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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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ninBecrchoog ancrcmoai = nlug accrne

tTha neigb si,ad ulgn icanarocmonaed icspyellcfai is daciosseta htwi pctiephoyhrr hohtearsoartyo,pt hciwh is a caliptpnaaesro rsndoeym czarreihaetcd by ditigal lbbug,icn gai,laarrth tjnoi eufosnfs,i and seoostipsir fo ubltaru noseb

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luke.10  hyw tno tcssemiy drealrscmeo iscne i did sith ntsoieuq gnwro nda i scoeh mietsycs silcsesor scloeraedmr , can oeesnom xliepan htta ? +2
kernicterusthefrog  My esbt egsus sarewn to taht @0k1eu.l si :htat )a tee'hsr no mnnioet of yna nksi nvtlieemvon hch(iw teher uodwl eb ni dorre to eb )mes)ard eoblcr emrcolSader woshs pntigti in the ,slain otn ugcn)blibc erheT wluod eb glaoecnl sdiptnoeio hwit iforsibs, not hptryeyphro of teh ebon ta tsni ioyn gSja t,tah I lsao tgo hits norwg! (utb ptu R..).A so m'I nto aiglcnim to gte" t"ihs Hope my tthugho eossrcp ,phsle hh!uotg +8
yotsubato  Tish si ni FA 9210 peag 229 +11
larascon  I rgeea tiwh @rfogeeshuneickrrtt on tish neo, icognhcBnreo caniramoc = lngu necar.c quoaSusm clle ariacnmoc egisv ouy repcehimlaacy n(we oben om;nrtioaf abm?y)e, ymocolmn fdonu in KRMOSES ... +5
waterloo  teh bnbcgliu si teh tmposmy ahtt asekt uot aotl of eht resnwa chc.oesi It's ersup iktrcy. +
jawnmeechell  sulP eth napteit hsa na 48 p-carekya gskmion oiyr,sht psreu ihgh isrk rfo lgnu caernc +
veryhungrycaterpillar  AF 1902 pg 922 is lla airpnaltcpaeso .ydosnrmse ehTre is no neionmt fo obigrhecnnoc aomicracn in yan fo e.tmh eeTrh si ,anecocaodrianm but atht is omts keilyl in nno ,oemksrs nto ni eeonmso hiwt 48 ckap eyar of ksgoinm htsiyro. yWh dose he evah 5 uoeptsv ofr eiergnfrnec fisrt iad rhe,e htwa ma I isigmsn? +3
jakeisawake  gnreh@arpruycalveiltyr oussdn ekil biceonochnrg nmroicaca is a lgerena remt rof ngul canec.r ouY aer gtihr tath if a ksnmno-oer gste lung erncca ti is sotm klleyi oardecnnaiaocm sa rosonkm-nes ryrale etg llsma .clle Hvw,oree sskrome can etg mcoianscenodraa sa wll.e ehT tlisoogcon atht I osdahw sese sith y.eqrfnetul nemAocioaarndc fo eht unlg csesau otihyrcrhpep trrehsooohyttaap pre 292 in A91F02 +2
mangotango  ylr@aiplcetrunargrhev jawe@kkiaesa nocoaAmraiencd is the tsom ncmmoo roumt ni oesnonkrms dna in mfeael eksmsor ikle( this ti),eptan so naeoicormacnda owldu itlls be teh msto lykile ccnrae rof thsi tp over het rethos. hamPtoa .Pg .69 +3
fatboyslim  taeArylppn ihnebccgnoor nraocmaic si aillsybca an rlemblua term for glun cenr.ac ru:oSce s.dr/u/n-tsl/aacichpetg/-liaceargr:3ntroeoaidp +
lifeisruff  ebrnigoohcnc si erohnta etrm rof cnmoenidoarcaa ni usit rcdiocnga to tapahmo +1
topgunber  ihtW eth eincpxteo fo ieomh-esltoam %95 are oognireccbhn +1
meja2  ieif@frfslu ,No inobrhocegcn ariocacnm is a bnatlke ertm ofr lal lugn es.cracn Hvwreoe, eht mnorcanioeacda in tisu ubtseyp si dcella lhcaoorvreBalo ac. f:eR FA 120,8 pg 566. +1
an1  eSh salo ahs a ewf stmsmpyo to ospturp it hc,go(u u,sutpm ko)semr. heT lslwieng amy otrwh you off nda seem ilke RA but hre gae dnset'o relaly fit hte dssaeie lao,s( no pasitcl .lenios)s weN nebo amootfrni is a vgei waya. WU assy ttha ebon oifrmgn acrscen rea rat,ptseo nidoHgk nda aslml lecl weasreh yilct rea noig,-nknohd llmonn-as ,ecll r.enal IG and memnalao lfla ni twbeeen het lctai/bs icylt .pesrcmtu ibbuglnC si nteaohr igev waay snee( ni ugnl AC, B,T FC, e,eaypmm rneoibta,ishcsc ccinroh glnu sebsc,esas aicradc citayocn ss,deseia etifceniv iesoit,rnacdd ,IDB hy,idtpohmeyrris dna taibpsoonrm.la a ) yognu aemsl wiht abombo eisnp nda slcaar anpi )c derseetnp erealir ayoctcin( dsesesia psneetr ni asbbie nda dene reyla rrn)ooitecc d) lkoo rof semo MSH dan ineaujcd lteraed isndifgn or ameyb a yhtrios of fnectiion teruos ) e conmehoyb rpaepn,caea nculbibg si seernpt tub not tonef eredlat ot eobn iinsndfg g) tonfe ensrptse hiwt TSECR (im)eitld, ro iskn usfe(f,i)d dsaoinbiet + +1
an1  ocecir:rnot IG nad sraetb ear mdex,i meloaman si lityc as si iellmtup elmayom +



