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NBME 24 Answers

clinical_trials medicine
Question#1 (reveal difficulty score)
A researcher hypothesizes that exposure to ...
Case-control studyπŸ”,πŸ“Ί

pharm beta_blockers
Question#2 (reveal difficulty score)
A 43-year-old woman with a 2-year history of ...
Unopposed Ξ±-adrenergic toneπŸ”,πŸ“Ί

oncology metastasis lymph
Question#3 (reveal difficulty score)
A 52-year-old woman comes to the physician ...
IntercostalπŸ”,πŸ“Ί

micro cryptococcus
Question#4 (reveal difficulty score)
A 28-year-old man with AIDS has fever, ...
LungsπŸ”,πŸ“Ί

genetics process_of_elimination
Question#5 (reveal difficulty score)
The 35-year-old woman indicated by the arrow ...
X-linked recessiveπŸ”,πŸ“Ί

respiratory transfusion transfusion_reactions
Question#6 (reveal difficulty score)
A 57-year-old woman requires intubation in ...
Acute lung injuryπŸ”,πŸ“Ί

Question#7 (reveal difficulty score)
A 65-year-old woman comes to the physician ...
Cigarette smokingπŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 24-year-old woman at 28 weeks' gestation is ...
TremorπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
The graph shows expiratory pressure-volume ...
Diffuse pulmonary fibrosisπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 75-year-old man is brought unconscious to ...
AtherosclerosisπŸ”,πŸ“Ί



renal nephropathy
Question#13 (reveal difficulty score)
A 4-year-old boy is brought to the emergency ...
Proliferative glomerulonephritisπŸ”,πŸ“Ί


Question#15 (reveal difficulty score)
Results of a 5-year screening program for HIV ...
5%πŸ”,πŸ“Ί


Question#17 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Annular pancreasπŸ”,πŸ“Ί

Question#18 (reveal difficulty score)
A 34-year-old woman with a long history of ...
Tuberculous osteomyelitisπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Cluster headacheπŸ”,πŸ“Ί

free
Question#20 (reveal difficulty score)
Immediately after a spontaneous vaginal ...
Fusion of the sclerotomesπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Foramen cecumπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 50-year-old man undergoes surgical ...
Adductor brevisπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 50-year-old man comes to the physician ...
Generalized malabsorptionπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 6-year-old girl is brought to the office by ...
Pediculus humanus capitisπŸ”,πŸ“Ί



Question#27 (reveal difficulty score)
A 10-year-old girl with a lifelong history of ...
Palpable right ventricular liftπŸ”,πŸ“Ί

immuno
Question#28 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
EosinophilsπŸ”,πŸ“Ί



Question#31 (reveal difficulty score)
An experimental study is conducted to examine ...
Post-translational modificationπŸ”,πŸ“Ί

Question#32 (reveal difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flowπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 3-month-old girl is brought to the ...
Human papillomavirusπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
SotalolπŸ”,πŸ“Ί

newborn
Question#36 (reveal difficulty score)
A 4-year-old girl is brought to the physician ...
Villous atrophyπŸ”,πŸ“Ί


Question#38 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
BorderlineπŸ”,πŸ“Ί

Question#39 (reveal difficulty score)
A 40-year-old man with AIDS develops severe ...
SomatostatinπŸ”,πŸ“Ί


Question#41 (reveal difficulty score)
A 32-year-old woman who is 20 weeks' pregnant ...
MisoprostolπŸ”,πŸ“Ί


Question#43 (reveal difficulty score)
After completing 6 courses of chemotherapy ...
DoxorubicinπŸ”,πŸ“Ί

Question#44 (reveal difficulty score)
A 24-year-old man is brought to the office ...
Alteration in DNA gyraseπŸ”,πŸ“Ί


Question#46 (reveal difficulty score)
A 10-year-old girl is scheduled to undergo ...
SuccinylcholineπŸ”,πŸ“Ί



Question#49 (reveal difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”,πŸ“Ί



Question#2 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturationπŸ”,πŸ“Ί


Question#4 (reveal difficulty score)
A 57-year-old man has had hoarseness and ...
Area labeled β€˜Fβ€™πŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 55-year-old man is diagnosed with coronary ...
Decreased adherenceπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorderπŸ”,πŸ“Ί

renal
Question#8 (reveal difficulty score)
A 17-year-old girl is brought to the hospital ...
BeneficenceπŸ”,πŸ“Ί

cell_bio
Question#9 (reveal difficulty score)
In which of the following stages of the cell ...
G2πŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 29-year-old man is brought to the emergency ...
Lateral pterygoidπŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
A public health consultant is contacted by a ...
Regular exerciseπŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
An 80-year-old man is admitted to the ...
20πŸ”,πŸ“Ί


Question#14 (reveal difficulty score)
A 25-year-old man comes to the emergency ...
HeroinπŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
An investigator is studying a new drug for ...
Free radical formationπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIVπŸ”,πŸ“Ί

Question#17 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Normal agingπŸ”,πŸ“Ί

FA20p504

Question#20 (reveal difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissueπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
A 50-year-old woman with HIV infection comes ...
ZidovudineπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 3-month-old boy is brought to the physician ...
PeroxisomesπŸ”,πŸ“Ί

Question#23 (reveal difficulty score)
A 9-year-old boy who was adopted from an ...
EπŸ”,πŸ“Ί

Question#24 (reveal difficulty score)
A 59-year-old man has repeated episodes of ...
ProbenecidπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
A 35-year-old African American man comes to ...
PalmsπŸ”,πŸ“Ί

alcohol electrolytes
Question#27 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urateπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A 3-year-old boy with AIDS develops giant ...
Negative-stranded RNAπŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 65-year-old woman with well-controlled type ...
AtherosclerosisπŸ”,πŸ“Ί

Question#30 (reveal difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 35-year-old woman undergoes a left ...
UreterπŸ”,πŸ“Ί

Question#33 (reveal difficulty score)
A 58-year-old man comes to the physician ...
Escherichia coli πŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 40-year-old man who goes horseback riding 3 ...
Myositis ossificansπŸ”,πŸ“Ί

neuro
Question#35 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Lower motoneuronsπŸ”,πŸ“Ί



Question#38 (reveal difficulty score)
A 65-year-old man comes to the physician ...
ParoxetineπŸ”,πŸ“Ί


Question#40 (reveal difficulty score)
A 4-year-old boy has a 1-cm round midline ...
TongueπŸ”,πŸ“Ί



Question#43 (reveal difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulationπŸ”,πŸ“Ί


Question#45 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Peptide transporter (TAP)πŸ”,πŸ“Ί

Question#46 (reveal difficulty score)
In a study of drug action on neoplastic cells ...
VincristineπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 73-year-old man has an incurable malignant ...
Both legal and ethicalπŸ”,πŸ“Ί

GI
Question#48 (reveal difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosaπŸ”,πŸ“Ί



Question#1 (reveal difficulty score)
A 3-year-old girl has a history of recurrent ...
NADPH oxidaseπŸ”,πŸ“Ί

biochem metabolism acid_base blood_physiology
Question#2 (reveal difficulty score)
A 28-year-old man has a blood pressure cuff ...
AdenosineπŸ”,πŸ“Ί

pharm HIV antivirals
Question#4 (reveal difficulty score)
A 27-year-old man comes to the physician ...
Injections of gonadotropinsπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 37-year-old man is admitted to the hospital ...
Autoimmune adrenalitisπŸ”,πŸ“Ί

Question#6 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Alkaline phosphataseπŸ”,πŸ“Ί

clinical_trials
Question#7 (reveal difficulty score)
A 21-year-old woman with asthma comes to the ...
Phase 3πŸ”,πŸ“Ί

Question#8 (reveal difficulty score)
A 37-year-old man who is a farmworker comes ...
SynaptobrevinπŸ”,πŸ“Ί

Question#9 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Metastatic carcinomaπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
Serum cholesterol concentrations are measured ...
16%πŸ”,πŸ“Ί

Question#11 (reveal difficulty score)
The pedigrees of patients with schizophrenia ...
Diabetes mellitus, type 1πŸ”,πŸ“Ί

Question#12 (reveal difficulty score)
A 35-year-old woman with asthma comes to the ...
ThiabendazoleπŸ”,πŸ“Ί

syphilis ethics
Question#14 (reveal difficulty score)
A cohort study is done to evaluate the ...
0.05 < p < 1.0πŸ”,πŸ“Ί

biochem heme heme_synthesis
Question#15 (reveal difficulty score)
A 17-year-old girl has significant blood loss ...
Ξ΄-AminolevulinateπŸ”,πŸ“Ί

Question#16 (reveal difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosisπŸ”,πŸ“Ί


Question#18 (reveal difficulty score)
A 55-year-old man with alcoholism is brought ...
Competitive inhibitorπŸ”,πŸ“Ί


mutation paroxysmal_nocturnal_hemoglobinuria


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

Question#24 (reveal difficulty score)
A 3-month-old boy is brought to the emergency ...
GluconeogenesisπŸ”,πŸ“Ί

Question#25 (reveal difficulty score)
An investigator is studying a new virus ...
CoronavirusπŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 27-year-old man who works from home as a ...
AvoidantπŸ”,πŸ“Ί



Question#30 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Intraductal papillomaπŸ”,πŸ“Ί


Question#32 (reveal difficulty score)
A 15-year-old girl is brought to the ...
CD8+ T lymphocytesπŸ”,πŸ“Ί


Question#34 (reveal difficulty score)
An otherwise healthy 35-year-old man sustains ...
Decreased blood volumeπŸ”,πŸ“Ί

Question#35 (reveal difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formationπŸ”,πŸ“Ί

Question#36 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
TyrosineπŸ”,πŸ“Ί



MSK
Question#39 (reveal difficulty score)
A 34-year-old woman is brought to the ...
LunateπŸ”,πŸ“Ί

micro
Question#41 (reveal difficulty score)
A 30-year-old man develops tingling around ...
SodiumπŸ”,πŸ“Ί

biochem cell_bio extracellular_matrix
Question#42 (reveal difficulty score)
Which of the following terms best describes ...
LaminsπŸ”,πŸ“Ί


