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Some recent contributions

... athenathefirst made a comment (nbme20)
 +0  submitted by athenathefirst(7)

How is this 61.2 level of difficulty when biostats questions are usually 17 or 18 #crying


... deletion259 made a comment (step2ck_form6)
 +0  submitted by deletion259(1)

Subacute (masked) mastoiditis — Clinical features of include fever, cough, ear pain, and tympanic membrane findings compatible with AOM. Subacute mastoiditis occasionally presents with an extracranial or intracranial complication without signs of AOM or mastoiditis.

Subacute mastoiditis should be considered in children with AOM that is not responding to antibiotics and in children with signs of intracranial infection without another focus of infection.

Subacute Otitis media has to be Diagnosed with CT scan. If you suspect regular mastoiditis you may forego CT scan and do tympanocentesis.


... olddoc made a comment (nbme19)
 +0  submitted by olddoc(1)

The doctor can't have the patient's opinion here because her mother is in the room watching when the doctor asks the patient's preference. The patient may then feel awkward to agree with her mother leaving the room. She may even feel intimidated to do so if the mother abuses her at home (The mom may get back at her at home later when they're alone). So I believe in such cases the doctor has to have the upper hand requesting the parent to leave the room to make the patient feel more comfortable. I don't have a reference but think this is just common sense.


... an1 made a comment (nbme20)
 +0  submitted by an1(5)

This is a Delayed Hemolytic Transfusion Reaction (in FA 19 or 20; new topic). Presents after 24 hours but often 1-2 weeks later, may be more. Patient presents with signs of jaundice, low Hb, and high reticulocytes. This occurs when the patient was exposed to a previous minor RBC antigen (NON-ABO). The 1st response is undetected and undocumented. Diagnosis is made with a newly + Direct Coombs test. High unconjugated (NOT conjugated) bilirubin and LDH. Check UW QID 17780.


... an1 made a comment (nbme20)
 +0  submitted by an1(5)

Major controlling mechanisms in the brain are CO2 and pH. A high CO2 and pH (high CO2 is related to acidosis) result in vasoDILATION. When there is dilation, the vessels are better able to perfuse the organ. More perfusion in the brain will result in higher intracranial pressure. Thus to increase ICP, we need to increase the CO2 in the body. This will be done by reducing the RR and retaining CO2.


... psaucy made a comment (nbme22)
 +0  submitted by psaucy(1)

I miss so many questions on NBME exams not knowing the common names for things lol fuck me


... mmizell made a comment (step2ck_free120)
 +0  submitted by mmizell(8)

So I was between L4 and S1 radiculopathies on this one and couldn't remember the sensory/motor/reflex losses that differentiated the two. Here's a summary (including L5 for completeness)

L4 Radiculopathy:

L5 Radiculopathy:

S1 Radiculopathy:

https://next.amboss.com/us/article/ji0_rf#Z4e6b97d11a53a281e346032ace785757


... osler_weber_rendu made a comment (step2ck_free120)
 +0  submitted by osler_weber_rendu(112)

Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway


... len49 made a comment (step2ck_form6)
 +0  submitted by len49(22)

+Hofman sign (calf tenderness w/ dorsiflexion) for DVT. Pregnancy is a hyper-coagulable state


... len49 made a comment (step2ck_form6)
 +0  submitted by len49(22)

Young IV drug user w/ weight loss makes me think of HIV infection, and so before even looking at the CSF values think opportunistic infections such as Cryptococcal meningitis, which is an AIDs defining illness.


... len49 made a comment (step2ck_form6)
 +0  submitted by len49(22)

Wernicke triad:

  1. Oculomotor dysfunction -- (dysconjuugate gaze and prominent nystagmus)
  2. gait ataxia -- (difficulty walking, can only stand with assistance, wide base)
  3. Encephalopathy -- (confusion, disoriented)

Treat with thiamine.


