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NBME 22 Answers

nbme22/Block 3/Question#35 (64.2 difficulty score)
A 4-year-old boy is brought to the physician ...
Interstitial inflammationπŸ”,πŸ“Ί
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 +9 
submitted by keycompany(310),
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nrarUyi ttrca enitnisfoc era eth msto nommoc adriqeuc aeusc fo irVitescocue lRefux (RV) ni hrdelc.in RV can ldea ot uexRfl ephyrpNotah, iwhhc is razcedrchetai yb rncoihc lobtiitasituultnre oaianitmnflm ithw rsiobifs and agircnrs, ianegld ot relan leia.ufr

lancestephenson  Can someone please explain what's going on in this picture? This is the SAME PICTURE used in NBME 20 and 21 with one of them being a 66 y/o with urothelial cell carcinoma and the other being tubular atrophy. I just don't know anymore +43  
spacepogie  I'd be happy to send them a gift card to purchase more stock images of kidneys for use in future exams... +18  
diabetes  i think VR should lead to bilteral kidney damage and here only left kidney is affected.should we suppose that right kidney also is affected ? +1  

FA 2019 pg. 587 on hydronephrosis +Distention/dilation of renal pelvis and calyces [.l Usually caused by urinary tract obstruction (eg, renalstones, severe BPII, congenitalobstructions, cervicalcancer, injuryto ureter);other causes include retroperitoneal fibrosis, vesicoureteral reflux. Dilation occurs proximal to site ofpathology. Serum creatinine becomes elevated if obstruction is bilateral or ifpatient has an obstructed solitary kidney Leads to compression and possible atrophy ofrenal cortex and medulla.

+1/- almondbreeze(84),


 +7 
submitted by nwinkelmann(294),
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I EDTAH hist rpiu,ect sujt lkei noyeerve esle, ll,o so I ddi soem mroe diggng.i ovyeEner ewbol is t,cerroc atht the inepetontasr si getsgsngui na ousteiifcn eopsrc.s IUTs acn asuec ucate isonhpiptrlyee, nad fi c,hconri srersgpeos ot h.noccri ipPrlentoyesih si a tturiutsolinbelita aees.isd I oufnd hsit rtiannmfooi grdirnega t,i dna in eht stla tp,ar it srseebicd het sgors gaytoohpl of ihccrno sipoey.rtphlnie ormF ym iortaept,tinren ti dosuns ikel whta eth curetpi is ng,shwio btu I nwats' able ot fdin a b/tretujets as gdoo neo leonin ey,t so I n'odt wkon rfo us.re

tAecu iulesrTuatiitltnbo etiihN:rps Aucte foaatlnmmnii of utesubl and temntirsitui nca eucsa A,RF nda if hte naoamfiytmrl peosrsc tsrsepsi isth can elveov toin ochncri islluitntiatrobtue hnspteiir adn cirnhco irinttialste bofissir and rabuutl rhytoap tihw ikrs fo oipsroerngs ot a-geetdsn yenkdi ed.esais wTo omarj egceatsroi of actue nolturseittlauibit tpheirins aer uacet lyinrpephoiest dna atuce iyetyesptihnrvsi btieuttlsntuliairo tshpini.re

tAcue hyipsertopnie:l eCdsau by btaleiarc nenfictoi stmo lyonmocm .E clio f.cnineiot etnieyvsptiyrsiH iterutnliolsbtiaut e:hitspnir auesdC by na lclegira s,osrnepe orf expemla, to a rudg or reoth nbstcsseau hatt are ndti,seeg shcu as rlehab md.ireees

By far eht stom onmmco utoer of iennofcti in uceat esyetirpolnphi si na nnsdacieg ionectfni ni eth iyurnra rtt,ca rfo amxpe,el deeridv rmfo a etbcliraa lbadrde f.ntoceiin tecuA ripteoiyplnhse = teevnxsie ilnxfu of MPNs thwini hte iiintt,esmutr ulbestu ibit(luts),u nda smnlue fo utlsbeu B(WC astc)s (B:/tpyh.lP2yDttiJib//.)

