welcome redditors!to snoo-finity ... and beyond!

Some recent contributions

... divya made a comment on nbme21/block1/q#33 (A 30-year-old man comes to the physician because of...)
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submitted by divya(0)

look at the image

Immunosuppression causes reactivation of VZV.


... necantoramericanus made a comment on nbme21/block3/q#12 (A 55-year-old man with hypertension comes to the...)
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submitted by necantoramericanus(0)

Im not really sure but I think the point is that with the captopril radionuclide scan there is a delay in function of the kidney. What they wanted us to remember here is that when you give a " A pril" to a patient with Renal artery atherosclerosis the renal function worsens because there is constriction of the efferent arteriole

FA 2018 - 567


... divya made a comment on nbme21/block1/q#18 (A 61-year-old woman is brought to the physician by...)
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submitted by divya(0)

Currently Alzheimer's disease treatment includes -

1)Enhanced Ach transmission (Donepezil, Rivastigmine, Galantamine

2) Neuroprotection via antioxidants (Vitamin E)

3) NMDA receptor antagonism (Memantine)


... lilmonkey made a comment on nbme21/block4/q#33 (A female newborn delivered at 26 weeks' gestation is...)
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submitted by lilmonkey(0)

Anyone reading this question


... niboonsh made a comment on free120/block2/q#24 (A 33-year-old man undergoes a radical thyroidectomy...)
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submitted by niboonsh(76)

external carotid branch supplies the superior parathyroid glands as well........?


... lilmonkey made a comment on nbme21/block4/q#47 (While lifting weights, a 24-year-old man develops a...)
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submitted by lilmonkey(0)

There is nothing indicating that this is a femoral hernia. It could be any type of hernia in the inguinal region (femoral, direct of indirect inguinal). No need to overthink: symptoms of incarceration, piece of dead bowel - strangulation, done, keep going.


... lilmonkey made a comment on nbme21/block2/q#47 (A 55-year-old woman comes to the physician because...)
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submitted by lilmonkey(0)

Remember PTH as Phosphate Trashing Hormone.

↑Phosphorus -> ↑PTH secretion -> ↑bone resorption -> ↑ALP and bone pain.


... paloma made a comment on nbme23/block4/q#6 (A 35-year-old woman, gravida 2, para 1, undergoes...)
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submitted by paloma(0)

This might help


... sunshinesweetheart made a comment on nbme24/block2/q#32 (A 35-year-old woman undergoes a left oophorectomy...)
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submitted by sunshinesweetheart(4)

suspensory ligament has ovarian vessels --> ovarian artery + ureter can be damaged in oophorectomy

cardinal ligament has uterine vessels --> uterine artery + ureter can be damaged in hysterectomy


... sunshinesweetheart made a comment on nbme24/block2/q#32 (A 35-year-old woman undergoes a left oophorectomy...)
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submitted by sunshinesweetheart(4)

suspensory ligament has ovarian vessels --> ureter can be damaged in oophorectomy

cardinal ligament has uterine vessels --> ureter can be damaged in hysterectomy


... sunshinesweetheart made a comment on nbme24/block2/q#1 (A 73-year-old woman has had easy fatigability for 2...)
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submitted by sunshinesweetheart(4)

macrocytic anemia (seen in blood smear) = RBC precursors can grow but not divide

oval macrocytes (seen in blood smear) = megaloblastic anemia (if they don't show neutrophil hypersegmentation)

B12 has neurologic symptoms and low methylmalonic acid while folate deficiency does not

folate is absorbed in jejunum, B12 in ileum

causes of B12 deficiency = pernicious anemia, gastrectomy, ileal resection, fish tapeworm, veganism

D) failure of MTHFR --> THF (via methyltransferase = B12 deficiency and macrocytic anemia

B) G6PD deficiency = normocytic because of incr RBC destruction; pt would show intravascular hemolysis sx precipitated by an oxidative stressor

C) protoporphyinogen oxidase deficiency = microcytic anemia because of low heme synthesis

A) decr transferrin = high ferritin = anemia of chronic disease = microcytic anemia because of low iron


... sunshinesweetheart made a comment on nbme24/block2/q#6 (A 50-year-old woman is admitted to the hospital for...)
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submitted by sunshinesweetheart(4)

acute exacerbation of CHF leads to reduced CO --> hypervolemic hyponatremia, body perceives it as hypovolemic (so you expect high ADH) ["non-osmotic release of ADH"]

let's say she wasn't crazy and really was having CHF exacerbation - tx with diuretic and fluid restriction as they did--> note that you can also use vaptan drugs for CHF-related hyponatremic hypervolemia (block ADH) --> should cause the urine to be dilute which will reduce the hypervolemia and reduce salt resorption to correct the hyponatremia

random diabetes inspidius side note for psychogenic polydipsia (DI dx is hypernatremia/normal, hypovolemia, dilute urine <100mOsm/kg)

