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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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igeonroncBhc ccmoinara = lgnu ernacc

hTta iegbn da,is guln cnecdrinoamaoa yfellaispcci si setdscoaai hwit tphrrecphoyi rhota,hyttorposae hwihc is a transoeiapcapl onmsdrey ahecrtzaercid yb tgaldii igunbcb,l iarrlgah,ta tonij fnfoiss,ue and riosposetsi fo bluraut esnbo

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luke.10  ywh not isctsmey lroesercmda ensic i idd shit sqnoutie gronw and i soche msciseyt eolsssrci erdaemlcosr , acn emoseon enixalp taht ? +2
kernicterusthefrog  My best geuss sarwen to htat uekl01.@ si taht: a ) e'sreht no ontnmei fo yan iskn teevlvmnnio hic(wh rehet louwd be in oedrr ot be cb e)rasrdemol) Seelacmrrod sswho tiptnig ni teh ,nasil ton lnb gb c)iuc rehTe wluod be geocllna toisdeoinp ihtw r,bissifo ton hpotyrryehp of eht enob ta atgjon Synsii atht, I laos tog hsti r!wngo (tbu tpu )A..R. so m'I otn cnaimgli to "etg t"hsi epHo ym ohhtutg orsescp heslp, hoh!tgu +8
yotsubato  hTsi is in FA 9102 pega 229 +11
larascon  I geera htwi ctforske@nehreiugtr on thsi n,oe cnchoBornige maricnaco = ulng enc.arc Samosuqu lecl anmaocirc gsevi ouy iryaeeclmahcp n(we oneb to;aonfirm yb?m,)ae lomymcno fodun ni RKOSSEM ... +5
waterloo  eth gbucilbn is teh msoytmp that ekats uot atlo of eth wraesn hecoics. tIs' srpeu icrtky. +
jawnmeechell  suPl eht intpeta sah an 84 aray-epkc sgniokm ,stroyhi usper ighh sirk rfo unlg rnacec +
veryhungrycaterpillar  AF 2019 pg 229 is lla iaropapanletcs ss.emnrdoy Teehr is no neoinmt of eonnrgbchoci ionacracm ni yan of tme.h reTeh si amrcncdoaen,ioa btu that is tmso lyeilk ni nno ,mressok ont in emesoon twih 84 pkac yrae of konsmgi oy.rshit Wyh osed eh veah 5 epsvtou rof erfnierngce rifts iad ehe,r ahwt am I siimn?gs +3
jakeisawake  arrhnlgpay@cilrreyevut osdsun leik ncoibncegrho aaicrcomn si a rlagene rtme orf nlug cncr.ae ouY aer ihrtg atht fi a oomkner-sn stge ngul eaccrn ti is tsom ilkley noaieaaocrmdcn sa nomen-sroks aerryl gte almls ecll. ewvre,oH sokmesr nac egt oiacasnmnoedacr as .ellw The tlnisogooc atht I awoshd sese tsih f.yrlneqeut acdiraomoncenA of hte lngu asuces iycrheppthro aaeroshptrhttooy per 292 in 02F91A +2
mangotango  hnrr@eyaltgirlcrueavp aakeiekjas@w nnmcaAioerdcao si het otsm ocmonm outmr ni esosknrnom nad ni almfee rmkesos eil(k hits ti)etn,ap os naoncmdaacorei owuld sltli eb hte tmos likyle ncerac for ihts tp revo eth oteh.sr aomPath P.g .69 +3
fatboyslim  rAlptypean nognrbeoccih iaoraccmn is ilbycalsa na lubarmle term rof nlug .ccaern cuSreo: :el/raop.islttaaicpnca3reu-ggaotr///ncshdier-d +
lifeisruff  ngbrhncoioce is ranhteo metr orf dnaaroaccemnoi ni iuts giocdcarn to ahomatp +1
topgunber  tihW hte eepxcotni of mteasmoloeih- 95% rea oingbenchroc +1
meja2  @elsriffiuf oN, bnohcgrnoiec nmcircaoa is a knltbea metr rfo lla lgnu carne.cs eev,rwHo hte reaaodmicnnaco ni itus butepsy si cleadl lvharrBeloooca ca. e:Rf FA ,1820 pg 6.56 +1
an1  hSe aosl sha a few ssmotypm to rptpsou it (ucgo,h pust,mu so)mkre. ehT lgeiwnsl mya hrotw uoy fof nad esem elik AR but ehr gae esod'tn elalyr itf eht desiaes s,(alo on ipalcts .sonies)l Nwe oenb fomtoiran si a igve waya. UW asys ttha oenb gofnimr acsrecn ear eopstra,t Hgkiodn nda lamls cell sehraew ctlyi era nkod-n,gionh alslnnmo- ,clle rlen.a IG and aemonalm afll ni twenbee eht a/cilstb lctyi uprtem.cs uCbinglb si otahren evgi aawy (ense ni lngu AC, T,B ,CF yaeepm,m c,isesoratbnhci ohrccni guln cessesa,bs acirdac tycncioa a,essdies ivinefcte rcdasi,detino DIB, sirmyrhoipd,they and opit.aalsmnobr )a uynog smeal htwi obbmoa ensip and ralsca aipn c) etsdepner raereil (cytnaoic sesdiaes psntree ni siabbe nda eend alyer eoirtr)occn d) kolo for moes HMS nda idnceauj eadltre niisndgf ro byame a toiryhs fo nificnote srteuo ) e bmohoycen epnaraaec,p cbliugnb is tepsern tbu tno nfoet adtlree ot neob ifgnsnid )g fnote stsenepr twih CETSR di(,lie)tm ro snki fsd(,if)eu bitanediso + +1
an1  reorctn:coi GI dna satber are di,mxe emoaalnm is cylti as si lulmtepi oemmlay +



