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

Some recent contributions

... sharpscontainer made a comment on nbme21/block3/q#27 (A 55-year-old woman with a benign nodule in the left...)
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submitted by sharpscontainer(0)

I was duped; did anybody here get it wrong because they thought about the thyroid ima artery arising from the brachiocephalic trunk? No? Just me? Okay.


... j000 made a comment on nbme22/block2/q#15 (A 62-year-old woman comes to the physician 3 days...)
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submitted by j000(0)

this is not mentioned in FA or pathoma, but according to Amboss:

In invasive ductal carcinoma, the mammography finding shows "star-shaped lesion occurs due to clustered microcalcifications of the surrounding tissue."

It is not DCIS because DCIS doesn't produce a mass It is not fibroadenoma (it is most common in women <35) It is not fibrocystic changes (premenopausal women 20-50, often bilateral, tender)


... j000 made a comment on nbme22/block4/q#26 (A 60-year-old woman comes to the physician because...)
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submitted by j000(0)

also according to pathoma: meningioma expresses estrogen receptor, which means more likely a female adult than male


... j000 made a comment on nbme22/block4/q#19 (A 76-year-old man with a 1-month history of a...)
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submitted by j000(0)

AAA is usually below renal arteries and above bifurcation (pathoma)

the kidneys are stuck at IMA level (IMA is normally below renal arteries and above bifurcation)

so when repairing AAA in a patient with horseshoe kidney, it is complicated by the fact that renal arteries are lower than normal... in the area where AAA usually occurs

anomalous origins of renal arteries = instead of being higher up, it is stuck at IMA level

hope that helps


... covid2019 made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
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submitted by covid2019(0)

Hi there! Predicting some questions on pandemics in STEP1s in the near future. Stay tuned!


... j000 made a comment on nbme22/block4/q#27 (A 78-year-old man comes to the physician because of...)
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submitted by j000(0)

multiple myeloma is the most common PRIMARY malignancy of bone (pathoma), so it's not MM.

it's not paget (lack other Sx, would also have sclerotic lesions)

mostly likely renal or lung cancer metast to the bone


... b1ackcoffee made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
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submitted by b1ackcoffee(1)

Any good material to prepare for this kind of stuffs?


... tulasi made a comment on nbme20/block4/q#13 (A 62-year-old woman comes to the physician because...)
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submitted by tulasi(0)

The presentation of Bronchigenic carcinoma is -Cough and hemptysis The tutor metastasis to Bone,Lung,brain and adrenals. So now the question is mentioning the same points The cough and sputum and also new bone formation on affected bones on Xray and also clubbing represents the lung.

Reference- 100 concepts of anatomy slide 94


... haozhier made a comment on nbme24/block4/q#5 (A 45-year-old man comes to the physician because of...)
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submitted by haozhier(0)

How do you guys know about this? I chose stool O&P...and muscle biopsy is not mentioned anywhere...


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

So once you're down to OI and Rickets think about the pathogenesis of the two diseases and ignore the rest of the stem for a second. Bone is basically two parts. A fibrous "rebar" part and a calcium "cement" part. OI has defective type 1 collagen leading to bones that have no problem mineralizing (cement) but are lacking the rebar. This leads to super brittle bones that break all the time. Like hundreds of fractures.

Vit D deficiency causes an inability to mineralize but has no problem with laying down the collagen or "rebar". As a result you get soft and bendy bones. Sure they can break but the main problem is lack of strength.

From there you pick OI because the kid has 1000 fractures. Rickets wouldn't present that way.

Also bonus buzzword: apparently "wormian appearance" is an important diagnostic clue for OI.


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

wtf kinda question was this? where the hell am i even going to use these concepts in medicine?!


... waterloo made a comment on nbme24/block1/q#50 (An 11-year-old boy is brought to the emergency...)
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submitted by waterloo(0)

a little messed up, but "Inability of neurons to perform glycolysis" seems like a tempting answer. But the reality is, the neurons are able to perform glycolysis, they ready to rock but just waiting on insulin. I still chose this as my answer tho.

I guess this is one of those choose the best answer questions. I think FA should add the reasoning behind cerebral edema, being that it's a major cause of death (but I couldn't find it in Robbins either). Having so much glucose in the blood vessels causes water to be drawn out (ICF --> ECF). So that's a intracellular dehydration.


... waterloo made a comment on nbme24/block4/q#9 (A 10-year-old boy who was adopted from the...)
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submitted by waterloo(0)

Reading microfilariae reminds me of three things. all from sketchy.

  1. Loa Loa --> Deer flies --> subcutaneous nodules and larva crossing eye.
  2. Onchocerca volvulus --> black fly --> deposits larva in skin which mature into adults producing microfilariae causing scattered puritiic papules and potentially eye blindness.
  3. W. Bancrofti: this is due to mosquitos and causes elephantiasis. Also has microfiliariae.

Honestly, I was looking for deer fly. But culex mosquito is west nile, reduviid is chagas. I think everyone knows ixodes and body louse is not this.


