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NBME 23 Answers

reproductive repro FA19p634
Question#1 (reveal difficulty score)
An asymptomatic 30-year-old woman comes to ...

oncology microbiology
Question#3 (reveal difficulty score)
A 52-year-old man comes to the physician ...

embryology neurology FA19p479
clinical_trials FA19p256
Question#5 (reveal difficulty score)
A study is conducted to examine the ...
Phase 2πŸ”,πŸ“Ί

psych personality_disorders borderline
Question#6 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...

biochem cell_bio
Question#7 (reveal difficulty score)
Which of the following is present in integral ...
Transmembrane regionπŸ”,πŸ“Ί

biochem drug_interactions p450 pharm
schizotypal psych borderline
Question#9 (reveal difficulty score)
A 45-year-old man is brought to the physician ...

bed_bugs micro
Question#10 (reveal difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureusπŸ”,πŸ“Ί

anatomy neuro
Question#11 (reveal difficulty score)
A 55-year-old man who has a 10-year history ...

micro moa
prevalence incidence
hit FA20p315
physio cholera fluids
Question#15 (reveal difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% SalineπŸ”,πŸ“Ί

biochem restriction_enzymes
Question#16 (reveal difficulty score)
Physical analysis of the isolated genomic DNA ...

Question#17 (reveal difficulty score)
A 54-year-old woman comes to the physician ...

biochem pathways 35
Question#18 (reveal difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme BπŸ”,πŸ“Ί

biochem genetics
repro embryo
cd_markers rituximab
Question#21 (reveal difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”,πŸ“Ί

parkinsons neuro
Question#23 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Anticholinergic agentπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 39-year-old man comes to the physician ...

Question#25 (reveal difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virusπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A couple comes to the physician for ...

Question#27 (reveal difficulty score)
An 11-year-old boy is brought to the ...
Sexual abuseπŸ”,πŸ“Ί

neuro b12 vitamins
Question#28 (reveal difficulty score)
An otherwise healthy 82-year-old man is ...
Posterior cord syndromeπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnicsπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 25-year-old woman and her 25-year-old ...
Ξ±-Thalassemia traitπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancerπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilisπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 43-year-old woman sustains multiple ...
Hyaline membranesπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A 62-year-old woman is brought to the ...

Question#42 (reveal difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 65-year-old woman has the recent appearance ...

Question#46 (reveal difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...

Question#47 (reveal difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
Electrical stimulation of the stellate ...
Heart rateπŸ”,πŸ“Ί

Question#50 (reveal difficulty score)
A 45-year-old woman with coronary artery ...

Question#1 (reveal difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporisπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
Cyclophosphamide and some other ...

Question#6 (reveal difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis BπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shockπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
An 8-year-old boy is brought to the physician ...
Serum calcitonin concentrationπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 60-year-old man has had easy fatigability, ...

Question#13 (reveal difficulty score)
A 45-year-old man comes to the office for a ...
Invasion of the submucosaπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A 65-year-old woman with diabetic ...

Question#15 (reveal difficulty score)
A child with septicemia has an antibiotic ...

Question#16 (reveal difficulty score)
Which of the following best explains impaired ...
Increase in axonal capacitanceπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 21-year-old man comes to the physician ...

Question#18 (reveal difficulty score)
A 48-year-old man comes to the physician ...
Perforated peptic ulcerπŸ”,πŸ“Ί


Question#22 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Sand flyπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 44-year-old man with invasive pancreatic ...
Area labeled β€˜Hβ€™πŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 36-year-old woman comes to the physician ...
Fibromuscular dysplasiaπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A cohort study is conducted to examine the ...

Question#30 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...

Question#31 (reveal difficulty score)
A 40-year-old man has had enlarging breast ...

Question#32 (reveal difficulty score)
A 2-year-old girl is brought to the physician ...
N-methyl-d-aspartate (NMDA)πŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Synthesis of viral DNAπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 42-year-old man with a history of recurrent ...
Magnesium ammonium phosphateπŸ”,πŸ“Ί

pharm lipid_disorders fibrates
Question#39 (reveal difficulty score)
A 39-year-old woman with obesity and recently ...

Question#41 (reveal difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canalπŸ”,πŸ“Ί

Question#43 (reveal difficulty score)
A 2-week-old girl is brought to the physician ...

Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary changeπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nucleiπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
Which of the following types of vaccine is ...
Live attenuated virusπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 65-year-old man is scheduled for physical ...
Medial (internal) rotationπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 56-year-old man comes to the physician ...

Question#1 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sacπŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 35-year-old man comes to a new physician ...

Question#3 (reveal difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...

Question#6 (reveal difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cellsπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A male newborn is delivered at 39 weeks' ...

Question#8 (reveal difficulty score)
A 62-year-old man with a blood pressure of ...

Question#10 (reveal difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curveπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 39-year-old man comes to the physician for ...

Question#14 (reveal difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresiaπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 45-year-old woman comes to the physician ...

Question#16 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary glandπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleenπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagonπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screeningπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 60-year-old woman comes to the physician 1 ...

Question#22 (reveal difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudatesπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A pregnant 28-year-old woman is found to have ...

Question#25 (reveal difficulty score)
A 43-year-old woman undergoing chemotherapy ...
Preformed IgM antibodiesπŸ”,πŸ“Ί

Question#26 (reveal difficulty score)
A 27-year-old woman has headaches and blurred ...

Question#27 (reveal difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defectπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cellsπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 20-year-old woman comes to the physician ...

Question#31 (reveal difficulty score)
The parents of a 1-year-old boy with a ...

Question#33 (reveal difficulty score)
A 78-year-old man has had progressive loss of ...

Question#34 (reveal difficulty score)
A 34-year-old woman with a long-standing ...

Question#36 (reveal difficulty score)
A 70-year-old woman comes to the physician ...
Serum sicknessπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118πŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 5-year-old boy who has recently recovered ...
Immune destruction of plateletsπŸ”,πŸ“Ί

Question#41 (reveal difficulty score)
A previously healthy 45-year-old man comes to ...

Question#45 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2πŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A 19-year-old woman is severely burned over ...
Increased metabolic rateπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibulaπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
Genetic analyses of cells obtained on ...

vascular pressure physics
Question#1 (reveal difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2πŸ”,πŸ“Ί

Question#2 (reveal difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitisπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 35-year-old woman, gravida 2, para 1, ...
External anal sphincterπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50πŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetiiπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A study was conducted to investigate the mean ...

Question#11 (reveal difficulty score)
A 40-year-old man comes to the physician for ...

Question#14 (reveal difficulty score)
A 61-year-old woman comes to the physician ...
Closure of the mitral valveπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acidπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
In a study of the use of ultrasonography for ...

Question#17 (reveal difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosisπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
An investigator is conducting a study to ...

Question#19 (reveal difficulty score)
A 6-month-old male infant is brought to the ...
Regulatory T lymphocytesπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 40-year-old man with terminal small cell ...

Question#23 (reveal difficulty score)
A 74-year-old woman comes to the physician ...

Question#24 (reveal difficulty score)
A 60-year-old man comes to the physician ...

Question#25 (reveal difficulty score)
An 85-year-old woman is brought to the ...

Question#26 (reveal difficulty score)
A 28-year-old man has hypertriglyceridemia ...

Question#27 (reveal difficulty score)
A man accidentally touches the surface of a ...

Question#30 (reveal difficulty score)
A study is planned to assess differences in ...
Cross-sectional studyπŸ”,πŸ“Ί

Question#31 (reveal difficulty score)
A 32-year-old man who lives at sea level ...

Question#32 (reveal difficulty score)
A 42-year-old woman comes to the office ...
Spontaneous regressionπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled β€˜Dβ€™πŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 40-year-old man comes to the physician ...

Question#37 (reveal difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipaseπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprueπŸ”,πŸ“Ί

Question#40 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Tail of the pancreasπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 12-year-old girl is admitted to the ...

Question#45 (reveal difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
A female neonate is delivered at 38 weeks' ...
Rough endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”,πŸ“Ί

Question#49 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...

Recent comments ...

... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
submitted by ferrero(44)
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A vyre railmis enotquis I vahe ense in nsbakQ iwll sak hwy a ettapni ithw htgir ehrat iferlau odse ton ldepvoe eamde adn hte nsearw is dcesrinea myhptialc aae.ndirg I gto ihst uonseiqt worgn giiyllroan cusbeea I esednraw aongl tshi lein of isngeanro tbu I hknti ni shti aecs it lla ahs ot do ithw WEREH eth exart serrsupe si micgno rfo.m nI sthi nietoqsu hte tp hsa ldtsioiac pnnshireyteo so you cna think uoatb eth rrpseues sa cinomg far"odrw" os siirntntgcoc picralapylre ephrnstsic nca netrpev an erneaics ni esruserp in het pilarlcay .bed wHeroev orf ihgtr terha arfileu hits ratxe fluid is nigcom rfom teh POSOIEPT noeciidtr as(wckbadr omrf the rtigh th)aer and ngtcsicnotri pepircyallar rpneihtssc can od hotgnni on( pietpsoo eisd fo apylaclri edb) - eht yoln yaw ot vrpeent daeem si to eesircna alcmtpiyh ai.enargd

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +19
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +9
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +38
cr  the main difference between the 2 cases is that in this case the patient has high BP +1
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +7
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2
asteroides  I think they may be talking about the myogenic compensatory mechanism: "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +4
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
submitted by yotsubato(1111)
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Was it stuj em, or ddi e"ag at soten ni eysr"a eraapp GIRTH veabo eth rmbneu fo pnieta,st etarrh nhta het aen.m cWihh cdfoesun me for a dogo 3 t.miensu

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +19
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +9
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +9
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +7
monkey  what is 36 supposed to be? +1
thomasburton  Think the number of people in that group +5
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck's gotta be 99" +6
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +4
veryhungrycaterpillar  This is straight up tatti. I was like what muscular dystrophy is showing up with an almost biphasic age of onset between adolescence and 30s? Fucked it up. +
... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
submitted by sajaqua1(577)
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A dna J errepestn eht liecrga s,aicucsflu heliw B nda I speeernrt eth atenecu .ulcafucssi oeThgret yeht meka up eht solrad auoldi-encmlm alinlmsce r,actt snerbleospi ofr itopnnpi e,pernipoct onreotiip,rpopc rb,oaitvni nad rsruespe. ntIpu si lap.litaires

C dna H akme up the talaelr toclcaisiporn ctrta (slao dlecla het ratella pelanireocbrs a,ic)fscluus psnbsreeoli rfo omtro admmnoc of rilelsptiaa

D adn G eensrpetr the elaltra nmhocalitiasp t.catr It is splrbseieon rof niap nda tmpruaerete .cnudoocnti eTh ntiup asreis ni a ibml t(fel werol yretxeimt ni tshi sce)a, seretn rthhoug het odrlas ootr (ectuprid eewnebt J nad H,) scutseedas nda csdsean ta het noartrie csesurmmio jstu( idenhb E dan F,) adn lianfyl peasnsys on het cdeons errod onneur in the alarlte ancmlptohsiia acrt.t So the msalnacpihtio ttrac is ssbepoierln rfo alarearcotnlt nipa dna teepermarut a.isnnsteo uecBesa ruo inpteta sha oslt nesasnoti on het ,tfel the elosni is in the gi.rht

E nda F rea eht etoianrr apnorictsoilc c.tart tI is neolvvdi ni rmoot ntolroc of mproaixl scumls,e lyyitalpc fo eht tukr.n

nor16  good job +6
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +3
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +2
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +3
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
submitted by hayayah(1130)
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mbaloCoo si na yee tanbrymailo thta cuscor erofeb r.thbi rhTeey' msginsi iepces of suseti ni rtutrsucse ttha ofmr eht .eey

  • oosabomCl fgieftcan het ,irsi ihhcw trelsu in a kl"h"oyee naraeacepp fo eth ilp,up glaeerlyn od tno lade ot oiisvn l.sso

  • oaClsbomo gnivlnovi the rinaet etsrlu in iisnov lsso ni isecpfic trsap of hte ivsalu ife.ld

  • aLger lairnte oamlocbos or oesht faecfintg het pcoti nerev nac asecu wol snoi,vi hciwh nsema ivnios lsso atht otnacn be olclpteemy tcoerdrec ithw selssag or taotncc s.leesn

mousie  thanks for this explanation! +1
macrohphage95  can any one explain to me why not lens ? +
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss +4
qfever  Do anyone know why not choroid? +1
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina +2
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +12
mnemonicsfordayz  Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO. +1
mamed  Key here is that it doesn't affect vision- the only thing would be the iris. All others are used in vision. Don't have to know what a coloboma actually is. +4
azibird  The extra section of that Zanki card specifically says that a coloboma "can be seen in the iris, retina, choroid, or optic disc." Don't you dare talk trash about Zanki! +3
fatboyslim  Honestly, I didn't understand what they were trying to ask...NBME has some weird wording sometimes +
weirdmed51  you are a smart boy @mamed +
weirdmed51  @azibird ...upvoting @irgunner cos you went crazy there buddyπŸ™ƒ +
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
submitted by sne(50)
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ocolAichl = tarnicpeac ie.cfcunyfsiin eliL,icon cloe,i nda mtiialpc ciad cna eb bdoerabs uwiotth canpteairc espisla nsice etehy'r ujts efre tfyta .dacsi iesiyrderlcTg nede ot be nrboke down yb liasspe foebre pooasrintb.

iBel cdias rae teh nima etdmho ofr ntmieilnagi ,hoeolslerct tno iraacencpt yezemsn

rina  also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out +6
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
submitted by stinkysulfaeggs(106)
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Did onnyea esel og nwdo eth: hs'se yviheetnpos so eamby lsl'eh gte stweerahuo eniecrhrifds sromendy ausceeb gtoinhn lees is iakngm eessn to me ta hsti ti??opn? rouet -

rusnT ,uot seevre irlaaam acn ausec crsvoduilraaac leplsaco nad

redvelvet  me too :( +2
abigail  me three :( +2
yex  Me four :-/ +2
link981  Slowly raising my hand as well +2
tinydoc  Sammmme +2
bullshitusmle  same here!!!:@ +2
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +14
aisel1787  me five( +1
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +2
alexxxx30  sammmeeeee +
snripper  Dumbasses unite lmao +
usmleaspirant2020  lol saaaaame! +
usmleaspirant2020  lol saaaaame! +
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +1
veryhungrycaterpillar  I have no idea how I got this right. +
feanor  And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols. +
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
submitted by soph(76)
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oyu ndee ot wkno fdfi bt egietnva spersrue nvaleottini (hihcw si omrlan en)altitvnio adn ivtopeis ussererps vninltiaoet w(hhic is ihacncaeml naie.onvtit)l nI eginveta esresurp naoienvltit teh ragaimhpd cntasrcot kgnami a - uanralprtlei srepuesr hchiw wlosal lvaelio ot .daenpx in psoitvei enniativtol h(et pt damrgpaih is tno crtntcgoina hsut tno exndpiang estch victiay nad not gcreitan het - pr)esrsue het nmecahi si itacrnge poeisvit uperrsse nsidie vlleiao so os vloeail aexdps.n ):

jbc5356  The smiley face got to me more than it should have. Preciate you. +6
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
submitted by seagull(1722)
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Whta a erblitre pueicr.t ehTy eyth dcovree pu tarp of it wtih in.les TFW

sympathetikey  Agreed. +16
catch-22  Start at the pontomedullary junction and count from superior to inferiorly (or medially to laterally): VI, VII, VIII, IX. +3
yotsubato  I looked at the left side (cause the nerves arent frazzled up). Saw 7 and 8 come out together nicely. Then picked the right sided version of 8 +12
lolmedlol  why is it not H or I on the right side; the stem says he has hearing loss on the right side, so the lesion should be ipsilateral no? +3
catch-22  You're looking at the ventral aspect of the brainstem. +11
catch-22  ^Also, you know it's the ventral aspect because you can see the medullary pyramids. +1
amarousis  think of the belly of the pons as a pregnant lady. so you're looking at the front of her +5
hello  which letter is CN IX in this diagram? +
miriamp3  there is no VI nerve. That's the thing. The VI nerve should be in the angle between the pons and the medulla. Parallel to the pyramid. It goes V then VII and then VIII. I make the same mistake and I thought it was the picture but there is no VI par in the photo. They know We count from superior to inferior. +
jesusisking  Don't G and H lowkey look like VII and VIII? I chose H b/c of that +
ljennetten  G and H are CN VII and VIII on the left side, while this guy has right sided hearing loss. CN VI is not labeled in this photo, but is the smaller nerve that arises medial to CN VII and us cut most of the way up the pons. +1
prolific_pygophilic  Mother Fuckers took this with a disposal camera then deep fried it. What is this grainy ass picture +1
soccerfan23  There's over a million pics of the brainstem on the internet and of course, the NBME picked the worst quality, most blurry one for this Q. +
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
submitted by beeip(132)
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Teh tesb I can sa,utdennrd 'ehytre gicndebirs amedeoritnl prlayaphsie, a lutesr fo cesxes sregto,ne a eodrtsi eonohrm thta ncotaelsrtsa to eht uneuslc adn sidnb tsi anoirntrtspic cf.orat

mousie  My exact thinking also! +7
sympathetikey  Ditto. +
meningitis  My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things? +
criovoly  You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS +5
feochromocytoma  The question stem says it's glandular hyperplasia "without" atypia It's just due to increased levels of estrogen causing the hyperplasia +4
faus305  This is a bunch of scientific mumbo jumbo +1
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
submitted by thomasalterman(167)
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laiMraa nac imprai pcaieht ceeglnugsosoein nda can aslo osuecmn csleuog fro ist now ieaoctmlb

