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Retired NBME 23 Answers

nbme23/Block 2/Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock 🔍 / 📺 / 🌳 / 📖
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 +4  upvote downvote
submitted by sympathetikey(1600)
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adM at felysm for ghnincga ym awns.re

ayuFtl oicgl emad me rnodew fi httgini uoyr eadh udowl usdeca scneeirad ICP ,so elki a nhsugic erl,uc you owuld etg aseeidnrc Vsgua nreev tcitvayi dna mbaey ydarciaradb + nhepsooiyt.n But I gssue the SARA systme wulod avhe acudenteotrc ttha and aducse isicncsonaotrvto oerv 24 u,osrh so copvoimyHle coshk si lneefyidit eth sbte oih.cec

aylsAw oldsuh og twih teh isobuov nawres :)

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seagull  I had the diae htta shit swa a conregeniu sohck dan gncisenira rlacaiantrni eeuprrss odclu tcfaef teh avusg t.oo I nhkit hte seotniuq yalrle swnat us ot og htat .idcnetiro +17
uslme123  Teh Chsinug feerlx sdael ot darrib!adyca +7
purdude  Wati 'Im o.ndefucs I hhgtuto polmchiovye okchs alsed ot na nrdcseaei SRV? +2
littletreetrunk  e,ltaanppry ehster' a ithng adlecl yeipacmhtts epecsa atth anc papnhe earft a whlie .e(.i ehs' eneb tou rof 42 h)ousr: uomlciutAnac fo tsesui etmoibacl aoalsortvid esnasstbcu msrpaii dsmdheacpityiemtate- ,rtosiconasvincto wichh edsla ot loss fo vcsuaral no,te sevegpriros oytsipneonh adn gnaro oyfseuopr.pnhi +1
littletreetrunk  olas laso if eh hit shi dahe he codul veha osls fo tamstciyhep olotwuf mrfo a yhicpxo lmaeldu hhwic lcuod leda ot stvalaoiodin, whihc urfhtre csuerde traielar urspers,e but ihst asw a hrad eno for em oll. I osal ptu aceidersn IPC .awh +1
catch-22  Any lack of htpaytesmci /cswouaoitnedlfre vglaa loufwto sudloh udreec ,RH nto ieaecnrs it. rreF,uth uyo woldu tceepx intmbsear gissn if heetr swa iayohxp ot eth nmsraeb.it Fro aeelp,xm fi ouy dha ademag ot the ysorital u,lecuns uoy notuw'dl be bale ot atgeeurl ryou HR ni espsnreo to cdrdeeu .PB neiSc sthi aettpin has eucdred BP and cdsereani ,HR isht stceindai atth eht mprariy eicnbutards si lkeiyl the ucdered 'P .HseB aosl eneb in a edetrs rof +42 uhros os. +5
charcot_bouchard  In a nptetia owh ldsoeepv nstpyeihoon ofigolwln ingreyehhg- au,atrm nngeiruoec oschk si a diangsosi fo cnxoleisu ttah si edma tefra hioeymvlocp and iecstvrtuob oicdrncgiae khsoc hvea eben drule utPou!ls sneAtb yariBacdard ueslr ti uto +2

Increased ICP would present with the cushing reflex (hypertension, bradycardia, irregular respirations). This occurs because during increased ICP, the brain will compress cerebral arteries causing reduced cerebral perfusion. As we all know, cerebral perfusion pressure = MAP - ICP, and thus the body will force a pressor reflex to raise the MAP to try to keep the brain perfused.

Unfortunately, this causes reflexive bradycardia due to the baroceptor reflex activating. The irregular respirations are because the brainstem is compressed.

Since our patient does NOT have the classic cushing triad, you can rule out increased ICP.

+17/- drzed(333)


 +4  upvote downvote
submitted by yex(128)
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Hmm.m Wlel ym imdn ahs wboln off acseebu atwh iht my ndmi saw hnaireddyot isecn eh was ni the eest.dr sA oson as ym nimd satrtde ot wrndae tobau lal of the rehto inotspo that cuold akme n.s..see I tjsu cdiklec dna !mdveo

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charcot_bouchard  raStm obi +5
usmlecharserssss  iikhng in ashraa etsder HMS +4
cbreland  Silpem = armst +



 +2  upvote downvote
submitted by diabetes(31)
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enbedlig + eupesrsr onwd eups+l pu elqua epilcoomvhy kcsho

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I fnudo htsi obatu easdri PCI: "tenieraPsnot of direas arirltinnaac ursepesr = acha,deeh epmpldiaal,e anuamo/,nsvgieit roews ni hte nmnorig as ICP asries giundr the htgni sa a usnceenceoq of mrecncoybe, a ersi ni CO2P rgundi plees esudac yb sporirtyaer ee,posnisrd nda aybplrob a eeseardc ni CFS oipstoabrn, pirlaulyp iitl,noad itso,ps diarpmei g,eaz oartrpsyire turiyagerlr,i AS,M dan eshgnca ni ,BP RH, nda espyrirrota pttaern rea ayusull etal gisns fo aserid IPC and leretda ot amntsrebi tsinodrtoi ro ii"eamchs.

utl_n/tt.scpejcop33:7/2n/tm/js1obnhm.nppi//

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 -1  upvote downvote
submitted by hello(429)
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'hatsW hte oheyssemc sdpuosep ot be a luec baot?u seDo shit paitent evha ?CDI eoDs CID awsyal cesua ocmoypliveh ckhso?

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drdoom  Dimesaednist ltvrsiacunaar niolctuoaga C)ID( si a sdymiocrn ntiedioni.f ee(S .nae)nttg It sdeo ont wsa“lya” lead ot oskhc tbu ksohc si iyedntlfei a ispebslo elsqaeu i(csn,e by dnif,neitio DCI = ss“itcemy mocbhtorit cop”ssr;e naygtinh cmytsies lohusd gte uoy a titlel r,o)irdew adn so a teiaptn hiwt IDC douhsl be odrmineto lsyelc!o +
yesa  I tikhn heyt add to het leampoohvyi u;ptriec he si dedderahyt AND ilgeenbd tino shi eisstsu uabesec fo nnsocsiuto -g-&t; dsrdeeace actlsrnauriav elvo..m..u +

From https://meshb.nlm.nih.gov/record/ui?ui=D004211:

Disseminated intravascular coagulation. A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.

+/- drdoom(1206)


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