and we’re back! with BRAND SPANKIN' NEW tangents!
welcome redditors!to snoo-finity ... and beyond!

Some recent contributions

... angelaq11 made a comment on nbme22/block3/q#11 (A 38-year-old man with Down syndrome is brought to...)
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submitted by angelaq11(0)

I hate Qs like this. They make me feel all kinds of sadness.


... consuela_salon made a comment on nbme20/block1/q#12 (72 yo woman with dysphagia)
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submitted by consuela_salon(0)

This was the picture that I liked the most for this question. If you imagine that the injury is at the level of the left subclavian vein (LSV) and thoracic duct (TD) crossing each other, maybe it will help you realize that the left breast & left upper extremity bypass the injury. The right lung is drained by the right lymphatic duct, not the TD (see one of the links bellow). And the heart is where eventually all the drainage is going to end up to be pumped again (TD -> LSV -> SVC -> heart).


... angelaq11 made a comment on nbme22/block2/q#1 (A 29-year-old woman is brought to the emergency...)
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submitted by angelaq11(0)

I think besides knowing basic anatomy (I suck BIG time on anatomy), we could more or less easily rule out most of the options. She is in pain, but she is awake and with stable vital signs (even after 6 hours) so I think arterial damage would definitely lead to a more rapid deterioration. That leaves us with the portal vein and the hepatic veins. The portal vein (if knowing zero anatomy) brings much more blood to the liver than the hepatic artery (if I'm not mistaken), and so that leaves you with only the hepatic veins.


... yex made a comment on nbme24/block4/q#34 (A 55-year-old woman comes to the physician for a...)
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submitted by yex(4)

I think they are referring to Kulchitsky cells = pulmonary neuroendocrine cells (PNEC). According to Wikipedia: Specialized airway epithelial cells that occur as solitary cells or as clusters called neuroepithelial bodies (NEB) in the lung. They are located in the nasal respiratory epithelium, laryngeal mucosa and throughout the entire respiratory tract from the trachea to the terminal airways. They can be the source of several types of lung cancer- most notably, small cell carcinoma of the lung, and bronchial carcinoid tumor.


... jfny21 made a comment on nbme22/block2/q#13 (A 5-year-old boy who lives on a farm has had...)
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submitted by jfny21(0)

Here's a way for me to remember: Y. enteroCOLDitica. Hope it helps.


... fleurmuxlin made a comment on nbme22/block1/q#2 (A 28-year-old man has recurrent pancreatitis...)
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submitted by fleurmuxlin(0)

First Aid Page 94

Type 4 -hypertriglyceridemia is caused by Hepatic overproduction of VLDL. If we just consider the primary issue, then it is easy to see why decreasing VLDL would be the answer.

(full disclosures, I also was think about the types of medication that should be used)


... kimcharito made a comment on nbme23/block3/q#22 (A 54-year-old woman with rheumatic heart disease is...)
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submitted by kimcharito(3)

it is normal irradiation to the RIGHT neck? what does it mean?


... link981 made a comment on nbme20/block2/q#2 (Following a wedding reception that was attended by...)
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submitted by link981(24)

Norovirus is the most common cause of viral gastroenteritis in the USA due to vaccination. + Rotavirus is the most common cause of viral gastroenteritis in the rest of the world. In this question you had to know the most common cause


... soph made a comment on nbme21/block3/q#25 (A 32-year-old woman comes to the physician because...)
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submitted by soph(9)

ok but why is blue nevi wrong? i thought q asks lession in both exposed and unexposed areas.


... soph made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
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submitted by soph(9)

all the other options pt would have uterus, ovaries. turners they wouldnt look normal and they would have atrophic ovaries.


... yex made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
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submitted by yex(4)

This was on a previous NBME. How I got it? Intercostal (posterior) is how you get to the vertebral bodies; the other vessels are anterior.


... eacv made a comment on nbme21/block4/q#39 (A 46-year-old man comes to the physician because of...)
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submitted by eacv(2)

If u are not goot in math like me xD. I did it this way: They gave me p^2=1/900 so p=1/30.

Now I need to find P, so use p+q=1. p= 1-(1/30)= 1-0.03= 0.97

So, 2pq= 2(0.97)(0.03)= 0.064 = (1/15) :D I got it right, this is my way to do it cause im not good at fractions.


... medulla made a comment on nbme22/block3/q#29 (A 45-year-old man with end-stage renal failure is...)
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submitted by medulla(1)

Renal Failure: MAD HUNGER Met Acidosis Dyslipidemia Hyperkalemia Uremia (inc BUN etc) Na/water retention (HF, pulmonary edema, HTN) Growth retardation and developmental delay Erythropoietin failure (anemia) Renal osteodystrophy


... maxillarythirdmolar made a comment on nbme16/block4/q#11 (78 yo man, 1 month fever, chills, fatigue, 5.4 kg weight loss)
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submitted by maxillarythirdmolar(0)

You should be thinking of something like Enterococcus. They had a GU procedure and subsequent cardiac issues.