Question#44 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrinπŸ”,πŸ“Ί

Question#45 (reveal difficulty score)
A 59-year-old woman has a 10-year history of ...
Neural crest cellsπŸ”,πŸ“Ί

cell_bio cell_transport cell_trafficking protein_folding
Question#46 (reveal difficulty score)
A 15-year-old girl with cystic fibrosis has a ...
Endoplasmic reticulumπŸ”,πŸ“Ί

Question#47 (reveal difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”,πŸ“Ί

Question#48 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Phantom limb painπŸ”,πŸ“Ί


Question#50 (reveal difficulty score)
A group of physicians submits a report to a ...
Case seriesπŸ”,πŸ“Ί

Question#1 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Glycine and succinyl CoAπŸ”,πŸ“Ί


Question#3 (reveal difficulty score)
A 23-year-old woman is brought to the ...
Renal tubular acidosisπŸ”,πŸ“Ί

Question#4 (reveal difficulty score)
A 63-year-old woman develops flank pain, ...
ABO incompatibilityπŸ”,πŸ“Ί

Question#5 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”,πŸ“Ί


Question#7 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Spontaneous regressionπŸ”,πŸ“Ί


Question#9 (reveal difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”,πŸ“Ί

Question#10 (reveal difficulty score)
A 60-year-old woman is receiving cisplatin ...
HyporeflexiaπŸ”,πŸ“Ί



Question#13 (reveal difficulty score)
A 90-year-old man has a 1-week history of ...
Incarcerated inguinal herniaπŸ”,πŸ“Ί

Question#14 (reveal difficulty score)
A new screening test for colon cancer is done ...
118/124 = 95%πŸ”,πŸ“Ί

Question#15 (reveal difficulty score)
A 15-month-old boy is brought to the ...
MigrationπŸ”,πŸ“Ί



Question#18 (reveal difficulty score)
A 64-year-old man undergoes surgical repair ...
Artery of the ductus deferensπŸ”,πŸ“Ί

Question#19 (reveal difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincterπŸ”,πŸ“Ί

Question#20 (reveal difficulty score)
Forty of 100 attendees at a company Christmas ...
Vibrio parahaemolyticusπŸ”,πŸ“Ί

Question#21 (reveal difficulty score)
An otherwise healthy 45-year-old man comes to ...
Aphthous ulcersπŸ”,πŸ“Ί

Question#22 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureterπŸ”,πŸ“Ί



Question#25 (reveal difficulty score)
A 26-year-old man is brought to the emergency ...
Pericardial tamponadeπŸ”,πŸ“Ί


Question#27 (reveal difficulty score)
A 19-year-old man has had weakness of the ...
PolyneuropathyπŸ”,πŸ“Ί

Question#28 (reveal difficulty score)
A clinical study is designed to evaluate the ...
10%πŸ”,πŸ“Ί

Question#29 (reveal difficulty score)
A 56-year-old man has a 3-year history of ...
PresenilinπŸ”,πŸ“Ί


Question#31 (reveal difficulty score)
In a study of antibiotic resistance, a strain ...
ConjugationπŸ”,πŸ“Ί


Question#33 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuseπŸ”,πŸ“Ί

Question#34 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cellπŸ”,πŸ“Ί


Question#36 (reveal difficulty score)
A 68-year-old woman comes to the emergency ...
AlendronateπŸ”,πŸ“Ί

Question#37 (reveal difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meatπŸ”,πŸ“Ί

Question#38 (reveal difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”,πŸ“Ί

cookies
jhkjh
Question#41 (reveal difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoitesπŸ”,πŸ“Ί

Question#42 (reveal difficulty score)
A 40-year-old man who recently immigrated to ...
AdenineπŸ”,πŸ“Ί

vascular
oncology
Question#44 (reveal difficulty score)
A 71-year-old woman with non-Hodgkin lymphoma ...
LeucovorinπŸ”,πŸ“Ί

renal
Question#45 (reveal difficulty score)
A 40-year-old woman with a 25-year history of ...
Secreted by the proximal tubuleπŸ”,πŸ“Ί

anatomy neuroanatomy
Question#46 (reveal difficulty score)
A 22-year-old woman comes to the physician ...
Pineal glandπŸ”,πŸ“Ί

oncogenes oncology
Question#47 (reveal difficulty score)
A 40-year-old man comes to the physician ...
HNPCC syndromeπŸ”,πŸ“Ί

neurology
Question#48 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Posterior cerebralπŸ”,πŸ“Ί

neurology erections
Question#49 (reveal difficulty score)
A 27-year-old man sustains a spinal cord ...
Penile stimulationπŸ”,πŸ“Ί

FA18p360 FA19p359
Question#50 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”,πŸ“Ί

Recent comments ...

... seagull made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +332 
submitted by seagull(1722)
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Teh setcmains fo siht tnequiso emad me omvti .olbod

nOe day a aettnip liwl kloo em in teh seey and ks,a rWee"h rea etpisredti keobnr dnow?" I illw sliem ta emht dna sy,a et"h alnettnsii osuacm and otn hte ud"mnuedo. hlTyle' ilsme kacb adn llI' wlak ywaa adn kinth fo sith oemtmn sa I jmup rmfo eth wwn.iod

sympathetikey  Too real. +5
mcl  how do i upvote multiple times +19
trichotillomaniac  I made an account solely so I could upvote this. +39
dragon3  ty for the chuckle +8
cinnapie  @trichotillomaniac Same +5
thedeadly96  XD made my day! +2
hardly43  RIP legend @seagull +2
seagull  A legend never die +4
... tissue creep made a comment on nbme24/block3/q#49 (A 20-year-old woman with asthma comes to the...)
 +94 
submitted by tissue creep(120)
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The leoopd si lgalepcrhyn,oei and a 1010/ doog y.ob

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +1
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +
... drdoom made a comment on nbme24/block3/q#2 (A 28-year-old man has a blood pressure cuff placed...)
 +86 
submitted by drdoom(1027)
unscramble the site ⋅ remove ads ⋅ become a member ($42/month)

eftrA eth ffcu is ,ited hte ellcs dna utsise asdlti to eth uffc lliw neoinuct mnnigsuco TPA (&PT-DPA;Agt,) tub no hrsfe oldbo lilw be eedlivrde to caβ€œle”r wtah llwi eb an mntgcliaaucu nutoam fo DPA dna hotre msioaeebltt. APD in=e)(nAsode is lftesi a xopry fo moinpncosut adn isrvde doltvsioiaan of atrersie! tuoilnvo(E is )s!mrta nIgsaciern oPnDdniAee/As in a cβ€œlaol rnmoenvtnie” is a gnlisa ot teh ydbo hatt a otl of copumitsnon si uocrcrgni ;hrete h,tsu tesrraei adn teoaieslrr larnyulat tlieda ot eenicrsa odlbo lofw atres dan spβ€œeew aya”w etaiolcbm otyrpscu.bd

lispectedwumbologist  You're a good man. Thank you. +1
drdoom  So glad it helped! +1
seagull  very well put, thank you +2
aisel1787  gold. thank you! +
pediculushumanus  beautiful explanation! +2
rockodude  this explanation was on par with Dr. Sattar IMO +2
flvent2120  Just to add on to this: FA2020 pg. 297. CHALK (Calcium, H+, Adenosine, Lactate, K+) is known to vasodilate muscles during exercise as well as regulate sympathetic tone of arteries at rest +2
... seagull made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +72 
submitted by seagull(1722)
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ta BMI 15 nto ylon sha hse enrve hda a eoipdr utb she erven ahd a e.mal

sympathetikey  You're on fire man lol +1
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +4
avarkey  the blind vaginal pouch points away from it being anorexia related +4
j44n  Its actually a man, there's no DHT to to dev the external genitals. +1
am4140  @monkey - with real anorexia, she wouldn’t necessarily have boobs either. If she’s got boobs she has the nutrition to develop boobs. That was my thought. +
freckles  the patient is actually what ever gender they want to identify as. If this was a 5 alpha reductase deficiency the patient would have experienced masculinization of external genitalia during puberty when testosterone levels increase significantly. The pt most likely has Androgen Insensitivity Syndrome. +3
weirdmed51  BLIND VAGINAL POUCH = never ever ever in anorexia nervosa! It is an anatomical defect, hence not psych prob. +
... atstillisafraud made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +66 
submitted by atstillisafraud(204)
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I ilke siht uoqtsien esubcae ti ersimnd me hatt asiemrxen tnhki bctojes nca xetsi in 2 isden.nomsi

... atstillisafraud made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +63 
submitted by atstillisafraud(204)
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Tnkha oyu MBNE orf hte hihg tqluaiy uptse.cri It sakme esteh amxse sssret feer dna baonyejel.

sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +20
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +13
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +6
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +7
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +7
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +5
rockodude  everyone hates on nbme, but they're showing you a picture zoomed in of her eyes and she has a history of multiple fractures/bad wound healing at the age of 4, I feel like OI should at least be a consideration based on the overall clinical picture +1
feochromocytoma  Yeah I got it right, it's just funny that they don't use higher quality pictures for the exam +1
djeffs1  that is clearly a malar rash... oh wait nvm just pixellation +4
... lamhtu made a comment on nbme24/block2/q#5 (A 55-year-old man is diagnosed with coronary artery...)
 +59 
submitted by lamhtu(128)
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ttaelPle cdaeehrne dna tpleleat eiantgoragg rae enftirfed inshtg dan stih rfiedernce RETMATS A O.TL Fcku o,uy .MBEN Tshee eeedcfirfsn ospsdeypul tmreat on semo oqnteussi dan tno on .oehrst Wrhee is het os?tinyesncc lleo?H

hungrybox  Agreed. This is so fucking stupid. +
hungrybox  "Aspirin inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme that is required for TXA2 synthesis." literally straight from Big Robbins +1
susyars  Im gonna upvote this bc i love to be right +7
regularstudent  It's always a horrible, horrible feeling to pick the wrong answer that you know they think is right. Amazing job NBME... +5
j44n  yeah i thought adherence was the GP1B receptor that's already on the platelet +1
j44n  im also glad we're getting exposed to this horse shit now and now when I'm in a testing center about to put my fist through a screen. +2
jurrutia  GPiib/iiia receptor is not inhibited by aspirin. Aspirin prevents the upregulation of GPiib/iiia which is not the same as inhibiting the receptor itself. +1
jj375  @jurrutia I think you are thinking of Clopidogrel, prasugrel, and ticlopidine which downregulate GP2b3a expression. Aspirin inhibits COX therefore inhibiting TXA2 and platelet aggregation. +
jbrito718  This is whaat I call a FUCKBOY question +
... niboonsh made a comment on nbme24/block4/q#30 (An investigator is studying an outbreak of...)
 +58 
submitted by niboonsh(376)
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tihs entoqusi aemsk me tnaw ot ate an e cloi eciook nda oeph i bleed tuo

caitlyncloy  pick C and move on was my strategy :P help lol +2
thegooddoctor2  lol good one +1
... drdoom made a comment on nbme24/block2/q#48 (The breakdown of dipeptides and tripeptides to free...)
 +50 
submitted by drdoom(1027)
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The naoudedl munel na(d aecatcnpir sosearpte liek )CNHTIPSRYYMO is eth esti rehwe pccntaeria esyzenm β€œeedesipopd(”)tsna eecalv grael ytidolpspepe oitn lsealrm ibst itee=.rdip(te)dptieis,dpsp tI is at hte RHUBS DBERRO ehwer eth lssletma sdkni fo tsepiedp ppspeept(id,ties)itrdide are roekbn ndwo into iterh noami icsa,d ichwh fylnial nac eb nr-orsatteodpc with +Na iotn het lesnitnati elc.l

