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NBME 21 Answers

nbme21/Block 2/Question#22 (36.2 difficulty score)
A 33-year-old woman, gravida 4, para 4, is ...
Transfusion-related acute lung injury🔍

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submitted by yo(79),
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shiT rdcouerc nwiith 6 oruhs nda suacde moes oynpumlar deaem dna yatirerpsro dssietsr arfet a tnoisansurf uceasd by the ndso'or tytenoaic-keul eboatiisdn juts ogdetnisyr het icresetpin tlsnrpueohi adn ertprsriyoa hintdelaloe scell.

ilewh xs/lynapallaiaichgre anc euasc yerriptsaor rseart dna khcos ti sha a tsawheom fnrdfiete iuerct,p no geei,hzwn incsesthi or atewhrev adn cnoicdgar to rtsfi dAi ti ashppne iwhtni stmeuni to -32 sruoh iwchh is at slate bdeulo htaw erew' ensieg salo rwbeea of IAg fceietdni eplpeo ni hsit .ihocec

PE, he I 'notd nkhti ti tfcasfe oPa2 ttha eofnt hmuc dcociagrn to itsh erpus dprue ghhi ylied rorseuc.e ubt huh yeha e'tdsno lefe PE idank tnqesuoi d:/a/trd2keeo.ir0#1sptc10e03cchlcewc-ip9no/mm/pi.teaesum

,ainmoenp right ratef all het fsinnuoi sssiebun nda on tineomn fo veefr ro gyantnih? h.aN

go ot epag 141 fo ftsri .dia 'mI tytper esru ew dnee ot okwn oru satn/sontfniulprnia rcap eeuabsc ti sjut epkes gmiocn pu in wolurd ubt shit lweoh xmae is a orpstahco.

rgoiveF me fi I mdea a na/sgwiomketr uabot hginna,yt I tlysom got info romf irtsf plz cerotrc fi terhe si a tmiea,ks odog u.clk

hungrybox  we gonna make it bro +7  
hungrybox  or sis +8  
nala_ula  I did the same, basically went through each one and the time of onset between each. Good luck on your tests!! +  
temmy  i don't think pulmonary embolism will cause bilateral lung infiltrate +6  
athenathefirst  I hope you guys made it. Your post 9 months ago +1  

submitted by hungrybox(976),

I’m trying to really learn this and know how to rule out all the answer choices. So far I have:

A: Anaphylactic reaction induced by IgA antibodies <2-3 hrs

B: Hemolytic transfusion reaction <1 hr

C: Postoperative bronchopneumonia Pneumonia, right after all the infusion business and no mention of fever or anything? Nah

D: Pulmonary embolus with pulmonary infarction

E: Transfusion-related acute lung injury Correct! Occurs <6 hrs

I was thinking D could be ruled out b/c there’s no mention of history of immobilization/hyper-coagulable states. And I guess it seems obvious the question is focusing on the transfusion. Seems kinda iffy though. What do you guys think?

pass_this  I actually got this wrong and chose D. But the question completely is trying to lean you towards transfusion and like you said no reason for PE. +  
blindophthalmologist  Bilateral lung infiltrates makes it sound more of a immune process. CXR of a PE can be normal I believe. +  
lovebug  and also, as you all know B) clinical Sx of Hemolytic transfusion reaction is hemoglobinuria and jaundice. there is no such thing. so rule out :) +