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NBME 21 Answers


Question#2 (reveal difficulty score)
A 6-month-old girl is brought to the ...
GM2 πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
An investigator is studying the efficacy of ...
Flagellin πŸ” / πŸ“Ί / 🌳

Question#4 (reveal difficulty score)
A 67-year-old man comes to the emergency ...
Translation πŸ” / πŸ“Ί / 🌳


Question#6 (reveal difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome πŸ” / πŸ“Ί / 🌳

Question#7 (reveal difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes πŸ” / πŸ“Ί / 🌳




Question#11 (reveal difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
Schistocytes πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia πŸ” / πŸ“Ί / 🌳


Question#14 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae πŸ” / πŸ“Ί / 🌳


Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician for ...
Aortic πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 61-year-old woman is brought to the ...
Donepezil πŸ” / πŸ“Ί / 🌳




Question#22 (reveal difficulty score)
A 36-year-old man with AIDS elects to ...
Chemokine πŸ” / πŸ“Ί / 🌳

Question#23 (reveal difficulty score)
A 59-year-old man comes to the physician ...
Foci of keratinization πŸ” / πŸ“Ί / 🌳

Question#24 (reveal difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm πŸ” / πŸ“Ί / 🌳

Question#26 (reveal difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 47-year-old man is brought to the emergency ...
Mixed venous oxygen tension πŸ” / πŸ“Ί / 🌳

Question#29 (reveal difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
A newborn has female external genitalia and a ...
Dihydrotestosterone πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis πŸ” / πŸ“Ί / 🌳


Question#34 (reveal difficulty score)
A 30-year-old man develops urinary ...
Pelvic nerves πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead πŸ” / πŸ“Ί / 🌳



Question#38 (reveal difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B πŸ” / πŸ“Ί / 🌳

Question#39 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes πŸ” / πŸ“Ί / 🌳

Question#40 (reveal difficulty score)
A physician prescribes a recently marketed ...
Phase 4 πŸ” / πŸ“Ί / 🌳


Question#42 (reveal difficulty score)
A 36-year-old woman undergoes a total ...
Hyperplasia πŸ” / πŸ“Ί / 🌳

Question#43 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
Histamine πŸ” / πŸ“Ί / 🌳


Question#45 (reveal difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase πŸ” / πŸ“Ί / 🌳


genetics pedigree
Question#48 (reveal difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP πŸ” / πŸ“Ί / 🌳

Question#49 (reveal difficulty score)
An 80-year-old woman comes to the emergency ...
Hydrochlorothiazide πŸ” / πŸ“Ί / 🌳


Question#1 (reveal difficulty score)
A 27-year-old man comes to the physician for ...
Schizoid πŸ” / πŸ“Ί / 🌳


Question#3 (reveal difficulty score)
A 17-year-old boy returns to the locker room ...
Apocrine πŸ” / πŸ“Ί / 🌳




Question#7 (reveal difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease πŸ” / πŸ“Ί / 🌳

Question#8 (reveal difficulty score)
A 55-year-old man is diagnosed with renal ...
Cortex πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Rosacea πŸ” / πŸ“Ί / 🌳

Question#11 (reveal difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis πŸ” / πŸ“Ί / 🌳

Question#13 (reveal difficulty score)
A 53-year-old woman with gastroesophageal ...
Omeprazole πŸ” / πŸ“Ί / 🌳


Question#15 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal πŸ” / πŸ“Ί / 🌳

Question#16 (reveal difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair πŸ” / πŸ“Ί / 🌳



Question#20 (reveal difficulty score)
A 14-year-old girl is brought to the ...
Trichotillomania πŸ” / πŸ“Ί / 🌳




Question#24 (reveal difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma πŸ” / πŸ“Ί / 🌳


Question#26 (reveal difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex πŸ” / πŸ“Ί / 🌳


Question#28 (reveal difficulty score)
A 64-year-old woman with type 2 diabetes ...
Gemfibrozil πŸ” / πŸ“Ί / 🌳

Question#29 (reveal difficulty score)
A healthy 25-year-old man is participating in ...
Alanine πŸ” / πŸ“Ί / 🌳


Question#31 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...
Intercostal πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 17-year-old boy has the acute onset of ...
Lymphocytes πŸ” / πŸ“Ί / 🌳



Question#35 (reveal difficulty score)
A 4-month-old female infant is brought to the ...
Hyponatremia πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
An investigator is conducting a study of ...
Enfuvirtide πŸ” / πŸ“Ί / 🌳






