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

Some recent contributions

... diabetes made a comment on nbme23/block2/q#4 (An 18-year-old woman comes to the physician because...)
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submitted by diabetes(3)

can somebody explain how energy production by glycolysis increased, since aerobic glycolysis produce 32 net ATP,compare to 2 net ATP through anaerobic glycolysis ?


... resolutestorm made a comment on familymed1/block0/q#27 (A 62-year-old woman comes to the physician because...)
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submitted by resolutestorm(0)

The person is presenting with symptoms of CHF (dyspnea on exertion, pitting edema) as well as b/l basilar crackles all of which indicate a fluid overloaded state. In addition, there is cardiac dysfunction with improper pumping of the blood. Due to decreased cardiac output, the body perceives this as a "hypovolemic" state and causes the release of hormones like ADH and Renin in an effort to reabsorb water to bring the volume up. While the patient is having extracellular fluid accumulation (edema) the arterial blood volume is low which is what causes the "hypovolemic" state.


... resolutestorm made a comment on familymed1/block0/q#17 (A 56-year-old woman comes to the physician because...)
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submitted by resolutestorm(0)

rash seems to be that of shingles. Age range also matches up. Antiviral is the best option


... resolutestorm made a comment on familymed1/block0/q#5 (A 62-year-old woman comes to the physician because...)
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submitted by resolutestorm(0)

I believe that metformin is contraindicated due to Patients with renal disease having a higher chance of lactic acidosis. This patient has increased BUN and Cr indicating renal disease


... lovely made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
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submitted by lovely(0)

It appears that both the genitofemoral nerve (genital branch) and the ilioinguinal nerve both are external to the spermatic cord and at the superficial inquinal canal. Depending on location of the genitofermal nerve makes a difference for what it innervates. It appears that the genitofemoral nerve (genital branch) innervates the lateral anterior surface of the srotum, while the ilioinguinal nerve innervates the anterior surface of the scrotum.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503924/

Google also says that the genital branch of the genitofemoral nerve can innervate the sensation of the skin of the anterior surface of the scrotum. Does it appears that either nerve choice would lead you to the correct answer?


... lovely 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 lovely(0)

Sources of nitrogen can be meat, eggs, and dairy product which he wasn't eating. The man had a low nitrogen intake but was still excreting nitrogen. Therefore, he had a negative nitrogen balance. A prolonged negative nitrogen balance may lead to a decrease in the plasma protein level, edema, anemia, lowered resistance to infection, increased susceptibility to certain toxic substances, the development of fatty liver or perhaps other serious sequel


... divya made a comment on nbme20/block3/q#10 (A 59-year-old man develops fatigue and decreased...)
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submitted by divya(1)

FA 2019 Pg 415

Prosthetic heart valves and aortic stenosis may cause hemolytic anemia secondary to mechanical destruction of RBCs.


... paulkarr made a comment on nbme23/block2/q#24 (A 46-year-old woman has a 1-day history of...)
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submitted by paulkarr(1)

Chronic Myelogenous Leukemia vs Leukemoid Reaction has a few differentiating features:

As vshummy pointed out FA-2019 pg 424 has all this information as well as UWorld problem...I just can't seem to find the Q.ID. Maybe someone else can tag-team in.


... drpatinoire made a comment on nbme22/block3/q#38 (A 73-year-old man comes to the physician with his...)
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submitted by drpatinoire(0)

Guys I have another thought.

Giving other choices are about his other abnormal values (increased creatine, glucose, uric acid), I guess the question is testing us which of these values will improve if his OSA is improved by CPAP.

Since OSA is one of the most important causes of idiopathic hypertension, it should come to us that once his OSA is treated, his hypertension will improve soon.

So "decreased BP" instead of other abnormal values.

(Thanks to my friends for hinting me about this!)


... paulkarr made a comment on nbme23/block2/q#37 (A 62-year-old woman is brought to the physician...)
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submitted by paulkarr(1)

I had a pretty straight forward line of thinking for this. Cool discolored leg automatically rules out problems elsewhere (all the brain related choices). We know blood has been cut off to the left foot. Specifically, there is an embolus in the arterial blood supply. (Venous would lead to a warm foot)

If you take into account the acute episodes of palpitations, it is plausible to think that she had some sort of A-Fib triggering a blood clot to break off and be sent through the systemic circulation. It then got lodged in the femoral artery cutting off poor g-ma's blood.


... paulkarr made a comment on nbme23/block2/q#22 (A 42-year-old man comes to the physician because of...)
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submitted by paulkarr(1)

Visceral Leishmaniasis aka. "Kala-Azar"

Caused by Leishmania Donovani. (an intracellular protozoan)

Transmitted via the Phlebotomine Sand Fly.

Treated with Amphoterrible B. Can also use Sodium Stibogluconate, miltefosine, or paromomycin.

Will commonly be seen with pancytopenia, fever, and splenomegaly are the three big clues. Other symptoms you can see are night sweats, blackening of the skin, scaly skin, weakness, and substantial weight loss. This will kill ya if you don't get treatment.


