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Retired NBME 20 Answers

nbme20/Block 4/Question#13 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Bronchogenic carcinoma 🔍 / 📺 / 🌳 / 📖
tags: pulm

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 +10  upvote downvote
submitted by xxabi(293)
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eocginchnrBo carmcniao = nulg acrecn

hatT eibng siad, ungl cennadcoiarmoa ccaflepsiyli si cisosadeta with rrcpehhyptio hortophtseryoat,a hiwhc si a acotranisalepp nsredymo iraacrhtzedec by tiigdal lni,bgcub rairhta,lga tojni e,sfnoiusf dan stsesipoior of utrblau nebso

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luke.10  yhw not seytmcsi eaoedcrrslm inesc i idd hsit tqousine wonrg nad i ecsoh mseicyts leosrcssi oedelarcsmr , acn nmseooe ipxaeln atht ? +2
kernicterusthefrog  My etsb usegs arnswe to atth 1@.l0uek si tht:a a) rh'etes on eminotn of nay ksin mienevvlton hhcwi( ereth wudol eb in eordr to eb ls)med )erarbco ademSlrcroe hwoss tpniitg ni the n,alsi otn )lbun bic cg ehrTe odlwu be eloacgnl nsidteooip tihw i,irfobss otn rpyoehyprht of eth boen at n otgynijiaSs tt,ha I olsa tog shti !rngwo ut(b put ..A)R. so Im' ont inlamcig to et"g "this oHpe ym touhgth oserpsc seplh, u!htohg +8
yotsubato  sTih is ni FA 0291 paeg 229 +11
larascon  I raege whit ektrnguorhcrst@eife no tsih ne,o onrccoiehBgn cacnrmaoi = lgnu rcaenc. muqSusao lecl nccamoria giesv ouy clarheymieacp enw( obne f;arimootn a?,mby)e mmlnocoy doufn in SSEKMRO ... +5
waterloo  eth ugcbblin is hte ymtpmso atth ektas tuo alot fo eth rwasne ic.oshce s'tI rspeu crti.ky +
jawnmeechell  Puls eth eapttni sah an 48 ce-yaprka oksmnig tiys,hro spreu ighh kris for lgun arcecn +
veryhungrycaterpillar  FA 1290 gp 292 is lla tpaalasnirocpe ysomdrn.es eTerh si on itnnmoe of igrcneochonb ciomaacnr in nay of .emth herTe is amonnao,rieccad btu ttah is tsmo keilly in nno oss,rkem nto in senoome twih 48 apck ryea of snkiomg .itsryoh Wyh esod eh evha 5 peovstu for fnneeiregcr rstfi aid h,eer htwa ma I isin?gms +3
jakeisawake  elgnyaula@terrrpicvryh usnsdo ikle cgcohbnoenir iacramcno si a relaeng etrm ofr nlgu cenar.c ouY era hirtg htta fi a -osoenrnkm etgs glun arcecn it si mtso ikelyl dcnamriaconeao sa mne-osrsokn arleyr teg lslam ce.ll ,vwroeeH kresmos cna egt ocsacoanaidnrem sa lwl.e Teh ctglsiooon that I doswha ssee siht .enturfqely ncemanciraAdoo fo eht glnu sceaus hyeihrctoprp rottyrahoeopasht per 922 in 19A20F +2
mangotango  inlrr@upgyetcraralveh k@iakeawseaj nAcinmodraceoa is hte mtos oconmm murto in mosoennkrs adn ni faelem sromesk ki(el shti )a,tnipte so naocaidomrcnae dwoul litsl be eth sotm elilyk crenca rof isht pt roev eht sohtre. mtaoaPh g.P .69 +3
fatboyslim  aelyAppnrt obichgonrecn mcoainrca is absclalyi na bmelrlau term ofr ugnl er.canc croe:uS .:rsnnrta/cg/eo-sa3gdhi/iacp-rlurc/taleiptoeda +
lifeisruff  creconohbgni si ahnrteo etmr fro cmonioradnacae in uist cndogrcai ot hopmata +1
topgunber  thiW teh pcixetnoe fo hmaseeiolm-to 5%9 aer orgoncbhniec +1
meja2  sfuifl@fier N,o gcrnhioceonb aimnarcco si a ktnleab retm ofr lal glnu scr.nace wo,reHev hte aaeocmondairnc ni tusi bsuytep si cdlael ercaooollhavBr ca. :fRe AF 182,0 pg 6.65 +1
an1  heS oals ahs a wfe pmsmtsyo to utppros ti (guo,ch pmsut,u m)rkseo. eTh ellngsiw mya ohtrw ouy ffo dan msee klei RA tbu erh ega n'tdeos leyarl tif hte sdieeas s(o,la on ltpiasc sles).oni wNe eonb itmnofora is a igev .ywaa WU yssa taht neob oifgrmn ancesrc rea ,strotepa kgndioH nad lasml clel asewreh tcyil aer n-dn,okhgnoi ls-mlnnoa lecl, rae.ln IG and meoaanml flla in enebwet eth lac/tibs tliyc ucts.mpre Cbilngbu is oanerht vgei awya n(ees in ulgn C,A B,T FC, pmye,mae etacis,hobscrni richnco ulng ssss,eebca araicdc itocancy assde,eis vfieitenc deai,stdicrno IBD, y,drhmiihorpyste nad oa.oabmispnrlt a) gnuyo slmea tihw booamb snipe nda lraacs pnai c ) eerdenpst reeiral ac(ycntio eseiassd tsnerep in siebab adn ndee ayrle rreicnc)oto ) d kolo fro mose MHS adn niejucda eretlda dfiinngs or amybe a hystiro fo fcetniino rotsue )e ncbeohyom aeear,npapc ncubbgil si tseenrp utb ont oetnf daerlte to obne figninds g ) efnto ertnsesp hwti CTERS el(iidt),m or knis def)(,sfiu bietosndia + +1
an1  eniocortrc: GI dna taerbs rae ,idemx oamnlame is ycitl sa is lmutpeli emaylmo +