Question#42 (reveal difficulty score)
A 26-year-old man with HIV infection comes to ...
Penicillin πŸ” / πŸ“Ί / 🌳

Question#43 (reveal difficulty score)
A 78-year-old woman is brought to the ...
Embolectomy πŸ” / πŸ“Ί / 🌳

Question#44 (reveal difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left πŸ” / πŸ“Ί / 🌳




Question#48 (reveal difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis πŸ” / πŸ“Ί / 🌳

Question#49 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus πŸ” / πŸ“Ί / 🌳


Question#1 (reveal difficulty score)
A 30-year-old woman develops dimness of vision
Ethambutol πŸ” / πŸ“Ί / 🌳




Question#5 (reveal difficulty score)
A 70-year-old woman is found to have ...
Candida albicans πŸ” / πŸ“Ί / 🌳

Question#6 (reveal difficulty score)
A 40-year-old African American woman comes to ...
1,25-Dihydroxycholecalciferol πŸ” / πŸ“Ί / 🌳

Question#7 (reveal difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation πŸ” / πŸ“Ί / 🌳

Question#8 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
A 30-year-old man has had intermittent severe ...
Cysteine πŸ” / πŸ“Ί / 🌳

Question#11 (reveal difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia πŸ” / πŸ“Ί / 🌳



Question#14 (reveal difficulty score)
A 35-year-old man is brought to the emergency ...
Activation of adenylyl cyclase πŸ” / πŸ“Ί / 🌳

bilirubin
Question#16 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric πŸ” / πŸ“Ί / 🌳


Question#19 (reveal difficulty score)
A 25-year-old woman develops increasing ...
Four-chamber dilation πŸ” / πŸ“Ί / 🌳


Question#21 (reveal difficulty score)
A screening program is instituted for ...
10% πŸ” / πŸ“Ί / 🌳

Question#22 (reveal difficulty score)
A 9-year-old boy has mild mental retardation ...
Rhabdomyoma πŸ” / πŸ“Ί / 🌳



Question#25 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi πŸ” / πŸ“Ί / 🌳

Question#26 (reveal difficulty score)
A 19-year-old woman comes to the office ...
Descending colon πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid πŸ” / πŸ“Ί / 🌳




Question#31 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4 πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin πŸ” / πŸ“Ί / 🌳


Question#34 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Membranous glomerulonephritis πŸ” / πŸ“Ί / 🌳







Question#41 (reveal difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder πŸ” / πŸ“Ί / 🌳

Question#42 (reveal difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia πŸ” / πŸ“Ί / 🌳

Question#43 (reveal difficulty score)
An undernourished 70-year-old man has fever, ...
Interferon-Ξ³ πŸ” / πŸ“Ί / 🌳


Question#45 (reveal difficulty score)
A 28-year-old man comes to the physician for ...
Fructose πŸ” / πŸ“Ί / 🌳

Question#46 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale πŸ” / πŸ“Ί / 🌳


Question#48 (reveal difficulty score)
A 29-year-old woman comes to the physician ...
Baclofen πŸ” / πŸ“Ί / 🌳

cell_bio cell_transport cell_trafficking
Question#50 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector πŸ” / πŸ“Ί / 🌳

Question#1 (reveal difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix πŸ” / πŸ“Ί / 🌳


Question#3 (reveal difficulty score)
A study was performed that evaluated the ...
Odds ratio πŸ” / πŸ“Ί / 🌳


Question#5 (reveal difficulty score)
An 11-year-old boy has had persistent pain in ...
Lung πŸ” / πŸ“Ί / 🌳

Question#6 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Cortisol πŸ” / πŸ“Ί / 🌳

Question#7 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue πŸ” / πŸ“Ί / 🌳

FA_missing
porphyria phototherapy
Question#9 (reveal difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda πŸ” / πŸ“Ί / 🌳

renal SIADH hyponatremia
Question#10 (reveal difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia πŸ” / πŸ“Ί / 🌳


Question#12 (reveal difficulty score)
A 24-year-old man with a history of drug ...
Heroin πŸ” / πŸ“Ί / 🌳




Question#16 (reveal difficulty score)
A 40-year-old woman who had pneumonia due to ...
Surfactant πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis πŸ” / πŸ“Ί / 🌳

Question#19 (reveal difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY πŸ” / πŸ“Ί / 🌳

Question#21 (reveal difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization πŸ” / πŸ“Ί / 🌳

Question#22 (reveal difficulty score)
A 57-year-old woman is brought to the ...
Ninth πŸ” / πŸ“Ί / 🌳

