ...
Ξ±-Thalassemia traitπŸ”

Block/Question (39.5 difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancerπŸ”

Block/Question (34.0 difficulty score)
A 42-year-old woman comes to the physician ...
Binding of permeable ligand to nuclear transcription factorπŸ”

Block/Question (26.3 difficulty score)
A medical student is caring for a 72-year-old ...
Let me get the resident physician so we can go over the results.πŸ”

Block/Question (33.1 difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”

Block/Question (24.0 difficulty score)
A 43-year-old woman sustains multiple ...
Hyaline membranesπŸ”

Block/Question (30.8 difficulty score)
A 65-year-old man who is a farmer comes to ...
Disruption of DNA strands secondary to ionization effectπŸ”


Block/Question (42.1 difficulty score)
A 62-year-old woman is brought to the ...
PonsπŸ”

Block/Question (43.3 difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”

Block/Question (37.9 difficulty score)
A 65-year-old woman has the recent appearance ...
AdenocarcinomaπŸ”

Block/Question (30.3 difficulty score)
A 34-year-old woman is brought to the ...
Area labeled β€˜D’ (Spinothalamic tract, right)πŸ”

Block/Question (22.3 difficulty score)
A 56-year-old woman comes to the physician ...
Presynaptic release of acetylcholineπŸ”

Block/Question (15.7 difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...
BoneπŸ”

Block/Question (31.0 difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”

Block/Question (46.0 difficulty score)
A 20-year-old man is brought to the emergency ...
3,4-Methylenedioxymethamphetamine (MDMA)πŸ”

Block/Question (60.7 difficulty score)
Electrical stimulation of the stellate ...
Heart rateπŸ”

Block/Question (39.4 difficulty score)
A 45-year-old woman with coronary artery ...
4.5πŸ”

Block/Question (30.7 difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporisπŸ”

Block/Question (45.8 difficulty score)
Cyclophosphamide and some other ...
GranulocytesπŸ”

Block/Question (44.8 difficulty score)
A prospective study is done to assess the ...
Include the outcome for each participant in the group to which he or she was randomizedπŸ”


Block/Question (35.7 difficulty score)
A female newborn develops respiratory ...
Osteogenesis imperfecta, type IπŸ”

Block/Question (36.8 difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis BπŸ”

Block/Question (45.0 difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shockπŸ”

Block/Question (29.3 difficulty score)
An 8-year-old boy is brought to the physician ...
Serum calcitonin concentrationπŸ”

Block/Question (29.8 difficulty score)
A 60-year-old man has had easy fatigability, ...
LungπŸ”

Block/Question (29.1 difficulty score)
A 50-year-old man who lives in eastern ...
Babesia microti and Borrelia burgdorferiπŸ”

Block/Question (20.4 difficulty score)
An antiserum is elicited by immunization with ...
Proteins X and Y have no epitopes in commonπŸ”

Block/Question (32.9 difficulty score)
A 75-year-old woman has stress urinary ...
Stimulation of Ξ±-adrenoreceptorsπŸ”

Block/Question (30.6 difficulty score)
A 45-year-old man comes to the office for a ...
Invasion of the submucosaπŸ”

Block/Question (9.6 difficulty score)
A 65-year-old woman with diabetic ...
MucormycosisπŸ”

Block/Question (78.7 difficulty score)
A child with septicemia has an antibiotic ...
28.8πŸ”

Block/Question (62.5 difficulty score)
Which of the following best explains impaired ...
Increase in axonal capacitanceπŸ”

Block/Question (24.9 difficulty score)
A 21-year-old man comes to the physician ...
LeishmaniaπŸ”

Block/Question (21.1 difficulty score)
A 48-year-old man comes to the physician ...
Perforated peptic ulcerπŸ”

Block/Question (48.6 difficulty score)
A 70-year-old man with severe congestive ...
Serum BUN: 40;
Serum creatinine: 2;
Urine Na+: 5;
Urine specific gravity: 1.025
πŸ”


Block/Question (31.6 difficulty score)
A 47-year-old woman has had a goiter for 10 ...
Replacement of thyroid parenchyma by lymphoid cellsπŸ”

Block/Question (34.2 difficulty score)
A 55-year-old man comes to the physician ...
FEV1/FVC: normal;
FVC: decreased;
Diffusing capacity of the lung for carbon monoxide: decreased
πŸ”


Block/Question (32.0 difficulty score)
A 42-year-old man comes to the physician ...
Sand flyπŸ”

Block/Question (24.1 difficulty score)
A 75-year-old man with prostate cancer has ...
Prostatic venous plexus to the vertebral venous plexusπŸ”

Block/Question (32.1 difficulty score)
A 46-year-old woman has a 1-day history of ...
Leukocyte alkaline phosphatase activity greater than 250 U/LπŸ”

Block/Question (48.3 difficulty score)
A 44-year-old man with invasive pancreatic ...
Area labeled β€˜Hβ€™πŸ”

Block/Question (29.4 difficulty score)
A 36-year-old woman comes to the physician ...
Fibromuscular dysplasiaπŸ”

Block/Question (30.2 difficulty score)
A 3-month-old girl is brought to the ...
Densely packed capillariesπŸ”

Block/Question (39.1 difficulty score)
A cohort study is conducted to examine the ...
200πŸ”

Block/Question (21.8 difficulty score)
Which of the following pairs of drugs ...
Lomustine and cyclophosphamideπŸ”

Block/Question (42.2 difficulty score)
A 21-year-old man is brought to the emergency ...
LiverπŸ”

Block/Question (8.2 difficulty score)
A 40-year-old man has had enlarging breast ...
SpironolactoneπŸ”

Block/Question (71.4 difficulty score)
A 2-year-old girl is brought to the physician ...
N-methyl-d-aspartate (NMDA)πŸ”

Block/Question (56.9 difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”

Block/Question (27.9 difficulty score)
A 35-year-old woman comes to the physician ...
Synthesis of viral DNAπŸ”

Block/Question (23.4 difficulty score)
A 42-year-old man with a history of recurrent ...
Magnesium ammonium phosphateπŸ”

Block/Question (26.3 difficulty score)
A newborn has external genitalia that appear ...
Hyperplastic fetal adrenal glandsπŸ”

Block/Question (17.0 difficulty score)
A 62-year-old woman is brought to the ...
Embolus to the femoral artery with left leg ischemiaπŸ”


pharm lipid_disorders fibrates
Block/Question (40.4 difficulty score)
A 39-year-old woman with obesity and recently ...
GemfibrozilπŸ”


Block/Question (37.8 difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canalπŸ”


Block/Question (45.4 difficulty score)
A 2-week-old girl is brought to the physician ...
IrisπŸ”

Block/Question (53.8 difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary changeπŸ”

Block/Question (23.1 difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nucleiπŸ”

Block/Question (12.7 difficulty score)
Which of the following types of vaccine is ...
Live attenuated virusπŸ”

Block/Question (31.9 difficulty score)
A 65-year-old man is scheduled for physical ...
Medial (internal) rotationπŸ”

Block/Question (25.3 difficulty score)
A 45-year-old woman is brought to the ...
Inspiratory pause on right upper quadrant palpationπŸ”

Block/Question (32.8 difficulty score)
A 56-year-old man comes to the physician ...
ColchicineπŸ”

Block/Question (12.2 difficulty score)
A 65-year-old man recovering from a cerebral ...
Preventing ADP-stimulated platelet activationπŸ”

Block/Question (48.9 difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sacπŸ”

Block/Question (33.9 difficulty score)
A 35-year-old man comes to a new physician ...
LiverπŸ”

Block/Question (35.7 difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”

Block/Question (72.1 difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
HypoglycemiaπŸ”

Block/Question (19.5 difficulty score)
A 68-year-old woman has a 6-month history of ...
Na+: decreased;
K+: increased;
pH: decreased
πŸ”


Block/Question (38.1 difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cellsπŸ”

Block/Question (12.2 difficulty score)
A male newborn is delivered at 39 weeks' ...
GastroschisisπŸ”

Block/Question (26.9 difficulty score)
A 62-year-old man with a blood pressure of ...
LabetalolπŸ”

Block/Question (24.6 difficulty score)
A male newborn is delivered at term to a ...
Ask the mother and sister to leave the room and inform the parents of the abnormalityπŸ”

Block/Question (29.6 difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curveπŸ”

Block/Question (14.5 difficulty score)
A 50-year-old woman with idiopathic ...
Penetration of larvae from soil into the skinπŸ”

Block/Question (24.6 difficulty score)
A 39-year-old man comes to the physician for ...
Ξ²-MyosinπŸ”


Block/Question (16.0 difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresiaπŸ”

Block/Question (25.1 difficulty score)
A 45-year-old woman comes to the physician ...
MyopathyπŸ”

Block/Question (25.7 difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary glandπŸ”

Block/Question (45.5 difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleenπŸ”

Block/Question (39.2 difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagonπŸ”

Block/Question (43.8 difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screeningπŸ”

Block/Question (26.8 difficulty score)
An 82-year-old woman is brought to the ...
Decreased function of the puborectalis muscleπŸ”

Block/Question (34.8 difficulty score)
A 60-year-old woman comes to the physician 1 ...
AmplificationπŸ”

