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NBME 20 Answers

nbme20/Block 4/Question#13 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Bronchogenic carcinoma 🔍 / 📺 / 🌳 / 📖
tags: pulm

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 +10  upvote downvote
submitted by xxabi(293)
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cBegoncorinh oiranccma = unlg arnecc

ahtT gbien ,iads lngu caenocoianrmda cyfcaslpilie si secaadsito tihw ihtyrephcorp toahhor,toyasrpte hhciw is a saiploaecantpr rodsmyne zhdarectreica yb aitildg ic,lbbugn haa,rrigalt jinot ffnuoies,s and psrtiisoeso fo uutbarl esbon

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luke.10  why nto cyismtse amloedcersr esicn i ddi iths ioetsqnu onwrg nad i seohc mistescy oieslssrc rmescdrloae , nac moseeno naeplxi atht ? +2
kernicterusthefrog  My setb esgsu rswaen ot htat lu.1@ke0 is tht:a a ) sh'teer no nneomti of any sikn mivnelvteno whh(ci hteer luwod eb in dreor to be cbersl er amdo)) ecSeoaldmrr ohwss ptgiitn in het asli,n tno un gcc i)blb herTe luwdo eb lglaoecn onpdetosii hitw io,sbrifs ont pyrytrephoh fo the onbe at oyitn snS jiga ,htat I aslo tog tish !wngor utb( upt A...R) so mI' tno nilgmaic ot e"tg tis"h poeH my thtguho ersopcs ephs,l o!htugh +8
yotsubato  Tshi si in FA 2019 gpae 229 +11
larascon  I eerga ihwt t@rsuefeoihntcrrekg no tish en,o cnBenhicgroo cinorcama = ungl .cercan mSaqusou ecll iocaamrnc vsige oyu rachmliepayce ewn( bneo ma;froonit ?,eymab) clmyoonm oufnd in OSERKSM ... +5
waterloo  eht lbuibngc si eth mytospm atth eatsk tuo atol fo the narwes cecs.iho s'It prsue t.kycri +
jawnmeechell  luPs hte ntpitea sha na 48 c-kraaype nmgksio sitoh,ry srpeu hihg skir rof guln acecrn +
veryhungrycaterpillar  FA 1902 pg 922 is lal rcsntplpeoaiaa oymdsrsn.e eTerh si no inenotm of nengobchicro maioarccn in any of ethm. eTrhe si aoodcci,reaamnn tub ttah si mtso iyellk in non mes,kors otn ni oeeomns ithw 48 pkac raye of nogsmik .tyirosh Why eods eh evha 5 tsvoeup fro cnenfeerirg tirfs adi e,hre whta ma I ss?igimn +3
jakeisawake  rly@icytganparuleevrhr dossnu klei brgniceoconh mraicaocn si a eanelrg rtme ofr ugnl cacn.er ouY are ighrt ttah if a o-knreonms gste lgnu nraecc it is tmso eylkli anramaeoiocncd sa kreoon-ssnm laeryr get asllm .clel wHvroee, skmorse nca egt maraoocnndcseia sa llwe. Teh lostgonoic ttha I doawsh ssee tihs .lfernyequt cannoedoicAmar fo eth glnu secaus pehcroriptyh ohroprtehtasytoa epr 229 ni 1290AF +2
mangotango  @rtrahepglyecnvuriral ikakeaj@eswa onncaarecoimdA is het toms mnoocm umotr in nonoskemrs dan ni fmlaee osemrks (ikle tihs at,nepi)t os aorocniaaemdcn dluow sllti eb teh msto kliyel cencra for shit tp ervo hte reoh.st Potamha .gP 96. +3
fatboyslim  nltyAappre oncocrbgnehi mcoanriac si lylcasabi an lemaubrl trem for glnu cea.rcn or:ueSc a/-r-ip/le:gshuied/raeoacrcatlongrnic3ttd./sap +
lifeisruff  nghnceiorboc is rheonat rtem for ancearadoniocm ni itsu gdncaoicr ot ampohta +1
topgunber  ithW hte nptoiecex fo ooe-imshelmta 59% ear ohcrigecnbon +1
meja2  @ilfsiuferf ,No gncoroecihnb amcrnocia si a kabetln mert for lal ugln cce.rsan rvoe,eHw eht reaiaonmnoccad ni usit epsutby si dallce Breoharcvlooal a.c Rf:e FA 280,1 pg 56.6 +1
an1  ehS slao hsa a wef smptyoms ot porputs ti ,(choug spuu,tm ek)r.mso eTh ilsglewn yam hrowt yuo fof nda smee eilk RA btu her gae enosdt' elryal tif the esesida slo,(a on lascpit noe.lis)s weN nboe mnfroitoa si a vige .yaaw WU syas thta enbo fmgnroi cnsrace are rspa,tote diHokng dan slmla ecll rshwaee cltyi aer no-nonhg,ikd anlml-osn elc,l .naler GI dna aoaemlmn llfa ni ewbente eht c/salbit icylt tcpemrsu. ginbulCb si retonha vegi wyaa (nees in lngu C,A BT, ,CF ym,aeemp rbcs,acsinothie oirhccn lgnu ebsss,acse idcacra ynctocia edas,sesi eneiifctv r,oicstiddena DBI, tiyehrr,spyidomh dan tpi.nobaamsrlo a) yungo seaml wtih oobbam ipsne nad aslcar inap ) c seerdetpn elerair cciatyo(n sedaseis eetsnrp ni bbisae dna eedn ryela e)ooncirrct d ) okol rof seom HMS nad jdnaceiu eedalrt dgsfinin or mbyae a itorysh of eiconntfi rustoe e) bhcmonoey raepae,canp biunlcgb si trpeens but otn oetnf ldrteea to nobe nifgdins g) eonft srensetp hiwt ETRCS tm)ied,i(l ro skin duif(,e)sf sienbdaoti + +1
an1  itcncoreor: IG dna beatrs rea medix, almnmeoa si clyti as is mlileptu eylamom +



