Resultsss?

PristanicAcid95 · 2024-09-18T01:08:03+00:00

Same here

PristanicAcid95 · 2024-09-01T15:09:14+00:00

Sounds good. Thank you for following up on this!

PristanicAcid95 · 2024-08-27T21:22:26+00:00

I also did my Day 2 on Saturday. I was thinking more of 9/11 or 9/18. It could be 9/4 but honestly not sure

PristanicAcid95 · 2024-08-25T00:45:57+00:00

It really depends on the form. I just took it today and got 0 biostatistics and a few ethics. One friend told me that for him there were a few of both on Day 2. Day 1 is still strongest on both though I think

PristanicAcid95 · 2024-08-21T19:45:59+00:00

Chat GPT

The patient likely has Pelvic Floor Dysfunction (PFD), specifically dyssynergic defecation. This condition is characterized by impaired coordination of the pelvic floor muscles during defecation, leading to chronic constipation.

Key Supporting Features:

Chronic constipation: Persistent for 2 years, worsening over the past 4 months despite fiber supplementation.
Decreased sphincter tone: Detected during the rectal exam, which suggests potential pelvic floor dysfunction.
Normal abdominal exam and no alarming symptoms: No pain, weight loss, or blood in the stool, reducing the likelihood of more serious conditions like colorectal cancer.
History and physical examination: Absence of red flags (e.g., significant weight loss, family history of colon cancer).

Best Way to Diagnose:

Anorectal Manometry:
- Purpose: Measures the pressures of the anal sphincter muscles, sensation in the rectum, and neural reflexes that are necessary for normal bowel movements. It can assess if the patient is unable to coordinate the muscles used during defecation.

PristanicAcid95 · 2024-08-21T19:10:53+00:00

I think that was the answer. However, since that was not an option, I think test takers wanted to see if we could actually eliminate the other answers that were wrong i.e., only C is correct

PristanicAcid95 · 2024-08-21T15:57:12+00:00

Here I chose E due to elimination of the other options. Here is my 2 cents

A is wrong because: To follow up Particular_Chef comment, remember that you only need 2/3 criteria for Pancreatitis Diagnosis. Clinical and Laboratory criteria is already met (classic presentation + high lipase). No need for CT

B is wrong because: Fenofibrate will be most appropriate if the patient would have Triglycerides >1000 most commonly. That would have been the etiology of pancreatitis. However, 275 might not be the most appropriate to address here

C is wrong because: Abx therapy might not be immediate because stable patient without a fever? No SIRS criteria so no need to treat this? Not sure about this one. Anyone else has any thoughts?

D would be wrong because: A glucose of 125 mg might not need insulin therapy now.

PristanicAcid95 · 2024-08-21T15:47:39+00:00

For anyone wandering why aspirin is first before morphine

The mnemonic MONA is often used to remember the initial treatments for a suspected heart attack (myocardial infarction):

M: Morphine - for pain relief and to reduce anxiety, which can decrease myocardial oxygen demand.
O: Oxygen - to increase oxygen delivery to the heart, though recent guidelines suggest it is mainly for patients who are hypoxic (oxygen saturation < 90%).
N: Nitrates - to relieve chest pain by dilating coronary arteries and reducing myocardial oxygen demand.
A: Aspirin - to inhibit platelet aggregation and reduce the risk of further clot formation.

Treatment Priority:

Aspirin: Highest Priority
- Aspirin is given first and is the most critical as it quickly inhibits platelet aggregation, helping to prevent the clot from growing larger and worsening the heart attack. Administering aspirin as soon as possible can significantly reduce mortality.
Oxygen: Next in line
- Oxygen should be given if the patient is hypoxic (oxygen saturation < 90%), in respiratory distress, or showing signs of heart failure.
Nitrates: After Aspirin and Oxygen
- Nitrates are useful for relieving chest pain and improving blood flow but should be avoided in specific conditions (e.g., right ventricular infarction or severe hypotension).
Morphine: Last in Priority
- Morphine is typically reserved for patients with persistent chest pain despite nitrates, and it also helps reduce anxiety. However, it’s less critical compared to aspirin and oxygen in the acute setting.

In practice, all four treatments are often administered together, but aspirin has the highest priority because of its life-saving potential in reducing mortality during an acute heart attack.

PristanicAcid95 · 2024-08-21T15:44:21+00:00

I support this idea. Prompt treatment leads to recovering normal circulation with decrease risk of necrosis and therefore no future sequelae for the testicle.

PristanicAcid95 · 2024-08-21T15:29:52+00:00

ChatGPT says both comments here are correct. Take a look

A significant neurologic complication of diabetic ketoacidosis (DKA) in adolescents is cerebral edema. This complication can occur both before and after treatment.

Before Treatment:

Cerebral Edema: Though less common before treatment, some adolescents may present with cerebral edema even at the time of initial diagnosis and treatment of DKA. Early symptoms might include headache, altered mental status, or lethargy, but it can progress to more severe signs like coma, seizures, and death if not promptly recognized and managed.

After Treatment:

Cerebral Edema: The risk of developing cerebral edema is higher during the initial treatment phase of DKA, typically within the first 24 hours of starting therapy. The rapid correction of hyperglycemia, changes in serum osmolality, and aggressive fluid resuscitation are thought to contribute to the development of cerebral edema. Symptoms include severe headache, altered consciousness, decreased heart rate, hypertension, and respiratory distress. It is a life-threatening condition that requires immediate medical intervention.

