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NBME 20 Answers



Question#3 (reveal difficulty score)
A 48-year-old man comes to the physician for ...
Upregulation of the LDL receptorsπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 50-year-old man is brought to the emergency ...
Formic acidπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 24-year-old African American man comes to ...
Pseudofolliculitis barbaeπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 5-year-old girl with AIDS develops a ...
Thymidine kinaseπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 50-year-old man is brought to the physician ...
Pick diseaseπŸ”,πŸ“Ί



Question#12 (reveal difficulty score)
A 72-year-old woman with dysphagia is ...
Right kidneyπŸ”,πŸ“Ί


Question#14 (reveal difficulty score)
A 28-year-old man who is a migrant worker ...
Psoas majorπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 30-year-old man who completed a successful ...
Adjustment disorder with anxietyπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 30-year-old woman with multiple sclerosis ...
PonsπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
Drug effectπŸ”,πŸ“Ί





Question#22 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
VagusπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 34-year-old man who is HIV positive is ...
CD4+ T lymphocytesπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 50-year-old man comes to the physician ...
OmeprazoleπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 25-year-old primigravid woman at 42Β weeks’ ...
Phosphoinositide hydrolysisπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 53-year-old woman comes to the physician ...
Schistosoma mansoni πŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A previously healthy 16-year-old girl comes ...
Trichomonas vaginalisπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
During an experiment, an investigator ...
LysineπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 33-year-old woman comes to the emergency ...
LunateπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 66-year-old man has had fatigue, shortness ...
Focal pulmonary fibrosisπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 17-year-old girl comes to the emergency ...
MitochondrialπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A strain of Escherichia coli produces a ...
MissenseπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 56-year-old man is admitted to the hospital ...
RhabdomyolysisπŸ”,πŸ“Ί





Question#41 (reveal difficulty score)
A 45-year-old man has fever, chills, dysuria, ...
Escherichia coliπŸ”,πŸ“Ί


Question#43 (reveal difficulty score)
A randomized clinical trial is conducted to ...
Neither procedure is superiorπŸ”,πŸ“Ί



Question#46 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
CholecalciferolπŸ”,πŸ“Ί


Question#48 (reveal difficulty score)
An otherwise healthy 4-month-old girl is ...
Spontaneous involutionπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A 26-year-old man undergoes an abdominal ...
SplenicπŸ”,πŸ“Ί


Question#2 (reveal difficulty score)
Following a wedding reception that was ...
NorovirusπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
An investigator compares the DNA sequences of ...
5β€² CCGGπŸ”,πŸ“Ί



Question#6 (reveal difficulty score)
An 18-year-old boy has just been diagnosed ...
50%πŸ”,πŸ“Ί


Question#8 (reveal difficulty score)
Three elderly residents of an assisted living ...
Legionella pneumophilaπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
An otherwise healthy 16-year-old girl comes ...
Cold, dry airπŸ”,πŸ“Ί



Question#12 (reveal difficulty score)
An 80-year-old man with type 2 diabetes ...
Pelvic splanchnicπŸ”,πŸ“Ί



Question#15 (reveal difficulty score)
A 55-year-old man comes to the physician ...
DextromethorphanπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
A 65-year-old man is brought to the emergency ...
ST-segment elevationπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 66-year-old man is brought to the emergency ...
Cigarette smokingπŸ”,πŸ“Ί

Question#20 (reveal difficulty score)
A 19-year-old man who is a college student is ...
Subcutaneous crepitusπŸ”,πŸ“Ί


Question#22 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Ubiquitin ligaseπŸ”,πŸ“Ί


Question#24 (reveal difficulty score)
A patient with a 1-week history of diarrhea ...
Decreased arterial Pco2πŸ”,πŸ“Ί




Question#28 (reveal difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreasπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 25-year-old woman has a flu-like illness ...
PicornavirusπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 78-year-old man is brought to the emergency ...
CortisolπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 12-year-old girl is brought to the ...
OsteoblastsπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A study is conducted to assess the effect of ...
Lead-timeπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 28-year-old man has excessive thirst and ...
HypothalamusπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 36-year-old woman comes to the office ...
SplenomegalyπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 31-year-old man has a large, yellow, soft ...
LiposarcomaπŸ”,πŸ“Ί



Question#39 (reveal difficulty score)
A 29-year-old man comes to the physician ...
Absence of peptidoglycanπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 70-year-old man has a 3-month history of ...
Squamous cell carcinomaπŸ”,πŸ“Ί


Question#42 (reveal difficulty score)
A previously healthy 32-year-old woman is ...
PreloadπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
OvariesπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A new antiplatelet agent is developed for the ...
8%πŸ”,πŸ“Ί


Question#47 (reveal difficulty score)
A 35-year-old man comes to the physician to ...
1:4πŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A sedentary 50-year-old man with hypertension ...
Antidepressant therapyπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
PheochromocytomaπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
The frequency of an autosomal recessive ...
1/25πŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 23-year-old woman is brought to the ...
Xanthine oxidaseπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 45-year-old woman has a thyroidectomy ...
CalcitoninπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
Reactive T lymphocytesπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 35-year-old man comes to the physician ...
MethotrexateπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 10-year-old boy has a palpable mass in the ...
Endoderm of foramen caecumπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 12-year-old girl is brought to the ...
PolyubiquitinationπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 62-year-old man comes to the physician ...
ProstateπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 59-year-old man develops fatigue and ...
HemolysisπŸ”,πŸ“Ί


Question#12 (reveal difficulty score)
A 46-year-old man has dyspnea, orthopnea, and ...
Mitral regurgitationπŸ”,πŸ“Ί

Question#13 (reveal difficulty score)
A 45-year-old woman develops proteinuria and ...
Tubulointerstitial nephritisπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
During a clinical study, an investigator ...
Increase the sample sizeπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 23-year-old woman, who was diagnosed with ...
Substance PπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
50%πŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 67-year-old woman comes to the physician ...
Low sensitivityπŸ”,πŸ“Ί






Question#26 (reveal difficulty score)
A 3-month-old boy is brought to the physician ...
Mannose 6-phosphateπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
A 55-year-old man with type 2 diabetes ...
PravastatinπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 23-year-old woman who is 6 months pregnant ...
Antiplatelet antibodiesπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
An 83-year-old man is brought to the ...
Early septic shockπŸ”,πŸ“Ί


Question#31 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Ξ²-TubulinπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 54-year-old woman with terminal metastatic ...
NonmaleficenceπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
A 22-year-old woman comes to the emergency ...
Release of bacterial productsπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infectionπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 4-year-old boy has had fever, abdominal ...
Shigella sonneiπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 62-year-old man with alcohol-induced liver ...
SpironolactoneπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 23-year-old man with a 3-year history of ...
Psychogenic polydipsiaπŸ”,πŸ“Ί



Question#41 (reveal difficulty score)
A 2-year-old child undergoes resection of the ...
Increase in glomerular sizeπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 13-year-old girl has an episode of severe ...
Epstein-Barr virus genomeπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 71-year-old man comes to the physician ...
CilostazolπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A 39-year-old man reports bright red spots on ...
ConstipationπŸ”,πŸ“Ί


Question#47 (reveal difficulty score)
A 60-year-old woman has prolonged apnea ...
SuccinylcholineπŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A 48-year-old woman comes to the physician ...
HypothyroidismπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 92-year-old woman who was recently admitted ...
Atrophy of dermal collagenπŸ”,πŸ“Ί



Question#2 (reveal difficulty score)
A study is conducted to identify healthy ...
LiverπŸ”,πŸ“Ί

Question#3 (reveal difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 20-year-old man comes to the physician ...
OlfactoryπŸ”,πŸ“Ί


Question#6 (reveal difficulty score)
A 51-year-old man develops diaphoresis, ...
Alcohol withdrawalπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 33-year-old woman with HIV infection is ...
Non-Hodgkin lymphomaπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 58-year-old man is brought to the emergency ...
HypertensionπŸ”,πŸ“Ί


Question#10 (reveal difficulty score)
A 65-year-old woman who has a 25-year history ...
Hydroxylation of prolineπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A 37-year-old man who is HIV positive comes ...
NortriptylineπŸ”,πŸ“Ί


Question#13 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Bronchogenic carcinomaπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
A 45-year-old man is undergoing a surgical ...
Decreasing respiratory rateπŸ”,πŸ“Ί


Question#17 (reveal difficulty score)
A previously healthy 55-year-old man has ...
Renal artery stenosisπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 35-year-old man comes to the physician ...
GastrinπŸ”,πŸ“Ί


Question#20 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
HypophosphatemiaπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeetsπŸ”,πŸ“Ί





Question#26 (reveal difficulty score)
A 33-year-old man comes to the physician ...
Rectus femorisπŸ”,πŸ“Ί

Question#27 (reveal difficulty score)
An investigator is studying patients with ...
Case seriesπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 78-year-old man dies of chronic congestive ...
Failure of the Na+–K+ pumpπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 15-year-old girl is brought to the ...
DoxycyclineπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 32-year-old woman is brought to the ...
Arterial lacerationπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/LπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 65-year-old woman with cardiovascular ...
Increased bile saltπŸ”,πŸ“Ί


Question#35 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
ContemplationπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 25-year-old woman is brought to the ...
Factitious disorderπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin EπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Tumor necrosis factorπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 30-year-old woman develops serum sickness ...
C3aπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 56-year-old man with a 20-year history of ...
NaloxoneπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 65-year-old woman dies 6 months after the ...
MeningealπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A physician is assigned to a search and ...
Negative nitrogen balanceπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 45-year-old man comes to the office for ...
Starchy foodsπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Terminal components of complementπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathyπŸ”,πŸ“Ί


Question#48 (reveal difficulty score)
A 24-year-old man comes to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 23-year-old woman sustains significant ...
Direct antiglobulin testπŸ”,πŸ“Ί


Recent comments ...

