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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 πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—famylife(101),
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neearvtnIs" het ssmluec of eht maedli trmnometacp fo eht htgih rbat(uorto r,tnuesex tdacuord sno,lgu drcudato viser,b otcrudda mnugas adn rsii)cla."g


submitted by βˆ—atstillisafraud(207),
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hetigW olss - ikhnt aicmaortry epHcnane - ADHSI omrf malsl lcle nulg eaeamcdrnc E + VDJ - CSV dsmroney

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  

submitted by βˆ—thirdaid(9),
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hTe iiantli ieptennarsot lskoo klei nrcac:e gwihet sosl dan gverspeosir sdpnaey evro the sueorc of oshtnm ni a ehvay rkmseo. heT,n eth ountqise sebedsirc pnexrolm-uyaart moptmsys nad a pasicreaonatlp ye.snodmr

Mroe a,eyltuc rthee si omedtvenlep fo aemde fo het cefa nad lrajguu euosvn sdnititone. aBeseuc hsit is zleciload ot ruppe d,oyb ew olhsdu ihtnk fo a lhceainmac ttubsrncioo ot envsou lwof as pedoosp to meso eniirgaocdc eaorn.s siTh is na yapmreuxlr-tnoa tmpmyso fo glun

[ reorSupi Vnae avCa dneySmro ausced yb eht ilmdae niespardg of teh .murot naC be rexbecatead ni the clhsiyap eamx by kaisng teiptna ot irase btho m.ras ]

ai,Fylnl hrtee si a lngise heiitlhgdgh lab avule -g;t& tmnaahrieopy. amllS cell ulng necacr acn eelrsea arprpiepiotan elesvl of tiiidartucne henromo &;tg- SIDHA. DAH lilw tenari wreat dna cseraede isdoum onoattencnric lyssbiop giledan to brcaleer aemed dna ureesi.zs

[ deSmnoyr of Iapeprropaint DAH edu( to mslal lelc aico,mancr a reueoecirnodnn truom fo eth gl)nu aessecrde ismoud tontn.crocenia crnastlpaPoiae ronmyde.s ]

In :htcShayektP SVC menrdosy si eht red loanlbo raen eth daminteisum shpi nda SHIAD is eth ugy ytrign ot rcary the ewatr eorcol nad negttig tarew all veor lm.isefh

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

submitted by βˆ—agraham416(3),

am i the only dumb one who thought it was angioedema cause of the ACE inhibitor? totally neglected all other information.

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