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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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ochBrngcnioe oiaarccmn = ulng arcenc

tahT ibgne asid, gnul cdncmrnooaeiaa iaispefcycll si dtssaoicea ithw rytpcipeohrh ,ortheyotoharastp iwhch is a cetlpirpanaaso yrnmedos echrizcaretad by iaglitd l,uncbibg ilrrhaatag, ojnti soesinf,fu nad tssoesoriip of talurbu bsone

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luke.10  yhw ton sesmicty eomrdrcslea cnise i did ihts uniesotq gownr dna i oches imssctye osceilssr odmrlcarsee , anc meonose xenpali htat ? +2
kernicterusthefrog  yM tebs ssueg rasnwe ot tath e.1k0ul@ is at:ht a ) shetre' on nointem of ayn sink nnmelvoeivt hiwhc( trehe dolwu eb ni rdroe ot be )sldoaceemr r b) aeeomrSrcld swhso pigitnt in teh nl,ias not uigncl)b bc herTe uowld eb geacllon piintosdoe wiht bssi,foir otn tyrpporyhhe of the neob ta os ijtS ngiayn atht, I saol tgo htsi o!nrgw (utb tup .AR).. os 'mI tno agimncil ot "teg th"is oepH my hhgtuot espocsr hselp, ohu!htg +8
yotsubato  Tsih is ni FA 1029 pgea 229 +11
larascon  I eerga ihtw eetrhkrsouitgn@cefr on stih ,eon hrgcnecinoBo iorcmnaca = nlug .crnaec qSomauus ecll ncaroacim veigs you laemieaccyhrp (ewn oben ifroonm;at ey,)m?ab omclyomn dnfuo ni KESROMS ... +5
waterloo  het bcgbnliu is teh msoptmy tath kaset tou tola of eht awnsre ce.hcios st'I pseru rcit.yk +
jawnmeechell  lsuP teh paentti hsa an 84 pacaek-ry nmoikgs ostiy,rh purse hgih iskr ofr ungl acncre +
veryhungrycaterpillar  FA 9012 gp 229 is lla ceaiptransalpo nsdmyos.re rheTe si no inmtnoe of noinocbghrec iccranmao in nya fo hmet. ehTre is ndnmoaeccrao,ai ubt ttah si otms ellyik in non m,erskso tno in oneemso wiht 48 pcak eray of kminsog hort.isy hWy dseo eh vaeh 5 evsupot rof efngnrirece tfsri aid h,ree waht am I iigsm?ns +3
jakeisawake  tay@ypcreuerlalrrgvinh dssonu leki oncbgihrcoen inrcmaaco si a egnlaer trem fro gunl ecnar.c Yuo aer rihtg atth fi a ekmn-sorno steg ngul nrceac it si smot yllkie aoncercnmidaao sa erksonnom-s yeralr tge llmas lecl. eHvwe,or skoserm can tge eianmdrccansooa sa lel.w Teh onlsiogcot that I wsohad sees htis .tqlnureeyf omAodeanrcican of hte ugln euassc hproprehcyti osapotrhtteohayr per 292 ni 0912AF +2
mangotango  yurtcrvalgnerlhaepir@ eksjaweak@ia cancoeinroadAm si hte tmso ncomom rotum ni knromonsse dna ni fealme meorsks (liek tsih iaep)tt,n os idocnmaeaconra uodwl ilslt eb het tosm klyeil encarc for shti pt oerv eth etsho.r aoaPhmt P.g .96 +3
fatboyslim  ylnetrpapA gocceohnnrib marconiac is byalcilas na lrambuel temr for ngul c.acnre oruce:S o-a-eih/etinagrtitodalpudlnrcscarr/.aeg3/cps:/ +
lifeisruff  eocohgnnbrci is tronaeh emrt for rnonaoaaimcedc ni tsui congradci ot amthapo +1
topgunber  tWhi the ncoeptiex of eoheom-istmal 5%9 aer hnongrecocib +1
meja2  rlfi@ffsuie No, chocoreingbn riaacmcno is a tenklab ermt orf lal guln ac.nrecs voreH,we eth niomaencdcoara ni istu peysutb is ellacd rvhoraolacloeB .ac :fRe FA 21,80 pg 656. +1
an1  She laos has a ewf ypommsst ot rppsotu it ,(ghocu tpmusu, )sr.okme ehT slwgnile mya thowr uoy off nda eesm lkie RA tub ehr age eons'dt rlayel itf eth sdeiesa (s,ola no stclpai sle)niso. wNe enob arnmfooti is a igve .aywa UW ysas thta nboe mgofirn cecnrsa rea to,tseapr kodHign dna lamls lcle raewseh tcyli rea ,oh-gidnnkno a-nlnmlso ,cell .alnre IG and mnaoemla flal in tebewne the tsibcl/a cylti ursc.temp lniuCbbg si htronae vieg aayw ee(sn ni gnlu ,CA BT, F,C peemam,y snccehisirab,to chcrino ugln ,sseasbsce rdacaic cncyiato aesdssei, ivcteiefn rcadso,deniit IDB, yisrrpyde,hmitho dan p.sioatmbrlnoa ) a ouyng leams tihw bomaob esnip dan aslcra pian )c persnteed rialere tacyoci(n sessdiea eprnste ni baeibs adn ened lreay ncoecrirt)o )d kolo orf seom MSH dna ajnducei dretlea sindingf ro baemy a othsiyr of tninfoeci rseuto ) e omhbcnyoe ppreaeac,an bcnbguil is eeptnrs tbu ton fenot eatrdel ot beon ingndfis g ) otenf etneprss wiht ECTRS l(mt)i,dei ro skin sd)(ffe,ui tnaiseodbi + +1
an1  oerortci:cn GI adn atbsre rea m,eixd aamnmoel si lctiy sa is pmlitelu lyaeomm +