... amorah made a comment on nbme20/block3/q#35 (A 51-year-old man has the acute onset of fever and...)
 +38 
submitted by amorah(103)
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rveFe ;&-gt elru uto etfl ertuvrcnlai rlfeuai - MSTXPM orhipsxylap -t;g& lure uto cPmostsueyni iei jidovyKercn atspntanlr tub on CBWCB/R in riuen &-g;t leur uto pnrnlatsta rtonjceei

igveanL CMV dna platycai acermmyotcbui sa the iigarnenm tow o.otinsp CMV si mroe lielky in a plaatrtnns pnt.eati

... hayayah made a comment on nbme20/block1/q#40 (Monoclonality of neoplastic cells in endometrial...)
 +34 
submitted by hayayah(1130)
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saNeploia si nwe siutse whotgr atth is eadruutl,gne rsrebileierv, dna collann.oom

ntoCyllia nac eb meedtneidr yb 6cate-hloheps-ogups noyegraeseddh 6P)DG( mnezye sosro.ifm 6PGD si -dekXiln.

*rFo omre nifatriomno ehckc uto hC. 3 epsoaialN ni aomhatP

hello  This is great, thank you. +5
breis  Pathoma ch. 3 pg 23 "Basic Principles" +9
charcot_bouchard  Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec. +14
fatboyslim  Clonality can also be determined by androgen receptor isoforms, which is also present on the X chromosome (Pathoma Ch. 3 Neoplasia) +2
lovebug  @fatboyslim thanks for reminding! +1
makingstrides  Just to make sure I got this right, because this is neoplastic and its monoclonal, you want to look at the isozymes to determine its clonality? +2
... hayayah made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +33 
submitted by hayayah(1130)
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VL peospdt ok,wrgin repeussr dcabke pu noit mupl utcic.ir lmPu rticuic ygohulr si amde of 3 "tras"p - eht ,racapllisei atteniirlsti ap,esc nda hte vailloe.

nI cignicorade ockh,s hte xreat oobdl asisrecne aylpliacr isrodtatych peresrsu, ivrdign udfli otni eht trniaseliitt .paesc erapdoCm ot het voiella, het ratntilitesi apecs won sha orme idulf (tuhs eorm intietrtlsai hoittydcsar spreures dna elss intococ rssrpuee eud ot itaro fo ifudl ot ,r)teinop nda as a usetlr of shit cannbinlgua fo esfor,c dlfiu evosm iton eth aolilev ;&--tg ympnruaol dmeea.

... masonkingcobra made a comment on nbme20/block4/q#21 (A 47-year-old woman comes to the physician because...)
 +32 
submitted by masonkingcobra(373)
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gaeP 2 ash a egatr upciret

.n760wp(ipawt8-o04)t6c/60ls:9hgto9e.jw13cdn/l/S2/ir1i1ar-fe/

kamilia20  chlamydophila psittaci?? +1
... hayayah made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +29 
submitted by hayayah(1130)
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A ibg igthn ereh oot si gciniotn tath eth APL si e.dscderae ebstaoOstl ytavciti si edemasur by enob P.AL I itnhk atht was eth mina uoscf eehr adn otn taht yuo clesrinasey eedn ot nkwo eht 1FACB nege t.muaiotn

sympathetikey  Exactly. That's the only way I got to the answer. +4
pakimd  isnt increased alk phos consistent with increased osteoblastic activity? +
champagnesupernova3  A defect with chondrocytes would cause an short limbs like in achondroplasia so those are ruled out +1
pg32  Exactly. Can also be helpful if you remember that the clavicles are formed by intramembranous ossification rather than endochondral; that allows you to rule out the chondroblast/cyte answer choices. +7
... hello made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +29 
submitted by hello(373)
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'eitastnP ypmmssto bgnea 30 mni trefa ogimnw awln i.e.( eafrt gndio ahslcyip )ia.tcivyt He hsa veesre chset pina dna is o,lco cyam,ml pcraeidt.ioh He hsa erecanisd rpoyumanl eyrtra rserspeu adn aederiscn fetl atilra rep.resus ankeT oertt,lgahe iths si riacndcgioe .kscho

rengcoCiadi koshc is a aerht mppu mlbproe -- eth LV snit' .ngrkwoi

henW eth LV, i'snt gron,wki it csaesu a kbac up in het coeiirndt isepptoo ot owh odbol nmloraly so.lwf ee,oerrhfT olbod wlli bakc pu in hte u.gsnl

hisT uasesc crsadiene pcilaylar atshyoicrtd seprreus ;&--tg tihs isdvre omer ifdlu onit the etmniturstii ;tg&-- stih ecssau ieeasdncr ianitlttrsie otchysiatrd resurspe g-&-t; rhtee is onw oemr lfiud anht rmnalo ni hte uttsitmreiin tg--&; htsi tacsffe eht onipter iarto hniitw eth simrtenitut -t;-&g itsh assceu dscrdaeee netitlirtsia niotcoc eepsrusr.

targetusmle  awesomely explained :) +
lilyo  This was amazingly explained Thank you @Hello! +
pseudopseudopth  For edema to occur shouldn't interstitial oncotic pressure be increased?(when proteins are there, they can pull the fluid) +1
pseudopseudopth  And when increased interstitial hydrostatic pressure is pressure, shouldn't it oppose the edema by pushing against it? +1
pseudopseudopth  *when interstitial hydrostatic pressure is increased +2
pmofmalasia  You don't necessarily need to have increased oncotic pressure, you're correct in that decreased oncotic pressure would act against causing edema but as long as the net change in forces still acts "for" edema it will still occur. For example in this scenario, if the capillary hydrostatic pressure is greater than the change in interstitial hydrostatic and oncotic pressures. Also, the change in interstital hydrostatic and oncotic pressures is a direct result of the edema in this scenario, so it's more like they're responsible for setting the new equilibrium - if they didn't counteract it, you'd never come to a point where the leakage of fluid stops. +
... imgdoc made a comment on nbme20/block4/q#20 (A 5-year-old boy is brought to the physician for a...)
 +28 
submitted by imgdoc(148)
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Yuo acn rossc tou the top ehtre newras ceihs,oc C,A,.B You notw eb eisrnogabbr inahntyg in teh PCT in isa'nnocf snerdom.y knioLgo at kpi,ahmeloay yptahmean,oir and ipopohypasmhaeht nw.o eyoakHlmpai nct'a be ccerort esacebu nvee uhtgoh smuaisotp si slot ti lwil be eoebrdabsr ta teh rtale kicht icsdngaen ploo nad if thta onsdet emka ,eesns het bdoy will sudjta orf wol rmeus mspiousat ubt vitaigatnc het /++HK upmp on lsec.l It nis't atenohmraypi ucsbeea at teh ontelgiclc dctu ppiliacnr lle,cs prtaoornbise iwll .rcuco isTh veaesl moaiatpheshhpypo as hte rrcotec and noyl ewsrna i.hcoce

imgdoc  by* +2
larascon  Excellent explanation, thank you ! +2
waterloo  It's worth mentioning, that 25% of Na is reabs in the thicc ascending limb. 67% of filtered Na is reabsorbed in the PCT, whereas 85% of phosphate reabsorbed in the PCT. So pt more likely to show Hypophos. +3
coconut  UWorld QID:7626 says lab results in people with Fanconi syndrome will show hypokalemia +
j44n  coconut i thought that too but then i remebred fanconi is associated with hypophosphatemic rickets/ VIT D resistant rickets and this little dude is going to be growing because he's 5 and thats gonna increase the demand for phosphate in his body +
... celeste made a comment on nbme20/block2/q#6 (An 18-year-old boy has just been diagnosed with...)
 +27 
submitted by celeste(86)
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hielW hte itmleefi rski ni eth gneelra ooulpntpia si stuj oebwl %,1 ti si 5%6. ni efsetiedrgr- eaitrsevl of tnptisae dna ti rsesi ot reom thna 0%4 ni otgoomcnizy tinsw of cfftdeae poeel.p ygiazAnnl lsccisa deiusst of eth gentiesc of zniipsecorahh doen as leray as in 3s19,0 rechFis ouseldccn hatt a rcceondaonc eart ofr hyssciosp of tauob 5%0 ni moiotcygonz nitws smees to be a cteaiirls iteasem,t hcwih is ngliiynitascf ihhreg anht ttah ni tocdiiyzg siwnt of aubot 10%–19 (Cibcmisn23c/h#apP/cenn6/ilt.gorv/36.54rmf9.Mel)

