NBME 15 Cardiogenic (NBME Answers)

NBME 15 Answers

nbme15/Block 2/Question#43 (reveal difficulty score)
A 37-year-old woman is brought to the ...
Cardiogenic 🔍 / 📺 / 🌳 / 📖
tags:

+4 upvote downvote
submitted by ∗ergogenic22(401)

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Cool and pale extremities rules out distributive causes (neurogenic, anaphylaxis, septic).

Hypovolemic would describe a process of volume loss (bleeding or dehydration) and would not explain the crackles or jugular vein distension.

don't be thrown off by the normal heart sounds.

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baja_blast Raise your hand if you were also thrown off by the normal heart sounds. +11

jmd2020 I think this question is poorly constructed. Cardiogenic shock would result in an INCREASE in SVR - this woman's BP is 70/40... +3

drdoom @jmd2020 low BP does not mean the SVR isn't increased — it /is/ increased! it's just that the heart is so effed up that even massively increased SVR is not enough to maintain good pressure +4

drdoom another way to explain: imagine you are losing blood volume at a constant rate (someone punched a tube into your aorta and draining you like a pig); at first, your heart would beat stronger (ionotropy) and faster (chronotropy) to maintain BP; at the same time, all your arterioles would constrict to maintain blood flow rates (and perfusion) to vital tissues ... but at some point you will have lost so much blood that all the ionotropy, chronotropy & SVR in the world could not save you or your BP .. your BP will plummet no matter what compensatory mechanisms your body has up its sleeve. +7

drjo Jugular venous distension clued me into cardiogenic shock (heart isn't pumping well resulting in back up) vs the others listed, esp since obstructive shock isn't an answer choice +

kavarthapuanusha Crackles gave me the clue +

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submitted by ∗trazobone(97)

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Cool and pale extremities rules out distributive causes (neurogenic, anaphylaxis, septic).

Hypovolemia would describe a process of volume loss bleeding (or dehydration) and would not explain the crackles or jugular venous distention.

Don’t be thrown off by the normal heart sounds. I am getting real good at this descrambling thing.

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cheesetouch JSYK, if it shows scrambled to one person doesn't necessarily mean it does to another. And wouldn't this possible show scrambled too to them :P? +

trazobone No because I’ve seen a trend where they only descramble comments posted more than a year ago. Everything that’s I’ve seen commented last month or within the last couple of months is unscrambled. But this is only a working theory lol +2

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