Saline Lymphatic

Question#25 (reveal difficulty score)
An 80-year-old woman cannot concentrate her ...
2.0 πŸ” / πŸ“Ί / 🌳





Question#30 (reveal difficulty score)
A 5-year-old boy is admitted to the hospital ...
ApoC-II πŸ” / πŸ“Ί / 🌳


Question#32 (reveal difficulty score)
A 19-year-old college student says he hears ...
Risperidone πŸ” / πŸ“Ί / 🌳

Question#33 (reveal difficulty score)
A female newborn delivered at 26 weeks' ...
Retina πŸ” / πŸ“Ί / 🌳


Question#35 (reveal difficulty score)
A 50-year-old woman is admitted to the ...
Didanosine (ddI) πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Chondrosarcoma πŸ” / πŸ“Ί / 🌳



Question#39 (reveal difficulty score)
A 46-year-old man comes to the physician ...
1/15 πŸ” / πŸ“Ί / 🌳


Question#41 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide πŸ” / πŸ“Ί / 🌳

Question#42 (reveal difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...
Multifactorial πŸ” / πŸ“Ί / 🌳


renal diuretics GFR
Question#44 (reveal difficulty score)
A 28-year-old woman with chronic renal ...
Furosemide πŸ” / πŸ“Ί / 🌳

neuro pharm magnesium
process_of_elimination Li_Fraumeni p53
Question#46 (reveal difficulty score)
A 14-year-old girl is brought to the ...
TP53 πŸ” / πŸ“Ί / 🌳

Question#47 (reveal difficulty score)
While lifting weights, a 24-year-old man ...
Strangulation πŸ” / πŸ“Ί / 🌳


Question#49 (reveal difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus πŸ” / πŸ“Ί / 🌳

Question#50 (reveal difficulty score)
A 19-year-old woman is brought to the ...
Scaphoid πŸ” / πŸ“Ί / 🌳

Recent comments ...

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
 +75 
submitted by nosancuck(95)
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Bhur tel em ltel oyu a lil scerte

PPEE nterpesv sAsaeitelct KAA dta NLGU ALECOPSL

oDnt eb yionrrw btuoa nodrma dosrw htey sptu ni ftorn of the HHGI YLEID nseo

hungrybox  literally LOL'd lmao I love this +15
... assoplasty made a comment on nbme21/block3/q#31 (A 28-year-old woman at 18 weeks' gestation has...)
 +74 
submitted by assoplasty(103)
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I khtin eht ctnpceo ’etryeh gesittn si eth siadcreen GBT lesvel ni nnacpye,gr dna nto tsju ortyrpemsdihhiy ni lanrg.ee

eWnh egenicrns fro roopydhyymrhiis,hetp/ STH sellve are YASLWA irllrteaenpeyf echkced aecsueb ehty ear moer vsteesiin ot utienm ieeesrcndff in /3.4TT Ofnet istem HTS leslev can tsdrtnmeaoe a genach enve wnhe 4T3/T eselvl ear ni hte ucciabllsin earg.n Teh olny enopxeict to tsih olwdu be ni pcangnery a(dn I ssueg mabey rlvie ar?leufi I bodtu tehy wuold ska itsh o)ghh.ut hiHg ereostgn vsllee eetspnvr teh rivle rfom rngaibke nowd B,GT indegla to anresicde TGB slvele in teh r.mseu hsTi inbsd to feer ,T4 degirecnas teh uatnom fo aaavbllei reef T4. As a rtomcnoaeyps ic,hmseman HTS eesvll rea nsetiayntlr sdncierae and the TEAR fo T4 iodtpnuorc si edsieanrc to pienrshle niealbse eref T4 ele.lvs vHoeewr the OALTT natoum fo 4T si rean.cdies

ehT qsteoiun is niksag owh ot omfnrci iyedrhtomsrhpiy in a nngrptae mowna g&-;t- oyu eden ot ccekh EREF T4 ellevs ucab(ees ethy hlduos be ronalm ued to setoamnoyprc ro.pseen)s You ctanno cckeh THS (llauuys evdtleae in rgnpencya ot otncmeepsa fro eaisdrecn )TB,G nda yuo ctnaon hecck ttaol 4T lvelse il(wl be are)n.cside uYo gto eth rwsnae rihtg eetrhi awy tub I hntki tish si a tedenfirf nsgiearon tohrw eicnsgid,nro asucbee etyh nac ska htsi centocp in hrote toesctnx fo oit-m,heryneessgrp nad if htey dliets HSβ€œβ€T sa na srawne iohecc atht lwudo eb icrrcn.eot