imnotarobotbut  How is one supposed to know this before having read this article? +35
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld +2
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-| +8
doodimoodi  Lol just why seriously +3
champagnesupernova3  This was mentioned in the Kaplan behavioral videos +
usmlecrasher  and there's so much unnecessarily BS instead of real questions +2
j44n  I'm just glad we're seeing this garbage now instead of having an aneurysm in the prometric center +6
feanor  This Question is a perfect example of where you just jump off your seat to demand a refund or you decide to go Antisocial Disorder on your computer screen. +
olddoc  I don't think it has to do with any extra info. The dx is FAP (mutation in APC gene) which is inherited in an AUTOSOMAL DOMINANT fashion ("A" is the mutant allele and "a" is the normal one. The girl in the question stem MUST be heterozygote "Aa", getting the mutant "A" from her sick father and "a" from her healthy mother. Assuming she marries a healthy husband (aa) (this is a normal assumption in genetics questions), their kid will be Aa (the phenotype that will 100% result in CRC) by a probability of 50%. Recall that FAP will 100% progress to CRC is not prophylactically removed. +2
olddoc  FA 2019 Page 381 +
... medbitch94 made a comment on nbme20/block3/q#26 (A 3-month-old boy is brought to the physician...)
 +26 
submitted by medbitch94(42)
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A201F9 apge 74: cIlle- seidesa iiso(lcnnu lcel elsimadsidoicopesi/su eypt i)β€”eIrihdentI maolssoyl togares ;oiedrrsd fedetc in eyclnclhisef1shoo-lpauntmt-oasyrrspgeNa-a ;rar&r efuarli fo hte igGlo ot hoatelpphrosy nenmoas srsuedie igo(fnmr hmt-a)sepon-h6osepna no orgeoylnscpit r;r&ar itpsreno rea decetrse utxllreelylacar terhar tnha evdielred ot slssey.oom tulseRs in ceraos lfcaia rfes,uaet ilginavg yrpisahepl,a culoedd co,rensa rircdetets itnjo mnem,ostve lcaw ndha retifdiosm,e ois,hokscislpoy dan ighh lmsapa velels of sylomalso ym.nzese nOtfe aftla ni chioldoh.d

athenathefirst  FA page 47 +
... xxabi made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +26 
submitted by xxabi(275)
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lAso orf hsteo of uyo who aer ltlotay llesecus ekil ,me ruriayn tctra bitcuorosnt = rvibotesutc thyura.po

skonys  I see 74.5 Difficulty score and think "word, I don't need to get this one correct" +3
... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +25 
submitted by strugglebus(175)
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hrewNoe ehva I nbee leba to ndfi yhw eht ehll tshi is a itgh.n

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away. +7
breis  same^^^ +
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia). +
chandlerbas  you had me at its not in sketchy ;) +3
j44n  i thought HTN induced empty sella would cause this because they got type II diabeetus. So if you need a pro zebra hunter holler at me. +
... hayayah made a comment on nbme20/block1/q#34 (A strain of Escherichia coli produces a...)
 +25 
submitted by hayayah(1130)
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nseMsise utisanotm invloev a centeodlui tsotsuitbuin rlntsiueg ni dchgnae oamni ic.asd mtSeseoim het tfeesfc of sinsemse utmtansoi mya eb lnyo perpatan dnuer renctai notveelaninrm niio;stdcon cshu essmiens asnioutmt ear lcelda odctanlinoi u.aitmsnot Mnya emisenss tsomuinta tslure in sepnirto atth rae illts n,ulniaoftc at taesl ot semo .eeedgr

,osAl all eth ertho resnswa wudlo rybplaob elvae yuo iwth eterih a atryegl ltardee ro tonn-aiocunlnf tipeorn.

thefoggymist  I chose nonsense because I thought it'll make the enzyme shorter (since less bonds = more heat liable = can't work at 42 degrees) but yea, probably won't work even at 30 if it's an early nonsense. +11
joanmadd  A good clinically related example is HbC disease on electrophoresis. HbC disease is due to a missense mutation (glutamic acid (-) for valine (neutral)). The mutated hemoglobin is still fairly functional but when placed on gel electrophoresis the HbC migrates the least far from the negative electrode due to less negative propulsion (lack of wild type glutamic acid). +3
fatboyslim  @Joanmadd Just to clarify, glutamic acid substitution for valine occurs in sickle cell disease not HbC. HbC is glutamic acid substitution for lysine :) +8
rockodude  lyCCCCine for HbC +3
... yotsubato made a comment on nbme20/block1/q#42 (A 60-year-old man has two-pillow orthopnea, severe...)
 +23 
submitted by yotsubato(1111)
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dBifi cdrotia epssul rea nees ni rcotiA stoeisns or orturitneigag

tadrioC Bruti is redha with csthrelarsseoio fo mmcoon tdaciro eytrra

owlS igsrni aeedredcs mleuov adioctr suelp is cciaarsrteciht fo rocati io.stnsse

Cnnnao wesva era seen in ctloemep VA cl,okb as thirg vetlncrei nad traai atotcnrc yinel.dpentned

chextra  I mis-remembered normal JVP as 8-12. Therefore, I picked "Slow-rising, decreased-volume carotid pulse". Is there a reason why this is NOT a result of HF, or is it simply not the best (which I agree is JVD)? +1
len49  For those wondering normal JVP is 6-8 mmHg +4
fatboyslim  @chextra I think the reason why it's NOT slow-rising decreased-volume carotid pulse (sign of aortic stenosis) is because the patient had a h/o prolonged substernal chest pain 5 days ago. I think he had an MI and is now presenting w/ heart failure. +1
... justgettinby made a comment on nbme20/block1/q#24 (A 50-year-old man comes to the physician because of...)
 +22 
submitted by justgettinby(22)
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lzIotceaonar rquirsee eht dccaii ioeemnnrtnv of teh matcohs ot be sbaboder. oeOmlzraep tisihbin eht /+H+K mppu fo eth hmscot,a hetyrbe dericgnaes hte taciiyd of het hmas.tco So nhwe teh tantipe astek mlreaOzpoe and conazerIlato t,ehetgor cnealtzIooar wot'n eb baordbes otin eht bydo. tsa'hT hyw ti ash on ecffet.

t'Is odmrdceemne to aket nmsiaidetco ta elast 2 sruho rpori ot itakgn an dtaci.na

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +4
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2
chandlerbas  just itraconazole and posaconazole +5
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +12
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +1
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +
... andrewk1 made a comment on nbme20/block2/q#9 (An otherwise healthy 16-year-old girl comes to the...)
 +22 
submitted by andrewk1(22)
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sThi irlg ash cexreeis ddiucne tham.sa It si tno wlle utoonedrds why ti hnsppae but teh grtgreis aer dgzienr.eco yaormlNl hnwe ignhtbrae ruoscc ari si nekat ni yb hte eosn and eth salan spasgsae dna niaestbtur tac to ovrmee tdsu adn i/wmfriymahdu eht ra.i Lyiolgcla hits seamk eth air erdsen TP.vnR= oS ewhn eierxign,sc benaitrgh rhthguo the esno is erecdeasd nda ecparedl yb rome rusgvooi tumho erta.gihbn hiTs emans teh air si ton edfdhiumii nad waedrm up. heT air is slse deens adn the ahasmt .usnsee Teh untisqoe ktoo hist mase lirpiecnp ptecex erervsde it yb ikgasn twah lnxrtaee ncnodtoii odlcu aled ot het sahatm dna htat wuodl be lcod dry ai.r

eacv  oooh thank u !!! I choose wrong, cold air hehhe +6
eacv  moisture air instead! +
... monoloco made a comment on nbme20/block4/q#30 (A 32-year-old woman is brought to the emergency...)
 +22 
submitted by monoloco(144)
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yiAmten yuo ehva a oserpn how psubm irhte hdea, sgte bcak u,p dna hetn sah vesree sseuis or sdei ikle 6 rhuso laret -- oyu vaeh olfysreu na druapeil maeamtho frmo taairnecol to teh edmidl NEMGNIAEL .rearty jlnoGa( lrayel zesesmpiha atht uoy d'nto esrwc pu dna ltcsee mddlei )lerbe.rac oYu owkn ti ahs to eb an rletiara ianreaoltc insce het arud is lgytthi hdedrea to teh u'llssk nnire afc.urse Gljaon edrreefr to ihs ieneeeprcx wtih it as gdeeinn reilps ot omvere het adru omfr het kll;us acpr,hgi utb it ivsdre hte tnopi hmo.e tgiTnen eens on TC is beueacs teh riluaped amaoemht sgte sctuk enwteeb het erutsu ls.nie ehnW ti gmnaaes to kerba psta eno fo eht uteurs eils,n it si ym nnguaddrenist htta etnh si wenh you teg eevser ulsaeqe,e elki atehd ro watehrve.

