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NBME 24 Answers

nbme24/Block 4/Question#40 (52.0 difficulty score)
A 25-year-old woman is brought to the ...
Pulmonary capillary leakage🔍,📺

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submitted by neonem(572),
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Tish tnpitea tsn'i lt,ypinthigaveno tryeeh' aRHviPEgt,ntinleY cehen eht CO2P l&t; 04 mm Hg.

ts'eL kalw it acrawk:sbd Tehy are iipntveraglenthy to ncstoeeamp rof teh bomecital iaciossd esucda by aiwdpersed axophy.i eyitHatnvngplire lwsoal you to wblo fof eomr C2O.

hyW era ehyt hcxpoiy? heT eopnsr si pixyohc eud ot iatnaomfnlmi nda eutac otsriyearpr sresidst myrndeos rmfo het .mnneoiuap llA het syctoniek form eth lfmtamniyora llecs scuea endricsae mnaolyupr ralpcalyi klga,eae chiwh klobcs up eht aaollerv naeebmmr so thta O2 t'can teg huotrgh to teh dl.obo

hWy od hety aevh boemliact odciassi in het tifrs eap?cl No gxyeon ;gt&-- no crtenelo rtonaptrs inach nad no ACT ;--gt& tlccia so.sacidi

diabetes  no pneumonia it is UTI +3  
makinallkindzofgainz  The infection from the UTI spread to her lungs +  
makinallkindzofgainz  this is essentially urosepsis, one of the leading causes of sepsis +1  
cmun777  UTI -> Sepsis -> ARDS (exudative pathophysiology d/t increased pulmonary vasc permeability) +17  
peqmd  urosepsis +  
snripper  lmao I read it as upper respiratory tract infections, too. +3  
thisshouldbefree  she has an increased A-a gradient. +  

submitted by dbg(151),
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iDd noneay lese oerwdn TAHW MRAP"ULNOY MSOP"MSYT si eht qnuiseto rrrgefnei ?t?o Terhe si illeltyra nto a enilgs mptosym dneitmnoe ni teh lewoh t.itnvege No ecalr"kcs derah evor btoh lung lsdefi" are ont eyhT ear signs ufodn yb eht a.chsiiypn

rieolSysu nbuigdto hte lohew BMNE odrba estt isrtwer rgiht own. Do ehyt eeyqtlaaud ersive theri okwr? iTsh si ont hte rfsit hetnacicl saketmi I lezarei on the new r.ofsm

nbmehelp  Yup. Looking back its clear what they were trying to get at, but this definitely threw me off when I was taking the test bc I kept rereading the question looking for a specific symptom the pt had that they wanted me to explain. +2  
ergogenic22  I agree with you that the writers are whack but this question clearly says "diffuse crackles are heard over both lung fields" +2  
ergogenic22  i take that back i understand what you're saying +5  
peqmd  I think what are causing her pulmonary "signs" might be more accurate question. +1  
an_improved_me  I get where you anger is coming from.. They expect the students to pick up the most minor details as they may be relevant to an extremely vague and tedius questions and answers, but don't hold themselves to the same standard. +  

submitted by diabetes(28),
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Ut)UI( t&=;=g siseps CADg;&E&=gI=tRRtSE=AS=;N arloaevl calpylair rmapiiyelbte g=&t=; ixmyapheo ==g;&t hypvlientiernato oca;=ynp&it=gpha

avocadotoast  This is correct. The patient doesn't have pneumonia, but sepsis from her UTI. Sepsis is a known cause of ARDS. ARDS can be due to extra-pulmonary tissue damage that leads to the release of inflammatory mediators, alveolar damage, pulmonary edema, and hyaline membrane formation. The hyaline membranes impair gas exchange and lead to hypoxia. +2  

submitted by famylife(94),
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rmoF PA:AF

"ceAut ytarpisroer sisrtsed sonmyder is a tmestifnionaa fo tacue nriyju to the lg,nu comynoml neugslrti frmo sps,sei mrauat, nda reeevs planruyom oici.tfnens ,lllayCinci ti si azerhrcdtcaei by ad,nepys unrpdfoo yhxpa,omie eaecsderd nlug lcpmeco,ian nad efdiufs rlltiebaa rinstflaeit no secth a.hi.ogr.ypdar

In ,DRSA the juderin glun si dvileebe ot og otrhuhg ehrte a:phess u,ivexeadt v,fiarrepieotl and rt,ofiicb utb eht serocu of chae sehap and eht olaerlv isaeesd onssgpoirer is .elvaabri In hte iueavextd h,apse aaegmd ot het alvolear lpuehiitem nda auscavlr edotienumlh drpscueo leaagek fo a,wret e,itonpr and oairtmlmnayf nda edr blodo esllc otin the tuesrinimtti and arlvlaoe nmule. ehseT cgaensh are cuindde by a xmceolp iatrlnpye of anpirofrmtmyalo adn aortimntfim-yaanl dire"astom.


submitted by sattanki(71),
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Teh pt is ivahgn a eeersv aesc of nns/oeemipspauis SA)DR?(, sa ’hstat hyw ehr 2PO is lwo ta 4.6 oS in uenminpao teehr si csrdeeina rcpyialla lekaaeg ngalide ot rnouapylm .deaem

submitted by ankistruggles(14),
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How od you onkw hre muaploynr syomsptm era due to npymlraou lpaialryc leeakga dna ton vletipyoaihno?nt sI paumorynl layrpcial laakeeg utsj hortean ywa of gisany rnmyoplau d?emae

sattanki  Hypoventilation in no way leads to pulmonary edema. +  
fenestrated  Hypoventilation would increased the PCO2 +1  

submitted by am4140(1),

I see people are having problem with the “pulmonary symptom” part, but they way I thought about it is: what symptom?

She’s tachypneic because the CO2 is low, which I’m sure she could have noticed before she passed out. Everything else is a sign. So what makes a patient tachypneic? Well, your lungs filling up with crap can do it, which it says in the question since she has diffuse bilateral infiltrates.

So what causes your lungs to have infiltrates? Well, she has a kidney infection that’s turned into septic shock with gram negative bacteremia, so it’s going to be all the inflammatory mediators we produce in response to all of that bacterial LPS in the bloodstream causing pulmonary capillary leakage and ARDS.