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NBME 23 Answers

nbme23/Block 1/Question#47 (31.2 difficulty score)
A 61-year-old man comes to the emergency ...
Budd-Chiari syndromeπŸ”
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 +11 
submitted by sajaqua1(520),
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daid-BuihrC rdomnsye oscurc wenh eetrh si onuoccsli fo the acpehit ievn or teh eithacp vnie flasi to dainr ntio teh IV.C This cna eb ucased yb istsmorhob fo het ethcapi i,env ro yb ihgtr sdeid rhate reluaif g(cusani olobd to b'akc 'pu eyeve,hrewr ubt its tanoaifiemtns oghuhrt the ihtacpe nvei aer lla hte sgnsi of rdhuadBiC-i eonyrm.)sd nyhgAnti taht nac enrsacie het rksi fo simstroobh acn hetn aenersci teh krsi of iadhiCBdu-r .nsemoyrd shTi dnulseic hactpoiymeyl erv,a a cbelagalrpoueyh ats.et Oru titneap dna VP ubt dissem hsi ioampntpent two esekw .oag He now ssepentr iwth eclrasl teucsir, an enedragl veril, nad mseo nssig fo prlato snhy.erneiotp sTshoorbim of eth lnoy anamtoliac ipootn eeserntdp thta eocsvr lal of iths is the iatecph vine ie ruo atinpte has drdhiiu-.BCa Rebermme ttha hddii-auBCr ilwl vahe a g"utmne rvlei" eppernaaac no sgsro yloho.apgt

)B aitHecp rici-oshrs s'it rtyleine bpssoeil our itpetna eosd veah pteahic ssrchoiri orf duaerntel aso,nesr vrwoeeh eht auetc enots aemks sith less elki.yl C) eiPccnarat -coacramin craipteanc arncmoica ritbusnctoo fo hte mmcono ibel uctd duloc sucea a ac'bk pu' of ,eilb eimlltyaut cansuig smoe eivrl gmaaed and calrsel euistrc. Hreevwo eonc angai het nitigm kasem ihts liuy.lenk )D tParlo eniv omb-soihstr alptor nive brsosimhot ucold ecasu moes iscnlpe nmgaeteernl nda ptlora .ehstpeynniro ewHro,ev sti bsutorconti woldu nto aecus a tn,rede ereldgna levri bceaeus it si rp.mtaues E) yairPmr sm-shtomhoaeoric edu to a tedfce ni cihneipd nopt,ciurdo isht niro dvoeolar pssrnete ihtw adnkrede skn,i nlnisui ed,stoilingrua tecaphi madaeg w(tih het iltapeotn rof ucrllhpeolaate oiamnac)rc adn htare adesies steiecir(vrt or eltdadi ycaidpoao,yhtmr engidenpd on ryou .sueo)cr Teh nlyo oen fo etshe nsgsi that uor tipntae ash is an ngerlaed e.rvil

almondbreeze  FA 2019 pg 386 +  



 +9 
submitted by dentist(50),
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fnduo iths repsu eufsul okob on oanazm uoabt drdia-BiCuh ch(cek out het skci rvc)eo

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 +3 
submitted by notadoctor(152),
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Aorcgcdni ot jGl,ano macipelohyty vare is one of hte toms ncmmoo uaescs fo BCiddiauhr- ednsr.omy ccrgAdnio ot AF, Bi-uhCdadir is sdecisaoat emro yleelrnga hwit guerpyhcalebola seatt,s cihtyleamyop rave, mpsutratop s,ttase adn H.CC

caeipHt srcihiosr can eb luder out asdbe on hte mtei resouc of teh t'psnaiet aenotsniterp - he saw iefn 2 wekes ago adn het blaodainm pian tdatser na hour ao.g

krewfoo99  Also in cirrhosis, the liver wont be enlarged or tender on palpation +1  
almondbreeze  @krewfoo99 Good job. accoring to FA2019 pg.368, congestive liver disease (hepatomegaly, ascites, varices, abdominal pain, liver failiure) seems to be the key in Budd-Chiari SD +2