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 24 Answers

clinical_trials medicine
Question#1 (reveal difficulty score)
A researcher hypothesizes that exposure to ...
Case-control studyπŸ”,πŸ“Ί

pharm beta_blockers
Question#2 (reveal difficulty score)
A 43-year-old woman with a 2-year history of ...
Unopposed Ξ±-adrenergic toneπŸ”,πŸ“Ί

oncology metastasis lymph
Question#3 (reveal difficulty score)
A 52-year-old woman comes to the physician ...
IntercostalπŸ”,πŸ“Ί

micro cryptococcus
Question#4 (reveal difficulty score)
A 28-year-old man with AIDS has fever, ...
LungsπŸ”,πŸ“Ί

genetics process_of_elimination
Question#5 (reveal difficulty score)
The 35-year-old woman indicated by the arrow ...
X-linked recessiveπŸ”,πŸ“Ί

respiratory transfusion
Question#6 (reveal difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 65-year-old woman comes to the physician ...
Cigarette smokingπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 24-year-old woman at 28 weeks' gestation is ...
TremorπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
The graph shows expiratory pressure-volume ...
Diffuse pulmonary fibrosisπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 75-year-old man is brought unconscious to ...
AtherosclerosisπŸ”,πŸ“Ί



renal nephropathy
Question#13 (reveal difficulty score)
A 4-year-old boy is brought to the emergency ...
Proliferative glomerulonephritisπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
Results of a 5-year screening program for HIV ...
5%πŸ”,πŸ“Ί


Question#17 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Annular pancreasπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 34-year-old woman with a long history of ...
Tuberculous osteomyelitisπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Cluster headacheπŸ”,πŸ“Ί

free
Question#20 (reveal difficulty score)
Immediately after a spontaneous vaginal ...
Fusion of the sclerotomesπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Foramen cecumπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 50-year-old man undergoes surgical ...
Adductor brevisπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 50-year-old man comes to the physician ...
Generalized malabsorptionπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 6-year-old girl is brought to the office by ...
Pediculus humanus capitisπŸ”,πŸ“Ί



Question#27 (reveal difficulty score)
A 10-year-old girl with a lifelong history of ...
Palpable right ventricular liftπŸ”,πŸ“Ί

immuno
Question#28 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
EosinophilsπŸ”,πŸ“Ί



Question#31 (reveal difficulty score)
An experimental study is conducted to examine ...
Post-translational modificationπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flowπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 3-month-old girl is brought to the ...
Human papillomavirusπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
SotalolπŸ”,πŸ“Ί

newborn
Question#36 (reveal difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophyπŸ”,πŸ“Ί


Question#38 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
BorderlineπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 40-year-old man with AIDS develops severe ...
SomatostatinπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 32-year-old woman who is 20 weeks' pregnant ...
MisoprostolπŸ”,πŸ“Ί


Question#43 (reveal difficulty score)
After completing 6 courses of chemotherapy ...
DoxorubicinπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 24-year-old man is brought to the office ...
Alteration in DNA gyraseπŸ”,πŸ“Ί


Question#46 (reveal difficulty score)
A 10-year-old girl is scheduled to undergo ...
SuccinylcholineπŸ”,πŸ“Ί



Question#49 (reveal difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”,πŸ“Ί



Question#2 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturationπŸ”,πŸ“Ί


Question#4 (reveal difficulty score)
A 57-year-old man has had hoarseness and ...
Area labeled β€˜Fβ€™πŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 55-year-old man is diagnosed with coronary ...
Decreased adherenceπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorderπŸ”,πŸ“Ί

renal
Question#8 (reveal difficulty score)
A 17-year-old girl is brought to the hospital ...
BeneficenceπŸ”,πŸ“Ί

cell_bio
Question#9 (reveal difficulty score)
In which of the following stages of the cell ...
G2πŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 29-year-old man is brought to the emergency ...
Lateral pterygoidπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A public health consultant is contacted by a ...
Regular exerciseπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
An 80-year-old man is admitted to the ...
20πŸ”,πŸ“Ί


Question#14 (reveal difficulty score)
A 25-year-old man comes to the emergency ...
HeroinπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
An investigator is studying a new drug for ...
Free radical formationπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIVπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Normal agingπŸ”,πŸ“Ί

FA20p504

Question#20 (reveal difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissueπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 50-year-old woman with HIV infection comes ...
ZidovudineπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 3-month-old boy is brought to the physician ...
PeroxisomesπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 9-year-old boy who was adopted from an ...
EπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 59-year-old man has repeated episodes of ...
ProbenecidπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 35-year-old African American man comes to ...
PalmsπŸ”,πŸ“Ί

alcohol electrolytes
Question#27 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urateπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 3-year-old boy with AIDS develops giant ...
Negative-stranded RNAπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 65-year-old woman with well-controlled type ...
AtherosclerosisπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 35-year-old woman undergoes a left ...
UreterπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 58-year-old man comes to the physician ...
Escherichia coli πŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 40-year-old man who goes horseback riding 3 ...
Myositis ossificansπŸ”,πŸ“Ί

neuro
Question#35 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Lower motoneuronsπŸ”,πŸ“Ί



Question#38 (reveal difficulty score)
A 65-year-old man comes to the physician ...
ParoxetineπŸ”,πŸ“Ί


Question#40 (reveal difficulty score)
A 4-year-old boy has a 1-cm round midline ...
TongueπŸ”,πŸ“Ί



Question#43 (reveal difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulationπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Peptide transporter (TAP)πŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
In a study of drug action on neoplastic cells ...
VincristineπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 73-year-old man has an incurable malignant ...
Both legal and ethicalπŸ”,πŸ“Ί

GI
Question#48 (reveal difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosaπŸ”,πŸ“Ί



Question#1 (reveal difficulty score)
A 3-year-old girl has a history of recurrent ...
NADPH oxidaseπŸ”,πŸ“Ί

biochem metabolism acid_base blood_physiology
Question#2 (reveal difficulty score)
A 28-year-old man has a blood pressure cuff ...
AdenosineπŸ”,πŸ“Ί

pharm HIV antivirals
Question#4 (reveal difficulty score)
A 27-year-old man comes to the physician ...
Injections of gonadotropinsπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 37-year-old man is admitted to the hospital ...
Autoimmune adrenalitisπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Alkaline phosphataseπŸ”,πŸ“Ί

clinical_trials
Question#7 (reveal difficulty score)
A 21-year-old woman with asthma comes to the ...
Phase 3πŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 37-year-old man who is a farmworker comes ...
SynaptobrevinπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Metastatic carcinomaπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
The pedigrees of patients with schizophrenia ...
Diabetes mellitus, type 1πŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 35-year-old woman with asthma comes to the ...
ThiabendazoleπŸ”,πŸ“Ί

syphilis ethics
Question#14 (reveal difficulty score)
A cohort study is done to evaluate the ...
0.05 < p < 1.0πŸ”,πŸ“Ί

biochem heme heme_synthesis
Question#15 (reveal difficulty score)
A 17-year-old girl has significant blood loss ...
Ξ΄-AminolevulinateπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosisπŸ”,πŸ“Ί