... flexatronn made a comment on nbme20/block1/q#4 (A 50-year-old man is brought to the emergency...)
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submitted by flexatronn(0)

This is metabolic acidosis with a HIGH anion gap, this scenario involves the "M" (methanol aka formic acid) in the mnemonic "Mudpiles"

Classic scenario for methanol (as per B&B) is suspected ingestion, suicide, alcoholic.....symptoms include confusion, VISUAL symptoms, HIGH AG metabolic acidosis

Treatment: Inhibit alcohol dehydrogenase or Ethanol


... yobo13 made a comment on nbme22/block4/q#46 (A 39-year-old woman comes to the physician because...)
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submitted by yobo13(1)

Easy way: Lab values. The only one that made sense/was different for men vs women = Hb


... ribosome01 made a comment on nbme22/block4/q#39 (A 5-year-old boy is brought to the physician because...)
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submitted by ribosome01(0)
SOMATIC CELLS RETINAL CELLS

HERE. RB 1st mutation(already+) 2nd mutation

SPORADIC RB Intact alleles Both spontaneous mutations in retinal cell


... flexatronn made a comment on nbme20/block2/q#16 (A 10-year-old boy with mild mental retardation is...)
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submitted by flexatronn(0)

This pretty much answers 3-4 of the mnemonic for tuberous sclerosis: "HAMARTOMASS"

H-amartomas in CNS and skin/ A-ngiofibromas/ M-itral regurgitation/ A-sh leaf spots (hypopigmented macule) / R-cardiac Rhabdomyoma/ T-uberous Sclerosis/ O-autosomal dOminant/ M-mental retardation / A-renal Angiomyolipoma/ S-eizures/ S-hagreen patches /


... maddy1994 made a comment on free120/block1/q#20 (An investigator is studying the incidence of the...)
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submitted by maddy1994(5)

stress increases cortisol..which decreases IL-2 activity,hence decreasing Th1 production and effects macrophages.


... medninja made a comment on nbme15/block2/q#29 (2-month-old male infarct, brought to ER, 2 days generalized tonic-clonic seizures)
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submitted by medninja(2)

This question sounded like botulism, anybody knows why is tetanus?


... divya made a comment on nbme20/block1/q#12 (72 yo woman with dysphagia)
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submitted by divya(1)

for anatomy dummies like myself


... divya made a comment on nbme20/block1/q#1 (A 37-year-old nurse is accidentally stuck with a...)
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submitted by divya(1)

For anyone interested, the current post exposure prophylaxis regimen contains - Tenofovir + Emtricitabine + Raltegavir

Link for PEP prophylaxis following occupational exposure


... diabetes made a comment on nbme22/block2/q#50 (An 18-month-old boy is admitted to the hospital...)
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submitted by diabetes(3)

i was hesitated between neurofibromatosis type1 and tuberous sclerosis ,the two have skin + brain lesions ,AD,but the first has 100% penetrance ,optic gliomas ,hperpigmented cafe-au-lait spots,no seizure,so seond is the answer.


... diabetes made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
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submitted by diabetes(3)

The pampiniform plexus, testicular artery, cremasteric artery, artery of the ductus deferens, lymphatic vessels, testicular sympathetic nerves, and ductus deferens all run deep to the internal spermatic fascia. The ilioinguinal nerve runs on the superficial surface of the external spermatic fascia The ilioinguinal nerve is a sensory nerve that innervates the skin over the groin region, the medial aspect of the thigh, the upper part of the scrotum and the penile root. It is normally encountered during open repair of inguinal hernia.


... hello36654 made a comment on nbme23/block2/q#16 (Which of the following best explains impaired action...)
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submitted by hello36654(0)

so why is "cessation of fast axonal transport" wrong? Don't myelinated axons, by definition, have fast conductance? So demyelinated axons would have "cessation of fast axonal transport", which is the answer A, right?


... imgdoc made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
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submitted by imgdoc(33)

I thought of it as, a Beta agonist would cause vasodilation, and reflex tachycardia, her pulse is already at 100, so it would jump higher. She could get palpitations and tremors. Probably the least likely explanation out of the rest though.


... hello36654 made a comment on nbme23/block2/q#9 (A 60-year-old man has had easy fatigability, loss of...)
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submitted by hello36654(0)

I understand why it's lung now, but I picked thyroid gland because often times thyroid tumors press on the parathyroid sitting above, which causes the parathyroids to secrete more Ca...can someone comment if they've read this too?


... alexp1101 made a comment on nbme20/block3/q#4 (An 18-year-old woman comes to the physician because...)
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submitted by alexp1101(0)

These atypical lymphocytes, aka Downey cells (Downey 1923), are actually activated CD8 T lymphocytes, most of which are responding to EBV-infected cells.

CD8+ T- cells increase in numbers in the blood stream and are activated (aka Downey cells, reactive lymphocytes or atypical lymphocytes because of their atypical presence in peripheral blood) to eliminate EBV infected B- lymphocytes.


... divya made a comment on nbme20/block4/q#1 (A 32-year-old man comes to the physician because of...)
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submitted by divya(1)

uworld q id - 582 for reference gonadotropins increase aromatase activity.

Aromatase activity is increased by - 1) age 2) obesity 3) insulin 4) gonadotropins 5) alcohol


... yobo13 made a comment on nbme24/block4/q#3 (A 23-year-old woman is brought to the emergency...)
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submitted by yobo13(1)

Can someone explain why it can't be Crohn's since that would also cause a non AGMA?


