NBME 23 Hypovolemic shock (NBME Answers)

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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 🔍 / 📺 / 🌳 / 📖
tags:

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submitted by ∗sympathetikey(1600)

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daM ta lyfems rof hgnagnic ym na.wres

tlFayu ciolg maed em onerdw if gtitihn oyur dhea udolw udceas siaeedrcn CPI ,os leik a uchnsig ,eurcl yuo udlwo tge dncreaesi Vsagu rneve vtitcyia and myaeb radraicydab + nhein.posyot utB I seugs teh RAAS tysmse wdulo aevh atecruocdetn ahtt and asedcu vcsaoncorotinits roev 42 uohsr, so viloymecoHp ocksh is lndeifitey eth etsb h.oeicc

wasyAl dlhous go ihwt het voisbou aernws ):

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seagull I adh the iaed ttha stih was a erunoenicg hkosc adn ncirgseani nairatnaicrl serupers ldcuo cetfaf het uavgs oto. I hknit teh qtionesu laeryl awsnt su ot go htat eic.droitn +17

uslme123 The nshiCgu xfleer seadl to r!yadadrabci +7

purdude iWta 'Im doefscun. I htuohgt peicmlvoohy ohsck asled to na eiascdern V?SR +2

littletreetrunk yaept,lnpra 'erhtse a ghint ladcel esctpyitham pcasee thta can hpaenp arfet a iewhl .ie(. se'h eben tou fro 24 uho):rs cuultAonaicm fo uestsi ecbmoltai atraiolvsdo subssnceat rsmpiai aedaeymtdhtemst-pici asoiotnsnoct,rivc ichwh salde ot osls of svuralac t,noe pogeverissr psonenoythi dna anrgo uooeryhpnfips. +1

littletreetrunk lsoa asol if eh iht ihs haed he oducl aveh slos fo sheiytpatcm oofltwu mfro a pxocyhi llmdaue hiwhc dlocu lade to dlsaitonov,ai hicwh rheftur eedcrus litarear prssr,eeu tbu ihst aws a ahrd eno orf me oll. I alos utp adeecinrs PCI h.aw +1

catch-22 Any ackl of ectyptmhasi laondou/scriwetef lvgaa wltoouf sulohd ducree ,RH otn reecians it. eh,rurFt ouy ludwo xepcte tremabins sgnsi if rehet asw paohiyx to hte abitnms.re oFr lexm,eap fi oyu hda emagad ot the iltosyra scenluu, ouy wuoltn'd be blae ot alutrgee uoyr HR ni pernosse to ddcruee B.P nSiec hist iptneta ahs uedcder PB adn escednari ,HR sthi niaetdsci atht teh yamirrp nuabecrtdsi si yillek hte eduderc P'eHs B. alos eebn in a dteser for 2+4 rhsou o.s +5

charcot_bouchard nI a paeintt how edoveslp sytheononpi llingwfoo hegyhireng- ,maratu nrigeecuon ockhs is a ngaiidsos fo coisexuln taht is meda aeftr yvcoipemhol nad tsbriovcuet ndcicroagie chsok ehav nebe rldue usP l!otu etAbsn idarayBcdar serlu ti uto +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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submitted by ∗yex(128)

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.mmmH lWle ym inmd hsa bownl fof ueacesb hawt hti ym nmid was rnhdityedoa nisec eh wsa in het et.dser As oson as my idnm atesrtd to wnadre utbao all of the roeht nposoit taht coudl emka se..nes. I just dkcceli dna d!mveo

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charcot_bouchard Srmta boi +5

usmlecharserssss kihing ni aahasr seredt SHM +4

cbreland Speiml = rmtsa +

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submitted by ∗diabetes(31)

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lbdgiene + rsspeeur dwon elp+us pu lueqa hipoemlvyco sohck

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submitted by ∗nwinkelmann(366)

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I ufond sthi tbaou derias PI:C rn"Pietsoneta of iadser acitlaninrar spurseer = dheaecah, eipmlep,dala igovnua,me/atisn wesor in het ignmnro sa CIP iesars ndirgu hte gthni sa a eqnonecesuc of eccbmneo,yr a eirs ni 2COP rugind eples daseuc by tyoprraseri rsnedispoe, and bbaopryl a recesdae in FSC oont,bpsrai lrypipalu lta,ioidn ospti,s irepimda ,egaz raiyerptsor ir,teiyraglur ,SAM dna aehncsg in ,BP ,RH nda riertpsoray nttepar era lyuulsa tlea ssngi fo rsiaed ICP nad aeldert ot imabtsner tioodtsnri or a.mhie"csi

3pho.spbt:nel/i7pjucm/jn/omt1ttpcs/nn/_.23/

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submitted by ∗hello(429)

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'tWsha hte ycomesehs sspoepud to eb a elcu auobt? osDe hist ttanipe heva D?IC esoD CID swalay suace hvomiypolce cksho?

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drdoom saesmtindDei rclauivasantr niualaootcg D)CI( si a dsmiyrcon i.eintodfin e(Se e.)nngtat It odse tno aly“”saw adel ot hoksc utb csohk is ntideyflei a ebplsiso uesaqel icn,es( by nifiotde,in ICD = st“siymce otohribmct sr”o;spce aiyhgtnn iscstyem ldusoh teg uoy a letilt ,)rwierod adn os a einttap tihw DCI dusloh eb termdnoio yos!lecl +

yesa I kihtn yeth add to the lovoepymiah rupc;eit eh si aehytreddd ADN gnldibee ntoi sih etsusis eeabsuc of osoncnitus t&g-;- eseadedcr arcnlaurstiav u..e.v.mol +

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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