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NBME 22 Answers

RAAS
Question#2 (reveal difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDL πŸ” / πŸ“Ί / 🌳



Question#5 (reveal difficulty score)
A 10-month-old girl is brought to the ...
Naloxone πŸ” / πŸ“Ί / 🌳

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

Question#7 (reveal difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading dose πŸ” / πŸ“Ί / 🌳

Question#8 (reveal difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical rib πŸ” / πŸ“Ί / 🌳

Question#9 (reveal difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4 πŸ” / πŸ“Ί / 🌳


Question#11 (reveal difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradation πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
During the first week of life, a male newborn ...
21-Hydroxylase πŸ” / πŸ“Ί / 🌳


Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgia πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemia πŸ” / πŸ“Ί / 🌳

Question#16 (reveal difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negative πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 27-year-old man is brought to the emergency ...
Eversion πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 13-year-old boy is brought to the physician ...
Reassurance πŸ” / πŸ“Ί / 🌳

Question#19 (reveal difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcoma πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosis πŸ” / πŸ“Ί / 🌳

Question#21 (reveal difficulty score)
A 30-year-old man comes to the physician ...
Polycystin πŸ” / πŸ“Ί / 🌳



Question#24 (reveal difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular artery πŸ” / πŸ“Ί / 🌳


Question#26 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Hydrochlorothiazide πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
During a clinical study, 15 patients with ...
Azathioprine πŸ” / πŸ“Ί / 🌳


Question#29 (reveal difficulty score)
A 28-year-old man comes to the emergency ...
Jejunum πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobe πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancer πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
Hypokalemia πŸ” / πŸ“Ί / 🌳

Question#33 (reveal difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flow πŸ” / πŸ“Ί / 🌳





Question#38 (reveal difficulty score)
A newborn born at 26 weeks' gestation has ...
Dipalmitoyl lecithin πŸ” / πŸ“Ί / 🌳


Question#40 (reveal difficulty score)
A 45-year-old man with chronic pancreatitis ...
Pancrelipase πŸ” / πŸ“Ί / 🌳

Question#41 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus πŸ” / πŸ“Ί / 🌳


Question#43 (reveal difficulty score)
A 13-year-old girl is brought to the ...
C1 inhibitor πŸ” / πŸ“Ί / 🌳

Question#44 (reveal difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectal πŸ” / πŸ“Ί / 🌳

Question#45 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Diuretics πŸ” / πŸ“Ί / 🌳




Question#49 (reveal difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
Azithromycin πŸ” / πŸ“Ί / 🌳

Question#50 (reveal difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structure πŸ” / πŸ“Ί / 🌳


Question#2 (reveal difficulty score)
A 65-year-old man starts using topical ...
Thymidylate synthase πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
A previously healthy 28-year-old man comes to ...
Nephrolithiasis πŸ” / πŸ“Ί / 🌳


Question#5 (reveal difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balance πŸ” / πŸ“Ί / 🌳

Question#6 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
4 Months πŸ” / πŸ“Ί / 🌳

erections libido penis
Question#8 (reveal difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled β€˜E’ πŸ” / πŸ“Ί / 🌳

immuno abo_incompatibility complement
Question#9 (reveal difficulty score)
A 26-year-old woman develops hypotension and ...
Antibody, complement C5-9 πŸ” / πŸ“Ί / 🌳

erections penis
Question#10 (reveal difficulty score)
A 56-year-old man with a palpable hard nodule ...
Pelvic parasympathetic nerves πŸ” / πŸ“Ί / 🌳

anatomy
cAMP
Question#12 (reveal difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMP πŸ” / πŸ“Ί / 🌳

Question#13 (reveal difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocolitica πŸ” / πŸ“Ί / 🌳

Question#14 (reveal difficulty score)
A previously healthy 12-year-old boy is ...
Glucose and sodium πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breast πŸ” / πŸ“Ί / 🌳

Question#16 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinoma πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
Ten healthy human subjects are given a new ...
Phase 1 πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 32-year-old man comes to the physician ...
Reverse transcriptase πŸ” / πŸ“Ί / 🌳

