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NBME 17 Answers


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


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

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

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


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

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



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

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


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

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

Question#13 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4 πŸ” / πŸ“Ί / 🌳

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


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

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

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


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

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

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

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

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


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



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

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

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


Delivering_Bad_News
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 ligase πŸ” / πŸ“Ί / 🌳


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


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


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

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

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




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

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


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


Question#27 (reveal difficulty score)
A 20-year-old man with suspected appendicitis ...
T10 πŸ” / πŸ“Ί / 🌳

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



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


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

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


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

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

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






Question#0 (reveal difficulty score)
An 80-year-old man with Type 2 Diabetes ...
Pelvic Splanchnic πŸ” / 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)
45-year-old man with poorly controlled type 2 ...
Enterococcus faecalis πŸ” / πŸ“Ί / 🌳



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

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

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

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


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


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

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

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

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

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

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

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


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

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





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



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



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

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

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



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

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

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

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

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


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

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

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

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

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

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

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

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


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

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


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

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

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

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

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

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

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

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

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


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

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

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



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

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

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


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

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

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

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


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

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

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

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

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

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


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

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



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




Question#36 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus πŸ” / 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 ...
Leptin πŸ” / 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...)
 +32 
submitted by cassdawg(1698)
unscramble the site ⋅ become a member ($59 $42/month)

I o'dtn ekil ohw yeth aer gsikna hsti, but I hkitn htwa ehyt ear tgtigne at si thta farte eth stetn npetlcame seus"unebt(q ot eth tetns )mpc"aetnel heter lilw be rorufeesinp jyurin to the cioydarlma suties hwhic crousc gtrhuoh eerf iadrlac njiyru dan trferoeeh rmemeabn piidl oiptidexoanr is the tbes reawns 22AF(00 p210 esninotm anebrmme pdlii riteoapxdion as a eacmshmisn fo eefr aidrlca daemga dan tlsis rueoinseprf jnuyri eartf miorhlcytobt eapytrh as a ty).ep avisetEnol in eht dacraic nyzmese I meuass aer ebcesau fo hte ryujni ot the .sclle

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. +5
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)
 +24 
submitted by cassdawg(1698)
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ehT qiuotens emst si girrerenf ot a nuoategcj anc.cevi ihsT si ucebsae gajenuoct acceinvs cvotenr neneneTpddti- aesngitn hyodialcar)sps(ce ntio epetdnTn-ed igtnesna yb tcguionjgna temh hitw a .ptirnoe 2F[A002 217p]

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Yuo nac mremeber sthee paelnaesctdu agmosnris nda hteir tecajunog anivcec beaecus ehty rea HTE EAMS noiagrmss htta yuo coeemb suteepscilb ot ehwn oyu aveh a lntesyocmpe dan hwchi isetnaesetc v.ntccoaaini

drippinranch  I appreciate this explanation so much. Thank you. +9
j44n  cassdawg you are a beast +3
... cassdawg made a comment on nbme17/block0/q#0 (An 80-year-old man with Type 2 Diabetes Mellitus is...)
 +24 
submitted by cassdawg(1698)
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iclPev cnsilnpahc nreevs arycr teh paepchtmyiratas erfsbi ahtt aer spnsoelbeir orf unhgdti antnisilet lyiiottm iugnicdln gioinvd (iemga.) 0FA2[20 p.43]6

bDteesia slumleit can ecusa evren gamead nad igoses,saraptr atdrete hitw dpemlmcteoioor FA02(20 p.04)0

pakimd  thank you for sharing the image +1
... cassdawg made a comment on nbme17/block1/q#21 (42 yo farmer, 7 mm red scaly plaque on ear)
 +21 
submitted by cassdawg(1698)
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sJut to dad to eht oieanxlanpt heer si ahwt uoy uwold see ni teh etrosh mst(o on 2A020F p)484

  • alasB lecl ccr:mniaao
  • rcanKoa:toetmhaa
    • lbeseRmes qossaumu lelc acronamic in taht it is a iraydlp giongwr moed dphesa ulenod ithw a einrtak dfeill retcen
    • nO sgthyooil it alsyablci estspern sa a errcta eldfli twih nireatk
    

  • linanatMg nmomlaea:
    • dBa ,oib kool rfo teh ACsEDB ersm(tamyy, robedr rgrruyiteila, corlo raovanii,t drietmae ,m;6t&mg dna uinootvel)
    • On oyoltihgs uyo ese eanolcmeyt ltonrfoierpia lewbo teh aenmtebs eabmnmre dan it sujt losok reigul
    

  • Mleekr lecl nc:iaoramc
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 +1
... cassdawg made a comment on nbme17/block4/q#1 (83 yo man found bedridden and confused)
 +19 
submitted by cassdawg(1698)
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IDTEUBIVISTR HOKCS ..I(E ITPECS RO PA)AAXSHNYLI RAE TEH LOYN SCSHOK HTWI NRIEDACES CDIAARC U!TTOPU

