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NBME 21 Answers

nbme21/Block 3/Question#11 (60.5 difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia🔍
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 +12 
submitted by cantaloupe5(69),
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stoHgloyi edhwos tvaclogaeiu reisoscn sve(erpder ehtertciacur of lyoramidac s)eifrb hwti retnohlipu iaotnirlifnt ihchw theidn tath hte MI saw hitwin 24 h.soru stMo kleiyl ascue of ahdet iwithn rfsti 24 rusoh fo IM is r.tiyhamrha yclMaraido urrpuet wlodu oals be ilisvbe on grsos ppenraaeac of the etrha, hwcih ethy rdebdcsei in hte me.st

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 +9  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +2  
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. +4  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +2  
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. +  



 +9 
submitted by hungrybox(823),
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 +2 
submitted by volcanobuns(2),
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MI ddeuns hdeta g&;-t hrayiah.mtr eTh rreod fo mcnomosesn is tharrihmya ;t&g ccndagoriie oskhc ;&tg pteuu.rr




 +2 
submitted by zpatel(19),
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cechk thsi out

smpate  Nice find, thanks! +  



 +0 
submitted by frimmy_11(0),
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gtiotnMl nda eostgninf fo eirrtnoa wlla no utyospa gtsssuge it swa otn rdeol hnat 24 .hrs hatDe from lafta yaiarhmrth kile bfiV- ostm lomycmno csurco iithnw eno dya fo eht .IM hTta d,asi ocen asrc ash mderfo ni ydiralocma tesius ti, to,o nca uaecs .ythhrmiaar

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? +