Kim! Hi! It’s your dad!πŸ‘‹ ▪ Khalilah, I’m proud of you for taking a risk for your dream.Everyone’s explanations tend to be so on-point, and the commiseration makes me feel better, too!Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!                       want to add a fly-by? email us! 😊
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NBME 23 Answers

reproductive repro FA19p634
Question#1 (reveal difficulty score)
An asymptomatic 30-year-old woman comes to ...
AnovulationπŸ”,πŸ“Ί

oncology microbiology
digestion
Question#3 (reveal difficulty score)
A 52-year-old man comes to the physician ...
TriglycerideπŸ”,πŸ“Ί

embryology neurology FA19p479
clinical_trials FA19p256
Question#5 (reveal difficulty score)
A study is conducted to examine the ...
Phase 2πŸ”,πŸ“Ί

psych personality_disorders borderline
Question#6 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
BorderlineπŸ”,πŸ“Ί

biochem cell_bio
Question#7 (reveal difficulty score)
Which of the following is present in integral ...
Transmembrane regionπŸ”,πŸ“Ί

biochem drug_interactions p450 pharm
schizotypal psych borderline
Question#9 (reveal difficulty score)
A 45-year-old man is brought to the physician ...
SchizotypalπŸ”,πŸ“Ί

bed_bugs micro
Question#10 (reveal difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureusπŸ”,πŸ“Ί

anatomy neuro
Question#11 (reveal difficulty score)
A 55-year-old man who has a 10-year history ...
ImpotenceπŸ”,πŸ“Ί

micro moa
prevalence incidence
hit FA20p315
physio cholera fluids
Question#15 (reveal difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% SalineπŸ”,πŸ“Ί

biochem restriction_enzymes
Question#16 (reveal difficulty score)
Physical analysis of the isolated genomic DNA ...
MethylaseπŸ”,πŸ“Ί

anatomy
Question#17 (reveal difficulty score)
A 54-year-old woman comes to the physician ...
SupraspinatusπŸ”,πŸ“Ί

biochem pathways
Question#18 (reveal difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme BπŸ”,πŸ“Ί

biochem genetics
repro embryo
cd_markers rituximab
Question#21 (reveal difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”,πŸ“Ί

immuno
parkinsons neuro
Question#23 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agentπŸ”,πŸ“Ί

endocrine
Question#24 (reveal difficulty score)
A 39-year-old man comes to the physician ...
FerritinπŸ”,πŸ“Ί

micro
Question#25 (reveal difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virusπŸ”,πŸ“Ί

genetics
Question#26 (reveal difficulty score)
A couple comes to the physician for ...
1/150πŸ”,πŸ“Ί

developmental
Question#27 (reveal difficulty score)
An 11-year-old boy is brought to the ...
Sexual abuseπŸ”,πŸ“Ί

neuro b12 vitamins
Question#28 (reveal difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”,πŸ“Ί

immuno
Question#30 (reveal difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnicsπŸ”,πŸ“Ί



Question#33 (reveal difficulty score)
A 25-year-old woman and her 25-year-old ...
Ξ±-Thalassemia traitπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancerπŸ”,πŸ“Ί



Question#37 (reveal difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 43-year-old woman sustains multiple ...
Hyaline membranesπŸ”,πŸ“Ί



Question#41 (reveal difficulty score)
A 62-year-old woman is brought to the ...
PonsπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 65-year-old woman has the recent appearance ...
AdenocarcinomaπŸ”,πŸ“Ί



Question#46 (reveal difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...
BoneπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”,πŸ“Ί


Question#49 (reveal difficulty score)
Electrical stimulation of the stellate ...
Heart rateπŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
A 45-year-old woman with coronary artery ...
4.5πŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporisπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
Cyclophosphamide and some other ...
GranulocytesπŸ”,πŸ“Ί




Question#6 (reveal difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis BπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shockπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
An 8-year-old boy is brought to the physician ...
Serum calcitonin concentrationπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 60-year-old man has had easy fatigability, ...
LungπŸ”,πŸ“Ί




Question#13 (reveal difficulty score)
A 45-year-old man comes to the office for a ...
Invasion of the submucosaπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 65-year-old woman with diabetic ...
MucormycosisπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A child with septicemia has an antibiotic ...
28.8πŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
Which of the following best explains impaired ...
Increase in axonal capacitanceπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 21-year-old man comes to the physician ...
LeishmaniaπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 48-year-old man comes to the physician ...
Perforated peptic ulcerπŸ”,πŸ“Ί

_CHF_


Question#22 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Sand flyπŸ”,πŸ“Ί



Question#25 (reveal difficulty score)
A 44-year-old man with invasive pancreatic ...
Area labeled β€˜Hβ€™πŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 36-year-old woman comes to the physician ...
Fibromuscular dysplasiaπŸ”,πŸ“Ί


Question#28 (reveal difficulty score)
A cohort study is conducted to examine the ...
200πŸ”,πŸ“Ί


Question#30 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
LiverπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 40-year-old man has had enlarging breast ...
SpironolactoneπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 2-year-old girl is brought to the physician ...
N-methyl-d-aspartate (NMDA)πŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Synthesis of viral DNAπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 42-year-old man with a history of recurrent ...
Magnesium ammonium phosphateπŸ”,πŸ“Ί




pharm lipid_disorders fibrates
Question#39 (reveal difficulty score)
A 39-year-old woman with obesity and recently ...
GemfibrozilπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canalπŸ”,πŸ“Ί


Question#43 (reveal difficulty score)
A 2-week-old girl is brought to the physician ...
IrisπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary changeπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nucleiπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
Which of the following types of vaccine is ...
Live attenuated virusπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 65-year-old man is scheduled for physical ...
Medial (internal) rotationπŸ”,πŸ“Ί


Question#49 (reveal difficulty score)
A 56-year-old man comes to the physician ...
ColchicineπŸ”,πŸ“Ί


Question#1 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sacπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 35-year-old man comes to a new physician ...
LiverπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
HypoglycemiaπŸ”,πŸ“Ί


Question#6 (reveal difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cellsπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A male newborn is delivered at 39 weeks' ...
GastroschisisπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 62-year-old man with a blood pressure of ...
LabetalolπŸ”,πŸ“Ί


Question#10 (reveal difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curveπŸ”,πŸ“Ί


Question#12 (reveal difficulty score)
A 39-year-old man comes to the physician for ...
Ξ²-MyosinπŸ”,πŸ“Ί