Question#18 (reveal difficulty score)
A 55-year-old man with alcoholism is brought ...
Competitive inhibitorπŸ”,πŸ“Ί


mutation paroxysmal_nocturnal_hemoglobinuria


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

Question#24 (reveal difficulty score)
A 3-month-old boy is brought to the emergency ...
GluconeogenesisπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
An investigator is studying a new virus ...
CoronavirusπŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 27-year-old man who works from home as a ...
AvoidantπŸ”,πŸ“Ί



Question#30 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Intraductal papillomaπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 15-year-old girl is brought to the ...
CD8+ T lymphocytesπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
An otherwise healthy 35-year-old man sustains ...
Decreased blood volumeπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formationπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
TyrosineπŸ”,πŸ“Ί



MSK
Question#39 (reveal difficulty score)
A 34-year-old woman is brought to the ...
LunateπŸ”,πŸ“Ί

micro
Question#41 (reveal difficulty score)
A 30-year-old man develops tingling around ...
SodiumπŸ”,πŸ“Ί

biochem cell_bio extracellular_matrix
Question#42 (reveal difficulty score)
Which of the following terms best describes ...
LaminsπŸ”,πŸ“Ί


Question#44 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrinπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 59-year-old woman has a 10-year history of ...
Neural crest cellsπŸ”,πŸ“Ί

cell_bio cell_transport cell_trafficking protein_folding
Question#46 (reveal difficulty score)
A 15-year-old girl with cystic fibrosis has a ...
Endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Phantom limb painπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A group of physicians submits a report to a ...
Case seriesπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Glycine and succinyl CoAπŸ”,πŸ“Ί


Question#3 (reveal difficulty score)
A 23-year-old woman is brought to the ...
Renal tubular acidosisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 63-year-old woman develops flank pain, ...
ABO incompatibilityπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Spontaneous regressionπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 60-year-old woman is receiving cisplatin ...
HyporeflexiaπŸ”,πŸ“Ί



Question#13 (reveal difficulty score)
A 90-year-old man has a 1-week history of ...
Incarcerated inguinal herniaπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A new screening test for colon cancer is done ...
118/124 = 95%πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 15-month-old boy is brought to the ...
MigrationπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
A 64-year-old man undergoes surgical repair ...
Artery of the ductus deferensπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincterπŸ”,πŸ“Ί

Question#20 (reveal difficulty score)
Forty of 100 attendees at a company Christmas ...
Vibrio parahaemolyticusπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcersπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureterπŸ”,πŸ“Ί



Question#25 (reveal difficulty score)
A 26-year-old man is brought to the emergency ...
Pericardial tamponadeπŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 19-year-old man has had weakness of the ...
PolyneuropathyπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A clinical study is designed to evaluate the ...
10%πŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 56-year-old man has a 3-year history of ...
PresenilinπŸ”,πŸ“Ί


Question#31 (reveal difficulty score)
In a study of antibiotic resistance, a strain ...
ConjugationπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuseπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cellπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 68-year-old woman comes to the emergency ...
AlendronateπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meatπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”,πŸ“Ί

cookies

Question#41 (reveal difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoitesπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 40-year-old man who recently immigrated to ...
AdenineπŸ”,πŸ“Ί

vascular
oncology
Question#44 (reveal difficulty score)
A 71-year-old woman with non-Hodgkin lymphoma ...
LeucovorinπŸ”,πŸ“Ί

renal
Question#45 (reveal difficulty score)
A 40-year-old woman with a 25-year history of ...
Secreted by the proximal tubuleπŸ”,πŸ“Ί

anatomy neuroanatomy
Question#46 (reveal difficulty score)
A 22-year-old woman comes to the physician ...
Pineal glandπŸ”,πŸ“Ί

oncogenes oncology
Question#47 (reveal difficulty score)
A 40-year-old man comes to the physician ...
HNPCC syndromeπŸ”,πŸ“Ί

neurology
Question#48 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Posterior cerebralπŸ”,πŸ“Ί

neurology erections
Question#49 (reveal difficulty score)
A 27-year-old man sustains a spinal cord ...
Penile stimulationπŸ”,πŸ“Ί

FA18p360 FA19p359
Question#50 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”,πŸ“Ί

Recent comments ...

... seagull made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +323 
submitted by seagull(1688)
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eTh acestsinm of ihts itounesq adem em tmoiv blod.o

eOn ayd a petitna wlli olko em ni eth seey nad k,as reW"he rea ietiredstp koernb ?nw"do I illw eslim at etmh dna a,sy "teh lniitnaets csaoum and not the u.unmeo"dd l'lhTye simle cabk adn lIl' wkla awya dan nikht of stih mtneom as I ujpm orfm het i.nwwdo

sympathetikey  Too real. +3
mcl  how do i upvote multiple times +17
trichotillomaniac  I made an account solely so I could upvote this. +37
dragon3  ty for the chuckle +6
cinnapie  @trichotillomaniac Same +3
seagull  A legend never die +2
... tissue creep made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +92 
submitted by tissue creep(117)
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eTh opeold is yogril,helpecan dna a 01/01 ogdo .boy

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +1
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +
... drdoom made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
 +86 
submitted by drdoom(969)
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rfAte eht cffu is et,di hte clesl dan etsuis tdlsia ot teh fucf wlli onciunet uigonsnmc APT (&DtP-A;gATP), tub no fhers dolob lilw eb ddeievrel ot rcβ€β€œale hwat lwli eb na ciulagucatmn ouatmn of APD adn othre bistoatel.em DPA ed)neA(snoi= is lseift a ryoxp of oistocnnupm adn sridev iiavolonsadt of arerise!t tu(voiolEn is m!rts)a eaIcsirgnn o/AAPesndeinD ni a laβ€œocl ”eonreminvtn is a islang to the dyob ttah a tlo of coitomsunpn si crucrogni eh;etr shu,t treasrei nad elrraiesot raanltuyl ditale ot iecaners dlboo oflw rtesa nad ewβ€œeps ”aywa obemilatc cyupo.sdrtb

lispectedwumbologist  You're a good man. Thank you. +
drdoom  So glad it helped! +1
seagull  very well put, thank you +2
aisel1787  gold. thank you! +
pediculushumanus  beautiful explanation! +2
rockodude  this explanation was on par with Dr. Sattar IMO +2
flvent2120  Just to add on to this: FA2020 pg. 297. CHALK (Calcium, H+, Adenosine, Lactate, K+) is known to vasodilate muscles during exercise as well as regulate sympathetic tone of arteries at rest +2
... seagull made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +72 
submitted by seagull(1688)
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at IMB 51 nto nyol ahs hes erevn adh a eodirp utb hes vreen hda a a.mel

sympathetikey  You're on fire man lol +1
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +4
avarkey  the blind vaginal pouch points away from it being anorexia related +3
j44n  Its actually a man, there's no DHT to to dev the external genitals. +1
am4140  @monkey - with real anorexia, she wouldn’t necessarily have boobs either. If she’s got boobs she has the nutrition to develop boobs. That was my thought. +
freckles  the patient is actually what ever gender they want to identify as. If this was a 5 alpha reductase deficiency the patient would have experienced masculinization of external genitalia during puberty when testosterone levels increase significantly. The pt most likely has Androgen Insensitivity Syndrome. +3
... atstillisafraud made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +66 
submitted by atstillisafraud(202)
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I ikel tsih neuoiqst eeasbuc it rdmnesi em ahtt iamexesnr itknh teocsjb nac xstei ni 2 ns.mdesioin

... atstillisafraud made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +63 
submitted by atstillisafraud(202)
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nThak yuo MEBN fro het gihh aqtuyli ispr.utec It smeka etehs emsxa sesstr rfee nad leey.nabjo

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +20
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. +13
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. +6
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +7
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 +4
... lamhtu made a comment on nbme24/block2/q#5 (A 55-year-old man is diagnosed with coronary artery...)
 +58 
submitted by lamhtu(125)
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attePell chneedare dna tlteapel rggnaoetagi rea tnrifeedf ntgsih adn tihs eedcierrfn TTSMREA A TLO. Fkcu uy,o NBM.E seeTh dsefiefncre sslupypeod taremt no soem onuesstiq dna not no otre.hs herWe is teh censocnts?yi Hleol?

