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NBME 13 Answers

Question#1 (reveal difficulty score)
A 77-year-old woman dies in the hospital ...
Interleukin-1 (IL-1)πŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
An 18-month-old boy is brought to the ...
Iduronate sulfataseπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 3-year-old girl is found to have a grade ...
Ventricular septal defectπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Myasthenia gravisπŸ”,πŸ“Ί




Question#30 (reveal difficulty score)
A 43-year-old man comes to the physician for ...
Low-calorieπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 20-year-old man has cramping periumbilical ...
Interleukin-1 (IL-1)πŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
An 18-year-old man has had temperatures to ...
T lymphocytesπŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A male newborn at 34 weeks' gestation is ...
EndotheliumπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...
Type I (immediate) hypersensitivityπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A female newborn is delivered at 34 weeks' ...
Nitric oxideπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 5-month-old boy is brought to the physician ...
Thyroglossal ductπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
In order to determine risk factors for death ...
Observational cohort studyπŸ”,πŸ“Ί



Question#38 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
IschiumπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 23-year-old woman comes to the physician ...
DextromethorphanπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 54-year-old man has a squamous cell ...
Loss of heterozygosityπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A previously healthy 42-year-old Asian woman ...
Induction of cytochrome P450πŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
Homologous pairing of chromosomes in prophase ...
Crossing overπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
ClomipheneπŸ”,πŸ“Ί



Question#15 (reveal difficulty score)
A 33-year-old woman who is right-handed is ...
Voltage-gated Na+ channelsπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A study is conducted to evaluate the onset ...
Population-basedπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
An autopsy is done on a 46-year-old woman who ...
ParagangliomaπŸ”,πŸ“Ί



Question#35 (reveal difficulty score)
A 25-year-old woman undergoes a radical ...
Compression sleeveπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A young adult couple has been unable to ...
Seminal vesiclesπŸ”,πŸ“Ί


Question#2 (reveal difficulty score)
An 18-year-old woman with mild mental ...
Apo BπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A mouse melanoma, B-16, is highly metastatic. ...
HomingπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A previously healthy 32-year-old man is ...
Alcohol dehydrogenaseπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 40-year-old woman is brought to the ...
Vascular malformationπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Cortical hyperplasiaπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 55-year-old man with hepatic encephalopathy ...
LactuloseπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A previously healthy 25-year-old man is ...
Alveolar hyaline membraneπŸ”,πŸ“Ί


Question#46 (reveal difficulty score)
A 62-year-old man is brought to the emergency ...
Pulmonary edemaπŸ”,πŸ“Ί


Question#19 (reveal difficulty score)
A 1-year-old girl is brought to the physician ...
Defect in phagolysosome functionπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 46-year-old man receives the diagnosis of ...
AortaπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
HeteroplasmyπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 9-year-old girl is brought to the emergency ...
PeriosteumπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 60-year-old man comes to the physician ...
Difficulty swallowingπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A previously healthy 35-year-old man comes to ...
BromocriptineπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 5-year old girl is brought to the physician ...
Cleavage and polyadenylationπŸ”,πŸ“Ί

Recent comments ...

... drjungly made a comment on nbme13/block3/q#7 (32 yo woman, 5 years inability to conceive)
 +10 
submitted by drjungly(15)
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mNorla oe,mhnooarnrlm meal mpers ustyd dan aonrml s:emsen siltl a’tnc inecveco tenh egiv TRY iwht eminpcel,ho tath si tainsAntog at RnHG coeerrtp at ,alaHapmsothy kBcol tegnrsEo medieatd ohbtiniini of nHGR ecehn acrneesI lreseea of &cgtgG;gtg;Rg&;n&tti&;Hn.;tt;g&& LH gseur utnilpnroci vroeBoimtoa - ludwo eb flplhue if eth tp ash lnfeiitiytr ude ot SECRANIE .DLRC AENSIOTP - is edspotp ni US edu ot alecr lcel riacmcaon in uogyn lmfeea obnr ot lttEeyr.hmih no itrsldeoa - dnbi tsrgneeo ig&;ti;egcbto&&tgr;tiphe;tgtt;&ng& HGRn gt>tg;nt;&;g;&o& LH gurse: on .cse (uni Rkis of itroemeanld e)cecromtgre rooerdnpniaxayMs - si episngrort -nβ€”dib nereptegoors orn.sonomtteiprp.(.e.ecc of omninrg tearf )pill

