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NBME 24 Answers

nbme24/Block 2/Question#2 (34.2 difficulty score)
A 45-year-old man comes to the physician ...
Oxygen saturation🔍

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submitted by brethren_md(90),
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isCscal lepse naape in het .atpietn snaoCtsie fo itenarhbg seaucs ouarnclnt oaiyxph nad ceistysm pyeetdrehia/hnissrrndyut/honcm htdea nca eirtsp.s aOP2 is maonrl ungird day dna eeddesacr rdugni sseiodep adn ta tnhg.i alsliycsCla sene in bsOee aitsnpte husc as eht ptteina ni hte tqionseu mes.t

tinydoc  Caused a cessation of breathing rather than a ↓ in lung volume although a patient could develop an obesity related restrictive lung disease thats not whats happening with this question. +2  
sunshinesweetheart  p 665 FA 2019 +1  
syringomyelia1  p 679 FA2020 +  

submitted by krewfoo99(93),
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Lngu umloev lliw eesraced in ysebito nntvthyoiolpeai onmesd.yr venE htgohu hist ptiante is eeosb, he sha all the liciclan useftrea of eselp eaapn

j44n  also the lung volume would't have an "episodic" decrease. It would be constant due to the weight on their chest. +  

submitted by amphotericin(8),
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How edso OAS eadl to paehrpreli mdeea adn loud S?2

futuredoc  Hypoxia leads to pulmonary vasoconstriction and therefore pulmonary HTN. This can lead to the peripheral edema. Furthermore pulmonary HTN can present with a loud S2. +9  

submitted by abhishek021196(61),

Sleep apnea

Repeated cessation of breathing > 10 seconds during sleep = disrupted sleep = daytime somnolence.

Diagnosis confirmed by sleep study.

Nocturnal hypoxia = systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/flutter), sudden death.

Hypoxia = More EPO release = More erythropoiesis.

submitted by therealslimshady(25),

Daytime sleepiness, fatigue, frequent nighttime awakening, snoring, and obesity (BMI>30) are all symptoms of obstructive sleep apnea. Frequent cessations of breathing during sleep result in a decreased O2 saturation in his lungs, which causes hypoxic vasoconstriction in the pulmonary vessels, and over time this leads to irreversible pulmonary hypertension (loud S2), and the pulmonary HTN eventually causes right heart failure, which is what's causing his peripheral edema.