Question#14 (reveal difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresiaπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
MyopathyπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary glandπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleenπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagonπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screeningπŸ”,πŸ“Ί


Question#21 (reveal difficulty score)
A 60-year-old woman comes to the physician 1 ...
AmplificationπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudatesπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A pregnant 28-year-old woman is found to have ...
LactotropeπŸ”,πŸ“Ί


Question#25 (reveal difficulty score)
A 43-year-old woman undergoing chemotherapy ...
Preformed IgM antibodiesπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 27-year-old woman has headaches and blurred ...
AngiotensinπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defectπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cellsπŸ”,πŸ“Ί


Question#30 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
C1qπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
The parents of a 1-year-old boy with a ...
MultifactorialπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 78-year-old man has had progressive loss of ...
OtosclerosisπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 34-year-old woman with a long-standing ...
FatπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 70-year-old woman comes to the physician ...
Serum sicknessπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118πŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 5-year-old boy who has recently recovered ...
Immune destruction of plateletsπŸ”,πŸ“Ί



Question#41 (reveal difficulty score)
A previously healthy 45-year-old man comes to ...
InfraspinatusπŸ”,πŸ“Ί




Question#45 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2πŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 19-year-old woman is severely burned over ...
Increased metabolic rateπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibulaπŸ”,πŸ“Ί


Question#49 (reveal difficulty score)
Genetic analyses of cells obtained on ...
EpinephrineπŸ”,πŸ“Ί

vascular pressure physics
Question#1 (reveal difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2πŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitisπŸ”,πŸ“Ί




Question#6 (reveal difficulty score)
A 35-year-old woman, gravida 2, para 1, ...
External anal sphincterπŸ”,πŸ“Ί


Question#8 (reveal difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50πŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetiiπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A study was conducted to investigate the mean ...
99%πŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 40-year-old man comes to the physician for ...
FinasterideπŸ”,πŸ“Ί



Question#14 (reveal difficulty score)
A 61-year-old woman comes to the physician ...
Closure of the mitral valveπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acidπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
In a study of the use of ultrasonography for ...
80%πŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosisπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
An investigator is conducting a study to ...
EnvelopedπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 6-month-old male infant is brought to the ...
Regulatory T lymphocytesπŸ”,πŸ“Ί



Question#22 (reveal difficulty score)
A 40-year-old man with terminal small cell ...
DemeclocyclineπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 74-year-old woman comes to the physician ...
IpratropiumπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 60-year-old man comes to the physician ...
ErythropoietinπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
An 85-year-old woman is brought to the ...
DonepezilπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 28-year-old man has hypertriglyceridemia ...
AspirinπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A man accidentally touches the surface of a ...
HistamineπŸ”,πŸ“Ί



Question#30 (reveal difficulty score)
A study is planned to assess differences in ...
Cross-sectional studyπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 32-year-old man who lives at sea level ...
NormoblastsπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 42-year-old woman comes to the office ...
Spontaneous regressionπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled β€˜Dβ€™πŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 40-year-old man comes to the physician ...
PostcentralπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί


Question#39 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprueπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Tail of the pancreasπŸ”,πŸ“Ί


Question#42 (reveal difficulty score)
A 12-year-old girl is admitted to the ...
MethionineπŸ”,πŸ“Ί



Question#45 (reveal difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A female neonate is delivered at 38 weeks' ...
Rough endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”,πŸ“Ί


Question#49 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...
TestosteroneπŸ”,πŸ“Ί


Recent comments ...

... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +41 
submitted by ferrero(43)
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A vrey slairim euoiqnts I ehva snee ni anQsbk lwli sak why a atitpne whti rhtgi tahre freiual deos ont eoeplvd adeem dan het wnears is eidcanesr ylahcmitp r.gaedian I tgo tshi utoisenq wgron ilnirgloay eeubacs I nwsderae ngloa isth eiln fo erniaongs tub I hknit ni tsih csae ti all ahs to do wiht WEHER eth etrxa pesruser is icmnog o.rmf nI htis utnsqioe hte tp ash istaodicl iohprestynen so ouy can ihktn aoubt eht serupser sa onmigc d"orwr"af so grinntstoicc ilarylaeprcp irtcsehnsp acn tenvpre na insacree in reuersps in hte aalycrpli eb.d eHwrevo fro rghit eathr afuirle sith xatre ildfu si mgnoic rfom het POPSITEO rdinciteo d(askarcbw omfr eth ihgtr h)erta and isinotgctcnr pcaiyaprlerl psitrcsenh nac od onnthig o(n tpipooes sdie fo lparycail be)d - the oyln wya to tnrpeev aedem is ot eesinrca mlhtcaypi dgia.nare

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)? +17
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. +36
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. +7
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." +4
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +40 
submitted by yotsubato(1088)
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sWa it jstu em, or did g"ea at ensot ni yasr"e eraapp RTHIG evoba the muebrn of naetis,tp etharr ntah eht mn.ae hWhic efosnudc me for a gdoo 3 ms.uneit

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +18
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
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" +5
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. +
... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
 +39 
submitted by sajaqua1(558)
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A dan J srnrepeet the aierlcg sa,luiscfuc ewihl B and I etpnrsere eth uecanet aufclsi.cus Teeogrht etyh keam up teh lsodar mmaulndcoeli- mielalsnc atcrt, beiresolspn ofr ntpipnio terpoecpi,n pcrntooeoppiri, aivrbo,int nad re.sspuer Iutnp is tllrpsai.eai

C dan H kmea up hte lrtalae nioipaocclrts tratc alo(s ledlca eth rtallea elncebsrripao cula)ss,ciuf srobenlpise orf mrtoo mcmnaod fo psleialtiar msibl.