... bking made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
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submitted by bking(0)

I understand the edema is from decreased protein- why is Starvation Ketosis wrong? Couldn't his proteins be degraded through this process: Protein--Amino acids-- Acetyl CoA-- Ketones


... fexx made a comment on nbme22/block3/q#34 (The risk for hemorrhagic stroke from drug X is...)
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submitted by fexx(2)

I got this wrong but Case contrOl (O for Odds ratio): compares group who has DISEASE vs no disease - trying to find out what caused it CohoRt (R for Relative risk): compares group with RISK FACTORS/ EXPOSURE vs no exposure - trying to figure out if they will develop disease


... asharm10 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
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submitted by asharm10(3)

Phosphate is down that means something is wrong with PCT, then non anion gap acidosis that means bicarbonate is not being absorbed, glucosuria again PCT so just use your brain and choose decrease bicarbonate reabsorption in PCT


... 69_nbme_420 made a comment on free120/block0/q#1 (A 67-year-old woman with congenital bicuspid aortic...)
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submitted by 69_nbme_420(7)

Aminoglycosides (Which inhibits 30S) are coupled with cell wall active agents - e.g. Penicillins, Vancomycin

(Sketchy Reference on Aminoglycoside Sketch: Beta-lactam bomb!!)


... shirafune made a comment on nbme20/block3/q#27 (A 55-year-old man with type 2 diabetes mellitus,...)
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submitted by shirafune(0)

Classic statin-induced myopathy. As a side note, when patients started on commonly used statins such as atorvastatin, rosuvastatin, and simvastatin and present with rhabdomyolysis, it is not always an absolute contraindication to statins. Example would be 30yo male with long life-expectancy in which statin therapy would still have a large benefit.

Instead, a more hydrophilic statin (i.e. less lipophilic) would be selected. These include pravastatin and fluvastatin. The more lipophilic a statin is, the greater the risk of rhabdomyolysis. In fact, cerivastatin was pulled off the market for an unacceptably high-rate of rhabdomyolysis.


... neovanilla made a comment on nbme22/block4/q#14 (In patients with adenosine deaminase deficiency,...)
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submitted by neovanilla(9)

Got this wrong, but when looking this up, I saw that SCID is associated with a lack of adenosine deaminase --> accumulation of adenosine, which is lympho-toxic.


... kakashihatake261996 made a comment on nbme20/block1/q#10 (A 77-year-old woman has been having difficulty...)
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submitted by kakashihatake261996(0)

diifculty fastening buttons = muscles of thumb are affected(supplied by meadian nerve) & intrinsic muscles of hand effected are also effected(ulnar nerve) & loss of sensation in the C7-T1 dermatome (https://www.pinterest.com/pin/643944446689455948/)

general rule : if multiples muscles in the hand, supplied by different nerves are effected, it should indicate an injury at the level of spinal nerves(C8-T1)


... drdoom made a comment on step2ck_form7/block1/q#3 (A 52-year-old man comes to the physician because of...)
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submitted by drdoom(375)

“It’s awfully quiet in these here pages ...” 🌵🤠

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... drdoom made a comment on step2ck_form6/block1/q#3 (A 20-month-old girl is brought to the physician...)
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submitted by drdoom(375)

“It’s awfully quiet in these here pages ...” 🌵🤠

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... apurva made a comment on nbme21/block3/q#45 (A 28-year-old man comes to the physician for...)
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submitted by apurva(0)

Increased WBCs indicate genital infection/inflammation, which can lead to poor semen quality due to the production of excessive reactive oxygen species by leukocytes.

Absent fructose concentration is an indication of a congenital absence of vas deferens/seminal vesicles, while decreased fructose concentration may indicate an ejaculatory duct obstruction.

pH > 8.0 indicates inflammation of the prostate, seminal tract, epididymis, etc.; pH < 7.2 indicates seminal vesicle dysfunction or obstruction of the ejaculatory ducts.


... apurva made a comment on nbme21/block3/q#50 (A 32-year-old woman comes to the emergency...)
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submitted by apurva(0)

I wonder i chose “sexual transmission” because same background of question stem was in AMBOSS stating the acute serum sickness like presentation for Hep B.

None the way, NBME wins.


... solgabrielamoreno made a comment on nbme24/block3/q#16 (An 18-year-old woman is brought to the physician...)
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submitted by solgabrielamoreno(0)

https://www.kaggle.com/c/siim-acr-pneumothorax-segmentation/discussion/98498

exact picture from the exam explained. :)


... mdrahimi7 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 mdrahimi7(-2)

The answer must be protein regulation not structure ! First of all you know that cystic fibrosis can have several mutation 1.severe splicing defect In which cftr protein is normal but less in concentration due to 3 types of mutation 1_ promotor box defect and leading to less transcription 2_ premature stop codon 3- and reading frame mutation All these mutation leading to less synthesis of normal cftr protein.The second type of mutation is 3 bade deletion that ctfr protein problem is in folding 3. The mutation is in those part of protein which regulates its function like nucleotide binding domain and regulatory domain Actually to clear more this protein has three part Regulatory domain, Nucleotide bonding domain and transmembrane part . And type 4 mutation is that transmembrane part of protein is defective channel will be made but work less. Now as you can see in the first picture that i sent you actually in(( bronchial and respiratory part)) the cftr protein is present that it normally you know that it secrets cl and inhibits na channel on membrane until na +chlorine absorb the h2o to soften the mucus so it means normally in respiratory system this protein secrets cl and regulate the function of na channel. Now according the respiratory problem that the patient had it points to this point that the mutation of this cftr leads to this that this protein can't secret cl +can't regulate the function of na channel so So the type of mutation occurring to this person is with the regualtory part not the structure (cftr protein is present but can't work in this way to secret cl and regulate the na channel. Because you can see that patient mutation of cftr is not so severe (if it was sever I mean the structure of protein has the problem so according this matter that cftr protein are present in different system of our body in respiratory,gis, other salivary gland , liver complication , heart complication , sweat gland all these systoms will be effected ) but the baby just it has problem in respiratory system and sweat gland so it is mild when it is mild so the mutation should be in this way that either structurally cftr is present but less in number or cftr protein is present but the problem is with the regulatory party that just it can't secrete the cl and can't regulate the function of na channel as you can see in this patient respiratory and sweat gland. Finished😊