... jsmoov made a comment on nbme13/block4/q#2 (18 yo woman, mild mental retardation, 3 days decreased ability to see in reduced light)
 +8 
submitted by jsmoov(19)
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hiTs ybab ash atpeiaapi.ternmolieob (tutwio"h teBa easnptiopiro)lp"o. hTsu thye lilw alck 8B-4 and 010B- dan hvea entsab vsllee of h,rnslocyimoc L,VDL nad DLL. fIntnsa srenept ihwt rseeve atf aoionbsmltpra dna dicsinefceie of lal fta oueslbl sitmavin )E(KAD. akLc of nmtiiva A eedrsnr htem nalvbeurle ot itRtniise eipoatngsm dna lkca of tiEV dsale to baloeeerrpinscl nanroietde.eg

... skip_lesions made a comment on nbme13/block2/q#38 (5 yo boy, 6 months progressive clumsiness and fatigue)
 +4 
submitted by skip_lesions(15)
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l:usecM uAdctrod uamgsn

:rigniO Psbi,u bteysurtio of smichiu

t:nrInisoe muFre

t:coAin cdutAsd eht ighht at the phi

... jsmoov made a comment on nbme13/block3/q#21 (Autopsy of 46 yo woman, adenocarcinoma of colon)
 +4 
submitted by jsmoov(19)
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eiPtsivo iinnstag ofr hyoisstpnpyan dan gmrhnoaonric aer eidiametm obzzuwdsr for eerurnidnoeonc sr.utom mangorsiPlaaga rea het oyln yept tldsei .eehr

Otehrs wdluo be small cell cnaarocmi fo nlg,u ocndacrii ,tmour au,ansgisotmtoeinc/mraln/ssi ope,sh yueadlmrl cnarmiaco fo rotdi.hy

... trazobone made a comment on nbme13/block3/q#21 (Autopsy of 46 yo woman, adenocarcinoma of colon)
 +3 
submitted by trazobone(64)
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fI noeany esle is on het udmudm abto nad dt’dni know twah a mrnigaaaglnopa ws:a a ourdenicneorne omrtu ahtt ibsgne ni evenr e,clsl lloeycs dretela ot a rtmaopoyhoocmhec

cheesetouch  Mayo clinic says 2 out of 1 million people have a paraganglioma. Talk about a zebra! +2
... jsmoov made a comment on nbme13/block3/q#31 (23 yo woman, type 1 diabetes mellitus, follow-up examination)
 +3 
submitted by jsmoov(19)
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siaHeld era eth etmneles in eth dn2 teh tlas omcnlu fo eht ipceidor abetl (,F ,Cl r,B I, tc).e eteecvfDi OPM respvtne niovcsoner fo O2H2 oint HlCO a( y)dxiydoeharl-h wchhi si aak alhcbe and the msto ouprlfwe iibroanltmcia uro easctyohpg anc nyeeistzsh

... skip_lesions made a comment on nbme13/block3/q#45 (25 yo man, cystic fibrosis, 3 days fever, cough, progressive shortness of breath)
 +3 
submitted by skip_lesions(15)
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.P raousengia ahs nbee hswno ot mrfo bo-ekimiifll eicsocloiomrn ni teh usnlg fo FC ttiaensp nkiagm it dtuicflfi ot atter thwi .citaibiotns

... thegooddoctor2 made a comment on nbme13/block1/q#1 (77 yo woman, dies in hospital after long illness)
 +2 
submitted by thegooddoctor2(1)
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ree,mbmeR HTO T eBno .taekS L1-I csaseu ersvee imtaafnonlmi nad si ryledtic inevvldo ni eth intecoar fo teh tiylc sli.neo

... l0ud_minority made a comment on nbme13/block3/q#14 (40 yo man, brought to ER, 1 hour after sudden onset of severe pain in left leg)
 +2 
submitted by l0ud_minority(2)
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I ogt isht onwgr I thguhto aecersdeD noyMsi iLhtg Cniha pasthaoPehs viyattci wdlou ylpa a tcoarf rmof teh glon lge atcs nmazibtoiliimo for 6 .sthomn otN nbige leab ot use hte gel dlouw suaec otahryp. utB I aws .rwgon

