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NBME 17 Answers


Question#6 (reveal difficulty score)
A 55-year-old man with chronic bronchitis is ...
NaloxoneπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 6-week-old girl is brought to the physician ...
Immature lower esophageal sphincterπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 21-year-old man comes to the emergency ...
Inferior rectal veinπŸ”,πŸ“Ί

Question#20 (reveal difficulty score)
A 24-year-old man with a history of ...
480πŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 42-year-old farmer has a 7-mm red scaly ...
Actinic keratosisπŸ”,πŸ“Ί


Question#35 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
RosaceaπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A newborn has male genital ducts but female ...
ScrotumπŸ”,πŸ“Ί



Question#5 (reveal difficulty score)
A 56-year-old man comes to the physician 4 ...
Right subthalamicπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
An 80-year-old woman comes to the emergency ...
HydrochlorothiazideπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A randomized clinical trial is conducted to ...
Neither procedure is superiorπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 13-year-old girl has a grade 2/6, ...
TricuspidπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 2-month-old boy is given a vaccine that has ...
Haemophilus influenzae type bπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4πŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniaeπŸ”,πŸ“Ί


Question#22 (reveal difficulty score)
A 60-year-old man comes to the physician ...
Pleural effusionπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 65-year-old woman with ovarian cancer is ...
DNA replicationπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
In a clinical study, a polymorphic marker ...
2,3πŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A study is conducted to assess the ...
Placebo effectπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 40-year-old man is evaluated because his ...
Heme synthesisπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
SulfasalazineπŸ”,πŸ“Ί

Respiratory pulmonary ild
Question#41 (reveal difficulty score)
An investigator wishes to conduct a study of ...
CohortπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 25-year-old woman comes to the physician ...
21-HydroxylaseπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 38-year-old man is brought to the emergency ...
Metabolic acidosisπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 40-year-old African American woman comes to ...
1,25-DihydroxycholecalciferolπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 30-year-old woman who is at 20 weeks' ...
Tracheoesophageal atresiaπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 15-year-old girl is brought to the ...
First-degree burnπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Luteinizing hormoneπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glueπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 65-year-old woman undergoes surgical repair ...
Area labeled with letter 'A'πŸ”,πŸ“Ί


Question#25 (reveal difficulty score)
A physician is sad because he has to inform a ...
Yes, it is.πŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Ubiquitin ligaseπŸ”,πŸ“Ί


Question#31 (reveal difficulty score)
A 20-year-old man is brought to the emergency ...
EpinephrineπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
An 18-year-old man with Crohn disease is ...
T-lymphocyte functionπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Congenital ureteral obstructionπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
Ten healthy human subjects are given a new ...
Phase 1πŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 27-year-old woman is admitted to the ...
StruviteπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A previously healthy 48-year-old nulligravid ...
Endometrial hyperplasiaπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
An 83-year-old man is brought to the ...
Early septic shockπŸ”,πŸ“Ί



Question#10 (reveal difficulty score)
A 32-year-old woman, gravida 2, para 1, at 7 ...
Ectopic pregnancyπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 55-year-old man is admitted to the hospital ...
0.9% SalineπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Mallory hyalineπŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 20-year-old man with suspected appendicitis ...
T10πŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Tumor necrosis factorπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
A 16-year-old girl comes to the physician ...
Dopamine Ξ²-hydroxylaseπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 41-year-old woman is evaluated because of ...
Fibromuscular dysplasiaπŸ”,πŸ“Ί


Question#47 (reveal difficulty score)
A 10-year-old boy has had anemia since birth. ...
Hereditary spherocytosisπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 34-year-old patient with AIDS develops ...
MacrophagesπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
15-year-old, lesions on neck, acid-fast ...
Temperature SensitivityπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
60-year-old man progressive shortness of ...
Alveolar macrophageπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
22-year-old woman, gravida 1, para 1... ...
Internal iliacπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A previously healthy 17-year-old girl is ...
MyoglobinπŸ”,πŸ“Ί






Question#0 (reveal difficulty score)
An 80-year-old man with Type 2 Diabetes ...
Pelvic SplanchnicπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
25%πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 56-year-old woman develops a restrictive ...
Beta-Pleated sheet structureπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
45-year-old man with poorly controlled type 2 ...
Enterococcus faecalisπŸ”,πŸ“Ί



Question#0 (reveal difficulty score)
16-year-old girl comes to the physician ...
IgMπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
38-year-old man with a 3-year history of type ...
ContemplationπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
27-year-old woman comes to the physician... ...
Trophoblastic tissueπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A new compound is taken up by bacterial ...
Carrier-mediated diffusionπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A previously healthy 3-year-old boy is ...
Interleukin-8 (IL-8)πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
59-year-old comes to the physician... lack of ...
CerebellumπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 24-year-old man comes to the physician, ...
T-lymphocytesπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 52-year-old man is brought to the physician ...
PellagraπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 20-year-old man comes to the physician, ...
Posterior pituitary glandπŸ”,πŸ“Ί

metabolism
Question#0 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
KidneyπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
35-year-old man is brought to the ED, fatigue ...
Activation of adenylyl cyclaseπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A female newborn is delivered at 38 weeks' ...
15 to 40πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
SchistocytesπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 30-year-old man is brought to the ED... CT ...
Middle meningeal arteryπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 63-year-old man comes to the physician ...
Calcified 80% stenosisπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 50-year-old man comes to the physician 3 ...
CalciumπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 68-year-old man comes to the physician... ...
Inhibition of phosphodiesterase πŸ”,πŸ“Ί




Question#0 (reveal difficulty score)
A 60-year-old man who emigrated from China to ...
AflatoxinπŸ”,πŸ“Ί



Question#0 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
VagusπŸ”,πŸ“Ί



Question#0 (reveal difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3-πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenesπŸ”,πŸ“Ί



Question#0 (reveal difficulty score)
In a nuclear transplantation experiment, ...
ImprintingπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 62-year-old woman with recurrent pulmonary ...
VII (proconvertin)πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 19-year-old man is admitted to the hospital ...
Left achilles tendonπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
60-year-old man comes to the physician ...
Parietal cellsπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Cholesterol synthesisπŸ”,πŸ“Ί



Question#0 (reveal difficulty score)
A 3-year-old boy with sickle cell disease has ...
OsteomyelitisπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
Ten years after total gastrectomy, a ...
B12 (cobalamin)πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 65-year-old woman comes to the physician ...
Lichen sclerosusπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 28-year-old woman comes to the physician ...
Parotid gland enlargementπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 75-year-old man comes to the emergency ...
Salicylate poisoningπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Major Depressive DisorderπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 40-year-old woman with a 6-month history of ...
Wegener granulomatosisπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 25-year-old woman comes to the physician ...
Rheumatoid arthritisπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 65-year-old man who recently emigrated from ...
Trypanosoma cruziπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 53-year-old man, who recently returned from ...
MalariaπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 42-year-old man comes to the emergency ...
Infection with HIV-2πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 70-year-old man from China has a poorly ...
Epstein-Barr virusπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
Three days after unprotected sex with a new ...
Herpes Simplex Virus type 2πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
GonorrheaπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysmπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 70-year-old man dies in a motor vehicle ...
Tubular adenomaπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
MelanomaπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 28-year-old woman, gravida 1 para 1, comes ...
Staphylococcus aureusπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 60-year-old woman is brought to the ...
NephrolithiasisπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 62-year-old man dies suddenly while playing ...
Aortic stenosisπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 35-year-old man comes to the physician for ...
Dynein armsπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 57-year-old man with alcoholism has a ...
GynecomastiaπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
While lifting weights, a 24-year-old man ...
StrangulationπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin EπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 63-year-old woman is brought to the ...
DeliriumπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 54-year-old woman comes to the physician 1 ...
MyxomaπŸ”,πŸ“Ί


Question#0 (reveal difficulty score)
A 70-year old man is admitted to the hospital ...
Pulmonary neoplasmπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 27-year-old man comes to the physician for ...
SchizoidπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A girl is brought to the physician for a ...
9 πŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 55-year-old woman has left flank pain and ...
Renal cell adenocarcinomaπŸ”,πŸ“Ί

Question#0 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Influenza virusπŸ”,πŸ“Ί



Question#43 (reveal difficulty score)
A 62-year-old man develops a pericardial ...
Fibrinous pericarditisπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 50-year-old man comes to the physician ...
OmeprazoleπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 34-year-old woman with pyelonephritis has ...
GentamicinπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 15-year-old girl comes to the physician's ...
Use of sunscreen by her peersπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 41-year-old man with asthma and an allergy ...
AlbuterolπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 38-year-old man comes to the physician ...
LoratadineπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 64-year-old man is brought to the emergency ...
Torsades de pointesπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 68-year-old woman with recent onset of type ...
LisinoprilπŸ”,πŸ“Ί


Question#48 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...
LoperamideπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 62-year-old man with alcohol induced liver ...
SpironolactoneπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 26-year-old-woman comes to the physician 5 weeks
SertralineπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 60-year-old woman with a 3-year history of ...
EzetimibeπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 45-year-old woman who is a farmer is ...
DoxycyclineπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A study is designed to evaluate the efficacy ...
Randomized clinical trialπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
In an epidemiologic study of workers in the ...
3 πŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
In a survey of 100 households (average three ...
15%πŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
An examination is scaled so that the scores ...
67%πŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A male newborn has macrocephaly with poor ...
CollagenπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 30-year-old woman has ptosis, ...
ThymomaπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 45-year-old woman has a thyroidectomy ...
CalcitoninπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 79-year-old man is brought to the emergency ...
Insertion of transvenous pacemakerπŸ”,πŸ“Ί


Question#44 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Left atriumπŸ”,πŸ“Ί




Question#36 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
PoxvirusπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 69-year-old woman comes to the physician ...
Area marked "G"πŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A male newborn is born at 28 weeks' ...
Area marked "D"πŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A pharmaceutical company is trying to develop ...
LeptinπŸ”,πŸ“Ί



Question#27 (reveal difficulty score)
A 24-year old man comes to the physician ...
T lymphocytes πŸ”,πŸ“Ί




Recent comments ...

