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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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adM ta esmfyl ofr hcgianng my rane.sw

tlFuay colig eamd em rdwone if tniigth your daeh uowld uedcas aeiesrndc IPC ,so klie a shugcin e,lcru uyo uodlw etg eecnadris uVsga eervn tiyvtiac dan yameb rdicbraayda + hs.iponnyteo tuB I eguss hte AARS ssteym doulw heav uttncreedoca atth dan dasceu iocsaovotrcistnn veor 24 uosrh, so voyielpHcom ohskc is eeditlnfiy the setb ohccei.

ylwAas lhdous og wiht eth ivbusoo swaren ):

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seagull  I had eth idae ttah ihts was a rnouneeicg shkoc dna eicingrsan anatrclriina esurespr loucd aceftf het guasv oot. I hintk teh ioutnqes yarlel wtnas su to go htat nctiorei.d +17
uslme123  hTe shingCu xrelef saedl ot irybd!aadrca +7
purdude  iatW mI' nufsed.oc I tthouhg hevolopciym ohcks alsed ot na ncreaseid S?RV +2
littletreetrunk  pnetlaypr,a rehtse' a hnitg dlacle epitastmhcy acspee hatt acn ehppna farte a heilw (i..e se'h been tuo for 42 uso:r)h Aucloicnuatm fo stiues cielbtoam rsoltaoaivd bsncsauets imarips mhetapimea-ctyieddst nci,tavoonorscsit wcihh asdel ot lsso fo arsvalcu ,neot isseegorvpr tpinnehsooy dan anrog ooerf.puypishn +1
littletreetrunk  osal olas if eh hti ihs dhea he cloud vhae lsos fo asempycitth fuwtloo omfr a ycxohip ldumela hchiw luodc ldae to tsivda,oolain ihchw hretrfu erescdu irearlta e,srepsur tub ihts asw a rdah neo fro me .oll I lsao put casenrdie CIP .hwa +1
catch-22  Any kcla of stectimapyh uosnacwtefodi/elr lgvaa uotwflo lsdhuo eeducr HR, ton niceasre ti. Fhrerut, yuo wdluo xtecep eitnrmabs snigs if erteh swa pyaxhio to eth smiabter.n For x,plmaee fi uoy adh daegam ot the alirtsoy ecnlsu,u uyo notdu'lw be bale to agtrueel uoyr HR ni sosnerpe ot ueerddc P.B ineSc itsh tatepni ash erudced BP and eaiendcrs RH, hsti ntiedasci tath the ryapmir sutnirabcde si likyel the edrecdu .BPe'Hs losa nbee in a rsedte orf +42 osurh so. +5
charcot_bouchard  nI a natetip woh sopledev nhniyeopsot ionfoglwl ngie-ehrghy tar,uma necrneguio hoksc si a sisiagndo fo clusnieox hatt si daem afetr yovomchilep nad ttocebsurvi ocgeicnirad hscko ehva nbee elrdu !Pustlu o nsAbte cyaaaidBrrd rleus it uto +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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mHmm. Wlel ym mdni hsa lwnbo ffo bacuese waht tih ym dimn wsa tnaoydrideh eincs he swa ni teh t.dsree sA sono sa my ndmi tretads to rwnaed tbuao lal fo the hetor ioptosn taht ldcuo kema .n.ese.s I usjt cedlkic dan !mvdoe

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charcot_bouchard  rtaSm oib +5
usmlecharserssss  gkhnii in asraha redste MSH +4
cbreland  impelS = tasmr +



 +2  upvote downvote
submitted by diabetes(31)
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gibleend + urspeser dnwo u+lspe pu eulqa hicpvmleyoo ochsk

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I donfu ihst autbo adeisr PI:C siPonrenta"te fo airdes nnrlriaitcaa reruesps = each,hade maelpde,iapl nmaveiu,/intsgoa roswe ni hte omrning sa CPI siraes riungd hte higtn sa a eecncnoesuq fo ercym,encbo a isre ni 2POC idgunr eelsp asduce by yoptrrareis nredp,sieos nad opyrbbal a sdeecrae ni CFS oobpnt,srai parylulip ondtili,a tio,pss rimpedai ,egaz rrieopsraty lrtuyigriaer, SM,A nad ensagch ni ,BP HR, nda rrrptaesioy atntrpe ear lauluys elat isnsg fo rdesai IPC and tedlaer to naimsbrte osriinttod ro "amihe.isc

opsppt.o1c/p.mnub/e/2thjs3n3jnmt/t_nlc:7/i/

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 -1  upvote downvote
submitted by hello(429)
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Wh'ast hte eemcshsyo opusspde to eb a lceu ?btaou eDso tish peantti vaeh CI?D sDeo CID lwaays aeucs oholicemypv ko?hcs

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drdoom  diseseatnmiD aicntaarlsrvu anooucltgai (ID)C is a dcoimsrny .nofidineti See( g)tantne. It dose otn sl”a“yaw eald ot ckhos btu coksh is niltidfeye a bslosipe selequa eins(,c by tiifidneo,n DCI = “icmstsey cttmoibohr c;ross”pe iangtnyh mictsesy uholsd get yuo a little eirodw),r nad os a tnetaip with CDI ouhdsl eb iodmtnreo oecyl!ls +
yesa  I kinht yhte dad ot het mlpiyoohvea ;crtpieu he si ydddrteahe ADN edlebign ntio sih setissu bsceuea of itocussonn g;-&t- aseeeddrc luvsaacrnaitr vem...ol.u +

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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