... apurva made a comment on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
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submitted by apurva(0)

https://webpath.med.utah.edu/HEMEHTML/HEME069.html


... neovanilla made a comment on nbme22/block3/q#7 (A 50-year-old man who is a college professor has had...)
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submitted by neovanilla(9)

But he doesn't feel healthy...he's been coughing for 6 months, with blood for a week. If I were him, I'd think something was really wrong with me, and that I was certainly NOT healthy...By telling him it must be hard, yeah, it's compassionate, but you're not answering his question at all. He asked you, "How can this be happening to me?"


... apurva made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
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submitted by apurva(0)

The real thing is TSH, T3, T4 and thyroglobulin cannot cross placenta. TRH, Iodine, TSI can cross. If mother has high TSH (considering primary hypothyroidism) —> Poor brain development If mother has TSI (Hashimoto) —> cross the placental barrier —Increase in thyroid gland (May present with stridor at birth.


... sweetsummerblowout made a comment on nbme24/block1/q#15 (Results of a 5-year screening program for HIV...)
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submitted by sweetsummerblowout(0)

https://step1.medbullets.com/stats/101011/statistical-hypotheses-and-error

The chart on this site shows alpha/beta/power/True negative(correct). This question asks "likelihood of missing an association" - which basically means what is the false positive rate, which is the definition of alpha/Type I error. Question stem states alpha=0.05, which is 5%.

Beta is Type II error, and would be 10% (false negative). 90% would be Power (1-beta)


... fullmetalapathist made a comment on free120/block0/q#10 (A 22-year-old woman comes to the office because of a...)
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submitted by fullmetalapathist(0)

CD80 is also known as B7. Question is asking if you know that CD28 (T-cells) interacts with B7 (APC) as a co-stimulatory signal to activate the T-cell.

Looks like the picture is demonstrating contact dermatitis (due to her recent use of new hair dye) which is a type IV HSR

I usually remember that B-7 is on the B-cell (an APC)


... llamastep1 made a comment on nbme23/block1/q#41 (A 62-year-old woman is brought to the emergency...)
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submitted by llamastep1(5)

So did I just get lucky? I just did rule of 4s, bilateral motor meant medial and I interpreted horizontal eye movement as CN6 which is also medial and pons(CNs 5,6,7,8). Couldn't really place the disarthria but medial pons seemed like a good option.


... jesusisking made a comment on nbme24/block3/q#48 (A 62-year-old man comes to the physician because of...)
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submitted by jesusisking(0)

I got this wrong b/c didn't read where it said "[pain localized] to the distal portion of the absent extremity." That's the giveaway :D


... bharatpillai made a comment on free120/block2/q#19 (A 73-year-old woman comes to the physician because...)
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submitted by bharatpillai(8)

Subacute combined degeneration never produces exagerated reflexes. It's one of the causes of babinski + with absent ankle reflex.


... asharm10 made a comment on nbme22/block1/q#1 (A 66-year-old man develops worsening shortness of...)
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submitted by asharm10(3)

Always know this Hypo or hypernatremia is because of change in the volume, this patient is going through heart failure, renal perfusion has gone down that leads to release of ADH cos of osmoreceptors stimulation. Now high ADH will reabsorb more free water that will lead to hyponatremia. So hyponatremia is almost always related to high ADH. I know few of you will think but RAAS system is activated too but that abosrb Na along with water but ADH just free water.


... asharm10 made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
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submitted by asharm10(3)

It's an anabolic hormone, muscle mass, RBC mass will increase.


... asharm10 made a comment on nbme22/block4/q#24 (A 39-year-old woman with rheumatoid arthritis comes...)
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submitted by asharm10(3)

Rheumatoid arthritis in an inflammatory process, you wanna block Tnf alpha which is a major inflammation accelerator, IL 2 blockers used for tansplant rejections, because you dont want your B and T cells proliferating, IL 2 induces differentiation of all immune cells.


... asharm10 made a comment on nbme22/block1/q#42 (An 18-year-old woman develops sepsis after an...)
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submitted by asharm10(3)

Acute phase reactants Upregulated: More FFiSH in the C Ferritin Fibrinogen Serum Amyloid A Hepcidin C-Reactive protein


... asharm10 made a comment on nbme22/block4/q#31 (A 65-year-old man comes to the emergency department...)
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submitted by asharm10(3)

S3--> dilated cardiomyopathy (eccentric)--> systolic failure--> blood builds up--> increase hydrostatic pressure in pulmonary vessels--> exudate--> crackles


... asharm10 made a comment on nbme22/block4/q#41 (A 65-year-old woman with a 20-year history of...)
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submitted by asharm10(3)

If knee is mentioned just look for L4 and then rule out all the other options, you are left with just one option just pick it and don't think beyond.