When I hear soft S1, i think that the patient must have had a issue with the closing of either the mitral or tricuspid valves. Playing odds, this should be the mitral valve. You also here an early diastolic murmur, so you might be thinking volume overload (S3).


... ap88 made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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submitted by ap88(0)

Why can this not be papillary necrosis? Given the gross Hematuria and proteinuria with a history of analgesic use... I thought that was what this was getting at?


... minhphuongpnt07 made a comment on nbme20/block3/q#32 (A 54-year-old woman with terminal metastatic...)
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submitted by minhphuongpnt07(0)

super vague question ! Dr denies assisting suicide=> nonmaleficience do everything he can to manage her pain => beneficience


... drdoom made a comment on nbme23/block3/q#35 (A 31-year-old woman comes to the emergency...)
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submitted by drdoom(166)

The prevailing rule of American medicine (and law) is individual autonomy, otherwise known as liberty. In American law, no other person, professional or otherwise, is granted “default access” or privilege to another person’s body—that includes the physician! (It even includes spouses! That’s why, in American law, you can be married to someone and still be charged with sexual assault/rape; marriage ≠ your spouse surrendering “bodily rights”.) The physician must receive consent from “a (conscious) person” before they become “a (conscious) patient”. In the same way, the person (now, patient) must give consent before anyone else is permitted to be involved in his or her care—spouses included!


... tinydoc made a comment on nbme23/block1/q#22 (An investigator is studying the adverse effects of a...)
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submitted by tinydoc(39)

https://youtu.be/HIRz5hJf3mU

MOA of proteosome inhibitors for MM. TLDR: is that they basically block the proteosome from functioning so that myeloma cells can't recycle protiens (they make a ton of them) and when they can't be recycled they build up and thats toxic to the cell and it dies.

beyond that the question is basically asking if the inhibition of proteosomes isnt specific to the Myeloma cells and it inhibited other cells' proteosomes what would be effected?

MHC class I is present on all nucleated cells (all cells in the body except RBC) and function to present endogenous antigens to CD8+ t cells to be destroyed (for example Viral DNA in an infected cell). The way they do this is by taking the protien it needs to present and breaking it down into much smaller peptide chains (so it can fit on the MHCI. If this step was inhibited in other cells then the the Presentation of MHC I wouldnt be able to present their antigens to CD8+ T cells and Natural killer cells. as the question implies.

The question was super tricky because if you don't know how proteosome inhibitors work then you start looking for an answer that would explain how they would kill tumor cells as well. I got it wrong too. It required knowledge of the way MHC I presents peptides.


... minhphuongpnt07 made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
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submitted by minhphuongpnt07(0)

Thiazide=> hypercalcemia=> Oxytoxin (Gq coupled protein-> incr Ca2+)=> nipple discharge


... maxillarythirdmolar made a comment on nbme23/block4/q#33 (A 16-year-old girl with bulimia nervosa is brought...)
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submitted by maxillarythirdmolar(0)

Best comment i read was to treat this like it's a VIPoma. You would get all three electrolyte/metabolic disturbances.

https://www.ncbi.nlm.nih.gov/books/NBK507698/


... t0pcheese made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
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submitted by t0pcheese(0)

why is the Na normal in this patient? Everything else made sense, the high K and 17 hydroxyprogesterone.


... medulla made a comment on nbme20/block3/q#21 (A newborn is born with a lethal chromosome defect....)
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submitted by medulla(1)

lethal chromosomal defect - > he is going to die -> maintain comfort


... usmle11a made a comment on nbme23/block3/q#35 (A 31-year-old woman comes to the emergency...)
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submitted by usmle11a(2)

ok the way i looked at this was:

youre not 100% sure she was attacked nor do you want to be the person telling the husband hes an attacker so you remove: B C

allowing him in with the patient, god knows what that guy has hidden with him also you will make a huge scene : A

the only thing to do is be diplomatic as people know they arent allowed in the treatment area and by that you assure her saftey.


... usmle11a 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 usmle11a(2)

the child is asymptomatic because hepatitis B is mostly silent in infants due to poor lymphocyte system. other diseases would probably show more symptoms


... maxillarythirdmolar made a comment on nbme23/block2/q#36 (A newborn has external genitalia that appear to be...)
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submitted by maxillarythirdmolar(0)

Likely an inhibition of 21-hydroxylase. This is the most common of the congenital adrenal hyperplasias. Presents in infancy or childhood.

Another symptom they may have that I've seen around is vomiting!! Took me a while to find it, but they are salt wasting by having no aldosterone, so the loss of electrolytes is causing increased ICP.