I hntik atoub it ihst :ywa

  • tocahms idca nuedtaers adn soneβ€œp pu” oeirpsnt htu(otiw csfciipe agcee;av)l
  • acaprincte syezmne enth vcalee daduneert ipedeytlppso tnio lesamlr ib;st
  • hsurb redrob nymeesz nylflai aekbr wond tnstiie sdetiepp noti seablbobar ioamn icad.s
regularstudent  Isn't the brush border still part of the intestinal lumen? Don't the amino acids enter into the intestinal cell (the "intestinal mucosa")? +1
drdoom  @regularstudent No, the lumen is literally the cavityβ€”the empty space. +2
jj375  Still annoyed about this question, but here is a schematic in case it helps anyone else: https://doctorlib.info/physiology/medical/medical.files/image1890.jpg +2
drdoom  @jj375 best schematic i’ve seen so far. superb. +1
... drachenx made a comment on nbme24/block2/q#13 (An 80-year-old woman, gravida 4, para 4, comes to...)
 +49 
submitted by drachenx(65)
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eThse dnski fo eiouqssnt rea aelylr radh sbueeca eI'v rnvee sene mleaef vptercdeiuro rstcusteru l.ri c:

nbmehelp  Lmao +3
regularstudent  Lmao +1
mutteringly  Lmao +
rockodude  lmao +
abkapoor  Lmao +
dang90  LMao +
icrieeverytiem  lmao +
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
 +44 
submitted by tea-cats-biscuits(252)
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tsaM cllse utdaeagr,len cprduigon nesiatmhi wihhc tttarsac s.oipeihsnlo ehT yaelr atesg of na icrgella niatcroe si tams clel ,ddaieetm ubt eth eatl tages giiunl(dcn usucm iudron)tpco si mdtaeedi by s.iinlhopeso

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills +18
medguru2295  Thank you- I was really thinking this question had 2 correct answers... of course my dumbass picked Mast cells. +5
ajss  where do i find this info?? +
paperbackwriter  @ajss pg 112 of first aid 2019, under type I hypersensitivity. Immediate --> mast cells releasing histamine and tryptase, late--> eosinophils and leukotrienes recruited via chemokines +3
graciewacie9  Wow, i missed the fact that the question is asking for the RESULT of the reaction, NOT the cause of the reaction. Mast cells cause the initial reaction, eosinophils would be the result of the eosinophils. *facepalm +8
greentea733  @graciewacie9 SAME UGH +
lba9587  Pathophys (as far as I understand it)...Mast cell degranulates, thus the phospholipid bilayer et. Al are left behind and needs to be degraded. Who comes in? Our good friend eosinophils, as they contain Major Basic Protein (responsible from breakdown of expired mast cell). Note, you can tie this in to the delayed Leukotriene effects of an allergic rxn, as the bilayer is also broken down by arach. Acid. (See this link to support my credibility https://images.app.goo.gl/3cUF3ZVc7qy8uxAi9) +
mutteringly  who else looked up what T21 pills were +5
... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
 +43 
submitted by lsmarshall(438)
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tanPeti sha aSipn faiidb caucotl cwihh si a lurean uetb ftcdee ulif(era fo unofis of the rsroeunep)o. lsceemStoro era eth prta fo each sotemi ni a abetrreetv rbomey ivgign reis ot ebno or teorh klealset i.eutss eniSc a tpar of tshi 'sienttap npisa baifdi elunidcd cbsaeen"s of issonpu srpos"ec hent a mscoroetel asw levoi.dvn wnnigoK thta lurnea buet stdcefe rae na seuis wiht ounsfi hsodul be gnouhe ot get to teh rhgit n.esraw

fI hte orncootdh lfieda ot vepoled tehn the nirtee NSC dwulo ton evldope sa teh tnodhrcoo cnieuds ofmortina fo luaren alp.et

If het lnerau tebu ildaef to doelpve htne teh ehwlo SCN wdluo tno hvae eedd.oelvp

Ylok sca si eranlvrite ot shti ie.ptant

hneW rlneua ctesr lecl it hsa diereffnt tuoecoms in ffereidnt iest.ssu aurlieF fo lurean ecrts to mgietar ni reath nac seacu onoasiTsirpnt of etarg slvse,es trTalyeog of F,atlol or nsrtPietse tursnuc srteraoi.su rileuaF fo ealurn escsrt ot mitager in GI can ecusa Hrupicgnsrhs sadiees (tglniaecon agmlo.)noce recTerah lolisCn rmeSdnyo acn ocucr newh unrlae ertcs llces ifla to rigaetm otin t1s lhpgeanyra ra.hc ulareN utbe stedfce sha inontgh to od wtih urafeil fo anrlue rsect onaiigmtr .gtohuh

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation. +14
hungrybox  Fuck I picked "Formation of neural tube" but yea that makes sense... that would affect the whole CNS +4
ruready4this  I also never heard of sclerotomes and I chose that and then switched it to formation of the neural tube because I thought that was close enough ugh close enough is not the right answer +1
ih8payingfordis  FA 2019 Pg 479. They don't specifically mention sclerotomes but you can review the different neural tube defects here :) +
... sympathetikey made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +42 
submitted by sympathetikey(1475)
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vyoEeern hwo otg shti inetquos tgihr si a .cop ΰΌΌβŒΰΌ½β– ΝŸΩ„β– 

dr_ligma  Fkn narcs +2
j44n  whippet_gang +
... lsmarshall made a comment on nbme24/block4/q#8 (A 1-week-old newborn is brought to the physician...)
 +40 
submitted by lsmarshall(438)
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Uera lyCec oedsrriDs g&;t loIsdtea veeres emaapimenhorym t;(g& 0001; e..i, on rthoe eesevr ibtloaemc tscsdrinbaeu

iOtrnnihe almserasrbctnyaa ycedfeinci tg;& som(t mnoomc uare lceyc )sid. tcorio cmcaiadaradeu/iii, nmriapmaeoyemh

cOnirag Aidaseimc t&;g mieaoenHrm,amyp nai-naogp scs,aoidi isstkeo (frmo ymgcoaplehiy)

-iiuedMcnmha ocACa-ly eohyddsaengre fyicinedec g;t& pnroam,eymHmaie ctetoopihky ligyoyecahpm (snee in xΞ²i-naoodti irsdsedro, ETCPEX nyhkeorrddueotao)plsy

ervLi fdouticynsn ;gt& mmaerpyn,maioHe TsLF deemss up, ledro t.p

lsmarshall  Summary of metabolic issues relating to hyperammonemia +9
seagull  i'm leaning towards Ornithine transcarbamylase deficiency. +3
notadoctor  Not sure why this isn't considered a mitochondrial disorder since the issue is Ornithine transcarbamylase deficiency in the mitochondria? +2
charcot_bouchard  if it was mitochondrial disorder no one would escape +3
wowo  figure in OTC deficiency, they might have to explicitly mention the orotic aciduria AND typically presents earlier, around 24-48hrs of life after they've fed (at least per BB) + also per BB, propionic acidemia and MM acidemia have an onset of weeks to months and lead to build up of organic acids --> acidemia in addition to hyperammonemia (not sure why, but several aa enter the TCA cycle via propionyl CoA --> methylmalonyl CoA --> succinyl CoA, but now this is defunct d/t enzyme deficiencies...?). Anywho, propionic acidemia described on FA2019 p85, but doesn't list hyperammonemia +2
artist90  i think it cannot be Ornithine transcarbamylase deficiency bc it is XR disease. this pt has a healthy 2yr old brother which rules out X-linked recessive disease correct me if i m wrong +5
artist90  it is 100% Propionic acidemia Uworld Q-id: 1340. it is an exact copy question of uworld. i got it wrong bc i forgot these are organic acids. But i am still confused on 2 things 1-how does acidosis cause Hypoglycemia and Ketosis. 2-why is Ammonia elevated in these pts bc urea cycle will be fine? +
yb_26  1) hyperammonemia is seen in all urea cycle disorders except arginase deficiency 2) organic acids directly inhibit urea cycle => hyperammonemia (from UWorld) +1
yex  According to UW, there is another question # 1341. This one refers to methylmalonic acidemia (ORGANIC ACIDEMIA). HYPOGLYCEMIA results from overall increased metabolic rate leading to increased glucose utilization and direct toxic (-) of gluconeogenesis by organic acids. The presence of hypoglycemia leads to increased free fatty acid metabolism that produces KETONES, resulting in a further anion gap met acidocis. Finally, organic acids also directly (-) the urea cycle, leading to HYPERAMMONEMIA. +15
ih8payingfordis  I think there has been some confusions because FA does a poor job integrating these concepts together but here are some references: FA 2019 pg 85: Propionic Acidemia (this is one example of organic acid metabolism disorder) In the summary figure on Pg 74, look at the protein metabolism (located bottom right). Basically, you can have disorders where you have Propionyl-CoA buildup alone OR Proionyl-CoA and Methylmalonyl-CoA buildup. And these organic acidemias are autosomal recessive in their inheritance pattersn, which fit with the stem we're given (ie XX individuals can be affected) One thing that UW state that I do not have an explanation for: the buildup of organic acids inhibit the urea cycle hence the increase in ammonia (anyone knows how this happens?) +
aaftabsethi1  Can someone tell me why not MELAS ? +1
jaramaiha  @aaftabsethi because all of the siblings would show some symptoms if it were to be a mitochondrial disease. Which his brother is healthy, and sister was full-term but died due to unspecified causes. +
utap2001  Why acidosis cause Hypoglycemia and Ketosis and hyperammonia? In acidosis(such lactic acidosis)-> indicate body energy crisis -> inc. glycolysis, Hypoglycemia-> inc. protein breakdown, Hyperammonia -> dec. TCA cycle, Ketosis +
... azibird made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +38 
submitted by azibird(210)
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ohW eles aecm here teraf tiggnet rerigtdeg yb tish nrsewa?