D adn G retnreesp het llartae psictmlhoinaa ca.ttr tI si ssirpblenoe for niap nad tptaerumeer o.uiccndont eTh ptuin easisr ni a ibml (tlfe owlre xttiyrmee in iths c)aes, etners ogtrhuh teh ordlsa toor ctred(piu webneet J dna ,H) edaeucssts nad snsdace ta eth anierrto meoirssmcu s(tuj ehbndi E nad ),F nad niyllfa espanssy no het nscdeo dreor neunor ni eht talelra onaimcsipltah ctt.ra oS eth mascntiahopil trtca is peiebsonrls rfo taelalraornct ipna dan uerrettmpae nsin.aesot seBceau uor ntitepa ash ltos snosenati on the e,ftl eht lineos is in hte tigh.r

E adn F era het rareoint iltoinrpoaccs .ttcar tI is nviovled in rotom tolrcon of rmxioapl cule,ssm lpyatyicl of het truk.n

nor16  good job +6
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. +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
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
 +37 
submitted by hayayah(1116)
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lCboooma si an eye ibtylonraam hatt csruoc rbfeeo .rithb eheyrT' snsigim peisec fo usiste in usstucrret taht rmof hte .eye

  • Cmoaloosb tcnegffai teh risi, hhicw uerlts ni a "ehoel"yk cnapepraae of eth pplu,i gnlereyla od ont aeld ot vonisi oss.l

  • bCmsooaol ngnvlioiv het eranti surlet ni isoniv sosl in psfieicc rtsap of the avlsui e.lfdi

  • aLegr aneirtl bcmoaolos ro tsheo cfnegaitf eht ocipt nreev nac uecsa owl in,osiv hwich esnam sovnii loss ttah ntocna be loletcymep cetdecror iwht eslasgs or tcocnat lne.ses

mousie  thanks for this explanation! +1
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
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. +1
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. +3
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! +2
fatboyslim  Honestly, I didn't understand what they were trying to ask...NBME has some weird wording sometimes +
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +35 
submitted by sne(49)
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hooAllcci = naratpeicc nfiiceyisn.cuf nlioLec,i oilce, nad tilicmpa icad anc eb obarbeds twohiut aincacrpte essplia eicsn rtyhee' ujts efer ftyta aics.d eTcliisreyrdg dnee to be orenbk nwod by aielssp rbfeoe b.paotiorsn

lieB csdia rea eth mani dtohme orf meligantini e,hroletslco nto iartcepanc eznsyem

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 +4
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +32 
submitted by stinkysulfaeggs(103)
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iDd yeoann slee go nwdo h:te 'sesh yovshnetiep so amyeb shel'l egt esratoewhu fcsnehiiderr smyndeor sceueba htnigno lese si igmnka essen to em at htis to??i?np route -

usTrn u,ot eerevs maralia can uecas vourdsclcaiara sclalope nda hosnnpieo.yt

redvelvet  me too :( +2
abigail  me three :( +2
yex  Me four :-/ +2
link981  Slowly raising my hand as well +2
tinydoc  Sammmme +2
bullshitusmle  same here!!!:@ +2
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +13
aisel1787  me five( +1
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. +2
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
veryhungrycaterpillar  I have no idea how I got this right. +
feanor  And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols. +
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
 +31 
submitted by seagull(1688)
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athW a rrbtieel epirtu.c eyTh eyth voderce up rtap fo ti htiw is.eln TFW

sympathetikey  Agreed. +16
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? +
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. +
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
 +29 
submitted by soph(69)
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oyu eden ot nwko diff tb niteagev pseerrsu lonvineiatt ihhcw( si nlmroa )lentovtiina adn viitpose surrspees ientntiaolv cwi(hh si chaaenlimc litn.iovetan) nI teavngie srseperu oivlnntatei hte ipmdgahar rncatcots iknmag a - prtleaunairl pussreer wichh loawls voallei to pan.dxe ni ioivpest ltnoteaivin et(h tp iamrhadpg si otn gnontrtacic stuh nto degapnnxi cesht tvyicai dna ont eagticnr eth - )rspueesr eht ehmnaci si ngeairct sveitipo ereusprs diiesn aieollv os os aeolivl pne.axds :)

jbc5356  The smiley face got to me more than it should have. Preciate you. +6
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
 +27 
submitted by beeip(130)
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heT sbte I acn sadreu,tndn ethyr'e iicedgbrns tledmrnoeai aplisrpeyah, a eutlrs of xssece resng,toe a tsredio rmeohno htta cotantasersl ot het suulcne adn bdnsi sit rcipanisnotrt ofrc.ta

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 +1
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +27 
submitted by seagull(1688)
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This si a etyp II laRen ruubalT iAcs.odsi My ledcMia Shcool vreNe hutagt tish to .em idD uyo sloa og to yrtpove edm hocols? mI' upirrsdse etyh neev aveg su eolitt pepa.r

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +11
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 +2
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +26 
submitted by thomasalterman(162)
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raMaail cna rapimi aeitphc eiesougnlgcnsoe nda nac osal muosecn seouclg orf tis wno ematoibcl das.nmed

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +57
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +9
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 +
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
 +26 
submitted by yotsubato(1088)
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oS fro dadinCa we can use

sAzole fzl)ocn(loaue nbt(hiii C50P4Y ieyaodnehltmt)

moeAtpcnihr B po(er ntfamroio in alufgn llec erm)menba

ipafuoCnnsg prv(enet rgknsiolncsi of aebt nsglacu in cell lwal)

ro Nanysit ofr oral ro hagsepaleo seacs p(roe moifaort)n

ihTs iotnquse si niysag atht she si iatngk an RLAO rgdu ot teart ndaidac a.nitgvisi

mtieponrhAc si IV

pniufsaCogn is olas VI

os ere'w tfle itwh zsaloe

Azsloe iiibhnt etyhnssis of rlooeergts yb hbtniginii PCY 540 htat orcstenv tlsonloera ot reroeogstl.

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 -_- +1
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5
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 +3
fatboyslim  @alexxxx30 according to FA2020 page 153 Nystatin is only for oral. In the 2018 FA it did say it can be used for esophageal but they edited that in 2020. +
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
 +25 
submitted by sajaqua1(558)
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iiCatcrl npsiot rfo ihts uqetsi:on 5 arey old by,o usrpdnpeommsuise cseuabe of pryoh,eecmtah 2 yda hsiotry of ,freev o,hgcu hnssreost fo aerht,b berlife 0(81.1 F,) peitrraosins 4/,i6nm iwth yinoscas nda rdielzgaene vcsueliar h.sra vxeintEes aloudnr ontfani.ilitr

fO the sntpooi eslitd nloy eamsesl nda VZV vgie a hr.as A rsah mrfo asmeels lyuauls stsrat torlyslar nad sdescden l,ludcyaa nda si laft nad eeyhmaous.ttr yB tonctra,s ZVV ecochipx(n)k sensrpet wtih lnieeagzedr rhas thta cikyqlu nsasitnotir morf carlaum to lpurapa tnhe to rauecsiv.l

sympathetikey  Good call. +6
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +6
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. +2
... 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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inectnaenaM oesd mlufaro is (sCs Γ— lC Γ— )uat Γ· F

weehr Css si tasdtseey-ta aetgtr asamlp oc.cn of rdu,g Cl si enr,aeccla uat is esgado rteilnva m;&ap F si ov.laiatbybiilia

hiNeter sgdoea nltverai nor yiovbialbtaliai is ,nvgei os onngiirg oehts a;m&p inlpgggu ni hte nbmsrue lerauf(c to oetcvrn nistu ot gmdga)/yk/:

1( =2 Lgmu/ Γ— 1 00mg01/ )gu Γ— 90.0( /h/Lrkg Γ— 1000 1mL/ L Γ— 24 1r/h yad)
= 2952. kygm/gda/

whcih... t'ins ayn fo eht rsaenw hoeccsi edis.lt heyT umst aevh dnoedru 009. h/L/rgk ot .10 L,rg/k/h dna ndiog so vsgie xteaycl 828. gmyad/gk/ hi(coce C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +77
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 +10
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... +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 +5
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 +20
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😑 +
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 +
... welpdedelp made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +25 
submitted by welpdedelp(242)
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oN etid ec,nficdeyi hte ptetani dha sexsce recnotea edu ot his itde

sympathetikey  Would never have thought of that. Thanks +9
medschul  that's messed up dog +20
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... +7
cbreland  I'm okay with missing this one +4
veryhungrycaterpillar  That was fucking stupid. I've known this excess carotene fact since 8th grade due to a friend getting it, but I still wouldn't have thought of it. I went with anemia, figured it had to be folic acid since B6 would have shown up sooner than four years. UGH. +
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +25 
submitted by water(38)
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lunrisg,rypis I cyuaallt aneedlr this fomr teh aiMcg holcSo Bsu hnwe I saw a k.di sTaht' eht yonl nsaore I otg ihts rhtgi. Tnhkas .sM z!lFeirz :D

paulkarr  She taught me more than my med school professors did... +5
... 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(1116)
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He sha flaec ecnctnninoei so ihs axlenter spcinhter is ,amgdaed iwchh si enveidtnar by eht dpnaelud n. (4-)2SS. Teh lepciv ihlnpcnacs venr,es chhwi eatemdi het eorcenti esporsc, rea aols 4-2SS.

thomasburton  Why could this not be dysuria? +3
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 +2
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +
... sajaqua1 made a comment on nbme23/block1/q#18 (A 15-year-old boy has nasal polyps and develops...)
 +23 
submitted by sajaqua1(558)
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Enzyme A datssn in rof soPpiosehlahp 2,A ntnriug lpiohoshpdpsi ni teh elcl mmenearb itno ciicndrahao ascid. Fomr h,eetr zemynE B natssd rfo Conagxsclyyoee )O,(XC hweil nyzemE C satdsn rof -ygep5eosxLian -L5(O.) 5OL- urpecdso TEEPH,5- ichhw si ndteru oitn teknsoelire.u Loeenkrstuie aylp a uodble lreo in nveets elik sa,maht scebuae yhet aseuc coiosonrnntcictrobh n(ese in isth tnea)pit dan yb iatngc as hecaimcl ttrsatactan fro mrtaofynmial lslce, woseh ctvtiayi ilwl coesl het iyaarw r.rtefuh yB biglcnok COX pamlebyusr( hwit an ,NAID)S ew aleve more fo teh srsttebua hioiaarndcc daic rfo OX5L- to atlyutmile cvteonr inot snot.eirkeelu iTsh si eth sbsai rof aahmriassna-nititotlrn,e-p ihhcw is qtrufneyel tesaoscaid htiw lasan oppyl.s s(Stamr'e dat).ri

5tl3rcxea/hTewocFp/tg/sw95:t/k9tull4m.eia/r.wr

)D ylrcinPcoast nhaestsy . E) xoohTbmnaer sthyaesn

... sajaqua1 made a comment on nbme23/block1/q#28 (An otherwise healthy 82-year-old man is brought to...)
 +23 
submitted by sajaqua1(558)
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Prtserooi ordc eonydsmr ourcsc edu ot ratniionfc fo teh strioerop alhf fo hte nlpsia dc,ro romf ncosliuoc fo het ioeotrspr siplna rte.rya ruO tnatpei setrepsn wiht dercadsee enasnstoi ot pcnikrpi obewl eht velel of eth knsee as wlle sa iaglnwk ihtw a ebdwedsi-a gt,ia lyeilk idgtcaniin sslo of pooptoirprienc. Teh tiaepnt is salo aimnce twhi edtreenhy-pesmg leoruinphs.t

dengeyepsmerHt hnsrtpiuelo are llpiytyca uscade yb an tnylibaii ot kema unoegh ,NAD scduae yb a alkc of ereyacsns ucpssorrre nda isvtmian ndciigunl 9B tleo)af( dan 12B aa.c)onib(lm If het eptniat is lfoaet efi,necidt ew ees tleeedav smieyontohce iedf.eicnyc fI hte epaitnt is 1B2 tednciief, ew see vadleete lntmcleomhayi caid adn ysothciomnee el.evsl cmseenHihirtopeyamyo acn ienaercs rhboomt.iss sosrhomibT ni eht soeporitr nipals erytar nca aucse ierostopr dcro dnrm.esoy nI t,iinodad lkca of tiiavnm 2B1 pmsiiar eyimnl oiafmrton and saedl to aeucutbS nCodemib niDtern,goeea cwihh cffseat hte moSincalaphti atrct nnitouc(agc rof sedcdraee pipkcnir nsats),neoi toCpsnlicorai rTa,tc nda raDslo meadu-lCniolM imssucLen tcraT anc(ociugnt rfo het cerddue cropieip.onoptr

)A eorAitrn ordc -osnyemdr loss of tormo nmamd,oc sa wlle sa blrteaali lsso fo thea nda ni,ap het nipetat sha otn otsl romto ifo,cuntn os ti cnntoa be i.tsh B) naetlrC orcd -msrydeno stenpres sa a tnoaicinmbo fo rotmo adn seornys ,sslo llayuus thwi redabld tcfnyd.soiun iThs teptain osed ton dylasip ortmo sslo ro redabld yfondtciu.sn )C eocmrdHi rmeydno-s oslA dlclea -BerduwaoSrq,n ihst si pcemltoe rnyjui to therie the tlef or thgri sdei fo teh lipnsa ro.cd It repsetsn iwht mtoro nfindcsotyu dna lreexf odsuycfintn lpatlaisyelir at hte evlle of teh n;iloes sosl fo purpe mrtoo doncmma eolbw het esnoil lalsrilatpeyi ctsipa(s s);epiars sslo fo rlaods nlmcrourciae-d snsaniteo alpleryialsit at nda elwbo hte n;lsoei nad lsso fo inpa nad utremeteapr nnssaoeit ntolrraetacllay 2 to 3 vtaebrer oewbl the lsoe.ni )E yntemgreSa dn-emsoyr a igetlnonca euialrf ot pvedoel rtap fo the plaisn or.dc ehT enw netos fo ypsstmom ta 28 ryeas old skmae itsh an eunlyilk .iagnis,dso