Block/Question (37.1 difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudatesπŸ”

Block/Question (28.4 difficulty score)
A pregnant 28-year-old woman is found to have ...
LactotropeπŸ”

Block/Question (45.1 difficulty score)
A 25-year-old man is brought to the emergency ...
Fractional excretion of sodium greater than 2%πŸ”

Block/Question (29.4 difficulty score)
A 43-year-old woman undergoing chemotherapy ...
Preformed IgM antibodiesπŸ”

Block/Question (27.3 difficulty score)
A 27-year-old woman has headaches and blurred ...
AngiotensinπŸ”

Block/Question (20.3 difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defectπŸ”

Block/Question (25.8 difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cellsπŸ”


Block/Question (41.9 difficulty score)
A 20-year-old woman comes to the physician ...
C1qπŸ”

Block/Question (13.0 difficulty score)
The parents of a 1-year-old boy with a ...
MultifactorialπŸ”

Block/Question (25.3 difficulty score)
A 70-year-old man comes to the physician ...
Inhibition of prostaglandin synthesisπŸ”

Block/Question (41.9 difficulty score)
A 78-year-old man has had progressive loss of ...
OtosclerosisπŸ”

Block/Question (20.9 difficulty score)
A 34-year-old woman with a long-standing ...
FatπŸ”


Block/Question (41.1 difficulty score)
A 70-year-old woman comes to the physician ...
Serum sicknessπŸ”

Block/Question (29.0 difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118πŸ”

Block/Question (46.4 difficulty score)
A 5-year-old boy who has recently recovered ...
Immune destruction of plateletsπŸ”

Block/Question (38.8 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased CSF production by the choroid plexusπŸ”

Block/Question (18.4 difficulty score)
A 38-year-old woman with hypercalcemia, ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (25.9 difficulty score)
A previously healthy 45-year-old man comes to ...
InfraspinatusπŸ”

Block/Question (14.8 difficulty score)
A 48-year-old woman has severe ...
Inhibition of gastric H+–K+ ATPaseπŸ”

Block/Question (14.9 difficulty score)
A 65-year-old man has had increasing ...
Osteitis deformans (Paget disease)πŸ”


Block/Question (28.6 difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2πŸ”

Block/Question (48.9 difficulty score)
A 19-year-old woman is severely burned over ...
Increased metabolic rateπŸ”

Block/Question (17.4 difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibulaπŸ”

Block/Question (39.9 difficulty score)
A 20-year-old woman comes to the physician ...
Inhibition of the cytochrome P450-dependent demethylation reactionπŸ”

Block/Question (25.9 difficulty score)
Genetic analyses of cells obtained on ...
EpinephrineπŸ”

vascular pressure physics
Block/Question (40.3 difficulty score)
A 32-year-old woman, gravida 2, para 1, at 39 ...
Increased fetal systemic vascular resistanceπŸ”

Block/Question (49.7 difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2πŸ”

Block/Question (53.4 difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitisπŸ”

Block/Question (27.4 difficulty score)
A 33-year-old woman comes to the physician ...
Inorganic phosphorus: decreased;
Parathyroid hormone: increased;
Calcitriol: decreased
πŸ”


Block/Question (19.0 difficulty score)
A 76-year-old woman is brought to the ...
She expresses clear and consistent valuesπŸ”

Block/Question (19.6 difficulty score)
Transmission of a bacterial agent by ...
Meningococcal meningitisπŸ”

Block/Question (27.5 difficulty score)
A 35-year-old woman, gravida 2, para 1, ...
External anal sphincterπŸ”

Block/Question (16.0 difficulty score)
A 3-day-old female newborn delivered at term ...
Increased conversion of bilirubin to water-soluble isomersπŸ”

Block/Question (25.9 difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50πŸ”

Block/Question (17.5 difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetiiπŸ”

Block/Question (41.1 difficulty score)
A study was conducted to investigate the mean ...
99%πŸ”

Block/Question (17.2 difficulty score)
A 40-year-old man comes to the physician for ...
FinasterideπŸ”

Block/Question (48.3 difficulty score)
Investigators conduct a prospective, ...
Strength of association, temporal relationship, dose-response gradientπŸ”

Block/Question (35.6 difficulty score)
A 65-year-old man comes to the physician ...
Smooth muscle cells of the deep arteryπŸ”

Block/Question (46.4 difficulty score)
A 61-year-old woman comes to the physician ...
Closure of the mitral valveπŸ”

Block/Question (38.1 difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acidπŸ”

Block/Question (25.4 difficulty score)
In a study of the use of ultrasonography for ...
80%πŸ”

Block/Question (22.0 difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosisπŸ”

Block/Question (49.1 difficulty score)
An investigator is conducting a study to ...
EnvelopedπŸ”

Block/Question (27.2 difficulty score)
A 6-month-old male infant is brought to the ...
Regulatory T lymphocytesπŸ”

Block/Question (32.2 difficulty score)
A 7-year-old boy is brought to the physician ...
Release of interferon gamma by TH1 cellsπŸ”

Block/Question (27.6 difficulty score)
An otherwise healthy 26-year-old scuba diver ...
Hyperresonance over most of the left side of the chestπŸ”

Block/Question (23.9 difficulty score)
A 40-year-old man with terminal small cell ...
DemeclocyclineπŸ”

Block/Question (37.7 difficulty score)
A 74-year-old woman comes to the physician ...
IpratropiumπŸ”

Block/Question (43.5 difficulty score)
A 60-year-old man comes to the physician ...
ErythropoietinπŸ”

Block/Question (15.7 difficulty score)
An 85-year-old woman is brought to the ...
DonepezilπŸ”

Block/Question (24.1 difficulty score)
A 28-year-old man has hypertriglyceridemia ...
AspirinπŸ”

Block/Question (38.3 difficulty score)
A man accidentally touches the surface of a ...
HistamineπŸ”

Block/Question (59.5 difficulty score)
An 18-month-old girl is brought to the ...
Decreased sodium bicarbonate reabsorption in the proximal tubuleπŸ”

Block/Question (30.6 difficulty score)
A 2-week-old male newborn is brought to the ...
Galactose-1-phosphate uridyltransferaseπŸ”

Block/Question (20.5 difficulty score)
A study is planned to assess differences in ...
Cross-sectional studyπŸ”

Block/Question (43.7 difficulty score)
A 32-year-old man who lives at sea level ...
NormoblastsπŸ”

Block/Question (49.1 difficulty score)
A 42-year-old woman comes to the office ...
Spontaneous regressionπŸ”

Block/Question (62.5 difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased
πŸ”


Block/Question (23.4 difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled β€˜Dβ€™πŸ”

Block/Question (15.2 difficulty score)
A 17-year-old girl with type 1 diabetes ...
Acknowledge the patient's reasons for missing insulin injectionsπŸ”

Block/Question (22.7 difficulty score)
A 40-year-old man comes to the physician ...
PostcentralπŸ”

Block/Question (30.5 difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipaseπŸ”

Block/Question (16.5 difficulty score)
A 45-year-old woman is scheduled to undergo a ...
Accompany the resident while the resident obtains signed consentπŸ”

Block/Question (52.9 difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprueπŸ”

Block/Question (30.2 difficulty score)
A 16-year-old girl is brought to the ...
Tail of the pancreasπŸ”

Block/Question (56.4 difficulty score)
Electrophysiology of the heart is studied in ...
Ablation of the atrioventricular nodeπŸ”

Block/Question (24.3 difficulty score)
A 12-year-old girl is admitted to the ...
MethionineπŸ”

Block/Question (25.3 difficulty score)
A 65-year-old man develops a progressive ...
Right cerebellar hemisphereπŸ”

Block/Question (31.9 difficulty score)
A 44-year-old man is brought to the emergency ...
Entrapment of the inferior rectus muscleπŸ”

Block/Question (84.7 difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”

Block/Question (35.9 difficulty score)
A female neonate is delivered at 38 weeks' ...
Rough endoplasmic reticulumπŸ”

Block/Question (34.5 difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”


Block/Question (28.6 difficulty score)
A 15-year-old boy is brought to the physician ...
TestosteroneπŸ”

Block/Question (44.6 difficulty score)
A 48-year-old man has complete loss of ...
Area labeled β€˜C’ (Cranial nerve 8: vestibulocochlear)πŸ”

Recent comments ...

... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +38 
submitted by ferrero(40)
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A vyer sraiilm ietquons I ahev seen in nsbQak liwl aks ywh a tntaiep twih githr ahrte ufleria deso ton lpoveed meade adn teh seawrn is irdseneac cplitamyh aarend.ig I tgo tshi stieoqnu gwnro olriygnial aesuecb I aeesdwnr anglo isht elin of ginnrsaeo ubt I tnkhi in isth scea it lla sha ot do whti RWEEH eht axetr sserrpue is ngmioc mrof. nI hist nsotuiqe hte pt hsa iaoltcsdi hntesoniprey os yuo acn hintk atuob het eusrsepr as cingom ""odrawfr os ncrtgctoinsi reyppcialalr snirspchte nac rtnepev an aseiencr ni srpeersu ni het ayclrplai .edb evweHro for itrgh treah uirlefa hits rtxae idufl si gmcion ofrm het IPTEOPOS odcirinet dbrakacs(w ofrm the hrgit rhaet) nad tgncnrostiic pyelpiaralrc prsencihts nca do gthinno (no oiopspte desi fo laiyrpacl eb)d - eth nloy wya ot terpnev edaem si to nresaiec ypctlimah eran.gida

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)? +15
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +5
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. +31
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. +6
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." +3
... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
 +36 
submitted by sajaqua1(518)
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A adn J rtesperne het leracgi lu,sascicuf hlwei B nad I rrteenpse teh netaceu ccfs.luiaus thTgeoer yhet make pu hte oldras iomad-lcmlneu amcnsllie ,tatcr brsplensieo fro oitinpnp ,recotnepip opritopnecri,op aibor,invt dna ers.eusrp ptnIu si rle.aasilpit

C dan H maek pu the teallra psciarconilot ctatr olsa( lecadl hte laeratl acnbeposirler ,)sculufsaic nloieepssbr for otrom omandcm of latpsilriae lbs.im

D dna G npsrtreee hte ealrlta mnaihliatposc rtcat. It si eebposnlirs orf anpi nad maeeutrterp dioc.tcunon Teh nptiu saesir in a milb e(lft rloew emrttxyie ni shit ea,)sc nsteer tohugrh teh daslro orto rd(ptueic benweet J nad ,H) aesucsestd nda sdances at het rirtonae rieumcsoms u(tsj biedhn E dna ),F dna aliflny spsenays on hte nsecod erord noeurn ni het atrllae miahpicsatnol ttra.c So hte hcanltmasipoi rttac is peesibolsrn rof ltorcatarlnae pina dan temruraetep inoeasn.st seecaBu our tipaetn sah tslo niaesostn no teh lt,fe hte nelios si ni eth t.hrgi

E adn F are the atrnreio prtoislnccaio atrtc. It is enivdolv ni omrot onrotlc of ixormlap smsluce, ycayltipl of het tkrun.

nor16  good job +5
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3
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. +1
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 +1
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +36 
submitted by yotsubato(963)
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Wsa it sjtu ,em or did ea"g at stneo in sra"ey ppaaer GTHRI ebova hte bnemru of pattne,si athrre tnah the nema. hWchi ofndcesu me fro a ogdo 3 inesum.t

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +13
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) +7
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +7
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +5
monkey  what is 36 supposed to be? +1
thomasburton  Think the number of people in that group +5
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99" +4
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +3
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +34 
submitted by sne(45)
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ioAlclhoc = ctracpeani f.nifsiyineucc nio,eLcli eoc,il dna tlacimpi icda nac eb dbaorbes thowiut pinaceratc paslesi nscei hyet'er juts free yttaf scad.i liideycesrrTg need to eb obnkre wndo by asiespl beoefr roas.bpnoit

eiBl adcsi aer the aimn mthedo orf lnntiaimeig elr,oohlscte not atecprcina senmyez

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 +2
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
 +34 
submitted by hayayah(1056)
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mbaolooC is na eey iytlonbarma ttha ucrcos eboefr tbh.ir rehTy'e mssigni esepic of itssue ni tucrsusert tath omrf eth .yee

  • somoabClo fnicafegt het ii,rs ichhw rtlues ni a eyohk"el" anepacprae fo the ,pulip relynelag od ton edla ot iionsv ls.so

  • lmabsoooC oglinnviv eth iaetnr slrute in sioinv ossl ni isecfpic tsrap of teh avlisu dei.lf

  • aeLgr elnaitr clsbaoomo or oseth egntfcfia the itpoc vreen acn scuae olw siv,oni hcwhi nasem isnoiv ossl hatt nntaoc be mcplyeolte cdcterreo htiw glseass or otcacnt se.senl

mousie  thanks for this explanation! +
macrohphage95  can any one explain to me why not lens ? +
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 +4
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 +2
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +11
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. +2
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! +1
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
 +31 
submitted by seagull(1391)
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Whta a leebtirr ceupti.r eThy heyt cerevod pu tpar fo it with .nleis WTF

sympathetikey  Agreed. +10
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 +11
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? +2
catch-22  You're looking at the ventral aspect of the brainstem. +10
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 +4
hello  which letter is CN IX in this diagram? +
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. +
jesusisking  Don't G and H lowkey look like VII and VIII? I chose H b/c of that +
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. +
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +29 
submitted by stinkysulfaeggs(91)
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dDi eyoann lese go wond :eth she's eienshoyvtp os mebya lesl'h etg ahwreseuot rirsfdcnheie dersmyon cubeesa nthnoig lsee is nkgmia eness ot em at iths ?pni?ot? utero -

ursnT ,otu sereev almaari anc esauc cicarovsadualr celaposl adn opnytniheso.

redvelvet  me too :( +1
abigail  me three :( +1
yex  Me four :-/ +1
link981  Slowly raising my hand as well +1
tinydoc  Sammmme +1
bullshitusmle  same here!!!:@ +1
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +9
aisel1787  me five( +
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. +
alexxxx30  sammmeeeee +
snripper  Dumbasses unite lmao +
usmleaspirant2020  lol saaaaame! +
usmleaspirant2020  lol saaaaame! +
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
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
 +26 
submitted by soph(54)
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oyu deen ot wkno fdif bt entvegia reuserps noivlttiean cih(wh is arlonm teto)inaviln nda opveiist rurspsees iettnivalon wh(ihc si lecnaamcih )ei.tanvniotl In gnetieva psrreues tolaevinnti teh iaagrhmdp trotsncac gamkni a - eunpitalarrl sesrpuer chwhi lwsloa olilave ot dxe.apn in iptivose eotitnvailn (eht pt rphdgaima si not irtncontcga suth not nnpexgdai tsceh aiicvty adn nto aricegtn eht - e)usrerps teh amhcien si agrcenti oivteips prssuree isdeni ilaveol so so vliolae dsp.naxe ):

jbc5356  The smiley face got to me more than it should have. Preciate you. +2
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
 +25 
submitted by beeip(123)
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Teh btse I acn edsntdar,un yrht'ee nrdgescibi dlrntaiemeo phasaiyrlep, a etlusr of seecsx eter,nsog a iresdto eoomhnr htat lecasoansrtt to het secuuln dan dbins tis sctirtnpriaon tacf.ro

mousie  My exact thinking also! +7
sympathetikey  Ditto. +
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? +
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 +4
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 +
... wired-in made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
 +25 
submitted by wired-in(67)
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acitnaMnnee does aruomlf si sC(s Γ— Cl Γ— t)au Γ· F

eehrw sCs is taatseet-ysd aegttr amsalp c.ocn of g,rud lC is c,neaacler aut is sagoed nvealrit ;a&mp F si ya.ioiltblavaiib

ehNriet eoadsg nvielart orn abyiibtlovaalii si vg,ien so ognngiir htseo apm&; gnlpigug in het erbmuns f(uaerlc to tervcno instu ot gm/)g:day/k

12= ( /Lmgu Γ— 1 01/gm00 ug) Γ— .0(90 h/kLgr/ Γ— 1000 mL1/ L Γ— 24 /1rh )dya
= .9522 magkgd/y/

hc..hi.w ntis' nay of eht wsnear cscoieh letsdi. yheT utms heav redundo 00.9 rhLg/k/ to 1.0 Lg,rk//h dan oding os sgeiv tclxeya 2.88 gda/ky/mg hc(eico C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +69
hyoid  ^^^^^ +11
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9
praderwilli  Big mad +9
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +8
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18
bigjimbo  JOKES +1
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
d_holles  LMAO games NBME plays +2
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 ...... +6
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 +3
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 +2
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 +15
qball  Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +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 28.8😑 +
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +25 
submitted by thomasalterman(147)
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ailMaar anc rmaipi haepcit eoiunlngeescosg adn can sola eoumcsn eulgcos rfo tis nwo lmotaicbe ne.dsdam

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +54
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +8
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: https://labmedicineblog.files.wordpress.com/2018/06/mal3.jpg?w=840 Life-cycle: https://www.cddep.org/wp-content/uploads/2017/06/malaria-life-cycle_4-1440x1080.jpg +1
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. +
curlycheesefriesguy  I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
 +24 
submitted by sajaqua1(518)
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liirtCca istonp rof stih qusoet:in 5 arey lod b,yo uspemdsospimrune seubcea of cyht,paheomre 2 ayd orsytih fo ve,rfe ,gcuoh orthsenss of arbht,e ieeflbr (8110. F,) etsisanprori n4/mi,6 tiwh sisaoycn dan egadeiernzl cuaisvrle hrs.a nsixtveeE onralud antir.flnioit

fO eht ipnsoto dltsei yonl alssmee nad ZVV giev a hsr.a A asrh form eessmal ysulaul atsstr lrratylos and dsnseced dlalyuc,a nda si ftal dan rhae.msoeutty By strtnoac, VVZ he)cxiokc(np ptseerns wiht ieenagrzlde shar taht ycilqku atrnotniiss rmof lcruama to prlpaau enth ot ri.alsvuec

sympathetikey  Good call. +6
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +1
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
 +24 
submitted by yotsubato(963)
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So for iandCda we can ues

lAezos zfun)oe(clloa iibi(nth 0Y5P4C mie)eloyntdtha

phoremntcAi B epo(r ooatrmfni ni ugfanl clel m)mebrean

fasniCgpuon tvrn(epe nlosgrkiscni of btea lcansug ni llec l)awl

ro Nntiysa orf alor or ehasaegopl assec reop( atoirn)fmo

shTi iotneqsu is asginy tath esh si ingkat an RLAO rudg ot taret aadindc insgvti.ia

ciomepnAhtr is IV

nagnfCuispo si sloa VI

os erw'e eltf thiw zlsaeo

Aslzeo hitnbii yisnssthe fo segrteorol yb bnihitgnii YPC 504 ahtt stovncer tesalrooln ot er.teoogsrl

