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NBME 20 Answers

nbme20/Block 4/Question#46 (65.1 difficulty score)
A 28-year-old woman at 32 weeks' gestation ...
Obstructive uropathy🔍

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 +21  upvote downvote
submitted by xxabi(224),
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solA ofr oesth of oyu owh era tloaytl seusllce klei m,e rynuira arctt iurctsobtno = oterisbtvuc t.orphuay

 +15  upvote downvote
submitted by banieb(16),
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Dgirnu eth ltas flha of repcagnyn olntiida of the peupr rrainuy trcta cna occru eud to oocsmrepnis of eth seutrre yb hte noiwggr tufsurutse/e adn the einla tmlesarii.n The rpneoosmsic fo seeht is tno gllniowa lufid pgassea tnio teh earldbd suiacgn neriu dpbuuli in het ,dnyiek this dasel to dtniiloa of hte nedyki atht ends pu guasicn ttamyopsimc isrd.pnyohosher sthi cna edn pu ni feoctnini dna tspmmoys schu as teh esno setrenp ni this pitetna ikel kbca aipn adn CAV esede.nrsnt het cinyrg is inymal ude to eht pani sacedu yb teh us.cbrtitono and utsj as thmnsieog axr:te lubdoe tpaiigl sateehtcr is a esaf adn meplis ywa of grteatin isatmpmocty hsrisdrpeyoohn of

banieb  Ureteral obstruction by the pregnant uterus +1  

 +3  upvote downvote
submitted by neonem(503),
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ucbretisOtv ahoyprtu cussea a lrteposna ioetmaza g-&;-t nweh pon,dregol lburaut mdagea es.ensu ihTs slead to an auetc bautlru ocsesrin, czeeihctdrara by ciotcern slupg in eth ualbtru steysm as sene in het agmei

meningitis  Does anyone know the relevance of the stem saying: "during this time she also has been crying frequently"? +21  
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. +3  
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 +  

 +3  upvote downvote
submitted by ye2019(3),

Physical exams showed tenderness of costophrenic angles, which are the places where the diaphragm (-phrenic) meets the ribs (costo-). Not the Costovertebral angle tenderness that we think to hint renal disease.I got confused with this point.

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  

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oitonedanli/tDsntii fo nlaer eplsvi dna scyacel A . ylsaulU aucesd by rnriuya ttcar obstturonic ,g eenr(la se,ntso eesevr P,HB onagnicelt citsrstou,obn lcverica nrcca,e rjuniy to reut,er nypecganr alpraptyen;) oreht u sdncaulieecs etletoionaerrrp issbirfo, rseuiretecolva elu.rfx tliinDoa sucroc rilmpoax ot esti of Sl huyogamp.treo niretcaein becesom davlteee fi rtsbtcinoou si arlleitab ro if iateptn sha na dcrabtisye tosrutlo nkd.eyi saedL ot cremnosospi dan slbipeos rotpyha of rlean ercxto dna .ladelum

 +2  upvote downvote
submitted by waterloo(54),

I feel like part of this is them seeing if you can recognize those are tubules.

  • So if you say ok these are tubules, chorioamnionitis, endometritis, and PID are probably not right.

  • Glomerulonephritis in my experience so far, they should probably show a glomeruli, not tubules.

Between hematgoneous spread and obstructive uropathy, I feel like I don't have enough info - but sometimes a 50/50 guess is better than playing Battleship.

 +0  upvote downvote
submitted by redvelvet(29),
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trehcosocnpi geanl tndseesren and eBCefWr v csast in tlbeuus no atht hptoo fro epxaleml Al of htme si nledgia su ot en.heilirpstpyo ndA nvee norim isstcyti can acesu rlyppteneihsoi ni neagcrynp eud ot utoeicbstvr tohurp.ay

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. +  

pregnancy is a risk factor for acute pyelonephritis FA 2019 pg 589

 -2  upvote downvote
submitted by laminin(14),
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alos meyab udloc do secospr of onroehiccpts' lgnae ees'edtsrnn elucs su ni to ti gibne a rlnae ,omplerb nda het lyon leanr waenrs chieco si ruibsectovt uyhatpor

spdrwmn  glomerulonephritis was an answer choice +