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NBME 15 Answers

nbme15/Block 2/Question#36 (10.7 difficulty score)
A 72-year-old woman is admitted to the ...
Left coronary, circumflex, posterior interventricular (posterior descending)πŸ”

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submitted by ergogenic22(321),
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Thsi tnisoque si aikgsn htwa telf mtnaiond rtlicuocani .smnea I ppeuoss it ntasw us ot nrefi that eht ADP is pgyplsuin eth madipghra afersuc adn VA .dneo

tI si fnusnocgi to me aceusbe lynomarl the tgiRh gliaarnm yretra seuppsli the mahapaiigrtdc erobdr c(eaut amignr) of hte etra.h 'mI ont reus atht it esagcnh ni left nandtmio uairnc.licot Foretrmrheu ti olwud nto crhabn fof teh PAD, hghaotul ayemb aprst of it ear dupsilep by hte PDA

osAl eht VA doen is uldspepi yb the eialtnrortuvAirc odnal ,rteary iwhhc nac be a anrcbh off of teh LAC ro het utCXLb not yrlale eth DPA


os scniugofn tosequni rfo em utb the ointp is ot okwn teh seoruc of etlf nnadimto tcucionalir to hte DAP

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submitted by cheesetouch(138),

Left dominant circulation - posterior descending artery (PDA) which supplies AV node etc is coming from the *left circumflex. Prompt says it is blocked. To get to there, the correct anatomical pathway is Left coronary artery, circumflex artery, posterior interventricular (PDA).

This can be reasoned by process of elimination too. 1- Given the Left dominant circulation, we can eliminate pathways beginning at the right coronary. 2- To get blockage at posterior of heart, we will NOT use anterior interventricular artery, so you can eliminate the 2 options listing those. 3 - The circumflex artery gives rise to the PDA, but is not the final artery in our path to the blockage (so can eliminate another two). This should give you the correct answer.

cheesetouch  FA2018 P277 heart anatomy drawing +  

submitted by pakimd(14),

Anterior (or sternocostal) – Right ventricle.

Posterior (or base) – Left atrium.

Inferior (or diaphragmatic) – Left and right ventricles.

Right pulmonary – Right atrium.

Left pulmonary – Left ventricle.

both left and right ventricles are on the diaphragmatic surface. AV node is also affected. PDA supplies posterior 2/3rd walls of both right and left ventricles and the AV nodes so we know that PDA is affected. now we need to figure out the order of cath passage. question states left dominant circulation. so itll be left coronary -> LCX -> PDA (aka posterior interventricular since PDA supplies post. 1/3 of interventricular septum)

pakimd  FA pg 283 +