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

Some recent contributions

... moxomonkey made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
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submitted by moxomonkey(2)

the lack of Howell jolly bodies in asplenic patients is suggestive of accessory spleen


... moxomonkey made a comment on nbme23/block3/q#18 (A patient with a 20-year history of type 1 diabetes...)
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submitted by moxomonkey(2)

glucagon secretion is inhibited by hyperglycemia, somatostatin and insulin FA2019 - 325


... neovanilla made a comment on nbme20/block4/q#6 (A 51-year-old man develops diaphoresis, tachycardia,...)
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submitted by neovanilla(0)

For those curious why it's not D, the way I reasoned it out was that 1. they were referring to opioids, so 2. withdrawal would be

Diarrhea (opposite of constipation that they feel) + nausea Mydriasis (opposite of the miosis) Piloerection Seizures are rare, and they're more associated with alcohol (and also benzos) You may get mild hypertension


... neovanilla made a comment on nbme20/block4/q#21 (A 47-year-old woman comes to the physician because...)
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submitted by neovanilla(0)

Why the other answer choices aren't correct

A - Not an anaphylactic reaction mainly due to chronicity (consumption of soy, which has glycoproteins that people may have allergies towards)

B - Not asthma (characterized by more acute episodes of bronchoconstriction, wheezing)

D - Anemia (B6, B9, B12), or maybe a pulmonary embolism due to B9 or B12 deficiency --> elevated homocysteine levels --> thrombosis --> DVT?

E - Pulmonary anthrax; The time course would be much more acute, and would also present with symptoms of flu-like symptoms. Rapid death too


... neovanilla made a comment on nbme20/block4/q#47 (A 61-year-old man has erectile dysfunction due to...)
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submitted by neovanilla(0)

A = Maybe the superficial dorsal vein

B = Areolar tissue

C = Urethra (surrounded by corpus spongiosum)

D = Corpus cavernosum (correct answer)

Sildenafil increases blood flow to the penis by dilating the corpus cavernosum (increased NO via inhibition of PDE5 --> cGMP --> smooth muscle relaxation). It doesn't actually affect the blood vessels supplying the corpus cavernosum, I believe


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

The crux of the question is asking, if the patient feels decreased pain (which is driven by opioid molecules; that's why opioids are administered as painkillers), then how do you stop the inhibition? An opioid antagonist (naloxone is the only one that is an antagonist)


... ibestalkinyo made a comment on nbme20/block1/q#35 (A 70-year-old man dies of coronary artery disease....)
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submitted by ibestalkinyo(0)

The corticospinal tract runs from the cerebral cortex (Pre-Central Gyrus), through the posterior limb of the internal capsule, and into the posterior portion of the brainstem where they form highly myelinated medullary pyramids. These travel down the spinal cord, decussate and synapse of lower motor neurons in the ventral horn of the spinal cord.

A past history of cerebral infarction must have affected this patient's left middle cerebral artery and through Wallerian degeneration, the left medullary pyramid degenerated.

Destruction of the left corticospinal tract before decussation leads to contralateral spastic hemiparesis (since this is an upper motor neuron lesion.


... pg32 made a comment on nbme21/block4/q#27 (A 65-year-old woman is being treated in the hospital...)
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submitted by pg32(5)

The only way to get this question correct is to break the rules of the hospice center because you assumed there was a romantic relationship between the women. Couldn't be more straightforward.


... taediggity made a comment on nbme22/block3/q#2 (A 30-year-old man is brought to the emergency...)
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submitted by taediggity(1)

So this patient is essentially in hypovolemic shock because he's hemorrhaging blood from the aorta.

A) You'd have increased ADH to conserve volume B) You'd have increased BUN:Cr ratio b/c due to a decrease in blood flow C) Increased TPR naturally due to less pressure on barorecptors D) Decreased Capillary hydrostatic pressure b/c they have decreased volume E) Decreased Carotid sinus firing rate b/c less pressure F) The Answer: RAAS is activated -


... maleehaak made a comment on free120/block2/q#36 (An 8-year-old boy is brought to the office by his...)
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submitted by maleehaak(0)

pink eye,pharyngitis,hemorrhagic cystitis,and given live vaccine for military recruits.


... maleehaak made a comment on free120/block2/q#16 (A 14-year-old boy is brought to the physician for a...)
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submitted by maleehaak(0)

klinefelter,hyper hypogonadisim, dec testosterone,inc estrogen inc LH and FSH.


