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NBME 24 Answers

nbme24/Block 1/Question#30 (44.0 difficulty score)
A 55-year-old man is brought to the emergency ...
Pulmonary capillary wedge pressure: increased;
Cardiac output: decreased;
Systemic vascular resistance: increased


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submitted by tea-cats-biscuits(239),
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tnPeiat sah igaicedornc hc,osk seafyplcclii eht VL secin ’its an airerotn lwla IM si’nt npmgpi.u Hetynosl uyo otdn’ ndee ot nowk whta eanpshp ot PVR to rwesna trerocc ensic teh ylon occehi taht sha irednscea SRV adn dedsaecer WPCP is teh neo werc/eesadd PV.R m’I otn yoaleublst seur fi oyu uolcd egifur ti tou enigv het alvseu in dariecgcoin csko.h hTe tanquieo lkingni het sauelv is:

PRV = pmlna(uroy arlriaet suepsrer - deegw) ÷ CO

submitted by pseudorosette(13),
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hyW is ti ahtt het mynulprao ayriplcal dgwee erssueerpes is die?rensca no .pg 703 of AF 2019 ti assy it cna be eridaecns or aesededrc /:

giggidy  Depends on where the infarct is I guess? Crackles in lung base means increased left sided pressure and therefore PCWP. At least that's how I thought of it. +9  
titanesxvi  Because think the circulation as a closed circuit, in this case the heart isn't pumping well and the pressure is going to backup. that is why the PCWP is increased +4  
mw126  It depends if the patient goes into heart failure because of the infarct or whatever the insult is. The crackles in the lungs gave it away. If crackles are present then there is blood backing up. the increased pressure in the pulmonary vasculature causes leaking into the alveoli which we hear as crackles when the lung expands. +1  

davidw  If the Infarct was on the right side they you would have a decrease in PCWP +  
usmile1  yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up. +6  

submitted by 2zanzibar(12),
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nPettai is in erigcidanoc ocskh. aisrctiCarceht uefsater fo gindaiocrec ksohc: draecsien iccdraa usespsrer nad eesrdaedc darccai uuottp eud to iedmdpe wdfroar fo,lw as lwle as inceesdar yismcest vralausc tssnerciea