... maxillarythirdmolar made a comment on nbme23/block3/q#42 (A 48-year-old woman has severe gastroesophageal...)
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submitted by maxillarythirdmolar(0)

The question says they don't responds to antacids THEN asks which you to identify which drug is the most effective at suppressing acid production, NOT what the most effective antacid is. The answer is PPI's.

I will say, however, I was looking for something like octeotride.


... maxillarythirdmolar made a comment on nbme23/block3/q#12 (A 39-year-old man comes to the physician for a...)
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submitted by maxillarythirdmolar(0)

FA 19, pg. 305 - May see Mitral regurgitation due to impaired mitral valve closure.

I always find it important to remember that once you get pathology somewhere in the heart, you can expect pathology everywhere behind it, over time.

So in this case you start with HCM -> Mitral regurg -> LA dilation -> A.fib -> LA/LV failure -> Pulm edema -> RHF -> etc.

It's always a matter of time.


... eacv made a comment on nbme21/block2/q#50 (A 65-year-old woman comes to the emergency...)
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submitted by eacv(2)

here is also a picture about the veins and proximity to the lungs

https://ars.els-cdn.com/content/image/1-s2.0-S0007091217327587-gr1.jpg


... dentist made a comment on nbme23/block1/q#32 (Which of the following sets of serum findings is...)
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submitted by dentist(1)

I took the simplistic approach: I chose the opposite of whatever the kidney usually does and then lack of neg PTH feedback


... hyperfukus made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
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submitted by hyperfukus(5)

so should we just skip these? cuz there's prob 10 more i couldve gotten write wasting my life on this one


... dentist made a comment on nbme23/block3/q#22 (A 54-year-old woman with rheumatic heart disease is...)
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submitted by dentist(1)

rheumatic hrt dz = mitral stenosis = pulmonary edema (bilateral crackles) = dyspnea


... dentist made a comment on nbme23/block1/q#47 (A 61-year-old man comes to the emergency department...)
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submitted by dentist(1)

found this super useful book on amazon about Budd-Chiari (check out the sick cover)


... goodkarmaonly made a comment on nbme23/block4/q#41 (Electrophysiology of the heart is studied in an...)
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submitted by goodkarmaonly(0)

The ECG shows a Mobitz Type 1 block (prolonging PR followed by a dropped wave. These blocks usually arise as a byproduct of a dysfunctional AV node, so ablation at the AV node is the most appropriate answer in this case


... link981 made a comment on nbme24/block1/q#31 (An experimental study is conducted to examine the...)
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submitted by link981(24)

Keywords from Dr. Turco from Kaplan:


... hello made a comment on nbme22/block1/q#29 (A 28-year-old man comes to the emergency department...)
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submitted by hello(51)

Please help - how are you able to tell that the CT image is not at the level of duodenum?

I don't know what I'm looking for to compare and contrast a CT at the level of the duodenum vs the CT given in this Q.


... hello made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by hello(51)

There has to be a better explanation for why ANP is wrong?


... hello made a comment on nbme22/block1/q#4 (A 48-year-old man begins furosemide therapy for...)
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submitted by hello(51)

Spironolactone and eplerenone are potassium-sparing diurectics that inhibit the Na/K ATPase. Na/K ATPase is on the basolateral membrane. None of the answer choices fit with this.

Amiloride and triamterene are also potassium-sparing diuretics. The mechanism is to block ENaC channels on the luminal membrane, this is choice "B."


... link981 made a comment on nbme24/block1/q#35 (A 1616-g (3-lb 9-oz) male newborn is delivered to a...)
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submitted by link981(24)

Per American Lung Association: Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. It results from damage to the lungs caused by mechanical ventilation (respirator) and long-term use of oxygen. Most infants recover from BPD, but some may have long-term breathing difficulty. + Prematurely born infants have very few tiny air sacs (alveoli) at birth. The alveoli that are present tend to not be mature enough to function normal, and the infant requires respiratory support to breathe. Although life-saving, these treatments can also cause lung damage


... goodkarmaonly 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 goodkarmaonly(0)

Disorders common in east Asia according to Goljan: Hepatitis B EBV infection - mostly leading to nasopharyngeal CA Alpha Thalassemia Nitrosamine linked Intestinal type gastric CA

In this question, since the patient is asymptomatic and EBV isnt exactly "screened for", went with HepB as the answer


... nbmeans made a comment on nbme21/block2/q#45 (A 3-year-old boy is brought to the emergency...)
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submitted by nbmeans(0)

I wasnt sure of this one, it said thrombin time was normal


... maxillarythirdmolar made a comment on nbme21/block4/q#50 (A 19-year-old woman is brought to the emergency...)
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submitted by maxillarythirdmolar(0)

Lol uhhh also the scaphoid is literally fractured in the X-ray


... hello made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
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submitted by hello(51)