... maleehaak made a comment on free120/block2/q#16 (A 14-year-old boy is brought to the physician for a...)
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submitted by maleehaak(0)

if it was steroids , he must have acne,aggressive behavior,testicular atrophy,raised RBC mass,and gynecomastia.


... nicsar made a comment on nbme23/block2/q#47 (A 65-year-old man is scheduled for physical therapy...)
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submitted by nicsar(0)

a)abduction: supraspinatus-deltoid-triceps-serratus anterior

b)adduction: subscapularis-pectoralis major-lattisimus dorsi- teres major

c)extension=horizontal abduction; post. deltoid, infraspinatus, teres minor

d)internal rotation: subscapularis

for isolated work out, d is better.

TEN REPS.


... beanie368 made a comment on nbme22/block4/q#14 (In patients with adenosine deaminase deficiency,...)
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submitted by beanie368(2)

I did not know the mechanism of how dATP is harmful, although I knew that it was lymphotoxic. You can check out U world question ID: 15293 for a pretty good explanation


... pg32 made a comment on nbme21/block3/q#12 (A 55-year-old man with hypertension comes to the...)
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submitted by pg32(5)

NBME/Uworld love to test renal artery stenosis in the setting of hypertensive urgency/emergency. Just because this has been done so many times, you can basically get the right answer from the first half of the question. Pt with end organ issues (headache, confusion) and really high BP (I know it isn't 180/120, but it is really high). So this guy basically has hypertensive emergency. I'm already thinking it's renal artery stenosis. Next sentence? A bruit over the left abdomen. Bingo. Renal artery stenosis, most often caused by atherosclerosis in older men (as compared to fibromuscular dysplasia in younger women).


... taediggity made a comment on nbme22/block4/q#31 (A 65-year-old man comes to the emergency department...)
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submitted by taediggity(1)

2/6 systolic murmur over the left sternal border,an S3 (increased LV filling), low 02 sat, figured this patient had hypertrophic cardiomyopathy and early signs of CHF, so the answer was crackles from the pulmonary edema from fluid back up from the HF as brise pointed out below the 1st comment.


... wheredidbuzzwordsgo made a comment on nbme23/block4/q#1 (A 65-year-old man is brought to the emergency...)
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submitted by wheredidbuzzwordsgo(0)

Seems like I did what most of you did. I read the "symptom" as pain and went for PGE2.

Turns out if I had just read the 2008 paper Undiscovered role of endogenous thromboxane A2 in activation of cardiac sympathetic afferents during ischaemia I would have known that TXA2 MAY be a cause of MI pain. https://www.ncbi.nlm.nih.gov/pubmed?term=18483073

There are also theories that the pain is from adenosine/bradykinin/acid/ROS/5-HT which you can read about here:

https://www.ncbi.nlm.nih.gov/pubmed?term=10099685 https://www.ncbi.nlm.nih.gov/pubmed?term=10222339 https://www.ncbi.nlm.nih.gov/pubmed?term=11458709 https://www.ncbi.nlm.nih.gov/pubmed?term=12411532

I found these via the UpToDate page Angina pectoris: Chest pain caused by coronary artery obstruction which does say the mechanism is "complex and not entirely understood."


... epiglotitties made a comment on nbme20/block4/q#10 (A 65-year-old woman who has a 25-year history of...)
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submitted by epiglotitties(1)

There is an abnormally decreased function of the hydroxylation of proline because the 2nd stage in collagen synthesis (hydroxylation of specific proline and lysine residues) requires vitamin C. Since this patient has Scurvy (vit. C deficiency), this process is unable to occur.


... donttrustmyanswers made a comment on nbme18/block2/q#8 (39 yo man, polycystic kidney disease)
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submitted by donttrustmyanswers(0)

Uremia = Metabolic acidosis = Bicarb is low. High respiration = Low Co2; for respiratory compensation.


... donttrustmyanswers made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
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submitted by donttrustmyanswers(0)

The fallopian tubes should leak contrast because there is a gap between fallopian tubes and ovary. I.e. if there is no spillage, that means there is a blockage = infertility!


... donttrustmyanswers made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
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submitted by donttrustmyanswers(0)

According to UpToDate:

At levels below 886 mg/dL (10.0 mmol/L), the risk of pancreatitis appears to be quite small [76-78]; however, it is reasonable to consider drug therapy at levels of 500 mg/dL (5.6 mmol/L) or above in patients with a prior episode of pancreatitis.

Bonus: They say fenofibrate>gemfibrozil always.