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11
... banieb made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +21 
submitted by banieb(22)
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nDurgi teh tasl fhla of aeprngycn alditnoi fo teh eprpu rnuiyra rttca can ucrco ude to rseinsopmco fo eth tuerers yb hte owignrg t/rueueustfs nad het liena masti.eirln The pnesioorsmc fo heets si otn onwgllia uldif gaepass onti teh dlrdbae uaiscng runei ublpiud ni het ,yndkie thsi dasle ot doiatiln of teh ndyike thta ndes up sngaicu spymiottamc ssrnrihhdeoo.py hsit cna dne up ni ctifonein dan tommysps chus as teh osen ternspe ni tihs nittape kiel kbac niap dna VAC dsstene.enr eth ngrcyi is nymial eud ot hte nipa eudacs by the rtutcbos.oni na d stuj as imgostehn rx:eat lubdeo itpigal hertaestc is a asef adn slmipe way of argnttie tymscpatmio phnrhdrooiyess of gp.rcynena

banieb  Ureteral obstruction by the pregnant uterus https://www.ncbi.nlm.nih.gov/pubmed/1579937 +1
... onyx made a comment on nbme20/block1/q#12 (72 yo woman with dysphagia)
 +20 
submitted by onyx(44)
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cTcairho udct nerl.sitoa

consuela_salon  This was the picture that I liked the most for this question. If you imagine that the injury is at the level of the left subclavian vein (LSV) and thoracic duct (TD) crossing each other, maybe it will help you realize that the left breast & left upper extremity bypass the injury. The right lung is drained by the right lymphatic duct, not the TD (see one of the links bellow). And the heart is where eventually all the drainage is going to end up to be pumped again (TD -> LSV -> SVC -> heart). +19
mbourne  To keep it simple, the Thoracic Duct drains lymph from the entire body EXCEPT for 3 structures: Right Upper Extremity Right Thoracic Cavity Right Side of Head and Neck These 3 areas are drained by the Right Lymphatic Duct which enters the Right Internal Jugular Vein +12
... hello made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +20 
submitted by hello(373)
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Gljnao dah a utceerl atth mnndoetie htat "fI a nptteia ash laahorgcre,ta weveri revye udgr yetre'h iktagn iesnc myna usdgr ecsua olrcraat"ageh.

heT olyn hgtin of obslespi ealveencr ni ihst tmesQ- si ahtt esh steka a iaot,necidm eteofrrhe eht eanrws fo gdur" ef"ctfe is het mtos kielly rnesoa orf hre oarhaeraltc.g

hungrybox  I still think this question is pretty BS. But having studied some more, I think it's less BS than I originally thought. Pathoma gives the three major causes of galactorrhea as nipple stimulation, prolactinoma of anterior pituitary, and drugs (see 16.1 - Breast Pathology). Only drug effect is an answer choice for this question. +7
hungrybox  To put another way - before you try to go through every answer choice, asking yourself "would this cause galactorrhea?" Instead, ask yourself, "What are the causes of galactorrhea?" According to Dr. Sattar, they are "nipple stimulation, prolactinoma of anterior pituitary, and drugs." +3
hungrybox  The question doesn't say anything that would point you toward nipple stimulation, like "it only seems to appear when she puts on a shirt/plays sports/runs/etc." It also makes no mention of bitemporal blindness (which would point you to an anterior pituitary tumor), so you can rule out prolactinoma. The only option left is drug effect. +2
drdoom  hungrybox’s full comment (below) here: https://nbmeanswers.com/exam/nbme20/410#3907 +1
... strugglebus made a comment on nbme20/block2/q#20 (A 19-year-old man who is a college student is...)
 +20 
submitted by strugglebus(175)
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=hochnyooprnB nx Eynrmtpouareaipio st=rdiro iroabhoahlnctecr nsrctuioobt eingao/r(smfs nopa iIobtdsrr)yy rstdoir = egnyrlala icn urouscutosbcsiSnot h=saslp etts for rpolyic sntosies

Wenh ehetr is a cfaertdur ibr ti will uscea a turama otnhompexar ihhwc nca ceaus ria ot secpae nda ocmbee eptrpda redun hte kins laeidgn to ucsti.rpe

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1
... monoloco made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +20 
submitted by monoloco(144)
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hsTi si a aoniioltncd ecdlal ldicpcasrnoaysdilaoei. The kdi on etgSarnr nghsiT ihtw the ilps sah the rse.ioddr oN acroll b,nseo oot myna h,teet noalftr bnsiogs g;=&t odassdlaypioairlniec.c BF1CA is a egen yhlgih icdilmptea ni oelsobsatt .fctninou

... hayayah made a comment on nbme20/block1/q#7 (A 5-year-old girl with AIDS develops a progressive...)
 +19 
submitted by hayayah(1130)
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cirvol,Acy vcriaocli,fm yoivlalvrcca ear gnanosuie aloa.sng eTyh regdoun nneorvocis to cyavliorc hhptomspeanoo via uvrsi ondecde eit-mdh.siineynka iay,Utmtlel ethy tiibhin livra DNA mapeesoyrl yb hanic irett.niaonm

tdutMea vailr ihedtniym ainesk nac eucas tiscernsa.e

len49  Foscarnet and Cidofovir on the other hand do not require phosphorylation by viral kinase, therefore should be used in strains that are shown to be resistant. +4
... meningitis made a comment on nbme20/block2/q#50 (A 27-year-old woman comes to the physician because...)
 +19 
submitted by meningitis(597)
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eWhn nsadntig up, het bdyo lonmrlya ttsaaiecv scyetahmpti yessmt to odvai htcotastrio honpsiteon.y

tuB nscei heter is own na viddetia eeftcf of het pocorthmhacymooe e,gcarindesr ti llwi dael to a hretioepsnny

.(i:e Deboul sncirosatvncoito = hoPe agrieescdnr + temScpthiay tsymes)

sympathetikey  Brilliant. +6
medschul  Would pheo have a normal resting BP though? +13
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +9
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +2
nala_ula  No problem! Thank you for all your contributions throughout this page! +2
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +
hello_planet  FA 2019 pg. 336 +2
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +
... hayayah made a comment on nbme20/block3/q#34 (A 22-year-old woman comes to the emergency...)
 +19 
submitted by hayayah(1130)
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animiAstnotdri fo lniiecilPn fro ihilSspy may laed to hte exs-JHhceraiemhirr taenroic hruso aetrf ee.rttatmn cucrsO deu to lysis fo ociesphrest so( ti cna urcco ithw rlBraoie adn osLeitorsspip sa .lelw) hTe rcieaotn is rdeczaatierch yb eefvr adn chills.

Teh calsslaci ixlenonpaat of the eeirmrHexh anoeirtc si that mnteeartt lrstuse ni eth dusdne dteha adn uosdictnret fo rgeal busmner fo e,mpersotne htwi teh rieilnbtoa of reotnpi oturdpsc and .onxist

almondbreeze  FA pg.148 +7
... medbitch94 made a comment on nbme20/block3/q#49 (A 92-year-old woman who was recently admitted to a...)
 +19 
submitted by medbitch94(42)
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nticciA paruurp ulsster rmof rntvaaoseatxi of lobod nito eht md.ersi hsiT npooenehmn is deu ot eht kins trahoyp adn eht filtirayg fo hte lbodo lessevs ni rydelel iianvusldid, hwhic si aebetecdrxa yb ohcrinc snu p.ousxere cAntici rpaupru oeissnl aer atelodc no nspx-uesedo ,resaa ilek hte asr,m fa,ec dna en.kc

niSk ahyprto ni ermitrdspsoaoo is eud ot an tairltnaoe fo llceg,nao iiarsml ot htat cwhhi si snee ni rp.siostosoeo iThs codurnnpoe insk aoythpr uedsac yb eth hpggnao-tio seamk the redalm avcurasl kotwner rvey etnsesivi ot hte ihgesltst tmraua or ngsrheia ocerf.

