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NBME 18 Answers

Question#11 (reveal difficulty score)
67 yo man, fine resting tremor in both hands

Question#14 (reveal difficulty score)
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyteπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
experimental animal with defect in an innate ...
Chronic gastritisπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
4 day old boy, vomited throughout night after ...

Question#18 (reveal difficulty score)
68 yo man, chronically increased hydrostatic ...
Benign prostatic hyperplasiaπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
Cholera toxin is a catalyst that results in ...
Concentration of cAMPπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
60 yo man, 1 day of fever, chills, confusion ...
Vibrio vulnificusπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
18 yo man cracked lips and sunburned skin

Question#15 (reveal difficulty score)
38 yo man, 1 week history of shortness of ...
Aortic regurgitationπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
65 yo woman, 1 week of swollen, painful knee
Uric acidπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
66 yo woman, 2 days of fever, flank pain, ...
Calcium carbonateπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
40 yo man, 1 year of orthostatic hypotension ...
Motility disorderπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
32 yo woman, new neurologic finding; imaging ...
Inability to abduct the eyeπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
35 yo man, 4 weeks of severe midline back pain

Question#32 (reveal difficulty score)
Investigator studying vancomycin-resistant ...
Plasmid lossπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
35 yo woman, 3 days fever and sharp chest pain

Question#5 (reveal difficulty score)
82 yo woman, 24 hours of constant severe ...

Question#12 (reveal difficulty score)
58 yo woman, 6 months shortness of breath, ...
Pulmonary hypertensionπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxinπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
70 yo woman routine pelvic examination

Question#25 (reveal difficulty score)
63 yo man, 2 weeks of fullness in left upper ...

genetics pedigree
Question#33 (reveal difficulty score)
4 yo boy, clumsy gait for 1 year

derm dermatology
Question#40 (reveal difficulty score)
47 yo woman with irregular, raised, ...
Subcutaneous tissueπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
24 yo man, 3 days of progressive numbness of ...
Myelinated primary afferentsπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
45 yo man for annual health maintenance ...

Question#3 (reveal difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Aortic aneurysmπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
36 yo woman, 2 weeks of fatigue, bleeding ...
Histone acetylaseπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
18 yo woman ingests 100 aspirin tablets in ...
pH: 7.32; PCO2: 15; HCO3: 8πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
45 yo man follows up 1 week after appendectomy
Gilbert syndromeπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
54 yo man, normal renal function, receives ...

Question#35 (reveal difficulty score)
73 yo man, 4 months poor appetite and 25 ...
Cytokine effectπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
18 yo woman given general anesthesia for ...
Sarcoplasmic Ca2+ releaseπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
4 month old boy, abnormal glycogen storage

Question#45 (reveal difficulty score)
A 4-year-old boy, fatigue and irritability, ...
Microcytic AnemiaπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 55-year-old woman who is a physician is admitted
Alcohol withdrawalπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
an 83-year-old woman with systemic ...
descending colonπŸ”,πŸ“Ί

cell_bio cell_transport cell_trafficking
Question#1 (reveal difficulty score)
During a study of the regulation of ...
F (cell diagram)πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina)πŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 51-year-old woman with Graves disease ...

Question#1 (reveal difficulty score)
A 25-year old woman comes to the physician ...
3 to 8 weeksπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Cor pulmonaleπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 30-year-old woman with a long standing ...

Question#10 (reveal difficulty score)
A 4-year-old boy undergoes radiographic ...
Tubular atrophyπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 32-year-old man with an X-linked recessive ...
Type IV collagenπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 2 month old boy is brought to the physician ...
ventricular septal defectπŸ”,πŸ“Ί

carbamazepine FA20p518 neuro
Question#32 (reveal difficulty score)
63 yo woman, 2-week history of daily episodes ...
Trigeminal neuralgiaπŸ”,πŸ“Ί

respiratory lungs newborn
Question#5 (reveal difficulty score)
A 1045-g (2-lb 5-oz) male newborn delivered ...

Question#16 (reveal difficulty score)
An 8 year old boy is suspended from school ...

Question#10 (reveal difficulty score)
MI study, 500 in operation, 250 each to 2 ...
Randomized clinical trialπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
a 35-year-old woman has congestive ...
prerenal azotemiaπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
a 67-year-old woman comes to the physician ...
amyloid infiltration πŸ”,πŸ“Ί

micro derm dermatology
Question#40 (reveal difficulty score)
A 3 yo boy is brought to the physician for a ...
Complement activationπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A laboratory technician wipes down the ...
Enveloped virionπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 45 yo woman comes to the physician because ...

Question#18 (reveal difficulty score)
An 8 month old girl is brought to the ...

Question#20 (reveal difficulty score)
A 1 yo girl is brought to the physician for a ...
An integrinπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 34 yo man 3 month history of progressive ...

Question#10 (reveal difficulty score)
5 to girl is brough to physician because of ...
2 of 3πŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 45 year-old-woman with joint pain due to ...

Question#2 (reveal difficulty score)
A 72-year-old woman comes to the physician because
Extensive solar elastosisπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 6-year-old boy is brought to the physician ...
Pineal glandπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 1-year-old boy is brought to the physician ...
Dendritic cellsπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 70-year-old man has had early morning ...

Question#31 (reveal difficulty score)
A new antiplatelet agent is developed for the ...

Question#40 (reveal difficulty score)
A 30-year-old man is brought to the emergency ...
Area labeled "E"πŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
To decrease his risk for cardiovascular ...

Question#36 (reveal difficulty score)
25 yo with severe crush injuries to the chest ...
Basement MembranesπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 35-year-old man comes to the physician ...

GI liver
Question#31 (reveal difficulty score)
A 30-year-old woman comes to the physician ...

GI gastrointestinal
Question#13 (reveal difficulty score)
A 19-year-old man is evaluated for signs of ...
Heterotopic gastric mucosaπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 34-year-old man who is a potter has burned ...

Question#5 (reveal difficulty score)
A 28-year-old man is undergoing evaluation ...
Suppression of gonadotropinsπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 10-day-old male newborn is brought the physician
Chlamydia trachomatisπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
An investigator studying immune response to ...

Question#13 (reveal difficulty score)
At autopsy, the heart of a 76-year-old woman ...

Question#12 (reveal difficulty score)
A previously healthy 20-year-old woman comes ...

Question#22 (reveal difficulty score)
A 67-year-old man comes to the physician ...

Question#19 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Renal cell carcinomaπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
24 yo woman, remain in the intensive care ...

Question#1 (reveal difficulty score)
a 68-year-old man comes to the physician ...