... xlulu made a comment on nbme24/block2/q#32 (A 35-year-old woman undergoes a left oophorectomy...)
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submitted by xlulu(1)

Ureter courses retroperitoneally, close to gonadal vessels-> at risk of injury during ligation of ovarian vessels. FA 2020 pg 625


... adong made a comment on nbme23/block2/q#3 (A prospective study is done to assess the relative...)
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submitted by adong(10)

By default you should use intention to treat analysis b/c it's the most conservative.


... adong made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
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submitted by adong(10)

You can answer by process of elimination. "Competitive interactions" makes you think stimulatory NT. Cross out GABA and glycine. In the cortex so glutamate. Metabotropic would mean there's second messengers involved and the receptor would not transmit calcium. Hence NMDA.


... hvancampen made a comment on nbme24/block2/q#7 (A 75-year-old man with a 10-year history of...)
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submitted by hvancampen(0)

According to lumen, "the Bowman’s capsule space exerts hydrostatic pressure of its own that pushes against the glomerulus. Increased Bowman’s capsule hydrostatic pressure will decrease GFR, while decreased Bowman’s capsule hydrostatic pressure will increase GFR.

An example of this is a ureter obstruction to the flow of urine that gradually causes a fluid buildup within the nephrons. An obstruction will increase the Bowman’s capsule hydrostatic pressure and will consequently decrease GFR."

https://courses.lumenlearning.com/boundless-ap/chapter/physiology-of-the-kidneys/


... garima made a comment on nbme20/block4/q#44 (A 45-year-old man comes to the office for counseling...)
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submitted by garima(3)

Because of the starchy nature of bread, rice, and pasta, after your surgery, they can form a paste in your throat that is hard to swallow without liquid. In some cases, they can block the stoma, the hole to the pouch that is your new stomach. You don’t have to completely reject these high-starch foods, but it’s best to avoid them in the beginning. When you do eat them, try to have very small portions and make sure that you only eat small bites of each.


... adong made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
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submitted by adong(10)

If you're confused by the systolic murmur look at FA2019 p.288. ASD can cause systolic ejection murmurs in the pulmonic location (can think of it as increase turbulent flow).

Of course the more important thing is fixed splitting so SMASH away.


... adong made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
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submitted by adong(10)

In addition to what has already been said I think an important point in the question was regulatory adjustments which points more towards arteriolar regulation.


... adong made a comment on nbme23/block4/q#44 (A 44-year-old man is brought to the emergency...)
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submitted by adong(10)

tricky image but question is asking more specifically about his visual complaints which is just "double vision" so IR entrapment is the best answer


... h0odtime made a comment on nbme21/block2/q#44 (A 75-year-old man has the sudden onset of partial...)
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submitted by h0odtime(4)

... rainlad made a comment on nbme23/block4/q#12 (Investigators conduct a prospective, community-based...)
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submitted by rainlad(1)

my approach to this question was to eliminate all the answer choices that mentioned specificity or sensitivity, since the data here did not provide information about any sort of screening test.

that left me with two possible answer choices: I eliminated the one about consistency of other studies, since no other studies were mentioned in the question stem.

not sure if I oversimplified things, but it led me to the right answer!


... h0odtime made a comment on nbme21/block1/q#41 (A 35-year-old woman comes to the physician because...)
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submitted by h0odtime(4)

Heme Mnemonics


... adong made a comment on nbme23/block1/q#10 (A 13-year-old girl is brought to the office because...)
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submitted by adong(10)

I don't think you're supposed to know any complicated niche piece of knowledge. You have to infer that the pt has a skin lesion and is therefore prone to skin infections, most commonly from Staph aureus.


... h0odtime made a comment on nbme21/block1/q#50 (A photograph is shown of a myelin-stained cross...)
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submitted by h0odtime(4)

Thoracic Cross Section Reference


... h0odtime made a comment on nbme21/block1/q#45 (An 18-year-old man comes to the physician because of...)
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submitted by h0odtime(4)

... h0odtime made a comment on nbme21/block1/q#36 (A 51-year-old woman comes to the physician because...)
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submitted by h0odtime(4)

Labels

Credit to Histo_Man/reddit


... h0odtime made a comment on nbme21/block4/q#24 (A 56-year-old man undergoes a renal transplant. Five...)
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submitted by h0odtime(4)

Transplant Rejections (p.119)

Transplant Types

ABCD Hypersensitivity (p.112 FA2020)


... suckitnbme made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
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submitted by suckitnbme(4)

I was stuck between mitral and aortic and went with aortic because the L ventricle looks enlarged, possibly hinting that the patient had aortic stenosis.