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

A. Not appendicitis as your pelvic exam suggest a gynecologic issue given the bloody cervical os and motion tenderness

B. Ectopic pregnancy not likely given her last period was only 10 days ago and she is regular, so it is reliable.

C. A 5cm mass could be a cyst which may predispose you to ovarian torsion, but again that cervical motion tenderness much more specific for something else

D. No CVA tenderness or dysuria and again with the abnormal pelvic exam suggesting gyn

E. Fever, tachycardic, cervical motion tenderness, friable mucosa, inconsistent condom use, adnexal mass -> bingo


... len49 made a comment (step2ck_free120)
 +1  submitted by len49(22)

Pt has malignant effusion, which you would expect to be exudative. Exudative is characterized by protein pleural/serum > 0.5 LDH pleural/serum >0.6, and a LDH >2/3 upper limit of normal. So that would be increased protein or increased LDH, LDH is not an answer, so easy to rule out.


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

Hits all the CRAB symptoms for MM

C - hypercalcemia @ corrected 11+

R - renal dysfunction w/ elevated Cr @ 1.5

A - anemia w/ hematocrit @ 32%

B - bone/back pain

Appropriate workup is to send SPEP/UPEP


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

Two reasons this man has bought himself a abdominal US.

  1. He is a male who smoked between the ages of 65-75
  2. He is a male >60 with a sibling (could also be offspring) who has a confirmed AAA

... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

This patient has decompensated and has met criteria for ARDS. How to tell it is ARDS:

  1. acute onset

  2. P/F ratio <300 (in this patient it is super low at 55 , which is classified as very severe ARDS)

  3. non-cardiac cause (states no cardiomegaly and no other cardiac hx/disease)

  4. CXR showing diffuse bilateral infiltrates

The most important thing for ARDS treatment is lung protective ventilator strategy which includes low tidal volume based on ideal body weight (6cc per kilo) and high PEEP for recruitment of closed alveoli


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

ARR = CER - EER, in this case 2.2 - 1.2 = 1.0% NNT = 1/ARR, in this case = 1/0.01 = 100 RRR = CER- EER/CER = 2.2 - 1.2/2.2 = 45.45%


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

Risk factor for suicide completion can be remembered by acronym SAD PERSONS:

S: sex (male)

A: age 18-24

D: depression

P: previous attempt

E: ethanol or other drug abuse

R: rational thinking impaired (psychosis)

S: sickness (medical illness)

O: organized plan

N: no support

S: stated future intent


... len49 made a comment (step2ck_free120)
 +0  submitted by len49(22)

A displaced femoral neck fracture in a patient <65 needs to be internally fixated, pick the answer with that. >65, you probably want to go with replacing the entire joint with a prothesis over fixation.


... macroorchidism made a comment (nbme18)
 +0  submitted by macroorchidism(1)

The way I rationalized this one was like this: 1) He was already 'caught' so you can eliminate any answer choice that deals with the handling of the law, as that will be handled by the third party (C&E) 2) Choice D also can be eliminated because you never want to snitch to the parents, especially since he is a grown ass man (he is over 18 and his parents have nothing to do with him now Medically/HIPPA) 3)Choice B is basically referring him to another doctor and comes off as passive aggressive (Pretty sure trust issues doesn't stop your obligation to help patients when concerning NBME) 4)Now you're left with A or F. F is almost like jumping to a treatment option without any 'consent' or discussion to see what's really going on with the patient...so no. 5) Above all else when dealing with ethic questions 99% of them require the answer that is the most empathetic, level-headed, and benevolent. Basically which answer tucks your tail between your leg and makes you "The perfect doctor"


... mmizell made a comment (step2ck_free120)
 +0  submitted by mmizell(8)

Skipping the symptoms, I initially thought a1-antitrypsin because of the "adult-onset asthma/younger COPD," but the remainder of the symptoms don't fit and none of the answer choices are consistent with that. My next thought was also Wegener's v. Churg-Strauss v MPA, but I thought that all three could have peripheral neuropathy, and was quite thrown off by this question. I knew CS had elevated IgE levels and stupidly guessed that response.

However I think that the main goal of the question was to get you to figure out the first step in differentiating the three (as separate from other vasculitides), making the answer "serum ANCA-ab assay." Then evaluation for granulomas, then eosinophilia (neither of which were answers). Evidently IgE levels aren't necessary for diagnosis.

