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Recent comments (see more)

... lulumomovicky made a comment (nbme23)
 +0  submitted by lulumomovicky(2)

The key point was ''sphincteric incompetence''. Stimulation of B3 adrenoreceptors will work if it was overreactive bladder, where detrusor muscle is over activated. This patient's main problem was sphincteric incompetence, so relaxing the bladder wouldn't solve the problem. I think of it as if you should try to close the door, so there are two doors, internal (sympathetic) and external (somatic, pudendal). In stress incontinence, the external door is not working, probably due to pudendal nerve injury after vaginal delivery or obesity. So you should try to close the remaining door, the internal sphincter which contracts with Alpha 1 adrenergic stimulation.

... manarashour made a comment (nbme20)
 +0  submitted by manarashour(1)

regarding my understanding, we are looking for option with high anion gap metabolic acidosis so you will exclude choice A and D because HCO3 high in them, then you will consider Na 140 as they mention in the question it is normal so if you add the cl to HCO3 in option C you will get 134 so it will be normal anion gap so only choice you left with is B.

... abhishek021196 made a comment (step2ck_form6)
 +0  submitted by abhishek021196(93)

Quoting step-prep - https://step-prep.org/tutoring/

Memory loss

  • NBME loves to ask about complaints in elderly patients to assess whether you know which changes are physiological vs. pathological (same with newborns and developmental milestones)

  • In this patient, all of the findings are normal except for the memory loss because it has only been present for 1 month, which does not correspond with the typical picture of Alzheimer’s

  • Patients with suspected cognitive impairment are often worked up with cognitive tests (MOCA, MMSE, Mini-Cog), Lab testing (CBC, B12, TSH, BMP +/- syphilis) and Imaging (CT or MRI of brain)

-Key idea: Mild cognitive impairment = short-term memory/cognitive problems that are concerning to patient/family but that DON’T affect daily life or ADLs (using phone, driving, cooking, etc.)

... jatsyuk38 made a comment (nbme21)
 +0  submitted by jatsyuk38(1)

doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything...

... l0ud_minority made a comment (nbme18)
 +0  submitted by l0ud_minority(2)

Echinocandins is a class of antifungals that include caspofungin MOA is to inhibit synthesis of beta-glucan component of fungal cell wall. This will lead to decreasing the glucan expression on the fungal cell wall.

... meiraim made a comment (nbme17)
 +0  submitted by meiraim(1)

Delivering bad news requires the physician to be direct, to not give false hope about treatments not readily available, and to use limited medical jargon.

... meiraim made a comment (nbme17)
 +0  submitted by meiraim(1)

In DKA, epinephrine (adrenaline) stimulates hormone-sensitive lipase to breakdown fat stores in the body, releasing ketones and free fatty acids.

In DKA the body can't use the glucose (due to lack of insulin), and enters starvation mode by breaking down fat stores for energy, releasing free fatty acids (causes an acidosis) and ketones. Adipose cells release energy via hormone-sensitive lipase. Adrenaline including epinephrine stimulates lipase in adipose cells.

... meiraim made a comment (nbme17)
 +0  submitted by meiraim(1)

This patient still has histoplasmosis. Omeprazole (a PPI) changes the pH of the stomach and can prevent the absorption of certain drugs that require acidic breakdown to be absorbed. Omeprazole is also a P450 inhibitor, increasing the effect and concentration of other drugs.

... laplace1 made a comment (nbme18)
 +0  submitted by laplace1(1)

"Viridans" literally means green

... handsome made a comment (nbme23)
 +0  submitted by handsome(2)

fa 2020 pg 527 You'll see IDIOPATHIC INTRACRANIAL HYPERTENSION

Also called pseudotumor cerebri. INCREASE ICP with no obvious findings on imaging. Risk factors include female sex, Tetracyclines, Obesity, vitamin A excess, Danazol (female TOAD).

Treatment: weight loss, acetazolamide, invasive procedures for refractory cases (eg, CSF shunt placement, optic nerve sheath fenestration surgery for visual loss

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

said simply, in biomedical research, the default is to use an intention-to-treat analysis instead of an as-treated analysis.

I find this counterintuitive but such is life.

... j123 made a comment (free120)
 +0  submitted by j123(11)

First lymph nodes to drain different regions of the tongue:

  • Poster third of tongue = Superior Deep Cervical nodes
  • Tip of tongue = Submental nodes
  • Lateral anterior two-thirds of tongue (not including tip) = Submandibular nodes
  • Medial anterior two-thirds of tongue (not including tip) = Inferior Deep Cervical nodes
... peteralamir made a comment (nbme24)
 +0  submitted by peteralamir(1)

Why did they ask this same questions twice doe

... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

It spells "WitHHold" :).....................

drdoom  🤦🏻‍♀️ +
... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

Fancy buzzwords for the same shit: "Amaurosis Fugax" and "Duplex U/S of the neck".

... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

Small Cell - Central. SIADH. Squamous Cell - Central. PTHrP. Adeno - Peripheral. Clubbing (EGF). Carcinoid - Bronchi? Flushing (Serotonin).

... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

Share the results with your friends on Facebook.

... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

I remember my man Dr. Goljan talking about taking Aspirin and Acetaminophen together and saying buy-buy to your kidneys. good ol' days...

lilmonkey  I mean bye-bye (: +
... lilmonkey made a comment (step2ck_form6)
 +0  submitted by lilmonkey(22)

2 in 1 - Tx + Dx for little bastards. But don't do it to an old crank with a perforated diverticulum.

Some notes
❧ Comments submitted this year are scramble–resistant (Scramble–resistant Staphylocomment aureus)
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Help your fellow humans! (see more)

jatsyuk38 asks (nbme21):
doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything... help answer!
lilmonkey asks (step2ck_form6):
Small Cell - Central. SIADH. Squamous Cell - Central. PTHrP. Adeno - Peripheral. Clubbing (EGF). Carcinoid - Bronchi? Flushing (Serotonin). help answer!
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!
rdk3434  okay so i had the same doubt which is why i got this question wrong , but then i had this eureka moment , in uworld there's repetitive images about obstructive and restrictive disease volumes and they always show TRACHEAL STENOSIS along with that , this question is somewhat like tracheal stenosis presentation , just google lung flow volume tracheal stenosis! hope this helps! +
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!
j123  Fasciculations = UMN sign +
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

Tag directory (see more)
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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