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NBME 23 Answers

nbme23/Block 4/Question#47 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxoma๐Ÿ”,๐Ÿ“บ

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submitted by nwinkelmann(312),
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mrursuM dan n:uaesvrme ts1 otthuhg = woh does ti agehnc wtih dleopa.r All mmururs etcxep OH,MC M,PV dan railat aoxymm esveiyrt is trcielyd trapiponolro to cgahne in raoedlp e.(i. ndarcseie eprr=awlesood rmuu,rm ec.t). ecuseaB fo hits, DDx acn be rdraweon wdon ot OH,MC P,VM dna arliat amxmoy ithgr aywa becseau eht rmruum wnersdoe twhi edeaecsrd odpearl (.i.e tndnagsi p)u nhwe all tbu cptxonesei hiwt rvim.peo

Atilra moayxm = CMC marpyri iccdara uromt eud ot nfpiraeirootl of etoecnicnv seusti ees;ychmemn a cnlteeddpuau asms oeecntcnd via kslta to iramut utmsep taht si duepsensd ni eth ilrata obldo vleomu dna mvsoe ithw eht umelov

Ptresno:nieat ditra fo 1) mtialr lveav toocbtirusn ..(ie a,mlseai mmtypsos of cdricaa u,erlifa pnc,yose c).te, 2) yptsmmso of blesmmoi .(.ei ialafc and rgith mra iesiahremsp ni tpnt)iae, and 3) ttunnocoalitsi tpmyomss (i.e. verfe, hgtwie ls,so smptymos nirbgeesml tncnviceeo tssuei es,eadis bscauee orumt eeelrass -LI.6) hrtOes euclndi onrguloeci mytss,omp tsmi"deur-loap vevla ieses"da asyutalructo idgnnisf i.(.e otlciiasd u,m)urmr dna atailr anmleentgre ic(hhw olcud osrscepm elgndrinuy rutrtscuse dan aecsu smpstyom osl).a

oNt yoln odse antgnsid deseeacr po,dealr ihwch namse LA vumole is wlroe os ssma ni'ts sa usdsendp""e tbu mroe ie,lbmo nisgtdan also ceirenssa eth onwwrdda iraivtaogtn cr,foe hwcih odluw cureotbnti ot hte motru nigomv dasowtr the aesb of het trlaai hm,reabc ilno"ppgp" on the mrtila elavv ela,setfl dna ettniaylplo gnnxdetei trgohhu dna nsicgua a outifnnacl yept fo ltmair iesntsos ..(ie wonrseing olticdsai urr)mu.m siTh ivode nlsipaex it earlyl :ellw m4ao;va/uc.y=wssVc1lopth&6bwesttut=6.I/iwgLn?mp/Y1w:ht

dentist  Sorry, you narrowed it down to HOCM, MVP, and LA myoxma, but I only see LA myxoma as an answer choice. Wouldn't you have been able to stop right there? +2  
hello  @dentist, I appreciate this full answer b/c nwinkelmann is telling those of us that were wondering "how to ddx one from the other in case we need to"? +7  
hello  @dentist btw, HOCM is an answer choice (RVOT is part of HOCM) +4  
thotcandy  @hello but since that's pseudo-aortic stenosis, it would present with a systolic murmur, correct? +1  

submitted by sne(49),
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I ugtthoh of ti klie enwh she segt pu mrfo a poern iotp,nsoi seh si seneidrgac eht loobd noggi ot her eha,tr os os eth teh xmyoam uacses orem tino.ocbruts Aosl yxsmaom uaecs ntyi eimb,lo hciwh anc og ot eth stmycesi cuacinotlri aingucs nmii iohmrbt ni the inarb adn i.sblm

bigjimbo  Left atrial myxoma can mimic mitral stenosis (thus diastolic murmur) +1  
btl_nyc  RVOT obstruction would cause a systolic murmur that gets louder when standing, not diastolic. +2  
snripper  RVOT obstruction = Hypertrophic Obstructive Cardiomyopathy which causes diastolic dysfunction (S3) not a systolic murmur. +