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Retired NBME 22 Answers

nbme22/Block 3/Question#38 (reveal difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressure 🔍 / 📺 / 🌳 / 📖
tags: pulm repeat

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 +7  upvote downvote
submitted by trump2020(3)
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uoY gsuy ear way neviinhgrkot h.its cihCnor yhxoipa suacse esrpnethnyio eud to NSS totivncaia nad PEO od.ptcinuor

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teepot123  epy +



 +5  upvote downvote
submitted by ∗drpatinoire(19)
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suyG I vahe tehaorn .thtoghu

vGiing treho eihsocc era outab his rteho roblaamn avseul e(daesrinc tanr,eeic oegls,uc iucr adc)i, I susge het qnotusie is egtsint us hcihw fo seteh avsleu lwli omrveip if ihs OSA is eirmvdop yb .PAPC

nciSe OSA is neo of het tsmo tipntmora eascus fo thiopcaiid ,enrstnoepihy ti houdsl oecm to us ahtt eocn ihs AOS is ,dttraee shi eprhenointsy wlil merovip no.so

oS aedd"seecr "BP saneidt fo etorh mrlaabno svleau.

hk(anTs ot ym ndirsfe rfo inhignt me uabto s!)ith

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dodgerslakers15  Thsi is eth reroctc wya of nhtniikg tabou htis it.soenqu ^mn lauoPyr ylhgypioos si ton aneyecrss. heT oort fo eth qnuestoi is skaing tawh lilw omevipr oevr eitm wtih etnamtetr fo psele ,penaa cihhw is obdlo sesp,ruer gevni taht leesp epnaa cassue rdicseane amyehptitsc ntoe nad oetrehrfe seiysmtc HT.N Teh tmeatenrt fo lepes neaap twhi CAP,P lilw elph uerecd sptatmeyhic enot dna roev itme, emvirpo B.P +2



 +5  upvote downvote
submitted by madeforupvoting2(16)
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PCAP snesiraec lirplrntaeua uspresre as teh tdeeveal rwiyaa seeusprr si meidrttntsa ot hoter tnhgis in eht tyavci glu(n puehss no rplalue vccpyia/ates hhiwc can hetn pshu on erhto sr.r)sttuuec Tish nac eald ot soonmepscir of is,nev nnucgildi eth eanv acav tg;-& resedadec unveos rteurn tg&;- ceeddreas pb (morf asrcdeeed op.e)rald Tish si iimalrs ot wtha aphepsn gnidru vallaasv nterxie(o asphe)s ugohht the tipvsoei rerussep si rpdveiod by a minheac ppmu eidnats of ianadmolb hdlurimgs.e/pamacs I hitkn ehtar reat lekyil nersacise teisadn of reeasdce sa a rmaotescpyno pns.ereos

esHre’ noe seit ttha nspailxe it ewll (het rf”ee“ nctotne si uenhog and rpoblayb delayra dxeesec teh dphte one thigm need to wnok) ao-ta-vyncfi/i-/eleaenicceartkphoelcsotfosmy/matpunatfnetctx.-rhcml/:iohr

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dodgerslakers15  muPlraony gsiloyohpy is tno esracseyn eehr. T he orto fo eth sietnuoq si agknis hwta liwl vmroeip vroe etmi tihw ttaenrtme of eleps ,pnaea cwihh si bodol eursper,s gvein thta epsle apean suseac nireasecd csitmpehtay noet adn ofreether siscyemt T.HN hTe rntmtetae of epels paaen wtih CP,AP iwll lpeh rceude actesyhitpm tneo nad vreo te,mi pvreomi .PB +15

Guys don’t forget that in OSA, periods of apnea results in increased sympathetic tone, hypoxia causing pulmonary hypoxia vasoconstriction, thoracic movement without inspiration increasing negative intrathoracic pressure ==> all these factors leads to hypertension in OSA.

To remove all this we give CPAP, which results in decrease in BP over long period. (It is not only about increasing intrathoracic pressure and reducing BP)

+16/- apurva(101)


 +4  upvote downvote
submitted by ∗meningitis(643)
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uhhAlgot s’ti bouat PPV, ihst rreaheniscg eplhed em desrnnutda cbias pyhs, I ehpo this elhps yeeoenrv in smeo ywa.

kwaeyaaT: rDginu ,VPP vuneso urenrt easrdecse, cacidar totpuu sdasecr,ee dan areth pruessres dcreease ni eht igrht iesd of the raht.e

hWy sdeo PPV secraede neusvo ?uretnr

  • ainrtriocahct erpsusre esrompssec rah,te unsigca odbol tno ot rrutne

uCesas fro srdeeacde etfl anuecrlrivt ptutou rnidug i:intnoltaev

  • hgntfiiS fo evanirrtlitcnrau tesmup to tLfe due ot aindcsere RV ulovem
  • aDeeedscr enuovs teunrr
  • eCahgns ni hstear aibliyt ot onttcarc deu to opisitev peersusr
  • ackl of O2 ot rhaet

ormNla oocnytsemrap mnsmahisec rfo aiiigmnnant OC nad BP undigr VP?P

  • aiedcenrs HR to noscaeetpm for ederdasec VS
  • seindcear VRS to nmtiaain PB

Ohetr gclsPhooiyi :psnesesro

  • rceseDade cerbrale rsouepinf resrsupe ds’b(yo osespnre ot a flal in CPP is ot eiars sceyitms odolb pssruree nad tiadel lcreebar dloob s)elvses
  • cDreeasde arlne enuorsfip Ise(dnrace A,DH AR,SA nad ePtitna ash aerln eopslbmr so seecadinr nrniiceate dan riuc diac)
  • oblisseP nitoilrmuant reasd(eicn sguoecl vai egienlscsneuogo ).cte
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meningitis  yorrs obtua the mtfnrogta,i yhet rwee epsspudo to be tebllsu not i.itcal +30
drdoom  skloo godo to e!m ); eatinds fo sirksesta rty nisug teh lups ngsi for enedrdoru its;ls hte messty tges ouencfds mstoemise cbaeues the ristseak is saol orf tisiacl 😊 +2
meningitis  h,aYe I etncdoi :s , Oh I dtind ownk teh + isng idd !ahtt ryeV mhcu r,cdetaeipap I will rty ttha enxt .mtei +1



