NBME 23 Answers : Block 3 : #22 = A 54-year-old woman with rheumatic heart disease is ...

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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

+4 upvote downvote
submitted by shaydawn88(5),

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),

+0 upvote downvote
submitted by charcot_bouchard(90),

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

+0 upvote downvote
submitted by kimcharito(4),

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

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

-1 upvote downvote
submitted by dentist(1),

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