If you need a different orientation for a diagram of the pathways:

https://media.springernature.com/full/springer-static/image/art%3A10.1038%2Fs41433-018-0216-y/MediaObjects/41433_2018_216_Fig1_HTML.png?as=webp


... usmle11a made a comment on nbme23/block4/q#12 (Investigators conduct a prospective, community-based...)
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submitted by usmle11a(2)

guys watch this : https://www.youtube.com/watch?v=TnuosYuKGos

anyway (p.s i got it wrong)

A) dose-response = biological plausibility. p.s somehow equal. B) C) E) sensitivity; wrong D) my answer; consistency of other studies ( it wasnt applied to other communities)


... hello made a comment on nbme22/block1/q#41 (A 21-year-old man is brought to the emergency...)
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submitted by hello(51)

Patient has a hemithorax + CXR shows trachea deviates towards the hemithorax --> most likely diagnosis is spontaneous pneumothorax.

Epidemiologically, spontaneous pneumothorax is most associated with thin males


... cr made a comment on nbme24/block3/q#37 (A man accidentally touches the surface of a hot...)
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submitted by cr(1)

Which type of cell we r going to find in blisters?, neutrophils?


... hello made a comment on nbme22/block1/q#48 (A 1-year-old boy is found to have an impairment of...)
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submitted by hello(51)

please help -- If catalase-positive bacteria neutralize their own superoxide, why isn't it the case for catalase-positive bacteria to infections in everyone?

I'm not understanding the connection to NADPH oxidase deficiency.


... maxillarythirdmolar made a comment on nbme21/block2/q#39 (A 64-year-old man with bronchospastic pulmonary...)
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submitted by maxillarythirdmolar(0)

I'm sure it's related to the activating effect of Cortisol on phenylethanolamine-N-methyltransferase, converting NE to Epi. Sounds like a synergistic thing to me. (FA.83)


... hello made a comment on nbme22/block4/q#20 (During a study of symptomatic proximal deep venous...)
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submitted by hello(51)

Why isn't this a cohort study?


... hello made a comment on nbme22/block4/q#32 (A case-control study is conducted to assess the...)
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submitted by hello(51)

For people asking why the data table was even included if it was not needed to answer this Q, here is a useful explanation:

The table was given because a 2x2 table is typically what you do see regarding data for case-control studies.

If the 2x2 table wasn't included, then literally everytone would pick Choice "E" as the correct answer b/c you can't calculate something without being provided numbers.

The difference in including the data-table is that:

  1. Again, you need to report a 2x2 table because that is typically what you will see regarding data for a case-control study

and

  1. by including the 2x2 table, it actually tests if the test-taker realized that the data in the 2x2 table does not help at all with calculating prevalence-- because case-control studies NEVER report on prevalence.

... doctorevil made a comment on nbme21/block3/q#19 (A 25-year-old woman develops increasing shortness of...)
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submitted by doctorevil(0)

I thought of it as pregnancy being a volume overload state, which causes dilated cardiomyopathy.

Not sure if this was the correct reasoning, but other comments seem very detailed.


... usmle11a made a comment on nbme23/block3/q#13 (A 65-year-old man with a history of gout comes to...)
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submitted by usmle11a(2)

The medical requirements to obtain a permit vary by state, but are usually confined to specific types of disabilities or conditions. These as a general rule include the use of any assistive device such as a wheelchair, crutches, or cane, as well as a missing leg or foot. Some states also include certain cardiovascular, pain, or respiratory conditions. About half of US states (26) include blindness as a qualifying disability enabling the person to obtain a disability parking permit for use as a passenger, and 14 states include a disabled hand as a qualifying disability. Four states include deafness, and two states (Virginia and New York) include mental illness or developmental disabilities as qualifying disabilities

our guy uses a cane so...

btw i got it wrong :) cause i thought it is up to the DMV


... charcot_bouchard made a comment on nbme23/block3/q#22 (A 54-year-old woman with rheumatic heart disease is...)
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submitted by charcot_bouchard(42)

Old dudette have Aortic stenosis. Atrial contraction become essential for this patient. so AS + AFIb is dangerous because this reduces the LV preload significantly and this patient develops HF. So AFib in AS patient need to correct immediately


... ergogenic22 made a comment on nbme15/block3/q#6 (50 yo man, routine health maintenance examination)
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submitted by ergogenic22(28)

Medullary thyroid carcinoma is defined as:

a malignant proliferation of parafollicular "C" cells that secrete calcitonin

histology shows malignant tumor cells within pink (hyalin), amyloid stroma


... ergogenic22 made a comment on nbme15/block3/q#15 (65 yo man, hypertension, participates in clinical trial of loop diuretic)
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submitted by ergogenic22(28)

Due to "contraction alkalosis" loop diuretics cause volume contraction, thats why you give them.

