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NBME 23 Answers

nbme23/Block 4/Question#23 (reveal difficulty score)
A 74-year-old woman comes to the physician ...

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submitted by abhishek021196(79),
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o-mpsPt,Uotr mR-uiutrIepoAii - POD,C sathma (Iโ€œ aryp I nac hetbrae !oos).โ€n

csMrciinau otcyoiiagepe mvattstlnnsi lbokc mrcnsuciia srteperc,o norpcncn.vs eotoiiethrnicrgnotb riuotmpToi is ngol .aicgtn

submitted by yotsubato(1088),
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Arent we NTO sspduoep to eus piotmrirapu ni lod ?peoelp

amirmullick3  Who said not to use it in old people? Remember "I pray that tio can breathe soon" and tio is an old uncle in spanish but its also the other drug, tiotrropium. +2  
drdoom  discussion of anticholinergics & elderly also discussed at some length (but different context) here: +  
guillo12  Ipratropium does not penetrate the blood-brain barrier, so I think this is why it can be given to old people. +4  

submitted by sne(49),
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etuAc amtahs ecxitbo1a.arne 2lore tAblu. istC.ieo3tcs odrro uIporpimrat

youssefa  I guess they described a COPD exacerbation here since she's a smoker and Xray showed a wide AP diameter. Either ways Ipratropium would make the best answer since its used in both cases. +3  

submitted by krewfoo99(104),
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eyAnno knwo why ertah osdusn uldow eb ndttasi ni OPCD tbexaiear?onc

marat  Cause lungs are overextended +5  
marat  overexpanded +4  

submitted by skonys(9),

Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients)

submitted by krewfoo99(104),
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yneAno onwk hyw eathr unssdo duowl be tdaints ni DCPO x?tcieoraneba

yng  Patient is usually obese (blue bloater) --> diaphragm movement is limited --> can't take deep breaths, and in extreme cases, the chest size increased and causing distant heart sound. +1