 +3  upvote downvote
submitted by niboonsh(409)
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nuofd sith lonn:ei ia0utpt5u/mcc0rhkec:r/spit0oy.4.p/5omm/9//lde0ac/12a8a4reh/

ehocppHytirr rupaynlom hasraroptohetoty ()PAOH is a orsmndey chactardeirze by hte ditar of ttriiospes,i datliig lginbubc dna iflupan tohrrhytpaa of eht galre notsi,j peiaclyesl iiovvnlng teh lerwo l.smib nlCugbib is eacidrtherazc yb oulbusb nneaeregtml fo nlmeatri tseemsgn fo the ngirefs nda otse deu to napoterilofir fo uuglubsan ccetivnnoe uesti.s

iyr.p..mra si a earr daihyreetr on.ntioidc

A mjiaryto of asces g(9)0;&t% of oerncsday PAHO aer ostadaseci with lmnyraupo eimaaclnngsi 6][ or ihnrcoc iautepvrsup uylmopnra ssd.easie

omParnuyl s,inegcmliana liuncdnig miraryp ]7,[ iscattteam unlg ecrnac dan artihocctanir ha,mmploy cacuont for 08% of scsae fo oecasydnr P.HOA arnAicmadneooc fo hte ulng si eht tmso unfeetqr nad lsmal ecll nmiccoara is teh tesla euenqtrf ctogpasiohiotlh ptye of unlg erncac stiscaeado hwti PHOA []7.

hoetr cdeasaiots tcrhcataxoeir gamnincsliea duecnli ogpyraesalanhn canicmo,ra laenr cell c,acnimora hesgoaoaepl ae,nccr tgricas murout 8[], aitncaecrp ,enrcac seatrb oshldelyp tmoruu [,]9 oaame,mln iyordth er,ncac saooctosmare and lsaieinttn y.mhpmola

raViuos aicohltemgruo oi,itdnnosc nngluiidc AR ][0,1 SA 1[],1 lpastiyorerit odn,sao ESL ,]1[2 yaaukTas aissede ,3[1] isosra,oidsc PSA nad Meadnatinrere refve ear wknno to be dcoseiaats wthi stih oindctino sa l.wel

uormylPna ndtoiscnio such as syticc sibrfi,os liursot,suceb hioadiptic lraomynpu oiirsbsf 14[] and lnug tnpontiranaalst haev sloa eenb sdsaiocaet twhi H.AOP

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 +2  upvote downvote
submitted by queenofhearts(18)
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Tsih eitnatp sah eciyhrhptrop rsaatohotohertyp hhwci is dcaisaseot hiwt iccenrnhoobg iacoancmr. It nesepstr ihwt ifapunl nseglwil fo s,wrtsi sgne,irf ,kansel kes,ne or s.boelw nI iotdn,iad the edsn of gnlo eobsn sowh aleopietsr enw nebo onfrmioat , ihchw acn eudprco italgdi cbibgnul adn oneft tsrraiith fo ecaatnjd sojtin.

:rRcoeues nlpaKa nBoe oPgoltyah Pega 732

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an1  I hnkti tspsoeiitir lm(ifnmiantoa of het uep)imetors si nto hatw eth q is igefrrrne to hwne it sasy "new eonb mr"ntoa;ofi aths't ncaitdigni an letoosctbsai oniels ihwhc si orme moonmc ni sallm llce CA. +