... asharm10 made a comment on nbme22/block4/q#20 (During a study of symptomatic proximal deep venous...)
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submitted by asharm10(3)

When you are comparing the therapeutic effects of two drugs it's a clinical trial and when both the patients and providers know which drug it's open label. Clinical trial could be done between tx/control or tx/tx. It can't be crossover as there is no wash out phase


... llamastep1 made a comment on nbme23/block4/q#19 (A 6-month-old male infant is brought to the...)
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submitted by llamastep1(5)

So I didn't remember IPEX but I do know some basic inmuno and the stem sounded like many autoinmune manifestations, so logically a decrease in Treg lymphocytes (which are inmunosuppresive) seemed like the best answer.


... vishnu_c_singh made a comment on nbme22/block2/q#39 (A 22-year-old woman comes to the office because of a...)
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submitted by vishnu_c_singh(0)

"Postpartum cardiomyopathy, also known as peripartum cardiomyopathy, is defined as the new onset of heart failure between the last month of pregnancy and 5 months post-delivery with no determinable cause" - NCBI


... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
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submitted by alexxxx30(5)

did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha


... alexxxx30 made a comment on nbme23/block2/q#1 (A 26-year-old woman comes to the physician because...)
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submitted by alexxxx30(5)

also the word annular was supposed to be very helpful (it means ring shaped)...however my dumbo self didn't know this. Would have lead me directly to ring worm tinea


... asharm10 made a comment on nbme22/block2/q#23 (A 32-year-old woman comes to the physician because...)
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submitted by asharm10(3)

Unilateral periorbital swelling acute stage of chagas disease


... asharm10 made a comment on nbme22/block2/q#25 (A 37-year-old woman undergoes excision of a 1-cm,...)
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submitted by asharm10(3)

It,s not an infection, it's basically a healing process, angiogenesis leads to warmth and erythema,


... lsantiag made a comment on nbme20/block1/q#37 (A 1-month-old male newborn is brought to the...)
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submitted by lsantiag(-1)

An infant with vomiting after feedings + eager to eat is most commonly Hypertrophic Pyloric Stenosis.

Because there is vomiting, there is loss of HCl --> loss of Cl-

The loss of volume will increase RAAS --> K+ excretion

The loss of Cl- will cause the Cl-/HCO3- anti porter in the stomach to be active and thus lead to a state of metabolic alkalosis --> increase HCO3-

The volume depletion increase ADH secretion-->dilution of plasma-->low Na+


... frijoles made a comment on nbme21/block1/q#30 (A newborn has female external genitalia and a 46,XY...)
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submitted by frijoles(0)

I chose E) because I was thinking androgen insensitivity syndrome. However, I realize the wording of the question is which HORMONE would be reduced and in AIS, testosterone levels would not actually be reduce.

To be clear though, AIS could have the EXACT same described presentation, yes? (46.XY with male genital ducts & female external genitalia) Just want to make sure there is nothing else that could have tipped me off. Thanks.


... waterloo made a comment on free120/block2/q#33 (A 17-year-old girl has never had a menstrual period....)
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submitted by waterloo(0)

Just to add to explanation. Answer is not congenital adrenal hyperplasia, because pt has normal breast development and normal external genitalia. most common type 21-hydroxylase def would have precocious puberty or clitoral enlargement. Questions says patient has normal appearing external genitalia. 17a-hydroxylase def would lead to ambiguous genitalia in XY and in XX there would be no secondary sexual development because lack of sex steroids. But again, question says pt has normal breast development and external genitalia. In 11B-hydroxylase def, XX would have virilization, again not applicable here.

ectodermal dysplasia would have more characteristics like abnormal teeth, other abnormal findings from ectodermal layer.

a psych disorder could throw you off, maybe patient is not eating enough and is not having a period. But they said normal female body habitus, so I think that seems less likely compared to androgen insensitivity.

Sex chromosome mosaicism made me think of Turner Syndrome. There is a unique body habitus for Turner Syndrome so makes this a wrong answer.


... waterloo made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
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submitted by waterloo(0)

You can look at this question strategically.

  1. Southern blot --> so DNA.
  2. they are using an endonuclease to transfer bits, this doesn't really mean anything to you yet.
  3. cDNA is probing for single immunoglobulin-constant region.

That's important, because now you know they are looking at the constant region of immunoglobulin aka Fc of the heavy chain.

So why is this cDNA that encodes Fc, lighting up only once in other tissues, but the same cDNA lights up multiple times in lane 2 (bone marrow)? This is because, at the bone marrow random recombination of light or heavy chain occurs, and our cDNA is present in different random combinations with light chains. That specific cDNA sequence they used didn't change between the tissues or even within the bone marrow, and it will only bind to the one gene sequence. The fact it's lighting up multiple times tells you that the same sequence is present, your question is why so many times.

Also a side note, southern blots are time consuming, so labs use other methods to do the same thing (like PCR), but southern blots are still the best when it comes to checking immunoglobulin and T cell receptor gene rearrangement.


... drschmoctor 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 drschmoctor(24)

How does one differentiate factitious disorder from being thirsty w poor impulse control?


... drschmoctor made a comment on nbme24/block2/q#4 (A 57-year-old man has had hoarseness and difficulty...)
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submitted by drschmoctor(24)

ALL YOU HAVE TO DO is remember that last time they used this picture D & E were CNs VII & VIII, so anything else on the right side or down from there could be the right CN X.


