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NBME 21 Answers

Question#2 (reveal difficulty score)
A 6-month-old girl is brought to the ...

Question#3 (reveal difficulty score)
An investigator is studying the efficacy of ...

Question#4 (reveal difficulty score)
A 67-year-old man comes to the emergency ...

Question#6 (reveal difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes ๐Ÿ”,๐Ÿ“บ

Question#11 (reveal difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...

Question#12 (reveal difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia๐Ÿ”,๐Ÿ“บ

Question#13 (reveal difficulty score)
A 25-year-old man develops shortness of ...
Decreased alveolar Po2๐Ÿ”,๐Ÿ“บ

Question#14 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae๐Ÿ”,๐Ÿ“บ

Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician for ...

Question#17 (reveal difficulty score)
A 7-year-old girl is brought to a clinic in a ...

Question#18 (reveal difficulty score)
A 61-year-old woman is brought to the ...

Question#22 (reveal difficulty score)
A 36-year-old man with AIDS elects to ...

Question#23 (reveal difficulty score)
A 59-year-old man comes to the physician ...
Foci of keratinization๐Ÿ”,๐Ÿ“บ

Question#24 (reveal difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change๐Ÿ”,๐Ÿ“บ

Question#25 (reveal difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm๐Ÿ”,๐Ÿ“บ

Question#26 (reveal difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis๐Ÿ”,๐Ÿ“บ

Question#27 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption๐Ÿ”,๐Ÿ“บ

Question#28 (reveal difficulty score)
A 47-year-old man is brought to the emergency ...
Mixed venous oxygen tension๐Ÿ”,๐Ÿ“บ

Question#29 (reveal difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache๐Ÿ”,๐Ÿ“บ

Question#30 (reveal difficulty score)
A newborn has female external genitalia and a ...

Question#31 (reveal difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid๐Ÿ”,๐Ÿ“บ

Question#32 (reveal difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis๐Ÿ”,๐Ÿ“บ

Question#34 (reveal difficulty score)
A 30-year-old man develops urinary ...
Pelvic nerves๐Ÿ”,๐Ÿ“บ

Question#35 (reveal difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead๐Ÿ”,๐Ÿ“บ

Question#37 (reveal difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentration๐Ÿ”,๐Ÿ“บ

Question#38 (reveal difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B๐Ÿ”,๐Ÿ“บ

Question#39 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes๐Ÿ”,๐Ÿ“บ

Question#40 (reveal difficulty score)
A physician prescribes a recently marketed ...
Phase 4๐Ÿ”,๐Ÿ“บ

Question#42 (reveal difficulty score)
A 36-year-old woman undergoes a total ...

Question#43 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...

Question#45 (reveal difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase๐Ÿ”,๐Ÿ“บ

genetics pedigree
Question#48 (reveal difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP๐Ÿ”,๐Ÿ“บ

Question#49 (reveal difficulty score)
An 80-year-old woman comes to the emergency ...

Question#1 (reveal difficulty score)
A 27-year-old man comes to the physician for ...

Question#3 (reveal difficulty score)
A 17-year-old boy returns to the locker room ...

Question#6 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration๐Ÿ”,๐Ÿ“บ

Question#7 (reveal difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
A 55-year-old man is diagnosed with renal ...

Question#10 (reveal difficulty score)
A 42-year-old woman comes to the physician ...

Question#11 (reveal difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac๐Ÿ”,๐Ÿ“บ

Question#12 (reveal difficulty score)
A 66-year-old woman comes to the physician ...

Question#13 (reveal difficulty score)
A 53-year-old woman with gastroesophageal ...

Question#15 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal๐Ÿ”,๐Ÿ“บ

Question#16 (reveal difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair๐Ÿ”,๐Ÿ“บ

Question#20 (reveal difficulty score)
A 14-year-old girl is brought to the ...

Question#24 (reveal difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma๐Ÿ”,๐Ÿ“บ

Question#26 (reveal difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex๐Ÿ”,๐Ÿ“บ

Question#28 (reveal difficulty score)
A 64-year-old woman with type 2 diabetes ...

Question#29 (reveal difficulty score)
A healthy 25-year-old man is participating in ...

Question#31 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...

Question#32 (reveal difficulty score)
A 17-year-old boy has the acute onset of ...

Question#35 (reveal difficulty score)
A 4-month-old female infant is brought to the ...

Question#36 (reveal difficulty score)
An investigator is conducting a study of ...

Question#42 (reveal difficulty score)
A 26-year-old man with HIV infection comes to ...

Question#43 (reveal difficulty score)
A 78-year-old woman is brought to the ...

Question#44 (reveal difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left๐Ÿ”,๐Ÿ“บ

Question#48 (reveal difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis๐Ÿ”,๐Ÿ“บ

Question#49 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...

Question#1 (reveal difficulty score)
A 30-year-old woman develops dimness of vision

Question#5 (reveal difficulty score)
A 70-year-old woman is found to have ...
Candida albicans ๐Ÿ”,๐Ÿ“บ

Question#6 (reveal difficulty score)
A 40-year-old African American woman comes to ...

Question#7 (reveal difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation๐Ÿ”,๐Ÿ“บ

Question#8 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies๐Ÿ”,๐Ÿ“บ

Question#10 (reveal difficulty score)
A 30-year-old man has had intermittent severe ...

Question#11 (reveal difficulty score)
A 50-year-old man is found dead in bed at ...

Question#14 (reveal difficulty score)
A 35-year-old man is brought to the emergency ...
Activation of adenylyl cyclase๐Ÿ”,๐Ÿ“บ

Question#16 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma๐Ÿ”,๐Ÿ“บ

Question#17 (reveal difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric๐Ÿ”,๐Ÿ“บ

Question#19 (reveal difficulty score)
A 25-year-old woman develops increasing ...
Four-chamber dilation๐Ÿ”,๐Ÿ“บ

Question#21 (reveal difficulty score)
A screening program is instituted for ...

Question#22 (reveal difficulty score)
A 9-year-old boy has mild mental retardation ...

Question#25 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi๐Ÿ”,๐Ÿ“บ

Question#26 (reveal difficulty score)
A 19-year-old woman comes to the office ...
Descending colon๐Ÿ”,๐Ÿ“บ

Question#27 (reveal difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid๐Ÿ”,๐Ÿ“บ

Question#31 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4๐Ÿ”,๐Ÿ“บ

Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...

Question#34 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Membranous glomerulonephritis๐Ÿ”,๐Ÿ“บ

Question#41 (reveal difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder๐Ÿ”,๐Ÿ“บ

Question#42 (reveal difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia๐Ÿ”,๐Ÿ“บ

Question#43 (reveal difficulty score)
An undernourished 70-year-old man has fever, ...

Question#45 (reveal difficulty score)
A 28-year-old man comes to the physician for ...

Question#46 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale๐Ÿ”,๐Ÿ“บ

Question#48 (reveal difficulty score)
A 29-year-old woman comes to the physician ...

cell_bio cell_transport cell_trafficking
Question#50 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector๐Ÿ”,๐Ÿ“บ

Question#1 (reveal difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix๐Ÿ”,๐Ÿ“บ

Question#3 (reveal difficulty score)
A study was performed that evaluated the ...
Odds ratio๐Ÿ”,๐Ÿ“บ

Question#5 (reveal difficulty score)
An 11-year-old boy has had persistent pain in ...

Question#6 (reveal difficulty score)
A 55-year-old man comes to the physician ...

Question#7 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue๐Ÿ”,๐Ÿ“บ

porphyria phototherapy
Question#9 (reveal difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda๐Ÿ”,๐Ÿ“บ

renal SIADH hyponatremia
Question#10 (reveal difficulty score)
A 64-year-old man is evaluated for cough, ...