scoresloth  same here +1
bugdrivergirl  I thought that was only for smooth muscle though +
... drjungly made a comment on nbme13/block3/q#19 (Study of onset and course of cardiovascular disease in African American men and women)
 +2 
submitted by drjungly(15)
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crerhearses watn ot nokw VC ksir uatob rAiacnf namrAice tluanosoppi but od ton ahev atad ofr eyrev nsf.Ipore a aescrrehre wnadet to narle heerhtw gbeni rtnecai yitincthe nceesria a rkis of aaitrcrplu ds,eeias it wluod ont be tclcpaair ot dysut eyver idlniuvida ofmr that ticiytenh . ndIatse, het earerescrh hmgti stcele a lpseam fo teh uipalpntoo. A slpmea is a elraslm uopgr of mmreseb of a liponaoptu sdleeect to esprnrete eth opi.apltoun In rredo to ues scsiiattts ot lrane hntgsi atubo eth loiap,otpun the maples umst be .nroamd A maordn salpme is oen ni ihcwh ervey bmemre of a oountpiapl ash na elqau cenhca of geinb cedte.sle eTh tmso olyomncm eusd smelpa is a mislep omdanr .apsmle It rrsuqeei atht eyvre osipbels lampes of the edseltce izes has na aqleu cehnac fo ngieb sdu.e

... trazobone made a comment on nbme13/block4/q#21 (40 yo woman, brought to ER, 30 minutes after severe chest injuries in motor vehicle collision)
 +2 
submitted by trazobone(64)
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I esnrwdea thsi aiv csrepos fo meiit.inloan

)A oisblaGoatm imfurltoem - on b/c ahtt uwdol edne to wosh a oB umt)r SVH ipnetcsalieh - wdluo ndee to be ni teh torpmlea reinog dan oals ’nsdeot iqute tif twhi het 52 aery siezeru rsiddreo Chiystor) eMlasi prtlaome lescorsis - i vhae on iead htwa shti si lryea,l tbu unjggid mofr esβ€œc”osrsli i sseaum erteh nesde to eb osme nssgi of lrsseocsi which si not setnpre ni eth Dhpot)o oatnleaN mceihcsi rktsoe - on ehs )l oEd cVlasura finoolmatarm - ducol not nhkit fo a cvuarals drdsiroe ahtt asw siacdsteoa with zusier,es utb ti samke enses /bc the ectiupr oswhs a nbcuh fo ladtdie sespac iwhhc I samdesu ear teh vseless bnegi aerdlmfmo

trazobone  I answered this via process of elimination. A) Gliobastoma multiforme - no b/c that would need to show a tumor B) HSV encephalitis - would need to be in the temporal region and also doesn’t quite fit with the 25 year seizure disorder history C) Mesial temporal sclerosis - i have no idea what this is really, but judging from β€œsclerosis” i assume there needs to be some signs of sclerosis which is not present in the photo D) Neonatal ischemic stroke - no she old E) Vascular malformation - could not think of a vascular disorder that was associated with seizures, but it makes sense b/c the picture shows a bunch of dilated spaces which I assumed are the vessels being malformed +2
... iceberglettuce made a comment on nbme13/block4/q#36 (25 yo man, admitted to hospital for viral pneumonia)
 +2 
submitted by iceberglettuce(10)
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Defufis lerovlaa amegad = ASRD -&;tg orelaavl ineaylh anrsmbeem

... schep made a comment on nbme13/block1/q#1 (77 yo woman, dies in hospital after long illness)
 +1 
submitted by schep(33)
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I hhutotg lycti eonb lpe&-;t-glliemsontiu lgyice-ymotlmam;&pae-caher

utb I ouespsp htta alucmci ins't vievlnod ni the secspor fo ieartgcn het yitlc ,olnies htat lowud eb I-L1 nad TNF

... jsmoov made a comment on nbme13/block1/q#19 (22 yo woman, 3 months painless, slowly enlarging mass on left neck)
 +1 
submitted by jsmoov(19)
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iacBnrhal letcf sctys piyalyclt ouccr due to irfaeul fo het n2d airahclbn eclft ot lbtriaoeet lerngiust ni a rtipssetne icaelvrc u.snis lBcrahian fctle tyssc wlli ont vmeo whit slialwgown adn laallcicssy uccro oitnearr to het seolinimradodtectos scumle

... trazobone made a comment on nbme13/block1/q#29 (43 yo woman, metastatic colon cancer, taking bevacizumab)
 +1 
submitted by trazobone(64)
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isTh si grittahs pu nstgite fi uyo kenw bA omnacntelure πŸ™„. -ubma sdsgatinee amnuh ogrini hweli -omab sgetidsena uremin rnioi.g oS iaumbzevabc is a inuhemazd .bA ehT tehor snarwe coecih iasngy ti saw a inmrue bA drdteeic gtniaas FVGE swa nesegdid to rkcit uy.o ciuklLy I ddi not lalf rof uchs yerwhict.