0A2F02 301p

siTh anm preestns ihtw trmhyeiahpo (sptiec hcoks acn neetsrp hwti yehpr ro o)hhpyairt,em chaiyr,atdca and wol loodb rsesuepr thwi aceisredn cacardi uputot, sihttrccaaiecr fo ecptis .hocks thuerrF tiiveutisrdb hoksc si staaocsdei ihtw eveser deearsce in tssymeic lascurva isesenrtac lihwe erhto mrosf fo hkocs ahev rsidceane sscmieyt valrcsau sntre.iesac

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
dwillis17  FA2019 page 307 +
dwillis17  FA2019 page 307 +
... cassdawg made a comment on nbme17/block3/q#31 (20 yo man, 6 hours of difficulty breathing and vomitting)
 +17 
submitted by cassdawg(1698)
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eoHnrmo eestsnvii seiapl (LH)S si the yeezmn hciwh esradged gscreeyidrtli dortes nhiitw eaostidpcy 0(2FA02 93.p) uTs,h ti makes nsees taht ti is aietadctv ni meits of itnasgf nda udsssppeer in hte dfe .atets

lsnnuIi would bnhtiii HSL, as iinlusn si a dfe ttsae menyez edcetser yb eth snearacp and ludwo awnt to igtrreg teroags of c.lgsrdyieitre

In satorcnt ggcnolua is cetesder ni enpsosre to ehclayymgiop yb eht seracanp dan lilw gegtrri destfa tates oaiain.tcvt nI tmser of het ffadse/t saett I lwyasa inkth fo nagoclug adn rnepiheinep kind fo ilke a ehseurorp dan ihetr dise k,kci aesecub yhet uslyalu okrw hretteog ni eth stngifa sttae on iliasmr tastger ot eneusr eht dboy sah ueohng yeergn i(hts ehlsp me mrebmere ttah ieenhpneirp adn caluogng era ntsiafg eatts nh)os.reom eeHr ogthhu si npiehp'senrie igb tcaoni away rfom lcngoag,u hreew claoggnu ahs limanmi feectf nda peniieperhn ahs eht gbi atonci fo atcvtigani S!HL ncgoualG sah a rmino erol dan otehr aaliccsoteemnh nda TACH cna aosl ervse to teaaicvt SLH as e.llw

oerthnA xpmlaee fo hte stenicirsgy owrk of gucanogl dan pneerphinei is ni egoycgnl wneadkorb 2(002FA 8)p.5 otBh lwil gigtrre AMPc eesnciar dan rotienp kensai A nitavoacit ihwch lliw asrlhoeotyphp clnggeoy hhpaepyolporss dan tctaevia ti SF(TA OR!TPOHSPAELYH oHonmre eissntevi ilesap is ulayaltc oestporahyhldp ot aateticv it as )wle.l

UNF :CFAT roomnHe isenvetsi asepil tlculaay tog its neam seebacu ti wsa enviteiss to ner!inipeehp

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. +2
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)
 +16 
submitted by cassdawg(1698)
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shiT sah ot od tihw het rmlihtoga of itnrtage oskc.h piStce a( yetp of ur)divtteiibs hocsk sa lwle sa ohcvmoyilpe hcoks aer ratdete hwit IV ifldu tinsareoictsu 02(2AF0 0)1.p3 lltsoirdyCa uifsld rae ftrlsi-nie ch,ocie nda orlnma salien 0.9,(% onitsc)oi si ierltnfis- iyclsilcfaep ni essac fo ksohc.

5% toedrxes in etwra dan %40.5 snlaie is ohntceyrip nda otn elsufu he.er

%5 sedoetrx lenao is onscotii ni the agb tbu hoaplylglyoicis inooyt.phc tI is omer otenf ievng rfo udlfi pmtneelacer eatfr eserev adt.yoerndih

.4%50 iesanl lyon is ncipotoyh dan otn sfluue re.eh

%3 nelisa is cyorhpinte adn nto efuuls erh.e

epiglotitties  cause i like charts lol you do you, especially if it helps us +
... waitingonprometric made a comment on nbme17/block0/q#0 (A 70-year-old man dies in a motor vehicle collision....)
 +16 
submitted by waitingonprometric(257)
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Fmro ,F20A20 gp. 318:

uulrTab ed-aa-&tmngo; tasc;ipnelo talbruu shygtoloi sha sesl namiltnag iotpnealt tahn lvo;siul subilvluoltuo hsa tianeieemdtr ilnnmtaag i;tleanopt aysluul tc,aiposmymta aym strepen wthi lrctea ebg.eidnl encHe rou etiantp who ash ebne ergndgnuio uionaevlta orf fclea lctcuo dlboo.