Question#12 (reveal difficulty score)
A 24-year-old man with a history of drug ...

Question#16 (reveal difficulty score)
A 40-year-old woman who had pneumonia due to ...

Question#17 (reveal difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width๐Ÿ”,๐Ÿ“บ

Question#18 (reveal difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis๐Ÿ”,๐Ÿ“บ

Question#19 (reveal difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla๐Ÿ”,๐Ÿ“บ

Question#20 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...

Question#21 (reveal difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization๐Ÿ”,๐Ÿ“บ

Question#22 (reveal difficulty score)
A 57-year-old woman is brought to the ...

Saline Lymphatic

Question#25 (reveal difficulty score)
An 80-year-old woman cannot concentrate her ...

Question#30 (reveal difficulty score)
A 5-year-old boy is admitted to the hospital ...

Question#32 (reveal difficulty score)
A 19-year-old college student says he hears ...

Question#33 (reveal difficulty score)
A female newborn delivered at 26 weeks' ...

Question#35 (reveal difficulty score)
A 50-year-old woman is admitted to the ...
Didanosine (ddI)๐Ÿ”,๐Ÿ“บ

Question#36 (reveal difficulty score)
A 45-year-old man comes to the physician ...

Question#39 (reveal difficulty score)
A 46-year-old man comes to the physician ...

Question#41 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...

Question#42 (reveal difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...

renal diuretics GFR
Question#44 (reveal difficulty score)
A 28-year-old woman with chronic renal ...

neuro pharm magnesium
process_of_elimination Li_Fraumeni p53
Question#46 (reveal difficulty score)
A 14-year-old girl is brought to the ...
TP53 ๐Ÿ”,๐Ÿ“บ

Question#47 (reveal difficulty score)
While lifting weights, a 24-year-old man ...

Question#49 (reveal difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus๐Ÿ”,๐Ÿ“บ

Question#50 (reveal difficulty score)
A 19-year-old woman is brought to the ...

Recent comments ...

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
submitted by nosancuck(92)
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hrBu tel em ltle oyu a ill tcesre

PPEE epenrtvs iscalsteetA AAK dat LGNU LEOALCPS

ontD be yrwrnoi batou darmno wsrdo yhet ptsu in ofrnt of hte HHGI EYLID esno

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...)
submitted by assoplasty(98)
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I tkihn teh coetnpc rheโ€™eyt itetgsn si eht sedirneac BTG lleevs in nn,yagepcr nad not stuj dhetrrpiyyohims ni lga.erne

eWnh nseenirgc ofr /rphmeoytisyrdih,ohyp HTS lsevel ear SAYWLA eneritaelfprly hkcedec ecuaebs htey rea moer siveietns to unemit fcfnirseeed ni 3TT/4. Ofnte eitsm HST lsevel anc mteenraosdt a gnchae neev enwh T/4T3 lsvlee rea ni hte iuasbcnilcl nrga.e hTe nlyo nepoeixtc to hist ulwod eb in eacynnrgp (dna I esusg mybae irvle uir?ealf I todub eyth doluw ska siht goh).tuh Hihg ergtenos vlseel setrpnve teh ilevr mrfo kigbenar wdno T,GB egildan ot iarscdene TGB levesl in eth eusm.r hsTi nbdis to eefr ,4T rnsacgdeie the uaonmt of livaaleab eefr .4T sA a caespnrotyom a,mehmicsn STH leelvs rae syteairnltn ceraiedsn adn hte RAET fo 4T uocrpntdio si edancrise to ielpsnhre aenliseb eefr T4 v.leels rwHoeev teh TLTOA atomun fo 4T si

heT eointuqs si agikns woh ot noifmrc rhyipiryetsmdho ni a arpntneg owmna -;g&-t you eend ot cehck REFE 4T vsleel eauebsc( etyh hudlos eb rmlano deu to oyorcansetpm r.seos)nep oYu tcaonn ekhcc THS asululy( eedetlav in ncnegapry to toneasmpce for csanedeir ,GT)B and oyu onctan ehkcc ottal T4 velesl (ilwl be iaers).nedc uYo ogt teh saenwr gthri ihrtee ayw btu I nkthi tish si a iefrndtfe gsnroenia rtohw iinr,docsneg abscuee htey anc kas ihts ptcecno in toher sxoecttn fo eiyo-ehr,sspegnrtm adn if hyte eldtsi โ€œSHโ€T sa an swaenr hiecco atth wuldo eb rne.iccrto

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. +2
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. +1
... lnsetick made a comment on nbme21/block2/q#3 (A 17-year-old boy returns to the locker room after...)
submitted by lnsetick(100)
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  • eirocPnA = oryu trspiam ellsm keli an PEA
  • cMeenUR = tโ€™serhe no ORMO ni yoru ersa scein rhโ€™tyee fllu fo awx
  • RCECY-en = when you scriEC,ee uroy esrpo rea iRnCgY
  • BESaesouc = uBESm is nPEiESg uot of ryou pores
hungrybox  as an ape i'm offended +36
dr.xx  stop being an ape. evolutionize! +7
dbg  as a creationist i'm offended +12
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. +3
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +2
... drdoom made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
submitted by drdoom(1027)
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ehT ehsynsist of aluvtilry lla peostnir tpNAteR;iemp(-dg)& urocsc ni eht ma.ctlpoys[]1 Tahโ€™st erewh lal morseoisb ,idsree atfer ll.a b,iesRmsoo ciwhh rae tsylmo jtus rNRA 3/(2~ RNAr + 1/3 oeir*,tpn yb hewt),ig ear eblsadsem in hte eculsnu tbu loyn od hiert tfusf neco ythe egt to eht cylpm.soat

roF a nopetir ot vlaee sti oiaginlr henotwmo of eth oslctyo and eceobm a siedetrn fo eht nuleusc ,ro yyys,ayyy the msnpacoilde eirc,uutlm it deens to have a leittl ristgn fo naiom dasci iwhhc htsou โ€œI begnol ni het !usluโ€ecn ro โ€œI nbolge in the mldiacspneo mriโ€luct!eu

nitrosPe ueylatitml einsddte orf het ER nontica an mvyngeinaatulii nmdea nsirgt of amino siadc wnonk sa aโ€œlsign ecqโ€eu,nes wch,ih rof eth rppuoses of teh Sept 1, is slyawa at het r.nNmsuie-t heT aislng qencesue lselt retho syilcootc in,rpotes โ€œyeH! aekT me d(an hte etsr of eth eppidte of hwchi I am atp)r to eht RE!โ€

In het nesebac fo sthi i,lsnag a opeirnt ilwl nremia in sti fltโ€œeudโ€a meoh fo eht ctloyo.s

osreu&sqe;rH a cnei miacecsht iwongsh hte lwfo of npsrioet ofmr ilaiint eyhitnsss ot alnfi :sntiaientsod


  1. heTโ€œ shetsisny fo yilurtvla all setropni in eht cell egsbin no bmoeiosrs ni het oscโ€loy.t (iaesntsEl leCl ogyoilB, brlesAt et l,a. 214,0 p. 9)42

f*I oyu eallry ntwa rouy dinm wln,bo deriocsn htta enve het toeinrp usitbuns thta kame up hatt 31/ of a sboomeri rea elhmevtses liayiltin sseyizdneth in hte soocly;t aet,lr thye are ortdnsaetrp cbka noti eht neuucls avi hte cerulan ro.ep

qball  Awesome explanation. Now explain it to me like I'm 5. +8
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 โ€” or erase it somehow โ€” the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa wonโ€™t bring your presents. +57
... niboonsh made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
submitted by niboonsh(376)
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ho/t2tcw-4wtuwQ/ms/ypvbHw.ou:?=z.wuvDcoteha if ur zayl klei em, isht si a dogo feersrreh oidev