 +2  upvote downvote
submitted by noselex(9)
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I etrnndsaud epsel apaen ldowu scuea ixhyapo dna ierseanc ni NSS tvi.ayitc So attmnetre luodw ecdrue PB nad etarH eRat. I swa skctu webteen teh otw oi.sntpo yhW aws the arnwse dloob purseesr dna nto HR? I odoggel druaon a ibt and odfun sdseuit ttha swoh prdo in ohbt RH nad .PB I eussg BP sdrop mero? Can seenomo eelasp .xpenlai

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madeforupvoting2  ACPP creiaenss rtreilanalup urssrpee sa eht eevtadel raayiw rreuessp is nmtstireadt to erhot nsthgi in eth atvicy nu(gl sphuse no plraelu eyvapcsic/ta hwhci cna hent suph on etorh )eusrtcsr.tu iTsh can edla to nooesripcsm fo nvies, cliduingn teh vean cvaa >- escdaeerd osevnu uretrn >- serdeadce pb rf(mo rsedeecad l.aodepr) sThi si sirailm ot awht naphpse rnuigd laaavvsl irxonee(t asp)she ougthh hte oteipvis uersepsr si eoirdvpd by a nmiaehc pupm tednais fo onmbialda ipadmhgre/cluas.sm I nikth thare etra lileyk sraneicse edaints of deerscea as a cprymenaotso sreH ’er o.sn pees neo stie htat nlasipex ti wlel (eth ”fe“er ctneton is ugheon dna arbyoplb dayrale esxecde het htped eno imght dnee ot nwko) ksleexrva-syictn/nhl/amlccr:.utmmafrooeent-pci/yfathatcinpote--ocoihaef/t +4
apolla24  I usges nicse cgnashe in RH rea ucsh a rtnaisten nhenpmoeon nad you olyn eavh seaunsitd erseiacn ni HR hnew cnsrixeegi ro klei lteayuc eirpengcxeni mose dealcmi ymngceeer vs PB hatt nca eb edvetale rof nolg rpeisod of tsime whti no efetfc.s ehferTeor an etmroivepmn in BP si omre t.naomirpt sa’hTt ym kea.t +1



 +2  upvote downvote
submitted by ∗cathartic_medstu(37)
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naC meeosno eoctrcr ym ennriagso reh:e

I swa iknghint tipevsoi ryiwaa erpsesur lilw rciseena rlvoleaa toilvnnaeti dan dreeeacs pyoxiha cdeunid pouylmarn nnoovcsoirti.satc h,sTu VR farte olda oduwl edsaerce ;&tg= emor lperoda ot VL nad eomr cairacd utupo.t Then ou'twdln BP ecd?esear

ynA help is ri.epctadape .snTakh

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pg32  I utjs thtghuo fo ti sa lfoslow: eh sha ghhi PB ude ot yrulomnpa itnnsactocoovrsi as lewl as ewdiaedrps stiytaphemc tioanavtic (sa fi he si beign tailayplr rtneagdsl lla het ,emti baecesu he laislbayc ).si sIniecagrn oneatxygion lilw ralxe sih nuyrlompa vslcauatrue dna deeraecs mehtisycpat isnmiattolu ohruttugoh eth od,by legdina ot a prod ni lodbo sueprr.es +1



 -5  upvote downvote
submitted by ∗welpdedelp(270)
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eaenIrdcs lciaratinnar uprsrese that etsusrl in gsChu'isn raidt fo seiarecnd oobld sp,ursere argeruirl ehb,anrtig dna a.dyaadibrcr Tush, high CO2 suecdni ginuhcs atird dan if uoy veig PP hnte ti lliw eureddc ,OC2 and thne donw taerguel eht epshmatytci tnaiovrsns.tccioo nlirOaylig het nrabi ahd os umch O2C htat it edpazsz out nda derti to inecresa eth PB in drore to sphu mreo neoaedtxgy lobdo to eht abri.n

p./gStjtodm:sJetA/:AqmpbmwUilg/psefcg5ZrC3aha-iKsk./.

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lispectedwumbologist  a ryc"B8d rai"ad4 mbp lo l +
lispectedwumbologist  The eorhetnpsiyn ni uvstbetcrio selpe aaepn si eud ot erenisadc ycesaimttph otne ont aeensrdic atrnarliiacn upssrere omla +1
meningitis  sslg@ieclubtopeiodtmw : Be eaumrt eohgun ot rocectr mr/ihhe and mevo no, tno lugah ta m./hrieh +16
namesthegame22  lsuPe tare yma eb fcdafete by ugsesr of yatcethspim aittyvic nduigr aipnec psoesed,i re,vhewo siht nisehraoitlp sah enbe ssel yledra dosentetmdra athn hatt tebnwee eapna ani.ns ehetpdnory +



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