... mdsu 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 mdsu(1)

Lung abscess pic https://commons.wikimedia.org/wiki/File:Lung_abscess_(7468374032).jpg

Squamous cell carcinoma; Central - Hilar mass- Cavitation


... madojo made a comment on nbme24/block1/q#44 (A 24-year-old man is brought to the office because...)
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submitted by madojo(11)

Going over other answers:

Alteration in 30S ribsomal RNA refers to aminoglycosides, tetracyclines, glycylcylines Alternation in RNA polymerase refers to drug like Rifampin Alterations in penicillin binding proteins would be for penicillinases


... madojo made a comment on nbme24/block1/q#41 (A 32-year-old woman who is 20 weeks' pregnant has...)
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submitted by madojo(11)

Going through other answer choices:

Bismuth and Sucralfate is used for ulcer healing or travelers diarrhea, it provides physical protection by binding to the ucler base and allows bicarb secretion to establish pH gradient in mucous layer.

FamotiDINE is a H2 receptor blocker

Omeprazole is a PPI and increases risk of C diff infxn, and decreases Mg and Ca absorption (can cause fx in elderly)


... madojo made a comment on nbme24/block1/q#34 (A 62-year-old man comes to the physician for a...)
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submitted by madojo(11)

-Adenosine decreases AV node conduction used in SVT, and its side effects include flushing, hypotension, chest pain, impending doom. -Flecainide is a Sodium channel blocker Class 1C with strong Na channel blockage and its contraindicated in structural and ischemic heart disease. -Phenytoin is an anti epileptic, associated with teratogenicity, p450 induction, osteopenia


... madojo made a comment on nbme24/block1/q#7 (A 65-year-old woman comes to the physician because...)
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submitted by madojo(11)

This is transitional cell carcinoma aka urothelial carcinoma which is the most common urinary tract system tumor. On histo you expect to see fibrovascular core in a papillary tumor and dysplastic urothelium. It occurs with painless hematuria with no casts.

Predisposing risk factors: Pee Sac Phenacetin (NSAID), smoking, aniline dyes, and cyclophosphamide (alkylating agent that cross links DNA).

Vinyl chloride is incorrect because thats associated with angiosarcoma of the liver, because vinyl chloride is whats in PVC pipes (plumber). Schistosoma is a trematode fluke that is associated with squamous cell carcinoma of the bladder in which you would also see painless bleeding but see squamos cell and not really the papillary growth we see here.


... lilmonkey made a comment on nbme24/block4/q#31 (In a study of antibiotic resistance, a strain of...)
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submitted by lilmonkey(2)

Today I learned that different liberal species of bacteria can have conjugation. So nasty.


... lilmonkey made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
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submitted by lilmonkey(2)

The keyword is "INDEPENDENTLY"(associated). Which in human language means "NOT ASSOCIATED".


... lilmonkey made a comment on nbme24/block4/q#4 (A 63-year-old woman develops flank pain,...)
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submitted by lilmonkey(2)

To conclude: 1) ABO: IgM -> Complement -> Intravascular 2) Rh: IgG -> Splenic Macrophage -> Extravascular


... poormedstudent made a comment on nbme24/block2/q#26 (A 35-year-old man is brought to the emergency...)
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submitted by poormedstudent(0)

I was trying to figure out how are the catecholamines cause the K shift into the cells. I was not seeing the connection at first. normally in old NBMEs and Uworld questions- Insulin is causing K+ to enter the cells. then I remember seeing the sketchy band camp and in the far right of the sketch there is B2 activation = beta 2 tuba or something.. anyway beta 2 is found on pancreatic beta cells, catacholamines activate beta 2 on pancreatic beta cells which will cause insulin to be released. insulin released causes K to be driven inside the cells, causing the hypokalemia

references:

-FA 2019 pg 238 Beta 2 --> increase in insulin release and increase cellular K+ uptake.

-Linda S. Costanzo's physiology text:image showing insulin and beta agonist driving K+ into the cells


... lilmonkey made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
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submitted by lilmonkey(2)

Always chose smoking if you see it. In any type of question. Don't even read :)


... titanesxvi made a comment on nbme24/block1/q#22 (A 50-year-old man undergoes surgical transection of...)
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submitted by titanesxvi(4)

... titanesxvi made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
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submitted by titanesxvi(4)

These sclerotome cells differentiate into chondroblasts that form the cartilaginous precursors of the axial skeleton and bones of the cranial base (form netter embrio)


... madojo made a comment on nbme24/block3/q#7 (A 21-year-old woman with asthma comes to the...)
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submitted by madojo(11)

FA 19 256

Does the drug SWIM? Phase 1 - small number of volunteers assess for Safety Phase 2 - moderate number of patients, does it Work Phase 3 - large number random assignment, with placebo, any Improvement? Phase 4 - hit the market, any unexpected side effects, can be withdrawn from Market


... madojo made a comment on nbme24/block3/q#9 (A 43-year-old woman comes to the physician because...)
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submitted by madojo(11)

Pathoma

Lung metastasis is the more common than a primary lung cancer and its most common source is breast or colon carcinoma. You will see canon ball nodules on imaging. Seperated by space nodules. Search canon ball nodules gross looks similar to this image.

Carcinoid tumor is the most common primary lung tumor in CHILDREN. Could be a central or peripheral tumor but i think they would show a polyp like mass in the bronchus for carcinoid. https://www.webpathology.com/slides-13/slides/Lung_Neoplastic_Carcinoid_Gross1.jpg

Malignant mesothelioma some sort of asbestos exposure with the tumor encasing the lung like the other photo posted on the comments.

Pulmonary hamartoma umm well there's two of them in this photo, a hamartoma is usually just a single nodule.

Small cell carcinoma would be more centrally located not peripheral.