trazobone  This is straight up testing if you knew Ab nomenclature πŸ™„. -umab designates human origin while -omab designates murine origin. So bevacizumab is a humanized Ab. The other answer choice saying it was a murine Ab directed against VEGF was designed to trick you. Luckily I did not fall for such witchery. IN CASE ANYONE TRIES TO SCRAMBLE +2
... skip_lesions made a comment on nbme13/block1/q#30 (43 yo man, routine health maintenance examination)
 +1 
submitted by skip_lesions(15)
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enPttai is oeebs hiwt a IBM of 03 dan a jmoar irsk arfoct ofr TMD2 si teobysi adn lg-richioaeh .tide

castlblack  what is wrong with low carbohydrate? Carbs raise insulin after all +6
trazobone  I also have this question ^^^. My guess is the question says which diet is most effective so if he had a low-carb diet but high in everything else, then he won’t lose weight. Versus no loopholes in a low-calorie diet +2
... meryen13 made a comment on nbme13/block1/q#43 (18 yo man, 8 days temperature of 38.3 C, sore throat, cervical lymph node enlargement)
 +1 
submitted by meryen13(26)
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sd1epr.i5arrscatc0wbpan4lesi/.hmph/et4s/wbnd-5-rws/st5:6 i duonf iths nlik plfhul.e hte aylcpiat 8dc+ ymyocsheptl rea igdcanotsi rfo VEB

castlblack  Despite being dormant in monocytes (premature macrophages), causing B cell immortality and B cell lymphomas, EBV causes atypical T cells in the blood. +3
... victor_abdullatif made a comment on nbme13/block1/q#48 (Male newborn at 34 weeks gestation delivered vaginally)
 +1 
submitted by victor_abdullatif(5)
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isogiaDsn: syratbrwre imahaoegmn

mHee = l-odn ao-bg = loses-vma e = gnenbi msas

A gbnnie mrtou of salacepr,lii erhtrefoe teh ignoir si mnieeudhlot

cheesetouch  NOTE: Endothelium derived from mesoderm. (I was mis-reading this as endoderm). +1
... schep made a comment on nbme13/block2/q#6 (Female newborn, delivered at 34 weeks gestation, advanced-care setting)
 +1 
submitted by schep(33)
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YFI nesic I dtdi'n okwn the feefncidre

Nritic NieoxO=d

oriuNts oe=NixO2d

... cv020496 made a comment on nbme13/block2/q#21 (36 yo man, HIV seropositive, 2 weeks nonproductive cough)
 +1 
submitted by cv020496(1)
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P. eoricvi:j essaCu cestPnomysiu oenpmiaun ()CPP, a dufsife itnieaitsrlt iunopamen. fnseuusile-ta kgY l(ilniaryog esifdaslic sa nopor.a)tzo eldIhna. stMo ictosnefin era moopspyutaiicss.amsenIm noupmtr ,g(e SA)DI pspseriesod to ise.deas fe,sDifu airtalebl gos-dslagrun tisoaceip C XCT/R.on ngDeaosdi by nlug ypbosi ro g.veaal da-ssiheDcp estya nsee on mentaniheme anvitl rises fo lugn stiseu

tlr:T/psnhemaaoxityepr XTMSPM-, pemandinit,e dnsaeop psophxylra(i ,l)yno vt.aoqnaeou xtihpta orprSslya enhw 4DC+ ucotn podrs to < 020 mcels3lm/ in HIV apst.niet

... trazobone made a comment on nbme13/block3/q#7 (32 yo woman, 5 years inability to conceive)
 +1 
submitted by trazobone(64)
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Noalrm aoolhnrm, ealm emprs udtsy and lonamr ns:eme lsitl c’tan ivcneoce hnte ivge YRT ???() tihw l,eopechmin that is itganaonts ta RGnH epocretr ta yhspohaaum,tl bcolk snreotge detmieda itniihnboi fo HGnR nheec sceernia aeseelr fo HL cripoBemiortrngues - wdoul eb hllupfe fi eht pt hsa fiiyetnlitr ude ot EENISARC LPEDS OIRTANC ???( I ma smungais its PIL)ANRTCO - si epdopst ni US ued to rlcea llec amcincaro ni yguno eemlfa bnro to em.tr ytihEln delasriot - ibdn gseotenr pam;& HnGR; HL ursge: on es.u nIc( ksir of natridemoel nc)raacmoi yodesnrpetegexrooMr - si oengrtiserp dibn orpnetgreose pe.tete.nir.oco(moscprn. )(??? fo nrnmgio etfar pll)i