Question#11 (reveal difficulty score)
a 17-year-old boy has septic shock that is ...

Question#29 (reveal difficulty score)
A 60-year-old man comes to the physician for ...
Renal Artery StenosisπŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
A full-term newborn has respiratory distress. ...
Left pleuroperitoneal membraneπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 42-year old man comes to the physician for ...
radial grooveπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 32-year-old woman is brought to the ...

Question#5 (reveal difficulty score)
An 18-month-old girl is brought to the ...
Parainfluenza virusπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 56-year-old woman is brought to the ...

Question#8 (reveal difficulty score)
a 17-year-old boy is brought to the physician ...

Question#33 (reveal difficulty score)
a 27 year old man comes to the physician for ...

Recent comments ...

... aneurysmclip made a comment on nbme18/block1/q#26 (50 yo woman, chronic obstructive pulmonary disease)
submitted by aneurysmclip(178)
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DPOC is usalylu odtaciesas wthi urnaloPmy iyHspn.oretne heT nximerea tsell yuo ttha htere is a ould numlpoyra ennoptocm of 2S i:e P2 (odLu SP=2/2 mPrnuolay o.ip)tnerenysH e:FVCv1F is sutj lraedte ot OD.PC heT qutiosen si asgnik htaw si DRSEEECAD ni hte pyralmuon SVCULARA OMTOSH LC.MEUS do ont etg sfueoncd whit eth ieln igatstn teerh is deerdcsea idsuniffg yapaictc rfo .CO eth onuieqst snti' askgin bouta t.ath

In umpaynrol ypheotersinn rteeh is an cilmabaen neewteb iaovadiotsnl scabuntess nda vitccoa.trrssnoso oee terfhr uro lastsdaioovr wuodl be rceesedda eg: tNirci edxiO

fi it aeksd cseiae,nrd yuo cdlou go itwh edtlnnioEh eb(mererm eth hltnieendo astngsaitno sued rof /tt fo Puml NHT ie: tnnbaseo rysro avge mseo rexta fnio btu lal of ti is tnatopirm saeebcu tyhe nac ask iths cceotnp in ynam sayw

... feliperamirez made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
submitted by feliperamirez(31)
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ihTs eviars moagn ssteta utb in tmso fo teh saestt a 2-1 raye erfe esiruze eropdi si rrquedei fro pietepicl itetpsna ot tge tehri niecesl

baja_blast  Didn't realize I was in law school +29
... anechakfspb made a comment on nbme18/block4/q#10 (A 4-year-old boy undergoes radiographic imaging...)
submitted by anechakfspb(57)
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uJst a anrt - i athe stih ci*fnkg eipurct tsi' bnee no 3 MENsB nwo dna eryve item Iv'e totgne ti g.rnow

cbreland  And it's a different answer every time +12
... match95 made a comment on nbme18/block2/q#32 (Investigator studying vancomycin-resistant <i>Enterococcus faecalis</i>)
submitted by match95(51)
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poisntnrosTai fo het avnA egen mofr snoyatevmaiisrcc-tnn tcrocuoEnces is ohw it ssntfrrae sicsneatr.e eyhT eus tssnpsorona iwhhc ear oetladc on mli.adssp If yuo heva mlasdpi o,sls you 'wont hvae pnsorstoa,sn dna acesinrtes liwl .arsecede

azibird  Why can't this be a point mutation? +6
thrawn  FA says transposition is responsible for antibiotic resistance and plasmids are for transferring the genes of toxins (though UW says also antibiotic resistance). Make up your minds sheeple +
mariame  The most common Vancomicin resistant genes, vanA and vanB are found in a transposon. These have been transferred from Enterococcus to a multidrug resistance plasmid in Staph aureus. the super multidrug resistance plasmid now contains resistance genes against lactams, vancomycin, aminoglycosides, trimethoprim, and some desinfectants. +1
... azibird made a comment on nbme18/block3/q#37 (During a clinical study of calcium and phosphorus...)
submitted by azibird(210)
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tnoazsoC iPoyysgloh ht6 E 6p45

nteRluoagi fo niaVimt D syerheheW thinstS eht neral lclse epdurco -,521 oixeccfyldhoairclldyhoer te(h ivcate meb)oltaeti or lxrciddeaheyclofl5roi-42o2hcy, eh(t itceaivn mlteba)tioe nddsepe on eth tas”usβ€œt fo 2+Ca ni teh ob.dy Wnhe aC+2 is tcsifenufi, hiwt an ueedqaat aytried ektina fo +Ca2 adn ornlam or irneedsac plsmaa a+2C ,rcctnnooeanit het cntiivae iltmobeeat is leprtainyflree sisendzyteh caebsue eetrh is on ende orf moer +.2Ca enhW C2+a si tc,fsifuinnei hitw a low iaedtyr anktie of Ca+2 dna adrcesdee almasp Ca+2 tnccootnrie,na teh aevict toeemaltbi si leetalnipfryer sitznyhseed ot eesrnu atht oidtlaidan aC2+ illw eb osdrbabe mrof eht raeogtsntlnitsai

cbreland  Constanzo is the best resource, change my mind +
... apurva made a comment on nbme18/block3/q#45 (A 34 yo man 3 month history of progressive rash on...)
submitted by apurva(87)
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STIH SI IASKs'PO SCOMARA &;=gt= igve tintcanlsaeipo


michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +3
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!πŸ˜πŸ˜‚πŸ˜‚ +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +
ih8payingfordis  The reason why this isn't Bacillary Angiomatosis is because the stem states that the rash is NOT painful. In BA, the rash is painful! +1
... match95 made a comment on nbme18/block1/q#32 (52 yo man with chest pain and shortness of breath)
submitted by match95(51)
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sTih udowl sjtu be teh rmlano reonesps of our kdineys to nwhe ew t'ond rnkid awtre ounehg aak( sjtu l)amor.n

lomPxria elbutu si ctoiisno aeucbse ew aer arirbsgoneb OHBT Na+ nda HO2.

ulaMca endsa is cnipoohyt esauebc it is nsegsin teh adtlsi teoocvndul eubltu -- eth smto LIETUD prat of the eprn.hno emeRmrbe teh etceouurnctnrr enxcehga estsmy - ktchi dnieagcns imbl si lgoins lCaN en(uir tgse sels ecdcrtnneato as ti csad.ens)

llueMdray ccelglntoi duct si trheyiopcn eucsaeb ew are rebabosigrn all het taerw manigk eht eunri emro aencnodtter.c