... madojo made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
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submitted by madojo(11)

https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjI9vbV3IjmAhWcJzQIHcePAeMQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.sketchymedical.com%2Fproducts%2Fcatalog&psig=AOvVaw3PXpjXjFDqMEYjGeHg2O9a&ust=1574886803769838

CORONAVIRUS SKETCHY

positive sense RNA virus, sun crown corona king wearing robe - encapsulated helical virus - spiraling road, helical trees sneezing and blowing king - common cold with bronchiol tree on king pointing to SARS and middle east respiratory syndrome (acute bronchitis)

This virus replicates in the cytoplasm thats why King is outside his castle (nucleus)


... madojo made a comment on nbme24/block3/q#29 (Drug X is given to a 25-year-old normal subject....)
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submitted by madojo(11)

A key property of partial agonists is that they display both agonistic and antagonistic effects. In the presence of a full agonist , a partial agonist will act as an antagonist, competing with the full agonist for the same receptor and thereby reducing the ability of the full agonist to produce its maximum effect. Ex. Morphine (full agonist) vs buprenorphine (partial agonist) at opioid mu receptors 234 FA 19


... madojo made a comment on nbme24/block3/q#41 (A 30-year-old man develops tingling around the lips...)
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submitted by madojo(11)

The main ingested seafood toxins we should know (246 Fa2019)

Histamine, Tetrodotoxin, and Ciguatoxin. Histamine - spoiled dark meat (tuna, mahi mahi) causes like an anaphylactic reaction because the bacterial toxin converts histidine --> histamine. Tetrodoxin - seen in this Q, pufferfish - blocks Na channels NO depolarization Ciguatoxin - reef fish barracuda - opens Na channels so CONTINUAL depolarization

For last 2 no cure, supportive only


... madojo made a comment on nbme24/block3/q#18 (A 55-year-old man with alcoholism is brought to the...)
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submitted by madojo(11)

The Km is inversely related to the affinity of the enzyme for its substrate so in this case we want to increase Km so that the affinity of hepatic alcohol dehydrogenase decreases for methanol and the ethanol can then act as a competitive inhibitor by overcoming the concentration of methanol thus preventing toxicity.


... madojo made a comment on nbme24/block3/q#30 (A 38-year-old woman comes to the physician because...)
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submitted by madojo(11)

Ugh when you do it in uworld, write it down but still miss it.

Anyway going over other answers (pathoma): Fibrocystic changes of the breast --> benign, usually no discharge with this and you will usually have a lumpy breast or something palpable and it is hormone mediated. Pagets disease of the breast --> extension of ductal carcinoma in situ to lactiferous ducts and skin of nipple producing rash, so you see skin changes. No skin changes mentionedh ere. Prolactinoma --> gallactorhea not blood tinged

So per UW intraductal papilloma is a proliferation of papillary cels in a cyst wall or duct that may cause focal atypia - IT IS THE MOST COMMON CAUSE OF BLOODY NIPPLE DISCHARGE AND BREASTS WITHOUT BREAST MASS OR SKIN CHANGES

compare this to papillary carcinoma where you also have nipple discharge but you would see it in a post menopausal women.


... madojo made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
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submitted by madojo(11)

I don't know if this was the right way i thought about it but i remembered C.H.A.L.K the things that cause vasodilation in skeletal muscle

C - Co2, H - H+, A- adenosine, L - lactate K- K+


... madojo made a comment on nbme24/block3/q#45 (A 59-year-old woman has a 10-year history of...)
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submitted by madojo(11)

Going over other choices (FA 19 514): Oligodendrocytes are part of the CNS so a tumor there would be an oligodendroglioma which is relatively rare, and in frontal lobes. On histology you would see fried egg appearance with chicken wire capillaries. Glioblast tumor would be a glioblastoma multiforme which is common and has a 1 year survival, its the one with the butterfly glioma crossing the corpus callosum.


... madojo made a comment on nbme24/block4/q#9 (A 10-year-old boy who was adopted from the...)
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submitted by madojo(11)

SKETCHY https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjQy9nft4fmAhUiCTQIHXh6BZEQjRx6BAgBEAQ&url=https%3A%2F%2Fquizlet.com%2F348275903%2F52-tissue-nematodes-dracunculus-medinensis-wuchereria-bancrofti-onchocerca-volvulus-toxocara-canis-loa-loa-flash-cards%2F&psig=AOvVaw2G9ehu-3FpT74t1v5_W2Ut&ust=1574842527097175

FLY GUY IN THE BACK Stains on the lab coat and pants --> black fly bites human host and the larvae burrow down into the host and make microfiliarial that come back out making hyper and hypopigmented spots. Human hand covering eyes --> causes river blindness Stray pink granules --> eosinophilia Microscope --> microfilaria on skin biopsy under microscope No dumping drains to river - Ivermectin for treatment


... madojo 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 madojo(11)

https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi_15-2tYfmAhXEGDQIHUx4D1MQjRx6BAgBEAQ&url=https%3A%2F%2Fquizlet.com%2F355174098%2Fsketchy-micro-super-worms-enterobius-vermicularis-ancylostoma-duodenale-necator-americanus-ascaris-lumbricoides-strongyloides-stercoralis-trichinella-spiralis-intestinal-nematodes-diagram%2F&psig=AOvVaw0NZl1rWBeFkgoYNiM5nwJb&ust=1574841902769110

SKETCHY trichenlla spiralis pig (can be polar bear too) * round glasses --> perio orbital edema sweating and green vomit round things on walls ==> forms cysts in striated muscle (so for this question makes sense that you do muscle biopsy) fire --> inflammation of muscle eosinophil granules --> non specific as you can see its all over this image so its for many different types of nematodes


... motherfucker made a comment on nbme23/block3/q#39 (A 44-year-old woman comes to the physician because...)
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submitted by motherfucker(1)

MedScape: "Acetazolamide (ACZ) and furosemide (FUR) treat posthemorrhagic hydrocephalus in neonates. Both are diuretics that also appear to decrease secretion of CSF at the level of the choroid plexus."