trazobone  Clomiphene: a SERM, antagonist at estrogen receptors in hypothalamus (FA18 637) +1
... iceberglettuce made a comment on nbme13/block3/q#15 (33 yo woman, right-handed, 3 days progressive weakness, numbness of arms and legs)
 +1 
submitted by iceberglettuce(10)
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ishT eno aws a odoy.z I ihntk by sainyg "renve stidesu swho lsow ocicdntonu evtyolic," teyh ear crigreenefn otalasrty ctocdnniuo ate.iipmrnm eeoehrrTf thye ear nkisga us ichhw eshnacnl rea sesercayn fro yaattorls untciocdon - hwhci dowul eb gtlvaot-agede +Na helnas.nc

... jsmoov made a comment on nbme13/block3/q#30 (Cluster of three cases of nosocomial pneumonia caused by <i>Klebsiella pneumonia</i>)
 +1 
submitted by jsmoov(19)
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Kalsleelib ahs a sulecpa adn si eprdsa ohhugtr os-ot-snoerprpne otccatn g.(e. omrf peaitnt ot tpaneit iva hte cmoedntaanti hdasn of telhachaer esn)pl.enro Te"h rabtecai aer ton drasep hghruot teh air"

... skip_lesions made a comment on nbme13/block4/q#35 (55 yo man, hepatic encephalopathy, 24 hours of confusion and lethargy)
 +1 
submitted by skip_lesions(15)
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Clooicn aecibrta nevrcot suoletacl nito caictl iadc nda ecatci ,aicd cwhhi safeicidi onoiccl tenn.tcso hiTs adels to hte nvosoreicn of nmamioa ,)3H(N which si a kwea ,aesb into its aeaboobrnbsln arottnodep fmro, inmmumoa N(4)H.+ cOne rdpoan,tote het ivoepits grhcea repetvns umnamomi mofr ignosrcs lcel e,sabrmmen epgknei hte oemleclu in the l.onoc As hte leelvs of oamnami in coiltiucran arllgyadu enlci,des the sptomsmy of itahpec yalnppechehoat riopevm

... cheesetouch made a comment on nbme13/block2/q#22 (A 9-year-old girl is brought to the emergency...)
 +1 
submitted by cheesetouch(215)
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2 pcasel wtih rosttoooinegrep eslcl aer esurmioetp dan tse.mudone Stme leslc rfmo sruieeotmp rea odivlevn in ruaerftc lihnag,e shraewe hetos ni teh emseunodt rae odelvinv in noeb eoign.drmle eSro:uc nb.ieaorn/lb-t/wtos-/hociwogba/rtotuh./nehy/lasy:pyknfoemmw

... trazobone made a comment on nbme13/block3/q#41 (A 60-year-old man comes to the physician because of...)
 +1 
submitted by trazobone(64)
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HMS I aws ngnitkhi lacohicol B12 sslo fo rbtvrayio, so osibovu own he hsa S.LA reyaHxpreefli UMN ins,g sfciltsiaanuco LMN s.ngi ndA omocnm aesuc fo ahedt is ude ot pisanoatir maeniupon easeucb fo ygipahasd (LNM ct.idf)ei FA 8021 p 415

trazobone  Sorry dysphagia (UMN deficit) +
trazobone  SMH I was thinking alcoholic B12 loss of vibratory, so obvious now he has ALS. Hyperreflexia UMN sign, fasciculations LMN sign. And common cause of death is due to aspiration pneumonia because of dysphagia (UMN deficit). FA 2018 p 514 +
cheesetouch  UMN vs LMN is FA18 p 513 also! +1
... pharmtomed made a comment on nbme13/block1/q#1 (77 yo woman, dies in hospital after long illness)
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So I itknh erweh I got ppterid pu is taht hse o,sde ndeedi, hvea lueiltmp aleoymm so( teerh llwi eb ecrseidan suerm ,GgI) tub teh gtihn htta is lyatluac ucganis ehr snobe to hosw eth oectcitaosls linesso nwsho in het aigem is L-1I ttlsaco(eos aatitgcvni o)ctrfa. irdeW ownig.rd Thsank .MENB

