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NBME 23 Answers

nbme23/Block 2/Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock 🔍 / 📺 / 🌳 / 📖
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 +4  upvote downvote
submitted by sympathetikey(1600)
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Mad ta lmfsye ofr ihncaggn ym .sneraw

ulytFa coilg mdae me dweonr fi ihgtint ruoy deah dolwu asudce reidenasc CIP so, eilk a scinuhg urcle, uoy oulwd get esrncaedi uVgas rneve tcytvaii dna ymbea irddyrcbaaa + sheptno.niyo uBt I sgues het ASAR syetms doluw vaeh nceraecudtto atth nad esuacd oacncitvorntsosi voer 24 u,rhos os ypoeoiclvmH hosck is ieediyfltn hte esbt coheic.

sAlawy hsludo og thiw eht uvobosi nasrew :)

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seagull  I dah teh daie thta tshi swa a rneuoeigcn kshco nda criaenisgn iranrnitlaca rressepu lduco cetaff teh uavgs to.o I ktnhi teh squtoine lyrlea astwn su ot go atth reniodic.t +17
uslme123  hTe hnCugis efrxle ladse to acrradbyd!ia +7
purdude  itaW I'm .cdosfneu I hhtougt ophivyoecml oksch sedal ot na iaresncde S?VR +2
littletreetrunk  ,yetplpaarn seehtr' a tgnhi acdlel ttcepmyisha eacspe atht nca nephap rfeat a lheiw i..e( s'eh eenb otu orf 42 or)u:hs Aaumncotulic of sesuti lacmeoibt otarilsdaov btsncseaus ispamir e-aayeeidmtstcidpthm arso,cionivttsonc ihchw eldsa ot lsos fo ursvalca eot,n gspviesorre ohnypeniots adn rngao snphfipor.yoeu +1
littletreetrunk  aols laos fi eh iht sih hdae eh udloc heva olss of ypacihmttse lftowuo romf a xycioph daleuml hcwhi ldocu aedl ot oodsaivliat,n hicwh ruhfert eurcdse larteiar usp,eerrs utb iths saw a hdra oen fro em ll.o I slao utp sadeircne CPI hwa. +1
catch-22  nyA alck fo epscimyhtta oeruwd/eaintcflos agavl utlofow hlousd duerce ,RH ont esacneir i.t eutrFhr, yuo wuldo exeptc msebnrtia sngis if rehte swa apxyhoi to eth tbnr.msiea orF ,xalmeep fi yuo adh mageda to eth tolisray ,scunule you nltwduo' be blea ot raglutee uroy HR in srsepeon ot ucedrde .BP eniSc hsti tpeatni sha eedrcud PB dan seaecdnir H,R tish etcinsadi ahtt eht rmrypai rdcibansetu is iyellk hte cerudde '.eBsPH saol nebe in a etedrs orf 2+4 uohsr s.o +5
charcot_bouchard  In a tanpeti who pdloseve pyothisenon llfiowgno enhyeggih-r urt,aam eecgnonriu ckhso is a agndiossi of nlxeoucis taht si eadm eaftr vhliepyocom dna vboitsrtecu nicdgaeicro shcko haev bene luedr louPsut! esntAb Bdaarcydria lresu ti tou +2

Increased ICP would present with the cushing reflex (hypertension, bradycardia, irregular respirations). This occurs because during increased ICP, the brain will compress cerebral arteries causing reduced cerebral perfusion. As we all know, cerebral perfusion pressure = MAP - ICP, and thus the body will force a pressor reflex to raise the MAP to try to keep the brain perfused.

Unfortunately, this causes reflexive bradycardia due to the baroceptor reflex activating. The irregular respirations are because the brainstem is compressed.

Since our patient does NOT have the classic cushing triad, you can rule out increased ICP.

+17/- drzed(332)


 +4  upvote downvote
submitted by yex(128)
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mmm.H elWl ym dnim ahs wnolb ffo ebuecas twah hti ym indm saw ioeadnydhtr sienc eh saw ni het etesdr. As osno as ym dimn rtsetad ot dwrean batuo lla of het ehrot stionop htat dcluo kaem e..esns. I jtus lkcedic nda odevm!

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charcot_bouchard  rStma iob +5
usmlecharserssss  kghnii in haaasr retesd MHS +4
cbreland  mleipS = samtr +



 +2  upvote downvote
submitted by diabetes(31)
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nbeiledg + psreseru wndo +usepl pu aeqlu vehlmpciooy cshko

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I noufd siht uatbo iadres CP:I tnnPr"oeiaest of idaers aciararnintl euerpsrs = heca,ehad eaa,leipdmlp otaien,uvimngas/ wrseo in the mgiornn sa PIC riasse durgni the itgnh sa a eqsenceocun of oeymern,bcc a ries in CPO2 dugrin lespe eacsud by eryspoarrti p,rsdsenoei and aobblpry a eedaecrs ni FCS no,oasitpbr yplurlipa l,tiaodin stops,i pdmireia egz,a asrprorytei rugiritley,ra AMS, dna cgneahs ni B,P R,H nda otpyersarri apenrtt rea usauyll etal insgs fo arisde CIP nad daetrle ot rtsiaebmn irodtntsoi ro em"cshiia.

oop:ntn/pmb1js/7tenn/t/3m.h3_pc.p/t2isjl/cu

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 -1  upvote downvote
submitted by hello(429)
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tasWh' het mseyesohc dpssueop to be a cleu t?obua Dsoe tihs peaitnt vhea D?IC soeD IDC ywaals csaue oivopehclym sockh?

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drdoom  imaestDdiens atcavsurrnlia oncugatalio )ICD( si a ricyndoms feiitinon.d ee(S .gett)nna It osde ont lyaa”ws“ edla ot hksco ubt skhoc si infyetiled a sebisopl easleuq ncsei(, yb fie,ndtioin ICD = systie“cm orcthbmtoi seoc;r”sp inayhtng estscimy duslho etg uoy a tillte )d,rriewo and so a nptatei with DIC hlsoud be dnrmoetio o!eylcls +
yesa  I tnihk yhte add ot het vyeamlphoio eirtcpu; he is eratddehyd DNA enleigdb toni ihs sseusit aesbecu of ostcnonuis --&g;t rdacsedee tsacarulrniva .oeulv...m +

From https://meshb.nlm.nih.gov/record/ui?ui=D004211:

Disseminated intravascular coagulation. A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.

+/- drdoom(1206)


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