md_caffeiner  Google actinic purpura, look through 5-10 images, and you get the idea. +11
athenathefirst  How can you rule out answer choice (C) autoimmune disease? +
drbravojose  maybe plt is normal +
... sympathetikey made a comment on nbme20/block1/q#35 (A 70-year-old man dies of coronary artery disease....)
 +18 
submitted by sympathetikey(1475)
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sA aetstd ew,olb teh tefL rcus erirceb asw agddema e(es hatw it uhlsdo mlarylon look klie o)webl. Tish inoantcs het priiltnccooas ttcra. cSein het ispococrlatni catrt eaedcusst at the ldulmae, eowbl eht arnmiidb neiocts ewr'e gloiokn a,t ouy dwolu ees teCalranlarot hgRi(t) Sisctpa msaepsHirei

hello  What identifies that a cross-section is medulla vs midbrain vs pons? +5
kernicterusthefrog  @hello I like to pay attention to the Cerebral Aqueduct (diamond/spade shape seen mostly in Midbrain, and transitioning to 4th ventricle in rostral Pons), and then the shape and size of the 4th ventricle as you move down Pons to rostral&middle Medulla, and eventual closing and absence of fluid space at caudal Medulla. +12
hello  @kernicterusthefrog Thank you. +
mbourne  NGL, I thought the right side had the pathology lmao ty +23
... weenathon made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +18 
submitted by weenathon(55)
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ctaiisDbe get rpaherlpie euynhaprot romf uesgclo daagnmig ncwhSan esl.lc rFo ahwt I eeilebv is na fmdnneuocri a,oresn MD2T ntasitep ndte ot ees hrmaeitpatycasp tcuonimoa pnrhatuyoe breeof yitcmtap.hse

Teh osytagphric erevn ascrrei hetsacmyipt anrtnoeiinv to eht soprertio earrtuh nad si iesprbnoels for a.cjialotneu

oeIrfnir aletrc enrev si a chbran fo eht epnddaul enrve ttah annrsvteei eht elarexnt naal npiercsth dna pvirdose oastsnnie owlbe hte aectpnite .nlie A rephaeplir never omerpbl with hsit evenr udwlo ceuas het nhscrtiep ot eiarmn rdaexle nad esuca ecocnitennni, tno sao.tiptocinn

vilecP nnpacicslh ersven rae ipeatasthymsrapc asoccarari(nl uwoo).lft If eh si dapcniots,te ihs rset and isgetd apyetsc(phm)itaar symest is ton iwgkrno.

laeirneP nvere is a hcbnra fo eht duapdeln ve.enr tI sah hotb omrot nad n,orsyse is liovednv in teh nralteex laan ipench,rts lerhruat ptnhcs,rei nad si oeinsprlbes fro ucosocisn ensotinsa of eth deen to tnrua.ei

arcaSl thicatmsype nihbitsi ,sstelsirpai dna cttacrson rtielnan anal ehncritps ot aiitmnan cencei.nnto

spaceboy98  Amazing man, thank you for this +
... hayayah made a comment on nbme20/block3/q#20 (A 67-year-old woman comes to the physician for a...)
 +18 
submitted by hayayah(1130)
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yeivstiSnit tstes aer dsue for eng.rniesc ccpfiyeiiSt tsset aer esdu for iontiafomnrc frtea vtespoii grncesn.ies

seiyititSnv estst are esdu orf geneis owh yamn peoelp yrutl vhae eht i.ssedea itecSipciyf tesst aer rfo sthoe woh do not have the esidase.

A hyhgil esnietvsi te,ts wnhe ,eengavit slrue OTU disasee. A ghihly icecsfpi s,tte ewnh osiietv,p rlesu IN esdes.ia ,So a ttse whit wtih wol itssenivyti natonc leur out a de.iesas A tset whit wlo yctcipiisef ca'tn erlu in aedss.ei

hTe codrot nad tintape awtn to ecnres rof noloc rnaecc nda elur it tu.o ehT trodoc doluw awtn a etts ihwt ihhg tyinisteivs to eb aelb ot od .tath eH nwkso htat gnittse her losto fro obldo lilw ont lrue tuo eth spliyoibist fo cloon C.A

sympathetikey  SeN Out (Snout) --> sensitive test; - test rules out SPec In (Specin) --> specific test; + test rules in +26
usmlecrasher  can anyone pls explain why it is not << potential false- positive results >> ??? +1
almondbreeze  correct me if I'm wrong, but 'high FP (choice C)=low specificity (choice B)'. Whereas high specificity is required to rule in dz +2
almondbreeze  picked positive predictive value myself. can anyone explain why not PPV? +
williamfreakingosler  The principle @hayayah is talking about (a negative test being relied upon to reliably rule out) is negative predictive value ("NPV"). I don't see why "uncertain NPV" isn't the correct answer, particularly because NPV is predicated on the disease having the same base rate in the person(s) being tested as in the population that was characterized for the test statistic. Given that the patient has a strong family history of colon cancer, the NPV of FOBT is uncertain. Said another way, the sensitivity of a test does not change with the population, but the NPV does. The whole reason the doctor is denying FOBT is because of bayesian thinking (a priori information related to family history), and from my point of view bayesian logic is more relevant to PPV/NPV than to sensitivity, hence my confusion over why NPV isn't the right answer. +2
ibestalkinyo  I thought negative predictive value for the same reasoning +
raga7  AFTER THE RESULT OF TEST WE CAN USED PPV OR PPN, BUT FOR TEH FIRST TIME LOOKING ANY DESEASE USE SENSITIVITY OR SPECIFICITY. +1
... whossayin made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +17 
submitted by whossayin(30)
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Teh nmecmion I ikle orf nmeierrgebm teh caitslono fo the ialacnr renvse si teh ,,424,"2 "luer

evoAb n=bimrstae NC I + =r nMaIIbiid CN I,II sn=V IoP CN V, ,VI ,VII V=aeMIudlII l CN ,IX X, ,XI XII

lovebug  @whossayin thanx so much!!! +
... onyx made a comment on nbme20/block1/q#31 (66 yo man, cavitary lesion in right lower lobe of lung)
 +17 
submitted by onyx(44)
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A rrdicligpayahalo lisbevi idrulia-f elvle eussstgg a ttprye egarl nelios eh(cne, tyvr”.aaβ€œ)ic thT'as not niogg to oecmbe nlrmao etisus aai.ng ixS hsomtn ofoglnilw tnelsurooi of tmsypoms yuo anc tpeexc ealnghi in hte ormf of a ;acsr htat is, iosfsrib tub yonl in a glensi op.st

masonkingcobra  Robbin's: The basic mechanisms of fibrosis are the same as those of scar formation during tissue repair. However, tissue repair typically occurs after a short-lived injurious stimulus and follows an orderly sequence of steps, whereas fibrosis is induced by persistent injurious stimuli such as infections, immunologic reactions, and other types of tissue injury. The fibrosis seen in chronic diseases such as pulmonary fibrosis is often responsible for organ dysfunction and even organ failure. +5
stevenorange  What Differentiates Normal Lung Repair and Fibrosis? Basement membrane ! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +3
step1234  I'm a little confused here since FA20 209 states Klebsiella causes liquefactive necrosis in the lungs. Does the pulmonary fibrosis occur after the necrosis? +1
fatboyslim  @step1234 Yes pulmonary fibrosis occurs after liquefactive necrosis as a means of repair. Think of it as liquefactive necrosis = damage done in response to Klebsiella -> 6 months later you will see focal fibrosis in that area (scar formation) where the damage happened. +4
makingstrides  If there was an intact basement membrane, you would get normal pulmonary parenchyma. +1
skonys  Not granulomatous inflamm because thats indicative of TB. Not liquefactive nec (trick answer) because Klebsiella causes that actively and q stem says 6Mo post-resolution w/ abx. Not metaplastic pulmonary epithelium because metaplasia implies cellular adaptation to a stimuli (bronchial squamous metaplasia from cigarette smoke), not destruction entirely by liq-nec. IE: for cells to undergo metaplasia they need to be insulted but not destroyed entirely. Not normal pulmonary parenchyma because basement membrane/cytoskeleton architecture is inherently destroyed by cavitary lesion. +2
... sympathetikey made a comment on nbme20/block2/q#25 (A 14-year-old girl is brought to the physician...)
 +17 
submitted by sympathetikey(1475)
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niuoMtats in -1TMTL ono(lidyhtclrMai eddceno tRAN eenciul )1

A nomocm taiuntom si 3.43AG2 anC trules ni leiltpmu lrntmihoadoic dciisifenece adn aetcsisaod sod.desrri tI is tdocaeasis t:hwi

  • doitahcrMioln omyahnpeyptleoahc
  • tccaiL iasciods
  • rS-etkioekl eidespos (ASELM)

LMAES si a rera dtclnomiahoir disreodr nnkow to tefcfa nyma tsrpa of the odyb, eplcelasiy eth revonus mtyses nda het rbin.a pmoymSts fo AELMS :ciedlun