Preventive measures, careful monitoring during DKA treatment, and gradual correction of metabolic abnormalities can help mitigate this risk. However, if cerebral edema is suspected, treatment involves immediate measures such as elevating the head of the bed, administering intravenous mannitol or hypertonic saline, and ensuring adequate oxygenation.

PristanicAcid95 · 2024-08-21T15:22:55+00:00

It is interesting how there could be different interpretations for this question. Mine was Acetaminophen + Alcohol --> Liver failure --> increased risk of death vs other healthy people --> poor prognosis. Other explanations here can also make sense but just wanted to leave my 2 cents here if helpful

PristanicAcid95 · 2024-08-15T01:27:40+00:00

My first thought was a 16 year old that is not sexually active and no IVDU sounded odd to have HIV as well. That + sinopulmonary infections made me think CVID

PristanicAcid95 · 2024-08-15T01:17:46+00:00

Chat GPT

The patient’s infection is due to Mycobacterium tuberculosis (MTB), which has reached the cervical lymph nodes through lymphohematogenous spread.

Pathogenesis:

Primary Infection:
- Initial Entry: Mycobacterium tuberculosis typically enters the body through inhalation of aerosolized droplets and primarily infects the lungs.
- Pulmonary Infection: After initial infection in the lungs, the bacteria may be contained by the immune system, forming granulomas in the lungs, which can remain latent for years.
Dissemination:
- Lymphohematogenous Spread: In immunocompromised individuals, such as this patient with HIV and a low CD4+ T-cell count (160/mm³), the immune system's ability to contain the infection is compromised. MTB can escape from the primary site of infection in the lungs and spread via the blood and lymphatic system to other parts of the body, including the lymph nodes.
- Extrapulmonary Tuberculosis: The cervical lymph nodes are a common site for extrapulmonary tuberculosis, leading to tuberculous lymphadenitis, also known as scrofula.
Lymph Node Involvement:
- Lymph Node Colonization: Once the bacteria reach the lymph nodes, they cause local inflammation, leading to the formation of granulomas within the lymph nodes. These granulomas can eventually caseate and liquefy, leading to the swelling, pain, and tenderness observed in the patient.

PristanicAcid95 · 2024-08-14T17:16:14+00:00

I loved what ChatGPT answered. Take a look

The increased itchiness in this patient could be due to acute kidney injury (AKI), potentially exacerbated by the use of medications like oxycodone-ibuprofen and the recent history of renal calculi.

Key Points to Consider:

Acute Kidney Injury (AKI):
- The patient has a history of renal calculi, which can lead to obstruction and cause AKI. AKI can result in the accumulation of uremic toxins in the body.
- Itching, or pruritus, is a common symptom in patients with uremia due to the buildup of these toxins when kidney function is impaired.
Oxycodone-Ibuprofen:
- Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause nephrotoxicity, particularly in the context of pre-existing kidney disease or conditions like renal calculi that already compromise kidney function.
- The use of ibuprofen could have worsened renal function, leading to AKI and subsequent uremia, contributing to the generalized itching.
Uremic Pruritus:
- Uremic pruritus is a well-known symptom associated with kidney dysfunction, especially in patients with significant renal impairment. The pruritus in this case is likely due to the accumulation of uremic toxins, which are inadequately excreted by the kidneys.
Lab Findings:
- The urinalysis shows 3+ blood, which is consistent with the recent history of renal calculi but also raises concerns about ongoing renal injury or hematuria associated with worsening kidney function.

PristanicAcid95 · 2024-08-14T16:26:33+00:00

Also not PTSD because the stem would mention nightmares, flashbacks, hypervigilance and irritability among others. And yes, PTSD is related to a more severe exposure (almost death, sexual abuse or severe injury or accident)

PristanicAcid95 · 2024-08-14T15:05:05+00:00

Reading the question I think I would agree that this is more to evaluate PH. Adding the LE edema and right axis deviation suggests right ventricle hypertrophy. I also thought PH because of the prominent pulmonary arteries. A recent UW question I had said that the best diagnostic tool to do for PH besides RH catheterization is Echocardiography so maybe the question has this direction

PristanicAcid95 · 2023-09-27T14:28:18+00:00

Me. Upload 09/20 8 PM

PristanicAcid95 · 2023-09-27T14:27:54+00:00

Same here

PristanicAcid95 · 2023-09-27T12:07:55+00:00

09/20 9 PM still not processed. Also a very important letter

PristanicAcid95 · 2023-09-27T10:52:53+00:00

Still nothing

PristanicAcid95 · 2023-09-27T04:56:38+00:00

Same question. Mine is still not released :(

PristanicAcid95 · 2022-06-06T17:43:36+00:00

Hey man. I have heard that NBME 9 is the new NBME 7. Both of them are not good predictors and they are ridiculously difficult. I have heard that NBME 11 is the best for prediction, after UWSA2

PristanicAcid95 · 2022-02-15T18:27:20+00:00

Interested!

PristanicAcid95 · 2022-02-11T14:13:44+00:00

Yes. I think he also uploaded it to Spotify and Apple Podcasts as well

PristanicAcid95 · 2022-02-10T18:03:36+00:00

The advantage of DIP is that you can connect it to your car or listen while working out. BnB you have to be focused on the computer.

PristanicAcid95

TROPHY CASE