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NBME 21 Answers

nbme21/Block 3/Question#35 (reveal difficulty score)
A 63-year-old woman comes to the physician ...
Increased resting cardiac output 🔍 / 📺 / 🌳 / 📖
tags:

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 +20  upvote downvote
submitted by ∗cellgamesgojan(43)
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AV Flsuatsi urrte-o boldo mrfo hte traareli ytmses to eht oseuvn s,tmyse aginyb-ssp teh eotrslrieA = scIneera PL -t-;-g& NEIARSCE RV. llA ni lal = rceaensI CO.

oigcrndAc to ,dWrUol hte eoeraitslr aer a major sceoru of seeticsarn ... so pgsybsnia the teseoarlri sesrult in a cradseee ni otTla eiPerlhrap sesiRetcan ... cnuagis na eiarsecn ni the rtea nda ouvmle fo oldbo nutrinerg to eht .ahtre I ma ptyert usre etreh is omre ot eht yoyspilgoh bdenih s,thi tub I peho itsh nepxdeial a lte.ilt

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big92  "mdemilyaetI fingollow terioca,n rovnoesiatuer tfuilas A)V(F si soasactdei thiw na asneceri in circada puottu ()C,O iehvacde epodyatrmnnli rtghhuo a idutrnceo ni ctmysise acluvsra esnte,ciasr adercesin aolimrdyca attnitic,yorcl dna na easincre ni kstore uvmleo )S(V dan tehar tra.e Ovre eth wlionoflg kw,ee crcianluigt oblod lveumo ncsaeesri in cnnoojciunt hitw nsaircese in aiarlt nda bairn eatitcinrur spie.pted seehT ironateatls rea taciasoesd ithw eylra inseersca in eftl lrnvaeruict V)L( lgiifnl rupresse wthi the ptontleia rfo saturenlt iacpmt no ailrat and lrcirautenv eahmcrb nissmnidoe and noic"nt.fu (PDI:M 2 e'5)84h55 sT 52 er laso rhetano ytuds yb snpeiEt morf teh s9105 knloogi at eth efsecft of VFs'A cetffe no CO in mne DMP(:I 7521310)8. ,rnetypaplA eht eisanrec in gtisern CO is a ibg oelrbmp suebaec it nca dlea to potuuitghh- rdaciac iaurefl )H.V(L +32
hungrybox  suseJ 2b9ig oyu netw in on hte rahcrese malo u must be MPTS +6
temmy  29gib uoy aer gtrhi. thta si yhw ptgsae seesida psgaet heva gihh utuopt dciaacr urfieal buecsae of the va .thsuns +5
kevin  waht si ecnrasi"e L"P +6
jhan17  ioAcrgndc ot wW ne"ihik na rnsiaevtueoor afliust is remfod iogilnvnv a amjor rteyar lkei teh idalobnam arato, ti nca edal to a lgrae reeedsac ni eparlhperi eesincrtsa beaecus it by sspa lteairroe hew(re aomjr BP is )meofdr . isTh weedlor piaerrehlp ssaetiecrn suesac eht hreta ot scneiare ngirets dicacar tpuuot ot tiiananm prpeor olodb flow to lal .sst"esui +



 +6  upvote downvote
submitted by ∗azibird(279)
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I dno't efel ikel ayn of ehset emostcnm aveh fully eadsrdesd ywh teh ptatein yrenrcltu has ecensaird ngriste OC and TNO serdaeecd S.V eHre is hwo a rfiend fo imne idneapxel :it

APM t(a sentgri RH) = 23/ PBD + /31 SBP = 77 Hgmm in siht apn,ttei hihcw is wrole hnta omrnal 39( mmgH fi oyu sue 2.010/8) So PAM is deeearcsd adn the ydkotsehinr/e agonsr naer't tgtineg teh rpusoenif teyh dee,n dnialeg to SRAA atcotvniia nda edSmeaOB/. MPA = OC × T,RP so this ludoc eb due ot wol OC iltaerev to RTP (ahwt we sauulyl )tecxep ro wlo RTP leievtar ot O.C Tihs tptasine' arleg AV fiuslta ahs pdderop her RTP revy ,low whhic asmen reh CO smut veha eben eryv hhig for eth apts 15 earys ot scpeotamne g(hhi ptouut erath iearf.lu ehS ash noyl 5 sady of smompsyt, chihw msaen she si layer on ni erh FH. Seicn she dha such a ihgh CO ot ngieb th,wi ehr odrp in VS ihts leyar on dwoul tslil levae eehr twih na RAICENSDE VS drapcoem to a rmoaln nptate.i snUsle hre uepsl si upsre ihg,h her reaht tums be pmpugni a amvsies setrko uemvol to atanimni a ormnal tisylsco blodo psrruees whit ushc a low RTP (AMP = SV x HR x .)RTP tlEuye,vnla reh VS mya esdcerea to be lowbe am,lrno ubt nto so aryle .on

orF leptNnsootcms:ee dceseread rreaital 2O ats eceusab bdool is nowglif frmo tayerr ot ,vnei ton eht orthe ayw oaod u.nNtr ersdcaeed dmiex osunev O2 tas ubsceea irtrlaae dbolo is fgoodinl het saanlibuvc einv girth ebrofe mdxei O2 tas owlud be adsru .moeNte erediascn RVS ebucase fo eht aregl VA fs.uaitl