See Figure 2: https://www.aafp.org/afp/2002/0415/p1615.html


... stunna216 made a comment (free120)
 -1  submitted by stunna216(0)

why is ther hyperreflxia and a babinski sign meaning that there is an UMN lesion?


... an1 made a comment (nbme20)
 +0  submitted by an1(5)

the child was in a daycare, sonnei and rotavirus are the ones to keep in mind. sonnei can also be due to unwashed veggies too. and the inflammatory stool (neutrophils) also indicates sonnei. the lack of exposure (undercooked meat for EHEC) helps to rule out E.Coli. dirty water (ETEC and EIEC) aren't possible because of this kids bloody stool. Also for this to be HUS (the only possible E.Coli with bloody diarrhea), we should have seen the triad or at least something about it (anemia + thrombocytpoenia + Acute Renal Insuff.). Also, "mucoid stools" is right from the FA chart for shigella.


... an1 made a comment (nbme20)
 +0  submitted by an1(5)

I just used common sense to rune out the answers here. Firstly, knowing that cortisol is increased during times of stress (starvation; like this stem). Insulin causes hypoglycaemia so the body wouldn't produce more in a stressful state (expect glycogen to be higher). IGF-1 acts like GH and these states of growth require energy which this man clearly doesn't have. There wasn't enough to support testosterone and T3 changes so those were ruled out pretty quick.


... chj7 made a comment (nbme20)
 +0  submitted by chj7(3)

Side note for those of you who hate familial dyslipidemias: don't usually watch dirty USMLE videos but I couldn't keep the familial dyslipidemias straight in my head and someone on reddit recommended his video on this. Personally found it really helped.


... failingnbme made a comment (nbme20)
 +0  submitted by failingnbme(1)

scary crying old ostrich man that's all I can see :O


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

This man likely has ALS-> weight loss, progressive weakness causing him to now be in wheelchair, dysphagia, no PMH, fasciculations. It is a mix of upper and lower motor neuron deficit and MOTOR ONLY. Because muscles will not be stimulated, they will atrophy. "USE IT OR LOSE IT"


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

SUBACUTE COMBINED DEGENERATION (B12 deficiency):

Spinocerebellar tract -- Unconcious proprioceptive sensation. 'tingling'

Lateral Corticospinal tract -- Controls ipsilateral limb fine motion. 'weakness of extensors and flexor muscles. exaggerated reflexes'

Dorsal Column -- White matter in posterior. Made of gracille and cuneatus fasciculi. Gracile is for lower body sensory and cuneate is upper body sensory. 'decreased sensation to vibration and position'

-initially i put B6 because of descriptions of peripheral neuropathy, but the decreased vibration/proprioception was the key differentiator


... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

This homing phenomenon may be related to tumour cell recognition of specific “exit sites” from the circulation or to awareness of a particularly favourable—or forbidding—“soil” of another tissue. This may occur because of an affinity that exists between receptor proteins on the surface of cancer cells and molecules that are abundant in specific tissues.


FA 2020, pg 221, "Hallmarks of Cancer"

Metastasis is defined by distant spread via blood/lymphatics --> binding to endothelium --> extravasation & homing.

Since metastasis to only one organ has been affected, it's safe to say this liver cell surface antibody has affected "homing" towards the liver.


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

ACE inhibitors are associated with oligohydramnios, renal failure, hypocalvaria. - FA2019 pg600; FA2020 pg 614


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

"Ileal (Meckel) diverticulum occurs when a remnant of the vitelline duct persists, thereby forming a blind pouch on the antimesenteric border of the ileum. It is often asymptomatic but can become inflamed if it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration. It is typically found 2 feet from the ileocecal junction, are 2 inches long, and appears in 2% of the population."

Kaplan 2020 Book.

Antimesenteric seems to be a buzzword for Meckels, saw this in UWorld as well (might have been one of the UWSA).


