NBME 23 Toxicology screening (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 3/Question#19 (reveal difficulty score)
A previously healthy 32-year-old man is ...
Toxicology screening 🔍 / 📺 / 🌳 / 📖
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submitted by ∗seagull(1933)

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This patient is tripping balls. Better do a drug screen which seems obvious.

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sympathetikey When the answer is so obvious that you pick a stupid answer instead of it. DOH +49

jooceman739 Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +5

yotsubato @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +2

yogi probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +3

charcot_bouchard Lol. I got the right answer but took long time +

goodkarmaonly The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +1

llamastep1 Bilateraly messed up pupils = Drugs (most of the time) +1

targetmle why is there basal ganglia hemorrhage? +

dul071 Wait! doesn't it take like a week or two to get the results back!?!? i chose to measure catecholamine levels because that may be more timely. but clearly i'm wrong +1

usmile1 basal ganglia hemorrhage is an intraparenchymal hemorrhage secondary to hypertension. according to FA, this occurs most commonly at the Basal Ganglia (FA19 pg 501) +3

fatboyslim I think this is cocaine intoxication which raised his blood pressure too high and it popped an arteriole in the basal ganglia. +

+10 upvote downvote
submitted by ∗hhsuperhigh(49)

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"His friends believe there may have been drugs at the party", period. lmao...

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aisel1787 ahahaha +

qball What a snitch +12

bend_nbme_over Good thing they were at the ED cause that friend is gonna need some stitches +2

+2 upvote downvote
submitted by ∗thotcandy(131)

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i figured it was cocaine or amphetamines so I picked plasma free metanephrines. Why is this not correct?

According to this:

Sympathomimetics: Ephedrine, Pseudoephedrine (Sudafed), Amphetamines, Albuterol (Proventil) can cause positive results in serum metanephrines.

https://www.ncbi.nlm.nih.gov/books/NBK278970/table/pheochromocytoma.table4drug/

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drzed Because a toxicology screen would both answer your question (e.g. that it could be amphetamine abuse) and would also pick up any other drugs that the patient might have been using. So even though the pre-test probability is high for amphetamine use, lets say it was something else, well then the tox screen would pick that up as well. Or lets say that it was simultaneous use of two drugs, same scenario. +4

+1 upvote downvote
submitted by ∗diabetes(31)

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pupillary dilation ,hypertesion ,tachycardia,seisure ,wakefulness are typical for amphetamines intoxication.

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