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. +2
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
makingstrides  Like most of these questions, pick the closest/ best answer. For reasons above, this is the best one. +
skonys  FA19 pg69 says B12 deficiency causes SCD AND parasthesias. This patient has progressive numbness/decreased pinprick, ataxia (spinocerebellar & DCML). Also it's important to remember that B9 and B12 both have megaloblastic anemia but B9 DOESN'T have neurological symptoms. +
... praderwilli made a comment on nbme23/block2/q#10 (A 50-year-old man who lives in eastern Minnesota...)
 +23 
submitted by praderwilli(71)
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tsnW'a erus ouabt iRaettik,cs btu I nkew nroib of xdesio was no shi erliyctc ni teh ersohatnt adn gntteig rodrteut by hte pmvirae sb.eab

mimi21  LMFAO facts ! +11
... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
 +22 
submitted by thomasalterman(162)
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heS tsju etcleodmp eht soucre fo iumarib,xt which attgser 20CD cetrpesr.o -cBell ieneycifdc nca perosedisp ot acarbteil c.osenitnfi

b) BM ilerfua si not iaassdcote ithw xuiract ib)m gdnro)w ngwo r)e hits srucoc w/in -107 ayds fo gtaintsr t,entremat and dluwo not rcuoc eftra eplctginmo a tn-mo4h rucoes of mr.iabtuxi

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#42 (A 68-year-old woman comes to the office because of a...)
 +21 
submitted by sajaqua1(558)
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hTe pittnea hsa a iporr ysihtro of htersyoetcym whti lretalabi ecsoolphtnoaoompy,g-ri dan dcerivee lrenaext maeb aatniorid to the peilv.s heT peittna own siapdlys dohhirspsyoner nad er,yrruodeth twhi dltsia lerutera nrnwgario tlar.leayilb The etleisilk ipoont is ttah ew aer isgene oesnhdasi mrof ueiosrvp rruegsy cionsrttc teh uer,etrs sunacig .hits

)E rllhaUtoie mraioncac o(las adllce olannaisirtt clel caincmao)r is aslo a sl.iiobtypis ahWt kesma siht ekynulli si eth toniocal: il.reatlba Teh rriop yeytsohmertc nda tabillare ohgocset-ioonapoyrlmp doulw laeev cras sutsei no thob sdsie of the yob,d but the sodd of ruahletlio rioccamna isgnira iletarbllya are very sm.li

)A eTh taneipt had a etehomcytrys, so eth odsd fo recuetrrn lavricce ccroinmaa rea olas icreybdinl .olw )C dan )D rrhlUate myndloaoc and ualhetrr tnliiartnsao lcle pomillaap rae in eht rwgon ilaotocn to caotcnu for lalebtari rlatrheu ringowran whti erydreuo.rth

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). +14
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
yesa  My understanding is the cancer risk with radiation is late-onset, a decade or more after the fact +
fatboyslim  Why does she have increased daytime and nighttime urination? I couldn't figure that part out. +
... mcl made a comment on nbme23/block3/q#28 (A 10-year-old boy sustains an abrasion on his left...)
 +21 
submitted by mcl(619)
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uBnos qikuc ierevw

... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +21 
submitted by smc213(151)
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To be clplmeeyto ce!alr

shTi tnaitpe ahs tissysinCo a erra usaolaotm rveseicse lsyaomlso torsage ersrdido dna omst conmmo ucesa fo ianocFn enmordsy in .rdcheiln sCiistonys is smictsye nad edasl to yctseni tcasryl oiptsdse in llcse nad sssieut orouhhgutt hte ybdo.

hhtgoAul ssiolnW edsaesi can lade to F,S het ytslscar in teh coasenr osed tno elcetorar wtih lssWnoi si.seaed
r Meo :ifon 8Prpmnn11w..wnv0c/4a.c/gs:tt.ieCl/h/o6Msclipih//mb4wt

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
... cocoxaurus made a comment on nbme23/block1/q#43 (A 65-year-old woman has the recent appearance of a...)
 +20 
submitted by cocoxaurus(55)
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Per WLOR-UD edoancoarcAinm si oatsscadie w/ nglu arrsncig tearled to luaoasurnmogt es,eisda dol PDOC (r)hcconi nda agdame ude to nreerurtc maineu.nop

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_(111)
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ieAbrablttut ikrs = cdneienic in epeosxd – eniceicnd ni xnupedose

= 0010,/30 oms)ers(k - 00/,3030 soe)o(nkrnms
= .300 - 0.01
= .002 s(o het brteuttaabli rksi is uaotb %2)

lpAgpyin it ot a nioptpulao fo 0:1,000

= 20.0 * 000,01
= 002

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. +3
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. +16
... 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(237)
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onarifaMd tshabiu + aucolMs uormsane + Nkce sams = NME 2B M(MP) eoh,P yreMullda ytdiorh AC inilCatnoc( )ereincst,g cuolsam rneusmao

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 +2
... sajaqua1 made a comment on nbme23/block3/q#5 (A 68-year-old woman has a 6-month history of...)
 +19 
submitted by sajaqua1(558)
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sTih attpine ahs adpiwsered stetrondicu of thbo raalend ngal,ds ichwh smnea htta seh illw eols ohbt erh milotosradricenoci nad rhe loo.idrcutscocig Teh sols of the aroienmdcclioosrit dan the etffec no hte sdenyik si ahwt is niebg esdtte .eher hWne detoolresan si inutfngoinc nda ana,nbdtu ti ash rleaesv tclciiar nficsuont no teh nroenh.p ri,Fts ti prsuugateel /N++Ka ATsPea seirnxpose no het orabaellast r,aemnmbe hitblseasngi a trnosg acltclcrheomiee naerdgit ttha treebt osbrbsa +aN, ihelw het ciesrande unlerarltalic +K tnintccneoora saekm it iseare ot oesl K+ ormf the cell tino eth nmlu.e nrdAestoole sloa regulsupaet eth sepinosrex of eeiaptillh sdoumi hanelsnc E(aCN) on teh tngcellcio uctd, onraeisrbbg mroe N+a. Fa,llyin seonldartoe eaeinsrsc xesorspein of +H PsAseTa on adnheactlei-trlpaa cslel fo het olegcltnic t,cdu hhciw rae eoebpsinrls for sterncegi +H (itsh is part of icrtaonotnc .laosalisk)

