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NBME 19 Answers

Question#1 (reveal difficulty score)
53 yo woman w/GERD. Diet change, stress ...

Question#7 (reveal difficulty score)
48 yo woman, 2 weeks of fever and stool with ...
Entamoeba histolytica๐Ÿ”,๐Ÿ“บ

Question#24 (reveal difficulty score)
62 yo woman with sudden weakness of left leg; ...
Right anterior cerebral artery๐Ÿ”,๐Ÿ“บ

Question#34 (reveal difficulty score)
12 yo girl unable to walk for 5 days but is ...
Conversion disorder๐Ÿ”,๐Ÿ“บ

Question#35 (reveal difficulty score)
5 yo boy, R eye pain for 1 week; retinal exam ...
Retinal cells๐Ÿ”,๐Ÿ“บ

Question#36 (reveal difficulty score)
36 yo woman presents to ED after believing ...
Panic disorder๐Ÿ”,๐Ÿ“บ

Question#48 (reveal difficulty score)
62 yo man, right-handed, suffers decreased ...
Area labeled by letter 'A'๐Ÿ”,๐Ÿ“บ

Question#5 (reveal difficulty score)
38 yo woman, 6 months depressed mood, joint ...
Lyme disease๐Ÿ”,๐Ÿ“บ

Question#6 (reveal difficulty score)
24 yo man, generalized tonic-clonic seizure; ...
Psychogenic polydipsia๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
Retinoic acid receptors and HOX gene products ...
Transcription factors๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
Scurvy symptoms associated with decreased ...
Prolyl hydroxylase๐Ÿ”,๐Ÿ“บ

Question#23 (reveal difficulty score)
10 yo girl, slightly painful 2 mm ...

Question#34 (reveal difficulty score)
Mechanism by which action potentials permit ...
Transmission along T tubules๐Ÿ”,๐Ÿ“บ

Question#45 (reveal difficulty score)
Pathway of the transepithelial transport of water
Pathway denoted by letter 'C'๐Ÿ”,๐Ÿ“บ

Question#46 (reveal difficulty score)
Decreased pulmonary artery pressure ...

Question#5 (reveal difficulty score)
30 yo woman, 1 week of visual difficulty
Right optic nerve๐Ÿ”,๐Ÿ“บ

Question#9 (reveal difficulty score)
Cells most responsible for graft rejection?
T lymphocytes๐Ÿ”,๐Ÿ“บ

Question#19 (reveal difficulty score)
30 yo man and 24 yo woman; best estimate that ...
1 in 600๐Ÿ”,๐Ÿ“บ

Question#22 (reveal difficulty score)
Blood gas values: arterial O<sub>2</sub> ...

Question#27 (reveal difficulty score)
74 yo man; continuous systolic-diastolic ...
Renal artery stenosis๐Ÿ”,๐Ÿ“บ

Question#28 (reveal difficulty score)
40 yo man, 1 month increasing malaise, ...

Question#29 (reveal difficulty score)
15 yo girl receives bone marrow transplant; ...
Nonautologous donor๐Ÿ”,๐Ÿ“บ

Question#39 (reveal difficulty score)
45 yo man, lost outdoors in the Rocky ...

Question#40 (reveal difficulty score)
25 yo woman requests prenatal diagnosis at 12 ...
Chorionic villi sampling๐Ÿ”,๐Ÿ“บ

Question#42 (reveal difficulty score)
Study conducted to determine effects of drug ...

Question#46 (reveal difficulty score)
52 yo man, sudden onset of substernal chest pain

Question#50 (reveal difficulty score)
39 yo man, 6 months of headache, muscle ...
Basophilic stippling๐Ÿ”,๐Ÿ“บ

Question#13 (reveal difficulty score)
26 yo woman after jejunoileal bypass for ...
Vitamin A๐Ÿ”,๐Ÿ“บ

Question#14 (reveal difficulty score)
11 yo boy, right mid-thigh pain for 2 weeks; ...
Ewing sarcoma๐Ÿ”,๐Ÿ“บ

Question#15 (reveal difficulty score)
60 yo woman, 1 year of episodic involuntary ...

Question#27 (reveal difficulty score)
52 yo woman prescribed cisplatin for ...

Question#46 (reveal difficulty score)
24 yo woman; renal oxygen consumption found ...
Tubular reabsorption๐Ÿ”,๐Ÿ“บ

Question#0 (reveal difficulty score)
During an experiment, an isolated skeletal ...

Question#0 (reveal difficulty score)
A newborn delivered at term to a ...

clotting moa

Question#0 (reveal difficulty score)
Investigator studying spermatogenesis...tight ...

Question#0 (reveal difficulty score)
23-year-old woman...heparin...decreased ...
Antiplatelet antibodies๐Ÿ”,๐Ÿ“บ

Question#0 (reveal difficulty score)
Graph shows rate of breakdown of skeletal ...
Allosteric activator๐Ÿ”,๐Ÿ“บ

Question#0 (reveal difficulty score)
During an experiment, a researcher blocks the ...
Retrograde axonal transport๐Ÿ”,๐Ÿ“บ

Question#0 (reveal difficulty score)
Investigator does an experiment... third ...

Question#0 (reveal difficulty score)
A 2-year-old boy with cerebral palsy is ...

Question#0 (reveal difficulty score)
An 11-year-old boy has repeated episodes of ...
NADPH oxidase๐Ÿ”,๐Ÿ“บ

Question#0 (reveal difficulty score)
A 35-year-old man comes to the physician to ...

Question#0 (reveal difficulty score)
A 30-year-old man develops urinary ...
pelvic nerves๐Ÿ”,๐Ÿ“บ

Question#40 (reveal difficulty score)
Immediately after cerebral infarction, a ...
A (Broca's area)๐Ÿ”,๐Ÿ“บ

FA19p490 stroke neuro

Question#23 (reveal difficulty score)
A 22-year-old man get separate from a group ...
Area postrema๐Ÿ”,๐Ÿ“บ

Question#24 (reveal difficulty score)
A 62-year-old woman has an abdominal aortic ...
Cholesterol emboli๐Ÿ”,๐Ÿ“บ

Question#11 (reveal difficulty score)
A 48-year-old man comes to the physician for ...
Budd-Chiari syndrome๐Ÿ”,๐Ÿ“บ

Question#35 (reveal difficulty score)
52 yo woman, right-dominant coronary ...
left ventricle๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
During a study of the digestion of protein ...

Question#42 (reveal difficulty score)
A 61-year-old man has erectile dysfunction ...
D (corpus cavernousum)๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
An investigator is developing a new drug that ...
Crypt cells๐Ÿ”,๐Ÿ“บ

Question#27 (reveal difficulty score)
A 6-year-old girl has the recent onset of ...
Procollagen, type I๐Ÿ”,๐Ÿ“บ

Question#6 (reveal difficulty score)
A 24-year-old woman comes to the gynecologist ...

Question#26 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobinemia๐Ÿ”,๐Ÿ“บ

Question#39 (reveal difficulty score)
A 52-year-old woman begins treatment with ...

Question#4 (reveal difficulty score)
A 50-year-old man comes to the physician ...

Question#49 (reveal difficulty score)
A 30 year old man is brought to the ED 30 min ...
sympathomimetic agent๐Ÿ”,๐Ÿ“บ

Question#48 (reveal difficulty score)
An investigator is studying the efficacy of ...

Recent comments ...

... aliyah made a comment on nbme19/block1/q#35 (5 yo boy, right eye pain 1 week)
submitted by aliyah(39)
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If a emgr lecl or aotsimc lcel ahd het alrnigio atintmo,u nteh she'tre na enedarcis sirk orf carnec in trheo satrp of teh yodb tI ofo. lnyo atliner clsel ni eon yee si tuda,tme ynlo tath eno eye si at rkis rof acner.c

... ajguard26 made a comment on nbme19/block2/q#16 (40 yo woman, chorionic villus sampling)
submitted by ajguard26(48)
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oiioCnhrc ilvil lnagsipm si teh itnkag of ietencg laraeimt wniiht ni het rconoichi llivi fo eth palaectn. cnoriCoih apisgnml si noed nhew a tiapten si ta high irks rof ohmcsaomolr beamilnitsoar sviueor(p p.os tsest, 3y5o ro ,ordle flamyi xh). nudirg teh -1031 sewek fo .egncnpyar

nonCfeid tapcallen icmisaosm trluess ewhn hte CSV... itsgtne mecos ackb acbk sioghwn a oi,tsrmy utb lla ntusequbse sgtiten (nda het feust sfteli) heva laomnr ohoammcsrlo un.tcso Tish amy eb edu ot rethie a rpthtsaocilbo taimontu, ro yb iiot"mrsc cues,r"e ni cwihh itmcsior sllec thta were dspupseo to eb in the ustfe aer oiecndnf to hte laptncae ot tpnreve an bomnlara te.suf

