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NBME 23 Answers

 +21 
submitted by βˆ—seagull(1794),
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Why si tish ont ?HSU woH ddi ouy ugys porcapah het ?toqsieun


 +12 
submitted by βˆ—nwinkelmann(349),
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98g@8h seaBuc"e eth bntsoucriot si aboev teh llarveao igreson trhee is a ercaeesd ni ari owf,l not lngu msvl,ueo iwchh doluw aekm ihst na tiervcsbtuo h"tapolgoy is het ostm plfuhle ainoxaletp.n If uoy nwko the omst scbai oyihsotfdyathpilinn/gpooie of bttcosrvuie vs seerrcttiiv c(whih I do, tsuj i'dntd in htta mtso idlmipsife yaw,) then uoy cna igurfe ihtnnagy .otu If sigmnoeth si cmgtinpia arwyia folw = rce,ovubitst if nomseghti is imcagptni aawryi oevmlu = cit.revsrtei HNKAT OUY!

burningmoon  How about emphysema? airway volume changed but it's obstructive. +3  
almondbreeze  i think OP meant to say that something DECREASING airway volume = restrictive +3  
jgraham3  I think they mean if something is impacting LUNG volume (ie. expansion/compliance) = restrictive Airway disorder --> obs. / Parenchymal disorder --> res. With emphysema the airway collapses (obs.) before they are able to exhale fully thus the air is trapped +  
dna_at  Just to be clear, this is not a classical obstructive lung disease affecting the small airways, as it is above the carina (trachea). This is better classified as a fixed upper airway obstruction. See the flow loop here for "fixed obstruction" - it came up in IMED UWorld so maybe familiarize yourself with the image since it is unique! https://www.grepmed.com/images/2948 +4  



 +5 
submitted by xkno(5),
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I hgouvttreho itsh eon ibg e.itm neicS het itoqensu dais het sasm was pgnsrsie no teh eusdoti fo hte a,taehrc I gifdure that gnudir priiaion,tns /cb eht eshtc ndapxs,e os reom ,cesap os hte smas dowlu vahe sles efftec on eht rheacat as eth setch sedaxpn a(nd eloryvsn,ec 'dit ahve meor fo na tcfefe ngrdui rtoieinaxp as eht htsec lwla sr)rt.eatc tapplny,reA it aws jtus hrgttias up bkegolca nad I ugthhot aywaa ot rhad. .spOo




 +3 
submitted by βˆ—usmleuser007(444),
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kLie yna of the ODCP, eht itntpae sha a tfdcfuiil ietm lehigxna eht psedniri ria sh(tu tis cledla na rsctobiutev iaedse)s

DPOC etslsur ni VFC ,asdereec V1FVFCE/ oaitr scaere,de RFC ,enseaicr nad epek oeyapitrx oflw ecear.sde

A orumt ro nya eroth tbcoje ttah duolw crosemps on ro rnoraw ehste eth rai ayw cttra uodwl pnrsete as a .POCD

nnIalihg dna niaehxgl dulwo eb miltide




 +3 
submitted by βˆ—visualninjacontender(17),
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tI dluco be ttha tshi is a dxife uerpp irwaay iot,ocrubsnt iwchh olwud enprtve nlofaniti adn afolietnd of hte araiwsy edu to the oumrt icaglpnm down no the aetch.ar




 +3 
submitted by βˆ—.ooo. (37),
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I pelarlynos ohtghtu fo hsti soqntesiu tiinhngk of ti in shtee etm.sr. ceiSn eth itptaen sha a smas ni hte aachetr aekp oxiryprtae adn ynoirtraips owfl illw be dupee,irrtnt nda wloud errfeohet be sc.eaddere V1FC ouldw sola vaeh ot csadeere yb ts.ih ihTs miiteedlan lal hte roeth os.eichc

charcot_bouchard  Are you Me? +3  



 +2 
submitted by βˆ—azibird(227),
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hyW is eehrt a ddesrecea V?CF Treeh si a mssa rsgipnes no erh eatacr,h woh dcluo htta pssbloie ftaecf nlgu eu?mlov fI we eigv rhe nuhgoe i,etm wyh n'odltcu hes kate in a full rhbeta?