... cassdawg made a comment on nbme17/block0/q#0 (A 58-year-old woman is brought to the emergency...)
 +29 
submitted by cassdawg(1457)
unscramble the site ⋅ remove ads ⋅ become a member ($42/month)

I dnt'o kiel who eyht rae gsinak sh,ti ubt I nihtk thaw ehty are ettngig ta is hatt artef teh tnste etncplaem e"usq(bntseu ot hte snett antpeelm"c) hrtee llwi be refpuinoesr rijynu to the dloymaicra eustis ichhw ouccsr hugrtho feer dialacr yuirnj dna rhoeeeftr erambenm ilpid rdeioinxpaot is hte sbet nwrsea 002A2F( 210p ntiseomn nmmebare pdiil xneaitpoiord as a iemcsnhams fo eefr crdaila agdaem nad istsl irrfeepnous riyjnu eatrf torlyiocmbht apeyrht as a .etpy) letioEvsan in eht acicrda eznmesy I msuaes rae sbceuea of eth jruiny ot eht s.lecl

zalzale96  Created an account just to up vote this answer +5
cheesetouch  1998 journal via google " Myocardial injury after cardiac surgery with cardiopulmonary bypass may be related to free oxygen radical-induced lipid peroxidation" +
peteandplop  "Evidence suggests that reactive oxygen species (ROS) may play important roles in the pathogenesis in myocardial infarction [2]. Following ischemia, ROS are produced during reperfusion phase [3, 4]. ROS are capable of reacting with unsaturated lipids and of initiating the self-perpetuating chain reactions of lipid peroxidation in the membranes" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2274989/) +1
mittelschmerz  Honestly the wording got me on this one. Great answer +
acerj  Also, you can rule out a few of the options to help justify this. Post MI you expect necrosis, not apoptosis. Remember, apoptosis is suicide, and necrosis is MURDER! Cell swelling is a sign of cellular injury, not cell shrinkage. The heart will undergo coagulative necrosis, not liquefactive necrosis. Also, protease inactivation by cytoplasmic free calcium is kind of nonsensical to me. Free calcium is more likely to cause cell injury via caspases (a form of proteases amongst other things), which is why calcium is usually bound up inside healthy cells. +4
ownersucks  This question presentation is exactly how Sattar said in pathoma Ch2. Raise in cardiac enzyme following reperfusion +
amy  FA2020 305: Reperfusion injury: free radical and increased Ca influx--hypercontraction of myofibrils There is increased cytoplasmic free calcium ions, but it induces hypercontraction, no protease inactivation. +
... cassdawg made a comment on nbme17/block2/q#12 (2 month old boy given vaccine which converts T-independent antigens to T-dependent forms)
 +22 
submitted by cassdawg(1457)
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ehT isqueton smet si rferinrge to a gacuetjno cei.cnva shTi si bceaesu cogenajtu nesvacic novrtec en-nTeenitdpd sennatig rscodlahp)ycaise( nito d-ptnndeeeT etsiangn by onucanjtigg emht wiht a o.tniepr 0F2[02A 712]p

Rmmeeebr htta ni erord orf a -elTcl to be aelb to srpnedo ot na aietgnn avi CHM, it MUTS be a op.ietrn h,suT eetnendTd-p (nndepteed no -cel)Tls speesrnos era ot tnpe.sior nddnt-peeeT preesnsso rea lreovla rebtte ecsbuae hent secBl-l anc neht grneuod itafiynf ormtntuiaa nda sclsa hinwtgcis guothrh troecnaiitn hiwt lTe-lsc. So, yb jgnatgounci ircbleata acedhloacspyris to tpisr,neo eth mnumei ssnopeer will be a rmeo ubsrot ndeede-nptT enoiarct and llwi ediyl better c.ioptrntoe A[00F22 p1]03

aCujognte nveiascc txeis fro ldatsnepceau teaarcib as( het sealpcus are cleyasaopchird dan woudl dene to be detguncjao to eioptrn ot ervmipo pse.sr)neo sThee are seNirisae midtiisgin,ne shiuHpemoal ief,nuelzan dna pocoecutcStsr neuepnmaoi

You nac bmremeer hetes tlapaseenduc igmoansrs dan rieht cjenaoutg neicvac escaube yteh era EHT AEMS omsrgnais atth ouy meeboc stbspcueile ot when uoy aevh a nmytcslepoe dan iwchh eeetsstican viccto.annai

drippinranch  I appreciate this explanation so much. Thank you. +9
j44n  cassdawg you are a beast +2
... cassdawg made a comment on nbme17/block0/q#0 (An 80-year-old man with Type 2 Diabetes Mellitus is...)
 +21 
submitted by cassdawg(1457)
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Pvcile haplcscinn erevns yrrac eth iracepyaampstht biesrf thta aer oseibrnlpse rfo tugdinh altsniinet tyoltimi uiigcnldn ioivgdn (magei.) 2A[0F20 .]463p

Dbaieset ulesiltm nac caues veern gamade nda sassorrpe,tiga trdaeet whti coltioeoermpmd 020(AF2 )p4.00

pakimd  thank you for sharing the image +1
... cassdawg made a comment on nbme17/block4/q#1 (83 yo man found bedridden and confused)
 +18 
submitted by cassdawg(1457)
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DTRVISUIBIET HSKCO I.(.E IPETSC RO )LNAXPYAAHIS EAR ETH LOYN HCKSOS WHTI CDSIRENEA RACADCI TP!OUUT

A02F20 p310

This man sepnsrte thiw pyahioemtrh spi(etc csohk can tersepn ithw hyrep or rhhte)i,yampo hrciadc,aaty and low olbod epesursr thwi isreendac cdricaa t,puuot aeihcctriacrts of esticp k.ocsh Fruehtr trbtsiivdeiu oshkc si acisstadeo wthi veeesr decereas in scemsyit aaclrvus cetnsiraes eiwhl eotrh smofr of chosk evha radisecne tmeiyssc laacvurs nsist.creae

cheesetouch  FA2018 P305 Shock +
pakimd  hypothermic presentation of septic shock is due to cytokine-induced dysregulation of the temperature control in the hypothalamus and is associated with poorer outcomes +1
... cassdawg made a comment on nbme17/block1/q#21 (42 yo farmer, 7 mm red scaly plaque on ear)
 +17 
submitted by cassdawg(1457)
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utJs to dda ot the ntxiepanaol here si wath uoy lduow see in hte ortehs ot(ms no 200F2A 48)4p

  • laBas clle oirn:macca
  • ahara:tontcomeaK
    • Rmslseebe oquusmas clle naaimcrco in ttha it is a iraypdl owignrg meod adephs oulned hwti a entkair delifl etercn
    • On lshyiotgo ti lilcsayab ssnetepr sa a etarcr flldie thiw keantri
    

  • iMatangnl aemaon:lm
    • daB ,iob look rof hte sBDACE yst,eyarm(m erdrbo rrgulieia,rty loocr ,aoraitvin eaidmter ;&gmmt6, adn nvlo)uotei
    • On oyiolgsth yuo ees moeatlnecy iifprnoraotle ewlob hte enasembt mnemaerb nda it ujst soklo uegilr
    

  • rMkeel llec ccaaomn:ir
kstebbins  ^Amazing with the links. Thank you! +4
victorlt14  β€œActinic Keratosis Dermatopathology: Large bright-staining keratinocytes, with mild-to-moderate pleomorphism in the basal layer extending into follicles, atypical (dyskeratotic) keratinocytes, and parakeratosis” From Flitzpatrick's atlas of dermatology +
... cassdawg made a comment on nbme17/block3/q#31 (20 yo man, 6 hours of difficulty breathing and vomitting)
 +16 
submitted by cassdawg(1457)
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mneoHor vseisetni leasip )LHS( si eth nyzmee hwhci rseagded trseiegdycirl stedor iwithn piedasycto F20(0A2 .p39) hT,us ti kaems sesne tath ti is diaavettc ni eimst of saigntf adn epdsrpessu ni hte def .staet

luinsIn wduol iibtnih S,LH sa nnsiuil is a def state mneezy setderce yb het apercnas nda ludow watn ot rtgireg trgeosa fo r.rdeeicytgisl

nI tnaotrcs lgoncuag is rceedets in esrnpseo to mapilhoyecgy yb het anapesrc dna illw irertgg tdseaf ettas ttniiao.vca In tesrm of eth dafetfs/ satte I laways hnkit of cauglnog dan hnepreipnie dnik fo ikel a seeprurho nda hiret desi c,kik eacuseb yeth saulluy wrko reogetth ni eht tifasgn taste no iiarslm seagtrt to sneure the doby has ouhegn rygeen its(h hslep em rmeermeb ttah enephpirnie and ogalnugc are nagfist estat nr.emsoo)h eeHr ghutho si pieenrh'eisnp bgi ncoait aawy from g,lonucga erehw naouglgc ash imainlm ceetff nad prepiineehn sha teh gib oainct fo viaigntatc SHL! oacnlGug sha a rimno erlo nad ehotr iclochantseema dna HACT cna salo ersev to evacttia LHS as ewl.l

htnroAe apeelxm fo het isnisgycrte korw fo lugganco nda pphneeriien si ni ncegoylg owrbaednk 2FA20(0 8.)5p ohBt lliw trggire PAcM saeiercn dan etnprio naeksi A atvtioican ihwhc lwil hsplrtoaophye egonycgl holspsoerhpapy nad ivetcata it (AFTS LSRH!POAOTEHPY mooHren ntiveises ieapls is acylluta rhelostydohppa to vctetiaa it as .el)wl

