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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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Mad at sfelmy rof haggincn ym .wsnear

atlyuF cliog eadm me dorwen if thitign oyur hdea lwduo deascu dieenacrs PCI s,o ikel a suignhc ,eulrc yuo uwdol etg iacneedsr uaVgs nvere tiytcavi nad ebyma yrradaidabc + ophtnseyn.oi tBu I gesus het ARSA eysstm wlduo hvea countdtaceer ttha dan cseaud tonsocosairivntc vreo 24 rho,us os lcmoeiyHovp cskoh si idelyfteni hte etbs ch.ieoc

lAaswy sdhuol og iwth teh ovibsuo searnw :)

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seagull  I dha eth eiad htat sith aws a noeingruce khcso and rnisgiacen nrinlaaarcti esrseurp ulodc afctfe eth suavg t.oo I hitkn hte neiqusto elyral twnsa us ot og atth ncrdti.oei +17
uslme123  eTh ugshnCi reelxf saedl to ibadaradcyr! +7
purdude  itWa Im' uoce.sfnd I uotthhg epioyvhlocm sokch dlase to an cnrieesda VS?R +2
littletreetrunk  rpaae,yltnp etrs'he a ghnit ldleac cetstphaymi ceespa ttha can peahpn rtafe a iehwl (i.e. s'eh ebne tuo rof 24 s:rhuo) oaiutAncmluc of sestui timacbole alraidotosv easnsbscut imarisp eidcmedahtpyeiat-mst sncotos,noarticiv hwich dlsea to sols of usalcarv ne,to erivsrsopge oipsnyhenot dan goran rfeuosypnpho.i +1
littletreetrunk  also oasl if eh thi his edha he cudol have ossl of pcstmeiayth futowlo ormf a cypoxhi emaldlu hichw uocdl elad ot iaaoivtnslo,d hcwhi rfureht esdrecu artleari seurs,erp tbu thsi was a darh noe rof em .oll I aosl ptu adenceris PIC .wha +1
catch-22  ynA clak of icestapthmy fle/euoocdisrntaw gvaal oulfwot dhsulo recdue RH, ont erenscia i.t rFrute,h yuo wdulo pcxete bmriseant sisng fi reeth aws ayxoihp ot het tnmarseb.i roF ,lemxpea fi you hda adgame ot teh iroaltsy nsluu,ec uoy ldnuto'w eb ealb ot etguerla uoyr HR ni oepressn ot cededur P.B iecSn sthi ttpenia has eddceur BP nad dceeisnra R,H isht ecstiaind that eth irypmra endacturibs si liykel het eddurce sH Pe'B. loas eebn ni a estder fro 42+ uhros .os +5
charcot_bouchard  nI a pntteia how lpevdose seniyhtopon lnwofliog inygheh-gre tra,uma rnegeconiu sokch si a gasoiisdn fo luocseinx thta is aedm atref mlooiyevcph adn tsvcuieotrb ogirnecciad sckho heva bene urdle uslo!tuP tnsbAe ayrBidaardc rusel it otu +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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Hm.mm lleW ym nmid sah bwonl fof cesbaeu twha ith ym imdn wsa endoryhatdi nceis eh was ni hte re.estd As sono as ym ndmi trdatse to nwrade toaub lla of eth eroth nptosoi hatt ocudl akme e.n..ses I jtus elcdkci dna ove!dm

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charcot_bouchard  trSma obi +5
usmlecharserssss  ikghin ni rahasa detser SHM +4
cbreland  lipmeS = rmsta +


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 +2  upvote downvote
submitted by diabetes(31)
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nleibdeg + uresesrp owdn l+pseu pu uelqa loyhoiemcpv cshok

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I fudno this tuaob siedra :IPC etrPosn"ntiea fo rsadie nlrnaatiriac uersrsep = dcaheeh,a ella,pepdmia nvat,/giunmsaeoi ewsro ni teh norngmi as CPI srsaei ugnidr eth hngit as a enccqneesuo fo rnoycc,mebe a ersi in P2OC rigndu lepse sacedu by yrreistaopr isrepn,sode adn obbyprla a sdaceere ni CFS oirptb,snao rulpipyla toadni,il t,soisp pdieraim ea,zg erypatiorsr eratiu,liyrgr ,MAS dan escgnah ni P,B H,R nda artsiopreyr rtanept ear alsuluy ltae snsgi of asredi IPC dna eerdalt to emainbstr idoostitnr or ahmei".csi

ctnmnlpm//o/n:/nisu3ep/_7o.1tb3phs/.tctjjp2

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 -1  upvote downvote
submitted by hello(429)
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hts'Wa the cyhsesmeo sespdpuo to be a leuc buoa?t esoD ihst tiepnat evah ID?C oDse CID yaawls eusac oilmyovcehp oskh?c

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drdoom  Dseiantmiesd atrnlcrsuvaia ailuanogoct DI)(C is a rcsodynmi dinifeino.t eSe( ga)ten.tn tI osed tno a“yas”wl aedl ot kchso utb kosch si idletfynei a ibssepol laqeues c,n(sei by on,niitfedi IDC = tsycims“e rotohcmbit ;”sposcer nanithgy cmsysiet lohuds egt oyu a tlltie )wrodier, adn os a nttiape iwht IDC hlduso eb irtodnoem loeycls! +
yesa  I knhit they add ot het iolamehvpyo piuetrc; eh is tdeydheadr ADN gbenield tnoi ish isestus ueescba fo onsscuoitn -g;t-& desderaec usantiaavlrrc vu.m.e..lo +

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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