tWhi teh ossl fo r,loeatoensd we illw see a ecesardse K/++Na tnaiergd nda csedraede +Na snrba;tpoeoir tihs aseld ot sadeerdec merus omdisu nad eneciarsd remus otpiusm.sa At het eams im,et ont sgprisnxee +H aTAesPs lwli aled to +H otn ngeib rdeetes,c cgrtaine a emro dcaiic tvenrinnmoe Hp( wlil .s)aeceder

abhishek021196  Very well written explanation. Bravo +2
... sajaqua1 made a comment on nbme23/block3/q#38 (A 5-year-old boy who has recently recovered from an...)
 +18 
submitted by sajaqua1(558)
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ehT ramorw hwsso surrrsecop ot ryhrecettos,y sa well sa rcegyaaomtkye.s iThs is ot hwos you atht eth ssuei sitn' p,oeuuoicrdndrtn wihch ensam tath we rae lnogis BCR and plattesle reswemeoh ie rcniu.stedot htaT usrle otu D nad E. Teerh is ihngtno to ieaictnd aht hte cdhli ash tdedsisimnea rtoluecbsius (.B) tA shit tionp ew rea ltfe whti A ro C. A uldwo eindtcia Ddessnatmeii ulrsctraavnaI aogonutlaCi CDI() or ontigemhs asmilri, whcih wulod esurlt in olw tatelleps nad RBC tbu we oduwl lsoa ees rnalbmao RBC lkie sctocteisshy ("l"mtehe )les.lc eW rae lyciltxeip tdlo hatt eht syteycrthero ear romncrhimoco adn c.otocmynir wHeeo,vr unimem idrcouetnst of ellttaesp xpseilan ti l-al the onecrdtutis fo ltsltaeep ealsd to osme gohearinmgrh dna os a ordp ni B,CR dna PIT iyllsasclac iesars tfrae a neertc prpue sapoeiyrrrt tarct alvir icnifto.ne

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. +7
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. +
... youssefa made a comment on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
 +17 
submitted by youssefa(141)
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aoa:Phmt - ysytpcoLemh are het msot isstievne esllc to wleho obyd dtonraiia - astoylGercnu (alnyiM tlsnioprue)h era yuripclltaar ryve visenesti ot etaecitmhcuoeprh nygtailalk tgsaen rqe(inirgu -GSFC rstylho eft)ra

arcanumm  Always think of NEUTROPENIA when chemotherapy is treating rapidly dividing cells (a small fever is an ER visit for these patients). +8
... imnotarobotbut made a comment on nbme23/block2/q#17 (A 21-year-old man comes to the physician because of...)
 +17 
submitted by imnotarobotbut(168)
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rlsaiecV shissaeimanil sceuas nepaaeghlsomleotyp adn tmso mtp,ionayrtl caenpntapyio. It si nftoe ofdun ni eplpeo hwo sivti het deidlM Etsa adn si tatedmrstin yb hte n.Sydalf yWh idd NEBM put 2 nmLsiehaai qsnostuei on itsh mrfo llo

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +12
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. +2
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. +1
jaramaiha  Sketchy for the save :) +1
srmtn  also if they say pancytopenia...they could have mention anemia in order to make us answer malaria +
... usmleuser007 made a comment on nbme23/block2/q#23 (A 75-year-old man with prostate cancer has...)
 +17 
submitted by usmleuser007(419)
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  1. aCnecsr fo eth ,ivlspe icignulnd teh tpter,osa sarepd to teh smaboclurla ipens via eth ertrbelav esunov lepsxu )VP(V.

    • hTe VPV nomaiucsmect thwi a ubnerm fo evsnou okrew,nst ncngiliud teh opttsriac eusovn lspuex, ihhcw srvieece teh ovneus slyppu morf hte ,setatrop ,pisen and bearld.d

    • VPV nsur up the inreet sipaln lmocun dan cntcosne thwi hte enuvos upslpy fo hte irabn via a vlaseevsl msseyt so’ntsa(B esul)Px wichh walols rof caiorbndleiit flow adn gitnorulae fo nriicrlnataa pusTihrse.rse ousnev inccenotno ot teh reabcrel urinclicota yam lpeh ailenxp hte psptrineyo of romsut to sztemsietaa to eht arin.b

  2. The VPV sloa cueintosmmac wtih the ygoazs envi in het es,cht ciwhh slexaipn in ratp hyw sterba nda ulng snaeccr rfylteenqu ssmtzeeaati ot het hatorcci einsp.

    • ilal,yrmiS ude ot unomalrpy oenvsu negdaair iton the ftel ides of teh a,reht gunl tousrm fotne sarepd atclylsemysi via eht rrtaaeli tsms.ey
  3. ulAghhto mhylp ndose era het mtso oomnmc isste fo ittaesasms ni ,enaeglr acyimplth drespa to eht kaeestll msetsy is reyv rr.ea

  4. Teh fmairionppm spxeul vreecesi nvseou aadegrin romf hte ,stitse yd,dismipei adn ductus srneefde adn sdanir nito the aeltuscrti nsevi.

... sympathetikey made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +17 
submitted by sympathetikey(1446)
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gTouh itesoun.q

Rlelac htat mntenaMei zrm(ilesh'ae gud)r is a ADNM oRetrpce angtotnAsi htta lehps trepvne cotiycitextox yb Bglconki +a2C tyner. tTh'sa owh I errmmeeb sti.h

veryhungrycaterpillar  https://www.jneurosci.org/content/10/3/909.short Great little read, and this is the paper they pretty much based this question on. +
veryhungrycaterpillar  Linked the wrong paper. Meant to link this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867560/ +
... 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(558)
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Besucea eht basyb' thoemr ash ypTe 1 bsitDaee eltusi,ml it si ibllpsuae taht eyth adh daevltee oldbo cuslgoe evlles nuridg ro tlyhros rebfoe tbhri. nlIisnu esod tno soscr het nc,paelat tub ogcleus ods,e os ugirdn ihtrb the noneeat ulodw hvea nbee relhmyci.epgyc sihT olduw dael ot het antenoal sareapcn egelrsina iusnil,n rgdniiv clougse oint elslc dna ugtirnn onwd oe;ngligosuecnes itsh is ywh teh aybb is lmcypygchoei rghit no.w

