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Recent comments (see more)

... imgdoc made a comment (nbme15)
 +0  submitted by imgdoc(151)

The patient has UTI secondary to E. coli. The organism is resistant to ampicillin and sensitive to cephalosporins. I think alot of people are confused over why penicillin binding protein alteration wasn't the correct answer so here is my take:

Ampicillin - Penicillin antibiotic, with a beta lactam ring.

Mechanisms of resistance - Penicillinase (Beta lactamase which cleaves the beta lactam ring of penicillin drugs making them ineffective) OR PBP alteration (penicillin binding protein alteration).

Ceftriaxone - third generation Cephalosporin. Mechanisms of resistance - CEPHALOSPORINASE (Another type of beta lactamase), OR PBP alteration.

The question asks, which mechanism of resistance does the organism produce that causes ampicillin to be inactivated BUT ceftriaxone to be resistant.

It's the TYPE of beta lactamase produced by the two drugs that are different. so Beta lactamase production against Ampicillin (Penicillinase) would inactivate Ampicillin but NOT Ceftriaxone (cephalospoirinase).

If the mechanism of resistance were penicillin binding protein alteration, BOTH drugs would be resistant, because that mechanism of resistance is SHARED by both drugs.

It's a shitty question, which is nitpicky and goes after a pretty dumb detail.

imgdoc  FA page 188,189 for reference. Add this little note and you guys will be gold. +
... imgdoc made a comment (nbme15)
 +0  submitted by imgdoc(151)

This is an abdominal aortic aneurysm which ruptured, evidenced by: hypotension, pulsatile abdominal mass, the guarding and rigidity in the periumbilical region. (Pathoma page 70, FA 2018 page 298) Additional findings would include decreased femoral pulses.

A- Patient is hypotensive/hypovolemic, you probably won't see normal ankle, and brachial indices.

B - Aortic regurgitation is seen in thoracic aortic aneurysms secondary to syphilis, or cystic medial degeneration in marfans/ehler's danlos. Could also be due to aortic root dilatation from aortic dissection.

C/D - both are seen classically in aortic dissection.

imgdoc  Pathoma 2016 edition* +
... an1 made a comment (free120)
 +0  submitted by an1(73)

Always be kind! Spending a few extra minutes will make him feel better, solidify your relationship, and not really waste too much of your time. She passed away on this same day, he must be very sad and having someone to talk to can change everything.

... an1 made a comment (free120)
 +0  submitted by an1(73)

AR disease. She's got all the symptoms, she must have both defective genes. Genetic testing for the 36 most common mutations shows a detectable mutation (G551D) in one allele of the CFTR gene. What about the 2nd gene... we KNOW she has the disease. It wasn't detected.

... an1 made a comment (free120)
 +0  submitted by an1(73)

Patient had Cushing disease. Basically had to work out what high cortisol does. All 5 options had 1 thing that was wrong, and 1 that right.

(A) Hyperkalemia and numerous bruises

(B) Hypertension and muscle weakness

(C) Hypocalcemia and hyperglycemia

(D) Hypoglycemia and fat pads between the scapulae

(E) Jaundice and thinning of the skin

D was wrong because it causes hyperglycaemia. E was wrong becasue there's no jaundice associated with high cortisol. Opted to not go for A or B, as I wasn't sure about the electrolyte issues related with cortisol.

... an1 made a comment (free120)
 +0  submitted by an1(73)

Patient had ALS. Combination of UMNL + LMNL --> only answer option that had anything to do with these was atrophy (LMNL). Also, remember that their MCC of death is due to respiratory/ diphragmatic failure!

... an1 made a comment (free120)
 +0  submitted by an1(73)

Alpha (I Error) -- Confidence Interval

Beta (II Error) -- Power

Values have an inverse relationship with each other

... an1 made a comment (free120)
 +0  submitted by an1(73)

"pink, soft, granular, edematous wound" describes granulation tissue, which appears around day 3 and last several weeks. At this time, there is also an abundance of fibroblasts, endothelial cells (which contribute to angiogenesis with up regulation of VEGF) and macrophages as well as keratinocytes.

... an1 made a comment (free120)
 +0  submitted by an1(73)

The infraorbital nerve is a major branch and is the termination of V2. Fractures at the infraorbital region can damage the inferior rectus and the V2 branch, which supplies sensation beneath the eye and till the upper lip.

... kstudy made a comment (step2ck_form8)
 +0  submitted by kstudy(1)

Next time your attending asks you your top differential for a 2nd trimester pregnant female coming in with severe acute bleeding, say "cervical cancer" and when they question you, flash this question at them as the source. Ah, NBME really prepares us for the real world.