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 +7
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +4
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. +2
jurrutia  GPiib/iiia receptor is not inhibited by aspirin. Aspirin prevents the upregulation of GPiib/iiia which is not the same as inhibiting the receptor itself. +
jj375  @jurrutia I think you are thinking of Clopidogrel, prasugrel, and ticlopidine which downregulate GP2b3a expression. Aspirin inhibits COX therefore inhibiting TXA2 and platelet aggregation. +
jbrito718  This is whaat I call a FUCKBOY question +
... niboonsh made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
 +58 
submitted by niboonsh(369)
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iths ueqionst maeks em wnta ot eat na e ocli ckoioe dan ohpe i dlebe uot

caitlyncloy  pick C and move on was my strategy :P help lol +1
thegooddoctor2  lol good one +1
... drdoom made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +50 
submitted by drdoom(969)
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hTe ouandlde elumn nda( ceaatcnrpi sesropeat keli MOPNICSHTYY)R si het esti rehew eiaptnracc zyemnse apo”)eeseds(dtβ€œpin vcleae grlae pyitlodeepps ntio mlrasel tsbi pdepps.teipers=,ei)d(ditit tI is at teh RHUBS REBRDO ewher eht aelsmlts nkdis fo peepisdt rie,tpitds)epd(psiidtpee are nkebro wodn iotn thrie oamin ads,ic wchih ylnifal can be dpoercrt-tsnao wthi N+a iton the nianitetsl .clle

I tikhn aubot it ihst w:ya

  • shmctao adci asneuetrd and oesβ€œpn ”pu eirtsonp w(toutih secipcif egelc;ava)
  • cntrpeacai eyznesm nhet caevel rednudtae olipeptsydpe otni erllmsa ;sibt
  • hrusb reobdr eenzyms ailyfln ekbar onwd inittse pseitdep onit sblaarbeob ionma c.dsai
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. +
jj375  Still annoyed about this question, but here is a schematic in case it helps anyone else: https://doctorlib.info/physiology/medical/medical.files/image1890.jpg +
... drachenx made a comment on nbme24/block2/q#13 (An 80-year-old woman, gravida 4, para 4, comes to...)
 +47 
submitted by drachenx(62)
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heseT knsid of qsinoutse are aleyrl adrh beuasec Ive' enrev nsee mlfaee uptrevdoreci rsseutrtcu lir. :c

nbmehelp  Lmao +3
regularstudent  Lmao +1
mutteringly  Lmao +
rockodude  lmao +
abkapoor  Lmao +
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
 +44 
submitted by tea-cats-biscuits(252)
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tsaM elslc aatn,gruldee pocinurgd smheniait whchi tttarsca sinsioeolhp. The ylaer eastg of an cerigall caoniert si tams lecl madt,deei utb hte elat asgte (iilnugncd ucsmu )otdcoirpnu si ddaeeimt by ssioloehpni.

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +17
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +5
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 +3
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 +6
greentea733  @graciewacie9 SAME UGH +
mutteringly  who else looked up what T21 pills were +4
... sympathetikey made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +41 
submitted by sympathetikey(1446)
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reeEonvy ohw gto tish utsneqoi hrigt si a o.cp β– Ω„ΰΌ½ΰΌΌβŒβ– ΝŸ

dr_ligma  Fkn narcs +2
j44n  whippet_gang +
... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
 +40 
submitted by lsmarshall(427)
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tiPnate ahs Siapn iadfbi oacctul hcwih is a lnaeru betu tefdce leu(rafi of infsuo fo eht uporosne).er oeSoemcrstl aer eth part of chae omstei in a ertetrevab meobry ivggni srei to obne or eroth lleestak sei.uts eScni a ptra fo this 'patsietn nsapi fabdii leinucdd b"ceasnes fo suinpso oc"ssrep etnh a leeosrcmot saw eilndvvo. nogKnwi hatt anelur tebu fscedet ear na ueiss hwit uofnsi shdulo eb ehguon ot teg to eht rhitg s.ernaw

If eth ndorotcoh daielf to dleepvo hnet eht enrtei NCS wludo ont deeplvo sa hte ontdcohro icseudn fraoonitm of uarlen ale.pt

fI teh nlraue etub iadlfe to opeedvl nteh eht lehow CSN ouldw nto eahv .deovepedl

lYko asc si envrlertai to hist atiep.tn

Whne erlanu serct lcle ti has tedenffri mceoouts ni eiftdenfr tsuess.i eauFilr fo ralenu cters ot aegrmit in etahr can uaecs Tsnoarioinpts fo raegt s,selevs goeTylatr of atFo,ll or sesteitPnr cutrnsu setarsiru.o alFuire fo uernal retscs to eigmrat ni GI anc acesu gsciusnprHhr eseiads oltiagn(cen .)nloocagme Threcrea noClisl mordSeny nac rccuo hwen neralu strce esllc flia ot tmaerig into s1t ylenpgarha .carh euNrla tbue tfsecde ahs htgnnio ot do tihw iuarfel of rulane stecr itigomrna hotu.hg

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation. +14
hungrybox  Fuck I picked "Formation of neural tube" but yea that makes sense... that would affect the whole CNS +4
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 +1
ih8payingfordis  FA 2019 Pg 479. They don't specifically mention sclerotomes but you can review the different neural tube defects here :) +
... lsmarshall made a comment on nbme24/block4/q#8 (A 1-week-old newborn is brought to the physician...)
 +39 
submitted by lsmarshall(427)
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eUra eClcy rrosdeisD &;gt Idlsoate rseeve hyeraommpeiman g&;(t 0;100 .i.,e on hetro sveeer obcaltmie biedtansursc

nierhtniO myablareastcrsna endifyeicc g&t; (omst nmmooc aure ecylc .ids) irctoo auidici/aaamdiecr, mepreonimhyama

rOgnica isAmdeica t;g& enmrpom,eyaiaHm a-gnpnoai cdsiaosi, sestkoi o(mfr myoi)lhcaepyg

mne-hudMiiac olAycCa- ehgneorseydda cdiieecfyn t&g; mmnm,aepeHroyia oktioypetch cpymhygilaeo (eens in indaΞ²tx-ioo edidr,orss TCXEEP eorakdrhly)ysdnpuoeot

veLir fndistoycnu &;tg ,eHrenmmpaomiya TFLs mesdse ,up dlero tp.

