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NBME 22 Answers

nbme22/Block 3/Question#43 (28.1 difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitis🔍
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submitted by seagull(1080),
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iHTs tiqnesuo is ujst tliiracc kihnit.gn hTe arednsal are lyiaaltbelr nad myslmeycitlra slalm. lAl trohe rsaewn scheico ear not leikly to eb neev lyl.aebrtlia rnceCa ownt' qeyulla dapesr in ereptfc ymmsrtye onr ifsoiecutn assuec wleih ngintiianam hte erladan urecrcta.ihte

slim23shady  Will TB be the answer if they'd mentioned the patient from developing world? +  
step1soon  Autoimmune adrenalitis aka addisons disease → adrenals atrophy common cause: 1. developing world: TB 2. Western world:autoimmunne FA 2019 page 334 +12  
drschmoctor  FA 2020 p 349. +  
drzed  I think the cancer reference (C) was with respect to an ACTH secreting tumor, which would symmetrically and bilaterally HYPERTROPHY the adrenals +1  
drzed  ^Just kidding, it says metastatic. My bad! +1  



Why couldn't it be retroperitoneal idiopathic fibrosis?




Recognize this is adrenal insufficiency. The key is that both adrenals are dec in size. From FA 2018 Chronic—Addison disease. Due to adrenal atrophy or destruction by disease (autoimmune destruction most common in the Western world; TB most common in the developing world).




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yimPrar rnlea ceiin;fsicnyuf hrocnic acues; odsAdin eaesisd FA( )332