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NBME 24 Answers

clinical_trials medicine
Block/Question (73.1 difficulty score)
A researcher hypothesizes that exposure to ...
Case-control studyπŸ”

pharm beta_blockers
Block/Question (21.0 difficulty score)
A 43-year-old woman with a 2-year history of ...
Unopposed Ξ±-adrenergic toneπŸ”

oncology metastasis lymph
Block/Question (41.7 difficulty score)
A 52-year-old woman comes to the physician ...
IntercostalπŸ”

micro cryptococcus
Block/Question (31.5 difficulty score)
A 28-year-old man with AIDS has fever, ...
LungsπŸ”

genetics process_of_elimination
Block/Question (42.7 difficulty score)
The 35-year-old woman indicated by the arrow ...
X-linked recessiveπŸ”

respiratory transfusion
Block/Question (39.8 difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”

Block/Question (30.6 difficulty score)
A 65-year-old woman comes to the physician ...
Cigarette smokingπŸ”

Block/Question (49.2 difficulty score)
A 24-year-old woman at 28 weeks' gestation is ...
TremorπŸ”

Block/Question (18.9 difficulty score)
The graph shows expiratory pressure-volume ...
Diffuse pulmonary fibrosisπŸ”

Block/Question (40.0 difficulty score)
A 75-year-old man is brought unconscious to ...
AtherosclerosisπŸ”

Block/Question (49.2 difficulty score)
A 55-year-old man with type 1 diabetes ...
Persistent activation of voltage-gated Na+ channels in the nociceptorπŸ”

Block/Question (13.3 difficulty score)
A 26-year-old man comes to the physician for ...
Increased number of LDL receptors on hepatocytesπŸ”

renal nephropathy
Block/Question (55.4 difficulty score)
A 4-year-old boy is brought to the emergency ...
Proliferative glomerulonephritisπŸ”

Block/Question (21.0 difficulty score)
A thin 66-year-old man is brought to the ...
Urine osmolality > plasma osmolalityπŸ”

Block/Question (45.2 difficulty score)
Results of a 5-year screening program for HIV ...
5%πŸ”

Block/Question (32.2 difficulty score)
A 32-year-old man is brought to the emergency ...
Flexion at the distal interphalangeal jointπŸ”

Block/Question (22.4 difficulty score)
A 3-year-old boy is brought to the emergency ...
Annular pancreasπŸ”

Block/Question (26.0 difficulty score)
A 34-year-old woman with a long history of ...
Tuberculous osteomyelitisπŸ”

Block/Question (11.7 difficulty score)
A 35-year-old man comes to the physician ...
Cluster headacheπŸ”

free
Block/Question (50.0 difficulty score)
Immediately after a spontaneous vaginal ...
Fusion of the sclerotomesπŸ”

Block/Question (28.9 difficulty score)
A 35-year-old woman comes to the physician ...
Foramen cecumπŸ”

Block/Question (27.9 difficulty score)
A 50-year-old man undergoes surgical ...
Adductor brevisπŸ”

Block/Question (26.4 difficulty score)
A 50-year-old man comes to the physician ...
Generalized malabsorptionπŸ”

Block/Question (22.3 difficulty score)
A 6-year-old girl is brought to the office by ...
Pediculus humanus capitisπŸ”

Block/Question (29.8 difficulty score)
A 7-year-old boy has metabolic acidosis and ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (22.2 difficulty score)
An 80-year-old woman with poorly controlled ...
Hematocrit: decreased;
Serum parathyroid hormone: increased;
Serum calcitriol: decreased
πŸ”


Block/Question (39.7 difficulty score)
A 10-year-old girl with a lifelong history of ...
Palpable right ventricular liftπŸ”

immuno
Block/Question (48.6 difficulty score)
A 32-year-old woman comes to the physician ...
EosinophilsπŸ”

Block/Question (17.8 difficulty score)
An 80-year-old woman comes to the physician ...
Determination of erythrocyte sedimentation rateπŸ”


Block/Question (49.4 difficulty score)
An experimental study is conducted to examine ...
Post-translational modificationπŸ”

Block/Question (49.3 difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flowπŸ”

Block/Question (15.2 difficulty score)
A 3-month-old girl is brought to the ...
Human papillomavirusπŸ”

Block/Question (19.1 difficulty score)
A 62-year-old man comes to the physician for ...
SotalolπŸ”

newborn
Block/Question (37.0 difficulty score)
A 1616-g (3-lb 9-oz) male newborn is ...
Bronchopulmonary dysplasiaπŸ”

Block/Question (16.1 difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophyπŸ”

Block/Question (27.9 difficulty score)
A 25-year-old woman at 16 weeks' gestation ...
Increased hepatic production of T4-binding globulinπŸ”

Block/Question (16.2 difficulty score)
A 37-year-old woman comes to the physician ...
BorderlineπŸ”

Block/Question (22.1 difficulty score)
A 40-year-old man with AIDS develops severe ...
SomatostatinπŸ”

Block/Question (42.9 difficulty score)
A 26-year-old man and his 25-year-old wife ...
One in four will have 25% Ξ²-globin function and may require occasional transfusionsπŸ”

Block/Question (13.7 difficulty score)
A 32-year-old woman who is 20 weeks' pregnant ...
MisoprostolπŸ”

Block/Question (26.4 difficulty score)
A 68-year-old woman with acute myelogenous ...
Granulocyte-macrophage colony-stimulating factorπŸ”

Block/Question (15.7 difficulty score)
After completing 6 courses of chemotherapy ...
DoxorubicinπŸ”

Block/Question (16.0 difficulty score)
A 24-year-old man is brought to the office ...
Alteration in DNA gyraseπŸ”

Block/Question (35.2 difficulty score)
A 71-year-old man is brought to the emergency ...
Area labeled β€˜D’ (Posterior inferior cerebellar artery)πŸ”

Block/Question (17.6 difficulty score)
A 10-year-old girl is scheduled to undergo ...
SuccinylcholineπŸ”

Block/Question (22.3 difficulty score)
A 35-year-old man comes to the physician 1 ...
Increased serum angiotensin II concentrationπŸ”

Block/Question (25.4 difficulty score)
A 70-year-old man is brought to the emergency ...
Stroke volume: decreased;
Left ventricular end-diastolic volume: increased;
Cardiac output: decreased
πŸ”


Block/Question (23.7 difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”

Block/Question (55.0 difficulty score)
An 11-year-old boy is brought to the ...
Intracellular and extracellular dehydrationπŸ”

Block/Question (48.0 difficulty score)
A 73-year-old woman has had easy fatigability ...
Failure of conversion of N5-methyltetrahydrofolate to tetrahydrofolateπŸ”

Block/Question (32.7 difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturationπŸ”

Block/Question (30.4 difficulty score)
A 13-year-old boy is brought to the physician ...
This will typically resolve within the next 12 to 18 months.πŸ”

Block/Question (43.9 difficulty score)
A 57-year-old man has had hoarseness and ...
Area labeled β€˜Fβ€™πŸ”

Block/Question (43.0 difficulty score)
A 55-year-old man is diagnosed with coronary ...
Decreased adherenceπŸ”

Block/Question (29.4 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorderπŸ”

renal
Block/Question (29.5 difficulty score)
A 75-year-old man with a 10-year history of ...
Hydrostatic pressure in Bowman spaceπŸ”

Block/Question (20.0 difficulty score)
A 17-year-old girl is brought to the hospital ...
BeneficenceπŸ”

cell_bio
Block/Question (54.5 difficulty score)
In which of the following stages of the cell ...
G2πŸ”

Block/Question (28.0 difficulty score)
A 29-year-old man is brought to the emergency ...
Lateral pterygoidπŸ”

Block/Question (30.3 difficulty score)
A public health consultant is contacted by a ...
Regular exerciseπŸ”

Block/Question (47.2 difficulty score)
An 80-year-old man is admitted to the ...
20πŸ”

Block/Question (45.8 difficulty score)
An 80-year-old woman, gravida 4, para 4, ...
Damage to the rectovaginal septumπŸ”

Block/Question (15.8 difficulty score)
A 25-year-old man comes to the emergency ...
HeroinπŸ”

Block/Question (33.9 difficulty score)
An investigator is studying a new drug for ...
Free radical formationπŸ”

Block/Question (27.7 difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIVπŸ”

Block/Question (24.0 difficulty score)
A 68-year-old man comes to the physician ...
Normal agingπŸ”

FA20p504
Block/Question (37.1 difficulty score)
A 68-year-old man has loss of pain and ...
Right dorsolateral medullaπŸ”

Block/Question (29.8 difficulty score)
A 70-year-old man comes to the physician ...
Alveolar-arterial Po 2 differenceπŸ”

Block/Question (41.9 difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissueπŸ”

Block/Question (27.7 difficulty score)
A 50-year-old woman with HIV infection comes ...
ZidovudineπŸ”

Block/Question (29.8 difficulty score)
A 3-month-old boy is brought to the physician ...
PeroxisomesπŸ”

Block/Question (26.4 difficulty score)
A 9-year-old boy who was adopted from an ...
EπŸ”

Block/Question (17.8 difficulty score)
A 59-year-old man has repeated episodes of ...
ProbenecidπŸ”