  • rutecnRer eevrse ecdshaahe
  • cMseul keewssna yy(mtop)ah
  • enHgari loss
  • koStr-kelei edspiseo htiw a lsos fo ,ucescssioonsn isusr,eez nad rhtoe mseobprl ffaniegtc eht neousvr yss.etm

euo:cSr npr1dwsat:k/ig/wii-pT/t/kM.ieo.hLeTi

j44n  i just saw that every tissue that was affected had a high 02/aTP requirement and mixed with the lactic acid that meant she wasnt using her electron transport chain so i picked the only answer that had mitochondria in it +5
topgunber  The disease is MELAS. Mitochondrial encoded tRNA leucine 1 is the mutation. Apparently associated with high tone deafness. It is apparent its mitochondrial with maternal transmission, though unfortunately the etiology is utter memorization / process of elimination. Maybe next time the stragy will focus more on mitochondiral diseases and see that this choice is the only mitochondiral answer choice. Mitochondrial Encephalomyopathy Lactic Acidosis Stroke like symptoms."MELAS is a rare mitochondrial disorder known to affect many parts of the body, especially the nervous system and the brain. Symptoms of MELAS include recurrent severe headaches, muscle weakness (myopathy), hearing loss, stroke-like episodes with a loss of consciousness, seizures, and other problems affecting the nervous system.[5]" Source :Wiki +
... karljeon made a comment on nbme20/block3/q#2 (A 23-year-old woman is brought to the emergency...)
 +17 
submitted by karljeon(125)
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Tish eon was a eamtshow epmlsi qetiousn sncie oapcethhryem --;tg& tmoru lissy ;-&t-g dnee neixtahn aidesox bohinriit e,(g teoausbf.)xt

UBT YHW SI EBMN MAGARRM OS A?RPC PTU RUYO MOCSAM NI TEH HRGTI AEP!CL

... drdoom made a comment on nbme20/block1/q#11 (The sequence surrounding the first two exons of the...)
 +16 
submitted by drdoom(1027)
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As cesdedibr in teh teuoqisn ,tmse isht uanmitot roucsc ihintw an rnoint a( egne mstegne whhic si irdestanrcb -AtD[;RNAN&]g but otn )lsedrt.naat ANR lipingcs ne(z)seym abgr ARN and lβ€œoop it;” an nitnro si ctu tou nad eht snxeo no eerhti esdi of the ntroni aer edji,dnoa ielk stih:

1oeβ€”t2nroβ€”nnoeixnx g;=t& eo1oβ€”ex2nnx

lpTya,ycil htsi ipgiclsn soccru ta het eryv sgdee of teh onrint awht( I doedent iwht the β€”β€β€œ rrch)aaet.c tBu in uro ,seac a aotiunmt whniti teh rtnion si csainug RNA sigpnlic eyznem ot ngceerizo a new it:es het irclpes stcu nwithi teh inrton iatsde(n fo ta eht yvre ge,de sa ti ld.o)shu S,o ew gte otnghmies atht slkoo liek shi:t

xnβ€”1β€”erninxeot2o

ashtT’ a tolatly entfridfe RmNA ,ecumolle nad i'ts nogig to aekm uro liΞ²gon-b etpoinr loko (and vah)bee alfwyul atnse.rg

drdanielr  I remember that in the pre-mRNA, the splicing sites of the intron where the spliceosome attaches are surrounded by "GU---AG" like "guac", so here the homologous DNA to this strand would be transcribed into "gu............ag......" and this would create a 3' slice site too soon +7
vivarin  if this is supposed to be pre-mRNA, why are there T's in the sequence? I'm so confused by this for some reason +8
sars  This is the gene (DNA), not heterogenous mRNA. +
athenathefirst  The biggest clue they said this is B thalassemia, which even if you didn't know anything about exons and introns you should have known that b thalassemia involves a mutation in splicing or promoter site (pathoma page 44). I got this question wrong too :( +
... thecatguy made a comment on nbme20/block1/q#16 (A 30-year-old woman with multiple sclerosis comes to...)
 +16 
submitted by thecatguy(19)
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sTih is a yerv iipkyntc .tieqosun As I ees i,t hte 3 nmai tpocsnce edtset rae:

  • iTsh epitant sah tareilnigm aeraulnig ,pr(ahs brfie, ocdpiies niap in eth ,ae)cf hichw si ceauds by a olensi ot aprrymi syerons ribfes that cyrra anpi astnnioes fmor eht fcea.
  • elpMlitu ssilrosce, hihwc teh atitpne s,ha si a ylninmeteaidg isdaees ,..(ie it atcffse etihw )e.attrm
  • ehT liymatdnee xaosn cnrairyg naip tnsneoais orfm eth aiptrslaeli eafc tnree the btesmiran at teh velle fo eth npos nda thne deendcs m(eeobc teh lasnip atctr of the gmtelirna).i eesTh twehi tmrtae sefbri spsa ohruhtg eth sonp to nssyepa on eth asplin csuulne fo het mtaegn,iilr cwhhi si in eth uamleld euslucn( = rgay mtear).t (ructepi heer.) T,rerofehe a ienlos in eht wihte aermtt ,.ie(. pa)qlue ni teh opsn uolcd uecsa elrniamgti egaiul,ran dna this nmneneooph sah bene dveresbo.

obvAe the lelve of het aibtsemrn mt(lsahua m;&pa rarelebc ),tercox uyo veha nedocs oedrr osryens nnrsu.oe osniLse in isht tpra of het crctiiu rea ont ryelgenla ni agletmnrii n.legaauir I epousps htey lsoa wtna us to sasmeu ttha once teh apnils rtatc of eth milrtgeian tnrees eth lmdla,ue ts'i ont leeanmiytd yr.eonma I tond' hnkti sthi is lmeeoltcyp u,ert tbu givne eht iclgo sredeidbc aevob, nspo oduwl llits be eht erebtt wa.rsen

As lpeeop haev dntioep ,out hte rrpaymi eoyrssn bfsier rirayncg litgh tochu sonasetni ofmr eth cefa neyssap on eht ceifh yeornss sceulun ni teh sonp eiyteadmlim ftaer ehty eentr eth pn.os siTh qtsnueio si ont asnigk botau toesh irfbes .toghhu

I tog eht unosqtie gnwro to.o.

mightymito  Wow this is the best explanation yet! Thanks so much for very clearly walking us through a tricky question. +5
lovebug  @thecatguy Are.... you a professor? thank you very much :) +1
... hayayah made a comment on nbme20/block1/q#20 (An 8-year-old boy is evaluated for ventricular...)
 +16 
submitted by hayayah(1130)
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natitraCooc fo teh toara elsad ot saedrcine VL voerdoal gnacisu LV yehyrrhppot dna a L axsi tivodniae.

hungrybox  Similarly, RV overload leads to R axis deviation. Could point to PAH. +2
athenathefirst  Why not pulmonary valve stenosis? +1
... neovanilla made a comment on nbme20/block2/q#23 (Which of the following changes in the cardiovascular...)
 +16 
submitted by neovanilla(50)
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Teh ywa I phocdaepar hte queintos aws to erdsocni awht hspnaep 1. neWh oyu orwg ofrm a ybba ot a hc,lid and 2. whne uyo ogwr rmof a eeetangr ot an eolrd t.dlau vaehWert dnmreeai rteu neebtwe ohbt fo thme was het gtirh .erwsan

gRtih an:erws eh T erintsg BP fo a bnenwro si 054/6 ologg)(,e wheli htat fo a 1tmnh-o ldo si 60.9/5 hTe aareegv lduat is g,ihher wthi het aniAcmer Hrtae aitnAssooic citnig badrs,(lyu M)IO that rolnm""a si t/0;l0t1;2l&&8. tslhevreeNes, het nerdt is that BP recnsieas sa we ae,g rweehht we rae srnenowb ro odl poepe.l

gnWro :nsrwsea eD nlptmoeev of ncaoyorr taleohcosrs:iesr rhepaPs deu to hte nirAmeca ited it anc eb ruadeg that het etneepdmolv fo aolhcsrsiostree is tomsla tevlinaeib as uyo oebemc an rledo .ldaut ieCnaytrl tno uetr as a byba -&-tg; lh.cid

otDnvmeplee of imalrt :neotssis imlraiS iongsnera as arrooycn eortcl;eosirsahs uoy YAM poelevd ti sa na talud (nto yenlar as comnmo as a uduilpb fo crretotsoaielhc ql)eusap, but eu,sr 'tsle yas htta it anc ppaeh.n otN urte as a bayb &--;gt hicl.d

dencIrase lsbaa htare r:tae heT pooetsip si ctluayal tr.eu eTh blsaa areth atre fo a nonbwer anc yesali cdxeee ,051 nad 'tsaht onescreidd l.amrno sA ew ga,e this rhtae aret egos nodw.

aeedrnsIc rcaaidc lsecum :msas hsTi neo asw het rshtead to krow .utrhhgo It si urte htta sa we gae rmof a bbay g&-;-t ilcdh ruo rahet srgwo ni sei.z tBu if ew wetka rou pimoasstun mrfo orefeb twhi eht Ainmrace d,iet adn aesdint tup our etianpt no a orem eeotmdar tie,d aliyesralitlc ihs areth udnstolh' naeseric in izes oot h,mcu at stale ot the nipto fo gydrace.lmoia

edseacrnI conleaimcp fo rte:earsi sA ew ecombe ldroe ,dsatlu hte lncmpieaoc of arertsei seredecsa dan sssfifent eiraencss ulfc(are ont to enufsoc eatirrse wiht u,sgln ihwch yctlaula od raecesni in nceimapclo sa ew gea)!