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +1
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2
staghorn  Me - picks Metronidazole -_- +
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +3
turtlepenlight  I have seen that on the wards so I hope it works! +
fexx  and my smartass picks amphp B +2
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +2
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +24 
submitted by seagull(1391)
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shiT is a ypet II aRlen bTrulua Assodc.ii yM alciMde lohcSo everN ghtuta tish to me. iDd yuo alos go ot vrtypoe emd ?clsooh Im' ediruspsr yhet vnee agve us liteot pr.eap

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +6
yotsubato  I didnt have physiology in my medical school. None, zip, zero, none. Nor did I have biochem. They said "you learned all this shit in undergrad, youll memorize it again for step 1 and forget it promptly" and then just moved on. +9
jcmed  In the Caribbean thats 1 thing we were given... lots and lots of toilet paper +1
... hayayah made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
 +23 
submitted by hayayah(1056)
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He has flace tnnnocneieci so sih nexlreat tpsehcnir si agdma,ed cihhw is nrevtaiden yb teh aupldnde n. .-2S)(S4 The lveicp nilhnacpcs v,eersn chihw eaemtdi the rocenite s,scoepr rae lsoa 2-.4SS

thomasburton  Why could this not be dysuria? +2
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +16
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +3
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +
... welpdedelp made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +23 
submitted by welpdedelp(215)
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oN tedi ince,iyfdec eth iantpte dah scesxe eecrnoat ude to sih dite

sympathetikey  Would never have thought of that. Thanks +8
medschul  that's messed up dog +18
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +
davidw  this is directly from Goljan "Dietary Ξ²-carotenes and retinol esters are sources of retinol. Ξ²-carotenes are converted into retinol. (a) Increased Ξ²-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +7
davidw  Ξ²-Carotenes are present in dark-green and yellow vegetables. +
hyperfukus  ohhhh hellllll no +7
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +6
cbreland  I'm okay with missing this one +4
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +23 
submitted by water(33)
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yiurr,ilsgpns I luatylac ldnaree this ormf het gMaic ooShcl sBu ehwn I saw a .kid shTa't eht yonl sorena I otg isth rhti.g nskTha sM. zeFrilz! D:

paulkarr  She taught me more than my med school professors did... +5
... sajaqua1 made a comment on nbme23/block1/q#18 (A 15-year-old boy has nasal polyps and develops...)
 +21 
submitted by sajaqua1(518)
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eymnEz A anstsd ni rfo pposPeiaohslh A,2 irtnugn olsihsphpodip ni teh ecll mernabem ntoi ncarhaicodi ca.dis Frmo e,hter myneEz B natdss orf oyaescCxeoyngl )X,O(C ehwli nyemEz C dtsasn orf yexoa5ep-iLgns .)-(O5L 5L-O uresdocp E,PTE-5H icwhh is edturn tnoi r.ueoekeltnsi oeiseutLkenr ylpa a belodu elro ni tvnese ekli ,hmatas buecesa yeth sucae nrboctsonoccntoihri ne(es ni isth piea)tnt dan yb gaintc as meihaccl trancttaats orf toimylnfmara le,scl hwseo tcavtyii lwli elcso teh yrwaia uhte.rfr yB lnocbkgi OXC (pluraebsym thwi na ,IAS)DN ew eealv emor of teh seuabrtts iaadcnochir cdai fro L-5XO to tumyellati oectrvn ntoi nesr.ioueltke sThi si het ssbai ofr tin-aiptis-snnatm,aroarhel chhiw si neefrqutyl ictdeaoass iwth nsala ps.pyol tsS(mea'r it)adr.

mea3x/cwpt5:e49Frlrg9/il.aw//kt5ue.r/lsTttcowh

)D isnclcroPayt ynhastse . E) nmTbxrhoaeo sahnteys

... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
 +21 
submitted by thomasalterman(147)
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ehS jtsu dlecomtep eth ecsour of rax,buitim icwhh srgtate 2D0C pceseorrt. -Belcl cdiyeenicf anc erepdpsosi to aritblcae s.oientficn

)b BM fauirel si ton osiaecstda itwh trx ai)cbmui ng) rowd og)erwn htsi cocsru wni/ 7-10 sayd of tsgratin ,tttnarmee adn ludwo otn urocc ratfe ngclptemio a -nth4mo rocuse fo turaxmibi.

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +20
stinkysulfaeggs  Same. Crap. +2
medstudent22  Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization. Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded. +1
... sajaqua1 made a comment on nbme23/block1/q#28 (An otherwise healthy 82-year-old man is brought to...)
 +21 
submitted by sajaqua1(518)
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sPtroeior cdor omsdrnye urccos due to iitnnfaocr of het tsrooeirp lfha of het slnpia rod,c morf nocoilsuc fo eth sorperoti aislpn er.ayrt uOr tpinate etsrsnpe ihwt crdeeasde tnoasines to icpkrnpi lebwo the vlele fo eht snkee sa lwle as agwilnk wthi a awd-eesdbi gtia, kielyl igninaticd osls of oepotinrpprioc. ehT iepntta is salo aeimnc iwth p-eeedrnhteymgs otrhlpi.seun

ynHmteperedegs psrhlonteui rae alicylpyt usacde by na labtiiniy ot akme nugheo NA,D auescd yb a klac of ersescyna porssurecr nda vaitsnmi gnnlcuidi 9B le(a)fto and B12 minb(oa)ac.l If eth ntpaite si oefalt edefni,itc ew ees aedvltee hmooceeitnys ycfc.eindie If eth epintta is B21 e,ientcfid ew ees taeeldev yintolalcmmhe idac dna ehmncooyties .eesvll eiaemHyshyitocnmerpo nca aecneris bimot.hssor hbmsrioosT ni eth rtirposoe spanli treary acn eacus etsirorop odcr nm.yesrod In ,ditinoad ackl fo aitinmv B21 mpaiirs imlyne riofntoma nad dsela to cebuatuS imCdnbeo raD,eionngete cihhw ftecafs eth ltmoiapaShcni catrt onntuicac(g ofr sederacde icppkirn tonas)eins, pClnriaoiotsc ct,aTr nda lsaroD mdeon-lulaiMC nsemsciLu aTrct catgocn(uni rfo hte ercudde opnioioerrtpcp.

)A riAoetrn cdor erns-ymdo lsso fo omort acmo,dmn as elwl sa aaeilbrlt sols of thae dan ap,in het pttaeni sha not ostl morto iotc,nufn so it toncna be hst.i B) Ctlnaer rodc dysnrem-o nsertspe as a biooniacntm of romto nda reosnys lo,ss uylalsu iwth reladbd yucti.nfsndo hsTi ttainpe dose ont psialyd oormt ossl or alrebdd tuydion.nfcs )C Hircodem -menoyrsd lAos celdla qB-dorwunSe,ra htis si omctpeel irnujy ot eehirt hte etlf or ghtir eids fo het anpils r.doc It essnerpt ihtw romot uftnsnodyic and exefrl icutonsdfny ltpsialaeryil at het ellev fo het lioe;ns ssol fo ppure ormto omncmad ewbol eht lenosi aitsrlyelplia a(sistpc si)reap;s slos of roslda rcei-urcldmona aossentin tralesllypiia ta nad elwbo hte e;lnsoi nda sols fo nipa adn teapetruerm aotennssi ytaorcnaltrleal 2 ot 3 abrevret belwo the enisol. )E gameeSrnty onerd-msy a ageitnolnc eiralfu ot oepldve ptar fo eht lnspia .rocd eTh enw eostn of ypmsmsto at 82 ryeas ldo sakme siht an lukyinel .dnoaisgis,

yb_26  amazing, thank you! +
aisel1787  great explanation +
rockodude  sensation to pinprick is DCML tract. SCD affects spinocerebellar (not spinothalamic), corticospinal, and DCML. otherwise good explanation. +1
azibird  Sensation to pinprick is not dorsal column-medial lemniscal tract, it's spinothalamic tract. So this patient has a lesion of the dorsal columns, spinothalamic tract hypersegmented neutrophils, and anemia. What the hell is going on? How is this just posterior cord syndrome? Spinothalamic is not posterior cord. +4
... sajaqua1 made a comment on nbme23/block1/q#42 (A 68-year-old woman comes to the office because of a...)
 +21 
submitted by sajaqua1(518)
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The aitnpte has a pirro tiryhos of toytrsceyhem thiw liaraetbl -potaso,ocoynrielopmhg nda rediceve atneerxl emab tdrainoia ot eht ise.vlp ehT pttanie onw dalpyiss nrdshsyhoorepi and hru,rrytdeoe wthi tialsd eeultrar oirgrwann atlyielarlb. The teiiklels onopti si atht we rae egnise eadnohiss frmo uivrspeo rergsyu crstitonc eth eest,urr nuisgac .hsit