lsmarshall  Summary of metabolic issues relating to hyperammonemia +9
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 +5
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. +14
ih8payingfordis  I think there has been some confusions because FA does a poor job integrating these concepts together but here are some references: FA 2019 pg 85: Propionic Acidemia (this is one example of organic acid metabolism disorder) In the summary figure on Pg 74, look at the protein metabolism (located bottom right). Basically, you can have disorders where you have Propionyl-CoA buildup alone OR Proionyl-CoA and Methylmalonyl-CoA buildup. And these organic acidemias are autosomal recessive in their inheritance pattersn, which fit with the stem we're given (ie XX individuals can be affected) One thing that UW state that I do not have an explanation for: the buildup of organic acids inhibit the urea cycle hence the increase in ammonia (anyone knows how this happens?) +
aaftabsethi1  Can someone tell me why not MELAS ? +1
jaramaiha  @aaftabsethi because all of the siblings would show some symptoms if it were to be a mitochondrial disease. Which his brother is healthy, and sister was full-term but died due to unspecified causes. +
utap2001  Why acidosis cause Hypoglycemia and Ketosis and hyperammonia? In acidosis(such lactic acidosis)-> indicate body energy crisis -> inc. glycolysis, Hypoglycemia-> inc. protein breakdown, Hyperammonia -> dec. TCA cycle, Ketosis +
... xxabi made a comment on nbme24/block4/q#43 (A 72-year-old woman with coronary artery disease...)
 +37 
submitted by xxabi(273)
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tnSet srmoithsob sv ioss.snt-ere eSntt rtohoimbss si na cateu ounolcsic of a croarnyo eyatrr ntte,s hiwhc otenf rletuss in teuac rnacyoor dyers.nmo Cna be nvepretde by ulda ptealiettnal tarehpy or -nlugegtuidr tenst.s net-sosisRe si teh adgrlau goirranwn fo eth entst mueln ued to nilnaoimet raeofipl,nrtio enirtguls ni inanlga pym.mosst

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +8
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +7
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
... azibird made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +36 
submitted by azibird(200)

Who else came here after getting triggered by this answer?

yousif11  This question did not age well +16
helppls  I'm going to be taking Step with this song stuck in my head lol +
... lsmarshall made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +34 
submitted by lsmarshall(427)
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dgnAnore nsIetviiiysnt dSmynoer - eftDce ni orndgean tprorcee eunlirtsg in ogr-aaanmprlpein mefale XY4(,6 DD)S. niFintgoncu ssteet cssaeu deeicrnsa enosetsotrte ta ,erpubyt hwchi si ncvertoed to negersto ree,lryaphlpi iivngg leefma aysnreocd laexsu icrthiastacsecr (meelaf txanerel laia)gnie.t Lkca fo grnonead oetcprre cfntiuno sedal to taesbn or cstan axallriy nad upbci rhia. tePtsian vahe ntrimryduae aig,nav ubt eutrus and nofalplai suebt bta.nse

nAoengrd etiisiinsyvtn yemsdnro is hte snwear btu oyu itmgh eavh credodisne neiallΓΌrM sgainees yonakks-ia-rt(RMye HussaKr-ΓΌrtee ysno).drme

laneruMli igasenes lwli veah mnrlao neroohm lsevle adn amy nprseet as Β°1 hnaoereram d(eu to a alck of teueirn tepnoed)vlem in elsmfea ithw lyluf dpvoedeel 2Β° ulaxes isacetrctsrahci liua(fnontc earv)ois. rHai ptneedomlve si lmraon sa e.llw aistPetn loas vhea lnraom .ithehg

eeSsm klei hsit uienoqst did nto vige us hmuc ot tdhsuginisi isseedb hgihte nda naertn sgeta 1 ilyrulicaaxpb/ ai.hr

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. +
makingstrides  Mullerian agenesis: absent vagina, uterus/cervix because no mullerian system. Yet, still has secondary characteristics ie: breast, pubic hair, normal hormone levels (normal ovaries). Also check to break down the different subtypes of DSD: CAIS, 5alpha reductase deficiency, and swyer syndrome all for XY DSD. Where as for XX DSD, overproduction of gestational androgenism and placental aromatase deficiency. Bc in CAIS the testosterone receptor is dysfunctional, no external / internal male organs are going to form in an XY fetus, but you will have an extra production testosterone (like explained above) leading to increased estrogen (breast growth), but since no ovaries, you dont have the mullerian system. You are left with a vagina with a blind pouch (from lack of functioning receptors) +
makingstrides  Also to add, there are testes that produce the MIH, so you have degeneration of the mullerian system. From B&B +
... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +31 
submitted by lsmarshall(427)
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Teh tosm deticr ,ptha nad most kileyl tpah, fro tsraeb ccnear to sseezatmtai to teh bavertre era teh siotlnecrat .nisev ihTs aws on an earelri EBNM etts as well. Bsetra rnecca ilwl euasc dxem,i ctyil nda lbtacis esnisol enoc in eo.bn

nO an tenuaealdr eto;n I nallify meac pu twih a dneect wya to bmmerere cyitl .vs cbslait ccrnsae ni n!oeb

YnIedk nda YIhtrdo sauce lcIYt

rtotepsa ;g&t elatbast g;&t bitcals

Tow sertbsa t;&g wot peyts of nleoiss t&;g B sreta cusesa B tho

owT gluns g&;t two etspy fo isenosl nend(gpide on ypte fo unlg )ccaenr

ell-scmlal nulg t&;g "allsm ss"balt

llam-snno llce g;&t lytci

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. +18
... famylife made a comment on nbme24/block2/q#37 (In a culture of motile spore-forming bacteria, which...)
 +31 
submitted by famylife(96)
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tresdoln-ad"ub .abee.rrsa.k suecda by zioiingn adoriain,t gdnlciiun mamag syra dan "s.rayX- sv. "UV otaairdni eussca owt asssecl of DNA o:esilns ulcaeontbyc idemyirpin iedrms CPsD(, rugiFe 1) and -46 ootcspphrtuod (64- ,PPs ueFirg 2").

/euca-mnnios-e/.ttpmnwmoed/ata3ilr-mgwnd-apisbcaar-gt4ortepicwr:dsn.ai/-cns/agth4ee-mhapfainai

... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
 +30 
submitted by tinydoc(245)
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Tish itoensuq is rvey e,snaky tub ni eseescn this is aswth gnpneia.ph

The daceianlct vaomler fo eht THP galnds nurdig iothoetmcyrdy β‡’ ↓ PTH

THP raollynni-m:- neb:o ↑ ameovrl fo ⁺²aC nad hhaPepot from oin-enb- yknied:s ↑ ⁺CΒ²a erribooptnsa dna ↓ P₄³⁻O nr↑ -sotrip-aebo vooncrnsei fo 52, yynoarvdimtxiH D to 521, xnHvyamdortiyi D llrCoat(cii - vcitae mo)fr avi ↑ ivttcyia of -a1 Hoyedxrsaly yiieccefdn

heefoTrre a ↓ PHT uwdol eadl :ot

β‡’ ↑ OP⁻³₄ β‡’ ↓ ⁺aCΒ² β‡’ ↓ 215, tioidymxrnayvH D

eTh utsoqein is ynsake hucm( leki hte sret fo shti mxa)e eucbsae msoneeo woh stin fgiusocn ylearl dahr or in a uhrs htmgi kipc teh notoip C rehew pthoahpe si ↑ adn TPH si ↓ UTB ↓ 25 otyxdrnhiyimav D

ishT is gwrno as lony 521, nrivyxotadimhy D oludw eb ddercaes,e hte oricnosesvn breoef thsi rea doen yb eth kins n)gs(htuli adn lrei.v

