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NBME 20 Answers

nbme20/Block 2/Question#35

A 36-year-old woman comes to the office because of ...


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 +8  upvote downvote
submitted by beeip(90),

Liver looks pretty normal-sized to me. Pic here for comparison

Spleen so huge -- look like this girl has 2 livers.

 +2  upvote downvote
submitted by medschul(33),

I can get behind splenomegaly, but what is the disorder?

sup  Felty syndrome, an extraarticular manifestation of RA. Symptoms include a triad of RA, splenomegaly and neutropenia. It's in FA, you just have to squint (look at the fine print under the RA vs OA table in the MSK section). +7  

 +1  upvote downvote
submitted by dickass(32),

I spent like 5 minutes trying to figure out what kind of trick question this was. They're just trying to get you to figure out 'oh look the spleen is YUGE!'

 +1  upvote downvote
submitted by sammyj98(6),

maybe I overthought this one, but doesn't she have free air in the bottom left? Or is that the bottom of the pleural space...

ibestalkinyo  That's probably the most inferior portion of the right lung +1  

 +0  upvote downvote
submitted by hello(144),

Spleen is enlarged. Compare it to CT scan showing normal-sized spleen:


I thought the liver looked huge af too lol which made me requisition the whole radiograph

 -1  upvote downvote
submitted by thomas(3),

Looked like hepatosplenomegaly, but I went with liver b/c the edema could be due to liver dysfunction.

WHY she has a huge ass liver too? I don't understand how you can choose big spleen over big liver or visa versa

dickass  I like big spleens and I can not lie~ +2