... an1 made a comment (free120)
 +0  submitted by an1(73)

History and image are a type 4 HSR. This is T cell induced. Cd40L --> Cd40 is T cell --> B cell CD28 (on T cell) --> binds to APC's (including Langerhans cells); CD80/ 86/ B7

Options with ICAM, I immediately crossed out because they're associated with margination and rolling, etc. CD45 isn't mentioned in regards to T cells (or anywhere I might add). Leaving us with the 2 options I mentioned above ^

... handsome made a comment (nbme23)
 +0  submitted by handsome(1)

FA 2020 pg 399

misoprostol clinical use - prevention of NSAID induced peptic ulcers

MOA: PGE1 analog in effect causes decrease acid production and increase secretion of gastric mucous barrier.

... handsome made a comment (free120)
 +0  submitted by handsome(1)

FA 2020 ,pg 195 Metronidazole MECHANISM Forms toxic free radical metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.

pg 251 Disulfiram-like reaction 1st-generation Sulfonylureas, Procarbazine,certain Cephalosporins, Griseofulvin, Metronidazole

acetaldehyde accumulates in disulfiram as acetaldehyde dehydrogenase is blocked

PG 353 Biguanides Metformin ADVERSE effect GI upset, lactic acidosis (use with caution in renal insufficiency) clue "sx began after drinking champagne -an alcohol"

pg 610 lisinopril adverse effects: Cough, Angioedema (both due to  bradykinin; contraindicated in C1 esterase inhibitor deficiency), Teratogen (fetal renal malformations), increase Creatinine (dec. GFR), Hyperkalemia, and Hypotension. good thing HCTZ is not on the option pg 609 hydrochlorothiazide adverse effects: Hypokalemic metabolic alkalosis- can have nausea and vomiting, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia. Sulfa allergy

... handsome made a comment (free120)
 +0  submitted by handsome(1)

FA 2020 PG 258

Absolute risk reduction BY DEFINITION : The difference in risk (not the proportion) attributable to the intervention as compared to a control.

ARR = (c/c + d ) - ( a/ a + b )

I assumed c+d as 50 for azithromycin and a+b as 50 for erythromycin

= 15/50- 5/50 = .3 -.1 = .2

in FA the example is If 8% of people who receive a placebo vaccine develop the flu vs 2% of people who receive a flu vaccine, then ARR = 8%–2% = 6% = 0.06.

... forkyeaa made a comment (nbme21)
 +0  submitted by forkyeaa(1)

why is the MCV elevated in this question when it's supposed to be normocytic non hemolytic aplastic anemia?

... kstudy made a comment (step2ck_form8)
 +0  submitted by kstudy(1)

this is a great example of why I struggle with this silly nbme and steps. Are we testing knowledge here or semantics?

... 07chess made a comment (nbme22)
 +0  submitted by 07chess(1)

Overthinking screwed me. The question stem asks for a chance for a sister to get the same alleles, not that she is homozygous with them. So I picked 75% instead of 25%. At the top of it, they put 2D6*4(I thought that means that pt. has 4 copies of alleles(two from each parent like HLA). They have to make questions impossible to understand.

... handsome made a comment (free120)
 +0  submitted by handsome(1)

FA 2020 PG 212 Common in normal aging increase risk of atrial fibrillation where there's possible Isolated atrial amyloidosis where ANP is fibril protein --)

... handsome made a comment (free120)
 +0  submitted by handsome(1)

pg 511 FA 2020

DORSAL Midbrain lesion consequence: Parinaud syndrome—vertical gaze palsy, pupillary light-near dissociation, lid retraction, convergence-retraction nystagmus

seen in Stroke, hydrocephalus, pinealoma --- present in patient

Some notes
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Help your fellow humans! (see more)