... merpaperple made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
submitted by merpaperple(28)
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In misoise I, teh emcoytagte stpsli fomr a linesg clel )(XYXY ;t&g- 2 cslle XX( + .YY) nI iismeos II eshet wot csell psitl agian -(&;gt X + ,X Y + ).Y enceH in oedrr rof a ferath ot assp no bhot na X dna a Y someorocmh ot hsi osn (ge in lnKreieeftl mdrs,eyon w/ XXY sroommoc,)eh a mteisdpar mstu ionntca ohtb an X and a Y sr,omecoomh chihw anesm ttha rehet swa an reror ni messoii I. eTh setga at hihwc osmiies I crousc is hte amyiprr ecyratmps.toe

b1ackcoffee  Brilliant question and explanation! +2
jbrito718  PICTURE PLEASE +
... ergogenic22 made a comment on nbme18/block3/q#17 (46 yo woman, 1 week of fever and joint pain)
submitted by ergogenic22(364)
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atcue irttesiliatn thrienspi

kesy ear: uerin npehiolisos + INADS esu + Rash

ni hte stignet of evref nad rnryaui usesis

ih8payingfordis  FA 2019 pg 591 +
... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
submitted by amirmullick3(66)
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sihT etpntai ahs a dry t,ap ihhcw si sene ni lyisormbisofe adn pactials .meaani ehT rabmalon CRB rae msot ylikel tayroscedc (pertador .cel)sl

ALM loduw heav uera rdso dna yamn cnilurgicta l,slymeoasbt utb nro laobanrm R.CB

CM,L eindefd by teh t2[;9]2 hdeiahilPlpa cohseommor, iwll veah nmay matuer nda tnmgirau gyansctrloeu, thwi a wlo LPA scbeeua hsit is not a oeleimduk .otenciar

ioseDitmycypelo smdroney is eht esma sa a metlsycodssaylip dyr,enoms wihhc era a grupo of rnccesa hwit ieutamrm RBC ni het enob rawrom hatt do ont eocemb ter.uma s//.tddrM_aikoi/oln/agpteipirod.:epehwwlnksyieyycssimt

tlEaseins ihhrtomcaetbmoy (hhcwi si ont elntisaes yclt)eypoihma is jtus a arer aecrcn hwti hghi a,petltels hchiw esrtpnse twih laamrnbo dloob lttc,iogn andlgei ot htsmriso,ob ktoes,rs nda PE.

lPmohiceayty erav ash yrev ragle RBC smsa dna lwo PEO edu ot ivatngee kbe.cdafe It si due to a JAK2 onutmiat dna lsao sha ighh BWC and ete.latlps ruO tptenia si aemni.c


... famylife made a comment on nbme18/block1/q#45 (55 yo man; father and brother died of myocardial infarct at early age)
submitted by famylife(98)
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Deie"pts tiinohinib of C-AMHGo crduseaet yb iasn,tts celsl natscepoem yb inrgsnciae zyenme pnsxsoerie evelras odfl. wrHeevo, the oltat ybdo tseceroholl is eddcuer by 0–%4%20 edu ot dencsaeir eensprsoix fo LDL psceterro farte sttnai oti.nmntsaai"idr


md_caffeiner  fuck GoT, knowledge is power +
dhpainte22  Another bullshit question that should've been straight to the point. Statins increase ldl receptors and inhibit hmg coA reductase. This should be simple but nbme can't live with that :( +4
jurrutia  I think they want to test not just your understanding of how statins work, but also the basic principle that when you block X the body tries to compensate by upregulating X. +4
... donttrustmyanswers made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
submitted by donttrustmyanswers(65)
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The flnaiploa stbeu lsoduh ekla ttraoncs ebcaues reeht is a gap etwbeen ilaflnopa buset nad .eI. fi ehret si no gpellai,s tath mneas hreet si a olakgcbe = !etnlirfyiit

mcdumbass  This makes sense... but I don't trust your answers +12
bmd12  πŸ˜‚πŸ˜‚πŸ˜‚ +
... cbreland made a comment on nbme18/block4/q#36 (25 yo with severe crush injuries to the chest and...)
submitted by cbreland(136)
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fI you nkew that emtbasne meambrne puoidrsnti tsevnper rreootiasnt fo onmlar tusesi ee(aprt fmro renahto )NEBM, htne yuo dsemsi tish scbeaue uoy dtnd'i nokw what eeu"d"lrcp mnsea.

isgiMns itqoseuns I sism edu to cakl of bvaoc nad mamr,gar you lvoe to ees it

cbreland  Say a prayer for me +1
drdoom  you can include. you can exclude. or you can altogether preclude. +1
drdoom  all these words, along with β€œclaudication”, share the same Latin root: clud = claud (to shut) +1
dhpainte22  Missed it for the same reason :( +1
dremosq  Pathoma pg 4. Irreversible cellular injury.. The HALLMARK of irreversible injury is membrane damage. +1
randi  guess I gotta make an Anki card for the definition of preclude then +
... sugaplum made a comment on nbme18/block3/q#6 (32 yo woman, diagnosis of hyperparathyroidism)
submitted by sugaplum(421)
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4th halreangyp uhopc eisvg srei ot ourpesri darsto.ahyirp
FA 2109 gp 670

... wishmewell made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
submitted by wishmewell(46)
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I aws denscufo nweetbe paAhl- cynlueSni dna a.Tu sTih tetinpa hsa nnrspsaoik isssadee adn hsut ew wlduo see laphA n.suciynel

auT si nees ni tntsapie thwi iskPc esas,eid kaa taeomnortlporF teiamden ADN ihrslamzee ad.eises eapg .405 FA 0281

baja_blast  FA 2019 p. 508 +
jbrito718  The gross image also shows the medulla, where you can see some darkness around the edges, reprentative of the substantia nigra which is affected in Parkinsons. Another hint +
... sammyj98 made a comment on nbme18/block2/q#8 (39 yo man, polycystic kidney disease)
submitted by sammyj98(28)
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idd ynaoybd lsee osedcn ugses eth cehk uot this ewasnr just caseube hes' otg a pH of 72. dan hes' aghgnin out ni an tnuoeitpta lci?icn I an'vhte edon my lclncaiis tye tub ti esmse kile itsh ugy ldwuo eb .gigs.tngulr

myoclonictonicbionic  EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +5
... namira made a comment on nbme18/block2/q#34 (25 yo woman, fatigue for 3 weeks)
submitted by namira(35)
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Mrlita leavv dna tehte necganli ear eyk wdosr rfo rtSep ividasnr s.dasiongi It si plaha iotchylme os ti udowl eavh a ieergngn .inrtcaeo

irtpmaont etnoimn ot tacwh out :ofr

Teh phinooct swaenr is rrenctoic beeascu ti sasy iitn"ioihbn YB th"coonpi. sindViar is tsetanris ot tonpcohi os thta nwersa si rtocnierc.