 +3  upvote downvote
submitted by niboonsh(409)
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fndou isht inelon: o5irk/h/a//a0.m1m0t2ec80are./:urt/h4/9teucasppi0/col5dpmc4y

erycphtiHrop omrypnula oepohtsrhayartot O)(PHA si a mnrdyeos ezccertaiadhr yb het adtir fo tioistps,ier agtiild bcbginul nda ufipnal ttrrhoyahap fo teh eralg itjno,s clysieaple lvgivnino het rwelo biml.s ilCnugbb si hcearzteracid by usobblu eltenreangm of raltienm esngsemt fo eht sgfiren nda oset due to erotfnprlioia of abgusunul innevtocec is.esut

p.r.a.myri is a arre ihatyrreed otnnici.od

A jmaityor fo escas 0&t)%9g(; fo rayescnod HOPA era dcassaoiet hitw ponmalruy smleaigiancn ][6 or rncocih sivuppuetra mpynroalu eadss.eis

ymualPrno eig,cnianmsal dilcgnuni riyarpm []7, aimttacste guln narcce nda tahiricncrota hml,opmay tcnaouc fro 80% of escas fo reaynsdco .PHAO Acoeomnraaincd fo het ugln is eht msto fuenerqt nda lsalm lecl araicomnc si the least nrueteqf aohioitloscthgp tepy of nlug ncaecr escaadtsio iwht OHAP [7].

hetor esicdtaosa aetrtoxchairc angeicmailns enulcid aoeyasgrpanlhn acncior,am arlen lecl ,nacamroci ohsglapoeea ae,ccrn gisctra mruuto ]8[, cpncietaar r,neacc ratesb dlhypoels umtrou ]9,[ e,mmoalna hoidytr cnarce, oamercsaosto dna teiatnisln a.omlhpym

sriVuao mcoliogutrahe isdnoc,otni luiingcdn AR 1,[0] AS 11][, ytriaospilert onads,o LSE [,21] akyTauas sadeies 3][,1 sirodsc,soai SPA dan aMenearenitdr fveer aer nonkw to eb csdaieosat wtih tish dnociitno as lew.l

mrPonyaul tnodinocis shcu as iccyts sir,fsibo sbs,lociruuet daictoipih olurmnayp iirssfbo 14][ adn lgun ntnotsariatplan evah laso ebne tcadiseaos iwth HO.AP

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 +2  upvote downvote
submitted by queenofhearts(18)
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shTi ttipnea ahs hphripcrotye stoyrtptoreahaho which is cdoasteisa itwh corhnegnoibc aarcinomc. tI rpstsene wtih fnaiupl swleilng of s,iwrst firgne,s ke,nals ,sneke ro o.wlbes In iidtnado, hte sdne of lngo bonse wosh tloisearep wne ebno orafoinmt , wcihh can rpudoec ialgdti lgibnbuc nad eonft tsitrirha fo jnaaedct ojnsti.

soRer:cue lanKap eonB ygPlooaht gPae 273

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an1  I itnhk ipiosstteir nfatnmiolam(i fo eht eempo)urist is tno twah eht q si frenrirge to henw ti syas e"wn ebon tmo"fan;iro hts'ta dcgiitanni an ltsooscetiab noeisl ichwh si meor momnoc ni aslml lcel A.C +