 +3  upvote downvote
submitted by niboonsh(409)
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ofnud stih ioe:nln hor:cp.tl/m.0a4ea0rhmo5e8asciu//1t//m9kpu40dr0/ite/y2ap5cc/

ypepHohirrct olmpruyan pthotohatoyrresa )(AHPO si a rndeysmo rhcrctaaiedez yb eth itrad of sitrpis,ieot gitldia bunlicbg adn nlfapiu hatrpytaroh fo eth arlge jtnosi, pelielascy invglnvio hte lewor lsimb. lbniCbgu is craiceratezdh yb busbuol nnmlagetree of lemairnt sgemesnt fo teh rgfeisn nda otes ude to taofirepolirn fo unsagluub ciencvtnoe sesuti.

.rrypmi.a. si a arer iteehrydar .oidntcoin

A oayjrtim of sscea &g)t%;9(0 fo ydnersoca PHAO rae tisoeaascd thwi aomnplruy silmianngace ][6 ro ocnihcr iaturuvpeps lrauynomp s.saeieds

ayPmounlr iiaelscnamgn, inidlnguc paimryr ],[7 asiteatmct ugln rccane adn atricanthocri plymm,oha catnuoc for 80% fo sesca fo seydocrna HAOP. acricamoAondne of the glnu si hte stom qfneetru and lalsm ecll acimancro si the steal fqetuenr thpoihiocsolgta epyt fo lngu crecna cadstosaei iwht HAPO [.]7

teohr isdtsaaceo exhcrotatrica lmniesaaignc ludeinc eslnrypoanahag aoanrimcc, elran ellc cmoracnai, eaeopsohalg ecrcna, csrgait uoumrt 8,[] cacerintap cce,nar rabset elophysld uroutm ],9[ omnmeal,a yidroht ,ccnear asmeoracstoo adn iietnasnlt mylpahm.o

oisraVu oahuemclgirot nditocisn,o ngnildiuc AR ][10, AS 1]1[, raitpreoltyis oo,dsan LES 12],[ ayTsukaa iadsees ][,31 ,iorsaidocss APS dna tderMeneiaanr vrefe rae nwkno to eb taeacossid whti siht dionnotic as well.

rnluomyaP notisicdon suhc sa tscyic ,boriisfs cotilusbsure, hciodipiat olpanymur osfbsrii ]1[4 dna nulg atniarsalpotntn vhae soal eneb icatdeaoss htwi .AOHP

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 +2  upvote downvote
submitted by queenofhearts(18)
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sTih eapttin ahs ytpcherophir hrroaptaoshtyeto chihw is eisdtascao thiw icnnoochbrge anaccorim. It nsrtepse iwht lpanfiu llsingwe fo ts,wris s,renifg asenk,l e,nsek ro .oblesw nI toadi,ind eht nsed of lgon bneos whso ltpsreoiea wen boen oritaomfn , hwchi anc podeurc aidgtil nubcgbil nad oentf srthaiirt of jneadatc onisjt.

:rReuecso aaKnpl Bnoe tgyloohPa geaP 732

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an1  I nhtki reiipostist mioaf(natimnl fo hte r)sepetomui si ont hwta het q si nrgrireef ot whne ti asys enw" eonb aonifot";rm hs'tat inagtidicn an oolsteasbtic isnole wchih is orme mnocom in lmlas clel AC. +



 +0  upvote downvote
submitted by tulasi(0)
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eTh apsroitnneet of iBgocnhricen nrmacioca shg oCi-u nda e Tmhshitpesy trotu sitesstama ot B,uaoin,Lnnegrb nad es. ldarna So won the sqoietnu is itngmioenn eth msea pstoin hTe cuogh dan supmtu nda losa nwe nboe ootfnarmi on cadtefef enobs no yXar nda osal ibunglcb rernsspete het lg.nu

fce-neeeRr 010 cosncetp of atymnoa esldi 94

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tulasi  oslA its lecl ptey is saoumqus lcel amrcncoai keil tno cadeocnonmaari ikl.e +
tulasi  lAos ist ellc ytpe si msuoaqsu elcl acrmiacon elki otn aococaiamrnden ielk. +
tulasi  losA sit ecll epyt is amqssouu llec coriamacn ikel otn cairaamocnenod .ekil +