As a result, there is increase angiotensin II release, increase in Na+/H+ exchange in the PCT (a function of increase angiotensin II), and then increased HCO3- reabsorption, leading to alkalosis


... angelaq11 made a comment on nbme21/block2/q#12 (A 66-year-old woman comes to the physician because...)
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submitted by angelaq11(0)

I first chose diverticulitis because of the history, but then I saw the picture, and honestly I wish I hadn't. I didn't see ANY diverticulum, so I thought...hmmm, they're want to "trick" me into choosing diverticulitis, but it's actually "something else"... :'( :'(


... ergogenic22 made a comment on nbme15/block2/q#36 (72 yo woman, admitted to hospital for acute myocardial infarction)
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submitted by ergogenic22(28)

This question is asking what left dominant circulation means. I suppose it wants us to infer that the PDA is supplying the diaphragm surface and AV node.

It is confusing to me because normally the Right marginal artery supplies the diaphragmatic border (acute margin) of the heart. I'm not sure that it changes in left dominant circulation. Furthermore it would not branch off the PDA, although maybe parts of it are supplied by the PDA

Also the AV node is supplied by the Atrioventricular nodal artery, which can be a branch off of the LCA or the LCX but not really the PDA

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537199/

so confusing question for me but the point is to know the course of left dominant circulation to the PDA


... ergogenic22 made a comment on nbme15/block2/q#26 (47 yo man, admitted to hospital for myocardial infarction)
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submitted by ergogenic22(28)

Acute MI and mitral regurg (from the murmur) leads to LV failure and backflow of blood into the lungs.

This leads to increased pulmonary hydrostatic capillary pressure. This will lead to excess volume leaking from the pulmonary capillaries into the interstitial and this will manifest as pulmonary edema (crackles).

Pulmonary edema will interfere with gas exchange leading to hypoxemia.


... ergogenic22 made a comment on nbme15/block2/q#40 (4 yo boy, 2 months progressive weakness, loss of muscle function)
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submitted by ergogenic22(28)

Classic picture for Duchenne muscular dystrophy. which is due to deleted dystrophin protein.

From FA: "Dystrophin helps anchor muscle fibers, primarily in skeletal and cardiac muscle. It connects the intracellular cytoskeleton (actin) to the transmembrane proteins α- and β-dystroglycan, which are connected to the extracellular matrix (ECM)"


... ergogenic22 made a comment on nbme15/block2/q#43 (37 yo woman, brought to ER by husband after being found unconscious)
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submitted by ergogenic22(28)

Cool and pale extremities rules out distributive causes (neurogenic, anaphylaxis, septic).

Hypovolemic would describe a process of volume loss (bleeding or dehydration) and would not explain the crackles or jugular vein distension.

don't be thrown off by the normal heart sounds.


... ergogenic22 made a comment on nbme15/block2/q#45 (3 yo girl, 1 year of short stature)
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submitted by ergogenic22(28)

This question describes I-cell disease (inclusion cell disease/mucolipidosis type II). You can tell because there is mixed accumulation of junk forming the inclusion bodies. Other lysosomal storage diseases have accumulation of one type of substance.

Essentially, there is a defect in defect in the enzyme N-acetylglucosaminyl-1-phosphotransferase.

This means the mannose-6-phosphate tag cannot be added to proteins. Without this tag, proteins are incorrectly sent to the extracellular space rather than delivered to lysosomes.


... ergogenic22 made a comment on nbme15/block2/q#49 (1950s study to determine the causes of lung cancer)
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submitted by ergogenic22(28)

A cohort study compares a group with a given exposure (cigarette smoking) to a group without such exposure. It then looks to see if exposure or risk factor is associated with later development of disease. "does smoking lead to COPD"

on the other hand, a case-control study looks at those with the disease vs without to see if there is a difference between prior exposure or risk factor "Did people with COPD smoke"


... ergogenic22 made a comment on nbme15/block2/q#15 (64 yo man, 2 months progressive shortness of breath)
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submitted by ergogenic22(28)

TLC decreased suggests restrictive disease. Reticular pattern suggests pulmonary fibrosis


... ergogenic22 made a comment on nbme15/block2/q#21 (43 yo woman, 6 months altered consciousness)
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submitted by ergogenic22(28)

She has motor and sensory symptoms. This r/o both kinds of simple. Her seizures are not described as tonic/clonic movements, and include periods of impaired consciousness. This rules out generalized tonic/clonic. There is a post-ictal state, that rules out absence.

Also the lip smacking is characteristic of automatism, which is found in complex partial seiuzres


... ergogenic22 made a comment on nbme15/block2/q#28 (35 yo woman, gravida 1, para 1, 2 months generalized weakness and fatigability)
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submitted by ergogenic22(28)

classic myasthenia gravis picture. Worsens with use. Sx include diplopia. Improvement with AChE.