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +9
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +3
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +1
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +3
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +2
lovebug  Amazing answer! THX +1
an_improved_me  Just to add: Pregnancy is not an exception to using TSH in suspected hyperthyroid pregnant patients (not sure in hypothyroid); you would still get a TSH first, and if its unusually low, you would then proceed to measure T4 (free, total), and so on. https://www.uptodate.com/contents/hyperthyroidism-during-pregnancy-clinical-manifestations-diagnosis-and-causes?search=hyperthyroidism%20in%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H994499 +1
... lnsetick made a comment on nbme21/block2/q#3 (A 17-year-old boy returns to the locker room after...)
 +58 
submitted by lnsetick(103)
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  • iPoArenc = royu rasmtip esllm ekli na EAP
  • nReUeMc = estre’h no OMRO in ouyr aesr nisce eryeht’ lulf fo wxa
  • RCE-YnCe = enhw ouy rC,cEseie uory oerps rea YgCniR
  • EoBacSseu = EBmuS is ingESPE uto fo oury epors
hungrybox  as an ape i'm offended +37
dr.xx  stop being an ape. evolutionize! +7
dbg  as a creationist i'm offended +13
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +4
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +3
... drdoom made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
 +57 
submitted by drdoom(1110)
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heT hsesintsy fo ialyvurlt all enrstoip e&gA(t)ptNdiem-p;R sccuro ni hte tp.lmycsoa][1 s’taTh ehrwe lal osbrseoim seird,e aerft a.ll eRbiossom, hhciw aer tmlosy utjs rRAN 3~(2/ rNAR + /13 p,reon*it yb hgwte,)i are esaebsdml ni eth snuecul ubt noyl do rehti utffs ncoe tehy tge ot teh pmt.ylocas

For a rpieont ot lveae sti ogailrin teoohwnm fo eth ytloosc dan emeocb a erednsit fo hte eunlucs or, yay,yyysy hte cmpasdnlieo etru,ulimc ti eensd ot ahev a ilttle nitrgs of inmoa dacsi hiwhc uoths Iβ€œ ogbenl ni eht l”seu!ncu ro Iβ€œ enoblg in teh solmcianpde u!i”etumrcl

itrosnPe tietlmyula etesdind fro the ER antonci na unyliivmageinat namde ritsgn fo ioanm dcasi wnonk as sniaβ€œlg cuseqene”, ciw,hh rof eht psoepurs of hte eptS ,1 si ayswla at hte reN-sti.unm The nisalg esnucqee tlsle heort yolccitso spoerit,n eH!β€œy eTka me d(an eth setr fo eth tpeepdi of wihch I am ar)pt to teh ER!”

nI eht sabceen fo isht anigsl, a eprinto illw rimena in sti tefdβ€œal”u emho fo het oso.lyct

ss;qeorure&H a icne ehaccsmit sghionw hte fwol of orpnesit form atiinil siythessn ot linfa tnsiiae:nsdto


sontdnEe

  1. β€œehT enhyssits of ltarliyvu all epitsorn ni eht ellc sbgien no smibesroo in eht cs”.yotol (lEestaisn lCle ooiBgyl, resbAlt te .,la 14,02 p. 92)4

I*f ouy alryel tanw yrou idnm wlob,n ecrdsnio tath vnee the onperti ustbisnu taht ekam pu tath 1/3 fo a oeiombrs rae mvsheeselt iylatiiln eihsseyzntd in het toclosy; altr,e yeht aer oretrtpnsda ackb itno the eusnluc iva the nuelacr p.eor

qball  Awesome explanation. Now explain it to me like I'm 5. +10
drdoom  All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark β€” or erase it somehow β€” the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa won’t bring your presents. +68
... niboonsh made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
 +57 
submitted by niboonsh(394)
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vboQ:zty4mw=uovw-.H?wshtwec./ttph/cuoauw/D2 fi ur zyla keli me, hits si a godo eesrrfehr oidve

d_holles  Amazing video dude. Somehow never learned this in neuro lol. +7
aag  Awesome video! Is this why you can give Mg2+ to eclampsia patients, because if so, mind goddamn blown. +3
... seagull made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +53 
submitted by seagull(1789)
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! I htea eeths htiw a inrugnb **ingF* sspo.ina mTubhs up if uyo greae