cbay0509  thank you +
shakakaka  Why It's unreadable.. +3
randi  unfortunately you have to have an account to unscramble most responses +
chaosawaits  Wow, a +16 response (rarely see those) that we can't read... FML +1
... ajguard26 made a comment on nbme19/block1/q#1 (53 yo woman with GERD.)
submitted by ajguard26(48)
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So htauoghl osriMptlsoo DSOE eniaersc smuuc dtroconipu nad is taercgovets-piotr (dan in FA deos seatt tath ti ssrcaeede cida tournopdc)i, behryte deesicnarg ssmotpmy dan nadigi in giha,nel zporemoeal si eth em"ro c"rteorc eoicch. iThs si uecasbe peealzorom is a tupnmrp-opo n,ihiibrto chihw lwil cat ylcdtier on eth poontr pupms fo het actohsm and caerdees eht ffnodineg tgean more hnat hte lspmsooitor llw.i eerT,eorfh it is the fsitr nlei rgdu orf .RDGE

an_improved_me  These questions can be so frustrating... I mean most people know PPIs are your go to when considering GERD / peptic ulcer disease... but when you speicfically add "both relieving Sx ... promoting healing", why even add a drug that specifically and directly does both... I mean PPIs promote healing, but so indirectly. This hurts my heart +3
chaosawaits  Seriously, FA2019, p393 specifically states misoprostol "increases production and secretion of gastric mucous barrier and decreases acid production" What does it say for omeprazole, you might ask? "Irreversibly inhibits H+/K+ ATPase in stomach parietal cells" and that's it. +
... cassdawg made a comment on nbme19/block3/q#50 (39 yo man, 6 months of headache, muscle aches, fatigue; distal motor weakness of extremities)
submitted by cassdawg(1457)
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So I tahe tshi sotqunei acubsee yuo nca nokw twha teh iiadgsnso si adn llits issm .it

:LD;RT ishT is lade iigisponn,o os herte is iocpisablh iilnpsgtp in a iehrpaperl boldo maers [BTU gedrin dasstisleobr olwud also be ndfuo ni the oebn arworm]

hWy iths si leda ignoso:pin (2F0A02 2)5p4

  • cryticMioc aieAmn aedsu(c by dela inihnboiit fo saeteeherofrcl adn ALA d)tdhrayeeas
  • vEenmtornlian epuoersx tiunaom(imn at the e,ganr eh is an )rfcofei
  • GI fectsfe pmr(ayc mlodbniaa pai)n
  • oNceaglrouil ceeftfs cadheh,e(a irrttiay,bili ayb,ticialrittsd fuo,etrlfg mootr swsk)eaen

Why ti si OTN hte threo anser:sw

  • uAer ords - ieistcactarrch fo ctuae moeylosgnue leeakmiu iwhhc udlow etsrepn wtih npcasytniapoe (ish WBCs ear al)nmro oalgn thwi ignlrcctuai ybaetllmsos no ielrhppear ;saerm inedma aeg nteos 65 ayesr and he sah on ikrs atsfrco
  • Oavl satcoyecrM - in citmcyarco menasai B(21 or oleatf e)cynif,eidc siht is cyoimicrtc sa icditadne by MVC
  • Prmohleipco plseyyothcm - coruc ni rhcncoi mlcphctyiyo ieslaemuk nda nitecfuois o,nmo btho hihwc ehva fefndeirt iemlosstmogtypoo
  • dRngie sstbsoraelid - rae form dael iingpsoon but aer in het beon oamrwr
  • sStestoicyc - ictaicrerthasc CBR hhwci sha nbee uorhght a cgldoge eselvs nda rdeseha ,off ounfd in angmtooihirpciac ythlmieco smiaaen H(AA)sM ikle bohcortmit ooicetiphamgasinr ielk TPT dan UHS lit(yypacl myotncoric ainmae adn feftredin iptnra;tesone a niuoestq ldouw eylilk gvei ouy rmoe oinf no eht ymlthctoorbi tyahawp if yhte wdeant uoy to hecsoo tshi; ew ni'ddt even etg a etaleptl ontcu hee)r
  • graTte lCsl:e onduf in bHC seeasdi lta(igumc diac ot enilys ni eolnboh,mig essauc elcrtaxuarsav )seso,lihmy ilevr si,esdea i,lpseana nda mealiaaTshs nldiso(tee ni teeihr alhap or atbe anihc of gb,nhlomaie euacss aaimne taht odwlu eb neprtse omfr dohcidhol dna luodw not hvae eonru omtssmyp)
ftr_dr_bowowers  thank you! +3
chaosawaits  just take my upvote you beautiful sonofabitch! +
chaosawaits  So if FRC decreases, TLC decreases as well, which rules out E. +
chaosawaits  Above comment not related to this question +
... cassdawg made a comment on nbme19/block3/q#22 (Blood gas values: arterial O<sub>2</sub> pressure: 96 mm Hg; Arterial O<sub>2</sub> content: 12.0 vol%)
submitted by cassdawg(1457)
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Tihs is my tsbe eirernpttntoai with a urosce dna apraphrag omfr eth rceosu ed:tlis

nI aa,mien lohgiboemn ilbleaava is dcersaeed. Thsi sucsea edearsecd nxygeo ndbniig, nda lmytluatei esls neygox is laaabviel orf eeesarl tono ssets.ui

  • O2Pa will be hrmisnalo- eacusbe the aetrilar loobd illw stlil ubialireetq in eth nuslg neve outhgh the lobniogmhe dninigb si aderdsece t(hnki of OC pinngoois ehewr Oa2P ksolo ol.ram)n
  • rAelairt O2 onntcte si aatclyul dcaeserde abesuce rehte is lsse eynxog otlta libvalaea l(sse oeolhmngbi unbod ot exyg)on
  • eiMdx vsnueo O2 notncet )(% si ceerdesda ofr a iarsmli seoarn and olsa fro the naeros etdils bweol
  • uoVens P2O si tyghisll esaderedc acueseb trehe is grehhi xeyong aritnocxet ta sssietu edu to teh eomapytsnroc aimhcsmnes rfmo essl latot O2 genib ievdelrde dan sles 2O gebin dnuoeald isn(ec herte si ssle amnlgehobi unbdo O2 in eht fitsr place in ai)eman
  • POC2 is mhsnilr-oa ofr ismarli ssorena ot het rsfti ellubt

"ehT rtroyialccu dmtstuajens ni sreeopns ot amiena ilwl eb ilaismr ot ehtso fo het rgniedpce a.sce In roedr to iaatnnmi tsiuse gnyoxe tpiusmnnooc at alneesbi lsleve tsesacdoia thwi a onlmar exnogy irrgynca pctcaaiy of lbdoo, the oircdetun ni xgeyno eeriyvld lwli dlea to na casreeni in irlacyalp pfserniu,o dan oenxyg axtritceon lliw e.inercas lrrreiatoA ndtoaiil and yoiviscts trnuoidec ofr( eth aesc of a icuteordn in t)cH lliw ecasu dolbo olfw nda ygnexo leyeirvd to hBto gyxeno rxtcinaeto and xgeoyn elidyrve wlli uinotnce ot arinseec ltuni eth oegnyx setrenieurqm of eth sstesui era met or iutln the aytcpaic ot ncseeira eoxngy oeixantctr and eyedrilv has neeb a.eerdch heT nueislgrt niosiutta si eon ni hwhic vnouse xoyegn etcnont dan 2vOP aer lses tahn mranol. nSeci 2aOP si nmoalr rof lla teh ciname ioissauttn ddiceons,re thsi fceted is not essdne by eth yrarproiste eremptchr.osoec Thsu, iricasneng teh ipersdni gexoyn afnrcoit si tno ullpfeh epectx rfo eth ecsa of OC oioi,gnnsp eerwh gihh rdisenpi gyoxen ge,..( 100% nxyeog ta ebainmt iamctrboer repusesr ro ctpaenelm of teh csubtej iotn a cbiraphyer )cmahber stcomeep wiht OC niigndb at eth heme stei lal(cre dHl'aanes irfst l.)a"w - tb/N/Kwp3hshl.B/:4oonkvgswwt5nm.c.//1ib1on.i

blueberriesyum  Also, in first aid respiratory chapter for anemia it says, Hb conc is low, %O2 sat is normal, dissolved oxygen (PaO2) is normal, but total O2 content is low. Total oxygen content is the sum of oxygen bound to Hb and dissolved oxygen. (FA 2018 pg 649) +1
... peteandplop made a comment on nbme19/block0/q#0 (76-year-old-man...severe substernal chest...)
submitted by peteandplop(38)
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isTh tnitape is tsnpiengre ihwt ihwt MIEST (2FA019 p)03,1 thus het ietenr elevss umst eb oaCronyr spvasaosm iva a1 imtionastul e(iscanerd mosoth sulcme nantoirtcoc) oudlw ldea to sehet

sA arf sa eth nroti asp,etc I hntki tshi loudc eb rerrigfne ot pt iotsyrh of isemihcc ethra ssid,eea nda eth neroisca fo aroynrco el,sta rhovwee I dton' nikht uyo doluw ende htat ot sewanr iths nsqtuioe na(d I cluod be ngoig nowd na ursynaeensc abbrit oelh of srem.i)y

tOreh hepfull gpsea rea 2A91F0 p83,2 a1 ipcetsyhmat aisutmoinlt luestsr ni esaceirdn saaclurv smtooh lemcsu taintcco.ron

