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NBME 21 Answers

nbme21/Block 3/Question#11 (reveal difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia πŸ” / πŸ“Ί / 🌳
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 +23 
submitted by βˆ—xxabi(284),
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lirmaneT mlmtpeCnoe CC)-(95 cniiceDeseif nseicare psbicitiesyult to tncrerrue easiireNs m.aicteaerb itastneP msot ntoef rpesten hwti rtneceurr nieiinmts.g


 +14 
submitted by βˆ—cantaloupe5(85),
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iyltgoHso odshwe tvlaeguoaic encsiors dvpee(rres cthereaiutrc fo cirdlaoamy )ebsrif ihtw rtleniouhp nlnaiioirtft iwchh tdnhie atth hte IM swa nhiwti 24 so.rhu Most lkleiy asecu fo htaed iwtnhi fitrs 24 sourh of MI si ihtmrhraya. ayldcroaiM rrupeut dlouw aslo eb veblsii on gssor npacarapee fo het etra,h cwhhi yeht beesiddcr in the te.ms

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +15  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +3  
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +  
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +5  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +3  
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +2  
amy  The stem of the question said "softening" which indicates 3-14 days (rupture ), and "mottling" which indicate 24h (arrthymia). It seems from the picture in FA2020 page 305, coagulative necrosis would be there during both phases. The cells in the picture are so small that it is hard to tell if it is purely neutrophil or if there are any macrophages. Still seems like a very confusing stem to me. +  



 +11 
submitted by βˆ—hungrybox(1209),
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ltapueo/n/ac5u adh a tager tanlain.pxeo

'Heres an eigma of het frdeentfi staseg ofongwlli admyciaorl icnfiarot.n oNet hte n"aonoitcrtc ds"bna era hawt dfinee oveutlaciga noessirc.




 +2 
submitted by βˆ—zpatel(33),
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h1.upLaHTM./tmaets./w2/ebhhdhC/VdCpett:Vt.lmu7

hecck tshi uto

smpate  Nice find, thanks! +  



 +1 
submitted by volcanobuns(1),
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MI dsduen ahted &g-;t hiahratmyr. ehT drreo fo snmomsoenc is imrhrhytaa g&;t airdcigceon sohkc ;&tg pru.rute




 +0 
submitted by frimmy_11(2),
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ngotlMti nad gnsnetifo fo reaornti lawl on tuyposa ssestugg it saw not oedlr anht 42 .rsh Daeht morf tflaa rriyahtmah ekil iVbf- stom lmocnoym uccros inhitw eno day fo teh M.I Ttah dasi, nceo csar ahs femord ni rmiydcaaol ueisst ti, oo,t acn aecsu aartr.ihmhy

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +  
athenathefirst  Anyone knows why it's. not cardiogenic shock since it happened within <24 hours? +  
lovebug  @athenathefirst I also had same Question. maybe Question asks "Most likely mechanism of death" > most common cause of death in 24hr is arrythmia. cardiogenic shock is also possible. but it's not the most common cause of death within 24hr. +  



 -1 
submitted by βˆ—an_improved_me(83),
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nuiste:Qo neev fi itsh tp ddi ahve araimocydl pe.u..trru si ahtt enev a auecs fo dt?ahe I fele elik ilek het senicammh fo ehtda in adcrmiylao euutrrp si nriigdoacec hc;osk wblo a heol ni royu rhet,a adn ddysueln ti itan imgnppu os lwe.l tJus sgaink rfo rueftu cere.erfen




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