--> if urine concentrates, it's psychogenic

--> if it does not concentrate, give desmopressin and if it concentrates = central DI, does not concentrae = nephrogenic DI


... sunshinesweetheart made a comment on nbme24/block2/q#45 (A 2-year-old boy is brought to the physician because...)
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submitted by sunshinesweetheart(4)

ADA mutation = autosomal recessive SCID

IL-2-R gamma chain mutation = XLR SCID

IL-2-R alpha chain (CD25) = T-reg dysfunction; assoc with autoimmunity esp. T1DM, MS

Fas ligand (CD95) mutation = no T cell apoptosis in negative selection in thymic medulla = incr circulation of self-reacting lymphocyte = autoimmune lymphoproliferative syndrome


... sunshinesweetheart made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
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submitted by sunshinesweetheart(4)

epi = pheochromocytoma of adrenal medulla = episodic HTN PTHrP = squamous cell carcinoma of lung (plus others) = hypercalcemia VIPoma = neuroendocrine pancreatic tumor =secretory diarrhea [WDHA (watery diarrhea, hypokalemia, achlorhydia]


... sunshinesweetheart made a comment on nbme24/block2/q#4 (A 57-year-old man has had hoarseness and difficulty...)
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submitted by sunshinesweetheart(4)

A = CN III

B = CN V

C = CN VI

D = CN VII

E = CN VIII

F = CN X


... sunshinesweetheart made a comment on nbme24/block4/q#36 (A 68-year-old woman comes to the emergency...)
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submitted by sunshinesweetheart(4)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - ADMEs = esophagitis, ONJ, atypical femoral stress fractures

  3. pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  4. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)

  5. denosumab (mab against RANKL i.e. mimics OPG)

  6. rarely calcitonin


... sunshinesweetheart made a comment on nbme24/block4/q#36 (A 68-year-old woman comes to the emergency...)
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submitted by sunshinesweetheart(4)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)
  4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin

... sunshinesweetheart made a comment on nbme24/block4/q#36 (A 68-year-old woman comes to the emergency...)
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submitted by sunshinesweetheart(4)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm 1. Ca2+/Vit D supplementation (prophylaxis) 2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) 3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) 4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin


... sunshinesweetheart made a comment on nbme24/block4/q#36 (A 68-year-old woman comes to the emergency...)
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submitted by sunshinesweetheart(4)

pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm - Ca2+/Vit D supplementation (prophylaxis) - bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) - SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) - denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin


... sunshinesweetheart made a comment on nbme24/block4/q#38 (A 33-year-old woman at 34 weeks' gestation has a...)
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submitted by sunshinesweetheart(4)

p 619 FA 2019 - physiologic changes in pregnancy

incr CO, anemia, hypercoagulability, hyperventilation, incr lipoylsis and fat utilization to preserve glucose and AAs for the baby


... sunshinesweetheart made a comment on nbme24/block4/q#46 (A 22-year-old woman comes to the physician because...)
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submitted by sunshinesweetheart(4)

some fun facts 4 u hoes to rule out the wrong answers:

Arcuate nucleus aka “infundibular nucleus” = hypothalamic nucleus. Projects dopaminergic neurons to anterior pituitary gland --> inhibits PRL. One of the 4 main dopamine pathways of the brain. Prolactin also gives feedback and inr dopamine secretion via this pathway [p 487 FA 2019]

Frontal cortex = oligodendrioma [p 514 FA 2019] rare, slow growing, fried egg appearance, may present with seizures

pituitary adenoma [p 514 FA 2019] - Bitemporal hemianopia - Most commonly a prolactinoma (hyperplasia of lactotrophs) - Male: decr libido, infertility - Female: galactorrhea, amenorrhea (PRL negative feedback on hypothalamic GnRH) - Can also see hyperplasia of somatotrophs (GH) --> acromegaly, gigantism or corticotrophs --> Cushing disease

PPRF = in charge of eye movements/conjugate gaze [p 503 FA 2019] - A stroke by the basilar artery of circular willis will lead to loss of horizontal, but not vertical eye movements


... niboonsh made a comment on nbme18/block1/q#23 (22 yo man, professional cyclist)
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submitted by niboonsh(76)

CONcentric - CONstricts ventricle

ECCentric - ECCpands ventricle (expands)


... macrohphage95 made a comment on nbme23/block1/q#48 (A 20-year-old man is brought to the emergency...)
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submitted by macrohphage95(0)

MDMA is the only hallucinogen that has sympathetic activity as it is derived from methamphethamines ( look at its name) ... that explains everything.


... divya made a comment on nbme21/block4/q#37 (A 66-year-old right-handed woman develops the acute...)
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submitted by divya(0)

simply internal capsule has corticospinal and corticobulbar tracts pass thru it, hence the c/l hemiparesis of body and face.