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

Damage to orbital floor can lead to impaired vertical gaze (ocular movement is restricted)via entrapped inferior rectus, numbness and paresthesia of the upper cheek/lip/gingiva, enophthalmos. UWORLD qid:11742, same concept


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

According to UW qid:839 "The membranous segment is relatively unsupported by the adjacent tissues and is the weakest point of the posterior urethra. Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the bulbomembranous junction." The presence of a pelvic fracture and presence of blood at the urethral meatus are key signs of urethral injury.


... jbrito718 made a comment (free120)
 +0  submitted by jbrito718(3)

the MAIN SUPPLY IS FROM THE INFERIOR THYROID ARTERIES. the little bit of blood received from the collateral (superior thyroid from external carotid) keeps them alive but now they sense low ca2+ --->>> so release tons of PTH... if the superior was knocked out = not a big deal --> not main supply to the glands.

** I copied @mistermbg explanation because he explains it really well!


... justanotherimg made a comment (free120)
 +0  submitted by justanotherimg(1)

why is the answer not choristoma?!!


... cassdawg made a comment (free120)
 +0  submitted by cassdawg(1398)

Atropine reverses acetylcholinesterase poisoning due to organophosphates

Bethanechol is an M3 agonist used to treat urinary retention

Physostigmine is an antidote for anticholinergic toxicity


... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(3)

This is the stupid way I've ever seen anyone ask a question


... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(3)

Di- and Tri- peptides can enter into enterocytes via PepT1 transporters and be broken down to amino acids within the enterocytes. Hence why the lumen is not the best answer


... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

Top 1/3: Esophageal branches of inferior thyroid artery, which is a branch of the thyrocervical trunk (option E)

Middle 1/3: Esophageal branches of thoracic part of aorta (option B)

Bottom 1/3: Esophageal branches of left gastric artery (which is branch of celiac trunk, which is branch of aorta) (option A)


FA 2020 pg 364: abdominal aorta --> celiac trunk --> left gastric --> esophageal arteries


... humbertodiaz93 made a comment (step2ck_free120)
 +0  submitted by humbertodiaz93(1)

This question has changed. Sept 23rd 2020. 2-day-old female with murmur. Next step in management: Observation only.


... meryen13 made a comment (nbme22)
 +0  submitted by meryen13(23)

how to remember its lamber eaton and not MG: it doesn't matter how much you move your muscle the ach receptor is blocked the same amount and ach release will by repetitive movement is not gonna change the number of available receptors in Lambert the more you move the muscle the more calcium is released to fuse the vesicle with the plasma membrane and if finally you get enough concentration of calcium in the cell, you will merge the vesicle with the plasma membrane and enough a normal amount of ach is in the synapse.


... meryen13 made a comment (nbme22)
 +0  submitted by meryen13(23)

E. faecalis has different type of hemolysis in fact it could look alpha too just like strep pneumonia but what makes a difference is that E. faecalis is one of the most common causes of catheter infections in dialysis patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614136/


... imgdoc made a comment (nbme20)
 +0  submitted by imgdoc(144)

This question was a little tricky, but the way I went about it was process of elimination. You don't see costophrenic angle tenderness in A,B, C, or D.

She has fever and back pain, definitely don't see that in PID, which presents with cervical motion tenderness, and purulent discharge. Micrograph also isn't showing cervical histology.

As an added bonus: urinary stones cause excruciating pain when you're trying to pass it through your ureters, basically dragging alongside. Hence the patient crying.

You didn't need the micrograph, other than to see all those neutrophils, but we've all seen glomerulonephritis histology slides, and it doesn't even look close.


... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(3)

Fucked up thinking the S in SADPUCKER was for spleen when its actually suprarenal arteries. Such an easy question to miss.


... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(3)

very similar UWorld questions which may help explain: #19893


... feanor made a comment (nbme24)
 +0  submitted by feanor(1)

Apparently being a Muslim didn't help me much while answering this piece of teratomatic question, guess I'd have to be a little bit conservative then eh....


... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

Link to info about crossing over


... imkingran made a comment (nbme13)
 +0  submitted by imkingran(1)

FA 2020 pg 206 - Cellular Adaptations - Atrophy


... saraluciachega made a comment (nbme18)
 +0  submitted by saraluciachega(1)

Also, remember that Paget disease increases risk of osteosarcoma (seen in histology as neoplastic spindle-shaped stromal cells admixed with tumor osteoid and thin trabeculated bone)


... utap2001 made a comment (nbme24)
 +0  submitted by utap2001(14)

This figure helps a lot! https://stats.stackexchange.com/questions/7402/how-do-i-find-the-probability-of-a-type-ii-error

null hypothesis is divided into two type, true or false

null hypothesis is true-> H0, null hypothesis is false-> H1, when you accept H1, it is β error, when you reject H1(false), it is true(=power=1-β )

so, no association between caffeine and pancreas cancer, it is H0(-> all H0 are no association, no difference in default).

an association between caffeine and pancreas cancer, it is H1 -> missing in H1-> β error


... jbrito718 made a comment (nbme24)
 +0  submitted by jbrito718(3)

This is septic shock leading to pulmonary edema aka “symptoms”. The leakage is caused by LPS leading to IL-1, IL-6, TNF-alpha which increases vascular permeability! The question and answers tries to trick you into thinking it’s something else but you know she had gram neg infections and the presentation is just sequelae of septic shock!


... jbrito718 made a comment (nbme18)
 +1  submitted by jbrito718(3)

Snitching to the mom would ruin your relationship with the patient. his social skills are pretty good to me if hes getting laid at his age. based on vignette, testosterone levels dont seem to be an issue. and suggesting decrease in masturbation is not medically relevant. The most lucrative next step would be to schedule next appointment like you would with any patient. Dont overthink this question. its straight forward! keep it simple!


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

FA2019, p259: Remember that prevalence / (1-prevalence) = incidence * (average duration of disease). It has nothing to do with this but I wanted to write that because I saw it written wrong on another website explaining this. This is a very simple question that I completely overthought. To answer this question, I think all you need to know is that TB is a chronic disease. Therefore incidence > prevalence. Lowering the threshold for negative results will increase the incidence of positive results. And since prevalence must always be greater than incidence, it will increase the prevalence as well. Sounds logical to me now.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

Everything else is an NSAID and contraindicated due to chronic abdominal pain. Acetaminophen is antipyretic and analgesic. It is not anti-inflammatory, but more importantly, it does not affect gastrin release or stomach mucosa.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

First-line therapy for chemotherapy-induced nausea are ondansetron and aprepitant. If she was actively vomiting due to chemotherapy, you could give metoclopramide as it is a strong antiemetic, according to UWorld, but this is written in a prophylactic sense. So go with the above mentioned.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

CO = HR*SV, HR is increasing because SV is decreasing fast. If CO output decreases, pulses will weaken. RBF decreases during SNS activation. That's why you don't have to pee while working out or until few minutes after sex.


... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(3)

Area labeled: A= mitochondria B= Golgi C= Cell membrane D=Lysosomes/vacuoles E= Cytoplasm or free Ribosomes (subjective) F= [Rough] Endoplasmic Reticulum

Precursor protein would be coming from translation of mRNA which would happen in the rough ER


... jbrito718 made a comment (nbme18)
 +0  submitted by jbrito718(3)

The question hints at ADHD due to "constant motion", disruptive behaviors, incomplete assignments in school + impulsive/reckless behaviors outside of school leading to MULTIPLE ER visits from injuries.Methylphenidate (Ritalin) is tx for ADHD.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

I got this question more by ruling out everything else. Not B because no symptoms of CHS (albinism, primary hemostasis deficiency, peripheral neuropathy), not C because Streptococcus is catalase negative, not D because no symptoms of DiGeorge (cardiac defects, facial defects, no missing thymus), not F because IgA deficiency would have airway and GI infections. Recurrent ear infections doesn't seem related to IgA. That leaves me either Bruton agammaglobinemia and IgG2 deficiency. And Bruton's is more commonly seen in males. So I went with A.