... mcdumbass made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
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submitted by mcdumbass(0)

I thought thought measuring a gas in the blood only measures partial pressure of dissolved gas in the blood


... garima made a comment on nbme20/block3/q#39 (A 19-year-old woman has severe refractory pustular...)
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submitted by garima(3)

I think the question asks 'if it binds to RXR, what happens?'

The retinoid X receptor (RXR1) is an intriguing and essential member of the steroid/thyroid hormone superfamily of nuclear receptors (NRs) that predominately function as transcription factors with roles in development, cell differentiation, metabolism, and cell death

which means its related with development etc


... almondbreeze 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 almondbreeze(5)

FA 2019 pg 455 on avascular necrosis of bone: Infarction of bone and marrow, usually very painful. Most common site is femoral head (watershed zone) (due to insufficiency of medial circumflex femoral artery). Causes include Corticosteroids, Alcoholism, Sickle cell disease, Trauma, SLE, "the Bends" (caisson/decompression disease), LEgg-Calve- Perthes disease (idiopathic), Gaucher disease, Slipped capital femoral epiphysis- CASTS Bend LEGS.


... osler_weber_rendu made a comment on free120/block3/q#15 (A 46-year-old woman with active ankylosing...)
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submitted by osler_weber_rendu(1)

Monoclonal Antibodies are always last resort! I just use this as a general rule


... usmlehulk made a comment on nbme22/block4/q#16 (A 4-month-old boy is brought to the office by his...)
 +1  upvote downvote
submitted by usmlehulk(2)

can someone please explain this question. i thought the patient is actually having cleft lip and palate, but why is the correct answer addressing only the cleft lip.


... mrglass made a comment on nbme23/block2/q#42 (A 63-year-old woman comes to the physician because...)
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submitted by mrglass(3)

I figured this was a variable intrathoracic obstruction and got it wrong.

According to UpToDate, INTRAluminal tracheal obstruction is varaible, while EXTRAluminal tracheal obstruction (like in this case) is fixed.


... almondbreeze made a comment on nbme22/block4/q#34 (A 17-year-old boy comes to the physician because of...)
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submitted by almondbreeze(5)

uw: EBV commonly infects B cells, stimulating them to enter the cell cycle and proliferate continuously ("transformation or "immortalization"). this is accomplished when EBV-encoded activate proliferative and anti-apoptotic signaling pathways w/i the infected B cell. ... the immortalized B cells maintain the ability to secrete Ig and B-cell activation products (eg. CD23), with very few of them releasing virus particles at any one time.


... almondbreeze made a comment on nbme22/block4/q#28 (A 48-year-old man comes to the emergency department...)
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submitted by almondbreeze(5)

UW: the short gastric vv drain blood from the gastric funds into the splenic vein, pancreatic inflammation (e.g. pancreatitis, pancreatic ca.) can cause a blood clot w/i the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varies only in the funds


... almondbreeze made a comment on nbme22/block4/q#19 (A 76-year-old man with a 1-month history of a...)
 +1  upvote downvote
submitted by almondbreeze(5)

a good pic showing anomalous arteries in horseshoe kidney

https://www.researchgate.net/figure/A-case-of-horseshoe-kidney-with-accessory-renal-arteries-Posterior-aspect-of-the_fig1_313729399


... dartosfascia made a comment on nbme24/block1/q#42 (A 68-year-old woman with acute myelogenous leukemia...)
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submitted by dartosfascia(0)

Why would you give GMCSF to someone with AML?? Isn't the whole goal of treatment to knock out the granulocytes? I feel like giving someone GMCSF after they were JUST treated for AML is asking for a relapse but what the hell do I know.


... saturdaynightpalsy made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
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submitted by saturdaynightpalsy(0)

So we are just supposed to know that poodles are hypoallergenic...

I put "get an air cleaner" because I thought asking the roommate to stop smoking would be beyond the scope of the physician and since I didnt know poodles were hypoallergenic, I thought "well, even if the roommate stopped smoking, she'll still have issues because of the pet dander."

cries


... usmlehulk made a comment on nbme22/block2/q#27 (A 50-year-old man who has smoked 2 packs of...)
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submitted by usmlehulk(2)

can anyone please explain why option E which is increased in Urinary pH is not the correct answer. becasue hydrogen wasting is also a form of correcting respiratory acidosis.


... euchromatin69 made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
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submitted by euchromatin69(0)

pregnancy is a risk factor for acute pyelonephritis FA 2019 pg 589


... djtallahassee made a comment on nbme22/block3/q#10 (A 50-year-old man comes to the physician for...)
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submitted by djtallahassee(1)

Wouldn't telling the patient about the referral do more harm than good?