forkyeaa asks (nbme21):
why is the MCV elevated in this question when it's supposed to be normocytic non hemolytic aplastic anemia? help answer!
kstudy asks (step2ck_form8):
this is a great example of why I struggle with this silly nbme and steps. Are we testing knowledge here or semantics? help answer!
marypoppins asks (nbme24):
Why can't it be choice E? I assumed the patient had bipolar. help answer!
agraham416 asks (nbme22):
am i the only dumb one who thought it was angioedema cause of the ACE inhibitor? totally neglected all other information. help answer!
an1 asks (nbme18):
Holosystolic: MR, TR, or VSD Lower left sternal border (the left border is Erb's point, beneath that is the Tricuspid area) --> TR or VSD Whats more common? VSD (by far!!) If they had mentioned the mum having BPD or taking pills for a psych disorder, then TR could be a big contender. help answer!
agurl1000 asks (nbme23):
This might be a straightforward answer, but I was wondering why the patient would have a decreased inspiratory flow? Because to my understanding, people with obstructive diseases have trouble breathing out, not in.. Could someone explain to me why it decreases? help answer!
agraham416 asks (nbme15):
How do we tell the difference between uncompensated respiratory acidosis and compensated? help answer!
agraham416 asks (nbme15):
I understand why the answer is B-Lactamase prod., but can someone explain why alterations in the PBP in incorrect? help answer!
dnazmzm asks (step2ck_free120):
I thought the baby was bitten by lizard then I didn't know what Saccharomyces cerevisiae was, so I thought it was something related to a lizard lol!!! too imaginative? help answer!
chaosawaits asks (nbme23):
Who else read that last sentence 100 times and still had no idea whether it was even English or not? help answer!
michik92 asks (free120):
Can someone please clarify why this wasn't myasthenia gravis? There weren't any upper motor neuron signs in the question stem. help answer!
chaosawaits asks (nbme22):
Can someone please explain why this is not hypercholesterolemia? It also presents with HSM and there are numerous foam cells. Since hypercholesterolemia also presents with pancreatitis, couldn't that explain recurrent vomiting? FA2019, p94. Thank you for your responses! help answer!
chaosawaits  I mean Type I familial dyslipidemia (hyperchylomicronemia). Am I correct in assuming that the most differentiating presentation is the developmental delay? +
imtheman asks (step2ck_form7):
Why wouldn't a bone morrow transplant prevent this? Technically not wrong...? help answer!
charcot_bouchard asks (step2ck_form7):
If its intrinsic defect HTF urinalysis is normal with no casts? help answer!
ali_hassan asks (nbme21):
How does 500 men with various urological conditions result in a precise estimate? Wouldn't the variety of values due to various degrees of illness reduce precision and cause a wider variety? Maybe I overthought it help answer!
weirdmed51 asks (nbme22):
Any other conditions where pulsation in the liver can be found ? help answer!
agraham416 asks (nbme18):
I eliminated this answer because the mother already stated her concerns, which was that he's shorter than the father's height and about him not having a growth spurt. Is that not a concern? help answer!
failingnbme asks (nbme24):
can nephritic syndrome be without HTN? help answer!
athenathefirst asks (nbme20):
How do you know the answer is not E? I chose E because I thought of ATN :( Someone help please help answer!
osler_weber_rendu asks (step2ck_free120):
Even if we're suspecting abuse, the answer should be to contact child protective services. What if the abuser does not hit the child? Can be abuse with a neg skeletal survey anyway help answer!
len49  Pick the best answer of the choices, not necessarily what you would do in real life. +1
drdoom  @len49 Sure, but in that case you’re not saying much about /why/ “Skeletal survey” is the best answer choice from the NBME-frame-of-mind. Can you elaborate? +1
drdoom  @osler My guess is that a skeletal survey is what “clinches” evidence of ongoing abuse, since skeletal surveys can reveal bone and tissue injury at /varying (time) stages of healing/, which is the kind of evidence CPS is going to need to establish a PATTERN of abuse and discredit claims like “this was just a one-time ‘accident’.” +1
arthur_albuquerque asks (nbme20):
What helped me to answer this one quite easily was the following rationale: Hypercalcemia + high PTH -> "primary hyperparathyroidism" How do high PTH lead to hypercalcemia? Increasing osteoclast activity! help answer!
shaz464 asks (step2ck_free120):
Still confused.. Can anyone rule out all other options please? help answer!
len49  A. Conducting a nursing in-service won't help because they do not have the ordering power, that should rest on the person writing prophylaxis prescriptions/orders. C. Not feasible for every patient (not every patient is well enough to be ambulatory. Moreover ambulation only helps so much; patients at high risk for thrombus (for instance like this patient who is hypercoagulable due to malignancy, recent surgery) need bigger guns. D. LMWH is not appropriate for all post-op patients. For instance, inappropriate for people who may be actively bleeding, patient with previous diagnosis of HIT, patients with ESRD as it is renally cleared E. It is not an isolated case, as you know DVT provoked from long hospitalizations and post-op patients is pretty high and taken pretty seriously. +1
sizario asks (step2ck_form6):
how come this couldn't be decreased FSH? Doesn't estrogen have negative feedback on FSH/LH? help answer!
embeemee asks (step2ck_form7):
what is "allergic nonhemolytic transfusion reaction"? i thought it was the febrile one, but febrile is listed separately help answer!

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vitamins visual_field_defect visualfielddefect vascular TSH transfusion_reactions transfusion syphilis surgery stroke skin SIADH schizotypal Saline rituximab ribosomal restriction_enzymes Respiratory respiratory reproductive Repro repro Renal renal RAPD RAAS pulmonary psych protein_folding process_of_elimination prevalence pressure pregnancy post_partum postop porphyria Poorly_written_question picture_frame_vertebre picture_frame_vertebrae physio

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