 +0  upvote downvote
submitted by tulasi(0)
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The nrttoaepsine of nBgicrichnoe irnamaocc ihg-Co us adn ehs ehimyspTt tutor tasssiaetm ot nub,L,ieBroangn nad .a srlaedn So nwo hte noiequst is nigemtonin eht easm nsotpi ehT ucogh nad uupstm nad osla new enbo orfimoatn on tdefcaef bseno no Xrya and oals nbcuibgl nsetrserep eth n.ugl

nfecerRee- 001 secnpcot fo ytaomna dlies 49

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tulasi  oAsl its llce tyep is msuausoq llec cicamorna lkei tno cdanneaoicmaor l.iek +
tulasi  sAol sit elcl pyet is asusqmuo llce irmancoca ekli not caaemdaoircnon lki.e +
tulasi  Alos tis ecll tyep si asuuoqsm llce amaricnco leki ont macnerdaoainoc ile.k +



 +0  upvote downvote
submitted by assley(1)
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rreHpitycpho yoteotsarahthorp is a meialcd diooncint cogimnnib uigcbnbl nda rtoipetssii fo eth sallm hadn ojts,ni sleecpilay eth ladtsi eanrlatplgniahe ointsj adn the gltrplpaaaamohecane o.isjtn saDlit sepaoxnni fo hte nlog bonse sa lelw as i,afnulp snwolel osjtin nda avoiynls ivluols rinliapfertoo rea nfoet n.ese ehT nodciinot yam rocuc aonel irmy)rp(a, or it may eb ycornsade to eadsises lkie lgnu acrcne. ogmAn tnietasp iwth ugln cnc,rae it si msot ioestascda tihw acdomecriaanon and atesl aiesaotdcs iwht msall clel unlg ae.ncrc Tshee istapten feotn egt uiblncgb nad nareseicd bnoe odnetopsii on ognl sebno. heTri peesrngint mosypstm aer eomsmtise ynol lcbiugnb adn afplniu nes.kla rotecHhpypir tsoorhopahtyetar is eon fo many asnidtt cteffe dodsrrsie ude ot r,ancec twih lugn ccnaer nbige the otms nmcoom cause btu aosl corcigrun with oavrnia or ndralea nia.lgsemianc )b chnbroogecni .aC and the lnyo ewrsna tasht sltreea ot nlgu ccaren adn lal hotre snewsar do o.nt I esohc RA, utb fi oyu ontd' ko...ownnw uoy nowk.

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 -2  upvote downvote
submitted by step1soon(51)
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Teh eordeprt eccednini fo anplCa eonysmrd si 1 ni vyree 01000,0 eopelp. Tihs has eben a elgincind mneubr ude ot rolwe reposuxe ot ocal, bsstao,es nda iic.asl ePcreenavl of Calanp dsryenmo si gehhir ni ptestian with cailis expoeusr eocpmard to het retoh es.usca hTe sfitr olioedmeipcig stuyd udeknterna by eth uiPnnscoimoeos ahseRecr inUt sdvrboee an sdrneceai necaeepvrl fo RA staomgn men ihwt iersseovpgr smavsei srsiifbo .)MPF( alliM te l.a noudf no rndcseeia nelervacep fo mdeiuraoth trhtisria ni emsrin whne dmpcreao to a ummitcnoy herew MFP adn datuimheor hisartirt ewer peeartnvl dan eroreefth uoddelcnc that hte ytleioog fo RA wsa ton ateoidsacs wiht sxrpeeou to tuds ro ugnl egnscha fo cocdpilmeat supoimcnniooe.s eThre aws a ghih laenevprce trea fo PMF adn uesstlcbiuor anmgtos mresni dna mnise-rex tiwh tmhaiduero r]tir[ih5[a.4t]s

oAahiohny s:tPlyopg mmituaeuon cndoiotni is a oemeopnnnh eewrh oe'sn oydb sah mrlmyiatnfao clsle ihhcw atctak sit wno utisse nd,a ni eht eacs of AR, het invy.omus It is dieelvbe atth ni eesth e,ttnsapi rehet si na atetonrila chwih cesusa hte nacseeidr enmmui sneoeprs to nogrefi elamrtisa in teh ns.gul rTehe si nmeuim ivthtecpiyyra tath is ekpsard yb liicsa in iwchh mytnoesco dan cmoasgpeahr eleeasr ksctnieyo hcsu sa -rlutik1nenei dna leutrgtoeyrc-mioicastoaunma-olcpngya-nlgh trfcoa dna rtomu ncsoisre ocafrt p.aahl The sphra seged of hte claiis oals aeucs isyls of lomayslos tessroepa in csehgrpoaam. pmshceoytyL rae tecaaitvd by eht nketsiyoc rldaeese yb agm.seohrcpa siTh all asedl ot na ontauiemmu nnoemopneh hhtguro rpexesuo to scalii chwih si grgeiretd in ticlygnalee dssoerdpeip idnaisvduil how evah AR.

'nwluodt het nyuineldgr seiedsa be AR hwihc si ehtn nicgasu ccgehibronno aci?rcmnoa I'm d!c!eosfun

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kpjk  i odnt kinth tis ,RA easebuc yhte sida xrya ssohw wen nbeo noatfri,om eehrw as RA wodul haev esoonri +1



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