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NBME 22 Answers

nbme22/Block 1/Question#20 (60.3 difficulty score)
A 49-year-old man comes to the physician ...
Avascular necrosis🔍
tags:

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 +7 
submitted by dr.xx(150),
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RIM is hgyilh vti,ineses fispicc,e dan aaerucct in hte dientcote fo AV.N

ie-dgt1Thwe e:imags AVN sotm neoft ptersesn with a teeicncrs,c rniei-glk ro lwel nidefed bdan fo wol asgnil iihwtn eth rrsopeiu rpioont fo eth rluahnocsbd oemalfr dhae ebon w.mraro hsiT anbd si htoguht to eepnrsrte eth eiacvetr aenctfrie beweent het cicortne dan aratipvere oes,zn dna pclytilay esedntx ot het hournldascb atelp.

aonr.f-/teup-vhpi/ceth:u-r//adshots




 +4 
submitted by paloma(8),
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ogdAcnirc to WU, lcoloha eubas is a riks traocf rfo uaclasvar ensorci.s ehT otms cmoomn iest si hte aoefmlr a,ehd whhic npteessr tiwh npai taht si tdarceexbae by gwehti rbeaign ituowth tarinyofmalm sgisn on hlcpiyas oxtmaen.aiin

cbreland  Similar thought process over here, didn't get a whole lot from the MRI other than lack of symmetry, but pt with alcohol problems was the key for me. Just played the odds +  



 +2 
submitted by tiredofstudying(53),

FA 2020: 463

Causes of avascular necrosis: CASTS Bend LEGS. +Corticosteroids +Alcoholism +Sickle cell disease +Trauma +SLE

+“the Bends” (caisson/decompression disease) +LEgg-Calvé- Perthes disease (idiopathic) +Gaucher disease +Slipped capital femoral epiphysis

drdoom  for bulleted lists, be sure to follow the plus sign with a space! :) +2  



 +1 
submitted by usmleuser007(396),
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)(A ikRs scrofat orf ioplgeenvd casaaulvr nseiorsc i:dlcneu

1) ruTaam = jre Is,nui shcu sa phi aocdonitsil ro r,uftecar can aegmda ayebrn dbolo lessesv dan eduecr obdol fowl ot n.ebos

)2 teodSir u=s e esU fo iesgodh-h oo,ertsrdoiistcc ushc sa des,noneipr si a mocmon useca fo lsuvaacra nescrso.i hTe orneas si nnownku, tbu neo stephyhsoi is hatt oeosdicricortst can asniecre idlpi vlelse in ouyr olo,bd cudigren lbdoo w.lof

3) seeEvxsci lcohlao use = onnsiugCm vaelres ocohllcia dsirkn a dya fro alreevs yesar also can ceusa ftaty ipdtesos ot form ni uyor oldob sl.seevs

4) oshBiptsepaonh ues = o-tgLnrme ues fo nasediotimc ot snerieca enbo eydnsit itmhg rinocttebu ot pdeoegvinl ostsonieecros fo teh .jaw hsTi rera aonplmcotiic sah ecoucdrr ni eosm ploepe eretdta itwh ighh sdose of eehts etmocndiias rof rccnsea, ushc sa iullmtpe meymola dan cmtitaeast astreb arcnc.e

)5 nteraCi aecdlim nesmrttate = oitadniaR eharpyt rof neaccr acn nkweea n.beo ngraO ntp,nirotnasaalt lalseyecip iykned tan,ptsanrl lsoa is aacoteissd iwth uarsclaav roisnse.c

e(Bla) icMd scoitnndio sisdeatoac iwht saluvarac isocsrne dcenliu:

esPrtihtaea cs'iGact bueriDesan /IsiaeSI emicHstey dDSsVA luusp ceuteserlmSsiokayh t llec neaima




 +1 
submitted by almondbreeze(83),

FA 2019 pg 455 on avascular necrosis of bone: Infarction of bone and marrow, usually very painful. Most common site is femoral head (watershed zone) (due to insufficiency of medial circumflex femoral artery). Causes include Corticosteroids, Alcoholism, Sickle cell disease, Trauma, SLE, "the Bends" (caisson/decompression disease), LEgg-Calve- Perthes disease (idiopathic), Gaucher disease, Slipped capital femoral epiphysis- CASTS Bend LEGS.




 +0 
submitted by warbyparker1(3),
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I ughttoh ti wsa tiecps iratsitrh bc inap ihtw gwthei irngbea + mr,i btu 2 ntshmo whit epcsti tatisirrh mcoe n,o ti asw an seay ueintsqo adn I ssmedi t.i

warbyparker1  Evolution time is key +  



 -1 
submitted by seagull(1555),
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emaby oeenmos anc ixpelan hyw tish is raasvcula iorssecn dan nto p.issse tI eonsdt' teminon eevfr ro nsbcaee fo .eefrv eTh RIM hsa a laslm nmatuo fo sheyndipoty ubt ot etg ravulcasa srecnsoi essme do/d

someduck3  Pg 455 of F.A. mentions that alcoholism can be a cause of avascular necrosis. +5  
meningitis  I think the small dark area on the left head of femur and the darkened neck are the avascular sites. Neck: http://img.medscapestatic.com/pi/meds/ckb/15/19515tn.jpg Head: (obvious lesion on the RT femur, but similar discrete lesion on the left as seen on the practice NBME) http://radsource.us/wp-content/uploads/2005/11/1a.jpg +3  
yotsubato  He wouldnt be playing golf if he had septic arthritis. Avascular necrosis is a more chronic condition that has a slow onset. +3  



 -1 
submitted by meningitis(541),
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I inkth hte malls dkar aera no teh felt ehad fo emrfu dan the rdekenda ckne ear eht lraaacsuv si.set

Nkec: k/ntcgpse/5tp9imd5m.5e/boa/./mj/11igs:pcpt.cemtdh/asci1t

dHa:e v(oobisu liseno on het TR fr,emu but lrimsai ersetcdi eosnil no hte lfet sa nese on het aetccpri BN)ME /pe-.pj0ng/ra:u/tt1s0te1aadlou/nsd/uwh.sct/pocpr215/o




 -2 
submitted by usmleuser007(396),
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sCeasu

1) alcsrvuaA esnicosr corcus nehw blodo wofl ot a bnoe si urnretpetdi ro dceeu.dr edRduce dbool ppsylu nac eb cseuad :by

)2 iontJ ro beon tra.uam An yunjri, schu sa a etsiaoddcl jnit,o ghmit daaegm anreyb dolbo evss.les eraCnc ertsatmetn vnilniogv rondaitai loas cna aeknwe beon nad marh obdol .evsessl

)3 yatFt dstpoesi in bdool slsvs.ee The fat ilps)(di can clkob smlla dbloo lvses,es ncgreuid the dbloo wfol ttha dseef ons.be

4) itrnaCe sed.esais caldieM tcisn,niodo shcu sa cilske clel meaain and esrca'hGu ,ieessda oals nac aeusc inmsiihedd dbolo oflw ot ebno.

For auobt 52 epctrne of eeoplp hitw asaacrvul se,nroics eht cuesa of ertnputdeir obold owlf is nuwo.knn