 +3  upvote downvote
submitted by niboonsh(409)
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odnfu hits enloin: 40a.ml/t80:pah5p/str4cucp/r/kte1c500dr//yahei/e9/oamu2cim.o

phreHcitypor lyrnpouma eoosrotttahhpray )APH(O is a ronemsyd artcdrzeheica by het atird fo pistis,tireo dgtiial clnbgiub and palunif yatprothhar fo eht realg nt,osji ycaelilesp vliingovn eht erlwo m.bsil glnbbCiu si caratecherdzi yb bsuuolb nelargnteme fo ertinlma ntssegme fo the nergifs nda oets edu to aperlrtfoonii of ubgulnaus nneecotvic stuise.

a.y.rr.imp is a erar rdiaeyehtr ioin.ontdc

A ymatojir of assce ;(&%90)gt of ceyrsanod HPAO are easioascdt whit aluryopmn scgaiinalnem 6][ ro ihroncc iveuptupars rmonayplu s.ieadsse

ymlonrauP caegmli,snain dcunilnig ripamry [7], tisecmaatt lung nrcace nda ttcaaoirinhcr la,pyohmm cuoatcn orf %80 of scesa fo yedanorcs HAPO. oocmdaAnincrae of hte ugln is hte toms qturnfee nad lmlas clle cciamnroa is teh tesal nrfteequ goahscoipthiolt yept fo gnlu nraecc deotasacsi hitw OAPH .][7

etohr seoaidastc rtcoxeatharic nmcnalegsaii lduneci neosnagrapahly cocimrnaa, rnlae llce imoaracc,n opaaoesghel rnccea, sctiarg touurm ][,8 rtciacepna nc,cear tsbera ysleplhod rtumuo 9[,] aeao,mmln hoityrd ace,cnr oomarssoteac dan ittneasiln pmyhamol.

iusrVoa iocrglahmtoue no,iciotdsn liinnudgc RA 1[,]0 AS [,]11 etyplriiatosr nasdo,o ESL ,]12[ uasakyTa sseiade ]31[, adsirossic,o PSA and tardeneMnriae eevfr aer nokwn to be caiseaotsd tiwh ihts donnioitc as wl.el

arnuoPmly soidonncti shuc as cciyts fribsoi,s eio,sutrcuslb oaiciidhpt mplrunaoy siosrifb 1[4] dan guln tinasontptnaral ehva laso bnee ecodsasiat wthi .POHA

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 +2  upvote downvote
submitted by queenofhearts(18)
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hiTs tnpieat ahs oicyrphrphet aheotsrapttoryoh hhwci is sdesoactai hiwt ghcocoernibn aonrmciac. It etesnspr tiwh pnflaiu llnseiwg fo i,swrst fgnir,es kslnea, ,esekn ro s.wleob In adtdioi,n the ensd fo glon snebo owhs erlspatioe new nboe nmtirafoo , whchi cna pcrueod itgldia cgbbnilu adn enoft riiatshrt fo nctdeaja nsjtio.

Ro:seruce pKaanl Bneo ologtahPy ePga 327

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an1  I inkth sioitisrept fniaomal(nimt of teh )utemoepris si otn ahtw teh q si refiengrr to enwh ti sasy wn"e nboe oorm;itaf"n astht' iigdncniat na ebaoittoclss osinel hwcih is oemr conomm ni mlsla llec .AC +



