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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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daM ta meysfl rfo inhcggan my arwns.e

lyFaut gloci made me wderon if iintthg royu deah udlow adeusc erniesadc CPI ,so like a scnhiug ,lruec you ouldw egt niaedcers asugV ernve victytia nda eabmy barrdydicaa + yohnetpisn.o But I ssuge eth RASA etssym woldu ehva eaetndcotcur tath dan eaucds itnsaiconcoosrvt eovr 24 hro,us os oemHlycoivp kscoh si fteidniyle hte setb .cohcie

aywsAl lhodus og htwi het ibosuov wseran :)

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seagull  I hda eth edai hatt siht saw a rnegnecuoi cskoh and scrigneian aartiilcnarn speresru dclou fcfeta the vaugs too. I ntihk eht seoqutin erally twnsa su to og thta cinriet.od +17
uslme123  Teh snghiuC lxreef lased ot adyiacdrbar! +7
purdude  aitW 'Im unfs.edoc I uhthgot loivchympeo hsokc deals to na deecisnra ?VSR +2
littletreetrunk  a,rpaenltpy erthse' a htngi dclela ictmspeyhat csapee taht acn anphpe rfeta a heilw .i(.e she' ebne uto rfo 42 :ouhr)s anuolcumcitA fo suseti ctaiebolm aovotsraldi netbssucsa risimap yt-sedmamhteaieptcid soctr,invootcsnia cwhih saled to lsos fo sraaulvc one,t ogrivrseesp ieotsnoynhp nad oangr ypshn.fuoierpo +1
littletreetrunk  soal aosl if eh hti hsi ahed eh lcdou haev ssol of htcisaeptmy lftowou rfom a hiocyxp alleumd whchi ucldo deal to ilaovtan,osid chhwi uhertrf cdesrue ertliraa eupsrre,s tub htis swa a hrad neo orf me ll.o I soal utp danriscee ICP h.aw +1
catch-22  ynA alck fo hecitmstpya oaocluewfe/idnrst glava lwtofuo dlhuos crduee HR, otn ecsnaeri ti. rtuFhre, oyu uwdlo tepxce ntiresmba nigss if erhet saw ihoaxyp to hte bmneisa.rt For l,xpeema fi oyu dah eadgma to het oirtaysl cuseln,u uoy dltn'ouw be lbae ot reglutea rouy RH ni eeossrpn to euedcdr .BP cinSe sthi patinet has eddceur BP and encrsdeia ,HR iths tainiescd thta eth pirmray ciadbesrnut is elkliy het cderued 'B. HPes loas enbe in a tesder ofr +24 usohr s.o +5
charcot_bouchard  nI a tetapin how ledepovs onhieotnpys nowfgioll gehygnrhi-e muaa,tr rginueeonc sockh si a sgsinidoa fo snlxuieoc ahtt is amed faret cemyivlpoho dan cievuorbstt cicegraodin khcos veha been uerdl P!uu lots teAnbs craByirddaa ursel it out +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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mHm.m llWe ym dnmi hsa nobwl off asueecb hwta ith ym indm was dyehndaroti icsen he saw ni teh sdeet.r As oson sa my dimn reatdst ot raendw otaub lal of eht herot spoiton ttah ldocu kmea e..s.nse I tjus klciced adn !odmve

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charcot_bouchard  atSmr boi +5
usmlecharserssss  iihgkn in arhaas esdrte SHM +4
cbreland  Splmei = mrtas +


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 +2  upvote downvote
submitted by diabetes(31)
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dgneblei + rpsueres nwdo p+elsu up qluae piveyohcoml khocs

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submitted by nwinkelmann(366)
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I nodfu itsh btoau adsrie CP:I nsanrt"iteePo fo aedisr rraictlnaani pessruer = eeadch,ah ,admlppleeai m,agansitoeuvi/n eowrs in het nnmrigo sa PCI siesar indurg hte inhtg as a ncqeosuncee fo rembync,coe a eris in 2COP grunid lpsee saceud by triyasorrep pordsne,ise dna rpolybab a sareeecd in SCF ob,rpnsiota alyurplpi ao,diitln ,ispots prmiaeid gzae, rsioarrpyte luaie,ygrtirr S,MA nda cnaeghs in B,P HR, dna orreiatspyr eprttan era syullua ltea ngssi fo dsirae IPC nad ateelrd ot srbnaiemt dintrsoiot or miicshe".a

tj.1//m3cjb:.hltpsu/3so2/ncnpe/nmpp7n/it_ot

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 -1  upvote downvote
submitted by hello(429)
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sW'aht hte sesyhcmoe spedspuo ot be a uecl ?btauo eDos isht atnepti heav DI?C seDo DCI ylawsa sueac hiyoclemopv hsco?k

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drdoom  emiiadstDens avscraitruanl agoctlouain I)D(C is a doirscnmy eidtinnf.oi See( )e.ngntat tI oesd tno yws“ala” deal to kohsc btu sohkc is fltdeineyi a islebpso lusaeeq isenc(, yb tdiinieon,f IDC = emctysis“ coobirthmt spec;r”os hgyatnni smstycei sluohd get oyu a ttlile )e,rirwdo nad os a iantetp tiwh DCI uoldhs eb tenmrooid y!osclel +
yesa  I tinhk tyhe add to the ayvopholeim ecurtip; he si daydrheedt NDA lbngidee ntoi ihs seussti eesabcu of noctiosnus ;t-g&- raeecddse rcarauantivsl l.e.u.vo.m +

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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