  1. Pt considers it a bribe and leaves
  2. Ruins study due to placbo effects
  3. Puts doc/hospital at risk for potential legal hassle.

I guess maybe I read it as a study when it really is just a referral but its not that much of a leap to think that this "experimental"" treatment is part of a study


... sammyj98 made a comment on nbme20/block2/q#35 (A 36-year-old woman comes to the office because of a...)
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submitted by sammyj98(4)

maybe I overthought this one, but doesn't she have free air in the bottom left? Or is that the bottom of the pleural space...


... pg32 made a comment on nbme20/block4/q#48 (A 24-year-old man comes to the emergency department...)
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submitted by pg32(5)

Can anyone explain why the lipase concentration is so high if there is an issue with LPL in hyperchylomicronemia?


... mbourne made a comment on nbme20/block2/q#48 (A sedentary 50-year-old man with hypertension comes...)
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submitted by mbourne(6)

I think that if they had something like "statin therapy" as an answer choice, we would have an argument for that as it would decrease mortality by helping prevent ANOTHER heart attack. However, I think that anti-depressant therapy will do a LOT to prevent suicide, while omega-3 fatty acids (healthy as they are) wouldn't do AS MUCH to prevent a heart attack.

The question is basically asking, "You can only prescribe one of these to keep this dude alive as long as possible. Which one will have the best chance at accomplishing that?"

Therefore, the answer should be anti-depressant therapy.


... mbourne made a comment on nbme20/block2/q#38 (A 50-year-old woman with a restrictive pulmonary...)
 +0  upvote downvote
submitted by mbourne(6)

In restrictive lung disease, literally all lung values are DECREASED ("restricted") except for the FEV1/FVC ratio. FEV1/FVC ratio may be normal or increased (increased only if FEV1 decreases a bit less than the decrease in FVC, resulting in an increased ratio).


... mbourne made a comment on nbme20/block2/q#23 (Which of the following changes in the cardiovascular...)
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submitted by mbourne(6)

Although everyone's arteries WILL get stiffer as we age, every single person will not develop coronary atherosclerosis and mitral stenosis. Will the valves become a bit stiffer? For sure! Will they develop "mitral stenosis"? No, that is not congruent with "normal aging".

"Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic‐diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805932/


... mbourne made a comment on nbme20/block3/q#39 (A 19-year-old woman has severe refractory pustular...)
 +5  upvote downvote
submitted by mbourne(6)

This is a mish-mash of information I can find on this subject. Can't find good info on this anywhere. I think this question sucks

"Isotretinoin has a low affinity for retinoic acid receptors (RAR) and retinoid X receptors (RXR), but may be converted intracellularly to metabolites that act as agonists of RAR and RXR nuclear receptors.

In the nucleus of a cell, retinoic acid acts as a ligand, which is a molecule that binds to a site on a specific protein, to activate two families of transcriptional factors. These two families are the retinoic acid receptors (RAR) and retinoid X receptors (RXR), which bind to genes that respond to retinoic acid. There are three forms of RARs and three forms of RXR.

Studies with in vitro rat embryos have shown that retinoids act directly on the embryo, causing those embryo to develop abnormally."


... rossiememe made a comment on nbme23/block3/q#10 (An investigator is studying two drugs, Drugs X and...)
 +4  upvote downvote
submitted by rossiememe(4)

DOSE x F = AUC x CL

(F= Bioavailability)

If dose is constant and F is increased for Drug X then AUC would increase.


... jinzo made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +4  upvote downvote
submitted by jinzo(5)

A - nucleus ( with nucleolus inside ) B - mitochondria C - RER ( you can see attached ribosomes ) D - ?? may be lysosomes E - glycogen granules


... em_goldman made a comment on free120/block3/q#15 (A 46-year-old woman with active ankylosing...)
 +4  upvote downvote
submitted by em_goldman(6)

Rituximab (anti-CD 20) is currently undergoing trials for AS. My sparse googling just now shows that rituximab probably only has a moderate effect, so probably second-line to anti-TNFa therapy. Probably.