If at all they want to know what specifically passes thru ic (which is practically NEVER), then anterior limb - thalamocortical tracts, genu - corticobulbar, posterior limb - corticospinal, all sensory


... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
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submitted by amirmullick3(9)

This patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC.

CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction.

Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome

Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE.

Polycythemia vera has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive


... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
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submitted by amirmullick3(9)

his patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC.

CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction.

Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome

Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE.

Polycythemia vera has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive


... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
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submitted by amirmullick3(9)

This patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC. CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction. Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE. Polycythemia vera (pg 466) has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive


... macrohphage95 made a comment on nbme23/block3/q#3 (An 18-hour-old male newborn is 61 cm (24 in) long...)
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submitted by macrohphage95(0)

my understanding of the question is that he is asking about the cause of neonatal hypoglycemia.

as you know insulin will be high prenatally due to hyperglycemia and high levels will persists.

so if you think about hypoglycemia...the normal response for the glycogen concentration is to decrease (as well as glycogen synthase) and the gluconeogenesis to increase. so a person with impaired gluconeogenesis (which is abnormal) is more likely to develop hypoglycemia


... macrohphage95 made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
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submitted by macrohphage95(0)

Hypoglycemia is a frequently encountered complication in falciparum malaria that is usually ascribed to increased glucose use and impaired glucose production caused by the inhibition of gluconeogenesis.

from trends in parasitology: https://www.cell.com/trends/parasitology/pdf/S1471-4922(06)00175-9.pdf


... sunshinesweetheart made a comment on nbme24/block4/q#7 (A 3-year-old girl is brought to the physician for a...)
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submitted by sunshinesweetheart(4)

"purplish" is a frustrating word here but they key is CAVERNOUS VASCULAR CHANNELS. Port wine stain in sturge weber and salmon patch ("stork bite") are both flat lesions, not a hemangioma.


... divya made a comment on nbme21/block4/q#26 (The immunosuppressive agent cyclosporin A (CsA) is a...)
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submitted by divya(0)

Can anyone discuss what's responsible for inhibiting the processes given as other options?


... krisgsxr600 made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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submitted by krisgsxr600(0)

Was just going over Pathoma again and he explanes this concept really well in CH 1, "Free Radical Injury", Section II "Examples of Free Radical Injury"

ultimately cell swelling (the hallmark of acute/reversible injury) = ribosomes off RER = decreased protein synth = decreased Apolipoprotein synth = fat accumulation in cells


... usmleaspirant5 made a comment on nbme20/block1/q#27 (A 53-year-old woman comes to the physician because...)
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submitted by usmleaspirant5(0)

Schistosoma has spines whereas Giardia doesnt have a spine


... divya made a comment on nbme21/block4/q#12 (A 24-year-old man with a history of drug abuse has...)
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submitted by divya(0)

Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same?


... sunshinesweetheart made a comment on nbme24/block3/q#10 (Serum cholesterol concentrations are measured as...)
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submitted by sunshinesweetheart(4)

look at FA 2019 pg. 261

in a Gaussian, 66% are within 1 SD and 95% within 2 SD

this is high yield af


... sunshinesweetheart made a comment on nbme24/block3/q#3 (A 37-year-old woman with HIV infection is brought to...)
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submitted by sunshinesweetheart(4)

out of curiosity, why are AST and ALT high? is that saying the NRTI used was diadenosine which led to pancreatitis also?


... niboonsh made a comment on nbme23/block4/q#35 (A 17-year-old girl with type 1 diabetes mellitus...)
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submitted by niboonsh(76)

One of the questions in the uworld practice test 2 actually touched on this.

motivational interviewing: indication principles Technique (OARS)

... eli_medina9 made a comment on nbme24/block2/q#42 (A 3-week-old female newborn is brought to the...)
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submitted by eli_medina9(1)

ALLELIC HETEROGENEITY (FA page 57 2019)

Theres multiple allele variants for the CFTR gene in a single locus, so you could get cystic fibrosis from a mutation in any one of those allele variants(theres over 1500 different mutations described) the question stem mentioned they tested for the most common types, so we can assume they probably just missed testing for mutations in other alleles.


... paloma made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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submitted by paloma(0)

What about pulmonary vascular resistance? It follows the systemic vascular resistance?


... dubywow made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by dubywow(0)

Decompensated HF. Lack of blood flow due to failing heart -> lower BP -> increased ADH to increase blood pressure back to stable level. In DHF, ADH outpaces homeostasis of counteracting ANP & BNP. Thus, the term "decompensated". Associated with shortness of breath, edema (often of lungs).

This vicious cycle continues as body prioritizes adequate BP for survival, but it comes at the expense of overworked heart that must work harder and harder, ultimately exacerbating the heart failure condition.


