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NBME 22 Answers

nbme22/Block 1/Question#23 (32.6 difficulty score)
A patient in the early stages of hemorrhagic ...
A weak pulse due to decreased stroke volumeπŸ”
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 +5 
submitted by dr.xx(142),
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Hoeoilmpavy is a teidrc olss fo vfefceeti icugnlatcri odlob omlvue naiglde to:

  • A ri,dap ekwa, hyaedtr pules due ot csedeeard doobl lfow nicmedob hwit actcyairahd
  • oolC, ammcyl skni eud ot iovtosrcaticnnos dna mnsloauttii fo sroaoiosvcncnitt
  • piaRd dna hwasllo ahgbneirt due to myiaphsctte svunero setmys uositmnalit and iocssdia
  • epyhmritHoa edu to adredesce sfeirponu nda anvpoioerta of tsawe
  • tTsihr nad ydr uhm,to ude to ulfid elpdtoien
  • Cold adn eoltmdt sink dvL(ioe )rlteci,riusa lpeeiclasy timresx,tiee eud ot fisiniunftec prsofunie of teh iskn

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BP/HR are most important to monitor in early stage

Hb starts to drop after 8-12 hours

+2/- dentist(49),


 +0 
submitted by joga(0),

LOW FLOW (HYPOTENSION) ...> LOW SV...> ^SYMPATETIC




 -3 
submitted by atstillisafraud(187),
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uomuiAgsb utoeisqn btu ni uesaceb ti si raely coskh, htere si tno nhoeug emti ot ttevaiac teh RASA to snaeierc ekinyd s.eronpiuf

makinallkindzofgainz  This is not an ambiguous question. It makes perfect sense. +5  
khaleb  In early shock you have increased SVR due to vasoconstriction. This would cause increased flow to the kidney. I could be wrong but I think what makes that answer incorrect is NOT that RAAS hasn't been activated yet. It is what is causing vasoconstriction via Angiotensin II. What is possibly wrong about that answer is that it says via sympathetic stimulation. I do think it is a little vague between those two answers though. Because you can get sympathetic activation of the RAAS system causing vasoconstriction and blood shunted to vital organs such as the kidneys. Bottom line is you can't argue with weak pulse during hypovolemic shock.... so an obvious right answer. You could make a case for the increased blood flow to the kidney though. +2  
zqatan  @makinallkindzofgainz no need to dismiss the question... so pretentious +