rhteO rw:ssnea

apestiylrcHp py-lp&;t-og most m,oomcn rnlelgaey lselmar nad in osogirctmdei eo.ingr I'm nsuggeis eth rtucepi hdatacte ot iths qeuinost is niytrg to elcu us iont stih nto bnige a sllam .nisleo

raonyItmmfla ut-&-pppsolygdseo; ude to aluscmo onoseir in aontfylrimam lbewo .dasesie rTeeh is no rceeppaialb iesnrsoo in hsit trupc,ei slao hte asms paaserp acldp,duuneet os we nkwo 'tis nto a tspo of rmnaol caumso taht ujts osolk dieras emoprdca ot sruuorigdnn o.rsoien

lnueivJe lpoyp dan e-tehrJePgzsu gy;e-&-sontrmd etshe are btho teicnge rsedisrdo ihwt ruonesmu mahomasrttuoa ypslpo nese ni eth ol.onc eghuzJer-stPe olas cdsaeiosta hitw neeaisdcr iksr of srteab nad rohet GI ncrcea.s tI si lkulyine ttha ruo neitpat adh ieerth of etehs bc/ eh si 70 /y;o fro,hereet fi he ahd noe fo he,set he ludwo elliky hvae remo hatn oen coonl nlisoe nda aym osla snreetp thwi a oirthys of htoer ransecc at ish ega.

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/block2/q#13 (28 yo woman, 18 weeks gestation and palpitations)
 +13 
submitted by cassdawg(1698)
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In enrageetm ihwt the rhote t:pos se(e 22F0A0 )331p

uYo wolud tawn ot kechc EREF 4T eescaub pecangrny sniaresce ioyTdrh nindigb glulbion. It is epsbosil she tgmhi evah areendcis arlloev 4T, tbu TNO eavh hdmyyitphiersro eecusab eht efre T4 is noarml ie(.. reh icnsraese oaumtn of tyhrodi gdiinnb ligluobn sha ndbou remo T4, dna scnei ruo obdise edpnsro to eth cncnoitanorte of eerf T4 n,yol eth laumoytpshha oduhls useren atht teh eefr 4T is etkp ;ctosannt shti owuld aaprpe as asnedeirc lloraev T)4

nAheort way fo iginhtnk of isht:

  • evlarOl 4T = dnbuo T4 + efre T4

If we icreanse bodun T4 nda kepe efer T4 eth em,sa we ludwo lslit eercanis leavlor .T4 Tush ot wkno fi esh ultry sha ohpitehysirrdym we utms kolo at eref T4 tc.cnanironteo

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) +
step1dreamteam  Radioactive Iodine (option C) is wrong because radiations are teratogenic for the fetus. +
... flapjacks made a comment on nbme17/block2/q#33 (Study conducted to assess effectiveness of lidocaine injections)
 +13 
submitted by flapjacks(100)
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yM snniaoerg rfo isth ntuei:qos

  • nI hbot osu,stitnai you ees a iclyccal asecrnei in niap oerefb civrngiee the .einjctoni isTh uclod be nese if hte tceffe aws iagwner f;fo voh,eewr if ouy ,oitecn erthe si a daercese in ipan brfeeo teh nniejotic si eenv iv.gne I libveee sthi milesip taht seonmgtih etnhrien about eht inteojinc is girvniopd pani lefei.r
  • ,mForhuetrre ohbt csuvre olwofl het esam hatp wiht an tvenuela rdecasee in ,ipna rslgeeasrd of nointeenvit.r
  • Mybae na ilnadoadit nopti - I ma otn unniisegtqo eihtr npi,a btu abalfogimyri ilytyplac whoss on lnamobra lab sulsret in anoiiddt to lcyliapty ctsigonixe hwit mseo rofm fo mealtn o.hgoaltyp I odtn' nkhit bpaceol negbi attdsdemoenr is raf .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/block4/q#37 (An 18-year-old man has yellow nodules on the...)
 +13 
submitted by cassdawg(1698)
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loewlY elsduno coetesrllh(o tpdes)soi no het asecllih sdnneot vhea a rvye ihhg isoociaastn ithw yepT II laamiilf aedilmsidip,y or aimllifa hprsimeaolhetceoleyr. iThs si eusdac stom nteof by a tecedf in the LLD peoercrt touncfn.i 02F(20A )49p

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! +28
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) +12
jdc_md  you trick me nbme. veryy veryy tricky +5
kevinsinghkang  Why not E? partial reduction? +
kevinsinghkang  never mind i see it above now. thanks ginachipotle +
... cassdawg made a comment on nbme17/block3/q#24 (10 yo girl, well-child examination)
 +12 
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eHre si a rgtea mieag snoigwh het itnlemei fro the fietrfnde reubtapl hcgesan in almse nda .aselmef Tenrna tsasge rae fdnou ni 0AF022 63.p7

In ese,alfm teh reitlsae eatbcedlte gisn of etuablrp ahegcn si sbtear ubd mvpeeodtenl hiwhc nyol litsylgh cpedseer cipbu rahi tvopede.neml nI esam,l esttciralu amnereglnet si hte fitsr atbeeetdcl n.sig

flapjacks  You share excellent charts. Thank you! +3
eleezi  **Page 637 FA2020. Thanks for the info! +1


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