... sanup400 made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
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submitted by sanup400(0)

This is how I interpreted it. The patient has diastolic hypertension. This leads to activation of RAAS System. Activation of RAAS will increase Aldosterone. Increase in Aldosterone result in increase in sodium reabsorption but the question is telling he is unlikely to get peripheral edema directing towards the " Aldosterone escape" mechanism. The mechanism is due to release of ANP/BNP.

ANP/BNP acts mainly by dilating the precapillary arterioles resulting in natriuresis and "Aldosterone escape" mechanism.


... criovoly made a comment on nbme23/block2/q#33 (A 68-year-old man who has been treated for the past...)
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submitted by criovoly(1)

The first drug given was an NSAID (prostaglandins inhibitor) this caused GERDS/ulcer because of decrease mucosal protection.

The second drug was misoprostol which gives mucosa protection and a common side effect is diarrhea.


... criovoly made a comment on nbme23/block3/q#18 (A patient with a 20-year history of type 1 diabetes...)
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submitted by criovoly(1)

Insulin decreases the level of blood glucose and Glucagon increases levels of blood glucose. They both counter block each other. If insulin is high glucagon will be inhibited, and when glucagon is high insulin will be inhibited. FA 2018 page 76.


... criovoly made a comment on nbme23/block3/q#6 (A 25-year-old man has an orchiectomy for a recently...)
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submitted by criovoly(1)

In the picture there is no fibrosis, leyding cells tumors have crystals, there is no muscle and Sertoli tumors are rare.. You have only Germ Cells answer.


... niboonsh made a comment on nbme23/block1/q#34 (A 64-year-old woman is found dead at the foot of her...)
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submitted by niboonsh(76)

https://webpath.med.utah.edu/LIVEHTML/LIVER059.html


... niboonsh made a comment on nbme23/block3/q#33 (A 78-year-old man has had progressive loss of...)
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submitted by niboonsh(76)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069039/


... criovoly made a comment on nbme23/block1/q#15 (A 26-year-old man who is a Peace Corps volunteer...)
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submitted by criovoly(1)

This patient is giving symptoms of hypovolemic shock, mainly due of dehydration. The HYPOTENSION is an example of severe dehydration and hypovolemic shock. You need to expand the vessels rehydrating the patient in order to avoid further shock and dehydration.


... criovoly made a comment on nbme23/block1/q#49 (Electrical stimulation of the stellate ganglion is...)
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submitted by criovoly(1)

the stellate ganglion is part of the sympathetic nervous system flight or fight. Increase heart rate is the most obvious.


... nutellamed made a comment on nbme20/block4/q#41 (A 56-year-old man with a 20-year history of chronic...)
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submitted by nutellamed(0)

Maybe the pt was under opiods tx before the surgery and with the administration of naloxone the grade of pain that was relief by opiod but not by the implant comes up. That worked for me


... nutellamed made a comment on nbme20/block4/q#42 (A 65-year-old woman dies 6 months after the onset of...)
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submitted by nutellamed(0)

" Meningiomas arise from arachnoidal cells ... are circumscribed; they may be attached to the dura, though they do not arise from the dura per se. Usually, they displace brain tissue without invading it." - from: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html


... bronchophony made a comment on nbme24/block3/q#50 (A group of physicians submits a report to a medical...)
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submitted by bronchophony(0)

Why not clinical trial? They could report a rare adverse effect in phase 4 clinical trial right?


... nutellamed made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
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submitted by nutellamed(0)

Maybe all symptoms are related to hypercalcemia ("stones, bones, abdominal groans, thrones and psychiatric overtones") via PTHrP

The Role of PTHrP in Regulating Mineral Metabolism During Pregnancy - https://link.springer.com/article/10.1007/s12018-014-9157-6


... niboonsh made a comment on nbme20/block4/q#13 (A 62-year-old woman comes to the physician because...)
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submitted by niboonsh(76)

found this online: https://academic.oup.com/rheumap/article/2/1/rky009/5040548

Hypertrophic pulmonary osteoarthropathy (HPOA) is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. Clubbing is characterized by bulbous enlargement of terminal segments of the fingers and toes due to proliferation of subungual connective tissue.

primary... is a rare hereditary condition.

A majority of cases (>90%) of secondary HPOA are associated with pulmonary malignancies [6] or chronic suppurative pulmonary diseases.

Pulmonary malignancies, including primary [7], metastatic lung cancer and intrathoracic lymphoma, account for 80% of cases of secondary HPOA. Adenocarcinoma of the lung is the most frequent and small cell carcinoma is the least frequent histopathologic type of lung cancer associated with HPOA [7].

other associated extrathoracic malignancies include nasopharyngeal carcinoma, renal cell carcinoma, oesophageal cancer, gastric tumour [8], pancreatic cancer, breast phyllodes tumour [9], melanoma, thyroid cancer, osteosarcoma and intestinal lymphoma.