Also side note, don't focus on the pregnancy status, but women who are in the postpartum eriod are at particularly high risk of developing myasthenia gravis


... ergogenic22 made a comment on nbme15/block2/q#47 (75 yo man, chronic obstructive pulmonary disease, admitted to hospital 6 hours after acute exacerbation)
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submitted by ergogenic22(28)

blood count shows elevated neutrophils, Neutrophil chemotactants include bacterial products, IL-8, C5a, kallikreinm platelet-activating factor and LTB4


... ergogenic22 made a comment on nbme15/block2/q#14 (25 yo woman, rheumatic fever and mitral valve prolapse, 2 weeks of fever, fatigue)
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submitted by ergogenic22(28)

Strep Viridans is oral flora, causes subacute endocarditis affecting previously damaged valves, and is often associated with sequelae of dental procedure.

A) enterococci can also cause subacute endocarditis but they are gamma hemolysis and follow GI/GU procedure B) beta hemolysis and causes acute c) beta hemolysis and causes acute e) alpha hemolysis but unlikely to cause endocarditis, causes meningitis, otitis, pneumonia, sinusitis - (MOPS)


... ergogenic22 made a comment on nbme15/block2/q#3 (2 yo girl, brought to ER, 20 minutes after ingesting insecticide)
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submitted by ergogenic22(28)

vitals and need to be treated first, so atropine and then pralidoxime.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493390/

important to note that organophosphates become irreversible at a certain point so pralidoxime does still need to be given early


... ergogenic22 made a comment on nbme15/block2/q#39 (43 yo man, 10 years alcoholism, change in skin color)
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submitted by ergogenic22(28)

NAPQI is a toxic intermediate is formed by in small amounts by metabolism of acetaminophen. Depletion of hepatic glutathione stores by NAPQI leads to acute APAP toxicity and acute liver injury.


... ergogenic22 made a comment on nbme15/block2/q#6 (56 yo woman, 3 weeks progressive difficulty swallowing)
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submitted by ergogenic22(28)

mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver


... ergogenic22 made a comment on nbme15/block2/q#6 (56 yo woman, 3 weeks progressive difficulty swallowing)
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submitted by ergogenic22(28)

mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver


... ergogenic22 made a comment on nbme15/block2/q#9 (67 yo man, 2 days double vision and drooping left eyelid)
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submitted by ergogenic22(28)

He has a down and out pupil, caused by CN III palsy. His gaze is due to unopposed action of the lateral rectus and superior oblique; ptosis due to denervation of levator palpebrae superiosis.

The only injury listed that could cause a CN III palsy is aneurysm of the PCA compressing the ocularmotor nucleus.


... masonkingcobra made a comment on familymed1/block0/q#33 (A 37-year-old man comes to the physician because of...)
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submitted by masonkingcobra(56)

No one ever does this assay it seems:

UpToDate: However, serologic tests require validation at the local level, which is impractical in routine practice. In addition, concerns over its accuracy have limited its use.

The urea breath test is first line


... masonkingcobra made a comment on familymed1/block0/q#32 (An 82-year-old woman with dementia, Alzheimer type,...)
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submitted by masonkingcobra(56)

https://caregiver.com/articles/driving-dilemmas-risk-vs-independence/


... hyperfukus made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
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submitted by hyperfukus(5)

I think that since they're asking for an explanation of the patient's current SSx which shows that she's in the state of Transient Hyperthyroidism: which is due to C: Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytes


... hyperfukus made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
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submitted by hyperfukus(5)

so the lesion is in the Right MLF right? If so I'm just about to memorize the eye see SAME MiLF lol its the MLF on the same side of the eye keep it simple i hope that's what yall are saying lol


... wolvarien made a comment on free120/block3/q#20 (A 35-year-old woman comes to the office because of a...)
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submitted by wolvarien(0)

Never tell any patient to pay money or to do anything to so that the hospital or the doctor get paid. That strikes out choices A & E,

Never try to scam the insurance with false findings because you will face legal percussions. That strikes out choice D.

Informing the insurance company about the patient's thoughts or behavior will breach the privacy of the patient. That strikes out choice C.

The only logical thing is to politely explain to the patient that you can not comply with her request.


... jboud86 made a comment on nbme23/block2/q#48 (A 45-year-old woman is brought to the emergency...)
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submitted by jboud86(1)

FA 2019 page 390. This patient is expressing symptoms of biliary colic due to neurohormonal activation by CCK after a fatty meal. The labs will be normal and ultrasound will show cholelithiasis. However, I think this can be confused with acalculous because it also presents with inspiratory arrest on RUQ palpation due to pain. Acalculous cholecystitis is seen in critically ill patients.