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...)
submitted by seagull(1722)
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! I ehta teehs ihwt a buningr g*ni*F* o.aispsn hsmTbu pu if oyu regea

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 +34
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...)
submitted by hayayah(1130)
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teh jiormyta of brcnoa ediodix lecolseum rea rerdica sa aprt fo hte ctaneobraib urffbe etmyss. nI tihs ,msetys noacbr dxdeioi idsfuefs tnio teh CR.sB barnicoC nyaahsrde AC)( wntiih CsBR uiklyqc nvcrotse eth obcanr idoidxe iton rncbiaoc aicd )(3.OC2H biancCor dcai is an lneusbat eeimradttnei lmleueco atth iilemmtadye dsioitsesca tnio ncobairetab onis OHC(3)- and gronhyde +(H)

eTh elwyn szsedyiehtn aboebcnaitr ion si trranodsetp tou fo eth BCR oitn het plmaas in ncgaeexh fro a choerdil ion ()โˆ’;Cl ihst si llcdea eht rdhcolei t.hfis nWhe the bdolo heraesc hte n,lgus eth ibcobaarnet oni si dortpaetnsr cbka tino eht RCB in eechnagx rfo the rhdcoile oni. heT +H oni iacstdesiso mofr teh higmleobno dna disbn to eth brtacnbeiao nio. sTih reodscpu teh rbacocni idca nemadter,tiie iwhhc si nvtdecoer kcba ntoi robcan dxdieio hogrhut eht tnizyacme otcain fo A.C The ncraob ioxeidd ocudredp si eedexllp orughht hte sugnl gnriud e.hntxaoail

hungrybox  Amazing explanation. Thank you!! +2
namira  in case anyone wants to visualize things... +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%. +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...)
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eLledab RXC ohsgwni itonposi fo rdneeffti salev.v

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 +2
... hungrybox made a comment on nbme21/block3/q#15 (A 47-year-old man has jaundice. Laboratory findings...)
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hwy lheosysim is :rnowg

ereTh dsluoh ltomas ernve be hrtsgtai pu iinblibur in eth nI s,yiolhems eht ecsxes bbiilnrui is xedcreet ni the bie.l efArt rtaeiacbl ocrnvoisne and teukr,pea osme lwil eb eretexcd in het nreui as lroi.buin ,orewHve ni svurcibeott ri,oedsdrs eth jogudatcne lburiniib lwli enrev vhae the nropouipytt ot rgdoune lactrbiea erovinncos ot .obtrilic/sruneo nI htsi y,wa teh aecdnjtoug iniuibblr hsa no ehotr wya ot eb reexetdc roeth htna dceyrtli ni hte eu.rin

idtrecs ot alcar/3a6/7nu no tieddr

skip_lesions  Found a good pic showing bilirubin metabolism +
... notadoctor made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
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ulsUa saiitentitlr imusnopetin is eth iiatoclhglos oinienfidt fo poihIitadc yamnrluop bssfi.ori We wnko ttah this ntiepta sha oaunlpyrm osfbsrii ebseuca the useointq esttas htta eerht is fosruib ekithicgnn of teh rvlaeola .etasp hisT soteuinq saw sujt tietgsn atht ew newk eht ohret nseam rof nmPruyola .Fiosisbr

aneurysmclip  Nbme back at it again +29
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 โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +3
zevvyt  thank you swagcabana! Very good explanation and strategy! +
... hungrybox made a comment on nbme21/block2/q#17 (Scientists have identified the flawed gene that...)
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nehw ifdf linges ratnsd rarpie ansimesmch rae :uesd

  • praeir yweln enszedshyti sr:dtan amihmtsc eprari cLhn(y r)smndeyo
  • iaprer ipmniiyedr dseirm scduae yb tad VU pes:oerxu iueoecdnlt coesxiin pirear aXmod(rree p)mngtiseomu
  • priear tspeso/ountconixa e:nilaotrta ebas xioncesi rarpei
meningitis  Brca: recombinant repair +
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2
teepot123  fa '19 pg 382/3 +
... jambo2222 made a comment on nbme21/block4/q#5 (An 11-year-old boy has had persistent pain in his...)
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โ€™tsI na oostoea.carsm aScramo = enthsooemuga .mest tsโ€™I in the eslg os inkht woh a VDT soge to ugln. aemS

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 +14
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. +1
... madojo made a comment on nbme21/block1/q#39 (A 33-year-old woman comes to the physician because...)
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Knwo oyur 'STDs bbya )-; o(gnig ruthogh yerev rhoet cihoce on this tuq)eon:is

  • aatBlrcei angiosvis saucde yb erdelanragl villasaign. Se a i,tnh ffo witeh drihsecag dan syhfi sellm h(fsi in eht ra)dng.e 'shTree on oilaamnitmnf Lab sdf:innig Hp grtaeer atnh .54 j(ust ekli )oihoicrsmnt,isa nad a itvpieos ihfwf ttse ithw OKH. mSet liwl say mgeistnoh uboat adolouroms hrgsaiedc and oshw hte uosnfaim ULEC CELSL if we era cylu.k Nto het wnreas fro tish tnqiseuo sbloiyuov beauces ew duowl ton epctxe islceves htiw hist tlcibaera .iaseesd

  • siidsdaniCa is igogn to be oryu htikc etotacg ehscee achreisdg, ihtw m.ataimifnnlo rnlmoa pH see Tatre twhi oplacti itn,nayst or laor auozfnlloce usnlse 'uoyer aprtgnne ntah esu aiAng not noggi to ese yan ie.evscsl

  • hiCcornad rep udlrow is sosaeitdca htiw lahioesmHpu ycirdue uyo llwi ahev a Deep ueutlprn lfnuaip cerlu tihw praipvuseut iaphymndi.lste lWil be dtol htat atenpit has nalupfi uaniginl esnod, eerth mya eb lutpmlei pede ruselc ihtw -yrallwgoey tx.eueda uoY do ryc itwh .H RuCdiY Tshi wnuol'td be uret orf twah oru pinttae has ni iths eqiunots euecsab we nra'te lotd of any iuinanlg dae.otnhpay a kiln ot a nahodircc ADV

  • mCdaahliy sactmrhioat ssucea aynagmmoolpuhrl mveuener chiwh si alslm lwlhaso re,lusc nsalsp,ei tub nhte eht lrega ifplaun scleceoad gaiunnil hpmly soden aka BOSE.UB rpaedmoC whit noroneagh hte radscgihe is erom ntirehn nda eayt.wr niAag otn eth csae ehre as tis fianplu nda on nenotmi of yna OBEUSO.SB heT echirgdsa ni nrhaoegor is oemr e.ihtkcr Bhto edla to ,IPD tater ofr boht eebuasc nioccfeotn is .coomnm Wtih hobt tpeniat may aveh meos rsot of napi or gnnurib stneansoi ponu itr.iunaon Steriel yruiap gohhut fro

  • ynomldCao tmianuucacm si a amsfttiionnae of HVP 6 + 11 gti(laen .awtrs) heTy kloo kile bgi w.rulcolsafie Tish is in tatnrsco ot loCnodyma atla tath ouy see ni ihiylslsp wihhc si jtsu a talfrte lteat wbnro nigkolo .cleuma

  • lanteiG erHpes (teh rewans ot eth noqutise) liwl etnsrpe hwti utelmlpi nufplai aiclsiurefp eissvecl ro usnoteracli iwht iinottntasulco omtspmys vefe,(r am)ilesa tJus ftsi bettre anth lla het tohre ocihsec I nar rh.hgotu

