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NBME 21 Answers

nbme21/Block 2/Question#16 (54.7 difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle🔍

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submitted by hayayah(1057),
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Tshi tp hsa na DAS hwhic si a e"l"oh etnwbee the AL dna .RA xnigiF it locdu mdgeaa hte AV .nludseb

sahusema  the atrioventricular bundle is also called the bundle of his +3  
bbr  What if it had said "AV node", that's in the interaatrial septum as well, right? I'm wondering, that could be answer as well. (FA 2019 pg291) +  

submitted by chandlerbas(95),
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DLR:T atls ceetnesn zmasesrumi it

heT ceaxt cmheinmas enrdulingy BVA wfnlloigo ADS ulrcoes enrisma atepelu.cvsi eW nca thzophieeys thta het ilseospb mhcsniame fo ABV si na rmaafimyntlo pseeonrs nad eutbessqun eeamd sa a rtreliaeocv rluest fo cmaanchile bubirng of the rodlucec instgaa het ixplaomr cotdunncoi seytm.s heT nmirgsa of het cmudnues tilaar pstael efdetc lidecun smn’haaBnc ,lduneb eth raymrip tpha for cetlcielar oncnoitudc mfor hte iasolntari oedn ot het ticriaaevlountrr .eond hTe ariatrrletunovic coudntocin ,eulnbd whhic egmeres ofmr mhB’acnasn lbdnue ni teh aenvcalurtiroitr oden raae ot dctcoun eiraltccel uepmsisl ot het rkjuinPe ,ibfres si eaileypcls nrpeo ot emaa.dg

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submitted by hello(302),
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esaPle hepl

itMlo-ssdciy neijoetc kiclc = comluipn iessstno

woH si miuoplnc esnotiss ledrtae to eht aties'ptn ASD -- odes ADS uacse mopluinc nseit?s?os

burak  ASD has typically 3 associated sounds according to UW, they are all about increased blood in RA. Increased blood in RA causes more blood do ejected from tricuspid (dşastolic rumble), and more blood to be ejected to pulmonary circulation which cause pulmonary flow murmur (midsystolic murmur in pulmonary region). It even can cause pulmonary regurgitaion like murmur, but most important murmur in ASD is typically midsystolic murmur. You can check it out on FA 2018 page 284 +2  
hello  Ok, what I learned: Extra blood in the right heart (due to ASD) doesn't lead to pulmonic stenosis? Instead, it's that pulmonic stenosis = most common comorbid heart association with ASD +1  
burak  No it's not pulmonic stenosis, it doesn't lead. Murmur associated with ASD is pulmonic stenosis-like murmur, because it's caused by excess RA and RV volume ejecting to the pulmonary arteries. So it's same location with pulmonic stenosis, and it's systolic. You get it? +1  
hello  @burak Yep! +  

submitted by burak(52),
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n'Its ti pntneedde on eht ?ialooctn I edeawsnr it rnoayrco sinus beeucsa av node si lceoatd ni ohcK tenliag;r wihch oemodspc of ,iusCSn donTne of ooT,adr suirpcidT ?nulunas

hello  The correct answer was atrioventricular BUNDLE-- it's also known as the Bundle of His. AV Bundle ≠ AV Node. +2  
burak  Now it's more confusing to me:) because av bundle is more inferior to the av node. +  
hello  Patient has ASD --> need to repair interatrial septum. AV bundle aka bundle of His is located neart interatrial septum. Coronary sinus opens into atria but is not located near the interatrial septum +4