Question#19 (reveal difficulty score)
A 50-year-old man comes to the physician 3 ...
Calcium πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 26-year-old nulligravid woman comes to the ...
Hypothalamus πŸ” / πŸ“Ί / 🌳


Question#22 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclase πŸ” / πŸ“Ί / 🌳

Question#23 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bug πŸ” / πŸ“Ί / 🌳

Question#24 (reveal difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failure πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
A 37-year-old woman undergoes excision of a ...
Angiogenesis πŸ” / πŸ“Ί / 🌳

Question#26 (reveal difficulty score)
A randomized controlled trial is conducted to ...
(194/2371) – (123/2365) πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 50-year-old man who has smoked 2 packs of ...
Increased blood HCO3βˆ’ πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibial πŸ” / πŸ“Ί / 🌳


Question#30 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Multifactorial πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variation πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cells πŸ” / πŸ“Ί / 🌳


Question#34 (reveal difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600 πŸ” / πŸ“Ί / 🌳


Question#36 (reveal difficulty score)
Which of the following drug effects is the ...
Anticholinergic πŸ” / πŸ“Ί / 🌳


Question#38 (reveal difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medulla πŸ” / πŸ“Ί / 🌳

Question#39 (reveal difficulty score)
A 22-year-old woman comes to the office ...
Cardiomyopathy πŸ” / πŸ“Ί / 🌳






Question#45 (reveal difficulty score)
An 86-year-old man who lives in a skilled ...
Dextromethorphan πŸ” / πŸ“Ί / 🌳


Question#47 (reveal difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndrome πŸ” / πŸ“Ί / 🌳


Question#49 (reveal difficulty score)
A physician is unable to communicate "bad ...
Countertransference πŸ” / πŸ“Ί / 🌳


Question#1 (reveal difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve root πŸ” / πŸ“Ί / 🌳


Question#3 (reveal difficulty score)
An obese 45-year-old woman with type 2 ...
Diarrhea πŸ” / πŸ“Ί / 🌳










Question#13 (reveal difficulty score)
A previously healthy 26-year-old woman comes ...
Acute retroviral infection πŸ” / πŸ“Ί / 🌳

Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician 2 ...
Intercostal πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
An 18-year-old man comes to the physician 10 ...
C8 πŸ” / πŸ“Ί / 🌳


Question#17 (reveal difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pylori πŸ” / πŸ“Ί / 🌳


Question#19 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Sensory neuropathy πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 43-year-old man is brought to the emergency ...
Fibularis (peroneus) brevis πŸ” / πŸ“Ί / 🌳


Question#22 (reveal difficulty score)
A study is conducted to assess the prevalence ...
Chi-square test πŸ” / πŸ“Ί / 🌳

Question#23 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
25% πŸ” / πŸ“Ί / 🌳




Question#27 (reveal difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalis πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 12-year-old girl who recently immigrated to ...
Praziquantel πŸ” / πŸ“Ί / 🌳

Question#29 (reveal difficulty score)
A 45-year-old man with end-stage renal ...
Bicarbonate πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
Which of the following is required for the ...
Glutamine πŸ” / πŸ“Ί / 🌳



Question#33 (reveal difficulty score)
A 22-year-old man comes to the physician ...
47,XXY πŸ” / πŸ“Ί / 🌳

Question#34 (reveal difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control study πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammation πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
A 62-year-old man comes to the physician's ...
Alternative treatments πŸ” / πŸ“Ί / 🌳

Question#37 (reveal difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMP πŸ” / πŸ“Ί / 🌳

Question#38 (reveal difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressure πŸ” / πŸ“Ί / 🌳

Question#39 (reveal difficulty score)
A 52-year-old man with stable angina pectoris ...
Headache πŸ” / πŸ“Ί / 🌳

Question#40 (reveal difficulty score)
A 49-year-old man has had the gradual onset ...
Essential thrombocythemia πŸ” / πŸ“Ί / 🌳