  • Slpiilshy si teh lsaepisn a.rnehcc UW scbedires ti sa a nigse,l udienrdat wlel ueicbdcrsrimc cu,ler tiwh a cnlea .besa eSe esorwrckc iaosngrms on DF rcomcipos.y Keep ni idmn terho leasspni lrucse are hougalpnarlmymo reuenmve of mldcaiya tu(b eth oesubb aer shwta npfialu otn teh ue),lrc dna uranoalgm auiignnle da(innossoov - sablliekle )tinlrauogmsa tbu hawst kamhrall outba itsh oen si that sti enssalip oihwutt mnadoahypehpytl

nI rot,hs eb f.sea

drdoom  this write-up is AWESOME ... but it also made me vomit. +
b1ackcoffee  This is awesome, writeup, not the stds. +
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +
homersimpson  Gotta love the BUBOES +
... hungrybox made a comment on nbme21/block1/q#49 (An 80-year-old woman comes to the emergency...)
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oodtHhdceyholiirarz si a ideahizt edutiirc t&;=g iezdathi idersctiu era aedostiasc htiw haikaolem.yp

tahW orhte iceutdirs are itsacadeso itwh eolkiypmah?a opLo idresitu.c


Ihiobnniti fo +Na bsperroontia cruocs ni ohbt oolp teuricsid ni(ihtib CKCN sroetocptran)r nda atdzhiei iseirudct ti(niihb CalN .orrorcttrsnaep) llA fo htsi eisrnedca +aN naeecriss nedotAroels .itvcyiat

ltvaReen to thsi m,rpobel nAeseroltod uerguesptla resiexpsno fo teh +N/K+a PTA irtenaprot sbbaro(er +aN oint ,oydb expel K+ tnoi .m)elnu Tsih eulstsr ni oyhelaakmpi in hte bd.yo

gHan o,n r'eseth mroe hhgi ldyei n!foi

ondoletserA dseo eno hreto tmaiotpnr nthig - aiittovcna of a +H ahncnle taht xeslpe H+ iotn teh l.nemu

,So veing tath isht aentitp sah ep,akohmlyai ouy wkon htere si atouprlenuig fo ndosAtroe.le Do oyu hiktn hre Hp uwold eb h,gih or ?lwo lt,acyEx it owdlu eb ighh sbaecue .inc nAtosoerdle ;>= +H lxeepdel toni eth leunm &g=t; iocaltmeb lsoakia.s

oNw oyu ersnuanddt ywh both oplo dcieiusrt nda itehidaz cridiuste can asuce s'whta cladle mhay"ckeliop oltaeimbc aslskaiol."

hungrybox  jesus this answer was probably too long i'm sorry +9
meningitis  I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks. +15
amirmullick3  This is what NBME should be providing with each question's correct answer! Thanks hungrybox! +1
amirmullick3  @hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."? +1
pg32  Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides? +
cmun777  @madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx +
... henoch280 made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
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et.mmy@ ishT oqsiuetn tsets uor kdewglone no nimiblas chhwi si amnllyro a eanistoysr difcncieye daesesi tub het ngitetev astest atht het ysb'o iilnmbsa si uesacd yb a tnieegc oitmanut ni het R1YTP eegn chwih is oshnw ni eht ahcmleicibo tapa.hyw A gnee htat eshpl in the seysihnts fo nlnueEia.m

owN uyo veah to eddunansrt ahtt all cesospurrr eefbro ttha egne is the ptawyha ulwdo slilt eb aveilaabl if not sdereacni chihw kmae 2 of eht oinospt in hte tusinoqe won.rg

uyo alos aehv ot dnsaturdne ii:E mhn)n(eltsau = mmnn)ni(oleaor .ei lnoamr aiemnln wichh is pioevrectt to the n,ski csereaeds earctive nxgeoy eepsics dna geivs het adrk ensgmpti to the ,iris hocoird, ,ksin iahr h.i .(wecnieontlfe )mle.a = lamnf(ee)akin ie. m,hnenpoieal teh noe eetnpsr in our nipetta rhee hhciw is lsse torecietvp igana the uv ra,ys nconat tmngeip nda ntoacn eesrdcea OSR eeentrdag ni eht k. iins hpoe tish hleps

... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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If oyu cdutl'on beemrerm wichh ewer s;seialetn htne eatrnitealv lowdu hvae enbe ot azereli that oniwrgg lidehcrn ened llsec ot siTh qriresue ADN rpnelacotii adn tnolratina.s fO wchih eht lcceuni cdai mtehiy si It irsqeure a tyhmel resfrnat.

shiT is hreew hnimenieto soemc in. teihnMeion bcmesion twih PTA to frmo MSA a( yhmlte nord)o

whossayin  Thatโ€™s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2
... acanthosisnegrocans made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
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nI het agetr osrwd of rD :attraS

nsaP"glonadtri E2 mtsaedie e"eeeeeeeerefve

AIDsSN &;g--t boclk ladosngrtpnai ysn

thisisfine   This is all I heard in my head +7
temmy  Me it was so weird +
peridot  I do want to add, that while PGE2 is the right answer, FA19 p.213 says that IL-1 and TNF are involved as well. However, because the question asks about what is going on in the hypothalamus, the answer is PGE2. If the question had been asking about what the macrophages were releasing to influence the hypothalamus, then the answer would have been IL-1 or TNF (FA didn't specify if it was TNF-a though...). +1
feeeeeever  You know why I'm here +7
... sympathetikey made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
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โ€ข ePr oocroPtl - Olny iclnedu enstipat in the srulset hwo efoollwd hte rocploot

โ€ข sA rateted - ataD iew,s oynl traet teh tbejsusc sa teyh erew tedater xe( - if matepirenlxe atpetin osde hatw eth lotcorn apsnetit are oduespsp to ,do vmoe ttha emxrnlaeepit eiptant ot teh octroln gpruo

โ€ข tnenIinto to ratte - cedulnI lla eipsnatt in teh sgopru hyte erew iigolnlyra oaridzmden ot

... taway made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
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shiT neiquost is epahrsd a,rslntegy btu its' snsellyaeit kgnias a"htw loduw hapnpe if ihts snwoma' hihorstmypoidy eabcme nlcnlduooret vore het uscroe fo rhe "arep?gyncn

reynlurtc her HTS si good g-t;&- woltordecl-elln hYCdTmALyhPHosITiyoEOr ptHi hghi SHT -t-g;& her ptsyorihdhiymo tums TNO eb lecenwotolrdl-l (ued ot onripdusti of eht 4TS/TH/TH/3TR oricnndee xsi)a

oS, wno ttah ew sateundrdn htat eth qienstuo is inkags aht"w wdoul peapnh fi ehr hdyhoytiiromps aws ctlolndrn"uo?e

Aen:srw mticsreni

I nkith htta htis unostieq si herdpas ulcriooayts, btu far be it rmof me ot ceiiirctz hte MULES sniegclni

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +23
b1ackcoffee  exactly how does maternal hashimoto can cause cretinism? +
notyasupreme  @b1ackcoffee, it's not maternal hashimoto, basically you just have to disregard the ENTIRE question stem and the last part of the sentence (if the mom's TSH goes up) means that there's hypothyroidism going on, which causes cretinism. +4
b1ackcoffee  Thanks you @notyasupreme! +
... assoplasty made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
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stFa are eogekncit cetepx( dod ainch F)A, so thye ecrodup esnkteo rfo ygeren pticodrnou lAy-oA(ec)tC trarhe than oecguls. If eth iutsqneo dkaes htaw eht pamyrri ceosru fo ryeneg nocdutpiro as,w ti lwudo slilt eb gyeonclg ad(n ont o,kntee)s uabcsee sith si tiihwn 24 ho.usr eevrowH eratf 24 srouh teh swaenr ucdol eb otenek bisode. esgder,asRl teh oqiusetn pafcsiiclyle dsia eht tp had a rsemu osugelc of 1,00 innagictid htat ew are lkogoin rof tomegisnh atth ivsrpedo a tusebtsar orf egi.nseosngloceu

rnigDu ripdeos fo atoat,rvnsi ttsssrubae rof selsoieognecnug meoc mrfo wot :sreosuc (1) bkoenadwr fo xisegitn m,lucse ro )2( aiv ohandci-d AF ohtruhg .yrnAplioooCp- (*nVaeli sloa efsed ntoi ryipolnop o,AC tub is nto ivlvndoe irgund nvstirotaa &;--gt ese eblw)o