Block/Question (45.9 difficulty score)
A 35-year-old African American man comes to ...
PalmsπŸ”

alcohol electrolytes
Block/Question (55.5 difficulty score)
A 35-year-old man is brought to the emergency ...
Catecholamine-mediated intracellular shifts of K+πŸ”

Block/Question (28.4 difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urateπŸ”

Block/Question (18.1 difficulty score)
A 3-year-old boy with AIDS develops giant ...
Negative-stranded RNAπŸ”

Block/Question (47.8 difficulty score)
A 65-year-old woman with well-controlled type ...
AtherosclerosisπŸ”

Block/Question (33.4 difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”

Block/Question (15.9 difficulty score)
A patient with cancer who is being treated ...
Granulocyte colony-stimulating factorπŸ”

Block/Question (30.5 difficulty score)
A 35-year-old woman undergoes a left ...
UreterπŸ”

Block/Question (20.8 difficulty score)
A 58-year-old man comes to the physician ...
Escherichia coli πŸ”

Block/Question (41.0 difficulty score)
A 40-year-old man who goes horseback riding 3 ...
Myositis ossificansπŸ”

neuro
Block/Question (43.1 difficulty score)
A 55-year-old woman comes to the physician ...
Lower motoneuronsπŸ”

Block/Question (27.2 difficulty score)
A 27-year-old woman comes to the physician ...
Transforming growth factor-Ξ²πŸ”

Block/Question (34.9 difficulty score)
In a culture of motile spore-forming ...
Irradiation with x-raysπŸ”

Block/Question (24.8 difficulty score)
A 65-year-old man comes to the physician ...
ParoxetineπŸ”

Block/Question (17.8 difficulty score)
A 3-year-old boy has short stature and ...
Endochondral ossificationπŸ”

Block/Question (41.8 difficulty score)
A 4-year-old boy has a 1-cm round midline ...
TongueπŸ”

Block/Question (13.7 difficulty score)
A 56-year-old man who is admitted to the ...
Determine whether the patient has decision-making capacityπŸ”

Block/Question (48.0 difficulty score)
A 3-week-old female newborn is brought to the ...
The patient has another mutation that was not included in the previous analysisπŸ”

Block/Question (25.8 difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulationπŸ”

Block/Question (26.6 difficulty score)
A 35-year-old man with quadriplegia develops ...
Area labeled β€˜B’ (Proximal convoluted tubule)πŸ”

Block/Question (38.0 difficulty score)
A 2-year-old boy is brought to the physician ...
Peptide transporter (TAP)πŸ”

Block/Question (21.4 difficulty score)
In a study of drug action on neoplastic cells ...
VincristineπŸ”

Block/Question (19.0 difficulty score)
A 73-year-old man has an incurable malignant ...
Both legal and ethicalπŸ”

GI
Block/Question (77.0 difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosaπŸ”

Block/Question (44.1 difficulty score)
A 17-year-old girl comes to the physician ...
Increased serum testosterone concentrationπŸ”

Block/Question (31.1 difficulty score)
An obese 57-year-old man comes to the ...
Normal ciliated columnar epithelium replaced by normal squamous epitheliumπŸ”

Block/Question (19.4 difficulty score)
A 3-year-old girl has a history of recurrent ...
NADPH oxidaseπŸ”

biochem metabolism acid_base blood_physiology
Block/Question (53.4 difficulty score)
A 28-year-old man has a blood pressure cuff ...
AdenosineπŸ”

pharm HIV antivirals
Block/Question (32.5 difficulty score)
A 37-year-old woman with HIV infection is ...
Nucleoside reverse transcriptase inhibitorπŸ”

Block/Question (33.9 difficulty score)
A 27-year-old man comes to the physician ...
Injections of gonadotropinsπŸ”

Block/Question (25.8 difficulty score)
A 37-year-old man is admitted to the hospital ...
Autoimmune adrenalitisπŸ”

Block/Question (25.0 difficulty score)
A 43-year-old woman comes to the physician ...
Alkaline phosphataseπŸ”

clinical_trials
Block/Question (27.5 difficulty score)
A 21-year-old woman with asthma comes to the ...
Phase 3πŸ”

Block/Question (46.0 difficulty score)
A 37-year-old man who is a farmworker comes ...
SynaptobrevinπŸ”

Block/Question (31.1 difficulty score)
A 43-year-old woman comes to the physician ...
Metastatic carcinomaπŸ”

Block/Question (19.8 difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”

Block/Question (34.7 difficulty score)
The pedigrees of patients with schizophrenia ...
Diabetes mellitus, type 1πŸ”

Block/Question (36.0 difficulty score)
A 35-year-old woman with asthma comes to the ...
ThiabendazoleπŸ”

syphilis ethics
Block/Question (45.2 difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privatelyπŸ”

Block/Question (43.3 difficulty score)
A cohort study is done to evaluate the ...
0.05 < p < 1.0πŸ”

biochem heme heme_synthesis
Block/Question (34.7 difficulty score)
A 17-year-old girl has significant blood loss ...
Ξ΄-AminolevulinateπŸ”

Block/Question (47.6 difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosisπŸ”

Block/Question (23.9 difficulty score)
HOX genes play a role in embryogenesis ...
Regulation of transcriptionπŸ”

Block/Question (22.7 difficulty score)
A 55-year-old man with alcoholism is brought ...
Competitive inhibitorπŸ”

Block/Question (45.3 difficulty score)
A 23-year-old primigravid woman at 22 weeks' ...
Ask the patient if she would allow the examination if her husband is present at all timesπŸ”

mutation paroxysmal_nocturnal_hemoglobinuria
Block/Question (33.6 difficulty score)
A 33-year-old woman comes to the physician ...
Defect in a cell membrane anchor proteinπŸ”

Block/Question (21.3 difficulty score)
A 7-year-old girl is brought to the emergency ...
Factitious disorder imposed on anotherπŸ”

Block/Question (25.2 difficulty score)
A 32-year-old woman recently diagnosed with ...
Epstein-Barr virus-induced brain lymphomaπŸ”

Block/Question (44.6 difficulty score)
A 32-year-old woman comes to the physician ...
BuccinatorπŸ”

Block/Question (52.1 difficulty score)
A 3-month-old boy is brought to the emergency ...
GluconeogenesisπŸ”

Block/Question (65.9 difficulty score)
An investigator is studying a new virus ...
CoronavirusπŸ”

Block/Question (24.2 difficulty score)
A 54-year-old man with a myocardial ...
Decrease in intracellular ATP concentrationsπŸ”

Block/Question (12.2 difficulty score)
A 27-year-old man who works from home as a ...
AvoidantπŸ”

Block/Question (46.9 difficulty score)
A 22-year-old man is brought to the emergency ...
Area labeled β€˜E’ (Cerebellum, posterior lobe)πŸ”

Block/Question (25.5 difficulty score)
Drug X is given to a 25-year-old normal ...
Partial agonist at Ξ²-adrenergic receptorsπŸ”

Block/Question (18.4 difficulty score)
A 38-year-old woman comes to the physician ...
Intraductal papillomaπŸ”


Block/Question (27.3 difficulty score)
A 15-year-old girl is brought to the ...
CD8+ T lymphocytesπŸ”

Block/Question (40.7 difficulty score)
A 12-year-old boy is brought to the physician ...
Nocturnal luteinizing hormone pulsesπŸ”

Block/Question (69.2 difficulty score)
An otherwise healthy 35-year-old man sustains ...
Decreased blood volumeπŸ”

Block/Question (41.5 difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formationπŸ”

Block/Question (24.5 difficulty score)
A 1-month-old male newborn is brought to the ...
TyrosineπŸ”

Block/Question (38.9 difficulty score)
A man accidentally touches the surface of a ...
Interendothelial gaps in venulesπŸ”


MSK
Block/Question (36.0 difficulty score)
A 34-year-old woman is brought to the ...
LunateπŸ”

micro
Block/Question (22.4 difficulty score)
A 2-year-old boy is brought to the emergency ...
Polysaccharide protein conjugate vaccineπŸ”

Block/Question (17.2 difficulty score)
A 30-year-old man develops tingling around ...
SodiumπŸ”

biochem cell_bio extracellular_matrix
Block/Question (51.2 difficulty score)
Which of the following terms best describes ...
LaminsπŸ”

Block/Question (36.0 difficulty score)
A 35-year-old woman with a long-standing ...
Infiltration of lymphocytes and monocytesπŸ”

Block/Question (38.1 difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrinπŸ”

Block/Question (26.0 difficulty score)
A 59-year-old woman has a 10-year history of ...
Neural crest cellsπŸ”

cell_bio cell_transport cell_trafficking
Block/Question (45.8 difficulty score)
A 15-year-old girl with cystic fibrosis has a ...
Endoplasmic reticulumπŸ”

Block/Question (22.8 difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”

Block/Question (17.0 difficulty score)
A 62-year-old man comes to the physician ...
Phantom limb painπŸ”

Block/Question (38.9 difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartmentπŸ”

Block/Question (25.1 difficulty score)
A group of physicians submits a report to a ...
Case seriesπŸ”

Block/Question (17.3 difficulty score)
A 30-year-old woman comes to the physician ...
Glycine and succinyl CoAπŸ”

Block/Question (19.7 difficulty score)
A full-term male newborn has lethargy, poor ...
Enzymatic reaction labeled β€˜Cβ€™πŸ”