E) teaihUlorl nimoacacr laos( lcdlea tranoilatnsi lelc icana)ocmr si lsao a ypsts.iiboil thWa esmka hits ullikyen si eth :coaotiln latrba.lie Teh rripo tycmteohyers dan relaaltib aoroscp-lotgponihyemo wuldo aleve arcs eusits on tbho isdse fo eht d,yob ubt eht ddso fo uoleaitrhl raccaionm gnasiir areblialtly era eyvr .mlsi

)A heT ittepan adh a eythyset,cmro os eth sddo fo rnteeurcr laccreiv coarmaicn era aosl rcidinelby w.ol C) dan D) eUtrlhar lmnaocdyo adn arrtulhe nrsaaoitltin ellc apoamilpl aer ni hte rwogn clintooa to cocautn orf llretaiab trlauehr awrgnnior itwh uthrreyr.edo

stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect). +13
spow  Why would the onset be 15 years later though? +3
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor. +3
... praderwilli made a comment on nbme23/block2/q#10 (A 50-year-old man who lives in eastern Minnesota...)
 +21 
submitted by praderwilli(63)
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stnWa' uers uoatb ects,tiaRki utb I kwne ronib of oidsxe wsa on ihs ycretcil ni teh hosrttnae dna einggtt urtredto yb hte mprieav e.bsab

mimi21  LMFAO facts ! +8
... cocoxaurus made a comment on nbme23/block1/q#43 (A 65-year-old woman has the recent appearance of a...)
 +20 
submitted by cocoxaurus(56)
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Per RL-UDWO ecrnadciomoaAn is soataescdi w/ glun sriacngr dtlaeer to mnarsauogtuol essead,i odl DPOC cn)rc(hoi dna megada ued to ercuenrtr ep.inmnuao

arcanumm  Here i was thinking i was being clever by not being tricked by distractors when metastasis is more common... +6
brise  Metastatic would have multiple lesions +
... colonelred_ made a comment on nbme23/block2/q#28 (A cohort study is conducted to examine the...)
 +20 
submitted by colonelred_(99)
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leabAturibtt srki = edceininc ni xdpesoe – necniedci ni udenxsope

= 01,000/3 s)osemrk( - 330/,000 msken)o(nros
= 300. - 010.
= 20.0 o(s eth ueraltbaitbt iskr si buaot 2)%

pAyilgpn ti ot a ltiupapnoo fo 0010:0,

= 20.0 * 0,0100
= 200

charcot_bouchard  What if i tell you this is a ques of Attributable risk % in exposed? AR= 0.02 / IR in exposed (30/1000) = 0.6667 30 case in 1000. So 300 case in 10,000 0.6667 x 300 = 200 or in another word 66% cases of 100 lung cancer cases in smokers is actually due to smoking. so in 300 cases of smokers 200 is actually due to smoking +4
charcot_bouchard  This is a mind fuck. Lemme tell u guys if any consolation while doing the ques during test i did it with AR = 0.02; NNH = 1/0.02 = 50. 50 persons smoke to cause 1 cancer. 10K smoke to cause 200 cancer. +1
ls3076  Sorry if this is a stupid question. Why is it incorrect to simply apply the same proportion (30 cancer per 1000 smokers) to 10,000 smokers? +2
krewfoo99  @is3076 Thats exactly what is did. I still dont understand how that is wrong. But i guess they want us to think about it in terms of AR +
hhsuperhigh  @Is3076 and @Krewfoo99, If a person doesn't smoke, the natural risk of getting lung cancer is 30/3000=1%. The smoker's risk is 30/1000=3%. This 3% is not purely contributed by smoking, but mixed with the natural risk. So for calculating the pure contribution made by smoking, you should use 3%-1% which is 2%. And this 2% is the pure contribution of smoking. Not all smokers get lung cancer, the same thing, not all lung cancer among smokers are attributed by smoking. They may get lung cancer anyway despite smoking or not. +10
... mousie made a comment on nbme23/block2/q#8 (An 8-year-old boy is brought to the physician by his...)
 +19 
submitted by mousie(209)
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doinraMfa utabshi + Muacols rsoeaumn + kcNe amss = EMN B2 )(PMM hPe,o aeyrMuldl orhtyid CA anti(ciCnol ,nistr)cgee sluacmo aoseumrn

thotcandy  I knew it was MEN2B but forgot medullary ca of Thyroid is parafollicular/c cells which means Calcitonin, not T3/T4 Other answers: AntiThyroglobulin: Hashimoto's (or other thyroiditis) Dexamethasone suppression test: positive/suppressed in pituitary adenoma (acth secreting), negative/unresponsive in Adrenal hyperplasia/adenoma (suppressed by high dose) or ectopic acth (unresponsive to high dose) Serum TSH test: for papillary or follicular ca, thyroid adenomas are usually cold but could also cause HyperT TSHR antibodies: graves disease, hyperT +1
... mcl made a comment on nbme23/block3/q#28 (A 10-year-old boy sustains an abrasion on his left...)
 +19 
submitted by mcl(578)
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sunBo qkicu vriewe

... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +19 
submitted by smc213(124)
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To eb lctoelmpey rae!cl

sTih ttaenip ash soniCstysi a erra otmoaasul eiesversc loalssymo eaosrtg driedrso and most nmoomc caseu fo oaiFcnn dnsreyom in .dhienrlc tCosiyniss si ctmesisy and esadl to tcynsei altcyrs piesodst ni llcse and usstsie rtohothugu hte od.by

hglhuotA lsnoiWs aeidess cna adel to F,S het lrtsycas ni teh noecsra sdeo ton elrrcaeto hitw siosWln eedas.si
oreM :inof /hwnc/t0ic./gtpps11/8inawwn/emMbc/.it4ml.v.6CrlshPo4:

highyieldboardswards  Thank you! You are a legend for figuring this out! +
paulkarr  Appreciate you. +
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT =Β IncreasedΒ excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1
... sajaqua1 made a comment on nbme23/block3/q#38 (A 5-year-old boy who has recently recovered from an...)
 +18 
submitted by sajaqua1(518)
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Teh mwrrao hsswo rsruorpsec ot reetcyr,soyht as lwle as ryme.tcaagosyke This is to show ouy ttah het suies 'itns dticundrouor,npe ihcwh naems tath we era soigln BCR nad sptetelal oehewrmse ei eunictsdrt.o thaT resul tou D adn E. reehT is gonnhti to eictdani hta eht hcdli ahs esenmitidsda ulrsuocbiets (B). At hits notpi ew era flte whit A ro C. A dlwou teiincad snaDesimidte alvunararsctI uiCaongotal )D(IC ro hetginsom i,amilrs hhwci odluw stluer in wol lptaestle dna BRC utb we ulodw lsao see lronmaab CBR leki csshttiosyce tme"(hl"e ).slcle eW are ixpctilley odlt ttah eth eetrcyytrohs are oormnoicmhcr adn nym.cicoort oHwee,vr eumnmi otcesniutdr fo etetsapll peilxans it al-l hte isndrcoeutt fo saptllete aldse ot eoms enmggihrhoar nad so a dopr ni ,BRC dna TPI alssicycall esrasi raetf a trceen ppeur tyerrorispa trcta avirl iicntoe.nf

meningitis  Just in case anyone is wondering like I did, the low platelet count explains thethose multinucleated cells. They are Megakaryocytes in Bone Marrow Biopsy. +12
nwinkelmann  Also, don't forget that autoimmune thrombocytopenia purpura has 2 demographics: young kids, which generally resolves spontaneously fairly quickly, and then young adult females which is a true autoimmune condition that doesn't resolve. Patient's age + thrombocytopenia + essentially normal rest of heme pannel = autoimmune thrombocytopenia purprua in child. +6
abhishek021196  That is exactly how I approached this question. Normal heme panel and a decreased Platelet count in a young boy after an infection just made me intuitively select ITP. +
... sajaqua1 made a comment on nbme23/block3/q#3 (An 18-hour-old male newborn is 61 cm (24 in) long...)
 +17 
submitted by sajaqua1(518)
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uesacBe the ybsb'a tromhe ahs yepT 1 itesabeD itl,lumse ti si plaulisbe ttha eyht adh aevetled dlobo goucels leevls dgrnui ro hotslyr eerfbo irht.b Ilunins oeds otn ssorc eht ,claaepnt tub ocgeslu s,eod os rgudin irbht hte etnnaeo douwl eavh eneb eepgycyc.rhmli shiT ulwod dlae ot teh noenaalt anpsecar iereaslng sniliun, driingv ocluegs nito celsl dna grntuni owdn egncls;iensogeou htis is wyh hte byba si yelopgcmcyhi hrtig w.no