... cv020496 made a comment on nbme13/block1/q#13 (18-month-old boy, 6 months progressive facial abnormalities, slow growth)
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Hruler odrymnes Au(ot )Rce spmtmoys - amoevlnlpDete aye,ld amls wgoiyr,ayriag oruocsit,btn loancre iei ggtaoleo.encloi n,aupteecpfnDhydmls - luiodadi-eΞ±-rns tacunumol aic o-f raenpHa nraltdse,aaefmtu ftulsea

tenHur omdnresy dei(k-lXn eR)c - ldiM ruHrel + vierggsaes b,ovreiha o leanrnco oeeic lgfitni.ducdn - orInuedat fssaultae luBdi pu - naeaHpr mlutdeena,rtaasf tesalfu

... athenathefirst made a comment on nbme13/block1/q#20 (3 yo girl, grade 4/6, loud, harsh, high-pitched holosystolic murmur)
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Wyh si sthi S?DV Is it juts beueacs esh si 3 syrae dl?o I swa ktucs eewbnte VP,M DV.S

schep  I picked VSD because of the description of the murmur-loud, harsh, holosystolic, radiates over precordium and palpable thrill at left sternal border (I think because high pressure blood is moving from LV-->RV so you can feel a thrill) MVP is late systolic, crescendo murmur with midsystolic click +1
castlblack  rule out all diastolic murmurs including -aortic regurg, -mitral stenosis, -PDA (no sound in diastole so cant be continuous). Rule out all murmurs that are heard on A and M sites, -aortic stenosis, -mitral regurg. Coarctation of the aorta is heard between the scapula I read so rule that out too. Rule out crescendo decrescendo murmurs, because holosystolic murmurs are like they sound: the same throughout systole. -pulmonic stenosis, -atrial septal defect. (AS has already been ruled out) You are now left with tricuspid regurg and VSD. Use harsh, high pitched descriptors to pick VSD. Tricuspid is described as blowing just like mitral regurg. Tricuspid regurg is a close candidate because it is heard in the same place as VSD, can be due to congenital malformation e.g. ebstein anomaly. It is also seen in rheumatic fever and endocarditis, but no other symptoms are mentioned so this question is leaning toward congenital malformation. +
... cv020496 made a comment on nbme13/block1/q#25 (32 yo woman, 1 month progressive shortness of breath and anxiety)
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ilddMe egad wamno inkignth eituaumnmo dioon..itn.c ctiRireetsv lung oysmspmt eardcsde(e lgnu )voemlus htat etg wreso as eth ady eeossprgsr shmeatc elwl iwht ayhmstinae .giravs

Crhocni hnbcsrioti adn tp-1srtianapyalni dyeceifnic obth saeuc btetvrsiuco ungl ae.diess

... schep made a comment on nbme13/block1/q#26 (4 yo boy, brought to ER, 1 hour headache, nausea, vomiting, dizziness)
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brcona omodxine tihsniib het afnli teps fo TCE, yrmtoccohe aeoxdis

... jsmoov made a comment on nbme13/block2/q#8 (5-month-old boy, 5 days difficulty feeding)
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dlieMin sasm hatt ovesm tiwh wlwinosalg = oolstlahsygr cdtu syct

... trazobone made a comment on nbme13/block2/q#41 (23 yo woman, 3 weeks persistent cough worsened by cold air)
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submitted by trazobone(64)
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)A odiCene - comnmo ni ugcho sypur btu sti’ a kawe gtniosa ta um and dteal srcoept,er so eh’rste toaiplten for acneutbss ea.ubs
B ) xornethphDmtroea - a gchou eupassnprst tihw wlo toeinlpta rfo euasb dan deos ton cusea ;oopstcanniti gnnteoaaszi DMAN tcrsoepre n(ot mu aappk ro etlda rep)e.tcosr
C &m;ap D) hreodHooynmpr ;am&p doxcoeony -- oetpnt dsipooi eusd ot retat dteoaerm to evsere apni I( am amnsgisu tyhe orwk ta um rtepcsore utb ’sit ton in FA os )οΈπŸ€·β€πŸ»β™€

)E ordalamT - a wkea piodio gtoians edsu rfo oucrenhptai nai,p tsca by tuakrepe of NE nad TH5

trazobone  A) Codeine - common in cough syrup but it’s a weak agonist at mu and delta receptors, so there’s potential for substance abuse. B) Dextromethorphan - a cough suppressant with low potential for abuse and does not cause constipation; antagonizes NMDA receptors (not mu kappa or delta receptors). C & D) Hydromorphone & oxycodone -- potent opioids used to treat moderate to severe pain (I am assuming they work at mu receptors but it’s not in FA so πŸ€·πŸ»β€β™€οΈ) E) Tramadol - a weak opioid agonist used for neuropathic pain, acts by reuptake of NE and 5HT IN CASE ANYONE TRIES TO SCRAMBLE +1
... iceberglettuce made a comment on nbme13/block3/q#5 (42 yo Asian woman, brought to ER, 24 hours nausea, vomiting, progressive lethargy)
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niCohcr HtOE cinesdu 04.CtPy5 hipeoenmAncat lbostmaeim ldiesy AIQP,N hwcih is ihghly echx.ptioaot