sL,ta gib sup ot hte ohrerbt fro gntesti tsnemargu dsaei nad llits iagnkt ihs mrnohea ot teh crgmeyeen etpeman.tdr hPeapsr htye eewr gruiang at woh rsodpnede ot D1OV-9IC dna cidmela etnuacodi re:wso SMEUL or ro.mtiPecr

prolific_pygophilic  ^Comment of they year +1
chaosawaits  Who else got a little distracted by the tragic story of watching your brother have a heart attack because of an argument you were having with him and then had to refocus to get this question? +
an1  wouldn't coronary vasospasm refer to prinzmetal angina? can someone go over the other options? +
neurotic999  The way I approached it was, since they specifically asked about the role that the argument played in developing the symptoms, it seemed as though they were pointing in the direction of vasospasm rather than an occlusive cause like atheroemboli, ruptured plaque, etc. So I looked at the options with that in mind. Some of the options were blatantly wrong: -vasospasm d/t beta (beta is vasodilatory) -increased afterload d/t beta (beta 2 would cause vasodilation, decreasing afterload. beta 1 would increase hr but I don't think it alone is enough to increase afterload) -negative chronotropy d/t alpha (that would be a beta blocker) -positive inotropy d/t b2 (that would be beta 1, not 2) The one I wasn't sure about was decreased perload d/t alpha1 stimulation. I was thinking decreased preload, hence decreased blood in the coronary circulation. But it didn't seem convincing enough to cause an MI. Plus not sure if alpha stimulation decreases preload to begin with. +
neurotic999  If the ST elevation part of it throws you off, FA2019 301 says prinzmetal angina has transient ST elevation. +
... aliyah made a comment on nbme19/block1/q#17 (29 yo man untreated HIV)
submitted by aliyah(39)
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Atfre het 4+DC celsl emcbeo dfiect,en het +CD8 eslcl klli tmeh.

cbreland  Same for the macrophages and dendritic cells that would be infected. Intracellular pathogen that would need to have CD8 T cell mediated death +2
vetafig692  After the CD4+ cells become infected, the CD8+ cells kill them. +1
... blueberriesyum made a comment on nbme19/block0/q#0 (A 70-year-old man develops a progressive disinhibiton)
submitted by blueberriesyum(16)
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A 70 yrea lod oveedpsl a gorrspesevi btidiniiishon deomrsny tiwh osispeed of eamootiln u,bsuttosr eaipptrrnopai seu of agunlaeg, dna ioallsyc rneaairpiotpp ebv.hiroa hWere is eth smot eilkyl ?amaedg

seAnw:r taornlF lobe di.hinsbniitoi

elitaralB dalmayga (ileadm pmeolrat eo)bl e'vdluow been ftaecfde if it swa Krluve yucB modSn.eyr

flapjacks  If you know the story of Phineas Gage, it can help +6
helppls  How do you tell the difference from a frontal lobe issue and Kluver Bucy Syndrome? +
nikitasr27  I would say the emotional and language part. The frontal lobe is very involved in emotions and the limbic system as well as in complex language concepts. Kluver Bucy would lack these aspects as the individual is โ€œindifferentโ€ to everything (no fear, no emotions) just like my ex +1
randi  Kluver-bucy is also marked by specific behaviors like hyperphagia, hyperorality, hypersexuality. Apparently can also be associated with HSV-1 encephalitis FA2019 p499. +1
chaosawaits  What am I looking at? From what viewpoint am I looking? Can anyone identify the labels? I have A is olfactory tract, C/D are optic nerves, E/F are optic tracts, G/H are substantia nigra of midbrain & still I am totally lost. +1
chaosawaits  I imagine that we are viewing the front of the brain from underneath and slightly angled to expose the midbrain more easily. Obviously B is the frontal lobe. But what are I and J? +
an1  @chaosawaits I think J might be the partial lobe. the only thing confusing me is that B is the frontal lobe with the amygdala is actually in the temporal lobe... +
an1  I take that back, I thought it was Kluver body for a second but its just frontal lobe stuff lol +
pakimd  can anyone explain why this is kluver bucy and not frontotemporal dementia? +
doida  it is not kluver, it is frontal lobe dementia +
... drdoom made a comment on nbme19/block1/q#4 (66 yo man, 2 months no erection)
submitted by drdoom(1027)
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ibatnIyil to nniiaatm na roeeicnt = eretcile itodynfcsun. So nwo het qouensti si "yhW"?

Fiae,utg tcfluifdyi ig,epsnel cudiytlffi tanrnteicgcon is ttnrgsai to nsdou kile spsneordie. "utfyfcDiil tcoctrgn"iaenn hgitm be erdinertept as pidrmaei ueievetxc itnfcuon or teh inesbnging of rl-veaaecaulrdts edetnmai a(nedteim leardet ot llmsa ubt seumruon eaercbrl ),asticnfr tbu on Spte 1 itmednea lwil eb lbatnat .,i(.e s"lto ihs yaw oh"e,m "d,"giwnenar .)ce.t

essopeiDnr is cyulltaa oonmmc tfrae a igidlbtneati teenv eikl otk,sre as you mithg c.pexte hWti nsedespior smeco a sslo of laeuxs teitresn and heeartdistโ€” is daedserce doibil.

nOe can aemk hte uagermtn ahtt a a"vcarslu n"ipatte mghit ahve semo ussise tihw hsi ""espip orrris,elsistoc(ea pytti/phaptsatcaimhymecarse cdfno)ytinus ,dan rfo hsti ,enasro alnucnotr rioenect soulhd eb ddareesec; ubt oent hatt onitghn si demtoneni oubta nignosgnal-td acruaslv sdeeisa n(o xh fo epesioyrnt.)hn

As a ,teursl the sbte esrnwa iocche eehr is C. io(bidL deeeasrdc tbu urltcaonn csrietoen oa).nmrl The big oienqsut I ehva s,i who het hcek eods tsih uyg wokn e'sh rdah hewn 'ehs s!ale!?pe p:

cbay0509  thank you +1
ilikedmyfirstusername  there are several UWorld questions about psychogenic ED with the answer being normal libido and normal nocturnal erections, idgi +14
djeffs1  Yeah NBME says its C, but I still think with a recent stroke you can't bank on normal nocturnal erections... +
drdoom  @djeffs nocturnal erections happen at the level of the spinal cord (S2โ€“S4)! a โ€œbrain strokeโ€ (UMN damage or โ€œcortical damageโ€) would not kill your ability to have nocturnal erections! +
drjo  fatigue, difficulty sleeping and concentrating could be depression or hypothyroidism both of which can cause decreased libido +
jurrutia  @djeffs1 when you say NBME say's it's C, how do you know that's the official answer? Did NBME post the answers somewhere? +
djeffs1  in the versions I purchased from them they highlight the correct answer in the test review +1
shieldmaiden  For me the keyword in the stem is "maintain"; he can maintain an erection, therefore nocturnal erections must be normal. Libido, on the other hand, is psychologically driven, so if he is depressed (trouble sleeping, concentrating, fatigue, recent major health problem) then the strength towards any kind of desire, including sexual, will be low +1
chaosawaits  His nocturnal erections are normal because his spinal cord is not damaged. His libido has decreased because he's showing signs of depression. +
... shadowbox made a comment on nbme19/block3/q#19 (30 yo man and 24 yo woman; best estimate that child will have oculocutaneous albinism?)
submitted by shadowbox(15)
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enciS hte asrte'hf ibglins is atdeffec, ew nwok that hte 'rhaefts nprseta aer bhot .rcsriear thTa nsame hte pbleossi gpyteonse of het rhtfae rea ,AA ,aA a,A or .aa

eW wnok eht eaftrh is cuefetna,df os atht neasm eh canont eb ,aa nad utsm eb ierthe A,A A,a or .Aa

cinSe herte are yoln 3 edrtieffn oypsgente he cludo evah, thiw 2 of mhte igbne rercira tnsepy,ego eerht is a /23 iblotpariyb he is a .raricre

So we inabto eth rliiapoybtb fo het haeftr spsinga no a cseevseir aellel as 2/3 tla(yibrbpoi fo bengi a rr)ierac x 21/ lb(tbopayrii of sgpasin no a receesvsi lealel if eh si a cer.rrai) The 2/3 is not envrelat ot eth rapitbiolby ttah teh hoetmr is a erc.riar

We wnok teh fycqunree fo eftfaecd dsainviidul in hte ptioauonpl ta eglar is 00/04,10 (,^)=q2 os q02=01./

P+q=,1 so 9290=/1p0 and /21))221(90(p0092=./q0

To kmea lutplicatiomni seeari ew mseaus 901,=219/0 so:

101p20020*1//2q=)=( g-&t-; hits is eth racrire fcuynqeer a...(,ak )eyrzethegstoo in eht pnpalooiut, ihchw ew anc auesms orf hte erhmto.

o,S ot easrwn eth ntiree netuiosq ew tpmlulyi hte tioyblbpari thta tehfra si a erircra )2/3( adn spesas no eht lleela )12(/ itmes eht otrbabpliiy ttha omrteh is a ieracrr 10(/)01 and saessp no hte lealel (/2;)1 pittgun ti all ethtgero ew :hvea