Block/Question (53.5 difficulty score)
A 23-year-old woman is brought to the ...
Renal tubular acidosisπŸ”

Block/Question (42.8 difficulty score)
A 63-year-old woman develops flank pain, ...
ABO incompatibilityπŸ”

Block/Question (57.7 difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”

Block/Question (57.9 difficulty score)
A 68-year-old woman comes to the physician ...
Inferior mesenteric and superior mesentericπŸ”

Block/Question (43.6 difficulty score)
A 3-year-old girl is brought to the physician ...
Spontaneous regressionπŸ”

Block/Question (61.7 difficulty score)
A 1-week-old newborn is brought to the ...
Organic acid metabolism disorderπŸ”

Block/Question (50.5 difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”

Block/Question (45.5 difficulty score)
A 60-year-old woman is receiving cisplatin ...
HyporeflexiaπŸ”

Block/Question (37.0 difficulty score)
A 53-year-old woman comes to the physician ...
Fixed cardiac output in spite of increased demandπŸ”


Block/Question (31.2 difficulty score)
A 90-year-old man has a 1-week history of ...
Incarcerated inguinal herniaπŸ”

Block/Question (7.8 difficulty score)
A new screening test for colon cancer is done ...
118/124 = 95%πŸ”

Block/Question (19.8 difficulty score)
A 15-month-old boy is brought to the ...
MigrationπŸ”

Block/Question (37.3 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal
πŸ”


Block/Question (48.9 difficulty score)
A 63-year-old woman undergoes operative ...
Decreased movement through the arachnoid villiπŸ”

Block/Question (56.8 difficulty score)
A 64-year-old man undergoes surgical repair ...
Artery of the ductus deferensπŸ”

Block/Question (35.3 difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincterπŸ”

Block/Question (18.1 difficulty score)
Forty of 100 attendees at a company Christmas ...
Vibrio parahaemolyticusπŸ”

Block/Question (30.3 difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcersπŸ”

Block/Question (30.9 difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureterπŸ”

Block/Question (27.9 difficulty score)
At 2:00 am, after sleeping for 5 hours, a ...
Phenylethanolamine N-methyltransferaseπŸ”

Block/Question (28.4 difficulty score)
A 13-year-old girl who has a 6-year history ...
Discuss further the impact of the patient's illness on the familyπŸ”

Block/Question (13.1 difficulty score)
A 26-year-old man is brought to the emergency ...
Pericardial tamponadeπŸ”

Block/Question (62.4 difficulty score)
A 10-year-old girl is brought to the ...
Ovarian Sertoli-Leydig cellsπŸ”

Block/Question (54.6 difficulty score)
A 19-year-old man has had weakness of the ...
PolyneuropathyπŸ”

Block/Question (25.6 difficulty score)
A clinical study is designed to evaluate the ...
10%πŸ”

Block/Question (31.7 difficulty score)
A 56-year-old man has a 3-year history of ...
PresenilinπŸ”

Block/Question (58.2 difficulty score)
An investigator is studying an outbreak of ...
Only cookies are independently associated with E. coli casesπŸ”

Block/Question (44.5 difficulty score)
In a study of antibiotic resistance, a strain ...
ConjugationπŸ”

Block/Question (13.9 difficulty score)
A 45-year-old man with hypercholesterolemia ...
Increased synthesis of LDL receptorsπŸ”

Block/Question (35.1 difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuseπŸ”

Block/Question (48.7 difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cellπŸ”

Block/Question (67.5 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”

Block/Question (21.6 difficulty score)
A 68-year-old woman comes to the emergency ...
AlendronateπŸ”

Block/Question (29.6 difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meatπŸ”

Block/Question (51.4 difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”

Block/Question (37.5 difficulty score)
A 30-year-old woman comes to the physician ...
Decreased afferent arteriolar resistanceπŸ”

Block/Question (48.4 difficulty score)
A 25-year-old woman is brought to the ...
Pulmonary capillary leakageπŸ”

Block/Question (60.4 difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoitesπŸ”

Block/Question (39.1 difficulty score)
A 40-year-old man who recently immigrated to ...
AdenineπŸ”

vascular
Block/Question (47.4 difficulty score)
A 72-year-old woman with coronary artery ...
Neointima formation in the right coronary stentπŸ”

oncology
Block/Question (33.2 difficulty score)
A 71-year-old woman with non-Hodgkin lymphoma ...
LeucovorinπŸ”

renal
Block/Question (22.3 difficulty score)
A 40-year-old woman with a 25-year history of ...
Secreted by the proximal tubuleπŸ”

anatomy neuroanatomy
Block/Question (29.4 difficulty score)
A 22-year-old woman comes to the physician ...
Pineal glandπŸ”

oncogenes oncology
Block/Question (20.4 difficulty score)
A 40-year-old man comes to the physician ...
HNPCC syndromeπŸ”

neurology
Block/Question (47.0 difficulty score)
A 55-year-old woman is brought to the ...
Posterior cerebralπŸ”

neurology erections
Block/Question (57.3 difficulty score)
A 27-year-old man sustains a spinal cord ...
Penile stimulationπŸ”

FA18p360 FA19p359
Block/Question (22.1 difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”

Recent comments ...

... seagull made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
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The itnmsseca of htsi nqsuteoi daem me iotvm .oodbl

neO yad a anttepi illw olko me in het eeys dna ,ksa Were"h rae eetrdsitip ronbek "wn?do I iwll esilm at emth dan ays, het" teianitsnl ausmoc nad otn eht duou"ndm.e ylTl'he ielms cakb nda 'llI wlka ywaa nad ihtkn of isth memton sa I pmuj ofrm teh n.wwdoi

sympathetikey  Too real. +2
mcl  how do i upvote multiple times +15
trichotillomaniac  I made an account solely so I could upvote this. +29
dragon3  ty for the chuckle +5
cinnapie  @trichotillomaniac Same +3
seagull  A legend never die +1
... drdoom made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
 +80 
submitted by drdoom(801)
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trfAe eht cfuf is dti,e the secll nda tsiues dsialt ot het cffu illw ticonnue counmnigs PTA (&tDTgP-APA;,) ubt no rfhse bdloo liwl eb dedevirle ot areclβ€β€œ hwat illw be an gaucanclumit onmtua fo PDA adn oerht ltosebatim.e ADP =d)Aonsie(ne si tfisle a ryopx of otmcnupison adn iversd ntoosaividla of sire!eart tuvlEonoi( si a!trms) eanrIsicng eoA/PnsindAeD ni a lcaloβ€œ neoeivnrtn”m is a lngasi to eht odyb thta a olt fo untsiomopcn is nrurigcco eht;er ts,uh esrirtae nad lseeritaor anyurltla tialed ot isnaecer boldo wflo srate nad eeβ€œpws y”waa blamicteo opt.bucsrdy

lispectedwumbologist  You're a good man. Thank you. +
drdoom  So glad it helped! +1
seagull  very well put, thank you +1
aisel1787  gold. thank you! +
pediculushumanus  beautiful explanation! +2
rockodude  this explanation was on par with Dr. Sattar IMO +1
... tissue creep made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +77 
submitted by tissue creep(102)
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eTh epodol is eliroagchylpn,e nad a 01/10 ogod byo.

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +
... seagull made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +68 
submitted by seagull(1389)
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at MBI 15 tno ylon ahs hse rneev dha a iporde tub seh vener dha a lm.ae

sympathetikey  You're on fire man lol +
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +2
avarkey  the blind vaginal pouch points away from it being anorexia related +1
j44n  Its actually a man, there's no DHT to to dev the external genitals. +1
... atstillisafraud made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +62 
submitted by atstillisafraud(184)
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I klie hsti ueitqson usabece ti msdneir me ttah emrinsxea nkthi tocsejb anc estix in 2 iess.dnomni

... atstillisafraud made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +57 
submitted by atstillisafraud(184)
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nTkah uyo MBNE ofr hte ghhi qtlyaiu .uesitrpc tI kmsae tshee measx restss rfee nda nlyeejao.b

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +17
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +12
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +6
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +4
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +6
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +5
rockodude  everyone hates on nbme, but they're showing you a picture zoomed in of her eyes and she has a history of multiple fractures/bad wound healing at the age of 4, I feel like OI should at least be a consideration based on the overall clinical picture +1
feochromocytoma  Yeah I got it right, it's just funny that they don't use higher quality pictures for the exam +1
djeffs1  that is clearly a malar rash... oh wait nvm just pixellation +2
... lamhtu made a comment on nbme24/block2/q#5 (A 55-year-old man is diagnosed with coronary artery...)
 +54 
submitted by lamhtu(112)
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eelPlatt enarheced dan lpelttea rntgeggoaia era rndeitfef isghnt dan htis rrifenceed MSRETTA A .TOL Fuck ,oyu BN.EM ehTse desecefinfr podupysesl ttamer on oems tioqssenu and ont on t.osrhe reheW is the occnssnieyt? elHol?