... jboud86 made a comment on nbme23/block2/q#1 (A 26-year-old woman comes to the physician because...)
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submitted by jboud86(1)

FA 2019 page 152. The whole getting bitten by kitten things is a distractor. The two giveaways are NO lymphadenopathy and erythematous plaques with central clearing and scaly borders. Bartonella spp. is the cause of cat-scratch disease and causes bacillary angiomatosis. Bacillary angiomatosis can be found on page 469 of FA 2019.


... usmile1 made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
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submitted by usmile1(9)

does anyone know what the structure E is pointing to?


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

I CANNOT VIEW THE ENTIRE QUESTION. IS THIS NORMAL?


... jboud86 made a comment on nbme22/block4/q#21 (A previously healthy 45-year-old woman has had...)
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submitted by jboud86(1)

FA 2019 page 419. Pt's PC is low and BT is increased. TTP presents with the triad (thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury), fever, and neurologic symptoms.


... warbyparker1 made a comment on nbme22/block1/q#20 (A 49-year-old man comes to the physician because of...)
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submitted by warbyparker1(0)

I thought it was septic arthritis bc pain with weight bearing + mri, but 2 months with septic arthritis come on, it was an easy question and I missed it.


... hyperfukus made a comment on nbme22/block1/q#2 (A 28-year-old man has recurrent pancreatitis...)
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submitted by hyperfukus(5)

so I think if you forget actual drugs on the market that we know of and how they work, the question is purposely not asking you that specifically...If you flip it in your head to think what the problem is that leads to inc TG its because of VLDL therefore they said administering a DRUG with which of the following EFFECTS is MOST appropriate--->DECREASING VLDL b/c that's the culprit

Although drugs we know of have the other characteristics, for this guy, we would be looking for the effect of VLDL everything else is a side thing that doesn't directly address his condition


... a1913 made a comment on nbme22/block1/q#50 (A 9-year-old boy is brought to the physician by his...)
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submitted by a1913(0)

delF508 is a 3 base pair deletion of phenylalanine at amino acid position 508. Mutation causes impaired post-translational processing of CFTR (improper folding) which rough ER detects. Sends mutant misfolded CFTR to the proteasome for degradation, preventing it from reaching cell surface. So problem is not malfunctioning CFTR channels in the surface; problem is complete absence of CFTR on cell surface (since they keep getting misfolded and sent to proteasome to be trashed). Source of primary problem: error in protein structure


... monoclonal made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
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submitted by monoclonal(3)

The point here is, they are asking us to eliminate the only answer that is not possible. I got it wrong. read well fellas


... hello made a comment on nbme22/block4/q#9 (A 5-year-old boy is brought to the physician because...)
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submitted by hello(51)

Patient has red lacy rash- this fits more with HHV-6 (Roseola virus), not Parvovirus.

HHV-6 causes deformation of erythoblasts, leading to anemia.


... tinydoc made a comment on nbme23/block2/q#38 (A 78-year-old man is found unresponsive in his yard...)
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submitted by tinydoc(39)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116089/#!po=56.2500

I've had a uworld q where the correct response was to remove the life support if the patient is determined not to be an organ donor.even if the family is actively against this decision. In my experience the answer that is most honest (and likely makes you sounds like a tactless asshole) is usually the correct one on NBMEs. I picked E and I don't see how this friends opinion on his advanced care directives are at all relevant if the patient by all acounts medically and legally is considered dead.


... whoissaad made a comment on nbme23/block4/q#31 (A 32-year-old man who lives at sea level travels to...)
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submitted by whoissaad(8)

Several names are used for nucleated RBCs—erythroblast, normoblast, and megaloblast—with one minor variation in word sense. The name normoblast always refers to normal, healthy cells that are the immediate precursors of normal, healthy, mature (anucleate) RBCs. The name megaloblast always refers to abnormally developed precursors. Often the name erythroblast is used synonymously with normoblast.

From all the things they could test us on... :)


... whoissaad made a comment on nbme23/block3/q#39 (A 44-year-old woman comes to the physician because...)
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submitted by whoissaad(8)

HCO3- is needed to make CSF. Acetazolamide inhibits carbonic anhydrase and decrease HCO3- absorption from renal tubules.


... kimcharito made a comment on nbme21/block2/q#13 (A 53-year-old woman with gastroesophageal reflux...)
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submitted by kimcharito(3)

well...in FA2018 said misoprostol increase production of GASTRIC mucosa and the question said ESOPHAGUS mucosa....maaaay be is that reason


... hello made a comment on nbme22/block2/q#43 (A 20-year-old man comes to the physician because of...)
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submitted by hello(51)

Patient cannnot extend wrist, which is innervated by radial nerve

Patient has been on crutches, which would affect axillary nerve --> this affects deltoid muscle, which does arm abduction 15-100º (so it can normally move arm above shoulder)

The only location in the given diagram to effect all of these nerves would be location "C"

Note: normally, arm movement above the horizontal is associated with serratus anterior muscle/long thoracic nerve. However, none of the diagram locations allow for inclusion of SALT. Since the patient has been on crutches for weeks, it suggests axillary nerve involvement --> deltoid is affected


... hello made a comment on nbme22/block2/q#14 (A previously healthy 12-year-old boy is brought to...)
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submitted by hello(51)

The patient is dehydrated. Need to give water to rehydrate.

