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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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eronhccongiB inrocmaca = lugn crenca

Ttah ebnig dsa,i gunl acoaicradneonm lsifpaccylie si sadeacotis ihwt rihchepyrotp ht,searoaytrophto ihhcw si a ratsialceopanp dnymoser idzechceaatrr by gltiaid in,gbulbc rgal,iharta iontj oesu,ifnsf and seoprositsi of ltbaruu bsoen

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luke.10  hyw otn csiytsme erlermcasod ecnsi i idd shit niqtesou wgrno adn i hcose eyistmcs ssrcilseo ecoderlarsm , nca onoseme xnepali htat ? +2
kernicterusthefrog  My tsbe gseus aesrwn to ahtt .01k@eul is :ahtt a) ret'hes on imotnen of nay skni vnlmiteovne ihhw(c three udwlo be in rorde ot eb mldcro ersa))eb alcSmdeerro swsoh intgpti in het snla,i otn )cg bulcnb i eThre lwduo eb enoacllg odnsoeipit htwi isbofis,r tno ehyyhrpprot of hte obne at j onystn igSia ht,at I sola ogt hsti wnogr! ut(b tup .)..RA os mI' otn gniaicml to g"te s"tih pHoe ym guhotth sseorpc e,plhs uoh!ght +8
yotsubato  ihsT si in AF 2109 gepa 292 +11
larascon  I aereg wthi erhskofeentgt@ricru no sthi n,eo cnoeogncBihr cnaimcaor = ngul ae.rccn sSmqaouu clle oacrncmia gseiv you lacmrcyhpeiea n(we neob oor;mtnfai ?mbye,a) mnmoclyo ofdun ni SOKRMSE ... +5
waterloo  hte ncubiblg si het psmotmy ttah atske uto otla fo eht nwsaer hceicso. s'It reups rikty.c +
jawnmeechell  Plus eht ttinape sah an 48 aaecy-kpr msgnoik s,rthoyi peurs ighh sikr fro nugl ecrnca +
veryhungrycaterpillar  FA 9120 gp 922 si lal tponrspaclaaie oerndsmy.s reTeh is on noteinm fo ngcihnoreboc croaacmin ni nya fo tmh.e Theer is cnmona,aoeracid utb atth is stmo liekyl in onn rmo,kess otn ni eomsoen htwi 84 kpca ayer fo ginmoks h.ytirso yWh edso he vaeh 5 epvsuto orf nceefrrgien rfsti adi eehr, tawh am I isnism?g +3
jakeisawake  ey@hryupagrtanlvirrecl duossn keli gccrehnonibo iacmranco is a lagrene retm orf ugln ecrn.ac You aer rhtig htat fi a m-kesroonn etgs nlgu acncre ti si osmt ilkely rnamoiocnacade as okmesrnno-s eyalrr gte lalsm lle.c Hwover,e rkoesms anc get aiaoansneodmcrc sa wlle. hTe sitogoclno ahtt I odhwsa eses shit nu.rlqeyetf cdmocariAnoane fo teh ulng scaseu rrieohycppht rtsrpoateythhoao per 292 in 2A190F +2
mangotango  ailr@gyverlaeurhnrptc kasjwi@ekeaa ocaoredmacAnni is the tosm moconm ormtu ni eonssmrkon dna ni mleafe erksmos i(lke this aptn)iet, so aocaonedcmrani owldu itsll be eht stmo eilkly ecranc orf isth pt veor het eor.sth otPaahm gP. .69 +3
fatboyslim  yelrntpapA oegcnicbhnor rnmcicaao is aslibyacl na lrleambu mrte fro ugnl anc.cer u:ecSor r/pntracitsrigdalua/crenso/hdaotag.-eilc/p:e-3 +
lifeisruff  gbricnneohoc is ronhate term fro aocamnicdnreoa in suit dogcanrci ot atmhpao +1
topgunber  thWi eth ctoiepxen of emhosltoeima- 95% rae neonbhrogcci +1
meja2  iuifsflef@r No, oinhcecgrnbo cacamnori si a lnakbet ertm ofr all glun crnceas. ,wHveoer het adnccaaooeimrn ni tuis pyubets si cadell aleBcrhorvaloo .ac :Rfe AF 2018, gp 66.5 +1
an1  hSe osla sha a wfe myotmsps to truposp ti uho,gc( pm,tsuu me).rsok The ginelwls yma rwhot you ffo adn seme ikle RA tbu rhe eag dn'tose arlely fti het aideses ,osl(a on cialpst nlisose). ewN nboe iofratonm si a iegv a.yaw UW syas thta bneo rigofmn nccrase are esttrpo,a Hdkgion dan lsaml lecl wehsear tlyic are n-kd,ogoninh mnnlosa-l lelc, .rlnea GI nad lamnemao flal ni btneeew the iscba/lt cyilt smt.cpure nbiugblC si atorhne vgei yawa e(esn ni lgnu A,C T,B F,C my,mepae boctscinri,haes ccironh nlgu se,ssaesbc iacracd ncytoaci daes,isse vfeiencti eacnsiddtiro, B,ID shotyideiphy,rrm nad nos.polatibamr a) gyuno lmase thiw bbmooa speni and caalrs pina c) pstndeere rlieaer toy(canic issesdea etresnp in sebabi dan eden lyear riotocrec)n d) kool fro osme MSH adn nueacidj teealrd nfnidigs ro ebmay a hyroist of iinnoftec ustreo )e cnyooemhb ecpneparaa, bcibgnlu si snepert utb ont fenot eeatrdl to ebno nfdsgiin ) g tofne ressnetp twih ERTCS ,(l)itimde ro snki (idff,ues) enbtosdiai + +1
an1  otrrccnoe:i IG nad sbraet rea emdi,x amemloan is yctil sa is utllmeip aeymmol +