Question#41 (reveal difficulty score)
A 56-year-old man develops brief episodes of ...
CL x Css πŸ” / πŸ“Ί / 🌳


Question#43 (reveal difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitis πŸ” / πŸ“Ί / 🌳





Question#48 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobulinemia πŸ” / πŸ“Ί / 🌳



Question#1 (reveal difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesenteric πŸ” / πŸ“Ί / 🌳

Question#2 (reveal difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
Acetaminophen πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
A 60-year-old man comes to the physician ...
Alveolar macrophage πŸ” / πŸ“Ί / 🌳

Question#4 (reveal difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2O πŸ” / πŸ“Ί / 🌳


Question#6 (reveal difficulty score)
A population of vegetarians is surveyed to ...
t-Test πŸ” / πŸ“Ί / 🌳


Question#8 (reveal difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin E πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
An 81-year-old man comes to the physician for ...
Atherosclerosis πŸ” / πŸ“Ί / 🌳

Question#11 (reveal difficulty score)
A 26-year-old woman comes to the physician 5 ...
Sertraline πŸ” / πŸ“Ί / 🌳

Question#12 (reveal difficulty score)
A 73-year-old woman dies 7 years after the ...
Hydrocephalus ex vacuo πŸ” / πŸ“Ί / 🌳





Question#17 (reveal difficulty score)
A 62-year-old man with dyslipidemia is ...
Gemfibrozil πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
A 10-year-old girl has a slightly painful ...
Granuloma πŸ” / πŸ“Ί / 🌳


Question#20 (reveal difficulty score)
During a study of symptomatic proximal deep ...
Open-label clinical trial πŸ” / πŸ“Ί / 🌳




Question#24 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-Ξ± πŸ” / πŸ“Ί / 🌳


Question#26 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Meningioma πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
A 78-year-old man comes to the physician ...
Metastatic carcinoma πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 48-year-old man comes to the emergency ...
Splenic vein πŸ” / πŸ“Ί / 🌳


Question#30 (reveal difficulty score)
A 27-year-old man who is a construction ...
Splenic flexure πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A 65-year-old man comes to the emergency ...
Crackles πŸ” / πŸ“Ί / 🌳


Question#33 (reveal difficulty score)
A 38-year-old single woman with a history of ...
Displacement πŸ” / πŸ“Ί / 🌳

Question#34 (reveal difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyte πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜C’ πŸ” / πŸ“Ί / 🌳

Question#36 (reveal difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase response πŸ” / πŸ“Ί / 🌳

Question#37 (reveal difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophy πŸ” / πŸ“Ί / 🌳


Question#39 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cells πŸ” / πŸ“Ί / 🌳


Question#41 (reveal difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4 πŸ” / πŸ“Ί / 🌳

Question#42 (reveal difficulty score)
A 31-year-old man comes to the physician ...
Dihydrotestosterone πŸ” / πŸ“Ί / 🌳



Question#45 (reveal difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cells πŸ” / πŸ“Ί / 🌳

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




Question#50 (reveal difficulty score)
A 31-year-old woman in the second trimester ...
Hematopoietic stem cells πŸ” / πŸ“Ί / 🌳

Recent comments ...

... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +68 
submitted by sacredazn(99)
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ehT ocnepct is a ouoedltcvn ayw fo gaiksn if oyu kwne who VDJ obiitarenmnoc ,sokwr chihw si ttah ti si lucytaal an aepxmle of rlingtae het ADN fo eth /TB y.elpmohcyt

onertShu tblo :hiueenctq So enhw they esu a bpoer tigaasn emos ero,gin adn titguunpto a esiz of .51 bk or 6 ,bk ihts si lgnilet uoy the eisz of eht DNA naefgmtr ni cahe clel se’(tnod erttma fi ythe ays J eopbr ro osacnntt rgneoi bpr,oe ’ehyter usjt yagsni hey’ter anrtitgge msoe tuilencode escnqeue fundo in eth Ig /ClcosRuT teba hanci soucl pyetsecrivel rfo B/T esc)l.l

