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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 ymslfe for nghgnica my r.ewans

tFluya cgoli eamd em onwred fi igithtn uyor eahd dwolu saeduc niscadere CPI ,os elki a sihugnc rlceu, oyu doluw egt ensaercdi sgVau evrne ciatvtyi nad ebmay rarbiayddac + nsoo.ihyntpe utB I suseg the AASR stmesy owdlu eahv teaocudcrten htat dan sacued tosacircsnivtnoo orve 24 ,rohsu so lomcepiyovH oshkc si fditelynei eth tesb h.icceo

yAawsl udslho go ihwt the iuovobs easnrw :)

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seagull  I hda teh edia hatt hist asw a cuirengneo ohskc adn cgneaisinr aarrtanniicl sreuspre dlcou aftecf het vgusa .oot I hktin the eunosqti yerlla tsanw su to og ahtt tie.rnciod +17
uslme123  The hsnCgiu lxefer aleds to ad!aicdrybar +7
purdude  Wait mI' oensfcdu. I ttohhgu pimycohvleo ckosh asdel to na naedcsrie SRV? +2
littletreetrunk  anaepyrplt, ese'thr a gniht cleald caithypstme pacsee atht can nhappe rfate a wlieh (ei.. 'esh ebne uot rof 24 uh:o)rs cnAautimuloc of ssutei mlebaicto tasdrvialoo acstbsneus ipmiars dyeaat-echidmepsimtt ocoirsvtnaoics,nt hwhci edasl to slos fo ursaaclv eno,t sserrgopive oeoinnhspyt nad oagrn rouohfenpi.pys +1
littletreetrunk  olas osla if he thi ihs daeh he cudlo ahve sslo fo pyemctatshi wtfolou frmo a oyxphci aldulme ciwhh cdoul leda ot oaniis,vladot ihcwh fretruh udrsece aitralre rur,seeps tub sith asw a darh eno orf me o.ll I oasl upt deaiernsc CPI wh.a +1
catch-22  nAy kalc fo mtthceasiyp ocdrlsoaitfeewu/n agavl toulwof lsoduh deeruc H,R ont aecesrni ti. rr,Futeh ouy wodul pctxee tsnriambe sisng fi ereth wsa xihpayo to the sitrbnam.e For emlpa,ex fi ouy ahd adgmea to eth tlasroiy ceus,nlu you otd'wnul eb leba ot artgeleu oury HR ni rsnoseep ot rdeudce .PB nSice sthi teiptna sah derdecu PB dna dneeiasrc H,R stih acidtnies hatt hte mrpariy ntusdacrbie si lyklie teh eduecrd sP e'.BH olsa bene ni a tsdeer rfo +24 osuhr .os +5
charcot_bouchard  In a naeptit hwo sdovplee syhoiopetnn wflnlgooi hyinge-hrge uamar,t oiuenergcn hksco si a oaigndiss of colexnsiu atth si mead fetar yelhivcpomo dan iueotcrvstb oigaecnidcr khcos veha bnee duler P utl!uos esAbtn craBdaiardy ursle ti uot +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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mmH.m eWll my mndi sha wnlbo off uacsebe twah hit my dinm asw adehdonytir encis he asw in teh trds.ee As osno as my dmin rtsadet to daenwr atubo lla of eth reoht toopsin ttah dluoc amke esn..se. I jtus cldicek nda !oevdm

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charcot_bouchard  tmaSr obi +5
usmlecharserssss  hnigki ni saarah tsrdee MHS +4
cbreland  lSipem = asmtr +


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 +2  upvote downvote
submitted by diabetes(31)
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dgebnlei + ssrrpeeu owdn seup+l up ueqal iolcpovhmye okcsh

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submitted by nwinkelmann(366)
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I uondf hsit utoab irsdae :IPC iPets"rannteo fo sieadr nitarcliraan speurrse = ,caaehdeh mlp,paaidlee siaingvat/o,nmue owser ni the ninrgom as PIC eisars gruidn eth itngh sa a neuocsneceq of crycmnoee,b a rsie in CO2P iurdgn elpse deuasc yb ateprorrysi pnioes,edsr and bolrbpay a eadecres ni FCS rnpoba,soti iarpllupy adtiilno, spto,is iaemirpd zgea, riretoapysr y,grrlteuiiar MAS, adn sgcnhea ni ,BP R,H adn syptrioraer tnrptae ear yuslual aelt isnsg of esadir ICP and laerted ot isnbratem osidrtntoi ro maiehi.sc"

/upso1np.tcsebnjm/o/c2/nt3//7tiph:_pj.tnlm3

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 -1  upvote downvote
submitted by hello(429)
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aWst'h eht emocheyss opusedps ot eb a cleu abut?o esoD stih iattnep ehav D?CI soeD IDC ywslaa uasec moohypecvil ko?csh

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drdoom  iemesnDdaist atsiurcanlarv tgonaiolauc (CD)I si a ncsiomyrd ndt.eiionfi See( agenn.)tt tI edos otn ”a“alyws dale ot ckohs ubt kscho si tfliiyeend a eolispsb lsauqee ecsi(n, yb i,dioeifntn CID = scytei“sm irtctoombh ”psser;oc yigntahn tmycssei hdolus egt uoy a illtte idew,ror) nad so a taenitp wtih ICD dlohsu be iremntodo lly!ecso +
yesa  I kthni htye dda ot teh voieoypmahl eu;ritpc eh is teddarhyde NAD bdegnlie toin hsi essusti cuesbae of oisnnstcuo -;g-t& craseddee rcvaatnsilaru uv.e.olm.. +

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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