NBME 22 Answers : Block 4 : #10 = An 81-year-old man comes to the physician for ...

NBME 22 Answers

nbme22/Block 4/Question#10

An 81-year-old man comes to the physician for ...

Atherosclerosis

+10 upvote downvote
submitted by keycompany(182),

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290806/

Osler Sign is a low-sensitivity, low-specficity finding of Mockenberg Arteriolosclerosis (MA) characterized by "a palpable although pulseless, radial artery while the BP cuff is inflated above systolic pressure".

It is possible that either: a) The low-specificity of this test means it is also applicable to atherosclerosis (not just MA) b) The NBME incorrectly implies that MA is interchangable with atherosclerosis.

bubbles This was my reasoning, too. I thought this was Mockenberg for sure +

hello I don't think think it's a type. According to 2 other comments: "It's atherosclerosis because it said “radial artery is NON-pulsatile BUT REMAINS PALPABLE even as the cuff is inflated”--> normally, you can’t feel the artery when the cuff is overinflated b/c overindlation occludes blood flow and arteries are squishy (compliant); BUT if you had atherosclerosis, which is literally hardening, you would not be able to compress the artery, and neither would you expect the normal radial (outward) expansion of an artery during systole. (that is, the pulses!): "If if something were to not be palpable then it would have to collapse -- atheroclerosis prevents this vessel collapse." +8

arcanumm I agree, I just reasoned that atherosclerosis would not be thicker when the lumen is blocked. I don't think they were going for Mockenberg at all. +

arcanumm would be thicker +

drzed Atherosclerosis isn't common in the radial artery though... it's common in the abdominal aorta + coronary, popliteal, and carotid arteries. I am not going to assume a guy has radial artery atherosclerosis when he is in his 80s without a dyslipidemia syndrome over monckeberg calcification! +

+2 upvote downvote
submitted by yb_26(124),

FA 2019, page 299: types of Arteriosclerosis: arteriolosclerosis and Mockenberg sclerosis.

then on page 300: Atherosclerosis - form of arteriosclerosis caused by buildup of cholesterol plaques.

+0 upvote downvote
submitted by catacholamine16(5),

what is happening in this stem? unable to occlude the radial artery ? Can someone please explain?

lilamk I chose atherosclerosis because they said “radial artery is non-pulsatile but remains palpable even as the cuff is inflated”--> my reasoning was that normally you can’t feel the artery anymore once you overflate the cuff bc this occludes blood flow and arteries are squishy (compliant); BUT if you had atherosclerosis, which is literally a hardening, you would not be able to compress the artery, and neither would you expect the normal radial (outward) expansion of an artery during systole. (that is, the pulses!) +8

mnemonia I think athero is just a subtype of arteriosclerosis. Also my thought process was (like Lila) if something were to not be palpable then it would have to collapse and athero prevents this from happening. +3

yb_26 FA 2019, page 299: types of Arteriosclerosis: arteriolosclerosis and Mockenberg sclerosis. then on page 300: Atherosclerosis - form of arteriosclerosis caused by buildup of cholesterol plaques. +

+0 upvote downvote
submitted by paperbackwriter(12),

For those that didn't quite get what the stem was saying, basically Osler's sign is when you're squeezing the blood pressure cuff and keep going higher and higher because the arteries won't collapse as easily (due to natural stiffening of the arteries with age). The lack of collapse upon squeezing is why you can still feel the radial artery in the stem. So even though the pressure inside the arteries might be normal, you're gonna measure it as high (pseudohypertension). Apparently it's a common finding in the elderly.