Safe to say for boards that AS: TNFa > CD20


... adong made a comment on nbme22/block1/q#49 (A 17-year-old primigravid woman at 16 weeks'...)
 +1  upvote downvote
submitted by adong(10)

the patient is pregnant so not doxy. azithro is alternative (see sketchy vid)


... adong made a comment on nbme22/block4/q#44 (A 10-year-old boy has bruised easily since...)
 +1  upvote downvote
submitted by adong(10)

Dicumarol is in the coumarin family which includes warfarin. It helps if you think about warfarin's brand name Coumadin. Coumadin, coumarin, dicumarol...all the other derivatives have COUM it in some fashion


... adong made a comment on nbme22/block4/q#45 (An 1814-g (4-lb) male newborn is delivered in the...)
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submitted by adong(10)

neuroendocrine cells doesn't always mean neural crest


... em_goldman made a comment on free120/block1/q#9 (During an experiment, a Southern blot analysis is...)
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submitted by em_goldman(6)

I believe (pls correct me if I'm wrong) you would have similar Southern blot results seen in B cells undergoing somatic hypermutation, but that takes place in the secondary lymphoid tissue, not in the bone marrow.


... poisonivy made a comment on nbme21/block3/q#19 (A 25-year-old woman develops increasing shortness of...)
 +5  upvote downvote
submitted by poisonivy(10)

this is actually a UW question (14992) Peripartum cardiomyopathy manifests as a dilated cardiomyopathy, can occur during last month of pregnancy or within 5 months after delivery, pathogenesis poorly understood, but may be related to impaired function of angiogenic growth factors (e.g VEGF) or predisposed by mutations in cardiac structural proteins.


... blahblahblah made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +0  upvote downvote
submitted by blahblahblah(0)

Melanin in darkly pigmented skin can provide an SPF (sun protective factor) of 1.5 - 4. Amount of UV light getting through is 1/SPF, so a SPF of 4 reduces UV radiation by 75%. So the areas without this protective feature are most at risk (palms/soles).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/


... adong made a comment on nbme22/block1/q#38 (A newborn born at 26 weeks' gestation has...)
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submitted by adong(10)

literally know every single name they can possibly call this


... hungrybox made a comment on nbme20/block3/q#7 (A 10-year-old boy has a palpable mass in the ventral...)
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submitted by hungrybox(309)

The endoderm of the 3rd and 4th pouches form the parathyroid gland and the parafollicular cells of the thyroid gland.


... adong made a comment on nbme22/block1/q#2 (A 28-year-old man has recurrent pancreatitis...)
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submitted by adong(10)

from uworld: fibrates activate PPAR-alpha to increase LPL and decrease VLDL production


... adong made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
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submitted by adong(10)

uworld says somewhere that testosterone increases hematocrit, increases LDL, and decreases HDL


... adong made a comment on nbme22/block4/q#43 (A 44-year-old man comes to the physician because of...)
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submitted by adong(10)

got confused by the systolic pulsation of the liver but basically regurgitant blood from RV will go into RA > IVC > hepatic veins


... hungrybox made a comment on nbme20/block3/q#33 (A 31-year-old woman receives a prescription for...)
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submitted by hungrybox(309)

Here's my reasoning for why the answer I chose was wrong...

Casein is a milk protein. Because most milk is pasteurized, all proteins will be denatured before consumption, and would not have any effects (Choice B).

This is in contrast to avidin, which is found in RAW eggs and binds vitamin B7 (biotin), preventing carboxylation.

...

bullshit question btw 😡


... adong made a comment on nbme22/block3/q#8 (A 38-year-old man who lives at sea level flies to a...)
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submitted by adong(10)

the question can easily be misinterpreted. it's asking for urinary pH, urinary bicarb, and urinary volume


... adong made a comment on nbme22/block4/q#30 (A 27-year-old man who is a construction worker is...)
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submitted by adong(10)

hit the kidney so retroperitoneal. leaves only the duodenum and splenic flexure. kidneys are more lateral structures so splenic flexure (at turn of descending colon)


... adong made a comment on nbme22/block2/q#7 (A 66-year-old man comes to the physician because of...)
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submitted by adong(10)

Pretty much if they can masturbate or get it up alone in any way their nocturnal tumescence should be normal meaning that their innervation and reflex pathways are all intact. Libido aka sex drive from what I’ve seen so far is altered by depression. So like in the question on NBME 21 the stem stated that screening for depression was negative which is why libido would also be normal in this case. If there’s ever a Q with a depressed guy and normal lab values and physical exam, most likely gonna be decreased libido with normal night erections - courtesy of /u/diffuseaxonalinjury


... adong made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
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submitted by adong(10)

you need to add an amine (nitrogen) and most biochem processes from sugar --> amine requires glutamine


... adong made a comment on nbme22/block3/q#35 (A 4-year-old boy is brought to the physician by his...)
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submitted by adong(10)

Super annoying they are using the same picture BUT you can answer with process of elimination. No mass in the picture so not nephroblastomatosis or RCC. 4 year old so not amyloidosis. Stem does not really cue you into membranous GN. Instead it talks about UTIs which would have inflammatory processes --> interstitial inflammation.


