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NBME 23 Answers

nbme23/Block 3/Question#22 (32.7 difficulty score)
A 54-year-old woman with rheumatic heart ...
Intra-alveolar transudates🔍

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sI ti rlaaetiona-lvr tntasseraud buecsea sthi npttiea gihmt ehav FH t/d .a ifb nad eflt atialr egnr;te-n&elgtam cni hydaictotrs -stee&;upgrsr ueatndtsra luraepl ins?uoffe

sajaqua1  Basically. +2  
medschul  Why can it not be arterial hypertension? +2  
meningitis  I think Arterial HTN is referring to Pulmonary Artery HTN which would be present in LT HF in the long run with RT HF and edema. Pulm HTN would cause a backflow, and doesn't really answer the question "explain the patients Dyspnea". At least, that's how I saw it. Hope this helped. +5  
sugaplum  the question has 2 murmurs, so does she have aortic stenosis too? i guess it is not relevant since it asked for what is causing her SOB +1  
nukie404  I guess pulmonary HTN would happen in response to increased pressure after the edema happens, and would cause backflow (to the RV) over pulmonary edema. +  
vulcania  There's a really great diagram in UWorld (QID 234) that explains what happens as a result of mitral stenosis. Very similar sounding to the patient in this question. +  
srdgreen123  @sugaplum, yes rheumatic heart disease can cause mitral and aortic stenosis. Rheumatic aortic stenosis can be distinguished from degenerative aortic stenosis by 1)coexisting mitral stenosis and 2)fusion of the commisures. +  

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submitted by dentist(40),
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ethcmuari hrt dz = iartml eiostnss = amlnproyu demae (ailblaret ceaks)lrc = nsadeyp

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it si ramonl iadriaonrti to the TGHRI cnke? wtha edso it m?nea

krewfoo99  @kimcharito Aortic stenosis radiates to the carotids FA pg. 285 (2018) +1  

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dlO udteetd aveh otrAci t.iesnsos tAilra totoinacrcn bmoece eseainlts orf tihs apttne.i so AS + bIFA si dguornsea uceeabs tsih uedcrse hte LV dplroea ylfintgciains nad tshi ttanpei dopevsle .HF So FibA in AS tiatpne deen ot rrcetoc timildeamey

aisel1787  she's not so old! stupid comment +