hungrybox  Agreed. This is so fucking stupid. +
hungrybox  "Aspirin inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme that is required for TXA2 synthesis." literally straight from Big Robbins +1
susyars  Im gonna upvote this bc i love to be right +5
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +3
j44n  yeah i thought adherence was the GP1B receptor that's already on the platelet +1
j44n  im also glad we're getting exposed to this horse shit now and now when I'm in a testing center about to put my fist through a screen. +1
... niboonsh made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
 +48 
submitted by niboonsh(335)
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tish tonueisq askme em tnaw ot aet an e lico ocoeik nad peho i eldbe uto

thegooddoctor2  lol good one +1
... drdoom made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +47 
submitted by drdoom(801)
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eTh endalodu mnleu nad( cpraacinet sseperaot ikel YCRIMYNHPS)TO is the iest hewre capicnrtae yzesmen β€œβ€pnes(taipedosd)e leeacv lgrae ppelsedipyto into armlles tbis de.(t,d=dp)pispesiitteerpi It si ta hte HUBRS RBORED hrwee het mlasslte dksin fo etdspeip deettpdi,pr)dppseseiti(i rea konebr dnow oitn htrei mnioa ds,cai wchih lylnfia acn be crtndaoor-tpse wiht a+N inot hte ltateinisn lce.l

I ikhtn atubo it hist w:ya

  • catshom idac rtdeuanse and β€œnspoe ”up roptsien hiuwtot( fscieipc aaecl;v)eg
  • trpicaacne mezeysn nteh celeva euanetdrd ytepdplopsei inot ellmsra ti;sb
  • usrhb drrobe myezsne iyalnfl baerk nowd tniitse tdpeeips tino obaerlabsb oianm a.cdsi
regularstudent  Isn't the brush border still part of the intestinal lumen? Don't the amino acids enter into the intestinal cell (the "intestinal mucosa")? +
drdoom  @regularstudent No, the lumen is literally the cavityβ€”the empty space. +
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
 +39 
submitted by tea-cats-biscuits(211)
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Msat eslcl u,naldtreeag dugiopcrn henmsiiat hciwh tsactrta sool.hnspiei The yrale segta of an lrlaecgi eantoirc is msta cell amedtedi, btu eht laet tgeas cgduiilnn( ucsmu tordicp)uno is iededmta yb n.pehsisiolo

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +15
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +4
ajss  where do i find this info?? +
paperbackwriter  @ajss pg 112 of first aid 2019, under type I hypersensitivity. Immediate --> mast cells releasing histamine and tryptase, late--> eosinophils and leukotrienes recruited via chemokines +2
graciewacie9  Wow, i missed the fact that the question is asking for the RESULT of the reaction, NOT the cause of the reaction. Mast cells cause the initial reaction, eosinophils would be the result of the eosinophils. *facepalm +5
greentea733  @graciewacie9 SAME UGH +
mutteringly  who else looked up what T21 pills were +2
... lsmarshall made a comment on nbme24/block4/q#8 (A 1-week-old newborn is brought to the physician...)
 +39 
submitted by lsmarshall(392)
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eraU cCley rrssdDeio ;t&g tosedaIl esevre rmohnyipameame (tg;& 0100; ,ei.. no rohet seerev cbimalteo ieastrscdunb

rOneitnih rcsmateyarnlbaas ycfieicden g;&t to(sm moocnm aeru eccyl sd)i. rcoiot iaaieaicdimdc/aur, yeeihpmonrmmaa

airncOg imdsAceia t&g; amormypenema,iH nnpaoga-i ici,aosds sosteki rfmo( ymy)helacoipg

cnih-iMueadm oClycAa- dhnderaoyegse defyicnice &t;g ommrmpy,Hiaaene khpotteoyic ygclpoyieham sn(ee in dxnaΞ²ioti-o rsrsedodi, TXCPEE laoeyho)ourrdnpdtesyk

eLirv uiontdsfycn ;g&t emHyonieaapr,mm FLTs esdmse pu, loedr pt.

lsmarshall  Summary of metabolic issues relating to hyperammonemia +7
seagull  i'm leaning towards Ornithine transcarbamylase deficiency. +3
notadoctor  Not sure why this isn't considered a mitochondrial disorder since the issue is Ornithine transcarbamylase deficiency in the mitochondria? +2
charcot_bouchard  if it was mitochondrial disorder no one would escape +3
wowo  figure in OTC deficiency, they might have to explicitly mention the orotic aciduria AND typically presents earlier, around 24-48hrs of life after they've fed (at least per BB) + also per BB, propionic acidemia and MM acidemia have an onset of weeks to months and lead to build up of organic acids --> acidemia in addition to hyperammonemia (not sure why, but several aa enter the TCA cycle via propionyl CoA --> methylmalonyl CoA --> succinyl CoA, but now this is defunct d/t enzyme deficiencies...?). Anywho, propionic acidemia described on FA2019 p85, but doesn't list hyperammonemia +2
artist90  i think it cannot be Ornithine transcarbamylase deficiency bc it is XR disease. this pt has a healthy 2yr old brother which rules out X-linked recessive disease correct me if i m wrong +4
artist90  it is 100% Propionic acidemia Uworld Q-id: 1340. it is an exact copy question of uworld. i got it wrong bc i forgot these are organic acids. But i am still confused on 2 things 1-how does acidosis cause Hypoglycemia and Ketosis. 2-why is Ammonia elevated in these pts bc urea cycle will be fine? +
yb_26  1) hyperammonemia is seen in all urea cycle disorders except arginase deficiency 2) organic acids directly inhibit urea cycle => hyperammonemia (from UWorld) +1
yex  According to UW, there is another question # 1341. This one refers to methylmalonic acidemia (ORGANIC ACIDEMIA). HYPOGLYCEMIA results from overall increased metabolic rate leading to increased glucose utilization and direct toxic (-) of gluconeogenesis by organic acids. The presence of hypoglycemia leads to increased free fatty acid metabolism that produces KETONES, resulting in a further anion gap met acidocis. Finally, organic acids also directly (-) the urea cycle, leading to HYPERAMMONEMIA. +9
... drachenx made a comment on nbme24/block2/q#13 (An 80-year-old woman, gravida 4, para 4, comes to...)
 +35 
submitted by drachenx(48)
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esThe dskni fo ssueonitq ear elrayl ahrd abseuce 'vIe vnere eesn fmeela edircrueovtp etrtcusurs ri.l c:

nbmehelp  Lmao +3
regularstudent  Lmao +1
mutteringly  Lmao +
rockodude  lmao +
abkapoor  Lmao +
... sympathetikey made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +35 
submitted by sympathetikey(1244)
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eroevnEy who gto htis iteqosnu rtigh is a .cop ΝŸΩ„β– βŒβ– ΰΌΌΰΌ½

dr_ligma  Fkn narcs +2
j44n  whippet_gang +
... xxabi made a comment on nbme24/block4/q#43 (A 72-year-old woman with coronary artery disease...)
 +34 
submitted by xxabi(248)
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tnSet omrsitobhs sv e-sssenito.r netSt boshitsorm si na cutea usoncocli fo a cnrrayoo rytrea nt,ste hwchi ntofe esruslt ni autec oyornrac .snyoredm Can eb pnrdveeet by dlua eeataipltlnt arhetpy or gu-nrdltuegi .tstsne eet-oiRnsss is the arualdg grronniaw of het tntse nmuel eud to eiminnoalt tlfoaeipirorn, usrgntlie ni nglniaa smyostpm.

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +3
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +3
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +2
... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
 +33 
submitted by lsmarshall(392)
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ittnaeP sha aipSn bfidia oalutcc icwhh si a alenru uetb decfet (afreliu of nsuofi of hte )enp.roseour ooSltsrmeec ear teh trpa of echa mseito in a terverbaet orbemy giignv sier to oenb or oterh slalkete uei.sst niecS a rtpa fo tish stin'paet pansi diabif lunidced bsensaec" fo nuiposs rssoce"p tenh a mtersoolce asw ndvelvo.i Knigonw ahtt leuarn etbu tfceesd rae na eusis tihw oisnuf dulosh be hognue ot etg ot eht rhgti seanrw.

If teh nroocodth idfeal to vopedel ehnt hte eitner SNC odwul otn epodvle sa eht rdootcnho icdneus nfoitamor of rneaul altpe.

fI teh rluean buet ldeafi to elpeovd neth hte weohl CNS luowd not vahe evd.ledeop

koYl asc si aierlntver to thsi tnetai.p

ehnW lnerau rtsec lcle ti ahs ndetferfi tesmoocu ni ifdtrenef u.stiess aeurFli of ralune tsrce ot eaigrmt ni taher can sacue oisTspirntaon of tager esvss,le yaolgrtTe fo lFlta,o or tserPnites scntuur toesrasr.iu iraluFe fo ulrena sertsc to igtrmea ni GI nca uaecs rsiHchupsnrg siedesa ctnogiela(n )aec.mglnoo creTaehr lsCnoil mdrSenyo cna rccuo hewn uenarl rcets lcesl afli to atmierg tnio s1t aeahrgypln rh.ca eraNlu eutb efscedt sha niohngt to od thiw ulafeir of raneul etsrc gimnaotir oth.hgu

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation. +12
hungrybox  Fuck I picked "Formation of neural tube" but yea that makes sense... that would affect the whole CNS +3
ruready4this  I also never heard of sclerotomes and I chose that and then switched it to formation of the neural tube because I thought that was close enough ugh close enough is not the right answer +
... azibird made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +30 
submitted by azibird(158)

Who else came here after getting triggered by this answer?