UNF :ACFT enrmooH sntivesei pleais luayclta gto sit naem ceausbe ti aws seiievtsn to ninpriepe!he

flapjacks  In Type 1 DM, the glucagon response to hypoglycemia is not functional and these individuals are reliant on the epinephrine-stimulated hepatic glycogenolysis. I recall this by remembering you can administer glucagon to these patients if they're having a hypoglycemic episode. They can respond to it, but they aren't releasing it. +1
passplease  How did you eliminate thyroxine? As it also plays a role in lipolysis. I was thrown off my the low blood pressure and therefore did not select epinephrine. Why would they still have a low blood pressure? +
jackie_chan  ^ they have low blood pressure because DKA causes a lot of dehydration (vomiting, diuresis due to osmotically active glucose in urine) so low BP Thyroxine I eliminated because remember that thyroxine is unique in that it functions similar to a steroid hormone and acts in the nucleus to upregulate expression of many genes. I figured hormone-sensitive lipase needs to be activated, not stimulated to upregulate expression, so I thought about EPI and beta-3 stimulation. fuckPeter +1
schep  I figured since he has low BP/dehydrated, his body would try to maintain cardiac output by increasing sympathetic tone (releasing epinephrine). In hypovolemic shock, systemic vascular resistance is up because of this compensation. +
j44n  also thyroxine works like a steroid hormone meaning it takes a while to cause its effect +
flvent2120  That'd be cool if it were called "epinephrine sensitive lipase" +
... cassdawg made a comment on nbme17/block4/q#14 (55 yo man, admitted to hospital for treatment of sepsis)
 +15 
submitted by cassdawg(1457)
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shTi sha to od htiw teh lhitgoarm fo tantreig hc.kso icepSt a( epyt of vturtdisib)ie kshco sa elwl sa lempoyhovci schok ear reetatd wiht VI dfuli esutistnoirca 0F20(2A .1)03p rsadlCyotil fidsul aer ie-ntrslfi ei,ccoh adn oarnlm elnsia 90,.(% )onstocii si iis-lfertn pacicsleiylf ni acses fo hckso.

5% seoetdxr in wraet dna 5.%04 nleasi si otrcpihyne dna otn sfeulu eer.h

%5 esdexort nlaoe si ooisnict in eht bga utb gylcsihpyoaolil cyooi.htnp tI si emro feotn ivegn ofr diful lectpaemrne feart rveees dyaoirtedn.h

0%5.4 isalne nloy is tnochopyi and ton feuusl eer.h

%3 lsiane si ecroyitpnh and not useflu e.erh

... cassdawg made a comment on nbme17/block2/q#13 (28 yo woman, 18 weeks gestation and palpitations)
 +13 
submitted by cassdawg(1457)
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nI nmteargee wiht teh ehtor p:tso s(ee 02A0F2 p33)1

You uwlod wnta ot chkec EFRE 4T csebaeu nreygcanp srecaiens yidrhTo idngbin blguilno. It si oeisplsb hes migth hvae drcesenai elvlroa ,T4 tbu TNO ahve yreodmithrhyisp cbaesue het eref T4 si monarl e.(.i her cesaiensr omtnua fo diroyht nnibigd iubglonl ahs bunod oerm ,4T nda scnie our oesdbi rsodenp ot het trcnnoiacneto of eefr T4 oly,n het hyhposaualmt uoshdl ruesne ttha teh eref T4 si ekpt ;tcanntos tish ouwdl aaprpe as eearcnids aloverl )T4

orntehA way of tnkihing of :tsih

  • arlvleO T4 = budno 4T + rfee T4

fI we naeiecrs obdnu T4 adn kepe eerf 4T the ,asem we loudw sitll ceansire aloelrv T4. sThu to wokn fi she yrltu ash idiotrysphhymer we utsm oolk ta feer 4T onaoni.encctrt

lpp06  Does Overall T4 stay the same because TBG+T4 can last longer in circulation? Cause I always struggle thinking that free T4 is low because its being bound by the extra TBG +
covid_19  I'm not sure if I'm interpreting your question correctly, but I thought overall T4 increases in pregnancy? The way I think of it is that early in pregnancy, Ξ²-HCG (acting like TSH) β†’ ↑ free T4 β†’ ↓ TSH via (-) feedback β†’ TSH back to nml as ↓β-HCG during pregnancy (i.e. gestational thyrotoxicosis). If the mom really has hyperthyroidism, then free T4 remains high and TSH low even as Ξ²-HCG ↓ and ↑TBG. Later in the pregnancy, estrogen β†’ ↑TBG β†’ ↓ free T4 β†’ TSH release β†’ ↑ free T4 to regain equilibrium. (bound T4: free T4) 2:2 (nml) β†’ 3:1 β†’ 3:3 (new nml where there's a relative increase in free T4 AND overall T4). What are your thoughts on this? +
topgunber  Overall t4 increases, but when t4 is bound to thyroid binding globulin it is not active, therefore someone would not show characteristics of hyperthyroidism if they had high thyroid binding globulin and high total t4. Basically, free t4 is the actual amount of thyroid hormone that can cause a physiologic effect. As the first comment says, total thyroid hormone and thyroid binding globulin are increased in pregnancy. Thus to check for hyperthyroid we are concerned only with free t4 (if it is low then the patient would be hypothyroid) +
... waitingonprometric made a comment on nbme17/block0/q#0 (A 70-year-old man dies in a motor vehicle collision....)
 +13 
submitted by waitingonprometric(231)
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omrF 2FA,002 .gp 38:1

aTublur d-t&gaaoe;m-n nit;apceosl uulrbat ysogoihtl ahs slse nimgnaalt npaeioltt hnat ;ilusvlo lbiuovstluulo sha tdeeentriima annitmalg ltaentp;oi uslyalu mtcoaa,pymits amy tesepnr htiw etcral dinbee.gl Heenc rou ttianep who hsa eenb enoirdgnug uivnatloae rfo cfael oluctc d.lobo

Orteh rwas:nes

cleHpisaprty t;-&y-ogppl mots moomc,n glneyaler relamsl adn ni croegdoismit gro.ein I'm igsgsenu hte etciurp aectdaht to siht oqntusie is rtiygn to ecul su onti ihst tno bngie a mlsal eoins.l

tfaalImmyrno psd-s-eg&pyl;optou ude ot aluocms riosone in ramfianylotm ebolw isedae.s reThe is no pibaceplaer ssonrioe in shit ri,tcpeu alos eht asms erpapas dt,neuadlpuec so ew oknw i'ts nto a ptos of alomrn sacomu thta ustj osklo dsriea aemdorcp to rudoinnrsug nsoie.ro

eJiulevn oylpp and -urPegeseJhtz --m&trndsyoeg; eeths rea othb ntcgiee oddrisrse twih senurmou mtaaarmotuhos sylpop eens ni eth lc.oon t-huPsereJezg loas aciseasotd itwh eidrsacen ksir of ratbes and htoer GI necsr.ac tI si yuklelni thta uro eatnitp hda eihter of ehset cb/ he is 70 oy;/ efer,htero if eh dha noe of sethe, eh uwlod yeikll eahv mreo htan eno ncool olesin and may saol enptrse whit a itrshoy of thore scrcena at ihs eg.a

cheesetouch  great refutation of others, thanks! +3
lpp06  To add - tubular adenomas are pedunculate masses, as seen in the image +2
soccerfan23  great explanation and username lol +
sexymexican888  Also... idk if this helps but it got me the right answer (plus clinical scenario) : golijan said TUBULAR ADENOMA -> STRAWBERRY ON A STICK I know thats for the histology but idk thats what it looked like to me haha +1
kcyanide101  I got this question because of Goljian!!!!!!!!! STRAWBERRY ON A STICK :) +
... cassdawg made a comment on nbme17/block4/q#37 (An 18-year-old man has yellow nodules on the...)
 +12 
submitted by cassdawg(1457)
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llYoew duenslo lreesoh(ctol ptsiedso) on the lsalehci ndseotn vhae a rvye gihh acsioisanto ihtw Tyep II liafimal p,aieiysilmdd or alimfila lolachp.oersimeyhtere sihT si cdaesu tosm ofnte by a dctfee in eth LDL etropcer uot.nincf FA(0022 4p9)

cassdawg  NOTE: This patient shows a SELECTIVE increase in LDL so it is a defect in the LDL receptor NOT a defect in ApoB100. A defect in ApoB100 would present with increased VLDL as well! +27
ginachipotle  Note that the answer is ABSENT LDL receptors vs. partial reduction b/c LDL >700 (LDL = 980), indicating individual is likely homozygous for the trait. (FA2020 pg. 94) +10
jdc_md  you trick me nbme. veryy veryy tricky +5
... waitingonprometric made a comment on nbme17/block2/q#22 (60 yo man, 1 month of progressive shortness of breath)
 +11 
submitted by waitingonprometric(231)
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F10,2A9 gp. 666:

asBde no teh sifnnigd of eecsdedar braeth ud,sosn ludl c,rsioneusp nad aeredcdes alcteit trsumfei, reulapl ffonusie si ruoy aswnre.

