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NBME 24 Answers

nbme24/Block 4/Question#17 (49.0 difficulty score)
A 63-year-old woman undergoes operative ...
Decreased movement through the arachnoid villiπŸ”

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submitted by happysingh(41),
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,os hte eyK dwros ttah no eon si oinimntnge : oigncuitmcnam uohhselarydpc

eht ahtpyphos oseg elik tsih :

an tfrmloaimayn estnigt ,(e.i. ioscabhdunra ermrhe)haog ldyei osbiifsr / rgaincsr fo the ocnarhaid onriltaugsna ;=tg& pmadirie CSF enaigadr

teh key sption / tconpsce yeht era igtnry ot tets hree : 1. od you wonk thaw acitmignmunoc lyuaerohdpsch towu(iht ehtm ntlielg ouy sheto osr)dw . 2 od oyu okwn 'thswa the ptoohslpioygyha o(f mtiuoaincnmgc lycsohpuahde)r is ?

potentialdoctor1  Exactly. To add to this, communicating hydrocephalus can be subdivided as follows: Normal-pressure hydrocephalus: Chronic/gradual decrease in CSF reabsorption at arachnoid granulations, usually due to calcification due to aging. CSF accumulates slowly, so ventricles are able to widen without causing an important increase in intracranial pressure. Symptoms occur due to compression of periventricular white matter tracts ---> Wacky, wobbly, wet High-pressure hydrocephalus: Acute decrease in CSF reabsorption at arachnoid granulations, usually due to inflammatory state in the subarachnoid space (eg, meningitis, sub-arachnoid hemorrhage). CSF accumulates suddenly, causing an acute-onset increase in intracranial pressure +7  
sunshinesweetheart  not to take away from your perfect explanations, but if it were a woman with neck stiffness and fever (rather than circle of willis rupture) that could lead to increased CSF production, right? I think that's the only case where CSF production would increase. Also I think decr absorption in arachnoid granulations in that situation as well so it'd be a shit question +  
peqmd  If anyone like me also got "decreased absorption in choroid plexus", as their wrong answer it's because the choroid plexus doesn't "absorb" it produces. +8  
alienfever  FA 19 p510 +1  
alienfever  If anyone chose F, communication hydrocephalus is caused by decreased absorption and not increased production. FA 19 p510. +1  

submitted by colonelred_(100),
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oNallymr het rchaiodna iilvl nrdsia eth FCS mrof hte iobhsacnuard aepcs to hte oenvsu stysem; if ihts rpat esbemco tvcefdeie hten yuo cna eimiagn all ttha SFC nwo iibunldg pu in the ahrsbncidaou acps.e

keycompany  Also take into account this patient had surgery that requires penetration into the subarachnoid space (hence through the arachnoid mater). This can lead to scarring of the arachnoid granulations and subsequent communicating hydrocephalus. +14  

submitted by roygbiv(20),
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ehT teaptin ash a agelkni erryb aymrunes gt&-;- stih sadel ot a ocbaaudhrsin rghhoamere or( legaaek oitn diacarhsbonu caspe) tg-&-; etuac HSA cna dale to sereceadd obsrpionta and etemomnv iav ohncdarai vliil

zbird  So this patient has a leaking berry aneurysm which undergone to surgery and repaired but in two days she developed widening of the SA space which could be explained by increased CSF production but a decreased in absorption, which is due to blockage of the arachinoid granulations by the leaked red and white cells therefore there is a decreased movement of the CSF via the arachinoid villi +1  

submitted by krewfoo99(88),
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yhW doulw seaedrced oetnevmm rouhthg the eelrcabre cqduuata eb gno?wr ithW lla the buldi fo obdol ni the SCF arttc owihutt rsnbtpaoi,o uotwnld mvonetem osla eb eeerdsacd hhgourt eth tc?uqueda

ergogenic22  this would cause a non-communicating hydrocephalus with enlarging of the lateral and 3rd ventricles but normal 4th ventricle and subarachnoid space +1  

submitted by diabetes(25),
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yplism hte dlboo endisi eht FSC ebmcoe beodlck rguohth hrndaaioc alninotuarsg =&g=;t arceesde oistpoanbr fo tCui=cgn&FSnaict;=gomm yhlsuh.adcpeor