rockodude  basically the American diet is... SAD;) +1
... jotajota94 made a comment on nbme20/block3/q#1 (The frequency of an autosomal recessive disease in a...)
 +16 
submitted by jotajota94(16)
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eUs the HgerWieab-yndr tqinaoeu

  1. kaeT eht eausqr roto of 06/011, dan htta lilw veig oyu het runyeceqf fo eth vseeicers leeall = 1/40.
  2. acetlaCul the nuqcryfee fo eht mtdonani leeall thwi =q1p,+ hwihc is p= 9.705.
  3. yThe aer ltlineg yuo to acletluac teh eunqryfec fo teh seaesid rscra,ier chwih si hitw het eqitunao 2.pq
  4. yehT atnw nloy eht deiseas iaerrrsc ni chhwi etdleoni si e.nrtpes oT uaaltcecl thi,s seu het q aeluv /04(1) adn myiplltu yb 0%8 ni hsti hsdlou vgei you ..002
  5. ,yFallni cllaucate fro 2q 2P (509.0.)=)(270 .400 = 152./
yex  Nice! ...and we are supposed to read the stem and do all this in a minute or so? :-/ +25
charcot_bouchard  Allele frequency 1/40. so carrier freq 1/20. 80% of 1/20 is 1/25 (80/100 x 1/20) +14
dickass  Ah feck, 2pq got me +1
hello_planet  A handy shortcut for Hardy-Weinberg is that you generally can assume p ~= 1 if q if fairly low. It also tends to be easier to work in fractions if the answer choices are in fractions so you don't have to bounce back and forth between fractions and decimals. So with that, you send up with 2pq = 2 * 1 * 1/50 = 2/50 = 1/25. +8
topgunber  hate this whole scramble thing: In one line: 2 * q * 80%. This is for diseased individuals (two q alleles).I = 1/1600 = q^2 The frequency of q = 1/40 Now carriers is 2 p q. P is close to one assuming HW eqm (p+q=1). There's an additional step in this question due to the two different mutations. so 2(q) = 1/20. 80% of these carriers are deletions so multiply 1/20 * 0.8 = 1/25 +
... hayayah made a comment on nbme20/block4/q#17 (A previously healthy 55-year-old man has recently...)
 +16 
submitted by hayayah(1130)
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,solA uyo l'udhtons eb enseig dga-nneor admaeg or crienadse nerni / edkyni roepsnes ithw a ruplvseoiy hyhetla ietapnt atth stuj odvedepel etnsailse .NHT heT oydb dsneto' nawt to airsceen rneni hnwe it ahs .NHT Hwoee,vr if ouy ahve no,seists the diyesnk rfkea otu beausce re'htey tno iegttng uengoh ofwl and htkni hte hlewo boyd tins' retehi, so ethy ceiaattv the AASR mysse.t When uyo vieg ehtm na A-CIE, hte rnien is llist iebng cduedopr yb hte enky,di ti jsut ni'st gnbie nedotcrev to tnIa.-nIisgonei

oT mleeitnia htreo :ecishoc

  • He sha inedacers renin itviycat so ouy cna timelinea rpmayir itdnmorsleosa. Thta ahs in.c tonsdraoeel, .cde nerin.
  • No snsig ro sxs fo usiC'hgns os ttas'h neitiea.dlm
  • 1yrsaBh-olyxd-1e icfdcneiey odlwu ssx hitw eth nlitg.eiaa Yd'ou ehav ce.d irenn ictaviyt losd-e(ketrinoael cfeefts slilt .)ntespre
  • isElesatn NTH: epdienxal vobea
sammyj98  I like you sticking up for the kidneys, thinking they're increasing Renin for the benefit of the whole body, but lets face it, the kidneys are a couple selfish dicks who want the high blood pressure all for themselves. LeftVentricularSolidarity +7
trazobone  ^ I love reviewing NBMEs for comments like this πŸ˜‚ +
... hayayah made a comment on nbme20/block1/q#4 (A 50-year-old man is brought to the emergency...)
 +15 
submitted by hayayah(1130)
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teMlhoan si icotx by two m:nsemsihac

,strFi leomhtan acn be tlaaf ude to its CNS tnadsrpees risoeeprtp ni hte saem rmanne as hetnalo ig.nnspooi

oScnde, in a ersocsp of itacotxoi,n it is oeildbzeatm to fomicr aidc iav edahdrymfelo ni a soecrps taiteiidn by eht zeymen oholalc hsdoayrgednee ni the .vriel atlMhneo si cvrdteeon ot adefydmhorel iva alhoclo gryhdsaondeee )D(HA dna yledmadrhefo is nrctdovee to crmoif ciad rot)(fema via hdlyeead ehdaeneygsrdo AL(D.)H

Featmro is iotcx beauecs it tniiihbs radinhooiclmt meorthycoc c aosdeix, acsgiun yioapxh at teh ecualrll evl,el and bietmaclo sas,cioid mgnoa a terivya of ohtre acoiblmte .sansrtciudbe

sugaplum  Good pictograph comparing methanol, alcohol, and ethylene glycol. https://wikem.org/wiki/File:Toxic_alcohol_ingestion.JPG +10
... hayayah made a comment on nbme20/block1/q#38 (A 9-year-old girl is brought to the physician...)
 +15 
submitted by hayayah(1130)
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nattePi sha a gaaonraioinmhcrpy. Mtos cmomon ocoddhhil ruaneoitplstar ortmu. Drvedei rfom nesrmnat of hRketa ucpho (aolr o.)tcdemer iaifcoltCanci si .omcomn oCelherotls alctssry ondfu ni toormβ€œ e”oilkil- ufdli iwihtn tmr.ou

A stcciy rrapslusale asms wtih faocnlcsaiitic and nmteeennach fo eth alwl or oilds ipsnorto in a lichd ro oastcdenle is oasmtl slyawa a miaghcranrypoian.o

ayM be snfdceuo htiw rtpiyatiu eaadnmo bth(o usaec oapleitrbm oh.epiia)mna

dickass  Cholesterol crystals in motor oil +
ally123  "Due to the proximity of the tumor to the hormone-producing cells of the hypothalamus and the pituitary gland, there is significant endocrine dysfunction in most children and adolescents presenting with craniopharyngioma...Among the hormone deficiencies, growth hormone deficiency is the most common and is seen in approximately 75% of children with craniopharyngioma." Source: http://campus.neurochirurgie.fr/Programme_Enseignement/_art1030/endocrinManifest.pdf +
... hayayah made a comment on nbme20/block1/q#45 (A 2-year-old boy is brought to the physician because...)
 +15 
submitted by hayayah(1130)
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i'caFsonn si a lzeadreneig sobrotnpriea deetfc ni PTC singuac adrcesien ecxenoitr fo inamo ds,aic cls,ogeu O,–HC3 dna 3–PO4, and all esnuabcsst esbdroebar by het .CTP

baja_blast  FA2019 p. 581. Fanconi syndrome causes a type 2 (proximal) renal tubular acidosis +3
... hayayah made a comment on nbme20/block2/q#17 (A 57-year old man has a hemoglobin concentration of...)
 +15 
submitted by hayayah(1130)
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isTh si taercive ylhamyceitop era,v hwich is eud to hghi utilaetd ro lngu isee.asd Sa2O si ,wlo nda PEO is dr.incseae

otneArh ywa ot paacroph eht etqounis is iglkono ta eth doolb msear. Is't trtpye anrolm n(o ymaegoscye,rkta no dcaesiner ubrnme of ets,ptlale no ,odsr thignno u,ebl cte). A dbolo smera omfr a DCPO antpeti lilw eb lrom.na Jtus na cinraeeds rbneum fo sCBR due to hte isenardce PEO adlngie ot aceresdin .bHg

mbourne  You shouldn't call it reactive polycythemia "vera", as polycythemia vera is a seperate disease with entirely different etiology. This is Reactive Polycythemia, or as another poster said, appropriate absolute polycythemia secondary to chronic hypoxia. +19
j44n  i jumped on myelodysplastic thinking it was PV due to the jak w mutation but you technically get elevated everything in that mutation so it would be more than just RBC's +
beetbox  I also thought it was PV. How can we tell reactive polycythemia from actual PV, if PV does not show other kinds of blood cell counts raised but just an isolate of RBC rise? +
... beeip made a comment on nbme20/block2/q#35 (A 36-year-old woman comes to the office because of a...)
 +15 
submitted by beeip(132)
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iLrve okslo ytetpr -neosiazmdrl ot me. iPc ereh rfo rimpcaoosn

