NBME Answers : 305charlie94's page

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submitted by gh889(154), visit this page

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• Severe SBO presents with:

 • ↓ bowel sounds when it is a complete block (hyperactive/high pitched when less than 100% b/c the body is trying to push pass it)

 • Distended and tympanic abdomen

 • Postprandial pain

 • Pain relieved with vomiting (relieves some intra-abdominal pressure)

• SBO initially has high pitched bowel sounds but a complete obstruction has ↓ or absent bowel sounds

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jlbae Crohn disease -> likely a stricture complicated by bowel perforation, peritonitis, and/or bowel ischemia +1

305charlie94 Why was her last menstrual period 7 weeks ago? Any correlation +2

nicspabi probably a side effect of the steroid she's taking @305charlie94 +

submitted by kingfriday(45), visit this page

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Catecholamine producing tumor -> not likely since the presentation would be more of an intemittent episode of HTN and other sympathetic symptoms
Decreased distensibility caused by atherosclerosis: could be describing RAS which is discounted by the lack of abdominal bruits
Execess production of ANP -> can be seen in volume overload states and would also result in a reduction of Na+ in the serum due to the actions of ANP- maximal point of impulse not displaced, no edema, low-normal resp.
Juxtaglomeular cell hypertrophy and sclerosis -> this would suggest findings of diabetic nephropathy. Patient doesnt have hx or HTN.
along with patients labs suggesting high aldosterone state - answer is most likely pointing toward autonomous production of aldosterone.

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305charlie94 if aldosterone is increased, and aldosterone increases NaCl retention, then why is the Cl low here? Wouldn't it have to be increased as well with the sodium? +

submitted by medicalmike(82), visit this page

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This distribution of rash in a medical assistant suggests urticaria (Type I HS) from wearing latex gloves.

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happyyoyo she has allergic contact dermatitis which is a type 4 hypersensitivity reaction. Urticaria is a type 1 hypersensitivity +1

tinylilron First Aid Step 2 CK says that Latex allergy is NOT a contact dermatitis--its a type 1 hypersensitivity reaction +7

lilmonkey Her boyfriend should be informed as well to prevent further and deeper complications. +3

305charlie94 First Aid 9th edition Step 2 CK stated that Latex is a type I HSR, however the newer 10th edition now mentions latex allergy as a type IV contact dermatitis +

submitted by masn8cc(3), visit this page

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Can someone explain how they r/o aortic stenosis? because that could enlarge the LA and give the same sx of hoarseness etc. And the murmur also fits with AS

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bmalamet You would not see a "viable pulsation above the manubrium, which you should not confuse with a "brisk carotid upstroke" associated with aortic stenosis. +2

nbmeanswersownersucks "brisk carotid upstroke" is the description of a normal carotid pulse. Aortic stenosis has a slowly rising/late peaking upstroke since the stenosis impedes flow out of the LV. +9

overa AS affects the LV first. it isn't until later in the disease progression that there will be a significant enough enlargement of the LA to cause impingement of the LA. By the time the problem was that bad there would also be pulmonary findings of backed-up pressure (in my not so expert opinion). +

305charlie94 Can anyone explain why the trachea is deviated in an aortic aneurysm? Made me think of a pneumothorax here +3

baja_blast ^It's basically mass effect. Aortic aneurism takes up space in the thorax, displacing the trachea to the right. Take a look at this CXR: https://radiopaedia.org/cases/thoracic-aortic-aneurysm-3?lang=us +6

thrawn pneumothorax has mass effect to +

leemax severe chest pain -aortic aneurysm +

submitted by cassdawg(1781), visit this page

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IgG can be aquired from the mother by crossing the placenta, but IgM cannot. Thus, the presence of IgM indicates that the baby has encountered the infection in utero and generated its own antibodies to the infection. So the baby has congenital CMV. (See FA2020 p105 for information on immunoglobulin isotypes)

NOTE: IgM is the first antibody formed in response to infection and for most serologies IgM presence will be indicative of ongoing infection.

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frijoles Why is the IgG up then? Wouldn't that suggest a resolved infection? I get that kid is infected but I figured the IgG was a false result and that it would explain the labs. +9

nsinghey Mother's IgG was transferred through placenta +1

305charlie94 Shouldn't the mother also be positive for IgM? I get that the baby has congenital CMV but I figured the mother should be infected as well to transmit the disease +

pfebo Had the same question, I figured the infection was resolved in the mother. However the newborn has the infection at the moment and developed IgM and the IgG's in the are from the mother. +4

pfebo Had the same question, I figured the infection was resolved in the mother. However the newborn has the infection at the moment and developed IgM and the IgG's in the are from the mother. +

neoamin I got that wrong because I thought the baby could not create immunoglobulin at that point. +

nbmesucks CMV is a herpes virus which like most herpes virus can remain latent. CMV remains latent in mononuclear cells. Since the mother has had the infection before she makes IgG she would no longer need to make IgM to defend active infection. IgM is only present at the initial infection every time thereafter your memory B-cells would make IgG - they don't need to waste time making IgM (which is really only made to buy time for the B-cells to class switch and undergo affinity maturation to make IgG) +2

submitted by docred123(9), visit this page

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Are all interstitial/restrictive lung diseases indicative of a LOW DLCO?

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nlkrueger only if it's an interstitial lung disease i believe. like polio can cause a "restrictive lung disease" but it's due to muscle effort and would expect to see a decrease in diffusing capacity (FA 2018 pg 657.2) +6

meningitis Construction worker, Diffuse reticular opacities screamed restrictive and low DLCO for me. Anything that either adds fibrosis to alveoli, or thickens the diameter between alveoli and alveolar capillaries will cause low DLCO. +10

305charlie94 Actually polio is one of the restrictive lung diseases that have a normal diffusing capacity for carbon monoxide (FA 2019 p.661) +1