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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 ta femsly for acgginnh ym swrna.e

uytalF cogli dmae em noewrd if ntgiiht oyru hade wdolu seacud arendceis PIC os, lkei a niugsch l,ucre you luowd teg rsndeceia usgaV eevrn iittcvay and yeamb idadacyrbar + opiet.oynnsh utB I segus eth ARAS msyets lwuod vhea ecnraettdouc ttah nad deasuc ntionotasivosrcc vero 42 ,ohrus so Hvopemilcoy hoksc si fyinieldet hte ebts hoic.ce

wayAls suhodl go iwht eth boisuov ewrnsa :)

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seagull  I dha the iead ttah htis aws a uegonneirc oshkc dna gniicaesnr lartianrniac eperussr oucld catffe teh vgaus o.ot I hitnk the eqsiunot erylal twasn su to go atht crn.tiiode +17
uslme123  hTe Cngshiu elferx dlsae to addrycaai!rb +7
purdude  atiW mI' fosn.educ I thugtho emivylohocp shock ldsae ot an decranise V?RS +2
littletreetrunk  ,yppaaetrnl eh'etrs a thign acleld pacmseityht peeasc ahtt cna neapph farte a whlie .e(.i se'h eebn tou for 24 ho:)urs imacucolAtun of ssteui mbeoclati vortasolida asunbtsecs rpmasii hieiaepsyate-ctmtmdd n,iinaorcssototvc hihcw aldse to sosl of alcuvars no,te essrrogepvi nipthsnyoeo nda graon uefopyhn.oispr +1
littletreetrunk  slao aslo if eh hti ish dhea he ulocd aveh ossl fo sacpmyettih lotfwou romf a opxhyic elmudal chwih ucldo dlae ot dtioisaov,lna hcwhi trfuehr cersedu rrleitaa rseur,spe ubt htis swa a rhda eon rof me llo. I lsoa tpu eecrsaind CPI ha.w +1
catch-22  nAy ackl of chsitymeapt /wdeseuolocnritaf agavl tfoolwu ulhdos ecdreu ,RH otn eacirnes i.t he,rFtru uyo uodwl ecpext rtsimenba ssign fi erteh was aioypxh to het tsbnream.i oFr l,eaxpem fi oyu ahd admaeg to teh iotlsyra ecuusln, uoy ud'nowtl eb bela to geeratlu yrou RH ni nsosrepe ot deeudrc .BP enicS isht iepntat ahs erducde BP nda dacrneesi RH, tsih dscieitna ttha eht ipayrrm uesicrtnbda is ilkely the deudecr '.sPBHe asol bnee in a rdseet ofr 4+2 osurh so. +5
charcot_bouchard  nI a pitneat woh opvseeld ennosotihyp lgfooinlw rg-heieghyn ra,taum unnrigeoce cohsk is a doinsigas fo icuxlosne hatt si dame aetfr ylvmooicpeh nda tuirsoecbtv grndciacieo csokh heva enbe eludr Plus out! etAbsn iyacdaaBrdr rlsue 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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mH.mm lWel my mdin has bolwn off auecbse thwa hit my dnim was deaiyrnhtdo sncei eh wsa in het tdse.er As sono sa ym nidm etsdatr to awnerd abotu all of teh htore ootpnsi thta dluoc kmae .se.e.sn I utjs kidlcec nda mvedo!

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charcot_bouchard  aStrm bio +5
usmlecharserssss  nkghii ni ahaasr teerds SMH +4
cbreland  liSemp = tsram +


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 +2  upvote downvote
submitted by diabetes(31)
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ibegdenl + repesrus wdon +ulpes up uaelq olemoicvphy khsco

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submitted by nwinkelmann(366)
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I ndfou hits ubtoa eisadr :PIC nPaeteoistr"n of siaerd alacritniran eurerpss = a,hcadehe iep,plelaamd uoa/tiegv,innams swore in het ngmnroi sa PCI aesris irnudg eth ingth sa a ncqceeouesn of ymocbrn,eec a esir ni CPO2 dirgun seepl auedsc by pyertsarroi psrsidon,ee and bobplary a earecdes ni CSF in,soarbotp palrilyup ildo,itan sotis,p rimiaedp ega,z etirporyrsa rlrrtuigy,aie MA,S nad segcnha in P,B ,HR nda oysritraerp tepnart aer luylusa elta gsnsi of resaid ICP nda dletrae to tmbnrasei tsorotdnii or sme.h"aici

tpj7p.cbpjtme//tht/ml2/unc./n3oonsi_:s/p3n1

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 -1  upvote downvote
submitted by hello(429)
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hWat's hte oecshsmey pdpesuos ot eb a eucl ?autbo seDo isth npteita evah CD?I oDse CID aawlsy ucsae ohleicpvymo hcsk?o

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drdoom  Dnmiistsaede ravalcsrainut ouicgatnola DC)(I is a cyrsndimo ienfitod.in (eeS n)agtn.et It eods ont sl“awya” leda to ohskc but cshko is eienydtfil a besiolsp usaeqle is(enc, by ief,oindnti ICD = cy“tiessm rttiohombc ;oes”cpsr anhtnygi ystcsime dsuhol etg you a elltit r)doer,wi nda so a ettnipa tihw ICD luhdso be tieoomdnr yollsc!e +
yesa  I tiknh teyh dad to eht ohmayoelvip iteup;cr he is hddteyerad DAN ibndgeel iotn hsi ssteusi usebcae of noicnstuso t&--;g edsrcdaee utinraavsarlc ..vl.emuo. +

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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