Various rheumatologic conditions, including RA [10], AS [11], polyarteritis nodosa, SLE [12], Takayasu disease [13], sarcoidosis, APS and Mediterranean fever are known to be associated with this condition as well.

Pulmonary conditions such as cystic fibrosis, tuberculosis, idiopathic pulmonary fibrosis [14] and lung transplantation have also been associated with HPOA.


... divya made a comment on nbme21/block4/q#18 (A previously healthy 4-week-old male newborn is...)
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submitted by divya(0)

obvious answer choices between duodenal atresia and pyloric stenosis. duodenal atresia presents with bilious vomiting within 1st day of life. other features - double bubble on xray. whereas pt here has non bilious vomiting at 4th week of life.


... divya made a comment on nbme21/block4/q#41 (A 66-year-old man with stage IV colon cancer comes...)
 -1  upvote downvote
submitted by divya(0)

loperamide is basically diphenoxylate + atropine. atropine is added to reduce abuse potential by diphenoxylate.


... divya made a comment on nbme21/block4/q#33 (A female newborn delivered at 26 weeks' gestation is...)
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submitted by divya(0)

agree with burak. they're trying to say that primary goal of treatment with supplemental o2 is to make sure there is no retinal damage.


... vish7287 made a comment on nbme24/block2/q#11 (A public health consultant is contacted by a health...)
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submitted by vish7287(0)

Primary to Prevent - Vaccine, Exercise, Not eating sugar to prevent cavities Secondary to Screen - X-rays to check tooth decay


... champagnesupernova3 made a comment on nbme21/block2/q#35 (A 4-month-old female infant is brought to the...)
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submitted by champagnesupernova3(4)

Diarrhea causes loss of water, Na and Bicarb. Remember that diarrhea is a cause of non anion gap metabolic acidosis because the loss of bicarbonate is compensated by increasing Chloride reabsorption. So she can have hyperchloremia or hyponatremia due to intake of only free water for 24 hours. But she has SEIZURES so hyponatremia is most likely


... champagnesupernova3 made a comment on nbme21/block2/q#35 (A 4-month-old female infant is brought to the...)
 +1  upvote downvote
submitted by champagnesupernova3(4)

Diarrhea causes loss of water, Na and Bicarb. Remember that diarrhea is a cause of non anion gap metabolic acidosis because the loss of bicarbonate is compensated by increasing Chloride reabsorption. So she can have hyperchloremia or hyponatremia due to intake of only free water for 24 hours. But she has SEIZURES so hyponatremia is most likely


... vish7287 made a comment on nbme24/block2/q#27 (A 47-year-old man comes to the physician because of...)
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submitted by vish7287(0)

If Its Pseudogoat thn answer would be calcium pyrophosphate!!


... md_caffeiner made a comment on nbme20/block4/q#5 (Immediately after a cerebral infarction, a...)
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submitted by md_caffeiner(0)

https://imgur.com/a/lCFnj1e FA19 P489 Cerebral cortex regions


... md_caffeiner made a comment on nbme20/block4/q#12 (An investigator is conducting a randomized,...)
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submitted by md_caffeiner(0)

what to do with the NONADHERIANT BADDIES???

Intention to treat, "i had the intention to treat so i am gonna leave in this group no matter what"

as treated , "he is not treated as it is so im gonna change his group to control"

per protocol, "you are fired from all of it, protocols bitch"


... md_caffeiner made a comment on nbme20/block4/q#17 (A previously healthy 55-year-old man has recently...)
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submitted by md_caffeiner(0)

FA19 P592: Renovascular disease: Renal impairment due to ischemia from renal artery stenosis or microvascular disease.  renal perfusion (one or both kidneys) Ž INC renin Ž INC angiotensin Ž HTN. Main causes of renal artery stenosis: ƒ Atherosclerotic plaques—proximal 1/3rd of renal artery, usually in older males, smokers. ƒ Fibromuscular dysplasia—distal 2/3rd of renal artery or segmental branches, usually young or middle-aged females. Clinically, patients can have refractory HTN with negative family history of HTN, asymmetric renal size, epigastric/flank bruits. Most common cause of 2° HTN in adults. Other large vessels are often involved

FA19 P 596: Angiotensin- converting enzyme inhibitors Captopril, enalapril, lisinopril, ramipril. mEChANism Inhibit ACE Ž DECR AT II Ž DECR GFR by preventing constriction of efferent arterioles. INCR renin due to loss of negative feedback.