yousif11  This question did not age well +16
helppls  I'm going to be taking Step with this song stuck in my head lol +
... xxabi made a comment on nbme24/block4/q#43 (A 72-year-old woman with coronary artery disease...)
 +37 
submitted by xxabi(275)
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Setnt rsmbohoist vs ernssieost-. tSnte mssohorbit is an auect niooslucc fo a oyrrcaon ryetar ,tnset cwhih fneot uesltrs in eutca nrroyoac eo.yrsmnd Can be pdretenve yb uadl entalaipttle rheatyp ro trluugdg-nie ts.tnse e-ssnoeRtsi si eht udrlaag wnirgrano fo the tnest umlen ude to nalntiomie nptolfarro,iei snutgielr in nilanga .ymssmtop

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +8
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +7
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +2
... lsmarshall made a comment on nbme24/block2/q#49 (A 17-year-old girl comes to the physician because...)
 +34 
submitted by lsmarshall(438)
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Adgnneor ivnIysitsinte Soymnerd - eceDtf ni eanorgdn epteorrc tinurlegs ni ana-pmopelgnrrai eeamfl 6Y,(X4 D.S)D unFngiintoc eetsts csesau cdrsnieae eottreensost at e,rpbytu chwih si netcdover to eonsrtge pheayl,priler vnigig mealef rdcsoayne lusxae ieracctstshacir elfem(a telxaner at)li.engai kLca fo agorendn reoprtce cuontnfi sdela ot tsanbe ro nastc illxayar nda ipbcu irah. ttnasiPe veha aunymtrerdi iga,van tbu urtues adn inalofalp uestb t.aesnb

rnnegAdo yiestsiinnvti ernsdoym si eth ranwse tbu oyu tgimh hvae nrcosdeeid ailrMnelΓΌ einaesgs siykaoM(-arekt-Ryn sKeser-rΓΌuHta .eymrodsn)

Mraileunl sgisneea lwil aevh almonr moehrno eelslv dna aym stenrpe as Β°1 oremnehara (due to a clak fo terueni peeelndotvm) in melfsea wiht ylful veddpleeo Β°2 sauxle ciscraaerthistc uo(litafnnc a)r.seivo irHa eptelnvdmoe is lmoarn sa wl.el naiPsett oasl eavh mrolan .theihg

eemSs eikl stih uoesniqt ddi ont vieg us umch ot udintiihssg seseidb etihgh adn nrntea seagt 1 bclpariaiy/lxu iahr.

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +
makingstrides  Mullerian agenesis: absent vagina, uterus/cervix because no mullerian system. Yet, still has secondary characteristics ie: breast, pubic hair, normal hormone levels (normal ovaries). Also check to break down the different subtypes of DSD: CAIS, 5alpha reductase deficiency, and swyer syndrome all for XY DSD. Where as for XX DSD, overproduction of gestational androgenism and placental aromatase deficiency. Bc in CAIS the testosterone receptor is dysfunctional, no external / internal male organs are going to form in an XY fetus, but you will have an extra production testosterone (like explained above) leading to increased estrogen (breast growth), but since no ovaries, you dont have the mullerian system. You are left with a vagina with a blind pouch (from lack of functioning receptors) +
makingstrides  Also to add, there are testes that produce the MIH, so you have degeneration of the mullerian system. From B&B +
... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +32 
submitted by lsmarshall(438)
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ehT otsm dicert tha,p dan stmo elikly ,thap rfo basert ccaner to smtaaietsze ot eht vetbraer rae hte ceaoltisnrt isnve. hiTs wsa no na earelir ENBM ttes as el.lw straBe cecanr lliw suace xdim,e tcliy dna atlbcis soelsni neco in eb.no

nO an aruldntaee eont; I aifllny aemc pu wthi a dnctee ayw to eeremrbm liytc sv. atisbcl crscnea ni !enbo

IkYedn adn rdoYhtI scuea ltcYI

rpsatote &;tg tasatebl g&t; atsibcl

owT strbesa g;&t otw ytsep fo sseioln t&;g B seatr sesuac B tho

owT ugnls &;tg wot speyt of slneois edi(degnpn no yetp fo glnu )crcena

alelm-lcsl lgnu ;g&t malsl" tsbl"as

sn-anmoll llce ;> lcity

artist90  VEINS: 1-Intercostal veins drain into Azygous vein which drains into SVC BUT some blood from this Azygous vein is also draining into BATSONS VERTEBRAL VENOUS PLEXUS how the breast cancer metastasizes to vertebral column. 2-Internal thoracic(mammary) vein drains directly into Brachiocephalic vein. 3-Lateral thoracic vein drains into Axillary vein which drains into Subclavian vein which drains into Brachiocephalic vein. ARTERIES ARE DIFFERENT: Subclavian artery----branches into---Internal thoracic(mammary) artery---Intercostal arteries. Internal thoracic artey is used for CABG if there is 1 vessel block. +19
... famylife made a comment on nbme24/block2/q#37 (In a culture of motile spore-forming bacteria, which...)
 +32 
submitted by famylife(98)
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bdesalu-"drotn rbaeska.r..e sdaceu by giozinin i,iaortnad dnciglniu amagm arsy dan yX-sr"a. .vs U"V airtndaio sscuae wto cssasle of NAD sno:lsei tubcaynlcoe iindimyepr dmsrie CPDs(, rugiFe )1 nad -46 pcsrhootuotpd -(46 P,sP Fueirg 2.")

iaab.nratstmmgca/a-aoaclc-drioinnia/thg-/w:s/eu4-pfpmhane-sotti.m-tserwinriaw-ecmpand4de3egpn/

... tinydoc made a comment on nbme24/block4/q#16 (A 24-year-old woman who has diffuse toxic goiter...)
 +30 
submitted by tinydoc(251)
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ihsT iteuoqsn si ervy kysane, ubt ni seecnse hsti si hawts .engppnhai

The naaldicect melrvoa fo het HPT agsnld dnirug octiodtmhyeyr β‡’ ↓ HPT

PHT lniaym-:onr-l :neob ↑ vlaomre fo ⁺²Ca nda optahhPe mfro ineb on-- i:nkysed ↑ Β²C⁺a irbrotpnsoae dna ↓ ⁻₄PΒ³O irarns b↑oetp--o onsvornice of ,25 viamondxrHyyti D ot ,512 ioyaitrmnxdyHv D liCiat(ocrl - eicatv )omfr avi ↑ ytiaticv of -1a srxoyeylHad cncieifeyd

errheofTe a ↓ HTP udolw aeld o:t

β‡’ ↑ ⁻³POβ‚„ β‡’ ↓ Β²aC⁺ β‡’ ↓ 51,2 Hiridaytvymnxo D

eTh etoqnusi is nsyeka u(cmh kile het tser of ihts me)xa ascubee oeeosmn ohw tsni fognuisc ylelar rahd ro ni a rsuh imgth ckip the pntioo C eerwh ohaethpp si ↑ and HTP is ↓ UBT ↓ 25 rmtahxodyviniy D

hiTs si rwong as lyno 1,25 hyotydixaimvnr D dwulo eb eaecdsdr,e the srnoescivon brfeeo this rae noed by eth ksin tiulsn(gh) nda evrli.

I rleayl sihw etyh ludwo tops ngikam teh noueitqss noisungfc PRLYEU ofr eth skea fo kmnaig mthe nunso.gifc nIts it hugnoe that we vaeh ot nwko tihs cirluoduis uoantm of aoitnoi,frmn ithwout vihang htme nteonialtynil nakmig ti rdaher yb iptgonin yuo ot 1 awersn ccoeih but aginnghc a ntiume ieltda to ekma uyo rsawne wgnor. rO ugsni a domrna sas eoartumnnecl for a edesais to oadvi gmkian ti oto semlip GNS(P = peotaielr"rfvi )NG"

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +3
graciewacie9  Amen to the PSGN question. They got me on that one. lol +
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +
msw  *pointing +
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +2
avocadotoast  this bs is prob why the question isnt on step 1 anymore +
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +1
... brethren_md made a comment on nbme24/block1/q#40 (A 26-year-old man and his 25-year-old wife come to...)
 +29 
submitted by brethren_md(97)
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aMke a ntnpetu uearsq htwi a sscro fo B +B nda B 0B; +B rsrtpensee 50% nitcnouf wilhe 0B psstnerree %0 lun)l( nfic.uotn oS in tshi acse, eht dhubasn dwoul aehv a B 0B neegpoty ewlih eth fewi hsa a B +B pegnytoe.

srosC fo hetes owt illw suretl ni hte gowollnfi tpe;gyones ,BB 0B,B +,BB B0+B BB = 0%10 ni,oucnft +BB = %57 fu,oncitn BB0 = 50% iuonfnc,t B+B0 = 2%5 fnnuicto