This wsa ermo fo a oerutul- teniqosu naht a serepar-g---mtin-reebnrhw--eoamoAaF nuoqiste fro em!

hBerat snduos are ecradde,se so oyu nca eulr uto ctaiahmst irotsbhinc wzhi)enge( nad unoparylm silombem a(lrnom rbateh ,nodsus tbu )np.cciayeth irBnsaitcoecsh cna avhe a ermunb of sk-nfcsrlgi-dineac, orhi,hcn e,engizwh rtymspn-diioria seaku,qs te.c

Eymamehps o(lss of eloavral lapest etsius) dna xtahmnroepuo veha inedrceas iar in hte sul,ng eeethr,rof eyth lwli eb nrtoaerspyhne no serosnu,pci os erul ehsto tou ot.o

eicltaT suirfetm adseceres hwit sotm tgiy,rvehen tub tincowon-sola-lodi fqeneuryc usdosn talerv wlel in sdene retaamil (rablo pemiu)no,na tbu vertal oyporl gthuhor iidqul ul(plrae fni.)foesu r,feehreTo bsaed on ceeesrdda e,trmfuis elur uto maouenipn.

o.ey.Sr'uo. felt hwit upaellr euosfnfi sa yruo sena!rw

mw126  Physical exam findings related to the FA table for pulmonary embolism are usually normal, may have a pleural friction rub over the area of infarct. +
an1  why are there crackles in the opposite lung? +
srmtn  pleural effusion secondary to HF (bilateral lung involvement). so crackles is the finding before pleural efussion- +2
... flapjacks made a comment on nbme17/block2/q#33 (Study conducted to assess effectiveness of lidocaine injections)
 +11 
submitted by flapjacks(90)
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My nroiesnag fro hsti eu:qosint

  • In otbh oaii,snsttu oyu ees a ccllayic icnersea ni pnia orbefe evicireng eht jcoie.innt isTh ldocu be sene fi het fetcef aws nraewgi of;f wveoe,rh fi yuo ,ecoitn ethre si a eacedser in ianp fbeoer hte oijnectin is neve viegn. I bieveel htsi ilesipm htta hsemintog hniterne aotub eht eojintnci si dvipgiron ianp feri.el
  • h,emeFurtrro ohbt rsevcu loflwo eth msae athp tihw na eenlavtu esdereac in anpi, alrrdseseg of nieeonv.rttin
  • yMaeb na dilditaano pnoti - I am ont ongitnuseqi threi a,nip utb aryagfmliibo ylpyctila woshs on lmbaaorn lab rstulse in oaddniti ot atylcylpi cisnegtxoi wthi some rfmo fo almnte pt.yhogoal I otnd' nktih bpceola inebg dsttroaedenm is afr fof.
j44n  I agree that was my though process, except i didnt notice the decrease before the injection, good eye! also the other answers didnt really apply regression toward the mean is the phenomenon that arises if a random variable is extreme on its first or first few measurements but closer to the mean or average on further measurements and there was no way for us to know about confounding or their selection procedures so from that we couldn't really know about the types of errors they made +3
... cassdawg made a comment on nbme17/block3/q#24 (10 yo girl, well-child examination)
 +11 
submitted by cassdawg(1457)
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Heer si a rgeat iaemg honsigw eth tenlimei fro eth edffrtien rleptabu ncghaes in mseal dna esfa.mel nnreTa gsesta ear ufnod in F02A20 3p.67

nI sfemla,e the sertaile edcttlbeae igns of beutparl aegnch is aretbs dub dpetevemnlo hciwh olyn tgillshy seerdcep pbicu rhia tmlp.noveede nI ,leasm lrtcuiaset gtmenerneal si hte fitrs dclbeatete gs.in

flapjacks  You share excellent charts. Thank you! +2
... tinyhorse made a comment on nbme17/block0/q#0 (A 45-year-old woman comes to the physician for a...)
 +10 
submitted by tinyhorse(10)
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nkyFarl yertpt orfodel htta adynoyb ttuoghh atth hits estiquon diantcnoe nheuog inafiormton fro mooeesn ot dneycfiontl aswren .ti

heT queoinst ahs uyo ssmaeu htta boht easntrp era oeeyetgsrotzh ta het oclu.s h?Wy I mseasu 'Im nsmgiis oems otecresi afct atobu 4P50 lalele sfqcueernie.

flapjacks  I got lucky guessing the same % chance that siblings share HLA markers +4
baja_blast  I agree with OP seriously no idea how anyone could have gotten this right without totally guessing it. Am I missing something here?? +2
sschulz2013  However, if one parent is homozygous and the other is heterozygous, then it works out that the sister will have the same allele 50% of the time, not 25%. So still not sure about the above answer. Don't think assuming the parents are both heterozygotes is something we should have to do. There is probably more to it than just that. +1
j44n  the probability for being the same gene as a sibling thats homozygous is always 25% this has been on just about every practice NBME +
chaosawaits  Because neither of the parents have history breast cancer, it is assumed that neither parent is homozygous. +2
... cassdawg made a comment on nbme17/block0/q#0 (A 3-year-old boy with sickle cell disease has the...)
 +10 
submitted by cassdawg(1457)
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etoetmisOilys is a ocommn tonclimcopai of lkeics lcle isaedse dna cna eb ehtgdsnisiiud heer aeebsuc fo eth aedtleve enouChrtBp/liW tiiic(andgn claiebatr ncinote)fi. It si rminoptat ot tone teh omst mocmno saecu of sckiel cell lmyttessoieio si lmlaSoneal ro aShpt eusuar i(n a hhetyla uvldianiid hte osmt momcon ecsau si hpaSt ueru)sa. 0A22[F0 p081 nda ]224

... bingcentipede made a comment on nbme17/block0/q#0 (A 55-year-old woman has left flank pain and gross...)
 +10 
submitted by bingcentipede(305)
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heT csilcas atrdi of a lrean clel ocarmncai i:s )1 tem;uhaari 2) lnkaf ;pnai dna )3 a bpellpaa aklnf mshae Ts. aisclsc RCC csome mrfo a HVL aumittn.o oN LVH nemsa uyo 'tacn bhniiit IHF yi(xopah cbenudlii f.a)crot Tihs slade to ldnrloecunto iatntivcao fo EVFG, neildga to eth cruhayelravsp mas.s

cheesetouch  FA2018 P583 +4
... lfcdave182 made a comment on nbme17/block1/q#28 (12 yo boy, swimming in mountain stream; immersed in 60-degree water for 20 minutes)
 +9 
submitted by lfcdave182(39)
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Cldo e:ueptmtrare ssCuea reehriappl nrtcoioivcatonss dna ecnlrta loaondvisait

  • sncdearIe lctraen oodbl eovlmu tg-&;- ewroL DAH due to ecnradise loobd uvomel hgturho nydeiks
  • sdeanIcer ltrcean bldoo elvom -t;g-& sedla to iraalt irn,etgthsc aiercndse derlopa >-- dIcseaenr NPA lraeees
passplease  what organs are considered "central"? I initially thought that the kidneys would not be getting more blood with most of the blood flow going to the lungs and heart +1
brise  Same :( +
drdoom  the kidneys are the lungs for waste products that can't be expelled via your breathe. (another way of saying this is: the lungs are like the kidneys of your mouth: instead of urinating out of your mouth, you "pee out" CO2 in the form of expired air.) tl;dr the kidneys are very vital organs!! +2
mkayman  my dumbass was like alright you pee in cold water so that means central blood volume is up since you're filtering more blood in the kidneys, ADH is down because you wanna pee and ANP is up because you wanna pee... worked out okay +1
... lfcdave182 made a comment on nbme17/block4/q#20 (45 yo man, 4 days of yellow skin)
 +9 
submitted by lfcdave182(39)
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Pg 319, FA 0202

  • oohiAclcl t:ipiaesth nSlwole dan ticoecrn oceepstyhat wthi ptruceloiinh lnrftiinaoi;t oalrMyl iesdBo ma(loracipItcntys iipnhelcisoo uiloiscnns of demadga rtkaine lm)ieanstf
cheesetouch  FA2018 P385 +4
randi  FA2019 p.385 +1
... cassdawg made a comment on nbme17/block0/q#0 (A female newborn is delivered at 38 weeks'...)
 +9 
submitted by cassdawg(1457)
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sihT cildh kiylel hsa a noyoceminmelegle elanr(u teub tcefde aedusc by lfraieu of hte usrenpreoo ot efus in keew ,4 2F020A 9.)p41 uaelrN eubt emveldntpoe ni energal csocru sewek 83- A220F(0 61)2p cihhw pdrrssecnoo omts cyleosl to days 4501-. ansggineresOo adn toms ltiav mpodeletnve saol ocrsuc irundg isht rde.poi

sDay 11-0 rae yatilpcly lal" ro gonnht"i ni htat a feectd dwoul suace tlafe idsme.e

sDya 0-576 (eks~we 8)10- are eatcissoad wtih txeenrla einlgat enltopmed,ev taaepl and hee.tt

ehT tmos carlctii irdpose rae ilacylypt rove yb keew 10 se(e tsih trach)

... cassdawg made a comment on nbme17/block0/q#0 (A 50-year-old man comes to the physician 3 days after)
 +9 
submitted by cassdawg(1457)
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Tish vniuididla si giffrsune omfr maceloayphic, whhic linxspae hte ei,zsruse httnwiicg rnoe(as rof Chkotsve gins - napitpg fo teh aiaclf renve casguni itocnorctna fo eht ,)elscsum nad assmps lrmais(i to rsaTuuoes insg - oinfailnt of eth lobdo euersspr ufcf cniusga paarcl ap)ms.s tI olsa mya enesrtp tiwh TQ nlnirogatopo adn unsensbm and gtlninig (as cebed)dr.is It is sloa miotnarpt to neto ttha hgthou diml colpmcaeayhi causes a,proeixfelyh mertxee mcypehicaola nac lead ot rrpfy,aiheelex tn,etay siasptaahes,r nad zuesseir ees( eerh). iaclsalBy yuo ntcona bakn no the ee.lrsxef

arHecpilymaec uoldw rnsptee hwti snesot )ln(a,re b),(asnopnie d(mgarnaobiasnlo apni), n(ohters ayinrru eq)en,curyf atiyphscicr e(seitnatyvoeor,xn trldeae enmatl ut).sats

The rohtse rwnaess aer creoitrnc ce:useab

  • criaebatBon isnceabdstru ear reetadl ot bcda/asei aebcanmli nda douwl otn pterens whit teh symmpost eiddr.bcse
  • :ieChdolr
  • ooraclimypeHh tiada(ssoec with sveeiscxe om)invgti is llyatpiyc mnodaecicpa yb meoahirytapn dna yclylpait etpesnrs wiht ftuieeae/swnsgka adn riad.doyhten
  • mHayhreporclie canbiusdrste ear alelnygre dlreeta to ynedik ussies nad ehwn gssni teesprn ethy era eytn,rhadodi cessieexv ,rihtst at,uigef nad dyr cmuus srmeneamb
  • isa:tsPmuo
  • mkpeayoHail senpetrs with cesmlu psca,mr s,spam dna esanweks tbu olsa hiwt crdcaai aneomlasi y)ahstrmrha(i nda telfaedtn avTsw-e no GC.E
  • Hiepmaeaylkr tnseesrp thwi deiw QSR adn eeadkp T vawes no CEG, knwa,eses dna amhhyasrir.t
  • udo:mSi
  • pyHemonatrai cna ceaus srzusiee and rs,toup btu ti sloa yyialcltp stpserne hwit asenua nda ntiv,mogi swtuk,gnifa/esaee dna nncosu.ofi eerH is a ogdo hipreyoanmta icuoenpmn OT(SSLALS - topSr,u rnan,isouAxeaae[ o],igvtinm Lhgt,arye Tonend elxeserf ceareesdd, mLip ke/scunseeslws,am hcartottOis htonyies,pno ,Ssuieezr Hdaheca)e
  • pnraiteyeHmra erpsetsn htiw itiraytbrlii nda stopur

trecylotelE uesarntiDscb: 0A220F 159p

chaosawaits  everything is great except "mnemonic" +
... abkapoor made a comment on nbme17/block0/q#0 (A 56-year-old woman comes to the physician for a...)
 +9 
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Jtsu to ca,fliyr mecolept ensoitolur fater rnuyij nca nloy crouc fi eht nsebemta mrnebame asiemrn tancit sa isht owleb tish si ehrew het emts elcsl rae da.teocl fI ehtre si geamad ot eth ebmnetas emema,bnr you wlil avhe mlneeotcpi uilrsnteoo nad crsa fimor.atno eTh tbes empalex fo hits is isnk uyinjr.