... step1soon made a comment on nbme22/block3/q#33 (A 22-year-old man comes to the physician because of...)
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submitted by step1soon(8)

Testicular biopsies of adult males with Klinefelter syndrome are characterized by extensive fibrosis and hyalinization of the seminiferous tubules and hyperplasia of the interstitium; however, the tubules may show residual foci of spermatogenesis. Histologic findings may include small, firm testes with seminiferous tubular hyalinization; sclerosis; and atrophy with focal hyperplasia of mostly degenerated Leydig cells

http://www.pathopedia-india.com/Klinefelter_Syndrome.htm


... paszw0red made a comment on nbme24/block2/q#26 (A 35-year-old man is brought to the emergency...)
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submitted by paszw0red(1)

Emedicine says: Delirium tremens (DTs) is the most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse.

Also ref. https://pubs.niaaa.nih.gov/publications/aa05.htm

I assume the patient has Delerium tremens, had a seizure, and now is hypertensive because of the "sypathetic overdrive", with excess secretion of catecholamines, thus the hypokalemia.


... paszw0red made a comment on nbme24/block3/q#44 (A 62-year-old man comes to the physician for a...)
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submitted by paszw0red(1)

The use of any agent that inhibits gastric secretion of acid (H2-receptor antagonists or PPIs) will result in a rise in serum gastrin as the feedback inhibition of gastrin release is diminished.

If you want to rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial measure of elevated Gastrin was not due to your drug rather than the patients disease.


... paszw0red made a comment on nbme24/block3/q#32 (A 15-year-old girl is brought to the physician...)
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submitted by paszw0red(1)

Lymphocytosis associated with infectious mononucleosis is caused by an increase in the number of circulating activated T and B lymphocytes.

The atypical lymphocytes are CD8+ T- cells that are activated to eliminate EBV infected B- lymphocytes.


... tamey made a comment on nbme21/block4/q#19 (A 45-year-old woman comes to the emergency...)
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submitted by tamey(2)

im a little confused isnt blocking ampulla of vater(hepatopancreatic ampula) would cause obstruction of both pancreatic duct and common bile duct and in this case the patient would have cholangits too, not only pancreatitis!!!


... charlie made a comment on nbme24/block4/q#47 (A 40-year-old man comes to the physician because of...)
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submitted by charlie(0)

I think there's a typo on that question. MSH2 gene mutation is the culprit for HNPCC. For MHS2 gene, according to what I just searched, causes Malignant Hyperthermia Susceptibility.


... champagnesupernova3 made a comment on nbme20/block4/q#3 (A 23-year-old woman comes to the physician for a...)
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submitted by champagnesupernova3(4)

This is a keloid. In normal wound healing type 3 collagen is first synthesized and then degraded by Matrix metalloproteinase (a collagenase which uses Zinc as a cofactor) and replaced by Type 1. In a Keloid an excessive amount of disorganized Type 3 collagen persists. Therefore the defect is in Collagen synthesis (Type 1 synthesis)


... gautham made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
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submitted by gautham(0)

if put diaphoresis because beta 2agonist increase insulin cause hypoglycemia then leading to diaphoresis ? could anybody explain


... poisonivy made a comment on nbme20/block3/q#15 (A 23-year-old woman, who was diagnosed with Sjögren...)
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submitted by poisonivy(0)

Per UWorld; capsaicin found in chili peppers causes excessive activation of TRPV1 (transmembrane channel), which increases intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). It also causes release and depletion of Substance P, causing at first burning and erythema but over time causes decreased pain sensation.


... poisonivy made a comment on nbme20/block3/q#15 (A 23-year-old woman, who was diagnosed with Sjögren...)
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submitted by poisonivy(0)

Per UWorld; capsaicin found in chili peppers causes excessive activation of TRPV1 (transmembrane channel), which increases intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). It also causes release and depletion of Substance P, causing at first burning and erythema but over time causes decreased pain sensation.


... houseppary made a comment on free120/block2/q#30 (An otherwise healthy 45-year-old man comes to the...)
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submitted by houseppary(0)

but what is wrong with "Spirochete invasion of gastric cells"? It seems like H pylori is sometimes described as curved and sometimes as a spirochete. And "gastric cells" is general enough that I don't see why it can be wrong. There is H pylori in the gastric cells.


... houseppary made a comment on free120/block2/q#28 (A 55-year-old man who is a business executive is...)
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submitted by houseppary(0)

I see how it's splitting, but I also think an argument could be made for reaction formation. He acts as though he hates the one child who didn't come with him to the hospital - maybe he feels hurt and wishes the child had come. Reaction formation would be showing resentment and negativity towards the child to compensate for the fact that he actually wishes the child was there.

Or maybe I just overthink psych questions.


... nukie404 made a comment on nbme23/block2/q#5 (A female newborn develops respiratory distress. Her...)
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submitted by nukie404(0)

At first I was thinking aha! Child abuse! But I guess wormian bones are more suggestive of OI, although the no family hx part was rather bleh.


