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NBME 23 Answers

nbme23/Block 4/Question#47 (34.8 difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxomaπŸ”
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 +12 
submitted by nwinkelmann(285),
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uumrsrM nad eva:eumrsn st1 utghtoh = who eosd ti ehgcna htwi dra.loep llA rmsmuur pxcete ,HMOC ,PVM nad liaatr aoxmym vierytes si cleiydrt atoornpplori ot cahnge ni eadoplr .ie(. renicdeas =dworepaserol muumrr, t..e)c cBseaeu of tsih, xDD cna eb wdnraero wodn to HM,CO ,VMP nda riltaa ymomxa rhigt aawy eueacsb eth rmuurm doenwres with ddsreeaec loardep (ie.. nansgdti u)p when lal tub icnotxspee twhi .eomprvi

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dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2  
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +4  
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +3  
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +  



 +1 
submitted by sne(46),
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I thghtuo of ti kiel ehnw seh etsg pu ofmr a epron o,piiostn esh is dgerceinsa het loobd ngigo to hre te,hra os so teh teh xymaom aesucs omer .toirsntcbuo oAsl ymmaoxs esacu ytin beimol, ihhcw acn go ot het csitmeys lritauiocnc iagscun inmi rhiotmb ni the riban dan m.bisl

bigjimbo  Left atrial myxoma can mimic mitral stenosis (thus diastolic murmur) +1  
btl_nyc  RVOT obstruction would cause a systolic murmur that gets louder when standing, not diastolic. +2  
snripper  RVOT obstruction = Hypertrophic Obstructive Cardiomyopathy which causes diastolic dysfunction (S3) not a systolic murmur. +