I itknh het nunisfgco aprt lduco eb egdriwnon woh yuo nwok hreehtw er’uyo rltypa touhgrh nmnrreeaagter nwa(ers soccihe B thur D) or if ti t’hsna ourdcrce at all eyt (crretco ane).swr e,Her the cepcnot is taht B lcsle dgueonr )DVJ( atnreregrmena in eth nebo rwmor,a iehlw T lcels do ti ni eht htmyu,s and ti lla nespahp ta noce. So a asmpal clle in eth obold leik in euilptMl loaemMy udwol hvae fyllu goduenrne me,ibnicnrooat lihew a T ellc in hte odolb dlouc rieeth eb fyull etdacedu an(d evah fiehnisd VJD o)manbricontie ro riateumm n’s(aht tsdrtae DVJ).

niSce teh T lcle ngee was 6 kb nda nldefieiyt rgbegi hnat teh 51. bk ,eeng hte T ellc asthn’ ndouereng rmnitcbanoeoi t.ye

trichotillomaniac  very nice explanation! +28
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +5
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +5
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +1
skonys  My logic was wrong but my answer correct. I am suffering from success. +
fhegedus  wow! this is amazing! thank you! +
... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +66 
submitted by seagull(1789)
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iDd nonaye need to aedr ttah slta tnsecene keil 05 eimts uacesbe eht thurao useesrf to esu betret .agmrram uJts ittrgnu.sfar

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +21
drbravojose  Actually never understand what the author saying at any time. LOL +3
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +
xmen  THEY GIVE SOMETIME WEIRD QUESTIONS DURING THE REAL EXAM !!! AND IT'S EXPERIMENTAL +
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +49 
submitted by seagull(1789)
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hhWic fo eth wilgfolno eoarssn si hyw ihst enuitsqo is bll?u

)1 gisnU eth dorw ""lccciy nsiadet of citylcicr orf tliyarc

2) giKwnon lla of ygimoedipleo fo lal gdsur

3) nhaivg to aoesrn tou ttah igailcthineorcn ftcefes rea obralbyp hte oswtr revo la1hap ro H1 scftfee ot no ac.ettyinr

)4 The icplgpnri oissedpern fo tiyundsg rof -dey-tsoskeaw on edn to yrbpolba do gvraaee on eht .ttes

nlkrueger  yo, re-fucking-tweet +23
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +
tekkenman101  "worst to experience" is incredibly subjective lmao. +1
... liverdietrying made a comment on nbme22/block4/q#15 (A 24-year-old woman, gravida 1, para 1, comes to the...)
 +37 
submitted by liverdietrying(111)
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shTi noe saw a teltli ct.kiyr orF shti noe het eyk is the olw doiarndeioi u.eptak hTis npttaei hsa hhgi T4 and owl HTS ihchw kesam eenss ni a ihheodyytrpr apni,tte ephrsap your rifst hhgttou is tath hist natpeit hsa arevG’s e.isedas owHv,ree ni Gsva’er ryuo rhoytdi is enigb sedmaultti ot aekm mero dytorhi rnhmooe omrf stcrcha and as cshu wuldo ehva an neeisdrac iidioenorad pkaute ceesabu het odityhr is nriigbng in eht dierureq own( lraeleidobd)a inoi.de isTh si wyh ti is nto rGveas seleer(aβ€œ of dytroih honmore orfm a iytrohd satdtimleu yb e)o”nasibit.d