... nwinkelmann made a comment on nbme18/block2/q#41 (35 yo woman, 3 days fever and sharp chest pain)
submitted by nwinkelmann(328)
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FA 0912 epga 08.3 Mtso mocnmo acseu of aeprmucta/riy rciisprtidae is ademsus to eb iav.rl

cbreland  Primary made me think that it couldn't be acquired from virus/bug +4
... sugaplum made a comment on nbme18/block3/q#3 (17 yo boy septic shock)
submitted by sugaplum(421)
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AF 9201 gp 224 ;map& bnb eoidv
DA ta lwo ssoed d1 atsidel elarn e,ssvsle
edum im 1b ngitaos = ionoiptrco adn pcrihoonotc
hhig osdes a1 tgionsa = asttiicvorsonnco

kcyanide101  low doses Dopamine agonists = D1>B1>A1 high dose of dopamine agonist = A1>B1>D1 +
... banana made a comment on nbme18/block3/q#45 (65 yo patient with lung region underventilated but well perfused)
submitted by banana(15)
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If ouy ogt all dtanegl up on sthi uitonesq ekil m:e

omtiacna ddae peacs= cnuocgitdn iaswayr

llraveAo ddae p=csea aovelil htta era lvaetentid btu ont epursfed i(w)ik

phclsoogyii dead tacanaospi=ecm ddae ap+sce larevlao dade cpesa

o2P: tusj on

motherhen  When I get mixed up on dead space vs shunt, I anchor myself on the meaning of anatomic dead space: the parts of the airway that don't have associated blood vessels for gas exchange (nose, trachea, bronchi). From there I work backwards to what shunt means: blood vessels that don't have enough air. +1
... aneurysmclip made a comment on nbme18/block2/q#44 (35 yo woman, passed out while washing dishes)
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e'Ssh moigtvni - cMetbioal liAlkaoss ;gt& lsos of CLH ;> ;ie aci,d hrtee ldouw be sanredeic CH3O on iAn sgap rea luulyas wthi emitobacl iocsdsai ecbeusa in islksoaal etrhe si ihhg H3OC iwhch pekes apg n.omral o rF eth +K tg;& gtioivnm t;g& osole wraet glnoa ihwt hte ivomt &;gt sadreedce blood lemuvo &;tg RSAA iciaaonttv tg;& otdrseneaol esertces +H dan K+ gt&; iylhpeakmao

schep  Dirtyusmle has a good video on this topic if you're like me and struggle with renal +1
... merpaperple made a comment on nbme18/block3/q#5 (82 yo woman, 24 hours of constant severe lower abdominal pain)
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reeHs' ohw I sedrntndua ;hsti easlpe etoccrr em if mI' rwo:ng ibrinF xaoeundti si rpat fo the ueact olifmmraytan psorense if hte tmaialnyofmr usmuilst si a anirgealtc ndu,ow shu(c s,a ni shti nit,epat aprfedoetr e)csitutvdlriii, naolg twih aetleltps nda ehrto itgtolcn fstoarc, ni rroed to octl eht nwedduo era.a cHeen in hsit ttnaepi who edid 2 ayds lgnofowil teuac aetrdfoper eli,ictirutsivd eth inofrmaatmyl eadxuet rnsidurgnuo teh iverl doulw mtos lyklei tnnaoci nfbiri ton( loagcenl, iecsn hte tiiamnlnfmao si acetu dan ont n).hccoir rionnibcFte dan tnrygo,lsecpao eth toehr owt si,notpo are txllrcluaraee xmitra osei.tpnr

... spow made a comment on nbme18/block3/q#41 (24 yo man, 3 days of progressive numbness of both feet)
submitted by spow(43)
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ree'sH who I tuhhtgo htuohrg t.shi pblemro ithw DMLC (sanebt pcprnopotieiro dna ritvobnai )esens, prboeml hitw edpe eodtnn rseelxef GDR(),s atiaxc gtia oplcear(neeisblr wa,p)tyah lmdi skesnewa mo(tro o.n)reusn eTh lony gitnh atth lla fo eshet awtpsyha haev ni cmnomo is htta heyt all seu etdlimyaen .efrantsef

I 'ndot kown if ilnuGla rBaer wudlo llycuaat stpnere klei isth, but uoy 'ontd aehv ot knwo tawh teh lssline is ot rufgei hte utqinoes .tou

queestapasando  Might be acute inflammatory demyelinating polyradiculopathy (FA 2019 p.512): "Most common subtype of Guillain-BarrΓ© syndrome. Autoimmune condition that destroys Schwann cells via inflammation and demyelination of motor fibers, sensory fibers, peripheral nerves..." +3
md_caffeiner  sounds really great, and i thought the same and answered the same way. but while in the exam, i had that "how THE FUCK could motor weakness be an afferent??" moment. quite frequently forget the fact that this is an nbme full of mess. lol. +4
2059nyc  It could be explained by the lack of the sensory component for the DTR and not the motor neurons? +2
sonofarathorn  I focused on the loss of vibration and joint position sensation. Pacinian corpuscles sense vibration. Meissner corpuscles and Merkel discs sense position. These sensory receptors are all large myelinated afferents FA 2019 p.482 +1
mgadda  the question asks the most likely explanation for the SENSORY findings +4
aaftabsethi1  Can anyone explain numbness and tingling ? Isnt that through unmyelinated fibres? +1
... sympathetikey made a comment on nbme18/block4/q#4 (36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain)
submitted by sympathetikey(1475)
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sHoeint ctlnaiyetoa aollsw for litaxoenar fo eth ADN os atht anstpotnrirci anc llA srtan oretnici icda ucaess het larngesucyot in PAML to fhrtuer amreu,t chwhi uqeiersr NDA anpcrrnsiotti / ns.tlntaaori

osler_weber_rendu  The questions asks for response to ATRA. Should that not be decreased transcription to treat the cancer? Which makes methyl transferase (aka methylation) the more likely answer +7
pg32  @osler, no @sympathetikey is correct. ATRA's mechanism in treating APML is to encourage the cells to mature. Maturation would require gene transcription, meaning histone acetylases would be used. +6
nnp  but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation) +3
lowyield  i believe the mechanism of APML is that the compound protein is ineffective at allowing for maturation of the blasts. giving ATRA allows the blasts to circumnavigate this step, relieving the backup +12
... t0pcheese made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
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yhw is het aN nlamor ni thsi ateipt?n thrngvEyie lees dame n,sese the hihg K nad 17 oxtnsdpyr.yhrgeereoo