... komodo made a comment on nbme24/block3/q#13 (An 83-year-old woman is brought to the physician by...)
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submitted by komodo(0)

I think one of the confusions here is that the microhemagglutination assay doesn't necessarily indicate current infection with syphilis, because treponemal tests can stay positive even for years after treatment (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095002/) That in combo with the very low RPR titer could indicate treated syphilis. So really the best thing to do would be to ask the patient directly about it before you waste time doing possibly unnecessary testing (and I would definitely ask her directly since most people don't talk about their STIs with their children)


... snripper made a comment on nbme22/block1/q#24 (A 48-year-old man with renal artery stenosis...)
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submitted by snripper(2)

Essentially, we're trying to get to the renal artery from the femoral.

We cross through internal iliac (B) already to reach the aorta.

Remember the branches of the abdominal aorta: Celia -> SMA -> Renal -> IMA (FA 2020 pg. 363)

Celiac (A) and SMA (C) is superior to the renal so cross them out.

We're left with testicular artery.


... jinzo made a comment on nbme23/block4/q#32 (A 42-year-old woman comes to the office because of a...)
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submitted by jinzo(10)

I have ganglion cyst since 2012 and this shit doesn't disappears . Moreover , it may cause some pain , when I flex my wrist . So why answer is not parasthesia???


... abhishek021196 made a comment on nbme23/block1/q#22 (An investigator is studying the adverse effects of a...)
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submitted by abhishek021196(4)

Bortezomib, carfilzomib

Mechanism = Proteasome inhibitors, induce arrest at G2-M phase and apoptosis.

Use = Multiple myeloma, mantle cell lymphoma.

Adv Effects = Peripheral neuropathy, herpes zoster reactivation


... abhishek021196 made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
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submitted by abhishek021196(4)

Rituximab

Mechanism = Monoclonal antibody against CD20, which is found on most B-cell neoplasms.

Use = B-cell Non-Hodgkin lymphoma, CLL, ITP, rheumatoid arthritis, TTP, AIHA, MS.

Adv effects = Increased risk of progressive multifocal leukoencephalopathy in patients with JC virus.


... abhishek021196 made a comment on nbme23/block1/q#23 (A 35-year-old man comes to the physician because of...)
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submitted by abhishek021196(4)

One of the tx strategies for drug induced Parkisonism or otherwise is to Curb excess cholinergic activity. Done by Benz-tropine, trihexyphenidyl (Antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia in Parkinson disease). Park your Mercedes-Benz.


... abhishek021196 made a comment on nbme23/block1/q#6 (A 32-year-old woman comes to the emergency...)
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submitted by abhishek021196(4)

Borderline = Unstable mood and interpersonal relationships, fear of abandonment, impulsivity, self- mutilation, suicidality, sense of emotional emptiness.

Females > males.

Splitting is a major defense mechanism.

Treatment: dialectical behavior therapy.


... abhishek021196 made a comment on nbme23/block1/q#37 (A 47-year-old woman with multiple sclerosis is...)
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submitted by abhishek021196(4)

Dorsal column (pressure, vibration, fine touch, proprioception)

ASCENDING

• Fasciculus graciLis (Lower body, legs) • Fasciculus cUneatus (Upper body, arms)

Dorsal columns are organized as you are, with hands at sides. “Arms outside, legs inside.”


... abhishek021196 made a comment on nbme23/block1/q#31 (A 16-month-old boy is brought to the physician for a...)
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submitted by abhishek021196(4)

Male child, recurrent infections, no mature B cells = Bruton disease (X-linked agammaglobulinemia)

Common variable immunodeficiency - Defect in B-cell differentiation. Cause unknown in most cases. May present in childhood but usually diagnosed after puberty. Increased risk of autoimmune disease, bronchiectasis, lymphoma, sinopulmonary infections Decreased plasma cells, Decreased immunoglobulins


... paperbackwriter made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
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submitted by paperbackwriter(14)

S2,3,4 keeps the 3 P's off the floor (Penis, Poo, and Pee)


... paperbackwriter made a comment on nbme23/block3/q#41 (A previously healthy 45-year-old man comes to the...)
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submitted by paperbackwriter(14)

INfraspinatus goes OUT (i.e. external rotation) and therefore supraspinatus does opposite (internal rotation).


... dumbo123 made a comment on nbme23/block2/q#39 (A 39-year-old woman with obesity and recently...)
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submitted by dumbo123(1)

I think its because she has a hx of peptic ulcer disease (stated in hx) that is currently flaring up (mild epigastric tenderness to deep palpation).

There are drug interactions--- Atorvastatin (choice A), which is a CYP3A4 substrate, shouldn't be used with Clarithromycin/some other antibiotics used to tx peptic ulcers/CYP3A4 inhibitors.

Under warnings and precautions, page 1, FDA- https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020702s056lbl.pdf https://www.pdr.net/drug-summary/lipitor?druglabelid=2338

(I also got the questions wrong and chose Atorvastatin-- this is just my guess!)