B) ceDaseerd elgngoyc iaccenor-nnott I 'dotn wonk teh ceyngogl titnoconcaenr rpmocdae ot na udlta tinp,eat tbu a deaserec in ocnlegyg ccroinntaetno dlwuo icdintae ygneusol/ccoeggl esaere,l ihcwh doluw otn be a yioecygmphcl e.tats C) eeredcsDa ggocyeln etysnsha taivyci-t aesceeddr goncglye hynastse aiticvty tasiedinc negyer ,tcsablaimo and owuld dael to eirghh sreum goseulc llevs.e D) eaDedcser msuer nilsiun etannrtionco-c reesdcaed urmes ninislu odluw laed to hhigre eelvsl fo lgosceu ni su.rme E) ascdeenIr mesru inuskeiill-n gwrtoh caft-or IFG sdoe tno bind lyanre as lwel ot inlsinu reopcsert as iiunnsl ,soed and so lwudo ehav to be ni lxyremete ghih tnriceonncsato ot heva stih tef.fec IGF si isatcoadse hwti tasoimc otgrhw dna umeslc eltovndmeep.

yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +3
alexb  Also explains why he's 12 pounds. +3
krewfoo99  Also, think of it like this: Insulin causes hypoglycemia, thus this baby must have increased insulin. It is also an anaobolic hormone which is clear by the babys weight. Insulin increases glycogen synthase activity, and causes an increase in concentrations of glycogen. Decrease in insulin would do exactly the opposite +1
tyrionwill  fetus of a mom with DM will develop pancreatic beta cell hyperplasia, which leads to insulinemia trying to reduce the blood glucose. after birth, the excessive blood glucose will be automatically withdrawn while the insulin at that moment is still high, which leads to hypoglycemia. +2
... sajaqua1 made a comment on nbme23/block3/q#5 (A 68-year-old woman has a 6-month history of...)
 +17 
submitted by sajaqua1(518)
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sTih aeintpt hsa peswiderad dsteortuinc of hbto erldana g,ldsna cwhhi amens tath seh liwl osel thbo reh odntrseolimiicroca adn ehr .iigcosrcdcuolto heT slso of hte oesmcociialorndirt nad the cffeet on eth yekdsni si twha is nbeig tetsde he.er nWeh otreoaendsl si nnfiioguntc nda nnba,taud ti sha rvseael rcatiilc nictfosnu on eht pnorneh. r,tFsi it gupuesltrae a+KN/+ AseTaP preenisoxs on hte asoetarlabl n,rabmeem bsitgshlaine a tnorgs emechctaileorcl deitargn ttha rettbe arsbsob ,+Na welih eth driesneca lanaueitcllrr K+ aocnronicettn keasm ti aeiser to leso K+ rmof eth lcel iotn hte .eumnl lredetsonAo asol gseultruepa teh nsxoerspie of iliepetlah sdoimu nashelnc )ENCa( on het gcitcnolel u,cdt arnbgoresib oemr +.aN nyla,Fli oetaolrdens rinacsese seisorexpn fo +H AsTaPes no haetea-clarinptlda sclel of eht cgltlinoec dt,cu cwhih ear orspeesnbil for tegnsrcie +H (tshi is patr of tocricnntao aklslao.)si

Wiht eth sslo of alns,reeotod ew illw ese a esecdrase /KN++a nigadtre adn aedesrcde aN+ riena;prsoobt iths dasel to eeesdcdra sremu udomis nda ncrideaes suemr uospt.siam At eth smea ,emit ton epgxirssen H+ aePTssA lwli ldae ot +H not einbg eertdsc,e neicrtga a rome aicdic veiertnnonm Hp( illw )cee.edsar

abhishek021196  Very well written explanation. Bravo +2
... sympathetikey made a comment on nbme23/block4/q#21 (An otherwise healthy 26-year-old scuba diver has...)
 +17 
submitted by sympathetikey(1248)
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rHda to ees due ot roop irutpec q,alituy utb ebads no atwh I uclod ee,s it emsse keli a usnsantopoe unoermapxtho ot me s(deba on eht kalc of gnlu arkgnim no hte felt eacrdpmo to eht rtgih sde)i.

reh,reofTe cnesi eth ulng si ,fdeadelt lal oyu owuld have ni hte telf dsie of hte oenp ,ciyatv chhwi udolw amek eth ltef eids eepna.srsnrtyho

sugaplum  FA 2019 pg667 +14
... imnotarobotbut made a comment on nbme23/block2/q#17 (A 21-year-old man comes to the physician because of...)
 +16 
submitted by imnotarobotbut(160)
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rleVcsia sminsiihsaela secusa eaeohyltnpmgapolse nda omst mrniyatolp,t eip.canpontay It si etofn fndou in ppoele how tsivi eth iedldM asEt dan is andermisttt by teh dnySa.fl yhW idd NBEM utp 2 ieinhsamaL qnusisote on thsi morf oll

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +11
rongloz  I got both questions within 5 questions from one another! I was seriously doubting my answers haha +1
faus305  Visceral Leishmaniasis affects about 0.001% of the world population each year so it only makes sense to have two questions on it. https://www.cdc.gov/parasites/leishmaniasis/epi.html#:~:text=For%20cutaneous%20leishmaniasis%2C%20estimates%20of,to%20400%2C000%20or%20more%20cases. +
underd0g  How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia? +
faus305  @underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa. +
... usmleuser007 made a comment on nbme23/block2/q#23 (A 75-year-old man with prostate cancer has...)
 +16 
submitted by usmleuser007(370)
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  1. rcaeCns fo hte lp,vsei igucdilnn hte oerpt,ats aeprds to teh oumlscblraa nepsi aiv eth rerabtlev oenvsu uxples V.VP)(

    • The PVV cmcsnatmouei ihtw a uenbrm of vunsoe rnto,sewk diilcunng het itoaptscr esvonu spx,elu ichwh eeevcris eth nsouev psyupl mrof eth poeas,rtt pns,ei adn .ldbrdae

    • VPV nurs up hte eniter alpins lconum dan tcosennc iwht eht soevun spuypl fo eht bnira via a levvelssa essymt nssB(ta’o exPu)sl ihcwh olwlas ofr naireiditlobc lwof nad ntuorigeal fo naicanirlrta pih.Tesssuerr nvesuo occeinnotn to teh craelber ciriacltuon amy help apxniel hte riepnpstoy fo uotrsm to tasasmtzeei ot het .rinab

  2. eTh VPV sola etmiumnccsoa htwi het yzgsao evni ni teh ,cshte wihch asepilnx in atrp hyw rtseab adn nlug asnccre ueqnyerftl zsseaaetimt to eht ioraccht .esnpi

    • yml,iirlaS ude to rupyamnlo noeuvs danriaeg noti eth ltef isde fo eht rae,ht nlgu mostru onfte epdasr selyasymiclt aiv teh atrearli em.ysts
  3. ghluAoth phyml sdone are eth stmo mcmnoo tsies of smiestatas ni r,agleen altmpycih edrsap ot eth elteklas tmessy si ervy .raer

  4. eTh fipmaoirmnp pselux verecise neusov nraadgei rmof teh stit,se mydpsiie,di dan tdcusu redeesfn nda idrans tion the lsaertucit evn.si

... mcl made a comment on nbme23/block3/q#26 (A 27-year-old woman has headaches and blurred...)
 +16 
submitted by mcl(578)
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ePatitn hwit rlaaiblet anrle rayret tuibsr nad niresphontye lwil for erus hvea iinocatatv fo ASR mysset nad rtfeorhee cieerans ni natei.sgionn

hgltAhuo chtyhmmoaeocproo nad uoqenntsce daevetle toceamselcaihn can aeircsen boold resup,esr sotsmymp rea itapycyll piisdcoe dan nelar ubsrti rea ton leklyi ot be ehd.ar tvdeleaE evlesl fo ronoseitn nac lsao usace nenspohiey,rt but ew louwd laso txeepc ot ese shul;gfni ,lsao heetr is ithgonn ni the estm ot dcieaint atetpin si iatgnk RSSIs ro henosigtm lese taht cduol serpesiopd her ot letvedea velesl fo n.rstooine dvteealE evesll fo rdyhoit rohomen cdoul soal geiv pittaen yernnpeth,iso but ew woldu slao xceept ehrto sigsn fo hiytyrompidehsr mrr,steo( wgtieh ,slso c.et.)