... cassdawg made a comment on nbme17/block0/q#0 (A 65-year-old woman comes to the physician because of )
 +9 
submitted by cassdawg(1457)
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hcenLi ursecsols is a vruavlul hglaptooy oivnivlng nithngin of eth impidsere ihwt sr/eioosglbfrcisnis rdie,sm omst cymmoonl esentinprg iwht ksin gifrlitay enrppa-i)(ht in a-lsmtnupepoosa wnemo F2020A( 4)64p

ehT htreo esnsrwa od nto i:tf

  • Cddniala oftiinenc = ciyssehnt dna tgoecat seeehc r;echdgias teh esvicsexe ntichig nca leda to cinhle rsslcueos tbu dwulo asol eb eadrett by hte eaoiocnzml
  • PHV = tlenaig rtaws ro ecrviacl rnecca
  • icoTasrimoinsh = yhict hwti enegr symlle gaescd,hir ese imrsnogsa on scooprmyic
  • lehtarUr lersapop = rea,r u,pflian oduwl tno useca seeht sstmypom dan wdluo cseau isnllgwe in heulatrr aear
... bingcentipede made a comment on nbme17/block1/q#16 (A healthy 70-year-old woman has participated in a...)
 +9 
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Cehsgan that haenpp ni :gniga

Sysat het :aems TCL yre(v otnmtrapi to nkow tih)s

edrIn:saec lung lpecnmc,iao drelausi evoml,u VQ/ ,cmashmti a-A enitgadr

eaeDr:esdc stehc lalw anep,liomcc ,CFV VEF,1 orrrpsieyat emulcs etghnrts, rtetvlaniyo spneoser ot ie/xmxhioyyaoppah

AAK td'no gte ldo

gooooose  FA 2020 p665 +1
sschulz2013  Exception: severe kyphosis can cause decrease in TLC! +4
ownersucks  Even though lung compliance increases there is stiffening of chest wall which balance out increased lung compliance. Thus TLC remains unchanged RV increase and FEV decreases because there’s collapse of out flow tract which weakens with age +1
... andro made a comment on nbme17/block1/q#8 (6 week old girl, 6 days of vomiting a small amount of milk)
 +8 
submitted by andro(222)
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tfieDeianflr saoingsDi of teonleNN/rabwnoa imngitoV

Bi-enng gagloehpastesaro freulx ( .ie iemratmu erolw eaehpsoalg ithpscner )airnuigetrtog fo dofo orshlyt ftera dengfie .
oN erhtrfu mymposst , yhtaelh hnldceri twhi lraonm enlpmtodvee

ihoyrH-cpretp ypliorc ositssen
gugriRainttoe - cprjeitoel niolnsbiou imtivnog leoetcyrelt mnaaelsbci ( ilosklsaa dna hakeyolamip ) * lcaisphy omaanxnetii may raelve na ovile sasm on ptlpoiana fo itriepgsamu
taly*cyl pi sattsr ofrm nbewete 2nd adn th7 wkee fo age

-tduiMg slvluuvo r/aoontMilat oDale/dun atiesar * iiuobsl miitvgon * oaalbmidn osneinttid * mnggiaI yma elerav nsgis iekl eht dlboue blbbue sngi ( oandeudl staeari ) ect

eotN: The tisl is nto aisexeuvth as ereht rae ynma more esausc saoaditsce ihwt bnrwoen igtimnovi

covid_19  To add on to Benign GER, I couldn't find anything in a cursory look through FA and also didn't know that GER was a thing in neonates, so I found this nice and concise article in UpToDate: https://www.uptodate.com/contents/gastroesophageal-reflux-in-premature-infants +
i_hate_it_here  I don't understand why Esophageal spasm isn't right +1
topgunber  I would say esophageal spasm would cause immediate regurgitation or inability to swallow properly. so we would be looking for dysphagia. +4
nikitasr27  In general neonates have an immature nervous system (e.g. babinski) and I think that also applies to the ANS. That’s why you see so many YouTube videos of babies vomiting out of the blue without even changing their face expression. I don’t knoow, babies are weird +
pakimd  is immature esophageal sphincter the reason why babies spit up milk when parents burp their babies? +
chaosawaits  babies burp up their milk because they swallow too aggressively when they feed. Burping them helps get rid of some of the air in their stomach and helps prevent distention from too much air, thereby relieving of potential stomach pains. +1
... lfcdave182 made a comment on nbme17/block1/q#14 (21 yo man, excruciating anal pain for 4 hours)
 +8 
submitted by lfcdave182(39)
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Pg 663 FA 220.0

  • Bolwe cntepitae lie:n lrEexnta :mrhsedioroh iaPflnu if trdsh:ombeo nrrieIfo ectRal .iVne
neovanilla  Note: pg 365 FA 2020 states: anorectal varices: portal <--> systemic: superior rectal <--> middle and inferior rectal. Not sure if that's correct, but definitely the info cited in pg 366 is correct +3
cheesetouch  FA 2018 p360 +1
... cassdawg made a comment on nbme17/block2/q#41 (Seven hundred healthy women observed for 10 years)
 +8 
submitted by cassdawg(1457)
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20F02A 25p6

Tshi woldu eb a strcveiepop hcoort sa yeth era iknoolg ta owt gpours tiwh nda utwtioh krsi fcorsta nda ensssgasi aeesids iene.cdcni

WrUodl has a ursep tetpry rieucpt chihw selhp ilsyulav xaelinp the eiesfrecndf igotyrhCp( WdU,rol hlab habl uyb WlU)rdo

... waitingonprometric made a comment on nbme17/block2/q#46 (38 yo man, brought to ER 30 minutes after being found near his home, unsbale to stand upright)
 +8 
submitted by waitingonprometric(231)
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aieotbMcl ocassidi esbcaue the leatairr pH sgoe ni the msae torceinid sa eth icabbr nda OpC2 i.(e. othb pH adn c2Ca/bObrpi aer ecsedadre form r)onl;am ni ripymra rsirreopayt aolodiail/sksaciss eht rtraelai Hp oges in eht tposipoe etrodinic as the riabbc nad 2CpO.

enOc ouy wonk atht it si a yripamr miltecaob dacso,sii ouy vhae to ceckh rof nonoaiccttm srirertyapo ersd.isodr Do tsih iwth irtsenW' raflm:uo

edxceept p2CO = 5()3.OCH1 + 8 /-+ 2

..os. txcpeede pO2C = .1(15)1 + 8 /+- 2 --&t;g 2COp = 5.42 -+/ 2 = pdecexet 2CpO is tenbwee 2,..256-25 eertreoh,f 32 si ni het xeedpect eag,rn no cmnacoottni oeyrtsaprri ssopcer

baja_blast  Was looking for "Metabolic acidosis and respiratory acidosis" and was wondering why it wasn't a choice. Totally forgot about Winter's formula. Thanks!! +7
... cassdawg made a comment on nbme17/block0/q#0 (22-year-old woman, gravida 1, para 1... vaginal bleeding)
 +8 
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ogniiatL of eht itnalner iialc yarert is udse ot opts raupopstmt rnietue ndieelbg lwieh esipregrnv ttlifreiy as eht ranvaio staereir prviedo atolreacll oclicainrtu (020AF2 p)64.0

reHe si na ameig shngwoi hte ieurnet yrerat mcinog fof teh nalrtien laici htiw eht aoivarn ayrert le.olaltrac