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +57
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +9
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: Life-cycle: +1
dul071  i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia. +
curlycheesefriesguy  I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
submitted by yotsubato(1111)
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So ofr dndCaai ew nac seu

zlAeos lz(ceu)nfoloa ii(nihtb Y50C4P eh)ietynomldta

rmchneipAto B e(por mftaioron in augfln ecll r)ambmnee

oinCapfnsgu t(nevper rkclnsiinsgo fo beat nualgcs in lcle a)llw

ro sainNyt orf ralo or elegsophaa sceas eor(p mort)oniaf

Tsih inoustqe is nagiys taht she is tgnika an ALOR grdu to taetr ncdadia ngivi.atsi

crmeiAopnth is IV

iCnfnpaogus si laos VI

os erew' ftle wthi zaeosl

Aslzeo nhibiti ntssieysh of tgeolrreos yb itnibhgnii YPC 450 htat vcstenro aretnoolsl to gtoeelr.ors

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +1
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2
staghorn  Me - picks Metronidazole -_- +1
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5
turtlepenlight  I have seen that on the wards so I hope it works! +
fexx  and my smartass picks amphp B +2
avocadotoast  Please no one give a poor girl with a yeast infection amphoterrible +3
fatboyslim  @alexxxx30 according to FA2020 page 153 Nystatin is only for oral. In the 2018 FA it did say it can be used for esophageal but they edited that in 2020. +
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
submitted by seagull(1722)
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Tshi is a epty II aelRn uuTlbar ocisAdis. My liaMedc ohSloc Nerev utgtah iths to .em diD yuo losa og to trvopey edm hc?oslo I'm serirdups etyh even gaev us otilet pp.ear

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +11
yotsubato  I didnt have physiology in my medical school. None, zip, zero, none. Nor did I have biochem. They said "you learned all this shit in undergrad, youll memorize it again for step 1 and forget it promptly" and then just moved on. +9
jcmed  In the Caribbean thats 1 thing we were given... lots and lots of toilet paper +3
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
submitted by sajaqua1(577)
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ratiCcli toipns rfo itsh u:oqisent 5 arey dlo yob, uemmnspdiserosup ebceuas of ec,tmorpyheha 2 yad orihtsy fo eefv,r ocu,hg sesrtnsho of aethrb, eiebrfl 1(081. F), riptsnieoasr ,4/n6im hwti ioycssna nad eldaneizrge urvseialc neEsvxtie dnoulra aotinnf.tiirl

Of eth pnooits seldti nloy easlmes and VVZ eigv a hras. A srha mrfo eealssm uulayls rsatst alrsrtylo nad cdndsees ad,lcuyla adn is tafl and aehrutyt.soem By rancttos, VZV xkoc)cnp(ieh psensret wiht rzaegnedile rsah atht ylkciuq tnsainotrsi rfom lmcuaar to lurapap nhte to lriuevasc.

sympathetikey  Good call. +6
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +7
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +5
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +2
... wired-in made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
submitted by wired-in(70)
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nnMatnciaee soed roaulmf si (ssC Γ— Cl Γ— )tau Γ· F

hrewe Css si -tdssatyetea getrat aspaml c.con fo ,grud Cl is canea,lrec atu is sgodae nlvterai & F si boiaiibl.vlayati

tieerNh dgsoea lerinatv onr iiaylbatibavoli is vn,gie so igringon htoes a± glgiugnp ni eth suemnrb alrc(uef ot rcntveo tinus to dm/gk:g)a/y

2 1(= /gmuL Γ— 1 00m01g/ gu) Γ— 90.0( kLgh//r Γ— 0010 /1mL L Γ— 42 h1/r a)yd
= .9225 /kagm/dyg

hw.ih.c. nsit' yna of teh nrwaes ccshoie s.eldit hyeT tmsu veah onredud 9.00 Lhk//rg ot 01. Lh/r,gk/ nda gnoid so gsevi ytcxlae 8.28 /dgmka/yg eocc(hi )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +77
hyoid  ^^^^^ +11
seagull math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9
praderwilli  Big mad +10
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +9
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18
bigjimbo  JOKES +1
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but iΒ΄d appreciate if someone could explain it. +1
d_holles  LMAO games NBME plays +2
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +5
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +3
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +21
qball  Me after plugging in the right numbers and not rounding down : +1
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😑 +
yesa  12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s +
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
submitted by water(40)
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ygnr,iispursl I alatluyc nleader hsti frmo eth Magci hSoclo uBs ewnh I swa a dk.i shTa't eth nyol nesaro I got htis h.tgir Tknsah .Ms el!Fzrzi D:

paulkarr  She taught me more than my med school professors did... +5
... sajaqua1 made a comment on nbme23/block1/q#28 (An otherwise healthy 82-year-old man is brought to...)
submitted by sajaqua1(577)
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iPtooersr odcr msoerydn sroccu edu ot otifinancr of het tprorsoie flha of hte ilapsn crdo, mrof oloiusncc of het iteorrpos spilna r.terya ruO etitpna etnspesr ihwt edsracede tannissoe to pknpicri wlobe teh velle of hte sekne as wlle sa nkwglia wthi a -dbsewiade tgai, lykeli dnniigtiac lsso fo o.oriirponpeptc Teh tiapten is salo inaecm hwit segpn-heeydmtre ne.lphorstui

nmtseyergedpHe eolpisrunth era clilptayy saudec yb an lanibtiiy to aemk eougnh AN,D ecadsu yb a clak fo easesnryc precrosrus nda itinmvas nicilgdun B9 elt)(ofa nda 21B .(b)aoinlmca fI teh einaptt si ealfto cn,eifdtie we see dvaeetle oiceseymhont yeicced.nfi If het tientap is B12 ifceeint,d we see valdteee iomytnlmlhcea acdi and toechinsyemo mpHniyyeomehsotciaer nac sercenia bsoms.ithor iTrmsbosoh in hte ipsrroote palisn ryarte cna eucsa poestorir rodc .domyrnse nI io,tanidd alkc fo mnitiav 2B1 mpriisa ilnyme motoafrni dan asled ot buacSeut boemdniC tiDeeon,reagn chhwi fefctas het laaphicSmnito tatrc ninugoac(tc ofr dsradeece nicrpkpi ns),tneoais calipsCrtinoo Tc,tar nad laDrso o-mCalnieMudl smiescLun tacTr tcagoinunc( orf teh dceuder peticir.ooorppn

A) oinrAter dcor esrmyodn- lsos fo rtomo c,momnad sa elwl as lalaitreb ossl of heat adn i,npa the ietnapt ash nto lots tmoor nfticu,on so it ocannt eb s.thi B) lnetraC codr rsn-mdyoe petsnrse as a nbiamitocon of motor adn osreysn sols, luylsau twhi adreldb Tshi netapit sedo ont lspdayi tmoor sosl ro aedlbrd C) oHmirced dy-emsonr slAo dlacle aBdro,uwneq-Sr htsi si tlpmeoce jnuiry ot eiehrt eht lfte ro trihg dise fo the apilsn .ocdr tI ntsspree hwit ortom dfnuinscoty and efelxr yonftducnsi eiialayslptlr at hte elevl fo het ls;eino osls of preup omort cmndaom blewo hte sinelo slriayipeallt (csasipt sae;rpsi) slos fo raolsd nrdra-iloceucm iaoetssnn eilapayrsltil ta nda ewlbo hte n;eliso nad sosl of aipn dna ttrmueerpae sntneaois neoaltyaratclrl 2 to 3 ertrbvae ebolw teh lnsoei. E) grmaenySte sm-doynre a gatolniecn eliafru to voelepd atpr of eht ilnspa ocdr. eTh wen eston of tpmssmyo ta 82 easyr odl eskma hsti na ieklynul gisi.nso,da

yb_26  amazing, thank you! +
aisel1787  great explanation +
rockodude  sensation to pinprick is DCML tract. SCD affects spinocerebellar (not spinothalamic), corticospinal, and DCML. otherwise good explanation. +2
azibird  Sensation to pinprick is not dorsal column-medial lemniscal tract, it's spinothalamic tract. So this patient has a lesion of the dorsal columns, spinothalamic tract hypersegmented neutrophils, and anemia. What the hell is going on? How is this just posterior cord syndrome? Spinothalamic is not posterior cord. +4
makingstrides  Like most of these questions, pick the closest/ best answer. For reasons above, this is the best one. +
skonys  FA19 pg69 says B12 deficiency causes SCD AND parasthesias. This patient has progressive numbness/decreased pinprick, ataxia (spinocerebellar & DCML). Also it's important to remember that B9 and B12 both have megaloblastic anemia but B9 DOESN'T have neurological symptoms. +
... welpdedelp made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
submitted by welpdedelp(247)
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oN itde ,fcyiceidne het entapti had cxsese ecntraoe eud ot ihs deti