... madojo made a comment on nbme24/block2/q#31 (A patient with cancer who is being treated with...)
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submitted by madojo(11)

IL-3 (not an answer choice) also functions like GCSF supporting growth and differentiation of bone marrow stem cells.


... madojo made a comment on nbme24/block2/q#38 (A 65-year-old man comes to the physician because of...)
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submitted by madojo(11)

Alprazolam is a benzodiazepine whose MOA is to facilitate GABAa action by increasing Cl- channel opening, this would be more for anxiety than the depression presented. Amitriptyline is a TCA that inhibits serotonin and NE reuptake and is not indicated for those over 65 (Beers). Buspirone is for generalized anxiety disorder and stimulates serotonin receptors, again this patient has depression. Carbamazepine is an anti epileptic drug that blocks Na channels and is first line for trigeminal neuralgia. Haloperidol is typical antipsychotic that blocks D2 receptors and should not be given to 65+ (De beers plus why would we want to give him extrapyramidal symptoms). Methylphenidate is a stimulant used in ADHD. Finally paroxetine is a SSRI that inhibits serotonin reuptake. It is first line for major depressive disorder and has fewer side effects than TCA.


... madojo made a comment on nbme24/block2/q#19 (A 70-year-old man comes to the physician because of...)
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submitted by madojo(11)

The answer is not B because with interstitial fibrosis you have a decrease in the diffusing capacity because of the thickened alveolar membrane. The answer is not FRC because that will decrease in a restrictive lung disease such as fibrosis. FVC, RV, and TV are all expected to decrease.


... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
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submitted by madojo(11)

Another way to think about this is whats the closes stage to mitosis because right before M (mitosis) you need to have mitotic cyclins synthesized, and that would be G2

G1 --> S --> G2 --> M


... madojo made a comment on nbme24/block2/q#15 (An investigator is studying a new drug for the...)
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submitted by madojo(11)

The two main types of radiation type are ionizing and nonionizing.

The ionizing would be the radiotherapy and non-iodizing is from the sun.

Ionizing = free radical formation non ionizing (UVB) = DNA damage by formation of pyrimidine dimers


... madojo made a comment on nbme24/block2/q#28 (A 3-year-old boy with AIDS develops giant cell...)
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submitted by madojo(11)

Sketchy Micro coming through with the Paramyxovirus family and the night scene.


... madojo made a comment on nbme24/block2/q#4 (A 57-year-old man has had hoarseness and difficulty...)
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submitted by madojo(11)

A is oculomotor Theres 4 cranial nerves that are medial (3, 4, 6, 12) So C is abducens B is big fat one so trigeminal I think D is 8, and E is 9 so Vestibulocochlear and Glossopharyngeal I guess F is vagus....


... madojo made a comment on nbme24/block2/q#46 (In a study of drug action on neoplastic cells in...)
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submitted by madojo(11)

Cyclosporin is an immunosuppressant that blocks T cell activation by inhibiting IL-2, so we know thats not right. Cyclophosphamide is an alkylating agent. Doxorubicin is an antitumor antibiotic that generates free radicals and causes breaks in DNA. 5'fluorouracil is associate with pyrimidine synthesis. Leaving Vincristine which is a neoplastic drug that works on microtubules (other drugs that do this colchicine, paclitaxel.

As mentioned already, the cell is stuck in metaphase and cannot undergo the seperation anaphase. M cycle arrest is associated with vincristine and which the mitotic spindle which is what separates the chromosomes is not forming.


... madojo made a comment on nbme24/block2/q#39 (A 3-year-old boy has short stature and extremities...)
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submitted by madojo(11)

The answer is not osteoclast activity because that would be referring to osteopetrosis in which there is a defect in osteoclast activity and you have thick dense bones that fracture easily. Improper osteoclast activity could also refer to Pagets disease of the bone aka Osteitis deformans but I don't think that would present this young and would be more associated with bone remodeling problems and an increase in hat size, etc.

The head size isn't increased it just looks like a large head in comparison to the dwarfism because achondroplasia doesn't affect membranous bones of the head. Increased growth hormone synthesis would be acromegaly I think but that is seen in adults. Low nasal bridge = saddle nose.

TMI but in FA there's something called Laron syndrome which is AR, and a defective GH receptor so you have increased GH and would also see dwarfism and a saddle nose and prominent forehead but a small head circumference.


... pg32 made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
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submitted by pg32(0)

The fact that the odds ratio in the top left is incorrect makes this question very difficult. It makes it appear as if the cookies are causative but the milk had some protective factor. So obnoxious.


... jellyfish923 made a comment on nbme24/block4/q#35 (An investigator is conducting a study of a novel...)
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submitted by jellyfish923(0)

https://www.researchgate.net/profile/Mithun_Bhowmick5/publication/317179550/figure/fig1/AS:500004767715328@1496221834988/Cross-section-of-human-skin-Stratum-corneum-SC-and-epidermis-the-main-barrier-to.png maybe this picture can show where the desmosome exist


... docshrek made a comment on nbme21/block3/q#40 (A 65-year-old woman undergoes surgical repair of an...)
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submitted by docshrek(0)

Question stem says: PE shows Right pupil is larger than the left pupil. (Note: It is not light reflex). And weakness with movement of eye (that means most movements).

