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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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dMa ta mlsyfe fro gingchna ym wasrne.

aFyult oclig aedm me drnwoe fi tinghti yuor hade udolw cdaseu sneacerdi PIC ,so ikle a siuhcng rcle,u yuo lowud gte iersdcena ausVg envre avcyiitt dna yaemb dyaaradcrib + pone.hoynsit utB I esgus eht RSAA msyste ulwod aveh turctdonecea ttha nda dsecau ntoorosicstcnavi reov 24 rusho, os oepimyocHvl khcso si fneilidtey the steb hcoi.ce

ywasAl dlhuos og twih het vubsooi waenrs ):

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seagull  I had eht diea taht hsit was a nngreeciuo schko and saergicnin tnnirilraaac rresspue ludoc eatcff eth gavsu oto. I hnkti eht nuiosteq lalyre taswn su ot go htat cdinot.rie +17
uslme123  heT gsCuihn refelx aesdl to r!dcaaiaydrb +7
purdude  atiW 'Im fd.sncuoe I utgthoh cyivmloepoh khocs daels ot an drieenacs ?VSR +2
littletreetrunk  tanyrp,epla 'ehsret a hgtni lldace atytshpecmi ceepas that acn pehapn ratfe a ehwil ..e(i h'es nbee tuo fro 24 oh:r)su otAilumcucan of usseit telaicomb sataoolrvdi caustessnb iaipsmr dimhetsipmeattedcy-a o,oiaoscsinvttncr wchih asdel ot osls of lavacsur eto,n vrerpossieg oyintnesoph dna ragon oieosnruhpf.py +1
littletreetrunk  sola aosl if eh iht his dahe eh lcudo eavh sslo of yitseamtchp fwtluoo fmor a iphoxcy duamlel hhciw dulco ldea to ooiasi,ntalvd hcwhi thefrur scrueed aleirart ssru,eper but sith saw a rhda oen orf em ol.l I slao tpu csaerenid ICP w.ah +1
catch-22  nyA clka fo catymshietp dncaeri/fotsuoewl lagav oluftwo odhlus urdcee HR, ton ecesianr .ti ther,uFr you owdul tepxce sinmearbt ssngi fi rehte was oixhpay to het nm.reisabt oFr p,xaeelm fi oyu hda dmaega to hte aslytoir luucs,en ouy udtownl' be ebla ot releguta yuor RH ni snoepsre to edrcued P.B niceS hsti aepnitt hsa decrdeu BP adn cnadrseie HR, this stiacdien taht eth pamiyrr tesabniucrd is ikeyll het redcedu e.BHs' P aslo eneb in a sreedt ofr 4+2 uosrh .so +5
charcot_bouchard  nI a patient ohw lvpedose pyohsnoenti nolwfgiol gehg-yihren aar,utm ciugeroenn hosck si a oiisgsdan of xieslnuoc atth si mead arfet voohcyliemp and eiocstuvrtb orciedgcnia sckoh have nebe lrued o!sltuu P eAsntb yrddcaraaBi eslur ti 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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m.mmH leWl ym ndmi has wlnbo ffo acesube waht ith ym idmn wsa dntdoeyrhia ecnis he saw ni the sre.tde sA noso sa ym imdn rtsedta ot nawrde atobu all of eth teorh tosnipo tath oucld akem .ne.s.es I sjut eckcild nad !mvdeo

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charcot_bouchard  tamrS ibo +5
usmlecharserssss  gkhini in aahsra derste HMS +4
cbreland  mlSepi = msrat +


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 +2  upvote downvote
submitted by diabetes(31)
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gdnlbeie + ssurepre nodw s+lpeu up alequ evhyoocimlp ksoch

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I oundf hist btaou esdira CPI: tns"rPeoenait of ardise ctlrairiaann erpsuesr = hchea,ade eeaplmi,adlp angmvnisoatu/ei, weosr in hte nngmrio sa ICP sarise idungr eht hintg as a unoeenceqcs of eeb,ymroccn a reis in OCP2 dnguri peels ecuads yb saryoieptrr drp,onieess dna lobrabpy a eedsraec in CSF op,nibaostr rllapypui ionitl,ad istpos, ireadmip ,zaeg ipyarsrreto riet,rglruayi AS,M dna segacnh ni ,BP R,H dna yeapsrrtori trtpnae rae uallyus etal nssgi of ersadi PIC and adetler ot bsitaemrn dsiiotrotn or "cemih.ais

tmns23ptpeh/.cn/3:l//itom_jpspot1/cnu.jn/b7

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submitted by hello(429)
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ahWt's hte semeyshoc espspudo to eb a eclu b?oaut esDo hsti ntteaip aevh I?DC Deos DCI waayls aseuc cemhoyiolvp cksho?

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drdoom  ssnmidiDeaet slcatanurirav tongolcauia ()DCI is a oidrsycnm iitdefno.ni See( ent.)tagn It edos ton ylaa”s“w aeld ot kcsho ubt sohkc is fendlietyi a bisesopl aeuqlse cs,(nie by fien,tdnoii IDC = ieyscm“st ttrhiomocb s;e”ropcs ytanihng ciymesst dosluh etg yuo a eltlit )rr,oidwe dan os a ainetpt thiw ICD oulhsd eb inormodet ec!slloy +
yesa  I ithkn eyth dad ot the pioeovlhyam e;rctpiu he si etyraeddhd NAD lginbeed toin sih iuessst auecseb of stnonsiuoc gt-;-& rscededae acnvsitlrauar oelvu....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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