I asw a lieltt cdfueosn fi OPE dwolu be teeleavd -- fi ether is snsiesto fo nlaer erirseta as( cndtiiaed yb eth ti)srbu teh inkedys ocdlu osla teetcd this sa pohaxyi nda rpma up tropocdiun of .EOP ,Hverweo I eendd up ggino tihw nnnaetsoigi einsc ti esmede omer rocc"ne"et ot me ahtt RSA duolw eb .up sDoe nneayo wokn hwy ist' otn PO?E

brise  Wouldn't that be more long term? +3
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2
... aladar50 made a comment on nbme23/block3/q#29 (A 50-kg (110-lb) experimental animal receives 1 L of...)
 +16 
submitted by aladar50(40)
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mI’ not eht steb ta teh noscuatcaill fo FICC/EF, tbu lslcaibay oyu aer usgininf a ehrpioyntc ootinusl iton the nlaami. Inltla,iiy hits is all ginog ot go tnoi eht leeaautxlrcrl scpae, as nay VI nfoisinu iwll d.o nceiS ti si ghhier anth oiinstco itu,nools terwa is ognig to go ofmr eth clurltrlenaai eapsc to the ctarrlxlluaee easpc to rty to aabnecl ti out, so eht ietllraalurcn aecps ilwl aveh asrddeece lmouev and escaidenr ltmisloyao (snice yoln ratwe si ilaveng, gkmani it eomr rcodttn.)eecna

oS you nkow fro esru CFI lumevo is esdeerdca nda matololsyi incdraes,e dan eht cuxalretlearl mueolv illw be reedicsa.n I hnitk het ymolstolia of eth leualrctxrael eacsp si eht rctyik rpat adn hte tapr eehrw yabem mesnooe lsee anc lhpe wtih eht nlasioacclut tbu cbailasly tsi’ iecrtynhop neguho taht eth siomoayltl lilw lstil eb idaneecrs.

btl_nyc  Since hypertonic solution was added, osmolality has to go up. The degree of the hypertonicity doesn't really matter. The fluid flowing out of the ICF will increase ICF osmolality. Since water follows salt, the water's gonna flow only until the ECF and ICF have the same tonicity. So if the ICF osmolality went up, the ECF osmolality also had to go up, because they both need to be equal after the water is done equilibrating. +18
krewfoo99  ECF fluid is hypertonic because we infused an hypertonic solution. ECF volume is going to go up because A) we added more volume via injection B) Sodium attracts water, and since hypertonic solution was given water goes from ICF to ECF ICF volume decreases because the water is going to ECF. This causes an increase in Intracellular osmolarity, since you have more solutes compared to water (Less water to dilute it) +1
... thomasalterman made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
 +16 
submitted by thomasalterman(147)
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nttiePa has ocmlatypeiyh v,aer sa eeiddevnc yb rrio,ythssotyce is,tguarocynsol and ehcdeasah ;amp& nsdisie.z POE si screedead eud ot hcssieytt.royro adceeresD PLA udlow dacntiie ,CLM not PV.

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +4
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +9
arcanumm  Tricked me. I knew right away that it was PV, but I thought PV would crowd out normal cell creation (e.g. decrease platelets). So apparently crowding out normal cells is just a quality of AML/CML? +1
drzed  More AML. Remember Sattar always stresses that all the myeloproliferative disorders are expansions of ALL lineages, ESPECIALLY "xx" (depends on which one, for CML it'll be granulocytes, for PV it'll be RBCs etc). They're called MYELOproliferative because all the myeloid linages go up, but one will be increased more than the rest. In this case, it is the RBCs. +3
... youssefa made a comment on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
 +15 
submitted by youssefa(122)
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hatoPam: - yhmLosypcet rea the tsmo ivseitsne lcsel to lwohe odby iantrdioa - tyoaurcnGsel (Minlay p)oiuhstnler aer alaictyrrplu evyr sivisteen to tpitmhhruececoea lakngaytli nsgtae qnuigirre( CGSF- rhtsoyl tra)fe

arcanumm  Always think of NEUTROPENIA when chemotherapy is treating rapidly dividing cells (a small fever is an ER visit for these patients). +6
... sympathetikey made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +15 
submitted by sympathetikey(1248)
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hTguo o.usiqnet

ellRca ahtt ientameMn '(mezhrlesai rdg)u is a ADMN ocreetpR gnaotnitsA ahtt lsphe nptreve xoiyitttxocce yb nicklogB a+2C reynt. 'thasT owh I meermber hs.it

... yotsubato made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
 +15 
submitted by yotsubato(963)
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This is a snitueqo oabut ptiaent avcipry. hTe pietnta erhe is hte hdi.lc heT opyxr fro eht antietp si teh ortehm nad fterah. Tyeh mstu wnok hwsta o.wrgn eStisr adn oretmh are tjsu slooy,look adn aeptnrs mya otn ntwa to llet mthe i(dpust I wn,ok tub ewhet)arv os uyo ensd temh uot dan tnhe ltel the ntepsra hte .tisnotuia

dr.xx  agreed +
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +25
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +9
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +4
... sympathetikey made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
 +15 
submitted by sympathetikey(1248)
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nAy temi oyu ese xifed ediw gisiptntl fo 2S, smsha ADS.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +
usmlecharserssss  with airpods in 2012 +
paulkarr  Low key was hoping for someone to try and argue this one... +
... yotsubato made a comment on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
 +15 
submitted by yotsubato(963)
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aheY seru, etls vige eth ygu hwo wsatn to ekpe sih idck ionwgkr adn be tvariacett watrsdo ewmno aeiteinFsrd nda lyceeoptlm irnu hsi etsrtoontese lvsele dna vgei imh a mlpi d,ikc nam o,bsbo nda esredcdea pfroerncmea in .rpssot

moemseSti het BMEN lraeyl ujst emsak me ksa y?hW

ipalTco iiiomxndl dolwu be yaw rtebte tub no yhte notw ptu ttah sa a hcieoc

anjum  To clarify: the lack of DHT production caused by finasteride leads to gynecomastia and ED. The other options are synthetic androgens. Totally agree that this question goes against the benevolence vs. maleficence that we've been taught in medical school +
... sympathetikey made a comment on nbme23/block4/q#30 (A study is planned to assess differences in...)
 +15 
submitted by sympathetikey(1248)
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Beitggs ceul saw ahtt eetrh wsa no eitm earfm ivg.ne ror,efheTe hits esmse ot be a esl"ic in i"mte ysutd, ihwch senli pu ihwt osrcs stnalcoei dtu.ys

paulkarr  Damn, epi at it again... +4
... chris07 made a comment on nbme23/block1/q#10 (A 13-year-old girl is brought to the office because...)
 +14 
submitted by chris07(54)
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edB bsgu sslemveeht rea ton konwn ot be rscairre of ,nlessli tbu ethy nca veale ctyih i.tbes Teh ilrg si ieylkl to ctarhcs hsete t,esbi eabrad teh s,kni nad suth nerceias het ksri fo a patsh nkis oenfntcii n(iesc phsta esrauu is teh stom ocmnmo iskn cioifnetn oge)ahntp

mcl  Oh! The article I found said that MRSA has been shown to colonize the saliva of bed bugs for up to like 15 days, and that they isolated MRSA from several specimens. Is it just more likely that the patient scratches it in since staph is e v e r y w h e r e ? +6
chris07  I mean it’s possible. The last review course I took said that it wasn’t associated with anything. It may be, but either way...same answer :) +1
frijoles  So bedbugs can't transmit HIV. Cool. #whatareyou #anidiotsandwich +13
anechakfspb  @frijoles - Hey if it makes you feel any better I put HIV too, with my reasoning being that they feed on blood...and HIV is transmitted via bodily fluids. Whoops! +
... nwinkelmann made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +14 
submitted by nwinkelmann(282)
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oS, ofr semo nsaero, tormeinrtrnetsasu is hsemginot 'Ive SLYWAA rltedggsu t...hwi raplbbyo eeacsbu I nsta'w agtuth ti llew so enrve earlly neeadlr ,it juts aedlren unoheg for athrewve .amex I juts undof tsih boo uothhrg NBIC nad its SIF!NTTAAC st'I ormf 1002 so tmgih be do,l tbu it swa g.atre oYu cna srahec rutoghh eth obko nda fdni eht tcspae.hr I tprtey uchm tjsu twen ohthurg all of hte nenirrmotetruast erthcpa. :7.ip0w.Bb/lhmwgo9nKco/kw.tn/19.svtN/hbios/n

My mnai meatuay-tla: tGweaksa = rajmo oecatyxirt sunneettimaot.rrr woT tpeys fo ee1rtps: )cor ar,pbotecitom otsm of whhci era rnyppicstea iG ihhcw aslde to eeddrcaes MDAN eeprcotr ittycvia nad rski of xoytioeiiitxtcc, or ppsniyoctsta Gq otesrpcre hatt lade ot nseearic a,N+ +,K dna rsaddeece utemagatl ucsaes tnedoaoapilizr dna ecsirande g++M idnmlsctaeep dan AMND torrpeec iacttiyv nad irsk fo iixixcc,teootyt dan 2) onrpotciio chensnla iiclundng MDNA adn aktPnMaeA/Ai ls,ahnenc iwhhc lal lalow cennsofipic atconi ixln,fu btu lyon NAMD asolwl ++Ca uxnlfi (and oyln ni a tgaolev nedpdetne nnmera rfate neciuffsit potoeniaizaldr hsa spcdedlai the oithbrini M++g nio ni teh a.nhlnce)

GAAB dan ylcegni = nioiytrhib seautorsneritnm.rt 1) ABA-AG dna A-ABCG = opircnotoi ehnlcsan htat edla to xflue fo -C,l dna dpteise hsit caiungs ,inldziaotaroep the nnoeur tills styas weolb nrsteig potaeln.ti -GABAA ndniibg tsei ofr tsaebrutbira, si,tresod G,AAB nda ixntorpoci = eisndi oper of encnhal. GB-AAA dginnbi etis of dsbiieaenzenpzo = ositude of reop fo .nlcehna )2 leicnyG celannh is a vrey slirmai l-C feuxl ela.cnnh )3 BAB-AG si a bcetmapotior nncelah hatt itaacestv iG dlneiga ot edesecard PAMc ciwhh tesiavatc ffuxle +K nseacnhl and sthiiibn ++Ca lxfuin nnaehslc adginel ot zpnyhrareitlop.ioa

gBniecio maiens = aicehlsacnemto menadpoi ndocoriio(nta of odyb veeomn,mt ,wredar ,taniomviot r,nei)cemenotfr pninhepreieorn (,sepel elefauks,swn nietnt,ota eeindfg he,ioarbv inerpneeihp woe(slt iatnncterocno ni )SNC, uslp ooetsnrin pe(els, efnlsu,akesw ee,psdinros tne,ixya nse)aau nda hnmtiesia ,aola(urs ttnie,oant g,lrealy issuet e,gaadm nda may uflnnieec dlobo rianb .)flow lOiyvsobu, all of htsi si in ntioddia to ierngdcrea osimuisnerontasnr nda ifg,hlt ,ihrgft adn ightf oesrsepn.

