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NBME 20 Answers

nbme20/Block 3/Question#44 (56.2 difficulty score)
A 56-year-old man is brought to the emergency ...
Capillary hydrostatic: increased; Interstitial hydrostatic: increased; Interstitial oncotic: decreasedπŸ”,πŸ“Ί
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 +32 
submitted by hayayah(1100),
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LV oetsdpp gnwirko, sspereru dbckea up otni uplm iur.ctic luPm rcciuit ygrhluo si deam of 3 sp"a"rt - eht cilpi,aealsr ttarlneiisti ,saecp dan the vli.aoel

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 +27 
submitted by hello(350),
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inse'tPta smomptsy bgaen 03 imn tafre moingw anlw e(i.. eaftr gindo saicplyh ii.yvtt)ca He sha eserev ethcs npai adn is loo,c y,acmlm .poidareciht eH ash rdeeiscan ynmlproau yeatrr rrusspee adn ecsnrdaei ltfe liatar rurspese. Tanek etg,tlrhoea sthi si ccogadeniir kscoh.

crCnegaoidi sckho is a aethr ppum mrolbep -- het LV sn'it okwgi.nr

hneW eht VL, sn'it okwgi,rn ti sceaus a kabc pu ni hte doncireit iposepto ot who dbloo llmaoryn fsowl. erefT,hoer lodob lliw abck pu ni het .nugls

Tshi ssucae ircdsenae ayillrapc scyoidrhtta esrrespu t-&;g- hsit versid emor ludfi tnoi hte ntsimiuertti g;&-t- ihts euscsa creasedni iailtirstetn tasoirhtycd ssurpree tg;--& eehrt si won omer liufd tnha malnor in eht tntrimiuiste ;g-&t- this tcaeffs eht pirtneo aroit hiwint the isrimntttue -t;g&- sthi sscuae ecasdered tiaiensrltti tocnioc rusepsre.

targetusmle  awesomely explained :) +  
lilyo  This was amazingly explained Thank you @Hello! +  
pseudopseudopth  For edema to occur shouldn't interstitial oncotic pressure be increased?(when proteins are there, they can pull the fluid) +1  
pseudopseudopth  And when increased interstitial hydrostatic pressure is pressure, shouldn't it oppose the edema by pushing against it? +1  
pseudopseudopth  *when interstitial hydrostatic pressure is increased +2  
pmofmalasia  You don't necessarily need to have increased oncotic pressure, you're correct in that decreased oncotic pressure would act against causing edema but as long as the net change in forces still acts "for" edema it will still occur. For example in this scenario, if the capillary hydrostatic pressure is greater than the change in interstitial hydrostatic and oncotic pressures. Also, the change in interstital hydrostatic and oncotic pressures is a direct result of the edema in this scenario, so it's more like they're responsible for setting the new equilibrium - if they didn't counteract it, you'd never come to a point where the leakage of fluid stops. +