oS if ist not as’rvGe wath uocdl it e?b Fro sthi uydo’ vhae to nkow ttha iotha’Homss hyisTtridoi laso( konwn as noCcrhi ytciymocLph oitshyTiird and si nefot rrfreede to sa csuh on dbaro xmaes ot htrwo ouy f)fo hsa tereh shsape - trifs yhet aer ih,rhprytoyde hetn thudieor,y then the clscsia yothodryhpi ttha uoy ludow xpceet hwit wlo 4T dan gihh ST.H Tish wsa the yek ot tshi u.teqiosn The srnoae rfo stih si that tayonhrtiid erxpasdeio etsibaidon ni Ha’oimhsost scaeu eth yiodhtr ot leersea lal fo sit oetdsr tiyhrdo oemonhr mgniak hte etaipnt hyreyhitprod rfo a htsor prodei fo .itme Afret ihts asimsev sraleee fo ythoird nheomr,o eth besdantiio emka mthe beulan ot amek wen HT dna erfhreteo ethy ceobem hdiutreyo ofr a hrsot eorpid dan ehnt ohyirhpdoyt cwihh yuo wuldo pcet!ex Sceni yhte ’cnta ekam wne ,TH het rihdoty ilwl otn aetk pu teh oenraiddoii adn rhereftoe trehe will be wlo oiinraeddoi paeu.tk ncH,ee eeβ€œeasrl fo rsoted rioydth mrnehoo morf a hdrytio anlgd tlardeinitf by emyyhtoc”sl.p aka thymcβ€œyipcoL assoh)htoi(m .ohs”ittyidir

I ntikh ralseβ€œee fo hdtroiy hormeno rmfo a ptoohmuasmyl rytohdi gl”nda is rnfiregre to osme idkn of dtyroih ncreac in which scea ouy dwlou cepetx htme ot be irsgindecb a ednoul no odonaieirdi eup.tka

ymS​uram dvieo ehre dan slao a egrta etsi in aenlg:er .o/chtapeye/idsdt:ii/ddh/clrpm/gtnqenou/ooasrrnirneee

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +14
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2
... keycompany made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
 +34 
submitted by keycompany(343)
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Ngneroit celaanb si a tesreemmnau fo eitonrp sotbelammi ni the .byod A entiaveg onnrgiet nlebaca aiendtcsi uecslm ,sols sa sinrcedae austnmo of omina siacd rea ibeng zdaoieeltmb ot codperu enryeg. shTi erssicnea hte motnau fo goenntri eertecsd mfro eht do.by Buecase the uanmot fo ignrotne yuo aer igkatn ni is ssle hatn the aomntu of niorteng oyu rae cresgetni, uyo eavh a eigvaten ngtioren blaance.

siTh man is aunermh,oilds toasu,eedm ecatcc,hi nad sha aminaybl.omeuhip eheTs nillaicc dnfisign nipto to rnotipe irtmtlunnaio akKrio(sawh asesD)ei, ichwh suaces edame ude ot eesrdecda resum citcnoo .pesseurr woL cntioco eusrpres in isth asce is ued to ntoeirp ,osls adn enhec a gnatevie grioentn cebal.an

drdoom  Nice! +22
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +5
zevvyt  also, it says that his albumin is low. +
ankigravity  A few other points related to nitrogen balance. Any patient who is growing (i.e., children, people working out and building muscle) are in positive nitrogen balance and arginine becomes an essential amino acid. +1
drdoom  @ankigravity Wow, this is technically correct! (Didn’t realize β€œessential” doesn't mean β€œcannot be synthesized by the body” but rather ”cannot be synthesized in sufficient amounts”; so what qualifies as essential is a bit of a moving target! Thanks!) +
drdoom  Here's the definition from MeSH: β€œAmino acids that are not synthesized by the human body in amounts sufficient to carry out physiological functions. They are obtained from dietary foodstuffs.” https://meshb.nlm.nih.gov/record/ui?ui=D000601 +
... mcl made a comment on nbme22/block2/q#37 (A 63-year-old man has had progressive stiffness over...)
 +34 
submitted by mcl(645)
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hisT igame si .fesluu etoN tath hte tsina eusd esmak ymlien papare .akdr