 +3  upvote downvote
submitted by niboonsh(409)
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ufndo sthi :olnine aphtrccr/uk//ut5echdpae:109m0l8///s4tro5ae.4m20m/c/yipao0i.

hitocryprHpe ylunormap ohhoetotrryspata AOP)H( is a yesnrmdo zaaieetrhcdcr by eht ridat of ttessoiri,pi igiadlt ibcbulng adn ianpflu aorpathryht of het greal s,otinj sypeeciall ovginvlni eht rlewo i.mlsb Cgbbnliu is acezrheacdtri yb bubsolu eralmgeennt of artlemin ensgmset of teh snerifg dna eots ude to aoeiolpfritrn of nuubaugls nvinoteecc itue.ss

irymrpa... is a rare trhdyeraie nooiicn.td

A jymatrio of ecsas %)&(0t;9g fo aceroynsd OHAP era soiaseatdc ithw moyaulprn ciiesnnlmaag 6][ or coincrh vsuruaeippt lrompunya ees.saids

Ployamrnu ecg,aannmslii dgniulicn iaprmry ,7][ ciatatsetm ungl eacncr nad arnoitchatrci ,pmymahol ccuatno orf 08% of saces fo orcnyedas HO.PA dcaeocoariAnmn of the ungl is the otms tuqnerfe dna lalms llec cmraanioc si het selat teenfrqu tgoihhoiaspolct etpy fo ulng ecrnca eioatsacds htiw OHAP .7][

hoter stidaoesca trcthrcoxaiea acmegsinnlai dcnulie hgaalpesrynnoa nc,caraiom leanr llec ia,ncoacrm haeoegolpsa a,ncerc argtsci muortu ]8[, canpretaci acnr,ec esratb hespollyd turoum 9][, onleaam,m diyhtor c,nearc rasaoocomset nda iselantnti hoy.lmmpa

oVisrua hmgoulcteoari sndcoio,tni glucdnini RA 1[],0 SA ,[1]1 ersparilyotit soo,dan ELS 1[],2 sTuaakya esdsaei ]1,3[ osiioascdr,s PAS nad eertireMannda erfev are knwon to eb tsdioaesca iwth shti incootnid as .lwel

Pyorumlan sinnoodcit hcus as ccysit irfbo,sis sstoiuucre,lb cipotadiih ampoynrlu fiisbsor []14 nad ulgn atrstnlntpniaao heva sola been ctsdoaisea iwht .AHOP

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 +2  upvote downvote
submitted by queenofhearts(18)
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ishT eptnati sha hoytprprhice posthoraotrthaey hcihw si oatsscidea iwht oornibcenhcg omacranic. It rnpsetes wthi ialpnuf lwegsinl fo ,triwss ,sergnif aeskl,n skeen, or e.owsbl nI ,toainddi eht dens of gnol beson swoh trlioeesap wne nebo imrontafo , cihwh acn coedpur tigdial lnbugcbi adn ofetn trsiihtar of aencjatd otsnij.

c:Rreuoes paKnal onBe altgyPoho Pgea 732

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an1  I kinht osperitiist (lifminoaamtn fo het tsomi)urepe is not htaw the q is engefrrir to henw it syas "enw oben tna;oromf"i htt'sa cditnnigai na tlatseiocobs olines cihhw si roem momcno ni amlls ecll AC. +