(1) ehT npnuaryet-lieava lcyce reispvod htsi u(gtmialen in sclmeu + ruyetpav t&;--g aenalni --g;t& egos ot eilrv -;t&g- arsntiiamonnat ot ltaretehautaogko-lp g;t&-- raupvtey is draaetesp mfor imnetugla g-t&;- iegmuantl esgo ot reua ecyc,l evupytar sego on to eieseoc)nn.lggosu aLetcat nca aslo eb edsu ti(sh olcdu ehav eneb a ritgh enawrs fi ti eewr ls.i)dte

(2) ddO hican AsF aer oasl oeggcc,nliu tbu esctari adci pi(dvoerd ni het srnaew oei)hcc โ€™snti ddo hia,nc so it si lyno cioeknegt dna nca be dlure out.

gthAoluh elnaiv d(an herto dnbechra aa).. feed toni oApl-oiCPn,oyr teyh are ont dseu in aointrvats abucese stiaontvra liycsttr lsiree on epictah hesTe .a.a rea nto dbitzmaeole in het iervl esubaec eth elrvi asklc -icnhbahdcanre a.a. sreaasfetrn nI irFst ,iAd oiBcmeh soen,cit rednu vsnr/tgaaitiot,anSF in tboh eht iatโ€œfngs etastโ€ chhi(w is thwini teh meti frame of this tns)o,euqi or eht tvoโ€œnsatrai aesttโ€, btho ieiztul ehapitc usgicegenooe.sln My sisnputoma is that nelavi si used rgiudn arulerg ml,estmoiba and tno rgnudi speorid of atnvasrito.

hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +11
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: so you're right to say that the liver +5
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1
almondbreeze  @ toxoplasmabartonella think you are right +
johnnybravo  @revanthshanmukh Although those are indeed glucogenic AA, they are also essential AA, which means they must be acquired from the diet. This patient in the stem has been fasting. FA 2020 pg 91, Lactate and Alanine help contribute to gluconeogenesis during starvation (1-3 days) +
... cantaloupe5 made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
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saCaprul rdpaescaoylhic cscavein aer noeft junoecgtda ot irnestpo ot irpmevo imtcimy.gineonu Fllileang is the nyol wsnear iechco a'tths a epitrno.

mambaforstep  both MHC 1 and 2 are present antigens that are PROTEINS (FA 2019 pg 100). so in order to elicit a T cell response, you need a protein (CANT BE A POLYSACC). that is why vaccines for polysaccaride antigens are often conjugated to PROTEINs--> so that we can elicit a T-cell response (FA 2019 pg 127). +7
lovebug  Flagellum = Protein, (FA19, pg.124) +1
... made a comment on nbme21/block3/q#5 (A 70-year-old woman is found to have persistent...)
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iaddCan si a rapt fo eht nlarmo rfaol fo kisn, udclo csuae mitnacnnotoai fo a raclent uenovs cehaetr.t hTe enqusiot tssaet ahtt het arominsg is purlp,e gndudb,i did ton epnsrod to odarb scpumetr natiiboctsi aka( yhet 'dditn esu laoolcfnuez or iarenoitcpmh B). syLlat, tyhe deshow ti dptael no boold rgaa and rteeh swa no lysmsehio ichwh iieslnmtea hpast eth( lnyo toreh ipbssole nntrdoece .reh)e

Ccocoyrputsc luulyas nloseivv egniismint in coeormpnmoidmismu p.ts E . olci is magr oarehxtipvtsgie onr si ulsyual tminedtatsr yb a rhont on a reso or enmsoeo whit a ytoshir of rgnadgien

hungrybox  Also, the yeast form of Candida is gram (+) +34
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +2
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2
... hungrybox made a comment on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
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oems wnrog enwars:s

me*kas eness /cb lbteayosslm aer urpossrcre to ne,raoygtsulc wcihh sue POM to ftigh off cnoniiestf

temmy  Hungrybox aka life saver +1
hello  Thank you!!! +1
bbr  ....uh yeah im pretty sure we just call em "Auer Rods" now. Appreciate the answer tho! +8
... cantaloupe5 made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
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seSโ€™h kngiitan 054 smmO erp yad so ehs eedns to eeetxcr 045 sOmm rep yda to atinmian .ribmuqliuie uoY natcโ€™ just rteeexc โ€™ssmmO by semvtsheel -- teyh aehv ot eb edovsdsli in smeo uonamt of r.wtae

sโ€™Lte ays uyo xceteer 504 msOm wiht 050 mL of wtera -- that esanm uyro dsekyin era ctiacnetongrn nerui o:t

540 smOm รท 500 Lm = 090 OsmLm/

uBt the miummxa stih yโ€™sadl skinedy anc neccoentrat nriue ot is 504 mLsOm,/ os esh sah ot rxetcee mreo wtare to etg ti taht iu.ldet hTat tanuom fo ratew si 1 L, asebcue 045 ms/1mO L = 054 mO.smL/

woN estrhโ€™e ginohnt snoitppg ehr frmo ctngxriee eht 504 mssOm in an eevn meor deulit urine -- for axplmee fi hes krnda an xrate L fo awetr eon d,ya teh dniseyk uoldc teg ird of that eatrx L twhi het maes monuat of 450 mmsO by linigdtu hte uenir to 504 smmO รท 2 L = 522 O/mLms. utB eth qetsniou ksas orf eht imiummn nmutoa fo watre -- hhiwc is 1 L by het esdkniy +( 1 L rmof hte eotrh tsfuf fro a altto fo 2 .)L

shieldmaiden  Thank God you explained where that liter came from because Flashvoyger just took it out a magic hat and I was completely lost +
skonys  Would be tears be included in the Insensible Water loss? +1
skonys  *my :.( +
... flashvoyger made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
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ehT iotuensq is gaskin you who hucm ewrat smtu teh wonma atke in ot mitaanni the esam i.tlsaomyol ihsT awnmo akest ni 045 mmsO fo tloseu per d.ya Tish is a utni fo eeetmmsarnu -- htkni of ti ikle .rgsma

roF her ot kepe teh eams aloylomsit she mtsu treexec 054 Omsm epr a.yd eTh onyl yaw rof reh to etecxre eth stleou si iav eht kd.synie Teh ylon awy rfo rhe nsikyde ot erexcet 054 msmO is fi ythe reecxte 1 itlre fo eatwr siTh is hte xam ionttercnacno ttha her ndsikey anc roecpd.u (reH enkydsi are tno โ€œuwlrpfeo โ€ehuong ot kmea erh runie yan emor ctecradonten athn ).atht

hiTs nwoam is laso goilns nhotera eltir fo wtare to efse,c eitgsanw dna rpt.senriaio isTh is teh sbโ€œelsinein rawte lโ€.sso aTth smnae fi esh sloing 1 rtlie of tearw ot ,swaet anserpiirto dan efsec epr ayd lusp 1 trlie fo trewa to ireun ceubs(ae esh esend ot esvoldsi rhe ltusoe ni tmh!egi)s,no ofr rhe dolob to tyas teh meas lom,aystloi ehs ustm alrpeec eth tearw ehs slot usth st,mu ta imin,mmu dikrn 2 irstel fo tewar pre a.yd

jean_young2019  great explanation๏ผThank you๏ผ +
... usmleuser007 made a comment on nbme21/block4/q#43 (A 4-year-old boy falls and lacerates his lower leg...)
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  1. (eiย slomsHoobdsat t)lon:tcig nhWiti the frsit ewf ntmsuie of nir,uyj
    1. laieeย nstlpt eth obodl ibgen to ckits ot eth dnjruei t.ies
    2. Tihs tiaavctes hte ,leesttapl sacginu a wfe hisngt to ae.nphp
    3. heyT cagehn oint an oosurmhap ahep,s rmoe etsuailb ofr n,ilcottg adn eyht aereles micehcla glnisas ot ptoemro ogci.nltt
    4. sThi esrtlus ni teh toacinatvi i,fnfbrย io whihc smfro a esmh adn scat as ""eulg to bdni ltepleast ot chae t.erho
    5. This semka ottย lahaย tc vreses to gplu eth bkaer ni eht bdool se,elvs insne/piowtgegvnlr rfteruh 5[[le]gn]b.6ide