)B eaeeDdrcs ylgongce otntnri-ccnaoe I not'd wkon eth lnycggoe nrtaccnioeotn oedrapmc ot an laudt piea,tnt ubt a edrcsaee ni ggloceyn coeirntatnocn lowdu atiendci lg/yucgnelcogose rlasee,e ihhcw wdoul ton eb a ipcehloymcgy a.estt )C dseacDere ynglgceo haystnse t-icyviat eadecdrse negcogly shnseayt tiyvaitc dseinctai egyner lobasm,atic nad ludwo dale to eghrhi suemr lscguoe .lelves D) dDeeaecrs mrsue unsinli necitctanno-or aereedscd uersm nuiisnl wodlu dlae to reihgh veslle of socugle in .uesmr )E rdIsneaec msrue -lesiniiuknl ogtwrh -focatr GIF sedo nto dinb ylanre sa wlle ot unsinil rrtpoesce as suniinl o,des and so would veah to eb in lmeeytexr ihgh tnirnnocaescot to ehva tshi fefc.et IFG si ssaaeicotd wtih itcomsa orghtw nad smleuc .vlenmoptede

yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +6
alexb  Also explains why he's 12 pounds. +4
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. +3
... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
 +17 
submitted by alexxxx30(57)
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ddi yennao lsee vhae ot erdera tihs iuqentos avlrese i?stme The pmuijng abck and trhof fomr t"ish hapepnde brofee, 1 eewk a,fter 6 weesk tear"f etnh sith ppehaend o,ydat nhe"t htsi hepndape 6 keesw pt"ospo vage em hlahpswi. ellT the tyosr ni o!rrde 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 +1
homersimpson  Some Westworld Season 1 Shit +1
... mcl made a comment on nbme23/block3/q#26 (A 27-year-old woman has headaches and blurred...)
 +17 
submitted by mcl(619)
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neiPatt tihw raiteblla ealnr raytre urbist nda eirpyhetnnos llwi orf ures heav aivcitaotn of SAR tmessy adn eefrorthe nsereiac ni igna.nitsnoe

thuhglAo cpmceohmtoyoroah dan cuoetsnneq dleveeta iaetlnhmcscaoe can enscirae dolbo esuer,rsp psytmsmo rea cptailyyl sepodiic and rlaen sibrut ear nto kielly ot eb dea.hr levedatE lleves fo ronesnito nac aols sacue tnee,yirhnpos tbu ew oudwl loas ptxcee ot ese u;ighnlsf ,also htree is gionthn ni hte mset to enditaic itenpat is akgint SIsRS or hotsgniem lsee ttha oucdl rspesedipo hre to eelevdta evlsel fo tionsnro.e tdvlEeae velsle fo rtdohyi hmreoon udlco asol gevi aeptnti eeysth,iponnr btu we owdlu olsa xetepc rohet issng of roeyptirsiyhdhm ,(rsotemr tghiwe sols, .)t.ce

I aws a elttli oudcfesn if PEO olwdu be edeealtv -- if teehr is einstsos of renal rteaeisr as( idacnidte yb het b)urtis hte yndkeis could olsa detect htsi as ioapyxh nda apmr pu udntcriopo fo PE.O ,wHreevo I dened up gingo htwi tonenagsiin ceisn it sedeme eomr c"onr"eetc to me hatt ARS udolw eb .up Dsoe nyeano knwo wyh t'si not EO?P

brise  Wouldn't that be more long term? +4
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
... sympathetikey made a comment on nbme23/block4/q#21 (An otherwise healthy 26-year-old scuba diver has...)
 +17 
submitted by sympathetikey(1446)
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drHa ot ese due ot roop rcipetu aut,liqy but adsbe on tawh I olcud ,ees ti seems lkei a uspnseanoot xtrpmhouneoa ot em b(deas on het lakc of nglu rkmiang no the felt mcerpado to teh rthig di)e.s

erfeorhe,T ecsin eth nglu is ,eddlfeat all uyo dolwu veah in eth elft sedi of eht open ,vciaty hchwi lduwo ekma het felt edis .shnrtpysroaene

sugaplum  FA 2019 pg667 +16
... yotsubato made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
 +16 
submitted by yotsubato(1088)
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hisT is a etqisuno ubtoa attepin p.rvaicy eTh tiaetpn heer si teh ldich. heT oryxp rfo the teiaptn is the ohmert nad tfah.re eThy tmsu wnok waths nrwo.g eSirts nda hetomr aer jstu ookol,lsyo nda rnapste yam nto wtna ot ltle them dustip( I ,knwo tub eerawhvt) so you snde meht out dna tneh llte the ertspan eth stuiio.tan

dr.xx  agreed +
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +29
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. +11
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +8
... 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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’Im nto eth tbse at teh lacltnioacsu of FFEC/C,I utb ylisbcala uoy rea nifgiuns a ioyrtcehnp nisoluto into the a.ilman ltyinI,ali tish is lla goign to og niot het lxeeaulrtlrca ,eacps as yan VI nniisfuo wlli od. Sncie it is iehghr hatn oosictin olnuo,ist wreta is igngo ot og rmfo het alrneclitrula epsac ot the rtxrleuellcaa eapsc to rty ot lacaben it ou,t so the eilrraatnclul acpes lilw aveh adseecrde evmulo dna racseidne myallsitoo csie(n ylno watre si ie,agvnl nmakgi ti rmoe tda.coernent)c

So uyo owkn orf ruse IFC uovlme si acdeersed adn asmiltloyo saeicdr,en nad teh ertarlcelulax lemvuo lliw eb resncia.ed I tikhn eth oloslitmya fo teh xutllalaerrec apces is eht rtkciy ptar dna eht tpar whree ybeam enesomo lsee anc hepl wtih eht anillutccoas but baasclyil ts’i cyeionpthr ghneuo that eth lsytliooam iwll llsit eb nesredi.ca

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. +20
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
btl_nyc  0.9% saline is isotonic. When "normal saline" is given to a patient in a hospital, it's 0.9%. I think that's something you're expected to know. The good news is that now you do. +
... yotsubato made a comment on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
 +16 
submitted by yotsubato(1088)
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hYae rs,eu slet evgi teh uyg ohw wntsa to keep sih ikcd nirwgok adn eb aictevartt sdratow wmone isrentdeiaF and cepleomtyl rinu ihs ososrtntetee levsel and iveg ihm a ilpm ckdi, nam bboos, and eeaecdsrd efcrpnarome in strpos.

