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NBME 24 Answers

nbme24/Block 4/Question#38 (52.1 difficulty score)
A 33-year-old woman at 34 weeks' gestation ...
Stroke volumeπŸ”
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 +17 
submitted by sympathetikey(1265),
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oldeW'uv been cein if hety odtl oyu d2"n aoleittrncs esp"ca on eflt or mr.g.hst.ih

paperbackwriter  It wouldn't have mattered because the murmur is due to increased stroke volume, not anything mechanically wrong with the valves. If they had said A or P then it might have actually caused more confusion (stenosis etc.) +6  
cport12  Also an important side note is that with the addition of the placenta, systemic vascular resistance would actually decrease (another organ added in parallel) which should help point you towards an increase in stroke volume. +  



 +10 
submitted by seagull(1443),
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ooB"dl wflo ot avisuor sagorn iercaesns idrnug ypcnarneg to etem eth reicnased iltmobaec ndese fo tsessiu. s,huT oeuvns rreunt dna caicrad totpuu ssaeenirc aladramyctli udngri nrnpeygac. rCiadca utotup dllryuaga sacresein ingudr hte ifstr 2 emristsrte iwht the easgrtl nrcaseei nccurirgo yb 16 keswe of tneis.otg3a heT ieneasrc in adracci ouptut is lewl eebdssahtli by 5 eeswk fo ensgatiot adn rnssaeiec ot 5%0 bvaeo negcrnerypap elsevl yb 61 ot 02 weesk fo .atgosetin heT srie in craaicd tuputo calylpity stelapau freta 02 ewsek fo giosenatt dna smaeinr dlveteae inlut trm.e hTe ecssnriae ni airdcca outptu rae sacodieast wtih atgiinscinf cnrsasiee in osekrt lvmeuo nad ahtre arte (H"R)

hs.i8:/ca3/ilg2/pwcsPc1vrn1.bnlom//w/2t.0.CnmtMiphtew




 +7 
submitted by m-ice(326),
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A ostf yiolstsc rumurm si mmcono ni mayn trnnpaeg eomnw eud ot a hghi oluvem of lfwo dcin(aeesr irdacca .tutpuo) The mumrru tedns ot og yawa witihn a efw eeskw fo lieervyd eocn het radcaci puutot si coserl to si.benale




 +3 
submitted by sunshinesweetheart(69),
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p 961 FA 9102 - ycgspoihoil eghcasn ni aecgpnrny

ircn CO, eaan,im gtiuralhoyyelb,pcia toniparyveehitln, inrc lysslopii adn taf intiaotiulz ot rerpsvee ouscelg nda AsA fro eth byab




 +2 
submitted by usmle11a(73),
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ym way swa

SV V=SVEDE-

EDV aicsrenes ni ypcaegrnn ude ot an recnaesi ni pmaasl omvuel




 +1 
submitted by step420(33),
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I aveh a tn:ueqios ceSin CO = VS * ,RH dna in acnye,nprg nweom have an aeinscred lsaab RH, why can't eht rnwsea be usl?Pe

home_run_ball  I don't think HR would explain the grade 2/6 murmur, but SV would +4  



 -3 
submitted by neonem(556),
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yM btse sgues is hatt hits iaetnpt ahs a pisbidcu atorci valev and has a mruumr eud ot esrcaidne emoulv lveoorad mfro eht apny.cegnr

charcot_bouchard  Can be congenital mild Tricuspid stenosis also. it also exaggerate during preg +  
wowo  probably just a flow murmur, https://acpinternist.org/weekly/archives/2017/05/16/3.htm +5  
noplanb  Wouldn't Tricuspid stenosis be a systolic murmur? +  
noplanb  I mean diastolic* +1  
centeno  I think that a murmur of grade 2/6 is a clue for flow murmur. Maybe any pathologic cause of murmur would be exaggerated in pregnancy (due to increased blood volume) +