... gubernaculum made a comment on nbme22/block4/q#18 (A 10-year-old girl has a slightly painful 2-mm...)
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submitted by gubernaculum(1)

A suture granuloma essentially is a foreign body reaction to suture remaining in the tissue after surgery. It is generally a tender, erythematous nodule that occurs several days to weeks after surgery. A suture granuloma is treated with intralesional steroids or excision.

https://www.aafp.org/afp/2009/1215/p1483.html


... paperbackwriter made a comment on nbme23/block3/q#35 (A 31-year-old woman comes to the emergency...)
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submitted by paperbackwriter(14)

Obviously you wouldn't allow the husband inside, but after staring at this question for way too long, I reasoned that you wouldn't tell him to leave for 2 reasons:

  1. It might clue him in to the fact that she told you about the abuse, and he will leash out on her if he gets the chance.

  2. If she wants to call the police and press charges it will be better that you know where he is.


... paperbackwriter made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
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submitted by paperbackwriter(14)

can we all agree this was far too much math and unit conversion, WHY THE UNIT CONVERSIONS!?! WE ALL CLEARLY PASSED CHEM 101


... donttrustmyanswers 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 donttrustmyanswers(9)

I just realized there were solid arrows and dashed arrows in the image. Is there a significant to the dashed arrows vs the solid arrows?


... donttrustmyanswers made a comment on nbme23/block2/q#41 (A 44-year-old woman, gravida 2, para 2, comes to the...)
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submitted by donttrustmyanswers(9)

Anki Card I made: Vagina = {{c1::Stratified squamous}} Cervix = {{c1::Stratified squamous --> simple columnar (endocervix)}} Uterus = {{c2::simple columnar}} Fallopian tubes = {{c2::simple columnar}} Ovaries = {{c3::simple cuboidal}}


... donttrustmyanswers made a comment on nbme23/block2/q#25 (A 44-year-old man with invasive pancreatic cancer is...)
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submitted by donttrustmyanswers(9)

What is the area labeled 'G' and 'C'? And more characters?


... miriamp3 made a comment on nbme22/block4/q#49 (A 52-year-old man with metastatic oat cell carcinoma...)
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submitted by miriamp3(1)

I wasn't sure, but then I realize he is going to die, he is in a hospice + the best you can do is made him feel without pain. BUT at the end what made me decide was The reason of the medication. At this point you really don't care about controlling everything else.


... donttrustmyanswers made a comment on nbme23/block2/q#42 (A 63-year-old woman comes to the physician because...)
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submitted by donttrustmyanswers(9)

"disproportionate reduction in the peak expiratory flow rate or maximum minute volume compared with the forced expiratory volume in one second (FEV1). It should be noted, however, that there can be a significant loss in airway cross-sectional area before the textbook flattening of the inspiratory or expiratory loops are visualized."

https://www.uptodate.com/contents/clinical-presentation-diagnostic-evaluation-and-management-of-central-airway-obstruction-in-adults?search=tracheal%20obstruction&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H793418750


... abhishek021196 made a comment on nbme23/block4/q#40 (A 16-year-old girl is brought to the emergency...)
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submitted by abhishek021196(4)

Spleen—arises in mesentery of stomach (hence is mesodermal) but has foregut supply (celiac trunk -> splenic artery.

Splenorenal ligament = Connects Spleen to left pararenal space. It contains Splenic artery and vein, tail of pancreas. It is a derivative of dorsal mesentery.


... abhishek021196 made a comment on nbme23/block4/q#46 (A female neonate is delivered at 38 weeks' gestation...)
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submitted by abhishek021196(4)

Rough endoplasmic reticulum Site of synthesis of secretory (exported) proteins and of N-linked oligosaccharide addition to lysosomal and other proteins. Nissl bodies (RER in neurons)—synthesize peptide neurotransmitters for secretion. Free ribosomes—unattached to any membrane; site of synthesis of cytosolic, peroxisomal, and mitochondrial proteins. Mucus-secreting goblet cells of the small intestine and antibody-secreting plasma cells are rich in RER. Proteins within organelles (eg, ER, Golgi bodies, lysosomes) are formed in RER.

Smooth endoplasmic reticulum Site of steroid synthesis and detoxification of drugs and poisons. Lacks surface ribosomes. Location of glucose-6-phosphatase (last step of glycogenolysis). Liver hepatocytes and steroid hormone– producing cells of the adrenal cortex and gonads are rich in SER.


... abhishek021196 made a comment on nbme23/block4/q#23 (A 74-year-old woman comes to the physician because...)
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submitted by abhishek021196(4)

I-PRA-tropium, tiotropium Use - COPD, asthma (“I pray I can breathe soon!”).

Muscarinic antagonists competitively block muscarinic receptors, preventing bronchoconstriction. Tiotropium is long acting.


... abhishek021196 made a comment on nbme23/block4/q#9 (A 35-year-old man who is a veterinarian in a rural...)
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submitted by abhishek021196(4)

Q fever Coxiella burnetii, no arthropod vector. Spores inhaled as aerosols from cattle/sheep amniotic fluid. Presents with headache, cough, influenza-like symptoms, pneumonia, possibly in combination with hepatitis. Common cause of culture ⊝ endocarditis. Q fever is caused by a Quite Complicated Bug because it has no rash or vector and its causative organism can survive outside in its endospore form. Not in the Rickettsia genus, but closely related.


... justherefortheyield made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
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submitted by justherefortheyield(1)

Per multiple sources: measles can be vesicular and also can lead to giant cell pneumonia in the immunocompromised. ?!?!?!?


