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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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submitted by sympathetikey(1600)
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aMd ta syfmle ofr gancghin ym s.ranew

taulyF lgioc dmae me oerwnd if itthgni your ehad owldu cduaes deeracnis ICP o,s ilke a ugischn lc,uer oyu wuodl egt eerciasdn gsuaV veern tayciivt adn ymabe dybdcaraair + pienontshyo. tuB I gsuse hte AARS symset uoldw aveh atectneoudcr ttah dan esdcau scntortioascnvoi ovre 42 uhors, so ycliemHpvoo cohsk si ndiyeftlei het bste h.eoicc

syawAl uohlds go thiw teh obiovus rwnase :)

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seagull  I dah hte idea htta shit was a nnrocgueie ksoch dna ngeirinasc raarlncaitin ureessrp loduc aetffc the uagvs oo.t I hinkt the soeqitnu lyaelr wtsan su to og tath iioec.dntr +17
uslme123  Teh igunhCs flerex dlesa ot rcddbairya!a +7
purdude  Wiat mI' oused.fnc I ththuog ymeohiolvpc kosch ldsea ot an ncdersaei SV?R +2
littletreetrunk  ylnepp,rtaa htee'sr a htngi cedlal tpsymeicaht apesec ttah can npepah farte a lhwie e(i.. 'she been out ofr 42 soh:)ur almccuAutnoi fo ituses mlibcaote sotvaoladir ecssnstaub irsipam eitepahayesdmt-ditcm oosra,ictvstnonci chhiw eslda ot sols of saaulcrv ,note gvrpsorseei nhystoeoinp adn gnrao enup.oyofrishp +1
littletreetrunk  soal oals if eh tih his hdea he odclu aevh slso fo ehtasypcmit woulfot mofr a pixycho leludma ichwh oulcd aeld to nlivaiostdao, hwhic efhurtr rceudes iraarlet eru,psser tbu hsti saw a hrad eon rfo me o.ll I laso tup enaiedscr CIP wha. +1
catch-22  nyA lkac fo yhtteicmpsa rscufoetdelniwoa/ lagav uowlfto odhslu ueerdc ,RH otn aercsine .ti urehF,tr uoy oduwl eetpcx bnitmsear sgsin if ehtre swa haypxio to eth baetnrsm.i roF ,xmpaeel fi you ahd geadam ot eht iatsroyl enu,csul oyu tuldow'n eb labe ot aulegtre uyor HR in nespeors ot cdueerd BP. cienS hsit neatitp ahs ddeeruc PB adn resdeiacn R,H hist acitnesid tath teh yrpmira esiabtcrund is elkyli teh ededcru BP.es 'H loas bene ni a eresdt for 24+ suorh o.s +5
charcot_bouchard  In a aptnite how pvoeedls ptinsnooyhe ofwinlglo ggen-yerhhi aut,mra nnocgeueir hscko si a inosgsdia fo xnesliocu taht is mead rafte yvmoechpoli nda ttrbsuvcioe iecgcanorid chkos ahev bnee lured !usuPot l Atnbes arycadidBar eulsr it 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(332)

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 +4  upvote downvote
submitted by yex(128)
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mHmm. Wlel ym midn ash wolbn ffo scubaee whta tih my nmid asw hedtryaniod niesc he wsa in eht st.rede As oons as ym mind aettdsr ot wrande btuoa all of eht etorh piotons hatt duclo emak .see..sn I juts iclkdec dan veo!md

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charcot_bouchard  rtmaS oib +5
usmlecharserssss  gkinih in raasah etdres SMH +4
cbreland  epliSm = tasmr +


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 +2  upvote downvote
submitted by diabetes(31)
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ieegdnbl + rpsserue wdno +peusl pu luqea opcoimvhley ksohc

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submitted by nwinkelmann(366)
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I unfdo tihs ubota sidera CPI: inP"naoetsret fo rdieas iairntcralan uesprres = aehachd,e pplamdila,ee /imiat,ognusvane eowsr ni eth gmnnroi as CIP asisre indrug teh ihgtn sa a ecncosnquee fo yr,necmecbo a iesr in PCO2 rungid eepsl scedau by iapsrtyerro sredpe,osin adn ybrblopa a esrdeeac ni CFS ibtrsaonp,o ralulppiy ,tadniilo sipo,st deaipimr zaeg, irtrasropye giiurl,earytr ,MAS dna csneagh in P,B HR, and rpirysoaetr ptrnate era lusuyla leta snsig of iadser PIC adn redalte ot bmienasrt tdinosrtoi or i"sei.mcah

i/o.hpjt/e//3:np/us3blpcp2/7n_sj.mttoc1ntmn

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submitted by hello(429)
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'tshaW eht eosmeycsh edpsospu ot be a lcue b?outa sDeo itsh ptaneti veah C?ID soeD ICD wlasay caues hopmoycliev o?hskc

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drdoom  sDdaemiintes icaurvsrtalna tloiaognauc ()CID si a drymisnco dnfieton.ii eSe( anentgt). It edos otn ”y“asawl aedl ot oksch tub schko is teylidnife a slsepbio eelauqs ,(cseni yb oefii,dtinn DIC = i“csteysm otmiocbtrh rse;posc” tyhganin sstcimey oldhus gte yuo a tiltle ow,)drrie nda os a ptanite htwi DCI sodluh eb ndrmioeot !loslecy +
yesa  I kinht thye dad ot het iohmpoalvye ;irpcute eh si dedtrhydae AND inlbeegd toni his eitsssu aeucsbe of noitnsoscu ;--tg& rdeesdaec vticraasaurnl ..e..vouml +

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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