P0y45tC urscdni:e PRCA PSG

aeoanciRmzriCeAlif hlanbopmp a n nirhP(o)thcyneico

e Gialstb.oeihln nrfPrSuotvoib hn'Jos rwat

... imkingran made a comment on nbme13/block3/q#14 (40 yo man, brought to ER, 1 hour after sudden onset of severe pain in left leg)
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AF 2002 gp 062 - rlulCeal iaospaAtntd - pyohAtr

... skip_lesions made a comment on nbme13/block3/q#39 (Young adult couple, 2 years unable to conceive)
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submitted by skip_lesions(15)
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amleniS seisevcl bicutronet fcstuore to eht l.aeteujac ceDdeesra serftouc tceacrioonntn mya dneiacit an cylutaoejra dtuc ttrnucsob.oi

... mario made a comment on nbme13/block4/q#7 (Mouse melanoma, B-16, highly metastatic)
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iths celsl sodlhu be tmes lcle t,naasrptnl so mhgnoi is the nieretmonnv htta ccpeta ehtm nda hrisonu temh hwti whtgro coafrst to ermaut

... cheesetouch made a comment on nbme13/block4/q#21 (40 yo woman, brought to ER, 30 minutes after severe chest injuries in motor vehicle collision)
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Ssmotmyp fo inrba VMAS urvors(elaraiact oamf)nilratmso ilcenud usr.sizee nirBa vams nca eb dfnou ni THH irta(reyhed amrchrghoie laateeanitisgc / srleO eeWbr udnRe rd.)ymosen eoMr foni eer:h tst:.23av-owol/c0mmi-mncwps/osuss-ny6/-wb.ccahrtanodiagss/5n/paycms0dtei2syeero/i0iis am&;p ta hrc.htuergo

... cv020496 made a comment on nbme13/block4/q#34 (33 yo woman, 16 kg weight gain over 6 months despite dieting)
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crtCHneiTge-As tyaiprtiu modaean uhgCs(ni ;)sdiease aansiapocptrle ACTH ictonsere ,mlla s(ge ellc lnug ,ercacn rocnhilba sdβ€”lactiusroncire) in T,AHC blelairta dralena ip uILPySnAehCrgshA. eeadssi is plbrsoiense for het tromyaij fo nuodnegsoe aecss fo sCniuhg mdsnye.ro oltCsroi ocdduepr in aozn cicalsaauft in cx.oert

... scoresloth made a comment on nbme13/block4/q#42 (64 yo woman, 6 months heartburn, difficulty swallowing solid food and liquid)
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submitted by scoresloth(2)
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im/l/saMni.lrt/P29npmCv56hon:swct/tcgbwip.85/we/.ch.4

... cv020496 made a comment on nbme13/block4/q#42 (64 yo woman, 6 months heartburn, difficulty swallowing solid food and liquid)
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dSrroalmcee mcisesrtcso(si lse)y - a riTd of mittuoimyanu, mlyrominaatnfno chtvapya,osul dan agloecnl iiondstoep whit frCns.omiybomlio s lcrssoesi fo n,kis emnngisifta sa pf,uyf tuat isnk A oiwthut iekwn,rsl trnipgfei gBipi ttn . lAso lescissor of enl,ar maounrply o(tms omconm acues of edh)t,a riuarcoladscv,a IG se ysm7.%ts5 lmeea.f 2 jarmo tpes:y

Dsiufef laesdrmrecorwdepdsaeβ€”i iksn mvnvei,etlno idarp ropgeosnsi,r aeryl nsialvivreeemlntvo c. dsiteaoscA thwi -ia7Slnt0-c dtybnioa Nni(D-atA oorpietsemoas I yb.nitdo)a

miiteLd cemarsedrloileiβ€”dtm snki teevomvlinn nndeoicf ot enrigfs nad .fcae lsAo ES iwtRhTC edsyrmno: ncliiossaC C , reCteantimoren- oytnib,da anaRydu ,on anlogpemheaspeEohn ottyiysmld,i edyltoSccyla,r dan eaatgeanl.sTiic erMo gnebni naiilclc eocrsu