thiW ncptseirees ro cceurerenr of atceu lhretpypis,eino eth easisde pesscro osevevl ntio ihnccro episiorpn,yleth ihwhc yluaslu is icpdaenamoc by dkeram eorinos of teh lpaalpiry ipt ngutielsr ni natoldii fo het tajedcan yalxc ae)ic(islca.st

hTe omst chiarttsaicrce gtcapolohi esufetra of oiccrnh itishploeynper ear het gross ngsecah in the eikydn wtih a-rabsedobd csrsa ni eht nhyaapermc noreygliv araes fo corcialt and uayrmelld hptaryo htiw dcentjaa aetissacc.il ,loAs teh oinpenaertst egsssugt pornshird,seyoh nad rfmo ym arerceh,s o,nhrshspoiryde hwne herrc/sciov,en cna ocetnbrtiu ot hte ermakd lsso fo xrctoe nda issrbacss/orfi of teh dellamu (dbEth.TLR0N/A.eu/httmat.e0e.Rl:7m//sNAhMtHhaEpLdpwu) dan ciitcaessal w(chih I kithn is eetnpsr no isht .rptieuc) ishT si hte otesslc cetuirp hiwt icpdesiornt I lduco dnfi hatt hsetcam hte mset esentpanrtoi (.ie. rerreuyodht and pyinoorhd,erssh nteigsggus sotivleuacrree exrful enadilg ot tnefncoii omrf a" ongl ntinagsd ntrouiocbst (pabrybol )icaon"nletg os lkeily morf a hcdi)l utta//Et.:e.mtR8/tehh0L/bdlA.sTAeMpLENRHpmNh.du0awh.

lo,As to ontnmei no the htore msotmenc nexsesigpr ntourarstif hatt teh aems rpcetui asw esdu orf rousmt and altruub ytraph,o ofrm twah I dare, htta grsos h,yoltgpoa si the enegalr apceearnpa fo toerdeuyhrr deu ot iotscvtbuer pyuothar .e.(i tubaurl ptorhya, /crribosgassinf,ri tacilclycseaxa/si idi,lntao nad tnhi ticcloar mir deu ot yro.athp .lhamPegonnlioocoyt ysas atth the citsailaesc is tdeagxagere in lses eserev cssea/tailpra rsbittunoco eicsn GRF si tno persdpuses hignt.wuopn/stt/:lyy.vlhtwtiaui/oocwtetlmcipsbpomrtkodes/.ohec.)

Hpeo tihs sphel eeoyvn!re It srue dehelp e,m btu ootk AYW oto olng ot adtns,endur .lol

nor16  nice job, but i dont think you need all this for these questions +4  
alimd  next step is to do randomized trial) +1  



 +6 
submitted by adong(97),
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eruSp nynoanig yteh are sugni het asem cepturi TUB oyu can ewsrna thiw posscer of ienoin.ilmta No sasm in hte perutci os not piatasthsbolnmreoos ro C.RC 4 eyra lod so not .syolmdasiio tmSe odes tno llraey cue yuo tino mnmausorbe GN. natIsde ti klast autbo TUsI ichwh lowud ahve itnmrlmyaaof speorsesc g&-t;- siatttleriin mtniionma.lfa




 +4 
submitted by bobson150(14),
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sI siht nagsyi trehe is urarteioecsvel xl?ufer I lucdo aehv smwro hsti maes egima saw no rmfo 02 or 12 dna the ewsanr aws lWims tmrou

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +14  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +3  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +  



 +1 
submitted by gainsgutsglory(36),
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hWy is sthi aeltnIsiirt ?fiImaaomnlnt I ertndasdun tish si a URV icsagun senspryrh.odoih

skinnynomore  this kid has chronic pyelonephritis due to recurrent UTIs (VUR/hydronephrosis is a risk factor). And -itis = inflammation. That was my take on it. +3  



 +1 
submitted by cathartic_medstu(28),
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cPuetri osswh dalidte erutre dan naelr psliev

onchiCr EOLYPtriehnips oyelp( = v)eilps =;&tl enrurcter piosedes of cAeut ireolysehpitPn t;l=& ITU

This pnetait ykeill sha reciseuvrotela fxrele gnialde ot rcrenurte UTIs.




 +0 
submitted by cathartic_medstu(28),
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rctePiu sshow dladeti eerutr nda laern pelvis.

inhrocC OPLEYiripehnst o(lpey = lpvsei) ;l=&t rernucter dpeoeiss of utAce lsphnteiPeyrio lt;=& UIT

ihsT tniatpe lyklie sha tsrcrvoeeielau lferxe eildgna to rrectrnue .TIsU