So hte rwsnea liwl be 1 ni 4 evha a %25 fnnotiuc ngvie eth nygoee.tsp

tyrionwill  how about the choice of D: 1 in 4 have 50% function, which is true. shall 50% function needs transfusion? +
tyrionwill  In FA, it defines beta thalassemia into minor (HbA2 >3.5%) and major (both HbF and HbA2 go further up), and the major needs transfusion frequently. How can we take this classification based upon quantitive way like in this question? how much percentage of function left does not need a frequent transfusion? +
azibird  D says one in TWO, not one in FOUR. +4
hemehero  Is there a way to know that B+B0 will = 25% function. I was stuck between 25% function and 10% function, but couldn't figure out how to reason between the two of them. +1
neil_simmons  The question says the mother has a mutation known to cause 50% decrease in beta-globin gene function of one allele. So if one allele is working at 50% (B+) and the other allele is working at 0% (B0), then that would mean that particular set of alleles would function at 25%. +1
... medpsychosis made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
 +28 
submitted by medpsychosis(127)
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hTe way I htghout autob it asw a eilttl remo .ipcmiiltss We seu onn ivceteels btae esrlcobk e..g( loorlrP)pnoa fro teh nmterteta fo eltsiesan o.tmrre erTfehoer a atbe nsaogit uldwo ahve eht ppseotoi t,feefc aka auecs or enhacne e.trrmo

hungrybox  Genius +6
sunny  Also it(blockers) hides signs of hypoglycemia which are tremors. +5
... lsmarshall made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
 +26 
submitted by lsmarshall(438)
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"aseatlarrnP evhea f)lit( usrcco undrig hgrti nrclvurtaei htpypohrrey i.(e. renetm)ganle or yerv rryeal eseevr tlef ralait menlne.tr"eag RV yrohyrpthep acn be enes os saiyle eecausb eth VR is at the rrenaiot sefrcua of eht e.tcsh

In hist pttaein odblo omrf LA ot VL saseredec in osuart,nati os ti si giong rw.heoesme moFr eth O2 sta. we nac dudeec three si ropbylba a SVD d(aienesrc RV uersrpes ulodw aesuc RVH nda etpsaanrarl hv.)eae rmuorFrt,he eth vtigneet is liyelk ngicrbsdie aoegttryl of lltfoa ue(dacs yb esurernrotpaoi emceitlapdns of eht nifnribduaul ms.ptue) In Tet slsp,le RV oufltow is oot toerctusbd dna itepnta gtse saoiyscn dan ;gLRt& nhgntisu uStasq eicnsaer SVR, ceergdsnai &tgL;R sutnnhgi, upingtt rome odlob uthhorg aounpymrl cictiru dan virengiel cs.isoayn

seagull  i'm pretty sure your a prof and not a student. +26
nor16  nevertheless, we are greatful for explanation! +1
niboonsh  I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml +
anotherstudent  Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize? +1
pseudomonalisa  This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though). +1
furkan7  I does not need to equalizes.Moreover, in left to right shunt,left ventricle's O2 saturation is close to 100% +
... snoodle made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +26 
submitted by snoodle(28)
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tujs wtdnea to dda ttah sonstuieq ahtt ask amlsl litsdae keil ihts akme em ntaw ot ravce my lyeeblas uot

j44n  This is the shit that keeps me up at night +5
jbrito718  I just realized its asking about MITOTIC cyclins +
... neonem made a comment on nbme24/block4/q#29 (A 56-year-old man has a 3-year history of...)
 +26 
submitted by neonem(592)
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erP mhPtaao: alyer iihrnteed scaes of eliehsmr'Az ndimeeta are aoidesatsc whit iunsmotta in innrsenl-n,-ieipep1eli/r2s as llwe as Dsnw'o red.mosyn wDosn' lwoud be eud to an axter ohomsmeorc 21, hchiw esrrica eht egen ofr mlayiod urporsrce rpetnio (AP)P. atxrE PPA si ednotvcer ot at-beA lamidoy adn stih orfms exltarrecuall erntucii le,qspua a reptoninm frautee fo hme.'zAreisl

tamntIopr ot ton ucfeons mAioyld A tropnie e(on fo hte sarewn ceoihcs) twih doilmAy rourcpser et.nirop ioetpDsnoi fo AA iydaoml si rmoe dssaectoia hwti hncocir lyaiafrtnmmo tse,sta lcinnamgay, dna mlalaFii etdnenaMiarer ereFv. -aBe2t gbcunriloiolm is oneahrt yloimda ctnososia:ai discosy-staesaildai tpsiedso( ni tnj)iso

ih8payingfordis  Amyloidosis: FA 2019 pg 212 Alzheimer disease: FA 2019 pg 508 +
... sattanki made a comment on nbme24/block4/q#49 (A 27-year-old man sustains a spinal cord transection...)
 +26 
submitted by sattanki(73)
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plAprnatye erthe si a pcoeeyltlm aepserat slnpia rodc lerexf ewhre crtedi npliee itmlotuains elsad to na .rioentec ihsT eerxlf yonl seedn an natcit acr in 2-SS4, os sa nglo as tsih egoirn si tno iejd,nru an retcoine nac itlls uco.rc e,wHorve thwi iaocsrnentt at C8, tneh eth ocsiehcpnyg inercote erflex nctano ruc,co as siht iersuqre gsneidcnde efsbir fomr hte t.corex

lsmarshall  Just saw a good summary of nerves/vessels involved saying, "pelvic parasympathetic fibers from S2-S4 can cause cavernous arteriole vasodilation via the cavernous nerve without of central stimulation." +7
seagull  S2-3-4 keeps the penis off the floor +41
drdoom  Modifying @seagull into iambic pentameter: β€œS2, S3, and Number 4 / keeps the big ole penis / off the floor” +2
myoclonictonicbionic  I can assure you the validity of answer (speaking from experience) +2
raddad  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ Under the "autonomic control" header +2
llamastep1  I've always wondered how quadraplegics got it up. I guess their girls help em lol +
jj375  This article is shockingly helpful. Scroll down to the 3 types of erections (psychogenic, reflexogenic, nocturnal) https://craighospital.org/resources/sexual-function-for-men-after-spinal-cord-injury +1
... m-ice made a comment on nbme24/block2/q#18 (A 68-year-old man has loss of pain and temperature...)
 +25 
submitted by m-ice(351)
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ehT apeintt has loss fo pani adn eeeattmrupr on eht hgtir isde of sih ea.cf tnnasSeoi of teh fcea si p,lriitasael os eht sesui mstu eb no eth tisptn'ae tghri e,dsi wichh we nac oimfcrn by nwgknio htat onntsisea fo eth oydb si r,rlcolatatane dan eh ash stol lfte iedds anip dna tremeraeptu fo eth .bydo

iaPn dna ptereerumat ensiatons of eht ybod si atpr fo het tclioahmnaspi tra,ct hchiw alasyw rsnu ellyltaar tgouhhr hte r.tbaimsen ishT nca be eoirnmdcf yb ereimbrmegn htat saetniosn to the acef saol unsr erlaltyla rgtouhh het r.tmsenbai o,S we cna crionfm sith is a hgtir dside rlleaat sbramtine esi.us

heT osls fo gag lrxefe dna asyisarlp of het oavlc sdocr myipl iimnmatper fo ailarcn vresen IX nad X, hbot fo hwcih illzoace ot hte mealdl.u hTeer,erfo het aswenr is gtrhi tlelsaoorrda medal.ul

duat98  You're a good man. +5
charcot_bouchard  You must be handsome too +12
amy  The dorsal vs ventral is confusing! +
... aneurysmclip made a comment on nbme24/block3/q#25 (An investigator is studying a new virus isolated...)
 +25 
submitted by aneurysmclip(178)
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oneayn esel tge tihs rnwgo ewlih eth tucenrr ouavosinrcr cdn"a"imep c(ac ot eosm )rsosuce si e?agfp nlinihnepge lallaalre mubd rn

targetmle  yes because i thought they wont give ques on current coronavirus situation so early!! +
adamventure  I thought to myself "damn it sure would be fuckin hilarious if Coronavirus was the answer".. turns out it was and it wasn't hilarious since I got it wrong. +57
asdfjkl  no quotes needed for pandemic anymore :( big sad +13
yesa  Yes! but also, coronaviruses often cause the common cold, not all of them are really bad! So this 4yo girl could literally just have the common cold, and the coronavirus isolated from her likely doesn't have pandemic potential. So this question has nothing to do with the ongoing pandemic--it's just coincidence! +
jaramaiha  Was I the only one that thought it was cause it is enveloped and easily destroyed? lol I didn't even bother with descriptors. +
... m-ice made a comment on nbme24/block3/q#38 (A 55-year-old man comes to the physician because of...)
 +25 
submitted by m-ice(351)
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yheT ytipxleilc ettas htta eth neptait ash enbe tknaig exssce fo ihs ioteryeolhnxv i.eocnmatid Lvortenhxiyeo si eht ognusexoe frmo of T4. rTfeeh,eor eerf T4 tmsu be le.etvdea T4 si cdnveotre ot T3 at osmt aererhiplp e,itusss os T3 lwil saol eb e.veltdea auBecse hte bydo sha emor tdryioh nhrmoeo than e,edned ssle SHT wlil be md,ae nda eht rhodtyi lwil be sesl ,aitcve iknatg up ELSS en.dioi

procrastinator  I forgot that T4 is converted to T3 :( +4
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
 +24 
submitted by lsmarshall(438)
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Frxole uoirtdmgi odupnufsr si sesrlnoiepb ofr nefxiol fo PDI. aeiMdl tepacs fo eht sleumc ihhw(c lefexs eth h4t dna 5th d)igit is lpeduips by hte lraun eenrv ,C8( 1.T) ehT etaarll acpset iwh(hc fexels the 2nd adn d3r dg)tii is rdiventaen yb teh midena revne iefalylcsicp het onriaret tssurosineoe rhcbna ,8C( .)1T So the steouqni is regiiscndb a cainroltea namdaggi the eenvr ppsylu ot the IPD exlorf fo eth n2d tidig xdien( f)e.irng hTsi si ansiyg the dmieal veern is bgeni daeagmd 8C( adn T1; oelrw krunt .r)soto

imbcrLaslu ,(s2d1/tn dne;ima h/r43d,t )nrlau ear a grupo of ecsslmu tath lfxe at the CPM nto,ji dna eendtx IPP nda IPD j.stnoi

Cudlo reeembmr as xlf'eor tdgrmuiio durpunfos si lfyodounpr ong'l seinc ntnodse tinsre no DIPs. eapdrmoC to loerxf giomirdtu suiiafelrscip heswo dnteno sapwr aourdn sfpuuonr'd ieflapcisrlyu btu seritsn on P.PIs

toupvote  This is dumb but I remember FDP is needed for picking while FDS is need for scratching the superficial layer of the skin +13
whoissaad  @lsmarshall Flexor digitorum superficialis inserts at the middle phalanges to be more specific. +
aneurysmclip  shittt I remember it like this D for distal P for profundus > Double Penetration. and I know the PIP flexion from the other Flexor digitorum, which is superficialis. Extensors are lumbricals. (Lengthen your fingers with Lumbricals) +11
hungrybox  'flexor digitorum profundus is profoundly long' is such a good mnemonic, thanks bro +1
... tea-cats-biscuits made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +23 
submitted by tea-cats-biscuits(252)
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eeBucsa oyu rea isenup, etesr’h needirasc olperda gingo abck ot oruy reath no( ndee ot rwko satinag ,vtiaygr royu dbool sni’t lgoionp in royu sgle as cumh .)rheeit sA a tsreu,l ANP si ceerdset ude to RA tehstcr, dgienla ot iuseirsd nda a nriotdceu fo doobl evouml.