yousif11  This question did not age well +2
... lsmarshall made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +29 
submitted by lsmarshall(392)
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eronnAgd intssyntIivei dyoSenrm - eecDtf in oneadngr rcorepte uesgntrli in -irmapanrlgeopan efaelm X64(,Y D)SD. gcinFnuonit tetsse acssue eaidencrs netsseoroett ta euytb,pr iwhch is evoncetdr ot nesrgoet ,ehppliarerly gignvi alemfe srenyocad lxeuas trciscrcaaesthi elemfa( xerelnat )ag.taenlii cakL fo gradneno coerprte ncfiontu sldae to asebnt or castn yxairlal dan piucb ihra. aPtesnti haev urirdnyemat a,igvna btu resutu dna laplnaiof etsub sbat.en

dgnoreAn tsyeiviitinns romsnedy si teh nrwaes utb uyo ihtgm aveh idcrdeeson MlΓΌleniar neseaisg oyRia(sn-kkeryatM- -tKresHruesaΓΌ yms)n.dero

uMlnerali gisanese liwl aehv oalmnr monoehr llvese and yam etrenps as Β°1 nraamoreeh (ued ot a kacl fo trnieue ed)pneloevmt ni efmesal whti ulylf ededolvpe Β°2 eaxuls cetiiacshtacrsr ctolnnuf(ia o).eviasr aHir epotlnmevde si nmorla sa llwe. easitnPt also evha mlnroa etgi.hh

eesmS lkei htis sqtneoui ddi nto eigv su hmuc to tdnigisishu eseisbd hhgiet dan raennt etsag 1 /ualxriypabcil h.ria

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +
... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +28 
submitted by lsmarshall(392)
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heT mtos etrdci ,athp dna msot ilekly tp,ah orf abetsr necrca ot sttmaeizsae to eht aervetrb era hte lcietsoarnt seniv. sTih swa no an ialerre MBNE tets as ell.w tsBaer neccar wlli scaue ,dxemi iyltc nad tcsbali soesiln noec in ob.ne

nO an detaaurnel eto;n I nillfay acem pu wiht a ectdne wya to emreemrb yiltc .sv catsbil ercacns in oe!bn

IeYdnk nad YItrdoh sucea YcIlt

rsttaope t;&g ebttaals ;> taislcb

oTw sabtsre tg&; tow peyst fo snloise &g;t B tsear esacus B oht

wTo ulgns g&;t wot teyps of olisnes (pnededing on tepy fo ngul cca)ren

-lllemaslc gnul g;t& a"llms "stblsa

almolnns- ecll t&g; ytlci

artist90  VEINS: 1-Intercostal veins drain into Azygous vein which drains into SVC BUT some blood from this Azygous vein is also draining into BATSONS VERTEBRAL VENOUS PLEXUS how the breast cancer metastasizes to vertebral column. 2-Internal thoracic(mammary) vein drains directly into Brachiocephalic vein. 3-Lateral thoracic vein drains into Axillary vein which drains into Subclavian vein which drains into Brachiocephalic vein. ARTERIES ARE DIFFERENT: Subclavian artery----branches into---Internal thoracic(mammary) artery---Intercostal arteries. Internal thoracic artey is used for CABG if there is 1 vessel block. +15
... famylife made a comment on nbme24/block2/q#37 (In a culture of motile spore-forming bacteria, which...)
 +28 
submitted by famylife(86)
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olueb-at"nrsdd erarbek..s.a cadesu by iinoignz ,ainaitdro indgilucn agamm arys adn "s-Xary. sv. "UV nrioadiat ucseas otw eacslss of ADN osin:esl tlunbyeacco piieimrdyn msedri (D,PsC rigeuF 1) dna 64- utproodotshpc -4(6 Ps,P eFuigr .2)"

a4fnieiamts/etis3gdna--breec/.p-p4.ouoawiaipwrnldgotashn/sti-cnmi/:tcaagremcam-enrmantdap/w-h-

... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
 +28 
submitted by tinydoc(223)
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hTis qetoinus si ryve y,skena btu in csneese shit is hatsw hp.iapngen

Teh cdaneactli lmreova of eth HTP sdnlag inudgr tohyemorctiyd β‡’ ↓ TPH

TPH no-yrnml:-ali :bone ↑ eomvalr fo CΒ²a⁺ and atpeohhP rmfo -bn-enoi :ndyikes ↑ ⁺CΒ²a setnbaropiro adn ↓ ⁻₄POΒ³ tnsabir-↑- orpeo osneornvci fo 52, ynoirHtmvadiyx D to 512, Hmtivinoyyxrda D laltirioc(C - vceiat fmro) avi ↑ iycatvit fo a-1 yexyrdolasH cniecdyfei

heeefTrro a ↓ PTH lduow leda t:o

β‡’ ↑ ₄⁻³PO β‡’ ↓ ⁺CΒ²a β‡’ ↓ ,152 yntydixivmoaHr D

ehT isotnqeu si nskeya cm(uh liek eth esrt of tish mx)ae esabecu menoose hwo stni gscunofi ealryl dhra or in a husr tghim ikpc the pnoito C ehwre popehhta si ↑ dan PHT si ↓ UTB ↓ 52 niarmytdyhxovi D

hiTs si gnowr sa noly 152, ihmoatdxrynyiv D dowul be eaeddrec,s eht rovcseinsno befero hsit aer oedn by teh snik hiu)lsg(tn dan rlvie.

I llyrae whis teyh wuold spot kanmgi het sotiequsn iucsnngof LEYPRU for het seak fo kgnima hmet sgcno.unif stIn ti ngeuho taht ew haev to wkon tsih iouiludcsr muonta of ,rinomnitoaf wtuotih vgnaih meth yintnlaloteni kgnmia ti darhre yb tioinpgn uyo ot 1 wserna ecocih tbu ahicggnn a mueitn aitlde ot ekma uoy enarws .ngowr Or snigu a oramnd sas lcronetueman fro a sdeaesi to daoiv kangim ti too islepm (PNSG = v"rilraetfeipo GN")

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2
graciewacie9  Amen to the PSGN question. They got me on that one. lol +
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +
msw  *pointing +
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1
avocadotoast  this bs is prob why the question isnt on step 1 anymore +
... medpsychosis made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
 +26 
submitted by medpsychosis(109)
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eTh wya I htutgoh uoatb ti swa a ltelti rmoe sitmpsi.lci eW esu non evtsceeli tabe rcoelksb e.(g. Prolon)arolp for teh rtteanmet of lnseeasit e.rtmro roeferTeh a etab santigo dulow ehav the seopiopt fte,fce kaa eusac or neachen .metror

hungrybox  Genius +3
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +3
... sattanki made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
 +25 
submitted by sattanki(68)
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tApnlreayp terhe is a pmycletleo aasetpre nalips docr erexlf heewr ctderi einpel nlituostaim dlesa to na o.treenci ihsT lfrexe lnoy esdne na ntacit cra in 2,-4SS os sa ngol as stih grione is ton rdi,eujn na eonritce can stlil o.ccur H,wvereo wiht isnrettocan ta ,C8 enth teh gespoiyccnh erentoci efxler tocnan ,ccoru as ihst eesiurrq cdneeginsd efibsr rmof teh coxert.

lsmarshall  Just saw a good summary of nerves/vessels involved saying, "pelvic parasympathetic fibers from S2-S4 can cause cavernous arteriole vasodilation via the cavernous nerve without of central stimulation." +7
seagull  S2-3-4 keeps the penis off the floor +35
drdoom  Modifying @seagull into iambic pentameter: β€œS2, S3, and Number 4 / keeps the big ole penis / off the floor” +1
myoclonictonicbionic  I can assure you the validity of answer (speaking from experience) +2
raddad  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ Under the "autonomic control" header +
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
... brethren_md made a comment on nbme24/block1/q#40 (A 26-year-old man and his 25-year-old wife come to...)
 +24 
submitted by brethren_md(87)
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kaMe a tnnutep uasqre ihwt a rssoc of B B+ dan B 0;B B+ steeepnrsr 0%5 tuofincn ewilh B0 rssrpnteee 0% un)ll( otun.ficn oS ni sith as,ce eth abhndus udolw evha a B 0B neoeptyg lwieh eth eifw has a B B+ etonpg.ye

rCsos of shete wto lwil rlstue ni eth nowflgloi gpoenesy;t B,B B0,B +BB, B0+B BB = 010% tnuc,ifno +BB = %57 ,ctnuinof 0BB = 50% uoctninf, B+0B = 25% cofnnuti

So hte rnaews wlli be 1 ni 4 heva a 52% fonucitn vgine het yegotpe.ns

tyrionwill  how about the choice of D: 1 in 4 have 50% function, which is true. shall 50% function needs transfusion? +
tyrionwill  In FA, it defines beta thalassemia into minor (HbA2 >3.5%) and major (both HbF and HbA2 go further up), and the major needs transfusion frequently. How can we take this classification based upon quantitive way like in this question? how much percentage of function left does not need a frequent transfusion? +
azibird  D says one in TWO, not one in FOUR. +2
neil_simmons  The question says the mother has a mutation known to cause 50% decrease in beta-globin gene function of one allele. So if one allele is working at 50% (B+) and the other allele is working at 0% (B0), then that would mean that particular set of alleles would function at 25%. +
... m-ice made a comment on nbme24/block3/q#38 (A 55-year-old man comes to the physician because of...)
 +23 
submitted by m-ice(316)
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hTye pcieiyllxt tsate atth eht enattpi ash eneb ngkita excess fo his erliohxntoevy tdcieiom.an Lvteooinreyxh si eht suxegnoeo rmfo of 4.T eTrehf,ore erfe 4T sutm eb ve.atlede 4T is dnvetocre ot T3 at mtso rpeiehprla use,sist os T3 llwi osal eb evelet.ad eseBauc teh oydb sha mroe itdyrho omnoher hatn ed,ende sels HTS liwl be ,dmae dan het ihdryto lwil be sesl cit,ave inaktg up ELSS iidone.