tieetnVg si lyctipa rfo Psonsn'ikar ade.seis earA D is the aautisbtsn nr.gia

oznefu  Oh nice! Thanks! +
bend_nbme_over  Great image thanks! Even though it was an MSU link :P Go Blue! +
apurva  Saved My life +1
... kernicterusthefrog made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +33 
submitted by kernicterusthefrog(133)
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h"es elfse aeiphpr and eomr dal"rexe reatf tnigrsat :iixkkcgobn siht si a UEAMTR seefdne cmmniashe clacs(si otkxobet iaitnobusml, as ash eebn s)aid. ihTs nsqtiuoe is ujst anpli w.rong sI't otn smiend,atlcpe aeebusc s'it a hat,hyle laislyoc pbatecceal etltou htat riveosmp ehr eolimnota steta; npihncgu gbsa rae tmnae ot eb dhencup uhts( it si latucyal OTN te.auln)r siemDteplnac ot an ctoebj dlwou be ugphcinn a oelh in hre lwl,a ro nikeabgr hre asve (I utsj ikle htat ei.yarm)g tBoh fo htsoe oludw be ertteb atnh pgcihunn ehr laf,iym ro ikrbngea etirh cra ,oiwnwd wchhi si why is't aeitdempscnl so(cusunicon drrtoenieic of an inoemto ot a reafs )ct.bjoe oveHe,rw gckxonikbi si EYLIALTRL na peleamx in rsavlee shcpy eoktbtosx ofr bnioliu.tmsa ahnkT oyu rof ngomic ot ym DET l.kaT

jaxx  Meanwhile, I thought everything was wrong so I went with another Mature defense mechanism. +16
happyhib_  What if, just what if. Her taking time to do lessions was actually hurting her children by her having less time to spend with them and in turn not providing good care for them. (less of a mature defense mech now). Trust me I agree completely just not best answer, but given what we are given you could argue beyond that; amboss even says "a mom showing her feelings of anger towards the child instead of the actual problem, the husband". So in a way she is not addressing her actual problem (which she COULD address). +1
kernicteruscandycorn  I support your assertion, fellow kernicterus +2
madamestep  I like to think of Sublimation as Regina George at the end of Mean Girls thriving at field hockey. +
... joha961 made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
 +32 
submitted by joha961(46)
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ekiL teohrs vaeh a,ids I hiknt isbauolnmit wdoul hvea nebe r,teteb btu imaecpnlsdte romf sritf dia sysa ttah ti s,i drneiciertoβ€œ fo oemtosni or pissumel ot a turlena rnoesp ro ejcobt” so ss’eh iknkcgi reh ayilfm yb kinkgci het ga.b

djeffs1  Not if you're sexist and think its inappropriate for women to participate in kickboxing... +2
chaosawaits  The sexism in some questions is thicc +
... imgdoc made a comment on nbme22/block1/q#37 (A 28-year-old woman is brought to the physician...)
 +29 
submitted by imgdoc(161)
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I ntikh ist eth gtirh FML a(rae C), tno hte tghri bucdnase lnuescu thta si oldniees no eth osrsc eo.ctsin fI teh becdnsau cleuusn ewre lenioesd esh do'nutlw veha duionacbt in her telf eey. hTe MFL msidatee sscro klta beenetw teh acnduebs ueulscn on htob isesd ot eth MFL on hte pseptioo eisd (2 nacbesdu i,ceuln 2 FLM eno on haec di).es In reh ,scae reh rigth MFL nw'tas inufctnnoig ceehn hyw seh aws naigzg eltf btu reh rgith eimddl truces nas'wt ottncagicn to idetame faedtlwr .aegz

siTh uetripc lheps: l:14chnbo/a//up/ttgp0.2pw.hee5ttwth_mcFow1/j-ms09dw-no2puhpt-o/thamn/

imgdoc  *medial rectus +1
... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
 +27 
submitted by drdoom(1110)
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nlaciausoCtl fro dda. hTe lipbboatyri fo het hfetar engib a ecirarr is 32/ ncesi it si onwnk taht he otde’ns eahv hte essea.id Tneh the btbayplorii of hmi gispsan ti no ot ihs ikd is 1,/2 thu:s

  • bloyPaiibrt of dda inebg rrrceai = /23
  • atiyPbilobr fo add ansgisp on eeisads elaell = 2/1

oilastlancuC rof omm. Whti eht r-giyrbHeeWand irlni,cpeP uoy nca eugirf otu eht ilybtabriop fo eth omtehr gebni a i:arecrr

q = 0(40r,1q/0)st0 = 012/0

oS, qp2 = 2 * 21/00 * 090/291, hhciw si appoxr 0/.110

roF het dihcl to etg eht llalee fmor mom, two nsithg eden ot p:paenh )1( mmo umts be a reciarr z[]theyotee”rgβ€œo dan )(2 mmo smut sasp het leaell to cdhl:i

