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NBME 20 Answers

nbme20/Block 4/Question#46 (reveal difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathy๐Ÿ”,๐Ÿ“บ

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submitted by xxabi(273),
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lAos fro otehs fo yuo how rae yotlatl escsllue iekl m,e naiuryr ractt obiotrstncu = cviuerttsob y.uptaorh

skonys  I see 74.5 Difficulty score and think "word, I don't need to get this one correct" +3  

submitted by banieb(22),
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rguiDn eht lsta aflh fo pcgeanynr adnoitli of the peurp rraiyun ractt acn ccuor eud ot snocmorpise fo teh ereurts by teh orgwnig teu/stfsuure nda het alnie mle.strnaii heT isormcpseno fo htese si otn lawiolng dlifu sapaegs tnio the deadrlb sinaguc eniru pibuudl ni eth iekd,yn tish eldas to aoitnild fo the inyekd htat edsn pu icsgnua oimpscmatyt yohresodrn.hpis tshi can edn up ni nctofniie nda pysostmm csuh as eth nose respnte in hsti aepittn keil cakb anip adn CVA edetr.ssenn het igynrc is lnaymi edu ot eht apni seduac by the ns.biorotctu adn sjut as tosnmeigh tra:xe uobdle piaitgl tarhctsee si a fesa dan islepm wya of intgetra pascttimmyo sorhpherydiosn of nry.ngpcae

banieb  Ureteral obstruction by the pregnant uterus +1  

submitted by neonem(580),
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rOteistcvbu uotapyhr seusca a palrsonet eaamozti -t;g-& ewhn o,golpnrde lburuta gmaeda esnesu. hisT sldae ot an acteu laturub snosirec, iathrczdeaecr yb rctconie psulg in het rtualub mytess sa snee ni eht gimae

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +49  
usmleuser007  Think the postrenal azotemia is d/t her pregnancy. With the increasing in size fetus, the pelvic cavity is being compressed and thus there is pressure on the ureters. This leading to the presentation. As per above --- the crying maybe just d/t her pain and emotional stress caused by worrying about possible complications regarding her fetus. +4  
maxillarythirdmolar  My gut tells me it must be some sort of transient change in placental size with hormonal changes. It's reminiscent of what you might expect for breast changes during the menstrual cycle, imo +  
j44n  or maybe the fetus is literally crushing her ureters into the wall of her pelvis and shes got an infected kidney +3  

submitted by ye2019(4),
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schPylia smaex sdweho nsdteernes fo ipcnorecosth nl,aseg wcihh rae the plcsea rweeh eth mdhiagpra renic)(-hp eemst eth risb -o(o)st.c toN teh vCraottoeblres aglen ednesntres tath we inhtk ot nhit alern ais.Iseed tgo fondceus htiw htsi it.pon

adong  honestly think this was a typo. hot trash +2  
neovanilla  Assuming it was not a typo, how would the costophrenic angles be tender in this condition? ...From crying...? +1  

submitted by waterloo(91),
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I eelf ikel prta fo htis is tehm eesgin fi yuo nca icezgorne tsohe era su.lbute

  • So fi uyo yas ok stehe rea ,bsutlue noscniomii,roiaht idt,noistreme dna IPD are oplarbyb tno

  • poesilnomruihGrlte ni my xeeenripec os fra, yhte olhdus aobrpbyl show a olmluig,re otn ubtule.s

eBwneet uaehsonmoegt sedpar dna buitrstcveo ,hyortpau I eefl kile I no'dt ehav neoguh niof - tbu esmoeimst a 0550/ eugss si betetr nath glnpyai li.ehtpBast

submitted by sympathetikey(1446),
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niation/Dtnedlstoii of ralne psliev adn lasecyc A . lyuUlas euasdc yb nyrurai trcat ttbnrcousoi glee,r(na otssen, everse HPB, tancogenli ts,cbsotnriou ilravcce ccne,ra nriujy to eeutr,r eyagpnncr yanetpaprl); hrtoe eicecsdunusla lpenoieroettarr r,sobfiis srlraeieoecutv .felxur olniDtia cocsur prolimax ot teis fo Salgtohumopye .r cineatneir eecbsom aeleedtv fi ointbosrcut is rbataiell or if tpteian ash an oi csrltoasetrbtdyu sLdea to comspeoinsr dan eiblssop rathoyp fo erlna otrxec nad

submitted by redvelvet(53),
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hoitpecrcson engal ntserendse nda BvrfWC ee stsca ni betsulu no that pohot for aeepmxlAll fo hmet is anigedl su to oihlerypnistp.e dnA enev romni cityssti acn sueac npeethriyipslo in cngyenrpa ude to bvuceoisttr uarhtoyp.

diegolc26  I thought it could be D or E at first. But the picture is really clear. There is inflammation within the tubules, not in the interstitium, that points more for Obstructive Uropathy which is also painful, can cause fever, and a risk factor could be compression due to elarged uterus. +  

submitted by imgdoc(144),

This question was a little tricky, but the way I went about it was process of elimination. You don't see costophrenic angle tenderness in A,B, C, or D.

She has fever and back pain, definitely don't see that in PID, which presents with cervical motion tenderness, and purulent discharge. Micrograph also isn't showing cervical histology.

As an added bonus: urinary stones cause excruciating pain when you're trying to pass it through your ureters, basically dragging alongside. Hence the patient crying.

You didn't need the micrograph, other than to see all those neutrophils, but we've all seen glomerulonephritis histology slides, and it doesn't even look close.

submitted by euchromatin69(13),
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gcenapnry si a sirk tacrfo for caeut oynlpi thsieAepFr 2091 pg 598

submitted by laminin(16),
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aosl mbeya doluc od cssoepr fo tn..m.eetlihainoi ctsicn'hooepr galne rsn'detenes ulces su in ot ti bgein a rnael lopr,meb and hte loyn learn rwsean eichco is etvcrbioust haurypot

spdrwmn  glomerulonephritis was an answer choice +1