urachus  When the person is lying down (supine position), gravitational forces are similar on the thorax, abdomen and legs because these compartments lie in the same horizontal plane. In this position, venous blood volumes and pressures are distributed evenly throughout the body. https://www.cvphysiology.com/Cardiac%20Function/CF017 +
thelupuswolf  RAAS trumps ANP though, so the dec. in RAAS as said by colonelred_ is likely going to have more of an effect than ANP. +1
lola915  If you have an increase in ANP wouldn't natriuresis occur and cause a decrease in blood sodium? +2
mynamejeff  Because you are suprine, there's increased preload going back to your heart (no need to work against gravity, your blood isn't pooling in your legs as much). As a result, ANP is secreted due to RA stretch, leading to diuresis and a reduction of blood volume. +1
sars  This is a "read my mind" question and complete it in 1.5 minutes. Thanks +4
faus305  @sars that is every question +
... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
 +22 
submitted by ihavenolife(70)
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Aurnaln pcneaasr si an nmroaalb artooint fo eth tevlrna tnrcaeapci dbu. tI ceincrsle het 2nd tpra of eth odmuuedn klie a ignr dna rorswna the uelnm of the mneduduo. If teh ainraepcct ngir is hittg gouhne ot orawnr het meunl ue,hnog it aldse ot ivom.gtni eTh biiluso igmotniv pleismi teh oucostbnrit is dilsta to het uaAplml fo a.retV

rOhte wessnra

rPclyio oensists -tg&; NONuiiblos tjreiloecp tingovmi, i-aedophlesv smas ni pigrcsaeti rgeoni

Ealspogeah tsreaai ;-> uldwo eb nno iisbluo sa .lewl ulsylau nseotnea pentesr whti roodgnl,i koche nda mvoti iwht TIFSR egifed,n shit oby is 3 rys ldo os ti si ei.ulklny

ialyirB eriasta -;gt& -vortrFieoaliebibt rdtteuscnoi fo haxteictpera ilbe cdu,t desal ot .asltiehcsso lyUausl rbnwone iwth jid,aenuc dkra niure dan ahicolc sosotl aucesbe lbei kcaedb p.u

aneurysmclip  therefore biliary atresia would also be non bilious vomit. :) +2
ophmd  Curious as to why this presented at 3 years of age +3
ophmd  To answer my own curiosity; according to UWorld - most cases are asymptomatic at birth, so likely it presented when this child's organs began to increase in size (particularly the descending duodenum) +12
... dr_ligma made a comment on nbme24/block4/q#33 (A 12-year-old boy is brought to the physician by his...)
 +22 
submitted by dr_ligma(43)
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If BMEN ksas uatob a ikd ihtw siuouspics rahs duner ihs seno + /guhiedmaeelbdrhdt ni lcas,s ahtt kds'i ufgnifh guel

abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +3
... tea-cats-biscuits made a comment on nbme24/block3/q#24 (A 3-month-old boy is brought to the emergency...)
 +21 
submitted by tea-cats-biscuits(252)
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The sesedia eerh si octfesru oshsaihsbtaepp eey.dfnccii In t,i IV rglelocy or urofsetc e’osndt ehpl ucebaes tboh eentr het encnoeoliegugss hwytpaa elowb trceofus athppha.soiebs oGtsaeacl no eht htoer adnh rtsene aobev it. I d’ont tnhik uyo yllrae ndee to wonk sthi ot socheo the ercrtco srewan scnie eth aiclnlci priuect fo ngtfais yogcipmaheyl hatt si dotcerrce w/ emos srto fo guras htat anc etren hte onessicgongeule phaywat losuhd celu uyo tino hte githr wse.nra

neonem  I don't think you could have *totally* ruled out the other answers - I picked glycogen breakdown because it sounded kind of like Von Gierke disease (glucose-6-phosphatase) to me: characterized by fasting hypoglycemia, lactic acidosis, and hepatomegaly since you're not able to get that final step of exporting glucose into the blood. However, I guess in this case you wouldn't see that problem of glycerol/fructose infusion not increasing blood glucose. Nice catch. +26
vshummy  I think you were super smart to catch Von Gierke! Just to refine your answer b/c I had to look this up after reading your explanation, von gierke has a problem with gluconeogenesis as well as glycogenolysis. So they’d have a problem with glycerol and fructose but also galactose since they all feed into gluconeogenesis before glucose-6-phosphatase. Great thought process! +23
drmomo  glycerol and fructose both enter the pathway thru DHAP and glyceraldehyde-3-ph. Galactose enters thru Gal-1-ph to glu-1-ph conversion +3
linwanrun1357  In this cause (fructose bisphosphatase deficiency.,),fructose should help to increase serum glucose, bcz it can become into glucose-6-P by hexokinase. Therefore, this question makes me confused.... +
krewfoo99  According to uworld, fructose infusion will not increase blood glucose levels in Von Gierkes Disease as well +
atbangura  I believe Von Gierke is not a plausible answer choice because a galactose infusion would still not see an elevation in glucose levels. Remember, galactose could be converted to galactose 6 phosphate, but in order to complete gluconeogenesis and allow glucose to leave the Liver for an increase of its concentration in the blood, the patient would still need glucose 6 phosphatase which is eliminated in Von Gierke. +2
lilyo  So what disease is this??? I mean couldnt we have just answered the question based on the fact that the patient responds to galactose being infused and we know that galactose feeds into gluconeogenesis?? I am so confused. +1
djtallahassee  Its Hereditary Fructose intolerance right? gets sick after fructose and I guess glycerol can jump in via aldolase B on this pathway via page 74 of FA2019. It looked like a fructose thing to me so I just marked out the other ones and moved on. +1
paperbackwriter  @djtallahassee I was wondering same, but hereditary fructose intolerance also results in inhibition of glycogenolysis :/ confusing question. +
amt12d  A much simpler way to think about this, without trying to figure out a diagnosis, I looked at the time frame for when the child was presenting. He has eaten poorly for 3 days, by now, his glycogen breakdown is gone. His body would be trying to make glucose, therefore, gluconeogenesis is impaired, not glycogen breakdown. +5
tyrionwill  if fructose kinase is not available (fructose intolerence), then some fructose may go to F-6-P by hexokinase, then goes to G6P if gluconeogenesis is needed. however this patient's fructose kinase was intact, so no fructose would have go to F6P, so there would be no blood glucose increment after injection of fructose. +1
shayokay  You had to know that fructose and glycerol enter glycolysis at DHAP/G3P, and galactose enters glycolysis at G6P (gal-> gal-1-p -> glu-1-p -> glu-6-p). This means that one of the 3 enzymes between G6P and DHAP/G3P is not functioning properly. Most likely this would be fructose-1,6-bisphosphatase because there does not appear to be anything wrong with glycolysis. "Fructose-1,6-bisphosphatase (FBP1) deficiency is characterized by episodic acute crises of lactic acidosis and ketotic hypoglycemia, manifesting as hyperventilation, apneic spells, seizures, and/or coma. Acute crises are most common in early childhood; nearly half of affected children have hypoglycemia in the neonatal period (especially the first 4 days) resulting from deficient glycogen stores. Factors known to trigger episodes include fever, fasting, decreased oral intake, vomiting, infections, and ingestion of large amounts of fructose." https://www.ncbi.nlm.nih.gov/books/NBK550349/ +1
shayokay  Also, even though Von Gierke is categorized as a glycogen storage disease it is really a problem with gluconeogenesis not glycogen breakdown. So even if you thought this was VG, you still could have gotten the right answer. In VG, any monosaccharide other than glucose (fructose, galactose, glycerol, etc.) will not raise the plasma glucose level because they all require gluconeogenesis to be converted into glucose and this cannot happen because there is no glucose-6-phosphatase. This is why the treatment for VG is frequent oral glucose in the form of cornstarch and avoidance of fructose and galactose. +
... madojo made a comment on nbme24/block2/q#9 (In which of the following stages of the cell cycle...)
 +20 
submitted by madojo(186)
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orneAht ayw ot ihktn utoba htsi si hastw teh osselc gesta ot istmsoi csuabee rghti oerfbe M o(smtis)i oyu eedn to aehv cittimo csliync dsezsheyti,n nad thta uoldw be 2G

1G t-g-&; S &-g-;t G2 -t&-;g M

... lsmarshall made a comment on nbme24/block2/q#25 (A 35-year-old African American man comes to the...)
 +20 
submitted by lsmarshall(438)
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acArl iitlgensuo is omts onmocm ytpe fo aenmolam ni aAcfnir cimsnarAe nda is no eht lmpsa or so.les I suseg het plaitcy hnktngii of echts and bakc un(s d)poseex is a leitlt fieeftndr in shit ep?yt ngoAm lla gompdrs;iaehc oesnlaamm coruc the tyarjoim fo itme no hte blsmi 3%(~6 rlweo adn %9~1 rupe;p) nrtuk si .27.%~. So bdaes no atth and mhi eigbn fo afAricn esdtcne we can ooecsh .lsmap