/*))(32)(0*//011/21()21*( = 02/021 = 010/6

cbay0509  thank you +
garble  Why is it assumed that the mother is a carrier? Couldn't it also be possible the mother is unaffected and not a carrier? +1
garble  Turns out the difference is negligible, nevermind. +
chaosawaits  Who added all these questions with abbreviated stems? fml +
chaosawaits  The chance of the mother being a carrier is 2/3 because she's obviously not homozygous (so there are only three possibilities for her, 2 of which she is a carrier). Take the square root of 40,000 to get q = 200. (2/3) * (1/2) * 200 = 600 +1
neurotic999  For people like me who royally messed up: Probability that the father is a carrier 2/3 (since we know he isn't affected i.e he isn't aa. So only things he could be are AA, Aa & aA. 2 of the 3 options are carrier states) Probability that he passes the gene 1/2 Probability that the mother is a carrier-->2pq. q^2=1/40,000. q=1/200. 2pq=1/100 (considering p as 1) Probability that she passes the gene 1/2 2.3 x 1/2 x 1/100 x 1/2 = 1/600 +
neurotic999  For people like me who royally messed up: Probability that the father is a carrier 2/3 (since we know he isn't affected i.e he isn't aa. So only things he could be are AA, Aa & aA. 2 of the 3 options are carrier states). Probability that he passes the gene 1/2. Probability that the mother is a carrier-->2pq. q^2=1/40,000. q=1/200. 2pq=1/100 (considering p as 1). Probability that she passes the gene 1/2. 2/3 x 1/2 x 1/100 x 1/2 = 1/600 +
... cassdawg made a comment on nbme19/block4/q#14 (11 yo boy, right mid-thigh pain for 2 weeks; femur X-ray reveals single osteolytic lesion in mid-diaphysis)
submitted by cassdawg(1457)
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:LDT;R iTsh si wingE ocmsaar baceues ti is a gnyuo boy hwit mlals bleu cell oben torum in teh dsaiiypsh of eht femur

wigEn scaarom is a mgatilnna bnoe tourm ocmonm in uoygn osyb ot;1.5.&yl pcilyyalt fdnou in teh ssphaiied dm(ed)li fo gonl oebsn u(alprtcrlyia fru)em or ilvpec lfat sebn.o tI si a amlls leub cell u,ormt nmeangi eth iedrtsrocp fo l,aslm rioufmn, mhycrrhcepotai elcls hwit ihgh :lplutcncyemusoas roai.t tI soal has na oi"onn "inks oeaslrtipe cineator ni teh neob eics(derbd sa eusist drenouudrs by ocrnieccnt elysra fo rveciate neob ni the ui.nt)qsoe oNt demnnoite si eht ioscasaniot twhi );2.(t121 [AF 0022 p 4]64

yWh teh hestor rea norwg:

  • rhoaoCcdsraomn is a urotm of nimlgnaat cnroysdhcoet ag(l)eacti and fundo ialynm in eth ve,ipsl rmpoailx e,rvfe adn rsmehuu
  • soicEliphion magrulano is si a aerr, negbni t-ukiormel rsoirdde cdiactazererh yb anocll ieptonlraifro of agrenashnL escll dna eht tsmo ncmmoo avirnte of aghsLranen cell Wc.ssoshyolituidoit leylik sya noethsgim tuabo kcBiebr gualrnes in the smet dna dlwuo veha icaasdseto ysmtmspo cush sa hsra [FA 0202 p44]3
  • tlelpMiu ymlomea is a masapl clel iascdrays [AF 0220 1]34p htiw rotcivneoropud of c(yplityla) G.gI crCeacrtisiatsh lnceuid CARB - iher,mcplaaCey nRael nvntlie,emvo inAema, oenkc/aBB nipa deu to ehdnpuc otu cltiy enob seionls a(ycptilyl fo teh np)eis
  • aersb'omolspha/WliNmt mrTou is het tsom momonc alenr ncgmainlya of laeyr hdlihocod adn esptnsre as a lankf ssam A[F 0202 p 6]06
  • cromsseaOato (or nogceietso a)crmosa is a iyprarm bone umtro mmcoon ni mne .;0tl&2 It is ylcplyita donfu in eht smpsyahtei )its(p fo glno se.nob toyloiHsg woshs lrpohpecmioi itseodo crignupdo c.ells nO y-aXr uyo oldwu enpattilylo ese a doaCnm grelntia ie(laevotn fo iotr)emsupe or ursnutsb rtptean
  • lSlam pmiocylhcty pylhmamo si lnaislyeset hte mase ghint as irconhc hcmoiyltcyp uekmeil.a It si odcendries a gdoniH-nnko mmphyaol fo slcBl-e nda het tmso noomcm eemaulik fo tldsau sa( ).LLC dmSgue lselc uwodl ileylk eb nees on rieehaprpl dobol remas. It dowlu ont yllike rtsnpee as na octtsoeily lesoni dan is yilunkel in ihedcn.rl 0202FA[ p]342
cbay0509  thank you +
... corndog made a comment on nbme19/block1/q#26 (Niemann-Pick)
submitted by corndog(15)
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ME: I ntkih I llafniy heva these dsuipt aesrotg srddoseri nwdo

MBNE: Nto os ,atsf tapnerr

i_hate_it_here  Same bro +
... cassdawg made a comment on nbme19/block3/q#46 (52 yo man, sudden onset of substernal chest pain)
submitted by cassdawg(1457)
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nyaM pdioosi kiel( hprmnioe) era enptot entishaim seerl,srae which acn sceau pitsuri dan cplnyotiahaad onstaceir u(hsc as esen ni htis iaenttp hiwt het lafica hsli,fung rdpo ni ldobo essuperr and prndgoorsceni aeirnecs ni earth Pusirit si ytulcala a moconm esid fcfete of i.henmpro

ue:rocS stiFr Adi dna


solidshake  Opioids (morphine), radio contrasts, some antibiotics (vancomycin), and several other medications can trigger IgE independent mast cell degranulation. (Uworld Qid# 11852) +
... cassdawg made a comment on nbme19/block1/q#26 (Niemann-Pick)
submitted by cassdawg(1457)
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mkNne-caPiin is a solyomsla tergsao deiessa ahtt is a eeyiifdncc in mnlehsgpinsaeyoi that edlsa ot a uulidpb fo hselpyiingmon enmNia(n pkcis ihs nseo tiwh hsi srnigeph)

pyaneeioSsghlnmi is rndoseedci a lslyaosom searyodlh

chaosawaits  I'm guessing the reason "decreased synthesis of ceramide" isn't the answer then is based on FA2019 p88. Since there are 3 different paths to make ceramide, losing one throught Niemann-Pick disease will not significantly decrease the ceramide production +
... cassdawg made a comment on nbme19/block2/q#25 (48 yo woman, 3 months fatigue; X-rays reveal generalized osteopenia)
submitted by cassdawg(1457)
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riAgnsnwe tihs steiuqon rqeeusri uoy udatdsenrn hte chisneamm fo cooteastls ltmtiouinsa by ihrtpoadayr mronoeh FA( 0202 2)3p.3

aohPdirayrt mhnooer istemlusta ltacesoosse lyientdicr yb agiltimtusn hte eeelrsa of KNARL bu sltbotessoa whcih lliw ibdn ot NAKR coertrpe on tscotoeslsa nda ustlaitme hte rsptioonre fo eobn. iTsh is a rrcaenipa cerpsos usabeec paniecrra nigilasgn erersf to untaiostiml by oihginenbrg scell rhs(to )de.casisnt

... cassdawg made a comment on nbme19/block3/q#17 (45 yo patient, chronic alcohol dependence, foul-smelling brownish sputum)
submitted by cassdawg(1457)
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I evol ihst utqnesoi seacueb ew ear all uslvyboio deantri s.og.sdi.raoilt

In tralyie, heatrr than fgtnyieidin eyver -aryX ginve nda tyirng ot mctah it to het uqniesto mt,se eth sbte yaw to pharopca stih niquoset is ot ynfediit athw ihs somt likley i()usess dan mhatc to eht englear cicsearrhttaci of an yX-,ar igong to the -Xsray lgkioon rfo hstee iattrisaccc.srhe

eH si na clhlociao wthi ufol lsgnmeil (nidg )oeaabicrn s.pmuut Beacuse eh si na lciacoloh he si ta isrk rfo otispraani oiuampnne dna iroanceba ylnpruaom cabssesse romf niarsatopi (hiwch is why hyte eedtonimn eht btous of gklnaicb )o.tu oS awth are teh ccatiretsihscra of teshe adesisse? tnAsorapii oniamnupe is a lobar pmeainoun chhwi dwolu pensetr hitw olrab ntfitonrliia e(es ehre orf ea.elx)pm maunPyolr ecbsssa odlwu trpsene hwit ivaaonctit adn na riludfi-a nile es(e hree fro eplaxem ihtw ria iflud evlel noedtpi tuo dna eher orf /aittnsaevsbacocis nidtope .gai)an

gnnihkiT of tish won poaarhcp het syX-ra nlkigoo for picsicfe nisi.fngd nOe ash teh iar duifl lvele dan ,ttaaciiovn so thta si hte nwersa (it si na )sebscs.a enNo fo teh hrsoet evha loarb etlaitnifr and ear erihte omre udesffi or irlah os ythe oduhsl eb ruled .otu

an_improved_me  The even more frustrating part of this question is that they don't show an abscess in a more dependent region of the lung! +2
... cassdawg made a comment on nbme19/block3/q#41 (41 yo woman, 34 weeks gestation; amniocentesis shows lecithin-to-sphingomyelin ratio of 1.5:1)
submitted by cassdawg(1457)
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hisT iroat si edus ot eeedmrnit iopraetaprp uopiroctnd of lugn ansracutft, so itsh byab doluw ton vhae epiapptorar otodncrpui of ucasfttran if rdbieht at eth temi fo het ioart n.ltaicocual tI luwdo go ntio aoltaenn airrrpysoet sedstris onsyrdm.e

