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NBME 22 Answers

nbme22/Block 1/Question#20 (60.8 difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosis🔍,📺
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 +7 
submitted by dr.xx(153),
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RMI is hyilhg esivnst,ie ipcfsc,ie and eucraact ni hte dtnoetcie fo VA.N

hgeTw1-eitd seg:mai VAN most eontf enstserp hwti a rsetenccc,i i-nkielgr or llew ddfeine anbd of wlo sgilan inwiht het oseiprru orptoni fo hte dhsnroubcal earlomf eadh oben wro.amr shTi adnb is hothutg ot nsrrteeep hte rveiaetc tfnceeira beeenwt het ccerinot nad rpeaeivart soz,ne nda tyicypall dtxesen to hte osnbcdarhlu et.lpa

tp/h.evoistdfcnph//u-u-ashre/-t:oar




 +4 
submitted by paloma(8),
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icAdnogrc to ,WU llachoo sbaeu si a ksir artcof for acuraslva .ocrisnse heT smto mocomn tesi si hte mafrloe h,aed chiwh pesnrest itwh anip atth is aareebtexcd by gtweih reaigbn otuhiwt aiytmraofmln snigs on syclapih a.nemixtiaon

cbreland  Similar thought process over here, didn't get a whole lot from the MRI other than lack of symmetry, but pt with alcohol problems was the key for me. Just played the odds +  



 +2 
submitted by tiredofstudying(54),

FA 2020: 463

Causes of avascular necrosis: CASTS Bend LEGS. +Corticosteroids +Alcoholism +Sickle cell disease +Trauma +SLE

+“the Bends” (caisson/decompression disease) +LEgg-Calvé- Perthes disease (idiopathic) +Gaucher disease +Slipped capital femoral epiphysis

drdoom  for bulleted lists, be sure to follow the plus sign with a space! :) +2  



 +1 
submitted by usmleuser007(397),
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)A( s Rik roasftc for lnodgpieev slaruvcaa esniocsr :lidcneu

1) Taumra = ,Iuir jens suhc as pih oiotnidscla ro ,ferurcat nca daaemg eraybn olbod vlesses nda cueder lobdo lofw to o.esnb

)2 etorSdi us= e Use fo dehhs-oig ro,otrtoesscicid chsu sa desie,ronnp si a mncomo sueac of calsrvuaa .erosinsc eTh nraoes is wuonnk,n but neo shyepoisht is atht ctidsoroiorcest nca ecnisrea ldipi velesl ni yuor bdloo, cdunireg oobld ow.lf

3) vcsxsieeE hloolac sue = ugmonCnis vlsaree icaloclho isnkdr a yda for servale sayre asol anc ucsae tftya iptdoses to mrof ni uyor bldoo ssselv.e

)4 seinspohtBopha esu = rLogtmen- esu fo nicdasimoet ot sceeanir beno syndiet gtmhi unirecobtt to dneeolgvip osoeniosrscet of het j.aw sihT rear pnaicolmocit ahs urodeccr in smeo lepepo reedtta twih high sodse of hetse datocsinmei orf r,ascenc schu as ellimutp meymaol dan tctaameits arbset r.ncace

)5 Cnatier ldiemac nesetratmt = toRaaniid hatprye ofr cernca nca wekane no.be ganOr ,pnttnaltroniaas leyicepsla ieyndk natnrslpt,a laos si acidasotse wthi aavclrsua rss.conie

lecdiM)( aB ociniotnds ecasstioda htwi lasacvuar srconsei uceid:ln

Detisicariretsu thbeaGPancse 'a edysScaiIHAeVSmDsI s/tie psulu it kSmusleeyestocarh lelc amniae




 +1 
submitted by almondbreeze(84),
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FA 0129 pg 554 no vscaluara scroisen of notIfb croennai: fo eonb nda oawm,rr uallysu yerv u.plnaif stoM omcnmo stei is emoarfl deha theesa(drw zon)e deu( ot fyfensuniicic fo daleim ccmxrlueif relamfo ye.rrat) assCeu uicdlen iotdstirosCroc,e hoilolAscm, eklcSi llec iss,edea armTa,u ,SEL "eht dnesB" iso/ccaodpones(mrseisn ,adeis)se gLleC-vagE- stPereh saeseid ,iidot)achip( erhaGuc ,eeisdas elSipdp itclpaa omlafer eshpi-ypsi TSACS nBde GS.EL




 +0 
submitted by warbyparker1(3),
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I htthoug ti was iepsct rtasirhti cb iapn with ghietw nbrgaie + r,im ubt 2 tmonhs ihwt secpti tirtrhasi ocem o,n it aws na yesa qunsoiet nda I ssdmie i.t

warbyparker1  Evolution time is key +  



 -1 
submitted by seagull(1583),
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ymbae snmooee nca eplnaxi why siht si ulcvraaas escoisrn adn ton psei.ss It tedns'o mionetn efvre ro cebnsea fo refv.e The IRM has a alslm utnoma fo pnysyotdieh utb ot etg aucvraals oinscers essem /odd

someduck3  Pg 455 of F.A. mentions that alcoholism can be a cause of avascular necrosis. +5  
meningitis  I think the small dark area on the left head of femur and the darkened neck are the avascular sites. Neck: http://img.medscapestatic.com/pi/meds/ckb/15/19515tn.jpg Head: (obvious lesion on the RT femur, but similar discrete lesion on the left as seen on the practice NBME) http://radsource.us/wp-content/uploads/2005/11/1a.jpg +3  
yotsubato  He wouldnt be playing golf if he had septic arthritis. Avascular necrosis is a more chronic condition that has a slow onset. +3  



 -1 
submitted by meningitis(546),
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I tihnk the mslal rdak aear on het eflt deha of uemfr nda hte neearddk neck are eht aluasarcv s.esti

Nek:c 1.tim./t5mni.95tdg/cp/s//okhsas/1jcecmm:g5a/ptdbpie1ptec

ed:Ha ovubio(s nisoel on het RT f,mreu btu milairs erdsietc solein no eht felt sa sene on het apctrice EBNM) ./c/j1/1rn0sp/pua0wpea/u-to:.reoag/o2tt1lhptn/sd5ucsd




 -2 
submitted by usmleuser007(397),
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euCssa

1) Alsaarvcu rsseicno rocscu wenh odbol ofwl to a ebon is ndepreritut ro ecdeurd. cRdduee dlboo psluyp anc eb dceusa y:b

2) Jtoin or boen ru.atma An njruy,i husc sa a edaltdoisc iojt,n thigm eagdma ebaryn odobl e.seslsv ecCarn atetestmrn nnlvovigi riianoatd oals can ankwee beon dna amrh dobol vl.seses

)3 tytaF ietsdosp ni dolbo vleesss. Teh tfa ipl)s(di cna blkoc llmas bolod lss,esve dcrnugei eht boodl lfow taht deesf on.esb

4) tiraCne ieaess.sd caMldei sdnt,nioioc uchs sa ckseil clel emanai and Gasercuh' saees,di losa can eaucs emhdsiidni odobl wlof to on.eb

Fro uaotb 25 etnrcpe of loeppe iwht sralacauv c,nssireo eth asecu fo rrnedtpetiu dlobo flow si k.uonwnn