 +0  upvote downvote
submitted by tulasi(0)
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heT aiepsrttenon of ngnohreiccBi mcaorican C oi-sugh nad mytsehe shpTi outtr sstsietama ot ,nne,nuraobLBgi nad radn a.sle oS own het nsoqiuet is gtmnonneii het emas nptios Teh ghcuo nad mstupu adn aols wen obne oonimaftr no dffeeatc nesob no rXay dna alos nubblgic pesertensr het ngu.l

ece-fnRree 001 posencct fo onyamta ields 94

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tulasi  Asol its ecll tpye is uoussmqa clle ccoramnia ekli nto candoaecmniaro l.iek +
tulasi  soAl sit lcle epyt is oassmuqu lecl nirocacma ielk otn rdiecmaaaononc elki. +
tulasi  lsAo its elcl etpy is msuquaos llce nmarcaoci klie ont coaannioecarmd e.lik +



 +0  upvote downvote
submitted by assley(1)
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irrHhyeptcop sttohhpeoayrarot si a icmeald oicdtnino cminnbigo cnblbuig adn srtiopsiiet of eth sallm dhna sinoj,t ylceaslpei teh slatdi nhnpeiaertalagl nosjit nad het acalaaenmappgtehrlo tniojs. Dslait espoxainn fo het olng snebo as well sa ,unalfip lnsewlo jostin nda loiasnvy svilluo oanflieorritp are tenfo ne.es Teh icnoindto aym uorcc alneo r)(apmiy,r ro ti aym eb arneocsdy ot dssiseea klei unlg enc.cra gnmoA snatitpe tihw ulgn rcnc,ea ti is most ecoidassat wthi oeamcoaainndcr adn altse asdioetcsa tiwh lmsal llce nglu ca.rcne Teehs atspeint etnfo gte ulngbbci nda siecadenr ebon isdinpotoe no ongl ob.ens heTir erisnpgent mompsyts rea esmmtseio oynl blbincgu and lanpifu sanke.l iHppcotherry soythatraoropteh is one fo nmya dtasint fcefet eddrrosis ude to nccrae, tihw ugln cnerca gibne eht tmso nmmcoo aseuc tub saol rnigcruco with ainvroa ro rdelana niceigmaan.sl b) ioenccbonghr .Ca dan eth nlyo rnwsea satht eesarlt ot unlg acenrc and all heotr ssnrewa do nto. I ceohs A,R tbu fi uyo od'tn no.kww.no. uyo kwo.n

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 -2  upvote downvote
submitted by step1soon(51)
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Teh oterpedr idcecinne fo paCanl eymndors si 1 in eeryv 0000,01 epelpo. ishT ash been a iieglnncd remubn eud to elrow oeseprxu to ,coal osa,ssbet nad a.icsli Plneerevac fo planaC ysdmenro is hghrei in petsanti wiht alscii pseroxue radocmep ot eht hrtoe essuac. The itsfr eimolcidgoipe sdtyu ernanuektd yb teh susoniPenocimo eerRahcs itnU sredeovb na sceniader averlcepen fo AR tanmgso nme whti oivpersregs smsieav isrisfob )FM.(P lMlai te .al dnufo no ieendrsca eplvrecane fo mhoirdueta ritisthra ni sminer nwhe adcrmeop ot a icnomuytm weerh PMF nda rmtaeouihd sirrhtita reew lrneepatv dna tforeeher cdndeoluc ttha het goelyoit fo AR was nto cadastosie hitw xporsuee ot duts or gunl shgaecn fo otmcedcaipl enoioiucmsson.p erThe was a gihh cneverpael etra of FMP and lirousbuscet motnags ermsin nad exmsneri- hwti ioatmdrhue a]4rhi5[s].tt[ri

oyonlpPtAg:h ioayhs moiuemnaut oonidnitc si a noeennhomp hreew ne'os ybod sha tnmyrfiaoaml eslcl hwcih kaatct tis won tisseu nd,a ni het eacs of R,A the mnou.visy tI si veidlbee taht in ehest e,tipsnta teerh si an rinaotteal ichwh aussce the rdsniceae mmuein onprsese ot friogne mlsaairet ni eht ulgn.s ehreT si mmiune iyyiptvhatcer ttha si asdrkpe by siacil in wchih toyomesnc adn poschrgmaea erelsea ecyisontk cshu as iiunlek-t1rne dna onlgtguooategpciysu-tamyrla-nchacne-roilm faorct and mtuor srieocsn oafrtc pa.hla eTh arshp dgsee fo eth sciail alos sceua ssyil of olalomsys esareopst ni sha.rmcgapoe sempocLyyth are avicatdet yb teh keiotsycn eedalres yb pcoasagr.meh ishT all edsal ot na uatoimnmeu neehpnmoon rgthouh ouesrepx to iacisl ihhwc is eedrgtigr ni teclglyiane droiesdpspe isdaidluniv owh hvea A.R

l'onwdut teh lerndugnyi asiedes be AR hihcw si thne ucisgan neocrogbnhic ?coimnraca Im' ufcd!eon!s

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kpjk  i ndto knith tsi A,R aceusbe tehy siad arxy ssowh enw beon otaionrm,f weerh sa AR dlwou ehva rosione +1



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