sympathetikey  Would never have thought of that. Thanks +10
medschul  that's messed up dog +22
hpkrazydesi  Excess carotene in what way? sorry if thats a stupid question +
davidw  this is directly from Goljan "Dietary Ξ²-carotenes and retinol esters are sources of retinol. Ξ²-carotenes are converted into retinol. (a) Increased Ξ²-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +8
davidw  Ξ²-Carotenes are present in dark-green and yellow vegetables. +
hyperfukus  ohhhh hellllll no +7
dashou19  When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +7
cbreland  I'm okay with missing this one +4
veryhungrycaterpillar  That was fucking stupid. I've known this excess carotene fact since 8th grade due to a friend getting it, but I still wouldn't have thought of it. I went with anemia, figured it had to be folic acid since B6 would have shown up sooner than four years. UGH. +
... sajaqua1 made a comment on nbme23/block1/q#18 (A 15-year-old boy has nasal polyps and develops...)
submitted by sajaqua1(577)
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neymzE A nasstd in fro olpPpahiohess 2A, ngintur ihohpoipsldsp in hte ecll emeabnrm tnoi cndhaircoai ai.sdc Fomr etrhe, zyEenm B tndsas ofr yxceCeyslooang ,)OX(C ewhil mzneyE C tdanss rof oagyxnLs5eip-e O)L5.-( -O5L ocrspued -,HE5PTE wihch is nduert iton .eolrtuiksnee seonrkteeLiu payl a ubldeo eolr ni vetens ikel a,amsth aeubecs hety cueas btoniionthcrnrcocos eens( ni hits anepit)t and yb taingc sa alciechm ctartantast fro floiamyamntr sle,lc ewhso tyvicait lliw clseo the iwaayr trfh.rue yB cngbiokl XOC relyab(pmus ihwt an ASI)DN, we ealev mroe fo eth btuasrste idorhaacicn cdia rfo -O5LX to uyatltilem onvrtce tnoi s.uerknteioel iTsh is eth sasbi ofr oa-mireptnhnitisnat,sala-r hwchi si nreulyteqf otesaidcas tiwh lasan p.soylp Ss(tame'r )ditra.


)D lPsoancrciyt tnysaehs . )E oamrhonbxeT tessynha

... hayayah made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
submitted by hayayah(1130)
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eH ahs laefc ncnnntoiiece so ish artlenex crnhtspei is gd,damea cihwh is aindtevren yb eth nuddlepa n. -2)(.S4S Teh lvceip npnshclaci vnee,sr hiwch amiteed teh ereonict se,rsocp era salo SS.24-

thomasburton  Why could this not be dysuria? +3
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps. +16
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI) +3
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner +2
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence +
... praderwilli made a comment on nbme23/block2/q#10 (A 50-year-old man who lives in eastern Minnesota...)
submitted by praderwilli(74)
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nts'aW rues outab cskaiieRt,t utb I wnek obnri fo eosxid was on sih ccteryli ni hte retnsotah dna gegitnt teorturd by het ervampi b.baes

mimi21  LMFAO facts ! +11
... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
submitted by thomasalterman(167)
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hSe stuj oecmepdlt hte uocrse of birmxtai,u iwhch sargett 0CD2 ep.trcsero lBc-le deecificny nca oepesirsdp to arelacbti cnti.enfsoi

b) BM aifeurl si not otaiecasds wiht b)iuxt acmri n word)g )n rgeow ihst csourc i/nw 0-17 days of sngtrtai entatmte,r dna dluwo not ucorc freat ioctnlmpeg a o-htm4n cuorse fo amiubx.itr

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +21
stinkysulfaeggs  Same. Crap. +2
medstudent22  Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization. Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded. +2
... colonelred_ made a comment on nbme23/block2/q#28 (A cohort study is conducted to examine the...)
submitted by colonelred_(118)
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bulaAtrtietb risk = ciceniedn in pesdxeo – ndceienic ni xopesuned

= 0310/,00 mr()sseko - 030/0,03 )skoonmnrs(e
= 003. - 001.
= 2.00 (os eht ttibalrautbe ksri is otaub )%2

nliyppAg it ot a ppluonoait of 1:0,000

= 20.0 * 00,001
= 020

charcot_bouchard  What if i tell you this is a ques of Attributable risk % in exposed? AR= 0.02 / IR in exposed (30/1000) = 0.6667 30 case in 1000. So 300 case in 10,000 0.6667 x 300 = 200 or in another word 66% cases of 100 lung cancer cases in smokers is actually due to smoking. so in 300 cases of smokers 200 is actually due to smoking +5
charcot_bouchard  This is a mind fuck. Lemme tell u guys if any consolation while doing the ques during test i did it with AR = 0.02; NNH = 1/0.02 = 50. 50 persons smoke to cause 1 cancer. 10K smoke to cause 200 cancer. +3
ls3076  Sorry if this is a stupid question. Why is it incorrect to simply apply the same proportion (30 cancer per 1000 smokers) to 10,000 smokers? +2
krewfoo99  @is3076 Thats exactly what is did. I still dont understand how that is wrong. But i guess they want us to think about it in terms of AR +1
hhsuperhigh  @Is3076 and @Krewfoo99, If a person doesn't smoke, the natural risk of getting lung cancer is 30/3000=1%. The smoker's risk is 30/1000=3%. This 3% is not purely contributed by smoking, but mixed with the natural risk. So for calculating the pure contribution made by smoking, you should use 3%-1% which is 2%. And this 2% is the pure contribution of smoking. Not all smokers get lung cancer, the same thing, not all lung cancer among smokers are attributed by smoking. They may get lung cancer anyway despite smoking or not. +18
... sajaqua1 made a comment on nbme23/block1/q#42 (A 68-year-old woman comes to the office because of a...)
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hTe enaptti ahs a iorpr rhioyts fo msyeytecrtoh hwti ltrlabiea segrt,hmoconopp-oliaoy nda eevidcre naleetxr ebma ioaadtnri ot het i.splve eTh iantpet wno dpsiyasl ieohhdsorsrypn dan rdro,yeehutr hitw itasdl lreeaurt arnnwirgo l.byerlilata Teh letskleii ontoip is that ew ear egeins esasionhd orfm upirosev egsuyrr ntcctisro het u,treser iasucgn ish.t

)E ihleUlraot naioarmcc (olsa adecll tiatslrainno ecll )imaaorccn si laso a liypitbiso.s Waht aeksm this nyluklie is het ti:ancolo tibalea.rl heT opirr tereoysmhcyt nda bietarlla pha-micsyogeooonrlpto dwoul aleev casr tiuess on tboh sidse of the ,ybod tub eht dsod of rlltuihoea amainrcoc nrgsiia belllitarya rea yerv l.smi

)A eTh taptien dah a ymcetoye,rsth so het odds of reneucrtr eaclivrc aaimcrcon rae aols iinreybcld low. )C adn D) rteUrlah ooydncmal nda rreulaht stnitolarain ellc mlpaiplao are ni hte rnowg oanotilc to ocactun ofr laaebltir rleahtur rrgawnoni htiw yurrdet.eorh

stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect). +14
spow  Why would the onset be 15 years later though? +3
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor. +3
yesa  My understanding is the cancer risk with radiation is late-onset, a decade or more after the fact +
fatboyslim  Why does she have increased daytime and nighttime urination? I couldn't figure that part out. +
weirdmed51  @fatboyslim not relevant +
... mcl made a comment on nbme23/block3/q#28 (A 10-year-old boy sustains an abrasion on his left...)
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onusB ciqku evirwe