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 +2  upvote downvote
submitted by ∗the260guy(18)
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tBu sheer' ym ebmoprl hwit sthi q:ousniet it assy htat hse has a 5 day htiosry of BOS nda nsowell .esgl oS bivoosyul teh thrae is gfin.ila I cikdep seaeDdrec kteSro Volmeu rof hatt .oersna

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nwinkelmann  AV ilusfats aer oen scaue of ihgtuhpu-to ciacrad ru.ilefa ihsT rsepon epnersst twhi taehr irlaf,ue tub it si edu to cicahloyrnl endisarce tgrisen O.C +2
lukin4answer  linaw@nnmkne eys thast t,irgh he sha fgnilia rea.th tub entsoiqu is akigns waht is teh iinfgdn fo tish itp,eatn I rsddnntaue eht eaucs is suatiFl cigsnua gihh tupout ifel,aru btu ehyt idntd' ska het oensra fo his H,F heyt aer ianksg the n.dfiign I hcoeos esdecaer oetrkS OemlVu /: +
happyhib_  This swa my cogil nda tgo to deacedsre tkoser umolev sa ;lelw ythe nreta akings wtha cusade ihs FH or yngintah it asys awth si the stom kyliel ifdnign in htsi tiate.pn fI ihs thaer si nlfiiag deu to LVH fomr sotesctinn enasceidr CO odwnutl he TA TISH VYRE TEOMMN HIWT hsi rehat nfgiali vhea sredaeecd sortke em..ouvl? +



 +2  upvote downvote
submitted by ∗usmleuser007(464)
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CO is danseierc hitw 1) edrsecead ) delrtaa2of eisnardce rpdea3ol ) Icesnerad iactntortlyci

An oaentevosuri atlfius crsteae an ntrieaalevt otrue fro liatar boodl tion teh uonesv icnouatilcr wo/ nogig atsp eth lteraorise hte( ojarm auecs of hetiT,as s.secrnu) by oignd so hte TRP a(tlofe)dar redcsseae nad eht OC si rdaceies.n

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 +1  upvote downvote
submitted by ∗uslme123(86)
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'AFVs = recaedsin icrdcaa oUp.tBtTu u htsi ni'st nwe ofr tsih ?posrne I wvei hsti sa a taher atth ahs fnlilya ebgun ot lifa -- deacdrsee vtefcfeei ltyrrioaucc mluvoe ;>-- enaecdsir S.VR

utB i eusgs uyo 'tnca have B fbreeo A -- eavhrwet --\

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happyhib_  sih pb saw mshgioent ilek 530;/01 whit dilatscio doaurn 05 I firgued he cnutlod vahe raisedenc SVR eabesuc hsi idaitlocs dwluo be hrih?ge +2
trazobone  I had hist amse neorasing I emcotellpy lsgdose veor the BP 🏻‍️♀🤦 +



 +1  upvote downvote
submitted by nuts4med(8)
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enAnoy veah an eida hwy the esceerdad eritraal 2O iotsnaarut si nrctrie?oc iugAsmns seh sha ulpm deame cneis ehs has EL e,adme 'oluwtdn a leowr O2 sta eb epdexetc t?oo

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haliburton  I ebleevi eethr wlodu be no adsrceee ni 2O iurttsaaon cabeues gnoeadytxe oldob hgih( er)urssep is sheuntd ntio egoaeexdtydn iicctr.u As ogln as the nglus acn kpee p,u sthi lousdh cireesan neousv tonnieogyax on gerea.av +7
hungrybox  ty hbot of oyu rof ,itsh asw innowegdr eth mase tnghi +
coxsack  O2 tsa w’not hecgan /cb ou’yer ton gddnai gxtneaydeode ldobo ot eht rltiaaer ides. oYure’ jsut tknaig riaeralt odolb nda ttngipu ti toni uosvne obo.dl Smae saerno wyh >L-R cicdaar snsuht otdn’ aeerecsd O2 ats iwe(hl ni t,octrasn a -R>L hsnut .dl)wuo +5
hungrybox  jtsu lzr:eaied eth ghih erpesusr of hte eaiarlrt tmssye esepk tou -opelerwrssu ensovu obdlo in na VA lafusti brpa(oylb vbousoi ot ostm ppl utb ti saw a rueeka emmnot orf me ll)o +2
chandlerbas  ya uoy onwt veha edrseeadc laitrera 2O ast caseeub eoyatgnionx fo dloob si niupesrof miietdl F(19A -6-)54 teeorrehf aontgyoeixn of het dloob snapehp hiwitn the frtsi csd.enos3 of geiertnn het aylpuromn allpyrcai atth ouy uldoc vnee ndlhae vghani more tgoeydedanxe doolb tenre +



 +0  upvote downvote
submitted by ∗step1soon(51)
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atHre e:alrfui shTi is eht sotm iousser coaciipomtnl fo relag stionrvaoeeru s.utlaisf cineS yrou lbdoo wofsl emor yilukqc rtguhho an nvaeoeurstoir tusilfa anth ti ludow fi uroy boldo lefdwo ohruhgt a mlrnoa recuos fo aer,tires lcaalpisier nad i,snve uryo arteh pumsp drraeh to eamnpsotce for the dopr ni lbdoo uprseres (dlacle poguhhtt-ui ahrte afr.)luie revO ti,em hte inrseaced entnyiits fo ryuo s'taher ugmpinp acn wekaen yuor heatr eclsum, nliedag ot haert iua.lerf

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