... colonelred_ made a comment on nbme24/block3/q#34 (An otherwise healthy 35-year-old man sustains a...)
 +20 
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kodLoe ti pu dna fdoun atth ueebcas ’ryuoe ni a npesiu niiootps for a nlgo mtie ey’ruo niogg ot veah ardcesein neovsu rteunr chwhi elads ot eeiardcsn O.C Thsi avliyeengt akscdefbe no AA,RS lniegda to dedscaree eatr.soednlo sA a lrset,u eoyr’u ggnio to aehv ciradenes riuseisd ciwhh dales ot daeedcres oolbd dan mlpasa u.loemv

medstruggle  Doesn’t supine position compress IVC leading to decreased venous return? (This is the pathophys of supine hypotension syndrome.) There was a UWorld questions about this ... +4
tea-cats-biscuits  @medstruggle *Supine position* decreases blood pooling in the legs and decreases the effect of gravity. *Supine hypotension syndrome*, on the other hand, seems specific to a pregnant female, since the gravid uterus will compress the IVC; in an average pt, there wouldn’t be the same postural compression. +11
welpdedelp  this was the exact same reasoning I used, but I thought the RAAS would inactivate which would lead to less aldosterone and less sodium retention +3
yotsubato  You gotta be preggers to compress your IVC +5
nwinkelmann  Could you also think of it in a purely "rest/digest" vs "fight/fright/flight" response, i.e. you're PNS is active, so your HR and subsequently your CO is less? But the explanation given above does make sense. Also because I think just saying someone is one bed rest leaves a lot up for interpretation, maybe not with this patient because his pelvis is broken, but lots of people on bed rest aren't lying flat.... ? +1
urachus  wouldnt low aldosterone cause low plasma sodium? choice B +5
kpjk  could it be that, while low aldosterone levels decrease plasma sodium levels- there is also decrease in blood volume(plasma),so there wont be a decrease in the "concentration" of sodium +4
almondbreeze  FA 2019 pg 306 on Lt heart failure induced orthopnea - Shortness of breath when supine: increased venous return from redistribution of blood +
almondbreeze  if there was no HF, it would lead to increased CO --> decreased aldosterone +
theunscrambler  @peqmd thanks for sharing that. According to the presentation, the diuresis via ANP occurs (along with sodium), which is followed up by an increased in RAAS --> maintains sodium levels. This cycle can then continue. Slide 13. +
jj375  @urachus - Either BB or Sattar taught me this but I feel like it is often forgotten. "RAAS/Aldosterone affects blood volume, and ADH affects Na level". So Increasing aldosterone will increase blood levels however water follows the sodium so you will not get a change in sodium levels. ADH however does affect Na since aquaporins are bringing in water without affecting sodium levels. +
... consistentwrongdoer3 made a comment on nbme24/block4/q#10 (A 60-year-old woman is receiving cisplatin therapy...)
 +20 
submitted by consistentwrongdoer3(20)
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heT sanwer si aoeyhxperlfi eeaucsb the fnreefta arc fo eth cesuml cstrhet erfxle sah to og hhtgoru het ldraos irma and oasdrl toro angagl.i bmDu onqtes,iu I ,nwok ubt it’s eth nyol anwrse ttah aedm ne.sse fI uoy truh the RD,G oyu nto lyon sleo erfeftna mosacit ryessno br,feis oyu saol osel teh nessryo isebdo vneidvol in eth souirva feer.xsel

uoY anc lsao get rplhfoyiaeex ofmr damggani teh efetfrne snnuero htat anretniev teh lmsceu (ikel a MN)L, tub as uoy kwon tehse rea in teh enirotar rhon nda atvrnel imr.a

ankistruggles  Thanks! I agree with you. +1
brethren_md  Great explanation. +1
gonyyong  Agreed - I think I got this by thinking about tabes dorsalis (syphillis) and why it has hyporeflexia is due to dorsal root damage +8
duat98  I'm confused about why it wouldn't cause muscle atrophy. Isn't that a fever of LMN damage? +7
charcot_bouchard  Muscle atrophy wont occur because alpha motor neuron is intact. Motor control of Corticospinal tract on this is intact. so no atrophy. u can move shiti/ But remeber muscle spindle that is responsible for INITIATING stretach reflex send Ia fibre to DRG from where it synapse with Alpha motor neuron. if DRG is damage ur muscle is fine but u cant initiate strech reflex. areflexia +4
zevvyt  DRG you lose DTR +2
... m-ice made a comment on nbme24/block3/q#20 (A 33-year-old woman comes to the physician because...)
 +19 
submitted by m-ice(351)
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ihsT nwoam sha aosmyraxPl nctloaruN mblugorio.iHnae ihTs tsom fotne restepsn ni a ouyng uadtl how ash oedipess of akdr neiru ni teh idemdl of eth gnhit ro when kwgnai up ni hte .rmgnino t'sI cudeas yb tpnmmecelo tatviyci dtycrlei satngai eht sntpea'it nwo .RBsC nreaitC iodlpgilscy are dednee no het RBC ufasrec to tervepn kactta orfm etcn,emmpol eht msot ebtoanl fo hhicw era 55DC adn 5DC9. Pteintsa hwit HNP haev a cotmasi natiumot in hhciw yhet solt cnnuotfi fo a IGPA zeemny denede rof rprope snnoaieteptr dan tnmthcetaa of 5CD/C955D no het RBC rcfeua.s herTerfoe the ewnrsa is a tfeedc in a llce rembaenm ncraoh te.inpro httuiWo ,ihst moltecmpen tksatac CB.Rs

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +23
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +7
sexymexican888  @sunshinesweetheart Spherocytosis results in extravascular hemolysis (spleen) so no weird colored urine (due to intravascular hemolysis) as is seen in PNH (complement destroy RBCs in blood vessels) +
... neonem made a comment on nbme24/block3/q#26 (A 54-year-old man with a myocardial infarction...)
 +19 
submitted by neonem(592)
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erleGan hemte fo h:tooagypl oiyphax sramiip vtiixeaod npyohphairooslt g;-t&- lses TPA gt&;-- ssel NaK- mpup ayivtitc so udmios ibdlsu up in the e,llc scuiang ligel.wsn shiT si teh srfit tp.se nThe duo'y egt hte lcaumic bdliupu ni eht ecll nda evnlauet rabonaeic sslogl,ciyy ignsacu ialcct acid rnootcdiup nad drwolee ..H.p tub isth ppensah lrtae nad t'sin het crteid ecasu fo rullaelc n,ilslegw ichhw si awth het ounisteq is far.et

aneurysmclip  can we have a moment of appreciation for Dr Sattar +27
makinallkindzofgainz  blessed be His name +8
... sattanki made a comment on nbme24/block4/q#5 (A 45-year-old man comes to the physician because of...)
 +19 
submitted by sattanki(73)
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eucMsl inpa + leiriaprotb aeemd si a clissca ornetnsipate fro ionlcaelhrt l.asiisrp tsBe ogniissda for sthi is a ecmslu pbio,ys as hte rmwoy lkies ot nautohg wtnhii hte cesum.sl

sympathetikey  That's what you get for killing polar bears. +90
dr.xx  That's what you get for not cooking them well. +6
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2
jbrito718  fun fact: Can get vitamin A toxicity from eating polar bear meat which leads to fatal fulminant hepatitis! +
... neonem made a comment on nbme24/block2/q#30 (A 35-year-old man with small cell carcinoma of the...)
 +18 
submitted by neonem(592)
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llaSm llce nacmcairo fo eht ulng aym duorepc oeiapaarsntlcp d,snmoyser fo hhwci HTAC and DAH rae eht ermo momnco tbs.useyp TCHA cesesx sdlae to ssceex stnouiamtil no het dlanera tecorx to cedropu lcit,roso gesiutrln C'snhiusg dyomres.n ecsxEs icrlosot a(nlmroly a srests hrmoe)no uaescs rpyeetihsnon avi eatinoonttpi fo tihyeatpscm uaomiltistn on hte s.luecravatu It can salo csuea phokmayaiel yb cigtna sa a dclracnooiertioim wenh in ex,ssce iauttnrgas hte ybtalii of oeb-syyi1drxdar1h-otet eosahregdedny nt(epers ni eth elarn )lsuebtu to ncevtor loctrosi ot to,riesocn hihcw t'nodse act as a iltinorrcic.odeamo

therealslimshady  Adding some ways to eliminate the other answer choices for good measure: B) ADH can be secreted by small cell lung cancer (SCLC), and would cause SIADH, but that does not manifest with hypertension or hypokalemia. C) Epinephrine can cause hypertension (a1 effect), and hypokalemia (via stimulation of the Na/K-ATPase), but is secreted by pheochromocytomas rather than SCLC. D) PTHrP does not cause hypertension or hypokalemia, and is secreted by squamous cell carcinoma of the lung, not SCLC. E) VIP can cause hypokalemia through diarrhea (see VIPomas in First Aid), but not hypertension, nor is secreted by SCLC. +8
... hungrybox made a comment on nbme24/block3/q#31 (A 65-year-old man is brought to the emergency...)
 +18 
submitted by hungrybox(1146)
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I eryall nit’dd unntrddeas shit osenituq even efart aiegndr all the swreasn eher os I aemlied r.D nKeulbad (eth erpe!)tx

eHes’r wath he a:ids

ihsT is a ecsa of tceua aethr erluifa ogifnllow an cuate eihscmci vtnee (ST ieentlvao ni oriterna dsl.)ea SRV aenresics baesceu of rnoamohurleu vanttcaiio, wcihh hlspe to mianaint .PB PCPW cseiresan usaecbe taecu FH suecas bolod ot abck pu noit het nmyorlupa .cicortliaun esrdcaIne arnuomlpy oobdl vmluoe eauscs all teh rmaoyplnu rsuerpses to c.eesinar VRP ERCASESED bceaeus eht amlunropy etvualscrau hsa a eryv hghi cemclonaip, adn trheoefer ayelssvip sisdtend in rnspoese to ieaenrsc l.meuvo siTh apvseis ssnndeisoi eracsdese the PV.R

motherhen  I thought in cardiogenic shock, PWCP can be increased or decreased depending on if the blood is backing up in the lungs (LHF) or body (RHF). Can someone clarify how we know which is happening here? +1
motherhen  *PCWP +
jsanmiguel415  They say it's an "anterior STEMI" which to me meant V3, V4 aka LAD, which supplies the left ventricle so increased PCWP. If PCWP was decreased it would mean right ventricle is disrupted which is more RCA and would be II, II, AVF or an inferior leads +2
... itsdrgoodwood made a comment on nbme24/block3/q#35 (A 4-year-old girl has a history of multiple bone...)
 +18 
submitted by itsdrgoodwood(18)
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The aosinsgdi is ssioteesenOg rpa.tmeecfI aseeDsi saecus a cedfet ni ypTe 1 olaleCng ttha lsead to tebiβ€œtrl sen”b,o eanmgni het teiaptsn evha qetrfune faeurtscr whit lilett arm.tua epyT 1 olnlecag si aols a omajr meonoptcn fo eht scrale -tg&; htsi si awth the rtupeci was iignnht at i( t)?hikn dan ti usceas eβ€œblu .ea”rlcs heT ecsral aer hnutn/seactlirnt os yeht look beul ude to nilyrnudge hdoiarolc evs.ni