... usmle11a made a comment on nbme20/block3/q#19 (A 23-year-old man comes to the physician because of...)
 +15 
submitted by usmle11a(86)
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0w.6y.uw?Ympaehu=swt:tbocAvtE//qpAtwch-2/ko

sygu iths eoidv lxanipes lato

... hayayah made a comment on nbme20/block3/q#23 (A 50-year-old woman is brought to the emergency...)
 +15 
submitted by hayayah(1130)
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nI drroe rfo a udrg ot eb lcedrae yb the ykend,i it sumt tifrs eb elftdire in eth roeigullm. usDgr hitw a hhig VD hvae eomr fo hte ugdr in hte ieusst that rae ton laealbiva ot leidtref yb hte eikdy.n grDus hitw ighh iptnroe gbdiinn wnto' be dflereit ir.eeht So yuo natw a urgd itwh owl Vd dna lwo ndinibg fi ouy ntaw ti ldeearc avi hte sdkiney dan r.euni

zevvyt  But a low VD corresponds to high Plasma Binding Concentration(FA 233, 2019). That's my main confusion with this question. +3
kevin  If it's high plasma binding, then it's low Vd. But, low VD doesn't necessarily require high plasma binding. Low Vd can simply be due to it being a large polar molecule +2
topgunber  So you the confusion is that VD of 1 means it stays in the circulation/ intravascular compartment. This would make you think that it would bind highly to protein in because of the low VD. But im assuming if it bound proteins it would not be cleared by the kidneys, so if this had a low VD (can be cleared at glomerulus) and if it bound plasma proteins weakly (allows the kidney to filter the substance) then it can be filtered into the tubular lumen. Now the pka. Bases when protonated (ph under their pka) become charged, while acids at ph under their pka get protonated are UNCHARGED, meaning in acidic urine acids become more lipophillic and can diffuse out of the tubular lumen. If we made the urine more basic, then we want to deprotonate the acid (ph higher than pka) so it will remain stuck in the tubular lumen as an ion. +
... johnthurtjr made a comment on nbme20/block2/q#12 (An 80-year-old man with type 2 diabetes mellitus is...)
 +14 
submitted by johnthurtjr(155)
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921FA0 p 573 on tGiietrnasanlsot odlob ypulsp and rttcyaimahapspe toranneivni:

  • eoFrtug &g;--t laeicc ytrae,r guavs itnvairneon
  • tuMidg ;g&--t ,SMA uvags
  • ditnHgu -;&g-t ,MAI plveic iirenonavnt
neovanilla  Don't force it out, you gotta relax and it'll come out naturally ;) +
mysteriousmantyping  Why couldn't the answer be Inferior rectal nerve since that controls the external anal sphincter? +1
draykid  @mysteriousmantyping I think this question is looking at complications of T2DM, more specifically diabetic autonomic neuropathy. Patient more than likely has diabetic gastroparesis which may explain his constipation and abdominal distension. +1
cuthbertallg0od  Pudendal nerve controls external anal sphincter (per FA), and gastroparesis wouldn't have anything to do w pelvic splanchnics but instead vagus nerve... Don't know why pudendal nerve couldn't be right if he was just clogged up from not being able to relax his sphincter anymore ---- is parasympathetic just more likely to be the issue statistically or something? +1
cuthbertallg0od  Or would losing pudendal nerve result in incontinence... Its never been clear to me if activation/inactivation opens/closes sphincters... +1
cuthbertallg0od  Just realized that says perineal... whoops +2
vivijujubebe  External sphincter is innervated by pudendal nerve, more often damaged during labor. DM patients have autonomic neuropathy with parasympathetic/sympathetic nerves more likely damaged +
... strugglebus made a comment on nbme20/block2/q#46 (A physician prescribes a newly marketed drug to 45...)
 +14 
submitted by strugglebus(175)
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I oeshc itsh llesoy sabeuec it swa so amnd pscefcii

sympathetikey  Same. Learn something new every day: See more: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program +5
karljeon  I didn't choose it because it was so damn specific. :( +44
lovebug  Could anyone explain for B) for me? because I choose B).:( +2
j44n  B.) is wrong because its never been shown to show adverse effects "any offcial data linking the drug" and the fact that it's "newly marketed" +
j44n  and because its in 5/45 patients roughly 10% of the population, that might not seem like much but most of the diseases we freak out over are in 1-2% of the population, to put that into perspective if we gave this drug to every person in the US (every big pharma wet dream) with a population of 300 million... 30 million people would have this adverse event... hope that helps +
... neonem made a comment on nbme20/block3/q#5 (A 35-year-old man comes to the physician because of...)
 +14 
submitted by neonem(592)
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thetxeoeMart duwol be a drug of ochice orf ssprasioi crarorefyt ot ilcoatp mcesar dna tligh rea;pyht tibinish iodheyofrldta tadrsceue ni rrdoe to aeedesrc snki lcel roolretinfipa nad ecrued mfoamtnyrlia possee.nr

69_nbme_420  Cyclosporine can also be used to treat Psoriasis (NOT cyclophosphamide - ans B) +9
len49  Drugs that can be used for psoriasis include cyclosporine, MTX, TNF-alpha inhibitors including Etanercept, lnfliximab, adalimumab, certolizumab, golimumab according to FA +2
medstudent  Kinda summed up in the index - p 791 2nd row halfway down +2
lovebug  as We all know, 1st line therapy of psoriasis is topical corticosteroid, Vit.D analog (Vit.D inhibits keratinocyte proliferation and stimulates keratinocyte differentiation. +
shakakaka  What page if Fa says that these drugs can be used in psoriasis?) +
srmtn  FA 2019 p 476 +
... nala_ula made a comment on nbme20/block3/q#11 (A 3-year-old boy is brought to the physician because...)
 +14 
submitted by nala_ula(123)
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The yohoigslt si of cheoteysrsp laml(s psleiahrc cllse w/o elnacrt lo.ap)lr eadHrryeit sprsyctooiehs is deu to ecdetf ni otnieprs ngtrciianet with BRC bemmrane otsneekl nad lmsapa rmaemneb n(yin,akr adbn 3, oiptenr 24,. is.ncpr)et sMtlyo suaomalto tnnaodmi hatreinince (so eureooyzgsth atotminu encis ouy lnoy eend eno tnmuta lleeal ot etg het .)sseiade

wuagbe  To add to this: homozygous HS presents with hemolysis even in absence of stressors. this patient is only presenting with pale skin, and there are no schistocytes on the peripheral smear, so it's a heterozygous ankyrin mutation. +9
pg32  I wanted to pick hereditary spherocytosis but the mean corpuscular concentration was normal and I thought it was supposed to be elevated? Also, why are there so many RBCs that are way bigger than the spherocytes? +6
nephroguy  I'm assuming that the MCC is normal because the patient is heterozygous for HS. Not sure if this is correct, but that was my thought process +1
draykid  Are there any papers that explain the difference in expression of homozygous vs heterozygous HS? +21
waterloo  I don't know if that matters as much, like the phenotype difference of homozygous or heterozygous for this question. Since you only need one allele to show this, play odds. Is he more likely to have AA or Aa. That was my thought process. Also if you see spherocytes you'd be going for ankyrin right, not B-globin bc that should be target cells - regardless of MCHC. +1
alimd  as I remember AD are always heterzygous. Because homozygous are always lethal. +5
... louisville made a comment on nbme20/block3/q#36 (A 4-year-old boy has had fever, abdominal cramping,...)
 +14 
submitted by louisville(12)
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lentulee-eybMh dsieatn fecla amres ldveeer onreusum tihlusrenop ub(t nto nay ga)sm.ronis ialeSglh is roecllsso wehn satiden twhi elemeyhnt u;elb E ocil ssatin ubel thiw nlhtyemee uble eebausc it refemnts tsaoce.l

sympathetikey  E. coli stains green (just fyi) otherwise, perfect. +14
chandlerbas  only E coli stains green, all other lactose fermenters stain purple/black (just fyi) otherwise, perfect. ;) FA144 bottom +4
dmotav  I think this is actually a separate concept – E. coli stains "metallic green" on eosin methylene blue agar, which is in the E. coli sketchy and first aid. However this question is referring to the methylene blue test on a fecal smear. From what I can gather, this test will be positive (indicated by presence of neutrophils) in cases of invasive diarrhea (i.e. shigella, salmonella, enterohemorrhagic E. coli). The test will be negative (no neutrophils) in cases of diarrhea caused by toxins (cholera, enterotoxigenic E. coli, giardia, viral diarrhea). So even though E. coli can present with fecal PMNs (if it's the enterohemorrhagic type), I guess that's less likely than shigella? source: https://www.ncbi.nlm.nih.gov/pubmed/4554412 +5
srmtn  correct @dmotav, Eosin methylene blue agar is different from Methylen Blue stain which just show presence or not of leucocytes... just read this: Fecal leukocytes can be observed in those with the following conditions β€’ Salmonella infections β€’ Shigella infections β€’ Ulcerative colitis β€’ Crohn’s disease Leukocytes will be absent in fecal samples from those with Giardia, E.coli or viral infections and also in cases of food poisoning. +


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