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NBME 24 Answers

nbme24/Block 4/Question#40 (42.8 difficulty score)
A 25-year-old woman is brought to the ...
Pulmonary capillary leakageπŸ”

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 +16  upvote downvote
submitted by neonem(503),
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ihsT tnatpei isn't ,ptnahetnilygvoi yehter' liiatnEeYRPgvt,nH nheec hte PC2O t&;l 04 mm gH.

'teLs lwka ti :csbdwarka They ear eiltenngtprviahy ot npoceatsem orf hte emiblcato cadossii eudacs yb diesadrpew yp.xoiah yHilegeitvaptnrn owlals uyo to wbol ffo mroe .C2O

hyW rae they ipoy?hcx eTh nepors si iyhoxpc edu to mniaflomntia dan taeuc yspriaretor disssret dsyoemnr mofr eth noa.meuipn lAl eth nceyoiskt romf hte tnfoalrmiyam sclle csaeu cdaneseri mnaoryulp iacllaryp ke,eagla ihhwc lboskc up eth loevlaar emnbrame so htta 2O nt'ac gte uhtrgoh to hte bo.lod

hyW od etyh veah eoactlimb siscoadi ni eth irtfs ac?pel oN exonyg -t-&g; on ncleoert rasrpntto canih nda on TAC gt;-&- caclit

diabetes  no pneumonia it is UTI +2  
makinallkindzofgainz  The infection from the UTI spread to her lungs +  
makinallkindzofgainz  this is essentially urosepsis, one of the leading causes of sepsis +1  
cmun777  UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability) +7  
peqmd  urosepsis +  
snripper  lmao I read it as upper respiratory tract infections, too. +  
thisshouldbefree  she has an increased A-a gradient. +  

 +4  upvote downvote
submitted by dbg(114),
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Ddi oaneny sele denwor THAW LYUPNRMA"O MSOTS"MPY si het toseniuq rgierrfne ?t?o reheT si aleltrlyi ton a sglnie omyspmt netnomeid in het oehwl netgvie.t No lcckaes"r edrah roev thob glun s"fedli are nto o.mssyptm hTye rea sngis ndufo by eht ic.ypsiahn

oyrueslSi gtonduib eth wleoh NMEB bdoar stte werrits thrig own. oD eyth eqyaaletdu esevir rteih ok?rw ihTs si nto het rstfi lencthiac ketmasi I alzeier no the wen ormf.s

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +1  
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +1  
ergogenic22  i take that back i understand what you're saying +3  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. +1  

 +2  upvote downvote
submitted by diabetes(15),

U(UtI) ==> sepsis ==>ARDS==>INCREASE alveolar capillary permeability ==> hypoxemia ==> hyperventilation ==>hypocapnia

avocadotoast  This is correct. The patient doesn't have pneumonia, but sepsis from her UTI. Sepsis is a known cause of ARDS. ARDS can be due to extra-pulmonary tissue damage that leads to the release of inflammatory mediators, alveolar damage, pulmonary edema, and hyaline membrane formation. The hyaline membranes impair gas exchange and lead to hypoxia. +  

 +1  upvote downvote
submitted by sattanki(56),
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eTh tp is agnvhi a eveser asec of ienpaumiospsesn/ ,AS)(D?R sa ahst’t hwy ehr 2PO is low ta 46. So ni apunmineo hteer si cedsernai iaplylcra akalgee lneigda ot ampnylrou ed.ema

 +1  upvote downvote
submitted by famylife(77),
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rFom FP:AA

euctA" tpseiyoarrr stserdis ynmsdore si a ofniienattmsa fo aucet iunyjr ot hte lnug, ymconoml lgtuirnse rmfo i,essps mt,raau nad evseer ulromapyn ftiinsnco.e cnlaliC,liy ti si hrzaieatedccr yb dpna,sey pdoofnru xiy,hmpeoa edcrdaese gunl miaocnlp,ec dna fusfdie llearitab tsanltifeir on hcets rgd.ipr.o.hyaa

In ,RADS hte iuedrjn nulg si lbeevide to og urghhto hreet shs:aep taduvexi,e repafrtvoi,ile dan fb,criiot tbu het soruec fo aehc psahe dna eth velalor edsiesa enpsorosrig is baerliva. In eht avuxdetie she,ap amdgae to the elrloava uieimplhet adn usclvaar uedmethilon procduse lekaaeg fo aerwt, ponrie,t nda atmyimlanorf adn der oodlb slcel oitn the turntitiisme dan alaleovr mul.en Tshee cgsahen are udnceid yb a mxlpceo pelatnryi fo ompoltfnyrirama nad maitlmtoanairf-yn iter.msao"d


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oHw od uoy kwno erh ynauroplm symotsmp ear ued to luyopamnr cyaialrlp gekalae adn otn hn?lenotpiatvyoi sI urmonyapl ricllpaya lgakaee tujs thoaren way fo yisang mnypolura daem?e

sattanki  Hypoventilation in no way leads to pulmonary edema. +  
fenestrated  Hypoventilation would increased the PCO2 +