 +1 
submitted by βˆ—mrglass(44),
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I uefgdir hits asw a rbavelia aarnictcrohit otcrunobist dna got it gwrn.o

Aidgrncoc ot aDUTe,pot aulliRNITmnA aalchrte tsocnorbiut si rai,elvab leiwh uAlTXnmlRaiE rcalaeth tbntrioucso like( in htsi es)ac is xif.de




 +1 
submitted by docred123(8),
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iH ysgu nca seemnoo eapels aetbrelao on heest dgnin.isf I deruatnnds esh hsa ugnl rcecna htt'sa ipmgnedi rhe ra.tecah tBu who is shit nivsreaeptrete of na etbivcsruto sdrd?ieor etA'rn ugnl serccna vrcsiriette if yagthn?in sak Thn

nlkrueger  I agree that it's confusing but I looked at it as a physical *obstruction* since it's impinging on the airway.... but yeah idk this is weird +  
ferrero  Doesn't the trachea have cartilage rings so it wouldn't collapse which makes it seem less like a typical obstructive disorder? I'm really not sure why FVC would change because I don't see how total lung capacity or residual volume would change because those are static conditions where there is no airflow at all. I understand FEV1, peak expiratory flow, peak inspiratory flow etc. +2  
mousie  Agree this is a really tough Q but I also think I really over thought it... I eliminated all with a normal Ratio bc something obstructing would obviously produce an obstructive pattern although I don't know why FVC would be decreased. I wasn't sure about both peak expiratory and inspiration flow being decreased can someone help me with this or tell me I'm totally overthinking again.. are they both decreased simply bc theres an obstruction ..? +5  
mimi21  Yea I got confused on this question. But I guess they wanted us to look at it as a obstructive disease . If this were the case all of those function tests would dec. ( See FA ) +  
gh889  Because the obstruction is above the alveolar regions there is a decrease in air flow, not lung volumes, which would make this an obstructive pathology. +3  
charcot_bouchard  FVC here dec same way it dec in Obstructive lung disease. Read the concept of Equal pressure point of BnB. There he says in bronchitis we have onstructive pattern because inflammed airways gen more resistance. so EPP comes early. I guess here due to tracheal narrowing pressure inc downstream. which collapses smaller airway. result in air trapping. +1  



 +0 
submitted by βˆ—donttrustmyanswers(69),
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trspoopdaiorti"en etirocndu ni the keap yepxritaro flow erat ro mamxium nmteiu vmloeu raoecmdp whit eht ferdoc pyxeiaotrr voluem ni noe cdenos V(F)1.E It lhduso eb odten, eeovh,rw ttha hetre nca eb a anticgsifin olss ni ariywa s-consloriacste aera oebefr teh eotbxokt tetfilagnn fo teh niasorrypit or xiarrtpeyo oplso era eiivlaud"s.z

Ht-n=_nrmupetocrcsi.nea-coentntetirpo~aon;tltolt&eaedt--_aak-ps=1ttssnu_/1vgayaemoatmeyetl0tsscsohlii/4rpti=-1apa;eseacrhdwpp:aalatTwcn%7y/ce7fso=/aid;irdcud0i3fae2m0umnatartidrele&cb-tgtr=gantsnoemle98wsla&5?cainthcpitbuocoiu-splmr-alwuh5ene#l-us1oa;n-audr.ca&ens

mamed  google fixed upper airway obstruction - the spirometry curve shows decreased inspiration and expiration. A lower airway obstruction just blunts expiration. Extrathoracic blunts inspiration. +1  



 +0 
submitted by ninja3232(11),
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To itnkh tuboa shit iys,lpm it lliyaterl is na rocotsnitbu so uyo can stuj hcosoe teh ewsnra htwi eth CPDO ikle F.sPT

t'Is a tib nueitvretciuntoi thta eht FCV luowd eb c,dsereade tub eht rosane orf tish si eucasbe at eth end rxoptiiean for ,CVF het seioiptv uparlle perrusse sunhpgi eth iar otu has eeuzqidal twhi teh seerpsru of the sroaheemtp / iwryaa nawngti to peke eth lvieola n.peo Wthi an anreseic in het waryai ecisrsetna ofrm hte tbtusoocnri, stih izqoaunlatie tonip mseoc at a hhrige .CFV dyemobSo fcta khecc em lpesea




 +0 
submitted by βˆ—agurl1000(5),
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hsiT mhitg eb a rtsdrhiaroawfgt anrws,e tbu I aws ngiodwner why het inptate doulw hvae a eredcdase taioyrnsrpi l?wof Baeecsu to my trsaiuddnn,gne opplee wiht stiouetcrvb asdesies evha turbole rgihtaebn ,out nto in.. Cdolu eoesomn xpainel ot em wyh it e?aceerssd

rdk3434  okay so i had the same doubt which is why i got this question wrong , but then i had this eureka moment , in uworld there's repetitive images about obstructive and restrictive disease volumes and they always show TRACHEAL STENOSIS along with that , this question is somewhat like tracheal stenosis presentation , just google lung flow volume tracheal stenosis! hope this helps! +1  



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