iSsetoemm teh NEBM lyaelr jsut meksa me kas yW?h

iapclTo loxmiidni dulow be awy eettrb tub on tyhe wotn tup tath sa a oicche

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 +
... jrod77 made a comment on nbme23/block4/q#17 (A 24-year-old man has a grade 3/6 systolic murmur....)
 +16 
submitted by jrod77(30)
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eTh cosstyil rrpesuse cfdnfireee wtnebee the flte vnerelict nad hte arota in tshi .pt si epttry nctn,ifgiasi hrWsaee in a anlrom rheat seoht stisoylc seserupsr dusolh eb sutj uatob uqea.l sTih sthin ta eth afct hatt eth felt vlnetecri ash ot tpu in otal of wokr to hups ruhghto hte iraoct ea.vvl hTta exrat seserrpu sego oitn gonipne teh vleva dan sedo tno apaepr ni het aa.rto

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˜” +
jbrito718  @divya I think it has to do with the fact that the left ventricle is pumping so hard that some RV hypertrophy may occur since they contract simultaneously. Chronic aortic stenosis will eventually reflect backwards, causing increased pulmonary vessel resistance. +
... thomasalterman made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
 +16 
submitted by thomasalterman(162)
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tPetina hsa tlyaicoephmy var,e as ednidecev yb ythceysrisrtoo, sor,slcingotauy dna ehcaedhsa m&;ap nisze.ids OEP is rcadedsee edu to ycorhtryestios. eaDedcser LAP ludow aedcitin MC,L not .VP

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. +11
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. +5
... nwinkelmann made a comment on nbme23/block4/q#47 (A 43-year-old woman comes to the physician because...)
 +16 
submitted by nwinkelmann(313)
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urmMurs nad u:eeansmrv s1t houthgt = who deso ti cahneg with .ldpaoer lAl mmuusrr ptexec H,MCO P,VM adn atilra xymamo iseervyt is drietlcy rlopirtoanop to anechg ni aprdloe (.ei. needracsi waseprloo=der umm,rur c..)te eecBuas of tsh,i DDx nca eb ewradron wdon ot OM,CH VP,M adn iartla ymmaox gitrh ywaa usabeec teh rmrumu wednosre iwht eaceddser erpdoal .i(e. gatdnisn pu) ehwn lla utb eeposcixtn iwth rep.ivom

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dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +7
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +4
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +1
... nwinkelmann made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
 +15 
submitted by nwinkelmann(313)
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S,o orf oesm enaro,s sonaniertsumretrt si omeshntgi e'vI SLAAYW egduslrtg .h.iw.t pyroblab ubeeasc I awstn' hatutg it llwe os vener alyler lrdneae i,t usjt redanel ohuneg orf ereavhtw ae.mx I stju onufd itsh boo ughhrto CNBI nda sit TAACFS!ITN sI't ormf 0012 so hitmg be do,l btu it aws t.erag oYu cna ehascr hhrtuog teh bkoo nda find eht raephct.s I prteyt uhcm jstu wtne guhhtro lla fo hte rarneiemturotsnt pth.erca opmw.owbt./vnshs/wiilck9t9/h:B0/bK7no/1g.N.n

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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 +3
dorischang  Didn't finish reading this, but it looks awesome +2
... sympathetikey made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
 +15 
submitted by sympathetikey(1446)
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ynA etmi uoy see xidfe dewi tngiiptls of 2S, msash ASD.

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... +
... lfsuarez made a comment on nbme23/block4/q#22 (A 40-year-old man with terminal small cell carcinoma...)
 +15 
submitted by lfsuarez(146)
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This apttnie peensstr htwi a laslm ecll rmoaaincc ciwhh si yevr oncmom for apra osncplteia dnssme.roy In hist asce the nacerc si sgcanui I.AHDS lieeDlccoeymn is a yenialtrtcec itotnaiicb ttah si lsao edus ot rtate DSIHA

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). +17
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +4
... sympathetikey made a comment on nbme23/block4/q#30 (A study is planned to assess differences in...)
 +15 
submitted by sympathetikey(1446)
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tesBggi cuel was tath heret was no iemt ermfa igevn. hr,eeoerTf htis emses ot be a ce"lsi in e"tim ys,dut ihchw lsein pu hiwt osrcs ctaoesnli dsyut.

paulkarr  Damn, epi at it again... +5
... chris07 made a comment on nbme23/block2/q#6 (A 6-month-old girl is brought to the office for a...)
 +14 
submitted by chris07(64)
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Teh lyon nentfcoii no tath itsl hatt uoy luwdo neev senrec na toiswereh laethyh iaareppgn iuvdiaindl si eBHp. heT etsohr I ulowd thkni oyu loyn hckce fi eht paietnt sha a stipoentaern htta ksmea uoy tpcsuse mth,e klei BEV if hyet dah sgnis fo n,oom or SRV if hety dah isaorprrtey opyss.mtm At ttah ,pnoti he'etyr on enlrgo ecigsernn st,ste tbu moer oagisdnict nseo.

gilbert  I got it right because I thought of the prevalance of HBV in China. +8
yesa  Also, HBV forms chronic infection in children (HCV chronic in adults), so if she's not vaccinated for it, you screen for it first. All of the others you don't screen for even if they cause a latent infection (CMV...) +1
veryhungrycaterpillar  @gilbert. Exactly. You don't normally screen people for Hep B in the US, unless they're from a demographic. Chinese immigrants are among that demographic. +1
... brolycow made a comment on nbme23/block2/q#19 (A 70-year-old man with severe congestive heart...)
 +14 
submitted by brolycow(30)
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He ash tahre uferlia iwchh lsaed to a eeradecs ni nlrae dobol lwfo dna alenrrep ozmae.ita In lpnerera tme,oaaiz r:CBNU traoi si =g&;t ;02 ovacAniitt fo het SARA eytssm ude ot hte parlnree aimaeozt aemsn atth het escp vrga is ihgh at 210.5 dan he si giodhnl tono dmuosi so nrryuia omdisu will eb olw 20(,t;l& FEaN ).1;&l%t

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. +9
benzjonez  Very helpful video for acute kidney injury: https://www.youtube.com/watch?v=bMp6IxDKK2Q +9
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 +
... seagull made a comment on nbme23/block3/q#19 (A previously healthy 32-year-old man is brought to...)
 +14 
submitted by seagull(1688)
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sThi nittpea is pirgnpti s.ball tBeert do a rudg secenr chiwh eesms ob.voius

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +45
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 +
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +1
llamastep1  Bilateraly messed up pupils = Drugs (most of the time) +1
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) +2