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NBME 24 Answers

nbme24/Block 4/Question#33 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Inhalant abuse ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +46  upvote downvote
submitted by โˆ—sympathetikey(1600)

Everyone who got this question right is a cop. เผผโŒโ– ู„อŸโ– เผฝ

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dr_ligma  Fkn narcs +2
j44n  whippet_gang +

Whenever NBME asks about a kid with suspicious face rash and dizziness/grades falling... that kid's huffing glue

+1/- dr_ligma(46)

 +22  upvote downvote
submitted by โˆ—dr_ligma(46)

If NBME asks about a kid with suspicious rash under his nose + lightheaded/dumber in class, that kid's huffing glue

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abhishek021196  Inhalants intoxication causes disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness. Withdrawl leads to irritability, dysphoria, sleep disturbance, headache. +4

 +9  upvote downvote
submitted by โˆ—lsmarshall(465)

Inhalant abuse could be done with glue, paint thinners, fuel, nitrous oxide, or alkyl nitrites. Usually in high-school aged kids. Inhalants are 'downers' so whatever intoxication effects there are should be depressant and fully resolve within 30 min. to a couple hours. Patients may look drunk when intoxicated with inhalants, but usually quickly resolve. A characteristic "glue sniffer's rash" around the nose and mouth is sometimes seen after prolonged use.

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madamestep  Also I think NBME wants us to know that this is in a kid because of the access issue. It's hard for a kid to get cocaine, alcohol, heroin... but it's easy to get gasoline. +

 +2  upvote downvote
submitted by โˆ—mousie(272)

A Teen with injection of both conjunctiva = weed could also be abusing other drugs Is 12 years old and four months just too old and too long of a time for it to be impetigo? I narrowed it down to these two and guessed but... I wasn't sure I could eliminate it.

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medskool123  I picked impetigo because of the gold stippling... I guess I took that as honey crusted lesions. F*ck NBME. +8
yotsubato  Huffing gold spray paint. A la the chrome huffers in Mad Max +7
subclaviansteele  LOL I think that might be what they were going for here. Gold spray paint. +3
et-tu-bromocriptine  Anyone know what may be causing his weight loss and unwillingness to eat? I thought too much into it and put "mercury poisoning", since I thought the heavy metal's abdominal symptoms may have caused him to not want to eat. ยฏ_(ใƒ„)_/ยฏ +3
covid2019  I'm not sure about the pathophysiology there... But I do know that inhalants are popular in places where there's extreme poverty. I spent some time abroad, and one of the patients was using inhalants to take the edge off the hunger, so that she could spend her money on food for her kids instead. She also worked on the streets so I guess it also made it easier to, you know... +2

 +0  upvote downvote
submitted by โˆ—syoung07(58)

The gold stippling could simply be mucosal due to injury from the inhalant that has scabbed over. For whatever reason NBME loves kids huffing, this is a classic presentation.

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madamestep  I'm also thinking a kid wouldnt have impetigo for 4 months and it definitely wouldn't cause his grades to fall. But you're very right. NBME loves these huffers hahah +

 +0  upvote downvote
submitted by โˆ—aurelz(1)

Atopic dermatitis: Type 1 hypersensitivity rxn. Pruritic eruption commonly on skin flexures. Appears on face in infancy and then in antecubital fossa in children and adults. Associated with other atopic disease (asthma, allergic rhinitis, food allergies); aug. serum IgE. (FA2020 p. 477)

Impetigo: Bacterial infx on skin. Very superficial skin infx. Usually from S aureus or S pyogenes. HIGHLY CONTAGIOUS. Honey colored crusting. (FA2020 p. 479)

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