RTL:;D nftatscura adeeesrcs nugl oecil,r os eht lack of tsfucrtana in htis aybb llwi useac an resndicae roicle hicwh iwll eeseardc eth ciunoatlnf siuldera ctcipaay FA( 2002 66p2-1)66

Suatncatfr is caerssnye to dcrseaee sfcurae tnsenoi of eloalvi and ercsaein aploicnecm of the ngusl rbe(eemrm nhew hte lgnsu vhae atgerre ncamec,piol iths esmka hte usnlg aeiser ot llfi). natatfcSru soal hepsl ot ernvpte reoaavll aeolpslc sa teh lcka of ntcusfatra osllaw herte ot be aryignv asfrecu nntsiose eebwent lrega nda lmlas lviolae Law( of cpaaLle), os ckal fo facurnatts lwuod lade to wdeiapsrde iacesaetlst (lvrealoa o) Buceesa ratfutnsca sevrse to dacseere seteh focsre wcihh aollrnym oafvr laopclse of het ,lgnu ti also vsrese to eaercesd the ulgn ilorec.

Lkca of tfaartcusn ni a bayb = aceenidrs veralola esacufr ,tnseoin elwro nl,mcoeapci mero alrovael apoels,lc mreo ecroil (slse aresudil lseoumv)

Totla lnug apaicyct si hacuegnnd eebasuc hwit uhonge rofec uoy acn sllit dpaexn teh usnlg ot llfu aypicac.t

geekymle  hey ya! thanks for the explanation, but i'm still not able to understand why decreased functional residual capacity. +2
cassdawg  Not sure if this will help but another way of thinking of this is that it is similar to pulmonary fibrosis with decreased compliance leading to lower functional residual capacity! The only difference is here you retain total lung capacity because it is a "reversible" compliance issue (give them surfactant) and the lungs themselves are not the issue. Also, like you said in your comment, lungs won't open up so there is a lower starting point for breathing, and thus a lower functional residual capacity (volume left in the lungs after normal expiration). +4
chaosawaits  So if FRC decreases, TLC decreases as well, which rules out E +1
... cassdawg made a comment on nbme19/block4/q#33 (Oral fluid therapy for diarrhea caused by <i>Vibrio cholerae</i>)
submitted by cassdawg(1457)
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arOl hrtrniadyeo peyhatr onlmocym ionsctss fo gaeuocsl/tlterery wreta buceesa of eth bitaliy to iuitezl het dmiuos luseocg eyrormts.p Where dismuo eog,s ertaw ow,ollsf so by yinhdgart ihwt shti mxeitur ti awosll fro an cistmoo "upl"l of wreat itno eht etit.inenss

eHre is na aicertl wiht rome ealdti nda a tytepr aga:dirm tlicnractisltor-.v:sriishye/-raeepokcedmgaebtsymt//hta/afiop-

ftr_dr_bowowers  thank you!!! +3
... picodemolar made a comment on nbme19/block1/q#13 (Mechanism of action of tumor suppressor genes)
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nseOeoncg thwi naig of nntocufi toimtuna eald ot ecnadisre ncr,rpnsottaii etc,. eesrahw utmor srpspueors sgeen obklc ;-1-St&Gg hsaep. F1N geen dcpturo ahs RSA aGseTP ytitvaic ihwhc korsw by rntalpsyihopohg dan cgiaatitnv nortpie u(oifbinemrorn.) oS hrtee si ta lseta 1 tomur sprsroepsu eeng htat rowks rthhogu oo.shpotnirylpha

rwd1027  ่ฐ็Ÿฅ้“ไธŠ้ขๆ˜ฏไป€ไนˆ่ฏญ่จ€ๅ†™็š„ๅ†…ๅฎน๏ผŸ +
csalib2  ๅคไปฃ็ง˜ๅฏ†่ฏญ่จ€ +
pakimd  can you explain how neurofibromin works by phosphorylation? doesnt it cause hydrolysis of Ras bound GTP (by activating Ras GTPase) leading to formation of inactive Ras-GDP complex thereby downregulating Ras activity? thank you +1
... metformality made a comment on nbme19/block3/q#12 (23 yo woman engages in 30 minutes of strenuous exercise)
submitted by metformality(14)
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ihHg dricaca uouttp ot the onlmpryau ictraucniol rgnudi scxreeie lliw seuac hte nedossniti dna tretcnirmeu of veslosmecis nad atth woudl cueas eht aenrceis in otatl inoet-ocacsslsr .arae

reHe rae owt ismega ahtt eraiutltsl itsh elripcpin yni:cle

... anjum made a comment on nbme19/block3/q#16 (13 yo girl grows over the summer; what accounts for increased intestinal absorption of calcium?)
submitted by anjum(23)
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stylecelrddh-7rheooo si a mfor fo ti-npmevria 3D ehnytesisdz ni eth nisk romf BV.U It si oecrevtnd ot ilooerehcallcCf, hiwhc si eht iiatvcen morf of iVmanti D3 ttha si aaluyclt in isfrt iad.

kevin  Cholecalciferol is synthesized from 7-dehydrocholesterol by UV, but yes, correct +
i_hate_it_here  Didn't know the products of it were considered hormones my bad i guess +
... cassdawg made a comment on nbme19/block3/q#28 (40 yo man, 1 month increasing malaise, nausea, abdominal pain; CD8+ T lymphocytes resulting in liver injury)
submitted by cassdawg(1457)
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ishT vdnauiliid ahs veacti eaiHptsit B, as needvceid by ethir apsetiiHt B farecsu inaegtn .tiipvysiot taHpiseit B rusiv ueptodrlvicy tifcesn haotcstyeep. eTh D8C lsecl liwl tsuh aacttk teh .ehtcstypeao

Ahnetro awy of rnipoahgpca shit noeustqi is ot toiecn ATS and TLA enatlveoi ear ylpiyclat iidiancevt fo yeatpctohe gaaedm.

tIo lclse aer eht aems gtihn as talleets lc,els dna rhtie riparym iocnnuft is ot toser avtniim D dan atf adn cuodpre CME hnwe .cdaeittav Keufrfp clsle rae teh i'selvr esgcam.oparh elBi tcdu iuehmpielt is not ifdeentc ni si.ehittap

moms  Exactly. But Ito cells (located in space of Disse) store Vitamin A when they are quiescent and produce ECM when they are activated. Basically are responsible for hepatic fibrosis. p. 367 FA 2020. +5
... shadowbox made a comment on nbme19/block3/q#40 (25 yo woman requests prenatal diagnosis at 12 weeks gestation)
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hTe mset aestts ahtt het emhtor is 21 wekes i.ttegsnoa VSC is epfmdreor 1st i,trtersem ayulslu t/b 10-14 seewk asnegttoi dgriccoan to Ueat.poD-t- mAino si frodmeerp etrfa 15 weske. Fmor e-t-apDotU: mtnniicssAeeoโ€œ hdluso eb ferrpomed arfet 15 wkese of tistoeagn usebcae ilaerer rcspeouedr era ssle lieykl to eb ecfusus,lsc ear aidoeacsts itwh hgeirh aestr of lecl ctruleu erlfiua, adn yrrac aeregrt lfeat k.sโ€ris

... metformality made a comment on nbme19/block0/q#0 (Isolated skeletal muscle contracted with electrical stimulation)
submitted by metformality(14)
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hWne a mcselu nrsu tou fo lufe ,e(g locu)gse o/darn cpgruoidn essl PTA adn deicsnโ€eraโ€œ uuoilmantcac of setmlaetboi la(l teohr sonpito essbied eth rceoctr oc)i,hce ti si a insg fo ntseo fo lmcsue .tgfaeui eTh tmse si gsakin wchih of the illfonwgo wlli sadereโ€,โ€œc?e nad it is the Hp htat illw aeerceds si(oda)isc eud to het iamuactculno fo actlic caid be(rmreem icyossylgl htpwyaa ehwre yeuavtrp egts ocreventd to cilcat )adic.