 +0  upvote downvote
submitted by tulasi(0)
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eTh iaesnrpotten of recBgnihiocn ciacrnmao Chgu-oi s adn Tishyemhtse p tuotr stmaeatsis ot gnLo,nie,Brubna nda s. alnadre oS nwo hte tsnioueq si ntinniemog teh asme opitns heT uogch and ptsuum nda loas nwe eobn nfaroitom no cfteeafd bones no Xyar and osla cbnlbgiu steesrnrep eth .glnu

efceRe-rne 001 snecpcot of otamyan esdil 49

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tulasi  Aosl sit llec epty is umaossuq clle caacomnir klei tno nceamnroioadac ei.lk +
tulasi  osAl ist llce epty si qmuoauss clle canamroic elik tno carnomoindcaea kl.ei +
tulasi  Also tis lelc pyet si sqmsauuo ellc ociamcanr elik ont doonaecmcaairn l.iek +



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submitted by assley(1)
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epriycophtHr sarthoaopyhoertt is a dmaliec dionctoin gmcinnbio buicnlbg nda tpirssoeiti fo eth mslal nhda nj,siot pslliyeeac hte lidast lengiaetahnaplr ntsjio dna eht tapamaghraeanepcoll ts.iojn tsDila nasxionpe of het ngol boesn as ellw sa uflniap, sonewll isjotn and losiynav usllvio ofipniroletra rae otfne .seen Teh idonocint mya ucrco aeoln myp)rair(, or it yam be erasyondc ot esedsasi kiel lung ne.carc moAgn tnsteaip htwi lngu n,eacrc it is otms cdosaasiet whti dmnrnocaoaieca adn latse sdotcaseai wiht llsam lecl gunl cea.nrc eseTh tsetpnia ftoen get ugicblbn nad ieeracdsn nobe oondetisip on lnog oesnb. rhTie esgenitrpn tsmsopmy ear smstoieem onyl nbclugbi nda uialpfn k.lsena Heorphtrycip htyreottaahrosop si oen fo myan tdnitas tceeff risedsdor edu to ,acrcen wthi gnlu nracce nigeb teh osmt mmonoc saceu tbu saol nriougcrc ihwt vnaraio or enrldaa clningaeaism. )b ncoerbcinogh .Ca nad eht noly werasn httsa etreals to gunl rneacc adn lla ohret sawresn do n.ot I eocsh RA, tub fi uyo 'otnd oo.n..wkwn ouy nk.ow

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 -2  upvote downvote
submitted by step1soon(51)
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eTh eordretp dccnieien of aCnalp mednorys is 1 in veeyr 0100,00 .eoplep Thsi ahs bene a endgiilcn nbmeur edu ot lerow oeuexprs to l,aoc ase,btsso dan casl.ii Pervecalen of pCnala ydrneosm is ergihh in iestptan hwit iilsac eeprouxs pdceaomr to the oreht s.sauec heT tirfs ceilgeiiompod sudyt ektnnadrue yb hte onoimsieouncPs erRehasc tUni voredsbe an ideasrnec vclarepnee of AR mgtsaon emn thwi egvorriesps eimssva rsfiosib )PM(.F alMil et l.a unfdo on scdeareni reeaclepvn fo iumaredtoh trisirath in rsneim ewhn dorcamep to a nmutimyco ewerh PMF dan ahroiumdte thastirri rewe vnpeetral dan roferehet ucdecndol tath hte gyiloote fo RA saw nto etasoadsic iwht peeoxsru ot tsud ro guln shagcne of cecdpmtilao niensoipcouo.sm hreTe was a hhgi alenrpvece erta fo PFM nda obleuisrtcsu gtosnma ermins and -nerixesm with mhoedtiaru tsa]h[5r].[riti4

i:po AgaloPyhtsohyn immntuoaeu iodonicnt si a eoehnpmnon wrhee on'se bdyo hsa afoyamlimntr ellcs hwhci tkcaat ist won teussi n,ad in the ceas of ,RA the yinu.omvs It is leevidbe tath in htsee tsp,itean herte is an taoneraitl whchi escsua het ridseacen mumnei esperosn to gerofin aalmretis ni eth snlgu. rThee is ummien yvecttiirhapy that si dprseak yb ailisc in hchiw ostcmnyeo adn macgrsepoha laerees toykisnce csuh as i-n1irktneeul adn elg--umioarcgnugyaplelcottma-notoniychsar fctora nad morut snicreos atfrco hpaal. Teh rapsh gseed of the iaclis soal eaucs lyiss fo lsoasmoyl taerosesp ni ragsmapo.ceh opsheLctmyy rea cdvtaieat yb hte iycsekotn edlresea yb .pcamerogsah sihT lal elasd to an umoaeitunm ennhonomep urohhgt rxouepse to lsciai hchiw si ridteregg in yletgleican drsesiopdpe aslindudvii woh ahve RA.

ntluwdo' eth ygnnluedri dasesie eb AR which is ehtn suangci hbrcioecgnno rica?noamc 'Im ensc!fo!du

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kpjk  i ntod thkni ist ,AR cebaesu ythe asdi xyar owhss ewn oebn imnr,otaof ewehr as AR udowl haev esroino +1



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