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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 ta sflyem orf cghigann my nwrsae.

uFatly ilcog maed em wrenod fi titignh yruo ahde ldouw caduse aecrdesni PIC so, leki a nsicugh ,ucler uyo dlowu tge drsecneia gausV erenv ivcyttai nda ayebm caydribarad + hnsy.enooitp tBu I sgseu eht ARSA essmty owldu evah ceruadctotne hatt nda cesuad ntoscctviaoorisn erov 42 rohu,s os ypoiovcmleH skhco is dlifentiey teh setb ecoi.ch

Alswya ohdslu og iwth eth osbuovi naswer ):

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seagull  I ahd eth diea ahtt htsi swa a ucronenige ksohc and ieacnsnrgi nanrlraaicti eresprsu cdluo etaffc het svaug oot. I hktni eht notquesi ealyrl wtasn su ot og that ei.rtincod +17
uslme123  hTe snuigCh reflex saedl to rcadryiaabd! +7
purdude  atWi 'Im uednscfo. I tuohhtg ceoopmvyihl ckosh saeld to na ncireades RV?S +2
littletreetrunk  nlyrpa,etap ethres' a hintg elladc ispmtyetahc acseep that can hpnepa rtfae a lihew e(..i hes' neeb uto fro 42 orhu)s: utnoimuaclcA of useist caoitblme idoraotvlsa stenascubs iisamrp cpettdde-tmiimahsaye natirctoissvcn,oo hicwh alsed ot osls of asvucalr no,te sieervsporg otsnnipheoy dan nrgoa pfrinooep.huys +1
littletreetrunk  oasl alos if he ith his head he locud aveh loss fo ymcttaiephs oowtful omrf a chpxiyo udellma wchih luodc adle ot oalat,vsiodni ichwh rteuhrf ecduser etalairr rpseures, tbu siht swa a hrad one fro me lol. I loas put ncdseaier ICP wh.a +1
catch-22  yAn klac fo shpmttaeyic nrcw/iefdsaloueot lavag futolwo should creued HR, tno sriaeecn ti. th,euFrr oyu udlwo petxce emabinstr nsisg fi trhee aws yxopaih ot the rabstim.en roF axepml,e fi uoy dha eamdag ot het taorlsiy nsleu,uc you wud'tlon eb laeb to leutegra oryu RH in rnseoesp to drdeuce PB. ecSin hits taenipt hsa dueerdc PB dna ascdnerei ,RH itsh iceadistn thta eth mrpiary cruaitbsend is lielyk teh reudced eH. B'sP lsao eenb in a eerdts rof 2+4 huosr s.o +5
charcot_bouchard  In a ptaient owh lepsevod hesyninopto ioolfglwn enr-yiehghg uarmat, uoigrennce hoksc si a aoisnidgs of cioluexns htta si made aterf iyphmcovloe dan ietbvroucst gcieirdacno kshoc heav eneb lurde !tlPou su esAbnt arrciddaBya luser it otu +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(332)


 +4  upvote downvote
submitted by yex(128)
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.mHmm lWle my mind sha bowln ffo eeucsba tahw iht my imnd saw yadiehtdonr cines eh saw in the srde.et sA noos as ym mdni adrstet to nwdear tbauo lal of hte hoert nitosop taht dculo amke .e..esns I jsut kecdicl dan md!ove

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charcot_bouchard  ratSm bio +5
usmlecharserssss  ikngih ni ahaasr sdtree MSH +4
cbreland  mlpSie = rsamt +



 +2  upvote downvote
submitted by diabetes(31)
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bgienlde + usperesr wndo +puels pu equla coeiyhovplm ckosh

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I nfuod isht tboau adsrei P:IC tnoPte"snriae of iaserd ranrlncataii spsruree = edehahac, dalpie,leapm io/ai,tvenmgnsua rswoe in hte irgmnon sa IPC saeisr ugdirn eth tginh sa a qnconuescee fo ecnc,rmbyeo a rsie ni 2COP dirgun eslep caudes yb arpirtseoyr or,dsseienp dna plrabbyo a earsdcee in SFC btinao,psro ypprualil naodtil,i tpi,sso edmparii ,geza trpseoryira i,luyigraerrt MSA, and gshnace ni P,B HR, dan rirrpastoye aerpntt era lsaluyu atel snisg fo esrdia PIC dna earlted to merisnabt ndrtisioto or ieachi"s.m

3.ils/h2ppm//te_cono/t.jcjnt/st3p:mn/nb1u7p

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 -1  upvote downvote
submitted by hello(429)
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Wa'hst eht ocmshesye dsspeoup to be a celu oaut?b seoD ihts aptntie avhe CD?I eDso IDC aawsyl eusac ioeophlvycm cso?kh

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drdoom  naseiDistemd ntluvaarcrais antcgoiloau (IDC) si a ocyinrmds .fonitindei e(Se tnneg)t.a tI sdeo nto yas”wal“ ldae to oschk but kohcs is ietynilfde a piesolbs suaeqel nei(sc, by odnitneifi, CID = estiyms“c tticobmhor s”orecp;s ihayngtn ystiemsc lhusod etg yuo a leitlt o,e)wrrdi dna so a ntitepa ithw ICD loshud be drotineom leyocs!l +
yesa  I ihknt tyeh dda to eht phvmyeaooil ti;uperc he is drtedayhde DAN nlibgede otin ihs tessisu ceusabe of ntsosuconi -g-;t& aecderdes rutsclanvaiar ..o.umv.el +

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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