... ajguard26 made a comment on nbme19/block1/q#24 (62 yo woman sudden weakness of left leg)
submitted by ajguard26(48)
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sThi tepiatn setnreps hitw lsiccsa rupep rotmo ournen leonsi s:mopmsty akw,nsees elfxreehr,yipa dna ecarededs eHov,wer eth qtnosiue satest hes ncaont" ellt ehtewrh reh eftl atrge teo is aidres or eerp"dsesd hnew erh eesy are csleod, hciwh aym akem oyu edsronecri nda thnik hetre amy be eoms etpivopiopecrr ssuise yhte rae ngtiry ot nthi .ta ishT is ont hte .caes asieylEcpl eocn heyt ienontm rhtee ear on eotrh boiemainltras e,.i.( no purep ilbm rsbetnaalmioi or rtigh ddsei .ilotminb)eaasr If isth is teh ac,es rhtee si no dagmae to eth atcsrt at lal cihwh( aer sllit eidcsdnreo U)M.N

feTereho,r het eadagm is uerlpy toorm nad snoryse ni hte eftl g,le hihcw si on eth deimla teacps fo hte arlntfo and iatlpera lobse c.riltsypeeve Tihs aare si ipduselp yb the treranio eclbrera ryter.a

issamd1221  contralateral deficits +1
cbay0509  thank you +1
flapjacks  I think her 60 pack-year history suggests possible PAD and therefore loss of proprioception in the lower extremities, leading to an unfortunate distractor +1
an_improved_me  I don't understand why you would consider the propioceptive deficit a distractor... doesn't the DCML (which carries propioceptive information) project to the primary somatosensory cortex (via the VPL?). In this case, a lesion to the right anterior cerebral artery, which supplies both motor and sensory information to the lower limb would lead to somatosensory, propioceptive, and motor deficits. +1
... doofusmd made a comment on nbme19/block1/q#35 (5 yo boy, right eye pain 1 week)
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This si thaw is knwon sa a atcsmoi mtauotni: a niotumta atth ccrous in -innneemrlog sllce ,nda fehro,reet oyln eftfsec utgreadh ellsc deeivdr fomr eht ptaenr ecll with teh maoit.tun S,o a uiomntat reuroccd ni a etefaitdfenrdi preant clle taht agev reis to a ste fo edaturgh esllc hiw(,ch in htis ca,se weer eteddins ot ecoemb etanril )us.esti

... ajguard26 made a comment on nbme19/block1/q#42 (Advantage of randomized controlled studies)
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ofunidgoCnn" re"bialavs eehr amsne dgfuinocn"no sai,"b niesa.llsyet And shit is rtue uebceas a eotivecpsrp oochtr klsoo ta a ecicfpis xpeourse ot a cssunebta voenita(rnmnle nox,it gr,ud ,ct.e) nad assk "Who will leevdop sith edsesia if pxoe"eds? SP'sC loko mtattpe to nifd a ritaleev ikrs eotdascasi whti an eeox.purs eTyh do ont ktae toni nuctoac het ftfaces trohe sxoupeer.s ishT is your ofgnuoncidn sb.ia AF gesvi het mexpale of cnnfdoigoun siab sa roamP"nuly eedsais is mreo ocmonm ni wkrerso ni a loac mei;n v,hroewe emsinr era more llykie to ,k"oems dan isecn ikmsgon nca also laed ot lamrounpy sie,dsae uoy n'cta yealrl ays eherwth eht knisomg sfri(t or coesnd dh)an ro het ocal utds ssauec hte opbe.mlr A iiccnall l,tair no eth ohrte ndh,a cnitnoas a tets rpugo and a ootlcnr u,orpg os iarebsavl shuc as eht odinougfnnc aevrblia emetidnon veoba are mel.diti

winnshak  unscramble plz +
... cassdawg made a comment on nbme19/block1/q#44 (Best testing strategy when treatment has serious side effects)
submitted by cassdawg(1457)
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LRT;D: uoY atnw teh msot visnetsie stet tsfri to uerl uot eht eaediss ni asgieevtn a(lset hlokeloiid fo flaes iatevnge) dna hte osmt icipcefs stte tnex to "reul "in lyon ture eitspovis stela( dioioeklhl of lesfa pi)voisste 0[FA022 725p]

heT wya I wsayla htnki of tisynetiisv nad pcsiiicyeft si ni oeialtrn ot alsef seieagvnt and safel itisso.pev

  • hHgi Se N ysiietvt nsame ouy rea ssel elilyk ot vahe lsaef igatesevN seoo(men who sah eth edissea btu estts ateeni)gv
  • igHh s P ycfecitiie nmsea ouy rae sesl lekyli ot vhae lasfe tiPiosvse oe(msnoe how estts spvteoii ubt osde ont ahev teh sdeias)e

In sith seqntoi,u ouy anwt ot eseunr oyu era only tirnaegt ohste hwo cayatllu evah the saedes,i ro in oerht odrsw that you atnw ot imznimei oyru easlf ptovssiie. ehT etsb wya ot do sith is ziemixam ciPtiefiyc.s teTs 1 sha %010 icspyietfci ienagmn ti lwli ahev ysasneietll NO flaes vpitoeiss iwchh si taerg os we eiftinydel nawt ot sue it imieiang(nlt lla tbu two !tsp)nooi ehT trbtee wya ot nreesu uoy rea cinagtch as amny sasec as lsebsipo hlwei tlsli ynlo itgtgen etur vietspios is ot sett hitw ttes 3 irtsf, hchiw ahs a much ighhre t.nytiesivsi Taht awy we rea unilrg tuo easedis ni eht eaisvetng of test 3. shTi alos adds ot oru ailtiyb to only trlyu etatr oesht iwht deseias sa we veha rueld uto sedsaie in our ftisr etnaigev oloitnp,pua tneh ew etts het episvosit to ru"le "in deieass iwth a hyhgil cepcsfii ts.te

Teh usise wthi ungis steT 1 fitsr nad olny sitgnet eht evossitpi is we okwn teh pvisisoet ormf stet 1 are ylilke reut stesi,ipvo as het hgihyl epscific tets wlodu veah a siyabclla zroe fales vsptoiei rt.ea tA htat ption rteeh lwdou be no tnpio ni egnstit thwi test ,3 as we aveh csyialabl a eutr pioivtes plaoo.iutnp The usies si ew eahv imesds a lto of ediassed ude to teh lwo itetsvniyis adn high lseaf tiaegvne erat of test .1

hternAo ayw ot ihtnk of htsi is to mremrbee hte omlsrufa s(a estiyNiivts nocintas selaf es,gavieNt dna cyiPicsetif ctonisan lafes sioisPvte ni teh sra;mulof see :)dsAirtFi

  • tiveytsnisi = urte viespoit / uer(t tipovise + fesla ieg)vtaen = 1 - lafes itgenvae raet &-gt;- gihehr niyitessivt naesm elss erta of aself evigtnaes
  • pyiefcsctii = etur itvgeean / rtu(e egainvet + afels ps)eitvoi = 1 - sflea soietivp tare -tg-;& hgireh isyipcticfe manes sesl tare of sefla optissive

O/SNPUNITS laso eshpl ot remerbme htat efsipcci ssett rule in eidseas, adn svesnitei sestt erul uot asdeesi

... wherearetheanswers made a comment on nbme19/block3/q#39 (45 yo man, lost outdoors in the Rocky Mountains for 10 days)
submitted by wherearetheanswers(13)
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Teh disykne kaem gcesulo ?oot 6 reays fo dsygnuti ecnecis nda no eon nesmotin eht

... wherearetheanswers made a comment on nbme19/block3/q#49 (Schematic representation of eukaryotic translation)
submitted by wherearetheanswers(13)
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tonrAhe tNRA ahs to ahtcat to eth A iset eforeb hte ptepdie inhca can be zohdydreyl fmro eht P esti and eodvm to teh A etis RtAN AF( 0202 pg )54

fataldose  As the Peptide chain is transfered to the tRNA at the A site, the ribosome moves down the mRNA moving the now empty P site tRNA to the E site, and the tRNA from the A site to the P site, making room for the next amino acid charged tRNA to attach to the A site. Additional points- The translation comes to an end when a releasing factor recognizes one of the stop codons (does not code for an amino acid), which then catalyzes the release of the peptide chain from the tRNA in the P site. Peptidyl transfer to E site is wrong because peptidyl tranfer occurs between P site to the A site, not to the E site eIF4E is a eukaryotic translation initiation factor involved in directing ribosomes to the cap structure of mRNAs. Once methionine charged tRNA locates the start codon, all initiation factors are released. +7
... cbay0509 made a comment on nbme19/block4/q#15 (60 yo woman, 1 year of episodic involuntary rhythmic jerking of R leg and foot; brain MRI reveals 2 cm round enhancing lesion within interhemispheric fissure)
submitted by cbay0509(7)
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eth rmlalakh fo miaogenmni is sti reaonitl ot a gminenela cusarfe nehec rtoalnie to sscluu


cbreland  I really wanted to pick GBM/astrocytoma here +
... metformality made a comment on nbme19/block4/q#17 (60 yo man, 20-year history of hypertension; shortness of breath and fatigue for 3 months)
submitted by metformality(14)
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Thsi eintatp ihwt a hoyrtis hrnoicc rsneyonitphe si tsom klyeli snigfruef orfm tlfe rahte rafeiul r(ddaeesce icaardc op)o,tuut nsgiacu het obdol ot cakb up in the ngsul eC(lrkcas aer edarh llliaytar,eb rnsosehts of hat)bre nda htat rtgnelisu tnoi eicasnrde lrteaadfo rof eht ritgh seid of eht r,aeht nigrsia hte sreseurp in the trhgi arthe ,haresmcb hhicw gte rttiedmsant kbca to aenlrct eniv.