procrastinator  I forgot that T4 is converted to T3 :( +1
... m-ice made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +22 
submitted by m-ice(316)
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The tniteap ahs sosl fo apni nad rumeateeprt no teh ithrg side fo his ca.fe sintaoSne of hte efac si ipaiarl,tsle os hte iesus mtus eb no teh ipta'ents ghtri dise, ihhcw ew cna ocnfmir yb gnoniwk taht stosnenai of hte ybod si c,teaaralnltor nda he hsa tslo eltf isdde pani adn trrueeatmpe fo hte ody.b

Pian dan rtaeuempter esonsaint fo the oybd si rtap of teh italpainmsoch ,tcatr cihhw asaywl nsur ellyaaltr thogrhu the trisaem.bn shTi can be enmocdifr by mermirgneeb atth notassine to het ceaf lsao urns laleyarlt uhtorgh eth mtiaerb.sn o,S ew anc mornfci htis si a trhgi esdid laaertl mrnbeatis sis.eu

Teh lsos fo gag xelefr adn arpilayss fo teh caolv drcos imply iirmtanmep of craainl nesver IX adn X, boht fo cwhhi ceailozl to eht leudaml. hrTeefre,o the awenrs si ghirt staoralreodl l.lauedm

duat98  You're a good man. +2
charcot_bouchard  You must be handsome too +7
... neonem made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +22 
submitted by neonem(549)
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Per othPaa:m elyra erhtinedi cssae fo mlzhei'esrA eitadmen aer scaesidato twhi iuamottns ni snilp2-nii,-ele/sr1inepern as wlle sa on'wsD nysdroe.m o'wnDs wludo eb ued ot na exatr somecomohr ,12 iwchh esrriac teh neeg rfo lidmyao crupsorer otrpnei PPA)(. rEaxt APP si tendvceor ot bAae-t yoalmid dna hist osrfm clrxrtelaaleu ucerniit eu,paqls a mnpetnoir afuteer fo mh.l'ieserAz

torpatInm to not nuosfec Aiylmod A petnior neo( of teh rsaenw hcoi)ces wthi iydomlA srrpource irpeotn. Donsipeoti fo AA mloaiyd si reom aescdosati tiwh noircch immataorlfyn st,aset nanmiclgy,a nad aiiFmlal Mreeatednarni F.eevr -teBa2 cboliumnigrol is onhtera yolaidm i:oastsnciao coiaaeistyiads-sdsl ispstode( ni itos)nj

... tea-cats-biscuits made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +21 
submitted by tea-cats-biscuits(211)
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eseBauc yuo rae n,ipuse e’resht aridencse pdlraoe oging kcba to yuro ehrta (on eend to owkr tsianga ayitrv,g royu odobl snti’ opolgin in rouy glse as hcmu t)hee.ri As a reu,lst NPA is ecsrtdee edu ot RA stt,ehcr glednai to ieidrssu adn a uicedrtno fo odlob muelov.

urachus  When the person is lying down (supine position), gravitational forces are similar on the thorax, abdomen and legs because these compartments lie in the same horizontal plane. In this position, venous blood volumes and pressures are distributed evenly throughout the body. https://www.cvphysiology.com/Cardiac%20Function/CF017 +
thelupuswolf  RAAS trumps ANP though, so the dec. in RAAS as said by colonelred_ is likely going to have more of an effect than ANP. +1
lola915  If you have an increase in ANP wouldn't natriuresis occur and cause a decrease in blood sodium? +2
sars  This is a "read my mind" question and complete it in 1.5 minutes. Thanks +2
faus305  @sars that is every question +
... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
 +20 
submitted by ihavenolife(66)
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nnAular rcpenasa si na aronbaml otrtinoa fo eth etrvnla tpiercnaac bud. tI reelnsicc het 2nd ptar fo teh muneduod kiel a rnig nda nasorwr eth ulnme fo the ddnomuue. If eht tecaarpnci ginr si thtgi hgnueo ot rraown het eulmn egu,hon ti daels ot tmni.givo ehT bsioilu mtgionvi milsepi het obcrinoutst si idtals ot the lAumlpa fo at.Vre

thOre awnsres

yirPocl tseiossn t&-g; NONilousib tipjcerleo tmonivig, vlihoasdpee- mssa ni estcgiapir irgeon

ohEsleaapg eiatsar tg-&; dlouw be nno uiblois sa wle.l lsuyaul ntosnaee petesrn hwit o,gidornl ehcko dan otimv with TFRSI ifege,nd tihs yob si 3 yrs lod os ti is .kiyeunll

lByiria arsteia -;&tg -rttoibelebiiovrFa rtcdtiuenos fo ceterixphaat ilbe ,tudc dslea ot hsal.sceitso lyuUlas oernwbn thiw je,iunacd akdr ieunr adn ahoiccl toosls asueebc biel dcakeb .up

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +
ophmd  Curious as to why this presented at 3 years of age +3
ophmd  To answer my own curiosity; according to UWorld - most cases are asymptomatic at birth, so likely it presented when this child's organs began to increase in size (particularly the descending duodenum) +10
... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +20 
submitted by dr_ligma(38)

If NBME asks about a kid with suspicious rash under his nose + lightheaded/dumber in class, that kid's huffing glue

abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
 +19 
submitted by lsmarshall(392)
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oeFlxr mrtdoigiu unrspudof is sbilonprees rof nefixlo fo PDI. aMiedl ectasp of eth euscml h(hwic flsxee eth ht4 nda th5 ig)tdi si eppduisl yb eht larnu ervne C(8, T)1. Teh rteaall etcpas (iwhch seexlf het dn2 dan rd3 iig)dt si vdnanereti yb the dmaein eervn ciisyleplfac het eortrain nessiourseto rcabhn 8C(, 1T). oS eht ustioeqn is rngceibdsi a otnacraiel gdganaim eht veren ppslyu ot hte PDI lefrxo fo hte d2n tidgi d(einx nr.gef)i This is sgnayi eht liadem evenr is ibgne ddmaega (8C dna ;T1 elrwo ntruk or.)sto

curmalLbis 2(d/t,n1s ian;med dt,r4h/3 anr)ul rae a rogup fo ssuecml taht xfel ta het MCP otnij, nad edxetn PIP nda IPD ni.tjso

Cuodl rmmebree sa lfxo're udtioimgr pfsurduno si lynupdfroo 'nlog incse osedtnn trensi no D.PsI ormCdeap ot ferxlo imgiturdo salifriieucsp hoews dnoetn rspaw auornd uupofnrsd' eisfllyuaipcr tbu sntersi no sPI.P

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +10
whoissaad  @lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific. +
aneurysmclip  shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals) +6
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +
... lsmarshall made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
 +19 
submitted by lsmarshall(392)
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rlasPre"aant aveeh til()f ccusro nirudg hgitr etlvurnraci yrhhrypotpe (..ei )nelrgtemena or yver earryl esvere etlf taiarl tmae"nrn.glee RV hroehypyptr nac eb ense so ayisle bsceaue hte VR si at eth rtroanei sucfear fo the sh.etc

nI shit ttinpea bodol romf AL to VL dseesecar in oaa,tnitrsu os ti si ngiog srmew.eohe omrF het O2 t.as ew anc eceudd terhe is ylborpba a SDV (ecsiadrne RV usrerpse wudol sueca VHR nda rteranaapls vaeeh). ehuFm,orrrt eht intgvete is yelkil geisicbnrd rayetltgo of latolf dseua(c by ieeoarsrptounr imndeastlecp fo hte ruianndfbiul .u)petms In eTt ,selslp RV twoufol is oto scotrdubte dna atitnpe tegs ssnaoiyc nad &Rg;Lt nsntgihu Squtas searcien SVR, crsaegnedi ;LtRg& nhugi,tns intutgp emro oobld trohhug opmluyanr irctcui dan ivlegrnei cay.isosn

seagull  i'm pretty sure your a prof and not a student. +14
nor16  nevertheless, we are greatful for explanation! +
niboonsh  I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml +
anotherstudent  Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize? +1
pseudomonalisa  This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though). +
... snoodle made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +19 
submitted by snoodle(20)

just wanted to add that questions that ask small details like this make me want to carve my eyeballs out

j44n  This is the shit that keeps me up at night +1
... aneurysmclip made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +19 
submitted by aneurysmclip(131)

anyone else get this wrong while the current coronavirus "pandemic" (acc to some sources) is happening? feeling reaaallll dumb rn

targetmle  yes because i thought they wont give ques on current coronavirus situation so early!! +
adamventure  I thought to myself "damn it sure would be fuckin hilarious if Coronavirus was the answer".. turns out it was and it wasn't hilarious since I got it wrong. +43
asdfjkl  no quotes needed for pandemic anymore :( big sad +13
... lsmarshall made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +18 
submitted by lsmarshall(392)
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alrcA lnteguiosi si smto mnocmo eypt of aonamlem ni fAcanri mncaesrAi dna si on eht mlsap or .essol I uesgs the atlycpi tihkignn fo escht dna kcba un(s odpesex) is a illtte nterdfief in hits epyt? nAomg lla dmrao;iechsgp meaamlosn crcuo the jiamotry fo emti no eth mlibs 6~%(3 olwre nad ~1%9 ppr)eu; rkunt si 7.%.2~. So basde on htat dna mih igebn fo iArcnaf csdtnee ew acn osoehc .mspla