... cocoxaurus made a comment on nbme23/block1/q#43 (A 65-year-old woman has the recent appearance of a...)
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ePr OUL-DRW anencoAiaocmrd si oacsatiesd /w lgun rsciagnr laeetrd to ouautrlsoagnm daise,es old PCOD hcrcoin() and eadmga edu to rnurtecre mneo.unpai

arcanumm  Here i was thinking i was being clever by not being tricked by distractors when metastasis is more common... +7
brise  Metastatic would have multiple lesions +1
... mousie made a comment on nbme23/block2/q#8 (An 8-year-old boy is brought to the physician by his...)
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oMnfdraia butiash + coMslau usrneoam + ekNc ssam = NEM B2 (P)MM ho,eP ardlyelMu htiydor CA iCitnaocl(n r,cienetg)s caoumls omnauers

thotcandy  I knew it was MEN2B but forgot medullary ca of Thyroid is parafollicular/c cells which means Calcitonin, not T3/T4 Other answers: AntiThyroglobulin: Hashimoto's (or other thyroiditis) Dexamethasone suppression test: positive/suppressed in pituitary adenoma (acth secreting), negative/unresponsive in Adrenal hyperplasia/adenoma (suppressed by high dose) or ectopic acth (unresponsive to high dose) Serum TSH test: for papillary or follicular ca, thyroid adenomas are usually cold but could also cause HyperT TSHR antibodies: graves disease, hyperT +3
... smc213 made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
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oT be ceyoplmetl arcl!e

hiTs tpeaint hsa tyossisCin a arre moousalat ciesvrsee aomsyllos sgtoera ireorsdd adn toms nmoomc csuea fo nnFoica ysondrme in rni.dclhe tsniyCioss is estmscyi nad dsale ot entycis ycltsar opeitdss ni sllce nda tssueis ohguruthot het d.byo

lhgouthA Wsoilsn dissaee cna laed to ,SF eth trssyalc in eht crnaeso odse ton rtceeoarl tihw Wsnoils i.esesad
Mor e oif:n t1wn1mtw.e/0:ph4.c/i4MC.ltnss./gw/rmpP/nh8blvc6/iiaco

highyieldboardswards  Thank you! You are a legend for figuring this out! +
paulkarr  Appreciate you. +
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT =Β IncreasedΒ excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1
... sajaqua1 made a comment on nbme23/block3/q#3 (An 18-hour-old male newborn is 61 cm (24 in) long...)
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acueseB the b'bays oetmrh hsa yepT 1 teasebiD ,seutilml ti si pubiellas htta hyet ahd evaeltde odlbo eugsolc leevsl urngid ro yrsohlt bferoe i.brth nsilnuI sdoe ton rscso hte ctapaln,e tub scueolg s,oed so grduin htbir het naonete dowlu hvea eneb ymcilche.reypg shTi olwdu elad ot eht aotlanne apcsnear geaenilrs linns,ui idrginv uselgoc noti slecl adn ringnut ndow unng;ecoeeislsgo hsti si why teh yabb is iyoempghcylc rghit .now

B) sceradDee cngogely ntoccenan-rtoi I dno't nokw hte cyogngle eonnatcrtiocn cadoermp to an adult pti,aten ubt a ereadsce ni ylcgnego noconnrtectai odluw eindatci eoc/geylgglonsuc el,asree hcihw olwud ton eb a yceghomlpyci .esatt )C aceDdesre ycolggen hytsneas itatcivy- eedescrad enyoggcl neshtsay tycviita aetdnciis yreeng t,ombaailsc nad dlouw elad ot herihg eumrs leusgoc lvels.e D) ceredDeas emusr lsniniu anricottnen-co ceddeaesr eursm unnlsii owdul deal ot hreihg eelsvl fo oclseug ni srem.u )E nsedreIac emsru unliili-skne owthrg atrcfo- IGF eosd nto ibdn alnery sa lewl ot ilunnsi crptesroe as lniunsi o,sed nda os dlwou heav ot be ni eextremyl ghih eoarscoctnintn ot hvae tsih ce.ffet GFI is atseaicdos hiwt timsoca hgrowt adn cmelus mtv.oeeepnld

yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +6
alexb  Also explains why he's 12 pounds. +4
krewfoo99  Also, think of it like this: Insulin causes hypoglycemia, thus this baby must have increased insulin. It is also an anaobolic hormone which is clear by the babys weight. Insulin increases glycogen synthase activity, and causes an increase in concentrations of glycogen. Decrease in insulin would do exactly the opposite +1
tyrionwill  fetus of a mom with DM will develop pancreatic beta cell hyperplasia, which leads to insulinemia trying to reduce the blood glucose. after birth, the excessive blood glucose will be automatically withdrawn while the insulin at that moment is still high, which leads to hypoglycemia. +3
... sajaqua1 made a comment on nbme23/block3/q#5 (A 68-year-old woman has a 6-month history of...)
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Tshi eapittn sha drispawdee renoctustid fo hobt dlnreaa lsnagd, whcih means htat hse lwil eosl otbh ehr icaomictdlnosioerr and erh heT sslo of het odnmracocilrsieoit nda the cteffe no het skneyid si twha si gienb estdet .eerh hnWe reoasdleont si nnoftcuingi adn tn,uabdna ti ahs learsev ciacrtil sfcutnion no the nphoen.r r,Fist it luautregesp +NK+/a eAsPTa isporesxen on eht talsaaebolr ,mmrnabee nahsetslbigi a nrstgo clmcothceilaree ntigaedr ttah etertb bsasorb Na,+ ewilh eht recdsenia anriluelrctal +K cnatoncroitne skmae ti sireae ot leso K+ mrfo the llce ntoi eht eul.nm rosAendleto saol stareguluep the rsxsiepnoe of iethieplla musdio cneslnha NE(aC) no hte cientolclg utc,d rnabriboesg rmoe .a+N la,nFyil eoanrdeotsl sasereicn iepsnxeros of H+ AasPseT no iapeharla-cldettna scell of the cenllgciot ,ctdu ihcwh aer elrsobspnei rfo cgtnirsee +H his(t is tpar fo aicoontrtcn oakl.sais)l

ithW teh sols fo dlarnsot,oee ew wlil ees a eeersscad KNa+/+ drengtia dan dsreeaecd aN+ b;otierornspa tshi adlse ot aecesrdde emrsu iusodm adn desainerc surme .ptasmusio tA het msae emti, tno xerenisspg H+ ssaAePT lwli lade to H+ not ingbe ertcseed, gtricane a moer acciid oermevnintn (pH wlil asd)eece.r

abhishek021196  Very well written explanation. Bravo +2
... sympathetikey made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
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huTog nstiquo.e

clRlae hatt atMimnnee ea(h'iesrzlm gd)ur is a MNAD pRectore noasttgAin ttah hepls erntpev tcieociyxxtto yb nkiloBcg 2Ca+ etryn. ta'hTs hwo I mbreemre .shit

veryhungrycaterpillar Great little read, and this is the paper they pretty much based this question on. +
veryhungrycaterpillar  Linked the wrong paper. Meant to link this one: +
... sajaqua1 made a comment on nbme23/block3/q#38 (A 5-year-old boy who has recently recovered from an...)
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The rrawom shosw ocrersrpsu to h,yrteyertcos sa llwe sa koygmeratasye.c shiT si to wsho oyu ahtt teh isues 'nist crdeodonupri,nut whihc nemsa taht we rae ogslin RBC dna elpatltes oeerhmews ei .ritsnuctdeo taTh lesru out D adn E. eherT is tnoihgn ot tndcaeii ath eth ihldc sha idstdimaeesn buoceuilssrt )B.( tA isht optni ew rae eltf hwit A ro C. A dowul itndceia meDiedanisst rstuavraIncal oCugointaal )ICD( ro homintseg ,misrial ihchw wuldo uterls in wlo stetlelap nad BCR but ew udowl aols see naroabml RCB iekl cthstsyiecso "l(ee"thm )esc.ll eW aer pliiltceyx odtl ttha eth reotseyryhtc ear rmmicocorohn nda imoc.rnoytc e,erowvH eunmim eotnducsrti of estpllate snxlaepi it -all teh incrtoedsut fo lltaeptes seald ot mseo hraighmreogn adn os a oprd in ,RBC adn PIT cllaaislycs isresa ratfe a teencr perup setproyirar tract railv .ncoietnif

meningitis  Just in case anyone is wondering like I did, the low platelet count explains thethose multinucleated cells. They are Megakaryocytes in Bone Marrow Biopsy. +12
nwinkelmann  Also, don't forget that autoimmune thrombocytopenia purpura has 2 demographics: young kids, which generally resolves spontaneously fairly quickly, and then young adult females which is a true autoimmune condition that doesn't resolve. Patient's age + thrombocytopenia + essentially normal rest of heme pannel = autoimmune thrombocytopenia purprua in child. +7
abhishek021196  That is exactly how I approached this question. Normal heme panel and a decreased Platelet count in a young boy after an infection just made me intuitively select ITP. +
... nwinkelmann made a comment on nbme23/block4/q#47 (A 43-year-old woman comes to the physician because...)
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Mrmrusu nda ramene:vsu t1s thughto = owh dose it nehcga whit All mruurms etpxce ,OCHM P,VM dan trlaai amoymx iversety si dryltiec oitrnolpapor to eachng in ldeaorp .(.ei edeiasnrc sadlrro=oweep ,mumrru ).ect. cusBeae fo th,si DDx nac be owrrnade owdn ot HCM,O MV,P dan tlaira mxyaom girht away bueseca the urrumm roewesdn tihw eaedsdcer derolpa i(.e. ndansgit pu) hnew all tbu tnspeoeicx whti irev.pom

tlAari xymmoa = CCM airpmyr caadrci ruomt eud ot toaernrliipof fo ocvnntceie eutiss ;mcshmneyee a lduetpcuaden mass teccdenno aiv latks ot mtiura upsetm ttah is pdenduess ni hte atliar dbloo volemu and mveos htiw the emlvou eomvenm.t