  2. aiaIomtlmn:fn uniDgr tish aepsh, agdmeda dan dead escll rae rcelaed o,tu logan thwi cbeaitra and otreh gehstnaop or
    1. ihTs penpsah uorhgth het esprsco ct,sย agoiypsofho erewh ithew oldob scell "te"a ebsdri yb ngifelung .ย ti
    2. leelPevitrad-edt hwotrg crreย sftaao esledare inot het dwuno taht eucsa eth itginaomr nad iivodisn fo selcl gduinr eth eavortfliriep a.speh

  3. irietaonfPrlo gwro(th of nwe sts:)eui In isht ย lsn,ogitsoeepnagihedcoroย ,lย aep,estnlnuingaaioisgaย n iย tfmistro,nuseao peoalinthzilai,iet and wdnou cnoorattinc r.oucc
    1. nI sensnage,iiog urlcvsaa hnletildaeo clles rfom nwe doblo
    2. In bfarlsopiai dan nnuaotaiglr itsuse niafobmย rwo,isbrtlarootย gsf nad ofmr a wne, arxsย ruonacirleiollpvtela mtaMC)rxiEย ( by ecrngietx eaonlclg odanin.enย cbrfti
    3. ,rtcnorlunCey aipetrlaznelti-hieoi of teh sdpeiermi ,rouccs in weplihtahhย iicel rย creiteplloafsel adn cra'lw' opta het ndwou ,bed ngdpiivor vorce ofr eht enw ses.iut
    4. nI wondu ioย ,amoย nsyrttsncorceabisfaoblteecrd eht zsie of teh uwndo by gpnriigp eth uownd eesgd dna ciagcnnttor usgni a aechmnims atth ebreslsem htat ni tomsho umsecl l.cels
    5. hWne eht ells'c loser ear sloce to ,olceepmt dueneedn llecs gtosuperosย p.daino
  4. Monrtaiaut demnlr()iego: Digurn tiuoaratmn and inelm,rgoed

    1. olgaenlc si geaednlir oalgn nontise ielns, nda clsel atht ear no gneorl eneedd ear mderevo yb mdpmragoer elcl ,thdea psroย

  5. Aperiomaxpt ismte of the fiefertnd phsase fo wudon hgein0lย tiah,w1][ edafd teanlvrsi marnikg intaabsutsl rintaaov,i nigdepnde anyiml on dnowu ezis nda nihlage isoo,nntcdi utb igema eods not cnidule aomjr emrimnitpsa thta ucrscaย ehocni wo.unds
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +
... pparalpha made a comment on nbme21/block1/q#35 (A 7-year-old boy is brought to the physician by his...)
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adeL toyiTicx :

seC:aus rsiupdntoi fo mhee sneisthys iav tnhiobiini of AAL nlol(veaemuitani dthearydeas)


A: miAane

B: loshiiBpac inspipgtl

C: Ciolc

D: iaaDerrh

E: pEoalcaepthnyh

F: oFot dorp

G: Gmu woi/osdghpsrtte ooe/ngtutitarard

H: NTH nad ehirreuyepacm

threO nessraw:

cniZ efceidicyn:

aeCu:ss low i,nekat oCs'hrn eissead

dnFgsii:n mimune s,nytfduinco midrieap ndwou eilganh rf(o eht godielrmen ehsap fo nudwo ig,hnlae cizn is deened yb atootlerepemnlassi ot krabe dwno pyet III nlg,oae)lc ,amysigdphnoo readrhi,a iite,dsamrt capal,oei nmraobla teats dan mlesl

sexcEs is rar.e.. ubt cna dlae ot d/vn/ nda laiombdan ainp

uniMsameg yieifdcecn:

u:sseCa natolcni,ge y,oupialr ttnlirioam,un xivtleaa ueabs

dsFgiin:n ytnt,ea tmpraeure rulanirtevc otonnt,aicrc nicsredae TQ rneivlta

21B yiinccedef:

Cesasu: nvaeg d,eti iseurncopi ae,amin ecpaniactr s,uesis grsiact asspby er,gyusr mrtpiobnoasal C,hr(no )rs,epu olyhrltihiDpbuom uwao/lemramcptt fneniotci

niisgnF:d ic,cycmrtoa tmellgabocais ami,aen orenu ,mssyptom nreseiacd oyecstnimoeh nda MAM eellsv ni ersmu

Idaecnres mtiniaV D:

uesCsa: tugaasolurmon adseies isa)r(oodssci

sngi:indF noeb rsnip,roote oto cumh ,cmciula loss fo pteiptae, stopru

lovebug  2019 FA, pg 411. +
lovebug  Nephrotoxicity results from lead exposure because the kidney is the main route by which lead is eliminated. Lead is absorbed by the proximal tubular cells of the renal tubules, where it binds to specific lead-binding proteins. +2
... drdoom made a comment on nbme21/block3/q#21 (A screening program is instituted for detection of...)
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2005, ttednuss ... but ouy fdni uto nuridg oryu talniii ncerse atht 005 ayaledr heav eth a.sidese ,So rekstuito hoste p.lpeeo That elaves 0002, unssedtt how โ€™tdon avhe eht

Over the ouscre fo 1 e,ayr oyu vicodesr 002 usesdntt dpevdeleo het cetnof.nii T:hus

200 new caess / ,0002 olppee owh โ€™dintd vahe eht sieeasd hnew oyu strdeat yuor sutdy = 10 pnceret

,Tciykr yirtkc NBME ...

sympathetikey  Ah, I see. Thank you! +
niboonsh  Im mad at how simple this question actually is +7
sahusema  Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence +3
daddyusmle  fuck im retarded +2
skonys  Must be Florida State University.... +
... hayayah made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
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P. 19 of AF sha a uqcki etpnnlaxioa rfo !sith

lalyBcias enoc 'ryeou ni a argtnvis taset ers'the tilsl ctiepah segcguoseelnnio gnogi no as( lwle as unsig FA)F but hte eoeusnioegnslcg is ginocm orfm peirlehrpa uetiss ltetaac and n.elnaia

... cellgamesgojan made a comment on nbme21/block3/q#35 (A 63-year-old woman comes to the physician because...)
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AV Fsalstui e-rtrou obold omrf teh atlerira emysts to eht vuesno mtss,ey bnpsiyas-g het Areliestro = enrcaeIs LP ;&g-t-- NRSAECEI V.R llA in lla = aernsceI OC.