... abhishek021196 made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
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submitted by abhishek021196(4)

http://what-when-how.com/wp-content/uploads/2012/04/tmp15F28.jpg


... justherefortheyield made a comment on nbme23/block3/q#46 (A 19-year-old woman is severely burned over 35% of...)
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submitted by justherefortheyield(1)

Couldn't hypoalbuminemia lead to hypercholesterolemia? I recall sittar talking about this in the context of proteinuria but couldn't this still apply?


... abhishek021196 made a comment on nbme23/block4/q#19 (A 6-month-old male infant is brought to the...)
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submitted by abhishek021196(4)

Regulatory T cells Help maintain specific immune tolerance by suppressing CD4 + and CD8 + T-cell effector functions. Identified by expression of CD3, CD4, CD25, and FOXP3.

Activated regulatory T cells (Tregs) produce anti-inflammatory cytokines (eg, IL-10, TGF-β).

IPEX (Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked) syndrome— genetic deficiency of FOXP3 = autoimmunity. Characterized by enteropathy, endocrinopathy, nail dystrophy, dermatitis, and/or other autoimmune dermatologic conditions. Associated with diabetes in male infants.


... abhishek021196 made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
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submitted by abhishek021196(4)

Primary polycythemia = Disorder of Increased no of RBCs, usually due to acquired JAK2 mutation. May present as intense itching after shower (aquagenic pruritus). Rare but classic symptom is erythromelalgia (severe, burning pain and red-blue coloration) due to episodic blood clots in vessels of the extremities. There is DECREASED EPO (vs 2° polycythemia, which presents with endogenous or artificially raised EPO). Treatment: phlebotomy, hydroxyurea, ruxolitinib (JAK1/2 inhibitor).


... dr_pepper made a comment on nbme21/block4/q#34 (A healthy 8-year-old boy is brought to the physician...)
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submitted by dr_pepper(0)

Quick google search reveals that methylphenidate works by inhibiting dopamine and NE reuptake, Am I missing something here? How is this "release of biogenic neurotransmitters"?


... texaspoontappa made a comment on nbme23/block1/q#6 (A 32-year-old woman comes to the emergency...)
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submitted by texaspoontappa(3)

well if that ain't my ex then I don't know what is


... bharatpillai made a comment on nbme24/block4/q#5 (A 45-year-old man comes to the physician because of...)
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submitted by bharatpillai(8)

Just adding on- Xray of large muscle groups would help in diagnosis of cysticercosis since cysts are calcified, in trichinella they are not. I think i'm the only one who got this wrong :/


... bharatpillai made a comment on nbme24/block2/q#42 (A 3-week-old female newborn is brought to the...)
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submitted by bharatpillai(8)

IRT is measured in routine heel-prick blood taken for biochemical screening of all newborn infants born in the UK. This test is one of a number of completed in newborn screening (the "Guthrie Test"). In Australia it is known 94% of those with eventual diagnosis of CF have a positive IRT on newborn screen. Samples with a raised IRT (defined as highest 1% of values) are then screened for common CF gene mutations. Each centre has a slightly different gene panel; currently 40-50 of the most common genes are sequenced. However, there are more than 2000 known mutations, so gene panel testing does miss occasional CF patients

If gene testing finds one mutation they will then have a sweat test to help confirm the diagnosis. Sweat testing is more likely to be equivocal in infants and typically not attempted in those under 5kg. If sweat test is positive more expansive gene testing is considered. If two mutations are found they are diagnosed with CF.


... bharatpillai made a comment on nbme24/block4/q#6 (A 68-year-old woman comes to the physician because...)
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submitted by bharatpillai(8)

One way to look at this would be to go back to pathogenesis of fatty streaks. They are most commonly found at the aortic bifurcation, so basically the lower down you go down the abdominal aorta, more turbulent the flow, causing higher potential for atherosclerosis and stenosis of branch vessels. Also, renal artery stenosis is well described which is given off after the celiac trunk so safe to say celiac trunk is spared in any kind of atherosclerotic stenosis.


... abhishek021196 made a comment on nbme23/block3/q#40 (A 38-year-old woman with hypercalcemia,...)
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submitted by abhishek021196(4)

Early PCT—contains brush border. Reabsorbs all glucose and amino acids and most HCO 3 – , Na + , Cl – , PO 4 3– , K + , H 2 O, and uric acid. Isotonic absorption. Generates and secretes NH 3 , which enables the kidney to secrete more H + . PTH—inhibits Na + /PO 4 3– cotransport = Increased PO 4 3– excretion


... abhishek021196 made a comment on nbme23/block3/q#11 (A 50-year-old woman with idiopathic cardiomyopathy...)
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submitted by abhishek021196(4)

Ingested—Enterobius, Ascaris, Toxocara, Trichinella, Trichuris You’ll get sick if you EATTT these!

Cutaneous—Strongyloides, Ancylostoma, Necator These get into your feet from the SANd

Bites—Loa loa, Onchocerca volvulus, Wuchereria bancrofti Lay LOW to avoid getting bitten


... hungrybox made a comment on free120/block1/q#3 (A 24-year-old man comes to the office because of a...)
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submitted by hungrybox(445)

Other answers:

sebaceous gland → acne, Cutibacterium acnes (formerly Propionibacterium acnes)

apocrine gland (aka sweat gland) → The substance secreted is thicker than eccrine sweat and provides nutrients for bacteria on the skin: the bacteria's decomposition of sweat is what creates the acrid odor.

eccrine gland → used to secrete stuff inside the body (ie salivary glands, pancreatic glands)

dermis → middle layer of skin.


