NBME 20 Splenomegaly (NBME Answers)

Retired NBME 20 Answers

nbme20/Block 2/Question#35 (reveal difficulty score)
A 36-year-old woman comes to the office ...
Splenomegaly 🔍 / 📺 / 🌳 / 📖
tags: imaging

+18 upvote downvote
submitted by ∗dcdaskalakis(18)

get full access to all content ⋅ pick a username

Fuck me dude, I thought it was too obvious. Like here's a picture of a giant fucking spleen, then they ask "which of the following additional findings was most likely seen in this pt?". I thought they meant something other than than the obviously enlarged spleen.

get full access to all content ⋅ pick a username

+15 upvote downvote
submitted by ∗beeip(141)

get full access to all content ⋅ pick a username

Liver looks pretty normal-sized to me. Pic here for comparison

get full access to all content ⋅ pick a username

+7 upvote downvote
submitted by ∗sympathetikey(1600)

get full access to all content ⋅ pick a username

Spleen so huge -- look like this girl has 2 livers.

get full access to all content ⋅ pick a username

+6 upvote downvote
submitted by ∗bbr(58)

get full access to all content ⋅ pick a username

damn, the spleen was so big I thought we were looking at the 2 kidneys. Found a new way to get things wrong.

get full access to all content ⋅ pick a username

lovebug @bbr me too. lol +3

+4 upvote downvote
submitted by ∗dickass(127)

get full access to all content ⋅ pick a username

I spent like 5 minutes trying to figure out what kind of trick question this was. They're just trying to get you to figure out 'oh look the spleen is YUGE!'

get full access to all content ⋅ pick a username

+2 upvote downvote
submitted by ∗medschul(113)

get full access to all content ⋅ pick a username

I can get behind splenomegaly, but what is the disorder?

get full access to all content ⋅ pick a username

sup Felty syndrome, an extraarticular manifestation of RA. Symptoms include a triad of RA, splenomegaly and neutropenia. It's in FA, you just have to squint (look at the fine print under the RA vs OA table in the MSK section). +28

+1 upvote downvote
submitted by ∗sammyj98(39)

get full access to all content ⋅ pick a username

maybe I overthought this one, but doesn't she have free air in the bottom left? Or is that the bottom of the pleural space...

get full access to all content ⋅ pick a username

ibestalkinyo That's probably the most inferior portion of the right lung +1

+0 upvote downvote
submitted by ∗hello(429)

get full access to all content ⋅ pick a username

Spleen is enlarged. Compare it to CT scan showing normal-sized spleen:

http://www.startradiology.com/uploads/scroll/18/14hiu6b3qot5.jpg

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by ∗strugglebus(189)

get full access to all content ⋅ pick a username

I thought the liver looked huge af too lol which made me requisition the whole radiograph

get full access to all content ⋅ pick a username

-3 upvote downvote
submitted by ∗medbitch94(56)

get full access to all content ⋅ pick a username

WHY she has a huge ass liver too? I don't understand how you can choose big spleen over big liver or visa versa

get full access to all content ⋅ pick a username

dickass I like big spleens and I can not lie~ +7

-3 upvote downvote
submitted by thomas(3)

get full access to all content ⋅ pick a username

Looked like hepatosplenomegaly, but I went with liver b/c the edema could be due to liver dysfunction.

get full access to all content ⋅ pick a username

Must-See Comments from nbme20

amorah on Cytomegalovirus infection
masonkingcobra on Contact with parakeets
hayayah on Capillary hydrostatic: increased; ...
hayayah on X chromosome-linked isoenzymes
medbitch94 on Mannose 6-phosphate
hello on Capillary hydrostatic: increased; ...
hayayah on Osteoblasts
imgdoc on Hypophosphatemia
hayayah on Missense
celeste on 50%
justgettinby on Omeprazole
andrewk1 on Cold, dry air
yotsubato on Jugular venous pressure of 12 mm Hg
strugglebus on Drug effect