CN III palsy - Opthalmoplegia, Ptosis, Mydriasis and loss of accommodation. Ptosis, Mydriasis and loss of accommodation are due to - Parasympathetics travel outside of CN III. So more likely CN III is damaged and not others in the cavernous sinus.


... drmohandes made a comment on nbme24/block1/q#37 (A 25-year-old woman at 16 weeks' gestation comes to...)
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submitted by drmohandes(4)

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

If patient -only- had hypertension: ACTH more likely than SIADH.

Patient with hypertension AND hypokalemia: 100% ACTH.

Don't feel bad friends, I also had this question wrong :(...


... imgdoc made a comment on nbme23/block4/q#48 (A 2-week-old female newborn of Mexican descent is...)
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submitted by imgdoc(33)

I just realized that the answer I selected would've been considered passive aggressive: "Have you considered talking to a faith healer to see if there are any other measures you should try?"

lmao


... imgdoc made a comment on nbme23/block1/q#16 (Physical analysis of the isolated genomic DNA from a...)
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submitted by imgdoc(33)

Explanations for this are too complicated. Think of it like this:

You've got a piece of mutated DNA that is able to be digested by a restriction endonuclease, that means the DNA was transcriptionally available to begin with. AKA it was not methylated, because as we know, methylation = heterochromatin which is transcriptionally inactive. that means methylase was mutated

Only other plausible answer was DNase, and if it was mutated it would be inactive, not overactive.


... xkno made a comment on nbme23/block2/q#42 (A 63-year-old woman comes to the physician because...)
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submitted by xkno(0)

I overthought this one big time. Since the question said the mass was pressing on the outside of the trachea, I figured that during inspiration, b/c the chest expands, so more space, so the mass would have less effect on the trachea as the chest expands (and conversely, it'd have more of an effect during expiration as the chest wall retracts). Apparently, it was just straight up blockage and I thought waaay to hard. Oops.


... diabetes made a comment on nbme24/block3/q#44 (A 62-year-old man comes to the physician for a...)
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submitted by diabetes(3)

When ZES is suspected, the initial test recommended is a fasting serum gastrin (FSG) determination in the absence of antisecretory therapy (Sensitivity- 98–100% in ZES patients various series. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757869/


... abhishek021196 made a comment on nbme21/block1/q#19 (A 22-year-old man has had frequent episodes of...)
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submitted by abhishek021196(0)

Hereditary angioedema (HAE) caused by C1-esterase inhibitor deficiency is an autosomal-dominant disease resulting from a mutation in the C1-inhibitor gene. HAE is characterized by recurrent attacks of intense, massive, localized subcutaneous edema involving the extremities, genitalia, face, or trunk, or submucosal edema of upper airway or bowels. Routine long-term prophylaxis with either attenuated androgens or C1-esterase inhibitor has been shown to reduce the frequency and severity of HAE attacks.


... abhishek021196 made a comment on nbme21/block1/q#13 (A 25-year-old man develops shortness of breath after...)
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submitted by abhishek021196(0)

Hypoxic pulmonary vasoconstriction (HPV), also known as the Euler-Liljestrand mechanism, is a physiological phenomenon in which small pulmonary arteries constrict in the presence of alveolar hypoxia (low oxygen levels). By redirecting blood flow from poorly-ventilated lung regions to well-ventilated lung regions, HPV is thought to be the primary mechanism underlying ventilation/perfusion matching.[1][2] The process might initially seem counterintuitive, as low oxygen levels might theoretically stimulate increased blood flow to the lungs to increase gas exchange. However, the purpose of HPV is to distribute bloodflow regionally to increase the overall efficiency of gas exchange between air and blood. While the maintenance of ventilation/perfusion ratio during regional obstruction of airflow is beneficial, HPV can be detrimental during global alveolar hypoxia which occurs with exposure to high altitude, where HPV causes a significant increase in total pulmonary vascular resistance, and pulmonary arterial pressure, potentially leading to pulmonary hypertension and pulmonary edema. Several factors inhibit HPV including increased cardiac output, hypocapnia, hypothermia, acidosis/alkalosis, increased pulmonary vascular resistance, inhaled anesthetics, calcium channel blockers, positive end-expiratory pressure (PEEP), high-frequency ventilation (HFV), isoproterenol, nitric oxide, and vasodilators.


... chandlerbas made a comment on nbme20/block2/q#19 (A 66-year-old man is brought to the emergency...)
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submitted by chandlerbas(14)

either bladder cancer (unilateral in this case) or transitional cell carcinoma (also uni) are precipitated by smoking inhalant toxic injury. BUT what matters more than the cause is that the reader recognize that this is without a doubt

obstructive hydronephrosis with dilated pelvicalyceal system and cortex of kidney showing atrophy and thinning.

Assuming that the pt lost blood from the MVA - this would further enhance the renal ischemia (PCT and ascending LOH are both very sensitive to ischemic conditions 30 minutes of blood loss is enough to exacerbate the already ischemic conditions.