Oetrh sn:asrew

  • Teh aeltexnr liica ivsge esri ot eht faomelr y,rtrea rieifnro iipasgcrte tyra,er dna eht pdee cecluixmfr iaicl artery
  • eTh ilnnrtae ndeldpua yertar ipleupss hte aelnxrte eagetnlia dna npemeuir avi eaitrrse uhcs sa het irnreoif relact traery aaln( lanca LEOWB eth tatpnecei i)ne,l lraneiep eyrrat, and dredoe/lpsal terrieas fo hte colritsi or dsoledepra/ terasrie of hte ipesn
  • heT eindma slarac yrtrae si almls adn speiuslp teh b/orcuy/cacmucsramlx rbervteae
  • heT aurrottob erytar si a bnrhca fo hte laentrin ciila hwhic isevg off the bcipu barcnh (pseusilp plveic e)csumls dna uacrbaelat bahnrc (ielpsusp heda of teh uer)mf
cheesetouch  fa2018 p624 +4
... cassdawg made a comment on nbme17/block0/q#0 (A 19-year-old man is admitted to the hospital...)
 +8 
submitted by cassdawg(1457)
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eH hsa na ppreu otrom ueonnr elisno icwhh is uagisnc laasspriy no sih eftl wloer dies, os eh wlli vhea hexeyearrlfip no stih .sedi Tush eth eedp dotnne rfeexl lwli alutclya be enesescrtgntodair/s ni hsi lfte sleaclhi dneont ailtiylni ferta eht aetccn.di 20[2A0F ]25p9

jurrutia  Wouldn't he also have hyperreflexia in the right brachioradialis, which is innervated by the radial nerve? Since the patient's right radial nerve was severed, he should also have an UMN lesion with hyperreflexia in the right brachioradials? +
kbizzitt  A radial nerve lesion is a LMN lesion (hyporeflexia). You can basically divide it by pre-anterior horn, and post-anterior horn of the spinal cord. After the synapse at the anterior horn it becomes a lower motor neuron. Before that (along the spinal cord and up back up to the motor cortex) is considered upper motor neuron. +3
jurrutia  Duh, of course! Dumb mistake. Thanks +1
an1  So if it's UMNL, why couldn't the right patellar tendon show hypereflexia as it was also in the initial injury? +4
solangelroma  the only paralysis for right cerebral cortex injury (UMN) is the left lower extremity - the radial lesion (LMN) is for the humeral shaft fracture. the tibial fracture is also right. UMN gives hyperreflexia, LMN hypo. +
... cassdawg made a comment on nbme17/block2/q#1 (A 38-year-old man comes to the physician because of)
 +8 
submitted by cassdawg(1457)
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rnaedotiaL si a ndocse eeaonigtrn eiatintisahmn nad hust oulwd eb pedefrerr ni this itnetap sa it odes otn auces estado.in F2020[A 6]p86

cSeni eh wsrok eoapignrt veyah ,ncyraeihm it uodlw eb rrpeeedrf to tup imh on a oecsnd entirenoag tna.amiietnshi o,nrprehiaminBe nidyroz,xhey dna imeaynnedphdihr are irfts etaignoenr esisnatiinmhta whcih sauce o.iadetsn

ntnaeiidiR is a itsnamieh H2 blckore sedu to aeecsrde nicesroet yb ireaptal secll in ceiptp lercu sedis,ae stgriista, dan tisagcr xferul A220[F0 ]p939

cheesetouch  FA2018 P667 +
... bingcentipede made a comment on nbme17/block1/q#23 (A 60-year-old man comes to the physician for an...)
 +8 
submitted by bingcentipede(305)
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otN ni tsFri idA, btu r.Ds arSatt dna lnojaaG izmehpsae shit tnpio

In l-lBce lomssnaep loymhap(,m MM), het ortai of bosilnmimogulun is nthwor off. aKpap dna daambl feerr to eth gI tgilh cainh ty,seogenp adn is myaronll 321-: for ppkaa ot mbaal.d ,eeHr sit' oamtsl 116:, nad shti is a gheu nisg htta heert si a llnmoacono iontplerfriao of eon elcl ypt.e

ehT erhto rwsaen cehcsoi uodcl eerfr ot ylcaonlpol ,oefprsoinliart but a nal()mocooln opnemsal uodlw be reletfdec in the ucseraf l:k iorta sa well sa hte D6PG ifsrooms fro grondean .repcsreto

dermgirl  Pathoma 2019- page.23 +
... icedcoffeeislyfe made a comment on nbme17/block2/q#5 (56 yo man, sudden onset of uncontrollable irregular movements on left side of body for 4 hours)
 +7 
submitted by icedcoffeeislyfe(49)
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isrtF iad 0220 gp 15--1 nbira sonlei in eht lisucmbahta lcsuuen = rlraltoteanca muilblihsemsa

cheesetouch  also: Caudate atrophy -> Huntington Disease [causes cognitive issues FA18 p 484 vs putamen has motor role] Dentate nucleus is the most lateral deep nucleus involved in cerebellar output (FA18 p 483) +
... icedcoffeeislyfe made a comment on nbme17/block2/q#34 (40 yo man, skin extremely sensitive to sunlight)
 +7 
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AF 2020 gp 254

yprriPaho ctnaeau at-d-ra eetcdf ni UROD ni the eemh enhystssi apaywth htta asescu eotiyposihvittns adn lengrsbiit

bingcentipede  Most common porphyria, too +4
brise  The thing that got me screwed was the "increases synthesis of compounds"; like what compounds? +
i_hate_it_here  I swear they just love to say shit to throw us off smh +3
sexymexican888  @brise I think they were referring to the previous products of heme synthesis that build up (hydroxymethylbilane, uroporphynogen - or however the fk u spell it) I think those are what cause the blistering photosensitivity, im guessing it is since these dont accumulate in acute intermittent porphyria -> no skin symptoms. but yeah I agree these ppl fucking suck +1
chaosawaits  "Disorder caused by the increased synthesis of compounds in the skin that are subject to excitation by visible light" = heme; "Disorder caused by lack of compounds in the skin that are subject to excitation by visible light" = melanin +1
awkword  @sexymexican888 is right. Dr. Ryan says that there's an accumulation of uroporphyrinogen due to lack of UROD which gets oxidized to uroporphyrin. Uroporphyrin then gets transported to the skin (along with being found in plasma and urine), and causes the characteristic skin lesions found when exposed to light. +
... cassdawg made a comment on nbme17/block3/q#33 (Female newborn delivered at 36 weeks, respiratory distress)
 +7 
submitted by cassdawg(1457)
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sTih si a Ceingnlato icgpDmahrtaai rHiane .00(20FA7p32)

Clnatiiong irahpaictmgad sherain rae sudeac by a taonnilegc eefdct of hte eeollupparrniteo mmberaen ihhwc oslalw cetntson fo hte bdanilamo vyitca ot htanerei pradwu, adn dlpeisca eht cnosntte of hte ahrtox e(nceh yhw ruo yabb has aediecsnlmpt fo eth ilmedsintaa tsctnone ot hte .ri)gth Tsih slao dasle to unlg fnmmooaralti dan esarrotypir rtdesiss ee(hnc hte wol argap r)so.ecs Beescau eth mocstha si kielly reihensat prwu,da a ssarogancti ubte cplaed ulodw arppae ni het ltef ietamsumnid ecsu(eab atht si ewhre het somcaht s)i. ,Futrreh there si an seenacb fo boewl sag in eth ambdoen kyliel aceseub eth eobslw era adeetirnh noit eht hx.oatr

cheesetouch  FA2018 P364 CDH +1
randi  FA2019 364 Diaphragmatic Hernia +1
kcyanide101  I had chosen lung hypoplasia in this question.... because i felt the hypoplastic lung creates room for the stomach to herniate into the thoracic region +
... cassdawg made a comment on nbme17/block4/q#47 (10 yo boy, anemia since birth; spleen is five times normal size)
 +7 
submitted by cassdawg(1457)
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etyeSploncm si iinactedd for dheraeityr sphosoricetsy usceabe it si na ctnsiirni tyeihcoml animea eehrw eth eslepn is gdeysotrni het der clsle evne uhogth ythe ucodl ylteihcclna ituocnfn .nief Thus ympesneoctl ilwl eenrvpt etpuramre voemalr by the eselnp F20A20( 2.p)24

cekiSl elcl iesseda sescau neiyatponpcsloetlcme/us qifertoatausnis/ertnc ubt tomecelyspn is ton dceitadni eecsbua eth elsenp is tno gitubnrtconi to the ssypmmto of ielcks lel,c teh spmtysmo rea aedcsu yb eth isuooasevlvcc ieesasd.

jzbjzb  why not thalassemia major? splenectomy reduces the need for blood transfusions and greater Hb levels +1
shieldmaiden  Because of the NBME law of the "Best Answer". Splenectomy is what "cures" HS, because that is the organ that prematurely targets it for removal leading to hemolysis. As for thalassemia, you could do it, but it is not indicated at this time for this 10-year-old. Splenectomy is only indicated for thalassemia when an enlarged spleen increased the frequency of transfusions and/or chelation therapy is not enough to control iron levels. +1
shieldmaiden  For the exam, only consider splenectomy for spherocytosis, refractory autoimmune hemolytic anemia, or massive trauma +1
... cassdawg made a comment on nbme17/block0/q#0 (15-year-old, lesions on neck, acid-fast bacilli,...)
 +7 
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Myoctabmuirec paleer klies olco mpetrsueeatr 0A2F(02 p411)

cteobMuaciymr rlapee si na dcaait-fs taicabre chhiw can cseau tow nksi tissatennfaoim:

  • pauLeotsrmo etsrenps yfsfldeiu oevr hte skin nad thwi ennoeli ecafis adn is erom seorsiu twih a leralyg Th2 esrospne nda hgih ecrbtaai dloa
  • ueldTuicbro (thaw oru atntepi )hsa psnesert hitw a efw eoisptyhhtce lseahisr inks luqepas whit a lrealyg 1Th seosnerp nda olw ctarieab laod

sLyepro slike ocol sptermruaeet so ti finesct snki nda arseliuifpc e.rnevs vEne tiutohw nwokngi eht ,somiganr het ilnk udocl aosl eb litatplneoy !ernfried

bingcentipede  In addition, the only other acid-fast bacterium is Nocardia; they would have to describe it as branching/filamentous (NOT a bacillus!). +3
... cassdawg made a comment on nbme17/block0/q#0 (14-year-old boy is brought to the emergency...)
 +7 
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raxylailM vener nrjuiy iseclp(ylfica teh bniarrfaltoi en)rve si na npiaorttm intelaotp ocotmpaiicln of baltior mir rfuesrcat g(.e. lbow uto faeu)ctsrr [See ereh]

ereH si a puitrce fo hte orstterreii fo teh ereinfdtf hbarecsn fo the grailmetni neerv orf otinsnaes wcihh ldcou lehp ouy wnaser isht oquintse as he ash snesmnub rudne eth eey ot het purep .lip

ilaOrbt rfool urtscafer anc lead to ranettepnm of hte nfiorrie suret,c chhiw nca be a cuase of inpa on prwuad ezga adn dpaiploi nhwe asdke ot olok aurw.pd siTh si na oihomptalochlg gecyemren (meav/cm8-ps7epcn/oe2c:t.i/redcris7ieve2a.mledte5o/thiw.)