APT nad hoter nipeusr = xceyiatrto nmtn,sosiasri cds-raeoele wtih thoer uoem-slellamcl mnrstsenoeatrruti. noesAdein i'snt yccsaislall icdrednoes a motsutrraienernt esuabce it i'snt esoedelste/drar ni +aC+ pnedneedt mr,enan tbu edvrdie from ATP ferebo gnhavi an ytxtareico lat.otnepi

lnclecoteAiyh = rmajo tormuteinrasrten ovelnidv ni mtnsrnriuneissooa aiv mcurnsia adn cointiicn srreetpco.

ePeitpd rustnsatrimoerent = omlcymno lerdaese sa prepeoipdt greral crrpsrouse atth rea aceldve yb epfiscci eeysznm ttah weer ni the emas rmtniorrteuasten evceils nuop ar.elsee ieFv ptsye = nraug/bti etppdeis, idioop pspe,deit riuiyttap p,edistp yphoalicahtm ngeeaislr onrhme,os dna toesh ont clsdi.aseif xsmlpEea = usercrrpo taht sigve eisr to tcuaesbns P mppocah(,supi coxeoen,rt nda TGI and seareedl rofm almsl arditeem SPN C brsfei that mnisartt inpa dna tearertmpue traiioofn,mn fpweluor teivhopnys,e nhtiibied yb pdooii ped,isp)et nrnnkiieou ,A eepentduroip ,K nda ueiptnpdeero gaamm, nad oidipo pesipetd nuilgincd palnt dsalloaki (leki )nip,rhome nttcsheiy poiodi veiei,rdtvas nad epsornndh,i nri,nhydpos dan e.nekipnlsha In ealnger pidioo tseppeid ear aresnpsstde .e.(i gaasnalie s)mnhmaice, nvoilvde ni epoclxm behsriavo e(lxsua tronaati,ct sbvimeesggesvui/ssrai ,vioreba)hs nad iidempatlc hoguh(t tno tvn)fidiiee in iptrysiacch sd.rrsieod

Oallerv, ouratmesettinnrsr = etyp yset:p elusemco-lamll sttitnseamrr nda deeppisotru,en eerwh lmlaeueols-lcsm reartsttimsn rea estraf nda tdaeiem prida typacsin saninrstisom ..e(i orandneg SSN fgfrt/ifihgtthli/hg uqikc )nps,osere heewr as dpiesproneetu onlg(a iwht iboliocg minesa dna emso lmsal clueomel irartstse)mnt rae rwleso dna etidaem laug,dar rondgpoel nonro.iteuisassnmr

emoS cptue:isr stwvoittwtri._hlr/vaeaeebun.etmhpopod_t//etsuhi_dwu:e.paifmkekosrnrdu/pmern/nc, 1cu.Bl1re5teohgrcgacdeta/Ra/epAgf3i/3ee-7B8ir-bot6/3/p.lfsf3u-6eao-nu6aw9sr/-gai21bed04Tg44b-rpdtwbAfin2cs2-1w06mrpions/0-epihstdt00sh1a8erl:PrGrea, adn fl/gg/af_edwe/edtac3lbdap;i6&-as1i3ha8x5e-l./=utbe#/ao1sbgeghbp4eend05xmad-l9nrw:rt=r1/21.i.-wbt2afUt-gh-fw-07sie-6n

sweetmed  This is amazing. thank you +
sweetmed  This is amazing. thank you +
paulkarr  Woah... +
brotherimodu  Short video someone posted from NBME-21 answers: https://www.youtube.com/watch?v=4-DuvwoH2zQ +2
dorischang  Didn't finish reading this, but it looks awesome +1
... seagull made a comment on nbme23/block3/q#19 (A previously healthy 32-year-old man is brought to...)
 +14 
submitted by seagull(1391)
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ihsT tptneia is gipnitpr alls.b eterBt od a dgru eensrc hhwic smsee ubovo.is

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +37
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2
charcot_bouchard  Lol. I got the right answer but took long time +
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +
targetmle  why is there basal ganglia hemorrhage? +
dul071  Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1
usmile1  basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +1
... lfsuarez made a comment on nbme23/block4/q#22 (A 40-year-old man with terminal small cell carcinoma...)
 +14 
submitted by lfsuarez(141)
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isTh titapen sepsnetr hiwt a lslma clel accnioram hwhic si very ommonc orf praa tanpoclesi .rnssdoeym In sith case hte cncare is uncigsa SDIAH. nyeiceoDclmle is a rceilanyetct obtiaincit ahtt is aosl used to ratte DHSAI

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +13
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +3
... brolycow made a comment on nbme23/block2/q#19 (A 70-year-old man with severe congestive heart...)
 +13 
submitted by brolycow(27)
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eH hsa ahetr ulefair hhcwi eslad ot a eecsrdae in ranel dobol lfwo adn lpanreer .ietamaoz nI peanerrl matzao,ie UBNr:C otria is =tg&; ;02 canvAittoi fo eth ARAS tsymse deu to eht eaplenrr ozamiate asmen ahtt the escp gvar si hhig ta 510.2 dan eh is idnolhg noot sidoum os aryunir uidoms will eb owl 2&;0t,l( FaNE tl%.;)1&

brolycow  I just usually remember from class that spec grav 1.001-1.010 is considered dilute urine, and anything 1.025 and above is concentrated. For this question specifically, I think I remember there only being one option that even had the ratio >=20, all of the others were like 15 or less, so just have to rule them out. +7
benzjonez  Very helpful video for acute kidney injury: https://www.youtube.com/watch?v=bMp6IxDKK2Q +7
notadoctor  Another explanation that helped me is that inability to concentrate the urine means something is wrong with the kidneys. If you have dilute urine, or the spec gravity is between 1.001-1.010 in someone with low urine output it suggests something is wrong with the concentration mechanisms of the kidney. Because this person had congestive heart failure we were already looking for something that matched up with prerenal azotemia so we can pretty much get rid of all the answer choices that suggest other azotemias. Then finally to get the precise answer I looked at the BUN/Cr ratio which you would expect to be high(>= 20). +
drdoom  @mikay92 is this the OnlineMedEd video you're referring to? -> https://youtu.be/EWFgzVtMN50 +1
drdoom  aha! there is an updated AKI video but you need an OnlineMedEd (free) account to view it: https://onlinemeded.org/spa/nephrology/acute-kidney-injury/acquire +
... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
 +13 
submitted by alexxxx30(44)

did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha

confidenceinterval  RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +1
faus305  Quentin Tarantino wrote this one +
... jrod77 made a comment on nbme23/block4/q#17 (A 24-year-old man has a grade 3/6 systolic murmur....)
 +13 
submitted by jrod77(27)
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hTe ysolitcs erperssu ffcedeeirn bweeent eht lfte cltiveern dan het toaar in itsh .tp is ptryte gftaiiicnn,s sreheWa in a loarmn erhta steoh icosslty reuspsrse udlsho eb jsut btuao a.qleu isTh ntihs at teh fatc ttah het lfet rcenlveti has ot tup in lota fo rkow ot ushp tohhrug het irtcao vaevl. thaT aetxr sepsruer sgoe oint geoipnn het lvave dan oesd nto erapap ni teh oraa.t

divya  why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6
leaf_house  @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005156 +
cbreland  @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gunπŸ˜” +
... thomasalterman made a comment on nbme23/block4/q#29 (A 2-week-old male newborn is brought to the...)
 +13 
submitted by thomasalterman(147)
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tanetPi is ceturrn efarets-bd, so ew acn eetalnimi rcfouest ft(urceos is noduf in yneho nad rsiuft and mseo malurof, but nto ni tsareb likm). niatteP sah dceurnig ceunasbtss ubt no gcosule ni teh ine,ur so eh mtsu moes ocgue-snonl srga.u yM efiedfantlir for neudigcr nlocegonu-s usasrg ni the reuni si droedsirs frtocsue mamietsolb ro lscetoaga obmseitlma. We avhe itmadenlei rot,usefc so thta lavees su hitw esciltgoaanak eiifdencyc or cailssc eaaotmlais.gc

sympathetikey  & Galactokinase deficiency would be much milder. +6
smc213  Big was soybean formula not giving any issues. Soy-milk can be used as a substitute formula in patients with Classic Galactosemia since it contains sucrose (->fructose and glucose). +1
almondbreeze  @oslerweberenu G6PD - increased RBC susceptibility to oxidant stress (eg, sulfa drugs, antimalarials, infections, fava beans) -> hemolysis; has nothing to do with presence of reducing sugar +1
makinallkindzofgainz  @almondbreeze; Glucose-6-phosphatase deficiency is Von Gierke disease, they are not referring to G6PD deficiency (an entirely seperate disease) +6