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NBME 22 Answers

nbme22/Block 1/Question#31 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancer ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
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 +14 
submitted by โˆ—famylife(104),
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rvetnnsIe"a eht umslsec of teh aiedml prttacnmmeo of eht hhigt a(botrrtuo e,uxnsret oduadtcr n,solgu uoartcdd ,rsvbie uaodtcdr sanmug nda )icasgr"i.l

reotsto:totcr/olmye/nernvf-tahetlep/ubr/remis/eaahw/mbniv.ano-


 +5 
submitted by โˆ—atstillisafraud(216),
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etihgW sslo - inthk naeicteo cyHrrpamna - DIHAS mofr llmsa lecl ngul eEaa ndccerm + JDV - CSV nmosryed

peridot  I was thinking lung cancer secreting SIADH, resulting in hyponatremia. But because the question asked specifically about the cause of the facial edema, I put hyponatremia (answer choice C). I was wondering how you guys were able to differentiate between C. hyponatremia and E. lung cancer? Thank you! +2  
mannan  The first thing that crossed my mind was SVC syndrome from the cancer obstructing the R brachiocephalic vein preventing venous blood from returning to the heart (and staying in the facial area). Also I assume Hyponatremia would be equivalent to decreased body volume so there wouldn't be edema. FA Renal physiology section has a good chart on what happens during electrolyte imbalances (hypo and hyper) +2  
mannan  @peridot +2  
peridot  I was thinking that hyponatremia would be more loss of osmotic pressure --> edema, but I definitely see the argument for a mass that's simply blocking blood flow. Thank you! +1  
jaramaiha  only thing affecting osmotic pressure is albumin, which would be more towards liver cirrhosis. The body will attempt to maintain a Na+ of 140 with various mechanisms, but doesn't contribute to osmotic pressure. +1  



 +5 
submitted by โˆ—thirdaid(10),
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Teh intlaii saoeernnptit oslok eilk ecc:ran hiwetg sslo adn irovspsgree sndpaey vreo eht cueosr fo snhomt ni a heavy mesork. Tne,h the ieotsqnu ibcsrseed rlxntreaa-omuyp ytmsomsp dna a pitepsaorlcnaa m.odresyn

rMoe lyec,uta tereh is novepldemet of emeda of the afce dan rujaglu vnueso ioeisnndtt. euBseca shit si edlcazlio to pepur oyb,d we ludhso thikn of a acencmilha ncotirstbuo to evsuno lowf as sdpopeo to smeo edoicicarng .easnro ihTs is na ar-mapxrnlyotue yptmsom of ungl necc.ra

[ oipuSerr enaV Caav ryemonSd adeusc by eth madlei pgansdeir fo the m.orut anC be tederaxecba in hte ylscaphi aemx by sgnaki einttap to siare otbh ra.sm ]

Fyln,lai eerth si a eigsln gitehlhgidh alb valeu -;t&g ioampnaryhet. lalmS ecll gnul rcncae anc laeerse tepapirpnrioa esvell of nriitacidute eoomrhn ;-> SAIHD. HDA illw atrnei ertwa dna ersdceae imusod econtntrnoica iylpssbo iadelgn to brraecle emead dna srie.euzs

[ rynSmedo fo aInrppaportei ADH (deu to allsm lecl orica,ncma a deinerournonce truom of eth )gnlu essrcaeed usdimo ncriceann.toto nacoatirPaselp rnsmeo.dy ]

In a:ehchytPSkt CVS reodymns si hte erd oolnbla near the mmitaiedsnu hisp dan DAHIS si eth uyg trginy to rryac teh atwer cerolo dna gtiteng terwa lal vore fmslh.ie

makinallkindzofgainz  I agree! Superior sulcus tumors is a lung carcinoma that occurs in the apex of the lung and can cause SVC syndrome. +2  



 +0 
submitted by โˆ—ekraymer(1),

Was it wrong to see blood tinged sputum, and automatically assume its cancer? since none of the others would have caused blood tinged sputum?




 +0 
submitted by โˆ—agraham416(3),
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ma i eth nlyo udmb eno owh thghtuo ti asw andiemaeog caeus fo the ACE r?iotnhibi toyaltl eetdlcgen lal hrteo omia.nfnitor




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