NBME 22 Atherosclerosis (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 4/Question#10 (reveal difficulty score)
An 81-year-old man comes to the physician for ...
Atherosclerosis 🔍 / 📺 / 🌳 / 📖
tags:

+7 upvote downvote
submitted by ∗paperbackwriter(161)

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For those that didn't quite get what the stem was saying, basically Osler's sign is when you're squeezing the blood pressure cuff and keep going higher and higher because the arteries won't collapse as easily (due to natural stiffening of the arteries with age). The lack of collapse upon squeezing is why you can still feel the radial artery in the stem. So even though the pressure inside the arteries might be normal, you're gonna measure it as high (pseudohypertension). Apparently it's a common finding in the elderly.

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submitted by ∗keycompany(351)

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290806/

Osler Sign is a low-sensitivity, low-specficity finding of Mockenberg Arteriolosclerosis (MA) characterized by "a palpable although pulseless, radial artery while the BP cuff is inflated above systolic pressure".

It is possible that either: a) The low-specificity of this test means it is also applicable to atherosclerosis (not just MA) b) The NBME incorrectly implies that MA is interchangable with atherosclerosis.

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bubbles This was my reasoning, too. I thought this was Mockenberg for sure +

hello I don't think think it's a type. According to 2 other comments: "It's atherosclerosis because it said “radial artery is NON-pulsatile BUT REMAINS PALPABLE even as the cuff is inflated”--> normally, you can’t feel the artery when the cuff is overinflated b/c overindlation occludes blood flow and arteries are squishy (compliant); BUT if you had atherosclerosis, which is literally hardening, you would not be able to compress the artery, and neither would you expect the normal radial (outward) expansion of an artery during systole. (that is, the pulses!): "If if something were to not be palpable then it would have to collapse -- atheroclerosis prevents this vessel collapse." +22

arcanumm I agree, I just reasoned that atherosclerosis would not be thicker when the lumen is blocked. I don't think they were going for Mockenberg at all. +

arcanumm would be thicker +

drzed Atherosclerosis isn't common in the radial artery though... it's common in the abdominal aorta + coronary, popliteal, and carotid arteries. I am not going to assume a guy has radial artery atherosclerosis when he is in his 80s without a dyslipidemia syndrome over monckeberg calcification! +1

mdmikek89 This explanation is completely incorrect. Whoever upvoted this is dumb. Pseudohypertension. Pseudohypertension, also known as pseudohypertension in the elderly, noncompressibility artery syndrome, and Osler's sign of pseudohypertension is a falsely elevated blood pressure reading obtained through sphygmomanometry due to calcification of blood vessels which cannot be compressed. +1

mdmikek89 This is a diffuse calcification. Monckenberg is like PAD with Calcium. Some places have it some places dont. The chance that there is a plaque at the same point as the doctor is feeling for palpation is...well low. Also Monckenberg is a complication of DM Type II. Not in this stem... +

haydenelise Would've thanked you for your explanation @mdmike if it hadn't included the "whoever upvoted this is dumb" comment. What a turd lol +8

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submitted by ∗yb_26(315)

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FA 2019, page 299: types of Arteriosclerosis: arteriolosclerosis and Mockenberg sclerosis.

then on page 300: Atherosclerosis - form of arteriosclerosis caused by buildup of cholesterol plaques.

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submitted by catacholamine16(14)

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what is happening in this stem? unable to occlude the radial artery ? Can someone please explain?

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lilamk I chose atherosclerosis because they said “radial artery is non-pulsatile but remains palpable even as the cuff is inflated”--> my reasoning was that normally you can’t feel the artery anymore once you overflate the cuff bc this occludes blood flow and arteries are squishy (compliant); BUT if you had atherosclerosis, which is literally a hardening, you would not be able to compress the artery, and neither would you expect the normal radial (outward) expansion of an artery during systole. (that is, the pulses!) +10

mnemonia I think athero is just a subtype of arteriosclerosis. Also my thought process was (like Lila) if something were to not be palpable then it would have to collapse and athero prevents this from happening. +3

yb_26 FA 2019, page 299: types of Arteriosclerosis: arteriolosclerosis and Mockenberg sclerosis. then on page 300: Atherosclerosis - form of arteriosclerosis caused by buildup of cholesterol plaques. +

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submitted by swandy(3)

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I think everyone mentioning Monckeburg Sclerosis via Osler Sign is correct. Monckeburg Sclerosis is a type of arteriosclerosis, and it turns out "arteriosclerosis" and "atherosclerosis" are often used synonymously/interchangeably. https://www.amboss.com/us/knowledge/Atherosclerosis

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swandy Still this exam #22 is full of poor question writing/answer choices +2

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submitted by ∗flecainide(0)

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From UWrold UID450 Medial band-like calcifications are characteristic of Mönckeberg's medial calcific sclerosis and present as pipestem calcifications on x-ray. They may be associated with atherosclerosis but do not directly cause symptoms and are usually not clinically significant.

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