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NBME 20 Answers

nbme20/Block 4/Question#8 (40.6 difficulty score)
A 58-year-old man is brought to the emergency ...

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submitted by xxabi(261),
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I asw eurnd hte epsmsrinoi atth iths saw an otcria siiso,dntce deu to es"rvee shetc ina"p sa lewl as het leasf mulne in eht otr.aa dAn HNT si teh #1 kisr torfca orf iotarc disie.sotcn moeSeon roretcc me fi m'i nogr,w ubt I tkhin hsti is racito soiistdcne tahrre ntah ricaot .rnymaeus

chefcurry  I believe so, FA 2018 pg 299 +3  
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension +2  
breis  FA 2019: 301 +  
pg32  First Aid says that aortic dissection causes widening of the mediastinum and is due to an intimal tear, so I thought it wasn't an aortic dissection. Can anyone help me understand why First Aid was wrong in this case? Thanks! +3  
nephroguy  @pg32 The question stems states that there is no widening of the Aorta, not the mediastinum. Widening of the mediastinum is seen in dissection while widening of the aorta is seen in aneurysm. Also the intimal tear creates a false lumen between the intima and media. Hope that helps! +11  
j44n pictures worth a 1,000 character limit +  

submitted by step1soon(48),
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nWednigi of eth = AY!NUSEMR

aEtrx mnlue in imeda fo toara = DCNSTSEOII

TSIH pt sah an arcoti scidntsoei

1 SIKR cratof is o!Herti !neypns

si(sllpuyh dluow eb etcrroc of eth pt had na sranemuy utb ISH CSETH YRXA- DO ONT oshw ndwienig of het rtoa)a

gabriela  @step1soon were you upset when you wrote this comment? lol +3  

submitted by kernicterusthefrog(118),
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siTh si otn na eusrnya,m hcwhi is hatw aeskm hsit netqoius so ierd:w "y-saxr of eht shtec od not swoh ewni"idn.g My trdnuiesgdann saw ttha necsstsidoi uyualsl coruc ni hte tiurepc of ny,rsuaem lpyeclsaie edu ot eov,wreH hsrppae a'stht tno eth csea, arurpyclailt in teesh fodStran Tepy A nieosd?tciss eTh ptreuci in FA seur skmea ti lkoo eilk a dedinew troaa (sreaumn)y itwh a oc.eds..intsi

submitted by eacv(36),
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siTh is na COARIT COISDS:NTIE .oN 1 FR is ,AHT mlnaiti atre grmonfi a selfa mlneu nad eht pian eudnds ostne aaitrsed to the .back

submitted by masonkingcobra(346),
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b:Rison'b Teh wto smto pntaomtir cessua of otacri reysuasnm ear etaorheicslosrs adn nsepoinytreh. sssohoceietArrl is eht oemr maionntd tafroc ni oaailmdbn ciaotr ruys,mnase elwih opysnerhneti is etcdsaaios hwti gnacedsin ictaor s.eraumsyn

submitted by step420(34),
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yereHotnsnpi anc alde to usersmnay leki ni tsih ttienap. Not ishipyls eaescub nto ahcctiro r.aoat

submitted by haliburton(215),
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FA 017:2 °3 sihlsiyp rsutidsp eht sava aosvurm fo eht rotaa hwti eoencnstuq hyorapt fo lsvees allw and ntildtioaa fo troaa nda vaevl ayn. iMgr ees lfctoaincaiic of taorci toor, cedningsa oacrit ch,ar nad tohccari eLsad to “reet kbr”a pepraecana of toCaan.ra esrtlu ni saynurem fo acindnseg oaart ro ictoar crah, traioc .ifsnecyicufni