... hungrybox made a comment on free120/block2/q#7 (A 23-year-old woman with bone marrow failure is...)
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submitted by hungrybox(445)

This whole question is on the different types of hypersensitivity. (pg. 113 FA2019)

eosinophil degranulation → Type 1 hypersensitivity (mast cells early, eosinophils/others later)

widespread apoptosis of B lymphocytes → B lymphocytes are involved in Type 2 hypersensitivity. Widespread apoptosis would not occur. If anything, B cells would proliferate?

Cytokine secretion by natural killer cells → NK cells use perforin and granzymes to induce apoptosis in type 2 hypersensitivity. (Not sure if they secrete any relevant cytokines...)

immune complex deposition in tissues → serum sickness (Type 3 hypersensitivity)

polyclonal T-lymphocyte activation → type 4 hypersensitivity


... ibestalkinyo made a comment on nbme21/block3/q#8 (A 55-year-old woman is brought to the emergency...)
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submitted by ibestalkinyo(11)

Anyone find it strange that the NBME loves to write questions where physicians are alcoholics?


... abhishek021196 made a comment on nbme23/block2/q#47 (A 65-year-old man is scheduled for physical therapy...)
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submitted by abhishek021196(4)

Shoulder muscles that form the rotator cuff: Supraspinatus (suprascapular nerve)— abducts arm initially (before the action of the deltoid); most common rotator cuff injury (trauma or degeneration and impingement; tendinopathy or tear [arrow in A ]), assessed by “empty/full can” test

Infraspinatus (suprascapular nerve)—externally rotates arm; pitching injury

teres minor (axillary nerve)—adducts and externally rotates arm

Subscapularis (upper and lower subscapular nerves)—internally rotates and adducts arm


... b1ackcoffee made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
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submitted by b1ackcoffee(1)

exactly how does maternal hashimoto can cause cretinism?


... b1ackcoffee made a comment on nbme21/block2/q#4 (An 18-year-old woman comes to the office because of...)
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submitted by b1ackcoffee(1)

wrist extensors (tennis - backhand)--> lateral epicondyl wrist flexors (golf - think near shot - don't know what it's called) - medial epicondyl


... cmun777 made a comment on nbme24/block1/q#1 (A researcher hypothesizes that exposure to more than...)
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submitted by cmun777(3)

I think the key on this question is recognizing how much "most time-efficient" jumps out in the question stem - a pretty unique thing to be specifically asking. Going off that and the fact they want to look at exposure -> outcome, by far the fastest approach would be to find people who currently have the dz in question and then just ask them if they have a previous exposure aka case-control.


... thotcandy made a comment on nbme24/block4/q#39 (A 30-year-old woman comes to the physician because...)
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submitted by thotcandy(16)

To add to what everyone else has said, this slide is pretty good: https://images.slideplayer.com/32/10012453/slides/slide_2.jpg

the prompt says RPF and GFR are unchanged, thus RBF is also unchanged, to do that, the renal arteries would have to decrease their resistance.

However, as shown on page 571 of FA19, a constriction or dilation of efferent would change FF which means RPF and GFR aren't changing equally - this is ruled out by the prompt saying they're unchanged.

Leaves us with a decrease in afferent resistance.


... thotcandy made a comment on nbme24/block4/q#26 (A 10-year-old girl is brought to the physician by...)
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submitted by thotcandy(16)

For anyone looking for more info:

Page 147 of Pathoma

3 types of Sex cord tumors: Granulosa-theca (follicle cells), Sertoli-Leydig, and fibroma.

G-T tumor: estrogen excess

S-L tumor: androgen excess

Fibroma: benign, fibroblasts, cause meig's syndrome


... thotcandy 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 thotcandy(16)

I think there's something that hasn't been mentioned and people are over looking:

Patient is presenting with CRC + anemia which most commonly occurs with RIGHT sided cancer. And how does that cancer develop? Micro-satellite instability (vs left sided = obstruction and polyp-adenoma sequence).

Misat instab mostly commonly occurs in HNPCC due to mismatch repair defect.

Thus, even though there's a type in the gene, or even if you don't know the gene, there's enough info to figure out it's HNPCC.

FAP doesn't match the picture, and is a pylop-adenoma sequence cancer. Li-fraumeni is defect in p53 (which is the last stage of pylop-adenoma sequence so I assume it follows that too?).

The constipation is kinda tricky because you'd think obstruction but the big key here is ANEMIA due to CHRONIC BLEEDING.


... divakhan made a comment on nbme21/block1/q#47 (A 26-year-old woman (III-2) comes to the physician...)
 -1  upvote downvote
submitted by divakhan(-1)
This is not XLD, its XLR disease (FA 2020 page 59)

Here, the mother is homozygous for the mutation therefore she displays the disease.

We see that,

  1. It skips generations
  2. Males are more severely affected (die in utero)
  3. Females are affected (only when homozygous)

Here we see, that mother can pass defective X chromosome to 50% females & other 50% will be carriers (healthy X chromosome from father, defective from mother) For males, Mother passes defective X chromosome so they die (only 1 X chromosome)

For the males who are living (III 6,11 shown in pedigree), they have been lucky to survive due to mosaicism! ;)