anjum  shortness of breath = Left heart failure +3
cassdawg  The way I approached the question was a little different: I realized it was heart failure and left would cause lung backup and right the venous backup. When addressing the +6
cassdawg  *the question my thinking was CO = HRxSV; in heart failure we are not pumping as much blood so lower SV (and on top of that his HR is not increased and I think the low blood pressure indicates decompensated heart failure) so CO is definitely lowered. Then CVP would have to be increased because that is how we get the edema (and backup into the venous system increases CVP). +1
chaosawaits  @cassdawg, I approached it very similarly. The best immediate indicator that this is cardiogenic shock is the pulse pressure (30 mmHg). Normal PP = 40-60 mmHg. Therefore, you know that CO has been compromised. The edema indicates that CVP (measurement of the venae cavae BP)has increased. +
an1  because this guy has crackles and ankle edema, we know that there is LHF AND RHF respectively. the most common cause of RHF is actually LHF. So crackles mean that fluid is accumulating in the lung. Where will it back up? RV and RA causing increased CVP. Crackles mean LHF, and the the LV isn't working well, the cardiac output will decrease for sure +
... cassdawg made a comment on nbme19/block4/q#46 (24 yo woman; renal oxygen consumption found to be 20 mL per minute; which process consumes the most oxygen?)
submitted by cassdawg(1457)
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I ma masingsu hist si tjsu misgohten ew rae tpexdece ot okwn; ualbtur bsraioptoern qrreesui the tsmo xegoyn ecsubae it uldwo cosnume eth smto PTA tou of the pssoscree ni the kydine?

waitingonprometric  I believe this is correct--assuming that active transport of solutes at the thick ascending limb and active transport of solutes (secondary to Na/K pump) at the PCT consumes O2 at highest rate b/c of ATP use. Since tubular reabsorption always happening...very high use of O2 relative to the other answer choices that occur sporadically in response to body homeostatic changes? Note: glomerular filtration is always happening, but that's passive movement through fenestrated capillaries (i.e. no ATP used). +3
hiroshimi  Also, PCT and thick ascending tubule are the two areas that are most susceptible to hypoxic injury in the kidneys. +4
... peteandplop made a comment on nbme19/block0/q#0 (80 year old shortness of...)
submitted by peteandplop(38)
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eTh above si ccoterr ni rsetm fo ,oAM ohevrew I eevelbi eht tsem etssta it is TP mb(inrrpo)oth oognrp,aiontl not TTP ralt(Pai bslmrti)po.haTon I ddi ton veha nya daei twha oilmurcda s.w.a tbu hree aws my log:ci

  1. ttinePa dah otacri valve n,tmlaeeeprc es'sh 0,8 lpbboayr utp on an icluaongant-at
  2. I wonk niarfWar si dols ruedn eth abrdn anem oaiCnudm
  3. Rdmine esyofurl ttha nrWafi aws orescveddi ni 9721 (2,9)7,01, nda tibniihs Vti K edntneepd tiltcgon scaortf it(v K idncylfcik-eeei tt)esa
  4. unocnePor het dgur ton ni FA sa rodOUCM,ial dna you slhla lefhylpou now wkno it sola siibthin oedpixe daetsucr,e nda eduosp geuss oyru awy ot cotr.iyv
rina  Yes it was PT! Personally I forgot that PT detects changes in I, II (thrombin), V, VII, & X. Vit. K affects II (thrombin), VII, IX & X so there is significant overlap. +
... sh_nu made a comment on nbme19/block1/q#7 (48 yo woman, 2 weeks fever and mucus in stool)
submitted by sh_nu(3)
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sTih Q doluc eb radwsnee owt ,sywa one goruhht oiniimaletn or owgnnki how to ienifdyt het uc!el owN via ilomiinaent ..A ). iaynml eens in SDIA tpansite ( Q tmse sedo not idtcer Q hatt C)a w)y louF melgsiln eirrhaad "yt)tD f"a eTreh sdeen ot eb a ardit " yse lHPgEATymaeO + eolmneygl"apSe in"skpig e"fevr cyn"nipt"aapeo yma sloa veha ksni etnvvmienlo )E ulfo nlgmseil ergne gnliava ardechgis

B) CEL*U RUQ NIPA + culer

cbreland  I marked off Entamoeba because I thought it always caused bloody diarrhea... damn +3
aakb  between Giardia and Entamoeba -- giardia doesn't invade intestinal wall but entamoeba does (per sketchy) +
pfebo  Entamoeba: flask-shaped ulcers, Liver abscess +1
... drdoom made a comment on nbme19/block1/q#13 (Mechanism of action of tumor suppressor genes)
submitted by drdoom(1027)
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isTh is tyeiaselsln a ormafl ocilg outse.nqi icLolyalg ekn,sigap eth nstoique sska us ot iinydeft a semchamin taht mtoru pessoprrssu vhea hcwhi enp-coseonrotgo od o.nt In oreht rs,dwo thaw si a ihmsceman sedrah by lla nowkn otmru opsrsusespr utb not rshdae yb any kwnno opcotsrn?eeoong- orF tath n,ersoa it ncโ€™at be nhlhopoarsyp;toi eus,r yopitalrspoohnh si a mmseicnha fo utomr rppesorusss utb โ€™its olas a ienhacmsm of mnya nkown opeenoogcn.s-rto

... cassdawg made a comment on nbme19/block1/q#16 (60 yo man, 2 weeks flank pain and blood in urine)
submitted by cassdawg(1457)
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;RTLD: lnaeR lcle rimnacaoc cna erptnse hiwt ylcomyaehitp (eud ot desecrnia ritopyrt)ehenoi and pcchiamelraye (edu ot rHT)PP FA202[0 28p2]

oS het eiosutqn is waht si teh iarymrp ?nrecca He sha wot moutr olointcsa en(diky nad gun,sl) which docul be mrpirya ro rofm stata.smsee

I aoedrnrw ti wndo to ttsaamicte arenl ecll omacnrcia dna bngchoceroin qsuomasu lcle ciroanmca se(e b.)lowe ehT onyl eohtr ioametnniof eayllr eginv atth coudl laolw us to iiutdssighn si eht lba uelasv ndcnaiigit taenlapaiprcso rymssdnoe. eseTh rea othb nnowk ot ausec plceporiaantsa yessndomr hhicw nac eaucs cica.lmpheyrea oS sfcnuigo no the eyymioh,captl sith si reom ispcfeic for elnra lelc raamcncio aubeecs no glnu accren secserte .EOP

I teeiimland enteetidffiuanrd anciamorc ucbesea ti si too ifocsnipnec nad tciaeasmtt oninltarisat elcl cncmaaoir ueseacb it is arre ni eht kindye (wthi no laiasoepntpacr nsemyodr atpllyyci aseitadsco ihcwh ludoc aescu teh bla atlienima)obsr dan ereht si on eimntno fo bra.ledd

lMultiep oaemmyl cna ehva rnale iveotevnnlm tub eods tno atcillypy nvoevli eth ulsng nda uwold npesrte ihtw nbeo tlicy ssiolne adn aaneim arreth anth aihtyyl.eocpm 0A2F[20 314]p

... cassdawg made a comment on nbme19/block1/q#34 (12 yo girl, 5 days unable to walk but unconcerned)
submitted by cassdawg(1457)
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eTh key ot rwinsagne itsh is tath hes sseem crecnndnoue with reh mstpy,mos chwih si a lmaalhrk fo csrivoeonn doedisrr al( lebel )defnfcirenie [F2002A gp 5]66

llensIs yeatnxi drordsei wdulo eb tcpoeunpcaoir iwth avignh a nriteac eslnils, dna nyiiilabt to eb ersserdau nhew rheet rae etienvga indnfsi.g

enlsdioaotale/Draezeprnanizoiit si a adoistcsviie dirersod and "out of yobd eecxerpe"ni htwi a eenglfi fo ahdnecttme romf teh yodb or

Bfrei thcpiycos srdidoer uwlod reesntp orme ikylel tihw ls,ienodus ,couinilathnals or osme ertoh achrcisctratie fo ihcysposs.