... nukie404 made a comment on nbme23/block2/q#6 (A 6-month-old girl is brought to the office for a...)
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submitted by nukie404(0)

To sum it up, even if you didn't memorize the whole immunization table, it's easy to remember HBV immunization is done at birth, 1mo, 2mo and 6mo roughly. Also added that the baby is of East Asian decent, and the fact that other infections on the list aren't screened for in the first place in healthy-looking patients, I think it's safe to deduce HBV was the answer here.


... titanesxvi made a comment on nbme22/block2/q#4 (A previously healthy 60-year-old woman is admitted...)
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submitted by titanesxvi(0)

The other answers are wrong because: (if I am wrong please correct me)

A) This would be true in a patient with liver or nephrotic syndrome

C) This would be correct if the we increase capillary permeability (example sepsis)

D) This is left heart failure

E) This could be ARDS (not sure though)

F) Malignancy


... ye2019 made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
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submitted by ye2019(0)

Physical exams showed tenderness of costophrenic angles, which are the places where the diaphragm (-phrenic) meets the ribs (costo-). Not the Costovertebral angle tenderness that we think to hint renal disease.I got confused with this point.


... ibrahim made a comment on nbme24/block3/q#17 (HOX genes play a role in embryogenesis through which...)
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submitted by ibrahim(1)

Hox genes come from a family of homeobox genes that encode transcription factors. These transcription factors bind to the DNA and allow for activation or repression of specific genes. Hox genes are primarily responsible for patterning of the anterior-posterior axis of the vertebrate embryo and limb bud. A characteristic unique to Hox genes is that they are found in clusters, instead of scattered across the genome as most genes are. This clustering of the genes allows for the sequential expression during development to correctly form body parts. However, if there is a mutation in these genes it can cause syndactyly, polydactyly, an extra cervical rib, and an increased risk of cancer.

Vitamin A is a teratogen that can lead to spontaneous abortion if taken in excess. Its use has also been shown to lead to developmental defects of the central nervous system and can lead to the disruption of Hox genes. Vitamin A can be found in a variety of foods including yellow vegetables, dark leafy greens, liver, and eggs. RX Q BANQ


... potentialdoctor1 made a comment on nbme24/block3/q#14 (A cohort study is done to evaluate the association...)
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submitted by potentialdoctor1(5)

p-value refers to the probability of making a type I error (probability of having a false positive). When the 95% confidence interval does not include the null value (1 for ratio, 0 for difference), 0 < p < 0.05 (between 0% and 5% chance of having a false positive). However, when the 95% confidence interval includes the null value, 0.05 < p < 1.0 (between 5% and 100% chance of having a false positive).

Think of it as follows ---> If the 95% confidence interval includes the null value, then you have somewhere between 5% and 100% chance of being wrong if you conclude it is right. Conversely, if the 95% confidence interval does not include the null value, then you have between 0% and 5% chance of being wrong if you conclude that is is right


... staph_aureusxx made a comment on nbme18/block4/q#30 (5 yo girl, 1 day severe leg pain after falling off sled)
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submitted by staph_aureusxx(0)

So the vitamin deficiency the girl is having is vitamin D. why? because of her diet how? bone fractures + demographics result? diet --> gut fiercely affects intestinal calcium absorption in the gut.

the distractor was the bone fractures and poor wound healing which wanted you to pick collagen synthesis.. which I did twice -_-.. but I think in this case of a question; when it seems too simple; explain to yourself why the other answers don't make sense.

I think I keep choosing A not realizing that vitamin C deficiency would present with lot more signs and symptoms like easy bruising and bleeding gums.


... osgoodschlatter10 made a comment on nbme23/block1/q#1 (An asymptomatic 30-year-old woman comes to the...)
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submitted by osgoodschlatter10(0)

The most common cyst in a young female is Follicular cyst; this is a cystic dilatation of an unruptured Graffian follicle.

Failure of Graffian follicle to rupture --> Anovulation

Ref FA2019 Pg 631-632


... staph_aureusxx made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
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submitted by staph_aureusxx(0)

precapillary resistance = describing the arterioles. he's got minimal protein in the urine; and no albumin. the key was paying attention to the blood pressure. Pressure is regulated by the resistance vessels as boards calls it which is the arterioles aka precapillary resistance.


... sway made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
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submitted by sway(0)

so what if this was inversed where the drug in question was a base and that urine was acidified.i know the pKa would need to be >7 but what about the pH


... md_caffeiner made a comment on nbme20/block1/q#3 (A 48-year-old man comes to the physician for a...)
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submitted by md_caffeiner(0)

this question is gramatically wrong, just move on. i did not and wasted maybe 5 minutes. just know that when you decrease chol. , there is no chol. left, so LDL regulating people open more receptors to balance the chol. back to its normal.


