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NBME 22 Answers

nbme22/Block 2/Question#4

A previously healthy 60-year-old woman is admitted ...

Increased central venous pressure

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submitted by nwinkelmann(109),

This article explains the pathophysiology well: https://www.ncbi.nlm.nih.gov/books/NBK431048/.

The right ventricle is primarily supplied by the RCA which also supplies the SA node and AV node (90% of hearts because they are right dominant), leading to loss of contractility of the right side, and thus fluid buildup causing elevated central venous pressure. Elevated pressures in the liver and portal system would lead to hepatomegaly and free fluid accumulation in the peritoneum.

henoch280  Hellppp. pls why is it not decreased capillary oncotic pressure? +  
whoissaad  @ henoch280 Because there is no change in the levels of protein in the blood. +  




The other answers are wrong because: (if I am wrong please correct me)

A) This would be true in a patient with liver or nephrotic syndrome

C) This would be correct if the we increase capillary permeability (example sepsis)

D) This is left heart failure

E) This could be ARDS (not sure though)

F) Malignancy