 +3  upvote downvote
submitted by niboonsh(409)
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fuond shit nleoni: m/4op5s.har9u/ttk0/rma0im0/aa/reeccie8/tpo02:/p5ydh1.lcu4c/

epcyptrhHori uroalmnpy shretopoyaatothr (HOPA) is a esdmnryo irazceetdhacr yb het atrdi fo ssitip,itreo lditaig lubnbgci and iaunfpl rhaatohtryp fo eth lager sjon,it llieapcyes iiovngvnl hte orlwe .msilb Cbluginb si ihrrtcaedzace yb usobbul aengnetelmr of ilamtren msetgnse of het nfisger dan sote due to ooipafertirnl of usubunlag necvetnoic e.stius

m.pa.yrir. is a arre erdaertiyh coonti.ind

A raytijmo of sscae ;&t0%()9g of nordcaeys AOPH aer atciaessdo wthi pymaunlor agmencanisil ][6 or rhncioc ppuuriveats omylnprau sas.edise

olmraPnuy lsmiainnecg,a dncilnugi ymrarip [7], atttieascm gunl ecnarc nad coriihactnatr hymmap,ol cucnoat for 8%0 fo assec fo sycndearo .PHOA eonamcnociAdar fo the ulng si the most tfqrnuee nad mlsal elcl ccrinmaoa si eth lsate ntuerefq cihgsttlooiphoa yept of gnul recanc cdaseosiat thwi PHAO ][7.

otehr icdseaatos xaeoacthirrtc elicnimagans uinelcd pagloyrnhesnaa occa,nmria alnre cell aroamccni, eglaopaohse ecnr,ca gtcaris tuomru [8], naercptiac crcena, srtaeb phdoyslel rutumo 9,][ aonm,leam todiryh an,ccre mosoreosatca adn lsttnianei .yhloampm

Virosua riuacmhtleoog ioicsndnot, icunidlgn AR 0,1][ SA 1,[]1 rlepittiyaros s,onado ELS []2,1 asaakyTu eisedas 1,3[] sicrodis,aos APS nda taenniardreeM erevf are wnnok ot eb toidesacas ihwt isht doicntnio sa e.lwl

rayPuonml sondniciot uhsc as cstcyi ,firiossb ocltbruseisu, itphcaiido polmnrauy iisbrsof [4]1 dna nulg nntslpattaoarin evha aols bene cedsastaoi with PO.AH

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 +2  upvote downvote
submitted by queenofhearts(18)
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ihTs teaintp has hehrpcptyior potyohhrtastreao hhwci is sstocaidae hiwt nbngrohcicoe arcacmino. tI rsepesnt tihw npfailu einwlgsl fo ssrwt,i rni,sgef k,leasn sneek, ro ewlo.bs In dd,iaoint het dsen fo glno nseob whos alpiestero wen nobe ifmaontro , chihw acn urdceop laidgit bclubngi nad enotf iritrahts of tanajced oitjns.

Rc:roesue lKaapn Beon hgPlyoato ageP 237

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an1  I hntik tsoeistirip nmi(amilnafot of eht oeriutemsp) si ton twha eht q si irefrnegr to enhw ti sysa wne" ebon ";aitnomrfo thats' nciingdita an soealtitosbc oilens hhcwi si rmoe cmonom ni amlls lcel .CA +



 +0  upvote downvote
submitted by tulasi(0)
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heT pittarsoenen of gBcirnconehi caomnrcai iCos-g uh and hemeTty pishs orttu aiassesttm to Lunn,binareog,B dan l.ar endas So won eth iqnsutoe is teonnnigim the aesm psitno The guhoc nad tsmpuu nda salo wen onbe mioarfton no aeecftdf oesnb on yaXr and salo nlbugibc enrpessret teh lugn.

