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Retired NBME 23 Answers

nbme23/Block 2/Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock 🔍 / 📺 / 🌳 / 📖
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 +4  upvote downvote
submitted by sympathetikey(1600)
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Mad at seylfm for ghgannic ym .awrens

taFyul iocgl emad me wneord if itgntih uryo daeh oudwl secaud necasdire IPC ,so lkie a ngcisuh l,ucre oyu uwdlo get srieendac sugaV nerev ciatviyt nda emyba aycddbriraa + oenponyt.his Btu I essgu het RAAS ysesmt owuld ehva uadcntoceret ahtt dan usdace ntncioioratocssv ervo 24 ursh,o os yoeHmoiclpv skhco si nieyfetdil teh setb oc.hcei

Aylaws dlhosu go wiht the isbvouo rwnesa ):

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seagull  I dha hte daei ttah isht was a reonnegciu ksohc nda niacinresg arnrantliaci sreusper uodlc caftef hte uavgs oot. I tiknh het enuqtosi lyrael wtnas us to og ttah eto.ncdiri +17
uslme123  The gCuhsni lrxeef elsad ot brariadad!yc +7
purdude  Wait 'Im esod.unfc I httoghu lmepvycihoo hksco desla ot na srcdnaiee ?VRS +2
littletreetrunk  nplytaea,pr e'sreth a ngiht declal hmtyacitesp cpasee taht acn ahnppe tefra a ilehw (ie.. eh's nbee tou ofr 42 o:u)srh uccouinaAmtl fo stieus obeilcmat osaroltiavd stasbucsne siraimp ditidmtaaye-mpecetsh invoooicnrcsatst, wchih lsead ot slso fo aavlscur ,otne iproessevgr oiyentohspn nda oarng epohpu.rnsoiyf +1
littletreetrunk  losa olsa fi he thi ihs aedh he oludc veah slos fo stmthyeapic lwouoft mrof a oxhipcy luedlma whihc oludc edla ot nt,vdiosaaiol cwihh hrfuter eeusrdc alretira se,rsruep tbu shti swa a ahdr neo rof me l.ol I olas ptu idecnsrae CPI w.ah +1
catch-22  Any aklc of heiptcmsayt oieswcdonuaerlf/t gaval ooutwfl olusdh ercdeu RH, nto rieaensc t.i u,eFrrht uoy dlowu xepcet nrsbaetim nisgs if etehr swa ayixohp to the ntimaerbs. For e,pmaelx if oyu dah egadam to eth saylrtoi cueslnu, ouy wutlo'dn eb aleb to eargtlue ryou RH in srsepone to ecdurde .BP Scien hsti epiantt ahs eddceru PB and easerdnic RH, tish istceanid ttha eth rripyam edsnatciurb is leylki eth urdeedc HBP.'se olas neeb in a dtsree orf +24 ursho .so +5
charcot_bouchard  nI a nteatpi woh sedopelv ninytephoos oloinfgwl hyenir-gegh ra,uatm geuniroecn hkocs is a niisodgsa fo olnsexciu ahtt is amde tearf oioelhymcvp nda ciotruvbtes drgoneciaic skhco veah eenb ldrue lto Pusu! tAbsne ydcadiaaBrr elurs ti uto +2

Increased ICP would present with the cushing reflex (hypertension, bradycardia, irregular respirations). This occurs because during increased ICP, the brain will compress cerebral arteries causing reduced cerebral perfusion. As we all know, cerebral perfusion pressure = MAP - ICP, and thus the body will force a pressor reflex to raise the MAP to try to keep the brain perfused.

Unfortunately, this causes reflexive bradycardia due to the baroceptor reflex activating. The irregular respirations are because the brainstem is compressed.

Since our patient does NOT have the classic cushing triad, you can rule out increased ICP.

+17/- drzed(333)


 +4  upvote downvote
submitted by yex(128)
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Hmm.m eWll my imdn ahs lbonw ffo suacbee whta tih ym midn asw tidoedhnray esnic he saw ni teh dte.ser As onos as my dimn esatdrt to eawnrd btoau lal of hte hrtoe istpono taht cuodl emka sn.se.e. I tsuj cciedkl dan o!evmd

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charcot_bouchard  tarSm bio +5
usmlecharserssss  hginki in rsaaha deetrs HMS +4
cbreland  Smliep = amsrt +



 +2  upvote downvote
submitted by diabetes(31)
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bendegli + serseurp odwn l+usep pu lqaeu vpmhelioyoc hocsk

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I fndou siht autbo eidasr :CIP tPriosneanet" fo searid lnancriratai usrepesr = he,eaadch melpp,deaali uinot/sniavm,gae rsewo in eth nmingro as PIC irssae igrund the ngthi as a ceneeoqnscu of nobr,cemyec a srie in P2OC gnduir esple uedcsa by irsraoptyer edsnorp,sei and brlbpoay a ecerdesa in CFS pooar,btnsi aylrlppiu iodl,nati o,sispt edpirmai a,zeg sprtirraoey ir,tgurairyel SMA, adn geancsh ni ,PB ,HR dna eayirpsrtor enrttpa aer suyalul aelt sngis of erdais ICP nad teledra ot saimetrbn tsrndooiit ro "sicemia.h

b1o/tcj:c_37smp2pons.3ptil.nmnutj///e/ntph/

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 -1  upvote downvote
submitted by hello(429)
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a'shtW the mcysoshee dsopspeu to be a luec o?autb Deos tish tneatip aveh ?CID seDo DCI wyalas cseau ioovcepylhm sock?h

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drdoom  eDmsdstiiaen rcarliunvatas alaonoiugtc )D(IC si a cyosrdinm tinoi.iednf eeS( ta.tg)nen tI dose ton “al”wsya dela to hkcso ubt okcsh si yefetilnid a sbpieols aqeusle cen(,si yb ,nfdtoeinii IDC = sytmisce“ boottcimhr spesco”r; nyhtnagi yitescsm uslohd gte yuo a titell oir,dewr) dna os a ineatpt whit IDC lsoduh be mroeitond lyoce!ls +
yesa  I ihtnk tehy add to the oepaylihomv ;prciute eh si yteadehrdd NDA leidbneg tnio his esussit acuesbe of ooincnsuts -;-tg& edcrseeda rtcaiuavlrnsa uo.e...vml +

From https://meshb.nlm.nih.gov/record/ui?ui=D004211:

Disseminated intravascular coagulation. A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.

+/- drdoom(1206)


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