... ejahan made a comment on nbme13/block1/q#19 (A 1-year-old girl is brought to the physician...)
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I ntihk iCahieigsH-kadh ei ,nnssmolydri-bam inecyopg tn,eicnsifo anitg elusanrg ni turlceog,snya gctpa etyon=i;& decetf in syllaosmo firctgkinaf uogtarelr eegn &tT ;(gSL)Y= ruoucembitl otsyunnicdf in ysoplheaogmos niu.fso

... imkingran made a comment on nbme13/block1/q#40 (A 46-year-old man receives the diagnosis of squamous...)
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Tpo 1:3/sl gapehaEo sanbcreh of iniofrer ydhirot yea,rtr hwcih is a hcbnar of teh hicvtrloeacry utnkr npoit(o E)

dMield 31:/ els agahpEo sraecbnh fo oarcciht prat fo oaatr oin(pto )B

ootBtm 31:/Eslhegpoa a hbesncra of letf gicatsr trreay h(wich is hcrnba of lcaeci nk,rtu whcih si rahcbn fo rota)a iopn(to A)


AF 0202 pg :4nadambl3o 6i artao ;-t-&g icalce kutnr ;tg&-- ftel satcrig ;g-t-& psgaelaeoh eesrtira

... cheesetouch made a comment on nbme13/block1/q#40 (A 46-year-old man receives the diagnosis of squamous...)
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submitted by cheesetouch(215)
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noultCs onymaat xsutbekotoe/ oscsrep of .ilnmaoiinte I( konw sthi ist'n ndim wblg,nio tub st'i hwat I )...did

... specialist_jello made a comment on nbme13/block1/q#40 (A 46-year-old man receives the diagnosis of squamous...)
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submitted by specialist_jello(25)
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be/chmslom/ic:eeosaemthc/dok./acyyiptsapgt. jsut reefr to iadagmr

... cv020496 made a comment on nbme13/block2/q#10 (A 40-year-old woman comes to the physician for...)
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oeyplmcaePteHnerress: of othb aronml nad tteDmdNaA ,umt esruitgnl ni arivbael oxesseripn oitcimnrynhllaido rdethenii eesadsi.

Anitcpait:oin Icsaendre tersvyie or eealrri otnse of eeisasd ni ueisdcgnec agrosetnien maEpe(xls rea ueictondrei-tl tparsee schu sa sgnniHtotnu nad ilgFaer X)

amahal  This question still feels like the answer should be anticipation can someone explain it better please. +
... cv020496 made a comment on nbme13/block2/q#22 (A 9-year-old girl is brought to the emergency...)
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slobsO:etat Bdsilu beon yb cnreteisg eollngac and yalactgizn neinizotralaim in ieknaall mirnnetnveo aiv lAlenaik shasapehtpo fAe.ianDrfet(Lsie)Pt form hmleseanmyc mest llecs ni oitu.remsep olsbietatcsO iycvttai meeusard y nobbe PA,L ceit,slncoao rdspptieope fo ytpe I lgnl(Fa.pec Aoor)

... trazobone made a comment on nbme13/block3/q#15 (A previously healthy 35-year-old man comes to the...)
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MHS I hda ti ni ym ehda atth rrbmpnectiioo is sude to tetar iknnPasor so I enitadilme the wnre.sa Btu si’t a adeimnpo gstnaio ttha wlil oals ttaer a utyartiip lrcoomi.natap

trazobone  SMH I had it in my head that bromocriptine is used to treat Parkinson so I eliminated the answer. But it’s a dopamine agonist that will also treat a pituitary prolactinoma. +1
... cheesetouch made a comment on nbme13/block3/q#12 (A 5-year old girl is brought to the physician...)
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submitted by cheesetouch(215)
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8FA1 p .14 '3 den ash ltyapieoadnolny giansl TAAAAA.

... specialist_jello made a comment on nbme13/block1/q#41 (20 yo man, cramping periumbilical pain; pain shifts to right lower quadrant)
 -1 
submitted by specialist_jello(25)
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I tge HOT T eonB TESAK L I 1 orf evfre

ubt %09 elnhptio,usr why tnac ti be TB4L uhnlpritoe o?ehctamixs

dentist  i picked LTB4 i guess the question itself is "which causes the patient's fever and leukocytosis" LTB4 wouldn't be a direct cause of fever. dumb question +


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