Water follows solute. If sodium is added to the solution, water will follow the sodium. Now, enterocyte uptake of sodium is mediated by Sodium-Glucose transporter. Hence, the solution needs to contain sodium and glucose in order to have the enterocytes take up the sodium.


... hello made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
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submitted by hello(51)

The Q is describing the genitofemoral nerve, which runs on the external surface of the spermatic cord at the superficial inguinal ring

This Q is NOT referring to ilioinguinal nerve -- the ilioinguinal nerve exits THROUGH the superficial inguinal canal whereas this Q is asking about a nerve that is EXTERNAL to the superficial inguinal canal.

See http://www.groinpainclinic.co.uk/data/images/nervesaffected.jpg


... hello made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
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submitted by hello(51)

This the same as @keycompany's explanation with more explanation those that need it...

The patient is unaffected by the particular autosomal recessive disease and his brother has the autosomal recessive disease --> this means each of their parents carries the AR allele. Now, for the patient to be unaffected given that both his parents have the AR allele, it means that the patient has a 2/3 chance that he is simultaneously unaffected and a carrier.

The patient's partner is unaffected and normal Hardy-Weinberg genetics (as stated in the problem)..when this is specifically mentioned, you are to assume that the partner has a carrier frequency for the AR allele, which equal to 2pq.

The disease has a frequency in the population of 1/40000. This is q^2 --> q^2 = 1/40000. Solving for q, you get q = 1/200.

Carrier frequency is 2pq. However, for a rare disease, 2pq ≈ 2q. So, the carrier frequency for the partner = 2q = 2 * 1/200 = 1/100.

Now, the Q asks about an offspring of the patient and his partner being affected, so to have an affected child, there is a 1/4 chance of having an affected child (becasuse the patient and the partner both have a 1/2 chance of passing the allele --> you multiple these together 1/2 * 1/2).

So, multiply 2/3 * 1/100 * 1/4 = 1/600. This is P(patient being a carrier) * P(partner being a carrier) * P(having an affected offspring together).


... hello made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
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submitted by hello(51)

The grammar of the actual Q was confusing.

To make better sense, it should say "Which of the following is the most likely result on the transcription of genes that inhibit cell division and that contain the consensus sequeence TATA..."

So, the Q is asking about the tp53 gene and specifically about the tp53 gene promoter region.

Promoter regions have a TATA box (obviously, meaning rich in A-T base pairs). A-T base pairing has 2 hydrogen bonds, which makes them easier to cleave --> allows for DNA transcription to occur more easily. RNA Pol does transcription of DNA into RNA.

The entire Q-stem talks about how Li-Fraumeni is due to a mutation in tp53 gene, leading to a lack of tumor suppression activity.

So, if the promoter region TATA box of the tp53 gene is mutated, then the tp53 gene will not get transcribed --> this is why there will be decreased RNA Pol binding. RNA Pol will have a reduced ability to bind tp53 --> less tumor supressor gene transcription --> less tumor suppression.


... et-tu-bromocriptine made a comment on nbme21/block1/q#30 (A newborn has female external genitalia and a 46,XY...)
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submitted by et-tu-bromocriptine(8)

Everything has been covered already, but here's to the visual learners - it's easy to see the relationship between DHT and testosterone. https://imgur.com/a/M8Y3Fdm

(ignore the whole black versus blue colors...it complicates things and I'm sure I miscolored somewhere).


... hello made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
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submitted by hello(51)

I want to re-emphasize something that @assoplasty has already stated :).

The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia.

Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources.


... baengotti made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
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submitted by baengotti(1)

The N-terminus is where you have signal peptides which define the target of the proteins (think of them as postal code). Typically, proteins are in the cytoplasm after they are made, but since the have tags at n-terminus, they go to different targets like this case ER. Now, if the protein is retained in the cytoplasm, this means the mutation disabled the tag (no postal code). Hence, it is kept in the cytoplasm.


... et-tu-bromocriptine made a comment on nbme21/block1/q#38 (A 47-year-old woman with aplastic anemia is being...)
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submitted by et-tu-bromocriptine(8)

Rule of thumb/shortcut

Additional info


... charcot_bouchard made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
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submitted by charcot_bouchard(42)

A case of Fanconi syndrome. If it was isolated Type 2 RTA option B would be the answer.