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NBME 18 Answers

nbme18/Block 2/Question#1 (reveal difficulty score)
a 68-year-old man comes to the physician ...
Angiodysplasia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—mariame(16)
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The stem says that he has a history of lower GI bleeding however upper endoscopy and colonoscopy show no abnormalities. With that said you can rule out all of the answers except for Angiodysplasia.

Angiodysplasia is confirmed with angiography. Tortuous dilatation of vessels that cause hematochezia.

FA2019 380

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adong  Another factoid that would support the angiodysplasia diagnosis is that they are associated with aortic stenosis, which would explain the cardiac findings at the beginning of the stem (light-headedness and tightness in his chest with exertion). +1
plaguedbyspleen  Hate to be the "actually.." person but the light-headedness and chest tightness with exertion is more likely due to anemia and the myocardium not getting enough oxygen during times of higher demand. Physical exam did not show any murmurs and ECG was normal. +5
drdoom  @plaguedbyspleen this site was made for "actually" people. this is your tribe. welcome home, friend. +4

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