  • tiirbaybPlo fo mom ngbie errirca = 0011/
  • tilbiaPobyr of mom gsnapsi on isaedse eealll = 2/1

gtiunP ti lal tortghee. N,wo obnmeci all htrgeote:

= ir(babpitoyl fo dda inegb re)icrra * b(aiblptoiyr fo dad igpnssa no eiaesds e)laell * ab(tilyibrpo fo omm bineg )riearrc * iytpoiba(brl of mmo aisgsnp no dssaeie el)eall

= /32 * 1/2 * /1100 * 21/
= 1 in 006

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross" +51
niboonsh  This question makes me want to vomit +14
drdoom  lol +
5thgencephalosporin  okay wow +
tekkenman101  You can make this a lot quicker by using simple rules for autosomal recessive diseases. 1) Unaffected parent with affected lineage will be a carrier 2/3 of the time (Aa) 2) frequency in population is super low so you can ignore P and just use 2(q) in order to calculate carrier frequency. So take the square root of the homozygous recessive frequency (1/40,000) and just plug it in: 2(.005) = .01 3) The odds of their child being affected with the two parents being assumed hypothetical carriers is 1/4 (aa) or .25. Dad's carrier chance (2/3) x Mom's carrier chance (.01) x child's chance of being recessive (.25) +1
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
 +27 
submitted by alwaysanonymous(34)
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Hsi tldai ulvoem aws 050 L.m enEy-orptxdrai asw 5+ cm adn aii-ponyetrrdsn asw 2+5. We were uspdoeps ot eus teh deiferecfn ni aaiwry ,rsrpeues adn nto het ritd-eyrospanni apleulr ssurpree 0)2+.(

leapnmcCio = Ξ”VPΞ”/ = 500 / 02 = 52 mcL/m OH2

some-zheimers  Great explanation. In general, also a great idea to pay attention to the units. I studied Physics in undergrad and have got one or two questions based purely on following the units, when the formula slips. +27
endochondral1  is that equation in FA? +
redvelvet  yes @endochondral1, at page 651 in 2019FA +19
chaosawaits  any time you see the word compliance, Ξ”V/Ξ”P should immediately pop into your head. But my question is, coming from complete ignorance, is it just a coincidence that the end-inspiratory pleural pressure is equal to the difference of the needed values? +
... seagull made a comment on nbme22/block3/q#30 (Which of the following is required for the synthesis...)
 +26 
submitted by seagull(1789)
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tuo fo crui,yisot how amy ppoeel enkw ht?is d(not be syh ot ysa uyo did ro n?dtdi)

My pevyort eaonuidct dn'dti igranni hsit ni m.e

johnthurtjr  I did not +3
nlkrueger  i did not lol +
ht3  you're definitely not alone lol +
yotsubato  no idea +
yotsubato  And its not in FA, so fuck it IMO +1
niboonsh  i didnt +
imnotarobotbut  Nope +
epr94  did not +
link981  I guessed it because the names sounded similar :D +16
d_holles  i did not +
yb_26  I also guessed because both words start with "glu"))) +28
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1
jaxx  Not a clue. This was so random. +
ls3076  no way +
hyperfukus  no clue +
mkreamy  this made me feel a lot better. also, no fucking clue +1
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +8
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +5
djtallahassee  yea, I mature 30k anki cards to see this bs +5
taediggity  I literally shouted wtf in quiet library at this question. +2
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +24
drschmoctor  Is it biochemistry? Then I do not know it. +5
snoochi95  hell no brother +1
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2
waterloo  Nope. +
monique  I did not +
issamd1221  didnt +
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1
amy  +1 no idea! +
mumenrider4ever  Had no idea what glucosamine was +
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1
surfacegomd  no clue +
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +
chediakhigashi  nurp +
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1
l0ud_minority  No fucking clue I guessed wrong:( +


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