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NBME 23 Answers

nbme23/Block 1/Question#34 (reveal difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancer๐Ÿ”,๐Ÿ“บ

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submitted by sajaqua1(558),
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Teh legsni omts anrimtopt ighnt aubot hsti rgoss oopthgayl si htat teh aisdese si aniomtdlu.rul shTi idateincs sssteaamet rmfo dintsta

rveiL ecsassbes ear alsyuu sgluir,an ifdell htiw acmrye oelwly ,spu dan mya whso a oruifbs ulpsea.c shrsCirio fneot ssowh a lyleow oorcl ued to taytf nhagec as ellw as teveernigera oneds,lu hihwc rea ont tserpne rhee. A aocfl noldaur pplyasaeihr is a lguisarn uortm of eth vile,r nad ihts si omn.iltldaruu paesttHii B is a etllti hrrade ot sgnisuihtid ubacsee ofrm twah I acn ellt it can be ornildtlumau in esmo e,cssa utb tish levir aosl owssh neon of hte lossresic rfmo crihonc mitnfoiaalnm taht ldouw liyelk nacymaopc Hep .B Faly,nli ew ese on dkar noitaocrsilod to neiciadt niorita.ncf

monkd  It doesn't explain the sudden death, but I suppose they aren't asking for that! +4  
charcot_bouchard  I hate this type of ques. Here it is. Tell me what it is? +2  
divya  also, a liver infarct is unlikely due to rich dual blood supply. +1  
drzed  @divya Rather, if there was an infarct, it will be hemorrhagic, not pale. +1  
llamastep1  Multiple solid lesions on a healthy liver = meta. I assumed breast wouldn't meta to liver (it's usually GI cancers) but it makes sense since all the blood gets filtered by the liver at some point. TIL! +  
sophia  UW QId: 59 +  

UW on FNH -pop: young women -mx: hepatic vascular deformity->localized hyperperfusion w/ secondary hyperplastic response -dx: small, solitary, pale nodule. central stellate scar w/ fibrous septae -sx: asymptomatic; discovered incidentally

+1/- almondbreeze(91),

submitted by seagull(1688),
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at eht vyre ,aetsl erteh rea eluimltp aears of aneccr vggiin osme aincodniit hatt ti eybma aecmittats.

submitted by niboonsh(369),
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submitted by cuteaf(7),

The tissue that invades the liver looks entirely different than the liver itself. This is what made me think that its origin is foreign. It doesn't look like fibrosis either, which would usually lead to some degree of constriction.