... jbrito718 made a comment (nbme18)
 +1  submitted by jbrito718(3)

Gynecomastia can be caused by elevated estrogen levels, decreased testosterone levels, or both. In pubertal males, adult estrogen levels are reached before adult testosterone levels. The effects of estrogen further causes increases sex-hormone binding globulins which further lowers testosterone, leading to gynecomastia (FA 2019-332; FA2020-337). Another cause of gynecomastia is hypogonadism (FA 2019-635; FA2020-649), which is what this patient seems to be experiencing .
Differentials: Kallman?, Prader Willi?,idiopathic I personally put low pitched voice, thinking his low testosterone would cause delay in deepening of his voice but I guess this varies and gynecomastia is a "better" choice in the eyes of NBME.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

I would love to know the true odds that three separate samples of the chorionic villus are made and each 3 are completely isolated genotypes and none are a mixture of both. Also, I'd like to know how often a laboratory error is. If anyone has that data, I would love to see it.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

Endometriosis explains the bleeding out of the butthole during menstruation. Furthermore, leiomyomas are estrogen sensitive, so it would be more likely to cause pain at ovulation. (FA2019, p634)


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

FA2019, p51: osteogenesis imperfecta. Patients with OI can't BITE (bones, eyes, teeth, ears).


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

Enterocytes have the highest turnover rate of any fixed cell population in the body. Stem cells for enterocytes are located in the crypts. Mature enterocytes do not stimulate cell turnover.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

This is a simple metformin MOA question (FA2019, p348). Everything before the last sentence is distraction.


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

(FA2019, p643): Sildenafil causes increased flow in corpus cavernosum, D. Rest of the answers: A is deep dorsal vein. B is areolar tissue. C is corpus spongiosum. The deep dorsal vein keeps you hard but it's increase blood flow to the corpus cavernosum that gets the fireman ready and able to put on his coat. Practice safe sex. :)


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

I don't know about you, but I got hung up on the fact that she's in her 20s and female and "recently developed" her symptoms of hyperthyroidism. Hypothyroid disorders are more common than hyperthyroid disorders and Hashimoto's disease, which is the most common hypothyroid disorder, has an initial hyperthyroidism. So I went with C "thyroid peroxidase autoantibodies." To be honest, the only thing that makes me confident it's not early Hashimoto's still is that B is also an autoantibody of Hashimoto's. And there can't be two right answers. So that leaves D "Thyrotropin receptor autoantibodies" (Grave's disease) as the correct answer. Better responses requested:


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

I think this question is only hard because it is written so vaguely that it took me a while to even understand what the question was: was it asking what was important for the virus to infect or for the body to recognize that an infection has occurred? Basically, to answer this question, all you have to understand is that for a virus to infect a cell, there has to be on the cell some receptor for which the virus can bind to. That's it. "If the virus cannot bind, you will be fine." -Johnnie Cochraine


... chaosawaits made a comment (nbme19)
 +0  submitted by chaosawaits(11)

See page 367 in FA2019. Trypsinogen is converted to trypsin by enterokinase/enteropeptidase, a brush border enzyme on duodenal and jejunal mucosa


... ag21 made a comment (nbme20)
 +0  submitted by ag21(1)

Serum Osmolality is self explanatory.

Increase Urine Na is because > Increase in Water Volume > + Natriuretic peptides.

As the name says: "NA trureric" ie, increase water diuresis with NA.

RAAS is suppressed


... amy made a comment (nbme19)
 +0  submitted by amy(1)

Circumflex artery(LCX) and Obtuse marginal artery(OMA) supply left ventricles ONLY. Acute marginal artery (AMA) supplies right ventricle ONLY.


... an1 made a comment (nbme16)
 +0  submitted by an1(5)

I had this narrowed down to Influenza virus and 23-Valnet Pnuemococcal. I was opting fro 23 but this patient actually has a dry cough, whereas Strep P often has a productive, rust coloured cough. Also, Strep Pneumo often causes pulmonary consolidation and so breath sounds would be increased. But don't forget, influenza can increase the risk of staph aureus pnuemo!