fRc-eeenre 001 sonptcec fo onaamyt eldsi 49

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tulasi  lsAo sit clel yetp si oauusmsq clle ncrmaacoi keil ont oocdmciaaanrne .leki +
tulasi  sloA its lecl tpey si aqsuomus elcl cairncamo leki ont onmecaiaarnocd lk.ei +
tulasi  loAs sti ellc epty si sumqasuo lelc imnacacro ikel ton danoccamaioern klie. +



 +0  upvote downvote
submitted by assley(1)
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Hcyopirprthe haoorosrtetaythp is a celdaim oinocitdn mboicnnig icbgnbul nda ioitrpsiste fo het mlals hnad otn,sij allyecspie the sdatil henenlgltaraiap sjnoti dan eht anematplaahcapeolgr ijtnos. asDtli pisenxnao fo hte nglo esonb sa llew as ,uiplnfa llsoewn jtiosn nda oslniyva usillov itrliopfreona rea eotfn s.een The iodoticnn amy cruoc naleo ,ipryma)(r ro ti amy be dcyoensar to asiseesd kile nlgu rcea.nc Agonm estaitnp wthi ugnl ,rceanc it is osmt aieotsscda thwi annoacrdmeicao dna estal sodsitaace iwth mlsal clel nulg can.erc sheeT saipetnt foten get ibunbclg nad nseiedcar beno noeotisidp on nglo no.bse heirT psitrnngee pmssomyt ear essiemmot loyn bgcuinbl adn nuialfp k.nslea rpcyritHophe ptoohhaasetrroty si eon of naym tatisnd ftcfee esdsdrroi ude ot rccane, hwit gunl nacecr nebgi the mtso moncmo esuca ubt soal cnuigcror with arnvioa or dnelara nilm.seagcani b) cigeorbonchn .aC dan eht noly nerswa thast earltse to ugln ecranc adn all otehr essarwn do ont. I ocshe R,A utb if yuo o'tdn k.o.nnww.o ouy w.kno

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 -2  upvote downvote
submitted by step1soon(51)
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ehT eodtprer incedenic of paClna dmnseyor si 1 ni verye 0000,01 .epolep Tish has eneb a lnidnigce mernbu ued ot roewl ousexrpe to cola, ,sotbssea adn .ciials veelcrnPea of alapCn oedrsmyn is righeh in tsepinta htwi cilsia resxeupo aocmdepr to het htoer scsue.a The irtsf mcdiieeopogli sdyut ranetenkud by the sinPunimcoseoo reshceaR intU deesorvb na acdiensre rpeveeacln fo RA moansgt mne thwi sereropvsig svieams bisoifrs P().FM laMli et l.a fuond on asercndie nreceelapv fo eurhotdmai trisarhti in senirm hwen edorampc to a mtcmoinyu hwree PMF adn mdaoithuer israithrt ewre ernlpevat adn treeefroh loedndcuc htta hte iogtloye fo AR wsa tno dscoaaseti with ersexpou ot tdsu or gnlu sahcgne of epldcamocit oocmssnnepoiu.i eehrT swa a gihh plcenaevre ater of PMF and lrusbucseoti gsaomtn snriem and rxen-smie twih emrtodhaui ii4rahttr]5.[s][

pPntosaiAo:lyghyho tieaummuno iicnodnot is a mnhpeneoon ewehr oes'n obyd sah rofytammlina scell chwhi atktca sti onw uitess n,da in teh ecas of AR, teh suiy.mvon tI is vdeelibe ttha ni heset a,ptestni rteeh si na taoiantelr ihhcw eacuss teh seedrinac emimun spnrseoe to iornfeg aeatimlsr in the n.usgl rTeeh is emunim chtvyairyepti ttha si akdersp by alsici ni wihch eocsymton nda carhgeapsmo esalere eoctkiysn hcus sa tlrn-nkuiei1e dan tng-uncoaomietuegyrhpncyclamgtosioa-l-lra torcfa and muort oinsrcse farotc pa.alh ehT parsh edegs fo the ilcais asol esuca lsyis fo asollsmyo essprateo ni ageprh.smcao yhtecLmopsy are aevdictat yb het nkiceytso aeerdsle yb perg.mchaaso shTi lla dsela ot an muiumeatno neohmopenn htouhgr xrspuoee ot islica cwihh si gegeridrt in elnetycalig epsspiodder dsidvinliua owh hvea .RA

w'otdlnu het idlenynugr sasedei be AR iwchh si etnh ugiscan nhgcrebciono maciarcn?o 'Im sueo!c!ndf

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kpjk  i ondt nhkti sit A,R useebca thye isda yrax shwso ewn nboe roo,namfti ewhre as RA dlowu aevh osneiro +1



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