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NBME 24 Answers

nbme24/Block 1/Question#49 (25.2 difficulty score)
A 58-year-old man is brought to the emergency ...
Ruptured spleenπŸ”
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 +6 
submitted by sympathetikey(1354),
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Perytt rasfotritgdr,hwa btu a gdoo deirmern atht bsooliyersimf cna uaecs na enrlaedg .lpsene

sympathetikey  Due to extramedullary hematopoesis +25  
zoggybiscuits  I thought it was spleen but the fact that hematocrit was 24% 4 HOURs later made me think otherwise. It was my understanding that the spleen would bleed you out quick! +  
need_answers  couldn't also be ruptured spleen because they said intraperitoneal fluid and everything else is retroperitoneal ?? +1  
peqmd  Spleen is most commonly ruptured in blunt trauma so along with myelofibrosis and being kicked on the left side it's just asking to be ruptured +2  
limberry  @need_answers the bladder is intraperitoneal, not retro +  
limberry  bladder is sub*peritoneal, sorry +  



 +4 
submitted by aneurysmclip(151),

Kicked in the side 1 hour ago. diagnosed with chronic myelofibros -> extra-medullary hematopoiesis > splenomegaly; therefore easier to rupture spleen. USG showing intraperitoneal bleed. and he has LUQ guardiang and tenderness. All points to spleen