... neonem made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
 +18 
submitted by neonem(549)
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Sallm lelc miracocan of het ungl amy odrpeuc aersctpaanliop ,nodmsysre of hwhci CHAT dan DAH are the emro moocnm .sepbtusy HATC sseexc aedls ot secesx aoumtsltiin on eth adlnear xrcteo to poecrud cotoir,sl etnursgil gnsuh'isC d.sorymen exsscE ioortlcs ln(rolyam a setrss )ohoermn sscaue irynohtpnees iav pttioionneat fo httesmcayip tsiltiunoam no teh sucuaare.tvl tI acn also uesca aaeylkmpioh yb antcgi sa a deilnriacmootcior enwh in s,esxce autairtnsg the yiabitl of -d1y1hrotxdasbiotrye-e dayeodngesrhe teerps(n ni hte arlne ubtelus) ot crtvnoe osoiltrc ot si,nooectr hihwc tnsoed' cat sa a ooccnimoerdr.talii

therealslimshady  Adding some ways to eliminate the other answer choices for good measure: B) ADH can be secreted by small cell lung cancer (SCLC), and would cause SIADH, but that does not manifest with hypertension or hypokalemia. C) Epinephrine can cause hypertension (a1 effect), and hypokalemia (via stimulation of the Na/K-ATPase), but is secreted by pheochromocytomas rather than SCLC. D) PTHrP does not cause hypertension or hypokalemia, and is secreted by squamous cell carcinoma of the lung, not SCLC. E) VIP can cause hypokalemia through diarrhea (see VIPomas in First Aid), but not hypertension, nor is secreted by SCLC. +6
... tea-cats-biscuits made a comment on nbme24/block3/q#24 (A 3-month-old boy is brought to the emergency...)
 +18 
submitted by tea-cats-biscuits(211)
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heT aseides rehe si foserutc bhpahasospsiet ydie.niecfc nI ,it IV geocrlly ro ocertsuf eso’dnt hpel esceabu obth neter het ongeugcseesilon whtyapa boelw crtoufse ao.tshheipapbs elcatGaso no teh orhet ndah nrtees vboea it. I o’ntd nhtki uyo lyaerl ened to wnok stih ot oocshe eth crteocr nraswe isenc het anlcclii uietprc fo nfgasti oepgylmchaiy htat is rrecotcde w/ meos tors fo gsrua ahtt acn ernte het lcnoggsoeeseuni ytwpaha udoshl eclu uyo onit the gtirh e.awrsn

neonem  I don't think you could have *totally* ruled out the other answers - I picked glycogen breakdown because it sounded kind of like Von Gierke disease (glucose-6-phosphatase) to me: characterized by fasting hypoglycemia, lactic acidosis, and hepatomegaly since you're not able to get that final step of exporting glucose into the blood. However, I guess in this case you wouldn't see that problem of glycerol/fructose infusion not increasing blood glucose. Nice catch. +24
vshummy  I think you were super smart to catch Von Gierke! Just to refine your answer b/c I had to look this up after reading your explanation, von gierke has a problem with gluconeogenesis as well as glycogenolysis. So they’d have a problem with glycerol and fructose but also galactose since they all feed into gluconeogenesis before glucose-6-phosphatase. Great thought process! +22
drmomo  glycerol and fructose both enter the pathway thru DHAP and glyceraldehyde-3-ph. Galactose enters thru Gal-1-ph to glu-1-ph conversion +2
linwanrun1357  In this cause (fructose bisphosphatase deficiency.,),fructose should help to increase serum glucose, bcz it can become into glucose-6-P by hexokinase. Therefore, this question makes me confused.... +
krewfoo99  According to uworld, fructose infusion will not increase blood glucose levels in Von Gierkes Disease as well +
atbangura  I believe Von Gierke is not a plausible answer choice because a galactose infusion would still not see an elevation in glucose levels. Remember, galactose could be converted to galactose 6 phosphate, but in order to complete gluconeogenesis and allow glucose to leave the Liver for an increase of its concentration in the blood, the patient would still need glucose 6 phosphatase which is eliminated in Von Gierke. +1
lilyo  So what disease is this??? I mean couldnt we have just answered the question based on the fact that the patient responds to galactose being infused and we know that galactose feeds into gluconeogenesis?? I am so confused. +1
djtallahassee  Its Hereditary Fructose intolerance right? gets sick after fructose and I guess glycerol can jump in via aldolase B on this pathway via page 74 of FA2019. It looked like a fructose thing to me so I just marked out the other ones and moved on. +1
paperbackwriter  @djtallahassee I was wondering same, but hereditary fructose intolerance also results in inhibition of glycogenolysis :/ confusing question. +
amt12d  A much simpler way to think about this, without trying to figure out a diagnosis, I looked at the time frame for when the child was presenting. He has eaten poorly for 3 days, by now, his glycogen breakdown is gone. His body would be trying to make glucose, therefore, gluconeogenesis is impaired, not glycogen breakdown. +2
tyrionwill  if fructose kinase is not available (fructose intolerence), then some fructose may go to F-6-P by hexokinase, then goes to G6P if gluconeogenesis is needed. however this patient's fructose kinase was intact, so no fructose would have go to F6P, so there would be no blood glucose increment after injection of fructose. +
... sympathetikey made a comment on nbme24/block4/q#38 (A 33-year-old woman at 34 weeks' gestation has a...)
 +18 
submitted by sympathetikey(1244)
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Wued'vlo eenb enic if teyh lotd you 2"dn oecltirstan aec"sp on lfet ro tr..mh.ighs

paperbackwriter  It wouldn't have mattered because the murmur is due to increased stroke volume, not anything mechanically wrong with the valves. If they had said A or P then it might have actually caused more confusion (stenosis etc.) +6
... seagull made a comment on nbme24/block2/q#6 (A 50-year-old woman is admitted to the hospital for...)
 +17 
submitted by seagull(1389)
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siTh si a ncei aoacprph ot iinyntgdief adn tegtiarn itcaiofsut rrideosd.

goactrxh2wt+cordc=bs:eptess=mkp/wim6X8=alRsltFgi.vM:aqomOcb#teh+&h6ob.cawn?khg/p/

cinnapie  Not all heros wear capes +
privwill  Mother of mine strongly believes in this method of treatment... +8
aisel1787  lmao +1
... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +17 
submitted by madojo(156)
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tenAhor way ot kthin ubaot isth is awsht teh cslose setga ot oitsism esubeca thrig ofeber M s(im)oist uoy ndee to ahve ttimioc cyilncs edieyh,stzsn dan ahtt ludwo eb G2

1G -&-t;g S g--t&; 2G ;-gt-& M

... lsmarshall made a comment on nbme24/block2/q#22 (A 3-month-old boy is brought to the physician...)
 +17 
submitted by lsmarshall(392)
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Zlgeerwel nydrmsoe - mtlouosaa revseecis odriders of iospremexo binisegeos ued to tedumta PEX segn.e inpH,tayoo ierze,sus pyaegetmlo,ah aelry ehtad nitwih( 1 er).ay Ξ²dn-xiooati fo CLFAV pnsaehp in eeorxomisps os hte ldhic eigenlyms vagnih soem osrt of nlgiateonc mcbeltaoi rdrdseoi htiw vlaetede VAFLsC hlsduo vaeh eebn gnehou ot egt hte esnarw owuhitt iknognw uoatb re.Zgelwle

jucapami  furthermore, FA 2019 pg 47 +4
tiredofstudying  Same page for FA 2020^ +4
... neonem made a comment on nbme24/block3/q#26 (A 54-year-old man with a myocardial infarction...)
 +17 
submitted by neonem(549)
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leGnera hetem of pyhoogalt: aypxioh asmipri oeditaxiv ohnliphsparoyto tg&-;- essl ATP ;--> less N-aK uppm tcitviya os domius idlsub up ni eht c,ell iaungsc ilgs.wnle ihsT si eth firts ts.ep Tneh oud'y egt teh malucic udlubip ni eht ellc adn vuetlane ecbiarano ysgl,slcyio agscinu ciltac iadc ipodotrucn and elwrdoe H...p btu siht spneaph tlear dan tins' eth ierdct ecsua fo lleurlac liwgs,enl chwih is ahtw hte eouqinst si af.ter

aneurysmclip  can we have a moment of appreciation for Dr Sattar +17
makinallkindzofgainz  blessed be His name +5
... colonelred_ made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +17 
submitted by colonelred_(98)
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edoLok it up nda nfuod ttah ceaubes ’oyrue in a snpuie ontisopi for a olng eimt eyr’ou nogig ot eahv ecedirnas unsove nerurt hhcwi dseal ot scaeinder CO. sihT nvgeetlayi eskecadfb on A,ASR iadnleg ot aecdsdeer dselonaeto.r As a lsteu,r ’ruoye ngogi ot heav esrcdniae siudesri ihcwh adesl ot sceederda obldo nad aampls veolmu.