 +0  upvote downvote
submitted by assley(1)
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ihpyrprtHceo tyharorposttohae si a aemdicl tocdinnoi mgcinbnio ugbcbiln adn ttsriiipose fo hte aslml nadh jints,o ipyaesclle het stldia pnanirhaglateel sijtno dan hte anphaoeltcgaeapamrl .tsoinj tlDsai naeisxnop of teh gnol snbeo sa lelw sa puian,lf lnewosl njsoit dna iyvasoln usolilv onarptfieirol rae tfnoe es.en ehT iditocnno mya cuocr anelo mar,iyr)p( or it mya eb anedrysco ot ieasdess klei lgnu enac.cr Anmog taentisp ihwt unlg ern,acc ti si omts etcdoiasas twhi oaarcidmoceann adn telsa oiaedacsts iwth smlal lcle lnug craenc. ehesT nspiteat oentf gte gblncubi nad eiecanrds oenb piieosntod no glno .sbneo erhTi sginnerpte tpymsmos ear isemstmeo olyn cluinbbg dna lpafuin .eaklsn triyoHrechpp ttrorethosopyaha si one of myan istadnt ctfefe derosrdsi ued ot c,renca wthi lgun ccaren niebg the mtos nmomco eusac tbu oasl rgcuicron ihwt anavrio or eraland esmlanicangi. )b ecnbroinoghc .Ca and eht nylo snarew astth traeles to lung ccnaer nda lla erhto nswreas od o.nt I echos RA, but if ouy otn'd .wo.k.ownn you ow.nk

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 -2  upvote downvote
submitted by step1soon(51)
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eTh pdrtoeer eccnidine of lpCnaa rdyemsno is 1 ni erevy ,001000 peelpo. iThs sah been a nngciedil bruenm eud to loewr eeousxrp ot a,clo s,etsasob nad cs.iial rveneelcPa fo aaCpnl nyeordms is righhe in itanepst hitw lsacii perusoxe edmorcpa ot hte treoh aseu.sc The sfrit gipodmeciiloe ydtus eadruenktn yb the meoosnoniuPcis cReshear ntiU ebrovsde an rcdianese lnerecaevp of AR angostm enm itwh pessrirevgo vsmiase sisiforb P.)(MF lliaM et al. oufdn no sieanerdc percalvene fo homurdeiat iatritshr ni mrsein hnew opredamc to a tnucmiymo eerwh FMP adn udimahtroe tihsriatr reew epalrtnve and eoeerhrft ecdcodlnu atht hte otogleiy fo AR wsa not osaideacts thiw sexrepou ot sutd ro glun ascnghe of ocetpamdlic on.sioumsecpoin Tehre wsa a ihhg epeeranvlc arte of MFP adn setbosriuclu namsgot sinrme and nmexir-se itwh iamhrdeuto r45ha[]]iitrts.[

ya:h AonPosolgtiphy niumeamuto otnicndio si a peonohmnen rwehe ones' obyd has mriyfaatlnmo elcsl cihhw tcakta sit nwo uetiss ,adn in eht caes of ,AR the osinm.uyv tI si evbldeei ttah ni stehe saptetn,i terhe is na aiterntoal hhiwc eusacs eth acnrsidee uimmne pnsesreo to rfeongi rsealamit ni hte lugn.s reThe is uimmne vtrytiyecpahi thta is aepdksr yb aiscli in wihch nscyeotmo adn agmphaoercs reaeles stcoinkey uhcs as neulr1tii-enk dan lpehtcmnaecguimrn-oyitgr-ll-oaatoscanoygu otrfac nda rutom onsirsce farcot alph.a The ashrp dseeg fo eht iisalc soal uecsa lysis fo lsomsylao reespatos in oasgmchera.p shmetpLycoy rea tiadcaevt by the ynkctosie edarlees by ems.coaghrap hiTs lal aesdl ot an ioenamtmuu nnooeenhpm houtrgh rueeospx ot aicsli hwhic is errdigegt in eeilaytlgnc eroidsdpspe ivaundsdlii woh veah AR.

wuondt'l the ruinedygnl iaesdes be AR cwhih si ehnt uacings orhcbincgeno ?aocmcinar m'I !ueof!sdcn

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kpjk  i ontd ntkhi tsi RA, aeusceb thye adsi raxy whsos enw beon ,nmtiraoof rweeh sa AR dluow evha sonoire +1



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