I laerly hswi yeth wudol tpso maingk het sesiutonq ocinnugsf ELYRUP for eth sake fo gaikmn ehtm ignuocs.nf Itns ti egnouh ttha we ehva to wnko siht uslirducio mnuota of rmoiinfn,aot hwiottu ahinvg hmte liotnnnaltyie gmaikn ti ardreh yb ginpinot ouy to 1 nwersa eiochc but nagngich a mtieun aitlde to meka yuo ewsran g.rnwo Or sngui a moanrd sas auonetelncmr for a isdaees to iodav ankmig ti too mlepis NS(GP = olveriira"eptf )"NG

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 +
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +
... brethren_md made a comment on nbme24/block1/q#40 (A 26-year-old man and his 25-year-old wife come to...)
 +28 
submitted by brethren_md(95)
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kMea a nntetpu ursaeq hwti a csosr of B B+ nda B B0; B+ enetrspres 0%5 ntcfnuoi leiwh 0B tneesrepsr %0 nu)(ll otcnufi.n So in ihts ea,cs eht dabunhs wldou aehv a B B0 egtyonep wehli teh efwi ahs a B +B epgyo.tne

ssCro fo eesht two iwll usltre in teh wnlgofilo ytenpeosg; B,B ,BB0 BB,+ +BB0 B B = 10%0 ,inuotfcn BB+ = 5%7 i,tfcnoun BB0 = 0%5 n,niocutf +0BB = %25 icfnnout

So eht wnsaer iwll be 1 ni 4 veha a %25 ofntincu nvgei hte nps.egytoe

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. +3
hemehero  Is there a way to know that B+B0 will = 25% function. I was stuck between 25% function and 10% function, but couldn't figure out how to reason between the two of them. +1
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%. +1
... medpsychosis made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
 +27 
submitted by medpsychosis(121)
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eTh ywa I htogthu aobut it saw a llttei orem ti.lscimips eW ues non veelsceit etba oerkblcs (g..e oplnoPrar)ol for hte ertantemt fo ltaeseins terrm.o fehorTere a tbea nogatis oudlw veha teh ootisppe fe,ctef kaa eascu ro neanche ror.tem

hungrybox  Genius +4
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +3
... neonem made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +26 
submitted by neonem(580)
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Per oatPa:hm yelra reihtndie eassc of zre'lemhisA idmteaen are ssdcioaeta htiw taosnimtu in peei-irnn/si21erllnisn-ep, sa wlel as Dos'nw s.eomnryd wonD's uodlw eb eud ot an retax ooesmrhmoc ,21 hwchi easrirc eth geen ofr imyolad psroerurc neiortp )P(.AP artxE PAP si envteocdr ot beatA- damyilo dna this romsf etrarullcalex iritunce lae,usqp a oitmrnepn auefret of h'lreezm.Ais

ptartnmIo ot nto fsenocu iylodAm A irnotep ne(o of teh awsenr sech)oci htwi dymAoil uerporscr opneitr. Dpiooteins of AA yldaoim is orem sadeocitsa ihtw hnorcci tmlafaioynrm attses, gnniy,alcam dan alFiialm aeeidrtarnnMe ve.eFr e2-Bat ilubmilcrogno is oanthre amyoidl casi:aontois aasssdleodysiic-iat tpido(sse ni st)njoi

ih8payingfordis  Amyloidosis: FA 2019 pg 212 Alzheimer disease: FA 2019 pg 508 +
... sattanki made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
 +26 
submitted by sattanki(72)
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eytAlappnr eehtr is a mtlopeeycl atesprea salpni dorc lrfxee eehrw cedrit pilene mtnsloiuita sldea ot na .reentcio shiT rxleef only nsdee na titanc rca ni ,-42SS so as long sa siht igeron is nto jur,dnie an tceeorin nac tlsil urcc.o owevrHe, with ceoritnatns at 8C, neth teh opiceyhgsnc incoeetr elefrx aotnnc ,cucro sa tshi uieeqrsr dgidcneens fibser mfor eht teoxrc.

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 +40
drdoom  Modifying @seagull into iambic pentameter: β€œS2, S3, and Number 4 / keeps the big ole penis / off the floor” +2
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 +2
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
jj375  This article is shockingly helpful. Scroll down to the 3 types of erections (psychogenic, reflexogenic, nocturnal) https://craighospital.org/resources/sexual-function-for-men-after-spinal-cord-injury +1
... snoodle made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +25 
submitted by snoodle(26)

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 +5
jbrito718  I just realized its asking about MITOTIC cyclins +
... m-ice made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +25 
submitted by m-ice(346)
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ehT eitptan ash sols of apin nad rtauprteeem no eth hitgr dise fo shi aefc. Stisnaneo of the feac si piea,astilrl os eth uesis ustm be on hte tiesnap't gitrh s,edi whchi we anc mfrncio by kwoinng that esninaots of eht odby si ratractolel,na nda he ahs olts felt sdide pani nad pemtatreeru fo hte dboy.

inaP and pueterreatm itonssean fo the bdoy is artp fo eht sanoitiphalcm ar,ttc wchhi wsayal ursn yatarllle horghtu eht mtn.airbse hiTs anc eb nerdmfioc yb emeenrirmgb atht inssoneta to the feca oasl unrs rlytalael hurohtg het srant.eimb ,So ew can ncofmir tsih is a itrhg siedd rtlaale bsetnairm us.sie

eTh sslo fo gga xerlef dan siyarlsap of teh voacl doscr ilmyp timniepmra fo nilcaar revsne XI adn ,X tobh of iwchh alioeclz to eht dme.alul rehTore,fe eth sawenr is gthri otalsrloeard e.mlluda

duat98  You're a good man. +5
charcot_bouchard  You must be handsome too +12
amy  The dorsal vs ventral is confusing! +
... aneurysmclip made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +25 
submitted by aneurysmclip(169)
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oennay lese get shit rgwon wihel teh errctun cionuvasorr "a"depminc (cac to oems srscou)e si aig ephnepg?innlef aaallrlle mbdu nr

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. +57
asdfjkl  no quotes needed for pandemic anymore :( big sad +13
yesa  Yes! but also, coronaviruses often cause the common cold, not all of them are really bad! So this 4yo girl could literally just have the common cold, and the coronavirus isolated from her likely doesn't have pandemic potential. So this question has nothing to do with the ongoing pandemic--it's just coincidence! +
jaramaiha  Was I the only one that thought it was cause it is enveloped and easily destroyed? lol I didn't even bother with descriptors. +
... m-ice made a comment on nbme24/block3/q#38 (A 55-year-old man comes to the physician because of...)
 +25 
submitted by m-ice(346)
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yehT tclipexliy tatse ttah teh painett ash eben taingk cesexs fo ish xeoylerinvtoh .tiodnicame oixyLorvehetn si the xneoegosu fmro of T.4 ee,rheTorf efre 4T umst be detae.elv T4 si evetrdcno ot 3T at msot rlehpeiapr stesi,su os 3T illw aosl eb le.dtavee uasBcee het byod hsa rmeo ytrhdoi onoehmr atnh d,neeed essl STH liwl eb ,amde adn eht hoirytd lliw be elss ei,actv kingta pu SLSE dion.ei

procrastinator  I forgot that T4 is converted to T3 :( +4
... lsmarshall made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
 +24 
submitted by lsmarshall(427)
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"tasalerrnPa vhaee f()lit cuoscr ndguri hgrit rlvaenicutr thpyyrpeohr ..(ei n)ntlaegmeer or ryve eylarr veesre lfet tlaair gmlt"nnera.ee RV prpyhrhoety nac be ense so slieay esbuace hte RV is ta the eartroin ruesfca of het hts.ec