... poisonivy made a comment on nbme21/block3/q#30 (A 41-year-old man comes to the physician because of...)
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submitted by poisonivy(10)

question #15553 in UW explains this one well. Basically, C5 branches innervate Deltoid (abduction) and Infraspinatus(external rotation) and C6 Biceps (forearm flexion), so the right option should be abduction of the upper extremity.

I got it wrong though lol


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

what I'm thinking is, normally the perineal body is cut during a posterior episiotomy. so reading over the question again, the last line "which is at greatest risk for damage IF this incision is TORN FURTHER during delivery" Torn further being the key imo.

as for why it isn't bulbospongiosus or ischocavernosis -> https://en.wikipedia.org/wiki/Transverse_perineal_muscles#/media/File:1116_Muscle_of_the_Female_Perineum.png


... samsam3711 made a comment on nbme21/block2/q#24 (A 65-year-old man dies in a motor vehicle collision....)
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submitted by samsam3711(0)

Esophageal squamous cell cancers are more common in smokers


... rainlad made a comment on nbme21/block3/q#12 (A 55-year-old man with hypertension comes to the...)
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submitted by rainlad(1)

How do we explain the bruit in this case? Also why isn't it left artery aneurysm? That seems like it would better explain the bruit


... rainlad made a comment on nbme21/block3/q#38 (A 28-year-old man develops a temperature of 39.9°C...)
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submitted by rainlad(1)

would we be worried about using G-CSF given that he has acute leukemia? would it stimulate growth of his cancer cells?


... umbriix made a comment on nbme21/block1/q#20 (A 10-year-old girl develops fever, malaise, and loss...)
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submitted by umbriix(0)

https://www.amboss.com/us/knowledge/Rabies

two different types of rabies


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

} Pathology – CFTR mutation - Pts usually do NOT have cystic fibrosis phenotype, but are only carriers } Presentation Low-volume, acidic azoospermic ejaculate


... hungrybox made a comment on nbme20/block1/q#5 (A 24-year-old African American man comes to the...)
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submitted by hungrybox(309)

I did this by process of elimination:

Acne is not itchy or painful from my experience (Choice A).

Never heard of cutaneous lupus eryhtematosus, but I'd asssume you'd have a malar rash (involving the nose/undereye area), not spread out over the cheeks, jaw, and neck (Choice B).

Keloids are just overgrown scars. Scars are not particularly itchy or painful (Choice C)

Rosacea is just redness/flushing in certain areas of the skin. Mainly an aesthetic issue. Not itchy or painful (Choice E).

tbh I was between B and D.


... hungrybox made a comment on nbme20/block1/q#30 (A 33-year-old woman comes to the emergency...)
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submitted by hungrybox(309)

Here's my approach (downvote if wrong):

falling on outstretched arm → usually scaphoid

BUT

scaphoid problem → pain in anatomical snuffbox

so then it goes to the next most commonly injured bone when you fall on an outstretched arm, your lunate

(which is right next to the scaphoid)


... readit made a comment on nbme21/block2/q#35 (A 4-month-old female infant is brought to the...)
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submitted by readit(3)

The key to this question is that the patient is 4 months old and getting water.

Newborns should NOT be getting plain water until after 6 months of age because it can cause hyponatremia --> seizures


... readit made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
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submitted by readit(3)

Addition to Hungrybox's explanation:

Why it's not 47,XXY:

This would be referring to Klinefelter's, which is characterized by small, poorly functioning testicles.

However, question states "morphologic studies of a biopsy specimen of the testes show no abnormalities"


... almondbreeze made a comment on nbme20/block4/q#14 (A 60-year-old man has a round, semitransparent...)
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submitted by almondbreeze(5)

'round, semitransparent nodules'

FA2019 p.473 says BCCs are waxy, pink, pearly nodules


... nicsar made a comment on nbme22/block2/q#21 (A newborn has cyanosis, tachypnea, and retractions...)
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submitted by nicsar(0)

Pco2 Is high, acidosis; Respiratory acidosis.

If Compensated well, ΔHCO3-= E(Erythrocytiv compensation)ΔPCO2/10, (1~2)(65-40)/10=2.5~5 >> ΔHCO3=15-24=-9, not compensated, even less HCO3-; Combined metabolic acidosis.

for, Kidney compensation. use 3~4 instead of 1~2 in erythrocyctic compensation. and with this, the Gap between well compensated and the case even farther.