... blah_blah made a comment (nbme24)
 +0  submitted by blah_blah(1)

helpful https://www.youtube.com/watch?v=QfjIGXNey3g&ab_channel=HussainBiology


... usmile1 made a comment (step2ck_form7)
 +0  submitted by usmile1(120)

This presentation really could be either retained placental tissue or uterine atony. i think the key with these nbme questions is to go with the most likely diagnosis, and the most common cause of post partum hemorrhage is uterine atony

"At times the bulk of the placenta will deliver spontaneously or manually, but small portions or an accessory lobe may be retained. This may be suspected when the placenta appears fragmented after delivery or when there is ongoing heavy uterine bleeding. In this situation, the uterine cavity may be evaluated with manual exploration or with ultrasound. The utility of ultrasound in this situation has yet to be established, with a focal endometrial mass, particularly with Doppler flow, being the findings of interest. In one study of routine ultrasound immediately after vaginal delivery, the sensitivity for diagnosing retained placental fragments was only 44% with a positive predictive value (PPV) of 58%" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789409/#S0006title


... amy made a comment (nbme18)
 +0  submitted by amy(1)

2 feet is about 60cm. so he IS within the range of the 2s (2 feet proximal from ileocecal valve). Not medically related knowlege at all, I got this wrong


... usmleaspirer made a comment (nbme20)
 +0  submitted by usmleaspirer(1)

i think i have seen this in zanki cards...

Rotavirus- most common cause of viral diarrhea(watery) in CHILDREN.

Norovirus- most common cause of viral diarrhea(watery) in ADULTS.


... arthur_albuquerque made a comment (nbme20)
 +0  submitted by arthur_albuquerque(1)

What helped me to answer this one quite easily was the following rationale:

Hypercalcemia + high PTH -> "primary hyperparathyroidism"

How do high PTH lead to hypercalcemia? Increasing osteoclast activity!


... victorlt14 made a comment (nbme17)
 +0  submitted by victorlt14(1)

I think my mistake here was failure to recognise she had similar symptoms for 2 months prior to delivery. For postpartum depression/psychosis symptom onset would be 4 weeks from delivery. Thus a previous diagnosis of OCD would be more likely.

Answer: SSRI (1st line for OCD)


... shaz464 made a comment (step2ck_free120)
 +0  submitted by shaz464(1)

Still confused.. Can anyone rule out all other options please?


... shaz464 made a comment (step2ck_free120)
 +0  submitted by shaz464(1)

This was a really confusing question.Pt being diagnoses with URI and then bullae I wasn't thinking of abuse at all. If this is how the exam will be I think I'm doomed. :(


... amy made a comment (nbme21)
 +0  submitted by amy(1)

I got stuck on the no organomegaly...I had thought that immune thrombocytopenia would have splenomegaly since it is the destruction of platelet in the spleen, like many extravascular anemias that present with splenomegaly due to the overworking of this organ. But I learned my lesson, splenomegaly would NOT be present when destructing platelet.


... feanor made a comment (nbme22)
 +0  submitted by feanor(1)

The C7 nerve root is in bold on Page.494 FA 2018 in the Tricep reflex rootlets, That's enough for me lol. This might sound a bit anecdotal but I remember reading somewhere that whenever C8 or T1 goes the intrinsic muscles of the hand are always effected.


... sizario made a comment (step2ck_form6)
 +0  submitted by sizario(1)

how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH?


... kungfupanda made a comment (nbme23)
 +0  submitted by kungfupanda(2)

Check Pg 203 in FA . its clearly given. but i choose the wrong answer!


... huszagmc made a comment (nbme23)
 +0  submitted by huszagmc(1)

https://step1.medbullets.com/biochemistry/102006/signal-transduction

https://step1.medbullets.com/pharmacology/107011/g-protein-coupled-receptors-gpcr


... huszagmc made a comment (nbme23)
 +0  submitted by huszagmc(1)

Bursitis tends to cause pain both during movement and at rest (e.g. simply laying on your shoulder is painful), while tendonitis only causes pain while you are actively using the muscle of the inflamed tendon. This expands on @doomarion's comment! Note for both, though, that you can have point tenderness since you are actively putting pressure where there is inflammation...