... lilyo made a comment on nbme20/block3/q#10 (A 59-year-old man develops fatigue and decreased...)
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submitted by lilyo(3)

Prosthetic valves are one of the causes of extravascular hemolysis so suspect this in a patient that has symptoms of anemia such as fatigue, pallor, jaundice. Further supporting evidence in this patient is the increased indirect bilirubin. Also, look for elevated LDH, decreased haptoglobin.


... mamorumyheart made a comment on nbme23/block4/q#36 (A 40-year-old man comes to the physician because of...)
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submitted by mamorumyheart(1)

The deficit is purely sensory involving anatomic structures that are adjacent in the way they are mapped on our cortex. Think back to the sensory homunculus. What we are looking for here is the primary somatosensory cortex, which is located in the post central gyrus.


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

The pituitary tumors in MEN 1 are prolactin or GH, so Calcium levels, for Parathyroid adenomas, would be the best answer.


... elf16 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 elf16(0)

How is this different from the question on NBME 21 in which a 68-year old man also had psychogenic ED? But the answer was normal libido and nocturnal erections.


... diabetes made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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submitted by diabetes(3)

RBC casts===> glomerulonephritis the only option there.


... ergogenic22 made a comment on nbme23/block3/q#33 (A 78-year-old man has had progressive loss of...)
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submitted by ergogenic22(55)

1) know that BC>AC = conductive hearing loss 2) conductive hearing loss means issue with structure before the inner ear 3) everything else occurs in the inner ear or in the brain


... drmohandes made a comment on free120/block3/q#31 (After being severely beaten and sustaining a gunshot...)
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submitted by drmohandes(4)

36 hour surgery:

...oral acetaminophen is not gonna cut it after major surgery. Also, our opioid crisis is mainly due to overprescription/misuse in chronic pain patients.


... diabetes made a comment on nbme24/block1/q#18 (A 34-year-old woman with a long history of...)
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submitted by diabetes(3)

this question they gave you the answer (osteomyelitis).


... sciguy made a comment on nbme20/block3/q#11 (A 3-year-old boy is brought to the physician because...)
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submitted by sciguy(0)

HS is autosomal dominant, but exhibits incomplete penetrance. So he had no record of personal family, but still likely heterzygous.

(Wikipedia) The clinical severity of HS varies from symptom-free carrier to severe hemolysis because the disorder exhibits incomplete penetrance in its expression.


... chandlerbas made a comment on nbme20/block3/q#9 (A 62-year-old man comes to the physician because of...)
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submitted by chandlerbas(14)

Legend:

OB = osteoblastic

OC = osteoclastic/osteolytic

P=prostate, B=breast, K=kidney, T=thyroid, L=lung

my mneumonic: Lead Kettle

P------------B-------------K--------------T------------L

OB-------OB/OC------OC------------OC--------OC/OB


... chandlerbas made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
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submitted by chandlerbas(14)

alright lets do this. some of the comments were really well explained, however im going to try another route. lets deal with pKa since the other comments exaplained Vd well enough. kudos fellas/fellos.

first thing is you have to determine if its an acid or base. 90% of the time its going to be a weak acid, we simple dont formulate much medications as bases in general. also its sodium salt and CNS so you know it has to be phenobarbital. step (1) low pKa means acid (4-7). you must know this. (2) you must know that all acids start off neutral and then lose an ion --> becoming charged. and all bases start off charged and then lose an ion to become neutral (this is why we dont use basic drugs because this neutral charge has a high vd and deposits in tissues = bad in elderly). you want charged bc thats what is hydrophilic aka pee it out. (3) next use what i jjust said and apply it to this chart:

+2 = 99%

+1 = 90%

-1 = 10%

-2 = 1%

the first number represents the difference between pH and pKa (pKa is given by the question always), pH is what you changed when you alkalnized the urine. so for this question it would be: pH-pKa = high basic value (>7) minus pka ( weak acid 4-7).

now the second percentage represents the percentage of dissociated proton. so for an acid, they will become charged, this means that if the difference between the ph and pKa is over +1 then 90% of the acid will go from neutral to charged. if the ph is 2+ greater than pKA then 99% of the acid will have lost its proton and become charged

lets summarize this: were told its a weak acid = aka pKa between 4-7. we want to get to take the weak acid from its neutral form into a charged form to get rid of it. so we alkalanize the urine, because bases are higher pH you will get a more + number thus the weak acid will go from neutral to charged and be excreted.


... lilyo made a comment on nbme20/block4/q#29 (A 15-year-old girl is brought to the physician by...)
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submitted by lilyo(3)

Tetracyclines most common adverse effects are nausea/vomit/diarrhea and photosensitivity. Can affect bones and teeth of newborn if given to pregnant women. Also this drug class covers GAS, GBS, +/- MRSA, respiratory flora and intracellular.

Why Cipro is not the answer: Macrolide covers GNR + Pseudo, therefore not a treatment for acne (skin flora). And common adverse effects are C.Diff infection, QT prolongation, tendon rupture, teratogenic effects.


... diabetes made a comment on nbme24/block4/q#17 (A 63-year-old woman undergoes operative repair of a...)
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submitted by diabetes(3)

simply the blood inside the CSF become blocked through arachnoid granulations ==> decrease absorption of CSF==>communicating hydrocephalus.


