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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 ta mlfsey rfo hngcaign my srn.eaw

autFyl cgloi meda em wreodn fi ingttih yoru ehad uowld esdcau craesiedn PCI ,os kiel a nsihgcu ,leurc oyu uodwl gte eaneriscd gsuVa enrev ivtactiy dan meaby aryradbdcai + .iehotspnnoy Btu I gssue teh RSAA semtys uldow ehva ttunocrcaeed ttha nad ucdase onoiisttacrnsvco evor 24 u,shro os eyomlHpvico chosk is eneiityfld eht tsbe ei.cohc

slyAwa sldhou go wtih hte isuoobv wsaern :)

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seagull  I had the aide taht htsi swa a ecingneuro cksho nda inngcseria arntaanliirc ressuper cludo eatffc teh gavsu oto. I ktnhi the suinoetq rellay nwast us ot go ttah oc.tiedrni +17
uslme123  The gisnhCu felxre aldse ot ba!arrcddyia +7
purdude  atiW m'I csdo.uefn I tthhoug pyoicovelmh khocs aldse to na isrncaeed RS?V +2
littletreetrunk  lteypr,anpa rh'sete a ghtni llcaed yiphatemcst sapeec atth cna epphan eftar a eilhw ..e(i 'ehs enbe otu ofr 24 :uoshr) Atuciacolunm of suties tbiecoaml lvodoatasir ssesnbutac risiamp teemptedhiydm-iacsta srtnsonioiactoc,v ihhwc sleda to lsso of asuacvrl noet, grpeissvero nsohenypoit adn nrgao o.hufpsrypoein +1
littletreetrunk  oals olas if he hit sih edha he dculo heva loss of ctishyeaptm wftluoo ofmr a xcoihyp dullmea ichwh loduc lade to ,soadloviinat whchi tuehrrf eedcsur rrealiat sr,rsepeu tbu htsi aws a dahr eon rfo em .llo I soal put sedericna CIP a.wh +1
catch-22  yAn ckla of miytcstpaeh lnweesd/tacoioruf avalg lwtufoo lduosh recedu ,HR otn saecenri .ti tre,Fuhr oyu uwdol peecxt ansbtimre nssgi fi rehet asw axhiypo to teh ni.ebmastr Fro exlempa, fi uoy dah emagad ot hte lsoyarit ,suulenc you nwuol'td be leba ot uarglete ryuo RH ni rsesnepo ot uceredd B.P neiSc sith tapinte ash rdueced PB dan seacerdni RH, htsi dsiciaten htta hte pyirram bceatunsrdi is ykelli the ecuddre sPBH.' e oasl enbe in a edsetr orf 24+ hsoru .os +5
charcot_bouchard  nI a npiatet owh vodelspe psneohynoti ofoingllw yeegnhrhig- uaamtr, nnioeuregc hocsk si a sniiogsda of xouclnesi ahtt is adme ftrae olmephyociv and tucoeritvsb naiciorgcde kscoh ahev bnee uerld t!luou sP sebnAt cdBdraryaai eurls ti tou +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(333)

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 +4  upvote downvote
submitted by yex(128)
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H.mmm eWll ym nimd sha onblw ffo uacbese tawh hit ym mnid was eddtahiryon esnic he was ni the e.rtdes sA onso sa my midn strtdea to ewdran obtua lal of teh oterh nooipst atht docul keam sn..ese. I ujts dclikec dna vd!ome

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charcot_bouchard  tmraS boi +5
usmlecharserssss  gkhnii in aharas etserd HSM +4
cbreland  impeSl = asrtm +


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 +2  upvote downvote
submitted by diabetes(31)
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bedlnieg + ruepress ownd plue+s up eaqul hlycoopevim kosch

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I uofdn ihts autob sraied P:CI Pteeas"irotnn fo reisda riaaatrinlcn spreuser = acdah,eeh eeadmap,pill ian,mgis/natueov osrwe ni hte ngmrnoi sa CIP rsiesa rnuidg teh hngti as a cesoenncequ of mbcocrneye, a rsie in OCP2 nigdur eeslp eucdas yb irrypartose eipsro,nesd dan rlapbboy a eesdecar ni FSC tsi,arpbono yiplaulrp itad,loin ssot,ip rpiemdia e,gaz rsriapyerto r,ieyratrilug AS,M nad ahescng in ,BP ,RH nda rrrpetaysio apnrtet are uasyllu teal issgn of disrae CIP adn laeedrt ot bmersntai sotrniotid or hsaeimci".

stps/h/.pbu:tojpj3eo//m1ml_icn7tncnn3tp.2//

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 -1  upvote downvote
submitted by hello(429)
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Waht's eht oysecehms uspdepso ot eb a luce btua?o seoD shit ieatptn ehav ?DIC eosD CID aawlys cuase evyhicolpmo os?ckh

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drdoom  mnDiseeidsta urvlnicrasaat tlooncaiuga ()IDC is a nycdmsior n.dtofiiien (eSe ntatne)g. tI eosd not w”ysaal“ lade ot sohck utb hcosk si iyidelnfte a oilsbpes saeeqlu s(ceni, yb ntindif,eoi ICD = cissetm“y hoircotmbt o”sr;psec tayginhn siestmyc sloduh teg you a ltltei ew)rd,ior dna so a tinteap wthi ICD lohsud eb rdtmeioon y!lscoel +
yesa  I hknit ehyt dad ot the mooyaiphvle erict;pu he si eadyetdrhd AND lebgdien otin sih suistes auecbes of ntoscoiusn t;-g&- ceesredda cvnltuiararsa lv.meo..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.

+/- drdoom(1206)

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