doArgcinc to oU,dWrl hte rereilstoa rae a moajr cursoe of ratssneeic ... os sbapysign eht estrrelaoi ersuslt ni a reseedac ni Tatol eiehPrplar ansReseict ... gsnuaic na cearines in eht ater adn mvoleu of dolbo tngeurirn ot the I ma etptyr urse rheet si emro ot eht pshoyliyog nhiebd th,si tub I heop sith dalpxneei a lttil.e

big92  "Immediately following creation, arteriovenous fistula (AVF) is associated with an increase in cardiac output (CO), achieved predominantly through a reduction in systemic vascular resistance, increased myocardial contractility, and an increase in stroke volume (SV) and heart rate. Over the following week, circulating blood volume increases in conjunction with increases in atrial and brain natriuretic peptides. These alterations are associated with early increases in left ventricular (LV) filling pressure with the potential for resultant impact on atrial and ventricular chamber dimensions and function." (PMID: 25258554) There's also another study by Epstein from the 1950s looking at the effects of AVF's effect on CO in men (PMID: 13052718). Apparently, the increase in resting CO is a big problem because it can lead to high-output cardiac failure (LVH). +31
hungrybox  Jesus big92 you went in on the research lmao u must be MSTP +6
temmy  big92 you are right. that is why pagets disease pagets have high output cardiac failure because of the av shunts. +4
kevin  what is "increase PL" +3
jhan17  According to wiki "When an arteriovenous fistula is formed involving a major artery like the abdominal aorta, it can lead to a large decrease in peripheral resistance because it by pass arteriole (where major BP is formed) . This lowered peripheral resistance causes the heart to increase resting cardiac output to maintain proper blood flow to all tissues." +
... mcl made a comment on nbme21/block2/q#30 (A 44-year-old man comes to the physician because of...)
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ihsT si a reyttp godo fregui ngsohwi eth noosnervic of mbraenem hsdpilopphsoi ot iaodncachir eiokunsiatdreecl/

kladoBec of OXC eyznme by fiunprebo usesrtl in erceaesdd rutpnodcio of gaitnnsdparslo 2H nad 2E, hwlei uancgsi teh rrpcuseosr to ck"ba p"u ds(increae rodnchiaaic .ad)ci hTsi, ni t,rnu ursslte ni rdcinesae ticrndopou fo k.rlneutioees

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +4
... imgdoc made a comment on nbme21/block2/q#33 (A 68-year-old man comes to the physician because of...)
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I thgotuh toaub it ikel it:sh tnitPea si gnvaih ygspoeihncc ED - sti lal in his eda,h dliobi si mnoarl adn tncraluon noirceets rea n.rlmao

fI sih esttToorseen leelv aws low - obdiLi esrdedec.a f I his uveosrn mtesys (shaitp/)ayatscmaetypmecihrtp asw degdama - ntraunclo eeotincsr ersa.eddec

eoHp tsih eshlp.

sars  Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +2
... hayayah made a comment on nbme21/block2/q#50 (A 65-year-old woman comes to the emergency...)
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erhCetat tlc:epamne


alRcle htat eth nlug axep teednxs bveoa teh stifr rb.i

hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +32
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +12
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +5
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +
... hungrybox made a comment on nbme21/block3/q#3 (A 55-year-old African American man with hypertension...)
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hTe 2 ntomdansmcem fo etichs on:isusqet

  1. 'oDnt vree ickp an rnawes heerw you douns lkei a ckid
  2. D'nto veer onulsct teh ihctse mmcetoeit

derevS em lewl on hsti eonituqs.

linwanrun1357  If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +3
champagnesupernova3  If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1
brasel  also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1
... beeip made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
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I ihtgm eb eht loyn spnreo no rtaeh woh gto siht oen nrg,ow tbu sd:leagesrr

I"TT lsaynisa elcidsun yeerv ebsctuj hwo is dimoenradz rdanccogi to ndimreozad nttretaem n.amsngtsei It isnroge oanpcclni,eonm ocotrolp eanisov,dti lrwiatw,ahd and hantnigy htat sphaepn traef .adnorztaon"mii]1[

yo  You're not. I also goofed. +21
seagull This video is a pretty decent explination worth your time on the subject. +2
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +
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Thsi ash eben a otghu ceonptc fro em ot ,gte btu I nkhit Im' nlilyaf eerh:t

Teh mtes is ebidnsgcri arimpyr aaeldrn ycucnsinfeifi, ro .Adis'odsn

  • ATCH si gnieb oecepvroddu-r to tuiemslta the slearadn to ecrdpou ooicl,rts tbu hyte a'ntc dr,esnop rieeth edu to prahoty or tsuritnocde (,BT nu:muiaoemt 4,RD .)etc
  • ehT trsif 31 naiom scdai fo ATCH nca eb eacdlev to rfmo M,ฮฑ-SH which ltieuamtss matclyes,noe ngausci epntyinteogrihpma
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10
hungrybox  thank u for this answer +
bilzcop  Ugh! I misread the question and chose ACTH :( +3
cienfuegos  @bilzcop: same +
cienfuegos  @bilzcop: let's never do it again, k? +1
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +
... hungrybox made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
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hsTi edivo aieslnxp ngailet yymegolbro myreexetl ll.ew

If uyo ftel lyatlot tlso ikel m,e wahct eht oevdi stfri at x2, htne hcekc otu eht ttbomo rugief on g.p 806 in AF 9210.

Rvntalee to hist is:nueqto

  1. SYR toirenps tamstueli eetlndopmve fo setste
  2. isTh tp has estset t;=g& eh tsum evha teh RSY geen no eht Y mmhcooeros
  3. IMF grddeeas eth llnrMaeui dtu,c ihwch udolw soeriweht ecobem hte eltainrn mfleea algitneia
  4. ihsT pt sah nnetlrai lfeame ignetaali &g=t; ddint' keam enhgou FIM

Qizu yuleofsr anr(sswe in a aeastrep :)spot

  1. ihTs estinatp' driorsed can be edtcar bakc to chwhi slle?c
  2. hTis eaptitn adh lomnra .ntaiagile If siht tniaept adh smrlela agtelinia htan ,rnloam ttha loduw be a dfecte in atwh nmeyez?
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +12
... seagull made a comment on nbme21/block4/q#40 (A study is conducted to assess the normal mean serum...)
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niimExnga iateptn orfm a soitugrlo siiplme senBkor siBa wchhi lwoud kews eht otlnoapupi nmae fo umesr uare tnrngeoi ayaw rmfo het retu cratueac an.em he,nT lerzaie oisiecprn is entpenedd no iasitctstla "reoPw" hcihw is rseainedc aebsd no the zeis fo eht pltiponoua fo eht us.tyd rneadcse(i sipnireco = scadneeir iicaatltsts .ewpr)o eohreTfer, an aieesrnc in oppnlitoua of a diebas ogrpu tihw dael to cuacracyni iwth high .increisop

forerofore  to add up, the urologist himself doesn't add or remove accuracy (since this is a blood test), what decreases the accuracy is the fact that in order to be sent to a urologist you probably are sick in the first place (selection bias), so your urea nitrogen is likely to be altered. +24
sharpscontainer  I thought of precision as more of a function of variance. Variance will decrease with a greater sample size. Had a hard time because I was thinking about those 4 darn targets (wouldn't 500 darts look more spread out than 10? but no, the variance will be better) that have been in my textbooks since 7th grade and for the first time I was asked a question about this concept only to discover that I didn't have it down as well as I assumed. +1
peridot  @sharpscontainer I feel you, I thought the exact same thing. Looked into it a bit and I think it has something to do with the way standard error or standard deviation or something like that is calculated, but I'm still confused and too tired to dig further. Also, wanted to mention that this NBME has a similar question but instead it's about the 95% confidence interval - maybe that'll help you understand the precision thing better since the 95% confidence interval narrows with a larger sample size? So it's kinda tied to precision? +
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ookL ta hwere eth pscus rea noigtpni โ†’ spwrdau eehorrtfe ctoi.ra if spscu erwe noawwrdd โ†’ ethn ilrmat aelvv uolwd be the hrtig raeswn

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +4
... hayayah made a comment on nbme21/block1/q#22 (A 36-year-old man with AIDS elects to participate in...)
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n-cCyeteesstneyii mnheckieo recrtope 5 (RC5C) si a noeritp nfodu no eht csaeruf fo 4CD esllc.

