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Retired NBME 15 Answers

nbme15/Block 3/Question#35 (reveal difficulty score)
A 43-year-old man comes to the physician ...
Inherited protease deficiency ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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He has alpha-1 antitrypsin deficiency which is causing panacinar emphysema and liver damage. This is the major disease to think of when you have a young-ish patient who presents with liver and lung issues. (FA2020 p392)

From the stem: hyperinflation combined with decreased diffusion capacity and decreased FEV1 points toward emphysematous change; lower lobe predominance is seen in panacinar emphysema; hepatomegaly pointing to liver involvement

NOTE: diffuse idiopathic interstitial fibrosis would cause a decreased diffusion capacity, but this is a restrictive lung disease which would not have hyperinflation but instead decreased lung volume

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cheesetouch  FA2018 p386 +1
lucifer546  hyperinflation rules out IPF decrease diff capacity rules out asthma (it is actually increased in asthma) marijuana is not associated with pulmonary disorders as such +1



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