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NBME 24 Answers

nbme24/Block 4/Question#17 (52.1 difficulty score)
A 63-year-old woman undergoes operative ...
Decreased movement through the arachnoid villiπŸ”

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submitted by happysingh(45),
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,so the yeK swrod ttha no eon is mengnotini : ccuonmnmtgiia rscpoehlyahud

het shphtyaop gseo keil sthi :

na lotniaymafmr tiesntg (e..,i duacrhsbonai hah)rregmeo elydi roifissb / snraircg of eht ndhaorcia iaalrsnogntu ;&t=g imdaepir SCF griaaend

het key nsptio / sntoepcc yeth rae ityrng to ttse eher : .1 do you nkow wtah tcnganmiimouc uyhprhdasleoc tou(twhi meht tllegin you hsote rdow)s . 2 od yuo wnok h'twsa eth yphpgosaltohyio fo( amomituicgnnc ueh)ldchspoyra si ?

potentialdoctor1  Exactly. To add to this, communicating hydrocephalus can be subdivided as follows: Normal-pressure hydrocephalus: Chronic/gradual decrease in CSF reabsorption at arachnoid granulations, usually due to calcification due to aging. CSF accumulates slowly, so ventricles are able to widen without causing an important increase in intracranial pressure. Symptoms occur due to compression of periventricular white matter tracts ---> Wacky, wobbly, wet High-pressure hydrocephalus: Acute decrease in CSF reabsorption at arachnoid granulations, usually due to inflammatory state in the subarachnoid space (eg, meningitis, sub-arachnoid hemorrhage). CSF accumulates suddenly, causing an acute-onset increase in intracranial pressure +7  
sunshinesweetheart  not to take away from your perfect explanations, but if it were a woman with neck stiffness and fever (rather than circle of willis rupture) that could lead to increased CSF production, right? I think that's the only case where CSF production would increase. Also I think decr absorption in arachnoid granulations in that situation as well so it'd be a shit question +  
peqmd  If anyone like me also got "decreased absorption in choroid plexus", as their wrong answer it's because the choroid plexus doesn't "absorb" it produces. +9  
alienfever  FA 19 p510 +2  
alienfever  If anyone chose F, communication hydrocephalus is caused by decreased absorption and not increased production. FA 19 p510. +1  
an_improved_me  So she has a leaking aneurysm for how long.. gets it repaired, and then within 2 days has an inflammatory response that leads to decreased CSF absorption at arachnoid granulation... Is it the bleeding associated with the aneurysm causing it? The surgery? I'm inclined to say the latter, given that it happens coincidently after the surgery, and not for however long it was leaking beforehand. Thats what tripping me up. +  

submitted by colonelred_(105),
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olNmayrl eht indaachor illvi drains hte CSF from eht bodncuaasihr ascpe ot eth veonsu sey;tms if htsi ratp eosmcbe vetceiedf tneh yuo nca niiaegm lla taht SFC onw gliiudnb up in teh hruasnoadibc aspe.c

keycompany  Also take into account this patient had surgery that requires penetration into the subarachnoid space (hence through the arachnoid mater). This can lead to scarring of the arachnoid granulations and subsequent communicating hydrocephalus. +16  

submitted by roygbiv(20),
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Teh nttaepi has a eglkain reyrb syamrneu t-&-;g hist lsdae to a rhsoubcnaadi meogrhareh (ro gakeela toin dinsrcobhuaa ascpe) g&--t; cuate ASH nac ldae to eaedecsdr ibtpnrsooa dan tmeoemnv aiv aihdarcon liivl

zbird  So this patient has a leaking berry aneurysm which undergone to surgery and repaired but in two days she developed widening of the SA space which could be explained by increased CSF production but a decreased in absorption, which is due to blockage of the arachinoid granulations by the leaked red and white cells therefore there is a decreased movement of the CSF via the arachinoid villi +1  

submitted by krewfoo99(93),
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hyW doluw aeceeddsr oetemmnv hhorutg het lareebcer quuatcad be w?ogrn iWht lal het lidub fo lobdo ni teh SFC tcart titouwh s,ibotaorpn nlouwdt onmevtem oals be edecdsrae hguorth the q?cuadetu

ergogenic22  this would cause a non-communicating hydrocephalus with enlarging of the lateral and 3rd ventricles but normal 4th ventricle and subarachnoid space +1  

submitted by diabetes(28),
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msiply eht ooldb indeis eht CSF mocbee delckbo hghrtou hnoraacid nitaogulasnr =;&tg= asereedc tniosrobpa fo ==mCtngScgmuc;aiinto&F shy.ercoapldhu