P:einrntaesot tdari of 1) tailrm vleav curtonstboi (.i.e aaimsl,e ysptosmm fo rciacad freiaul, s,enpcyo ct)e., )2 ptmsomsy fo ibosmmel (.i.e falica and trhig arm iieeshrsmap ni i)an,ttep and 3) itulttcaoosnni psstmmyo .(e.i ee,vfr ewithg ,lsos tmsspoym sberilnmeg envnoeictc ssieut ,easside escuabe urtom selrease )L-6.I reOsth cdueiln cinourgloe spmsy,tmo p-rituledas"mo aelvv e"eidsas yrosaactutul fnniidsg i.(e. sditclioa ,rm)uumr dna rlaita emgntnlaere chw(ih oudcl scmrepos ruileydgnn ttecruussr and eausc mstmospy a)

Not oyln dsoe atdignns escredae oldeapr, which asnem LA lmovue si lrweo so ssam stni' as ed"e"uspnsd ubt oemr ebmlio, gndasnit loas isersenac hte dnworwda atotraigivn rc,oef hwhic dwuol trounebcit to teh ortum vnmiog doratws eht ebas of the ailtar acrmbe,h ipnlp"p"og on hte irltma lvvae ,eelfatls adn alltnoyitpe ntignxdee uhghrot adn ucaisgn a clfntnoiua ypte fo artilm ssesotni (i.e. igoswenrn dciaoslit .)urmumr ihTs eodiv eilsanpx it llyrae elw:l ybw/a;1tnL6w/=h4wV&1uvIt/tp:m.wmtpYusi6cgceao?t.hoss=l

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +7
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +4
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +1
... youssefa made a comment on nbme23/block2/q#2 (Cyclophosphamide and some other chemotherapeutic...)
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Po:taamh - pesyocmtLyh rae hte smto ssiveniet cslel ot owehl ydbo aadtonrii - snyctueraGlo y(nliMa hn)reitulsop ear aurtlayclipr eyrv neeivssit to ctrhaeteeioupmch kinalyaltg asgtne (genqiurri SC-FG hltosyr eatrf)

arcanumm  Always think of NEUTROPENIA when chemotherapy is treating rapidly dividing cells (a small fever is an ER visit for these patients). +9
... imnotarobotbut made a comment on nbme23/block2/q#17 (A 21-year-old man comes to the physician because of...)
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Vlsacire anissisimaelh uasecs gnyleoheapsoatelpm dna msto ilym,tnrtopa peynan.aptico tI si fnteo fdnou ni oeplep who iisvt the dlMied astE adn si artsttemnid yb eht .aySnlfd Why idd MEBN put 2 hemainsiaL siuotnsqe no iths rfom llo

stinkysulfaeggs  tell me about it... I got both in one block and started seriously reconsidering my answer choices! +13
rongloz  I got both questions within 5 questions from one another! I was seriously doubting my answers haha +1
faus305  Visceral Leishmaniasis affects about 0.001% of the world population each year so it only makes sense to have two questions on it.,to%20400%2C000%20or%20more%20cases. +2
underd0g  How do you differentiate leishmaniasis vs malaria? I picked malaria because I thought, no way leishmaniasis is on here twice. But doesn't malaria also cause splenomegaly, fever and abdominal pain? is the key differentiator PANcytopenia? +
faus305  @underd0g, correct no Pancytopenia in malaria. But also malaria probably would've said the patient was in Africa. +1
jaramaiha  Sketchy for the save :) +1
srmtn  also if they say pancytopenia...they could have mention anemia in order to make us answer malaria +
... usmleuser007 made a comment on nbme23/block2/q#23 (A 75-year-old man with prostate cancer has...)
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  1. carCesn fo hte ,pvisel ilugcidnn the se,roptat adspre to het saulrbolacm pensi aiv het tlabreerv uvseno supxle V.P)V(

    • The PVV mctsoeniaumc ihwt a eumbnr fo vsenou ,nkoswter ugnlicnid hte tcpirsaot vsoneu slxepu, iwchh isrevece hte nvoeus pulpys mfor eth t,rtoeaps epsin, adn

    • VVP srnu up eht eirten alnisp oncmlu adn tosnccen hiwt hte vnoseu pypslu of eth ibarn avi a eeasllvsv sstemy ’oBan(sst xeslu)P hiwhc woslal rfo rclioinedabit wlof dna ltoarengiu of iraiaalrctnn eer.ssrTpishu vusnoe ceonincnto to teh arbrecel iucrolincat mya leph naexlip the neysipport fo motusr ot mtzetsaiesa to eht iabrn.

  2. The VVP salo ioamstncemcu hitw het gzaosy einv ni hte ctehs, ichhw paislexn in rtpa yhw abtres and unlg narcesc reufqelytn mztiaaetses ot the hatoicrc sepin.

    • liaSiy,rlm deu to napmlyuor unevso nraiedga itno het elft ieds of teh e,hrat unlg stuorm otnef asredp ilylectsamys via teh trareial s.tesmy
  3. Aotglhhu lhmpy onesd ear teh otsm mocnom steis of staaestsmi ni aee,glnr tmhapicly esdapr to het lastkele mysste is yevr r.are

  4. heT ppmirnfmaio xlpesu ivceesre svonue adgraine omrf the tistse, idspym,diie nad dusctu ndreefse nad asdrni inot eht aciurelstt i.vens

... alexxxx30 made a comment on nbme23/block3/q#17 (A 24-year-old woman comes to the physician because...)
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did neynoa slee evah ot eeradr sthi enuotsqi reaslve meis?t hTe pgjmuin cabk adn rofth omfr hti"s ppeehand reo,bef 1 kwee eaftr, 6 wkese e"ftar nhet thsi apnhdeep o,dyta ht"en itsh epdeapnh 6 seekw t"pposo evga me ahiphl.sw Tlle the rstyo in d!eorr ahah

confidenceinterval  RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +1
faus305  Quentin Tarantino wrote this one +1
homersimpson  Some Westworld Season 1 Shit +1
... mcl made a comment on nbme23/block3/q#26 (A 27-year-old woman has headaches and blurred...)
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aenittP hiwt rlatbaeli anlre ateyrr tsuibr dan rneestpyhoni wlli orf eurs ahve aianivoctt of SRA mtseys adn tohrfreee irsnacee in isnag.enoitn

ulghhAot erpcommohaohtocy nda nenseocutq tledaeve itchcsmealenao can cesneari oobld rpeue,rss yotpmsms aer cilatpyly deiocpsi and anerl subirt rea tno klilye ot be drha.e elvtEeda svlele of norietsno nca loas cseua hnn,rptiseyeo ubt we oldwu soal epextc to see infush;lg ola,s rehte si ogninth ni eht setm ot tiienadc patenti si natkig sSRIS ro imhsteong slee tath cdoul pspeeidros rhe ot levdeeta eslvel of nrooi.ents ealdtEev lsvlee fo rihtydo mnohreo doucl alos igve itaenpt eyio,tpsnerhn but we woldu asol texcpe otreh gsnis fo osrmdhpeiyrhtiy o(tesm,rr higetw slso, .)tce.

I saw a tellti sfodcune if POE lduow eb eedalvte -- if heetr is sneitsos of elnra iaterrse as( cdnidtaie by teh )tubsri teh seknydi odluc also etctde iths sa yixapho dna rapm pu dnitproouc fo E.OP eHvoer,w I edned up gigno ihwt ietnnaionsg niesc ti eedsem omer roete"cc"n to me taht RSA loudw eb u.p oseD enonay oknw why tis' ont E?PO

brise  Wouldn't that be more long term? +4
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2
... sympathetikey made a comment on nbme23/block4/q#21 (An otherwise healthy 26-year-old scuba diver has...)
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ardH ot see ued to roop cuirtep ,uiylatq tub easbd no awht I ulocd ee,s it smese leik a onenpatusso pouoxertanmh to me edsa(b no het cakl fo lugn rangimk no the tlfe epamordc ot hte tirgh dis.)e

rThe,rfoee siecn eht ugnl is ed,dealft lal oyu ludwo aevh in the tfle deis fo eth nepo i,avcty iwchh douwl aemk teh tlfe sedi srhnteyerspno.a

sugaplum  FA 2019 pg667 +16
... yotsubato made a comment on nbme23/block3/q#9 (A male newborn is delivered at term to a 30-year-old...)
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iThs is a tquiosne obuat tineatp pcarivy. hTe etinpat eher si eht .diclh heT rxyop for teh tanitep is het eotrhm nad etfha.r hTey stmu nkow aswht nwgro. rstiSe adn mehtro ear utsj sookolylo, dna eastrpn aym ton ntwa to ltel tehm tdsp(ui I ,wkon utb h)earwevt os oyu dnes hetm tuo dan nhte eltl teh tnasepr het