F,lanlyi tpaneist heva oopr wnoud nheiga.l oWudn eprari hwit nnolurigata usitse einlvosv ypte 3 oclagel ihchw is hten eodvenctr to etpy 1 nlloecag ruignd racs fon.mraoti cstDfee ni pyet 1 loncealg iyulsovbo ot’nd lwlao hist sopescr to etka lcep.a

... tea-cats-biscuits made a comment on nbme24/block3/q#42 (Which of the following terms best describes the...)
 +18 
submitted by tea-cats-biscuits(252)
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tnFrinocbei si na caxerlerutlla mraixt pc,ireogytnlo hlewi ialnm si na emiatrnediet imefnlat hatt fycaiieslcpl pvsideor osturpp ot het cell uuelcsn. ’oDtn csfenou mlnai htwi malinin nciees(c steah su erl)lcay; lnmiina si keil ebncotirfi,n na EMC pntiycogloer nad a joarm ooptncnem fo eth baasl ailanm fo abetnmse ms.bmnaere

masonkingcobra  Lamin looks like a "cross" and held up Jesus and the basal lamina is super important just like jesus (you bet there are people who believe this) https://answersingenesis.org/biology/microbiology/laminin-and-the-cross/ +43
dr.xx  blasphemy @masonkingcobra +1
luciana  I clearly confused lamin with laminin, now I know +3
almondbreeze  FA 2019 pg 48 lamin +1
almondbreeze  picked tubulin but i guess tubulin makes up microtubules and therefore is spherical +
abkapoor  Also remember progeria is due to lamin a dysfunction, and progeria patients have messed up nuclei +
brise  @abkapoor the f is progeria? and do we need to know it for step? +
brise  @abkapoor omg jk jk wow +
... sajaqua1 made a comment on nbme24/block4/q#20 (Forty of 100 attendees at a company Christmas party...)
 +18 
submitted by sajaqua1(577)
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broiiV ehlaroc nda V. ayoctauephismral aer treelnfuyq tacsdaoies wthi uoisnotcmnp fo udknodreeco eaoosdf eilk slfesl.ihh .V fcilsiunuv si caotaedssi tiwh rbakshic eratw ro twr.tealsa

)A .B us-cree egievsttn nted to acssotiea hsti hitw etehdrae eicr at a ,ffetbu mivognti si rome nmmoco tnah ra.radehi B) .C ui-ejjn aasidoesct with rucdeedonok ,food laeiesyclp ,iknchec or can eb cdcartonet by tcnoatc htiw nilaasm. tI asusec r,mnotlaafmiy olbyod ead,rhari adn yam also elda to aBGruliael-nr myods.nre C) .C eierfpnrgs-n sa a rtralosupo, shti is oidateascs thwi godo htat is threaede neht ftle ot tngmriaee at orom taeumreeptr orf a nglo time boefer ponoc.usntmi smmyStop uldecin tnovgmii and ia.erradh )D .S euaru-s a teah bsetla xnito odudpcre by S. aesuru is osaaciedts hiwt radpi senot of votgn,mii amy eb piaacoendcm by airhd.are Mtos otfen deaiatssoc twih riday dcprstou and .tame

armageddon_oh  Perfringens is also usually a delayed response, can help in vignettes! +
jj375  Vibrio cholera and V. parahaemolyticus are usually associated with seafood. B. cereus is re-heated rice, plus the vomiting type is a preformed toxin, but the diarrhea form is not, so I guess if it was rice, this could technically fit. Campylobacter is blood diarrhea, not watery. S aureus is preformed toxin so it usually happens within a few hours of eating the food, not 12 to 48 hours later. C. perf is less commonly asked about if its not gas gangrene, but First Aid also says that it's usually diarrhea after 10-12 hours and resolves by 24 hours. +
... lsmarshall made a comment on nbme24/block2/q#22 (A 3-month-old boy is brought to the physician...)
 +17 
submitted by lsmarshall(438)
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ewgeZlrle dsymrnoe - otoulaams srceeseiv redoisdr of oeiesmxopr sbgiesonei eud to deauttm PXE e.nesg y,otanopiH iressu,ze eptalyhagm,eo ylera ehadt iniwht( 1 reay). niax-odΞ²oti fo LVAFC psapneh in psimorseoex os the clihd emglysein vingha moes rtos of clonnitaeg oeblimcta rdridseo whti lvdetaee sLAVFC olshud vhea eenb eouhgn to tge eht nawsre hoiwttu wnongik toabu lrw.leeZge

jucapami  furthermore, FA 2019 pg 47 +6
tiredofstudying  Same page for FA 2020^ +6
... neonem made a comment on nbme24/block3/q#4 (A 27-year-old man comes to the physician because he...)
 +17 
submitted by neonem(592)
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I itknh eth raeosn you edne to injtec npgiooraodstn ni isth sace si csbaeue ouy nede HSF dan LH ot orpcedu s.perm SHF suitetsmal hte tlrieso lles,c ihcwh neil het iiroesemnsuf bustelu adn ehlp het sogaipaotmnre roupdec otsmat.yrsceep Ttseenrsteoo is a drotpuc of gydieL ellcs hwen ry'teeh mtduealits yb HL, os tenjnigic nseosetettro ulwdo ssapby that pste tub ti tlo'nuwd rleayl pehl wthi itseasesernm.opg w,vHeore cetinnjgi nRHG sloa tesod'n tne'sod llerya phle cbseeau uoy ndee ttha atlesuilp nHRG at tgnih to maek LH adn HSF reaehws oin-gclnatg RHnG aslogan ylutcala escarede HL nda FSH .cuoripondt

m-ice  Adding on to the answer above. I was stuck between the gonadotropin injections and clomiphene. But, clomiphene acts to increase activity of GnRH which then exerts its effects on the pituitary. The man in this question had his pituitary removed because of an adenoma. So, he needs the FSH and LH directly. +24
mousie  agree! Removal of the pituitary would case a deficit in Gonadotropins (LH, FSH) and therefore nothing to simulate the testes to make sperm... replacing the T with a patch would not stimulate the testes to make sperm and if his axis was intact (although its not) this would further down regulate the production of sperm. I eliminated Clomiphene because if he dosent have T to induce negative influence on the hypothalamus he will have increased GnRH and further increasing it with Clomiphene would not correct the deficit in Gonadotropins. +4
neonem  Oh duh... that makes much more sense. Thanks! P.s. I thought clomiphene was more of a fertility drug for women, since it blocks negative feedback of estrogen on the hypothalamus/pituitary. But in men the system is under feedback due to testosterone, not estrogen. +6
utap2001  clomiphene is estrogen analogue, competitive antagonist, not effective in man. 2. The mechanism of clomiphene is feedback increase of GnRH-> increase FSH,LH, not effective in pituitary removal patient. +
... tea-cats-biscuits made a comment on nbme24/block3/q#29 (Drug X is given to a 25-year-old normal subject....)
 +17 
submitted by tea-cats-biscuits(252)
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laiPatr gsnsioat heva kwea sioatng tvicayit no tiher own sut(h ni ihst aces ti ssueac RH to eai,srenc rbaenic-rdge ecf)tfe but nhwe an atcula gstaoni si eeptsnr aak( wneh uoy ear ecxe,isnrig yuo rae upgcirodn NE nda E tath vhea lluf -oibtsgan )ste,effc iptalar agnotis tulaaycl haev a dlmi gnansottia ecfeft u(sht the htrea arte esea.decr)s

potentialdoctor1  Might be relevant to add that there are two beta-blockers that are actually partial beta-agonists (exert their blocking effects due to lesser effect when compared with endogenous catecholamines) ----> Pindolol and acebutolol +10
thelupuswolf  Key to note as madojo said that a partial agonist will compete with the full agonist in the presence of the full agonist, preventing the full agonist's maximum effect +
... neonem made a comment on nbme24/block4/q#4 (A 63-year-old woman develops flank pain,...)
 +17 
submitted by neonem(592)
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shiT is atuec lmiohtecy riuantsfson inteacor, a type II nsivythtiesypire rhwee pdomreefr- IgM esditainob ibnd ot elmbcinotiap AOB enagitns on doonr CBs,R wihch auscse laarvtunsaric syhml.ieso hR ilpimcbatn,iytoi like e_loloncdre dsia, ecsom omer otin pyla ihtw loabmtciipRh-yit of ncpanegry and ti si ude to gGI ,ibisnodeta hwihc eomr etonf seuac searxrtaluvca siysemolh niecs plcsein gaoarecpshm ahve oeths amFgam-R-c setrcrope to bind aehtvwre GIg ahs c.htagu catvsurEaarlx n'edots seuac atht eisnhoton,py ,ferve fnlak napi aadssotiec htwi iaiobunelghorm sniec eth crmpagshaeo hodl no to eth dgedrdae BsRC and retcvon ti ot r,iivbediln ciwhh cna eylfsa be rexdcete yb the vei.lr

mousie  Could you help me with understanding why this isn't a Type I HSR? I understand that ABO incompatibility is Type II HSR but I don't know how to tell the difference between a patient who is IgA deficient and having a Type I Reaction to an infusion vs ABO incompatibility .... +11
sympathetikey  @mousie - https://imgur.com/QH5rCEX Basically, think of Type 1 HS like a normal allergic reaction (itchy, wheezing, etc.). Whereas, with ABO incompatibility you get the question's presentation. +9
medpsychosis  When it comes to Acute hemolytic transfusion reactions, they are Type II hypersensitivity and divided into Intravascular (ABO) and Extravascular (host Ab against foreign antigen on donor RBC). The differentiating factor between them is simple. Intravascular (ABO) will present with hemoglobinuria alongside all the other common symptoms (fever,hypotension, tachypnea etc.) Extravascular hemolysis will stand out with Jaundice as one of the presenting symptoms. Hope this helps! +8
cassdawg  Also just to add: Rh incompatibility causes a delayed hemolytic transfusion reaction, this reaction was immediate so it is indicative more of the ABO blood group incompatibility (FA2020 p114 has all the blood transfusion reactions) +3
ooooopss  I just wanna say God bless all of you cuzI needed this +1
drdoom  ^ linkify @sympathetikey https://imgur.com/QH5rCEX +1


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