... diabetes made a comment on nbme24/block4/q#40 (A 25-year-old woman is brought to the emergency...)
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submitted by diabetes(3)

U(UtI) ==> sepsis ==>ARDS==>INCREASE alveolar capillary permeability ==> hypoxemia ==> hyperventilation ==>hypocapnia


... lilyo made a comment on nbme20/block1/q#5 (A 24-year-old African American man comes to the...)
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submitted by lilyo(3)

https://mybeardgang.com/pseudofolliculitis-barbae-treatment-tips-razor-bumps/


... lilyo made a comment on nbme20/block1/q#8 (A 10-year-old girl is brought to the physician by...)
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submitted by lilyo(3)

Take a look at FA pg.623 for tanner stages of sexual development.


... socialismkills made a comment on nbme22/block2/q#11 (A 52-year-old man comes to the physician because a...)
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submitted by socialismkills(0)

From KenHub.com

https://www.kenhub.com/en/atlas/anterior-scrotal-branch-of-ilioinguinal-nerve


... chandlerbas made a comment on nbme20/block2/q#2 (Following a wedding reception that was attended by...)
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submitted by chandlerbas(14)

i think because they were so specific in detail for when the sx began, theyre trying to test us if we know the onset of rota vs norovirus. also if you look at the transmission of rotavirus its FO and respiratory, so unless youre playing with poop at a wedding, its much more likely food was the transmission. sketchy says anytime you touch food with your hands its noro

heres a table for reference. https://contemporaryclinic.pharmacytimes.com/journals/issue/2016/february2016/best-approaches-to-acute-gastroenteritis


... chandlerbas made a comment on nbme20/block2/q#31 (A 25-year-old man comes to the physician 8 hours...)
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submitted by chandlerbas(14)

not sure if you all have seen the uworld chart Ddx for back pain but i found it really helpful. ill summarize it here: condition (key feature): degernative osteoarthritis (positional relieved with rest), radiculopathy - disc herniation(radiates to the leg aka lasegue sign), spinal stenossi(pain with standing), spondylorpathy(relieved with exercise, and ddominant at rest), spinal metastasis(constant pain, worse at night, not relieved by positional changes), vertebral osteomyelitis(focal tenderness, acute back pain, and fever), aortic dissection (severe restrosternal pain, radiating to the back)


... lilyo made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
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submitted by lilyo(3)

I was thinking along the lines of facial sensation which is mediated by the trigeminal nerve and the fact that the trigeminal nerve is located in the pons.


... cyrus_em made a comment on nbme20/block3/q#18 (An 18-year-old woman comes to the physician to...)
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submitted by cyrus_em(0)

I don't know why I feel the correct answer is 100%. The ques states, "what is the chance that offsprings will EVENTUALLY develop cancer?, not inherit the mutation"

Prophylactic colectomy or else 100% EVENTUALLY progress to CRC.


... chandlerbas made a comment on nbme20/block2/q#19 (A 66-year-old man is brought to the emergency...)
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submitted by chandlerbas(14)

SPOLIER ALERT for future readers, the content following may contain subjects seen in other NBMEs


... chandlerbas made a comment on nbme20/block2/q#14 (A 23-year-old woman has had fever, hypotension, and...)
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submitted by chandlerbas(14)

"However, in the years, the bacterial pattern of splenectomy sepsis have been changing. The most important capsulated pathogen is Streptococcus pneumoniae (Str. Pneumoniae), but Haemophilus influenza (H.Influenzae) and Neisseria meningitidis (N. meningitidis) are also significant. In a study of 1991,36 reporting 349 episodes of sepsis in patients with asplenia, 57% of infections and 59% of deaths were caused by Str. pneumoniae." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621170/

honestly i tried to find data to support E.Coli or any higher risk of gram - sepsis, but pneumo is still numero uno


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

This is actually describing myocardial infarction I think, from this article: https://www.ncbi.nlm.nih.gov/pubmed/6485997

We conclude that generation of thromboxane A2 occurs during the early stages of AMI and may be an important pathophysiologic phenomenon in AMI.

Damaged endothelial cells cannot produce PGI1 and prostacyclin => platelets begin to aggregate and release TXA2


... usmlecrasher made a comment on nbme20/block4/q#36 (A 25-year-old woman is brought to the emergency...)
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submitted by usmlecrasher(0)

c peptide = endogenous insulin , low c peptide + low blood glucose = exogenous insulin. very simple


... chandlerbas made a comment on nbme20/block4/q#16 (An investigator wishes to determine the...)
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submitted by chandlerbas(14)

Pt 1 (takes citric acid)

Pt 2 (takes candy)

Pt 1 (2x saliva = high flow rate, 2xNaCl [irrelevant - ignore])

Pt 2 (1x saliva = low flow rate, 1xNaCL [ignore not imp])

Pt1 = citric acid stim* ductal cell to secrete intracellular ductal storage of bicarb. bicarb neutralizes citric acid. thus low bicarb.

Pt2 = low flow rate, thus more bicarb reabsorbed out of duct. thus low bicarb

why do they have the same bicarb, because low flow rate.

*via Ach signal transduction to increase intracellular ductal calcium release --> HCO3 stored inside ductal cell


... ber1ber1 made a comment on nbme23/block1/q#1 (An asymptomatic 30-year-old woman comes to the...)
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submitted by ber1ber1(0)

for anyone who thought it was endometriosis its not because endometriosis of the ovary would have multiple blood filled "chocolate cysts" and presents bilaterally and patient would typically have pelvic pain as well FA 2019:p634


... cat5280 made a comment on nbme23/block1/q#37 (A 47-year-old woman with multiple sclerosis is...)
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submitted by cat5280(1)

Could someone please explain why you were able to eliminate the spinocerebellar tracts?