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NBME 20 Answers

nbme20/Block 4/Question#30 (31.2 difficulty score)
A 32-year-old woman is brought to the ...
Arterial lacerationπŸ”,πŸ“Ί

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submitted by monoloco(136),
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nAyteim yuo veah a srpneo hwo umbsp itreh dhae, estg kcab up, nda enth has vesere usssei or sedi ikle 6 uosrh erlat -- oyu hvea rsefyolu an peldauir tmoahema from aoitceanrl to hte edlmid IEGMLNNEA retrya. anl(Gjo laylre siesaphzme atth oyu nodt' rswce up dan tclees dlidem clbr)eear. uYo wkon ti ash ot be na atrerail ilnatoacer isecn het drau is httgyli eedahdr to eth usl'lks iernn cu.aserf nljaGo rerfrede to his perenxciee htiw ti as niegedn replsi ot voreme eht radu rofm teh u;sllk ,higrapc ubt ti rdveis teh intop meho. ietTnng nees no CT si sauebce eht pidelaur htaemoma gets tucsk enbteew eth resutu li.sen enhW ti aeamsgn to eakbr tasp neo fo teh utrues nlsei, ti si my ntgaisredunnd tath ethn si when uyo tge seeevr e,qulesae like haedt ro haeretv.w

usmile1  omg monoloco!! I miss you dude! We used to hang forever ago, hope all is going well in med school! +11  

submitted by misterdoctor69(46),

To add on, a trauma to the skull => middle meningeal artery laceration => epidural hematoma. Epidural hematomas are known to cause transtentorial herniations and CN III palsy, which is what led to the patient's right pupil being dilated and poorly reactive (ipsilateral to the side of trauma).