... md_caffeiner made a comment on nbme20/block1/q#33 (A 17-year-old girl comes to the emergency department...)
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submitted by md_caffeiner(0)

Easy AF explanation for doing mitoch. q's: Mothers have diseased children; Fathers don't

Dont forget this trick.


... humble_station made a comment on nbme23/block3/q#37 (A 48-year-old man is referred for evaluation of...)
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submitted by humble_station(6)

So a simpler way than all the math being done is understanding what CI means.

CI - range of values w/in which the true mean of the population is expected fall

So a CI of 95% will be more precise and have a narrow range compared to a CI of 99% will be less precise because its including more values in and result in a wider range.

So if CI of 95% is 110 to 116 then a CI of 99% has to be a range that is wider... 108 to 118


... humble_station made a comment on nbme23/block3/q#44 (A 23-year-old woman comes to the physician for...)
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submitted by humble_station(6)

Irradiation of food products is one way to limit the risk of germ contamination and food poisoning. In the United States, some foods, such as spices, are routinely irradiated. Irradiated meats and other foods are also widely available. Because radiation is known to cause cancer, there has been concern that food irradiation may present a cancer risk. However, radiation does not remain in foods that have been irradiated

According to American Cancer Society... Learned something new


... amphotericin made a comment on nbme21/block2/q#6 (A 38-year-old woman comes to the physician because...)
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submitted by amphotericin(0)

Why would you not check cortisol, if you're worried for MEN1? I assumed high calcium was implied based on the renal stones


... step1soon made a comment on nbme21/block3/q#7 (A 65-year-old man comes to the physician because of...)
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submitted by step1soon(8)

Orchiectomy: One or both testicles is removed through a small cut in your scrotum. tissue removal from body → no nutrients → cell death


... step1soon made a comment on nbme21/block3/q#35 (A 63-year-old woman comes to the physician because...)
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submitted by step1soon(8)

Heart failure: This is the most serious complication of large arteriovenous fistulas. Since your blood flows more quickly through an arteriovenous fistula than it would if your blood flowed through a normal course of arteries, capillaries and veins, your heart pumps harder to compensate for the drop in blood pressure (called high-output heart failure). Over time, the increased intensity of your heart's pumping can weaken your heart muscle, leading to heart failure.


... chagas14 made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
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submitted by chagas14(0)

Maybe the question is dealing with the concept of myogenic arteriolar vasoconstriction which is a another anti-edema mechanism. The pre capillary sphincter contract in response to a raise in BP. I got the Q wrong because I picked lymphatic flow. They love to go for the "what else" element of any topic. I cannot find any reason why the lymphatic option could be wrong :/

https://www.ncbi.nlm.nih.gov/books/NBK53445/?report=classic Check the figure 4.1 The Margin of Safety Against Edema Formation – Edema Safety Factors


... feliperamirez made a comment on nbme18/block2/q#30 (35 yo man, 4 weeks of severe midline back pain)
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submitted by feliperamirez(1)

Even though TSH producing adenomas mat also produce compression fractures they are far less common than ACTH producing tumors


... feliperamirez made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
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submitted by feliperamirez(1)

According to the AHA every patient with TG above 500 should receive fibrates, even though statins can decrease TG levels.


... feliperamirez made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
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submitted by feliperamirez(1)

This varies among states but in most of the states a 1-2 year free seizure period is required for epileptic patients to get their license


... bullshitusmle made a comment on nbme24/block2/q#15 (An investigator is studying a new drug for the...)
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submitted by bullshitusmle(1)

therapeutic ionizing radiation(gamma rays,x-rays); -DNA double-strand breakage -Free radical formation


... jorgejeje made a comment on nbme18/block4/q#45 (35 yo man, prolonged QT interval)
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submitted by jorgejeje(0)

Is a case of congenital long QT, there are two principal causes; Romano-Ward (dominant) and Jervell and Lange-Nielsen syndrome, the second one related to deafness (recessive). It's important to remember the relationship of the EKG and the cycle of action potential of the cardiac muscle cell because the QT is correlated with the repolarization (FASE III), similar with the antiarrhythmics, the ones that affect potassium channels (FASE III) are more related with alterations in QT and ventricular arrhythmias.


... fallot4logy made a comment on nbme24/block2/q#26 (A 35-year-old man is brought to the emergency...)
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submitted by fallot4logy(4)

in the other hand , urine potassium is high enough , so if seizures =>rhabdomyolysis => myoglobinuria => ATN => high potassium excretion , why not?


... humble_station made a comment on nbme22/block1/q#16 (An Rh-negative woman, gravida 3, para 2, has had an...)
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submitted by humble_station(6)

The mother is Rh - & fetus is Rh +

pg 397 FA 2019 Administration of anti-D IgG to Rh - pregnant mother during 3rd trimester & early postpartum period (if fetus Rh+)

Prevents maternal anti-D IgG production

anti-D IgG = O, Rh -