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +7
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3
yotsubato  You gotta be preggers to compress your IVC +5
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +
... itsdrgoodwood made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
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hTe gisoidnsa si stgOeeoinsse ete.rIampcf sDiesae uassce a detfec in Tpey 1 ollgeCna ttha lsdea ot lbtβ€œirte eo,b”ns ginmnea teh pttsaein aevh fetuenrq fracsetru thiw tleitl u.mraat Teyp 1 nlcogeal si oals a jmroa tnemopocn of eth secrla g&t-; hist si hatw hte iuprect saw hiinngt ta i( )khni?t nad ti ssuace β€œuleb ea.src”l hTe selacr ear stnatnerluth/inc os ehyt olko lbue deu to rnelgudyni rocoliadh is.nve

allyniF, aesptnti heav proo wnodu ali.nghe uondW iaprre htiw agnoniatlur itsuse lioevnvs ytep 3 eacgllo cwhhi si thne evdotncer ot teyp 1 clnolgea girndu rsca io.noamftr ftsecDe ni ptye 1 ganlocle subylivoo dotn’ wlaol hist rssecpo ot ekat .pleac

... tea-cats-biscuits made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
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nFbcoeintir si an alraruceexltl tmxair cngpiooyt,erl ewhil malni is na ntreeeitdami efltnmai htat eilcylisfapc eisrovdp psorutp ot het cell ulu.ncse oDt’n nosfcue ilnam itwh imiannl (ecsncei teahs su l;ar)yecl imnanil is like intreofnib,c an CME retiopongcyl dna a moajr emptoncon of eht absal ilanam fo mesnbate smeeb.anrm

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +30
dr.xx  blasphemy @masonkingcobra +1
luciana  I clearly confused lamin with laminin, now I know +3
almondbreeze  FA 2019 pg 48 lamin +1
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +
brise  @abkapoor the f is progeria? and do we need to know it for step? +
brise  @abkapoor omg jk jk wow +
... sattanki made a comment on nbme24/block4/q#5 (A 45-year-old man comes to the physician because of...)
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celsuM pain + lriietpboar medae is a ccaslsi anptrtnseieo fro retchalonli iias.srlp stBe iognssadi fro tsih si a muscel oyb,psi sa eht yomrw liesk to hgtnauo iithnw the lces.mus

sympathetikey  That's what you get for killing polar bears. +73
dr.xx  That's what you get for not cooking them well. +4
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2
... consistentwrongdoer3 made a comment on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
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hTe snearw si aleyxfoireph uebecas eht rfetnaef acr of teh leumcs herctts lrxfee sah ot go hhturog teh drslao amri nad aoldrs otro angilag. mDub ,oentsuiq I nokw, tub ’sti eth lyon rewnsa ahtt aemd ns.ese fI oyu rhut het ,GRD uyo nto yonl olse eraffetn oticmas enrsyso refb,si uoy aosl eols eth syerosn dioebs vniedlov in eht iavrous sfxe.rele

oYu cna olsa get pyrxaloiehef rfmo nadmgaig eht feerfetn neusonr tath rneeitnva eth cusmel ilk(e a LM)N, utb sa uyo okwn eshet era ni het eirtroan onrh nda raeltvn i.mra

ankistruggles  Thanks! I agree with you. +
brethren_md  Great explanation. +
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +6
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +4
charcot_bouchard  Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/ But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia +3
... stars and more made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
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X deinlk srvcseiee eetrh nca veenr eb yna elaM to lMea tsfrrnea csnie hte lmea iofrfgnps gtes Y mrof arth.fe het deirepge owshs leMa ot aleM msirtnsosina os thsi nnoatc eb X dnkeli vciserese

... lsmarshall made a comment on nbme24/block2/q#45 (A 2-year-old boy is brought to the physician because...)
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CMH scasl 1 ptdeiep itennag oeicsprsgn &;gt tge"nnAi tesdpepi oadedl noto CMH I in ERR ertaf rivdleye iva TAP toepstnarrr( aetsoiasdc wiht gitnnea oinsp)ser"cg - itrFs Adi 902.1

eBar eoyhpymtcl drmnsyeo ypet 2 (BLS I;I fitacegfn CHM )II si edu ot iattonmsu ni ensge thta oecd rof otrtainnicspr scafotr atht loamnlry tlegruae the srxneseoip nege( itrrincop)tnsa of hte CMH II .esneg raeB phmctyyleo drnesomy pety 1 BS(L I; iagtcfnef MHC ),I si mhcu mroe a,rre nad is tdcsaaeios twhi ATP .ieifciedensc

tyrionwill  in the question, it says absence of MHC-I presenting cells. I guess the meaning is lack of MHC-I. IF TAP is missing or dysfunction (bare lym syn type-1), MHC-I should be there, however Ag cannot be loaded to the MHC-I. Can anyone help me to understand more. +
peridot  @tyrionwill From wiki: "The TAP proteins are involved in pumping degraded cytosolic peptides across the endoplasmic reticulum membrane so they can bind HLA class I. Once the peptide:HLA class I complex forms, it is transported to the membrane of the cell. However, a defect in the TAP proteins prevents pumping of peptides into the endoplasmic reticulum so no peptide:HLA class I complexes form, and therefore, no HLA class I is expressed on the membrane. Just like BLS II, the defect isn't in the MHC protein, but rather another accessory protein." +
j44n  i hate this question because MHCI is on all nucleated cells. So this person is literally a bag of RBC's +1
soccerfan23  @j44n Not quite. It's true that MHC I is on all nucleated cells. Because of the TAP mutation, these cells don't express MHC I on their membranes. But these cells still exist. That is what is meant when the vignette says "flow cytometry shows absence of class I MHC-expressing cells. +
... neonem made a comment on nbme24/block3/q#4 (A 27-year-old man comes to the physician because he...)
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I nthik eht sanoer uyo dene ot cjenti ngodrtoaiposn ni this cesa is ebuacse ouy ndee FHS dan LH to ropcedu epmr.s SFH mtlasetusi the eolstri ,elscl icwhh lnei eth osfueiernsmi blustue adn hlpe eth iemaospgrtona ucdroep aoscsyept.ermt toTeostseenr is a utpcrod of ygedLi selcl nhew hyete'r asuitdemlt yb ,HL os igtinencj otersesettno ldwou pysbsa tath espt tub ti wonl'tud yaellr phel htwi ia.strensspemego rw,Hoeev gninjceit nHGR slao osdet'n d'osent ealryl eplh eaucsbe uyo ende atth pulsleita nGHR at ngtih to meka HL adn HSF eearwsh -lontggnaci HRGn lnsoaga cualltay ecaersde HL nda HSF oprod.tcniu

m-ice  Adding on to the answer above. I was stuck between the gonadotropin injections and clomiphene. But, clomiphene acts to increase activity of GnRH which then exerts its effects on the pituitary. The man in this question had his pituitary removed because of an adenoma. So, he needs the FSH and LH directly. +21
mousie  agree! Removal of the pituitary would case a deficit in Gonadotropins (LH, FSH) and therefore nothing to simulate the testes to make sperm... replacing the T with a patch would not stimulate the testes to make sperm and if his axis was intact (although its not) this would further down regulate the production of sperm. I eliminated Clomiphene because if he dosent have T to induce negative influence on the hypothalamus he will have increased GnRH and further increasing it with Clomiphene would not correct the deficit in Gonadotropins. +4
neonem  Oh duh... that makes much more sense. Thanks! P.s. I thought clomiphene was more of a fertility drug for women, since it blocks negative feedback of estrogen on the hypothalamus/pituitary. But in men the system is under feedback due to testosterone, not estrogen. +6
... neonem made a comment on nbme24/block4/q#40 (A 25-year-old woman is brought to the emergency...)
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hTis tapient snti' hapielt,vongtniy rteyeh' givRnYHeiEna,Pltt nchee the 2OCP ;&tl 40 mm .gH

setL' akwl it rackwda:bs ehTy era ngieatrhiyptlevn to menetoacps rof teh toealbimc doisaisc auceds yb peerisdadw hai.xypo ieHnayrvingpltet slawlo you ot lobw off mero CO2.

yWh rea tehy oxhp?yic eTh osrenp si oyipcxh due to imtlaminnofa adn aceut tsroiraeyrp isedtssr nosdryem omfr hte punniaome. llA the ysekcniot rfmo eht ntmriymalafo lescl caesu sencedair aryolpnum ycplriaal ,aeaelkg hwhic bsklco pu het ellroaav renbaemm os atht O2 nt'ca gte ohhrutg ot teh do.lob

yhW od ythe vaeh etobamcli acdsoisi ni the fstir eapl?c oN neoxyg &tg-;- no lretonce rtnortspa cainh adn no TAC -tg-;& itaclc oaicssdi.

diabetes  no pneumonia it is UTI +3
makinallkindzofgainz  The infection from the UTI spread to her lungs +
makinallkindzofgainz  this is essentially urosepsis, one of the leading causes of sepsis +1
cmun777  UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability) +11
peqmd  urosepsis +
snripper  lmao I read it as upper respiratory tract infections, too. +1
thisshouldbefree  she has an increased A-a gradient. +