... baja_blast made a comment on nbme17/block0/q#0 (A 30-year-old woman comes to the physician for a...)
 +7 
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Golnenicsuesego aplyrmrii csuroc ni het ,liver utb emysnez for cnuoegsoeglnise rea lsoa nfdou ni nkydsei dna nettlsinai ei.uethpilm 19A2F0 p. 87

dermgirl  FA2020 p. 78 +
... cassdawg made a comment on nbme17/block0/q#0 (A protein found in the brown adipose tissue of mice...)
 +7 
submitted by cassdawg(1457)
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ishT orintep si an ugpcnulino gaetn (keiyll eneirotmnhg cwihh is udfno in bonrw aieodsp dna eersvs ot encaiesr ahet pioodutcnr. iolnuUncpg sgenta llwi casue esadcenri meipiarbleyt fo the cinodoirhtma bmaenre,m ssinanetgecti rmoe enoyxg sotconmupni ni rdreo to tgneraee eth asem ion ani.detrg cSien oerm enoxyg si mecnsdou to atnregee eth mase ,gtiaendr rome enygox wudol eb nousecmd ot netergea eth smae mntuoa fo AP,T so the oiatr of gyxone numonipostc to PTA aoneeirgnt reeanic.ss 020(A2F 8)p7

Aorhent yaw fo intgknhi bouat isth si ttha noxgey iwll dniunotec to eb ecdnmuso to tmaetpt to ganereet the dtrn,agei utb the keyla enmaemrb lwil venrpte eth dairengt ormf ngebi rmfode yerpolpr dna erohertef rpvetne ATP omrf bgeni .fromed hsTu rhete is hte asme omuant of nxoyge ueonsdcm for litelt ot on ATP iengb emda so aniag teh ioatr of eyogxn iconnsutmop ot PTA tanoeinger anr.seisec siTh si slceor to wath laualcyt enphaps in hte doyb utb I undfo it reaeis to itnkh uboat ti het irtfs a.yw

feochromocytoma  Exactly, the electron transport in the mitochondria will keep going, but ATP synthesis would stop, which causes production of heat. +
thegout  if you're like me, you picked decreased ratio of oxygen to ATP in a brain fart without thinking about what a ratio is, gotta read the answers more carefully in long grueling exam. +14
... cassdawg made a comment on nbme17/block0/q#0 (A 53-year-old man, who recently returned from Africa)
 +7 
submitted by cassdawg(1457)
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olweB era kinsl to tucpesri fo tawh chea osgnriam udlow oklo leik no a tsian:

  • aoiBessbsi si verfe nda hielytcom siseead ntpmlodyarnei ni hte retsohtna ,US aullyus nrpteess thwi caislsc ls"emeta "ossrc ni sCBR 02FA02[ 1]5p7
  • ssaihinamseiL cna be auesntocu htwi creul eatsinrpento ro riselacv tiwh pniskig se,vfre th,elysmenelaooappg dna eanpiac.pyont eTh itoagssatem are npertes in mgeasrohpac ont RBsC 2F[A020 5p8]1
  • Miaarla is udecas yb hte sldomuamip eecipss adn tenesprs twih hotipoorezt grin ofsmr in CR.Bs tI si ttasmerdint yb het lenapesoh mooqstiu dan is edicenm in apsrt of aifAc.r It asscue revef, aaeed,chh ama,ein nad mypalnoeglse 2[0A02F 71p]5
  • olmosxpoaisTs si is na riltlreacnual sritpaea ubt a mslla nurbm xtsei eytalrcaeuxllrl as httoeasizyc in bdol;o it nca osal ecaus etsusi sscyt fllide twih iazosyrbdte. nI netinumetpmmooc tssho ti duepocrs mol-nokie oysptmsm tbu ni osomidmmepocrnumi it lilw stinsiaimed dan scuae -hergaincngnin brusaei/isnt .basessces [A020F2 ]561p
  • smaTsynoiaosirp can eb csduae by pyaoromsTna ceirbiu n(aicrfA pigslene scess,ikn 65)p1 ro raoysTpaomn iuiczr h'(Cagsa aed,isse uohtS iram,Ace p.15)8 Tseeh ioagssmnr rea rllceutaraexl no oobld s.earm
... compasses made a comment on nbme17/block1/q#20 (24 yo man, history of intravenous drug use, brought to ER 30 minutes after he could not be aroused)
 +6 
submitted by compasses(7)
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ttloa arcniocttenno = l0g.0/3m x 20L0 = e6 g0mh okot eth durg 6 suhro gao @ hf-tla fo 2 r64os==40g=ugu04suhur=o02 sgmh=m1o8rgs=ho262=hrms0r0mh =

... osler_weber_rendu made a comment on nbme17/block1/q#21 (42 yo farmer, 7 mm red scaly plaque on ear)
 +6 
submitted by osler_weber_rendu(118)
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ahWt uoy nca see is

1tsrp.eisroaykHe dthnie(ekc asmttru eemokcPuara)i rtasr2.nos yu(o anc ese het uecnli ervy ylcelra ni eht sumttra 3iayelu.s)cosapDm rn (eotinc encsoktartiey rahriccyemhopt and eralg nulcei og pu atsmol lal eht ywa ot the pot. sThi tins so ni oanlmr kis)n

lla stih itsf acntici sikoraset

cassdawg  Actinic keratosis is FA2020 p482 if anyone needs it! +5
baja_blast  FA2019 p. 472 +3
cheesetouch  Sweet name @osler_weber_rendu #represent #cureHHT +1
... waitingonprometric made a comment on nbme17/block1/q#35 (42 yo woman, 3 years of intermittent facial rash)
 +6 
submitted by waitingonprometric(231)
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rdiAgnocc to 0,A921F gp. 84:6

Rscoeaa is a lcaafi rieddsro eatdehiccrzra yb uesyatethrom pupslea dna u,ulesspt ubt on omencdeos cehn(e htis ietpsnta ryaemhet ovre het snoe nda chs,eke wtih rtetsecda egtcitlseasnaia dna a ewf p)leu;spa aym be aoictadsse twih ficala isglfhnu ni repsenos ot leneratx umtiisl ,ehcen( nbsgiuhl eaiy,sl pcisy foosd reniptpgicita a lsungfhi t).ocnaire

ognrW a:ssrnwe

cnAe uirsvalg owuld repntes wthi odc.esemon

niaridcCo smrondye cna losa sereptn ihtw csioeipd lnsigfuh gdtegrrie yb s,ofod ,lhlaooc ro rse.sst u,tB sith dulwo loas tepsern hwti scstimye doe--apsihrm,maytrs eenw,saks O,SB e,wnsitga te.c

asyitsPiri osear is a lvari sarh atth tlsas eeenwtb 261- weske and olwud not be dtecepex sa eth uesac aedsb no ihst nsptit'ea ry-3 hr.isoyt

bheocerirS iemirdsatt essuca an htciy sarh iwth yaklf eslsca (no afglnik terneps ni oru attpien er)eh,

chaosawaits  Pityriasis rosea literally means "pink scurf" or pink dandruff, as I think of it. It's basically pink scaly skin that self-resolves in 6-8 weeks. +
... cassdawg made a comment on nbme17/block2/q#24 (65 yo woman, ovarian cancer treated with cyclophosphamide)
 +6 
submitted by cassdawg(1457)
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epasCpyohomhdlic is na iyltalangk ngate chhwi orsnc-sskil NAD at uageinn dan snietfeerr hitw DNA rieicpnlato 0)2A4F(4p102

Otrhe lngiayaktl satgen hatt ftrieeern htwi NAD prceinlioat iuecdln ualfs,bnu oamof,esdiifs esruaiosrnt adn nreociazabrp rrpcibazean(o is icnfoe.c)nips

retOh nrwa:sse

  • aatitIdb/bo/inntnilsainimibi agtsret hte bBAR-Cl tiseyonr sniake nda ear udse for MLC )443p(
  • Ceassap 3 is otn a ridetc argtet of nya emurteoap.ihhectc
  • DNA hntoies esaceydtael is het attger of HDAC sbohni,rtii not in rtsiF Aid but pvorpdae for some e-lTlc m.ahloymp
  • NAD apelyomrse hlpaa is one of eth ytcrioekau AND a.eolemysrsp It is seislnepbro rfo iiitonanti adn some nsesytihs fo gganilg strdan but edos ont have eth hgih sctiivoepyrs of Plo .etlda It si tno ytdrclei eagtretd in nya tp.hyera
  • NAD osreetoaisopm II htorisnibi udilecn oiteep,osd ipedntieos alrmipryi( liods tmoru ,seu p)4,42 nirbuodioxc, dcroniauibn lio(ds rtoum,s ,kaeueilm myaohl,pm )349p. NDA Tpo I hsotinbiri ear aols rtnapomti antrouimt aesntg, inlcndugi ntceiinrao adn taeoocnpt 4(p4)2
  • elpmdairE rhgotw faotrc otecrerp erytison aisnek EF(G syroetni )ineska tronhibii is inibo,Elrt adn it si oniaptmrt in ibgcanottm -nlnsomal clel gunl carenc p24()4
pakimd  thank you for the explanation. one question: arent all alkylating agents cell cycle independent/non-specific? thanks +1
... icedcoffeeislyfe made a comment on nbme17/block3/q#9 (40 yo African American woman, 2 weeks of fever, malaise, dyspnea)
 +6 
submitted by icedcoffeeislyfe(49)
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Teh pt ash diosoaiscrs via eth ssacicl mhrpdiacego osciinotsaa dan hte l/b rliah ndaehapoyt

ni iadocrs you egt crisdneae CAE nad you salo tge cepemrchalyia eud to eircendas hpadoyeyl1xalar-sh- avi( aatectdvi mgesachprao) hcwhi sdael to neiedcasr tviinma D

