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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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dMa ta fmyles for nnichgga my raes.wn

yFtula gocli dmae em ndeowr fi gthntii uroy head dolwu sdcuea ianecsedr ICP ,so kile a inhugsc leu,rc uoy odluw get ednaciesr sVgau ervne cyvittai dan ymbea ycbraaddrai + tih.oeynnpos But I ssueg teh RSAA ytessm dowul have cnecratouedt that adn usceda sootcainitconvrs rveo 24 ou,hsr os cpeHliyvoom shkco si etnfleiyid eht steb .eoicch

swAyal ouhlds go hwit eht subooiv nweasr ):

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seagull  I had hte eadi thta ihst swa a roecnigenu hoksc adn nnseiacrgi iactarannlir puresser ulcod fctefa teh auvsg o.ot I tkinh het oinetsuq aelryl nawts us to go ttah diorneti.c +17
uslme123  hTe ishgnCu lxrfee eslda to dirrbacyda!a +7
purdude  iatW 'mI dnosc.euf I ugothth vocliyhpmeo shcko sleda to na serencdai VS?R +2
littletreetrunk  prlpaty,ena rse'het a tnghi ecalld stpcymehait sceeap ahtt nac heppna tfera a wleih ei.(. s'he ebne tuo rfo 24 so:ruh) uucntoaicmlA of uisest embotalic otvioasdlar ssnuebcats paimsir cy-dteehaatpdmteiims tcnvoantsri,osico ihwch easdl ot lsso of uavrscal en,ot svrioegsepr pnhiytooens adn aorgn .yrnpiusophfeo +1
littletreetrunk  olas oasl fi eh ith shi eahd he dlocu vaeh slso fo eypmacsihtt uowfotl fmor a yxicohp aleulmd hihwc cdulo lead to ,osiavlaiodtn whhic errfuth reuscde rartalei prusee,sr ubt sith saw a rhda neo rof me ol.l I laos tup caeirends PIC haw. +1
catch-22  nAy lcak fo pahsyittmec siecoldw/neuotraf galav lowftou houdls deucer ,RH tno aiscrnee it. trrhue,F oyu lduow tpxece nsebrmati gnssi fi heter was pixhoay ot the tie.mrasbn orF ex,alpem fi you had geamda ot eht iolyrtsa cuul,sen oyu ltod'wnu eb labe ot grleutae yruo RH in enosespr to ceueddr P.B cnSie ihst anpttei has drdueec BP adn idreasnce HR, hsti itcensdia hatt teh yapmrri saduicebtnr si kyliel the cudered 'PHBse. soal neeb ni a etedsr rfo 42+ husor so. +5
charcot_bouchard  In a neiaptt how vdospele innootseyph fowgnilol regn-eygihh rm,taau cenierugon osckh is a sasidgnio fo xuesoncil ttah si eadm fetra ihylpmoeocv and erubitstcov ianodegcric coskh ahev nbee ulred u!oPt lsu snAteb ayicrBrddaa ulser it out +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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mmm.H Wlle ym ndmi sah onwlb ffo seabecu wtah thi ym mndi asw rtiadohnyed icnse he was in eht rt.esde sA oons sa ym mndi radsett to aewdnr abuto lal fo eht oehtr toinpso atht udolc meka e.s.se.n I tjus kdcciel nad emod!v

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charcot_bouchard  traSm boi +5
usmlecharserssss  khigin ni haasra estred HMS +4
cbreland  mpeSli = amrts +



 +2  upvote downvote
submitted by diabetes(31)
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edgebiln + rsprusee onwd ules+p pu elaqu ecomlhvpyio shokc

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I nodfu tshi atuob searid CIP: raetn"nsotPei of ierdas rnaciatnirla suesrpre = a,caehehd alppla,ieedm innu,aamsteio/vg swreo in eth mignrno as ICP aeirss udrngi eht hgtin sa a neqocseeunc of remcb,eynoc a irse ni P2OC undrig peels ecausd by tyreorriasp ,irodpneess and prlbybao a cersdeae ni FSC aisonb,rtop yiprlluap o,ilndiat po,isst iapimred ,azge erosprtayri iaytreir,uglr A,MS dan hescnag in ,PB R,H adn oayirpsetrr rtanetp ear alyulsu aetl gsnsi of sardei PIC nad reeldta ot abtsienrm noisoirtdt ro ic"ismea.h

2///nlb_oepj/ctpp/n1o:tu.st/i33hmnct7j.nspm

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 -1  upvote downvote
submitted by hello(429)
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htWas' eth myeecoshs puospsde to eb a luce boaut? Dose hist iptanet aehv I?CD esDo CDI awsaly seacu lohmypievoc cos?hk

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drdoom  aeDsmitniesd suataainrlvcr lnagoiautco DI)(C si a ocdmisyrn ninfit.oide eeS( .ntg)eatn tI osed nto “way”sal ldae to kchos tub kchso si fdiytleine a ebpslsoi eseuaql (cni,es by eitfoidinn, ICD = ycissem“t hocrotmbti escso;”rp innhagyt eiscmtys sldhuo get yuo a etitll )dorewi,r nda so a itaenpt ihwt CID dulsho eb mtoiedron elcyos!l +
yesa  I inkth htye dad ot het yvmlieahoop erpti;cu he si htddeearyd NDA ndglebei iotn ihs suistse sbceaeu fo onssnutoic &-g-t; sdaeeecrd rlarisatavcnu .ome.uvl.. +

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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