 +0  upvote downvote
submitted by tulasi(0)
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hTe ostiranetpen of inioeBgnrchc aaincrcmo o-suih gC dan pmyTeh ishtes rutot etatssasim to ,ubeannoiBLg,nr and saande.r l So now teh euqotsni is mnigioennt het asme nstpio Teh cohug adn tspmuu adn sloa wen nbeo manoioftr no cdfeefat soebn on ayrX nda aols cgnbibul tsereseprn the gl.un

eR-cenfere 001 ecoptscn fo noymata sidel 94

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tulasi  Aslo its ecll ytpe is msqousua clel acairmcno elik nto oecmidroaacnan l.eki +
tulasi  olAs sit llec etyp is uqassmuo lcle nccaroima iekl not mdrcianooenaca k.eil +
tulasi  losA sit clle etpy is uqssouma cell acnocimra eikl not eadcacoarnniom lek.i +



 +0  upvote downvote
submitted by assley(1)
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ioHrrpeypcht yrtaartosohpeoht si a ecldmai oincidont mcngibion gubbilcn and siroistitpe of eht mslal dnah ,iotsjn sieyelalpc het ldatis htalienlnraegap tnijos adn eht hprllameacepatagnao ijst.on Dialts isnnxepao fo eth logn bnoes as lwle sa pi,naluf ownslel ijntso dan avoyilsn ouvlsli roipanirtelof era noetf .esen hTe oniitndoc mya ccoru anoel ()mrri,ypa ro ti mya be sronyaecd ot ieessasd lkie ulgn cncar.e gmAon ipsttnae ihtw ungl e,crcna it is smto dcaosteias wthi cndinrecaoaaom and aetls siosctaade thwi lsaml ecll lnug ca.recn eehTs stitpean etonf egt iulncgbb adn irdsecean nobe edpiinstoo no nogl sboe.n eThir preesinntg syptmmso rea emmetosis ynol iubncglb and npifual s.enkla rpioetchyHpr ttpooraarothsyeh si oen fo nmya nttsaid etfefc odsedsirr ude ot nrceac, twhi glnu enaccr igneb the tsmo ommcon aeusc utb soal cuirngcro wiht iavnrao or ardelna sicia.nalgnme b) ccghrnoeinob a.C and hte nloy searwn thats eaerslt to ugln ncerac and lal eorht swreans do on.t I cohes A,R tub if ouy dtn'o konoww..n. uyo .nowk

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 -2  upvote downvote
submitted by step1soon(51)
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heT epordetr nieciencd of laCanp nsoyremd si 1 in yever 001000, plee.op siTh sha bene a ildiencgn ebrunm ued to rowle xosepure to ca,ol bssoate,s and ca.ilis lPvenreeac of pCaanl sydrnoem si hghire in ineattps htwi iaislc eusxorep omrdcaep ot eth oehrt e.uassc heT frits diicoeigelmpo dusty dnruekeatn by teh uimnPocseinoos reRhceas ntiU rvosbede na rcsniadee enaveplrce of AR gnastom nme twhi seirposvreg vamiess iofsrsib (P)FM. laMli et .la fndou no irdsaecne elecearpnv fo ameurihotd thatsriir ni emnirs hewn podmrcea to a inmuoyctm wheer FPM adn tmraudeohi rhiitarts rwee prevtnlae dna etrorheef cdeunodlc that teh gtyoioel of AR swa nto atseocdais hwti rpueseox to dust ro ugnl gcsneha fo ltedccimpao o.omopunisiscne reehT asw a hhig vlaepnrcee reta of FPM and ouesrtisbucl mtnosga ensmir dan xesmnr-ie ihtw hmaetiudor ir]]t[s[.h5ria4t

Potsyaio:hygnh oplA numotieuma nointiocd is a eenpnmoohn wereh sen'o ybod hsa olafnaitmymr llces cwhhi ktacat sti onw issetu nda, in eth csea of R,A het ounyvsi.m It si ilvbeede ahtt in etehs pite,tnsa three is an nrteltoiaa chhwi ueassc eht rniadecse emiunm preosesn to eiogfrn msriatlae ni the u.lngs eehTr is mneimu ieitryhpayctv htat si kapdsre by csiila in chhwi synotmeoc and hprmaaoesgc areesle ycikotsen hcsu as tiunekelir1n- dna rnc-acalusem-ohnareyticgomgpol-auyottnilg trafco dan rtomu ocnsrsie cfoart palah. hTe hapsr dsgee of eht aiscli alos esacu siysl fo lmyoalsos searpoest ni r.pgaamocseh tLyysehopcm rea daeatitcv by eth eckiyotns derleesa yb .asmocgpaehr hsTi lal aedls ot an itmumeuoan nhpeennmoo rthugho oeseuxrp ot sicila iwhch is egirredgt ni ctnealylgei ppseirddeos lisaundviid ohw eavh .AR

unot'dlw teh eldgrunyni iesdaes be AR cihwh si neth suganic beohcgrnnoic acm?onicra I'm fn!de!socu

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kpjk  i dnto tihnk tis AR, sebaceu tehy sdai ryxa sswoh nwe ebno ifaonrom,t wrhee as RA lodwu heav nosroie +1



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