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NBME 23 Answers

nbme23/Block 3/Question#22

A 54-year-old woman with rheumatic heart disease is ...

Intra-alveolar transudates

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Is it intra-alveolar transudates because this patient might have HF d/t a. fib and left atrial enlargement-> inc hydrostatic pressure-> transudate pleural effusion?

sajaqua1  Basically. +1  
medschul  Why can it not be arterial hypertension? +  
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. +2  
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 +  
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. +  


this patient has pulmonary hypertension secondary to mitral stenosis that's why left atrium is enlarged , and mitral sound is heard in apex, pulmonary hypertension can explain 2/6 systolic ejection murmur radiating right side of neck. i think patient experiencing pulmonary edema

+/- usmlecharserssss(-3),


Old dudette have Aortic stenosis. Atrial contraction become essential for this patient. so AS + AFIb is dangerous because this reduces the LV preload significantly and this patient develops HF. So AFib in AS patient need to correct immediately





it is normal irradiation to the RIGHT neck? what does it mean?

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




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submitted by dentist(1),

rheumatic hrt dz = mitral stenosis = pulmonary edema (bilateral crackles) = dyspnea