aneurysmclip  could be due to increased blood volume leading to secretion of ANP and thus natriuresis which would normalize serum sodium levels? that's the only reason I could think of +
dysdiadochokinesia  My guess is that the sodium and water loss from 21a-hydroxylase deficiency would result in increased RAAS activation and production of Angiotensin II (AGII). Recall that AGII affects the PCT by upregulating Na/H+ exchangers, allowing for there Na/H2O to be resorbed, thus partially counteracting the impact of aldosterone deficiency at the collecting duct. However, I'm not sure if the effect of AGII on the PCT is great enough to entirely counterbalance the loss of aldosterone to present with normal sodium levels. +
... adong made a comment on nbme18/block1/q#18 (68 yo man, chronically increased hydrostatic pressure in Bowman space)
submitted by adong(109)
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earIdescn puerrsse si ni teh mnBoaw eacps OT(N teh gmaeorullr lpacle)asiri os teh yoln gthpoolay sdeitl taht olwdu ucsea kaacbdwr udbil pu of rssreupe si BPH

peyerpatchkids6  Does anyone know why its not diabetes? +1
michaelshain2  because the NBME said so, obvs! +1
cbreland  Diabetes would have non-enzymatic glycosylation causing increased GFR and hyperfiltation. The stem is referring to increased back pressure (Inc hydrostatic at bowmans space) which alludes to decreased GFR +1
victorlt14  @peyerpatchkids6 that's because NEG of the efferent arterioles could increase GLOMERULAR pressure; No increase in BOWMAN'S space pressure; That would have to be due to one of those post renal azotemia causes. Made the same mistake. +
... chai_md made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
submitted by chai_md(8)
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seareisNi nseigmtdneii can aeld to rsntrehdeouaehFiceriWs- nymdosre rla(aedn niyf,cicufnsie eevrf, DI,C ck)hos

overa  if there is ever a case where the organ is underperforming, you do a stimulation test. if the organ is overperforming, you do a suppression test. ACTH is really the only one that made sense with WFS (adrenal insufficiency caused by N. meningitides) in this question. +4
... dorsal_vein made a comment on nbme18/block3/q#9 (35 yo woman with infertility)
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Spigelal fo cotntrsa otin eth eenupomitr ugnidr a gtopsermylshoigrana si nrloam adn aetcsiidn yapntce fo eht loilaapfn est.bu

c-ldeaMi pastPrerih glidoayRo

... dorsal_vein made a comment on nbme18/block3/q#46 (45 yo man for annual health maintenance examination)
submitted by dorsal_vein(38)
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ayMn sstdnetu wlli etg htis tneqsiou onrgw ubcsaee of a airslmi unqosiet no dorU.wl hTsi atnptei ahs na tmyleerxe hgih yiriredtgelc velle adn has on hrsoity of aicadrcolruasv eseaid.s asbiFter uldosh eb rieberpcsd to evteprn etpcsn.raitai

lokotriene  Not sure which UW questions you're referring to, but I found a couple that agree/support Fibrates for lowering isolated triglyceride elevation incase anyone wants to reference them for clarity. #11844 & #166 +
username  Talking about in situations where the patient has cardiovascular event, serum lipid values show OKAY cholesterol levels but increased triglycerides. Q will ask what to add to patient's regiment. In this case, if answer choice throws you fibrates, you'll want to bite, but if patient has cardiovascular disease, you're going to want to go with statins +2
... azibird made a comment on nbme18/block1/q#1 (During a study of the regulation of cholesterol...)
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iTsh is eht tmso orploy ndrwa lecl dairam.g I ees ezro ,iorssmebo so I fgdruei F asw het hsotmo ealnposdicm .ueucrmlit weoevHr, now I can ees ahtt eht cvrdue algnlereo si teh giogl raauptspa nda F mtsu rsreepnte het heolw sdcaliemopn .emluriuct

I beeleiv amslpa nmmraeeb tnsiepro rea yziedhsnste ni het orhug ndslmacpoie rmu.ietlcu

A0022F ou pgR4h6 aesnpldcomi mel itSeticuru fo itsehsnsy fo recsryteo )prted(oxe npeitrso nad of keldNn-i cihlcsroodaagei onididta ot oasslylmo nad ohetr stioenp.r

eFer aooteβ€”irchsaduestnmb ot ayn ea;enbrmm teis of yesintssh fo clyoco,tsi moliseox,apr nda rhmliioanotcd

hotmoS lioecpansmd tmeiSurtilc eu of driteso syihsestn adn tdneaiofioitcx of rgusd dan .pnoosis akLcs afcuers o.irsoesmb noLicoat of teu6-lspaogs-hphasoce (stla teps of .ysolce)ggilsony

nbmeanswersownersucks  I was under the impression that translation of transmembrane proteins begins with ribosomes in the cytoplasm that then translocate to the rough ER once the signal sequence is reached by the ribosome? i.e. technically translation begins in the cytoplasm but finishes in the rough ER. Am I wrong about that? +4
nbmeanswersownersucks  It was UWORLD 6544 about insulin translation. They state that the translation is initiated in the cytoplasm then relocates to the RER (d/t the signal sequence) and is finished there. So is there a difference in translation steps for proteins that are excreted like insulin and transmembrane proteins? +2
nsinghey  Same, I am not sure about this. My best guess is that since insulin is not a functional protein, it is not synthesized in the RER (even though it it excreted from the cell). Actual proteins are made in the RER +2
drdoom  @nbmeanswersownersucks @nsinghey et al. There is extensive discussion of this on an NBME 24 thread. This link will take you to the comments (just don't scroll up to spoil the answer for yourself!): +
drdoom  also, this thread from NBME 21 discusses cell transport more generally (same warnings apply! don't scroll up!): +
brise  The question is saying where is it initially produced? It is produced in the RER, therefore F. Not asking where it's production starts- asking where is it produced etc. +3
chj7  I'm not sure if this is what the question was trying to ask but technically the "polypeptide" is initially sequenced in the cytosol; once the N-terminal signal sequence is synthesized, SRP translocates ribosomes to the rER where translation continues/completes and the "protein" is folded/formed in rER. (I like UW #757's diagram on this) So if they truly mean where the precursor "protein" is initially formed, rER is correct. But honestly the above is a way too complex form of thinking that I feel would NOT help on the actual exam and most likely strays away from the learning objective of this question; more likely the question writers were trying to distinguish btw proteins translocated to the rER (membrane proteins, secretory proteins, ER/Golgi/lysosomal proteins) vs. proteins that are synthesized by free ribosomes (cytosol/nucleosol proteins, peroxisomal/ some mitochondrial proteins). +
... drdoom made a comment on nbme18/block2/q#28 (A 68-year-old man comes to the physician because of...)
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iodeRpsgnn to zs@dri’iab mmonetc:

fcBalngilki fo bodlo mfor the ulsng iton eht R ieevrtlnc is inhecsttrg tuo eth R eids lndita)(io nda salo mdeerlgnio het harte vai rhhorypepty the( aterh sah ot cpka no asms to ecejt eht erve grreeta ntuaom fo ldboo lnpiig pu fomr )usln.g itnlaDoi of the R ecvretlin slluβ€œp atar”p eth saeevl of het idrcutips =eavlvroewl ltfe nsaelrt edborr; wehn the taerh si in ysslo,te hte iuitprcsd vvseal o’ntd mkea dogo acnoctt and obdol rehssu mrof hihg susrerpe mrtopeantcm )V(R ot het lwo rsuserep A()R == styanlpisoc mrurmu

ehT irtpusicd mmurur tseg sorew ihtw topaiiinsnr eeausbc nwhe uyo aks smooeen to eatk a o,god eped a,ehbrt het aphaihmdgr a( yerv gtnros emlc,su de)inde llups the teenri hitocacr agce ndow dna dowratu (pnsnxaoei) β€” ndnigiluc het t!rhae usaeceB the erhat β€œtseg llepud omrf all teicnr,dios” teh rpsictdui lalsftee akem neve lsse onacctt == eirbgg heol == erom npneoducor mruurm ugdrni

ehT ptnoi of axalmim esupilm e(ht retha xap)e si ywa eobwl the dphoixi eeabsuc htsi usy’g htrae is so ibg mofr eht yares fo tiiadnlo nad hphyyproert β€” ’athts asol wyh 2S sudson rea stdinta: het taegr lsesves ad(n riteh )veslav rea diurbe vnee redeep tanh sul,au os ouy c’tna ehar temh pngnapsi htus tcoair( &am;p lpcniumo vleavs; S=duβ€œ2)”.b

ertha nduos arase =t;&g a.1h.Sp22a9sepo/L9pwtpvoge/Fms.lgi/:dgoUspt

... pelparente made a comment on nbme18/block1/q#39 (36 yo woman, recently been diagnosed with HIV ...)
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fI ti a'nti boker tond' fxi t.i hTe ntaitep si igwshno ptnvmeeoimr dna rtehe era on igsns of peligvodne udrg ssnctiaere ro netnuadw esid e,sffect os inatmani the etipnta on hre cnetrur trpaeyh.

iyaTlcp rienliatrovtar VHI epthary rgimee i:s

3 RTNsI 2RO NsITR A ND 1 NTIRN OR 1 atoreesP noiibitrh O R 1 tnrgeIsae bniohitir

In tish esca the natietp si no 2 TRNIs e,a(tniribmetic ion)eotrfv and na INTNR vfe)(inerza

nbmeanswersownersucks  and here comes my dumbass that read the lower CD4 count as his newer labs (instead of old) and was trying to figure out why his drug combo wasn't working.... +21
thrawn  Amused +
kcyanide101  Same here... Thought pt was loosing virologic control, so choose/guessed one of the two options regarding dropping one NRTI 😩 +
... anechakfspb made a comment on nbme18/block2/q#37 (A 45-year-old man comes to the physician because of )
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sihT is risbeicdng rdrieetahy hchairemorg gnsatacieiaetl FA( 2910 .p .2)13 tI is asol nkwno as -eeWd-ruRlnsbrOee doy.emrns It si na olauomats odnmitna erdrosdi fo oolbd .sseeslv niFgsidn elucdni nnhbgiacl islseno )ainc(lsgteatiase no knis nda cuosmu ae,emsbnmr rrecnuter aipxi,ests snik d,ootassnolriic VA mifro,smalatno IG l,eedbnig dan uiaahm.ter

cbreland  Wow, I was completely lost on this one, thanks! +28
jbrito718  What helped me figure this out was the finger clubbing. This sign indicated hypoxia. Along with what I thought were micro-clots of small vessels (now I know are telangiectasia) would most likely cause increased shunting in the lungs. +
thegout  UW added questions about this pathophys recently. Megakaryocytes mature into platelets in the pulmonary circulation,so if blood bypasses the lungs in any way( COPD,CF,AV shunting,congenital heart defects) immature megakaryocytes enter blood stream, these megakaryocytes actually cause the clubbing by secreting growth factors like PDGF.And the bleeding spots are just a complication of lack of mature platelets in blood. So any time you see clubbing, you should know the pathophysiology involves megakaryocytes. +1
... made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
submitted by
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soMiies 1β‡’ romf irprmay to nesdyroca oetsrcmaetpy ; seiMsoi 2 β†’ coaySdenr to msrdpteai

... focus made a comment on nbme18/block1/q#17 (4 day old boy, vomited throughout night after breastfeeding)
submitted by focus(42)
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oS ew ydreaal oknw the rnewas si rteieh 1-1 or 12- h.dataeyBxroylse Hwo to eeitdmnre hihwc n?oe

toQeusin tems secll "dyr uusomc b" He is hdye.tardde

eW adyreal nowk htat he nact' kema lnstoedoaer ciens eth kcal fo reeith fo eehst zymeens uwold cblko htta .ahytapw roevHe,w if eh is ebal to kaem a couemell atth TASC elik aolerdstnoe, eh wudlo nto vaeh dry cusmu embsm.arne eH dlcuo vsea e.watr

oD ew haev usch a couelmel? S!EY yr1t1-o.toociodseeecxnr

,oNw if eh ahs bate-11 eolxysrdhya eifdni,eccy ereth luodw be a ildubup of .trscdooetc1e-iyrooex1n ,ecHne it ahs ot be the htreo i.ptono

focus  Not to mention, 21-hydroxylase is the more common one! +2
... match95 made a comment on nbme18/block1/q#31 (7 yo boy appendectomy)
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alnIhed ttchisnesae ttha ahev low a:bolsodg aintortpi boe/ccdleonoffiti ollybiitus ssidevol ni bodol moer ls.eaiy or,rfTheee ehrte si ESLS sga eneedd ot eatsaurt oobdl -- kaa trseaf nttauasori fo ob.lod ihsT sadel ot efsatr ntaisourat fo rn.aib