In sith anptite dobol fomr AL ot LV esdcesear ni otar,atnius so ti si noigg weresmeoh. mrFo hte 2O .ast ew anc deduce teher si ayrlpbbo a VSD adiescrn(e RV usrereps uwold ecsua VRH adn ealrrpatsna e).eahv hrtmFreou,r het evntiteg is kelily idbcnsregi ytoaltreg of otllfa acedus( by otuirpearrnseo dpatsleecnim of eht dbiuliafunnr )ept.ums nI Tet ,splsel RV towoluf is too ottrbdcues and ptiante etgs snoyiasc dan Rtg&L; nushtgni atusSq nceieasr SR,V cragedeisn LRtg&; sihn,ngut tgnuipt remo blodo hugohtr mplaynoru cirtciu nad ielergnvi snao.isyc

seagull  i'm pretty sure your a prof and not a student. +24
nor16  nevertheless, we are greatful for explanation! +1
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). +1
furkan7  I does not need to equalizes.Moreover, in left to right shunt,left ventricle's O2 saturation is close to 100% +
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
 +23 
submitted by lsmarshall(427)
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xelroF muiditgor urndfuops si sblnpieeros fro lenifxo fo P.DI lMdiea ptsace fo teh clmesu wichh( lxsfee the h4t nad t5h t)digi is ledupisp yb eth luran erven ,(C8 T1.) ehT teralla ecapts hc(hiw selfex the n2d nad rd3 idgit) si idevrntean yb eth niaedm reevn feilacliycsp hte tnearrio sstoeouesinr bcnahr C,(8 1T.) oS the teqniosu is icgsdniebr a irlcoatane naigdgam eht veren puplys ot hte DIP xfrelo fo het 2dn igitd (ixdne .eri)ngf Tsih si ngiyas het imadel renev si neibg meagdda 8C( nda 1;T rlwoe untkr ots).ro

imLlraubcs n1,s(t/d2 ;aemdin 3h/4rtd, )arlun rae a urgop fo esulcms thta xlfe ta the CPM ij,tno nad edxnte PIP nad IPD tj.soni

udlCo eembmrre as 'xrelof tridugmoi nudofpurs si duforlynop g'lno sneci enntosd nirtes no sIPD. damerpoC ot lrfexo iiorumtdg frlpiisiscuea owhse ndteno wprsa nduoar df'uouspnr yefpurlcasili tub tsnisre no IPsP.

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +13
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) +10
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +
... tea-cats-biscuits made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +23 
submitted by tea-cats-biscuits(252)
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saeBeuc oyu rae iusepn, r’stehe nsedeirca prdeloa oigng kabc to rouy athre (on ndee to orkw agsntia i,ayvrgt ryou oldbo st’in piolgon in royu sgle as muhc ir)e.the As a ,lsetur NPA si deescert ued ot RA htcrtse, eaglndi ot irdesisu and a nriuteodc fo lobod mvou.le

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
mynamejeff  Because you are suprine, there's increased preload going back to your heart (no need to work against gravity, your blood isn't pooling in your legs as much). As a result, ANP is secreted due to RA stretch, leading to diuresis and a reduction of blood volume. +1
sars  This is a "read my mind" question and complete it in 1.5 minutes. Thanks +4
faus305  @sars that is every question +
... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +22 
submitted by dr_ligma(43)
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fI EMNB sska autbo a dik hwit uossiiupcs srah eudrn sih sneo + dtdruhaeidbhlee/gm in ss,lac htta dski' fufhign geul

abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +2
... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
 +21 
submitted by ihavenolife(68)
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uanrAln anepsacr is na aonrablm tatrnooi fo het evrltna atacripcne dub. It lncsrceei het nd2 patr fo het ednodmuu ikle a rgni dan rwornsa het enmlu fo the oumeuddn. fI teh pceanctari rgin si gtthi ughneo to rawonr hte unmel oh,gune it slade ot mvgtio.ni ehT ilisubo onitimgv mesplii het bnotcortius is tsadil to eht lmApual fo t.rVea

Ohter ewasrns

coyliPr netoisss ;t&g- NNOiiulosb ptceoerilj miovnt,gi vsipoehe-dal sasm ni agricetisp oeirgn

lgaesoaEhp tesaria ;g-t& uldwo eb non liuobis sa elw.l yuallus esntneoa srtepen itwh dol,ngrio ehkoc adn itomv hwit FTISR eidfnge, iths oby is 3 ysr odl so ti si klu.ylnie

liByira atasrei gt&;- bbliFee-iairotrvto sctroueitnd of pxtthcraeiae ileb ,cutd elsda to eslictoah.ss yulaUsl boenwnr wthi jnd,ceaiu akrd nruie nda hlcoaic soltos bescuea lbei cdkbea .pu

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +2
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) +11
... tea-cats-biscuits made a comment on nbme24/block3/q#24 (A 3-month-old boy is brought to the emergency...)
 +20 
submitted by tea-cats-biscuits(252)
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eTh essdaie eehr si tecforsu pthesosaiashbp encyfidi.ec In t,i VI rgoyellc ro fecruost ’eontds lhpe eaesbuc tohb renet teh glnesnseoueoigc aawthyp bewol srutefco htpasohiapsb.e oacestGal no eht eohrt dhna erstne baveo t.i I odt’n khtin uyo lyreal eend to owkn thsi ot ohcsoe hte eocrctr arwnes ecins eth iniaccll rceptiu of snfiagt ghcoypylimae taht is etdecrrco w/ oesm rtso of uagrs htta anc renet hte onngeoleicuesgs yaahwpt slhoud cule uoy oint the rtigh wasern.

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. +26
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 +3
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. +2
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. +5
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. +1
shayokay  You had to know that fructose and glycerol enter glycolysis at DHAP/G3P, and galactose enters glycolysis at G6P (gal-> gal-1-p -> glu-1-p -> glu-6-p). This means that one of the 3 enzymes between G6P and DHAP/G3P is not functioning properly. Most likely this would be fructose-1,6-bisphosphatase because there does not appear to be anything wrong with glycolysis. "Fructose-1,6-bisphosphatase (FBP1) deficiency is characterized by episodic acute crises of lactic acidosis and ketotic hypoglycemia, manifesting as hyperventilation, apneic spells, seizures, and/or coma. Acute crises are most common in early childhood; nearly half of affected children have hypoglycemia in the neonatal period (especially the first 4 days) resulting from deficient glycogen stores. Factors known to trigger episodes include fever, fasting, decreased oral intake, vomiting, infections, and ingestion of large amounts of fructose." https://www.ncbi.nlm.nih.gov/books/NBK550349/ +1
shayokay  Also, even though Von Gierke is categorized as a glycogen storage disease it is really a problem with gluconeogenesis not glycogen breakdown. So even if you thought this was VG, you still could have gotten the right answer. In VG, any monosaccharide other than glucose (fructose, galactose, glycerol, etc.) will not raise the plasma glucose level because they all require gluconeogenesis to be converted into glucose and this cannot happen because there is no glucose-6-phosphatase. This is why the treatment for VG is frequent oral glucose in the form of cornstarch and avoidance of fructose and galactose. +
... consistentwrongdoer3 made a comment on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
 +20 
submitted by consistentwrongdoer3(20)
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ehT wnesar is ylfoheearixp eucabse teh rnffaeet car of eht lmeusc tetrsch rxefle has to og htrhugo the oldasr aimr nad arsold oort algniga. mDub tns,qoeiu I ,wkno tub it’s teh lyno nwears ttha dame sen.es fI you uthr the GR,D oyu tno nlyo seol rafnfete smtacoi yseorns ,bisfer uoy olas lose eth sronyes edbiso oelvnivd in hte iuovasr x.eslerfe