... embeemee made a comment (step2ck_form7)
 +0  submitted by embeemee(1)

what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately


... embeemee made a comment (step2ck_form7)
 +0  submitted by embeemee(1)

i get the answer, but would a VB even be possible given her GBS+ status?


... bguidry17 made a comment (free120)
 +0  submitted by bguidry17(1)

Kid chews on thumb with the HSV vesicle in his mouth, gets herpetic whitlow: https://en.wikipedia.org/wiki/Herpetic_whitlow


... hemoglobin_ made a comment (free120)
 +0  submitted by hemoglobin_(1)

The congenital type is due to a deficiency of the enzyme NADH-cytochrome b5 reductase, which impairs the ability of hemoglobin to bind oxygen, leading to poor oxygenation of body tissues. Cyanosis and hypoxia result. Source: https://www.visualdx.com/visualdx/diagnosis/methemoglobinemia?moduleId=101&diagnosisId=56035


... hemoglobin_ made a comment (free120)
 +0  submitted by hemoglobin_(1)

FA 2020, pg 195. MTZ adverse effects -Disulfiram-like reaction (severe flushing, tachycardia, hypotension) with alcohol -headache -metallic taste


... embeemee made a comment (step2ck_form7)
 +0  submitted by embeemee(1)

the change from green liquid to yellow liquid threw me off. i was thinking gastric outlet obstruction that initially let out bile until it progressed further until letting out only stomach acid?


... kungfupanda made a comment (nbme23)
 +0  submitted by kungfupanda(2)

Increase in body metabolism is also due to the inflammation thats seen after the burns in any patient irrespective of the severity. though its explained that huge skin loss (35% burn) increases the body metabolism to compensation for the excess heat loss due to the huge skin loss(as explained by others), this explanation depends in how severe the burns are.


... aoluwatayo made a comment (step2ck_form6)
 +0  submitted by aoluwatayo(1)

causative organism; cryptococcus treatment; Amphotericin B and Flucytosine IV Maintenance phase with Fluconazole.


... lukin4answer made a comment (nbme23)
 +2  submitted by lukin4answer(4)

During normal inspiration, alveoli starts from FRC(0mmH2O) to -1 mmh2O; this NEGATIVE pressure sucks air in. In PPV, the machine is pushing air making person do "inspiration" but now alveolar pressure is POSITIVE. & then expiration occurs passively (by elastic recoil). PEEP is an additional VERSION of PPV. Here, we do PPV but, in expiration, after some passive recoil (END EXPIRATORY PRESSURE), the machine pushes some air. So the lung does not fully deflate and return back to FRC. That's how we stabilize the small alveoli from getting collapsed after every PPV. REMEMBER, in PEEP, lung NEVER GOES BACK TO FRC. So, Alveolar pressure will ALWAYS be POSITIVE. Normally IPP is -5 after EXPIRATION (END-TIDAL) and -8 after INSPIRATION. Here we are giving +10 with Ventilation. That will overcome normal END-TIDAL (-5) making END-TIDAL IPP to +5. And of course, this +5 has no chance to become even +4 because the machine will push the air during inspiration which will make IPP even more +ve.PEEP is used to Rx Hypoxemia of ARDS. The downside is, this +ve IPP decrease VR to Rt heart and also Lt heart> reducing Cardiac Output.

Here is an Awesome video that will help: https://www.youtube.com/watch?v=24gsHagkL_8


... amy made a comment (nbme20)
 +0  submitted by amy(1)

Found this in uptodate: Omeprazole drug information, so it can go both ways.... "Itraconazole: Proton Pump Inhibitors may increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction. Exposure to Sporanox brand itraconazole capsules may be decreased by PPIs. Give Sporanox brand itraconazole at least 2 hrs before or 2 hrs after PPIs Risk D: Consider therapy modification"

For ketoconazole, it did say PPI decreases its serum level


... skonys made a comment (nbme23)
 +0  submitted by skonys(9)

"I do not know who I am. I do not know why I am here. All I know is rotator cuff anatomy" ~ The Writer of this Exam (probably)