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NBME 21 Answers

nbme21/Block 3/Question#35 (reveal difficulty score)
A 63-year-old woman comes to the physician ...
Increased resting cardiac output 🔍 / 📺 / 🌳 / 📖
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 +20  upvote downvote
submitted by cellgamesgojan(43)
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AV Fssautil -etrour doolb mofr teh lreaairt ssymet ot teh veuons st,esmy -nsysbgiap eth tolreeirsA = ecarnesI LP ---g;&t SERINCEA .VR lAl ni all = aeecnsIr C.O

rdccongiA to WUoldr, the loersterai are a ojrma uerosc fo tcsniseera ... os aiysbpnsg eht reresitloa selstru in a esdaceer ni oaTtl rarpPhieel seietsacnR ... snugcai an neiarsec in het rtea dan leuvmo of ldoob tirnngreu to het te.hra I ma retpyt seur reeht is erom ot the hoiosylpgy ebhnid i,sht btu I ophe shti ixpeneadl a tetlli.

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big92  mliteeamdI"y lwiolfgon aotec,irn reivraneoutso alufsti A(VF) si eaisasdotc whti na snceriea ni icadacr uptotu ,OC)( eichadve remyotdninpal rhugoht a teuicndro in esmictys valcasur aissrect,en rdneiecsa domiraacly nit,rcatotylic dan na srcaieen in otsrek lmvoeu )V(S nda etarh re.ta Ovre teh gollwiofn w,eek aruncltciig boold evmuol ianssecer in ccouinnojtn iwht rnessecai ni italra dan inarb riecritnaut .deetspip heesT lsatneiotra are atiasoecds thwi ealyr inecsarse ni elft lrteiavucrn V)(L nilfilg spruesre whit teh ntaletiop rfo tretulsna ptmcia no iaralt dna ulrrvainetc hrmebca minodsesin adn ifco"nu.nt :PMDI( )' 55se T2h 245er 85 alos haoetnr tusdy yb intEpes orfm eth 95s01 nlooigk at het ftesefc of sF'AV feftce no CO ni nem M(IDP: 35).118207 atpreylApn, teh iraensec in egsirtn OC is a igb bmerpol ebecsua it acn dlea to g-ihpttouuh riaacdc auirfle H.L()V +32
hungrybox  Jseus igb29 uyo nwte in on the sarcrhee olma u must eb PTMS +6
temmy  i9g2b yuo aer rhtig. atth si why saegpt esaised aetsgp haev ihgh ptuotu idcaarc fraelui caebesu fo eht av unstsh. +5
kevin  wtha si een"sacir "LP +6
jhan17  gnrcoAdic ot hinik eW"w an siorrteaneouv altuisf si fredmo nvilgovni a mjora reyrat ikle eht noadabilm rato,a ti acn aedl to a rleag adecerse ni arihelrpep aseitcensr becsaeu ti yb psas reeilorta r(eweh ormja PB is oemrdf) . Tsih eloewdr riaehpprle itecearssn saesuc het ehatr to crnaiees iretsng accriad utotup ot inntamai rppore oobld olfw ot all u.sstsie" +



 +6  upvote downvote
submitted by azibird(279)
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I dnto' eelf liek yna of tsehe tomecsmn aevh lylfu eddessrda yhw het ipatnet utenlyrcr ahs cisdaener egrtisn OC nda OTN cdeeerdas S.V erHe si woh a ndfeir of emni nexpleadi :it

APM (at rtesgni RH) = /23 BPD + 1/3 SBP = 77 mHmg in hist itnatep, icwhh si rlowe htna olrnma (39 Hgmm fi uoy sue /2)1080. So AMP si cedersead adn teh t/eedyrnhkiso gonars e'rtan tggetin the fueiosnrp they dee,n gldanie to RAAS onctiaativ adn mO.BaS/ede APM = CO × ,RTP so ihts ucldo eb due ot wlo OC vrileaet ot TRP th(aw ew sylaluu e)cpext ro owl PRT ivreeatl ot C.O Tsih atpi'nest laegr AV tialsuf ahs rdepodp rhe TRP eyvr lw,o chwih mnase hre OC tusm veah nbee evry ihgh rfo het taps 15 eaysr ot noeastempc i(hgh poutut rheta eau.rlfi Seh has lnoy 5 dysa fo ymstomp,s iwhhc msane hse is ayrle on ni her HF. nScei hse had hcus a high OC ot inbeg ih,tw her rpdo in SV tshi areyl no dowlu tills veael rhee itwh an ECSNEDRAI SV aeopcdmr to a namorl .apentit snsUel her pusle si pruse igh,h erh ahtre ustm be upgpimn a vissaem sotekr emuolv ot amnantii a mroaln oilsstyc obdol ueessprr htwi csuh a wlo PTR PM(A = SV x HR x .RT)P Eetalvny,lu ehr SV aym crseeade ot be lbwoe orn,mal but ton os yerla o.n

orF ps mottsleoeNen:c aecesddre tlriarae O2 sta beeascu ldboo si liogwfn mfro terayr to einv, tno the hreto yaw tuaoor.dNn ddseceare mxedi uoevsn 2O sta euacseb relaatri doolb si ldnifgoo hte aacbinslvu vien rthig beroef exidm 2O ats olwdu be Nurs maeoet.d adsrience SRV seeacub fo het garle AV sui.flta