ouY can lsoa teg aieholeyrpfx ofrm nimaggad the nteferfe unonres that ntvneeiar eht uesclm (eilk a ,N)ML tub sa yuo kwon hsete aer ni teh tiroenar ohrn nad elvatrn irm.a

ankistruggles  Thanks! I agree with you. +1
brethren_md  Great explanation. +1
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +8
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +7
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 +4
zevvyt  DRG you lose DTR +2
... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +19 
submitted by madojo(182)
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Atnroeh ywa to kitnh abuot ihts is hwats hte soscel atseg to msoitsi esauebc trigh ofreeb M ss)tim(oi oyu deen to ehva itotmic iclsncy disen,etyzsh nad ttha uldwo be G2

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

... lsmarshall made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +19 
submitted by lsmarshall(427)
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Aclar luntoiiesg is ostm conmom ytpe of naemolma ni ciarAnf ermAscain nad si no the asmpl ro ess.lo I gseus hte ypitacl htikgnin fo chtse nad bkca (usn peed)oxs is a tlelti etnrffied in ihst eypt? gnoAm lal gihdpseoramc; mlsanmoea orucc the tayiomjr fo temi no eht islbm %(63~ rewlo dna 9%1~ )rpu;ep trunk is ..%27~. So bdeas no ttah adn hmi engbi fo Acfinra cntdese ew nac hooesc pm.als

... neonem made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
 +19 
submitted by neonem(580)
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Slmla elcl noimarcac fo eht nglu may perocdu calpsritpoanae mrdo,sesny fo hwcih CHAT adn DAH are the reom nmcoom sstu.eybp THAC eesxsc selad ot esescx saitmlinuot on teh aaldenr coertx to rcduope s,orltcio egtulrsni Csnh'isgu odsym.rne sxEces cosotirl mlonr(lya a ssrste er)omonh ecassu rynsneoiethp vai patoonnttiie fo asicphtmety iinoamtstul on eth seluatcvau.r tI acn oasl scaeu kyaoilhaemp by iancgt sa a tiordrceiooilmnac hewn in e,cssex anitturgas het taiibly fo ayyrixbedtht11--esoodr anesyeordedhg prnts(ee in the ealrn tuulbs)e ot evrcotn csroitlo to rcosntie,o hihwc nd'oest cat as a .drriioeolicconatm

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. +8
... m-ice made a comment on nbme24/block3/q#20 (A 33-year-old woman comes to the physician because...)
 +18 
submitted by m-ice(346)
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ishT nmowa has raxmPasoyl lctuanorN Haol.gbunirmoie sTih most otnfe senrteps ni a ugnyo luatd ohw ahs epdoessi of adrk uneri in eht ldmedi fo the ignth ro nehw wkgnia up ni het .oinnmrg sI't aecusd by otnmpemcel tcavtiiy lyedtric sgainta eth tesiaptn' onw CR.Bs inraCte cgdpylloisi aer eendde no teh BCR rfaeusc ot epvnrte aactkt frmo ,emnpleomtc eth otsm alntoeb of chwhi era 55DC adn .D5C9 Ptaietns hwti PHN have a amiscto unoitmta in whhci yteh tols ontfinuc of a AGPI nezeym edende for reorpp sotietaerpnn and tnehtcatam of 9C5D55D/C no hte CRB eucasrf. Treeofehr eth wenrsa si a tdfece ni a lecl rbnemeam rnhoac e.ponitr Whiotut ,tihs pteommnelc saakctt .BCRs

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +23
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +7
sexymexican888  @sunshinesweetheart Spherocytosis results in extravascular hemolysis (spleen) so no weird colored urine (due to intravascular hemolysis) as is seen in PNH (complement destroy RBCs in blood vessels) +
... neonem made a comment on nbme24/block3/q#26 (A 54-year-old man with a myocardial infarction...)
 +18 
submitted by neonem(580)
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laereGn mteeh fo :tplayohog yohapix siarpmi vxotdiiea psiootynhrloaph tg--&; sesl TAP g;t&-- essl NK-a mupp tayivcit os uidosm uidlsb pu in eth cell, igscanu sgenlil.w Tsih si eht tfisr p.set Thne du'oy teg eth calmiuc uuilbdp in eht ecll dna lnteuvea icoraenab lliysgsyc,o uagincs licact dica ritundocpo and rdoeelw ..Hp. tub hist sepnahp laetr nda stin' teh cdietr aesuc fo elrlaucl ,inlwsegl iwchh si wtah eht equnosit is erfta.

aneurysmclip  can we have a moment of appreciation for Dr Sattar +26
makinallkindzofgainz  blessed be His name +8
... colonelred_ made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +18 
submitted by colonelred_(111)
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Ldokeo ti pu nad uondf atht cuebeas y’uoer in a iepnus pnoiiots for a ongl meti re’uoy iongg ot have irsdacnee nvsueo rnuetr ihchw eadsl to rcsdneaei O.C This eaitlenygv beskdaecf no ARS,A gnleadi to eecdaerds eso.tdlnaeor As a s,utelr yeoru’ ogngi ot ehav iescraden sisriude icwhh ledas to aseerecdd bdool dan asplam u.lovem

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. +10
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 +
theunscrambler  @peqmd thanks for sharing that. According to the presentation, the diuresis via ANP occurs (along with sodium), which is followed up by an increased in RAAS --> maintains sodium levels. This cycle can then continue. Slide 13. +
jj375  @urachus - Either BB or Sattar taught me this but I feel like it is often forgotten. "RAAS/Aldosterone affects blood volume, and ADH affects Na level". So Increasing aldosterone will increase blood levels however water follows the sodium so you will not get a change in sodium levels. ADH however does affect Na since aquaporins are bringing in water without affecting sodium levels. +
... itsdrgoodwood made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +18 
submitted by itsdrgoodwood(18)
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Teh soandsiig is esOieesosgnt reeI.ptmacf sDeesia scesau a cetfde in eTyp 1 elnCgoal that desal ot rtlβ€œeibt snbe”o, ainemng hte pttsanie evha fquerten ftrcesrua hitw litetl mrata.u eTpy 1 acegolln si asol a mojar npcooment of teh ecsarl -&g;t isht si tawh het ecutrip asw nhnitig ta i( ?thkni) nda it ucssae lβ€œbue ”la.serc Teh rlcaes rae cntnnleurshtita/ os hety loko ubel ude to nlngeyirud orhoaildc eni.sv

,alniylF aiestntp vhae oopr nwdou hei.angl Wudon rarpei hwti nagnltaroiu ssieut nselviov yetp 3 eolalcg cihhw si tenh vdrctenoe ot etpy 1 nloelacg dgnriu rsac iomna.rfto cefsDet ni tyep 1 cenglloa ybloiuovs nd’to ollwa sith opssrec to aekt ep.lac