TSPD luowd neetprs ftear an yexmleter artitcmau neevt nehw tmpsysom hcus as an,xyiet blcfssahak, esuoaapy,hlrr dna rnishatemg iprtses fro gareert anht 1 nohmt afret hte

... ajguard26 made a comment on nbme19/block2/q#13 (25 yo man, exercise test. Most likely physiologic changes)
submitted by ajguard26(48)
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As the elmcsu rksow nad asebkr dnow ,ATP endisenoa is ucpeddor, gnleaid to na cenresia in het isuset.s Thsi iesraecnd aenesoind sscuae itvoa,loadsni ichhw ni turn acsernies saaluvcr tnceacnoduc eth( fwol fo a uloevm of odlob hutorgh eht .ceu)ulrstaav

ghtuloAh uyo mya kthni smluec norcnioctta mya deal to a edaresce in wlfo ohgrtuh teh (evlssse) yb useqnzgei wnod no t,mhe itsh aemnmchis si rmovoeec by eht cesdnriea dcaairc utpotu rfmo teh .rateh

rwd1027  ่ฟ™ๆ˜ฏไป€ไนˆ่ฏญ่จ€๏ผŸ +
csalib2  ่ฟ™ไธๆ˜ฏไธ€็ง่ฏญ่จ€ใ€‚ ่ฟ™ๆ˜ฏโ€œไบ‰ๅคบโ€ใ€‚ ๆ‚จๅฟ…้กปไป˜่ดนๆ‰่ƒฝๆŸฅ็œ‹่ฏดๆ˜Žใ€‚ +
... cassdawg made a comment on nbme19/block2/q#17 (Scurvy symptoms associated with decreased activity of which enzyme?)
submitted by cassdawg(1457)
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vyScur si hte inyeiccefd ni iitnaVm C. nViamit C is ycseasern orf dnioyxthalroy fo eoiplnr nad iynsel sesrediu in gnaloelc. lolyPr herloyyaxds is bsepinloers ofr teh dhynlaxytioor of pelnroi e(es tshi Wieiapked ciartle)

... blueberriesyum made a comment on nbme19/block2/q#23 (10 yo girl, slightly painful 2 mm subcutaneous nodule on chin)
submitted by blueberriesyum(16)
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rcPeeesn of clluettneamdui tanig eslcl rngnsduruoi irognef dboy ls)tap(e shosw lnaamur.og

... cassdawg made a comment on nbme19/block2/q#46 (Decreased pulmonary artery pressure facilitated by increase in the intracellular concentration of which molecule?)
submitted by cassdawg(1457)
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ishT rereuisq ewldongke fo OAM for tiesasseoorphdphe iniiohstbr ichwh( rae soal sdeu rof ecteelir llA ehaoieprdpsohtses rthiioibsn illw itibhin shorsepoat,spdeihe ihcwh ayolnlrm eayasclzt ysyilrodhs of MPAc or GP,cM so eyht wlil kwor yb nicnargsei MPPGMccA/ !eleslv 2[A20F0 2p64]

OT:NE do ton teg fcnuesod yb teh ndiodati of ON sa na rsneaw, hhoutg aoierltre nltodaii by hrpoehssdatoesiep sinrtihbio oswrk in arpt yb hieacgnnn NO iivyctta on hsotmo cmle,us it osde tno iasecnre eht ntntaceionocr fo O.N ON irrggtse arcndiese cGPM ot eailtd msohto emssclu, nda opesesrsidhotpeah hniobitrsi tvnrpee wneakodrb of hits ,MPcG os eyht kwor in yernys!g

... aliyah made a comment on nbme19/block3/q#5 (30 yo woman, 1 week of visual difficulty)
submitted by aliyah(39)
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Teh tgirh yee's feeternf vresne era ow,nkrgi as etfl eey atltuimniso ussaec a hcgnea ni the ghirt .ey eeTh hirgt eye opitc n. adgema sasuce tsi' tnfarfee n. ot eb a.gemdad It 'tanc cryra ionf to ir,nab os thgir nad tefl yee 'ctna ntsrotcic ot htlig.

icedcoffeeislyfe  APD--> swinging flashlight test, light in the AFFECTED eye will result in dilation of both pupils inappropriately +1
cbay0509  thank you +
nbme_123  Can someone please explain why it cant be the Right Edinger Westphal nucleus? +1
chaosawaits  But if right optic nerve doesn't work, why does it dilate normally in the dark to 6 mm? +1
pakimd  @nbme_123 im not sure if im correct but i think the reason why right edinger westphal nucleus is not the correct answer is because the left edinger westphal nucleus sends one axon to the right edinger westphal nucleus and one to right pretectal nucleus so that way damage to right edinger westphal will still result in relaying of efferent innervation to the right eye +
... peteandplop made a comment on nbme19/block3/q#39 (45 yo man, lost outdoors in the Rocky Mountains for 10 days)
submitted by peteandplop(38)
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liWeh not iiltydorntala sesud,dics eth eiskd'ny rstonibucotin to niingaaimtn lecogus maoothsssei era afgsticniin adn cineudl such nnuscofti as lsraeee fo usclego inot het oailcuctinr vai soocgleeugsi,nne ueaptk of olusecg fmro het urncatcoiil ot ifatsys rhtie yegnre ede,sn nad iptasneorbor fo cueglos at het ellev fo teh oxpilarm blutue.

021A9F 8p7 - e[ucolsno]ingesG oucscr iramryilp in teh ;ierlv esrsve ot tmaaniin eluiaegmcy nirgud as.fitng zsyEnme lsao dfuno ni iekdyn, aeintilsnt mlpieeu.tih

... smees eikl a islly tngih ot hrugss sseuhdlro haglsu in NBME

shieldmaiden  especially silly since they also list the small and the large intestine +1
... the_enigma28 made a comment on nbme19/block3/q#40 (25 yo woman requests prenatal diagnosis at 12 weeks gestation)
submitted by the_enigma28(55)
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mocAntii ulidf plidsphohoip salinysa si ueds rfo tnegits telaf nlug ruiymtat iav uirsamneg tucasfnrta coidonpur.t

eFalt eygpicraodcraohh owldu lvraee any lncnieatog hrtea tecesdf fi ste,pern btu oldwu tno eb dasigconti of nwsoD ydeornsm

Fltae dutalruosn esitir-srrtFtme aurnlduots lmoncymo sowhs eeascrdni anhucl naurcsltency and lcistyophap anasl nobe. utB I efel itsh is euds mroe mmonylco ni derol oemwn how mghit veah ohsclrmomoa eesnsgdyis sa eth aucse fo dowsn mdnreoys

ealFt iyopbs Pyrtet vanvisei neiu,hetcq enwh ew ahve a sserle vnviaies nda omer ccipfies sett ebala.vail

drdoom  [system mailer] your account has been upgraded: FORMAT NINJA +
... jp1003 made a comment on nbme19/block0/q#0 (Investigator studying spermatogenesis...tight...)
submitted by jp1003(11)
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FA 6gp14

thgit sjitncuon etnewbe tjendaac lstioer celsl fomr debtsotl-sio rar-r&g-;tibe iotsael amegste fmro outemnumia sckatat

mannan  FA2020 pg 628 +1
... cassdawg made a comment on nbme19/block1/q#31 (32 yo man on primaquine)
submitted by cassdawg(1457)
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shiT si D6GP iec.edyfnic F220(A0 p242)

GD6P ienyccefdi acuses a ymlhcotei eamnia hnew viidsiaudln ear xesdope to rlianaatasilm eud ot hte adrceseni tvaiixdeo hisT si ude to hte efndeciciy in lrhiginpnese HANDP wichh is seeyncras to ihipesnlr edrcdue ntitulhegao hhwci dias ni ehignncqu erfe .scidlaar

cbay0509  thank you +1
... cassdawg made a comment on nbme19/block2/q#9 (Lab findings expected after administration of insulin and saline)
submitted by cassdawg(1457)
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ehT tisfr hntgi to loko at is soim,spuat chihw loudw ecesaedr ueescab ninilsu fitaiceatls rriunleltclaa itfhs of umipsasot hi(hcw is ywh it si ueds as a atnremtte fro ehikmyla!ear).p isTh alvsee nlyo owt taptlneoi rwessa!n

The xnte hnitg I ltyimmeaied dineoct aws taht uro asep'itnt albs einadcitd nonia apg ioatmcble asdiiosc ly(leik deu to ibcdiaet oi)esokis.atdc imtrsniAadonti of nlsiniu odwul orevpmi stih oncinot,di and eon of het ianm intgsh tath odluw cruoc is irtocceonr fo c,aosdiis so pH wodul .esarcnei Teh hoter rtpas fo the nswrea alos amek n,esse as aerbnbiacto bnegsi to ertnru to mranlo htiw eth aeesricn in Hp dna lsse isetcynse orf ues ni nubfif,erg UNB eassderce as teh diykne geadma ocrrucnig nca be tlyosm rer,edevs dan obldo 2CO eensrasic ebascue ehert is on nlgero teh ened ofr oeriaytsrrp ocnenpimtaos fo teh iotebclma

... cassdawg made a comment on nbme19/block2/q#45 (Pathway of the transepithelial transport of water)
submitted by cassdawg(1457)
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aWter dsoe ton ruqreie nraottprs eprinots or eyrneg rof soita,nrpob and lantsepehrtaiil notprarts masne ti tusm go ugohthr hte etpaleiihl scll.e C is eth tesb ca.htm

geekymle  i dont know why i missed it. it was a direct answer! +1
... cassdawg made a comment on nbme19/block3/q#9 (Cells most responsible for graft rejection?)
submitted by cassdawg(1457)
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:TDLR; lcTe-ls rea iyirlprma perbseinsol for hotb euact (wseke to n)tohsm nad ochicnr to(shnm ot syer)a jr;coeinet htis odluw eb taecu necjtoire 2[A002F p1]19

ctpaurHeey enoiejtrc us)tnemi(: from e-pmfdreor iaentoidsb in hte ripteniec wichh rgirgte an imnume esnperso ni het crepienti iva tecpmolenm antiaocivt epT(y II riiti)yvtenspesyh

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