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NBME 21 Answers

nbme21/Block 3/Question#11 (68.2 difficulty score)
A 50-year-old man is found dead in bed at ...
ArrhythmiaπŸ”
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 +12 
submitted by cantaloupe5(77),
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ysiloHtog sodhwe aiauoetlgvc nsroesci rdvepeser( utrcecrtiahe of mdioacryla rbisfe) thiw urhnpoietl intatnrfilio ihwhc tidhen ttah teh MI was itwnih 42 hr.uos Mtos eillyk aesuc fo eathd tihwni irfts 42 srouh fo IM si .matyahhirr Mlocyridaa urtepur oudlw oasl eb ivbisle on sgsor epaapncaer of eht tra,eh hchwi yteh ddeirbsec in the et.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 +14  
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. +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. +1  



 +10 
submitted by hungrybox(1040),
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uaent/pluoa5c/ had a trgae pnt.exlaiano

erHe's na eagim fo teh dreneftif etassg nllfgwioo yiramdclao aof.itnincr oeNt the ocnaot"trcin asbdn" ear wath niedef acegaoiuvtl inserosc.




 +2 
submitted by volcanobuns(2),
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IM edunds hteda -t;&g triamah.rhy hTe oerdr fo nnosemsmco si hrtmhyraia &;gt rcnoceiadgi ckhos ;&tg r.euturp




 +2 
submitted by zpatel(24),
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bt/.:tMHtmuuaCVemtlap12w.7h/thphsCdd.V/h/Le.Te

hceck hits tou

smpate  Nice find, thanks! +  



 +0 
submitted by frimmy_11(0),
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oiMtgntl nad itsfoengn fo eirtanor wlla no oaupsyt sutggses it wsa otn oelrd tanh 24 rh.s Dthea mfro alfat rmayrhiath leki i-fVb mtso clyonmmo csrcou iwhtni neo yda fo het .IM athT dias, ncoe arcs hsa fordme in oidlymraac uteiss t,i ,oto anc cuaes ahmy.htrari

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. +  



 +0 
submitted by an_improved_me(14),

Question: even if this pt did have myocardial rupture... is that even a cause of death? I feel like like the mechanism of death in myocardial rupture is cardiogenic shock; blow a hole in your heart, and suddenly it aint pumping so well. Just asking for future reference.