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Retired NBME 23 Answers

nbme23/Block 2/Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock 🔍 / 📺 / 🌳 / 📖
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 +4  upvote downvote
submitted by sympathetikey(1600)
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aMd at eyslmf for ghacngni ym ew.sran

Fayult lcigo adem me wronde if httiign uroy deha owdul scdeau cariseden IPC os, keli a csungih ue,lcr yuo ulwod teg densceari ugaVs never atticyiv nad abyem yaadidracrb + .sihnpotynoe But I segus the RAAS sytesm udolw have ttcradeuoenc that dna ducesa ocsrointcnstviao vore 42 urs,ho so opomceHylvi kochs si filyedenit teh sbte oh.icec

wsalyA dsluho go whti eht osviuob wensar :)

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seagull  I hda the iaed htat tsih saw a ginuorneec hocsk dan iarnicnesg racatniirnla eeprsrus odluc eafftc eth svaug ot.o I htnki teh outnqise llayre snwta us to og ttha r.dnitceio +17
uslme123  Teh nihgsCu fexler edlsa ot yb!aiadcradr +7
purdude  iWta 'Im nds.ceouf I outhhtg mlyeooichpv shcko slade to na endcriaes ?SVR +2
littletreetrunk  ryept,npaal 'eehsrt a hnitg dlcela ipcetmtayhs peeacs ahtt can pnpaeh traef a hiwle (.i.e s'eh bnee out orf 24 rho:su) mnciuucAatol of usetsi atcmeloib oloastvidra bsssnuatce samiirp atteye-tsmpadeihdimc ntvrc,oaocniisots hwhic dslae to ossl fo lrvsuaca ,neto evigssrpore iehopsytnno dna arngo roopnyuifps.he +1
littletreetrunk  laos oasl if eh tih ish hdae eh ducol heva osls of ictaphymset wtooflu form a cxyioph amldeul ichwh luodc leda to iaoltsdoi,avn ciwhh utfhrre esrecud aaretlir u,persres tub shti wsa a hdra one ofr me lo.l I olsa tpu eedisancr PIC wah. +1
catch-22  yAn lcka fo tescimahtpy dooeuawtscern/ilf gavla lwoftou lodhus rcedue H,R nto eeraicns i.t uFh,rret you oldwu epcext mbrtianes ingss fi ether aws xhypaoi ot the remti.nasb For eela,pmx if uyo hda edamga ot eht rlysaito ,usuenlc yuo t'wdonlu be albe to lreuaetg uyor HR ni eporsnse to ddreecu B.P necSi tshi tpateni ahs cedured PB dna drseiacne RH, itsh snaeitdci htta eth imyrarp ndtbsriucea si likley eth edecdur .PHB' se laos neeb ni a dseert ofr 42+ srouh os. +5
charcot_bouchard  In a antipet ohw eesplvod nptnoioheys wlflnoiog -eghghreiny rtuma,a neoucergin hocsk is a aigonsdsi of eosunlcxi atht is mdae tfare lhepyovomic and vtsrubceoit ccogdneraii sckoh heva neeb elurd utl s!oPu ensbAt dyaaarBidrc lesur ti uto +2

Increased ICP would present with the cushing reflex (hypertension, bradycardia, irregular respirations). This occurs because during increased ICP, the brain will compress cerebral arteries causing reduced cerebral perfusion. As we all know, cerebral perfusion pressure = MAP - ICP, and thus the body will force a pressor reflex to raise the MAP to try to keep the brain perfused.

Unfortunately, this causes reflexive bradycardia due to the baroceptor reflex activating. The irregular respirations are because the brainstem is compressed.

Since our patient does NOT have the classic cushing triad, you can rule out increased ICP.

+17/- drzed(332)

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 +4  upvote downvote
submitted by yex(128)
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.mHmm Wlle ym imnd ahs obnlw ffo eusceab tahw iht my dnim was rneothiddya einsc he wsa ni eht st.erde sA noos as my dnim erdttsa to awenrd toaub lla fo the hreot opstion htta lucod make .sn.e.es I jsut ciclkde dna omdve!

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charcot_bouchard  trmSa bio +5
usmlecharserssss  ghikni in sahaar eedtrs MSH +4
cbreland  epmlSi = mtasr +


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 +2  upvote downvote
submitted by diabetes(31)
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bginedel + srspeure odwn e+plsu up qealu hoylimecvop khosc

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I oufnd isth tboau iresda C:IP insr"oantPete of iadsre rntnailraica eurressp = heahdec,a emp,aldeaipl uimnngt,ieaosv/a oresw ni hte imnognr sa PCI rsisea drugni eht inght as a cqsueenceon of coemcebnyr, a ersi in 2OPC ndurig slepe sducea yb yoirsrpater nsrds,epeio adn rpobblay a cdereeas ni FCS parst,onobi uilpralpy ito,iandl s,sotpi apdimeir eagz, torsyiprrea iularreg,irty A,MS and censahg ni ,PB H,R and rpestyoairr trtnpae ear asulylu elat inssg of adesir CIP and eardlte ot tbrminase dnittisoro ro ".caisihem

t3itbcsppe:tolp3t/.o/_jn.scmu/nhn17m/nj/p/2

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 -1  upvote downvote
submitted by hello(429)
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tsW'ha eth oycheesms dpuepsos ot eb a lecu abuto? sDoe sthi atepnit heva C?ID oesD DIC yslwaa ucase cliheovmyop ckoh?s

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drdoom  deDsitmnsiae ucvrlisatraan aoglictanou CD()I si a simncrdoy n.dtifniieo e(Se .nte)tnag tI eosd not a”a“sylw adle ot cskoh utb shock is lfiedenyit a eoblipss suqalee ce(in,s yb inni,itdfoe IDC = tcism“sey ootithcbrm secrp;s”o ithngnay tssiycem odlsuh teg you a telitl dri)rew,o and so a antpite itwh IDC uhdsol be dmooitnre !oslceyl +
yesa  I hkitn thye dda ot eth iohmyoleavp pci;etru eh si tedrdhdyae DAN eignebdl noit his tusseis ucbeaes of csntisuono -g&t;- esacedder rautrslaaicvn .m..elvo.u +

From https://meshb.nlm.nih.gov/record/ui?ui=D004211:

Disseminated intravascular coagulation. A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.

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