... drbravojose made a comment on nbme22/block2/q#23 (A 32-year-old woman comes to the physician because...)
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submitted by drbravojose(1)

FA 2019 p156 Does anyone know how to differentiate the picture labeled Trypanosoma brucei and cruzi?


... readit made a comment on nbme21/block1/q#25 (A 28-year-old man is brought to the emergency...)
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submitted by readit(3)

Why is is not pseudo aneurysm?

"Aortic pseudoaneurysms typically occur as a result of trauma +/- intervention, a considered subset of traumatic aortic injury in the majority of cases. They can be acute or chronic."

https://radiopaedia.org/articles/aortic-pseudoaneurysm?lang=us


... readit made a comment on nbme21/block3/q#36 (Which of the following best explains why the use of...)
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submitted by readit(3)

An anti-idiotypic antibody is an antibody which binds an antibody.

As an example, an anti-idiotypic antibody be helpful for treating a naiive B cell prior to activation, which express IgM and IgD on their surfaces. This is because the anti-idiopathic antibody can bind to the IgM/IgD antibody on the surface of a naiive B cell.

Multiple Myeloma cells, however, are made up of Plasma cells, which no longer express Ig's on their surface like naiive B cells do. Thus, there is no surface antibody [aka "membrane bound surface immunoglobulin"] for an anti-idiotypic antibody to bind to.


... readit made a comment on nbme21/block3/q#16 (A 16-year-old boy is brought to the physician...)
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submitted by readit(3)

Why it is not MVP:

Full quotation from UpToDate: "Symptoms [... such as] various nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, and dizziness have been attributed to MVP. However, symptoms are not reliable indicators of MVP. Furthermore, symptoms frequently seen in individuals with MVP have not been conclusively determined to be more prevalent than in the general population. As an example, in a study of 147 patients referred for echocardiography for suspected MVP, the presence of symptoms was not associated with MVP on echocardiography (found in 22 percent) [43]. (See "Mitral valve prolapse syndrome".)"


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

Hyponatremia from Heartfailure pt.

It should be approached from Heart faiure.

HF-> RAAs -> excessive Aldosterone, ADH; ANP escape faiure, like secondary hyperaldosteronism; Hyponatremia

https://www.wjgnet.com/1949-8462/full/v5/i9/WJC-5-317-g001.htm


... fatboyslim made a comment on nbme21/block3/q#39 (A 74-year-old woman with mild dementia is admitted...)
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submitted by fatboyslim(2)

4 criteria must be met to know if a patient has capacity (taken from Dirty Medicine'sYouTube channel): "ICAL"

I: patient is fully INFORMED about the decision at hand (e.g. doctor tells patient you had a lung infection which worsened and spread to your blood and you become septic then you developed cardiac arrest and we had to perform CPR on you and give you epinephrine to bring yo ass back)

C: patient COMMUNICATES their decision (e.g. explicitly says "I want to be discharged")

A: patient APPRECIATES the nature and severity of the illness (e.g. doctor tells patient you might die if you leave against our medical advice and then the doctor asks the patient to repeat it back to make sure he comprehended that fact)

L: patient can explain their decision in a LOGICAL and linear fashion (e.g. patient says his dad was in an ICU before with many tubes and blood samples being drawn and was on a ventilator and the patient doesn't want to end up like his dad)

NOTE: the patient's "logical" explanation of their decision does NOT have to actually be a good medical decision. As a doctor, you can disagree with their poor medical choice, but as long as the patient came to that decision with capacity intact, then you should respect their decision (autonomy).


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

After I did this NBME, I got QID 166 wrong (I put niacin); and now I'm not sure which is the right way to think about it. In 166, the pt has hyperTG and answer is to treat him with fibrates to prevent recurrences - idk if anyone else had this confusion.


... foxo made a comment on nbme18/block3/q#5 (82 yo woman, 24 hours of constant severe lower abdominal pain)
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submitted by foxo(0)

Fibrin deposition initiated by peritonitis is thought to be an important local defense mechanism because it sequesters and walls off bacterial spillage."

Rotstein 1986


... mrglass made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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submitted by mrglass(3)

The way I remember the essential amino acids is by referencing the amino acids groups I already know. So the essential amino acids are:

  1. The branched chain amino acids: Isoleucine, Leucine, and Valine

  2. The ringed amino acids EXCEPT Tyrosine (which becomes essential in those with PKU): Tryptophan, Histidine, Phenylalanine

  3. The sulfur containing amino acids: Cysteine and Histidine (You will see debate over whether Cysteine qualifies as essential or not)

  4. The two you just have to memorize: Threonine and Lysine