mcl  Amen brother +2
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +35
mcl  oh my god are you me +2
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +7
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +5
abhishek021196  What is HSM? +1
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +1
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +3
djeffs1  @lakshmi Link? +1
... hayayah made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
 +41 
submitted by hayayah(1170)
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het mrayoitj of nrocab odixdei cemlloseu ear craredi sa rapt fo het biortnaebca rebffu tssyme. In sith m,ytsse rncoba eoxiddi idsufsfe tino eth Cs.RB ncbCoair ahsanryed )(CA nhwiti sBCR qlcyuki cronsvte teh arncbo dxiodei itno orinacbc cdia (.HCO32) icnoCrba adci is an uatbnlse trimieaneted meuoclle ahtt eemytlmiiad esacdsstiio noti acreaitbbon nsio (CO-3)H dan edngryoh (H)+ n.iso

The lnywe tenyzdheiss aaobtcenirb oni si tneasdtrrop out fo het RCB iton hte malpsa in hnxeaceg rof a lhciedro ion (βˆ’)Cl; isht is ldecal the iehrdclo ifs.th ehnW the lbood aehecsr eth l,sung eht ebbionrcata nio si prasnoetdrt kabc tion eht RBC in ehcaxnge fro teh edhrlico oni. The H+ oni stodecassii morf hte noomgbihle dna isdbn to het atbbirecaon o.ni sTih sorudcep the cbricano acdi etema,inetird wchhi si ovnterdec kbca into cbaorn iixeddo oguthrh teh miaycznte iantco of CA. eTh abrocn ixdedoi ocdrepud si lxpldeee htguohr het lgsun udnrig lehaaxtoin.

hungrybox  Amazing explanation. Thank you!! +2
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +6
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +5
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3
teepot123  fa 19 pg 656 +2
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +
... mcl made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +37 
submitted by mcl(645)
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Lleedab XCR isnwhgo iontpois fo ndefterif aelv.vs

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +3
... hungrybox made a comment on nbme21/block2/q#17 (Scientists have identified the flawed gene that...)
 +33 
submitted by hungrybox(1204)
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enhw fdif lignse tdsrna rrepia nechssammi are ueds:

  • iraerp ewnyl nethsiedzys atsrd:n chmsitam rirpea L(yhcn ysm)drone
  • iaprre ermnypidii isermd cdsaue yb dta UV uspereox: dnlieouect eiincosx priera aXoee(drrm ieposnmmt)ug
  • priare encxpuo/aootsnsit eolattirn:a baes xescoiin erpair
meningitis  Brca: recombinant repair +
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2
teepot123  fa '19 pg 382/3 +
... hungrybox made a comment on nbme21/block3/q#15 (A 47-year-old man has jaundice. Laboratory findings...)
 +33 
submitted by hungrybox(1204)
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hyw eiolmssyh is r:gwno

Terhe holusd lmosta veern be gtsahrit up nbiilirub in the nri.ue In lyohess,mi eth ecsxes iulibribn si eedtcxer ni eth e.ibl fetrA teclaaibr risconnvoe adn ekute,rpa eoms lwli be eexrdetc ni eth nurei as uinbril.o wrHoev,e in ebutsoicrtv srdidr,seo eht ugcnajdeot briniulbi liwl vrnee heav the pyntoioptru to eodrngu ectbalair snocrenivo to roireionbcusl.t/ nI shit ay,w eht utegaoncdj ibirbuinl has on eroth yaw to eb extecder ehtor anth icrldeyt ni hte uri.en

tcdersi ot a/7l/3raan6uc on edditr

skip_lesions  Found a good pic showing bilirubin metabolism +
... jambo2222 made a comment on nbme21/block4/q#5 (An 11-year-old boy has had persistent pain in his...)
 +33 
submitted by jambo2222(33)
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s’tI an omacosose.rat camraoS = tnuegashoome ems.t ’tIs in hte elgs so kntih how a VTD soge ot l.ugn aSem aied.

tinydoc  Perfect way to remember it. Thank you! +10
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +15
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +2
... notadoctor made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
 +32 
submitted by notadoctor(170)
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sUaul snaettliitir isonuniptem si het gciholaisolt eotiinnfid of Iiopitahcd naopylmru fo.sibsri eW onwk that ihts titnape has nlupramyo iobisrsf scabeue het unsotqie tseats atth tehre si uosfbri gciennkthi of het rolaavel e.apst shiT tnquiose asw jstu nsgteit atht we wnek eth htore smena for yrumloPna sFbro.iis

aneurysmclip  Nbme back at it again +30
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6
mangotango  I picked β€œdiffuse alveolar damage” with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +3
zevvyt  thank you swagcabana! Very good explanation and strategy! +


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