... tea-cats-biscuits made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +18 
submitted by tea-cats-biscuits(252)
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nonreiitcFb is na aeaxeutllrcrl iaxrmt logor,yiepntc ihlew nialm is na riteimtaende menltfia that ecllpiaifcsy deirvpos urpstop ot eht clel uscln.eu oDtn’ uefsocn imlan itwh ninlmia ineeccs( tahes us )ael;ylcr mnaliin is ekli fieioncrn,bt na MEC pgeonltriyoc nda a jmora eontpconm of eht asalb nmaila fo seeabmtn nebsmrm.ae

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/ +43
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...)
 +18 
submitted by sattanki(72)
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uelscM anip + pliraberoti eaemd is a ssilcca etnaoprnseti rof orhtiaellcn liipssra. etBs nigsdaosi orf tish is a cmuels y,psibo sa the yrmow likes ot ogahtnu nhiwti the su.lmesc

sympathetikey  That's what you get for killing polar bears. +90
dr.xx  That's what you get for not cooking them well. +5
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2
jbrito718  fun fact: Can get vitamin A toxicity from eating polar bear meat which leads to fatal fulminant hepatitis! +
... lsmarshall made a comment on nbme24/block2/q#22 (A 3-month-old boy is brought to the physician...)
 +17 
submitted by lsmarshall(427)
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erwllegeZ rnoedysm - osatmauol veeissrec rodeisdr fo poerismxeo neiosisebg eud ot tatedum XPE e.egsn Hn,oyiotap ezsre,uis p,ytaelagoehm ylrea heatd n(ithwi 1 a.re)y doiaxΞ²i-nto of FVALC ppnaseh ni soeioxsermp so the dcilh ingsmeely ghinav moes otrs fo icotanleng embolicat reroddsi whti adtleeve ALsVCF udslho ahve been eoghun to etg eht narswe ithwotu iwnkong uabot e.lZgweerl

jucapami  furthermore, FA 2019 pg 47 +4
tiredofstudying  Same page for FA 2020^ +4
... tea-cats-biscuits made a comment on nbme24/block3/q#29 (Drug X is given to a 25-year-old normal subject....)
 +17 
submitted by tea-cats-biscuits(252)
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tiarPal siotnsga aevh awek tgnioas catiitvy on heitr wno hs(ut ni shit cesa ti caeuss HR ot ecr,aiens g-rbrecandie ceet)ff but wehn na tluaca atonisg is rnpetes kaa( hwne uyo aer e,inxeriscg uoy rae cipdongur NE nad E tath haev llfu nat-bigso feft,sc)e apilrta osnaigt aalyuclt ehav a lmdi totsningaa effetc (uhts the tearh rtea es.c)edsaer

potentialdoctor1  Might be relevant to add that there are two beta-blockers that are actually partial beta-agonists (exert their blocking effects due to lesser effect when compared with endogenous catecholamines) ----> Pindolol and acebutolol +10
thelupuswolf  Key to note as madojo said that a partial agonist will compete with the full agonist in the presence of the full agonist, preventing the full agonist's maximum effect +
... sajaqua1 made a comment on nbme24/block4/q#20 (Forty of 100 attendees at a company Christmas party...)
 +17 
submitted by sajaqua1(558)
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iiborV eahrolc adn .V hleaaucrsyaomtip ear utnreylefq otdiaascse wiht incsonpuotm fo oerdeoukdcn foeaods ikel fsleh.ilsh .V sfcunuiilv si aisoasetcd wtih hsrikcab ewtra or tetslraw.a

)A .B -ceures igensevtt entd ot coesasita hits itwh aertheed irce ta a ,ebufft toivginm si mero commno thna .reihdaar )B C. e-jiujn sctaeadois wiht eoukcdnerdo ,fodo picaelyesl k,cicenh ro can eb trccnaeodt by tnacoct iwth a.ialmsn tI sceasu fmi,ormytanla oyodlb dararehi, and yam loas elda to aGrelnilarB-u nsyreodm. C) C. -sgrpenrifen as a rrouosta,lp hits si etidocasas hwti ogod htta is daeerhet ehtn telf to nitameger ta moor epetrtmreau fro a olng mite fbereo nnosuoptcm.i spoytmSm ndeilcu miointgv adn h.iaaerrd D) S. su-eura a ehta sabtle tioxn dodecpru yb .S usaeru is scsotdaeia ihtw ripda onste fo vonti,mig aym be ainmaepccdo yb eairrah.d tosM oftne asectosdia wthi dyari oscputrd dan aet.m

armageddon_oh  Perfringens is also usually a delayed response, can help in vignettes! +
jj375  Vibrio cholera and V. parahaemolyticus are usually associated with seafood. B. cereus is re-heated rice, plus the vomiting type is a preformed toxin, but the diarrhea form is not, so I guess if it was rice, this could technically fit. Campylobacter is blood diarrhea, not watery. S aureus is preformed toxin so it usually happens within a few hours of eating the food, not 12 to 48 hours later. C. perf is less commonly asked about if its not gas gangrene, but First Aid also says that it's usually diarrhea after 10-12 hours and resolves by 24 hours. +
... sympathetikey made a comment on nbme24/block4/q#38 (A 33-year-old woman at 34 weeks' gestation has a...)
 +17 
submitted by sympathetikey(1446)
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Wulevo'd nebe cien if ethy odtl ouy n"d2 cstaontelri secap" on flte ro hh.grsm.t.i

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
cport12  Also an important side note is that with the addition of the placenta, systemic vascular resistance would actually decrease (another organ added in parallel) which should help point you towards an increase in stroke volume. +1
... neonem made a comment on nbme24/block4/q#40 (A 25-year-old woman is brought to the emergency...)
 +17 
submitted by neonem(580)
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hsiT patietn nits' tatgh,onvplneiyi eehryt' Ptl,eintvERYganHi enche het O2CP l;&t 04 mm .Hg

'seLt aklw ti aarkbwdcs: yTeh aer aelynrengtithvpi ot nemacpesto orf eht oetmilbac oasdisci dceasu by wpesaiedrd aoxhy.ip gpnHylattverinie alolsw uoy to wobl ffo reom 2.OC

Why era yhet oyh?picx heT epsnro is iycophx edu ot ltmamoiainnf nad cauet ytrieraorps stsrides ynrosdme rmof hte paonumi.en lAl eth scontkiye rofm het manfotiraylm slecl uscae icsdrnaee ympolanru alapyrlic aa,eelkg ihhwc sokcbl pu eht aorlleav amenremb so htta O2 ac'tn get hrhougt ot the dlboo.

hyW od yeht vhea bimalctoe oadiciss ni eht ritsf c?aple No yegnxo ;&g--t on erolcnet ttoarsprn icanh dna on TAC ;-&-gt acctil oia.dciss

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) +18
peqmd  urosepsis +
snripper  lmao I read it as upper respiratory tract infections, too. +3
thisshouldbefree  she has an increased A-a gradient. +
... stars and more made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
 +16 
submitted by stars and more(16)
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X enlkdi veiescers tereh anc renve eb any aelM ot laMe fsernatr isnce het laem sfgfnropi esgt Y fmor a.hetfr eht geerdeip sowhs Mael ot aMle trsmiosnnais so isht nctoan be X likned eieerscsv