dr.xx  agreed +
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +29
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +11
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +8
... aladar50 made a comment on nbme23/block3/q#29 (A 50-kg (110-lb) experimental animal receives 1 L of...)
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’Im nto het bset ta teh atiocnaucsll of C,FIEFC/ utb byascllai you are guifnisn a hiycpreotn onotusli oitn the la.amin nItlaiyi,l hist si lal gngoi to go tion the laxueeallrrtc e,ascp sa ayn IV inonfsiu lwli .od nieSc ti si ihhgre htan iioncots suiol,not tewra is gogni ot go frmo eth alerialulntrc ecasp ot the ctluaexallrre ecaps to tyr to alcneba it ,tuo os the eultrcniaallr saepc lilw aevh eedrcasde mvoelu dan rasecendi lmstyoloai is(nec nylo ewtar is ,vglinea mkigan it reom nctceenrt.)oda

oS uyo kwon fro rsue CIF omvule si cdedersae nad taoilmylso c,sdrieaen nda the rlaaueclxlert vuolem lilw eb dn.asrieec I khitn het ltloysoaim fo teh acetxalullrer csaep is eth tkcryi atrp nad eth tapr hewre eybam ensoeom slee cna lphe iwht teh csacuainllto utb aylbsclia sti’ yocitprneh enguho htat het ioasoymtll ilwl sllit be c.aenisdre

btl_nyc  Since hypertonic solution was added, osmolality has to go up. The degree of the hypertonicity doesn't really matter. The fluid flowing out of the ICF will increase ICF osmolality. Since water follows salt, the water's gonna flow only until the ECF and ICF have the same tonicity. So if the ICF osmolality went up, the ECF osmolality also had to go up, because they both need to be equal after the water is done equilibrating. +20
krewfoo99  ECF fluid is hypertonic because we infused an hypertonic solution. ECF volume is going to go up because A) we added more volume via injection B) Sodium attracts water, and since hypertonic solution was given water goes from ICF to ECF ICF volume decreases because the water is going to ECF. This causes an increase in Intracellular osmolarity, since you have more solutes compared to water (Less water to dilute it) +1
btl_nyc  0.9% saline is isotonic. When "normal saline" is given to a patient in a hospital, it's 0.9%. I think that's something you're expected to know. The good news is that now you do. +1
... yotsubato made a comment on nbme23/block4/q#11 (A 40-year-old man comes to the physician for a...)
submitted by yotsubato(1111)
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Yeah rseu, selt igve hte ugy how wastn to ekep sih dcik rinkgwo adn eb acritaevtt soardwt nweom iisteardFne nda ocpmlelety runi his ronsetttseoe selvel dan vige hmi a ilpm ckid, mna so,obb adn redacesed rreacenpfom ni ports.s

eSmiseomt eth NBME yrleal utjs meska me kas W?hy

alocpTi mxioildni wlodu eb awy trebet tbu on ethy town ptu htta as a eihcco

anjum  To clarify: the lack of DHT production caused by finasteride leads to gynecomastia and ED. The other options are synthetic androgens. Totally agree that this question goes against the benevolence vs. maleficence that we've been taught in medical school +
... jrod77 made a comment on nbme23/block4/q#17 (A 24-year-old man has a grade 3/6 systolic murmur....)
submitted by jrod77(30)
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eTh ioycslst uerepsrs iefrdefecn wnebtee teh tlef eliecrtnv and teh oaatr in shti .pt si tpryte ig,tfnainsic hsaeWer ni a nmroal trhea stoeh slsyicto eureprsss udohls eb stju auotb q.uale sThi stnih ta eht ctaf ahtt het ltfe eenrltciv ahs ot utp in toal fo kwro ot pshu rhtugoh eth trcoai veval. htaT eraxt seesrrup sgeo tnoi eognipn het vvela adn dseo ont reppaa in eth .oatar

divya  why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6
leaf_house  @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: +
cbreland  @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gunπŸ˜” +
jbrito718  @divya I think it has to do with the fact that the left ventricle is pumping so hard that some RV hypertrophy may occur since they contract simultaneously. Chronic aortic stenosis will eventually reflect backwards, causing increased pulmonary vessel resistance. +
... thomasalterman made a comment on nbme23/block4/q#24 (A 60-year-old man comes to the physician because of...)
submitted by thomasalterman(167)
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nPettia hsa iletypaomchy vaer, sa dceeevdni yb ,ohiostyrsctrye snyauooir,sglct nda ehaehdcsa ;amp& inizdess. OPE si ersecaded due ot ytstyoorcsh.rie seeaDcdre LAP udlwo tdicanie L,MC ont .VP

btl_nyc  I thought this was CML. What am I missing that would say CML over PV? +4
btl_nyc  Nvm, RBCs go down in CML, but everything goes up in PV. +11
arcanumm  Tricked me. I knew right away that it was PV, but I thought PV would crowd out normal cell creation (e.g. decrease platelets). So apparently crowding out normal cells is just a quality of AML/CML? +1
drzed  More AML. Remember Sattar always stresses that all the myeloproliferative disorders are expansions of ALL lineages, ESPECIALLY "xx" (depends on which one, for CML it'll be granulocytes, for PV it'll be RBCs etc). They're called MYELOproliferative because all the myeloid linages go up, but one will be increased more than the rest. In this case, it is the RBCs. +5
... sympathetikey made a comment on nbme23/block4/q#30 (A study is planned to assess differences in...)
submitted by sympathetikey(1475)
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eggitBs uecl saw thta terhe aws no etim feram ieng.v erfe,hoerT hsit sesem to be a "ciels ni emit" t,dyus whchi lnsei pu twhi soscr inaostlec usdty.

paulkarr  Damn, epi at it again... +5
... nwinkelmann made a comment on nbme23/block2/q#32 (A 2-year-old girl is brought to the physician...)
submitted by nwinkelmann(328)
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S,o rof eoms saon,er eenittatrssnrumro si eoghinstm veI' WASYAL desugtgrl .t..iwh abopybrl cbuesae I wnst'a ahutgt ti ewll so erven layrle deanrel ti, stju derlnea heuogn for ewartehv axm.e I ujst dofun this obo uohhgtr INCB and sti ANTCTFSIA! s'It frmo 0012 os gitmh be o,ld tub it aws .terag Yuo nac hcears urthgoh the obko dan fidn the ershap.ct I prttey mhuc ujst wten oghrhut all fo eth ttrsrmirnunaeeot arehctp. cn99n.1pB/0v/b//nNwi/Kow..tish7ms.hbgootw:kl

My inma aytkeaGtas-ema :tluaw = jmrao toeaxyrcit otrnire.sturemtna wTo yespt fo psrr1o)e:cet eaoibt,crptom mtos of icwhh rea nspypeaticr Gi ciwhh aelsd to dcderesae MAND torcerep ivttacyi dna srik of i,iocctteoxiixty or spypisotctna Gq perroctes ttha dlae ot aescneir a+,N +K, dna rdsdeeace alegtautm essauc alipnaioeozdtr dna icarsened +M+g lcmpnadseeti and ADMN tropreec cattiyvi dan rsik fo et,ioiictxocxty nad 2 ) poiocotinr lhcasnen nucidinlg AMND dna k/PeMnAAaiat n,slenhca hiwhc all olawl ifecnionscp naocit ,nixlfu utb noyl DAMN wolsal +a+C lnufxi an(d ylon ni a votaleg pneeddnte enranm tfera nsftuicief ponzioliaardte has aleddspic eth ibroithin gM++ nio ni eth hcn)nle.a

BAGA nad ilgycen = triibihyno rreurstimnaoett.ns 1) -AGAAB nda AABC-G = onipcoitro saenclnh htta aeld to fluxe of Cl,- nad dptesei sthi uicsnga toraiielnz,opda teh eunnro ltisl stays lebwo regstni ipntt.leao GA-ABA nbgdini iste ofr rbiteataub,sr t,siroesd GB,AA nad oxocinritp = inieds preo of annlec.h AA-ABG dgniibn ites fo zdieboenzanpise = ostidue fo roep fo nc.anhle 2) cnilyeG hlacnen is a eryv siariml -lC elxfu encnlah. 3 ) AGBAB- is a teiporabomct lenhnca hatt teatvscia iG neaglid to deedesarc APcM iwhhc aeitsvact lxufef +K nchsneal dan sthnibii C+a+ nufxli cnelhasn delgina ot orrezintpaiopyhla.

inBgioec iesnam = ecctmnihaaosle moaniedp o(cordonaitni of ybdo eveomn,mt ,raedwr tioatmovni, )efmintecenr,ro poenhneinerrip l,psee( le,uewsnksaf atientton, nfegdei haibev,or nhriieneepp t(wlose tonrocatnicen in ,CNS) psul oterinnos (s,elep l,keneswsfua n,priesdeos xine,yta suaa)en adn haimntsie o,r(aalsu etttnani,o eglarly, teissu da,mage dna yam ciflnnuee odlbo bairn w)lfo. ,uyloiObsv lla fo itsh si in ndiiotad to gredneicra ostsienionmnrsaru dan ftl,gih fi,ghrt and ghtfi spreone.s

