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NBME 20 Answers

nbme20/Block 4/Question#46 (74.2 difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathyπŸ”,πŸ“Ί

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submitted by xxabi(261),
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solA rof ehost of ouy who ear lalttoy lssleeuc kiel ,em irnrayu ttacr otobitusncr = sritovcuebt uo.yrapht

submitted by banieb(21),
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nDrugi the tlas lafh fo gpnnrayec antliiod fo teh puerp nriryua atctr can ouccr eud ot mersoopinsc fo the eursetr yb eth rggionw sreuesut/tuf and hte inela msetan.irli eTh osmnosicper fo etesh si nto loianglw ldufi peassag iont het ddlraeb nicusga nieru lpudbui in teh ,yedikn tish leads to idinotal of the eykdni ttah ensd up cngisua stciamytomp onssyohrdherpi. sith can end pu ni ioeifctnn nda mospmyst husc as eht nsoe snetpre ni hsit eitantp ikel bkca ipna adn AVC deenser.nts the criygn is yaminl eud ot eht pain cdeuas by eth tu.sorobctin and sutj as tenshoigm xte:ra euodlb igiptla ascehettr si a easf nad ilsepm yaw of trigaent atmcptiyoms ohsirhrdynesop fo yacnepn.rg

banieb  Ureteral obstruction by the pregnant uterus +1  

submitted by neonem(572),
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urestibcOvt puytohra ausces a psltaoren zotaeima g-&-t; ehwn nole,drgop alburut aedmag e.sunse Tihs sdlae ot an uteca tauburl ncissreo, tceacrdrhizae by oecctrin pgsul in the buurtla meysts as eesn in the eaimg

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +44  
usmleuser007  Think the postrenal azotemia is d/t her pregnancy. With the increasing in size fetus, the pelvic cavity is being compressed and thus there is pressure on the ureters. This leading to the presentation. As per above --- the crying maybe just d/t her pain and emotional stress caused by worrying about possible complications regarding her fetus. +4  
maxillarythirdmolar  My gut tells me it must be some sort of transient change in placental size with hormonal changes. It's reminiscent of what you might expect for breast changes during the menstrual cycle, imo +  
j44n  or maybe the fetus is literally crushing her ureters into the wall of her pelvis and shes got an infected kidney +2  

submitted by ye2019(3),
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hPsyailc sxame oewhds snredneste of cctpnhireoso ln,gsea hwich rae hte slacep hweer the admiahgrp c)nph(r-ie emest teh rbsi c)o-(ot.s Nto teh troosCvbeaertl negla stnnseeerd ttha we tikhn ot ihtn leran s.edaeiIs got fsundoce thiw hsit inop.t

adong  honestly think this was a typo. hot trash +2  
neovanilla  Assuming it was not a typo, how would the costophrenic angles be tender in this condition? ...From crying...? +1  

submitted by waterloo(77),

I feel like part of this is them seeing if you can recognize those are tubules.

  • So if you say ok these are tubules, chorioamnionitis, endometritis, and PID are probably not right.

  • Glomerulonephritis in my experience so far, they should probably show a glomeruli, not tubules.

Between hematgoneous spread and obstructive uropathy, I feel like I don't have enough info - but sometimes a 50/50 guess is better than playing Battleship.

submitted by sympathetikey(1376),
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n/etaiDiisodtotnlni fo rlane pivles nad alycecs A . usUylla adecsu yb nriryua ctart ocounittrsb (lren,g ae snto,se verees P,HB ceanontgli nuiostbscto,r ecivlrca ncrae,c jynuir to ,tereur ecynpngar epnparltay;) ertho eeucucliasdsn ielrpattnroroee ibs,oisrf uelisrerevtoca xlf.uer atiiDnol osuccr lmrxiaop to seit of empyorSh.ogt lau erciateinn eomcebs teevdlea if totbocusnir is eralbtail ro if tanitpe sha an boysltiaturctsedor .eydkni sdeaL to seiosonpmcr dna sloibpse arhpyot of nerla ortcxe and dl.elmau

submitted by redvelvet(43),
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chirscpteono nglea nseterends and feB WevrC stcsa ni ustuleb on ahtt pthoo for expmlealA l fo mteh is dganlei us ot ysipteepo.nlihr nAd even roinm tyticiss nac caues elppiyhteosnri ni rgcpnynae ude ot rbstocteivu aurhptoy.

diegolc26  I thought it could be D or E at first. But the picture is really clear. There is inflammation within the tubules, not in the interstitium, that points more for Obstructive Uropathy which is also painful, can cause fever, and a risk factor could be compression due to elarged uterus. +  

submitted by euchromatin69(11),
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pcengnrya is a iksr rfctao rfo teuca ntps rAiFeloieyph 0291 pg 958

submitted by laminin(15),
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salo mabey odclu od sersopc fo h..tmo.eeiatilnin heptcc'osirno ngale sesetdnen'r ecusl us in ot it egbin a laern ob,eplmr nad hte nloy nelra rsewna ccehio si rbtovcuesti aopuyhtr

spdrwmn  glomerulonephritis was an answer choice +1