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NBME 22 Answers

nbme22/Block 4/Question#43 (reveal difficulty score)
A 44-year-old man comes to the physician ...
Tricuspid insufficiency πŸ” / πŸ“Ί / 🌳
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 +15 
submitted by jointaccount(1),
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ln"yo kthcnaaeimrpcio ssoreceps hwcih rae lgylcoibialo ro blhicaeoiymcl eedmaidt evha eht lnopetita to xibieht fefisencerd beewnte lrcaai ro tecihn .rospgu hsTu, eth ranacmokipthcie ostfrac hihwc cna be epxeecdt to tylntloepai exbiiht icalar fidrecnsefe rea 1)( blbyavtaoialiii for grsdu hwcih dgoneur tgu ro phetcia aistspsf-r sobeaitml,m )(2 ioprnte dn,inbig 3)( leuvmo fo drnstit,iibuo )4( htepiac mobsla,time nda )(5 nlaer buturla srneioet.c itAsrbonpo u(enlss c,vae)ti itlnfratio ta het rllms,ogueu adn asisevp tbularu oietrrbapnos lduwo ont eb ecdeexpt ot ibihxet racail .idfecernefs "

vi:a m02vcm/ote/uhsnlpwwt..w:npgh.db9in4/4/ib13.


 +6 
submitted by βˆ—pppro(25),
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IV drgu bsuea + R hrate erliafu poymmtss odetenscg( v)lrie: thkni rcisudpti syifinfcuicne

fukprometric  why couldn't it be something cirrhosis related given his IVDU? I was thinking that the increased systolic pressure was a sign of portal HTN from cirrhosis so he'd also have a portosystemic shunt, but that was wrong +2  
schep  I picked portosystemic shunt, too. Looking at the question now, I should have focused on the fact that he is IV drug user, has a fever and has signs of right heart failure (back up of blood into the liver) which makes me think endocarditis +1  
jaramaiha  Portal HTN wouldn't give him a fever, but those septic emboli would. TBH to go 10+ years as IVDU w/ no heart conditions, he seems to have played his luck, but luck has run out :( +2  



 +6 
submitted by βˆ—adong(113),
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got ncofedus yb teh tsoyilcs snouatpli fo the evilr but acailblsy gigatrurent bodol mrof VR wlil og noit AR gt;& CIV tg&; chptiea svein




 +3 
submitted by medbound57(8),
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nrdcicoag to pa,&BmB; a lulstipea" l"irev si a sclaics ifnngdi ni servee rgtih HF acseeub het dpusirtci uogtnagtriier is nmaesdtritt to the anmd.beo

ivypoison  Hepatic pulsation is wave from aorta in systolic. Normally (no tricuspid insufficiency), no congestion,no pulsation. In tricuspid insufficiency, ventricular extrasystole (blood from ventricle regurgitate back to vena cava and hepatic vein rather than to lung) + wave from aorta -> hepatic pulsation. Also weak S2 http://rwjms1.umdnj.edu/shindler/heptr.html +1  



 +1 
submitted by confidenceinterval(5),
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I aws entweeb isdipcrtu bpserlmo or rhrioscsi rfom eph .C I hkint fi lla hyte gvei you is a bngiuond vreli og rof the llavvura oblrpem bscauee srcshoiir wloud ehav mroe smytpmos like iareedncs eso.rgetn I asol hktni teh bmoprel engbi os atuce sloa opitsn to a craiadc gniod.Rnigia re het sieonqtu ni,gaa myrpitosetcso tsnhu t'nsi os cumh a nodasgiis as a se.ueelqa I cuold iagenmi irdctpius fesunnicfyici euyavnllet uanisgc n,hsut ubt at'ths not laryle eth inneurlydg gsd.ansioi




 +0 
submitted by βˆ—weirdmed51(16),
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yAn ehtro ciotsdionn wrhee sintapuol ni hte lievr acn eb udnfo ?




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