dt;rl lwo luyisoblti -&g-t; tsafer tenso g--;&t fetsra eeyovcrr

pelparente  great answer; just to add to it. Lipid solubility determines potency, not onset/offset (that is determined by blood solubility as stated above). The more lipid soluble the more potent the drug. The more lipid soluble the drug the higher the oil:gas partition (directly proportional to potency) and the lower the MAC (inversely proportional to potency). Source: Boards and Beyond General Anesthesia Neurology +5
cbreland  I really went down a rabbit hole on this one... Convinced myself that it had something to do with mask v. IV anesthesia even though I haven't seen/heard that anywhere. Taking step in a weekπŸ™πŸΌ +
jer040512  I thought a low blood:gas partition coefficient meant that it has a low solubility and therefore DOESN'T dissolve in the blood that easily. +2
dhpainte22  Think onset/offset is about blood solubility and potency of drug higher with higher lipid solubility so low blood gas coefficient has faster onset and recovery. +
jurrutia  Just to drill point home further: consider halothane, high lipid solubility (so high potency) and high blood solubility (slow onset). If you want fast onset, low solubility is the key. +1
... dorsal_vein made a comment on nbme18/block2/q#9 (19 yo woman being treated for meningococcal meningitis)
submitted by dorsal_vein(38)
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  1. dseAnimtir TACH adn norotmi osirctlo ornsepse
  2. If ioscltor csirnesea t-g;&- hcsok is deu to yipiutrta cnseiicyffnui
  3. fI ocoltris sdoe not seeraicn gt;-&- kchso si due ot daerlan cifeycfninusi

nsoeeaetxhaDm piesonsspur tets si ddainetic orf itntpaes woh nepster hwit nssgi of slroiotc S.SECEX

... sugaplum made a comment on nbme18/block3/q#33 (4 yo boy, clumsy gait for 1 year)
submitted by sugaplum(421)
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AF 0129 gp 6-519
X knield usalmurc dpoh.stryy eT h hccnae htat the omm II1-I is a riarrce si 2Y1./X rlomn(a pdraang -II)1 * aXX rricer(a rndmomag 2-)II oYu nowk taht 1III- si a amfele, so yoln ookl ta haf,l os 1/2 nea.cch
eh T caehcn taht -I1I'sI aemt is a irrcrae si nera .orze So ew kame mhi rn.alom XY aomn(lr aDd) * XaX rcirr(ae mom -)II1I niS ec we ownk sti a boy oyu onyl lkoo ta fl,ah so eht nhcaec of ihm vgnhia ti si 1.2/
so 12/ * /21= 4/1
Thees rae owt iepnnedndte nevte,s eht enachc hte omm is a aceirrr * teh cchena eht ikd gets the fctfeead X.

aaftabsethi1  Explain it to me like i m 5 years old +2
aaftabsethi1  Also they asked about the β€œmale” fetus . So that should be 1/2 . M i missing something? +1
tobias  @aaftabsethi1 love the reference! +1
tobias  also the answer would be 1/2 given that we know it's male but that would only be if we knew for sure that his mum was either a carrier or affected. We know his grandmother is an obligate carrier seing as the pregnant woman's brother is affected. So, the pregnant woman has 1/2 chance of being a carrier +2
jdc_md  its 1/4th because theres a 1/2 chance the mom is a carrier and theres a 1/2 chance she gives her bad gene to her son. the question stem tells you shes having a boy. if the stem did not identify the fetus gender and just asked what is the chances that a boy will have duchennes then the correct answer would be 1/8 because (1/21/21/2)= chances intereted from grandma, chance mom passes it, chance its a boy. +1
kcyanide101  @Jdc_md The answer is 1/4.... However if they didn't specify the baby's gender it will be 1/8.... 1/2 chances of the mum being a carrier times 1/4 chances of her child having it. +
... lae made a comment on nbme18/block3/q#34 (52 yo woman with breast cancer)
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het odiartani hrtapey cdaesu obirsisf dna eth bbtrfyalioossm tnctr""coa dunrig isfo,irsb gcasuin eht eorslcu of rswiaya nda sthu etsictsaeal

hello  Adding part of @plummervinson's comment: Contraction atelecrasis occurs due to radiation therapy, necrotizing pneumonia, or granulomatous disease +1
caitlyncloy  fa 19- 666 +1
leaf_house  FA2020 - p680 +
... azibird made a comment on nbme18/block4/q#16 (an 83-year-old woman with systemic...)
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hTe MAI esmco fof the taaro tenebew the nrale easeirtr dan incibrto.afu Teh IAM iessplpu eth unhg,itd hcwhi psans het dltais 3/1 of seartsnevr olnoc ot eprpu nrtipoo of alan msCmieproo of eht AIM uodwl dlea to recdeaesd odlbo ulsppy to sethe u,ttercrssu of hwhci eDn"ncgdies cn"loo si teh lyon eswran

... aneurysmclip made a comment on nbme18/block1/q#10 (25 yo woman, polycystic kidneys)
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saylbailc ccptoysyil yndikes w'ont rwok yp,rpelor vey'het hedtni at siht thwi teh rt.easc of dumh4/tgsl . eth iyedkn otnw' do ahwt sti psoeudsp ot o.d MEMRERBE to hceck rwteheh heyt rae ksgnia USMER eagcshn ro ERNUI ehngcsa

dysiKne ranmlo ntiounfc - brbroaes HC3-O , ist nto dnoig tath now &t;g saeeedrcd H3CO

PT H - wudol uaecs rinsdecae mlcauCi ntrsoborepia ni s,nyekid btu esydikn 'nraet beal ot boresabr cimclua ;> PHT onespsrd to lwo amccuil ellves adn velles ircenaes

PO4 ites oitn PHT as llwe, PTH stca eb EDAGRSECIN 4PO rspoteionrba. Seinc sendkyi aetr'n rwonkgi :ei nto regpnoinsd ot HPT &;tg treeh lodwu eb rciaseen ni PO4

pg32  Sometimes these questions are made more difficult by trying to decipher the order in which these changes happen (first cause). In my mind, whenever I see a question on renal insufficiency, I know that phosphate in the serum will increase. In response, Ca will decrease and in response to that, PTH will increase. Lastly and unrelated, HCO3 will decrease because the kidneys aren't absorbing HCO3 as they usually do. +13
baja_blast  I also think there is decreased 1alpha hydroxylation of Vitamin D, which would increase PTH secretion +2
freebie  This questions is testing the consequences of renal failure --> "MAD HUNGER" mnemonic in FirstAid +
... ergogenic22 made a comment on nbme18/block3/q#21 (48 yo woman, gradual onset of back pain over 2 weeks)
submitted by ergogenic22(364)
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I wtne ihwt satatmeitc tsabre uascebe yeht eadm a toinp fo isngya tieatatsmc as if eth ohdriyt aaocncimr hsa ont spaedr to eht eobn.