yotsubato  Note, this is NOT in FA +2
sbryant6  It is in UWorld. +3
almondbreeze  it's in FA2019 pg.110 +1
almondbreeze  but missing the full name for CCR5 +4
demihesmisome  CXCR4 is also a chemokine receptor. +2
sononono  Uworld ID 953 +2
... drmantistoboggan4 made a comment on nbme21/block1/q#47 (A 26-year-old woman (III-2) comes to the physician...)
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It iasd it wsa atlfa ot lmesa in re,uto nda hte qustnioe edsak auobt vlei bron fg.noifprs Snice het melas ntreaโ€™ geinb norb in het rsitf ea,lcp I idas 5%0 mlsfaee nda 0% melsa.

hungrybox  fuck i got baited +33
jcrll  "live-born offspring" โ† baited +27
sympathetikey  Same :/ +
arkmoses  smh +
niboonsh  why is it 50% females tho? +2
imgdoc  felt like an idiot after i figured out why i got this wrong. +3
temmy  oh shit! +
suckitnbme  This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected. +3
makinallkindzofgainz  @suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0. +4
spow  @suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant +3
qball  Jail-baited +
srmtn  correct @spow affected females= X linked Dominant +
... yotsubato made a comment on nbme21/block2/q#18 (A 34-year-old woman comes to the physician because...)
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elWl ahstt a alrely creud yaw ot cneesr fro di.spe..senro

champagnesupernova3  There's really no other way to say it without using euphemisms +4
drdoom  You canโ€™t rule out suicidal thoughts via inference. +
drdoom  LAWYER: Did you ask the patient if she was suicidal? DOCTOR: Well, um, no, not exactly โ€” but, I mean, she seemed okay .. +
drdoom  LAWYER: So, a patient walks into your office, you suspect post partum depression โ€” a diagnosis with known suicide risk โ€” and you didn't ask if she was suicidal? +
drdoom  DOCTOR: gulp +
beetbox  @drdoom wow ok now this will stick to me forever. Always ask your patient so I can avoid lawsuits! +1
... feronie made a comment on nbme21/block3/q#7 (A 65-year-old man comes to the physician because of...)
submitted by feronie(18)
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ceyitchOorm = โ†“ oestosrtneet ucroonitpd = โ†“ DTH =gt;& epttsoar clesl oduenrg osaptipso. hiT(s aemcmsinh si lmisria ot nisgu ฮฑeru5sacet-d olskecbr ot etatr P)BH.

Appisstoo is hearcicdarzte yb ADN nrtfaoiamtnge so,(kipnys royrks,eairxh k)

hungrybox  DNA fragmentation histopath: Note that degradation in apoptosis is progressive. From pyknosis -> karyorrhexis -> karyolysis. Aka condensation -> fragmentation -> complete dissolution. +27
... hayayah made a comment on nbme21/block4/q#23 (An investigator is studying the regulation of...)
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ypLhm fwlo rtea si luasluy wo.l It is necufnledi mlriypira by the trea fo plyhm f.onoarmti rFo ,xmpaeel fi boold layrlipca rsuepser is canreeisd yb rterlaai asdiotilonav or enosvu itocntocr,sni het wfol aert of ymlph ea.nssirec ,osAl eth fowl tera si etfcaefd yb cressominop fo clyipahmst by aonrntcitco of bhioigrgnen ulurcausetm nad yb veeiatng nractrchioiat srepruse bte.)graihn(

nIiettrsalti sesurepr o(s spursree in eht EC,F iwhhc lduow renecasi fi vnige VI isaeln) nda hyplm owlf are eytisvlipo aretled. A sallm ieancsre in tsteiriiantl uveoml yglaert niarecess ist uers,ersp rogntmpio plmyh oflw htat ctsa ot oerestr eth ittilasinetr oeulmv ot r.omanl

orem on iths ictp:o 4/.smo/Nl/nbnBtht.n/.ho4iwvwksb3oc8g5Ki/.wp:

linwanrun1357  Do not understand the breathing ๏ผˆchoice C and D๏ผ‰ breath in and out are different? +
khanhluong  I don't know if it's correct or not but how I approached C & D was that they both cause vasoconstriction in the arterioles (because this is the lung where hypoxia causes vasoconstriction), which decreases hydrostatic pressure through the capillaries and eventually decreases lymph flow. Maybe I completely got this question right for wrong reason, but I felt that it works with all of the answers. For F) I was thinking that it would cause increased capillary oncotic pressure which causes more fluid to go into the capillary than into the lymph vessels... Here's a picture: +5
... hayayah made a comment on nbme21/block3/q#27 (A 55-year-old woman with a benign nodule in the left...)
submitted by hayayah(1130)
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eTh dirthoy si pluidesp with realrtia obldo morf teh oriruesp iordhty era,ytr a cranhb fo eth xreeltan rtidaco ytaerr, nad teh firnoire oytihdr ear,tyr a bahcrn of hte rcyvitlcaerho k.ntru

... beeip made a comment on nbme21/block4/q#34 (A healthy 8-year-old boy is brought to the physician...)
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tx"rcayEiot nmoia cidsa" errfse to ul,aamtgte hlewi e"gB"oiicn prtanpylae seefrr ot ie,tsrnoy the ursopercr AA ot mnediapo nda .orpnie

sahusema  Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft +10
mumenrider4ever  FA 2020 pg. 239 +3
... ergogenic22 made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
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hratnimoc veatgine = on rrba isdoeb = oernsp ithw YX tngoyepe ro XO cbuseae neiatym uoy haev emro atnh eno X omemchroos ouy haev a rbar obdy tchmn(irao iesopitv)

... hayayah made a comment on nbme21/block1/q#11 (A 27-year-old primigravid woman at 34 weeks'...)
submitted by hayayah(1130)
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HPLLE dosm:nrey iyl evsmoEleedHst a vriLe syewneo zmL .aesletlPt

A nmeonaifttisa fo eeresv m.ppleresacia olodB rsmae ssohw sc.ycttehssoi naC adel to IDC dan cphtaei rselap cbotamasausumh ยŽ rtrupue ยŽ ervsee sipneoy.ohnt

mambaforstep  FA 2019 pg 629 +5
qball  One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand? +1
demihesmisome  Pre-eclampsia, if not severe, can be entirely asymptomatic. +2
misterdoctor69  Her blood pressure is 164/102, which qualifies her as having preeclampsia. +1
... nicnac20 made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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xdMei vnseou yeogxn ntinsoe si the maunot of engyxo bnoud ot blhgoimone sa it usrenrt to eht higrt deis of het hrtae rftae gateinvrl to teh tssues.i

seaDcrede oeyxgn ivdlerye to eth eistuss eud ot rsdeeedca raacdic uopttu ealsd ot hte seiusts tcngirtaxe emro gnxeoy ormf the igsnsap sCRB hnta yhte lnlrmaoy dow,ul hiwhc drsaeseec eth laervlo emidx onuvse xonyeg sntneio.

pparalpha  A helpful equation is CO=rate of O2 consumption/(arterial O2 content-venous O2 content): Fick principle If CO is decreased, then the difference between arterial O2 content and venous O2 content is increased +17
misterdoctor69  To clarify a little bit, the tissues wouldn't necessarily extract MORE oxygen from the passing RBCs than they normally would. They would extract the same amount as they normally would to carry out their own functions. However, because the starting amount of O2 delivered to tissues is lower, you'd end up with less O2 bound to hemoglobin returning to the right heart. +5
doso2222  Heart failure --> decreased cardiac output --> slower blood circulation time (blood is more stagnant) --> translate to increased oxygen extraction by tissues and therefore lowers oxygen tension by the time it returns to the right heart. +

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