20AF02 gp 766

jdc_md  black females lungs= sarcoidosis +2
... cassdawg made a comment on nbme17/block3/q#26 (34 yo man, lightheaded after 12 miles of marathon)
 +6 
submitted by cassdawg(1457)
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hTis tonieusq is itlylesnsae ngsaki whta paphsen to ymaeistcpht adn tmatheysriacppa efsrfetne ni the tsgtein of idvetaahiponrlyh/ooe.mdy nI siht iset,gtn hetre ldwou be lerwo odblo psrrsuee and tsuh hsit wuodl ausec ucreded igrfin fo the idtocar paerser,brtoco llaumytiet idnagel to efcekabd hwchi italmtsuse teh cysmaihtpet vernosu esytsm (to eerinsac ather taer nad uecsa plriaeeprh svicctnirnoosota in eordr ot aeemnctspo rof peyaohom)vli lehiw oals hniibiigtn eht are.iatcpaptsmysh

saqeer  silly me thought they were asking about heat stroke. +1
... covid_19 made a comment on nbme17/block4/q#23 (72 yo man, weakness and fatigue)
 +6 
submitted by covid_19(6)
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Aislacpt mainea: ,anaime aklienopeu, eimbrptyachoonto

MLC, i..e kmeeusail: im,aean ↓ mterua CWB, ↓ tlp, ehapreprli boold sream owshs mratue &pma; ntuiramg lerstacyognu A(F 220,0 .p 4)23

ahmalteΞ²-issa mrjoa: yctcm,ocrii pmrohoccyhi meniaa htiw aetgtr eclls adn oislaikctsoonspyioi, eksatlle eseorftmiid, e.tc (FA 2,200 .p 814)

mboainaCl fcdiceieyn: t/d ,tpblaioansmor acnatcpire e,yuisfinifcnc sat,emotyrcg or sifiufcetnin aientk, eonocgilluar Sx

soe,Panlyrl I tog ihst ,gwnor besucae ot ,me eth RsCB ni ahtt sarem lkodoe thob arlreg dan oerm ygrureallri psaeh,d os ni iinghth,sd I lyealr lhudseo'v hdneo in omer no hte IPH, ..ie teh patetin rellya ash nimaea dna no ohert naleevtr x.MP

flapjacks  I believe Goljan mentions that the #1 cause of anemia in older adults is GI bleeds +6
flapjacks  (colon cancer) +2
mark0polo  Also, B-thalassemia major would present in childhood, not in a 75 year old man +3
sexymexican888  ALSO, #1 cause of Iron deficiency anemia in a older person -> colon cancer. HOWEVER, remember golijan ALSO SAID "GUYSSSS YOU THINK RBCs JUST TURN MICROCYTIC OVERNIGHT?! LIKE YOU HAVE IRON DEFICIENCY ANEMIA AND THEYRE ALL LIKE CHEERLEADERS AND GO 1,2,3 ->MICROCYTIC?! NO!! ITS NORMOCYTIC FIRST THEN MICROCYTIC EVENTUALLY" It was hilarious lol but yeah they dont really say how long he's been weak and had fatigue so its probably pretty recent, it takes a few days for the IDA to turn microcytic +
sexymexican888  Also an adult male (not elderly) with IDA -> peptic ulcer disease +1
sexymexican888  ALSO IDA can be due to blood loss or dietary lack. Remember iron is VERY tightly regulated in the body and there's no real official way to get rid of it except bleeding (menstruation in females & sloughed of cells in the intestine that had ferritin stored) thats why male patients with hemochromatosis get HCC and all these horrible manifestations in their 40s cause getting rid of iron is actually hard unless you're underconsuming it or bleeding +
chaosawaits  I also thought those were some large looking microcytic RBCs +
chj7  Side note: CML should have high platelet counts (as most chronic myeloproliferative disorders). [FA 2020 P.433] +
amy  Thrombocytopenia indicates CML acceleration +
neurotic999  I got caught up between GI blood loss and B12 def. The RBCs were clearly hypochromic but they also seemed large for some reason. Also the other cell in the picture (PMN?) I assumed was a hypersegmented neutrophil and so I drifted toward B12. +
ali_hassan  guys aplastic anemia has def. of all the cells; not the case here. CML i don't need to explain. B-thalassemia would present with target cells and simply have more manifestations than just weakness and fatigue and B12 would present with some neurologic symptoms like peripheral neuropathy. while knowing GI bleed is a common cause of bleeding in the elderly population, the answer was GI blood loss (i answered it correct through ruling out the rest) +
... cassdawg made a comment on nbme17/block4/q#34 (16 yo girl, 2 years of intermittent fainting while standing)
 +6 
submitted by cassdawg(1457)
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wsAnregin shti qtuioens eqrsruie rglanee nwkedolge of eth cinoehctaamel nehstisys tyahawp 2A2F00( )p3.8

ehT opcraahp I toko to hsti ioutnsqe swa ymianl imnaoltiine fo owrgn ew:ssanr

  • AMO e(monnmiao )xeoisad ldocu eb enemtdiali eeuabcs she si agnlcki peeinnhirpe nda iscen OMA si lveniodv ni teh raoknwdeb of lnc,caitaeesohm a iceinydefc ni AMO loduw esincrae cncnottrsnioae of rihpeoneneinpr nad ehtor oeea.liachtmcns
  • ernihenNeropip rptserantor doluc eb dtialmeeni ebuasec ninbohtiii of uaretpek fo epnreohinnrepi lwd,uo a,inag scnreaie nhoeiirreenppn nasrittoneccon nad hes hsa edceadres toer.ntcocinan
  • enyTrosi laeyxsohdry nac eb emitidnela suacebe ti si eth tirsf ptse in chloienamacte hsiyntsse and riudeqre orf mnpodeia ssiytsh,ne nad as hes hsa idncesrae daipenmo shti etps si not ifdn.ectie
  • Amion dica ,ceaxdyoblrsea or om-nLia iadc esaabxelrycdo sola ealcld ADOP ayasod,becrxle is soal queerird in nmepaoid sehtsinsy adn anc be enimtldeai esbceua fo her nsaiceerd dimpneoa tenn.actoocnri

Tihs vlseae teh nwrase, pndieaom yheot-ldaxebyr.as

waitingonprometric  Awesome answer, but just to add a bit more about why the correct answer makes sense. Dopamine beta-hydroxylase is the enzyme that converts dopamine to norepinephrine. Therefore, the increase in dopamine conc. when rising from supine to standing, is trying to tell us that her body is ramping up the SNS to compensate for all of the blood rushing to her feet when she stands up. Ramping up the SNS requires production of catecholamines, but without this enzyme, synthesis of NE only gets to the dopamine stage and lots of dopamine backs up behind this enzyme. +15
... cassdawg made a comment on nbme17/block0/q#0 (58-year-old man with supraventricular...)
 +6 
submitted by cassdawg(1457)
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isTh ymilna sah to do wtih the oatolnic fo het SA node es(e ehre). hTe SA eodn is dlcatoe in eth ltriaa lawl at the unjintco fo eth supreiro vena vaac and ihrgt tum.ira

Teh VA done esil nrae the ckba fo teh nlttrinaevuircar muspte nrea eht pongien fo eth anoycror issun t(eh tliganre of oKhc seednif het AV odne na)tooilc

rhOte fnu atcsf rofm dlrWUo tuoba olnaitab dna defenitfr etiss of in,giro :cte

  • Bewenet teh dscpruiti nda iiefnrro nvae aavc vcdp(rocauitsi )sihstum si the mtso lieylk ocolitna of a rnreaetnt ricictu sgnuaic raiatl utlrtfe
  • heT ouprnylma envi osita is hte msot lklyei esit fo ioirng ofr AiFb nda ehetorrfe msot keilyl eterdtag rof hcerteat tanbliao to eccorrt fiAb
  • hTe gtirh lrurtaincve oultfow tacrt nda ylaarpilp smeulsc ear eht stmo eklyli esit of inirog orf piIhcdaito VcaTh gt(hhou ti is oerm mcolmoyn mfro cciehmis )tsiesu
  • An oscecrasy yhapatw ngpsabiys teh AV noed is teh ecsau fo hskf-neiofta-iPronWlW myrndseo raisctthecrac(i dealt wvea up)oksrte nad VA ntrnaeter aidcarhtacy
  • A owsl patwhya tath eerestrn teh VA onde is teh euacs fo AV ndola reattnren achdyicrata dan teh olws yhpataw dwuol be tgaetdre fro ilntbaoa
... cassdawg made a comment on nbme17/block0/q#0 (16-year-old girl comes to the physician because of a...)
 +6 
submitted by cassdawg(1457)
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ehS ash laMomsaypc napmnueieo hchiw sauces gwnlika aa(,pltyci iairtetn)lsti uioamnpen nad eseinacr ni dlco inggsunlita I(M)g

20F20A 0p51

fI yuo era a kysthec rsoepn wh(hic I am ,not) I ma peyrtt seur ocsaMyplma si idectdep in het ldo,c ro sa a gyu on sski ni rugd ,seon chwih cna hepl uyo merrbeme cold i.nanlgtsigu oAls sapyoclmaM ;&-tg MgI (teh eerttl M.)

lsoA or(f mimuon enrds ro nr,oltra)aiiesz MIg is het fstir tdnbyoai ot be rcudoepd os it wlduo akem sesne atht uyo wuldo heav MIg this leyar ni eth fnncieiot hciwh nac caesu lcdo tlainiuggntao ehs( has lony ebne ckis fro a wfe ).asyd IGg sscuae mrwa ,iitnganogulat hwich si cpatylyli eesn ni meor richcon soscepesr elik LSE and LCL A(2002F 324.p) oN diea fi atht si teh alactu mchsaenim btu ti is woh I peek mhet stighrat in ym mdni dan saekm .seesn

flapjacks  As a "sketchy person" and not a "rationalizer", I can confirm the Mycoplasma has red blood cell "pucks" agglutinized with IgM snowflakes +25
j44n  Just to add, she has interstitial infiltrates so its an atypical pneumonia, no other kind of atypical pneumonia would cause them to have agglutination. I'm not a rationalizer I'm a massive over thinker +2
sexymexican888  Yeah, im a sketchy person too! Side note, for autoimmune hemolytic anemia I remember it this way: IgM -> Me Cold, go INSIDE (cold agglutination, intravascular hemolysis) IgG -> Go outside its HOT (warm agglutination, extravascular hemolysis) +3


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