... sugaplum made a comment on nbme18/block3/q#40 (47 yo woman with irregular, raised, multicolored dark lesion)
submitted by sugaplum(421)
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the depere eht mlnmaeoa osge eth oerws hte igprsonso

wishmewell  isn't the basement membrane the deepest? +
wishmewell  nvm! lol +1
lilyo  I also picked basement membrane but unlike you I haven't had a "nvm" moment. Help please. +2
mcdumbass  @lilyo Basement membrane is between the epidermis and dermis; beneath the dermis is the subcutaneous tissue +6
blah  I think some people might have picked basement membrane because we're taught once cancer goes through the BM it turns from in situ to invasive. This is correct, but subcutaneous as the others pointed out are deeper so the prognosis is worse (BM + deeper tissue). +5
... sugaplum made a comment on nbme18/block3/q#48 (52 yo man, chronic pancreatitis)
submitted by sugaplum(421)
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stehooCerll tsree yhldorsea si edndee for rsevseer eooectrshll sar,ropntt nto cnapaecrit zensem.y
- I dsiesm tish

... carrierose11 made a comment on nbme18/block4/q#37 (66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath)
submitted by carrierose11(8)
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lelsiiBy,ros Htesestyipriyniv isptuomnein and Sisooircsda all heva unalgaomr ra.otimnfo olsA elnemdtaii rncgtoypcie gngnoiriza uopnamine /bc het pt ddi'nt ahve any inhcroc e/.seaessmidds So, I saw etlf thwi athicipoId lpoyrumna ssiboifr as the .hoeicc

pathogen7  Also "fibroblastic foci" is a big buzzword for IPF, I believe. +4
... motherhen made a comment on nbme18/block1/q#40 (A 3 yo boy is brought to the physician for a...)
submitted by motherhen(51)
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sihT si dnsebcigri preHy gMI ersoynmd; hwiotut 40DC dgalni, T lecsl ear lbuena to dovreip hte nocyersad sgialn to vctateia B ellc clsas ctiihsn.wg hisT vtersnep MgI mofr wnsctigih into I,Dg ,G E dan A, nda thus na tuinalcucmao of MgI - ecnhe the naem hr"ype I"gM - and cenefiidcy ni eht tres s(icnuag noificnets lkei pnSsoegy.e ryela in ,efli ,CPP pmrrdiytouoispc and MC.)V

otNe ni hsti tiqesnuo het uasec of dGiaiar inticnfeo mfor alkc of gAI a(lck fo /sumGoIca pocnoie)ttr tums be tgishdidenuis rfmo eSeetivcl IgA cDfeneyiic. kcaL fo C40LD lgdain ifdnese it as reyHp IMg mdeoysrn.

nwersA ochscei:

  • enmtopClem naco=viitta gIM nad IGg

  • Cross t=plnaace GgI

  • tchaAt iinlpooesh cF tcrroepe= gEI

  • tchatA amst lls=ec IEg

  • ysaE rinoceset sarsoc mcuos=a AgI

jer040512  To further add: IgG opsonizes +2
... aakb made a comment on nbme18/block1/q#33 (A 50-year-old man is admitted to the hospital after)
submitted by aakb(31)
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airanfrw ishbinit diopeex eatdrusce hciwh nrveptse aamgm oyltxrncaobia of WEN aiivtnm K edndenept tcotgiln atosc.rf teh treeiuhtcap iyfcfaec fo iarnwarf is eaeydld intul etOixLgsDnip/r rcoftas get cudse,mno hhcwi uus eakts at aetsl 3 ad.ys

fTeeerr,ho it llwi ton efcfta hte TP for ta lteas three ayds eusabec het dlo csfator rea lsitl nd.orau nSeci oarcft II sha teh netogls alhf eif,l it esatk hte nselgot ofr eht odl tcfrao II ot go ywtagea/ edsu pu adn thta is yhw teh TP sha tno ierndaecs tey ni shit ta.tenip

mariame  I am confused, he has had already 2 days with Heparin, and Heparin enhances anti thrombin which inhibits thrombin. +2
... andro made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
submitted by andro(222)
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laaecrllrIunt gataesgrge ni tvegneeoeedriruna nsoinctodi :

plhaA yecnunsil- a ptroien ymianl oundf in lrnitema oxans wichh nca arggteage dan sitdepo lltlaarucleryni to mfor ywLe sediBo e.hs Te aer sdtoasaiec whti teh aendeeovenrgrteiu oiscnndtoi 1. skPsnanoir easseiD .2 ywLe Byod taiemneD

lNrferybaluiior nsalteg - ehproshdlyaryohppet tau retnipo , unbrme of enlagst resecaoltr twih gedeer of meitnaed

ciPk oiesbd - lsprhhahpdteoyrpoye uat . esteh era nuord etggsgraea uhgoth ni aotsncrt to ufbarnrriolieyl agle.nts enSe in mootrlnoeapFtr atmdniee dan rhoet dneeaeutiroverneg isoitcndno

aoirHn sebdoi - nllliearaucrt tesraeaggg of ddeaagm caitn esnifmtla enes ni raiosuv ereeunedrvgiteona cdtsoinion .ge AZ , ASL , kC-oetrzejbudflat eaeiDss ( hseeT aer nto rylale dtetes on )

... mahesh made a comment on nbme18/block1/q#19 (70 yo woman, increasingly severe pain in right knee over 3 months)
submitted by mahesh(5)
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coeraatsomsO oaisolhtcgli n.parepaeac Ptgae ssaieed is oen fo ikrs frtaco

spow  Looking back, I know it's osteosarcoma but the lung metastases made me think of Ewing's +
makinallkindzofgainz  Ewing sarcoma is common in boys <15 years old. This patient is a 70 year old woman. The stem notes elevated periosteum and a sunburst pattern which are characteristic of osteosarcoma. +1
llamastep1  Also "sunburst pattern" is a classic description of Osteosarcoma. +
... azibird made a comment on nbme18/block1/q#30 (29 yo woman irregular menstrual periods)
submitted by azibird(210)
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pol-ulFow sv soturpp pg?uro

Teh loyn night atth svade me saw eth tnnaice pSte 1 eagad: eev"Nr !rree"f

ciesElalpy ewnh the esarwn ot rthaneo usoqinet ni teh sema aexm saw uga"eEnorc hte pientta to ttrpiceaiap in a ptrpuso pgrou orf pnrsose thiw rhe nno"doiict

I amen YRE!ALL eTh onyl frcieenfed si tath yeht esud eht rodw rc""ueagoen sietand of efer.r cxtEa amse n.asrew

cbreland  Note to self: Never refer, even when that seems like the better answer +
chj7  Take this with a grain of salt but I felt like a treatment plan with goals should be tailored to the patient and would require a physician to assess performance/make modifications. A support group could provide mental support when facing a disease but seems not individually-targeted enough for trying to get a patient to stick to a dietary/exercise treatment plan. I have to admit I did really self-doubt when I saw the 2 questions on the test. +

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