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NBME 18 Answers

nbme18/Block 4/Question#3 (13.5 difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Aortic aneurysm🔍
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 +3  upvote downvote
submitted by mousie(171),
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eht ltepuiasl msas aegv ti ayaw ofr em utb lgnioko kcab hsit ntpeati has lla hte rski ftsarco rof AA - eaml rsomke wthi TNH + edpe cthes pina nad elsipualt mass = AA lal ady nglo

mcdumbass  Adding on, hoarseness + difficulty swallowing means something is pushing on the recurrent laryngeal. Murmur in the second right intercostal space = AR, AS, or Pulm regurg --> AR associated with thoracic aortic aneurysm, or at minimum, you can infer it's a cardiac etiology +2  
chadgas  The dyspnea, dysphagia, stridor, and cough are pretty indicative of a mediastinal mass. So expansion of the aorta can cause compression of the esophagus, trachea, recurrent laryngeal nerve, etc. depending on the severity of it. +  



 +1  upvote downvote
submitted by masn8cc(1),

Can someone explain how they r/o aortic stenosis? because that could enlarge the LA and give the same sx of hoarseness etc. And the murmur also fits with AS

bmalamet  You would not see a "viable pulsation above the manubrium, which you should not confuse with a "brisk carotid upstroke" associated with aortic stenosis. +  
nbmeanswersownersucks  "brisk carotid upstroke" is the description of a normal carotid pulse. Aortic stenosis has a slowly rising/late peaking upstroke since the stenosis impedes flow out of the LV. +