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 +2  upvote downvote
submitted by the260guy(18)
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utB r'eshe my mepbrlo ihwt shti nets:uqio it sysa htat hse hsa a 5 dya ryhsoit of OBS dan nelowls .segl oS livbyosuo teh thaer si gifnil.a I dpecki Decaesred okerSt eumoVl for tath nosae.r

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nwinkelmann  AV ltsasfiu ear one ueasc of hi-tpugthou adacrci .uirlefa ihsT nproes pnetsres whit hetra luie,afr but it si ued ot lylcacoirnh drceieans itnesrg .OC +2
lukin4answer  minlnnaknew@ sye hastt ihr,gt eh ash fgliian h.tear ubt oisqeutn si nkigsa twha si eht dnigfin fo stih it,ptena I neudtadsrn eht suace is ltFsiua iacgusn hgih ptoutu ei,raful but yeht nd'tid ska het oesarn fo ihs HF, tehy are singka teh ndfgn.ii I eohcso eredcase kreoSt mOVleu :/ +
happyhib_  sTih wsa ym cilgo nda gto to aecsededr kstroe lvoume as wle;l yteh renat ikngas tawh edascu his FH or tiynhagn it sysa awht si teh omts elyilk nfdniig ni isht it.enatp If ihs threa is iglnfai eud to VHL mfro nstoecntsi eneaisdrc CO nloudtw he TA SIHT EVYR NOTMME THIW shi aterh igalfni veha raeddcese sokter .e?olvum. +



 +2  upvote downvote
submitted by usmleuser007(464)
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OC is nsearcide whti 1) dedaercse letda or)a2f edeansrci )3 perdlao eIdcasner ytincttirocla

An raenuteisovo altfsiu ecesatr an eilnratvaet oetru rof iarlat loodb otin hte nsuevo ctuailniocr ow/ ggnoi psat hte erlaroseti (eht roamj sueac fo a,.)eT ssnersituhc by dnogi so eht PRT (reoafal)dt eseaercsd dan hte CO is rensdei.ca

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 +1  upvote downvote
submitted by uslme123(86)
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A'FVs = deraesicn ciaarcd T ButtuUpo. isth s'itn enw rfo this enr?spo I wiev itsh sa a ertah ahtt has inlyfal buneg to iafl -- ddcerseae ffeteceiv yulrocricat emlvuo &-;tg- drieecsna SVR.

tBu i uegss oyu cnat' aevh B refbeo A -- heatewvr -\-

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happyhib_  shi pb aws osmghteni ielk 135;00/ ihtw iltdoscai ounadr 05 I gfdreui eh onucdlt avhe idrnseeca VSR bcueeas ish iidtacosl wulod eb eirhh?g +2
trazobone  I dha tsih msea aorsnegin I pmlceloyte dsolegs vore eth BP 🏻️‍🤦♀ +



 +1  upvote downvote
submitted by nuts4med(8)
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neyAno haev na aide hwy teh dsderceea alearrti O2 trtousaian si onrecc?itr isAmsung hse sha puml maeed senic seh ahs EL ,daeme onl'twdu a rlowe O2 ast eb epeetdxc ot?o

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haliburton  I evelieb hteer ulodw be on deseerca ni 2O ttrusonaai eacbeus gdyotxnaee olbdo (ihgh spesur)er is nhtsedu ntio etdgoxeeynda triu.icc sA goln as eht lugns nac kpee pu, tihs uhsodl ienrasec venuos tyaonxinoge no ravae.eg +7
hungrybox  ty tboh fo yuo rof ,tshi was onwndergi het msea hnigt +
coxsack  2O tsa ont’w gcehna b/c yuor’e nto dgiand exngydtaeedo doobl ot teh irelarta .sied ueYr’o tjsu iktnag raltaeri bldoo dna ttngupi ti iont usoven lbod.o ameS arsoen ywh -L>R cardaci usnsht td’on radesece O2 tas ei(lhw in rsta,cnot a ->RL shtun wdl.uo) +5
hungrybox  tsuj e:aeldrzi teh hgih seupresr of teh traliear tymsse eespk tuo sserrlopuw-e nvueso obodl ni na VA luisaft oarl(bybp isuovob to mtso lpp but it wsa a reuaek mtnemo rof me lol) +2
chandlerbas  ya uoy tnwo ehav ddeecsaer rietrala 2O tsa cbuasee yoonigtnxae of oldbo si rpfsnieou itdeilm (19AF 6-45-) rhoerefte nooaityngex fo het olbod hpanspe twinhi eth ftrsi do3cnses. fo gnriente het unolpmrya ilyacrlpa htat ouy ouldc neve ehnald avgnhi emro dextaeygedno blodo tnree +



 +0  upvote downvote
submitted by step1soon(51)
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Hreat r:filaeu sTih is hte ostm essouir taocmiocpnil of ralge otreuanoeirsv tasif.sul Sneic yuro odblo wsofl oerm icuqylk gorhtuh na orueseotavrin aliutsf naht it wdulo if royu oodbl odewfl thrhuog a rlamon uocser fo ertir,sae iealripcasl nad vn,esi uyro athre msppu raherd to ecopatmesn ofr teh podr ni dbloo ersrsupe c(lelda gh-tuptihuo aehrt rilue).af erOv ,etim the daceeirsn ynitntesi fo oruy trashe' mgiupnp anc eaknew yuro aethr ,sleumc adeglni to trhae laufier.

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