ATP nda toehr rsnpuei = ycxtetoiar nntso,siaimsr cla-rdeseeo twhi erhto aeemulmloclsl- ntatenuetmrrosis.r odnAiesen sit'n clcsisaalyl nsoreeiddc a rurnrstnetomiaet ebaeusc it stni' arssre/odtledee in +aC+ eepndtden rnne,ma ubt dvieder ofrm TPA fberoe hvaign an atyorcetix oltpenti.a

nlyhccleioeAt = maorj tuterortmreinsan dloivvne in rnnomtaisnsriuoes vai cimarnus dan conctiini .trpceerso

dtPeipe tenatrienoursstrm = moyclomn lerdseae sa diepeorptp algerr rusecrsrop taht rae eladvce by cecfpsii nsmezey htat eewr ni eht amse tsrotnrniareutme eicsvle poun elerea.s iFev sytpe = gti/brnua s,eetppdi poidoi ,espepidt tpuyirtia eptdp,si htyhpmaailoc larsignee moneh,sro dan hetos ton ai.cilssdef spElemax = ceopsrurr tath eisvg ersi ot sbtuansce P ps,uocmhpap(i ,enocretxo adn TIG nad eeaerdls omfr sllam adrmteie NSP C bfsrie tath tirsmant apin dna treeearpumt iintmno,roaf lopwfeur ,stpvheeiyno dnthbiiie yb odpiio ,idetsep)p nikonnreui ,A uptpedoeneri ,K adn ipdonreepteu ma,mag adn oidpoi pdstipee gdunnilic paltn iadallsko ikl(e pn,ermoh)i thitnysec oidopi etevriavsid, dna n,odnsihper ,rihyopnnsd adn ekin.sphlnea nI raeenlg oiopdi dsetiepp ear asdenretssp .(e.i asalaieng hcanmmis),e onvdeliv in xeolmpc ibsvhoaer xlueas( ,orttiatnca rie/svsimsvguessbgaei rb),oisaevh nda pitdelmcai (tuhhog ont etii)ifdven in satrychicip sddorrsei.

llraevO, oatresrrteisnnumt = eypt stype: leemulml-osalc astsrreinttm and neusrtipoeed,p eerhw smsucemloll-ael istnesatrtrm are aetfrs dan tiadeem dipar yptsanci romnansissti e.i.( rnaegodn NSS thfftghilhftg/g/iri kuiqc e,epsn)rso ehwer as pdnetesiuproe nalog( htiw icoglibo aenmsi dan mseo mllas meuelolc setirst)natmr era lrsewo nad itmadee ar,ualdg enoorgpld ai.stresrsounninmo

Smoe ceuptsir: tmavmbedwtniaec/onn.oomtpfpe/priuthnrr_vustde.khed.w_h/klproiwtser/u/et:uie_as, at4c8dgRoeibs5wtaiPa-rBt-0r3/8sr6h/td/leGge.tpo9r0c/h1ir1e20a1buraar4l-g3.3-ftipeeauebbue1o-nf/B6/6:02fnh-w/2ilcg7A0Ar4pgcsm6-eaio-wpndssperTf3s1ed, dna f/di#a4wwt.en/ei9xeg-_aa:1atbep1hnlgb-e8-70aahfu5d/geel-d5--0.r;gfl=wr3xofsgs/c3h2bdU-d6e-w1i/rp1n=te6.2tliabms&/abt

sweetmed  This is amazing. thank you +
sweetmed  This is amazing. thank you +
paulkarr  Woah... +
brotherimodu  Short video someone posted from NBME-21 answers: +4
dorischang  Didn't finish reading this, but it looks awesome +3
... sympathetikey made a comment on nbme23/block3/q#27 (A 30-year-old man reports increasing fatigue and...)
submitted by sympathetikey(1475)
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Any meit oyu ese dfxei ewid igstiptln fo 2S, ssmha SAD.

someduck3  I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +
usmlecharserssss  with airpods in 2012 +
paulkarr  Low key was hoping for someone to try and argue this one... +
... lfsuarez made a comment on nbme23/block4/q#22 (A 40-year-old man with terminal small cell carcinoma...)
submitted by lfsuarez(147)
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This tetpnia estsrnpe tiwh a lmasl ecll icamcrano hwhci is ervy cmmnoo fro aapr seclinopta eds.yomnrs nI htis eacs het nrecac is gscnuia .SAIHD icDlcnmeelyoe is a ciercttlynae ticintbioa ahtt si loas seud to eartt HSADI

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +17
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +4
... thomasalterman made a comment on nbme23/block4/q#29 (A 2-week-old male newborn is brought to the...)
submitted by thomasalterman(167)
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eatPnti is uerntrc -serad,fbte so we nca eiatleimn fseructo coe(fstur si dufon in eyonh nad tiusrf and mose rlm,oafu tub ton ni braste mk)il. eiantPt sha gdrneciu sbtseucans tub on ocluseg in het n,ieur os eh muts semo ocgson-nuel u.rags My diietlfenarf orf dgcienru snecngouo-l ursgsa ni hte rnuie is isersddro ecfturso oetialmmbs ro lsgeatcoa eW heva daleniitem scoefut,r so that veasel su wtih ntlaaikaosceg ydfncceiie or cassilc olgc.aemtasia

sympathetikey  & Galactokinase deficiency would be much milder. +8
smc213  Big was soybean formula not giving any issues. Soy-milk can be used as a substitute formula in patients with Classic Galactosemia since it contains sucrose (->fructose and glucose). +4
almondbreeze  @oslerweberenu G6PD - increased RBC susceptibility to oxidant stress (eg, sulfa drugs, antimalarials, infections, fava beans) -> hemolysis; has nothing to do with presence of reducing sugar +1
makinallkindzofgainz  @almondbreeze; Glucose-6-phosphatase deficiency is Von Gierke disease, they are not referring to G6PD deficiency (an entirely seperate disease) +8
... paperbackwriter made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
submitted by paperbackwriter(137)
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,342S, epkse teh 3 s'P ffo eht lfoor n,se(Pi ooP, dan )eeP

alexxxx30  love it +1
prolific_pygophilic  A true scholar +3
... sajaqua1 made a comment on nbme23/block1/q#39 (A 65-year-old man who is a farmer comes to the...)
submitted by sajaqua1(577)
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ritFs, ilrccatiyl, it is not esreiddcb as oni iniordata pl(aha and aetb i)stalrpec tbu sa idinaorta htat has an iniiaozotn .cfetef urO earmrf hsa enbe out sgidnnat ni hsi dlef,i nisaogk up the .iglthsnu U-BV si aevw rdiianoat ttah eicusnd teh troinmafo of fere hTese efer cdalirsa ni rnut od aemadg ot eth cel,l dingnuilc the mifrntaoo fo ynimpideri .dimers ishT NAD adagem is eth essba rof hsi oqusuasm lcle rmicaaon.c oFr more on UBV- cindude eerf darical gedama of NDA, m/dbw5.56cbit7o4./ehipwun.lm/s16n.hnp/gt6:vw . Fro omer roimtnaiofn no VU aordiinat ofmr the carmeniA rCance Sye,oitc epasle vstii attac.eura-pmrnrennaw/warusivh:seuv-etnetadutsdo.igawtici/-ohiipovwtsnda/o/rca/---creuisxcc.nhra-ocl//ra

)A serDecdea utoifncn of het knis sa a aebrrir ot ccin-oegnras the taitepn ash on tirhsyo ustegsg seouxepr ot icarogcsnne bieesds VU g,ilth nad as nlog sa hte ksin si tcitna and irealtvyle lehhyat it usohld nocfnuti as meso ndik fo braie.rr C) Irdceenas snovoenicr fo 3-5D2 ot D,23-51 - iths nonsiocevr eakts epcal ni eth ynesidk iav ya-1lphadalhxe,rs-yo alos eexssepdr ni sunormglaa d(an os -1D3,25 is noetf eealtedv in s)i.coiadross hiTs udlow ton pelxian D) nareIdsec otmciti ivittyac oghruth uiiotsmnlat fo so-atcelmyne rou teianpt si odngseadi itwh smuosaqu lcel aancicomr, ton nmam.eaol E) denecIrsa iuiisspcbettyl to nski a-mutar ewhli het deaamg ormf UV glthi ot genoclal soed ekam skni nnerthi and omer deylari adme,gad tshi dulwo tno aeipxnl omsuaqus elcl nr.acaimco

ineedhelpwitmed  this is incorrect, UV-B induces formation of pyrimidime dimers, not free radicals. ionizing radiation from x-rays or nuclear reactions causes free radical formation +1

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